| Rank |
Pathway / Axis |
Cancer Cells (↑ / ↓ / ↔) |
Normal Cells (↑ / ↓ / ↔) |
TSF |
Primary Effect |
Notes / Interpretation |
| 1 |
Hepatic ketogenesis → ketone bodies ↑ |
↔ / ↓ viability (model-dependent; often indirect) |
↑ ketone availability |
P/R |
Systemic metabolic re-fueling |
Primary biological “output” is ketone rise; tumor impact depends on tumor’s ketolytic capacity and diet context. |
| 2 |
Insulin / IGF-1 axis |
↓ growth signaling (context-dependent) |
↓ insulin excursions (context-dependent) |
R/G |
Growth-factor tone reduction |
More likely when MCTs displace carbohydrates or support ketogenic dietary patterns; not guaranteed with isocaloric add-on. |
| 3 |
Warburg / glycolysis pressure |
↓ glycolytic dependence advantage (model-dependent) |
↔ / ↓ glucose reliance (context-dependent) |
R/G |
Metabolic stress in glycolysis-addicted tumors |
Some tumors can oxidize ketones/fats; others are more glucose-addicted—expect heterogeneity. |
| 4 |
Epigenetic signaling (βOHB; HDAC-related) |
↔ / ↓ proliferation (model-dependent) |
↔ / adaptive signaling ↑ |
G |
Gene-regulatory adaptation |
Ketone-body signaling effects more plausible in vivo than direct MCFA cytotoxicity; direction depends on baseline stress state. |
| 5 |
ROS |
↔ / ↓ ROS (context-dependent); sometimes ↑ (stress models) |
↔ / ↓ oxidative burden (context-dependent) |
P/R |
Redox tone shift |
Ketone metabolism can change mitochondrial redox state; net direction varies by oxygenation, ETC status, and nutrient context. |
| 6 |
NRF2 |
↔ / ↑ cytoprotection (context-dependent; resistance risk) |
↔ / ↑ protective responses |
G |
Stress-response modulation |
If NRF2 up in tumor, could support survival under therapy; in normal tissues may be protective—highly context-dependent. |
| 7 |
Inflammation (e.g., innate immune / NLRP3) |
↔ (model-dependent) |
↔ (model-dependent) |
R/G |
Inflammatory tone modulation |
Not consistently suppressed with short C8 supplementation in healthy humans; effects depend on dose/diet/background inflammation. |
| 8 |
Clinical Translation Constraint |
GI tolerability limits dose (often GI distress at higher intakes), adherence/diet context confounds, and tumor metabolic heterogeneity limits predictability. |
— |
Adjunct-only practicality |
Many “metabolic therapy” benefits require broader dietary control; adding MCT alone may not replicate ketogenic physiology. |