Alternative Treatments
Several researchers have posited that because brain tumor cells require sugar (glucose), a diet that greatly reduces sugar and carbohydrate intake—such as a Ketogenic or Zone type diet—may offer an effective therapy for brain tumors [Seyfried et al., 2009, 2005, 2003, 2001]. The body’s healthy cells (including brain cells) can easily switch to using ketones (from fats) for their energy source. Tumor cells, however, are entirely dependent upon glucose and cannot utilize ketones. This diet plan offers a macronutrient ratio of 70% calories as fat, 20% protein and 10% carbohydrates. When gluocse intake is restricted healthy cells in the brain and body use ketones (made from fats) as an energy source. Apparently, brain tumor cells are unable to utilize ketones, and the lack of sugar causes them to “starve.” A pilot study of children with advanced brain stem tumors showed that after several months on a ketogenic diet, the metabolic activity of the tumor (on PET scan) was significantly reduced [Nebeling et al., 1999]. In addition, a 4-year-old girl in this study, with BSG (brain stem glioma) metastasized to the spine, responded well to the diet, continuing it for 1 year. She remains alive and well 10 years later. Italian neurooncologists have reported on a 65-year-old woman with a rapidly progressing multi-focal GBM tumor treated with partial resection, followed by standard therapy plus a Ketogenic diet [Zuccoli et al., 2010]. The patient fasted (water only) for 2-3 days twice in the 2 week period after surgery, then began a Ketogenic diet [supplying 600 calories/day as 42 grams fat, 32 grams protein, 10 grams carbohydrates and 10 grams medium chain triglycerides (MCT) from coconut oil] for 2 weeks. At this time, radiation and Temodar were begun while the calorie restricted diet was continued. MRIs after completion of radiation showed complete regression of the residual tumor and resolution of edema. Over the next 5 months, follow-up MRIs showed no evidence of tumor recurrence. At this time the patient discontinued Ketogenic diet, and an MRI 10 weeks later showed tumor recurrence (at which time she began Avastin + CPT-11 therapy). Rapid regression of GBM tumor is rare in older patients following incomplete surgery and standard therapy alone, and this demonstration of the efficacy of Ketogenic Diet is promising. A pilot trial of the Ketogenic diet in adults with recurrent glioblastoma tumors has been conducted in Germany. Results were presented at the 2010 meeting of the American Society of Clinical Oncologists (ASCO). Eleven patients were treated with the diet alone; 7 were also treated with Avastin. The researchers have reported promising results, and shown the ketogenic diet clearly has antitumor activity in glioma patients [Rieger et al., 2010]. The diet may be particularly beneficial in combination with anti- angiogenic therapy. None of the participants experienced serious adverse side effects from the diet. This diet is experimental. It is not a replacement for chemotherapy and/or radiation treatments. It appears to work better in patients not requiring decadron (as steroids raise blood sugar levels). If you have exhausted medical treatment options, the Ketogenic diet may be of interest to you. Because you and I are working at distance, you must have a local doctor or nutritionist who can monitor your use of the KetoGenic diet. Do not attempt to follow the diet without supervision. Here are some options for following the Ketogenic Diet: (a) Hire a nutritionist who specializes in planning ketogenic diets to make up food plans (b) Use Keto- Cal, a canned liquid diet available commercially (c) Use Dr. Wallace’s modified Ketogenic Diet, the Keto-BT smoothie (call the office to request the recipe and related handouts). The diet needs to be followed very carefully, without deviations which would alter the ratio of fats to carbohydrates. Using Keto-BT or Keto-Cal allows you to carefully control the ratio of carbs to fats to protein in the diet. An excellent resource for additional information about the Ketogenic Diet is The Charlie Foundation, www.charliefoundation.org. NUTRITIONAL SOLUTIONS CONSULTING GROUP Clinical Nutrition Research & Consulting for Brain Tumor Patients Jeanne M. Wallace, PhD, CNC National Association of Nutrition Professionals (NANP #20022) Board Certified in Holistic Nutrition (HNCB 2007) • Member, Society of Integrative Oncology 1697 East 3450 North, North Logan, UT 84341 USA Phone: (435) 563-0053 • Fax: (435) 563-0052 • Email: This e-mail address is being protected from spambots. You need JavaScript enabled to view it. © 1997-2010 • Updated August 2010 Mukherjee P, Abate LE, Seyfried TN: Antiangiogenic and proapoptotic effects of dietary restriction on experimental mouse and human brain tumors. Clin Cancer Res, Aug 15, 2004;10:5622-9. Mukherjee P, El-Abbadi MM, et al: Dietary restriction reduces angiogenesis and growth in an orthotopic mouse brain tumor model. Br J Cancer, May 2002;86(10):1615-21. Nebeling LC, Miraldi F, Shurin SB, Lerner E: Effects of a ketogenic diet on tumor metabolism and nutritional status in pediatric oncology patients: two case reports. J Am Coll Nutr, Apr 1995;14(2):202-8. Nebeling LC, Lerner E: Implementing a ketogenic diet based on medium-chain triglyceride oil in pediatric patients with cancer. J Am Diet Assoc, Jun 1995;95(6):693-7. Rieger J, Baehr O, Hattingen E, et al: The ERGO trial: a pilot study of a ketogenic diet in patients with recurrent glioblas- toma. J Clin Oncol, 2010:28(suppl., abstract#e12532). Seyfried, T. Caloric restriction reduces growth and angiogenesis in a mouse brain tumor. Proc Amer Assoc Cancer Res, March 2001,42:651. Seyfried TN, Kiebish M, Marsh J, Mukherjee P: Targeting energy metabolism in brain cancer through calorie restriction and the ketogenic diet. J Cancer Res Ther. Spe 2009;5 Suppl 1:S7- 15. Review. Seyfried TN, Mukherjee P: Targeting energy metabolism in brain cancer: review and hypothesis. Nutr & Metab, Oct 21, 2005;2:30. Seyfried TN, Sanderson TM, El-Abbadi MM, et al: Role of glucose and ketone bodies in the metabolic control of experimental brain cancer. Br J Cancer, Oct 6, 2003;89(7):1375-82. Zuccoli G, Marcello N, Pisanello A, et al: Metabolic management of glioblastoma multiforme using standard therapy with a restricted ketogenic diet: Case Report. Nutr Metab (Lond.), Apr 22, 2010;7:33.