The world is changing fast and to keep up you need local knowledge with global context.
One of the most controversial papers – and one of the most exciting – presented at the recent low-carb, high-fat summit in Cape Town was on the metabolic model of cancer presented by Australian orthopaedic surgeon, Dr Gary Fettke. What does an orthopaedic surgeon know about oncology? Well, lots as it turns out. Fettke, a senior lecturer at the University of Tasmania, does ongoing research into the role of diet in diabetes, obesity and cancer. He is also a cancer survivor.
The metabolic model is not his idea, or even a new idea, though it is still controversial. Doctors and scientists who speak out about it are very quickly branded quacks – a common knee-jerk reaction from establishment elements wedded to conventional scientific wisdom these days. The American Cancer Society says there is ‘no convincing scientific evidence that metabolic therapy is effective in treating cancer’, and some practices ‘may be harmful’. (The latter may be true. The former isn’t.)
The theory behind the therapy is based on the work of German physiologist, medical doctor and Nobel laureate Otto Warburg who died in 1970. It is supported by a growing body of research. In July 2014, US scientists at Dartmouth College Geisel School of Medicine published a study in Cancer Epidemiology Biomarkers & Prevention, showing that reducing carbohydrate intake could reduce the risk of breast cancer recurrence among women whose tumour tissue was positive for the IGF-1 receptor. Lead author Dr Jennifer Emond, an instructor in Dartmouth’s department of community and family medicine said: “There is a growing body of research demonstrating associations between obesity, diabetes, and cancer risk.”
Fettke believes that dietary intervention, in particular a low-carb, high-fat, ‘ketogenic’ diet approach could be the cancer treatment of the future. Here’s a summary I wrote of Fettke’s fascinating presentation to the conference . – MS
‘So you think you need sugar? Your cancer needs it even more’ – a presentation by Dr Gary Fettke
Could we have been travelling down the wrong road of cancer treatment for 90 years? This opens up a whole new way of managing cancer, based on a nutritional approach that is cheaper and doesn’t have the bad side effects of conventional treatment.
Cancer rates are rising worldwide. We never used to see cancers in traditional societies, such as the Inuit and the people of New Guinea, but now we do. Estimates are that there will be a 70% increase in cancers over the next 20 years especially in developing nations, and there is already a 3% increase in children’s cancers per annum. One in two men and one in three women will develop cancer.
There is an increasing incidence of worldwide cancer and poorer prognosis.
The genetic model of cancer doesn’t make sense. It raises the question: is cancer a problem of chromosomal damage as we’ve been taught? But what if the chromosomal damage is just a cancer marker, not the cause. What if the model is wrong, if we are doing things the wrong way when treating cancer? If we have been going down the wrong road for 90 years?
The most dangerous phrase in the English language is: “We’ve always done it this way.”
I blame the microscope for taking us on a detour over the last century. It distracted us. I call it my “Ancel Keys of the cancer world”. (Keys was an American scientist responsible for the “diet-heart hypothesis”, and the now discredited official dietary guidelines that have been in place since 1977. A study by another conference speaker, British obesity researcher Zoe Harcombe, published in the BMJ Open Heart in February, shows that these were introduced in the US in 1977 without any scientific evidence.)
The microscope gave us cholesterol plaques to blame for cardiovascular disease, but now we know that cholesterol is just a marker. Looking down the microscope revealed a variety of changes in chromosomes and the obvious thing was to see the chromosomes as the cause of cancer, but what if the chromosomal damage is just a marker?
I don’t have all the answers. I just want us to consider the possibility that the primary problem is nothing to do with chromosomes; instead, it may be tied up with glucose metabolism – the idea that the chromosomal changes are what we see and have been blamed as the cause but in fact are jut the effect.
This is not a new idea. It is based on the Warburg effect – the work of German physiologist, medical doctor and Nobel laureate, Otto Warburg. It could lie in a message he has been giving us since 1924, when he described aerobic glycolysis – a defect in mitochondrial glucose metabolism that causes fermentation of glucose and diverts glucose away from energy production to cell growth.
The problem with modern cancer treatment is that it ignores the glucose metabolism. There is growing evidence to show that the future of cancer management is about how to use nutritional ketosis in management – starving cancer of glucose and insulin.
Nutritional ketosis is bad for cancer, and it is protective of cells around the cancer.
We also have not fully the recognised the association of diet in the causation of cancer. The problem is sugar, particularly fructose, refined carbohydrates and polyunsaturated seed oils. The modern diet is inflammatory and it produces masses of oxygen free radicals.
Our current treatments are not benign either. It is known that chemotherapy and radiation therapy can rarely cause cancer, but they certainly damage non-cancerous tissues.
If we are prepared to look at that common glucose pathway for cancer we can consider a metabolic model that gives us the potential to starve cancer of the fuel it needs for growth.
The cancer cell isn’t interested in energy. It’s about growth. The metabolic model of cancer considers the building blocks for growth.
All cancers go wrong in the same way: the real problem is based around cellular energy – a diversion of glucose metabolism away from adenosine tri phosphate (ATP) production to the assembly of more cancer cells. The byproducts of this process are the likely cause of the secondary chromosomal damage.
The driving force behind all of the further damage is oxygen free radical formation. The production and release cause random DNA damage – the cause of chromosomal abnormalities.
We do know the source of the oxygen free radicals: inflammation. If we can unlock the key to what’s behind inflammation we may have a new model for treatment of cancer.
Our modern diet clearly plays a role. We have been on a fad diet for the last 50 to 60 years and definitely for the past 30 years. The modern diet is inflammatory and produces a mass of oxygen free radicals. It has made us fatter and sicker.
Cancer gets it building materials by foul means or fair. Cancer cells don’t only require glucose. They also require substrates – building materials that include protein, fatty acids, phosphate and acetate.
The Warburg effect describes how a cancer cell metabolises glucose. A diversion of glucose away from ATP production towards building cell and mitochondrial membranes (via the pentose phosphate pathway) and to that of DNA backbone (ribose 5 phosphate). There is a significant up regulation of glucose on cancer cell membranes to aid this process. This altered glucose metabolism is what we see on the PET scan used in cancer diagnosis and monitoring.
The reverse Warburg effect describes how the other material required for cancer growth is sourced locally. The local invasion of surrounding cells and specifically, fibroblasts is via the same glucose-dependent pathway of aerobic glycolysis. The release of oxygen free radicals produce hydrogen peroxide in tissue water and that is damaging to the surrounding cells and membranes. The subsequent cell death releases all the building materials that a cancer cell requires for growth, bar the glucose.
Ketogenic diets are very low in sugar and carbohydrates and are the food sources of glucose. Both provoke an insulin response. Reducing the consumption of glucose deprives cancer cells of the fuel needed for growth as well as removing the stimulatory effect of insulin (and IGF-1).
A diet very low in carbohydrate and high in natural fats leave the individual utilising ketone bodies for energy. They are a very efficient fuel source from healthy fat consumption that all cells in the body (apart from erythrocytes – red blood cells) can utilise, including the brain. In cancer patients, if you can switch over into nutritional ketosis then the cells surrounding a cancer are protected even more so. That may have a profound effect at times of chemotherapy and radiotherapy.
Cancer cells need glucose to survive and metabolise glucose differently – it’s called aerobic glycolysis – the Warburg effect. Cancer cells cannot metabolise ketone bodies. The ketogenic diet is one that protects surrounding cells but deprives cancerous cells of the fuel needed to survive.
There is some association evidence. Look at what the food industry has given us in the last 50 years. But also we as consumers have demanded of the food industry: we’ve demanded convenience food that is transportable, has a long shelf life, tastes sweet and is cheap. We are just as much to blame as the industry.
There is drug association evidence:
- Aspirin – 43 randomised controlled trials showed 15% reduced cancer death, and 12% reduce non-vascular death.
- Metformin – trials have shown that it reduces overall cancer rates and mortality, a 31% reduction in cancer risk in diabetic patients, and near non-diabetic rate of cancer in diabetic women.
- Antioxidants – have multiple papers of varying quality show benefits of antioxidants and eating fresh food. Vitamins are all involved in modifying inflammation and oxidation.
- Vitamins also have multiple papers of varying quality, so it’s hard to draw definitive conclusions.
Based on history we do have epidemiological evidence on the effect of traditional eating habits in relation to cancer.
We can look at communities around the world that live to a very old age with low cancer rates. Common factors are as more in what they don’t eat – processed foods. They are also spiritual, have a sense of community, and low stress.
We have also associative evidence for the metabolic model for cancer management. Intervention evidence comes from 63 laboratory studies and limited human studies (small numbers), and miracle cures.
The studies are using calorie and carb restriction diets that are shown to reduce cancer. Ketogenic diets are shown to be more effective than just calorie restriction.
Currently there are 15 registered clinical trials looking at ketogenic diets in the management of cancer.
The modern diet is inflammatory at a tissue level. Chronic inflammation is the underlying link to cancer. Inflammation produces masses of oxygen free radicals that are involved in the development and progression of cancer – all cancers.
The current amount and frequent consumption of sugar, particularly fructose, refined carbohydrates and polyunsaturated seed oils combine to give us that inflammatory model. That processed food combination is the source of the massive oxygen free radical onslaught that our bodies are exposed to.
This ultimately makes sense. It provides multiple points of intervention as we go forward. Our options include cutting out sugar, cutting way back on carbohydrates or avoiding polyunsaturated seed oils. We can also use antioxidants at multiple points in the metabolic pathways or ….
We could simply do the lot by cutting out all processed foods.
If we consider this model then we have new treatment options that will direct treatment at causes of damage and not just chromosomal replication as in conventional treatment.
Nutritional ketosis is not there to take over from conventional chemotherapy and radiotherapy options. It should be considered in every cancer patient to make it harder for the cancer to grow, to make the local environment as inhospitable as able and to protect the surrounding tissues from the cancer and from the treatment.
The power of hope
If you have cancer, you definitely want to avoid sugar and carbohydrates. The right amount of healthy fat needs to be increased in your fat intake. Eat real food that is local and seasonal. Combine this with conventional cancer treatments and we have a new way to treat and theoretically prevent cancer.
I don’t have all the answers. I have a personal interest, because I had cancer 15 years ago. I was having vision problems, and was diagnosed with a tumour at the base of my brain. Extensive surgery was followed with radiation treatment and chemotherapy.
My life and our families life changed completely that day I was diagnosed in 2000. All certainty was slashed away, literally the air is sucked out of your lungs and we were struck with a sensation of helplessness.
I did as the doctors told me. Surgery, radiotherapy and chemotherapy – that’s fine because I am still here. But there was no mention of nutrition – ever.
In 2000, I was feeding my tumour with a feast of sugar and kept encouraging its growth with insulin as a result of my diet. I had no concept of nutritional ketosis let alone skipping a meal or fasting.
I started researching and a few years ago, I changed to a ketogenic diet. I decided to starve my cancer. I have decided to make my tumour “allergic” to carbohydrates.
My weight has come down. My inflammatory have come down. My lipid profile is perfect despite my high healthy fat diet. If there is any tumour alive in me it is having a ‘hungry’ time and it’s not getting fed. I have a vested interest. I have taken control of what I can. I am no longer the helpless victim of cancer.
And never underestimate the power of hope. It’s about taking back control.
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