While OP's trial is bigger, it should be noted that just like metformin treating epilepsy and T2 diabetes, a ketogenic diet also seems effective for this condition: https://pubmed.ncbi.nlm.nih.gov/16190943/
To be clear, a ketogenic diet is not as effective as modern anti-seizure medications. It can come close in about 1/3 of patients (~90% reduction in seizure frequency) but it's not effective for all patients and shouldn't be viewed as an alternative to medication for everyone.
A secondary problem is that the modern definition of a ketogenic diet has become muddied as it has entered mainstream dieting culture. Many people who claim to be on ketogenic diets aren't actually consuming enough fat, or are consuming too much protein, to technically pass the thresholds required to reach the ketone levels used in these studies.
The most common mistake is consuming too much protein. Contrary to popular belief, even fatty foods like bacon are not strictly ketogenic. In fact, it's difficult to reach classic ketogenic thresholds without augmenting with MCT oil, heavy whipping cream, or very large amounts of nuts. Most "keto" recipes online barely meet Atkins criteria, let alone full ketogenic diet ratios. Once people realize they have to literally drink heavy whipping cream or oils to stay in the levels of ketosis required for therapeutic effect, the medications don't sound so bad.
sounds great tbh
https://www.escardio.org/The-ESC/Press-Office/Press-releases...
I wouldn't be surprised if most people doing keto have way, way less fiber than they should.
If you think scientists don't know that correlation does not imply causation, I'm happy to report to you that they, in fact, do. Separating out incidental correlation from causation is actually kind of the point of science, and by extension, medicine. The primary population that gets it wrong is the people that read a single study, and immediately conclude something based on that one study, like "oh hey ketogenic diets reduces bad cholesterol, it must be super good."
And it's simply intellectually dishonest (at best) to state that the motivation of the researcher is only to increase their paper count with presumable producing junk science, without presenting a shred of evidence to support such a claim(talk about bad science).
You said that all cause mortality increases on a ketogenic diet, and this study shows no such thing.
...
> The risks of all-cause and cause-specific death over an average 6.4-year follow-up rose with each fall in carbohydrate intake (see table), and remained significant after adjusting for all available factors that might have influenced the association (Model 2 in the table).
Quoted from the study.
It suggests exactly that thing. I suggest you read the study again.
Because that means that you're grabbing a large cohort of people, fixing their diets, and following them until a good number of them die.
The timescales required here, not to mention the cost, means that such studies are virtually unfeasible.
On the plus side, we're slowly making the public aware that the DNA theory of cancer isn't actually right and that carbohydrate metabolism is much more powerful.
It's not just Coke and donuts. Even bacon and eggs don't reach the threshold of ketosis used in these studies. The pop-culture definition of a ketogenic diet is really more like Atkins or low-card than the ketogenic diets used in these studies.
Ketosis at this level requires not only restricting carbohydrates, but restricting protein intake as well. This usually means drinking heavy whipping cream and oils.
A classic ketogenic diet would require significant quantities of heavy whipping cream (or MCT oil or other oils) with every meal, including snacks. Wikipedia has a good example: https://en.wikipedia.org/wiki/Ketogenic_diet#Classic
Doing a true ketogenic diet is hard work. Most of what people call ketogenic diets are actually more like Atkins or low-carb. Going into full ketosis requires significant protein restriction and augmenting with significant fat sources.
Edit: also if you could introduce a change in the cells that only changed the metabolism and didn’t alter DNA you could prove your theorem if you then caused them to be tumorigenic.
If it's "just DNA" then we should focus on relevant therapies. But this is what we've done for 60 years and it hasn't gotten us very far. In fact depending on how you slice the numbers we've made almost no progress since chemo was "invented".
On the other hand if it's mitochondria and DNA damage is just one possible route, and damage happens all the time, then there are metabolic approaches. These include simple diet changes, metformin and all kinds of other things.
We need to abandon the "just DNA" paradigm. Epigenetics is far bigger than most understand, and DNA is far more malleable than most people know.
As both books (I think) say, the TCGA project was largely a failure for exactly these reasons: DNA is a big moving target and the cell-to-cell variance is very large.
The DNA paradigm explains this very well. How does the book explain this treatment?
How about a stem cell transplant? Why do they cure certain cancers? Does the metabolism of the person donating their stem cells get taken up and adopted permanently by the recipient?
Let's look at the first Wikipedia sentence on tyrosine kinase as a starting point:
"A tyrosine kinase is an enzyme that can transfer a phosphate group from ATP to the tyrosine residues of specific proteins inside a cell."
What's ATP? We both know what ATP is. Is ATP deeply part of metabolism? We both know it almost is a definition of metabolism. I want to shout at you. But I don't know who you are or how to connect with you.
Please, for the love of anything that you find Holy, instead of arguing with me on the internet do this: Read the books I recommended, and start looking for the links to metabolism like I just did for you instead of trying to "see DNA everywhere". You will go so much further and help all of us than just arguing with me.
As to the atp issue, yes it is involved with metabolism but so so much more. If you have time read The Biology if Cancer by R A Weinberg. He does a good job of exploring the historical investigations as wellas the science.
This is an unnecessary dichotomy. The Warburg effect has been theorized for almost a hundred years. It's not that only one of "DNA theory" vs. "cellular metabolism theory" can be right, the prevailing theory is that they are highly intertwined.
So, yes, some cancer types are fed on carbohydrates, and if that's what people eat, they will get those cancers.
If people have a better diet, a better kind of cancer will kill them. =)
It is very infrequent to actually die of "old age" at over 100.
And the common thing of all cancers is still they are DNA mutations.
Having said that, yes, people should avoid a carbohydrate heavy diet, not only because it helps against common cancers, but because metabolic disease is just getting sick without any unavoidable reason.