Ketogenic Diet
Ketogenic diets are high in fat, moderate in protein and low in carbohydrates, with weak to preliminary evidence of anticancer effects, relief of side effects, and benefits on your body terrainthe internal conditions of your body, including nutritional status, fitness, blood sugar balance, hormone balance, inflammation and more.
Ketogenic diet at a glance
The goal of a ketogenic diet (KD) is to decrease glucose and increase ketones to alter the metabolism of cancer cells and their associated stromal cells. KD has been studied primarily in malignant glioblastoma.
Ketogenic diets are medically regimented, high in fat, moderate in protein and low in carbohydrates. KD can be implemented either by restricting calories or by keeping the same number of total calories from your previous diet (isocaloric KD). Calorie restriction is considered an important component of an anticancer KD, as it supports your body’s retention of ketoneschemicals made in your liver to fuel metabolism; when your body doesn't have enough insulin to get energy from blood sugar, your liver turns fat into ketones and releases them into your bloodstream to fuel your brain, muscles and other tissues and also lowers cancer growth from extra calories or body weight.
Overall, evidence is weak to preliminary that a ketogenic diet has any anticancer effects or improves side effects of cancer treatment. Some evidence shows better blood sugar and insulin sensitivity among people with cancer (and strong evidence among people with diabetes), and also less inflammation among people following a ketogenic diet. Experts we reference do not recommend or use the KD much, and safety concerns are notable compared to the possible benefits.
CancerChoices ratings for ketogenic diet
We rate a ketogenic diet on seven attributes, with 0 the lowest rating and 5 the highest. We rate the strength of the evidence supporting the use of a ketogenic diet for a medical benefit, such as improving treatment outcomes or managing side effects.
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Improving treatment outcomes
See More- Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) of tumor response, either with or without chemotherapy, among people with advanced cancer
- Weak evidenceone or more case studies, supported by animal evidence OR small treatment effects of limited clinical significance OR studies with no controls OR weak trends of effects (this is the CancerChoices definition; other researchers and studies may define this differently) of better progression-free survival among people with brain cancer following a ketogenic diet and achieving stable ketosis
- Insufficient evidencepreclinical evidence only OR clinical studies with such poor or unclear methodology that no conclusion can be drawn OR conflicting findings across clinical studies with no preponderance of evidence in one direction; conflicting evidence occurs when studies find conflicting effects (positive effect vs no effect or negative effect) with the same treatment and the same general study population (same cancer type, for example) (this is the CancerChoices definition; other researchers and studies may define this differently) of anticancer effects overall
- See How can a ketogenic diet help you? What the research says ›
Optimizing your body terrain
See More- Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) of better blood sugar and insulin levels among people with cancer following a ketogenic diet
- Strong evidenceconsistent, significant effects in several large (or at least one very large) well designed clinical studies or at least two meta-analyses of clinical studies of moderate or better quality (or one large meta-analysis) finding similar results (this is the CancerChoices definition; other researchers and studies may define this differently) of better blood sugar and insulin levels among people with diabetes following a ketogenic diet
- Modest evidencesignificant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently) of better (lower) body weight and fat mass among people with cancer following a ketogenic diet
- No evidence of an effectoverall, one or more studies did not demonstrate that a treatment or intervention led to an expected outcome; this does not always mean that there is no effect in clinical practice, but that the studies may have been underpowered (too few participants) or poorly designed. Larger, well-designed studies provide more confidence in making assessments. on a hormone promoting tumor growth or on inflammation among people with cancer following a ketogenic diet in a combined analysis of studies
- Preliminary evidence of less inflammation during chemotherapy among people with locally advanced and metastatic breast cancer following a ketogenic diet
See How can a ketogenic diet help you? What the research says ›
Managing side effects and promoting wellness
See More- Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) of better quality of life among people with cancer following a ketogenic diet
- Preliminary evidence of better overall side effects, sleep quality during radiation therapy among women with breast cancer following a ketogenic diet
See How can a ketogenic diet help you? What the research says ›
Reducing cancer risk
See MoreWe did not find any published research investigating KD for reducing cancer risk.
Use by integrative oncology experts
See More- Very limited use (only one of our program sources)
- Not mentioned in oncology clinical practice guidelines
Safety
See More- Moderate caution is needed, and supervision by a medical professional is highly recommended
- Short-term side effects including nausea and vomiting, constipation, and heartburn are often seen early in implementation of this diet, and are usually transient and easily managed
- More severe and long-term side effects include weight loss, anemia, fatigue and more
- Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) of low adherence and completion rates among people following a ketogenic diet; researchers interpret these as an indication that side effects or quality of life during KD are a barrier to participation or adherence
Affordability and access
See More- Widely available without restriction
- Somewhat expensive (between $500 US and $2000 US/year) if professional services and supervision are used as recommended
Keep reading about a ketogenic diet
Authors
Laura Pole is senior clinical consultant for CancerChoices. Laura is an oncology clinical nurse specialist who has been providing integrative oncology clinical care, navigation, consultation, and education services for over 40 years. She is the co-creator and co-coordinator of the Integrative Oncology Navigation Training at Smith Center for Healing and the Arts in Washington, DC. Laura also manages the “Media Watch Cancer News That You Can Use” listserv for Smith Center/Commonweal. In her role as a palliative care educator and consultant, Laura has served as statewide Respecting Choices Faculty for the Virginia POST (Physician Orders for Scope of Treatment) Collaborative as well as provided statewide professional education on palliative and end-of-life care for the Virginia Association for Hospices and Palliative Care.
For CancerChoices, Laura curates content and research, networks with clinical and organizational partners, brings awareness and education of integrative oncology at professional and patient conferences and programs, and translates research into information relevant to the patient experience as well as clinical practice.
Laura sees her work with CancerChoices as a perfect alignment of all her passions, knowledge and skills in integrative oncology care. She is honored to serve you.
Ms. Hepp is a researcher and communicator who has been writing and editing educational content on varied health topics for more than 20 years. She serves as lead researcher and writer for CancerChoices and also served as the first program manager. Her graduate work in research and cognitive psychology, her master’s degree in instructional design, and her certificate in web design have all guided her in writing and presenting information for a wide variety of audiences and uses. Nancy’s service as faculty development coordinator in the Department of Family Medicine at Wright State University also provided experience in medical research, plus insights into medical education and medical care from the professional’s perspective.
Reviewer
Dr. Alschuler, ND, FABNO, is a professor of Clinical Medicine at the University of Arizona where she is the associate director of the Fellowship in Integrative Medicine at the Andrew Weil Center for Integrative Medicine. She received her undergraduate degree from Brown University and completed her naturopathic medical training at Bastyr University where she also completed her residency in general naturopathic medicine. She is board certified in naturopathic oncology and maintains a clinical practice out of Naturopathic Specialists, LLC. Dr. Alschuler co-hosts a podcast, Five To Thrive Live!. She is co-author of Definitive Guide to Cancer, now in its 3rd edition, and Definitive Guide to Thriving After Cancer.
Last update: December 12, 2023
Last full literature review: September 2021
CancerChoices provides information about integrative in cancer care, a patient-centered approach combining the best of conventional care, self care and evidence-informed complementary care in an integrated plan cancer care. We review complementaryin cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocial therapy, and acupuncture therapies and self-care lifestyle actions and behaviors that may impact cancer outcomes; examples include eating health-promoting foods, limiting alcohol, increasing physical activity, and managing stress practices to help patients and professionals explore and integrate the best combination of conventionalthe cancer care offered by conventionally trained physicians and most hospitals; examples are chemotherapy, surgery, and radiotherapy and complementary therapies and practices for each person.
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