The real myth is that eating sugar doesn’t feed your cancer

EDITORIAL INTRODUCTION to Travis Christofferson‘s post “The real myth is that eating sugar doesn’t feed your cancer” (Read below)

Guardian warns cancer diet off oncologists’ turf

All respect to the Guardian for its investigations into the murkier practices of big corporations but why does it routinely side with the heavily corporate medical mainstream when it comes to diet?

Vitamins are often dismissed as useless and possibly dangerous while recently it gave space to a piece that defined fad diets as ones that made a health claim. See more here: (See HealthInsightUK article…

Then last month Dr. David Robert Grimes, a physicist at Oxford, laid into the very low carbohydrate “ketogenic” diet, dismissing as a ‘persistent and pernicious myth,’ the idea that it could be effective against cancer. See here: (Link). This is part of a decades-long campaign by oncologists to deny that any benefits can come from diet in the fight against cancer. 

I believe that the time has come to say: ‘Enough’. Criticize the ketogenic diet – the most interesting and promising new approach to cancer for a long time – by all means but do it in an informed and thoughtful way. Don’t hand the job to a ‘postdoctoral research associate studying mathematical modelling of oxygen distribution in both vascular and avascular tumours’.

Why the ketogenic diet offers real hope

I don’t intend to insult Grimes but I believe that that he is under-qualified and over-confident for such an apparently casual dismissal. After reading the feature I asked my friend and colleague the American science journalist Travis Christofferson to write a rebuttal explaining the science behind the ketogenic diet and why it offers real hope to cancer sufferers.

Christofferson is eminently qualified to do this because he has written the definitive book about it: ‘Tripping over the Truth: The metabolic theory of cancer.’ An updated version is due to be published in the UK next month by Chelsea Green Publishing Co.

In this post – a second part will be published next week – he shows where Grimes makes a number of fundamental mistakes, such as denying that sugar from the diet feeds cancer and the claim that cancer is solely driven by genetic change.

Christofferson also explains how ketones (packets of energy the body naturally derives from fat when carbohydrate intake is very low) have a number of features that are hostile to cancer such as:

Ketones strengthens healthy cells weakens cancerous ones

‘The ketogenic diet is unique among cancer therapies in that it affects healthy cells and cancer cells very differently,’ he writes. ‘Cancer cells have difficulty using ketones and so become stressed when the body begins making them, while normal cells are actually energized by the ketogenic diet.’ As one senior researcher observes: ‘Ketones have a strange ability to make healthy cells healthier and cancer cells weaker.’

Next week Christofferson reports on what could be one of ketones most valuable contribution to treating cancer – reducing side effects. Being on the ketogenic diet for several days before and after chemotherapy has been shown to diminish ‘every one of the 14 most common chemotherapy related side-effects’.

As he says: ‘If the benefits of the diet were the myth Grimes claims, it’s odd that it is currently being investigated as a cancer therapy in over a dozen clinical trials .’

In fact the real scandal of the ketogenic diet is that bright young researchers are not becoming properly informed about it and instead write pieces that seem solely designed to prevent patients benefitting from something desperately needed by the cancer community right now – a treatments that is obviously cheap, very safe and very promising. 

 


The real myth is that eating sugar doesn’t feed your cancer 

By Travis Christofferson

 

Before I go into why Grimes’ attack is based on several serious misunderstandings, I need to answer the most basic question: What is the ketogenic diet? Here comes a quick biochemistry lesson. Your body, like a hybrid car, can burn two types of fuel. It’s been designed that way by millions of years of evolution.

The fuel we all know about is sugar/glucose which comes from carbohydrates. The other much less familiar type is known as ketones – small energy dense molecules which the body makes in the liver from fat. It’s a kind of back-up system that automatically kicks in when carbohydrate/glucose supplies run low. So a ketogenic diet involves eating almost no carbohydrates and replacing them with fat.

And what has this got to do with cancer? Healthy cells can make energy in small ‘power plants’ called mitochondria using either glucose or ketones. Some athletes claim that ketones are a better source of fuel for long distances. Crucially the mitochondria in cancer cells don’t work very well, if at all, so the cells have to switch to a cruder and less efficient system called glycolysis which needs much larger glucose supplies than the mitochondria route.

Simple: remove cancer’s preferred source of fuel

Going ketogenic can damage cancer cells because not only are they getting less glucose in the blood but their faulty mitochondria can’t use ketones. So the logic behind the ketogenic diet as a cancer therapy is seductively intuitive: remove the cancer cells preferred source of fuel and replace it with a fuel it has difficulty burning. Simple

Given this very plausible scenario it’s probably a big mistake to categorically claim the ketogenic diets is a “cancer treatment myth.” Especially if your life is at stake. Grimes attempts to challenge the scenario by saying changing diet is flawed from the very git-go because cancer is caused by mutations to DNA—and therefore any dietary intervention “can’t affect cancerous cells.” The dogmatic assumption that cancer is exclusively a genetic disease, however, is a position that’s becoming harder and harder to maintain.   

A massive governmental effort to understand the genetic underpinning of cancer, called The Cancer Genome Atlas (TCGA) project that kicked off in 2006 (and concluded in January of 2015) has left many cancer researchers scratching their heads. Its findings have shaken the very foundation of the standard theory of cancer.

Cancer not exclusively caused by DNA mutations

This is the one we all know about, which says that cancer is the result of a relatively small number of ’driving’ mutations turning a healthy cell cancerous and causing it to grow uncontrollably. This would allow them to be targeted with drugs. However, this is not what the atlas shows; the most defining feature of the cancer cell genome as revealed by TCGA is that it is completely chaotic.

The TCGA sequenced the entire genomes from 10,000 malignant tissue samples and reportedly discovered 10,000,000 cancer related mutations but there was no clear pattern. Some cancers had 20 or more mutations; others might have just one mutation or even none at all. The conclusion: cancer is not exclusively caused by mutations to DNA. It can’t be. Something else must be causing and driving it.

TCGA was intended to be our last battle with cancer, we would finally know it in it’s entirely, but rather, it left us with a murky, muddled mess. A 2015 Nature article titled End of cancer-genome project prompts rethink, highlighted the confusion:

A bewildering hodgepodge of genetic oddities

“Also a problem was the complexity of the data. Although a few ‘drivers’ (driver are genes that when mutated cause or ‘drive’ cancer) stood out as likely contributors to the development of cancer, most of the mutations formed a bewildering hodgepodge of genetic oddities, with little commonality between tumors.”

This is what James Watson, the Nobel Prize winning co-discover of the structure of DNA, said of TCGA:

“We can carry on and sequence every piece of DNA that ever existed, but I don’t think we will find any Achilles heels. We’ve had about 10 years. It’s not the story I wanted to hear. I would have hoped for a lot more success.”

If mutations to DNA are not the entire picture, as Grimes claims in his article, then what is the ultimate cause of cancer?  We’re still trying to figure that out.

Cause of cancer; more than one way to skin a cat

What we do know, is that something called epigenetics—the turning on and off of genes—is involved in transforming a normal cell into a cancerous one. Dr. Jean Pierre Issa of M.D. Anderson, a tremendously respected cancer researcher, said in an interview for NOVA, a division of Public Broadcasting:

“Up until recently the idea was that cancer is a disease of genetic changes. The genes themselves, their structures, become abnormal. Over the past few years we have come to realize that there might be more than one way to skin the cat—that there might be changes other than genetic changes that would account for the bizarre behavior of cancer cells. And these relate to epigenetics.’

Epigenetic changes—the turning on and off of genes without changing the underling sequence of DNA—are responsible for a striking metabolic shift within the cancer cell. This involves a major change in the way cancer cells make energy.

This dates back to 1924 the great German biochemist Otto Warburg discovered that cancer cells were doing something strange. Unlike normal cells they were making most of their energy via a method called ‘aerobic fermentation’. Also known as glycolysis. It involves burning glucose (sugar) very fast and making lactic acid in the process. Today this metabolic quirk of the cancer cell is called the Warburg effect.

Cell turns into a sugar consuming machine

Normal cells make 90 percent of their energy in the tiny power plants found in almost every cell in the body called mitochondria.  They use oxygen and don’t produce lactic acid. We now know how cancer cells switch to the Warburg effect but the reason why is still hotly debated.

They do it by changing the amount of protein produced by a gene called hexokinase 2. The gene doesn’t change it just becomes more active – this is epigenetics. The result is the cell turns into a sugar consuming machine.

So Grimes got something else very important wrong when he wrote: “In 1924, Otto Warburg suggested this metabolic switch to glycolysis might drive cancer. Subsequent investigations showed that in fact the switch actually stems from the very mutations that give rise to cancer – basically, it’s a consequence of cancer rather than the cause.”

I’ll give Grimes 1000 dollars—to donate to his favorite charity—if he can show me a single mutation that is a cause of the Warburg effect—not just a trigger of the epigenetic shift to hexokinase II. 

Grimes claim on sugar absolutely wrong

The reason why it matters whether the energy production switch is due to a mutation or to epigenetics is because an epigenetic change can be reversed, unlike a mutation.

If you’ve seen a PET scan, you’ve seen a visual image of the Warburg effect. A PET scan is done by injecting radiolabeled glucose into the patient. The “hot spots” that then appear are a dramatic visualization of cancer voracious appetite for sugar.

Grimes wrote: “there’s no preference for Sugary’ carbs to gravitate toward cancer cells.”

This too is absolutely wrong. This is the basis of a PET scan. Without the ability of sugar to “gravitate” and become concentrated inside cancer cells, the PET scan would not exist. In fact there is no argument about cancer’s love of sugar which leaves the basic idea behind the ketogenic diet – energy reduction – untouched.


 

Next week:
The experts who are investigating the ketogenic diet and the growing evidence that it can dramatically reduce the damaging side effects of chemotherapy while improving outcomes. Also how the bar for gathering evidence to show that non-drug treatments are safe and beneficial is set far too high and damages patients. 

Travis Christofferson

Travis Christofferson

Travis Christofferson is a science writer and a graduate of the Montana State Honors Program in molecular biology. He also has an M.S. in Material Engineering and Science from the South Dakota School of Mines and Technology. He is the author of the bestselling book 'Tripping Over the Truth: The Metabolic Theory of Cancer'. It gives an historical perspective on the re-emerging theory that cancer is triggered and driven by damage to mitochondria. Link

14 Comments

  • There are specific cancers that are not glucose-guzzlers, and that can be made to grow in the lab with ketogenic diets. I wrote about one of them here.
    http://hopefulgeranium.blogspot.co.nz/2017/01/will-ketogenic-diet-increase-risk-for.html

    However, this is the sort of evidence that strengthens the case for a medical theory, because it has to be specific to be credible. Cancers are a variety of very different conditions, and to claim that any treatment will have the same effect in every case is inherently implausible.

    For example, it can clearly be demonstrated that the ketogenic diet works in regard to inhibiting prostate cancer in the study I cited, and in the melanoma study has no effect on one type of melanoma (leaving open the possibility that a better-designed ketogenic diet might), and a growth promoting effect on the other.
    These are different tumour cells with different natural histories, and it seems obvious that some rely on glycolysis, some may be inhibited by ketones, and some prefer ketones, or perhaps specific ketogenic fatty acids.

    • Editorial

      What makes the ketogenic diet so interesting and promising is that the majority of cancers do change the way they generate energy which suggests a range of new targets that might well be found in a variety of cancers. Prostate cancer may well be one where it is not effective but there is promising research to show it can benefit brain cancer – one that is particularly hard to treat otherwise.

      It’s worth remembering, when swapping studies supporting either side, that there is a vast imbalance in resources. The number of researchers trying to unravel the intricacies of ketones and cancer across the board is tiny compared with the number of well funded scientists working on the next generation of a single biologic for a single cancer.

      The real question is not, Why has this or that aspect of the ketogenic theory not been sorted out but why are cancer charities, funded by us to “beat” cancer, not doing any research into it at all? Instead they seem content to continue recommending the low fat ‘healthy balanced diet’.

      • I think Mr Henderson is saying that the ketogenic diet does benefit prostate cancer.

        • Yes, it seems to be effective for prostate cancer (though I would limit linoleic acid because there is evidence that consumption of this fatty acid is increased by PC cells and used to make prostaglandins which promote growth), seems to harmful for one type of malignant melanoma, and is at worst neutral for another. Neurogliomas I think there is good evidence for efficacy, and I’d predict this for leukaemia too based on its metabolism.
          But all of these cancers have, like the melanomas, genetically diverse types, some of which may tolerate ketosis better than others.
          I think this is unlikely for brain cancers and cancers in cells that normally have high glucose use such as immune cells.
          If fat promoted cancer globally then cancers of adipose tissue would be the most common cancers, which of course they are not.

        • Editorial

          Thanks for pointing out that prostate is actually one that benefits from ketones, misread Henderson’s post. But there are some that don’t- which they are is just one of many questions that a patient focused research program would be sorting out. Ignoring patient feedack is one of the signs of an area where the mainstream is getting it wrong. Think addiction and suicide potential of SSRI antidepressants and statin side-effects.

      • I no longer contribute to cancer charities. I think they have been taken over by drug companies and a ketogenic diet is no good to them.

        • Hi Stephen – have a look at Yes to Life – a small UK charity which actually supports people with cancer who look at taking an integrative approach. If you fancy contributing to a cancer charity – you really should seek one that aims to support people’s choice

  • Great points George. More research will be needed to,untangle which cancers the ketogenic diet works best for. Theoretically, any cancer that is PET positive should be affected. Some very interesting research is being done on the epigenetics of ketones. BHB’s histone deactylace inhibitory activity is shown to turn down about a dozen cancer related genes; HIF 1 alpha, TNF, VEGF, ect.. It’s important to note that a histone deactylace inhibitor is already approved for a type of leukemia and is in over 80 trials. The problem is BHB is free, so ironically, it will never get the backing for a clinical trial.

  • To Henderson: A theoretical approach. If one did a PET scan with cetone bodies in stead of glocose. Then the cells that use ketone as fuel coul be discovered.

  • The Ketogenic diet does work. It works A WHOLE LOT BETTER when Coconut oil and coconut is used as a ready source of ketones as well as the Adaptogen it is… in bringing about body systems functions cancers disrupt, as well as being the antibacterial, antiviral, antifungal, and antiprotezoal that it is too. Drop not only the sugars and carbs, but most PUFA oils too. USE Coconut oil, Red Palm oil, Olive oil, Butter, Avocados, fresh nuts and seeds. I was losing my battle until I made these switches. They were far enough spaced (discovery without guidance was slow) that I could make direct observation on improvements. Healing up damage can be as important as arresting and starving out the cancer. It was a couple of years literally later that I stumbled across Travis Christofferson’s book Tripping Over the Truth and Dr. Thomas Seyfried’s Cancer As A Metabolic Disease. Read Dr Bruce Fife’s The Coconut Oil Miracle and his book The Palm Oil Miracle. It works. People need to know this now.

  • Very many years ago, I remember reading about some research testing two very simple compounds, dimthylsulphoxide (DMSO), and something else whose name I forget, as ‘miracle’ cancer cures.

    On reading above that some tumour cells were found to have no mutations at all, I remembered that article because the theory was that these two compounds were able to convert cancer cells back into ordinary cells. Of course, if cancer was caused by a mutation, this seemed very unlikely.

    A quick GOOGLE found this article – still using DMSO, but with a different proposed mechanism of action:

    https://www.cancertutor.com/dmso/

  • Thanks for a really interesting conversation. A question to all of you that has had me pondering for a long while. I am a cancer thriver, managing metastasised prostate cancer. I am on an extreme vegan diet, in the belief that I need to keep IGF-1 levels low (in addition to low glucose). I am very interested in the ketogenic diet but my vegan proteins come coupled with carbs (eg grains, lentils, pulses). So it seems that veganism and ketogenic are competing theories. I would love to hear your views. Thanks in anticipation.

    • Hi Nick,
      my understanding is that a vegan diet, if you do it right, is full of phytochemicals that can be more-or-less toxic to some cancer cells (though the science of this with regard to humans is a bit hit-or-miss, is seems plausible enough). Because it is low fat and protein it will, if you were non-diabetic to start with, keep insulin and IGF-1 levels low. And being low fat you won’t have much omega-6 linoleic acid in LDL particles, which is what prostate cancer seems to thrive on.

  • Hi Nick, I’ve heard of people doing vegan versions of the keto diet although it is more difficult. I think one of the reasons the keto diet works for cancer is because it drastically lower IGF-1. When calculating macro ratios remember carbs and protien are bundled together on the keto diet because both raise blood sugar (and IGF1).

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