title: Modified Atkins diet in advanced malignancies - final results of a safety and feasibility trial within the Veterans Affairs Pittsburgh Healthcare System.
abstract: BACKGROUND
  Dysfunctional mitochondrial processes limit malignant cells ability to use energy from fatty acids and ketones. Animal studies using ketogenic diets for cancer show encouraging results. We tested the diet's safety and feasibility in cancer patients across a broad variety of solid tumors.
  
  
  METHODS
  We recruited 17 advanced cancer patients who were not on chemotherapy. They consumed 20 to 40 g of carbohydrates daily with evaluations performed weekly until week 4, then every 4 weeks until 16 weeks. Quality of life questionnaires monitored for tolerability and compliance. Positron emission/computerized tomography was ordered at baseline, 4,8 and 16 weeks. Student t-testing evaluated differences between baseline and last visit scores for quality of life, weight, body mass index, and serum parameters. Correlations between weight loss and serum ketones, glucose, lipids and creatinine were done. Two-tailed unpaired t-testing of the mean weight loss compared responders against non-responders.
  
  
  RESULTS
  Eleven out of seventeen enrolled patients were evaluable. Mean age was 65+/- 11.7 years, weight 203 +/- 4.98 lbs. (92 ± 2.3 kgs.) and previous treatment failures was 1.7, +/- 0.97. All lost significant weight with hematologic, biochemical and lipid tests remaining stable. Quality of life scores slightly improved. At 4,8 and 16 weeks, six (54.5 %), five (45.4 %) and four (36 %) patients were stable or improved. We observed no correlations between serum glucose, ketones or lipids. Clinical response did not correlate with ketosis or glycemia. Responders (stable disease or partial responders) lost statistically more weight than non-responders. Dietary compliance was difficult. Only three patients continued dieting past 16 weeks. Out of these, two patients developed brain metastases and were on steroids. They survived 80 and 116 weeks respectively. The third patient underwent residual tumor resection and has no disease at 131 weeks.
  
  
  CONCLUSIONS
  Modified Atkins diets are safe and feasible in advanced cancer. Quality of life was preserved. Patients who lost at least 10 % of their body weight responded the best. Steroid intake affected optimal ketone and glucose levels. Despite this, survival improved in some melanoma and lung cancer patients. Further studies are recommended.
  
  
  BACKGROUND
  Clinicaltrials.gov NCT01716468. Registered on September 18, 2012.
authors.affiliation: Veteran Affairs Pittsburgh Healthcare System, Pennsylvania Pittsburgh, USA ; University of Pittsburgh School of Medicine, Pennsylvania Pittsburgh, USA.
authors.forename: Jocelyn L
authors.initials: JL
authors.lastname: Tan-Shalaby
authors.affiliation: Veteran Affairs Pittsburgh Healthcare System, Pennsylvania Pittsburgh, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Carrick
authors.affiliation: Veteran Affairs Pittsburgh Healthcare System, Pennsylvania Pittsburgh, USA ; University of Pittsburgh School of Medicine, Pennsylvania Pittsburgh, USA.
authors.forename: Krystal
authors.initials: K
authors.lastname: Edinger
authors.affiliation: Veteran Affairs Pittsburgh Healthcare System, Pennsylvania Pittsburgh, USA ; University of Pittsburgh School of Medicine, Pennsylvania Pittsburgh, USA.
authors.forename: Dana
authors.initials: D
authors.lastname: Genovese
authors.affiliation: Veteran Affairs Pittsburgh Healthcare System, Pennsylvania Pittsburgh, USA ; University of Pittsburgh School of Medicine, Pennsylvania Pittsburgh, USA.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Liman
authors.affiliation: Veteran Affairs Pittsburgh Healthcare System, Pennsylvania Pittsburgh, USA ; University of Pittsburgh School of Medicine, Pennsylvania Pittsburgh, USA.
authors.forename: Vida A
authors.initials: VA
authors.lastname: Passero
authors.affiliation: Veteran Affairs Pittsburgh Healthcare System, Pennsylvania Pittsburgh, USA.
authors.forename: Rashmikant B
authors.initials: RB
authors.lastname: Shah