There’s been some fantastic progress lately in treating different types of cancer and good news keep coming, as genetic and immunotherapies advance.

Malignant brain tumors however, have so far proven to be tough nuts to crack. We’re basically limited to surgery, chemo and radiation, and survival rates remain dismal.

All is not hopeless however; there’s a revived interest among researchers and clinicians in looking at the effects of Ketogenic diet.

Keto is a regime rich in fat and low on carbs. It’s to LCHF what a formula 1 car is to a roadster. In fact many doctors consider it so extreme and hard to follow that they refrain from recommending it, even though it’s showing promise.

It was ‘invented’ a hundred years ago, and was used back then to treat severe forms of epilepsy. It works because it’s changing the neurochemistry of the brain.

Thanks to the invention of better epilepsy medications, Keto fell out of favor during the latter half of the 20th century. Then it surfaced dramatically again in 1994, thanks to Hollywood producer Jim Abrahams. His two year old son Charlie suffered from epilepsy that seemed to resist all state-of-the-art meds.

Luckily Charlie got completely cured when he ended up at Johns Hopkins hospital, which at the time was one of few institutions that hadn’t given up on Keto. The ‘miracle treatment’ got picked up by national news, and a couple of years later made it onto the silver screen. The rest is history; these days Ketogenic diet is back to being a natural part of the toolbox when it comes to fighting epilepsy.

Then late 2015 this guy Dom D’Agostino, PhD, goes onto Tim Ferriss’ podcast talking about Fasting, Ketosis, and the End of Cancer. D’Agostino is invited back six month later for a conversation exclusively on the Ketogenic diet. Then in 2018, he’s back again talking about Disease Prevention, Cancer, and Living Longer. The three episodes taken together spans more than five hours, and feel more lika a university course than a talk show.

The background is this: Dom D’Agostino been tasked by the army to see if it’s possible to develop a pill that instantly puts the body in ketosis, which is the state where cells burn fat instead of glucose. The reason for this is exotic. It’s important to the military because a state of ketosis radically improves the body’s oxygen uptake. This would be beneficial to special forces soldiers when they’re diving with a piece of equipment called rebreathers, which will always feed some CO2 back into the lungs of the diver (apparently they’re used by the Navy SEALs so that there are no bubbles on the surface to reveal a divers presence).

The project was inconclusive. It did show that it’s possible to synthesize a type of ketone ester that helps speed up the transitioning into ketosis, but those are expensive; won’t work fast enough for military purposes, and taste so vile that people tend to throw up when taking them. All in all, it’s simpler to just stop eating carbs, which will put the body in ketosis within a couple of weeks.

What D’Agostino found out in the process however, was that a state of ketosis seemed to be a very efficient way of slowing down the growth of aggressive tumors.

It all made sense from the perspective of cell metabolism. It’s a well known fact that the mitochondria of cancer cells have defects that make them rely on glucose in order to thrive. This is just one of the ways they’re different from healthy cells, the mitochondria of which retain the ability to adapt so that they can use ketone bodies for energy instead of glucose.

The skeptics objected that even in a state of ketosis, there’s still always going to be some level of glucose in the blood stream, without which the body wouldn’t be able to function. They went on to say that even if Keto is efficient against tumor growth, it’s not necessarily worth the side-effects, which include the dreaded keto-flu. (For the record: I’m personally on a strict Ketogenic diet since eight years back. The keto-flu was indeed unpleasant, but it was also over in about ten days).

Now that we’ve paid due attention to the nay-sayers—who will always be there, that’s what science is about after all—let’s look at the potential upsides.

Two years ago the Journal of Practical Neurology reported that 21 out of 25 patients suffering from Astrocytoma—a nasty form of brain cancer—had metabolic changes in the tumor, which was likely an effect of their strict adherence to a Ketogenic diet.

The study’s author Roy E. Strowd, MD, MS, MEd, of Wake Forest School of Medicine in Winston-Salem, NC, and a Fellow of the American Academy of Neurology, says this:

“These cancer cells rely on glucose, or sugar, to divide and grow. Since the ketogenic diet is low in sugar, the body changes what it uses for energy—instead of carbohydrates, it uses what are called ketones. Normal brain cells can survive on ketones, but the theory is that cancer cells cannot use ketones for energy. Of course, more studies are needed to determine whether this diet can prevent the growth of brain tumors and help people live longer, but these results show that the diet can be safe for people with brain tumors and successfully produce changes in the metabolism of the body and the brain. There are not a lot of effective treatments for these types of brain tumors, and survival rates are low, so any new advances are very welcome,”

Pracitcal Neurology, 21-07-13

Other studies are more cautious. American Journal of Neuroradiology just states—this from 2019—that a Ketogenic diet can be proved to change the metabolism of tumor cells.

Going back to 2016, the year after Dom D’Agostino surfaced on my radar, a study published in Frontiers of Molecular Neuroscience concludes that:

Preclinical data has demonstrated that the anti-tumor effects of the KD [Ketogenic diet] and CR [caloric restriction / fasting] are multi-faceted, and alterations in energy metabolism can inhibit cancer cell growth and increase the tumor’s response to therapy. This provides a strong impetus to continue work designed to elucidate the mechanisms through which KD exerts its anticancer effects, as well as suggesting the need for the design of controlled clinical trials that will shed light on the most effective way to implement metabolic therapies in combination with standard therapies for the treatment of malignant disease. This is a novel therapeutic paradigm, and we have only begun to scratch the surface of its potential.

Meanwhile Imperial College of London’s Brain Tumor Research Lab looks at the effect of Ketogenic diet in mice and states that:

Researchers in the US have shown that when the ketogenic diet is used alongside radiotherapy in a mouse model, brain tumours disappear from the brain and, amazingly, stay away even when the mice are then moved back onto a normal diet. There is obviously a big difference between obtaining this result in a laboratory and in humans, but research in other laboratories (including those at Imperial College) also indicates that the ketogenic diet may make surgery, chemotherapy and radiotherapy work more effectively so it is vital that we explore this possibility.


So, where does all of this leave us?

The honest answer is: it might be too early to say. Anecdotal evidence keep piling up to suggest that Ketogenic diet (preferably combined with fasting) might be effective at battling brain tumors. I also know from personal experience that many clinicians are starting to come around, the medical professionals I know have a very different attitude towards Keto now, compared to a decade ago.

With that said, they are probably not very representative. I was reminded of that the other day when I attended a talk on the topic of “Research on diets and its effects on health, cancer and brain tumors“, held by an oncologist who had also just published a cook book with vegetarian recipes.

To my surprise, he categorically dismissed any possible cancer-battling effects of a Ketogenic diet. According to him, the only thing that could be “scientifically proven”, was the benefit of dropping red meat.

I approach the speaker after his performance to share my doubts about his recommendations but was only met with the question whether I was a medical doctor, implying that anyone who isn’t, should stay away from the field.

Indeed I’m not a medical doctor, just a bit of a curious geek. Sometimes that’s a good vantage point; one from which it’s easier to see around corners.