International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. IJCRI publishes SUMMARYMetabolic syndrome is made up of a cluster of conditions including obesity, impaired insulin sensitivity, hypertension and altered lipid profile. These conditions are also considered as risk factors for type 2 diabetes and cardiovascular disease. Occurrence of these conditions is on the rise worldwide despite of the increasing number of drugs used. There is evidence from the literature indicating that intervention with low carbohydrate diets, including the paleolithic diet, may be beneficial in the metabolic syndrome. Except for one study with the paleolithic diet these investigations are short in duration. Another limitation is that they do not give clues how to deal with medications patients are treated with. Third, in these studies the paleolithic diet did not produce ketosis which may limit the clinical effectiveness. Here we present a case of a patient with metabolic syndrome and excessively medicated. The patient shifted toward the paleolithic ketogenic diet and was able to discontinue medication, lost weight and her glucose parameters markedly improved. Her hypertension normalized. Currently she is on the diet for 22 months and show good adherence as also confirmed by laboratory tests. She is free of symptoms and no side-effects emerged. Previously we reported cases with epilepsy and type 1 diabetes successfully treated with the same diet. We suggest that a dietary intervention with the paleolithic ketogenic diet may be a simple, feasible and cost-effective method in some forms of chronic disorders in highly motivated patients.(This page in not part of the published article.)