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Successful treatment of obesity and insulin resistance via ketogenic diet status post Roux-en-Y
  1. Richard Todd Handley1,2,
  2. Ryan E Bentley3,
  3. Tony L Brown4,
  4. Abigail A Annan3
  1. 1Chief Operating Officer, Wells World Services, Valencia, California, USA
  2. 2College of Medicine, University of Science, Arts and Technology, Montserrat, BWI
  3. 3Department of Family and Community Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, USA
  4. 4National Institutes of Health, National Cancer Institute, Bethesda, Maryland, USA
  1. Correspondence to Dr Richard Todd Handley, richard.handley{at}


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.

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

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  • Contributors This patient was treated between July 2016 and December 2017 by REB. REB provided all the necessary data points, patient history and background knowledge of the case required for RTH to write the manuscript in its entirety. The scope and direction for this paper was developed and directed by REB, who also analyzed and interpreted the data. RTH conducted a full literature review. Each subsequent draft was then reviewed by REB, TLB and AAA. They then provided RTH with editorial comments and direction, which further guided him in his writing. Specifically, AAA made suggestions on an appropriate title, which they ultimately used. REB provided RTH with a handful of key research papers and discussed with him the specific physiological mechanisms he wished to focus on. TLB Suggested/guided major revision of manuscript topic, suggested major rearrangement of manuscript sections, and suggested graph axis labels, and supplied additional reference manuscripts. It was REB’s idea to focus on hyperinsulinemia and its systemic effects as the key marker to the metabolic derangements that improved with KD.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.