Restricting the fuel sources required by cancer cells – glucose and glutamine – is a useful adjunct to conventional cancer treatment. This strategy can be achieved via the ketogenic diet, fasting, or calorie restriction. The effectiveness of these interventions is even greater when combined with certain drugs and procedures.
“Press-Pulse” Strategy
This combined strategy is called “press-pulse”. A “Press” disturbance is a chronic stress that creates a hostile environment that will essentially “weed out” the weakest cells. A “Pulse” disturbance is an acute event that causes more significant disruption and harm to the vulnerable cells.
“Press” Disturbances
In the setting of cancer treatment, the “press” disturbance is the ketogenic diet that limits the amount of energy that is available for cancer cells to grow. Ketogenic diets also protect muscle mass and delay the wasting-away of lean body mass (cachexia) that is commonly seen in cancer patients. There is preclinical data supporting the benefits of ketogenic diets in the following types of cancer:
- Neuroblastoma
- Lung cancer
- Pancreatic cancer (ref)
- Prostate cancer
- Breast cancer
- Ovarian cancer
- Head and neck cancers
- Colon cancer
- Glioblastoma
Another “press” disturbance is the reduction of psychological stress. Chronic psychological stress is known to contribute to tumor growth due to elevations in glucose levels, stress hormones, and Insulin-like Growth Factor (IGF-1). Thus, techniques to mitigate psychological stress appear beneficial as a “press” disturbance.
“Pulse” Disturbances
There are many “pulse” disturbances that have shown effectiveness against cancer cells, particularly when used simultaneously with a “press” disturbance.
- Drugs, e.g. fenbendazole that target the availability of glucose or glutamine cause further reduction in these fuel sources.
- 2-Deoxyglucose (2-DG) targets glycolysis and appears to be a potent therapeutic tool when used in combination with a ketogenic diet, but not when administered with a standard, high-carbohydrate diet.
- Radiation therapy, which damages the DNA of cells, appears to be more effective when used in conjunction with a ketogenic diet.
- Hyperbaric oxygen increases the presence of reactive oxygen species (ROS), which causes oxidative stress within the cancer cells and leads to death of the cell. It is modestly effective against cancer cells by itself, but enhanced when utilized with a ketogenic diet.
- Glutamine-targeting drugs such as DON (6-diazo-5-oxo-L-norleucine), fenbendazole, and mebendazole show promise in clinical trials due to their effect of limiting glutamine availability in the body, working synergistically with a ketogenic diet.
Role of Ketogenic Diet in Cancer
Several studies report good tolerability of the ketogenic diet, and it appears to be quite safe. Some express concern about weight loss from a ketogenic diet, citing research that demonstrates worsened outcomes in cancer patients who lose weight.
“The body weight loss associated with KD [Ketogenic Diet] is considered therapeutic, in contrast to the weight loss associated with cachexia or toxic cancer therapies, which is pathological.” (ref)
Studies show that a ketogenic diet reduces fat mass but preserves lean body mass (ref). Individuals who maintain larger amounts of lean body mass experience less toxicity from cancer treatments such as chemotherapy and also experience better outcomes (ref).
Furthermore, both fasting and a ketogenic diet improve one’s tolerance of chemotherapy, with significant reduction in nausea and vomiting, along with overall improved quality of life (ref).
Summary
The ketogenic diet is a promising therapeutic strategy for cancer in conjunction with standard treatments. In addition, it cultivates a hostile environment that makes cancer cells more susceptible to various acute stresses, all the while improving tolerance of conventional cancer treatments like chemotherapy. While there is growing clinical evidence for its role in treating cancer, the ketogenic diet presumably also can play a role in cancer prevention by these same mechanisms.
