Category: Lifestyle

The Anti-Cancer Properties of the Ketogenic Diet

Promoted for a host of associated benefits – ranging from weight loss and lowered blood pressure to improved glucose control – the ketogenic diet has surged in popularity in recent years. Consisting of a high level of fat, an adequate amount of protein, and a very low amount of carbohydrates (fewer than 50 grams daily), the keto diet may be recommended for the management of certain health conditions. However, there is little evidence supporting its efficacy and adequacy as an eating pattern; forthcoming research aims to ascertain whether the purported benefits of keto outweigh the potential long-term cardiometabolic consequences.


By depriving the body of carbohydrate-derived glucose, the ketogenic diet induces ketosis, forcing the body to utilize stored fat as an alternative source of energy. Although the precise mechanisms of action are unknown, this state is believed to have neuroprotective effects even able to diminish the number of seizures in patients with epilepsy. Furthermore, preliminary research suggests that the ketogenic diet may assist diabetes patients with blood glucose management and weight control. 


Clinical studies have begun to investigate the additional potential therapeutic benefits of a ketogenic diet on health conditions, such as polycystic ovary syndrome, Alzheimer’s disease, and more recently, cancer. Emerging evidence implicates that the ketogenic diet may have anti-cancer properties and can complement standard therapies such as chemotherapy and radiation, boosting their efficacy by selectively inducing metabolic oxidative stress in targeted cancerous cells.


Ketogenic Diet Effects on Tumor Growth


In a new study, researchers at the University of Texas investigated the effects of blood glucose restriction via a ketogenic diet and diabetes medicine on cancer treatment in mice. Corresponding author Dr. Jung-Whan Kim, assistant professor of biological sciences at the university, and colleagues restricted circulating glucose levels in mice with xenograft lung and esophageal squamous cell carcinoma (SCC) tumors by feeding them a low-sugar ketogenic diet and the SGLT2 inhibitor canagliflozin.


Published in Cell Reports, their findings implicate that the ketogenic diet alone may have a tumor-growth inhibitory effect on squamous cell carcinoma cancers, while combination treatment of chemotherapy with an adjunct SGLT2 inhibitor may be even more effective. Researchers found that xenograft tumor growth of lung SCC and esophageal SCC in mice was significantly restricted in those fed a ketogenic diet compared with those fed with normal chow. The investigators note that both the keto diet and pharmacological treatment inhibited SCC tumor growth when tested alone however, the interventions did not decrease tumor size or affect other, non-squamous cell carcinoma tumors. The author’s findings implicate that lung and esophageal SCC cancers may be particularly vulnerable to glucose restriction. “Our results suggest that this approach is cancer cell type-specific. We cannot generalize to all types of cancer,” Dr. Kim concluded.


Glucose Restriction for Improved Cancer Treatment Outcomes


As part of their investigation, Dr. Kim and colleagues also examined the blood glucose levels of patients with lung or esophageal squamous cell cancer and compared them with those from lung adenocarcinoma patients. In analyzing blood samples from 192 lung or esophageal SCC patients and 120 lung adenocarcinoma patients, researchers found a strong correlation between elevated blood glucose concentration and decreased survival rates among SCC patients. None of the patients had diabetes and no such correlation was found in the lung adenocarcinoma cohort.


The results of the preclinical human trial further implicate the potential efficacy of glucose restriction on inhibiting squamous cell carcinoma growth although, authors note that the research is still in its early stages and requires more extensive investigation. Nonetheless, Dr. Kim’s findings uncover a potential new therapeutic strategy for improving cancer treatment outcomes. “Manipulating host glucose levels would be a new strategy that is different from just trying to kill cancer cells directly,” he says, I believe this is part of a paradigm shift from targeting cancer cells themselves. Immunotherapy is a good example of this, where the human immune system is activated to go after cancer cells.”


Despite the treatment’s preliminary success – and the significant role of the ketogenic diet in the trial ­– researchers stress that the results cannot be generalized to all types of cancer. Further investigation is necessary to determine the impact of diet-induced ketosis on squamous cell carcinoma growth inhibition before any clinical recommendations are made.


Benefits of a Plant Based Diet in Keeping A Healthy Heart

Over the last decade, cardiovascular disease (CVD) has taken the form of a global epidemic, with an estimated 18 million deaths each year, making CVD the number one killer globally.* In the US, approximately 1 of every 3 deaths is due to some form of CVD like coronary heart disease (CHD), stroke, hypertension, or heart failure.* 

Even though these facts and figures paint a grim picture, the silver lining is that CVD is preventable. The key is to be aware of the risk factors and manage them for a healthy lifestyle; for example, an unhealthy diet, sedentary lifestyle, and heavy tobacco/alcohol usage can certainly be avoided or minimized to prevent cardiovascular events.

Currently, direct dietary counseling of CVD patients is still a challenge mostly due to lack of formal nutrition education among clinicians and the time required to convince patients to adhere to a specific diet.* Additionally, the abundance of information and controversies on food and food groups regarding optimal diet do not necessarily make it easy for people to decide what to eat.

Historically, countless epidemiological studies have highlighted the importance of diets in preventing CVD. They show how specific diet patterns—like eating plant-based foods, consuming foods with low saturated fat—reduce CVD incidence and severity.* In fact, diet changes are the biggest drivers of a healthy heart. Thus, almost all the guidelines now recommend that, along with adequate treatment, clinicians should actively incorporate evidence-based dietary counseling as part of cardiovascular therapies. 

As scientific research continues to shed light on the importance of diet and nutrition, perhaps the most critical questions that we face today are — What is an optimal diet? And how do we implement this optimal diet counseling in clinics? 

Nutrition research and evolution of the plant-based diet

Some of the earliest nutrition research (in the 1950s) highlighted the adverse outcomes of fat-enriched diet (mainly saturated fat) on heart diseases, giving rise to the widespread belief that fatty foods contribute to CVD.* Subsequently, the 1980 Dietary Guidelines for Americans focused heavily on isolated nutrients: “avoid too much fat, saturated fat, and cholesterol; eat foods with adequate starch and fiber; avoid too much sugar; avoid too much sodium”.* 

Soon after, in the 1970s, the Seven Countries Study, spearheaded by Ancel Keys, explored the association of diet and dietary habits with CVD incidence in populations representing seven different regions. The study design illustrated the influence of eating on the risk of CVD. It recognized the power of the plant-based diet, popularly known as the Mediterranean (MED) diet, in lowering cardiovascular mortality risk. Simply put, the MED diet entails — high intake of legumes, vegetables, fruits, and low consumption of dairy and meat (saturated fat), with fats mainly from nuts.* 

This ground-breaking study eventually inspired and prompted a slew of subsequent dietary research. DASH (Dietary Approaches to Stop Hypertension; 1997) and PREDIMED (Prevención con Dieta Mediterránea; 2018) are particularly noteworthy since they championed the idea of plant-based foods and the associated benefits to heart health. Similar to the MED diet, the DASH diet consists of a high intake of vegetables, fruits, whole grains, and olive oil with minimal consumption of red/processed meat, refined carbohydrates, and processed foods.

Adherence to the DASH diet resulted in a significant drop in heart failure risk among healthy adults (27% in men; 37% in women),* while a Mediterranean diet supplemented with extra-virgin olive oil or nuts lowered the incidence of major cardiovascular events among high-risk individuals.*

Diving deep into the plant-based diet

As of 2017, 6% of Americans claim to be vegetarians or vegans compared with just 1% in 2014.* The number is expected to rise in the coming years as more people become aware of the health benefits of the plant-based or vegetarian diet. 

A plant-based diet not only prevents risks of coronary diseases, but it also has multiple other health benefits that include improving gut microbiota and cognitive brain function. Plant-based foods are one of the richest sources of dietary fiber and essential phytochemicals and great for antioxidant vitamins, minerals, and micronutrients.

Despite being universally accepted as heart-healthy, wholesome, and nutritionally superior to animal products, plant-based foods are considered protein poor by many. The long-standing belief is that plant-based proteins are incomplete because they don’t have all the essential amino acids that humans need. However, growing evidence from research work is breaking this myth.

Citing the research work of William Rose and team, John. A. McDougall, an American physician and author, states that: “A vegetarian diet based on any single one or combination of these unprocessed starches (e.g., rice, corn, potatoes, beans), with the addition of vegetables and fruits, supplies all the protein, amino acids, essential fats, minerals, and vitamins (except vitamin B12) necessary for excellent health”.*

Christopher Wharton reviewed various research works that show how a plant-based diet is on par with the omnivorous diet in supporting athletic performance and strength among recreational athletes.* Recently, Novak Djokovic, the Serbian tennis legend, credited his plant-based diet as the secret to his remarkable recovery after injury.

Because nutrition is the cornerstone of human health, the role of a physician is crucial than ever in educating patients about positive dietary changes to improve their health and wellbeing. It’s about time that the wealth of scientific knowledge in favor of plant-based diets makes its way into the clinical care regimen, and clinicians incorporate diet communication along with pharmacotherapy.

Contributed by:

Sangeeta Chakraborty Ph.D 
Associate Researcher,
National Jewish Health,
Greater Denver Area, Colorado


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