Can the ketogenic state from fasting make the body more efficient in preserving itself and correcting anomalies or disease? We're faced with an epidemic of modern diseases from diabetes and hypertension and obesity to myriads of autoimmune and degenerative diseases. Many studies have linked diet and lifestyle to play direct and important roles in the pathogenesis of some of our modern diseases such as diabetes. The question now is "can we reverse the process"? Can we reset our body and make the cells more efficient both in the utilization of energy required and the destruction of anomalies in the case of immune cells? What if the real problem is "efficiency"? Could the problem be the abundance of readily available calories in our body which makes the cells inefficient in its utilization of calories for energy. Can we train our molecular cell system to become very efficient like the well trained athletes who can accomplish his work very efficiently. We know that counting the amount of calories consumed does not often translate into the amount of weight gain or loss that we expect. The brain, of course, such as the hypothalamus has important functions to control hunger and satiety that can not be ignored in its role to control our food intake. Hormones play very important roles in how the piece of bread or grain of rice will end up being utilized by our body. We can do a randomized study in a diverse population of 1000 for example. We feed each and everyone the same exact identical diet that contain the same exact identical amount of calories living in the same controlled environment and doing the same amount of daily work. I would dare to speculate that we will see a bell-curved type result in terms of weight gain and loss or how each one person utilizes calories for energy. Our GI system, of course, plays an important role in the chain of events of food into energy. How much of the piece of bread or grain of rice will be turned into usable calories and how much is wasted in the stool could be different for everyone. We can also extrapolate the same thinking into our immune system. How efficient is our immune system in detecting and destroying abnormal cells? Can the abundance of readily available calories make them inefficient in detecting and destroying abnormal cells? If the system is efficient, less energy is required to do the work. We see the very fact everyday on the roads in the form of cars. Some cars burn much more fuel than others to accomplish the same task. I often say this to my patients, "don't work hard, work smart instead".