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:


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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98 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?

  3. 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 and

    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…

    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?

        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:


      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.
    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.

  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


    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 )

    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:

    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 (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:

          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.


          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.

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

      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 ?!?!

    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 ”


            …. 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:

  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.

    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, which seems quite balanced and tentative in its reference to cancer).


    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?

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