Most people turn to the ketogenic diet to lose weight or to enhance athletic performance. Today, nutritionist Miriam Kalamian, author of “Keto for Cancer,” explains how this diet is a powerful tool for improving our health overall. She tells how her son’s cancer diagnosis launched her on a mission to explore the possibility of nutritional therapy to improve his outcome. When she came across the keto diet, she saw promise. And once she changed how he was eating to align with keto, she saw its efficacy. Science backs up what she witnessed first-hand. Not only does the keto diet help cancer patients live longer, it also allows them to enjoy a much higher quality life.
On this episode, we discuss the origins of the healing keto diet, how it works on a cellular level, and why it is an effective and safe treatment for cancer. Miriam explains how nutrition can be the first line of defense for cancer treatment & recovery of health, or, how, at the very least, it can be an adjunct to conventional therapies.
Listen to the episode here:
This is episode 146. My guest is Miriam Kalamian. Miriam is an educator and an author specializing in the ketogenic diet as a therapy for healing. She has a Master’s in Nutrition and is the author of Keto for Cancer. Most of us see the keto diet as a way of eating to lose weight or get our bodies into better shape. Miriam got into it as a result of an intensely personal experience. In 2004, her young son, Raffi, was diagnosed with brain cancer. When conventional treatments failed to turn things around, Miriam stumbled upon research that indicated that diet could be used to treat cancer. We discussed the core tenets of the ketogenic diet, how it can help improve your health, how you can discern if it’s right for you, and its role in helping cancer patients not only live longer, but also enjoy a much higher quality of life.
Thank you, Hilda. I’m very happy to be here.
I am so excited because I feel like keto is the rage. Every time I turn around, someone’s talking about keto. Tell us a little bit about the keto diet to kick things off here.
Keto diet has been around for about 100 years. It’s flying under the radar in the epilepsy world. That’s where it was developed as a nutritional therapy to help children who had intractable epilepsy. It gained traction there, then it lost ground with the introduction of some of the anti-seizure medications, which weren’t very effective for kids and had all kinds of side effects. It came back into prominence in the mid-‘90s through Charlie Abrahams’ success with it. Jim and Nancy Abrahams, Charlie Foundation kinds of information, and even a movie. Jim is a director and a writer. They produced a film with Meryl Streep called First Do No Harm. That’s how it regained its position. All this time, they were also doing a lot of research and looking at it for obesity, and starting to look at it for diabetes. They had looked at it early on, but lost favor with some diabetes medications, particularly insulin.
Now, in the magazines and the social media, we see stars touting it as a weight-loss method.
That is a double-edged sword. You get the celebrity weight loss stories, and that’s what helped to make it visible. Also, it’s so much more than weight loss. It’s about health improvement. It’s about improving your metabolism, your health span and all kinds of wonderful things. In my case, it’s also a nutritional therapy for cancer.
What are some of the core tenets of the keto diet?
A ketogenic diet is a low carbohydrate diet. I should stress, it’s a very low carbohydrate diet. We’re talking about somewhere around in the neighborhood of 50 grams of carbs a day or less in order to get into that state and maintain that state of ketosis. That is where you’re using fats as your primary fuel. One of the products of using fats are these little molecules and they are synthesized into ketone bodies, which are energy molecules. Our brains love ketones, and our muscles and our hearts can use ketones. There are very few tissues that don’t use ketones or fatty acids. It’s a shift from what we call glucose-centric, that means taking in a lot of carbohydrates and using that as your primary energy, and adipose-centric, which is using fats for energy.
How do people know if the ketogenic diet is right for them?
It can vary greatly, depending on what you’re using it for. There are some what they call absolute contraindications. Those are inborn errors of metabolism that are identified in early childhood. It makes it impossible to use the diet because people aren’t able to metabolize fats the way that were intended to. There’s a whole much longer list of things that can happen over time that make it more challenging. One of my biggest challenges with cancer is if somebody is malnourished or underweight coming into it, because ketogenic is not a weight-gain diet. If you’ve learned anything from the populous view of ketogenic, it’s that it’s a weight-loss diet, not a weight-gain diet. There are things besides weight. Certain health conditions or places that people are at in terms of their environment. They don’t have any social support and they can’t get out to do the shopping. How are you going to do keto?
It’s not going to be for the person who is underweight or struggling in the ways you mentioned.
If somebody is underweight, I prefer to do a low carb diet, not a ketogenic diet. There are some other things that work for somebody who is underweight. There’s a big difference in doing this for weight loss and in doing it for cancer. There are nuances for cancer.
Let’s stick with cancer since your book is entitled Keto for Cancer. How is it that this diet in particular helps cancer patients?
One of the main drivers for cancer is a shift in the way that cells use glucose. They don’t run it through the normal, healthy mitochondrial pathway. They ferment it. Cancer cells ferment glucose very inefficiently and making a lot of acid in the process. It makes a lot of lactic acid. When we think about how cancer thrives in an acidic environment, that’s what we’re talking about. We’re not talking about whether your urine is acid or alkaline, which is what the alkaline diets are all about.
When I think of keto, I think of a primarily fat-centric diet. Is that the crux of it?
It’s a combination of limiting the carbohydrates down to about 50 grams or lower sometimes. With the people that I worked within cancer, it’s around 20 grams. When your carbohydrate intake is that low, your body has to make up its energy deficit by burning fat. That’s a wonderful thing. It’s evolutionary biology at its best. It is an exquisite adaptation. We burn fat and we make these ketone bodies in the process and we burn those as well for energy. They’re a much cleaner burning fuel than glucose, particularly for cancer.
Do you understand this intellectually or physically? Have you lived this out? That’s what I’m wondering.
I’ve lived it out myself. I am ketogenic. Everyone my age that is healthy enough to do this can benefit by it. I also lived the experience with my son, Raffi. He was diagnosed with a brain tumor when he was four years old. It was huge, the size of an orange in a four-year-old’s head. They told us it’s inoperable. We did fourteen months of weekly chemotherapy, and that didn’t stop the cancer from growing. We did another chemo and it didn’t stop it from growing. We did two surgeries and it did a lot of damage, and it was still growing, then a nine-week clinical trial. By the time, he was seven and this was raging out of control, we were at the end of our rope with this.
I was not looking for a diet. I was looking online the chemo drug he was on, and I accidentally found this study that had been published from Dr. Seyfried’s lab at Boston College. It was about a ketogenic diet and brain tumor. I thought, “I’ll take this to the oncologist and see what he says.” His reaction was he rolled his eyes and said, “It’s not going to work.” I was like, “Is it going to harm him?” We don’t have anything else we can do right now. He was going to move him to palliative care. He said, “No, it’s not going to harm him.” Why wouldn’t I want to do this? “Because it’s not going to work.” That wasn’t a good enough reason not to do it when you’re about to lose your little guy. We put him on the diet and in three months, he had this amazing response to dietary therapy and nutritional. All we did was take the carbohydrates out of his diet. Finally, we saw a positive thing going on. He lived for six years on a ketogenic diet. It’s mostly good quality of life in that time. That wasn’t in the cards for him at that stage.
That must have been miraculous.
That’s what it felt like. We were hoping for any response, anything that could slow this train wreck down. Instead, we got an amazing response to treatment. I was blown away, and because I was so blown away, now I’ve got to learn everything I can about nutrition. I’ve got to unlearn what I know or what I currently believe. I’ve got to relearn this whole other way of eating. That’s what I did. I had no background in nutrition, but I did have the desire to learn and quite a powerful motivator. I went back to school and got my Master’s in Human Nutrition. The whole time I focused on ketogenic rather than the dietary guidelines that I knew weren’t going to help him. That’s what I’m still doing now. I wrote the book, but I also work with people, I speak at conferences, and I do whatever I can to develop this awareness of this nutritional therapy that can be used alongside whatever it is you’re doing.
I wonder why so many of us think diet doesn’t matter. When we find we are in a health crisis, we immediately go to the professionals in the white coats. We think we’re going to take all pills or all the protocol. Generally, nutrition doesn’t seem to play a part in it.
The doctors in their white coats are not trained in nutrition. In medical school, they get virtually no training. This is not a conspiracy theory, I’m stating fact. Medical schools are funded by pharmaceutical companies. The training that doctors get has to do with pharmaceuticals. It has to do with diagnostics, algorithms, pharmaceuticals. It does not have anything to do with nutrition. Within their practices, they hire registered dieticians. This hasn’t caught on yet in the registered dietician world. I suspect at some point, there will be more of a major break. There will be registered dieticians who are willing to step out of the box. There are a few right now, but they’re in scarcity.
That’s why I’m glad we’re having this conversation. There are people reading this who might have clicked on this episode because they have a loved one who’s dealing with cancer, and they want to know how can the ketogenic diet help them.
You’ve hit on something that touches me every day. When I get up in the morning and I open my inbox, there are emails in there from people with a loved one who has been diagnosed with cancer. They are at the end of their rope like we were with conventional care and being shunted off to palliative care. There’s a huge awareness among a certain segment of people. They tend to be the people in their 20s, 30s, 40s. Older people may come across it, but more often they’re guided by their adult children. I’m hearing from the adult children, cousins, nieces and nephews, and they are very on board with this as something that might benefit their loved one. The person with the disease has to also be on board.
I interviewed someone who was saying that the person who has the sickness needs to believe and be willing to take the steps. Otherwise, you’re pushing something on someone who doesn’t want to go through it.
What I tell people is I’m here to educate and inform, but I don’t coerce or proselytize. I want to help you understand why this may benefit you, but ultimately diet is a choice. I believe that diet does matter. Support the person with cancer in any way that you can. Education is huge. People are not aware of it or they may have a false equivalency with some other anticancer ways of eating like the alkaline diet that is set out there. Since cancer thrives in an acidic environment, we want to be alkaline. That’s not going to slow cancer down. That’s going to change the pH of your urine, but it won’t slow cancer down because the acidity is happening at the cellular level and just outside the cell. It’s not happening at the system level and all that.
Let’s talk a little bit about the science here. How does keto affect the system?
When you are ketogenic, it means you’re not taking in very much of carbohydrates. Carbohydrates are basically glucose. There’s some fructose involved in there and some lactose in there, but it’s glucose that cells can use directly to meet their energy needs. We have glucose transporters and we have insulin receptors, and it brings glucose into the cells where it’s utilized for energy. The problem with cancer is the cell stops using glucose in the normal way, which is in the mitochondria. It starts fermenting it like crazy in the cytoplasm of the cell. It’s increasing the number of glucose transporters on the cell and insulin receptors to bring it into the cell. That’s allowing cancer to proliferate and spread to other areas. Once that cell becomes deranged in this way, it requires more and more glucose. It ferments some other fuels too like glutamine.
By lowering your carb intake, you’re lowering the food essentially for these cancer cells. You’re starving them to death.
I think of it more this way. It’s an austerity program. When there are less nutrients available, then the cells are signaling like, “We don’t have enough for everybody. We’re going to start rationing. We’re going to focus on providing the nutrients to healthy cells over here because we need you in order to stay alive. You dysfunctional cells over here, including you cancer cells, I’m sorry, we don’t have enough for you right now.” That’s what happens with the ketogenic diet. It’s this cellular perception that there isn’t enough nutrition to fuel this unlimited growth. When the body is switching to using fat, that’s very similar to what you would experience in a starvation state, “There’s none of this glucose coming in. We’ve got to use that for energy instead. We’re going to make up the balance of that with some ketones here. We’re going to make just the amount of glucose that red blood cells need and a few other tissues need.” There’s not this abundance of energy. On the other hand, when you eat like people do now, you have all this availability of food and this over-nutrition, then what your cell is signaling is that, “We have this bounty and we’re going to share it with everybody. You get this and you get this. Cancer cells, why not, you get this too.” They get not only the nutrition, but since they’re set in hyperdrive for growth, they get all of the growth factors they need as well to proliferate.
Do you ever look back at when your child was little, and that tumor kept growing and growing despite the treatment and the surgeries and wonder, how are they fueling that? Do you ever look back and think about that?
Of course. I look at what went on in the cancer treatment room and still goes on in cancer treatment, when there’s a birthday, they celebrate it with cake and ice cream. When somebody is losing weight because their GI tract is trashed by chemotherapy. It becomes difficult to eat a lot of the things that would maintain their weight. They’re encouraged to drink things like Ensure and Boost, which is sugar molecules, protein and whatever. It’s the sugar molecules that are going to keep driving the cancer along. I look at that and I go, “That’s nuts.” To say it doesn’t matter is at its best a naive statement. At its worst, it’s dangerous and it proves fatal for a lot of people.
I’m shaking my head in sadness about that and how uninformed the medical community can be at times. Season Johnson who founded KICKcancER to help children with cancer, I interviewed her and she said the same thing when her son was going through cancer treatment. They were like, “Let him eat whatever he wants.” The idea is to keep the weight on. It’s all about shakes with a lot of sugar or this or that. She realized how unhelpful that was.
There is a recommendation from the American Cancer Association. I have a slide on this in several of my presentations. The advice was to use ice cream as a topping on the cake. That’s how you’re going to maintain your weight. What that’s going to do is maintain your fat. It doesn’t do anything in terms of the health of your body. Ultimately, it even fails to maintain your fat because once cancer has progressed to a certain point, it’s signaling for the breakdown of tissue, muscle mass, fat mass, whatever it can grab in order to get the nutrients it needs to keep going. It’s in control. It’s in the driver’s seat.
My question is let’s say someone is reading right now and they have a loved one who’s been diagnosed, or maybe they’re the one that has been diagnosed with cancer. How would they get started on this keto for cancer plan?
I would say read my book. There is very little online about cancer. There’s all this information about weight loss, there’s all this information about diabetes, but people are not as familiar. I look at all the new books coming out, some of them are super books on keto. They’ll have a paragraph on cancer and it will usually be very noncommittal, or a little talk about the speculation that a ketogenic diet might help, but we need the research. Of course, we need the research to figure out which cancers are going to be impacted most by this therapy, which may not be impacted much at all. Another question I get a lot is, “Is my cancer going to respond to this?” My answer is, “Do they use PET scan to look at this? Are they looking for metabolic activity?” If they’re looking for metabolic activity, are they using PET scans that rely on glucose tracers? That’s how they can see these hypermetabolic areas that indicate cancer.
Why not give it a try? Why not see if you can impact your cancer by changing the mix of what you eat? A lot of the people I’ve worked with are coming from healthy whole food diets. They already know how to cook, but they’re using a lot of grains because it seems like it’s okay. It’s 45% to 65% healthy whole grains. In the context of chronic disease, I do not believe that there is such a thing called healthy whole grains. I don’t believe that we should be using sugar. I personally don’t eat it. I don’t think there is a safe amount as far as sugar goes. I see it as toxic. A little bit sneak in here and there is probably not going to matter, but thinking that you can have teaspoon here, honey there and date sugar there, it all adds up and it’s all sugar.
It surprises me sometimes in this foodie movement, slow food movement that I’ve been part of, how many healthy treats I see it on Instagram or this or that. I’m like, “Somebody’s got a sweet tooth.” We’re feeding our bodies on that glucose. Maybe they were designed to feed on something else.
I almost got kicked out of my health club because knowing that I’m a nutritionist, they asked me about this bar and I looked at the bar. I was sitting there, I wasn’t proselytizing. I was educating. What I said was, “It’s date sugar. It’s got however many grams of carbohydrate coming from date sugar. It doesn’t matter what the source of the sugar is. Sugar is sugar.” That filtered back to management. They thought that I was giving some bad advice and that I needed to be stopped. I needed to be blocked from giving that advice. It wasn’t advice. I’m educating that sugar is sugar, no matter what the source.
Miriam, you’re our kind of lady. We love people that say it like it is. This information is valuable. Our readers are going to appreciate it. We’re about some level of carbs and grains, but we also tell people this. They need to listen to their own bodies and they need to figure out what works best for them with everything that we’re putting out there. I’m glad we’ve had you on the show so they can consider how their balance of macros is going to be and what they’re feeding in their bodies.
Almost everybody that I work with and meet out there, I go to yoga and then we’d go out afterwards, for me, it’s tea. For my friends, they know what I do. They know what I believe and think, but I’m not the diet police. They’re sitting there eating some big supersized pastry. They’ll get several of them, split it up and share it around. I’m thinking, “You’re undoing all of the good stuff we did in yoga and you’re undoing it with your food choices.” It’s sad. I feel genuinely sad for people who either believe it doesn’t matter or feel that they can’t make that commitment or they can’t make that lifestyle change. Cancer is a motivator. Even if somebody has not done well with using a low-carb diet in the past for weight loss, they come to me already knowing what it’s going to involve. I don’t even need that part of the education. They know what they’re going to need to do. They just need my help for fine-tuning it for cancer. The motivation there is so different than it is for weight loss.
Wouldn’t it be nice if people could make those changes before they hit the pain point of cancer?
You bet. I don’t know for a fact that a ketogenic diet is a cancer prevention diet. There’s a lot more out there. You look at brain cancer. The initiation of that has very little to do with diet and everything to do with either internal wiring gone wrong or something in the environment. There was a paper that came out that I was looking at that was suggesting it could be cell phone usage and the mechanism behind why it might be, and why it might be an increase in radiation in the atmosphere. Not that it is, I’m not going to commit. This was a UK study. When you look at the incidents of glioblastoma doubling in recent decades, there’s some driver there.
I don’t think that the initiation has to do with diet, but other lifestyle factors. You look at other cancers like breast cancer, not younger people but older women, post-menopausal women that develop breast cancer. How much of it is about diet and what they might have done in the past to head this off? How much of it is exercise? How much of it is circadian rhythm? How much of it is how well their immune system is functioning? We know that changes over time. There’s so much we can do to improve all of the lifestyle stuff that we’re not doing. My feeling is we’re not going to be able to do it all. If you could do it 80% of the time, we’d be in a lot better shape as a nation. We’d see a lot fewer of these devastating cancers, breast cancer being one, colon cancer is another that we see developing in the older population. There are important differences between early onset of these diseases and the more traditional getting into your 50s, 60s and 70s and developing cancer.
This leads me to my last question. If the reader could only do one thing to improve their health, what would you recommend that they do?
I would say stop grazing. We’re not cattle. If you’re hungry in between meals and there’s something wrong with your food choices, and most likely you’re way too reliant on carbohydrates. When you think about it, each of those times that you eat, you are spiking glucose and insulin. You’re creating this inflammation and insulin resistance in your body that leads to more hunger, and that keeps the cycle going. That’s setting the stage. You do decades of this that sets the stage for the chronic diseases that ruin our quality of life.
I have this wonderful study that I would love to share it with your readers. It has nothing to do with food quality or the type of diet. It’s not about vegan or Mediterranean or keto or any of that. It has strictly to do with meal timing. What the study did is it took some data from the nurses. It looked at the food logs of the nurses. When they did an analysis of this data, they were doing this with early-stage breast cancer. This was not deliberate fasting. They were looking at the timing of the food intake, but the women that had fasted for less than thirteen hours a day had a 36% increased risk of recurrence. This is not about exercise. This is not about whether their circadian rhythms were shut or not.
A lot of them are working night shifts. This was about the risk of recurrence in people who did not stop eating for a long enough period of time to allow their bodies to rest, digest, clear out the dead cells, which is what we do overnight, and restore metabolic health. We could spend the next hour on this easily, but I would like to send you to that study. I know that not all of your readers are going to be like, “I’m going to jump on the keto bandwagon.” Everybody can limit the number of hours that they’re eating in a day. I’d be willing to bet my life that is going to improve the health and reduce the burden of chronic disease.
Thank you for bringing that to our attention. This whole conversation has been amazing. I appreciate your taking this time, Miriam. It has been a pleasure.
It’s been great. I hope that anybody interested in this is going to get up to speed on how to do this properly as nutritional therapy for cancer.
Thanks again, Miriam. We look forward to talking to you sometime soon.