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Dear Friends,

We have just had our third meeting of the book study groups, reading The Metabolic Approach to Cancer, by Nasha Winters, ND. We discussed Chapter 4, which promotes the ketogenic diet. I asked Dr. Winters for clarification on her recommendations and whether her thinking about it has changed since she published the book 2 years ago.

According to Wikipedia, the Ketogenic Diet is a high-fat, adequate-protein, low-carbohydrate diet that in medicine is used primarily to treat difficult-to-control epilepsy in children. The diet forces the body to burn fats rather than carbohydrates.

Here is a summary of Dr. Winters' response:

There are currently 27 studies in the US alone on Ketogenic Diet for cancer, and many more worldwide. A paper just came out last week reviewing all data and showing it is a powerful tool as adjunct to many cancer therapies. No diet is a stand-alone treatment for cancer. All research indicates that patients who are metabolically flexible have better outcomes.

Metabolic flexibility means your body can create energy from either carbohydrates or ketones (from fats). There are multiple ways to approach this. Ketogenic diet (80-90% fat / 10-15% protein / 0-5% carbs) is one way. Another way is just eating low carb and including some low key intermittent fasting such as 13 hours/day (lowers recurrence rates in breast cancer patients per MD Anderson studies—and doesn't even take into account what they were eating! Just narrowed their eating window and lowered recurrence by 70%!).

Another way is more focused restricted eating windows (16 hours fasting / 8 hours eating for instance) even up to a few times per week at most. And of course, longer fasting, per Valter Longo's work. ALL of us should be what we call "low carb." In Western worlds, up until the1850's, we were all "low carb" with only 30% of our calories coming from carbs, whereas today, it's closer to 70-80% of our calories.

We are naturally meant to wake in some level of ketosis when fat adapted/metabolically flexible, after a 13 hour or more fast. The current stats show that less than 12% of all Americans are metabolically flexible. I have yet to meet a cancer patient who is metabolically flexible without doing some focused work ― like a therapeutic ketogenic diet, to restore that function, and then maintain with a balanced lifestyle thereafter.

When we are using the Ketogenic Diet as a therapy — like chemo or IV Vitamin C, we then use the 85/10/5 approach, most often along with standard of care or other oxidative stress therapies to apply pressure to the system and increase apoptosis while up-regulating mitochondrial number and function.

The other thing you have to remember is to test, assess, and address OFTEN, understanding that things change and our needs change. Not to acknowledge that our needs change is dangerous with any medication, supplement, diet, or other interventional therapy.

I have tons of podcast interviews on the media page on my website (https://www.drnasha.com/media/). I speak more to the fact (as the book discusses and my interviews discuss) that the goal is metabolic flexibility, in whatever way that it takes to get there . . . which may or may not include a very high fat, very low carb, low to moderate protein diet.

We have to be careful not to only focus on the tumor, but rather pay close attention to the terrain. The terrain is where our healing needs to happen. That is why there is no one diet or supplement or drug to impact this. And, it is why it is a moving target that constantly needs assessing and addressing.