The document discusses using a ketogenic diet to treat cancer. It begins by outlining previous research showing that cancer cells rely primarily on glucose for fuel, unlike normal cells which can use ketone bodies. The document then summarizes several studies that found: 1) a calorie-restricted ketogenic diet significantly decreased tumor growth and improved survival in mouse models; 2) ketone bodies inhibit the viability of neuroblastoma cells; and 3) a ketogenic diet may improve quality of life for advanced cancer patients with no severe side effects. Overall, the document suggests that a ketogenic diet may be a viable non-toxic therapy for some cancers by starving the tumors of their preferred fuel source, glucose.

1. Starving Cancer using
Ketogenic Diet
By: Jamie Luu
Sodexo Dietetic Intern 2013®

2. Personal Intent

3. Personal Intent

4. Personal Intent

5. Personal Intent

6. Objectives
• Name three areas that the ketogenic diet has been applied
• Explain the metabolic difference between brain cancer cells and
normal brain cells
• State one way this information can be helpful and used in our current
or future practice

7. Epilepsy Treatment using Ketogenic Diet
• Effective treatment for refractory seizures in children

8. Weight Management using Ketogenic Diet
• AKA Modified Atkin’s Diet
• Strict low-carb diet to achieve optimal ketosis
• Optical ketosis for maximum weight loss - 1.5 - 3 mmol/L
• Keeps insulin levels low, puts your body in fat-release-fat-burn mode
and teaches your body (liver) to use ketone bodies as energy by
breaking down fat into fatty acids and ketone bodies.

9. Diabetes Type 2 Treatment using
Ketogenic Diet
• Improve glycemic control
• Decrease in HbA1c
• Decrease in medication usage
• Patients must be closely monitored
• Yancy, Wiliiam et al. A low-carbhydrate, ketogenic diet to treat Type 2 Diabetes. Nutrition and
Metabolism (2005) 2:34. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1325029/
• Poplawski MM, Mastaitis JW, Isoda F, Grosjean F, Zheng F, et al. (2011) Reversal of Diabetic
Nephropathy by a Ketogenic Diet. PLoS ONE 6(4): e18604. doi:10.1371/journal.pone.0018604
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0018604

10. Cancer is a Mitochondrial Metabolic
Disease
• Mitochondria
• Power house of the cell
• Central point in the origin of
most cancers
• Can be damaged by:
• Inherited mutations,
increasing your risk for
breast- and ovarian cancer
• Environmental factors,
toxins and radiation,
leading to dysfunction and
tumor formation

11. Sugar is the Primary Fuel for most cancers
• 1931, Nobel Prize awarded to Dr. Otto Warburg, who
discovered that cancer cells have a fundamentally
different energy metabolism compared to healthy cells,
and that malignant tumors tend to feed on sugar.
• Confirmed by: Dr. Thomas Seyfried, one of the leading
pioneer academic researchers in promoting how to treat
cancer nutritionally at Yale University and Boston College
and has written over 150 peer-reviewed scientific articles
relating to cancer treatment.

12. Ketogenic Diet
• An elegant, non-toxic way to target and marginalize tumor cells
• Allows you to dramatically lower your glucose levels, as the ketones
will protect your body against any hypoglycemia that might otherwise
be induced by carb restriction
• New state of metabolic homeostasis: a state where ketones reach
the steady state level in your blood and glucose reach a steady level
in your blood
• “If it’s done right and implemented right, it has powerful therapeutic
benefits on the majority of people who suffer from various kinds of
cancers. Because of all cancers have primarily the same metabolic
defect.” - Dr. Seyfried

13. Ketogenic Diet
• Low amounts of carbohydrates
• Eliminating all but non-starchy vegetable carbohydrates
• High amounts of healthy fats
• MCTs - avocado, coconut oil, butter, olive oil and macadamia nuts
• Low to moderate amounts of high quality protein

14. Ketogenic Diet
• Reverse Glucose to Ketone Ratios
• Glucose - 55-65 mg/dL (half “normal” level)
• Ketones - 3-4 mm/dL (millimolar)
• Measure glucose and ketone blood levels
• Glucose, 3x day
• Ketones, every few days
• Adverse side affects can occur with medications
Body’s New
physiology

15. • Purpose: Evaluate the efficacy of KetoCal®
, a new nutritionally
balanced high fat/low carbohydrate ketogenic diet for children with
epilepsy, on the growth of vascularity of a malignant mouse
astrocytoma (CT-2A) and human malignant glioma (U87-MG)
• Methods: Animal study. KetoCal®
administered to groups of mice
either in calorie restricted or unrestricted amounts. Tumor growth,
vascularity, and mouse survival were examined and compared
between two diets.
• Results: KetoCal®
administered in restricted amounts significantly
decreased tumor growth in both groups by 35-65% and enhanced
health and survival rate compared to control group (received
standard low fat/high cho diet). Tumor microvessel density was less
in KetoCal®
compared to calorically unrestricted groups. Less gene
expression for mitochondrial enzymes in tumors than normal brain
cells - reduced ability to metabolize ketone bodies for energy.
• Zhou et al. The calorically restricted ketogenic diet, an effective alternative therapy for malignant
Research Studies1

16. Research Studies
• Background: Tumor cells,
decrease expression of SCOT,
key enzyme in ketone body
metabolism, therefore cannot
use ketone bodies as a primary
source of energy.
• Purpose: Examine viability of
neuroblastoma cells when using
ketone bodies at its primary
energy source
• Methods: In Vitro method.
Human foreskin fibroblasts
(control group) grown in
standard media with/out
glucose and glucose-free
media with ketone bodies,
acetoacetate or B-
hydroxybutyrate vs. Human
• Skinner, R. et al. Ketone bodies inhibit the viability of human neuroblastoma cells. Journal of Pediatric:
Surgery (2009) 44. 212-216.
2

17. • Analysis: MTT assay - determine
cell viability; Fluorescence-
activated cell sorting analysis -
determine apoptosis;
Immunoblotting for SCOT
protein expression.
• Results: Viability and apoptosis,
not affected in normal fibroblasts
compared to neuroblastoma
cells - 52%-61% significantly less
viable and more apoptosis.
SCOT protein was significantly
less in neuroblastoma cells vs
fibroblast cells.
• Skinner, R. et al. Ketone bodies inhibit the viability of human neuroblastoma cells. Journal of Pediatric:
Surgery (2009) 44. 212-216.
Research Studies2

18. • Purpose: Investigate the feasibility of a KD and
its influence on the quality of patients with
advanced metastatic cancer.
• Methods: 3 month intervention, patients
followed a KD (less than 70 g CHO per day) with
protein/fat shakes.
• Analysis: Quality of life, serum and general
health parameters at baseline, two-week
follow-up, or after drop out. Monitor effect of
dietary change on metabolism daily by
measuring urinary ketone bodies
• Results: 5 patients completed intervention,
showed improved emotional functioning, less
insomnia. Found no severe adverse side effects
and no changes in cholesterol or blood levels.
• Schmidt et al. Effects of a ketogenic diet on the quality of life in 16 patients with advanced cancer: A pilot
trial. Nutrition and Metabolism 2011, 8:54.
Research Studies3

19. Comparative Findings
• Tumor cells cannot use ketone bodies because of their respiratory
insufficiency and decrease expression of SCOT protein (enzyme).
• Therapeutic effect of KetoCal®
for brain cancer was largely due to
caloric content, which reduces circulating glucose.
• It’s possible to target brain cancers with calorically restricted high
fat/low carbohydrate ketogenic diets.
• KD suitable for even advanced cancer patients. KetoCal®
is safe
effective diet therapy and should be considered an alternative
therapeutic option for malignant brain cancer.
• No severe adverse side effects.
• Might improve aspects of quality of life and blood parameters in some
patients with advanced metastatic tumors.
More findings needed...

20. Dietetic Clinical Application
• Nutrition Assessment
• Diet Intervention
• Ketogenic Diet
• Calorically-restricted
• Monitoring and Evaluation
• Counseling
• Labs: Ketone Bodies and Glucose Monitoring

21. Thank you!