Cancer survival guide for the newbie – beyond chemotherapy

March 25, 2022

Cancer has a way of interrupting life. Unwelcomed and unexpected, a cancer diagnosis demands immediate attention. It spares no one. Rich or poor, kings and paupers, father, mother, son or daughter, best friends, young or old- cancer can strike anyone. The initial shock and anxiety that comes with unpleasant news can be quite disabling. Thinking straight becomes a major challenge and thoughts of the past and future take center stage. The present, however, remains the reality, and one must make the right move to survive and to beat this cancer. To all my current, and future patients, here is a cancer survival guide.


Planning the next move

 

Here are some quick and meaty tips to help you survive the first few days of a cancer diagnosis.

Find a doctor as soon as possible. A medical doctor who is trained in treating cancer is called a medical oncologist. Don’t worry about whether you might need radiation right now. The medical oncologist will call for the radiation specialist later if it is needed.

Get a journal and write everything down. Anxiety has a way of muddling memory. Record your potential questions to ask the doctor. Don’t forget to write the answers down. It is better to ask questions if something is not clear. However, be aware of the doctor’s time. He or she may be genuinely trying to help you but there are other patients waiting in line.

Diagnosis

Supposing there is a mass in the lung. Does that mean it is lung cancer? Not necessarily.

The diagnosis is usually confirmed by the biopsy of tissue and is read by another doctor, called a pathologist. Pathologists specialize in identifying tissue and matching it to the correct diagnosis. A biopsy is a sample of the tissue or tumor, usually harvested using a needle. The sample is then examined under a microscope in order to determine the origin from which the cancer was born.

Therefore, a lung tumor is not always a lung cancer. The pathologist might find out that the lung tissue actually has colon cancer cells. Therefore the diagnosis is no longer lung cancer, but rather, a colon cancer that relocated or metastasized to the lungs. The treatment is based on the organ of origin, and not the final destination. Since the biopsy showed colon cancer cells, the chemotherapy chosen will be tailored to colon cancer. If there is any question, try to get a second opinion from another pathologist at an outside institution.

Blood tests can sometimes help clinch the diagnosis. My favorite test to order is lactate dehydrogenase or LDH, and tumor markers.

Blood cancers like myeloma, leukemia or lymphoma, might need a bone marrow biopsy.

In the past few years, new treatments other than chemotherapy have evolved. Biologics, immunotherapy and monoclonal antibodies are a few of the newer, non-chemotherapy treatments.

What to do if you are seeing a doctor for the first time

If you are transferring your care from a small town practice to a bigger one, maybe even a university hospital, make sure that you collect all the necessary information.

When asking the old hospital to send records, don’t just say “records”. It is too vague and the clerk in the medical records office will have the final say on what pages to pull. If there are thousands of pages in your file, there is a good chance that only a sample of that will be pulled. The best way is to “specify”. Specifically write down in your request that you want any tissue slides, paraffin blocks, CAT scans or MRIs, PET scans, and bloodwork. Progress notes from your former doctor can be very helpful and will minimize delays in your care. Some practices will refuse to see a new patient until all the requested data and files are received.

If your records are being faxed, be prepared and get a paper copy of your records so you can also hand carry them to your next consultation. Many times a fax would not go through on time, or if they do, some vital information may be lost in transit.

If you are transferring imaging records ( CT scans, x-rays, etc.), try to get the actual CD which contains the images. This way, you will always have a copy on hand and not be at the mercy of slow transfer of records.

Bring your medications or at least, a complete and accurate medication list, to your first doctor’s appointment.

After the diagnosis is confirmed, the next step is to “stage” cancer. Generally, we stage cancers a “Stage I” if it is early. Most solid tumors are staged from 1 to 4. Each organ has its own staging system, and one does not fit all. Treatment is matched to the stage.

Not all Stage 4 are incurable

Lymphomas, for example, can still be completely cured if in Stage 4. Most leukemias can be staged, but other leukemias, like chronic myelogenous leukemia CML, do not even have a stage.

Stage 4 in solid tumors, is not always a death sentence. Years ago, stage 4 colon cancer was terminal. Nowadays, thanks to advances in medicine, there are even treatments for colon cancer that has already traveled to the liver. "Chemoembolization" which is a method by which specialized radiologists can clog off the blood vessel supplying the liver tumor by inserting medical gelfoam into the artery feeding the tumor, while sparing the normal liver. Thanks to new treatments, the cure rate for Stage 4 colon cancer which has metastasized to the liver is no longer zero, but rather, can be in the range of 20-30%.

Outside the box

Aside from choosing a doctor whom you can trust to deliver the best treatment, YOU can also do something to make a difference. and help improve your chances of survival.

Food, you are what you eat

I always wondered at the power of a tiny pill. A pill which has the ability to control blood sugar, blood pressure, growth, heart rate, or even shrinks cancers. In comparison, a whole plate of unhealthy food can certainly do damage, yet very few of us will lose sleep over that fact.

What you DON'T eat, also matters

Diet is something that one can easily change, as long as there is the will and motivation. Diets, especially the high glycemic type (high carbohydrate ) that promotes high levels of insulin, can increase the risk of relapse and shorter survival[1]. When we eat food, this triggers the body to release insulin from the pancreas. Multiple repetitive episodes of insulin release can be detrimental. Therefore, it isn't a good idea to keep eating small amounts of food scattered over the day. Less is actually more. Eat only until you are no longer hungry but also don't try to get too full.

It pains me to hear that our institution ran, completed and published results of the safety trial “ Ketogenic Diet in Advanced Cancer” [2], and yet we are back to our old ways of serving iced cold cans of fizzy soda laced with scandalous amounts of sugar and high fructose corn syrup, to our cancer patients. In 2018, both Geisinger Medical center and the Lancaster Hospital adopted a ‘no added sugar beverages “ policy. https://tinyurl.com/y3eb63a2

Uninformed eyes will roll whenever I bring up the topic of ketogenic diets in cancer. Diet is taboo since weight loss in cancer patients is usually associated with poor performance. However, there is mounting evidence that supports the idea that yes, diet does matter.[3] And no, I do not recommend feeding pudding, ice cream or jello to advanced cancer patients.

Not only the type of diet but the timing can be critical. [4]

MEAT

Good or bad for you? Meat and cancer, the facts only please

"I have cancer, does that mean I should be juicing and become a vegetarian?" - Meat lately has been getting some bad publicity. However, I prefer to stick to the facts. Meat, if chosen properly, can be beneficial to cancer treatment success.

Anti-aging and autophagy

Autophagy, (auto= self, phagy-to eat) is a means by which cells can renew themselves after damage and aging. When autophagy is damaged, a disease can develop, including cancer. Dietary restriction by way of intermittent fasting appears to be a means to improve autophagy and can enhance cancer therapy while protecting normal cells.[4]

Keto vs Intermittent fasting vs Caloric restriction?

Keto diets have become the fad.. You limit carbs and produce ketones, lose weight and possibly help treat cancer. Intermittent fasting supposedly preaches that by limiting the window of eating to a ten hour or so bracket, that one might benefit similar to the keto diet. Caloric restriction has ample data which shows improved lifespan in animals, fruitflies and elegans worms. However, a 2014 literature review of studies involving the ketogenic diet, intermittent fasting, and caloric restriction showed that there was enough animal lab evidence to support the ketogenic diet and/or caloric restriction as being effective for cancer, however, there was insufficient evidence to back up intermittent fasting. [5] Confused? We need more studies...

Does sleep matter?

Does it matter if I sleep at night or during the day? Night shift workers often have disrupted sleep. Studies in breast cancer patients who were undergoing chemotherapy showed that repetitive chemotherapy sessions can disrupt the sleep cycle and result in impaired production of nighttime melatonin.[6]. Melatonin goes down when sleep deprived. Studies of sleep-deprived rats show that melatonin supplements can preserve the levels of the sirtuin protein in the brain. Sirtuins, which can be found in red grape skin or in the supplement “resveratrol”, are supposedly responsible for longevity [7]. Therefore, will melatonin supplements extend lifespan? Data is lacking. However, melatonin supplementation appears to delay nerve degeneration caused by chemical exposure in rats[8].

Maintenance of the sleep-wake cycle is important for quality of life therefore, we should pay attention to this matter.[9]

Unconventional? Perhaps. The science behind these options seems sound, but yes, it's mostly mice. There is definitely room for future scientific research.

Stress management

Many cancers are linked to inflammation and high levels of interleukins. Interleukin 6 can stimulate production of another tumor-promoting signaling. Cortisol, the stress hormone, was found to be higher in lung cancer patients compared to patients without lung cancer. [10] How can we reduce cortisol levels?

Studies in breast cancer patients showed that stress management techniques were effective in decreasing stress hormones / cortisol levels . Other ways include relaxation and massage techniques which can also decrease levels of the proinflammatory interleukin 6 in addition to cortisol [11-13].

So there you have it, some tips and explanations. Some facts and some news. I know this will not completely answer the ton of questions in your mind, but the added knowledge will at least lessen the anxiety, knowing what to expect and what to do to win your personal war against cancer.

 

  1. Morales-Oyarvide, V., et al., Dietary Insulin Load and Cancer Recurrence and Survival in Patients With Stage III Colon Cancer: Findings From CALGB 89803 (Alliance).J Natl Cancer Inst, 2019. 111(2): p. 170-179.
  2. Tan-Shalaby, J.L., et al., Modified Atkins diet in advanced malignancies - final results of a safety and feasibility trial within the Veterans Affairs Pittsburgh Healthcare System.Nutr Metab (Lond), 2016.13: p. 52.
  3. Harvie, M.N. and T. Howell, Could Intermittent Energy Restriction and Intermittent Fasting Reduce Rates of Cancer in Obese, Overweight, and Normal-Weight Subjects? A Summary of Evidence.Adv Nutr, 2016. 7(4): p. 690-705.
  4. Antunes, F., et al., Autophagy and intermittent fasting: the connection for cancer therapy?Clinics (Sao Paulo), 2018. 73(suppl 1): p. e814s.
  5. Lv, M., et al., Roles of caloric restriction, ketogenic diet and intermittent fasting during initiation, progression and metastasis of cancer in animal models: a systematic review and meta-analysis.PLoS One, 2014. 9(12): p. e115147.
  6. Li, W., et al., Disruption of sleep, sleep-wake activity rhythm, and nocturnal melatonin production in breast cancer patients undergoing adjuvant chemotherapy: prospective cohort study.Sleep Med, 2019. 55: p. 14-21.
  7. Chang, H.M., U.I. Wu, and C.T. Lan, Melatonin preserves longevity protein (sirtuin 1) expression in the hippocampus of total sleep-deprived rats.J Pineal Res, 2009. 47(3): p. 211-20.
  8. Reiter, R.J., et al., Melatonin, longevity and health in the aged: an assessment.Free Radic Res, 2002. 36(12): p. 1323-9.
  9. Chang, W.P. and C.C. Lin, Changes in the sleep-wake rhythm, sleep quality, mood, and quality of life of patients receiving treatment for lung cancer: A longitudinal study.Chronobiol Int, 2017. 34(4): p. 451-461.
  10. Lichter, I. and N.E. Sirett, Serial measurement of plasma cortisol in lung cancer.Thorax, 1975. 30(1): p. 91-4.
  11. Phillips, K.M., et al., Stress management intervention reduces serum cortisol and increases relaxation during treatment for nonmetastatic breast cancer.Psychosom Med, 2008. 70(9): p. 1044-9.
  12. Lengacher, C.A., et al., A Large Randomized Trial: Effects of Mindfulness-Based Stress Reduction (MBSR) for Breast Cancer (BC) Survivors on Salivary Cortisol and IL-6.Biol Res Nurs, 2019. 21(1): p. 39-49.
  13. Listing, M., et al., The efficacy of classical massage on stress perception and cortisol following primary treatment of breast cancer.Arch Womens Ment Health, 2010. 13(2): p. 165-73.

Exploring the Link Between Cancer and Weight Loss:

March 14, 2024
Breaking Down the Fear  Ketogenic diets often result in weight loss. Cancer patients frequently lose weight. Does this mean that keto diets are harmful to use in cancer patients? Cancer and weight loss are two topics that often come hand in hand, yet the relationship between them can be complex and sometimes frightening. Weight loss, particularly unexplained or rapid, can evoke fear in many individuals, often signaling underlying severe health concerns. However, when it comes to cancer, weight loss can sometimes be one of the earliest signs of the disease. In today's blog, we delve into the connection between cancer and weight loss, unraveling why the latter often instills fear and how understanding this relationship can lead to better health outcomes. Understanding Cancer and Weight Loss: Cancer involves uncontrolled cell growth and abnormal spread of cells throughout the body. These invading cells affect various organs and systems and disrupt their normal function. Weight loss can be very subtle or profound depending on the type of organ invaded. As cancer takes root and establishes itself, it also spews out cytokines (unique inflammatory proteins) that also serve as signal messengers, signaling muscles to lose volume, resulting in a weight loss phenomenon known as cachexia. Cachexia is a complex syndrome. Inflammation is often at the root of this problem, of profound muscle wasting, generalized fatigue, and poor appetite, Why Are We Afraid of Weight Loss? Weight loss, in general, is often perceived negatively in society. There's a prevailing notion that thinness equates to health, beauty, and success, while weight loss may imply illness or a lack of control. However, when weight loss occurs without intentional dieting or exercise, it can be a red flag for underlying health issues, including cancer. In cancer, especially, the presence of weight loss is disturbing because we traditionally associate it with illness. Association with Illness: Unexplained weight loss is commonly associated with illness, particularly severe conditions like cancer. The fear of the unknown and the potential implications of such weight loss can be daunting for individuals. To be of "normal" weight is equated with health. Loss of Control: Weight loss, especially rapid or involuntary, can make individuals feel like they've lost control over their bodies. This loss of power can be unsettling and exacerbate feelings of anxiety or fear. Uncertainty: Weight loss without a clear cause can be perplexing and raise questions about what might happen within the body. The uncertainty surrounding the underlying cause can contribute to fear and anxiety. During chemotherapy, however, weight loss is inevitable because we are in a catabolic state. The active cancer is making us lose weight. The key is to control or snuff out the underlying cancer. Once you weaken the tumor, less cytokine release and less inflammation will follow. As this occurs, the "source" of the cytokine release will die, and weight gain should naturally recover. Therefore, loading up on carbohydrates to make us appear to be of "normal weight" is incorrect. Loading up on sugary treats will only strengthen the cancer and will only be counterproductive! Conclusion: The fear of weight loss, particularly in the context of cancer, is understandable, given the potential implications for health and well-being. However, by understanding the complex relationship between cancer and weight loss and challenging societal stigmas, we can accept some form of healthy weight loss during chemotherapy. We can learn to recognize unhealthy weight loss (loss of muscle mass) and differentiate it from healthy weight loss during a ketogenic diet (most of which is weight loss from fat and excess water). As long as one feels energetic, with normal blood parameters and no indication of significant liver or kidney failure, anemia, or marrow failure, then some healthy weight loss during chemotherapy or implementation of a ketogenic diet CAN be acceptable.

GINGER ALE DURING CHEMOTHERAPY

March 4, 2024
Are you still drinking "ginger ale" during your chemotherapy sessions? You know, those gleaming, chilled cans of sparkly soda that your cheerful chemotherapy nurse hands out along with your anti nausea pills?  The scent and the taste of ginger help nausea stay away. But did you know that your "ginger ale" contains no ginger? Worse, the HFCS high fructose corn syrup, a highly processed sugar, can do you more harm than good. And making your cancer cells really happy. Next time you go for your chemo session, ask for water instead. Or better yet, bring your own ginger-infused drink from home. Here is some background about ginger. For centuries, ginger has been used as a remedy for nausea and digestive issues, and some scientific evidence supports its effectiveness. Here are some examples. Morning Sickness: Pregnant women often experience morning sickness, and ginger has been traditionally used to alleviate these symptoms. Several studies have shown that ginger can reduce nausea and vomiting during pregnancy. For example, a meta-analysis published in the Journal of Obstetrics and Gynaecology Research in 2014 concluded that ginger supplementation significantly reduced the severity of nausea and vomiting in pregnant women without any significant side effects. Motion Sickness: Ginger is effective in reducing motion sickness. A study published in Aviation, Space, and Environmental Medicine 1986 found that ginger was more effective than a placebo in reducing symptoms of motion sickness. Subsequent studies have supported these findings, suggesting ginger can alleviate symptoms like nausea, vomiting, and cold sweating associated with motion sickness. Chemotherapy-Induced Nausea: Cancer patients undergoing chemotherapy experience nausea and vomiting. The Journal of Alternative and Complementary Medicine 2009 published a review that analyzed several randomized controlled trials and found that ginger supplementation could reduce the severity of chemotherapy-induced nausea. Postoperative Nausea: Nausea and vomiting are common after surgery. A meta-analysis published in the journal Integrative Cancer Therapies in 2012 found that ginger effectively reduced postoperative nausea and vomiting compared to a placebo. However, we need more research to fully understand its mechanisms and best dosage. Everyone responds differently, but ginger, in its natural form, is usually safe to take during chemotherapy. Just make sure its the real thing! Photo credit Dan Sorum @ unsplash

Welcome to all our new members

January 30, 2023
Welcome to all our new members

Getting Started On A Keto Diet

May 17, 2022
Getting started on the keto diet usually sounds like someone is trying to lose weight? When you add cancer to that recipe, it becomes a whole new ball game. Do any of these thoughts sound familiar? “ I want to fight my cancer , and I heard that this diet can help me heal “ “ I’m confused because the keto diet will make me lose weight” “I’m afraid to lose more weight.” “I can’t afford to lose weight! “ “When is weight loss just right, and when is it too much? “ Is there real hope for me? Over the past two decades, I’ve seen my share of cancer patients. Yup, the whole package - diagnosis, anxiety, chemo, radiation, hair loss, weight loss, and, failures. But, I also saw many patients who achieve clean CT scans, remission, happy news, hair growth, and of course, the coveted weight gain. I have my own collection of patients with stage four cancers, a few have actually reached their ten to twelve year anniversary with me. Most of them have made it past five years and some are in complete remission. Yes, stage four to stage zero! How did they do it? You may have come to this website, searching for answers. I wish that I could tell you all that I know, in one sentence, but I can’t. It usually takes me several office visits to educate my patients. For now, you can stick around, and try to absorb the knowledge from current posts. Take time to read through my past blogs. Signup for a keto conference. There is one coming up very soon. The MHS 2022 in Santa Barbara California. May 5 to 8. Read books, and more books. You might be surprised. Not all books are the same. Some are full of dense material, while some are mostly fluff. But eventually, you will find the right book for you. Join me in one of my subgroups. But you need to fit the profile and be past the beginners stage when you join. Or you might get bored! I do show up there from time to time, to break the ice. And by the way, when you are stuck and can’t find the answers you are looking for...you need to make your voice heard and post your questions. What if my cancer doctor doesn’t approve? If your cancer doctor doesn’t know much about the keto lifestyle, or about metabolic approaches to cancer, don’t lose hope. Try to educate them, Share your knowledge. Even if they are at first resistant, with time, some will marvel at your progress and will notice that you are doing better than their average patients. Finally... the number one question that shows up on my blog.... What diet is best for me? I’m so CONFUSED! “ Dr. XXX on YouTube said that a keto diet and weight loss is good for cancer, but another doctor YYY said the opposite, that I should eat, healthy carbs, more plants, fruit , avoid fat and protein, try to gain weight. “ Dr. WWW advocates a vegan diet, but Dr ZZZ said do a carnivore diet.... , help!!!! Let me know your thoughts in the comments below!

New drug for relapsed Glioblastoma, a deadly form of brain cancer

March 30, 2022
There is exciting news on the horizon for glioblastoma, which is a deadly form of brain cancer. Have you heard of activated T cell therapy? It is similar to the car-T cell therapies that you often hear about for blood cancers. Well, this form of therapy is now available for patients with brain cancers. The catch is, you must enroll in a clinical trial. It is not yet available to the public. To qualify, one must have glioblastoma, a form of brain cancer , and cancer must have relapsed after the first diagnosis. Patients who are interested are now able to ask for information about enrolment at the Cedars Sinai Medical Centre in Los Angeles. This trial will be classified under a Phase one type of clinical trial. The drug company, Kairos pharma is the sponsor. This exciting new therapy, otherwise known as KROS 201, is a form of activated T cell therapy. The patient’s white blood cells are first harvested. Blood is removed by a simple intravenous blood draw, and then sent off to the lab to be processed in a cell culture. In the lab, the white blood cells are primed by exposing them to small protein substances called cytokines. This process will in turn activate the white blood cells, specifically the killer T cells. Once activated, these cells can now fight cancer by inactivating cancer stem cells. The T cells are returned to the patient’s body by intravenous infusion. The link for enrolment is not yet available but do keep checking on www.clinicaltrials.gov

Mistletoe plus chemotherapy in non small cell lung cancer

March 25, 2022
Iscador, a type of mistletoe preparation was tested by a medical team in Israel alongside conventional chemotherapy in the treatment of patients with advanced non small cell lung cancer. Although no improvement in survival or quality of life was noted,non hematological side effects from the chemotherapy and hospitalizations were less in the group which received the mistle toe preparation. Possible yet unproven mechanisms of action include improvement of immune function via increasing the number of NK natural killer cells as well as improve the function of Tumor Necrosis Factor Alpha. Fever which is also a noted side effect of this preparation has been described prior to spontaneous regression of certain cancers such as melanoma implying a possible role of immunotherapy in the fight against cancer. No randomized trials on cancer patients have yet been published. 

Brain cancer – Challenges with the ketogenic diet

March 25, 2022
We made little progress in the way of survival in the treatment of malignant brain tumors, specifically the deadly glioblastoma multiform. Despite aggressive surgery followed by radiation therapy and precautionary chemotherapy, they relapse early and survival is measured in months. Patients rarely survive beyond a year. Alternative therapies abound with few successes. Some patients attempt to enroll in clinical trials in search of new drugs that might make a difference in their survival.  There is a biologic treatment available. It is the monoclonal antibody called Bevacizumab. It supposedly controls the growth of blood vessels that supply nutrition to the brain tumor. Shrinking the blood supply supposedly starves the tumor. Very exciting, but nonetheless isn't a cure. Long term survivors still remain a rarity. There is mounting interest in metabolic basis of cancer development. In this respect, I do feel that ketogenic diets have potential benefit in brain cancer patients. The role of sugar and carbohydrates in the progression of brain tumors is interesting. Since most patients also are on steroids to improve brain swelling. It is also bad for them because this also increases their blood glucose. I wonder, if we are indeed adding fuel to the fire. A few case reports of brain tumor patients who were offered the ketogenic diet showed that some tumors stopped growing while others improved their survival. Notably, upon discontinuation of the diet, the tumor was noted to again progress, only to regain control upon reinitiation. Currently there are 4 clinical trials ongoing in the United States involving the ketogenic diet in the treatment of various forms of cancer. Another is ongoing in Germany. More clinical trial participation is desperately needed if we are going to move ahead and forge any progress with this deadly cancer. =

Lonsurf, newly approved colon cancer drug

March 25, 2022
Three weeks ago I got word that another new chemotherapy drug has been approved for the treatment of colorectal cancer. Ideal candidates for this drug are patients who failed previous chemotherapy involving one of the following drugs: 5-Fluorouracil, Oxaliplatin, Irinotecan, Cetuximab (also known as Erbitux) and Avastin ( also known as Bevacizumab).This new drug has two active components, trifluridine and tipiracil. Trifluridine is a new nucleoside analog. In other words, a nucleoside is a nitrogen containing biologic compound linked to a sugar, which when phosphorylated, turns into a nucleotide, which is a vital part of the DNA backbone. Trifluridine therefore is a nucleoside analog, meaning it isn't but acts like a nucleoside. It incorporates itself into the DNA structure and interferes with cell growth and proliferation. Tipiracil inhibits the enzyme thymidine phosphorylase, which catalyzes the degradation of Trifluridine, thus allowing it to last longer. Thymidine phosphorylase by itself has pro-angiogenic properties, meaning it promotes blood vessel formation and encourages better blood supply of tumors, so Tipiracil directly stops this advantage. Furthermore, Tipiracil by stopping thymidine phosphorylase, prevents the formation of thymine and 2-deoxy-alpha-D-ribose 1-phosphate. 2DARP is a strong reducing sugar product of thymidine catabolism and causes increased oxidative stress within tumors, promotes release of more tumor blood vessel promoting factors ( angiogenic growth factors) such as interleukin-8, vascular endothelial growth factors VEGF, and matrix metalloproteinase-1 an enzyme which breaks down collagen and extracelular matrix, which is key in promoting tumor metastases. This three mode action of tipiracil ( inhibits thymine production, thymidine phosphorylase VEGF activity, stops ROS and MMP-1 , VEGF and cytokine production)- makes it more attractive since it can potentiate the action of the common colorectal chemotherapy drug 5- fluorouracil whose main action is to inhibit formation of thymine. The RECOURSE trial, a —international, randomized, double-blind, placebo-controlled study conducted in patients with previously treated metastatic colorectal cancer apparently resulted in statistically significant improvement in overall survival and progression free survival . The drug is given orally, twice a day, for two straight weeks, minus weekends, followed by a two week break. Side effects are listed as anemia, neutropenia, asthenia/fatigue, nausea, —thrombocytopenia, decreased appetite, diarrhea,vomiting, abdominal pain,—pyrexia. Since it is barely a month since FDA approval ( Sept. 24, 2015) it still has not hit our pharmacy shelves. I am however eager to try this. Will update you again in a few months. 

Getting into ketosis

March 25, 2022
How long does it take to get into a state of clinical ketosis? By ketosis, I mean the levels of beta-hydroxybutyric acid reaching to above normal levels yet not high enough to bring you into a medical emergency such as ketoacidosis. As little as a day is all it takes. You an achieve this in different ways. The most common and sure fire method is to simply stop eating. If you fast and only limit your intake to water or sugarless herbal , which technically has ZERO calories, you will achieve a state of ketosis in no time. Another way is to try fasting for 15 hours a day, or roughly, just eat one full meal daily. this should bring you into ketosis too, though not all 24 hours are involved. If you try a ketogenic diet, that means, you will be limiting your carbohydrate intake to approximately 20% of your total daily intake, and take the rest in the form of fats ( 70-75%) and proteins (5 to 10%).  Monitoring your progress will be helpful. A simple glucometer will suffice. Individual serum Ketone sticks, readily available from Amazon.com or special order through your pharmacy can be used to check your ketone levels throughout the week.

Update on clinical trials of the ketogenic diet in cancer

March 25, 2022
Several clinical trials are ongoing throughout the United States at the moment.  The University of Iowa Department of Radiation Oncology is running a couple of Phase I trials on the use of the ketogenic diet plus radiation and chemotherapy in head and neck cancers, and they also have another which studies the ketogenic diet plus chemoradiation in non-small cell lung cancers and pancreatic cancer. Michigan State University has one which recruited brain cancers, also known as glioblastomas, a very deadly type of brain cancer. Duke University recently began a randomized trial studying the ketogenic diet plus androgen deprivation therapy in prostate cancer , using the ketogenic diet versus a control standard diet. Unfortunately per recent info posted on the clinicaltrials.gov website, the trial was terminated as of December 2015, due to lack of funding, and due to the principal investigator leaving . Closer to home, the Veterans Affairs Medical Center in Pittsburgh has their own trial which recently concluded in 2015. This trial recruited patients with advanced solid tumors across broad tumor types and patients dieted up to 16 weeks or until tolerated. The results have not yet been publicly released as it is currently under manuscript review.
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