Plant-Based and Ketogenic Diets As Diverging Paths to Address Cancer – A Review

Author(s): Urvi A. Shah, MD1,2 Neil M. Iyengar, MD2,3
Source: JAMA Oncol. Published online July 7, 2022. doi:10.1001/jamaoncol.2022.1769
Lucio Gordan MD

Dr. Gordan's Thoughts

This is a frequent question we get in community oncology – is there a diet that the reduces risk of cancer? In my opinion, the data are strong (although no numerous randomized/prospective trials are available) insofar as Mediterranean or caloric-restricted diets in decreasing inflammation, insulin and other growth-factor levels. I generally recommend mostly a  plant-based or Mediterranean diet, with decreased exposure to alcohol and at minimum 3 hours of exercise per week. This article is interesting in reviewing the pathophysiology of neoplastic cell growth and interaction with food intake.

ABSTRACT

IMPORTANCE

As the incidence of cancer and metabolic disorders, such as obesity, concurrently rise, there has been increasing awareness of the pervasive effect of nutrition. The whole foods plant-based diet (WFPBD) and ketogenic diet (KD) have gained popularity in oncology, and this topic is increasingly permeating clinical dialogue.

OBSERVATIONS

Dietary intake is associated with multiple pathways involved in carcinogenesis and tumor progression. Consumption of a plant-enriched diet is associated with reduced cancer incidence and is recommended by dietary guidelines for cancer prevention. Despite a starkly different nutrient composition, a WFPBD and KD can be associated with weight loss, decreased inflammation, and decreased insulin levels. In addition, a WFPBD is associated with increased fiber, phytochemicals, and butyrate levels and decreased insulin-like growth factor 1 levels, whereas a KD exerts potential anticancer effects by increasing β hydroxybutyrate levels. A KD may be of interest in select, less common settings, such as tumors treated with phosphatidylinositol 3-kinase inhibitors, which induce hyperinsulinemia and hyperglycemia. Completed interventional trials have focused on increasing fruit and vegetable intake or reducing fat intake but have not specifically tested WFPBD or KD for cancer prevention or treatment. Currently available data support plant-based diets as opposed to KD as part of a lifestyle associated with reduced cancer risk. In the postdiagnosis setting, there are currently no rigorously tested approaches that support the recommendation of any diet to treat cancer.

CONCLUSIONS AND RELEVANCE

The results of this review suggest that the collective evidence supports plant-enriched diets vs KD for the reduction of cancer risk and the improvement of metabolic disorders in survivors. Additional prospective randomized clinical trials are needed to encourage use of dietary modification across the cancer continuum. Rigorous trial designs that adapt classical oncologic end points may identify populations that are likely to benefit from starkly contrasting diets. Current data support prioritization of plant-based diets, and future data could further personalize dietary recommendations in cancer populations.

Author Affiliations

1Myeloma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York 2Department of Medicine, Weill Cornell Medical College, New York, New York 3Breast Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York

Leave a Comment

Your email address will not be published.

Related Articles