Low Carbohydrate Dietary Intervention Improves Insulin, Hormonal Levels and Inflammatory
Markers in Early Stage, Postmenopausal Breast Cancer Survivors
Amy K. Krie, MD,1Krista N. Bohlen, PharmD,1,2 Yueshan Hu, PhD,2Cheryl Ageton, RN,1,2 Heidi Nickles, MS,1,2
Daniel Norfolk, RN,1,2 BSN,1,2 Julie Kittelsrud, RN, C-NP,2Reggie Thomes, BS,2Adam Fahrendorf, BA,2Jessica Muth, RD, LD,1
Luis A. Rojas-Espaillat, MD,1and Gareth E. Davies, PhD2
1Avera Cancer Institute, Sioux Falls, SD, 2Avera Research Institute, Sioux Falls, SD
San Antonio Breast Cancer Symposium –Cancer Therapy and Research Center at UT Health Science Center –December 10-14, 2013
1. Body mass index of 25.0 kg/m2 or greater. Source: Behavioral Risk Factor Surveillance System, CD-ROM (1984-1995, 1998) and Public Use Data Tape (2004, 2006),
National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 1997, 2000, 2005, 2007.
2. Chlebowski, R, G Blackburn, C Thomson, et al. Dietary fat reduction and breast cancer outcome: interim efficacy results from the Women’s Intervention Nutrition Study. J Natl
Cancer Inst 2006; 98: 1767-1776.
3. Demark-Wahnefried W, Peterson BL, Winer EP, et al: Changes in weight, body composition, and factors influencing energy balance among premenopausal breast cancer
patients receiving adjuvant chemotherapy. J Clin Oncol 19: 2381-2389, 2001.
4. Ewertz, M, M-B Jensen, K Gunnarsdottir, et al. Effect of obesity on prognosis after early-stage breast cancer. J Clin Oncol 29:25-31, 2011.
5. McTiernan A, Rajan KB, Tworoger SS, et al: Adiposity and sex hormones in postmenopausal breast cancer survivors. J Clin Oncol 2003; 21: 1961-1966.
6. Sinicrope, F, A Dannenberg. Obesity and Breast Cancer Prognosis: Weight of the Evidence. JCO 2010; 4-7.
7. Jen, K, Z Djuric, N DiLaura, et al. Improvement of metabolism among obese breast cancer survivors in differing weight loss regimens. Obes Res 2004; 12:306-312.
8. Duggan, C, M Irwin, et al. Associations of Insulin Resistance and Adiponectin With Mortality in Women With Breast Cancer. JCO 2010; 29:32-39.
9. Samaha, F, N Iqbal, et al. A Low-Carbohydrate as Compared with a Low-Fat Diet in Severe Obesity. N Engl J Med 2003; 348 (21): 2074-2081.
10.Yancy, W, M Olsen, et al. A Low-Carbohydrate, Ketogenic Diet versus a Low-Fat Diet to Treat Obesity and Hyperlipidemia. Ann of Int Med 2004; 140:769-777.
1. Determine if patients could comply with dietary intervention and achieve weight loss.
2. Evaluate efficacy of dietary intervention on decreasing serum hormone levels.
3. Evaluate efficacy of dietary intervention on decreasing serum insulin and
Obesity has been associated with decreased disease free survival and overall survival
in postmenopausal breast cancer survivors. Proposed mechanisms for this finding
include elevated estradiol levels, hyperinsulinemia, and increased inflammatory
mediators. This feasibility study evaluated whether a low carbohydrate, calorie restricted
dietary intervention could achieve weight loss and measurable metabolic changes in a
group of obese postmenopausal breast cancer survivors.
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Decline in serum estradiol levels were approaching statistical significance (p=0.056).
1. A low carbohydrate dietary intervention can successfully be implemented in a group
of overweight breast cancer survivors to achieve significant amounts of weight loss.
2. A rapid and significant reduction in serum hormonal levels and serum inflammatory
markers can be achieved with dietary intervention.
3. This feasibility study provides additional support for larger trials evaluating the role of
carbohydrate restriction in cancer survivors.
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Average body weight
Dietary intervention time (week)
Weekly Weight Loss
The mean weight loss was
19.9% of total body weight, the
equivalent of 43.7
pounds. Total body fat lost was
6.86%. Weight loss averaged
5.4 pounds in week one and
2.14 pounds per week in weeks
A rapid decline in fasting insulin level was seen with a 23% decline by
Week 3 (p=0.0959), 26% by Week 7 (p=0.0139), and 42% by Week 19 (p=0.0071). References
57 years (42-68)
220 lbs (171-300)
Weight Loss Period
23 weeks (5-59)
Early Stage ER+ breast cancer survivor
Completed surgery & adjuvant chemotherapy
No underlying inflammatory condition
No treatment for diabetes
Serum Estradiol levels (pg/mL)
Dietary Intervention time (weeks)
Serum Estradiol Levels
Average fasting insulin level
Dietary Intervention time (weeks)
Serum Fasting Insulin Levels
(0.5 g protein/lb
<40 gm carbs,
Labs every 2
weeks x 12
** * *
A statistically significant improvement in the CRP level compared to baseline was also
demonstrated with a 40% decrease at Week 19 (p=0.0272).
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Serum CRP (mg/L)
Dietary intervention time (weeks)
Serum C-Reactive Protein Levels
* * * * *