Sugar, Calories, and Cancer.

Bonnie and Steve - one sentence that appears in a new Nutrition and Metabolism cancer study, written by two brilliant researchers at Boston College University, sums it up: "It remains to be determined if the members of our species are willing or motivated enough to adopt the lifestyle changes necessary to prevent cancer."

If you are one of these motivated members of our species, read the highlights of this incredible study, which boasts over 178 references, and should be embedded in the minds of every oncologist, physician, and health professionals the world over.

Cancer as a Metabolic Disease
by Professors Thomas Seyfried and Laura Shelton
Nutrition and Metabolism, April 9, 2010

Numerous studies show that dietary energy restriction is a general metabolic therapy that naturally lowers circulating glucose levels and significantly reduces growth and progression of numerous tumor types to include cancers of the mammary, brain, colon, pancreas, lung, and prostate. The bulk of evidence indicates that dietary energy restriction can retard the growth rate of many tumors regardless of the specific genetic defects expressed within the tumor. Bonnie Translation: reducing caloric intake has a tumor-reducing effect.

Reduced glucose availability will target aerobic glycolysis and the pentose phosphate shunt; pathways required for the survival and proliferation of many types of tumor cells. Dietary energy restriction specifically targets the IGF-1/PI3K/Akt/HIF-1α signaling pathway, which underlies several cancer hallmarks to include cell proliferation, evasion of apoptosis, and angiogenesis. Calorie restriction also causes a simultaneous down-regulation of multiple genes and metabolic pathways regulating glycolysis. This is important, as enhanced glycolysis is required for the rapid growth and survival of many tumor cells.
Bonnie Translation: limiting or eliminating high glycemic load carbohydrates and added sugar, in particular, will starve tumors and cancer cells.

Dietary energy or calorie restriction can be considered a broad-spectrum, non-toxic metabolic therapy that inhibits multiple signaling pathways required for progression of malignant tumors regardless of tissue origin.
Bonnie Translation: reading this makes me smile!

Besides lowering circulating glucose levels, dietary energy restriction elevates circulating levels of fatty acids and ketone bodies (β-hydroxybutyrate and acetoacetate). Fats and especially ketone bodies can replace glucose as a primary metabolic fuel under calorie restriction. This is a conserved physiological adaptation that evolved to spare protein during periods of starvation. Many tumors, however, have abnormalities in the genes and enzymes needed to metabolize ketone bodies for energy. A transition from carbohydrate to ketones for energy is a simple way to target energy metabolism in glycolysis-dependent tumor cells while enhancing the metabolic efficiency of normal cells. The shift from the metabolism of glucose to the metabolism of ketone bodies for energy is due largely to the shift in circulating levels of insulin and glucagon, key hormones that mediate energy metabolism. Insulin, which stimulates glycolysis, is reduced under dietary restriction, while glucagon, which inhibits glycolysis and mobilizes fats, is increased. Glucose reduction not only reduces insulin, but also reduces circulating levels of IGF-1, which is necessary for driving tumor cell metabolism and growth.
Bonnie Translation: replacing added sugar and high glycemic load carbs with lean protein and healthy fats starve cancer cells.

Inferences that tumor cells have a growth advantage over normal cells are inconsistent with principles of evolutionary biology. Although viewed as a growth advantage, the dysregulated growth of tumor cells is actually an aberrant phenotype. How can tumor cells that express multiple mutations and mitochondrial abnormalities be more "fit" or "advantaged" than normal cells that possess a flexible genome, normal respiratory capacity, and adaptive versatility? The short answer is that they are not. Normal cells can grow much faster than tumor cells during normal wound repair. Metabolism of ketone bodies and fatty acids for energy requires inner mitochondrial membrane integrity and efficient respiration, which tumor cells largely lack. In contrast to the tumor cells, normal cells evolved to survive extreme shifts in the physiological environment and can readily adapt to fat metabolism when glucose becomes limiting.
Bonnie Translation: the italicized text, and the fact that lean protein and healthy fats keep normal cells healthy, is all that needs to be said here.

Consequently, a shift in energy metabolism from glucose to ketone bodies protects respiratory competent normal cells while targeting the genetically defective and respiratory challenged tumor cells, which depend more heavily on glycolysis than normal cells for survival.
Bonnie Translation: cancer cells require sugar, and lots of it, to stay alive.

Proof of concept for cancer metabolic therapy was illustrated for the management of malignant astrocytoma in mice, and malignant glioma in children. Prostate and gastric cancer also appears manageable using low carbohydrate ketogenic diets. Recent studies show that dietary energy restriction enhances phosphorylation of adenosine monophosphate kinase (AMPK), which induces apoptosis in glycolytic-dependent astrocytoma cells, but protects normal brain cells from death. This further illustrates the differential response of normal cells and tumor cells to energy stress.
Bonnie Translation: lowering empty calories and infusing nutrient-rich calories kills tumor cells and nurtures normal cells.

A possible concern is how any therapy, which reduces food intake and body weight, can be recommended to individuals who might be losing body weight because of cancer cachexia. These therapies could be supplemented with omega-3 fatty acids, which can also reduce the cachexia phenotype. Omega-3 fatty acids from fish oil also have the benefit of maintaining low glucose while elevating ketone levels. Once the tumor becomes managed, individuals can increase caloric consumption to achieve weight gain.
Bonnie Translation: if you have cancer, it is not about the amount of calories you eat, it is about eating the right calories. I have been harping on this for years. Most oncologists say, "just get more calories, it doesn't matter how." They don't realize the damage this recommendation can do. This is also why my cancer patients are instructed to keep their protein and healthy fat intake high while getting almost all of their carbohydrates from fruits and vegetables.

There are no known drugs that can simultaneously target as many tumor-associated signaling pathways as can calorie restriction. Hence, energy restriction can be a cost-effective adjuvant therapy to traditional chemo- or radiation therapies, which are more toxic, costly, and generally less focused in their therapeutic action, than is dietary energy restriction.
Bonnie Translation: Big Pharma is not a big fan of this statement.

Although dietary energy restriction and anti-glycolytic cancer drugs will have therapeutic efficacy against many tumors that depend largely on glycolysis and glucose for growth, these therapeutic approaches could be less effective against those tumor cells that depend more heavily on glutamine than on glucose for energy. Glutamine is a major energy metabolite for many tumor cells and especially for cells of hematopoietic or myeloid lineage. Moreover, glutamine is necessary for the synthesis of those cytokines involved in cancer cachexia including tumor necrosis factor alpha, (TNF-α) and the interleukins 1 and 6 (IL-1 and -6). It therefore becomes important to also consider glutamine targeting for the metabolic management of metastatic cancer.
Bonnie Translation: this is why I have never recommended glutamine as a dietary supplement and I always recommend that my clients stay away from glutamine byproducts such as glutamic acid and monosodium glutamate (MSG).

Recent studies suggest that the green tea polyphenol (EGCG) could target glutamine metabolism by inhibiting glutamate dehydrogenase activity under low glucose conditions. This and other glutamine-targeting strategies could be even more effective when combined with energy restricting diets, which lower glucose levels while elevating ketone bodies. Hence, effective non-toxic targeting of both glucose and glutamine metabolism should be a simple therapeutic approach for the global management of most localized and metastatic cancers.
Bonnie Translation: then why do most oncologists tell their patients not to consume green tea while undergoing chemotherapy?

If impaired mitochondrial energy metabolism underlies the origin of most cancers as proposed here, then protecting mitochondria from damage becomes a logical and simple approach for preventing cancer. It is well documented that the incidence of cancer can be significantly reduced by avoiding exposure to those agents or conditions that provoke tissue inflammation such as smoking, alcohol, carcinogenic chemicals, ionizing radiation, obesity, viruses etc. Simply reducing exposure to cancer risk factors, which produce chronic inflammation and mitochondrial damage, will reduce the incidence of at least 80% of all cancers. In principle, there are few chronic diseases more easily preventable than cancer.
Bonnie Translation: I could not have said it better myself.

The origin of mitochondrial ROS comes largely from the spontaneous reaction of molecular oxygen (O2) with the semiquinone radical of coenzyme Q, QH, to generate the superoxide radical O2−[40,84,299] Coenzyme Q is a hydrophobic molecule that resides in the inner mitochondrial membrane and is essential for electron transfer. Ketone body metabolism increases the ratio of the oxidized form to the fully reduced form of coenzyme Q (CoQ/CoQH2). Oxidation of the coenzyme Q couple reduces the amount of the semiquinone radical, thus decreasing superoxide production.
Bonnie Translation: this is why Co-Enzyme Q10 has always been in our top five most important dietary supplements. Your body cannot produce CoQ10 on its own, it is only found in animal protein. Supplementing with the right CoQ10 is crucial. If not sealed in an enteric-coated softgel or encapsulated lipid, CoQ10 oxidizes and becomes worthless. With CoQ10, you get what you pay for!

Ketone body metabolism will also increase the reduced form of glutathione thus facilitating destruction of hydrogen peroxide. The reduction of free radicals through ketone body metabolism will therefore reduce tissue inflammation provoked by ROS while enhancing the energy efficiency of mitochondria. Ketone bodies are not only a more efficient metabolic fuel than glucose, but also possess anti-inflammatory potential.
Bonnie Translation: eating more lean protein in your diet enhances free radical quenching.

The simplest means of initiating the metabolism of ketone bodies is through dietary energy restriction with adequate nutrition. It is important to emphasize adequate nutrition, as calorie restriction associated with malnutrition can potentially increase cancer incidence.
Bonnie Translation: go see a licensed health professional to assess your individual dietary needs.

Consequently, consumption of foods containing the active groups of respiratory enzymes (iron salts, riboflavin, nicotinamide, and pantothenic acid) could be effective in maintaining health when combined with dietary energy restriction. The lowering of circulating glucose levels through calorie restriction facilitates the uptake and metabolism of ketone bodies for use as an alternative respiratory fuel.
Bonnie Translation: avoid sugar and eat nutrient-rich food.

The implementation of periodic dietary energy restriction, which targets multiple cancer provoking factors, can be a simple and cost effective life-style change that is capable of reducing the incidence of cancer. In light of this fact, it remains to be determined if members of our species are willing or motivated enough to adopt the life style changes necessary to prevent cancer.
Bonnie Translation: this is the million dollar question that each of you must answer for yourself.

Evidence is reviewed supporting a general hypothesis that cancer is primarily a disease of energy metabolism. All of the major hallmarks of the disease can be linked to impaired mitochondrial function. Two major conclusions emerge from the hypothesis; first that many cancers can regress if energy intake is restricted and, second, that many cancers can be prevented if energy intake is restricted. Consequently, energy restricted diets combined with drugs targeting glucose and glutamine can provide a rational strategy for the longer-term management and prevention of most cancers.
Bonnie Translation: the future is in your hands. We hope you're now motivated to make a lifestyle change!