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# Ketogenic diet - The Evidence Ledger

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### [Ketogenic diet](/c/keto)

MechanismESTABLISHEDOutcomeC, some B

Claimed

Starving the body of carbohydrate drops blood glucose and insulin, forces normal cells onto ketones, and leaves glucose-dependent tumors short of fuel.

What holds up

Textbook Warburg-effect biology; reproduced across labs.

What it does not show

Pooled trials show reliable metabolic effect (glucose, insulin, IGF-1) and safety; no RCT has shown survival benefit yet. ERGO2 was feasibility, not efficacy.

Evidence for

Voss et al., ERGO2, Int J Radiat Oncol Biol Phys 2020, Kamali et al., umbrella review of systematic reviews, Integr Cancer Ther 2026, Rieger et al., ERGO pilot, Int J Oncol 2014, Diet2Treat phase II, ClinicalTrials.gov

Sources

PENDING Voss et al., ERGO2, Int J Radiat Oncol Biol Phys 2020. PENDING Kamali et al., umbrella review of systematic reviews, Integr Cancer Ther 2026. PENDING Rieger et al., ERGO pilot, Int J Oncol 2014. PENDING Diet2Treat phase II, ClinicalTrials.gov.

## Grade history (append-only)

Every grade change is kept, never overwritten, so the current grade and every prior one stay visible.

Mechanism gradeJustificationGraded byStateGraded at

ESTABLISHEDTextbook Warburg-effect biology; reproduced across labs.seeddisplayed2026-09-03T21:29:06.014Z

Outcome gradeJustificationGraded byStateGraded at

C, some BPooled trials show reliable metabolic effect (glucose, insulin, IGF-1) and safety; no RCT has shown survival benefit yet. ERGO2 was feasibility, not efficacy.seeddisplayed2026-09-03T21:29:06.014Z

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