The metabolic approach to cancer

The metabolic
approach to
Cancer
Dr. Fathi Neana, MD
Chief of Orthopaedics
Dr. Fakhry & Dr. A. Al-Garzaie Hospital
September,19 - 2018

‫و‬ِ‫ب‬‫ا‬َ‫ن‬‫أ‬‫ع‬َ ‫أ‬‫اْل‬َ‫و‬ ِ‫ل‬‫ي‬ ِ‫خ‬َّ‫ن‬‫ال‬ ِ‫ت‬‫ا‬َ‫ر‬َ‫م‬َ‫ث‬ ‫ن‬ِ‫م‬ُ‫ه‬‫أ‬‫ن‬ِ‫م‬ َ‫ون‬ُ‫ذ‬ ِ‫خ‬َّ‫ت‬َ‫ت‬َ‫ك‬َ‫س‬‫ا‬ً‫ر‬َ‫ل‬ َ‫ك‬ِ‫ل‬ََٰ‫ذ‬ ‫ي‬ِ‫ف‬ َّ‫ن‬ِ‫إ‬ ۗ ‫ا‬ً‫ن‬َ‫س‬َ‫ح‬ ‫ا‬ً‫ق‬‫أ‬‫ز‬ ِ‫ر‬َ‫و‬ً‫ة‬َ‫ي‬
َ‫ون‬ُ‫ل‬ِ‫ق‬‫أ‬‫ع‬َ‫ي‬ ٍ‫م‬ ‫أ‬‫و‬َ‫ق‬ِِّ‫ل‬(67)‫النحل‬ ‫سورة‬

The big question about cancer
why the new cases of cancer and the deaths due to
cancer are still increasing ?
Is it due to the new life style ?
Is it due to the mainstream medicine and conventional
healthcare ?
What is the root cause of cancer ?
Is it a genetic disease or a metabolic disease with
metabolic solutions ?

New Lifestyle diseases
Non-communicable diseases (NCDs)
• Obesity
• Metabolic syndrome
• Coronary artery disease
• Diabetes type 2
• Hypertension
• Arteriosclerosis
• Stroke
• Cancer
• Depression - anxiety
• Arthritis
• Osteomalacia
• Osteoporosis
• Swimmer's ear – loss of hearing
• Ch. obstructive pulmonary disease
• Liver Cirrhosis
• Nephritis
• Neuro degenerative diseases
• Etc, etc, etc…
Emerged as bigger killers than infectious or hereditary ones.
The leading cause of death worldwide.
63% of all annual deaths.
> 38 million people are killed /year.
1- Cardiovascular diseases (17.5 million)
Complications of hypertension (9.4 million)
2- Cancers (8.2 million) – (8.8 m 2015)
3- Respiratory diseases (4 million)
5- Diabetes (1.5 million)
These 4 diseases account for 80 % of all NCDs deaths (> 38 million)
4- USA’s 4th Leading Cause of Death – Pharma’s Drugs
Posted on June 25, 2012 by Child Health Safety
Causes:
• Stress-Depression
• Diet
• Sleep-awake
• Lack of Exercise
• Sun avoidance
• Wireless WiFi devices
• Leaky gut syndrome
• Other pollutants
Including Medicines

Cancers is the second leading cause of death
Worldwide (8.8 million 2015)

Cancer Statistics,
2018
American cancer
society

The Root cause and Culprit behind
Chronic Diseases, Cancer and Aging
1- A state of chronic low grade
inflammation
Dr. Richard K. Bernstein
Diabetes & Inflammation—the Vicious Cycle
(Hyperglycemia – Omega 6 - Obesity) - Leukotriene B(4) (LTB(4)
Lindsay Christensen
Lindsay Christensen is a health writer and researcher with her B.S. in
Biomedical Science and an Emphasis in Nutrition
(Pathogens, unhealthy diet, lack of exercise).
2- Mitochondrial dysfunction
(not the genetic make up)
Dr. Ron Rosedale
Breakthrough views on clinical metabolic biochemistry
1- Harmful Effects of too much Sugar
->> Insulin and leptin receptor resistance
->> Free radicals (ROS) 90% Mitochondria
2- Harmful Effects of too much Protein
->> Activation of the (mTOR) metabolic signaling pathway
3- Physical inactivity (lack of exercise) - (PGC-1α)
4- Pollutants - (free radicals –oxidative stress)
5- Drugs causing mitochondrial toxicity
(iatrogenic)
Mitochondrial dysfunction
Energy (ATP - ADP)
Leukotriene B(4) (LTB(4)
acts as a signal to relay
information from cell to
cell over long distances.

1- A state of chronic low grade
inflammation
2- Mitochondrial dysfunction
(not the genetic make up)

Mitochondria are tiny organelles in our cell.
- Thousands comprising 15 to 50% of the cell volume
-Red blood cells and skin cells have very little to none
- Germ cells have 100,000
-Most cells have one to 2,000 of them
-Cardiac muscles 5000
-Liver cells >2000
Energy is required for our organs to function properly, that energy is
produced by the mitochondria (the power engine).
Mitochondrial function is at the very heart of everything that occurs in
our body, It is our body’s lifeline. It is a Power plant.
They're the primary source of energy for our body. They supply over
90% of our body’s energy by Converting the food we eat and the air we
breathe into usable energy
It have enormous potential to influence our health, specifically cancer,
and optimizing mitochondrial metabolism may be at the core of effective
cancer treatment
The Mitochondria
How Your Mitochondria Influence Your Health
January 24, 2016

Unlike mammalian muscle, flight
muscle predominantly relies on
lipid oxidation
lipid oxidation, result in higher long
lasting energy and lower reactive
oxygen species production in birds
compared with mammals.
Mitochondria occupy 35% of fiber
volume in hummingbird flight
muscles
Mitochondria Cluster beneath the
sarcolemmal membrane adjacent to
capillaries to a greater extent than
in mammalian muscles

Acetic acid acetyl group, derived from acetic
acid, is fundamental to the biochemistry of
virtually all forms of life. When bound to
coenzyme A it forms acetyl-CoA
The citric acid cycle is a key metabolic pathway that unifies carbohydrate, fat, and protein metabolism.
The reactions of the cycle are carried out by 8 enzymes that completely oxidize acetate, in the form
of acetyl-CoA
ِ‫ب‬‫ا‬َ‫ن‬‫أ‬‫ع‬َ ‫أ‬‫اْل‬َ‫و‬ ِ‫ل‬‫ي‬ ِ‫خ‬َّ‫ن‬‫ال‬ ِ‫ت‬‫ا‬َ‫ر‬َ‫م‬َ‫ث‬ ‫ن‬ِ‫م‬َ‫و‬ُ‫ه‬‫أ‬‫ن‬ِ‫م‬ َ‫ون‬ُ‫ذ‬ ِ‫خ‬َّ‫ت‬َ‫ت‬
‫ا‬ً‫َر‬‫ك‬َ‫س‬ََٰ‫ذ‬ ‫ي‬ِ‫ف‬ َّ‫ن‬ِ‫إ‬ ۗ ‫ا‬ً‫ن‬َ‫س‬َ‫ح‬ ‫ا‬ً‫ق‬‫أ‬‫ز‬ ِ‫ر‬َ‫و‬‫أ‬‫ع‬َ‫ي‬ ٍ‫م‬ ‫أ‬‫و‬َ‫ق‬ِِّ‫ل‬ ً‫ة‬َ‫ي‬ َ‫ل‬ َ‫ك‬ِ‫ل‬َ‫ون‬ُ‫ل‬ِ‫ق‬
(67)‫النحل‬ ‫سورة‬
‫وسلم‬ ‫عليه‬ ‫هللا‬ ‫صلى‬ ‫قال‬:(َ‫خ‬‫ال‬ ُ‫م‬‫دا‬ِ‫اإل‬ َ‫م‬‫أ‬‫ع‬ِ‫ن‬ُّ‫ل‬)
‫مسلم‬ ‫رواه‬(2051)
‫الكحو‬ ‫ل‬ ّ‫تحو‬ ‫توضح‬ ‫التالية‬ ‫الكيميائية‬ ‫المعادلة‬‫إلى‬ ‫ل‬
‫األكسجين‬ ‫غاز‬ ‫مع‬ ‫بالتفاعل‬ ّ‫ل‬‫خ‬:
CH3CH2OH + 2 O2 --- >
2 CH3COOH + 2 H2O
Alcohol + Oxygen ---->
Acetic Acid + Water
‫كحول‬+‫أوكسجين‬----->‫حمض‬‫الخل‬+‫ماء‬
Mitochondria
CoA
How the human life is maintained

AIR
O2
FUEL
Carb-Protein-Fat
How the human life is maintained
WATER
﴾ٍِّ‫ي‬َ‫ح‬ ٍ‫ء‬‫أ‬‫ي‬َ‫ش‬ َّ‫ل‬ُ‫ك‬ ِ‫اء‬َ‫م‬‫أ‬‫ل‬‫ا‬ َ‫ن‬ِ‫م‬ ‫ا‬َ‫ن‬‫أ‬‫ل‬َ‫ع‬َ‫ج‬َ‫﴿و‬[‫اْلن‬ ‫سورة‬‫الية‬ ‫بياء‬:30]
And We have made from water every living thing.
ENERGY
Cell survival
Waste (ROS)
Free radicals
Cell apoptosis
Control system: (Signaling pathway - Feed back) - Nervous
(hypothalamus) – Hormonal – Enzymatic
Aged cells
Cancer cells
Mitochondria

15
nDNA & mtDNA
Damage or Mutation
The free radical
Reactive Oxygen Species (ROS)

Reactive Oxygen Species (ROS)
Possess multiple functions in cellular biology,
involving cell death, proliferation, and differentiation.
Moderate Amount of (ROS)
Regulates cell death (Apoptosis) ,
proliferation, and differentiation.
(Apoptosis) of aged cells, cancer cells, damaged cells
Too much (ROS)
Harm the mitochondria DNA itself
We adjust the dose of medicines to kill the
pathogens not to harm the host
The free radical - Reactive Oxygen Species
(ROS)

The common factor in Chronic Diseases, Cancer and Aging
Too much Free radical
Oxidative cell stress
Metabolic (ROS) Environmental,
Drugs, Chemicals, virus, Radiation,
Infection, Starvation, etc..
Degenerative Diseases
Pulmonary fibrosis - Neuronal
degeneration - Heart failure -
Kidney failure
Metabolic dysfunction
Obesity - Diabetes
Cancer
Warburg effect
Aging & Apoptosis
Abnormal inflammation & Immunity
Mitochondrial
dysfunction
Less Bioenergetic
metabolism
nDNA
mtDNA
Damage or
Mutation

The common factor in
Chronic Diseases,
Cancer and Aging

Cell commits suicide by apoptosis. Cellular homicide is necrosis
Apoptosis (from Ancient Greek word “falling off”)
Apoptosis is a process of programmed cell death that
occurs in multicellular organisms.
Biochemical events lead to characteristic cell changes (morphology)
and death.
Programmed cell death (APOPTOSIS)
Dr. Anurag Jain
Pathological causes :
1) Cell death produced by a variety of mild injurious stimuli like
– heat, radiation, cytotoxic cancer drugs, infection, etc.
that cause irreparable DNA damage that in turn triggers cell suicide pathways.
2) Cell injury in certain viral diseases such as viral hepatitis.
3) Cell death in tumors.
Physiologic causes:
1) The programmed destruction of cell during embryogenesis. It is programmed
because it is death of specific cell types at defined times during development.
2) Hormone-dependent physiologic involution, such as involution of the
endometrium during the menstrual cycle.
3) Cell deletion in proliferating cell population, such as intestinal crypt epithelium
4) Death of cells that have served there useful purpose, such as neutrophils in
an acute inflammatory respone.
5) Elimination of potentially harmful self reactive lymphocytes.

Mitochondria is a semi autonomous cell
organelle
1- Mitochondria have their own copy of
DNA which can replicate independently.
The mitochondrial DNA produces its own mRNA,
tRNA and rRNA.
2- The organelles posses their
own ribosomes, called mitoribosomes.
3- Mitochondria synthesize some of their own
structural proteins. However, most of
the mitochondrial proteins are synthesized under
instructions from cell nucleus.
4- The organelles synthesize some of
the enzymes required for their
functioning. e.g. succinate dehydrogenase.
5- They show hypertrophy .i.e. internal growth.

Mitochondrial fission, fusion, and stress
Youle RJ1, van der Bliek AM.
Mitochondrial fission and fusion:
play critical roles in maintaining functional mitochondria when
cells experience metabolic or environmental stresses.
Fusion:
helps mitigate stress by mixing the contents of partially
damaged mitochondria as a form of complementation.
Fission:
is needed to create new mitochondria, but it also contributes
to quality control by enabling the removal of damaged
mitochondria and can facilitate apoptosis during high
levels of cellular stress.
Disruptions in these processes affect normal development, and they have been
implicated in neurodegenerative diseases, such as Parkinson's

PPARGC1A
PGC-1α )PPARGC1A):
The master regulator of mitochondrial biogenesis
is a protein encoded by the PPARGC1A gene. known as human accelerated region 20
(HAR20).
PGC-1α is a transcriptional co activator that regulates the genes involved in energy
metabolism. It is the master regulator of mitochondrial biogenesis.
plays a central role in the regulation of cellular energy metabolism.
It stimulates 1- mitochondrial biogenesis 2- promotes the remodeling of muscle tissue to a
fiber-type that is metabolically more oxidative and less glycolytic in nature.
It participates in the regulation of both carbohydrate & lipid metabolism.
It is involved in obesity, diabetes, & cardiomyopathy.
PGC-1α activating host factors:
1- Free Radicals
Reactive oxygen species (ROS) and reactive nitrogen species (RNS),
both formed intracellularly as by-products of metabolism but upregulated during
times of cellular stress.
2- Cold Exposure
adaptive thermogenesis
3- Endurance Exercise
PGC-1α determines lactate metabolism, preventing high lactate levels in
endurance athletes & making lactate as an energy source

Creating energy, by burning fuel in the mitochondria, is necessary, but it
is destructive to our bodies,
Just like burning gasoline or diesel is necessary, but destructive to the
engine of the automobile.
The mitochondria can only burn fat or sugar for energy.
Our Mitochondrial Cellular Engines Run Best With Fat As Fuel,
Instead of Sugar!
•more energy than does burning sugar
•Fewer free radicals are released when burning fat than when
burning sugar
Main Mitochondrial Fuel Concept
Fat is the Best Fuel
•Burning sugar is very fast compared to burning fat, and so, sugar burning is very USEFUL DURING
TIMES OF EMERGENCY.
If our bodies had been designed to primarily burn sugar as a fuel, then we would store sugar cubes
within our bodies, but we don’t, we store fat. We store only minor amounts of sugar (in the form of
glycogen) — enough to last for 30 to 60 minutes of emergency exertion.

There are only three reasons for the body to be in
sugar burning mode:
• Too much stress.
Stress creates the adrenal gland to relase adrenaline. Adrenaline overrides the
hypothalamus signal and instructs sugar burning.
• Too much blood sugar.
Blood sugar (over time) damages receptors in the hypothalamus. When these
receptors are damaged then the hypothalamus cannot correctly sense leptin... and
believe there is no fat (i.e. starvation is occurring).
• Too much stored fat (Obesity).
Too much stored fat produces large amounts of circulating leptin which desensitizes
the hypothalamus’s ability to detect leptin (Leptin resistance). When leptin levels
are not able to be detected, because the receptors in the hypothalamus have been
desensitized, the hypothalamus believes the body is starving and instructs sugar
burning in order to conserve and build up fat stores. This is ironic because essential
the body’s pantries are full of fat, but these pantries are inaccessible and so the cells
are instructed to ignore fat and look for sugar to burn for energy ( Craving).
Why Does the Hypothalamus Unnecessarily Force
a Sugar Burning Mode in Our Bodies?

This book aims to provide evidence, through case studies, that
cancer is primarily a metabolic disease requiring metabolic solutions
for its management and prevention.
Is Cancer a genetic disease?
Why it is not transferred through the nuclear DNA (nDNA -
nGenome)?
Cancer as a Metabolic Disease: On the Origin, Management,
and Prevention of Cancer
by Thomas N. Seyfried

Is Cancer a genetic disease?
Why it is not transferred through the nuclear DNA (nDNA - nGenome)?
Why mitochondrial DNA (mtDNA - mtGenome) promote or inhibit metastasis ?
Mitochondrial DNA (mtDNA) Plays a Role in
Metastasis
Experiments in mice show that mitochondria, both within the tumor
and beyond, can make the difference between promoting or
inhibiting cancer spread.
Apr 18, 2018
KERRY GRENS
Mitochondrial genome (mtDNA) was tied to the speed
of cancer growth and metastasis
2017 report in Cancer Research by Welch’s group
Danny Welch, a cancer biologist at the University of Kansas
Medical Center

With hypoxia and mitochondrial dysfunction cells should die by autophagy
Cancer cell adapted with defective aerobic respiration and resist apoptosis
(autophagy) by fermenting the sugar

Dr. Otto Warburg was a physician with a
Ph.D. in chemistry and was close friends
with Albert Einstein.
Most experts recognize Warburg as the
greatest biochemist of the 20th century.
He received a Nobel Prize in 1931
for his discovery that cancer cells use
glucose as a source of energy production
(anaerobic Glycolysis)
This is called the "Warburg Effect"
Sadly, to this day it is essentially ignored
by nearly every expert.

Some Features of Warburg Effect
Rule of hypoxia, mitochondrial dysfunction and sugar
Smaller numbers of mitochondria & mitochondrial
dysfunction in tumour cells
thus resulting in less ATP generation and higher consumption of Energy
(ATP).
Glucose uptake and glycolysis
proceed about ten times faster in most solid tumours than in non-
cancerous tissues.
Hypoxia of Tumour cells
(limited oxygen supply), because they initially lack an extensive capillary
network to supply the tumour with oxygen.
HIF-1 (Hypoxia-Inducible Factor -1)
is a protein that stimulates the activity of eight glycolytic enzymes and it
gives tumour cell capacity to survive Anaerobic conditions.
Glycolytic enzymes, overproduced by tumour cells including
an isozyme of Hexokinase-II and it results in committing the cell to continued
glycolysis.

4- ketogenic diet,
forces cancer cells to use its mitochondria (cut off sugar) with a burst of reactive oxygen species
ROS.
ketogenic diet which radically improves mitochondrial health, could help most cancers, especially if
used in conjunction with glucose fermentation poisons like 3-bromopyruvate.
1- Serious mitochondrial dysfunction with decreased numbers of
functional mitochondria.
The mitochondria can still function in cancer cells
2- The metabolic switch:
Hypoxia in the presence of sugar cancer cells become immediately dependent on
glucose (Anaerobic glycolysis) and not using their mitochondria (no reactive
oxygen species ROS any longer)
3- Forcing it to use its mitochondria (cut off sugar)
we get a burst of reactive oxygen species ROS that lead to death, because that
cancer cell is already primed for that death. It's ready to die.
Mitochondria's Role in Cancer
The metabolic switch of Cancer cells

The metabolic switch of Cancer cells
Anaerobic Glycolysis
1- Mitochondrial dysfunction 2- Hypoxia 3- Sugar
Cancer cells
1-
2-
3-

Cut of this metabolic switch
1- Mitochondrial Biogenesis
2- Hyperbaric oxygen
3- Cut the Sugar off
The logical and sensible salvage
is to Cut off this metabolic switch

What causes
Mitochondrial
dysfunction ?

Dr. Ron Rosedale : Defective metabolic processes in mitochondria, not the genetic make up That cause
cancer and nearly all other chronic diseases, including accelerated aging
What causes Mitochondrial dysfunction?
The causes of Defective metabolic processes in mitochondria ?
1- The Harmful Effects of too much Sugar
A- Diet (HCLF)
Insulin and leptin receptor resistance
Free radicals (ROS) 90% in Mitochondria
B- Stress.
Adrenaline – hypothalamus ->> sugar
C- Obesity
Leptin resistance - hypothalamus ->> sugar
2- The Harmful Effects of too much Protein
Activation of the mTOR metabolic signaling pathway
3- Lack of exercise and Physical activity
Inhibition of PGC-1α (PPARGC1A)
4- Pollutants
free radicals – oxidative stress
5- Drugs
causing mitochondrial toxicity (iatrogenic)

Sugar is a “dirty” fuel, excessive free radicals caused by reactive
oxygen species (ROS).
Wile fat burns much cleaner. So by replacing carbs with healthy
fats,’ mitochondria are less likely to suffer damage
90 % or more of the total ROS (Reactive oxygen species)
are produced within the mitochondria, causing devastating
damage.
It was thought excessive ROS could be addressed by taking
antioxidants, but we now know that this was a flawed strategy and it
is far better to prevent their production by eating an optimal fuel
mixture.
LCHF - MMT - KD can help our cells’ mitochondria reach the
“Goldilocks” zone for producing ROS — not too much and not too
little, but just the “right” amounts for healthy cellular and
mitochondrial function.
Harmful Effects of too much Sugar
Chronic low grade inflammation - Mitochondrial dysfunction

Harmful Effects of too much Sugar
Chronic low grade inflammation - Mitochondrial dysfunction
1- State of chronic inflammation
2- Lipoprotein Oxidation & Glycation
3- Hyper insulinemia syndrome - Metabolic syndrome
-> Insulin resistance (type 2 DM)
-> increased triglycerides VLDL (Very-low-density lipoprotein)
-> Cholesterol (small dense LDL type B particles)
4- HFCS (High-fructose corn syrup) is found in almost all types of
processed foods and drinks (Sugar: toxic, addicting, and deadly)
5- feeds” the cancer cells fructose is readily used by cancer cells (not
using mitochondria – no ROS to kill it)
6- Gaining weight (insulin and leptin signaling resistance)
7- Increases uric acid levels - risk for heart & kidney
8- Overloads and damages the liver much sugar or fructose likened
the effects of alcohol
9- Other diseases linked to metabolic syndrome include: Type 2
diabetes, Heart disease, Hypertension, Polycystic ovarian syndrome, Lipid
problems, Dementia and Alzheimer's disease

Harmful Effects
of too much
protein

Harmful Effects of too much Protein
Paleo diet
The mammalian target of rapamycin (mTOR) -
Discoveries that have been made over the last decade
phosphatidylinositol 3-kinase-related kinase family of protein kinases.
signaling pathway integrates both intracellular and extracellular
signals
The mTOR pathway serves as a central regulator of cell
metabolism, growth, proliferation and survival.
The mTOR pathway is activated during:
1- Tumor formation, angiogenesis, insulin resistance, adipogenesis
and T-lymphocyte activation etc
2- Deregulated in diseases as cancer and type 2 diabetes.
Nutrients and Exercise modify mTOR function
Growing therapeutic use of mTOR inhibitors (rapamycin and
rapalogues) in solid tumors, organ transplantation, coronary
restenosis and rheumatoid arthritis.
The figure highlight and summarize the current
understanding of how mTOR nucleates distinct
multi-protein complexes, how intra- and
extracellular signals are processed by the
mTOR complexes, and how such signals affect
cell metabolism, growth, proliferation and
survival.

Hypoxia-inducible factor 1alpha (HIF-1) is
regulated by the mammalian target of
rapamycin (mTOR) via an mTOR signaling
motif.
J Biol Chem. 2007 Jul 13;282(28):20534-43. Epub 2007 May 14.
Land SC1, Tee AR.
1Institute of Medical Genetics, Wales College of Medicine, Cardiff
University, Heath Park, Cardiff, Wales, United Kingdom.
Abstract
Abstract
Tumors that form as a result of heightened mammalian target of rapamycin (mTOR) signaling are highly vascularized. This
process of angiogenesis is regulated through hypoxia-inducible factor (HIF)-mediated transcription of angiogenic factors. It is
recognized that inhibition of mTOR with rapamycin can diminish the process of angiogenesis. Our work shows that activation of
mTOR by Ras homologue enriched in brain (Rheb) overexpression potently enhances the activity of HIF1alpha and vascular
endothelial growth factor (VEGF)-A secretion during hypoxia, which is reversed with rapamycin. Mutants of Rheb, which do not
bind guanine nucleotide (D60K, D60V, N119I, and D122N) and are unable to activate mTOR, inhibit the activity of HIF when
overexpressed. We show that regulatory associated protein of mTOR (Raptor) interacts with HIF1alpha and requires an mTOR
signaling (TOS) motif located in the N terminus of HIF1alpha. Furthermore, a mutant of HIF1alpha lacking this TOS motif
dominantly impaired HIF activity during hypoxia and was unable to bind to the co-activator CBP/p300. Rapamycin treatments
do not affect the stability of HIF1alpha and modulate HIF activity via a Von Hippel-Lindau (VHL)-independent mechanism. We
demonstrate that the high levels of HIF activity in cells devoid of TSC2 can be reversed by treatments with rapamycin or the
readdition of TSC2. Our work explains why human cancers with aberrant mTOR signaling are prone to angiogenesis and
suggests that inhibition of mTOR with rapamycin might be a suitable therapeutic strategy.

World Health Organization MONICA
study
(MONICA : multinational MONITORING
trends and determinants in
CADIOVASCULAR disease)
14 European countries
+ urban Australian Aborigines
10 years
7 million people
40 studies collected
The ten year data collection was
completed in the late 1990s,
A diet low in saturated fat 'will not prevent
heart disease or prolong life'
"The Great Cholesterol Myth". Dr. Malcolm Kendrick
MD . July 2011.
As any person (no medical experience needed) with eyes can
see, the Aborigines had the lowest cholesterol and the highest
death rate from heart disease.

44
The typical atherosclerotic plaque comprises of the lipid
core and the fibrous cap, and is the most commonly
classified histologically by the American Heart Association
Atherosclerotic plaque
Causes:
1- Endothelial damage & permeability
2- Small dense particles LDL type B
3- Smooth muscle cells migration and proliferation
4- Monocyte adhesion, migration and foam cell
development.
Caused by:
1- State of chronic inflammation
->> Oxidative stress
2- Hyperglycemia
->> Lipoprotein Oxidation & Glycation
3- Hyper insulinemia – Hyper leptinemia
-> increased triglycerides VLDL
-> Cholesterol (small dense LDL type B particles)
Treat the cause is the logical thinking:
1- Anti-inflammatory lifestyle
2- Control Hyperglycemia-
3- Control Insulin - Leptin resistance
Hyper insulinemia – Hyper leptinemia
(Diet too high in sugars & Obesity)

Figure 1: Oxidative stress affects four fundamental mechanisms that contribute to atherogenesis (i)
oxidation of LDL to form ox –LDL (ii) endothelial cell dysfunction (increased release of MCP-1, MMPs,
increased expression of VCAM-1, ICAM-1 and LOX-1, decreased activity of NO, platelet aggregation) (iii)
vascular smooth muscle cells migration and proliferation (iv) monocyte adhesion and migration and
foam cell development. [15]

In Summary, Saturated Fats Are
Healthy
•Increase your LDL levels, but they increase the large fluffy
particles that are not associated with an increased risk of
heart disease
•Increase your HDL levels. This more than compensates
for any increase in LDL
•Do NOT cause heart disease as made clear in all the
above-referenced studies
•Do not damage as easily as other fats because they do not
have any double bonds that can be damaged through
oxidation
•Serve to fuel mitochondria and produce far less damaging
free radicals than carbs
Could Eating the Right Fats Save 1 Million Lives per Year?
D. Mercola - March 06, 2016

In many epileptic patients, anticonvulsant drugs either fail adequately to control
seizures or they cause serious side effects.
An important adjunct to pharmacologic therapy is the ketogenic diet, which often
improves seizure control, even in patients who respond poorly to medications.
The mechanisms that explain the therapeutic effect are incompletely understood.
Evidence points to an effect on brain handling of amino acids, especially glutamic
acid, the major excitatory neurotransmitter of the central nervous system.
The diet may limit the availability of oxaloacetate to the aspartate aminotransferase
reaction, an important route of brain glutamate handling.
The ketogenic diet and brain metabolism of amino acids: relationship to
the anticonvulsant effect.
Yudkoff M1, Daikhin Y, Melø TM, Nissim I, Sonnewald U, Nissim I.
Annu Rev Nutr. 2007;27:415-30.
As a result, more glutamate becomes accessible to the glutamate decarboxylase reaction to yield gamma-
aminobutyric acid (GABA), the major inhibitory neurotransmitter and an important antiseizure agent.
In addition, the ketogenic diet appears to favor the synthesis of glutamine, an essential precursor to GABA.
This occurs both because ketone body carbon is metabolized to glutamine and because in ketosis there
is increased consumption of acetate, which astrocytes in the brain quickly convert to glutamine.
The ketogenic diet also may facilitate mechanisms by which the brain exports to blood compounds such as
glutamine and alanine, in the process favoring the removal of glutamate carbon and nitrogen.

Cancer_in_australia_summary_pages_2017-55
Now we know why the new life style diseases are high rocketed
after the high carb low fat (HCLF) guidelines 1980
our world in data cancer

Harmful Effects of
Lack of exercise and
Physical inactivity

PPARGC1A
PGC-1α )PPARGC1A): The master regulator of mitochondrial
biogenesis
is a protein encoded by the PPARGC1A gene. known as human accelerated region 20
(HAR20).
PGC-1α is a transcriptional co activator that regulates the genes involved in energy
metabolism. It is the master regulator of mitochondrial biogenesis.
plays a central role in the regulation of cellular energy metabolism.
It stimulates 1- mitochondrial biogenesis 2- promotes the remodeling of muscle tissue to a
fiber-type that is metabolically more oxidative and less glycolytic in nature.
It participates in the regulation of both carbohydrate & lipid metabolism.
It is involved in obesity, diabetes, & cardiomyopathy.
1- Free Radicals
both formed intracellularly as by-products of metabolism but upregulated during
times of cellular stress.
2- Cold Exposure

Mitochondrial
Biogenesis
The salvage usually lies behind
the cause
Treat what causes mitochondrial
dysfunction ?

1- Ketogenic diet (KD)
Mitochondrial Metabolic Therapy (MMT)
low carb High fat Diet Regime (LCHF)
Mitochondrial Metabolic Therapy (MMT) 2017 is Similar to a
ketogenic diet (epilepsy 30-50%)
MMT is a high fat, moderate protein, low carb eating
plan
Unlike a ketogenic diet, it emphasizes on high-quality,
(unprocessed whole foods )
Unlike Paleo diet it does not consume far too much protein
(moderate protien)
Mitochondrial Biogenesis
Salvage 1- The Harmful Effects of too much Sugar

Mice with metastatic cancer lived 103% longer with a combination of the ketogenic diet (KD),
ketone supplements (KE) and hyperbaric oxygen therapy (HBOT), compared to mice fed a
standard diet (SD), according to Dominic D’Agostino’s research.
1- KD – MMT – LCHF
can help our cells’ mitochondria reach the
“Goldilocks” zone for producing ROS — not too
much and not too little, but just the “right” amounts
for healthy cellular and mitochondrial function.

Cancer is a metabolic disease that can be
prevented and treated with the low-
carb, high-fat ketogenic diet,
according to a growing body of scientific
research.
Studies show the ketogenic diet may beat
chemotherapy for some forms of cancer
Because cancer is a metabolic – not a
genetic – disease
Travis Christofferson, author of Tripping Over the Truth:
The Metabolic Theory of Cancer.
Tripping over the Truth The Metabolic Theory of Cancer
by Travis Christofferson - 2014

2- Intermittent fasting
Fat burning
More energy – less Reactive oxygen ROS.
Calorie restriction
Less ROS with fasting
Increase your antioxidants
Avoid eating several hours before going to sleep
Autophagy (Apoptosis)
Remove damaged mitochondria known as mitophagy
Triggering the Immune System for Cancer Patients
Reducing Cancer Recurrence and Mortality Rates
Interventional strategy
where in individuals are
subjected to varying periods of
fasting.
Sources
•https://news.usc.edu/103972/fasting-like-diet-turns-the-immune-system-against-cancer/
•https://www.osher.ucsf.edu/patient-care/self-care-resources/cancer-and-nutrition/frequently-asked-questions/cancer-and-
fasting-calorie-restriction/
•https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3680567/
•https://health.clevelandclinic.org/2015/10/interested-fasting-health-get-facts-first/

How does intermittent fasting work?

Intermittent fasting and autophagy?
Autophagy—An Intracellular Recycling System”
Certain types of cellular stress, including nutrient deprivation,
protein aggregation or unfolding (clumps of protein) or
infections will activate autophagy to counteract these problems
and keep the cell in good working order.
Autophagy is one of the most evolutionarily conserved
pathways known to exist, and can be seen in almost all multi-
cellular organisms and many single celled organisms.
Autophagy refers to the body’s response to a lack of food
(fasting) which stimulates a degradation pathway of sub
cellular components.

The main regulator of autophagy is:
1- The mammalian target of rapamycin
(mTOR) kinase.
When mTOR goes up, it shuts down
autophagy.
mTOR is exquisitely sensitive to dietary
amino acids (protein).
2- The other main regulator is 5' AMP-
activated protein kinase (AMPK). This is a
sensor of intracellular energy (adenosine
triphosphate or ATP).
When AMPK is high (low fuel), this shuts
down fatty acid synthesis and activates
autophagy.
(Decreased mTOR or increased AMPK),
activate autophagy. then 20 or so genes
(ATG) are activated to carry out the
cleaning process.

•Improved mental clarity and concentration
•Weight and body fat loss
•Lowered blood insulin and sugar levels
•Reversal of type 2 diabetes
•Increased energy
•Improved fat burning
•Increased growth hormone
•Lowered blood cholesterol
•Prevention of Alzheimer’s disease (potential)
•Longer life (potential)
•Activation of cellular cleansing (potential) by stimulating autophagy (a
discovery that was awarded the 2016 Nobel Prize in medicine)
•Reduction of inflammation
Some of the purported physical benefits of
fasting include

Fasting offers many important unique advantages that are not available in
typical diets.
Where diets complicate life, fasting simplifies.
Where diets are expensive, fasting is free.
Where diets can take time, fasting saves time.
Where diets are limited, fasting is available anywhere.
Where diets have variable efficacy, fasting has unquestioned efficacy.
There is no more powerful method for lowering insulin and decreasing body
weight.
Advantages of intermittent fasting

3- Why Does the Hypothalamus
Unnecessarily Force a Sugar Burning
Mode in Our Bodies?
-Overcoming too much stress.
-Reducing blood sugar.
- Overcoming Leptin Insensitivity. (Obesity)

Salvage 2- The Harmful Effects of too much Protein
Mitochondrial Metabolic Therapy (MMT) 2017
high fat, moderate (adequate) protein, low carb
eating plan
Unlike a ketogenic diet, it emphasizes on high-
quality, unprocessed whole foods
Unlike Paleo diet which allow consumption of far
too much protein
The mammalian target of rapamycin (mTOR) pathway is
Central regulator of cell metabolism, growth,
proliferation and survival.
What about glutamine amino acid (used by cancer & our
immune system)

Role of Regular Physical Exercise:
A- Burn of fat
(as MMT & Ketogenic diet)
B- Improve insulin sensitivity
(depleting glycogen & fat stores)
C- Peak rise of hormones
Human growth hormone(HGH-GH) – Endorphins , Dopamine, Norepinephrine,
Serotonin) - exercise intensity
D- Mitochondrial Biogenesis
1- Free Radicals (Exercise)
2- Cold Exposure
Salvage 3- Lack of exercise and Physical activity

1- Exercise is one of the most powerful signals for
PGC 1-alpha . The master regulator of mitochondrial
biogenesis
A protein encoded by PPARGC1A gene (Peroxisome proliferator-activated
receptor gamma coactivator 1-alpha (PGC-1α) )PGC 1-alpha:
PGC-1α is a transcriptional co activator that regulates the genes involved
in energy metabolism. Is the primary signal for Mitochondria to Reproduce and
Multiply, a process called Mitochondrial biogenesis
.
2- Exercise and Nutrients (less protein) modify
mTOR function
The mTOR pathway serves as a central regulator of cell metabolism, growth,
proliferation and survival.
activated during: Tumor formation, angiogenesis, insulin resistance,
adipogenesis and T-lymphocyte activation etc
PPARGC1A

Exercise slashed the risk of cancer in 13 out
of the 26 cancers
for example
Kidney cancer by (23 %)
Lung cancer by (26 %)
Liver cancer by (27 %)
Esophageal adenocarcinoma by (42 %)
Large Study 2016 Underscores Value of Exercise for Cutting Cancer Risk
Journal of the American Medical Association Internal Medicine 2016; 176(6): 816-
825=
The research involved a mega-pool of
1.44 million men and women from a dozen
large European and U.S.
prospective cohort studies (groups of
participants who’d been followed for
several years).
Participant age, body mass index, gender,
self-reported data on exercise, smoking
status and, if applicable, any cancer
diagnoses, were analyzed to determine
the effect exercise had on various
cancers.
A total of 186,932 primary cancers were
diagnosed during the follow-up period,
which had a median length of 11 years.
Regardless of the person’s weight or
smoking history, the data suggested
physical activity cut their risk of cancer.

Salvage 4- Feeding Your Mitochondria
The following nutrients; co-factors needed for mitochondrial enzymes
to function properly:
•CoQ10 or ubiquinol (the reduced form)
•L-Carnitine, which shuttles fatty acids to the mitochondria
•D-ribose, which is raw material for ATP molecule
•Magnesium
•Omega-3 fatty acids
•All B vitamins, including riboflavin, thiamine, and B6
•Alpha-lipoic acid (ALA) - Thiotacid
Get as many micronutrients as you can from whole foods

Salvage 5- Avoid Environmental Toxins
Free radical create oxidative stress which
inhibits antioxidants from defending the body
from cancer.
Reactive oxygen species (ROS) are a potent type
of free radical which can deplete vitamin C levels
and stimulate systemic inflammation.
As inflammation in the body increases, the
central nervous system has been shown to leak
signals to the brain and gastrointestinal tract.
This results in an autoimmune response from the body. Available antioxidant sources become
depleted as the immune system attempts to defend the body from an unknown threat.
Individuals with mitochondrial dysfunction have been found to have low levels of antioxidant
support including carnitine, glutathione, and thioredoxin.
Cancer is characterized by numerous factors which lead to depression, a weakened immune system,
and chronic oxidative stress. Mitochondrial dysfunction is associated with promoting every one of
these factors.

Improving Your Mitochondria Function to Reduce Cancer Risk
By Dr. David Jockers DC, MS, CSCS
Mitochondria are unique. Contain their own copy of DNA.
3% of mtDNA responsible for 90% of a cell’s energy in the form
of ATP . (90% of ROS by mitochondria).
What the function of 97% of mtDNA
Mitochondria Sustain Life’s Functions:
1- Mitochondria are not only energy generators but are key
organelles in supporting everyday metabolic processes such as:
2- Maintaining lipid levels
3- Provide the energy needed for blood circulation
4- Buffers ion concentrations required for physiological
communication
5- Supporting glucose and insulin transportation
6- Removing health hazards including damaged cells (apoptosis)
which can wreak destruction on health
The destruction or weakening of mitochondria can lead to severe health complications including: multiple sclerosis,
autism, bipolar disorder, chronic fatigue syndrome, type-2 diabetes, heart disease, and cancer.

Cancer is One of the Most Manageable Diseases Once we realize
that cancer is a metabolic disease
Dr Josef Mercola - 2016
We can take charge of those kinds of things , with Eating too many sugars
and carbs without fiber, along with too much protein,
we ignite a cascade of metabolic events that includes:
•Widespread inflammation and cellular damage, especially our
mitochondria, or cells’ power factories
•Faster aging and a greater risk of all cancers from the activation of body’s
most important signaling pathway mTOR from eating excess protein
•An increase in insulin resistance that can progress to prediabetes or Type
2 diabetes because cells have lost their ability to respond to insulin
effectively
•Overeating due to leptin resistance with loss of control over appetite and
knowing when you’re “full”
•An inability to lose weight because body is holding on to fat instead of
burning it for fuel
Summary

1- Diet: High fat – adequate protein – cut off the sugar
Ketogenic diet (KD) - Mitochondrial Metabolic Therapy (MMT) –
low carb High fat Diet Regime (LCHF)
2- Intermittent fasting
Fat burner (less ROS) – low calorie intake - mitophagy
3- Avoid stress – sugar – obesity
Hypothalamus – sugar burning mode
4- Exercise and physical activity
Regular – endurance - PGC 1-alpha – ROS fission – mTOR like protein
5- Feeding Your Mitochondria
CoQ10 or ubiquinol (the reduced form) - L-Carnitine, which shuttles fatty acids to the
mitochondria - D-ribose, which is raw material for ATP molecule – Magnesium - Omega-3
fatty acids - All B vitamins, including riboflavin, thiamine, and B6 - Alpha-lipoic acid (ALA)
– Thiotacid.
Get as many micronutrients as you can from whole foods
6- Avoid Environmental Toxins
Oxidative stress
Summary

Proper food
selection
Oxidants
Vs.
Antioxidants

The metabolic approach to cancer

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