Nutritional Manipulation as Mind-Body Therapy for Cancer

To the Editor:

Farooqui and colleagues describe a variety of mind-body therapies for patients with cancer. ¹ One such therapy that they did not mention is nutritional manipulation. Some forms of nutritional manipulation convey rational hope for remission or cure that can engage the placebo effect. ^2,3 Among these forms of manipulation, the simplest is a low-carbohydrate, high-fat diet popularized by Atkins. ⁴

Normal tissues are well oxygenated and can metabolize fats for energy. Solid tumors are hypoxic. ⁵ Because there are no anaerobic pathways for deriving energy from fat, tumor cells will starve on a ketogenic diet. Tumor cells need glucose and insulin for biomass synthesis in addition to energy. ⁶ Dietary depletion of carbohydrates, and the consequent hypoinsulinemia, therefore, will be selectively toxic to tumors. Gluconeogenesis will attempt to compensate for diet-induced hypoglycemia, but patients with cancer can inhibit gluconeogenesis, and thereby intensify stress on their tumor cells, by moderate consumption of alcohol. ^7,8 By convention, moderate alcohol consumption is defined as up to one drink per day for women and up to two drinks per day for men, wherein a drink is defined as 355 mL of beer, 148 mL of wine, or 44 mL of 80-proof liquor. ⁹

Diet-induced hypoglycemic ketosis is the essence of cachexia, which is the body's own response to advanced cancer. Just as moderate fever was once thought harmful and then discovered to be bactericidal, so too might cachexia, which is currently thought harmful, turn out to be tumoricidal. The low-carbohydrate, high-fat diet with moderate alcohol consumption is ideal for patients with cancer who have been declared terminal but who are not yet ready to embrace hospice and palliative care. It gives such patients a convenient, low-cost, relatively safe, and legitimate means to hope for remission or cure, while preparing, eventually, to embrace death.