Changes

Ketogenic Diets for Cancer

25,744 bytes added, 21:10, 29 December 2013
Created page with "The Ketogenic Diet may help with the treatment of cancer, including brain tumors<ref name="Seyfried-2011"/><ref name="Seyfried-2009"/><ref name="Seyfried-2005"/>. There ar..."
The [[Ketogenic Diet]] may help with the treatment of cancer, including brain tumors<ref name="Seyfried-2011"/><ref name="Seyfried-2009"/><ref name="Seyfried-2005"/>. There are researchers who believe that the origin of cancer lies with metabolic abnormalities that lead to genetic problems rather than the genetic problems being the root cause<ref name="SeyfriedFlores2013"/>.
=How the Ketogenic Diet may help=
There may be several mechanisms behind the effect of the ketogenic diet on cancer.
* Tumor cells are unable to metabolize ketones<ref name="Maurer-2011"/>.
* Cancers promote the growth of new blood vessels, something the ketogenic diet inhibits, as Ketones are [http://en.wikipedia.org/wiki/Angiogenesis_inhibitor anti-angiogenic]<ref name="Zhou-2007"/>. This is also seen with calorie restriction, which reduces vascularity and increased apoptosis in mouse and human brain tumors<ref name="Mukherjee-2004"/>.
* Cancer cells often don't undergo natural cell death, something the ketogenic diet enhances<ref name="Skinner-2009"/>.
* Ketones may directly reduce the viability of cancer cells<ref name="Skinner-2009"/>.
* The ketogenic diet typically reduces blood glucose levels, and high blood glucose is associated with tumor growth and reduced survival rates in cancer patients<ref name="Chaichana-2010"/><ref name="Derr-2009"/><ref name="McGirt-2008"/> and animal models<ref name="Venkateswaran-2007"/>.
* Carbohydrate restriction lowers insulin and insulin-like growth factor (IGF) which directly stimulate tumor cell proliferation<ref name="Klement-2011"/>.
=Animal Studies=
There are a number of animal studies that have looked at the ketogenic diet and cancer.
* A study of [http://en.wikipedia.org/wiki/Glioma Glioma] tumor cells showed that an unrestricted ketogenic diet in mice that raised ketone levels without lowering glucose levels did not change survival rates<ref name="Maurer-2011"/>.
* The unrestricted diet combined with [[Omega 3]] and [[MCT]] delayed the growth of implanted gastric cancer cells in mice<ref name="Otto-2008"/>.
* The ketogenic diet may need to be combined with calorie restriction to ensure lowered glucose levels for the treatment of brain tumors<ref name="Seyfried-2008"/>. A study that compared an unrestricted standard diet, an unrestricted ketogenic diet and a restricted ketogenic diet in mice with implanted brain tumors, only the restricted ketogenic diet improved survival rates<ref name="Zhou-2007"/>.
* Drugs are being developed for cancer treatment that target metabolic pathways<ref name="Tennant-2010"/>.
* Giving a no-carbohydrate ketogenic diet to rats with grafted prostate cancer tumors resulted in a 33% smaller tumor size than controls fed a western diet<ref name="Freedland-2008"/>. In another study, rats with grafted prostate cancer tumors given 0%, 10% or 20% carbohydrate had similar survival rates<ref name="Masko-2010"/>.
* Rats with grafted prostate cancer tumors given a no-carbohydrate ketogenic diet (83% fat, 0% carbohydrate, 17% protein) had a better survival rate than those given a medium carbohydrate diet (40% fat, 43% carbohydrate, 17% protein), but their survival was similar to those given a low fat diet (12% fat, 71% carbohydrate, 17% protein)<ref name="Mavropoulos-2009"/>.
* Rats with grafted lung cancer tumors showed that a ketogenic diet improved the effectiveness of radiation and chemotherapy<ref name="AllenBhatia2013"/>.
* Rats with metastatic cancer had a 57% longer average survival time on the ketogenic diet than controls, and 78% longer when the ketogenic diet was combined with a hyperbaric oxygen therapy<ref name="TangPoff2013"/>.
=Human Case Studies=
While I have not found any large studies of the ketogenic diet on humans, there are a number of smaller case studies that look promising.
* A case study of two children with inoperable [http://en.wikipedia.org/wiki/Astrocytoma Astrocytoma] brain tumors that regressed under the ketogenic diet that lowered blood glucose levels is promising<ref name="Nebeling-1995"/>. This trial used the [[MCT Diet]] with 60% of calories from [[MCT]], 20% from protein, 10% from carbohydrate, and 10% from other dietary fats, with total calories calculated at 120% of target to ensure weight gain<ref name="Nebeling-2-1995"/>.
* A study looked at the use of the Ketogenic Diet in 16 patients with advanced cancer and no other treatment options concluded that the diet was a suitable possibility and might improve some aspects of their quality of life<ref name="SchmidtPfetzer2011"/>. Not all the patients maintained the diet, with only 5 completing the 12 week study. Because of the low number of subjects and their heterogeneity, it was not possible to evaluate the impact of the diet on the tumors. However, the outcome for the 16 patients is intriguing:
** 4 patients dropped out early.
** 2 patients died early.
** 5 patients discontinued the diet and their disease progressed.
** 5 patients followed the diet and their disease was stable.
* A 65 year old woman with Glioblastoma multiforme (the most malignant primary brain tumor in adults and children) was treated with partial tumor resection and a combination of standard therapy and a restricted ketogenic diet. The diet was a calorie restricted (600 kcal/day) [[Ketogenic Ratio Diet]] (4:1) for two months, resulting in a 20% reduction in body weight. After the two months there were no discernable signs of the tumor with FDG-PET or MRI imaging<ref name="ZuccoliMarcello2010"/>. When a normal diet was resumed for 10 weeks there were signs of the tumor resurging on MRI scans. (See timeline of treatment below.)
* A (non-ketogenic) high fat diet may help maintain body weight and improve quality of life<ref name="Breitkreutz-2005"/>.
[[File:KetogenicCancerTimeline.jpg|none|thumb|500px|Timeline of the treatment of a 65 year old woman with Glioblastoma multiforme ..]]
=Non-Ketogenic Fat Intake and Cancer=
There are a number of studies that have looked at the general relationship between fat intake and cancer.
* Fat intake in a non-ketogenic diet impacts tumor growth<ref name="Welsch-1992"/>.
* [[Omega 3]] supplementation may improve the effectiveness of conventional chemotherapy and radiation therapy treatments of cancer<ref name="Hardman-2004"/><ref name="Hardman-2002"/><ref name="Xue-2009"/><ref name="Dupertuis-2007"/>, as well as directly impacting the tumor<ref name="Gutt-2007"/><ref name="Hardman-2007"/><ref name="Kato-2002"/><ref name="Rose-1995"/><ref name="Rose-1996"/> and metastasis<ref name="Rose-1995"/><ref name="Rose-1996"/>.
* Omega-6 oils may increase tumor growth<ref name="Rose-1995"/><ref name="Rose-1991"/><ref name="Welsch-1992"/>.
* Saturated fat tends to stimulate tumor growth, Omega-6 stimulates more than saturated fat, and Omega-3 inhibits growth<ref name="Welsch-1992"/>.
** [[Fiber]] may reduce the impact of fats on cancer risk<ref name="Hursting-1990"/>.
* Omega-3 supplementation may reduce the risk of some cancers<ref name="Karmali-1989"/><ref name="Terry-2003"/><ref name="de Deckere-1999"/>.
* In a study of 35,298 Singapore Chinese women aged 45-74 years, those with the lowest intake of fish Omega-3 had a 26% higher risk of breast cancer<ref name="Gago-Dominguez-2003"/>. For those with the lowest intake of Omega-3, the intake of Omega-6 was inversely related to their breast cancer risk. However, another study of 23,693 postmenopausal women showed that fish consumption increased the risk of estrogen receptor-positive breast cancer by 50% in those with the highest intake compared with the lowest<ref name="Stripp-2003"/>. It has been suggested that this may be due to contamination with organochlorines or other endocrine disrupters in the fish<ref name="Terry-2004"/>. Other studies have found no relationship between fish intake and cancer<ref name="Holmes-2003"/><ref name="Missmer2002"/>.
* The results of trials with mono-unsaturated oils such as olive oils on tumor growth have been inconsistent<ref name="Welsch-1992"/>.
* Restricting calories intake also impacts tumor growth, with 12% restriction reducing tumor growth in rodents<ref name="Welsch-1992"/>.
* Even modest amounts of Omega-6 or saturated fat may negate the benefit of Omega-3<ref name="Welsch-1992"/>.
{{KetoSeeAlso}}
=References=
<references>
<ref name="SeyfriedFlores2013">T. N. Seyfried, R. Flores, A. M. Poff, D. P. D'Agostino, Cancer as a Metabolic Disease: Implications for Novel Therapeutics, Carcinogenesis, 2013, ISSN [http://www.worldcat.org/issn/0143-3334 0143-3334], doi [http://dx.doi.org/10.1093/carcin/bgt480 10.1093/carcin/bgt480]</ref>
<ref name="Mukherjee-2004">P. Mukherjee, LE. Abate, TN. Seyfried, Antiangiogenic and proapoptotic effects of dietary restriction on experimental mouse and human brain tumors., Clin Cancer Res, volume 10, issue 16, pages 5622-9, Aug 2004, doi [http://dx.doi.org/10.1158/1078-0432.CCR-04-0308 10.1158/1078-0432.CCR-04-0308], PMID [http://www.ncbi.nlm.nih.gov/pubmed/15328205 15328205]</ref>
<ref name="Maurer-2011">GD. Maurer, DP. Brucker, O. Bähr, PN. Harter, E. Hattingen, S. Walenta, W. Mueller-Klieser, JP. Steinbach, J. Rieger, Differential utilization of ketone bodies by neurons and glioma cell lines: a rationale for ketogenic diet as experimental glioma therapy., BMC Cancer, volume 11, pages 315, 2011, doi [http://dx.doi.org/10.1186/1471-2407-11-315 10.1186/1471-2407-11-315], PMID [http://www.ncbi.nlm.nih.gov/pubmed/21791085 21791085]</ref>
<ref name="Maurer-2011">GD. Maurer, DP. Brucker, O. Bähr, PN. Harter, E. Hattingen, S. Walenta, W. Mueller-Klieser, JP. Steinbach, J. Rieger, Differential utilization of ketone bodies by neurons and glioma cell lines: a rationale for ketogenic diet as experimental glioma therapy., BMC Cancer, volume 11, pages 315, 2011, doi [http://dx.doi.org/10.1186/1471-2407-11-315 10.1186/1471-2407-11-315], PMID [http://www.ncbi.nlm.nih.gov/pubmed/21791085 21791085]</ref>
<ref name="Tennant-2010">DA. Tennant, RV. Durán, E. Gottlieb, Targeting metabolic transformation for cancer therapy., Nat Rev Cancer, volume 10, issue 4, pages 267-77, Apr 2010, doi [http://dx.doi.org/10.1038/nrc2817 10.1038/nrc2817], PMID [http://www.ncbi.nlm.nih.gov/pubmed/20300106 20300106]</ref>
<ref name="Seyfried-2009">BT. Seyfried, M. Kiebish, J. Marsh, P. Mukherjee, Targeting energy metabolism in brain cancer through calorie restriction and the ketogenic diet., J Cancer Res Ther, volume 5 Suppl 1, pages S7-15, Sep 2009, doi [http://dx.doi.org/10.4103/0973-1482.55134 10.4103/0973-1482.55134], PMID [http://www.ncbi.nlm.nih.gov/pubmed/20009300 20009300]</ref>
<ref name="Seyfried-2011">TN. Seyfried, MA. Kiebish, J. Marsh, LM. Shelton, LC. Huysentruyt, P. Mukherjee, Metabolic management of brain cancer., Biochim Biophys Acta, volume 1807, issue 6, pages 577-94, Jun 2011, doi [http://dx.doi.org/10.1016/j.bbabio.2010.08.009 10.1016/j.bbabio.2010.08.009], PMID [http://www.ncbi.nlm.nih.gov/pubmed/20804725 20804725]</ref>
<ref name="Seyfried-2005">TN. Seyfried, P. Mukherjee, Targeting energy metabolism in brain cancer: review and hypothesis., Nutr Metab (Lond), volume 2, pages 30, Oct 2005, doi [http://dx.doi.org/10.1186/1743-7075-2-30 10.1186/1743-7075-2-30], PMID [http://www.ncbi.nlm.nih.gov/pubmed/16242042 16242042]</ref>
<ref name="Seyfried-2008">TN. Seyfried, M. Kiebish, P. Mukherjee, J. Marsh, Targeting energy metabolism in brain cancer with calorically restricted ketogenic diets., Epilepsia, volume 49 Suppl 8, pages 114-6, Nov 2008, doi [http://dx.doi.org/10.1111/j.1528-1167.2008.01853.x 10.1111/j.1528-1167.2008.01853.x], PMID [http://www.ncbi.nlm.nih.gov/pubmed/19049606 19049606]</ref>
<ref name="Zhou-2007">W. Zhou, P. Mukherjee, MA. Kiebish, WT. Markis, JG. Mantis, TN. Seyfried, The calorically restricted ketogenic diet, an effective alternative therapy for malignant brain cancer., Nutr Metab (Lond), volume 4, pages 5, 2007, doi [http://dx.doi.org/10.1186/1743-7075-4-5 10.1186/1743-7075-4-5], PMID [http://www.ncbi.nlm.nih.gov/pubmed/17313687 17313687]</ref>
<ref name="Nebeling-1995">LC. Nebeling, F. Miraldi, SB. Shurin, E. Lerner, Effects of a ketogenic diet on tumor metabolism and nutritional status in pediatric oncology patients: two case reports., J Am Coll Nutr, volume 14, issue 2, pages 202-8, Apr 1995, PMID [http://www.ncbi.nlm.nih.gov/pubmed/7790697 7790697]</ref>
<ref name="Nebeling-2-1995">LC. Nebeling, E. Lerner, Implementing a ketogenic diet based on medium-chain triglyceride oil in pediatric patients with cancer., J Am Diet Assoc, volume 95, issue 6, pages 693-7, Jun 1995, doi [http://dx.doi.org/10.1016/S0002-8223(95)00189-1 10.1016/S0002-8223(95)00189-1], PMID [http://www.ncbi.nlm.nih.gov/pubmed/7759747 7759747]</ref>
<ref name="SchmidtPfetzer2011">Melanie Schmidt, Nadja Pfetzer, Micheal Schwab, Ingrid Strauss, Ulrike Kämmerer, Effects of a ketogenic diet on the quality of life in 16 patients with advanced cancer: A pilot trial, Nutrition & Metabolism, volume 8, issue 1, 2011, pages 54, ISSN [http://www.worldcat.org/issn/1743-7075 1743-7075], doi [http://dx.doi.org/10.1186/1743-7075-8-54 10.1186/1743-7075-8-54]</ref>
<ref name="Breitkreutz-2005">R. Breitkreutz, K. Tesdal, D. Jentschura, O. Haas, H. Leweling, E. Holm, Effects of a high-fat diet on body composition in cancer patients receiving chemotherapy: a randomized controlled study., Wien Klin Wochenschr, volume 117, issue 19-20, pages 685-92, Oct 2005, doi [http://dx.doi.org/10.1007/s00508-005-0455-3 10.1007/s00508-005-0455-3], PMID [http://www.ncbi.nlm.nih.gov/pubmed/16416368 16416368]</ref>
<ref name="Hardman-2004">WE. Hardman, (n-3) fatty acids and cancer therapy., J Nutr, volume 134, issue 12 Suppl, pages 3427S-3430S, Dec 2004, PMID [http://www.ncbi.nlm.nih.gov/pubmed/15570049 15570049]</ref>
<ref name="Hardman-2002">WE. Hardman, Omega-3 fatty acids to augment cancer therapy., J Nutr, volume 132, issue 11 Suppl, pages 3508S-3512S, Nov 2002, PMID [http://www.ncbi.nlm.nih.gov/pubmed/12421878 12421878]</ref>
<ref name="Xue-2009">H. Xue, S. Le Roy, MB. Sawyer, CJ. Field, LA. Dieleman, VE. Baracos, Single and combined supplementation of glutamine and n-3 polyunsaturated fatty acids on host tolerance and tumour response to 7-ethyl-10-[4-(1-piperidino)-1-piperidino]carbonyloxy-camptothecin (CPT-11)/5-fluorouracil chemotherapy in rats bearing Ward colon tumour., Br J Nutr, volume 102, issue 3, pages 434-42, Aug 2009, doi [http://dx.doi.org/10.1017/S0007114508199482 10.1017/S0007114508199482], PMID [http://www.ncbi.nlm.nih.gov/pubmed/19250573 19250573]</ref>
<ref name="Dupertuis-2007">YM. Dupertuis, MM. Meguid, C. Pichard, Colon cancer therapy: new perspectives of nutritional manipulations using polyunsaturated fatty acids., Curr Opin Clin Nutr Metab Care, volume 10, issue 4, pages 427-32, Jul 2007, doi [http://dx.doi.org/10.1097/MCO.0b013e3281e2c9d4 10.1097/MCO.0b013e3281e2c9d4], PMID [http://www.ncbi.nlm.nih.gov/pubmed/17563460 17563460]</ref>
<ref name="Gutt-2007">CN. Gutt, L. Brinkmann, A. Mehrabi, H. Fonouni, BP. Müller-Stich, G. Vetter, JM. Stein, P. Schemmer, MW. Büchler, Dietary omega-3-polyunsaturated fatty acids prevent the development of metastases of colon carcinoma in rat liver., Eur J Nutr, volume 46, issue 5, pages 279-85, Aug 2007, doi [http://dx.doi.org/10.1007/s00394-007-0662-y 10.1007/s00394-007-0662-y], PMID [http://www.ncbi.nlm.nih.gov/pubmed/17593466 17593466]</ref>
<ref name="Freedland-2008">SJ. Freedland, J. Mavropoulos, A. Wang, M. Darshan, W. Demark-Wahnefried, WJ. Aronson, P. Cohen, D. Hwang, B. Peterson, Carbohydrate restriction, prostate cancer growth, and the insulin-like growth factor axis., Prostate, volume 68, issue 1, pages 11-9, Jan 2008, doi [http://dx.doi.org/10.1002/pros.20683 10.1002/pros.20683], PMID [http://www.ncbi.nlm.nih.gov/pubmed/17999389 17999389]</ref>
<ref name="Hardman-2007">WE. Hardman, Dietary canola oil suppressed growth of implanted MDA-MB 231 human breast tumors in nude mice., Nutr Cancer, volume 57, issue 2, pages 177-83, 2007, doi [http://dx.doi.org/10.1080/01635580701277445 10.1080/01635580701277445], PMID [http://www.ncbi.nlm.nih.gov/pubmed/17571951 17571951]</ref>
<ref name="Skinner-2009">R. Skinner, A. Trujillo, X. Ma, EA. Beierle, Ketone bodies inhibit the viability of human neuroblastoma cells., J Pediatr Surg, volume 44, issue 1, pages 212-6; discussion 216, Jan 2009, doi [http://dx.doi.org/10.1016/j.jpedsurg.2008.10.042 10.1016/j.jpedsurg.2008.10.042], PMID [http://www.ncbi.nlm.nih.gov/pubmed/19159745 19159745]</ref>
<ref name="ZuccoliMarcello2010">Giulio Zuccoli, Norina Marcello, Anna Pisanello, Franco Servadei, Salvatore Vaccaro, Purna Mukherjee, Thomas N Seyfried, Metabolic management of glioblastoma multiforme using standard therapy together with a restricted ketogenic diet: Case Report, Nutrition & Metabolism, volume 7, issue 1, 2010, pages 33, ISSN [http://www.worldcat.org/issn/1743-7075 1743-7075], doi [http://dx.doi.org/10.1186/1743-7075-7-33 10.1186/1743-7075-7-33]</ref>
<ref name="Chaichana-2010">KL. Chaichana, MJ. McGirt, GF. Woodworth, G. Datoo, RJ. Tamargo, J. Weingart, A. Olivi, H. Brem, A. Quinones-Hinojosa, Persistent outpatient hyperglycemia is independently associated with survival, recurrence and malignant degeneration following surgery for hemispheric low grade gliomas., Neurol Res, volume 32, issue 4, pages 442-8, May 2010, doi [http://dx.doi.org/10.1179/174313209X431101 10.1179/174313209X431101], PMID [http://www.ncbi.nlm.nih.gov/pubmed/19589201 19589201]</ref>
<ref name="Derr-2009">RL. Derr, X. Ye, MU. Islas, S. Desideri, CD. Saudek, SA. Grossman, Association between hyperglycemia and survival in patients with newly diagnosed glioblastoma., J Clin Oncol, volume 27, issue 7, pages 1082-6, Mar 2009, doi [http://dx.doi.org/10.1200/JCO.2008.19.1098 10.1200/JCO.2008.19.1098], PMID [http://www.ncbi.nlm.nih.gov/pubmed/19139429 19139429]</ref>
<ref name="McGirt-2008">MJ. McGirt, KL. Chaichana, M. Gathinji, F. Attenello, K. Than, AJ. Ruiz, A. Olivi, A. Quiñones-Hinojosa, Persistent outpatient hyperglycemia is independently associated with decreased survival after primary resection of malignant brain astrocytomas., Neurosurgery, volume 63, issue 2, pages 286-91; discussion 291, Aug 2008, doi [http://dx.doi.org/10.1227/01.NEU.0000315282.61035.48 10.1227/01.NEU.0000315282.61035.48], PMID [http://www.ncbi.nlm.nih.gov/pubmed/18797358 18797358]</ref>
<ref name="Otto-2008">C. Otto, U. Kaemmerer, B. Illert, B. Muehling, N. Pfetzer, R. Wittig, HU. Voelker, A. Thiede, JF. Coy, Growth of human gastric cancer cells in nude mice is delayed by a ketogenic diet supplemented with omega-3 fatty acids and medium-chain triglycerides., BMC Cancer, volume 8, pages 122, 2008, doi [http://dx.doi.org/10.1186/1471-2407-8-122 10.1186/1471-2407-8-122], PMID [http://www.ncbi.nlm.nih.gov/pubmed/18447912 18447912]</ref>
<ref name="Kato-2002">T. Kato, RL. Hancock, H. Mohammadpour, B. McGregor, P. Manalo, S. Khaiboullina, MR. Hall, L. Pardini, RS. Pardini, Influence of omega-3 fatty acids on the growth of human colon carcinoma in nude mice., Cancer Lett, volume 187, issue 1-2, pages 169-77, Dec 2002, PMID [http://www.ncbi.nlm.nih.gov/pubmed/12359365 12359365]</ref>
<ref name="Rose-1995">DP. Rose, JM. Connolly, J. Rayburn, M. Coleman, Influence of diets containing eicosapentaenoic or docosahexaenoic acid on growth and metastasis of breast cancer cells in nude mice., J Natl Cancer Inst, volume 87, issue 8, pages 587-92, Apr 1995, PMID [http://www.ncbi.nlm.nih.gov/pubmed/7752256 7752256]</ref>
<ref name="Rose-1991">DP. Rose, JM. Connolly, CL. Meschter, Effect of dietary fat on human breast cancer growth and lung metastasis in nude mice., J Natl Cancer Inst, volume 83, issue 20, pages 1491-5, Oct 1991, PMID [http://www.ncbi.nlm.nih.gov/pubmed/1920496 1920496]</ref>
<ref name="Rose-1996">DP. Rose, JM. Connolly, M. Coleman, Effect of omega-3 fatty acids on the progression of metastases after the surgical excision of human breast cancer cell solid tumors growing in nude mice., Clin Cancer Res, volume 2, issue 10, pages 1751-6, Oct 1996, PMID [http://www.ncbi.nlm.nih.gov/pubmed/9816126 9816126]</ref>
<ref name="Welsch-1992">CW. Welsch, Dietary fat, calories, and mammary gland tumorigenesis., Adv Exp Med Biol, volume 322, pages 203-22, 1992, PMID [http://www.ncbi.nlm.nih.gov/pubmed/1442296 1442296]</ref>
<ref name="Klement-2011">RJ. Klement, U. Kämmerer, Is there a role for carbohydrate restriction in the treatment and prevention of cancer?, Nutr Metab (Lond), volume 8, pages 75, 2011, doi [http://dx.doi.org/10.1186/1743-7075-8-75 10.1186/1743-7075-8-75], PMID [http://www.ncbi.nlm.nih.gov/pubmed/22029671 22029671]</ref>
<ref name="Karmali-1989">RA. Karmali, n-3 fatty acids and cancer., J Intern Med Suppl, volume 731, pages 197-200, 1989, PMID [http://www.ncbi.nlm.nih.gov/pubmed/2539832 2539832]</ref>
<ref name="Terry-2003">PD. Terry, TE. Rohan, A. Wolk, Intakes of fish and marine fatty acids and the risks of cancers of the breast and prostate and of other hormone-related cancers: a review of the epidemiologic evidence., Am J Clin Nutr, volume 77, issue 3, pages 532-43, Mar 2003, PMID [http://www.ncbi.nlm.nih.gov/pubmed/12600840 12600840]</ref>
<ref name="Gago-Dominguez-2003">M. Gago-Dominguez, JM. Yuan, CL. Sun, HP. Lee, MC. Yu, Opposing effects of dietary n-3 and n-6 fatty acids on mammary carcinogenesis: The Singapore Chinese Health Study., Br J Cancer, volume 89, issue 9, pages 1686-92, Nov 2003, doi [http://dx.doi.org/10.1038/sj.bjc.6601340 10.1038/sj.bjc.6601340], PMID [http://www.ncbi.nlm.nih.gov/pubmed/14583770 14583770]</ref>
<ref name="de Deckere-1999">EA. de Deckere, Possible beneficial effect of fish and fish n-3 polyunsaturated fatty acids in breast and colorectal cancer., Eur J Cancer Prev, volume 8, issue 3, pages 213-21, Jul 1999, PMID [http://www.ncbi.nlm.nih.gov/pubmed/10443950 10443950]</ref>
<ref name="Stripp-2003">C. Stripp, K. Overvad, J. Christensen, BL. Thomsen, A. Olsen, S. Møller, A. Tjønneland, Fish intake is positively associated with breast cancer incidence rate., J Nutr, volume 133, issue 11, pages 3664-9, Nov 2003, PMID [http://www.ncbi.nlm.nih.gov/pubmed/14608091 14608091]</ref>
<ref name="Terry-2004">PD. Terry, JB. Terry, TE. Rohan, Long-chain (n-3) fatty acid intake and risk of cancers of the breast and the prostate: recent epidemiological studies, biological mechanisms, and directions for future research., J Nutr, volume 134, issue 12 Suppl, pages 3412S-3420S, Dec 2004, PMID [http://www.ncbi.nlm.nih.gov/pubmed/15570047 15570047]</ref>
<ref name="Holmes-2003">MD. Holmes, GA. Colditz, DJ. Hunter, SE. Hankinson, B. Rosner, FE. Speizer, WC. Willett, Meat, fish and egg intake and risk of breast cancer., Int J Cancer, volume 104, issue 2, pages 221-7, Mar 2003, doi [http://dx.doi.org/10.1002/ijc.10910 10.1002/ijc.10910], PMID [http://www.ncbi.nlm.nih.gov/pubmed/12569578 12569578]</ref>
<ref name="Missmer2002">S. A Missmer, Meat and dairy food consumption and breast cancer: a pooled analysis of cohort studies, International Journal of Epidemiology, volume 31, issue 1, 2002, pages 78–85, ISSN [http://www.worldcat.org/issn/14643685 14643685], doi [http://dx.doi.org/10.1093/ije/31.1.78 10.1093/ije/31.1.78]</ref>
<ref name="Hursting-1990">SD. Hursting, M. Thornquist, MM. Henderson, Types of dietary fat and the incidence of cancer at five sites., Prev Med, volume 19, issue 3, pages 242-53, May 1990, PMID [http://www.ncbi.nlm.nih.gov/pubmed/2377587 2377587]</ref>
<ref name="Mavropoulos-2009">JC. Mavropoulos, WC. Buschemeyer, AK. Tewari, D. Rokhfeld, M. Pollak, Y. Zhao, PG. Febbo, P. Cohen, D. Hwang, The effects of varying dietary carbohydrate and fat content on survival in a murine LNCaP prostate cancer xenograft model., Cancer Prev Res (Phila), volume 2, issue 6, pages 557-65, Jun 2009, doi [http://dx.doi.org/10.1158/1940-6207.CAPR-08-0188 10.1158/1940-6207.CAPR-08-0188], PMID [http://www.ncbi.nlm.nih.gov/pubmed/19470786 19470786]</ref>
<ref name="Masko-2010">EM. Masko, JA. Thomas, JA. Antonelli, JC. Lloyd, TE. Phillips, SH. Poulton, MW. Dewhirst, SV. Pizzo, SJ. Freedland, Low-carbohydrate diets and prostate cancer: how low is "low enough"?, Cancer Prev Res (Phila), volume 3, issue 9, pages 1124-31, Sep 2010, doi [http://dx.doi.org/10.1158/1940-6207.CAPR-10-0071 10.1158/1940-6207.CAPR-10-0071], PMID [http://www.ncbi.nlm.nih.gov/pubmed/20716631 20716631]</ref>
<ref name="Venkateswaran-2007">V. Venkateswaran, AQ. Haddad, NE. Fleshner, R. Fan, LM. Sugar, R. Nam, LH. Klotz, M. Pollak, Association of diet-induced hyperinsulinemia with accelerated growth of prostate cancer (LNCaP) xenografts., J Natl Cancer Inst, volume 99, issue 23, pages 1793-800, Dec 2007, doi [http://dx.doi.org/10.1093/jnci/djm231 10.1093/jnci/djm231], PMID [http://www.ncbi.nlm.nih.gov/pubmed/18042933 18042933]</ref>
<ref name="AllenBhatia2013">B. G. Allen, S. K. Bhatia, J. M. Buatti, K. E. Brandt, K. E. Lindholm, A. M. Button, L. I. Szweda, B. J. Smith, D. R. Spitz, M. A. Fath, Ketogenic Diets Enhance Oxidative Stress and Radio-Chemo-Therapy Responses in Lung Cancer Xenografts, Clinical Cancer Research, volume 19, issue 14, 2013, pages 3905–3913, ISSN [http://www.worldcat.org/issn/1078-0432 1078-0432], doi [http://dx.doi.org/10.1158/1078-0432.CCR-12-0287 10.1158/1078-0432.CCR-12-0287]</ref>
<ref name="TangPoff2013">Chih-Hsin Tang, Angela M. Poff, Csilla Ari, Thomas N. Seyfried, Dominic P. D'Agostino, The Ketogenic Diet and Hyperbaric Oxygen Therapy Prolong Survival in Mice with Systemic Metastatic Cancer, PLoS ONE, volume 8, issue 6, 2013, pages e65522, ISSN [http://www.worldcat.org/issn/1932-6203 1932-6203], doi [http://dx.doi.org/10.1371/journal.pone.0065522 10.1371/journal.pone.0065522]</ref>
</references>