Abstract
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.
Published Version
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