5 Things You Should Know About Ketogenic Diets and Breast Cancer

Apr 21, 2019

I've never been a big fan of the so-called “diet”, instead, I'm more an advocate of balanced eating and moderation.  However, I also try to keep an open mind when I hear about new food trends.

As a health and fitness professional, I often read about nutrition trends in industry publications before they catch on to the general public. So, after reading several rave reviews about the health benefits of following a ketogenic diet, I thought it was time to look into this a little deeper.

What is a Ketogenic Diet?

There are two versions of a ketogenic diet. One is a low-carb, high-fat diet (LCHF)  which is similar to the Atkins diet. The other is a traditional ketogenic diet meaning 85% - 90% of its calories come from fat.

The Atkins diet, which is generally considered the original low carb, high fat diet, recommends 50% to 60% of calories come from fats versus the LCHF diet which recommends more than 75% of calories coming from fat sources.

Atkins also includes more protein than the ketogenic diet or LCHF diets which recommend keeping protein intake between 20-25% of total calorie intake and then adjusting it downward as needed for weight loss.

These diets are primarily concerned with controlling levels of insulin and glucose, and higher intake of protein can cause an insulin release.

One of the first resources that I was fortunate enough to come across when I began looking into the ketogenic diet was Dr. Dominic D’ Agostino.  a researcher in the field of ketogenic diets and their impact on cancer, among other things.

His website, www.ketonutrition.org is packed with tips and resources that can help you figure out if this diet is right for you and how to follow it.

History of the Ketogenic Diet

The ketogenic diet (keto diet) has been around since 1921, when it was discovered that this diet worked exceptionally well for children who suffered from epileptic seizures.

When these kids were put on a ketogenic diet, the majority of them completely recovered and stopped having seizures. After a period of time, this diet fell out of fashion as more pharmaceutical drugs were developed to control seizures, even though many of these drugs did not have the same success rate that the ketogenic diet did.

The keto diet was resurrected for the treatment of epilepsy in the 1990s when James Abrahams, the writer of several popular movies including Airplane, The Naked Gun, and Scary Movie Four, was searching for help for his young son, Charlie, who had severe epilepsy.

His search lead him to Johns Hopkins where he became acquainted with a dietitian who recommended the ketogenic diet for Charlie. 

Even though all the drug therapies Charlie had been subjected to in the short span of his 11-month life had failed to manage his condition, the ketogenic diet succeeded. 

Eating this way allowed Charlie to get off of the drugs he was taking to manage his seizures, recover from epilepsy and live a normal life. This was in stark contrast to  his original prognosis that he would live a life filled with seizures which would result in progressive mental retardation.

James was amazed at the results of the ketogenic diet and passionate about getting information about it to other parents that were in his situation. He started the Charlie Foundation to spread the word and educate other people who desperately needed help for their epilepsy or for their epileptic children. He also wrote, directed and produced the 1997 movie, “First Do No Harm” featuring Meryl Streep. The story of an epileptic child whose life was changed by the ketogenic diet.

Since starting the Charlie Foundation, the ketogenic diet has been found to benefit many other conditions including Parkinson's disease, ALS, cancer, Autism, Traumatic brain injury, and type two diabetes.

As a result, the name of the foundation has been changed to the Charlie Foundation for Ketogenic Therapies in an effort to continue to promote the studies and trials of the ketogenic diet across the spectrum of these diseases. I highly recommend checking out their very informative website for information, dietary plans and recipes.

5 Ways Ketogenic Diets Benefit Breast Cancer Survivors

1. Cancer cells need glucose to grow and survive
In 1923, near the time the benefits of the ketogenic diet were discovered for epilepsy, a German biochemist named Otto Warburg, publicly stated his hypothesis that cancer was a metabolic disease. Meaning the root cause of cancer is something gone wrong in the body rather than being caused by genetics, which was the accepted theory at that time.

What Warburg discovered was that cancer cells used a different way of creating or accessing energy than normal cells. Cancer cells use a process called cellular fermentation even if there is oxygen present for them to use, which is what healthy cells would go to first.

Fermentation requires glucose or blood sugar to be present. In fact when cancer cells do not have access to glucose they often die. This process of cancer dying in the absence of glucose to this day is called the Warburg effect.

We all know that chronically high blood sugar is something we want to avoid, however when blood sugar gets very low, our body can use stored fat to make ketones which can be used for energy instead.

When ketones are the primary source of energy rather than glucose we are said to be in ketosis. (A very different state than ketoacidosis, a potentially dangerous condition associated with type 2 diabetes.)

When a person is in ketoacidosis their system has become very acidic. They begin producing ketones, but just as their body has become resistant to insulin and is not able to correctly use blood glucose for energy, the energy from the ketone bodies is also not being used properly.

These ketones build up in the blood, get filtered out by the kidneys and are found in the urine.

Another situation in which your body produces ketones for energy is when you're in a fasted state. At this time your body accesses your stored fat and your liver makes ketone bodies for energy.

2. LCHF/ Ketogenic diets keep glucose low and reduce insulin response.

Following a ketogenic diet helps to keep blood sugar and insulin levels low in the body. This benefits cancer patients and survivors because cancer cells cannot use ketone bodies to create energy, to live, or to multiply.

When our bodies make ketones and we use them for energy rather than glucose, studies show that cancer cells don't have the food necessary to grow and multiply. In a situation where people are currently being treated for cancer, this can be a supportive therapy for chemotherapy or radiation. In fact, tremendous success is being found using both fasting and a ketogenic diet while patients are in treatment.

Dr. Jason Fung, Author of the “Obesity Code unlocking the secrets of Weight Loss”, is a kidney specialist in Canada, and an advocate of bot the ketogenic diet, and intermittent fasting. Dr. Fung talks about how important it is to keep the insulin response low so that our bodies don't become insulin resistant which leads to having chronic high blood sugar.

Insulin also encourages fat storage, it’s basic function is to store energy in the body. The more carbohydrates we eat, the higher our blood sugar goes, the more insulin we secrete, and the fatter we get.

Additionally, the higher our blood sugar is, the more fuel there is just floating around in our body ready to be picked up by cancer cells.

3. LCHF/ Ketogenic diets reduce metabolic syndrome and risk of diabetes.

Metabolic syndrome is a cluster of conditions that increase your chance of heart disease and your risk of becoming a type II diabetic.

If you have at least three of the following conditions occurring at the same time, you have metabolic syndrome:

  • A waist conference for females larger than 35 inches (89 cm), or for men, greater than 40 inches (102 cm)
  • Chronically high triglyceride levels
  • Low levels of high-density lipoprotein (HDL cholesterol)  Which is less than 40 mg/dL in men, and less than 50 mg/dL in women.
  • High blood pressure, consistently 130/85 or higher.
  • Fasting blood sugar greater than 100 mg/dL or higher.

On a ketogenic diet, studies have shown that all of these conditions are improved in most people. Additionally, most people experience a decrease in waist circumference pretty quickly after following a ketogenic diet. 

This is significant for more than just your favorite bathing suit. Abdominal fat is the most dangerous place to carry extra body fat when it comes to increasing your risk of disease. (It’s also the first place that body fat loves to accumulate after menopause.)

4. LCHF/ Ketogenic diets reduce cravings and hunger.
There's an ongoing debate as to whether people lose weight on a ketogenic diet because they eat less, or because they metabolize fat differently than carbohydrates (maybe both).

In my experience and the experiences of those around me, the high amount of fat in the diet leaves you feeling so satisfied that you really do eat less.

You don’t constantly feel the need to graze throughout the day. As you become more adapted to eating this way you begin to  lose the cravings for sugar and sweets.

5. LCHF/ Ketogenic diets Improve Brain Function.
For cancer survivors who underwent chemotherapy as a part of their treatment, chemobrain is no joke. The American Cancer Society (ACS) states on their website that even though the direct cause of chemo brain is uncertain, the results are real and can include:

  • Memory lapses
  • Trouble concentrating
  • Trouble remembering details
  • Trouble multitasking
  • Feeling disorganized, slowed thinking and processing of information
  • Trouble remembering common words or difficulty completing a sentence

ACS also states that these symptoms can last for months to years after treatment.

Although I didn’t find any research on a ketogenic diet specific to chemo brain, I did discover other studies on ketogenic diets and cognitive impairments including one study, published in March 2016 by the Annals of the New York Academy of Sciences.

This report said that part of the problem in Alzheimer's disease is the brain’s lack of ability to properly use glucose as fuel. However, this report states that “...clinical trials have shown increasing ketone availability to the brain through nutritional ketosis has a beneficial effect on cognitive outcomes in Alzheimer's disease and other cognitive impairments.”

How to start a Ketogenic diet

A traditional ketogenic diet, also called a strict ketogenic diet, has a 4 to 1 ratio of fat calories to other calories, meaning fat provides four times more of your calories than carbohydrates and protein combined.

You can imagine that it's challenging for some people to cut carbohydrates back that low, but also to increase fat by that much.

Another option is a moderate ketogenic diet which keeps the carbohydrate intake around 50g per day rather than the strict version where carb intake should be 20g or lower.

If you’re not one for calculating percentages, there are several online tools that can assist you in creating a ketogenic food plan. One that is particularly simple and yet thorough is called the Keto diet buddy.

Just enter your height, weight, age, gender and this website will calculate your goals at a maintenance level, for a moderate calorie deficit, and for a large calorie deficit.  Keto diet buddy also has an app that you can put on your phone.

My Fitness Pal also shows your macronutrient intake in a little pie chart which makes it easier to balance your food intake. I recommend finding a tool that's easy for you to understand and use. There are lots of resources out there and new ones are popping up all the time as this diet becomes more well-known.

Considering a ketogenic food plan could cause a bit of panic in some because it means going through the emotional struggle of detaching from sugar.

It’s important to understand that a ketogenic diet is not something you do halfway. You can't take in large amounts of fat, carbohydrates and sugar at the same time and expect positive results. A ketogenic diet is something you have to commit to at least for a few weeks.

Once your body adapts to eating this way, you can have a treat now and then, (if you still have a desire for it.) but you have to cut out the sugar when you increase the fat.

Simple steps to getting started:

1. Eat Whole Foods- One of the first steps you have to take in beginning a ketogenic plan is to get the processed food out of the house. If food comes in boxes or bags when it shouldn't, it has had things added to it to keep it preserved and fresh for a longer period of time than it would be in its natural state.

You'll also find hidden sugars in sausages, sauces, salad dressings and other places that you might not expect so check labels for high fructose corn syrup, cane sugar, maltose, dextrose or sugar by any other name and steer clear of those products. This includes eating processed or fake low carb foods. Focus on eating vegetables, meats, cheese, dairy products, eggs, nuts, and other natural foods.

We have vilified the word carbohydrate so much that whenever we say it, people think of bread, donuts, cookies and that’s not always the case. Fruits, vegetables, beans and legumes are carbohydrate foods but they're also rich in phytonutrients, vitamins, minerals, and fiber.

So, don't be afraid of fruits and vegetables because they’re carbohydrates just be mindful of  how sensitive your body is to any or all carbohydrates

2. Don’t fear fat- We have been programmed to fear fat that, so even when we are given free rein to consume it we struggle to get our mind around the fact that it's OK to eat. A ketogenic diet is not a high-protein diet, which is the first thing people tend to go to.  It's a moderate protein diet meaning, your protein intake should be between 20% and 25% of your total calorie intake.

I'll give you an example of this. The other night while having dinner with my sister, who is trying to follow a ketogenic diet and I was showing her how to calculate her nutrients in the Myfitnesspal app. When we saw that her fat intake was below 60% she was a little surprised, but as we reviewed what she had been eating, a lot of the foods were much higher in protein than fat.

She was ordering a ribeye steak and a side of vegetables for dinner, so I had her order an extra side of drawn butter and some blue cheese crumbles to put on top of those veggies and that steak. Sounds delicious right? It was!

So slather on the butter and don't be afraid of cheese. Obviously, if you're lactose intolerant you’ll work around the dairy and if you're vegan you have many beautiful oils to choose from as well.

3. Get a cookbook or sign up for a website that's focused on a ketogenic diet- It's a very simple diet to follow, but make sure you have an understanding of how it works. Many people see quick weight loss when starting a ketogenic diet and then they plateau.

If that happens, it's important to know that you have options like drinking more water, reducing the amount of your protein intake, exercising a little more, and maybe adding more fat. The Dietdoctor.com is a fantastic resource. This website is beautiful, simply laid out, and contains interviews with physicians and specialists that can answer and address all of the concerns that you might have about eating a high-fat low-carb diet. It has delicious recipes, and the ability to customize meal plans.

4. Be aware of the Keto flu- A common experience people have when they're transitioning from using glucose to using ketones as their primary source of fuel in the body is called keto flu.  Common symptoms can include leg cramps, fatigue, constipation and lack of endurance.

I personally experienced a challenge in getting through my workouts for about two weeks, and then surprisingly I showed up in the gym one day and felt like wonder woman. That’s when I knew that I had made it past the adaptation point. So be patient with this way of eating, and consider, being more gentle with yourself for the first couple of weeks as you're adapting.

Instead of intense workouts, take some walks, do some restorative yoga and give your body time to adjust as you eliminate refined carbohydrates from your diet. You may notice that your body flushes fluid very rapidly and you have to pee a lot!  Keto flu symptoms can be related to this loss of fluid and can often be remedied by becoming more hydrated, adding salt to your food, or drinking sugar-free electrolyte beverages.

5. Find a community or a buddy for support.- I highly encourage you to find somebody to begin this new lifestyle with. If you have children or a partner at home that will support you in this, do it together. It's fun to experience the results and try out the new delicious foods together. Having support can make the whole transition a lot easier and help you stick to the ketogenic lifestyle when you're at home or even when you're out.

Be patient with yourself

Remember, we are all different and going through cancer treatment affects our DNA and the way that we respond to many different things. So be patient with yourself. At the end of the day, the priority for any nutrition plan is to support and improve your health. If you also have a weight loss goal, allow that to happen as a pleasant side effect to your overall healthy lifestyle.

Let Your Lifestyle be Your Medicine,

Listen to The Breast Cancer Recovery Coach Podcast for more insights on creating a healthy life after breast cancer

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