Is a Keto Diet Really Necessary to Enable Healing of Insulin Resistance, the Main Cause of Type-2 Diabetes?

A ketogenic or keto diet is a diet that is very low in carbohydrates, high in saturated fats and has adequate protein and fibre, that is meant to induce ketosis, i.e. switch most of the body into the alternate metabolic pathway of buring fat derived ketone bodies, instead of the usual glucose metabolism. It is prescribed for people in the early stages of type-2 diabetes, and is also popularly called as the low carb, high fat (LCHF) diet. This ‘food as medicine’ approach is reported to work better than the usual drug regimen of insulin and metformin¹.

However, the keto diet is a radically different diet to the traditional diets that most people are used to. It is understandable to cut off the addictively tasty high sugar (sucrose), high glycemic index/high glycemic load foods like sweets, white rice, and the many tasty food stuffs made from refined wheat flour. But, the keto diet goes well beyond this and requires cutting out even ‘healthy’ carbs like brown rice, whole wheat, lentils and even millets. The only lentils allowed are sprouted green gram and sprouted chickpeas, due to the very low carbs in a typical portion. The other banned items are all the starchy vegetables that grow below ground: potatoes, carrots, etc. and also all fruits! This is a tall order.

Given these stringent requirements, and the approximately 3× higher expense² of the keto diet, the question arises:

Is it really necessary to go that far? Won’t just cutting out the tasty high glycemic index foods and excercising more regularly suffice?

To answer this, one needs to have a reasonably accurate model of how the body regulates blood glucose, and the breakdown of this regulation in type-2 diabetes.

Figure 1: Some of the main players in blood glucose regulation. Note how everything that is digested in the intestines first proceeds to the liver via the portal vein. Source: Wikipedia: Portal Vein

Figure 2: Skeletal muscle and fat tissues, the other main players in blood glucose regulation. Source.

The main players are the following:

• the digestive system
• muscles
• fat tissue
• liver
• pancreas

Ordinarily, the digestive system is the main source of glucose. The muscles and fat tissue can act as both sources and sinks of glucose.

The liver is a versatile converter organ that can convert:

• glucose to glycogen (compact glucose polymer) and vice versa,
• proteins into glucose (gluconeogenesis),
• saturated fats into their storage form triglycerides, and triglycerides back into glucose and fats, and,
• saturated fats into ketone bodies.

The pancreas is the controller or director. The control is applied via two opposite acting hormones: insulin and glucagon.

The pancreas senses the blood glucose concentration (BGC), and attempts to maintain this in a range of about 80-140 mg/dL (dL = 0.1L = 100mL). Approximately, if BGC goes above 140, insulin secretion is increased, and this insulin signals the liver, muscles and fat tissue to take up blood glucose and thus lower BGC.

On the other side, if BGC falls below about 80, usually after a few hours of fasting, insulin is reduced and glucagon secretion is increased and this signals the liver, muscles and fat tissue to release glucose. After the glycogen stores are depleted, usually after about 32 hours, the liver ramps up gluconeogenesis to produce glucose and it also produces ketone bodies which become the main source of fuel for all tissues expect (mainly) the brain.

In type-2 diabetes (T2D) this happily balanced situation breaks down in a couple of ways:

1. Over several years of gluttony and sloth, the muscles and fat tissues become resistant to responding to the insulin signal. Initially, the pancreas responds by increasing insulin secretion. But, a vicious spiral sets in. In parallel with the increasing doses of sugar needed to create the same level of pleasurable sensation, increasing production of insulin leads to increased insulin resistance and larger and larger doses of insulin are required to persuade these tissues to take up the same amount of blood glucose.
2. After several cycles of this fruitless increased insulin production and increased insulin resistance, the pancreas’ insulin producing cells get fatigued and insulin production drops.

When these two happen, usually in succession, the body loses its ability to control blood sugar and the symptoms of hyperglycemia (BCG > 200) and later T2D result.

Given the above mechanism for T2D, the suggestion arises: what if carbs are cut out from the diet? Won’t this lead to lower insulin production and over some time help to bring the sensitivity of muscle and fat cells to insulin back to their previous levels?

This is exactly the key idea behind the keto diet as a therapy to help heal T2D.

At this point we have most of the information needed to answer the question posed: is such a radical diet absolutely necessary?

First, let us see what happens when no carbs are eaten³:

Figure 3: Rate of glucose production by gluconeogenesis in the absence of dietary carbs. Source: Fuel Metabolism in starvation–Cahill-2006

A small amount of glucose is still needed by the body, about 5 gm/hr, mostly by the brain. As a sanity check, note that 5 gm/hr of glucose = 5*4 kcal/hr = 23.24 Watts⁴, which corresponds to the often quoted fact that the brain, while only 2% of body weight, consumes 20% of the total energy expenditure of about 100 Watts (2000 kcal/day). In the absence of carbs in the diet, this amount is produced via gluconeogenesis from stored and dietary protein and stored, not dietary, fat in the form of triglycerides. All of this glucose production is regulated mostly by glucagon. Only low to very low amounts of insulin are needed to modulate any BGC peaks produced by gluconeogenesis in excess of requirements. Such low levels of glucose production and associated low need for insulin production is what will maximize the chances for the body’s insulin resistance to heal.

At this point, it is worth mentioning the case of run away ketosis, which leads to the life threatening condition of keto acidosis. Ketosis, the production of ketone bodies from fats is usually well regulated by the joint action of glucagon and insulin. Glucagon acts like the accelerator pedal, while insulin as the brake pedal. High glucagon levels gets the process started, and even the lowered levels of insulin secretion in T2D is usually sufficient to regulate it and keep it from going out of control and causing keto acidosis. In type-1 diabetics, there is almost no insulin production and these people are at the highest risk to keto acidosis, and so a keto diet is not recommended for type-1 diabetics.

Figure 4: Table 1 from Beyond weight loss: a review of the therapeutic uses of ketogenic diets¹. Note the concentrations of insulin and ketone bodies (KBs) during normal regulated ketosis in column 3 vs. unregulated keto acidosis in column 4.

Next, let us see what happens when some “good” carbs are ingested by someone with T2D:

Figure 5: Carbs in Brown Rice. Source: Google/USDA

A typical serving of brown rice (1 rice cup ≈ 3/4 cup, 1 cup = 236.6 ml) contains about 109 gms of carbs and assuming it takes about 4 hours to be completely absorbed, can potentially provide 27 gm/hr, which is way above the fasting glucose production and consumption of 5 gm/hr in a keto regime. This extra glucose inflow from the large surface area of the intestines results in a BGC spike, which then requires turning off glucagon and turning insulin production back on to bring it down. Also, most of the body’s tissues will switch back from burning ketones to glucose. While this can bring down BGC, it also leads to increased production of ghrelin which causes a hunger for carbs, which if acted on, switches off ketosis completely. All this results again in hyperglycemia due the insulin resistance in T2D.

So, yes completely cutting out carbs is a necessary purgatory to allow insulin resistance to heal. In a well planned keto/LCHF diet, the only source of carbs comes from the (above ground) vegetables. These are necessary to provide a source of fibre to maintain a healthy gut bacteria culture and to also provide indispensible micronutrients. The total amount of carbs from typical servings of these vegetables is very low, about 20–30 gm/day. Assuming they are spread out in 2 meals, each meal provides about 15g and further assuming a 3 hr absorption period, the glucose provided is about 5 g/hr. So, for a 6 hour period gluconeogenesis can be switched off, providing some rest to the liver. Of course, the liver is still busy converting the saturated fats into ketone bodies.

Figure 6: Don’t be fooled by appearances: Purgatory in not a piece of cake. Going through keto purgatory or a carb holiday is necessary to restore insulin sensitivity.

Usually, a keto diet takes about 3–6 months to help the body’s insulin sensitivity to heal. After this healing, it becomes possible to reintroduce healthy carbs, i.e., the non-addictive low glycemic index and low glycemic-load carbs.

Regular exercise, is the most effective way to improve and maintain insulin sensitivity of muscles and fat tissues. Excercise and sticking to healthy carbs are required to prevent falling back into the vicious cycle of insulin resistance and T2D.

Figure 7: Source: The essential role of exercise in the management of type 2 diabetes.

Footnotes:

¹

Paoli, A., Rubini, A., Volek, J. et al. Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. Eur J Clin Nutr 67, 789–796 (2013). https://doi.org/10.1038/ejcn.2013.116 , https://www.nature.com/articles/ejcn2013116

²

As a typical example: rice provides 56.7 kcal/₹ vs. butter’s 12.6 kcal/₹. This is calculated based on current (May-2025) market prices for white rice and unsalted butter. Rice: ₹63.15/kg, 358 kcal/100gm; Butter: ₹570/kg, 717 kcal/100gm.

³

Cahill GF Jr. Fuel metabolism in starvation. Annu Rev Nutr. 2006;26:1-22. doi: 10.1146/annurev.nutr.26.061505.111258. PMID: 16848698. https://doi.org/10.1146/annurev.nutr.26.061505.111258 , https://pubmed.ncbi.nlm.nih.gov/16848698/

⁴

A food calorie, which is capitalised as Calorie = 1000 calories or 1 kcal. A calorie is a physical unit, originally it was the amount of heat energy required to raise the temperature of water at 20°C by 1°C. James Prescott Joule in his famous series of experiments establishing the equivalence of mechanical work and heat measured that 4.184 units of mechanical work (Joules) equals 1 calorie. A Watt is an energy expenditure of 1 Joule/sec, it is a unit of power.

The Yin-Yang (Tai Chi) Symbol is Inspired by the Full Moon

While looking at a reflection of the full moon today on a slightly distorted glass window, I suddenly realized that the Yin-Yang symbol is a stylized full moon. 

♃♄: 'Great Conjunction' of Jupiter and Saturn

 

Google's Doodle to mark the Event

 

The 7 'planets': ☉, ☾, ♂, ☿, ♃, ♀, ♄ (in week day order*), and the 12 constellations of the Zodiac: ♈, ︎♉, ︎♊, ︎♋, ︎♌, ︎♍, ︎♎, ︎♏, ︎♐, ︎♑, ︎♒, ︎♓ (in order as on the Ecliptic) give us a natural celestial clock. The zodiac signs are the face markers and the visible 'planets' the seven 'hands'. 

* I never could figure out why the weekdays are ordered this particular way.

The Celestial Clock: As the Earth goes in its orbit around the Sun, the Sun, the Moon and the 5 visible Planets appear to move on the ecliptic (red), through the constellations of the Zodiac. The fact that the orbital planes of all the planets are more or less coincident with the orbital plane of the Earth, confines them to a narrow path across the sky.

The moon completes a full zodiacal circle in 28 days*, and acts as the day-of-the-month hand. The sun moves a zodiacal sign per month, and is thus the month hand. It should be no surprise that by learning to read the hands of a clock one can make all sorts of useful predictions about periodic phenomena.

* Since 365/28 ≈ 13, 13 months and 13 zodiac signs would make more sense. However, Babylonians had problems computing interest payments with 13, and today, too many people fear the number 13, so this 'reform' is not going to happen anytime soon. Even cultures which follow a lunar calendar, like the Telugu calendar call the 13th lunar month as simply 'extra' month and don't have a name for it. Again, I don't know why. 

The other visible planets have more complicated movements, with Saturn taking the longest to complete a full cycle of the ecliptic/zodiac, and Mars having the most obviously mysterious movement (Jupiter and Saturn also have the same mysterious or retrograde movement, but take much longer to complete). Accurate measurement of Mars' movements by Tycho Brahe and the spiritually inspired passion to make sense of these measurements, and thereby understand the 'mind of God', by Kepler and later Newton yielded classical physics. "As above, so below".

Kepler's initial solar system model (Mysterium Cosmographicum) based on the 5 perfect solids was inspired by Kepler's deeply held belief that Gott's creation had to be perfect in every way. In this view, the reason there are 5 planets is because there are 5 perfect solids. As per Carl Sagan (COSMOS Episode 3), when Kepler finally realized that the orbits of Mars, Jupiter and Saturn could only be fit by ellipses and not perfect circles, Kepler's faith in Gott was shattered. This faith shattering theological problem, along with others, was 'solved' by Leibniz's "Best of all possible worlds" theology.

My preferred interpretation of astronomical combinations is as useful mnemonics. My basic mnemonic code is:

♀: Play, maximize this
☉: Food, eat carefully
☾: Sleep enough
♂: Exercise regularly
☿: Work, minimize this

♃: Good Judgement, cultivate this
♄: Good Luck ('Unknown unknowns')

So, for the great conjunction: ♃♄, my mnemonic interpretation is:
"Good Judgement ultimately meets Good Luck".

Of course, if we forget that these are merely mnemonics, then we move into Astrology.

TIL: String Theory is Essentially an Aether Model and a Rehash of W. Thompson's (Kelvin's) Vortex Atom Theory

W. Thompson (a.k.a Kelvin)

(sometimes confused with) J. J. Thompson

While reading through Edmund Whittaker's famous treatise: 'A History of the Theories of the Aether & Electricity': Chapter IX: 'Models of the Aether', I came across this interesting set of paragraphs:

One of the greatest achievements of Helmholtz was his discovery in 1858 that vortex rings in a perfect fluid are types of motion which possess permanent individuality throughout all changes, and cannot be destroyed, so that they may be regarded as combining and interacting with each other, although each of them consists of a motion pervading the whole of the fluid.
...
The individuality of vortices suggested a connection with the atomic theory of matter.
...
The earliest attempts to build up a general physical theory on the basis of vortex motion were made in 1867 by William Thomson (Kelvin), and were suggested by a display of smoke rings which he happened to see in the lecture room of his friend, P. G. Tait, in Edinburgh University. He used vortices in the first place to illustrate the properties of ponderable matter rather than of the luminiferous medium, and pointed out that if the atoms of matter are constituted of vortex rings in a perfect fluid, the conservation of matter may be immediately explained.

As the wikipedia article says:

Tait's work especially founded the branch of topology called knot theory, with J. J. Thompson providing some early mathematical advancements. Kelvin's insight continues to inspire new mathematics and has led to persistence of the topic in the history of science.

While W. Thompson and J.J. Thompson attempted to model atoms with vortice ring knots, string theorists use the same idea to model the fundamental subatomic 'particles' one level below.

Compare:

Aether Vortex Knots

 

 

In String Theory, the Aether (now relabeled euphemistically as the Quantum Vacuum) is modeled as a Quantum Foam consisting of knots of memBRANES. Compare with Kelvin's 'Vortex Sponge' described below.

Continuing with Whittaker:

The vortex-atom hypothesis is not the only way in which the theory of vortex motion has been applied to the construction of models of the aether. It was shown in 1880 by W. Thomson that in certain circumstances a mass of fluid can exist in a state in which portions in rotational and irrotational motion are finely mixed together, so that on a large scale the mass is homogeneous, having within any sensible volume an equal amount of vortex motion in all directions. To a fluid having such a type of motion he gave the name vortex sponge.

The greatest advance in the vortex-sponge theory of the aether was made in 1887, when W. Thomson showed that the equation of propagation of laminar disturbances in a vortex sponge is the same as the equation of propagation of luminous vibrations in the aether.

Ultimately, however, these attempts to create mechanical models of the aether were abandoned. One of the implicit aims of Whittaker's treatise was to present the history of the ideas leading up to the theory of relativity and the many scientists who contributed to it, thus putting Einstein's contribution in context, thereby humanizing him, and deflating the unwarranted, ardent hero worship of Einstein. Whittaker credits Larmor as one of the first to state that the aether models were all unsatisfactory, and suggesting that the very idea of modeling the aether with mechanical models was probably hopeless:

Towards the close of the nineteenth century, chiefly under the influence of Larmor, it came to be generally recognised that the aether is an immaterial medium, sui generis, not composed of identifiable elements having definite locations in absolute space. The older view had supposed ‘the pressures and thrusts of the engineer, and the strains and stresses in the material structures by which he transmits them from one place to another, to be the archetype of the processes by which all mechanical effect is transmitted in nature. This doctrine implies an expectation that we may ultimately discover something analogous to structure in the celestial spaces, by means of which the transmission of physical effect will be brought into line with the transmission of mechanical effect by material framework.’  Larmor urged on the contrary that ‘we should not be tempted towards explaining the simple group of relations which have been found to define the activity of the aether by treating them as mechanical consequences of concealed structure in that medium; we should rather rest satisfied with having attained to their exact dynamical correlation, just as geometry explores or correlates, without explaining, the descriptive and metric properties of space.’

However, I disagree with Larmor (and Whittaker). With the vast increase in experience with complex emergent phenomena and modeling them mathematically/numerically since 1910, it might be time to give the aether another shot.

Beetel M56 Landline Phone: How to Store Numbers for One-Touch Dialing

 The quickest way to make a call is still with a landline phone. However, to make a 'one-touch' call, the number first has to be stored in one of the 'one-touch' memory locations of the phone. Unfortunately, most of these phones do not come with any user manual, and it can be frustrating to figure out how to store a number for one-touch calling.

The following instructions are for the Beetel M56 phone pictured below and, hopefully, similar models.

To store a number in one of the three one-touch locations: M1/M2/M3:

1. Type in the number on the keypad.
2. Press the 'PH. BOOK' button. (This is the counter-intuitive step. One would guess that, to store a number, you should press the 'STORE' button. )
3. Press one of the M1/M2/M3 buttons to pick the memory location in which to store.
4. If the memory location is empty, you are done.
5. Otherwise, press the same button (M1/M2/M3) again to OVERWRITE the location.

To dial the number, you just press M1/M2/M3.

If more quick-dial numbers need to be stored, the 10 keypad numbers, [0-9] can be used, (the keypad letters can serve as a mnemonic guide). To store numbers in these, the procedure is:

1. Type in the number on the keypad.
2. Press the 'PH. BOOK' button.
3. Press the 'STORE' button.
4. Press one of the keypad buttons: 0-9.
5. If the corresponding memory location is empty, you are done.
6. Otherwise, press the 'STORE' button again to OVERWRITE the location.

To dial the number, you press 'STORE' followed by the keypad number location.

A Better Way to Implement Affirmative Action: Competency Exams Instead of Competitive Exams will Automatically Ensure Proportionate Reservation

The following article that came in the news today reminded me once again of this old idea.

Maharashtra government wants reservations ceiling raised beyond 50%

The Maharashtra government told the Supreme Court on Wednesday that the 50% ceiling on reservation fixed nearly 30 years ago by a nine-judge SC bench required reconsideration by an 11-judge bench as 70-80% of the population belonged to backward classes and it would be unfair to deny them proportionate reservation.

The current system in India for selecting people from the university/college level onwards is to conduct intense, extremely stressful competitive exams, rank all the participants and allow them choice of branch or job based on their rank. But, the total positions are partitioned beforehand based on caste. Needless to say, this causes a huge amount of social friction, immense amounts of stress and many cases of burnout and suicides.

An immensely better way to implement affirmative action is to have competency exams instead of competitive exams. A competency exam is designed to ensure that a person who achieves more than the passing score, is very likely to have the necessary background preparation or competency required for the position being applied for.

Since there will always be far more competent candidates than the positions available, ALL passing candidates are admitted into a pool of eligible candidates and from this pool, candidates are selected at RANDOM.

The laws of statistics, in particular the law of large numbers, will automatically ensure that candidates are selected proportionate to their caste representation in the general population. The same system will also automatically ensure that people belonging to marginalized groups other than caste are also proportionately represented, such as gender, wealth/family income, etc. Also, all the social friction and needless stress is eliminated.

A Minimal Python Implementation of Conway's Game of Life

I was incredulous that the simple rules of John Conway's Game of Life could result in such complex behavior, providing many analogies to Biology, Physics and Economics. So, I wanted to check it for myself. Unfortunately, most code available online has a lot of bells and whistles that obscure the simplicity of Conway's rules. So, here is a minimal implementation in Python. Being small, it is easy to verify that the program does implement Conway's rules faithfully, and introduces nothing else.

Download link: game-of-life-minimal.py

import numpy as np
from scipy import ndimage
import matplotlib.pyplot as plt

n  = 100   # grid size
t  = 1/24. # simulation update interval in seconds
pT = 0.1   # percentage of cells initialized to True/on

# randomly initialize a boolean grid, with more off cells than on
G = np.random.choice([True, False],n*n,p=[pT, 1-pT]).reshape(n, n)

# neighbor weights for convolution
W = np.array([[1,1,1],
              [1,0,1],
              [1,1,1]], dtype=np.uint8)

fig = plt.figure()

while(True):
    plt.matshow(G, fig.number)
    
    # find the Live Neighbors around each cell using convolution
    LN = ndimage.convolve(G.view(np.uint8), W, mode='wrap')
    
    # update grid based on Conway's rules using boolean operations
    # G = G*((LN==2)+(LN==3)) + np.invert(G)*(LN==3)
    G = G*(LN==2) + (LN==3)
    
    plt.pause(t)
    plt.cla()

A simple experiment that can immediately be carried out, is to see what happens when Conway's rules are ever so slightly tweaked. Say what happens if the 'overpopulation limit', 3 is changed to 4, or the 'reproduction number' is adjusted. Depending on your worldview/weltbild, the results will remind you either of 'Intelligent design' or the 'Anthropic principle'.

Verifying Correctness

As per Wikipedia, the rules of Conway's Game of Life are:

At each step in time, the following transitions occur:

1. Any live cell with fewer than two live neighbours dies, as if by underpopulation.
2. Any live cell with two or three live neighbours lives on to the next generation.
3. Any live cell with more than three live neighbours dies, as if by overpopulation.
4. Any dead cell with exactly three live neighbours becomes a live cell, as if by reproduction.

These rules, which compare the behavior of the automaton to real life, can be condensed into the following:

1. Any live cell with two or three live neighbours survives.
2. Any dead cell with three live neighbours becomes a live cell.
3. All other live cells die in the next generation. Similarly, all other dead cells stay dead.

The above rules translated into pseudocode:

if C==1 AND ((LN==2) OR (LN==3)):
    C' := 1
else if C==0 AND (LN==3):
    C' := 1
else:
    C' := 0

are equivalent to the Boolean expression:

C' := C AND ((LN==2) OR (LN==3)) OR (NOT(C) AND (LN==3))

or equivalently (using * for AND and + for OR)

C' := C * ((LN==2) + (LN==3)) + (NOT(C) * (LN==3))

simplifying:

C' := C*(LN==2) + C*(LN==3) + NOT(C)*(LN==3) 
   := C*(LN==2) + (LN==3)*(C + NOT(C))
   := C*(LN==2) + (LN==3) ∵ (C OR NOT(C)) is always True.