Is Keto for Cancer Quackery or Science?
When I was 11, I lost my father to cancer. I’m not alone. It turns out cancer is the #2 cause of death worldwide.
I have been using the ketogenic diet for productivity for more than two years. I have also read a lot about it since I started. It does not take long to encounter this fantastic claim: a ketogenic diet helps prevent and helps cure cancer.
Is this true? I’m naturally fascinated by this possibility. At the same time, I don’t have any tolerance for quackery when it comes to cancer.
The first step is to check whether the scientific community is exploring this question.
If we search Google Scholar for “ketogenic diet cancer,” it yields has 20,000 results. The first page result has studies from 1995 to 2014. The most cited study has 458 citations. It appears the topic is being studied.
I don’t have the training to go through these studies. Here’s what I did instead.
What are the claims? How trustworthy are those making and those opposing the claims?
To get an idea of the claims for and against keto for cancer, I read through the top results for a neutral search term (“ketogenic diet cancer”) and two negative search terms (“ketogenic diet cancer debunked” and “ketogenic diet cancer quackery”).
I then placed them in a spreadsheet, summarized the positions and backgrounds, and color-coded them.
The positions can be categorized into four:
- Strong support: keto can replace conventional cancer therapy
- Nuanced support: keto can assist conventional therapy for some types of cancer
- Nuanced opposition: it may be possible for keto to assist conventional therapy for some types of cancer
- Strong opposition: keto is dangerous (see reasons in the spreadsheet)
There appear to be two types who bring up the claim that keto can replace conventional therapy. First are those who are arguing against it. This is the straw man technique — propping up the weakest version of what you plan to attack. The second type have something to sell — eg, cannabis oil.
I think it is safe to dismiss this claim. If it were true, cancer would not kill as many people as it does.
The claim at the opposite end is that keto is dangerous. When compared to conventional therapy, this makes no sense. Chemo, radiation and surgery are way more damaging to the body than any diet.
The moderate claim from both sides converge and makes the most sense: the ketogenic diet may be an effective adjunct to conventional therapy for some cancers.
What is the mechanism behind this and how is this applied to therapy? The most fascinating discussion I’ve heard on the current state of research in this area is this interview with Dom D’Agostino with Dr. Peter Attia (the keto for cancer discussion starts at 1hr and 59min):
Using a ketogenic diet to assist conventional cancer therapy clearly has to be done on a case-to-case basis by a specialist doctor.
Keto for Cancer Prevention
I’m actually more interested the claims that keto could help prevent cancer. Is there any truth to this claim? How do we apply this to our lives?
Among the articles I’ve read on cancer prevention with keto, here are the best I’ve come across:
- Peter Attia, M.D., on how most cancers use energy for growth, and how we can exploit this
- Colin Champ, M.D., on myths of keto and cancer and the state of research in 2018
- Pretty good overview at ruled.me
Here are my highlights:
Application
What do I start/stop/continue doing based on these data?
A few months ago, I made this list of tools I use to decide whether I should believe claims in health and nutrition, as a layman who just wants the practical application:
Let‘s apply a couple of them to keto for cancer.
Skin in the game
Nassim Nicholas Taleb has a new book with this title. I have not read it yet. However, he has touched on this concept in his previous book, Antifragile. Here are a couple of quotes from that book:
The psychologist Gerd Gigerenzer has a simple heuristic. Never ask the doctor what you should do. Ask him what he would do if he were in your place. You would be surprised at the difference.
I believe that forcing researchers to eat their own cooking whenever possible solves a serious problem in science. Take this simple hueristic — does the scientific researcher whose ideas are applicable to the real world apply his ideas to his daily life? If so, take him seriously. Otherwise, ignore him.
We should ask two questions when we rely on others for answers:
- Does this person have the expertise to answer our question —in this case, how do you apply current knowledge to cancer prevention?
- Does this person have skin in the game?
Dr. Peter Attia clearly has the expertise to answer this question. From his about page:
Skin in the game is straightforward for health and nutrition. What does the expert actually do? In Dr. Attia’s case, he:
- Fasts daily / time restricted feeding (eats within a span of 2hrs to 8hrs)
- Avoids junk most of the time (junk for him: sucrose, high-fructose corn syrup, processed carbs like potato chips).
- Does not limit carbs and starches like rice, potatoes and vegetables.
- Exercises daily (strength 3x/week; cardio for the rest)
- Occasionally does a ketogenic diet and an extended fast (eg, the nothing burger: 1 week keto + 1 week fast + 1 week keto)
- Takes sleep very seriously
- Meditates consistently
Dr. Colin Champ (University of Pittsburgh Cancer Institute) has a similar list:
- Keep carbs low
- Figuratively and literally “chew the fat” — work hard, relax, eat healthy fats
- Fast periodically
- Intensely exercise and lift heavy weights
- Cycle in and out of ketosis
Effort vs reward; risk vs reward
If you have not taken nutrition, sleep and exercise seriously, perhaps cancer might change your mind.
But is it worth the effort? What are the risks involved? How do these probabilistic risks weigh against the probabilistic reward of preventing cancer?
Eating healthy fatty food and reducing carbs (especially highly processed and sugary food) has been easy and even enjoyable for me and many people. However, it has also proven to be a great challenge for many others — especially the abstention from sugar, bread, pasta and rice.
As far as I could tell, the biggest risk for a long term ketogenic diet is that for some people, keto increases LDL. I happen to be one of those people. The consensus of the medical establishment is that high LDL increases the risk of heart disease.
If your LDL also increased when doing keto, here’s a good guide in thinking about the risks:
One way to reduce LDL in the context of a ketogenic diet is by replacing saturated fats with monounsaturated or polyunsaturated fats:
That unfortunately did not work for me. What worked was the “Feldman Protocol.” More than a solution, it is an experiential lesson on LDL’s role as a transporter of energy:
Ultimately, this is a choice based on what you value in life. On one hand, you have the joys of sugar and starches. On the other are the health and productivity benefits of restricting carbohydrates. If keto raises your LDL, experts say that your risk for heart disease increases as well. At the same time, some doctors use keto to reduce risk of cancer.
Here’s how I made my choice.
I prefer health and productivity over carbs.
I want to extend my health span, but we are all going to die at some point.
I’d rather die of heart disease than of cancer. It’s personal.
