The results of the diet were dramatic. His HbA1c fell from 7.2 percent to 5.2 percent without medicines during the first phase.
Published Mar 10, 2026 | 8:00 AM ⚊ Updated Mar 10, 2026 | 8:00 AM
HbA1c test for diabetes diagnosis. (iStock)
Synopsis: A case study has documented a South Asian man who kept Type 2 diabetes in remission for 10 years without medication after adopting a structured low-carbohydrate diet. His HbA1c fell from 7.2 percent at diagnosis to below 5.3 percent and remained stable for a decade, while other health markers such as heart, kidney, bone and eye health stayed normal during long-term follow-up.
A South Asian man kept Type 2 diabetes in remission for a decade without medication after changing his diet, a new case study says.
Published in Frontiers in Nutrition, the N-of-1 trial followed Shashikant Iyengar, who was diagnosed with Type 2 diabetes at age 49. After diagnosis, he adopted a carefully structured, culturally adapted low-carbohydrate diet and stopped diabetes medication. His HbA1c remained at or below 5.3 percent for 10 years.
The study describes the case as a 10-year, medication-free remission in a South Asian man who was not overweight by BMI but still faced metabolic risk.
Researchers led by Jasmeet Kaur in Punjab documented Iyengar’s case using an N-of-1 trial design, where a single patient serves as their own control to test how a specific treatment or diet affects their health.
When doctors diagnosed him in 2015, Iyengar had a fasting plasma glucose of 152 mg/dL, post-meal glucose of 253 mg/dL, and HbA1c of 7.2 percent, all in the diabetic range.
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Normal weight, but high metabolic risk
Despite a BMI of 22.5 kg/m², which is considered normal, the study says Iyengar fit the “metabolically obese but normal weight” (MONW) phenotype because he had central adiposity and a high waist-to-hip ratio. The authors wrote that these measures are “well-established predictors of cardiometabolic risk in South Asians”.
A person may appear to have a normal weight by BMI but still carry high internal metabolic risk because of fat distribution and underlying metabolic dysfunction.
At diagnosis, Iyengar also had several conditions linked to insulin resistance and poor metabolic health, including early fatty liver disease, osteoarthritis, frozen shoulder, cervical spondylosis, acid reflux, chronic fatigue, mild anxiety, mild depression and abdominal fat.
Before diagnosis, he followed a traditional South Indian vegetarian diet high in polished rice and fermented grains, with limited high-quality protein and little intake of omega-3 fats and some vitamins.
The authors wrote that this nutrient profile was “relatively deficient in essential amino acids, long-chain omega-3 fatty acids, and select fat-soluble vitamins”, which likely worsened post-meal blood sugar spikes and metabolic resilience.
The study says this case shows that diabetes risk is shaped not only by body weight but also by fat distribution, diet and underlying metabolic health.
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A decade-long three-stage diet plan
The intervention was not a one-size-fits-all ketogenic plan. The study describes a three-stage dietary approach over 10 years: an initial phase of moderate carbohydrate reduction, followed by a stricter ketogenic phase, and finally a long-term phase that reintroduced some carbohydrates.
From September 2015 to May 2016, Iyengar followed a diet with about 100 grams of carbohydrates a day, mainly from pulses, legumes, non-starchy vegetables, nuts and dairy products. Small amounts of low-glycaemic staples were allowed, and protein intake was kept at at least one gram per kilogram of body weight per day.
From June 2016 to December 2019, carbohydrate intake fell to below 30 grams a day. The diet emphasised green vegetables, eggs, dairy, nuts and seeds. Nutritional ketosis was periodically confirmed using urine ketone strips. Continuous glucose monitoring during this period “consistently demonstrated normoglycemia,” the study says.
From January 2020 to June 2025, carbohydrates gradually increased to about 100 grams a day. Each meal prioritised protein and included healthy fats. This phase also allowed culturally familiar foods such as fermented dosa, pulses and occasional small portions of cooked white rice. Even after carbohydrates were reintroduced to this level, the study says “normoglycemia was maintained throughout this phase without pharmacotherapy.”
The authors say this may be one of the most important takeaways from the case. Rather than saying everyone must stay on a strict ketogenic diet indefinitely, they say some people may maintain remission with a moderate, sustainable carbohydrate intake, especially if they start the intervention early and follow it carefully.
“Long-term stabilization with ~100 g/day carbohydrate intake was associated with sustained remission, improved glycemic variability, and preserved systemic safety,” the paper says.
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Blood sugar and insulin markers improved rapidly
The results of the diet were dramatic. Iyengar, speaking to South First, said his HbA1c fell from 7.2 percent to 5.2 percent without medicines during the first phase.
During the ketogenic phase, fasting insulin and HOMA-IR normalised, suggesting near-complete reversal of insulin resistance. HbA1c fell further to between 4.7 percent and 4.9 percent.
After carbohydrates were reintroduced to about 100 grams a day, remission still held. HbA1c stayed between 5.0 percent and 5.3 percent, mean glucose was around 109 mg/dL, and glucose monitoring showed more than 90 percent time in range.
The study found an unexpected pattern during the strict low-carb phase. Blood sugars were generally excellent, but the body showed a temporary exaggerated rise when challenged with carbohydrates.
During ketosis in 2016, a standardised carbohydrate challenge sent peak glucose to 215 mg/dL. In 2025, after structured carbohydrate reintroduction, the same dosa meal caused a peak of only 120–130 mg/dL. The authors say this was about 40 percent lower than during ketosis, which points to improved carbohydrate tolerance after reintroduction.
The study explains that this pattern may reflect “physiologic insulin resistance” during ketosis. In this state, the body becomes temporarily less efficient at handling sudden carbohydrate loads because it is adapted to burning fat. After carbohydrate reintroduction, the body appeared metabolically more flexible.
The authors write that this final phase “achieved the most favorable balance of metabolic control, dual-fuel flexibility, and cultural sustainability.”
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Heart, kidney, bone and eye health stable
The heart safety findings may attract more attention because low-carbohydrate diets often face criticism over cholesterol and cardiovascular risk.
In this subject, LDL cholesterol rose during the ketogenic phase and later stabilised at around 150 mg/dL. The study says this did not translate into visible cardiovascular damage.
Other markers remained reassuring. The ApoB/A1 ratio stayed in the protective range of about 0.8 to 0.9. Triglycerides stayed below 100 mg/dL over the long term, HDL remained modest but acceptable, and coronary artery calcium scores were zero in 2019, 2024 and 2025.
Coronary CT angiography in 2025 showed CAD-RADS 0, meaning no detectable plaques or stenosis. The paper says these findings “demonstrate the absence of atherosclerotic disease, despite a decade of T2D and long-term carbohydrate restriction.”
Another unusual finding was a fall in lipoprotein(a), a cardiovascular risk marker often considered largely genetic and difficult to modify.
In Iyengar, it fell from 43.4 mg/dL to 25.3 mg/dL over the decade. The authors describe this as “a particularly novel observation” and say it may link to the diet’s whole-food fat composition along with improved metabolic health.
Inflammation markers also stayed low. The subject’s hs-CRP remained below 1 mg/L throughout follow-up, including at diagnosis. Homocysteine stayed below 10 micromol/L with monitoring and vitamin B12 supplementation when needed.
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The study says this helps address a common criticism of long-term low-carb eating – that it may raise inflammation or cause micronutrient deficiencies. In this case, the researchers found no such deterioration.
Kidney function, another concern often raised with higher-protein diets, also remained stable. Creatinine, eGFR and cystatin C were tracked over time. The paper says these markers together confirm that “kidney health was maintained during long-term low-carbohydrate, higher-protein intake.”
Bone and eye health also appeared preserved. DXA scans showed normal lumbar spine bone mineral density, with only mild stable osteopenia at the femoral neck. There were no fractures.
Eye tests found no diabetic retinopathy, stable retinal nerve fibre layer, and no glaucoma or cataract. The paper notes that preserved ocular health after a decade of diabetes contrasts with the “high incidence of retinopathy typically observed in long-standing T2D.”
Iyengar also lost abdominal fat. Waist circumference fell from 92 cm to 80 cm, while lean body mass was preserved. Weight fell from 69 kg to 63 kg early in the intervention and then remained stable.
He also reported better sleep, improved energy, less gastrointestinal discomfort and better musculoskeletal function. Symptoms such as GERD disappeared, tinnitus diminished, chronic fatigue resolved, and baseline musculoskeletal complaints improved and remained stable.
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Researchers urge caution but see relevance for South Asia
The researchers stress that this is an N-of-1 study that tracks just one person. That means it cannot prove the same outcome will occur in everyone with Type 2 diabetes. “Findings cannot be extrapolated to broader populations,” the paper states. The authors add that the observations should be seen as “hypothesis generating rather than as causal evidence.”
That caution matters because diabetes varies widely between individuals. Not everyone can safely or sustainably adopt such diets without medical supervision.
The study also says the subject was highly motivated and closely monitored. He kept food logs, reviewed them weekly, attended monthly consultations, used continuous glucose monitoring during stressful or disruptive periods such as travel and festivals, and underwent lab testing every three to six months.
The authors note that remission likely persisted not from a diet sheet alone but from “continuous education, coaching, and monitoring, rather than delivered as isolated dietary instructions.”
Even so, the paper raises an important question for South Asia, where diabetes often appears earlier, at lower body weights, and in settings where lifelong medication can be financially and practically difficult.
The authors say a moderate low-carbohydrate plan built around local foods may be more feasible than imported meal-replacement plans or highly restrictive Western protocols.
“This study demonstrates that a culturally adapted, nutrient-dense, three phase low-carbohydrate dietary intervention can achieve durable remission of T2D, restore metabolic flexibility, and preserve long-term systemic safety in a non obese South Asian individual,” the researchers wrote.
They add that about 100 grams of carbohydrate a day may offer a practical bridge between the stronger metabolic effects of stricter low-carb diets and the flexibility needed for long-term adherence.
(Edited by Dese Gowda)
