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Last actualisation May 2007

Brochure for patients

Dear patient,
You have been diagnosed with a cancer disease and you decided to change your diet in compliance with the TKTL1 nutritional therapy in addition to traditional therapies. We encourage you to do so since experience has shown us that it is always positive to be active and to do something for oneself and against the cancer. The present brochure will explain the exact procedure for the change in diet to you. We advise you to quite consistently follow the recommendations and daily plans so that the hoped-for success can be reached. At the beginning, we will explain to you on which observations and discoveries the TKTL1 nutritional therapy according to Dr. Coy is based. For your better understanding, we will describe the relevant metabolic functions, explain which biochemical reactions take place in tumour cells and which chances there are in an interaction of nutrition and conservative treatments such as chemotherapy and radiotherapy. In doing so, we wish to inform you as a patient so that you get the necessary knowledge in order to be able to assess what TKTL1 nutritional therapy means for you. As an informed patient, you can better use scientific advances for you and you are able to make decisions yourself and to act according to them. We would like to be sure to point out that the TKTL1 nutritional therapy does not yet form part of the recommendations of nutritional science. The approach is specifically aimed at the metabolism of aggressive cancer cells or metastases showing TKTL1 enzyme activity. The change in diet can be recommended: - when there are aggressive, invasive tumours with metastases - when the test of a biopsy or tissue sample for the enzyme TKTL1 is positive We will be glad to provide you with a list of laboratories where your tumour can be examined by means of a test for TKTL1 enzyme activity.

Full of hope, we accompany and support you in the fight against cancer. You are not alone, you have a large number of allies! Best wishes for a favourable course of your disease, Your TAVARLIN Team TAVARLIN AG Heidelberger Landstr. 190 64297 Darmstadt Germany Phone: ++49-6151-950 55 50 Fax: ++49-6151-950 55 51

When the diagnosis is cancer what does that mean?


Cancer is a disease that, according to the present level of knowledge, is caused by mutations in genes. These mutations concern genes that control growth and dying off of body cells. Malfunctioning of these mutated genes results in cancer cells growing uncontrollably and no longer dying off. A single mutation, however, is not enough to cause cancer. Mutations in various genes are necessary in order to cause uncontrolled growth. So cancer is not a single-stage process, but a multi-stage process. Uncontrolled growth of cancer cells, however, is not necessarily dangerous to life. Primary tumour At first, the cancer cells growing uncontrollably form a cell cluster that becomes larger and larger and forms the primary tumour. While growing, the primary tumour drives out healthy cells and, so to say, pushes them aside. Some primary tumours keep this growth behaviour and, so to say, grow as encapsulated tumours. This type of primary tumours is not very malignant since it does not decompose the surrounding tissue and does not form daughter colonies (metastases). Invasive Tumours Certain mutations, however, cause these tumours, that grow locally restricted to a certain area, to destroy the surrounding healthy tissue by dissolving the cell-cell contacts of healthy cells (degeneration of the matrix) and by provoking a suicide program in the surrounding healthy cells (programmed cell death - apoptosis). This is how the cancer becomes invasive (it invades healthy tissue) and gets the opportunity to spread fast. Secondary tumour A striking feature of malignant tumours is their metastasising. Individual cells come off the tumour and migrate into neighbouring tissues. They can spread in the entire body through the bloodstream and there again invade other tissues at various places and form secondary tumours. From the medical point of view, the development of invasive, metastasising tumours actually is the serious stage in a cancer disease. These tumours are very dangerous since there is currently no effective therapy against spreading cancer and metastases. 3

As invasive, spreading tumours may develop from some of the non-invasive, not spreading tumours, it is of great importance to detect tumour diseases as early as possible. When a tumour disease is detected early, cancer can be cured very successfully through a treatment such as chemotherapy, radiotherapy or surgical removal of a not spreading tumour.

Not all tumour cells are the same


In 1924 already, German Nobel Prize winner Prof. Dr. Otto Heinrich Warburg found out that certain cancer cells do not gain energy in the normal way this is by glucose burning even if there is enough oxygen for burning. Warburg explained this phenomenon by the fact that the cells power plants (mitochondria) are deactivated. He could not explain, however, why cancer cells change over to fermentation of glucose. Under normal circumstances, our body cells are prepared for burning dextrose (glucose). Decomposition of sugar to water and carbon dioxide for energy production takes place mainly using oxygen and thus constitutes a combustion reaction (in chemical terms oxidation). Fermentation of glucose to lactic acid normally is known as alternate reaction taking place when oxygen supply is insufficient: When you do a lot of sports without being able to place enough oxygen at the muscles disposal through breathing (insufficient training condition), the muscle cell changes over to fermentation. Certain cancer cells, however, carry out fermentation of glucose even when they have enough oxygen at their disposal.

Warburg effect finally cleared up


The discovery of the TKTL1 enzyme by the German cancer researcher Dr. Johannes F. Coy now explained the biomolecular and biochemical fundamentals of the Warburg effect. The enzyme TKTL1 (=transketolase-like 1) allows fermentation of glucose. Through the activation of the TKTL1 enzyme in cancer cells, these cells are able to gain energy out of glucose even if there is not enough oxygen available for burning glucose. That is how 4

energy can be produced without the cells power plants the mitochondria. If the cell has enough glucose at its disposal, the cell is able to produce sufficient energy and to reproduce constantly through cell divisions thanks to the enzyme TKTL1. Large amounts of lactic acid are produced during this process.

What are the tumour cells advantages of gaining energy through fermentation?
The metabolic changes in energy production out of fermentation of glucose provide the cancer cells with selective advantages: The lactic acid (lactate) produced during the fermentation of glucose causes destruction of the surrounding tissue. This allows the tumour cells to invade the surrounding tissue and to metastasise. The deactivation of the mitochondria in cancer cells results in resistances (cells are insensitive) to a large number of chemotherapeutics. The dependence of these cancer cells on oxygen decreases drastically. They survive inadequate supply of oxygen as well (hypoxia). Cancer cells in hypoxic regions (of limited oxygen) become more insensitive to radiation therapy. These changes in the metabolism, however, also have disadvantages for the cancer cells: They depend on the supply of glucose since only glucose can be used as source of energy for fermentation. Fructose (fruit sugar) cannot be used directly for energy production. At the same time, fat burning is interrupted in such cancer cells. In terms of biochemistry, this is called inhibition of oxidation. Therefore, these cells cannot use oils or fats as source of energy any more. The TKTL1 nutritional therapy pursues the strategy of using these disadvantages for combating the cancer cell. The absolute dependence on glucose supply and the inability of exploiting oils or fats constitutes the Achilles heel of this type of cancer cell. The TKTL1 nutritional therapy takes advantage of this Achilles heel for the patients sake. The diet is changed specifically in order to supply healthy cells with sufficient energy, 5

whereas TKTL1-positive cancer cells are isolated from energy supply.

TKTL1 nutritional therapy according to Dr. Coy


The famous Greek physician Hippocrates already said more than 2000 years ago: Let food be thy medicine and let medicine be thy food It has been beyond doubt for a long time now that food plays a very decisive role in preservation of human health on the one hand and in the development of diseases on the other hand. Nutrition scientists, however, are discussing vehemently which diet is the right one for the human being. It becomes clearer and clearer that that there are genetic and biochemical differences between the individuals which result in the fact that one person tolerates well a particular foodstuff, whereas it causes problems for someone else. In addition, a certain type of nutrition may be wholesome during a certain stage, whereas it makes you ill during another stage of life. To be able to better understand such phenomena, you have to know how food and its components (carbohydrates, proteins and fats/oils) are digested in the human body. Thanks to the discovery of the pathway of the TKTL1 sugar metabolism, we can now understand for the first time the particular manner in which sugar (glucose) is dissimilated and digested. This trailblazing discovery forms the basis of the TKTL1 nutritional therapy. The TKTL1 metabolic pathway is not active in every tissue of the human body, but only in very special tissues such as for example in the nerves, the retina and the vascular cells. It there protects these cells against the detrimental effects of excessive glucose concentration. The activation of the TKTL1 sugar metabolism in tumour cells explains for the first time why tumour cells do not burn glucose, but ferment it even if there is actually enough oxygen available for burning. The activation of sugar fermentation allows them to grow, to invade neighbouring healthy tissues and to develop metastases (secondary tumours) even in case of low oxygen concentration. Moreover, these glucose-fermenting tumour cells are resistant to a large number of chemotherapeutics and are more insensitive to radiation therapy. This constitutes a serious problem in the therapy of tumour diseases.

Generally, there are two types of cancer cells: a) cancer cells that burn glucose b) cancer cells that ferment glucose Cancer cells that ferment glucose through the activation of the TKTL1 sugar metabolism instead of burning it need extremely much glucose compared to glucose-burning cells (20 30 times more). In addition, glucose-fermenting cancer cells are generally no longer able to burn fats and oils. The large quantity of required glucose and the inability of extracting energy out of fats or oils make these cancer cells vulnerable. The TKTL1 nutritional therapy is based on the newly discovered specific features of TKTL1-positive cancer cells.

Glucose is a simple sugar and component of double sugars such as table sugar (cane sugar, crystallised sugar, saccharose) and milk sugar (lactose); in addition, glucose also is the basic element of polysaccharides such as starch. Some basic foodstuffs have a high content of carbohydrates such as starch, that release glucose very fast during digestion. These foodstuffs include bread, noodles, rice and potatoes. The glucose released during digestion in the intestine is absorbed through the intestinal mucosa and delivered into the blood very quickly. Since a quick rise in the blood sugar level is very dangerous, the pancreas spills out the hormone insulin. Insulin docks to the cell wall and causes glucose to be actively taken up from the blood into the cells and the blood sugar level thus to be normalised. Insulin prevents the damage involved in excessively high blood sugar levels by means of this mechanism. If, on the contrary, the blood sugar level falls below a certain value, the hormone glucagone is spilled out which releases glucose from the glycogen stores and delivers it into the blood. These mechanisms ensure a relatively constant glucose concentration in the blood. If, however, the glycogen stores are empty, glucose will be made from amino acids, the components of the proteins. Glucose can never be made of oils or fats. This means that it is possible not to eat any carbohydrates or glucose, if you take sufficient quantities of protein. The sufficient supply of proteins ensures a sufficient blood sugar level. A diet 7

only consisting of oils or fats is not possible. This would result in death. In a diet that hardly contains any glucose or glucose-releasing carbohydrates and shows a high content of oils/fats, the glucose present in the food and the quantity of glucose made of protein is enough in order to ensure the necessary blood sugar level. In this case, however, the energy supply of the cells cannot be permanently ensured by glucose. The same situation occurs when a person is deliberately fasting or is starving due to lack of food. A regular supply of foodstuffs is a rather young achievement. During World War II, a large part of the population starved. If the human body was not adapted to such a situation, it would inevitably die. Therefore, the human body is adapted to this situation very well. If the content of glucose or glucose-releasing carbohydrates in the food decreases below a threshold value (approximately 70 g), most of the cells will change over to another supply of energy. In this case, glucose no longer is the cells principal source of energy. To be able to use the stored energy reserves in the form of fat reserves very rich in energy, most of the cells start to exploit ketone bodies, that are then the organisms source of energy. By means of this changeover, the cells are able to live on the decomposition products created in the breakdown of fats. In this case, the cells principal source of energy no longer is glucose, but the ketone bodies. Glucose is used for special purposes only. By the way, the heart always does this. It lives on these ketone bodies even in times of best glucose supply. This explains the fact why it is extremely rarely affected by cancer (heart cancer) and metastases are hardly ever developed there. The changeover to ketone bodies as main source of energy is a process for which the human body is prepared and that even is the normal condition in some tissues. By means of the TKTL1 nutritional therapy, you can gently change your body over to the use of ketone bodies as source of energy. At the same time, you are supplied with sufficient nutrients and sources of energy.

The quick rise in the blood sugar level is avoided; hardly any insulin is released anymore. After the changeover to the TKTL1 nutritional therapy, hardly any insulin is released anymore. That is why blood glucose can no longer be taken up by the tissue cells. Due to the limitation of the glucose supply, they only have the possibility to change over to ketone bodies (metabolic products that are formed during extraction of energy from fat) as source of energy. This changeover is not possible in TKTL1-positive cells since oxidation is blocked there. They cannot change over to burning ketone bodies, fats or oils like healthy cells can do. This is how TKTL1 cells are cut off from glucose supply without release of insulin. Dependence on glucose as sole source of energy constitutes the Achilles heel of this special type of cancer cell. Without energy supply or production, no cell is able to reproduce, not even a cancer cell.

Conclusion:
Even if glucose concentration in the blood remains constant, the glucose supply of the cell can be influenced decisively through a change in diet according to the TKTL1 nutritional therapy. The TKTL1-positive tumour cell is cut off from energy supply.

TKTL1 nutritional therapy may complete chemo- and radiotherapy in an ideal way
Even if a tumour tests positively for TKTL1, there are two different types of tumour cells in the tumour in most cases: TKTL1- positive and TKTL1- negative cells in varying percentage. They differ in their form of energy production. Whereas the burning cells cover their energy requirement through the respiratory chain of the mitochondria, for which they need oxygen, fermenting cells have become completely independent of this metabolism. Therapy strategies against mitochondria (power plants of the cell) or enzymes of the respiratory chain have no effect on these cells.

There is evidence suggesting that TKTL1-positive cells are insensitive to a large number of chemotherapeutic agents. If this is the case, chemotherapy may offer a selective advantage to TKTL1-positive cells. They are better supplied with glucose after the therapy - when TKTL1-positive cells have been combated effectively - and again have more space for spreading out. This is how, in the course of the disease, the ratio between TKTL1-negative and TKTL1positive cells shifts, which might explain why the response rates of chemotherapeutics worsen in the further course and the tumour-free period shortens. The prospects of recovery worsen. Therefore, TKTL1 nutritional therapy should always be applied parallel to chemotherapy if TKTL1-positive cells can be detected in tumour tissue. It is similar with radiotherapy. It is a generally known fact that the effect of radiotherapy is clearly smaller in hypoxic (not adequately supplied with oxygen) and hyperacid tissue. In the TKTL1 metabolic pathway, however, the cancer cell produces large amounts of lactic acid that form a proper acid protection around the tumour. The change in diet according to Dr. Coy de-acidifies the surroundings of the tumour through various mechanisms so that the effectiveness of radiotherapy can also be increased.

Cancer cachexia does the changed metabolic state of TKTL1positive cells explain the phenomenon of cancer cachexia?
The term of cancer cachexia describes the severe loss of weight and the emaciation of the body due to a cancer disease. In Germany for example, more than 20% of the patients do not die of the tumour itself, but from the emaciation accompanying the tumour disease. As we see it, there are two reasons for it: Cancer therapy often is associated with loss of appetite, disorders of the liver function and vomiting. As a rule, this results in a drastic loss of weight. The changed metabolic state, however, can also play a very decisive role. TKTL1positive cells take up 20-30 times more glucose than healthy cells. This is how they ensure that they get the energy they need, and the healthy cells do not get enough of it. Since the tumour does not burn the glucose using oxygen, but produces lactic acid in the fermentation process, the tumour patient permanently has to transform the lactic acid produced by the tumour cells into glucose in the liver, which requires a consider10

able amount of energy. This is a considerable strain on a cancer patients body. In addition, many patients develop a dislike for meat and fat, but a craving for sweets and carbohydrates which exactly corresponds to the needs of the cancer cells. The sugar and carbohydrates supplied, however, no longer are of benefit to the organism, since the glucose absorption of the TKTL1-positive cancer cells is 20-30 times higher than the one of healthy cells. At the end, so much energy is consumed that it is possible that the cancer patient dies of starvation or of the consequences of the changed metabolism (e.g. hyperacidity). The TAVARLIN assortment contains foodstuffs rich in energy that cannot be used by TKTL1-positive cells. This energy will then be at the disposal of the healthy cells and may prevent the threatening loss of weight.

Cancer and sport:


Scientists have been aware of the influence of exercise on the development as well as on the course of cancer diseases for a long time. Already 20 years ago, specific studies confirmed that persons doing a lot of sports had a reduced risk of dying of the cancer disease. In the meantime, a large number of epidemiologic studies have been published that confirm the connection between physical activity and cancer. At the end of 2002, the American Journal of Nutrition gave a review of 170 relevant studies all of which showed a decrease of the cancer risk in persons doing a lot of sports. The discovery of the TKTL1 metabolism gives a conclusive explanation for this fact as well. By doing sports, more glucose is consumed and the glycogen stores are emptied. At the same time, the blood sugar level remains low, the metabolism is stimulated, less insulin is used for the metabolisation of the carbohydrates taken in. So, in terms of biochemistry, sport has an effect similar to the effect of a change in diet according to the TKTL1 nutritional therapy. And so, sport and TKTL1 nutritional therapy complement one another in an ideal way and we can only encourage you to do sports if your disease allows you to do so. Your exercise should focus on steady endurance training and you should avoid short-term strain. Cycling, rowing and walking as well as long walks and much more are suitable.

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The TAVARLIN food assortment


The TAVARLIN food assortment contains functional foodstuffs that are suitable for carrying out a TKTL1 nutritional therapy. These foodstuffs have been developed specifically to meet the requirements of the TKTL1 nutritional therapy. They make it possible for you to comfortably carry out the therapy and ensure at the same time that the organism is sufficiently supplied with energy, vitamins and trace elements. It is very important that in particular the TAVARLIN oils and the lactate drink contain components that have an inhibiting effect on the TKTL1 sugar metabolism. Mouse experiments at the University of Wrzburg (Germany) showed that the change in diet according to Dr. Coy inhibits TKTL1-positive human cancer cells. Details on the products We would like to present the products to you in four categories according to their role in the change in diet according to Dr. Coy: A) Products that inhibit the TKTL1 metabolism

Two mixtures of vegetable oil: TAVARLIN Oil basis and TAVARLIN Oil addition. Both vegetable oils are selected mixtures of vegetable oils and extracts of vegetable oils that are specifically adapted to the TKTL1 metabolism. They contain bioactive substances and a high content of omega-3 fatty acids. There is more and more evidence indicating that they have a life-prolonging effect for some types of tumours. Both vegetable oil mixtures are high in energy and permit the supply energy to healthy cells without TKTL1-positive tumour cells where fat burning is blocked being able to use these oils for their energy supply. Both oils are intended for use for cold dishes and must not be heated. TAVARLIN Oil basis is particularly suitable for salad dressings, TAVARLIN Oil addition can also be stirred e.g. into curd. It is also important to consume fermented dairy products having a low content of milk sugar and a high oil/fat content. The assortment includes a TAVARLIN lactate drink made of yoghurt, selected vegetable oils and cream. This drink is intended as snack between meals. Lactic-acid bacteria are added to the milk in order to produce fermented dairy products such as yoghurt. In the TAVARLIN Lactate Drink, the bacteria have used nearly all the milk sugar, also 12

called lactose, and transformed it into lactic acid (lactate). Therefore the remaining content of carbohydrates is very low in contrast to traditional yoghurt where the fermentation process is interrupted earlier for reasons of taste. Especially fruit yoghurts are sweetened additionally using sugar and often contain more than 10 g carbohydrates/100 g. The high content of dextrorotatory lactic acid in the TAVARLIN Lactate Drink has been used successfully for a rather long period in biological cancer defence for de-acidifying the tissue (RMS drops) and presumably leads to end-product inhibition of the TKTL1 metabolism. B) Guaranteeing the energy metabolism of the healthy cells

High-quality TAVARLIN protein powder serves as source of essential amino acids and additional source of energy. It prevents the transformation of the bodys own amino acids into glucose in case of a diet low in carbohydrates. C) Products high in omega-3 fatty acids and low in carbohydrates The TAVARLIN Protein Bread is a wholemeal sourdough bread where a part of the glucose-releasing starch has already been decomposed to lactic acid thanks to bacterial fermentation of starch. The flour content of the protein bread has been clearly reduced by adding rice flakes, bran and milk protein and the protein content has been increased considerably. In addition, the protein bread is very rich in dietary fibres. 100 g of the protein bread only contain 14.1 g carbohydrates, that is only approximately a third of the quantity of carbohydrates contained in a traditional wholemeal bread. In addition, 2.2 g omega-3 fatty acids are contained. TAVARLIN hemp nuts are included in shelled form. They are used for additionally increasing the oil content in the daily food intake. They, too, contain an ideal combination of omega-3 fatty acids that are very important in terms of nutritional physiology as well as all eight essential amino acids which the human body cannot produce itself and therefore have to be supplied through food. The body can use these elements for example to produce immunoglobulins that are indispensable to defence against infections.

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Meat and sausage: Feeding and way of life of livestock have great influence on quality, composition and taste of the meat. The content of omega-3 fatty acids is considerably higher in free-range animals not fed with grain than in other animals. If you have the opportunity, always buy high-quality meat from free-range animals as often as possible. We offer TAVARLIN salami and sausage made of the meat of buffaloes from the Swabian Mountains. The meat of the buffaloes from the Swabian Mountains excels by a pleasant, discreet gamey taste, contains 40% less cholesterol and 27% less fat than beef, has a high content of protein and vitamins (rich in vitamin A and B12) and is high in omega-3 fatty acids. The high-quality buffalo meat has been processed into salami and sausage without addition of sugar or glutamate. Caution! For reasons of taste, traditional sorts of salami contain large quantities of added sugar (10-15%). Sugar is added to many sorts of sausages and cold cuts as well in order to drown the taste of the table salt added for reasons of preservation. By eating these sausages, you would consume hidden sugar and put the success of the TKTL1 nutritional therapy at risk. D) Complementary products

Basic foodstuffs naturally high in carbohydrates such as noodles as well as foodstuffs of taste appeal such as cake, jam and sweets have been produced using far less carbohydrates or using sugar substitutes. TAVARLIN protein noodles contain considerably less flour than traditional noodles. They mainly consist of whey and soybean protein as well as wheat gluten and dietary fibres. They only have 21 g carbohydrates / 100 g instead of 75 g carbohydrates / 100 g of usual noodles.

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The TAVARLIN nutritional approach in catchwords:


Strongly limited supply of glucose and carbohydrates (= diet with approx. 60 - 70 g carbohydrates per day) Diet rich in oils and proteins including a new combination of vegetable oils and proteins Use of specifically developed foodstuffs containing valuable vegetable oils, polyunsaturated fatty acids and proteins Supply of foodstuffs of low glycemic index that only cause a slight rise in the blood sugar and reduced insulin release. Grape or cane sugar has been replaced by other sugars or sweeteners. Five meals a day, including two snacks in the form of a lactate drink Use of dairy products strongly fermented by lactic acid Consumption of high-quality meat produced from grazing animals not receiving grains. Completion of the foodstuffs offered in the nutritional approach through fresh foodstuffs that can be chosen freely from a list of allowed products (green, yellow, orange list)

Caution!
Please only use the products included in the TAVARLIN assortment and do not buy alternative products in the supermarket. The daily plans are designed in a way so that the allowed maximum supply of carbohydrates is achieved using the TAVARLIN products only. The consumption of other basic food (bread and noodles) and sweets (jam, chocolate, cake, chocolate hazelnut spread) would quickly exceed the daily allowed amount of carbohydrates by far and the change in diet would miss its goals and compromise the therapy.

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Further dietary recommendations for your everyday life


TAVARLIN oils are intended for cold dishes. We recommend high-quality rapeseed oil for frying. You can use butter or diet margarine (without hardened trans fats) as spread. Vegetables and lettuce ideally complete fish and meat in the TKTL1 nutritional therapy. However, please only use the foodstuffs listed in the Green list. Of course, fruit is rich in vitamins and tasty, but it has to be considered critically on account of the usually high contents of glucose and fructose. Several sorts of fruit are listed in the Yellow and orange list. They are stated with indications of quantity. Please only use the sorts of fruit included in this list and only up to the maximum quantity and when stated in the daily plan. Please leave canned fruit in the shelf since they always contain added sugar. Bananas, dates, figs, kaki, raisins and sultanas are a no-no. Please abstain from dried fruit since sugar is contained in concentrated form here (see Red list)

Recommendations on fluid supply


Try to drink about two litres of fluid a day. Prefer water, herbal infusions or green tea (unsweetened or with sweetener). Please do not add milk to your coffee (because of the milk sugar contained), but use cream! If you prefer fruit juices mixed with water, please make sure to use a mixing ratio of 1:10 (1 part of juice and 9 parts of water) so that you do not take in too much sugar. If you use juice, please do not use any fruit drinks, but only 100 % pure fruit juices. Soft drinks rich in sugar such as coke and fizzy drinks are completely unsuited. You should do without beer as well. You may have a glass of diet beer (< 1 g KH / 100 ml) that you can round off by adding a small dash of sugar-free juices. Red wine (dry) has to be judged positively on account of the secondary plant substances having a cell-protecting effect and is included in the diet plan.

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On account of the energy content, milk and milkshakes are already not considered to be drinks, but foodstuffs, and have to be avoided because of the (milk) sugar contained.

The TAVARLIN diet plan for TKTL1 nutritional therapy


The diet plan covers a period of two weeks. Five meals a day are planned. Lunch and dinner may be interchanged. You will find in all four colour codes in the daily plans. These codes have the following meaning: Green: The foodstuffs marked in green can be used in TKTL1 nutritional therapy and are considered to be harmless. They can be replaced by other foodstuffs included in the Green list as you like. These foodstuffs are not limited in quantity (exception: you will find indications of quantity in the list for nuts!). You can use these foodstuffs for eating your fill and enjoying. Edged in red: The foodstuffs edged in red are foodstuffs that imperatively have to be consumed in the context of the nutritional therapy. These are usually TAVARLIN products fulfilling a special function regarding the TKTL1 metabolism. A red edge marks for example the foodstuffs TAVARLIN Oil basis and curd. This combination is important for guaranteeing the supply with TAVARLIN Oil basis. Yellow/orange: The yellow and orange lists include sorts of fruit and vegetables that may be used in limited quantities during the diet. Fruit/vegetables included in the orange list should only be eaten when stated in the daily plan. Reason: These foodstuffs cause an elevated release of glucose / insulin than the foodstuffs included in the yellow list. Light blue: All foodstuffs having a light blue background are included in the TAVARLIN food assortment. Protein noodles, sausage, cocoa biscuits, cocoa spread and strawberry jam are not edged. These foodstuffs are not absolutely necessary for the success of the nutritional therapy. We offer these foodstuffs since they highly simplify the realisation of the nutritional therapy. Experience gained up to now shows that it is difficult for a large number of persons affected to do without e. g. noodles.

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Regarding the TAVARLIN products, please stick to the quantities indicated in the daily plans. These products partly contain carbohydrates, that are, however, clearly reduced compared to normally available foodstuffs. When larger quantities are eaten (e.g. four slices of bread instead of two), however, you run the risk of exceeding the daily quantity of carbohydrates allowed. The same applies to the protein noodles.

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Green list
Meat Beef Veal Lamb Pork
Sausages and cold cuts

Fish Eel Trout Shark Halibut Herring** Cod Carp Wild salmon** Ocean perch Sardine Haddock Plaice Swordfish Sole Tuna** Zander Crustaceans Shrimp Lobster Crayfish Mollusks Oysters Mussels

Vegetables Cauliflower Green beans Broccoli Aubergines Sauerkraut Fennel Slicing cucumber Kale Red cabbage White cabbage Savoy cabbage Kohlrabi Cress Celery Pumpkin Leek Chard Parsley Red radishes Brussels sprouts Olives Asparagus Spinach Tomatoes Chicory Onions Lentils Avocado Garlic Black salsify

Lettuce Endive Butterhead lettuce Lambs lettuce Iceberg lettuce Watercress

Dairy products Cream Curd Sour cream Buttermilk Eggs Hens egg Fats + oils

Chinese cabbage Chicory Romaine lettuce Rocket Mushrooms Meadow mushrooms Chanterelles Ceps Shiitake Nuts + seeds No restriction: Linseed Poppy seed Sesame

Raw ham Cooked ham Salami* Poultry Duck Goose Chicken Ostrich meat Turkey Game Hare Deer meat Rabbit Venison Wild boar

Traditional style sausage Mackerel**

Butter Linseed oil Rapeseed oil Hempseed oil Animal fat Cheese Full-fat cheese Camembert Edam /Gouda Emmental Parmesan

Portion corresp. to Roquefort 5g carbohydrates: Hard cheese 50 g peanuts 140 g Brazil nuts 60 g pine nuts 45 g hazelnuts 100 g coconut 120 g almonds 45 g walnuts 35 g macadamia Hand cheese Goats cheese Sheeps cheese Mascarpone Miscellaneous
Stevia, steviol glyc.

Squid, unbreaded Courgettes

Tofu

* Be careful with sausages and cold cuts: For prolonging the shelf life, they are often salted and then sugared in order to improve the taste. ** Foodstuffs marked with two asterisks are particularly valuable and should be preferred to the other foodstuffs of the group, if possible.

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Yellow list (raw, unsugared products!)


Name Portion containing 5 g carbohydrates 80 g 55 g 90 g 65 g 60 g 100 g

Strawberries Bilberries Raspberries Redcurrants Gooseberries Cranberries

The products included in the yellow list can be consumed in addition from time to time in the corresponding quantities, if you leave out carbohydrates/sugar stated elsewhere in the daily plan.

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Orange list (raw, unsugared products!)


Name Portion containing 5 g carbohydrates 80 g 30 g 45 g 80 g 85 g 60 g 35 g 200 g 60 g 85 g 45 g 55 g 40 g 45 g 55 g 50 g Be careful: Foodstuffs included in the orange list should only be eaten, when stated in the Honeydew melons Grapes Kiwi Ananas Beetroot, cooked Water melon Mango Papaya Grapefruit Carrots, raw Mandarins Peaches Apples Plums Apricots Oranges daily plan. The quantities indicated must not be exceeded in a meal.

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Red list
Amaranth Maize Drinks Alcohol (exception 1 glass of red wine) Beer Vegetable juices Pomegranate Liqueur Fruit juices, undiluted Spirits Milk

Bananas

Jam and marmelade

Beans, white Prezels Rolls Bread Buckwheat Crisps Dates

Farinaceous food Noodles Quinoa Rice Raisins Salt sticks, biscuits Chocolate Breadcrumbs (breadcrumb coating!) Syrup Sauces, thickened Soups, thickened Sweets Tortilla Dry fruits White bread Sugar

Peas

Figs Ready-to-serve meals Biscuits and pastry Cereal products Pomegranate Honey Potatoes Chickpeas Cake

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Day 1
Breakfast 125 g curd 4 tsp. TAVARLIN Oil basis dill 80g smoked salmon Snack TAVARLIN Lunch rib of pork sauerkraut 50 -100 g TAVARLIN nut cake

Day 2
Breakfast coffee / green tea 50-100g TAVARLIN nut cake

Day 3
Breakfast 125 g curd

Day 4
Breakfast 100 g TAVARLIN protein bread

Day 5
Breakfast 125 g curd 1 tbsp. TAVARLIN hemp nuts 4 tsp. TAVARLIN Oil basis fruit,vege fruit,vege -tables Snack

4 tsp. TAVARLIN 100 g TAVARLIN Oil basis 50 g sour cream chives, red radishes slicing cucumber Snack

buffalo sausage egg

-tables

Snack TAVARLIN Lunch salmon steak broccoli

Snack TAVARLIN Lunch (marinated) roast red cabbage 70 g TAVARLIN protein noodles beef Lactate drink

TAVARLIN Lunch

TAVARLIN Lactate drink Lunch lamb (pork) loin green beans

Lactate drink

Lactate drink

Lactate drink

beef goulash broccoli 50 -100 g TAVARLIN nut cake

bacon

Snack TAVARLIN Dinner 100 g TAVARLIN protein bread butter 2 eggs, slicing cucumber 70 g blue cheese

Snack TAVARLIN Dinner 125 g curd 1 tbsp. TAVARLIN hemp nuts 4 tsp. TAVARLIN Oil basis 1 tbsp. peanuts

Snack TAVARLIN Dinner 100 g TAVARLIN protein bread buffalo sausage 1 egg 1 tomato

Snack TAVARLIN Lactate drink Dinner 125 g curd Oil basis TAVARLIN Lactate drink Dinner fried goats cheese tomatoes

Lactate drink

Lactate drink

Lactate drink

100 g TAVARLIN 4 tsp. TAVARLIN

80 g smoked salmon chillis dill

1 glass of red wine 1 glass of red wine 1 glass of red wine 1 glass of red wine

1 glass of red wine

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Day 6
Breakfast 50 g TAVARLIN protein bread

Day 7
Breakfast 125 g curd 4 tsp. TAVARLIN Oil basis

Day 8
Breakfast coffee / green tea
50 - 100 g TAVARLIN nut cake

Day 9
Breakfast 125 g curd 4 tsp. TAVARLIN Oil basis Fruit, Fruit, vegetables vegetables

Day 10
Breakfast 50 g TAVARLIN protein bread

butter

butter

2 tsp. TAVARLIN cocoa spread

1 tbsp. TAVARLIN

2 tsp. TAVARLIN strawberry jam 50 g TAVARLIN buffalo salami

hemp nuts

Snack
TAVARLIN

Snack
TAVARLIN

Snack
TAVARLIN

Snack
TAVARLIN

Snack
TAVARLIN

Lacate drink Lunch


rump steak spinach 70 g TAVARLIN protein noodles 50 - 100 g

Lactate drink Lunch


sole fillet green salad

Lactate drink Lunch


unbreaded cutlet mushrooms

Lactate drink Lunch


pork goulash broccoli 50-100 g TAVARLIN

Lactate drink Lunch


rump steak green salad

rocket salad slicing cucumber,

lettuce

nut cake

Rocket salad

TAVARLIN nut cake tomato 50 - 100 g TAVARLIN nut cake

courgettes

mushrooms 50 - 100 g TAVARLIN nut cake

Snack
TAVARLIN

Snack Lactate TAVARLIN drink Dinner


100 g TAVARLIN

Snack Lactate TAVARLIN drink Dinner

Snack Lactate TAVARLIN drink Dinner


100 g TAVARLIN

Snack Lactate TAVARLIN drink Dinner Lactate

drink Dinner

125 g curd 4 tsp. TAVARLIN Oil basis

protein bread

125 g curd 4 tsp. TAVARLIN Oil

protein bread

125 g curd 4 tsp. TAVARLIN Oil

butter 50gTAVARLIN

basis 1 tbsp. TAVARLIN


hemp nuts

butter 2 tsp. TAVARLIN cocoa spread 50 g TAVARLIN

basis 1 tbsp. TAVARLIN hemp nuts

80 g smoked salmon buffalo salami slicing cucumber dill 1 egg

fried shrimps

buffalo salami

fried shrimps

1 glass of red wine 1 glass of red wine

1 glass of red wine

1 glass of red wine

1 glass of red wine

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Day 11
Breakfast

Day 12
Breakfast
100 g TAVARLIN

Day 13
Breakfast

Day 14
Breakfast
50 g TAVARLIN protein

125 g curd 1 tbsp. TAVARLIN hemp nuts

protein bread

125 g curd 4 tsp. TAVARLIN oil

bread

butter

basis 1 tbsp. TAVARLIN hemp nuts

butter 2 tsp. TAVARLIN strawberry jam 50 - 100 g TAVARLIN

4 tsp. TAVARLIN oil 50 g buffalo basis TAVARLIN salami slicing cucumber, tomato

half of an avocado

nut cake

Snack Lactate drink Lunch


lamb (pork) loin green beans

Snack Lactate drink Lunch


salmon steak broccoli 70 g TAVARLIN

Snack Lactate drink Lunch


duck breast green salad

Snack Lactate drink Lunch


beef tenderloin green salad

Bacon

protein noodles

rocket, chanterelles

rocket salad

50 100 g TAVARLIN 50 - 100 g nut cake TAVARLINnut cake

fruit
50 - 100 g

fruit

mushrooms, tomatoes

TAVARLINnut cake

Snack
TAVARLIN Lactate TAVARLIN Lactate

Snack
TAVARLIN Lactate

Snack
TAVARLIN Lactate

drink Dinner

drink Dinner

drink Dinner
100 g TAVARLIN

drink Dinner

herrings in brine 100 g TAVARLIN protein bread

125 g curd 4 tsp. TAVARLIN Oil basis 1 tbsp. TAVARLIN

protein bread

125 g curd 4 tsp. TAVARLIN Oil

butter TAVARLIN cocoa spread TAVARLIN buffalo

basis

butter

hemp nuts

dill

fried shrimps

salami

80 g smoked salmon

1 glass of red wine

1 glass of red wine

1 glass of red wine

1 glass of red wine

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Preparation of the snack

Ingredients:
cup of TAVARLIN Lactate Drink 2.5 tsp. TAVARLIN protein powder ( = 10 g) 2 tsp. TAVARLIN Oil addition (= 8 g) Each snack is made up of the ingredients mentioned above. The lactate drink forms the basis. Ideally, you pour it into a measuring cup or shaker of a capacity of at least 500 ml so that you can easily add the other ingredients, the protein powder as well as the oil using a hand blender or immersion blender. We recommend using an immersion blender since shaking alone will not result in an ideal consistency and creaminess. Patients who have already lost a considerable amount of body weight may use 3.5 tsp. of protein powder for each snack for regaining weight. You can also add allowed fruit and vegetables in order to improve the taste.

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Preparation of the nut cake Ingredients:


TAVARLIN Nut Cake Mix 6 eggs 150 g butter 100 ml cream 100 g TAVARLIN hemp nuts, shelled Put the cake mix into a large bowl and add one after the other butter, eggs, cream and hemp nuts. The butter should have room temperature so that it can be mixed well. Mix all ingredients well using a mixer. Slightly grease a baking tin and dredge it with nut flour, fill the mixed dough in it. A springform would be ideal. Bake the cake in the preheated convection oven for approx. 40 min. at 175C. The finished cake weighs approx. 700 g. We recommend you freeze the cake in portions so that you have a fresh piece of cake every day. We included nine portions in the daily plans. 100 g of cake contain not more than 3.0 g carbohydrates. You can also round off the cake by adding a mixture of mascarpone and cream and some raspberries.

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Questions and answers on the TKTL1 nutritional therapy


1. When does it make sense to change my diet according to Dr. Coy's TKTL1 therapy? We recommend a consistent change in diet (60 to 70 g carbohydrates / day) in case of clinical findings of an aggressive, invasive tumour or metastases. The same applies to TKTL1 test results of tissue samples or biopsies and as accompanying therapy in addition to scheduled chemotherapies or radiotherapies. In this case, a reduced formation of lactic acid in the tumour tissue may improve the baseline situation for the therapy. 2. How long does this nutritional approach have to be followed? There is no general answer to this question. At first, a period of three months is considered to be a guiding value. Ideally, the application period of the strict nutritional therapy is made conditional on the development of the tumour. After three months, we recommend you continue to stick to a diet moderately low in carbohydrates and use the core products (oils and lactate drink). Depending on the clinical course, we recommend you stick again to the strict nutritional therapy of approximately 60-70 g carbohydrates per day. 3. What happens when the diet is interruped? An interruption does not mean that the success is put at risk automatically. It is important, however, that the recommendations are then stuck to very consistently again. A permanent interruption and the regular consumption of not allowed foodstuffs will surely not result in success. 4. What happens in case of not allowed excess intake of carbohydrates / sugars? An excessive quantity of sugar supplies the tumour with the energy required to continue to grow. The so-called PET procedure for the detection of aggressively fermenting tumours shows that sugar and/or carbohydrates taken in accumulate in tumour cells. This phenomenon can be visualised by marking the sugar taken in.

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5. How can the patient check that the approach is applied correctly and/or the allowed quantities of sugar are not exceeded? The safest approach consists in sticking consistently to the quantities stated in the recipes and only replacing foodstuffs by other foodstuffs the content of carbohydrates of which is identical or lower. According to our assessment, it is better to follow the TKTL1 nutritional approach very consistently for a rather short period of time than less consistently for a long period of time. When your body uses fats and no longer carbohydrates to produce the main part of its required energy, products of fat breakdown (ketone bodies) can be detected both in the blood circulation and in the urine. 6. Are the costs refundable, does a health insurance bear the costs? Currently, the costs are not refundable yet. 7. Are there already data available regarding a prolonged survival time for patients suffering from cancer? There are more and more progress reports stating a positive effect of the nutritional therapy according to Dr. Coy. 8. Are there different effects of food in case of different forms of cancer? Approx. 30 different tumours have been tested for TKTL1 activity and the TKTL1 fermentative metabolism has been identified in all of them. It does not seem to be a phenomenon that occurs in some types of cancer only, but a general phenomenon Not every tumour of a type of cancer, however, has the TKTL1 metabolism. Therefore, Coy's nutritional therapy does only make sense when TKTL1-positive tumour cells have been detected. These are the only cell forms to ferment glucose, and the burning of fatty acids is deactivated in these cells. If no TKTL1-positive cells are detected in the tumour, a therapeutic effect of Coys diet cannot be expected.

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9. Have clinical studies been carried out? There is a large number of progress reports stating positive results associated with this diet. Even if the positive results are documented by physicians, they do not constitute clinical studies. Clinical studies require standardised and controlled conditions for proving efficacy in a sufficiently large number of patients including a control group. It is only then that therapies obtain the status scientifically established. These studies are starting in several clinics so that the first results are expected for the near future. 10. What happens in and with the body when the diet is changed to the TAVARLIN approach? When the diet is changed from a mixed diet rich in carbohydrates to a diet low in sugar, the body may react with indisposition. You might have symptoms such as circulatory disorders, lack of concentration, tiredness, constipation or headache during the first days. These signs, however, generally disappear when the TAVARLIN nutritional therapy is continued. After their organism has successfully changed over to ketone bodies as source of energy, most of the persons concerned report that they feel very good physically. 11. Is the approach suitable for vegetarians as well? It is more difficult for vegetarians to perform Coys nutritional therapy. Since one of the main nutrient groups (carbohydrates) is already strongly limited here, doing without animal products would also clearly restrict the possibilities of protein intake. Since the change in diet aims at an increased consumption of meat and fish we advise the persons concerned to at least eat regularly fish if possible. 12. What do I have to bear in mind in case of existing allergies and food incompatibilities? The TKTL1 nutritional therapy does not require a stricter compliance with existing allergies and incompatibilities than required in a usual diet. 13. Which drinks are allowed? Mineral water, coffee and tea and infusions without sugar are allowed. Fruit juices mixed with water may be drunk in a mixing ratio of nine parts of water and one part of fruit juice (100 % fruit juices only). Red wine is even recommended on account of the 30

bioactive substances in the grapes and is an element of the daily plans. A glass of diet beer of < 1 g KH / 100 ml is possible as well. 14. Are fruit juices and fizzy drinks containing sugar allowed? Drinks containing sugar and pure fruit juices should be avoided. For giving some flavour to mineral water, a mixing ratio of fruit juice and water of 1 plus 9 is possible. 15. Are sweets strictly forbidden? Conventional sweets no matter whether bought in the supermarket or the health food store are absolutely forbidden. The food package contains cocoa biscuits, a cocoa spread and strawberry jam, which you may eat. When eating these sweets, please stick to the quantities indicated in the daily plans. These quantities are calculated in a way so that not more than 70 g of carbohydrates are taken in daily. 16. Is the supply with vitamins and minerals secured in the low-carbohydrate diet? If you stick to the given diet plans, the supply will be secured. These plans have been examined regarding the content of all essential nutrients, vitamins and minerals. 17. What effect does sport have on the diet? Sport may contribute much to the success of the nutritional therapy. Carbohydrates taken in can be dissimilated faster through sports and glycogen stores can be emptied. This is how regular sport may maintain glucose concentration in the body at a low level, reduce the insulin requirement and so support Coys nutritional approach. It has been shown generally that sport has positive effects on the immune system and has a positive effect on the course of the disease in cancer patients. 18. Is it absolutely necessary to consume the lactate drinks as snacks? Yes, they are an essential element of Coys diet since lactate is of particular significance in the therapy. In addition, cancer patients have to prevent the imminent risk of losing weight. Therefore, the snack also is of great importance regarding the sufficient supply of nutrients. The lactate drink is enriched with cream and oils and so is rich in calories. In addition, essential amino acids that are essential for a smooth metabolic function are supplied through the TAVARLIN protein powder. 31

19. Is it absolutely required to eat the warm main meal at lunchtime? The main meal can be eaten in the evening as well. It is also possible to eat another warm meal in the evening. 20. What may I eat when I am out or at work? Restaurants offer a large number of dishes that can be eaten within the scope of the TKTL1 nutritional therapy. Salad/vegetables with fish or meat are particularly suitable. 21. Do I have to take additional vitamin preparations? Generally, we recommend no isolated intake of large-dose vitamin preparations since vitamin C, E and B1 may have unfavourable effects on the TKTL1 metabolism.

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