Peter Attia

They didn't have glioblastoma.

It's one of the cancers that really gives cancer a bad name.

Is there any evidence that any form of ketogenic diet, even at a one-to-one ratio of glucose to ketone, is going to produce a durable remission in a patient with the GBM?

In an RCT, when you place full standard of care versus full standard of care plus ketogenic therapy, what is the difference in median survival?

But it's hard to imagine you're ever going to get glucose to less than 40% of the brain's fuel, which would be a big achievement.

If you did all of those tricks, you ramped up ketones, you took glucose down peripherally to 2.5, even 3 millimole.

So if you have a glucose to ketone index of 1.1 and they're both sitting at 3 millimole, then you're doing all those therapies.

The neurons are still getting 40 to 50% of their energy from glucose.

None of this has been demonstrated clinically.

This is all kind of anecdotal, meaning we don't have evidence in a clinical trial that this works.

We're sort of extracting mechanistically from what we think these things do.

No RCTs.

What's the holdup?

I interviewed Tom seven years ago, and we had this exact same conversation.

Why do you think, especially for these cancers that are basically just killing machines, people are dead within a year of diagnosis.

Why is it so hard to do these trials?

But oncologists are not going to read that, right?

So the people that are on the front lines that are taking care of these patients.

Some of them are authors, so they've read it.

But again, what they want and what they need is a clinical trial that says this stack of interventions is going to double median survival.