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At 1 year, 68 (46%) of 149 intervention participants were in remission and 36 (24%) had achieved at least 15 kg weight loss. Studies evaluating intrapancreatic fat in relation to glucose metabolism and beta cell function in individuals with type 2 diabetes are scarce and provide conflicting data, possibly due to the largely heterogenous distribution of fat within the pancreas . While both diet groups in the present study achieved reductions in HbA1c levels during weight loss, the CRHP diet reduced HbA1c levels significantly more than the CD diet. Weight loss achieved by a standard diabetes diet has been shown to ameliorate abnormalities in glucose metabolism and decrease HbA1c [2, 12], particularly when at least 5% of initial body weight is lost . Both groups achieved improved glucose profiles after weight loss compared with the baseline habitual diet (Table 3). 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Urinary excretion of acetone (a ketone body) is increased in phloridzinised dogs and fasting rats after feeding with acetic acid (MacKay et al., 1940). Thus, they bypass the usual route of absorption (for the more common long-chain fatty acids) into the lymphatics and deposition into the bloodstream via the subclavian vein, and instead, are transported via the hepatic portal vein to the liver where they can be converted into the ketone bodies (Bugaut, 1987; Bourassa et al., 2016; Stilling et al., 2016). The authors postulated that this could be due to the ketogenic effect of leucine, but may also result from a greater availability of BCAAs (Evangeliou et al., 2009). Adaptation to a VLCKD, or ‘keto-induction’, and the achievement of NK, when transitioning from a standard, higher carbohydrate diet, can cause various unpleasant effects (Hartman & Vining, 2007). So, while the achievement of ketosis has been described in the medical literature, there are inconsistencies in the measurement of, and definition for ketosis in these papers. Other studies have measured either tangentially or directly, the achievement of ‘ketosis’ but have not specifically identified the time at which a level of ≥0.5 mmol L−1 was achieved. The process of ketogenesis further allows coenzymes to be freed to ensure continued fatty-acid β-oxidation (Lehninger, Cox & Nelson, 2008). Ketosis refers to the production of ketone bodies, derived from fats (and some amino acids) for use as an alternative fuel in times of fasting or drastic carbohydrate restriction. This demonstrated that butyric acid is more ketogenic than either leucine or an 8-chain monoglyceride. Several methods have been suggested as useful for encouraging entry into nutritional ketosis (NK) and reducing symptoms of keto-induction. 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