One of the most useful frameworks I have encountered for understanding why age-related disease develops comes not from the weight loss literature, but from the work of Dr. Bruce Ames at UC Berkeley. He calls it the Triage Theory — and once you understand it, the way you think about nutrition changes fundamentally.
The Core Idea
Ames proposed that when the body is under conditions of micronutrient shortage — insufficient vitamins, minerals, or other essential compounds — it makes triage decisions. It prioritises short-term survival over long-term maintenance.
The logic is evolutionary: if you are starving in the short term, you will not live long enough for long-term deterioration to matter. So the body directs available nutrients toward the functions needed to survive today: immune defence, reproduction, energy metabolism. It deprioritises the maintenance and repair processes that protect against cancer, cardiovascular disease, neurodegeneration, and other conditions that typically manifest over decades.
The consequence: chronic low-grade micronutrient insufficiency — not dramatic deficiency, but the kind of shortfall that produces no obvious symptoms in the short term — produces insidious long-term damage. The mechanisms of protection are chronically under-resourced. Disease develops not because of a single dramatic cause, but because the maintenance systems have been running below capacity for years.
Why This Matters for Keto
A ketogenic diet done poorly can be micronutrient-deficient. If it consists primarily of meat, eggs, and cheese with minimal vegetables, it may lack adequate magnesium, potassium, zinc, selenium, vitamin C, and various B vitamins. These are not hypothetical concerns — they are documented risks of poorly designed low-carbohydrate diets.
A ketogenic diet done well, on the other hand, can be micronutrient-rich: organ meats (some of the most nutrient-dense foods available), fatty fish, eggs, leafy greens, cruciferous vegetables, nuts, and berries within the carbohydrate budget cover most requirements efficiently.
The Health Spectrum Food Guide in the NKFB programme was designed with this in mind — not just listing what to eat for ketosis, but mapping foods to their nutrient profiles so that the protocol achieves both goals simultaneously.
The Practical Implications
If the Triage Theory is correct — and the mechanistic evidence supporting it is substantial — then the following conclusions follow:
Supplementation matters more than most people assume. Not as a replacement for food, but as insurance against the gaps between what we eat and what optimal maintenance requires. Magnesium is chronically insufficient in the modern diet. Vitamin D is deficient in most people in northern latitudes for most of the year. Omega-3s are significantly under-consumed relative to omega-6s.
Age-related disease is not inevitable. This is the central claim of the Triage Theory, and it is important. We have accepted a model in which cognitive decline, cardiovascular disease, and metabolic deterioration are normal features of ageing. Ames's framework suggests they are, at least in part, the downstream consequence of decades of suboptimal micronutrient status — which is modifiable.
The goal is not just fat loss. Fat loss is a signal of metabolic improvement. But the deeper goal of the NKFB approach is systemic metabolic health — the kind that reduces long-term disease risk, supports neurological function, and gives you the best available chance of a healthy later life.
Where This Leaves Us
I am a pharmacist. I have spent decades working at the interface of drug therapy and disease management. What I have observed is that we are very good at managing the downstream consequences of chronic disease and much less focused on preventing the upstream conditions that produce it.
The Triage Theory is not a perfect model. No model is. But it is one of the most coherent frameworks I have found for explaining why chronic disease is so common despite modern healthcare — and what can be done about it at the individual level.
Eat well. Cover your micronutrients. Address the metabolic dysfunction before it becomes disease. This is what the NKFB protocol is designed to support.
