Ketones and Cancer

This might piss off some keto fans, but this is worth reading.

Can a ketogenic diet promote cancer? A study from 2011 says that ketones and lactate increase the “stemness” of cancer cells, so they grow more cells.

Previously, we showed that high-energy metabolites (lactate and ketones) “fuel” tumor growth and experimental metastasis in an in vivo xenograft model, most likely by driving oxidative mitochondrial metabolism in breast cancer cells. To mechanistically understand how these metabolites affect tumor cell behavior, here we used genome-wide transcriptional profiling. Human breast cancer cells (MCF7) were cultured with lactate or ketones, and then subjected to transcriptional analysis (exon-array). Interestingly, our results show that treatment with these high-energy metabolites increases the transcriptional expression of gene profiles normally associated with “stemness”, including genes upregulated in embryonic stem (ES) cells. Similarly, we observe that lactate and ketones promote the growth of bonafide ES cells, providing functional validation. The lactate- and ketone-induced “gene signatures” were able to predict poor clinical outcome (including recurrence and metastasis) in human breast cancer patients. Taken together, our results are consistent with the idea that lactate and ketone utilization in cancer cells promotes the “cancer stem cell” phenotype, resulting in significant decreases in patient survival.

Ketones and lactate increase cancer cell “stemness”, driving recurrence, metastasis and poor clinical outcome in breast cancer

This is a huge bummer, and a good argument against really pushing ketosis as some kind of health cure-all.

Lactate is a chemical in the blood was not well understood until the 1970s.

For much of the 20th century, lactate was largely considered a dead-end waste product of glycolysis due to hypoxia, the primary cause of the O2 debt following exercise, a major cause of muscle fatigue, and a key factor in acidosis-induced tissue damage. Since the 1970s, a ‘lactate revolution’ has occurred. At present, we are in the midst of a lactate shuttle era; the lactate paradigm has shifted. It now appears that increased lactate production and concentration as a result of anoxia or dysoxia are often the exception rather than the rule. Lactic acidosis is being re-evaluated as a factor in muscle fatigue. Lactate is an important intermediate in the process of wound repair and regeneration. The origin of elevated [lactate] in injury and sepsis is being re-investigated. There is essentially unanimous experimental support for a cell-to-cell lactate shuttle, along with mounting evidence for astrocyte–neuron, lactate–alanine, peroxisomal and spermatogenic lactate shuttles. The bulk of the evidence suggests that lactate is an important intermediary in numerous metabolic processes, a particularly mobile fuel for aerobic metabolism, and perhaps a mediator of redox state among various compartments both within and between cells. Lactate can no longer be considered the usual suspect for metabolic ‘crimes’, but is instead a central player in cellular, regional and whole body metabolism. Overall, the cell-to-cell lactate shuttle has expanded far beyond its initial conception as an explanation for lactate metabolism during muscle contractions and exercise to now subsume all of the other shuttles as a grand description of the role(s) of lactate in numerous metabolic processes and pathways.

Lactate metabolism: a new paradigm for the third millennium

Additionally, more recent work shows lactate can be a benefit for athletic performance. Of course, the risks related to cancer still stand.

In contrast to its early portrayal as a metabolic waste product and fatigue agent, lactate is the chief messenger in a complex feedback loop. Short-term challenges to adenosine triphosphate (ATP) supply stimulate lactate production, leading to immediate, short- and long-term cellular adaptions to support ATP homeostasis. The physiology and biochemistry of this topic were extensively reviewed by Bruce Gladden in 2004 and should be consulted (Gladden, 2004), but subsequently new information has become available, particularly with regard to the role of lactate and lactate shuttle, to understand basic physiology and metabolism as well as to treat injuries and illnesses.

The Science and Translation of Lactate Shuttle Theory

However, there’s a lab rat study that indicates that ketones may reduce cancer growth.

Cancer cells express an abnormal metabolism characterized by increased glucose consumption owing to genetic mutations and mitochondrial dysfunction. Previous studies indicate that unlike healthy tissues, cancer cells are unable to effectively use ketone bodies for energy. Furthermore, ketones inhibit the proliferation and viability of cultured tumor cells. As the Warburg effect is especially prominent in metastatic cells, we hypothesized that dietary ketone supplementation would inhibit metastatic cancer progression in vivo. Proliferation and viability were measured in the highly metastatic VM-M3 cells cultured in the presence and absence of β-hydroxybutyrate (βHB). Adult male inbred VM mice were implanted subcutaneously with firefly luciferase-tagged syngeneic VM-M3 cells. Mice were fed a standard diet supplemented with either 1,3-butanediol (BD) or a ketone ester (KE), which are metabolized to the ketone bodies βHB and acetoacetate. Tumor growth was monitored by in vivo bioluminescent imaging. Survival time, tumor growth rate, blood glucose, blood βHB and body weight were measured throughout the survival study. Ketone supplementation decreased proliferation and viability of the VM-M3 cells grown in vitro, even in the presence of high glucose.

Ketone supplementation decreases tumor cell viability and prolongs survival of mice with metastatic cancer.

Before telling anyone that a keto diet causes cancer… don’t do it. It doesn’t. All it says here is that in breast cancer, ketones seem to be implicated in making the cancer cells behave more like stem cells and grow into bigger clusters of cancer cells (which is exactly what you don’t want).

Likewise, will it stop cancer? It seems to for mouse cancer cells.

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