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1. Ketogenic Diet should be part of Cancer patients and Cancer survivors. People suffering from Diabetes and Weight Gain also use Ketogenic Diet BUT this article focuses on Ketogenic Diet and its affect on Cancer. What is Ketogenic Diet? A Balanced and Right diet consists of very low carbohydrate content with high fat and moderate to low protein content. This Low Carb diet forces the body to burn fat instead of carbohydrates or glucose for energy synthesis, so that the body derives 90% energy from fats, 8% from proteins and about 2% from carbohydrates. Shakra Keto This ‘Ketones’ Diet is the brainchild of Dr. Seyfried, thus the name Ketogenic Diet When an individual is on a Balanced and Right diet, metabolism of fats occurs in the liver, which converts fatty acids into ketone bodies. Ketones are then transported in the blood to tissues where they are metabolized further to produce energy. This source of energy is capable of crossing the blood brain barrier and is an excellent form of energy for brain cells. Ketogenic Diet is regarded as First Line Approach for Epilepsy. Is Cancer Next? The Ketogenic diet has been used for managing seizures in children for quite some time and is regarded as the first line of therapy for refractory seizures in children. While Dr. Seyfried and his team were working on brain tumor and epilepsy in mice, one of his students suggested investigating affect of Ketogenic diet on cancer cells. So, since the late ’90s, they began to work on Ketogenic diets for epilepsy and cancer together, eventually suggesting the mechanism that how changing your whole-body metabolic state can be effective in targeting, weakening and eliminating tumor cells.

2. What causes Cancer? 1. The Gene Theory of Cancer. Our genes are made of DNA that tells our cells exactly how to build all the proteins they need to conduct their daily activities. This information has to be flexible, because cells need different proteins under different circumstances. We have read that cancer is about genes going haywire—some toxic chemical or a beam of radiation, attacks your DNA, and leads to mutations (changes)- which changes healthy cells into cancerous cells. These Mutant cells start dividing haphazardly and taking over your body. But there are many poking holes in this Mutation theory of Cancer. And Dr. Thomas Seyfried PhD, a brain cancer researcher in his book “Cancer as a Metabolic Disease”, explains this. He says, “If cancer is a genetic disease, caused by hundreds of thousands of mutations, what we should do, develops hundreds of thousands of different drugs to treat it?” President Nixon commenced war on cancer 40 years ago. Despite the enormous amounts of money, time, and energy that have been poured into cancer research since, we continue to lose the war against it. More than 700 expensive chemotherapy drugs have been developed so far, yet none of them has proven to be fully effective. Seyfried argues that the genes are not the enemy; these are rather damaged and destabilized by the cancerous process. But if genetic mutations do not cause cancer, what causes it in the first place? 2. Metabolic theory of Cancer. Healthy cells turn any kind of nutrient (fat, carbohydrate or protein) into energy by the process called respiration. This process breaks food into water and carbon dioxide in the presence of oxygen. Cancer cells turn inefficiently glucose (from carbohydrates) or glutamine (from proteins) into energy by the process called fermentation. This process doesn’t require oxygen, produces 20 times less energy as compared to respiration and breaks down food into lactic acid and ammonia. Healthy cells sometimes have to resort to fermentation if they are temporarily experiencing oxygen shortage. Whereas Cancer cells use fermentation even when there’s plenty of oxygen around. And this effect is called the Warburg Effect. Cancer cells don’t rely on respiration because their mitochondria are damaged. Mitochondria are the organelles present in each cell where respiration takes place. Radiation, cancer-causing

3. chemicals, viruses and chronic inflammation by generating reactive oxygen species (ROS) damage mitochondria. ROS are the chemical species containing oxygen that are capable of causing damage to the molecules around them. Damaged mitochondria brings a variety of genes into action namely- Myc, Ras, HIF-1alpha, Akt, and m-Tor. These genes are required to run fermentation and are known in the cancer research as “oncogenes” (genes that are associated with increased cancer risk). While these oncogenes are revving up, their respiration counterparts (Genes like p53, APE-1 and SMC4) are gearing down. These genes are important for respiration and also code for DNA repair proteins and are called tumor suppressing genes (genes that prevent tumor). Inside cells, damaged mitochondria causes…unstable DNA, disorganized cells with abnormal shape and uncontrollable proliferation and reproduction. Sound familiar? Sound…cancerous? All these are the hallmark of cancer. Studies have proved that that mitochondrial damage happens first, and this leads to genetic instability Standard Dietary Recommendations for Cancer patients Many people still believe that a low-fat vegan diet is the healthiest diet for cancer. However, as soon as chemotherapy starts causing rapid weight loss, people are told to eat whatever they can to keep up their calorie intake and maintain energy. Some patients are even fed high-glucose solutions through I.V.’s. On the contrary this could be the worst diet ever given to cancer patients as supposed by Dr Seyfried this is because sugar is the primary fuel for most cancers. 1. Cancer has a sweet tooth. Say No to Sugar (Carbohydrates). Mostly all tumors drive energy from glucose for survival, which is how PET scans are able to detect tumors. In PET scans, radioactive glucose is made to travel through the bloodstream. This Radio-labeled glucose accumulates in cancerous tissue more than the normal tissues and lights up on the scan. High blood sugar raises insulin levels, which assists cancer cells in taking and using more glucose for producing energy. Insulin also stimulates the activity of the fermentation pathway and fermentation leads to additional cellular damage. 2. Elevated IGF-I accelerates tumor cell growth.

4. High blood sugar also raises levels of another hormone called IGF-I (Insulin-like Growth Factor I). The cancer cells, which have receptors on their surfaces for this hormone, grow more rapidly. IGF-I stimulates a chemical pathway that accelerates tumor cell growth. This pathway turns on cell multiplication, sets the stage for cells to escape death (apoptosis) and recruit their own blood supply (angiogenesis). So in short, more glucose = more insulin AND more IGF-I = more fermentation and more tumor growth. Dr. Seyfried’s work confirms that cancer is a Mitochondrial disease- and diseased mitochondria prefer glucose for fuel. Healthy cells with normal mitochondria function best when they burn fat for energy. But cancer cells cannot burn fat, because burning fat requires respiration and healthy mitochondria. So by restricting Sugar (Carbs) and providing fat as an alternate fuel, you can dramatically reduce the rate of growth of tumor. Ketogenic Diet for Cancer: How it works? Restricting food rich in carbohydrates lowers blood glucose level, which further lowers insulin and IGF-1 levels. This can inhibit tumor driving genes and pathways described above, which means by changing the fuel of our body from glucose to fats we are practically starving tumor cells. Under low blood glucose conditions, another hormone called glucagon kicks in. Glucagon accelerates fat burning and raises ketones and fatty acids in the blood. When ketones are burned for energy instead of glucose, fewer “reactive oxygen species” (ROS) are generated. These are free radicals responsible for inflammation and “oxidative damage”, which is associated with numerous chronic diseases. This type of diet is also considered by neurologists to be “neuroprotective.” This means they protect brain cells from harm. Summary of Dr. Seyfried’s Recommendations of Ketogenic Diet for Cancer Patients Most of the Cancer cells grow best when they have access to a combination of glucose (from dietary carbohydrates) and the amino acid glutamine (from dietary proteins). However, there

5. are some types of cancer cells which are dependent on glutamine as a primary fuel for energy. That this is why BOTH glucose AND glutamine should be restricted in order to best starve the cancer cells. Dr. Seyfried recommends a “Ketogenic” diet that contains 80% fat, with the rest (20%) being made up of protein and carbohydrate to target cancer cells. People following strict Ketogenic diets need to weigh and measure everything they eat, and monitor their blood sugar and blood ketones daily. The blood sugar levels should be allowed to fall into the 55-65 mg/dL ranges, and ketones rise to at least 4.0 mm (this is described by Dr seyfried as therapeutic zone) Kick-start with a 3-day Fast: The quickest way to get into this zone is by fasting for 3-5 days. During this phase, some (harmless) carbohydrate withdrawal symptoms may occur, which typically include lightheadedness, nausea, gastrointestinal discomfort and headaches. An alternative to this fasting is limiting your carbohydrate intake to less than 12 grams per day and limiting protein to 0.8 to 1.2 grams per kg body weight per day for several weeks to be in the therapeutic zone values. He also recommends supplementing your diet with a multivitamin, calcium, omega-3 fatty acid and vitamin D. If your cancer would benefit from surgery, he recommends being on the Ketogenic diet for at least few weeks before undergoing surgery. This is because Ketogenic diet can reduce blood supply, inflammation, and tumor size, making it easier for the surgeon to remove the tumor more efficiently. As far as the specific types of fats are concerned, Dr. Seyfried recommends medium-chain triglycerides, i.e. coconut oil, extra virgin olive oil, flaxseed oil, seeds, avocado, eggs, butter, macadamia nuts, and other sources of saturated fats. “The saturated fats are converted to ketones much more readily than polyunsaturated fats,” he added. Avoid refined carbohydrates, glucose, fizzy soft drinks, high fructose corn syrup, and high glycemic index foods. But you can consume non-starchy carbs from the plants. Some basic precautions while on Ketogenic Diet This diet can affect dosages of many prescribed drugs so all your medications should be monitored by your physician timely when you are on Ketogenic diet. Blood tests to monitor electrolytes and other important medical values should be done regularly.

6. This diet may not work if you are taking steroid medications such as dexamethasone because steroid medications raise blood sugar levels. It may also not work if you are receiving I.V. medications containing glucose. Designing a nutritionally adequate Ketogenic diet is not easy; so make sure you seek guidance of a nutritionist with expertise in medical Ketogenic diets. Potential risks of Ketogenic Diets The acute side effects of this diet are typically lethargy, nausea, and vomiting due to intolerance of high fat content, especially in children. In contrast, some adults may have gastrointestinal discomfort as a side effect. Some studies have also reported deficiencies in minerals like selenium, copper, and zinc. So appropriate supplementation of these minerals is required while on the diet. One study has reported the presence of kidney stones with long-term consumption of ketogenic diet. This can be prevented by usage of oral potassium citrate. A Sample Ketogenic Diet. The Ketogenic diet focuses on good fats. Eggs Butter Olive oil Avocados Coconut oil Flaxseed oil Raw seeds and nuts The diet also allows non-starchy carbohydrate vegetables

7. Kale Celery Cabbage Spinach Broccoli Asparagus Cucumber Cauliflower Mushrooms Collard greens Brussels sprouts Protein sources Whole Eggs. Bacon and Sausage: Watch out for anything cured in sugar. Poultry: Go for free range or organic Chicken, Duck, Quail and Pheasant Peanut Butter: opt for natural peanut butter, Try to go for macadamia nut butter if possible. Meat: Try to include grass-fed meat as it has better fat content and this includes Veal, Goat and Lamb Fish and sea food: consume anything that is caught wild like catfish, cod, halibut, mackerel, mahi-mahi, salmon, snapper, tuna, shellfish, oysters, lobster, crab, scallops and squid. Dairy products: Raw, organic and full fat milk products are preferred Buttermilk

8. Sour Cream Cottage Cheese Heavy Whipping Cream Cheese– (Cheddar, Mozzarella, Cream Cheese, feta) Nuts and Seeds Avoid peanuts, as they are actually legumes which are not permitted in the ketogenic diet Macadamias, walnuts and almonds has high carbohydrate content and can be eaten in small amounts. Beverages The ketogenic diet has a natural diuretic effect, so it can cause dehydration if you don’t consume adequate water Water Coffee Tea (Herbal and non-herbal), but be careful in using sugar Sugar and Sweeteners Staying away from sugar and sweeteners is generally the best bet – as it helps in reducing carb cravings and promotes successs on the Ketogenic diet. If you want to have something sweet, go for liquid sweeteners as they don’t have maltodextrin and dextrose which have carbs.

9. Erythritol Stevia in liquid form Sucralose in liquid Spices Sea salt is preferred over table salt Read the nutrition label of pre-packed spice mixture. Spices have carbohydrates in them, so make sure you are adding them into your counts. Please Note: I am not qualified to recommend any particular diet to anyone with cancer, and these recommendations are not intended as Medical advice. Ketogenic Diets are very challenging and alone these cannot provide disease resolution. It is just an adjunct to mainstream Cancer treatment.