Ketogenic Diet
Ketogenic diets are high in fat, moderate in protein, and low in carbohydrates, with weak to preliminary evidence of anticancer effects. A ketogenic diet can also improve body weight and insulin resistancea condition in which cells in your muscles, fat, and liver don’t respond well to insulin and can’t efficiently take up glucose from your blood for energy and support healthier blood sugar levels.
How can a ketogenic diet help you? What the research says
We summarize the clinical evidence for each medical benefit here. We begin with our assessment of the strength of evidence within each category, followed by a brief summary of individual studies or reviews of several studies. In assessing the strength of evidence, we consider the study design, number of participants, and the size of the treatment effect (how much outcomes changed with treatment).
To see more details, click the plus sign to the right of any section.
Our assessments of evidence for each medical benefit fall into one of these categories:
- Strong evidence: consistent, significant effects in several large (or at least one very large) well designed clinical studies or at least two meta-analysesa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of clinical studies of moderate or better quality (or one large meta-analysis) finding similar results
- Good evidence: significant effects in one large or several mid-sized and well-designed clinical studies ( randomized controlled trialsa study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects with an appropriate placebo or other strong comparison control or observational studies that control for confounds)
- Modest evidence: significant 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 observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies), or several small studies aggregated into a meta-analysis
- Preliminary evidence: significant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect
- Weak evidence: one 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
- Insufficient evidence: preclinical 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)
Learn more about how we research and rate therapies and practices in How We Rate Therapies ›
Improving treatment outcomes
Is a ketogenic diet linked to improved survival? Is it linked to less cancer growth or metastasis? Does it enhance the anticancer action of other treatments or therapies? We present the evidence.
Notable preclinical evidence is listed in Are you a health professional? ›
People with cancer eating a ketogenic diet have not been shown to live longer across many studies.
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 better cancer outcomes among people eating a ketogenic diet
- Overall, “inadequate evidence to support the beneficial effects of LCKDs [low-carbohydrate ketogenic diets] on antitumor therapy” in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 6 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects of generally poor quality1Yang YF, Mattamel PB et al. Efficacy of low-carbohydrate ketogenic diet as an adjuvant cancer therapy: a systematic review and meta-analysis of randomized controlled trials. Nutrients. 2021 Apr 21;13(5):1388.
- “Clinical data were insufficient to draw conclusions regarding efficacy” in a systematic review of 7 clinical studies2Noorlag L, De Vos FY et al. Treatment of malignant gliomas with ketogenic or caloric restricted diets: a systematic review of preclinical and early clinical studies. Clinical Nutrition. 2019 Oct;38(5):1986-1994.
- “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” in a systematic review of clinical studies3Erickson N, Boscheri A, Linke B, Huebner J. Systematic review: isocaloric ketogenic dietary regimes for cancer patients. Medical Oncology. 2017 May;34(5):72.
People with locally advanced breast cancer eating a ketogenic diet showed a greater response to chemotherapy in one study, but people with metastatic breast cancer did not show the same effect. In separate, poorly-designed studies, some people with advanced cancer eating a ketogenic diet had better outcomes; people with higher markers of ketosis were more likely than those with lower markers to have stable disease or remission.
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 following a ketogenic diet
- Greater decrease in tumor size and stage after chemotherapy among people with locally advanced breast cancer eating a ketogenic diet for 12 weeks compared to controls but no evidence of an effect on response rate among people with metastatic disease in a small RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects4Khodabakhshi A, Akbari ME et al. Effects of ketogenic metabolic therapy on patients with breast cancer: a randomized controlled clinical trial. Clinical Nutrition. 2021 Mar;40(3):751-758.
- At 4 weeks, 6 of 11 people had stable or improved disease; at 8 weeks, 5 of 11 had stable or improved disease; and at 16 weeks, 3 of 11 had stable disease among people with advanced cancer eating a ketogenic diet in a small uncontrolled triala study in which a therapy is used, but without a comparison group against which to judge outcomes; an uncontrolled trial is considered a weak study design5Tan-Shalaby JL, Carrick J et al. Modified Atkins diet in advanced malignancies—final results of a safety and feasibility trial within the Veterans Affairs Pittsburgh Healthcare System. Nutrition & Metabolism (London). 2016 Aug 12;13:52.
- Change from rapid disease progression to stable disease or partial remission among people with advanced incurable cancers following a ketogenic diet (carbohydrates limited to 5% of total kilocalories) who achieved dietary ketosis compared to those who did not achieve ketosis in a small clinical study6Fine EJ, Segal-Isaacson CJ et al. Targeting insulin inhibition as a metabolic therapy in advanced cancer: a pilot safety and feasibility dietary trial in 10 patients. Nutrition. 2012 Oct;28(10):1028-35.
- Stable disease among the 5 people with advanced metastatic tumors and no conventional therapeutic options who were able to adhere to a ketogenic diet compared to baseline, but disease progression among those who discontinued the diet in a small uncontrolled trial7Schmidt 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. Nutrition & Metabolism. 2011 July 27;8(1):54.
- Stable disease or partial remission among the 5 (of 9 total) people with advanced incurable cancers and prior rapid disease progression who achieved higher dietary ketosis, but progressive disease among those who did not with a ketogenic diet for about 4 weeks in a small uncontrolled trial8Fine EJ, Segal-Isaacson CJ et al. Targeting insulin inhibition as a metabolic therapy in advanced cancer: a pilot safety and feasibility dietary trial in 10 patients. Nutrition. 2012 Oct;28(10):1028–35.
People with recurrent brain cancer who ate a ketogenic diet had only weak evidence of better progression-free survivalthe time during and after treatment of a disease that a patient lives without disease progression (worsening) in one study.
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
- A weak trendan apparent change due to a therapy, close to but not achieving full statistical significance (this is the CancerChoices definition; other researchers and studies may define this differently) toward better progression-free survival among people with recurrent glioblastoma following a ketogenic diet and achieving stable ketosis compared to those not achieving stable ketosis in a small clinical trial with a similar finding in mice9Rieger J, Bähr O et al. ERGO: a pilot study of ketogenic diet in recurrent glioblastoma. International Journal of Oncology. 2014 Jun;44(6):1843-52.
People with locally advanced breast cancer eating a ketogenic diet showed higher survival rates in one study, but people with metastatic breast cancer did not show the same effect.
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 survival among women with locally advanced breast cancer, but not metastatic breast cancer, eating a ketogenic diet
- Higher survival rate among women with locally advanced breast cancer, but not metastatic breast cancer, eating a ketogenic diet containing 20% calories from medium-chain triglyceride (MCT) oil for 12 weeks compared to standard diet in a small RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects10Khodabakhshi A, Akbari ME et al. Feasibility, safety, and beneficial effects of MCT-based ketogenic diet for breast cancer treatment: A randomized controlled trial study. Nutrition and Cancer. 2020;72(4):627-634.
People with rectal cancer who ate a whole foods-based ketogenic diet during radiation therapy showed only weak evidence of more tumor regression.
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 more tumor regression after radiation therapy among people with rectal cancer eating a ketogenic diet based on whole foods
- A weak trendan apparent change due to a therapy, close to but not achieving full statistical significance (this is the CancerChoices definition; other researchers and studies may define this differently toward more tumor regression after radiation therapy among people with rectal cancer eating a ketogenic diet based on whole foods compared to a standard diet in a small controlled triala study design in which people are assigned to either an experimental group or a control group to compare the outcomes from different treatment; assignment is not random, and so this is not as strong a study design as a randomized controlled trial, but still stronger than an uncontrolled trial11Klement RJ, Koebrunner PS et al. Impact of a ketogenic diet intervention during radiotherapy on body composition: IV. Final results of the KETOCOMP study for rectal cancer patients. Clinical Nutrition. 2021 Jul;40(7):4674-4684.
People with glioma alternating a ketogenic diet with fasting and achieving lower blood glucose levels had better survival in one small study. People with glioblastoma who combined a ketogenic diet with intranasal perillyl alcohol treatments had smaller tumor sizes in one study.
Fasting and a calorie-restricted ketogenic diet: 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 survival among people with malignant glioma achieving a blood glucose level less than the median by fasting in addition to eating a calorie-restricted ketogenic diet
- Better progression-free survivalthe time during and after treatment of a disease that a patient lives without disease progression (worsening) and overall survival among people undergoing reirradiation for malignant glioma eating a calorie-restricted ketogenic diet (KD) and fasting (3 days of KD, then 3 days of fasting and then 3 days of KD) and who achieved a blood glucose level less than the median on day 6, but 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 survival otherwise compared to a calorie-restricted ketogenic diet alone in a small RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects12Voss M, Wagner M et al. ERGO2: a prospective, randomized trial of calorie-restricted ketogenic diet and fasting in addition to reirradiation for malignant glioma. International Journal of Radiation Oncology, Biology, Phyicss. 2020 Nov 15;108(4):987-995.
Intranasal perillyl alcohol and a ketogenic diet: preliminary evidence of smaller tumor area among people with recurrent glioblastoma treated with intranasal perillyl alcohol and following a ketogenic diet
- Smaller tumor area among people with recurrent glioblastoma treated with 55 mg intranasal perillyl alcohol (POH) 4 times a day for 3 months and following a ketogenic diet compared to baseline, but no difference in tumor area among people eating a standard diet in a small controlled triala study design in which people are assigned to either an experimental group or a control group to compare the outcomes from different treatment; assignment is not random, and so this is not as strong a study design as a randomized controlled trial, but still stronger than an uncontrolled trial13Santos JG, Da Cruz WMS et al. Efficacy of a ketogenic diet with concomitant intranasal perillyl alcohol as a novel strategy for the therapy of recurrent glioblastoma. Oncology Letters. 2018 Jan;15(1):1263-1270.
Optimizing your body terrain
Does a ketogenic diet promote an environment within your body that is less supportive of cancer development, growth, or spread? We present the evidence.
See Optimizing Your Body Terrain ›
Find medical professionals who specialize in managing body terrain factors: Finding Integrative Oncologists and Other Practitioners ›
We also recommend that you share with your doctor the information here about how a ketogenic diet might affect these terrain factors if you have any imbalances.
Weight loss among people who are overweight is typically regarded as beneficial in cancer care, but weight loss among people who are underweight, have advanced cancer, or lose weight unintentionally can be dangerous.
People with cancer eating a ketogenic diet had lower body weight and lower fat mass across many studies. People with polycystic ovary syndrome eating a ketogenic diet had lower body weight in two studies; one of these studies also found that those eating a ketogenic diet had lower fat mass.
People with cancer: good evidencesignificant effects in one large or several mid-sized and well-designed clinical studies (randomized controlled trials (RCTs) with an appropriate placebo or other strong comparison control or observational studies that control for confounds) (this is the CancerChoices definition; other researchers and studies may define this differently) of lower body weight and fat mass among people with cancer eating a ketogenic diet
- Lower body weight, and a weak trendan apparent change due to a therapy, close to but not achieving full statistical significance (this is the CancerChoices definition; other researchers and studies may define this differently toward lower body mass index (BMI) among people with cancer eating a ketogenic diet in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 8 controlled trialsa study design in which people are assigned to either an experimental group or a control group to compare the outcomes from different treatment; assignment is not random, and so this is not as strong a study design as a randomized controlled trial, but still stronger than an uncontrolled trial14Taftian M, Beigrezaei S et al. The effect of ketogenic diet on weight loss in adult patients with cancer: a systematic review and meta-analysis of controlled clinical trials. Nutrition and Cancer. 2022;74(4):1222-1234.
- Better (lower) body weight and fat mass among people with cancer following a ketogenic diet compared to controls in a meta-analysis of 10 controlled trials15Zhao H, Jin H et al. Effect of ketogenic diets on body composition and metabolic parameters of cancer patients: a systematic review and meta-analysis. Nutrients. 2022 Oct 8;14(19):4192.
- Lower body weight and lower body fat mass during radiation therapy among people with rectal cancer eating a ketogenic diet based on whole foods compared to standard diet in a small controlled trial16Klement RJ, Koebrunner PS et al. Impact of a ketogenic diet intervention during radiotherapy on body composition: IV. Final results of the KETOCOMP study for rectal cancer patients. Clinical Nutrition. 2021 Jul;40(7):4674-4684.
- 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 body weight among people with cancer eating low-carbohydrate ketogenic diets compared to any other diet in a meta-analysis of 6 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects of generally poor quality17Yang YF, Mattamel PB et al. Efficacy of low-carbohydrate ketogenic diet as an adjuvant cancer therapy: a systematic review and meta-analysis of randomized controlled trials. Nutrients. 2021 Apr 21;13(5):1388.
- Lower weight, body mass index (BMI), and waist circumference among people with type 2 diabetes eating a ketogenic diet compared to baseline in a meta-analysis of 13 uncontrolled studiesa study in which a therapy is used, but without a comparison group against which to judge outcomes; an uncontrolled trial is considered a weak study design18Yuan X, Wang J et al. Effect of the ketogenic diet on glycemic control, insulin resistance, and lipid metabolism in patients with T2DM: a systematic review and meta-analysis. Nutrition & Diabetes. 2020 Nov 30;10(1):38.
- Lower fat mass but no evidence of an effect on lean mass among women with endometrial or ovarian cancer eating a ketogenic diet for 12 weeks compared to the American Cancer Society diet (high-fiber, low-fat) in a small RCT19Cohen CW, Fontaine KR et al. A ketogenic diet reduces central obesity and serum insulin in women with ovarian or endometrial cancer. The Journal of Nutrition. 2018 Aug 1;148(8):1253-1260.
- Lower body weight among men with advanced cancer eating a ketogenic diet for 16 weeks in a small uncontrolled trial20Tan-Shalaby JL, Carrick J et al. Modified Atkins diet in advanced malignancies—final results of a safety and feasibility trial within the Veterans Affairs Pittsburgh Healthcare System. Nutrition & Metabolism (London). 2016 Aug 12;13:52.
- Weight loss among people with advanced incurable cancers eating a ketogenic diet (carbohydrates limited to 5% of total kilocalories) who achieved dietary ketosis compared to baseline in a small uncontrolled study21Fine EJ, Segal-Isaacson CJ et al. Targeting insulin inhibition as a metabolic therapy in advanced cancer: a pilot safety and feasibility dietary trial in 10 patients. Nutrition. 2012 Oct;28(10):1028-35.
People without cancer: 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 lower body weight among people with polycystic ovary syndrome eating a ketogenic diet
- Greater reduction in body weight, body mass index (BMI), and body fat among women with polycystic ovary syndrome eating a ketogenic diet for 8 weeks compared to a less carbohydrate-restricted plant-based diet in a small RCT22Sharifi M, Saber A et al. The effects of portfolio moderate-carbohydrate and ketogenic diets on anthropometric indices, metabolic status, and hormonal levels in overweight or obese women with polycystic ovary syndrome: a randomized controlled trial. Nutrition Journal. 2024 Dec 2;23(1):152.
- Lower body weight among obese women with polycystic ovary syndrome and liver dysfunction eating a ketogenic diet for 12 weeks compared to standard pharmacological therapy (Essentiale, containing essential phospholipid for liver damage, and Yasmine, containing estrogen and progestin) in a small RCT23Li J, Bai WP et al. Ketogenic diet in women with polycystic ovary syndrome and liver dysfunction who are obese: a randomized, open-label, parallel-group, controlled pilot trial. The Journal of Obstetrics and Gynaecology Research. 2021 Mar;47(3):1145-1152.
People with cancer eating a ketogenic diet showed lower blood glucose levels but no evidence of an effect on insulin levels across several studies. People with diabetes or polycystic ovary syndrome eating a ketogenic diet had better blood sugar control and lower insulin resistancea condition in which cells in your muscles, fat, and liver don’t respond well to insulin and can’t efficiently take up glucose from your blood for energy across many studies.
Among people with cancer: 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 levels but 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 better insulin levels among people with cancer eating a ketogenic diet
- Lower blood glucose levels among people with cancer eating a ketogenic diet in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 7 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects24Salido-Bueno B, Gil-Hernandez E et al. Effects of ketogenic diets on cancer-related variables: a systematic review and meta-analysis of randomised controlled trials. Nutrition Bulletin. 2024 Sep;49(3):264-277.
- A weak trendan apparent change due to a therapy, close to but not achieving full statistical significance (this is the CancerChoices definition; other researchers and studies may define this differently) toward lower fasting blood glucose but 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 insulin among people with cancer following a low-carbohydrate ketogenic diet compared to any other diet in a meta-analysis of 6 RCTs of generally poor quality25Yang YF, Mattamel PB et al. Efficacy of low-carbohydrate ketogenic diet as an adjuvant cancer therapy: a systematic review and meta-analysis of randomized controlled trials. Nutrients. 2021 Apr 21;13(5):1388.
- Substantially lower blood glucose among people with high-grade glioma treated with concurrent chemoradiotherapy and adjuvant chemotherapy and following a ketogenic diet compared to an unspecified/standard diet in a small observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods study26Champ CE, Palmer JD et al. Targeting metabolism with a ketogenic diet during the treatment of glioblastoma multiforme. Journal of Neuro-Oncology. 2014 Mar;117(1):125-31.
- Lower serum insulin levels among people with advanced incurable cancers following a ketogenic diet who achieved dietary ketosis compared to those who did not achieve ketosis in small controlled trialsa study design in which people are assigned to either an experimental group or a control group to compare the outcomes from different treatment; assignment is not random, and so this is not as strong a study design as a randomized controlled trial, but still stronger than an uncontrolled trial; only about half or fewer of the people in these studies achieved ketosis27Fine EJ, Segal-Isaacson CJ et al. Targeting insulin inhibition as a metabolic therapy in advanced cancer: a pilot safety and feasibility dietary trial in 10 patients. Nutrition. 2012 Oct;28(10):1028-35; 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. Nutrition & Metabolism. 2011 July 27;8(1):54.
Among people without cancer
Strong evidence of better blood sugar and insulin levels among people with diabetes eating a ketogenic diet
- Lower marker of blood glucose (glycated hemoglobin) among overweight people with type 2 diabetes following a ketogenic diet compared to controls in a meta-analysis of 8 RCTs28Zhou C, Wang M, Liang J, He G, Chen N. Ketogenic diet benefits to weight loss, glycemic control, and lipid profiles in overweight patients with type 2 diabetes mellitus: a meta-analysis of randomized controlled trails [sic]. International Journal of Environmental Research and Public Health. 2022 Aug 22;19(16):10429.
- Lower markers of blood sugar (glycated hemoglobin) and insulin resistance (homeostatic model assessment index) among people with diabetes following a ketogenic diet compared to a low-fat diet, but comparable effects among people without diabetes in a meta-analysis of 14 RCTs29Choi YJ, Jeon SM, Shin S. Impact of a ketogenic diet on metabolic parameters in patients with obesity or overweight and with or without type 2 diabetes: a meta-analysis of randomized controlled trials. Nutrients. 2020 Jul 6;12(7):2005.
- A greater decrease in a marker of blood glucose (hemoglobin A1c) among people with type 2 diabetes following a ketogenic diet for 3 or 6 months, but no evidence of an effect at 12 months, compared to controls in a meta-analysis of 8 RCTs30Rafiullah M, Musambil M, David SK. Effect of a very low-carbohydrate ketogenic diet vs recommended diets in patients with type 2 diabetes: a meta-analysis. Nutrition Reviews. 2022 Feb 10;80(3):488-502.
- Lower fasting blood glucose and glycated hemoglobin A1c among people with type 2 diabetes following a ketogenic diet compared to baseline in a meta-analysis of 13 uncontrolled trials31Yuan X, Wang J et al. Effect of the ketogenic diet on glycemic control, insulin resistance, and lipid metabolism in patients with T2DM: a systematic review and meta-analysis. Nutrition & Diabetes. 2020 Nov 30;10(1):38.
Preliminary evidence of lower fasting blood glucose, insulin, and insulin resistance among people with polycystic ovary syndrome eating a ketogenic diet
- Greater reduction in fasting blood glucose, insulin, and insulin resistance among women with polycystic ovary syndrome eating a ketogenic diet for 8 weeks compared to a less carbohydrate-restricted plant-based diet in a small RCT32Sharifi M, Saber A et al. The effects of portfolio moderate-carbohydrate and ketogenic diets on anthropometric indices, metabolic status, and hormonal levels in overweight or obese women with polycystic ovary syndrome: a randomized controlled trial. Nutrition Journal. 2024 Dec 2;23(1):152.
People with polycystic ovary syndrome eating a ketogenic diet had a greater reduction in two sex hormones—luteinizing hormone (LH) and dehydroepiandrosterone sulfate (DHEA-S)—in one study. In two small studies, people eating a ketogenic diet showed lower levels of triiodothyronine (T3), a thyroid hormone.
Sex hormones: 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 lower levels of two sex hormones—luteinizing hormone (LH) and dehydroepiandrosterone sulfate (DHEA-S)—among women with polycystic ovary syndrome eating a ketogenic diet
- Greater reduction in LH and DHEA-S levels among women with polycystic ovary syndrome eating a ketogenic diet for 8 weeks compared to a less carbohydrate-restricted plant-based diet in a small RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects33Sharifi M, Saber A et al. The effects of portfolio moderate-carbohydrate and ketogenic diets on anthropometric indices, metabolic status, and hormonal levels in overweight or obese women with polycystic ovary syndrome: a randomized controlled trial. Nutrition Journal. 2024 Dec 2;23(1):152.
Metabolic hormones: preliminary evidence of lower (better) triiodothyronine (T3) but insufficient evidence of an effect on a hormone promoting tumor growth—insulin-like growth factor 1 (IGF-1)
- 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 IGF-1 among people with cancer eating a ketogenic diet compared to controls in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 10 controlled trialsa study design in which people are assigned to either an experimental group or a control group to compare the outcomes from different treatment; assignment is not random, and so this is not as strong a study design as a randomized controlled trial, but still stronger than an uncontrolled trial34Zhao H, Jin H et al. Effect of ketogenic diets on body composition and metabolic parameters of cancer patients: a systematic review and meta-analysis. Nutrients. 2022 Oct 8;14(19):4192.
- Better markers of metabolism (lower IGF-1 and lower T3) during radiation therapy among women with breast cancer following a ketogenic diet compared to the standard diet in a small observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods study35Klement RJ, Weigel MM, Sweeney RA. A ketogenic diet consumed during radiotherapy improves several aspects of quality of life and metabolic health in women with breast cancer. Clinical Nutrition. 2021 Jun;40(6):4267-4274.
- Lower levels of T3 during radiation therapy among people with breast cancer eating a ketogenic diet compared to a standard diet in a small controlled trial36Klement RJ, Champ CE et al. Impact of a ketogenic diet intervention during radiotherapy on body composition: III-final results of the KETOCOMP study for breast cancer patients. Breast Cancer Research. 2020 Aug 20;22(1):94.
Eating a ketogenic diet did not show an effect on a marker of inflammation (TNF-α) among people with cancer across many studies. However, people with breast cancer had lower pro-inflammatory markers and higher anti-inflammatory markers during chemotherapy when eating a ketogenic diet in one study.
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 marker of inflammation (TNF-α) among people with cancer following a ketogenic diet in a combined analysis of studies
- No evidence of an effect on a marker of inflammation (TNF-α) among people with cancer following a ketogenic diet compared to controls in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 10 controlled trialsa study design in which people are assigned to either an experimental group or a control group to compare the outcomes from different treatment; assignment is not random, and so this is not as strong a study design as a randomized controlled trial, but still stronger than an uncontrolled trial37Zhao H, Jin H et al. Effect of ketogenic diets on body composition and metabolic parameters of cancer patients: a systematic review and meta-analysis. Nutrients. 2022 Oct 8;14(19):4192.
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 less inflammation during chemotherapy among people with locally advanced and metastatic breast cancer following a ketogenic diet
- A decrease in pro-inflammatory biomarkers and an increase in anti-inflammatory biomarkers during chemotherapy among people with locally advanced and metastatic breast cancer eating a ketogenic diet for 12 weeks compared to controls in a small RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects38Khodabakhshi A, Akbari ME et al. Effects of ketogenic metabolic therapy on patients with breast cancer: a randomized controlled clinical trial. Clinical Nutrition. 2021 Mar;40(3):751-758.
People with glioma alternating a ketogenic diet with fasting who achieved lower blood glucose levels had lower levels of insulin and leptina hormone that helps regulate energy balance by inhibiting hunger.
Changes in hormone levels seen in the study here may not be beneficial in every situation. Your oncology team needs to determine whether any changes would be favorable for your condition.
Ketogenic diet and fasting: 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 lower levels of insulin and leptin on day 6 among people with malignant glioma alternating a calorie-restricted ketogenic diet with fasting
- Lower levels of insulin and leptin on day 6 among people with malignant glioma eating a calorie-restricted ketogenic diet (KD) and fasting for 9 days total (3 days of KD, then 3 days of fasting and then 3 days of KD) compared to standard diet in a small RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects39Voss M, Wenger KJ et al. Short-term fasting in glioma patients: analysis of diet diaries and metabolic parameters of the ERGO2 trial. European Journal of Nutrition. 2022 Feb;61(1):477-487.
Managing side effects and promoting wellness
Is a ketogenic diet linked to fewer or less severe side effects or symptoms? Is it linked to less toxicity from cancer treatment? Does it support your quality of life or promote general well-being? We present the evidence.
Also see evidence of side effects from a ketogenic diet impairing quality of life among some people with cancer: Safety and precautions ›
People with breast cancer eating a ketogenic diet had better quality of life during radiation therapy in one small study.
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 overall therapy side effects during radiation therapy among women with breast cancer following a ketogenic diet
- Better quality of life scores during radiation therapy among women with breast cancer following a ketogenic diet compared to the standard diet in a small observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods study40Klement RJ, Weigel MM, Sweeney RA. A ketogenic diet consumed during radiotherapy improves several aspects of quality of life and metabolic health in women with breast cancer. Clinical Nutrition. 2021 Jun;40(6):4267-4274.
Weight loss among people who are overweight is typically regarded as beneficial in cancer care, but loss of muscle mass can be dangerous.
People with cancer eating a ketogenic diet showed a trend toward less loss of skeletal muscle or may even have gained a bit in two out of three studies.
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 less loss of muscle mass among people with cancer eating a ketogenic diet
- A weak trendan apparent change due to a therapy, close to but not achieving full statistical significance (this is the CancerChoices definition; other researchers and studies may define this differently toward less weight loss and less loss of skeletal muscle during chemotherapy among people with head and neck cancer eating a non calorie-restricted, ketogenic diet based on whole foods compared to standard diet in a small controlled triala study design in which people are assigned to either an experimental group or a control group to compare the outcomes from different treatment; assignment is not random, and so this is not as strong a study design as a randomized controlled trial, but still stronger than an uncontrolled trial41Klement RJ, Sweeney RA. Impact of a ketogenic diet intervention during radiotherapy on body composition: V. Final results of the KETOCOMP study for head and neck cancer patients. Strahlentherapie und Onkologie. 2022 Nov;198(11):981-993.
- 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 skeletal muscle mass with loss of body weight and fat mass during radiation treatment among people with rectal cancer eating a ketogenic diet based on whole foods compared to standard diet in a small controlled trial42Klement RJ, Koebrunner PS et al. Impact of a ketogenic diet intervention during radiotherapy on body composition: IV. Final results of the KETOCOMP study for rectal cancer patients. Clinical Nutrition. 2021 Jul;40(7):4674-4684.
- Slight increase in lean body mass among cachectic cancer patients eating a ketogenic diet compared to baseline in a small uncontrolled triala study in which a therapy is used, but without a comparison group against which to judge outcomes; an uncontrolled trial is considered a weak study design43Fearon KC, Borland W et al. Cancer cachexia: influence of systemic ketosis on substrate levels and nitrogen metabolism. American Journal of Clinical Nutrition. 1988 Jan;47(1):42-8.
People with cancer eating a ketogenic diet have shown better quality of life in three small studies and stable quality of life in another three. People with breast, ovarian, or endometrial cancer showed some evidence of better physical function in two studies.
Preliminary evidence of better quality of life among people with cancer following a ketogenic diet
Weak evidence of better physical function among people with cancer following a ketogenic diet
- Better quality of life and mental health among people with stage 2 or 3 cancer eating a modified ketogenic diet utilizing medium-chain triglyceride fats for 4 months compared to an institutionalized standard traditional diet in a small RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects44Augustus E, Granderson I, Rocke KD. The impact of a ketogenic dietary intervention on the quality of life of stage II and III cancer patients: a randomized controlled trial in the Caribbean. Nutrition and Cancer. 2021;73(9):1590-1600.
- Better quality of life scores during radiation therapy among women with breast cancer eating a ketogenic diet compared to a standard diet in a small observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods study45Klement RJ, Weigel MM, Sweeney RA. A ketogenic diet consumed during radiotherapy improves several aspects of quality of life and metabolic health in women with breast cancer. Clinical Nutrition. 2021 Jun;40(6):4267-4274.
- Better quality of life and physical function at 6 weeks but 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. at 12 weeks among women with locally advanced or metastatic breast cancer eating a ketogenic diet containing 20% calories from medium-chain triglyceride (MCT) oil for 12 weeks compared to a standard diet in a small RCT46Khodabakhshi A, Seyfried TN et al. Does a ketogenic diet have beneficial effects on quality of life, physical activity or biomarkers in patients with breast cancer: a randomized controlled clinical trial. Nutrition Journal. 2020 Aug 22;19(1):87.
- Better physical function but no evidence of an effect on quality of life among women with ovarian or endometrial cancer eating a ketogenic diet for 12 weeks compared to the American Cancer Society diet (high-fiber, lower-fat) in a small RCT47Cohen CW, Fontaine KR, Arend RC, Soleymani T, Gower BA. Favorable effects of a ketogenic diet on physical function, perceived energy, and food cravings in women with ovarian or endometrial cancer: a randomized, controlled trial. Nutrients. 2018 Aug 30;10(9):1187.
- Stable quality of life among men with advanced cancer following a ketogenic diet for 16 weeks in a small uncontrolled triala study in which a therapy is used, but without a comparison group against which to judge outcomes; an uncontrolled trial is considered a weak study design48Tan-Shalaby JL, Carrick J et al. Modified Atkins diet in advanced malignancies—final results of a safety and feasibility trial within the Veterans Affairs Pittsburgh Healthcare System. Nutrition & Metabolism (London). 2016 Aug 12;13:52.
- Stable quality of life among people with advanced metastatic tumors and no conventional therapeutic options eating a ketogenic diet compared to baseline, but only 5 of 16 people were able to complete the 3-month intervention in a small uncontrolled trial49Schmidt 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. Nutrition & Metabolism. 2011 July 27;8(1):54.
People with breast cancer eating a ketogenic diet during showed better sleep quality during radiation therapy in one study.
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 sleep quality during radiation therapy among women with breast cancer eating a ketogenic diet
- Better sleep quality scores during radiation therapy among women with breast cancer eating a ketogenic diet compared to a standard diet in a small observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods study50Klement RJ, Weigel MM, Sweeney RA. A ketogenic diet consumed during radiotherapy improves several aspects of quality of life and metabolic health in women with breast cancer. Clinical Nutrition. 2021 Jun;40(6):4267-4274.
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 sleep (less insomnia) among people with advanced metastatic tumors eating a ketogenic diet
- Less reported insomnia among people with advanced metastatic tumors and no conventional therapeutic options following a ketogenic diet compared to baseline, but only 5 of 16 people were able to complete the 3-month intervention in a small uncontrolled triala study in which a therapy is used, but without a comparison group against which to judge outcomes; an uncontrolled trial is considered a weak study design;51Schmidt 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. Nutrition & Metabolism. 2011 July 27;8(1):54.our note: the patients in this study were very ill from cancer, and 2 died during the study; symptoms such as these would likely have worsened either with or without the change in diet, but since the study was uncontrolled, we have no comparison group.
Reducing cancer risk
Is a ketogenic diet linked to lower risks of developing cancer or of recurrence? We present the evidence.
One very large combined analysis of studies found that people who ate plant-based low-carbohydrate diets had lower mortality from cancer, but people eating low-carbohydrate diets as a whole or animal-based low-carbohydrate diets had higher cancer-related mortality.
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 lower all-cause mortality but 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 cancer mortality among people eating plant-based low-carbohydrate diets
- Lower all-cause mortality but no evidence of an effect on cancer mortality among people eating plant-based low-carbohydrate diets in a combined analysis of 10 observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies;52Ghorbani Z, Kazemi A et al. Overall, plant-based, or animal-based low carbohydrate diets and all-cause and cause-specific mortality: a systematic review and dose-response meta-analysis of prospective cohort studies. Ageing Research Reviews. 2023 Sep;90:101997. also see evidence from this study that low-carbohydrate diets as a whole or animal-based low-carbohydrate diets are linked to higher cancer-related mortality in Safety and precautions ›
People with polycystic ovary syndrome eating a ketogenic diet showed fewer signs of fatty liver, a risk factor for liver cancer, in one small study.
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 fewer signs of fatty liver, a risk factor for liver cancer, among women with polycystic ovary syndrome (PCOS), fatty liver, and obesity eating a ketogenic diet
- Disappearance of signs of fatty liver among 6 of 7 obese women with polycystic ovary syndrome and fatty liver eating a ketogenic diet for 12 weeks compared to 1 of 10 who ate a standard diet with pharmacological therapy for liver dysfunction in a small RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects53Li J, Bai WP et al. Ketogenic diet in women with polycystic ovary syndrome and liver dysfunction who are obese: a randomized, open-label, parallel-group, controlled pilot trial. The Journal of Obstetrics and Gynaecology Research. 2021 Mar;47(3):1145-1152.
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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.
Sophie received her Bachelor of Arts from the University of Cambridge, where she studied Middle Eastern languages and the philosophy of science. She then completed a premedical post-baccalaureate at the City University of New York. Before joining CancerChoices, she worked for several years at the Cornell Center for Research on End-of-Life Care, where she helped to conduct research on terminal illness and grief. Working in end-of-life research filled her with the conviction that all patients deserve free, accessible, and scientifically accurate information about the therapies available to them. While taking classes in anthropology, she also became curious about traditional medical knowledge and philosophies. These interests led her to CancerChoices. She is delighted to be part of CancerChoices’s work creating rigorous, evidence-based treatment guides for patients and physicians.
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: January 30, 2025
Last full literature review: December 2024
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.
Our staff have no financial conflicts of interest to declare. We receive no funds from any manufacturers or retailers gaining financial profit by promoting or discouraging therapies mentioned on this site.
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