This morning, I checked the comment section of my website. Because spamming is so common these days, I have to go through all my comments and approve them before they appear on my website. A few days ago, Dr Nóirín Nic A Bháird from Trinity College in Dublin posted a response– or I’d rather call it public shaming- to my blog on metabolism, to which I started responding but soon realised that my reply would take up too much space. So I decided to turn it into a blog post. And here it is…
Although unpleasant, your comment is somewhat enlightening and answers a few questions I’ve been asking myself over the past 2 months, since the publication of our book “The Ketogenic Kitchen“. We have been publicly attacked, shamed, defamed and belittled by many highly qualified health and other professionals. At times, we were wondering whether our book’s main recommendation was to ingest proven carcinogens, take up chain smoking or binge drinking!
Anyway, here goes the comment for readers who don’t want to flip back to the original blog post first and also for refreshing your memory. I’ll be responding to it bit by bit underneath:
“Your posts about metabolism are so inaccurate that I don’t know where to start but let me point out a few errors in your blogs. If you are a fully qualified nutritional therapist how can you say that there is confusion about whether food affects blood pH? You should be aware if you had done any study that the pH of the blood is maintained within a very narrow range and that food does not affect it. You say that sugar feeds cancer- yes cancer cells consume a lot of glucose but so do the cells of the immune system that are essential for fighting infection and inflammation- do you tell your clients that? One of the reasons why you should wait for the results of clinical trials is for example what happened in the clinical trial looking at the effect of antioxidants on cancer. The NEGATIVE effects were so strong that the trial had to be halted because patients were dying on the antioxidants.
You say that there is a recent change in opinion about whether cancer is a metabolic or a genetic disease as if these are quite different. What do you think the effect of a genetic disease is? It changes the metabolism of a cell is what it does. You say that open-minded scientists are now accepting that cancer is a metabolic disease and ask why we don’t hear about this more often. If you put ‘cancer metabolism’ in to Pub med search engine you get 440660 papers the first of which dated 1935 is entitled ‘The metabolism of normal and cancer tissue….’
And by the way we do not have abundant pre-clinical data on the effect of a ketogenic diet on cancer.
Shame on you for peddling misinformation.”
First of all, you seem to be the first person I’ve come across who hasn’t realised that there IS confusion among the general public, and that I simply list a few examples of topics that cause most people the biggest headaches: Concerns around red meat, juicing, pH balance, sugar and antioxidants are the ones that I’m being asked about most. In my blog post, I provide these as examples to illustrate how many opposing (using “VS”- meaning “versus” or “against”) and very confusing views there are. They don’t reflect my opinions nor my research, it’s simply a list of observations.
When you ask how “a fully qualified nutritional therapist […] can […] say that there is confusion about whether food affects blood pH”, then this shows me that either a) you have completely misinterpreted or misread my list (in dubio pro reo- but I cross my fingers you’re more thorough when reading medical research!), and/or b) you haven’t read my post on this subject and/or c) you are just plain suspicious of my work- fair enough. Having a critical mind and opening a debate is more than welcome. As Prof Michael Gibney recently said to us- “It’s the fuel for progress”. But please- in a fair, thought-through and civilised manner.
You go on to state that “yes cancer cells consume a lot of glucose but so do the cells of the immune system that are essential for fighting infection and inflammation- do you tell your clients that?”. Thank you for pointing this out, I know about this and attended your colleague’s, Dr David Finlay‘s, lecture on this subject in March 2015. I think you compare apples with pears (or diet with immunotherapy). In my opinion and from what answers I got to my questions, this field also still needs a ton more research to actually allow for significant clinical applications and recommendations when it comes to dietary choices. One of my questions- how much glucose there REALLY is needed to support immune cells and could this potentially come from endogenous production rather than diet- seems to be unresolved (please prove me wrong if there has been a recent new development in research).
Also, very new research coming out of Valter Longo’s camp, showing how fasting triggers stem cell regeneration of a a damaged immune system, is simply too compelling to favour high glucose consumption. As you say, cancer cells consume vast amounts of glucose. But as Dr Finlay pointed out during his lecture, glucose levels within tumour cells of solid tumours are often very low, making it hard for NK/CTL cells to access enough glucose. Do you think that eating more glucose will solve this “problem”, i.e. make the tumour cell direct excess glucose to immune cells rather than using it to support further growth and metastasis? I acknowledge that there is a competition for glucose between cancer cells and the immune system but I seriously doubt that this “war” can be influenced with diet, i.e. by eating foods that easily and rapidly turn into glucose. Or that indeed the ketogenic diet, which mimics fasting, can damage the immune system by restricting glucose. How would fasting, which goes hand in hand with a severe drop in glucose, be so successful for immune cell regeneration then?
And when it comes to inflammation: I always get my clients to test for inflammatory markers (e.g. CRP, GGT). I see very favourable effects of the ketogenic diet on those markers, which is also confirmed by research, e.g. here (although this is “just” a review article). Hence, I’m not concerned about increased inflammation on the ketogenic diet, quite the contrary! If you research the properties of ketone bodies, you’ll know what I’m talking about.
Your concerns around antioxidants are justified. Not that the SELECT study (which I assume you allude to?) is one of my favourite. This is something everybody in the field of nutrition is (or at least should be!) taught at the very beginning when learning about supplements: NEVER supplement single antioxidants in significant doses over a prolonged period of time. They ALWAYS have to come in a compound or, ideally, be food-based only. The fact that a study did exactly this is quite mind boggling to me, to say the least. While there are studies favouring the use of a broad spectrum (!) antioxidant complex for cancer patients, others are clearly against it, especially when there are high doses involved. Some antioxidants like alpha lipoic acid have other functions though, and may offer additional benefits under certain circumstances- which we have to research. So, to sum it up- I agree with you that the evidence for antioxidants is mixed and that therefore cancer patients should stay away from them, especially while undergoing active treatment.
Regarding your comment on “[w]hat [I] think the effect of a genetic disease is? It changes the metabolism of a cell is what it does.” – this is EXACTLY what I’m discussing. I’m talking about the ORIGINS, not the effects. And that’s what we have to find out- and it’s a difficult, maybe impossible task to get to the bottom of. Very similar to the chicken and egg situation. I could turn your statement around: “do you know what the effect of a metabolic disease is? It leads to DNA mutations in the nucleus is what it does.” You see, mitochondria are responsible- among a host of other functions, but I don’t need to tell you this- for apoptosis, for instance. This means programmed cell death- if “something” in the cell replication goes wrong, mitochondria are involved in “spotting” this and inducing apoptosis so that this “error” can’t develop into something more serious, e.g. cancer. So, what happens if mitochondria are damaged or have impaired function? Yep, DNA mutations can be a consequence. Prof Seyfried’s research into this is too compelling to ignore and could have tremendous significance to the cancer field in the future.
“Cancer metabolism” isn’t the same as “cancer as a metabolic disease”, which addresses the root cause rather than a process. You don’t get many “hits” on Pubmed for that. And that’s what I’m talking about in my 2nd blog post that follows the one you commented on. I don’t know many researchers who are researching this area. And, by the way, research into this topic started way earlier than 1935.
And what “abundant” means, is a question of definition. 5 years ago, when I started researching the subject of the ketogenic diet, the evidence was scarce for cancer. But still enough to convince me to give it a go, especially given that trials into the ketogenic diet had been done in the field of epilepsy, confirming that the diet was safe. I didn’t need to be concerned about this, which is paramount. I’ve been closely following the field of the ketogenic diet for cancer for 5 years and the amount of evidence and information we have now has grown significantly since 2011. It’s very clear that there’s increasing interest all over the world. Human trials are also underway.
Does this mean I don’t need to be cautious and recommend that every single cancer patient go on the ketogenic diet? Of course not. And I’ve never claimed this. Those who are familiar with my work and our book know that I’m very careful and thorough with implementation and monitoring of the diet. Trust me, if I didn’t get clinical results and also feedback from random people from all over the world using the ketogenic diet and seeing benefits not only in terms of cancer management, but also in quality of life, I’d have given up using it a long time ago!
Fact is: Whatever is being done now- in cancer prevention but also treatment- doesn’t seem to have the desired outcomes, to put it mildly. Is it not more than justified and simply logical to look at cancer from a different angle? Maybe simply think outside the box and turn on our scientific curiosity because there’s not much to lose, is there? Cancer rates are projected to steadily rise. 1 in 2 men and 1 in 3 women will develop cancer at some stage in their lives. Is nutrition- or the ketogenic diet- the answer to our chronic health problems? As with all complex problems, there will never be ONE answer. But that nutrition and lifestyle changes are certainly part of it, of that I’m confident.
I know I keep repeating myself but there is no single treatment or management tool for cancer patients that will work for absolutely everyone. I’ve seen tumours double in size- while new ones start to form- while on high doses of chemotherapy drugs. Accompanied by terrible side effects, needless to say. A double whammy: Terrible quality of life that isn’t even “rewarded” by positive outcomes for the patient. How frustrating, but a reality for many people. There is, and probably never will be, a silver bullet when it comes to cancer treatment. Whether it’s conventional, alternative, complementary or whatever else you want to call it. I’m more than aware of this- being a cancer patient myself whose tumour survived the strongest possible proton beam therapy– and would NEVER mislead people. Or “peddle misinformation”, in your own words.
What have I learned from your comment? A few things:
- Throwing angry comments and public shaming on Twitter and online without exactly reading what the message is seems to be en vogue. Factual, civilised and rational debates that could ACTUALLY create value and help people are outdated. Pity. I refuse to engage in this and prefer to get back to critics in a civilised, thought-through manner. Although it’s frustrating. But hopefully worth it in the long run.
- Many medical experts seem to judge by headlines, book titles and sound bites rather than by looking in-depth into the source of information. Following what an authority says is easier. I made a pact with myself that I stay open-minded, embrace new information and thoroughly research before writing off something. And have the courage to say “I don’t know enough about this to comment”.
- Resistance to novel concepts (oh well, how novel the concept of the ketogenic diet is, that’s debatable…) is huge. I’m not going into details about this but attacks like yours give me invaluable insight into what’s going on. The anger/rage that is accompanied by this resistance is quite remarkable, too. Please- we’re all trying to help patients and shaming people with opposing views in public is NOT the way to go. It simply causes more confusion.
- Peace be with you, Nóirín. Not anger.
Addendum (1 September 2016): Because I decided to remove the comment section for my blog posts with the re-launch of my website at the end of August, please go here to read the comments on this post. Thank you for understanding!