Episode Overview

In this final episode of the Nutrition After Breast Cancer: Just the Facts series, we talk about one of the most misunderstood topics in the cancer space.

Ketosis.

Not as a cure.
Not as a replacement for treatment.
Not as a magic solution.

But as a metabolic state that may influence the internal environment your cells live in.

In this episode, I explain:

What metabolic health actually means
What ketosis is in simple terms
The difference between ketosis and ketoacidosis
What the Warburg Effect tells us about glucose and cancer cells
What the Keto-CARE trial at The Ohio State University found in women with stage IV breast cancer
How beta-hydroxybutyrate may influence inflammation
How therapeutic ketosis is being studied in metabolic oncology
Why genetics like FTO, PPAR-alpha, and CPT1A can make ketosis harder for some women
Who may benefit from ketosis
When ketosis may not be appropriate

We also talk about something that does not get discussed enough.

Ketosis is a tool.
It may support treatment.
It may support insulin sensitivity.
It may reduce inflammation.

It is not a cure.

Context matters. Deeply.

If you want to understand how your body’s energy system works and how that knowledge can give you more options, this episode is for you.

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Read the full transcript:

0:00
You're listening to better than before breast cancer with the breast cancer recovery coach, I'm your host, Laura Lummer. I'm a certified life coach, and I'm a breast cancer thriver. In this podcast, I will give you the skills and the insights and the tools to move past the emotional and physical trauma of a breast cancer diagnosis if you're looking for a way to create a life that's even better than before breast cancer, you've come to the right place. Let's get started.

0:33
Hey, friends, welcome to episode 453 of better than before breast cancer. I'm your host. Laura Lummer, breast cancer survivor living with healing from stage four metastatic breast cancer, metabolic health and life coach and someone who cares very deeply about helping you understand how your body actually works and how it interacts with food. So that's why I've been doing this series, nutrition after breast cancer, just the facts, and this is the final episode in that series. Today we're going to talk about ketosis, but before we go any further, I really want to make something very, very clear, ketosis, the metabolic state of ketosis, which we can get to through many ways, which we'll talk about as we go through this episode, is not a cure for cancer. It is not a replacement for treatment. It is not a magic fix. What we're talking about today is metabolic support, and we're talking about how to change the body's fuel system and how that may influence the internal environment your cells live in. We'll talk about research and what the research shows, because in some research settings, metabolic ketosis has been shown to potentially support the effectiveness of certain cancer treatments, meaning that it may help create conditions where treatments work more efficiently and where maybe you recover easier from them. And that's a very different thing from saying it treats cancer. And I think that distinction matters. I want to get it out up front very clearly. So before I even define ketosis, I want to slow down, and I want to talk about this word that I use all the time, metabolic because sometimes I say metabolic health, or I say metabolic approach, and I realized not everyone fully understands what that means. That's because my mom asked me. So when I say metabolic health, I'm talking about how your body makes and uses energy, how steady your blood sugar is, how your hormones signal, how your cells turn food into fuel. So another way of thinking about metabolism, or metabolic is your internal energy system, and another word that I use that I was really pretty much introduced to this word in relationship to our body when I started my training with Dr nation winters and her book the metabolic approach to cancer and her survey that takes a deep look at all aspects of health, called the terrain tent. So what is terrain? It's just the environment inside your body. Is the condition your cells are living in. So think about just your whole body as a garden. It's the soil, it's the terrain. So today, we're going to talk about a state called ketosis, and how that state may influence your internal energy, environment, your terrain and your metabolism. So now that we're grounded in the language, we get the definitions. Let's talk about what ketosis actually is, because I think a lot of people this does not make sense to so let's think of your body like a hybrid car. I have a hybrid. So it uses gasoline and it uses electricity, and it can switch back and forth. So most of us have been running on glucose or sugar our entire lives. Every time you eat carbohydrates, your body breaks them down into glucose, and that becomes fuel, but your body has another fuel system, and when carbohydrate intake drops low enough, typically below 40 to 50 grams a day. But again, that depends on the person. It depends on your body. Sometimes it has to be much lower than that. For me, it has to be much lower than that, and we'll get to why. And it also depends on which level of ketosis you want to be in. So we'll talk about that today too. But anyway, when carbohydrate intake drops low enough, so typically between or below 40 to 50 grams per day, your body will shift, and it would begin burning stored fat. Your liver converts that fat into molecules that are called ketones. So when ketones rise above a certain measurement on a blood test, and you can use a little device called the Keto Mojo, and there are other devices, but I'm most familiar with the Keto Mojo, it will tell you how many ketones you have in your blood. Now, some people say that when your ketones measure point five on a blood test, you're in what's called nutritional ketosis. Dr Naisha always says point eight. She believes that it's she's got these more stringent. Rules, because she's dealing with a very specialized population of people for the most part. So when we are in nutritional ketosis, this is not starvation, this is not an emergency, this is not a failure of metabolism. It is a built in survival mechanism. It's brilliant. Your body knows how to do this, which is fascinating. And here's another thing that's so interesting to me, many women this is also my experience, feel like their energy gets steadier. They have fewer crashes. They have less brain fog when they get into a state of ketosis. So why does ketosis matter in the context of breast cancer or recovery or healing or wellness. So let's walk through what the research actually looks at and tells us, because a lot of people, when they hear about ketosis or ketogenic diet, immediately say there's no evidence. It's all anecdotal. Sorry, friends, I call bullshit. So I do want to be very careful here, because things can get very oversimplified. So I'm going to emphasize again, even though researchers looking at this, it is not replacing treatment. It is not about avoiding chemotherapy, and we're not talking about curing cancer with a diet. We're talking about whether changing the metabolic environment of your body can support treatment. Okay, so almost 100 years ago now, Otto Warburg, a scientist observed that cancer cells relied very heavily on glucose for their energy, even when oxygen was present in the body. So other cells, normal, healthy cells, are going to function more in the presence of oxygen, you're going to use oxygen. But cancer cells didn't like that, and so that finding has been confirmed and validated again and again in modern cancer biology. Now, most healthy cells can switch between glucose and ketones for their fuel, which is super cool. We're going to talk about that, but many cancer cells struggle to use ketones efficiently. So researchers, including metabolic oncology researchers like Dr Thomas Siegfried at Boston College, have explored whether lowering glucose and increasing ketones might create metabolic stress for cancer cells, while healthy cells can adapt and use those ketones. So this is about shifting the environment and the usage of energy inside our body. And when you understand that glucose piece, I think the next layer makes even more sense, because I'm going to simplify this process as much as I can. But one of the reasons why getting in ketosis, or why a diet is not a cure is because cancer is complex, and so no one thing has ever been that I know of put out into the world as a cure. Now maybe some people have adapted a ketogenic diet, or found themselves in a state of ketosis, and as a result of that, maybe they have healed. Maybe they have no evidence of disease. Maybe their therapies have worked better for them, but I'm not, and I've never heard any valid source put anything out there around ketosis or ketogenic diets as a cure. I'm going to say that over and over, because it's just so dang important that we understand it. Okay, so let's talk about the next layer here, insulin and growth signaling. Because every time we eat a carbohydrate, insulin rises. If insulin stays elevated for a long period of time or chronically, it increases another hormone that is involved in growth signaling, and that hormone is called IGF one so in many breast cancers, those growth pathways are already turned up, meaning many breast cancers can use insulin and IGF one. So when researchers look at ketogenic diets, they're often looking at what happens to insulin. So you hear people say, glucose feeds cancer. Well, maybe, but is that the only piece? Absolutely not, because, again, anytime glucose increases, insulin increases, and insulin is a growth factor, so we've got to think about that too. So there was a study called keto care at Ohio State University. Small study, 20 women, but they all had stage four metastatic breast cancer. They followed a well formulated ketogenic diet, which is very important here, because well formulated means it's got a lot of plants. It's got healthy fats, not gross fats, not Crisco oil, not too much fat, not drinking olive oil. A well formulated diet, and they took this diet while they were undergoing chemotherapy. Researchers found significant improvement in insulin resistance within three months. Three months insulin resistance meaning that our body is exposed to high glucose levels for so long that When insulin is knocking at the door. At a healthy level, our cells are like not opening the door. I. I'm already full of blood sugar here. I've got glucose stores up the wazoo B so the pancreas makes more insulin, and it knocks harder and longer until the cell lets that blood sugar come in because of all of the insulin that's knocking on the door, right? It's like, shut up. Fine. I'll let it in. So insulin resistant means that our cells now are like, Oh, no more, I'm not going to open the door, right? So we want our bodies to be insulin sensitive. We want the lowest amount of insulin necessary in order for ourselves to receive glucose, because we want to have we're always going to have some glucose. So we want that insulin resistance to be low, and we want the amount of glucose to be a healthy level, as low as possible, because both can contribute to inflammation. So the researchers in that study concluded that diet was feasible and metabolically beneficial during active treatment, and when insulin stabilizes, it may create a more favorable internal environment during therapy. So that's very important. Now, I mentioned inflammation a second ago, and this is really fascinating. So ketones, what our body makes when the carbohydrate intake is low enough, are not just fuel, not just fuel like we say. You know, glucose is fuel, ketones or fuel. That's oversimplifying things. The primary ketone that our body makes is called beta hydroxybutyrate, and we're just going to call it BHB. So BHB also acts as a signaling molecule, and research that was published in the frontiers in nutrition showed that BHB may help reduce inflammatory signaling, including activity in something called the nlrp three inflammasome. And we know that inflammation is deeply connected to cancer progression and treatment side effects. So if ketosis lowers inflammation even a little bit modestly, that may support overall resilience. So again, pay attention to language I'm using support, influence, shift, not cure. So when you put all of this together, glucose dependence, insulin signaling, inflammation, you start to see why metabolic oncology researchers are interested. So some early research suggests that therapeutic ketosis, which is going to be a higher level of ketone production, may increase metabolic stress inside the cancer cells, while normal cells adapt more. So it stresses out that cancer cell by taking away its easily accessible and easily usable fuel sources. So there are animal studies and small human trials that are exploring whether this metabolic pressure can enhance the sensitivity to chemo or radiation. Now I'm going to first of all, this is not standard of care, and it is not universally accepted yet, but the research is ongoing, and I want to share with you an experience I had because I've been through radiation multiple times. And the first time that I went through radiation, I did not know about the state of ketosis or how to get into ketosis. It was early in my stage four diagnosis. But the second time, I did know, and I made sure that I was in a very high state so therapeutic ketosis. And I can tell you, I had a dramatically different experience with radiation, between being in ketosis and not. And I also have clients who have decided to be in a deep state of ketosis when going into some of their treatments, and have shared with me that their treatment is considerably less uncomfortable, and that they rebound from the treatment faster. So again, that's the anecdotal part. Those are the stories I'm sharing with you, but the facts look like they're definitely supporting this. Yet the research is ongoing. So knowing that that research is ongoing based on what we already know is important, because the conversation continues to evolve before we go any further, I want to clear up another thing. I want to tell you the difference between ketosis and ketoacidosis, because when people hear the word ketones, they sometimes panic. So let me talk about the different attributes of ketosis and ketoacidosis, so when you are in nutritional ketosis, so that's the kind of the entry level of being in ketosis, not therapeutic, which is much more challenging when you're in nutritional ketosis. Here are some of the criteria. Your ketones are between point five and three on a little meter, such as the Keto Mojo, developed by Dr Thomas Seyfried and his lab, you also have normal or low blood sugar. Insulin is present, but you're in a controlled physiological state, so it's intentional. Diabetic Ketoacidosis usually occurs in type one diabetes. Insulin is. Absent. There's no insulin present, because type one diabetics do not produce their own insulin. Blood sugar gets extremely high, and ketones get dangerously high. That is a medical emergency, two completely different metabolic states if you have normal insulin function, nutritional ketosis does not turn into ketoacidosis, okay? And then so I want you to feel kind of at peace with that, knowing these are two very different things, and one is much more related to diabetes, and not just type one. It can happen in type two as well. Okay, so now let's talk about something else that comes up and often confuses people, or I often hear this. Sometimes women say they're trying to get into ketosis, and they tell me it doesn't work for me. And let's talk about why that might happen and why getting into the state of ketosis can be harder for some people than it is for others. Not everyone can get into ketosis easily, and this is where genetics and metabolic state come into play. So let's talk about a couple of genes. There's a gene called FTO. There are FTO variants that are associated with stronger hunger signals and carbohydrate cravings. If that's you lower carbohydrate intake may feel really challenging, and it not because you lack discipline, but because your hunger hormones scream at you. There is another gene called P, P, A, R, alpha. These variants can affect how efficiently your body regulates fat metabolism, so how your body uses fat, how it stores it, how it burns it for energy, and they can make a very slower transition into fat burning mode. Then there's one that's called CPT one a the variants in this gene can influence how fatty acids get into your mitochondria, which produce energy, and they get into your mitochondrias your mitochondria can burn them and use them, and so that may get make getting into deep ketosis, that therapeutic level, much more challenging for some people. That does not mean it can't happen. It just means your body might need a more gradual transition, and it might be a little slower. That's me. I have all of those genetic variants, and we have to think about your metabolism as well. So if you have a lot of extra body fat, if you are metabolically unhealthy, if you have metabolic syndrome, if you have non alcoholic fatty liver disease, there can be all of these things. Your body has been in a state of using glucose and eating large amounts of carbohydrates for a long time. So it might take you longer for the body to retrain itself and understand that it can use other fuels and that it's safe for your body to tap into those fat stores and start using what is stored in those fat cells as energy. So if you decide you want to try to be in a metabolic state of ketosis, because whatever reason you believe it will benefit, you know that sometimes you have to be very patient with yourself. There are some people that I see, I swear, it's just like they think about ketosis and bam, they're in it. I mean, some people can get into this state so easily that is not me. It is not easy for me. It takes energy, it takes intention, and it takes patience, but I feel so much better when I do it. So just know that it's a little bit different for everybody, which is why I did this series of nutrition facts. Because isn't everything different for everybody. We just need to listen to our body, and we need to give it grace and space and patience. So the real goal may not be living in ketosis forever. So if you have active disease, most likely a metabolically trained practitioner is going to try to support you into staying in the highest possible level of ketosis as often and as long as possible, because that state puts so much stress on the cancer cells, and because it can help so much with the treatments that we take. But that's not for everybody. Everybody doesn't need to be in that higher level of ketosis in order to take down inflammation, maybe to lose extra body fat, nutritional ketosis can be plenty. And so what this does, this state does, again, teaches your body how to switch fuels efficiently, and that's an awesome goal. So the ability to move between glucose and fat without crashing, without feeling hungry, without having huge insulin spikes, without feeling like you have what's called the Keto flu, that's a sign of metabolic health, flexibility, not rigidity. Like everything, right? We want to be flexible, and that perspective, I think, can take a lot of pressure off when it comes to the tool of metabolic ketosis. So let's talk about who could benefit. From experimenting with being in the state of ketosis, women with insulin resistance, women carrying central body fat, so belly fat, if you're in belly fat, ketosis could really help a lot with that, hormone sensitive cancers, women who struggle with brain fog. I mean, I'm saying women, because I work with women, but any human right, humans with chronic inflammation, this is so important because the state of ketosis can work wonders for reducing inflammation, but just as beneficial as it can be for people in these different metabolic states, there are also times when being in ketosis might not be appropriate, and you need to approach it with caution and the support of an experienced professional in those cases, this could be somebody who experiences unintentional weight loss. They could be if there is a metabolic state called cachexia, which is kind of the body starting to eat itself up in a in an advanced state of cancer or illness using its own muscle, if someone is very underweight or malnourished, or if there's a significant kidney or liver disease, or if it increases stress and obsessive thinking about Food, okay, if you have an eating disorder, if you are in a lot of fear, and this creates more stress. And I know I've worked with clients like that. They're obsessed with testing their blood. They're obsessed with the highest level of ketosis. And even though ketosis is a range, right from nutritional is a certain range, therapeutic is a certain range, and people will be in this really high range of therapeutic ketosis because they have active disease. And then that range will lower because they ate and then they start to really go into a spin, even though they're still in a state of therapeutic ketosis, just not as high as what it once was. So if the mind is so obsessed and so stressed and in so much fear that this creates more stress, then this may not be a great approach for you. It may not be the best thing to support your body's ability to heal, because psychological stress is a huge player in our healing and our healthy lifestyle. We must feel safe inside. We must find internal peace with the lifestyle we choose. Critical now I want to just touch on something really quickly. When we're talking about stress over food, I've said repeatedly that being in the state of ketosis, which we can get into by following a ketogenic diet fasting or using exogenous ketones, which is a supplement, or lowering your carbohydrate content enough that your body starts producing ketones. So there are different mechanisms, different ways to get there, but what I often see are people so fixated on diet that they're failing to look at the other things I often say to my client, you've got this you understand the diet. You know what to eat. You're doing a fantastic job. Let's check that box. Let's leave that alone. Let's take it off the table, and now let's look and say, I've got the food. I understand the ketosis. I understand how to get into this state. What else could I look at we cannot allow ourselves to get so obsessed with food that we think food is the be all and the end all and the thing that's going to heal us. We must work on the non tangibles. We must work on the emotional safety, on processing trauma, on releasing anger and grief and bitterness and resentment. We must work at having a balanced life, mentally, emotionally, energetically in every single way. So when it comes to ketosis, it is a tool. It may influence your metabolic environment. It may support certain treatments, efficacy, efficiency. It may support insulin sensitivity and reduce inflammation, but it is not a cure. So understanding your body's energy gives you options. It helps you ask better questions. It allows you to feel informed instead of reactive. It helps you know your body is adaptable, and I think when you understand how that works, you get to move more out of fear and into clarity, because you understand there are more tools available to you. And being someone who's worked for five and a half years to heal from widespread metastatic breast cancer, having more tools is very exciting. It's very empowering, and it feels like I have some control over what happens in my body. I hope it helps you too. All right, if you have questions about this podcast, if you have comments about this podcast, please come and join my free community living well after breast cancer, where we have a whole section just to talk about what you learn in the podcast, what questions you have in the pod. Test, or maybe what you've tried and what works for you. So go to my website. You can see the little banner right at the top of the website. So the breast cancer recovery coach.com

25:09
if you're interested in doing metabolic calls coaching, or in just learning more and being more connected to your body, come to my website, the breast cancer recovery coach.com click on coaching and programs and find a program that works for you. All right, friends, I hope you have enjoyed this series. If there's something else you'd like to hear about again, come to my living wall after breast cancer community and let me know what topics you would like to hear more about. I'd love to hear from you. All right, I'll talk to you soon. Be good to yourself.

25:39
You've put your courage to the test, laid all your doubts to rest. Your mind is clearer than before, your heart is full and wanting more. Your future's at the door.