01/14/2026
METABOLIC THERAPY FOR CANCER
Despite the vast differences in cancer prognoses and treatments, one fact remains constant: every patient should consider their nutrition for optimal health. Of course, this is a fundamental truth that extends to all people, but how does the role of diet interplay with a cancer diagnosis? We know from numerous epidemiological studies that poor diet is indeed a significant risk factor for cancer incidence, and the role of poor diet in driving the obesity epidemic has only added more fuel to this fire. Yet, nutrition and diet are rarely brought up in the oncology ward, especially as a modality for treatment. Cancer isn't something you treat once and walk away from. It's a condition that requires daily attention, and our interventions should match that pace—consistent, integrated, and present in the patient’s everyday life.
This reality is addressed with ketogenic metabolic therapy (KMT), a targeted diet-drug strategy designed not only to nourish the patient to optimal health through the treatment process, but to reduce the fuels and “building blocks” that cancer cells require for growth. Grounded in decades of research on cancer metabolism—starting with the pioneering work of Otto Warburg—KMT exploits a fundamental weakness of cancer cells: their near-total dependence on GLUCOSE and GLUTAMINE for sustained proliferation. Unlike healthy cells, which can flexibly switch to oxidative fuels such as ketone bodies and fatty acids during periods of metabolic stress (fasting or low carbohydrate intake), most malignant cells are metabolically inflexible, incapable of efficiently using ketones and fatty acids in the absence of glucose and glutamine due to loss of mitochondrial OXPHOS efficiency.
In a time when most new cancer therapies are expensive and limited to only certain patients (by cancer subtype or even genetic profile of the tumor), ketogenic metabolic therapy aims to offer something radically different: an accessible, universal intervention. Because nearly all cancers depend on glucose and glutamine to fuel their growth, this approach targets a metabolic vulnerability that cuts across cancer subtypes. So, what exactly does ketogenic metabolic therapy entail?
Three common frequently asked questions:
(1) does this KMT framework apply for all cancers, not just glioblastoma?
(2) does KMT also target glutamine, or is it primarily focused on targeting glucose?
(3) if managing cancer, is KMT something that has to be done consistently and across the patient’s lifetime?
Ketogenic metabolic therapy (KMT) is envisioned as a synergistic therapeutic strategy that combines baseline metabolic pressure (induced by dietary strategies) with pharmacological agents that target the two bioenergetic pathways required for cancer growth (glycolysis and glutaminolysis). In essence, it is a diet-drug combination, where metabolism is considered the primary treatment modality upon which other therapies are added. The research community is also learning that this “metabolic priming” can potentiate the effects of conventional therapies. Each cancer diagnosis should have a unique risk/benefit assessment for both standard and metabolic therapies, where the informed patient must evaluate the need to integrate KMT into their treatment regimen based on the expected efficacy of standard of care.
KMT is composed of dietary KMT and pharmacological KMT. Dietary KMT focuses on achieving a whole-body shift in physiology that recapitulates the metabolism of fasting. Dietary KMT encompasses different interventions or procedures, including biomarker-driven ketogenic diets, calorie restriction, fasting/fasting mimicking diets, as well as exercise. A ketogenic diet that does not induce chronic metabolic pressure on cancer cells (for example, high ketones but also high glucose/insulin) would not be considered dietary KMT, and therefore not expected to reduce tumor growth.
Pharmacological KMT aims to inhibit glucose and glutamine utilization in cancer cells at the substrate, enzyme and/or transport level; this can be done more safely and effectively only after reaching stable nutritional ketosis via dietary KMT. Some drugs in this category are approved generics and off-label medications, while others are still in the research phase. After achieving this sustained metabolic pressure, a multitude of repurposed drugs and systemic treatments (such as hyperbaric oxygen therapy) can be added with the goal of forcing an already metabolically-vulnerable population of cancer cells beyond their limit. In my opinion, this is where conventional chemoradiotherapy and immunotherapy would have the highest likelihood of success, not the other way around.
KMT is a long-term therapeutic strategy to be maintained as long as there is evidence of disease; from a mechanistic standpoint, it may also prevent recurrence after treatment, but logically, the intensity should be adjusted to differentiate between active disease and post-treatment surveillance.
The KMT framework was written for GBM because the long-term survival is unfortunately less than 1% at 10 years from diagnosis, despite maximal standard therapies. I believe this offers an ethical opportunity to explore metabolism-based therapies. However, the rationale is applicable to most if not all malignant cancers, proportional to their aggressiveness (i.e., it would be difficult to envision a rapidly proliferating tumor that does not require energy and building blocks for proliferation, even without knowing anything about its molecular makeup). At this stage, dietary KMT (e.g., ketogenic diet) is typically advocated for and implemented by patients themselves: it is not a passive treatment, it must be actively chosen. It is important to work with knowledgeable dietitians and medical professionals to implement KMT, but there is also a personal learning curve that every patient will need to go through. This greatly increases the responsibility of the patient in the therapeutic process, which is quite rare in modern medicine, but I strongly believe this cooperative, proactive approach is essential for the success of metabolic oncology.
In contrast to most new cancer therapies being tested, the theory behind KMT is sound, so positive results are to be expected in the clinical trial setting. We are beginning to see just that. In a recently published clinical study, researchers from Greece implemented a Mediterranean-style ketogenic diet to supplement standard care in 18 patients with GBM—again, one of the most lethal cancers. The diet was meticulously designed to keep blood glucose low and ketones elevated while keeping a healthy micronutrient balance, using olive oil, nuts, fatty fish, and targeted macronutrient ratios to shift patients into a state of therapeutic ketosis.
Of the six patients who adhered to the diet for over six months, all six surpassed 30 months of survival post diagnosis—more than doubling the expected (median) survival time of 15 months. Four patients in the ketogenic diet group were still alive at the time of publication, with one reaching seven years post-diagnosis. Meanwhile, among the twelve patients who did not adhere to the diet for over six months, only one was able to surpass the 30-month benchmark. A statistically significant difference in survival between those who did or did not adhere to dietary KMT signifies the profound power of optimizing nutrition through cancer care, and we are here to continue pushing that research forward. Stay tuned.
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