Metabolic Outcomes and Lived Experience Following a Low-Carbohydrate Dietary Approach: A Mixed-Methods Case Study
1
The Noakes Foundation, Cape Town, South Africa
2
Health Science, Open University of Catalonia, Barcelona, Spain
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
Women living with hypothyroidism frequently experience weight gain, metabolic risk, and reduced quality of life despite pharmacological treatment. Low-carbohydrate (LC) dietary approaches are increasingly explored as a means of supporting metabolic health and self-management.
METHODS:
Four women with clinically diagnosed hypothyroidism participated in a longitudinal mixed-methods case study. Participants completed Nutrition Network online courses within two weeks, followed by a three-month supported implementation phase in 2024 that included biweekly focus group discussions to support application of LC dietary principles. Quantitative measures (body weight, waist circumference, fasting glucose, HbA1c, lipid profile, and thyroid function tests) were collected at baseline, post-intervention (3 months), and at 6 and 12 months. Qualitative data were collected in 2024 through individual interviews (July and October) and five fortnightly focus group discussions (July–October), and in 2025 through individual interviews (April and October) and three focus group discussions (May, August, and November). Data were analysed descriptively and thematically, with mixed-methods integration.
RESULTS:
Mean body weight decreased from 85.6 ± 11.2 kg at baseline to –4.1 ± 2.4 kg at 12 months, with three participants achieving sustained weight loss (–4.8 to –10.5 kg) and one returning to baseline weight. Waist circumference decreased by 2.6 ± 2.3 cm. Mean HbA1c improved from 5.35 ± 0.26% to 5.19 ± 0.24%, with modest reductions in triglycerides (–0.05 mmol/L). LDL cholesterol increased slightly (+0.33 mmol/L). Thyroid markers remained clinically stable, and one participant reduced thyroid medication under medical supervision. Qualitative findings showed progression from early uncertainty and social barriers (2024) to increased health literacy, self-efficacy, and lifestyle integration (2025), explaining variability in outcomes.
CONCLUSIONS:
This case study suggests that an LC dietary approach, supported through structured engagement, may facilitate sustained metabolic improvements while underscoring the importance of lived experience and context in long-term public health strategies for hypothyroidism management.
Women living with hypothyroidism frequently experience weight gain, metabolic risk, and reduced quality of life despite pharmacological treatment. Low-carbohydrate (LC) dietary approaches are increasingly explored as a means of supporting metabolic health and self-management.
METHODS:
Four women with clinically diagnosed hypothyroidism participated in a longitudinal mixed-methods case study. Participants completed Nutrition Network online courses within two weeks, followed by a three-month supported implementation phase in 2024 that included biweekly focus group discussions to support application of LC dietary principles. Quantitative measures (body weight, waist circumference, fasting glucose, HbA1c, lipid profile, and thyroid function tests) were collected at baseline, post-intervention (3 months), and at 6 and 12 months. Qualitative data were collected in 2024 through individual interviews (July and October) and five fortnightly focus group discussions (July–October), and in 2025 through individual interviews (April and October) and three focus group discussions (May, August, and November). Data were analysed descriptively and thematically, with mixed-methods integration.
RESULTS:
Mean body weight decreased from 85.6 ± 11.2 kg at baseline to –4.1 ± 2.4 kg at 12 months, with three participants achieving sustained weight loss (–4.8 to –10.5 kg) and one returning to baseline weight. Waist circumference decreased by 2.6 ± 2.3 cm. Mean HbA1c improved from 5.35 ± 0.26% to 5.19 ± 0.24%, with modest reductions in triglycerides (–0.05 mmol/L). LDL cholesterol increased slightly (+0.33 mmol/L). Thyroid markers remained clinically stable, and one participant reduced thyroid medication under medical supervision. Qualitative findings showed progression from early uncertainty and social barriers (2024) to increased health literacy, self-efficacy, and lifestyle integration (2025), explaining variability in outcomes.
CONCLUSIONS:
This case study suggests that an LC dietary approach, supported through structured engagement, may facilitate sustained metabolic improvements while underscoring the importance of lived experience and context in long-term public health strategies for hypothyroidism management.
| eISSN: | 2654-1459 |
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