ABSTRACT & COMMENTARY
Ketogenic Diet and Breast Cancer
Feasibility and effects during adjuvant radiotherapy REFERENCE
Klement RJ, Champ CE, Kämmerer U, et al. Impact of a ketogenic diet intervention during radiotherapy on body composition: III—final results of the KETOCOMP study for breast cancer patients. Breast Cancer Res. 2020;22:94. DESIGN
A prospective comparison study, nonblinded, at a single outpatient clinic in Germany OBJECTIVE
To assess the feasibility and effects on body composition of a ketogenic diet versus a standard “prudent” diet during adjuvant radiotherapy for breast cancer PARTICIPANTS
All participants were women with nonmetastatic breast cancer (aged 25-78 years) who were scheduled to receive adjunctive radiotherapy (from 16-35 days). Allocation of participants was done consecutively at a single clinic (Leopoldina Hospital Schweinfurt, Germany) in 3 batches: For Batch 1, 5 consecutive participants were placed into the ketogenic diet (KD) group to assess whether compliance was likely; for Batch 2, the standard diet (SD) group was recruited (38 women were asked, 30 enrolled, and 1 dropped out before analysis); and for batch 3, the rest of the KD group was filled (total of 52 women were asked, 19 declined, 32 enrolled, and 3 dropped out). Participants were given the opportunity to self-select KD or SD group if they felt strongly, and this resulted in 1 woman electing to participate in the SD group. Total participants in each group at the study’s end point were KD=29 and SD=30. Despite nonrandomization, there were no significant differences in baseline characteristics between participants, except the average phase angle per bioimpedance analysis (BIA) was slightly higher in the KD group (4.98 vs 4.65, P=0.05) at baseline. EXCLUSION CRITERIA
Karnofsky Performance Scale Index <70, body mass index (BMI) <18 kg/m2, metallic implants (due to interference with BIA measurements), pregnancy, inability to understand German, any condition that made the KD a contraindication INTERVENTION
The SD group received no specific dietary recommendations or advice. However, 4 patients in the SD group requested dietary guidance and received standard guidelines of the
Tina Kaczor, ND, FABNO
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Many patients who believe they are eating a ketogenic diet are not doing so in the strict sense of producing ketones.
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German Nutrition Society. This included consuming mostly “unrefined foods of plant origin (in particular whole grains, vegetables, and fruits), and limiting fats to 30-35% daily energy intake, with an emphasis on reducing fat from animal origin.” Participants in the KD group were briefly counseled by their medical oncologist (5 minutes). The day of their baseline metabolic measurements, they also received instructions from a registered dietician experienced in KD implementation. This included handouts with food choices and cooking recipes. KD participants were instructed to replace carbohydrates with fat, specifically consuming 75% to 80% of calories from fat and limiting carbohydrates to 50 grams daily or 10 grams per meal. There was no caloric restriction. High-quality animal protein and nutrient-dense foods were emphasized along with avoidance of grains, legumes, processed foods, and vegetable oils (except olive and coconut). Dairy was allowed in moderation, with instructions to favor butter, cheese, and fermented dairy products. Medium-chain triglyceride (MCT) oil was provided for free. Lastly, they were instructed to begin the KD at least 2 days prior to initiating radiotherapy. Note: Of the 29 participants in the KD group, 15 were given a 10-gram amino acid supplement on the days of radiotherapy (Master Amino Acid Pattern, or MAP), which they consumed right after receiving radiation. (Contrary to what may be expected, this did not modify body composition trends, likely due to adequate high-quality protein in the KD group as a whole.) PARAMETERS ASSESSED
Baseline measurements, which were taken at the time of radiotherapy planning (about 1 week before radiotherapy) and included weight, BIA, a validated quality-of-life (QOL) questionnaire (EORTC QLC-C30), and a blood draw for baseline measurements of complete blood count CBC, metabolic parameters, liver enzymes, insulin, insulin-like growth factor 1 (IGF-1), and free T3 and T4. BIA and weight measurements were repeated weekly throughout the
14 ©2020 NATURAL MEDICINE JOURNAL. ALL RIGHTS RESERVED. NMJ, OCTOBER 2020 SUPPLEMENT—VOL. 12, NO. 101 (SUPPL)
