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Today on Healthcare PittStop I have with me Dr. Adrienne Scheck to talk about the ketogenic diet. But before we get to the diet, I’d like to talk about who you are and then how you got interested in the diet. Could you tell the folks listening in a little bit about your research prior to the ketogenic diet, what you were involved in here at the Barrow in terms of cancer research?

AS: I’m a brain tumor researcher and molecular biologist by training, so when I first got here in 1989, a lot of my work revolved around therapy resistance and genes that might be involved in therapy resistance—genetic heterogeneity in tumors. Heterogeneity means that the cells in a particular tumor, even in one individual, have a different genetic background, which is probably why some of them are resistant to therapies and some aren’t. So we are looking at that on a molecular basis. I was involved in that work for quite some time.

AP: I spent a year doing molecular biology, and that’s really looking at the genome and how the genome expresses proteins. It’s really hard-core basic science research. That was pretty much what your focus was, is that correct?

AS: Correct. Specifically with respect to why some cells are resistant to therapy in tumors.

AP: And then someone came to you with this idea of the ketogenic diet, which they thought would be of value in cancer. That must have seemed foreign to somebody doing molecular biology.

AS: It was. Dr. Jong Rho, a Pediatric Epileptologist and also a fantastic bench scientist, had a lab on the same floor as mine. His research is basically on ketones and the ketogenic diet used as a treatment for epilepsy, especially in kids that don’t respond to drugs, and it’s quite effective. As often happens in science, you bump into another scientist and start chatting and one thing leads to another. So Dr. Rho said, hey, there’s this guy in Boston that’s looking at the ketogenic diet for brain tumors. I have a student that wants to work in a lab for six months and I’ve got the funds to pay. Do you want to take this person into your lab and see what it looks like with brain tumors? So I said yes. When my students and I started doing some work in my lab, the results just shocked me. That changed the direction of my whole lab.

Dr. Adrienne Scheck, Barrow Neurological Institute

AP: I’m familiar with the word “ketosis” and the diabetes ketogenic diet as kind of an induced metabolic starvation in some ways. Is that correct?

AS: It mimics caloric restriction, or fasting essentially. It’s very high fat, low carb, low protein, and it not only raises a chemical called ketones in your blood—because that’s what your body makes when it breaks down fats—but it also reduces glucose in your blood. And tumors really like glucose. The thought was at first that by reducing glucose you could inhibit the growth of tumors. But it turns out that our work and the work of others suggest it’s way more than that.

Now, the first thing I would suggest is that everybody from a therapeutic point of view take the word “diet” out of it because it really is a metabolic therapy—the diet as a means to an end to change the body’s metabolism in a very good way with respect to cancer. And in a more relaxed sense, the Ketogenic diet is also being used for weight loss. It promotes enhanced sports ability, enhanced power, and enhanced stamina. So people that are involved in sports are working on it. Body builders have used it for a long time. It’s safe in its general form and also in its more extreme form when used for cancer or epilepsy. It’s amazing how changing the metabolism in your body changes the expression of genes.

AP: So let me get this right. You go on a diet that is without carbohydrates, like breads; you eat lots of protein; that changes your metabolism, reducing the amount of available glucose sugar for bad things, and that that helps patients do better with cancer. Do you have any sense of how much better?

AS: It’s not actually a lot of protein—more what we call “adequate protein with respect to the extreme therapeutic version —because if you have a lot of protein, your body can make glucose from it. But, again, it’s very high fat because your body uses the fats to make ketones, and the normal cells in your body are very happy using ketones as an energy source. Your normal cells are not all that upset about the reduced glucose. Cancer cells on the other hand don’t like that. They don’t like to use ketones. They really want the glucose.

So that’s one way it’s helping. But we also found that even if you don’t mess with the glucose at all in the laboratory, ketones all by themselves make a huge difference. They make the tumor cells more sensitive to radiation; they make them more sensitive to chemotherapy; and they reduce their growth. So in the extreme therapeutic diet, you’re making tremendous changes in the gene expression in the tumor cells.

In the layperson version, which is a little bit more relaxed, you’d have a little bit more protein, be a little bit more relaxed on the carb, but still go with very high fat. It’s unusual for what you might think, but it’s great for weight loss; it’s great for athletic endeavors. It just has a lot of apparent health benefits. It seems to reduce inflammation in general.

The therapeutic version is also being looked at for Alzheimer’s and for other neuro-degenerative diseases. So the diet is sort of a continuum of how strict you want to be and how much you want to change your blood ketones and blood glucose. But the effects seem to be very beneficial.

AP: I think you told me that genes are actually turned on or off based on the diet itself, the gene expression.

AS: Absolutely. We’ve seen a lot of gene expression changes, specifically ones that are good for the patient and bad for the tumor. In fact, when we look at the gene expression changes in the tumor, a lot of the things that seem to be happening are also things that the pharmaceutical companies are trying to make happen. We don’t think the diet should be used alone in cancer, but I do think it can and maybe should be used to enhance the activity of the pharmaceuticals and the treatments that are currently being used because it does seem to make them work better.

AP: Do you have any sense yet, if you compare patients on and off the diet with the same tumor and the same conventional therapies, how much better a patient would do on a ketogenic diet than off one? Or is it too early?

AS: Honestly, I think it’s too early in terms of a clinical trial because there are a couple of challenges with clinical trials, one of the main ones being funding. It’s very difficult to get funding for something like this because a lot of the new clinical trials are funded by pharmaceutical companies, and they want their drug to be approved. That’s not a bad thing; I’m not vilifying the pharmaceuticals in any way. It’s very expensive to do these studies. They can’t afford to fund something like this and not have a benefit.

The federal government? Yes, they should fund stuff like this. But in the NIH, for example, grants are reviewed by a panel of scientists and clinicians. And while some scientist-clinicians are very positive about this, funding is so difficult to get that it only takes one or two that are not on the bandwagon to bring it down. So, we don’t have everybody on board with respect to changing food or seeing a metabolic therapy as being useful. It’s getting better, but it’s a slow uphill climb on that one.

AP: I think you told me once that “diet” is a four-letter word when it comes to writing a grant.

AS: Yes, I’ve been counseled get that word out of there. I said, well, not only have we done work with the full diet in an animal model, as have other scientists, but we’ve also done a lot where we’re just adding ketones to cell culture—to cells that are growing in the laboratory. What we know for a fact is that it’s the change in the ketones that makes a difference.

There are probably also excellent changes that happen due to glucose, but we haven’t messed with glucose yet. There are other people that are dropping glucose in various model systems and they’re finding really good results. We’re concentrating on the ketone side of it.

A ketogenic diet is a means to an end. It’s a way to change the body’s metabolism—raise ketones, drop glucose. But the word “diet” has a connotation that is not as scientific as you’d like because there are a lot of fad diets out there. This is something that has a very strong scientific basis.

A lot of work has been done in epilepsy showing that not only is it safe but it also changes gene expression as well as things in the brain— the way the brain is doing it’s signaling so that it affects seizures. So, this is not a fad. If you go to PubMed there’s a bunch of research that’s been done. And there’s more research being done about exactly how it changes gene expression and some of the other things it does.

AP: So let me get this straight. This “diet” helps your endurance if you’re a long-distance runner, if you’re a cyclist . In some cases it helps you if you have epilepsy. It might help for cancer and even other neurodegenerative diseases. We’ve discussed all of these things related to diet, yet conventional science has turned its back on it because it doesn’t really fit their model. Is that fair?

AS: Yes, that’s fair. Some conventional science has turned its back, and there are still those naysayers that just don’t want to go that route. But more and more people are starting to get excited about it. In fact, I’m very excited and honored that the Society for Neuro-oncology—which is the big international society for brain and spinal tumors—has asked us to speak at their annual education day on this topic. It’s a chance to tell more physicians and scientists out there some of the things that we’ve been finding with the addition of ketones, with the use of the ketogenetic diet in our mouse model, and how we think this can enhance the activity of a variety of therapies.

AP: A lot of folks, particularly out of Silicon Valley, seem to be looking for the next big thing. Peter Thiel has been quoted as saying that he’s injecting himself with young people’s blood to live longer. In fact, the television show Silicon Valley made fun of this practice of young “blood boys” giving these billionaires their blood. This is different though; you’re telling me this is hard science behind something that shows improvement in health, longevity, anti-cancer.

AS: There’s a lot of hard science behind it. I don’t know that it does much in the way of longevity, although in animal models reducing calories and fasting have shown to extend life. The clinical trials are not mature enough to say much, but it does appear to help some people. We’re not sure it helps all people, but that’s true of all therapies used for cancer.

What we’d like to do is get the funding to do the research to find out what it is about the tumor in person A that responded but failed to respond in the tumor of person B. That’s what needs to be done—and is being done—with a lot of the therapies and pharmaceuticals available now. And what people need to understand is that it’s not just food. It is an actual metabolic therapy that is changing a person’s metabolism. You can test your ketones and glucose in your blood—which is one of the things we use to monitor whether a person is doing the diet correctly for their body—and it changes that. Now what we need to do is start to get it into more people.

It’s not an easy thing to do, so you need the assistance of a trained dietitian, which means you’ve got to be able to pay that individual to help the patients get through it. Then you can start to say, OK, in this patient it helps stay the advance of tumors.

AP: So what I’m hearing from you is that you need further funding to do the studies, and you also need to make it a little easier. It’s like going to the grocery store and all the organic foods are double the price. There needs to be a ketogenic aisle, if you will, to help those people who want to be on this diet find the foods that they want. Make it easy for them to be on the diet.

AS: There are a couple of companies now that are making premade TV dinners that are ketogenic. The problem with those is that it’s expensive to do it and then ship it. But if we got more medical data, then perhaps it would be classified as a medical food, and the insurance companies would help to offset that. There are lots of recipes out there now. I guess one of the issues is that many of us no longer cook; people are very busy; they go out for meals. One of the patients we’ve had and his good friend are chefs, and they’re looking into the potential of opening a restaurant. They look at the ingredients that you’re allowed to have on a ketogenic diet—the creams, the butter, things like that—and they’re all excited; they say they could do all kinds of stuff. You can get a ketogenic diet cookbook in Costco, although it’s more the gentler layperson version—the weight loss plan—as opposed to the hardcore therapeutic version. Still, the tide is turning even if it’s turning very slowly.

AP: Some of my colleagues are on this. They’re all “we’ll lose weight.” They’re raving about it. Of course they say it’s difficult to stay on it. Maybe with Jeff Bezos’s acquisition of Whole Foods Amazon will get into the ketogenic diet game. Can people who want to learn more reach out to you?

AS: To be perfectly honest, if they want to know exactly how to do it, I’m likely to refer them to our dietician, who is much more schooled in that than I am. I’m the one who figures out what genes are changed by this thing and how it affects cancer. But they can certainly reach out to me by email. There are a number of Web sites out there that are very helpful and all kinds of information on the web—websites that will give them recipes and things like that. I’d be happy to steer them in the right direction.

AP: That would be awesome. I really appreciate your time in bringing this to the forefront. It’s fascinating that you have something that is not a pill or a surgery that may make a difference. We have to figure out how to have conventional science be a little more open to some of these things that are getting the right science and data to show that there is a true benefit. Thank you so much for your time.

AS: My pleasure. Thank you for having me on the show.