My PSA: Yes, I have heard of this…

Fresh on the news feed this Sunday morning was a link to this article about using the Ketogenic Diet to combat cancer:

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I first learned about the ketogenic diet a few years ago when I saw the 1997 film, “First Do No Harm.” This was a powerful film directed by Jim Abrahams, featuring Meryl Streep, Allison Janney, and Fred Ward. This story was brought to light largely in part due to the fact that Jim Abrahams’ son, Charlie,  developed a severe seizure disorder at the age of 2 that did not respond to medications.

In the initial forward to the book “Ketogenic Diets: Treatments for Epilepsy and Other Disorders,” by John M. Freeman, Abrahams wrote about the search for help for his son:

“… thousands of seizures and countless medications later, when physicians were unable to help, Abrahams searched on his own and found reference to the ketogenic diet program at Johns Hopkins…. within one week of starting on the diet, Charlie’s seizures were completely controlled, his EEG returned to normal, his development resumed, and he no longer suffered the side effects of medication.”

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Dr. Freeman was an American pediatric neurologist specializing in epilepsy. He is best known for bringing the previously abandoned ketogenic diet back as a treatment for pediatric epilepsy. The diet is a carefully managed high-fat diet that reduces the incidence of seizures in children during and after its use.

When I first saw the Meryl Streep film (…First Do No Harm) about the Abrahams family story, I was well into my initial SCD journey. I had been following SCD strictly for over a year; my Crohn’s was in complete clinical remission, and I was completely off all my medications.
I was a 100% believer in FOOD First, FOOD as MEDICINE, etc.

But to get back to today, and the current conversation about this new trend in cancer treatment, using the ketogenic diet…. (deep breath inserted here)…

Cancer does not equal IBD. Cancer does not equal Epilepsy. Cancer is the Uber disease process. Really, a whole out-of-control, Donald Trump style Bad Seed, the Honey Badger of all disease processes.

I am always, always, the first to say that I think we (“we” being patients, and medical researchers and providers), need to look at *Food as Medicine.*

Now, I’m going to say, that when someone is in the midst of health crisis, the single most insensitive, alienating, and harmful thing you can do, is ask them if they’ve tried (insert: A,B,C).

When I was working 12 hour night shifts on the Bone Marrow Transplant unit, I had a patient in tears: A 50+ year old man who was 2 weeks into his chemotherapy transplant preparatory regimen, he had gotten an email from a cousin asking if he had heard about/tried something along the lines of a ketogenic diet.

Seriously, this man was inpatient, on isolation precautions, he had been getting chemo basically round the clock for 2 weeks. His white blood cell counts were down to one nano-notch above zero, and some genius who read some article on NPR, or Web MB, or Dr. Kale’s Cancer Cures webpage (I made that last one up), was asking is he had thought of trying giving up sugar.

I think saying that to a cancer patient would be somewhat akin to me asking my young friend who recently had their colon removed due to advanced, life threatening, medication refractory Crohn’s disease progression, if they had “heard of SCD.” As in, “Hi, so sorry about your colostomy,  would you like me to teach you how to make your own yogurt? I think it could really help your IBD.”
No. Just no.And then to the question, have I heard of this (ketogenic diet) for cancer treatment?
Yes, of course I have. That is part of my job as an oncology nurse navigator: I need to stay apprised of both the most current changes & advancements in Evidence~Based practice, and any upcoming trends and research. I’m the person that fields all those questions from my patients.

And yes, this (ketogenic diet), has come up recently as part of that role. I have a patient, they have an advanced cancer. They have “done their own research” an decided to put themselves on the ketogenic diet.

They had also read (one of my *favorite*) books, “The Emperor of All Maladies: A Biography of Cancer,” by Siddhartha Mukherjee. So, they felt that they had a pretty good handle on what had caused their cancer, and how best to treat it. (Gulp).

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So, again: as both a Crohn’s patient, and as an oncology nurse, I am all about integrative medicine, Food as Medicine, Mindfulness, acupuncture, all those really, really, good things.

But, here is what this patient, and many like them, are up against specifically in regard to the ketogenic diet:

If the cancer is already advanced enough that surveillance is not appropriate, and treatment must be started to ensure the best chances for survival, there are going to be some practical, and logistical, obstacles to adhering to this diet.

1) There is not adequate, science-based evidence to have brought this into the accepted main stream of oncology medical practice. Your cancer team most likely will either not be familiar with this theory, and/or have specific reasons to object to its use.

2) We are all trained to be considerate of cultural, spiritual belief systems and practices. It is our job to get to know you, and learn what is important to you as a patient. And along with that, we need to practice within our Science-based frame, and ensure you have the education you need if you make choices that may not match well with certain aspects of the treatment you have chosen.

3) Steroids. Steroids pretty much trump the ketogenic diet. And here is why:

If you elect to have Chemotherapy and/or Radiation Therapy, there will likely be a time when you need to take steroids.

There are 3 primary reasons why they are prescribed:

a) They are used as a component of treatment to help destroy cancer cells, and to make chemotherapy more effective.
b) They can help reduce allergic reactions to certain chemotherapy agents.
c) They are often used in low doses as anti-nausea medications, and to help increase appetite.

So, one might ask, “OK, what’s the problem, in relation to the ketogenic diet?”

Steroids have many, many, unpleasant side effects. One of the big ones, is that they raise blood sugar levels. In fact, some cancer patients, who have never had any history of diabetes, end up needing to be on insulin for a while to manage their blood sugar levels while they are on steroid therapy.

In the ketogenic diet, the core, main premise, is that the cells do not have sugars to “feed” them. The very definition of ketoacidosis, is that it is a state where the body cannot use glucose (sugar) as a fuel source, and has no other choice but to use fats (lipids) as a fuel source instead. The goals for blood sugar range while following the ketogenic diet, are impossible to maintain while taking steroids.

My patient who was following  the ketogenic diet, realized that this would be an insurmountable problem, at least for the short term. In the end, they opted for surgery and Chemo/RT, and plan on returning to their Keto Diet when they are no longer on steroids.

It’s a hard call. One that every patient needs to make on their own. That being said, if you choose to go to a licensed, board certified Oncologist, you can’t do it part-way. You can choose to say ‘no’ to their treatment, of course. But please don’t let your “own” research, or the current trends that are not yet part of the Evidence-Based Practice protocols, put you even further at risk.

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