What is a ketogenic diet?
A ketogenic diet is a high fat, moderate protein (meaning protein-adequate), very low-carbohydrate diet that has been used to treat refractory (difficult to control) epilepsy and other brain disorders in children and adults. It has also been used in the treatment of multiple sclerosis, Grave’s Diease, other thyroid disorders, type I, II, and III diabetes (Alzheimer’s disease), and the metabolic management of cancer, auto immune disorders, chronic migraine headaches, and many other conditions. The diet forces the body to run on fats rather than carbohydrates. In the process, the body produces ketones, which show up in the blood and often in the urine.  Your brain and heart prefer to run on ketones because they are a virtually unlimited energy sources if you are overweight (overfat) or if you eat enough dietary fat.

All about ketones
From Sweet Potato Power by Ashley Tudor:
“The human body was designed to function well in the presence of ketones. are highly adapted to running on ketones. Ketones are used in many of the same metabolic pathways where carbs exist. For many systems in the body, ketones and carbs are used interchangeably. Ketones are a preferred fuel source for the brain. This is why low-carb diets help with clear mental functioning and high-carb diets leave you with a feeling of mental fogginess. But, more importantly, ketones protect neurons from oxidation and oxidative stress, making them less susceptible to degenerative brain diseases such as Alzheimer’s. They also help regulate dopamine (the happy makers) and they have been hypothesized to help regulate depression. For decades, ketosis has been recommended by doctors as a last resort to fight persistent seizures. Beyond the brain, other cells in the body also respond well to ketones. One type of ketone, beta-hydroxybutyrate, is a super fuel. It increases energy while decreasing oxygen consumption, making cells more efficient at doing their job.”

The ketogenic diet and the treatment of epilepsy
The ketogenic diet was popularized in the treatment of pediatric epilepsy by John’s Hopkins University in the 1920s and for the next decade. The diet waned in popularity with the advent of new anticonvulsant drugs and the push made by the pharmaceutical industry to promote their prescription drugs.

The diet was featured in the film, First Do No Harm with Meryl Streep, created by Hollywood producer Jim Abrahams, whose son, Charlie’s severe epilepsy was effectively controlled by the diet. He not only became seizure free; he also got off anti convulsant drugs, become more alert and happier. Many of the films’ actors were themselves helped by the diet as children. Abraham’s created the Charlie Foundation to promote the diet; the foundation later sponsored a multicentre research study, the results of which—announced in 1996—marked the beginning of renewed scientific interest in the ketogenic diet, which has over time been modified by some experts to include better quality fats than in the earlier years.

According to Wikipedia, “Almost half of children and young people with epilepsy who have tried some form of this diet saw the number of seizures drop by at least half, and the effect persists even after discontinuing the diet. The most common adverse effect is constipation, affecting about 30% of patients. In the film, those who followed the diet strictly for at least three years were later able to discontinue the diet.”

“There is some evidence that adults with epilepsy may benefit from the diet, and that a less strict regime, such as a modified Atkins diet, is similarly effective. Clinical trials and studies in animal models suggest that ketogenic diets provide neuroprotective and disease-modifying benefits for a number of adult neurodegenerative disorders.’’

Is this a high protein diet?
No. Contrary to what many people assume, a low-carb diet is not automatically a high protein diet. A properly designed ketogenic diet contains a moderate amount of protein,
just enough protein for normal bodily growth and repair and sufficient calories to maintain correct weight for a child’s age and height. (Note: For cancer patients and those requiring or desiring weight loss, a calorie-restricted ketogenic diet  (CRKD) is essential. This will be explained more in my forthcoming book, The Ketogenic Cancer Care Cookbook (Planetary Press, Spring or Summer of 2014).

Protein must be limited because in excess it can be converted into glucose, by a process called gluconeogenesis, which keeps the body in a sugar-burning mode. In the case of cancer patients, the excess protein converted into glucose can raise insulin and glucose levels and fuel the growth of cancer cells.

The bulk of the calories (75 to 80% of total calories) in a properly designed ketogenic diet come from fat. The diet usually contains a 4:1 ratio by weight or calories of fat to combined protein and carbohydrate. Protein typically ranges from 15 to 20% of calories. Carbohydrates are restricted to 2 to 5% of total calories. This is achieved by avoiding all high-carbohydrate foods, such as fruits, starchy vegetables, grains (breads, pasta, cereals), beans and legumes, alcohol, sugar, and other caloric sweeteners (see list below), as well as milk protein.

Refer to a chart on calories and breakdown of calories for height and weight. You will find such a chart in the e-book mentioned here about the Ketogenic Diet for Cancer by Ellen Davis.
http://ketonutrition.blogspot.com/2012/12/starving-cancer-ketogenic-diet-key-to.htmlome websites provide calculators that will figure your energy and macronutrient needs once you type in height, weight, some body measurements, and BMI if you have it, along with activity level and how long you have been on a low carb diet.

You will find a chart in the appendix of Ellen Davis’ book and my Ketogenic Cancer Care Cookbook (due out later this year; subscribe to this blog to receive updates when I make new posts) that shows you how many grams of each macronutrient you need for your ideal weight on a restricted ketogenic diet.

Here is another book about the Ketogenic Diet for Cancer
This was written by a women who had aggressive breast cancer that kept growing. Within weeks of starting on the diet, she was completely cleared of cancer! She also helped her type I diabetic son get off insulin! Her book is called The Cantin Ketogenic Diet: For Cancer, Type I Diabetes & Other Ailments by Elaine Cantin.

The restricted ketogenic diet (RKD) and why it’s important
A restricted ketogenic diet (RKD) is a lower calorie diet that emphasizes consuming foods high in fat, moderate in protein, and very low in carbohydrate. According to Ellen Davis, a nutrition student and author of Fight Cancer with a Ketogenic Diet: A New Method for Treating Cancer, “The RKD is designed to target cancer cell metabolism by reducing the metabolic factors that promote cancer growth, while protecting normal cells from the toxic effects of traditional therapies.” You can read more about her work on her website: www.ketogenic-diet-resource.com

In a calorie-restricted state, your body will be more likely to do cellular cleanup. Autophagy is a natural process by which the body breaks down and recycles dysfunctional cellular components, allowing the body to get rid of pathogens, including cancer cells. The amount of calorie restriction doesn’t have to be extreme but there should be one there. If you are losing too much weight, you will want to increase the amount of fats you are consuming from healthy sources (see lists above).

Autophagy and the death of cancer cells
“Our cells are constantly breaking down, repairing themselves, and regenerating.  However, this process is by no means perfect, and often some parts are unfixable. Also, often cells are just too old and beat up, and much like an old 1985 Yugo, sometimes it’s better to just totally replace the old piece of junk. Of note, the Yugo may actually be the worst car ever.  Well, autophagy is the process that takes this old Yugo, strips off the pleather seats and interior, and reuses the metal to build a brand new Ferrari.  In fact, the process of autophagy uses structures called lysosomes, which are able to tear apart and reuse our cellular parts or even completely destroy unusable Yugo-esque parts1,2.  This garbage is converted to amino acids, the building blocks of proteins, which can then be transported throughout the body for use.  This process helps rejuvenate cells and clear out the junk that builds up, explains Colin E. Champ, M.D., a radiation oncologist and assistant professor at Kimmel Cancer Center and Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA (aka The Caveman Doctor).
http://www.cavemandoctor.com/

“Autophagy is important not only in that it removes detrimental cells and machinery, but also in how it removes these parts.  Autophagy kills these cells in a contained environment, doing it safely and effectively.  This “hazmat” type programmed destruction is much unlike its counterpart, necrosis.  When necrosis occurs, the kill is uncontained and leaks inflammation and damaging chemicals into the surrounding environment, which can in itself lead to further cellular damage and cancer3.  While autophagy would be like pulling out a weed in your yard, necrosis would be the equivalent of spraying your whole lawn with roundup to kill that one weed.  Autophagy basically kills defective or dying cells in a controlled manner and this alone could be a large benefit of autophagy.

“Autophagy is to a club or rock, as necrosis is to a bomb.”

The Benefits of Autophagy:
1.    Decreases unnecessary cellular processes during starvation or fasting
2.    Rids the cells of clutter, which causes aging of cells and the body
3.    Performs cellular remodeling, which is a form of internal spring cleaning
4.    Suppresses cancer and tumor formation by blocking over-proliferation of cells
5.    Destroys microbes and other infectious elements of cells
6.    Regulates our immune system to fight future infections
7.    Supplies us with energy during times without food

Autophagy reduces:
1.    Cancer
2.    Insulin resistance
3.    Infections
4.    Aging
5.    Heart Disease
6.    Neurodegenerative diseases (Parkinson, Alzheimer’s, etc.)
7.    Inflammation
Source: Reprinted with permission from Colin E. Champ, M.D., The Caveman Doctor, located at http://www.cavemandoctor.com

Understanding cancer cells
In the 1930s Dr. Otto Warbrurg discovered what made cancer cells different from normal, healthy cells. For this he was awarded a Nobel Prize.

“Cancer, above all other diseases, has countless secondary causes. But, even for cancer, there is only one prime cause. Summarized in a few words, the prime cause of cancer is the replacement of the respiration of oxygen in normal body cells by a fermentation of sugar.”
~Otto H. Warburg

“Until recently, Dr. Warburg’s hypothesis has been marginalized by the persistent belief in the oncology world that cancer is a genetic disease. However, in a new book Cancer as a Metabolic Disease: On the Origin, Management, and Prevention of Cancer, Dr. Thomas Seyfried has placed Dr. Warburg’s efforts to solve the cancer puzzle back in the medical limelight,” explains Davis.

What does it mean, cancer is a metabolic disease?
“Metabolic diseases are conditions in which the metabolism, or the making of energy from the food we eat, is broken or abnormal in some way.

“Normal body cells are able to create energy by using the food we eat and the oxygen we inhale to complete normal cellular “respiration” and make ATP (adenosine triphosphate), our main cellular energy source. Most of this energy making process happens in the mitochondria, tiny organelles which are the “powerhouses” of the cell. There are two types of primary food based fuels that our cells can use to produce energy:

• The first cellular fuel is glucose, which is also called by the common name of blood sugar or blood glucose. Glucose mostly comes from carbohydrates in our diet, and is converted into energy in our cells via a process called glycolysis. In normal cells, glycolysis is a source of other molecules that flow into the mitochondria to complete normal cellular respiration.
www.ketogenic-diet-resource.com

• The second type of cellular fuel comes from fatty acids. There are various kinds and they come from fats we eat or from the metabolism of fats which have been stored in our fat cells. When large quantities of fatty acids are available, they are broken down by the liver into products called ketone bodies. This process is called ketosis.

“Ketone bodies are an important part of human metabolism. They act as a backup system when blood glucose levels fall either through starvation or carbohydrate restriction. Ketones allow normal cells to be metabolically flexible, so to speak. When glucose levels are low, most normal cells will switch to using ketone bodies for fuel. Even the brain and nerve cells, which are highly dependent on glucose, can use some ketone bodies if there are enough of them circulating in the blood. This ability of a normal cell to use ketones when glucose is unavailable is a sign of good cellular health. It indicates the cell’s mitochondria are working correctly.

“In contrast, cancer cells are unable to utilize ketones when glucose is low. Cancer cells have broken mitochondria, and they lack metabolic flexibility. Since they can’t use ketones, cancer cells must have glucose, or a source of glucose to stay alive and grow.

In other words, most cancer cells are vulnerable to any metabolic change that denies them blood sugar or a source of sugar for fuel,” says Davis.

Cancer cells derive energy from the fermentation of sugar. The metabolism of cancer is approximately eight times greater than the metabolism of normal cells. Cancer cells also have 80 to 100 times more glucose receptors on their surface than normal cells, making them adept at getting their sugar needs met. Your goal is to deprive them of food so that they die.

Insulin, glucose, early recurrence and decreased relapse-free survival
“Both insulin and IFG-1 have been shown to increase cell proliferation, protect cells from apoptosis, and induce cellular pathways known to result in worse cancer-related outcomes [46, 50]. As breast tumors often express higher levels of the IGF-1 receptor [51–54], it is of no surprise that insulin and IFG-1 have been correlated with early recurrence and decreased relapse-free survival in breast cancer as well as increased resistance of tumor cells to both chemotherapy and radiation therapy [45, 46]. Elevated levels of insulin also result in the inhibition of SHBG [55] synthesis and therefore an increase in circulating steroids, as described previously.

“Accordingly, several risk factors associated with elevated serum glucose, including elevated insulin and insulin resistance, have been associated with increased recurrence and worse outcomes, as discussed previously. This effect is compounded by the increase in glucose utilization by tumor cells, as tumors derive a majority of their energy from the process of anaerobic metabolism of glucose [49]. Along these lines, tumors need excess amounts of glucose to fuel this inefficient process, and as per data previously, if elevated serum levels are present, these patients may be at increased risk of tumor recurrence. Therefore, replacing dietary fat with carbohydrate sources in cancer patients may be reducing a major source of energy for normal cells and replacing it with fuel for tumor cells,” explains Dr. Colin Champs in his article, “Weight Gain, Metabolic Syndrome, and Breast Cancer Recurrence: Are Dietary Recommendations Supported by the Data?” by Colin Champ, MD, (International Journal of Breast Cancer.Volume 2012 (2012), Article ID 506868).

PET scans & sugar
Because it is known that cancer cells have a strong affinity for sugar, western medicine uses sugar, in the form of glucose, to test for and confirm the presence of cancer. PET scans are used to diagnose cancer, to reveal the stage of cancer, to show whether it has spread, and if so where. It can also be used to reveal the effectiveness of treatments, such as chemotherapy. PET scans may also be used to investigate epilepsy, Alzheimer’s disease, Heart Disease, and for certain other conditions.

Patients are asked to fast for 6 to 8 or more hours prior to a PET (Positive Emission Tomography) scan and often asked to follow a very low carbohydrate diet the day before the test, then they are injected with a radioactively tagged glucose (referred to as a radiotracer), asked to rest for 45 to 60 minutes, then scanned. Once inside the body, the radiotracer will go to the areas of the body that have metabolically active cancer cells. Because cancer cells use glucose differently (they take up more of it) than healthy cells, the radiotracer will concentrate in those areas and light up on the scan. This form of nuclear imaging produces a three-dimensional, color image showing where active cancerous lesions are growing. They must be at least one centimeter in size to show up on a PET. Sometimes a PET is used in conjunction with a CT scan.

A PET scan not only shows where the tumors are but also shows how much update of the radioactively tagged glucose the tumors have, telling you and your doctors how metabolically active they are and how much they are growing or shrinking if compared to recent or future scans.