I’ve written a boatload of articles about cancer on this website. Admittedly, my interest is mainly based on the incredible harm done to people by fake cancer treatments, but others, like Science Based Medicine and the estimable Orac are experts in cancer, so I’ve just limited myself to sniping from the sidelines, like debunking the nonsense about weed cures cancer. But then I saw someone post a link to some pseudoscience about starving cancer. I just had to take a look.
I have a rule about cancer science. Anyone who oversimplifies prevention, development or treatment of cancer shall be treated with disdain unless it meets the standard of “extraordinary claims demand extraordinary evidence.” If you’re going to tell me that blueberry-kale shakes™ prevent cancer, I want overwhelming evidence in the form of meta-reviews.
Why am I such an aggressive skeptic about cancer? Because, if someone says “starving cancer is better than chemotherapy,” well that means some gullible person will take that advice and forgo more aggressive, and frankly more evidence based, treatments. And that patient could die, relying upon junk medicine.
Furthermore, I need to keep reminding my readers – and various people who push this nonsense – that there are approximately 100 to over 200 different cancers– the variation in numbers is a result of different definitions. Each of those cancers have a different etiology, pathophysiology, and treatment strategy. Starving cancer may actually be a brilliant idea – some research is involved in cutting off the blood flow to cancers. But that’s at a very localized level, and changing your diet will have approximately zero effect
On the other hand, I guess you could starve a cancer by starving one’s self. But I don’t think there would be a good prognosis and outcome for the patient.
Let’s take a look at the pseudoscience of starving cancer.
Starving cancer – what is it
This whole area of cancer research can be laid at the feet of Nobel laureate Otto Warburg, a controversial Nazi sympathizer who happened to be half-Jewish. He was protected by Hitler, despite most of his Jewish colleagues being rounded up and murdered by the Nazis. That being said, he discovered one of the critical cellular processes, respiration.
In this case, cellular respiration contains the metabolic reactions and processes within cells that convert biochemical energy (like glucose) from nutrients into adenosine triphosphate (the basic energy source for the cell) and waste products. This fundamental understanding of the biochemistry of the cell is taught to biology students all over the world. His discovery of cellular respiration is certainly a critical one to our understanding of cellular physiology.
Prior to working for the Nazis, Warburg observed that most cancer cells produced energy by a high rate of glycolysis – glucose metabolism – in the absence of oxygen. Normal cells have a low rate of glycolysis while consuming oxygen. In general, rapidly growing tumor cells have glycolysis rates that are 200X higher than normal cells, even if oxygen is present, where the normal metabolic process, oxidative phosphorylation, could be supported.
(Note, I’m not trying to go Godwin here, I have a problem with someone who accepts protection from Nazis, while those same Nazis are carrying his close friends and colleagues to concentration camps. Nevertheless, the reputation of his science is based on evidence, not his Nazi sympathies.)
In oncology, the “Warburg hypothesis” states that this change in metabolism is the fundamental cause of cancer. This hypothesis was eventually replaced by modern science – mutations in oncogenes and tumor suppressor genes (caused by viruses, environmental hazards, and random DNA errors) are responsible for malignant transformation. Warburg’s observations result from the mutations, and they are not the cause of cancer.
In his later years, Warburg doubled down on his “belief” that the driver of tumorigenesis is an insufficient cellular respiration caused by damage to mitochondria. There is simply no evidence that ever supported his belief that this caused cancer. He even invented a quote from Max Planck, a Nobel laureate in physics, that said “science progresses not because scientists change their minds, but rather because scientists attached to erroneous views die, and are replaced.” In fact, science progresses through evidence derived from the scientific method, not because someone whines that their unsupported ideas are not being accepted.
Despite my rather negative opinions of Warburg, his essential observations are the foundation of some areas of research in cancer treatment. No, the Warburg hypothesis has been roundly debunked, but only when looking at it as a “cause” of cancer. However, his data have been repeated many times, and there are bodies of research that use his fundamental research to develop drugs that can attack some cancer cells.
Unfortunately, there are quacks and woomeisters who have grabbed onto Warburg’s hypothesis and taken it in some illogical and pseudoscientific directions. Yeah, we are all shocked.
Starving cancer – ketogenic diet
As a result of Warburg’s research, some people came to believe that if you could cut off the supply of glucose and increase oxygen, you would cut off the energy requirements of the tumor cell. This kind of makes sense, but remember, this is not the cause of cancer.
Dr. David Gorski has written an detailed article about the ketogenic diet, so I’ll try to digest his gazillion words into just a few, hopefully, without destroying the essential points made by Gorski. Dr. Thomas Seyfried, a professor of biology at Boston College and a well published researcher, has said this about the ketogenic diet:
The low-carb, high-fat ketogenic diet can replace chemotherapy and radiation for even the deadliest of cancers, said Dr. Thomas Seyfried, a leading cancer researcher and professor at Boston College.
In an exclusive interview, Dr. Seyfried discussed why the ketogenic diet has not been embraced by the medical community to treat cancer despite its proven track record both clinically and anecdotally.
“The reason why the ketogenic diet is not being prescribed to treat cancer is purely economical,” said Dr. Seyfried, author of Cancer as a Metabolic Disease. “Cancer is big business. There are more people making a living off cancer than there are dying of it.”
In other words, Dr. Seyfried thinks that we can treat all cancers with a low carb diet, implying that carbohydrates and sugars feed cancers. Furthermore, he thinks that real oncologists, who depend upon science based medicine to make real choices on how to treat cancer, are just making money off of complex treatments instead of telling their patients to eat all the steak all the time.
Seyfried and I will both be there, along with a long list of other excellent speakers. There, you’ll learn more about how to implement a ketogenic diet and much more. I will also be speaking and attending the event and will share my absolute latest on how to use nutritional ketosis, many of which have never been previously presented.
So, is there any evidence that Seyfried is onto something, despite being in bed with Joe Mercola? Again, according to Dr. Gorski, not so much.
Much of Seyfried’s research has focused on murine (mouse) models. Research on rodents is an important start to any medical discovery, but less than 10% of these preclinical studies ever amount to anything clinical. And on the hierarchy of medical evidence, animal studies rank just above anecdotes. I’m much more strongly opposed to the value of murine research than Dr. Gorski is, but that’s because I’m much crankier.
However, there are some clinical studies upon which Seyfried relies. There are a couple of case studies, which, on the hierarchy of research is just above a murine study, that really aren’t that convincing. One case study had two patients, one of whom died from the cancer while on the ketogenic diet, while the other showed some decrease in glucose levels, but no efficacy was demonstrated.
There was also a retrospective study, that eventually only included 6 patients, which maybe showed safety but hardly any efficacy. If you’re going to make some huge argument that oncologists are ripping off patients by pushing expensive treatments, instead of a ketogenic diet, then you need to bring some extraordinary evidence. What Seyfried has brought is kind of weak, lame evidence.
Here’s what David Gorski said about Seyfried’s evidence:
Preclinical experiments are intriguing but fairly limited in applicability, and the case reports demonstrate nothing of the sort. There’s more to Dr. Seyfried’s hypothesis, for example, his idea that metastatic cancer comes about because of alterations in glutamine metabolism, but unfortunately he appears to misunderstand the genetics of metastasis when he bases part of his conclusion on observations that metastatic cancers often have the same genetic derangements as the primary tumor.
It’s been a longstanding question whether clones of tumor cells possess the ability to metastasize as an intrinsic part of the process of becoming cancer cells or whether they acquire it later. Given that evolution is a major force driving cancer cells to become more invasive and that tumors are very heterogeneous, full of lots of different clones with different sets of genetic mutations, Dr. Seyfried’s hypothesis is at best simplistic. Also disappointingly, the evidence for any diet as a treatment for cancer is weak at best.
Ketogenic diets aren’t the only direction that Warburg’s ideas have pushed some researchers. There’s more.
Starving cancer – increase alkalinity
Some quacks have pushed the idea that because cancer’s reliance on glycolysis, which causes a localized acidic environment, you can kill the cancer with a more alkaline diet. This myth has been demolished several times, but let’s just hit the highlights:
- There is no evidence that the acidic environment is either causal to the cancer or promotes its growth. It’s merely a consequence of the metabolic process of cancer cells.
- Even if you could limit the growth of the cancer cells by neutralizing the acidic environment, that would take a locally targeted therapy, not a diet change.
The pH of blood runs about 7.34–7.45 in healthy human beings. It’s slightly alkaline (very slightly), and controlled in a very narrow range. The balance between the acid and base of human blood is called acid-base homeostasis.
Essentially, the acid-base balance is tightly regulated by chemical buffers in the blood, the lungs, and the kidneys. These organs work together in a very complex manner, with numerous feedback loops, to maintain the blood pH. For example, the lungs can expel more or less carbon dioxide to produce or reduce bicarbonate, which buffers acids. The kidneys help in the same process.
In other words, the blood is already slightly alkaline, and short of some major metabolic condition, such as diabetic ketoacidosis, which causes the pH of the blood to drop to around 7.1, as a result of uncontrolled blood sugars. Even that small of a change can cause a coma and death.
If you tried to change the pH of your blood by consuming enormous quantities of an alkaline, like sodium bicarbonate, you’d simply fail. First, sodium bicarbonate is toxic at high doses (it is a very safe compound, but as we’ve mentioned here before, dose makes the poison). For a normal 65 kg adult, 30 gm of baking soda can cause serious health problems, as a result of the excess sodium and gases released when the baking soda hits the acidic environment of the stomach.
You just cannot change your diet enough to make your blood more alkaline, because your body has enormous control over the blood chemistry.
Removing sugar and adding more steaks to y our diet is not going to materially affect your blood pH. And even if it did, it probably would not have any effect on the microenvironment of the cancer. And even if you could change that, there is no evidence that a more alkaline environment would harm a cancer.
I just don’t get why seemingly intelligent human beings try to oversimplify the utterly complex human body. We have evolved, over millions of years, to interact with our environment without fundamentally destroying ourselves. Our proteins, enzymes, cellular structures, everything evolved to be the most efficient at a certain pH. To move that pH, even if you could, has only one consequence – death.
Wrapping this up
If you’re a regular reader of mine, you know I repeat a mantra over and over – there are only a handful of scientifically sound methods to potentially lower your risk of cancer. Quit smoking is near the top. Stay out of the sun. Maintain a healthy (that is, very low) weight. Don’t drink alcohol. Get exercise. And a handful more.
And even if you do all of them, you just reduce your absolute risk, not completely eliminate it. You could randomly get a set of mutations – there are several trillion cells in the body, and even if genetic copying in cell division or transcription were 99.999% perfect, it still leaves millions of chances of mutations – that lead to cancer.
Starving cancer may become a major research effort in science, but not by some meta activity, like stopping eating sugar. It will work because some scientist will figure out a drug that targets the cancer cells, blocks glucose transport across the cell membrane, thereby starving those cells.
But that results from real science, real research, and real clinical trials. Not pseudoscience and junk medicine.
People want the easy way for medicine. They don’t want to listen to an oncologist that describes a set of treatments that will make you lose your hair and throw up several times a day. And then hear that the chances of success may be 25% or 75% depending on which of the 200 cancers you contract, where it is located, and how early it was caught.
The junk medicine pushers tell you “eat steak, guaranteed to kill cancer.” Of course, most of the evidence says a high fat, high meat diet may lead to a slightly higher risk of cancer. So there’s that.
- Bertram JS. The molecular biology of cancer. Mol Aspects Med. 2000 Dec;21(6):167-223. Review. PubMed PMID: 11173079.
- Brand RA. Biographical sketch: Otto Heinrich Warburg, PhD, MD. Clin Orthop Relat Res. 2010 Nov;468(11):2831-2. doi: 10.1007/s11999-010-1533-z. PubMed PMID: 20737302; PubMed Central PMCID: PMC2947689.
- Champ CE, Palmer JD, Volek JS, Werner-Wasik M, Andrews DW, Evans JJ, Glass J, Kim L, Shi W. Targeting metabolism with a ketogenic diet during the treatment of glioblastoma multiforme. J Neurooncol. 2014 Mar;117(1):125-31. doi: 10.1007/s11060-014-1362-0. Epub 2014 Jan 19. PubMed PMID: 24442482.