How can a ketogenic diet help you? What the research says

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.

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? ›

Cancer as a whole

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

Advanced 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 tumor response, either with or without chemotherapy, among people with advanced cancer following a ketogenic diet

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 study⁴Fine 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.
Greater decrease in tumor size and “stage decreased significantly” among people with locally advanced breast cancer receiving chemotherapy and following 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 effects⁵Khodabakhshi 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.
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 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 design⁶Schmidt 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 trial⁷Fine 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.

Brain 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

Ketogenic diet combined with other therapies

Preliminary evidence 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

Preliminary evidence of smaller tumor area among people with recurrent glioblastoma treated with intranasal perillyl alcohol and following a ketogenic diet

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.

Body weight

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

High blood sugar and insulin resistance

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

Preliminary evidence of better markers of metabolism during radiation therapy among women with breast 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

Preliminary evidence of better blood sugar and insulin levels among people with cancer following 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 lower fasting blood glucose but no evidence of an effect on insulin among people with cancer following a low-carbohydrate ketogenic diet compared to any other 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 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 quality¹²Yang 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 adjusted serum insulin during chemotherapy treatment among people with locally advanced and metastatic breast cancer following a ketogenic diet for 12 weeks compared to controls in a small RCT;¹³Khodabakhshi 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. our comment: any adjustments to insulin must always be done under medical supervision
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 study¹⁴Champ 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 ketosis¹⁵Fine 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.

Preliminary evidence of better markers of metabolism during radiation therapy among women with breast cancer following a ketogenic diet

Better markers of metabolism, including IGF-1, during radiation therapy among women with breast cancer following a ketogenic diet compared to the standard diet in a small observational study¹⁶Klement 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.

Strong evidence of better blood sugar and insulin levels among people with diabetes following 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 RCTs¹⁷Zhou 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 RCTs¹⁸Choi 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 RCTs¹⁹Rafiullah 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 trials²⁰Yuan 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.

Hormone balance

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 among people with cancer following a ketogenic diet in a combined analysis of studies

Inflammation

Preliminary evidence of less inflammation during chemotherapy among people with locally advanced and metastatic breast cancer following a ketogenic diet

No evidence of an effect on a marker of inflammation (TNF-α) among people with cancer following a ketogenic diet in a combined analysis of studies

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 ›

Side effects as a whole

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

Body composition or cachexia

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 weight loss but no evidence of an effect on blood lipids or cholesterol among people with cancer following a ketogenic diet

No significant effect on body weight among people with cancer with low-carbohydrate ketogenic diets compared to any other 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 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 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.
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 blood lipids among people with ovarian or endometrial cancer following a ketogenic diet (70% fat, 25% protein, 5% carbohydrate) compared to the American Cancer Society diet (high fiber and lower fat) for 12 weeks, with adherence 57–80%, in a small RCT²⁶Cohen CW, Fontaine KR, Arend RC, Gower BA. A ketogenic diet is acceptable in women with ovarian and endometrial cancer and has no adverse effects on blood lipids: a randomized, controlled trial. Nutrition and Cancer. 2020;72(4):584-594.
Lower weight, body mass index (BMI) and waist circumference among people with type 2 diabetes following a ketogenic diet compared to baseline in a meta-analysis of uncontrolled trialsa 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 design²⁷Yuan 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.
Weight loss among people with advanced incurable cancers following a ketogenic diet (carbohydrates limited to 5% of total kilocalories) who achieved dietary ketosis compared to baseline in a small uncontrolled trial;²⁸Fine 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.
Slight increase in lean body mass among cachectic cancer patients following a ketogenic diet compared to baseline in a small uncontrolled trial²⁹Fearon 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.
Weight loss and lower body mass index (BMI), but no evidence of an effect on cholesterol or blood lipids 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 study³⁰Schmidt 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.

Changes in appetite

Weak evidence of worse appetite among people with advanced metastatic tumors following a ketogenic diet

Quality of life and physical function

Preliminary evidence of better quality of life among people with cancer following a ketogenic diet

Weak evidence of worse physical function among people with advanced cancer following a ketogenic diet

Preliminary evidence of better quality of life among people with cancer following a ketogenic diet

Weak evidence of worse physical function among people with advanced cancer following a ketogenic diet

Better quality of life and mental health among people with stage 2 or 3 cancer with 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 effects³²Augustus 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 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 study³³Klement 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.
Stable quality of life and slightly worse physical function 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 design³⁴Schmidt 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. 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.

Preliminary evidence of low adherence and completion rates among people following a ketogenic diet

Low rate of acceptance of the KD dietary restrictions by patients—only 37% of those on the KD were able to follow the diet for the duration of the study—in a review of clinical studies³⁵Erickson N, Boscheri A, Linke B, Huebner J. Systematic review: isocaloric ketogenic dietary regimes for cancer patients. Medical Oncology. 2017 May;34(5):72.
Quality of life was a factor in decisions to decline participation in a trial which also had poor retention—only 4 of 12 patients completed the 3-month diet—among people with glioblastoma in a small RCT³⁶Martin-McGill KJ, Marson AG et al. Ketogenic diets as an adjuvant therapy for glioblastoma (KEATING): a randomized, mixed methods, feasibility study. Journal of Neuro-oncology. 2020 Mar;147(1):213-227.

Sleep disruption

Preliminary evidence of better sleep quality during radiation therapy among women with breast cancer following a ketogenic diet

Weak evidence of better sleep (less insomnia) among people with advanced metastatic tumors following a ketogenic diet

Helpful links

Cancer as a Metabolic Disease with Thomas N. Seyfried ›

Subscription required

Ketogenic Diet in Cancer ›

How to Starve Cancer ›

Jane McClelland’s book and online course for purchase

Ketogenic Diet and Cancer Treatment ›

Keto for Cancer ›

By Miriam Kalamian, EdM, MS, CNS

The Metabolic Approach to Cancer ›

By Jess Higgins Kelley, MNT, and Nasha Winters ND, FABNO, LAc DiplOM

Keep reading about a ketogenic diet

See all our reviews of complementary therapies

Authors

Laura Pole, MSN, RN, OCNS

Senior Clinical Consultant

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Nancy Hepp, MS

Lead Researcher

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Reviewer

Lise Alschuler, ND, FABNO

Naturopathis oncologist and CancerChoices advisor

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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.

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.

Ketogenic Diet

How can a ketogenic diet help you? What the research says

Improving treatment outcomes

Optimizing your body terrain

Managing side effects and promoting wellness

Helpful links

Keep reading about a ketogenic diet

Authors

Laura Pole, MSN, RN, OCNS

Nancy Hepp, MS

Reviewer

Lise Alschuler, ND, FABNO

Learn more

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References
1, 12, 25	Yang 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.
2	Noorlag 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.
3, 35	Erickson N, Boscheri A, Linke B, Huebner J. Systematic review: isocaloric ketogenic dietary regimes for cancer patients. Medical Oncology. 2017 May;34(5):72.
4, 28	Fine 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.
5, 22	Khodabakhshi 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.
6, 38	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.
7	Fine 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.
8	Rieger 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.
9	Voss 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.
10	Santos 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.
11, 21, 23	Zhao 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.
13	Khodabakhshi 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.
14	Champ 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.
15	Fine 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.
16, 24, 33, 37	Klement 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.
17	Zhou 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.
18	Choi 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.
19	Rafiullah 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.
20, 27	Yuan 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.
26	Cohen CW, Fontaine KR, Arend RC, Gower BA. A ketogenic diet is acceptable in women with ovarian and endometrial cancer and has no adverse effects on blood lipids: a randomized, controlled trial. Nutrition and Cancer. 2020;72(4):584-594.
29	Fearon 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.
30, 31, 34	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.
32	Augustus 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.
36	Martin-McGill KJ, Marson AG et al. Ketogenic diets as an adjuvant therapy for glioblastoma (KEATING): a randomized, mixed methods, feasibility study. Journal of Neuro-oncology. 2020 Mar;147(1):213-227.