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.
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.