Ketogenic Diet and Cancer: Dietician’s Experience
Magali Walkowicz, dietician-nutritionist, author of Ceto Cuisine and The Carbohydrate Counter, follows cancer patients who have opted for a ketogenic diet. She testifies.
The ketogenic diet, low in sugars, high in fat, makes a growing number of followers among people diagnosed with cancer. They must know that to date there is no scientific evidence that this dietary approach is effective; they should also know that it is a binding diet for which there may be contraindications and adverse effects. In this exclusive interview, the French dietician-nutritionist Magali Walkowicz, who has been following patients (and healthy people) who have been using the ketogenic diet for several years, shares her experience. An important testimony, as few studies are still available. We answer 8 questions that are often asked about the state of scientific knowledge about the ketogenic diet and cancer. We recommend that patients who wish to follow a ketogenic diet first obtain the opinion of the health care team (potential benefits and risks, state of knowledge), and, in the case where the diet is in place, follow-up and advice from a nutritionist or dietician-nutritionist familiar with the ketogenic diet.
Magali Walkowicz, who consults you?
Magali Walkowicz : Essentially, patients who have been diagnosed with cancer but not only. Some people simply want to optimize their health by following it. I now have a patient in all France but also in other countries. I had to adapt and offer consultations via Skype and Facetime.
They are usually “informed” people, who have read books, newspaper articles about the ketogenic diet, or who know someone who follows this diet. Because health professionals side, the diet has a way to go. It is simply not known and therefore rejected. Some oncologists or referring physicians communicate with me in the care of patients we have in common. It is a real plus in the therapeutic accompaniment. Oncologists are asking me directly. But all this remains marginal. For some time, I have health professionals as patients, including doctors. It seems to me that things are starting to move.
What results do you see in patients?
The results are generally positive. Experience shows me that during cancer, very often, the progression of the tumors is either in regression, stopped or slowed down, compared to before the establishment of the regime. Some patients who had to stop their treatments because they could not stand them, were able to resume them after following the ketogenic diet. But the results are not equal for everyone. The side effects of conventional treatments are often diminished. I make certain adjustments to the diet on a case-by-case basis for the days surrounding chemotherapy to minimize side effects. The energy boost is impressive. Many are able to re-engage in sport or work at the same time as treatments while they were off.
What I observed from the introduction of the diet in my patients – (especially visible in patients a time without diet then after late introduction of the diet):
- better tolerance of conventional care: chemo, radio, with fewer side effects;
- a boost of energy;
- a better nutritional profile – in consultation I do not focus only on ketosis but on ketosis and on the improvement of nutritional status. Both are very compatible; I also take care to introduce antiangiogenic food or dietary supplements and maintain the pH;
- a more positive attitude, both because ketones bring a feeling of well-being, but also because following the diet makes them actors of care;
- a regression, stabilization or slow progression of the disease.
Can the ketogenic diet be followed alone, except treatment, in case of cancer diagnosis?
No. The diet can not be dissociated from conventional treatments. It’s the meeting of the two that works and I remind it to patients all the time. Many think to treat themselves just like that. I do not believe it at all. I see patients who arrive very weak, with severe undernutrition, due to a drastic fast that they initiated without having a sufficiently satisfactory nutritional state to support it, or diets based on juice and a total lack of treatment . Here it is difficult to trace their nutritional status.There are ” specialists ” who advocate alternative methods of care and encourage patients to stop conventional treatments and even to stop testing. This is very damaging. The long-term result is catastrophic, and it’s difficult then to convince patients to recover. I do not say that you have to accept everything with your eyes closed, but to reject everything is dangerous, and I see it. What is needed is to become informed, to question in order to understand the role of each therapeutic action put in place. Some say that being patient is a job. There is truth in there.Another point that I think is important to remember: do not put the ketogenic diet alone, because it must respect the needs of the organization, which differ from one person to another and can be modified in the context certain pathologies, especially cancer. Certain cancers such as breast, prostate, pancreatic head, liver, kidney for example also require adaptations.
So a ketogenic diet alone is not enough to stop the disease. It potentiates the chances of remission or in patients considered at the end of life, who no longer have any other treatment, with a short term announced by the oncologist, in some cases months or even a few years of extra life while remaining asymptomatic.
What are the side effects?
I continue to find that there is an exaggeration of the symptoms of allergy, chronic pain, during the setting in ketosis, but they disappear after. Definitively according to some patients. I did not manage to discuss this point with other practitioners. I have not found any studies that mention this. It’s just a feedback.
I have never seen in four years of treatment most of the side effects mentioned in a 2017 article . It seems to me that the problem in this article comes from a bad way of leading the diet but not from the diet itself
There are side effects during the first week of the diet, such as fatigue, nausea, vomiting, lack of energy, risk of hypoglycemia if physical activity is performed in parallel, the time that the cells change fuel, but not at the same time. beyond On the contrary, the diet then brings a boost of energy, even to the weakest. If the nausea persists, it is because the ketosis is too strong. It must be lowered. If the energy does not come back, it is not the diet that is involved, it is that there is something else behind: perhaps a loss of muscle mass, a liver tired by chemotherapy without help adequate supplementation…
For my part, I have never found calcium deficiency: the diet provides oilseeds, sardines, calcium water, vegetables and some even dairy products … The diet valuing fatty foods, fat soluble vitamin D is well present in the diet, and as for any other French, whatever its diet supplementation is prescribed in winter. In terms of bone mineral density, it should be noted that many patients take long-term corticosteroids that are not foreign to the problem – the same as for hormone therapy sometimes prescribed. The risk of deficiency (and not deficiency) in magnesium and potassium that can be induced at the beginning of the diet is offset by supplementation. There is no risk of dehydration if the patient does not remove salt from his diet. My patients are advised to monitor their urinary pH, and, in case of too much acidity, brought primarily by cancer metastasized in particular (and therefore that appears regardless of the diet), we make sure to increase the vegetables carrying basifying minerals , to make sure of lemon juice pressed with sodium bicarbonates / potassium. A nutritional supplement is eventually put in place that provides basifying minerals.
Gastrointestinal syndromes can occur especially if too much coconut oil is consumed and / or depending on the cooking techniques used (cooked or raw oil).They can also be related to the state of the flora and intestinal permeability… But all this can be corrected in consultation. It is not the diet that induces the condition but it reveals it.
Cholesterol problems are specific to how to lead the diet. Here too we can correct them if necessary by making sure to focus on vegetable fats.
If we take care of potassium intake, there are no kidney stones. I have rarely had patients with kidney stones. In fact, there are no more calculations with the ketogenic diet than with another diet if the diet is well framed.
Are there contraindications?
Very few patients can not follow the diet. It is sometimes said that patients with kidney, pancreas, liver, or serious diseases affecting other organs can not follow.Certainly, some of them can not if for example the head of the pancreas is affected and the bile ducts are obstructed, if there has been a recent duodenopancreatectomy, if there is kidney failure… ie if the body can not manufacture ketone bodies and can not eliminate them. But in other cases, even with a tumor affecting these organs or metastases, the practice of the diet is possible. This is determined on a case by case basis. Ketosis is not a pathological condition and will not stress the diseased organs.
Do patients lose weight when on a ketogenic diet?
At equal amounts of calories, between a conventional diet and a ketogenic diet, the weight does not vary in the same way. The more calories and fats you get, the less calories you get from carbohydrates, the more weight your ketogenic diet can cause. To maintain the weight, it is necessary to play on the distribution of these three macronutrients, which is done on a case by case basis, without hindering the ketosis. In reality, with the ketogenic diet, we do what we want on the weight, we can lose, we can maintain, or even take a patient. For this it must be followed because finding the right distribution is not easy for someone who does not master the scheme.
But is not it dangerous to lose weight when you have a diagnosis of cancer?
The greatest confusion reigns on this point. What should alert is not weight loss but loss of muscle mass. Fat mass does not enhance resistance to the disease. I have often heard my patients say ” the dietician, the nurse, the oncologist… told me that I had to get fat, otherwise I will not stay, for that I have to eat, and especially what It’s a mistake. Eating anything, in any quantity can make you gain weight but by increasing fat and not muscle mass, which can promote cancer. In the end, patients are weakened. With this type of reasoning, some obese patients are considered to be able to withstand the disease, treatments, while behind this obesity lies a lack, a loss of muscle mass. This is called sarcopenic obesity. Muscle mass is very important. Losing muscle mass means being asthenic, also weakening immune cells and having less resistance to the disease. Cancer by itself is a catabolizing disease (promoting the loss of muscle mass). The ketogenic diet does not promote the loss of muscle mass. Systematically and for each of my patients, I assess their need for protein because they are the ones that maintain muscle mass, to maintain or increase their muscle mass. We check that everything is fine on this point by measuring the level of blood albumin. In the studies referenced in a recent article, most patients have framed their diet alone.One can easily imagine that they have made many mistakes. One of the most common mistakes is that many believe that 100 g of meat = 100 g of protein gold or 100 g of meat is on average 18-20 g of protein. This is just one mistake among others.
It is often reported that patients have difficulty following a long-term ketogenic diet
I am very surprised at the figures in the 2017 article on non-compliance with the scheme. I have been working almost exclusively with this diet for almost 4 years and the number of people who have not managed to follow it is counted on the fingers of one hand. After the first 15 days of the diet, patients usually tell me it’s not that hard. Many report taking pleasure even. Failure certainly comes either from a failure to take into account the habits / preferences of the patient by the professional who has framed the diet because any diet, not just ketogenic, that does not take into account the patient’s preferences is doomed to fail. It can also come from the fact that the patient did not know how to appropriate it. It must be said that it upsets so much the eating habits, both in terms of the choice of food and culinary techniques to implement, that some do not dare to diversify their diet for fear of getting out of ketosis and remain de facto on a diet monotone. It is then inevitably wearying. For example, when after a few months of diet, the patient is tired of eating fat, it is commonly decided to put a low-carb pose from a week to a month to better recover then.