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American Journal of Medical Case Reports, 2016, Vol. 4, No. 8, 288-292
Available online at http://pubs.sciepub.com/ajmcr/4/8/8
©Science and Education Publishing
DOI:10.12691/ajmcr-4-8-8
Halted Progression of Soft Palate Cancer in a Patient
Treated with the Paleolithic Ketogenic Diet Alone:
A 20-months Follow-up
Csaba Tóth1, Zsófia Clemens1,2,*
1Paleomedicina Hungary Ltd, Evolutionary Medicine Working Group, Budapest, Hungary, H-1026 Hidász u. 3/A, Budapest, Hungary
2University of Pécs, Department of Neurology, Pécs, Hungary, H-7623 Rét u. 2, Pécs, Hungary
*Corresponding author: clemenszsofia@gmail.com
Abstract Introduction: Myoepithelial tumor of the soft palate is associated with rapid progression and poor
outcome. The standard care includes surgery with optional radiotherapy and/or chemotherapy. Case report: Here we
present a case with myoepithelial tumor of the soft palate where the patient denied conventional treatment options.
Instead, the patient started the paleolithic ketogenic diet which resulted in a halted progression of the tumor as
evidenced by imaging follow-up. Currently, the patient is on the diet for 20 months, without symptoms and side
effects. Conclusion: We conclude that the paleolithic ketogenic diet was effective and safe in this patient.
Keywords: soft palate tumor, myoepithelial tumor, paleolithic diet, ketogenic diet
Cite This Article: Csaba Tóth, and Zsófia Clemens, “Halted Progression of Soft Palate Cancer in a Patient
Treated with the Paleolithic Ketogenic Diet Alone: A 20-months Follow-up.” American Journal of Medical Case
Reports, vol. 4, no. 8 (2016): 288-292. doi: 10.12691/ajmcr-4-8-8.
1. Introduction
Otto Warburg was the first to suggest that cancer
emerges from abnormal cellular metabolism [1]. He
postulated that key points in tumorigenesis include
impaired oxidative phosphorilation, compensatory
glycolysis and aerobic fermentation [1]. Utilization of fat
for energy ultimately relies on the mitochondria and the
associated metabolic pathways. Tumor cells, with
dysfunctional mitochondria are unable to use ketones but
largely depend on glucose for energy [2,3]. Based on this,
adopting a ketogenic diet, which represent a shift from
carbohydrates toward fat, has been repeatedly suggested
as a promising option to treat cancer [3,4].
Encouraging studies in cancer patients with the
ketogenic diet include a landmark study from 1995
reporting long-term survival in two children with brain
tumor [5] and another case report which reported halted
progression of glioblastoma for a few months [6]. In
recent years several group studies have been carried out
using the ketogenic diet in cancer. Overall, these studies
did confirm that the ketogenic diet is relatively safe [7,8]
and may diminish side effects associated with
chemotherapy and/or radiotherapy [9]. However, as
regards hard clinical endpoints, such as survival, no clear
evidence is coming from these group studies supporting
that the ketogenic diet is indeed beneficial. In the study of
Schmidt et al. [7] and that of Fine et al. [10] advanced
cancer patients were put on the ketogenic diet. In both
studies [7,10] there was a tendency for halted disease
progression in those patients adhering to the diet.
However both studies were limited in follow-up duration
with three and one months. In the ERGO study recurrent
glioblastoma patients were put on the ketogenic diet but
all patients progressed while on the diet [8]. In a
retrospective study of Champ et al. [11] six glioblastoma
patients were on the ketogenic diet for 3-12 months.
Survival benefit was uncertain, however, one patient
showed no signs of recurrence at 12 months of diet
therapy. In patiens with tuberous sclerosis tumor
progression was not halted by the ketogenic diet [12]. In
the most recent study the ketogenic diet resulted in tumor
regression in those patients with early stage cancer [13].
This study was however limited in duration too.
An assessement of the available patient studies shows
that there are two features common to all of them. First,
the dietary therapy was used following and/or
concurrently with radiation and/or chemotherapy. Second,
all studies used the classical version of the ketogenic diet
which is based on vegetable oils and/or also included
dairy, formula feeding or supplements.
Ketosis is often viewed as an evolutionary adapted state
in humans [14]. In their study Schmidt et al. [7] also cite
Steffanson who studied and proposed the traditional diet
of the Inuit which is actually an animal meat-fat diet [15].
The most comprehensive overview on the animal meat-fat
diet is provided by gastroenterologist Voegtlin [16], who
is rarely cited in the context of the ketogenic diets.
Considering ketosis as evolutionary adapted state
combined with the knowledge on the diet of ancestral
people [17], we propose that an ideal therepeautic diet in
cancer would also rely on animal fat instead of vegetable-
based oils used in previous clinical trials.
Accordingly, the authors of the present study are using
a diet based on animal meat and fat, similar to that
American Journal of Medical Case Reports 289
proposed by Steffanson [15] as well as Voegtlin [16]. In
an attempt to distinguish this diet from both the classical
ketogenic as well as the diet termed paleolithic in a series
of clinical studies [18] and books [17], we refer the diet as
paleolithic ketogenic. Previously we have published cases
of type 1 [19,20], type 2 diabetes [21], epilepsy [22,23],
Gilbert’s syndrome [24] and Crohn’s disease [25] where
we successfully applied the diet. Here we present a case
with soft palate tumor of myoepithelial origin, an
aggressive cancer type, where using the paleolithic
ketogenic diet without any conventional treatment
modalities resulted in halted progression of the tumor for
20 months, while producing no symptoms or side effects.
2. Case Report
The 60-year-old patient was non-smoker and denied
alcohol consumption. For the six months before diagnosis
she had been feeling a lump in her soft palate which was
asymptomatic and did neither cause airway obstruction
nor dysphagia. The mass was firm and without ulceration.
Biopsy was taken on on 31 Oct 2014 and histopathology
showed myoepithelial carcinoma (Grade 2 tumor). The
MRI on 20 Dec 2014 showed a well-circumscribed and
non-infiltrative mass measuring 36x33x27 mm arising
from the left soft palate. The tumor was staged as
T2,N0,M0. Knowing the malignicity of such tumors, the
patient was offered radical surgery and palatal lift
prosthesis which she did not accept. The patient did
neither received chemotherapy nor radiotherapy.
3. Paleolithic Ketogenic Diet
We first met the patient in December 2014, shortly after
diagnosis onset. We recommended the paleolithic
ketogenic diet which the patient started instantly. The
paleolithic ketogenic diet is an animal meat-fat based diet
with a fat:protein ratio of approximately 2:1 and with a
plant content less than 30% (in volume). In the diet,
consumption of red and fat meats over lean meats as well
as organ meats are encouraged. In the first six months the
patient followed the most strict form of the diet: a full
meat-fat diet. From July 2015 on, she was allowed to eat
small amounts of vegetables with a frequency of ≤2 times
a week. From this time on she was also allowed to drink
coffee in moderation as well as to use small amounts of
honey for sweetening. No calorie restriction was applied
but the patient was suggested to eat when hungry and then
to eat until satiation. Typically the patient had two meals a
day. The patient regularly used urinary ketone strips
which indicated sustained ketosis. Altogether, the patient
exhibited a high level of dietary compliance as assessed
by laboratory parameters (Table 1) and patient feedback.
The patient was followed by personal visits every three
months. In between she was followed by e-mail and phone
calls. At the time of writing the manuscript the patient is
on the diet for 20 months.
Table 1. Laboratory measurements during follow-up ont he paleolithic ketogenic diet
17.04.
2015
25.09.
2015
30.10.
2015
25.11.
2015
26.02.
2016
17.06.
2016
21.07.
2016
normal range
WBC (G/l)
4.32
5.22
4.37
4.34
3.5
3.9
3.6
4-10
RBC (T/l)
4.32
4.47
4.31
4.58
4.48
4.65
4.55
4-5.6
Hgb (g/l)
126
129
126
130
130
135
132
120-160
Hct (%) 0.371 0.381 0.371 0.387 0.402 0.411 0.403 0.36-0.46
Thrombocyte (G/l)
232
217
244
230
192
213
211
120-350
CRP (mg/l)
-
1.4
1.9
2
1.6
2.9
1
< 5
ESR (mm/h) 14 14 26 25 18 27 25 1-30
Total protein (g/l)
-
71.7
66.7
67.2
65.7
71.5
70.4
66-83
Carbamid (mmol/l) 7.2 8.4 6.2 6.2 8.7 6.9 8.7 2.8-7.2
Creatinine (µmol/l)
51.5
50.1
40.1
45.8
40.6
44.7
44.1
45-84
Sodium (mmol/l)
137
140
139
140
141
138
138
136-146
Potassium (mmol/l) 3.7 3.9 3.7 4.2 3.5 4 4 3.5-5.1
LDH (U/l)
-
246
230
249
259
245
253
208-378
GOT (U/l) 18 15 15 17 16 19 18 < 31
GPT (U/l)
19
16
17
18
17
-
26
< 34
GGT (U/l)
14
15
13
13
13
13
14
< 38
ALP (U/l)
-
67
60
-
-
64
-
30-120
Iron (µmol/l)
11.6
11.2
10.3
11.8
11.3
13
12.4
10.7-32.2
Uric acid (µmol/l) 213 301 318 267 199 - 187 155-357
Glucose (mmol/l)
4.4
4.9
4.7
4.6
4.9
6
5.8
3.5-6
Calcium (mmol/l)
2.29
2.27
2.24
2.31
2.3
-
2.33
2.2-2.65
Magnesium (mmol/l) 0.85 0.83 0.81 0.84 0.81 0.79 0.85 0.77-1.03
T. chol. (mmol/l)
9.5
8.3
8.6
8.6
9.6
9.4
9.4
3.9-5.6
HDL chol. (mmol/l) 2.04 1.97 1.93 2.11 1.98 2.21 2.44 1.15-3
Triglyceride (mmol/l)
0.71
0.87
0.67
0.64
0.72
0.68
0.6
0.5-1.6
Fibrinogen (g/l)
-
-
4.7
4.5
3.5
4.7
4.1
2-4
Urinary ketones ++ ++ +++ ++ + ++ +
Abbreviations: WBC: white blood cell count, RBC: red blood cell count, Hgb: hemoglobin, Hct: hematocrit, CRP: C-reactive protein, ESR: erythrocyte
sedimentation rate, LDH: lactate dehydrogenase, GOT: glutamate-oxaloacetate transaminase, GPT: glutamate-pyruvate transaminase, GGT: gamma-
glutamyl transferase, ALP: alkaline phosphatase,
T. cholesterol: total cholesterol, HDL chol.: high density lipoprotein, LDL: low density lipoprotein. – indicates that a given parameter was not measured.
290 American Journal of Medical Case Reports
4. Laboratory Data
Laboratory workup was performed seven times during
the follow-up which indicated a high level of dietary
adherence (Table 1). Glucose levels averaged 5 (±0.6)
mmol/l. Renal and liver function as well as ions were
normal. Inflammatory markers CRP and ESR (erythrocyte
sedimentation rate) were in the normal range while
fibrinogen was mildly elevated on some measurements.
Cholesterol was elevated while triglyceride was low.
Urinary ketone was positive on each workup.
Figure 1. Subsequent MRI scans showing the tumor in left soft palate. The first one (on 20 Dec 2014) was performed at diagnosis onset. The three
subsequent MRI were performed during follow-up on the paleolithic ketogenic diet
5. MRI Imaging
Three follow-up MRI examinations were carried out
which indicated a minor decrease in tumor size. The first
follow-up exam, on 18 Apr 2015, showed no change in
tumor size (36x33x27 mm) while the two subsequent MRI
examinations (on 28 Oct 2015 and 12 Jan 2016) showed a
decreased tumor size (33x27x24 mm). No enlarged lymps
nodes were seen on either MRI exams.
6. Condition and Symptoms
The patient was highly motivated and so it was
relatively easy for her to maintain the diet.
The patient reported no side effects of the diet but
improved physical fitness and well-being. Currently she is
on the diet for 20 months. Subjectively she feels that the
tumor diminished. At diet onset she weighted 68 kg and
was 165 cm tall (BMI=25). Currently she weights 63 kg
(BMI=23).
7. Patient Consent
Written informed consent was obtained from the patient
for publication of this case report.
8. Discussion
In animal models the ketogenic diet has been shown to
have antitumor effects [3]. In the human literature several
benefits have been associated with the ketogenic diet
including imrovement in quality of life [7] as well as a
decrease in therapy-induced side effects [9]. Yet, apart
from an early study from 1995 [5], no reports are available
on long-term survival benefit associated with the diet. The
ketogenic diet is generally proposed as an adjunct to
conventional treatments to enhance their effectivity. At the
same time, as also pointed out by Seyfried [26],
chemotherapy and radiation may induce necrosis and
inflammation both of which elevate extracellular
American Journal of Medical Case Reports 291
glutamate and glucose concentrations and thereby may
contribute to cancer progression. Cortocosteroids, which
are frequently administered along with radiation therapy,
also contribute to this process [26]. As a result,
conventional treatments may turn counterproductive and
may also conteract the beneficial effect of dietary
carbohydrate restriction [26]. As far as we know, our case
study is the first one in the literature where a ketogenic
diet is used as a stand-alone therapy in cancer. This study
is also the first in using a ketogenic diet based on animal
meat and fat instead of the classical version based on
vegetable oils and dairy. We assume that both factors
might have significantly contributed to the success
achieved in the present case.
Myoepithelial tumors are rare tumors accounting for
less than 1 % of all salivary gland tumors [27]. In this
tumor type surgery is the first choice of treatment with
optional postsurgical radiotherapy and/or chemotherapy
[28]. Myoepithelial tumors typically exhibit extensive
growth and infiltration to adjacent tissues [28]. Overall,
prognosis for myoepithelial tumors of the head and neck is
poor with the 3- and 5-years survival of 59% and 32%,
respectively [27]. Incomplete surgery is known to be
associated with an even worse outcome [27]. Halted
progression and the absence of tumor-associated
symptoms in our case represent a much better outcome
than could be expected based on the statistics of this tumor
type.
The patient showed excellent dietary adherence as also
shown by laboratory workups. Her laboratory parameters
are similar to that seen in our other patients on the paleolithic
ketogenic diet with other diseases [19,20,21,22,23,24,25].
We opine that, beyond maintaning ketosis, avoiding
vegetable oils, dairy as well as other non-paleolithic food
items all represent key factors in the successful
management of this case. As we showed in a previous
case study, the paleolithic ketogenic diet was also more
efficient in reducing symptoms as compared with the
popular version of the paleolithic diet [24]. Non-
paleolithic components (e.g. milk and dairy, grains) of the
classical ketogenic diet and that of the standard diet have
been suggested to increase pathological intestinal
permeability [17]. Accordingly, in our previous case study
on Crohn’s disease, we showed that pathological intestinal
permeability had normalized while on the paleolithic
ketogenic diet [25]. Such a normalizaton of intestinal
permeability was not seen in a study using a much more
popular and indulgent version of the paleolithic diet [29].
Importantly, increased permeability of the intestine and
that of other membranes was suggested to play a role in
the cancerous transformation of normal tissues [30]. In
addition, while the classical forms of the ketogenic diet
has been described to induce side effects including
diarrhea, constipation, deficiency of magnesium, iron and
other vitamins [31], the paleolithic ketogenic diet results
in no such side effects.
We assume that the paleolithic diet may be of superior
effectiveness while having no side effects as compared to
the classical ketogenic diet in cancer management. It is
our opinion that such a preferable effectivity/side effect
profile of the paleolithic ketogenic diet can only be
explained evolutionarily. We assume that the paleolitic
ketogenic diet is the evolutionary adapted diet itself for
humans.
Acknowledgement
The authors received no support from any organization.
Conflict of Interest
The authors declare no conflict of interest.
References
[1] Warburg O. "On the Origin of Cancer Cells". Science 123: 309-14,
1956.
[2] Seyfried TN, Kiebish MA, Marsh J, Shelton LM, Huysentruyt LC,
Mukherjee P. Metabolic management of brain cancer. Biochim
Biophys Acta. 1807: 577-94, 2011.
[3] Seyfried TN, Flores RE, Poff AM, D'Agostino DP. Cancer as a
metabolic disease: implications for novel therapeutics.
Carcinogenesis. 35: 515-27, 2014.
[4] Klement RJ, Kämmerer U. Is there a role for carbohydrate
restriction in the treatment and prevention of cancer? Nutrition &
Metabolism. 8: 75, 2011.
[5] Nebeling LC, Miraldi F, Shurin SB et al. Effects of a ketogenic
diet on tumor metabolism and nutritional status in pediatric
oncology patients: two case reports. J Am Coll Nutr 14: 202-8,
1995.
[6] Zuccoli G, Marcello N, Pisanello A et al. Metabolic management
of glioblastoma multiforme using standard therapy together with a
restricted ketogenic diet: Case Report. Nutr Metab (Lond) 2010,
22,7:33.
[7] Schmidt M, Pfetzer N, Schwab M, Strauss I, Kämmerer U. Effects
of a ketogenic diet on the quality of life in 16 patients with
advanced cancer: A pilot trial. Nutr Metab (Lond). 8: 54, 2011.
[8] Rieger J, Bähr O, Maurer GD et al. ERGO: a pilot study of
ketogenic diet in recurrent glioblastoma. Int J Oncol 44: 1843-52,
2014.
[9] Seyfried, T. N. Case Studies and Personal Experiences in Using
the Ketogenic Diet for Cancer Management, in Cancer as a
Metabolic Disease: On the Origin, Management and Prevention of
Cancer, John Wiley & Sons, Inc., Hoboken, NJ, USA. 2012.
[10] Fine EJ, Segal-Isaacson CJ, Feinman RD, Herszkopf S, Romano
MC, Tomuta N, Bontempo AF, Negassa A, Sparano JA. Targeting
insulin inhibition as a metabolic therapy in advanced cancer: a
pilot safety and feasibility dietary trial in 10 patients. Nutrition. 28:
1028-35, 2012.
[11] Champ CE, Palmer JD, Volek JS, Werner-Wasik M, Andrews DW,
Evans JJ, Glass J, Kim L, Shi W. Targeting metabolism with a
ketogenic diet during the treatment of glioblastoma multiforme. J
Neurooncol. 117: 125-31, 2014.
[12] Chu-Shore CJ, Thiele EA. Tumor growth in patients with tuberous
sclerosis complex on the ketogenic diet. Brain Dev. 32: 318-22,
2010.
[13] Klement RJ, Sweeney RA. Impact of a ketogenic diet intervention
during radiotherapy on body composition: I. Initial clinical
experience with six prospectively studied patients. BMC Research
Notes. 9: 143, 2016.
[14] Fine EJ, Segal-Isaacson CJ, Feinman R, Sparano J. Carbohydrate
restriction in patients with advanced cancer: a protocol to assess
safety and feasibility with an accompanying hypothesis. Commun
Oncol 5: 22-6, 2008.
[15] McClellan WS, Du Bois EF. Clinical calorimetry XLV. Prolonged
meat diets with a study of kidney function and ketosis. J Biol
Chem 87:651-668, 1930.
[16] Voegtlin WL. The stone age diet: based on in-depth studies of
human ecology and the diet of man. New York: Vantage Press;
1975.
[17] Cordain L. The paleo diet: lose weight and get healthy by eating
the food you were designed to eat. New York: Wiley; 2002.
[18] Manheimer EW, van Zuuren EJ, Fedorowicz Z, Pijl H. Paleolithic
nutrition for metabolic syndrome: systematic review and meta-
analysis. Am J Clin Nutr 102: 922-32, 2015.
[19] Tóth C., Clemens Z. Type 1 diabetes mellitus successfully
managed with the paleolithic ketogenic diet. Int J Case Rep
Images 5: 699-703, 2014.
292 American Journal of Medical Case Reports
[20] Tóth C, Clemens Z. A child with type 1 diabetes mellitus (T1DM)
successfully treated with the Paleolithic ketogenic diet: A 19-
month insulin freedom. Int J Case Rep Images 6: 752-757. 2015.
[21] Tóth C., Clemens Z. Successful treatment of a patient with obesity,
type 2 diabetes and hypertension with the paleolithic ketogenic
diet. Int J Case Rep Images 6: 161-167, 2015.
[22] Clemens Z., Kelemen A., Fogarasi A., Tóth C. Childhood absence
epilepsy successfully treated with the paleolithic ketogenic diet.
Neurol Ther 2: 71-6, 2013.
[23] Clemens, Z., Kelemen, A., Tóth, C. NREM-sleep Associated
Epileptiform Discharges Disappeared Following a Shift toward the
Paleolithic Ketogenic Diet in a Child with Extensive Cortical
Malformation. Am J Med Case Rep 3: 212-215, 2015.
[24] Tóth C., Clemens Z. Gilbert’s syndrome successfully treated with
the paleolithic ketogenic diet. Am J Med Case Rep 3: 117-120,
2015.
[25] Tóth C, Dabóczi A, Howard M, Miller NJ, Clemens Z. Crohn’s
disease successfully treated with the paleolithic ketogenic diet. Int
J Case Rep Images 7: 570-578, 2016.
[26] Seyfried TN, Shelton LM, Mukherjee P. Does the existing
standard of care increase glioblastoma energy metabolism? Lancet
Oncol. 11: 811-3, 2010.
[27] Xu T, Liao Z, Tang J, Guod L, Qiub H, Gao Y, Hu W.
Myoepithelial carcinoma of the head and neck: A report of 23
cases and literature review. Cancer Treatment Communications. 2:
24-29, 2014.
[28] Ren J, Liu Z, Liu X, Li Y, Zhang X, Li Z, Yang Y, Yang Y, Chen
Y, Jiang S. Primary myoepithelial carcinoma of palate. World J.
Surg. Oncol. 9: 104, 2011.
[29] Boers I, Muskiet FA, Berkelaar E, Schut E, Penders R,
Hoenderdos K, Wichers HJ, Jong MC. Favourable effects of
consuming a Palaeolithic-type diet on characteristics of the
metabolic syndrome: a randomized controlled pilot-study. Lipids
Health Dis. 13: 160, 2014.
[30] Lin JE, Snook AE, Li P et al. GUCY2C opposes systemic
genotoxic tumorigenesis by regulating AKT-dependent intestinal
barrier integrity. PLoS ONE 7: 2, e31686, 2012.
[31] Kossoff EH International consensus statement on clinical
implementation of the ketogenic diet: agreement, flexibility, and
controversy. Epilepsia 49 Suppl 8: 11-3. 2008.
