Ketogenic diets (KDs) have gained popularity among patients and researchers alike due to their putative anti-tumor mechanisms. However, the question remains which conclusions can be drawn from the available human data thus far concerning the safety and efficacy of KDs for cancer patients. A realist review utilizing a matrix analytical approach was conducted according to the RAMESES publication standards. All available human studies were systematically analyzed and supplemented with results from animal studies. Evidence and confirmation were treated as separate concepts. In total, 29 animal and 24 human studies were included in the analysis. The majority of animal studies (72%) yielded evidence for an anti-tumor effect of KDs. Evidential support for such effects in humans was weak and limited to individual cases, but a probabilistic argument shows that the available data strengthen the belief in the anti-tumor effect hypothesis at least for some individuals. Evidence for pro-tumor effects was lacking completely. Feasibility of KDs for cancer patients has been shown in various contexts. The probability of achieving an anti-tumor effect seems greater than that of causing serious side effects when offering KDs to cancer patients. Future controlled trials would provide stronger evidence for or against the anti-tumor effect hypothesis.
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As most philosophers of science, Carnap  who formulated this principle made no clear distinction between evidence, data and confirmation . Within our framework (see Materials and Methods section), his principle of total evidence would better be described as the principle to consider all relevant available data when making inferences about hypotheses.
A distinction should be made between “fundamentalist” skepticism, a term coined by M.M. Ćirković  and other, more rational forms of skepticism that for example acknowledge the mechanistic data, but consider the human data not supportive for methodological reasons. Examples of the former have been critisized by us previously [117, 126].
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Conflict of interest
The author declares that he has no conflict of intrest.
This review was undertaken without requesting ethical approval, since ethical approval was granted for most of the included studies, all human data were anonymous, and the ethical recommendations of the Declaration of Helsinki were adhered to.
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Klement, R.J. Beneficial effects of ketogenic diets for cancer patients: a realist review with focus on evidence and confirmation. Med Oncol 34, 132 (2017). https://doi.org/10.1007/s12032-017-0991-5
- Ketogenic diet
- Realist synthesis
- Realist review