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David Perlmutter, M.D.

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When it Comes to Brain Cancer, Let's Look Beyond Chemo

Posted: 07/25/11 05:28 PM ET

The most common -- and unfortunately the most aggressive -- malignant tumor arising in the brain is the glioblastoma (GBM). And despite the advances made over the past decade in cancer therapy, the median survival from the time of diagnosis of this tumor remains at about 12 months.

Typically, treatment involves surgery to remove as much of the tumor as possible followed by a combination of radiation therapy and chemotherapy. Patients are often treated with steroids as well, in an effort to reduce brain swelling. These modalities have been shown to increase survival by only a few months compared to the choice of foregoing any medical treatment. Indeed, even with what most would consider the very best of currently available treatment, Senator Ted Kennedy succumbed to this type of brain tumor in just 15 months.

A fundamental premise in cancer therapy is trying to identify how the metabolism of cancer cells differs from normal tissue. When differences are identified, it often paves the way for treatments that will disrupt the cancer's metabolism while sparing normal tissue.

Recent discoveries have revealed an important difference between GBM cells and normal brain tissue. We've all learned that the brain depends upon an adequate supply of glucose -- its primary fuel -- to function appropriately. Interestingly, the human brain has developed an important backup plan when food is scarce. Humans are not the fastest or the strongest animals on the planet, but when it comes to survival we have had the unique advantage of being clever. Our ancestors relied upon their advanced brains to survive during times of food shortage and fortunately the human brain is able to utilize body fat as an extremely efficient fuel to sustain function when glucose providing food is unavailable. Essentially, the body breaks down fat to create ketones, a form of fat that readily and effectively powers the brain.

Recently, it was discovered that while normal brain tissue easily adapts to using ketones as a metabolic fuel, cancerous GBM cells lack this ability. This type of brain tumor depends almost entirely on a constant supply of glucose to thrive.

In a recent research publication, Dr. Thomas Seyfried from the Biology Department at Boston College, described a dietary modification designed to take advantage of the fact that GBM cells cannot thrive in a ketone rich environment while normal brain cells can. He proposed, "an alternative approach to brain cancer management that exploits the metabolic flexibility of normal cells at the expense of the genetically defective and metabolically challenged tumor cells."

Essentially, he described how a ketogenic diet would provide fuel for normal brain cells while profoundly reducing the glucose that the tumor cells required for survival. The fundamentals of this groundbreaking approach basically involve incorporating a low-carbohydrate diet like the popular Atkins approach, coupled with the addition of a nutritional supplement to provide extra ketones. For the latter, he described medium chain triglyceride (MCT) oil, a non-prescription supplement.

After his initial publication, aptly entitled, "Metabolic Management of Brain Cancer," Dr. Seyfried went on put his theory to the test. In April 2010 he published a report detailing his experience actually employing this approach in the treatment of a GBM patient. In this report, published in the journal Nutrition and Metabolism, Dr. Seyfried described the dramatic results achieved in treating a 65-year-old woman diagnosed with GBM who was treated with standard therapy including surgery, chemotherapy and radiation, as well as an aggressive ketogenic diet. The results were remarkable as the tumor regression far exceeded what would have been expected with standard therapy alone.

There are many reasons, some of which I suspect may be economic, that Western medicine settles on aggressive therapies like radiation and chemotherapy when confronted with the challenges of cancer. While nutritional approaches may seem less heroic or sophisticated, nonetheless when we see science-based ideas like those described by Dr. Seyfried, we owe it to our patients to pay attention.

While radiation and chemotherapy offer some degree of benefit, it's clear that their effectiveness in treating GBM is limited. The very best physicians can do is to remain open-minded.

 
 
 

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ziggy3339
07:05 PM on 09/23/2011
It seems we are evolving towards an answer (cure) that attacks the root cause for diseases. I've heard for years that chemo/radiation will some day be obsolete, considered barbaric, etc. I'm thinking that regardless of the disease there's always a cause. (To every action there's an immediate & opposite reaction reasoning). I'm glad to hear that diet is being considered as part of a helpful, progressive and doable course of action. I, like others here, have seen the low carb, high protein diet promoted as a cure for so many things. I've heard that in the US the quality of food isn't nearly as high as in europe. I don't know if this is part of the problem/cause or not. I know my local grocery has VERY limited space for organic foods (even eggs) . That means, I suppose, pesticides are in every other thing? Just a thought. thanks for the article.
12:16 AM on 08/01/2011
Let's see. Ketogenic diet is the best diet to fight GBM cancer and obesity, prevent/control Type 2 diabetes and epileptic seisures, improve triglyceride and HDL numbers, reduce inflammation, help people with HDD, autism and mental/gut problems, control Type 1 diabetes, etc Can anyone add to this list?

Sounds like a pretty valuable diet for doctors to know, love and RECOMMEND.
07:31 PM on 07/27/2011
Dr. Perlmutter, my dad was diagnosed with a GBM about 8 weeks ago and has completed surgery and chemo/radiation. We have been talking with leading ketogenic dieticians about getting my dad started on this therapy very soon. If you can, would you contact me to share any additional information you may have gathered as you did research for the writing of this article? thanks!
11:08 PM on 07/31/2011
Reid, Here's Seyfried's page at Boston College:

http://www.bc.edu/schools/cas/biology/facadmin/seyfried.html

Contact him immediately. He's more than happy to talk to you.

My father had GBM and I know about as much as a lay person can know about this goddamn thing. Please feel free to contact me at

psjehle2@gmail.com

I can put you in contact with a neuro-oncologist who's willing to help and a few survivors who are treating themselves with the RKD (restricted ketogenic diet--emphasis on RESTRICTED).

The current treatments for GBM are shamefully bad. Medical science has nothing to be proud of when it comes to the treatment of this disease. So it is up to us to do something about it. Seyfried's approach seems to work for just about everybody I've talked to, and it seems to have a sounder theoretical basis than the current (extremely vague) idea that genes are somehow behind it all.

Also realize that the 12-month survival time is REAL, okay, so don't let anybody say that "everybody's different." Everybody is different--but not that much. So get going with this treatment as soon as your father is off steroids. In fact, get everything in place before then. It's not easy and he and everyone helping him or doing it with him best get used to it.

Anyway, please contact me -- and definitely contact Dr Seyfried.

Stay strong. Best to your father & the rest of your family.

Patrick Jehle
06:09 PM on 08/01/2011
I wish your father the best. My stepmother passed away two years ago from a brain tumor. There's a documentary I would highly recommend watching: go to burzynskimovie.com and watch it. It can't hurt you or your father to at least have this information available to you and you can research what it talks about and come to your own conclusions. I personally am very sad that it came out after my stepmother passed away. Good luck.