ketooncologist

What to do when you discover cancer

Wed, 11 Feb 2026 14:45:48 GMT

Your Anti Cancer Game Plan

Cancer often comes as a shock to patients. Even cancer doctors develop cancer. No one is immune. Upon finding out that you have this diagnosis, you need to first take a deep breath and make a checklist.

Make an appointment with a medical oncologist ASAP. You may have learned about your diagnosis from the surgeon who performed your biopsy, but the medical oncologist will be the center of your treatment. He or she will coordinate your care with the surgeons, the radiation oncologist, the palliative care doctors, and the pharmacist.
What is the true "histologic" diagnosis? For example, if someone tells you that you have lung cancer, it matters to the oncologist to know what TYPE of lung cancer! Try to get a hold of the "pathology report". This is a detailed summary of what the pathologist saw under the microscope. The appearance, arrangement, and staining of the tumor cells will help the pathologist narrow down the actual diagnosis.
Collect any written reports of your CT scans, MRIs, or PET scans. If you can obtain a disc or CD of the actual images, it will help your doctors make quick decisions about your care. Delays in care often happen when you seek treatment from doctors in different hospital systems, and if they don't have access to your records because you had tests done at a hospital outside their work system, then you will encounter delays.
Gather information about all your active medications, including supplements and over-the-counter medications.
Make a list of all your previous hospitalizations, major surgeries, and allergies, and gather information about your family history. Your oncologist will want those.
Keep an open mind about integrative therapies, such as acupuncture, meditation, supplements, and weight management. Oftentimes, a cancer returns quickly even after doing all the right things. Surgery, radiation, and months of chemotherapy are standard of care but are not 100% guaranteed to stop cancer. I know of no cancer that has a 100% cure rate. The underlying causes, such as a bad lifestyle, poor sleep, substance abuse, etc. might contribute to the relapse. It is not all about poor genes. Did you know that some cancers, when tested for genetic defects, show normal results?
Did you know that many cancer centers now have integrative oncology clinics? MD Anderson in Texas, Memorial Sloan Kettering in New York City, and the Integrative Oncology Clinic at the Veterans Affairs now offer both in-person and virtual consultations.
Read, read, read. But make sure the books you read on integrative cancer therapies are by reputable authors. Not all famous social media influencers are legit. It is nowadays too easy to get a few months of training, then label oneself as a "health practitioner. Look for certified. MDs, DOs, and NDs. These stand for Doctor of Medicine, Doctor of Osteopathy, and Naturopathic Doctors. Board certification is another added layer of reliability. Always discuss your findings with your medical team. We look for integrating care, not for substituting care.
Take a deep breath, then slowly let it out through your nostrils and feel the stress release with that motion. Repeat.
Cut out processed foods, obvious sugary foods, or foods with high-fructose corn syrup as an ingredient. Don't forget the foods with hidden sugars. These include rice, pasta, bread, and potatoes. Yes, even wheat bread and oats have high amounts of hidden sugars. Now is not the time to be "moderate". We are fighting the big C. Foods with artificial food colorings, such as Red and blue dyes, are easy to cut out. Read food labels. If your great-grandmother doesn't recognize that food item, you should avoid it.
Get a copy of Keto Oncology, a comprehensive guide. Or the Keto Code. I gathered information for the layperson so you can understand how cancer develops, how cancer metabolism works, and what you can do now to optimize your metabolism to complement your doctor's standard-of-care treatments.

ACID and CANCERS

Fri, 25 Apr 2025 18:49:51 GMT

Here is a common question:

Are cancers acidic?

Should we be trying to make them alkaline?

Is there any benefit to choosing foods based on their acidity or alkalinity?

ANSWER:

There is some benefit to choosing foods based on their pH or acidity/alkalinity.

Traditional Chinese medicine does this all the time.

If we go by the balance of Yin versus Yang, yes, we ideally should choose foods to have a good balance of acidic versus alkaline foods.

In traditional Chinese medicine, Yin and Yang foods are categorized based on whether they cool or warm up, the body.

A healthy body needs a good Yin-Yang balance.

Yin foods are considered alkaline foods or "cooling" foods.

Yin/alkaline/cooling foods include fruits, vegetables, tofu, avocados, nuts and lentils.

Yang/warming foods are considered "acidic" - examples include poultry, red meat and fish.

Cancers, however, are a different story. The cancers that love sugar are also endlessly converting glucose into lactic acid.

This creates an acidic zone surrounding the cancers.

The balance between Yin and Yang is extremely lopsided here.

Cancers love lactic acid. And if you feed it glucose, it will make more acid.

Lactic acid can lower the oxygen levels of cancers and promote pro-cancer signals.

Too much lactic acid can also disrupt the MMP or matrix-metalloproteinases. MMPs are enzymes that degrade the ECM extracellular matrix or cell boundaries. When the matrix around cells breaks down, cancers metastasize easily.

How can we prevent this?

Eating alkaline foods? ..... baking soda? Alkaline water?

Avoiding acidic foods? ...... avoiding citrus? what about apple cider vinegar?

TIP#1

We must first cut out the carbs.

Without cutting carbs, increasing alkaline food intake will have little impact and not much to prevent the lactic acid accumulation around tumors.

We first need to stop the source of lactic acid.

And that is the first step. - GLUCOSE

STOP the excess glucose, and there will be less lactic acid production.

Yin and Yang food choices can come later.

Read more about lactic acid...Keto Oncology Chapter 4. https://tinyurl.com/4rtuhvf9

What about IVERMECTIN?

Fri, 25 Apr 2025 16:33:44 GMT

Ivermectin is a veterinary drug that helps treat parasitic infections.

During the COVID 19 pandemic it was drug that was effective in decreasing the replication of the COVID-19 virus.

Normally, ivermectin is restricted to animal use only.

Animal use however, was quickly overtaken by human use after the pandemic, with human use now surpassing that of animals by as much as 24X!!!

Lately, several scientific papers described the anticancer effects of ivermectin on cancer cell lines in the laboratory.

Blocking of pro cancer signaling pathways , slower cell growth , and prevention of metastases are some of the described possible benefits.

Blocking of cancer stem cells, reversal of chemotherapy resistance, and blocking of proliferative cancer signals such as mTOR, AkT and MAPK, are additional observed benefits.

These studies were in the lab, in the petri dish, in animals.

But....

Human studies that prove the effectiveness of these benefits in real life cancer patients, are lacking.

What people need to understand is that the human dose can also cause toxicity!!!

Large doses especially can result in side effects such as nausea, vomiting, diarrhea, constipation and abdominal bloating.

One out of three persons were reported to have required hospitalization from ivermectin toxicity.

Others reported confusion, loss of balance , low blood pressure, blurry vision, rash, and significant seizures.

Some people ended up in the intensive care unit. Most people develop symptoms within 2 hours after a large dose, while others developed symptoms weeks later.

Why? The dose required for humans as a therapeutic or preventative medication, is still not fully understood. Interactions with existing prescription medications, may also play a role.

Above all, the use of ivermectin in cancer care is still considered experimental, and not part of the standard of care.

If you are thinking of using ivermectin as an alternative or complementary therapy, please inform your cancer treatment team, and preferably, seek medical supervision.

Have you, or a loved one, used Ivermectin at some point but were not aware of its benefits or side effects?

Exploring the Link Between Cancer and Weight Loss:

Thu, 14 Mar 2024 21:32:07 GMT

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

Mon, 04 Mar 2024 21:19:46 GMT

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

Mon, 30 Jan 2023 02:37:00 GMT

Welcome to all our new members

I would like to send a warm welcome to all our new members!

I was away overseas for the New years and welcomed 2023 abroad!

… hence for the old timers in this group, this is why you heard no peeps from me.

My family and I flew more than 13 hours to our final destination-Cairo. It wasn’t my first trip to the area, but this time it’s different. I went , hoping to explore , reconnect as well as recharge. My laptop stopped working so yes, I did unplug!

Halfway through the flight, the captain was calling for anyone with a medical background to assist with an emergency . Apparently a woman was feeling faint and appeared very pale with very low blood pressure!

As I shuffled myself to the back of the plane, I wondered how an oncologist could be of any help to someone who might be experiencing a heart attack!

Luckily my traveling partner was a cardiologist, and together we managed quite well. Her blood pressure was low . After laying her down and raising her legs above her head, she regained her facial color and her pulse got stronger. After a drink of lightly salted water, she was almost back to normal.

Minutes later, a gentleman appeared, staggering towards the back of the plane, and dropped himself to the ground. He began vomiting. Down to the floor he went. Luckily we revived him with no real issues.

What did these two individuals have in common? They were both slightly overweight, they were young, and they both appeared to be healthy!

Take away :

Life is fragile.

Youth is not a guarantee of health.

Anytime , anywhere, someone may suddenly fall ill. Health is valuable . Like money , you may think you have it but it can be gone in literally seconds. Take steps to help yourself, now, before it’s too late.

(Newcomers can jumpstart their keto journey by checking out my Facebook page, KETO for CANCER and look for the “guides” . Desktop version is best. )

Keto for Cancer Facebook page >

Getting Started On A Keto Diet

Tue, 17 May 2022 20:10:45 GMT

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

Wed, 30 Mar 2022 22:55:39 GMT

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

Fri, 25 Mar 2022 22:52:43 GMT

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

Fri, 25 Mar 2022 22:51:58 GMT

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

Fri, 25 Mar 2022 22:51:16 GMT

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

Fri, 25 Mar 2022 22:50:35 GMT

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

Fri, 25 Mar 2022 22:49:56 GMT

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.

The modified Atkins’ and ketogenic diets are not the same

Fri, 25 Mar 2022 22:49:16 GMT

In case you were wondering, is there a difference between these two diets? Yes indeed, but they are also very similar.

Both diets are predominantly comprised of fats (60-75%), and both limit carbohydrates (5%).
Proteins do not need to be restricted in the modified version, usually runs in the 30% range, and is otherwise also known as the popular Atkin's diet.
Ketogenic diets have been in use for close to a century, for treatment of seizures. It is still in use today by some neurologists, when drug therapy has failed.
Whether one is better than the other is not quite fully resolved.

Getting started on the ketogenic diet, useful tips.

Fri, 25 Mar 2022 22:48:39 GMT

Whether for purposes of weight loss or for improving one's metabolic health, the first thing one will need to know when starting either the ketogenic diet or modified ketogenic diet, is what food items are allowed. Then, identify the non-allowed food items and gather them up from your home. Decide on how long you are planning to diet and send these taboo items to a friend's home or personal storage system for safekeeping. Or better yet, donate the food items to a non-diabetic friend or relative. Out of sight, out of mind! Thinking that you will simply cut down on your carbohydrate intake is not usually a good idea. Taking half a bagel versus a whole bagel will not only push you out of ketosis immediately, it will also result in an unwanted rise in blood glucose, which inevitably will be followed by a precipitous drop. It is this sudden drop in glucose levels that will give you the unpleasant feeling of hunger. Better to avoid that bagel altogether (not even a bite) and one will maintain a steady state of low blood glucose and likely not even feel hungry. Starting meals with a full glass of water not only makes one feel fuller, it will keep one hydrated because the ketogenic diet has a diuretic effect (more restroom trips). If done properly, the lightheadedness that usually comes when one skips a meal does not occur. Instead the ketones that the body will produce during times of dieting or shorter fasting will provide energy to the brain cells in place of the absent glucose and the result is that one will probably feel fine, if not more clearheaded. Do make a shopping list and plan meals ahead of time. Identify possible emergency low carbohydrate snack items and keep them at hand (i.e. ready made tuna salad/real mayo, chicken salad, eggs, celery sticks stuffed with cream cheese, and the occasional small portions of nuts) when hunger strikes. Lastly, eat only when hungry and stop before you get full!

Beginners guide to the metabolic theory of cancer and how the Ketogenic diet can help

Fri, 25 Mar 2022 22:48:04 GMT

Sugar causes cancer? Not really. But once cancer begins, sugar does feed cancer. Glucose is a form of sugar carbohydrate. It is good for fueling your normal cells but the bad news is that your tumor cells are also benefitting from this. Cancer cells lack the internal machinery to absorb nutrition from fats and proteins therefore therefore cannot efficiently make use of them. As a result they depend almost entirely on carbohydrates and glucose in order to survive. If we feed ourselves a low carbohydrate, low glucose diet, high fat and moderate protein diet (ketogenic diet), normal cells will feed but the tumors would starve.

What are ketones? When one is fasting the body does not have enough carbohydrate or glucose therefore they need to break down fat and muscle. In the process they produce ketones and fatty acids as substitute energy. This will provide the needed energy to your brain and body during times of starvation and fasting . Cancer cells don't have the sophisticated machinery to use ketones and therefore rely mostly on glucose. When you exercise for a long time your muscles start to cramp.This is because you are producing lactic acid. In the same way, cancer cells also produce a lot of lactic acid which can cause reactive oxygen species damage to the internal parts of the cell. This damage promotes inflammation, tumor invasion and metastasis . Metastasis occurs when tumors break off and spread to other organs. A Ketogenic diet can potentially help slow down these processes.

The most popular theory of cancer is that it begins with a defect in the DNA of the cell's nucleus. The metabolic theory of cancer believes that there are also mutations (irreversible changes) in the mitochondria, otherwise known as the powerhouse of the cell. Defects in the mitochondria can lead to many diseases such as autoimmune disease, heart problems, diabetes and cancer. Chemotherapy usually targets the nuclear DNA to cause cell death but clearly with only chemotherapy we have not yet unlocked the cure. Dietary measures can help make chemotherapy work better by weakening the energy supply to cancer cells , lessen the damage from too much lactic acid production, while continuing to nourish normal cells.

I found this book very helpful for total beginners. It is not a strict ketogenic diet but a modified one. The ketogenic diet restricts protein but the Atkins diet has no limitations on protein.

Dr. Tom Seyfried’s Ancestral Health Symposium lecture (2012)

Fri, 25 Mar 2022 22:47:18 GMT

Some of you may have already watched this lecture. It is one of my favorites.

[youtube https://www.youtube.com/watch?v=sBjnWfT8HbQ?rel=0&controls=0&showinfo=0&w=560&h=315]

History of the ketogenic diet, starting from ancient times

Fri, 25 Mar 2022 22:46:40 GMT

This time of year, many of the faithful are observing a religious fast. Daunting as it may sound, there are many benefits to it that you might want to hear. Fasting and short-term starvation were in use as early as 500 B.C., as a treatment for many medical conditions.

OUR FOREFATHERS DID IT

Galen, Hippocrates and Paracelsus, the three fathers of Western Medicine, advocated fasting. So did Plato, Ghandhi, Socrates, and Buddha and Muhammad.

In rat models, intermittent fasting which means eating only every other day, increased their life span and reduced metabolic related diseases. It was only in the 1920s that Mayo clinic physicians formulated the ketogenic diet, which used a ratio of 4:1 (fats and protein:carbohydrates), to treat seizures instead of using short term starvation. It then became well known as an effective treatment for persistent seizures but lost popularity with the invention of effective new medications.

Bernarr Macfadden, (1868-1955) physical fitness guru of the 1930's also vigorously promoted fasting as a means to longevity. Here he is , standing next to Teddy Roosevelt. At one time he proposed to President Roosevelt that he create a Department of Health and appoint himself as Secretary. He predicted that he would live till 150, but only made it to age 87!

By the mid twentieth century, the diet slowly lost favor and became virtually unknown, both in the fields of cancer and neurology.

Revival of the ketogenic diet underwent a jumpstart during the 1980s when in 1984, the Charlie foundation publicized the success of the ketogenic diet on treatment of Charlie Abrahams , a young boy with epilepsy. Robert Coleman Atkins (1930-2003) popularized a modified version of this diet but added more protein into the mix.

Today, many know the ketogenic diet as a fad diet regimen of body builders and weight watchers. Momentum in cancer research is not far behind.There is probably more to this than meets the eye!

Ketogenic diet in cancer patients- safety issues

Fri, 25 Mar 2022 22:45:32 GMT

Safety is of importance, whether you are dieting for weight loss or for health reasons. The problem with diet studies is that the investigator has to rely on the patient to do most of the work. What he actually eats is a matter of trust. We hope that he/she is following the diet to a " T "but nevertheless, safety monitoring is probably a good idea.

I receive hundreds of requests asking for a copy of "the" diet, but hardly anyone asks for guidelines on safety monitoring.

Weight loss- How much weight loss is too much? Obviously, weight loss will occur within the first few days of dieting. No cause for alarm. As long as you feel great, then there is no need to panic. If you happen to be starting out with a body mass index BMI (http://www.calculator.net/bmi-calculator.html ) that is within the obese or overweight category, then you have plenty of room to spare. Normal weight individuals should proceed with caution as long as the weight remains within normal and not fall into the underweight (<18.5) BMI category.
Glucose levels- By this I mean blood glucose. Without a glucose meter, in normal individuals, the first symptoms of too low glucose levels is usually that of being lightheaded. If ketosis has already kicked in, this lightheaded feeling will not likely occur since the ketones are protecting the brain by providing the needed energy that normally is provided by glucose. If taking insulin or medications for lowering glucose, proceed only with the help of a physician. Diabetics on insulin or long acting glucose lowering drugs should proceed with caution and be closely monitored because a sudden drop in glucose levels can be expected, and with close monitoring of symptoms and blood glucose, dangerous levels of hypoglycemia (extremely low blood glucose leading to coma) can easily be avoided.
Ketones- As far as doing it "correctly", achieving ketosis within the first few days is a sign of initial success. Diabetic ketoacidosis DKA is not the same as dietary ketosis. DKA is seen in diabetics (type I or late stage type II). Medically dangerous ketoacidosis occurs when even in the presence of glucose/sugars, a diabetic's body is unable to produce insulin to convert the sugars into energy so the body senses that it is in "starvation" and begins to continuously burn fats to make ketoacids. The acid level becomes excessive and it changes the acid balance of the body into dangerous levels requiring hospitalization. Low carbohydrate dieting simply is not the same. It will also produce ketones but will produce levels far below medically unstable DKA because in the presence of insulin and available fats and protein, our bodies still has feedback control over the amount of fat breakdown and ketone production, and should not result in metabolic derangement.
Cholesterol: Will this diet give me a heart attack? We still do not know the final word on cholesterol and heart disease while on this diet. Theoretically, if done correctly, lipid profiles should improve. Current published research indicate that it is probably safe, although there also were some published cases of worsening lipid profiles during short-term dieting. As far as cardiovascular side effects, it is a good idea to have blood pressure, triglycerides and cholesterol levels monitored.
Uric acid. Uric acid levels can also rise with the use of this diet. This can lead to acute gout attacks and kidney stones. People with borderline kidney problems should avoid high protein intake. That being said, the ketogenic diet actually is NOT high in protein. Fats comprise 70-75% of the total, with 20% coming from protein and 5-10% from carbohydrates. Mouse models of diabetes and kidney failure, exposed to a ketogenic diet, actually showed a reversal in kidney damage (Poplawski et al., 2011).
Water. Hydration, hydration. Due the mild diuretic effect (increased frequency of urination), it is a good idea to check one's blood pressure and ensure adequate fluid intake. (6-8 glasses of water or equivalent daily)

Long term effects

Long term use in pediatric patients with seizures reveal some case reports of up to 12 years without ill effects. Not much data exist in terms of the ketogenic diet in cancer patients. Close medical monitoring is always a good idea.It is also wise to have an initial physical checkup by a doctor, including blood work and urinalysis to check on heart, lung , liver and kidney health, as well as screen for cholesterol problems, gout and kidney stones. Once cleared, one still needs monitoring on a regular basis, especially if going for the long-term.

Monitoring tools

Home blood monitoring is available . A quality home glucometer/ketone meter is useful to have, http://www.amazon.com/Precision-Glucose-Ketone-Monitoring-System/dp/B008UZVLM8/ref=sr_1_1_a_it?ie=UTF8&qid=1457437263&sr=8-1&keywords=precision+xtra , as are several online dietary resources.

Charting the glucose ketone index may be helpful. (GKI). More on this another topic.

Charting weight, blood pressure, diet intake, and glucose or ketone readings are good moves. It is preferable to find a doctor and a nutritionist familiar with the ketogenic diet since they know what to look for and provide ongoing guidance.

Raspberry ketones and cancer- Does it have a role in a ketogenic diet?

Fri, 25 Mar 2022 22:43:56 GMT

Do Raspberry ketones have a role in the ketogenic diet?

People frequently ask me about raspberry ketones, also known by its scientific name, p-hydroxyphenyl-2-butanone or botanical name, Rubus Idaeus , and whether this supplement can increase the effectiveness of a ketogenic diet.

Following the popular endorsement of TV physician celebrity Dr. Mehmet Oz, this supplement became widely sought after for purposes of achieving quick weight loss and was immediately barely available in drugstores.

What are ketones? Ketones are basically composed of a carbonyl group which is simply a carbon atom connected to oxygen via a double bond, which in turn is connected to two other carbon atoms, typically two methyl (CH3) groups.

Raspberry ketones are extracted from the fruit. The structure of raspberry ketones is similar to capsaicin , an ingredient found in chili peppers, which is also known to exert anti-obesity properties. Raspberry ketones per se occur naturally but are scarce and to extract this from raspberries is expensive. It is widely used as an industrial flavoring in many fruit drinks, puddings and ice cream, and the naturally occurring ketone can be synthetically mass produced in the laboratory. One technique is by growing fungal culture cells in the laboratory and using these cultures to produce enough quantities for public consumption. During food deprivation or fasting, the body goes into a slow metabolic (hypometabolism) mode. Rubus Idaeus and capsaicin can prevent this from happening. Aside from slowing down fat metabolism, they also prevent more fat cells from developing by increasing fatty acid oxidation and breakdown.

Despite this fascinating bit of news, scientific data regarding raspberry ketones' anti obesity properties were mostly obtained from studies performed in rodent models and in petri dish cultures of rat cell lines. No reliable human studies, as far as I am aware of, were previously done.

In the lab, rats were fed a high fat diet http://www.ncbi.nlm.nih.gov/pubmed/15862604 and fed different amounts of raspberry ketones. Increasing amounts led to more breakdown of fat, prevented obesity and prevented the risk of developing a fatty liver.

Scientists also grew rodent fat cells in a petri dish in a lab and added raspberry ketones to the cultures. http://www.ncbi.nlm.nih.gov/pubmed/20425690 The scientists found that this resulted in production of the hormone adiponectin which in turn increased the breakdown of fats within these cells.
As far as the ketogenic diet is concerned, the ketone from the raspberry and the ketones produced from the liver during starvation are not the same.

The red raspberry fruits (and shoots) contain Ellagic acid , an antioxidant which can decrease inflammation and protect one from developing fatty liver damage. Aside from this, data on the potential benefit of red raspberry ketones on cancer is virtually unknown.

On the other hand, beta-hydroxybutyrate BHB , the first ketone produced by the liver during fasting, provides energy to the brain and body when glucose is absent or unusable. BHB ketones can also decrease free radical damage and directly slow down tumor growth.

When following a ketogenic diet, it is not only the ketosis that we are after. We also want to decrease serum glucose. Consuming raspberry ketones alone will not affect glucose levels. By lowering glucose we expect to deliver less nutrition to the tumor. Indirectly it also shuts down tumor signaling, leading to less tumor invasion. Cancer cells also tend to be immortalized and by using a ketogenic diet we expect to maintain the programmed cell death of cancer cells.

Bottomline, if you want to use raspberry ketones as a nutritional supplement, note that the Food and Drug Administration FDA has no official backing for this, and as far as anticancer properties, I would not hold my breath. It is probably just as good as taking a supplement with antioxidant properties such as Vitamin C. To get into a therapeutic state of ketosis you still need a monitored diet that restricts glucose and carbohydrates, which subsequently leads the body to produce ketones (BHB) of its own. As far as fat cell breakdown and weight loss, indeed there is positive evidence of this in studies of animals and animal cell cultures, but this does not necessarily translate into human success. At least, not yet.

Motivation at the dinner table: Andy Griffith’s 1964 Carbohydrates and Glucose episode

Fri, 25 Mar 2022 22:41:56 GMT

It takes a lot of will power to get into the swing of this diet if you are used to having lots of carbohydrates day in and day out. Keep this video in mind the next time you are faced with that sweet piece of pie!

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Ketogenic Diet in Advanced Cancer trial, www.clinicaltrials.gov NCT01716468

Fri, 25 Mar 2022 22:41:17 GMT

Many of you have emailed me or my research coordinator, Jennifer regarding enrollment into this clinical trial.

This began in late 2012 and successfully completed in 2015. We are no longer recruiting patients.

https://clinicaltrials.gov/ct2/show/NCT01716468

4/14/16 update. ASCO accepted our abstract for publication! Will be released (abstract only) sometime in May 2106. Keep checking in for more updates.

5/18/16 Abstract was finally published and now viewable online. It was one of the accepted abstracts of the recently concluded American Society of Clinical Oncology Annual meeting.

http://abstracts.asco.org/176/AbstView_176_170081.html

8/15/2015 The full manuscript was accepted and published online by Nutrition and Metabolism as an open access article.

http://nutritionandmetabolism.biomedcentral.com/articles/10.1186/s12986-016-0113-y

Can I use sugar substitutes?-Sugar alcohols, aspartame etc.

Fri, 25 Mar 2022 22:40:33 GMT

No, no, no. Not all sugar substitutes are alike.

Table sugar is obviously out of the menu. Despite their dubious reputation these days, we do allow artificial sweeteners such as aspartame and saccharin! Stevia and sucralose (Splenda) should also be fine.

But what about the other kid on the block, sugar alcohols?

They have been in existence for awhile. Much were written about them as early as 1910 , perhaps even earlier (1). For a little bit of background, sweeteners are classified into two main types - natural or nutritive, and artificial (2).

Artificial ones lack calories and will not raise blood glucose. Sucralose (Splenda), aspartame (Equal, Nutrasweet) and saccharin (Sweet N low, Sugar twin) , Neotame, cyclamate (previously banned for possible links to bladder cancer in laboratory animals) , acesulfame-K Stevia (Enliten, Trivia, Stevia).

Natural sweeteners include sucrose (table sugar), Galactose, lactose, maltose, sucrose. fructose, levulose, invert sugar, sorbitol and all sugar alcohols.

Sugar alcohols technically are natural compounds and are a form of digestible carbohydrate. Sugar alcohols come in a variety of "ol" names- erythritol, maltitol, sorbitol, isomalt, lactitol, mannitol, xylitol. They are also present naturally in fruits , some vegetables and in mushrooms. Commonly present in food additives to give sweetness, they don't bring up blood glucose as much and don't stimulate the secretion of insulin.

Generally regarded as safe to consume, why then, are they discouraged in a ketogenic diet?

Table sugar obviously is anti-ketogenic. Fructose, is also antiketogenic. Aside from the obvious side effects, diarrhea and bloating, sugar alcohols are apparently also "anti-ketogenic". They are also considered carbohydrates though to a lesser degree than common table sugar.

Woodyatt in 1910 suggested that when ketoacids are mixed with alcohol, they undergo combustion in the presence of light. Reactions ensue where alcohols, glycerin or sugars become oxidized and ketones are reduced . When starvation occurs, carbohydrates are absent and fats turn into butyric acid which in turn become acetoacetate , acetone and beta-oxybutyric acid . Sugar oxidation/sugar combustion then decreases and acidosis develops. When fed sugar alcohols, laboratory induced diabetic rats not given sugar alcohols were found to have 52% less fatty acid oxidation. The proposed explanation for this is that it prevents fatty acid oxidation and therefore decreases ketone production (3,4,5,6).

Although artificial sweeteners are allowed, the downside is that when consumed, the body senses that they are sweet and they still have the effect of increasing hunger, and worsening sugar cravings. This is what they call the neuronal response to artificial sweeteners (7). Paradoxically, the use of artificial sweeteners will actually result in more weight gain. Better to avoid all if possible, but in the end, for purposes of achieving ketosis in the short-term , it is still the allowed choice of two evils. For my patients who are confused about which sweetened drink to buy, I always tell them , "what's wrong with water ?"

References:

1.Woodyatt RT. The action of glycol aldehyd and glycerin aldehyd in diabetes mellitus and the nature of antiketogenesis. JAMA December 17, 1910 Volume LV , No 25 2112-2119

2. Małgorzata Grembecka;Review Paper-Sugar alcohols-their role in the modern world of sweeteners:a review;Eur Food Res Technol (2015) 241:1–14 DOI 10.1007/s00217-015-24377

3. BASSLER, K. H.; DREISS, G.; (Antiketogenic effect of xylitol in alloxan diabetic rats.) Antiketogene Wirkung von Xylit bei alloxandiabetischen Ratten.Klinische Wochenschrift 1963 Vol. 41 pp. 593-595

4.M. Hamaleinen, K. Making; Metabolism of Glucose, Fructose and Xylitol in Normal and Streptozotocin-Diabetic RatsJ. Nutr. July 1, 1982 vol. 112 no. 7 1369-1378

5.BASSLER, K. H.; FINGERHUT, M.; CZOK, G.(Inhibition of fatty acid oxidation as a factor in the antiketogenic activity of sugars and polyalcohols) Hemmung der Fettsaureoxydation als ein Faktor bei der antiketogenen Wirkung von Zuckern und Polyalkoholen.
Klinische Wochenschrift 1966 Vol. 44 pp. 899-900

6.Norimasa Hosoya, Tadahiko Machiya, Comment Xylitol Effect on Ketogenesis in Alloxan Diabetic Rat Liver SliceInternational Symposium on Metabolism, Physiology, and Clinical Use of Pentoses and Pentitols 1969; pp 248-249

7.Yang Q. Gain weight by “going diet?” Artificial sweeteners and the neurobiology of sugar cravings: Neuroscience 2010. The Yale Journal of Biology and Medicine. 2010;83(2):101-108.

Weight loss in cancer patients while on the Ketogenic diet-when to worry?

Fri, 25 Mar 2022 22:39:15 GMT

One of the top questions of concern when contemplating a ketogenic diet for cancer is the inevitable weight loss. "Isn't weight loss bad for cancer patients?"

The first instinct regarding nutrition of cancer patients is to encourage high calorie intake and promote weight gain. Evidence is showing that this might not always be a good idea.

When we talk about cancer and weight loss, the first thing that comes to mind is that of a malnourished, skin and bones appearance, human being near death. These terminal patients are rapidly losing weight and have no appetite or strength.

The reality is, it does not matter if one has a poor appetite or a good one. Advanced cancer patients can rapidly lose weight despite a voracious appetite and when it is too late, we see a futile attempt to gain weight despite increasing the calories. In this scenario, the tumors produce increased levels of pro-inflammatory proteins called cytokines. Back in the mid 1950's another peptide (small protein) called " toxohormone " was studied extensively and they found that mice injected with tumors happened to contain higher tissue and fluid levels of these cytokines and toxohormones whereas normal, non tumor bearing mice had none of these levels (1).

By the 1990's toxohormones fell out of popularity in the medical literature and gave way to a new class of pro-inflammatory substances called cytokines . The body begins wasting away and this is caused by unlimited and relentless muscle and fat breakdown. There is an absence of a feedback mechanism to stop the production of these inflammatory cytokines and hormones.

You have seen it before, a cancer patient with a great appetite but no matter how much he eats, and the weight continues to drop. Not only weight loss and muscle /fat breakdown is involved. There is also anemia (low red blood cells) and depressed immunity. This syndrome seeing late stage cancer patients is called the " cancer cachexia syndrome ". Very little can be done about this at this time. The best way to effectively treat this is to get rid of the underlying cancer. We do have medications that help slow the process, but inevitably this cancer syndrome, which involves rapid weight loss, low immunity and dropping blood levels will finally take its victim if the cancer itself is still active.

Weight loss in cancer is very difficult to treat once it begins.

However, it is NOT the same as the weight loss that you see when you fast , starve or go on a ketogenic diet. During fasting the body senses the absence of glucose and carbohydrates and compensates for this loss of energy source by breaking down fats and protein with increased ketones to provide needed energy. Pro-inflammatory processes are diminished instead of being increased. Weight loss at some point is expected to plateau and does not result in decreased energy, rather the opposite is seen. Studies in rodents suggest that a Ketogenic diet can actually INCREASE weight in cancer patients (2).

Cancer cachexia is unhealthy weight loss while that from fasting or the ketogenic diet is healthy weight loss. As Dr. Tom Seyfried once said, this point cannot be overemphasized.

Best indicator of whether the ketogenic diet is a good fit in cancer patients is not the amount of weight loss but rather the degree of well being. If it makes you feel great and energetic then you are probably on the right track.

References

Kajimura N1, Iseki H, Tanaka R etal. Toxohormones responsible for cancer cachexia syndrome in nude mice bearing human cancer cell lines. Cancer Chemother Pharmacol. 1996;38 Suppl:S48-52.
Tisdale, M. J., Brennan, R. A., & Fearon, K. C. (1987). Reduction of weight loss and tumour size in a cachexia model by a high fat diet. Br J Cancer, 56(1), 39–43.

Using FATS to fight cancer

Fri, 25 Mar 2022 22:38:26 GMT

Using FATS to fight cancer…

Hmmm, let me get this straight… you are telling ME to eat MORE fat in order to fight cancer???

The ketogenic diet is made up most mostly of fat, in fact, 70-75% of the daily allowance. Only 5-10 % is from carbohydrates and the rest is from protein. So isn’t there a danger in taking in too much fat? How about heart disease?!?!?

It may surprise you to know that a low carbohydrate, high fat diet if done properly, does not increase the risk of heart disease.

On the contrary, eating a high fat diet might actually decrease your risk of coronary artery disease. 1,2

Not all fats are alike. There are good fats and bad. When we check our yearly fat (lipid) profile at the doctor’s office, we will see a breakdown of the numbers. The total cholesterol or TC. Then there is HDL or high density lipoproteins which are known as the good fat. LDL or low density lipoproteins are the bad fats, and the VLDL or very low density lipoproteins are the very, very bad fats. Triglycerides TG are another type of fat, which go up when we take in carbohydrates. Our doctor will tell us that we need more of the good fats (also known as HDL), and less of the bad fats LDL, VLDL and triglycerides.

For years, society has blamed cholesterol and saturated fats as the cause for heart disease and atherosclerosis. Saturated fats tend to be solid at room temperature, due to their chemical structure which has carbon atoms all strung together and attached to hydrogen atoms or other atoms without using any double bonds. As a result they are structurally very stable and are solid at ordinary room temperature.

For many years it was assumed that because this type of fat solidified quickly, it was natural to assume that saturated fats will just as quickly solidify within the body and clog our arteries.

The other incorrect assumption is that if you take in too much fat, you will naturally become fat!

Therefore it came to be that the popular health advice in the 1970s and 1980s consisted of promoting a high carbohydrate, low fat food as a “heart healthy” diet. Grocery shelves complied by increasing their stocks of low fat food items. People shunned whole milk and started buying skim or low fat milk products. Diets low in fat and heavy in carbohydrates and grains became popular and were felt to be the correct path to becoming healthy. Recently, it now is becoming clear that this was not the correct solution after all. Over the past half century many people lost weight, only to quickly regain it plus more. Ironically, we actually saw a RISE in heart disease, diabetes and cancer.

Why is the reason for this? These "heart healthy" low fat alternatives have fat removed and it their place manufacturers add fillers, usually in the form of starch and add loads of sugar to make up for the loss of palatability which is a consequence of the removal of the tasty fats. When one consumes ltoo much carbohydrate we easily gain weight, and also increase our levels of harmful CYTOKINES. Three of the most common cytokines are leptin, adiponectin (adipo means "fat") , and tumor necrosis factor-alpha (TNF-alpha). These proteins called CYTOKINES are found within and secreted by our white blood cells and also are found within the lining of blood vessels.

When excessive cytokines are released, inflammation rises. Inflammation is increasingly being linked to heart disease, diabetes, autoimmune disease and cancer.

How do atherosclerosis or blocked arteries develop? It Heart disease and blocked arteries first need inflammation to trigger damage to the blood vessel walls.

A good rule of thumb would be “ BREAD AND BUTTER SHOULD NOT MIX”. In other words, if you like to eat butter, better shy away from bread.

When you consume carbohydrates (starches, bread), they turn into glucose. When glucose levels become high, the inflammation in blood vessel walls increases. High blood glucose and carbohydrates also stimulate the liver to increase the production of certain fats called triglycerides and also to produce high levels of the bad fats. Bad fats (called LDL and VLDL) levels increase, and bring a rise in fatty acid production.

These bad fats VLDL (very low density lipoproteins) and LDL (low density lipoproteins) also contain cholesterol. When the blood vessel wall is attacked by high glucose and inflammation, the VLDL and LDL easily deposit their cholesterol into the wall of the blood vessels. Arteries become clogged and heart disease develops.

Emerging evidence now show that a low carbohydrate, high fat diet did better than a low fat, high carbohydrate diet in terms of improving cholesterol levels, and achieving overall weight loss. 3,4,5,6,7,8 Low-carbohydrate, high fat diets also were more effective in lowering inflammation. 7,8

Inflammation is blamed for the growing list of chronic medical diseases such as diabetes, arthritis and neurodegenerative diseases, and cancer.

Thanks to modern medicine, we can now measure inflammation in the blood. A blood test called CRP or C-reactive protein, we see levels increase when there is inflammation. Studies show that low carbohydrate diets decreased the concentration of C-reactive protein better than a conventional diet. Other markers of inflammation (leptin, adiponectin and tumor necrosis factor alpha) also decreased with a low carbohydrate diet. 9–11

I am not advocating that you can eat all the fat that you can. But do keep an eye out on the percentage of fat consumed, and choose fats wisely. The inuit Eskimos survive on a diet high in fat and barely have any cancer. Their fat is mostly of the omega-3 type, the kind which elevates your good HDL cholesterol and lowers your triglycerides. The younger Eskimos who live closer to town, eating the modern diet that we now are used to, are slowly acquiring the diseases of modern man. http://discovermagazine.com/2004/oct/inuit-paradox.

When fat is consumed in the absence of carbohydrates, the body naturally has to use the existing fat and protein for energy and as a result, there is weight loss. Unlike the spiraling weight loss that is seen in very advanced cancer, this type of weight loss is controlled.

Which fat is better? Not all fats are alike.

Omega-6 versus Omega -3

Oils with high omega 6 fatty acids like safflower and corn oil can increase inflammation, and along with it, higher risks of heart disease and cancer.

Oils high in omega -3 fatty acids such as fish oil, can protect against these diseases. 12–14

A study of human evolution reveals that humans began with a diet consisting of a ratio of omega-6 to omega-3 essential fatty acids of approximately 1:1. The Western diet now has a disproportionately abnormal ratio of 17:1.

Fast food and highly processed foods are the usual suspects. (Say goodbye to processed cupcakes!) This high omega-6/omega-3 ratio makes one more prone to developing the diseases of modern mankind, such as heart disease, autoimmune disorders, diabetes, and cancer.

Unsaturated versus saturated?

Saturated fats are made of chains of carbon atoms tied together by single bonds. Unsaturated fats have a chemical structure that consists of chains of carbon atoms © and some of these atoms are tied together by one or more double bonds. They may have less hydrogen atoms per carbon atom and as a result they have to use double bonds to keep their structure intact and are less stable than saturated fats. These areas where the carbon atom is replaced by a double bond are more prone to attack by free radical damage. When heat or radiation strikes, these become places where damage is inevitable. Examples of these vulnerable fats /oils are those that come from grains (corn oil, peanut oil, sunflower seed oil, and vegetable oil, etc.). I prefer to use saturated fats like coconut oil or good old butter. Olive oil has one double bond, so it too is prone to oxidative damage, but to a lesser degree than other unsaturated oils. I therefore prefer olive oils to vegetable oils such as corn, sunflower or peanut. If using olive oil, it is better to just drizzle it on salads, and if you have to cook with it, better to use only for light frying or baking, but avoid grilling or deep frying with it.

Do you prefer it steamed, boiled , grilled or fried?

The way we cook can also affect the damage to these oils and make them more pro-inflammatory. Cooking in high heat (deep frying or grilling and broiling) or cooking with acid can increase oxidation of unsaturated fats. Microwaving food can also cause oxidative damage to these fats. Better to cook using baking or steaming methods where the heat is not as sudden or high.

Why isn't the diet working?

Sometimes we find that a ketogenic diet is not always effective in cancer patients. This may be true, especially if one does not lose weight. Despite the lack of available sugar, persistent inflammation from other hidden sources may be still present. Patients with high amounts of body fat often have high amounts of leptin. Leptin was discovered in 1994. It is a hormone naturally found within fat tissue and plays an important role in appetite regulation and weight control. Leptin by itself is pro-inflammatory. High leptin levels are linked to increased breast cancer risk. 15,16

A commercially available leptin inhibitor is not yet in sight. However, decreasing the amount of body fat by way of low carb dieting is obviously one way to decrease leptin levels. Vitamin D , which brings down inflammation, is another way to decrease leptin levels. 15 What other food have anti-inflammatory and anti-oxidant effects? Another topic for another day.

It all ties together, glucose--->fat--->inflammation. To be more effective in the fight against cancer, one must bring all three down.

Seshadri P, Samaha FF, Stern L, et al. Adipocytokine changes caused by low-carbohydrate compared to conventional diets in obesity. Metab Syndr Relat Disord. 2005;3(1):66-74. doi:10.1089/met.2005.3.66.
Rothstein WG. Dietary fat, coronary heart disease, and cancer: A historical review. Prev Med (Baltim). 2006;43(5):356-360. doi:10.1016/j.ypmed.2006.07.013.
Vidali S, Aminzadeh S, Lambert B, et al. Mitochondria: The ketogenic diet - A metabolism-based therapy. Int J Biochem Cell Biol. 2015;63:55-59. doi:10.1016/j.biocel.2015.01.022.
Garg a, Grundy SM, Unger RH. Comparison of effects of high and low carbohydrate diets on plasma lipoproteins and insulin sensitivity in patients with mild NIDDM. Diabetes. 1992;41(10):1278-1285. doi:10.2337/diabetes.41.10.1278.
Hudgins LC. Effect of high-carbohydrate feeding on triglyceride and saturated fatty acid synthesis. In: Proceedings of the Society for Experimental Biology and Medicine. Vol 225. ; 2000:178-183. doi:10.1046/j.1525-1373.2000.22521.x.
Halton TL, Willett WC, Liu S, et al. Low-carbohydrate-diet score and the risk of coronary heart disease in women. N Engl J Med. 2006;355(19):1991-2002. doi:10.1056/NEJMoa055317.
Foster GD, Wyatt HR, Hill JO, et al. Weight and metabolic outcomes after 2 years on a low-carbohydrate versus low-fat diet: A randomized trial. Ann Intern Med. 2010;153(3):147-157. doi:10.7326/0003-4819-153-3-201008030-00005.
Yancy WS, Olsen MK, Guyton JR, Bakst RP, Westman EC. A Low-Carbohydrate, Ketogenic Diet versus a Low-Fat Diet to Treat Obesity and Hyperlipidemia: A Randomized, Controlled Trial. Ann Intern Med. 2004;140(10):769-777+I. doi:10.1038/nm0603-677.
Randomized a, Trial C. Annals of Internal Medicine Article A Low-Carbohydrate , Ketogenic Diet versus a Low-Fat Diet To Treat Obesity and Hyperlipidemia. Ann Intern Med. 2004;140:769-779. doi:10.1038/nm0603-677.
Dupuis N, Curatolo N, Benoist JF, Auvin S. Ketogenic diet exhibits anti-inflammatory properties. Epilepsia. 2015;56(7):e95-e98. doi:10.1111/epi.13038.
Ruskin DN, Kawamura M, Masino SA. Reduced pain and inflammation in juvenile and adult rats fed a ketogenic diet. PLoS One. 2009;4(12). doi:10.1371/journal.pone.0008349.
Wall R, Ross RP, Fitzgerald GF, Stanton C. Fatty acids from fish: The anti-inflammatory potential of long-chain omega-3 fatty acids. Nutr Rev. 2010;68(5):280-289. doi:10.1111/j.1753-4887.2010.00287.x.
Simopoulos AP. The importance of the omega-6/omega-3 fatty acid ratio in cardiovascular disease and other chronic diseases. Exp Biol Med (Maywood). 2008;233(6):674-688. doi:10.3181/0711-MR-311.
Bagga D, Capone S, Wang HJ, et al. Dietary modulation of omega-3/omega-6 polyunsaturated fatty acid ratios in patients with breast cancer. J Natl Cancer Inst. 1997;89(15):1123-1131. doi:10.1093/jnci/89.15.1123.
Menendez C, Lage M, Peino R, et al. Retinoic acid and vitamin D(3) powerfully inhibit in vitro leptin secretion by human adipose tissue. J Endocrinol. 2001;170(2):425-431.
Gonzalez-Perez RR, Xu Y, Guo S, Watters A, Zhou W, Leibovich SJ. Leptin upregulates VEGF in breast cancer via canonic and non-canonical signalling pathways and NF??B/HIF-1?? activation. Cell Signal. 2010;22(9):1350-1362. doi:10.1016/j.cellsig.2010.05.003.

Confused about how much protein? Will protein increase my risk of colon cancer?

Fri, 25 Mar 2022 22:37:10 GMT

Dear Dr. Jocy,

I’m glad for your accomplishment! I want to ask you about how much protein intake is appropriate, 10-20% for example? And what do you think about a high protein diet predisposing to colon cancer?

~Facebook follower

Dear Facebook follower:

While cooking tonight's dinner of ground beef and yellow zucchini I decided to share your protein related question on my blog!

1. How much protein do we need? Are there different types of low carb diets?

It depends on what type of diet you want to follow and what your goals are. Are you thinking of the ketogenic diet, the modified ketogenic diet, the Atkin’s diet, or simply a low carbohydrate, non-ketogenic diet? It also matters whether you are looking for a goal of weight loss only, or is it towards a goal of preventing or helping improve cancer treatment?

The ketogenic diet is used commonly for seizure control, and now is gaining popularity in cancer patients. It is quite strict, and involves measuring and weighing exact amounts of your food portions. In general, the proportion of fats in calories should be about 70-75% in the KD, 5% carbs and the rest is protein. In the modified diet, fats are around 60-65%, carbs 5-10% and the rest is protein, which is about 20-30%. In cancer patients, there is a mathematical formula which calculates for the GKI or glucose ketone index. This gives you an idea of the proportion of glucose blood levels in relation to blood ketones. Theoretically a certain ratio or number needs to be reached in order to enter the zone of tumor control. Most studies were in animals, and human studies have yet to gain momentum. 1

Atkins and Ketogenic Diet are not equal

For the other diets, weighing and measuring becomes less of an issue since the protein proportion is unlimited, unlike in the ketogenic diet KD. The Atkin’s diet for example, instead of proportion, the focus is on calculating the total number of NET carbohydrates taken in a day. Percentage of calories or of fats and proteins are not strictly measured. When net carbs is being considered, the Atkins diet allows you to subtract the amount of fiber from the total carbs in order to get the net carbs. As long as the daily total is within your set limit, you are good. 20-40 grams carbs a day. As far as weight loss is the main goal, the Atkin’s diet should be easier to follow.

2. Red meat can't take all the blame for cancer

Red meat has been blamed for raising the risk of colon cancer. But is it really just the red meat alone?

Studies by public health experts show that in the western world, colon cancer risk is very high. People who live in areas of low colon cancer develop higher rates of colon cancer simply by moving to the western part of the world. In the west where cancer cases are high, we see that a sedentary lifestyle, high intake of carbohydrates and sugar, low fruit and vegetable intake and high red meat intake are part of a common way of life. 2

The blaming of red meat alone as a source of cancer fails to recognize that most red meat eaters also happen to be high consumers of carbohydrates. When we constantly take in starch or sugar, these high levels of carbohydrates increase insulin secretion. Insulin is a growth factor that in high levels encourages growth of the lining cells of the colon and also promotes growth of colon cancer cells in the laboratory. 2 Insulin levels when high (we see this in people with diabetes and non diabetics who consume high amounts of starch and sugar leading to high insulin levels) in turn increases colon cancer risk. Inflammation increases and this promotes colon cancer cell growth. 3

Now that I have taken some of the blame off the meat, what kind of meat should we buy?

3. Not all meats are equal

When it comes to cancer risk, not all red meat is the same. There are fresh meats, canned and processed meat, as well as dried, cured and preserved meats, organic, regular, fresh, grain fed and grass fed. Grocery shopping is getting confusing, and you are not alone!

Those from the deli laced with preservatives such as sodium nitrites and coloring should be avoided. Do read the labels! Sodium nitrite, one of the common N-nitroso amines found in processed meats can increase the risk for colon cancer. 4 , 5

Buy fresh unprocessed meat if possible. Fresh meats are either grown from farms or from factory bred cattle. Factory bred cattle usually are fed grains instead of being allowed to forage in the fields to eat grass. Organic cows are fed organic meals, and that could be grain or grass.

So why should you pay more for grass fed meat? Grass fed meat tends to have higher levels of antioxidants compared to grain fed. The type of fatty acids in grass fed meat have more of the cholesterol neutral fatty acids and less of the cholesterol raising fatty acids. Grass fed cow meat also has more of the good omega-3 fatty acids, and higher body levels of cancer fighting antioxidants like glutathione and superoxide dismutase, Vitamin D and E as compared to grain fed. 6 The overall fat content of grass fed meat is also much lower than the grain fed ones.

When you do bring home the meat, be it beef, mutton or pork; keep in mind that the cooking process is also important. Cooking food at very high temperatures can cause formation of heterocyclic amines and aromatic hydrocarbons which are cancer causing. 5 Avoid grilling or broiling and instead try to learn new techniques of steaming, baking or light sautéing. You can overcome the blandness of steamed foods by adding spices and making use of lemon sprigs or readily available herbs.

Collect the recipes that appeal to you and your family and keep them handy for future reference. You do not need a lot of recipes! Most people find out that they cook the same old recipe over and over again. Keep it simple and healthy cooking will become second nature.

Acknowledgement: Thanks to Krystal Edinger RD, our nutritionist for her added advice regarding the dietary issues!

References:

Meidenbauer JJ, Mukherjee P, Seyfried TN. The glucose ketone index calculator: a simple tool to monitor therapeutic efficacy for metabolic management of brain cancer. Nutr Metab (Lond). 2015;12(1):12. doi:10.1186/s12986-015-0009-2.
Giovannucci E. Insulin and colon cancer. Cancer Causes Control. 1995;6(6):164-179. doi:10.1007/BF00052777.
Terzić J, Grivennikov S, Karin E, Karin M. Inflammation and Colon Cancer. Gastroenterology. 2010;138(6). doi:10.1053/j.gastro.2010.01.058.
Knekt P, Järvinen R, Dich J, Hakulinen T. Risk of colorectal and other gastro-intestinal cancers after exposure to nitrate, nitrite and N-nitroso compounds: a follow-up study. Int J Cancer. 1999;80(September 1998):852-856.
Santarelli RL, Pierre F, Corpet DE. Processed meat and colorectal cancer : a review of epidemiologic and experimental evidence. Nutr Cancer. 2008;60(2):131-144. doi:10.1080/01635580701684872.Processed.
Daley C a, Abbott A, Doyle PS, Nader G a, Larson S. A review of fatty acid profiles and antioxidant content in grass-fed and grain-fed beef. Nutr J. 2010;9:10. doi:10.1186/1475-2891-9-10.

Isn’t ketosis dangerous? A layman’s guide to ketones and ketosis.

Fri, 25 Mar 2022 22:36:27 GMT

What is a ketone?

Ketone, also pronounced "key-tone" is that chemical substance which causes that fruity breath odor in people when ketone levels rise in our blood.

Ketones are natural substances found within living organisms. They can be recognized by their carbonyl groups. Carbonyl groups have a chemical structure containing a carbon (C) atom attached to an oxygen (0) atom by two arms called "bonds" and it appears like this C=0.

There is more than one type of ketone

Beyond the chemical jargon, suffice it to know that there are more than one type of ketone body. In humans, the three common ones are called Acetone, Acetoacetic acid, and Beta-hydroxybutyrate, which are all produced in the liver.

Food is not just food, and it isn't always "harmless", The Big 3

Food is made up of three main nutrients- carbohydrates, protein and fats. Carbohydrates are found in plants, dairy and even in meat!

Starch, pasta, sugary food have high levels of carbohydrates. Vegetables are also carbohydrate sources, as are meat and dairy products.

Protein can be found in many animal sources- meats, dairy, eggs, cheeses, and also in vegetables

A few examples of fats are butter, oils and ghee.

When too much ketones bring on "Ketoacidosis", a medical emergency ...

Carbohydrates are digested by the body and before it can be used, it is broken down further into glucose or sugar. After that, the pancreas produces insulin and this insulin prepares the "insulin receptors" that are found within the body cells to prepare it to accept glucose and use it for energy. Type 2 diabetics however, have pancreas that do not work very well.

After years of taking in carbohydrates and glucose, a prediabetic's constantly high blood glucose levels make the pancreas decide that enough is enough and they quit . Now, even in the presence of glucose, the insulin receptors no longer function well and as a result excess glucose remains in the blood. This is what we call "insulin resistance".

Even with the very high levels of glucose around it, the body cannot use it and it begins to starve for lack of energy. It is like being a refugee on a raft in an ocean and yet you can't have a drop to drink because the water is too salty! As a defense mechanism the body finds a way to get energy from fats. It does this by breaking down fats into ketones. In a diabetic, this becomes a dangerous state because the fat breakdown is so rapid, resulting in dangerously high levels of ketones which can lead to a critical medical emergency known as ketoacidosis.

Nutritional ketosis , not a dangerous state?

Normally, when glucose levels are low, the body survives by breaking down fat and muscle cells to make more glucose. We take substances from the broken down fat and muscle cells and transport it to the liver where new glucose is produced. Fasting, short term starvation or limiting our calories makes our bodies break down fats in order to produce ketones for additional energy. However because there is little or no glucose in the blood, the ketones produced do NOT result in the dangerously high levels seen in diabetic ketoacidosis. Ketosis can in fact be a healthy thing.

Why ketones are good for you and not good for cancer?

Cells produce the bulk of their energy within the mitochondria. This is an oval shaped "battery pack" that lies within every cell of the body. In it lies the factory that produces adenosine triphosphate, or ATP. Cancer cells have defective battery packs (mitochondria) and as a result they have to rely on other existing but more primitive energy sources which happen to be heavily dependent on glucose as fuel. When glucose is scarce, normal cells can adapt by surviving on ketones which come from fat. Cancers cells cannot use these ketones therefore they die easily due to the lack of a backup energy plan. And there you have it, ketosis in a nutshell! Feel free to drop me a line if you have any questions.

Glucose causing cancer – the inside story

Fri, 25 Mar 2022 22:35:28 GMT

In our normal diet, you would be surprised to know that almost everything we eat contains some form of carbohydrate. Most of our carbohydrates are found in plants or vegetables in the form of starch.

Ordinary table sugar contains sucrose and milk contains a lactose. Both sucrose and lactose are carbohydrates.

Glucose is a chemically smaller molecule than sucrose or lactose and in fact when you break down either sucrose or lactose, you will find glucose inside. But wait, did you know that meat contains glycogen, also another form of carbohydrate?

Which carbohydrate is better?

We want to avoid carbohydrates but we obviously cannot stop eating. We can however choose our diet wisely by focusing on avoiding the carbs that cause blood sugar to rise rapidly, (white bread, starchy vegetables, obvious sugary food, refined sweets) and by limiting our intake of calories or by not overeating.

When Less is More

Simply cutting back on carbs might worsen the feeling of hunger. That is because the carbs that you do eat (especially the highly refined ones) will quickly bring up your glucose levels and on its way down, the hunger sensation is triggered. The taller the spike, the faster and steeper the fall and it is this sudden drop in glucose levels that triggers the uncomfortable feeling of hunger. It might be better to avoid it all together, and not get the sugar spike.

Why do cancer cells attract glucose?

Cancer patients have high levels of glucose within the tumor cells. One of the reasons behind this is in a faulty glucose transportation system.

You can begin to understand this by first learning about how glucose normally gets absorbed by the body.

What happens to food after it enters your mouth?

The normal process of digestion

When food enters through your mouth, it is digested by the enzymes in your saliva, and broken down by the grinding action of your teeth, tongue and cheeks. Carbohydrates break down into glucose, get absorbed into the gut, and finally are pushed into the bloodstream. Once it gets close to the cell, there is a wall called the plasma or cell membrane. In order to gain entry into the cell , the glucose must enter through a protein gate called GLUT or glucose transmembrane transport protein.

The sugar gates are wide open!!!

Scientists have identified that cancer cells possess defective or overactive GLUT proteins, resulting in easy access of glucose into the cancer cell. 1,2

This overactive glucose transportation system provides easy nutrition to cancer cells.

"Loss of ability to die"

Overactive glucose transporters can also do harm by a different mechanism, which keeps cancer cells immortal. Cancer cells somehow have difficulty dying. They call this phenomena a loss of “apoptosis”.

What is APOPTOSIS? What does it have to do with cancer?

Apoptosis comes from the Ancient Greek word ἀπόπτωσις which means "falling off”.3

Like autumn leaves, normal cells eventually age and are programmed to die at a certain stage of life. This is what we call normal apoptosis.

In normal cells, as they age, pro-death proteins begin to punch holes into the mitochondria, also known as the powerhouse of the cell. When these holes (doctors like to call them pores) occur, the mitochondria switches on the self destruct switches or in fancy medical terms what we call the "apoptotic cascade" and cells start to die. This gives room for younger , healthier cells.

Within cancer cells, the apoptosis or normal death process is messed up. In cancer cells , when there is too much glucose metabolism going on, the pro-death proteins start malfunctioning. Similar to the metro rail, the faulty GLUT transportation system indirectly affects the pro-cell death proteins and makes them malfunction. The cells` then become immortal and don't die. It is like a subway system without a ticketing process. Everyone gets to ride, and the subway system gets overloaded with people. The brakes fail and the subway keeps going around in circles, never stopping or running out of gas!

Oncologists can give chemotherapy, hoping that it can kill tumor cells. But in order to win the battle, the chemo must kill all the tumor cells or it will certainly grow back. By watching what we eat, we may be able to keep the normal cells healthy and prevent them from turning into cancer cells in the first place.

Tian M, Zhang H, Nakasone Y, Mogi K, Endo K. Expression of Glut-1 and Glut-3 in untreated oral squamous cell carcinoma compared with FDG accumulation in a PET study. Eur J Nucl Med Mol Imaging. 2004;31(1):5-12. doi:10.1007/s00259-003-1316-9.

Brown RS, Wahl RL. Overexpression of Glut-1 glucose transporter in human breast cancer: An immunohistochemical study. Cancer. 1993;72(10):2979-2985. doi:10.1002/1097-0142(19931115)72:10<2979::AID-CNCR2820721020>3.0.CO;2-X.

Macheda ML, Rogers S, Best JD. Molecular and cellular regulation of glucose transporter (GLUT) proteins in cancer. J Cell Physiol. 2005;202(3):654-662. doi:10.1002/jcp.20166.

Wikipedia; https://www.google.com/search?client=safari&rls=en&q=apoptosis&ie=UTF-8&oe=UTF-8

What is the cause of Cancer?

Fri, 25 Mar 2022 22:34:27 GMT

WHAT CAUSES CANCER ?

Despite the obvious lack of a single answer, this is a very commonly asked question. I will barely scratch the surface here.

When we think of cancer, we think of tissue cells that suddenly become overactive. The cells now endlessly divide, grow, and even move out of their home organs in order to invade other organs. Like unwanted guests, they burrow into other organs, claim illegal space and take over the function of other organs, eventually killing them.

Something must have gone wrong within the inside of a cell, causing it to actively make more of itself. Something must have gone wrong within the inside of a cell, causing it to actively make more of itself. Normal cells stop multiplying when the space becomes too crowded. Cancer cells don’t stop. This is what we call “loss of contact inhibition.”

There is also a phenomenon unique to cancers, and that is the loss of their ability to die! Or failure of “apoptosis. “ (Greek word meaning to fall off).

BASIC CELL MACHINERY-

"PARTS OF THE CELL"

The cell also has two main parts, the nucleus and the mitochondria , plus many other organelles.

Like a computer, all cells have a hard drive serving as the brain (this is the nucleus ) and a main energy source or battery pack (the mitochondria ).

Add to this we have other peripherals ( Golgi bodies, ribosome, lysosomes ) like a mouse, camera, microphone and a keyboard, all important but which are not central players.

Dateline 2016:

It is clear that even with the latest ground breaking discoveries in immunology and targeted cancer therapies, in the majority of cancer cases, we still have not nailed down the cure.

We can treat, extend life, and in early stages of cancer, might even be able to cure. But in most cases of advanced stage cancers, the aim of surgery, chemotherapy or radiation is sadly only to prolong the inevitable.

One main cause of cancer is having TOO MANY BIRTHDAYS.

But what happens after you blow out your Nth candle?

Just like a political election process, there is a leading candidate and an underdog. The forerunner in this case is a supporter of the more popular GENETIC BASIS OF CANCER theory. This theory proposes that something has gone wrong within the “genes”. The current underdog is the METABOLIC THEORY candidate.

THE GENETIC THEORY

A good analogy would be to think that each cell is like a car, each with its own chauffeur (in this case the chauffeur contains the nuclear DNA, which is a ladder shaped coiled structure and is an important part of our chromosomes, much like the hard drive is in control of a computer).

This NUCLEUS located in the center of a cell is the mastermind controlling the many essential cellular processes needed to survive and grow.

When we age, like a car, things start breaking down within the hard drive or nucleus.

The proposed target is the nuclear DNA, (Recall that this is that helical ladder like structure that rests within the nucleus). Nicks or cracks begin to develop in the rungs of this DNA ladder, or parts of the nucleic acid rungs get damaged or start falling off .

The genetic theory blames this “mutation” or “defect” for the loss of the cell’s ability to contain itself. It now rapidly multiplies without concern for the limited space, and in addition, they also lose the ability to die.

It follows that if we identify the defect, then we can fix it and the cancer will be gone.

Hence the race to identify all the genetic mutations that exist within cancers of every type. The belief is once we identify the mutation, we can produce a drug that will cure it.

THE METABOLIC THEORY

Evidence is emerging regarding the METABOLIC THEORY of cancer. It is an old theory, popular more than 80 years ago. It lost popularity and research basically fizzled when pharmaceutical companies began developing more effective drugs. This field of though especially in relation to cancer only recently began to resurface. 1–3 Again we can also blame too many birthdays for this. The breakdown is inevitable, but the metabolic theory looks at the defects of the energy production process rather than at the nuclear DNA defects.

DEFECTIVE POWER PACKS- "MITOCHONDRIA"

As we get older, the mitochondria becomes more easily damaged. The processes that produce the energy found inside the “battery pack” or mitochondria simply are not working as well as before. There is a process within the mitochondrial battery pack which I can compare to a warehouse sweatshop. Normally there are chains of workers inside, hurriedly passing around electrons and oxygen atoms, from one worker to another, trying to produce quality energy fuel for the cell. Without getting too technical here, this is where the “high energy batteries” are made. In cancer cells, the mitochondria or main energy machine, becomes damaged by outside forces. Reactive oxygen species (a highly charged type of oxygen atom) is one offender, and the inside of the mitochondria becomes dysfunctional. The energy output decreases, and so the energy production has to rely on a smaller backup generator, which is located outside of the mitochondria. This backup generator (a process called glycolysis) produces only a smaller amount of energy, but enough to survive a power failure. It also happens to rely heavily on glucose! So it appears that the small backup generator is working overtime even when there is no power outage. This is cancer, the backup generator /machinery (glycolysis) that drives it is running at full speed even though there is no power outage in the main (normal cells) building.

Mitochondria also affect the normal cell's dying process. Defective ones have immortal cancer cells due to the processes seen in the diagram at the top of this page. More discussion for another day though.

TOO MUCH STIMULATION-

"INSULIN GROWTH FACTORS"

That is not all. There is also insulin. Population research shows that diabetics have higher rates of cancer compared to non diabetics. 4–7 When the body receives carbohydrates, it is turned into glucose. Glucose causes insulin to rise. Insulin is what pushes glucose to enter the cell in order to be used. After years of excessive glucose intake, the body fails to recognize insulin and it becomes “ insulin resistant ”. The levels of insulin begin to rise. The high insulin blood levels leads to more IGF or “ insulin growth factors “ which are linked to higher cancer rates. Animal studies show that by controlling glucose intake we can manipulate the insulin growth factor pathway into prolonging lifespans. 8

Slowing down the aging process

Autophagy

http://www.the-scientist.com/?articles.view/articleNo/31630/title/How-Autophagy-Works/

Autophagy. Greek word meaning "Auto"- means “self” , "Phagy" is “to engulf or to eat”

“To eat oneself”. The cell the ability to remove defective particles including defective mitochondria, encourage regeneration, and slow down tumor growth. During starvation, the body adapts by revving up the autophagy process, as a survival mechanism. Similar to the garbage collectors on strike, when autophagy is low, the house will not function efficiently. 9–11

Fasting can offer the same benefits of short term starvation. When you fast, you are effectively renewing yourself. A low carbohydrate diet can also mimic fasting. Exercise activates AMPK (AMP protein kinase, which is an enzyme that inhibits tumor signaling called mTOR) and slowdown tumor growth and multiplication. Exercise also lengthens telomeres, the caps seen at the end of chromosomes. Telomeres shorten with age. By preserving telomere length exercise , fasting and sensible dieting can potentially prolong the aging process , and lower the risk for cancer.

References:

Chen EI. Mitochondrial dysfunction and cancer metastasis. J Bioenerg Biomembr. 2012;44(6):619-622. doi:10.1007/s10863-012-9465-9.
Vidali S, Aminzadeh S, Lambert B, et al. Mitochondria: The ketogenic diet - A metabolism-based therapy. Int J Biochem Cell Biol. 2015;63:55-59. doi:10.1016/j.biocel.2015.01.022.
Shaw RJ. Glucose metabolism and cancer. Curr Opin Cell Biol. 2006;18(6):598-608. doi:10.1016/j.ceb.2006.10.005.
Giovannucci E. Insulin, insulin-like growth factors and colon cancer: a review of the evidence. J Nutr. 2001;131(11 Suppl):3109S - 20S. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11694656.
Gallagher EJ, LeRoith D. Minireview: IGF, insulin, and cancer. Endocrinology. 2011;152(7):2546-2551. doi:10.1210/en.2011-0231.
Dunn SE, Kari FW, French J, et al. Dietary restriction reduces insulin-like growth factor I levels, which modulates apoptosis, cell proliferation, and tumor progression in p53-deficient mice. Cancer Res. 1997;57(21):4667-4672.
Fine EJ, Segal-Isaacson CJ, Feinman RD, et al. Targeting insulin inhibition as a metabolic therapy in advanced cancer: A pilot safety and feasibility dietary trial in 10 patients. Nutrition. 2012;28(10):1028-1035. doi:10.1016/j.nut.2012.05.001.
Clancy DJ, Gems D, Harshman LG, et al. Extension of life-span by loss of CHICO, a Drosophila insulin receptor substrate protein. Science. 2001;292(5514):104-106. doi:10.1126/science.1057991.
Chen N, Karantza-Wadsworth V. Role and regulation of autophagy in cancer. Biochim Biophys Acta - Mol Cell Res. 2009;1793(9):1516-1523. doi:10.1016/j.bbamcr.2008.12.013.
Hippert MM, O’Toole PS, Thorburn A. Autophagy in cancer: Good, bad, or both? Cancer Res. 2006;66(19):9349-9351. doi:10.1158/0008-5472.CAN-06-1597.
Levine B. Cell biology: autophagy and cancer. Nature. 2007;446(7137):745-747. doi:10.1038/446745a.
https://www.tasciences.com/what-is-a-telomere/

FAQs – Introduction to chemotherapy

Fri, 25 Mar 2022 22:33:10 GMT

INTRODUCTION TO CHEMOTHERAPY- what you need to know as a patient

THE BEST CURE FOR CANCER?

Just remove it. Screen early and screen regularly. When you see the tumor, take it out. Surgery for early stage cancers is considered a cure. But remember, nothing is ever 100%. Even the stage I colon cancers still have a 10% relapse rate. Why is this so when the surgeon told me that they “got it all?”

Microscopic cancer cells could certainly have been left behind, but are too small to be detected by an x-ray or CT scan. It only becomes visible years later, after the cells grow and multiply enough to be seen. Like a small family left on a deserted island, the search and rescue party in a plane will not see them until years later, the family has multiplied enough to be recognized from far away.

PRECAUTIONARY CHEMOTHERAPY-

Deciding who gets treated?

We call this “adjuvant” chemotherapy, in other words, it is given AFTER surgery or after radiation, in order to clean up any traces of microscopic cancer, and hopefully increase the cure rate.

NOT all patients get chemotherapy after surgery. Only those with high risk scores do get “precautionary chemo”. You line up the pros and cons of giving chemo and the pros or benefits must outweigh the risks and hassles before we decide that chemotherapy is even worth trying.

Many patients refuse chemotherapy because the surgeon told him/her that “we got it all”. Yes, to the naked eye, it looks like all tumor was removed, but in reality only time will tell, maybe 2-5 years later, when those microscopic cells have revived themselves and reestablished their growth, that you will see them reappear in a CAT computerized tomography scan in a renewed comeback years later.

Not all tumors are the same. After the surgery the tumors undergo slicing and are processed into neat glass slides, stained with special stains and sometimes with antibodies, and gene mutations are sometimes examined. This gives us something to examine under the microscope. Tissue that is aggressive and likely to metastasize later on can be identified by the microscope. Things that escaped the surgeon’s eyes may be revealed with special pathology stains. And gene mutation testing can give us clues whether the tumor can be treated with new , less toxic, but more effective biologic therapies instead of conventional chemotherapy.

With all the new targeted therapies , biologic treatments and programmed cell death antibodies, do I still prescribe regular chemotherapy these days? Yes, but it depends on the type of tumor. Microscopic exams can help in the decision making.

CHEMOTHERAPY FOR LATER STAGES AND CAN IT CURE?

Conventional chemotherapy is given in order to attack cancer cells, target the nuclear DNA and hopefully make them die. If we can kill ALL of them, then you will achieve a cure. If you only kill some of the tumor, the left over tumor cells will still be around after the chemotherapy has faded, regrow, and weeks or months from then, will rebuild from the ashes, into a renewed, perhaps more aggressive tumor. Since it is nearly impossible to tell if chemotherapy has killed ALL cells, we usually rely on surgery to remove the tumors, plus a good margin around the tumors, to ensure cure. This is only possible with early stages of a cancer. When a cancer gets too large, it starts to encroach upon surrounding tissue and it becomes impossible to get a good clean cut with a scalpel without leaving microscopic cells behind. In general, chemotherapy if given in the later stages, will rarely be cured, but should be available to offer relief from symptoms and prolong life.

The exception are late stage blood cancers like leukemia, lymphoma of the Hodgkins variety, and selected non hodgkins lymphomas, which have a decent chance of being cured with chemotherapy even if discovered at stage 4. But the chances are of course lower, compared to similar cases discovered when only at Stage One.

WILL CHEMOTHERAPY MAKE ME SICK?

It really depends. I want patients to know that unlike during the 1960s, when we had only a few chemotherapy choices to choose from, we now have hundreds to choose from. I am referring to the drugs that target the nuclear DNA. We have chemotherapy that can avoid hair loss, while some will still cause hair to fall. Some are intensely nauseating while others have no nausea inducing side effects at all. We now have new drugs that control nausea and vomiting very well.

25 years ago, many were still vomiting but nowadays, with the newer anti nausea drugs, vomiting has become almost rare.

What about the hair loss?

Biologic agents and the newer targeted therapies will not cause hair loss. Some of the chemotherapy agents also do not have hair loss as a side effect. Ask your doctor if these particular drugs are suitable for your cancer.

For each tumor there are usually more than one type of chemotherapy

Chemotherapy for colon cancer is different from leukemia, and the leukemia drugs are also very different from the chemo that we give to breast cancer patients can come in intravenous form, or pills, some can even be given as a form of cancer vaccine. Depending on what side effects you are willing to handle and depending on the effectiveness on tumor shrinkage, the dose can also be dialed up or dialed down.

Chemotherapy can be very intense , like in bone marrow transplant regimens, and side effects can last for a very long time.

Some regimens have very few side effects, even to the point that the patient wonders whether we gave him only a placebo!

Many people would rather choose a milder form of treatment even if it means the tumor will only be stable, meaning no growth but no shrinkage either.

We also have newer medications, that are what some doctors call “ biological” therapies. They do not act the same way as conventional chemotherapy but act on other mechanisms like tumor signaling pathways, and mutation targetting . We have tumor antibodies, drugs that act on programmed cell death, drugs that cut back the growth of the blood vessels supplying the tumors instead of attacking the tumor itself, etc. Biologic drugs tend to be more easily tolerated, and do not usually cause hair loss or nausea.

WILL CHEMOTHERAPY PERMANENTLY DAMAGE MY IMMUNE SYSTEM?

On the contrary, modern chemotherapy can now be used to stimulate the immune system and trick it into turning around and attacking the cancer itself. What is being confused as immune system damage is actually the slow recovery of bacteria fighting white and red blood cells that we see after a dose of chemotherapy. Chemotherapy can make the red blood cells low and this will make one tired. It can also bring down white blood cells which can make one easy prey to infections. In most cases the effect usually is temporary, and one usually recovers within days and is ready when the next treatment date rolls around. Antibiotics are sometimes given as a prophylactic measure to prevent infections. Depending on the drug, the side effects on the label can vary. Most of the time, side effects are short lived. Some side effects are severe, (kidney failure, heart failure, nerve damage) and may become permanent, especially if the drug is given for extended periods of time ( months to years). Fortunately , complete and permanent organ damage is rare in a closely monitored clinic. Rotating between different treatments or strategic dose reductions or brief chemotherapy “vacations” can help minimize or entirely prevent the damage.

MILD, MEDIUM or WELL DONE?

Most patients only want chemotherapy if it will not make them sick. Others will brave any chemotherapy as long as it will cure them. I can’t promise anything, but for every regimen we can certainly dial down the intensity of chemotherapy, offer only one drug, give breaks in between, and even adjust the dose in order to increase tolerability. For elderly or frail patients, this may be the only option. That way they still get to benefit from the tumor delaying effects of chemotherapy even though it might take longer to do so.

Aggressive regimens usually entail two or more drugs. Although this should improve the effectiveness of the treatment, it can also increase the toxicity.

CHEMOTHERAPY and NAUSEA- New advances

Over the past twenty years, we now have very effective drugs to combat nausea and vomiting. Decades ago, doctors and nurses used to see people vomiting up to 10 times a day while on chemotherapy. Now, it is rare in my practice to see anyone vomit. Perhaps some will get nauseated, and vomit once daily. Others will not even get to that point as long as they take the new anti nausea medications on time.

TARGETING THE GENETIC OR THE METABOLIC THEORY?

SHOULD WE TARGET BOTH?

I think using drugs that target both cancer theories, is a good idea.

I DON’T WANT CHEMOTHERAPY, CAN I JUST USE NATURAL ALTERNATIVE MEDICINE?

Although some of the “natural alternatives” out there sound very promising, keep in mind that they being "natural" does not always guarantee safety. Most alternatives are non FDA approved, and have been tested only in animals. We don't know what the equivalent doses are in humans, and most likely that drug that you purchased from the internet is either too low a dose, or worse, could be too high and potentially toxic to your internal organs. Side effects of these alternatives should also be considered and discussed with your doctors because some of the side effects can be fatal, and we obviously won't get any of the victims to testify.

WHAT ABOUT HERBAL MEDICINES?

Herbal does not necessarily mean non toxic. Mushrooms can be very toxic, if you choose the wrong one! Did you know that many of our chemotherapies were originally plants or herbs? Vincristine, a treatment for a lot of blood cancers, actually came from a flower? Paclitaxel, a potent drug for breast, ovarian, lung and many other cancers, was made from the bark of the Pacific yew tree? It was only after it went through clinical trials and now commercially available that it became known only as chemotherapy.

REFUSING CHEMOTHERAPY AND CHOOSING WATCHFUL WAITING- IS THIS AN OPTION?

When the cancer is identified as being low risk, sometimes, delaying chemotherapy can be a good option, as long as very close clinical monitoring is followed. This means that instead of treatment, frequent (every 1-3 months) doctor visits and frequent blood testing and /or full body scans are done in the hopes of catching the cancer if it does decide to come back. Sounds like a great idea? The only problem is , we do not know how or when the cancer will return. Sometime the cancer undergoes what we call a malignant transformation. The slow tumor now has metamorphosed into an aggressive one. Many times, the cancer returns when we are not looking, and are alerted only by symptoms. We can only hope that we can catch it at a treatable state. But sadly sometimes the cancer returns in a very sneaky fashion, and may show up in a distant organ like the lungs and the liver, where it is now incurable, and surprisingly, without any symptoms. By the time we discover it on a CAT scan or Xray, it will be too late. There is simply no foolproof way to accurately predict how and where the tumor will make its grand reappearance. Lower risk tumors can take advantage of waiting, in order to avoid potential chemotherapy side effects. If the cancer risk score is high enough, chemo might be a better option than waiting. Consultation with your oncologist who knows your case best is probably a wise move.

CAN I JUST WAIT FOR SYMPTOMS?

This is probably the worse game plan. Early cancers are treatable, and usually have NO symptoms. By the time symptoms appear, it may be too late for a cure. Or, even if curable, a symptomatic person will be too sick to tolerate treatment. The best time to treat with surgery, chemo or radiation is when one is feeling healthy.

Younger patients can tolerate chemotherapy better than older patients. People without diabetes, heart disease or lung disease are better off than those who do.

WILL A KETOGENIC DIET WORK TO PREVENT CANCER?

I feel that dietary manipulation has some role in improving cancer patients’ quality of life. There is also potential that the diet can add to the effectiveness of chemotherapy and radiation. We do not have any human proof of this, at least not yet. Clinical trials are still ongoing. For now I predict that by itself the diet will not produce a complete cure in most advanced cancers, but may help one tolerate chemotherapy side effects, possibly make the tumors respond better to chemo and help people live longer. There is still so much that we do not know about how cancers develop and we know even less about how to conquer them. A metabolic approach sounds like a non-toxic way of slowing down the processes that do activate cancer. I feel in order to control tumor growth, it is important not only to douse the flames of cancer, but also to remember to turn off the gas! This where the diet becomes important.

Full Paper of our ketogenic diet in cancer trial is now available online

Fri, 25 Mar 2022 22:31:35 GMT

Great news! The long awaited manuscript of our ketogenic diet trial is finally out!

You may access it at this link.

http://nutritionandmetabolism.biomedcentral.com/articles/10.1186/s12986-016-0113-y

Ketogenic Dieting while undergoing chemotherapy

Fri, 25 Mar 2022 22:30:58 GMT

Dear Keto oncologist,

I found the results of your trial very interesting and encouraging. But now I am confused. I was recently diagnosed with cancer. Should I still try chemotherapy? Do you recommend it at all?

Miss LA

Dear Miss LA,

Chemotherapy is still a powerful tool against cancer. Yes I do STILL believe in it. The Atkins diet is supplementary to a good chemo treatment plan and hopefully both, when tried together, will increase the treatment success rates.

Many are afraid of chemotherapy because they fear the loss of hair….

(Charlie Brown - from Peanuts)

It may come as a surprise to you, but hair loss is not always a side effect! Many chemotherapy drugs do not even cause this. And for the drugs that do, the hair loss is usually only temporary.

Patients may also see themselves as getting infected, nauseated and losing energy. We now have new drugs that prevent and control nausea very well.

The most serious side effect of chemotherapy is probably the risk of infection. This can happen when the chemotherapy makes your white blood cells drop. We call this “neutropenia”, (“neutrophils” mean white blood cells, and “enia” means a low blood count) This usually occurs within a week or two after a dose of chemotherapy. However, the good news is that this effect can be dialed down with a dose reduction, or you can also take frequent breaks in between treatments. We also have antibiotics that are more effective now than they were 30 to 50 years ago.

Most of the chemo treatments are now also given as an outpatient. Hospitalization is reserved only for the more aggressive regimens. Many can continue to work while receiving treatment. It really depends on the type of regimen.

One should not deny themselves chemotherapy or radiation treatment because of the results of this trial. What this trial is saying is that that the modified Atkins diet is probably safe to use in cancer patients. What our trial does NOT say is that the diet is a one stop cure!

How about with chemotherapy? One of the patients in the trial did try ketogenic dieting in combination with chemotherapy and also combined it with radiation, and he did well. We need more future trials with more participants in order to make better conclusions.

As always, please consult your doctor for the best treatment plan tailored to your individual diagnosis.

Kind regards,

KetoOnc

Ketogenic lifestyle – 15 unmistakable signs

Fri, 25 Mar 2022 22:27:51 GMT

When you decide to adopt a ketogenic lifestyle, you realize soon enough:

Fifteen unmistakable signs of a ketogenic lifestyle

15. Your fridge no longer stocks soda.

14. While dining out you pass over bread baskets. Instead you look forward to those shrimp cocktail appetizers or asparagus . Also think of sashimi, clear soups or chicken skewers instead.

13. You own at least a dozen low carb and paleo cookbooks. Once you buy one, your thirst for knowledge on the topic grows. Soon you become an expert in your own right.

http://amzn.to/2eUkklL

12. Your favorite fast food joint serves bunless burgers with double veggies.

11. Slacks in your closet are suddenly too large.

10.You donated your toaster, bread maker and all your cookie cutters to Goodwill.

9.You don't remember the names of these kitchen gadgets.

8. When an officemate celebrates their birthday with pizza and cake, you suddenly disappear.

7.Your Facebook friends post photos of yummy high carb treats and you start un-friending them.

6.Fellow shoppers stare at your grocery cart filled with 6 boxes of butter, 4 dozen eggs and 14 heads of lettuce.

5. You know what the word "tempeh" means.

4. You start raising backyard chicken for eggs. (or pets)

3. You are diabetic and your doctor says you no longer need insulin! This is because you no longer have those awful spikes of glucose that occur after a load of carbohydrates.

2. Your bank account has more money. Since your grocery list consists mainly of fresh food, you find less of the prepackaged foods and desserts making their way into your shopping cart. Good for your body, and good for your pocketbook!

1. It's been 5 years since you were diagnosed with cancer and with your new ketogenic lifestyle, you now know who your true friends are!

Frequently asked ketogenic diet questions- Tasty ketogenic food ?

Fri, 25 Mar 2022 22:25:55 GMT

FAQS-

Tasty ketogenic food? Staying ketogenic - Finding the right food to eat.

My kidneys are bad. My doctor says that I should avoid food with high protein! Can I still do this diet?

Contrary to popular belief, the ketogenic diet and Atkins diets are not necessarily high protein.

The Atkins diet does not have to have high protein. The main requirement is to limit carbs to 20-40 grams a day and the rest of the diet is really up to you. You can choose to be high protein or moderate protein and the rest is fat.

In the ketogenic diet however, the focus is on more on fats and carbohydrates. Fats are about 70-75% of the total diet and carbs are limited to ~ 5-10%. The rest is allotted to protein.

I want to lose weight using the Atkins diet but I am vegetarian.

Sorry, because essentially all vegetables contain carbohydrates, it is difficult for a pure vegetarian to satisfy the dietary proportions of a ketogenic diet. The inability to consume low carb food like eggs, cheese, fish and meats limits the vegetarian’s food choices.

Our family is Italian. We love to eat pizza and pasta is a main part of our diet. It is impossible for us to follow this diet!

There are many substitute “pasta” options. Invest in a gadget ( the Vegetti as seen on TV) that turns vegetables like zucchini and squash into long thin strands. You can also turn carrots into strands that look like thin noodles. Saute these with butter and season with cheese, salt and pepper. These are wonderful low carb choices that can be made tasty with the help of oils and seasoning. Pizza crusts can also be fashioned from low carb options. Almond flour or coconut flour can be used as substitutes. Shredded cheese that is baked to a crisp are nice crunchy alternatives to the pizza crusts. Go online to search for recipes or get help from a nutritionist.

We love Chinese food and cannot live without rice and noodles.

The Chinese menu is diverse enough that you can search for and find true low carb options. “Cauli rice” is available abroad and is made from shredded cauliflower. Here in the United States, you can simply buy heads of cauliflower and bake them till tender but not mushy. Grind or blend quickly in a food processor and then sauté briefly to desired firmness. This can also be used to substitute for the flour and rice that many use in shepherds pie or lasagna.

We travel a lot and find nothing acceptable to eat in most of the fast food restaurants!

One patient of mine solved this problem by bringing a small cooler filled with home cooked ready to eat finger foods. Baked chicken strips, celery sticks, hard boiled eggs with mayo dressing, crispy pork rinds, are all low carb and easy to pack. If eating out, identify restaurants serving bunless burger options, and request for extra lettuce before hand. If you have to buy breaded meat, peel off the breaded layer and eat only th insides. Drink water instead of juice or soda. Pass up on the bread basket and ask for more salad. Use oil instead of ketchup. Ask for more shredded cheese toppings instead of white sauce. Choose coffee or tea instead of sweets for dessert.

The layman’s version: Veterans Ketogenic Diet trial 2016

Fri, 25 Mar 2022 22:24:57 GMT

Dear Dr. Tan,

I found your abstract , but can you please send me a link to a layman's version that I can understand? Thanks in advance.

Canadian follower

Results of the ketogenic diet in cancer trial

http://nutritionandmetabolism.biomedcentral.com/articles/10.1186/s12986-016-0113-y

Abstract- Veteran Affairs ketogenic diet trial

Goals :

To see whether veteran cancer patients can tolerate the low carbohydrate/Atkins/modified ketogenic diet .

To observe how much weight loss will happen as a result of this ketogenic diet trial and whether this weight loss is healthy or dangerous for cancer patients.

To see whether cholesterol and blood glucose levels will be affected by the diet.

To examine the emotional health of cancer patients while on the modified Atkins/ketogenic diet.

To examine whether the energy levels of cancer patients increase or decrease while on the modified Atkins/ketogenic diet.

How long will it take to develop ketosis while on the diet?

To observe the tolerance of elderly cancer patients while on the modified Atkins/ketogenic diet. There was no age limit other than having a minimum age of 18.

Background :

Both cancer cells and normal cells have the ability to use glucose , starch and sugar for growth and energy. Cancer cells however are quite primitive and lack the sophistication to fully use fats and proteins. Within the cancer cell, there is an important portion of it that we call the "mitochondria", in other words, it functions as the battery pack/energy supplier of the cell. Cancerous "mitochondria" develop internal defects making them unable to produce as much energy as a normal cell. When we fast or starve, the body can survive for many days and stay alive because our normal cells will start to use our stored fats and muscle protein to survive. Normal cells can use this energy from the hidden stores within our muscles and fat until we can find food again. On the other hand, cancer cells, are too simple in structure and too primitive to extract energy from the fat and protein, therefore will starve. They also have a defective "mitochondria" within their cells so they naturally will not have enough energy to power themselves in times of stress or starvation. The ketogenic diet is specially formulated to imitate the effects of starvation or fasting. When we use this diet, we are in effect trying to stress our bodies and starve the tumor. When we fast, the body also produces energy packed substances called "ketones". Cancer cells cannot use these ketones for food while normal cells can. Aside from supplying energy, these ketones have another additional advantage. They can be directly toxic to cancer cells and stop tumor signaling proteins found in the blood to slow down the growth of cancer.

Methods:

We recruited patients from the Pittsburgh VA Medical Center. All of the qualified candidates must have a diagnosis of advanced solid cancer and other wise be in good physical shape. They enrolled in this veterans ketogenic diet trial and were taught to limit their starch, sugar and sweets intake to a total of 20 grams of less a day. That's probably the equivalent of a half of a bagel! Their blood cholesterol levels , kidney and liver tests were monitored closely while they were on the diet. Blood pressure and weights were closely recorded. Full body scans were done at the beginning of the trial and repeated approximately every 2 months. We gave them a questionnaire /survey during their visits and asked them to comment on their symptoms. There were questions on whether they had worsening or improvement of fatigue, poor appetite, breathing problems, financial problems, mood disorders , constipation, diarrhea, or sleep disturbances. To each of these questions they had to give a score. Their weight and blood pressure, heart rates and breathing rates were also recorded at each visit. We wanted to see if their quality of life remained stable while on the diet. In addition, we also drew blood at every visit , to monitor their ketone levels. You will recall that ketones are produced by the body as a defense mechanism when food is lacking. We also measured the ketones in their blood as a way to ensure that they were following the diet correctly. We used statistical tests to analyze the collected data in order to measure the effectiveness and safety of the diet.

The Menu:

Sweets, starchy food and fruits were not allowed. Soda was banned and so was wine. Hard liquor however was allowed but in small amounts. Coffee and tea were allowed , and so was unflavored soda and low calorie drinks. Water intake was encouraged because the diet made one urinate often and may put one at danger of dehydration. Full fats like butter, coconut oil and ghee, full cream dairy , eggs, meat, fish and green vegetables were encouraged. Non fat dairy (milk or low fat yogurt) had a lot of hidden carbohydrates to make up for the loss of fat, therefore these were prohibited. Patients were encouraged to snack only if hungry but we suggested they replace high carbohydrate foods with green vegetables, nuts and cheese or meat jerky. Multivitamin supplements were also added. Artificial sweeteners were used often as long as there were not sugar alcohols. You will recognize sugar alcohols because they end in "ol", like sorbitol, xylitol, etc.

Results:

Many prospective candidates applied for this ketogenic diet trial. Many were not veterans and were therefore immediately disqualified. Out of approximately 300 candidates, 17 male Caucasian veterans were accepted and qualified to join the trial. All of them had advanced stages of their solid cancers. Most had 2 or more treatments in the past which failed to control their tumors. They all had about 6 months or less to live because of the advanced stage of their disease. All of them were in good physical shape other than their cancers. When they began the diet, they were not allowed to have chemotherapy. Most of the patients were in their mid 60s but some were in their early forties and a few were in their late 80s. There was one patient with prostate cancer, another had cancer of the liver and one had cancer of the bile ducts. Two had brain cancer, one patient had colon cancer , two had cancers of the head and neck, and two had pancreatic cancer. There was one patient with kidney and another had thyroid cancer. Three had melanoma, two had lung cancer. One of them had diabetes which was poorly controlled. When he started the diet, he found that his blood sugars went down and he no longer needed his insulin. The diet made them all lose at least 10% of their weight. Some veterans lost as much as 25% of their starting weight. Their blood tests however remained stable and the average cholesterol levels did not rise. They did not have any worsening of their symptoms. A few of the patients reported some improvement in their breathing while others reported a slight improvement of their nausea and vomiting. The scores showed that the quality of life did not change and in some instances did improve with the diet. Dieting did not make their blood sugars drop, nor did they go up.

When the PET/CT scans were performed, they showed that some patients had worsening of their cancers despite the diet and therefore had to quit before 8 weeks were up. Some patients felt well and their tumors did not grow therefore they continued to diet until 16 weeks. Overall, half of the patients had no growth in their tumors after 4 weeks. After 8 weeks, slightly less than half ( 45%) of the patients had no tumor growth, and after 16 weeks, about one third of the total number of patients still had good control of their tumors. The rest had worsening tumors or they decided that the diet was too difficult to follow therefore they quit. Some patients signed the consent but were not able to start the diet because their tumors grew too quickly. One patient had a brain tumor that did not light up on a PET scan, and was disqualified because his tumor was not actively seeking glucose. Only four patients were able to continue the diet for more than 16 weeks. All of these four patients underwent PET scans which showed that their tumors remained unchanged or became smaller at 16 weeks. Three of them had melanoma, a deadly form of skin cancer. The fourth patient had stage 4 lung cancer. This lung cancer patient however, decided to return to a regular diet and died after 40 weeks. The other three with melanoma continued to stay on this diet and lived almost two years or more. The 88 year old's melanoma eventually spread to his brain but he continued on the diet nevertheless and stayed active until he died at 80 weeks , The 62 year old also had his melanoma spread to the brain but he did try some chemotherapy and radiation after that and survived a total of 116 weeks while on the diet. The 42 year old had some tumor remaining in his left arm and had it surgically removed. He then went on the diet for two more years and stopped. He is now on a low carbohydrate but no longer a strict ketogenic diet. He currently has no tumor visible at his 131 week PET/CT scans and remains alive and well at 138 weeks.

Discussion and Conclusions- Veterans ketogenic diet trial:

This ketogenic diet trial was not easy to perform. It requires planning, motivation and perseverance. A family member could be very helpful in menu planning and can keep one motivated. Out of 17 patients, only 3 did very well. Dropout rates were high. The diet appears safe even when one has lost weight. As long as one feels well and energetic, the weight loss becomes less of an issue. It appears that cancer patients who had high levels of ketones in their blood but did not lose much weight, lived a shorter time than those who did lose a lot of weight but had only mediocre ketone levels. Why was this the case? Before we began this trial we predicted that high ketone levels would be better than low. It could have been because the timing of the blood tests were not always uniform, or the patient may have eaten something shortly before the test, the results were therefore affected.

There is a formula that we use to calculate for the target levels of blood glucose and blood ketones. According to this formula (GKI Glucose ketone index), when someone diets, the blood glucose goes down, while the blood ketones rise to compensate for the loss of energy /loss of glucose. This ratio divides the glucose by the ketone values with the target number as 1.0 or something around that range. Only a few of our trial patients achieved this target number. Was it the weight loss that made the difference in the superior survival of the three patients in this trial? It appears to be so. Was the presence of tumor promoting hormones that lurk in the body's fat deposits, causing cancer to fail treatment? Possibly. Some scientists speculate that a stricter form of this diet, the ketogenic diet instead of the modified Atkins diet, could possibly produce better results in the future. The ketogenic diet has a larger proportion of fats compared to the Atkins diet. We chose the Atkins diet because we felt it would be an easier diet to perform.

This veterans ketogenic diet trial was a short one and we can't make any conclusions about it being a cancer cure, but it appears that for the time being a low carbohydrate ketogenic diet is safe for cancer patients and may possibly help make chemotherapy treatment better tolerated and maybe even more effective. More studies are desperately needed.

New cancer diagnosis – What to do now?

Fri, 25 Mar 2022 22:23:45 GMT

New cancer diagnosis? Sooner or later, you or someone you know will be faced with news of cancer [The big C].What to do next? There is initial disbelief and denial. Then, panic will engulf the first few hours of dealing with the new unwelcome status. Possibly coming into the picture is depression and confusion…

Don’t panic and don’t believe the first thing you see on Google. Having a new cancer diagnosis is not like it was twenty years ago. People are living longer and some lead nearly normal lives even if the cancer fails to completely disappear. Stage 4 cancers, some of them at least, are still curable, and not necessarily a death sentence. Examples would be some leukemias, some lymphomas, and colon cancer or melanoma that is stage 4 but have only one site of (surgically removable) metastases. Furthermore, the survival numbers on Google might only reflect the data from 5 years ago, not taking into account the improved survival with newer therapies that still have not been published.

Do find a medical oncologist (cancer doctor), one that you can trust to help you navigate your way from diagnosis to the best treatment, and finally, long term surveillance. Your oncologist is instrumental in coordinating your treatments , especially if you also need surgery and radiation. They will help expedite your care! Today's treatment choices are many, and should be tailored to your goals. Do you want to live longer or do you prefer to preserve quality of life?

After the treatment is over, the work is really not yet done. Someone needs to monitor your regular follow-up tests, to make sure relapses are detected on time.

Do understand the deeper aspects of your diagnosis

It is not enough to know that you have a cancer of a certain organ, say, lung cancer. What type of lung cancer? The sample tissue from the biopsy has yet to be sent to the lab and examined, further classified and given another name. Lung cancers come as “small cell” or “non-small cell”, each divided further into more detailed categories (adenocarcinoma, squamous, large, neuroendocrine, mesothelioma, etc). The treatment will depend on the subcategories that they fall under. The same goes for other tumors like kidney, breast, and even pancreas.

Do ask about chemotherapy alternatives

Nowadays, there is also precision oncology. This involves identification of gene mutations (defects) that genetic scientists believe are behind the cause of cancer itself. They hope that by identifying the defect, they can make drugs to match these and effectively shut down the tumors. In addition to traditional cell killing chemotherapy, we now have readily available -- New Targeted Therapies, FDA approved “monoclonal antibodies”, “tumor vaccines”, and drugs that target tumors indirectly by affecting “tumor signaling pathways” and tweakers of the “programmed cell death” mechanisms. Make sure you ask your doctor if you qualify for any of these.

Assemble your cancer team. Your family doctor should help you assemble a team of doctors who work together to treat your cancer.

SURGEONS:

They usually are the first responders to the scene. They do your biopsy and then surgically remove the tumor. Some would say that they “GOT IT ALL”. What this really means is they got everything that their naked eyes can see. Many people delay in seeing the oncologist, who should be in the picture within the first 3 months after surgery.

PATHOLOGISTS:

These unsung heroes are medical doctors who work behind the scenes. They know the intimate microscopic details of your tumors, make the final diagnosis but never really get to meet you. Details like how wide the margin of clean tissue surrounds your tumor, the aggressiveness of the cancer cells based on their microscopic arrangements, and the color of the tissues, all give clues on whether they are slow or fast growing.

ONCOLOGISTS: In many centers, the oncologists see all types of cancers. Some do specialize in certain cancer types over others. They will follow you from diagnosis till hopefully, complete remission .

NUTRITIONIST: Now is the time to rethink your diet. If you are reading my blog then you are already on the right path. You can make a difference in your cancer journey to cure. Nutritionists are highly trained to help you choose the correct food to eat.

RADIATION ONCOLOGIST: These cancer doctors specialize in radiation therapy, depending on your type of cancer. In most cases, radiation will help prevent cancers from returning to the site of radiation, but will not be able to prevent the cancer from metastasizing to a more distant organ.

ONCOLOGY NURSES: Highly specialized nurses who not only administer complex medications but also can identify side effects as they arise. They too will follow you closely as you progress on your cancer journey.

PALLIATIVE CARE DOCTOR: Offers treatment directed at comfort, including pain control, nutritional support, counseling, and hospice care.

KEEP YOUR APPOINTMENTS: Don’t be a no show to your treatments , which could take anywhere between 1-6 months to complete. Also, once these are over, don’t forget your follow up appointments. The first two years are when most relapses occur.

ALTERNATIVE TREATMENTS versus COMPLEMENTARY MEDICINE: If it’s too good to be true, it probably is. While complementary treatment such as essential oils, vitamins and herbs sound non-toxic and helpful, keep in mind that many of these are not FDA approved, or maybe have encouraging results in the dish laboratory, but never got to be tested in wide scale phase III human trials.

Don’t fall for “cures”

You will recognize these because they promise complete remission with one dose. Especially if it is linked to a mail order catalog with a hefty price tag per bottle of pills being sold. Some if not all alternative cancer treatments out there, came about as a result of a smaller, positive laboratory finding. Many used tissue cultures of cancer cell lines to experiment on, and found positive results. While that is all very exciting, many do not have solid human data to back up their claims. Search for those which have previous clinical data, preferably using human or animal subjects. And if possible try to enroll in a clinical trial that uses these drugs. That way you will get the benefit of close monitoring, and whatever result comes out of this trial, whether good or bad, will still add to existing and future cancer knowledge. TIP: If a “cancer pill” bought from the internet makes claims such as “scientifically proven”, “100% effective”, think again. Dead giveaways of bogus treatments would be words on the label like “Clinically tested”, exciting new breakthrough”, “all natural”, “cure”, and once I even saw one labeled “cosmic”. They will also come with a hefty price tag to boot, therefore simply stay clear of these.

WHAT TO DO WHILE WAITING

Exercise more (at least 10 minutes a day),

it can rid your body of defective cells that could turn into cancer. http://well.blogs.nytimes.com/2012/02/01/exercise-as-housecleaning-for-the-body/?_r=0

Get more quality sleep (dark environment without light interruption, use white noise if needed)

http://www.nature.com/nrc/journal/v9/n12/full/nrc2747.html

Eat healthy (avoid sugar and carbohydrates), http://bottomlineinc.com/starve-cancer-to-death-with-the-ketogenic-diet/

Ketogenic diets are new and so far most trials completed focused only on safety. There is emerging but still not definite evidence that this type of diet may improve survival. If you want to try this, get a doctor to monitor you and a nutritionist well versed in ketogenic diets to help you. You can find some at large children’s hospitals where the diet is currently being used for anti-seizure therapy. Miriam Kalamian is an online ketogenic expert dietician who charges a nominal fee for her services. http://www.dietarytherapies.com/faqs22.html

Take a multivitamin pill BUT stay away from megadoses

http://www.nytimes.com/health/guides/nutrition/vitamins/print.html

Check your Vitamin D levels . There is evidence linking Vitamin D deficiency to many cancers. https://www.cancer.gov/about-cancer/causes-prevention/risk/diet/vitamin-d-fact-sheet

and … if your doctor says its OK, gulp down an aspirin daily

https://www.theguardian.com/science/2014/aug/06/aspirin-could-dramtically-cut-cancer-risk-say-scientists-biggest-study-yet

Try to reduce stress. A new cancer diagnosis does not mean that you stop living. Take a vacation!

https://www.mdanderson.org/publications/focused-on-health/december-2014/how-stress-affects-cancer-risk.html

Do consider joining a clinical trial: Call the National Cancer Institute NCI 1-800 -422-6237. Someone on the other line will be able to help you find the correct trial. You can also go on clinicaltrials.gov if you feel like doing your own search. The best time to join a trial is when you are in tip top shape. Most trials are looking for people with cancer but who are healthy otherwise. This is a chance to avail of new drugs that are still not out on the market. TIP: If you wait until after you have had standard treatment, you might no longer qualify for the new drugs in trial.

Phase I trials are the easiest to get into, because they are testing the dose of a new drug, and trying to find out which dose would be the maximum safe, non toxic level. This type of trial welcomes almost any type of tumor since it is primarily a safety trial , and the number of participants is usually small, (20-100). The chance of getting a tumor response to the drug is very low, because they still don’t know which tumor type best responds to it since it has not yet been tested in Phase II. Once the correct dose is discovered, the drug goes into Phase II .

Phase II This trial recruits more subjects (100-300), and the drug is now compared to a placebo. It is also tested in a single type of tumor.

Phase III is more sophisticated,and have more subjects (500-3000 ) because not only is the drug being tested against placebo, but also against the current standard treatments. Results that are statistically positive tend to make their way into general public use and FDA approval.

If you have a “rare type” of cancer, ask for a second opinion.RARE CANCERS: A new cancer diagnosis that happen to be rare. Best to try to go to a center of higher patient volume where doctors see more of the same kind of rare tumor. Preferably choose a university based hospital where cutting edge treatments are born and actually used on a daily basis.You can also ask your oncologist to secure a second opinion of your case history, outside of their hospital, for you. In addition, your tumor specimen itself can also be sent off to a different laboratory for a microscopic and sometimes, immunologic special restaining for a second opinion. If you don’t have the time, money or resources to go in person for a second opinion, nowadays there are virtual clinics (online medical consultations) which for a fee, will have you access a licensed doctor and have them review your case and provide medical advice. Top tier doctors practicing in big hospitals like Memorial Sloan Kettering in New York, and Johns Hopkins in Baltimore, Maryland, offer virtual consultations for a fee, which can be pricey, usually around $2500.00 https://www.mskcc.org/experience/become-patient/international-patients/requesting-medical-records-review-mail

http://www.hopkinsmedicine.org/second_opinion/

Or you can go to find a private doctor on other globally oriented websites like Healthtap.

www.healthtap.com and schedule a consultation for less money, starting at $30 per consult. They also take medical insurance now, and welcome US, Canadian, as well as international patients.

9. And last but most importantly, find yourself a companion (i.e. spouse, sibling, friend) who will be willing to support you physically and emotionally throughout the challenges that a new cancer diagnosis brings. They will help you get started on what to do now!

Thanksgiving ketogenic survival plan

Fri, 25 Mar 2022 22:22:00 GMT

Do you have a Thanksgiving ketogenic survival plan? With the cold weather now signaling the impending arrival of yet another holiday feast, the warning signs are definitely here. Your relatives are coming over.

https://www.youtube.com/watch?v=e2zyjbH9zzA

Your diet is about to be trashed. Holiday get togethers are going to test your will power. As we well know, overindulgence is common at the holiday dinner table. With the excuse that "this happens only once a year", it becomes very easy to eat twice or even thrice your daily consumption.

Thanksgiving ketogenic survival plan

Look forward to the meal but don't go to the dinner table hungry. Try to eat small portions of food throughout the day, so that by the time dinner rolls along, you won't be totally famished and as a result, overeat.
Plan ahead. Mentally think about how much you are going to fill your plate with. Once you visualize your plate, stick with it and avoid overfilling it. By now you should have a good idea of what foods are allowable. Identify them quickly and attack those first.
Fiber + oil can be your best friend. Always take a huge salad before the meal. Drizzle with lots of oil. Oil has a high satiety value. This means that compared to starchy food, oily food keeping you full longer.
If you spot a bread basket next to you, quickly pass it over to the other end of the table. Distance can make this less appealing.
Fill your drinking glass full of water. It will help fill you up, at least temporarily. If you don't want to appear like you have a drinking disorder, consume your "liter" of water before leaving home.
If you can't dine without alcohol, remember you should still pass over the wine ( wine has carbs too!) but are allowed to take some vodka.
Find yourself a seat mate who likes to converse. You will find yourself chatting away as well. The more you talk, the less you will eat!
Take small sized plates instead of a regular dinner plate. This way, it becomes impossible to take too much food and overeat. You can go back for second helpings and not feel too guilty.
Pass over the appetizers that have biscuits or rice in it. Look for dishes that contain fish, meat, eggs, mushrooms and cheese. These are very popular during the holidays and have very little carbs in them. They are quite filling too.

What to do when the lure of dessert overpowers you

Ignore the dessert table and hover over to the tea and coffee instead. You will thank yourself later. If you cannot resist because all your seat mates have plates brimming with decadent desserts , then do get yourself a small favor. Bring your own keto - approved dessert. A bite sized sample of the desserts on the table will NOT be OK. Or, just try to let everyone take desserts first before you even attempt to do so. This will automatically shrink the number of available desserts left on the buffet table and if you are lucky, by the time you get there, the deserts will vanish!

I hope this Thanksgiving ketogenic survival plan is helpful. Keep yourself in ketosis while keeping your stomachs satisfied and happy!

Baking soda cancer cures – hoax or fact?

Fri, 25 Mar 2022 22:21:13 GMT

Baking soda cancer cures? What is the truth behind the "baking soda cancer effect"? Can acid promote cancer? And does baking soda cure?

Let's put this into perspective, "does acid cause cancer", or is it the opposite??? -->>Does cancer make cells produce too much acidity?

and NOT the other way around...

This is a classic chicken versus the egg dilemma.

HOW TUMORS ARE BORN

Normally, cells are born, multiply and then get older.

These older cells shed or die off and new cells replace the old.

That is the normal cycle of cell life.

Then something insulting, like an infection or inflammation comes along, and the cells get irritated, and the aging process speeds up.

Irritated cells die early and shed off while more and more younger cells are born and take the place of the older ones.

With more tissue irritation , we see more and more new cell production which overtakes the cell death . A lot more. The tumor now becomes visible to the naked eye. What's more frightening is the fact that these brand new cells begin to lose the ability to age and die. Programmed cell death, which is present in normal bodies, start malfunctioning in cancer. The cells can't stop multiplying and they don't die. A cancer is born.

HYPOXIA or (hypo = low) LOW OXYGEN LEVELS and HOW a low oxygen environment makes our blood ACIDIC

When tumors grow, cell crowding results in less available oxygen. The blood oxygen levels drop and all of a sudden there is not enough oxygen for all the cells to use.

This is what we call HYPOXIA. "HYPO" means "LOW" while "OXIA" means "Blood levels of Oxygen".

HYPOXIA (LOW OXYGEN LEVELS IN THE BLOOD) . When the tumor crowds out normal cells and blood oxygen levels begin to fall, the tumor cells compensate by increasing their energy supply.

You recall that cancer cells get their energy from GLYCOLYSIS or the break down of glucose (recall that this is the process of early glucose metabolism ) .

When this happens, glycolysis produces more and more LACTIC ACID .

There is now overproduction of lactic acid in the blood and a worsening of the blood acidity .[1]

ACIDITY AND METASTASIS- WHY IS THIS IMPORTANT

The tumor cell itself undergoes a transformation, and reprogramming. Each tumor cell has a special pump located within the membrane (wall) of each cell. This pump , called the V-ATPase proton pump, moves positively charged subatomic particles like hydrogen protons across the cell membrane. When tumors are active, the pump becomes very active, transferring protons over and when this happens, the excess protons make the outside of the cell ACIDIC.

When the tissue surrounding the tumor now becomes more acidic, the pH goes down. This acidic pH encourages the matrix around tumor cells to weaken, allowing tumors to easily grow, break off , spread or metastasize. [1,2,3]

Acidic pH also can neutralize some chemotherapies which are alkaline, making the chemo drug less effective. [4,5]

Baking soda cancer cures - are they real?

A few trials studying the use of pH /acid regulation in mice with tumors showed no improvement in shrinking tumor size although some studies did show some slowing down of tumor spread.

I am referring to the studies where scientists ( Robey, et al) injected breast cancer cells into the tails of laboratory mice and then treated these tumor bearing mice with bicarbonate (this is where the famous baking soda cancer cure rumors began) . They did this because they wanted to try and bring the mice's blood pH up (high pH means less acidic or in other words, it is alkaline).

When they did this, they were surprised to find out that in the mice treated with baking soda , the blood pH did not change. In other words, there was no effect on blood acidity.

The tumor sizes also did not shrink.

The tumors continued to spill into the blood stream and the baking soda did nothing to stop this process.

The tumors also continued to grow and multiply.

However they did notice that the mice treated with baking soda had less of the tail tumors spreading to their lungs.

To summarize, they found that although the mice had less metastases "tumor spread", they also found out that their tumors ( the source of the acidity) did NOT shrink. [6,7] The lower acidity did NOT have any effect on delaying tumor growth and was ineffective in diminishing tumor size. And when they repeated the experiment using a different tumor, they discovered something else.

When they used melanoma cells instead of breast cancer cells, they discovered that the bicarbonate had no effect whatsoever in preventing tumor spread from the tail to the lungs.

This trial was not attempted in larger animals, nor was it ever tested in humans.

Baking soda does NOT cure cancer!!!

When we say cure, it means the tumor is gone, and gone forever.

From an insider's perspective I can safely tell you that this is not even close to a cure.

Although "baking soda cancer cures" sound promising, in reality there is very little evidence that it does work. The existing evidence is extremely weak and has not been tested further in humans. The dosing, scheduling of doses and safety issues were also not tested . Without human trials to back up this theory, this approach is probably going to be ineffective , and possibly even dangerous . In other words, I would not bet my life on it!

When someone starts swallowing large amounts of bicarbonate soda, this might lead to uncontrolled metabolic acidosis which can be life threatening and have fatal consequences.

The bottom line goes back to the original question, the CHICKEN or the EGG? In this case, did the CANCER or the ACIDITY come first? It seems obvious to me that the cancer did come first, and not the other way around. Obviously the external environment of cancer cells is acidic, therefore "baking soda cures" will not really help the main problem of the cancer growth since it is not targeting the cancer but rather just the surrounding acidity. If a fireman douses water on the periphery of a fire but forgets to destroy the center of the fire itself, it becomes a losing battle.

So before you rush out to your local grocery store to buy a box of Arm and Hammer, think again. The better approach to controlling acidity is by stopping the source of the acidity, and what better way to stop GLYCOLYSIS than by holding back on dietary glucose?

*disclaimer

1. Coussens LM, Fingleton B, Matrisian LM. Matrix metalloproteinase inhibitors and cancer: trials and tribulations. Science 2002; 295: 2387–92

2. Raghunand N, He X, van Sluis R, et al. Enhancement of chemotherapy by manipulation of tumour pH. Br J Cancer 1999; 80: 1005–11.

3. Andreev OA, Dupuy AD, Segala M, et al. Mechanism and uses of a membrane peptide that targets tumors and other acidic tissues in vivo. Proc Natl Acad Sci U S A 2007; 104: 7893–8.

4. De Milito A, Fais S. Tumor acidity, chemoresistance and proton pump inhibitors. Future Oncol 2005; 1: 779–86.

5. Murakami T, Shibuya I, Ise T, et al. Elevated expression of vacuolar proton pump genes and cellular pH in cisplatin resistance. Int J Cancer 2001; 93: 869–74.

6. Robey IF, Baggett BK, Kirkpatrick ND, Roe DJ, Dosescu J, Sloane BF, Hashim AI, Morse DL, Raghunand N, Gatenby RA, et al: Bicarbonate increases tumor pH and inhibits spontaneous metastases. Cancer Res. 2009, 69 (6): 2260-2268. 10.1158/0008-5472.CAN-07-5575. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2834485/

Disclaimer: This is general information and not medical advice. Results may vary from person to person.

Weight gain – too much of a good thing?

Fri, 25 Mar 2022 22:20:15 GMT

Cancer nutrition direly needs major changes. How we advise our patients and loved ones on proper eating habits during cancer care may be the key to their success or failure. One common observation is the need to push calories during meals and snacks. There is also the common belief that cancer patients eating sugar loaded food is a harmless activity.

CHEMOTHERAPY COMFORT BAGS

If you or a loved one has had cancer and needed chemotherapy, you must be familiar with those " chemotherapy comfort bags ". You know, the ones that we pass out to patients in the chemotherapy suite. Our bags contain snacks, usually a fruit or a high energy protein bar. These bags may contain oatmeal or chocolate chip cookies, a juice and fruit cup, potato chips, and a "white bread" turkey or ham sandwich.

In the middle of the large room where we administer the chemotherapy, we have a table where patients can freely help themselves to light saltine crackers, sticks of cherry red licorice, mini chocolate bars and a huge jar of peppermint candy mints. Occasionally the volunteer service staff would visit the patients and bring up a warm tray of fresh oatmeal cookies and icing laced donuts plus carafes of free hot chocolate.

Holiday cookies from grateful families of patients are plentiful and occupy every nook and cranny.

For those common bouts of post chemotherapy nausea, we also provide an unlimited supply of chilled ginger ale or soda pop (gasp).

Patients who cannot eat due to radiation induced mouth sores or with tumors blocking their airways or stomach, have take in only fluid. In most cases this consisted of orange or packaged apple juice, and of course, flavored and high sugar containing protein drinks such as "Ensure or Boost." Weight gain is clearly recognized as a desirable goal.

These nutritional choices constantly remind me of the days when ashtrays were an integral part of a doctors office. These days, you will be hard pressed to even find one.

For now, weight gain and the abundance of sweet comfort foods are still looking pretty "harmless". OR AREN'T THEY?

SPIRALING WEIGHT LOSS

For years the traditional cancer diet's goal is to promote weight gain. By this we mean a diet high in calories, carbohydrates, and of course, glucose. Not so surprisingly, for most patients, this approach is usually futile. The more calories you feed the cancer, the healthier "it, the cancer" becomes. At the expense of the patient, the body gets weaker and weaker despite the onslaught of calories. Feeding cancer high calorie and high glucose containing food is like adding fuel to a flame. I believe the better approach to combatting cancer weight loss is to target the "cause".

A ketogenic diet will feed the normal cells but because cancer cells lack the mitochondrial machinery to effectively process fats and protein, the absence of carbohydrate will theoretically starve the cancer cells.

SUGAR FEEDS CANCER - how much of this is true?

Around five years ago, a patient of mine came to me and said, "Doc, did you know that sugar feeds cancer?" Rubbish, man. Where did you hear such a ridiculous idea? At the time I defended the prevailing wisdom, which is the basic need for glucose. How can your body fight the cancer without energy from glucose? To be able to fight cancer, your body must strengthen itself with calories! As you can see, I changed my tune not too long after that! Glucose and cancer- the inside story

I remember some of my past patients who have by now passed on. My favorite guy would regularly have a large (32 ounce!!!) "BIG GULP" tumbler filled with ice cold soda by the side, sipping it throughout the day while awaiting chemotherapy to completely drip into their tired veins. I would remind them that their choice of drink was not exactly nutritious. They would respond that the drink was "for hydration and the caffeine is for energy, doc". "But do you know that this drink of yours is loaded with as much as 64 grams of sugar? " Sugar content of soda

Rainbow colored soda drinks contain nothing more than sugar, high fructose corn syrup and food coloring.

These patients clearly had serious problems going on. Add to this the general public feeling is that sugar is harmless. In fact, we encourage sugar and weight gain during cancer treatment. What I did realize was that these same soda pop drinking and overweight patients all performed very poorly while on chemotherapy.

Despite the success of the newest forms of chemotherapy , I find out too often that these wonderful clinical remissions last for only a short while. None of the latest monoclonal or the anti programmed cell death antibodies promise home run cures. The cancer no doubt will rear its ugly head again, reminding us that the chemotherapy once again, did not work. The therapy is simply another fire extinguisher used in a forest fire. We need to somehow destroy the source !

Chemical and hormonal signals which are present in the blood can fuel the growth of many tumors. Drug companies are now making new "targeted therapies" which can stop these signals / hormones. They are effective but we all know that there are still many failures even with the new drug. One reason behind this is that patients fail to make lifestyle and dietary changes. If we improve our diet and exercise and sleep more, we cut back on those signals the natural way and help these drugs to work even better!

DIETARY TIMING

The best time to begin this low carb ketogenic diet approach is when the patient is still healthy, not yet losing weight and has no symptoms. In other words, START EARLY. The weight loss involved in this diet is considered healthy weight loss, and is expected to plateau after it reaches the optimal healthy level. A patient who is already on the downhill spiral of weight loss will continue to lose weight despite increasing their caloric intake. At this point, this low carbohydrate dietary attempt might be too little, too late.

IS A LOW CARBOHYDRATE DIET SAFE FOR CANCER PATIENTS?

We recently completed our small trial of the Atkins diet in advanced cancer patients and it looks this diet and the resulting weight loss is safe and possibly beneficial. ( Modified ketogenic diet clinical trial )

Weight gain versus weight loss ?

For the first time, medical staff are beginning to realize weight gain could actually be undesirable.

CHANGE IS FINALLY COMING

Enough is enough! So...when is the change coming?

Boldly, I tried to negotiate and convince our dietary department and nurses to get rid of the sugar cookies and replace them with low carb options. "These chemotherapy care bags need a major revamp"! I declared. Why can't we swap the sweets for something else? Hard boiled eggs, maybe?

Our dietician responded, "No, the salmonella risk is too real. We can only serve scrambled eggs but that would be too inconvenient." I suggested, "How about substituting the donuts with other stuff, like cheese sticks and jerky?" Low carb? With a shrug, she said, "Sorry, we don't have direct control over these chemotherapy care bags. They simply come up from the main kitchen, already preassembled."

Well today, I was pleasantly surprised when I later opened my email inbox and found a message from who else, our dietician! She happily announced that the canteen will be soon delivering to us specially marked white papered chemotherapy care bags. Instead of white breaded sandwiches and potato chips, these revamped bags will have only low carbohydrate snack items. Our first trial run will supply bags filled with celery sticks, carrots, cheese and beef sticks, with low fat ranch dressing.

Low carbohydrate snacks during chemotherapy

Yes! Progress at last! But wait, they are only providing us with a "trial run" of three (3) bags. Only three bags? Well, she explained, due to the expected unpopularity of these low carb options, dietary staff worries about having too many unclaimed bagged treats going to waste. " If no one takes them, these bags will be discontinued. "

Hmm, certainly, we cannot allow this wonderful idea to fizzle off! I made sure to promptly notify all of my motivated patients who are already on the low carb diet, of the impending availability of these chemotherapy care bags. They clearly are getting very excited. I am excited too. If this catches on, we will be officially the first hospital to do so.

Pushing for excess weight gain should no longer be a major concern.

And when will the candy jar join the ashtray? Hopefully the exodus has begun.

The RAS cancer switch – Can we turn it off?

Fri, 25 Mar 2022 22:19:14 GMT

Is there such a thing as a cancer switch? Faced with a new diagnosis of cancer, one often wonders how it developed , and if there was indeed such a thing as a cancer switch, how to turn that switch off?

RAS ONCOGENE

Yes Virginia, there is such a thing as a cancer switch, and the RAS protein is one of them. RAS stands for "Rat Associated Sarcoma virus protein" a very tiny cancer causing protein that was discovered in the rat sarcoma virus. In the normal cell, it is inactive but when this protein develops a defect or "mutation", it no longer controls regular cell division and now makes cancers very aggressive. ("Oncogene" means Onco-"Cancer" + gene. )

This is only one of the reasons why some cancers are so difficult to treat. And also why many cancers respond to regular chemotherapy for only awhile, only to relapse just a few months later.

CONTROLLING THE ENTRY OF SIGNALS

The RAS protein attaches to the inside of the cell membrane, and waits for signals coming to the cell surface from outside the cell.

Like a doorman sitting inside the entrance of the doors of a department store, the RAS protein waits by the door and decides whether to allow the signals coming through the door, into the rest of the store. Once they approve the visitor, they lead the signals into the inside of the store through a long pathway, until they reach the inner storeroom ( nucleus or brain of the cell ). There the nucleus makes more proteins, which eventually produce more new cells.

A BROKEN CANCER SWITCH

A CANCER IS BORN

When there are too many cells, the RAS protein decides to turn away new signals, in order to prevent overcrowding inside the store. It does this by deactivating itself by binding to a G protein called GDP which is a small portion of your DNA. When there is a defect in the RAS protein, it binds instead to GTP and it loses the ability to deactivate itself and as a result the doors to the cell remain perpetually open. In other words, it stays active. Signals keep coming, and the cell keeps sending these signals endlessly through the pathways into the the inner cell, and tumors are born. Cells cannot stop dividing.

This RAS protein is the cancer switch that now failed to switch off!

RAS cancer switch When attached to GTP, it turns on, causing cancer to grow, Attached to GDP, becomes inactive, and cancers stop growing.

Nowadays, every other flip of a magazine page brings me to an advertisement of the latest fashionable cancer drug boldy emblazoned in glossy print. Theses ads somehow are promising us that a cancer cure is finally on the horizon.

New biologic agents promise to target the tumor signaling pathways that encourage tumors to grow, divide and invade. Sounds like a winner eh? Chemotherapy to kill the cells and biologic agents to block the receptors and signals? But wait, there is one problem that needs to be addressed and that is the tumor "Switch". Even if you block one of the pathways, or even if you block one of the doors ( we call these doors tumor receptors) , cancer treatment can continue to be ineffective due to the presence of other doors and pathways.

There are also so many pathways, and if you happen to block the correct pathway, good. But if another pathway takes over, then the tumor will probably resurface.

FINDING A CURE

Is there a way to cover all the pathways? How about a drug to deactivate the cancer switch - RAS protein? A RAS blocking drug would be nice. Something to turn the cancer switch off.

Scientists are working overtime, trying to find out the correct combination of biologic drugs. Does it make sense to combine these new biologics with conventional chemotherapy in order to find a better cure?

Could a ketogenic diet (that helps tone down some of these tumor signaling pathways) be added to a RAS inhibitor drug? And could this plus chemotherapy (to kill tumor cells directly) be a winning anti cancer combination? The future is still bright and exciting things are in the horizon.

Ketogenic bread – My first attempt at flax meal bread

Fri, 25 Mar 2022 22:18:30 GMT

Ketogenic bread. I am so excited to share with you my latest kitchen adventure - Making low carb, guilt free flax meal bread. Over the weekend I was attacked by a craving for bread but instead of heading to the grocery store, I decided to make it myself! Knowing that this kind of specialty bread costs about $7 a loaf in our neighborhood gourmet supermarket, made me doubly motivated...

Armed with my laptop, I consulted Google and found this online ketogenic bread recipe which unfortunately had mixed reviews. However I was attracted to it due to the simplicity of the ingredients and by the fact that this low carb bread recipe did not require any kneading or yeast.

It actually turned out fine, and was ready in less than an hour.

All right, the first attempt actually took 2 hours because I kept removing the loaf from the oven and it kept failing the knife test for doneness. I ended up doing this twice. Both times it did come out nicely browned and crusty on the outside, tender on the inside, like bread should be. The aroma of the spices helped. If I had to do it again, I would probably add a pinch of cinnamon. My daughter volunteered a bite and after a few seconds came her polite verdict-

"Not bread, but not bad!".

Hmm, but in my opinion, this ketogenic bread has a bit of a nutty flavor and it tastes great!

FLAX MEAL KETOGENIC BREAD RECIPE

Ingredients:

2 cups flax seed meal

https://www.amazon.com/Bobs-Red-Mill-Organic-Flaxseed/dp/B00MFC5GCI/ref=sr_1_9_a_it?ie=UTF8&qid=1487113026&sr=8-9&keywords=ground+flax+seed+meal

2 teaspoons baking powder (gluten free baking powder is also available if needed)

1-2 teaspoons Italian seasoning ( I had parsley, basil and oregano on hand)

1 shake of lemon pepper

5 eggs

1/2 cup water

1/3 cup olive oil

Measure out the dry ingredients and mix in a separate bowl.

Mix the eggs, water and oil using a blender for 30 seconds or until very frothy.

You will want it very bubbly, so keep the mixture airy.

Combine the egg mixture with the flax mixture until wet. Don't overmix. You want to keep the mixture fluffy. It will appear watery at this point but set it aside for about 5 minutes and you will see that the consistency will thicken. Spoon it into a parchment paper lined loaf pan.

Bake for one hour at 375 degrees until a knife comes out clean. If you want the top a bit more golden brown, add 10 more minutes.

Slice when cool. This can also be toasted if needed. So there you have it, a basic ketogenic bread. Enjoy!

Soupy at first..

After 5 minutes the consistency was thicker.

Packed with omega -3 and protein. Gluten free, sugarless and wheat free.

Sliceable, guilt free bread!

New publication : Ketogenic Diets and Cancer – February 2017 issue Federal Practitioner

Fri, 25 Mar 2022 22:17:31 GMT

I invite you to take a look at my latest publication, entitled "Ketogenic Diets and Cancer - Emerging Evidence". It appears in the February 2017 issue of the Federal Practitioner.

What is this all about?

This review article summarizes most of what we know today regarding ketogenic diets and how they may benefit cancer. It contains a brief history of the ketogenic diet, detailed explanations on how it might work to slow down cancer, and examples of animal and laboratory studies involving the diet in cancer investigation. Also included are human case reports and summaries of existing and recently completed clinical trials involving ketogenic diets and cancer. The link to the online article is available below.

http://www.mdedge.com/fedprac/article/130641/oncology/ketogenic-diets-and-cancer-emerging-evidence/page/0/1

This busy diagram explains how tumor signaling can be better adjusted by using a ketogenic diet. Glucose can increase cancer growth signals. Apoptosis refers to cell death. Overactive glucose metabolism can disrupt this and in addition to promoting growth, can also make cancer cells escape cell death.

Can ketogenic diets replace chemotherapy?

While many would conclude that diets can "cure" cancer, it cannot. At least not yet. The trials listed in this article are still going on. Many of the completed ones, tested for safety and tolerability only, and did NOT specifically test whether the diet can actually improve a particular cancer. Follow the advice of your cancer doctor. Chemotherapy and radiation are still very much the treatment of choice for cancer. Diet changes (low carbohydrate or ketogenic diets) are meant to be used in addition to chemotherapy and radiation, and not to replace them!

Ketogenic diets, are they safe?

Yes, based on the available completed safety trials, ketogenic or low carbohydrate diets are probably safe to use in cancer patients who, other than having cancer, are otherwise in good health! The diet however, is not easy to follow. A family member who is highly motivated to help, can be a key factor to successful dieting.

Is this diet right for me?

Results may vary. Always consult with your medical oncologist (cancer doctor), whether this diet is right for you. It needs motivation, good health ( other than the cancer), and close monitoring by your doctor ( to check for cholesterol, uric acid, and glucose/ketone levels) in order to be successful.

Maximizing ketosis – Examining the old research

Fri, 25 Mar 2022 22:16:46 GMT

Maximizing ketosis. Aside from being on a ketogenic diet, what else can one do in order to be as "ketogenic" as possible?

SOME BASIC SCIENCE BACKGROUND

The body normally produces ketones in the liver. What are ketones? ketones

When the body produces more ketones than it can excrete , we begin to see high levels in the blood or urine. This is ketosis .

EXPLAINING THE LINGO

IS IT IN THE BLOOD OR IS IT IN THE URINE?

(Emia vs uria)

Hyperketon uria –“Hyper (too much), keto (acid that is produced during fasting), uria (in urine)- in other words, amount of ketones ketones found in urine.

Hyperketon emia - hyperketone (many ketones) + emia (in blood) – from the word “heme or hemoglobin which is what makes blood red- in other words, hyperketonemia stands for “amount of ketones found within blood”.

THERE ARE THREE MAIN TYPES OF KETONES

The ketones are of three main types and are formed inside the liver. They have special names that set them apart and are called acetoacetate, acetone, and beta-hydroxybutyrate.

These ketones all come from Acetoacetate, which is also found in the liver. Of the three, beta-hydroxybutyrate would be the most abundant measurable ketone seen in human ketosis.

TRACKING YOUR KETONE LEVELS

At the beginning of ketosis, the first substance to appear is acetoacetate. As ketosis increases, you begin to see beta-hydroxybutyrate. When I monitor for ketosis during a ketogenic diet, I like to measure the serum for beta-hydroxybutyrate, or BHB for short. Urine tests measure acetone and not BHB. I prefer to measure blood ketones , not urine. Blood tests measure BHB, which is a better indicator of a higher level of ketosis. We can measure BHB ketones by drawing blood in the clinic and sending it off to a special lab, or a more convenient way would be via finger prick blood testing using a home ketone monitor which you can buy online. Urine tests for ketones measure acetone and not BHB. You might detect acetone but a better test would be for BHB.

DIABETIC KETOACIDOSIS -

NOT THE SAME AS NUTRITIONAL KETOSIS

DIETARY ketosis is different from DIABETIC ketoacidosis ( DKA ) that is seen in uncontrolled diabetes, which can be a dangerous thing. Fortunately with dietary/therapeutic ketosis, the levels do not get high enough to be life threatening. Diabetics who go on a ketogenic diet, find that not only do they lose weight , their glucose levels may become more controlled. Caution must be taken though if you are diabetic, and already on anti diabetic medications like insulin or glipizide. The resulting lower glucose levels might mean greater risk of very low glucose levels and might result in lightheadedness and dangerously low glucose levels in diabetics on medication. Always consult a doctor when trying the ketogenic diet for the first time! This is a medical diet, not a fad diet, and should be monitored medically to be safe and successful.

NUTRITIONAL KETOSIS

ACHIEVING KETOSIS VIA FASTING or a HIGH FAT DIET

FASTING OR STARVATION

The quickest way to becoming ketotic is via fasting , starvation or in other words, by not eating! One could fast from solid food for 14 to 18 hours and quickly reach ketotic levels but must keep up with their hydration and drink water or low calorie broth.

HYDRATION IS IMPORTANT TOO- DRINK!!!

Drink plenty of water. If you find yourself drinking less than a liter a day you can quickly LOWER ketosis, (antiketogenic) therefore it is important to take enough water to keep well hydrated during periods of fasting. Fasting also has a "diuretic" effect , meaning it makes you want to urinate or “pee” more. Too much urine output will lead to dehydrations and lower ketosis.

KETOGENIC DIETS

Another way to ketosis is by taking in more fat compared to protein or carbohydrates. This is generally what we call a ketogenic diet. In the 1950s and 1960s, experimental studies on human subjects used diets that consisted only of oleomargarine and saltine crackers which provided 1000 to 2000 kilocalories a day, out of which 900 came from fat, which would be roughly equivalent to 20% of carbohydrates, 2-5 % protein, and 75-78% from fat . Sounds a bit extreme to me!

SOME PEOPLE ARE BETTER KETONE PRODUCERS THAN OTHERS

The scientists also found out something interesting. After consuming this type of diet, not all of the young men in their studies had ketosis. Inspite of the fact that they all ate the same diet, some were not ketotic at all while others achieved high levels of ketosis. It appears that other hidden factors came into play, and diet was not the only driving force. After 7 days of starvation some of the men measured ketone levels as high as 7 mM/L while others only made 1 mM/L.

MEAT EATERS

Another ketogenic diet regimen used during the late 1950s/1960s contained only dried meat and lard, which meant that 70 % was fat and 30% was protein, with zero carbohydrates! You can clearly see however that with a diet like this, ketosis will be achieved easily, but the overall nutritional content might need more attention .

TYPES OF MODERN KETOGENIC DIETS (1990s-2017)

I wrote about this previously, ( diets )but will go over them again. Nowadays, the ketogenic diets are used in children with uncontrollable seizures. Nutritionists made these diets more pleasing and use more ingredients other than just saltines and margarine. You can probably find a lot of these online. These diets still contain an overwhelmingly high amount of fats (70-75%), and lower amount of carbohydrates ( 5-10%). The rest of the diet contains the protein (~20%). When using a ketogenic menu, all ingredients are weighed, and not simply measured with a spoon or cup.

In the 1980s and 1990s, the Atkins diet became popular, this means limiting the daily amount of carbohydrates to 20-40 grams daily, while allowing more proportions to fats and protein. While ketosis can be achieved, the levels may or may not be as high as with a strict ketogenic diet.

This is the same as the Atkins diet. Fats are 60% and Carbs are 10% of the diet. Contrary to belief, Atkins does not have to be high in protein.

Strict ketogenic diet. Notice the large proportion allocated to fats. 70-75%

POST EXERCISE KETOSIS, WEIGHT AND KETOSIS

WEIGHT DOES MATTER- Less is more

Weight and exercise also can affect ketosis. When starting the ketogenic diet, most if not all people will lose weight immediately, but because of differences in body weight, not all will become ketotic. Scientists noticed that heavier subjects produced less ketosis compared to normal weight people despite being on the same diet. More fatty tissue appears to be less conducive to achieving ketosis, despite adherence to a strict ketogenic diet. Newer evidence regarding the presence of the hormone leptin, which is found in fat, show a link between higher leptin levels and cancer risk.

EXERCISE CAN INCREASE KETOSIS, BUT REST IS IMPORTANT TOO

Moderate prolonged exercise followed by a prolonged rest period, can also quickly produce ketosis. During moderate exercise, the liver produces ketones while the muscles are busy destroying (oxidizing) them. Due to this balanced process, we don't see elevated blood ketones during exercise. However, once exercise stops, the ketone destruction stops, but the liver keeps producing ketones, therefore the levels now begin to rise. Therefore one has to have a period of rest right after the exercise, in order to see the higher levels of ketones in the blood.

COLD EXPOSURE AND KETOSIS

Cold Temperature appears to increase ketosis.

Patients measured higher levels of blood ketones during winter and they produced less ketones during summer Subjects who were exposed to extreme cold (8-14 C) also produced more ketones than those who were exposed to warm (21-25 C) temperatures.

Winter ketosis versus lower ketones in summer

The cold exposure appears to trigger the pituitary gland ( pea sized gland in the brain ) to increase catabolism ( opposite of anabolism ). Catabolism is a breakdown of energy.

Increased catabolism will lower overall blood glucose while at the same time, increase blood and urine levels of ketones

SUMMARY - MAXIMIZING KETOSIS -

HOW TO?

See your doctor first, then get a good menu plan

Seems like the key to success is to get together a decent menu plan or diet plan , monitor one's weight, and see a health professional first before embarking on any diet, especially if it is a ketogenic diet.

Diabetics , take some precautions

Diabetics should be especially aware that this low carb approach might lead to dangerously low blood glucose / sugar levels. We can avoid this by cutting back on some of the glucose lowering medications. It is probably a good idea to have a doctor supervise you while you try to do this.

OTHER THINGS THAT CAN HELP BESIDES DIET

Losing some weight will help in maximizing ketosis. A target goal of BMI (Body Mass index) 29 or below . We calculate BMI using body height and weight. If the weight is too much for the height, the BMI rises.

Obese people will have larger BMIs. There are many online BMI calculators that one can use to estimate the correct weight for one's height.

Here is a handy BMI calculator:( BMI calculator )

Exposure to cold climates can increase ketosis. There is some decent research behind it. See this interesting JAMA paper . I thought this was pretty much " Vintage research" , but this is understandable because very little research was done on ketosis between the 1960's-1990s!

Daily moderate exercise followed by rest is another achievable goal. A daily half mile or mile walk followed by a few hours of rest should be decent exercise for most people. People with heart disease or high blood pressure should see a doctor before trying any strenuous exercise regimen.

Keep well hydrated. Drink at least 2 liters of water daily. Anything less than a liter a day is antiketogenic. Take into account the body weight. More weight means you need to drink more in order to keep hydrated.

SUMMARY

A brisk early morning walk gives you the benefits of the previous night's fast (assuming it is 7-8 hrs minimum). Eat dinner early (~before 6 pm). Take a nice long walk in the cold (winter preferred) air. This will keep the heart pumping !

Don't forget to take a long rest after the exercise.

During the exercise, we produce no ketones. It is only after the exercise ends that we see ketones rising during the rest period!. This exercise + fast strategy will quickly help the " get-into-ketosis-quick" plan. Add to that, drinking at least a liter of water will improve hydration and boost ketosis!

BLUE LIGHT CAN BE BAD

Lastly, a good night's quality sleep and shutting down your iPads and iPhones early in the night should help top off your day .

Ketogenic diet-benefits in the elderly

Fri, 25 Mar 2022 22:15:24 GMT

If the ketogenic diet is safe for cancer patients, what about benefits for the ( over 75) elderly dieters? Can they safely try this diet without fear of permanent harm?

Older people are not only weaker , they have more chronic disease .

Conditions like strokes, heart disease, high blood pressure , dementia, and diabetes are common diseases of old age.

However, there is ongoing research which suggest that low carbohydrate diets are not only sin fact, beneficial for our senior citizens .

Ketogenic diet benefits in the elderly - a short list!

1. It is probably safe. Several safety trials now show that this diet is safe to use in cancer patients. Most of the completed human trials were small. None of the low carb dieters showed any serious damage or permanent side effects. Some did follow the diet for over two years without any safety issues.

2. It can improve memory and make you think more clearly. Did you ever have the feeling of lightheadedness whenever you forget to eat? The brain depends so much on sugar that when you suddenly remove it, one begins to feel unwell, feel unsteady and lightheaded. Luckily, within a short time, this momentary discomfort will disappear. The body makes up for this naturally. Fasting or low carb diets will stimulate the liver to produce ketones. Ketone levels rise whenever there is a shortage of glucose or carbohydrates. These ketones are a form of substitute energy. Ketones can supply the brain with enough food to protect it from lasting damage due to low sugar in the blood. This condition is called “hypo- glycemia” = " hypo meaning "low" , and gly-cemia meaning "glucose in the blood".

3. It strengthens the immune system. Mouse models of glioma, a type of brain tumor, show that the diet can improve immunity.

4. It decreases inflammation. Ketosis brings down inflammation, by curbing the production of pro - inflammatory substances called "cytokines" . Elderly patients commonly have joints issues like arthritis and chronic injuries from when they were younger, and the diet can potentially help relieve these symptoms.

5. It can slow down the onset of debilitating nerve (neurodegenerative) diseases like Alzheimers and Parkinsonism. Similar animal models show that ketones can protect the brain from permanent damage. Damage is seen often after traumatic brain injury and strokes. The ketone we are referring to is the type called "beta-hydroxybutyrate". Studies in fruit fly models (scientific name : Drosophila melanogaster) show that ketones can improve poor motility. This is important for research in movement disorders like Parkinsonism.

Fruit flies have a genetic makeup that is very similar to humans, and that is why scientists frequently use them to experiment on human disease, especially for nervous system disorders. Unfortunately, human trials to prove this theory, are lacking. This is because clinical trials based on diets are hard to organize, and even harder to successfully recruit and pull through to completion.

6. It can improve pain from nerve damage. Elderly people often take a lot of medication. Many of these medicines do have side effects, including permanent nerve damage. Mouse studies again show that when ketones are applied to damaged nerve endings,can improve some of the pain. This makes sense because seizure disorders and nerve pain have one thing in common. Both disorders have hyperactive nerve endings . The ketogenic diet is effective because it stimulates the body to produce more of the hormone adenosine. Ad which has an anesthetic and nerve calming effect.

7. It can help improve blood glucose control in elderly with diabetics. This is obvious. Insulin rises when there is too much sugar. Therefore once you cut out glucose and sugar, your body will no longer need as much insulin. You will also need less of your anti diabetes pills. In our recently completed safety trial , a patient with diabetes and high blood glucose became insulin free after only two days of dieting! https://clinicaltrials.gov/ct2/show/NCT01716468

8. It will help people lose excess weight . When there is no glucose or carbohydrate, the body has to start burning fats to produce energy. Therefore one loses weight because of the burned fat. Unlike the unintentional weight loss of terminal cancer, this type of weight loss is healthy .

9. Being Ketogenic saves money! This means buying less junk food, less processed food, and more concentrated efforts to choose healthy , low sugar containing food choices.

One can save on clothes since everything that was once too small are now fitting again.

It is now OK to fire your coach at Weight watchers....

Elderly ketogenic dieters are usually on a fixed income, and any extra pocket money is welcome!

Shopping for ketogenic groceries

Fri, 25 Mar 2022 22:13:12 GMT

Shopping for low carb, ketogenic groceries can be a challenge, especially for beginners. Ketones https://www.ketooncologist.com/tag/ketones-and-cancer-treatment/ are what we produce for energy, in the absence of glucose or carbohydarates.

Make sure you go prepared.

Shopping for ketogenic groceries

Shopping for ketogenic groceries, what to avoid.

Have a list on hand

Once you step into a store, you will see that the front of the store is usually stocked with impulse buys, threatening to immediately make you go off track. Furthermore, if you live in a modern society, ninety percent of the store will be stocked with carbohydrate loaded food. The impulse buys will often include carbohydrate rich snacks like chips, cookies, cakes, and of course sweets. Don't browse, but move quickly past these. At first it will seem that there is nothing "low carb" that one can buy.

Your list should help you make a beeline to the essential items. If possible, know the layout of the store before you step in, to save time.

Look high and low

Check the top shelves and the bottom shelves. This is where the store owner will usually stock the quality, sugar free, basic, (boring) items that you are searching for. The less nutritious (colorful, sugary and expensive junk food) are usually placed in the middle shelves where you might be more inclined to just snatch off the shelf when in a hurry.

Look to the back of the store

Essentials like milk, eggs and butter, are always located at the back of the store. Start first with the items that don't need refrigeration, like fresh vegetables. Plan to shop for the perishables right before checking out. Fortunately, most stores have the fresh produce at the beginning of the store. Green leafy vegetables are also good choices for your shopping cart.

Beware of prepackaged items

Don't assume that these are sugar free. You have to read the labels!!! Roasted almonds for example, can be lightly seasoned with canola oil, and sprinkled with a dusting of sugar. Avoid these. Pro-inflammatory oils like sunflower seed oil, corn oils, vegetable and peanut oils, you should scratch off your list! If it is in a bag or box, there is a high chance that the processing includes many undesired additives.

Just because it's gluten free doesn't mean it's healthy

Gluten free , natural and wheat free does not mean always mean healthy. Again, read the labels. Hidden starches and sugar are in almost everything! High fructose corn syrup, maltodextrin, modified corn starch, dextrose- avoid these ingredients!!!

Are all fruits and veggies healthy for you?

So are all vegetables healthy for you? Not necessarily. Remember, all vegetables have carbs. But some have more carbs than others. For example, potatoes and corn are all high in carbohydrate content and should be avoided , while green veggies like spinach, broccoli and brussel sprouts have less. Because fruits tend to have high sugar content, it is best to avoid these completely if your aim is to be ketotic. Bananas are high in sugar and are starchy, definitely to be avoided. Berries have lower sugar content but all fruit, tomatoes included, should be avoided too if you are still trying to get into ketosis. Onions are high in carbohydrate content , therefore if you need onions to liven up your dishes, remember to use these sparingly.

Juicing, is it OK?

Juices , especially fruit juices are also high in sugar and low in fiber, so choose water instead. If you are a soda addict, try unsweetened sparking water. This will help transition you to plain water later on. Juicing green vegetables is fine, as long as you don't add sugar or fruits to your blend.

Breads and cakes

Bread is synonymous to comfort food in many cultures. I just think we are getting too comfortable!

In our local grocery, the breads and cakes are found right next to the vegetables and fruits.

Whole wheat bread is known to be "healthy for you", but it still contains starch, which means it is loaded with tons of carbs. Therefore if you follow a ketogenic diet, definitely avoid this as well.

Bread addicts, (people who can't live without bread). I think its time to come up with possible substitutes for your dinner table....
If you are used to having a bun or a cup of rice next to your meat or fish, consider swapping the bread for a bowl of salad, and instead of rice, use a cup of buttered stir fried veggies. Mushrooms, chopped up and lightly fried, are also a good rice substitute. For added flavor, sprinkle everything with parmesan cheese.

If you are still not convinced and you absolutely cannot live without bread, or if you are dreaming of having bread occasionally, consider learning how to make low carb options like "cloud bread" and "flax seed bread".

Cloud bread http://thebigapplemama.com/2016/01/no-carb-cloud-bread.html
Flax breadhttps://www.ketooncologist.com/2017/02/14/ketogenic-bread-first-attempt-flax-meal/

Rice

Rice is a staple in Asian households. Diabetes is also the number one chronic medical disease in Asian countries. Here in the USA, rice has gained popularity and more and more families have it as part of their daily meals. When I was in med school, we had to devote one whole day of the week, just for diabetes clinic!!!
What to buy instead? Crumbled cauliflower can substitute for rice and although I've never tried it, can also be turned into low carb pizza crusts. Nice idea, but making cauliflower pizza crusts sounds like a lot of work for me, the cook.
I prefer to simply bake them. Just cut up the cauliflower heads, and stir fry them in butter or coconut oil. Add some parmesan cheese over the hot finished product, and shove the entire pan into the oven for a few minutes, to get it nicely browned.

Pasta

If you crave for pasta, cabbage (cut up into strips) makes a good pasta substitute.
Have you seen the kitchen gadget called "Vegetti maker"? http://tinyurl.com/y9x85pc4 With this nifty gadget you can turn yellow squash or zucchini ito pasta like strips and saute these with butter to make a quick low carb snack.

Spaghetti substitute - spiraled zucchini

Spaghetti squash is available and easy to cook. Just poke it with a knife before microwaving the entire thing for 8-10 minutes , just tender enough to easily poke a knife into it but not overdone, to prevent mushiness. The squash has naturally long spaghetti like fibers which you can scoop out after cooking. Serve with butter, salt and pepper.

What's in my shopping cart?

If I had only 15 minutes to shop, I would run to a familiar grocery store and grab some lettuce, mushrooms, celery, brussel sprouts, green peppers, asparagus, eggplants, green zucchini, avocadoes and of course, cauliflower and cabbage. A couple of whole chickens, packs of tuna, block of swiss cheese and grass fed butter, whole cream greek yogurt, half quart of whipping cream, 5 lbs chicken breast, bag of shrimp, and 2 dozen eggs. If I had more time, full fat cream cheese, sour cream, black olives, artichokes and specialty cheese will also be in my cart.

Resources

There is always room for more learning. I keep on the lookout for online recipes, youtube videos https://youtu.be/Dg35ZcHPC14 and books in the library. http://tinyurl.com/ybw92p4c Many keto friendly recipes are out there. Find one that appeals to you and is easy to implement. Once you shop and cook several times, you will get into the habit and find that your meal planning gets easier.

Meat and cancer risk – What you need to know

Fri, 25 Mar 2022 22:12:16 GMT

HEADLINES: Eating meat is linked to cancer risk

but...

ATKINS DIET DOES NOT EQUAL A "HIGH MEAT DIET"

This is a common misconception. Some people think that in order to go on a low carb Atkins diet, one has to eat high amounts of protein. You can, but it is a matter of choice. Atkins simply means "low carb." As long as you fulfill that criteria, it doesn't matter if fat equals or surpasses protein with the Atkins. Ketogenic diets are a bit more defined, as you will read below.

ATKINS VERSUS KETOGENIC

Many patients come to me with concerns about eating so much meat! "Will this increase my risk of cancer?"

Contrary to popular belief, the low carb diet does not mean that one has to eat high amounts of protein.

When we refer to the Atkins diet, the requirement is that you consume low amounts of carbohydrates, which usually means 5-10% of your daily requirement. The rest is really up to you. The remaining 80-90% will be broken down into fats and protein.

When we refer to the ketogenic diet, you also consume low amounts of carbohydrate, but must watch and weigh all your food. The predominant portion of this diet is actually FAT, not protein. Take the total and calculate the proper proportions that go into the categories of FAT (65-75%), PROTEIN (20-30%) and CARBOHYDRATES (5%).

TYPES OF MEAT

Red meat usually refers to beef, lamb and pork.

White meat refers to poultry (chicken, duck,turkey) and fish.

Processed meat: These are usually the meat that you see in delis, preserved and salted meats. Bacon, salami, sausages. These usually have special plastic packaging and are labelled. Check to see if they have the ingredient "SODIUM NITRITE." This is used as a preservative, and can be carcinogenic (cancer causing). It is added in order to prevent food poisoning, and to prevent botulism, another bacterial contamination which can make the meat deadly. Unfortunately, this preservative can encourage cancer to develop.

PROCESSED MEAT, RED MEAT, AND HOW IT CAUSES CANCER

How does meat increase cancer risk? And what types of cancer?

According to the World Health Organization (WHO), colon cancer is the third most common cancer in men and the second most common cancer in women. Over half of these cases are seen in highly developed, industrialized countries.

The American Institute for Cancer Research recommends avoiding processed meat like ham, salami, bacon, sausages and hotdogs. These processed meats have preservatives such as sodium nitrite.

Red meat contains chemicals called nitrosamines, which is linked to colon and stomach cancer.

Red meat also contains "heme," the molecule present in the muscles of meat, which also gives meat its color. This is also what is found in our blood, and is what helps carry oxygen around within our bodies. Poultry and fish also contain some "heme" but it is TEN TIMES (10X) LESS. When the body digests the heme, this molecule is broken down and the"iron" that is trapped within it is released.

This "heme" iron can cause damage by triggering the production of "reactive oxygen species" (ROS) which can then damage the body's DNA, and promote the formation of cancerous cells.

Heme can also promote lipid peroxidation (breakdown of fat) which leads to another cancer causing chemical called malondialdehyde.

COOKING MEAT, THE DANGEROUS WAY

Cooking meat at very high temperatures (grilling, open flames, roasting, deep frying) can trigger formation of cancer causing heterocyclic amines and PAH polycyclic aromatic hydrocarbons (types of chemical compounds formed during the high heat cooking process) that can cause cancer.

HOW MUCH MEAT IS TOO MUCH?

The American Society of Clinical Oncology recommends that people can eat up to 18 ounces (500 grams) of red meat (beef, lamb, and pork) a week (or 70 grams per day) without raising cancer risk.

EATING MEAT TO BEAT CANCER

WHITE MEAT CAN BE GOOD

White meat (poultry and fish) are not associated with cancer risk. In fact, increased intake of fish is somewhat protective.

PROTECTIVE FOODS

Rats were protected from developing colon cancer when they were fed supplements of calcium and alpha-tocopherol (tocopherol has Vitamin E activity and is found in olive oil and sunflower oils, European diets).

GRASS FED BEEF and GOOD FATS

The difference between grass fed cows and corn fed fed cows is in the amount of omega-3 polyunsaturated fatty acids (AKA good fats, like those found in fish and flax seeds) found within their meat. Grass fed beef has more omega-3's compared to omega-6 fatty acids (bad fats, linked to inflammation). They also have higher levels of antioxidants which have anti-cancer properties. So in this case, eating grass fed beef could be more beneficial than NOT eating beef. The grass fed cattle industry is growing, another sign that people are indeed taking note, and buying this type of meat.

COOKING THE SAFE WAY- USE MODERATE TEMPERATURES

Boiling, steaming, and baking are safer alternatives over grilling, roasting and deep oil frying, which we mentioned earlier are cooking methods that can produce cancer causing compounds in your meat!

So, next time you fill up your dinner plate, relax, use your new found knowledge, and don't be shy to include some beef!

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References:

World Cancer Research Fund and American Institute for Cancer Research, Food, nutrition, physical activity and the prevention of cancer: a global perspective.Washington DC: AICR; 2007

Corpet DE, Meat Sci. 2011 Nov;89(3):310-6 Red meat and colon cancer:Should we become vegetarians, or can we make meat safer?

Sesink AL, et al. Carcinogenesis. 200 Red Meat and colon cancer: dietary harm, but not fat, has cytotoxic and hyper proliferative effects on rat colonic epithelium.

Akyan NF, Oncol Rev. 2015 Feb 10; 9(1):288 Red Meat and Colorectal Cancer

My dad has a glioblastoma (brain cancer). Will the ketogenic diet help?

Fri, 25 Mar 2022 22:11:13 GMT

Dear Dr. Tan,

Help! My dad was recently diagnosed with brain cancer . It is called a glioblastoma. I was told he has some options but the prognosis isn't good regardless of what he does. I was researching on ketogenic diets and found your trial on clinical trials.gov. https://clinicaltrials.gov/ct2/show/NCT01716468

Do you have the results of your trial published somewhere?

Is the ketogenic diet worth pursuing? Do you have any resources which I can read about on previous trials? Was wondering how effective it is in previous cases of brain cancer like his.

Also, can you please refer me to someone who can advise us on how to do this diet properly? Thank you.

Worried son in Pennsylvania

Dear Worried Son,

I am sorry to hear about your dad's glioblastoma diagnosis. Brain cancer comes in different forms, and grades. The glioblastoma type (also known as grade 4 astrocytoma) is unfortunately the most aggressive type of brain tumor. It is difficult to remove completely by surgery, and relapses early even with aggressive treatment (chemotherapy and radiation).

Compared to tumors from other organs, the brain appears to be highly dependent on carbohydrates as a source of energy. The ketogenic diet limits carbohydrates is already being used as a treatment for seizures. It also happens to be very effective. Studies however are only beginning to emerge in human brain cancer. We still don't have substantial evidence of effectiveness in humans but there is emerging evidence based on scientific work on animal experiments and in the laboratory. https://www.barrowneuro.org/research/research-programs/brain-tumor-research-center/scheck-laboratory/tapping-the-ketogenic-diet-to-fight-brain-cancer-scheck-lab/

I find this to be very exciting.

Our trial did study humans but it focused on safety issues and quality of life. It has already ended and the results were published last year in the journal Nutrion and Metabolism. You can read the original manuscript here. https://nutritionandmetabolism.biomedcentral.com/articles/10.1186/s12986-016-0113-y

Keep in mind, this trial that we completed does not provide data on efficacy. It is mainly a safety and feasibility trial.

In this trial, we recruited 17 patients , all were male and all were US veterans, with a diagnosis of advanced or metastatic solid tumor cancers. It was not a trial for glioblastomas but rather a trial that recruited all sorts of solid tumors. Some of the patients did have a brain tumor diagnosis. We had them all undergo observation while on the Modified Atkins diet. They actually did well, with no significant serious side effects. Although only 4 patients dieted until 4 months and beyond, all patients did achieve some degree of ketosis during the first three days. As far as solid data regarding whether this diet actually helps halt or slow down the growth of brain cancer, or any cancer for that matter, we don't have any solid data other than that seen in animal studies.

I am hopeful that in the near future, many more trials will be completed and give us more evidence that this diet does help in the fight against cancer.

You can read more about the existing evidence and ongoing trials being held elsewhere , in my latest publication. https://www.ketooncologist.com/2017/03/05/ketogenic-diets-cancer/ which is a review article on ketogenic diets and cancer.

Keep in mind, the Modified Atkins diet is a form of ketogenic diet, but they are not exactly the same.

Proportion of carbohydrates, fats and proteins . Different diets for cancer patients.

They differ in the proportions of fats, protein and carbohydrates. One thing for sure, the carbohydrate proportion is indeed low! As far as a qualified nutritionist, I suggest that you first get in touch with your hospital or oncologist's clinic. They can probably refer you to one. Most ketogenic diet oriented nutritionists however are based in childrens hospitals, where the ketogenic diet is currently being used for the treatment of seizures. Unfortunately it still is not considered a standard diet for glioblastoma patients.

Hope this helps.

KetoOnc

What can I EAT (or NOT EAT) to fight cancer?

Fri, 25 Mar 2022 22:10:20 GMT

" Doc, WHAT CAN I EAT to help fight cancer?"

Clearly, "eating to fight cancer" ranks among the top 10 questions that patients ask of me during our first consultation.

We all know that diet trends come and go. The "anti-cancer" food industry is robust and well. Facts supporting a certain food usually evolve from basic scientific experiments with sound scientific theory. However, somewhere along the line the facts get distorted and blown out of proportion. A promising food suddenly evolves into a "cure". The food is glorified as a "superfood" and people turn a blind eye to potential side effects. The prices go up, and many susceptible patients buy into this, willing to shell out even more dollars for higher priced items, believing that if it is expensive, then it must be effective! Fortunately for the businessmen behind this, if the "superfood "fails to cure" cancer, the victim will never survive to testify to its failure!

Although many foods do have anti oxidant properties and other anti cancer features, one must be wise and not totally rely on these alone.

PROMISING BUT STILL FAR from 100% PERFECT

In the city of Pittsburgh, many billboards now proudly advertise the latest biological/targeted cancer therapies. While these new drugs now promise better tumor shrinkage with less side effects, the reality is that we are still far from a cure. While many are very effective, relapse rates of many cancers remain high, patients survive longer, and many still eventually die. Drugs are as good as spraying insecticide onto your weeds. Weeds have a special way of coming back even after the initial weed kill. The "cure" will come if you are able to completely uproot the weed itself, or if you eliminated its food/ nutrition and water. In other words, cancer in order to be successful against it, one must eliminate ALL traces of cancer.

A TEAM IS ALWAYS BETTER

A team approach which includes team members- the doctor giving the treatment, the patient making lifestyle changes ( stopping smoking, alcohol, reducing stress and improving sleep and changing DIET) , plus the supportive family , together, the team will work far better in fighting cancer than simply the doctor fighting it alone.

KILLING CANCER CELLS BY FOOD, OR LACK OF......

Early on, scientists during Otto Warburg's era found that if you starved a tumor long enough, fed only with water, the tumor would eventually die. In other words, if you provide NO FOOD, all tumors will DIE. So how can we go around this. There must be a way to starve tumors, yet continue to feed the rest of the body....

KETOSIS

What is ketosis? This is a natural body process that happens when there is no available glucose. The glucose which normal gets used up in the biochemical process called glycolysis. When there is a lack of food, glucose is not readily available, glycolysis slows down, and the body tries to get its energy from other sources, via burning fat stores. The body then produces acids called ketones which are then used for energy. Getting into a state of ketosis is possible by starvation, fasting, or by using a special diet called the ketogenic diet.

Ketogenic cancer diet – Just the essentials

In addition to starving the cancer of nutrition, the ketones also possess anti cancer properties , by slowing down the cell's tumor signaling pathways, and by revving up the pro oxidant, anticancer processes that occur within the cell. In other words, ketones themselves act as a natural chemical with tumor killing actions similar to that of chemotherapy.

DIFFERENT WAYS TO GET INTO KETOSIS

FASTING

The body senses little or no nutrition during periods of fasting. Fast periods range from 6 hours to as long as 24 or 48 hours without food. Water or non nutritious liquids such as broth, are allowed. When blood is examined during these periods, the level of ketones is noted as elevated. http://www.npr.org/templates/story/story.php?storyId=16513299

KETOGENIC DIET

At some point, we will have many dropouts from the ketogenic diet https://tinyurl.com/y7kqngg3. Either the lack of resources or the lack of motivation, makes this approach unsustainable. The ketogenic diet KD allows for 20 grams or less of carbohydrates per day! A less stringent diet, the Modified Atkins diet, also restricts carbohydrates but does not restrict proteins as much as the traditional KD. http://www.mdedge.com/fedprac/article/130641/oncology/ketogenic-diets-and-cancer-emerging-evidence

If the ketogenic diet is not your cup of tea, alternative ketogenic therapies do exist.

DOES "WHEN" ALSO MATTER?

INTERMITTENT FASTING

This consists of breaks from eating, allowing only water or broth, or nothing very high caloric, for up to 24 hours. In between fasting, one eats normally but does not binge or overdulge.http://www.aicr.org/assets/docs/pdf/research/rescon2014/harvie_intermittent-diets.pdf

Fasting periods can vary. One can fast for only one or two consecutive days, or separate these days by 2 or 3 days in between. For example, one can choose to fast every Monday and Thursdays, and eat normally the rest of the week.

TIMED / DELAYED FULL MEALS

Another approach growing in popularity, this is done by spacing out your meals. One can plan for lunch times to land in close proximity to dinner . Eating the first full meal closer to lunch, and dinner close to lunchtime, is a way to ensure a 15-17 hour period of fasting and ketosis per day.

FEASTING ONLY WHEN IT IS DARK?

Studies in rats bearing liver cancer and also rats with sarcoma cancer cells suggest that cancer cells , like people, also depend on a sleep-wake cycle of their own. They found that timing the fasting or reduced calories during the light /wake phase of the sleep cycle, seemed to suppress cancer growth and potentially help increase the effectiveness of chemotherapy. https://www.ncbi.nlm.nih.gov/pubmed/16231323

SUPPLEMENTARY KETONES

I receive many questions about this. Can we buy ketone supplements? Are they effective in bringing up ketosis? https://www.ketooncologist.com/2016/03/15/raspberry-ketones-and-the-ketogenic-diet/

In the absence of actual fasting, and the absence of carbohydrate restriction, these supplements will NOT create a state of ketosis. Ketone supplements may have some weak antioxidant effects. If you are taking these for a supplement, that is fine, but if your goal is to boost ketosis, I do not recommend these due to the high cost in exchange for minimal benefit.

So there you have it. Cancer remains an elusive disease. Seek out the latest therapies. Chemotherapy can be your friend. Treat with all that you have, but when it comes to food and nutrition, having less might be more!

Reviewing the latest cancer detectors- the MassSpec, I-Knife and Shrimp Eyes?

Fri, 25 Mar 2022 22:09:29 GMT

Ever hear about cancer sniffing dogs, or about the wiz kid https://tinyurl.com/yc2oe48fwho invented a nanoparticle coated urine strip that can accurately detect pancreatic cancer? Somehow most of the attention grabbing cancer headlines, gravitate towards news on early detection and away from actual effective treatment.

In case you were unaware, another high-tech cancer detector just made its debut.

On my way to work last week, I turned on my car radio just in time to catch the announcer excitedly sharing another hot medical breakthrough. It was a surgical device (did they say I-knife??) claiming to be able to detect cancer tissue with the touch of a bladed finger, and with near 100% accuracy. Oh no, not again!

MASS SPEC PEN

This newscaster was summarizing a recent article that came out in the Sept 2017 issue of time.com . The famous online magazine described a pen (the MassSpec pen) developed by researchers at the University of Texas at Austin. This fancy new device can detect cancer during surgery, with close to 100% accuracy. The MassSpec pen uses a technology called "mass spectrometry" which can examine the fat, protein and metabolic waste products of cells. How does this work? If you think of soup, not all are the same. Some are broth like, with hardly any meat or vegetables, while others are densely packed with stuff and almost like a bowl of chili. You can tell one soup from the other, just by looking at the ingredients. You can look at cancerous tissue in the same way. Deep within, the tumor cells have a certain molecular profile. Using a single drop of water, the pen uses light shining through the drop to examine the cell’s metabolic profile and determine whether it fits a cancerous pattern. http://time.com/4928010/diagnose-cancer-pen/ Apparently this pen has amazing accuracy (96.3 %) , and is able to scan tumor tissue and examine its protein and fat content, as well as cellular waste products. Fantastic news indeed! Does this mean that surgeons can now more confidently say that they did, indeed, "Got it all?"

LUM015

This type of gadget isn't new. A similar article appeared back in Jan 2016, which showcased a device / probe called LUM015 developed by scientists at Duke University, Massachusetts General and the Massachusetts Institute of Technology. This device claimed to detect cancer by using light to identify cells containing certain cancer markers. https://www.google.com/search?client=safari&rls=en&q=Embden-Meyerhoff&ie=UTF-8&oe=UTF-8

The Mass Spec promises to be as safe as the LUM015. It also claims to be an improvement over the illuminating LUM015 probe, by performing 30 minutes faster. It detects cancer tissue vs non cancer and what is more, it can tell the difference between the different types of lung cancers. It can also determine whether the cancer is new or whether it transferred from another site or in other words, metastatic.

SHRIMP EYES

Engineers and biologists at the University of Illinois at Urbana-Champaign likewise tried to develop a similar device patterned after “shrimp eyes”, which can detect disorganized cell patterns by using polarized light. Cancer tissue is different from normal tissue because in cancer, we lose the orderly pattern of cells lined up in the tissue, These once organized cells now appear haphazardly aligned under the microscope. The polarizing light device appears very promising as a surgical cancer detection tool!

http://www.npr.org/sections/health-shots/2016/11/15/501443254/watch-mantis-shrimps-incredible-eyesight-yields-clues-for-detecting-cancer

SUGAR SNIFFERS

Well, since cancer loves sugar, why don’t they also create a device that detects sugar metabolism?

Apparently some smart fellow already did. Several researchers (Sarikaya, Cohn) have previously developed and studied a surgical probe that can detect glucose tagged to radioactive tracers injected into cancer cells. It works like a mini PET scanner.

How does a PET scan work as a cancer detector? It is like a full body CAT (computerized axial tomography) scan which takes sliced pictures of the body organs, but in PET CT scans, we also inject a radioactive carbohydrate called 18F-FDG fluorodeoxyglucose, into the blood. Once in the blood, the FDG makes its way to the cells and knocks on the “door” asking the cells to let them in. Each cell has a door which only lets sugar (glucose ) in. It is called GLUT or glucose transporter (GLUT1 and GLUT3). Cancer cells happen to have too many doors (too many GLUT transporters/receptors), so it is easy for glucose to enter cancer cells. Once inside the cell, the glucose molecule no longer looks the same. Glucose now gains a new blue antennae called a phosphate group (see the blue arm in the diagram which is a new phosphate arm). It now has a new name, glucose-6-phosphate because of the new phosphate arm now attached to the glucose. https://www.ketooncologist.com/2016/07/20/glucose-and-cancer-the-inside-story/

Glucose cancer detection depends on glucose turning into glucose 6 phosphate or G6P. G6P can't leave the cell and it accumulates enough that the PET scan or the handheld gamma detector will find it.

During fasting the body will realize that it needs glucose and it will try to make change the glucose 6 phosphate to turn back into its original form which is glucose. However, in cancer cells, this cannot happen because the G6P enzyme is in low supply, the glucose does not get metabolized and therefore accumulates within the cancer cells. When you go for a PET scan they will ask you to fast. This fasting will trigger the liver to try to make glucose . The enzyme called glucose-6 phosphatase will now try to remove the phosphate antenna from G6P. Because the glucose is now radioactively tagged, the PET scanner will light up and show us where the tumors are by detecting the areas where the radioactive glucose now lie.

Using Gamma detectors , one can pinpoint the radiation emitted by the radioactive glucose. Scientists found it is a useful tool in colon cancer and ovarian cancer surgery.

ARE ANY OF THESE GADGETS AVAILABLE?

Very interesting. But I have yet to see a cancer detector prototype approved and get into mainstream clinical practice. Time will tell. In the meantime, I think we are better off trying to change our lifestyle and removing the triggering risk factors (smoking, over eating, sedentary lifestyle, lack of sleep) that caused our cancers to grow in the first place!

Balog J, Sasi Szabo L, Kinross J et al Science translational Medicine 17 Jul 2013 Vol 5, Issue 194, pp. 194ra93

Zhang J, Rector J, Lin J et al Non destructive tissue analysis for ex vivo and in vivo cancer diagnosis using a handheld mass spectrophotometry system. Science Translational Medicine 06 Sept 2017 Vol 9, Issue 406 eaan3968

Sarikaya I, Sarikaya A,,Reba R. Gamma probes and their use in tumor detection in colorectal cancer; Int Semin Surg Oncol. 2008; 5: 25.

Published online 2008 Nov 19. doi: 10.1186/1477-7800-5-25

Sarikaya I 1, Povoski SP , Al-Saif OH ,

Combined use of preoperative 18F FDG-PET imaging and intraoperative gamma probe detection for accurate assessment of tumor recurrence in patients with colorectal cancer. World J Surg Oncol. 2007 Jul 16;5:80.

Cohn DE 1, Hall NC , Povoski SP , et al. Novel perioperative imaging with 18F-FDG PET/CT and intraoperative 18F-FDG detection using a handheld gamma probe in recurrent ovarian cancer. Gynecol Oncol. 2008 Aug;110(2):152-7. doi: 10.1016/j.ygyno.2008.04.026. Epub 2008 Jun 9.

Ketogenic diet trials – December 2017 update

Fri, 25 Mar 2022 22:08:25 GMT

I am pleased to note that more and more of the major cancer centers are taking interest in ketogenic diet trials.

The trials cover a vast amount of topics, including neurologic disorders, sleep apnea, autism, migraine, and of course, cancer. A quick search brought up 84 registered trials in total. https://clinicaltrials.gov/ct2/results?cond=ketogenic+diet&term=&cntry1=&state1=&recrs=

As of my last research trial search on www.clinicaltrials.gov, there are 21 total registered ketogenic diet trials for cancer. Out of the 21, 10 are devoted to brain cancers, 8 are actively recruiting, one study for non small cell lung cancer has closed, another for pancreatic cancer is likewise no longer recruiting, and one prostate cancer trial is still seeking applicants.

Majority of the ketogenic diet trials are studying brain tumors

The Midatlantic Epilepsy and Sleep Center in Bethesda Maryland has a trial of the Ketogenic Diet as adjunctive treatment (given after surgery) in brain cancers that relapse. They are looking for the Glioblastoma type of brain cancer, which as we know is a very aggressive type of brain tumor. NCT01865162 Clinicaltrials.gov identifier number. Contact Pavel Klein MD 301-530-9744 email kleinp@epilepsydc.com

Nicklaus Children's Hospital ( AKA Miami Children's Hospital) in Miami Florida is studying the effect of a ketogenic diet in children with malignant brain tumors. NCT03328858Clinicaltrials.gov identifier number ; Contact Jennifer Careers, MS, RDN 786-624-4854 jennifer.caceres@mch.com or Jenny Esteves 786-624-2854 or by email: jenny.esteves@mch.com

Newly diagnosed Malignant Glioma (brain tumor) patients can check out NCT03278249, a safety and feasibility study of the Modified Atkins Diet in treatment of Newly diagnosed malignant glioma at the University of Cincinnati Cancer Institute, Ohio. This study will examine whether patients can successfully produce ketones while on the Atkins diet. Contact the UC Cancer Institute Clinical Trials Office 513-584-7698 email: castle@ucmail.uc.edu

Michigan State University/Sparrow Hospital in East Lansing, Michigan- Dr. Kenneth Schwartz is doing a pilot study of the energy restricted (this is also ketogenic) diet in Glioblastoma Multiform, the most common brain tumor in adults. They will offer the diet in addition to standard of care surgery, radiation and chemotherapy to see whether the diet will add to the efficacy of the therapy and perhaps improve outcomes/delay relapse. NCT 01535911 Contact Dr. Schwartz at 517 975 9547 email: ken.schwartz@hc.msu.edu or Dr. Mary Noel PhD 517 884 0451 email: mary.noel@hc.msu.edu

The University of Liverpool in the United Kingdom is studying "Ketogenic Diets as an Adjuvant therapy in Glioblastoma. " NCT03075514 clinical trials.gov identifier number. They plan to recruit newly diagnosed brain cancer patients with Glioblastoma and after dividing them into two groups, assign one group the modified ketogenic diet (MKD) and the other, a medium chain triglyceride ketogenic diet (MCT). Per their description on the clinicaltrials.gov website, both diets follow the same high fat, low carbohydrate principles, with the MCT diet requiring the patient to consume some fat as a drink instead of solid food. The diet trial will run over 12 weeks. Contact Kirsty J. Martin, MSc, RD +44 (0) 151 529 5593 email: kirsty.martin@liverpool.ac.uk or contact the University of Liverpool +44 (0) 151 794 2000

Other Ketogenic Diet trials (Breast, Colorectal, prostate, uterine, head and neck, lymphoma

Memorial Sloan Kettering in New York City is recruiting overweight or obese patients with uterine cancer to participate in a ketogenic diet study. This study is actively recruiting. NCT03285152 Clinicaltrials.gov identifier number Contact Vicky Makker MD 646-888-4224 email: makkerv@mskcc.org or Dr. Abu-Rustum MD 212-639-7051

Prostate cancer patients can try to contact the University of Maryland in Baltimore. Their pilot study is looking for overweight prostate cancer patients to monitor over 8 weeks. They plan to check blood chemistries while on the ketogenic diet. Tests like testosterone, cholesterol, glucose,and other biomarkers are to be followed via blood testing during those 8 weeks to see if treatment can be delayed by a ketogenic diet. NCT03194516 Clinicaltrials.gov identifier number. Unfortunately they are recruiting by invitation only.

Albert Einstein College of Medicine in the Bronx, New York, has a trial but it still isn't recruiting. It is planning to enroll breast cancer patients. NCT02744079 Clinical trials.gov identifier number. Dr. Eugene Fine 718-904-2639 eugene.fine@einstein.yu.edu or Dr. Joseph Sparano MD 718-405-2555 email: jsparano@montefiore.org

Elsewhere, in Germany, A radiation oncology group is recruiting patients with either breast, rectal or head and neck cancers to participate in the ketogenic diet while receiving radiation therapy, and study potential body changes ( weight, glucose, etc) while on the diet. It appears to be similar to a safety / feasibility type of trial. NCT02516501 clinicaltrials.gov identifier number. Contact Dr. Reinhart Sweeney MD +49 9721 7206420 email: rsweeney@leopoldina.de or Dr. Rainer J. Klement , PhD +49 9721 7206424 rklement@leopoldina.de

Lastly, Chinese investigators at the Beijing Tiantan Hospital , Beijing China are planning but not yet recruiting a study of the ketogenic diet in patients with primary central nervous system (BRAIN AND SPINAL CORD) lymphoma. THey plan to add the ketogenic diet to high dose methotrexate chemotherapy . Contact Dr. Song Lin, M.D. 861067096509 linsong2005@126.com or Dr. Chun Zeng MD 861067096509 zengchun79@aliyun.com

Small cell lung cancer, will the ketogenic diet help?

Fri, 25 Mar 2022 22:07:30 GMT

NEWLY DIAGNOSED WITH SMALL CELL LUNG CANCER AND THINKING OF THE KETOGENIC DIET? WILL IT HELP?

Dear Dr. Tan,

I have small cell lung cancer, and it recently was also found inside my brain. Luckily the surgeons acted quickly and they removed most of the tumor in the brain. Now I am being told that I could still receive radiation, and possibly some chemotherapy. I am afraid of the side effects of chemotherapy and radiation. I am thinking of doing the diet alone, since it is readily available to me, and if I get any side effects, would you think they are small? Also, does this mean that I now also have brain cancer? Will the ketogenic diet help?

Anxious in Idaho

KETOGENIC DIET FOR SMALL CELL LUNG CANCER?

Dear Anxious in Idaho,

I am sorry to hear about your lung cancer. Even though it is also in your brain, you do not have brain cancer. Putting it simply, your small cell lung cancer was born in the lung and part of it decided to relocate to the brain. The stage simply changed, from limited , to advanced.

There are two main types of lung cancer, the nonsmall cell lung cancers, and the small cell variety. This is determined by how the cells appear to the pathologist under the microscope. There are many other types of less common lung cancers but we will limit our discussion to the small cell type.

Lung cancer of the small cell variety responds very well to chemotherapy and in many cases disappears completely after only a few months of treatment. The chemotherapy usually consists of a couple of drugs, Cisplatin and Etoposide, given via intravenous injection every three weeks. With the proper anti-nausea medication (we have several very effective ones now on the market), nausea and vomiting are no longer major problems. The radiation is also offered in some cases and will help shrink the cancer quickly but it will not be a cure either since relapses are very common.

Unfortunately most of these patients will have a relapse of their cancer within the first 1-2 years and eventually die of their cancer. Even with the early stage, which we call limited stage disease, the median survival time is 15–20 months and less than 15% of patients will survive up to 5-years.

With the more advanced stage which we oncologists call the "extensive stage", overall, patients only survive up to 12 months or less and less than 20% will be alive by 2 years.

Because of these dismal numbers, most patients are referred to clinical trials in hopes of benefitting from a new treatments that are not yet available to the public.

I would however, still recommend doing the chemotherapy and the radiation. They are called "standard of care" treatment, and although most patients relapse, it is still worth doing, since a temporary disappearance of the tumor can still mean a valuable improvement in "quality" of life, with "quantity" coming in second.

KETOGENIC DIET SAFETY ISSUES

As far as doing the ketogenic diet, previous small case series and pilot studies did show it to be safe, even in advanced cancer patients.

Long term studies in patients who did the diet for seizure control suggests a possible increase in gout and kidney stones. However, recent articles suggest otherwise, that gout could actually be prevented, by a ketogenic diet. https://www.medicalnewstoday.com/articles/316111.php

KETOGENIC DIET IN SMALL CELL LUNG CANCER

Currently there are no active trials involving ketogenic diets and small cell lung cancer patients.

The only other trial on lung cancer that I know of was conducted in "non-small cell lung cancer patients" and it was terminated recently due to poor recruitment. https://clinicaltrials.gov/ct2/show/NCT01419587

KETOGENIC DIET, IS IT WORTH TRYING IN SMALL CELL LUNG CANCERS?

Unfortunately I do NOT have the answer to that. We really need a clinical trial involving hundreds of small cell lung cancer patients in order to confidently say that a certain treatment will work. However, since the diet assumes that all cancers work on a similar metabolic platform, it is reasonable to think that the diet should "work" in all cancers that possess this type of metabolism, regardless of the organ of origin.

SPECIAL NOTE FOR DIABETICS

Diabetics also can do this diet successfully but under the monitoring eye of a medical doctor. Because most diabetics are on some form of glucose lowering drug such as insulin , glipizide or metformin, it is a good idea to watch the sugars closely because once one gets into a fasting state or ketogenic state, the blood glucose will inevitably drop, and being on these medication, will drop even further. There is the real danger of "hypoglycemia", a condition of having very low blood glucose/sugars ( lower than 40 mg/dl), which can lead to lightheadedness and even a life threatening condition known as "hypoglycemic shock".

An open letter from an oncologist to her patients

Fri, 25 Mar 2022 22:06:46 GMT

Dear New Patient,

Cancer sucks.You are probably still in disbelief, tired, terrified, and maybe even angry. Thankfully, by the time most of my patients arrive to see me, they are already weeks out from the first news of their diagnosis. Spared of this unpleasant job, your diagnosis nevertheless catapulted you here to meet me, a total stranger.Within the span of less than an hour you will share with me more details than your best friend might ever know in a lifetime. Your gastrointestinal symptoms, your two hundred paged medical file and the details of your social and personal life. I realize that you have placed your trust in my education and literally your life in my hands. In exchange I promise to offer you the latest, most effective treatments for your cancer.

Knowing this, I have a few secrets to share with you.Some of you are still recovering from a badly executed "delivery of THE diagnosis". I am sorry that it happened that way, and I wished I could have been the one who delivered the news to you. But what is done is done. I can only help by making things smoother and perhaps more hopeful from this day on.

CHEMOTHERAPY: Despite being a Keto Oncologist, I still do believe in chemotherapy.Some patients come to me already skeptical of chemotherapy, because of a relative whom they believed went "downhill" as soon as treatment began. But is it possible that perhaps they went "down hill" not because of the chemotherapy, but rather because the chemo did not work?Chemotherapy can still provide a cure for many cancers, especially the early staged ones and especially in patients who are otherwise in good health. However, the most aggressive treatment may not always be the best for you.If you are too weak or ill, it might be better to start slow and work your way up to more complex regimens . Clinical trials are a way to get to a new treatment before it is FDA approved. FDA stands for the Federal Drug Administration, which approves drugs before they go out to market.

GOOGLING the RESEARCH : I don't mind if you do some of your own research. In fact it is a sign that you are involved in your care. I'm happy to help you with that too. Googling your research is nice but sometimes is not the best resource since many of the facts could be more than 5 years out of date or worse, flawed. We cancer doctors like to do our research on Pubmed. Sometimes also on Google Scholar. https://en.m.wikipedia.org/wiki/PubMed. If you are searching for a bonafide clinical trial, try www.clinicaltrials.gov The NIH stands for National Institute of Health. Based in Bethesda, Maryland, this is a federally funded facility where the cutting edge cancer research is being done. You don't have to be a veteran to avail of the free medical services. Civilians are welcome. If you are accepted into one of their trials, they also pay for travel expenses and maybe a tiny bit for housing. We also have this big organization called ASCO, the American Society of Clinical Oncology. Once a year oncologists from all over the world attend an ASCO meeting in Chicago to exchange ideas and our members include expert oncologists from all over the United States and all over the world. Most of the ideas that come out of this yearly meeting will eventually go into clinical practice.

FINDING SUPPORT : If you have a solid organ type of cancer, it is a good idea to find and join an online support group. https://www.cancer.net/coping-with-cancer/finding-support-and-information/support-groupsIf you don't have anyone to talk to , a virtual friend with a similar cancer might actually be an emotional lifesaver.If you have a blood cancer, consider the Leukemia and Lymphoma Society. https://tinyurl.com/y6utvpweIf I sent you to see the Palliative Care doctor, this does NOT mean that I am already giving up on you. Although hospice is one of their services, they have other useful things to offer. Counseling, pain management, spiritual support, referral for home nursing services.I do wish that YOU try be part of our team, because you can make a difference!

WHAT TO EAT , or NOT EAT ...Other little things that you need to know….Cereal and oatmeal are no longer my idea of the best foods for breakfast. Too much carbohydrates which when eaten, turn into sugar/glucose. Same with the whole grain muffins and brown bread. Evidence is emerging that eating grain based diets have links to increased inflammation which in turn can promote cancer. Swap your rice, pasta and potatoes for spinach, broccoli and cauliflower.Juicing sounds like it's healthy, but did you know that a glass of orange juice is full of sugar, and low in fiber? If it was shaken in a blender, chances are, it now has very little vitamin C. If you like fruit, I would prefer that you eat the whole fruit itself.Learn to love cheese, and cook omelets with veggies and mushrooms for breakfast. These are low in carbs but high in protein and nutritional value. Eat more green vegetables.Meat is not always bad if you choose well. https://tinyurl.com/y9xj68sySpice up your food with curry, garlic, butter and salt and learn to love seafood.Dairy has lactose which is a form of carbohydrate.Sugar sounds harmless, but it isn't!

Glucose causing cancer – the inside story

Please get rid of your soda habit. It's not just too much sugar, but has artificial food coloring too. Pass over the candy in the chemotherapy suite. Empty calories indeed! Focus instead on nutrition dense food. When the volunteers bring in the tray of donuts , I hope you'd look the other way. When the nurse offers you ginger ale with your chemo, politely ask for diet soda instead. Better yet, ditch the soda altogether and ask for water instead. I don't like ingredients that sound like hardware codes. (Red 40, Yellow #6, etc) . Try to eat fresh , unprocessed food....but, if your cancer is already very advanced, I don't think the price of organic food is worth the benefits. GIVE YOUR THROAT A BREAK : Give up smoking. Or at least try... If you have throat or gut cancer, say goodbye to alcoholic drinks. At least for the next 2-3 years... Did you know alcohol also causes cancer? Despite being common knowledge among doctors, it is virtually an unknown fact amongst the laypeople!LOSING WEIGHT: Exercise more . Lose some weight. Check out this link. https://tinyurl.com/yawlusrjContrary to popular belief, when you have cancer, weight loss can actually be better than weight gain.SLEEP AND EXERCISE: Get more quality sleep and turn down the night lights! https://www.webmd.com/sleep-disorders/news/20170619/is-blue-light-bad-for-your-health If possible sleep during the dark hours. If you have sleep apnea and own a CPAP (continuous positive pressure ) machine, use it. White noise could help you sleep better, without needing a sleeping pill.Exercise. Even 5 minutes a day is better than nothing. Yoga and relaxation techniques sound harmless and might help reduce your levels of stress hormones.ORGANIZE AND DE-STRESSGet organized. Chemo and radiation schedules can be very confusing. Buy a nice journal and write down every important date and appointment. If you are tech savvy, get a calendar app! Make a living will. If you can, appoint a relative as a POA (power of attorney) in case you later can no longer make your own medical decisions. Reorganize your finances and declutter your possessions. The ultimate goal is to reduce stress. (Again, see above). Listen to some relaxing music. In between chemo sessions, go somewhere far for a mini vacation. If you don't have any friends, make new ones. Try not to burn your bridges.Rekindle old friendships and reconcile with distanced relatives. There is no such thing as a perfect family. Besides, you might need their bone marrow one day.... �� https://tinyurl.com/yb6r7oee MY PROMISE : I am glad that you took the time to read this open letter. I might not always have twenty minutes to sit down with you and chat, in fact it seems that I am always running off to something else. I will try to invest as much quality time with you as I can find, even if it is only 5 -10 minutes. This is my challenge as much as it is yours, your future success as it will be mine.

Your Oncologist

Ketogenic Diets , a new Panacea for all illnesses?`

Fri, 25 Mar 2022 22:05:22 GMT

Ketogenic Diets , is this the new Panacea for all illnesses?`

For many of us, the word “cure” means a pill. Panacea- means “cure for all” Pills yes, but food, no. Food hardly ever comes to mind as a possible treatment for disease. I find it fascinating that most people look up to a treatment that is the size of a tiny pill and believe that it will be a cure, while ignoring the dangers of eating large quantities of carbohydrate and sugar rich food. Could it be that many believe, that edible food, as long as it doesn’t taste bad or make us pass out, is harmless? Or that food in general cannot be used as a treatment for disease? Fast forward to 2018…Thanks to the rise of the internet, we now have unlimited access to the information superhighway from the comforts of our home. I myself never heard the word “ketogenic” until the year 2012. This was a queer word that I found while stumbling across some clinical trials posted on the web, and now it is part of my daily vocabulary.

WHAT DOES "KETOGENIC" MEAN?

For the benefit of our novice readers, what is the meaning of “Ketogenic”?

“Keto” is a shortcut word for “Ketone”. Ketones are energy rich substances our bodies produce during times of fasting or starvation. When food is scarce, the body senses the need to continue providing energy, especially to the brain. Therefore the liver begins to make an alternate form of power and these are what we call ketones. “Genic” is derived from the word “generate” or to “produce / beget”. Instead of fasting, a ketogenic (Freeman, Kossoff, and Hartman 2007) diet is another way for our bodies to produce ketones, because when there are low amounts of carbohydrates and glucose, the body also senses this and our livers go into ketone production mode.

The ketogenic diet is a strict, high fat, low carbohydrate diet, Protein is ideally also very low.

To many, it appears that the “ketogenic diet” may yet be another hot new food fad…But it isn't. Back in 1923, it was already being used. I am not sure why the alcohol proportion was deleted though.

DIABETES

It may come as a surprise but did you know that as early as the early twentieth century, doctors were already recommending carbohydrate restriction for diabetic patients? This was way before the invention of medications for diabetes. In fact, a textbook of internal medicine authored by Osler in 1923, prescribed that diabetics consume diets wherein carbohydrates comprised no more than 2% of the total daily allowance. Compare that to the 5% carbohydrate limit which modern ketogenic diets allow! The rest of the diet was made up of 75% fat, 6% alcohol, and 17% protein. Insulin and oral antidiabetic medicines were eventually discovered, and doctors slowly relaxed these dietary restrictions, reasoning that medications alone can successfully do a good job of controlling glucose levels. By the 1960s to 80s, the diet was practically unheard of in medical circles.

Modern day doctors recommend that diabetic patients take hypoglycemic drugs. Hypo- (lower) and glyc (glucose) -emic (being in blood) - means to lower blood glucose levels. The catch here is that when a patient uses these drugs, they have to be careful not to upset the balance of blood glucose versus drug dosing. There is always a risk of developing dangerously low glucose levels or “hypoglycemia” which can make one very ill, or even result in death. To avoid this, one must consume very high amounts of carbohydrates. And so a self perpetuating cycle continues. When one eats carbohydrates, the blood glucose rises higher, and medications are again dosed higher, as needed to help bring it down. Diabetes is already a state of high blood glucose. Why aggravate this by eating more carbohydrates? If diabetics on insulin go on low carbohydrate diets, they must be careful because they might experience dangerously low glucose levels. If this diet is attempted seriously, one might have to reduce their insulin by 50% on the day of the diet, to prevent critically low blood glucose levels (hypoglycemia). Close medical supervision is required because this can get very tricky.

EPILEPSY or SEIZURE DISORDERS

The same is true for the treatment of seizures, also known as epilepsy. Around the same time frame (1920s), the ketogenic diet was also used as the primary treatment for seizures. Later, as anti epileptic drugs were discovered, the diet slowly fell out of favor. The modern convenience of “a pill a day” took over and the diet was only rarely mentioned. It was only in the 1990s when the Charlie Foundation raised awareness over the benefits of the ketogenic diet, that we once again recognized this effective treatment for seizures that no longer responded to medications. It is presently being used again by some neurologists. The success rate is around 40%.

MOOD DISORDERS, AUTISM SPECTRUM DISORDERS

Since the ketogenic diet is very effective for seizures, why not other neurologic and psychiatric disorders? Scientists hypothesize that ketones can protect nerve tissue by protecting them from reactive oxygen species damage. Ketones can also raise the ATP ( a form of cellular energy) levels and by doing so , also protect from oxidative damage. Inflammation can be reduced and nerve cell death slowed down. Human studies are also desperately needed in this field.

CANCER

The big C. It spares no one. The excitement over using this diet in cancer is understandable. Even with the discovery of multiple genetic mutations in different cancers, we see very little progress in terms of a "complete" cure. With the new FDA approved targeted chemotherapies, much hype and hope is generated. When offered to patients with advanced cancers, one can reasonably hope for tumor control, but in reality a complete cure still remains possible but for most patients is very unlikely. A more reasonable expectation would be to hope for some prolonged tumor control. Still there, not gone, but stable. Why? Because despite a drug being precisely engineered to attack a tumor signal, there are usually many other competing tumor signals that feed the tumor.

With time the cancer gets wise, and finds a way to get its nutrition from other sources. Sometimes these tumor signals are multiple, and unless your drug targets more than one signal, the tumor will take advatage of signals that crosstalk. By using this defense mechanism, tumors may escape the damaging actions of the drug. To be successful, a drug must be able to target ALL, if not most of the tumor growth signals and mechanisms. For chemotherapy to cure, one must kill ALL traces of cancer. This is why many cancers are still not curable. Also this is why cancer has a tendency to come back and with revenge. A ketogenic diet theoretically can control cancer growth because it has the capacity to attack not just one, but several tumor signaling pathways, and all at the same time.

The early studies of this diet were focused mainly on brain cancer. It is only now that some scientists are taking notice and trials for other tumors are being created.

Unfortunately, there are still no solid randomized trial data on the use of this diet in cancer. Most of the existing HUMAN data center around case reports, case series, safety trials and anecdotal data.

ALZHEIMERS and PARKINSONS DISEASE

Only 10% of Alzheimers disease is inherited. 90% are because of other causes, one of which is the process of "aging".

Type II Diabetes , radiation exposure, are all possible causes.

Mouse studies show improved memory and brain functioning when the lab animals were subjected to calorie restriction or intermittent fasting from food. Examination of the mice brains also show improvement in the amyloid deposits that are commonly seen in brains of people with Alzheimers.

As we age, the brain becomes less able to use glucose. The neurotransmitters become less active and we begin to see slowing down of brain processing speed as well as a decline in memory. Chronic diseases like Alzheimers and Parkinsonism begin to emerge.

Scientists suggest that ketone supplementation can replace some of this energy loss, and improve memory and possibly delay aging.

CHRONIC PAIN

TYING TOGETHER THE CAUSES

Inflammation

Emerging evidence points to inflammation as a possible cause of neurodegenerative disease , autoimmune disease, heart disease, and even cancer. Inflammation is a basic protective mechanism within our bodies. When an infection attacks, the body reacts by producing heat, and sometimes swelling. A fever may be a sign that the body is trying to protect itself from the invading bacteria. When inflammation happens over and over again, it becomes a chronic source of irritation.

A good example of inflammation causing disease is that of liver cancer or hepatocellular carcinoma. The process of liver cancer development is well linked to chronic infection.
Many liver cancer patients have a history of hepatitis. Hepatitis B or C is a viral infection that attacks the liver. During a chronic hepatitis infection, the body goes into repetitive cycles of cell death and rebirth. Cells die as a results of the virus insult, but are so active that they can repair themselves in no time. However as time goes on, one day, the body will have had enough of this repetitive insult and even though the regeneration keeps on going, eventually the cell loses the ability to die (apoptosis). This is the point whereby a liver tumor is born. Due to the loss of death, the cell becomes immortal.

Autoimmune disorders also rely on inflammation as a possible disease trigger.
A ketogenic diet can potentially be of help via decreasing the body’s proinflammatory signaling pathways.

Autophagy

Auto what??? In addition to inflammation, there is also this process called Autophagy.
Autophagy – Auto (means --> self) + Phagy(means --->eating)- is a means by which the body “eats parts” of itself, mainly the defective parts, in an effort to “renew’ itself. This cannibalistic modes kicks in when one exercises or fasts. The body goes into “autophagy” mode. It is by this process that the body renews itself. The body also uses this process to get rid of defective cells that might turn into cancer.

Scientists think that autophagy or self renewal is a powerful tool to fight cancer.
In addition, control of inflammation can also help control tumor growth.
What is more interesting is the theory that a ketogenic diet can help not only slow down tumor signaling but also curb inflammation and increase autophagy.

KETOGENIC DIETS EFFECT on WEIGHT LOSS IN CANCER

What about cancer patients who are already losing weight? Is it safe?
The patients who were enrolled in our trial all lost some weight, some lost as little as 5 lbs while others lost almost 20% of their baseline body weight. None had any deleterious effects resulting from the weight loss. In fact the patients who lost the greatest percentage of their body weights actually did better in terms of quality of life and survival . In the laboratory, scientists studied pancreatic cancers cells that were planted onto lab mice and found that when these mice were fed ketones, their body weight improved and their muscles were preserved. Tumor growth was also delayed by the ketogenic diet.

https://www.ketooncologist.com/wp-admin/post.php?post=1871&action=edit

Is this the modern day “snake oil?

This diet is getting more and more interesting.

In my humble opinion, ketogenic diet alone is not going to cure cancer. But it does have several properties that may help make existing cancer therapies work better. Whether it can help improve cancer care in humans, remains to be seen. But at least we know that it works well ...at least in mice....

CARBOHYDRATES AND THE IMMUNE SYSTEM , WHY IT MATTERS

Fri, 25 Mar 2022 22:03:33 GMT

INTRODUCING THE PLAYERS

The immune system of the body depends on many players.

One special type of player lives within our blood, and they are called leucocytes.

Leucocytes are white blood cells, also known as WBC. These WBCs are responsible for defending our bodies from foreign attackers such as bacteria and viral infections.

Like fruits, where you can choose between apples, oranges, berries and bananas, there are several types of white blood cells. There are neutrophils, lymphocytes , eosinophils , basophils, monocytes, and macrophages. They all look different and all have different job descriptions. The most abundant ones are the neutrophils and the lymphocytes.

Neutrophils protect us from bacteria. They “eat” them. But when blood glucose goes up, this ability to eat bacteria (Phagocytosis= phago /to eat—cyto-cells) becomes weak, and the patient becomes susceptible and catch bacterial infections easily. This is why diabetics often have a hard time healing from bacteria infected wounds.

Lymphocytes attack bacteria and viruses, produce antibodies, and attack cancer cells.

LYMPHOCYTES

There are B - lymphocytes which produce antibodies, and there are T -lymphocytes which play a big role in activating the immune system.

The T lymphocytes when activated, depend heavily on glucose for their energy. They just love glucose, which is a common type of dietary sugar.

When T lymphocytes sense an excess supply of glucose, there is a corresponding activation of the cell’s glucose transporter system also known as GLUT1. This increase in GLUT1 allows more glucose to enter the T lymphocytes.

WHY BOOSTING THE IMMUNE SYSTEM IS NOT ALWAYS A GOOD IDEA

The metabolic requirements increase and the immune system becomes HYPERACTIVE.

We often hear people say that they have to “rev” up our immune systems in order to become healthy. However, is a hyperactive immune system always good? Contrary to popular belief, too much activation of the immune system is not good for you because it can lead to diseases like cancer and autoimmune disease.

Ordinarily, the body defenses attack invaders like bacteria and viruses but when the immune system is overstimulated, the body might begin to attack itself.

Cell growth and multiplication goes into overdrive and can trigger cancer. The process of cell death or apoptosis gets messed up and cells no longer die.

Not only does this trigger cancer growth, the inflammation also causes cancer to start spreading to other organs , a phenomenon that we call "metastases".

Hyperglycemia (too much glucose in the blood) therefore can promote inflammation, development of autoimmune disease and cancer! Glucose stimulates insulin release, and insulin interacts with insulin receptors that trigger the release of tumor signaling . More glycolysis occurs and more cancer growth!

How glucose stimulates cancer growth (solid line arrows mean to stimulate, broken line arrows mean to inhibit). How the Ketogenic diet can help. Tumor signals (PI3k, Kat, mtor, ampk). MMP breaks down cell barriers and allow cells to spread. IGF - insulin growth factor.

Luckily, when we take in less glucose, we can slow down this influx of energy. And with the low glucose levels, we trigger a self defense mechanism called apoptosis or spontaneous cell death, which balances out all this excess cell growth.

A CANCER IS BORN

The increased inflammation also makes cancer cell genes unstable and develop more genetic defects. These defects make these cancer cells become resistant to chemotherapy and hormone therapy.

Tumor cells become wise and develop new blood vessels of their own, increasing their chances of survival. This is why cancer is like a parasite, it develops its own blood supply, its own mind, and its own life!!!

Blood cells can do the same. New cells are born and they overtake the number of dying cells. Bone marrow spaces become quickly over crowded with immature cells which have no choice but to be pushed out into the blood stream before they are ready.

So next time your sweet tooth craves for something, think twice. You don't want to turn on an unwanted switch!

Coffelt SB, De Visser KE. Cancer: Inflammation lights the way to metastasis. Nature. 2014;507(7490):48-49. doi:10.1038/nature13062.
Calder PC, Dimitriadis G, Newsholme P. Glucose metabolism in lymphoid and inflammatory cells and tissues. Curr Opin Clin Nutr Metab Care. 2007;10(4):531-540. doi:10.1097/MCO.0b013e3281e72ad4.
Allavena P, Garlanda C, Borrello MG, Sica A, Mantovani A. Pathways connecting inflammation and cancer. Curr Opin Genet Dev. 2008;18(1):3-10. doi:10.1016/j.gde.2008.01.003.
Colotta F, Allavena P, Sica A, Garlanda C, Mantovani A. Cancer-related inflammation, the seventh hallmark of cancer: Links to genetic instability. Carcinogenesis. 2009;30(7):1073-1081. doi:10.1093/carcin/bgp127.
Maciver NJ, Jacobs SR, Wieman HL, Wofford J a, Coloff JL, Rathmell JC. Glucose metabolism in lymphocytes is a regulated process with significant effects on immune cell function and survival. J Leukoc Biol. 2008;84(4):949-957. doi:10.1189/jlb.0108024.

HOSPITAL FOOD

Fri, 25 Mar 2022 22:02:02 GMT

I have a few patients who unfortunately have to spend several weeks in the hospital for chemotherapy. Upon admission, their assigned intern dutifully notes their non-diabetic state and, without a second thought, checks off the box marked “regular diet”. Most short-term patients do not comment on the food, but for these long-term patients, food often becomes a big issue. One day, I decided to investigate.

Curious to see what “regular” meant, I intentionally made my rounds at lunchtime. Apologizing for the mealtime intrusion, I stepped in just in time to see the food trays arrive. Glancing at the entrees, I couldn’t help but empathize with my obviously disappointed patient. Thanks to the accompanying menu, we were able to recognize some of the food. In addition to bland vegetables and half reheated frozen entrees, the familiar dessert - repackaged fruit cups, ice cream and slices of iced pound cake added to the absurdity of this nutritional offering. They don’t call patients “patient” for nothing, I mused. “I hope you are hungry, Mr. Tiredofbeinghere (not his real name). You are allowed to stroll down to the cafeteria, you know. Maybe you’ll find something you like there.” Flicking at my phone, I saw it was close to half past noon. I forgot my packed lunch that day, so I too decided to take the elevator down to the cafeteria and check out the public offerings. If not settling for the hard boiled eggs and prepackaged salads, a person hoping to stay ketogenic will have to be extra creative. Unfortunately, pizza, breaded chicken nuggets, hoagies, rice and french fries were standard fare. Suddenly, intermittent fasting seemed to be a very attractive excuse.

“Next!!!” The short order cook waved his arms at me and yelled, “Hey Doc, what can I get for you?” I answered, “No potatoes or rice please. Just the salmon.”

“Uh, that’s actually chicken, Doc,” he said. “Ok, ok, chicken breast please. But without the breading.”

A quick survey of my half-filled tray revealed a strange combination. A cup of cottage cheese, a pack of mayo, a slab of chicken, and two boiled eggs. Filling up a small cup of coffee, I threw in some half and half and paid for my lunch.

Later, as I headed back to the chemotherapy outpatient suite, I stumbled across the familiar snack table. I strolled in just in time to see a nurse surreptitiously swipe a fist of Hershey’s Kisses and transfer them to her coat pocket. The volunteers were too busy restocking the licorice and thumbprint cookies to notice. Generous cups of sweet hot chocolate were being passed out to wornout patients and family members. Nauseated patients were sprawled out in deep plush recliners, dutifully taking comforting sips of chilled ginger ale, courtesy of our ever-cheerful nurses. A familiar patient was busy munching through bag of potato chips. Secretly shaking my head, I shuffled on to the back of the huge room.

This past week, some cancer drug representatives dropped off piles of cookbooks at the nurses’ station for the cancer patients to take home. Beautiful photographs of ribbon pasta and rice pilaf dishes graced the front cover. Still individually protected in crystal clear shrink-wrap, the stacks of gleaming paperbacks beckoned to me. I picked one up and quickly glanced at the bold title - “What to Eat When You Have Cancer”. Hmmm. Wheat muffins and strawberry ice cream floats graced the back cover. “Take one, Dr. Tan, it’s for free”, our nurse urged. Obligingly, I picked up a copy and tucked it under my elbow. With a half smile, I thought to myself, “For coffee table entertainment only”.

Change is desperately needed in Oncology. As far as nutrition is concerned, I see a long, lonely road ahead.

Medical Oncology Lingo – today’s word is CACHEXIA

Fri, 25 Mar 2022 22:00:51 GMT

A quick search on Dr. Google shows that "Cachexia is a condition that causes extreme weight loss as well as muscle wasting. The name comes from two Greek words: kakos, meaning "bad," and hexis, meaning "condition."

Cachexia = Bad condition. The condition is a symptom or side effect of chronic conditions, such as cancer, type 1 diabetes, HIV, and multiple sclerosis."

We use this word a lot when discussing the poor physical condition of patients who lose weight while on chemotherapy. Despite efforts to maintain weight, the pounds keep sloughing off. The nutritionist is called in, and prescribes a case of nutritional shakes, to be taken with high calorie meals, three times a day. Days pass, and this maneuver does not seem to work. It becomes harder and harder to swallow, and soft meals begin to replace regular solid dinners. Soon, everything loses its appeal, and the patient only tolerates ice cream and pudding. The muscles continue to wane, and along with it the patient's strength and stamina. Standard treatment for this condition is to increase caloric intake. Sadly, this method is usually not effective.

Non small cell lung cancer and the ketogenic diet

Fri, 25 Mar 2022 21:59:58 GMT

Dear Dr. Tan,

I have recently been diagnosed with non-small cell lung cancer.

Does it make sense for me to try the ketogenic diet ?

Can I combine this with chemotherapy?

Mr. Anxious in California

Non Small Cell Lung Cancer and the ketogenic diet

I receive this question everyday. Lung cancer is very common, especially in people over the age of 60.

There are two main types of lung cancer, Non Small Cell lung cancer (NSCLC for short) and the other variety called Small Cell lung cancer (SCLC). These are staged differently, and treatment is also tailored to the stage. The American Cancer Society estimates that for the year 2018, there will be over 234,000 new non small cell lung cancer cases in the United States, and from that number, men outnumber women (121,680 men versus 112,350 cases in women). The chance of getting lung cancer is 1 in 15 in a man’s lifetime, and 1 in 17 risk in women. 154,050 deaths from lung cancer are expected this year.

Chemotherapy is the mainstay of treatment, especially if the tumor is so advanced, it cannot be removed by surgery or radiation. As far as the ketogenic diet being studied in lung cancer, there were experiments wherein non-small cell lung cancer cells were injected into lab mice. The mice were then separated into two groups. One group was fed a ketogenic diet and the other, a standard diet. The mice were then treated with chemotherapy and radiation. The tumors shrank more in the ketogenic fed group. The scientists then conducted a human study at the University of Iowa, but unfortunately could not make any good conclusions due to a very low number of recruited patients.

https://www.ncbi.nlm.nih.gov/pubmed/28437190

Researchers at the University of Texas in Dallas found that a type of non small cell lung cancer, the squamous variety, has more Glut1 expression on the tumors, meaning these squamous cell lung cancer have more sugar cravings than other types of non small cell lung cancers . https://www.google.com/amp/s/medicalxpress.com/news/2017-05-sweetens-cancer-sugar.amp

At the Pittsburgh Veteran Affairs Hospital, although we recruited a larger number of patients, it was by no means a huge sample. The group included not only lung cancer patients, but also other tumor types. Out of the 17 recruits, only two had stage 4 non small cell lung cancer. One patient quit early, while the other enrolled into the trial and followed the diet without difficulty. This gentleman was an 84 year old who decided to try the ketogenic (Modified Atkins diet). Prior to the trial, his diet was high in carbohydrates. He also did not receive chemotherapy or radiation.

He had good family support, and was able to diet successfully until 16 weeks. After the trial was over, the PET CT scans showed that his disease was still stable, meaning that he still had no significant tumor growth. He then decided to return to a regular diet, but died around 6 months later. As far as combining the ketogenic diet with chemotherapy, we still don't have the answer. The Iowa study was trying to answer this question but unfortunately did not recruit enough patients. So the answer is not clear cut. We have ample evidence in mice, but hardly any research was done in humans. Diets are difficult to implement, even harder to monitor. Motivated patients may stick to the diet for as long as 3-5 years. Their experience can be written up as case reports. Although not ideal, case series can sometimes provide a lot of useful information for diseases that otherwise cannot make it into clinical trials due to the rarity of their case.

The Ketogenic Diet-Defining a role in cancer therapy

Fri, 25 Mar 2022 21:59:02 GMT

From time to time I am asked to write something about our favorite topic. On what else, but the Ketogenic diet. Here in a short review, my thoughts on how the diet can affect cancer care.

http://www.oatext.com/the-ketogenic-diet-defining-a-role-in-cancer-therapy.php

Be forewarned, this was written in medically technical language. ��

Enjoy!

Outside the Box at ASCO 2018 – Ketogenic diets in colon cancer and lymphoma

Fri, 25 Mar 2022 21:57:47 GMT

This year we have exciting news here for all ketogenic diet followers! Not just one, but two clinical abstracts were accepted for online publication as part of ASCO 2018, the yearly mega conference of US and international oncology experts and professionals.

The much awaited annual American Society of Clinical Oncology ASCO annual meeting (Chicago June 1-5) will attract approximately 40,000 attendees (oncologists , pharmacists, businessmen, students, researchers) from all over the United States as well as leading cancer experts from over 100 countries. Most of the breaking news that will emerge from this conference deal with new drugs and combinations of previous chemotherapy drugs. For 2018, under the category of new targets and therapies many will see something that seems outside the box, but isn't really new to most of us...

I am especially pleased to see that our abstract proposal “Modified Ketogenic diet in lymphoma: a case series in the Veteran Affairs Pittsburgh Healthcare System", was accepted this year for online presentation.

But , we are not alone. This year , a group of Japanese researchers led by Furukawa et al also presented their abstract “Clinical effects of one year of chemotherapy with a modified medium chain triglyceride ketogenic diet on the recurrence of Stage IV colon cancer."

In this abstract, they reported ten patients with Stage IV recurrent colon cancer , all of whom could not tolerate conventional chemotherapy nor best supportive care. These patients were given chemotherapy in addition to a modified medium chain triglyceride MCT Ketogenic diet. For comparison, fourteen patients, also with stage four relapsed colon cancer , were given chemotherapy alone. When they compared the two groups they discovered that although the weights and serum albumin levels did not differ much between the two groups, the blood levels of ketones were significantly higher in the Ketogenic diet group. What's more, the group that received chemotherapy plus the modified MCT Ketogenic diet did much better in terms of tumor shrinkage and response compared to the group that did not diet at all. They found a 21% response rate for non dieters versus a 60% response rate in the Ketogenic dieters.

http://abstracts.asco.org/214/AbstView_214_214327.html

Our abstract reported on a small case series of lymphoma patients who self administered the modified ketogenic diet, and their clinical course over one to two years. Unlike the Japanese report, all of the lymphoma patients lost significant amounts of body weight . In addition , they also had increased serum /blood levels of ketones. All three patients improved clinically with improvement of their symptoms. Out of the three, two had complete disappearance of their disease on subsequent full body scans.

http://abstracts.asco.org/214/AbstView_214_222321.html

This is by no means definite evidence that the diet works since the patient numbers are very small. However it is indeed ground breaking and is a step in the right direction. Hopefully it will fuel further excitement and research on this very exciting topic.

Transitioning out of a High Carbohydrate Lifestyle

Fri, 25 Mar 2022 21:56:13 GMT

No such thing as an "Essential Carbohydrate"

So you've been leading a high carbohydrate lifestyle, and now you've decided it is time for a change. If you are truly serious about embarking on a ketogenic diet , you have to start thinking of sweets and traditional baked pastries and bread as "optional". Unlike essential vitamins and minerals, there is no such thing as an "essential carbohydrate".

We don't NEED dessert!!! We also don't NEED snacks on a daily basis, and bread is NOT an essential food. And yes, we CAN celebrate without sugar!

#1 Beginners mistake

The biggest mistake of beginners to the low carbohydrate lifestyle is that they try to "cut down" on their carbohydrate intake. It is never a good idea to "cut down", better to just "cut off completely". Once you bite into half a bagel, your blood glucose will naturally rise and then plummet . It is that plummeting blood glucose that will create the unpleasant feeling of hunger. Better to eliminate that in the first place. "Low carb" dieting will result in steady and low glucose levels. No spikes, no plummeting levels, means also less hunger. Hunger is the number one reason why diabetics on a "diabetic diet" fail.

Fighting back with Low Carbohydrate Sweets

But once in a while, you will be faced with some kind of social event or family celebration and it sometimes helps to know how to make your own take away version of low carb sweets.

The internet is rich with keto recipes of all sorts. I recently realized that almost anything can be turned into a "keto-friendly" version. And this includes pasta, breads, pastries, and even ice cream! You just need to creative and know what to substitute in terms of ingredients.

The problem with sugar substitutes though, is that they INCREASE YOUR CRAVINGS for sugar. So if you use them, do so rarely.

Celebrating with sugar - a must?

This time of year I receive countless invitations to graduation parties, birthdays, weddings and of course springtime barbecues. This past weekend we celebrated Memorial Day, in memory of our men and women who served in the armed forces. As expected, in each of these events there is the inevitable presence of decadent sugar rich sweet desserts and carb laden entrees. What party does not have rice, buns, a tray of cookies or pie? Despite the near epidemic proportions of diabetes and heart disease in both sides of my extended family, for most family celebrations , carbohydrate rich meals and scandalously rich sugary desserts remain a firm tradition. How did it become an unwritten rule that we cannot celebrate properly without a fabulous cake or sugar filled concoction?

5 Tips - Leaving A High Carbohydrate Lifestyle

1. Consume or donate all your non-keto food and start fresh. If you don't buy it, you can't eat it accidentally.Make sure your pantry and fridge contain ony keto approved food and ingredients.

2. Learn to create substitutes. If you still have cravings for carb laden food, learning to create your own keto bread, pastries and desserts should help one transition out of their previous carbohydrate laden diet into a new way of eating.

3. Recruit someone. Its always more fun with company. Get a family member or friend to try the ketogenic diet with you.

4. Stop buying sugar substitutes altogether. The downside of artificial sweeteners is that they tend to increase your cravings for sugar.

5. Don't taper off carbs, just cut back to the fullest . Cutting back slowly on carbs is harder to do because the hunger that will still be present will become your recipe for failure. Better to just jump in and do it the right way. Eventually the hope is to no longer crave for sweets, and keto friendly snacks and sugar substitutes will no longer be needed.

Change is Always Slow in Coming

Despite the mounting evidence against carbohydrates and sugar, our cancer patients are still being served low fat, high carbohydrate and sugar rich meals and snacks. During workplace potluck celebrations, the rice dishes, pasta and pizza still predominate. Many of my patients who do hear about the ketogenic lifestyle, still wonder about the "cardiac dangers" of "eating too much fat". It might take a decade or two before we see this way of eating go mainstream. Change is never easy. In the meantime it pays to be patient, and rewards will come later.

My Experiment with “Keto” Ice Cream

Fri, 25 Mar 2022 21:55:19 GMT

My Experiment with "Keto" Ice Cream. The other night, my teenagers were craving for something sweet and cold. Instead of running out to buy a quart , I decided to try making my own "keto" ice cream.

Why not? I felt it was time to experiment. I tried to convince myself that the next time I need something sweet and celebratory, I will be ready! Milk is not allowed in a Ketogenic diet, because lactose is a carbohydrate. A lot of the non fat dairy products are also not allowed because they have hidden carbohydrate fillers to make them bulk up. For our quick and easy keto ice cream project, heavy cream is what made the main base . Luckily I had some on hand. Not to be bothered by complicated menus, I googled and read through several online YouTube links and finally found one that required only four easy to find ingredients. (You will see some affiliated links).

Cream, eggs, unsweetened cocoa powder and non-sugar sweetener.

My own version of easy chocolate Keto Ice Cream

Ingredients:

One cup heavy cream ( if you can't find heavy cream, heavy whipping cream will do)

2 teaspoons cocoa powder

1/3 cup sugarless Sweetener (I chose Splenda).

4 whole eggs

Using a small saucepan, combine the first three ingredients and cook at medium heat, whisking the mixture briskly with a fork or whisk, until it thickens slightly. Then add eggs one by one, while mixing with a whisk till frothy. You can add some vanilla at this point if you wish. Transfer the mixture to a chilled container and freeze. Intermittently (I did check it every half hour) open your freezer to check on the "ice cream" and beat it with a spoon or whisk each time. You will know it is ready because it will eventually thicken and look like a gelato. This went so quickly in my family, I had to make this three nights in a row!

Optional toppings and flavors:

For the whipped topping I whisked up a firm cream using the following ingredients:

1 cup heavy cream

Flavors you can add later:

Rose water

Unsweetened coconut flakes

vanilla flavoring

Gadgets:

Fluffy cream using a portable whipper

It isn't very powerful but with some patience, it does the job of frothing some low carb cream for my coffee.

Ice cream is only the beginning. Although I do not recommend regular snacking, it is fine for a once in awhile treat.

Will a ketogenic diet work for MY cancer?

Fri, 25 Mar 2022 21:51:40 GMT

Dear Dr. Tan,

Will the ketogenic diet work for my type of cancer?”

The single most common question posed to me by my readers is “ Will the ketogenic diet work for my type of cancer?

How effective is it for my cancer?

Strange as it may sound, what is as obvious as an elephant in the room, is not obvious to many.

PET scans and how they can diagnose cancer

As oncologists, we commonly send our newly diagnosed cancer patients to the nuclear medicine department in order to undergo a pre-treatment, baseline POSITRON EMISSION TOMOGRAPHY (PET) scan. Patients will fast the night before, and in the morning, they will receive a dose of radioactive Flurodeoxy glucose (FDG)- G is for the tagged radioactive glucose - prior to taking their images. If the tumor is metabolically active, it will absorb the radioactive glucose in order to be visible on the final scan. Normal non-cancer bearing organs will not absorb this stuff. Tumors however will be hungry for this, and will immediately gobble up the glucose.

The more glucose the tumor absorbs, the brighter it will appear on the scan. This is true, regardless of the organ involved. Brain, stomach, colon, bone cancers. If it is a cancer, they all have the capability of absorbing glucose and showing up “bright” on a PET/CT scan. The more aggressive the tumor, the more glucose is absorbed. Some cancers however, grow and divide so slowly, that they hardly " light up" on the PET scans. As expected, these patients tend to live much longer than those with highly PET positive tumors.

Should cancer patients abstain from glucose?

Now, knowing this, isn’t it logical to think that we should also advise our PET-positive patients to abstain from glucose? Ironically we don’t. And why not?

Despite the obvious, in order to make such a statement, one must be able to cite well designed, preferably, randomized clinical trials, achieve statistical significance, and arrive at a respectable (well accepted by all) conclusion. As of today, there are still no substantial human efficacy trials of the ketogenic diet in cancer. Luckily, there is an abundance of studies in lab animals and in the lab.

Will it eradicate cancer completely? Based on our recently concluded trial, the diet alone probably won't. But it may help slow down the progress of cancer, and possibly help chemotherapy work better.

Is the ketogenic diet safe for cancer patients?

We do have a smattering of published “safety trials”. If we cite the existing safety trials, we can probably say the diet is safe to use in cancer patients.

Is the ketogenic diet safe for elderly patients ?

Our study enrolled at least two patients in their eighties, several in their seventies and sixties. They did fine.

What do all cancers have in common?

If we go back to the central tenet of this theory, we will see that most cancers have something in common.

Metabolic hyperactivity.

The cell machinery (IN THIS CASE, THE PROCESS OF GLYCOLYSIS) that processes glucose is in overdrive.

Glycolysis (breaking up /lysis of glucose) is the process by which the cell takes a 6 carbon molecule called glucose, which recently entered the cell , and breaks it down into two 3-carbon containing molecules called pyruvate, eventually losing another carbon atom which turns it into acetyl CoA which then enters the higher energy producing process called the Krebs cycle, and electron transport chain within the inner mitochondrial membranes in order to produce even more energy.

That is what normally happens in cells. Cancer cells are stuck in this first step, which is glycolysis. The steps that follow, entering into the mitochondria, Krebs cycle and electron transport chain also known as OXPHOS or oxidative phosphorylation, do not easily occur in cancer. The first step (glycolysis) became very inefficient in making energy so it compensates by working double time. Instead of acetylcoA, the pyruvate goes on to become lactic acid, and glycolysis becomes the main energy producing process from which cancer cells get their energy source.

Did you catch any of that? Don't worry if you didn't. My point is, cancer cells have a defect inside their innermost part which allows them to survive longer than regular cells. And too much glucose helps this happen.

Why does this promote cancer? There is more than one explanation. Aside from the mere overabundance of glucose, there is also malfunctioning of the normal anti cell death processes (antiapoptosis- cancer cells refuse to die), plus stimulatory effects on tumor signaling pathways, to name just a few. In other words, cancer cells become IMMORTAL. They do not know how to die. DNA repair mechanisms also malfunction. Tumor suppressor genes become deactivated and tumor promoting genes become active. Too much lactic acid also lowers the cancer cells ability to "stick together", so we see more tumors breaking off from the parent tumor and metastasizing to other organs. A ketogenic diet may be able to combat some of these effects.

What about weight loss ?

Visualize a fish tank. There is a large fish and a baby fish. You feed them a fixed amount of food each day, but the larger fish gobbles the food faster, leaving almost nothing for the smaller fish. Days pass, and this repeats daily. The larger fish gets larger, while the smaller fish remains the same in size. This is true of cancers. Cancers can consume glucose at least twice as fast, while the normal tissue lags behind. The more carbohydrates you feed a cancer patient, the thinner and weaker they get. The tumor gets stronger, while the rest of the body gets weaker and smaller. This is what you see during the terminal phases of cancer. This also happens during the early phases of cancer but is less obvious, until later on, when the tumor has grown and has dominated the body, culminating in the spiralling weight loss and plummeting energy of the terminal patient.

Withholding sugar and carbohydrates will put a brake on this process. The body will sense the absence of glucose and compensate for the loss of the energy by producing ketones , another energy source that can sustain the body, yet it will not be of benefit to tumors. Once the tumors weaken from lack of glucose, the ketogenic diet will contiue to nourish normal cells, and the once rapid weight loss may be replaced by weight gain.

Can the ketogenic diet alone eradicate cancer?

Will the ketogenic diet alone eradicate cancer? That is a very tall order. In our last safety trial, we did NOT see that happen. The trial, which did not allow chemotherapy, had a few shortcomings. It involved a very small number of advanced stage cancer patients (17). The majority of the ketotic responders in that trial only had a partial response, while most were stable, showing no growth or shrinkage of their tumors. The trial only lasted 16 weeks, but we did follow patients until their demise. three patients lived past a year, two past 2 years, one nearly three, and one is still alive, almost 5 years now since the trial ended. The one patient who did get rid of all his cancer, had surgery to remove the last few traces , and also strictly followed the diet for two more years. He is no longer on a ketogenic diet but is still following a low carbohydrate lifestyle, while maintaining his weight.

Combination of chemotherapy or radiation, plus the ketogenic diet, may be a more effective strategy. This is currently the subject of many ketogenic diet trials now ongoing.

The Art of Medicine

Fri, 25 Mar 2022 21:50:50 GMT

July is here. The month of the year when all throughout the United States and perhaps elsewhere in the world, new doctors come into training, fresh from medical school. The interns from last year now become residents and last semester’s students become interns. The first month of training. The month when you should avoid getting ill and pray that you don’t have to check into a hospital. A time when medical interns should begin learning the art of medicine.

It is not just the time when we see a high rate of medical errors, but also a time when bedside manners , or rather the lack of manners, become very visible. New doctors , anxious but excited, armed with extensive checklists and medical books, eagerly assume their new duties.

No time for empathy?

I recall my time as a budding doctor, a first year medical intern in week one, rotating through a county hospital ward. I had on a newly starched white coat, my double barrel heavy duty stethoscope, a tiny spiral notebook, fifty index cards, and a then “fancy electronic calculator with phone directory and calendar capabilities.” The place was clean but was far from luxurious. The patients were mostly of low income status, and the food that was passed out in melamine trays looked no different from the day before. Some of the patients were residents of the nearby county jail (a.k.a prisoners), were handcuffed and dressed in orange jumpsuits, and were always accompanied by police escorts. Nurses seemed to speak to us interns and to patients in a loud volume, and I found no gestures of politeness anywhere. Scenes from the TV show St. Elsewhere began to look pretty good by comparison. Suddenly, through the loudspeakers, we hear CODE 64!!!* A crash team sped out of nowhere towards Mr. Green (not his real name), my assigned elderly patient. He was all of 64 years old, a frail army veteran who was perpetually in and out of the hospital with bouts of pneumonia and COPD. This time however, his fever would not break, and his breathing got worse and worse with each passing day. Out of nowhere, a critical care cart came rushing towards my now critically ill patient, surrounded by a team of medical staff frantically trying to resuscitate him. After what seemed like eternity, the night float resident rushed out of the room and threw his gloves and mask on the floor. “Another one bites the dust!”, he shouted, and then ran off to his tiny call room, eager to catch a few moments of pillow time. By this time the nurses were seen scurrying over to clean up the clutter from the recently concluded code.

Amidst the clean up, the ward clerks mentioned that no family members were around. I then overheard the other night float intern calling up the relatives of the newly deceased. It was our late night shift and close to midnight. Finding no one at the other end, he nonchalantly proceeded to leave a voice message announcing the passing of Mr. Green, hung up the phone, and continued to sip his coffee. I was stunned. Is this bad manners? Ignorance? Or just indifference?

Empathy is something that is expected of doctors, yet it is not something that is formally taught. Some doctors become masters of the science of medicine, but sadly, not of the “art “of delivering bad news.

Is it because we are used to seeing patients as specimens rather than as human beings?

The gift

Suddenly I felt a pair of eyes on me. It was the anesthesia resident. He motioned to me to come and approach my patient . “Take this and intubate him”. He showed me a stainless steel contraption that looked like a giant shoehorn of a torture device. It was some kind of a surgical tool, used to help pry open the airway and allow one to easily see the vocal cords. I was supposed to tilt Mr. Green’s head backwards, as far as I could go, peek into his throat, try to find his vocal cords at the end of it. Once the cords were in sight, I had to deftly insert the airway tube in between the cords into the lungs. I realized with a bit of horror but fully understood what he meant. “This is your golden opportunity to practice how to INTUBATE, to insert an airway tube into a real human being”. “Don’t worry, we practice on deceased patients all the time, and it is perfectly acceptable here. How else are you going to learn? Now quick! You only have 5 minutes before the caretaker arrives! ”

But this wasn’t just a specimen. He was a bit ashen but was still warm and supple. He was still human, Mr. Green, MY patient. Silently asking for forgiveness, I bit my tongue, and drew the curtains around his bed, so as not to show his demented roommate what we were doing. Surprisingly, it was a fairly easy task and in less than two minutes the deed was done. I successfully inserted the tube and inflated the ambu bag. His chest rose with each compression of the bag, indicating a successful intubation. Giving me the thumbs up, the resident shook my hands and congratulated me on my new achievement. Removing the tube, I glanced at my motionless patient. Closing his eyelids, I wiped his face, and gingerly draped him with a clean sheet. Looking at his tired face for the last time, I silently thanked him for his role in educating me, his last gift to humanity.

Balancing the science with the art

There is a delicate balance between learning the science of medicine, and learning to be a better human being. It becomes too easy to develop a degree of callousness during one’s medical education. One must have a tough personality, yet try not to lose sight of compassion at the same time. Not everyone will have the stomach to be able to dissect a cadaver amidst the aroma of formaline, endure long sleepless nights of study, subsist on coffee, Ramen noodles and buttered bagels, miss out on social engagements, stand in rounds for hours on end until your shoes and knees give out, and see favorite patients suffer and die. But in the end, the satisfaction of being able to gift the less fortunate with your future knowledge, is priceless.

* code 64 - “cardiac arrest” alert, followed by members of the critical care team rushing over to the scene and embarking on a full effort to resuscitate the patient

** ambu bag- https://en.wikipedia.org/wiki/Bag_valve_mask

Can I take metformin for my cancer?

Fri, 25 Mar 2022 21:49:55 GMT

Dear Ketooncologist,

What are your thoughts on using metformin for cancer?

Sincerely,

A Veteran’s wife

Dear Veteran’s wife,

Metformin is receiving a lot of publicity lately, as far as being a possible new “cure for cancer”.

The basics about METFORMIN

Metformin began in 1918 as a traditional European herbal medication called Galega officinalis (also known as goat's rue). It was found to be rich in guanidine, an organic compound derived from guano , (literally bird and bat poop !) and found to be able to lower blood glucose. Later, insulin and other glucose lowering drugs were discovered and metformin lost popularity for a time, until recently it came back into favor.

Because metformin does not normally cause weight gain or hypoglycemia (dangerously low blood glucose), it is currently the preferred first-choice oral blood glucose-lowering drug used today to treat type 2 diabetes. Metformin is a pill and is also known as Glucophage, Glucophage XR, Glumetza, Fortamet, or Riomet.

When the body senses that glucose is scarce, the liver finds a way to make it (official scientific term is gluconeogenesis or glucose-new-generation). The newly made glucose is then released it into the bloodstream. (This reminds me of my teenage son. He loves bread, but because we try not to buy any, he learned how to make bread from scratch!)

Once in the bloodstream, glucose then makes its way into cells where it can then be used for energy.

Metformin can decrease liver production of glucose as well as help glucose that is in the bloodstream, move into cells . It becomes particularly helpful in type 2 diabetics, because there is a lack of responsiveness to insulin and therefore glucose accumulates because it has a hard time exiting the blood and there is poor uptake into cells.

Does metformin have anti cancer properties? 2,3,4,5,6

Metformin activates the enzyme called AMPK ( AMP-activated protein kinase ). Other ways of activating AMPK is via caloric restriction , fasting , or resistance exercise . 2

What is AMPK and how does AMPK and metformin help fight cancer?

AMPK is a tumor suppressor . If tumor suppressors are dormant or malfunctioning, cancers may grow.

AMPK also cuts back on inflammation, and controls the amounts of fats in the body by stimulating fatty acid oxidation. Inflammation can trigger cancer.

AMPK also reprograms our metabolism by acting on molecules that control cell growth and signaling. When AMPK is suppressed, the pro-cancer tumor signaling pathways (such as Raf/ERK/RSK pathways) are activated!

Metformin, just like AMPK, can also inhibit tumor survival pathways and can also inhibit glycolysis (glycolysis is the main energy source of cancer cells) itself. If you like to read scientific journals, you might be familiar with “mTOR signaling”. mTOR is a nickname for “mammalian target of rapamycin, which is just a fancy term for a type of cancer signal that exists within the body. It so happens to be a common signal that fuels cancer cells to grow and multiply. It is similar to the Raf/ERK/RSK pathway that I just mentioned above. They are all signaling pathways that are pro-cancer. Metformin however tends to mainly affect the mTOR pathway, which in turn, stimulates the insulin and insulin growth factor receptor pathway, which is involved in cancer development and maintenance. There are many more pathways and signals involved in cancer, and they all communicate with each other in some way, but I won’t discuss this further because it will take hours.

Just remember, AMPK maintains normal metabolism. Normally, the body senses the lack of energy, or lack of oxygen (hypoxia) and activates AMPK, to maintain the overall metabolism of the normal body. When something goes wrong, there is a loss of this self defense checkpoint and AMPK fails to activate, causing cancer to emerge.

AMPK also helps normalize glucose levels by helping the body accept the good effects of insulin, and help making one “insulin sensitive ”. Type 2 diabetics often have the opposite. They are “insulin insensitive ” and often have overproduction of “reactive oxygen species” which can damage our DNA, which can lead to mutations and ultimately, cancer . When the body becomes insensitive to insulin (type 2 diabetics), it does not realize it (insulin) is already there, as if it is invisible, the body continues to try to rev up more insulin by increasing IGF-1 (insulin like growth factor ). Too much IGF will stimulate production of even more hormones that stimulate cell growth , AND also prevents cell death . So in the end, there is an imbalance between cell growth and cell death. Too much cell growth plus cell multiplication outpaces cell death, and cancers are born. 1,2

Metformin can enhance insulin sensitivity (through AMPK )which then can improve glucose uptake (glucose moving out of the blood and into the cells) and thus improve blood glucose levels.

Many studies show that the risk of some cancers (pancreas, liver, colon) are reduced in type 2 diabetic patients treated with metformin.

Preliminary studies show that there are cancer fighting properties in certain drugs such as aspirin and metformin /antidiabetic drugs that can be effective in human cancers. 2,3,4.5.6

Making energy (ATP) less available for cancer

There is lab data to support the theory that low glucose plus metformin can enhance metformin’s anti-cancer effects. In the lab, scientists examined cancer cells in petri dishes and cell cultures and found that metformin can actually kill cancer cells.

In a study of breast cancer and ovarian cancer cells , they found that when metformin is given when glucose levels are high, the cancer cells did not die. But when they lowered glucose , the metformin became more effective in killing cancer. And vice versa, in cells that were unresponsive to metformin in the presence of high glucose, when they lowered the glucose levels they found that the cancer fighting effects got better. The reason behind this was proposed to be that metformin + low glucose enhanced metformin’s negative effect on ATP production . Less ATP, means less fuel for glycolysis, and less glycolysis, meant less energy to cancer cells, and therefore more cancer cell death.

Decreased tumor signaling with metformin + low blood glucose

Low glucose plus metformin also meant increased inhibition of tumor survival signaling pathways. There is a lab model (in vivo and in vitro) where cancer cells treated with metformin and grown in low glucose medium can kill more cancer cells by decreasing ATP production , inhibition of survival signaling pathways as well as strengthen inhibition of glycolysis itself.

What about using metformin in addition to chemotherapy?

Metformin is not FDA approved for treating cancer. However, many studies in human cancers are on their way. Enrollment in a clinical trial not only is safer for you, but the knowledge gained can infinitely help benefit others.

https://clinicaltrials.gov/ct2/results?cond=Cancer&term=metformin&cntry=&state=&city=&dist =

In summary, metformin is a drug for treating diabetes , but it is not a standard drug for cancer. At least not yet. Ask your doctor how you can improve your blood glucose and whether metformin is right for you.

All the best,

Dr. Tan

Arcidiacono, Biagio et al. “Insulin Resistance and Cancer Risk: An Overview of the Pathogenetic Mechanisms.” Experimental Diabetes Research 2012. Experimental Diabetes Research. Web.
Dreyer et al Resistance exercise increases AMPK activity and reduces 4E BP1 phosphorylation and protein synthesis in human skeletal muscle. J Physic. 2006 Oct 15; 576(Pt 2): 613-624.
Faubert, Brandon et al. “AMPK Is a Negative Regulator of the Warburg Effect and Suppresses Tumor Growth in Vivo.” Cell Metabolism 17.1 (2013): 113–124. Web.
Zhuang, Yongxian et al. “Mechanisms by Which Low Glucose Enhances the Cytotoxicity of Metformin to Cancer Cells Both in Vitro and in Vivo.” PLoS ONE 9.9 (2014): n. pag. PLoS ONE. Web.
Li D, Yeung SC, Hassan MM, Konopleva M, Abbruzzese JL. Antidiabetic therapies affect risk of pancreatic cancer. Gastroenterology. 2009 Aug;137(2):482-8.
Luo Z, Zang M, Guo W. AMPK as a metabolic tumor suppressor: control of metabolism and cell growth. Future Oncology. 2010 Mar; 6(3): 457-470
Quinn BJ, Kitagawa H, Memmott RM , et al. Repositioning metformin for cancer prevention and treatment. Trends Endocrine Metab 2013;24:469-80

Guanidine- an organic compound derived from guano - https://www.britannica.com/science/guano

Dear Ketooncologist – Newly diagnosed with pancreas cancer

Fri, 25 Mar 2022 21:49:06 GMT

Dear Dr. Tan,

I have stage 2 (adenocarcinoma) cancer of the pancreas. My cancer doctors propose starting chemo this coming Wednesday, in hopes of shrinking the tumor enough to do a Whipple surgery. I am fearful of all this. As a very health conscious, fit, blood type O diet follower for many years, I wonder if moving to a ketogenic diet alone could heal this? At 70, I feel I have another 20 years of service in me, and that chemo, etc., will probably kill me. Advice?

Feeling fit at 70

Dear Ms. Fit at 70,

I am sorry to hear about your cancer. Your pancreatic adenocarcinoma can still be operated on but without chemo the chances of cure (living past 5 years) are slim, even at stage 2.

The Ketogenic diet is not considered standard of care, at least for now. It should also not be used alone if you want the best chances of response.

I don’t think you will die from the chemo. It depends on the regimen. There are several they can choose from. You might get sick with the more aggressive regimens but you should discuss this with your oncologist.

The chemotherapy can be tailored along the way and doses decreased if it gets toxic.

If you want to get an official medical opinion from me as to the type of chemo I suggest you book a consultation online on Healthtap . That way I can look at your files in detail and give you more personalized advice.

Hope this helps .

Dr. Tan

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

Fri, 25 Mar 2022 21:48:16 GMT

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/y7frqf7q and 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 diet allows 5 % or roughly 20 grams, while the Atkins diets 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 studies of 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 Res 19 (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 Res 25 (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 Epidemiol 172 (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 Cancer 8:122. 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 One 10 (6):e0127407. doi: 10.1371/journal.pone.0127407.

Stanton, A. A. 2018. "Dietary carbohydrate intake and mortality: reflections and reactions." Lancet Public Health 3 (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 Res 187 (6):743-754. doi: 10.1667/RR14668.1.

Can I have milk while on a Keto Diet?

Fri, 25 Mar 2022 21:47:23 GMT

“Dr. Tan, I really want to lose weight. But this guide that you gave me, the one about the " keto diet ”, it says that heavy cream is low in carbs. And it also says that my favorite drink, MILK, is not allowed? I am confused. The cream is low in carbohydrates, and milk has cream, so why is milk not allowed in a keto diet???

My eyes were squinting at the tiny black font on my government issued computer screen, my overwashed and unmanicured fingers struggling to enter yet another encrypted password. I lifted my head and turned my gaze towards the voice.

Mr. Sweettooth (not his real name), was my 190 lb. 65-year-old patient. Diagnosed with stage 4 lung cancer three years ago, he used to weigh much more. After several courses of chemotherapy and targeted radiation, he miraculously went into complete remission. To celebrate, I gave him a copy of my favorite diet.

Ketogenic cancer diet – Just the essentials

"Mr. Sweettooth, I've told you many times before, milk has significant amounts of carbohydrates. Therefore, milk on a keto diet isn't allowed! " He was still holding up his crisp laminated copy of the Modified Atkins (ketogenic) diet for me to see. On the sheet, there were two neat columns. One column listed the permitted ketogenic foods while the other listed the prohibitions. I gently tapped my fingernails on the column of foods to avoid. "Cheer up, Mr. Sweettooth, this first column still has many of your favorite foods - meat, fish, poultry, oils, butter, cheese, and greens. Make sure that when you shop at the grocery, to choose a cheese that is sliceable. Milk and any soft cheeses or cheeses that cannot be sliced should be avoided. We should really avoid milk while on a keto diet because milk has too many carbohydrates (Carbs). It contains “carbs” in the form of lactose, glucose, and galactose. Lactose is a form of sugar, as are glucose and galactose. And of course, sugar and starchy food are obviously prohibited!"

Our session ran out of time quickly. I did not offer him any milk alternatives, but the short talk seemed to satisfy him. "I thank you, Dr. Tan, I will certainly give this some thought.

Regular Milk while on a keto diet

Milk is considered a complete food. It has protein, fat, and carbohydrates. But if ketosis is a goal, milk in your diet will NOT meet your goal of attaining a ketotic state. A single (8 fluid ounce) cup of 100% whole milk has 146 calories and 12.8 grams total carbohydrates. On a ketogenic diet, the total daily carb allowance is only 20 grams, therefore by consuming milk, we are going to reach the limit very quickly.

Low-fat milk is not any better than whole milk. For every cup of 1% low-fat milk, we consume 12.2 grams of carbs.

Non-fat (SKIM) milk is also a disaster at 12.3 grams carbs per cup!

In a low carb (not strict keto) diet, some milk may be permitted, but this will not trigger the body to make ketones. Ketones are our alternative fuel in the absence or lack of carbohydrates.

Almond Milk and Coconut Milk while on a Ketogenic (Keto) Diet

What can we use as a good, tasty milk substitute? Almond milk and coconut milk, both readily available in most grocery stores, are good milk substitutes when trying to follow a ketogenic diet. For someone accustomed to regular cow's milk, the switch to these alternatives may require an acquired taste. Almond milk is made from the ground pulp of the almond nut. Almond milk contains only 60 calories per cup and only 8 grams of total carbs. Coconut milk is also becoming quite popular. It is made from the juice of the grated kernel of the coconut. Compared to regular milk, the carbohydrate count for a cup of unsweetened coconut beverage is quite low (1 gm). Other milk alternatives include rice and soy milk, both easily available. However, these are not as ideal for a keto diet since their carbohydrate content are comparable to that of regular milk (roughly 12-15 gms carbs per 8 fl. oz cup). Heavy cream when added to a beverage, can impart some of the milk-like taste to many low carb/keto beverages.

Keto Chocolate Milk?

Keto chocolate milk?

I've seen many websites and Pinterest posts claiming to have a keto diet-friendly chocolate milk beverage. Keep in mind that unsweetened cocoa powder still has 3.1 gm of carbs and 12 calories per tablespoon. If possible, stay away from the chocolate varieties. Even if you prefer non-dairy drinks, the addition of chocolate will still add a significant amount of carbohydrate content to your diet.

Heavy cream while on a keto diet

We used to avoid heavy cream because of its high-fat content. In the 1970s and 1980s, fat was vilified as a cause of heart disease and obesity. As the years passed, fat was blamed less and when used in a low carb setting, can actually promote weight loss.

Coffee lovers may use heavy cream (this is not the same as whipping cream) as a keto-friendly substitute for milk!

Heavy cream has ZERO grams of carbs per fluid ounce. You can reconstitute this with water to make a low carb “substitute milk”. Heavy cream is not as readily available in city stores. What you will easily find is "whipping cream", which has more carbs. Smaller retail stores, farm shops, or organic food shops are more likely to stock the heavy cream variety. If you have a ketogenic diet cookbook you will see that many of the recipes indeed use heavy cream as part of the keto diet ingredients.

Heavy cream can be also used to make keto-friendly ice cream .

My Experiment with “Keto” Ice Cream

Half and half is another popular coffee creamer. However, it is not a true ketogenic food, since it does contain fifty percent milk and fifty percent cream.

The following table lists many of the milk varieties seen in stores, as well as the non-milk substitutes.

DRINKPORTIONCALORIESCARBS COUNT in GRAMSWhole Milk 3.25 % fat1 cup (8 fl. Oz)14612.8Low Fat Milk 1% fat1 cup (8 fl.Oz)10512.2Reduced Fat Milk 2%1 cup (8 fl. Oz)12212.3Non-Fat Milk1 cup (8 fl. Oz)9112.3Chocolate Low fat 1%1 cup (8 fl. Oz)15826.1Ultrafiltered Whole milk1 cup (8 fl. Oz)1506Ultrafiltered 2% milk1 cup (8 fl. Oz)1206Ultrafiltered 2% chocolate milk1 cup (8 fl. Oz)14013 Almond milk 1 cup (8 fl. Oz)608Coconut milk raw1 cup (8 fl. Oz)55213So Delicious Dairy Free Unsweetened Coconut Milk Beverage1 cup (8 fl. Oz)501So Delicious Dairy Free ChocolateCoconut Milk Beverage1 cup (8 fl. Oz)10012Rice Dream Enriched, Unsweetened Original Rice Drink1 cup (8 fl. Oz)9015Better Than Milk Original Ready to Drink Soy Milk1 cup (8 fl. Oz)9017Starbucks Chai Latte with Soy milk1 cup (8 fl. Oz)12023.5Starbucks Café Americano1 short 8 fl. Oz81.5Starbucks Hot Chocolate with Whole Milk, no whipped cream1 short 8 fl. Oz16523.5McDonalds McCafe Caramel Frappe, plus whipped cream and caramel drizzleMedium container51072Heavy Whipping Cream1 cup (8 fl. Oz)8207Heavy Cream (not whipping)2 tablespoons (1 Fl Oz)990

Source : calorieking.com

Notice that heavy cream has dense calories, so a teaspoon can go a long way. Adding chocolate to any item can add as much as 4 to 6 grams per spoon. I threw in some examples of calorie and carb-rich items from our favorite Starbucks chain, just for comparison.

Soy milk is also acceptable, but the carb count can add up quickly so be cautious and weigh, count and diet carefully!

Filtered milk apparently has similar calories but had lower carbs than regular milk. I happened to try out a sample of Fairlife Ultrafiltered milk. It comes in plastic opaque bottles. The milk itself tasted very light, almost like skim milk. Despite that, I actually enjoyed it and drank more than I should have. It had enough flavor yet was not too heavy or filling.

So there you have it, some tasty, nutritious alternatives to milk that can easily be obtained from the groceries or online. Feel free to leave comments or questions!

Cancer survival guide for the newbie – beyond chemotherapy

Fri, 25 Mar 2022 21:46:26 GMT

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.

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.
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.
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.
Antunes, F., et al., Autophagy and intermittent fasting: the connection for cancer therapy?Clinics (Sao Paulo), 2018. 73(suppl 1): p. e814s.
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.
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.
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.
Reiter, R.J., et al., Melatonin, longevity and health in the aged: an assessment.Free Radic Res, 2002. 36(12): p. 1323-9.
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.
Lichter, I. and N.E. Sirett, Serial measurement of plasma cortisol in lung cancer.Thorax, 1975. 30(1): p. 91-4.
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.
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.
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.

Keto and alternative medicine updates at the VA oncology conference 2019

Fri, 25 Mar 2022 21:45:20 GMT

Last week, I took a much anticipated break to attend the 2019 annual meeting of AVAHO , (Association of Veteran Affairs Hematology Oncology) . I heard that there were several alternative medicine topics, so I couldn't wait to attend. This year, the meeting took place in the lovely city of Minneapolis, Minnesota. The weather was forecasted to be rainy, but luckily it was mild and dry. I took a quick two-hour non-stop Delta flight and landed safely before it was dark. Together with my federal employee colleagues, we caught a quick $2, convenient 20-minute tram ride to the hotel.

My colleague, Dr. Sandy Blakowski, was a palliative care expert. She couldn’t make it, so I offered to present her poster on “virtual palliative care in the Pittsburgh VA.” Telemedicine is booming, at le"st in our hospital. We not only have palliative care, but also conduct virtual appointments with our patients who live in Altoona, over two hours away. More on this later!

I made myself a detailed schedule, planning to attend several interesting lectures, but made sure to sit in on the “Complementary / Integrative Medicine” sessions.

Not surprisingly, the hall was packed to the brim with people.

Herbs and (Pot) Cannabis

I enjoyed the “Herbal Supplements in Cancer Patients” session, and learned a lot from the “POTential uses of Cannabinoids as Medicine” session. It looks like despite the growing popularity of cannabis, we still cannot freely prescribe marijuana for our patients. Not surprisingly, the room was also packed with people.

Stress reduction

“Stress management techniques after a cancer diagnosis” was another informative topic which drew much interest. Receiving a diagnosis of cancer is a big deal. Stress, not surprisingly, needs to be addressed in addition to the planned cancer treatment. Meditation, yoga, exercise were some of the techniques discussed.

Cachexia, weight loss in cancer, and omega-3 oils

There was also a small interest group session on “Nutrition”. It was assigned a tiny hall by the side of the larger “Lung cancer updates” session. As I let myself into the packed room, I found a precious vacant seat by the front. Majority of those in the audience were nutritionists, but there were a few physicians sprinkled in between. The talk was about “Novel approaches to treating cancer cachexia ”.

Cachexia , according to the Oxford English language dictionary is another medical word for “weakness and wasting of the body due to severe chronic illness”. The lecturer shared several slides, some of which reviewed several of the publications that studied how to reduce cancer cachexia. One of the featured scientists was Dr. Ken Fearon who used to study different ways to slow down cancer related muscle wasting. One slide focused on omega-3 oils and how consuming these oils would help decrease inflammation, and ultimately slow down cancer wasting. [1]

It was a lively lecture, with many people fielding questions after the session. I raised my hand and pointed out to the lecturer that she forgot to include in her slides, Dr. Fearon’s studies regarding the effects of a high fat (ketogenic) diet in cancer cachexia. [2]

” In Fearon’s small study, he found there was some reduction of weight loss and also decreased tumor size [2]”, I said.

I asked the lecturer "what she thought of using the ketogenic diet" for cancer patients in general.

You are entitled to your (my) opinion

“NONSENSE!!!” boomed a heavy voice from behind me.

“THIS IS ABSOLUTE NONSENSE… Sugar does NOT feed cancer!!!” the heavy voice continued.

I turned my head around, to search for the source of this unwelcome intrusion.

There he was, just three seats away from me. Well dressed, and loud spoken, from his appearance I could tell that he was definitely not a follower of the keto diet.

Obviously, an engaged listener, he was definitely not in the mood for a friendly discussion.

Physically, I was no match for him, even if I owned a black belt in Tang Soo do karate.

“Ah-hem” - Clearing my throat, I answered- “You are welcome to voice your own opinion. But clearly you still do not fully grasp the concept behind this. I suggest that you do some more research on this in your free time.” I felt somewhat protected by the crowd around me. Not wasting any more time, I slipped out of the room, and onto the next session.

Are doctors receptive to the ketogenic diet?

Right now, there are growing numbers of oncology specialists who are taking notice and advising their patients to avoid sugar and starch, and to focus on more nutritionally sound diets.

Unfortunately, there are still an equally large number of physicians who feel that this is “nonsense” and that it doesn’t matter what you eat, to “enjoy what time you have left and eat what suits you”.

In the same way that Columbus had a difficult time convincing people of his time that the earth was indeed round [3], we are compelled to try and increase public and academic awareness of the value of improving nutrition in cancer patients.

Keto for cancer patients who are losing weight?

Patients that have cancer cachexia have a higher chance of dying [4].

How do we reverse this? The normal reflex is to increase caloric intake.

Strangely, this strategy does not work very well when it comes to stopping cancer related weight loss. In fact, weight loss seems to accelerate.

Tisdale studied cancer cachexia in the lab and found that mice with transplanted colon cancers lost a lot of weight. He gave some of the mice a normal diet, and another group of the mice, the same amount of calories, but included more fat. He discovered that a high fat proportioned diet, actually slows down weight loss, and shrinks tumors. [2]

Proper choices in nutrition, therefore, is as basic as the need for surgery and chemotherapy. My dream is that one day we can actually agree on which diet is the best, to prepare our patients for a stronger, patient-led battle against their cancers.

Barber, M.D., et al., Effect of a fish oil-enriched nutritional supplement on metabolic mediators in patients with pancreatic cancer cachexia. Nutr Cancer, 2001. 40(2): p. 118-24.
Tisdale, M.J., R.A. Brennan, and K.C. Fearon, Reduction of weight loss and tumour size in a cachexia model by a high fat diet. Br J Cancer, 1987. 56(1): p. 39-43.
Mulero, H.L., Columbus' trips to America. JAMA, 1977. 237(1): p. 25-6.
Ozorio, G.A., K. Barao, and N.M. Forones, Cachexia Stage, Patient-Generated Subjective Global Assessment, Phase Angle, and Handgrip Strength in Patients with Gastrointestinal Cancer. Nutr Cancer, 2017. 69(5): p. 772-779.

Keto beginners guide for cancer patients

Fri, 25 Mar 2022 21:44:24 GMT

What to do when you don't know where to begin

What to do when you don’t know where to begin with keto?

(The following was a real conversation between myself and a cancer patient. Names have been changed to protect privacy.)

“Dr. Tan, what do I eat while on the keto diet?”

I looked up at my patient, Mr. Brown (not his real name). At age 65, he is overweight, diabetic, and basically a “meat and potatoes” type of guy. He also has cancer.

What is important to know about starting the “keto” lifestyle, is not so much what to eat , but what NOT to eat . People are always looking for a magic pill. In this case, the first impression people have about the keto (ketogenic- to generate or make ketones) diet, is that a certain type of food “might” help cancer. That isn’t really the case. The keto w ay o f e ating (WOE), is actually more than a diet. It is a lifestyle change. When you cut down on your carbohydrate intake, the body senses it and produces ketones to use as a back-up energy source. Cancers, fortunately, do not rely on ketones, and by following a keto diet, we hope it could help slow down cancer growth. Unfortunately, the evidence behind this is not yet substantial. We do know that this “keto” diet has anti-cancer properties in lab animals, and the human trials done so far seem to say that it is safe to use, even in advanced cancer patients.

Me: “Well Mr. Brown, I can give you a detailed list, a menu, plus a shopping list. We also have a cookbook that you can borrow. It’s over there by the chemotherapy nurses station.”

“Just remember, it is very important that we keep this process simple…. Just think of two letters--- S-S…!!!”

Mr. Brown: “S-S?? “

Me: “ Yes, no SUGAR, no STARCH!!!”

Mr. Brown: “Okay doc, but what about wheat bread?”

I shook my head, “ no, no, no… bread is bread. Bread has many names Wheat bread, gluten free bread, challah, tortillas, - they are all bread, and bread is made of starch!”

Mr. Brown: “Ok, how about pasta?”

Me: “Mr. Brown, pasta is usually made from semolina flour. Anything made out of flour automatically contains starch, and that’s not allowed.”

Mr. Brown: “Fruits? ”

I took a deep breath. “ No sir, fruits, including tomatoes, are high in carbohydrates and sugar.”

Mr. Brown: “But aren’t fruits supposed to be healthy for you?”

Me: Yes, for prevention, but once cancer develops, the anti-oxidant advantage gained by eating fruits gets smothered by the metabolic overactivity of the cancer.

Mr. Brown: “What about oatmeal?”

Me: “No, that’s still carbohydrate rich.”

Mr. Brown: ”Peanut butter?”

Me: Sigh.

I opened the side drawer next to my desk and pulled out a copy of our ketogenic diet handout. “Here you go, Mr. Brown. This is a list of the types of food that you can eat, and on this other list, are the prohibited foods. As you can see, there are literally hundreds of things that are allowed. You really won’t starve. “

Me: “Remember, don’t overdo it. A ketogenic diet, if taken in excess, is not good either. Just eat until you are no longer hungry. Don’t wait until you are full. And don’t forget to add fat.” “If you have time, I can introduce you to our nutritionist, and she can guide you further. “

This encounter with my patient made me realize that perhaps, a minimalist method towards the ketogenic diet, is good way to start if one is a novice.

GETTING KETO READY, THE MINIMALIST WAY

Baby steps!!! With practice, we will become experts in due time.

For beginners, my advice is, to KEEP IT SIMPLE.

Do not worry about checking your ketones or about buying a ketone meter. Right now, you just want to get your feet wet.

Begin with a blank slate. Empty your fridge and pantry.

Remove all the items that are on the “not allowed “ list.

Restock it only with keto-approved foods. Donate the rest to a local food pantry.

Start eliminating the OBVIOUS STARCHES: Flour, rice, bread, cereal, pasta, potatoes.

Next, remove the OBVIOUS SWEETS: candy, sugar, syrups, honey, jams, and regular soda drinks, fruits.

Now, there are the NOT-SO-OBVIOUS items which are popular for being healthy, but are high carb anyway – cow’s or goat’s milk, cottage cheese, non-fat yogurt, fruits. Avoid these.

If unsure, place the item in question in a box for future analysis.

Look up the rest of the remaining food items, using my chart.

BEWARE OF HIDDEN CARBS

For example, a lot of foods actually have starch and they are not called bread. For example, “ rice, wheat, oats, quinoa, tortillas , are all starchy. Some vegetables are healthy but are not keto-friendly. Examples include chickpeas, beans and potatoes . Did you know that carrots are also high in carbohydrates?

WHAT ABOUT TOMATOES AND AVOCADOES?

Tomatoes and avocadoes also add up quickly to your carb limit. A medium avocado actually contains around 16 grams of carbohydrates. If you are counting towards a 20-gram daily limit, that will easily kick you out of ketosis. So no, I would not recommend avocadoes for the beginner.

PEANUT BUTTER, SPICES, and CONDIMENTS

Peanut butter is protein rich, but unfortunately, the popular versions are usually loaded with sugar. But, there is good news. Peanut butter now comes in PLAIN versions. Look at the labels. Ingredients should say “peanuts and oil”. If sugar is listed, put it back on the shelf.

Spices can have hidden carbs. Again, look at the labels and search for “total carbs”. You will be surprised at what you will discover.

Ketchup , an American favorite, usually has sugar, or worse, high fructose corn syrup. Pasta sauce and marinara sauce , likewise can have a significant amount of added sugar.

Mayonnaise . Make sure it is indeed “pure mayo”. Mayonnaise is essentially just made up of eggs and oil, plus some spices. Lookout again for those with added sugar, glucose or corn syrup. Some might even have cornstarch to act as thickeners. Put those back on the shelf.

CLASSIFICATIONS

Now that you have a general idea of what to look for, you may now begin to arrange your newly emptied pantry and fridge into three categories.

Yes, only 3. Make that 4 – for drinks.

ASSEMBLING YOUR MEAL

By now, you got the idea. It’s day one. Meal planning for lunch and dinner is simple.

Visually cut your plate in half. Half is your choice of greens. I usually assemble half of my plate with broccoli, cauliflower, spinach or kale .

Then, choose your protein. Is today your day for beef steak? grilled chicken? or fried fish? Make sure they are “ not breaded ”. Remember that’s hidden carbs too ( the flour).

Don’t forget to add your FAT. Once you assemble your simple meal, top it off with a cube of butter, or a big dollop of heavy cream. Feel free to cook with these or drizzle some oil or melted butter over your assembled plate of food. Don’t forget to consider sour cream as garnish for your plate, and heavy cream for your soups and coffee.

Season with salt and pepper .

So that is my version of a keto-diet made simple:

Repeat daily with minor variations.

I know, it sounds boring.

But in reality, people do eat the same thing day in and day out. Usually, its cereal in the morning with milk, and meals usually have rice or pasta. All I am doing here is, I am eliminating the carbs and swapping them out for a keto-friendly alternative. Make some variety by changing the way you prepare the food. Bake one day, and steam or stir-fry the next meal, to make food interesting. The possibilities are actually endless. Simple preparation actually increases one’s chances of success.

ADDING VARIETY

Mushrooms, celery, tofu are good low carb add-ons. Once you become attuned to this diet, you can even venture back into desserts! But go easy on the sweeteners. Even sugar substitutes such as sugar alcohols (sorbitol, erythritol, etc.) can spike your glucose. At this point, you might even want to buy yourself a cookbook, to expand your meal variety. However, once you get the hang of what I am saying, buying a cookbook is really an optional step.

SUPPLEMENTAL KETONES

There’s a lot out of “ketone supplements” out there now. None of these are FDA approved, nor are any with enough scientific data to back their efficacy. But certainly, we hope that with future trials, we can learn more about keto-supplements and whether they are indeed worth their buck. One thing is for sure if you are not on the keto diet, to begin with, adding extra ketones to your diet in the form of a supplement will not really benefit you since you are still not depriving the cancer of glucose. Remember, it’s not what you can eat, but what you shouldn’t eat that is the main idea here.

As you get more attuned to the basics, you will gradually try other foods, and even start monitoring your blood sugars and ketones. You might also want to secure a phone app that helps you track carbs and even exercise. Even if you remain stuck in the beginner’s stage, you have already made a great step that will have a positive impact on your fight against cancer!

Ziaei, S., & Halaby, R. (2017). Dietary Isoflavones and Breast Cancer Risk. Medicines (Basel, Switzerland), 4(2), 18. doi:10.3390/medicines4020018
https://www.calorieking.com/us/en/foods/f/calories-in-fresh-fruits-avocados-average-all-varieties-raw/zU9a9g9oQ5W3RHKaVFtG7A

Keto diet makes news at the SIO 2019 meeting

Fri, 25 Mar 2022 21:43:02 GMT

It was a beautiful keto conference weekend in the Big Apple.This year, the SIO Society for Integrative Oncology was being sponsored by Memorial Sloan Kettering, and this year, it was held at the Hilton Midtown Hotel in Manhattan, New York City!

A growing society indeed, the SIO now has a little over 600 members.

Integrative Oncology and Alternative Medicine

I was happy to see so many like-minded participants. It was a mixed crowd.

Alternative medicine experts who have an interest in Integrative Oncology - Yoga, TaiChi instructors, Chinese herbalists, Acupuncturists, Mindfulness experts, Keto dieters and vegans were right at home in this conference. Doctors of Medicine and Psychology, Naturopaths, medical students and fellows in training, nurse practitioners and pharmacists were a good portion of the participants. There were patients too, and many patient advocates.

In the field of cancer - complementary medicine, acupuncture, gut microbiome, and sleep, were the featured hot topics. Cognitive behavior training and mindfulness were likewise well represented. There were several speakers who expounded on the topics of insomnia, Chinese herbal medicine, and Aryuvedic drugs. Of course, no complementary medicine conference would be complete without some mention of how KETO DIETS come into the cancer treatment armamentarium!

I had a chance to view many of the accepted posters. Here is a sample of what I found.

Acupuncture

The Italians from the Gemelli Foundation in Rome, Italy, are holding a pilot study wherein acupuncture is being used to treat chemotherapy related nerve pain in patients with breast and gynecologic cancers. The researchers found that the patients who enrolled in their study had improved pain control, and better emotional outcomes after acupuncture treatment.

Honey

Doctors from the University of Kentucky and George Washington University, are using honey to help speed up healing of fistulas that form after laryngectomies ( removal of the voicebox). Featuring 4 of their own patients, they found that wound healing was faster when honey was applied. They concluded that this improved healing could be because honey has antifungal and anti-bacterial benefits.

Mistletoe

Swedish investigators are trying to treat pancreatic cancers with mistletoe extract and see if it had any effects on the survival. The trial is currently going on in 7 Swedish hospitals. 32 patients so far have enrolled. We are still awaiting the results.

At the Sidney Kimmel Cancer Center, which is part of Johns Hopkins University in Baltimore Maryland, the first intravenous mistletoe study is now going on. They are now recruiting patients with advanced solid cancers for their phase I trial.

Soy and phytoestrogens

Poster 180 reviewed the effects of soy on breast cancer. Did you know that soy has a protective effect against breast cancer in Asian women, but also has the opposite effect (might promote breast cancer) on women in the Western world? The authors suggested that the difference could be explained by the individual’s microbiota. In other words, the type of natural bacteria residing inside one’s gut could affect the way soy makes the intestine absorb or excrete estrogen. For now, the advice is to avoid soy if you happen to have breast cancer and are living in a Western society. At least, until we get more future scientific data.

Moxibustion

Have you ever heard of “infrared laser moxibustion? The Chinese are testing this treatment for lung cancers. Using lab mice, they injected them with lung cancer cells until tumors began to appear under their skin. Then, using the laser to treat these tumors, they found that they were able to increase the levels of CD4 T helper cells, which led to immune system activation and inhibition of tumor growth.

Gut Microbiome

The type of bacteria within your gut, apparently matters. Immunotherapy is a hot new treatment these days. For cancer, the FDA has approved immunotherapy for many cancers, however, it actually only works in a minority of patients. Why is that? The gut bacteria has a role.

Those with “clean guts” meaning to say, the bacteria within their guts did not have much variety ( think of the population in Idaho), tend to have shorter survival times. Patients who respond to and live a long time with immunotherapy were found to have a very diverse population of gut bacteria! (diverse- think of the population in New York).

When you use a lot of antibiotics, your gut gets cleaned out, and the number of varieties of bacteria in your gut becomes much less, and that could be a bad thing because it makes you less likely to respond to immunotherapy.

Scientists at MD Anderson Cancer Center, are therefore studying multiple approaches to cancer therapy, using bacteria. In other words, they are trying to use your stool (poop) and use it to fight cancer!

Ketogenic Diets

I was also happy to see a couple of KETO DIET related posters. Dr. Nasha Winters had her poster “Beyond Keto” which expounded on her approach to Keto counseling.

Ketogenic Diets, Hyperthermia and Hyperbaric Oxygen

Dr. Slocum from Turkey had his poster which featured the case report of their breast cancer patient whom they placed on a keto diet among other things, and how she was able to significantly extend her life by using a multi-metabolic approach to treat her cancer.

The treatment consisted of chemotherapy, plus a 12 hour fast prior to chemo. She also received insulin injections under hospital supervision, prior to her chemotherapy, to bring her blood glucose to below 60 mg/dl. In addition she received hyperthermia and hyperbaric oxygen therapy plus was placed on a ketogenic diet. Her PET scans showed complete remission following a six month treatment period. Below is a photograph of their poster.

I didn't have a poster this time, because I made a last minute decision to attend! Maybe next time!

The weekend went by pretty fast, and it was time to get back to the airport.

Until next time, see you all at the next SIO conference in 2020!

Why I chose to become a cancer doctor

Fri, 25 Mar 2022 21:41:33 GMT

Why I chose to become a cancer doctor - the very early years

This career decision didn’t happen overnight. When I was a fresh-faced, eager medical student, being an oncologist was furthest from my mind. Oncology was a very minor part of our training. We did not even have a rotation for it. It was also known to be a very depressing subspecialty. I still have vivid images of myself as a medical clerk , serving a shift in my Internal Medicine rotation. We had a few patients admitted with cancer to our wards. Our staff oncologist would appear without warning. I stared at him, imagining that he can be mistaken for a caretaker. He was a kind-faced man who always wore a pair of jet-black slacks and a starched white polo shirt, and wore no medical coat. He always arrived at our ward, carrying a huge glass bottle of chemotherapy. It looked like a milk bottle. Completely wrapped in aluminum foil, the bottle was a mysterious, delicate, dangerous package. It had a biohazard label. The oncologist would attach it to some long plastic tubing and a hollow sterile needle. He would then proceed and drip the drugs into the veins of our cancer patients. Then, we would all wait until all the medication has entered their frail bodies. There will be one or two more visits until the bed becomes empty. We never cured anyone, and I felt that the chemotherapy, indeed, hastened their deaths.

My first year as a "real" doctor

Things did not improve when I began my first year of residency. Choosing a cancer specialty was furthest from my mind. I was working as a young doctor in a busy county hospital, and the general medical clinics did not see cancer patients. Instead, they were immediately sent over to the subspecialty cancer clinics. I refused to choose hematology/oncology as an elective. The medical oncologists at the time appeared to lack compassion. There were no role models. We labeled almost all cancer patients as "palliative", and whisked them away to hospice . None of the cancer patients that I knew survived more than a year.I was, at the time, determined to leave. The field of medicine was getting depressing. The many, incurable medical problems that plagued elderly patients also began to discourage me. I began applying to OB/GYN programs to become an obstetrician, a field that we knew to be a “happy” specialty. But, that decision did not last long. I found and married my soulmate, and convinced myself that a hectic life as an obstetrician was not the way to go. So, I remained in internal medicine.

Choosing to be a cancer doctor - the middle years

Looking for a change in scenery, we left the county hospital's residency program and moved to the Bronx, and we transferred to the residency program at the Montefiore Medical Center . Montefiore Hospital was part of the Albert Einstein College of Medicine. It was a larger medical center, with hundreds of residents in training.

A new breed of cancer patients

The patients traveled from all over the country, and from abroad. We had a cancer treatment center that happened to be very active in clinical trials. Part of my last year of training was a medical oncology rotation. I wasn't excited, but this choice towards a cancer rotation changed my mind forever. For the first time, I met a 30-year-old woman with metastatic breast cancer. Her tumor had spread to her spine, and she was receiving chemotherapy. Back then, a diagnosis of stage 4 breast cancer usually meant survival of 3 to 6 months. But here she was, a survivor, at 13 months, and still talking and walking. What is this? Long term cancer survivors? This intrigued me.

The entry of the new cancer therapies

Another patient with a deadly cancer of the skin, melanoma, was receiving a drug called interleukin 2 . Interleukins were the hottest form of immune therapy at the time. I marveled at the patients who came, with large globs of metastatic melanoma on their legs, and then, after only a few rounds of intravenous interleukin, the tumors were gone! The FDA (Food and drug administration) had just approved Paclitaxel (Taxol), a new drug from the bark of the Pacific Yew Tree.

Taxus brevifolia, the Pacific Yew tree, from which we get the chemotherapy drug, Paclitaxel. Credit: Wikipedia.

We had early access to the drug and tried it on several patients with stage four lung cancers. To my amazement, the cancers were shrinking! Patients were alive a year or more, and their quality of life also improved.

Vomiting becomes a thing of the past

Ondansetron also came into the market. In the past, the patient would receive cis-platinum, a chemotherapy drug that was effective for many types of cancers. But the side effects were wicked. Patients would be violently nauseated and they would vomit at least 10 times a day. When Ondansetron came, the vomiting was miraculously cut down to none or at most, just once a day, and nausea became very manageable. At last, we have conquered the vomiting issue!

My career as an oncologist begins

It was an exciting feeling, seeing all this progress in so short of a time. I had to choose whether to go out into practice as a general internist , or to undergo more training to become a cancer doctor. I longed to be part of this budding field (the NEW oncology) that was developing rapidly before my eyes. I decided to apply for the oncology fellowship. Before I knew it, I was a newly minted medical oncologist. I sealed my choice.

My first medical job

I began my medical career at an underserved clinic, where drive-by shootings after sunset were a normal event. It was normal to see the parking lot's fence, flat on the ground, with a couple of bullet holes. "Don't worry, Dr. Tan, they will never harm the doctors. They know that we are here to help them." assured the medical secretary. I had a lot of patients during my first year of practice. I saw both general medicine patients and cancer patients. Most of them came in with no dollars in their pockets, no insurance, and - many times - no relatives. The social worker worked long hours, and the paper medical charts were always missing. Without paper charts to guide me, we had to hope our patients remembered what medicines they were on. I had to use my "expertise" to try and figure out how to give them advice based on the little information that I had. Many patients expected not only medical advice but also relied on us to give them medicine! Luckily, some of the patients had full Medicaid coverage and could receive chemotherapy. I treated many patients but also did a lot of listening. The lives of my patients, shared with me during office visits, fascinated me. Their struggles with their health and daily living became a major part of each visit. I felt like I was a psychiatrist! Soon, I moved on to new jobs, new cities, and new friends.

My mission as a cancer doctor

Something changed as the years passed. Choosing to become what I am now, a cancer doctor, finally came true. Seeing cancer patients no longer shocked me. As I saw many past successes, I wanted the same success for all of my patients. Their problems increased my desire to help them. I asked to be assigned to complicated, aggressive cases. The more complicated cases created a challenge for me, to try somehow to help them when others could not. Patients became my mission , and their families became my allies. Two decades have passed since the time that I received my medical license, and I am still an oncologist. I sometimes dream of packing up and trying my hand at the retail business, another childhood dream of mine. But the thought of disappointing so many of my patients, actually, now my friends, keeps me here. And of course, the research that we still need to do. While I am in no way a mega researcher, I hope my small contribution to science might one day, help us reach a “cure."

Why some cancers don’t use glucose

Fri, 25 Mar 2022 21:40:41 GMT

The Warburg Effect and Glucose

No discussion of the ketogenic diet would be complete without a mention of the “Warburg Effect and why cancers prefer to use glucose.

Dr. Otto Warburg was a German doctor (1883 to 1970) , who proposed that cancer was a disease where the tumor cells are able to produce their own energy, by breaking down glucose. Starchy food like rice, pasta, bread and potatoes, all contain glucose. Actually, carbohydrates can also be found in green vegetables, however, in greens, the carbohydrate levels are relatively lower, compared to the starchy veggies. The keto diet is a low carbohydrate, low glucose/low sugar diet that can help decrease the effect of the hyperbreakdown of glucose in cancer cells, and possibly control their growth and multiplication.

Normal cells are more sophisticated than cancer cells, and can get their energy from starch as well as from protein and fats. The Warburg effect is all about how cancers prefer to get their energy from glucose. The PET scan shows this by using a radioactive tracer called fluorodeoxyglucose, which looks similar to the glucose molecule. This radioactive tracer will emit gamma rays which are detected by the scanner. Cancer cells will rapidly consume the radioactive fluorodeoxyglucose and will show up on the PET scan images as bright orange-yellow areas of hyperactivity.

Stopping the cancer signals

Fri, 25 Mar 2022 21:40:02 GMT

New cancer drugs are now available that target and stop the cell signaling pathways. Normal cells rely on chemical signals that tell them how to grow, divide, talk to each other, move around, and die.
Almost like a subway map, these are complicated, intertwined signals that cells use to communicate the instructions of life. When the instructions go wrong, chaos happens, and cancer cells take over in a very disorganized way.

Organized chaos in an NYC subway. Tumor signals look similar. Credit NYC subway map

Signals that train cells to change into a cancer

Signaling is a way of communication between cells, between cells and their central information hub, the nucleus, or between cells and their outside environment.
Cell signals can teach cells to grow, to divide, to start moving, or reproduce. Signals tell cells to stay organized and stick together in neat patterns. Cell signaling also tells the cell when to die (apoptosis). Cell signals can also cause damage. They can trigger inflammation, or tell cells to start moving to another location ( metastasize). Cell signals can also communicate with the immune system and make it attack invading cancer cells when they do show up in the body.
When cell signaling goes wrong, the cancers develop. Cancer begins from a baby cell or a stem cell. Cancer cell signals are uncontrolled, or erratic. The cancer cell loses the ability to die because the signals for death are destroyed.

Pro-cancer gene signals

Genes are characteristics that inherit from our parents. Pro-cancer genes ( also known as Oncogenes) are blueprints that eventually create a protein that is strong enough to transform normal baby cells (stem cells) into cancer stem cells. The RAS oncogene is one example of a pro-tumor gene.
The reverse gene is called a tumor suppressor gene. Both pro and anti-cancer genes can create signals that teach the cell to turn into cancer. Many new cancer drugs are available, and their purpose is to target a signaling pathway that hopefully, will cut the energy that fuels cancer.

Signals stop a tumor's blood supply (VEGF inhibitors)

Vascular ( blood vessel) - endothelial (blood vessel's inner wall)-growth factor- cancer cell signaling pathway. Anti-VEGF drugs are drugs that target signals that boost blood vessel growth. Anti VEGF drugs can cut the tumor's blood supply and indirectly make it stop growing. An example of new drugs that target the cancer blood vessels are anti-VEGF chemotherapy like Bevacizumab (brand name Avastin), which is a popular drug for advanced colon cancer. It attacks the VEGF pathway and cuts off the tumor blood supply, indirectly starving it.

Signals make cells grow, divide, move and die

We have a signal for everything that a cell does. A signal to make it wake up and divide, another signal to it to grow, meet other cells, and when the cell gets too old, there is a signal that makes it die. Cancer develops because the signaling pathways become defective, or overactive. The PI3K pathway meets up with another pathway, the AKT pathway, and another pathway, the mTOR pathway. Together they control how cells grow, move and die. PI3K, AKT mTOR are just shortcutted initials for a fancier, longer scientific name. Just remember they are all signaling pathways for cells, and they are intertwined. Drugs are being studied to possibly target these pathways.(Yang, Nie et al. 2019) Copanlisib and Duvelisib are examples of available anti PI3K / anti-cell signaling chemotherapies.

How many cancer signals are there?

There is more than one. There are actually hundreds if not thousands of them, counting the ones we still don’t know about. It looks similar to the subway map. Tumor signaling pathways create changes in cancer proteins, in order to change their behavior to a less aggressive form. You will find it hard to convince me that a drug targeting a single signal, will cure your cancer. When the drug works, cancer will find a way to go around that roadblock. There is what we call "CROSSTALK" between cancer signals. It s easy to see why cancer will have no trouble finding a detour.

The cell membrane (on top) has receptors which process the signals and then transmits them through a complex maze, towards the center, where the cell will read the instructions and know what to do. Photo credit Qiagen

What triggers these pro-cancer signals?

There are many triggers. Metabolic stress , chemicals, radiation, carbohydrates , are all triggers for these cancer cell signaling pathways. Chemicals and radiation, heat, can cause cell damage from reactive oxygen species (ROS). Reactive oxygen species (ROS) are unstable molecules that contain oxygen and are highly reactive, causing damage to the center of our genes, the DNA, RNA and proteins. Our immune system can normally attack cancer cells and bacteria, when they do show up in our bodies. The immune system does this by releasing a vicious attack, and one of those defenders is the reactive oxygen species. However, if there is too much of this ROS, the stress builds up in the cell, and the cell becomes damaged. This is when OXIDATIVE stress occurs.

Our body defends itself against stress

Our body reacts by releasing enzymes that can melt away this stress from the reactive oxygen species. Some of these protective enzymes are called SOD (superoxide dismutase), and catalase. The words ends in "ase', usually means it is an enzyme. When our body is low on these enzymes, cell damage can happen. Pro cancer cell signaling is activated and cancers develop and grow. Food that are high in antioxidants can help blunt some of this damage.

Carbohydrates can trigger the PI3K/AKT cell signaling pathways

Veterinarians advice: Don't feed your dog human food, it will shorten their life! Photo by Christian Bowen on Unsplash

A study from Tehran found that high carbohydrate diets can help cancer cells survive by boosting the pro-tumor PI3K/AKT /mTOR cancer cell signaling pathway. Knowing that we now have drugs that target the PI3K and the mTOR pathways, it seems logical that a ketogenic diet might help multiply the anti-cancer effect of these targeted chemotherapies? Plant based food can tame overactive PI3K/AKT pathways, but adopting a ketogenic, low carbohydrate can be beneficial as well, since you can target not just one, but many cancer signals at once.

REFERENCES
https://www.clinicalnutritionjournal.com/article/S0261-5614(18)31888-0/fulltext
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5968394/
Yang, J., J. Nie, X. Ma, Y. Wei, Y. Peng and X. Wei (2019). "Targeting PI3K in cancer: mechanisms and advances in clinical trials." Mol Cancer 18 (1): 26.

When to worry about keto diet weight loss in cancer

Fri, 25 Mar 2022 21:39:13 GMT

Keto Diet weight loss – are we concerned?

The weight loss that we see when one goes on the keto diet, is often a cause for worry. Many well-meaning health providers (doctors, nurses, physician assistants, and nutritionists) become concerned when their patients on the keto diet begin losing weight. At this point, many would start advising the patients to increase their intake of carbohydrates. And more often than not, the weight loss accelerates, and more carbs are prescribed.

Here is a simple checklist

If you answer YES to most of these questions, chances are that you have nothing to worry about.

Look at your food. Are you trying to be healthy? Is your diet now replaced by healthy food instead of carbohydrate-rich, proinflammatory meals? Are you missing junk food in your home?

You have already made the change to a healthier diet. Keep it up. Swapping healthy food like vegetables and fish, chicken meta, for high calorie, low nutrient food like cookies, pudding and ice cream, is certainly not the way to go.

You are exercising. Naturally, this would make you lose weight. Your muscles feel firmer, and that fat band around your waist is missing. You are having healthy weight loss. Keto dieting will make you lose fat, not muscle.

You feel good. Cancer weight loss is usually a terminal process. When the body can no longer fight cancer, chemical substances called cytokines are circulating in the body, breaking down even more protein and muscles. At this point, fat is no longer an issue. Feeling trim and slim sounds healthier than heavy and fatigued.

Your body mass index is normal.

Why do doctors panic when a grossly overweight patient loses a hundred pounds? He is not only lighter, but his back pain is gone, and his sugars are better controlled? He is still overweight, by the way. The CDC Center for disease control lists the ideal body mass index as being anywhere within the range of 18 to 23. Most Americans are tipping the scales with a BMI of 26 and above.
Check the BMI calculator here.

Your serum albumin is normal. This is a good measure of nutritional status. Terminal patients usually have serum albumin that is literally in the “dumps”- below 3 mg/dl

Your blood chemistries are normal or close to normal. This is the blood testing that your doctor orders to see if your kidneys and liver are in working condition. If these tests are normal, then that is a sign that you are doing something right in terms of your diet.

Your tumor is stable, or better. This is probably the ultimate goal of every diet and every chemotherapy plan. Diet planning should be part of our anti-cancer plan. A healthy, well-fed body can better help you fight cancer. A tumor that is no longer growing is always a good sign, isn’t it? Why stop?

The CACHEXIA SYNDROME
Cachexia is a terminal phase of cancer, and when seen in cancer patients, it can signal a poor prognosis. The good news is, it is not simply to weight loss that makes one a cachectic person. Several criteria need to be met before one can be classified as "cachectic. "

weight loss of at least 5% within the past 12 months or less. or a body mass index of less than 20.

AND.....
2. weak muscle strength
3. fatigue
PLUS 3 of any of the following.... ABNORMAL BLOOD TESTS.
Check the markers of inflammation. CRP or C-reactive protein , ferritin, interleukin-6 , are all blood tests that your doctor can order to see if you have active inflammation.
Check your hemoglobin levels. This is the "color" of your red blood cells. How red are they? The lower the number, the more "anemic " you are. Any Hemoglobin level less than 12 g/deciliter is considered "anemic"
Check your ALBUMIN . I already mentioned this before. a low serum level of albumin, one that is less than 3.2 grams per deciliter, is considered low.
So, if you don't fit these criteria, and you feel good, there is probably nothing to worry about.
Ask your doctor to help you understand what your weight loss is really all about. Weight loss can be bad, but it certainly can be healthy!

Keto survival guide for high carb lovers (Rice, bread, pasta and potatoes)

Fri, 25 Mar 2022 21:38:18 GMT

Rice, bread, pasta, and potatoes - the big 4

Keto for high carb lovers? Bread and pasta lovers going on the keto diet, often have a rough time. If you live in a civilized society, bread is everywhere. Pasta, a popular convenience food, is likewise easy to find and makes for a very filling and satisfying meal. Rice is also cheap, filling side dish. Notoriously common in Asia, where diabetes is in near epidemic proportions, rice is also becoming fairly commonplace in North American dinner tables. Bread is comfort food. The soft, chewy consistency is often difficult to resist. And of course, the humble potato finds its way informal and not so formal dinner dishes.
But eating these foods will certainly not help one get into ketosis.
To succeed, one must have a solid game plan.

My survival pasta/bread lover’s keto survival menu:

You won't see any detailed recipes here. Feel free to experiment. This is what I discovered works, and requires a minimum of time, thought and effort.

Chaffles

I love the simplicity of this recipe. It is basically a WAFFLE, but instead of using wheat, the main ingredient is CHEESE. The base ingredients are only TWO. Get half a cup of shredded cheese (finely shredded cheese is what I use), and add one large egg. Beat the mixture until the consistency of a hotcake batter. Pour this into a waffle maker and cook it until it is done. Usually, this means at least 2 to 5 full minutes. The finished product looks surprisingly like a real waffle. Variations which use some added ingredients, such as sour cream, or baking powder, might change the consistency a bit. Do so for variety. Feel free to experiment!

Crack slaw

This is simply cabbage cut into strips, to look like pasta. Cook via sautéing in oil and ground meat, with your choice of small vegetables and fry with butter or coconut oil. Season with salt and pepper. Very filling and tasty!

Keto noodles

Buy a spiralizer. High carb lovers always love pasta. Make keto friendly noodles out of zucchini or squash. Heat some coconut oil or butter in a sauté pan. Throw in some garlic, season with salt and pepper, and wait until the aroma develops. Then throw in the spiralized zucchini and sauté quickly until al dente. Add some butter.

Cauli rice, ala Chinese rice style

This is my favorite. Saute some onion and garlic. Throw in a half cup of chopped carrots, and green peas. Add and saute the cauli rice. Add sesame seed oil for aroma. Season with salt and pepper, butter. Add some chopped green onions. Make a well in the middle of the cauli rice. Crack one egg into the well and mix briskly.

Keto Lasagna

The same recipe as any lasagna, but instead of the pasta layer, use leftover vegetables instead. Use at least tw0 types of cheddar cheese, mozzarella, ricotta, and beaten egg. Bake in an oven at 350 degrees until the top layer begins to set. About 40 minutes to 60.

Beef stew

Get yourself a crockpot. For busy people, this tool can be a true lifesaver. Throw ingredients in and forget about it all day. The slow cooking process of any beef stew will bring out the flavors of the ingredients. I like to throw in some beef cubes, pre sauté some onions and garlic then throw these in too. Followed by a cup of broth, some laurel leaves, cloves, salt and pepper to taste. Maybe some tomato paste, but go easy on the tomato paste, since this can easily add up in terms of the carb count.

Shish kababs

Truly easy to put together. Get some marinated meat, alternate the meat with pieces of green pepper, onion, zucchini or squash. Brush with olive oil, season with salt and pepper, and grill over a flame. Delicious and simple.

Shrimp cocktail

I usually get some frozen, ready-cooked shrimp, some dip, ranch dressing, or small amounts of cocktail sauce. Make sure you read the labels. Avoid the sauces that have sugar, or worse, high fructose corn syrup.

Keto bread

If you are feeling adventurous, you can try your hand at making keto “bread”. I had some previous success with Keto pound cake or Flaxseed bread. Many good recipes are available online. Or borrow a good keto recipe book from the library.

Salads

You can’t go wrong with green leafy salads. Easy to combine, make, and store.

Egg or tuna salad

This is a heavier, dense form of salad, you do need to like mayonnaise. Make sure that you buy “real” mayonnaise, and avoid the “low fat’ varieties. These usually have fillers of some sort, to make the mayonnaise appear thicker. Avoid these. Get pure mayonnaise.

Mac and cheese

Use cauliflower instead of macaroni. The problem with cauliflower is that when cooked, it becomes watery. Buy some cheesecloth and place the cooked cauliflower in the cloth, and squeeze out the excel liquid. Add half a block (4 oz) of cream cheese. Follow a standard mac and cheese recipe, but now you have substituted the pasta with cauliflower. The cream cheese will help make the salad achieve the same creamy consistency of regular mac and cheese.

French fries substitute

Have you heard of French-fried radishes? They take a bit longer to cook, but do end up being quite tasty and crunchy if done right.

How about something crunchy to eat?

Pork rinds. Or cheese chips. And I don’t mean the type of cheese chips made of wheat. I mean cheese wisps. These are made of just cheese, cooked, baked or dried to a “crisp”. They sometimes show up at Costco, but I did see these in Walmart too. Many stores now carry these on their shelves. Single-serve sushi wrappers now come in bite sized, pre-salted servings.

Single serve olive pieces

Olives packed in single serve cups , these are wonderful to throw into your lunch boxes for a quick low carb snack.

Protein shakes

Ice, coconut or almond milk, plus half of an avocado, some sweetener, Run your blender. The result is surprisingly a very nice, refreshing and filling shake. You can add a spoon of whey powder too. Silky tofu is also another popular added ingredient. Use your imagination!

Drinks?

Water is always welcome. I like to buy cans of flavored seltzer water. Hard liquor is low carb and allowed, but keep in mind that alcohol is carcinogenic too. Go easy and limit this as well.
Try to get a game plan ready. Beginners can start here.

What Really Causes Cancer? – How to know and prevent

Fri, 25 Mar 2022 21:33:56 GMT

What really causes cancer?

1. Radiation can be a trigger for head and neck cancers

High dose radiation can cause cancer to develop.

Cancer is common in survivors of exposure to Chernobyl. After World War II, survivors of Hiroshima and Nagasaki developed multiple cancers years decades after the disaster.

Cancer patients who were treated successfully with high dosed radiation for their nose and throat cancers may suddenly see new tongue cancers after several years.

Why is this so? Repeated damage.

During radiation, cells die and regrow repeatedly. This repetitious death and growth cycle can predispose one to an increased risk of other cancers.

Even low dose ionizing radiation IR can encourage new blood vessel formation and wayward surface cell movement, all of which are cancer-promoting.

There is also a loss of oxygen during radiation. Cancer cells usually grow fast and multiply fast.

Fast tumor growth means the cells will crowd each other out, meaning there is less oxygen for all the cancer cells. The existing oxygen supply suddenly becomes inadequate. This lack of oxygen will change the tumor metabolism towards one that favors and protects cancers.

Lack of oxygen will change the immune system into one that no longer destroys cancers, but instead, “protects” cancers from immune destruction.

When oxygen is low, there is a tumor signal that increases. This signal is called hypoxia (hypoxia - means "low oxygen") inducible factor (the official scientific name is HIF-1 alpha). Increased HIF-1 alpha, is an important trigger of cancer. HIF-1 alpha increases and encourages even more tumor growth and multiplication.

2. Smoking is a cause of many cancers, not just lung cancer

The chemicals in the smoke can damage our genes and cause defects or mutations. These mutations can cause cancers. Aside from the mutations, there is also the repeated cell damage that I was talking about when we discussed radiation. Repeated damage to the cells that line our airways, can cause a cycle of damage- followed by - cell recovery, and so on. Cell recovery-damage-cell recovery. After a while, the damage continues and the cell recovery fails. Then, cancer is born.

3. Alcohol, the most ignored cancer risk factor

Surprisingly, MANY PATIENTS DO NOT REALIZE that alcohol can cause cancer . Too much media hype is placed on the health benefits of red wine. What they fail to advertise is the cancer-promoting effects of the alcohol itself.

By the same-damage -recovery-damage-recovery cycle, cancers can develop.

Therefore, anything that comes in contact with alcohol, are prone to developing cancers.

This is why there are certain “drinker’s cancers”. What are these?

Cancers of the nasal passages, throat, tongue, tonsils, esophagus, stomach, and liver, are all common cancers of drinkers.

Alcohol can also damage the bone marrow, so blood cancers like leukemias, are also seen in the offspring of both male and female drinkers.

So much so, that men, as well as women, should avoid alcohol if they are planning a pregnancy.

4. Hormone replacement therapy, oral contraceptive pills can be risky

Birth control pills and hormone replacement therapy for women under age 55 can cause one to have a higher risk of female cancers (breast and uterus cancers).

5. Infections- HIV, Hepatitis, Human Papilloma Virus- more than just a bug!

Liver cancer risk is higher in people who have a history of liver disease, alcoholic hepatitis, and viral hepatitis. By the same token, the repeated cycling between alcohol or viral damage of the liver cells, alternating with periods of cell recovery, can cause new cancer in the long run.

Human papillomaviruses can cause head and neck cancers, and cervical cancers. HIV or human immunodeficiency viruses also predispose to cancers.

6. Low immune system - a risk factor for cancer

A poor immune system can lead to higher risks of causing new cancers. Kidney and liver transplant patients often have to take immune suppressant drugs, in order to prevent rejection of their newly transplanted organs.

Unfortunately, this also comes at a price. Increased vulnerability to infections, and increased long term risk of developing cancers.

Patients with autoimmune disease, on chronic immunosuppressive drugs, are also at risk of developing tumors. People with the human immunodeficiency virus (HIV) are also at risk of developing cancers like Kaposi's sarcoma, and Non-Hodgkins lymphoma.

7. Genetics/ Hereditary Family Syndromes are not as common as you think!

Hereditary cancers get a lot of news attention, but in reality, hereditary cancer is not very common.

Families might have a pattern of cancer in their family history. If the pattern is suspicious, one should seek genetic counseling.

We now have multigene testing available, but this is not for everyone.

Just because there are a lot of family members with cancer, does not mean that they are all hereditary.

See a genetic counselor first, before embarking on a potentially expensive but low yield genetic investigation.

8. Poor diets can increase cancer risks

In our society, overindulgence in glucose and carbohydrate s is common, and this too can cause one to have higher risks of developing cancer.

A diet high in carbohydrates and sugar can make our pancreas respond by producing more insulin, to try and bring the glucose down.

Insulin can trigger tumor growth signals such as HIF-1 alpha (hypoxia-inducible factor) as well as triggers other growth signals like insulin-like growth factor 1, epidermal growth factor and all these will go back and stimulate the central growth factor, which is a hypoxia-inducible factor. (HIF-1α)

When there is a lot of glucose, glucose breakdown products accumulate, such as pyruvate and lactate.

Pyruvate and lactate can directly activate the tumor signal HIF-1 alpha, and increase acidity. Acidity can cause cancers to break off and metastasize.

Lactate, through a series of chain reactions, will slow down the main energy production in the cell (mitochondrial respiration) and boost the more primitive forms of energy production (glycolysis), as well as boost new blood vessel production (angiogenesis) to supply the tumor with a fresh blood supply.

This is the Warburg effect in action. By promoting the shift towards glucose breakdown, (glycolysis), can directly stimulate more and more pro-cancer steps.

9. Too many birthdays- Gene damage AFTER birth

As we get older, our genes develop damage and this damage makes us prone to higher risks of cancer

We have genes (tumor suppressor genes) that prevent cancer, and if aging makes these genes no longer able to do their job, cancer will develop.

Gene damage is not always a requirement to get cancer. Some normal cells become cancer even without gene damage, but they develop cancers after their tissue is irritated after exposure to chemicals or irritants (carcinogens).

10. Then there are ONCOGENES- genes that are pro-cancer

Oncogenes are pro-cancer genes that have a purpose, which is to change normal cells into cancer.

Oncogenes , can talk with tumors to reprogram cell metabolism, and stop DNA cell repair.

Oncogenes can increase glucose breakdown and feed even more glucose to feed cancers.

Oncogenes can increase tumor acidity and stimulate new networks of blood vessels to grow and supply blood to tumors, increasing their chances of survival.

Oncogenes can make one resistant to radiation therapy and cause cancers to become aggressive. Many aggressive head and neck cancers do not respond well to radiation. Often, these patients have pro-cancer genes or oncogenes, OR they might have abnormalities in their tumor suppressor genes.

11. Gut microbiome - the bugs in your stool

There is a growing interest in gut bacteria as a possible cause of cancer. Gut bacteria can trigger immune responses and worsen chemotherapy side effects. Gut bacteria can stimulate the HIF-1 alpha signals to encourage even more blood vessel formation and pro-inflammatory interleukins. Targeting gut micro-bacteria can help improve tolerance to chemotherapy.

12. Beware of supplements

We often think that vitamins can be a good thing. But too much vitamin supplementation can be harmful.

Vitamin D supplementation can decrease cancer risk, Too much Vitamin A might increase head and neck cancer risk. Moderation is best.

13. Iron overload

Can iron excess be a cause of cancer too?

People have an inherited condition that we call hemochromatosis , and are at risk of cancers, commonly, liver cancers and possibly other cancers.

Too much iron can interfere with the elimination of the pro-tumor HIF1α signaling. Excess body iron can, therefore, encourage more cancers.

To treat this condition, we remove excess blood on a regular basis. They also have to avoid iron-rich food as well as vitamin supplements that contain extra iron.

14. Disrupted circadian rhythm/sleep cycles

There is a link between disrupted sleep cycles and cancer.

The disrupted sleep can reprogram cancer cells to develop, survive under stress, and grow, divide and avoid the immune system.

Bottom line?

What really causes cancer? It isn't just one thing. Rather, a combination of possible causes, over a course of perhaps, many years.

Eat well, moderate use of potentially harmful substances, or better yet, avoid them. Sleep quality is important, avoid stress. Live in the moment. Quality of life is always better than quantity, but if you can have both, why not?

References

Adamczyk, A. and A. M. Westendorf (2018). "Editorial: Cancer, drugs, and bugs-Bacteriotherapy on the rise?" J Leukoc Biol 103 (5): 795-797.

Beaber, E. F., K. E. Malone, M. T. Tang, W. E. Barlow, P. L. Porter, J. R. Daling and C. I. Li (2014). "Oral contraceptives and breast cancer risk overall and by molecular subtype among young women." Cancer Epidemiol Biomarkers Prev 23 (5): 755-764.

Brinton, L. A., D. R. Brogan, R. J. Coates, C. A. Swanson, N. Potischman and J. L. Stanford (2018). "Breast cancer risk among women under 55 years of age by joint effects of usage of oral contraceptives and hormone replacement therapy." Menopause 25 (11): 1195-1200.

Busund, M., N. S. Bugge, T. Braaten, M. Waaseth, C. Rylander and E. Lund (2018). "Progestin-only and combined oral contraceptives and receptor-defined premenopausal breast cancer risk: The Norwegian Women and Cancer Study." Int J Cancer 142 (11): 2293-2302.

Cane, G., A. Ginouves, S. Marchetti, R. Busca, J. Pouyssegur, E. Berra, P. Hofman and V. Vouret-Craviari (2010). "HIF-1alpha mediates the induction of IL-8 and VEGF expression on infection with Afa/Dr diffusely adhering E. coli and promotes EMT-like behaviour." Cell Microbiol 12 (5): 640-653.

Kennedy, S. R., Y. Zhang and R. A. Risques (2019). "Cancer-Associated Mutations but No Cancer: Insights into the Early Steps of Carcinogenesis and Implications for Early Cancer Detection." Trends Cancer 5 (9): 531-540.

Latino-Martel, P., D. S. Chan, N. Druesne-Pecollo, E. Barrandon, S. Hercberg and T. Norat (2010). "Maternal alcohol consumption during pregnancy and risk of childhood leukemia: systematic review and meta-analysis." Cancer Epidemiol Biomarkers Prev 19 (5): 1238-1260.

Lerman, O. Z., M. R. Greives, S. P. Singh, V. D. Thanik, C. C. Chang, N. Seiser, D. J. Brown, D. Knobel, R. J. Schneider, S. C. Formenti, P. B. Saadeh and J. P. Levine (2010). "Low-dose radiation augments vasculogenesis signaling through HIF-1-dependent and -independent SDF-1 induction." Blood 116 (18): 3669-3676.

Liu, J., G. Chen, H. Pelicano, J. Liao, J. Huang, L. Feng, M. J. Keating and P. Huang (2016). "Targeting p53-deficient chronic lymphocytic leukemia cells in vitro and in vivo by ROS-mediated mechanism." Oncotarget 7 (44): 71378-71389.

Lu, H., R. A. Forbes and A. Verma (2002). "Hypoxia-inducible factor 1 activation by aerobic glycolysis implicates the Warburg effect in carcinogenesis." J Biol Chem 277 (26): 23111-23115.

Milne, E., K. R. Greenop, R. J. Scott, N. H. de Klerk, C. Bower, L. J. Ashton, J. A. Heath and B. K. Armstrong (2013). "Parental alcohol consumption and risk of childhood acute lymphoblastic leukemia and brain tumors." Cancer Causes Control 24 (2): 391-402.

O'Connor, P. M., J. Jackman, D. Jondle, K. Bhatia, I. Magrath and K. W. Kohn (1993). "Role of the p53 tumor suppressor gene in cell cycle arrest and radiosensitivity of Burkitt's lymphoma cell lines." Cancer Res 53 (20): 4776-4780.

Orsi, L., J. Rudant, R. Ajrouche, G. Leverger, A. Baruchel, B. Nelken, M. Pasquet, G. Michel, Y. Bertrand, S. Ducassou, V. Gandemer, P. Lutz, L. Saumet, P. Moreau, D. Hemon and J. Clavel (2015). "Parental smoking, maternal alcohol, coffee and tea consumption during pregnancy, and childhood acute leukemia: the ESTELLE study." Cancer Causes Control 26 (7): 1003-1017.

Pavelic, Z. P. and J. L. Gluckman (1997). "The role of p53 tumor suppressor gene in human head and neck tumorigenesis." Acta Otolaryngol Suppl 527 : 21-24.

San-Millan, I. and G. A. Brooks (2017). "Reexamining cancer metabolism: lactate production for carcinogenesis could be the purpose and explanation of the Warburg Effect." Carcinogenesis 38 (2): 119-133.

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Tanooka, H. and A. Ootsuyama (1991). "Radiation carcinogenesis in mouse skin and its threshold-like response." J Radiat Res 32 Suppl 2 : 195-201.

Williams, D. (2008). "Radiation carcinogenesis: lessons from Chernobyl." Oncogene 27 Suppl 2 : S9-18.

Yoo, Y. G., M. Hayashi, J. Christensen and L. E. Huang (2009). "An essential role of the HIF-1alpha-c-Myc axis in malignant progression." Ann N Y Acad Sci 1177 : 198-204.

The negative side of the keto diet – is it really bad for you?

Fri, 25 Mar 2022 21:31:41 GMT

Is keto bad for you? Keto diets are good for durable weight loss, but some warn about harmful effects. Learn more about the facts. photo credit: emiliano-vittoriosi-703094-unsplash

Is the Keto diet bad?

It is great for weight loss, but "I heard so many bad things about it". We know about the benefits, but lately questions about keto being a harmful diet, has surfaced. I, personally am pleased about how the keto diet has taken on new popularity, both in the USA and abroad. Having taken an interest in this topic since 2012, I am happy to share what I know so far.

Will the keto diet shorten my life?

This year, the highly respected medical journal “LANCET PUBLIC HEALTH” made headlines when they published this article https://www.ncbi.nlm.nih.gov/pubmed/30122560
This article is about "low carbohydrate" diets, and how they think it shortens lifespan. The authors are saying that people should avoid low carbohydrate diets, and to focus instead on plant-based foods instead of meat, eggs, cheese, and protein.
In this observational study, 15,400 people’s past diets were examined and they found that people whose diets both low (< 40% energy) and high (>70% energy) in carbohydrates, were more likely to die, and they concluded that the people who ate moderate amounts of carbohydrates, lived the longest. They also concluded that people who ate meat, cheese, poultry, beef, lamb and chicken did worse in terms of shortened lifespan compared to people who ate plants, legumes, vegetables, and nuts.
Needless to say, the pro-low carbohydrate researchers, including myself, lost no time in examining the details of this study and responding to the editor.

The Lancet journal’s low vs moderate carbohydrate diet has flaws

The data was based on only two questionnaires, which were spaced several years apart. Basing your data on the memory of a dieter, and asking them to recall how many cups of milk or how many pieces of fruit they consumed days or weeks ago, is going to be subject to memory lapses and inaccuracies.
The low carbohydrate diet food items were NOT low carb. The people who they claimed ate low carbohydrate diets, were actually consuming well over 140 grams of carbohydrates a day. How can you call this low carb? I would say this borders on moderate to high carb!
If you examined the food items in the low carbohydrate group, there were items such as fruit, chocolate, and ice cream. When were these foods part of a low carbohydrate diet?

Sadly, this article got much-needed press exposure and was published last September 2018.
I wrote a letter to the editor, in response to this. You can read my letter here.
In a nutshell, I pointed out the glaring flaws in this study, and why this study should not jump to the conclusion that low carb, high-fat diets are bad.
https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(18)30207-X/fulltext

Will the keto diet cause kidney stones?

Uric acid will rise, but in our study , it was only for a few days, then it went back to normal. Kidney tests remained stable. In another study, uric acid was increased. They did not detail whether this was temporary. Since the keto diet does have a diuretic effect, do try to drink more fluids and keep hydrated.

Will the Keto Diet cause life-threatening ketoacidosis?

There is a concern for developing too much blood acidity. Diabetics especially are prone to going into a state where the body creates excessive ketones, usually triggered by a given stress (surgery, infections, trauma). However, when diabetics go on a low carbohydrate diet such as the ketogenic diet, this causes nutritional ketosis. Nutritional ketosis is an entirely different entity and cannot be compared to life-threatening diabetic ketoacidosis. The levels of ketones in dietary ketosis are way below the levels that we see in uncontrolled diabetes.
In a study of obese patients who followed the keto diet for four months, researchers found no changes in acidity or bicarbonate blood levels. Fortunately, no increased risk of ketoacidosis was found. (Gomez-Arbelaez, Crujeiras, et al. 2017)

Will I lose muscle mass while on a keto diet? Isn't weight loss bad if you have cancer?

Tisdale examined the effects of a high-fat diet on rats with transplanted colon cancer. He found that this diet reversed weight loss and reversed muscle wasting . (Tisdale, Brennan et al. 1987)
Fearon however, found the opposite. Ketosis had no effect on rats with transplanted carcinoma sarcoma (Fearon, Tisdale et al. 1985)
Another European study gave volunteers 21 days of a very low carbohydrate diet and found no serious changes in muscle mass . (Colica, Merra et al. 2017)
This is what we call mixed data. I wrote about weight loss in a previous topic. You can read more here

Will the keto diet damage my kidneys or liver?

The same European study found no changes in bone density, kidney, liver panels. (Colica, Merra et al. 2017). In the published US studies, liver and kidney function remained stable.

Will the keto diet cause heart disease and will the fat and cholesterol clog my arteries?

There is conflicting, if not absence, of evidence that heart disease or harmful cholesterol levels will result from following a keto diet.

Oxidized LDL or bad cholesterol

Saturated fats are solid at room temperature, but are in liquid form at body temperature. To think that fats will simply plug arteries is rather simplistic. The levels of low-density lipoprotein or LDL cholesterol alone is not the problem. Rather, it is the “oxidized” LDL that can be harmful. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3315351/
LDL when oxidized , can result in the hardening of the arteries.

Total versus Good HDL cholesterol ratio also can predict heart disease risk

The total level of LDL cholesterol alone is not enough to predict heart disease. What is also important is the ratio between the total cholesterol, and the HDL (good cholesterol) is also important. The higher the ratio, the higher the risk. https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/expert-answers/cholesterol-ratio/faq-20058006
In this study, a high carbohydrate, low fat diet resulted in decreases in total and LDL cholesterol. While this might seem like a good thing, there was also a greater decrease in HDL (good) cholesterol. This affected the total cholesterol: HDL ratio, for the worse. Also, the higher-carb group had higher triacylglycerol levels which is a risk factor for heart disease, diabetes and metabolic syndrome.(Ma, Li et al. 2006)

Oxidized lipoprotein was higher in high carb dieters

In another study of 63 healthy volunteers , half of the volunteers were fed a high fat, low carb diet (keto), and the other half fed a high carbohydrate, low-fat diet. After 4 weeks, the group fed the high carbohydrate diet /low-fat diet had much higher levels of oxidized lipoprotein compared to the group fed high fat/low carb. (Faghihnia, Tsimikas et al. 2010)
In a European study by Colica et al, the ketogenic diet did not cause changes in cholesterol or lipid blood tests.

Cholesterol levels remained stable even after 8 to 16 weeks on keto

The Veterans ketogenic diet study found stable lipid panels in almost all the patients who did the modified keto diet over 8 to 16 weeks. One patient had an increase in LDL cholesterol while another had a significant drop. The rest of the participants had no change in LDL cholesterol. (Tan-Shalaby 2017)

Keto diets keeps glucose steady. Increases total and good (HDL) cholesterol

A study in Ireland recruited 30 people and put half of them on a low carbohydrate, high-fat diet. The other half was on a standard diet. After three weeks, the total cholesterol was higher in the low carb, high fat group. The low carb high fat group also had higher levels of the HDL or good cholesterol. Uric acid was increased, but the blood tests that measured C-reactive protein showed no increase in body inflammation. Glucose levels also did not drop, and remained stable. The LDL cholesterol levels were more erratic. For some, the increase was minute (5%), while for others, the increase was huge ( 107%). (Retterstol, Svendsen, et al. 2018)

Bad breath and constipation

As if the above were not enough, now we have to deal with "ketone breath." Once ketosis is achieved, some of the ketones escape as the fruity breath odor of acetone. Mouthwash might be a simple solution.
Keto diets can also cause constipation, which is due to low fiber intake. Adding more fiber while continuing to count carbs, is reasonable. Try adding MCT ( medium chain triglyceride) oil or coconut oil to your diet. This move might help improve some of that constipation since MCT oil does cause the opposite effect, which is some diarrhea. Increase your fluid intake.

Summary

While there are a few annoying side effects, (bad breath and constipation), most of the negatives to the keto diet are either manageable or unfounded.
The evidence that low carbohydrate diets are linked to heart disease is actually very weak. The studies that were published usually centered around linking high-fat diets and high protein diets to heart disease. But if you examine those studies, you will find that the people who ate high fat or high protein/meat diets, were also eating high or moderate amounts of carbohydrates .
The high fat/protein/meat studies from the 1980s and 1990s, all do not have patients on low carb . Low carb/keto diets were not yet in fashion at the time!
While all this is interesting, the jury is still out. But emerging data in favor of the keto / low carb, the high-fat approach seems to indicate to me that it is the combination of high fat plus moderate or high carbohydrate, which may be harmful. Not just the fat alone.

References

Colica, C., G. Merra, A. Gasbarrini, A. De Lorenzo, G. Cioccoloni, P. Gualtieri, M. A. Perrone, S. Bernardini, V. Bernardo, L. Di Renzo and M. Marchetti (2017). "Efficacy and safety of very-low-calorie ketogenic diet: a double blind randomized crossover study." Eur Rev Med Pharmacol Sci 21 (9): 2274-2289.
Faghihnia, N., S. Tsimikas, E. R. Miller, J. L. Witztum and R. M. Krauss (2010). "Changes in lipoprotein(a), oxidized phospholipids, and LDL subclasses with a low-fat high-carbohydrate diet." J Lipid Res 51 (11): 3324-3330.
Fearon, K. C., M. J. Tisdale, T. Preston, J. A. Plumb and K. C. Calman (1985). "Failure of systemic ketosis to control cachexia and the growth rate of the Walker 256 carcinosarcoma in rats." Br J Cancer 52 (1): 87-92.
Gomez-Arbelaez, D., A. B. Crujeiras, A. I. Castro, A. Goday, A. Mas-Lorenzo, A. Bellon, C. Tejera, D. Bellido, C. Galban, I. Sajoux, P. Lopez-Jaramillo and F. F. Casanueva (2017). "Acid-base safety during the course of a very low-calorie-ketogenic diet." Endocrine 58 (1): 81-90.
Ma, Y., Y. Li, D. E. Chiriboga, B. C. Olendzki, J. R. Hebert, W. Li, K. Leung, A. R. Hafner and I. S. Ockene (2006). "Association between carbohydrate intake and serum lipids." J Am Coll Nutr 25 (2): 155-163.
Retterstol, K., M. Svendsen, I. Narverud and K. B. Holven (2018). "Effect of low carbohydrate high fat diet on LDL cholesterol and gene expression in normal-weight, young adults: A randomized controlled study." Atherosclerosis 279 : 52-61.
Tan-Shalaby, J. (2017). "Ketogenic Diets and Cancer: Emerging Evidence." Fed Pract 34 (Suppl 1): 37S-42S.
Tisdale, M. J., R. A. Brennan and K. C. Fearon (1987). "Reduction of weight loss and tumour size in a cachexia model by a high fat diet." Br J Cancer 56 (1): 39-43.

The BEST diet for 2020?

Fri, 25 Mar 2022 21:29:07 GMT

If you haven’t heard by now, CNN recently released its list of “Best and worst diets for 2020. Ranked by experts”, plant-based diets are being ranked the highest. This was based on the opinions of 25 judges from US News and World Report’s 2020 rankings, with 25 judges weighing in. The keto diet was ranked number 35 out of 36. Near dead last. Just a hair above the Dukan diet, which ranked at number 36. And not surprisingly, the Mediterranean diet came in first, and overall, a blanket recommendation for a plant-based diet was being touted as “the” diet to follow.
What’s more, the keto diet was called out for being “high in protein and full of saturated fat and dairy” which they said can contribute to heart disease and other chronic diseases.
Is there really evidence to back up these claims?

The role of vegan/vegetarian diets in chronic disease

Is there really a role of plant-based diets in fighting heart disease or cancer? Vegan/vegetarian diets are followed by many for a variety of reasons. Health (desire to be “heart-healthy), religious (Hindus, Seventh-day Adventists), and dental reasons (poor teeth) are some of the factors that make one choose to follow a vegan/vegetarian diet.

What are vegan/vegetarian/ omnivore diets?

Vegan diets allow no animal products, no milk or eggs, while vegetarians abstain from meat. An omnivore is one who eats both plant and meat products.

Benefits and disadvantages of vegan or vegetarian diets

“Eat your veggies”, we tell our children.
Vegetarian/vegan diets are usually thought of as healthy. Many believe that a plant-based diet is heart-protective and even cancer-protective.
But, is there really data to back up these claims?
I took some time to sift through the scientific literature to find out what research has been done so far, and what their results were. Here is a sampling of what I found.

ThGOOD NEWS about plant-based diets

Vegan/vegetarian diets can lower inflammation better than the AHA diet

As far as vegans who have heart disease, this study of 100 patients with existing coronary heart disease, assigned one group to a vegan diet, and the other group, to an American Heart Association diet. The AHA diet recommends we eat a variety of fruit and vegetables every day, grains, fish, and emphasizes diets low in saturated and trans-fat.
At the end of the 8-week trial, they measured blood levels of inflammation by testing the levels of c-reactive protein or CRP, in the blood. The vegan diet had 32% lower C-reactive protein blood levels compared to the American Heart Association diet.

Vegan diets are safe, even in preschoolers

23 vegan children between ages one and five, breastfed for the first six months of life, were studied. They grew normally but were shorter in height compared to children of similar ages. They all also had lower levels of vitamin B12, calcium, and vitamin D. The authors also felt a vegan diet is fine for small children, as long as we remember to supplement these expected deficiencies . (Sanders and Purves 1981)

Lower cancer risk?- Being vegan was no better than being vegetarian

In a study of female vegetarian cancer patients, they compared those who followed a vegetarian diet, vegan diet, and a lacto-ovo-vegetarian diet. They found a much lower risk of cancers of all cancers , in females who consumed a vegan diet but also found a lowered risk of gut-related cancers in those who were vegetarian but also consumed eggs and dairy (lacto-ovo-vegetarian). Keep in mind, this was not compared against keto diets . (Tantamango-Bartley, Jaceldo-Siegl, et al. 2013)

“Raw food” vegan diets can give us an antioxidant advantage

In a 1995 study of 20 Finnish female vegans, and one male vegan they were fed raw uncooked food. Then they compared blood test results to “cooked food” omnivores. They found that vegan blood samples had higher antioxidant levels. Blood concentrations of vitamins C, E and beta-carotene were significantly higher than the omnivores. The conclusion was that the "living food diet" vegans had higher levels of blood antioxidants than the cooked, omnivorous dieters. (Rauma, Torronen, et al. 1995)

The BAD effects of a Vegetarian / Vegan Diet

Increased risk of heart disease due to low Vitamin B12

B12 is important for heart health. Vitamin B 12 deficiency can worsen the health of the lining of our arteries, and increase their thickness, and increase atherosclerosis risk.

Vegetarian diets are felt to be beneficial for protecting the heart and lowering death rates from stroke and heart attacks. Vegan diets have fewer data. The Vitamin B12 deficiency in vegans is obviously a concern, and in places (Hongkong, India, rural poverty filled China) where vegans don’t take B12 supplements, this becomes a real issue. (Woo, Kwok, et al. 2014)

Other Vitamin and mineral deficiencies

59 postmenopausal overweight women who ate either a low fat, vegan diet or a low fat, low cholesterol diet, developed deficiencies in Vitamin D, Vitamin B12, calcium and phosphorus, selenium, and zinc. The authors concluded that supplements should be advised if one is planning a low fat, vegan diet. (Turner-McGrievy, Barnard et al. 2004)

Poor bone density

Vegans/vegetarians can suffer from poor bone density due to inadequate calcium and vitamin D intake, especially in children, who need adequate amounts for bone growth. (Ambroszkiewicz, Klemarczyk, et al. 2010)

Anemia, mental disorders, hairballs or bezoars

Bezoars, psychosis, and anemia- Aside from the megaloblastic anemia, the followers of the vegan diet can suffer from psychosis, bezoars ( balls of fiber that obstruct the small intestine) and small bowel obstruction,(Amoroso, Scarpa et al. 2019, Bachmeyer, Bourguiba et al. 2019)

Acidic gut pH

Strict vegetarian or vegan diets , both can make the gut and stool more acidic , compared to omnivores. A 1991 study of 41 seventh day Adventists examined stool samples. No change in stool counts of E. coli and Enterobacteriaceae were seen but there was a shift in the population and diversity that the pH was changed significantly into an acidic one.(Zimmer, Lange et al. 2012). In studies of fruit flies , an acidic gut pH can change their metabolism and cause increased body weight and higher lipid accumulation , leading to accelerated aging and a shorter lifespan .
(Resnicow, Barone, et al. 1991)

The confusing news

Conflicting news regarding heart advantage

The German vegan study followed 67 healthy men and 87 healthy women who were vegan for at least a year or more and measured their blood glucose scores (glycemic index). They also measured cholesterol, HDL (good cholesterol) and LDL (bad cholesterol). They found that fiber-rich vegan diets had lower glycemic index scores compared to the pre-diet levels. Also, they were not able to make conclusions about cholesterol because they found inconsistent and conflicting values . Cholesterol, for example, was lower in higher carbohydrate and higher fiber groups but were also lower in those with lower glycemic index scores. Based on the conflicting data, they could not find enough proof that a carb-rich diet can worsen heart disease. (Waldmann, Strohle, et al. 2007)

Both groups were similar in weight and waist circumference. Blood glucose control was no difference between the two. The levels of LDL cholesterol were slightly lower 13% in the vegans. The rest of the lipid blood tests were similar and there was no difference between the vegan and the AHA groups except for the difference in CRP. In conclusion, vegan diets can possibly decrease inflammation . The reduction in bad LDL cholesterol, however, was only minimal and did not reach statistical significance. (Shah, Newman, et al. 2018)

Mean serum insulin-like growth factor-I was 9% lower in 233 vegan men than in 226 meat-eaters and 237 vegetarians (P = 0.002). Vegans had higher testosterone levels than vegetarians and meat-eaters, but this was offset by higher sex hormone-binding globulin, and there were no differences between diet groups in the levels of sex hormones ( free testosterone, androstanediol glucuronide or luteinizing hormone).(Allen, Appleby, et al. 2000)

The Seventh Day Adventists lifestyle

The Seventh Day Adventist lifestyle is often thought of to be a healthy and wholesome one, believed to live longer because they don’t drink, smoke or use recreational drugs, and have an overall healthier lifestyle. They follow a vegetarian diet but do not insist on it. Meat is actually allowed, but only after following the Bible’s recommendations on what is considered clean or unclean. The dress is simple, modest and neat, and social dancing is not permitted. Music is allowed as long as it is wholesome and uplifting. What is interesting about their diet is that they also popularized breakfast cereal. Adventist John Kellogg invented cornflakes as a replacement for eggs and bacon. ( https://tinyurl.com/rfxezqa )
A Study of Seventh-day Adventists was published in 1994. (Fonnebo 1994) They found that SDA had lower total cholesterol in both men and women, and higher birth weights of their children. The chance of dying was decreased but only in the men. As far as a cancer risk, their lifestyle had no effect on the chances of developing cancer.
A more updated observational study in 2014 reviewed publications that included over 180,000 people. They tried to see the effects of a vegetarian diet on heart disease in Seventh Day Adventists and found that although men had higher chances of developing heart disease, the vegetarian diet had no clear reduction in death due to heart disease.(Kwok, Umar et al. 2014)
In a study of Seventh-Day Adventists students attending private universities in the southern United States , they had normal weight, 3.7% were underweight, 20.6% were overweight and 9.9 % were obese. Of these overweight SDAs, they were more likely to be me and African Americans. But, if you count all ethnic groups, the overweight and obese numbers were still lower than that of non- Adventist students in other studies . (Pawlak and Sovyanhadi 2009)
A 1983 study of cancers of the large colon, breast, and prostate, in 21,295 California white seventh-day Adventists compared their cancer rates to that of non-Adventists. Large bowel cancer was substantially lower but they also found that the fatal bowel cancers within the Adventists were not related to meat use, but rather, to coffee!
As far as breast and prostate cancers, they found no significant difference in cancer risk between non Adventists and strict Adventists . Cancer risk was therefore not proven to be linked to meat, in this study. (Phillips and Snowdon 1983)
The SDA lifestyle appears to be a wholesome one. Heart disease seems to be less common, but as far as the benefit of a Seventh Day Adventist lifestyle in preventing cancer, I found no strong evidence.

HEART DISEASE AND DIETS

Are plant-based diets a better diet for heart protection?

Researchers took the serum from healthy vegan, vegetarian, and omnivore volunteers and placed the sera into three separate lab dishes that contained primitive cardiac muscle cells called H9C2. They studied the cells to see what effect the three different diets had on muscle mass and muscle cell division. They also compared the antioxidant power of each group. Compared to the vegan and vegetarian group, the omnivores had better antioxidant protection than the vegan / vegetarians. There were more oxidative damage and shorter cardiac cell life span in the vegan/vegetarian group. They concluded that the vegan and vegetarian diet could not prevent the start of metabolic and heart disease. They also concluded that strict vegan/vegetarian diets could not protect heart cells from oxidative damage. (Vanacore, Messina et al. 2018)

Are keto diets better for heart protection?

66 healthy obese volunteers with an average body mass index of greater than 30, were placed on the ketogenic diet for 56 weeks. 35 had high cholesterol levels over 6 mmol/L and 31 had normal levels.
The body weight, body mass index, total cholesterol, good (HDL) and bad (LDL) cholesterol, glucose, and triglycerides were measured before and after the diet. The weights and body mass index dropped significantly in both groups. The levels of total and bad ( LDL) cholesterol, triglycerides, and glucose also fell while the good (HDL) cholesterol rose.
This showed that the long term use of 56 weeks of the ketogenic diet in obese people, was safe. In addition, 56 weeks of the keto diet benefitted even those who started out with normal cholesterol levels. (Dashti, Al-Zaid, et al. 2006)
20 normal-weight men with normal cholesterol, were placed on a 6-week ketogenic diet. After 6 weeks their good (HDL) cholesterol rose, but their bad and total cholesterol were unchanged. Fasting insulin also dropped. They concluded that a short term ketogenic diet, did not have any harmful effects on the lipid profiles of normal-weight men , There might actually be an improvement, in terms of the higher good HDL cholesterol values, and lowered triacylglycerols.
(Sharman, Kraemer, et al. 2002)

CANCER AND DIETS

Are plant-based diets a better diet for cancer prevention?

Several pro-vegan authors have criticized high meat and high-fat diets as the link to higher rates of cancer and heart disease. They describe vegan diets as favoring more glucagon production, which is good because it decreases the production of lipids and cholesterol while lowering IGF-1 activity. Lowered inflammation and the lowered IGF-1 activity can mean that a plant-based diet can help slow down cancer growth. Compare this to high animal intake which seems to be linked to more IGF-1 could explain why there are more cancers in the Western world, says this author. (McCarty 1999)
Vegetarian diets could have a protective role against breast cancer risk, while meat and processed meat dietary patterns were associated with a higher breast cancer risk(Chang, Hou et al. 2017)
There is news that gut bacteria might play a role in the development of colon cancer.
High fiber diets and vegetarian diets are popularly felt to be protective against colon cancer, while red meat and processed meat are linked to higher cancer.
When we digest the fiber in plant food, the fiber ferments with the “good” gut bacteria. This fermentation will produce a short-chain fatty acid called “butyrate”, which has anti-cancer properties.
Butyrate can fight cancer similar to the effect of chemotherapy that we now know as “HDAC inhibitors”. HDAC stands for “histone deacetylase”. In other words, it removes “acetyl” from our DNA. Through this removal of acetyl groups, HDAC inhibitors can improve our anti-tumor immune system by altering the genes. When we get older, our genes accumulate “acetyl” groups. These acetyl groups get hooked and attach themselves onto the parts of the chromosomes. The more acetyl groups there are, the more likely cancer will develop. So, aside from the commercially available HDAC inhibitors, a vegetarian diet might help, since the butyrate that comes out of the fermented ingested fiber, has similar properties, and therefore could be a form of ‘natural chemotherapy”. (Sofi, Dinu, et al. 2019)
Ketogenic diets have an anti-cancer effect that is similar to HDAC inhibition. When glucose is scarce, the liver produces ketones for energy. These ketones have a similar anti-HDAC effect that is anti-cancer. There is also the added effect of limiting cancer growth by limiting glucose. This, in turn, limits glycolysis which is the central reason behind the activation of multiple tumor signaling pathways that cause cancers to grow. (Tan-Shalaby 2017, Bonuccelli, Sotgia, et al. 2018)

MY THOUGHTS

Keto diets have a lot in common with the Mediterranean diet

Keto diets are also low in sugar, low in starch, and low or moderate in calories. Many keto diet followers in fact choose to consume healthy fats that are similar to what the Mediterranean diets favor (olive oil), fish oil, nuts.

High protein and high meat diets are not the same as a KETO diet

Ketogenic diets are high in fat and low in carbohydrates. The Atkins diet is a form of a keto diet that allows for more protein. As a result, many are confused and automatically think that a keto diet is high in protein, when in fact, it isn’t.

Blaming meat and saturated fats for heart disease?

Those studies which found an increased risk of heart disease in heavy meat eaters and saturated fat eaters failed to note that these dieters were likely NOT following the keto diet. These heavy meat and fat eaters were also moderate to heavy consumers of carbohydrates and calories.

Ketogenic diets have the potential to actually improve cholesterol values. Even those who started with normal levels still had the potential to further improve. (Dashti, Al-Zaid, et al. 2006) We do need more trials to strengthen this idea.

Vegan /vegetarian diets for cancer?

For prevention, it is good . But for fighting cancer that already developed ? Not good enough .

It's beneficial, it has antioxidant activity, its fashionable, BUT, a plant-based diet for established cancer, is too little, too late. Why? You are still feeding cancer!

Vegans and vegetarians are usually thought to have leaner physiques. Therefore, could this account for the lower cancer risk? The added fiber, anti-oxidant benefits of fruit and vegetables, all can be a good thing. Organic vegetables have an added appeal by being free from additives and pesticides. The benefits are increased if a calorie-controlled veggie-based diet helps keep one’s weight and calories down.

But, the cancer-killing properties are weak . I feel that, once cancer develops, a plant-based diet is probably too little, too late . Like a sprinkler when you are facing a raging forest fire, the vegan diet will probably not be enough to fight cancer. Cancer that developed, already created a life of its own, and a very flexible one too. To fight such a resistant enemy, we will fail if we rely only on “preventive strength” measures. We need to seek out a treatment strategy that is not only potent but also treatments that attack cancer on multiple sides . This is where the keto diet comes in. Keto diets will not only have the same anti-inflammatory benefits as plant-based diets, but keto will limit the feeding of glucose, which is something a vegan/vegetarian diet cannot match.

Like a basketball game, we can’t rely on just one player, but will do better if we employ a ‘full-court press”.

The combination of meat and high fat plus carbs and excess calorie intake, obesity, and high glucose in the blood is probably what drives the pro-cancer effect, and not just the meat or fat alone. In other words, a bad lifestyle is a problem! Obese meat-eaters are probably not following a keto lifestyle. They usually eat high amounts of carbs and sugar along with their high fat and high meat diets. Yet we tend to lump all meat-eaters, including the keto – low carb lovers plus high meat-high carb lovers into one group. Why blame the meat alone?

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KETO PLANNING AND STOCKPILING DURING COVID-19

Fri, 25 Mar 2022 21:26:32 GMT

Nothing is more challenging than stockpiling keto supplies during a major environmental crisis like the Coronavirus.
I apologize for not posting any keto-related topics lately; the coronavirus headlines are keeping me glued to the news channels. Its official name is Coronavirus Disease 2019 , or you can call it by its nickname, Covid-19.

WHAT IS COVID-19?

Coronavirus 2019 is our unwelcome unseen visitor. Already striking fear in other parts of the world, it is really only a matter of time before we see it on our doorsteps. Luckily, you still have time to prepare, keep calm, and still remain in ketosis.
Recognized only in December 2019, the COVID-19 virus is not only related to the previous SARS virus from 2002-2003, but it also bears some similarity to the MERS disease ( Middle East respiratory syndrome) of 2012 fame.
Most patients affected with COVID-19 are adults. For some reason, children younger than age 15 seem less likely to be infected. Fatalities are seen in both immune suppressed and normal patients. The older you are, or the more coexisting medical conditions you already have, the more likely you will be sicker.
Luckily, even though COVID-19 appears to be more contagious, the death rate among those with symptoms is only 2%. No cure right now. But scientists are hoping that once we have more recovered patients, we can use their antibodies to make medications to fight this disease.
Like most of my neighbors, I was kind of in denial. The virus seemed so far away. But, reality finally hits me.

EMPTY SHELVES

I went out on my usual errand-shopping the other day and found that my favorite store was out of coconut milk. Not only that, I noticed the entire shelves of “nothing”. What is missing? Why it looks like people are buying up bleach, but thankfully, so far, most of the shelves in my neighborhood store are still fully stocked. I assume bleach is to clean off suspected surfaces contaminated with COVID-19, and not to use it as a drink!

Like many families, my family is not particularly a solid follower of any one diet. We have a couple of vegetarian members, one was vegan for a while, another member needs to avoid gluten, two are carnivores, one is intermittently keto, while another is keto, one has fish allergies, one of us has nut allergies, and three are carb lovers. Did I miss anyone? When I go shopping it is not unusual for me to buy some obviously keto-friendly items, only to add some groceries that cater to the dietary requirements of the rest of my family. Keto becomes a challenge and needs more will power than usual when you have non-keto family members. But for the rest of us, the KETO followers, I have compiled a quick list that you might find helpful.

NON-PERISHABLE AND KETO FRIENDLY FOOD – THE BASICS

What about the food? We need to get out there and buy at least some basic supplies. What can you buy that is both non-perishable and keto-friendly?

KETO FOOD SURVIVAL SHOPPING LIST

OILS and FATS

Keto is mostly fat, remember?

Coconut oil

These come in bottles or sometimes are canned. Coconut oil has a very long shelf life.

Coconut oil is also solid at room temperature and doesn’t need refrigeration for up to two years. You can use this for deep frying, sauteing, and salads.

Ghee

Popular in India and in the Middle East, ghee is also seen in Southeast Asia and was used as a form of traditional medicine.

Thanks to the keto movement, ghee is now usually available everywhere, even at Walmart. Bottles of yellow ghee are definitely shelf-stable. Ghee is clarified butter and usually is found as globs of yellow “candle like” wax, packaged in glass bottles. If you keep the jar unopened, ghee can last on your shelf for up to a year. If under refrigeration, I suspect it can even be longer.

Sour cream

Yes, you can find sour cream, but it has to be in powdered form, the type that you can rehydrate with water before using. It is available in some camping stores, but for the majority of us, this type of specialty item, you will need to buy it online.

Heavy cream (canned)

If you would rather open a can, there are several options for you. Nestle makes these canned heavy creams , both available in stores and online.

Heavy cream (powder)

If you like cream in your coffee, or if you make your own whipped cream for dessert, you will want to make sure that you have heavy cream at all times. Powdered versions are available!!!

Butter

Backpackers and off grid survivalists are all too familiar with ready to eat food. And butter? It happens to be also available in powder form

Cheese

Yes, cheese too, can come in powdered form.

Mayonnaise

Watch out, many commercial mayonnaises have hidden sugar. Look for sugar-free options. I had no luck finding keto mayo in regular discount stores. Not surprisingly, scrutinize the label and you’ll find they all have sugar in them. Try the specialty grocers (Wholefoods and Trader Joes) and you will have a better chance of finding them there. Good luck.

Olives

Olives contain about 10 to 15% fat, are delicious, and flavorful.

Canned olives are always a good choice. There are many choices in the grocery store.

VEGETABLES

This could get tricky. Thanks to our pioneering forefathers, they used salting, canning, drying and pickling, way, way before we had refrigerators.

Vegetables can be dried or canned in order to last for several months.

If you don’t have an off-grid experience, don’t despair, go get some canned vegetables.

Canned vegetables

Easiest option. Go early to the stores to beat the crowds. Canned spinach, kale, mushrooms, artichokes, black olives are keto-friendly. Don’t forget, you will need a can opener.

Dried Vegetables = DIY do it yourself

If you happen to own a home dehydrator, you can even go out and buy fresh broccoli and dehydrate them yourself. Not all vegetables are keto-friendly. Remember, choose veggies such as *** broccoli peppers, eggplant, and Brussel sprouts. Kale, cucumbers, radishes, spinach, asparagus, bokchoy, cabbage, celery, mushrooms.***

A tip when drying your own veggies: Blanch them first before drying.

Broccoli has to be blanched first in some hot water. Once the broccoli changes color to a bright green, you can shake off the excess water and cut the stems up before placing the broccoli in your dehydrator. A basic, no-frills dehydrator should be fine. You might even be able to score a used one at a garage sale for $5. The dried broccoli can then be stored in large gallon zip lock bags to be stored for future use.

Dried Mushrooms

These are popular as meat substitutes. There are many kinds. You will find that mushrooms are also easily dehydrated. Our local oriental store sells dried mushrooms in bulk. They keep forever. Once you need some, you can soak them in water for a few hours until they swell up, and become soft enough to slice and cook.

Zucchini and cauliflower

These are dehydrator friendly, dry well, and are less likely to stick to the trays. Cut them thicker. If cut too thin, they tend to stick to the tray. See above *** for the other keto-friendly veggies.

Onions

Onions tend to carry more carbs so please limit to 2 tablespoons daily

Artichokes

bottled, canned or pickled

Red roasted peppers

bottled

Sprouters

Do you enjoy fresh alfalfa sprouts? Sprouting your own vegetables is not only fun but its also a good way to produce a portion of your daily greenery for side dishes.

PROTEIN

Meats

Beef, chicken and turkey jerky. Be sure to check for added sugar or honey. If they have these sweeteners on the list of ingredients, put them back on the shelf.

Canned sausage, canned meat, chicken cubes

Seafood

Canned clams, crabmeat, shrimp, tuna and sardines in oil. Dried anchovies, dried fish. DIY- do your own dry fish using a dehydrator.

KETO friendly long-life milk

Almond milk, coconut milk, and soy milk are all available in tetra brick packaging, which means they do not need refrigeration. You can find these kinds of milk under the baking section.Not only are protein powders convenient and shelf-stable, but you can also use them in baking, cooking or in keto smoothies.

Bone Broth

These come in cans and tetra bricks too. Some are bottled. Stock up on a few.

Keto-friendly ethnic food

If you are adventurous, you can try salted eggs. Many Wuhan households are doing fine as far as protein is concerned. With a stash of salted eggs and pickled veggies, all they need is rice. But if you have never been to, or are not brave enough to walk into an oriental grocer, you are out of luck, because that’s where you will find them. These eggs are usually vacuum packed, and if you find them on the regular shelf instead of in the freezer section, you can expect these eggs to last can stand a shelf life of up to 40 days. There are US versions of pickled eggs too.

Pickles

Pickled cucumbers, pickled eggs, pickled olives, pickled fish. The list is endless.

Peanut butter

Yes, its true. Peanut butter now comes in sugarfree versions. Look at the labels and you only need to buy the ones with two ingredients - peanuts and oil. You can find it on the shelf at Whole foods or online.

Keto Emergency Snacks

Nuts, pork rinds, jerky, baked cheese (Moon whisps, or keto cheese balls). Seltzer water, with a hint of lemon flavor, and no sweetener, is one of my favorites. We really should be avoiding snacks. But for those who struggle to get into a regular keto lifestyle, snacks might still be a needed bridge to success, at least in the beginning.

To summarize,

My favorite emergency keto shopping list

OILS AND BUTTER

Coconut oil
Olive oil
Clarified butter or ghee
MCT oil (medium-chain triglyceride oils)
Powdered sour cream
Coconut milk
Powdered cream

Powdered BUTTER

canned heavy cream

PROTEIN (Canned or bottled)

Tuna
Salmon
Sardines
Chicken chunks
Artichokes
Mushrooms
Black olives
Powdered whey isolate protein
Coconut milk in tetra brick packs (doesn’t need refrigeration)
Almond milk – in brick packs (doesn’t need refrigeration)
Dried eggs

Salted eggs
Century eggs (only for the adventurous)
Certain Keto BHB salts ( comes in powder form, but are expensive)

Bone broth

SNACKS

Nuts (peanuts, walnuts, macadamia, pecans, etc.)

Sugarfree peanut butter
Pork rinds

Sushi wrapper snacks
Unsweetened cocoa powder
Lilys - Chocolate chips (These are stevia-sweetened)- buy it at Wholefoods or Trader Joes
Quest tortilla chips (somewhat expensive)
Pickled foods

Seltzer water, plain!!! or with citrus flavor but unsweetened.

WATER

The recommendation is to have at least three days of water supply. That’s one gallon per person per day to account for cooking and personal hygiene. Store some water in jugs or get yourself some potable water purification tablets.

PET FOOD - don't forget Fluffy!

Stock up on Fluffy's food and medications.

Additional survival tips:

MEDICATIONS

Band-aids.
Allergy medications.
Acetaminophen, Ibuprofen.
Antibiotic ointments or a bottle of hydrogen peroxide
Sugar-free cough medicine.
Prescription meds – make sure you have enough refills
Write down a list of contact information - doctors contact numbers, pharmacy, next of kin

OTHER FIRST AID and EMERGENCY SUPPLIES

Rubbing alcohol at least 70%
Bottle of bleach or pine sol
Hand sanitizer
Tweezers
Scissors
Matches
Flashlight with batteries
Crank radio

CAR MAINTENANCE

Did you change your oil, filter, and check your tires?
Fill up with gas

CASH

Get some cash from the bank or ATM.

MASKS

Did your stores run out of protective N95 masks? The Center for disease control approves other forms of face protection.
They must fall under the following categories: N99, N100, P95, P99, P100, R95, R99 and R100.

MENTAL HEALTH

Call your relatives and friends, offer help to those in need.
Meditate, pray.

I hope this short blurb was helpful in some way. It is not too late to make a plan of action and at the same time, stay calm, sane and collected.

Here are a few of my favorite survival items on Amazon. Some may have affiliated links, proceeds of which will go to costs of my upcoming book. If you happen to be one of my patients, you can get my future book for free! If you are part of my Facebook Keto for Cancer group and are an active commenter, you will have a chance to win one keto-related book from my overstuffed keto library!

Whey powder
Powdered butter
Pickled eggs
Survival radio

How to fight both COVID-19 and Cancer

Fri, 25 Mar 2022 21:22:45 GMT

CAN CANCER PATIENTS SURVIVE COVID-19?

Cancer patients are already in a fight to survive, and with COVID-19 taking over the spotlight, cancer patients wonder whether it is safe to receive chemotherapy as scheduled. I received a ton of questions from concerned patients and their families. I am sharing with you, some of my responses below.

What is COVID-19?

In case you are not up to speed with the news, COVID-19 stands for the Coronavirus- circa 2019. What started out as a viral infection in Wuhan province, China, has now spread to practically most of the countries in the world, threatening us now at our very doorsteps.

Can we continue chemotherapy under Covid-19?

- DAMNED IF YOU DON’T, DAMNED IF YOU DO…

I was excited and optimistic when 2020 arrived. But, for me and my patients, it's suddenly a battle between COVID-19 versus cancer. “Your timing is bad”, I jokingly told Mr. John (not his real name), my patient. “Your cancer is back, and we need to offer you more chemotherapy. “ Chemotherapy, as we know, can sometimes depress our bone marrows, and with that, a low white blood count will also lower our bacteria-fighting blood cells and make us less able to mount a response to infections. Mr. John’s eyes seemed to grow larger. He said, “If I delay chemotherapy, my cancer might grow. What if I receive chemotherapy? Might I become more vulnerable to catching the COVID-19 infection?”

Are we closing the clinic during the COVID-19 pandemic?

For cancer clinics, it is business as usual

In my line of work, COVID-19 hardly dampened the rates of cancer. In my hospital, it is business as usual. Essential services are still operational, if not getting even busier. Every week, new cancer cases continue to show up. Some of my patients in remission are now relapsing, while some of my now “stable” patients are wondering whether to continue chemotherapy or take a break.

WHAT QUESTIONS SHOULD I ASK MY ONCOLOGIST?

How fast is my cancer growing?

Is it the slow-growing type, or will it grow rapidly if chemo is postponed for months? The keyword here is “rapid” versus “indolent”. Do I have the luxury of watchful waiting until the next CT scan? Or is it better to go in and try to get as much chemo as possible? I don’t want to instill panic, but in an overabundance of caution, we foresee that in the event of a total lockdown, chemotherapy sessions might cease and postponements “could be” prolonged. If you only have one CT scan, you will need another one. One scan is only a snapshot of what your cancer is at this time. You need to compare two scans, spaced far enough apart, to get a sense of how fast, or slow, your cancer is growing.

Is there another way to detect the speed of my cancer growth, without using a scan?

Yes, for some cancers, there is a “tumor marker” blood test available for certain types of cancer. Aside from cat scans or PET scans, are we able to monitor the growth of my cancer via blood tests? Yes. Liver cancers can be monitored via a tumor marker blood test called “AFP or alpha-fetoprotein”. Colon cancers are followed via a CEA , also known as a carcinoembryonic antigen test. Pancreatic cancers use the Ca 19-9 test, and sometimes we also use the CEA test. For neuroendocrine tumors and carcinoid tumors, we follow serotonin levels and chromogranin. Ovarian cancers use the Ca-125 tumor marker. For prostate cancers, we follow the PSA or prostate-specific antigen test and testosterone. Although tumor markers can sometimes not correlate with tumor size ( some tumors are large and still have normal tumor marker levels, therefore are considered “non-secreting tumors’), we still find testing useful since this cuts down on the need to use ct scans and limit our exposure to radiation.

Does your clinic offer telemedicine? Can I see my oncologist via a virtual clinic instead of coming to the office?

In most cases, this can absolutely be done. If you have a computer, laptop, Ipad or smartphone, plus a good wifi connection and camera, you are probably all set. Your doctor can see you using one of the many telemedicine platforms that are now available. Or, in the case of some of my patients, just use the good old fashioned telephone. I had a 70-year-old patient of mine the other day, eagerly await his “virtual clinic” appointment. He had all the necessary equipment, and an email address to boot. But when the time of the virtual appointment came, he was unable to open his email to find my invitation link to the virtual consult. Several minutes later, we gave up, and I called him via phone and completed his visit the old-fashioned way! Not all clinics are willing to do this though. But in the past few days I see more and more clinics shifting to this option. be sure to ask your oncologist!

How about pre-chemotherapy blood draws?“Instead of going to the hospital lab, can I go to a clinic that is closer to my home, or can I “skip” blood draws for now?”

It depends on your cancer, and on the type of chemotherapy that you are receiving. How critical is it for your doctor to know your blood test results? Some biologics like targeted therapies need less monitoring than others. Especially if you have been taking a targeted therapy pill for several months now, AND, if you have had no side effects and no recent dose adjustments, then remote renewals COULD be an option for you. But if you are still experiencing side effects from your drug, or if your doctor is still adjusting your doses, then blood testing might still be required. Home health visiting nurses can sometimes come to your home, instead of you going to the lab. This might depend on your existing insurance coverage and on neighborhood availability. Ask your oncologist to be sure.

I am already on chemotherapy. Will my chemo depress the bone marrow for a very long period of time?

For newly diagnosed patients, if you have not yet experienced chemotherapy, ask your doctor how likely is it for your planned chemo to cause “neutropenia”. Not all chemotherapy are the same. As far as the ability to depress bone marrow, I would say that all chemo drugs will fall under one of the following classifications of “mild, moderate, or severely neutropenic”. This simply means that some chemotherapies are likely to cause low blood counts for prolonged periods of time. Recovery with some drugs might take weeks and sometimes months. During that critical time, we do not know if we will have enough ( or any) hospital beds available for cancer patients. Other chemotherapy drugs (under mild) might be available, that are less damaging to the bone marrow, and recovery can be expected in a matter of a week or two. However, it all depends on whether the choice of chemo is effective for you. Your oncologist is best suited to help you make that balanced decision. Stopping chemo altogether may be good for recovery, but might be very bad for your cancer control.

Am I a candidate for a growth factor injection to help my marrow recover more quickly?

Ask your doctor if you are a candidate for a growth factor injection (i.e. Neulasta or similar colony-stimulating factor). Will it be suitable for you, to help boost recovery after chemotherapy? THis may be an option for those of you with solid cancers. It might not be a good idea if you happen to have blood cancer.

Is there an oral equivalent / version for my chemotherapy?

Some chemotherapies can be switched to an oral or pill/capsule/tablet form. Tablets can be used instead of intravenous administration. Yes. this is certainly possible, however, very few chemotherapies actually have this option. Capecitabine tablets can take the place of 5FU. Some biologics are also in pill form. Several targeted agents are also given orally. Ask your doctor if your situation applies. If you have this option, it will allow you to hunker down at home much longer than if you had to get intravenous treatment.

Can I safely space out the frequency of my treatments?

If you are taking Leuprolide shots every 3 months for your prostate cancer, ask if you can get this every 6- months instead of three. If you receive monthly intravenous IVIG, or intravenous Zometa, can this be spaced out to every two or three months? Slow growing cancers may be a good candidate for this plan.

Do I have low immunity to bacterial infections? Do I have low immunoglobulin levels?

If I happen to catch a viral pneumonia, a bacterial infection on top of that will make matters really worse. Patients with CLL or chronic lymphocytic leukemia, and some lymphoma patients are at risk for catching a really bad bacterial infection on top of a viral pneumonia. This is because they may have low immunoglobulin (antibody) levels. When they do, they are classified as having hypogammaglobulinemia. Hypogammaglobulinemic patients who are already getting monthly intravenous immunoglobulins (IVIG) should check with their doctors to see if they need to replenish their IgG levels. If you are at risk of infections and have had at least two previous hospitalizations requiring treatment with intravenous antibiotics, then IVIG injections might be right for you. Not all patients will qualify, though (because the guidelines are pretty strict). But it doesn’t hurt to ask.

In case of a total COVID-19 lockdown, is there an accessible hotline or telephone number to call for cancer-related questions?

It is usually harder to contact your doctor than it is to call your congressman! Tip-Ask for the direct line to your chemotherapy nurse. They usually will have one. If the practice has telemedicine, or a patient “email or secure messaging system”, register for it and make sure that you use it. Do not rely only on the main clinic or hospital number. You will probably get the round around. Nowadays, doctors and nurses are so busy, they can barely call back patients via phone. Therefore, secure text and office message systems are the easiest ways to send them a message. You will likely get a quicker response this way.

I am afraid to leave my home, even for chemotherapy and bloodwork. Will I get infected?

No one really knows. But one thing is certain, the more people there are around you (a.k.a large gatherings and big families), the higher are the chances of a cancer patient to catch the COVID-19 infection. Wash your hands frequently, wipe down potentially infected surfaces, and use hand sanitizer whenever possible. Ask if your doctor can arrange home visiting nurses who can come and check on you, take your vital signs, and maybe even do your bloodwork. If you are elderly, or unable to move around much because you are on oxygen or in a wheelchair, then this could be a good option for you.

My dad is elderly. but is independently living by himself in a small town. Should he move in with my family during the COVID-19 crisis?

The fact that your dad is independent is great! In pandemic situations, isolation is the best protection. My only concern is if he runs out of food and supplies, especially if a quarantine is enforced for months on end. Will he have enough food, water, and paper supplies to go by? And if he does get infected, will he be able to seek medical attention? Keep in mind that right now, many hospitals have enforced a “no visitation” policy. So even if he gets admitted to a hospital in your hometown, for COVID-19 related reasons, you probably won’t be allowed to visit him. So living in the same town as you will not be much of an advantage as far as a social support during hospitalization. Do you have a large family? If he stays with you in the same household, there is the advantage of being with family support. But with more people under one roof, this means a higher risk of infection. If you have a large family under one roof, he might be able to stay with you but I suggest that he hunker down in a separate guest room or basement bedroom so that he still remains physically isolated, yet accessible to you at all times.

Should I use herbal supplements to fight COVID-19 with chemotherapy?

Because of the lack of a proven cure for COVID-19, the use of herbal supplements for cancer patients is getting some attention. Although most supplements are not FDA approved, they usually receive a designation called GRAS, which means - "Generally Regarded As Safe”. While they are totally legal to sell and use for general consumption, the FDA does not endorse these supplements as being able to cure, diagnose or treat medical conditions. Use your own discretion. Some supplements do interact with chemotherapy, and some may even "neutralize" the chemotherapy effects. Do check with your oncologist and pharmacist before you decide to take a certain supplement, to make sure that they don’t have any serious drug to drug interactions with your chemotherapy.

Will the ketogenic diet (Keto diet) protect cancer patients against COVID-19?

Good question. Since COVID-19 related cancer mortality is tied closely to an overwhelming inflammation, then yes, the keto diet’s anti-inflammatory effects might be helpful. Keto related groceries are less likely to sell out on store shelves. But it is good sense to try and stock up on some supplies before this all gets out of hand.

Above all, keep your distance, stay put at home as much as possible, and remember to wash your hands for 20 seconds with soap and water!

Stay safe, everyone!

FASTING FOR CANCER

Fri, 25 Mar 2022 21:22:43 GMT

Is it safe for cancer patients to fast? Should I fast while getting chemotherapy? Should I fast all the time? I can’t fast. Is intermittent fasting just as good as long term fasting? What about water- will water break my fast? Is the ketogenic diet just as good as fasting? Can we combine chemotherapy with fasting?

So many questions. I cannot answer all these questions at this time, but will instead offer you a general sampling of my most pressing thoughts.

Fasting has been around since the time of Hippocrates , whom we consider to be the FATHER of medicine.

• Fasting is defined as voluntarily not taking in any solid food or stimulants. This may include caffeine, nicotine, alcohol, and other liquid beverages.

• The fast should last for a limited amount of time.

• Ideally, “sufficient” quantities of herbal tea and water may be allowed.

SHOULD CANCER PATIENTS FAST DURING CHEMOTHERAPY?

Yes, it has been done. Studies do exist where the reserachers studied fasting in different types of cancers. Researchers did find that not only is it safe, there are also many benefits.

1. LESS FATIGUE and BOOSTS OVERALL ENERGY
Fasting can help boost our energy. During fasting, our bodies sense the absence of glucose and trigger the production of ketones in our liver. Ketones serve as a higher power form of energy. Ever wonder how long term hunger strikers maintain their energy for days, even weeks, without food? They subsist on water and continue to function pretty well. That is because they have plenty of excess stored glucose in their bodies. Until that excess stored glucose is used up, people on prolonged fasts can still function well. If their bodies are already used to having ketones, or what we call keto-adapted, they will feel energized because their cells can easily get energy from ketones.

2. DECREASE CELL DAMAGE
Fasting can decrease stress hormones and improve antioxidant activity. Our normal cells will be preserved, which is important especially when we undergo chemotherapy.

3. IMPROVE MEMORY
The ketones that we produce while fasting will feed the brain and help improve our levels of alertness. I feel that this can significantly help patients who suffer from “chemo brain” or memory loss after receiving chemotherapy.

3. IMPROVE OUR IMMUNE SYSTEM. Inside our bodies, we have special white blood cells called monocytes. These turn out even more specialized cells called macrophages. They are huge ( hence the term macro) cells that also "eat" damaged cell parts. In addition to this housekeeping role, macrophages can prime the immune system to protect us against infection. But, (surprise, surprise), these same macrophages can also turn around and protect tumors.

Yes, these TUMOR ASSOCIATED MACROPHAGES , or TAMS, can help protect cancer cells , encourage them to build sturdy blood vessels, and even help cancer cells develop the ability to move around and metastasize to other organs.

Fasting can help manipulate our immune systems so that we reverse these pro-tumor TAMs and make them anti-cancer cells again.

4. LOSE WEIGHT

Believe it or not, losing weight during cancer therapy can be a good thing. Excess carbohydrates are not burned and will be stored. Obesity leads to stored fat. Stored fat can encourage these tumor-promoting macrophages. The weight loss that we see with cutting out carbs, will decrease this fat, but also indirectly limit these cancer loving macrophages.

This brings us back to item number 3. By improving our immune system we can also weaken cancer cells .

WHAT IF I CANNOT FAST? ( too thin, too weak, fear of more weight loss, lack of motivation)

Some patients are too weak to fast. Some are already "too thin" to fast. Weight loss is often thought of to be an ominous sign. Spiraling weight loss is usually seen near the terminal stages of cancer when the pro-tumor cytokine chemicals are already ravaging throughout the body. Muscle is being broken down, and fat stores are low.

Can fasting still be done when weight loss has already set in? Fat stores are probably already nearly depleted at this point. Fasting is best done before weight loss has already set in. When weight loss has already happened, the only way to reverse this rapid weight loss is NOT by feeding more carbohydrates. Because if you feed more carbs or sugar, that will further fuel cancer.

I rarely see success with this high calorie feeding approach. Actually, I never saw success with this approach of feeding more carbohydrates to a cancer patient losing weight. It is counterproductive.

The best way to deal with cancer related weight loss is to try and stop the supply of weight loss cytokines. And that will be located at its source. And that source is the cancer itself.

WHY WILL FASTING RESULT IN WEIGHT GAIN?

A fasting strategy might be logical. Fasting will weaken the cancer cell and we hope that while chemotherapy is going on, the starvation effect of fasting on cancers will make cancers shaky, and die faster. Because the ketones are also around, the normal cells will continue to be fed, and will not starve. By successfully killing more cancer cells, the source of the weight loss promoting cytokines will slow down, and weight loss should theoretically stop.

KETOGENIC DIETS HAVE SIMILAR BENEFITS AS FASTING

Instead of fasting, you can still reap the benefits of a fast by trying out a low carbohydrate diet.
The ketogenic diet was meant to give benefits that resemble the act of fasting. By limiting carbohydrates, we get the same metabolic benefits.

Produce ketones to improve fatigue
Ketones increase alertness and improve memory to counteract “chemo brain”
Decrease glucose
Decrease insulin
Modify the immune system
Antioxidant effect
Deplete the cancers of their oxygen supply

Using Spices to Stop Cancer – Turmeric or Curcumin

Fri, 25 Mar 2022 21:22:43 GMT

This week we will focus on how TURMERIC (CURCUMIN) can be used to help stop cancer.

Most of us have heard that using spices might help stop and heal your cancer?

June 10 was National Herbs and Spices day. To celebrate this day, I wrote this piece to focus on how spices might help you improve your cancer care.

Many of my cancer patients, partake of a spice or two with their daily meals , in hopes that they will benefit from their advertised anti-inflammatory benefits. Food, indeed can be your medicine.

I just want to emphasize here, that I did say "to help heal” your cancer. Not a cure.

When you think of using herbs and spices to stop cancer, it is meant as an additional "support" but is not meant to replace your main treatment. Also keep in mind, that spices do have a carbohydrate count. So, be sure to include spices in when you calculate your macros.

With that being said, In honor of spice day, I now wish to reflect my thoughts on TURMERIC. The active ingredient in turmeric is CURCUMIN , a natural compound that comes from the turmeric rhizome root. It goes by the scientific name Curcuma Longa Linn and is a key ingredient in many Indian and Eastern recipes.

Not only does curcumin have direct cancer-killing activity, but it can also indirectly kill cancer cells by targeting cancer stem cells, activate cancer cell death pathways or what we call pathways of "apoptosis", and in cases where chemotherapy no longer is working, to reverse resistance to chemotherapy.

Curcumin and Cancer Stem Cells

Studies of colon cancer stem cells show that they can "talk" to the ( fibroblast ) cells that surround them. Eventually, this crosstalk can tell the surrounding cells to break down. When they do, they melt away the physical barriers that keep the tumor cells contained from the rest of the body, and this now will allow cancer cells to metastasize to other organs.

In the lab, scientists found that curcumin can BLOCK these lines of communication

Lung cancers and curcumin

Curcumin also has activity in lung cancers. It kills lung cancers by reactivating the process of cell death and by dampening the protumor growth signals. With the signals gone, the cancer cells lose direction and ultimately die. Lung cancers can also lose some of their ability to form blood vessels when exposed to curcumin.

Curcumin and Sarcoma

Ewing sarcomas also responded to curcumin, which arrested the cell cycle and ultimately caused the cells to self destruct.

Curcumin slows glioma growth

In glioma cells grown in the lab, curcumin was able to slow their growth.

Breast, stomach, cervical cancers and curcumin

Cervical cancer cells, stomach cancer, breast cancer all have seen anti-tumor benefits with curcumin.

Failed chemotherapy? Reversing chemotherapy drug resistance with curcumin

We all know of someone who responds well to chemotherapy, only to find out months later that the chemo has stopped working. The cancer cells develop a way to pump out the chemotherapy from their insides and evade damage.

Breast cancer cells that have developed resistance to chemotherapy, saw a reversal of this resistance when exposed to curcumin.

In the lab, colon cancer cells grown in a dish that has grown resistant to and no longer respond to 5FU chemotherapy can reverse this resistance by exposure to curcumin. Curcumin can also make chemotherapy such as Irinotecan, work better.

Studies of mice injected with colon cancer cells show that curcumin can make the chemo drug bevacizumab more effective by preventing blood vessel growth.

Indeed, this is one spice that has multiple benefits. Not only does it help kill cancer cells faster, but it can also reverse chemotherapy resistance, making cancers that no longer respond to chemotherapy, become responsive again.

So, the next time you go to the grocery store, make sure that turmeric is on your shopping list. Use it, and use it in all your favorite spicy dishes!

Curcumin suppresses crosstalk between colon cancer stem cells and stromal fibroblasts in the tumor microenvironment: potential role of EMT. PLoS One, 2014.
Curcumin inhibits the development of non-small cell lung cancer by inhibiting autophagy and apoptosis. Exp Ther Med, 2017.
Enhancement in in vitro anti-angiogenesis activity and cytotoxicity in lung cancer cell by pectin-PVP based curcumin particulates. Int J Biol Macromol, 2017.
Cell cycle inhibition and apoptosis induced by curcumin in Ewing sarcoma cell line SK-NEP-1. Med Oncol, 2010
Dietary curcumin attenuates glioma growth in a syngeneic mouse model by inhibition of the JAK1,2/STAT3 signaling pathway. Clin Cancer Res, 2010.
Anti-Glioma Effect with Targeting Therapy Using Folate Modified Nano-Micelles Delivery Curcumin. J Biomed Nanotechnol, 2020
Curcumin counteracts the proliferative effect of estradiol and induces apoptosis in cervical cancer cells. Mol Cell Biochem, 2011.
Curcumin Enhances the Anticancer Effect Of 5-fluorouracil against Gastric Cancer through Down-Regulation of COX-2 and NF- kappaB Signaling Pathways. J Cancer, 2017.
Curcumin reverses doxorubicin resistance via inhibition the efflux function of ABCB4 in doxorubicinresistant breast cancer cells. Mol Med Rep, 2019.
Reversal of PGlycoprotein-Mediated Multidrug Resistance by Novel Curcumin Analogues in Paclitaxel-resistant Human Breast Cancer Cells. Biochem Cell Biol, 2020.
Curcumin reduces mitomycin C resistance in breast cancer stem cells by regulating Bcl-2 family-mediated apoptosis. Cancer Cell Int, 2017.
Curcumin chemosensitizes 5-fluorouracil resistant MMR-deficient human colon cancer cells in high density cultures. PLoS One, 2014.
Curcumin Regulates Colon Cancer by Inhibiting P-Glycoprotein in In-situ Cancerous Colon Perfusion Rat Model. J Cancer Sci Ther, 2013.
Combined therapy using bevacizumab and turmeric exhibited beneficial efficacy in colon cancer mice. Pharmacol Res, 2016. .

Will my hand lotion cause skin cancer?

Fri, 25 Mar 2022 21:22:41 GMT

Can chemicals in hand creams cause skin cancer?

Answer: Dear Sarah, this lotion of yours, appears to contain a lot of ingredients that I cannot pronounce, much less, try to explain to you. I do recognize paraffin, a key ingredient in candle wax. We also use paraffin to seal our home- canned jams. Paraffin is a waxy product derived from petroleum. And petroleum has benzene, which is a known carcinogen. So, theoretically, yes, there is a carcinogenic component to this. But the cream is also being sold as a skin protectant, right? Isn’t protection good for preventing skin cancer?

Yes, these types of skin creams and lotions do contain many unpronounceable ingredients. We use them on a daily basis. We brush our teeth with toothpaste, and shampoo our hair with even more chemical loaded shampoos. Yet, we don’t see an overwhelming amount of scalp cancer. Nor do I see much metastatic skin cancer. Why? Because the exposure to these chemicals are short. After the soap and shampoo has done their job, we remove them. We rinse off soap, and we wash away shampoo. The exposure is temporary. We know that early detection saves lives. Because the skin is so visible, we notice abnormalities right away, and the dermatologist can easily remove these cancers and treat them early.

How do skin cancers develop?

Skin cancer develops when there is enough irritation to trigger damage. There are two general types of skin cancer. Melanoma, and its less deadly version, the non-melanoma skin cancers.

Chimney sweepers used to be young boys, who were hired not only because child labor was considered legal at the turn of the “other” century, ( I am referring to the early 1900s) but also because they were the ideal size. They were slim enough to slide down into chimneys and can sweep the insides of those sooty chimneys with a broom! Many of these chimney sweep boys were poor, and would go for days without taking a bath. The black greasy soot, with all its chemicals and yes, petroleum by-products, stayed stuck on their skins. This allowed ample time for the cancer-causing chemicals to do their damage. Repeated and prolonged skin contact is key to the birth of a skin cancer.

Melanoma , the deadlier cousin, is often caused by sun damage. It is more frequently seen in office workers than in farmers. Why is this so? Office workers stay indoors all year long, and go for a well deserved vacation to a nice sunny beach. Unaccustomed to sunlight, they develop sunburns. Several vacations and sunburns later, they are diagnosed with melanoma. The farmer toils day in and out, and develops a nice tan. They rarely sunburn, and they rarely develop melanoma.

Protection versus irritation, that is the question

Going back to your question, will using this skin cream cause cancer? Possibly, if you lather on too much and too frequently it might begin to cause irritation. It can also go the other way. It can be protective against cancer, especially if you are prone to chaffing, and skin abrasions. The lubrication will reduce the irritation. Used in moderate amounts, the skin epidermis might be better able to do its job and actually protect the underlying sensitive cells from the damage of repeated friction, and prevent it from mutating. It therefore boils down to whether the cream or lotion will protect or irritate you. If it begins to irritate your skin, it is best to stay away from it. If you experience no irritation, you might be able to keep using it.

What Foods to Eat on Keto Diets – Are Tomatoes Good for Cancer Patients?

Fri, 25 Mar 2022 21:22:40 GMT

What Foods to Eat on Keto? ARE TOMATOES ALLOWED ON A KETOGENIC DIET FOR CANCER ?

What foods can you eat on ketogenic diets for cancer? Tomatoes are popular. Are tomatoes recommended or forbidden? Tomatoes are technically fruits. Tomatoes are not allowed on our keto diet (20 gm total carbs per day) for beginners list simply because of their carbohydrate content. According to www.calorieking.com, a single grape tomato contains 2 grams of total carbohydrates!

ANTI-CANCER BENEFITS OF TOMATOES

But there is evidence that tomatoes can be good for you. Tomatoes are showing benefits as an anti-inflammatory supplement.

Tomatoes contain lycopene, a natural substance called a carotenoid. This is what gives tomatoes and carrots their red color.

Lycopene has health benefits and can prevent heart disease and cancer by downregulating the inflammatory response of the body. Reactive oxygen species and signaling pathways can also be dampened, to decrease inflammation. It can also decrease cancer risk by decreasing signaling pathways such as the Nuclear factor kappa B and MAPK mitogen-activated protein kinase signaling. Immune warrior cells can also undergo programmed cell death, further decreasing the inflammation. (1)

The blood vessel walls benefit from the decreased nuclear factor kappa B signaling and become less likely to cause heart attacks and stroke. (2)

Inflammation is also a key reason behind Crohn's disease and irritable bowel syndrome..

Flavonoids can stop inflammation in the gut by dampening the pro-inflammatory signals in the epithelium. The epithelium is the top-most layer of cells that line your gut. A poor immune system will disrupt this top layer and cause a leak, cause the immune cells, usually the white blood cells or leucocytes to migrate and increase inflammation. A study of lab mice was conducted in order to study the effects of tomato extracts on the mice intestine. The researchers prepared some tomato extracts and applied these to the mice colons. They found that the extracts diminished the activity of several, but not all inflammation signals. Nuclear factor-kappa B and MAPK were decreased but not STAT-3. nor TNF-alpha tumor necrosis factor-alpha. Another article mentioned that tomato juice, when given to well-nourished elderly men and women, had no effect on natural killer cells or white blood cell immunity. (3)

AUTOIMMUNITY, LECTIN, AND TOMATOES

BUT, Tomatoes also contain lectin. Lectins are carbohydrate-binding proteins found in plants, like beans, potatoes, and cereals. Lectins can be inflammatory and toxic. Some lectins can get past the gut wall and deposit themselves in distant organs. (4)(5)

TOMATOES, LECTINS, AND KIDNEY DISEASE

Wheat gliadin contains a lectin-like substance that binds to intestinal lining cells and causes celiac disease. Wheat lectin can also go to the kidneys and bind to immunoglobulin A and clump together into a deposit, causing kidney damage to the tubules in the kidney. A trial of kidney disease called IgA nephropathy showed improved kidney function when the patients were told to avoid wheat gluten.

TOMATOES and CANCER: LECTINS, GUT HEALTH, and HISTAMINE

Lab mice were fed with lectins. The researchers found that the cells lining their guts sloughed off and essentially become "naked". The naked gut lining became exposed and vulnerable to abnormal bacteria and parasites called protozoa. The lectins also caused the stomach cell lining to react, similar to an allergic manner, by releasing a substance called histamine, which stimulates the stomach to release gastric acid. Now you have peptic ulcer disease!

Histamine release is also implicated as a risk factor for developing some cancers (5 ). Lectin can create an abnormal bacterial population in the stomach, which can make one vulnerable to Helicobacteria pylori infection. H. Pylori infection is what we know, can predispose some people to develop stomach cancer or lymphoma.

The lectin can also strip the cells in our upper airways, making us vulnerable to common viral infections. Therefore, a stone-age diet, where starchy foods are rare, might be protective.

In a nut-shell, lectins can act as an allergen. It can cause allergies and autoimmune-related diseases. It can indirectly cause diseases like diabetes, kidney disease, rheumatoid arthritis, and peptic ulcer, and upper respiratory infections.

Should we, therefore, avoid lectins (potatoes, tomatoes, lentils, beans, eggplants, peas, soybeans, dairy, including milk, grains such as barley, quinoa, and rice)???

The good news is, if you SOAK beans in water, you might be able to reduce some of the lectins. If you COOK these foods for at least 30 minutes, you might be able to reduce the number of lectins or even eliminate them entirely. However, cooking does eliminate some of the antioxidant, vitamin and mineral-rich benefits of these foods.

REDUCING THE HEALTH RISK WITH TOMATOES

How do we get the benefits of tomatoes without the obvious disadvantages?

The bottom line - it depends on your goals and on how you prepare your food.

If you cook food regularly, and keep these foods to moderation, you might be alright.

If you are planning to go on a ketogenic diet, keep in mind that tomatoes and carrots have a considerable carbohydrate content, so count carbs carefully.

If you eat raw food all the time, better consider limiting your lectin intake.

If you have some autoimmune disease, you might want to pay attention to what you are eating and try to eliminate as much as you can of the nightshade family of foods. (1-5)

If you are cancer free, and are trying to prevent cancer, you might be alright as long as you eat in moderation.

If you already have cancer, there might be a reason to avoid nightshade foods. That is, until you get your cancer under control first.

REFERENCES

Palozza et al Tomato and Lycopene inflammatory Cascade: Basic Interactions and clinical implications. Curr Med Chem 2010;17(23):2547-63

Armoza Haim2013 Tomato Extract and the carotenoids lycopene and lutein improve endothelial function and attenuate inflammatory NF-kB signaling in endothelial cells. J Hypertension. 2013 Mar;31(3):521-9\

Watzl et al Prolonged tomato juice consumption has no effect on cell- mediated immunity of well-nourisihed elderly men and women. The Journal of Nutrition , Volume 130, Issue 7, July 2000Pages 1719-1723

Wang Yu et al. Identification of intact peanut lectin in peripheral venous blood. Lancet 1998;352:1831-1832

Pusztai et al. Specific uptake of dietary lectins into the systemic circulation of rats . Biochem Soc Trans 1989, 17: 481-482

Kennedy et al. Histamine and histamine receptor regulation of gastrointestinal cancers. Transl Gastrointest Cancer , 2012 Oct: 1(3):215-227

Keto diets and heart disease – 3 Important Facts to Know

Fri, 25 Mar 2022 21:22:39 GMT

Keto diets and heart disease...

A paper was recently published in the February 21, 2021 issue of the JACC. Journal of the American College of Cardiology.

Another paper, published in the AHA journal, Circulation, also runs the same theme. Keto diets for heart disease.

Due to popular demand, I have translated both into a layman friendly version:

Questions to ask about keto and heart disease - Heart Failure

Will ketones help or harm the heart? Show me the research!

What about ketone supplements?
Will ketosis help PREVENT heart disease?
Are keto diets good or bad for heart disease?

Heart disease appears to have underlying metabolic derangements. Yet, we rarely see metabolic based treatments being used to help prevent or treat heart disease. At first glance, being a usually high fat diet, keto diets and heart disease seem to be a bad idea. Or is it?

Metabolic changes in heart muscle upon birth

During the life of a fetus, the heart does not need very much energy so it relies on simple fuels. Simple fuels like glucose (simple form of sugar). Glucose eventually breaks down to lactic acid. The fetal heart relies on both glucose and lactic acid for its fuel.

Upon being born, the fetus leaves the comfort of the womb and is cut off from the mother's blood supply. The fetus, now called a baby, has to rely on itself to survive. The heart by necessity, changes its fuel preference for higher energy types such as fats. The fats need to be broken down through a process called "oxidation", and this process of fatty acid oxidation has to happen inside the mitochondria. The mitochondria is the powerhouse ( think of energizer batteries) of the cell. The heart maturation process is accompanied by a sudden increase in energy producing signals, and following this, we see a burst of powerful mitochondrial energy. The number of mitochondria within heart tissue increases, to help the heart gain an amazing ability to pump blood to the different parts of our body. Heart muscles suddenly have to now depend on oxidative phosphorylation OxPhos, which is a process by which higher forms of living life can produce energy

Patients with heart failure develop defects in their metabolism. Their mitochondria become defective, and as a result, the heart cells cannot effectively process fatty acids. So the energy goes down, As a result the heart muscle pumping capacity starts to fail. Ketones, which are also high energy fuels, might be a form of rescue energy since we do not need mitochondria ( where OxPhos is found) to produce it. The failing heart starts to rely more on ketones.

Ketoacidosis (bad) is not the same as nutritional (good) ketosis

When we hear the word “ketones”, the first thing that comes to mind are those nasty, lethal doses of ketones that the human body produces during a state of ‘ketoacidosis”, usually seen in poorly controlled diabetic patients. Ketones can be also be made by following a keto diet, where the levels are not overwhelming, but just right to give the body benefits. Ketone supplements have also recently come into the marketplace.

The research paper discusses the many diverse benefits of ketones. And it is not just about the energy they produce. Will there ever be a role for keto diets and heart disease?

Benefits of keto diets for heart disease

Among the benefits of ketones are the following:

Regulating blood pressure

Repair of defective heart muscle

Toning down inflammation

Keeping our mitochondria (the powerhouse batteries of our cell) healthy

Help our genes (DNA) repair themselves

Improve blood glucose levels

Normalize body weight

Where are ketones made?

Ketones are made in the liver.

Our heart muscles also appear to have the ability to use ketones for their benefit.

Ketones can also be manufactured in other organs, such as the kidneys, nerve cells, and cells of our gut.

In fact, almost every other cell of our body can use ketones.

When are ketones made?

When we fast, when we limit our intake of sugar or carbs, or when we don’t have enough food.

Ketones are also produced after extreme exercise.

Why are Ketones made?

Ketones, therefore, can also be your friend. Ketones can act as a standby form of supplemental energy in times of starvation. Not only are ketones good for energy, but they are also helpful in preventing heart damage from inflammation. When blood vessels become inflamed, they lose their smooth character and become prone to clot formation, and eventually, heart attacks or strokes might occur. Ketones help maintain the linings of our blood vessels and protect them from losing their smoothness.

Keto Diets and Heart Disease - Preventing Heart Attacks and Strokes, heart failure

Keto diets and ketones Improved Blood Flow

Heart attacks and strokes also happen when the blood vessel openings constrict. The diameter of the coronary arteries ( the tiny blood vessels that carry oxygenated blood to supply the muscles of the heart) become too narrow, limiting blood flow to the muscle of the heart. Ketones can help dilate ( make the diameter bigger) blood vessels. Animals in the lab were fed ketone supplements and the scientists found that the ketones made the vessels larger and more blood flowed through the brain, kidneys and heart of these animals, improving blood flow by as much as 75%.

Keto diets help heart disease by rejuvenating heart tissue

Ketones can also improve the delicate oxygen balance within the cells and help prolong the lifespan of heart tissue . Even in animals that already suffered heart failure, they still saw improvement when ketones were fed to these animals after the onset of heart failure. Ketones deactivated signals that caused heart muscle cell death. In effect, ketones prevented the aging of the heart muscle.

Ketosis helps curb appetite

Ketones also helped animals lose weight by decreasing the levels of the appetite hormones in the body, helping the animals feel full faster.

Keto diets improve good cholesterol

As far as cholesterol levels, keto diets when given LONG TERM also increased the “ Good (HDL high density lipoprotein) cholesterol “ levels and decreased total and bad cholesterol. This benefit was anticancer because ketones also limited the levels of fatty acid synthase , an enzyme that synthesized or "made" fats and promoted cancer. A 2007 study of the keto diet and heart disease in 83 obese men and women with high body mass indexes ( greater than 35 ), was performed. The subjects all had high blood glucose and cholesterol levels. They followed the ketogenic diet for 24 weeks and they found that there was a significant improvement in their levels of good HDL, and Bad LDL cholesterol. LDL (bad cholesterol) blood levels went down, HDL (good cholestserol) levels went up, serum triglycerides went down. The patients all lost weight and decreased their body mass index significantly.

As a whole, keto diets and heart disease may be compatible. Keto diets seem to benefit animals and possibly, humans. It does so not just by providing energy, but through a host of other benefits.

SGLT type 2 inhibitors

Sodium-glucose cotransporter 2 inhibitors are new an currently on the market as anti diabetic drugs. They improve the body's ability to recognize and use insulin, resulting in better glucose control , blood pressure, and healthy weight loss. Certain cells of the body, such as the kidneys and intestines, have proteins which control the passage of sodium and glucose. These drugs can help diabetics from spilling glucose too much in their urine.

Main Points of the JACC (Journal of the American College of Cardiology ) and AHA American heart Association " Circulation " Papers:

1. Keto diets and heart disease may be a beneficial therapy, and can serve as a rescue form of energy for the failing heart. Ketones might help protect the heart of animals and humans.

2. Keto Diets and heart disease plus supplements: Adding ketone supplements may be beneficial.

3. Future studies on PREVENTION are still needed : We still do not know if a keto diet and heart disease is a good preventive strategy.

4. The new antidiabetic drugs , sodium-glucose cotransporter 2 inhibitors , have a side effect of producing KETOSIS. So it is interesting to see whether this side effect may be beneficial in treating heart disease of diabetics.

Should we be buying and consuming ketone supplements on a regular basis? These are preliminary studies, and are not yet accepted by the medical community as fact. But perhaps it might only be a matter of time?