Article on ketogenic dietary regimes for cancer highly misleading

Med Oncol (2017) 34:109 DOI 10.1007/s12032-017-0971-9 LETTER TO THE EDITOR Article on ketogenic dietary regimes for cancer highly misleading Ulrike Gonder1 Received: 24 April 2017 / Accepted: 25 April 2017  Springer Science+Business Media New York 2017 To the Editor, In their article ‘‘Systematic review: isocaloric ketogenic dietary regimes for cancer patients’’ [1], Erickson et al. summarized their view on the use of ketogenic diets for treating cancer patients which I find highly biased and containing an irritating number of mistakes. I fully agree with the critiques of Klement et al. [2], but as a nutritionist researcher and writer in this field, I would like to add some comments on the Erickson et al. paper which ignores a lot of research and the possible value of ketogenic diets. To counsel patients well and to prevent harm, nutritionists and dietitians are not only in need of evidencebased recommendations but also of good knowledge of the actual state of the scientific data (which eventually finds its way into guidelines and recommendations only after many years). They further need basic knowledge in nutrition and dieting to help patients find solutions for their problems and to guide them to follow their preferred way of eating as far as possible. There is already a lot of experience and knowledge about ketogenic diets in the treatment of obesity, cardiovascular risk factors, type 2 diabetes, epilepsy and emerging evidence for its usefulness, e.g. in cancer and dementia [3]. While more and more cancer patients wish to try a ketogenic diet and seek professional guidance to do so safely, unfortunately many nutritionists and dietitians are still not familiar with ketogenic diets and therefore vote to distract their clients from this way of eating. As a consequence, patients are at risk of making mistakes when self- & Ulrike Gonder mail@ugonder.de 1 Taunusblick 21, 65510 Huenstetten, Germany applying the diet without professional help. In this case, they might lose significant weight and get worse instead of better. The article of Erickson et al. further supports the notion that a ketogenic diet is dangerous for cancer patients, that the risk of side effects is high, and that it would be better to not try it before large RCTs have been done. This is simply incorrect as there is a lot of positive experience with ketogenic diets, e.g. in epilepsy [3, 4]. Erickson et al. have picked out the negative experiences which are mostly from earlier years and manageable today if the doctors and nutritionists or dietitians are well trained in this area. The long list of possible side effects which Erickson et al. wrote where ‘‘reported’’ side effects gives the impression they were often encountered by cancer patients trying the ketogenic diet. True is that most of those side effects stem from decades ago when much stricter ketogenic diets were applied to children and adolescents with intractable epilepsies. As Kossoff et al. [4, p. 161] stated even with these stricter diets: ‘‘we are at the point of preventing side effects before they happen’’. From personal experience, I know that many patients— cancer and other—urgently seek help in trying a ketogenic diet. Instead of informing them correctly about the state of the scientific exploration of this diet and instead of applying state-of-the-art nutritional knowledge which would allow to guide them safely eating this way the article of Erickson et al. will discourage more nutritionists and dietitians and will let them warn their clients and tell them to refrain from a ketogenic diet. As Klement et al. [2] have already pointed out in their letter, this is not based on scientific evidence and not on clinical or personal experience. To name just a few more irritating points from Erickson et al.: They use unusual wording (‘‘acid-forming fat’’), confuse the Warburg effect with the ‘‘Warburg hypothesis’’ 123 109 Page 2 of 2 (which are two different things), they give wrong numbers on the modified Atkins diet (it uses 10–20 g of carbohydrates [4], not 10% carbohydrates or ‘‘begin with 20 g daily and slowly increase…’’ as stated by Erickson et al.). They erroneously state that all ketogenic diets would be ‘‘nutritionally inadequate’’ which is simply wrong and speculate that common side effects of conventional cancer therapies (chemo and radiation) could be due to the ketogenic diet, an idea for which they can provide no reference. In summary, the Erickson et al. paper looks like the result of a highly biased and prejudiced view at the data. It would be of great help for the nutritionist and medical profession as well as for cancer patients to get an unbiased review of this important topic. Compliance with ethical standards Conflict of interest The author has received speaker’s honoraria from Swiss Medical Food, a company that developed and markets ketogenic meals as a medical food, and has written books about ketogenic diets. 123 Med Oncol (2017) 34:109 Ethical approval This article does not contain any studies with human participants or animals performed by any of the authors. Informed consent Informed consent was obtained from all individual participants included in the study. References 1. Erickson N, Boscheri A, Linke B, Huebner J. Systematic review: isocaloric ketogenic dietary regimes for cancer patients. Med Oncol. 2017;34:72. 2. Klement RJ, Feinman RD, Gross EC, Champ CE, D’Agostino DP, Fine EJ, et al. Need for new review of article on ketogenic dietary regimes for cancer patients. Med Oncol. 2017;34:108. doi:10. 1007/s12032-017-0968-4. 3. Paoli A, Rubini A, Volek JS, Grimaldi KA. Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. Eur J Clin Nutr. 2013;67:789–96. 4. Kossoff EH, Freeman JM, Turner Z, Rubenstein JE. Ketogenic diets. Treatments for epilepsy and other disorders. New York: Demos Health; 2011.