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A ketogenic diet refers to a diet which is high in dietary fats and low in carbohydrates with 80 % of the daily calories being derived from fats and less than 5 % from carbohydrates with the remaining being from proteins. Ketogenic diet has been suggested as an adjuvant therapy in cancer treatment as it caters to improve individual’s response to treatment. This article will cater to explore this claim with the help of succinct evidence.

A balanced diet includes carbohydrates in a greater proportion than fats, which means that ample amount of carbohydrates, and thus, glucose is available to all the cells of the body. Glucose is utilised both by normal body cells and cancerous cells. In fact, it has been recognized that cancer cells thrive on glucose. Like normal cells of the body require fuel or energy for survival, cancer cells also need some sort of fuel, which is majorly derived from these sugars. While normal cells of the body can also learn to thrive on alternate sources of energy like fats and proteins by altering their energy pathways, cancer cells find it increasingly difficult to alter their principal source of energy. This is in favour of the ketogenic diet as it reduces the availability of the major source of energy to the cancerous cells reducing their chances of survival.

Further, consuming carbohydrates raises blood sugar levels in the body leading to an increased production of insulin. Insulin has been found to mediate cancerous growth as it leads to the activation of P13K signalling in tumour cells causing these cells to replicate. By consuming a ketogenic diet, insulin levels in the body can be regulated, which makes cancer treatment more effective. However, definitive efficacy and safety of the ketogenic diet has not yet been established. Rather, some studies have found a reverse claim, in that, ketogenic diet consumed in isolation in cancer patients can have some harmful effects or it may exhibit no positive effects at all. This implies that there is a need to alter between different types of diets even while promoting ketogenesis in the patient. This also implicates that switching to a ketogenic diet without the recommendation of your doctor or the cancer group can indeed have a harmful effect, and thus, must be avoided[1].

While definite clinical course of the diet is yet to be established, ketogenic diet has demonstrated its repeated success as an adjuvant therapy for cancer in several preclinical and lab studies. These studies have provided evidence in the favour of anti – tumour effects of ketogenic diets. When combined with existing treatment protocol that is, chemotherapy or radiotherapy, ketogenic diet immensely helped in reducing the growth of neuroblastoma. This has been noted for 2:1 KD (ratio of fat to carbohydrates plus proteins) along with calorie restriction. Although calorie restriction has an anti – tumour potential as it helps to sensitize cancerous cells to chemotherapy, it is usually not recommended in patients due to weakness and weight loss witnesses in cancer. So, while ketogenic diet has been evidenced to have potential as a promising therapy, its clinical utilisation remains challenging.

Why a ketogenic diet has been proven effective with these lab studies can be explained in the lines of reduced ability of cancerous cells to proliferate in the absence of glucose. It has been found that cancer cells lack the ability to metabolise ketone bodies due to mitochondrial dysfunction and down – regulation of enzymes necessary for the utilization of ketone bodies. Further, reduction in blood sugar drops the levels of insulin and insulin – like growth factors, which are essential for the proliferation of cancerous cells[2]. Another pathway by which ketogenic diet is helpful in cancer therapy is that it also induces the shortage of lactate in the body, which is also essential for tumorous cells. It has been found that tumour cells take up an increased amount of glucose as compared to normal cells in the body and produce lactate, which they utilise for their proliferation[3]. By limiting glucose, the availability of lactate is also reduced, which is made through aerobic glycolytic pathways in cancerous cells.

Keeping aside the standard ketogenic diet, optimised ketogenic diets have proven to be more efficacious and safer during the treatment of cancer. Ketogenic diet in a ratio of 8:1 had a stronger anti – tumour effect as compared to a standard ketogenic diet when tested in patients. Within this diet, the fat content comprised of 25% medium-chain triglycerides and 75% long-chain triglycerides. This combination was more efficacious than an all long – chain triglycerides diet in the same ratio. This ascertains that there is a need for optimisation of the ketogenic diet based on the needs of the patient, the type of the tumour and the dietary requirements, in addition with optimization to suit the standard therapy for cancer management.

As stated above, ketogenic diets are not favoured in cancer therapy because of their weight – loss effect. However, if calorie restriction in ketogenic diet is managed, weight loss will not be a delinquent of ketogenic diet and then it can be more greatly utilised. When patients affected with gastric cancer were given a ketogenic diet for a duration of 8 weeks, they demonstrated increased energy intake and an improvement in body weight, which implies that weight loss effect in ketogenic diet can be managed with the help of optimizations. The effect of the diet also depends on the type of cancer. Particular benefit of the diet has been found in advanced cases of gastric cancer in which metastasis has occurred.

All in all, ketogenic diet is effective in the management of cancer as it improves patient’s response to treatment. However, this depends on the advancement of the tumour and the type of cancer. In cancer patients, optimised ketogenic diets have demonstrated greater potential than standard ketogenic diet and must be utilised while facilitating optimisation on the basis of type of cancer, its progress, patient needs, type of fat given and the amount of calories fed to the patient. It is important to rule out calorie restriction in ketogenic diets before advising it for cancer patients to prevent cachexia and other side effects. Due to the risk of these side effects, it is imperative that you do not begin a ketogenic diet unless so advised by your doctor and cancer group.

[1] https://blog.aicr.org/2018/09/17/the-ketogenic-diet-and-cancer-treatment-what-patients-should-know/

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5842847/

[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5624453/

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