The Modified Ketogenic Diet in Adults with Glioblastoma: An Evaluation of Feasibility and Deliverability within the National Health Service

Abstract

There is an increasing interest in the use of the ketogenic diet (KD) as an adjuvant therapy for glioma patients. We assessed the tolerability and feasibility of a modified ketogenic diet (MKD) in patients with glioma, along with willingness of patients to participate in future randomized controlled trials. The study was undertaken in two parts; a patient questionnaire and evaluation of the diet. One hundred and seventy-two questionnaires were completed; 69% (n = 119) of the population reported MKD should be offered to patients with glioma and 73% (n = 125) would be willing to try MKD for 3 months. Six male patients with high grade gliomas tried the diet; 4 completed the 3-month feasibility period. Ketosis was achieved in all patients. The only gastrointestinal side effect was constipation (n = 2). Minimal changes were observed in weight, body mass index, fat mass and cholesterol profiles. MKD was well tolerated, with few side effects and is deliverable within a financially viable, NHS service. There is a high level of interest in the diet within the glioma patient community to ensure adequate recruitment for a clinical trial. Further studies are required to demonstrate efficacy and patient benefit before implementing a service.

Ketogenic diets as an adjuvant therapy for glioblastoma (KEATING): a randomized, mixed methods, feasibility study

“…Out of the 12 patients randomized, 10 commenced KD and only four met the primary endpoint of three-month dietary intervention (1 KD, 3 MKD). Cancer trials in general report median retention rates of 89% (IQR 79-97% with valid primary outcome data at follow up) [33] and previous KD studies for patients with GBM report retention rates of 50 to 100%, with retention determined at eight weeks [19], three months [18,32] and the point of tumor progression [17]. However, patients in these previous KD studies self-selected to try the diet, mainly at recurrence or post-treatment, creating an optimistic bias in retention, when compared to the general unselected GBM population approached for KEATING.…”

“…Previous feasibility work estimated recruitment targets of one patient per month [32], in keeping with National Institute for Health Research (NIHR) funded trials [33]. Twelve patients were to be recruited over 12 months.…”

A ketogenic diet exerts beneficial effects on body composition of cancer patients during radiotherapy: An interim analysis of the KETOCOMP study

“…For example, a recently published survey among high grade glioma patients revealed that almost three quarters (73%) of patients would be willing to try a KD for three months and 66% would participate in a clinical trial investigating the effectiveness of the KD. 5 …”

Wilhelm Brünings' forgotten contribution to the metabolic treatment of cancer utilizing hypoglycemia and a very low carbohydrate (ketogenic) diet

“…A list of relevant KD studies published in peer-reviewed journals is given in Table 1, and Fig. 3 shows their chronological appearance relating to Brünings’ publications 7 , 10, 11, 12, 13, 14 , 32 , 34 , 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65. It took almost half a century after Brünings’ first publication until what is generally considered the first clinical study treating cancer patients with a KD was published (Fearon et al.…”