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01-05-2017 | Review Article

Systematic review: isocaloric ketogenic dietary regimes for cancer patients

Authors: N. Erickson, A. Boscheri, B. Linke, J. Huebner

Published in: Medical Oncology | Issue 5/2017

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.

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

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.CrossRefPubMedPubMedCentral

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.CrossRefPubMed

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.CrossRefPubMed

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

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

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.CrossRefPubMed

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

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

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.CrossRefPubMed

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.CrossRefPubMedPubMedCentral

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.CrossRefPubMed

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.CrossRefPubMed

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.CrossRefPubMedPubMedCentral

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

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.CrossRefPubMed

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.

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.PubMed

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.CrossRefPubMed

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.CrossRefPubMed

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.PubMed

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.CrossRefPubMedPubMedCentral

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.CrossRefPubMed

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.CrossRefPubMed

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.CrossRefPubMed

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.CrossRef

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.CrossRefPubMed

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.CrossRefPubMed

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.PubMedPubMedCentral

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.CrossRefPubMed

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

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.CrossRef

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.CrossRefPubMedPubMedCentral

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.CrossRefPubMed

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.CrossRefPubMed

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.CrossRefPubMed

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.CrossRefPubMed

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.CrossRefPubMed

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.

Title: Systematic review: isocaloric ketogenic dietary regimes for cancer patients
Authors: N. Erickson
A. Boscheri
B. Linke
J. Huebner
Publication date: 01-05-2017
Publisher: Springer US
Published in: Medical Oncology / Issue 5/2017
Print ISSN: 1357-0560
Electronic ISSN: 1559-131X
DOI: https://doi.org/10.1007/s12032-017-0930-5

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