Cancer as a Metabolic Disease

If cancer is only a genetic disease, as we’ve often been told, then patients have no agency. What good does it do to take control of your life? Why fight?

Fighting is what makes us human: enduring hardship, enduring suffering, and having the agency to say, “I will not die today.” It’s a cheesy line from a long-lost Leonardo DiCaprio movie set on a deserted island, where he’s telling a tall tale about facing a shark. (It turns out it was just a baby shark.) But the point remains.

If, however, cancer is a metabolic disease—as Thomas Seyfried and others have argued—then we have a choice. We don’t have to succumb to cancer just because it runs in our family. Genetics may not have as much say as we’ve been led to believe.

Obviously, this isn’t black and white. Cancer can involve both genetic and metabolic factors. My point is that there is growing evidence it is at least partly—and perhaps largely—metabolic.

This makes sense when you consider the leading causes of death: heart disease (metabolic), neurodegenerative diseases (metabolic), metabolic diseases as a whole (diabetes, metabolic syndrome, etc.), and cancer (also increasingly viewed as metabolic). Perhaps we’ve placed cancer in the wrong bucket for decades. Since before the War on Cancer was declared by President Richard Nixon in 1971, cancer rates have been rising.

We know cancer is not entirely genetic. Very few diseases are. Conditions like Huntington’s disease, Marfan syndrome, and polycystic kidney disease are strongly genetic. Some require just one copy of the mutated gene from a parent; others, like cystic fibrosis and sickle cell disease, require both parents to pass on the gene.

But there is no single “cancer gene” that guarantees you will get cancer. That said, some cancers do have a significant genetic component, such as certain forms of breast and ovarian cancer. (I’m not claiming genetics play no role at all, nor am I suggesting all cancers are the same or should be treated identically.)

The biggest risk factor for virtually all forms of cancer is smoking. The second biggest? Obesity. Obesity is a metabolic disease. And despite what Oprah says, there is no single “fat gene” that dooms a person to obesity.

When discussing treatment options with patients, I often tell them what I would do if someone I loved were in their situation—whether that’s me, my significant other, a parent, a sibling, or a child. Sometimes patients ask the question before I reach that part of the conversation, especially when there are several reasonable options within the standard of care.

If I were diagnosed with cancer, my approach would depend on the type and stage. If it were caught relatively early, I would clean up my already decent nutrition and go 100% carbohydrate-free, aiming for nutritional ketosis at all times. I would seek additional opinions from specialists and dive deep into the Press/Pulse theory of cancer treatment. The “Press” generally refers to stressing the cancer cells, since most cancers rely heavily on glucose for fuel. (This is why PET scans can identify cancer: a radioactive glucose molecule is injected, and the machine detects the “hot spots” where cancer cells are greedily taking up the glucose.)

I would focus first on stressing the cancer by depriving it of its primary fuel. Then I would consider the “Pulse” options—what we traditionally think of as cancer treatments: chemotherapy, radiation, and surgery. The idea is to weaken the cancer first, shrink it if possible, and only then hit it with therapies that can have significant side effects.

If the cancer were very advanced with a poor prognosis, I would still get multiple specialist opinions. However, I might choose not to pursue aggressive treatment at all. Instead, I would focus on making the most of the quality time I had left. I’ve seen the downsides of cancer treatment firsthand, and depending on the cancer, it doesn’t always extend life meaningfully. An extra six months spent mostly in the hospital, feeling miserable from chemo and radiation side effects, isn’t truly six months of living.

There is no one-size-fits-all approach to cancer treatment. Too many individual factors must be considered for each cancer and each patient. That said, I believe avoiding the biggest risk factors gives me the best chance of not succumbing to this disease someday.

When it’s my time, it’s my time. God already knows when that day will come. In the meantime, I’m doing my best to ensure it doesn’t arrive any sooner than it should.