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In their natural state within the body, normal cells use cellular respiration as their main source of ATP and energy. Carbohydrate deprived cells easily depend on the resulting ketone bodies for an alternative energy source. This natural evolutionary adaptation to starvation allows for survival of normal cells during times of fasting or famine. Cancer cells in contrast are defective in this respect, lacking the ability to utilize ketone bodies for energy and depend heavily on glycolysis for survival. The pancreas senses increased carbohydrate intake resulting in increased insulin secretion. Normal growth throughout the body depends on insulin, which by itself is also a potent growth factor which binds to cell membrane insulin receptors and stimulates mitosis via signal transduction and DNA synthesis, resulting in less
apoptosis or tumor cell death. Consequentially, carbohydrate restriction will increase tumor cell destruction. We are conducting a pilot study to examine the safety and tolerability of the ketogenic diet KD in patients with advanced cancer within the Veteran Affairs Pittsburgh Healthcare System (VAPHS) oncology patient population.