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Ketogenic diet does not “beat chemo for almost all cancers”

One of the difficult things about science-based medicine is determining what is and isn’t quackery. While it is quite obvious that modalities such as homeopathy, acupuncture, reflexology, craniosacral therapy, Hulda Clark’s “zapper,” the Gerson therapy and Gonzalez protocol for cancer, and reiki (not to mention every other “energy healing” therapy) are the rankest quackery, there are lots of treatments that are harder to classify. Much of the time, these treatments that seemingly fall into a “gray area” are treatments that have shown promise in animals but have never been tested rigorously in humans or are based on scientific principles that sound reasonable but, again, have never been tested rigorously in humans. (Are you sensing a pattern here yet?) Often these therapies are promoted by true believers whose enthusiasm greatly outstrips the evidence base for their preferred treatment. Lately, I’ve been seeing just such a therapy being promoted around the usual social media sources, such as Facebook, Twitter, and the like. I’ve been meaning to write about it for a bit, but, as is so often the case with my Dug the Dog nature—squirrel!—other topics caught my attention.

I’m referring to a diet called the ketogenic diet, and an article that’s been making the rounds since last week entitled “Ketogenic diet beats chemo for almost all cancers, says Dr. Thomas Seyfried.” Of course, when I see a claim such as that, my first reaction is, “Show me the evidence.” My second reaction is, “Who is this guy?” Well, Dr. Seyfried is a professor of biology at Boston College, who’s pretty well published. He’s also working in a field that has gained new respectability over the last five to ten years, namely cancer metabolism, mainly thanks to a rediscovery of what Otto Warburg discovered over 80 years ago. What Warburg discovered was that many tumors rely on glycolysis for their energy even in environments with adequate oxygen for oxidative phosphorylation, which generates the bulk of the chemical energy used by cells. I described this phenomenon in more detail in a post I did four years ago about a drug that looks as though its anticancer properties come from its ability to reverse the Warburg effect.

What not to do if you want your hypothesis to be taken seriously

So on the surface, Dr. Seyfried’s argument that cancer is primarily a metabolic disease (an argument I’ll look at in more depth shortly) is well within the bounds of current oncologic science. Indeed, a few years ago it was all the rage, and I remember attending several sessions and lectures on the Warburg effect and cancer at the AACR meetings three or four years ago, although, oddly enough, I don’t recall as many the last couple of years. In any event, if that’s all I looked at, I probably would have shrugged my shoulders and moved on, as in, “Nothing to see here.” But there are quite a few red flags. The first red flag is a claim that a ketogenic diet can treat cancer better than chemotherapy. The second, even bigger, red flag is on Dr. Seyfried’s Boston College web page:

In addition, Dr. Seyfried has worked with noted alternative health advocate Dr. Mercola to provide a thought-provoking discussion on the benefits of a ketogenic diet. Dr. Mercola provides a thorough synopsis of the talk on his website, and also includes the original audio recording of their conversation.

Über-quack Dr. Mercola? Oh, dear. His evident pride at having been interviewed by Dr. Mercola does not reflect well on Dr. Seyfried’s critical thinking skills and knowledge of medicine. Dr. Mercola sells quackery. He has promoted antivaccine views, breast cancer pseudoscience, and the rankest cancer quackery, such as that of Tullio Simoncini, who believes that all cancer is a fungus and that baking soda is the way to treat it, and the twice-a-day coffee enemas. Seriously, this is not the sort of person a legitimate scientist wants to associate himself with—ever—if he wants to be taken seriously. I can see a naive researcher making a mistake and, not realizing who Dr. Mercola is, agreeing to an interview, but that’s the sort of thing that a reputable scientist would do his best to disavow and distance himself from.

Neither is the American College for Advancement in Medicine (ACAM), which bills itself as the “voice of integrative medicine,” where he’s given a major talk, the sort of organization a legitimate scientist wants to associate himself with if he wants to be taken seriously. Don’t believe me? Just peruse the ACAM website, where you will find lots of chelation therapy, including a program to “certify” in chelation therapy and detoxification, as well as other quackery. There’s a good reason that ACAM has appeared in many SBM posts throughout the years, and not in a favorable light. I emphasize again, this is not an organization with which a scientist who wishes to be taken seriously by oncologists associates himself.

Also, if a scientist wishes to be taken seriously, he shouldn’t say things like this:

The low-carb, high-fat ketogenic diet can replace chemotherapy and radiation for even the deadliest of cancers, said Dr. Thomas Seyfried, a leading cancer researcher and professor at Boston College.

In an exclusive interview, Dr. Seyfried discussed why the ketogenic diet has not been embraced by the medical community to treat cancer despite its proven track record both clinically and anecdotally.

“The reason why the ketogenic diet is not being prescribed to treat cancer is purely economical,” said Dr. Seyfried, author of Cancer as a Metabolic Disease. “Cancer is big business. There are more people making a living off cancer than there are dying of it.”

And don’t associate yourself with Ralph Moss, the number one promoter of laetrile quackery and make easily refuted claims such as the claim that “chemo and radiation do not cure cancer or extend life, although cancer physicians often make this claim” and that radiation “often does more harm than good to the patient.” Given that all Dr. Seyfried has is a couple of case studies as clinical support for his treatment (see below) and I can produce reams of studies over nearly 50 years demonstrating that chemotherapy can cure specific cancers and prolong life when used appropriately, the “2% gambit” notwithstanding, it’s not a winning proposition, and it sure doesn’t help your credibility to use the language of cancer quacks to promote your idea.

So, what, exactly is Dr. Seyfried’s hypothesis?

Cancer as a metabolic disease

Red flags or no red flags, it is, of course, possible that Dr. Seyfried is on to something and has let his enthusiasm overwhelm his judgment with respect to whom he associates with and the sorts of statements he makes, many of which sound as though they could have come from Stanislaw Burzynski, Ralph Moss, or Joe Mercola. In actuality, he isn’t totally wrong, but he isn’t totally right, either. As is typical of someone without a medical background, in particular an oncology background, he is, basically, putting the cart before the horse, as you will see.

In his talk, Dr. Seyfried begins with what he refers to as a “provocative question”: Is cancer a genetic or metabolic disease? Actually, whether he realizes it or not, his question is not quite as provocative as he thinks it is, nor is the answer anywhere near as clear-cut as he thinks it is or as he characterizes oncologists and cancer researchers as thinking it is. I’ll tell you what I think the answer to the question is after I’ve discussed Dr. Seyfried’s hypothesis. In the meantime, not surprisingly, his answer is that cancer is a metabolic disease, while everyone else’s answer—according to him, at least—is that it is a genetic disease, making him the brave maverick doctor, who says things like:

The current view now, without any question, is that cancer is a genetic disease. If you go on the National Cancer Institute website or you read any of the major articles published in Nature and Science, often the articles will start with, “Cancer is a genetic disease.” I think that this has become dogma.

Except that it really isn’t, at least not anymore. If you do a Pubmed search on “targeting cancer metabolism,” which is what Dr. Seyfried is talking about, you’ll find over 22,000 articles, with over 3,000 in 2013 alone, with a sharply increasing curve since 2000 that only now appears to be leveling off. A search on “cancer metabolism” brings up 369,000 references, with 28,000 in 2013 alone. Cancer metabolism is an incredibly important topic in cancer research and has been for several years now, and finding means of targeting the common metabolic abnormalities exhibited by cancer cells is currently a hot area of research. From my perspective, Dr. Seyfried is exaggerating how hostile the cancer research community is towards metabolism as an important, possibly critical, driver of cancer, although, to be fair, one prominent cancer researcher, Robert Weinberg, has been very skeptical. To me, Seyfried just appears unhappy that genetics is currently thought—for good reasons, I might add—to be the primary driver of most cancers. Note that I intentionally used such phrasing, because Dr. Seyfried, in my readings, appears all too often to speak of “cancer” as if it were a monolithic single disease. As I’ve pointed out many times before, it’s not. Indeed, only approximately 60-90% of cancers demonstrate the Warburg effect.

There are three components to glucose metabolism: glycolysis, which feeds the Krebs citric acid cycle, which in turn feeds oxidative phosphorylation. I show them below in simplified illustrations:

glycolysis
krebscycle
oxidativephos

The issue with the Warburg effect is that it leads to a shift in metabolism that favors glycolysis. As a result of this shift, tumor cells tend to use a lot more glucose than normal cells because glycolysis is much less efficient at converting glucose into ATP molecules used for cellular energy than oxidative phosphorylation. One reason that this is thought to provide a growth advantage to cancer cells is because oxidative phosphorylation requires oxygen while glycolysis does not and cancers frequently outgrow their blood supply such that they often live and grow in tissue spaces where there is not much oxygen. In any case, the avidity of cancer cells for glucose has been known a long time and is the basis for positron emission tomography (PET) scanning, where a radiolabeled derivative of glucose is the most commonly used tracer for exactly that reason: Tumor cells take it up much more avidly than do normal cells, leading to ugly black blobs (old-fashioned PET scans alone) or pretty bright blobs (PET-CT) where there are tumor masses in the scans.

The idea behind ketogenic diets is very simple. If glucose is the primary fuel for cancer, then lower carbohydrate intake and replace carbohydrates with other sources of fuel, such as fats, in order to push the body’s metabolism into ketosis. It actually turns out that ketogenic diets are probably useful in the treatment of intractable epileptic seizures in children. Unfortunately, their mechanism of action in preventing seizures is unclear, although four potential mechanisms, including carbohydrate reduction, activation of ATP-sensitive potassium channels by mitochondrial metabolism, inhibition of the mammalian target of rapamycin (mTOR) pathway, or inhibition of glutamatergic synaptic transmission (glutamate as a neurotransmitter), have been proposed. Interestingly, the mTOR pathway is an important signaling pathway in many cancers that couples energy and nutrient abundance to the execution of cell growth and division, owing to the ability of TOR protein kinase to simultaneously sense energy, nutrients and stress and growth factors. It’s a commonly overactive signaling pathway in cancer.

It’s also interesting that the cancers used to produce the basic science cited by Dr. Seyfried are virtually all brain cancers and that virtually all the evidence comes from rodent tumor models. For one thing, if there is a tumor type that exhibits the Warburg effect and a high degree of metabolic derangement, it’s brain tumors. It’s no coincidence that dichloroacetate was first tested in brain tumors. In this study, VM/Dk mice were used, and a mouse histiocytoma cell line resembling human glioblastoma multiforme with macrophage/microglial properties derived from that same mouse strain (VM-M3) was implanted subcutaneously. This cell line has the property of metastasizing quickly and widely when implanted under the skin and allowed to grow, which actually makes it not very much like brain tumors, which seldom metastasize and usually kill through local invasion and taking up increasing volume in the closed space of the skull, something the brain most definitely does not like. The results showed that a ketogenic diet increased mean survival time by over 56%, while a combination of a ketogenic diet and hyperbaric oxygen therapy (HBOT) increased survival time 78%. The result is interesting, but it is a mouse tumor model, not a human tumor model, and that makes its applicability to humans tenuous, particularly given the nature of the murine tumor, but probably worth investigating further.

Another mouse study cited by Seyfried is one in which dietary restriction was reported to promote vessel maturation in a mouse astrocytoma model. Given that tumor angiogenesis is one of my scientific interests and I have a fair number of publications on the topic, I was interested. Unfortunately, I ended up being disappointed. This was another syngeneic model (i.e., a mouse tumor implanted in mice of the same strain from which the tumor was isolated as a cell line, like the one discussed above). Although it showed increased tumor vessel maturation (which is one mechanism by which inhibitors of angiogenesis work), I wasn’t quite convinced, because there was a distinct lack of quantification of the phenomenon, and the microscopy appears not to have been blinded, something that’s critical to avoid unconscious bias in the results. It’s not surprising that this result, which, if more convincing evidence had been obtained, could easily have appeared in Cancer Research, was published in a low tier journal. It’s an OK study, but not fantastic. Certainly it didn’t lead me to smacking myself in forehead and saying, “Of course!”

Throughout his talks, both here and elsewhere, Dr. Seyfried presents mouse studies that are interesting and suggestive that there might be something to this whole ketogenic diet thing, at least in brain tumors, such as this one. However, this is what we in the oncology biz would call pretty preliminary data, worthy of further investigation but not supporting the grandiose claims that Dr. Seyfried makes.

We need more beef. We need clinical studies. Unfortunately, they’re in short supply.

Clinical evidence for ketogenic diets as a cancer treatment

It’s not as though Dr. Seyfried doesn’t cite clinical evidence. It’s just that the evidence is so darned thin and unconvincing thus far. For instance, in this talk, the first study he presents is a very small case series (two patients, actually) performed in 1995 in which two girls with inoperable astrocytomas were placed on a ketogenic diet in order to “determine if a ketogenic state would decrease glucose availability to certain tumors, thereby potentially impairing tumor metabolism without adversely affecting the patient’s overall nutritional status.” Interestingly (to me, at least) these case reports came from University Hospitals of Cleveland, where I did my general surgery residency. In fact, I was still there in 1995. Unfortunately, I don’t have access to the journal back to 1995; so I’m stuck with just the abstract. However, the abstract is pretty clear:

Within 7 days of initiating the ketogenic diet, blood glucose levels declined to low-normal levels and blood ketones were elevated twenty to thirty fold. Results of PET scans indicated a 21.8% average decrease in glucose uptake at the tumor site in both subjects. One patient exhibited significant clinical improvements in mood and new skill development during the study. She continued the ketogenic diet for an additional twelve months, remaining free of disease progression.

One notes that the patient who didn’t survive 12 months wasn’t much mentioned; so I assume she didn’t demonstrate any clinical improvement. In any case, this study doesn’t really show anything, other than that a ketogenic diet might decrease glucose uptake in some brain tumors. It’s like a Burzynski case report, in which we have no idea whether the patient did better than expected because of the intervention or because she had less aggressive disease.

The next case report is from 2010. It describes the case of a 65-year-old woman who presented with progressive memory loss, chronic headaches, nausea, and a right hemisphere multi-centric tumor seen with magnetic resonance imaging (MRI). Following incomplete surgical resection, the patient was diagnosed with glioblastoma multiforme (GBM). Now here’s the kicker: The patient underwent standard therapy plus the ketogenic diet. A day after her surgery, she underwent a two-day fast, followed by a three day fast beginning a week after surgery, followed by a restricted ketogenic diet (only 600 Cal/day). Three weeks after her surgery (and two weeks after starting the ketogenic diet) she began standard of care treatment, concomitant radiation plus chemotherapy (temozolomide), “according to standard procedures,” which lasted six weeks. The patient also had a gene mutation in her tumor that produces increased sensitivity to temozolomide. The conclusion? Fortunately for the patient, she had what appears to have been a complete response, after which she went on a less restrictive ketogenic diet. Unfortunately, the patient recurred eight months later. By that point, the patient was off of the ketogenic diet. The authors’ conclusion? Because it was “unlikely” that the tumor would have responded this well on standard therapy alone, it must have been adding the ketogenic diet that done it. Worse, in the talk, Dr. Seyfried strongly implies that the tumor recurred because she had gone off the ketogenic diet two and a half months before her recurrence.

Irritatingly, during the same talk, Dr. Seyfried refers to having done a “biopsy” on the GBM when the case report clearly says that the patient underwent a partial excision of the temporal pole with incomplete debulking of the tumor, which is a different thing. When a surgeon tries to debulk a tumor, he is trying to remove as much of it as possible. When a surgeon biopsies a tumor, he is trying only to get enough tissue to make a diagnosis. He also heaps scorn on the hospital for insisting that the patient undergo standard of care therapy, clearly demonstrating that he has no understanding of clinical trial ethics. What most likely happened with this patient is that the debulking was significant, and the remaining tumor was small enough to be eliminated by the combined chemotherapy and radiation therapy—at least to the point of no longer being detectable on PET scan. Also, just because the diet appears to have decreased glucose uptake by the tumor doesn’t mean that the tumor was dying. In fact, it might have even made the PET scan less sensitive to whatever remaining viable tumor cells might still have been around, a possibility that I don’t see Dr. Seyfried as having considered.

There are other studies, but little or nothing in the way of randomized clinical trials. For instance, a recent retrospective study of 53 patients, of whom only six followed a ketogenic diet while being treated for GBM, concluded that the diet was safe, but no suggestion of efficacy was noted. More recently, a German group examined the effect of a ketogenic diet on 16 patients with advanced cancer of various types who had exhausted all therapeutic options. The treatment didn’t result in any serious side effects, although subjects found it very difficult to maintain the diet, particularly in the context of family life. Only five were able to complete the three month treatment period, and it was reported that these five didn’t have progression while on the diet. Of the remaining 11, two died early, one was unable to tolerate the diet and dropped out very quickly, two dropped out for personal reasons, one couldn’t continue the diet for more than a month and three had disease progression within less than 2 months of starting the diet and one dropped out to resume chemotherapy. As a whole, this study was well-nigh uninterpretable due to the different kinds of cancer, other than to conclude that less than 50% of patients with advanced cancer could adhere to the diet, and that those who could generally had no significant side effects. Of course, it’s unclear whether the diet helped the five who could adhere to it or whether those who adhered to it could do so because they had more indolent, less aggressive disease.

None of this stops Dr. Seyfried from concluding:

  1. Preclinical and case report studies indicated that the restricted ketogenic diet (R-KD) can be an effective “metabolic therapy” for managing malignant brain cancer in children and adults.
  2. The therapeutic effects of the R-KD against brain cancer can be enhanced when combined with drugs or HBOT that also target energy metabolism.

Uh, no. Not exactly. Preclinical experiments are intriguing but fairly limited in applicability, and the case reports demonstrate nothing of the sort. There’s more to Dr. Seyfried’s hypothesis, for example, his idea that metastatic cancer comes about because of alterations in glutamine metabolism, but unfortunately he appears to misunderstand the genetics of metastasis when he bases part of his conclusion on observations that metastatic cancers often have the same genetic derangements as the primary tumor. It’s been a longstanding question whether clones of tumor cells possess the ability to metastasize as an intrinsic part of the process of becoming cancer cells or whether they acquire it later. Given that evolution is a major force driving cancer cells to become more invasive and that tumors are very heterogeneous, full of lots of different clones with different sets of genetic mutations, Dr. Seyfried’s hypothesis is at best simplistic. Also disappointingly, the evidence for any diet as a treatment for cancer is weak at best.

Putting the cart before the horse

Clearly, ketogenic diets are not ready for prime time as a treatment for cancer, either alone or in combination with conventional therapy. Unfortunately, that hasn’t stopped it from being touted by all manner of alternative cancer practitioners (i.e., quacks) and others as a cancer cure that “they” don’t want you to know about or saying things like, “…it’s nothing short of medical malpractice and negligence to fail to integrate this type of dietary strategy into a patient’s cancer treatment plan,” as Joe Mercola did. Dr. Seyfried himself has contributed to the hyperbole quite a bit as well. For example:

These studies are all in combination with either radiation or chemotherapy. My preference is to start metabolic therapy with GBM (glioblastoma multiforme). This is a devastating type of brain cancer. Metabolic therapy with a restricted KD could be done with a few tumors where you know the conventional standard of care doesn’t work at all. You would choose those kinds of patients and do a clinical trial based on historical controls and see what the outcome would be and see if you could get some level of survival that would match or be better than the conventional standard of care.

Regular readers of SBM should know the problem with this sort of approach. No IRB worth its salt would approve such a trial because it would be ethically dubious, but, even worse, it would be ethically dubious and it wouldn’t really tell us anything unless those few patients either had near-miraculous responses or died very quickly. Anything else would simply tell us that the diet is probably doing no harm. More numbers would be needed, particularly if the comparison is to historical controls, to get even an inkling of whether there might be benefit. In that case, you might as well do a proper phase I/II clinical trial, which is what is happening. For instance:

In other words, clinical data should be rolling in fairly soon, and that’s a good thing. In the meantime Dr. Seyfried and other advocates who so passionately believe that ketogenic diets will greatly help patients with brain cancer do no one any favors by claiming unequivocally that cancer is a metabolic disease and saying that ketogenic diets are more beneficial than chemotherapy for patients with brain tumors.

This brings me back to the question of whether cancer is a metabolic disease or a genetic disease, y answer to which I promised early on. The likely answer? It’s both! Indeed, a “chicken or the egg” argument continues about whether it is the metabolic abnormalities that cause the mutations observed in cancer cells or whether it is the mutations that produce the metabolic abnormalities. Most likely, it’s a little of both, the exact proportion of which depending upon the tumor cell, that combine in an unholy synergistic circle to drive cancer cells to be more and more abnormal and aggressive. Moreover, cancer is about far more than just the genomics or the metabolism of cancer cells. It’s also the immune system and the tumor microenvironment (the cells and connective tissue in which tumors arise and grow). As I’ve said time and time and time again, cancer is complicated, real complicated. The relative contributions of genetic mutations, metabolic derangements, immune cell dysfunction, and influences of the microenvironment are likely to vary depending upon the type of tumor and, as a consequence, require different treatments. In the end, as with many hyped cancer cures, the ketogenic diet might be helpful for some tumors and almost certainly won’t be helpful for others. Dr. Seyfried might be on to something, but he’s gone a bit off the deep end in apparently thinking that he’s found out something about cancer that no one else takes seriously—or has even thought of before.

Posted in: Basic Science, Cancer, Nutrition, Science and the Media

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275 thoughts on “Ketogenic diet does not “beat chemo for almost all cancers”

  1. tgobbi says:

    Dr Seyfried is quoted: In an exclusive interview, Dr. Seyfried discussed why the ketogenic diet has not been embraced by the medical community to treat cancer despite its proven track record both clinically and anecdotally.

    “The reason why the ketogenic diet is not being prescribed to treat cancer is purely economical,” said Dr. Seyfried, author of Cancer as a Metabolic Disease. “Cancer is big business. There are more people making a living off cancer than there are dying of it.”

    Ooooohhh! Serious red flag alert!

  2. R. Miller says:

    The interesting thing about the ketogenic diet, as you said, is that it has a legitimate use in managing epilepsy. So you can parallel how neurology views it with the odd portrait that’s been painted by this character for the field of oncology. And go figure – everyone accepts and promotes that it’s a reasonable intervention. It has a biologically plausible mechanism of action and evidence to back it up, though by no means of course a panacea. Despite epilepsy being a condition that requires long-term pharmacotherapy for management as well as having the option of expensive medical device interventions (DBS/VNS) with procedural costs for surgery – I can’t think of any neurologists, neuropsychiatric pharmacist, researching academic, etc. who isn’t interested in understanding more about how it might can help. Most of us are on-board that patients should give it a shot, want more research – but also accept the massive hit to quality life the diet entails.

    So it’s puzzling why someone would play the “this isn’t studied because medical economics” card, when we clearly have direct example of a field where the same practice is used and the conspiracy doesn’t apply. Is his hypothesis simply that oncologist are more greedy than neurologists?

    1. David Gorski says:

      Of course. Just ask the quacks and cranks. According to their view, oncologists, for whatever reason, seem to be viewed as among the greediest of medical specialties, willing to subject patients to “useless” toxic chemotherapy, all to pad their bank accounts even though they “know chemo doesn’t work” and are, apparently, trying to suppress “natural” alternatives. Even cardiologists peddling “useless” statins aren’t castigated the same way oncologists are.

      Also, I rather suspect that the cranks and quacks don’t see anti-seizure medications as being the “big business” that chemotherapy drugs are, given that some of these medicines for epilepsy are quite old and long out of patent.

    2. JustKnight says:

      Massive hit to quality of life the diet entails? I am a perfectly healthy 26yo and I eat a ketogenic diet simply due to how much better I feel on it. Among some of the greatest advantages are:
      1. Stable energy levels. I no longer crash with no energy at any point during the day… even after a rough day after a large dinner. This alone has changed my life. I get more done at home than I did in years.
      2. Complete control over my appetite. My decision to eat something is no longer dictated by ravenous hunger and cravings… or immense amount of guilt I placed on myself to counter those strong feelings.
      3. I become significantly calmer and stress free. My base anxiety level goes down. Some perceive it as me being tired but its simply me being relaxed.
      4. Better skin quality: I have not seen any research on this but personally whenever I am in ketosis my skin clears up, no more random acne outbreaks AND more importantly my mild psoriasis completely disappears.

      1. R. Miller says:

        Glad you like the ketogenic diet. A 16 year old girl who became prohibitively restricted from ever socially eating again with her friends didn’t feel as good as you do about it, though.

        My comment on quality of life was, obviously, in the context of epilepsy patients. You’re conflating two issues. The ketogenic diet application for weight loss or generic “health” benefits is an easy to play diet – if you mess up, simply start over or move on. When the ketogenic diet is applied for epilepsy it – MUST – be maintained for therapeutic benefit. One slip and those benefits are gone, and seizures may return (sometimes with a vengeance).

        You and I have the luxury of choice in the matter of our diets; people with intractable epilepsy have a much, much tougher choice. It’s borderline insulting to try and compare them.

        1. WilliamLawrenceUtridge says:

          Not to mention the cancer ketogenic diet is only 600 calories per day and you’re missing out on some truly delicious foods – fruits, ice cream, bread, pizza, pasta, cake, cookies, potatoes, etc.

          And I wonder how long this 26 year old has been on said diet, and how long it will continue?

          1. Bob Johnston says:

            I believe it was just that one particular case study that was only 600 calories per day. A ketogenic diet can be any number of calories, the only provision being you are producing ketones of sufficient quantity. I eat up to 3000 kcal a day and remain in ketosis and I sure as heck don’t miss not eating the “delicious” ice cream, cake, bread and other carby foods I view as toxic as a hardship. I’ve been eating this way for 3 years now and unless our knowledge changes or I don’t continue to enjoy the health benefits I currently do I won’t be switching.

            1. WilliamLawrenceUtridge says:

              That’s great, nobody cares if you switch or not. But as I indicated above, your diet isn’t what Seyfried is proposing (as far as I can tell). You claim a maximum ceiling of 50 grams of carbohydrates. Based on Seyfried’s data in mouse studies (I couldn’t find the specific breakdown for humans, so I’m extrapolating), at best assuming a 3,000 calorie diet, you’d be restricted to 25 grams of carbohydrates (100 calories), not 50, and 125 grams of protein (500 calories), leaving 266 grams (2,400 calories) from fat. It’s considerably more restrictive. If you consumed the recommended 2,000 calorie diet that’s the rule of thumb for most men, you’d be down to 16 grams of carbohydrates, about 80 grams of protein and 170 grams of fat.

              You are not eating the diet Seyfried recommends.

              And it’ll be interesting to see if you can remain on this diet for longer than three years, since most people on ingredient-restricted diets tend to not last. Maybe you will, but for most people, the diet ultimately becomes something they can’t stick to. It’s not a universal panacea.

              1. Bob Johnston says:

                Perhaps you can tell me how long a period of time you find reasonable to say a diet is one someone can stick to. Here I thought three years was pretty good, what the hell was I thinking?

                And since reading for comprehension isn’t your strong suit I’ll be very specific here and point out I never said anything about Seyfried’s version. All I said was that ketogenic can be any number of calories, just as long as you’re producing ketones.

                Being combative just for the sake of being combative is neither helpful nor a good use of time. You should stop. People are reading this to learn, not to hear over and over again what your opinion is of a ketogenic diet.

              2. WilliamLawrenceUtridge says:

                Perhaps you can tell me how long a period of time you find reasonable to say a diet is one someone can stick to.

                Perhaps you can note that most people are unable to stick to a ketogenic diet, so pretending your experience is a panacea is inappropriate.

                Being combative just for the sake of being combative is neither helpful nor a good use of time.

                That depends on the person – I like being combative for it’s own sake, so it helps me feel good which I consider a good use of time.

                People are reading this to learn, not to hear over and over again what your opinion is of a ketogenic diet.

                Please feel free to never, ever read any of my comments, ever again.

  3. fglencross40@gmail.com says:

    Brilliant informative post.

    I don’t understand how the primary cause of a tumour clone is anything but genetic however. Bit then I am a Geneticist!

    1. David Gorski says:

      Obviously, you’re a tool of Big Genetics.

  4. DH says:

    Richard Feinman, a biochemist at SUNY Downstate Medical Center in Brooklyn, promulgates for a ketogenic diet for the tx of various advanced malignancies …. see http://www.ncbi.nlm.nih.gov/pubmed/22840388 and http://feinmantheother.com/2012/10/15/targeting-insulin-inhibition-as-a-metabolic-therapy-in-advanced-cancer/

    However, when you look at the actual data and study design, it is very low quality and quite “challenged” in terms of critical appraisal of sources of evidence (uncontrolled case series – basically not much better than case reports strung together, inadequately standardized treatment protocols, lack of controls, lack of blinding, lack of independent adjudication of study endpoints). What not to do if you want to advance your hypothesis is to produce these kinds of studies.

    The proponents of these therapies are highly prejudiced in favor of low-carb diets, which itself would make me question how the scientific hypothesis is being tested, and the reliability of the evidence.

    1. David Gorski says:

      I’ve alluded to similar claims, but I’ve never looked at Dr. Feinman’s claims in depth. Maybe I should…

      http://www.sciencebasedmedicine.org/more-breast-cancer-awareness-month-quackery/

    2. Andrey Pavlov says:

      It seems to me that this is a bit like some of the discussions lately about evolution. There were a couple of screeds written in the past year basically taking to task Dawkins and his idea of the selfish gene (and more nuanced, but I’m just using some shorthand) because there are other means of gene regulation that are important in evolutionary processes. Epigenetics is the biggest buggaboos of these folks (such as Shapiro out of Chicago). They are trying to say that genes and DNA are not the fundamental and essential substrate for evolution. The problem is that it still all boils down to the DNA (saying it boils down to just the genes is actually incorrect). The way in which DNA is methylated and thus epigenetically regulated (in a heritable manner) is indeed coded for in the DNA itself. Epigenetic modifications that are acquired environmentally have only been shown to persist for a generation or two and even then not particularly robustly.

      So in the case of cancer, while metabolic and environmental changes absolutely have influence on the course of the disease, it still ends up doing so by changing the DNA in a stable (at least stable enough) manner to be passed on down the clones’ lineages. So while metabolic and environmentally based therapies can certainly (and will certainly) be powerful tools in the treatment of cancer, I don’t see how that makes cancer anything but a primarily genetic disease anymore than evolution is all about the DNA as well.

      There might be a little more room to argue that non-DNA based changes have a much larger role in cancer evolution than they do in species evolution because the environment is smaller, generational time is quicker, and aberrancies in mitosis can lead to strange sharing of cytoplasmic contents that could themselves become stably (enough) heritable to drive oncogenesis. To my knowledge that has not been demonstrated yet, though it certainly could be the case. But even then, I do not see it displacing DNA modification enough to say that cancer is anything but initially and primarily a genetic disease (at least so long as we accept the larger definition of “DNA-based” since non-gene coding segments of DNA are obviously important for cellular genomic and proteomic regulation).

      Only in the narrow pedantic sense of “genetic disease” meaning genes only and not regulatory elements then could cancer be considered anything but primarily a genetic disease.

      Unless I am missing something?

  5. WilliamLawrenceUtridge says:

    It’s stunning to me that people are such strong proponents of such an unrealistic approach, given the poor-quality data. It essentially requires staying on an ultra-low-calorie diet, apparently indefinitely, while going through what is probably the most traumatic period in your life – diagnosis with one of the most feared maladies of the modern era.

    “Sure, I know you are in horrible pain and have trouble performing basic tasks, but we’re just going to cut your food intake down to three tablespoons of pure lard, some whey powder and tuna fish. You’ll have to eat this for the rest of your life.”

    It reminds me of the question asked of Stephen Barrett of Quackwatch, what would he do if he got incurable cancer – eat pizza and ice cream, and spend time with his family.

    Or, y’know, starve yourself to death over the course of your remaining months.

    A serious question – if the tumors have outgrown their blood supply, and thus their oxygen supply, how are they getting glucose, and how are they getting rid of the pyruvic acids that are essentially waste products when talking about glycolysis?

    1. Andrey Pavlov says:

      A serious question – if the tumors have outgrown their blood supply, and thus their oxygen supply, how are they getting glucose, and how are they getting rid of the pyruvic acids that are essentially waste products when talking about glycolysis?

      It is a diffusion gradient. The O2 and nutrients can and will still diffuse out into the tissue. Normal tissues would die at a certain distance from the nearest blood supply not because they are getting no O2/nutrients but because they aren’t getting enough. The idea then is that the cancer cells survive because they acquire mutations that allow them to survive in that sort of environment (natural selection). The same goes for waste removal.

      At a certain point, however, there is an absolute limit. Which is why many larger solid tumors tend to have necrotic cores. The cells nearer the surface continue to grow outwards, pushing the borders towards existing blood supplies and starving the core leading to larger areas of necrosis. Obviously the more “successful” tumors mutate to secrete angiogenic factors to enable the growth of vessels to feed the core, which is why Dr. Gorski’s own research back in the day was so exciting – it seemed like a great way to “starve” the tumor and keep it knocked down. But, as you know, life and cancer just ain’t that easy.

      1. David Gorski says:

        Sadly, contrary to Judah Folkman’s initial claims that tumors wouldn’t be able to evolve resistance to antiangiogenic therapy because the cells being treated (i.e., the endothelial cells that make the blood vessels) are normal cells and not the mutated mess of cells that are cancer cells, tumors actually can evolve resistance. They frequently do so just by cranking up the production of pro-angiogenic factors (the proteins that attract the ingrowth of new blood vessels) beyond what can be inhibited by the drug or by switching to other pro-angigoenic factors than the one being inhibited by the drug.

        1. CHotel says:

          I’m just gonna throw this out there as a suggestion, I think it would be peachy keen to see a post around the physiology of angiogenesis, diseases it influences, the available treatments (VEGF and TK inhibitors) and inherit shortfalls therein, and associated quackery. I don’t think we’ve had one with this as the main topic of discussion, if so my search skills are clearly waning.

          The concept seems to come up a lot (different cancers, ARMD, and I’ve heard of it being a research area in cardiology though I’ve not looked into that at all), and while when it gets mentioned brief descriptions usually follow, they tend to still be met with further questions. It would be nice to have a repository on the topic that could be referred to. Especially since I know that this is an area you do research in Dr. Gorski, you’d be able to give us great insight.

          1. Windriven says:

            I’d like to see that too. Great suggestion!

  6. tw says:

    I could be mistaken, But I remember reading that Seyfried acknowledged that either calorie restriction or a ketogenic diet may be beneficial in conjunction with chemotherapy and or radiation. His position on a curative outcome alone may have evolved.

    Having completed chemotherapy for Hodgkins recently, I think your article is an important one; because as you enter treatment you are searching for answers where no clear direction exists. The health team wants you to eat and stay strong, which may be difficult with radical dietary choices.

    Plus the doctor is faced with a myriad of things that people read on the internet. I look back and realize that if a certain strategy was optimal, he would have told me to do it, I would not have had to ask.

    The idea that cancer is big business is troubling as an excuse or selling point, because those delivering treatment, and those paying for it have a vested interest in minimizing expenses (insurance companies and governments) while maximizing outcomes. Therefore any solution that required say dietary counseling would be optimal in contrast to thousands in drugs. The big business argument fails to look at all sides of the transaction.

    I benefitted from science based medicine no doubt. What I think would be helpful from my limited experience would be a more comprehensive evaluation of what dietary options might be optimal for treatment, based on studies and evidence. In addition, the role of exercise, pre, during and post treatment, and what strategies might be optimal.

    These two areas allow a patient to focus on those things within their control: what they eat, and fitness/mobility and recovery.

    My observations on cancer and diet etc are the following: if something is linked, associated whatever with cancer in the press, it is probably worthy of ignoring. If you need to use the word healthy prior to a certain food, forget it. A healthy food doesn’t require this qualification. Most “studies” posted by the press on the internet are different from the way they are presented by the media. They are after eyeballs rather than helping people. Those parroting a cure for cancer via some service on the internet have likely never been through the disease, because if they had they would be telling you that their experience was their own, and may not apply to you. This is not how many of these services are marketed.

    Cancer as far as I can tell is a building rather than a Big Bang. Which is to say that any curative outcome will be a house of many building blocks. I think far too many are focussed on the Big Bang.

    1. David Gorski says:

      I could be mistaken, But I remember reading that Seyfried acknowledged that either calorie restriction or a ketogenic diet may be beneficial in conjunction with chemotherapy and or radiation. His position on a curative outcome alone may have evolved.

      His language seems to become more or less cautious depending on the audience.

      In the interview that I cited, he’s quoted as agreeing with Ralph Moss making a blanket statement that “chemo and radiation do not cure cancer or extend life, although cancer physicians often make this claim” and that the “low-carb, high-fat ketogenic diet can replace chemotherapy and radiation for even the deadliest of cancers.” Now, given that an exact quote wasn’t provided, it’s possible that the writer took liberties with what Dr. Seyfried said and exaggerated his certainty (although the headline makes me doubt that’s what happened). However, even if it were so that he was inaccurately quoted in this particular article (which is circulating widely in social media), Dr. Seyfried has said, both in the popular press and in at least one scientific editorial, that he thinks the ketogenic diet is likely to be able replace chemotherapy as a standard of care for advanced brain tumors and argued that the current standard of care might end up hurting by resulting in a milieu that favors tumor metabolism. In fairness, the latter assertion might have some validity to it. However, from a science-based perspective he asserts both in far too certain terms.

    2. WilliamLawrenceUtridge says:

      The idea that cancer can be treated* by diet is an odd one to me. Cancer is caused by DNA derangements (vis. Andrey above). How will diet unscramble that DNA? Unless the diet supports the immune system in killing tumors? If that’s the case, any reasonably-nourished person should be fine, because you can’t super-charge the immune system with diet (or anything really). If tumors (or really – all tumors) were reliant on the Warburg effect, then an ultra-low glucose diet might work, unless you managed to evolve a tumor that specialized in survivial in a low-glucose environment. I can see why brain tumors might be a special case since they seem to double-down on the Warburg effect, but the idea that you can treat cancer generally is just bizarre to me.

      *Prevented – yes; antioxidants would have a role in preventing oxidative damage to DNA. Not radioactive or chemical damage, but oxidation.

      1. Andrey Pavlov says:

        If tumors (or really – all tumors) were reliant on the Warburg effect, then an ultra-low glucose diet might work, unless you managed to evolve a tumor that specialized in survivial in a low-glucose environment.

        Even then I am highly skeptical. I would argue that a low-calorie or ketogenic diet might become something to help a little in the context of an entire regimen of cancer therapy, but I would argue that it can never become a sole or even primary means by which to treat any tumor*.

        The reason is I once did the math to prove that the way we are generally taught about Type I and Type II diabetes is patently false. The TL;DR: is that in med school it is still commonly taught (typically as a shortcut but I think many physicians who are not endocrinologists actually believe it) that the reason you get ketoacidosis in Type I vs Type II DM is because in T1 there is a lack of insulin so glucose can’t get into the cell, thus the cell “starves” and turns on beta-oxidation catabolic pathways, overusing fats and producing ketones. The reality is it is because there is a greater glucagon:insulin ratio and it has nothing to do with glucose entering the cell. All cells always have enough glucose flowing in because insulin only affects GLUT4 receptors and there are GLUT1,2,3,4,5 (and more) receptors. I did the math once to show that the influx of glucose in a person with high blood sugar, even in the absence of insulin, will be higher than the influx of a normal person after a meal.

        The real point relevant here is that I also did the converse calculation and showed that in order to actually “starve” a cell of glucose from a lack of influx the blood sugar would have to be low enough to be incompatible with life (or at a minimum incompatible with consciousness). And we know that it is trivially easy for a cancer cell to upregulate GLUT expression at the cell surface, thus preferentially sopping up whatever glucose there is (my calculations were based on normal cell fluxes that I had found in the literature).

        A key point to realize is that “ketogenic” does not mean “no glucose available.” It is still there, albeit typically at lower levels. But I cannot think of a way to induce glucose based starvation of a cancer cell that is compatible with human physiology.

        All that said, it might prove that the lower glucose simply makes it harder for the cancer cell to live, thus acting synergistically. It could also be that the state of ketosis makes it harder, also acting synergistically. The evidence is not there that this effect would be large and we certainly know it cannot apply to all cancers or even all individuals with the same cancer.

        Ultimately, and this is speculation on my part, I would bet that the balance would be against caloric restriction and ketogenic diets as being part of cancer treatment regimens at all (maybe in certain specific cases) because I imagine that the effect size will be small enough that the benefits of eating well and being happy (and thus more able to complete therapeutic courses and have greater reserve for surviving any sort of insults, like infection or sepsis) would vastly outweigh the benefits of such a diet. I think the effect size will be very modest at best, and that cancers can evolve resistance to anything, as Dr. Gorski just mentioned in regards to anti-angiogenic drugs.

        *The only possible exception I can conceive of (which is not to say it is exhaustive, of course) is a strange tumor as of yet unidentified that finds higher levels of blood ketones to be lethal. Of course, even then, we know that all tumors are necessarily heterogeneous, so it is nigh impossible that the entire tumor would carry this peculiar Achilles heel.

        1. WilliamLawrenceUtridge says:

          That’s a small oversight on my part, “an ultra-low glucose diet might work, assuming it’s not so low you don’t die while on it”. Plus, the liver can create glucose, and cancer can evolve, and as you say – what is the net advantage compared to being able to maintain a healthy weight while cancerous? One of the hallmark horrors of cancer is a skeletal patient unable to gain weight, will a 600 calorie diet help when one of the problems of cancer in general is already being dangerously underweight?

          1. Andrey Pavlov says:

            Plus, the liver can create glucose

            Yes it can and it will. At the expense of protein. Interestingly the heart and brain can survive on a shockingly high percentage of calories from ketone bodies – upwards of 80% and even more. But only if it is induced and ramped up over time. From my recollection in reading on the topic it would take between 4-8 weeks of increase for the brain to adjust to those high levels of ketone metabolism. Of course, you can get into trouble along the way because that also changes the osmolality of the blood, which the brain will adjust to, but then if you can’t maintain the diet or have water/electrolyte disturbances for other reasons it can cause big issues. Not that this would be a huge factor in any but the most extreme cases of ketogenic dieting, but then again neither would I expect much effect in the more moderate cases.

            But, no matter what, you still need some glucose for your heart and brain to function. And it doesn’t seem all that plausible to me that the levels necessary for brain function would be lower than the levels needed for a cancer to survive.

            One of the hallmark horrors of cancer is a skeletal patient unable to gain weight, will a 600 calorie diet help when one of the problems of cancer in general is already being dangerously underweight?

            It was MadisonMD who set me straight on this one, but it seems that these days the cachexia of cancer patients is much less to do with appetite and nausea than it is to do with the various molecular properties of cancer. TNF-alpha, for example, is also known as “cachectin” because it induces wasting regardless of caloric intake (no, this is not a miracle diet pill to promote on Dr. Oz’s show).

            That said, being undernourished most certainly will not help the situation. And even if you are not wasted away, there are many insults to the body that a cancer patient must face and that takes metabolic energy. The problem is that those demands vary greatly. I think people often underestimate just how much energy it takes your body to ramp up and sustain an immune response. In septic patients as much as a 20% increase in caloric need can occur while you are completely immobile, just from the ramped up white cell production. So when you are on an active round of chemo and your immune system is essentially non-functional, your caloric needs will be much lower. Then you are in between rounds and we give you some colony stimulating factors and your caloric needs shoot up. Then, unexpectedly of course, you develop a line infection from your PICC or port and next thing you know you are in the ICU with sepsis. In the meantime you are trying to manage a calorically restricted ketogenic diet without being able to predict or accurately compensate for these drastic swings in caloric demand. And if it happens when you get septic you can easily end up with no reserves and we just can’t feed you enough and the sepsis becomes overwhelming.

            Obviously I’m focusing in on just one aspect of the whole thing, and the vast majority of cancer patients do not get septic, but some do. And it is impossible to predict who will over the course of months of treatment.

            1. Ash Simmonds says:

              Plus, the liver can create glucose

              Yes it can and it will. At the expense of protein.

              *sigh*, it’d be nice if misinformation like this could just stop being circulated.

              The body won’t use structural mass unless it’s devoid of both glucose AND fat – ie, literally starving in an absolute last resort scenario to keep the brain and CNS functional.

              It’s simply too metabolically expensive to rip apart the amino acids for the glucose spine, when just by virtue of fatty acid oxidation there are glycerols available not to mention pyruvate recycling – both of which are far better precursors to gluconeogenesis than tearing the body apart.

              Also – dietary protein is available too, unless, again, you’re starving.

              Please let this “muscle wasting” myth of GNG die.

              1. Albie says:

                I was hoping others more qualified in this field than me would have quickly corrected you on this earlier, but with respect, I don’t hink you, as a LC’er, know what you are talking about. Glucose production from fat is very minimal, and most glucose from gluconeogenesis comes from protein breakdown. The body also tends to break down tissues like the thymus and other organs first. Under a LC ketogenic diet you also tend to lose calcium and other minerals from your bones. So you lose weight, not just fat, but water, muscle and tissue/organ proteins too, as well as bone loss, mineral loss, blood volume loss, etc, etc. Basically you feed on yourself. Accelerated ageing is very prominent in pictures of people taken before and after a very strict ketogenic diet in just a few months some times. If you think a Low calorie diet of 600 kCal/day is healthy long term, then good luck to you.

              2. Andrey Pavlov says:

                I’m happy to have Angora Rabbit correct me on this, but it is indeed true that the body will break down protein to create glucose. Obviously, it will not do so from just a moderate ketogenic diet. And in re-reading I see it wasn’t perfectly clear that I was referring to both gluconeogenesis and osmolality effects but I did say:

                Not that this would be a huge factor in any but the most extreme cases of ketogenic dieting, but then again neither would I expect much effect in the more moderate cases.

                In the context of the conversation, it seemed fairly reasonable for me to say that. I don’t expect much effect on cancer unless it is a truly extreme diet. In cases of truly extreme diet, your body will break down your own proteins for glucose. I also did not specify it would be only muscle protein vs dietary protein. You are reading into it a bit much, though obviously the point was that indeed body protein will get utilized.

                I also made the point somewhere else that ketogenic does not equal non-glucose. Meaning that people can certainly take in carbs and still be in ketosis. Just not that many.

                And actually, you can barely get glucose from fat (only the glycerol can be converted). The issue with pyruvate is that you cannot get it from fatty acid metabolism, period. So lacking fat intake is not going to be the issue – it would be protein intake.

                The metabolic expense doesn’t matter at all. Your body needs a certain amount of blood glucose. And it will use whatever energy it needs to maintain that.

                So I am sorry, but you’ve sort of missed the point of the conversation and while mostly correct in your own, still have some important errors.

  7. steney01 says:

    I came across another perversion of occam’s razor recently when I got to talking to a physician who told me all cancer is due to mitochondrial dysfunction and that the cure is always ozone therapy. Actually I wonder if seyfried has considered ozone as a means to force an increase in oxidative phosphorylation. That sounds right up his alley.

  8. nahthatsbs says:

    It seems that low carb diets just won’t die. In one form or another, they regain popularity every 15 years or so: Scarsdale, the original Atkins diet, Atkins New Diet Revolution, South Beach, Sugar Busters, Protein Power, reddit’s “keto.” Every time its adherents think it’s some kind of new, well-kept secret that only a few people know about.

    The Atkins diet was extremely popular during a time when the use of the internet was becoming more and more popular (late 90s, early 2000s) and, since then, it pops up in every forum, every post anywhere diet or nutrition are mentioned. Few people follow a very low-carbohydrate diet today, but you wouldn’t know that by reading forum posts.

    It’s compounded by the popularity of the “keto” community on reddit, an extremely large community already self-admittedly obsessed with bacon. Posts here that report the side effects people experience from the diet – gout, kidney stones, constipation, and the like – are met with a “you’re not doing it right” kind of attitude (drink more water and/or bouillon), or are ignored altogether. Of course, the most common complaint in long-term adherents seems to be that their LDL numbers rise significantly, but this is ‘explained away.’ Their LDL has changed to a “large, fluffy” pattern, which is clearly healthy (despite all the evidence to the contrary).

    A few of the modern claims: saturated fat isn’t just harmless – it’s healthful, grains cause almost every disease, carbohydrates cause diabetes, fiber is unhealthy, high fat diets prevent aging, and, of course, diets that induce ketosis prevent and treat cancer.

    Little of this is backed by any high-quality science. The same few people are always cited – Taubes, Volek, Phinney, Feinman, Attia. Blog posts and info-graphics, circlejerks about USDA conspiracies and big, evil government abound.

    The thing is, these diets have been studied rather well in their use as treatment for epilepsy, and the side effects are well known. The most common include constipation, elevated blood lipids, stunted growth in children, bone fractures, and menstrual irregularities.

    1. WilliamLawrenceUtridge says:

      fiber is unhealthy

      ???

      What could their argument possibly be? And given that a satisfying daily defecation is vital to mental health, I’m not surprised these people appear to be insane.

      1. KayMarie says:

        WLU – You mean you haven’t run into the fiber menace guy yet?

        http://www.gutsense.org/fibermenace/about_fm.html

        Conspiracy creation 101. If mainstream someone says anything, you must immediately believe the opposite.

        But hey at least he is spreading the word about the dangers of DHMO.

        1. WilliamLawrenceUtridge says:

          I have not run into said crazed lunatic, but he and Steve Rodrigues should get together. Steve-O also seems to believe that the correctness of a statement is based on who says it (i.e. anything mainstream is inherently wrong).

          Also, that guy is crazy, wow. The Japanese diet is practically fiber-free? Really? So…all those vegetables and rice found in traditional Japanese cuisine apparently don’t exist? And drinking water just makes you pee more…so if you never drink any water, you’ll never pee and live forever?

        2. David Gorski says:

          Whoa. That’s some weapons-grade crazy there.

  9. Lytrigian says:

    “The reason why the ketogenic diet is not being prescribed to treat cancer is purely economical,” said Dr. Seyfried, author of Cancer as a Metabolic Disease. “Cancer is big business. There are more people making a living off cancer than there are dying of it.”

    Obviously, Dr. Seyfried has never had to pay for Ketocal. That is big business.

  10. Ed Whitney says:

    A number of web sites are linking to this video. I have observed that they tend to be politically liberal sites for the most part, including even the Huffington Post, which often has stories promoting medicine of very uncertain scientific merit. As far as I can see, conservative sites like Newsmax are avoiding it. I do not know how to do a systematic search of links to ascertain the political leanings of the sites which provide a link to this video; perhaps someone with the necessary know-how can make a meaningful statement on this question.

  11. Dale Frakes says:

    I think the idea is that the cancer cells are derranged to the point that they can only process glucose as a fuel source (and not ketones, like many other cells in the body). So by going on a ketogenic diet*, there just isn’t much excess glucose available to feed the cancer cells, so they starve and fail to reproduce.

    This raises two questions in my mind. Is it actually true that many cancer cell types lose the ability to metabolize anything other than glucose? And does someone eating a ketogenic diet actually lower available glucose in the body enough to starve these afflicted cancer cells?

    * What’s not clear in the discussion is the definition of “ketogenic diet”. Are they talking about any low-carb diet that induces a state of ketosis (commonly used for weight-loss and diabetes control) or do they mean the very strict regimine that’s prescribed to control epilepsy.

    1. Andrey Pavlov says:

      @Dale:

      Yes, it is called the Warburg Effect. It is a loss of the oxidative phosphorylation pathway. Not all cancers exhibit this effect, however. Also, while most cells in the body can metabolize ketone bodies, most can only use them for about 20% of their caloric needs. The heart and brain are exceptions, going up to 80%.

      As I commented here I don’t think so.

      And yes, you are correct that “ketogenic” diet is a bit broad, but it seems that Seyfried is referring to the more strict regimen.

  12. Jason Bosch says:

    It was interesting to see this on my Facebook feed because I’d also seen links to an interview with Prof. Tim Noakes who mentioned ketogenic diets being good against cancer.
    http://www.biznews.com/health-biznews-com/2014/06/tim-noakes-makes-real-meal-critics-say-diet-dangerous/
    Noakes recently released a new diet book “The Real Meal Revolution” which is promoting a high fat diet. I hear a lot about it; mostly criticism that the science is poor from the medical side, but also a lot of ordinary people talking about how great it is. I searched on this site for his name to see what you guys thought but it didn’t come up.

    1. David Gorski says:

      I hadn’t heard of this guy before you mentioned him.

    2. Bob Johnston says:

      Tim Noakes is a South African researcher who literally wrote the book on distance running. He’s highly respected as a both a performance athlete and coach. In his book, “The Lore of Running”, he promoted a high carbohydrate diet, at least until he gained a lot of weight, developed Type II diabetes and his performance trailed off. His own personal experience led him to take another look at his dietary recommendations and that’s how he became a low carb convert. Since switching he’s lost weight and no longer has issues with his diabetes. He’s rewritten his chapter on nutrition and issued an apology for the bad advice in the earlier version.

      Doctors and researchers who can admit they are wrong are very unusual, I tend to listen to guys who have that quality.

      1. WilliamLawrenceUtridge says:

        Admitting you are wrong, much like claiming you are persecuted like Galileo or your ideas are laughed at, doesn’t mean you are right. In particular, it doesn’t mean you are right about everyone. The diet recommendations for a long-distance runner don’t and shouldn’t match the recommendations for a sedentary individual or a regularly-exercising cancer patient. And if Noakes were responsible, he would acknowledge that merely because it worked for him doesn’t mean it will work for everybody. Humans are genetically diverse in their ability to control glucose and weight, their potential for different types of exercise and in their daily activity levels, and ultimately can thrive on a very diverse set of potential diets from raw-meat carnivores to veganism. Noakes has merely switched from one fad to another, he hasn’t found the One True Path for All Humanity.

        1. Bob Johnston says:

          William – it’s okay to have an unexpressed thought. It won’t kill you.

          1. Windriven says:

            But his thoughts are generally well-expressed. Better still, they’re usually right.

            Besides, I’m not at all sure that an unexpressed thought wouldn’t kill him.

          2. WilliamLawrenceUtridge says:

            William – it’s okay to have an unexpressed thought. It won’t kill you.

            Shows what you know, I’ve got a couple thoughts I’m not expressing right now. One of them is that borderline tone-trolling in reaction to being unable to refute my points is a way of distracting from the fact that you are losing the argument.

          3. simba says:

            Nice way of pointing out you have no way of refuting his points, Bob Johnston.

            It’s totally original as a method of futile distraction, no-one has ever thought of that before, ever.

  13. Flower says:

    Pretty much anything beats chemo, given that the contribution of chemotherapy to the survival of cancer patients is less than 3%.

    Morgan G, Ward R, Barton M. The contribution of cytotoxic chemotherapy to 5-year survival in adult malignancies. Clin Oncol 2004;16:549-60

    Abstract: http://www.ncbi.nlm.nih.gov/pubmed/15630849

    It’s long since been known that the degree of efficacy of most conventional treatments have been misrepresented (and side effects downplayed).

    “…only 15% of medical interventions are supported by solid scientific evidence…(and)…only 1% of the articles in medical journals are scientifically sound…many treatments have never been assessed at all…”

    (Smith R. Where is the wisdom…? The poverty of medical evidence. Editorial. British Medical J 1991;303(Oct 5):798-799
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1671173/pdf/bmj00147-0006.pdf )

    This suggests that 99% of published trials, or at least the reporting of them – cannot be relied on.

    1. Windriven says:

      “Pretty much anything beats chemo, given that the contribution of chemotherapy to the survival of cancer patients is less than 3%.”

      You know Flower, the first time you tried this we wrote it off to naivete. But we’ve been through this with you. Chemotherapy has different values for different types of cancers. For some it is of little value. That was clearly shown in the paper you cited last time. Many lymphomas, leukemia, breast cancer, some anal cancers, and multiple myeloma to name a few. In some other cancers it isn’t very effective at all.

      Compare and contrast the way modern medicine has reshaped the human experience with any fricking thing you’d like from the world of altie nonsense. You’ve got squat. So like a petulant child you smear your fetid feces on that which you cannot create yourself, that which shows you to be small and impotent and inconsequential.

      You disgust me.

    2. David Gorski says:

      Flower, you’re spewing nonsense. That study shows nothing of the sort, as I’ve explained time and time and time again, for example, here:

      http://www.sciencebasedmedicine.org/chemotherapy-doesnt-work/

    3. Harriet Hall says:

      All cancers are not the same; chemo is CURATIVE for some cancers.
      Chemo is not just used to prolong life. It is often used to palliate symptoms.
      The myth that only 15% of medical interventions are evidence-based is demonstrably false. It is based on a misinterpretation of an old study. More recent studies gives estimates more like 78%. Dr. Novella estimates that nearly 100% of what he does is based on the best evidence combined with plausible and rational extension of what is known, as well as adequate evidence for lack of harm.
      According to Ioannidis, 50% of clinical studies (not 99%) are wrong; one of the things we do on this blog is to try to identify factors that make it more likely for them to be wrong. And we never rely on one study; we depend on the weight of evidence from several studies.
      If we couldn’t rely on scientific studies, what could we rely on?

      1. WilliamLawrenceUtridge says:

        If we couldn’t rely on scientific studies, what could we rely on?

        The doctrine of signatures?

    4. Dave says:

      Flower, have you not read any of the responses to your past posts, or done any research on what you’re talking about? It’s been pointed out to you numerous times that cancers are different diseases. Chemo works very well for some, such as testicular cancer or Hodgkin’s disease, It works poorly for others. You also don’t seem to know the difference between curative, adjuvant, and palliative chemo, despite this being pointed out to you numerous times. Additionally, the old study you continually bring up about evidence has been rehashed numerous times. I would suggest you go to a medical library, pick ANY condition, and ask them to access the discussion of that condition on UpToDate, which generally lists all the pertinent studies concerning the condition, followed by suggested treatment based on those studies.

      Your statement would be like me saying that antibiotics are generally worthless because there are none for ebola or west nile virus. It would make me look ignorant if not stupid.

  14. James Peters says:

    I’ve been to the examiner.com (a pro KD/Paleo diet site) were its claimed he said all these things (he ‘might’ have on the video but i can’t play it). But copying & pasting what he is claimed to have said is a little more than misleading, don’t you think?. Also if he had then shouldn’t you have emailed him and asked him for some comments on why he might have said ‘x’, ‘y’ and/or ‘z’?. Also asking him for more info on his hypothesis would have been nice too (i’m sure he says the main cause of cancer is damaged mitochondria which leads to damaged DNA)

    1. David Gorski says:

      But copying & pasting what he is claimed to have said is a little more than misleading, don’t you think?.

      No, because he’s written similar things, albeit a bit toned down (which is to be expected), in some of his scientific review articles. In one, he explicitly said that he thought that ketogenic diets should be used before chemotherapy because he thinks they’re bad and don’t work. Did you not see the paragraph I quoted near the end of the article, in which he wanted to try a clinical trial of a ketogenic diet without chemotherapy or radiation versus historical controls?

      1. James Peters says:

        Again, if he is writing this then it would be nice if you could put up links to it. Also thinking ‘x’ (the R-KD in certain cancers should be used before chemo, because they are bad and don’t work) is his view (link/s please?). A number of things with that statement need to be asked. 1. Why does he recommend it before chemo?. 2. Which chemo drug/s are bad?. 3. Why don’t they work?. A lot of his work is in a certain area (the brain) and in the case of GBM Median survival with standard of care which is radiation and chemotherapy with temozolomide is 15 month, which is hardly great and not much progress has been made for many decades (some say 40 years). So if he said it then maybe he is referring to this type of cancer (??). I didn’t see your paragraph at the end on him wanting a trial like this, but its not up to him and i doubt any ethics committee will allow it. I personally would say its up to the people who have cancer. If after being told of all the risks you still want to go ahead then its up to you at the end of the day. Also if it did work better than SOC in certain types of cancer then certain people couldn’t claim it was chemo and/or radio, unless they cancer was slow growing of course.

        1. WilliamLawrenceUtridge says:

          I think it’s pretty safe to say that Seyfried is a committed believer who doesn’t necessarily look for adequate evidence before he makes comments and recommendations. If he was serious about science-based recommendations, he’d be doing animal trials, not giving powerpoint presentations about human trials.

          But like so many CAM ideologues, he’s more interested in jumping right to humans.

          1. James Peters says:

            I’m sure he’s done some animal trials, even so they are no substitute for human ones

        2. David Gorski says:

          I didn’t see your paragraph at the end on him wanting a trial like this, but its not up to him and i doubt any ethics committee will allow it.

          Point one: You should be careful about complaining about a post if you haven’t actually read the whole thing.

          Point two: I did include links. Here’s one more:

          http://www.ncbi.nlm.nih.gov/pubmed/21885251

          And here’s one where he argues that Lamarckian evolution better describes cancer progression than standard selection, which, quite frankly, he does not argue well.

          http://www.ncbi.nlm.nih.gov/pubmed/24343361

          Quote:

          As each person is a unique metabolic entity, personalization of metabolic therapy as a broad-based cancer treatment strategy will require fine-tuning based on an understanding of individual human physiology. Also, personalized molecular therapies developed through the genome projects could be useful in targeting and killing those tumor cells that might survive the non-toxic whole body metabolic therapy. The number of molecular targets should be less in a few survivor cells of a small tumor than in a heterogeneous cell population of a large tumor. We would therefore consider personalized molecular therapy as a final strategy rather than as an initial strategy for cancer management. Non-toxic metabolic therapy should become the future of cancer treatment if the goal is to manage the disease without harming the patient. Although it will be important for researchers to elucidate the mechanistic minutia responsible for the therapeutic benefits, this should not impede an immediate application of this therapeutic strategy for cancer management or prevention.

          In other words, he is arguing for using “metabolically targeted” dietary therapy before using molecularly targeted (i.e., currently standard therapy, namely drugs aimed at a specific molecular defect, at least when available)

          1. James Peters says:

            I think you should email him some of your points and see what he has to say, unless you have?

  15. Elaine says:

    The author of this article is probably not aware of the latest scientific study on baking soda by the Moffitt cancer research center in Tampa, FL.

    Here is a quote from the study:
    “Tumor invasion did not occur in regions with normal or near normal pH levels. Furthermore, when we neutralized the acidity with oral sodium bicarbonate, the invasion was halted.”

    1. Scottynuke says:

      Oh Elaine, please do consider your audience before posting. A simple application of this site’s search function for “baking soda” yields, among other things, another blog item from Dr. Gorski.

      http://www.sciencebasedmedicine.org/another-cancer-tragedy-in-the-making/

      Or you could check with Dr. Gorski’s very very close friend, Orac, who regularly debunks “alkaline” cancer quackery:

      http://scienceblogs.com/insolence/

      1. Sawyer says:

        To Elaine’s credit, I’m now also curious if Dr. Gorski is familiar with this work, considering the collaborators are from Wayne State University. That could make for some awkward watercooler talk…

    2. WilliamLawrenceUtridge says:

      Found it. It’s a mouse study using mice with sever combined immunodeficiency. Suggesting at best it’s only useful for treating Kaposi’s sarcoma?

      Also, I just skimmed it – but there appear to be only 12 mice involved.

      Yep, that’s how you do good science.

    3. David Gorski says:

      One notes that Elaine didn’t supply a link. However, I am quite familiar with that particular study, partially because I personally know one of the investigators, who happens to be at my University, and have been on several grant applications and one paper with her.

      Let’s just say that the study does not support “alkaline” diets.

      1. Frederick says:

        lol, I like the irony : “The author of this article is probably not aware of the latest scientific study” and not only you know the person and had work with her lol.
        Brice De nice will Say “Cassé”.

  16. Markus says:

    @William, you can look the following website for animal cancer trials with ketogenic diet. They have pictures under cancer stories.

      1. WilliamLawrenceUtridge says:

        Cancer is a metabolic disease caused by injuries to the mitochondria of a normal cell.” At that point, I stop reading and call bullshit.

        Actually, I skim a bit longer to “Cancer cells lack the ability to die like normal cells – they instead continue to proliferate and make thousands of clones exactly like the generation before them.” and call Holy Mother of Bullshit. The genomes of tumors are really messed up, part of which is disruption of the duplication of genes during mitosis. Cancer cells are not “clones”. Quite the opposite.

        These animals aren’t being cured, they’re being abused. But who cares, right? They’re just dogs. Who needs research, anecdotes are just fine.

  17. dr mch says:

    ketogenic diet alone is not effective …..
    could be effective Budwig-diet ?!?!

    http://www.asbestos.com/blog/2013/01/23/budwig-protocol-led-to-dramatic-comeback-for-mesothelioma-survivor/

    1. WilliamLawrenceUtridge says:

      How many people tried the Budwig protocol and died of their cancer?

        1. Chris says:

          Stop spamming that nonsense.

          1. dr mch says:

            of course, I make money with cheese and oil …..

            1. Chris says:

              Who cares? You are spamming with idiotic websites that have no real science.

            2. WilliamLawrenceUtridge says:

              Financial conflict of interest is not the only type of conflict of interest that exists. Some people can’t be trusted to provide honest information because they have an ideological conflict of interest, or have a tremendous amount of ego invested in something, or because they’ve started down a road and because of cognitive dissonance they can’t bring themselves to ever admit they were wrong or deceptive. Others may simply not understand the scientific method and the importance of well-controlled trials. Other may not understand the topic at hand – for instance, lumping all cancers together as “cancer” rather than recognizing that there are tremendous differences in types and stagings of cancer. One can’t compare prostate cancer, for instance, to stage-IV lung cancer. Or one might pretend all skin cancers the same, ignoring the fact that there’s a huge difference between melanoma and squamous cell skin cancer. One might even be a pious fraud, convinced that their magical cottage cheese cure for cancer is too important to research or bother recording and reporting those whom died despite their magic diet. One could even be convinced that chemotherapy interferes with the magic cottage cheese cure, rather than, say, noting that people with more serious cancers are more likely to be receiving chemotherapy – in which case, the people who aren’t receiving chemotherapy aren’t getting better because of cottage cheese, they appear to be doing better because they have a less serious or more early staging of cancer.

              1. Chris says:

                Or this “dr” does not understand what the first word in the blog’s name means. Obviously this person has no clue that anecdotes and ads are not actual science.

                He is spamming that he is just very stupid.

        2. WilliamLawrenceUtridge says:

          Jesus Fuck, they’re bragging about curing prostate cancer, the world’s most indolent cancer, and at the bottom is a giant advertisement for magical prostate-cancer-curing-pills. If it’s that great, why aren’t they publishing even an observational trial in the scientific press? Because they’re assholes?

          1. dr mch says:

            medical science is also very effective
            Congratulations to these ” gentlemen ”

            http://www.ncbi.nlm.nih.gov/pubmed/23440794

            …. and leave in peace Jesus

            1. WilliamLawrenceUtridge says:

              So what you’re saying is, when new information comes to light, science changes its recommendations? Rather than, say, deciding something is the best thing ever, and never, ever changing no matter what evidence is presented that something is worthless? Or are you saying that because it changes its mind in the face of new evidence, scientific medicine is worse than having no evidence beyond anecdote?

              Your invocation of Jesus seems to indicate a generally credulous and authoritarian attitude towards evidence and certainty. It’s no wonder you think cottage cheese and oil can cure cancer, you appear to be stupid.

              Look – you want to be taken seriously here? Show us some peer-reviewed evidence that cottage cheese and oil are effective treatments for cancer (and what kind of cancer, because if you say “all cancer” you demonstrate you’re an even bigger idiot) and I’ll stop mocking you. Post another link to some credulous nutbag’s list of anecdotes and I’ll start insulting more than your intelligence.

              1. dr mch says:

                I have no illusions
                no one will ever do a study on cottage cheese
                … it’s interesting, however, that the majority of patients of Dr. Budwig were doctors

                Ps …. vai affanculo (google translate)

              2. Windriven says:

                “the majority of patients of Dr. Budwig were doctors”

                An easy claim. Do you have a citation? Not that it matters. Steve Rodrigues is a doctor and he believes in everything short of unicorn farts as the one true cure for all disease. Being a doctor does not obviate holding nonsensical ideas.

                “vai affanculo”

                Succhiare te, stronzo.

              3. Chris says:

                “no one will ever do a study on cottage cheese”

                Why? Though research on cancer diets has been done, including Budwig’s. From Counseling patients on cancer diets: a review of the literature and recommendations for clinical practice:

                Conclusion: Considering the lack of evidence of benefits from cancer diets and potential harm by malnutrition, oncologists should engage more in counseling cancer patients on such diets. Our recommendations could be helpful in this process.

                “… it’s interesting, however, that the majority of patients of Dr. Budwig were doctors ”

                I am sure that revelation came from the same place as the rest of your declarations: out of thin air. Perhaps you should try something different before making silly statements and linking to stupid websites: actually read the above article and the others articles on this site about cancer.

              4. WilliamLawrenceUtridge says:

                Yeah, they managed to fund studies of the eminently-unpatentable vitamin C, St. John’s Wort and tylenol, I think they can manage cottage cheese.

                Yogurt companies fund studies on the effectiveness of their particular bacterial brew on gut motility, irritable bowel and related digestive disorders.

                Somehow they managed to find out that olive oil is good for heart health. Imagine what Big Olive and Big Cheese would do if they knew they could cure cancer? Hell, there might even be a single company, some entity with the united control over the leverage of mixture of foods. Maybe they could also try mixing Parmesan cheese and malt powder to see if that cures cancer. Perhaps there’s another food combination that puts some pep, something significant, to co-opt the healing process. Maybe they could just generally mill some stuff together and try that too.

                My point being – companies will fund research. Curing cancer? That’s big news for cottage cheese manufacturers! The reason why nobody’s funding that? The cottage cheese manufacturers know it’s bullshit, because they understand the physiology of cheese production and digestion, and they know it just become amino acids. Olive oil (I realize it’s probably not olive oil, don’t care, the point stands) manufacturers would love to add “cancer” to the list of conditions that olive oil can cure, ameliorate or even merely stall.

                So shut up, you ignorant pork chop, you know nothing and you lie.

  18. Patrick McDonald says:

    It is true that chemo doesn’t always work, and that what the patient experiences can be worse than the disease. However, it is a logical fallacy to presume that only 2 options are available, ie, “conventional” versus “natural”(whatever “natural” is supposed to mean) so that if conventional has ever failed, natural must be the correct route. I’m sure there is a name for this logical fallacy, but it eludes me.

    1. Windriven says:

      False dichotomy. Or the brainless douche gambit. One of those two.

  19. Patrick McDonald says:

    Acutally, in some types of blood cancers, they are: http://www.ncbi.nlm.nih.gov/pubmed/20482911

  20. j123 says:

    This seems like a site for macho scientism, so please know I write this as an honest question (i.e., not looking for a fight): if we know from decades of use and study as a treatment for epilepsy that the diet is safe and feasible, even for children (i.e. it is not 3 tbs of lard and some tune fish and does not cause muscle wasting and the side effects are easily manageable under the care of an experienced practitioner) then why wouldn’t a brain cancer patient try this alongside standard of care? Eggs, bacon, and butter coffee aren’t that onerous.

    1. Harriet Hall says:

      “why wouldn’t a brain cancer patient try this alongside standard of care?”

      There is good evidence for its use in epilepsy but not for its use in brain cancer. There are all kinds of other claims for treatments in brain cancer that are not supported by evidence, so we have no rational way to choose which of those treatments to try. And while the ketogenic diet might be safe and manageable, it is an onerous burden that would likely decrease the quality of life for a cancer patient, and there would be questions about whether the diet would provide all the nutrients needed to support the patient during standard treatments. I wouldn’t want to make that kind of drastic change to my lifestyle without a pretty good reason.

    2. David Gorski says:

      Actually, it’s not clear that the ketogenic diet isn’t that onerous for cancer patients. For instance, the German study I cited in my post found that patients with advanced cancer had a hard time sticking to the diet more than a month. Only five out of sixteen could stick to it for the full three months of the study. Even the woman in the case study cited by Dr. Seyfried gave up on the diet after a few months. It wasn’t explicitly stated why, but my impression was that she couldn’t follow it anymore. Of course, in her case it was a very low calorie diet in addition to being ketogenic; so there is that.

      In any case, it’s not a trivial matter to change one’s diet so radically, particularly when seriously ill with a life-threatening disease. Moreover, it’s hard enough to keep cancer patients’ nutrition up as it is. I’m not saying that there might not be benefit to a ketogenic diet in patients with advanced cancer, but as of right now the evidence in humans is at best shaky and preliminary.

      1. Bob Johnston says:

        I’ve been on a ketogenic diet for three years now, the only onerous aspect of it is having to prepare my food (meaning I actually cook) as opposed to pour cereal out of a box or throw something in the microwave.

        A ketogenic diet done right is quite delicious – I eat a lot of vegetables and I love meats, cheeses, berries and fish. A ketogenic diet for most people is simply one that’s under 50 grams of carbs per day; it doesn’t need to be calorie restricted or even taste restricted.

        In any case, it’s not a trivial matter to change one’s diet so radically, particularly when seriously ill with a life-threatening disease.

        Frankly I think it would be trivially easy to radically change one’s diet if there was a chance it might be helping in your cancer treatment. Heck, just knowing a ketogenic diet would help combat metabolic syndrome (the precursor to many types of chronic disease) was enough to get me to change my diet, I can’t imagine how much more motivated I would be if I had cancer and a poor prognosis even with surgery, chemo and radiation.

        1. WilliamLawrenceUtridge says:

          I’ve been on a ketogenic diet for three years now, the only onerous aspect of it is having to prepare my food (meaning I actually cook) as opposed to pour cereal out of a box or throw something in the microwave.

          Straw man, I prepare food also but don’t follow a ketogenic diet. Not following a ketogenic diet doesn’t automatically mean your dinner is always cereal and microwave pizza.

          A ketogenic diet done right is quite delicious – I eat a lot of vegetables and I love meats, cheeses, berries and fish. A ketogenic diet for most people is simply one that’s under 50 grams of carbs per day; it doesn’t need to be calorie restricted or even taste restricted.

          You’re on a low-carbohydrate diet, not a ketogenic diet. A ketogenic diet is much more restrictive. Used to control epilepsy, it means eating virtually no carbohydrates, to the point of needing to avoid toothpaste. Further, the diet promoted by Seyfried is ketogenic-restricted, meaning not only do you have virtually no carbohydrates, your overall calories are extremely low as well.

          What you are doing is in no way comparable to what Seyfried recommends. Seyfried’s research on mice used a diet that was 80% fat, 16.7% protein and 3.3% carbohydrates by weight. Using your 50 gram max, that means you would be taking in about 12,000 calories per day, proportionately, because you would be consuming 250 grams protein and 1,200 grams fat.

          Frankly I think it would be trivially easy to radically change one’s diet if there was a chance it might be helping in your cancer treatment. Heck, just knowing a ketogenic diet would help combat metabolic syndrome (the precursor to many types of chronic disease) was enough to get me to change my diet, I can’t imagine how much more motivated I would be if I had cancer and a poor prognosis even with surgery, chemo and radiation.

          That might be because you think what you are doing is remotely comparable to what Seyfried is recommending. It is not. Seyfried recommends a radically restricted diet in terms of what you can eat and how much you can eat. Again, what you eat is not comparable at all. In fact, this is shown by Seyfried’s own work, where people simply couldn’t stick to the diet, despite having cancer and thinking this was a treatment.

          Would you care to rethink your position based on these facts?

          1. Bob Johnston says:

            Billy – you seem to be stuck on the idea there’s only one “ketogenic” diet. Ketogenic simply means you’re producing elevated ketones, it doesn’t necessarily mean the calorie-restricted version Seyfried is designing or the diet used on epileptics. Elevated ketones = ketogenic. Got it?

            Not following a ketogenic diet doesn’t automatically mean your dinner is always cereal and microwave pizza.

            No shit, Sherlock. Since I was comparing how I personally prepared food before I switched to a ketogenic diet how other people prepare food is immaterial. I wasn’t talking about other people, just myself. You’re too busy formulating your response to what you think I’m saying without actually understanding what I am really saying. You should stop that, it makes people want to skip over your replies or speak condescendingly to you as they would to a child. Personally I’d rather have an actual discussion but you make that nearly impossible.

            1. WilliamLawrenceUtridge says:

              My name’s not Billy, douchenozzle.

              I wasn’t talking about other people, just myself.

              Are you narcissistic enough to think that your personal experience is relevant to anyone else?

              You’re too busy formulating your response to what you think I’m saying without actually understanding what I am really saying.

              Well that’s true.

              You should stop that, it makes people want to skip over your replies or speak condescendingly to you as they would to a child.

              Feel free to skip over my replies. The condescension I’m pretty indifferent to, but I’ll try to eat my delicious pizza I’m having for dinner tonight in a condescending way while thinking of you. Might have some ice cream too!

              Personally I’d rather have an actual discussion but you make that nearly impossible.

              I want you to know – I feel just awful about that.

        2. Nell on Wheels says:

          Hey, Bob, before you blithely blabber on about how easy it would be for cancer patients to adopt any specific diet, let alone something completely different from what they’re used to, I suggest you talk to a few people who’ve been there.

          As someone who has actually been through surgery, chemo, and radiation, I can tell you that finding food that I could actually tolerate was restrictive enough. Vegetables, meats, meats, cheeses, berries and fish weren’t among those things I could stomach.

          Now, every cancer patient is different, but the ongoing advice is “Eat whatever you want and can tolerate,” I’m told some people can eat fairly normally during treatment, but no one I’ve talked to before, during, or since has been among those lucky folk. Some people can handle protein shakes or milkshakes–the thought of those made me gag. A friend bought a “cancer” cookbook to be able to prepare special meals to accommodate my specific side effects–I was never able to gag down any of them. Needless to say, gagging is to be avoided when you’re being treated for cancer.

          Aside from the fact that eating most everything was like eating wet sand, severe esophagitis and being thisclose to mouth and esophageal ulcers left me able to get down room temperature scrambled eggs, broth, noodles, pudding, and pureed potato soup. That was it. I couldn’t really taste them, but at least they went down easy. The smell of lettuce nauseated me. Even drinking water was an effort because no matter how pure and filtered it was, it tasted like stagnant pond scum. I prefer not to think about the bout of thrush–and its attendant treatment–I went through.

          Oh! And then there are the issues (and their management) that chemo causes at the other end of the alimentary canal. Talk about never knowing what to expect! Chemo can cause diarrhea, pain meds cause constipation. How much of what do you take to balance it all out and avoid unpleasant surprises?

          I guess that what I’m trying to say is that you know squat about diet and nutrition during cancer treatment, so STFU.

          BTW, you’re advised to avoid your absolute favorite foods during chemo because you can develop an aversion to them through an association with the “unpleasant” side effects of treatment. Good thing for me that chocolate wasn’t at all appealing during chemo.

    3. WilliamLawrenceUtridge says:

      The diet is highly calorie restrictive as well (as Seyfried promotes it), which could be an issue for cancer patients. 600 calories per day when you’re fighting off a tumor and getting chemo is no picnic. It would significantly impair your quality of life. And mostly – there’s simply no good reason to think it would actually do anything for cancer.

      If you’re in possibly the last months of your life, wouldn’t you want more to eat every day than a single egg, three slices of bacon?

    4. Andrey Pavlov says:

      Also note that we are not saying people should be forbidden from doing so if they choose. We are saying that they should do so after being properly informed of the real state of evidence so that they can make a truly informed decision. Being brutally honest about what the science actually says is the only way to truly grant the patient maximal autonomy. If the patient listens to what we have to say and still wishes to pursue it, then that is indeed their decision.

  21. John says:

    I’m on a LCHF (low carb high fat) diet for wellness reasons (no cancer or any other health problems). I’m persuaded by my amateur understanding of the metabolic dynamics (carbs raise blood glucose, leading to insulin spikes, leading to body fat creation). Works for me, meals taste better, I have loads of energy, etc.

    Still, I applaud this discussion. LCHF advocates have got overexcited and should get a grip. Claims about cancer curing just bring LCHF into disrepute.

    Generally, there seems a lot of science behind LCHF, more than acknowledged here, and more than for other diets. It’s just that the LCHF science doesn’t encompass cancer. (eg see http://www.nature.com/ejcn/journal/v67/n8/full/ejcn2013116a.html, which seems quite balanced and tentative in its reference to cancer).

    Views?

    1. WilliamLawrenceUtridge says:

      I like cake and bread, and am quite happy to continue eating them in the absence of evidence that such a limited diet will let me live forever.

      1. Windriven says:

        Pork. Cake and bread are important. But the addition of pork puts it over the top.

        1. WilliamLawrenceUtridge says:

          Keto is fat and protein, isn’t it? You could eat pork, couldn’t you?

          1. Windriven says:

            I could never do the ketogenic diet thing. gotta have my bread. I’m here for a good time. A long time is optional.

            1. WilliamLawrenceUtridge says:

              Bread, chocolate, ice cream, icing, hell, even a spoonful of brown sugar. Mmmmmm….

              1. n brownlee says:

                You guys are loaded, aren’t you?

              2. Windriven says:

                High on life, Nancy.

              3. Windriven says:

                “even a spoonful of brown sugar.”

                Next time you bake a galette or a pie, wash the edge with beaten egg and sprinkle with turbinado sugar. It’s like turning the amp up to 11.

              4. WilliamLawrenceUtridge says:

                I’m not high or loaded, but given the option I could easily be a borderline diabetic.

  22. Heidi says:

    Dr. Gorski,

    Thank you for this article. I was considering suggesting a ketogenic diet for my mother-in-law, who has metastatic breast cancer. I was trying to avoid the “fringe” by including the search term NIH. I hope Ketogenic and other nutritional interventions for cancer treatment can continue to be studied, along with other treatments and drugs. But I don’t see any reason to disrupt her life even more by proceeding with a strict diet that is unproven and possibly harmful.

    I’m not a doctor. I’m a supply chain analyst with a degree in Spanish literature, trying to help my mother-in-law get the best care possible. I sympathize with non-experts that distrust the medical community. My mother-in-law’s oncologist refused to prescribe anti-nausea medication for months despite massive nausea and weight loss. It didn’t seem to me the most scientific approach! That said, to replace distrust with pseudo science is a false choice. People just get desperate for hope.

    1. WilliamLawrenceUtridge says:

      My mother-in-law’s oncologist refused to prescribe anti-nausea medication for months despite massive nausea and weight loss

      Why on earth not?

    2. Nell on Wheels says:

      Indeed! Why not? I was given anti-nausea meds the day of chemo and told to continue them for two days after, longer if necessary. I made the mistake once of thinking I didn’t need them the second day after. Never made that mistake again–you have to take them before the nausea hits, otherwise its very hard to stop it.

      Some chemotherapy agents are more likely to cause nausea than others, but there is absolutely no excuse for not prescribing anti-nausea meds when a patient is puking her guts out.

  23. John Wagner says:

    Seyfried never said this would cure all cancers. He never said to throw out all conventional therapies. You complain there is very little clinical data. And why do you think this is? Because there is BIG money in oncology. There is BIG money in bilking insurance companies for overpriced medicine that was cutting-edge in the 1970′s. I say give Seyfried a chance. Something good may come of it. Maybe then you can print an article which actually says something. All you have right now is a diatribe on nothing.

    1. David Gorski says:

      Seyfried never said this would cure all cancers.

      No, but he did strongly imply that it could treat all cancers.

      He never said to throw out all conventional therapies.

      Straw man. No one ever said that he did. Seyfried did, however, say that “the low-carb, high-fat ketogenic diet can replace chemotherapy and radiation for even the deadliest of cancers” and that “these studies are all in combination with either radiation or chemotherapy. My preference is to start metabolic therapy with GBM (glioblastoma multiforme).” That was very irresponsible of him, and his suggestion for trial design was not good.

      You complain there is very little clinical data. And why do you think this is? Because there is BIG money in oncology. There is BIG money in bilking insurance companies for overpriced medicine that was cutting-edge in the 1970′s.

      Been reading Whale.to or NaturalNew.com, have you?

      1. Bob Johnston says:

        So are you saying there isn’t big money in oncology?

        Upton Sinclair said “It is difficult to get a man to understand something, when his salary depends on his not understanding it.” He said this not to imply a conspiracies were responsible for confirmation bias but simply because if one earns a decent living from a thing being so, they’re not going to look very hard at evidence to the contrary. That’s human nature and something we always need to consider when looking at motives.

        1. weing says:

          “That’s human nature and something we always need to consider when looking at motives.”
          That’s why CAM practitioners don’t want efficacy studies done before pawning their snake oil on the unwary public. That’s why SBM demands them. Who knows? It may be found that ketogenic diets are helpful in some cancers, neutral in others, and harmful in still others. That’s why recommendations keep changing as newer studies are integrated into the knowledge base. What’s there to keep up with in blood-letting, acupuncture, homeopathy, chiropractic? Newer ways of selling the same old snake oil?

        2. Sawyer says:

          This would be a great point if it weren’t for people like Dr. Gorski coming out guns blazing about the topic of over-treatment and over-diagnosis of certain types of cancer. Look back through previous articles on this site. Though I suppose it’s the insurance companies that are pulling Dr. Gorski’s strings in those situations instead of the drug companies, right?

          The reality is that for every cookie-cutter Upton Sinclair character working in the world of medicine, there’s another doctor or scientist genuinely interested in understanding reality and saving lives, salary be damned. The promoters of ketogenic diets are not in the group you think they are in.

        3. WilliamLawrenceUtridge says:

          So are you saying there isn’t big money in oncology?

          Of course there is big money in cancer – a massive number of societal resources are being poured into ending or at least mitigating a terrible health scourge and horrible way to die. But pointing out “there is big money in oncology” is not an argument, it’s a smear, and an attempt to distract from the fact that quacks also make money through their “alternative” oncology – but without evidence that it works, saves lives or reduces suffering. It’s a hypocrisy, distraction, and a false dilemma (either oncology is expensive, or it is effective; alternatively, either cancer treatment is cheap, or alternative treatments work).

          Also, just because you lost weight on a ketogenic diet or whatever, doesn’t mean it cures cancer (nor is it a particularly good diet for most people).

          He said this not to imply a conspiracies were responsible for confirmation bias but simply because if one earns a decent living from a thing being so, they’re not going to look very hard at evidence to the contrary. That’s human nature and something we always need to consider when looking at motives.

          Two points:

          1) What does this say about the primary source of complaints about the “cancer industry” – quacks who sell expensive and unproven alternatives?

          2) Most cancer researchers are paid a salary at their research institution. They apply for grants that fund their actual research labs, not their individual salaries. Individual, personal greed is thus mitigated, and no other, superior means of conducting cancer research has been identified. One thing that could help improve the quality of all clinical trials, not just in oncology, is Big Pharma depositing the money to fund clinical trials with a third (government) party and the actual trial is conducted by a separate research institution. But so far nobody has taken me up on this idea.

          And anyway, just pointing out “durrr…someone makes money” isn’t a point, it’s a dodge.

  24. Bill says:

    Hi David,

    Thank you for this article. Because my sister has the unfortunate circumstance of stage IV Glioblastoma Multiforme, I have been trying to get to the reality of ketogenic diets as a potential treatment. Because there is so much information (most of which is garbage) about these diets and the “miracles” they perform, it is hard to find the truth.

    When I initially came upon information about the ketogenic diet, I was eager to encourage my sister to try it. Now I am not so eager. It is beginning to look like it would be a waste of the precious time my sister has left, reducing the quality of her life by having to suffer through such a diet while suffering from the ravages of brain cancer, chemotherapy, radiation, surgery and steroids (oh God, the steroids change a person’s attitude so much).

    My father was essentially cured of stage IV lung cancer through chemotherapy, radiation and surgery over 15 years ago (he is happy and generally healthy today), so I had hoped the same advances had been made in brain cancer like GBM. Sadly, this cancer is far more vicious.

    I am grateful that you illuminated many of the issues with this “miracle diet” in your article. Thank you.

  25. Adam says:

    Is anyone familiar with the research of Dominic D’Agostino?

    http://tedxtalks.ted.com/video/Starving-cancer-Dominic-DAgosti

    1. Windriven says:

      Is this not they same old snack in a shiny new box?

      1. Adam says:

        Try being positive and having some hope for the people who this could possibly help. These people are trying to help others and if no one supports them or listens how will they going to get their message out. I’m sure that the findings are not purely anecdotal and no one is claiming they have a miracle cure. Why is everyone so negative?

        1. Windriven says:

          “These people are trying to help others and if no one supports them or listens how will they going to get their message out.”

          If there proposed diet offers no advantage why should I support or listen to them. And why should I accept that their intentions are noble? With some good scientific evidence, I’d be happy to support them. Until then …

          How the hell can you say, “I’m sure that the findings aren’t purely anecdotal…”? The point of studying something scientifically is so that you really can be sure. All that you are really saying is that it sounds good to you. That and a five dollar bill will get you a cup of burnt coffee at Starbucks.

        2. KayMarie says:

          no one is claiming they have a miracle cure. Why is everyone so negative?

          Unfortunatly not only do a lot of them (as a generalization) claim they have the ONLY cure, and it is certainly a miracle, they often seek to prevent their clients from seeking proven treatments.

          And when they don’t tell their clients that if they take anything the doctor gives them they will be dropped from the miracle, they will take credit for any healing that comes about from the patient seeking standard of care while also doing other things.

          Saying that all 1000different good ideas are are equally valid and should all only ever get positive attention (and no one should look to see if they are even plausible or make sense, because that would be negative) because gosh darn it the 998 with no scientific evidence just feel good compared to the 2 scientific ones that we know what dose on what schedule with what supportive care results in measurably different survival rates.

          If you are completely committed to only being positive all the time you may miss the red warning flags indicating danger ahead but hey at least you were wishing for the best when you died.

          Now you show a scientist the hard data that shows it really works with enough replication we are positive as heck, for at least the one cancer the treatment worked for. If we have amazing results for a leukemia drug I’m not going to claim it cures all cancers and demand someone give it to me for glioma.

        3. WilliamLawrenceUtridge says:

          Try being positive and having some hope for the people who this could possibly help.

          What if that number is zero? What if’ it’s one, the doctor getting rich of of dying patients? What if it’s a million, the number that could be helped if D’Agnostino’s treatment works, but he never gets off his ass and actually tests it?

          Cancer shills are assholes, selfish assholes, no matter how you slice it. If their treatment doesn’t work, they are bilking the dying. If it does work, they are keeping it all to themselves – far worse and greedier than Big Pharma.

          These people are trying to help others and if no one supports them or listens how will they going to get their message out.

          The most effective way to get their word out would be the peer reviewed press. It’s read by millions, and effective treatments become part of the cancer treatment infrastructure incredibly quickly.

          If these quacks were serious about getting their message out, they would run a clinical trial, publish it, and then drug companies would beat a path to their door to produce this cure, and distribute it to millions of desperate patients.

          It’s a real fucking shame how assholes like D’Agnostino just sell to a couple hundred, isn’t it?

          I’m sure that the findings are not purely anecdotal and no one is claiming they have a miracle cure. Why is everyone so negative?

          Because assholes like D’Agnostino take the most vulnerable among us, patients afraid of an agonizing death, and scrape their bank accounts dry and waste the remaining days of their lives on useless, expensive nonsense that has no chance of working, for ego and financial gain. That’s why we’re so negative.

          Real cures don’t need special protective treatment and brave maverick doctors. Real cures need public research demonstrating effectiveness.

          D’Agnostino doesn’t care about patients, he cares about his bank account.

          1. Adam says:

            That is a terrible way to speak about someone you don’t know and with that attitude how will you ever have faith in anyone or anything. This appears to be a consistent attitude with a number of posters on this site. He isn’t claiming a cure you must be confused. You cant paint everyone with the same brush. There are multiple clinical trials underway.

            1. AdamG says:

              Classic tone trolling.

              There are multiple clinical trials underway.

              Great! Get back to us when the studies are completed and show positive results. Until then, Cannabis is not an effective treatment for anything whatsoever.

              1. AdamG says:

                LOL I mixed up my quackeries. Get back to us when the studies are completed and show positive results. Until then, a ketogenic diet is not an effective treatment for anything whatsoever.

              2. Adam says:

                Nothing? Obesity, diabetes, epilepsy…

                Here is an informative and objective article on this matter.

                http://www.myhealthwire.com/news/breakthroughs/856

              3. AdamG says:

                In your own words, what is the difference between a ‘ketogenic’ diet and a ‘low-carb’ diet?

              4. WilliamLawrenceUtridge says:

                Adam, notice how you are providing a press release link and are about to not be taken seriously. That’s because it’s a press release. The commentors here are sufficiently scientifically literate to realize that a press release is at best a distorted and self-promoting summary of actual research. Get us some research and we’ll tell you why it’s premature.

            2. WilliamLawrenceUtridge says:

              That is a terrible way to speak about someone you don’t know

              You are free to not read my comments. And someone who sells unproven science to dying patients is an asshole in my book.

              and with that attitude how will you ever have faith in anyone or anything.

              The nice thing about science and evidence is that you don’t need to have faith, because you have evidence. Except this asshole doesn’t have any evidence. If he wants my respect, he should conduct real research and publish it. But he’s probably too busy getting his ego stroked and collecting book royalties.

              This appears to be a consistent attitude with a number of posters on this site. He isn’t claiming a cure you must be confused.

              Meh, I don’t really care that much. An oncologist who is an active researcher has given an expert opinion, I’m perfectly happy to trust him.

              You cant paint everyone with the same brush.

              Everybody who sells or promotes unproven cancer treatments can quite safely be painted with the same brush. They’re all unethical. Doesn’t matter if it works or not – no matter what, it’s unethical. I’m sorry if this truth is uncomfortable to you, but imagine you were dying of cancer and hungry all the time because some asshole has you on a 600kcal diet made up of mostly lard.

              There are multiple clinical trials underway.

              You say this as if it were a good thing. If those clinical trials were concluded, then he’d be in a good position to promote his cure (assuming they were positive). As is, he’s saying “trust me, spending your last couple months of life eating a repetitive diet and being hungry all the time is worth it. But you’ll have to trust me, because I don’t really have any evidence.” What an asshole.

              1. Chris says:

                Mercola? Seriously? Why would you believe a doctor with a link to the stuff he sells? Point to the link on this site for supplements, tanning beds and other junk.

                First, why do you think YouTube videos are valid evidence? And second have you read what this website says about Mercola?

              2. Adam says:

                The difference between Mercola and everyone a part of this site, regardless of what he promotes and whether it is valid or you want to believe it, at least he is out there pushing his beliefs and reaching people. He’s open to different research and methods and he is not some bitter ignorant troll hiding in blogs wasting their time arguing, trying to refute everything, or trying to feed their own ego. Get out there and spread your message whatever it is, make a change, educate people. And if you already doing this, obviously you’re not doing a good enough job.

              3. WilliamLawrenceUtridge says:

                The difference between Mercola and everyone a part of this site, regardless of what he promotes and whether it is valid or you want to believe it, at least he is out there pushing his beliefs and reaching people. He’s open to different research and methods and he is not some bitter ignorant troll hiding in blogs wasting their time arguing, trying to refute everything, or trying to feed their own ego. Get out there and spread your message whatever it is, make a change, educate people. And if you already doing this, obviously you’re not doing a good enough job.

                So what you’re saying is, it doesn’t matter if what someone says is true or not, the important thing is how effective he is at selling his message. Doesn’t matter if his advice harms, or even kills people, just if he believes in himself and gets a lot of attention.

                Interesting.

                Two points:
                1) Do you not see a valuable role in correcting misapprehension in comments sections on the internet, given they are a popular medium for spreading misinformation?

                2) What do you think of Hitler?

                Godwin FTW!

              4. weing says:

                “He’s open to different research and methods and he is not some bitter ignorant troll hiding in blogs wasting their time arguing, trying to refute everything, or trying to feed their own ego. ”
                Do you have evidence that he is not trying to feed his own ego? What is your evidence that he is open to different research and methods?

              5. Chris says:

                Adam: “The difference between Mercola and everyone a part of this site….”

                Is that he makes a very good living at selling his nonsense from supplements to tanning beds.

                Your praise of Mercola shows you are a gullible mark, which is what has made Mercola a very wealthy man.

            3. Adam says:

              I’m not praising anyone, if you disagree with the advice he offers challenge it. If you’re worried people may see his interviews and receive ill advice, comment on them and offer your own view. If you can offer better advice and are qualified to that then do it. Hiding in here isn’t doing anything. You claim he could be killing people then save them. What are you doing to help people or raise awareness?

              Are the products Mercola sells available elsewhere? Are there any health benefits associated with these products? Is he offering people advice on how to live a healthier life? Does he interview real people with real qualifications? Is his way of thinking incorrect because you don’t agree with it?

              Whats worse is sites like this where anonymous people discuss matters they are likely not qualified to comment on. Anyone could stumble across one of these discussions and make a life changing decision.

              Who are all of you? What are your real names? Where are you located? What sort of qualifications do you have? Maybe if people knew who they were discussing important matters with they could make a better decision as to whether or not they should consider the validity of issues raised. Who is liable if they follow some of the recommendations offered here?

              1. Chris says:

                Seriously, are you a Mercola employee or just a fan boy?

              2. Windriven says:

                “Is his way of thinking incorrect because you don’t agree with it?”

                No, we disagree because his ‘way of thinking’ is incorrect.

              3. MadisonMD says:

                …if you disagree with the advice he offers challenge it. If you’re worried people may see his interviews and receive ill advice, comment on them and offer your own view. If you can offer better advice and are qualified to that then do it.

                Done long ago. See here and here among other posts.

                Whats worse is sites like this where anonymous people discuss matters they are likely not qualified to comment on.

                See here. Moreover, most of the items promoted by Mercola have been discussed and shown to be devoid of a factual basis on SBM including toxic metals, statin drugs, thermography, HIV denialism, vaccine denialism, fluoridation, and GMOs. Use the search box at upper right and know that Mercola has promoted the quack view on each of these topics.

                If you’d like third-party opinions on Mercola from people with expertise, see here, here, here, and here.

              4. weing says:

                “I’m not praising anyone, if you disagree with the advice he offers challenge it.”
                Why? Bring him more attention so that he can scam more people?
                I would rather encourage them to check out the The Bullshit Detection Kit.

              5. WilliamLawrenceUtridge says:

                I’m not praising anyone

                So you don’t see linking to his videos as an implicit form of praise, or at minimum endorsement? Why not? If I link to something I disagree with, I provide appropriate (mocking) context. Unless you meant that Mercola’s points are so stupid as to not need context to mock or rebut? I would be inclined to agee, if it weren’t for the fact that he makes a fuckton of money selling crap to the public.

                If you’re worried people may see his interviews and receive ill advice, comment on them and offer your own view.

                If you don’t agree with his advice, don’t lnik to his youtube videos. If you do agree with his advice, then you’re stupid.

                Hiding in here isn’t doing anything. You claim he could be killing people then save them. What are you doing to help people or raise awareness?

                Honestly, what the fuck do you think this blog is? And if you disagree with Mercola, feel free to drop a link into a comment on the hundreds of youtube videos he has his paid employees posting.

                Are the products Mercola sells available elsewhere?

                According to Mercola – no. He makse a point of talking about how special, unique and high-quality his products are, and how you can’t trust the no-name brand you buy in other stores. Because he’s all about marketing to ensure perception overrides reality.

                Are there any health benefits associated with these products? Is he offering people advice on how to live a healthier life? Does he interview real people with real qualifications? Is his way of thinking incorrect because you don’t agree with it?

                Yes, but generally only in cases of frank deficiency, yes, but his advice is often paired with unnecessary products, yes, the qualifications are real but their actual statements go beyond the evidence base and these real people are usually no longer conducting active research, and no, it’s not incorrect because we disagree with it, we disagree with it because it is incorrect. Any more questions to JAQ off to?

                Whats worse is sites like this where anonymous people discuss matters they are likely not qualified to comment on. Anyone could stumble across one of these discussions and make a life changing decision.

                Yeah, it’d be a real shame if people stumbled on sciencebasedmedicine and decided to get actual, proven cancer treatments rather than trying to self-treat with an unproven diet of bacon and avocados, then dying of untreated cancer.

                Who are all of you? What are your real names? Where are you located? What sort of qualifications do you have?

                Jesus, who the fuck are you? It’s not like you’re “Madonna” where one name is sufficient to identify you, you hypocrite. Also, rather than attacking with ad hominems, why not address our points? Is it because you can’t?

                Maybe if people knew who they were discussing important matters with they could make a better decision as to whether or not they should consider the validity of issues raised. Who is liable if they follow some of the recommendations offered here?

                Maybe if people talked to their doctors, who are trained in interpreting the scientific literature, instead of relying on whatever they can find on google, they might get good advice.

                Nobody should be liable here, because nobody should be giving medical advice. Pointing out that there is no evidence behind ketogenic diets is not medical advice – it’s stating a fact.

              6. weing says:

                “Nobody should be liable here, because nobody should be giving medical advice. Pointing out that there is no evidence behind ketogenic diets is not medical advice – it’s stating a fact.”
                Correct on both counts. If someone is looking for free medical advice on the internet, the best that can be given is to see your doctor and hope that he/she is not a quack. There is no way I could give advice without an adequate history, exam, and review of relevant lab results.

  26. Christina says:

    Not enthused. I have been reading on this diet and what kind of things it actually helps, if your going to write an article about a doctor’s “hypothesis” not being correct then I would like to see your clinical studies on how this diet doesn’t work.

    1. Harriet Hall says:

      It’s not up to us to provide studies about how it doesn’t work. It’s up to the person making the claims to provide studies showing that it DOES work.

  27. Christina says:

    @heidi..
    “I don’t see any reason to disrupt her life even more by proceeding with a strict diet that is unproven and possibly harmful”

    What do u have to lose by trying? I have a friend that’s changed her diet to help with cancer and she has never felt better.
    My mother died less than a year ago from cancer. If I had known about this I would of given it a shot. Would of rather seen her eating bacon and eggs than boost drinks. And at the end what’s it really matter when u can look back and say you tried.

    1. Harriet Hall says:

      What do you have to lose? Your mother would lose one of the greatest pleasures of the time she has left: eating the foods she loves. Would you deny her that just to protect yourself from guilt feelings about not having tried everything possible?

    2. WilliamLawrenceUtridge says:

      What do u have to lose by trying? I have a friend that’s changed her diet to help with cancer and she has never felt better.

      Well, if nothing else, a lot of weight. I think it calls for a 600 kcal diet. Also, a lot of pleasure. It’s your last couple months on earth, and you want to spend it eating only butter and eggs?

      I don’t really get annoyed with patients who try stuff like this, I get annoyed with the doctors who promote it, who claim it is a miracle (then blame the patients for dying on them) without good evidence.

      My mother died less than a year ago from cancer. If I had known about this I would of given it a shot. Would of rather seen her eating bacon and eggs than boost drinks. And at the end what’s it really matter when u can look back and say you tried.

      Two points:

      1) It’s really not your decision
      2) Meat and eggs are biochemically somewhat complex; Boost and related beverages are used because they are nutrient-dense and easy to digest, if nothing else giving you the energy to keep going.

      But overall dying of cancer sucks. There’s nothing good about it.

  28. Adam says:

    Is the author of this article qualified to cast such aspersions?

    1. Adam says:

      Its hard to take someone serious who only discredits everyone and everything. I guess thats the writing style required to engage readers in discussion here, even if the content is unfounded. Hey David, can you produce an article on what lifestyle and nutritional changes you believe are helpful in preventing cancer and other disease?Your time here would be better spent working towards helping others or are you scared to put your recommendations in writting.

      1. simba says:

        It’s not okay to lie to patients in the name of being positive. And saying that you know something works, or that something works, without having good evidence for that, is lying to very sick people who are not in a good position to evaluate your statements.

        If you tried to do that to me when I was seriously ill, I would not think that was ‘helpful’. And I would think that discouraging others from telling people the truth, just because they’re sick, is disgusting and unethical. People do not lose the right to make their own choices about their body just because they are sick or dying. And when you lie to sick people about what will help them you take that choice away.

        Anything that combats that, by providing people with the information to make their own decisions, is actively helping. A lot more helpful, to me, than talking about nutritional and lifestyle changes that can prevent cancer- my doctor does that, I can educate myself on that in other places, but doctors don’t have time to go into every single daft idea and warn me against it.

        Besides which it is foolish to say that everyone can ONLY talk about whatever it is you want to talk about.

      2. WilliamLawrenceUtridge says:

        Its hard to take someone serious who only discredits everyone and everything. I guess thats the writing style required to engage readers in discussion here, even if the content is unfounded. Hey David, can you produce an article on what lifestyle and nutritional changes you believe are helpful in preventing cancer and other disease?Your time here would be better spent working towards helping others or are you scared to put your recommendations in writting.

        Hey buttercup, feel free to write your own post about what cures cancer if you don’t like reading this one. Until then, this website is dedicated to discussing what does, and doesn’t work, often focussing on the “what doesn’t” because it gets a lot more press time. But hey, if you want some advice regarding how to prevent disease, here are the top bits:

        1) Exercise
        2) Eat a diet rich in unprocessed foods, fruits and vegetables
        3) Get vaccinated
        4) Don’t smoke
        5) Avoid an industrial occupation

        And most important of all:

        6) Be born with strongly anti-oncogenic genes

        I really can’t stress the last one enough.

        Now, part of the reason, I’m sure, that Dr. Gorski doesn’t spend much time discussing these recommendations is because, as you’ve seen, they are quite fundamental not only to public health campaigns, but what yo mama told you to do. Perhaps you can see how repeatedly posting on these six bits of advice could be repetitive and redundant. There’s not much sexy about repeating every six weeks “don’t forget your peas and carrots”.

    2. Andrey Pavlov says:

      Is the author of this article qualified to cast such aspersions?

      Why yes in fact he is. He is a surgical oncologist specifically focusing on breast cancer who is also a PhD researcher in cancer with a lab that he runs. I’d say he is if fact stupendously qualified.

    3. WilliamLawrenceUtridge says:

      Is the author of this article qualified to cast such aspersions?

      In addition to Andrey’s reply, I’ll add that for the kind of basic knowledge it takes to point out the flaws in the ketogenic diet, and the lack of evidence to support it’s use in humans, can come from anyone with a keyboard. You don’t need to be a PhD cancer researcher to note that humans aren’t heavily-inbred mice.

      Show me dramatic results in humans and I’ll happily say “yes, it’s a good treatment.” Until then, it’s unethical to do book tours and TV appearances promoting it.

      1. KayMarie says:

        And even the mouse we have that posts here, on first visual impression, appears to be wild-type.

      2. Adam says:

        In my experience I am a lot healthier following a ketogenic diet, all markers of health have improved.

        1. Jopari says:

          Experience is rather unreliable, try using statistics instead, something quantifiable. Feelings of goodness simply cannot be recorded in numbers.

          1. Jopari says:

            Apologies, please clarify which markers were used, and why, then what was used to measure, then the changes.

            Thanks.

        2. WilliamLawrenceUtridge says:

          In my experience I am a lot healthier following a ketogenic diet, all markers of health have improved.

          That’s great, did it cure your cancer?

          No?

          Then why are you commenting on a page about ketogenic diets not curing cancer?

            1. WilliamLawrenceUtridge says:

              Oh, I didn’t know clinical trials were now having their results reported in youtube videos! I guess the letters to the editor are just posted in the comments section.

              Wait, that’s just joe mercola shilling his products for a profit!

              So you are what, one of his employees then, right? A critical comsumer like you would never fall for his idiotic products made of pure naturalistic fallacy, right? You’re smart enough to recognize that snake venom and smallpox and deadly nightshade and deaths cap mushrooms are natural, right? No, you are obviously a shill, not an idiot.

  29. Aoife says:

    There seems to be a lot of hyped-up talk here, and I feel the need to comment as I am a cancer patient following the ketogenic diet (non calorie restricted), and I see a lot of people saying this article has put them off suggesting this diet to loved ones with cancer.

    I have been following the ketogenic diet for a year. I have a stage IV highly aggressive cancer. Previous to starting this diet, all tumours were growing by 33% with each scan (roughly every 2-3 months). After starting diet, all tumours stabilised. I have since had a new conventional medical therapy that has managed to start to shrink the tumours. This was a targeted therapy that only worked on my liver. All other tumors in other sites remained stable. I am now on a systemic therapy. Without the ketogenic diet, which stabilised and held my tumors in check, I don’t think I would be here today. I would recommend that anyone with a cancer diagnosis should consider going organic, non-processed, and ketogenic. I felt I had to post as there were a lot of strong opinions on here, many without real foundation. The keto diet may not have a lot of scientific evidence yet, but for me, it has been a game-changer.

    1. WilliamLawrenceUtridge says:

      Did you have any chemotherapy before or during your starting the ketogenic diet? If so, how do you know it was the diet and not the chemo? Also, what size were the tumors? Sometimes the tumors outgrow the blood supply and the center dies, which I believe can cause them to shrink.

      And why on earth would you cite “organic” as a diet to change to? Organic food, assuming it’s not purely a waste of money and land resources, would at best prevent mutation, which is to say the initial tumors from starting. Organic food, and again there’s no evidence it’s any better than nonorganic, and the levels of pesticides and herbicides on regular foods aren’t anywhere near a toxic dose for humans, has no mechanism by which it could systematically re-arrange the genomes of the cancer cells back into a normal sequence. Assuming you weren’t malnourished in the first place, there’s really no reason to attribute any magical properties to eating organic.

      1. Adam says:

        WilliamLawrenceUtridge, state your real name, location and medical qualifications please.

        1. Chris says:

          So someone comments with his first, middle and last name with several references to the country he lives in, and then you, who posts only with a first name, needs to get more details? You might want to think this through a bit more carefully.

          Hello Adam, welcome to the internets. You are allowed a certain amount on anonymity. We don’t care who you are, what education you have or where you live. We only care about what kind of evidence you have to offer. You should have now learned that YouTube videos and websites from supplement salesmen are not sufficient.

          So instead of trying to get personal information on individuals you should be actually learning what constitutes real scientific evidence. Here is a hint: it is not the stuff you provided. So do try to learn how to get that data. Here is a good place to start, but it has its own issues: http://www.pubmed.org

        2. WilliamLawrenceUtridge says:

          WilliamLawrenceUtridge, state your real name, location and medical qualifications please.

          Why? If it turns out that I’m a homeless person living in Calcutta , contributing through a cell phone I stole from a prostitute, with a high school education and a festering sore on the inside of my anus, which of my points becomes invalidated.

          Also, I promise, sooooo hard, that if you tell me your name, location and medical qualifications first, I’ll totally tell you mine. I’ll even include a picture, and the latest copy of my vaccination records.

    2. Adam says:

      Aoife, that is fantastic news, I wish you all the best for the future.

      1. Aoife says:

        Thanks Adam!

        @WilliamLaurenceUtridge and Chris, wow!

        It cannot be said with 100% certainty that it was the ketogenic diet that gave me these results, but:
        1. I had stopped all treatment. I was scanned three days before starting the keto diet. Six – eight weeks later I was scanned again, having no treatment, and all tumours had stayed the same size, when they had grown on average 33% with each previous scan. Since then, tumours stayed the same size. I had no treatment for about six months (not by choice).
        2. Previous treatments that I had undergone had already been shown to be ineffective. I had not had any treatment in the 1-2 months prior to starting the diet.
        Could it have been a previous treatment that had been starting to work? Perhaps. Is seems very likely, in my case, that the ketogenic diet had some sort of impact.

        Two of my doctors have told me that my disease is now behaving very strangely, as in it is much more slow-growing than it should be. They have both told me to continue doing whatever I am doing. I shouldn’t be alive now, but I am! And I’m healthy, fit, and seem to be happier than some people commenting on here! You wouldn’t know that I have cancer if you met me.

        Also, I did not state that my tumours began to shrink on the keto diet, only that they stablized, and have done so for a long time.

        Organic? Well, if I have a highly aggressive cancer and I’m trying to change my diet to help my body fight it off, I am going to try and put less pesticides and unneeded chemicals into my body. This way it doesn’t have to deal with nasty things that i’m putting into it, and it can spend a little more time fighting off the cancer cells inside. Just saying that the levels aren’t “anywhere near a toxic dose” doesn’t really do it for me, I’d rather not take the chances, be kinder to my body, and try to eat clean.

        Mine is not scientific evidence, it is a personal story. I wanted to share it because in my case, the article above does not ring true. Cancer patients are vulnerable, and need solid information, not a fight on a message board. I am merely giving my personal story.

        1. WilliamLawrenceUtridge says:

          Could it have been a previous treatment that had been starting to work?

          It could also have been spontaneous remission, which does happen – even with stage IV cancers. Sadly, everyone with a similar story who dies will be unable to tell us about it.

          Organic? Well, if I have a highly aggressive cancer and I’m trying to change my diet to help my body fight it off, I am going to try and put less pesticides and unneeded chemicals into my body.

          Why? The assumption is that the low doses of pesticides and “unneeded chemicals” (which, I might point out, includes everything that’s not an essential vitamin, mineral and macronutrient, including flavour molecules, which are themselves toxic at high doses and often found in higher concentrations than herbicides and pesticides are) are going to cause or exacerbate your cancer. This is an assumption on your part, one that costs you more money as organic food is often much more expensive, and impacts the environment more as organic requires more space and water than conventional crops.

          Do you have similar concerns over ergot poisoning? E. coli? And why do you believe the hype of organic producers over the scientific literature? And consider this – with the money you save buying conventional crops, you could purchase more of them, particularly the expensive fresh fruits and vegetables that appear to have the greatest impact on health.

          I’d rather not take the chances, be kinder to my body, and try to eat clean.

          Maybe you don’t need to eat clean.

          Mine is not scientific evidence, it is a personal story. I wanted to share it because in my case, the article above does not ring true. Cancer patients are vulnerable, and need solid information, not a fight on a message board. I am merely giving my personal story.

          Sadly, everyone who tried your approach and died of cancer can’t give such a personal story. Everybody who tried a ketogenic diet and died of cancer isn’t around to testify about it. That’s why scientific evidence is considered far more reliable than anecdotes and testimonials.

          Do you know anybody else who tried a ketogenic diet and died? Do you know how many people who tried a ketogenic diet and died?

          I’m not trying to be mean – I’m pointing out the realistic kinds of questions that need to be asked if all of you are going to check all of your premises and assumptions. If we really want to prevent people from dying of cancer – we need good information, not merely good intentions.

          But perhaps your story represents a true result. Unfortunately, we’ll never know this. Only through aggregate testing will we ever be able to tell if the ketogenic diet is beneficial or not.

        2. simba says:

          Organic farming still uses pesticides and chemicals, try being downwind of an ‘organic’ farm while they’re spraying. They use some incredibly toxic ones, too, and often in high amounts.

          All that they need to show is that they’re ‘natural’ or traditional and on the list of ‘approved’ pesticides (or herbicides, fertilizers etc)- not that they’re safer than those being used by non-organic farming. Still pesticides, still chemicals.

          http://blogs.scientificamerican.com/science-sushi/2011/07/18/mythbusting-101-organic-farming-conventional-agriculture/

      2. WilliamLawrenceUtridge says:

        Aoife, that is fantastic news, I wish you all the best for the future.

        The sad thing is, if Aoife dies of cancer, you’ll never know about it. You’ll just have a pleasant little anecdote floating around in your head about someone who chose an alternative and did just fine.

        It’s one of the reasons why anecdotes aren’t data.

        1. Aoife says:

          Gee, thanks!

          1. WilliamLawrenceUtridge says:

            While cancer patients deserve a certain amount of sympathy, that doesn’t mean a free pass when it comes to making dangerous, or even merely scientifically untenable comments. On this website at least. That doesn’t mean I wish you a recurrence of your cancer – far from it. Merely that because you are a cancer patient, that doesn’t give you special insight into how cancer develops and how it is cured.

            1. WilliamLawrenceUtridge says:

              Bah, “a certain amount” should read “considerable”. Apologies.

              1. Aoife says:

                You asked a previous poster, Adam:

                “That’s great, did it cure your cancer? No? Then why are you commenting on a page about ketogenic diets not curing cancer?”

                I have stepped in as a cancer patient on the ketogenic diet. Has it cured my cancer? Not yet. Has it, given the tight scanning parameters and results that I have had on it, made a big difference to me? It would seem, yes.

                I feel that the aggressiveness with which you make your arguments does any ideas you have a disfavor. I personally find myself wondering, what is your agenda?

                My main point was about the positive results I have had on a ketogenic diet. You instead chose to focus on the fact that I also mentioned that I eat organic. It is a good politician who tries to hide a pretty sound argument in the smoke screen of side-stepping and talking about a minor point that was made.

                You say that,

                “While cancer patients deserve a certain amount of sympathy, that doesn’t mean a free pass when it comes to making dangerous, or even merely scientifically untenable comments.”

                I have already stated that my story is not scientific evidence, it is a personal story.

                As for it being dangerous – if I, as a cancer patient, one year ago when I was making my decision whether or not to try out the ketogenic diet, came across this article and the many negative comments below, I might have decided that it was not worth trying.

                I would most probably not be alive right now if I had taken that action. It is not the comments that I have made that are dangerous, rather the ones that go so abjectly against something that may work for some cancer patients.

                Is this diet dangerous? No. Let me guide you towards this study which showed that for terminally ill patients with cancer, the ketogenic diet might improve aspects of quality of life: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3157418/

                I am above having this discussion a comments board. I merely wanted to reply again for those people who may be reading this and may be confused.

                I have been on the ketogenic diet for a year, with great results. I have cancer, it has been stabilized. My doctors have told me to keep doing whatever I am doing. This is a personal story. Check out the ketogenic diet if you, or a loved one, has cancer.

              2. MadisonMD says:

                Hi Aolfie,
                Sorry you feel upset about the responses you are getting here. You say:

                I would most probably not be alive right now if I had taken that action. It is not the comments that I have made that are dangerous, rather the ones that go so abjectly against something that may work for some cancer patients.

                The problem is, there is no way of knowing this is true. The history of cancer treatment, in particular, is riddled with examples of interventions of various sorts with which a one or two people seem to have done wonderful. However, when attempted to be generalized to other situations and individuals, the interventions turn out to be abject failures. Careful review often reveals that there were some other factors involved, including abnormalities in underlying biology and that disconfirming evidence was ignored or undiscovered because of a lack of negative testimonials.
                When one uses testimonials such as yours, it must be understood that there is a bias. You see, all those people who may have undertaken a ketogenic diet but nevertheless became extremely ill or died of their cancer cannot provide a testimonials (WLU said this but you missed it?). So your testimonial cannot tell us whether it is a 1 in a million anomaly (perhaps unrelated to ketogenic diet altogether) or if it is a common outcome. [I cannot even tell if it is really an anomaly at all without knowing more details about your history, treatment, and meaning of 33% cancer growth, and actually see the data showing ketosis and verifying your or your physician's interpretations-- but no need to share these, of course because it doesn't really matter if we are dealing with a single anomaly or no anomaly.]
                Even if we grant that a ketogenic diet helped your cancer, it in no way would indicate how likely another individual would benefit. i.e. How generalizable is your experience? Is it limited to one type of cancer? Is it limited to 0.01%, 10%, or 100% of that type of cancer? Is it limited to a specific set of circumstances of cancer distribution and prior therapies? Is it limited to your particular variety of high-calorie ketogenic diet?
                So the advice you are getting for you to keep doing what you are doing is great. Given that you are doing well and your doctors do not know how or why this is occurring for sure, you should keep doing it. No question. However, it doesn’t mean that you have identified the cause of you doing well nor does it mean that your ascribed cause could be generalized to other individuals.

                So I agree with much of what you say. Not this:

                Check out the ketogenic diet if you, or a loved one, has cancer.

                For further reading about how easily it can be misled by experience, please see discussion of Bishop Berkeley and tar water here. Also amusing is the discussion of how people discovered that, when one is cut by a blade, healing is accelerated best with medicated ointment… when put on the blade rather than on the wound. You can’t make this stuff up.

                So Aoife, thank you for sharing your anecdote. I object to you recommending it to others without scientific evidence because it is not safe to assume your testimonial is accurate, correctly attributes the result to the cause, and is generalizable. I have no objection to you continuing it based on your experience.

              3. WilliamLawrenceUtridge says:

                I have stepped in as a cancer patient on the ketogenic diet. Has it cured my cancer? Not yet. Has it, given the tight scanning parameters and results that I have had on it, made a big difference to me? It would seem, yes.

                The thing is – you have no idea. Without randomization of a large-ish number of people matched for cancer type and stage (one way of doing it), you simply have no idea. You could have spontaneously regressed, you could have cured your cancer, whatever – either way, you haven’t proven it. Irrespective of what it might seem, what it actually is is an anecdote, the very starting point of research.

                I feel that the aggressiveness with which you make your arguments does any ideas you have a disfavor. I personally find myself wondering, what is your agenda?

                You may consider my criticisms aggressive. I do not. You may have told your story in venues that were not as versed in science, experimental design and cognitive fallacies as this one, and thus never experienced criticisms of your claims. Here, you will not be praised for your story of curing or slowing cancer with diet if you are not part of a clinical trial; your status as a cancer patient might get you more polite replies, but they will still challenge the naivete with which you treat your anecdote as a meaningful data point. It’s not because we hate you, or want you to have cancer, or even want your story to be untrue – it’s because single anecdotes are not scientifically convincing, and can be dangerously misused to turn people away from what effective treatments exist.

                If you find this challenge uncomfortable, I can’t really help you – I have tried to be civil, but factual.

                Also, I don’t have an agenda. I earn a salary, not from a drug company, and arguing with people on the internet is my hobby. The fact that you are imputing an agenda purely on the basis of making some quite elementary scientific points suggests the issue is with you, not me.

                My main point was about the positive results I have had on a ketogenic diet. You instead chose to focus on the fact that I also mentioned that I eat organic. It is a good politician who tries to hide a pretty sound argument in the smoke screen of side-stepping and talking about a minor point that was made.

                You claimed, twice, that eating organic somehow made your cancer better or something. This is nonsense, and I described why. I also pointed out why your overall approach of using a ketogenic diet is nonsense (anecdotal) but I know enough about organic food and cancer to go a bit deeper. You apparently haven’t really grasped much beyond the fact that you don’t like me pointing it out. That’s fine, you don’t have to read it.

                As for it being dangerous – if I, as a cancer patient, one year ago when I was making my decision whether or not to try out the ketogenic diet, came across this article and the many negative comments below, I might have decided that it was not worth trying.

                Yes, and scientifically, you would have been right on the money. Just like now. Again, you may think your ketogenic diet is staving off your cancer, but that doesn’t make it true. I’m sorry this makes you uncomfortable.

                I would most probably not be alive right now if I had taken that action. It is not the comments that I have made that are dangerous, rather the ones that go so abjectly against something that may work for some cancer patients.

                Two points:

                1) You probably would have been alive if you hadn’t changed your diet. There’s little good evidence ketogenic diets help.

                2) Nobody here has any idea if ketogenic diets work. You’re using the fact that you are alive now as a rationalization for switching to a ketogenic diet. But there are doubtless people who also switched and died of cancer – and we won’t here from them.

                That’s why your anecdote is not useful.

                Is this diet dangerous? No. Let me guide you towards this study which showed that for terminally ill patients with cancer, the ketogenic diet might improve aspects of quality of life

                Allow me to point out that quality of life improvements aren’t the same thing as a cure for cancer, and quality of life improvements can accompany a cancer getting worse. Ketogenic diets may even accelerate certain cancers – we don’t know. So it could be dangerous. It is uncertain.

                I have been on the ketogenic diet for a year, with great results. I have cancer, it has been stabilized. My doctors have told me to keep doing whatever I am doing. This is a personal story. Check out the ketogenic diet if you, or a loved one, has cancer.

                Well thank god you’re not recommending health decisions to desperate patients.

                Do you know anyone with cancer who tried the ketogenic diet and died of cancer? No, because you do not systematically track it. And that’s the problem.

  30. weing says:

    I second what MadisonMD so eloquently said.

    1. Bob Johnston says:

      What is wrong with you people?

      The effects of cognitive dissonance is so prevalent here it should be a psychological case study. The fight against cancer has gone essentially nowhere for years and years, people are still dying by the millions and doctors still have little more to offer than surgery, radiation and chemo.

      So researchers start looking in other directions and before they can even get studies funded they’re written off as quacks because it’s “impossible” that anything as simple as limiting the fuel cancer cells thrive on could be of any value. As an interested outsider do you realize how obtuse and narrow-minded that makes you look?

      Aoife told his story and instead of a normal response like “Hmmm, well that’s interesting, perhaps we should explore that possibility further” he’s met with “You’re full of sh#t, it was obviously the organic foods” or “You’re going to die soon and we’ll never hear about it” or my favorite “It’s just one of those things that we currently don’t understand but it couldn’t have been the diet, no way”.

      Do you have any clue how responses like that would either discourage people who have a lot of trust in the people with the white coats to not even try something that shows promise and yet no downside (unless of course not stuffing your face with bread and pie is a downside ) or with people like me who already have very little trust in doctors of chronic disease that you’re even less worthy of trust than I previously thought.

      I’m not saying a ketogenic diet is a cure for cancer, but I am saying that limiting the substance that most cancers use for fuel (glucose) sure does seem like something that might have possible benefits like it could have for Aoife.

      Sorry to get uppity (you should have seen the first draft), it’s just that you guys don’t seem open to new ideas and I think that’s a regrettable for doctors, particularly in a field that has had so little success.

      1. Chris says:

        “The fight against cancer has gone essentially nowhere for years and years, people are still dying by the millions and doctors still have little more to offer than surgery, radiation and chemo.”

        Really? Then why do so many more children survive leukemia? Why is non Hodgkin lymphoma no longer a death sentence like it was in the 1970s (the son of a family friend was one of the first to survive, now there are so many more)? See:
        http://www.sciencebasedmedicine.org/chemotherapy-doesnt-work-not-so-fast-a-lesson-from-history/

        Though if you are claiming that 100% of all cancers should be cured 100% if time, then you are living in a fantasy. The where the Nirvana Fallacy rules.

        Aiofe told a story. But that is it, it is just a story. And the way to explore it further is to examine his complete medical records, but he is not going to post them online. So the next way to examine it is to look at all of the published work, which was exactly what the above article does. Perhaps you should read it.

      2. weing says:

        “The effects of cognitive dissonance is so prevalent here it should be a psychological case study. ”
        I don’t thinking that phrase means what you think it means. The response to Aoife has more to do with epistemology and is not a personal attack.
        The pilot trial that Aoife cited is just that. There is no way you can use it to make recommendations one way or the other. Ever wonder why wise men fear to tread where the fools are rushing in?

        1. WilliamLawrenceUtridge says:

          Dunning-Kruger?

      3. WilliamLawrenceUtridge says:

        What is wrong with you people?

        We prefer facts over hope mostly.

        The effects of cognitive dissonance is so prevalent here it should be a psychological case study. The fight against cancer has gone essentially nowhere for years and years, people are still dying by the millions and doctors still have little more to offer than surgery, radiation and chemo.

        Not quite true – cancer rates have been slowly dropping and cancer cures have been slowly rising, but certainly not quickly. The reasons are enumerated in Emperor of All Maladies by Siddhartha Mukherjee. Basically, they tried to cure cancer with chemo before understanding what it actually was (in their defence, the researchers were working with much more primitive tech, particularly for gene sequencing). The fact that doctors still only have “surgery, chemo and radiation” is because that’s all that has been proven to work. If ketogenic diets is appropriately tested and found to work – it will be adopted.

        But testing comes first.

        Also, the idea that there must be more than surgery, chemo and radiation is itself problematic. Why does there have to be something other than these three? It would be nice if there were, but there’s no reason there must be greater alternatives.

        Also-also, a ketogenic diet helped you lose weight. Why does it have to cure cancer too?

        So researchers start looking in other directions and before they can even get studies funded they’re written off as quacks because it’s “impossible” that anything as simple as limiting the fuel cancer cells thrive on could be of any value. As an interested outsider do you realize how obtuse and narrow-minded that makes you look?

        No, they’re written off as quacks because they insist their quackery cures cancer without doing the hard work of actually testing it.

        Also, you do realize that cancer evolves, right? It’s pretty likely that in the absence of glucose, they’ll simply shift to fats as fuels because the ones that can’t survive on fats will die off.

        It’s not narrow-minded to ask for evidence before converting. It is narrow-minded to insist something is true in the absence of evidence.

        Aoife told his story and instead of a normal response like “Hmmm, well that’s interesting, perhaps we should explore that possibility further” he’s met with “You’re full of sh#t, it was obviously the organic foods” or “You’re going to die soon and we’ll never hear about it” or my favorite “It’s just one of those things that we currently don’t understand but it couldn’t have been the diet, no way”.

        Actually, we called the organic thing bullshit and gave reasons. And nobody said “you’re going to die soon”, we said “everybody who tried ketogenics and died won’t post a message”.

        But mostly we’re saying “anecdotes aren’t really useful, scientifically”. You might want to read the comments rather than skimming them and assuming you know what they said.

        Do you have any clue how responses like that would either discourage people who have a lot of trust in the people with the white coats to not even try something that shows promise and yet no downside (unless of course not stuffing your face with bread and pie is a downside ) or with people like me who already have very little trust in doctors of chronic disease that you’re even less worthy of trust than I previously thought.

        If you like bread and pie, not stuffing your face with it during the last months of your life actually is a downside. Don’t disparage it merely because you can’t eat it anymore.

        Most of us aren’t doctors by the way. I’m not. And patients shouldn’t be getting their information from the internet, they lack the expertise to interpret it within the context of human and cancer biology. I’m sorry if this basic truth offends you.

        Also, this is a website dedicated to science-based medicine. It’s not a discussion board for cancer patients or an online support group. If you bring statements here, they are going to be evaluated for their scientific value. If you don’t like that – don’t come here. If you don’t understand the criticisms, they can be explained in greater detail, or some books could be recommended. All you have to lose is your ignorance, but generally someone as dug into a position as you would tend to not want to change your mind. It’s called “cognitive dissonance”. Mistakes were made by Carol Tavris is a good book to read on the subject.

        Sorry to get uppity (you should have seen the first draft), it’s just that you guys don’t seem open to new ideas and I think that’s a regrettable for doctors, particularly in a field that has had so little success.

        Respect is usually gathered here on the basis of demonstrating an understanding of the scientific method and secondarily by appreciating cognitive fallacies. Uppity people who show neither usually get an initial polite response, followed by mockery. Just an FYI.

        Don’t mistake “I would like to see some evidence please, good quality if possible” for “all new ideas are terrible.” Also, don’t attribute your ignorance of the progress being made in cancer treatment as the reality of cancer treatment results. There are successes. Gleevec is a notable and dramatic one. There are many others, and as cancer genome mapping becomes more prominent, doubtless there will be more.

        And read The Emperor of all Maladies. You’ll learn something.

      4. MadisonMD says:

        The fight against cancer has gone essentially nowhere for years and years….

        How do you know this? I am thinking you made it up or found it in an unreliable source. Why? If you actually look at the American Cancer Society statistics, age-adjusted death rates from cancer have declined in the U.S. for both men and women. For example, mortality from breast cancer over the past 20 years has declined by 1/3. Putting that in real terms, about 40,000 women die from breast cancer each year in the U.S. whereas, if we were using 1990 technology, it would have been 60,000. So that’s 20,000 additional women per year in the U.S. alone that are alive solely due to improvements made over the past 20 years.

        … people are still dying by the millions and doctors still have little more to offer than surgery, radiation and chemo.

        Wrong there too. Newer therapies developed over the past 15 years or so include targeted therapies that have low toxicity and are used depending on the unique genetic characteristics of each cancer. These include imatinib, trastuzumab, erlotinib, afatinib, vemurafenib, pertuzumab, edo-emtansine and many more. Some of these have been so effective with so little toxicity that they have been fast-tracked for approval by the FDA without randomized studies, including imatinib which was approved based on phase I evidence.

        So researchers start looking in other directions…

        Absolutely and they should. In fact researchers today are exploring thousands of different directions. I for one am exploring a unique characteristic of certain cancers that may render them amenable to treatment with low toxicity. However, most of these directions turn out to be dead ends and the lines of research inquiry should be curtailed. They should not be promoted publicly in the absence of scientific evidence. Moreover, I would add, research resources are limited and should be devoted to the most promising directions. Ketosis might be one, but also might not because it is inconsistent with some observations.

        they’re written off as quacks because it’s “impossible” that anything as simple as limiting the fuel cancer cells thrive on could be of any value. As an interested outsider do you realize how obtuse and narrow-minded that makes you look?

        It’s not impossible. It is an unproven hypothesis which doesn’t necessarily fit well with what is known about cancer. For example, although diets are varied around the world and although cancer patients can become ketotic for a host of reasons, no strong correlations have been detected with response. For example, no-one has observed a strong correlation between cancer cachexia, bowel obstruction, or other causes of ketosis and rapid tumor response. Moreover, it is unclear which cancers in particular would merit trying and why. Any thoughts on that? It may be narrow minded to not consider the hypothesis. However, it is not narrow minded to think other hypotheses may be more promising. It is not narrow minded to avoid recommending therapies lacking strong evidence. However, I would easily change my mind with evidence. Not sure how that seems narrow-minded, but contrariwise, you sound a bit naive.

        Do you have any clue how responses like that would either discourage people who have a lot of trust in the people with the white coats to not even try something that shows promise and yet no downside

        I would recommend people who read blog talk about their treatment with their doctors. I’m not sure what you mean by ‘something that shows promise with no downside,’ because avoiding bananas, apples, orange juice, bread, pasta, rice, potatoes, toast might decrease quality of life for some without any known benefit. Moreover, it can cause medical problems, such as kidney stones– a well known phenomenon that has actually lead to clinical trials on reducing the risk in children who need to have ketogenic diet to prevent seizure (this is when it is medically indicated at present).

        I’m not saying a ketogenic diet is a cure for cancer, but I am saying that limiting the substance that most cancers use for fuel (glucose) sure does seem like something that might have possible benefits like it could have for Aoife.

        … and I’m saying sure, it might, but it might not. You are ignoring the physiologic needs for glucose, for example. You are also ignoring the discomfirming empirical evidence of benefit from cancer patients who are unable to eat, and the lack of evidence altogether, that any specific diet can have marked effects on cancer despite many many attempts to discover such a link.

        It’s just that you guys don’t seem open to new ideas and I think that’s a regrettable for doctors, particularly in a field that has had so little success.

        I’m open to new ideas. I’m not open to recommending those ideas before there is good evidence–even my own pet hypotheses. I also have studied cancer intensively for over a decade and am aware that most hypotheses will fail when put to the test.

        Cognitive dissonance is the pain felt when you have to reject a pet hypothesis. I have felt this pain when the data has not borne out my hypothesis (I usually really want them to be true). Ketosis for cancer seems to be your pet hypothesis. On another thread other individuals express the pet hypothesis that cannabis is effective therapy for cancer. It’s great to have hypotheses, evaluate their likelihood by other evidence, and then carefully test them. It is a disservice to recommend them based on guesses and anecdotes alone. Please read the link above to Worthington Hooker and you can see where premature adoption of ‘harmless’ interventions lead.

        So if you are a cancer patient, sure, you can decide to try a bunch of ‘harmless things’ based on anecdotes sourced from the internet. But if you try the later approach, you might end up eating tasteless carb-free cannabis brownies followed by half a box of baking soda and resveratrol 3x per day washed down with kombuchka, sticking magnets in across your chest, sitting in a light box, remove your fillings, boosting your immunity with flower remedies, injecting misletoe extracts, getting acupuncture and therapeutic touch…

        … or you could get advice from a licensed medical professional and spend the remainder of your day enjoying life, and the latter may include making an effort to watch the sunset or visit a grandchild, and enjoy a banana, a slice of toast with jam and a cup of coffee with a bit of sugar.

      5. simba says:

        Repeating my comment above: you ask what is wrong with us. What is wrong with you?

        In this conversation you have not spent your time advocating that further research be done, you’re advocating that no-one talks about the research (unless of course they do so uncritically and decide that it’s positive), that people don’t tell the truth to cancer patients, that people should not criticise testimonials being offered as evidence for others to try a treatment. All of that seems to me to be blatantly morally wrong.

        Testimonials offered as “hey maybe there’s something to this but it should be studied and is not proof of anything” would not get that kind of criticism, for obvious reasons. What is so terrible to you about telling the truth, that there is not good evidence for the ketogenic diet as a treatment for cancer?

        “What are you doing to help people or raise awareness?”

        Well I would think that helping people evaluate evidence for different treatments is a damn good start. Rather than them being limited to uncritical feedback by people trying to sell the treatment or lie to them in the name of being ‘positive’. Why do people lose the right to hear the truth because they are sick?

        There is an important principle called ‘informed consent’ in medicine, which means that people must know and understand the likely risks and benefits of the treatment they are going to be given, and be able to say ‘yes’ or ‘no’. You need full information when you have such a frightening and potentially dangerous illness, more than you do about any other subject. You need to know the real risks and the real benefits of any treatment, as well as any uncertainties (i.e. how well it has been studied), and testimonials do not cut it. It is frankly horribly wrong and sick to tell people only the positive, not the risks, not that there isn’t good evidence, in the name of giving people hope. That is not giving people hope, that’s just manipulating them. I do not understand how you cannot see this.

        Plus, while I don’t know Aoife’s sex, that is usually a female name to my knowledge.

  31. Bob Johnston says:

    -Madison MD

    I get what you’re saying, I really do, but your response is so typical of what we get from the medical community that it’s difficult not to yell at my computer screen to vent my frustration.

    I don’t want to get into a statistical bugaboo with you but my reading leads me to believe that cancer “survivorship” is up in the last 20 years due to people not being cured but just getting past some arbitrary period where the patient can be labeled a cancer survivor, only to succumb to the same disease at a later date. I think perhaps you and I probably have a different definition of “cured”.

    But what gnaws on me a bit is that as a doctor you seem to be unaware that carbohydrates aren’t an essential macronutrient. Your liver does a fantastic job of creating all the glucose a person needs from protein via gluconeogenesis. Our bodies attempt to control serum glucose in a very tight range – around 80 mg/dl. That’s just over a teaspoon of glucose in your blood, that’s not a whole lot. Levels above that your body views as toxic and it’s red alert until the levels can be brought back down by either storing it as glycogen in the muscles and liver or converting it to fatty acids for storage in adipose tissue or triglycerides in the blood. Elevated blood sugars – “no bueno” so when I read a statement like ” I’m not sure what you mean by ‘something that shows promise with no downside,’ because avoiding bananas, apples, orange juice, bread, pasta, rice, potatoes, toast might decrease quality of life for some without any known benefit.” I’m left wondering what the thought process is if you believe avoiding foods that cause inflammation and chronic disease is going to ruin someone’s quality of life.

    I am not a cancer patient, nor a patient of any kind anymore. However I’m sure I could have been one someday if I hadn’t stopped relying on the advice of the experts and started researching for myself. Five years ago I was 40 pounds overweight and asthmatic, following a low fat and high carb (“healthy” whole wheat) diet. Despite exercising a ton and limiting calories I was putting on weight every year. My doctor put me on a cortical steroid inhaler for the asthma and said he could give me something for some hand tremor issues and at that point I realized I was going down the wrong path. Once you’re in the (medical) system you never get out – your life will be a never-ending process of more and more medications to control symptoms but never a real cure and I said there has to be a better way. So I began doing my own research of available studies and I visited blogs of all types and it finally dawned on me that doctors don’t have a firm grasp on what causes chronic disease like CAD or diabetes or cancer because they’re not really looking. Research today is funneled towards pharmaceuticals that control symptoms or markers because that’s where the money is; very few people study diet because they can’t get paid to do so. It’s a cynical belief but one I’ve come to believe is accurate.

    As I said I began my own research and that eventually led me to carbohydrate restriction to avoid of elevated blood sugar, high insulin levels and chronic inflammation. And wouldn’t you know it after adopting this way of eating my asthma and hand tremors disappeared, I’ve dropped the 40 pounds and I have constant energy out the ying yang. Now I can hear you now – “sure but that’s just anecdotal” and you’re right, it is. But the thing is there are a lot of people out in the blogosphere who have had the same improvements and their collective impression of the medical community is you’re part of the problem and not the solution. And I have to agree.

    I’ve seen stunning improvements in peoples’ health – heart disease, diabetes, asthma and a whole host of other conditions have reversed by limiting blood sugar levels. Is it such a stretch to think that chronic inflammation from sugar might contribute to the development of cancer, particularly in light of the fact that most cancers use glucose as their fuel? I’m not talking about cannabis or carrot juice or whatever farfetched idea gets tossed out there, I’m talking about limiting the actual substance that the majority of cancer cells feed on by a method that isn’t invasive and isn’t toxic with the only downside being you can’t “enjoy a banana, a slice of toast with jam and a cup of coffee with a bit of sugar.”,/i>. But you still can enjoy a sunset and visit a grandchild, with the possible added benefit you’ll be around long enough to see that grandchild grow up.

    And low carb diets do not cause kidney stones, it’s simply an oft-repeated wive’s tale.

    1. simba says:

      I lost 21lbs (down to below my initial ‘ideal’ weight), my asthma improved, and I went from someone who had to sleep 10 hours a night not to feel groggy, to someone who could get by with 6. My back pain went, I had more energy, heck, even my hair got better (softer and shinier.)

      The only major change I can see in my diet at the time was that I started eating at least a bar of chocolate every day. More usually it was 3-6.

      The rest of my diet was mostly carbs (potatoes, white rice, white pasta, noodles of all kinds), veg, legumes, – small amounts of meat because I don’t particularly crave it, so I only had either meat or eggs 2-3 days a week. Same as before the weight loss only less meat.

      Does this mean that we should start telling everyone to eat a bar of chocolate a day? If not, why not? What does this say about the use of testimonials as evidence for particular diets?

    2. WilliamLawrenceUtridge says:

      I get what you’re saying, I really do, but your response is so typical of what we get from the medical community that it’s difficult not to yell at my computer screen to vent my frustration.

      If it makes you feel any better, most of us get the same impulse when we see someone promoting an unproven intervention, based on spurious reasoning, poor data, and often their own uncontrolled personal experience. Which in your case you don’t even have, I because you were never a cancer patient.

      I don’t want to get into a statistical bugaboo with you but my reading leads me to believe that cancer “survivorship” is up in the last 20 years due to people not being cured but just getting past some arbitrary period where the patient can be labeled a cancer survivor, only to succumb to the same disease at a later date. I think perhaps you and I probably have a different definition of “cured”.

      Your reading is wrong, or at least incomplete. A five-year survival point is chosen because at that point for most patients their risk of dying from their original cancer is equal or at best slightly higher than that of someone who never had cancer in the first place. If you’re getting your medical advice from Gary Null, Mike Adams or Joe Mercola, they like to make claims like this in part as a way of trying to make cancer researchers look unethical and in part as a way of shilling more of their products. Cancer researchers aren’t idiots, but the field is difficult and expensive. It’s not the cartoon version of easy research you seem to think it is. And yes, there are some cancer treatments (most notably for pediatric cancers) that do increase the risks of developing a different type of cancer in the future. It’s a shame and a tragedy, but considering the current options consist of “accepting an elevated risk of future cancer” or “death”, it’s the best that is managed. Cancer is a bitch, biology is complicated, and researchers aren’t morons.

      But what gnaws on me a bit is that as a doctor you seem to be unaware that carbohydrates aren’t an essential macronutrient. Your liver does a fantastic job of creating all the glucose a person needs from protein via gluconeogenesis.

      So what? Merely because we can survive by a complicated series of metabolically-expensive manpulations to create new glucose molecules doesn’t mean it’s magically better for us (indeed, sometimes it’s not, and sometimes it interferes with your ability to function).

      I’m left wondering what the thought process is if you believe avoiding foods that cause inflammation and chronic disease is going to ruin someone’s quality of life.

      Citation that fruit, bread, pastas, rice and potatoes cuase inflammation and chronic disease please. In humans, not petri dishes. And meaningful clinical implications, not markers.

      However I’m sure I could have been one someday if I hadn’t stopped relying on the advice of the experts and started researching for myself.

      Something something a doctor has a fool for a patient, a lawyer a fool for a client? Not to mention – quality matters; where are you researching? How much background in biology do you have to contextualize what you are researching?

      So I began doing my own research of available studies and I visited blogs of all types and it finally dawned on me that doctors don’t have a firm grasp on what causes chronic disease like CAD or diabetes or cancer because they’re not really looking.

      It’s amazing how you managed to be smarter than all the people who research these incredibly complex topics for their day jobs, year after year, just by reading some blogs! My god, you should publish your thoughts in a peer reviewed journal instead of this blog, think of the millions of lives you could save!

      Anyway, merely because you could lose weight on a ketogenic diet doesn’t mean everyone can (or that it cures cancer), and research indicates that a ketogenic diet is very hard for most people to stick with. You may be an exception. And like most people with a compelling personal experience, you immediately think it is universal and applies to everyone.

      Also, do you make a point of reading dissenting blogs and research articles, or do you just read the one side of the discussion? Real doctors and researchers are usually familiar with the arguments on both sides of an issue. So what’s your favourite anti-ketogenic blog?

      Research today is funneled towards pharmaceuticals that control symptoms or markers because that’s where the money is; very few people study diet because they can’t get paid to do so. It’s a cynical belief but one I’ve come to believe is accurate.

      And like most of such pharmanoiic beliefs, it’s self-confirming and a bit masturbatory.

      Is it such a stretch to think that chronic inflammation from sugar might contribute to the development of cancer, particularly in light of the fact that most cancers use glucose as their fuel?

      Yes, yes it is. It’s quite a stretch to believe that sugar, an essential nutrient (even if not consumed, it must be produced) that we find delicious (and thus is highly evolutionarily important) and incredibly nutritious (in natural forms like fruits and vegetables) and strongly associated with the prevention of cancer, might promote cancer.

      I’m talking about limiting the actual substance that the majority of cancer cells feed on by a method that isn’t invasive and isn’t toxic with the only downside being you can’t

      You’re also limiting a substance that is delicious, but is also an important fuel for the whole body while it is undergoing the metabolically-taxing process of fighting off cancer. On the basis of an idea that ultimately just isn’t quite convicing and the data hasn’t proven effective yet.

      Look – a low carb diet helped you lose weight. That doesn’t mean it cures cancer, and it doesn’t mean it even helps other people lose weight. Take the win – you’re 40 pounds lighter and you’ve stayed there. Don’t over-reach. Or at least, don’t do it here.

    3. MadisonMD says:

      …your response is so typical of what we get from the medical community…

      Have you considered it possible that there is a reason why many members of the medical community who are trained in and treat cancer, including dieticians, typically hold this expert opinion?

      I don’t want to get into a statistical bugaboo with you but my reading leads me to believe that cancer “survivorship” is up in the last 20 years due to people not being cured but just getting past some arbitrary period where the patient can be labeled a cancer survivor, only to succumb to the same disease at a later date. I think perhaps you and I probably have a different definition of “cured”.

      Your understanding is incorrect. In fact I explicitly selected mortality as the metric to avoid lead- and lag-time biases. It actually means that fewer people are dying of cancer and is not benchmarked to any diagnosis date. The definition of cured is immaterial to this metric. Your statements belie the high level of expertise you claim on cancer.

      But what gnaws on me a bit is that as a doctor you seem to be unaware that carbohydrates aren’t an essential macronutrient. Your liver does a fantastic job of creating all the glucose a person needs from protein via gluconeogenesis.

      Where did I imply that gluconeogenesis doesn’t exist?

      I’m left wondering what the thought process is if you believe avoiding foods that cause inflammation and chronic disease is going to ruin someone’s quality of life.

      Bananas cause inflammation and chronic disease? Citation needed, and even if true, how is that relevant to cancer patients? And why do you think dieticians specifically advise bananas for management of symptoms in cancer patients if it is, as you claim, harmful?

      However I’m sure I could have been one someday if I hadn’t stopped relying on the advice of the experts and started researching for myself.

      You cannot know whether or not you would have had cancer if you did something different. Although you could reduce your risk of cancer by avoiding obesity and smoking, for example, these do not prevent cancer. Part of cancer risk is avoidable. Much if it is just luck. Oh, and it depends strongly on age.

      Research today is funneled towards pharmaceuticals that control symptoms or markers because that’s where the money is; very few people study diet because they can’t get paid to do so. It’s a cynical belief but one I’ve come to believe is accurate.

      For cancer therapies, FDA requires demonstration of improved survival or, provisionally, on a known surrogate of of survival. When survival is not demonstrated, the FDA revokes approval, regardless of surrogates. Elsewhere on this blog, other commenters deemed the FDA as being too restrictive about drug approvals, but I think this is a fair benchmark. But I agree with you that pharmaceuticals are out to research drugs, including vitamins, from which they can make money. Your statement merely argues for improved public funding of research, where the profit motive is absent. Please feel free to write your congressperson about the flat National Cancer Institute budget (declining in constant dollars) over the past decade. Also feel free to donate to private foundations for cancer research such as the American Cancer Society.

      As I said I began my own research and that eventually led me to carbohydrate restriction to avoid of elevated blood sugar, high insulin levels and chronic inflammation. And wouldn’t you know it after adopting this way of eating my asthma and hand tremors disappeared, I’ve dropped the 40 pounds and I have constant energy out the ying yang. Now I can hear you now – “sure but that’s just anecdotal” and you’re right, it is. But the thing is there are a lot of people out in the blogosphere who have had the same improvements and their collective impression of the medical community is you’re part of the problem and not the solution. And I have to agree.

      If you lose weight and improve your health, by whatever diet possible, and moreover, maintain a healthy weight thereafter, then I agree! It might not be the only diet that accomplishes this, but it certainly appears to be a good option. But didn’t you also claim that somehow this is good for cancer patients? The very patients who are, depending on their specific situation, at risk of weight loss and even cachexia? [Incidentally, you should realize that this site is ScienceBasedMedicine and is dedicated to evaluating the scientific validity of health and medical-related concepts. Belief in a fact by many people in the blogosphere is not sufficient to conclude there is good scientific evidence... for obvious reasons.

      I’ve seen stunning improvements in peoples’ health – heart disease, diabetes, asthma and a whole host of other conditions have reversed by limiting blood sugar levels. Is it such a stretch to think that chronic inflammation from sugar might contribute to the development of cancer, particularly in light of the fact that most cancers use glucose as their fuel?

      Is it a stretch? A bit, yes. First, there's gluconeogenesis which ensures that the cancer cells are nevertheless bathed in a constant about of glucose. [Didn't you castigate me for not knowing this?]. Second, I would anticipate some preliminary observational evidence of therapeutic effect in the many, many cancer patients who become ketotic from obstructions or inability to eat for a host of reasons under which this occurs. Beyond that, you are admitting that, this is your hypothesis. That is a great place to start, but not sufficient to make recommendations to treat cancer patients.

      I’m not talking about cannabis or carrot juice or whatever farfetched idea gets tossed out there…

      That’s amusing because some posters here are equally strident about trying Vitamin C for cancer (It’s harmless!, why not?), trying cannabis, homeopathy, and about a dozen diets that are actually incompatible with yours (Look here under ‘diet-based’). I suppose they might characterized your hypothesis as a farfetched idea.

      I am merely trying to gather the evidence supporting one or more of these diets or interventions prior to recommending it to cancer patients. What part of that do you find offensive? Do you really expect me to take the word of ‘Bob Johnston’ just because you say it is plausible and at the same time, ignore the equally strident pleas of ‘Peter H Proctor, PhD,MD’ because ‘Bob Johnston’ finds his ideas on vitamin C farfetched? After all, I do not often accept hypotheses just because a Nobel Laureate claims them. And if you want to attempt to establish yourself as an authority with hypotheses about cancer worth considering, you should at least brush up on cancer epidemiology a bit.

      And low carb diets do not cause kidney stones, it’s simply an oft-repeated wive’s tale.
      Odd, then, that researchers at Johns Hopkins felt need to test if they could reduce the risk of kidney stones in a clinical trial, isn’t it? I would suggest you contact Dr. Kossoff and let him know that he is unnecessarily doing research on something that is a wives’ tale. I would be obliged if you could share his reaction.

      1. Wow says:

        An interesting discussion from a bunch of anonymous pretend doctors and scientists who like to argue with people in their spare time.

        I hope people realize not to take anything posted here too seriously, its obviously not a place for constructive discussions.

        The danger with the comments on this site is you don’t know who is posting or if the information they are providing is correct, and the topics covered tend to have a controversial one-sided view to begin with.

        I suggest you look elsewhere and converse with professionals who aren’t afraid to disclose their true identity.

        1. weing says:

          “I suggest you look elsewhere and converse with professionals who aren’t afraid to disclose their true identity.”
          Great advice. If by that, you mean see your doctor for this information.

        2. WilliamLawrenceUtridge says:

          An interesting discussion from a bunch of anonymous pretend doctors and scientists who like to argue with people in their spare time.

          And

          I suggest you look elsewhere and converse with professionals who aren’t afraid to disclose their true identity.

          I suppose, like Madonna, you go by a mononym, and your parents were really impressed with you when you were born? Or perhaps you’re merely a hypocrite?

          Further, Robert Young has disclosed his true identity, and he’s a menace. Same with Frank Arguello. Knowing someone’s true identity is no guarantee they aren’t a dangerous quack. That’s why the gold standard is the peer-reviewed evidence, not someone’s opinion.

          I hope people realize not to take anything posted here too seriously, its obviously not a place for constructive discussions.

          Correct. This is a place where evidence-based discussions that accord with well-understood principles of biology and respect for reality are given pride of place. This is not a place where you will be cheered and encouraged for following irrational, superstitious and unproven alleys of thought.

          The danger with the comments on this site is you don’t know who is posting or if the information they are providing is correct, and the topics covered tend to have a controversial one-sided view to begin with.

          Yes, that one of the very, very good reasons why you shouldn’t solicit advice from the internet in general, not merely here. And anyone giving you medical advice over the internet is acting unethically.

          Do you have anything of substance to contribute, or merely some more platitudes to offer?

      2. Bob Johnston says:

        Well this is getting fun.

        Your statements belie the high level of expertise you claim on cancer.

        I have represented myself as no such thing. What I am is an outsider who’s noticed that modern medicine’s failure rate of curing (or god forbid, preventing) chronic disease is dismal. Perhaps it takes an outsider (meaning someone with no financial or reputational interest in the status quo) to recognize that fact.

        Where did I imply that gluconeogenesis doesn’t exist?

        I guess it was when you went out of your way to end your prior response to me with the overly dramatic notion that people will suffer a regression in their quality of life if they can’t eat bananas and bread and other such crap while enjoying the company of their grandchildren during a tranquil sunset.

        Bananas cause inflammation and chronic disease? Citation needed, and even if true, how is that relevant to cancer patients?

        Fructose is a toxin that’s metabolized hepatically, unfortunately it’s chronic and not acute so the effect isn’t noticeable except over the years. If you don’t want to take my word about the harmful effects of fructose (and elevated glucose) then perhaps you’ll listen to Robert Lustig’s lecture on fructose and its effects.

        https://www.youtube.com/watch?v=dBnniua6-oM

        And being aware of the effects of carbohydrates and the resultant elevation of blood sugar and inflammation is important to cancer patients because there’s a decent amount of evidence that cancer is not a genetic disease but a disease caused by damaged mitochondria. This damage leads to the retrograde response to kick in and fermentation (along with its unfortunate byproducts) becomes the only option left for the cell to continue life.

        Obviously inflammation is not the only way cancer can develop, there’s also radiation, toxic chemicals and viruses as well but controlling blood sugar by not eating foods that elevate it (the carbs you’re so fond of) is an excellent way to prevent an environment that promotes inflammation and disease.

        Please feel free to write your congressperson about the flat National Cancer Institute budget (declining in constant dollars) over the past decade. Also feel free to donate to private foundations for cancer research such as the American Cancer Society.

        Yes, it’s totally my fault that these groups have essentially spun their wheels all these years because I didn’t spearhead funding drives for them.

        The very patients who are, depending on their specific situation, at risk of weight loss and even cachexia?

        Risk of weight loss? Sounds ominous. I think we should define what we mean by weight loss. If we’re talking about the loss of lean body mass then I agree that’s bad and should be avoided. But if we’re talking about 50 pounds of adipose tissue hanging over a person’s belt then you’re going to have a tough time convincing me that losing that belly fat would be detrimental to the health of a cancer patient.

        A ketogenic diet does not lead to the loss of muscle, quite the opposite. What it does is lead to a loss of visceral fat, the type associated with chronic disease like heart disease, metabolic syndrome, diabetes and cancer.

        As far as I know the mechanism for cachexia isn’t understood very well but there’s evidence linking it to inflammatory cytokines which leads me full circle back to damaged mitochondria.

        Is it a stretch? A bit, yes. First, there’s gluconeogenesis which ensures that the cancer cells are nevertheless bathed in a constant about [sic] of glucose.

        I agree, gluconeogenesis is a problem. Frankly I don’t believe that “starving” a tumor is possible; once the tumor has formed the damage is done and all that’s left is to do one’s best to minimize the damage. I don’t advocate not undergoing conventional treatment (as long as the treatment doesn’t make things worse), I simply feel any treatment should be augmented with an inflammation reducing ketogenic diet. Blood sugar at 80 is a far sight better than blood sugar at 100 or higher. Can we agree on that at least?

        Second, I would anticipate some preliminary observational evidence of therapeutic effect in the many, many cancer patients who become ketotic from obstructions or inability to eat for a host of reasons under which this occurs.

        I freely admit I have no info on this but I sometimes wonder if chemo is more effective in people who are too nauseous to eat than the people who do their best to follow their dietitian’s advice to eat their “healthy whole grains”. It would be interesting to find out more.

        Beyond that, you are admitting that, this is your hypothesis.

        Actually I’m not admitting that. I wish it were my original idea but it’s pretty obvious that Thomas Seyfried, the subject of the original post, arrived at this hypothesis long before I stumbled across it. And who knows, perhaps he got it from someone else who we never heard about because he couldn’t get any funding or board approval to actually do some studies. When the standard of care says drugs, radiation and surgery are the proper (and only) course of treatment, how is anyone ever going to be able to study diet? The only info you’ll see is anecdotal info from people like Aoife which people in the medical profession are quick to shrug off (admit it, you’ve already forgotten about his story, haven’t you?).

        Do you really expect me to take the word of ‘Bob Johnston’ just because you say it is plausible and at the same time, ignore the equally strident pleas of ‘Peter H Proctor, PhD,MD’ because ‘Bob Johnston’ finds his ideas on vitamin C farfetched?

        I’m sorry if Peter H Proctor is offended but since I never said anything about vitamin C treatment being farfetched then I think his resentment towards me is misplaced. Perhaps he should be mad at the guy who lumped his hypothesis in with cannabis and homeopathy (something else I never mention, btw). I understand putting words in people’s mouths to make a point look stronger but just understand I recognize when it’s happening and I’m usually going to point it out.

        After all, I do not often accept hypotheses just because a Nobel Laureate claims them.

        This is obvious as you appear to completely dismiss the the Warburg Effect. But I wish you luck with your drug treatment research.

        1. weing says:

          “I have represented myself as no such thing. What I am is an outsider who’s noticed that modern medicine’s failure rate of curing (or god forbid, preventing) chronic disease is dismal. Perhaps it takes an outsider (meaning someone with no financial or reputational interest in the status quo) to recognize that fact.”

          So this qualifies you as an expert in recognizing medicine’s failure rate? This also apparently magically qualifies you to know that you are asking the right questions about it. How do you answer someone on an airplane asking where to sacrifice the goat for a safe landing? What is reputational interest in the status quo? Is it different from the avante garde? How about it takes someone, or better yet a group of people, with a thorough knowledge of the various disciplines involved in treating a disease, let their minds wander and tinker to see if they can come up with some ideas that they can then put to the test?

          1. Bob Johnston says:

            So this qualifies you as an expert in recognizing medicine’s failure rate? This also apparently magically qualifies you to know that you are asking the right questions about it. How do you answer someone on an airplane asking where to sacrifice the goat for a safe landing?

            So I back the idea that limiting the substance (glucose) that cancer uses for fuel is a good idea to explore and you compare that to sacrificing a goat to safely land a plane? Interesting… and amusing.

            What is reputational interest in the status quo?

            A good question, allow me to explain. Say you’re a general practitioner who has for 30 years been telling your patients that they need to watch their cholesterol by eating a low fat diet, replacing saturated fat with vegetable oils and taking a statin. Suppose new evidence comes out that cholesterol is actually a good samaritan when it comes to heart disease and has gotten a bad rap. Suppose evidence comes out that High Omega 6 vegetable oils actually are linked to higher levels of heart disease. Suppose evidence comes out that people with higher cholesterol actually live longer and that statin side effects have been vastly under-reported, making them not only a waste of money but actually detrimental to the patients who followed the doctor’s advice.

            Do you think this doctor, who’s been giving this awful, rotten advice for 30 years is simply going to accept that his life’s work has actually made his patients worse? No way, his own view of himself would be devastated, he will blow off the new evidence and its presenters as snake oil salesmen, secure in his little cocoon of self-deception that his life’s work wasn’t wasted.

            1. Harriet Hall says:

              Despite the scenario you describe, doctors regularly DO follow the evidence and change the advice they give. Science-based doctors’ self image should not be threatened by recognizing that better evidence has come along. They needn’t say “I’m a terrible person and I was wrong.” They can say “I have always tried to do my best to follow the available evidence and I’m glad that this new evidence will allow me to change my practices and offer my patients better advice.”

              1. Bob Johnston says:

                Harriett – if what you say is true then why do doctors still prescribe a low fat, high carb diet and statins? My example above wasn’t snatched out of thin air, it’s really the truth.

                I like this video a lot, done by a pediatrician, because it explains quite a few concepts that people don’t really understand – the difference between absolute risk and relative risk (relative risk alone is meaningless), what the number needed to treat (NNT) and the number needed to harm (NNH) are and also does a nice job showing why taking statins is a very bad idea. The thing is, if an interested layman like me knows this stuff, shouldn’t all doctors?

                https://www.youtube.com/watch?list=UUabaQPYxxKepWUsEVQMT4Kw&v=e_ytF2-4NkI

                Of course doctors sometimes have their hands tied because of a thing called the “standard of care”. This is a course of action that is prescribed by some group of experts and if your doctor deviates from it he can be sued if there is a bad outcome. Following the standard of care takes the decision out of a doctor’s hands and effectively covers his ass. In the case of statins the standard of care was developed by the 9 members of the National Cholesterol Education Program, of which 8 of the members take money from drug companies. If you don’t think that arrangement reeks to high heaven then your olfactory sense ain’t working.

              2. KayMarie says:

                Harriett – if what you say is true then why do doctors still prescribe a low fat, high carb diet and statins? My example above wasn’t snatched out of thin air, it’s really the truth.

                There is research being done into how to disseminate new findings and how to get all doctors to implement the new findings.

                Unfortunately it isn’t as easy as just publishing a new guideline. Getting that information spread to all the doctors in all the practices in all the world is not the simple or easy exercise one might think.

                Doctors are not robots who immediately implement the new programing because a white paper is published.

                They have all the same human failings that the rest of us have and it brings to mind the metaphor of getting any group of humans to do anything is like herding cats. There are always those who do not want to change their ways, and those who do not want to do what the authorities tell them to do.

                Expecting doctors to not have the full range of human reactions to changing their ways…well that isn’t going to get you very far. Dissemination and Implementation is currently a fairly hot area of research to get funding for because it is considered difficult to get new information to all doctors and then get all doctors to change what they do. (and you will never get all of them, someone will always be the contrarian, the gadfly, the one who bucks the system).

                FWIW, having gotten the lower fat diet advice at the height of it, what most humans do with the information of that style of eating does not really resemble the actual recommendations. Humans still want to eat junk.

                FWIW the low fat, high fiber actually worked to lower my cholesterol that was artificially being raised to a scary level by a medication, once I stopped that med I was down to 160 total cholesterol in an astoundingly short period of time and it rebounded as soon as I stopped eating that way. But I wasn’t doing the standard American approach to eating all the snackwell cookies I wanted because they were labelled “low fat”.

                I still eat pretty well compared to most people, but I tend to crave more variety than most any restrict particular food group diet allows.

              3. WilliamLawrenceUtridge says:

                Harriett – if what you say is true then why do doctors still prescribe a low fat, high carb diet and statins? My example above wasn’t snatched out of thin air, it’s really the truth.

                I think the truth is that the evidence is complicated and being continuously re-evaluated, and that cholesterol skeptics are a vast bunch of nutters about as helpful to the debate and prolific in the scientific literature as climate change denialists.

                I like this video a lot, done by a pediatrician, because it explains quite a few concepts that people don’t really understand

                Does this pediatrician prescribe a lot of statins? Becuase thats more of a bug than a feature.

                The thing is, if an interested layman like me knows this stuff, shouldn’t all doctors?

                Well two points:

                1) Doctors have a much broader area to cover; you are claiming expertise in a tiny portion of the entire human body while they have to address the whole thing; and

                2) Doctors do know this, in aggregate, from a much broader perspective that includes all the people who disagree with your gurus. The thing is, you proclaim to have received the truth as revelation – but what you’re really getting are iconoclasts (most of whom are probably selling a book, a tour or a bottle of coconut oil) that usually don’t publish in the scientific literature and don’t reference or engage with people who disagree with them. Oh, and often present cartoonishly simple versions of the actual complex debates, for people like you who don’t understand enough about the body to see why their claims are false.

                In the case of statins the standard of care was developed by the 9 members of the National Cholesterol Education Program, of which 8 of the members take money from drug companies. If you don’t think that arrangement reeks to high heaven then your olfactory sense ain’t working.

                While conflicts of interest can indeed be a problem, the idea that you can use “I got grants from Pfizer” as an excuse to ignore the entirety of the medical literature to support a pre-existing conclusion is lazy and fallacious. COIs are a reason to be concerned, not a reason to create your own reality.

              4. Bob Johnston says:

                Whoa Harriet, you’re all over the place.

                First off, why would I care about studies being done to disseminate new info to doctors? I care about the actual information that is being spread.

                You say that doctors are not robots but unfortunately that’s exactly what they are. If they’re employed by a hospital then they do what they’re told and if they’re in private practice they follow the standard of care, whether it’s right or wrong. There’s no thinking outside the box going on here.

                Um, so you were taking a medication that elevated your cholesterol and when you stopped the medication it went back down yet you’re chalking that up to your diet. That makes sense to you?

                Billy – I see you’re still jibber jabbering about – this made me actually laugh out loud.

                ignore the entirety of the medical literature to support a pre-existing conclusion is lazy and fallacious.

                Tell you what sport, why don’t you lay some of this evidence on me that cholesterol causes heart disease, it should be very easy if it’s so prevalent in the entire medical literature. And while you’re at it, because you brought it up, perhaps you can explain to me how CO2 can be such a potent greenhouse gas when there hasn’t been an increase in temperatures for almost 18 years now (as shown by the RSS satellite dataset) despite CO2 concentrations continuing to move higher during that period. I’ll be waiting patiently for your response, it should be child’s play for someone with your awesome intellect.

              5. WilliamLawrenceUtridge says:

                You say that doctors are not robots but unfortunately that’s exactly what they are.

                You know how suffiicently advanced tech is indistinguishable from magic? You might be an example of sufficiently advanced knowledge being indistinguishable from indifference. Merely because you do not understand the clincial reasoning of a doctor doesn’t mean that your opinion is automatically right.

                There’s no thinking outside the box going on here.

                Again, that’s a feature, not a bug. When most of your problems are inside the box, that’s where you have to think. Do you really think that most patients present like what you see on House or something? Most patient complaints are routine and banal, and don’t need exotic tests or thinking. And part of the issue is how the box is built – if it is ever conclusively proven that a ketogenic diet is superior to conventional care for any reason, it becomes part of the box and is used along with other treatments. However an unfortunate reality is apparently that ketogenic diets are difficult to stick with, particularly over the long-term, making it a largely ineffective treatment in the end.

                Tell you what sport, why don’t you lay some of this evidence on me that cholesterol causes heart disease, it should be very easy if it’s so prevalent in the entire medical literature.

                Oh, no, I won’t do that. See, the medical literature is vast and complicated. You need years of study just to develop the background in order to even understand the issues – epidemiology, nutrition, biochemistry, cardiology, etc. I would never have the temerity to think that I would ever have the time or ability to understand it as well as a postdoc, let alone an actual senior researcher. Instead I defer to them, I trust them, because they spend their whole day studying it, publishing about it, interpreting it, teaching about it, and creating it. No, you’d have to be an idiot to think that as an amateur you can simply “get it” enough to make broad, sweeping statements about how wrong it is. The kind of guy who would read one or two popular books written from the same perspective, published in some sort of popular or second-string press, and decide that’s the truth. And that’s not me, I listen to the experts.

                And while you’re at it, because you brought it up, perhaps you can explain to me how CO2 can be such a potent greenhouse gas when there hasn’t been an increase in temperatures for almost 18 years now (as shown by the RSS satellite dataset) despite CO2 concentrations continuing to move higher during that period. I’ll be waiting patiently for your response, it should be child’s play for someone with your awesome intellect.

                Ahahhahahahahaha you’re a climate change denier too!

                Dude, merely because an idea is not mainstream doesn’t mean it’s right. In fact, quite the opposite – mainstream ideas are generally correct, the iconoclasts are usually jerking you around or simply wrong.

                Are you also a Peter Duesberg fan?

              6. KayMarie says:

                @ Bob Johnston

                Didja notice that I’m not Harriet? Well I’m taking that as a complement, not sure if Dr Hall will. :-)

                You asked a question that sounded like how could a doctor give out old/outdated information. Especially now that Mediterranean higher in the right fat diets seem to be more the direction medical information is going.

                I replied that based on some of the research we do here with practices that even when you look at standard of care and updated guidelines for how to practice medicine you will find plenty of issues with getting the new and updated information out to the doctors.

                Don’t assume just because your doc said it, it is the current standard of care document.

                Even if you created the bestest most perfectest information in all the world that would heal all people…you’d still have problems getting it to change practice behavior all over the country all at once. Even after years of work you’d still have doctors doing it the old way. Some changes are a lot harder than others, and most need support systems that aren’t available to all practices. Too often it seems people get whatever the standard of care was when the doc finished their training. Some are better than others at keeping up, but you can’t assume they are all changing in lockstep.

                You’d be surprised how far off from standard of care a lot of doctor are. Sometimes for good and sometimes for not so good, depending. Also how many doctors are removed from the profession for quackery and other non-standard practices. Really not that many.

                So can a low fat diet work.

                Time point 1. Cholesterol about 300 Family history of Cholestoerol about 190-200.

                Time point 2. After the diet still about 290-300, at this point stop taking medication.

                Time point 3. On diet Low fat high fiber (not just all the sugar I want, but veggies and extra fiber and all that with a good balance of lean protein). This is 3 months after drug stopped,
                I’m at 160 for total cholesterol.

                Time point 4-100. Not really following the diet. not on the medication. Cholestrol 190-200, but when I was doing Portfolio diet for a bit (also just hard to follow for too long for me and I like lean animal protein too much) numbers were lower than usual, but not the 160.

                Now it could be that 160 was a lab screw up, but I also know it was taken at a time when my diet was unusual and I wouldn’t expect my high to go way low before normalizing. Which could be a wrong expectation.

        2. MadisonMD says:

          Thanks for your reply. Bottom line: this is a hypothesis. The Warburg Effect is more than that… it is supported by data (who is putting words in others mouths?), but might not operate in every circumstance.

          Many posters put up their favorite hypothesis here. Peter Proctor about Vitamin C. Jo about weed. You are no different than the rest. I understand it makes sense to you and you believe it. But without hard data, that is not enough.

          Some of the many cancer diets proposed are actually incompatible. I don’t really find it plausible that blood sugar of 80 versus 100 would make a substantial difference. Metformin would accomplish this and has been fairly ineffective as an antineoplastic, thus far.

          If you or others provide good evidence supporting this particular hypothesis, I’ll change my mind. You’ve admitted multiple times you don’t and the ideas boil down to ‘it could work.’ So for now, it’s just that. Given the lack of observational evidence and related data (e.g. metformin) that I am aware of, I would handicap as unlikely but I realize you are much more sanguine. I would also want to know which cancers it is likely to work for, and how persistent and severe the ketosis would need to be.

          Not sure why you and others are offended by a medical professional not accepting a hypothesis that is not adequately tested. This is one of many. You think Pfizer would have an easier time convincing me? Not likely. Anyway, this isn’t going anywhere so good luck.

          PS, what did Kossoff say?

        3. WilliamLawrenceUtridge says:

          I have represented myself as no such thing. What I am is an outsider who’s noticed that modern medicine’s failure rate of curing (or god forbid, preventing) chronic disease is dismal. Perhaps it takes an outsider (meaning someone with no financial or reputational interest in the status quo) to recognize that fact.

          Being an outsider is a detriment if it means you lack the understanding of an insider. Based on your comments, you are sitting at the sweet-spot of Dunning-Kruger, having just enough awareness of one tiny slice of medicine, anatomy and physiology to get into trouble, but not enough to get yourself out, and therefore having the arrogance to believe that you understand everything.

          But hey, go to school, get a relevant PhD and you’ll be an insider, and understand why people don’t take the ketogenic diet particularly seriously.

          I guess it was when you went out of your way to end your prior response to me with the overly dramatic notion that people will suffer a regression in their quality of life if they can’t eat bananas and bread and other such crap while enjoying the company of their grandchildren during a tranquil sunset.

          I believe the point is “if it’s your last months on earth, you shouldn’t be miserable on an all-meat diet”. Particularly when the evidence for that diet is slim to none and the promoters of that diet are not doctors or researchers.

          Bananas and bread are not crap, they are delicious gustatory pleasures that you denigrate because of your near-religious beliefs about the magic of ketogenesis. And I would suggest that you have to denigrate them, because otherwise you would be tempted to eat them.

          Fructose is a toxin that’s metabolized hepatically, unfortunately it’s chronic and not acute so the effect isn’t noticeable except over the years. If you don’t want to take my word about the harmful effects of fructose (and elevated glucose) then perhaps you’ll listen to Robert Lustig’s lecture on fructose and its effects.

          Ahahaha no it isn’t. Fructose is a naturally-occurring sugar that humans consider delicious because it is a source of valuable energy and is usually accompanied by significant vitamins and fiber. Yes, if you eat pure fructose in large quantities, it’s not great for you – but the same thing can be said of anything, including fats and proteins. Fructose actually has a low glycemic index, far lower than pure glucose, and can play a significant role in maintaining stable blood sugar. Lustig isn’t quite a quack, but his popular lectures are not taken seriously.

          And being aware of the effects of carbohydrates and the resultant elevation of blood sugar and inflammation is important to cancer patients because there’s a decent amount of evidence that cancer is not a genetic disease but a disease caused by damaged mitochondria

          Yeah, not it’s not. Cancer is caused by disordered and damaged genes that lead to undifferentiated division. It’s very much a result of damaged mitochondria.

          Seriously, just because an idea is iconoclastic doesn’t mean it is right.

          Obviously inflammation is not the only way cancer can develop, there’s also radiation, toxic chemicals and viruses

          Yes, and what do all of those three things have in common? They disorder and damage genes. Because that’s what causes cancer.

          But if we’re talking about 50 pounds of adipose tissue hanging over a person’s belt then you’re going to have a tough time convincing me that losing that belly fat would be detrimental to the health of a cancer patient.

          Well that would mostly be because you think cancer is caused by inflammation and generally don’t appear particularly well informed on the topic. Did you know, for instance, that while high obesity is associated with an increased chance of developing sometimes of cancer, there is evidence it is also associated with increased survival while you have cancer? In some cases, survival is increased five-fold. It’s called the “obesity paradox”.

          A ketogenic diet does not lead to the loss of muscle, quite the opposite. What it does is lead to a loss of visceral fat, the type associated with chronic disease like heart disease, metabolic syndrome, diabetes and cancer.

          Evidence please. My understanding is that exercise is primarily what drives lean body mass.

          which leads me full circle back to damaged mitochondria.

          Know what the Texas Sharpshooter fallacy is?

          Thomas Seyfried, the subject of the original post, arrived at this hypothesis long before I stumbled across it.

          And why does nobody take Seyfried seriously? Oh, that’s right, conspiracy. Or…is it that they are too focused on cancer as a genetic disease? Or because they’re all so narrow-minded. But right after this comment, you claim that it is because funders are too focused on chemo, radiation and surgery (which, by the way, have extensive proof of actually treating, often curing, cancer). Yeah, it’s all prejudice and spite, it’s certainly not because Seyfried’s ideas have very little empirical support, even less good-quality support, and Seyfried is too busy giving public lectures to work up some convincing evidence. Because nobody has heard of the Warburg effect but him, despite Otto Warburg being awarded the Nobel Prize in 1931.

          The only info you’ll see is anecdotal info from people like Aoife which people in the medical profession are quick to shrug off (admit it, you’ve already forgotten about his story, haven’t you?).Yes, and why do doctors shrug off this “evidence”? Because, as I said to Aoife, the people who had cancer and tried the ketogenic diet and then died can’t provide anecdotes. Anecdotes are at best hypothesis-generating, because they’re cheap, easy, and systematically deceptive – you rarely hear from people who were burned by a Ponzi scheme, or CAM nonsense, or the relatives of those who died.

          This is obvious as you appear to completely dismiss the the Warburg Effect. But I wish you luck with your drug treatment research.

          People have been aware of the Warburg effect for over 80 years now. Pubmed has nearly 1,000 citations. Despite all that interest, it hasn’t been turned into support for the ketogenic diet yet. Though I will point out, others than Seyfried are actually researching the idea the way cancer researchers should.

          Also I’ll point out again that cancer isn’t one thing. Cancer varies by tissue type, staging, location, etc. and is united by one thing – derangements of genetics. So even if the ketogenic diet works for some cancers, it is unlikely to ever be a cure for “cancer” overall.

          1. MadisonMD says:

            I cannot understand the logic here. How does one link the concept of fructose as a toxin a la Lustig, with bananas and bread (hint: not fructose) as a cancer-causing toxin due to inflammation*, with the therapeutic effect of avoiding bananas and bread because cancer cells using the Warburg effect will starve if you avoid all carbs because, although they can metabolize glucose at 100 mg/dL, they would not be able to maintain viability with 80 mg/dL**. These are three different proposed mechanisms to support the hypothesis that avoiding carbs is good the first of which would not imply complex carbohydrates are detrimental.

            *Inflammation, i.e. immune response to cancer can actually have anticancer effects. Medications that actually increase inflammation have been recently discovered to have anticancer effects. See here and here. So if sucrose increased inflammation to a significant effect, it might actually be helpful to treat cancer, but I doubt it really has much effect on inflammation… perhaps a bigger effect on obesity and diabetes.

            **If so, I’d expect to see some routine effects on the occasional unfortunate hospice patient who is unable to eat.

            1. Bob Johnston says:

              I cannot understand the logic here.

              I can see how that would happen if the description that followed is what you think I was saying.

              and bread (hint: not fructose)

              No duh.

              *Inflammation, i.e. immune response to cancer can actually have anticancer effects.

              If this is true I would say it might have something to do with how non-robust cancer cells are. Anything that’s relying on fermentation is hanging by a thread. That’s why chemo works, it kills off cancer cells before it kills off healthy cells (but I suppose you already knew that).

              So if sucrose increased inflammation to a significant effect, it might actually be helpful to treat cancer

              Since the diet that people end up eating due to nutritionists’ recommendations actually does bathe their bodies in glucose I think we can pretty much disregard that hypothesis because it’s obviously not working.

              …avoiding carbs is good the first of which would not imply complex carbohydrates are detrimental.

              I think you’re finally getting it. Complex carbohydrates (whole wheat in particular) are some of the worst foods (and I use the word foods just for the lack of a better word) a person can eat. Not only are they full of proteins our bodies are not adapted to metabolize properly, they also spike blood sugar higher and longer than eating plain table sugar. Whole wheat bread has a glycemic index in the low 70′s, sucrose is 68. Eating whole wheat bread or sugar cubes is very much the same thing once your body has digested them. Now maybe you really think that bathing your body’s cells in high amounts of glucose for several hours after every meal is benign, I don’t, but what the f#ck do I know? I don’t wear a white lab coat every day at work.

              1. Harriet Hall says:

                I didn’t know there were proteins our bodies were not adapted to metabolize properly. Please identify some of them and explain their metabolism and how the improper metabolism harms the body. Please explain how that claim can be reconciled with your subsequent statement that whole wheat bread and sugar are very much the same thing once the body had digested them. Doesn’t the body break all proteins down into amino acids for absorption?

              2. MadisonMD says:

                You haven’t really engaged the critiques including lack of observational data on starving cancer patients, metformin, the unclear mechanism for what you are proposing, and the anticancer effects of ‘boosting the immune system’ by specific medical therapies (not chemo). Nor have you provided good supporting evidence for your hypothesis.

                If cancer cells were hanging by a thread, as you say, it would probably be a lot easier to cure cancer and perhaps HeLa would not be alive… Also, we would have to point out that the brain is hanging by the same thread so cutting the thread might have unwanted effects.

                The part where you say you think I’m getting it is amusing, because that is where I was restating your hypothesis not agreeing with it:

                These are three different proposed mechanisms to support the hypothesis that avoiding carbs is good the first of which would not imply complex carbohydrates are detrimental.

                But I try to be reasonable and reconsider my ideas when faced with contrary evidence.

                Now maybe you really think that bathing your body’s cells in high amounts of glucose for several hours after every meal is benign, I don’t, but what the f#ck do I know?

                Well, that is a bit of a strawman argument. I think we can agree that insulin resistance, glucose intolerance, and diabetes have negative health effects and are exacerbated by high load of simple sugars, which is what I think Lustig is saying. Also high enough blood sugars can certainly make cancer patients prone to infection. I don’t think complex carbohydrates are so sinister since it takes a while to digest/absorb them (except perhaps too much in diabetics), nor do I think that glucose has a significant direct effect on cancer despite the anerobic metabolism used by cancer (and the brain). [(I might also agree a bit with what the f#ck do you know part. Sorry, couldn't resist. :) ].

              3. MadisonMD says:

                Eating whole wheat bread or sugar cubes is very much the same thing once your body has digested them.

                So if you are avoiding foods with high glycemic load (and I fully agree with you that this a healthy choice given the incidence of diabetes, glucose intolerance, and metabolic syndrome), then you might <a href="“>choose carbs with low (<11) or medium (11-19) glycemic load:
                Apple
                banana
                pear
                grapes
                waffles
                barley or pumpernickel bread
                chikpeas
                kidney beans
                carrots
                etc.
                (see here for list of foods with glycemic load.)

              4. Andrés says:

                @Dr. Hall. About the digestion of vegetable protein I will focus on gluten. From Hausch et alter (via Julianne Taylor:

                We showed that these proline-glutamine-rich epitopes are exceptionally resistant to enzymatic processing.

                We had traditionally developed methods to predigest on purpose it seems. From Di Cagno et alter:

                This work was aimed at producing a sourdough bread that is tolerated by celiac sprue (CS) patients. Selected sourdough lactobacilli had specialized peptidases capable of hydrolyzing Pro-rich peptides, including the 33-mer peptide, the most potent inducer of gut-derived human T-cell lines in CS patients.

                Of course it seems safer skipping gluten all together. It seems that we have downgraded our bread production methods to less safe ones.

                Digestion resistant protein doesn’t happen only with some vegetable proteins but also with some of animal origin. From Sánchez-Rivera et alter about blue cheese:

                Peptidomic profiling of digests revealed several regions that are especially resistant to digestion (among them β-casein 60–93, 128–140, and 193–209). Some of them correspond to well-conserved regions between species (human, cow, sheep, and goat) and include peptide sequences with reported bioactivity.

                At least in milk case they seemed to have been selected for in our (offspring) benefit. I am not driving down my cheese intake in the near future.

                What it seems problematic with gluten is its effect in zonulin release in susceptible individuals such as those finally developing celiac disease or type I diabetes. From Dr. Fasano’s paper:

                Among the several potential intestinal luminal stimuli that can trigger zonulin release, we identified small intestinal exposure to bacteria and gluten as the two more powerful triggers (Fig. 7).

                By the way I occasionally eat dairy ice cream with sugar and drink beer.

              5. Bob Johnston says:

                You haven’t really engaged the critiques including lack of observational data on starving cancer patients, metformin>/i>

                Well since you didn’t present any evidence that I saw to back up your case I didn’t see any need to talk about it. Or did you expect me to research your criticism and then research my response? I will say that Metformin is a very poor medication when it comes to controlling diabetes, I’m not surprised it has little effect on cancer by itself.

                the unclear mechanism for what you are proposing

                I’m not proposing anything other than not blowing off Seyfried’s hypothesis. Do I need to be an expert cancer researcher to think it a good idea to look into something as basic as a diet that limits most cancer cells’ fuel and has an excellent track record with other chronic diseases?

                Also, we would have to point out that the brain is hanging by the same thread so cutting the thread might have unwanted effects.

                Actually most brain cells do very well using ketones for fuel – there a some holdouts that require glucose but not the entire brain.

                I think we can agree that insulin resistance, glucose intolerance, and diabetes have negative health effects and are exacerbated by high load of simple sugars, which is what I think Lustig is saying.

                I’m ecstatic we finally have some common ground but Lustig is not talking about simple sugars at all. Lustig is all about fructose, which is actually fairly low on the glycemic index. Fructose is about 25, which is why table sugar (a 50/50 mix of glucose to fructose) and high fructose corn syrup (45/55 mix of F to G) are lower on the GI than simple and complex carbohydrates. Fructose is metabolized by the liver (perhaps not coincidentally where toxins end up as well) and follows a much different pathway in the body than glucose. They are two different things and should be treated as such.

                nor do I think that glucose has a significant direct effect on cancer despite the anerobic metabolism used by cancer

                Like I said, I would just like to see hypotheses not discarded before the actual studies have been done.

              6. WilliamLawrenceUtridge says:

                . Anything that’s relying on fermentation is hanging by a thread. That’s why chemo works, it kills off cancer cells before it kills off healthy cells (but I suppose you already knew that).

                It’s amazing that cancer cells, apparently hanging by a thread, manage to be so aggressive as to kill their hosts.

                And the way chemotherapy usually works is by attacking quickly-dividing cells, which includes hair cells, gut cells and…cancer cells. Not fermentation.

                Also, not much in your body relies on fermentation. There are cells that rely on glycolysis, breaking a sugar molecule into two lactic acid molecules and producing 2 ATP molecules, but that’s not fermentation, and it can only be sustained in certain cells for limited periods of time.

                Since the diet that people end up eating due to nutritionists’ recommendations actually does bathe their bodies in glucose I think we can pretty much disregard that hypothesis because it’s obviously not working.

                So…unless a diet can cure or prevent all cancers it’s “not working”? What about purely genetic cancers like retinoblastomas?

                And what about the fact that ketogenic diets aren’t actually cures for all types of cancer?

                Not only are they full of proteins our bodies are not adapted to metabolize properly, they also spike blood sugar higher and longer than eating plain table sugar. Whole wheat bread has a glycemic index in the low 70′s, sucrose is 68. Eating whole wheat bread or sugar cubes is very much the same thing once your body has digested them. Now maybe you really think that bathing your body’s cells in high amounts of glucose for several hours after every meal is benign, I don’t, but what the f#ck do I know? I don’t wear a white lab coat every day at work.

                Sure, except for the fact that the fiber in whole grains slows the emptying of the stomach. Oh, and the glycemic index of glucose is 100. Incidentally, the GI of fructose, which I think you hate, is 11.

                Anyways, you’re basically getting into the realm of blatant lies here champ.

              7. WilliamLawrenceUtridge says:

                I’m not proposing anything other than not blowing off Seyfried’s hypothesis. Do I need to be an expert cancer researcher to think it a good idea to look into something as basic as a diet that limits most cancer cells’ fuel and has an excellent track record with other chronic diseases?

                I’ll just point out that Dr. Gorski is an expert on cancer, and that he notes there isn’t really good evidence that ketogenic diets are effective treatments. I agree with him, I poked around on pubmed for a bit trying to find clinical trials and came up with naught.

                I’m ecstatic we finally have some common ground but Lustig is not talking about simple sugars at all. Lustig is all about fructose, which is actually fairly low on the glycemic index. Fructose is about 25, which is why table sugar (a 50/50 mix of glucose to fructose) and high fructose corn syrup (45/55 mix of F to G) are lower on the GI than simple and complex carbohydrates. Fructose is metabolized by the liver (perhaps not coincidentally where toxins end up as well) and follows a much different pathway in the body than glucose. They are two different things and should be treated as such.

                Fructose has a low glycemic index because it must be metabolized by the liver before it becomes glucose – but at that point it does become glucose. Not sure where you’re getting this whole “toxin” thing from, except Lustig. I just hope he is as effective with scholarly audiences as he is with popular.

                Like I said, I would just like to see hypotheses not discarded before the actual studies have been done.

                That’s not how it works there champ – you don’t get respect and acclaim for proposing a hypothesis, you get it from testing and proving it. There are infinite possible hypotheses out there, if you want to make a positive claim, you need proof. So someone, perhaps Seyfried, needs to run some clinical trials rather than writing more popular books. If it works, great! Hopefully patient compliance is high.

                Respect is earned, not demanded.

  32. Philips says:

    The majority of posters on this site are guilty of groupthink, alternatives to the accepted solution are never considered and are subject to ad hominem attacks. Has anyone actually read the book being discussed? Has the author of this article read the book, or simply picked bits and pieces that make for an interesting discussion?

    Seyfried is a former cancer researcher from Yale University, he is a professor of biology at Boston College and the author of more than 150 PubMed indexed scientific articles. Does anyone in this discussion hold similar qualifications? No, then don’t pretend like you do, you’re just adding more to the growing amount of misinformation online. I doubt such professionals have time to waste arguing with random strangers endlessly, they are out there trying to make a difference and they have real names and real credentials.

    Anyone with legitimate questions regarding topics covered here should consult a real medical professional or their specialist who would be actually qualified to answer. Leave Gorski’s sheep and the conspiracy theorists to their squabble.

    Here’s a theory for you, in the case of cancer the ante is much higher since a huge industry would lose much of its income to an inexpensive diet therapy. Therefore, ulterior motives might more logically be placed at the feet of the expensive protocol apologists…

    Sadly, it’s because of the type of cynicism witnessed here that new and potentially effective protocols are never embraced. Now quote me and waste some more of your time with rebuttals and attacks that no one cares about, I hope it makes you feel like you have accomplished something for the day.

    1. MadisonMD says:

      All I would ask is for data supporting the hypothesis before putting it into practice.

      I agree with you here:

      Anyone with legitimate questions regarding topics covered here should consult a real medical professional or their specialist who would be actually qualified to answer.

    2. KayMarie says:

      Sadly, it’s because of the type of cynicism witnessed here that new and potentially effective protocols are never embraced.

      Oh, they are embraced, when they have the science to back them up. As much as some people love to point out the H. pylori study, or prions or any of the other “out of the box” science when they use the “they thought X was crazy and he was right” defense for whatever their pet theory is, they never seem to acknowledge that science and the science based critical, analytical, prove it to me types all changed their minds and practices once the evidence was in.

      Not before the evidence was in, not because if it is not mainstream it must be right, not because they liked the pretty picture the theory painted, or it felt like it had to be right….but because the people discovering the new and different thing went to work and did the hard job of rigorously testing the observation to ensure that the crazy idea was the one and only, necessary and sufficient, causal not not correlational, reality-based theory that fit.

      All the big advances in science that changed how people practiced medicine had to go through the hoops of being challanged and tested before adopted as the best practice we know of to this point in time. When the next new data comes in we will change our minds again, and again, decade after decade….abondoning that which did not work so well for that which works at least somewhat better.

      The anti-science brigade doesn’t do that. They cling to the same idea no matter what the evidence against it. Because they will never check to see when it didn’t work. They won’t check if A is more effective than B. Because abandoning the one true belief that you have the only cure in all the world is too painful.

      See everything thinks scientists think they have it right all the time. The more you do science the more you know that every single thing we know is incomplete. We know there is always a new discovery out there and we know that the only way to tell which one is the real breakthrough is to test it, again and again, in more and more detail. And even then, when we are sure, we look for what we missed. Because in that small thing missed is the seed of the next breakthrough.

      I don’t see alt med types moving on as new data comes in. Other than to massage the old data into some new fad diagnosis. Same symptoms, same things blamed for causing it, same supplements and diets proposed, but hey, you got a new name for why you aren’t feeling as well as you think you should.

      1. Bob Johnston says:

        All the big advances in science that changed how people practiced medicine had to go through the hoops of being challanged and tested before adopted as the best practice we know of to this point in time. When the next new data comes in we will change our minds again, and again, decade after decade….abondoning that which did not work so well for that which works at least somewhat better.

        This is how things should work but it’s unfortunately incorrect. Practices only change when the old guard dies out. Until that happens they act as gatekeepers, suppressing new ideas by squashing grant proposals, meddling with peer review and simply bad-mouthing new ideas.

        If you learn nothing else from history, learn this – people’s beliefs don’t change, particularly in the face of evidence to the contrary. It’s what led Max Planck to say “Science advances one funeral at a time” and people haven’t changed a bit since Max’s time.

        1. WilliamLawrenceUtridge says:

          This is how things should work but it’s unfortunately incorrect. Practices only change when the old guard dies out. Until that happens they act as gatekeepers, suppressing new ideas by squashing grant proposals, meddling with peer review and simply bad-mouthing new ideas.

          I guess we’ll find out when everyone dies, but may I just list some of the iconoclastic ideas that are now widely embraced?

          - Plate techtonics
          - Quantum physics
          - Big bang theory
          - H. pylori and ulcers
          - Epigenetics
          - Inattentional blindness
          - Dark energy

          But no – science never changes, it’s always the same. And the last four examples totally didn’t happen within my lifetime.

    3. WilliamLawrenceUtridge says:

      The majority of posters on this site are guilty of groupthink, alternatives to the accepted solution are never considered and are subject to ad hominem attacks. Has anyone actually read the book being discussed? Has the author of this article read the book, or simply picked bits and pieces that make for an interesting discussion?

      I’m not a cancer expert, so I’m in no position to judge the accuracy, or omissions, of his book. But I will ask this – what do actual cancer experts think of it? My search for reviews has turned up little in the peer-reviewed press. Perhaps Seyfried’s work will revolutionize cancer treatment. But the evidence so far is not a slam dunk. It’s still in preclinical stages.

      Seyfried is a former cancer researcher from Yale University, he is a professor of biology at Boston College and the author of more than 150 PubMed indexed scientific articles. Does anyone in this discussion hold similar qualifications? No, then don’t pretend like you do, you’re just adding more to the growing amount of misinformation online. I doubt such professionals have time to waste arguing with random strangers endlessly, they are out there trying to make a difference and they have real names and real credentials.

      Dr. Gorski comes close. And yeah, he doesn’t spend a lot of time arguing with random strangers. I’m not an oncologist or researcher, but then again – neither are you. I am willing to recognize that Seyfriend might have a “when all you have is a hammer” issue he needs to overcome however, and that it’s unethical and distasteful to promote a ketogenic diet as a cure before there is good evidence for it. Two or three promising clinical trials would probably be sufficient to open the tap on funding though. It’s a shame Seyfried has only published anecdotes. It’s an even bigger sham that he’s associating with that quack Mercola, which will probably muddy and delay any progress on the topic.

      But it’s great for giving Seyfried an audience.

      Anyone with legitimate questions regarding topics covered here should consult a real medical professional or their specialist who would be actually qualified to answer. Leave Gorski’s sheep and the conspiracy theorists to their squabble.

      Yes, I strongly agree with this point – talk to actual doctors (like Dr. Gorski maybe?). And feel free to leave…the squabbling to others.

      People pose promising and revolutionary ideas all the time. That doesn’t mean they are right. Clinical trials are needed, not press releases and interviews with quack shills.

      Here’s a theory for you, in the case of cancer the ante is much higher since a huge industry would lose much of its income to an inexpensive diet therapy. Therefore, ulterior motives might more logically be placed at the feet of the expensive protocol apologists…

      Here’s a theory for you – people who claim cancer treatment is a conspiracy are assholes who smear the names of the millions of researchers and practitioners who treat cancer, have died of cancer, or have friends and family who have died of cancer.

      Sadly, it’s because of the type of cynicism witnessed here that new and potentially effective protocols are never embraced. Now quote me and waste some more of your time with rebuttals and attacks that no one cares about, I hope it makes you feel like you have accomplished something for the day.

      It does, thanks.

      It’s not cynical to ask for evidence before urging cancer patients to radically change their diets. It’s not cynical to acknowledge that the Warburg effect has been around for 80 years and has not yet led to a definitive treatment for cancer. It’s not cynical to point out that the ketogenic diet has not been tried in humans yet. And it’s not cynical to wonder if significantly altering one’s diet to produce ketosis might, say, interfere with ongoing chemotherapy, or promote the evolution of the tumor to become able to survive on ketones (brain cells can, tumors have the same genes as brain cells).

      It is arrogance, however, to claim to have the answer on the basis of existing evidence.

      Time will tell. It would be great if the ketogenic diet worked (even better if you could mimic it by infusing ketones into the body while still eating all the bread you want). But only time, and more importantly research, will tell.

  33. Badly Shaved Monkey says:

    Bob

    Despite exercising a ton and limiting calories I was putting on weight every year.

    This tells us one thing for sure, you weren’t really restricting your calorie intake versus your calorie output whatever you thought you were doing.

    Diets don’t allow you to sidestep the basic physics of conservation of energy. If you lose weight, your calorie balance was negative, however that was achieved. If you gain weight, your calorie balance is positive however much you kid yourself about your intake vs expenditure. I can conceive that certain diets may cause you to feel satiety at lower calorie intakes, but that does not alter the basic requirement to create a negative calorie balance.

    1. Bob Johnston says:

      This tells us one thing for sure, you weren’t really restricting your calorie intake versus your calorie output whatever you thought you were doing.

      You should go back and read about Ancel Key’s metabolic ward starvation experiments in the 40′s. It disproved then and there that limiting calories, even to starvation levels, does not necessarily result in reduced weight. People who say it’s simply a matter of calories in vs calories out are ignorant.

      http://www.zoeharcombe.com/2009/12/the-minnesota-starvation-experiment/

      1. Harriet Hall says:

        I think you are misinterpreting the starvation experiment. The subjects DID lose weight when their calories were restricted, and their weight gain afterwards correlated with the number of excess calories they ate. And the starving subjects became lethargic and less active, which reduced their calorie expenditure. The experiment confirmed the calories in/out theory.

        1. Bob Johnston says:

          Harriet – it’s obvious you just skimmed the article. You definitely missed this nugget:

          All reached a plateau around week 20 and further weight loss could not be induced. At least one diary recorded weight gain in the final month of the ‘starvation’ period.

          Every test subject plateaued, even though some of the subjects’s calories were reduced down to 1000 calories per day. One guy even gained weight while being starved.

          And it’s nearly certain you didn’t catch exactly what it was these guys were eating:

          The meals were made up of foods typically available in Europe during the latter stages of the war: potatoes, turnips, bread and macaroni – i.e. starchy carbohydrates.

          These are all “foods” that raise blood sugar and insulin levels, the biochemical response that makes it impossible to successfully lose weight.

          I can understand people not reading the article but I get bugged when people claim to read the article and comment on it as if they had. You need to do better.

          1. Harriet Hall says:

            You are the one who needs to do better. You have misinterpreted what you read because you read it looking for any detail that might validate your beliefs. There is actually nothing in the study that would tend to invalidate the calories in/out hypothesis or to support your beliefs. Of course subjects reached a plateau: their calorie intake was constant at 50% of the level needed to maintain their pre-study weight, and their metabolism and activity levels adapted to compensate. On the plateau, “calories in” again equalled “calories out.” The guy who gained weight while being starved was actually only being semi-starved; he got 50% of his maintenance level and was able to reduce his “calories out” to less than his “calories in.” If the calories had been further restricted, to less than 50% of the maintenance level, everyone would have continued to lose weight. Yes, they were eating starchy carbohydrates, because they were trying to mimic the diets of starving people in WWII; but there is no evidence that the outcome would have been significantly different on an isocaloric diet with a different macronutrient composition.

            1. Bob Johnston says:

              Harriet – Have you ever seen The Biggest Loser? Time and time again on that show people who are 200 lbs overweight will starve themselves all week and work out like fiends and sometimes gain weight over the week. Is it really so difficult to even entertain the idea that that weight gain and weight loss has a hormonal aspect to it?

              People diet, loose some weight, and then gain it all back with interest way more often than not. Studies show that failure at losing weight and keeping it off is the norm and not the exception. Why would this be? Has everyone evolved in the last 40 years to be lazy and gluttonous (this would be the fattest adaptation in human history btw) or is it possible that an outside influence like “experts” telling us to shy away from saturated fat and eating more carbs could be a possible reason?

              1. simba says:

                You forget that people 40 years ago ate carbs.

                My (skinny) grandmother ate potatoes every day of her life, you had some meat with your dinner but potatoes were the star. As in 8 or 9 of them at least. Pasta-with-potatoes was a staple too. Breakfast was carbs, lunch was carbs, bread and biscuits were always in the house.

                This is what she had been brought up with, her brothers and sisters ate similarly (along with sugared tea) and talked about the old days when you couldn’t get meat, eggs, fish, butter, it was all cheap carbs to fill you up. And coincidentally, in the old days everyone was skinny by comparison to now.

                Now, why does that happen if carbs are the be-all and end-all of weight gain, independent of calories? How did I lose so much weight on my ‘chocolate, carbs, and veg/fruit/pulses’ diet?

    2. Bob Johnston says:

      This tells us one thing for sure, you weren’t really restricting your calorie intake versus your calorie output whatever you thought you were doing.

      And let me reiterate, after ditching all the carbs and upping the fat I did lose weight (close to 40 pounds) and I didn’t starve myself. I ate when I was hungry and stopped when I was full. I never deprived myself except for not eating bread, tortillas, low fat yogurt, cereal and other crap food.

      Obesity is a symptom of hormonal imbalance (namely insulin and leptin), it’s not a character fault as most people would like to believe. Lower your blood sugar and you lower your insulin, the hormone responsible for the storage of body fat. Lower insulin means your body fat is available to use for energy rather than being locked away in adipose tissue. It’s that simple.

      1. KayMarie says:

        Yep, you found a diet that made you feel satiated (so not hungry all the time) at a calorie total that allowed you to lose weight

        Surely if you ate the exact same things as the new diet, but 3X as much at every meal day in and day out, you probably wouldn’t have experienced the same weight loss.

        Much of the key of prolonged weight loss is finding the diet that over the long term induces you eat the appropriate amount of calories for the weight you want to be/should be.

        Now there are mechanisms in place (so a starvation diet over time) that will tend to slow weight loss so there isn’t a perfect line of calories in and weight. It is one of the reasons many scientifically based diets (rather than a lot of the fad diets out there) do tell you to only eat 500 calories a day less than you need not 1500 calories a day less than you need.

        You kick in the “OMG it’s a famine” response and your body will try to keep you from starving to death as quickly.

        1. Bob Johnston says:

          Yep, you found a diet that made you feel satiated (so not hungry all the time) at a calorie total that allowed you to lose weight

          I’m a big guy (6’3″ and 210 lbs) but for some reason I don’t believe that eating north of 3000 calories a day is a number that most people will equate with weight loss. And yet I did.

          Let me offer an n=1 example – I bring this up because it was done by a doctor who even though he was an endurance athlete and training over 3 hours a day was still getting fat. He went ketogenic, upped his calorie total, yet still lost weight (and improved his health markers).

          I know it’s a tough sell (because who wants to read something that completely goes against everything you believe) but I urge you to read the first three blog posts on this page. Peter Attia is an excellent researcher and a compelling writer, give him a chance and he might offer some insight you hadn’t thought of before.

          http://eatingacademy.com/my-personal-nutrition-journey

          1. WilliamLawrenceUtridge says:

            N = 1 examples are anecdotes, and are worthless. How much time do you spend looking for anecdotes that violate your preconcieved ideas?

            1. Bob Johnston says:

              Actually my initial preconceived notion was that a person could effectively lose weight by cutting calories, eating a low fat diet along with healthy whole grains and exercise. And when I did that and found myself even fatter and sicker I woke the fuck up and looked for a better idea.

              The only preconceived notion I’m operating under currently is that you have nothing to offer other than ad hominem attacks and appeals to authority. Why don’t you see if you can prove me wrong on that, sport.

              1. WilliamLawrenceUtridge says:

                That wasn’t my question there thunderballs, my question was how many anecdotes have you collected, or even looked for, that are contradictory to your beliefs? I see one, yourself.

                Your preconceived idea seems pretty solid, sounds like you should act upon your assumptions and not bother reading any of my comments sugartits.

              2. simba says:

                People were thinner 40 years ago and also ate Carbs. I lost weight and kept it off eating Carbs. There you go- a contradictory anecdote.

              3. simba says:

                Capital letter not intended on carbs. Stupid tablet.

              4. Nell on Wheels says:

                I also lost 27 lbs. eating carbs, counting calories and exercising and have kept it off for 25 years.

                That makes two of us to your one.

                We win!

      2. Harriet Hall says:

        If it were really that simple, a low carb diet should be far more effective than other diets. Studies have shown only small, short-term differences between low carb and diets with different amounts of macronutrients. Why have they not shown overwhelming superiority?

        1. Bob Johnston says:

          If it were really that simple, a low carb diet should be far more effective than other diets. Studies have shown only small, short-term differences between low carb and diets with different amounts of macronutrients. Why have they not shown overwhelming superiority?

          It is that simple and low carb diets are far more effective for weight loss than other diets. And unlike you I’ll offer some evidence to back up what I say. Here’s Christopher Gardner, a researcher at Stanford (and a vegan to boot) talking about how his study shows that an Atkin’s style diet kicked ass over low fat, high carb diets for weight loss and in particular, health markers. The good stuff starts at the 20 minute mark.

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

          1. MadisonMD says:

            It would be more convincing if you would post scientific studies rather than youtube videos.

            1. Bob Johnston says:

              It would be more convincing if you would post scientific studies rather than youtube videos.

              Yes – because I posted the video where the study author talked about his results and stressed the parts he thought were important rather than the actual study I must be trying to do something underhanded (like keep people from falling asleep reading a dry, boring study in PubMed). Watch the video or don’t watch it, I don’t really care. You obviously already have your mind made up.

              1. MadisonMD says:

                Actually I haven’t made up my mind. If you link the study I’ll read it… though, yeah, I’ll be critical as I would for any study I read. I’ve read enough to recognize a well done study and what conclusions can be reasonably made.

                I don’t think you are being underhanded either, but perhaps you are not used to discourse among scientists? The reason I trust a paper more than the author’s youtube video is that I get to look at the data and see if it matches the author’s interpretation and whether the author had considered all other explanations of the data, performed proper controls… and specifics of the intervention; e.g. how low was the low carb diet, over what time period etc. Also, how do the authors they fit their results in the context of possible disconfirming evidence from other scientists (and perhaps review the critiques from other scientists– who of course could also be wrong/unreasonable). If I’m reviewing a paper for a journal, I also do this.

                This may seem dull; it may even seem odd I would not take other scientists at face value. But this is actually normal discourse in the scientific community. I see plenty of author interpretations I don’t agree with in areas unrelated to the topic at hand. Authors are not often lying or trying to mislead, but it is well known that scientists look at their data through the lens of hoping their favorite hypothesis is true, and also needing to find *something* to publish. Sometimes disconfirming data is omitted for the same reaason. The youtube video, on the other hand, is only one point of view provided by the author, which may or may not match the data and, I would anticipate from most public statements of scientists versus results, might overstate or simplify the evidence.

                If the data support the contention that low carb diet is better than other diets (which others?) for weight loss, I would be happy to accept that. In fact it would be an interesting finding. I’m a bit worried that you alluded to markers (surrogate endpoints?), but maybe that is reasonable depending what they are, how many there are and whether endpoints were preselected and statistical analysis was proper.

              2. Andrés says:

                @MadisonMD: Bob Johnston must be talking (I am not going to check the video either) about The A to Z Weight Loss Study.

              3. MadisonMD says:

                Thanks, Andres. Pretty interesting.

                It’s a 4-arm study comparing 4 different diets for premenopausal women with baseline BMI 27-40. The primary endpoint was weight loss at 12 months. There were four groups so 6 pairwise comparisons but no mention how they were going to deal with false positives for multiple comparisons.

                Was the primary endpoint met? Figure 2 looks fairly convincing, but the legend states “the Atkins diet group was significantly different than the Zone diet group at 12 months.” Even ignoring the issue of false-positive rate with 6 comparisons, then, there was no detectable statistical difference in the primary endpoint between the low-carb diet with two other diets.

                On the biomarker side, most endpoints seemed improved with the low-carb diet; the exception being LDL, which according to discussion was seen in other studies.

                The discussion interestingly mentions this study which was very similar, but smaller in size/power and did not find a statistical difference between groups. The Gardner study attributes the difference to:
                (1) different populations in that the negative study included women with diabetes or cardiac risk factors. I don’t think this is legitimate. After all if the results are so fragile with respect to patient population, then we have no business applying results to men or postmenopausal women and, moreover, it is hard to imagine a mechanism of weight loss that would only apply in women without cardiac risk factors.
                (2) Statistical power. This is a legitimate issue as the negative trial was smaller and had less power to detect small differences.

                Also interesting about the Gardner trial is the CONSORT diagram. After identifying 781 subjects who were eligible and interested, a majority of these (470) declined to be randomized. So the findings will likely apply to only a highly motivated population– and even then Table 2 shows significant loss of adherence by 12 months.

                Seems like low-carb could be a good way to lose weight but:
                1. Conflicting results from two studies.
                2. The cited study didn’t really find statistical difference at primary endpoint for low-carb and 2 other diets.
                3. Even accepting results at face value, it is not clear how results would apply to other populations: men, diabetics, those with cardivascular risk, postmenopausal women, especially when the authors state this explicitly to explain differences in results with another negative study.
                4. Not clear whether this is long-term weight loss.
                5. A lot of non-adherence after 6 months even in a select group of highly motivated patients, especially for low-carb and high-carb diets in which patients were asked to change habits most drastically from baseline.

                Meh. Low-carb seems a reasonable choice to lose weight over a few months but this study doesn’t exactly provide slam-dunk evidence that it is the best way.

              4. Bob Johnston says:

                Dang, that was really difficult to find using Google… oh wait, no it wasn’t. :-)

                http://www.ncbi.nlm.nih.gov/pubmed/17341711

                This may seem dull; it may even seem odd I would not take other scientists at face value. But this is actually normal discourse in the scientific community. I see plenty of author interpretations I don’t agree with in areas unrelated to the topic at hand. Authors are not often lying or trying to mislead, but it is well known that scientists look at their data through the lens of hoping their favorite hypothesis is true, and also needing to find *something* to publish. Sometimes disconfirming data is omitted for the same reaason.

                I believe if you read what I’ve posted in these comments it boils down to a couple main points – the first is not to toss out a hypothesis simply because more advanced trials haven’t been done yet and the second is that medicine is full of standards and treatments based upon insufficient science. Your stance on checking the details of a study is exactly that of mine and commendable, the devil is in the details and unfortunately more often than not, particularly with nutritional science, the conclusions don’t match the data.

              5. MadisonMD says:

                That’s funny Bob. So now you say it is just a hypothesis worth checking out, whereas upthread you said:

                It is that simple and low carb diets are far more effective for weight loss than other diets.

                just before you provided the youtube link.

                But I’m glad to hear you agree with reserving strong conclusions without actually looking at the science.

              6. WilliamLawrenceUtridge says:

                Your stance on checking the details of a study is exactly that of mine and commendable, the devil is in the details and unfortunately more often than not, particularly with nutritional science, the conclusions don’t match the data.

                It’s almost as if nutrition is simultaneously incredibly complex, and incredibly simple – humans can eat just about anything and thrive, at least for a while, and there is no perfect diet for all of us. Kind of looks like a conclusion one could reach based on the scatter of all the data…

            2. Bob Johnston says:

              That’s funny Bob. So now you say it is just a hypothesis worth checking out, whereas upthread you said:

              It is that simple and low carb diets are far more effective for weight loss than other diets.

              just before you provided the youtube link.

              You’re confusing two separate issues now (at least I hope it’s simple confusion and not an attempt at obfuscation). The hypothesis worth checking out is the ketogenic diet for cancer. If you want to discuss weight loss then I’ll be happy to provide evidence supporting my claim that low carb diets are more effective for weight loss than low fat.

              1. WilliamLawrenceUtridge says:

                The hypothesis worth checking out is the ketogenic diet for cancer

                Except it’s not really – Dr. Gorski has analyzed the evidence and found it lacking. If nothing else, more preliminary data is required, and it’s also very hard to stick to such a hard diet in general, particularly if you have cancer, making compliance a real issue.

                If you want to discuss weight loss then I’ll be happy to provide evidence supporting my claim that low carb diets are more effective for weight loss than low fat.

                We’ve been over this too – the only advantage that low carb seems to have is a slightly faster initial loss of weight (glycogen and water perhaps?) but everyone is pretty much equal in the end – equal numbers comply with the diets, equal loss of weight and equal numbers regain the weight. I’m sure you can cite cherry pick individual studies, but meta-analyses seem to converge on this conclusion.

              2. MadisonMD says:

                You’re confusing two separate issues now (at least I hope it’s simple confusion and not an attempt at obfuscation).

                I think you are confused. On this part of the thread we were discussing your claim:

                It is that simple and low carb diets are far more effective for weight loss than other diets. And unlike you I’ll offer some evidence to back up what I say.

                For which you provided a youtube video as evidence. Andres provided the cite and I read and reviewed the cite here. After carefully reviewing the scientifica paper, my conclusion was:

                Meh. Low-carb seems a reasonable choice to lose weight over a few months but this study doesn’t exactly provide slam-dunk evidence that it is the best way.

                to which you responded:

                Your stance on checking the details of a study is exactly that of mine and commendable, the devil is in the details and unfortunately more often than not, particularly with nutritional science, the conclusions don’t match the data.

                So I am definitely not obfuscating. You are confused. Read the thread.

                If you want to discuss weight loss then I’ll be happy to provide evidence supporting my claim that low carb diets are more effective for weight loss than low fat.

                WTF? You did provide a youtube video as evidence. I did review the actual scientific article and found it wanting in support. Now you pretend to be oblivious to the entire thread and suggest I might be trying to obfuscate.

                It almost seems as if your eyes do not see anything that could disconfirm what you already believe.

          2. Harriet Hall says:

            See this study from NEJM http://www.ncbi.nlm.nih.gov/pubmed/19246357

            It concluded “Reduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize. “

            1. Bob Johnston says:

              When you picked out this study did you notice that none of the diets studied were actually low carb? The diet with the lowest amount of carbohydrate was still 35% carbs, which is still pretty darn high. I would consider a diet to be low carb if it was under 50 grams of carbs per day – if you were eating 2500 calories a day this would be only 8% carbohydrate, which is quite a bit less than 35%.

              1. WilliamLawrenceUtridge says:

                The nice thing about no true Scotsman is how you can use it as leverage to really move those goalposts.

  34. Badly Shaved Monkey says:

    Bob

    It’s a veterinary example, which is my home turf, and I don’t know whether you can access it in your jurisdiction;

    http://www.channel4.com/programmes/dogs-their-secret-lives/4od

    but the secret filming sections are an interesting insight into people’s perception of what they are doing versus the reality.

    Fat dogs and fat people, the physics is universal!

    1. simba says:

      Similarly my dog lost 20lb on a high carb diet. Hmmm. It’s nearly like there’s something to this ‘eating fewer calories’ business.

      One of the things I found most shocking when reading the scientific literature around this, was that even if owners were feeding the right amount of dog food, 20-40% of the dog’s daily diet was usually scraps and treats.

  35. Grant says:

    Ok, so here is my take. I really don’t give a shit? And here is why I say this.

    With cancer, and in general for people who are sick there are really 2 types of diets that the experts are recommending (I know this because my brother has a GBM, and I have sent over 200 emails/fed ex packages, etc, with his scans and reports, to the top cancer, brain, etc, doctors around this globe) and the answers are:

    1. The Gerson type diet, lots of juicing, lots of vitamins, veggies, etc
    2. The keto diet, this is coming back to me from many more people that the Dr in this study, doctors who are working in the trench’s for 25 years are now recommending this.

    So it comes back to my point, I don’t give a shit.

    I don’t care if its the Gerson, I don’t care if its Keto, I just want to know what works.

    You can go on and on about diet studies, bullshit clinical trials. I have been to 3 of the top cancer clinics in North America in search of an answer for my brother, you know what I get when I ask them about diet, they say, well, just eat a balanced diet.

    The bottom line is I have forgotten more about diet and nutrition than most doctors will ever know, because unless they learn it themselves, they are not a source of quality information.

    Doctors read studies, studies can be manipulated very easily. We can all find studies to validate our opinions. What matters, is what works.

    Most doctors go to school and study text books created by drug companies. If you have a headache, they go to their book, and the symptoms of a headache means you prescribe Tylenol or something similar. When they really need to stop, look at the patient, realize they drink Pepsi all day long, and never drink water, and realize they are dehydrated. They don’t have a headache for a lack of Tylenol, they have it because of a lack of water.

    Its time for people to stop the bickering, and figure this shit out. There are too many smart people, spending too many billions or dollars, for too many decades, to still be loosing this war on cancer.

    I have come to realize that if my brother is to get better, its up to him and I to do it, as no doctor is ever going to.

    If you want to get healthy, you better not rely on anybody else.

    Sorry for the rant, but you guys just add a layer of confusion to the pile.

    1. MadisonMD says:

      There is simply no good reason to think that cancer can be effectively treated with diet… as much as we would like to believe it could.

      1. Bob Johnston says:

        I’m sure you’re right. No doubt it would be a complete waste of time to do any studies. Glad we cleared that matter up.

        Somebody better tell the folks at Johns Hopkins they are wasting their time and resources attempting to create a drug that does roughly the same as a ketogenic diet. (Cynical Bob wonders why they have to create an expensive, patentable drug rather than just modifying the patient’s diet but I have it on good authority that blocking the sugar pathway is a non-starter so it’s a moot point anyhow).

        http://www.newswise.com/articles/compound-that-blocks-sugar-pathway-slows-cancer-cell-growth

        1. KayMarie says:

          Why have a drug that will work reliably day in and day out when you can just be certain your patient will never cheat on the diet and will be surrounded by supportive people who would never try to get them to eat just one bite of the forbidden treats.

          1. Bob Johnston says:

            How about because drugs usually aren’t all that effective, lead to added and unnecessary expense and generally have side effects?

            The real problem with drugs is that they’re rarely a cure, instead they’re a regimen that never quite gets the patient healthy and one they’ll never get off for the remainder of their lives. No thanks.

            1. simba says:

              Hang on- all of those concerns could apply to the diet you are recommending. Or is it a cure that fixes all health problems that you go on for a week and never again?

            2. WilliamLawrenceUtridge says:

              How about because drugs usually aren’t all that effective,

              Really? It’s funny, because I’ve never had smallpox, polio or pertussis, and I’ve had my pain suppressed by analgesics, I’ve been relaxed by anxiolytics and my consciousness turned off by anesthetics. I’ve never had any long-term adverse effects due to these drugs. And I don’t need many drugs now because I exercise and eat right (including lots of fruits and whole grains), just like my doctor recommends.

              lead to added and unnecessary expense and generally have side effects?

              Many of the drugs of the “golden age” of medicine are now off-patent, and are now every cheap. They’re also generally pretty safe, because unsafe drugs get pulled.

              What are the long-term consequences of a ketogenic diet by the way?

              The real problem with drugs is that they’re rarely a cure, instead they’re a regimen that never quite gets the patient healthy and one they’ll never get off for the remainder of their lives. No thanks.

              That’s true, in some cases drugs must be taken for the rest of one’s life. This is particularly the case for type II diabetes, hypercholesterolemia, hyperlipidemia and high blood pressure, all of which can be controlled with medication and in some cases can be improved or eliminated through lifestyle changes.

              It really is too bad that patients don’t follow their doctors’ orders and eat better while exercising regularly. But I guess all those patients just prefer the ease and convenience of a pill instead.

        2. MadisonMD says:

          Bob, you are not really understanding the science when you rely on youtube videos and press releases. Relying on the ‘sugar pathway’ headline is even worse. The actual publication referred to by the press release is here. As you will see the research in question uses a drug that inhibits the activity of glutaminase, an enzyme that primarily operates in the liver and brain axons and acts on the amino acid glutamine. In fact, the headline writers might more accurately have written a ‘protein pathway’ given we are talking about metabolism of glutamic acid. But this drug effect has very little similarity to changing diet with respect to either protein or carbohydrate. Moreover, it is thought by them to operate only in the setting of a particular mutation of IDH1 which is present in only certain types of brain tumors.

          Diets are varied amongst cancer patients– due to cultural and individual differences as well as medical condition. This variety can provide an exceptional opportunity for observation of outcomes with different diets between different individuals or cultures. If someone provides strong observational evidence, I would support deploying limited research resources to a large prospective follow up study. But my impression is that there is so much discussion about treating cancer with diet simply because we would all like that to be true.

          Beyond that, this is a difference of opinion between you and I about how promising your hypothesis is. Excuse me for pointing out that your position looks rather uninformed, but my idea nevertheless could be shown wrong. You or others are welcome to do the work or to donate to the work of researchers who are investigating the hypothesis you think most promising. You will also be encouraged to find that the NCI actually has a program to support this type of research and in context of underlying complexity of genetic differences among humans.

          1. Bob Johnston says:

            If someone provides strong observational evidence, I would support deploying limited research resources to a large prospective follow up study. But my impression is that there is so much discussion about treating cancer with diet simply because we would all like that to be true.

            I think I need to know your definition of “strong observational evidence”. Dr. Eugene Fine has done a small study on a ketogenic diet and cancer – I think his results are interesting and promising. Here’s a writeup from him that includes a link to his study. I thought this conclusion was informative:

            What about the results? Ten patients is too small a sample to draw firm conclusions. And it wasn’t so easy after all to get ten sick patients to do this trial. Four of the patients continued to have progressive cancer by our follow-up PET scan at one month, while five patients showed stable disease and one, a partial remission. We’d agree that these findings aren’t so remarkable in themselves. But the details are much more interesting: The patients with the worst PET scan results at study’s end were principally those who had the least degree of insulin inhibition, i.e. the least amount of ketosis (only five times their baseline level); whereas those that had the best PET scan results were those that had the most insulin inhibition, or the most ketosis

            http://feinmantheother.com/2012/10/15/targeting-insulin-inhibition-as-a-metabolic-therapy-in-advanced-cancer/

            1. WilliamLawrenceUtridge says:

              So we’re agreed then that the evidence is too preliminary to recommend as a treatment for cancer patients and further stratification and testing should occur? Great, no need to discuss further I suppose.

            2. Nell on Wheels says:

              You forgot to include these little tidbits:

              So, if a study showed safety/feasibility as well as some evidence for efficacy, it would open the door for further investigation of this diet at least as an adjunct to drug therapies. In short, an INSINH diet, by systemic and synergistic effects on multiple signaling molecules, might eventually be shown to reduce drug doses and therefore side effects, boosting efficacy at the same time.

              A word of caution: Cancers resist overly broad generalizations. Notice that I always say “many cancers” and not “all cancers.” Otto Warburg made a very important observation, but he went a little too far by stating that persistent glycolysis was the common feature of all cancers. The observation holds up well for many aggressive malignancies but by way of counterexample, 80% of prostate cancers are not especially aggressive, nor are they avid for FDG (or glucose), i.e. the Warburg effect does not apply.

              It should also be noted that all patients reduced overall calorie consumption and 9 of 10 lost weight. Calorie restriction has been postulated to have effects similar to those we’ve suggested. (We tried to over-feed the patients in order to maintain weight and calorie intake, but it didn’t work: very low CHO diets do indeed cause spontaneous calorie restriction and weight loss, even when you try to prevent that.)

              The pilot proposal excludes patients with a BMI “< 22 lb/in2" and acknoledges the difficulty of maintaing the diet, particularly in a "potentially fragile patient population." "Completion of at least 2 trial weeks permits evaluation of both study aims."

              You also didn't apparently read the follow-up article, that ends by saying:

              To sum up: For people on high CHO diets who develop cancer, a low carbohydrate diet targeting insulin (VLC/INSINH) ,b>may be therapeutic. The rationale is that control of insulin and the presence of ketone bodies provides a new selective evolutionary pressure to which the cancers may not be adapted. On the other hand, those cancers that develop in people who are already on low-carbohydrate diets (already in a state of dietary insulin inhibition) will not be expected to be vulnerable to the VLC/INSINH diet.

            3. MadisonMD says:

              Bob asks what constitutes strong evidence in support of investing limited research resources toward studying his favorite hypothesis and then cites a pilot study by legitimate scientists.

              Basically, these scientists would merely need to design a project and write a proposal to convince an NIH study section that this is more promising than other projects submitted to the review panel. If it has a high score, it would be funded.

              I would point out that I have met the corresponding author of the study in question, and if he believes this is a promising project to pursue, he is definitely capable of obtaining funding and a clinical trial network to pursue a definitive study.

              Until then, this is a hypothesis… one of thousands being tested today, a few of which will proven to be useful and adopted into routine practice.

    2. WilliamLawrenceUtridge says:

      The bottom line is – there is insufficient evidence to support diet being a cure for cancer. And why would we expect that it would be? Cancer is an evolutionary disease, both within and across people, that is the result of genetic derangements disabling controls over cell replication and specialization. How would diet help? Once the genes are messed up, they can’t be re-ordered, the cells can only be killed. Even if the ketogenic diet somehow interfered with cancer via the Warburg effect – cells are evolutionary and can evolve new ways of surviving on ketones. They have the same genes as brain and heart cells, both of which can live off of ketones. There’s excellent reason to believe that a good diet can prevent cancer by preventing oxidative damage to DNA, there’s no reason to expect diet to be able to treat it once cancer has started.

      Also, people have been trying to “figure this shit out” for a long time, but “this shit” is really, really complicated. Simplistic stories like “it’s all the drug companies” don’t help people “figure shit out”, it’s an excuse used by people with unscientific solutions they want to sell you, to justify why they don’t have any evidence from human trials to support their assertions.

      Drug companies might, or might not fund diet studies – but meat councils could, as could egg companies, and I’m sure the producers of virgin coconut oil would absolutely love it if they could prove coconut oil cured cancer.

      And of course, national research funding agencies can also fund research into diets.

    1. WilliamLawrenceUtridge says:

      It’s funny how in the past starvation was a common phenomena, and even now fasting is common in many cultures, but it’s really only in the increasingly-obese West that life expectancy continues to climb.

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