Skip to main content

Advertisement

Log in

Systematic review: isocaloric ketogenic dietary regimes for cancer patients

  • Review Article
  • Published:
Medical Oncology Aims and scope Submit manuscript

Abstract

The efficacy and benefits of ketogenic diets (KD) have recently been gaining worldwide and remain a controversial topic in oncology. This systematic review therefore presents and evaluates the clinical evidence on isocaloric KD dietary regimes and reveals that evidence supporting the effects of isocaloric ketogenic dietary regimes on tumor development and progression as well as reduction in side effects of cancer therapy is missing. Furthermore, an array of potential side effects should be carefully considered before applying KD to cancer patients. In regard to counseling cancer patients considering a KD, more robust and consistent clinical evidence is necessary before the KD can be recommended for any single cancer diagnosis or as an adjunct therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Maschke J, Kruk U, Kastrati K, Kleeberg J, Buchholz D, Erickson N, et al. Nutritional care of cancer patients: a survey on patients’ needs and medical care in reality. Int J Clin Oncol. 2016. doi:10.1007/s10147-016-1025-6.

    PubMed  Google Scholar 

  2. Allen BG, Bhatia SK, Anderson CM, Eichenberger-Gilmore JM, Sibenaller ZA, Mapuskar KA, et al. Ketogenic diets as an adjuvant cancer therapy: history and potential mechanism. Redox Biol. 2014;2:963–70. doi:10.1016/j.redox.2014.08.002.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Smyl C. Ketogenic diet and cancer—a perspective. Recent Results Cancer Res. 2016;207:233–40. doi:10.1007/978-3-319-42118-6_11.

    Article  PubMed  Google Scholar 

  4. Branco AF, Ferreira A, Simoes RF, Magalhaes-Novais S, Zehowski C, Cope E, et al. Ketogenic diets: from cancer to mitochondrial diseases and beyond. Eur J Clin Invest. 2016;46(3):285–98. doi:10.1111/eci.12591.

    Article  PubMed  Google Scholar 

  5. Neuropädiatrie GF. S1-Leitline 022/21: Ketogene Diäten. AWMF Online Register; 2014.

  6. Wheless JW. History of the ketogenic diet. Epilepsia. 2008;49(Suppl 8):3–5. doi:10.1111/j.1528-1167.2008.01821.x.

    Article  PubMed  Google Scholar 

  7. Hartman AL, Vining EP. Clinical aspects of the ketogenic diet. Epilepsia. 2007;48(1):31–42. doi:10.1111/j.1528-1167.2007.00914.x.

    Article  CAS  PubMed  Google Scholar 

  8. Henderson CB, Filloux FM, Alder SC, Lyon JL, Caplin DA. Efficacy of the ketogenic diet as a treatment option for epilepsy: meta-analysis. J Child Neurol. 2006;21(3):193–8.

    PubMed  Google Scholar 

  9. Kossoff EH, Wang HS. Dietary therapies for epilepsy. Biomed J. 2013;36(1):2–8. doi:10.4103/2319-4170.107152.

    Article  PubMed  Google Scholar 

  10. Lee PR, Kossoff EH. Dietary treatments for epilepsy: management guidelines for the general practitioner. Epilepsy Behav. 2011;21(2):115–21. doi:10.1016/j.yebeh.2011.03.008.

    Article  CAS  PubMed  Google Scholar 

  11. Ye F, Li XJ, Jiang WL, Sun HB, Liu J. Efficacy of and patient compliance with a ketogenic diet in adults with intractable epilepsy: a meta-analysis. J Clin Neurol. 2015;11(1):26–31. doi:10.3988/jcn.2015.11.1.26.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Bergqvist AG, Schall JI, Gallagher PR, Cnaan A, Stallings VA. Fasting versus gradual initiation of the ketogenic diet: a prospective, randomized clinical trial of efficacy. Epilepsia. 2005;46(11):1810–9. doi:10.1111/j.1528-1167.2005.00282.x.

    Article  CAS  PubMed  Google Scholar 

  13. Neal EG, Chaffe H, Schwartz RH, Lawson MS, Edwards N, Fitzsimmons G, et al. The ketogenic diet for the treatment of childhood epilepsy: a randomised controlled trial. Lancet Neurol. 2008;7(6):500–6. doi:10.1016/S1474-4422(08)70092-9.

    Article  PubMed  Google Scholar 

  14. Vander Heiden MG, Cantley LC, Thompson CB. Understanding the Warburg effect: the metabolic requirements of cell proliferation. Science. 2009;324(5930):1029–33. doi:10.1126/science.1160809.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Huebner J, Marienfeld S, Abbenhardt C, Ulrich C, Muenstedt K, Micke O, et al. Counseling patients on cancer diets: a review of the literature and recommendations for clinical practice. Anticancer Res. 2014;34(1):39–48.

    PubMed  Google Scholar 

  16. Hubner J, Marienfeld S, Abbenhardt C, Ulrich CM, Loser C. How useful are diets against cancer? Dtsch Med Wochenschr. 2012;137(47):2417–22. doi:10.1055/s-0032-1327276.

    Article  CAS  PubMed  Google Scholar 

  17. Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, et al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2016. doi:10.1016/j.clnu.2016.07.015.

    Google Scholar 

  18. EPaOoC (EPOC). EPOC resources for review authors. Norwegian Knowledge Centre for the Health Services. http://epoc.cochrane.org/epoc-specific-resources-review-authors.

  19. Fearon KC, Borland W, Preston T, Tisdale MJ, Shenkin A, Calman KC. Cancer cachexia: influence of systemic ketosis on substrate levels and nitrogen metabolism. Am J Clin Nutr. 1988;47(1):42–8.

    CAS  PubMed  Google Scholar 

  20. Nebeling LC, Miraldi F, Shurin SB, Lerner E. Effects of a ketogenic diet on tumor metabolism and nutritional-status in pediatric oncology patients—2 case-reports. J Am Coll Nutr. 1995;14(2):202–8.

    Article  CAS  PubMed  Google Scholar 

  21. Bozzetti F, Cozzaglio L, Gavazzi C, Brandi S, Bonfanti G, Lattarulo M, et al. Total nutritional manipulation in humans: report of a cancer patient. Clin Nutr. 1996;15(4):207–9.

    Article  CAS  PubMed  Google Scholar 

  22. Branca JJV, Pacini S, Ruggiero M. Effects of pre-surgical vitamin D supplementation and ketogenic diet in a patient with recurrent breast cancer. Anticancer Res. 2015;35(10):5525–32.

    CAS  PubMed  Google Scholar 

  23. Klement RJ, Sweeney RA. Impact of a ketogenic diet intervention during radiotherapy on body composition: I. Initial clinical experience with six prospectively studied patients. BMC Res Notes. 2016;9:143. doi:10.1186/s13104-016-1959-9.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Rossi-Fanelli F, Franchi F, Mulieri M, Cangiano C, Cascino A, Ceci F, et al. Effect of energy substrate manipulation on tumour cell proliferation in parenterally fed cancer patients. Clin Nutr. 1991;10(4):228–32.

    Article  CAS  PubMed  Google Scholar 

  25. Chu-Shore CJ, Thiele EA. Tumor growth in patients with tuberous sclerosis complex on the ketogenic diet. Brain Dev. 2010;32(4):318–22. doi:10.1016/j.braindev.2009.04.009.

    Article  PubMed  Google Scholar 

  26. Bozzetti F, Gavazzi C, Mariani L, Crippa F. Glucose-based total parenteral nutrition does not stimulate glucose uptake by humans tumours. Clin Nutr. 2004;23(3):417–21. doi:10.1016/j.clnu.2003.09.012.

    Article  CAS  PubMed  Google Scholar 

  27. Schmidt M, Pfetzer N, Schwab M, Strauss I, Kammerer U. Effects of a ketogenic diet on the quality of life in 16 patients with advanced cancer: a pilot trial. Nutr Metab (Lond). 2011;8(1):54. doi:10.1186/1743-7075-8-54.

    Article  CAS  Google Scholar 

  28. Fine EJ, Segal-Isaacson CJ, Feinman RD, Herszkopf S, Romano MC, Tomuta N, et al. Targeting insulin inhibition as a metabolic therapy in advanced cancer: a pilot safety and feasibility dietary trial in 10 patients. Nutrition. 2012;28(10):1028–35. doi:10.1016/j.nut.2012.05.001.

    Article  CAS  PubMed  Google Scholar 

  29. Schroeder U, Himpe B, Pries R, Vonthein R, Nitsch S, Wollenberg B. Decline of lactate in tumor tissue after ketogenic diet: in vivo microdialysis study in patients with head and neck cancer. Nutr Cancer. 2013;65(6):843–9. doi:10.1080/01635581.2013.804579.

    Article  CAS  PubMed  Google Scholar 

  30. Rieger J, Bahr O, Maurer GD, Hattingen E, Franz K, Brucker D, et al. ERGO: a pilot study of ketogenic diet in recurrent glioblastoma. Int J Oncol. 2014;44(6):1843–52. doi:10.3892/ijo.2014.2382.

    CAS  PubMed  PubMed Central  Google Scholar 

  31. Champ CE, Palmer JD, Volek JS, Werner-Wasik M, Andrews DW, Evans JJ, et al. Targeting metabolism with a ketogenic diet during the treatment of glioblastoma multiforme. J Neurooncol. 2014;117(1):125–31. doi:10.1007/s11060-014-1362-0.

    Article  CAS  PubMed  Google Scholar 

  32. Jansen N, Walach H. The development of tumours under a ketogenic diet in association with the novel tumour marker TKTL1: a case series in general practice. Oncol Lett. 2016;11(1):584–92. doi:10.3892/ol.2015.3923.

    PubMed  Google Scholar 

  33. Tan-Shalaby JL, Carrick J, Edinger K, Genovese D, Liman AD, Passero VA, et al. Modified Atkins diet in advanced malignancies—final results of a safety and feasibility trial within the Veterans Affairs Pittsburgh Healthcare System. Nutr Metab (Lond). 2016;13:52. doi:10.1186/s12986-016-0113-y.

    Article  Google Scholar 

  34. Kossoff EH, Hartman AL. Ketogenic diets: new advances for metabolism-based therapies. Curr Opin Neurol. 2012;25(2):173–8. doi:10.1097/WCO.0b013e3283515e4a.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Kossoff EH. International consensus statement on clinical implementation of the ketogenic diet: agreement, flexibility, and controversy. Epilepsia. 2008;49(Suppl 8):11–3. doi:10.1111/j.1528-1167.2008.01823.x.

    Article  PubMed  Google Scholar 

  36. Keene DL. A systematic review of the use of the ketogenic diet in childhood epilepsy. Pediatr Neurol. 2006;35(1):1–5. doi:10.1016/j.pediatrneurol.2006.01.005.

    Article  PubMed  Google Scholar 

  37. Klein P, Tyrlikova I, Mathews GC. Dietary treatment in adults with refractory epilepsy: a review. Neurology. 2014;83(21):1978–85. doi:10.1212/WNL.0000000000001004.

    Article  CAS  PubMed  Google Scholar 

  38. Neal EG, Chaffe H, Schwartz RH, Lawson MS, Edwards N, Fitzsimmons G, et al. A randomized trial of classical and medium-chain triglyceride ketogenic diets in the treatment of childhood epilepsy. Epilepsia. 2009;50(5):1109–17. doi:10.1111/j.1528-1167.2008.01870.x.

    Article  PubMed  Google Scholar 

  39. Sharma S, Sankhyan N, Gulati S, Agarwala A. Use of the modified Atkins diet for treatment of refractory childhood epilepsy: a randomized controlled trial. Epilepsia. 2013;54(3):481–6. doi:10.1111/epi.12069.

    Article  CAS  PubMed  Google Scholar 

  40. Levy RG, Cooper PN, Giri P. Ketogenic diet and other dietary treatments for epilepsy. Cochrane Database Syst Rev. 2012;3:CD001903. doi:10.1002/14651858.CD001903.pub2.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to N. Erickson.

Ethics declarations

Conflict of interest

Nicole Erickson has received a speaker honorarium from B. Braun, CSL-Behring and Fresenius Kabi. The content of these talks was not related to the content of this article. A. Boscheri, B. Linke and J. Huebner declare no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors and therefore did not require ethical approval.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Erickson, N., Boscheri, A., Linke, B. et al. Systematic review: isocaloric ketogenic dietary regimes for cancer patients. Med Oncol 34, 72 (2017). https://doi.org/10.1007/s12032-017-0930-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s12032-017-0930-5

Keywords

Navigation