Endocrine Abstracts

A 44-year-old woman with a history of Bartters syndrome wanted a second opinion. Her height was 1.54 m, weight 69 kg, waist circumference 102 cm, BP 112/74. A OGTT was arranged because of her waist circumference. Fasting glucose 8.9 mmol/l, 2-hour glucose 20.2 mmol/l, HbA1c 7.9% consistent with type 2 diabetes mellitus. She started taking metformin. However she was keen to pursue lifestyle driven reversal of type 2 diabetes and so a low carbohydrate diet was recommended restricting carbohydrates to <20 g a day.

At 4 weeks follow up she weighed 66.9 kg and her periods became regular. At 3 months her weight was 61.3 kg and waist circumference 88 cm. 6 months later her weight was 57 kg and waist circumference 86 cm. She stopped taking metformin. 4 years later she had managed to maintain her weight and repeat oral glucose tolerance test showed a fasting glucose of 5.8 mmol/l, two-hour glucose 7.6 mmol/L, HbA1c 4.8% or 29 mmol/mol.

This case illustrates the utility of a low carbohydrate; high fat (LCHF) or ketogenic diet in promoting reversal of type 2 diabetes especially when implemented soon after the diagnosis is made. LCHF diets have been shown to be highly effective at reducing weight, triglycerides and elevating HDL-C. They significantly reduce hepatic glucose output and inflammation associated with insulin resistance. In one study, 95.2% of patients on a ketogenic diet reduced or stopped anti-diabetic medications compared to 62% following a low glycaemic index diet. The potential to prevent progression in the disease process is not only extremely beneficial for long term health but to do so in a way that could also prevent a significant number of other co-morbidities associated with insulin resistance such as non-alcoholic fatty liver disease, hypertension and cardiovascular disease risk factors while reducing dependence on pharmaceutical agents is highly attractive and cost-effective.