Background: Type 2 diabetes (T2D) is traditionally managed as an irreversible disease with escalating polypharmacy. However, evidence increasingly shows that durable remission is achievable. Aim: This review synthesises evidence for T2D reversal, exploring pathophysiological mechanisms and clinical interventions that achieve remission, while addressing barriers to this paradigm shift. Methods: A narrative literature review was conducted across major academic databases focusing on T2D remission, beta-cell dedifferentiation, the twin cycle hypothesis, and clinical interventions like bariatric surgery, very-low-calorie diets and carbohydrate restriction. Results: T2D is primarily a disease of beta-cell dysfunction and dedifferentiation driven by chronic metabolic stress, not permanent cell death. Initiated by peripheral insulin resistance and hyperinsulinaemia, it culminates in glucolipotoxicity from ectopic fat in the liver and pancreas (the twin cycle hypothesis). Crucially, this process is reversible. Clinical trials demonstrate significant remission rates through weight loss and lifestyle interventions. The DiRECT trial achieved 46% remission at 1 year via very-low-calorie diets. Carbohydrate restriction models (e.g. Virta Health) showed 17.6% remission at 2 years with significant medication reduction. Bariatric surgery provides further proof of principle with up to 80% remission. Despite this, clinical inertia and systemic barriers slow the adoption of reversal as a primary goal. Conclusion: T2D is a reversible metabolic condition. Clinical management must shift from lifelong symptom management to strategic reversal of underlying pathophysiology through interventions that reduce insulin demand, clear ectopic fat and restore metabolic health. Contribution: This review provides an evidence-based framework for implementing T2D reversal in clinical practice, advocating for a new standard of care.
Background: United States (US) veterans face high rates of obesity and type 2 diabetes (T2D), with traditional interventions like VA MOVE! achieving limited success. Non-prescriptive low-carbohydrate (LC) nutrition education may offer a scalable alternative but remains under-evaluated. Aim: To describe metabolic outcomes observed following the introduction of informal LC nutrition education among veterans with obesity, prediabetes or T2D in a rural Veterans Affair (VA) primary care clinic. Setting: This clinical audit was conducted in a rural Veterans Affairs primary care clinic at the Martinsburg Veterans Administration Medical Center, where LC nutrition education was delivered during routine care visits without structured programming or additional clinical resources. Methods: A retrospective audit at the Martinsburg Veterans Administration Medical Centre included 481 veterans with obesity, prediabetes or T2D who received informal LC education during a routine primary care visit. No structured protocol was used. Metabolic markers were measured at baseline and at the final visit, with an average of 10 months later. All eligible patients receiving education were included. Results: Following introduction of the LC education approach, there was a statistically significant reduction in hemoglobin A1c (HbA1c) and weight, as well as discontinuation or reduction of insulin in 23 or 38 insulin-using veterans and of non-insulin glucose-lowering medications in 45 of 123 veterans. These reductions occurred in the context of an average 10-pound weight loss and a mean HbA1c reduction of 0.43% in those with prediabetes or T2D. Additionally, there was a statistically significant reduction in diastolic blood pressure (BP), triglycerides and the triglyceride-to-high-density lipoprotein (HDL) ratio, along with a 4.2-point increase in HDL cholesterol. Discussion: Observed improvements in metabolic markers and medication use suggest that informal LC education may be a promising low-burden approach within primary care settings. Larger randomised trials are needed to assess scalability and long-term outcomes. Conclusion: Informal low-carbohydrate nutrition education may represent a feasible and scalable approach to improving metabolic health and reducing medication burden among veterans. Further controlled studies are needed to confirm these findings and assess long-term outcomes, adherence, and generalisability.
Low-carbohydrate dietary approaches are increasingly explored as adjunctive strategies for Crohn’s disease (CD), particularly in patients who experience limitations or adverse effects with standard biologic therapies. Dietary intervention (DI) may offer a non-pharmacological option to support symptom control and remission. Evidence remains limited, particularly at the individual clinical level. This single-patient, retrospective case report describes an adult with established CD who initiated a therapeutic carbohydrate-restricted diet under clinical guidance. The intervention was implemented as part of ongoing disease management and followed longitudinally during routine care. Clinical outcomes were assessed through symptom patterns, medication use, and sustained follow-up over an extended observation period. Following initiation of the carbohydrate-restricted dietary approach, the patient achieved remission of gastrointestinal symptoms and progressively discontinued pharmacologic therapy. Symptom recurrence was temporally associated with lapses in dietary adherence and resolved promptly upon resumption of the intervention. Sustained adherence was related to continued symptom control and medication independence throughout follow-up. This case suggests that therapeutic carbohydrate reduction may support remission and medication discontinuation in select individuals with CD. The findings underscore the need for controlled clinical trials to evaluate the safety, durability and generalisability of DIs in inflammatory bowel disease. Dietary strategies may represent a complementary avenue for individualised disease management.
Background: Adoption of a very low-carbohydrate (VLC) approach to aid in type 1 diabetes (T1D) management has recently gained momentum; however, there is limited research to guide its optimal implementation and concerns about sustainability and safety. Aim: This study characterises the lived experiences of adult patients and caregivers of children with T1D who follow a VLC approach and patients’ diabetes medical providers (DMPs). Setting: Online surveys were fielded internationally to members of the Facebook group TypeOneGrit who follow the VLC approach. Methods: We performed applied thematic analysis of data based on responses to six open-ended survey questions. Multidisciplinary consensus coding was conducted, culminating in iterative higher-level qualitative analysis to generate a thematic depiction of participant experiences. Results: A total of 931 responses from 155 adult patients, 112 caregivers and 61 DMPs were included. Analysis yielded four cluster themes: (1) Predominantly negative patient and caregiver experiences within the medical system with regard to the VLC approach, (2) mainly positive patient and caregiver experiences with the VLC approach despite challenges, (3) desire for widespread dissemination of information on the VLC approach and (4) acknowledgement of the positive attributes of the VLC approach and/or patient or family by DMPs, amid DMP concern over potential or encountered adverse outcomes. Conclusion: This study produced valuable insights on the perceptions and experiences of adult patients, caregivers of children with T1D and patients’ DMPs with regard to the VLC approach. Contribution: The VLC approach can be a viable adjunctive method for T1D management but requires increased understanding and support.
This Table of Contents reflects the print compilation of peer-reviewed articles published in the journal. Each article listed was originally published online under the journal’s open access model and remains individually accessible and citable. This compilation has been created solely for print distribution, reference, and archival purposes. No new research content is introduced. The publisher affirms that all articles included in this compilation have undergone the journal’s standard editorial and peer-review processes.
Metabolic syndrome and food addiction frequently co-occur in clinical settings and mutually reinforce each other through overlapping biological pathways. Compulsive overeating in metabolic syndrome is associated with worsening insulin resistance and lipid profiles, while food addiction exacerbates metabolic dysfunction. Converging evidence highlights the roles of insulin and leptin resistance, endocannabinoids, inflammation and altered gut–brain signalling in sensitising reward circuits. Despite validated tools, few studies examine food addiction symptoms and detailed metabolic profiles together. Targeted interventions may improve both conditions. These shared pathways suggest new avenues for individualised treatment and risk assessment.
Background: Metabolic syndrome is a burgeoning global concern that predisposes individuals to cardiovascular diseases and shares a complex bidirectional relationship with type 2 diabetes mellitus (T2DM). Its prevalence and associated risk factors among T2DM patients vary across populations depending on diagnostic criteria. Aim: This study aimed to determine the prevalence, components and predictors of metabolic syndrome among T2DM patients. Setting: The medical outpatient department of Nelson Mandela Academic Hospital, Mthatha, Eastern Cape province, South Africa. Methods: A cross-sectional study was conducted among 142 patients with T2DM. Data on demographic, anthropometric, haemodynamic and biochemical parameters were collected using a structured questionnaire. Metabolic syndrome was defined according to the International Diabetes Federation (IDF) criteria. Variable-specific standardised descriptive and inferential statistics were computed using SPSS 29. Results: The prevalence of metabolic syndrome was 83.8%, with high rates among females (90.3%). Among males, hypertension (84.2%) and low high-density lipoprotein cholesterol (88.6%) were the most common components, whereas females exhibited higher rates of abdominal obesity (98.1%), hypertriglyceridaemia (83.3%) and dyslipidaemia (84.2%). Abdominal obesity was the predominant risk component (129 [90.8%]). Poor glycaemic control was evident with 111 (83.5%) participants having a glycosylated haemoglobin of 7% or higher. Predictors of metabolic syndrome were obesity in males (odds ratio [OR]: 28.34, 95% confidence interval [CI]: 2.23–359.80, p = 0.010) and dyslipidaemia in females (OR: 59.06, 95% CI: 3.46–1007.16, p = 0.005). Conclusion: Metabolic syndrome was highly prevalent, with abdominal obesity as the predominant risk component. Obesity and dyslipidaemia were significant predictors, and diabetes remained poorly controlled in a large proportion of patients. Contribution: This study is the first to report on the prevalence, main risk components and predictors of metabolic syndrome among T2DM patients in a typical rural South African population.
Nickel, a ubiquitous trace metal, is a common contact allergen that, for some people, can also be systemic, resulting primarily in cutaneous and gastrointestinal (GI) symptoms. This article presents a narrative review of the relevant literature on systemic nickel allergy syndrome and low-nickel diets (LNDs) and reports an autobiographical case of a 45-year-old male with a 25-year history of Crohn’s disease (CD) and contact nickel allergy. The case details the identification of systemic nickel allergy and the treatment of symptoms related to CD with a LND, implemented using a nickel points scoring system. During the initial 4-week implementation period, considerable reductions in cutaneous (dyshidrotic eczema), GI symptoms and systemic pain were observed. Specifically, the frequency of bowel movements decreased from approximately six or more per day to around three or fewer, and back and neck pain severity dropped drastically from a baseline average of 8 (on a 1–10 scale) to 2. These findings, along with ancillary improvements in mood and overall well-being, were concurrent with the use of the LND and have remained consistent and sustained at the time of writing, approximately 8 months later. Various diets that are, by nature, low in nickel content have shown promise for the treatment of CD, and this literature review and case report suggest a hypothesis that their efficacy may be related to reduced nickel intake.
This Table of Contents reflects the print compilation of peer-reviewed articles published in the journal. Each article listed was originally published online under the journal’s open access model and remains individually accessible and citable. This compilation has been created solely for print distribution, reference, and archival purposes. No new research content is introduced. The publisher affirms that all articles included in this compilation have undergone the journal’s standard editorial and peer-review processes.
Dental caries is an easily identifiable marker of poor metabolic health. The proposed model of dental caries aetiology portrays the caries process as both a local response and systemic hormonal and metabolic responses to diet-driven mitochondrial dysfunction and metabolic dysregulation. The prevention of dental caries through the life course should become a global healthcare priority and may assist in the prevention of chronic disease through the lifespan.
Research publications on the ketogenic diet have experienced an exponential increase in recent years, driving clinical interest, which has expanded along with media interest. The ketogenic diet, originally developed as an epilepsy treatment, has a broad range of applications that include metabolic disorders such as obesity, insulin resistance, and type 2 diabetes, and extends to a range of neurometabolic conditions such as neurodegenerative disorders and mental health conditions. The ketogenic diet promotes a state of nutritional ketosis that has unique benefits via multiple mechanisms. Heightened awareness of the potential benefits of a ketogenic diet has led to an increase in clinicians using this approach, and patients who are keen to explore this option may present having self-administered ketogenic diet therapy. Common misconceptions about the ketogenic diet abound on social media, causing confusion and distracting from its potential benefits, where nuance around diet quality and personalisation are key features of a successful implementation. By selecting common questions and misconceptions about the ketogenic diet from a social media platform, this article seeks to provide a concise, evidence-based guide to address these questions and support clinicians seeking to implement ketogenic diets in their practice.
Background: The very low carbohydrate diet (VLCHD) is gaining popularity as a therapy for metabolic syndrome. However, its effect on renal function in patients with comorbid moderate to severe chronic kidney disease (CKD) is currently unclear. Aim: This study analyses markers of kidney function in patients with metabolic syndrome and stages 3 and 4 CKD who undertook a VLCHD for at least 3 months. Setting: The study was conducted in a Mid North Coast general practice located in Port Macquarie, NSW, Australia, 2020–2022. Methods: Clinical data were analysed retrospectively from 18 participants with metabolic syndrome and CKD stages 3 and 4, who were prescribed a VLCHD ( 30 g carbohydrates/day). A linear mixed model was used to analyse markers of metabolic health (glycated haemoglobin (HbA1C), body mass index (BMI), blood pressure (BP), lipid profile (triglycerides and low-density lipoprotein cholesterol) and kidney function (estimated glomerular filtration rate (eGFR), serum creatinine, bicarbonate and urea)). Results: Strong evidence was found for reduced BMI (p 0.001) and HbA1c (p 0.001), despite reduced diabetic medications in 13/14 participants. Antihypertensive medications were reduced in 6/14 participants with no change in systolic BP. No changes were detected in eGFR or bicarbonate, while creatinine (p ≤ 0.001) and urea (p = 0.002) were reduced. No participants deteriorated to a more advanced stage of CKD; rather an absolute eGFR increase was found in 15/18 participants. Conclusion: For the first time, the VLCHD was demonstrated to reduce BMI, HbA1c, BP and medication burden in patients with CKD stages 3–4 without evidence of kidney damage. Contribution: The VLCHD could be a safe and effective therapy to improve metabolic health and consequently reduce cardiovascular disease risk in patients with metabolic syndrome and CKD.
This article presents the position of the Society of Metabolic Health Practitioners (SMHP) regarding therapeutic carbohydrate reduction (TCR) nutrition interventions for type 1 diabetes mellitus (T1DM). A modified Delphi methodology was used to arrive at a consensus consisting of several focus groups, multiple rounds, and an anonymous survey. The field of endocrinology has seen many new advances for the treatment of T1DM including hybrid closed-loop insulin delivery systems and continuous glucose monitors for better glycaemic control, monoclonal antibodies to delay the onset of disease and increased access to paediatric endocrinologists, among many other noteworthy achievements. Despite these advancements, standard of care approaches to T1DM result in higher than acceptable morbidity and mortality, with a high prevalence of microvascular and macrovascular complications. Insulin resistance in type 1 diabetes is an independent risk factor for adverse outcomes even in well controlled type 1 diabetes. In 2021, only 21% of adults with T1DM in the United States achieved the American Diabetes Association’s (ADA’s) target haemoglobin A1C goal of 7.0%, while data in the paediatric and adolescent population have demonstrated worse glycaemic control. Supported by observational and interventional evidence, the SMHP advocates for the reevaluation of the prevailing nutritional therapy for T1DM with more broad consideration for TCR. The SMHP recommends open access and clinical support for TCR nutrition interventions for individuals with T1DM of all ages and calls upon the medical community to help foster more attention and research on TCR for T1DM.
Background: The American Academy of Orthopaedic Surgeons (AAOS) has been recommending a weight loss of 5% of body weight or more as a treatment for those who have osteoarthritis (OA). However, the AAOS does not recommend or guide clinicians in the best weight loss strategies, leaving the clinician and the patients on their own to navigate the weight loss process. Aim: This scoping review addresses the most effective ways to reach the recommended weight loss and achieve symptomatic improvement through various methods, including diet, exercise, meal replacements and specific diet types, with or without the help of a trained professional. Methods: In a scoping literature review, this author investigated medication use, diet, exercise or a combination of diet and exercise as an effective method for weight loss to treat hip and knee osteoarthritis and whether the delivery method (i.e., telehealth or application-based versus in-person) played a role in the effectiveness of weight loss. Results: A loss of body weight between 10% and 20% results in more significant symptomatic improvement and is safe and effective with the help of a trained health care professional and meal replacement foods. Conclusion: A clear dose response exists between the amount of weight lost and symptomatic improvement, with better symptomatic improvement seen in patients losing more than the typically recommended 5% body weight. Contribution: This review shows that a weight loss of 10–20% of body weight through a low carbohydrate diet combined with exercise can effectively be used as symptomatic management of hip or knee osteoarthritis.
