The development of the ketogenic diet (KD) as a medical treatment is rooted in observations on the impact of fasting on various diseases. In the mid-19th century and the first few decades of the 20th century, different physicians began to use fasting and fasting mimetics as therapies for managing epilepsy and diabetes. In recent years, KD has gained more attention for its potential as an adjuvant therapy to treat cancer, especially in treating brain cancers (gliomas) and other brain-related diseases. So, the question many people still have is: What's the safety of the keto diet for brain cancers?
The hypothetical rationale for KD is simple but elegant: Unlike health cells that can switch their metabolic fuel source from glucose to ketones, tumor cells can’t utilize ketones and are glucose-dependent for growth and survival. Then, cutting the glucose substrate may decrease tumor metabolic activity, thus resulting in cell death. There are also non-metabolic roles of ketones, but the potent nature of carbohydrate restriction and insulin suppression is considered to play an essential role in cancer.
Although the pre-clinical evidence looks promising, few published human studies demonstrate KD’s efficacy. I did find a 2022 systematic review that involved nine studies published between 2014 and 2021. Even though the overall survival exceeded the prognosis of these patients with the usual chemo- or chemo/radiotherapy, there were limitations of these studies, such as inconsistent versions of KD, small sample sizes, different glioma types, and the absence of a control group in most studies (Sargaço et al., 2022).
Well-formulated KDs have a long history of safe use and an excellent safety profile in the published literature. KDs are also highly effective at reversing obesity and insulin resistance. Overall, there is a relatively low risk of implementing a KD, and the potential benefit may be from low to high depending on the comorbidities and the type of cancer. I think the key is to apply a personalized KD, and ongoing monitoring of the person’s symptoms and lipid profile is essential. Significant efforts to move this field forward are still underway.
Jenny Noland, MS, CNS, CNGS, CKNS, LDN, MBA
Functional Nutritionist in Eugene, Oregon
Board-Certified Nutrition Specialist
Board-Certified Nutritional Genomics Specialist
Board-Certified Ketogenic Nutrition Specialist
Certified Oncology Nutrition Specialist
Personalized Nutrition Therapy for Metabolic Dysfunction and Cancer Care
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Sargaço, B., Oliveira, P. A., Antunes, M. L., & Moreira, A. C. (2022). Effects of the Ketogenic Diet in the Treatment of Gliomas: A Systematic Review. Nutrients, 14(5). https://doi.org/10.3390/NU14051007