Tripping Over the Truth

Is Cancer a Metabolic Disease?

As I type these words, I’m hurtling through the sky somewhere over the North Atlantic on my way to the US from Germany. I just woke up from about a two hour nap, during which I was flat on my back and got to stretch my 6’2” frame to the max without hitting the end of my little cubicle. Yes, cubicle. I’m kicked back in business class in a medium-sized jumbo jet fending off the flight attendant’s offers of a multitude of libations and snacks. What a contrast to the first time I flew to Europe when I was a kid in 1969, off for a libidinous summer abroad. Then I was crammed into the last row, window seat of a Boeing 707, a small tube of a plane (but the largest around at the time), which didn’t have the avionics of a little Cessna trainer plane you could buy today. In the last 48 years, like most industries, commercial aviation has improved in virtually every aspect. Consequently, my trip today is much different than the one in 1969. Sadly, however, were I to come down with cancer today, I would discover that, for the most part, treatments now wouldn’t be much different or any more effective than they were in 1969. Or even 1959. And that’s an awful realization, since as cancer is on its way to overtaking heart disease as the leading killer, sooner or later everyone is going to come into contact with the ravages of it up close and personal.

What do aviation and cancer have in common? Not a lot, but cancer has been on my mind because before I left on this trip about a week ago, I finished an extraordinary book on cancer by Travis Christofferson called Tripping Over the Truth: How the Metabolic Theory of Cancer is Overturning One of Medicine’s Most Entrenched Paradigms.

Tripping over the truth

I have received more emails from people asking me my opinion of this book than any other book I can think of. I read it a couple of years ago when the first edition came out, so when I heard a new, updated version was soon to be available, I snagged a review copy from the publisher. I thought the first edition of the book was pretty good, but the new, revised edition is an absolute gem that should be read by everyone. But before I get to the book, let me tell you about my family’s close encounter with cancer.

A Typical Case of Cancer Treatment Today

On New Year’s Day in 2012, my wife MD and I were in Little Rock, Arkansas visiting her sister, Rose. A great cook who loves to throw dinner parties, she put together a small group of friends to join us at her house for a New Year’s spread. As usual, it was excellent. MD and I left the next day, but before we did, MD’s sis complained that she had an upper respiratory infection. MD checked her over and gave her a prescription for an antibiotic.

They talked a couple of days later on the phone, and Rose said she was much improved. But shortly she had a relapse and asked MD to call her in another round of medication. This went back and forth – her getting better then worse – for about a month. Rose was a long-time smoker, and in light of this lingering respiratory condition, MD had been badgering her to get a chest X-ray. When she finally did, she was ecstatic, as most smokers are when they get the normal-chest-x-ray news. But despite her normal chest film, she continued her cycle of upper respiratory infections, each one getting a little worse than the one before. And now she was becoming hoarse. MD finally insisted that her sister go to a physician there who could actually examine her, instead of simply listening to her symptoms over the phone. So, she made an appointment.

By the time she had her appointment in early March, she was seriously ill. She couldn’t sign in at the receptionist’s counter, not because she was so sick, but because her brain wasn’t working. She couldn’t figure out how to write her name. The doc checked her over and sent her immediately for a head scan, which came back showing five large masses, which were compressing her brain and creating her cognitive difficulties. Though there might have been other possibilities, when we got the news MD and I figured they were metastatic tumors, which often go to the brain. Her sister, of course, was then scheduled for the full cancer workup.

When the results came back on March 6, they were pretty grim. She had a chest full of cancer, but not so much in the lungs. It was mainly in the lymph nodes of her mediastinum (the central part of the chest) and hilum (at the base of the lungs) and also in an adrenal gland and, of course, her brain. A biopsy showed highly undifferentiated adenocarcinoma. Cell typing showed the primary came from the lung. Not a diagnosis anyone wants to get.

Due to the location of the tumors, surgery wasn’t an option, so she was spared the ‘slash’ part of the ‘slash, burn, and poison’ treatment protocol for cancer.

Since she was so ill, she was hospitalized. She lost her voice, which the oncologist thought was due to the cancer impinging on the nerve that makes the vocal cords work. He blasted her with a couple of doses of a potent chemotherapeutic cocktail that quickly knocked the cancer back enough so that she could speak and swallow, though her voice was a croaky whisper.

MD had dropped everything and hopped a plane once she learned the diagnosis. I came a week or so later. MD stayed in the hospital with her sister while she went through the first blast of chemo and saw first hand the wretchedness of it. The unremitting nausea and vomiting and all the rest.

I want to digress here for a bit to let you know that until MDs sister’s cancer diagnosis, I had never had any actual day to day exposure to the disease. (MD had some, with other family members, but never as up-close and day-to-day as this one.) We had both diagnosed plenty of it in our careers, but we always referred the cases on to oncologists to take care of. We knew a fair amount about cancer on an academic level. We could both have told you the prognosis of most any cancer you might name, and we understood on an intellectual level the misery cancer and cancer treatment bring about. But knowing it on an intellectual level and living it every day on a gut level are two different things. It was eye opening to both of us.

MD and Rose in Toledo, Spain late June 2011

MD and Rose in Toledo, Spain late June, 2011 nine months before Rose’s cancer diagnosis

Rose began a multi-week course of radiation therapy for the tumors in her brain and chest. MD schlepped her over to the treatment center five days a week for six weeks of treatment that left her exhausted, nauseated, and cost her her hair. She also took massive doses of steroids to prevent swelling of her brain after the insult of the radiation.

After the radiation, the chemotherapy began. And it was a nightmare from day one. She experienced almost every bad thing that can be experienced with chemotherapy. As she struggled on with her treatments, MD and I had to leave for a bit. We left her sister in the capable hands of their nephew, who had been there from the start, helping MD throughout the weeks of treatment with all the ferrying around.

Rose ended up having problems while MD was away (a deep vein thrombus that required placement of a vena cava filter and a bleeding gastric ulcer) and she had to be hospitalized. MD rode herd on her hospitalization from afar, because her sister’s oncologist was MD’s medical school classmate, so they spoke almost daily. She slowly improved and fought on.

At the end of the course of therapy, she had another total body scan. This one on May 12 showed pretty much a complete regression of the tumors in her head and a major regression of the nodes in her chest. All that was left was some scarring where the tumors had been in her head. Things looked pretty hopeful.

On June 2, a few days before we were planning to head back to Little Rock, the oncologist told MD that her sister was doing so well he planned to move her out of the hospital to a kind of halfway house rehab center. She was pretty weak and needed someone there with her. Rose was torqued because she wanted to go home. Which was under discussion because MD and I would soon be coming back and living there with her for a while.

The next morning — the morning of the day before we were headed back — MD got a call from the oncologist, who told her he was on his way to the hospital, because her sister was having some shortness of breath. A couple of hours later, MD got another call. The oncologist told her that he did a chest x-ray and that her sister had lymphangitic spread of the cancer throughout her lungs, which is pretty much a terminal stage event. He said that he had talked to Rose, explained the situation, and told her all he could do was make her comfortable and he told MD to come back quickly. He texted her chest x-ray to MD and me. It was horrific.

MD called her sister and told her to hang on, that we were coming. We tried everything to get a flight out that would get us there that day, but the only thing we could find was a red eye flight out of LAX that would get us there at 8 am, which we booked. As our ride was coming to pick us up to take us on the two hour ride to LAX, MD’s nephew called and told us her sister had just died.

It was June 3, 2012. Just three months after her diagnosis and six months after the New Year’s dinner party at which she seemed totally normal.  Not quite a year after the photo above was taken.

MD was the executrix for her sister’s estate. When she gathered all the medical bills for this three month treatment period, they totaled a little over $400,000.

I’ve gone on at length about MD’s sister’s illness to give those of you who haven’t lived cheek by jowl with someone with terminal cancer a better understanding of how devastating this disease can be. And how, in most cases, the treatment is worse than the disease. If MD’s sister hadn’t gone through this long and expensive process, she might have lived one miserable month instead of three. Or she might have lived six months. Was it worth it? I can’t speak for her, but having lived there on the front lines with it, it doesn’t seem so to me.

The War on Cancer

On December 23, 1971, as a Christmas present to the American people, President Richard Nixon signed into law the National Cancer Act, allocating $1.6 billion ($9.7 billion in today’s dollars!) to declare the War on Cancer. One of the observers cheering loudest was Senator Edward (Ted) Kennedy, one of the act’s biggest supporters. Confidence was high that with the massive funding involved and America’s can do spirit, cancer might be vanquished by 1976, the US Bicentennial.

Thirty-eight years later Senator Kennedy himself succumbed to brain cancer. He died on August 25, 2009 after having gone through the same kinds of horrendous treatment Rose did. Despite the billions of dollars spent on cancer research, Senator Kennedy ended up getting the same treatment and experiencing the same dreadful outcome he would have gotten had he developed his brain cancer before December 23, 1971, the kick off of the War on Cancer he so supported.

How come the multi-billion dollars thrown at cancer research hasn’t gotten us any closer to a cure than we were when Nixon signed the bill? Could it be for the same reason all the money spent to promote low-fat diets ended up making us fat and diabetic? Have the ‘experts’ been on the wrong track?

In Tripping Over the Truth, Travis Christofferson makes the case that the cancer research industry has been on the wrong track. While they’ve been fruitlessly throwing billions of dollars at the genetic theory of cancer, the real cause of most cancer is not genetically derived. Instead he posits that cancer is a disease of deranged cellular metabolism.

Dueling Cancer Theories

I’m sure if I dug in and pored through all the literature, I could find dozens of offbeat theories of how cancer gets its start. There are doubtless many people who have published their own theories of the initiating factors causing normal cells to undergo the transformation into malignant cancer cells, but the two theories accepted by the greatest number of people are the genetic theory and the metabolic theory. The vast majority of cancer researchers are believers in the first theory, the so-called Somatic Mutation Theory.

The Somatic Mutation Theory of Cancer

In 1914, Theodor Boveri, a German cell biologist, kicked off the Somatic Mutation Theory of Cancer (SMT) by publishing the first paper discussing the role of chromosomal abnormalities and their role in cancer. The main premise of the SMT is that cancer arises in a single somatic cell (any cell other than a reproductive cell – could be skin, lung, bone, brain, etc.) due to an accumulation of multiple DNA mutations over time. This single cancerous cell grows and replicates in an uncontrolled fashion due to other mutations in genes controlling growth and the cell cycle.

Should this theory be true, it would mean that if the specific mutations were known, then therapies could be designed to treat them. Countless dollars have gone toward discovering these mutations and trying to match them with specific cancers. But, unfortunately, there has been minimal success. Researchers have identified an enormous number of specific mutations, but there is little, if any, correlation between these mutations and types of cancer. Consequently, the treatments for the vast majority of cancers rely on surgery, radiation, and chemotherapy (slash, burn and poison) in combinations mostly unchanged over the past 50 years.

The typical outcome of these treatments: misery on the part of the patient, shrinking of the cancer, and little to no prolongation of life.

The Metabolic Theory of Cancer

After World War I another German scientist, Otto Warburg, started studying cancer. He found a unique feature of cancer cells: they fermented glucose in the presence of oxygen. In normal cells, under anaerobic conditions (i.e., without oxygen), glycolysis (the metabolism of sugar) proceeds and results in the production of lactic acid. When oxygen becomes available, anaerobic glycolysis is shut down in normal cells (the Pasteur effect), but Warburg found that cancer cells continue to produce lactic acid even in the presence of plenty of oxygen, a phenomenon now called the Warburg effect.

As Christofferson writes:

As Warburg continued his experiments, he found that cancer’s defective metabolism presented itself without exception in all types of tumor cells. Now he could be sure. To him, this reversion was the prime cause into which all other secondary causes collapsed. The shift from aerobic to anaerobic energy generation was the signature difference between cancer cells and normal cells. Nothing was more fundamental to a cell than energy creation. Nothing could be further reduced.

Years later, Warburg made another critical observation that hinted at why cancer cells were fermenting in the first place. He showed that when normal, healthy calls were deprived of oxygen for brief periods of time (hours), they turned cancerous. No other carcinogens, viruses or radiation were needed, just a lack of oxygen. This led him to conclude that cancer must be caused by “injury” to the cell’s ability to respire. He contended that once damaged by lack of oxygen, the cell’s respiratory machinery (later found to be the mitochondria) became permanently broken and could not be rescued by returning the cells to an oxygen-rich environment. He reasoned that cancer must be caused by a permanent alteration to the respiratory machinery of the cell. It was a simple, elegant hypothesis. Warburg would contend until his death that this was the prime cause of cancer.

Let’s take a minute to go over what he means by the “cell’s respiratory machinery.” Respiration is more or less defined as taking in oxygen, which is used to fuel metabolism (in the same way that oxygen is required to burn a fire in your fireplace), and releasing carbon dioxide and water. We do this constantly. We breathe in oxygen-containing air and breathe out carbon dioxide and water vapor (and make urine). Cells do the same thing.

Cells take in oxygen and produce carbon dioxide and water. But not all metabolic processes use oxygen all the time. Glycolysis, as we discussed above, can operate without oxygen. Other pathways that generate ATP (the cellular energy currency) can also operate without oxygen. The part of our metabolic process that cannot work without oxygen is located on the inner mitochondrial membrane and is called oxidative phosphorylation. The metabolic pathways that can work either in the presence of oxygen or not are called substrate level phosphorylation and represent about 12 percent of total energy produced. Oxidative phosphorylation produces 88 percent of total energy, the obvious lion’s share.

When the respiratory part of the energy production process becomes damaged, then the substrate level phosphorylation is left to come up with all the energy required for the cell to function, or the cell dies. Usually the cells die, but when they don’t, they become cancer cells.

Damage to the respiratory function of the cell can then lead to instability of the genome as the cancer develops. The instability of the genome can then lead to additional respiratory impairment, which then leads to more genetic instability, etc.

A major difference between the SMT and the Metabolic Theory of Cancer is what precedes what. Those who are supporters of the SMT believe the genetic instability arises first and causes the respiratory dysfunction. Those who favor the Metabolic Theory believe as described above: the initial insult is to the cell’s respiratory system with the genetic instability following as a consequence.

In Tripping Over the Truth you’ll learn the history and background to these two competing theories and why the Metabolic Theory is the odds on favorite for taking the cancer sweepstakes. It’s a book loaded with an unforgettable cast of characters, many of whom are less than savory. For example, James Watson of double-helix fame even slithers into the story by trying to purloin the work of a young researcher, who may have hit upon a real cure for cancer.

The new edition of this book is absolutely gripping. I thought it on par with some of the best mystery novels I’ve ever read, which is a lot to say for a non-fiction book on cancer. I read it over a few days, and when I wasn’t reading, I was thinking about it. I couldn’t wait to get back to it. I thought maybe it was just me, but I blathered on about it so much, MD wanted to read it. She felt the same way. She stayed up half the night polishing it off.

I believe the book is hugely important and should be read by everyone, because sooner or later cancer is going to cross everyone’s path one way or another. The book is a must-read for anyone with cancer or who has a friend or loved one with cancer.

It’s an important book, not just because it tells the story of the Metabolic Theory, but because it dispels a lot of myths I’ve heard bandied about on Facebook and Twitter.

It Must be True.  I Read it on Twitter

Since most cancerous cells must ferment glucose for energy, it means that if they don’t get glucose they can’t survive. Since the cancer cells can’t really use ketones or fat, because these substances require the broken part of the respiratory process to metabolize, it makes sense for cancer patients to go on high-fat, ketogenic diets. Which is true. Tripping Over the Truth tells many miraculous stories of sufferers of cancer of one kind or another being jerked from the jaws of death and allowed to live many more years by switching to a ketogenic diet. But too many people seem to think a ketogenic diet is the total answer. It makes sense. The cancer needs sugar to survive. Deprive it of sugar, and you’re cured. Unfortunately, it isn’t that simple.

Physicians who are treating cancer based on its being a metabolic rather than a genetic disease use many of the same therapies that oncologists use treating cancer as if it were a genetic disease. The best outcomes are those in which everything available is arrayed against the cancer. Especially the ketogenic diet.

A ketogenic diet, the mainstay of the program, makes the cancer cells more vulnerable to the radiation and chemotherapeutic agents while at the same time making the surrounding normal, non-cancerous tissue healthier, more robust and better able to withstand the assault of the poisonous drugs. Other treatment modalities such as hyperbaric oxygen add to the treatment armamentarium. From the limited number of studies, it appears that patients respond much better to therapies underpinned by the ketogenic diet than chemotherapy alone.

Reading about the virtues of the ketogenic diet in beating back cancer and enhancing the health of normal cells can’t help but make you a believer in the notion that a ketogenic diet would be a great way to prevent cancer.

One of the great virtues of this book is a description of many of the therapeutic modalities that have been used along with the ketogenic diet and a list of physicians who treat cancer as if it were a metabolic disease.

I feel heartened, because even the mainstream is starting to change. I had lunch a few weeks ago with my son and a friend of his, who had undergone surgery a couple of months before for esophageal cancer. When diagnosed out of the blue (both he and his gastroenterologist thought he had an ulcer), he headed off to MD Anderson Center in Houston, the most mainstream of the mainstream, to get a course of chemotherapy to shrink the tumor so that it could be operated on. After his chemo, he underwent surgery to remove and reconstruct the cancerous part of his esophagus. When he went back to his surgeon on a follow up visit, he asked what he could eat. The surgeon told him, “Pretty much anything…except sugar. Sugar is poison; it feeds the cancer.” If that’s what they believe at MD Anderson, they’ve come a long way and there is hope for the future.

I’m going to send this guy a copy of the book. I suggest you do the same for anyone you know with cancer.

Cancer as a Metabolic Disease

If you want a much more technical description of the Metabolic Theory of Cancer, you can read the book that inspired Travis Christofferson to write Tripping Over the Truth: Thomas Seyfried’s encyclopedic Cancer as a Metabolic Disease. It’s pricy (~$125 on Amazon) and is written for a scientific audience. It’s a terrific book, but it is highly technical and unless you’re used to reading this kind of material, I wouldn’t spend the money. But if you’re a person who relishes technical reading, by all means pick this one up.

Cancer as a Metabolic Disease is an in depth, extremely technical argument that cancer is a metabolic disease.  Tripping Over the Truth is the story of the development of the hypothesis.

You can also read Dr. Seyfried’s paper Cancer as a Metabolic Disease written in 2010. It is still fairly technical, but much less so than his book of the same name.

MD and I have discussed many times how much we wish we had the information in Tripping Over the Truth before Rose’s diagnosis.  But it wasn’t in print then.  I remember learning about Dr. Seyfried’s book and purchasing it immediately.  As you can see from the notice on my Amazon account, that was exactly ten days after Rose died.

Purchase of Cancer as a Metabolic Disease

 

Monthly Book Reviews

Reading_recommendations

I have been writing a series of book reviews each month that I email to subscribers. If you're interested and want to get on the list, sign up here (or above where it says Get free email alerts in the upper right). I'll send you an email notice of all new blog posts plus all my monthly book reviews. Also, you will get a link to all the previous month's book reviews I've sent. Hope to see you aboard.

Powered by ConvertKit

Please note: I reserve the right to delete comments that are offensive or off-topic.

Leave a Reply

Your email address will not be published. Required fields are marked *

63 thoughts on “Tripping Over the Truth

  1. Hi Dr. Mike! Thank you so much for this post (and we are so glad to have you “back” and blogging again!)

    I find this subject fascinating – of all the genetic predispositions we could have in our family, the one that scares me the most is our prevalence of cancer. My father died of it at 71 (prostate to bone) and my maternal grandmother died of it comparatively young (mid fifties). My biological mother died at 38 (accident) so we can’t know how the genetics would have affected her.

    About six months ago, I was reading one of your posts and the lightbulb finally went on for me. I’ve been LC (>50g/day, most days much less than that) ever since and feel better than I ever have (I’m 42 in a few weeks).

    Especially given how much better I feel since going LC, I plan to eat this way forever. I’m still exploring how best to feed our kids (5 and 4 ) because I do understand that kids’ metabolism is different. However, what I’ve read in the last 6 months about the connection between sugar and cancer makes me wonder (with no small degree of fear!) if the seeming explosion of childhood cancer in the last couple decades isn’t tied to the insanely high sugar content of the average American child’s diet.

    I will absolutely read the book, but as always, appreciate your analysis and thoughts on it. I was so very sorry to read of MD’s sister’s story.

    And if you have any general thoughts (understand you can’t give medical or specific advice) on the healthiest diet for kids in general, please post! I’ve read Peter Attia’s posts on this and regarding what he feeds his daughter, and found that helpful – we do roughly the same. Just curious what, if your kids were small again, you’d feed them today.

    As always – thank you again for all you do and share with us!

    • Our youngest kid was small when we started low-carb, so he ate pretty much what we did while at home. The way we dealt with all our children was to feed them lowish carbs at home and figure they would eat what they wanted when they were out with their friends.

      I think that the high sugar intake of the average kid’s diet is horrendous. Especially the average adolescent. When I was an adolescent and went out with my high school friends, we bought soft drinks individually. The price kept us from overconsuming. I hate to think how much I would have drunk if I had access to the unlimited dispensers that are now common in fast food places.

  2. I turn to you and Andrew Weil on most medical matters..Your sincerity and good intent comes out from your words…….You and Andrew Weil are a breath of fresh air in a medical world manipulated by the Pharmaceuticals.
    Thanks again from an appreciative Scot in the UK

  3. Thanks for this recommendation. I’m going to download on my Kindle now.

    You are a truly outstanding writer. Your ability to take complex subject matter and write about it in an accessible and conversational manner is unsurpassed by any author/blogger out there.

    I have a little cognitive dissonance on this subject. I’m a card-carrying member of the keto cult who “vacations” at low-carb conferences, tries like hell to avoid most carbs, and tests his B-OHB at least once daily.

    But I’m also an investor in a new biotech company that tests for genetic mutations in cancer tumors and is a pioneer in the liquid biopsy field which, as you know, tests for mutations by looking at cell-free DNA that is shed by cancer cells that are shed into the blood.

    From a selfish fiscal perspective (and a humanitarian one), I’m hoping the genetic and metabolic theories can be reconciled. Sort of like evaluation and creationism can be for those looking for a little truth in both. Your review suggests that the book will explain reconciliation is possible.

    Thanks again. And looking forward to seeing you present again this summer in San Diego.

  4. My wife was diagnosed with cancer in June 2016. We are still fighting. They did radiation on her left femoral head then started in on the other spots primarily lung. She had stopped smoking 6 yrears ago. The chemo wasn’t working so the went to immuno therapy. It was working but she had no appitite and was getting weaker to the point where she could not even walk with a walker. They hav stopped al therapy and are trying to build her up so they can pt scan and give her more immuno therapy. Whether on not I can get her eating more ketogenically is doubtful. This has been and contiues to be an emotional mess. I will get the book.

  5. I will read it. I remember running across … somewhere … that in Europe, the “poison” part is handled very differently from in the U.S. Here, as I remember, we just throw the biggest, baddest, worst poison we have at every cancer — even when that particular poison has NOT been found to be particularly effective against that particular type of cancer. Oh — it was Suzanne Sommers in one of her earlier books. (She’s actually extremely smart and does deep research for her books.) In Europe, they actually TEST the person’s particular cancer, and the various poisons — and only use the one that’s shown to be effective! (So, no poisoning someone with a chemo that is about 90% UNlikely to help that person! What a concept!) However, the testing is expensive, so the U.S. medical system doesn’t bother ({wince} “bother”); they just poison the hell out of everyone … and (make the patient) roll the dice!

    As a wise, wise doctor once wrote in his blog: when the pilot makes a mistake, the pilot dies. When the air traffic controller makes a mistake…. the PILOT dies!

  6. A nicely done article – adding the personal journey added a lot and so sorry for your loss. After reading the article I couldn’t help but wonder what you mean when you refer to sugar. (As in what should I not eat) Fruit? Potatoes? Baked goods made with whole wheat flour? Candy? Table sugar? Honey? Maple Syrup? The Carbs in green vegetables? Anything that makes insulin spike? Anything with carbs that doesn’t have lots of fiber? Could you be more specific?

    • Sugar, as referenced in the post, is blood sugar as that’s the sugar that feeds the cancer. Anything that increases blood sugar increases food to the cancer. a ketogenic diet reduces blood sugar markedly in most folks and creates a situation in which the cancer has to struggle to grow.

          • First off, severe sympathies!

            I’m fortunate not to have such up close experience though I’ve seen my share in colleagues and relatives of friends, some at appalling ages like 23 and 51 (two of the most recent)

            There’s a VERY weird familial pattern, according to relatives who have done genealogical research there is no cancer at all, ever, in my mother’s family, and very little in my father’s family. Most of them die of CVD or being completely worn out at an advanced age.

            However there’s a string of a form of Type 2 diabetics and prediabetics/undiagnosed diabetics in mother’s family, mostly males, who die prematurely from CVD.

            This makes me ponder, how many more diabetics would get cancer if they hadn’t already died of CVD? And for that matter, how many nondiabetics?

            From my reading it would appear that just as with the diabetes/CVD axis cancer treatment usually consists of a diet that diametrically opposes the other treatments, and that while a keto diet isn’t a cure it certainly potentiates the effects of whatever else you throw at it. Be interesting to follow Richard Feinman and Eugene Fine here.

  7. I hung out with a couple of MD Anderson docs a while back. They were not at all dogmatic in general conversation, which is not that common among cancer docs. My sense is the place is not intellectually closed off, and while they are mainstream, as you say, there is room for pragmatism.

  8. So interesting about MD Andersen becoming more open-minded. I just read about how MD Anderson collaborated on some research using the Banerji Protocol for treating cancer. The Banerji Protocol is a non-classical form of homeopathy that gives homeopathy more like medications for specific diseases after modern diagnostic procedures (as opposed to classical homeopathy that matches the remedy to the individual). The Banerji brothers focus a lot on cancer — brain cancer in particular. You can read more about it here: http://cdn.intechopen.com/pdfs/26491/InTech-Homeopathy_treatment_of_cancer_with_the_banerji_protocols.pdf (PDF)

    Relevant excerpt:

    “Our own studies done in collaboration with American researchers at the M.D. Anderson
    Cancer Center, University of Texas must be mentioned at this point, for they have
    demonstrated plausible biological mechanisms for the antitumor effects of the homeopathic
    medicines tested. In one report we described 15 patients diagnosed with documented
    intracranial tumors who were treated exclusively with the homeopathic remedies Ruta
    graveolens 6c and Calcarea phosphorica 3X without additional chemotherapy or radiation. Of
    these 15 patients, six of the seven who had glioma showed complete regression of the
    tumors.”

    The use of homeopathy would seem to be the ultimate test of open-mindedness in a mainstream establishment like MD Anderson. First they admit sugar is bad for cancer, then they start using homeopathy. What’s next? 🙂

  9. Thanks – interesting. A couple of questions that came up in my mind:

    1. I thought a few cancers, such as prostate cancer, didn’t show the warburg effect (that is, they were still aerobic)?

    2. Where does vitamin D fit into all this, since adequate amounts seem to prevent most cancer?

    3. Presumably the reason a ketogenic diet isn’t a solution on its own is because of gluconeogenesis?

    • Only 95 percent of cancers show the Warburg effect. I’m not sure where vitamin D fits in, but I’m sure it does. It does seem from an epidemiological perspective to prevent cancers, but we can’t know for sure until RCTs are done.

      Yes, a ketogenic diet can’t get blood sugars to zero because of gluconeogenesis, so it can’t be relied upon totally for a cure. But it does make the cancers more vulnerable, prevents the increase in angiogenesis needed to supply the growing cancer, and improves the health of the non-cancerous tissues.

  10. I watched my grandfather die of cancel in my early 20’s. He quit chemo after the first treatment, saying that the terrible side effects were no way to live out his remaining days. In my late 30’s, I cared for my 59 year old mother as she fought and ultimately lost against cancer over a 10 month period that started in late 2010. After watching her live a miserable life on the poison of chemo (sickness and intense neuropathy), I pretty much decided that I’d never do chemo when presented with the same decision.

    I discovered low carb, from Gary Taubes’ Why We Get Fat, at the same time my mother learned of her cancer. I wish I had known about the ketogenic diet and cancer in 2010. I would have pleaded with my mother to give it a try. It may not have helped, but there was absolutely nothing to lose. Traditional treatment did nothing to alter the outcome and clearly made her remaining days miserable.

    Having lived this as closely as one can without having cancer themselves, I’m curious about the Metabolic Theory. As I understand it, not all cancers respond to keto. Does this book discuss which cancers respond best to ketogenic diets or a combination of keto and traditional treatments? I’d love to understand the characteristics that make it helpful in some cases and not in others.

    • The book doesn’t really explain which cancers do and which cancers don’t respond. It basically describes how both the genetic and metabolic theories came to be and how researchers who regard cancer as a metabolic disorder are coming up with treatment regimens that work vastly better than the old “slash, burn and poison.” Ironically, it is difficult for a lot of these folks to get funding despite their outcomes being so good because their is little money to be made in the treatment. Tens of millions will be invested to find a new cancer drug that can be sold for (literally) $100,000 per dose, but not so much on dietary therapies or compounds that can’t be patented.

  11. Thank you for writing this review. I’m going to buy Tripping Over the Truth as soon as I finish this comment, and I’ll read it as soon as I’m done with The Case Against Sugar (another thanks for that one, I do love Gary Taubes’ work).

    My heartfelt condolences to you and especially your wife.

  12. Dear Dr. Eades … Does your advance copy have the Second Edition’s ISBN number? And any indication from the publisher as to the release date? Amazon currently lists only the First Edition. Thanks so much.

    • The link in the post takes you to the newest edition. I just checked and noticed what you mean. It does say 1st Edition, and I don’t know why.

      The ISBN is 978-1603587297 for the edition you want.

  13. While I’ve long found the metabolic theory to make more sense than the somatic mutation one, I have not yet taken any sides the carbs vs fat. On one hand, many, many folks like yourself state how sugar/glucose feeds cancer. On the other hand there are plenty, such as Ray Peat’s fans, stating the opposite: that ketones can feed cancer, that carb restriction can cause cancer.

    This page cites many studies that ketones feed cancer, I haven’t read the studies and can’t vouch for quality, and links to many other articles as well: http://www.functionalps.com/blog/2013/01/05/pufa-ketones-and-sugar-restriction-promote-tumor-growth/

    This quote from Ray Peat stands out to me in particular, as it discusses an alternate explanation of Warburg’s respiratory defect:

    “There are many people currently recommending fish oil (or other highly unsaturated oils) for preventing or treating cancer, and it has become almost as common to recommend a sugar free diet, “because sugar feeds cancer.” This is often, incorrectly, said to be the meaning of Warburg’s demonstration that cancer cells have a respiratory defect that causes them to produce lactic acid from glucose even in the presence of oxygen. Cancer cells use glucose and the amino acid glutamine primarily for synthetic purposes, and use fats as their energy source;the growth stimulating effect of the “essential fatty acids” (Sueyoshi and Nagao, 1962a; Holley, et al., 1974) shows that depriving a tumor of those fats retards its growth. The great energetic inefficiency of the cancer metabolism, which causes it to produce a large amount of heat and to cause systemic stress, failure of immunity, and weight loss, is because it synthesizes fat from glucose and amino acids, and then oxidizes the fat as if it were diabetic.”

    With so much conflicting/confusing data on so many health topics, it’s for me as a lay person to come to a conclusion on much else besides the basics: whole foods over processed foods, nutrient-dense over nutrient-poor, high pufa vegetable oils are bad, and intermittent fasting is probably not a bad idea regardless of one’s high/low/carbs/fat affiliation.

    I’m still figuring out my own body, luckily I have time, turning 26 next month. I wasn’t blessed with the magical youthful weight maintenance of my peers and I have the stretch marks to prove it. I found fasting was a miracle to lose weight even if I still ate plenty of carbs otherwise. I travel for my job, so a quality diet is harder work regardless of macros. Hopefully we’ll have a cancer cure long before I’ll ever need one.

    • Alex, you can also look here for additional info regarding cancer and ketogenic diets:

      https://feinmantheother.com/
      http://ketonutrition.blogspot.com/

      As with anything, the “truth” is somewhere in between, and we likely don’t understand one-millionth of what’s actually happening.

      I have been following a keto diet for a while and made my goal to be in ketosis for as much of 2017 as possible. Have been kicked out once, due to some sugar on a recent vacation with the family (last day of vaca). Otherwise, I’ve been in ketosis so far and likely will be until the next family vacation.

      I think if you want to get into ketosis for cancer, it could be tough. For instance, if I drink a single alcoholic drink, the next day, I will have blood sugar >100. I think this is the remnants of fatty liver. Also, I can have my blood sugar go up over 100 just by exercising, even while starting out in ketosis and not eating anything.

      Typically, for cancer, they want some high ketone values (eg, above 4 mmol/L). For me, I’m never that high unless I fast for days or eat nothing but fat. If I eat very low carb but eat protein, I’ll be way less than 4. Also, I have to measure ketones by blood or breath (which don’t always correlate well), as the urine strips simply don’t work for me (I have many samples where blood and breath say I’m in ketosis, but the urine strips do not). And measuring blood ketones is expensive, at least $2.50/sample.

    • I read one of the studies, I think the title of it is misleading – Biokhimiia. 1987 Sep;52(9):1501-11.
      [Activation of lipolysis and ketogenesis in tumor-bearing animals as a reflection of chronic stress states].

      If you add “due to cancer” then it is more accurate – the article indicates that glucose deprivation (presumably from the tumor sucking up glucose!) is the cause of ….wait for it…the increase in BHB and AA. So at least in this article, the ketosis / gng wasn’t the stressor it was the response to glucose deprivation.

  14. thanks doctor – appreciated.

    all the more reason to go LCHF or Paleo or Atkins (whichever is best for the individual) to reduce the risk of cancer. plus a fasting regime to improve the immune system and normal apoptosis.

    we met in Cape Town in Feb 2015.

  15. Fantastic article, Dr. Eades.

    Minor note: I think you wanted to paste in the screenshot from your purchase of Christofferson’s book, but you pasted in one of your Seyfried purchase instead.

    • No, I meant to paste the Seyfried purchase. At the time of my SIL’s death, I hadn’t read any material on the Metabolic Theory of Cancer. Right after she died, I learned of Seyfried’s book, so I bought it. I just wanted to show that I was a little late to do anything to help my SIL.

  16. Very sorry for your loss. I have two close relatives that have died of cancer.
    I am following the ketogenic/hyperbaric oxygen therapy treatment regime as a possible treatment for cancer. I work in hyperbaric medicine and follow a VLC diet myself.
    Sadly, we still have a lot of work ahead of ourselves to invite our colleagues to investigate these therapies as not so adjunct and more so curative.
    Humbly,
    Lauren Romeo, MD

  17. Thanks for this. I know a low carb diet makes me feel better and eases my copd. Have stumbled into intermittent fasting and the combo is helping me finally loose weight… I’m in my 70s, now and feel great.

  18. Some cancers respond very well to conventional treatment.

    Having been through ABVD treatment for Lymphoma, I can empathize with some of what you witnessed, although my journey was clearly a cakewalk by comparison.

    It’s an experience that I wouldn’t wish on anyone as a patient or a caregiver.

    Based on my experience, I think any patient faced with these difficult decisions can make important dietary and exercise (training) decisions to work their way through treatment and give themselves something to work with when they are done.

  19. Dr. Mike, this is a great inspiring review and I’m ordering the book tonight…along with Gary Taubes’ new book. My husband had to go into the hospital right after your review on that one. He is a type 2 diabetic controlled with pills, has peripheral neuropathy and a pacemaker so I want him to read your review, too. I try but we both fall off the low carb wagon eating sandwiches (white bread he loves), chips & junk when we’re in a hurry. I have all your books and most of the books on your reading list so I have nothing but excuses. I know better. This is a whole ‘nother reason for stopping the sugar cycle for good.

    Please pass along my sympathy to MD. So sorry you all are having to grieve. My mom died with lung cancer so this really inspires me to get my head out of the sand on sugar poison. I so enjoy your blogs and books lists…thank you for what you do.

  20. Thanks for doing this great article and helping to give this concept more of the attention it deserves.

    Clearly the best way to deal with cancer is to not get it in the first place, and to that end I’ve been trying to find more info about Dr. Seyfried’s recommendation to do a 7-10 fast every year for prevention and I’m curious if you’ve run across anything that adds more confirmation and clarity. I’m already very lean ( I would likely need to fatten up to safely do a fast of that length and it would hurt my athletic activities as well, from what I’ve experienced with shorter fasts) so I’ve been trying to find out if it is really significantly beneficial for someone who is already eating fairly low-carb and low insulin.

  21. MIKE,
    Appreciate you taking the time to read this material and sharing your thoughts on this subject. I have had two very good friends that died last year to cancer. I totally agree with you, I would rather enjoy what time I have than go thru hell to get to heaven. When I was in my early 30’s and they found a spot on my lungs (hasn’t changed all these years) my wife asked me what will I will do if it was found to be cancerous. I said I would move to Florida, play golf and drink till I died. She was not pleased with that response. Again, thank you Mike for sharing your thoughts and experiences!

    • Hey Mike,

      Great to hear from you. If someone found a spot on your lungs, and it hasn’t changed in forever, I wouldn’t worry about it. Probably some lesion secondary to drinking too much softened water. 🙂

      Cheers,

      Mike

  22. Condolences to MD. I respect both your opinions having added your books to my collection of paleo-primal literature over the last 15 years or so.

    The role of stress in the development of cancer is being recognised now and might be mentioned in that book you reviewed. Lots of cortisone etc means reduced ability to knock off the cancer cells.
    There is usually ultra severe stress 6 months to 2 years before diagnosis – often only recognisable in hindsight by the family! That is important to appreciate as it is all toeasy to feel one should have done more after the fact when it was the fact that alerted you. No fact meant no knowledge.
    Then there is the stress and worry of the diagnosis and the “slash burn and poison” etc. all of that can mean very high levels of anxiety and tension (every one calls it stress these days).
    Stress was not always recognised as playing a role in cancer. Down in Melbourne Australia a psychiatrist who treated pain (and other) patients in the mid 1940s- 1950’s using hypnosis over a decades or so gradually transitioned to teaching meditation on calm. This helped dissolve tension, anxiety and take the hurt out of pain. Ainslie Meares published his atavistic regression theory of mental homeostasis in the Lancet and other journals. He wrote a total of 34 books. Aside from being a mouthful the atavistic regression idea was that in hypnosis and meditation the mind went back to a simpler state in which tension and anxiety cannot exist. A simpler state which also enabled the growth of new patterns of coping. Meares was also adamant that short periods of his meditation enabled the person who let the calm spill over into daily life to live a busier, fuller, better Western life style. He believed that he had extracted the essence of eastern mysticism.

    The pain patients I mentioned included a lot of cancer patients. In the mid 1970s Meares retired and became a consultant in hypnosis and medicine and tackled the new frontier of using prolonged meditation on nearly dead untreatable cancer patients to fined out if his meditation could influence the growth of cancer. Some of them improved, nearly all who kept doing the meditation felt it helped them greatly in coping and pain control and facing their possible mortality. There were also some people who had discernible regression of tumours and a few who had (apparently) a complete regression of the tumour. Some of are still alive today
    As you are aware doctors want to ensure that patients are not harmed and tend to be resistant to new ideas – partly for that reason and partly as it would be upsetting to learn that ones treatment regime was not doing what you thought it was. The result was that back then, some 40 years ago, many in the medical profession in Australia rejected both Meares and his work. Eventually, the situation improved with more work resulting in a paper on cancer published in the Lancet. It is a great irony that the shadow cast on both Meares and his work has seen him practically forgotten in the world of meditation and hypnosis. Quite amazing when one considers that he was puting out major papers on his theory of hypnosis (atavistic regression thing in the 1960s) and was in fact President of the International Society of Hypnotists around that time as well as openly considered to be a pioneer in Australia in the field of hypnotism after the war and into the 1950s. I could go on but the gist should be clear.
    In Australia, his meditation is still taught by various persons including the Stillness Meditation Therapy Centre. That I know of there are no teachers overseas.
    To the paleo-primal movement, Meares meditation is the missing link in stress management – that is when you get to the bottom of his atavistic regression theory of mental homeostasis. One last thing reading about it is not enough to get the benefits one has to learn the method. For any non-Australians his books eg Relief without Drugs etc are a good place to start.
    Cheers OB

  23. Thanks for a brief view of the book , I agree that the conventional methods for cure for this deadly disease is a like walking a tight rope across two high mountain’s without a tight rope. As a child I remember my parents scolding me , Don’t eat to much candy,,It will rot your teeth, Makes me wonder what other parts candy (sugar) may rot, If nothing else was done to fight the war on cancer , I firmly believe if every one in the word cut their diets of high carbs and sugar and add a daily dose of exercise this disease would drop from the leader of killers, But like the voters for Hillary half of this country’s people have some form of brain disease or unable to make a intelligent decision with facts , figures. proven information and actions displayed every minute of every day. My life changed when I read the book Protein Power and followed the game rules , Sugar is rat poison , Try life without it and see what happens ,,,,

  24. Off topic: Be very interested in your view of breakfast or no breakfast, a topic that seems to be floating around the blogosphere. Thanks!

    • I’m not sure I have an opinion that’s valid. I, myself, eat whenever I get hungry. Sometimes that’s at 10 AM, sometimes it’s at 1 or 2 PM. I don’t pay it much mind.

  25. As a ten year cancer survivor following a VLC diet for its potential to prevent recurrence, I have read many articles and studies about the metabolic theory of cancer. Thankfully, your excellent book review includes a succinct and understandable summation of the theory to share with others who may find even this well-written book challenging. I bought the first edition of Tripping Over the Truth when it was published, but your review is so positive that I am doing the two things you encouraged…buying the new edition and giving the extra copy to my oncologist’s survivor clinic resource center.

    Dr Seyfried’s book, and even his 2010 paper Cancer as a Metabolic Disease, requires a strong science background, but Dr. Seyfried’s talks are informative and more accessible. The Epigenix Foundation posted all talks from its 2016 Metabolic Therapeutics conference, including Dr. Seyfried’s, for a deeper drive into the topic. The 2017 talks will be added soon. http://metabolictherapeuticsconference.com Dr Seyfried’s talk at TheIHMC was another good overview of his book.https://www.ihmc.us/lectures/thomas-seyfried/ Thank you for your comprehensive review which will bring both these books to a wider audience.

  26. Hello Dr. Eades.

    Personally, this book review would make me order the book today!

    Everything you have been talking about all of these years about carbs and sugar, surely this book had to have made you and MD do a high five.
    Validation!

    This is powerful! I cannot wait to read the book. It hits very close to home.

    Thank you!

  27. I just ordered “Tripping Over the Truth” and I read Seyfried’s book when you recommended it — quite fascinating — I worked in cancer research for several years as a tech. Sugar never entered into the equation in the 70s. I thought it interesting that so much of the research was done with C57Bl6 mice — a naturally rather rotund but vigorous strain (they do not carry the ob/ob obese mutation that Obese strains carry.) Seyfried recommended doing a full-on ketogenic diet for a week or two every six months as a preventative measure.

    I just ran across another doctor, Dr. Longo, who has a 5-day diet plan now available to the public (I believe) by L-Nutra, a company founded by Dr. Longo. It shows remarkable results in various metabolic markers. It is not a cancer diet — it is a metabolic repair diet. (See the WSJ, Tues. Feb. 21 of this year.) Although I feel confident is setting up my own diet for a week or two, this one has research behind it, and I feel that many people who follow mainstream MDs (and mainstream
    MDs as well) would be more amenable to s 5-day packaged diet prescription. (Okay, I am thinking of my husband, here.)

    I would love to hear your input on this option. It is, at least, a beginning for mainstream medicine to start looking at metabolic causes of disease.

    • I’ve read some of Dr. Longo’s papers, but I’m unfamiliar with his 5-day diet plan. I’ll see if I can track down some info and give it a look.

  28. Doctor,
    Have you ever explored the Physics of Cancer. Very compelling, and allows for both of your mentioned hypotheses to be true. The Physics of Cancer precludes, metabolically speaking, the development of either of the other circumstances, allowing both to be true!

    Physics, I am sure you know, is the study of energy which is to say, Cancer is (may be) caused by a persistent deficiency of Electromagnetic Energy, one of only 3 fundamental forces in the Universe – more practically called energy or electrons (antioxidant active ingredient).

    • Have not really looked into other than via the physics of the chemical bonds in biochemistry. Is Physics of Cancer a book? Or a system? Or just the application of physics to cancer?

  29. Speaking of “Tripping Over the Truth”, in yet another corner of human physiology. Google Hillary D White. A PhD in immunology, researcher at Dartmouth Medical School. You’ll find links to research articles on Stage I drug trials, treating fibromyalgia with testosterone therapy. Actually the simplest explanation for the onslaught of fm with women in their late forties. If you have a chance, take a look at the articles. I suspect you will find them interesting. From Seymour, MO? I’m in Lebanon, work in Springfield. Still haven’t got out of the hometown. Thanks for being a source of factual and thoughtful material. Ordered your Protein book, the Cancer book, and the sugar book, for a journey “out of the mainstream”.

  30. Dr Eades,

    thanks for sharing the story of your sis in law.
    cancer is of interest to me also because of a family member. i have read a few books on cancer but not this one. i have purchased the book.
    r

  31. Thanks for this. I just sent the links to a friend of 40 odd years who’s going through treatment for pancreatic cancer. I don’t know yet if he’s interested in reading this stuff, but I sure hope he is.