The metabolic model of cancer has to be one of the most exciting areas of research these days. Australian orthopaedic surgeon Dr Gary Fettke is making it his life’s work to spread the news.
What does an orthopaedic surgeon know about oncology? Lots, as it turns out.
Fettke is a senior lecturer at the University of Tasmania, and does research into diet to treat diabetes, obesity and cancer. He is also a cancer survivor. Here’s a summary of a fascinating presentation Fettke gave to the low-carb summit in Cape Town in 2015. He titled it: So you think you need sugar? Your cancer needs it even more! – Marika Sboros
By Gary Fettke
If you have cancer, here’s what you definitely want to avoid:
sugar and carbohydrates. You also need to eat the right amount of healthy fats. You need to eat real food that is local and seasonal. Combine this with conventional cancer treatments and you’ll have a new way to treat and theoretically prevent cancer.
And never underestimate the power of hope. It’s about taking back control.
Cancer rates are rising worldwide and prognosis is getting poorer. We never used to see cancers in traditional societies, such as the Inuit and the people of New Guinea. Now we do.
Estimates are that there will be a 70% increase in cancers over the next 20 years especially in developing nations; there is already a 3% increase in children’s cancers per annum. One in two men and one in three women will develop cancer.
The genetic model doesn’t make sense. It raises the question: is cancer a problem of chromosomal damage as we’ve been taught? What if the chromosomal damage is just a marker, not the cause. What if the model is wrong, if we are doing things the wrong way when treating cancer? What if we have been going down the wrong road for 90 years?
This opens up a whole new way of managing cancer, based on a nutritional approach that is cheaper and doesn’t have the bad side effects of conventional treatment.
The most dangerous phrase in the English language is: “We’ve always done it this way.”
I blame the microscope for taking us on a detour over the last century. It distracted us. I call it the “Ancel Keys of the cancer world”. (Keys was an American scientist who spawned the largely discredited “diet-heart hypothesis” on which official dietary guidelines are based.
British obesity researcher Zoe Harcombe has shown in a study published in the BMJ Open Heart in February 2015, that these guidelines were without much science to recommend them when they were introduced in the US in 1977.)
The microscope gave us cholesterol plaques to blame for cardiovascular disease, but now we know that cholesterol is just a marker. Looking down the microscope revealed a variety of changes in chromosomes. The obvious thing was to see the chromosomes as the cause of cancer, but what if the chromosomal damage really is just a marker?
I don’t have all the answers. I just have a personal interest because I had cancer 15 years ago. My life and my family’s life changed completely that day I was diagnosed in 2000. All certainty washed away; we were struck with a sense of helplessness.
I did as the doctors told me. I had surgery, radiotherapy and chemotherapy. That’s fine because I am still here but there was no mention of nutrition – ever.
I just want us to consider the possibility that the primary problem is nothing to do with chromosomes; instead, it may be tied up with glucose metabolism – the idea that the chromosomal changes are what we see and have been blamed as the cause but in fact are just the effect.
This is not a new idea. It is based on the Warburg effect – the work of German physiologist, doctor and Nobel laureate Otto Warburg. It could lie in a message he has given us since 1924. That was when he first described aerobic glycolysis – a defect in mitochondrial glucose metabolism that causes fermentation of glucose and diverts glucose away from energy production to cell growth.
The problem with modern oncology is that it ignores the glucose metabolism. There is growing evidence to show that the future of cancer management is about how to use nutritional ketosis in management – starving cancer of glucose and insulin.
Nutritional ketosis is bad for cancer and protective of cells around cancer.
We also have not fully recognised the association of diet in the causation of cancer. The problem is sugar, particularly fructose, refined carbohydrates and polyunsaturated seed oils. The modern diet is inflammatory and it produces masses of oxygen free radicals.
Our current treatments are not benign either. Chemotherapy and radiation therapy rarely cause cancer but they certainly damage non-cancerous tissues.
If we are prepared to look at that common glucose pathway for cancer, we can consider a metabolic model that gives us the potential to starve cancer of the fuel it needs for growth.
The cancer cell isn’t interested in energy. It’s about growth. The metabolic model considers the building blocks for growth of malignant cells.
All cancers go wrong in the same way. The real problem is based around cellular energy – a diversion of glucose metabolism away from adenosine tri phosphate (ATP) production to the assembly of more cancer cells. The byproducts of this process are the likely cause of the secondary chromosomal damage.
The driving force behind all of the further damage is “oxygen free-radical” formation. The production and release of free radicals cause random DNA damage – the cause of chromosomal abnormalities.
We do know the source of the oxygen free radicals: inflammation. If we can unlock the key to what’s behind inflammation we may have a new model for treatment.
Our modern diet clearly plays a role. We have been on a fad diet (the low-fat, high-carb diet on which official dietary guidelines are still based) for the last 50 to 60 years, and definitely for the past 30 years.
The modern diet is inflammatory and produces a mass of oxygen free radicals. It has made us fatter and sicker.
Cancer gets it building materials by foul means or fair. Its cells don’t only require glucose. They require substrates – building materials that include protein, fatty acids, phosphate and acetate.
The Warburg effect describes how a cancer cell metabolises glucose. A diversion of glucose away from ATP production towards building cell and mitochondrial membranes (via the pentose phosphate pathway) and to that of DNA backbone (ribose 5 phosphate).
There is a significant up regulation of glucose on cancer cell membranes to aid this process. This altered glucose metabolism is what we see on the PET scan used in cancer diagnosis and monitoring.
The reverse Warburg effect describes how the other material required for cancerous growth is sourced locally. The local invasion of surrounding cells and specifically, fibroblasts is via the same glucose-dependent pathway of aerobic glycolysis. The release of oxygen free radicals produce hydrogen peroxide in tissue water and that is damaging to the surrounding cells and membranes. The subsequent cell death releases all the building materials that a malignant cell requires for growth, bar the glucose.
Ketogenic diets are very low in sugar and carbohydrates that are the food sources of glucose. Both provoke an insulin response. Reducing the consumption of glucose deprives cancer cells of fuel needed for growth as well as removing the stimulatory effect of insulin (and IGF-1).
A diet very low in carbohydrate and high in natural fats produces ketone bodies for energy. Ketones are a very efficient fuel source from healthy fat consumption that all cells in the body (apart from erythrocytes – red blood cells) can utilise, including the brain. In cancer patients, if you can switch over into nutritional ketosis then the cells surrounding a cancer are even more protected. That may have a profound effect when chemotherapy and radiotherapy are used.
Cancer cells need glucose to survive and metabolise glucose differently. It’s called aerobic glycolysis and it is the Warburg effect. These cells cannot metabolise ketone bodies. The ketogenic diet is one that protects surrounding cells but deprives cancerous cells of the fuel needed to survive.
There is some association evidence. Look at what the food industry has given us in the last 50 years and what we as consumers have demanded of the food industry. It is convenience food that is transportable, has a long shelf life, tastes sweet and is cheap. We are just as much to blame as the industry.
There is drug evidence:
- Aspirin – 43 randomised controlled trials showed 15% reduced cancer death, and 12% reduce non-vascular death.
- Metformin – trials have shown that it reduces overall cancer rates and mortality, a 31% reduction in cancer risk in diabetic patients, and near non-diabetic rate of cancer in diabetic women.
- Antioxidants – have multiple papers of varying quality show benefits of antioxidants and eating fresh food. Vitamins are all involved in modifying inflammation and oxidation.
- Vitamins also have multiple papers of varying quality, so it’s hard to draw definitive conclusions.
Based on history, we have epidemiological evidence on the effect of traditional eating habits in relation to cancer.
We can look at communities around the world that live to very old age with low cancer rates. Common factors are as much in what they don’t eat – processed foods – as what they do eat. They are also spiritual, have a sense of community, and low stress levels.
The real ‘miracle cures’
There is associative evidence for the metabolic model for management of cancer. Intervention evidence comes from 63 laboratory studies and limited human studies (small numbers), and miracle cures.
There are studies using calorie and carb restriction diets that are shown to reduce cancer. Ketogenic diets are shown to be more effective than just calorie restriction. Currently, there are 15 registered clinical trials looking at ketogenic diets in the management of cancer.
The modern diet is also inflammatory at a tissue level. Chronic inflammation is the underlying link to cancer. Inflammation produces masses of oxygen free radicals that are involved in the development and progression of all cancers.
The current amount and frequent consumption of sugar, particularly fructose, refined carbohydrates and polyunsaturated seed oils combine to give us that inflammatory model. That processed food combination is the source of the massive oxygen free radical onslaught that our bodies are exposed to.
This ultimately makes sense. It provides multiple points of intervention as we go forward. Options include cutting out sugar, reducing carbohydrate intake or avoiding polyunsaturated seed oils. We can also use antioxidants at multiple points in metabolic pathways or ….
We could simply do the lot by cutting out all processed foods.
New treatment options will direct treatment at causes of damage and not just chromosomal replication as in conventional treatment.
Nutritional ketosis is not an alternative to conventional chemotherapy and radiotherapy options. Doctors should consider it in every cancer patient to make it harder for cancer to grow. The aim is to make the local environment as inhospitable as possible and to protect surrounding tissues from cancer and from the treatment.
In 2000, I was feeding my tumour with a feast of sugar and kept encouraging its growth with insulin as a result of my diet. I had no concept of nutritional ketosis let alone skipping a meal or fasting.
I started researching and a few years ago, I changed to a ketogenic diet to “starve” my cancer, and make my tumour “allergic” to carbohydrates.
Since then, my weight has come down. My inflammatory markers have come down. My lipid profile is perfect despite my high-healthy-fat diet. If there is any tumour alive in me, it is having a “hungry” time and it’s not getting fed.
I have a vested interest. I have taken control of what I can. I am no longer the helpless victim of cancer.