Metabolically Supported Therapies for the Improvement of Cancer Treatment
March 19, 2017
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By Dr. Mercola
Each and every day, more than 1,600 people prematurely die from cancer in the United States alone and 20,000 worldwide. While the situation can sometimes seem hopeless, there are effective ways to prevent becoming another statistic.
And, as you will soon learn, even late-stage cancer patients have cause for new hope these days.
In this interview, Travis Christofferson, author of "Tripping Over the Truth: The Return of the Metabolic Theory of Cancer," and Dr. Abdul Kadir Slocum from the ChemoThermia Oncology Center in Turkey.
They present data from one of the first studies documenting the effectiveness of metabolic therapies and nutritional ketosis in the treatment of advanced stages of cancer.
Alas, targeted cancer drugs have been a bitter disappointment. They barely moved the needle on cancer death rates. Globally, $91 billion was spent on oncology in 2013. In 2014, no cancer drug was approved costing less than $100,000 for a course treatment.
In 2015, eight drugs were approved that cost over $120,000 each for a course of treatment. As noted by Christofferson, this trajectory will eventually bankrupt the health care system. Adding insult to injury, these drugs have marginal efficacy at best.
Consider Tarceva, for example. This cancer drug was approved about 10 years ago. It has significant side effects, it's expensive, and boosts median survival for pancreatic cancer patients by a mere 10 DAYS!
The senior person of the team, professor Bulent Berkarda, was the first medical oncologist in Turkey. Educated in the U.S., Berkarda founded the first Department of Medical Oncology of Turkey at Istanbul University in 1974 and has now been practicing oncology for over 40 years.
Together with Berkarda, the other medical oncologist of the team, assistant professor Mehmet Salih İyikesici completed his education in the leading medical schools of Turkey.
At the center, all oncology patients are put on a ketogenic diet, which creates metabolic stress on the cancer cells. Then, prior to administering the chemo, the patient will do a 14-hour fast, which further increases the metabolic stress on the cancer cells.
The patients will typically have a blood glucose level around 80 milligrams per deciliter (mg/dL) at this point. They then apply glycolysis inhibitors to inhibit the glycolysis pathway in the cancer cells, which creates a terrific amount of metabolic stress, as the cancer cells are already starved of glucose.
Insulin is then applied to lower the blood glucose levels to around 50 or 60 mg/dL, to cause mild hypoglycemia. At that point, chemotherapy is applied.
The upshot of this metabolic approach is that a far lower dose of chemotherapy can be effectively used, thereby lowering the risk of side effects. In the days following chemotherapy, hyperthermia and hyperbaric oxygen therapy is applied, plus a daily infusion of glycolysis inhibitor therapies with high-dose vitamin C (50 grams) and dimethyl sulfoxide (DMSO).
Generally, if a patient has stage 4 pancreatic adenocarcinoma, their life expectancy is about six months, at most 10 months. If they have large-scale liver metastasis, death typically occurs within weeks or months. Yet despite the majority being end-stage advanced patients, they responded remarkably well to the treatment.
Here, the standard conventional protocol using either gemcitabine-based chemotherapy or folfirinox was again applied in a metabolically supported fashion, together with hyperthermia, hyperbaric oxygen therapy, the ketogenic diet, supplements and glycolysis inhibitors.
When the paper was published in 2016, 54 percent of these patients were still alive, and most are still receiving follow-up treatments to this day. Following the conventional protocol, the expected median survival time for the gemcitabine-based protocol is 6.2 months. For the folfirinox regimen it's 11.1 months. Using a metabolically supported protocol, the median survival time shot up to 20 months — and 54 percent of the patients are still alive today.
Using the metabolically supported protocol, however, all of the 44 patients in the study were able to receive treatment, and the overall survival time is 43.4 months — that's more than 400 percent longer than the longest survival time mentioned in any standard chemotherapy regimen.
This is, to the best of my knowledge, the first time all of this data has been publicly shared. It's really exciting to reveal to the world the shocking effectiveness of what Thomas Seyfried, Ph.D., has been speaking about for some time now. And, if you're stage 1 or 2, your cancer is going to be far easier to treat. The results for early stage cancers are likely to be beyond phenomenal.
Essentially, if you have a life-threatening condition like stage 4 cancer, you need to be a bit obsessive compulsive and follow the regimen to the letter. You cannot veer from the protocol if you expect to achieve these kinds of results. You really need to remain in nutritional ketosis. That said, if you're merely seeking to optimize your health or slow down the aging process, cycling through "feast and famine" — opposed to continuously remaining in nutritional ketosis — appears to be a better approach.
Nutritional ketosis is a powerful intervention, as Slocum's team has shown. But if you do it continuously, it can actually be highly counterproductive. You need to have days where you eat more net carbs and more protein, especially with strength training, to prevent sarcopenia that is common in cancer.
This is because when cancer cells are deprived of glucose they have the ability to break down muscle tissue to extract glutamine. Interestingly, Seyfried is working with a glutamine inhibitor called DON to prevent this from happening, thereby making the therapy even more effective.
It is important to understand that the "metabolic magic" actually occurs during that refeeding phase when net carbs and protein are increased, which increases muscle growth. After a day or two, you then cycle back into nutritional ketosis. Typically, this is done once a week. To a degree, Slocum uses this technique on cancer patients as well, although they're only allowed to eat higher amounts of net carbs once every two or three weeks, on the day they receive chemo.
If you're beyond that point and really want to implement this kind of metabolic therapy, I highly recommend preordering a copy of new book, "Fat for Fuel," which gives you all the details on how to do that. Anyone that preorders it will have access to my recent 2017 lecture that I have given at several events. Normally these lectures are never posted online. Incidentally, Christofferson was one of the experts who helped edit my book and actually wrote a section on Dr. Rosedale's work. I'm grateful for all his assistance.
Besides the information in the book, you'll also find many collaborative supports, including a nine-hour-long free video series that we hope to launch in early May. Miriam Kalamian is also developing a certification course to go along with it through the American College of Nutrition, to have more qualified therapists out there.
This certification will teach any qualified clinician — primarily certified clinical nutritionists but also physicians — how to practically implement nutritional ketosis. Eventually, I expect there will be a virtual army of clinicians available to assist patients with this kind of protocol. Hopefully, at that point we'll finally start making a dent in cancer statistics.
Each and every day, more than 1,600 people prematurely die from cancer in the United States alone and 20,000 worldwide. While the situation can sometimes seem hopeless, there are effective ways to prevent becoming another statistic.
And, as you will soon learn, even late-stage cancer patients have cause for new hope these days.
In this interview, Travis Christofferson, author of "Tripping Over the Truth: The Return of the Metabolic Theory of Cancer," and Dr. Abdul Kadir Slocum from the ChemoThermia Oncology Center in Turkey.
They present data from one of the first studies documenting the effectiveness of metabolic therapies and nutritional ketosis in the treatment of advanced stages of cancer.
"I'm very excited for this data to be presented," Christofferson says. "[Cancer] diagnosis has gone up from 1 in 4 to 1 in 3 and is heading toward 1 in 2 ... It's set to surpass heart disease as the No. 1 killer in the Western world by 2020 …
We've been treating this disease a long time. Nixon signed the Cancer Act in 1971 … Radiation and surgery have been around for over 100 years. Cytotoxic chemotherapy was developed right after World War II. [Yet] death rates from treatment have barely budged since the 1950s."
The War on Cancer Has Been Lost Many Times Over
In the mid-1970s, scientists believed they finally understood the molecular basis of cancer. The reigning hypothesis was that cancer was caused by sequential mutations to key oncogenes, which could then be precisely targeted using gene-based therapies. This ushered in the era of targeted therapy.Alas, targeted cancer drugs have been a bitter disappointment. They barely moved the needle on cancer death rates. Globally, $91 billion was spent on oncology in 2013. In 2014, no cancer drug was approved costing less than $100,000 for a course treatment.
In 2015, eight drugs were approved that cost over $120,000 each for a course of treatment. As noted by Christofferson, this trajectory will eventually bankrupt the health care system. Adding insult to injury, these drugs have marginal efficacy at best.
Consider Tarceva, for example. This cancer drug was approved about 10 years ago. It has significant side effects, it's expensive, and boosts median survival for pancreatic cancer patients by a mere 10 DAYS!
"In the meantime, we have these non-patentable therapies sitting on the sidelines that could potentially be game changers for cancer, but they cannot get the billion-dollar backing to push through these huge trials to get the burden of proof to where the oncology community will actually incorporate them," Christofferson says.
"We have all these interesting metabolic therapies. We have repurposed drugs that we could use. The oppressive regulatory environment just needs to be loosened so we can surmount the burden of proof, Phase 1, Phase 2 data, if we have good objective response.
If they're safe — most of these drugs and therapies are extremely safe — that should be good enough.
In the epilogue in my book, I ask the question, 'What would it look like today if we had a less onerous regulatory environment like they did in the '70s, and good oncologists were allowed to … try some of these therapies in the clinic and see what happens?'
That's why I'm so happy we have Slocum here, because he's given us the first glimpse of what metabolic therapies will look like when they're incorporated into the clinic."
Turkish Oncologists Apply the Metabolic Theory of Cancer
Slocum, who is originally from the U.S. but grew up and completed his medical training in Istanbul, Turkey, is part of a four-member medical team at ChemoThermia Oncology Center.1The senior person of the team, professor Bulent Berkarda, was the first medical oncologist in Turkey. Educated in the U.S., Berkarda founded the first Department of Medical Oncology of Turkey at Istanbul University in 1974 and has now been practicing oncology for over 40 years.
Together with Berkarda, the other medical oncologist of the team, assistant professor Mehmet Salih İyikesici completed his education in the leading medical schools of Turkey.
"We started as a team back in 2010, asking the question, 'How can we help our patients in a better way? What can we add to our standard treatment protocols?' Slocum says. "In the last six years, we started applying the [metabolic] therapies and seeing how our patients respond.
Now, for the last two years or so, we're doing retrospective analyses of our patients, publishing our treatment outcomes and sharing the remarkable outcomes we were able to achieve by combining metabolic therapies with standard conventional protocols."The treatment protocol at ChemoThermia Oncology Center includes:
- Metabolically supported chemotherapy
- Hyperthermia
- Hyperbaric oxygen therapy
- Glycolysis inhibitors, especially 2-deoxyglucose (2-DG) and dichloroacetate (DCA)
- Ketogenic diet with phytopharmaceutical supplements
Metabolically Supported Chemotherapy
Metabolically-supported chemotherapy involves applying chemotherapy with a variety of interventions to support its effectiveness.At the center, all oncology patients are put on a ketogenic diet, which creates metabolic stress on the cancer cells. Then, prior to administering the chemo, the patient will do a 14-hour fast, which further increases the metabolic stress on the cancer cells.
The patients will typically have a blood glucose level around 80 milligrams per deciliter (mg/dL) at this point. They then apply glycolysis inhibitors to inhibit the glycolysis pathway in the cancer cells, which creates a terrific amount of metabolic stress, as the cancer cells are already starved of glucose.
Insulin is then applied to lower the blood glucose levels to around 50 or 60 mg/dL, to cause mild hypoglycemia. At that point, chemotherapy is applied.
"[T]his increases the efficacy of chemotherapy in a tremendous way," Slocum says. "We've been applying this for the last seven years now. It's an improved version of insulin potentiation therapy (IPT). IPT is known for many years now, but it's not too widely applied.
Our version of chemotherapy is actually an improved and a much more effective version of IPT because it combines the metabolic theory with the IPT. Metabolically supported chemotherapy is just a different way to apply conventional protocols. We have seen that it increases the effectiveness of the standard chemotherapy regimes. This way, it gives us the option to apply lower doses, see much lower side effects, but much [better] outcomes."As in the U.S., Turkish oncologists are bound by "standard of care" treatment protocols, which includes chemotherapy. As noted by Slocum, "according to the current regime worldwide … the patient, even in Turkey, must receive what's written in the guidelines. If you go against the guidelines and if the patient doesn't receive the standard of care, which is chemotherapy, then you're in trouble." They essentially get around this by just using the lowest dose possible that's written in guidelines.
The upshot of this metabolic approach is that a far lower dose of chemotherapy can be effectively used, thereby lowering the risk of side effects. In the days following chemotherapy, hyperthermia and hyperbaric oxygen therapy is applied, plus a daily infusion of glycolysis inhibitor therapies with high-dose vitamin C (50 grams) and dimethyl sulfoxide (DMSO).
Complete Response for Stage 3 Rectal Cancer
In the team's first publication in 2016, they reported complete response for stage 3 rectal cancer. The standard of care for rectal cancer and the only curative option has been surgery or chemo-radiotherapy followed by surgery. In this case, they used metabolically supported chemotherapy, radiotherapy and hyperthermia. No surgery was necessary."The reason we published that was to explain what metabolically supported chemotherapy is and show how effective it can be," Slocum says. "The patient we published was 81 years old back then.
Generally, in an 81-year-old patient you won't be able to apply standard chemotherapy regimens. She won't be able to tolerate it. By the means of the way we apply chemotherapy, this patient was able to receive chemotherapy at lower doses in a metabolically supported fashion, together with radiotherapy and hyperthermia."In the video, Slocum shows the initial positron emission tomography-computed tomography (PET-CT) scan of this patient. The patient had a 5.5 centimeter large rectal tumor. Three months later, the tumor was in full remission.
"This publication mainly showed that chemotherapy, when applied in a metabolically supported fashion, can be applied to patients who normally can't receive treatment. Also, when it's applied with increased efficacy, responses that aren't normal, generally, which is a complete response in this stage of a disease, can be achieved by the means of metabolic support."
Case Series on Pancreatic Cancer
The second paper published last year was a case series of 33 patients with stage 3 and 4 pancreatic adenocarcinoma (pancreatic cancer) — one of the most aggressive and deadly cancers known. It was a retrospective analysis of patients treated at the clinic between 2011 and 2015. Eighty-one percent of these patients had stage 4 disease when the treatment began, and many of them also had large scale liver metastasis.Generally, if a patient has stage 4 pancreatic adenocarcinoma, their life expectancy is about six months, at most 10 months. If they have large-scale liver metastasis, death typically occurs within weeks or months. Yet despite the majority being end-stage advanced patients, they responded remarkably well to the treatment.
Here, the standard conventional protocol using either gemcitabine-based chemotherapy or folfirinox was again applied in a metabolically supported fashion, together with hyperthermia, hyperbaric oxygen therapy, the ketogenic diet, supplements and glycolysis inhibitors.
When the paper was published in 2016, 54 percent of these patients were still alive, and most are still receiving follow-up treatments to this day. Following the conventional protocol, the expected median survival time for the gemcitabine-based protocol is 6.2 months. For the folfirinox regimen it's 11.1 months. Using a metabolically supported protocol, the median survival time shot up to 20 months — and 54 percent of the patients are still alive today.
"The one-year survival rate for gemcitabine-based protocol is 20 percent. For folfirinox, it's 48 percent. We've seen in our metabolically supported chemotherapy regimen, [survival rate] is 82.5 percent. This shows how effective metabolic support can change the outcomes of treatments and how effective these kinds of treatments can be," Slocum says.
"As all of us know, the scariest cancer diagnosis is pancreatic cancer. Currently in our regimens, we're seeing amazing outcomes. It's so exciting to see how small differences can change these patients' lives so much."
Case Series on Stage 4 Lung Cancer
Next, the team will be publishing a paper on stage 4 non-small cell lung cancer. Here, they applied a chemotherapy regimen using carboplatin and paclitaxel. Large-scale clinical trials show an expected survival time of six to 11 months. Moreover, stage 4 patients typically cannot tolerate conventional chemo regimens so no large-scale studies have focused on such late-stage patients.Using the metabolically supported protocol, however, all of the 44 patients in the study were able to receive treatment, and the overall survival time is 43.4 months — that's more than 400 percent longer than the longest survival time mentioned in any standard chemotherapy regimen.
"This is a dramatic result, even though the patient group we had had more advanced disease and had poor performance status," Slocum notes. "[P]atients who normally were sent home to just wait for the end, to die, and also patients that won't be able to receive treatment … can respond [well] to treatment … The advantage of metabolic treatments is that they're generally not toxic at all. They support the general wellbeing of the patient while also treating the disease."
Survival Rates for Late Stage, Advanced Cancers Dramatically Improve With Metabolic Therapies
In the video, Dr. Slocum shows PET scans and reviews a number of different patient cases, showing the remarkable response of patients with advanced cancer of the rectum, pancreas, stomach, lung and breast.This is, to the best of my knowledge, the first time all of this data has been publicly shared. It's really exciting to reveal to the world the shocking effectiveness of what Thomas Seyfried, Ph.D., has been speaking about for some time now. And, if you're stage 1 or 2, your cancer is going to be far easier to treat. The results for early stage cancers are likely to be beyond phenomenal.
"We hope that this kind of treatment will be the standard of care in the upcoming years. We are all trying to share what would work and how we're achieving these kinds of results," Slocum says. "Other clinics and other physicians will also hopefully start doing similar therapies."Christofferson adds:
"[Thomas] Seyfried [Ph.D., a leading expert and researcher in the field of cancer metabolism and nutritional ketosis] and Slocum met in Tampa. They've started a collaboration ... Hopefully a year from now, when we talk about these shocking outcomes, they're even more shocking.
Just to summarize, [Slocum's] upcoming stage 4 lung cancer paper is incredible … A certain percentage of them aren't going to make it no matter what, but if they can get through this metabolic protocol, the median survival would increase 400 percent.
That's incredible. This stuff basically is free. It just took somebody motivated enough to do this. I mean 2-deoxyglucose (2-DG) is expensive, but ketogenic diet is free. It just takes work. I couldn't be happier that this data is coming to life."
Discipline Is Required When Your Life Is in Your Own Hands
It goes without saying that when using metabolic therapies, the patient carries a significant responsibility for their own outcome. The doctors are not going to cook your food, force you to take supplements or withhold food when it's time to fast. You have to be very diligent and disciplined in following the specified regimen. As noted by Slocum, when patients don't respond as well as expected, probing will usually reveal the problem — they didn't follow the diet, for example.Essentially, if you have a life-threatening condition like stage 4 cancer, you need to be a bit obsessive compulsive and follow the regimen to the letter. You cannot veer from the protocol if you expect to achieve these kinds of results. You really need to remain in nutritional ketosis. That said, if you're merely seeking to optimize your health or slow down the aging process, cycling through "feast and famine" — opposed to continuously remaining in nutritional ketosis — appears to be a better approach.
Nutritional ketosis is a powerful intervention, as Slocum's team has shown. But if you do it continuously, it can actually be highly counterproductive. You need to have days where you eat more net carbs and more protein, especially with strength training, to prevent sarcopenia that is common in cancer.
This is because when cancer cells are deprived of glucose they have the ability to break down muscle tissue to extract glutamine. Interestingly, Seyfried is working with a glutamine inhibitor called DON to prevent this from happening, thereby making the therapy even more effective.
It is important to understand that the "metabolic magic" actually occurs during that refeeding phase when net carbs and protein are increased, which increases muscle growth. After a day or two, you then cycle back into nutritional ketosis. Typically, this is done once a week. To a degree, Slocum uses this technique on cancer patients as well, although they're only allowed to eat higher amounts of net carbs once every two or three weeks, on the day they receive chemo.
"As an example, patients come and they're on a ketogenic diet. When they come in for chemotherapy after a 14-hour fast, then [we] apply glycolysis inhibitors to increase metabolic stress even more and insulin to lower the glucose and then apply chemotherapy.
After applying chemotherapy, on the day of chemotherapy, they are able to eat whatever they want, especially because of the mild hypoglycemia caused by supplying insulin. The day of chemotherapy is when they get as much carbohydrates as they want … We also do intermittent fasting [for a minimum of 14 hours] every other week or so. It seems to be effective."
More Information
The ChemoThermia Oncology Center treats many international patients, including people from the U.S. and Canada. The center also has published protocols your oncologist could make use of, regardless of where you live."We hope there will be physicians open to applying similar regimens to ours," Slocum says. "But a lot of patients who aren't able to come to our clinic, they can [still] do it. They first have to go on a ketogenic diet, which is very effective. Together with that, they should go to their chemotherapy in a fasting state, as long as they can stand it — a minimum of 12 hours. We generally recommend a 14-hour fast. The longer … the better."Ideally, a reduced amount of the chemotherapeutic agents would then be used. While the amount varies according to your diagnosis and condition, the center has included dose range recommendations in their publications. Typically, the lowest recommended dose is given, which will significantly reduce or avoid most of the complications associated with chemotherapy.
"I hope people out there can see how effective metabolic therapies can be and how they can enhance conventional treatment protocols also. I encourage clinicians out there to ask similar questions to us, to read the literature and start applying similar therapies to ours," Slocum says.Christofferson adds:
"What I would like to say is [that] patients who are confused by the ketogenic diet often don't know the difference between protein and carbohydrate. That's where they often get tripped up, because they're not sure what a carbohydrate is. Companies are stepping into this fray, making prepackaged ketogenic meals for cancer patients that take out the guesswork.
The ones I've seen are really well done by gourmet chefs and [use] real ingredients. That's another option. There's enough on patients' plates to begin with … That's going to take a lot of the guesswork out for patients, I think."To learn more about nutritional ketosis and the metabolic theory of cancer, I highly recommend listening to the interview I did with Christofferson last year, and to read his book, "Tripping Over the Truth," which provides the background as to why and how this therapy works, and why the conventional approach to cancer is fatally flawed.
If you're beyond that point and really want to implement this kind of metabolic therapy, I highly recommend preordering a copy of new book, "Fat for Fuel," which gives you all the details on how to do that. Anyone that preorders it will have access to my recent 2017 lecture that I have given at several events. Normally these lectures are never posted online. Incidentally, Christofferson was one of the experts who helped edit my book and actually wrote a section on Dr. Rosedale's work. I'm grateful for all his assistance.
Besides the information in the book, you'll also find many collaborative supports, including a nine-hour-long free video series that we hope to launch in early May. Miriam Kalamian is also developing a certification course to go along with it through the American College of Nutrition, to have more qualified therapists out there.
This certification will teach any qualified clinician — primarily certified clinical nutritionists but also physicians — how to practically implement nutritional ketosis. Eventually, I expect there will be a virtual army of clinicians available to assist patients with this kind of protocol. Hopefully, at that point we'll finally start making a dent in cancer statistics.
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