Interestingly, considering the assumption that ketosis decreases portal insulin levels, down-regulating hepatic GHR and thus reducing IGF-I synthesis, a 2-weeks eucaloric very-low-carbohydrate ketogenic diet (35 g of carbohydrates, ~155 g of fat, ~115 g of protein/day) has been used in patients with uncontrolled acromegaly as adjuvant treatment to first-generation somatostatin receptor ligands. The gene discussed is IGF1; the disease is acromegaly.