Whether it’s kale in everything or probiotic teas, we’ve heard about how proper nutrition can keep all kinds of ailments away. What if we told you to add fat to that list?
While fat has been deemed the enemy of a healthy diet for decades, a rising star in the field of oncology nutrition is finding that fat may actually play a highly beneficial role in combating cancer, diabetes and an array of challenging illnesses.
Currently at Cedars Sinai in Los Angeles, Oncology Dietician LJ Amaral is at the helm of discovering how a ketogenic diet can benefit those in cancer treatment. The ketogenic diet is best known as a high-fat, low-carb diet that changes how the body uses energy in ways that make it a potentially powerful addition to standard cancer treatment.
LJ studied Clinical Nutrition and Dietetics at NYU and started her career at New York’s Memorial Sloan Kettering Cancer Center. She is currently a Co-Investigator on a retrospective case series on the Ketogenic Diet and Brain Tumors, as well as a Phase I Clinical Trial.
We’re thrilled to have had the opportunity to sit down with her and learn more about this groundbreaking research.
Public Goods: First off, there are a lot of misconceptions about what a ketogenic diet is. Could you give us a clearer definition?
LJ Amaral: There’s not one true definition of the ketogenic diet. There are actually many different versions that depend on the context of its use. For instance, in Type II Diabetes, you might hear something like a modified ketogenic diet that is more like a 2:1 ratio of fat to protein and carbohydrates combined.
With cancer, we’re looking more at a 3:1 diet that is about 82% total calories coming from fat. Which means if someone is eating 2,000 calories a day, 1,600 of those calories would come from fats alone. The purpose of these ratios is to induce a state of ketosis in the body.
PG: For those who don’t know, what is ketosis?
LJ: Our bodies break carbohydrates down into glucose, the most preferred energy source for all our cells. Fat goes to ketone bodies when it gets broken down in our digestive system. The meaning of ketosis comes from the fact that there is a high concentration of circulating blood ketones and low circulating blood glucose when you restrict your carbohydrate intake from the average American diet.
When the body goes through periods of starvation or long periods of time without eating, it will eventually run out of its glucose stores and will start to use its secondary fuel source, fat. When it starts to mobilize its fat stores, it will start to burn ketones as fuel — using the secondary energy source instead of the glucose. This affects metabolic processes in a way that can be beneficial to the body.
PG: What drew you to focus on the ketogenic diet as opposed to another approach?
LJ: This diet found me.
I moved from New York to Los Angeles for my current job at Cedars Sinai. Six weeks into this new job, I get a call from Dr. Jethro Hu in neuro-oncology, who has a patient he wants to refer to me. This particular patient is very interested in the ketogenic diet and he has a glioblastoma multiforme, which is a stage-four brain tumor.
At this point, all I knew about the ketogenic diet was from a six-week summer course I took at NYU. A lot has changed in the three years since, but when I first started researching, what was available said things like: this diet is only possible for children, because you can easily manipulate their diet. Or you have to be hospitally induced and have a water-only fast. Or start out on this tube-feeding called KetoCal.
So when this patient came to me, I told him this diet seems really hard and really restrictive. He responded by looking at me straight in the eyes and saying, “I’m going to do this with or without you.” I saw that this was an opportunity, so I said, “Why not? Let’s do this together.”
PG: Your work with the ketogenic diet is most notably around its potential beneficial effects on reducing the size of tumors. Could you tell us about your findings and how you arrived at them?
LJ: We’ve seen some interesting and mixed results so far. The very positive results of our initial pilot study, where we had twelve patients with mixed central nervous system malignancies, allowed us to start the trial that’s going on at Cedars right now.
For the patient who catalyzed this for me, the location of his tumor when he first started with this diet made it really hard for him to read. Four months later, with no other changes to his treatment but the introduction of the ketogenic diet, this patient was able to read books again. Another patient, who was 28 and loved running, had hemiparesis where one side of his body was paralyzed from his tumor. Within two months of starting the diet, he was jogging, dressing up and working on his art again.
However, despite these amazing results, the diet doesn’t necessarily stop the disease nor is it the appropriate intervention for all cancer patients. For others, it can also be too socially isolating or they may not like the food selection.
PG: How exactly does the diet affect cancer?
LJ: There’s a scientist named Otto Warburg who hypothesized that cancer cells have a higher affinity toward using glucose. There then becomes this dependence on glucose to fuel the tumor’s proliferation. So when we’re restricting glucose in the diet and reducing the glucose in the bloodstream, we are essentially restricting the amount of nutrients that can get to the tumor. There are a number of changes the ketogenic diet can have on the microenvironment of a tumor that can contribute to shrinking it.
The diet is also very anti-inflammatory. There are three types of ketone bodies. The most common one that we measure in blood is called beta-hydroxybutyrate, which can act like an antioxidant. It can reduce the amount of cells that can cause damage to normal tissues. Also, the diet’s ability to promote the anti-inflammatory pathways of the brain can help with the swelling that often comes with brain tumors.
PG: You mention on your website, that you don’t believe everyone will benefit from a ketogenic diet. In your experience, who tends to benefit the most? And who sees less benefit?
LJ: Because it’s a very restrictive diet, personality plays a big role in who might be a good candidate for it. It takes a lot of planning, education, money, time and motivation.
Additionally, because this diet can make you lose weight, I urge caution to anyone who’s going through cancer treatment and struggling with cancer-related side effects or has a catabolic disease state. This includes things like head and neck cancer, pancreatic cancer, bone marrow transplants, lung cancer.
These diseases have the most risk of muscle protein breakdown and getting into a state of cachexia or wasting syndrome. We want to avoid further weight loss when you’re going through treatment where there is this risk.
You should always talk to your doctor about doing this diet.
Type II Diabetes patients can benefit. There’s also new research looking at benefits to Alzheimer’s, autism, athletes, depression and anxiety.
Those who are on a lot of glucose lowering medications, I don’t recommend going on this diet without supervision because low blood sugars are extraordinarily dangerous.
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