The outcomes of the food plan have been dramatic. His HbA1c fell from 7.2 p.c to five.2 p.c with out medicines in the course of the first section.
HbA1c check for diabetes analysis. (iStock)
Synopsis: A case research has documented a South Asian man who saved Sort 2 diabetes in remission for 10 years with out treatment after adopting a structured low-carbohydrate food plan. His HbA1c fell from 7.2 p.c at analysis to under 5.3 p.c and remained steady for a decade, whereas different well being markers akin to coronary heart, kidney, bone and eye well being stayed regular throughout long-term follow-up.
A South Asian man saved Sort 2 diabetes in remission for a decade with out treatment after altering his food plan, a brand new case research says.
Revealed in Frontiers in Vitamin, the N-of-1 trial adopted Shashikant Iyengar, who was identified with Sort 2 diabetes at age 49. After analysis, he adopted a fastidiously structured, culturally tailored low-carbohydrate food plan and stopped diabetes treatment. His HbA1c remained at or under 5.3 p.c for 10 years.
The research describes the case as a 10-year, medication-free remission in a South Asian man who was not chubby by BMI however nonetheless confronted metabolic danger.
Researchers led by Jasmeet Kaur in Punjab documented Iyengar’s case utilizing an N-of-1 trial design, the place a single affected person serves as their very own management to check how a selected therapy or food plan impacts their well being.
When docs identified him in 2015, Iyengar had a fasting plasma glucose of 152 mg/dL, post-meal glucose of 253 mg/dL, and HbA1c of seven.2 p.c, all within the diabetic vary.
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Regular weight, however excessive metabolic danger
Regardless of a BMI of twenty-two.5 kg/m², which is taken into account regular, the research says Iyengar match the “metabolically overweight however regular weight” (MONW) phenotype as a result of he had central adiposity and a excessive waist-to-hip ratio. The authors wrote that these measures are “well-established predictors of cardiometabolic danger in South Asians”.
An individual could seem to have a traditional weight by BMI however nonetheless carry excessive inside metabolic danger due to fats distribution and underlying metabolic dysfunction.
At analysis, Iyengar additionally had a number of situations linked to insulin resistance and poor metabolic well being, together with early fatty liver illness, osteoarthritis, frozen shoulder, cervical spondylosis, acid reflux disorder, power fatigue, delicate anxiousness, delicate melancholy and belly fats.
Earlier than analysis, he adopted a standard South Indian vegetarian food plan excessive in polished rice and fermented grains, with restricted high-quality protein and little consumption of omega-3 fat and a few nutritional vitamins.
The authors wrote that this nutrient profile was “comparatively poor in important amino acids, long-chain omega-3 fatty acids, and choose fat-soluble nutritional vitamins”, which possible worsened post-meal blood sugar spikes and metabolic resilience.
The research says this case exhibits that diabetes danger is formed not solely by physique weight but additionally by fats distribution, food plan and underlying metabolic well being.
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A decade-long three-stage food plan plan
The intervention was not a one-size-fits-all ketogenic plan. The research describes a three-stage dietary strategy over 10 years: an preliminary section of reasonable carbohydrate discount, adopted by a stricter ketogenic section, and eventually a long-term section that reintroduced some carbohydrates.
From September 2015 to Might 2016, Iyengar adopted a food plan with about 100 grams of carbohydrates a day, primarily from pulses, legumes, non-starchy greens, nuts and dairy merchandise. Small quantities of low-glycaemic staples have been allowed, and protein consumption was saved at at the least one gram per kilogram of physique weight per day.
From June 2016 to December 2019, carbohydrate consumption fell to under 30 grams a day. The food plan emphasised inexperienced greens, eggs, dairy, nuts and seeds. Dietary ketosis was periodically confirmed utilizing urine ketone strips. Steady glucose monitoring throughout this era “persistently demonstrated normoglycemia,” the research says.
From January 2020 to June 2025, carbohydrates regularly elevated to about 100 grams a day. Every meal prioritised protein and included wholesome fat. This section additionally allowed culturally acquainted meals akin to fermented dosa, pulses and occasional small parts of cooked white rice. Even after carbohydrates have been reintroduced to this degree, the research says “normoglycemia was maintained all through this section with out pharmacotherapy.”
The authors say this can be one of the vital essential takeaways from the case. Quite than saying everybody should keep on a strict ketogenic food plan indefinitely, they are saying some individuals could preserve remission with a reasonable, sustainable carbohydrate consumption, particularly if they begin the intervention early and observe it fastidiously.
“Lengthy-term stabilization with ~100 g/day carbohydrate consumption was related to sustained remission, improved glycemic variability, and preserved systemic security,” the paper says.
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Blood sugar and insulin markers improved quickly
The outcomes of the food plan have been dramatic. Iyengar, chatting with South First, mentioned his HbA1c fell from 7.2 p.c to five.2 p.c with out medicines in the course of the first section.
In the course of the ketogenic section, fasting insulin and HOMA-IR normalised, suggesting near-complete reversal of insulin resistance. HbA1c fell additional to between 4.7 p.c and 4.9 p.c.
After carbohydrates have been reintroduced to about 100 grams a day, remission nonetheless held. HbA1c stayed between 5.0 p.c and 5.3 p.c, imply glucose was round 109 mg/dL, and glucose monitoring confirmed greater than 90 p.c time in vary.
The research discovered an surprising sample in the course of the strict low-carb section. Blood sugars have been typically glorious, however the physique confirmed a brief exaggerated rise when challenged with carbohydrates.
Throughout ketosis in 2016, a standardised carbohydrate problem despatched peak glucose to 215 mg/dL. In 2025, after structured carbohydrate reintroduction, the identical dosa meal induced a peak of solely 120–130 mg/dL. The authors say this was about 40 p.c decrease than throughout ketosis, which factors to improved carbohydrate tolerance after reintroduction.
The research explains that this sample could mirror “physiologic insulin resistance” throughout ketosis. On this state, the physique turns into quickly much less environment friendly at dealing with sudden carbohydrate masses as a result of it’s tailored to burning fats. After carbohydrate reintroduction, the physique appeared metabolically extra versatile.
The authors write that this last section “achieved essentially the most favorable steadiness of metabolic management, dual-fuel flexibility, and cultural sustainability.”
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Coronary heart, kidney, bone and eye well being steady
The center security findings could entice extra consideration as a result of low-carbohydrate diets typically face criticism over ldl cholesterol and cardiovascular danger.
On this topic, LDL ldl cholesterol rose in the course of the ketogenic section and later stabilised at round 150 mg/dL. The research says this didn’t translate into seen cardiovascular injury.
Different markers remained reassuring. The ApoB/A1 ratio stayed within the protecting vary of about 0.8 to 0.9. Triglycerides stayed under 100 mg/dL over the long run, HDL remained modest however acceptable, and coronary artery calcium scores have been zero in 2019, 2024 and 2025.
Coronary CT angiography in 2025 confirmed CAD-RADS 0, which means no detectable plaques or stenosis. The paper says these findings “reveal the absence of atherosclerotic illness, regardless of a decade of T2D and long-term carbohydrate restriction.”
One other uncommon discovering was a fall in lipoprotein(a), a cardiovascular danger marker typically thought of largely genetic and tough to switch.
In Iyengar, it fell from 43.4 mg/dL to 25.3 mg/dL over the last decade. The authors describe this as “a very novel remark” and say it could hyperlink to the food plan’s whole-food fats composition together with improved metabolic well being.
Irritation markers additionally stayed low. The topic’s hs-CRP remained under 1 mg/L all through follow-up, together with at analysis. Homocysteine stayed under 10 micromol/L with monitoring and vitamin B12 supplementation when wanted.
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The research says this helps tackle a typical criticism of long-term low-carb consuming – that it could elevate irritation or trigger micronutrient deficiencies. On this case, the researchers discovered no such deterioration.
Kidney perform, one other concern typically raised with higher-protein diets, additionally remained steady. Creatinine, eGFR and cystatin C have been tracked over time. The paper says these markers collectively affirm that “kidney well being was maintained throughout long-term low-carbohydrate, higher-protein consumption.”
Bone and eye well being additionally appeared preserved. DXA scans confirmed regular lumbar backbone bone mineral density, with solely delicate steady osteopenia on the femoral neck. There have been no fractures.
Eye exams discovered no diabetic retinopathy, steady retinal nerve fibre layer, and no glaucoma or cataract. The paper notes that preserved ocular well being after a decade of diabetes contrasts with the “excessive incidence of retinopathy sometimes noticed in long-standing T2D.”
Iyengar additionally misplaced belly fats. Waist circumference fell from 92 cm to 80 cm, whereas lean physique mass was preserved. Weight fell from 69 kg to 63 kg early within the intervention after which remained steady.
He additionally reported higher sleep, improved vitality, much less gastrointestinal discomfort and higher musculoskeletal perform. Signs akin to GERD disappeared, tinnitus diminished, power fatigue resolved, and baseline musculoskeletal complaints improved and remained steady.
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Researchers urge warning however see relevance for South Asia
The researchers stress that that is an N-of-1 research that tracks only one individual. Meaning it can’t show the identical final result will happen in everybody with Sort 2 diabetes. “Findings can’t be extrapolated to broader populations,” the paper states. The authors add that the observations needs to be seen as “speculation producing relatively than as causal proof.”
That warning issues as a result of diabetes varies broadly between people. Not everybody can safely or sustainably undertake such diets with out medical supervision.
The research additionally says the topic was extremely motivated and carefully monitored. He saved meals logs, reviewed them weekly, attended month-to-month consultations, used steady glucose monitoring throughout disturbing or disruptive durations akin to journey and festivals, and underwent lab testing each three to 6 months.
The authors notice that remission possible persevered not from a food plan sheet alone however from “steady schooling, teaching, and monitoring, relatively than delivered as remoted dietary directions.”
Even so, the paper raises an essential query for South Asia, the place diabetes typically seems earlier, at decrease physique weights, and in settings the place lifelong treatment will be financially and virtually tough.
The authors say a reasonable low-carbohydrate plan constructed round native meals could also be extra possible than imported meal-replacement plans or extremely restrictive Western protocols.
“This research demonstrates {that a} culturally tailored, nutrient-dense, three section low-carbohydrate dietary intervention can obtain sturdy remission of T2D, restore metabolic flexibility, and protect long-term systemic security in a non overweight South Asian particular person,” the researchers wrote.
They add that about 100 grams of carbohydrate a day could supply a sensible bridge between the stronger metabolic results of stricter low-carb diets and the flexibleness wanted for long-term adherence.
(Edited by Dese Gowda)
