Mesothelioma Awareness Day – could an LCHF/Keto diet help?
by Veronique Murphy
Today, September 26, is Mesothelioma Awareness Day.
Mesothelioma is a rare and aggressive cancer caused by exposure to asbestos. According to the Mesothelioma + Asbestos Awareness Center (MAA Center), about 3,000 people are diagnosed with mesothelioma each year. The cancer is normally found in the lining of the lungs, abdomen or heart. Unfortunately, people diagnosed with mesothelioma have a very poor prognosis – average life expectancy is just 6-12 months after diagnosis. There is currently no known cure.
Asbestos has been used since the 1800s, but its use increased significantly during World War II. When asbestos was first discovered, it was hailed as a ‘miracle’ material – durable, heat and electricity proof, fire resistant, and able to absorb sound. It has been used for roofing, fireproofing, pipe insulation, and in paints, adhesives and plastics.
But when asbestos is disturbed, its fibres are released into the air and may be breathed in or swallowed, which causes irritation, inflammation and damage to the lining of the lungs, abdomen and heart. The resultant scar tissue can mutate into tumorous growths. (1)
In the late 1970s and 1980s the use of asbestos began to be outlawed, with researchers linking asbestos with the development of disease – not just mesothelioma, but also asbestosis (scarring and thickening of the lung tissue), lung cancer, pleural thickening (impairing the ability of a person to breathe properly) and pleural plaques (scarring on the lining of the lungs).
According to the MAA Center, the risk of developing mesothelioma is dependent on the amount of exposure to asbestos and the type of asbestos to which a person is exposed. Crocidolite (‘blue’), amosite (‘brown’) and amphibole asbestos are more likely to cause mesothelioma. In general, shorter and wider asbestos fibres are more likely to make their way to the mesothelium, and less likely to be expelled by the body’s natural defence mechanisms, than longer fibres.
Occupations at high risk of mesothelioma include shipyard workers, electricians and plumbers, construction workers, pipefitters, mechanics and other industrial jobs. Fibres brought home on clothing after work can also cause illness in families of those who work or worked with asbestos. (1)
Mesothelioma in South Africa
Incidence of mesothelioma in South Africa is among the highest in the world but the epidemic has been largely invisible both locally and internationally. (2) South Africa was one of the world’s major suppliers of asbestos, where asbestos mining began in the 1930s, producing 97% of the world’s blue and 100% of the world’s brown asbestos.
Mesothelioma is most common in the Northern Cape area, with men who worked or work in asbestos, diamond, gold and mineral mining having the highest prevalence of mesothelioma. In the Northern Cape, the exposure of women and children to asbestos was particularly high because they were involved in the extraction and bagging of the fibre above the ground, where climate was hot and dry. (2) Accurate data on the number of people with mesothelioma is hindered by the high prevalence of communicable disease (including HIV and tuberculosis) in South Africa, as people pass away from the communicable disease before the cancer is detected. (3)
During the South African Truth and Reconciliation Commission, the Health and Human Rights Project submitted a claim that asbestos mining companies had suppressed the findings of scientific research in the 1960s which documented the health risks of asbestos exposure. (4) According to the submission, there were extremely high rates of asbestos related disease in the Northern Cape, but studies which reported findings unfavourable to asbestos were not released. (5)
Cancer and ketogenic diet
There is ongoing research into the influence of a medically-supervised ketogenic diet and cancer. A medically-prescribed ketogenic diet is about 90% fat, 8% protein and 2% carbohydrates. No studies have been done specifically on the ketogenic diet and mesothelioma, but existing research into brain, colon, gastric and prostate cancers in animal models and human case reports hold promising research opportunities to further examine the role of the ketogenic diet in many different types of cancer. (6)
The key influences a ketogenic diet appears to have on cancer include starving the cancer of its food sources, protecting healthy cells from oxidative stress, and making therapies (such as chemotherapy) more effective.
How might a ketogenic diet effect cancer’s ability to grow?
Healthy cells, most of the time, extract energy from glucose using oxygen in the cell’s mitochondria (the ‘powerhouse’ of any cell).
However, it seems that cancer cells have defective mitochondria and so do not extract energy from glucose using oxygen. Instead, cancer cells ferment glucose (without oxygen) and produce about 90% less energy than a normal cell. The cancer cells metabolism is very inefficient.
Examples of potential causes of mitochondrial dysfunction could include genetic predisposition, radiation, chemical or toxin exposures (such as asbestos), and diet. (7) Because of this very inefficient metabolism, the tumour cell has to take in much more glucose than a normal, healthy cell does – in some cases, beyond 30 times more glucose than a normal cell. (8)
When a person eats a ketogenic diet, the normal, healthy cells are able to adapt and use ketones to produce energy. However, cancer cells do not appear to have this flexibility – they do not seem to be able to use fat-derived calories for their energy needs. (8)
What else happens to a cancer cell when there is no glucose?
Oxidative stress is caused by an imbalance of ‘Reactive Oxygen Species’ and antioxidants in the body. Oxidative stress can damage a cell’s proteins, lipids, and DNA. In all cells, there is an optimal balance between ROS and antioxidants.
Even a cancer cell also uses antioxidants to stop the level of ROS from becoming too high. It has been proposed that when a cancer cell is starved of glucose, it is also unable to detoxify itself – the level of oxidative stress becomes too high, causing the cancer cell to die. (6)
How else does might the ketogenic diet influence cancer?
Ketogenic diets also reduce insulin signalling and insulin-like growth factor-1. Higher levels of insulin-related molecules have been linked to increased risk of cancer and poor outcomes. (9) (7)
Ketone bodies also appear to create a metabolic shift towards an anti-inflammatory state in healthy tissue, and have the potential to target the antioxidant defence mechanisms in normal tissues (for example, brain tissue) – but not in cancer cells. (8) (7) In preliminary research, ketone bodies also appear to protect normal cells from the effects of chemotherapy. (6)
What about fasting?
Fasting has also been shown to increase the responsiveness of cancer cells to chemotherapy in pre-clinical models. (8) Fasting may also ameliorate some of the side effects of chemotherapy on healthy tissue. (10)
Fasting may be difficult for a cancer patient (who is already likely losing a lot of weight and struggling to maintain energy). However, fasting induces a state of ketosis and so may be mimicked by the ketogenic diet. (8)
Promising research opportunities
With the potential to selectively enhance oxidative stress in cancer cells, support the anti-oxidant and anti-inflammatory capacity of healthy cells, and increase the efficacy of existing cancer therapies, the role of the ketogenic diet in different cancer types represents a window of research opportunity. (6)
Despite great advances in cancer therapies, the prognosis for many cancer patients remains poor, and many treatments have severe adverse effects. There is a pressing need for complementary or adjuvant approaches with fewer adverse effects.
Mesothelioma has an exceptionally poor prognosis and The Noakes Foundation hopes that further research into the role of the ketogenic diet can uncover encouraging results for patients and their families.
The Noakes Foundation also emphasises that the use of a ketogenic diet in cancer should only be done under the guidance of a supportive medical professional.
For more information on mesothelioma and mesothelioma awareness day, please visit:
For more information on asbestos in South Africa:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1522094/
Veronique is a nurse from Melbourne, Australia, and is busy completing her studies in International Development. She is currently interning at the Foundation and is working on various important projects, proving to be an invaluable member of the team.
References:
(1) ‘Causes of mesothelioma’ 2017. Mesothelioma + Asbestos Awareness Centre. https://www.maacenter.org/mesothelioma/causes/
(2) Braun L, Kisting, S 2006 ‘Asbestos-related disease in South Africa: the Social Production of an Invisible Epidemic,’ Public Health
Then and Now, vol. 96, no. 8, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1522094/
(3) ‘Mesothelioma in South Africa’ 2017. The Mesothelioma Center. https://www.asbestos.com/mesothelioma/south-africa/
(4) Mining Companies Suppressed Cancer Study: Truth Commission Told. Cape Town, June 17 1997. SAPA. http://www.justice.gov.za/trc/media/1997/9706/s970617a.htm
(5) ‘Asbestos research suppressed.’ 17 June 1997. Mail & Guardian. https://mg.co.za/article/1997-06-17-asbestos-researched-suppressed
(6) Allen, B et al. 2014. ‘Ketogenic diets as an adjuvant cancer therapy: History and potential mechanism.’ Redox Biology, vol. 2, pp. 963-970. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4215472/
(7) Fine E, Champ C, Feinman R, Marquez S, Klement R 2016 ‘An Evolutionary and mechanistic perspective on dietary carbohydrate restriction in cancer prevention,’ Journal of Evolution and Health: 1(1)
(8) Bozzetti F, Zupec-Kania B. 2015. ‘Towards a cancer-specific diet,’ Clinical Nutrition, vol.
35, pp. 1188-1195
(9) Winter S, Loebel F, Dietrich J 2017. Role of ketogenic metabolic therapy in malignant glioma: a systematic review. Critical
Reviews in Oncology/Hematology. vol.
112, pp. 41-58
(10) Lee, C et al. 2012. ‘Fasting cycles retard growth of tumors and sensitize a range of cancer cell types to chemotherapy,’ Science Translational Medicine, vol. 4, no. 124.
