Nicolette: 0:01

Welcome to the Health Pulse, your go-to source for quick, actionable insights on health, wellness and diagnostics. Whether you're looking to optimize your well-being or stay informed about the latest in medical testing, we've got you covered. Join us as we break down key health topics in just minutes. Let's dive in.

Rachel: 0:25

You hear quite a bit, maybe from oncologists, maybe nutritionists this phrase cancer cells love sugar. It's a really common saying, yeah, and it sounds simple. But honestly it's more than just catchy. This whole idea that a lot of cancer cells really rely on glucose in a unique way. It's actually driving a whole new area of research really rely on glucose in a unique way. It's actually driving a whole new area of research looking into how diet, and specifically the ketogenic diet, could you know, play a real part in integrated cancer care.

Mark: 0:54

It's a fascinating intersection.

Rachel: 0:55

So just quickly for anyone maybe not familiar the ketogenic diet keto it's basically high fat but really really low in carbohydrates.

Mark: 1:02

Right, Very low carb.

Rachel: 1:03

And the whole point is to shift your body's metabolism. So instead of burning glucose, your default fuel, it starts using something else.

Mark: 1:11

Ketone bodies. It's your liver makes from fat when carbs aren't available.

Rachel: 1:15

Exactly Now you might have heard about keto for weight loss, maybe even for epilepsy, but today our deep dive is all about how this new research is looking at it as a potential metabolic therapy in the cancer context.

Mark: 1:29

Yeah, a very specific application.

Rachel: 1:30

So our mission today is to really unpack this. How do cancer cells actually use glucose differently? What's the science behind keto as like an anti-cancer idea?

Mark: 1:42

And, crucially, what does the research really say? The studies, the limitations?

Rachel: 1:46

Yes, exactly, and then we'll get practical like who might this actually be suitable for, who needs to be really careful and what lab tests are absolutely essential if you or someone you know is even considering this approach alongside other treatments.

Mark: 2:00

A lot to cover, but important stuff.

Rachel: 2:01

Think of this as maybe a shortcut to understanding some pretty cool complex stuff about how your body uses fuel, especially when it's facing something like cancer. Some real aha moments, hopefully.

Mark: 2:12

Let's dive in.

Rachel: 2:13

Okay, so first things first, this unique, almost weird relationship cancer cells have with sugar. It comes down to something called the Warburg effect.

Mark: 2:22

Right named after Otto Warburg, who first observed it.

Rachel: 2:25

So what is it basically? How are cancer cells different?

Mark: 2:28

Well, your healthy cells. They're pretty flexible. Metabolically speaking, they generally prefer using their mitochondria, the powerhouses, right Through a process called oxidative phosphorylation. It's slower but super efficient at making energy.

Rachel: 2:43

Okay, slow and steady wins the race for healthy cells.

Mark: 2:46

Kind of yeah, yeah, but many cancer cells? They do something different. Even when there's plenty of oxygen around, which is key, they often default to a much faster process called glycolysis.

Rachel: 2:58

That's just breaking down glucose.

Mark: 2:59

Exactly Breaking down glucose directly for energy. It's way faster but much, much less efficient. They burn through glucose like crazy.

Rachel: 3:06

So they're choosing speed over efficiency.

Mark: 3:08

In many cases, yes, especially those really aggressive, fast-growing tumors. This makes them incredibly dependent on a steady supply of glucose. It's like they're constantly sprinting these short bursts instead of running that efficient marathon.

Rachel: 3:22

That's a great way to put it.

Mark: 3:23

And what's really fascinating, I think, is this sort of metabolic inflexibility you see in many cancer cells. Healthy cells, they can usually switch fuels. If they need to Use fats, use ketones.

Rachel: 3:34

But these cancer cells are kind of stuck.

Mark: 3:36

Many seem to be yeah, Stuck on glucose. And that raises a really, really important question for researchers what happens if you limit that glucose, If you take their favorite fuel out of the picture or at least drastically reduce it?

Rachel: 3:50

Ah, okay, and that leads us right into ketosis, doesn't it?

Mark: 3:54

Precisely, that's the connection.

Rachel: 3:55

So when you cut carbs way down, like usually people say, under 20 grams a day, which is really low, very low.

Mark: 4:01

Yes, that's the typical threshold for nutritional ketosis.

Rachel: 4:04

Your liver starts making these ketone bodies. You mentioned them earlier beta-hydroxybutyrate, BHB is the main one.

Mark: 4:10

BHB and acetoacetate. Yeah, they're made from breaking down fat.

Rachel: 4:14

And this whole metabolic state is ketosis.

Mark: 4:16

That's it. Your body switches its primary fuel source from glucose to ketones.

Rachel: 4:21

So the main theory here, sometimes called the starvation theory, what's the thinking?

Mark: 4:32

The core idea is that, unlike your healthy cells, which adapt beautifully to using ketones, many cancer cells just don't expect. They lack the machinery or it's impaired.

Rachel: 4:36

So they can't use ketones efficiently for energy.

Mark: 4:39

That's a hypothesis. So if you switch the body's fuel supply to ketones, you're essentially nourishing your healthy cells but potentially starving those glucose-dependent cancer cells.

Rachel: 4:50

Interesting, depriving them of their go-to fuel.

Mark: 4:53

Exactly, but it might be more complex than just fuel deprivation. Some of the early preclinical research also hints that ketones themselves might have other effects.

Rachel: 5:04

Like what.

Mark: 5:05

Things like potentially reducing oxidative stress, maybe lowering inflammation, even possibly impacting angiogenesis.

Rachel: 5:12

Angiogenesis, that's the blood vessel growth tumors need right.

Mark: 5:15

That's the one Tumors need to build their own blood supply to grow, so there could be multiple mechanisms at play.

Rachel: 5:21

Okay, so this whole theoretical framework, it sounds pretty compelling, leveraging this metabolic weakness.

Mark: 5:27

It really is. That's why there's so much interest. But theory is one thing. The crucial question is always what does the actual research show? When we look at studies, what's the evidence?

Rachel: 5:36

Right, that's where the rubber meets the road. Let's get into that. What have the studies actually found? Maybe start with animal studies.

Mark: 5:43

Sure. The animal studies generally have been, I'd say, promising, but definitely still early stage. We see quite consistently that ketogenic diets can slow tumor growth in various models.

Rachel: 5:56

Slow the growth.

Mark: 5:57

Yeah, and sometimes improve survival times, in mice, for instance. They've also shown potential for enhancing the effect of other treatments like chemo or radiation in animal models.

Rachel: 6:07

Are there specific examples that stand out?

Mark: 6:09

Well, there was a meta-analysis back in 2014, I think it was in PLOS One. It looked at a bunch of studies and found that keto diet significantly prolongs survival in mice with systemic cancers compared to standard diet. Okay that sounds significant, and another one, maybe 2017 in Nature Communications that showed a keto diet combined with chemo improved survival and reduced tumor burden in mice with pancreatic cancer. So you see these signals suggesting a real biological effect, at least in these models.

Rachel: 6:37

Okay, so promising in animals, but the big question is always does it translate to humans? What about human trials?

Mark: 6:44

Right, and that's where we need to be a bit more cautious, but still encouraged, I'd say. The human trials are generally much smaller.

Rachel: 6:51

Smaller scale.

Mark: 6:52

Yes, and, very importantly, they almost always look at the ketogenic diet alongside standard cancer treatments. It's viewed as an adjunct, a supportive therapy, not a replacement.

Rachel: 7:02

Okay, so it's part of an integrated approach.

Mark: 7:05

Exactly. For example, there was a pilot study 2018, nutrition and Metabolism just 10 patients with advanced cancer. It showed things like improved quality of life, stable disease in some and, importantly, no major safety issues with the diet itself.

Rachel: 7:19

Small but positive signs.

Mark: 7:22

And there are case studies too. I remember one in Frontiers in Nutrition about a patient with a glioblastoma, that's a tough brain cancer, who maintained stable disease for over a year using keto alongside their standard therapy. And more recently, a randomized trial 2022 in cell reports looked at rectal cancer patients getting radiation. The ones on keto had greater fat loss, better metabolic markers and, importantly, similar tumor response rates to the standard diet group. So it seems safe and metabolically beneficial.

Rachel: 7:52

in that context, so even in these smaller human studies there is a consistent sort of signal emerging.

Mark: 7:59

There really is. It suggests we're tapping into something fundamental about cancer metabolism. But these are small studies, pilot studies, case reports, small trials.

Rachel: 8:08

Right, not definitive proof yet.

Mark: 8:10

Exactly. We absolutely need larger, well-designed randomized controlled trials to confirm if this really improves long-term outcomes like survival, and to understand the safety profile across different cancers and patient groups. The field is moving fast, though More studies are underway.

Rachel: 8:25

Okay, that makes sense. So looking at the mechanisms. Then we talked about starving tumors of glucose, but you mentioned other possibility. What else might be going on? How else could keto potentially support cancer treatment?

Mark: 8:37

Right, it does seem to be more nuanced than just cutting off the fuel line.

Rachel: 8:40

So first back to the glucose and insulin. Lowering carbs means lower blood sugar and, really importantly, lower insulin right.

Mark: 8:47

Critically important. Insulin is a growth hormone and high levels are linked to worse outcomes in many cancers. And there was that study, I think, in Nutrition and Metabolism showing keto reduced IGF-1.

Rachel: 9:00

Insulin-like growth factor one yeah.

Mark: 9:03

Another potent growth signal that many tumors respond to. So lowering insulin and IGF-1 could remove a significant growth stimulus for some cancers.

Rachel: 9:11

Okay, so that's one major angle. What else you mentioned? Mitochondria.

Mark: 9:15

Yeah, this is interesting. While cancer cells might struggle with ketones, your healthy cells generally use them very efficiently in their mitochondria. This might actually support mitochondrial health in normal tissues. How would that help? Well, it could reduce oxidative stress and maybe protect healthy cells from damage, which is particularly relevant during harsh treatments like chemo or radiation that can cause a lot of collateral damage. Preserving healthy tissue function is huge.

Rachel: 9:39

Okay, protecting the good cells makes sense and inflammation and angiogenesis?

Mark: 9:44

Right Ketones themselves, especially BHB, seem to act as more than just fuel. They act like signaling molecules. There's growing evidence they can have anti-inflammatory effects.

Rachel: 9:55

So dialing down systemic inflammation.

Mark: 9:57

Potentially, yes. They act like signaling molecules. There's growing evidence they can have anti-inflammatory effects. So dialing down systemic inflammation? Potentially, yes. Lowering markers like HSCRP Right, and since chronic inflammation can fuel cancer growth, that's a potential benefit. And then there's angiogenesis, that blood vessel formation. Some preclinical work suggests ketones might interfere with that process too.

Rachel: 10:11

Wow so multiple potential pathways.

Mark: 10:15

And one more big one enhancing standard therapies.

Rachel: 10:18

Making chemo or radiation work better.

Mark: 10:20

There's research, mostly in cell culture and animal models, so far suggesting keto might make cancer cells more sensitive to chemo and radiation. Like that 2017 study in Redox Biology on glioma models, combining keto and radiation seemed to boost the tumor-killing effect.

Rachel: 10:36

So it could be like a metabolic sensitizer.

Mark: 10:38

That's the idea. It's creating an internal environment that's less hospitable for the cancer and potentially more supportive of the treatments working effectively.

Rachel: 10:45

OK, when you lay it all out like that, the potential seems really multifaceted.

Mark: 10:51

It is, and it really underscores why it's best viewed as a complementary approach. It's not about ditching conventional medicine. It's about potentially adding another layer of support, metabolically speaking.

Rachel: 11:02

But tailored right. You mentioned that.

Mark: 11:04

Absolutely critical. It has to be individualized, based on the cancer type, the stage, the person's overall health, other treatments. It's not a one-size-fits-all prescription.

Rachel: 11:14

Which leads perfectly to the next question Given all this potential, who might be the best candidates for trying this? And, just as critical, who really needs to be cautious or maybe avoid it?

Mark: 11:25

Great question. Based on the mechanisms we discussed, patients whose cancers are known to be particularly sugar-hungry, highly glycolytic, might be prime candidates.

Rachel: 11:35

Like which ones?

Mark: 11:36

Things like glioblastoma often come up. Some pancreatic cancers, maybe colorectal, certain types of breast cancer, Cancers that show high activity on a PT span, for instance, which uses radioactive glucose.

Rachel: 11:47

Because the PT scan literally shows glucose uptake.

Mark: 11:49

Exactly. Also individuals who already have metabolic issues like insulin resistance, metabolic syndrome or obesity. We know those conditions can worsen cancer outcomes.

Rachel: 12:00

So keto could help address the underlying metabolic problem and potentially impact the cancer.

Mark: 12:06

That's the hope. Improving insulin sensitivity, reducing inflammation. It can make them more resilient during treatment too, and sometimes just stabilizing blood sugar can help with energy levels and appetite control, which can be major quality of life issues during therapy.

Rachel: 12:21

Okay, Now who needs to be careful?

Mark: 12:23

Definitely patients who are already experiencing significant weight loss or muscle wasting. That's called cachexia. It's common in advanced cancer.

Rachel: 12:30

Because keto can sometimes cause initial weight loss.

Mark: 12:33

It can. And if someone is already severely underweight or losing muscle mass, aggressively restricting food groups without very careful planning could make malnutrition worse. That needs expert management.

Rachel: 12:44

Okay, so cachexia is a big red flag. What about the liver and pancreas? Concerns you sometimes here, like, isn't a high-fat diet hard on those organs?

Mark: 12:53

That's a really common misconception and it mostly stems from thinking about fat in the context of a high-carb, high-insulin state.

Rachel: 13:00

Ah, okay, so the context matters.

Mark: 13:02

Immensely.

Rachel: 13:03

Yeah.

Mark: 13:03

When insulin is high, usually because of lots of carbs, yes, the liver can get burdened trying to process everything and it starts making and storing fat. That's de novo lipogenesis. But in ketosis insulin is low. Right Dietary fat gets absorbed differently initially, bypassing the liver more. It's actually the glucose and fructose from carbs hitting the liver via the portal vein. In a high insulin state that really drives fat accumulation there for many people.

Rachel: 13:29

So low insulin changes how the body handles fat.

Mark: 13:32

Completely. In fact, that 2020 review in nutrients really highlights how liver fat is more linked to the high insulin and carb load, not necessarily dietary fat in a low carb context. Some research even suggests certain saturated fats might be protective against liver fat when you're in ketosis, because they promote ketone production.

Rachel: 13:50

Fascinating. So the old fat is bad for the liver. Idea needs nuance.

Mark: 13:54

A lot of nuance, especially in the context of ketosis. However, if someone has pre-existing severe liver or pancreatic disease, they still need close monitoring.

Rachel: 14:04

of course, and anyone on complex medications.

Mark: 14:07

Absolutely. Keto changes fluid balance, electrolytes and can affect how some drugs are metabolized. If you're on meds for diabetes, blood pressure steroids or even certain chemotherapies, you need very close supervision to adjust doses and avoid issues like hypoglycemia or dehydration. It requires careful integration.

Rachel: 14:27

Okay, super important points on caution. So let's say, someone fits the potential profile, they're working with their team. What labs are absolutely essential to track? This isn't something you just wing right?

Mark: 14:37

Oh, definitely not. Monitoring is crucial for safety, for effectiveness, for making adjustments. You need data.

Rachel: 14:43

What's on the must-watch list.

Mark: 14:50

Start with the basics A basic metabolic panel, or BMP, that tracks your electrolytes, sodium, potassium, etc. Which can shift on keto, plus kidney function markers like creatinine and your basic glucose level.

Rachel: 14:55

Okay, BMP for the fundamentals.

Mark: 14:58

Then fasting insulin and glucose together. You want to see those numbers ideally coming down, reflecting improved insulin sensitivity. That's a key therapeutic target.

Rachel: 15:07

What about cholesterol? People worry about fat and cholesterol.

Mark: 15:09

Right the lipid panel Total cholesterol, ldl, hdl, triglycerides. Now LDL cholesterol might go up for some people on keto, but the context is everything.

Rachel: 15:20

What do you mean by context?

Mark: 15:21

You often see triglycerides plummeting and HDL good cholesterol going up, which is great, and the type of LDL often shifts towards larger, fluffier particles which are generally thought to be less problematic than small, dense LDL.

Rachel: 15:36

So just looking at the total LDL number might not tell the whole story.

Mark: 15:39

Exactly For a deeper dive, you might consider testing APOB, which measures the total number of atherogenic particles or even LDL particle size directly. That gives a much clearer picture of cardiovascular risk than just standard LDL-C alone.

Rachel: 15:53

Good to know what else.

Mark: 15:54

Inflammatory markers, things like high-sensitivity C-reactive protein, HSCRP, maybe ferritin, ESR. Tracking these can show systemic inflammation is improving.

Rachel: 16:03

And liver and pancreatic enzymes, since we discussed those organs.

Mark: 16:07

Yes, definitely monitor those, especially when starting out ALT, ast, alp, ggt for liver function and lipase for the pancreas, just to make sure everything is adapting well.

Rachel: 16:17

And the ketones themselves.

Mark: 16:18

Of course, beta-hydroxybutyrate BHB you measure this in blood. Usually it confirms you're actually in nutritional ketosis. Bhb you measure this in blood. Usually it confirms you're actually in nutritional ketosis. The therapeutic range often cited is somewhere between 1.0 and 3.0 millimole, but it can vary.

Rachel: 16:32

So you know the diet is working metabolically.

Mark: 16:39

Precisely. And finally, don't forget basic nutrient status. Restrictive diets can sometimes lead to deficiencies if not planned well. Checking things like magnesium, selenium, b vitamins like B12 and folate. Maybe zinc is wise.

Rachel: 16:48

OK, that's a pretty comprehensive list for standard monitoring.

Mark: 16:52

It covers the key safety and efficacy markers, but, you know, to get an even fuller picture of how the whole body is responding and balanced.

Rachel: 16:58

There's more you could look at.

Mark: 16:59

Yeah for a really optimized, personalized approach. Functional lab testing can be incredibly insightful Things like a GI map stool test to assess gut health, which is crucial.

Rachel: 17:09

The gut microbiomes role.

Mark: 17:17

Huge, or an organic acids test, the OAT test that looks at metabolic byproducts in urine and can tell you about mitochondrial function, nutrient needs, detoxification pathways. Wow, really detailed metabolic snapshot it really is, and a comprehensive micronutrient panel. Looking inside the cells can give a much better sense of long-term nutrient status than just serum levels. These functional tests help fine-tune the approach for optimal balance.

Rachel: 17:39

So layering deeper insights onto the standard monitoring.

Mark: 17:42

Exactly For a truly holistic view.

Rachel: 17:44

Okay, so let's try and pull all of this together as we wrap up this deep dive. What's the main takeaway? Clearly, the ketogenic diet isn't some kind of magic bullet for cancer right?

Mark: 17:55

Absolutely not, and, critically, it's not a replacement for standard, evidence-based cancer treatments like surgery, chemotherapy, radiation or immunotherapy. That needs to be crystal clear.

Rachel: 18:04

The evidence we discussed does suggest it could be something else.

Mark: 18:07

It suggests it could be a really powerful metabolic ally, a complementary tool, especially when used carefully under qualified supervision.

Rachel: 18:15

Particularly for those glucose-hungry tumors we talked about, or maybe for patients who also have things like insulin resistance.

Mark: 18:22

Exactly. Its potential value seems to come from multiple angles lowering that insulin and glucose, possibly supporting healthy mitochondria, reducing inflammation and maybe even starving those inflexible cancer cells of their preferred fuel.

Rachel: 18:37

So I guess the key takeaway is it's not for everyone, but for the right patient in the right situation, used in the right way.

Mark: 18:45

It could significantly support their metabolic health, maybe improve how well they tolerate their main treatments and ultimately contribute to a better quality of life during a really challenging time.

Rachel: 18:55

Yeah, you know this whole deep dive. It really highlights how fast our understanding of metabolism is changing, how interconnected it all is.

Mark: 19:03

It's an incredibly dynamic field.

Rachel: 19:05

It makes you wonder what else are we going to discover? How much more could personalized nutrition tailored to our unique biochemistry really revolutionize how we approach complex diseases like cancer, as we keep sort of unlocking these intricate pathways in the body?

Mark: 19:19

It's a very exciting and hopeful area of research. There's still so much to learn.

Rachel: 19:25

So final thought for our listeners, if this conversation has sparked interest, if you're considering exploring a ketogenic approach as part of a cancer care plan, the crucial step is to work with a healthcare provider or a team that really understands both oncology and metabolic nutrition.

Mark: 19:40

It's a specialized area.

Rachel: 19:42

And monitor those labs right. Track the data along the way.

Mark: 19:45

Essential, absolutely essential for doing it safely and effectively.

Nicolette: 19:52

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