… This was one of the questions I was asked at the 3rd International Conference on Exercise and Cancer in Munich (Germany) on 25 October 2014. It was a great honour to be speaking alongside highly regarded scientists like Dr Kerry Courneya or Dr Wendy Demark-Wahnefried.
What was pretty cool as well was that Dr Prof Thomas Wessinghage did the introductory talk to the conference. He was an incredible athlete and in my teens I used to follow his training protocols to become a faster runner…
The topic of my talk was- as you’d expect- my experience with the ketogenic diet. I also presented the latest evidence and studies I base my protocols on.
Here is a picture of me being interviewed by Prof Martin Halle after my talk.
I could upload my presentation here but given that it’s in German, I just give you a brief synopsis here:
- A summary of my cancer history, orthodox treatments/outcomes and how I came across the ketogenic diet. You can read in a lot more detail here.
- Where research into the ketogenic diet for cancer patients stands at the moment. Some references I used were:
- A high glycaemic/high carbohydrate diet can increase cancer risk. Champ C et al: “Weight Gain, Metabolic Syndrome, and Breast Cancer Recurrence: Are Dietary Recommendations Supported by the Data?”, International Journal of Breast Cancer, 2012.
- Patients suffering from hyperglycaemia (high blood sugar levels) have been shown to have a poorer prognosis. Goodwin PJ et al: “Insulin- and Obesity-Related Variables in Early-Stage Breast Cancer: Corrrelations and Time Course of Prognostic Association”, J Clin Oncol, 2012.
- Research shows that there is a positive correlation between blood glucose levels and tumour growth. J Hu et al: “Glycemic Index, glycemic load and cancer risk”, Ann Oncol, 2013.
- Downregulation of several pathways leads to better treatment outcomes in radio- and chemotherapy. Klement R et al: “Calories, carbohydrates, and cancer therapy with radiation: exploiting the five R’s through dietary manipulation”, Cancer Metastasis Rev, 2014.
- The main mechanisms of the ketogenic diet
- Blood sugar ↓, ketone bodies ↑
- Insulin ↓
- Growth factors ↓
- Ketone bodies (BHB and AcAc) inhibit cancer growth
- Ketones increase apoptosis (programmed cell death) in cancer cells
- Suppression of oncogenic growth signals
- Reduction of tumour growth and possible prevention of cachexia. S Shukla et al: “Metabolic reprogramming induced by ketone bodies diminishes pancreatic cancer cachexia”, Cancer & Metabolism, 2014.
After the talk, I was asked loads of questions… Here are some of them:
How do you feed your family while following a ketogenic diet?
I usually cook “my” ketogenic meal (for ideas have a look at the recipe section or my eBook, for instance a keto version of a soup, vegetable bake, fish stews, frittatas, Asian stir-fry or lots of other options. Sometimes, the whole family eats a ketogenic meal, too. But often the kids might have some seed/chestnut/buckwheat crackers, sweet corn, baked beans, whole spelt pasta, quinoa or something else “carby” that I cook separately in the steamer. They don’t generally tend to eat a lot of grains but they are NOT following a ketogenic diet. Their carbohydrate intake is definitely much lower than that of other children, though, and I make sure they always have adequate protein and good fats with each meal.
They love their fruit, sometimes I bake rye bread and we often make homemade treats together where I use dried fruit as sweeteners.
In the morning, the kids either have porridge with some hemp or other seeds and coconut oil or they have eggs about 2-3 times a week.
My husband has benefited a lot from cutting down on carbs, too. He has lost weight and blood tests are showing improved overall health.
How do you measure your glucose and ketone levels?
I use a diabetic kit by Abbott Laboratories called “Freestyle Optium”
I have type 1 diabetes and would be interested what your blood sugar levels are?
Usually around 4-4.5 mmol/l. I don’t get them much lower because I’m too busy! And, if I measured the levels now that I’m talking in front of a lot of people, my blood sugars would be higher, too.
Stress causes an increase in cortisol, which goes hand in hand with blood sugars. That’s why stress management is so important for cancer patients (and anybody). There is no point following the ketogenic diet but being stressed out of your mind about it. Lifestyle and dietary changes should become effortless after an introductory phase.
I sometimes have clients who put themselves under a lot of pressure to be in ketosis and their whole life evolves around food, their next meal, shopping etc. This is not as it should be and I usually ask these people to take a step back, slow down and re-focus after a while.
What do you eat all day long?
For breakfast, I could have some vegetables fried in coconut oil, eggs and some bacon, avocadoes, flax/coconut or nut bread, a kale shake, bone broth with sea vegetables and hemp seeds.
Lunch is often leftover and fresh salad time! In the summer, it’s usually just salads with fresh vegetables and lots of dressing and/or pestos/spreads, some fish or seeds. In the winter, I often have a bit of soup with chia/hemp seeds and a salad.
What are you eating at the moment when you are travelling and eating out?
This morning, I skipped all the muesli, breads, yoghurts and fruit salads at the breakfast buffet. Instead, I had some Parma ham with a little bit of cheese, tomatoes, cucumber and a scrambled egg with added butter.
For lunch, I didn’t have the lasagne and rice but had the chicken stew with the vegetables. In the evening, I will be looking for some fish and replace any potatoes, rice or pasta with broccoli, salad or other vegetables in the side dish section. It’s not that complicated at all!
Do you eat any carbohydrates at all?
Yes, of course, I can’t avoid them completely if I want to make sure I get all my vitamins, minerals and other micronutrients. There are carbohydrates in almost all vegetables, and there are quite a lot in starchy vegetables like butternut squash, carrots, beetroot, parsnips or pumpkins.
I also eat dark chocolate, nuts and seeds, which contain carbohydrates.
Do you take long breaks between meals or do you have any snacks?
I don’t snack any more but I used to have to eat every 2-3 hours until going to bed. I do intermittent fasting and have 3 meals a day, sometimes even just 2. Intermittent fasting means that I leave a long gap between dinner and breakfast, usually between 14 and 16 hours.
Breakfast is usually around 10am after dropping my daughter off to school by bike, preparing lunch for the family and doing a bit of work. Lunch typically is around 1.30pm and dinner at 6pm. In between these meals I never feel hungry at all.
I heard that fat is cancer-causing because I read a study where they used both palm oil and a type of animal fat, what do you say to that?
[After asking what the macronutrient ratios in this study were, the student said it was 95%]. Ok, embarking on a diet that is 95% fat is not considered ketogenic as we recommend it for cancer patients- I don’t know what you would call it.
We recommend a ketogenic diet that has approximately 75-85% fat, 12-20% protein and 2-5% carbohydrates.
Fact is, we do need protein for tissue repair, immune system, detoxification and many enzymatic processes in the body. Even if the remainder, 5%, is protein, this is not enough and I wouldn’t recommend following a diet with 95% fat- you would never be able to cover your micronutrient needs. The immune system would probably suffer so much that developing cancer could be a consequence of such a high fat intake.
What do you do when you’re invited for dinner by friends or family?
Most of my friends and family know that I eat “a bit differently” and know that it’s easier for me when all the different meal components are separated. For instance, a sheperd’s pie, a one-pot-meal or potatoe and leek soup would be hard for me to eat because everything is mixed in. But if the meat/fish, potatoes and all other starchy and carby foods are served seperately, it’s much easier for me to pick and choose.
Christmas dinner, for instance, is very easy: I just have some ham and turkey, Brussels sprouts, some carrots and add butter to the vegetables. I can skip the potatoes, stuffing, cranberry sauce for ham and the brown bread with smoked salmon.
What I often do is bring a dish along myself (it’s the polite way anyway, isn’t it ;)) so that I know there’s definitely something I can eat without being thrown out of ketosis. Sometimes I bring bread or desserts that are “keto-compatible” and I’ve never had any trouble.
Do you think a cancer diet exists?
No, I don’t think there’s such a thing as a cancer diet. Even though a ketogenic diet gives pretty strict guidelines when it comes to the ratio of carbohydrate/fat/protein, it still needs to be very individualised.
We are all biochemically different and have food sensitivties that somebody else might not have who follows the same “diet”. The foods I recommend for my patients also very much depend on medication, treatment protocols (someone who is going through treatment or has just finished will need more protein), weight management (is weight gain or weight loss a problem?).
It’s definitely not a good idea to just “copy” a regime another cancer patient is on, for various reasons. I do believe, though, that any diet and lifestyle regime that helps lower blood sugar levels can only be beneficial. We know, as I mentioned earlier, that permanently high blood sugar levels can lead to poorer treatment outcomes. And that high insulin levels can promote cancer growth and make cancer cells more resistant to chemo- and radiotherapy.
This is one reason why the drug Metformin is becoming more popular with oncologists: it helps lower both blood sugar and insulin and has been shown to be beneficial for cancer patients. A diet that keeps your blood sugars at a steady low level will have similar effects and targets the same pathways as Metformin.
As I said, it’s important to realise that the goal of lowering glucose is also achieved by exercising and managing stress levels. For me, exercise, nutrition and stress management/sleep are the basics that need to be addressed with every cancer patient.
Is it not too hard to follow this diet, why are you putting yourself through all this?
Anybody who has gone through so much surgery and treatments like me would confirm that following a so-called “restricted” diet is so much easier once you get used to it. Initially, it takes discipline, motivation, support and the will to learn lots of new dishes, cooking techniques etc. And fortunately there are more and more tools, food products and books on the market that make it easy to start and follow a ketogenic diet.
And yes, following a ketogenic diet puts an end to having cakes, biscuits, scones and ready-made meals from the shop. A lot more effort is required to make your own, keto-friendly snacks and “treats”. But for me personally, my joy of living (and seeing) is a lot more important than the joy of eating and having treats.
For me it’s literally a no-brainer. As long as it works, I’m doing it if it allows me to avoid more surgery, treatments, injections and endless waiting and tests in hospitals.
Having two small kids is certainly a huge motivator, too. I want to be here for them in the best of my health and with lots of energy. And that’s what the ketogenic diet has been giving me so far!
This is a brief synopsis of my part of the conference.
Other lecturers covered topics such as
- Resistance or relaxation- what do cancer patients benefit more from?
- Exercise after cancer: Impact on prognosis and survival
- Epigenetics, exercise and cancer,
- Quality of life during treatment
- Physical exercise during adjuvant chemotherapy
- Combining physical activity with a healthy diet- the benefits of a multi-component or holistic interventions in cancer populations,
- Antioxidants during treatments,
- Complementary therapies and cancer
- and many more!