Miriam It is an honor for me to write the foreword to Miriam Kalamian’s deeply important book, Keto For Cancer. Miriam has produced a masterpiece that translates decades of research on the anticancer therapeutic benefits of ketogenic diets and calorie restriction in preclinical models to a practical guide for people with cancer and practitioners who are increasingly drawn to the science behind this metabolic approach. The information in her book moves far beyond the limits of conventional anticancer nutrition to include the use of food as medicine, a concept first elucidated by Hippocrates, the father of modern medicine.

Miriam’s book comes at a critical time in our quest to manage cancer, as the cancer field is now stagnating under the weight of traditional therapies (radiation and chemotherapy) that result in unacceptable toxicity and impairment in quality of life, often with little improvement in survival. Even the new immunotherapy drugs are proving to be unacceptably toxic, marginally effective, and inordinately expensive. The rate of increase in deaths from cancer over the last five years (3.4 percent) is now twice the rate of increase in new cases (1.7 percent). According to data from the American Cancer Society, cancer deaths have reached epidemic proportions, with over 1,600 people dying each day in the United States alone. Too often, five-year survival statistics masquerade as a cure, allowing the conventional community to dodge any discussion of long-term survivorship, especially in those people with aggressive or metastatic disease.

How could this situation exist even with the enormous investment in resources and the decades of research directed at cancer therapies supported by the NIH, the pharmaceutical industry, and the many private cancer research groups, many of which are founded by people who have lost loved ones to this disease? This unacceptable state of affairs is due largely to the prevailing but flawed dogma that cancer is a genetic disease. Massive evidence shows the large impact that environmental influences have on the initiation and progression of this disease. Cancer treatment centers use buzzwords like personalized medicine, targeted therapies, and cancer mutation screening to imply that cancer is under their control. These are hollow words linked to a fundamental misunderstanding of the origin of cancer. Emerging evidence indicates that cancer is primarily a metabolic disease arising from a disruption in the ability of the cell to obtain the energy it needs to survive and proliferate from normal cellular respiration. Although the cancer research community acknowledges this aberration, it fails to connect the dots leading back to the origin of most cancers. That is, most cancer cells obtain their energy from the process of fermentation, which was the way primitive living organisms survived before oxygen became abundant in Earth’s atmosphere some 2.5 billion years ago. It is cancer’s protracted reliance on fermentation energy that leads to the many genetic mutations seen in cancer cells. In other words, the mutations are not the cause of cancer but instead are the downstream effect of the disturbed respiration that drives compensatory fermentation and even evasion from immune system surveillance.

Cancer mutations are “red herrings” that divert attention away from the real problem, which is a reliance on fermentation for growth and survival. It is no wonder that cancer therapies based on the gene theory have had so little success in managing the disease. Damage to cellular respiration, thus causing a reliance on fermentation, can arise from any number of provocative agents, including carcinogens, radiation, tissue inflammation, viral infections, focal hypoxia, rare inherited mutations, or simply age. Fermentation metabolism also makes tumor cells resistant to radiation and chemotherapies by strengthening their inherent antioxidant defenses. Miriam’s book provides a nutritional strategy to manage cancer based on the metabolic origins underlying most tumor cells. Cancer is not many diseases, as some would suggest, but it is a singular disease of abnormal energy metabolism regardless of the cell or tissue of origin.

It is now recognized that both glucose and glutamine, an amino acid, are the prime fuels that drive fermentation metabolism in most tumor cells. In addition to generating energy, these fuels are also the precursors for the synthesis of lipids, proteins, and nucleic acids, which pave the way for rapid tumor cell proliferation. It follows that the most logical therapeutic strategy for managing cancer centers on restricting glucose and glutamine. The low-carbohydrate, high-fat ketogenic diet is an alternative, nontoxic metabolic strategy for targeting those tumor cells that depend on fermentable fuels for their growth and survival. Therapeutic ketosis starves tumor cells of glucose while elevating blood levels of ketones, a metabolic fuel that enhances the health of normal cells. Tumor cells, however, cannot use ketones for energy because of defects in oxygen respiration. Ketogenic diets also enhance the therapeutic action of glutamine-targeting drugs, and there is evidence that ketogenic metabolic therapy sensitizes tumor cells, in effect targeting them for destruction without producing collateral toxic damage to normal cells. Recent studies from an oncology clinic in Istanbul, Turkey, showed that a ketogenic diet used together with a cocktail of glucose-targeting drugs and procedures that increase oxidative stress in tumor tissue could successfully manage a broad range of advanced stage IV metastatic cancers, including breast, colon, ovary, lung, and pancreas. The ketogenic diet has also been shown to enhance the therapeutic efficacy of low-dose chemotherapy while simultaneously reducing toxicity to normal cells, tissues, and organs. It therefore becomes essential for cancer patients and their caregivers to recognize and understand how therapeutic ketosis using ketogenic diets can be used for managing cancer while also improving quality of life.

Miriam Kalamian is exceptionally well qualified to instruct cancer patients, their family members, and their oncology teams in using therapeutic ketosis as either an adjunctive or alternative approach for managing cancer. Miriam experienced firsthand the therapeutic effects of the ketogenic diet over a decade ago when she initiated the diet as a nutritional strategy for her own son. Indeed, her book is dedicated to Raffi, and the passion she has for sharing this experience is palpable. Managing Raffi’s brain tumor with a ketogenic diet put her on the path to learning the science behind the therapy and helped her to face the many challenges she encountered as an advocate for her son. I consider Miriam Kalamian a foremost authority in the emerging field of metabolic therapies for cancer. Her book addresses every question or concern that cancer patients might have in using a ketogenic metabolic strategy for managing their cancer. Being part of the team takes on new meaning as the person with cancer now plays an active role in the management of the disease. Miriam has provided cancer patients with a playbook that lays out the moves and strategies necessary for the nontoxic management of their disease. It is my view that therapeutic ketosis that revolves around ketogenic diets should be incorporated into the standards of care in oncology. Miriam Kalamian’s book is an essential resource for any cancer patient, caregiver, or oncologist with an interest in metabolic therapy.

Thomas N. Seyfried, PhD
Professor
Boston College
Chestnut Hill, MA