Recently, Domini Kemp, Alchemy founder and co-author of The Ketogenic Kitchen, appeared on “Alive and Kicking”, the radio show of a well known GP, Dr Ciara Kelly. The purpose of the interview was to discuss the book, the ketogenic approach, low-carb eating and the scientific evidence backing it up. It was a fascinating discussion, as always. You can listen to it here:
In this blog post, Domini discusses her thoughts in relation to the interview and responds in greater detail to some of the questions raised.
I enjoy listening to Dr Ciara Kelly and was delighted to go on her show. Unfortunately she had not read our book in advance of the interview, but hopefully she’s had a chance to, as promised! One of Ciara’s points – which has been made to us several times by others interested in the science – was basically asking me why we had to include cancer in the uses of both ketogenic or low carb diets, because there is “no evidence”. Why didn’t we just stick to promoting its use in epilepsy, weight-loss, performance sports, cardiovascular health, T2D and PCOS? Why include cancer when the evidence is not well established?
The answer is simple. Both Patricia and I had cancer. We do not have epilepsy. Both of us were dismayed by the dietary advice available to us at the time. This dietary advice (namely the food pyramid) has rightly or wrongly been designed to protect against cardiovascular disease. It does not take cancer treatment into consideration. Some would argue that is does little to prevent cancer either. Our lives over the past six months would have been much simpler if we had avoided the “C” word. But “The Ketogenic Kitchen” is the book we both wish we’d had access to when we were diagnosed with cancer.
But let’s get back to the questions raised, namely the “no evidence” line:
There is plenty of evidence that low carb and ketogenic diets, or FMD (fasting-mimicking diets) have an effect when used in CONJUNCTION with conventional treatment. We acknowledge the evidence in preliminary…but it is incorrect and unscientific to say there is “no evidence”. Here are just a few papers and videos outlining the evidence.
It is deeply concerning when we hear so-called medical experts calling this field of nutrition and cancer “nutribabble” or pseudoscience. Emerging science does not mean “no evidence” and calling the ketogenic diet a fad diet when it has been used for over 100 years shows how misinformed some experts are.
I have looked at the comments some have made in relation to the idea of carbohydrate restriction for cancer patients and it’s clear they are not up to date with the latest research. Some useful recipe publications for cancer patients (such as from Breakthrough Cancer Research) have been released in the last couple of years, but I don’t believe it’s enough. Cancer patients should have options and support when it comes to diet.
I think this paper is important to read as it clearly outlines the issues with carbohydrates and cancer:
“Over the last years, evidence has accumulated suggesting that by systematically reducing the amount of dietary carbohydrates (CHOs) one could suppress, or at least delay, the emergence of cancer, and that proliferation of already existing tumour cells could be slowed down…. Second, high insulin and insulin-like growth factor (IGF)-1 levels resulting from chronic ingestion of CHO-rich Western diet meals, can directly promote tumor cell proliferation via the insulin/IGF1 signaling pathway.”
So, according to this study and in layman’s terms: our typical diet (where there is abundance of carbohydrates via processed food such as cereals, breads), can directly promote cancer. And what is the best and most effective dietary intervention for way of reducing this impact? A low carb or Ketogenic diet.
To date, the best (known) way to treat cancer is with surgery, radiotherapy and chemotherapy. Immunotherapies are becoming increasingly available, too. But there is no ‘silver bullet’ preventative measure or treatment for cancer. But sugar – and how our body reacts to it – is now being shown to be the root cause of a range of metabolic diseases. This is now accepted by many well-respected institutions.
Right now on www.clinicaltrials.gov, there are 251 studies low carb diets and 98 studies on ketogenic diet. There are also over 100 on-going or upcoming studies on the use of Metformin as a tool for cancer therapy, including evaluating its use in cancer prevention.
What is Metformin? It’s the first-line medication for the treatment of type 2 diabetes. It’s prescribed because the cells in a type 2 diabetic patient are unable to use insulin efficiently (also called “insulin resistance”), which causes higher levels of blood glucose. Insulin is the hormone that, amongst other important functions, helps remove excess glucose from your cells. What happens with T2D? You can read all about it here as well as how to possibly reverse it:
Lets also look at some of the highlights from another study on carbohydrate restriction:
“Clinical observations indicate that the prevalence of diabetes in newly diagnosed cancer patients ranges from 8% to 18%, suggesting bidirectional association between these two diseases”
Bottom line is this: metformin controls blood sugar. These studies indirectly illustrate the value of low-carb diets, because what metformin really does is it limits glucose and thereby insulin secretion. It has been shown to affect many important pathways- coincidently similar to the ones that KD also targets.
But why not also control blood sugar in the simplest way possible? Why not control your blood sugar – first and foremost – by reducing your intake of processed carbohydrates!
It’s clear to anyone who reads the literature on this that certain themes and ideas keep recurring: carbohydrate restriction, inflammation – which you can “cool down” by eating less processed foods – plus bidirectional links and risk factors for cancer & diabetes, hyperinsulinemia, hyperglycaemia and a high glycaemic load are all associated with increased risk of cancer. Studies clearly show that these conditions are also associated with poorer prognosis in cancer patients.
Now, look back at the food pyramid: do you think one supports the other?
And just to be extra clear, Patricia and I haven’t made this stuff up! Here is a list of those who are researching, publishing and utilising this approach:
Dr Colin Champ, MD, Radiation Oncologist, Pittsburgh Cancer Institute
Dr Adrienne Scheck, Professor Neuro-Oncology Research, Barrow Brain Research Centre, US
Sue Wood, RD and Specialist Ketogenic dietician, Matthew’s Friends
Georgia Ede, MD
Prof Dominic D’agostino, USF
Professor Tom Seyfried
Dr Eugene Fine
http://www.mycancertreatment.nhs.uk/treatment/single_report.php?hospital=CHARING CROSS HOSPITAL&trust=Imperial College Healthcare NHS Trust&service=Neuroscience Team&siteCode=RYJ02&sctcode=14-2K-2&teamid=1356&type=pdf
It’s well established that there is not one perfect diet for everyone and that a one size fits all approach should not taken with cancer nutrition. So then, why do we still see some institutions and cancer charities recommend food pyramids on their websites? Despite the changes made to the latest version of the food pyramid – where fruit and vegetables take prominence over the bread, cereal, pasta and wholegrains – the fact remains that a high-carb, low fat diet is still being promoted.
Remember, the KD is NOT a cure but as Colin Champ MD, radiation oncologist in Pittsburgh, says in our foreword:
“Based on a plethora of preclinical data, trials are underway from the US to Germany. The benefits of a ketogenic diet have already been shown for weight loss and metabolic improvement, and we are hopeful that similar benefits will be seen in the cancer world. Perhaps most intriguing is that some of the data, albeit based on preclinical animal studies, may suggest a preventative role of a ketogenic diet. While the diet has been shown to synergize with standard therapies, like radiation therapy in preclinical studies, recent studies are underway to test this in humans. Unable to wait for these results, many have chosen to engage in a ketogenic diet during their cancer treatment. It is our job to make sure this is done safely and effectively, and the book Ketogenic Kitchen is a vital resource that we have been lacking in the clinic. This is a great source of information for both patient and physician, helping to ensure that the diet is done safely with a variety of healthy, delicious, and nutrient-dense foods.”
Sadly, it seems to me – as a cancer patient – that the disconnect between published evidence and clinical practice persists. In summary, I think this advice from UK Oncologist Prof Rob Thomas sums it up nicely:
“If you have lots of foods that increase your glycaemic index (sugar, processed carbs or even overeating), then you have an increased risk of cancer. So how much evidence do you actually want. We’ve got laboratory data, we’ve got an underlying very feasible biochemical pathway which directly shows the link to cancer progression, we have large cohorts, too…. People want advice based on common sense. If some health professionals say “I’m going to wait for the randomised placebo controlled trials on sugar to advise my clients”- first of all, this is never going to happen. And you have to draw a line in the sand somewhere with the level of data.”