In this video, Dr. Patrick Nemechek shares an overview of how he thinks about supporting people undergoing standard cancer treatment. He emphasizes that he supports conventional oncology care—such as chemotherapy, radiation therapy, surgery, hormonal therapies, and immunotherapy (including checkpoint inhibitors)—and describes an additional strategy he refers to as metabolic therapy.
In Dr. Nemechek’s framework, metabolic therapy focuses on how cancer uses fuel for energy and growth, and how altering fuel use may make it harder for cancer cells to grow. He describes this approach as different in character from standard therapies, framing it as creating an “internal” challenge for tumor growth rather than relying on externally toxic effects.
Standard cancer therapies he references (and how they’re often combined)
Dr. Nemechek notes that common elements of standard oncology treatment may include:
- Chemotherapy (he mentions examples such as colon and breast cancers)
- Radiation therapy (he mentions brain and other cancers)
- Surgery
- Hormonal therapies (for example, estrogen or testosterone blockade in hormone-driven cancers)
- Checkpoint inhibitors / immunotherapy, which he describes as helping the immune system recognize and attack abnormal cancer-related features
He also points out that these approaches can be combined in different clinical settings.
Metabolic therapy: targeting tumor fuel use (as described in the video)
Dr. Nemechek explains metabolic therapy as an attempt to interfere with how tumors use fuel—especially blood sugar (glucose)—to support rapid growth. In his description, this approach aims to make it naturally harder for cancer cells to grow by limiting their access to, or ability to use, key fuels.
Glucose demand and cancer metabolism (Dr. Nemechek’s explanation)
In the video, Dr. Nemechek contrasts how normal cells and cancer cells use glucose:
- He describes normal cells as primarily using aerobic respiration to “burn sugar,” which he characterizes as more efficient per glucose molecule.
- He describes cancer cells as using anaerobic glycolysis, which he calls less efficient but faster—supporting rapid division and growth.
He further states that, because of this pattern, cancer cells may require 10 to 20 times the blood sugar compared to a non-cancer cell to divide (as he presents it in the talk). He frames this high glucose appetite as a key practical feature used in clinical imaging.
How this concept relates to PET scans
To illustrate the idea that many tumors have a strong glucose demand, Dr. Nemechek explains the principle behind a PET scan as he describes it: a person is injected intravenously with a radiolabeled sugar (he names fluorodeoxyglucose), and areas of higher uptake “light up” on the scan. In his explanation, tumors concentrate more of this radiolabeled sugar because of their increased glucose demand, while he notes there are also expected areas of normal uptake (such as in the kidneys and bladder).
The two compounds highlighted: DCA and metformin
Dr. Nemechek discusses two compounds he uses in this metabolic-therapy approach:
- Dichloroacetate (DCA)
- Metformin (which he notes is a common prescription medication)
In his description, both compounds are intended to make it harder for a tumor to use glucose and other fuels. He emphasizes DCA as having a particularly strong effect on making it hard for the tumor to burn sugar.
His proposed “blockade and adaptation” sequence
Dr. Nemechek explains that when DCA makes it difficult for a tumor to burn sugar, the cancer may attempt to adapt by routing around this “blockade.” In the pathway he describes, that attempted workaround can trigger apoptosis (cell death). He also describes that tumors may contain varied subpopulations of cells, and that some may shift to using lactate as a fuel source.
In his explanation, metformin is used to interfere with that potential workaround (lactate use), thereby worsening what he characterizes as an “internal starvation” environment for tumors.
Synergy (as he defines it)
Dr. Nemechek states that DCA and metformin can have a synergistic effect when used together—describing this as “1 + 1 = 3” rather than “1 + 1 = 2.” In his view, part of the reason is tumor heterogeneity: cancers are not a single blob of identical cells, and different subpopulations may rely on different fuels or respond differently to metabolic pressure. He suggests that using both agents can affect a broader range of these varying tumor cell populations.
How Dr. Nemechek positions metabolic therapy relative to oncology care
Dr. Nemechek is explicit that he views metabolic therapy as something to add to standard treatment—not a replacement. He also states that, in his clinic, a requirement for receiving this type of support is that a person must be working with an oncologist.
In the video, he also shares his interpretation that DCA and metformin can be combined with other cancer therapies and says that studies show they can make radiation therapy or chemotherapy more effective (as he states it). He describes clinical experiences in which some patients had such a strong response that chemotherapy was stopped early, and he also shares that he has seen people with very advanced cancer do exceptionally well, including individuals who were “near death” and later did well for extended periods while being maintained on metformin and DCA with ongoing oncology follow-up. These are presented as his clinical observations and experience.
Why this approach may not be commonly discussed (his perspective)
Dr. Nemechek comments that this metabolic approach is not often talked about and offers his viewpoint as to why: he suggests it may be because the compounds are inexpensive, there is not a large drug-company promotional push, and oncology culture may be less focused on “blood sugar” approaches.
Educational medical disclaimer
Medical disclaimer: This article summarizes statements and clinical perspectives shared by Dr. Patrick Nemechek in the referenced video and is for educational purposes only. It is not medical advice and is not a substitute for individualized diagnosis or treatment. Cancer treatment decisions should be made with a licensed oncology team; do not start, stop, or combine therapies (including metformin or dichloroacetate) without clinician supervision.
