title: Glycemic modulation in neuro-oncology: experience and future directions using a modified Atkins diet for high-grade brain tumors.
abstract: Dietary glycemic modulation through high-fat, low-carbohydrate diets, which induce a state of systemic ketosis and alter systemic metabolic signaling, have been incorporated into the clinical management of patients with neurological disease for more than a century. Mounting preclinical evidence supports the antitumor, proapoptotic, and antiangiogenic effects of disrupting glycolytic metabolism through dietary intervention. In recent years, interest in incorporating such novel therapeutic strategies in neuro-oncology has increased. To date, 3 published studies incorporating novel dietary therapies in oncology have been reported, including one phase I study in neuro-oncology, and have set the stage for further study in this field. In this article, we review the biochemical pathways, preclinical data, and early clinical translation of dietary interventions that modulate systemic glycolytic metabolism in the management of primary malignant brain tumors. We introduce the modified Atkins diet (MAD), a novel dietary alternative to the classic ketogenic diet, and discuss the critical issues facing future study.
authors.affiliation: Department of Neurology , Johns Hopkins School of Medicine , Baltimore, Maryland (R.E.S., M.C.C., E.H.K., A.L.H., J.O.B.); Department of Pediatrics , Johns Hopkins School of Medicine , Baltimore, Maryland (E.H.K., A.L.H.); Department of Oncology , Johns Hopkins School of Medcine , Baltimore, Maryland (J.O.B.); Institute for Clinical and Translational Research , Johns Hopkins School of Medicine , Baltimore, Maryland (B.J.H.).
authors.forename: Roy E
authors.initials: RE
authors.lastname: Strowd
authors.affiliation: Department of Neurology , Johns Hopkins School of Medicine , Baltimore, Maryland (R.E.S., M.C.C., E.H.K., A.L.H., J.O.B.); Department of Pediatrics , Johns Hopkins School of Medicine , Baltimore, Maryland (E.H.K., A.L.H.); Department of Oncology , Johns Hopkins School of Medcine , Baltimore, Maryland (J.O.B.); Institute for Clinical and Translational Research , Johns Hopkins School of Medicine , Baltimore, Maryland (B.J.H.).
authors.forename: Mackenzie C
authors.initials: MC
authors.lastname: Cervenka
authors.affiliation: Department of Neurology , Johns Hopkins School of Medicine , Baltimore, Maryland (R.E.S., M.C.C., E.H.K., A.L.H., J.O.B.); Department of Pediatrics , Johns Hopkins School of Medicine , Baltimore, Maryland (E.H.K., A.L.H.); Department of Oncology , Johns Hopkins School of Medcine , Baltimore, Maryland (J.O.B.); Institute for Clinical and Translational Research , Johns Hopkins School of Medicine , Baltimore, Maryland (B.J.H.).
authors.forename: Bobbie J
authors.initials: BJ
authors.lastname: Henry
authors.affiliation: Department of Neurology , Johns Hopkins School of Medicine , Baltimore, Maryland (R.E.S., M.C.C., E.H.K., A.L.H., J.O.B.); Department of Pediatrics , Johns Hopkins School of Medicine , Baltimore, Maryland (E.H.K., A.L.H.); Department of Oncology , Johns Hopkins School of Medcine , Baltimore, Maryland (J.O.B.); Institute for Clinical and Translational Research , Johns Hopkins School of Medicine , Baltimore, Maryland (B.J.H.).
authors.forename: Eric H
authors.initials: EH
authors.lastname: Kossoff
authors.affiliation: Department of Neurology , Johns Hopkins School of Medicine , Baltimore, Maryland (R.E.S., M.C.C., E.H.K., A.L.H., J.O.B.); Department of Pediatrics , Johns Hopkins School of Medicine , Baltimore, Maryland (E.H.K., A.L.H.); Department of Oncology , Johns Hopkins School of Medcine , Baltimore, Maryland (J.O.B.); Institute for Clinical and Translational Research , Johns Hopkins School of Medicine , Baltimore, Maryland (B.J.H.).
authors.forename: Adam L
authors.initials: AL
authors.lastname: Hartman
authors.affiliation: Department of Neurology , Johns Hopkins School of Medicine , Baltimore, Maryland (R.E.S., M.C.C., E.H.K., A.L.H., J.O.B.); Department of Pediatrics , Johns Hopkins School of Medicine , Baltimore, Maryland (E.H.K., A.L.H.); Department of Oncology , Johns Hopkins School of Medcine , Baltimore, Maryland (J.O.B.); Institute for Clinical and Translational Research , Johns Hopkins School of Medicine , Baltimore, Maryland (B.J.H.).
authors.forename: Jaishri O
authors.initials: JO
authors.lastname: Blakeley
keywords: cancer metabolism; glioma; ketogenic diet; modified Atkins diet; seizure