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BMJ Case Rep. 2018 Aug 17;2018. pii: bcr-2018-225643. doi: 10.1136/bcr-2018-225643.

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

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Chief Operating Officer, Wells World Services, Valencia, California, USA.
College of Medicine, University of Science, Arts and Technology, Montserrat, BWI.
Department of Family and Community Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, USA.
National Institutes of Health, National Cancer Institute, Bethesda, Maryland, USA.


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/m2 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/m2, 20.6% and 36.8%, respectively. Unfortunately, her BMI would return to 53.6 kg/m2, 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/m2, 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.


diabetes; endocrine system; gastrointestinal surgery; metabolic disorders; nutrition and metabolism

[Indexed for MEDLINE]

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