You probably know that each client I see on an individual basis has to fill in a very comprehensive intake form before we start working together. I need to know about current and past health issues, family history, signs and symptoms, treatment plans, typical diet and, of course, medication and supplement. And, what I’m always blown away by, is that many people take nutritional supplements or herbs. It’s not uncommon that I see lists of up to 20 (!) different products that people are on.
Now, on the one hand I totally understand that it’s incredibly tempting to just “throw in” anything and everything that has been shown to have potential anti-cancer effects. I get that we’re all in a mad panic when we’re initially diagnosed and try to do our best to get ourselves “into shape” before treatment, recover afterwards or manage our illness in the long term.
There are a few problems I have with this “all-inclusive” approach:
- Some supplements might interact with drugs or treatments a patient is on or even with other supplements.
- The sheer amount of supplements could completely overwhelm the digestive or indeed other systems.
- What is the absorption rate of supplements in general? Some of them, like for instance turmeric, are notoriously difficult to use by the body.
- Because it’s incredibly expensive to be on so many supplements, some people opt for more affordable products, which don’t always guarantee quality.
- It can be stressful to set up a schedule of supplements and not forget to take them.
There are a number of supplements that can support a ketogenic diet and initially, I leaned towards the recommendations made by ketogenic experts in the world of epilepsy.
In his book “Ketogenic Diets. Treatments for Epilepsy and other Disorders”, Eric Kossoff recommends the following:
My opinion: They can be useful for somebody on a ketogenic diet, but there are certain nutrients that I strictly avoid or at least limit with cancer patients, like folic acid, iron, copper but also calcium and betacarotene. Nutrient overload can be equally harmful for health as nutrient deficiency, which is why I’m being careful even with multivitamins.
Calcium and Vitamin D
My opinion: As I said above, I don’t like to supplement calcium in cancer patients unless they’ve done a dexa scan and there is a clear problem with bone health. There are many other nutrients required for healthy bones apart from calcium, like for instance Vitamin D to get the calcium into the bones in the first place. I always get my clients to get a Vitamin D (25-hydroxy Vitamin D (25(OH)D)) test done before supplementing. Otherwise you’re playing guessing as to dosage, frequency and safety!
Oral citrates (e.g. potassium citrate)
They can be very useful for people with a history of kidney stones or who are keen to prevent any complications in this respect. In hospitals, they often recommend Polycitra K for epileptic patients on a ketogenic diet.
L-carnitine is used to shuttle fatty acids into the mitochondria for breakdown into energy. It can be a useful supplement, especially if the lipid panel shows abnormalities or if somebody is very tired.
In my experience, taking pure MCT oil can be difficult to tolerate. Many of my clients- especially those who are very ill and compromised- just can’t digest it properly and suffer from nausea or weakness. While MCT oil can be helpful for raising ketone bodies (it’s converted very quickly), it’s a very refined oil that isn’t as nutrient rich as others. For all those reasons, I’m being cautious using it.
Because fat intake is so high on a ketogenic diet, getting the omega 3/6 balance right is crucial. Many people consume a good amount (to put it mildly!) of nuts, seeds and other sources of omega 6 on the ketogenic diet, which is why it’s important to balance it out with omega 3s. Again, there’s a test that gives valuable information into fatty acids in tissue and where there are possible imbalances. Based on this, I can adjust the omega 3 supplement regime. For people who have a good dietary intake of omega 3 fatty acids (oily fish, algae, chia/flax/hemp seeds), supplements aren’t usually a requirement.
Selenium can protect against oxidative stress and is usually available in good amounts in Brazil nuts, beef, chicken and turkey. But low levels are often seen in cancer patients as well, which is why testing and possible supplementation is a good idea.
Kossoff, author of the book “Ketogenic Diets“, also suggests working out dietary reference intakes (DRIs) based on this guide. http://www.nap.edu/catalog/11537/dietary-reference-intakes-the-essential-guide-to-nutrient-requirements. As I wrote in another blog post, DRIs and RDAs should only be used as a very rough guideline because we’re all unique and require different amounts of nutrients depending on genetic predispositions, age, environment, lifestyle, ability to absorb nutrients and many more.
Whenever I recommend supplements, I prefer to do this based on functional or blood testing. You’re probably asking yourself why I write about supplements being costly and then suggest doing tests that are even more expensive! BUT my experience is that those tests allow me to target specific “issues”, get more results quickly and correct biochemical imbalances in a much more appropriate and efficient way than by guesswork based on symptoms.
I give you an example: A client of mine spent a lot of money on probiotics but he didn’t feel that they gave him the expected benefits. Based on a stool analysis, we found out that he was very deficient in Bifidobacteria but that L. acidophilus strains were very contraindicated in his case. Taking a broad spectrum probiotic that contains both Lactobacilli and Bifidobacteria strains would have never given him the same benefits as the specific strains we used based on the stool analysis. Of course it’s not always that simple and there were other supplements that needed to be added for a short while to get him back into balance. But I’m sure you understand that testing doesn’t only allow me to make more tailored recommendations but that it’s for your benefit, too.
The same applies to specific mitochondrial supplements, which can obviously be of huge benefit to anybody but especially somebody on a ketogenic diet. We require certain nutrients to shuttle fatty acids into the mitochondria for beta-oxidation (e.g. l-carnitine) but also other ones that help with production of ATP (energy) from fats in the inner mitochondrial membrane: CoQ10 is the prime example. Of course you can just take a general mitochondrial support if you don’t test but you might have too many of certain nutrients- and upregulate certain pathways- or not enough of others.
Apart from doing functional tests like organic acid tests, comprehensive stool analyses, nutrient analysis or hormone panels, I obviously also always do standard blood tests that include full blood count, renal/liver/bone profile, thyroid function and Vitamin D.