Table 8 Diet Duration, Glucose Ketone Index, Clinical Outcomes

Tan-Shalaby et al.
Nutrition & Metabolism (2016) 13:52 Page 9 of 12
Table 8 Diet duration, Glucose ketone index, clinical outcomes

Patient Tumor type Weeks on trial, weeks total Glucose/ Outcome
on diet Ketone index
1 Cholangiocarcinoma Less than 2 weeks NA Dropped out of study. Menu planning difficulties.
2 Glioblastoma 4 NA Progressive disease at 4 weeks.
3 Prostate cancer 4 14.30 Stable tumor size at 4 weeks, but PSA was rising;
dropped out of study
4 Melanoma 16 on trial, continued diet 17 (week 4) Stable disease at 16 weeks, mixed findings, slow
post trial till 80 weeks 23 (week 8) progression, active until shortly before death at 80 weeks
14 (week 16)
5 Renal cell cancer 4 3.23 Progressive disease
6 Pancreas 4 2.06 Progressive disease at 4 weeks. Muscular body
builder habitus. Worked out daily.
7 Colon cancer 8 8.6 (week 4) Stable at 4 weeks, mixed mixed CT scan findings and rising
4.3 (week 8) CEA at 8 weeks.
8 Papillary thyroid 8 1.9 (week 4) Stable at 8 weeks, but removed because of
5.2 (week 8) grade 3 weight loss; still alive 15 months later.
Declined follow up bloodwork.
9 Melanoma 16 weeks on trial, continued 7.8 (week 4) Stable disease at 16 weeks, and at 92 weeks.
diet post trial till 116 weeks 28 (week 8) Active till 2 days prior to death at 116 weeks.
31 (week 16)
10 Parotid 4 18.3 Progressed at 4 weeks. Diabetic.
11 Astrocytoma NA NA Disqualified due to negative PET scan
12 Melanoma 16, continued diet post trial 4.5 (week 4) Stable at 16 weeks. Underwent metastectomy
till 100 weeks. He reported at 12 (week 8) of remaining axillary disease.
this time that he stopped the 80 (week 16) PET/CT scan no evidence of disease at 131 weeks.
diet at around 80 weeks.
13 Head and neck <4 12.14 Achieved ketosis in only 2 weeks out of 4.
Progressed at 4 weeks.
14 Hepatoma NA NA Progressed before starting diet.
15 Pancreas- post lung transplant; NA NA Very rapidly progressive disease. Progressed
on multiple immunosuppresive before starting diet.
anti-rejection drugs.
16 Lung cancer NA NA Had acute cardiac event and changed his mind
before starting the trial.
17 Lung cancer 16 6.1 (week 4) Stable at 4,8 and 16 weeks. Dieted for a week
5.2 (week 8) after 16, then back to standard diet. Died at 40 weeks.
3.2 (week 16)
four patients beyond 16 weeks and found that one (pa- collected in-hospital glucose and ketone readings may not
tient 17) reverted back to a standard diet within days be truly reflective of their actual glucose ketone indices.
while the other two (patients 4 and 12) continued to Discrepancies in blood draw timing and patient compli-
follow the diet without any subsequent chemotherapy ance with timing of clinic visits may have also affected
or radiation, remaining in stable status for as long as 80 some of our glucose values. Glucose ketone indices (GKI)
and 131 weeks. were calculated and we found that although no patient
Combining the diet with chemotherapy and/or radiation met the targeted range of GKI, some still derived benefit,
appears feasible. One patient (patient 9) subsequently tried significantly outliving their estimated lifespans. One pa-
a short course (one month) of oral chemotherapy and tient (patient #9) who had a good response and sur-
had also benefitted from invasive radiology as well as vived until 116 weeks, experienced persistent “ketone
radio surgical interventions. breath” despite achieving low βHOB ketone readings. It
In the VM-M3 glioblastoma model, a low GKI is related is possible that he achieved adequate therapeutic levels
to decreased invasion, proliferation and angiogenesis [19]. that somehow escaped detection [20, 21].
The study protocol was created prior to the introduction We wanted to attract a diverse population of patients,
of the GKI and our patients did not have the benefit of and standardize all evaluations. The small number of re-
frequent home glucose and ketone monitoring hence the cruited patients limited our trial, and our recruitment

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Tan-Shalaby et al.

Nutrition & Metabolism (2016) 13:52 Page 9 of 12

Table 8 Diet duration, Glucose ketone index, clinical outcomes

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