Energy restricted ketogenic diet (ERKD) treatment for advanced glioblastoma multiforme (GBM): Case report

• Published in: The FASEB journal 2013-04, Vol.27 (S1)
• Main Authors: Nikolai, Michele, Noel, Mary, Schwartz, Kenneth, Kurniali, Peter, Chang, Howard, Olson, Lawrence Karl
• Format: Article
• Language: English
• ISSN: 0892-6638; 1530-6860
• DOI: 10.1096/fasebj.27.1_supplement.lb302

Abstract only This study aimed to evaluate a 12 week ERKD protocol for advanced GBM. A 55 year old white male with progressive GBM was hospitalized to establish ketosis and initiate ERKD. A therapeutic range was established for serum betahydroxybutyrate (BHB) of 3–6 mmol/L and serum glucose of 50–70 mg/dl. Feeding began when patient achieved BHB of ≥3 mmol/L. While he was on ERKD his BHB and glucose were measured twice daily as fasting morning (AM) and two hours post‐prandial in the evening (PM). Initial diet consisted of Ketocal® 3:1 formula, 20–25 kcals/kg. The 3:1 fat: protein + carbohydrate ratio met protein needs of 0.6–0.8 grams protein/kg. The patient and wife received instructions from a dietitian on ketogenic meal preparation. The BHB and glucose were in therapeutic range initially. As feedings advanced, AM BHB levels decreased to < 3 mmol/L and glucose ≥ 80 mg/dl. Ketosis deepened daily and PM measurements >; 3 mmol/L. BHB and glucose levels did not always correlate. Patient found Ketocal® unpalatable and changed to a food only ketogenic diet. Diet manipulation alleviated his hunger and increased AM BHB. His weight decreased by 6%. Patient withdrew from the study when GBM progressed ERKD protocols can be administered with a trained team to adults with GBM. Study is needed to determine the optimal diet to maintain therapeutic glucose and ketones. Supported by Michigan State University Clinical and Translational Sciences Institute.