Successful treatment of a patient with obesity, type 2 diabetes and hypertension with the paleolithic ketogenic diet

Abstract

Introduction: Metabolic syndrome is a major public health problem affecting at least 20% of
the world’s adult population. Components of the metabolic syndrome include obesity, impaired glucose metabolism, hypertension and altered lipid profile. Currently, medical treatment relies on drugs. A major problem is that patients with long-standing disease are excessively medicated because of an increase in the number of symptoms over time. A few clinical studies indicate that low-carbohydrate diets, including
the paleolithic as well as the ketogenic diet, may be beneficial in the treatment of conditions
associated with the metabolic syndrome. Case Report: Herein, we present a case of patient with
metabolic syndrome successfully treated with the paleolithic ketogenic diet. While on the diet the
patient was able to discontinue eight medicines, lost weight, showed a continuous improvement
in glucose parameters and her blood pressure normalized. Currently, the patient is on the
paleolithic ketogenic diet for 22 months, free of symptoms and side effects. Conclusion: We
conclude that the paleolithic ketogenic diet was safe, feasible and effective in the treatment of
this patient with metabolic syndrome.

Full text

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Successful treatment of a patient with obesity,
type 2 diabetes and hypertension with the paleolithic ketogenic
diet
Csaba Tóth, Zsóa Clemens
SUMMARY
Metabolic syndrome is made up of a cluster of conditions including obesity, impaired insulin
sensitivity, hypertension and altered lipid prole. These conditions are also considered as risk
factors for type 2 diabetes and cardiovascular disease. Occurrence of these conditions is on
the rise worldwide despite of the increasing number of drugs used. There is evidence from the
literature indicating that intervention with low carbohydrate diets, including the paleolithic diet,
may be benecial in the metabolic syndrome. Except for one study with the paleolithic diet
these investigations are short in duration. Another limitation is that they do not give clues how
to deal with medications patients are treated with. Third, in these studies the paleolithic diet
did not produce ketosis which may limit the clinical effectiveness. Here we present a case of
a patient with metabolic syndrome and excessively medicated. The patient shifted toward the
paleolithic ketogenic diet and was able to discontinue medication, lost weight and her glucose
parameters markedly improved. Her hypertension normalized. Currently she is on the diet
for 22 months and show good adherence as also conrmed by laboratory tests. She is free of
symptoms and no side-effects emerged. Previously we reported cases with epilepsy and type
1 diabetes successfully treated with the same diet. We suggest that a dietary intervention with
the paleolithic ketogenic diet may be a simple, feasible and cost-effective method in some
forms of chronic disorders in highly motivated patients.
(This page in not part of the published article.)

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Int J Case Rep Images 2015;6(3):161–167.
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Tóth et al. 161
CASE REPORT OPEN ACCESS
Successful treatment of a patient with obesity,
type 2 diabetes and hypertension with the paleolithic
ketogenic diet
Csaba Tóth, Zsófia Clemens
ABSTRACT
Introduction: Metabolic syndrome is a major
public health problem affecting at least 20% of
the world’s adult population. Components of the
metabolic syndrome include obesity, impaired
glucose metabolism, hypertension and altered
lipid profile. Currently, medical treatment
relies on drugs. A major problem is that patients
with long-standing disease are excessively
medicated because of an increase in the number
of symptoms over time. A few clinical studies
indicate that low-carbohydrate diets, including
the paleolithic as well as the ketogenic diet,
may be beneficial in the treatment of conditions
associated with the metabolic syndrome. Case
Report: Herein, we present a case of patient with
metabolic syndrome successfully treated with the
paleolithic ketogenic diet. While on the diet the
patient was able to discontinue eight medicines,
lost weight, showed a continuous improvement
in glucose parameters and her blood pressure
normalized. Currently, the patient is on the
paleolithic ketogenic diet for 22 months, free
of symptoms and side effects. Conclusion: We
conclude that the paleolithic ketogenic diet was
Csaba Tóth1, Zsófia Clemens2
Affiliations: 1MD, Medical Director, Paleomedicina Hungary
Ltd. Evolutionary Medicine Working Group, Budapest,
Hungary; 2PhD, Senior Researcher, Neurological
Department, University of Pécs, Pécs, Hungary,
Paleomedicina Hungary Ltd. Evolutionary Medicine Working
Group, Budapest, Hungary.
Corresponding Author: Zsófia Clemens, Department of
Neurology, University of Pécs, Rét u. 2, H-7623, Pécs,
Hungary; Ph: 003672535900; Email: clemenszsofia@gmail.
com
Received: 11 December 2014
Accepted: 13 January 2015
Published: 1 March 2015
safe, feasible and effective in the treatment of
this patient with metabolic syndrome.
Keywords: Diabetes, Hypertension, Metabolic
syndrome, Obesity, Paleolithic diet, Paleolithic
ketogenic diet
How to cite this article
Tóth C, Clemens Z. Successful treatment of a patient
with obesity, type 2 diabetes and hypertension with
the paleolithic ketogenic diet. Int J Case Rep Images
2015;6(3):161–167.
doi:10.5348/ijcri-201530-CR-10491
INTRODUCTION
Obesity, type 2 diabetes and hypertension represent a
major health problem. These conditions are components
of the metabolic syndrome affecting every fifth adult
worldwide [1]. Although it is now acknowledged that
type 2 diabetes and hypertension mostly result from
lifestyle factors but medical treatment continues to rely
on drugs [2]. Symptoms of the metabolic syndrome
typically show up in mid-life but the number of co-
morbidities are increasing through later years. Typically,
symptoms are controlled with an increasing number of
drugs. In parallel side effects are also increasing and
are usually controlled with additional medications. It is
a vicious circle. Currently, a major proportion of elderly
in the western world is overmedicated [3]. In sharp
contrast with this diseases of civilization are virtually
absent in contemporary hunter-gatherer societies [4].
It is suggested that chronic diseases of civilization result
from an evolutionary mismatch between our ancient
and current diet [5]. It was also suggested that a return
to an evolutionary adapted diet may be beneficial for
CASE REPORT PEER REVIEWED | OPEN ACCESS

International Journal of Case Reports and Images, Vol. 6 No. 3, March 2015. ISSN – [0976-3198]
Int J Case Rep Images 2015;6(3):161–167.
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Tóth et al. 162
health [5]. The paleolithic diet has previously been shown
to confer metabolic benefits in healthy as well as in
patients with metabolic syndrome [6–10]. Voegtlin, first
proponent of the human evolutionary diet, suggested
an animal fat-meat based diet as being evolutionary
adapted [11]. Recently, we reported successful treatment
of patients with epilepsy [12] and type 1 diabetes [13]
with the paleolithic ketogenic diet. The diet we refer to
as the paleolithic ketogenic diet is close to the meat-fat
based diet originally proposed by Voegtlin [11]. Herein,
we report on a patient with obesity, type 2 diabetes
and hypertension whose excessive medication could be
discontinued and clinical parameters associated with the
metabolic syndrome markedly improved.
CASE REPORT
Previous medical history
The patient’s previous medical history included
gallbladder surgery in 1987 due to choledocholithiasis
and chronic cholecystitis. Hyperglycemia and impaired
glucose tolerance was first demonstrated on 24 February
2004. Due to bloody stool Weber test was performed
on 25 August 2006 which showed positivity. Therefore,
colonoscopy was performed on 19 September 2006 which
indicated a 2-cm polyp in the sigmoid colon. Irrigoscopy
performed on 25 September 2006 confirmed the above
mentioned polyp and also indicated dilation of the colon
as well as sigmoid diverticulosis. The polyp was removed
on 6 November 2006. Histopathology from this specimen
showed tubulovillous adenocarcinoma in polyp (Grade 1).
Resection margins were negative. Gastroscopy performed
on 21 September 2006 indicated reflux esophagitis and
erosive gastritis. Gastroscopy follow-up, three years
later, on 26 January 2009 indicated reflux esophagitis
but no evidence of gastritis. A next gastroscopy follow-
up on 26 January 2011, showed reflux esophagitis and a
5-mm gastric polyp which was removed. Histopathology
from this sample showed no abnormalities. A subsequent
gastroscopy performed on 14 March 2013 showed reflux
esophagitis. Colonoscopy follow-up on 26 January 2007
demonstrated dilation of colon. Subsequent colonoscopy
examinations on 27 August 2007, 25 August 2008, 31
August 2009 and 15 April 2013 were able to examine
the colon until the transversus lienalis and showed no
alterations. A computed tomography (CT) colonography
on 27 April 2011 was negative too.
On 10 December 2009, she experienced pressing pain
behind the sternum. Echocardiography on 14 December
2009 showed impaired left ventricular diastolic function
as well as aortic and mitral insufficiency.
A routine ophthalmological examination on 01 June
2006 showed crossing phenomenon and hyperemic
macula, ocular signs of hypertonia and diabetes. Follow-
up ophthalmology examination on 20 May 2009 and
on 21 May 2010 showed angiopathy while follow-up
examinations on 18 May 2012 and 30 July 2013 indicated
angiopathy as well as retinopathy.
Medications
Due to elevated blood glucose parameters and
high blood pressure from 01 March 2005 onwards
the patient was treated with acarbose, ramipril and
hydrochlorothiazide. On 02 November 2006 pantoprazole
was added because of reflux esophagitis revealed by
gastroscopy. Due to increases in blood glucose from 23
August 2007, the patient was also taking metformin.
On 14 December 2009 bisoprolol was added because of
high blood pressure. Following the cardiological event
acetylsalicylic acid was prescribed on 15 April 2010. From
28 October 2010, the patient was prescribed amlodipine
due to high blood pressure. The number and the names
(active substance) of the medications taken through the
course of the disease and the associated 90-min glucose
are indicated in Figure 1.
Paleolithic ketogenic diet
We first met the 65-year-old female on 30 January
2013. She was overweight (BMI 37.1, height 160 cm, weight
95 kg), had high blood sugar and frequent high blood
pressure spikes despite antidiabetic and antihypertensive
medication. At this time her systolic blood pressure was
between 130 and 160 mmHg and diastolic blood pressure
between 70 and 85 mmHg. Her fasting glucose level was
between 144 and 162 mg/dL. Altogether she was taking
eight medicines. The patient was motivated in weight loss
and in the reduction of her medication. She was advised
to start the paleolithic ketogenic diet. She was suggested
a diet consisting of at least 70% animal-based food with
a fat : protein ratio of at least 2:1. Fat and red meats were
preferred over lean meats. Offals meat were encouraged
to ensure adequate intake of vitamins. No more than
30% of the diet was suggested as plant-derived food
including root vegetables and small amounts of fruit.
Dairy, cereals, grains, legumes, solanaceous vegetables,
plant oils (including coconut oil), artificial sweeteners
and foods with additives were not allowed. In addition
to the paleolithic ketogenic diet, she was taking 2000
IU of vitamin D3 for four months then it was stopped.
No other vitamin or mineral supplements were used.
Typical foods the patient was eating include broth, stew,
fried bacon, beef steak, stewed calf liver, braised pork
marrow, greaves. Vegetables consumed as garnish were
limited and typically included root vegetables, onion and
cabbage.
Upon diet commencement (on the third day of the
diet) all medications were stopped promptly except for
bisoprolol which was discontinued within two weeks.
The patient was controlled tightly during the first weeks
of the diet. In case of high blood pressure, she was
advised to take captopril, a short-acting antihypertensive.
Laboratory workup was performed regularly (eight
times during 22 months on the diet) in order to control
adherence to the diet and to give feedback to the patient
(Table 1). All urinary analyses were positive for ketones.
While on the paleolithic ketogenic diet blood glucose

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Tóth et al. 163
Table 1: Laboratory parameters between 2004 and 2014. The red line indicates onset of the paleolithic ketogenic diet. Note that in
spite of the withdrawal of eight medications her blood glucose parameters and triglyceride decreased. Dashes indicate that a given
parameter was not measured.
Glucose
(mg/dL)
90-min
glucose
(mg/
dL)
HgA1c
(%)
Triglyceride
(mmol/L)
Cholesterol
(mmol/L)
HDL
(mmol
/L)
LDL
(mmol
/L)
Uric
acid
(mmol
/L)
ESR
(mm/h)
Urinary
ketone
Number of
medications
2004 24 Feb 133 165 – – – – – – – – 0
16 Jun 114 – 5.7 – 4.07 – – – – negative 0
30 Sep 126 – – 1.16 6.47 – – 209 12 – 0
2005 1 Mar 137 154 6 1.48 5.63 – 3.88 159 19 negative 0
28 Jul 126 126 6.2 1.25 4.08 1.2 2.31 268 37 negative 3
2006 11 Jul 139 143 6.3 0.77 5.22 1.3 3.5 179 17 positive 3
02 Nov 149 92 6.2 1.72 5.42 1.08 3.56 241 17 negative 3
2007 13 Feb 130 117 6.12 1.4 6.38 1.62 4.12 277 negative 4
17 May 126 – 5.6 1.18 5.56 0.95 4.07 324 23 negative 4
23 Aug 150 125 – 1.48 6.02 1.15 4.2 258 32 negative 4
29 Nov 116 81 5.03 1.64 5.61 1.03 – – – – 5
2008 11 Mar 129 120 5.6 2.38 5.95 1.23 – 284 21 negative 5
24 Jun 128 102 6.2 2.37 6.9 1.73 4.09 268 25 negative 5
09 Oct 106 – 6 2.06 6.1 1.55 3.61 222 34 – 5
2009 15 Jan 141 121 6.3 3.6 6.1 – 3.06 293 35 negative 5
09 Apr 105 110 – 1.56 5.1 1.1 3.29 348 30 negative 5
09 Jul 105 90 6 1.97 5.6 – 3.51 – 24 negative 5
13 Oct 106 99 5.5 1.76 5.2 1.51 2.89 – 29 negative 5
2010 14 Jan 115 103 6.3 1.78 5.2 1.23 3.16 – 19 negative 6
15 Apr 110 97 6.3 1.48 5 – 3.15 249 15 negative 6
27 Jul 112 97 6.76 1.34 5.6 – 3.54 207 24 negative 7
28 Oct 119 115 6 1.62 6.1 1.16 4.2 – – – 7
2011 01 Feb 133 146 6.6 2.31 6.4 1.26 4.09 378 20 negative 8
05 May 114 117 6.2 2.53 5.1 1.14 2.81 – – – 8
16 Aug 132 146 6.7 2.01 5.8 1.26 3.63 305 26 negative 8
17 Nov 124 119 6.9 1.99 5.9 1.29 3.71 – – negative 8
2012 21 Feb 151 173 7.2 2.12 5.3 1.03 – 419 45 negative 8
12 Mar 123 – – – – – – – 25 – 8
22 May 124 164 7 1.76 5.6 1.19 3.61 300 23 negative 8
06 Sep 150 173 7.1 2.88 6.7 1.28 4.11 – – – 8
18 Dec 159 137 – 1.49 6 1.2 4.12 217 21 negative 8
2013 26 Mar 128 114 6.4 1.14 5.3 1.29 3.49 – – – 0
13 Jun 139 123 6.8 0.77 4.5 1.22 2.93 282 8 positive 0
10 Sep 139 123 6.9 1.09 4.8 1.32 2.98 238 18 positive 0
09 Oct 110 – – – – – – – – – 0
19 Dec 108 114 7 1 4.51 1.52 2.54 274 20 positive 0
2014 05 Mar 118 – – 0.69 5.12 – – 297 – positive 0
10 Jun 121 108 6.8 0.96 4.8 1.23 3.13 248 15 positive 0
04 Dec 108 99 6.5 1.6 5.7 1.19 3.78 274 9 positive 0
Abbreviations: HgA1c glycated hemoglobin, HDL high density lipoprotein, LDL low density lipoprotein, ESR erythrocyte
sedimentation rate

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Tóth et al. 164
level, 90-min glucose on the glucose tolerance test, HgA1c
and total cholesterol levels decreased as compared to
previous measurements. Triglyceride levels also dropped
markedly as well as inflammatory markers including
erythrocyte sedimentation rate. A statistical analysis
(t-test) comparing laboratory measures during the two
years of the paleolithic ketogenic diet and during the
previous nine years on a normal diet revealed a significant
decrease for HgA1c (p=0.02), cholesterol (p=0.01)
and triglyceride (p=0.003). Typically, the patient had
two meals a day. She tracked glucose levels daily both
preprandially and postprandially before and after the
first meal of the day. The patient reported to strictly
adhere to the diet insofar not consuming non-paleolithic
food at all. At the same time she admitted having some
difficulties with fruit restriction and reported that her
spikes in blood sugar (Figure 2) and blood pressure to
be associated with these events of excess fruit intake.
Nevertheless home monitoring of glucose showed a clear
decreasing trend both preprandially and postprandially
between February 2013 and June 2014 (Figure 2). Then
due to the normalization of blood glucose she measured
blood glucose levels only occasionally. While on the diet
she also reported a decreasing tendency in the frequency
of high blood pressure spikes. At the time of writing this
case report, she had no high blood pressure spike for
six months. Despite no vitamin D supplementation, her
winter time vitamin D level (on 05 March 2014) was in the
normal range (85 nmol/L). The patient did not perform
exercise while on the paleolithic diet.
Currently, she is on the diet for 22 months. While on
the diet her weight changed from 95 kg to 81 kg and she
is still losing weight. Her BMI changed from 37.1 to 31.6.
She reported increased physical fitness and to be free of
symptoms. The patient gave written informed consent for
publication of her case.
DISCUSSION
Recent clinical studies show that low-carbohydrate
diets including the paleolithic diet are beneficial in
conditions associated with the metabolic syndrome
[6–10]. In the current medical practice, patients with
metabolic syndrome are generally treated with numerous
drugs. Yet studies available on the paleolithic diet does
not give clues how to deal with preexisting medications
when shifting towards the paleolithic diet. Our experience
indicate that upon the shift towards the paleolithic
ketogenic diet most drugs become unnecessary and
should be discontinued [14].
Herein, we analyzed past medical history of a patient
with metabolic syndrome to reveal how her medication
might have contributed to the worsening of her disease
and how disease was influenced by the paleolithic
ketogenic diet.
This case represents a typical disease career of a patient
with metabolic syndrome. Her medical history included
elevated glucose parameters and hypertension initially
controlled with oral antidiabetics and antihypertensives
in 2005. Then with the emergence of new diagnostic
findings pantoprazole was added. Two years later
metformin was added to support glucose metabolism.
Nevertheless glucose control deteriorated again in
2011 following the addition of three new drugs. These
included bisoprolol, acetylsalicylic acid and amlodipine.
Bisoprolol and amlodipine, which belong to beta-blocker
and calcium channel blocker type antihypertensives,
respectively, are known for their effect to adversely affect
glucose metabolism [15, 16]. Glucose parameters further
deteriorated in 2012.
Current guidelines first advise lifestyle changes and
exercise to treat the metabolic syndrome and to induce
Figure 2: Glucose levels preprandially and postprandially while
on the paleolithic ketogenic diet between February 2013 and
June 2014. Due to normalized blood glucose levels later on the
patient measured blood glucose only occasionally.
Figure 1: Time course of 90-min glucose level in the glucose
tolerance test and the number as well as the names of the
medications (active substance) between 2004 and 2014. Note
that 90-min glucose levels first tended to decrease with the use
of oral antidiabetics. Then from 2011 90-min glucose levels
increased again. We attribute decreased glucose tolerance to
the use of bisoprolol and amlodipine drugs known for their
diabetogenic effect. From January 2013 the patient shifted
toward the paleolithic ketogenic diet and was able to discontinue
all eight medications. In parallel 90-min glucose levels returned
to normal.

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Tóth et al. 165
weight loss [1]. Yet these dietary advices usually remain
without effect [17]. Also, overweight people are unable to
exert considerable physical activity. Therefore, patients
are prescribed medications. A main problem is that in
current medical practice each component of the metabolic
syndrome is treated separately even though targeting one
symptom by a drug may worsen another symptom also
associated with the metabolic syndrome. Therefore, the
number of drugs as well as side effects are increasing.
Our patient was overweight and was taking eight
medicines. When shifting towards the paleolithic
ketogenic diet she was able to discontinue all medications.
Her weight begin to decrease along with improving
glucose parameters and lowered blood pressure. Our
experience with patients on the paleolithic ketogenic diet
indicate that the use of antihypertensive drugs hinder
the normalization of glucose levels and weight loss [14].
Also, antihypertensive drugs become unnecessary since
the paleolithic ketogenic diet efficiently lowers high blood
pressure. In this case, antihypertensive drugs could be
discontinued because the patient had no atherosclerosis.
In those cases, with atherosclerosis antihypertensives
may be discontinued only within a longer time period. The
blood pressure lowering effect of the paleolithic ketogenic
diet is due to the fact that the paleolithic ketogenic diet
limits those food components which result in elevated
blood pressure. These components mainly include fruits
and foods with added fructose. Drop in blood pressure was
also reported in previous studies with the paleolithic diet
[6, 8]. Our experience with patients with hypertension
indicate that as compared to the paleolithic diet which
does not limit fruits and vegetables, the paleolithic
ketogenic diet more efficiently normalize blood pressure.
Given that in the paleolithic ketogenic diet carbohydrate
intake is strongly limited less insulin is required for
normoglycemia and therefore oral antidiabetics become
unnecessary.
While on the paleolithic ketogenic diet home
monitoring of glucose in our patient showed a decreasing
tendency both preprandially and postprandially.
Laboratory measurements also showed a decreasing
tendency in glucose parameters and triglyceride
normalized too. Total cholesterol and LDL cholesterol
tended to decrease while HDL cholesterol remained
relatively unchanged. Uric acid remained in the normal
range while on the paleolithic ketogenic diet. These
laboratory parameters are similar to those in our two
previous cases on the paleolithic ketogenic diet [12, 13].
All six urinary tests were positive for ketones indicating
a good adherence to the diet. The patient admitted to
occasionally exceed the advised limit for fruit. She also
linked excessed fruit intake to high blood pressure spikes
which is in accordance with literature data showing
high blood pressure to be associated with fructose [18].
Nevertheless our patient reported a decreasing tendency
of blood pressure across the 22 months.
Those patients who underwent gallbladder surgery are
advised against eating fatty foods and the ketogenic diet
too. Our patient, however, reported no gastrointestinal
side effects while on the paleolithic ketogenic diet. Of
note, her winter-time vitamin D level was normal in
spite of no vitamin D supplementation indicating that a
regular intake of offal, animal fat and meat may ensure
normal vitamin D status. Also, no signs of vitamin
or mineral deficiency emerged despite of the lack of
supplementation.
Currently, the patient is on the paleolithic ketogenic
diet for 22 months. No side effects emerged and she is
free of symptoms. She is resoluted to continue the diet.
CONCLUSION
The paleolithic ketogenic diet proved to be a safe,
feasible and effective therapy in this patient with
metabolic syndrome. Medications could be discontinued
and components of the metabolic syndrome improved
continuously. We used the paleolithic ketogenic diet in a
patient without a gallbladder indicating that, contrary to
the widely held notion, this organ is not a prerequisite for
maintaining a diet rich in animal fat. Neither vitamin nor
other supplements was used indicating the effectiveness
of the paleolithic ketogenic diet as a sole therapy.
*********
Author Contributions
Csaba Tóth – Substantial contributions to conception and
design, Acquisition of data, Analysis and interpretation
of data, Drafting the article, Revising it critically for
important intellectual content, Final approval of the
version to be published
Zsófia Clemens – Substantial contributions to
conception and design, Acquisition of data, Analysis
and interpretation of data, Drafting the article, Revising
it critically for important intellectual content, Final
approval of the version to be published
Guarantor
The corresponding author is the guarantor of submission.
Conflict of Interest
Authors declare no conflict of interest.
Copyright
© 2015 Csaba Tóth et al. This article is distributed under
the terms of Creative Commons Attribution License which
permits unrestricted use, distribution and reproduction in
any medium provided the original author(s) and original
publisher are properly credited. Please see the copyright
policy on the journal website for more information.
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ABOUT THE AUTHORS
Article citation: Tóth C, Clemens Z. Successful treatment of a patient with obesity, type 2 diabetes and hypertension
with the paleolithic ketogenic diet. Int J Case Rep Images 2015;6(3):161–167.
Csaba Tóth is physician from Hungary with 20 years experience in intensive care medicine, internal
medicine and family medicine. He is using the paleolithic-ketogenic nutrition in the treatment of chronic
medical illnesses including diabetes, cancer, autoimmune diseases and epilepsy for ve years. He is
operating private practice in Budapest and in a few other cities in Hungary. In 2013, he organized a
course on evolutionary medicine in the mandatory training of GPs at the University of Szeged, Hungary.
With an evolutionary medical attitude he strives for the full recovery of his patients.
E-mail: csaba@paleomedicina.com
Zsóa Clemens is biologist and clinical researcher specialized in nutrition, nutritional therapy and
brain research. She earned her PhD in electroencephalograpy of sleep and epilepsy from Semmelweis
University, Budapest, Hungary in 2005. Currently, she is Senior Research Fellow at the Neurological
Department, University of Pécs, Hungary and is also afliated with the Evolutionary Medicine Working
Group of Paleomedicina Hungary Ltd. In international academic journals, she has published 30
research articles with more than 500 citations. E-mail: clemenszsoa@gmail.com

International Journal of Case Reports and Images, Vol. 6 No. 3, March 2015. ISSN – [0976-3198]
Int J Case Rep Images 2015;6(3):161–167.
www.ijcasereportsandimages.com
Tóth et al. 167
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