Research Narrative Review| Volume 118, ISSUE 4, P668-688, April 2018

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A Nutritional Perspective of Ketogenic Diet in Cancer: A Narrative Review

Published:March 30, 2017DOI:


      The predominant use of glucose anaerobically by cancer cells (Warburg effect) may be the most important characteristic the majority of these cells have in common and, therefore, a potential metabolic pathway to be targeted during cancer treatment. Because this effect relates to fuel oxidation, dietary manipulation has been hypothesized as an important strategy during cancer treatment. As such, the concept of a ketogenic diet (KD) in cancer emerged as a metabolic therapy (ie, targeting cancer cell metabolism) rather than a dietary approach. The therapeutic mechanisms of action of this high-fat, moderate-to-low protein, and very-low-carbohydrate diet may potentially influence cancer treatment and prognosis. Considering the lack of a dietetics-focused narrative review on this topic, we compiled the evidence related to the use of this diet in humans with diverse cancer types and stages, also focusing on the nutrition and health perspective. The use of KD in cancer shows potentially promising, but inconsistent, results. The limited number of studies and differences in study design and characteristics contribute to overall poor quality evidence, limiting the ability to draw evidence-based conclusions. However, the potential positive influences a KD may have on cancer treatment justify the need for well-designed clinical trials to better elucidate the mechanisms by which this dietary approach affects nutritional status, cancer prognosis, and overall health. The role of registered dietitian nutritionists is demonstrated to be crucial in planning and implementing KD protocols in oncology research settings, while also ensuring patients’ adherence and optimal nutritional status.


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      C. L. P. Oliveira is a doctoral degree student, Nutrition and Metabolism, Department of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada.


      C. M. Prado is a registered dietitian, an assistant professor, and CAIP Chair in Nutrition, Food, and Health, Department of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada.


      S. Mattingly is a postdoctoral fellow, Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada.


      M. B. Sawyer is an associate professor, Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada.


      R. Schirrmacher is an associate professor, Department of Oncology, Medical Isotope Cyclotron Facility, University of Alberta, Edmonton, Alberta, Canada.


      E. J. Fine is a clinical professor, Department of Radiology (Nuclear Medicine), Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY.