Feasibility and Biological Activity of a Ketogenic/Intermittent-Fasting Diet in Patients With Glioma
Schreck KC, Hsu FC, Berrington A, Henry-Barron B, Vizthum D, Blair L, Kossoff EH, Easter L, Whitlow CT, Barker PB, Cervenka MC, Blakeley JO, Strowd RE
Neurology · 57 citations
How it was studied
- Design
- Controlled clinical trial (classified by our AI screen)
- Studied in
- People
- Main outcome
- Health markers and function
Who paid for it
- Funding
- Independent funding
- Government
- National Cancer Institute
- Government
- National Center for Advancing Translational Sciences
- Government
- NCI NIH HHS
- Government
- NCATS NIH HHS
- Grants
- National Center for Advancing Translational Sciences (UL1-TR003098); National Cancer Institute (P30CA012197); National Center for Advancing Translational Sciences (KL2TR001421); National Center for Advancing Translational Sciences (UL1TR001420)
Based on 4 listed funder(s).
Publication
- Published
- 2021-07-07 · Neurology · vol. 97 · issue 9 · pp. e953–e963
- Publisher
- Lippincott Williams & Wilkins
- Cited
- 70 citations · more than 95% of similar papers · 4.2× the field average
- Impact
- Top 10% most cited in its field
- References
- 45 works
- Access
- Open access (repository copy) · CC-BY
- Research areas
- Diet and metabolism studies · Dietary Effects on Health · Metabolism and Genetic Disorders
- Keywords
- Ketonuria, Medicine, Ketogenic diet, Glioma, Internal medicine, Ketone bodies, Hypoglycemia, Ketosis, Gastroenterology, Endocrinology, Insulin, Diabetes mellitus, Epilepsy
- MeSH
- brain, humans, glioma, brain neoplasms, ketosis, fasting, feasibility studies, adult, aged, middle aged, female, male, diet, high-protein low-carbohydrate, diet, ketogenic
13 authors
From GB, US, BY
- Karisa C. SchreckUniversity of Nottingham; Johns Hopkins University; Research Institute of Radiology
- Fang‐Chi HsuUniversity of Nottingham; Johns Hopkins University; Research Institute of Radiology
- Adam BerringtonUniversity of Nottingham; Johns Hopkins University; Research Institute of Radiology
- Bobbie J. Henry-BarronUniversity of Nottingham; Johns Hopkins University; Research Institute of Radiology
- Diane VizthumUniversity of Nottingham; Johns Hopkins University; Research Institute of Radiology
- Lindsay BlairUniversity of Nottingham; Johns Hopkins University; Research Institute of Radiology
Abstract
Objective
To examine the feasibility, safety, systemic biological activity, and cerebral activity of a ketogenic dietary intervention in patients with glioma.
Methods
Twenty-five patients with biopsy-confirmed World Health Organization grade 2 to 4 astrocytoma with stable disease after adjuvant chemotherapy were enrolled in an 8-week Glioma Atkins-Based Diet (GLAD). GLAD consisted of 2 fasting days (calories <20% calculated estimated needs) interleaved between 5 modified Atkins diet days (net carbohydrates ≤20 g/d) each week. The primary outcome was dietary adherence by food records. Markers of systemic and cerebral activity included weekly urine ketones, serum insulin, glucose, hemoglobin A1c, insulin-like growth factor-1, and magnetic resonance spectroscopy at baseline and week 8.
Results
Twenty-one patients (84%) completed the study. Eighty percent of patients reached ≥40 mg/dL urine acetoacetate during the study. Forty-eight percent of patients were adherent by food record. The diet was well tolerated, with two grade 3 adverse events (neutropenia, seizure). Measures of systemic activity, including hemoglobin A1c, insulin, and fat body mass, decreased significantly, while lean body mass increased. Magnetic resonance spectroscopy demonstrated increased ketone concentrations (β-hydroxybutyrate [bHB] and acetone) in both lesional and contralateral brain compared to baseline. Average ketonuria correlated with cerebral ketones in lesional (tumor) and contralateral brain (bHB R s = 0.52, p = 0.05). Subgroup analysis of isocitrate dehydrogenase-mutant glioma showed no differences in cerebral metabolites after controlling for ketonuria.
Conclusion
The GLAD dietary intervention, while demanding, produced meaningful ketonuria and significant systemic and cerebral metabolic changes in participants. Ketonuria in participants correlated with cerebral ketone concentration and appears to be a better indicator of systemic activity than patient-reported food records.
Trial registration information
ClinicalTrials.gov Identifier: NCT02286167.
Abstract via Europe PMC. Copyright remains with the authors or publisher.
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