Dietary carbohydrate restriction provokes systemic metabolic and cell signaling effects including down-regulation of insulin, insulin-like growth factors, fatty acid synthase, and other enzymatic and signaling targets. These effects as well as increased availability of fatty acids and ketone bodies may plausibly inhibit aggressive glycolytic cancers. We have designed a 28-day clinical trial diet of very low carbohydrate intake under nutritionist guidance to test the safety and feasibility in patients with advanced glucose-dependent solid cancers, determined by a positive baseline positron emission tomography (PET) scan using 18-fluorodeoxyglucose to demonstrate glucose avidity. Changes in a follow-up PET scan at study's end permit a surrogate measure of efficacy.
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