Our participant data show that long-term NK maintains and reduces HOMA-IR to very healthy levels, adding to existing evidence that sustaining a lifestyle that promotes ketosis (minimising insulin demand and secretion) is an effective modality in preventing insulin resistance and its associated diseases, including cancer, CVD, dementia, T2DM, and earlier biological ageing [1,7,9,33,34,35]. Here, INS is linked to type 2 diabetes mellitus.