Effects of dietary-induced ketosis on tumor metabolism, nutritional status, and quality of life in pediatric oncology patient

Brain tumors are known to utilize glucose as the primary fuel. Shifting energy metabolism from glucose to ketone bodies by use of a ketogenic diet, thus decreasing the availability of glucose to the tumor, could potentially inhibit tumor growth.;A six week study following three children with advanced stage cancer was conducted. Two subjects had Anaplastic Astrocytoma with different sites of origin. Patient #1, a 3 y.o. developmentally delayed girl, had spinal cord disease while Patient #2, a 8.5 y.o. girl, had cerebellar involvement. Patient #3, a 8.5 y.o. boy had Brain Stem Glioma. He was a study control and followed a regular diet.;A medium chain triglyceride (MCT) oil-based diet, consisting of 60% MCT oil, 20% Protein, 10% Carbohydrate and 10% Fat, was implemented to induce ketosis. The diet consisted of normal table foods and daily MCT oil shakes. Vitamin & mineral supplements were provided to meet safe and adequate ranges of the Recommended Dietary Allowances (RDA) for age and sex. Height, weight, dietary intake, and biochemical assays (blood and urine) for ketones, glucose, lipids, amino acids, insulin and glucagon were monitored. Tumor glucose consumption was measured by Positron Emission Tomography (PET) scan using (F-18) 2-Fluoro-2-deoxy-D-glucose (FDG) pre- and post-trial.;The diet was well tolerated by Patients #1 and #2. Initiation of the diet resulted in decline of blood glucose to low-normal levels. Blood ketones were elevated twenty to thirty fold. Weight and height remained stable. All blood values remained constant in Patient #3. PET data showed a decline in glucose uptake (22% in Patients #1 & #2, 41% in Patient #3), reflective of glucose metabolism, at the tumor site. The significant decline in glucose uptake by Patient #3 was attributed to chemotherapy and changes in steroid medication during the study. Patient #1 exhibited significant clinical improvements in mood and new skill development (gait, speech, hand coordination) during the study. She continued the ketogenic diet for an additional six months, remaining free of disease progression. Inducing a ketogenic state in oncology patients may be a useful adjunct to cancer treatment by affecting tumor glucose metabolism, while maintaining the patient's nutritional status.