Ketogenic Diet and the Metabolic Theory of Cancer (Q&A)
Emerging research suggests that a ketogenic diet, in conjunction with conventional treatments, offers new hope for those coping with cancer and other serious diseases.
For decades, the ketogenic diet—which shifts the body’s metabolism from burning glucose to burning fat, lowering blood sugar and insulin and resulting in a metabolic state known as ketosis—has been used to successfully manage pediatric epilepsy. More recently, it has been used by the Paleo community as a weight loss strategy.
With endorsements from leading researchers and oncologists such as Dr. Thomas Seyfried (Cancer as a Metabolic Disease), The Ketogenic Kitchen by Domini Kemp and Patricia Daly offers more than 250 recipes, as well as meal plans and comprehensive scientific information about the benefits of a ketogenic diet, with sensible advice to help readers through periods of illness, recovery, and treatment.
Below is a Q&A with the authors about the book, their use of low-carb and ketogenic meal planning, as well as their own personal journeys with cancer.
You can also hear them talk about the book on the Primal Blueprint podcast with Mark Sisson. They also took time to speak with Dr. Joseph Mercola, who said of this book, “If you’ve been wanting to implement a ketogenic diet but had trouble figuring out what to eat and how to plan your meals, I highly recommend getting The Ketogenic Kitchen.”
Check out this recipe and video on how to make low-carb, grain-free Cracking Crackers.
And, don’t just take it from us at Chelsea Green – check out this New York Times opinion piece on how a low-carb diet could save people tens of thousands of dollars on surgeries (that they don’t need) to stay healthy.
- It’s clear from the book’s subtitle that a ketogenic diet is high in fat and low in carbohydrates, but what does “ketogenic” actually mean in terms of the diet’s impact on the body?
- How did you come to write this book? And how did you meet each other and form this collaboration?
- The book is actually “two-books-in-one.” Why?
- How do the recipes differ in “The Low Carb Way” and “The Ketogenic Way”?
- Ketogenic diets have been used for decades to prevent seizures in children who suffer from epilepsy, most notably by The Ketogenic Diet Center at Johns Hopkins University, and the diet is also used sometimes for weight loss. But your book is the first to claim that a ketogenic diet can be an effective strategy in the management of cancer. What evidence has emerged—or is emerging—to suggest this?
- How do you respond to critics that say this type of diet could be harmful to cancer patients?
- Can the ketogenic diet also be effective in the management of other serious illnesses?
- In some ways, the ketogenic diet represents a shift in thinking about cancer—one that is less of focused on genetics and that views it as much as, or more of, a metabolic disease. This idea was first proposed by Otto Warburg in the early 20th century and is now garnering renewed interest and appreciation. How does the ketogenic diet fit, or not fit, into Warburg’s ideas about cancer as a primarily metabolic disease? Is that mutually exclusive or compatible with the more recent and prevailing focus on genetics?
- Superficially, the ketogenic diet resembles some other diets such as Atkins and Paleo. How do you distinguish it?
- What are some of your favorite recipes from the book?
Chelsea Green (CG): It’s clear from the book’s subtitle that a ketogenic diet is high in fat and low in carbohydrates, but what does “ketogenic” actually mean in terms of the diet’s impact on the body?
Patricia Daly (PD): When somebody is eating ketogenic, the goal is to get the body into a state called “nutritional ketosis” (not to be mixed up with ketoacidosis!). This means that the body is starting to use fat instead of sugar as the main energy source. Blood sugar levels will stabilise at a lower, steady level, which has many effects on overall health and well-being. Ketosis can be achieved by reducing carbohydrates to a very low level and also by keeping protein relatively restricted. The missing calories are then replaced with fat in the form of oily fish, avocados, olives, coconut products, and also fatty cuts of meat, for instance. I prefer to talk about a “lifestyle” rather than just a diet because there are so many other factors that impact and enhance the effects of ketosis: stress, exercise, toxins, and sleep are among them.
CG: How did you come to write this book? And how did you meet each other and form this collaboration?
Domini Kemp (DK): We didn’t meet until I went to Patricia for a consultation at her clinic after I had finished chemotherapy. Up until that point, I had done my own research and was feeling quite frustrated about the lack of good information, as well as all the misinformation available to patients. Patricia and I got on immediately, and her consultation gave me huge confidence that what I was doing was right for me and that I was on the right track regarding sugar, exercise, and nourishing foods, as well as fasting, which I was inadvertently doing. Over time and because of the encouragement (read: bullying!) of mutual friends and family, we decided to write a book that we both wished was available when we were diagnosed with cancer.
CG: The book is actually “two-books-in-one.” Why?
DK: We both follow different diets. I am a chef and food writer and run cafes and restaurants here in Ireland. Sometimes I eat carbs, so following a low carb diet 80-90% of the time works really well for me. But going into ketosis for 2-3 weeks a year potentially has lots of benefits and is well worth doing. Many gyms use it to help clients lose weight—which is a great aspect of the diet—but it gives you a sense that you’re recalibrating your body to some extent.
PD: I’ve been following a ketogenic diet for over 4 years now. Conventional treatment in 2008 put a (temporary) stop to the growth of my tumor but management via diet is clearly key for my ocular (eye) melanoma. Two years after my relapse in 2010, I struggled with significant side effects from my treatments that really impacted me in my daily life. I took a leap of faith and started going into ketosis while being monitored closely. The effects were visible within weeks only—the swelling in my eye went down, my vision started to come back, excess blood vessels disappeared, and there was just a general “calming down” noticeable around my tumour. I also had a tumour outside the eyeball, which was still unchanged after radiotherapy, but then completely disappeared once I adopted a ketogenic lifestyle. The interesting thing is that my diet is so second nature to me now although I keep researching, fine tuning, and optimising my protocols depending on what’s going on in my life. I’d say I spend less time planning, cooking, and eating now than I used before going keto!
CG: How do the recipes differ in “The Low Carb Way” and “The Ketogenic Way”?
DK: The amount of carbs in the Ketogenic section are much more limited and food needs to be measured a bit more carefully when going into ketosis. Low carb—for me—is easy to implement and stick to. You have to do what works for you!
CG: Ketogenic diets have been used for decades to prevent seizures in children who suffer from epilepsy, most notably by The Ketogenic Diet Center at Johns Hopkins University, and the diet is also used sometimes for weight loss. But your book is the first to claim that a ketogenic diet can be an effective strategy in the management of cancer. What evidence has emerged—or is emerging—to suggest this?
PD: The strength of this approach lies in the metabolic aspect—meaning that we teach our body to generate energy in a very different way compared to somebody whose diet is reliant on mainly carbohydrates. As you can imagine, this is a powerful approach that leads to many changes in the body. The first and probably most obvious advantage for a cancer patient is that blood sugars are kept at a low, steady level. Many studies and well-respected researchers have shown how cancer cells thrive on glucose. It’s their favourite food. This “quirk” of cancer cells is being used to diagnose the disease via a PET scan. Once a patient manages to keep blood sugars low for a while, many things start to happen: In response to low blood sugar and also insulin levels, the body starts to produce ketone bodies from fatty acids. These become the main source of fuel for most healthy cells but can’t be readily used by cancer cells—on the contrary, there are studies showing how they can make a cancer cell’s life very difficult. If someone implements a ketogenic diet in a safe and effective way, it has wide-ranging effects on many hallmarks of cancer (i.e., angiogenesis, gene expression, and inflammation, to name just a few) but also on general well-being. Many of my clients report, for example, better mood and focus, better digestion, more energy, reduced cravings, and clearer skin, possibly because of improved hormone balance. I’ve been in ketosis for over four years now—every single day, without a break. But my way of eating now is certainly very different to what it was at the beginning because my body is so adapted to burning fat now.
CG: How do you respond to critics that say this type of diet could be harmful to cancer patients?
PD: First of all, we make it incredibly clear in our book that the ketogenic diet does NOT replace conventional therapies but is a supportive and complementary tool. With low carb, it’s definitely different because there aren’t such dramatic metabolic changes involved. While I think it’s a good idea to monitor bloods on a regular basis (which most cancer patients should be doing anyway), it’s not compulsory on a low carb diet. Like with any dietary approach or indeed treatment, the ketogenic diet is NOT suitable for everyone. There is a list of contraindications in the book, which explains who should not attempt a ketogenic diet (mainly due to genetic metabolic dysfunctions). We also emphasize the importance of a multidisciplinary approach, regular blood monitoring, and involvement of professionals. Many people “out there” attempt a ketogenic diet on their own based on their internet research, which indeed can be harmful. We point out that certain individuals have risk factors that need even closer monitoring. Our book is aimed at people who are at the information gathering stage, who are planning to get support or indeed are already implementing a ketogenic diet but need a lot more carefully calculated meal plans and nutrient-dense recipes.
It’s important for health professionals to understand the clinical implications of a lack of resources/studies into this promising area of cancer research. Public interest is ever increasing—there’s no stopping this trend, whether our book is on the market or not. Online resources are growing on a daily basis—some good, others of very poor quality. When using our book, cancer patients can be assured that the information is up-to-date, well researched, and endorsed by top notch scientists, researchers, and medical professionals.
CG: Can the ketogenic diet also be effective in the management of other serious illnesses?
PD: As we outline in our book, the ketogenic diet has been used for centuries in the management of uncontrollable epilepsy, and a number of randomized controlled trials have shown that it’s a safe approach. When it comes to other diseases, we have strong evidence for the use of the ketogenic diet for weight management, diabetes, and cardiovascular disease. In other areas like cancer, PCOS, or neurological diseases like Alzheimer’s, we’re only just at the beginning of obtaining “hard data” from clinical trials. There are clinical studies underway now, and it’s my assumption that medical doctors are waiting for the results before being able to implement any protocols. But the issue is that this might still take months if not years, and unfortunately, many chronically ill patients don’t have the luxury of time. We actually already have a considerable amount of evidence in the form of laboratory data, and new studies appear on almost a weekly basis. It’s such a rapidly evolving field now that it can no longer be ignored.
CG: In some ways, the ketogenic diet represents a shift in thinking about cancer—one that is less of focused on genetics and that views it as much as, or more of, a metabolic disease. This idea was first proposed by Otto Warburg in the early 20th century and is now garnering renewed interest and appreciation. How does the ketogenic diet fit, or not fit, into Warburg’s ideas about cancer as a primarily metabolic disease? Is that mutually exclusive or compatible with the more recent and prevailing focus on genetics?
PD: There is a convincing—and growing—body of research that questions the origins of cancer and whether cancer is really a genetic disease. What most of us have learned about cancer is that it originates in the DNA of a cell when a series of mutations in a single cell happen. Mutations that affect cell division (particularly those that allow cells to divide uncontrollably) can be the start of many forms of cancer. That’s why some people call cancer “a genetic disease.”
For the past 50 years, this so-called “somatic mutation theory” (i.e., mutations that take place in non-reproductive cells) has been the prevailing paradigm in cancer research. But genomic instability hasn’t always been considered the primary cause of cancer. German physician Dr Otto Warburg was one of a number of researchers in the early 1900s who came to the conclusion that cancer is primarily a mitochondrial metabolic disease. Metabolic diseases are conditions in which the metabolism—or in other words, the creation of energy from the food we eat—is abnormal or defective in some way. Warburg demonstrated in his studies that cancer cells used sugar (glucose) as their preferred fuel, even when oxygen that healthy cells use for energy generation was present. This so-called Warburg effect has been confirmed in many studies and today is a well-established hallmark of many types of cancers (Hanahan and Weinberg, 2011). And yet the concept of cancer as a metabolic disease has still received little or no attention from the oncology world since the 1930s.
But recently, an increasing number of scientists have been looking for other approaches to cancer management. What if cancer has little to do with genes, but metabolism is much more important? One of the scientists at the forefront of the notion of “cancer as a metabolic disease” is Professor Thomas Seyfried from Boston College, who has been carrying out extensive research for many years now. He took a particular interest in so-called “nuclear transfer experiments,” which we explain in our book.
In my opinion, it’s a bit of a chicken and egg situation when we talk about the origins of cancer: what was there first, mitochondrial damage or mutations in the DNA? Fact is, these two don’t have to be mutually exclusive. We have preliminary (and I have quite a bit of clinical) evidence that the ketogenic diet—or even “just” a low-carb approach—can be beneficial for patients undergoing chemo- and radiotherapy. Side effects tend to lessen, and some studies show that the effects of conventional treatments can be enhanced.
The ketogenic approach is complementary to other therapies, and it should not be considered an alternative or stand-alone treatment. I also see a role of low-carb and ketogenic eating in prevention of chronic diseases, which obviously should be a key priority given the soaring rates of cancer and other illnesses.
CG: Superficially, the ketogenic diet resembles some other diets such as Atkins and Paleo. How do you distinguish it?
DK: I think it differs, as there are so many more vegetables in it. When you think of the Atkins diet, you imagine eating steak for breakfast! But going Ketogenic is much less geared towards reliance on protein. I love the focus on healthy fats, leafy veg, nuts, seeds, eggs, avocados, and oily fish.
PD: Atkins tends to be very focused on animal proteins and many people following an Atkins diet might not be in very deep ketosis—this depends on their activity levels as well. A Paleo diet can be very similar or incredibly different to keto, depending on how it’s implemented. Some people still eat loads of fruit, sweet potatoes and other starchy tubers on a Paleo diet, which would certainly be very far from a ketogenic diet. As Domini said, plant foods play an important role in a well-formulated ketogenic diet, and there are many ways of incorporating highly nutrient dense foods into the protocols.
CG: What are some of your favorite recipes from the book?
DK: I regularly make all the dishes in the low carb section, but I am addicted to the keto granola bars in the Ketogenic section. They are divine to eat and really keep you going all day. The meat pizza is also delicious. A little bit “Homer Simpson,” but rich and delicious.
PD: Domini has a number of fab recipes, and I love her spicy fish cakes, Harira chicken soup, the sun-dried tomato tapenade, and the Caesar salad dressing is to die for, too. My keto section obviously contains all my favorite recipes that I’ve been developing over the past four years. Only the best made it in this book.
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