The low-carbohydrate, high-fat ketogenic diet has become hugely popular over the last few years. For many people, the keto diet — including variations such as keto cycling or the less restrictive lazy keto — has become the go-to eating plan for weight loss and fighting disease.

Two years ago, I interviewed cancer specialist Dr. Patrick Hwu of MD Anderson in Houston about his research into what he calls the “fat-burning metabolism diet”, or fat-burning diet. Hwu, a tumor immunologist, has been following the ketogenic diet himself for six years, long before it was trending on social media.

As a leading cancer doctor, he has many patients asking him for the ideal diet while they go through treatment and he often suggests keto.

Hwu emphasizes that more research is needed to determine the ideal diet for cancer patients, but as he has seen in himself, the keto diet has been shown to improve biomarkers associated with heart health.

Keto isn't all meat

Keto is a diet that was developed decades ago and originally used for patients with severe epilepsy, some of whom were on the diet for life with no evidence of harm. It consists of low carb, high fat and only moderate protein intake, as opposed to the Atkins diet. Keto isn’t as meat-heavy as commonly believed. Hwu relies on certain “go to” foods like full-fat regular cream cheese, sour cream and avocados as staples. He also consumes a lot of green vegetables and cauliflower.

Since starting the keto diet, Hwu has dropped 25 pounds and has maintained the weight loss. His blood pressure, triglycerides and sugar levels have all decreased, which are healthy signs. His biomarkers, including lipid profile and blood pressure have been excellent, he said.

There have been a number of studies that show the connection between obesity and certain cancers. Hwu feels that keto makes sense because his patients are not hungry on it, it manages their weight and blood sugar levels and keeps insulin and IGF-1 levels low — two proteins that have been shown to drive some cancers.

“I feel that fat intake has been overly emphasized as a negative factor and that a high intake of carbs and the subsequent spikes in insulin and IGF-1 (an insulin-like hormone in the blood) that they cause are more harmful to health overall,” Hwu said.

How keto may help cancer patients

Hwu’s colleague, Dr. Jennifer McQuade, an assistant professor and physician scientist in Melanoma Medical Oncology at MD Anderson says they are currently conducting both human and animal studies of the effects of diet, including the ketogenic diet, on cancer. In addition, they are testing a plant-based high-fiber diet aimed at the gut microbiome, which has been shown to impact response to immunotherapy, a type of cancer treatment that utilizes the patient’s own immune system to fight the disease. They expect results from the studies early next year.

Recent work from the laboratory of Lew Cantley at Cornell has shown that the ketogenic diet can improve cancer control in mice treated with a type of targeted therapy that can cause elevated levels of insulin.

The MD Anderson researchers will test the ketogenic diet in cancer survivors to see if it lowers insulin and IGF-1, they will then move on to combining with targeted therapy.

The keto diet research will be prepared in an MD Anderson kitchen and provided to the patients in a controlled setting.

Meanwhile, Hwu would like to see a greater variety of keto-friendly offerings in grocery stores — because the key to sticking with keto is having enough substitutes, so you never feel “deprived.”

“You can bake almost anything with almond flour," said Hwu, "and stevia, erythritol and monk fruit are all safe sweeteners.”