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Ketogenic and low-sugar diets for patients with cancer: perceptions and practices of medical oncologists in Canada

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Abstract

Purpose

Many patients with cancer are interested in complementary therapies, including strategies such as reduced carbohydrate diets. Guidelines regarding the use of these diets during cancer treatment are lacking; therefore, we aimed to explore the perceptions and practices of medical oncologists in Canada regarding low-sugar and ketogenic diets.

Method

A cross-sectional, online multiple-choice survey was distributed to 206 Canadian medical oncologists. Questions explored frequency of patient interactions, oncologist perceptions of efficacy, advice given to patients, and concerns about side effects related to reduced carbohydrate diets.

Results

Responses were received from 57 medical oncologists in seven of thirteen provinces and territories, with an overall response rate of 28%. Forty-nine percent of respondents were asked at least weekly about a low-sugar diet, and 9% about the ketogenic diet. Eighty-five percent supported the use of a low–added sugar diet in patients with diabetes or hyperglycemia, while conversely 87% did not support the use of a ketogenic diet for any of their patients undergoing active cancer treatment. Respondents felt either that a ketogenic diet was not effective (31%) or that the effect on cancer outcomes was unknown (69%). Ninety-six percent of respondents had concerns about a ketogenic diet for patients receiving active cancer treatment.

Conclusion

The role of reduced carbohydrate diets during cancer treatment is topical. Canadian oncologists are particularly reluctant to support a ketogenic diet for patients on active cancer treatment, with concerns about side effects and unknown efficacy. There may be a role for continuing medical education and institutional guidelines to inform these discussions with patients.

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Acknowledgments

We would like to thank Emmy Moreno and Caitlin Woodrow, dietetic interns with the Manitoba Partnership Dietetic Education Program (2018–2019), for their assistance with analysis of the pilot survey data.

Author information

Authors and Affiliations

  1. Department of Nutrition Services, CancerCare Manitoba, Winnipeg, MB, Canada

    Pamela N. Klassen

  2. Division of Human Nutrition, Department of Agricultural, Food and Nutritional Science, University of Alberta, 4-126A Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada

    Pamela N. Klassen

  3. Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada

    Benjamin A. Goldenberg & Christina A. Kim

  4. Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB, Canada

    Pascal Lambert

  5. Department of Nutrition and Food Services, Health Sciences Centre, Winnipeg, MB, Canada

    Kathy Vagianos

  6. Manitoba Partnership Dietetics Education Program, Winnipeg, MB, Canada

    Kathy Vagianos

Authors
  1. Pamela N. Klassen
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  4. Kathy Vagianos
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Contributions

CK, PK, and KV designed research (project conception, development of overall research plan, and study oversight). CK, PK, and BG conducted data collection. CK, PK, and PL analyzed data. PK and CK wrote the paper and had primary responsibility for final content. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Pamela N. Klassen.

Ethics declarations

Informed consent was gained from all participants via the survey introduction, which stated the purpose of the study, the length of time required to complete the survey, and contact information of the study investigators. Ethical approval for the study was granted by the University of Manitoba Health Research Ethics Board and was conducted in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

Conflict of interest

CK has a research grant from Celgene Inc. PK, PL, KV, and BG declare that they have no conflict of interest.

Data control and review

The authors declare that they have full control of all primary data and agree to allow the journal to review their data if requested.

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Klassen, P.N., Goldenberg, B.A., Lambert, P. et al. Ketogenic and low-sugar diets for patients with cancer: perceptions and practices of medical oncologists in Canada. Support Care Cancer 28, 5243–5249 (2020). https://doi.org/10.1007/s00520-020-05361-9

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  • DOI: https://doi.org/10.1007/s00520-020-05361-9

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