Successful treatment of obesity and insulin resistance via ketogenic diet status post Roux-en-Y

Abstract

This is a single case of a 65-year-old American woman who presented with substantial weight gain and insulin resistance (IR) post-Roux-en-Y gastric bypass (RYGB) surgery. Before RYGB, she had reached 340 lbs (155 kg) and a body mass index (BMI) of 56.6 kg/m The surgery resulted in a 70 lbs (32 kg) weight loss, bringing her BMI, per cent total weight loss (%TWL) and per cent excess weight loss (%EWL) to 44.9 kg/m, 20.6% and 36.8%, respectively. Unfortunately, her BMI would return to 53.6 kg/m, nearly her pre-RYGB BMI. It was then she sought the guidance of a primary care physician with expertise in nutrition and medical management of obesity, who placed her on a ketogenic diet. One year later, she had lost 102 lbs (46.4 kg), resulting in a BMI, %TWL and %EWL of 36.6 kg/m, 31.7%, and 63.1%, respectively, also further resulting in significant improvements of her inflammatory biomarkers. This case presentation will explore current literature, covering the effects of obesity on IR, pre-diabetes and other disease-provoking inflammatory biomarkers.

Effect of the ketogenic diet on glycemic control, insulin resistance, and lipid metabolism in patients with T2DM: a systematic review and meta-analysis

“…Numerous studies have confirmed the role of KD consumption in weight reduction in obese patients [35][36][37][40][41][42][43]52 ; the current meta-analysis focused on the effect of KD on weight reduction in obese diabetic patients. The results showed the average reduction of body weight was 8.66 kg, waist circumference was 9.17 cm, and BMI was 3.22 kg/m 2 , which were consistent with previous studies in nondiabetic patients.…”

Effects of a two meals-a-day ketogenic diet on newly diagnosed obese patients with type 2 diabetes mellitus: A retrospective observational study

“…Previous meta-analyses have consistently shown that the KD significantly contributes to weight loss in obese patients. [10,[28][29][30][31][32][33][34][35][36] The reduction in body weight can be attributed to the very low carbohydrate content of the KD, and also to the energy restriction that leads to negative nitrogen balance. Although the control group followed the diabetic diet with energy restriction, the KD with 2 meals per day was superior to the regular diabetic diet at every meal in reducing body weight, body fat, and blood glucose levels.…”

Effect of a Ketogenic Diet on Some Biochemical Parameters in Obese People

“…On the other hand, there are very few studies examining the significance of KD in reducing insulin resistance in diabetic individuals; the majority of these studies concentrated on the impact on obese people [20]. For example, a controlled clinical investigation examining the impacts of KD consumption in obese individuals who don't have diabetes found that after consuming KD for 6 weeks, patients with insulin resistance in T2DM are more likely to have lipid metabolic disorders than other patient groups [21]. Dyslipidemia causes or worsens insulin resistance because it is lipotoxic to cells.…”