Does the low carb diet shorten your lifespan, or does it improve it?

March 25, 2022

Last August, the Lancet (a respected medical journal) published an article which said that following a low carbohydrate diet, actually shortens life, by four years!

I sent the Lancet this letter https://tinyurl.com/y7frqf7qand they agreed to publish it. Read if you want to be enlightened. Also please read the other responses from my low carb colleagues. Scroll to the bottom of the page and you will find the links.

It was not only a sensational news story that was widely shared and repeated, it was also grossly inaccurate and misleading.

The study was written by researchers from Harvard University and the University of Minnesota. They recruited middle aged participants and supposedly followed their eating habits over 25 years . They planned to have the patients visit the research team 6 times, over the span of 25 years, during which they were supposed to fill out a 66 item questionnaire. In it they listed several representative food items, and asked the subjects to respond in detail on the amount and frequency of their food consumption. Using this data they were able to group the people according to their dietary intake, whether they were low, medium or high carbohydrate eaters.

Most people I know will not sit for a 10 question questionnaire, even if you pay them! If they had indeed produced a 66 item questionnaire, I doubt the participants were very alert or accurate by the time they reach question 25. Even less likely if you are in your 80s. Unfortunately, they were able to get questionnaires filled out only twice, on visit 1 and on visit 3. So does this mean that for the rest of the unsurveyed visits , the participants were assumed to be still eating and drinking the same amounts and variety? Visits 4,5 and 6 certainly spanned several decades, and they used data from visit 3 to summarize what they ate on visits 4,5 and 6?

Do you really trust that elderly patient to recall what he ate, in detail, from the year before? Was that 8 ounces of milk a day, or was it 16 ounces? Do you recall how many days a week you drank that 8 ounce cup of milk?  Twice a week? Thrice? Or daily? Questionnaires are inexpensive, nice and easy to implement, but the accuracy of this type of survey based research is highly susceptible to errors. (Natarajan et al. 2010)

They also concluded that those who followed a “low carbohydrate” diet lived on average, 4 years shorter than if they were on a moderate carbohydrate diet. They even lived shorter than those on a high carbohydrate diet! Before we jump to conclusions, note that these patients who were middle aged, over the course of 25 years died or became elderly (in their 70s and 80s). Most of the patients in the “low carbohydrate” group were smokers and were sedentary , (Stanton 2018)thus more likely to have medical issues. Smokers and obese individuals have more cancer , stroke and risk of heart disease, and could have easily died as a result of these.

When some of the participants inevitably developed heart disease, diabetes or stroke, they should have examined the diets of these people, since it should have naturally changed after such life changing events. But this did not happen!

The people who lived longer, also ate less, on account of being elderly. So this is natural, and should not automatically make them “low carb”.

The trial counted all cause mortality, which means that even the deaths that were not related to medical reasons, were included. In other words, if one participant happened to die as a result of a car accident, that was also counted as a death attributable to low carb diets!

The researchers mentioned that within the low carb group, the animal based protein consumers did worse than those who ate plant based foods. Based on this, they concluded that low carbohydrate diets will cause early mortality. Did I hear that right? It is like saying the car broke down because you put in dirty oil, therefore, we should avoid using cars. If they were trying to prove animal protein is bad for you, then it is out of the focus of this trial. Placing the blame on the low carb diet for what they think the animal protein did, is simply not right.

But more importantly, was the low carb diet, truly a low carb diet? In this study, the participants were divided into 5 groups, according to carbohydrate intake. The lowest group , supposedly the low carbohydrate group, consumed a daily total of 1558 kilocalories, out of which 37% was carbohydrates. Calculating this, would bring us a gigantic total daily carbohydrate intake of 144 grams!!! This is nowhere near low carb.

In contrast, the ketogenic dietallows 5 % or roughly 20 grams, while the Atkinsdiets allows 40 grams daily.

The authors also cautioned that low carb animal based diets, cause increased body inflammation, activation of tumor signaling, and promotion of oxidative damage. On the contrary, animal and human studies show the opposite: Animal and human studies are beginning to show that the low carb diet can improve inflammatory markers, cause less stress, and slow down cancer growth and proliferation.

Human studiesof people with pancreatic cancer and multiple other cancers show improved quality of life, exercise tolerance and symptom control. (Otto et al. 2008, Poff et al. 2015, Zahra et al. 2017, Klement 2018, Cusso et al. 2018, Allen et al. 2013, Tan-Shalaby et al. 2016)

 

Meat is understandably getting bad publicity here, but we have to remember that meat, like vitamins and minerals , can be your friend or your enemy. In excess, animal meat protein can be your enemy. To blatantly discredit animal protein and low carbohydrate diets without solid evidence, is unacceptable.

References

Allen, B. G., S. K. Bhatia, J. M. Buatti, K. E. Brandt, K. E. Lindholm, A. M. Button, L. I. Szweda, B. J. Smith, D. R. Spitz, and M. A. Fath. 2013. "Ketogenic diets enhance oxidative stress and radio-chemo-therapy responses in lung cancer xenografts."  Clin Cancer Res19 (14):3905-13. doi: 10.1158/1078-0432.CCR-12-0287.

Cusso, L., M. Musteanu, F. Mulero, M. Barbacid, and M. Desco. 2018. "Effects of a Ketogenic Diet on [(18)F]FDG-PET Imaging in a Mouse Model of Lung Cancer."  Mol Imaging Biol. doi: 10.1007/s11307-018-1233-8.

Klement, R. J. 2018. "Fasting, Fats, and Physics: Combining Ketogenic and Radiation Therapy against Cancer."  Complement Med Res25 (2):102-113. doi: 10.1159/000484045.

Natarajan, L., M. Pu, J. Fan, R. A. Levine, R. E. Patterson, C. A. Thomson, C. L. Rock, and J. P. Pierce. 2010. "Measurement error of dietary self-report in intervention trials."  Am J Epidemiol172 (7):819-27. doi: 10.1093/aje/kwq216.

Otto, C., U. Kaemmerer, B. Illert, B. Muehling, N. Pfetzer, R. Wittig, H. U. Voelker, A. Thiede, and J. F. Coy. 2008. "Growth of human gastric cancer cells in nude mice is delayed by a ketogenic diet supplemented with omega-3 fatty acids and medium-chain triglycerides."  BMC Cancer8:122. doi: 10.1186/1471-2407-8-122.

Poff, A. M., N. Ward, T. N. Seyfried, P. Arnold, and D. P. D'Agostino. 2015. "Non-Toxic Metabolic Management of Metastatic Cancer in VM Mice: Novel Combination of Ketogenic Diet, Ketone Supplementation, and Hyperbaric Oxygen Therapy."  PLoS One10 (6):e0127407. doi: 10.1371/journal.pone.0127407.

Stanton, A. A. 2018. "Dietary carbohydrate intake and mortality: reflections and reactions." Lancet Public Health3 (11):e518. doi: 10.1016/S2468-2667(18)30205-6.

Tan-Shalaby, J. L., J. Carrick, K. Edinger, D. Genovese, A. D. Liman, V. A. Passero, and R. B. Shah. 2016. "Modified Atkins diet in advanced malignancies - final results of a safety and feasibility trial within the Veterans Affairs Pittsburgh Healthcare System."  Nutr Metab (Lond)13:52. doi: 10.1186/s12986-016-0113-y.

Zahra, A., M. A. Fath, E. Opat, K. A. Mapuskar, S. K. Bhatia, D. C. Ma, S. N. Rodman, III, T. P. Snyders, C. A. Chenard, J. M. Eichenberger-Gilmore, K. L. Bodeker, L. Ahmann, B. J. Smith, S. A. Vollstedt, H. A. Brown, T. A. Hejleh, G. H. Clamon, D. J. Berg, L. I. Szweda, D. R. Spitz, J. M. Buatti, and B. G. Allen. 2017. "Consuming a Ketogenic Diet while Receiving Radiation and Chemotherapy for Locally Advanced Lung Cancer and Pancreatic Cancer: The University of Iowa Experience of Two Phase 1 Clinical Trials."  Radiat Res187 (6):743-754. doi: 10.1667/RR14668.1.

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.
More Posts