Liver or kidney: Who has the oar in the gluconeogenesis boat and when?

Abstract

The prevalence of diabetes mellitus is increasing in resource limited settings. Simultaneously, there has been an increase in the number of novel therapies for the management of diabetes mellitus. However, use of novel antidiabetic therapies is limited because of major market access challenges in resource limited settings. Niching products to those patients with the highest absolute risk for major adverse cardiovascular outcomes, and thus most likely to benefit from the therapy, are less likely to have negative budget impact for funders. To improve access, and reduce morbidity and mortality, requires alignment amongst key stakeholders including patient advocacy groups, health care professional councils, national departments of health, the pharmaceutical industry, treasury and finance departments.

Can a Low-Phosphate Diet for Chronic Kidney Disease Treat Cancer? An Interdisciplinary Literature Review

“…As in the ketogenic diet, one of the effects of fasting for treatment of cancer is attributed to dietary glucose deprivation and the Warburg effect [114]. Yet, the compensatory mechanisms of glycogenolysis and gluconeogenesis that maintain serum glucose levels in the ketogenic diet also apply in fasting [111]. Furthermore, evidence in the present interdisciplinary review suggests that reduction of Pi concentrations in the tumor microenvironment through restricted dietary phosphate intake is a mediating factor linking fasting and effective cancer treatments.…”

“…The rationale for the hypothesis that the low-carbohydrate component of the ketogenic diet will reduce tumor size is based on the Warburg effect, which states that tumors are dependent on anaerobic metabolism of glucose [110]. But drastically restricting carbohydrate dietary intake has little effect on serum levels of glucose due to the compensatory release of glucose from glycogenolysis and de novo synthesis of glucose from the breakdown of lactate, glycerol, and glucogenic amino acids in gluconeogenesis, even during fasting [111]. Moreover, consumption of carbohydrates by a very large tumor weighing half a kilogram "would account for only 9.8 g/day, a negligible percentage of the total glucose disposal of the body" [112].…”