What does the science say about the clinical use of ketogenic diets for epilepsy and cancer? 

Blood sugar, also known as blood glucose, is the universal go-to fuel for the cells throughout our bodies. Our brain burns through a quarter pound of sugar a day because “glucose is the preferred metabolic fuel.” We can break down proteins and make glucose from scratch, but most comes from our diet in the form of sugars and starches. If we stop eating carbohydrates (or stop eating altogether), most of our cells switch over to burning fat. Fat has difficulty getting through the blood-brain barrier, though, and our brain has a constant, massive need for fuel. Just that one organ accounts for up to half of our energy needs. Without it, the lights go out…permanently. 

To make that much sugar from scratch, our body would need to break down about half a pound of protein a day. That means we’d cannibalize ourselves to death within two weeks, but people can fast for months. What’s going on? The answer to the puzzle was discovered in 1967. Harvard researchers famously stuck catheters into the brains of obese subjects who had been fasting for more than a month and discovered that ketones had replaced glucose as the preferred fuel for the brain. Our liver can turn fat into ketones, which can then breach the blood-brain barrier and sustain our brain if we aren’t getting enough carbohydrates. Switching fuels has such an effect on brain activity that it has been used to treat epilepsy since antiquity. 

In fact, the prescription of fasting for the treatment of epileptic seizures dates back to Hippocrates. In the Bible, even Jesus seems to have concurred. To this day, it’s unclear why switching from blood sugar to ketones as a primary fuel source has such a dampening effect on brain overactivity. How long can one fast? To prolong the fasting therapy, in 1921, a distinguished physician scientist at the Mayo Clinic suggested trying what he called “ketogenic diets,” high-fat diets designed to be so deficient in carbohydrates that they could effectively mimic the fasting state. “Remarkable improvement” was noted the first time it was put to the test, efficacy that was later confirmed in randomized, controlled trials. Ketogenic diets started to fall out of favor in 1938 with the discovery of the anti-seizure drug that would become known as Dilantin, but they’re still being used today as a third- or fourth-line treatment for drug-refractory epilepsy in children. 

Oddly, the success of ketogenic diets against pediatric epilepsy seems to get conflated by “keto diet” proponents into suggesting a ketogenic diet is beneficial for everyone. Know what else sometimes works for intractable epilepsy? Brain surgery, but I don’t hear people clamoring to get their skulls sawed open. Since when do medical therapies translate into healthy lifestyle choices? Scrambling brain activity with electroshock therapy can be helpful in some cases of major depression, so should we get out the electrodes? Ketogenic diets are also being tested to see if they can slow the growth of certain brain tumors. Even if they work, you know what else can help slow cancer growth? Chemotherapy. So why go keto when you can just go chemo? 

Promoters of ketogenic diets for cancer are paid by so-called ketone technology companies that offer to send you salted caramel bone broth powder for a hundred bucks a pound or companies that market ketogenic meals and report “extraordinary” anecdotal responses in some cancer patients. But more concrete evidence is simply lacking, and even the theoretical underpinnings may be questionable. A common refrain is that “cancer feeds on sugar.” But all cells feed on sugar. Advocating ketogenic diets for cancer is like saying Hitler breathed air so we should boycott oxygen. 

Cancer can feed on ketones, too. Ketones have been found to fuel human breast cancer growth and drive metastases in an experimental model, more than doubling tumor growth. Some have even speculated that this may be why breast cancer often metastasizes to the liver, the main site of ketone production. As you can see below and at 4:59 in my video Is Keto an Effective Cancer-Fighting Diet?, if you drip ketones directly onto breast cancer cells in a petri dish, the genes that get turned on and off make for much more aggressive cancer, associated with significantly lower five-year survival in breast cancer patients, as you can see in the following graph and at 5:05 in my video. Researchers are even considering designing ketone-blocking drugs to prevent further cancer growth by halting ketone production.  

Let’s also think about what eating a ketogenic diet might entail. High animal fat intake may increase the mortality risk among breast cancer survivors and potentially play a role in the development of breast cancer in the first place through oxidative stress, hormone disruption, or inflammation. This applies to men, too. “A strong association” has been found “between saturated fat intake and prostate cancer progression and survival.” Those in the top third of consumption of these kinds of fat-rich animal foods appeared to triple their risk of dying from prostate cancer. This isn’t necessarily fat in general either. No difference has been found in breast cancer death rates based on total fat intake. However saturated fat intake specifically may negatively impact breast cancer survival, increasing the risk of dying from it by 50 percent. There’s a reason the official American Cancer Society and American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline recommend a dietary pattern for breast cancer patients that’s essentially the opposite of a ketogenic diet. It calls for a diet that’s “high in vegetables, fruits, whole grains, and legumes [beans, split peas, chickpeas, and lentils]; low in saturated fats; and limited in alcohol consumption.” 

“To date, not a single clinical study has shown a measurable benefit from a ketogenic diet in any human cancer.” There are currently at least a dozen trials underway, however, and the hope is that at least some cancer types will respond. Still, even then, that wouldn’t serve as a basis for recommending ketogenic diets for the general population any more than recommending everyone get radiation, surgery, and chemo just for kicks. 

“Keto” has been the most-searched keyword on NutritionFacts.org for months, and I didn’t have much specific to offer…until now. Check out my other videos on the topic in related videos below. 

 For an overview of my cancer work, watch How Not to Die from Cancer. 

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Meet Chef Lois Ellen Frank, Ph.D. We had the pleasure of talking with her about food history, health, and culture. Read on and enjoy her recipe for Three Sisters Stew.

Tell us a little about your work.

Chef Walter Whitewater and I are based in Santa Fe, New Mexico, at Red Mesa Cuisine, a catering company specializing in the revitalization of ancestral Native American cuisine with a modern twist, using ingredients and preparing foods focused on health and wellness.

Together, we have worked with Native American communities in the Southwest of the United States for more than 30 years. I was honored to be the recipient of the Local Hero Olla Award, which recognizes an exceptional individual for the work they do to create healthy, innovative, vibrant, and resilient local sustainable food systems in New Mexico. Chef Walter and I work with the New Mexico Department of Health by providing training to cooks who work in Native communities. We also work with the Physicians Committee for Responsible Medicine (PCRM) on The Power to Heal Diabetes: Food for Life in Indian Country program. See www.nativepowerplate.org for more.

What are the Three Sisters, and what significance do they have for Native Americans?

The Three Sisters are corn, beans, and squash. They are believed by a number of tribes to be gifts from the great spirit. The way these vegetables grow in the garden exemplifies the notion of interconnectedness, as do the nutrients they provide. They are three ingredients that Chef Walter and I use regularly and a foundation to a healthy ancestral Native American diet.

We recently learned about the “Magic Eight” from you. Could you describe what the “Magic Eight” foods are and their history?

The Magic Eight are corn, beans, squash, chiles, tomatoes, potatoes, vanilla, and cacao. They are eight foods that did not exist anywhere outside of the Americas prior to European contact in 1492. If we deconstruct that, it means that the Italians did not have the tomato, the Irish did not have the potato, there were no chiles in any Asian, East Indian, or African cuisine, and there was no confection using either vanilla or chocolate. These are truly indigenous Native American foods that were given to the rest of the world and are now woven into the identities of so many cuisines. The Magic Eight are the focus of our cookbook, Seed to Plate, Soil to Sky: Modern Plant-Based Recipe Using Native American Ingredients, which was published by Hachette Book Group this summer.

What are your go-to favorite whole food, plant-based, oil-free meals? 

Yesterday, I made a Three Sisters enchilada. I combined savory refried pinto beans with zucchini squash and corn kernels, which I put into a corn tortilla and topped with a red chile sauce, green onions, and some of the sautéed squash and corn. It was delicious. Another favorite is a poblano chile stuffed with quinoa, mushroom, and spinach, which I serve with an heirloom tomato sauce that I can myself every year so I can use it throughout the winter months. Chef Walter loves to use corn and makes a traditional dish called Navajo Kneel Down Bread (Nitsidigo’i), which is sweet corn baked inside a fresh or dried corn husk. Chef Walter’s modern version adds dried currants, raisins, and fresh apples, foods that are readily accessible on the Navajo Nation in his community of Pinon, where he grew up.

Can you please tell us a little bit about your work with PCRM and its Native Food for Life program?

We have done a lot of work over the years with PCRM and its Native Food for Life program. Under its Native American resources, there are plant-based recipe booklets by Chef Walter and myself, as well as a lot of videos, other information, and recipes on healthy foods that are easy to make.

What message do you have for the Native American population regarding reclaiming their health through heritage?

I think that we all—all nations, all ethnicities, and all people—need to reclaim our health and wellness. In Native American communities, there is a movement to re-indigenize, reclaim, and revitalize the ancestral diet for health and wellness. This is a good thing, because when you eat the Magic Eight and other foods from the region of your own ancestors, you revitalize everything associated with those foods, including the land, techniques surrounding the foods, and agricultural practices, so that the knowledge surrounding these practices can be passed on from generation to generation.

Three Sisters Stew

makes 4 to 6 servings

Chef Walter and I originally made this recipe on the Navajo Reservation in the town of Pinon, Arizona, where he was raised. It has been made for numerous family gatherings and ceremonies. For this version, I’ve added zucchini instead of meat. The squash makes this stew hearty without being heavy. This recipe is great because you can make it to feed four to six people, or you can add to it and make enough to feed sixty to six hundred.

1 tablespoon bean juice ½ large yellow onion, chopped (approximately 1 cup) ½ green bell pepper, seeded and chopped (approximately ½ cup) 1 zucchini, cut into small cubes (approximately 1½ cups) 2 teaspoons blackened garlic 1 can (14.5 ounces) diced tomatoes, no salt added if possible 1½ cups cooked organic dark red kidney beans (or one 15-ounce can) 1½ cups cooked organic pinto beans (or one 15-ounce can) 1 cup corn kernels, fresh or frozen 1½ tablespoons New Mexico red chile powder, mild 1 teaspoon New Mexico red chile powder, medium (optional, for a slightly hotter stew) ¼ teaspoon black pepper, or to taste ¼ teaspoon dried thyme ¼ teaspoon dried oregano 4 cups water or bean juice

Preheat a cast-iron soup pot or heavy bottomed metal soup pot over medium-high heat. Add the bean juice and heat until hot. Add the onions, sauté for approximately 3 minutes until translucent, stirring to prevent burning. Add the bell pepper and sauté for another 3 minutes, stirring to prevent burning. 

Add the zucchini and sauté for another 3 minutes. You want the vegetables to caramelize and begin to turn brown. The bottom of the pan may begin to turn brown, but this is part of the caramelization process. Add the garlic and cook for another minute, stirring to prevent burning and to incorporate into the other ingredients.

Add the tomatoes. Cook for another 2 minutes, stirring constantly. Add the kidney beans, pinto beans, corn, mild chile powder, and medium chile powder (if you want a spicier stew), black pepper, thyme, and oregano, then mix well. Add the water, bring to a boil, then reduce heat and let simmer for 25 minutes, stirring occasionally. Taste and adjust seasonings, if desired. Remove from heat and serve immediately.

Note: Fresh thyme and fresh oregano can be used if available. Simply double the amount from ¼ teaspoon of each to ½ teaspoon of each. I usually buy herbs fresh if they are available, and if I have leftover herbs from whatever I am cooking, I dry them on a sheet tray in my pantry and then put them into glass jars for future use.

Excerpted from Seed to Plate, Soil to Sky: Modern Plant-Based Recipes Using Native American Ingredients by Lois Ellen Frank. Copyright © 2023. Available from Hachette Go, an imprint of Hachette Book Group, Inc.

You can find Chef Lois Ellen Frank here.

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