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High-grade glioma cells consume mainly glucose and cannot compensate for glucose restriction. Apoptosis may potentially occur under carbohydrate restriction by a ketogenic diet (KD).
The use of KD as adjuvant to standard treatment, with chemoradiation after first surgery, is feasible and safe in patients with glioblastoma multiforme (GBM). The value of these studies should be regarded in light of upcoming metabolic therapy trials which will be performed in several types of cancer. Specifically, in GBM, there are three studies ongoing.
The median survival duration of patients with GBM is 15 months after multimodal therapy combining surgery, radiotherapy and chemotherapy. As high-grade glioma cells consume mainly glucose, dietary carbohydrate restriction has been suggested as a possible therapeutic strategy to improve the survival duration. In recent in vitro and in vivo studies, cancer growth was inhibited by the ketosis and increased lipolysis induced by low-carbohydrate diets. It seems, therefore, that GBM cells do not compensate for glucose restriction, whereas normal brain cells do so by metabolizing ketone bodies. Apoptosis may potentially occur under carbohydrate restriction. An extremely carbohydrate-restricted diet, the ketogenic diet (KD; high-fat, low-carbohydrate diet), could be of interest because it mimics the metabolic response to starvation when ketones become the main fuel for the brain. Although low-carbohydrate intake alone has been found effective on survival in the treatment of GBM in several animal models and in vitro studies, combining current therapies with KD was even more effective.
Dr. Marcos Escosa