10. High blood sugar is bad; keto normalizes blood sugar

Researchers have long known that high blood sugar (hyperglycemia) is associated with poor outcomes for cancer patients. Ketogenic diets reliably reduce blood sugar. 

  • Decker, M, Sacks, P, Abbatematteo, J, De Leo, E, Brennan, M, & Rahman, M. The effects of hyperglycemia on outcomes in surgical high-grade glioma patients. Clinical Neurology and Neurosurgery 2019;179:9-13.

  • Derr, RL, Ye, X, Islas, MU, Desideri, S, Saudek, CD, & Grossman, SA. Association between hyperglycemia and survival in patients with newly diagnosed glioblastoma. J Clin Oncol 2009;27(7):1082-1086.

  • Gardner, CD, Kiazand, A, Alhassan, S, Kim, S, Stafford, RS, Balise, RR et al. Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial. Jama 2007;297(9):969-977.

  • Lu, VM, Goyal, A, Vaughan, LS, & McDonald, KL. The impact of hyperglycemia on survival in glioblastoma: A systematic review and meta-analysis. Clinical Neurology and Neurosurgery 2018;170:165-169.

  • Sainsbury, E, Kizirian, NV, Partridge, SR, Gill, T, Colagiuri, S, & Gibson, AA. Effect of dietary carbohydrate restriction on glycemic control in adults with diabetes: A systematic review and meta-analysis. Diabetes Res Clin Pract 2018;139:239-252.

  • Saslow, LR, Kim, S, Daubenmier, JJ, Moskowitz, JT, Phinney, SD, Goldman, V et al. A randomized pilot trial of a moderate carbohydrate diet compared to a very low carbohydrate diet in overweight or obese individuals with type 2 diabetes mellitus or prediabetes. PLoS One 2014;9(4):e91027.

9. High insulin is bad; keto normalizes insulin

Elevated levels of insulin (the hormone that gets produced by the pancreas that allows blood sugar to go into cells) have all sorts of negative health effects and stimulating cancer growth may be one of them. Ketogenic diets reliably reduce levels of insulin produced by the pancreas.

  • Cantley, LC (2018). Keynote Lecture: PI 3-kinase links obesity, insulin resistance, and cancer. Proceedings from the Annual meeting of the American Association for Cancer Research, 2018. 

  • Cohen, CW, Fontaine, KR, Arend, RC, Alvarez, RD, Leath, CA, Huh, WK et al. A Ketogenic Diet Reduces Central Obesity and Serum Insulin in Women with Ovarian or Endometrial Cancer. J Nutr 2018;148(8):1253-1260.

  • Fine, EJ, & Feinman, RD. Insulin, carbohydrate restriction, metabolic syndrome and cancer. Expert Rev Endocrinol Metab 2015;10(1):15-24.

  • Hopkins, BD, Goncalves, MD, & Cantley, LC. Obesity and cancer mechanisms: Cancer metabolism. Journal of Clinical Oncology 2016:JCO-2016.

  • Saslow, LR, Daubenmier, JJ, Moskowitz, JT, Kim, S, Murphy, EJ, Phinney, SD et al. Twelve-month outcomes of a randomized trial of a moderate-carbohydrate versus very low-carbohydrate diet in overweight adults with type 2 diabetes mellitus or prediabetes. Nutrition & Diabetes 2017;7(12).

8. May reduce risk of cancer-related weight loss

Life-threatening weight-loss in late stage cancer patients is known as cachexia. Ketogenic diets may prevent cachexia by positively affecting the body’s metabolic system as well as the metabolic environment of tumors.  

  • Kentaro, N, Hidekazu, T, Akina, S, & Kinya, A. A Ketogenic Formula Prevents Tumor Progression and Cancer Cachexia by Attenuating Systemic Inflammation in Colon 26 Tumor-Bearing Mice. Nutrients 2018;10(2):206.

  • Klement, RJ. Beneficial effects of ketogenic diets for cancer patients: a realist review with focus on evidence and confirmation. Med Oncol 2017;34(8):132.

  • Koutnik, AP, D’Agostino, DP, & Egan, B. Anticatabolic Effects of Ketone Bodies in Skeletal Muscle. Trends in Endocrinology & Metabolism 2019.

  • Shukla, SK, Gebregiworgis, T, Purohit, V, Chaika, NV, Gunda, V, Radhakrishnan, P et al. Metabolic reprogramming induced by ketone bodies diminishes pancreatic cancer cachexia. Cancer Metab 2014;2:18.

7. Protects the brain

Chemotherapy and cranial radiation are associated with long-term cognitive impairments. Ketogenic diets have shown to improve cognition in a variety of contexts. 

  • Cheung, YT, Khan, RB, Liu, W, Brinkman, TM, Edelmann, MN, Reddick, WE et al. Association of Cerebrospinal Fluid Biomarkers of Central Nervous System Injury With Neurocognitive and Brain Imaging Outcomes in Children Receiving Chemotherapy for Acute Lymphoblastic Leukemia. JAMA Oncol 2018.

  • Cheung, YT, Brinkman, TM, Li, C, Mzayek, Y, Srivastava, D, Ness, KK et al. Chronic Health Conditions and Neurocognitive Function in Aging Survivors of Childhood Cancer: A Report from the Childhood Cancer Survivor Study. JNCI: Journal of the National Cancer Institute 2017.

  • Ehrhardt, MJ, Mulrooney, DA, Li, C, Baassiri, MJ, Bjornard, K, Sandlund, JT et al. Neurocognitive, psychosocial, and quality-of-life outcomes in adult survivors of childhood non-Hodgkin lymphoma. Cancer 2017.

  • Francis, HM, & Stevenson, RJ. Potential for diet to prevent and remediate cognitive deficits in neurological disorders. Nutr Rev 2018;76(3):204-217.

  • Greco, T, Glenn, TC, Hovda, DA, & Prins, ML. Ketogenic diet decreases oxidative stress and improves mitochondrial respiratory complex activity. J Cereb Blood Flow Metab 2016;36(9):1603-1613.

  • Maalouf, M, Rho, JM, & Mattson, MP. The neuroprotective properties of calorie restriction, the ketogenic diet, and ketone bodies. Brain Res Rev 2009;59(2):293-315.

  • Pinto, A, Bonucci, A, Maggi, E, Corsi, M, & Businaro, R. Anti-Oxidant and Anti-Inflammatory Activity of Ketogenic Diet: New Perspectives for Neuroprotection in Alzheimer’s Disease. Antioxidants (Basel) 2018;7(5).

  • Stafstrom, CE, & Rho, JM. The ketogenic diet as a treatment paradigm for diverse neurological disorders. Front Pharmacol 2012;3:59.

6. May reduce pain sensitivity 

Cancer treatments and recovery are sometimes associated with physical pain. Ketogenic diets may reduce sensitivity to some types of pain. 

  • Di Lorenzo, C, Coppola, G, Di Lenola, D, Evangelista, M, Sirianni, G, Rossi, P et al. Efficacy of Modified Atkins Ketogenic Diet in Chronic Cluster Headache: An Open-Label, Single-Arm, Clinical Trial. Frontiers in Neurology 2018;9.

  • Masino, SA, & Ruskin, DN. Ketogenic diets and pain. J Child Neurol 2013;28(8):993-1001.

  • Ruskin, DN, Suter, TA, Ross, JL, & Masino, SA. Ketogenic diets and thermal pain: dissociation of hypoalgesia, elevated ketones, and lowered glucose in rats. J Pain 2013;14(5):467-474.

  • Ruskin, DN, Kawamura, M, & Masino, SA. Reduced pain and inflammation in juvenile and adult rats fed a ketogenic diet. PLoS One 2009;4(12):e8349.

5. Beneficial effects on body composition 

Childhood cancer survivors suffer from higher risks of metabolic dysfunction and a particularly harmful form of obesity called sarcopenic obesity, characterized by low muscle mass and high fat mass. Ketogenic diets help patients lose fat mass and preserve muscle mass.

  • Browne, EK, Zhou, Y, Chemaitilly, W, Panetta, JC, Ness, KK, Kaste, SC et al. Changes in body mass index, height, and weight in children during and after therapy for acute lymphoblastic leukemia. Cancer 2018;124(21):4248-4259.

  • Klement, RJ, & Sweeney, RA. Impact of a ketogenic diet intervention during radiotherapy on body composition: I. Initial clinical experience with six prospectively studied patients. BMC Res Notes 2016;9:143.

  • Marriott, CJC, Beaumont, LF, Farncombe, TH, Cranston, AN, Athale, UH, Yakemchuk, VN et al. Body composition in long-term survivors of acute lymphoblastic leukemia diagnosed in childhood and adolescence: A focus on sarcopenic obesity: Sarcopenic Obesity in ALL Survivors. Cancer 2017:2591.

  • Roberts, MN, Wallace, MA, Tomilov, AA, Zhou, Z, Marcotte, GR, Tran, D et al. A Ketogenic Diet Extends Longevity and Healthspan in Adult Mice. Cell Metab 2017;26(3):539-546.e5.

  • Volek, J, Sharman, M, Gómez, A, Judelson, D, Rubin, M, Watson, G et al. Comparison of energy-restricted very low-carbohydrate and low-fat diets on weight loss and body composition in overweight men and women. Nutr Metab (Lond) 2004;1:13.

  • Willi, SM, Oexmann, MJ, Wright, NM, Collop, NA, & Key, LL. The Effects of a High-protein, Low-fat, Ketogenic Diet on Adolescents With Morbid Obesity: Body Composition, Blood Chemistries, and Sleep Abnormalities. Pediatrics 1998;101(1):61-67.

4. May boost emotion/mood

Preliminary studies have shown that patients on ketogenic diets show an improvement in depression symptoms, anxiety, and other markers of emotional distress. Because cancer treatment and survivorship is associated with high levels of emotional distress, the ketogenic diet may have this additional psychosocial therapeutic benefit. 

  • Bostock, E, Kirkby, KC, & Taylor, BVM. The current status of the ketogenic diet in psychiatry. Frontiers in psychiatry 2017;8:43.

  • Brietzke, E, Mansur, RB, Subramaniapillai, M, Martinez, VB, Vinberg, M, González-Pinto, A et al. Ketogenic diet as a metabolic therapy for mood disorders: Evidence and developments. Neuroscience & Biobehavioral Reviews 2018.

  • Cox, N, Gibas, S, Salisbury, M, Gomer, J, & Gibas, K. Ketogenic diets may reverse Type II diabetes and ameliorate clinical depression: A case study. Diabetes & Metabolic Syndrome: Clinical Research & Reviews 2019.

  • Hernandez, AR, Hernandez, CM, Campos, K, Truckenbrod, L, Federico, Q, Moon, B et al. A Ketogenic Diet Improves Cognition and Has Biochemical Effects in Prefrontal Cortex That Are Dissociable From Hippocampus. Front Aging Neurosci 2018;10:391.

  • Hollis, F, Mitchell, ES, Canto, C, Wang, D, & Sandi, C. Medium chain triglyceride diet reduces anxiety-like behaviors and enhances social competitiveness in rats. Neuropharmacology 2018;138:245-256.

  • Phelps, JR, Siemers, SV, & El-Mallakh, RS. The ketogenic diet for type II bipolar disorder. Neurocase 2013;19(5):423-426.

3. May improve physical functioning

Cancer progression, cancer treatments, and late effects from treatment can all negatively affect physical functioning. In non-cancer contexts, ketogenic diets have been shown to improve physical functioning in a number of different ways.

  • Castro, AI, Gomez-Arbelaez, D, Crujeiras, AB, Granero, R, Aguera, Z, Jimenez-Murcia, S et al. Effect of A Very Low-Calorie Ketogenic Diet on Food and Alcohol Cravings, Physical and Sexual Activity, Sleep Disturbances, and Quality of Life in Obese Patients. Nutrients 2018;10.

  • Cohen, CW, Fontaine, KR, Arend, RC, Soleymani, T, & Gower, BA. Favorable Effects of a Ketogenic Diet on Physical Function, Perceived Energy, and Food Cravings in Women with Ovarian or Endometrial Cancer: A Randomized, Controlled Trial. Nutrients 2018;10(9).

  • Mohorko, N, Černelič-Bizjak, M, Poklar-Vatovec, T, Grom, G, Kenig, S, Petelin, A et al. Weight loss, improved physical performance, cognitive function, eating behavior, and metabolic profile in a 12-week ketogenic diet in obese adults. Nutr Res 2019;62:64-77.

2. May slow tumor growth on its own

Ketogenic diets have been shown to slow tumor growth in mice and in some individual cases in humans. However, most researchers believe ketogenic diets should not be used as a stand-alone therapy, but rather used alongside conventional treatments.

  • Ho, VW, Leung, K, Hsu, A, Luk, B, Lai, J, Shen, SY et al. A Low Carbohydrate, High Protein Diet Slows Tumor Growth and Prevents Cancer Initiation. Cancer Research 2011;71(13):4484-4493.

  • Klement, RJ, Champ, CE, Otto, C, & Kämmerer, U. Anti-Tumor Effects of Ketogenic Diets in Mice: A Meta-Analysis. PLoS One 2016;11(5):e0155050.

  • Morscher, RJ, Aminzadeh-Gohari, S, Feichtinger, RG, Mayr, JA, Lang, R, Neureiter, D et al. Inhibition of Neuroblastoma Tumor Growth by Ketogenic Diet and/or Calorie Restriction in a CD1-Nu Mouse Model. PLoS One 2015;10(6):e0129802.

  • Otto, C, Kaemmerer, U, Illert, B, Muehling, B, Pfetzer, N, Wittig, R et al. 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 2008;8:122.

  • Poff, AM, Ari, C, Seyfried, TN, & D’Agostino, DP. The ketogenic diet and hyperbaric oxygen therapy prolong survival in mice with systemic metastatic cancer. PLoS One 2013;8(6):e65522.

  • Stafford, P, Abdelwahab, MG, Kim, DY, Preul, MC, Rho, JM, & Scheck, AC. The ketogenic diet reverses gene expression patterns and reduces reactive oxygen species levels when used as an adjuvant therapy for glioma. Nutr Metab (Lond) 2010;7:74.

  • Winter, SF, Loebel, F, & Dietrich, J. Role of ketogenic metabolic therapy in malignant glioma: A systematic review. Critical Reviews in Oncology/Hematology 2017;112:41-58.

1. May sensitize tumors to radiation and chemotherapy

Research has shown that ketogenic diets are most effective when done alongside conventional cancer treatments. It appears that nutritional ketosis boosts the effect of radiation and chemotherapy.

  • Abdelwahab, MG, Fenton, KE, Preul, MC, Rho, JM, Lynch, A, Stafford, P et al. The Ketogenic Diet Is an Effective Adjuvant to Radiation Therapy for the Treatment of Malignant Glioma. PLoS ONE 2012;7(5):e36197.

  • Allen, BG, Bhatia, SK, Anderson, CM, Eichenberger-Gilmore, JM, Sibenaller, ZA, Mapuskar, KA et al. Ketogenic diets as an adjuvant cancer therapy: History and potential mechanism. Redox Biol 2014;2:963-970.

  • Hopkins, BD, Pauli, C, Du, X, Wang, DG, Li, X, Wu, D et al. Suppression of insulin feedback enhances the efficacy of PI3K inhibitors. Nature 2018;560(7719):499-503.

  • Nebeling, LC, Miraldi, F, Shurin, SB, & Lerner, E. Effects of a ketogenic diet on tumor metabolism and nutritional status in pediatric oncology patients: two case reports. Journal of the American College of Nutrition 1995;14(2):202-208.

  • Zuccoli, G, Marcello, N, Pisanello, A, Servadei, F, Vaccaro, S, Mukherjee, P et al. Metabolic management of glioblastoma multiforme using standard therapy together with a restricted ketogenic diet: Case Report. Nutr Metab (Lond) 2010;7:33.