ERGO2: ketogenic diet and fasting during re-irradiation of recurrent glioma
The only randomised trial of a ketogenic diet in brain tumours found no benefit. Patients could follow the diet and their ketone levels rose, but progression came just as quickly.
50 patients were randomised 1:1. The intervention was feasible and safe: glucose fell and ketones rose as intended, and the diet was well tolerated over nine days. Progression-free survival at 6 months, the primary endpoint, did not differ (20% vs 16%; median PFS 3.2 vs 3.4 months), nor did overall survival (median 11.1 vs 10.5 months). The trial is small and the dietary exposure brief, so it cannot exclude a benefit from sustained ketosis; equally, longer feasibility studies (KETOCAN, modified Atkins with standard chemoradiation) show adherence declining by three months. Together they define the current state: ketogenic diets in glioma are feasible, unproven, and widely promoted to patients as if they were not.
- 20 vs 16 out of 100 alive without the cancer growing at 6 months with Ketogenic diet + fasting compared with Standard diet; 4 more per 100.
- Roughly one extra person helped for every 25 treated. That is a rough figure taken from the two percentages, not a guarantee for any one person.
- This is a surrogate endpoint: it measures the cancer being controlled or absent on scans and tests, which often, but not always, translates into living longer.
- These results apply to the people the trial enrolled: Recurrent glioblastoma and other malignant gliomas undergoing re-irradiation: 6-day calorie-restricted ketogenic diet plus 3-day fasting during radiotherapy vs standard diet. People in a different situation may not see the same effect.
- Only 50 people took part, so the numbers are less certain than in a large trial.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
50 participants enrolled.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Progression-free survival at 6 monthsprimary | Ketogenic diet + fasting | 25 | 20% | — | — | link |
| Standard diet | 25 | 16% |
Pages like this
not linked directly; found by shared links- IdeaAsk about diet at diagnosis, and prebunk the myths before the internet does
Shares Warburg-effect diet claims ('sugar feeds cancer'), Ketogenic diets in glioblastoma, Misinformation and unproven therapies.
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Shares One definitive ketogenic diet trial in glioblastoma, then stop, Warburg-effect diet claims ('sugar feeds cancer'), Ketogenic diets in glioblastoma, Misinformation and unproven therapies.
- TechnologyFasting and fasting-mimicking diets around chemotherapy
Shares Warburg-effect diet claims ('sugar feeds cancer'), Metabolic therapy: starving the tumour of a nutrient.
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Shares Warburg effect, Warburg-effect diet claims ('sugar feeds cancer').
- TermGlycaemic index and glycaemic load
Shares Warburg-effect diet claims ('sugar feeds cancer'), Ketogenic diets in glioblastoma.
- IdeaRequire a randomised phase 2 before any phase 3
Shares Failures are hidden, Progression-free survival (PFS).
- InstitutionHolden Comprehensive Cancer Center, University of Iowa
Shares Metabolic therapy: starving the tumour of a nutrient, Glioma & glioblastoma.
- PathwayGlutamine addiction
Shares Warburg effect, Metabolic therapy: starving the tumour of a nutrient, Glioma & glioblastoma.