What is the cancer ketogenic protocol?

From the Guidelines

The use of a ketogenic diet for cancer management is not recommended due to the lack of clinical evidence and potential risks of malnutrition and micronutrient deficiency. The most recent and highest quality study, 1, published in 2022, provides guidelines for nutrition and physical activity for cancer survivors, emphasizing the importance of achieving and maintaining a healthy body weight, being physically active, and following a healthy eating pattern. However, it does not support the use of a ketogenic diet for cancer management.

Key Considerations

• The ESPEN guidelines on nutrition in cancer patients, 1, published in 2017, recommend against using dietary provisions that restrict energy intake in patients with or at risk of malnutrition, which may include ketogenic diets.
• The American Cancer Society guideline, 1, published in 2022, recommends a healthy eating pattern that includes a variety of vegetables, fruits, whole grains, and limits or does not include red and processed meats, sugar-sweetened beverages, and highly processed foods.
• The ketogenic diet may lead to insufficient energy intake and weight loss, particularly in cancer patients who are already malnourished, as noted in 1.
• There are no clinical trials demonstrating a benefit of a ketogenic diet in cancer patients, and the available evidence is based on in-vitro and animal experiments, as mentioned in 1.

Recommendations

• Cancer patients should focus on achieving and maintaining a healthy body weight, being physically active, and following a healthy eating pattern, as recommended by 1.
• Patients should consult with an oncologist and dietitian before making any significant changes to their diet or physical activity routine.
• A balanced and nutritious diet that includes a variety of whole foods, rather than a restrictive diet like the ketogenic diet, is recommended to support overall health and well-being.

From the Research

Overview of the Cancer Ketogenic Protocol

• The ketogenic diet, a high-fat, low-carbohydrate diet with adequate amounts of protein, has been proposed as a potential adjuvant cancer therapy 2, 3.
• The diet appears to sensitize most cancers to standard treatment by exploiting the reprogramed metabolism of cancer cells, making it a promising candidate for enhancing the efficacy of standard anticancer therapies 2.

Mechanisms of the Ketogenic Diet in Cancer Therapy

• The ketogenic diet probably creates an unfavorable metabolic environment for cancer cells, inhibiting tumor growth and explaining its potential antitumor effects 2, 3.
• The diet's therapeutic mechanisms may involve reducing energy supplies to cancer cells, thereby inhibiting tumor growth 3.

Clinical Evidence for the Ketogenic Diet in Cancer Patients

• Most studies on the use of ketogenic diets in cancer patients have low quality, high risk of bias, and are highly heterogeneous, making it difficult to draw conclusive evidence for anti-tumor effects or improved overall survival 4, 5.
• A systematic review of 39 studies with 770 patients found no conclusive evidence for anti-tumor effects or improved overall survival, with most patients experiencing significant weight loss and mild to moderate side effects 4.
• Another systematic review of 11 studies with 102 participants found mixed results for blood parameters, tumor effects, and quality of life, with low adherence to the diet 5.

Research Recommendations

• More molecular studies and uniformly controlled clinical trials are needed to further elucidate the mechanisms of the ketogenic diet as a therapy and evaluate its application in clinical practice 2, 6.
• High-quality clinical trials are essential to determine the effects of the ketogenic diet on cancer development and progression, as well as its potential as an adjunctive therapy 6.