Fig. 5.

Relationship of circulating levels of glucose and ketones (β-hydroxybutyrate) to tumor management. The glucose and ketone values are within normal physiological ranges under fasting conditions in humans and will produce anti-angiogenic, anti-inflammatory and pro-apoptotic effects. We refer to this state as the zone of metabolic management. Metabolic stress will be greater in tumor cells than in normal cells when the whole body enters the metabolic zone. The values for blood glucose in mg/dl can be estimated by multiplying the mM values by 18. The glucose and ketone levels predicted for tumor management in human cancer patients are 3.1–3.8mM (55–65mg/dl) and 2.5–7.0mM, respectively. These ketone levels are well below the levels associated with ketoacidosis (blood ketone values greater than 15 mmol). Elevated ketones will protect the brain from hypoglycemia. Modified from a previous version (241).