One patient's three-year evidence-based journey — combining standard of care with metabolic strategy, targeted supplementation, lifestyle and an unshakeable refusal to accept the median as a personal destiny.
If you are reading this, you have probably just received one of the most frightening diagnoses in medicine. You may have been given statistics. You may have been told about median survival. You may be sitting with a number in your head that feels like a sentence.
I want to tell you something important: the median is not your destiny. It is a statistical average across an enormously varied population of patients with different tumour biology, different fitness levels, different treatment responses, and — crucially — different levels of engagement with everything available to them beyond standard treatment.
I was diagnosed with glioblastoma in April 2023. The first signs were calf cramps and visible muscle spasms in October 2022, followed by a grand mal seizure in March 2023. I am writing this in October 2026 — over three years later, post-recurrence, post-second maximal resection, having completed twelve cycles of adjuvant chemotherapy in July 2026, with a clear scan on 23 September 2026, and currently on holiday.
This document is what I wish someone had handed me on the day I was diagnosed. Not false hope. Not miracle cures. But a coherent, evidence-grounded framework for giving yourself the best possible chance — built around the science of how glioblastoma actually works, and how to attack it from every available angle simultaneously.
I have left no stone unturned. You shouldn't either.
Glioblastoma (GBM) is a Grade IV primary brain tumour. It is the most aggressive form of brain cancer, and the statistics — a median survival of around 14 months with standard treatment — are genuinely difficult to read. It is important to understand them honestly.
But understanding the statistics also means understanding what drives them — and therefore where the opportunities to improve on them lie.
GBM cells are heavily dependent on glucose for energy — far more so than normal brain cells. This metabolic vulnerability is one of the most important targets available to patients.
Approximately 40% of GBM patients have a methylated MGMT promoter. This means chemotherapy (TMZ) works more effectively in their tumour. Ask your oncologist about your MGMT status — it is the single most important biomarker for your treatment response.
GBM actively suppresses the immune system's ability to recognise and attack it. Supporting immune surveillance is therefore a meaningful therapeutic target alongside standard treatment.
GBM frequently develops resistance to TMZ chemotherapy over time. Understanding and pre-empting resistance mechanisms is a key strategic priority.
This document was written by a patient with MGMT-hypermethylated GBM (exact percentage to be confirmed), and several elements of the protocol — particularly the cannabinoid evidence — have the strongest clinical evidence specifically in methylated patients. It would be easy for someone with unmethylated status to read this and feel the protocol is less relevant to them. That would be the wrong conclusion.
The vast majority of this protocol applies equally and powerfully regardless of MGMT status. The metabolic strategy — very low carb diet, intermittent fasting, GKI optimisation — targets the Warburg Effect which is present in all GBM regardless of methylation. The cannabinoids target CB1, CB2, GPR55 and TRPV1 receptors that are overexpressed in all GBM. The anti-inflammatory stack, the immune surveillance support, the exercise, the mindset, the repurposed drugs targeting angiogenesis and senescence — none of these are methylation-dependent.
For unmethylated patients, the honest picture is that TMZ is less effective as a standalone treatment — which makes every other element of this protocol more important, not less. The metabolic pressure, the cannabinoid apoptosis, the immune support, and the strategic reserve of mebendazole as a radiosensitiser all carry greater relative weight when chemotherapy alone is less reliable. Unmethylated status changes the emphasis within the protocol — it does not diminish its relevance.
There are also emerging treatments — immunotherapy, personalised neoantigen vaccines, and novel TMZ-sensitising combinations — that are showing particular promise specifically in unmethylated patients. The research landscape is moving. Do not read a biomarker result as a verdict. Read it as information that shapes your strategy.
The most important thing to understand is that GBM has multiple vulnerabilities — metabolic, inflammatory, angiogenic, immunological. Standard treatment targets some of them. An informed patient can target all of them simultaneously.
Context matters. Here is the honest account of what happened and what decisions were made at each stage.
This section comes before the science deliberately. Because without the right mindset, none of the rest of it is sustainable.
There are no guarantees with GBM. The goal is not to guarantee survival — it is to ensure that whatever happens, you have left no stone unturned. If you do everything available to you and it is not enough, you will have no regrets. That clarity is itself a form of peace — and it is the foundation everything else is built on.
Chronic psychological stress elevates cortisol and activates sympathetic signalling, which together suppress immune surveillance of tumour cells. A positive outlook directly reduces cortisol and strengthens the immune function that GBM works hardest to evade. Joy, holidays, connection, laughter — these are not separate from the treatment. They are part of it.
Not everyone facing a GBM diagnosis is naturally optimistic — and that is entirely understandable. Mindfulness offers a practical, evidence-based alternative that does not require positivity as a starting point. The practice of noticing small things — genuinely appreciating their existence — is both grounding and surprisingly powerful. A tree. A cup of tea. A moment of sunlight. These are not trivial observations. They are active interruptions to the spiral of catastrophic thinking that a terminal diagnosis can trigger. Mindfulness also provides a reliable distraction method when anxiety begins to build — redirecting attention outward rather than inward.
The months immediately following diagnosis — and recurrence — involve a level of shock, anxiety and sleeplessness that is genuinely unlike anything most people have experienced. Guided meditation apps, particularly Calm, proved invaluable in the early months. They helped process the initial shock, manage sustained anxiety, and — practically — get back to sleep after night terrors, which are a real and underreported experience for many GBM patients. Calm and similar apps (Headspace, Insight Timer) are inexpensive, immediately accessible, and require no prior meditation experience. A sleep meditation at bedtime became a consistent and effective part of Pete Spence's routine. Three years on, it remains an occasional tool rather than a daily necessity — which is itself a measure of how far things have come.
Radiotherapy and chemotherapy carry real cognitive consequences — and it is important to know that radiation necrosis (the brain's inflammatory response to radiotherapy) does not stop at the end of treatment. It continues for months or years afterward, meaning cognitive effects may emerge or worsen well after the treatment that caused them has finished. Rather than treating this as an inevitable loss, approach it as a problem requiring active solutions.
Daily brain training — apps like Lumosity, Elevate or even simple puzzles and memory games — provides measurable cognitive stimulation that appears to support neural resilience. Writing lists for tasks, appointments and decisions is not a sign of decline — it is a sensible adaptation that frees cognitive load for more important things. This habit, started early, becomes natural and protective. The principle is simple: rather than lamenting what the treatment may affect, find practical systems that compensate for it and preserve function.
A sustainable protocol you maintain for years is vastly superior to a perfect protocol you abandon after weeks. Every element of the approach described here was chosen partly because it can be maintained long-term by a real person living a real life. A 2026 systematic review and meta-analysis of ketogenic diets in GBM (35 studies) found something useful here: pooled survival across all patients on ketogenic diets showed no significant benefit, but the subgroup who sustained the diet for six months or more did show a survival signal. Duration appears to matter more than strictness. One honest caveat, because it recurs throughout this guide: comparing patients who stuck with a diet against those who did not is a confounded comparison — people who stop are often those becoming more unwell, so some of that signal may be the illness, not the diet. It supports sustainability over severity, which is the point being made here. It does not prove the diet extends life.
The single most protective factor in this entire approach — beyond any drug or supplement — is having an oncologist who takes your research seriously, engages with it honestly, and monitors you appropriately. Present your research clearly, show your evidence, and build that collaboration. It changes everything.
Adequate hydration is consistently underappreciated in cancer care. Dehydration impairs cognitive function, reduces physical performance, affects drug metabolism and absorption, and compromises the kidney function that chemotherapy depends on being maintained. For GBM patients on a complex multi-drug protocol, maintaining consistent fluid intake throughout the day is a simple and cost-free intervention with measurable physiological benefit. A practical target is 2–2.5 litres of water daily, adjusted upward on exercise days. Starting the morning with a large glass of water before anything else is a habit worth establishing from day one.
A protein-first breakfast — before carbohydrates, before coffee, before anything else — establishes blood glucose stability from the first meal of the day, supports lean mass preservation, and provides the amino acid substrate for neurotransmitter production that influences mood and cognitive function throughout the morning. Eggs, Greek yoghurt, smoked salmon, protein shakes — the specific source matters less than the habit of prioritising protein as the first nutritional input of the day. This is a simple, sustainable and effective anchor for the entire metabolic strategy.
Even three years on, there are moments. A period of poor sleep, an uncomfortable environment, a disrupted routine — these can trigger physical symptoms that feel alarming: muscle spasms, tension, racing thoughts. The critical skill is pattern recognition — learning to distinguish anxiety manifesting physically from something neurological, and responding appropriately rather than catastrophising.
Patients should actively learn their own body's behaviour patterns within treatment cycles. Certain side effects, sensations and mood changes are predictable and cyclical — understanding this calendar of your own physiology removes much of the fear. Paranoia about symptoms is a real and underreported challenge in GBM patients, particularly during and after radiotherapy. The antidote is knowledge, pattern recognition, and a pre-agreed response plan with your clinical team.
When anxiety peaks — three steps: Stop. Take three slow, deliberate deep breaths with an extended exhale. Name what is happening: "This is anxiety. It will pass." That simple act of labelling interrupts the feedback loop before it escalates.
"Anxiety will pass eventually — use breathing techniques.
Anxiety feeds symptoms. Symptoms feed anxiety."
— Pete Spence. Read daily during the first year after diagnosis to keep meaning grounded and prevent spiralling.
Having rescue medication prescribed — such as clobazam for patients with seizure risk — and knowing exactly when and why to use it, transforms a potentially frightening situation into a managed one. The protocol includes contingency planning precisely because good days and difficult days are both part of the reality of living with GBM.
The tumour's location in the left parietal lobe means the right leg is the deficit at risk. This is Pete Spence's honest framing of that possibility — shared here because it reflects a mindset that is both psychologically protective and biologically useful:
"If the cancer causes loss of function or full use in my right leg, then yes, it would be awful. But the rest of my body is functioning well. I've come across many people regardless of a cancer diagnosis that live full lives with restricted mobility. If I've still got a life, I'll continue living it and fighting all the way to the end of it."
"I don't fear death. I fear missing out."
— Pete Spence, May 2026
This is not denial. It is a considered, deliberate reframing of risk that preserves quality of life, maintains cortisol at manageable levels, and sustains the motivation to continue the protocol. It is, in the most literal biological sense, therapeutic.
You are not a statistic. The median survival figure describes an average across thousands of patients. You are one person, with specific tumour biology, specific fitness, and the capacity to engage with your treatment at a level most patients never reach. That capacity is itself a survival variable.
GBM cells are heavily dependent on glucose through a mechanism called the Warburg Effect — they burn sugar even when oxygen is available, unlike normal cells. This creates a direct therapeutic target: consistently lowering blood glucose places sustained metabolic pressure on the tumour, exploiting a vulnerability that normal cells do not share.
The key measurement is the Glucose-Ketone Index (GKI) — the ratio of blood glucose to ketone bodies. A lower GKI means less glucose and more ketones in circulation. Normal cells can run efficiently on ketones. GBM cells largely cannot.
35–45g carbohydrates daily as the baseline target. This is not full ketogenic — it is sustainable long-term, which matters more. A diet you maintain for years beats a stricter diet abandoned after weeks.
A 60g ceiling for up to 12 weeks per year allows for holidays, social occasions and eating out. Adherence over time is the goal — not perfection on every single day.
12–16 hour fasting windows, at least twice weekly. Deepens ketosis, activates AMPK, enhances the efficacy of chemotherapy and radiotherapy. Achievable by extending the overnight fast.
One tablespoon daily with breakfast. Caprylic acid (C8) is the most ketogenic MCT, rapidly converted to beta-hydroxybutyrate — raising ketones even on days where carb intake is slightly higher.
Protein intake should be prioritised at every meal — a minimum of 1.6–2g per kg of bodyweight daily. GBM treatment creates real risk of muscle loss (sarcopenia), which independently worsens outcomes. Protecting lean mass is a clinical priority, not just an aesthetic one.
Strict ketogenic diets — typically defined as below 20g of carbohydrates daily at a 4:1 fat-to-protein ratio — are clinically effective at lowering the GKI but practically brutal to sustain. The food options are severely restricted, social eating becomes genuinely difficult, and the psychological burden of rigid dietary rules on top of a cancer diagnosis can itself become a source of chronic stress — which, as we have established, is counterproductive for immune function. Many patients start strict keto with good intentions and abandon it within weeks, which produces worse outcomes than a sustainable moderate approach maintained for years.
A very low carb approach — 35–45g daily — achieves the majority of the metabolic benefit with considerably more food variety, social flexibility, and long-term viability. The exercise, intermittent fasting and MCT oil all enhance the GKI further, meaning the dietary component does not need to carry the entire metabolic burden alone. This is a team effort across multiple interventions — not a single dietary constraint doing all the work.
This is a practical guide — not an exhaustive list. The principle is simple: the closer food is to its natural state and the lower its carbohydrate content, the better. Food quality always matters alongside quantity.
A visual reference for understanding where your daily carb target sits relative to other dietary approaches — and what each zone means metabolically.
One of the most important practical discoveries of this protocol is that most family meals can be shared — with the carbohydrate component simply swapped for a low-carb alternative. This prevents the social isolation that strict dietary approaches can create and makes the protocol genuinely liveable long-term.
The internet is an extraordinary resource for low carb and keto recipe inspiration — far beyond what any single document can contain. Searching for "keto [dish name]" or "low carb [dish name]" will return hundreds of well-tested recipes for virtually any meal. Dedicated sites such as Diet Doctor, ruled.me, and Maria Mind Body Health offer extensive recipe libraries specifically designed for sustained low carb living. The substitution table above provides the principles — the internet provides the variety that makes those principles enjoyable long term.
Tracks daily steps, heart rate, active minutes and sleep quality. Real-time feedback on activity levels makes it easy to ensure the 10,000+ step target is being met. Most also track resting heart rate trends — a useful indicator of overall recovery and stress load.
Devices like Oura Ring provide detailed HRV (heart rate variability), sleep stage analysis, and recovery scores. HRV is particularly valuable — a persistently low HRV signals physiological stress or immune activity that may warrant rest rather than exercise on a given day.
Body composition scales tracking not just weight but lean mass, fat percentage and hydration. Lean mass preservation is a clinical priority — smart scales make it measurable daily, providing early warning if muscle loss is occurring before it becomes clinically significant.
Photographing meals, scanning labels and logging known portion sizes provides accurate daily carbohydrate, protein and calorie data. Precise tracking matters — the difference between 40g and 70g of carbohydrates daily is the difference between therapeutic ketosis and a standard low-carb diet. The gap is easy to drift across without data.
Pete Spence built MaxedHealth — a free, open-source nutrition and health tracking app — specifically to meet this need. It combines AI photo-based meal logging, a personal food library with locked macro values, wearable data integration, and daily trend analysis. It runs locally on an Android phone with no account or subscription required. It was built for this protocol and is given away freely. Read the story or download it here. A companion app for Android, which handles setup automatically and keeps wearable data syncing in the background, is coming with MaxedHealth Premium.
A home finger-prick blood monitor measuring both glucose and beta-hydroxybutyrate (ketones) allows the GKI to be calculated directly. Measuring 2–3 hours after eating shows the real metabolic impact of specific foods and meals — making dietary adjustments precise rather than guesswork.
Joining all data sources on a single daily date entry — steps, sleep, body composition, nutrition, mood, symptoms — creates a longitudinal record that reveals trends invisible in day-to-day observation. This data is also invaluable for oncology appointments and any future publication of outcomes.
MaxedHealth does exactly this — it imports data from Withings, RingConn, Amazfit/Zepp and Garmin (the devices it has been tested with) and from any other device that exports a CSV, and joins it to daily nutrition data in a single unified record. The dashboard answers questions like: was yesterday's weight change fat, muscle or water? Does higher carb intake correlate with worse next-day HRV? What does my sleep quality look like across the chemotherapy cycle?
Exercise is not a peripheral lifestyle recommendation in this framework. It is a direct metabolic and immunological intervention with specific mechanisms relevant to GBM.
10,000–15,000 steps daily at moderate pace. Continuously depletes glycogen, improving insulin sensitivity and lowering blood glucose — directly improving GKI throughout the day.
Twice weekly. The single most important intervention for preserving lean mass against the catabolic pressure of chemotherapy, cannabinoids and a very low carb diet simultaneously.
Exercise mobilises cytotoxic T cells and natural killer cells — the immune cells responsible for identifying and destroying tumour cells. This is not metaphorical. It is measurable.
Exercise influences key molecular pathways involved in GBM progression, including angiogenesis and metabolic reprogramming — the same pathways targeted pharmacologically by irbesartan.
The combination of fasted walking on IF days is particularly powerful — low-intensity fasted aerobic activity rapidly depletes glycogen, elevates ketones, and produces the most favourable GKI of any combination in the protocol. For patients managing seizure risk, low-intensity fasted walking is also considerably safer than high-intensity fasted training.
The following protocol was designed around clinical trial evidence, with each element targeting a specific GBM vulnerability. In September 2026 it was reviewed from top to bottom against the current literature — and several items were removed, reduced or reclassified as a result. What follows is the honest version.
Proven — supported by randomised controlled trials or large meta-analyses in humans. Rare in this field, and worth weighting heavily when it appears.
Early Stage — human data exists but is small, uncontrolled, observational, or in a different cancer. Reasonable to act on with clear eyes; not proof.
Speculative — cell line or animal evidence only, or human evidence that failed to replicate. Mechanistically interesting, but nobody has shown it works in a person.
A hard lesson worth stating plainly: a compound can be kept for one job and useless for another. Several items below stayed in this protocol — but for a different reason than they were originally included. Being honest about which job a supplement is doing matters more than the length of the list.
Removed: Metformin (randomised trial data null; positive findings are observational only). Quercetin (no human data of any kind). Generic mushroom complex (redundant with turkey tail, plus a bleeding signal). Mebendazole retired from the strategic reserve after a randomised Phase II failed.
Reduced: Curcumin from 2,400mg+ down to 1,000mg — above the trial range was buying nothing.
Reclassified but kept: Boswellia, turkey tail, omega-3, vitamin D3 and melatonin all stayed — but the stated reason for taking each one changed. Read the entries, not just the doses.
Corrected claims: the surveillance section overstated the evidence for early recurrence detection; the boswellia survival study was a three-compound combination, not boswellia alone; the CBD resistance-breaking property favours unmethylated patients, not methylated; sulforaphane was described as a result when it is a mechanism.
The single most useful finding: two supplements were being taken for a year at below trial-level active content because the labels quoted compound weight rather than active ingredient. Before concluding that something does not work for you, confirm you have actually been taking it.
The legal status of THC, CBD and CBG varies significantly between countries, and in some jurisdictions between regions within countries. Before pursuing any cannabinoid therapy, patients must verify the legal status in their own country and jurisdiction. In the UK, medicinal cannabis containing THC requires a specialist prescription from a registered specialist. In many countries it remains entirely prohibited. CBD legality also varies by jurisdiction and concentration. This is not an area where assumptions should be made — check your local law carefully and discuss with your oncologist before proceeding.
Important: The cannabinoid protocol described in this document is shared for informational and educational purposes only. The author neither encourages nor facilitates illegal activity of any kind. Readers are solely and entirely responsible for understanding and complying with the laws of their own country and jurisdiction. Nothing in this document constitutes legal advice.
A personal note from Pete Spence: It is with a heavy heart that this legal notice must exist at all. The human brain has cannabinoid receptors — CB1 and CB2 — that exist precisely because the endocannabinoid system is a fundamental part of human biology. The idea that a plant producing compounds specifically matched to receptors in our own brains is restricted or prohibited in law — while a patient with a terminal brain tumour tries to access something that may help them survive — is, frankly, ludicrous. The science does not support prohibition. The biology does not support prohibition. And the experience of patients navigating both a terminal diagnosis and legal restrictions on a natural compound simultaneously is one of the quiet injustices of modern medicine that deserves to be named plainly. Laws vary. The biology does not.
The ARISTOCRAT trial is double-blind and placebo-controlled — meaning one in three participants receives a placebo rather than active cannabinoids. This is standard scientific methodology, designed to eliminate bias and produce clean causal data. The reasoning is entirely valid in most medical contexts.
What the Phase I data actually showed: The earlier Phase I trial in 27 patients produced a striking result — after two years, 50% of patients in the nabiximols arm were still alive, compared to only 22% of those on TMZ plus placebo. Against a backdrop where average survival after recurrence is less than 10 months, this signal is striking, but it comes from just 27 patients, so the true effect could be far smaller, or absent. The ARISTOCRAT Phase II trial is designed to confirm whether this benefit holds at scale. These are the numbers that make the 1-in-3 placebo allocation so difficult to accept for an informed patient who has already reviewed the evidence.
But GBM is not most medical contexts. And this is a question every patient offered ARISTOCRAT participation deserves to think about carefully and honestly.
What placebo participation actually means: A 1-in-3 chance of receiving a placebo when your median survival is 14 months is not an abstract statistical inconvenience. It potentially means months of your life — the window in which cannabinoids at therapeutic doses might be making a meaningful difference — spent on an inactive substance. For a patient who has researched the mechanism and concluded the evidence justifies the intervention, that is an extraordinarily high personal cost to pay for scientific rigour that benefits future patients rather than yourself.
The blinding problem: There is a more specific issue that is rarely acknowledged openly. Double-blinding in high-dose THC trials almost certainly does not work in practice. A patient receiving therapeutic doses of THC via buccal delivery knows they are not on placebo — the psychoactive effects are unmistakeable. The trial therefore loses blinding integrity in the active arm anyway, while patients in the placebo arm lose their opportunity to access a potentially meaningful intervention. This represents a significant methodological limitation alongside the ethical one.
The equipoise question: Clinical trials are ethically justified only when genuine uncertainty exists about which arm is superior — a principle called equipoise. The Phase I data (27 patients) pointed to a hazard ratio below 0.5 for cannabinoids alongside TMZ, but numbers that small carry very wide uncertainty. Some patients feel that signal makes a placebo arm hard to accept in MGMT-methylated disease; the trial team's position is that real uncertainty remains, which is exactly why Phase II exists.
This is not an argument against science. Rigorous trials are how medicine advances and how future patients benefit. But informed consent means understanding exactly what trial participation involves — including a candid assessment of what the placebo arm means for you personally, given your specific prognosis and timeline. Every patient must make this decision for themselves, in full possession of the facts. The question worth asking your oncologist is simple: given what the Phase I data already shows, would you accept a 1-in-3 chance of placebo?
The ratio of THC:CBD:CBG at approximately 3:1:1.4 (126mg:42mg:60mg per component daily) is not arbitrary. Each cannabinoid targets a fundamentally different set of receptors and cellular mechanisms — meaning the ratio reflects the relative weighting of those mechanisms against GBM biology, balanced against practical tolerability.
Why THC is dominant (126mg daily): THC is the primary apoptosis driver in this protocol. It binds with high affinity to CB1 receptors — which are heavily overexpressed in GBM tumour cells and GBM stem cells — triggering a cascade that leads directly to programmed cell death. At apoptosis-level concentrations (above approximately 100mg), THC also acts independently of CB1/CB2 receptors through direct mitochondrial membrane disruption, creating a secondary apoptotic pathway. No other cannabinoid achieves this dual mechanism at equivalent concentrations. THC is therefore the highest-weighted component because it carries the greatest direct anti-tumour burden — provided patient tolerability allows it to be reached and sustained.
Why CBD is the secondary component (42mg daily): CBD targets GPR55 and TRPV1 receptors — pathways entirely distinct from THC's CB1/CB2 route — and triggers endoplasmic reticulum stress leading to a separate apoptotic cascade. CBD has also been shown to overcome both major TMZ resistance mechanisms — MGMT overexpression and mismatch-repair deficiency — with synergy alongside temozolomide-class agents (Brookes et al., 2024). Two honest caveats, corrected in the September 2026 review. First, that work was done in GBM cell lines, not patients, so it is a demonstrated mechanism rather than a demonstrated clinical benefit. Second, earlier versions of this guide claimed this made CBD particularly valuable for MGMT-methylated patients. That is backwards: if your MGMT promoter is already silenced, temozolomide works and there is less resistance to overcome. This resistance-breaking property is most relevant to unmethylated patients. CBD also modulates THC's psychoactive effects at the CB1 receptor — meaning adequate CBD in the ratio partially offsets the tolerability challenge of high-dose THC, allowing patients to reach higher THC doses than they might otherwise tolerate. This dual role — anti-tumour and tolerability-enabling — justifies CBD as the second-weighted component.
Why CBG completes the picture (60mg daily: 30mg morning + 30mg evening): CBG operates primarily through GPR55 — shared with CBD but through different downstream signalling — and uniquely arrests the cell cycle at both G1/S1 and G2/M checkpoints. This cytostatic mechanism (stopping cells from dividing) is complementary to, rather than duplicating, the apoptotic mechanisms of THC and CBD. CBG is particularly active against GBM stem cells — the highly treatment-resistant subpopulation responsible for recurrence after surgery and chemotherapy. Targeting stem cells directly addresses one of GBM's most clinically significant survival mechanisms. CBG is weighted below THC because its mechanism is cytostatic rather than directly lethal to tumour cells — but its stem cell activity makes it irreplaceable in the combination.
The combined effect: Together, the three cannabinoids cover CB1, CB2, GPR55 and TRPV1 receptors simultaneously, trigger apoptosis through at least three independent pathways, arrest the cell cycle, target GBM stem cells, sensitise the tumour to TMZ, and partially self-regulate tolerability. No single cannabinoid achieves more than a fraction of this — the ratio is the therapy.
The doses described above — 126mg THC, 42mg CBD, 60mg CBG daily — are maintenance therapeutic doses reached after a period of gradual dose escalation. No patient should begin at these levels. Starting at therapeutic dose would be both unsafe and counterproductive — THC in particular requires the body and brain to adapt progressively.
The titration approach used in this protocol was inspired by the ARISTOCRAT clinical trial's self-titration principle — where patients increase dose incrementally based on personal tolerability — but adapted to maintain proportional ratios across all three cannabinoids throughout the escalation process. The ARISTOCRAT trial used a fixed 1:1 THC:CBD ratio (Sativex/nabiximols) and allowed patients to titrate to their own ceiling. This protocol starts from a 1:1:1 ratio across all three cannabinoids and scales all three proportionally — preserving the mechanistic balance at every stage of escalation.
The most important principle of titration: tolerability is the rate-limiting factor, not a target timeline. Some patients will reach maintenance dose in 8 weeks. Others may take 6 months. The pace is entirely individual and entirely guided by the patient's own response. There is no clinical benefit to rushing — and significant risk in doing so.
What to expect during escalation: Mild psychoactive effects from THC — altered perception, drowsiness, mild anxiety — are normal during dose increases and typically diminish as tolerance develops. If effects are significant or distressing, reduce to the previous dose and remain there for an additional two weeks before attempting further escalation. CBD's presence in the ratio helps moderate these effects — one of the practical reasons CBD is maintained alongside THC throughout.
Buccal delivery throughout: All doses should be administered via the buccal (oromucosal) route — held against the cheek or under the tongue rather than swallowed. This bypasses first-pass liver metabolism, producing more consistent and predictable blood levels than oral capsules and making the titration process more reliable. Swallowing cannabinoids produces highly variable absorption that makes meaningful titration almost impossible.
This protocol was built by a real patient without unlimited resources. Cost was a genuine factor in every decision — and it is worth being transparent about that.
The affordable majority: With the exception of cannabinoids, almost everything in this stack is genuinely affordable. Simvastatin and irbesartan are NHS-prescribable for patients with existing indications. Supplements such as boswellia, curcumin, sulforaphane, omega-3, vitamin D3, melatonin, turkey tail and magnesium are all available online at reasonable cost — particularly when bought in bulk from reputable suppliers. The daily probiotic, MCT oil and dietary changes are modest ongoing costs.
And a point about cost that cuts the other way: the September 2026 review removed or reduced several items, which saved money rather than costing it. Buying the right formulation of one supplement beats buying three of the wrong ones. An AKBA-standardised boswellia costs more per bottle than a generic extract and is worth every penny; 4,000mg of curcumin costs more than 1,000mg and buys nothing extra. Pruning honestly is not austerity — it frees up money for the things that work.
The significant exception: High-dose medicinal cannabinoids — particularly THC at therapeutic levels — are the one genuinely expensive element of this protocol. In the UK, medicinal cannabis prescriptions are not currently NHS-funded for GBM and must be obtained privately, at meaningful cost. This is an honest limitation. Patients should explore whether their country provides any funded access, and discuss with their oncologist whether lower-cost CBD-only options represent a worthwhile starting point while pursuing broader cannabinoid access.
The principle: Do not be deterred from the affordable majority of this protocol by the cost of the expensive minority. The metabolic strategy, the exercise, the mindset, the supplements, the repurposed drugs — all of this is within reach. Start there. The cannbinoids are a powerful addition; they are not the only thing that matters.
The power of this approach is not in any single element. It is in the simultaneous, overlapping pressure applied to every major mechanism GBM uses to survive, grow, recruit blood supply, resist treatment, and evade the immune system.
A necessary caveat on this section. Mechanistic coherence is not the same as proven benefit. Every mechanism described below is real biology, but the fact that several compounds converge on a pathway does not establish that the combination extends survival — and a diagram of overlapping arrows can make a protocol feel more evidenced than it is. Treat this as the reasoning behind the design, not as evidence for it. The things in this protocol with genuine human survival data behind them are surgery, radiotherapy and temozolomide.
Very low carb diet + intermittent fasting + exercise + MCT oil. Multiple mechanisms suppressing the tumour's primary fuel source simultaneously. (Metformin was removed from this protocol in September 2026 — see the Removed section.)
Cannabinoids (THC/CBD/CBG) targeting CB1, CB2, GPR55, TRPV1 and ER stress pathways. Sulforaphane adding ER stress via a different route.
Boswellia (5-LOX and NF-κB), omega-3 and its resolvin mediators, and melatonin — hitting NF-κB, COX-2 and NLRP3 from several angles. Chronic inflammation is a genuine cardinal feature of GBM biology, not a peripheral concern. Note that no NSAID is included here: the COX-2 link is real, but long-term celecoxib carries cardiovascular risk that is a poor trade alongside a statin and an ARB for a speculative benefit.
Irbesartan blocking VEGF, PDGF and FGF — cutting off the blood supply tumour growth depends on.
Turkey tail, the gut microbiome, exercise-mobilised NK cells, vitamin D3, and lower cortisol from a settled mind — maintaining the immune function GBM works hardest to suppress.
What this protocol creates is not a diet you go on and off, or a fasting protocol you do twice a week as an isolated intervention. It is a sustained physiological environment where the conditions GBM depends on are chronically and consistently unfavourable — 24 hours a day, 365 days a year. That sustained metabolic pressure, maintained over months and years, is the most powerful single feature of this entire approach.
The recurrence in June 2025 was caught early precisely because of consistent 3-monthly MRI surveillance. Early detection of recurrence — when tumour burden is smallest and surgical options are greatest — is itself a survival intervention.
Some oncologists default to 6-monthly surveillance post-treatment. Advocating for 3-monthly MRI is reasonable and sits within mainstream guidance — NCCN recommends imaging every 2–4 months for the first three years. But an earlier version of this guide said the evidence for early detection improving outcomes is "clear," and that was wrong. A retrospective study in glioblastoma and anaplastic glioma failed to show better outcomes when recurrence was found on routine surveillance rather than when symptoms appeared — plausibly because treatment options at recurrence are limited either way. A review of international guidelines found recommended intervals ranging from 1–2 monthly to yearly, with most citing no evidence base at all. The honest position is that scan frequency is genuinely unsettled, and more scanning has not been shown to extend life. What frequent imaging reliably gives you is information and time to plan — which has real value, alongside the real cost of scan anxiety. That is a personal trade-off worth making deliberately rather than assuming more is always better. If you have already had a recurrence, consider discussing 6–8 weekly scans in the high-risk window immediately following treatment completion.
Daily tracking of body composition (smart scales), activity (smart watch/ring), and nutritional intake (calories, protein, carbohydrates) provides early warning of anything drifting in the wrong direction — weeks before it would show up clinically. Lean mass loss in particular is a signal requiring immediate dietary adjustment.
Regular liver function tests (LFTs) are essential given the combination of simvastatin, high-dose supplements and cannabinoids. Your oncologist will manage this — but understanding why these tests matter helps you engage with them actively.
The protocol described in this document was built over time, iteratively, in collaboration with a specialist oncologist. You do not need to implement all of it immediately. Here is a pragmatic starting sequence.
Before anything else. This single biomarker determines how well TMZ will work in your tumour and affects the priority of several interventions in this stack.
Very low carb (35–45g daily) is the one intervention with no contraindications, no prescriptions required, and immediate effect. Start before everything else.
To track it accurately, use a dedicated tool. MaxedHealth — a free app built for this protocol — lets you log meals by photo or description using AI, tracks your carb ceiling in real time, and brings in your wearable data. No account, no subscription, runs on your phone.
Daily walking and twice-weekly resistance training. Start at whatever level is manageable and build. The immunological and metabolic benefits begin with the first session.
Bring this document. Ask about statins with good BBB penetration, angiotensin receptor blockers (anti-angiogenic), and the cannabinoid evidence. Some repurposed drugs may require private prescription or a particularly engaged oncologist — but an oncologist who takes the evidence seriously changes everything. Build that relationship.
Start with the best-evidenced, and be clear what each is for: boswellia (AKBA-standardised — oedema and joints), turkey tail (immune and chemotherapy support), omega-3 (check EPA+DHA, target above 2,000mg), vitamin D3 (maintain sufficiency), then curcumin, sulforaphane and melatonin. Add one at a time so any reaction can be attributed clearly. Check the label on every single one before you start — several items in this protocol were being taken at below trial dose for a year because the label was read as the compound weight rather than the active content.
Find whatever gives you joy and protect it fiercely. It is not separate from your treatment. It is biologically part of it.
You are not powerless. The gap between what standard care offers and what an informed, engaged, disciplined patient can achieve is real, measurable, and documented in the research. This document exists because that gap should not be a secret.
The protocol described in this document is demanding. It requires discipline, research, daily monitoring, and sustained engagement with your clinical team. It is not easy.
But it is designed to be lived alongside a full life — not instead of one. Holidays, social occasions, restaurants, celebrations — all of these are accommodated within the framework deliberately, because a protocol you can sustain for years is the only protocol that matters.
At the time of writing, Pete Spence is on holiday — doing 15,000 steps a day, training in the gym, eating broadly within carbohydrate targets, and drinking the occasional beer. The protocol travels with him. Life does not stop for the treatment — the treatment is designed to protect the life.
Over three years post-diagnosis. Post-recurrence. Post-second maximal resection. Twelve cycles of adjuvant chemotherapy completed in July 2026. Clear scans in March and September 2026. The protocol is working. This story is not finished.
If this document gives one newly diagnosed patient a framework, a conversation to have with their oncologist, or simply the knowledge that this level of engagement is possible — it will have been worth writing. That is why Pete Spence chose to share it.
Leave no stone unturned. Have no regrets. Keep going.
This document will be updated as the journey continues. The ten-year version will be considerably longer.
Plain English definitions for every technical term used in this document, with a note on why each matters for GBM patients. Terms are listed alphabetically.