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    of 1

    Tan-Shalaby et al.

    Nutrition & Metabolism (2016) 13:52


    DOI 10.1186/s12986-016-0113-y

    RESEARCH Open Access

    Modified Atkins diet in advanced


    malignancies - final results of a safety and
    feasibility trial within the Veterans Affairs
    Pittsburgh Healthcare System
    Jocelyn L. Tan-Shalaby1,2*, Jennifer Carrick1, Krystal Edinger1,2, Dana Genovese1,2, Andrew D. Liman1,2,
    Vida A. Passero1,2 and Rashmikant B. Shah1

    Abstract
    Background: Dysfunctional mitochondrial processes limit malignant cells ability to use energy from fatty acids and
    ketones. Animal studies using ketogenic diets for cancer show encouraging results. We tested the diet’s safety and
    feasibility in cancer patients across a broad variety of solid tumors.
    Methods: We recruited 17 advanced cancer patients who were not on chemotherapy. They consumed 20 to 40 g
    of carbohydrates daily with evaluations performed weekly until week 4, then every 4 weeks until 16 weeks. Quality
    of life questionnaires monitored for tolerability and compliance. Positron emission/computerized tomography was
    ordered at baseline, 4,8 and 16 weeks. Student t-testing evaluated differences between baseline and last visit scores
    for quality of life, weight, body mass index, and serum parameters. Correlations between weight loss and serum
    ketones, glucose, lipids and creatinine were done. Two-tailed unpaired t-testing of the mean weight loss compared
    responders against non-responders.
    Results: Eleven out of seventeen enrolled patients were evaluable. Mean age was 65+/- 11.7 years, weight 203 +/-
    4.98 lbs. (92 ± 2.3 kgs.) and previous treatment failures was 1.7, +/- 0.97. All lost significant weight with hematologic,
    biochemical and lipid tests remaining stable. Quality of life scores slightly improved. At 4,8 and 16 weeks, six (54.5 %),
    five (45.4 %) and four (36 %) patients were stable or improved. We observed no correlations between serum glucose,
    ketones or lipids. Clinical response did not correlate with ketosis or glycemia. Responders (stable disease or partial
    responders) lost statistically more weight than non-responders. Dietary compliance was difficult. Only three patients
    continued dieting past 16 weeks. Out of these, two patients developed brain metastases and were on steroids.
    They survived 80 and 116 weeks respectively. The third patient underwent residual tumor resection and has no
    disease at 131 weeks.
    Conclusions: Modified Atkins diets are safe and feasible in advanced cancer. Quality of life was preserved.
    Patients who lost at least 10 % of their body weight responded the best. Steroid intake affected optimal ketone
    and glucose levels. Despite this, survival improved in some melanoma and lung cancer patients. Further studies
    are recommended.
    Trial registration: Clinicaltrials.gov NCT01716468. Registered on September 18, 2012

    * Correspondence: [email protected]
    1
    Veteran Affairs Pittsburgh Healthcare System, Pennsylvania, Pittsburgh, USA
    2
    University of Pittsburgh School of Medicine, Pennsylvania, Pittsburgh, USA

    © 2016 The Author(s). Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
    International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
    reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
    the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
    (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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