Keto: Therapeutic vs. General
I spend a great deal of time participating in various Keto-related groups, some of them specific to Cancer and some of them more general. One common misconception I repeatedly see is the confusion about what a Therapeutic Ketogenic Diet (TKD) is and how it differs from a more general Ketogenic Diets (KD). People often believe that if they are following some version of the KD, they are being ‘therapeutic.’ This is not necessarily true.
Let’s start by looking at the various versions of the Ketogenic Diet and the range of allotted carbohydrate (and other macronutrients) for each.
General: Macros - 75% Fat, 15-20% Protein, 5-10% Carb (50g a day or less)
Therapeutic: Macros -75-80% Fat, 15-20% Protein, 5-8% Carb (20-25g a day)
Targeted Keto for Athletes: Macros - 65% Fat, 20% Protein, 10-15% Carb (70-80g a day targeted around workouts)
As you can see from these examples there are several ways to use the Ketogenic diet and there are other versions that you can find online from both research-based and not-research-based sources.. The thing that separates these versions of the diet from each other is the reason behind your desire to use the diet; what’s your goal/plan?
As I mentioned in my earlier post, I had been following a Ketogenic diet prior to my Cancer diagnosis, but we were not tracking our macros. What we were doing is best described as a liberal version of a General Ketogenic Diet; more low carb or ‘Lazy’ Keto. If I had to guess what my macros were at the time I would have to say they were about: 35% Fat, 45% Protein, and 20% Carb. But, the point is there really wasn’t a specific plan for using the Ketogenic diet beyond being lower carb and eliminating grains (which we had discovered over the years I had trouble tolerating).
After my Cancer diagnosis I began looking into using the Ketogenic diet as part of my treatment. Initially, I was working with a Naturopathic Physician (ND) who had me on a very restricted Ketogenic diet; 70-80% Fat (mostly monounsaturated fat/little saturated fat), 15-20% Protein (mainly from fish and plants) and 5% or less Carb (she had me on a limit of 12g of net carbs a day, with 7g of those carbs coming from a supplement that had no nutritional value. This version of the diet (among other factors) left me feeling weak and lethargic. Eating became a chore and wasn’t very enjoyable. An unpleasant situation for a foodie family! Using the diet with the rest of the plan from the ND was not working to improve my situation with the Cancer; in fact my Cancer was getting worse.
Upon the advice of a family friend I sought out a second opinion from The Ohio State University James Cancer Center. In going to the James, I had the opportunity to connect with researchers who had done a clinical trial using the Ketogenic diet with women with metastatic breast Cancer. They immediately suggested I relax my carbohydrate limitation from the severe strategy I had been following. They explained that in terms of metabolic levers, breast Cancer responds more like diabetes. Therefore, the extreme carbohydrate limitation that is often recommended for Cancer (in general) isn’t necessary to be effective. I should note that in the Keto-Cancer world, much of the research looks at brain Cancers and to be the most effective in those cases, the carbohydrates should be more restricted because the ketone bodies have to cross the blood-brain barrier.
Almost immediately after relaxing my carbohydrate limit to about 20g of net carbs a day, I began to feel better. And I began enjoy eating again! By moderating my macros to a lesser strict version of Therapeutic Keto, I felt well enough to begin exploring more cyclic calorie restriction and compressed eating windows. The Cancer benefits of these practices include allowing the body to have more time to engage in something called “autophagy.” This is a term that refers to a mechanism the body uses to clean up toxins and cellular waste. This is very beneficial for anyone, but especially for people with Cancer. I will explore some of this in upcoming posts.
This brings me back to the question about having a goal and a plan. Many people seem to think that they can just use the Ketogenic diet to “fix” their Cancer in the short term. Cancer, regardless of the type, is a metabolic disease and it needs to be treated as such. I will explain this is much greater detail in an upcoming post. Our metabolic pathways (that determine how our body works) are influenced by a whole host of factors that work together. Therefore, it’s not just a dietary approach, a supplement, or a mindset alone that impacts the metabolism of Cancer; it’s everything you do, everyday that influences a range of metabolic pathways.
So, how do I use the Therapeutic Ketogenic Diet as part of my plan? I have things in my plan that I do everyday. I have things I do several times a week and I have things I do more occasionally. I will dive deeper into this when I post about Lifestyle strategies. The point is I have a plan that I am committed to and make a priority in my life.
