Starving cancer: why it makes sense.

Body poor at storing glucose

By this time the sharp-eyed reader may have noticed what seems to be a flaw in this theory. It’s all very well starving cancers of energy by bringing carb intake right down but what about the brain, heart, muscles and all the other organs? Where are they getting energy from? This is where the really special feature of going low carb comes in.

Glucose has a major drawback as an energy source: we can’t store much more than 500 grams – enough to keep a distance runner going for about 90 minutes. That is why evolution has equipped us with a back-up system, developed over millions of years, that kicks in when insulin starts dropping.

This allows fat to be released from the fat cells which can then be ferried to the liver to be turned into something called ketone bodies, which are an alternative energy source that can be used by the brain, muscles and other organs. But not, and this is crucial, by cancer cells.

Some dieticians regard ketones as dangerous toxic by-products; the Atkins diet was condemned for putting people in a ketotic (ketone producing) state. But for most of human history we have slipped in and out of ketosis daily or weekly depending on what foods were available. It’s only in the last 60 years or so that carbohydrates have become on tap around the clock in western countries.

Cancer’s power plants have shut down

The reasons that cancer cells can’t use ketones are controversial and can get complicated but the short version runs like this. In normal healthy cells the ketone bodies are fed into the tiny power plants (mitochondria) found in every cell, which use oxygen together with either glucose or ketones to produce the body’s energy molecule ATP.

But most cancer cells have damaged mitochondria, possibly due to gene mutations, and they are also low in oxygen. So they use a different pathway that doesn’t need oxygen (is anaerobic) to turn glucose into ATP. That pathway is less efficient, which is why they need so much more glucose. Cancer’s low oxygen state is why exposing tumours to extra oxygen in a hyperbaric chamber is damaging. They don’t have the systems to deal with it.

Cancer Research UK’s current position on ketogenic diets is that “research is at a preliminary stage” and to recommend a high carb/low fat diet. Given that the diet has been around since the 1920s and that there was a case study of its effectiveness in cancer in 1995  and that Seyfried has been publishing papers since 2000 you might ask why so slow?

Low carbs slow cancer progression in humans

A new review published a few months ago would be a good place for experts to catch up. It describes how the carbohydrate restricted diet changes the way the body handles fat and the effects this has on metabolism. The authors  make the point that saturated fatty acids and high cholesterol foods such as eggs generate totally different metabolic responses when eaten as part of a low carbohydrate diet. (The article is behind a pay wall but a good summary can be found here .)

The final step taking the very low carb/ketone diet from interesting idea to plausible therapy is to show it benefits human patients as well as lab rats. Research published last year found it either slowed right down or stopped cancer growth in five out of ten seriously ill cancer patients who didn’t want to or couldn’t have any more chemotherapy.

Particularly striking was the finding that those who did the best had three times the level of ketones than those who continued to get worse, suggesting it was the ketones rather than just weight loss or fewer calories that was having the effect.

“This is a study that could have been done any time in the last 20 years,” says the lead author Dr Eugene Fine of Albert Einstein College of Medicine, New York. “We now have a pretty clear picture of the basic biology of insulin signally and what it’s doing in the cell. This explains why lowering carbohydrates can have a beneficial effect on obesity, diabetes and general health. I have been amazed at the degree of resistance to this work, which has followed standard scientific principles.”


Jerome Burne

Jerome Burne

Jerome Burne is the editor of HealthInsightUK. He is an award-winning journalist who has been specialising in medicine and health for the last 10 years and now works mainly for the Daily Mail. His most recent book “The Hybrid Diet” was written with nutritionist Patrick Holford, published 2018. Award: 2015: Finalist for 'Blogger of the Year' Medical Journalists' Association.
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  • Thanks for a great article, Jerome. And for this website – it’s just what we need to bring together those of like mind and spread the word in the UK.

  • Omg just noticed you are hooked up with Patrick holford what are you thinking of? Oh and ignore comment !

  • Excellent – I have e-scribed. Agree – we all need this to spread the word further.
    Best of luck with it.

  • Excellent article, and website. Will spread the word!

  • I would like to believe it is that simple, but is it? Cannot cancer cells get their energy from the available protein (gluconeogenesis). But then maybe it is easier with protein ingested than with what is already part of a muscle?

    • Editorial

      We can certainly turn protein into glucose and its one of the things that clinicians who work with low carb diets are very aware of. I’m afraid I don’t have detailed clinical knowledge myself but if you contact the site via email – see a contact section on the home page – I can send you some links to sits that would be better informed on those specifics

  • Jerome Burn “works mainly for the Daily Mail”.

    Is this the same Daily Mail that has a ‘daily health scare’? The one that peddles astrology, ‘The Bible Code’ and any alarmist health scare story going?

    If so perhaps this is good news as we can look forward to more reasoned articles such as the one above.

    I will keep reading (the blog not the Mail).

    Many thanks.

    • Editorial

      I am a jobbing journalist – the Mail health pages runs some good features and, I would argue, has a better record on picking up on issues such as the excessive use of statins, the problems with Avandia and gross over-use of antipsychotics than the rest of what was once called Fleet Street. Do keep reading. Promise no Bible Codes or astrology.

  • Nice summary – I thought for a page or two that you had overlooked Seyfried & Fine, but you got them.

    It’s worth mentioning that a ketogenic diet seems to be a generally worthwhile try, but is much less likely to work with prostate cancer than others. At least that is what I read (sorry, source, which was respectable, is forgotten, although I think Fine touched on that point).

    Looks like this should be a very useful site.

    • Editorial

      Thanks for the comment. You are right about low carb not being effective with prostate. It’s clear that there are a lot of uncertainties about the clinical application – largely because research funds have been shamefully hard to come by. There is a lot of clinical experience with using a ketotic diet on children with epilepsy that doesn’t respond to drugs but I don’t know how much of the is applicable to cancer. Early days yet

  • You are right. Moreover you may know that people with the Laron syndrome cannot develop cancer, no matter how poor diets they eat. They are short of something called Free Insulin Growth Factor ( IGF-1 ) which halts their growth at a certain age (which resumes if they get the IGF-1). We have both IGF-1 and a Binding protein that controls it, IGFBP-. As the name implies IGF-1 is stimulated by insulin, and high insulin – or insulin resistance – can hence be a problem.
    The binding Protein also reduces on high blood sugar, leaving more free IGF-1.

    This whole area of IGF-1 is another side of sugar rich diet that whnen combined with tumors dependency on sugar as you wrote seem to provide make sugar and blood sugar increasing foods a double cancer whammy.
    Indeed drug companies have on the back of this created drugs to balance IGF-1, with side effects and all. For my part I will use my 5 cents to cut out most of the carbs!

    • Editorial

      Yes the story about the Laron dwarves from Ecuador who don’t get diabetes or cancer is fascinating. I wrote about it in Chapter 6 of the book I wrote with Patrick Holford ’10 Secrets of Healthy Ageing’ and if anyone is interested in following it up in detail have a look at this: Sci Transl Med. 2011 Feb 16;3(70):70ra13.

  • and on the other side of the arguement, non-ketogenic diets have cured cancer patients…

    I guess it depends on which cancer your treating reading between the lines.

    Good article though, and one that would probably go down well on Peter Attia’s blog.

    I’ve no connecion with either, just read both, and now this one.

    • Editorial

      Thanks for the point about Attia’s blog I’m a great admirer of his clarity and grip on the biochemistry.

      Yes I think Ornish has published on low fat and cancer and then there has been a lot on the web recently from Dr Nicholas Gonzales a NY physician who has been treating cancer patients with diet for a long time. He has written a long piece – part of which you can find here - – which sets out his ideas.

      He makes two points: firstly that different people respond differently to different types of diet – seems reasonable – and that he was a friend and colleague of Atkins who confessed to him that the ketogenic doesn’t work for cancer and that he was giving up trying to treat it and would be concentrating on weight loss.
      Even so a proper evaluation of ketone approach and its variations would seem well worthwhile

      • Atkins may contain too much protein to preserve weight loss after the usual first 6 months of success. Blood sugar is then produced from excess proteins via gluconeogenesis, showing up as higher morning readings despite even “zero” carbs intake. This affects weight loss badly and it keeps insulin from falling to ideal values, probably causing end of the road also for cancer treatment considering IGF-1 etc..
        Try LCHF instead where proteins remain same or reduced and fats – natural fats – are increased. Lard, olive oil, coconut oil, butter and beef tallow are good fats. Omega 6 fats from vegetable oils are all inflammatory.
        Jimmy Moore broke stagnated weight loss turned to weight gain by reducing proteins drastically.

  • According to Seyfried and D’Agostino, Pedersen and Young it will work effectively against all kind of cancers as the Warburg effect is a common denominator. But when gone into a far state of destruction by the cancers it needs also probably a another treatment together with this diet (3BP?). But heavely calory restriction and no carbs other than very low sugar carbs like green leavy vegetables and a healthy amount of exercise (HIIT and HIT) will surely have a very strong impact on the disease. Seyfried is not excluding any type of cancer yet. Nor is Dr Young with het 3BP treatment.

  • Hello – great article, but if there is a sugar link to cancer growth, why don’t more diabetics get cancer? I tried to understand both this article and the previous one, but again some of it was a little confusing about the role of sugars/insulin on cancer growth. thanks Sue

    • Editorial

      Anyone else can give useful response on this. Diabetics are at raised risk for cancer, the very low carb ketosis diet looks promising as a supportive cancer treatment and there is genetic research showing that mutated gene for insulin growth factor causes dwarfism and a resistance to cancer.

  • There is some interesting data I have seen where Type 2 diabetics on Metformin/Glucophage actually have a reduced chance of getting cancer. One of the “benefits” of being type2!

    • Editorial

      As i understand it the reason metformin seems to cut cancer risk- raised for diabetics – is that unlike other diabetic medication it reduces insulin resistance rather than pushing up insulin production, which is a growth hormone. One of the drawbacks of metformin is that it cuts absorption of B12, so an alternative appraoch could be to try bringing down blood glucose – and so insulin – by following a low carb diet. Check out Dr David Unwin’s success in reducing both the weight of his diabetic patients and their drug intake in this way. Search for his name on the site

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