The Case for the Keto Diet

I first became curious about the keto diet and cancer in 2015. I am a medical doctor that specializes in internal medicine. That means I focus on patients’ ‘long game.’ I think about questions like:

• What are the consequences of 20 years of high blood pressure?
• What happens when you have been overweight for 15 years?
• What are the risks of smoking marijuana for ten years?

I aim to help patients prevent disasters before they ever become aware of a symptom.  Thankless in many ways, but rewarding strategically. I specialize in assisting patients in achieving behavioral changes that add years to their lives.

I also like to study chronic brain problems like Parkinson’s, depression, bipolar, seizures, addiction, anxiety, high blood pressure, strokes, and brain fog. My practice displays a calico pattern of brains that don’t work correctly.

However, if you have one of the ‘bad boys’-I’m talking about cancers that kill people within six months- even Mayo Clinic will refer you to the crown jewel of all cancer treatment centers: M.D. Anderson. This organization leads innovation worldwide in treating cancer.

Releasing Their Cancer Protocol

When M.D. Anderson releases a cancer protocol, the medical world should sit up and pay attention. Strangely, M.D. Anderson did not announce their newly implemented ketosis protocol at any medical conference. I did NOT read about this update in any medical journal.

Nope. Instead, a patient whispered this information to me as if she was worried about how I would respond. This earth-shattering information, shared via my patient’s small hushed voice, has since changed my whole approach to patient care.

Her mother was diagnosed with a glioblastoma, one of the worst forms of brain cancer. Her mother lived in Texas, near M.D. Anderson. Accordingly, she landed in the hands of the most respected cancer treatment scientists today. When my patient heard that her mother couldn’t receive the first dose of radiation until she’d been in ketosis for two weeks, the daughter did what I would have done: she asked questions.

When she squeezed out all the information she could get from her mom’s medical staff, she hit the library. Still skeptical whether her mother was getting the very best care, she brought her questions to me-her primary care physician.  My response: a blank stare over the rims of my glasses as I processed the word ‘ketosis.’ Not one of my stellar moments.

This happens a lot. Patients bring me a multi-level-marketing-hyped super weird chemical. They ask me what I think. Most of the time these chemicals are a waste of their money. Usually, those products’ effects are so minor they won’t hurt anyone. But that’s not always the case, so I take the time to check them out. This patient’s ketosis question kicked my brain into high gear.

For starters, when she said ‘ketosis’ my brain automatically heard ‘ketoacidosis.’ Fifteen years had passed since I last encountered a ketoacidosis patient. Back in medical school, every time I took a test, they asked about this super scary syndrome of ketoacidosis. When I mistakenly heard ketoacidosis instead of ketosis, I reflexively answered, “Hell no, that sounds scary!”

Except, this woman’s mother was at the crown jewel of all global cancer treatment centers. Why would they be asking this woman to pee ketones before they zap her brain with cancer-killing radiation?  Every single day they delayed the radiation therapy made her survival chances worse. There had to be more to this situation.

I bought myself some time and asked the patient for a week to research the question. My trusty researcher flooded my inbox with ketosis research linked to M.D. Anderson. Her research led to the articles that changed my whole practice philosophy.

What I Found

I found the information referring to the new ketosis protocol at M.D. Anderson. It was very technical, advanced biochemistry chatter. I got the essence of the message that cancer cells used blood sugar or glucose for fuel. Cancer cells don’t use ketones for fuel. They don’t have the cellular goods to use ketones.

For starters, ketones are fuel? Hmmpt. Interesting. Ketones are not the super scary, acidic molecules known to send patients to the intensive care unit.

I’m sure we covered this in medical school. But that was so long ago it felt like new information to me. I had lost that fact many brain cells ago.

The articles went on to discuss that when we fed cancer-filled-animals only ketones, certain cancer cells starved. It sounded a little too good to be true. Still, I was not reading the latest self-published update from hucksters selling salts that change your eye color. It was straight from one of the world’s leading cancer research institutions.

I scanned the report for side effects. Patients in ketosis undergoing radiation treatment run the risk of killing off too many problem cells at once. It can clog their filtration system with dead cancer cells. What?

What a fantastic problem for terminally ill patients to have?!  Let me pick THAT problem for my patients any day. We kill cancer TOO WELL?  Awesome!

Department of Defense Studies on Ketosis

My gem of a researcher didn’t stop the search there. She sent me several other articles. One item from the Department of Defense caught my eye. As a doctor, this one resource stood out to me because the Department of Defense does NOT usually take money from Big Pharma.

Medical research requires funding. Someone has to foot the bill. Usually, that someone has a good reason to spend their money. Figure out who funded the study-and you quickly know the results before even reading the report. Call me cynical, but this is how things typically work in the world of Big Pharma or direct-to-consumer industries.

Put it this way, if a multi-level-marketing company funds a study, don’t be surprised if the report concludes that their product saves the world. What a coincidence, right? That is the reason why I don’t get excited quickly when a new ‘groundbreaking study’ starts making the rounds. For me to get excited, I need something more, well, objective.

When it comes to objectivity, the DOD (The United States Department of Defense) does not play around. It is one of those sources where any potential bias is so small that you can almost believe every word you read.

How the DOD Described it

The Department of Defense released an article describing a study involving ketosis and their divers. At first, I thought, “How strange.” Why would a deep-sea diver need ketosis? The short answer: seizures. The resource explained that our Navy SEALS spend a lot of time underwater. They also pride themselves on stealth. SEALS are all about sneak attacks. Accordingly, they don’t use standard scuba equipment. Their breathing devices won’t leak out bubbles. Good idea, right?

If you’re trying to hide from the enemy by swimming underwater, you can’t leave a trail of bubbles. Talk about a dead giveaway.

A rebreather allows divers to breathe the same air over and over again without leaking bubbles. It calculates the gas concentrations of particles in the air. Their oxygen delivery remains steady while toxic gas levels remain low. What an awesome tool. Right? GO NAVY.

The rebreather makes stealth diving possible without a bubble trail-except for one problem: Every single one of the Navy SEALS using this device started having seizures. Oops, that’s not going to work. There’s one thing worse than having a seizure: having one 30 feet underwater!

The DOD’s research team quickly set out to discover how to prevent the seizures. The first approach they used replicated what we kids having hundreds of seizures a day: anti-seizure medicine. They prescribed these meds to Navy SEALS.

The Results? Stupid Navy Seals. No,Really

The medicines slowed their brain processes down-by a lot. Their timing and reaction skills got super slow, and, worst of all it, didn’t prevent one stinkin’ seizure! Back to the drawing board.

After reading through some literature from the 1900s, research team members found that most of the seizure studies available focused on children. Sadly, most kids were prescribed medication that slowed down their brains. This effect, it turns out, was by design.

The most common anti-seizure drugs work this way. Since seizures are spread through the circuits in our our brain’s, slowing down electrical activity should hold the seizures at a standstill. This solution works for most kids at quite a substantial sacrifice of mental speed and performance.

What happens when the medication fails? The DOD Researchers Unearthed the Answer: The Ketogenic Diet.

The results were startling. The skeptic in me wondered about the chances of this DOD report containing your typical Big Pharma version of snake oil hype. I just could not put DOD in the same category as Big Pharma. The DOD is not in the business of getting the public excited about a new treatment for seizures. There’s no conflict of interest, at least, as far as I could see.

Thanks to this study, ketosis remained stuck to the roof of my mind like hard to reach mental peanut butter. Still, I was looking for something more convincing. The DOD report was eye-opening, but something still held me back from recommending ketosis to my patients.

Autopsy Studies

I needed another data source. Something I know that offers little wiggle room for hyped up conclusions. I found it in the form of autopsies. Yes. Autopsy studies are beneficial. You set up a study selecting a set of patients who have a childhood problem and follow them all the way to death.

Once dead, look at their bodies under a microscope. That’s my kind of study. Remember: I am an internist whose job is to predict what crappy things await you in the future and the best strategies to avoid them.

There is just one problem with long-range childhood to autopsy studies: They are very very very RARE.

How come? That is not how most drug research is done. Drug companies hate these kinds of studies. They take too long and are quite expensive. For Pharma companies to keep costs down, they use animal studies.

They might do a 2-year study to see how well their medicine works. From that point, a statistician makes some long-term extrapolation about future effects based on the two-year data. Bla. Bla. Bla. What’s wrong with this picture? How trustworthy is data based on some goofy numbers twisted by a statistician on a drug company’s payroll?

That is why the hairs on the back of my neck stood on end when my researcher drew my attention to an autopsy study involving ketosis. Dead people don’t lie … as often. Who are the dead people we were inspecting? They were not cancer patients.

Nope, these were the kids from the 1950s and 1960s who were put on a ketogenic diet because prescription seizure drugs failed to make their seizures go away.

The Ketosis Kids

Those were the called the ketosis kids. When these kids were in their early teens and suffering from severe seizure disorders, their doctors had failed to control the seizures using medication. After running out of other options, they began a ketogenic diet. These kids were hospitalized and underwent ketosis transition.

Even their families were trained by doctors to keep these patients on a ketogenic diet for a lifetime.  Their compliance with the diet was nearly perfect.  Going out of ketosis caused the return of their seizures.

And now they were dying. Not from seizures mind you. They were dying of old age or health problems unrelated to seizures.

As the dead patients rolled back into the study 60 years later, a few striking findings appeared in the first few corpses. For starters, their brains were some of the healthiest minds the pathologist had ever seen. Wait. Stop.

That is entirely backward. These are seizure patients. The drugs failed them. They got put on this diet as a last resort because they had hundreds of seizures a day.

If you want to see the worst human brains, take a look at the autopsies of seizure patients who suffered decades of untreated and uncontrolled seizures. Seizure patients’ brains are known for being in terrible shape at autopsy. Why are the ketosis kids’ brains so different?

Even when we controlled the seizures, seizure patients’ brains aged differently from normal healthy brains. They tend to be smaller. The insulation coating the nerves throughout seizure patients’ brains are usually thinner. Instead of the smooth areas seen in normal brains, the brain circuits of seizure patients have a poke-a-dot pattern. Simply put, typical seizure patients’ scans look a lot like some of my drug-addicted patients’: broken. Yet, these keto kids’ brains were pristine.

Neurofibril Tangles

Neurofibril tangles, also called brain plaques, are one of the disease markers we see in brains at autopsy. If you’ve ever looked into the grey matter of people with Alzheimer’s, you’d know what a neurofibril tangle is. For those of you that haven’t heard this word before, here is your crash course in neurofibrillary tangles: think of it as ‘rust’ in your brain. It is a buildup of ‘gunk’ that is linked to many brain diseases.  Brains struggling with seizures, even low-level ones, reveal many of these tangles when autopsied.

So why do the grown-up, keto kids’ brains look so good?  It seems impossible. How could a seizure brain have no neurofibrillary tangles?

At this point, I became extremely curious about ketosis. If the lack of brain damage among ketosis patients was eye-opening, my curiosity was kicked up a notch when the autopsies showed that the initial set of patients had no cancer. It was shocking to me because everybody has cancer.

Yeah, I hate to break it to you, but we all have some cancer floating around in our bodies. The real question is how well can we fight off that cancer and undo our body’s cellular mistakes. If you were to autopsy an old person and tell me that they don’t have cancer at all in their bodies, I wouldn’t believe you.

I’d insist that you look again. I’d think that you meant that they have a lower amount of cancer. I can’t imagine a human body at autopsy having no cancer. Everybody has little cancer.

In the 1920s, we learned that tumor cells don’t need oxygen to survive, but they certainly need glucose. Strange. Those cancer cells don’t like a high level of oxygen, but they need their sugar.

Here’s the clincher: cancer cells can’t use ketones for fuel. At this point in my research, only two words came to my mind: hot diggity!!

In 20 years of practice, I’ve never canceled my clinic to study. Studying always came in the extra hours of running a private practice. But I found myself counseling patients so I could better understand this phenomenon I’d stumbled upon. This was far too shocking to let another day go by without me understanding, “What’s the deal with ketosis?”