Rasputin

The title of your blog is misleading. The title of the paper is 'Metabolic management of glioblastoma multiforme using standard therapy together with a restricted ketogenic diet: Case Report.'. There is absolutely no evidence presented to suggest that the ketogenic diet contributed to the improvements noted on MRI etc. Furthermore, the brain tumour recurrence occured after radiotherapy and chemotherapy were ceased. Again the contribution of the strict diet therapy is speculative at best.
Such paper should be taken for what they are - an observation of what happened, not evidence of effectiveness of a given therapy or diet.

The paper was presented with the presupposition that the glioblastoma are difficult to treat at best using conventional treatment:

Management of glioblastoma multiforme (GBM) has been difficult using standard therapy (radiation with temozolomide chemotherapy).

One could consider the large number of patients treated up to that point using only standard therapy as the control group. The variable which differed in this study was the application of the ketogenic diet.

MRI evidence of tumor recurrence was found 10 weeks after suspension of strict diet therapy.

There was zero evidence of tumors remaining after the two months of diet and conventional treatment. The tumors recurred once a non-ketotic diet returned.

It does make sense, after all. Cancer cells switch off their mitochondria in exchange for freedom from apoptosis. In the process, they lose the ability to metabolize any fuel except for pure glucose, and even that they must ferment in their cytoplasm very inefficiently. Normal cells can utilize their mitochondria to "burn" a wide variety of fuels, such as fatty acids, ketone bodies, glucose, etc. In addition, insulin itself has been shown to be a growth factor in certain types of tumors.

Keeping blood sugar levels at maintenance levels ~80 mg/dl and allowing the patient to become fat-adapted starves the cancer cells of their only fuel while providing ample fat and ketones to run the rest of the body's systems.

In response to the points you raise.

1. First of all what you are talking about is a Case Study. For all you know, these people could have treated 2,456,098.345,624 patients by this method and this was their only success. Therefore your argument that the large number of patients treated up to that point using only standard therapy as the control group does not stand up to scrutiny.

2. No evidence of tumour remaining on MRI does not equate no tumour remaining. It only means the MRI is not sensitive enoughto pick up what's there.

3. After having been surgically debulked and zapped with radiation and chemotherapy, tumours do take a while to grow back, whatever diet the patient is on.

The last 2 paragraphs of you most recent post are what I call 'pseudo science'. That is you quote some research findings and generalise them to support your case without putting your theory to the test

Firstly you first point "Cancer cells switch off their mitochondria in exchange for freedom from apoptosis. In the process, they lose the ability to metabolize any fuel except for pure glucose, and even that they must ferment in their cytoplasm very inefficiently. " Is that true of all cancer cell or just some. Is it true of the cells in this patient's cancer?

Your second point " In addition, insulin itself has been shown to be a growth factor in certain types of tumors." My question - is it in this patient's tumour. If you're not sure, why even mention it?

Proper science involves taking a theory and putting it to the test. A retrospective case study like the one you posted is not evidence, it is merely an observation and if deemed important enough by the relevant experts, will lead to a proper scientific study. I'll wait for the result of such a study before recommending the diet in question to a cancer sufferer.

A question for you before I finish. How can you be sure that the diet did not contribute to the recurrence of the cancer rather than slow it down?

Cheers, Rob

In response to the points you raise.

1. First of all what you are talking about is a Case Study. For all you know, these people could have treated 2,456,098.345,624 patients by this method and this was their only success. Therefore your argument that the large number of patients treated up to that point using only standard therapy as the control group does not stand up to scrutiny.

2. No evidence of tumour remaining on MRI does not equate no tumour remaining. It only means the MRI is not sensitive enoughto pick up what's there.

3. After having been surgically debulked and zapped with radiation and chemotherapy, tumours do take a while to grow back, whatever diet the patient is on.

The last 2 paragraphs of you most recent post are what I call 'pseudo science'. That is you quote some research findings and generalise them to support your case without putting your theory to the test

Firstly you first point "Cancer cells switch off their mitochondria in exchange for freedom from apoptosis. In the process, they lose the ability to metabolize any fuel except for pure glucose, and even that they must ferment in their cytoplasm very inefficiently. " Is that true of all cancer cell or just some. Is it true of the cells in this patient's cancer?

Your second point " In addition, insulin itself has been shown to be a growth factor in certain types of tumors." My question - is it in this patient's tumour. If you're not sure, why even mention it?

Proper science involves taking a theory and putting it to the test. A retrospective case study like the one you posted is not evidence, it is merely an observation and if deemed important enough by the relevant experts, will lead to a proper scientific study. I'll wait for the result of such a study before recommending the diet in question to a cancer sufferer.

A question for you before I finish. How can you be sure that the diet did not contribute to the recurrence of the cancer rather than slow it down?

Cheers, Rob

My research into existing studies shows me that it is, if not all cancer cells, the vast majority of them which utilize glucose solely for energy. The question about insulin and growth factors is meant to inform regarding cancers as a whole. There is great merit in keeping glucose and insulin levels near baseline, as I have mentioned elsewhere, so this should be taken as one more reason.

1. It does not invalidate the finding, only limits its results to an N of 1. To falsify this study, all it would take is a similar study done with the same parameters which showed no effect on the cancer. If you had a melanoma on your face and I smacked it and the melanoma went away, the way to attack that study is to find someone else with a melanoma and smack it. Telling me that my face-smacking study only seemed to effect one melanoma is simply stating the obvious.

2. Sounds like a tree falls in the forest kind of an argument. If two diagnostic meters fail to find evidence of a tumor, I am OK with saying that it isn't there any more. By that logic, we are all carrying cancer, we just can't detect it.

3. I'll give you that.

Re: pseudo science--Well, as a layperson without access to funds or a pool of patients to draw from, it is all I have to work with right now. The best I can do is to draw from the work that others are doing and try to draw comparisons with work done in other related fields to see if there is potential for causation and/or treatment. Right now, the evidence is compelling enough that it deserves more attention, which is why I bring it out in this forum.

As for your last question, it depends on your definition of the word "sure". I cannot think of a scenario where I could be 100% guaranteed certain that the diet did not contribute to the recurrence of the cancer, since the best and brightest minds in all of Medicine are still trying to figure out exactly why cancers form, down to the molecular level. However, given the recent developments which show that cancer cells (including brain tumors) can only metabolize glucose as mentioned above, and the fact that cancer has been shown to be nonexistent in primitive hunter-gatherer societies even into the 20th century until they are introduced to white flour and sugar, at which time cancer (among other diseases) begins to appear in their populations, and the fact that studies (not just this one) have shown that removing carbohydrate from the diet and replacing it with fat causes remission of many types of tumors, Occam's razor begins to apply.

The simplest explanation for the creation and maintenance of cancer when the above is presupposed is that, for whatever reason the cancer begins in the first place, a necessary step in its perpetuation is a ready food source, and when it can only utilize glucose, maintaining a ready supply of it in the bloodstream would seem to be contraindicated, especially since that in itself is a health risk.

So, although certainty with digital precision is beyond my means at the moment, logic allows me to be as "sure" as I believe is reasonable, especially since I as a layperson must rely on the work being done by others with access to money, facilities and patients.

Some further information on the topic:

http://healthbeatnews.com/news/archives/431

http://www.time.com/time/health/arti...662484,00.html

http://www.newtreatments.org/cancer

http://www.lowcarb.org/josh_yelon/topic8.html

Yes, the double-blind, randomized studies are necessary for proof. However, the evidence is compelling enough, and the change to a more paleo-type diet innocuous enough (especially in comparison to the already toxic effects of the chemo and radiation already being used) that it would seem to me to be cruel at this point to NOT offer it as an option to a cancer patient, until such time as the studies can be completed.

Hi David,

You write
"So, although certainty with digital precision is beyond my means at the moment, logic allows me to be as "sure" as I believe is reasonable, especially since I as a layperson must rely on the work being done by others with access to money, facilities and patients."


I would like to point out the conclusion of the authors of the article you quoted "the response observed in this case could result in part from the action of the calorie restricted ketogenic diet. Further studies are needed to evaluate the efficacy of restricted ketogenic diets, administered alone or together with standard treatment, as a therapy for GBM and possibly other malignant brain tumors." The important word here is 'could'.

Their conclusion is very remote your statement, I quoted above and from the title of your blog 'Virulently malignant brain tumor in woman successfully treated with ketogenic diet.'

Cheers,

OK, so could != did. If that is the sole concern left at this point, I say we're good. If I had the ability, I would change the title of this entry to:

Virulently malignant brain tumor in woman May Have Been successfully treated with ketogenic diet.

Sufficiently lacking in certitude?

Another study which I found interesting:

http://www.ajcn.org/cgi/reprint/47/1/42.pdf

Originally Posted by page 46

These results demonstrate clearly that a ketogenic diet containing 70% MCT...can maintain these individuals in a positive N balance...Their mean weight did increase by ~2kg during the period of feeding with the ketogenic diet...Because there was no significant alteration in the blood urea concentration, this suggests that at least a component of the weight gain was due to an increase in body protein mass.

Yes, the study was not randomized, but it still lends credence to the theory that a ketogenic diet is a healthful one to cancer patients.

And, let's at least be fair, we are basically asking the patients to undergo a change in diet similar to one eaten by populations of humans which were cancer-free, which they themselves ate for thousands of years with no measured ill-effects.