7 ms·

Restricted Ketogenic Diet Therapy for Primary Lung Cancer with Brain Metastasis

53 points by birriel 3y ago

blakesterz 3y ago
"This case report gives hope that the KD might improve clinical outcomes for some patients with NSCLC. The tumor shrinkage, survival time, spectacular improvement in physical condition, and the restoration of daily attitudes are encouraging for further application of this therapeutic approach to larger numbers of patients." Under "Case presentation" they call out that the patient is right handed... "A 54-year-old right-handed man presented with headache,"... is that a common thing to pay attention to in the type of research? I can see why they note he's a smoker, but seeing right-handed surprised me.
- aarong11 3y ago
  I mean depending on which side of the brain the tumour is, it could be relevant. Don't quote me on this (I'm not a doctor) but the right hemisphere controls the left side of the body (including left hand) and the left controls the right.
- lukeinator42 3y ago
  Handedness is important in neuroscience as there are functional asymmetries for things such as language. Pretty much all right-handed brains have language lateralized to the left side, whereas around 70% of left-handers also have language lateralized to the left side. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4219560/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4219560/ So if a person is left-handed it's unknown if the lateralization of various functions in their brain is the same as a right-hander or if things are mapped in strange places. Left-handers also have higher rates of schizophrenia and other disorders. I say this as a left-hander who is doing his PhD in neuroscience, haha.
camelNotation 3y ago
Seems like a remarkably small sample group for a study like this. Maybe I am just not familiar with what is considered a significant sample size for cancer research.
- ddorian43 3y ago
  A case report is exactly that, a case.
- AlexErrant 3y ago
  Case report studies kinda by definition are on one patient.
ddorian43 3y ago
The epilepsy-level keto therapy (the one done in the study) can do wonders (80-90% of calories from fat, blood level GKI 1-2). It didn't say what exactly happened with `However, dyslipidemia developed after this time which led to the discontinuation of the diet.`. And if they consulted with a professional and recent research like "lean mass hyper responder".
- AlexErrant 3y ago
  > The KD was terminated 10 years after diet initiation (2018) as the patient developed dyslipidemia (cholesterol >280 mg/dL, triglycerides >300 mg/dL). It looks like his LDL was "only" 140, but yeah trigs at 300 are no bueno.
hallqv 3y ago
Cancer loves sugar.
- darkclouds 3y ago
  [dead]
- aYsY4dDQ2NrcNzA 3y ago
  Some do. A few love ketones.
kyleyeats 3y ago
I'm active in a community for a health condition. There's a very standard, very effective treatment which is mildly uncomfortable and time-consuming. You can also do diet stuff. The diet stuff is about 20x less effective than the actual treatment, but that doesn't stop people from selling diets or not doing the treatment at all in favor of the diet. That's what I worry about with studies like these. If you have a thing, do the actual treatment, don't mess around with diet. Diet impacts everything but that doesn't mean it can do anything. Do the treatment! Not the diet. This thinking can corrupt anyone, famously even Steve Jobs.
- ddorian43 3y ago
  > You can also do diet stuff. I don't know your health condition, but this is not "diet stuff". It's pretty specific. Look "ketogenic diet for epilepsy". If you break it, you have symptoms very quickly. It IS a medicine. The grams of protein/fat/carbs were pretty extreme, it's not just "low carb" or "just keto" or "diet" or "eat healthy". The difference is that the diet works on some occasions where nothing works, or on some occasions it works very good. Things like DT2 (virtahealth.com), maybe soon for kidney disease (ex from today Feasibility and impact of ketogenic dietary interventions in polycystic kidney disease: KETO-ADPKD—a randomized controlled trial), many mental disorders (metabolicmind.org, virtahealth will try for depression too), etc.
  - apwell23 3y ago
    > diet works on some occasions where nothing works Is there documented example of this for lung cancer ?
    - happytiger 3y ago
      Specifically: https://www.fortunejournals.com/articles/significance-of-calorierestricted-ketogenic-diet-for-lung-cancer.pdf https://www.fortunejournals.com/articles/significance-of-cal... > Conclusions: This study demonstrated the significant beneficial effect of a calorie-restricted ketogenic diet for two types of aggressive cancers with metastases. Even a brief KD intervention has a profound effect, implicating the significant therapeutic potential for the ketogenic diet as adjuvant therapy for cancer treatment. Obviously small sample size etc etc More generally: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6375425/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6375425/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10221628/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10221628/ https://www.sciencedirect.com/science/article/pii/S2212877819304272 https://www.sciencedirect.com/science/article/pii/S221287781... https://www.frontiersin.org/articles/10.3389/fnut.2021.594408/full https://www.frontiersin.org/articles/10.3389/fnut.2021.59440... It’s primarily as supporting therapy and quality of life, and is tumor specific, and at this time basically “more research is needed” effectively. I would love to hear from those more qualified.
evanjrowley 3y ago
You can also experience ketosis as part of autophagy during the final throws of stage 4 cancer (i.e., when you can no longer eat and starve), but at that point, the cancer is growing strong rather than shrinking. Where is the threshold between "ketosis treats cancer" and "ketosis is not having a noticeable effect on late stage cancer"? Personally I have benefited from ketogenic diet and would recommend others try it, but I also need to caveat that support by underscoring my lack of answers for critical questions like this.
- ddorian43 3y ago
  You experience ketosis by lowering carb intake. You may get shot in the mouth, stop eating, and get into ketosis but it doesn't mean ketosis results in gunshots to the mouth. > Where is the line drawn between "ketosis treats cancer" and "ketosis is not having a noticable effect on late stage cancer"? Different types of cancers, different stages of the cancer, different types of ketosis, different people.
misja111 3y ago
> The size of the brain and lung lesion remained stable after nine years of KD therapy. However, dyslipidemia developed after this time which led to the discontinuation of the diet. This is new to me, I didn't know that a keto diet can lead to dyslipidemia? If I search for secondary causes of dyslipidemia (primary cause is genetic), the only lifestyle factor I can find is excessive alcohol use.
- ajdude 3y ago
  I was doing the keto diet several years ago. I went from 240lbs to 175. I had to stop though because my bad cholesterol went through the roof. Came to find that I am APOE4/4, basically I have a genetic mutation that among other things means my body has trouble dealing with saturated fats. I stopped doing keto and ended up getting back up to 220lbs, but my blood levels went back to normal. I really want to do keto again because it's the only thing that's ever worked for me and I keep hearing about studies like this, but I also don't want to mess up my levels again.
  - Nelkins 3y ago
    There's evidence that having super high LDL cholesterol on keto may be fine (do your own research, obviously). Check out https://cholesterolcode.com/ https://cholesterolcode.com/ and look up Dave Feldman. Some really interesting research will be coming out soon.
    - AlexErrant 3y ago
      Feldman was on Peter Attia's podcast [0] and I was not impressed. LDL seems causal in the process of ASCVD. [1] I can't think of a stronger statement in science than one invoking causality. (In particular, it seems necessary, but not sufficient. Interestingly, it seems you can't go too low with LDL [2].) I wonder if OP could continue keto, but go on a statin/pcsk9 inhibitor/bempedoic acid/ezetimibe. Of course, these are prescriptions, so he'll need to find a willing doctor. And have money to shell out. It sucks that he's APOE4/4, since that makes him so much more susceptible to other types of metabolic/cardiovascular disease [3] 0: https://peterattiamd.com/davefeldman/ https://peterattiamd.com/davefeldman/ 1: https://pubmed.ncbi.nlm.nih.gov/28444290/ https://pubmed.ncbi.nlm.nih.gov/28444290/ 2: https://www.health.harvard.edu/blog/ldl-cholesterol-how-low-can-you-safely-go-2020012018638 https://www.health.harvard.edu/blog/ldl-cholesterol-how-low-... 3: https://peterattiamd.com/johnkastelein/ https://peterattiamd.com/johnkastelein/
oneepic 3y ago
Coincidentally my mother has an 80yo neighbor who got diagnosed with brain+lung tumors a few weeks ago. I'd like to recommend this article to her. Though it apparently has the risk of dyslipidemia, "Abnormally elevated cholesterol or fats (lipids) in the blood." (maybe some exercise too to help mitigate that risk)
- foxyv 3y ago
  This study should not be used to make ANY medical decisions and is only useful in proposing additional studies. I would recommend against sharing it with anyone who is not trained to read and understand these results. Often laypersons will take these studies and make absurd claims based off of them that kill people. Keep in mind that this is a study of a single person and the tumor reduction was insignificant compared to the 4CM reduction from radio/chemo therapies. There is no way to know if Keto even did anything without a larger cohort. For all we know, it made the cancer worse than it would have been.
  - kelipso 3y ago
    You read the abstract wrong. The reduction was significant and more than from radiation and chemo (ed. for one of the tumors). > Computed tomography following radiation and chemotherapy showed a reduction in the right frontal lobe lesion from 5.5 cm × 6.2 cm to 4 cm × 2.7 cm, while the mass in the upper-right lung lobe reduced from 6.0 cm × 3.0 cm to 2.0 × 1.8 cm. Two years after KD initiation and without any other therapeutic intervention, the right frontal lobe lesion calcified and decreased in size to 1.9 cm × 1.0 cm, while the size of the lung mass further decreased to 1.7 cm × 1.0 cm.
    - foxyv 3y ago
      Formatting to make it a little easier to parse. There was only a reduction greater than a CM on the right side which almost seems to be just lagging the left side reduction from the Chemo. However without a larger number of participants there is no way to call any of it significant. DIM ORG->CHM->KTD RX: 5.5->4.0->1.9 RY: 6.2->2.7->1.0 LX: 6.0->2.0->1.7 LY: 3.0->1.8->1.0 Edit: Also keep in mind that we are talking about 2 dimensions. For instance on the right side in cm^2: 34.1 -> 10.8 -> 1.9 And the left: 18-> 3.8 -> 1.7
voisin 3y ago
Related: “Tripping over the Truth: The Metabolic Theory of Cancer”[0] [0] https://www.goodreads.com/book/show/23496164 https://www.goodreads.com/book/show/23496164
davedx 3y ago
Jesus christ. A sample size of one? What on Earth is this quackery doing on a .gov website? Unbelievable. This is dangerous toxic bullshit.
incomingpain 3y ago
Not medical advice, if you have cancer don't listen to me. The keto diet, or subtypes, absolutely is anti-cancer. Nobel prize in 1931 basically proving the keto diet is anti-cancer. But how much, is it even a good treatment? Anthrax is anti-cancer, but doesn't mean ANYONE will use it as treatment. https://en.wikipedia.org/wiki/Warburg_effect_(oncology) https://en.wikipedia.org/wiki/Warburg_effect_(oncology) The thing is, it has more to do with kind of starving the cancer cells. They don't like using ketones. This won't work for pancreatic and some edge case types of cancer. Lung cancer is probably one of the best ones to treat this way? Far more effective than any of the 'lets poison them to the edge of death and hope cancer dies first' In the last 5 years many have studied this and the nobel prize may be wrong. Like we are discovering it works in a different way. So it's not keto that you want to do, it's actually starving yourself. Starving yourself to the edge of death and hoping the cancer dies. Kind of similar but far more effective? I would make a prediction though, this entire field of research is utterly pointless and if my doctor told me I had cancer I wouldn't concern myself with any of this. During covid, a particular celebrity revealed the cure to cancer. It has been known since the 1970s. His accident in revealing this created this massive censorship move. I've never seen anything at this scale like this, they really didn't want anyone taking it. The drug does seem to have been mislabeled rather egregiously. But cancer patients who got covid tried it and oncologists in Mexico and China found, 'wait off label anti-cancer use of a drug' The cat is out of the bag. Huge consequences though. What happens to population numbers if you eliminate the #2 cause of death and roughly 1 million people per year for just north america alone remain alive? I can see how that's beyond scary for the US government.

53 points by birriel 3y ago

"This case report gives hope that the KD might improve clinical outcomes for some patients with NSCLC. The tumor shrinkage, survival time, spectacular improvement in physical condition, and the restoration of daily attitudes are encouraging for further application of this therapeutic approach to larger numbers of patients." Under "Case presentation" they call out that the patient is right handed... "A 54-year-old right-handed man presented with headache,"... is that a common thing to pay attention to in the type of research? I can see why they note he's a smoker, but seeing right-handed surprised me.

aarong11 3y ago
I mean depending on which side of the brain the tumour is, it could be relevant. Don't quote me on this (I'm not a doctor) but the right hemisphere controls the left side of the body (including left hand) and the left controls the right.
lukeinator42 3y ago
Handedness is important in neuroscience as there are functional asymmetries for things such as language. Pretty much all right-handed brains have language lateralized to the left side, whereas around 70% of left-handers also have language lateralized to the left side. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4219560/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4219560/ So if a person is left-handed it's unknown if the lateralization of various functions in their brain is the same as a right-hander or if things are mapped in strange places. Left-handers also have higher rates of schizophrenia and other disorders. I say this as a left-hander who is doing his PhD in neuroscience, haha.

camelNotation 3y ago

Seems like a remarkably small sample group for a study like this. Maybe I am just not familiar with what is considered a significant sample size for cancer research.

ddorian43 3y ago
A case report is exactly that, a case.
AlexErrant 3y ago
Case report studies kinda by definition are on one patient.

ddorian43 3y ago

The epilepsy-level keto therapy (the one done in the study) can do wonders (80-90% of calories from fat, blood level GKI 1-2). It didn't say what exactly happened with `However, dyslipidemia developed after this time which led to the discontinuation of the diet.`. And if they consulted with a professional and recent research like "lean mass hyper responder".

AlexErrant 3y ago
> The KD was terminated 10 years after diet initiation (2018) as the patient developed dyslipidemia (cholesterol >280 mg/dL, triglycerides >300 mg/dL). It looks like his LDL was "only" 140, but yeah trigs at 300 are no bueno.

hallqv 3y ago

Cancer loves sugar.

darkclouds 3y ago
[dead]
aYsY4dDQ2NrcNzA 3y ago
Some do. A few love ketones.

kyleyeats 3y ago

I'm active in a community for a health condition. There's a very standard, very effective treatment which is mildly uncomfortable and time-consuming. You can also do diet stuff. The diet stuff is about 20x less effective than the actual treatment, but that doesn't stop people from selling diets or not doing the treatment at all in favor of the diet. That's what I worry about with studies like these. If you have a thing, do the actual treatment, don't mess around with diet. Diet impacts everything but that doesn't mean it can do anything. Do the treatment! Not the diet. This thinking can corrupt anyone, famously even Steve Jobs.

ddorian43 3y ago
> You can also do diet stuff. I don't know your health condition, but this is not "diet stuff". It's pretty specific. Look "ketogenic diet for epilepsy". If you break it, you have symptoms very quickly. It IS a medicine. The grams of protein/fat/carbs were pretty extreme, it's not just "low carb" or "just keto" or "diet" or "eat healthy". The difference is that the diet works on some occasions where nothing works, or on some occasions it works very good. Things like DT2 (virtahealth.com), maybe soon for kidney disease (ex from today Feasibility and impact of ketogenic dietary interventions in polycystic kidney disease: KETO-ADPKD—a randomized controlled trial), many mental disorders (metabolicmind.org, virtahealth will try for depression too), etc.
- apwell23 3y ago
  > diet works on some occasions where nothing works Is there documented example of this for lung cancer ?
  - happytiger 3y ago
    Specifically: https://www.fortunejournals.com/articles/significance-of-calorierestricted-ketogenic-diet-for-lung-cancer.pdf https://www.fortunejournals.com/articles/significance-of-cal... > Conclusions: This study demonstrated the significant beneficial effect of a calorie-restricted ketogenic diet for two types of aggressive cancers with metastases. Even a brief KD intervention has a profound effect, implicating the significant therapeutic potential for the ketogenic diet as adjuvant therapy for cancer treatment. Obviously small sample size etc etc More generally: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6375425/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6375425/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10221628/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10221628/ https://www.sciencedirect.com/science/article/pii/S2212877819304272 https://www.sciencedirect.com/science/article/pii/S221287781... https://www.frontiersin.org/articles/10.3389/fnut.2021.594408/full https://www.frontiersin.org/articles/10.3389/fnut.2021.59440... It’s primarily as supporting therapy and quality of life, and is tumor specific, and at this time basically “more research is needed” effectively. I would love to hear from those more qualified.

evanjrowley 3y ago

You can also experience ketosis as part of autophagy during the final throws of stage 4 cancer (i.e., when you can no longer eat and starve), but at that point, the cancer is growing strong rather than shrinking. Where is the threshold between "ketosis treats cancer" and "ketosis is not having a noticeable effect on late stage cancer"? Personally I have benefited from ketogenic diet and would recommend others try it, but I also need to caveat that support by underscoring my lack of answers for critical questions like this.

ddorian43 3y ago
You experience ketosis by lowering carb intake. You may get shot in the mouth, stop eating, and get into ketosis but it doesn't mean ketosis results in gunshots to the mouth. > Where is the line drawn between "ketosis treats cancer" and "ketosis is not having a noticable effect on late stage cancer"? Different types of cancers, different stages of the cancer, different types of ketosis, different people.

misja111 3y ago

> The size of the brain and lung lesion remained stable after nine years of KD therapy. However, dyslipidemia developed after this time which led to the discontinuation of the diet. This is new to me, I didn't know that a keto diet can lead to dyslipidemia? If I search for secondary causes of dyslipidemia (primary cause is genetic), the only lifestyle factor I can find is excessive alcohol use.

ajdude 3y ago
I was doing the keto diet several years ago. I went from 240lbs to 175. I had to stop though because my bad cholesterol went through the roof. Came to find that I am APOE4/4, basically I have a genetic mutation that among other things means my body has trouble dealing with saturated fats. I stopped doing keto and ended up getting back up to 220lbs, but my blood levels went back to normal. I really want to do keto again because it's the only thing that's ever worked for me and I keep hearing about studies like this, but I also don't want to mess up my levels again.
- Nelkins 3y ago
  There's evidence that having super high LDL cholesterol on keto may be fine (do your own research, obviously). Check out https://cholesterolcode.com/ https://cholesterolcode.com/ and look up Dave Feldman. Some really interesting research will be coming out soon.
  - AlexErrant 3y ago
    Feldman was on Peter Attia's podcast [0] and I was not impressed. LDL seems causal in the process of ASCVD. [1] I can't think of a stronger statement in science than one invoking causality. (In particular, it seems necessary, but not sufficient. Interestingly, it seems you can't go too low with LDL [2].) I wonder if OP could continue keto, but go on a statin/pcsk9 inhibitor/bempedoic acid/ezetimibe. Of course, these are prescriptions, so he'll need to find a willing doctor. And have money to shell out. It sucks that he's APOE4/4, since that makes him so much more susceptible to other types of metabolic/cardiovascular disease [3] 0: https://peterattiamd.com/davefeldman/ https://peterattiamd.com/davefeldman/ 1: https://pubmed.ncbi.nlm.nih.gov/28444290/ https://pubmed.ncbi.nlm.nih.gov/28444290/ 2: https://www.health.harvard.edu/blog/ldl-cholesterol-how-low-can-you-safely-go-2020012018638 https://www.health.harvard.edu/blog/ldl-cholesterol-how-low-... 3: https://peterattiamd.com/johnkastelein/ https://peterattiamd.com/johnkastelein/

oneepic 3y ago

Coincidentally my mother has an 80yo neighbor who got diagnosed with brain+lung tumors a few weeks ago. I'd like to recommend this article to her. Though it apparently has the risk of dyslipidemia, "Abnormally elevated cholesterol or fats (lipids) in the blood." (maybe some exercise too to help mitigate that risk)

foxyv 3y ago
This study should not be used to make ANY medical decisions and is only useful in proposing additional studies. I would recommend against sharing it with anyone who is not trained to read and understand these results. Often laypersons will take these studies and make absurd claims based off of them that kill people. Keep in mind that this is a study of a single person and the tumor reduction was insignificant compared to the 4CM reduction from radio/chemo therapies. There is no way to know if Keto even did anything without a larger cohort. For all we know, it made the cancer worse than it would have been.
- kelipso 3y ago
  You read the abstract wrong. The reduction was significant and more than from radiation and chemo (ed. for one of the tumors). > Computed tomography following radiation and chemotherapy showed a reduction in the right frontal lobe lesion from 5.5 cm × 6.2 cm to 4 cm × 2.7 cm, while the mass in the upper-right lung lobe reduced from 6.0 cm × 3.0 cm to 2.0 × 1.8 cm. Two years after KD initiation and without any other therapeutic intervention, the right frontal lobe lesion calcified and decreased in size to 1.9 cm × 1.0 cm, while the size of the lung mass further decreased to 1.7 cm × 1.0 cm.
  - foxyv 3y ago
    Formatting to make it a little easier to parse. There was only a reduction greater than a CM on the right side which almost seems to be just lagging the left side reduction from the Chemo. However without a larger number of participants there is no way to call any of it significant. DIM ORG->CHM->KTD RX: 5.5->4.0->1.9 RY: 6.2->2.7->1.0 LX: 6.0->2.0->1.7 LY: 3.0->1.8->1.0 Edit: Also keep in mind that we are talking about 2 dimensions. For instance on the right side in cm^2: 34.1 -> 10.8 -> 1.9 And the left: 18-> 3.8 -> 1.7

voisin 3y ago

Related: “Tripping over the Truth: The Metabolic Theory of Cancer”[0] [0] https://www.goodreads.com/book/show/23496164 https://www.goodreads.com/book/show/23496164

davedx 3y ago

Jesus christ. A sample size of one? What on Earth is this quackery doing on a .gov website? Unbelievable. This is dangerous toxic bullshit.

incomingpain 3y ago

Not medical advice, if you have cancer don't listen to me. The keto diet, or subtypes, absolutely is anti-cancer. Nobel prize in 1931 basically proving the keto diet is anti-cancer. But how much, is it even a good treatment? Anthrax is anti-cancer, but doesn't mean ANYONE will use it as treatment. https://en.wikipedia.org/wiki/Warburg_effect_(oncology) https://en.wikipedia.org/wiki/Warburg_effect_(oncology) The thing is, it has more to do with kind of starving the cancer cells. They don't like using ketones. This won't work for pancreatic and some edge case types of cancer. Lung cancer is probably one of the best ones to treat this way? Far more effective than any of the 'lets poison them to the edge of death and hope cancer dies first' In the last 5 years many have studied this and the nobel prize may be wrong. Like we are discovering it works in a different way. So it's not keto that you want to do, it's actually starving yourself. Starving yourself to the edge of death and hoping the cancer dies. Kind of similar but far more effective? I would make a prediction though, this entire field of research is utterly pointless and if my doctor told me I had cancer I wouldn't concern myself with any of this. During covid, a particular celebrity revealed the cure to cancer. It has been known since the 1970s. His accident in revealing this created this massive censorship move. I've never seen anything at this scale like this, they really didn't want anyone taking it. The drug does seem to have been mislabeled rather egregiously. But cancer patients who got covid tried it and oncologists in Mexico and China found, 'wait off label anti-cancer use of a drug' The cat is out of the bag. Huge consequences though. What happens to population numbers if you eliminate the #2 cause of death and roughly 1 million people per year for just north america alone remain alive? I can see how that's beyond scary for the US government.