Pre-Treatment Mitigation Strategies

Ketosis for Mitigation of Radiation and Chemotherapy Side Effects

Animal and recent human studies have identified that metabolic ketosis enhances the therapeutic ratio by making normal cells more resilient and cancer cells more vulnerable to cancer treatments. Metabolic ketosis describes the upregulation of fat burning through oxidative phosphorylation in the mitochondria. Most individuals become metabolically flexible and thus aid ketosis by practicing time-restricted fasting and low-carbohydrate diets as their default lifestyle practices. This efficient dietary lifestyle is our historical default changed in the last century as we increased the carbohydrate percentage in our macronutrients and felt compelled to eat every few hours.

Radiation Treatment Strategies

If a patient gets daily radiation, multiday fasting is impossible, as discussed in the Fasting Mimicking Diet. I advocate patients have an early lunch between 11 AM to 1 PM and then an early dinner around 5 PM. One would then start a modified fast with plenty of fluids and carbohydrate-free electrolytes, just no major protein or carbohydrates until the subsequent early lunch. Hopefully, the RT treatment gets scheduled for mid-morning, and one would turn down all the sugar-laden products as they arrive at the cancer center. Generally, a metabolically flexible person will drift into early ketosis by 12-16 hours of this modified fasting; over half of this time, one is asleep.

Enhancing Ketosis

To enhance this ketosis, one can add light exercise in the morning, like a long walk or your favorite level 2 workout, where your heart rate goes up, but you can still talk comfortably. Additional steps are to add exogenous sources of products that break down quickly into ketones or actual ketone esters that will rapidly bump up your ketones. Patients should consider adding a pre-ketone like Brain Octane Soft Gels, an MCT oil, or caprylic acid, quickly processed through the gut mucosa and cleaved into blood ketones. I like the capsules as they are easier on the stomach lining than the liquid form, and I suggest 3-6 soft gels, maybe with some celery, before one leaves their house for the treatment. One would then add 15-20 cc of Ketone Ester, and I suggest Ke4 (listed below) 30-45 minutes before the treatment. All these will help one feel well if you push the electrolyte hydration and enable you to engage the therapeutic benefits. Take your time getting a late breakfast or lunch, and try 2-3 more hours of modified fasting before eating. Make sure one limits the fasting if one is near the lower level of BMI or at risk for too much weight loss. Maintaining muscle mass is a priority as this best correlates with a favorable outcome with cancer and other medical conditions.

Chemotherapy Approach

For those getting an infusion of chemotherapy, scheduled as one every week, two weeks, or three weeks, one can thus use a more aggressive fasting program. The Fasting Mimicking Diet is an option if severe weight loss or cachexia symptoms do not threaten one. One could still add the exercise and exogenous ketones before the treatment. If one does not want to follow the 600 calorie 3-5 day FMD option, switch to modified fasting 24 hours before the treatment and try to forgo major carbohydrates and protein for 4-6 hours after the infusion. Remember to have coffee with some clean fat and celery and push the fluids and electrolytes.