Revisiting the Warburg Effect: Diet-Based Strategies for Cancer Prevention

Table 3

Clinical studies with CR/KD in cancer patients.

Cancer	Study group	Diet	Outcome	References
Malignant astrocytoma tumors	2	(8 wks)	↓PET, 1 patient alive at 4 years and 1 at 10 years	[73]
A partial gastrectomy and total colectomy for familial adenomatous polyposis	1	Parenteral nutrition 28 kcal/kg/d carbohydrates 45 g (5 months)	Treatment well tolerated	[91]
Mix: breast, lung, prostate, ovary…	10	CR (20-140 h pretherapy) (8-56 h posttherapy)	Low chemotherapy side effects	[92]
Glioblastoma	1	Patient conducted water-only therapeutic fasting and a restricted 4 : 1 (fat : carbohydrate+protein) ketogenic diet that delivered about 600 kcal/day	Complete response with radio chemotherapy	[74]
Mix: ovarian, breast, thyroid…	16	KD (less than 70 g carbohydrates per day) 3-month intervention period	1/3 completed CR, 3/4 tolerated well, few side effects from CR	[75]
Mix: breast, lung, colorectum, ovary…	10	KD 17 kcal/kg/d (4 wks)	Level of ketosis (not weight loss) correlated with tumor response	[93]
Advanced stage	Pediatric patients	Medium chain triglyceride- (MCT-) based KD (60% MCT, 20% protein, 10% carbohydrate, and 10% other dietary fats)	Blood ketone levels increased 20- to 30-fold; blood glucose levels declined	[94]
Gastrointestinal tract	27	Parental feeding with lipid-based diet (80% of total caloric requirement were fat, 20% dextrose) or glucose-based diet (100% dextrose)	Number of replicating cells increased in average 32.2% in the glucose-based diet group and decreased by 24.3% in the lipid-based diet but the results were not statistically significant	[95]
Glioblastoma	20 patients with recurrent disease	KD (calories: 77% fat, 8% carbohydrates, and 15% protein) for 3–9 months in combination with temozolomide (TMZ) or chemoradiation	Four patients were alive at median follow-up of 14 months; one of the four patients was under carbohydrate-restricted KD (4.5% carbohydrates) post radiation and TMZ treatment and had no recurrence after 12 months from treatment; the other three had recurrence and started alternative chemotherapy treatments	[96]
Malignant disease	5 patients with severe weight loss	KD (70% MCT supplemented with β-hydroxybutyrate (BHB))	Increased body weight after 7 days (∼2 kg), presence of ketosis already after 24 h in association with a reduction of blood glucose, pyruvate, and lactate levels	[97]