Does Ketogenic diet have any health benefits particularly in Cancer?

Tina asked me whether Ketogenic diet is good for cancer. I promised her that I would do some research and get back. Next day one of my patients, Nandita, said she is actually on ketogenic diet to lose weight, no carb, only fat and protein. She and her husband confirmed that they have lost weight. Well I said okay, this is interesting. Then my friend Rajesh said that he in fact used ketogenic diet for treating one of his relatives with epilepsy and it worked. I thought there has to be some benefit and I decided to go little deeper into this ‘ketogenic diet’.

Ketogenic diet, typically, is low to no carb diet with only fats and proteins. First of all I must say that it is difficult to handle because most of your foodstuffs do have some carbs. Particularly for a vegetarian ‘no carb and only protein’ diet can be almost impossible to handle.

Glucose is our absolutely basic substrate for producing energy.  That is how the entire human physiology works, using energy from Glucose and oxygen by the Krebs’ cycle. In the absence of glucose, however, there is an alternative source, a pathway developed for fat and protein metabolism. It may lead to catabolic phase  and then lipolysis of fat producing ketonic acid.

Brain is one organ, which finds it hard to metabolize anything other than glucose. Brain is dependent on glucose metabolism. So its not only tough, but difficult for the body to adjust to this new diet.

So let us look at the medical aspect of diet and see if any  benefit. Most of the studies have been done in epilepsy and it is certainly found to be beneficial in epilepsy. But in the randomized trial conducted, though there is decrease in the seizure rate in those on ketogenic diet, at least a third of them dropped off the diet because they could not handle the diet. For something like an epilepsy, it is a lifelong change in diet  can be difficult to adjust.

How about cancer? Though there is theoretical premise that cancer cells will be starved of glucose, it is hardly true. The cancer cells produce substances that produce a catabolic state and that is why there is a loss of weight in cancer and loss of appetite too. The muscles get completely wasted. So there is inherently a ketotic state. So far I have tried looking for any kind of scientific information or confirmed studies on ketogenic diet and cancer. I must say that except for a couple of case reports in brain tumours, no major study exists on the benefits of ketogenic diet in cancer. So if you believe that cancer in some way is going to be affected with ketogenic diet, right now, I can say that there is not enough proof for this.

If you are fighting cancer, it is good if you eat well, good proteins, good exercise, so that your body is in top shape and that really helps.

For weight loss; I believe it is important not go on crash diet. It is much easier to space your meals and good bit of exercise would control the weight. The effort you invest on ketogenic diet if you might want to try it out, I would be cautions in having it for a longer period of time.

I am sure there will be some responses and anecdotes on this but we need to go by scientific evidence rather than some individual anecdotes when we recommend it to a larger population. Hope this helps.

Scribble by a sporadic student of Yoga

I woke up on ‘World Yoga Day’

“Wow” 35,000 people and Prime Minister doing yoga at Rajpath and trying to break the Guinness record!

I got “josh” to recall my yoga lessons. After nearly 2 or 4 months, I did all my asanas – Yashtic, Bhujang, asthapatha usthang and Pranayam and even Kapalbhati ( I do know the asanas as you can see).

Well, I had a catch in the back.

Lesson 1: Don’t do yoga unsupervised.

By the way, I did start on yoga a couple of years ago. Yatin is my yoga teacher. I must confess that I started yoga with an objective of losing weight, which obviously did not happen after 1 year. Yatin has been quite patient with me in trying to do more of Shavasana rather than other asanas and finally after nearly a year he gave up on me. I looked for excuses like OT is starting, day is busy and slowly from 5 days a week to 2 days a week and now I am a defaulter.

Lesson 2:. Be regular and consistent

On seeing the TV programme I suddenly found a “Guru” proclaiming that yoga can cure cancer and reduce weight and there are atleast 500 videos on how yoga reduces weight and cures cancer. That got me thinking on the real benefits of yoga. There is no doubt that it is an ancient art practised by the Indian yogis and marketed in the United States as a billion dollar industry.

It has great potential benefits

Well , I am not a guru and nor do I want to profess to be one but what I can tell you is that if one starts expanding Yoga into cancer control and cure then there is a big big problem. Yes, yoga can help in the treatment phase when there is a lot of stress and physical factors coming in. Meditation would certainly help. It would also, as I told you, improve flexibility but yoga is not for cancer, yoga is not for weight loss. Certainly practice yoga for all the benefits which are substantial but not for those which are professed by some “gurus”.

Lesson 3 : Yoga does not cure cancer. Yoga is not for losing weight

It does improve flexibility which is the biggest casualty of the ‘couch potato culture’ which we have now. It is really pathetic to see someone who cannot even pick up a coin which is dropped on the floor and struggling to even bend their backs. As age advances with less and less use of joints we are likely to become stiffer purely because of lack of flexible exercises. Practising yoga gives the flexibility . See Iyengars yogic poses to be convinced.  That itself is good enough to start practicing yoga.

Lesson 4: Yoga improves flexibility

The second component of yoga apart from the asanas is ‘meditation’ which is an integral part. This is about keeping still and trying to keep your mind focussed. It is interesting to know the basis of trying to keep your mind still. Obviously you cannot keep your mind still and thoughts keep flooding you. You need to focus on something. Interestingly yogic teachers have discovered that breath which all of us inherently have as God given gift, can be used to focus and control your thoughts.   Autonomic nervous system controls breathing and the cardiovascular system which we do not even perceive. You don’t perceive that your heart is beating or that you are breathing. Only when you breathe consciously certain other physiological factors come into play. Like when you breath in deeply and watch your pulse, your pulse slows down. Slowing down of pulse actually is beneficial as you have a good physical fitness.

These physiological changes are perhaps what are harnessed by yoga for reducing blood pressure which is now well documented and also reducing stress which is also a big positive benefit. So just concentrating on your breath and chanting a simple word like ‘Om’ can reduce your stress.

Lesson 5: Meditation in Yoga reduces stress and calms your mind to focus better

I would leave you with this note that everything has to be practised consistently. Just doing yoga on ‘World Yoga Day’ like I did, might actually give you a backache. So be careful and like me promise yourself that you would be consistent in your practice of yoga.

It is good for us.

This is what keeps us going….

My Secretary said there is a little girl waiting to see me.

The ‘little girl ‘walked into my room. I said “Hello” . I have never seen this girl before. Then the parents walked in. I immediately recognized the parents. The mother was nursing the baby who had a liver tumour.   It was about a month after the surgery, when we had a fund raising event and Sachin Tendulkar was so moved by the story that he came and gave a personally signed bat to the family.sachin and child

The girl is now 5 years old and they had come to see Mumbai. I asked her what she liked about Mumbai. She said ‘shopping malls’. Yes of course, for a girl from a small town the shopping malls of Mumbai are the big attraction.I asked her if she had gone to the new aquarium and she said “yes, there are a lot of fish and  I liked the gold fish”. She was bubbly, full of life. She does not remember me and perhaps she does not even remember that she has been treated with chemotherapy and later undergone surgery for 12 hours and then recovery for another 12 days.child 2

It is a moment of immense satisfaction to see the little girl and the grateful family.

I was lucky that day. Shravan, a young software engineer who was diagnosed with Stage IV gastric cancer, was practically given 6 months and asked wind up his affairs. He was treated with chemotherapy and then, rather unconventionally, we went in for surgery followed by radiotherapy. I was pleasantly surprised and happy that it is now about 3 years and he is having a productive career . In spite of being a middle class professional he had been generous to donate a substantial sum towards ‘Crusade Against Cancer Foundation’ always saying that he is grateful for this gift of life.

All of them say they are grateful for their ‘second’ life. I am truly modest to reply that it is their courage and God’s will that brought about this happy outcome. I am just doing whatever I can do to the best of my capabilities.

In cancer you have two choices, either to give up or to fight. Giving up is very easy.  Fighting for the patient needs time, effort and multidisciplinary planning by many individuals. First and foremost, the patient has to muster courage and literally lift the weapons. We can only render our shoulders to fire.

Meanwhile I can only say that if you, by God’s grace succeeded in your fight, do help others. The only thing they need is a message that there are many victors in this world who have also battled and won.

God be with you!

Surgery in the morning and counseling in the evening.

Most of my days start at 9am with surgery, which goes upto 4-6 pm, and there is the evening clinic till 8 pm. While I find surgery most relaxing, not at all stressful as you may be imagining. I am in control and focused. There is no noise or distraction. No random thoughts. I do what I enjoy doing. Each surgery is a piece of art, except that the art is hidden under the abdominal scar. The reward is patients’ recovery.

I actually find the evening clinic to be much more stressful. In the evening, more than medical issues, I have to deal with emotional issues. On each day there are husbands who are worried about their wife’s illness and vice versa.

The most difficult question is “How much time do I have ?”. There is no clear answer and even a guess can be very hazardous. I do not think anyone of us has an answer to “How much time is there for anyone of us”. But it is certainly difficult to tell a mother who invariable asks “My children are small and need me to take care of them so at least give me that much of time”. As all mothers, they would rather sacrifice anything just to giet additional time for their children. Men on the other hand, are worried about their work, their finances, how to provide for their families and why should it happen to them and what are the consequences. Invariably the question“Can I go back to work?”

Questions to which I do not have answers.

But still, patients need to be comforted.

“ Yes, things are bad but can get better.”

It is ‘Hope’ that drives the whole human existence and effort.

For a student the hope that he will score well in the exams, for a mother, hope that the children grow up well, for a young man that he will find true love and live happily. May be for someone hoping to become wealthy, someone hoping to become happy.

A cancer patient hopes for ‘cure’ or ‘control’. There is no need for luxuries of life; just LIFE.

In fact TIME is most precious gift….

A few days more to settle the home, work, finances, children and many other issues

Only thing I can give is a bit of hope, to be optimistic, to allow them to gather courage in the face of adversity.

I just say “ I am there for you, the whole medical science is for you”. “Whatever best that can be offered anywhere in the world, we would  offer to you and then hope for the best”. Mostly they are comforted and go back with a feeling that ‘Yes, they can fight the disease’.

The drop-box for worries:

I started keeping a small box near the door and I generally tell them, ” Leave your worries in that box and let me take care of it”.

The least a doctor can do for a patient is to give comfort and hope. Yes, cure of disease may or may not be in our hands but certainly comforting someone in distress is an absolute must in this profession.

I feel privileged that I am able to help at least a few if not all on each day. Though it does make my heart heavy and I need to deal with this heaviness every single day and to be as normal as possible. Recharge for the next day and the days after. …

What keeps me going, week after week and year after year ??…

Is there ‘Super Test’ for Cancer? How about a PET scan ?

Madhuri’s mother was diagnosed with Colon cancer when she started passing blood in the stool and her hemoglobin fell to 8 gms. She then underwent investigations and was diagnosed; following which she came to me for surgery. Obviously there was immense panic in the family. Immediately Madhuri, her brother and sister asked me frantically if there is a ‘super test’ for cancer. A single test to say whether cancer is present or NOT. Then the whole family can get the test done !

There has always been a demand from the public, along with determined efforts from the research community to find a single blood test that can identify cancer. In the last couple of decades, there have been many false starts and false hopes;

The first set of blood-tests were called ‘tumour markers’, which are proteins circulated from the tumour cells. CEA was one such marker which was identified in colon cancer patients. The immediate expectation was “Oh! Yes” there is a blood test that can identify colon cancer. However, as people started getting checked for CEA it was found that CEA was not only high in colon cancer but also in colitis, in smokers and in many other non-malignant situations including cirrhosis of the liver.

This is the fundamental truth about cancer. As the cancer cell is very similar to normal cells, the protein secreted or discharged from cancer cells are also similar to those from the normal cells. Most of the screening tests lack the specificity expected out of such investigation.

The second important push for cancer diagnosis has been ‘imaging’, for example; Abdominal CT scans. Its an important investigation to detect a tumour, but is not recommended as a routine test just to reduce your anxiety.

The most frequently ill-advised investigation is the PET Scan. Unfortunately it’s being prescribed by family physicians – “When anyone is anxious about a cancer, Get a PET scan done “. Recently we went to a shop and the owner came to know that I am an oncosurgeon. His first question was, “How frequently should I get a PET scan done?”.

A PET Scan is based on the principle that the tumour cells uptake and metabolize glucose of the normal cell. But again there are many fallacies; (1) it should only be used for staging for cancer and not screening normal population (2) it should never be used to satisfy anxiety of relative diagnosed with cancer. There are many false positives like a simple infection can lead to increased glucose uptake of cells and show positive on PET Scan.

Recently a patient came and said “My brain is affected”. I asked ‘Why”? he said “It shows in the PET Scan”.   Obviously it will be shown because brain is one of the most metabolically active organ. Any investigation needs to be done after careful thought and then also interpreted in the context of ordering and not randomly.

In short, there is no single test that can be used in the community to detect cancer. Once again I go back to the same advice – Be aware of the symptoms and then get appropriate investigations. ‘Seven warning signals’ , Caution and Action ( see earlier blog) are the best bet we have for early detection.