Skip to main content

Advertisement

SpringerLink
Log in

Ketogenic diets in medical oncology: a systematic review with focus on clinical outcomes

  • Review Article
  • Published:
Medical Oncology Aims and scope Submit manuscript

Abstract

Preclinical data provide evidence for synergism between ketogenic diets (KDs) and other oncological therapies. The aim of this systematic review was to summarize data from clinical studies that have tested KDs along with other treatments used within medical oncology. The PubMed database was searched using the key words "ketogenic" AND ("cancer" OR "glioblastoma"). A secondary search was conducted by screening the reference lists of relevant articles on this topic. Relevant studies for this review were defined as studies in which KDs were used complementary to surgery, radio-, chemo-, or targeted therapy and at least one of the following four outcomes were reported: (i) Overall survival (OS); (ii) progression-free survival (PFS); (iii) local control rate; (iv) body composition changes. Twelve papers reporting on 13 clinical studies were identified. Nine studies were prospective and six had a control group, but only two were randomized. KD prescription varied widely between studies and was described only rudimentarily in most papers. Adverse events attributed to the diet were rare and only minor (grade 1–2) except for one possibly diet-related grade 4 event. Studies reporting body composition changes found beneficial effects of KDs in both overweight and frail patient populations. Beneficial effects of KDs on OS and/or PFS were found in four studies including one randomized controlled trial. Studies in high-grade glioma patients were not sufficiently powered to prove efficacy. Evidence for beneficial effects of KDs during cancer therapy is accumulating, but more high-quality studies are needed to assess the overall strength of evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Notes

  1. The general problems with evidence hierarchies have been thoroughly discussed. For examples see Stegenga [22] or Klement and Bandyopadhyay [23].

  2. These two types of skepticism parallel those identified by the astronomer–philosopher Milan Ćirković regarding SETI, the search for extra-terrestrial intelligence in the Universe:”instrumentalist” (or methodological) and “fundamentalist” skepticism [29]. Indeed we argue that certain parallels can be drawn between SETI, where dogmatic principles, religious or otherwise dictate an individual’s attitude towards the endeavor, and nutrition research which is often confounded with pseudo-scientific beliefs, conflicts of interest, and dogmatism [30].

  3. This statement is not strictly exact since the first clinical study applying a KD in cancer patients was published in 1941 and received a lot of newspaper attention. See Klement [53] for a historical review.

References

  1. Cohen IA. A model for determining total ketogenic ratio (TKR) for evaluating the ketogenic property of a weight-reduction diet. Med Hypotheses. 2009;73:377–81. https://doi.org/10.1016/j.mehy.2009.03.039.

    Article  CAS  PubMed  Google Scholar 

  2. Kossoff EH, Hartman AL. Ketogenic diets: new advances for metabolism-based therapies. Curr Opin Neurol. 2012;25:173–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Clemens Z, Tóth C. Paleolithic ketogenic diet (PKD) in chronic diseases: clinical and research data. J Evol Health. 2019;3:6.

    Google Scholar 

  4. Pérez-Guisado J, Muñoz-Serrano A, Alonso-Moraga Á. Spanish ketogenic mediterranean diet: a healthy cardiovascular diet for weight loss. Nutr J. 2008;7:30.

    PubMed  PubMed Central  Google Scholar 

  5. Klement RJ, Champ CE, Otto C, Kämmerer U. Anti-tumor effects of ketogenic diets in mice: a meta-analysis. PLoS ONE. 2016;11:e0155050. https://doi.org/10.1371/journal.pone.0155050.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Weber DD, Aminazdeh-Gohari S, Kofler B. Ketogenic diet in cancer therapy. Aging (Albany NY). 2018;10:164–5.

    PubMed  PubMed Central  Google Scholar 

  7. Klement RJ, Bandyopadhyay PS, Champ CE, Walach H. Application of Bayesian evidence synthesis to modelling the effect of ketogenic therapy on survival of high grade glioma patients. Theor Biol Med Model. 2018;15:12.

    PubMed  PubMed Central  Google Scholar 

  8. Klement RJ, Champ CE. Calories, carbohydrates, and cancer therapy with radiation: exploiting the five R’s through dietary manipulation. Cancer Metastasis Rev. 2014;33:217–29.

    CAS  PubMed  PubMed Central  Google Scholar 

  9. Allen BG, Bhatia SK, Anderson CM, Eichenberger-Gilmore JM, Sibenaller ZA, Mapuskar KA, et al. Ketogenic diets as an adjuvant cancer therapy: history and potential mechanism. Redox Biol. 2014;2:963–70.

    CAS  PubMed  PubMed Central  Google Scholar 

  10. Klement RJ. Fasting, fats, and physics: combining ketogenic and radiation therapy against cancer. Complement Med Res. 2018;25:102–13.

    PubMed  Google Scholar 

  11. Klement RJ. The influence of ketogenic therapy on the 5 R’s of radiobiology. Int J Radiat Biol. 2019;95:394–407.

    CAS  PubMed  Google Scholar 

  12. Hopkins BD, Pauli C, Du X, Wang DG, Li X, Wu D, et al. Suppression of insulin feedback enhances the efficacy of PI3K inhibitors. Nature. 2018;560:499.

    CAS  PubMed  PubMed Central  Google Scholar 

  13. Martin-McGill KJ, Marson AG, Smith CT, Jenkinson MD. The modified ketogenic diet in adults with glioblastoma: an evaluation of feasibility and deliverability within the national health service. Nutr Cancer. 2018;70:643–9. https://doi.org/10.1080/01635581.2018.1460677.

    Article  PubMed  Google Scholar 

  14. Psihogios A, Ennis JK, Seely D. Naturopathic oncology care for pediatric cancers: a practice survey. Integr Cancer Ther. 2019;18

    Google Scholar 

  15. Fearon KC, Borland W, Preston T, Tisdale MJ, Shenkin A, Calman KC. Cancer cachexia: influence of systemic ketosis on substrate levels and nitrogen metabolism. Am J Clin Nutr. 1988;47:42–8.

    CAS  PubMed  Google Scholar 

  16. Nebeling L, Miraldi F, Shurin S, Lerner E. Effects of a ketogenic diet on tumor metabolism and nutritional status in pediatric oncology patients: two case reports. J Am Coll Nutr. 1995;14:202–8.

    CAS  PubMed  Google Scholar 

  17. 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). 2011;8:54.

    CAS  PubMed  PubMed Central  Google Scholar 

  18. Fine EJ, Segal-isaacson CJ, Feinman RD, Herszkopf S, Romano MC, Tomuta N, et al. Targeting insulin inhibition as a metabolic therapy in advanced cancer: a pilot safety and feasibility dietary trial in 10 patients. Nutrition. 2012;28:1028–35. https://doi.org/10.1016/j.nut.2012.05.001.

    Article  CAS  PubMed  Google Scholar 

  19. Champ CE, Palmer JD, Volek JS, Werner-Wasik M, Andrews DW, Evans JJ, et al. Targeting metabolism with a ketogenic diet during the treatment of glioblastoma multiforme. J Neurooncol. 2014;117:125–31.

    CAS  PubMed  Google Scholar 

  20. Branca JJV, Pacini S, Ruggiero M. Effects of pre-surgical vitamin D supplementation and ketogenic diet in a patient with recurrent breast cancer. Anticancer Res. 2015;35:5525–32.

    CAS  PubMed  Google Scholar 

  21. 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 Res Notes. 2016;9:143.

    PubMed  PubMed Central  Google Scholar 

  22. Stegenga J. Down with the hierarchies. Topoi. 2014;33:313–22.

    Google Scholar 

  23. Klement RJ, Bandyopadhyay PS. Emergence and evidence: a close look at Bunge’s philosophy of medicine. Philosophies. 2019;4:50.

    Google Scholar 

  24. Huebner J, Marienfeld S, Abbenhardt C, Ulrich C, Muenstedt K, Micke O, et al. Counseling patients on cancer diets: a review of the literature and recommendations for clinical practice. Anitcancer Res. 2014;34:39–48.

    Google Scholar 

  25. Erickson N, Boscheri A, Linke B, Huebner J. Systematic review: isocaloric ketogenic dietary regimes for cancer patients. Med Oncol. 2017;34:72. https://doi.org/10.1007/s12032-017-0930-5.

    Article  CAS  PubMed  Google Scholar 

  26. Maisch P, Gschwend JE. Retz M. Wirksamkeit der ketogenen Diät bei urologischen Tumorerkrankungen: Ein systematischer Review. Urologe; 2018. p. 57.

    Google Scholar 

  27. Klement RJ, Feinman RD, Gross EC, Champ CE, D’Agostino DP, Fine EJ, et al. Need for new review of article on ketogenic dietary regimes for cancer patients. Med Oncol. 2017;34:108.

    PubMed  Google Scholar 

  28. Klement RJ. Ungerechtfertigte Empfehlungen zur ketogenen Diät. Urologe. 2018;57:605–6.

    PubMed  Google Scholar 

  29. Ćirković MM. Who are the SETI sceptics? Acta Astronaut. 2013;89:38–45.

    Google Scholar 

  30. Feinman RD, Keough SM. Ethics in medical research and the low-fat diet-heart hypothesis. Ethics Biol Eng Med. 2015;5:149–59.

    Google Scholar 

  31. Champ CE, Klement RJ. Commentary on “Strong adverse prognostic impact of hyperglycemic episodes during adjuvant chemoradiotherapy of glioblastoma multiforme”. Strahlenther Onkol. 2014;191:281–2.

    Google Scholar 

  32. Moher D, Liberati A, Tetzlaff J, Altman DG, Group TP. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6:e1000097.

    Google Scholar 

  33. Rieger J, Bähr O, Maurer GD, Hattingen E, Franz K, Brucker D, et al. ERGO: a pilot study of ketogenic diet in recurrent glioblastoma. Int J Oncol. 2014;44:1843–52.

    CAS  PubMed  PubMed Central  Google Scholar 

  34. Woodhouse C, Ward T, Chaudhary R. Feasibility of a modified Atkins diet in glioma patients during radiation and its effect on radiation sensitization. Curr Oncol. 2019;26:433–8.

    Google Scholar 

  35. Zahra A, Fath MA, Opat E, Mapuskar KA, Bhatia SK, Ma DC, et al. Consuming a ketogenic diet while receiving radiation and chemotherapy for locally advanced lung cancer and pancreatic cancer: the University of Iowa experience of two phase 1 clinical trials. Radiat Res. 2017;187:743–54. https://doi.org/10.1667/RR14668.1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Cohen CW, Fontaine KR, Arend RC, Alvarez RD, Leath CA III, Huh WK, et al. A Ketogenic diet reduces central obesity and serum insulin in women with ovarian or endometrial cancer. J Nutr. 2018;148:1253–60.

    PubMed  Google Scholar 

  37. Ok JH, Lee H, Chung H-Y, Lee SH, Choi EJ, Kang CM, et al. The potential use of a ketogenic diet in pancreatobiliary cancer patients after pancreatectomy. Anticancer Res. 2018;38:6519–27. 10.21873/anticanres.13017

    PubMed  Google Scholar 

  38. Klement RJ, Schäfer G, Sweeney RA. A ketogenic diet exerts beneficial effects on body composition of cancer patients during radiotherapy: an interim analysis of the KETOCOMP study. J Tradit Complement Med. 2019. https://doi.org/10.1016/j.jtcme.2019.03.007.

    Article  PubMed  Google Scholar 

  39. van der Louw EJTM, Olieman JF, van den Bemt PMLA, Bromberg JEC, Oomen-de Hoop E, Neuteboom RF, et al. Ketogenic diet treatment as adjuvant to standard treatment of glioblastoma multiforme: a feasibility and safety study. Ther Adv Med Oncol. 2019;11:1–13. https://doi.org/10.1177/1758835919853958.

    Article  Google Scholar 

  40. Iyikesici MS. Feasibility study of metabolically supported chemotherapy with weekly carboplatin/paclitaxel combined with ketogenic diet, hyperthermia and hyperbaric oxygen therapy in metastatic non-small cell lung cancer. Int J Hyperth. 2019;36(1):446–55. https://doi.org/10.1080/02656736.2019.1589584.

    Article  CAS  Google Scholar 

  41. Iyikesici MS. Long-term survival outcomes of metabolically supported chemotherapy with gemcitabine-based or FOLFIRINOX regimen combined with ketogenic diet, hyperthermia, and hyperbaric oxygen therapy in metastatic pancreatic cancer. Complement Med Res. 2019;1–9

  42. Khodabakhshi A, Akbari ME, Mirzaei HR, Mehrad-Majd H, Kalamian M, Davoodi SH. Feasibility, safety, and beneficial effects of MCT- based ketogenic diet for breast cancer treatment: a randomized controlled trial study. Nutr Cancer. 2019;1:1–8. https://doi.org/10.1080/01635581.2019.1650942.

    Article  Google Scholar 

  43. Furukawa K, Shigematus K, Iwase Y, Mikami W, Hoshi H, Nishiyama T, et al. Clinical effects of one year of chemotherapy with a modified medium-chain triglyceride ketogenic diet on the recurrence of stage IV colon cancer. J Clin Oncol. 2018;36:e15709.

    Google Scholar 

  44. Furukawa K, Shigematsu K, Iwase Y, Mikami W, Hoshi H, Nishiyama T, et al. Clinical effects of 1 year of chemotherapy with a modified medium-chain triglyceride ketogenic diet on the recurrence of stage IV colon cancer. J Jpn Soc Parenter Enter Nutr. 2018;33:1139–46.

    Google Scholar 

  45. Klement RJ, Sweeney RA, Gross EC, Champ CE. Problems associated with a highly artificial ketogenic diet: Letter to the Editor Re: van der Louw EJTM, Olieman JF, van den Bemt PMLA, et al. Ketogenic diet treatment as adjuvant to standard treatment of glioblastoma multiforme: a feasibility and safety. Ther Adv Med Oncol. 2019

  46. Cohen CW, Fontaine KR, Arend RC, Gower BA. A Ketogenic diet is acceptable in women with ovarian and endometrial cancer and has no adverse effects on blood lipids: a randomized, controlled trial. Nutr Cancer 2019; https://www.tandfonline.com/doi/full/10.1080/01635581.2019.1645864

  47. Cohen C, Fontaine K, Arend R, Soleymani T, Gower B. Favorable effects of a ketogenic diet on physical function, perceived energy, and food cravings in women with ovarian or endometrial cancer: a randomized, controlled trial. Nutrients. 2018;10:1187.

    PubMed Central  Google Scholar 

  48. Klement RJ, Sweeney RA. Impact of a ketogenic diet intervention during radiotherapy on body composition: II. Protocol of a randomised phase I study (KETOCOMP). Clin Nutr ESPEN. 2016;12:e1–6. https://doi.org/10.1016/j.clnesp.2015.11.001.

    Article  PubMed  Google Scholar 

  49. Khodabakhshi A, Akbari ME, Mirzaei HR, Kazemian E, Kalantari K, Kalamian M, et al. Effects of ketogenic diet for breast cancer treatment. a protocol for randomized controlled clinical trial. J Biochem Technol. 2018;9:90–4.

  50. Urbain P, Bertz H. Monitoring for compliance with a ketogenic diet: what is the best time of day to test for urinary ketosis? Nutr Metab (Lond). 2016;13:77.

    Google Scholar 

  51. Volek JS, Phinney SD. The art and science oflow carbohydrate performance. 1st ed. Beyond Obesity LLC; 2012.

  52. Howick J. The philosophy of evidence-based medicine. 1st ed. Oxford: Wiley; 2011.

    Google Scholar 

  53. Klement RJ. Wilhelm Brünings’ forgotten contribution to the metabolic treatment of cancer utilizing hypoglycemia and a very low carbohydrate (ketogenic) diet. J Tradit Complement Med. 2019;9:192–200. https://doi.org/10.1016/j.jtcme.2018.06.002.

    Article  PubMed  Google Scholar 

  54. Connelly J. Realism in evidence based medicine: interpreting the randomised controlled trial. J Health Organ Manag. 2004;18:70–81.

    PubMed  Google Scholar 

  55. Walach H, Falkenberg T, Fønnebø V, Lewith G, Jonas WB. Circular instead of hierarchical: methodological principles for the evaluation of complex interventions. BMC Med Res Methodol. 2006;6:29.

    PubMed  PubMed Central  Google Scholar 

  56. Mas S, Le Bonniec A, Cousson-Gèlie F. Why do women fast during breast cancer chemotherapy? A qualitative study of the patient experience. Br J Health Psychol. 2019;24:381–95.

    PubMed  Google Scholar 

  57. Boros LG, Collins TQ, Somlyai G. What to eat or what not to eat—that is still the question. Neuro Oncol. 2017;19:595–6.

    PubMed  PubMed Central  Google Scholar 

  58. Klement RJ. Restricting carbohydrates to fight head and neck cancer—is this realistic? Cancer Biol Med. 2014;11:145–61.

    CAS  PubMed  PubMed Central  Google Scholar 

  59. Buse MG, Biggers JF, Friderici KH, Buse JF. Oxidation of branched chain amino acids by isolated hearts and diaphragms of the rat: the effect of fatty acids, glucose, and pyruvate respiration. J Biol Chem. 1972;247:8085–96.

    CAS  PubMed  Google Scholar 

  60. Palaiologos G, Felig P. Effects of ketone bodies on amino acid metabolism in isolated rat diaphragm. Biochem J. 1976;154:709–16.

    CAS  PubMed  PubMed Central  Google Scholar 

  61. Sherwin RS, Hendler RG, Felig P. Effect of ketone infusions on amino acid and nitrogen metabolism in man. J Clin Invest. 1975;55:1382–90.

    CAS  PubMed  PubMed Central  Google Scholar 

  62. Nair KS, Welle SL, Halliday D, Campbell RG. Effect of β-hydroxybutyrate on whole-body leucine kinetics and fractional mixed skeletal muscle protein synthesis in humans. J Clin Invest. 1988;82:198–205.

    CAS  PubMed  PubMed Central  Google Scholar 

  63. Thomsen HH, Rittig N, Johannsen M, Møller AB, Jørgensen JO, Jessen N, et al. Effects of 3-hydroxybutyrate and free fatty acids on muscle protein kinetics and signaling during LPS-induced inflammation in humans: anticatabolic impact of ketone bodies. Am J Clin Nutr. 2018;108:857–67.

    PubMed  Google Scholar 

  64. Koutnik AP, D’Agostino DP, Egan B. Anticatabolic effects of ketone bodies in skeletal muscle. Trends Endocrinol Metab. 2019;30(4):227–9. https://doi.org/10.1016/j.tem.2019.01.006.

    Article  CAS  PubMed  Google Scholar 

  65. Tisdale MJ, Brennan RA, Fearon KC. Reduction of weight loss and tumour size in a cachexia model by a high fat diet. Br J Cancer. 1987;56:39–433.

    CAS  PubMed  PubMed Central  Google Scholar 

  66. Shukla SK, Gebregiworgis T, Purohit V, Chaika NV, Gunda V, Radhakrishnan P, et al. Metabolic reprogramming induced by ketone bodies diminishes pancreatic cancer cachexia. Cancer Metab. 2014;2:18.

    PubMed  PubMed Central  Google Scholar 

  67. Fearon KC, Tisdale MJ, Preston T, Plumb JA, Calman KC. Failure of systemic ketosis to control cachexia and the growth rate of the Walker 256 carcinosarcoma in rats. Br J Cancer. 1985;52:87–92.

    CAS  PubMed  PubMed Central  Google Scholar 

  68. Vidali S, Aminzadeh-Gohari S, Feichtinger RG, Vatrinet R, Koller A, Locker F, et al. The ketogenic diet is not feasible as a therapy in a CD-1 nu/nu mouse model of renal cell carcinoma with features of Stauffer’s syndrome. Oncotarget. 2017;8:57201–15.

    PubMed  PubMed Central  Google Scholar 

  69. Abdelwahab MG, Fenton KE, Preul MC, Rho JM, Lynch A, Stafford P, et al. The ketogenic diet is an effective adjuvant to radiation therapy for the treatment of malignant glioma. PLoS ONE. 2012;7:e36197.

    PubMed  PubMed Central  Google Scholar 

  70. Poff AM, Ari C, Seyfried TN, D’Agostino DP. The ketogenic diet and hyperbaric oxygen therapy prolong survival in mice with systemic metastatic cancer. PLoS ONE. 2013;8:e65522.

    CAS  PubMed  PubMed Central  Google Scholar 

  71. Poff AM, Ward N, Seyfried TN, Arnold P, D’Agostino DP. Non-toxic metabolic management of metastatic cancer in VM mice: novel combination of ketogenic diet, ketone supplementation, and hyperbaric oxygen therapy. PLoS ONE. 2015;10:e0127407. https://doi.org/10.1371/journal.pone.0127407.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  72. Morscher RJ, Aminzadeh-Gohari S, Hauser-Kronberger C, Feichtinger RG, Sperl W, Kofler B. Combination of metronomic cyclophosphamide and dietary intervention inhibits neuroblastoma growth in a CD1-nu mouse model. Oncotarget. 2016;7:17060–73.

    PubMed  PubMed Central  Google Scholar 

  73. Zuccoli G, Marcello N, Pisanello A, Servadei F, Vaccaro S, Mukherjee P, et al. Metabolic management of glioblastoma multiforme using standard therapy together with a restricted ketogenic diet: case report. Nutr Metab. 2010;7:33.

    Google Scholar 

  74. Elsakka AMA, Bary MA, Abdelzaher E, Elnaggar M, Kalamian M, Mukherjee P, et al. Management of glioblastoma multiforme in a patient treated with ketogenic metabolic therapy and modified standard of care: a 24-month follow-up. Front Nutr. 2018;5:20. https://doi.org/10.3389/fnut.2018.00020/full.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Tóth C, Dabóczi A, Chanrai M, Schimmer M, Clemens Z. 38-Month long progression-free and symptom-free survival of a patient with recurrent glioblastoma multiforme: a case report of the paleolithic ketogenic diet (Pkd) used as a stand-alone treatment after failed standard oncotherapy. Preprints. 2019;2019120264

  76. Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, et al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2017;36:11–48. https://doi.org/10.1016/j.clnu.2016.07.015.

    Article  PubMed  Google Scholar 

  77. Hyde PN, Lustberg MB, Miller VJ, LaFountain RA, Volek JS. Pleiotropic effects of nutritional ketosis: conceptual framework for keto-adaptation as a breast cancer therapy. Cancer Treat Res Commun. 2017;12:32–9.

    Google Scholar 

Download references

Acknowledgements

We thank Dr. Adeleh Khodabakhshi for providing us individual patient data from her study that allowed us to produce Figs. 2 and 3.

Funding

No funding was received for this work.

Author information

Authors and Affiliations

  1. Department of Radiotherapy and Radiation Oncology, Leopoldina Hospital Schweinfurt, Robert-Koch-Straße 10, 97422, Schweinfurt, Germany

    Rainer J. Klement, Nanina Brehm & Reinhart A. Sweeney

Authors
  1. Rainer J. Klement
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nanina Brehm
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Reinhart A. Sweeney
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by RJK and NB. The first draft of the manuscript was written by RJK and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Rainer J. Klement.

Ethics declarations

Conflict of interest

Rainer J. Klement, Nanina Brehm, and Reinhart A. Sweeney declare that they have no conflict of interest.

Ethical approval

This review was undertaken without requesting ethical approval, since ethical approval was granted for most of the included studies. All human data were anonymous, and the ethical recommendations of the Declaration of Helsinki were adhered to.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Klement, R.J., Brehm, N. & Sweeney, R.A. Ketogenic diets in medical oncology: a systematic review with focus on clinical outcomes. Med Oncol 37, 14 (2020). https://doi.org/10.1007/s12032-020-1337-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s12032-020-1337-2

Keywords

Search

Navigation