An Anti-Cancer Diet

Our cancer series resumes today with some tentative advice for cancer patients. (Note: This post is designed for solid tumor cancers, not blood cancers. However, most of the advice would also be applicable to blood cancers.)

This series began with Toward an Anti-Cancer Diet (Sep 15, 2011). There we advocated trying to shift cells away from the cancer phenotype via 8 anti-cancer strategies.

Future posts will explore in detail how to implement those strategies via diet and lifestyle. Today, I’m just going to give a general overview of what I would do if I had cancer.

Eat the Perfect Health Diet

This may sound self-serving, but it’s my best advice. Our diet is designed to optimize health generally, and that’s exactly what you want to do against cancer.

I said in the introduction that cancer is a disease in which cells lose their “humanness” – their proclivity to collaborate with other human cells to create a human organism. Instead, they lose recently evolved features and “remember” an identity similar to that of our distant evolutionary ancestors from the early days of multicellular life. This regression is possible because we retain the genes of our primitive evolutionary ancestors, and silencing of only a few hundred genes may cause a human cell to resemble, genetically, bacteria or fungi.

Many gut bacteria can take on two modes of behavior – a commensal or harmless phenotype, or a virulent harmful phenotype – depending on whether their environment is benign. In beneficial environments, bacteria tend to be cooperative with their host; in harsh environments, bacteria begin to look out for their own interests “selfishly,” and begin to display virulence traits which harm their host but help them move to a better environment.

Something similar may happen with “proto-cancer” cells. In a healthy environment, they are pleased to cooperate with their host – to retain their “humanness.” But in a harsh environment, they are more likely to withdraw from their neighbors and go their own way. An abused cell is more likely to become a cancer cell.

This may sound like anthropomorphization, but the metaphor is probably sound. Bruce Ames has remarked upon the fact that almost every compound is a carcinogen in large enough doses. Why? Because any unbalanced environment is harsh, and any harsh environment makes the cell more likely to develop the cancer phenotype.

It’s not only by discouraging “cancer virulence” that a good diet helps. A healthy diet also optimizes immune function.

Immune function is highly variable. Under stress, we suppress immunity so that all the body’s resources are available to meet “fight or flight” needs. Contrariwise, peaceable happiness is stimulating to immune function. A nutrient-rich diet, savory meals, happiness, calm, restful time spent in conversation – all of these things tell the body it has no pressing concerns and that available resources can be devoted to immunity and healing.

After cancer diagnosis, from a similar medical condition, those who are under stress tend to succumb to cancer, while those who are happy, cheerful, and sociable tend to recover from it. It is believed that this difference is primarily due to improved immune function in those under less stress.

I believe that a healthy, tasty diet is also a stimulant for immune function. Make your food nourishing and enjoyable.

Specific Dietary Aspects

A few aspects of an anti-cancer diet deserve special mention. Let’s look at the PHD Food Plate:

Some aspects I would emphasize for cancer patients:

  • Safe starches. I recommend obtaining 400 to 600 glucose calories a day, mainly from safe starches. I believe it is important to avoid a glucose deficiency, since glycosylated proteins are the means of intercellular coordination, and defects in glycosylation are characteristic of the cancer phenotype. (See, eg, this paper.) You don’t want to aggravate this with a self-induced glucose deficiency.
  • Low omega-6 meats. Omega-6 fats can be very damaging to mitochondria and can promote metastasis. Our needs for them are minimal, and they are everywhere. It’s important to choose foods that minimize omega-6 levels. Among meats, prefer seafood, shellfish, and red meats; obtain eggs, milk, and organ meats from pastured and naturally raised animals. Eat tropical plant oils like coconut and palm.
  • Omega-3 and omega-6 balance. The diet should include some marine sources of omega-3 fats, like salmon or sardines.
  • Bone broth soups and gelatin (cooked collagen). Collagen is 30% of our body’s protein and forms much of the extracellular matrix scaffolding which is crucial to maintainance of tissue health. The extracellular matrix is broken down in cancer. An anti-cancer diet should be rich in cooked joint tissue, such as can be found in Ox Feet Broth soups. Vitamin C and sulfur, discussed below, are also required for collagen formation; be sure you’re not deficient in these.
  • Fermented vegetables, yogurt, and acids. A diverse portfolio of gut bacteria can be helpful to the fight against cancer by several mechanisms. Probiotic flora from fermented  foods help shield against the entry of cancer-promoting pathogens to the body through the gut; they generate by-products, like short-chain fats and vitamin K2, which have anti-cancer effects; and they can modulate immunity in a favorable direction. Acids such as vinegar and lemon juice can also favorably modify gut bacteria.
  • Vegetables, herbs, and spices.Fiber is probably beneficial against cancer. Butyrate, which is produced by gut bacteria from the digestion of many types of fiber including “resistant starch” from safe starches, has anti-cancer properties. Moreover, many vegetables and traditional herbs and spices have been shown to have anti-angiogenic effects. Foods with anti-angiogenic properties include:
    • Garlic.
    • Tomato.
    • Green tea.
    • Dark chocolate / cocoa.
    • Maitake mushroom.
    • Bok choy.
    • Kale.
    • Many berries.
    • Cherries.
    • Ginseng.
    • Turmeric.
    • Oregano.
    • Parsley.
    • Polyphenol-rich extra virgin olive oils.
  • Organ meats and egg yolks. It’s important to be well nourished, and organ meats like liver and egg yolks tend to be rich in micronutrients. They are much better than plant foods for compounds like phospholipids. In particular, choline (and its phospholipid form phosphatidylcholine) is important for methylation status and epigenetic functioning – an important element in cancer prevention.
  • Sea vegetables, sea salt, and seafoods. These are good sources of trace minerals such as iodine, which is a critical anti-cancer nutrient.

In general cancer patients should focus on the foods in the apple of the PHD Food Plate more than the “pleasure foods.” However, there’s nothing wrong with some berries, dark chocolate, pistachios, and whipped cream for dessert, and some red wine with dinner. Above all, it’s important to enjoy your food. Try to obtain from every meal a sense of pleasure and well being!

Supplements

Much more could be said on this topic than I’m going to say today. One could make a very long list of supplements that might help against cancer (also a long list of those that hurt). However, the crucial five from my point of view are in our recommended supplement list:

  • Vitamin D
  • Vitamin K2
  • Iodine
  • Selenium
  • Magnesium

The tricky one here is the iodine. Iodine dosage should be built up very slowly from a low level, so as not to disrupt thyroid function. (Hyperthyroidism can strongly promote cancer, and hypothyroidism can inhibit immune function and healing, so any thyroid dysfunction is a serious risk.) Start at 500 mcg or less, and increase the dose no faster than a doubling per month. If you get either hypothyroid or hyperthyroid symptoms from an increase in dose, back off a bit (eg instead of going directly from 500 mcg to 1 mg per day, go to 500 mcg and 1 mg on alternate days). Be patient, but try to build up to 12 mg/day over a 6 month period. Then stay there. Be sure to get 200 mcg/day selenium along with the iodine.

I also recommend a multivitamin, for general nourishment; and make sure there is no deficiency of vitamin C, zinc, copper, or chromium. Also, when it comes to antioxidants, more is not better. Avoid most antioxidant supplements other than glutathione, vitamin C, selenium, zinc, copper, and manganese.

For magnesium, I recommend taking a 200 mg oral supplement of magnesium citrate or a magnesium chelate. Epsom salt baths might not provide magnesium, but they can be a useful source of sulfur (in the form of sulfate) which assists collagen formation.

Vitamin C is an unusual case. It supports collagen formation, and for this purpose and to avoid a deficiency I strongly suggest taking 1 g per day. In higher doses, vitamin C may be helpful because it has anti-viral properties (see Fighting Viral Infections by Vitamin C at Bowel Tolerance, Sep 26, 2010), and most cancers are probably viral in origin. Linus Pauling, of course, advocated high doses of vitamin C – either taken orally to bowel tolerance, or intravenously. However, there are arguments on the other side. Vitamin C can protect cancer cells from immune attack, and also makes them resistant to chemotherapies. Clinical trials have not yet proven high-dose vitamin C therapy, but it may help against a subset of cancers caused by viruses sensitive to vitamin C therapy.

If sufficient amounts are not obtained from diet, then choline should be supplemented.

Intermittent Fasting, Intermittent Ketosis, Intermittent Protein Restriction

This is an extremely important cluster of strategies that are probably highly effective against cancer.

Their common trait is that all three promote autophagy, or “self-eating,” which is both a means for cells to cope with resource scarcity and a central part of the intracellular immune response.

When resources are abundant, cells allow aged organelles and junk proteins to accumulate. When resources are scarce, they turn on autophagy and digest unnecessary components, recycling the resources.

Autophagy is the dominant innate immune mechanism inside cells – the primary way cells kill bacteria and viruses.

Autophagy also recycles damaged mitochondria, which can be digested, enabling remaining healthy mitochondria to multiply. The result is a healthier mitochondrial population.

Since viruses and damaged mitochondria promote cancer, autophagy helps transform cells from the cancer phenotype back to the normal human phenotype.

Fasting, by inducing resource scarcity, promotes autophagy. Scarcity of amino acids, which can be achieved by a protein restricted diet, also promotes autophagy. And ketosis, which is part of the metabolic profile of starvation, also promotes autophagy.

Note in my section heading the shared word: “intermittent.” We don’t want to sustain fasts or protein scarcity too long; that could create malnourishment and cause more harm than good. Permanent ketosis may promote fungal infections. The most helpful course is probably to follow these strategies intermittently:

  • Engage in daily intermittent fasting: eat only within a 6 to 8 hour window each day. Within the fasting period, eat some coconut oil or MCT oil to promote ketosis.
  • Eat high protein for a few weeks while engaging in resistance exercise to build muscle; then low protein for a few weeks.

A Note on Ketogenic Diets

Since we wrote our book, we’ve become a bit less excited about the therapeutic potential of ketogenic diets.

Ketogenic diets have demonstrated effectiveness in brain cancers, and several considerations suggest that they would be helpful against all cancers:

  • Cancer cells are dependent on glucose metabolism, a phenomenon called the Warburg effect. In ketosis, blood glucose levels can be decreased – a fall from 90 to 65 mg/dl is achievable – and reduced glucose availability should retard cancer growth.
  • Mitochondria do well on ketones, and some studies had shown that provision of ketones can restore the ability of mitochondria to trigger apoptosis, or the programmed cell death of cancer cells.

It’s too early to judge, but a few scraps of data published recently have made ketogenic diets seem a bit less exciting then hoped.

First, the group of Michael Lisanti has published work suggesting that tumors can evade the metabolic restrictions of a ketogenic diet by manipulating neighboring normal cells. The idea (here is an overview) is that cancer cells release hydrogen peroxide, which causes a stress response in neighboring cells, stimulating them to release lactic acid, which the cancer cells can metabolize. This process can happen nearly as well on a ketogenic as on a normal diet, so the effectiveness of a ketogenic diet in starving the cancer cells is reduced.

The Lisanti group results are hardly conclusive – indeed so far as I know no other group has supported their claims – and there are plenty of skeptics. Jimmy Moore gathered responses from a panel of low-carb experts.

Second, clinical experience with ketogenic diets has not yet shown them to be highly effective. The sort of data we have is well represented by a recent report in Nutrition and Metabolism. Sixteen patients with advanced metastatic cancer were put on ketogenic diets. The results:

One patient did not tolerate the diet and dropped out within 3 days. Among those who tolerated the diet, two patients died early, one stopped after 2 weeks due to personal reasons, one felt unable to stick to the diet after 4 weeks, one stopped after 6 and two stopped after 7 and 8 weeks due to progress of the disease, one had to discontinue after 6 weeks to resume chemotherapy and five completed the 3 month intervention period.

The conclusion: a ketogenic diet “has no severe side effects and might improve aspects of quality of life and blood parameters in some patients.”

Clinical trials with control groups and more statistical power are needed to evaluate whether ketogenic diets have therapeutic effect. For now, I think the most prudent course is intermittent ketosis and intermittent ketogenic fasting, rather than a continuously ketogenic diet.

UPDATE: Mario makes a great point in the comments: fasting prior to chemotherapy reduces toxicity to normal cells but increases toxicity to cancer cells. It is quite likely that a ketogenic diet might have the same effect during chemotherapy. So the combination of intermittent ketogenic dieting with chemotherapy should be given consideration.

Circadian Rhythm Enhancement

Many diseases become more likely, or more severe, if circadian rhythms are disrupted. Enhancement of circadian rhythms may be therapeutic for these diseases.

I’ve blogged about circadian rhythm therapies for hypothyroidism (“Intermittent Fasting as a Therapy for Hypothyroidism,” Dec 1, 2010) and for sleep disorders, psychiatric disorders, neurodegenerative disorders, and obesity (“Seth Roberts and Circadian Therapy,” Mar 22, 2011).

Well, cancer is another disease for which circadian disruption may be damaging. The International Agency on Research on Cancer (IARC) has recently classified “shiftwork that involves circadian disruption” as “probably carcinogenic to humans.”

It’s plausible that circadian enhancement may be therapeutic for cancer. Tactics that enhance circadian rhythms include:

  • Exposure to mid-day sunlight.
  • Sleeping in total darkness during hours of darkness.
  • Confining eating to daylight hours.
  • Socializing – especially, looking at faces and talking – during daylight hours. Seth Roberts found that looking at images of human faces can substitute for actual socializing.
  • Exercising during daylight hours. Even low-level activity – like standing instead of sitting – helps.
  • In people who are melatonin deficient due to a brain immune response, supplementation of melatonin just before bedtime.

Curiously, circadian rhythm disruption seems to make chemotherapy more effective. Also, timing treatments to match circadian rhythms may double their effectiveness.

Exercise and Other Lifestyle Factors

A number of lifestyle factors are important for cancer recovery. David Servan-Schreiber’s Anti-Cancer has an excellent overview of the evidence.

A recent study in the Lancet found that every additional 15 min of daily exercise beyond 15 min a day reduced all-cancer mortality by 1%. Exercise appears to be therapeutic even for late stage cancers. A meta-review found that two and a half hours of exercise a week could lower a breast cancer patient’s risk of dying or cancer recurrence by 40 percent, and could reduce a prostate cancer patient’s risk of dying from the disease by about 30 percent.

However, exercise should not be exhausting. Rather, it should be restful and relaxing; or build muscle. Resistance exercise on the “Body by Science” model of one intense workout per week, with more time spent in restful recovery than in stress, is probably a good strategy. Long walks outdoors in nature, and relaxing exercises like yoga or tai chi, are also great approaches to cancer therapy.

Being sociable, happy, calm, and optimistic are all important factors for cancer recovery. Those who have companions they love, and a purpose for living that makes them happy, have the best prognosis. Be grateful for what you have, and make your body understand that life is worth living.

Dealing with Anorexia and Nausea

Anorexia and nausea can seriously impair the ability of cancer patients to eat a nourishing diet and maintain their strength.

I haven’t had time to research this aspect of the disease yet, but there do seem to be some dietary and lifestyle interventions that help.

For instance, exercise can correct anorexia.

Among dietary interventions, ginger has been reported to reduce chemotherapy-induced nausea, reducing incidence in one study from 93% to 55%. (Hat tip: Healthy Fellow.)

Ginger teas are a traditional Asian folk remedy. Slice some ginger root in water, boil it on the stove, add some rice syrup for sweetness, and drink up!

Under-Utilized Therapies

There are a few therapies which are rarely prescribed, but might be more helpful than chemotherapies in treating cancer:

  • Low-dose naltrexone.
  • Anti-viral drugs.
  • Anti-fungal therapies.

Low-dose naltrexone is taken at night before bed. It temporarily blocks opioid receptors, which leads the body to increase production of endorphins and enkephalins – immune compounds which interact with opioid receptors. The following day, the naltrexone is gone and the opioid receptors are working again, but the endorphins are still around. Taking LDN thus increases endorphin levels. Endorphins inhibit cancer proliferation, and may enhance anti-cancer immunity. Here is a recent paper on anti-proliferative effects of LDN against ovarian cancer: http://pmid.us/21685240. Here is a recent paper on LDN plus alpha lipoic acid as a therapy against pancreatic cancer: http://pmid.us/20042414. For a general overview, see http://lowdosenaltrexone.org/.

Viruses cause or contribute to most cancers, and thus anti-viral drugs have great potential. A few cancer-causing viruses are famous, such as the Human Papilloma Virus for which there is a vaccine; however, most of the viruses that cause cancer remain unknown, though we know they exist because genetic mutations that impair viral immunity greatly increase cancer incidence.

Mario Renato Iwakura recently sent me a link to a paper that nicely illustrates the potential of antiviral therapies against cancer. Cytomegalovirus, also known as human herpes virus 5, is a common virus that infects 40% of adults worldwide and 50% to 80% of Americans. However, it is found in almost 100% of human tumors. It seems to be difficult to get cancer if you haven’t been infected by cytomegalovirus.

From the paper abstract:

Medulloblastomas are the most common malignant brain tumors in children…. Human cytomegalovirus (HCMV) is prevalent in the human population and encodes proteins that provide immune evasion strategies and promote oncogenic transformation and oncomodulation…. Remarkably, all of the human medulloblastoma cell lines that we analyzed contained HCMV DNA and RNA and expressed HCMV proteins at various levels in vitro. When engrafted into immunocompromised mice, human medulloblastoma cells induced expression of HCMV proteins. HCMV and COX-2 expression correlated in primary tumors, cell lines, and medulloblastoma xenografts. The antiviral drug valganciclovir and the specific COX-2 inhibitor celecoxib prevented HCMV replication in vitro and inhibited PGE2 production and reduced medulloblastoma tumor cell growth both in vitro and in vivo.

Tumor growth declined by 72% when treated with Valcyte (valganciclovir) and an NSAID drug. A press release notes that these drugs have “relatively good adverse effect profiles” and that “antiviral drugs are selective and largely affect infected cells.”

Yet another antimicrobial approach that may be helpful against cancer is antifungal therapy. Most cancer patients develop systemic fungal infections, and fungal infections such as Candida promote metastasis and tumor growth, and may also suppress anti-cancer immunity. An effective antifungal therapy may significantly retard cancer progression.

Conclusion

Much more remains to be said, and it’s certain that we’ll refine these suggestions after more thoroughly studying the literature. But I think this basic approach to an anti-cancer diet can’t be too far wrong.

Our prayers and best wishes go out to all those who are battling cancer.

Leave a comment ?

162 Comments.

  1. This is great, I am always in awe of your knowledge. I had heard that cancer cells can utilized lactate, those tricksters. We’ll have to keep an eye out on that.

    What do you think about environmental toxins and cancer? I suppose it depends on the type and dose, but would you go to great lengths to avoid common synthetic chemicals? On a scale from 1 to 10, 1 being complete apathy, 5 being your average health-conscious person, 8 being Dr. Mercola and 10 being living in a plastic bubble, what do you think is the most prudent? Without driving yourself insane, of course.

  2. What’s the main reasoning behind emphasizing starches rather than fruits, berries and vegetables for carbs? That seems to be the main difference between your recommendations and a lot of the other people I follow.

  3. It would be interesting to see a study conducted that gave healthy people an anti viral drug for some time, and a control group nothing, and compare cancer rates in both groups over the following decades..

  4. Could you elaborate a little on yoghurt as you mentioned it as a recommended food? I have been trying to find information about fermented dairy and the raise of IGF 1 it causes in the body. I have been given the information that IGF 1 lowers by 40% through the fermentation process but I do not know if what remains is still pretty much or can be neglected. I am asking because IGF 1 seems to play a role in hormone-related cancers. I think that fermented dairy is pretty healthy but I would like to know exactly if the raise in IGF 1 it causes is significant (and which amounts can be consumed “safely”)!
    Thank you so much!

  5. Would this be a cheap source of Mag Citrate?

    http://www.walgreens.com/store/c/walgreens-magnesium-citrate-saline-laxative-oral-solution/ID=prod5604183-product

    1 oz is 1.745 g. There are 10 ounces in a bottle so about 17g in a bottle for $2. 1/2 tablespoon would be about 500mg of Mag Citrate.

    Am I correct as this being a good source for magnesium?

  6. Paul,

    Really nice overview, thanks!

    I just wanted to add that if I were to undergo chemotherapy, fasting up to 5 days before it would be protective against the devastating effects of chemo and even enhance it’s effectiveness.

    http://www.ncbi.nlm.nih.gov/pubmed/21516129
    http://www.ncbi.nlm.nih.gov/pubmed/21088487
    http://www.ncbi.nlm.nih.gov/pubmed/19135806
    http://www.sciencedaily.com/releases/2008/03/080331172534.htm

    Best,
    Mario.

    • Thanks for posting this info, Mario. N=1 here, but sorry to say that fasting for 48 hours (25 hours of it before the chemo infusion began; taxol/carboplatin for ovarian cancer) did not reduce side effects for me–if anything, I’d say somewhat worse, longer duration fatigue & aches. I had done a fair amount of web research beforehand (in addition to checking the links you provided). My (gyn) oncologist said ok if I wanted to try it, but that the data is “immature”. Indeed, most of the published studies are on cell cultures and mice. There *are* some interesting clinical trials with people currently underway (eg, https://clinicaltrials.gov/ct2/show/NCT01175837).

      I hope others who decide to try this get better results than I did.

  7. Dr. does your recommendation regarding starches change for those of us who have elevated blood sugar after eating them?

  8. Dear Paul,
    Thank you so much for this. What a great expansion on the e-mail you sent me.
    The recommendations from you are the best I have seen – and I have been looking quite a bit lately. As I am just about to complete a year of treatment and hope to continue to be cancer free for a long time to come your advice will be a great boon.

    Looking forward to hearing more from you.

    Cheers,

    Kirk

  9. Hi Stabby,

    I’m about a 5. I’m sympathetic to the Bruce Ames argument that the amounts of environmental toxins people get are so small that they probably don’t matter much. And it’s been hard to prove that any is causing cancer. Even if you lived over Love Canal (http://en.wikipedia.org/wiki/Love_Canal), cancer incidence was actually decreased by 5% (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2721871/table/t3-ehp-117-1265/) and wasn’t statistically increased at the 95% confidence interval for any cancer (http://www.ncbi.nlm.nih.gov/pubmed/19672407), even though there were all kinds of health problems and birth defects.

    So I’m not looking to expose myself to toxins, but I’m not going to panic over trace exposures either.

    Hi Josh,

    Note that we recommend berries and vegetables for cancer patients.

    The main reason for the starches is that we think they’re beneficial foods (because (a) a modest amount of glucose is nourishing and (b) resistant starch is a good fiber). Fructose in fruit is non-nutritive and potentially cancer promoting. So I would favor a potato over an apple. Bananas are OK.

    Hi Ben,

    That would be interesting. It would be great if we had sufficiently non-toxic antivirals to make that feasible.

    Hi I.G.,

    It’s a great point about IGF-1. It would probably be best for cancer patients to restrict dairy to clarified butter/ghee and fermented yogurt (preferably from pastured animals). It’s a balance between the benefits of maintaining good gut flora and the IGF-1 and other hormonal / growth factors in milk which are probably deleterious.

    I would emphasize fermented vegetables / kimchi over fermented dairy, but I think a balance of the lactobacillus in gut flora is good. Probiotics are an alternative source.

    Hi Darin,

    That is the cheapest way to obtain supplemental magnesium.

    I’m leaning more toward Epsom salt baths these days, since I want some sulfur also. But if you want to save money, hard to beat the citrate.

    Hi Mario,

    Great point! Thanks for the links and idea. Ketosis is protective against chemotoxicity also. There may be a place for ketogenic dieting during chemotherapy.

    Hi Lawrence,

    Yes, I would reduce starches in those with diabetes or glucose regulation issues. It’s desirable to avoid blood glucose surges above 140 mg/dl, or at least sustained surges well above that level.

    But I would still get at least 200 calories of carbs per day from starches, fruits, and berries.

    Hi Kirk,

    So glad you’re doing well! Please stay in touch.

    Best, Paul

  10. Paul, for someone with a systemic fungal infection, is brown rice syrup OK, or stevia, or neither?

    Thank you!

  11. Hi Steph,

    Go for the brown rice syrup! Nothing wrong with stevia either, but a bit of glucose is good for fungal infections.

  12. Paul, this post is over-the-top fantastic.

  13. Perfect Health Diet » An Anti-Cancer Diet | The Angelove - pingback on September 29, 2011 at 9:06 am
  14. This article makes me think back to my mother with her breast cancer and what she was doing that could have been different. I see some similar ideas your presenting with her vegetarian approach such as nourishment, viral, importance of a harsh environment, and what cancer can feed on.

    She went with Innerlight and Dr. Young’s acid/alkaline balance near vegetarian diet. I’ve ran across this in most vegetarianish diets nowadays. They’ll say that the harsh environment we’re causing where fungus/bacteria and cancer thrives comes about by acidic foods like meat and the starches and even too much fruit. Thus avoid them but for cancer especially the starches and fruit because cancer thrives on sugar/glucose.

    Paul, could you address these two concepts for my belated sake and peace of mind concerning cancer?

  15. Hi Jay,

    The body regulates acidity closely everywhere, so changing the acid/base balance of the diet mainly changes the acidity of the urine, and secondarily may lead to a loss of minerals used as buffers by the kidney.

    So as long as you’re well nourished in minerals, you don’t need to worry about acid/base balance.

    It happens that an optimal diet is close to acid/base balanced, but I don’t think that proves that all diets need to be acid/base balanced.

    The fear of acidity among the vegans is overdone.

    Some pathogens do better in an alkaline environment, so we can’t say outright cancer patients are better with a more alkaline pH. It has to be proven.

    Our evolved acid-base conditions are going to be the best for us in most circumstances, so until there’s solid research I’m not inclined to mess with the body’s natural regulation of acidity.

    I don’t understand vegetarians who want to avoid starches and fruit. Where are they getting calories from? Coconut oil?

  16. Paul, Very nicely done! And very helpful info! My concern is general health. One thing I have been trying recently is a 10-minute self-massage using a solution of Epsom salts (1/2 cup Epsom salt, 1/2 cup water) which copies the “magnesium oil massage”. Since I read your article so carefully I found 2 sentences that you might need to edit: 1. (Under Omega 3 and omega 6 balance) “Some studies have shown anti-cancer effects from” 2. “Endorphins inhibit cancer proliferation, and . Here is”

  17. Hey Paul,

    I would like to inquire as to your thoughts on the efficacy of THC (marijuana) to increase the appetite of chemo patients. I would like to think that one could bypass the negative effects of inhaling burnt plant matter by cooking the THC out of the buds with coconut oil and then straining the resulting oil. Then, as the end of their daily fast is approaching, the patient could consume some of the oil providing both beneficial ketogenic effects with the SCFA and also stimulating appetite for breaking their fast with the THC.

    Thanks for all that you do for the community, you’re a true hero.

  18. Thanks, Mark! I’ve fixed those.

  19. It is not surprising that a disrupting circadian rhythm makes chemotherapy more effective, as chemotherapy is destructive – it benefits in an environment where its destruction potential is maximized, and as a side effect takes the unwanted cancer cells along with it.

  20. Paul, thank you! Some time, I am wondering if you could address whether there are any modifications one should make on the PHD to fight a systemic fungal infection? Frankly this post on a fungal/cancer connection scares me…

  21. Whoops, I guess it was your last post that referenced a study on fungal infections and cancer, sorry.

  22. Hi Funkadelic,

    Well, THC/marijuana can certainly increase appetite.

    I’m not sure if it’s advisable in cancer however. I would have to research that.

    Hi Matt,

    Agreed.

    Hi Steph,

    I’ll be doing a series before long on fungal infections. It’s been delayed but is on the burner. As far as diet, regular PHD is very good. This anti-cancer diet is good, a lot of the anti-cancer vegetables are also anti-fungal.

  23. So a cancer patient should get more carbs than a healthy person, at least 100 grams of carbs a day? Many cancer patients are also on Insulin for management of hyperglycemia induced by prednisone or other steroids prescribed as part of their cancer treatment.

  24. Thanks Paul.

    FYI…
    Innerlight, as I remember 5+ years ago… was 80/20. 80% alkaline mostly green veggies…alot + green drink of grasses concoction (bleh!) and 20% slightly acid food like …you guessed it …grains! Some small amounts of flax seed oil and maybe 4 oz salmon a month. Vinegar was a no no and only apple cider vinegar since its alkaline slightly. Awful tasting diet since you have to eat so much veggies..oh and their mostly raw or barely cooked. The gateway to this terrible diet was the motivational speaker Tony Robbins…at least he endorsed it back then. They had this “live” blood analysis where they take your blood and show you under the microscope. They show a picture of good blood and your’s looks bad compared to it. They can “diagnose” your diet problems and general health with it.

  25. Paul,

    The second issue of cancer feeding off of glucose more than let’s say protein/fat? Without glucose, cancer can’t live?

    Then there’s Doug Kaufmann who says fungus causes cancer and starches feed the fungus. He promotes a ketogenic strict paleo diet.
    http://www.thelivinlowcarbshow.com/shownotes/3021/doug-kaufmann-episode-132/
    http://www.knowthecause.com/

    So mom was thinking to avoid starches at all cost with her cancer.

  26. Thanks Paul. I’ll poke around a bit more on the site to see what I can find about starches/fructose/etc…or maybe just buy the book 🙂

  27. “For magnesium, I recommend Epsom salt baths…”

    You eat it, or bathe in it?

  28. @Darin, @ Paul Re liquid mag citrate, I don’t think it’s any good, I had been using that for some time too taking an ounce a day, which at that rate would take 10 days to get thru an entire bottle. But then I noticed several times a fuzzy white cobweb growing in the unused portion of an unrefrigerated bottle of clear lemon flavored mag cit that was in a clear bottle.

    So I re-read the label and noticed the warning “Discard unused product within 24 hours of opening bottle – store at room temperature – protect from excessive heat and freezing”, which means that to use the product as intended you’d have to go through the entire bottle within 24 hours, which would cause the laxative effect and take you back to using the product as a laxative instead of as a mag supplement, which apparently is safe and non toxic even though taking the entire 10 ounce bottle would give you 17.45 grams, or 17,450 milligrams all at once.

    Looks to me like even storing it at room temperature as recommended the stuff degrades or oxidizes which causes the formation of the cobweb. The stuff I was taking was lemon flavor however, and the label lists the ingredients as citric acid, flavors (lemon oil?) purified water, saccharin sodium and sodium bicarbonate. Not sure if refrigerating it would retard or prevent formation of the cobweb.

    Short of extracting and analyzing the cobweb to see what it is and what it’s made of, I decided I was probably wasting my time and money, even though it’s cheap, by taking a possibly oxidized and/or degraded product. Wasn’t real keen on ingesting the cobweb either, so I just started buying a separate bottle of mag aspartate supplements to make sure I’m get the magnesium, and there are specific benefits to taking either mag glycinate or aspartate anyway. At the very least you can be sure you’re getting what you paid for. Just my 2 cents worth, of course YMMV.

  29. Hi Jana,

    I think a cancer patient should get similar or slightly more carbs than a healthy person – when not fasting or in ketosis.

    Combining diet with drugs is a challenge sometimes. Our recommendations are low carb enough that the hyperglycemia problem will probably not be severe; but if there is hyperglycemia, that would almost force a very low carb diet.

    Hi clare,

    Thanks for letting me know.

    Hi Jay,

    Cancer is pretty hard to kill. Cancer cells do need glucose. The trouble is, without glucose, you can’t live either, so there’s no way to deprive cancer cells of glucose as long as they can access blood.

    Doug Kaufmann — It takes an elastic definition of “cause” to include fungi as a cause of cancer, although I do think they worsen the disease and promote its progression. Ketogenic diets are no way to treat fungal infections.

    Hi Josh,

    Buy the book, it’s worth it.

    Hi Tuck,

    I actually make a solution in a cup and spread the epsom salt water on my skin. My wife bathes in it. We decided drinking it isn’t a good idea since the sulfate favors some bad gut bacteria.

    Hi cancerclasses,

    I haven’t seen that happen before with magnesium citrate. But I agree, I much prefer either magnesium chelate supplements or epsom salt baths.

  30. Hi Paul. This is a great post with lots of good pointers.

    Have you heard of DCA (dichloracetate) as a treatment for cancer? There’s some excting news coming out of the University of Alberta regarding DCA and its ability to repair cancer-damadged mitochondria.

    http://www.dca.med.ualberta.ca/Home/Updates/2007-03-15_Update.cfm

    http://www.ncbi.nlm.nih.gov/m/pubmed/18766181/
    http://www.ncbi.nlm.nih.gov/m/pubmed/17222789/?i=3&from=/18766181/related

  31. Hi Robert,

    Yes, I know about DCA, it is exciting, but their last update was May 2010: http://www.dca.med.ualberta.ca/Home/Updates/2010-05-12_Update.cfm. I’m waiting for more results, the question is, can they create enough space between tumor regression and the onset of nerve damage?

  32. Hey Paul,

    Quite possibly one of the best posts I’ve read on the topic of anti-cancer diet and lifestyle. Looking forward to the rest of the series.

    Quick question. You mention that cancer cells can metabolize lactic acid. Would it then be a good idea to avoid too many fermented foods (which I believe contain lactic acid)?

  33. Hi Justin,

    I don’t think fermented foods are going to raise lactate levels in the body significantly. I’ve never heard anyone raise that concern. Good thought, but unlikely I would think.

  34. Paul wrote: “Cancer is pretty hard to kill. Cancer cells do need glucose. The trouble is, without glucose, you can’t live either, so there’s no way to deprive cancer cells of glucose as long as they can access blood.”

    Along that line, there’s something I’ve wondered about: It is my understanding that in a healthy, cancer free person who is adapted to a ketogenic diet, the body partitions available glucose to things that absolutely require glucose, such as the retina, and uses ketones for the many of the other functions. If a person with cancer were to go on a seriously ketogenic diet, are there aggressive cancer cells that would be able to “get in line first” and deprive the tissues such as the retina of glucose — even though, if they were not diseased, those cells would be using little if any glucose on a ketogenic diet?

    Sorry if the question displays my complete ignorance of the subject of metabolism, but I’ll be interested to see what you have to say.

  35. Paul,

    My dad has small cell lung cancer. SCLC strikes me as being a bit different from other cancers. I would guess that angiogenesis is quite different in the lung, since it already has such a high concentration of fine blood vessels. It also seems like an area that could easily be exposed to viruses. But, SCLC is highly correlated with past tobacco smoking.

    I guess I was wondering how you might think your general advice might be applied, modified, or differentially emphasized, in SCLC.

  36. What surprised me about cancer, when I learned about it, is how it evolves within the body. It has to sneak its way through a thicket of defenses in order to establish and maintain itself.

    I ran across one paper that described cancer and vitamin D. The active form of vitamin D, I think 1,25(OH)D, is strongly anti-cancer. In healthy individuals, we have a regulatory system which activates D when it’s low, and inactivates it when it’s high, via enzymes. Cancer cells over-express their genes which creates the enzyme that deactivates D, I believe it was something like 50-60 times a normal cell.

    Cancer evolves in response to efforts to kill it. My dad went through a round of Cisplatin. Cisplatin is interesting, it wrecks DNA during replication, as in mitosis. I met with my dad’s doctor to talk about “other” strategies to try in conjunction with the cisplatin. His response was pretty curt. His job, as he saw it, was to apply the strongest proven remedy, as demonstrated via controlled studies. It reminded me of an interview with a soldier, where he pointed out that his job was boiled down to blowing holes in things with ordnance. My dad’s doctor used drugs like ordnance to try and destroy cancer.

    But he’s not stupid, and the practical reality with SCLC, and probably most cancers, is that you can’t kill every single cancer cell with cisplatin. You might kill 99.999%, but that’s not 100%. The remaining stragglers have some resistance to cisplatin, somehow. And guess what. They reproduce like rabbits. So some time later, 6 months, 12 months, not a long time but not tomorrow either, there will be enough of them to show up in a CAT scan.

    And when they do, and you try cisplatin, it doesn’t work nearly as well as the first time… and there is no other drug that works as well as cisplatin, which is why they used it the first time…

    The fact that cancer cells evolve makes me appreciate the idea that once you have cancer that is spreading, there is a good chance that it will kill you, eventually, if something else doesn’t kill you first. It’s like the monster in a horror movie, or a nightmare. You can throw things in its way and slow it down, but eventually it catches you…

    I have more but no time to write.

  37. For a polyphenol-rich extra virgin olive oil, I can recommend Apollo Olive Oil’s “Barouni.” Their website talks about the milling process they use, which makes their oils particularly high in polyphenols. A warning for those (like me) who usually buy inexpensive, mild-tasting olive oil: This stuff isn’t cheap and it has a strong spicy/peppery/grassy flavor. It’s really grown on me though; love it now. Anyway, I have no connection with this company; just a satisfied customer who decided to try this oil after reading in the comments of another post that Paul recommends polyphenol-rich EVOO for candida.

  38. I love that you are doing this series. You are the first paleo blogger I know of to take on cancer. Luckily, you’re also one of the best bloggers too. Looking forward to digesting this post and series.

  39. This experimental treatment protocol involving LDN and Alpha Lipoic Acid is quite interesting – http://www.ncbi.nlm.nih.gov/pubmed/20042414
    full paper – http://tinyurl.com/4337e5n

    Milk thistle is another interesting anti-cancer treatment – http://www.ncbi.nlm.nih.gov/pubmed/18472213

  40. “An anti-cancer diet should be rich in cooked joint tissue”

    http://www.youtube.com/watch?v=HVi03uogzqk&feature=BFa&list=PL53AA35449C7DD652&lf=PlayList#t=29m5s I’ve always wondered if there was any auto-immune problems with chicken cartilage @31m11s

    But I could never find the study he cited “Meat-induced joint attacks, or meat attack the join: rheumatism versus allergy” in his PrizeCD2010 (I thought it would be in http://is.gd/XRMOmb).

    I used to pay for hyaluronic acid supplements after seeing this internet-popular video featuring Connie Chung: http://www.youtube.com/watch?v=PefdHNnDuv4 but I stopped after seeing that DrGreger video and reading the supplements could be made from chicken mohawk crown and second-guessing myself.

  41. Hi Marilyn,

    That’s not at all a dumb question, that’s often how cancer kills — by inducing cachexia or wasting due to lack of glucose and protein. When the tumor is extracting large enough amounts of glucose, the body can’t keep up.

    Hi Ed,

    I’m afraid I don’t have any special knowledge about SCLC. I’ll keep an eye out for it when I do research for future posts.

    Your story about cancer evolution is great. Yes, that’s why it’s so hard to defeat, once it reaches an advanced stage. It’s also why metabolic therapies like ketogenic diets are somewhat attractive — because the most metabolically disabled cells are the ones that evolve the fastest, so the ones that would be hit hardest by metabolic therapy.

    I suspect we may find dietary adjunct therapy is crucial to curing cancer.

    Hi Jess,

    Thanks for the recommendation.

    Hi Josh,

    That very paper on LDN and lipoic acid is mentioned in the post – in the sentence on LDN and lipoic acid for pancreatic cancer. Thanks for the full paper link and the link to the milk thistle paper.

    Hi Lance,

    I’m not aware of evidence that meat from healthy animals can induce immune attacks. (Meat with bacterial toxins, eg residue from E coli infected cows, can.)

    If you find anything, please let me know.

    Best, Paul

  42. Are there any papers that LDN actually works that way in-vivo ? From what I read its hypothetical.

  43. Great post, thank you. My father died from colon cancer, and my brother-in-law has lung cancer, so I have an interest in this subject.

    I appreciate you spreading the info regarding diet and cancer. A good diet full of REAL food is so important for preventing cancer, and also for reducing the effects if one already has it. I’d like to add that eating as pure as possible, from drinking water to organic fruits and veggies, is very important.

    I tend to disagree that the impact of environmental toxins is minimal. I think that if one takes into account, the TOTAL toxic load on each individual over the years, including ingesting and inhaling pesticides (which may mimic estrogen in the body) plus the use of strong household cleaning products, synthetic air fresheners, and other household products that contain formaldehyde – which is classified as a carcinogen, etc., there is a connection to illness and possibly cancer, but that’s a discussion for another time. 🙂

    Didn’t know if you’d seen this movie:http://www.amazon.com/gp/product/B003X3CF68 It’s about a doctor who uses a form of peptides for cancer treatment. Very interesting.

    Also, there is a book that others have great praise for, but I have not read it. http://www.amazon.com/World-Without-Cancer-Story-Vitamin/dp/0912986190/ref=sr_1_1?s=books&ie=UTF8&qid=1317392681&sr=1-1

    While my friend was doing chemo for ovarian cancer, she also did intravenous Vitamin C treatments, – before chemo, in-between the chemo sessions, and afterward. Not only were the typical chemo side effects greatly reduced, the cancer has not returned.

    I’ve read about different cancer treatments, and anecdotal evidence suggests that Vitamin C and Cannibis may be effective in shrinking tumors.

    Baking soda is also mentioned, but I haven’t delved into that yet.

    Cancer is a very profitable disease, unfortunately.

    I believe it is up to the individual person to find their best method of treatment and understand that there are alternatives to chemo – definitely not the only option.

    Cutting out all processed, prepared foods, non-organic fruits and veggies, and all forms of wheat if definitely a must – imo.

  44. majkinetor,

    Berkson paper on pancreatic cancer cited by Paul is not hypothetical, is from real, human, cases.

    There’s another Berkson paper “Reversal of signs and symptoms of a B-cell lymphoma in a patient using only low-dose naltrexone” (PMID 17761642), full paper here:

    http://www.ldn4cancer.com/techpapers/berkson-b-cell-lymphoma-paper.pdf

    You can, also, read personal testimony in the following links:

    http://www.ldnresearchtrustfiles.co.uk/docs/2010.pdf
    (Those Who Suffer Much Know Much, 2010)

    and

    http://www.ldndatabase.com/Cancer.html

  45. This is not about nutrition, but I’ve sometimes wondered whether persons with cancer might not do better without all the radiation from the many follow-up scans — the CT scans and PET scans. To what extent do these tests find new cancer developments so they can be dealt with in time, and to what extent to they actually encourage the development of new problems?

    http://online.wsj.com/article/SB126082398582691047.html

  46. I think now there’s a general tendency for society to place excessive reverence upon cancer patients, especially those who are seen to be ‘cheerful’ or ‘happy’. In my personal experience as caretaker of my late mother who succumbed to NHL, and as a former pediatric oncology and ICU RN, I think this line of thinking places an unfair burden on cancer patients and their caretakers.

    My mother was an extremely positive, outgoing, and cheerful person prior to getting her diagnosis. She remained mostly so throughout her treatment and up to the day she died. However, I’d notice that she acted extra cheerful to other family members and friends, while only sharing her fears/ anxieties with me. It made the situation all the more painful for the both of us, as the rest of the family and her friends saw mainly how upbeat she remained.

    When I worked on pediatric oncology unit and also the ICU, I also came across such behaviors. Many school-age or teenage patients would either voice to me or their parents their fears in private, all the while keeping up appearances for sake of other family members and friends. I think cancer patients do this partly because they have been socialized to do so, e.g. live up to the role of the cheerful, selfless cancer patient.

    It is up to those of us who are family members or friends or cancer patients, to give support in nonjudgmental fashion. We can give encouragement without also shutting them down on feeling/ expressing negative emotions. Many people are not comfortable dealing with negative emotions/ feelings, either expressing them or receiving them. But the most important thing to remember is to just offer your sympathies without judgment, even if you don’t know what to say or do at particular moments.

  47. Thank you, Jana.

  48. Hi Paul! Hailing from Maui right now! Loving every grain of sand beneath my feet.

    We were having a discussion about lemons as being potentially helpful for “curing” cancer. Do you have an opinion on that?

  49. The hypothesis that “more” fruits and vegetables will help against cancer has a lot of epidemiological support, as well as plausible en vitro evidence and mechanisms. There are some studies that put the hypothesis to the test in the real world and have come up as failures.

    The Women’s Healthy Eating and Living (WHEL) trial spent 8 years trying to show that increasing fuits & veggies & fiber would improve health. They did not succeed.

    http://www.ncbi.nlm.nih.gov/pubmed/15746825
    RESULTS: Total daily vegetable, vegetable juice, fruit, and fiber intake increased significantly (P <.01), while fat decreased significantly (P <.01). The percentage of women meeting the Healthy People 2010 fruit and vegetable objectives increased substantially. Overall dietary adherence was associated with increased cooking-class attendance (P for trend <.01).

    http://www.ncbi.nlm.nih.gov/pubmed/17635889
    CONCLUSION: Among survivors of early stage breast cancer, adoption of a diet that was very high in vegetables, fruit, and fiber and low in fat did not reduce additional breast cancer events or mortality during a 7.3-year follow-up period.

    http://www.ncbi.nlm.nih.gov/pubmed/15309460
    CONCLUSIONS: The dietary intervention efforts resulted in significant changes in diet toward an increase in plant foods and a decrease in dietary fat. Changes in weight, WHR, BMI, and body composition were not different over time or by study group assignment. Interventions that promote a plant-based diet without specific energy restriction do not appear to promote changes in body weight or body composition in women who have been diagnosed with breast cancer. To adequately examine the role of energy restriction in reducing obesity-associated breast cancer recurrence, future interventions should include prescribed energy imbalance either through reduced intake and/or increased expenditure.

    My guess is that the failure would be related to wheat, sugar, and vegetable oil consumption. That said, I think it is a reminder that humility is in order when discussing dietary interventions and cancer.

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