Could ketogenic diet “starve” cancer? Emerging evidence

Abstract

Cancer cells (CCs) predominantly use aerobic glycolysis (Warburg effect) for their metabolism. This important characteristic of CCs represents a potential metabolic pathway to be targeted in the context of tumor treatment. Being this mechanism related to nutrient oxidation, dietary manipulation has been hypothesized as an important strategy during tumor treatment. Ketogenic diet (KD) is a dietary pattern characterized by high fat intake, moderate-to-low protein consumption, and very-low-carbohydrate intake (<50 g), which in cancer setting may target CCs metabolism, potentially influencing both tumor treatment and prognosis. Several mechanisms, far beyond the originally proposed inhibition of glucose/insulin signaling, can underpin the effectiveness of KD in cancer management, ranging from oxidative stress, mitochondrial metabolism, and inflammation. The role of a qualified Nutritionist is essential to reduce and manage the short and long-term complications of this dietary therapy, which must be personalized to the individual patient for the planning of tailored KD protocol in cancer patients. In the present review, we summarize the proposed antitumor mechanisms of KD, the application of KD in cancer patients with obesity and cachexia, and the preclinical and clinical evidence on KD therapy in cancer.

Keywords:

• Cachexia
• cancer
• diet
• ketogenic diet
• nutrition
• nutritionist
• obesity

Acknowledgments

Obesity Programs of nutrition, Education, Research and Assessment (OPERA) group members served as collaborators and approved the final version of the paper:Annamaria Colao, Carlo Alviggi, Sara Aprano, Rocco Barazzoni, Luigi Barrea, Francesco Beguinot, Annamaria Belfiore, Giuseppe Bellastella, Silvia Bettini, Giuseppe Bifulco, Maurizio Bifulco, Caterina Brasacchio, Filomena Bottiglieri, Luca Busetto, Brunella Capaldo, Massimiliano Caprio, Felipe Casanueva, Luigi Di Luigi, Andrea Di Nisio, Laura Di Renzo, Carolina Di Somma, Lorenzo Maria Donini, Katherine Esposito, Massimo Federici, Francesco Garifalos, Dario Giugliano, Lucio Gnessi, Gianluca Gortan Cappellari, Brunella Guida, Maria Angela Guzzardi, Daniela Laudisio, Andrea Lenzi, Alessia Liccardi, Carla Lubrano, Paolo Emidio Macchia, Silvia Magno, Paolo Marzullo, Davide Menafra, Silvia Migliaccio, Fabrizio Muratori, Giovanna Muscogiuri, Raffaele Napoli, Caterina Pelosini, Francesca Pivari, Rosario Pivonello, Eleonora Poggiogalle, Gabriella Pugliese, Gabriele Riccardi, Alberto Ritieni, Fiammetta Romano, Domenico Salvatore, Alessandro Sanduzzi, Ferruccio Santini, Silvia Savastano, Paolo Sbraccia, Giovanni Scambia Laura Soldati, Giovanni Spera, Maria Grazia Tarsitano, Dario Tuccinardi, Olga Vaccaro, Mary Venneri, Samir Sukkar, Roberto Vettor.

Declaration of interest

The authors have nothing to disclose.

Funding

This article is published as part of a supplement funded by the scientific assistance of Panta Rei Impresa Sociale srl (https://www.panta-rei.eu/pantarei/).