The Truth About... That Low Carb Diet. Is Keto Really the Cure?

0:00 Welcome to episode 32 of the cancer pod. In this episode, we talk about that low carb diet, you know, the one everybody's talking. Where did it come from? What is it good for? Can it help cancer patients stick around to find out these answers in more, um, Dr. Tina Kaeser and his lay likes to say, I'm the science one. I'm Dr. Lee Sherman and I'm the cancer insider, and we're to naturopathic doctors who practice integrative cancer care, but we're not your doctors. This is for education, entertainment, and informational purposes only do not apply any of this information. Without first speaking to you. The views and opinions expressed on this podcast by the hosts and their guests are solely their own.

0:44 Welcome to the counselor pod. Hey Tina. Hey Leah. So we've got a new series pod series. Yeah. Yeah. Kind of straighten things out a little. Maybe talk about some, not so convenient truths out there. Yeah. So there are things that patients, you know, they hear from other people you've got to take this, you've got to do this. You've got to not eat this because it's good for cancer cancer in general.

1:24 And so we're going to take a look at whether it's a, a supplement or a diet or just some sort of recommendation. And we're going to kind of break it down and see, is this the cancer cure hall, right. That it's claimed. Exactly. And we're gonna start today with the ketogenic diet, which I think a lot of people get recommended to them by well-meaning loved ones, ketosis, ketosis. That's what we're talking about today, where the question is is, is ketosis. Truth about ketosis, actually the truth about the ketogenic diet. It's confusing because there's so many sources. So even if you're just sticking to the medical literature, it can be confusing.

2:05 So yeah. Add some, uh, Dr. Google in there. Whatever your search engine is, and it gets confusing quickly. Yeah. I had to do a lot of research for this, cause I don't really talk diet with my patients because we have dieticians. So I was just kind of looking to see if there was anything new. And I noticed I did a search in my. Inbox on Quito. And it seems to be like, kind of a, like, even a bigger thing in the medical newsletter world. Like there's a lot of information that is out there now. So I think it's even becoming more confusing. Yes. And you know what? I'll admit to something. I do not read anything, but the medical literature on ketogenic diet.

2:47 'cause, I don't want to confuse myself. I don't want the onslaught of, you know, public facing health information because a lot of that is put out by industry or by interested supplement companies that might skew the information. And so I stick to ketogenic diet in the realm of cancer care specifically. So I just stick to the reliable stuff, knowing that if I read it, then I read it from a reliable source that way. And the cancer part of it is, I mean, relatively new because. Initially, it was used as a treatment in the early 1920s for epilepsy. And they used it before the drugs ever were invented. I mean, they didn't know the drugs were going to be invented, but this was the, this was the standard treatment until anti-epileptic drugs were created.

3:33 And then it kind of fell out with popularity until. Yeah, it fell out of favor because phenobarbital, I think was the first or something of the sort was one of the first anti-seizure medications. And then there were some children, especially with epilepsy. Didn't have controlled seizures with the drugs and my recollection, although I don't know if I can find this again, 20 years ago. I remember reading and I think it was through the Charlie foundation, which is a foundation that was founded on promoting the ketogenic diet for epilepsy specifically. I remember in their materials a long time ago during my residency, when I was reading it, that there was a nurse.

4:14 Johns Hopkins that remembered the old ketogenic diet protocol. And she kind of was the, the one practitioner keeping it alive. And the whole Charlie foundation there's in there a movie based on that story too. Okay. For anyone who's interested, but yeah, there there's a movie based on the story of. The little boy. Yeah. Whose name was Charlie? And he had seizures that couldn't be controlled with medications and had seizure control with a ketogenic diet. And then the foundation was founded with the mission of bringing that to children, with epilepsy who needed to have seizure control. So through that we know a lot about the ketogenic diet. So one it's been used for a very long time. So we have lots of information on it.

4:54 It is used safely and can be used safely with guidance, professional guidance. So that that's a lot of evidence just right there to say, okay, this is not just fly by night. We didn't just make it up. You know, in the last 20 years, even though it is popular, like you go to the grocery store and you see things like keto donuts and keto bread, like all of that kind of stuff. Like it's kind of, I don't want to say jump the shark, but it's kind of jumped the shark. Yeah. We need our own term and natural medicine for when things do that. As jumping the sharks based on that happy days episode where Fonzie goes over to the sharks. Yeah. He literally jumps the shark. Yeah. Yeah. But that's kind of, yeah, that's kind of what happened with the keto diet. So maybe Tina, you want to explain what ketosis is, which is the foundation.

5:39 Like that's the whole thing. That's the whole point of the ketogenic diet is to put the human body into ketosis. What the heck is ketosis by definition, the ketogenic diet is a high fat. Low carbohydrate low. Protein diet that I should say adequate protein, you know, not low as in deprivation, adequate, but low protein intake that puts the body into a state of metabolism that uses ketones instead of glucose as its major energy source. So our bodies use glucose normally for energy. Our brains use a lot of glucose. Yeah. So if you look at a cell, glucose goes into the cell.

6:21 And that glucose basically gets modified. We'll just leave it at that. And we get. So instead of glucose going into the cell and making energy with ketosis, you have ketones going into the cell and entering a cycle that can then make energy within the cell. So you can run on ketones rather than on glucose. Your cells can, but it's getting it from fat. Yes. Right? So that's, that's the whole point of why it's like this high fat diet is because your body will convert and start to use fat for fuel instead of. Glucose. Right. Right. It's a little bit more intricate than glucose from carbohydrate, which is very simple. We can get, we all know that blood glucose comes from carbohydrates in our diets.

7:06 Some blood glucose can come from proteins in the diet. It is possible to convert some amino acids. Over into glucose, but we cannot make glucose from fats. So when you put fats in your mouth, you're going to make ketones from them, but only when there's a metabolic necessity to do so. And that metabolic necessity is starvation. Right. So if there's no, the feast and famine idea is what we're built on. Our physiology is founded on the whole idea that sometimes of the year we are feasting and other times we have famine and that has to do with seasons and cycles and geography. Um, it's kind of amazing when you think about what a fast is, the body can run on very low.

7:47 And when we don't have food going in, when we're truly fasting, ketosis is a survival mechanism. We go into ketosis to make sure that our heart and our brain and our liver and Al of our internal organs can function. So. When you think about it, it's a natural state of being, and I'm sure it does some physiological good to be, to be fasting because our bodies were made for that. Okay. So a ketogenic diet is low carb, but it's not no carb, but it may as well be no carb because if normally you eat between 200 to 300 grams of carbs, A day, the ketogenic diet limits at between 40 and 50 grams. So it's only five to 10% of your calories carbohydrates.

8:31 And from what I was looking up, cause I have to look all this up because it's not something I recommend. Um, for women, they need to go more towards the 40 than the 50. Yeah. And what I have seen in patients is it seems to be highly variable. I think it has a lot to do with how a person's physiology handles carbohydrates and how well they regulate it. So someone with trouble, you know, someone who's pre-diabetic, for example, might have to restrict it down to that 40. So in my experience, if there's some variability between people, but 40 to 50 is, is a good range, I think, to hit when you want to be ketogenic, it's very low it's. You know, it's not a convenient diet. I mean, online, you'll see a lot of variations, but what we're talking about is the medically therapeutic ketogenic diet, not the fad, not the fad.

9:20 And you know, I guess, okay. Let's take a quick break. And then when we come back, we can talk about why people do the ketogenic diet. Beyond the fad beyond the Instagram posts and all of that. Yeah. All right, let's do that. So, Tina, what the heck are ketones here? Okay, so, oh, ketones, as in you take the fat in the fat goes to your liver and your liver kicks out these ketones as needed again, when it sees the necessity for this, right? When you don't have enough glucose, your liver will turn out the ketone bodies and there's only three beta hydroxy. Butyrate is the one that we talk about the most beta hydroxy butyrate.

10:02 Measured in the bloodstream, then there's acetone. We all know acetone. Yes. It's similar to nail Polish remover. Yeah. And stuff. And acetoacetate is the last one, a CDOT acetate and beta hydroxy. Butyrate are the two that are used for fuel. Just an aside, they have that kind of sweet smell to them. So sometimes you can, you can smell this on someone's breath a little bit. You can smell. Do you remember juicy fruit gum? Good. Yeah. I love that. Yeah, it was delicious. Oh, it smells a little bit like that. Interesting. Yeah. I remember hearing about certain actresses on a very popular series in the nineties. They were all like, kind of doing a, an Atkins type, which.

10:45 Can be ketogenic in some ways. And yeah, they all apparently had really bad breath. It was like a gossip column was talking about how they all had really bad breath. Cause they were just all, um, yeah. Starving themselves and work well for today's world where people don't actually see each other in person. They just take pictures. Right. So you can have bad breath, but look great. Or you're wearing a mask and it doesn't match. Well, you got to live with your own breath then that's true. Okay. So what besides epilepsy? Is Quito used with and weight loss was a really, that's a really big popular one. I think that's what you see when you see people who are advertising, like all of these, like, I don't know why I'm obsessed with keto donuts and keto bread.

11:30 That's keto, ice cream, all of that stuff. I think. For people who don't want to deprive themselves while they're trying to lose weight, um, diabetes, it's been looked at metabolic syndrome, which is that sort of conglomerate of high blood sugars, high blood pressure and high cost. Um, different neurodegenerative diseases like Parkinson's and Alzheimer's, I think also it's being looked at, and then the reason why we're here, cause we're the cancer pod is it's also being studied with various cancers. Yeah. There's a few reasons it's become popular and the whole idea of the metabolic. In flexibility of the cancers, uh, various cancers has become popular.

12:12 So meaning the metabolism of the cancer cells is different than the metabolism of normal cells that we've known this for a very long time, right? That the metabolism within cancer cells is different than normal cells. The problem with this whole thing is, and I want to just put this out front is there is no cancer material. As a whole, it's not like one thing. It depends on the type of cancer. And then even within the type of cancer, which subtype of cancer. So breast cancer, for example, has a different metabolic picture for each different type of breast cancer. So if it's estrogen receptor positive versus negative, if it's her two positive versus negative, the type or subtype of breast cancer will change, it's likely metabolism.

12:54 So meaning when. Remember metabolism of every cell in the body is based on using either fat, amino acids or glucose as fuel. That's it, you've got three things that can be used as fuel within a cell and normal cells can be very flexible between using, for example, glucose when it's available and ketones, when there's no glucose available. The only exception to that by the way, is the liver. The liver cannot use ketones for energy. But otherwise all cells in the body can generally do that. And in some cancers like glioblastoma primary brain tumor, aggressive brain tumor, it happens to most often have a metabolic inflexibility. So it can't use those ketones.

13:35 So when glucose is not around glioblastoma cells have a hard time using ketones for. So it's, it's one of those that's been well-studied and well-proven, and I think of all the cancer is glioblastoma has the most research of any cancer and probably the best hypothesis for its use to. And so when somebody would start a ketogenic diet, if they had glioblastoma, this is something they have to be on for. That's what's also being looked at is the data that we do have implies that that is true. In the case of glioblastoma, we had some early anecdotal cases that were written up. I can think of one paper in particular. The patient had glioblastoma went on a ketogenic diet, had control of the disease long story short until they couldn't do this ketogenic diet anymore because it was so restrictive and they stopped doing it.

14:24 They had progression of disease and there was an assumption that, you know, this must have something to do, right. There's correlation here, but that was a case study. And there have been several trials of patients with glioblastoma who have tried ketogenic diets. And I want to say right now, the number of publications, either either nine or 10 out there, almost all of them are small. Um, they're not large enough to make a lot of conclusions, but I'll tell you just cutting to the chase, having gone through all of them, my opinion is this, the ketones are supposed to have an anti-cancer fact by way of not being used by the glio lest Alma cells or glioma cells. It's just called glioma. Glioblastoma just happens to be. Most aggressive type of glioma. So the glioma cells cannot use the ketones.

15:07 So we think, well, we'll starve them, right? We'll just put someone on a ketogenic diet and that should work. Well, it doesn't seem to work all the time. My guess is that some gliomas can use other things, maybe amino acids. Right. So maybe the protein has to be restricted as well. And it's already a pretty highly deprived diet. So that'll be hard in any case, it looks like when you parse out the data and this just came out earlier, this year was one study that said, look, ketogenic didn't have any different outcomes. They did a short. Diet with a small, fast, and then ketogenic diet again in glioma patients who were getting radiation and they didn't see any difference between the ketogenic diet group and the standard group in the first publication.

15:47 But then they went back and they parse the data and they said, oh, people who had their blood glucose below 83 had better outcomes. So it wasn't the ketogenic diet itself. Keeping her glucose low associated with much, much better outcomes. Like those people live twice, as long as those who didn't keep their glucose below 83. So is it ketones from fats or is it the lack of glucose and amino acids? That's therapeutic. And I think we're just getting to the point of realizing that it's the latter. I think we're going to have more and more information that coming out that says, if you can keep that glucose. Really suppressed, then you're going to have better outcomes in the case of glioma. Anyway, and I only say this because my own experience, it looks like that to my patients who have done best with gliomas have had ultra low glucose levels.

16:35 So that kind of also goes to there's that recent. Study that looked at patients who are undergoing treatment for pancreatic cancer. They're receiving, I don't remember what they were getting gem Abraxane and something else. And they also were put on a ketogenic diet. Um, and it was, it was, it's been in the news where, you know, it had good outcomes and we talked about that and it's like, well, is it the blood sugar control? Like what, what actually is going on there? Yeah. Yeah. And there's other things that are going on when someone's on a ketogenic diet and some of it has to do with. Acidity like acidosis, a lot of uric acid gets produced in some people we have to be careful of that. So is the pH of their body changed by this therapeutic diet as well.

17:16 So there's other things going on besides ketone manufacturing and low glucose. So I think if we watch the data, we'll see, we'll see more and more what's happening. But. Should have some anti-cancer effect, but I will say so far, it's not a standalone so much as it is complimentary to whether it's radiation or chemotherapy. It does not stand alone as its own therapeutic anti-cancer methodology. It's not. I would never say to someone, oh, just go ketogenic. That should control your cancer. I think that's a kind of at this point, a ludicrous idea. It's not going to happen. It may slow something down. It might have some beneficial effects, but I don't think that it can be called therapeutic as a standalone monotherapy.

17:59 Well, one of the results of people who do go on a ketogenic diet is weight loss. And so like with endometrial and breast cancer, it's being looked at as well. You know, is it the, is it the weight loss? Is it that blood sugar control? Like what exactly is driving the benefit in these very, very small trials? Like, I mean, I don't encourage patients to start a ketogenic diet if they come to me with questions, that's when I refer them to, to the dietician, because I like to think the dieticians are more on top of like the latest. Information that's out there. If somebody is at risk of losing weight, it's not something that I want patients to try.

18:44 So, you know, there was something that I saw on a, like a phase, one trial with head and neck cancer patients who are undergoing treatment. Had some sort of favorable outcomes, but like, to me, that would be really concerning because of the extreme weight loss that can happen with patients undergoing treatment for head and neck cancer. So, yeah, and again, like most of these studies, they like the lung cancer. One that also recently came out there. These are phase one trials. These are very, very small, um, colon cancer. That was the other one because I told you, like, when I was trying to find more information, I just did a search in my, in my newsletters for Quito and all these studies came up and one of them was just a few days old about, um, looking at the ketogenic diet.

19:27 It was actually the, what is it? Beta hydroxy, butyrate that was shown to be beneficial in mice. Colon tumors. Um, yeah, I want to be, I always keep reiterating this, but prevention of cancer and what one does once cancer cancers present are two completely different things. When it comes to diet in my mind, like there's a hard stop, you know, prevention of cancer means trying to prevent carcinogenesis, trying to prevent the normal. Becoming cancerous. That's very different than once cancer is present, whether we're talking colon or breast or whatever prevention of recurrence, where we're kind of making an assumption that maybe there's some old Colt cells, little tiny cells that we don't know about. We make an assumption that there could be cancer already present in the body.

20:10 And if someone's doing a therapeutic diet, that is more along the lines of when we think cancers present rather than prevention of cancer. So I just want to say that because when you mentioned colon cancer, I think of ketogenic diets as often not having enough in the way of. Just because of, you know, what they're made of generally. I mean, it can be gotten, you can have a high nutrient dense ketogenic diet, but I will say a lot of people don't do that. So just a cautionary. If someone's preventing colorectal cancer, it's very different than preventing recurrence. Living with metastatic colorectal cancer and these studies were not done in humans. And so if you're trying to prevent colon tumors in your pet mouse, it might be something that you can investigate. But yeah, these aren't weren't human trials.

20:52 Yeah. Um, I want to say one more, one more little trial that happened. This was quite a few years ago. But it made an impression on me. It was 17 people with various heavily pretreated metastatic cancers, and they did ketogenic diet for all of them. And they tracked whether people actually entered ketosis or not with the dietary restrictions and some did and some didn't. Um, and they did have a few people, I can't remember it's two or three had stable disease or, or some partial response to this. And it was the, it was the only treatment used, but what was most fascinating from the study was. The few people who had some stability of disease from the diet. We're not necessarily the people who went into ketosis, so they didn't match.

21:32 And I always thought about that. Like, well, that's interesting. What, so what we're seeing in the outcomes there, if we didn't look at ketones would have been like, well, those were probably the people who went into ketosis the best, right? Like we didn't test it, but they tested it. So you can say, well, that doesn't make a hundred percent sense, but it goes back to the deprivation of the other macronutrients. Did these people happen to have cancers that we're capable of using glucose and amino acids and that the deprivation of the, those two had something to do with their outcome? I don't know. So I'm just saying that because there's little things in the data that kind of keep informing me to say, oh, whether it's the ketones or the lack of the others is debatable. So what we'll do is we'll put links to these studies that we're talking about.

22:13 It's interesting just to kind of see where the research is going. Yeah. And you know, I, sometimes when I'm looking at natural therapies that are otherwise safe, you know, especially if I can make sure that it's safer person, you know, they don't, they're not at risk of severe weight loss of any kind or something like that. I kind of think is a reason not to do it. So I would say when people are going through radiation is one time that I lean towards ketogenic diets because there seems to be really good theoretical reasons to do it. And radiation is a limited time course for most people. Right? So you can do it for a short stint, whether that's five days or five weeks, um, depends on your radiation course, but radiation seems to be a place where it's worth doing.

22:54 And it's kind of like, it's not a lifestyle, it's a therapeutic diet that you're doing strictly. A finite amount of time. So that makes more sense to me. And it's probably more doable because I mean, that is one of the biggest things is compliance with, with staying on this diet. It's, it's such a deprivation, um, for patients, which is why it's concerning for, you know, for certain patients who are going through treatment for cancer. And then I would think that there would be caution, I guess we're going to talk about our cautions next, but I'm just, you know, there are some cancers where. Just high-fat in general. I mean, it seems a little sketch, so it's, it's, it's not one of these things, you know, I think that's what this whole, like the truth about that we're doing.

23:35 It's like one of these things where patients come to us and they're like, I heard the ketogenic diet is good for cancer patients and it's, it's not the same cancer is not the same. So one thing is not good for all. Patients except exercise. I will say exercise is good for everybody, but other than that, and maybe some hydration, hydration might be good for everybody and maybe proper sleep and sleep sleep. Yeah. Okay. But other than those things and proper nutrition, but yeah, after laughter's good. Yes. In forest bathing, forest bathing. Wait, how long has her list, but wait a minute. 50 grams of carbohydrate per day is an ultra Loma.

24:17 You can find 50 grams and just two medium apples or two medium bananas or one medium order of French fries or about 22 gummy bears. Okay. So side effects of the ketogenic diet. I think the biggest one. That people talk about is that sort of keto flu symptom. Oh yeah. Just getting through that. The keto flu, the keto flu. Have you ever experienced it? The keto flu? I don't know. Like, because from like doing intermittent fasting, I don't know.

24:57 I don't know because I only felt really crappy the first time I did. My, um, my ProLon dare I say it the first time I did ProLon I felt crappy, but I thought it was cause I wasn't having caffeine. Oh yeah. Kind of hard to tell that it's hard to tell when you're like told if you could only have one cup of coffee a day and I was drinking caffeine back then. So. Yeah, I got to give you a, I gotta give you a true story, right? Speaking of not, not wanting to deprive yourself of caffeine. I went to some extremes. So I go to this place in Mexico that does his fasting detoxification. I went with a patient and one of the things we're supposed to do is not have. So they got all this stuff, you know, they got yoga and exercise and warm baths and all sorts of energy medicine and hyperbarics, and they got all this stuff and they've got great food, always organic, put it out, juicing, all sorts of stuff, but they said no caffeine.

25:48 So, oh, there I'll do a lot of things, but I'm not giving up the caffeine. I'm not giving my coffee. I won't do it. I'm so stubborn about this. Went out and got an arrow oppress and brought my own coffee. You know, an air press that you can just like, press down the coffee. We're like doing this in your room. Oh yeah. Like on the low down it felt a little sheepish about putting it in the garbage cause I felt like, oh, this is the giveaway because I wasn't going to like haul it back to them, you know, to the states with me. But. Yeah, I did it anyways, because there was no way in hell five days. What's no way. And that is how dedicated I am to the cause of coffee in my day to day.

26:31 Is that wrong? I don't, I don't know. Cause I don't drink caffeine anymore, so, oh, Lottie di cause I'm cause I'm frailty. I like my daycare because I'm old. That was a confession of sorts. Yeah. So, so it's, it's confounding. I don't know if I've ever had the keto flu. I mean, yeah. Sometimes when I do pro-line I just feel like punky, but I think it's just, I don't. Blame it on ketosis. I just blame it on the fact that I'm having 800 calories a day so, and ProLon is totally marketing themselves as a ketogenic diet now, apparently, yes. I'm sure that because people don't know what a fasting mimicking diet is that terminology hasn't caught on quite as well as ketogenic.

27:19 And so I'm guessing their marketing team has on top of. Yeah. And like the big thing that you see in the news also now is the low carbohydrate diet. And so ketogenic is included in the low carbohydrate diet. Yeah. And I think low carbohydrate diet, I think of as, not as deprived, I mean, I know that there's diets out that are really low carbohydrate, but I kind of think of them as like none of us, especially. We middle-aged women and beyond should be eating a lot of carbohydrate in our diet, just because it's not great for our weight and our waistline, especially postmenopausally whatever age you are. If you're biologically post-menopause. It's really hard to maintain normal weight. If you eat a lot of carbs, unless you do a lot of exercise to burn it off, um, things that are really good for people of a certain age like fiber.

28:06 I mean, those are all, you know, those are all carbs. So, you know, it's, it's, it's that whole, um, refined carbohydrates versus whole fibers, whole fibers, whole carbs. I don't know, complex. Complex carbs. Yeah. There you go. Yeah, because even, even a potato, I mean, people are like, oh, potato is all starchy, that's all glucose. But now we know there are resistant starches in the potato that are good for your colon health and good for the bacteria, then habit you. So not every carb, you know, is evil. Like almost everything, you know, there's a good and a bad. So this whole truth about series. Part of the reason talking it out in the podcast makes more sense than even writing it out.

28:49 Because as much as we'd like things to be black and white, good and bad, there's a lot of gray area and there's context and there's the individual biochemistry, like what will it do in that person who has such and such history of whatever cancer. That's why this is, this is good that we're doing the myth-busting in a long format, I think. And plus neither of us want to write blog posts. So it makes it easier. There's that? There's that? All right. So, so side effects. So, um, they're typically short term. It would be things like nausea, vomiting, headache, fatigue, dizziness, insomnia, poor exercise tolerance, constipation. And those can happen from between a few days to a few weeks.

29:30 And just making sure that, you know, if somebody is on a medically prescribed ketogenic diet, make sure that you are getting enough fluids and electrolytes to kind of, um, help with, with some of the. The symptoms and those are the short-term symptoms and it, when it is medically prescribed, I think that very few people should be doing this alone. You have to be getting labs. You have to be checking for, you know, what your calcium is doing, what your uric acid is doing, what your sodium is doing. You have to make sure that you're getting the micronutrients. In addition to the macro nutrients. Medium chain triglycerides, help meet and chain triglycerides like that found in coconut oil oils.

30:11 Like think that's how people see it because I've seen it at Costco, right. MCT or oil MCT oil. Okay. Um, it's helpful because it boosts the production of ketones. So that medium chain triglycerides are saturated fats. They're medium chain. So butter has short chains of saturated fat lard has long chains. Coconut happens to be a medium chain it's absorbed without any. Carrier it's absorbed right through, go straight to the liver and the liver is responsible for making the ketones. And so it's a very fast, and you kind of facilitate the production of ketones by taking medium chain triglycerides and getting some calories through that. So just for the record when people are doing this, but I still say everyone should be working with someone who's knowledgeable in ketogenic diets.

30:56 No one should be doing this kind of on their own when they're doing therapeutic diet. Oh, absolutely not. Absolutely. They need. Somebody who is properly trained and not just like, oh, I took an online course. I mean, I'm talking like registered dietician or a doctor who knows exactly what they're doing. Um, there are some possible long-term side effects and you were talking about like the liver. So like fatty liver could be a possible long-term side effects. Low protein, mineral, vitamin deficiencies, and kidney stones. Cause you're also talking about like looking at uric acid levels. So those are other things that may happen. Um, oh, and then in the news, in the news, there's a keto rash that can happen too.

31:37 Huh? Called Perrigo pigmentosa. And it's this very sort of itchy rash that can happen when somebody goes into ketosis. Okay. I haven't seen that just for the record. Oh, sorry. Common it is, but I, yeah. And I'm not, I'm not sure either, um, anyone with diabetes or who is taking any sort of medication for diabetes, whether it's insulin or, you know, other antidiabetic medications. Um, this is why you need some. You know, a professional, especially a medical professional, who's watching you to make sure that your blood sugars don't go too low when doing this. And then because it is super high-fat diet, anybody with a history of pancreatitis or any pre-existing liver disorders, liver failure, any issues with metabolizing fat to start with, there are some people who have carnitine deficiencies, so that would be a contraindication.

32:33 And can I. Folks why that is sure. Carnitine is the necessary amino acids. For shuttling, fatty acids across the membrane and making the energy from them in the mitochondria. So the cell itself needs carnitine to use fatty acids as an energy source. Yeah. Yeah. So if you don't have, if you have a deficiency in that, then you're not going to be able to utilize it as energy and. There's a liver condition called porphyria, or it's a collection of porphyrias. Um, and then a kinase deficiency as well. PKD is another contraindication and these are things that are not common, but they happen. And so if somebody suspects that they may have one of these conditions, then that's when it would be, um, contraindicated.

33:20 Yeah. And that's, you know, it's interesting. They will often pool information on ketogenic therapeutic ketogenic diets and the modified Atkins diet. And I think that's because the modified Atkins diet allows a little more protein. It's still a high fat diet, and it's still a low carbohydrate, but it's a little looser with the protein than a strict ketogenic diet. And I wonder. Some of that is because that's the introduction into the ketogenic diet. Like when someone has epilepsy, I know that they do that first. If that doesn't control the seizures, they'll go on to ketogenic. Oh, they do Atkins first really modified Atkins diet. It's a very specific version of the Atkins diet. Yeah. So it's called modified Atkins diet.

34:01 That's how it appears in the literature. Where they, they add MCT oil specifically to that diet. So there is another product that I have seen patients and they've asked mostly for weight loss, if they can use it. And that's those exoticness ketones. What do you know about that? I don't know. Being a naturopathic doctor, it seems wrong to add ketones to somebody's normal glucose. You know what I mean? And I mean, are people following a specific diet? And doing these or are they just eating the same old, same old, and then taking these pills, thinking that it's going to help. Like, I'm not quite sure. I guess I should have really researched more about exogenous ketones, but that was just something I was curious about. I've seen people bring those in, I know there's evidence about ketones themselves helping build muscle.

34:45 So one of the things that's happened as a matter of, you know, course in some. Studies, I can think of one in particular that was done in Germany. They did radiation with these patients. They had. Ketogenic diet and they watched their body composition and yes, people lost weight. One of the important things is you got to watch for that in a ketogenic diet, any ketogenic diet, and most of the, and I didn't mention this, I should have mentioned this earlier. A lot of the information we have on a keto diet. Is not normal calorie diet. It's a low calorie diet on top of being ketogenic. It's like 600 to 800 calories or something. Some of it, yeah, there's no way you could actually live on these diets.

35:27 Sometimes they're too deprived calorically, but one wonders, you know, is that part of the therapy? So now you've got deprivation of calories, deprivation of carbohydrates, deprivation of amino acids, and then high fat just to keep. Halfway satiated and on Kio fuel. Um, in any case, what they found in that study I was referring to with the radiation is when they watch body composition, there was a rapid loss of water weight. So when people go on a ketogenic diet, they'll often lose weight quickly. And, and it's a lot of fluid extracellular fluid kind of just falls off quickly within days. And then. We'll go, you'll burn fat. As long as you're exercising, though, you will build muscle.

36:07 So it does seem that mechanistically the ketones do help support muscle mass. Of course, muscles are always use it or lose it kind of thing. Anyway. So you still have to challenge the muscle, but I'm wondering if maybe the raspberry ketones might be working along those lines of helping one's muscle mass. The higher your muscle mass, the more calories you consume when you're not doing anything I have to exercise. It sounds like you still have to exercise and you still probably have to eat a decent. If not low calorie diet, which, you know, I guess isn't really recommended anymore doing like super low calories for dieting because you're just going to rebound. Um, so anything else that you want to add on, um, cautions concerns, side effects of a ketogenic diet.

36:52 I mentioned the uric acid earlier. That has been a serious complication and people in studies out there, if they let that go, that's why that has to be checked. And again, with people, you know, can't get into a nutritionist for awhile, but they want to start on this right away. The modified Atkins diet is less stress on the. Then in a full ketogenic therapeutic diet. Well, hopefully, yeah. And I mean, hopefully someone can find, um, if it's a cancer person finding an oncology trained dietician who can either guide someone through it or, you know, find other options for them because it's not like one diet. Cure cancer, whether it's ketogenic or whatever kind of diet.

37:33 Yeah, I guess that's that's. The other cautionary is some cancers are known to use fatty acids as fuel one that comes to mind off the top of my head is triple negative breast case. So not all cancers use glucose as fuel. That's a fallacy that's out there. That Warburg effect where, you know, we kind of, uh, about, I don't know, 15 years ago was all the rage about the Warburg effect and now cancer cells use this shuttling, the glucose off into glycolysis, and there's this whole theory around it. But. It's still uses other means of making energy, besides the Warburg effect for people who know what that is. But some cancers can specifically use fatty acids for energy production. So, um, triple negative breast cancer is the one that I would say don't do this with.

38:16 Okay. So yeah, we'll put some things simple if there is something simple so that people can learn about the Warburg effect and yeah. See that's what I mean. Yeah. There's, there's not one diet fits all. No. I get adamant about that because I've been doing this for 20 plus years, and I will tell you if there was a diet that could control cancer across the board, I wouldn't be working so hard. I'd have a little place on top of the hill in a nice natural setting and put everyone on that diet, just check in with cancer and check out without it. Right. I mean, if it really, if we really had that, but it's not that simple, you know, mostly because cancers are not one thing. There are various cancers and various metabolic ways of getting what they need.

38:57 Um, I mean, I wish it was simpler. That's the, that's the, uh, truth about ketogenic diet is it's not that simple, right? Oh, nice way to bring that back around. So we're going to take another quick break. And when we come back, it's the return of the unofficial theme song, and we're going to have a few shout outs to, to people who have bought us coffees, people in our. People in our pod who buys coffee, because as you learned from her story, Tina really loves her caffeine. She's actually buying coffee. We'll be right back. There is so much more we have to learn about the ketogenic diet. Current studies are not only looking at the diets effect on camp. But also when Kadima traumatic brain injury, PCOM alcohol withdrawal, and the diets influence on the gut microbiome.

39:48 All right. So we're back and the reveal, the big reveal. Cause I don't know. Is the song. So I did a little search. I did a Dr. Google search for songs that had keto or ketosis or ketogenic. And there is a song by a Grammy nominated American guitarist basis. Songwriter podcast host did not see that part and producer based in Minneapolis. Um, his name is Corey Wong and he has this song called ketosis. And I have to send it to Tina because. Funky. It's like our theme song. It's like kind of this like space, age, bachelor pad kind of feel well. Now that I'm like an Uber editor.

40:29 I can add it right now. Oh, well you can't. Y I can do excerpts. We can do excerpts really of songs. I don't know. You can it's artistic license. Yeah, we totally can. Anyways, maybe we'll include it or maybe you have to go to our spot and check it out. Cause we will, I will add this to our Spotify song list, but yeah, I was like thrilled. The first one I heard was like really kind of one of those, like I was like, technically. And I was like, oh gosh, I don't think I could include this in our, in our playlist. But this one is very, it's very us. I think you'll like, all right, I'm excited to hear it. All right.

41:10 And so, and now we're gonna say thank you to some of the people who have bought us coffees and you can also buy us a coffee. The link is in our show notes and it helps us with hiring out different services, like getting. An editor. So right now we have enough to buy a multi build hat where each bill on the hat has a different thing where once it's produced and then you turn the hat and then one that says editor, and then one says talent, and then you turn the hat. So there's got like five bills around it. No, we can afford that though. No. Yeah. I think that can afford that. But yeah, anything that.

41:51 That you can donate is much appreciated, not only to fuel Tina's caffeine habit, but also just to kind of keep us going for the day-to-day costs of running a podcast. So big shout outs to Kristin Amy. Lynne Adam Brogan, Terry, and most importantly, thank you. Tina's mom. Thanks mom. Most important of all. Thank you. Tina's mom. I wouldn't be here without her. That's true. And you know, the cancer pod wouldn't be here without you. So thank you Tina's mom. Yes.

42:32 Thanks everybody. I really appreciate it. We really, really appreciate it. And we got big plans, so hopefully we can. Roll out some of those more in depth discussions. Oh, we also have a newsletter. So if you haven't gotten that, go to the website and sign up for that. Yeah. The first newsletter came out. You can sign up for it in the link in the bio, or you can go to the website. Um, you can send us fan mail. If there's something you want to say, that's nice or that isn't nice, but it's constructive and very polite. If it's not nice, I am going to read it. And I'm going to say your name and on Instagram, we are nearly at a thousand followers. Well, that's right. And I want to try, I want to try to figure out some sort of, um, like a, like a giveaway for when we get to a thousand followers.

43:18 So who knows by the time this episode comes out, We may be at a thousand followers. And that reminds me, we're doing things the hard way, because we could pay for 5,000, 10,000 or even 20,000 followers. But we won't do that. We have 976 organic real people out there that follow on Instagram, all because of Leah's hard work and artistic talents. So. Yeah, we got to get to a thousand. So if you have an account go over there and follow us with ya. That's right. And if you have friends share the account and share this podcast and rate and review and all of that good stuff, do all that good stuff that helps us out. And, uh, yeah, we'll keep it up. So on that note, I'm Dr. Leah Sherman and I'm Dr. Tina Kaeser, and this is the cancer pod until next time.

44:01 Thanks for listening to the cancer pod. Remember to subscribe, review and rate us wherever you get your podcast. Follow us on social media for updates and as always, this is not medical advice. These are our opinions. Talk to your doctor, but for changing anything related to your treatment plan. The cancer pod is hosted by me, Dr. Lee Sherman. And by Dr. Tina Kaeser music is by Kevin McCloud. See you next time.

44:50 Was going to be a hot mess today.