Welcome to the sardine challenge. So,

the only thing on the menu for the next

3 days is sardines. I challenge you to

try and eat three of those cans in a day

because that's a hell of a tool to help

you get into a ketogenic state. And when

you're in a ketogenic state, it helps

burn fat, muscle mass gets higher

preserved. I've seen patients that have

reversed their gray hair and their brain

performance, concentration, and energy,

all of those things improve. And so, I'm

going to teach you how to do an advanced

ketogenic diet.

Sorry, the sardine juice has gone on my

iPad.

>> Good luck getting that off. Dr. Annette

Bosworth is the insulin resistance

specialist.

>> With over two decades of experience,

she's discovered that the key to your

health isn't more treatments.

>> It's to get into a ketogenic state. Most

people have been making buckets of

insulin without knowing it. But when you

have excess insulin, it's a chronic

disease maker. It is what makes high

blood pressure. It is what makes cancer.

It is what makes debris in the brain,

which is linked to depression, brain

fog, Alzheimer's, and Parkinson's. And

so, to reverse the high insulin state, I

really push my patients to do the

ketogenic diet. And what I'm told is

your best life ahead within a year.

Like, I really rescued my mom from the

edge of death. So, where do I start?

>> First thing is quit eating so late at

night because you're stimulating an

excessive production of insulin. The

next thing, keep the carbs low, put the

fat up, more eggs, beef brisket, ribs,

pork belly.

>> But then people often say when you talk

about the ketogenic diet that it's not

sustainable. So, you have this idea of

this keto continuum, consistently keto

for life.

>> Yeah. I mean, I've been on a ketogenic

diet for 10 years. And those 12 steps

are it. And you're not going to have to

try very hard. So, the first step is

I see messages all the time in the

comment section that some of you didn't

realize you didn't subscribe. So, if you

could do me a favor and double-check if

you're a subscriber to this channel,

that would be tremendously appreciated.

It's a simple, it's a free thing that

anybody that watches this show

frequently can do to help us here to

keep everything going in this show in

the trajectory it's on. So, please do

double-check if you subscribed. And

thank you so much because in a strange

way, you are you're part of our history.

And you're on this journey with us and I

appreciate you for that. So, yeah, thank

you.

Dr. Annette Bosworth or shall I call you

Dr. Boz?

What is it that you

know and believe and understand that you

think the general public doesn't know,

believe and understand?

Mhm.

So, most of the reasons people come to

see me

could be reversed if they knew how to

make ketones on a regular basis.

So, I'm an internist.

Uh that means uh if you go to an

internal medicine doctor and we don't

know what's wrong, you're going to die.

We take care of tough puzzles and we do

this over a long management, chronic

disease management. So, I've got 25

years of studying chronic problems that

deteriorate the quality of life.

Lifespan, healthspan both go in the

toilet when you're chronically seeing

me.

And you could abort all of that destiny

if routinely you were making ketones.

An internist sounds like an intern. I'm

trying to understand the the definition.

>> on this is terrible. It just means

you're supposed to take care of very

complex answers. Your job I mean, the

buck stops with you. If if the internal

medicine team can't figure it out,

you're going to die. So, so you're

basically a chronic illness doctor.

>> Chronic disease management is absolutely

it. You know, I love the way uh Peter

Attia uses medicine 2.0, which is what

we are the masters of, managing it,

making sure the prescriptions are there,

making sure you are treating all these

problems.

The internist being one of your best

buddies cuz you're having to see them

routinely, you got to get the meds

refilled, you got to check for the side

effects. It's a mill. What is medicine

2.0 in your definition? Yeah, so I can

keep you from dying from childbirth and

infections and I have an antidote for

every one of your symptoms. We are in a

world where medicine has answered a lot

of problems. Little things like high

blood pressure, little things like it's

a few extra pounds around the middle,

little things like brain fog, oh, my

eyes are aging. All of these are signals

that your body has made more trash than

it cleaned up and there were some rules

to humans that you missed.

And for for my listeners that have

clicked on this conversation,

what are they going to get out of giving

us their time and staying with us and

listening to this? What is the end goal

going to be for them in their lives?

Listening to the way I talk to my

patients and teach them the steps how to

reverse the medical problems that you've

already got on the roster.

And by doing that, the freedom

is to be the kind of grandparent that

you dreamt of, but you've surrendered

can't be there anymore.

And what is the list of predicaments or

illnesses that Yeah. So

>> are relevant here? Most common one is

being overweight and a brain that's not

working right. What really is behind all

of the patients I've seen for 25 years

is

we're working on peak brain performance.

Even if you don't think about that,

that's what I think about. So when you

come in and you're 55 years old and I

can see the worry of Parkinson's headed

your way. Super young is 55 years old

with Parkinson's. That is a brain that's

got too much trash and you don't know it

yet.

And I mean, in the history of Dr. Boz

versus Parkinson's,

Parkinson's has like 3,500 patients, I

have zero. Parkinson's wins every time.

And the the biggest moment of people who

have chronic problems under the hood

is they have no idea that it's coming.

And once that lands, the reversal is

much worse. Seeing it 10 years before

it's supposed to be there,

this is a gift of saying, let me show

you how to undo that. Back away from the

edge. It's that brain function that

you're going to miss the most when it

doesn't work.

And it's linked to all of these things

like the arthritis, the you know, weight

around the middle, the high blood

pressure, the

severe connection to mental

uh

approach, meaning you can say

depression, but people say, "Oh, I don't

have that diagnosis." I'm talking about

a brain that doesn't want to engage,

that doesn't find joy in their life

anymore, because it's been too many

years since they took out the trash. Let

me show you how to take out the trash,

and you're going to have to do it a few

times,

but what unfolds is your best life ahead

within a year. So, you're going to teach

me how to take out the trash? Yeah. The

trash in my own brain. Yep.

And if I take out the trash in my own

brain, how is my life going to be

better?

You live in the 21st century, where

there's lots of processed foods and lots

of ways that your body did things

without telling you.

So, any injury that you've had, like a

joint injury that keeps coming back

every time you injure it, it is a little

easier to injure the next time.

Is there a ring around the middle that's

more more than pinch an inch?

Is there a uh,

distance in time where you say, "I can

focus for this many hours, but I can't

do it for this many hours anymore"?

Those are all places where if you did

this, if you were able to say, "Don't

stop taking out the trash several times

a year, several times a month if you ask

me." Then you never have to come into

this world that

I just see people they're they're in

quicksand, they're up to their waist.

And getting them out, they need a real

lifeline.

And what are the current solutions

people are typically offered when

they're feeling, you know, all the

the ways that you described there, where

they just don't feel good, they have

brain fog, they're they might have

chronic pain setting in in various ways.

What are the typical solutions that

medicine 2.0 would offer them? Yeah,

especially if they have good insurance.

Yeah. That doctor is going to be with

the covered insurance plan, and he's

going to say, "Tell me the symptoms.

I have a matching game. I will give you

the drugs that will take away that one,

and take away that one, and take away

that one."

What is always a downside is, well, play

that forward for 10 years. Play it

forward 5 years.

And are the symptoms gone? No, but it

will bridge and hold up the architecture

of the body and the human without

actually fixing the problem without

actually diving in and say you got some

chemistry problems under the hood that

you don't measure and you don't talk

about. But if you did even if you're not

perfect, even if you're 70%

you're going to find yourself

at the age of 54 with vitality and

energy and sleeping through the night

and not having what every other

54-year-old which is chronic joint pain,

a brain that can only focus for 3 to 4

hours without a break,

a a stamina of endurance and health and

and joy that falls apart. So when I'm

you're 54 years old, when I'm 54 years

old, I want to be as

young and energetic and articulate

and cognitively astute as you are.

So what should I be doing now to make

sure that I don't decline, decay in all

those areas I described? Oh, what did

you have for breakfast? Today? Yeah.

Um I have not eaten breakfast yet. Okay,

that's not a bad thing, but when you're

54, you should probably put the calories

in the morning, not at night. We know

that as you age, the cost of a calorie

turns into timing.

If you eat that food one bite of food

after 6:00

is worth 10 bites of food before noon.

So if you're trying to say how do I get

the best out of the nourishment, but

also eating's fun, if you only get one

bite after 6:00 and 10 before

move that food towards morning.

When you're your age, what did you have

for what's the last meal you ate?

Yesterday? Yeah. Uh for dinner I had

this cod and I had salad.

I also had pasta.

Okay.

But I ate pretty late, which is about

9:00. What did you have the rest of the

day before that? Was that your first

meal?

>> Just a big salad. Was that more towards

lunch or noon or

Probably about 4:00. So waited all the

way till 4:00 to eat. Very common. This

is a really common pattern of people

doing what we would say intermittent or

time restricted eating. They put that

eating window in this, but it's got that

balloon at the end of the day. Yeah. And

it really does I mean what you're

stimulating is an excessive production

of insulin.

And you're going to wake up the next

morning. What time did you wake up this

morning?

Today? I went to bed fairly relatively

early for me. I woke up at about 7:30

a.m. Oh. Usually it's later. And do you

have Did you have a solid 7 8 hours of

sleep or how? Yeah. So during that time

uh you finished eating around 10:00 then

it sounds like. Yeah. Okay. So then it's

7:30

>> Maybe a little later. Okay. So 11:00 and

you've got uh

7:30 in the morning is when you woke up.

So that's about 8 hours since you've

eaten. Your insulin is still churning.

Especially if the meal was large and

there was carbs in it. So now you've got

these processed foods late at night and

you're at the beginning of the disease,

right? You're at the beginning of the

chronic inflammatory churn of how do you

age faster and faster? You don't do

that. You don't have high insulin

throughout the night. So can you explain

to me like I'm a 12-year-old what

insulin is and the role it's playing cuz

you know I guess we're focused here on

how to

I guess longevity aging for a second,

but how does insulin play a role in all

of this and what is insulin? So insulin

insulates.

Okay? So think of it as it makes you

fluffy. It makes you It puts the fat on.

Uh

it's got some other roles, too. But

we're going to talk about chronic

diseases here where it's not a scarcity

problem. You You make plenty of it. And

when it's in excess, it will store

energy for when you go through a famine.

It will also cause you to grow.

Now grow means get a little fatter, but

it also means things like their skin

gets a little thicker, they have skin

tags, and what I always think about is

what's going on in their brain. And when

that insulin is high for years and years

and years

uh just like yours, because if if you

didn't eat the rest of today

and then you got up tomorrow morning, it

would be about that long after a late

meal last night, that's how long it

would take you to say,

"Okay, we're back down to where we

started from or where we should be in

the morning." For someone that's never

had the insulin before, there's some

context to give on in terms of what it's

doing. So, it's coming out like a

transporter and helping put away the

sugar or deal with the excess sugar.

Right. So, it is what what Yeah, it

lifts glucose or sugar from the

circulation into a cell. That's its

first primary job.

But if all the cells are full, their

storage is full, it's going to start to

pack it into the liver. And then let's

say all those stores are full, too. This

job of the of insulin, this hormone

oozes into every part of your body to

say, "Make sure it's got full fuel. Make

sure it's got that sugar."

But most people are like what I would

guess you are. Most of the time you

don't you aren't in a shortage of sugar.

And so, it fill it tops things off

and then it will turn things into fat.

It's too much sugar, they can't store

it, all the storage is full. So, you can

send the signal out, "Make me some more

cells. I need some more storage units.

This guy is eating more than he thinks

he is. And we're going to be prepared to

live through the famine."

But in the meantime, turn it into fat.

Make him a little fluffier. Is that the

only consequence of high insulin is that

I'm going to I might be a bit more fat?

No, that's just the one people hear

about the most. When you look at chronic

disease management, it is the growth

of of the diseases, of the inflammation.

It's the making of the trash.

So, I just keep saying, you know, you

need to take the trash out routinely,

which means that insulin, which has been

smoldering higher than you think it is,

because you live in today's world,

because you eat processed food, because

you eat super late at night, uh you

don't go two to three days without

eating. You've You've got storage filled

in your body.

The high insulin levels in a healthy

person

hides

that the debris is being made and you

don't know it.

Yeah, it hides it. Yeah, it's going to

put it in between two cells in your

brain. It's going to put it in between

the skin cells. The trash doesn't get

taken out until the insulin gets lower.

And unfortunately, most people

have been making buckets of insulin

without knowing it.

Why?

What are they doing to create buckets of

insulin? All the things you said about

>> Carbs.

Um

foods that comes from boxes and barcodes

and

bags instead of whole foods, instead of

a fat forward diet which would then push

that body into

making ketones. So, you can't you cannot

make a ketone

if your insulin's high.

Are there any signs that I might have

high levels of insulin or insulin

resistance? Abdominal girth is the first

thing that is the first place that the

fat goes. And so, you do this really

great part where you don't eat until

later in the day. Mhm. How does that

feel during the day?

During the day I feel really focused. I

actually don't even know that I'm not

eating. So, that's really good. So, what

I would love to know is show me what

your blood sugars are doing during the

day and show me if you make ketones.

That'll be The answer is you when you

have excess insulin, which is this

chronic disease maker,

it is what makes cancer. It is what

makes high blood pressure. It is what

makes debris in the brain where call it

depression or brain fog or Parkinson's.

It's the aging of the brain. It's linked

to all of those things.

>> All of those things. And that excess

insulin nobody tells you about. But, the

symptoms are dang, I feel like I got to

eat every two to three hours. Uh their

debris or their fuel keeps running out.

When you say, "Boy, I can eat

once at the end of the day and I'm

pretty good. My focus stays really

good." What I want you to prove is what

are your ketones during the day? So,

when when you've got a patient who has

done that,

their ketones will be 0.7,

1.0,

and they're taking out the trash all day

long.

So, there's these two energy sources.

One of them is the glucose. One of them

is which is from like, you know, eating

pasta, which I ate last night. Um so,

that probably put a lot of glucose in my

my blood. I probably had a high glucose

spike, and then insulin came out to deal

with that. And then there's ketones,

which start to appear when I'm fasting

or when I haven't been eating carbs for

a while and my body's looking for an

energy source.

>> Yeah, when In terms of these two energy

sources,

there seems to be a lot of hype around

ketones.

>> Mhm. So, why doesn't our body just run

off ketones? It will, as soon as you're

done lowering your insulin. And I mean,

insulin grew in these patients. They

didn't know that it was growing high.

They went to their blood test, and their

glucose looked normal. What nobody

checked for years is how much of that

insulating hormone did it take to keep

the glucose controlled. And that's where

chronic diseases are are grown in

spades. That's where autoimmune disor-

>> The insulating hormone being insulin.

Yes.

>> Okay. So, that excess insulin for the

last decade,

had you come into my clinic, we'll put a

label on it, call it PCOS, call it high

blood pressure, call it

autoimmune problems. All of them are

linked to high insulin. Glucose, when

you want to store it, we put it in a

fancy string called glycogen. And it's

just an efficient way to store glucose,

but as soon as your body needs it, it

will unlock all that sugar back into

your access back for you.

>> Mhm. What you don't realize is, well,

how much glycogen you got stored over

there?

How much is there in storage? And that

is what high insulin has been doing.

Just put it in storage, put it in

storage. And then, when you stop eating,

you'll know if you emptied out all your

stored sugar, which is some of the

regular sugar you just ate, but then all

this glycogen, this packaged sugar.

How empty are you? I don't know. Have

you made a ketone yet?

You cannot make a ketone. You cannot

burn fat until that that tank is empty.

Okay, so I have these glycogen stores

which last for well, a day or two. Oh,

no. Think of it as brown sugar.

So, you package the sugar really tight.

Then you put it in the back of the

drawer and it turns crusty cuz you never

lowered your insulin. I have patients

that are over overweight and we put them

on a ketogenic we put them on a 20 total

carbohydrates per day. So, super low

carbohydrate.

It is 15 days before they make a ketone.

Okay, so it's it could be a a while it

could be up to 2 weeks for example

before my glycogen stores are empty. And

it's not until my glycogen stores, my

glucose stores are empty that my body

can start producing ketones. Correct.

So, it's going to exhaust all of those

glycogen stores and then once it's run

out, it's going to switch into this

ketogenic state. Right.

Yeah, so think of it as your short-term,

easy to access sugar has to decrease.

And that means your insulin has

decreased.

That hormone for insulin, they both run

in tangents. You decrease your emptying

glycogen, your insulin's going down. So,

how do I know if I have insulin

resistance? What are what are the key

signs? You mentioned skin tags. I've

never heard that term before. Yeah, skin

tags are not moles. So, moles you can

feel this bump on your on your skin,

right? But a skin tag has a neck and

like a little mushroom.

And it's the most annoying thing when

patients come and say, "Well, I just

tried to cut them all off, but they kept

bleeding."

I'm like, "Do not cut them off."

They'll fall off

when your insulin's lower. So, that's

the first place. It'll be found in their

armpits or places where the skin rubs.

So, armpits and their groin. And once

insulin starts to grow them, it's like a

crop. A crop a little baby cauliflower

hanging out in their armpits. You talked

about velvety skin

>> Yes. as well being an an indicator.

Velvety skin is this Latin word

acanthosis nigricans, which is fancy

word that means the skin is darker and

thicker. So, the the places that usually

happens is the back of the neck. And

you'll hear, you know, stories of I

tried to wash my neck. It's It's dirty

all the time. It's not dirt. It is the

way the skin is under the the curse of

high insulin. And you see it in

teenagers all the time now. They put on

weight and their growth hormones are

already doing that teenage thing. Now,

you put high insulin in there and they

have this dirty neck syndrome. Or on the

creases of their elbow. It's just darker

here.

Uh that is pathology. That's not normal

from high insulin. You talked about

weight changes as well. What What's this

thing about hairy toes that I was

reading about?

>> Right. So, as my patients age, so most

my 55-year-olds that have had high

insulin, I will tell them, look at your

toes. They're supposed to have hair on

them.

And when your body has had that high

insulin state for a couple decades now,

it will start to say, we don't send

resources to a couple parts of the body

anymore.

And the follicles in their toe

are one of them. Like, you just stop

growing hair on your toes. And there's

an ascending problem with this where the

toe starts, then it's the ankles, then

it's up to the knees, and they don't

have hair anywhere on their lower

extremities.

It is a process

that started from high insulin. What

about aging? You talked about how if you

have high insulin, there'll be an impact

on your aging. Now, I'm thinking about,

you know, I'm getting a couple gray

hairs now. I'm thinking this is because

of my insulin levels. I I have seen

patients that have reversed their gray

hair on a ketogenic diet. It blew my

mind. They asked me for the reason why

that happened and I thought,

well, um the cells are healthier that

are making your hair. That's all I got.

Um aging is exactly that enemy, which is

they are going around the sun with more

growing of the trash than they needed.

So, that high insulin, they don't know

about it. They've not produced a ketone

in years, and that chronic disease is

now

difficult to get their the eye to clean

out. It's difficult to get that brain

trash removed. And you're supposed to do

it every night when you sleep. It's not

supposed to be behind this far. You're

two decades from taking out the trash in

your brain. That's aging. How do I first

start even know my ketone blood levels?

Well, when when a patient first comes in

saying, "How do I begin?"

I want them to tell me what they had for

their meal and then say, "How many carbs

do you think that was?"

Because this education like an apple is

20 g of carbs, 15 g of carbs for some of

them.

And we're going to ask you in the first

6 weeks to take your carb intake down to

less than 20. 20 total g of

carbohydrates or less is where we begin.

And again, I do this in a medical grade.

There are people who play with the

ketogenic diet, and there are people who

try to reverse medical problems with a

ketogenic diet. In order to do this, it

is not a lazy kind of keto. You have to

actually be on the same team as me using

data to reverse this medical problem.

And how how does one measure the blood

ketone levels? Yeah, I I think blood is

the best. There is a way you can measure

them in a in urine. The burning of fat,

if you

turn that string of fat into ketones,

there are two destinies for that. You

either put it into a mitochondria and

turn it into energy or you pee it out.

So, especially when they're early in a

ketogenic journey, they're they

overshoot. Evolution said, "Don't let

them die.

Turn that fat into energy. Help them

through the famine." So, the excess

ketones they make end up in their urine.

We call them pee tone strips, and

they're cheap and easy, and we don't

have to cross that barrier of somebody

pricking their finger at the beginning.

So, they're going to pee out ketones

every day

as long as they're not chronic insulin

resistant. So, if I avoid carbs for a

sustained period of time, which could be

a couple of days, it could be up to 2

weeks, eventually my body's going to

say, "Listen, we need energy." So,

it's going to start burning my fat

stores.

>> Yes. You know, from some of that fat

around the midsection, and it's going to

start turning that into ketones, which

are a

different type of energy. Are there any

reasons why ketone as a source of energy

is better for me in terms of performance

other than the insulin reasons that

we've talked about? Like, are there any

other parts of my body or my health that

benefit from ketones?

>> For starters, when you're burning a

ketone, there's less trash. Okay? It is

a cleaner

fuel with less byproduct, especially as

you age. So, you get the longer energy,

and you have less debris floating

around. You hear the word antioxidants

all the time. Well, burning ketones is

an antioxidant state. It is a and it's

in the space where you need it, which is

inside that cell. Uh you swallow

antioxidants, and you have no guarantee

that they end up where they're supposed

to.

So, number one, the fuel is reducing

trash at a cellular level, it lasts

longer, and it penetrates through that

blood-brain barrier to fuel a brain that

even if it's insulin resistant, it can

use a ketone.

So, the problem with somebody who's

chronic insulin resistance, their brain

needs a lot of glucose to stay on

online.

And I can try to get it there, but

insulin is constantly fighting that.

It's a war to try and keep the glucose

in their brain.

My hack is ketones will go right around

that. It doesn't need the same

transporters to get across the

blood-brain barrier, and especially to

fuel those cells in the brain. So, for

performance,

um I mean, name a game where you don't

use your brain.

There isn't one, right? You're You're

going to If you're looking at

performance to say, "Let's begin with

the sharpest brains and the most

focused, the most disciplined, the less

um impulsivity.

All of those things improve when that

brain is being fueled with ketones.

So, let's focus on the brain part then.

So, what have you personally noticed as

someone who I assume is in the ketogenic

diet right now? Yes. What have you

noticed the variances between when

you're in a keto diet and when you're

not? Right. Well, I've been doing this

since 2015. So, um the onset of it was

really messy, but uh the seasons where I

would do a great job and then I would

think, "Ah, I'm fine."

Uh

I I mean, I can tell you you see 25

patients in a day and I feel bad for the

last five.

Uh they've got a they've got a sluggish

brain. I don't care how much coffee

you've got in you, you can't keep that

focus for that length of time. Um when

you're in a ketogenic state and not in a

ketogenic state, uh the the the

brainpower, the concentration, the

ability to keep your mood controlled is

is just

it is a night and day difference for

most people, but uh I think especially

for me like

uh I'm pretty high energy and when it

runs out, I get crabby.

Uh and that's not a good place to be if

you're the patient.

Yeah, I think I've noticed that as a

podcaster, but I've also had a lot of

very well-known podcasters say the same

thing, which is the variance in their

ability to speak and articulate

themselves and think and sit here for 3

to 4 hours having a conversation is

night and day when they are in a fasted

ketogenic state versus or on a ketogenic

diet versus when they are in a higher

carb diet. Right. And it's so profound

to me that I that I almost wonder why

like more people don't Oh, it's it's

insane. Like one of the best things that

I've done in 25 years was I went out on

a limb and said, "I'm going to try and

teach 200 people at once how to do this

intense ketogenic diet for 3 weeks."

Uh it is hardcore. This is not playtime.

You're checking your numbers every day

and you're comparing them to your

classmates.

And what you get to see in this class of

200 people going with an extreme

ketogenic diet

is the testimony you just said. I cannot

believe how good I feel. By the end of 3

weeks, they're naming babies after me.

They They think this is a miracle. And

I'm like, exactly.

I mean

when you do it in a group like that,

I don't need to advertise. They tell

their friends. They tell their Like if

you want to be on a ketogenic diet that

really wakes up your brain. I didn't

think I could do this. I thought I was

too old for this level of energy.

And it's there within 3 weeks of doing

it right. How long does it typically

take on average for someone to feel

those brain benefits from doing the

ketogenic diet?

Typically, how long does it take you?

Me? Yeah. I rarely go out of it. Meaning

I I might have a couple of days where I

fly to LA and have a fancy meal and then

I need to be back on it. It just doesn't

feel good anymore.

So, but let's go let's go to when I was

overweight, okay? So, you say who's

insulin resistant? Any person who's had

a baby. Okay? You have to be insulin

resistant to hold that baby for 9

months. Okay? So, I had three of them

and then the weight never came off on

that third one.

So, here is an insulin resistant person

at 40-something years old

and I am probably 60 lb heavier than I

am now.

And the first time it it

I tried to get into a state of ketosis

for like 9 months. I was about to give

up on Like why can I not be a ketone?

Why does every I mean I'm a doctor. I'm

trying to use this for my brain

patients, but I'm afraid to tell them

about it cuz I personally cannot keep be

a ketone. I mean I was trying to follow

50 carbs, then I tried to do 30 carbs,

and then I tried to do none, but

I just couldn't make it long enough into

that ketogenic state. And what had

happened is at least a decade of high

insulin. Three babies, full practice,

busy life, you know, on call, those

kinds of things that are all dangerous

if you're going to try to have a peak

brain.

I took my kids on a

22-mile hike around the city

on Memorial Day in the name of troops'

mental health. And I said, "If I am not

peeing a ketone after walking 22 miles,

having fasted for a day, then I'm for

sure that this diet is a phooey."

So, that's how much energy it took for

me to pee a ketone.

Because I was very insulin resistant. I

had been making excess insulin for a

decade, and I'm a doctor. I I should

have known that.

My sugars are fine.

My hemoglobin A1C wasn't bad.

But that excess insulin, that stored

sugar, that stored glycogen, it took

forever to get that low.

And only after I fasted and then walked

22 miles did I pee a ketone.

So, I When you ask the question, "How

long does it take?"

I don't make a I do a much better job

now of telling people how to get there

cuz I I almost gave up thinking, "This

is junk science." If you if you were to

eat a high-carb meal now and take a

couple of days off, how long would it

take you to get back into a ketogenic

state where you have those brain

benefits now? Uh I could probably flip

back in within 12 hours.

So, that's how long it roughly takes for

someone who's got a bit in better

metabolic shape, it will take a couple

of days. Mhm. Um

is there a downside to living in ketosis

the whole time? Because people often say

when you talk about the ketogenic diet

that it's not sustainable. Yeah. I I

hear that a lot, but I have thousands of

patients that have been doing it for

years.

And what happens is uh

as soon as they

exit from the ketogenic diet

and they start to feel the trash build

up again, meaning the joints that didn't

hurt forever now hurt. The vision that

was super clear is now foggy again. The

brain that wasn't irritable and

depressive is back to doing those things

again. I mean, it is within a week or

two that

I mean, I like to think of

when you're in a ketogenic state, you

ring out that inflammation and trash in

their brain, and the brain is like

crisp. It is doing a great job.

And when you put the sugar back in, the

swelling goes back into their brain.

Insulin and water flood the body, and

it's almost like a minor concussion.

And their brain is not working right,

and they now know it. And is there any

other benefits to being in a ketogenic

state? You mentioned strength briefly.

Yeah. So, when you're looking at do you

do weightlifting? Yeah. Okay. So, when

you weightlift

how's

grade your soreness on the day after

your

like lifting day? Um if I've been using

that muscle consistently, there's no

real soreness. Good. So,

let's just take a day where you're

pushing it harder. You're deadlifting

harder, and you've got a strain in those

muscles. One of the key components for

repairing that as quickly as possible

is

is to be in a ketogenic state, to take

that inflammation way down.

And you probably didn't need the help of

repairing that muscle when you were, you

know, 18, 22, but as you get into the

30s, and especially into the 40s, the

amount of inflammation

that tries to help you repair that, it

overshoots.

And that's where the chronic pain's

from. That's where the delay in repair

comes from. So, when I look at power and

muscle training, I the first place I

talk to my patients about it is

how many days does it take you to get

back to to feeling good after you've had

an injury? Uh let's let's be on the side

of a ketogenic setting where your

inflammation is super low, and when you

tear something, which you're going to

tear things when you're lifting heavy,

the repair part is so quick.

The power is a little hard to talk

about. If you want me to go there, I

can. Uh

Yeah, so is there is there going to be

any impact on my my ability to train

Yeah. if I'm in a ketogenic diet? Am I

going to be impacted in terms of

endurance or strength or power or

anything like that? So, we looked at

this in um

in military people. Uh it's one of the

my favorite ones where they are all

insulin resistant. And we put them on a

ketogenic diet, and so they're trying to

meet the standards. And at a month of

being in a ketogenic state, they've lost

weight, but their power and time didn't

do anything too sexy.

Then you look at those same soldiers at

a year or I think it was 6 months was

the next time they did another big

check. Uh and by golly, they've lost

even more weight, and their power is

about 20% more than their counterparts.

When they get to 18 months of a

ketogenic diet, their power is almost

50% more than what their counterparts

were. So, let me explain that. As you're

looking at a muscle, it will choose

which fuel it wants to use. And when

you've been glucose using when you're on

a non-ketogenic diet, it's going to use

glucose first to fuel.

But if you can train it to to use fat

in that training, it's a longer, better

fuel with less inflammation, and um

especially in a a state where

it will use both fuels quickly.

That takes time. I mean, it takes And

what I tell patients is, you'll love me

in 18 months. You'll think I'm pretty

great at 6 months. But if you're trying

to run a marathon and we're only 3 to 4

weeks out, you should not start a

ketogenic diet. You're going to think

it's the worst thing ever. It's meant to

train muscles to use fat, and that takes

time.

And is there a link between some of

these cognitive

degeneration diseases like Alzheimer's,

dementia, etc. and the ketogenic diet?

Cuz I know that there's been some

research that's underway and has been

done to try and establish causality of

Is there a link here? Yeah, you know,

it's one of the saddest places where if

you look at what patients regret in

life,

they come into the clinic, and they're

already starting to say, "I was driving

the other day, and I I got lost.

And when I hear that, we are 15 years

too late. It is 15 years of building up

trash in that brain that we have to

clean out that debris.

And I had the privilege of an amazing

story that taught me I don't have the

gift of, you know, seeing into the

future. Am I going to reverse these

Alzheimer's before they show up? We

don't have the research for it. Um but I

have a lot of clinical experience

saying, "Boy, they are so much better."

I don't know if their memory is going to

stay this good. We're only 3 years into

a ketogenic diet, but it's way better

than when it started.

And then I had a Down syndrome patient

at 40 years old

uh in my practice.

So, her mother came to see me first. She

said, "I I want to try this ketogenic

diet. Um I've been helping my daughter

who's has Down syndrome. We've lost 100

lb uh because the doctor said that she

might do better

if um if we lost some weight."

And it's not an uncom- uncommon thing to

see they have advanced insulin

resistance and advanced Alzheimer's

earlier in life. So, it's a great uh

place to study Alzheimer's because they

have a a more rapid onset of it. So, the

woman comes, she's lost 100 lb, and

during that time her mental cognition

got worse.

So, now she's got 100 lb down, but none

of those brain things are better.

And I said, "All right, if we're going

to do this with your daughter, we're

going to make sure we're pricking your

finger. It's not going to be fake. We're

going to do a real ketogenic diet."

So, the mom starts on a ketogenic diet,

and I think both her and mom are

genetically super powered to make

ketones cuz they have ketones of like

three within a couple of days. Which is

the average would be

>> Like one. If I If they hit one in a few

days, I'm thinking, "Good job." And the

mom calls me at the end of the week

saying, "Do you think it could possibly

work this fast?" She is She's, you know,

doing the little jobs that she used to

do around the house. And I said, well,

call me again in a week. Let's see how

she's doing.

And the mom goes, the most profound

thing just happened.

I've taken care of this girl for 41

years.

And I asked her the other day if she was

doing something. She wanted to go to the

church with me, which means she left the

house.

And she was at the church and she was

giving her instructions to do this, go

around here and put it over there and

give her a little job.

And she said, do you understand? And the

girl replied, I understand.

I said, what's the big deal?

And the mother said, she had never said

a three-syllable word in her whole life.

Two syllables is all her brain could

ever put together. For the first time in

her whole life, 3 weeks on a ketogenic

diet.

And this Alzheimer's

diagnosed patient who had Down syndrome

now had a brain that was not only

working great,

it was doing the best mom had ever seen

it. And on a ketogenic diet, not only

did she lose about 15 to 20 more pounds,

but her world opened up again because

her brain, which had Alzheimer's, no

longer had that diagnosis.

I was looking at some of the supporting

studies around this, around the impact

that can have on the brain. And studies

show that in dementia, especially in

Alzheimer's, the brain struggles to use

glucose efficiently. Ketones provide an

alternative clean fuel source.

Um ketogenic diets can boost

mitochondrial function and energy

availability in brain cells. Keto lowers

systemic inflammation, which is linked

to slower cognitive decline.

Um

ketones may protect neurons from damage

and promote the growth of new neural

connections. And Alzheimer's is

something called type 2 diabetes, which

I've had a lot um and keto improves

insulin insensitivity, potentially

reducing this risk. And lastly, small

studies show temporary improvements in

memory and cognition in people with mild

cognitive impairment or early

Alzheimer's, but the evidence is early

stage. Long-term adherence can be hard

and the diet isn't suitable for

everyone.

Uh for example, underweight people um

and people with certain medical

conditions. Right. So, how do I measure

my blood ketone levels? Uh, is that what

are these devices are here on the table?

>> Yeah. I mean, when I look at um uh

giving patients the freedom to say don't

don't come to me for the things that I

that you can do at home.

First thing is be willing to check data.

Okay.

>> Okay? So, blood way better than any

other way to measure this. We're going

to be able to see Should we have a

contest which one's better? Yeah. Okay.

Okay? So, you want to go first? Okay.

So, what I'm going to do here is I have

a

finger prick here which is going to take

some blood. Just going to prick my

finger. Then I have this little reader

and I also have this little strip here

which I'm going to put my blood on to.

And within a couple of seconds, it's

going to tell me how many ketones I

currently have in my body right now. And

so, we're going to look at that at the

same time as your blood sugar, which is

how you can measure insulin. It's the

best proxy for saying how high is his

insulin. So, put both of them in there

before you go cuz then you don't have to

just prick yourself twice. Okay. So, A

blue one is going to measure the ketones

and a brown one is going to measure your

glucose.

Okay. And this device, how much does it

cost if people want to buy it at home

and start pricking their own Yeah, I

think there's a kit that comes with

about 50 strips so you can have ketones

and glucose at the same time. I'm

guessing it's around 70 bucks or maybe

it's 60 or 70 dollars. I They have quite

the Now, put it all in. There you go.

And so, they'll still It'll lights on

the other one, too, right? Perfect.

Okay. So, prick your finger.

Best to do it on the side of your finger

cuz there's less nerves there.

There you go. Good job.

Okay. So, I'm going to put my blood onto

this one, which is the keto reader.

And it'll it'll count down

uh see I think it's about

My glucose is 86.

Takes more blood for the keto one.

And my keto levels are 0.9.

>> 0.9. Okay. So, that's a Dr. Boz's ratio

of 86 / .9, which is probably like 95 or

something, like 90

five-ish, right? So, my glucose level's

at 86. Is that high or low? That's good.

Uh so, I would say that's not low, it's

just good. Okay, and my ketone level's

at .9. Right. So, when you look at them

in comparison, like you want to have a

blood sugar that's

not triple digits, so that's very good.

And the closer the higher you are above

.5, the better the result. So, that's a

pretty good number. So, if I'm in

ketosis,

>> Mhm.

what reading would I have on this ketone

meter? .5 or greater, but it would be

also that you have that reading without

a triple-digit blood sugar. So, when I

look at the combination of them, I do a

little math and say, "Your Dr. Boz ratio

is like 95." So, you are burning fat

right now.

Okay.

>> Okay? So, that's a good sign. When I am

trying to help people who are trying to

undo cancer or autoimmune or brain

injuries, they have to have a better Dr.

Boz ratio than that. Let's do your

readings to see where you're at.

All right.

Drum roll.

83

and 1.7. How are you at 1.7? What have

you done?

So, I've learned

I would love to be 33 again and be able

to eat that late at night.

You said that I'm like, "Oh, it's been a

while since I've eaten that late at

night." It's probably the hardest thing

to teach my patients too is like, "You

don't appreciate how much insulin you

make that late at night." Now, you're

still in season where you get to just

kick your heels and enjoy youth. But, at

my age, you cannot do that. I can eat in

the morning. I can have good calories of

high fat and good protein in the

morning.

And I've learned to stop eating

somewhere around 3:00 in the afternoon.

Um in fact, if I Yeah, I know.

>> 3:00 in the afternoon, you stop eating?

That's usually the case. You know, what

what's really hard though is how much of

your life is social. Like you said, "Oh,

there was this dinner party last night

and I had pasta."

And you're like, "Yep, uh that would be

something I have to teach my patients.

You have to say no to that. You cannot

be eating at 10:00 at night if you want

your insulin to not

to not do that debris thing. And boy,

when their memory isn't going well, when

their friends are dying of uh memory

problems,

you know, it's I don't like using fear

tactics. I don't think they last very

long. But it is such a reality

of poor performance that

I can't do that. I cannot eat at 10:30

at night. What is it about being asleep

that causes the sort of dysregulation?

Like, what is it about it doing it at

night? So now it's going to take that

metabolic curve and in order to

to store all of the part that gets

stored and then turn the part into fat

that needs to be tucked away and get

back to baseline, it's going to be 8

hours, at least 8 hours.

>> Which is fine. Right.

>> Because I don't eat till I'm probably

not going to eat till 2:00 p.m.

>> Right. Well, you you missed one part.

The sun will rise.

When the sun rises,

even if you're in solitary confinement,

you cannot see the sun. Yeah. Your brain

knows that the sun just went up and

cortisol rises. Okay. Cortisol leaves

your brain, goes to the liver and says,

"You know that stored sugar, that

glycogen, release."

You make glucose first thing in the

morning.

How much glucose? Depends on how insulin

resistant you are.

So you're going to you're going to have

an uneaten meal

when you wake up in the morning. Glucose

has been stored for the this purpose.

It's going to wake you up. It's going to

give you the energy when sun rises to to

fuel you.

If you got a bunch stored,

you're going to have a high blood sugar.

Can we do Jack's ketone levels? I'd like

to know what what Jack is at.

>> Ooh, let's do that.

What's Jack do for a

for his We're about to find out. I don't

think I'm going to No, wait a minute. Is

Jack the one that did the VO2 max with

Peter Attia? That was me.

Well, you know, peak brain performance

is my thing and one of the hardest

brains to heal are chronic runners.

That trauma thing is real. Like, it's so

hard to explain to them, too. If you're

a vegan who runs, ooh, you're in

trouble.

95% of vegans that listen to this

podcast frequently don't subscribe.

All right, so his glucose is 88, not too

bad.

Ketones, boo. Absolutely. Yeah. That's

an example of he is making trash.

There's no trash going out. So, his

ketone level is what .1 and his blood

sugar is 88. So, if you take 88 divided

by .1, it's like what, 1,000 or

something? It's really high. 888,

probably.

That is a lot of trash being made. When

that Dr. Boz ratio is high,

you can't take it out.

>> to say that to his face? I mean, I feel

like

I just think that when Peter Attia did

that and said, "Oh, I had no idea." I'm

like, you could have just checked this

first thing in the morning for 5 days.

If you have that kind of a Dr. Boz

ratio, you're insulin resistant. You're

insulin resistant. You have to be

hitting that in a routine regular

interval in life to not have those

problems. To have osteoporosis at such a

young age,

a ketogenic state would not allow that.

You would be using the resources much

better.

He actually did a test, it turns out he

doesn't have osteoporosis. Oh, good. But

that was

>> shocking. Yeah. I was like

You shouldn't have osteoporosis at your

age. No, I think that was a misreading

because of this kind of um Right.

>> But on this on this point in particular,

his ketone levels are 0.1. So, he's

basically running off glucose.

>> All glucose. And and so, why is that

happening? Okay, whatever he ate, the

insulin went up. So, let's say he was

your exact same eating pattern. He ate

last night, he had the 6-8 hours of

sleep, the cortisol said, "Oh, the sun's

rising." And it rose his blood sugar a

little bit. Okay, when the sugar's high,

you can't you can't your insulin's going

to be high, too. You're not making

ketones. When I did these this keto test

with most of the team here. They were

all around that region. They were were

in the region of 0.1 ketones in their

blood to 0.3. Welcome to my clinic in 10

years.

That is trash being made, never being

taken out. And so you'd say to them, you

need to do some fasting, you need to You

need to cut carbs. Yeah. I mean, if

you're looking for a quick Okay, if

they're in their 20s, I mean, I have

three kids, right? And they have heard

this chirp for 10 years.

Uh I mean, how I got into this was my

mother was very sick and she was sick

because of a high insulin problem

that caused cancer.

So, we put her in a ketogenic state and

everybody in the family got on board.

So, here is three little boys who no

longer have candy around. Now they're in

their young 20s and for the first time

they're actually listening to say,

"Gosh, Mom." One of them's at

Georgetown. He has to read for long

periods of time for Georgetown Law

School.

And he's like, "If I'm not in a

ketogenic state,

I can't keep the focus." And I said

Yeah, I said, "Well, how are you doing

that?" At first, he tried some of the

supplements, okay. But what really

happened was he cut the carbs down and

said, "I can say no to that because of

the sustained brain power." I mean, it's

really easy in your early 20s to do

this. Cut the carbs even to 50.

But prove to yourself that you made

ketones and that return on your

dividends is you won't be seeing me in

25 years. So, you have this idea of this

keto continuum. Mhm. What is the ketone

continuum? I read about it. I mean, it's

it's a book here I have which you

published in 2020

called The Ketone Continuum Consistently

Keto for Life. Right. So, the keto

continuum is this 12-step process Right.

to get into a consistent keto

>> Consistently keto. Yeah, that you're

constantly taking out the trash. The

first part is the beginner. Okay, so the

first part, the beginner section, has

four stages to it. Right. What are What

are those four stages? Well, I like to

tell patients that you never fall all

the way off of the continuum. So, the

first part the first step is really not

keto, but it is that they're eating

every two to three hours and if they

fall off the wagon, that's usually where

they land. So that's what most people

start at. They're eating every two to

three hours, they are not keeping their

carbs less than 20. Step two is cut your

carbs to 20. That's the only thing I

need you to measure and you're going to

be able to use a ketone strip, you know,

measure ketones in your urine

uh and that will ride you'll you'll ride

a wave

and that ketone production is happening,

the fat-based hormones in your body are

starting to resurrect, they're starting

to do the things that they need to do

and there'll be this magical moment in

the not too near future

where you skip a meal.

And this that beginning stage

how long does that last? I'll put this

on the screen so everybody can see Sure.

the continuum. Um how long does that

initial beginner stage last for people?

If they've been severely insulin

resistant, this is the ones where I've

said they took their carbs to 20 for for

two weeks before they pee'd a ketone.

So I use some other steps if that's how

severe that is. But let's just take the

average person. That's like not they're

not 100 lbs overweight, they're hitting

menopause and they've put on 25 lbs.

When they drop their carbs to 20,

they're peeing a ketone by the end of

the week and they are missing their

first meal by day 10. Okay, so day 10.

And then it says when we get to stage

five in the keto continuum, it says 16

80 16 8. Is that Yeah. So then we start

to use time-restricted eating uh where I

want we we're going to have your body

will adapt. People say you can't stay on

the keto diet because they go to step

four and then they think that that's all

they needed to do. There are several

steps to reversing this problem and

you'll know you have the right step if

the ketones are still present in your in

your blood.

Your body will adapt though. So we start

to say, all right, we're going to learn

some new behaviors.

We're going to learn what the nothing

burger looks like at least for 16 hours

out of the day. What does that mean? You

do not eat a thing in those 16 hours.

Now,

I give them a little hedge because most

people come in like you. They don't

start eating until 2:00 in the afternoon

and then they eat until 10:00.

And I want them fat forward. I want lots

of fat going in because insulin

resistance,

that high insulin state, means they've

locked or they've insulated their fat on

their body. And then we get stage seven

where it says 23:1. Is that fasting for

23 hours a day and eating for 1 hour a

day?

>> And the there's a little bitty line

between 16:8 and 23:1,

but there's a whole bunch of life there.

Meaning, we don't actually have patients

go from 16 hours of fasting

to 23. We have them slide it down by an

hour, slide it down by an hour, and then

we do that harder thing which is

move it towards sunrise. Quit eating so

late at night. And then the last stage

here,

so so step nine, 10, 11, and 12 is

prolonged fasting between 36 and 72-hour

fasting. Right. So, those folks that

have high insulin for 20, you know, 15,

20 years,

they're going to have to do a nothing

burger for 36 hours in most of them to

really give a good reset of their

metabolism. And although you you look at

other folks saying, "Oh, you should

never do that if you're a woman. You

should never do that over the age of

50." I'm saying you have too much

insulin in your body. You have to do

that to get the pancreas to make less

insulin over time. On that point,

between men and women, aren't there

metabolic differences that need to be

mentioned here? Because you know, when I

sometimes when I do ketogenic fasting,

my girlfriend, she takes much longer

than me to get into a ketogenic state.

And I'm wondering if her body is in some

way trying to defend Mhm. the switch.

>> Have you ever seen the the reality show

Alone? Oh, no. I'm not a reality show

guy. I'm not either, but they drop these

people off in the middle of nowhere and

they starve them to death. And you watch

the fat come off of them. And the men,

the fat just

melts off of them. And the women, they

do what your girlfriend does. It just

holds on to them. That we are designed

to have that fat on them. So, asking

them to do a ketogenic state, you'll

hear people say, "Oh, it's going to ruin

your hormones. Oh, it's going to You

can't do that." And um I would say you

can have all those conversations once

their insulin is normal. Well, I have

lots of women in childbearing years that

are excessive producers of insulin. And

their vitamin D is low, their estrogen

is low, they have hair loss on the top

of their head, they have skin tags

throughout their body, or maybe the

first sign was they had PCOS.

Okay, all of these are a sign that

insulin came in and it's too high in

their body. So, lowering it has rules.

And if you want to have a baby, carry a

baby, uh have uh the weight come off

after you've gestated a baby, um have

weight not be your enemy during

menopause, you have to be making ketones

at a routine and regular interval. And

start with the food. Start with the

menus in the kitchen.

Don't run to the gym first.

I've noticed uh in women in my life that

they've told me that their menstrual

cycles become more synced up when they

are in a lower carbohydrate diet. Right.

Their hormones can hear each other. I

mean, when insulin is high, insulin

dictates what that sugar does, but it

also is the dictator for every morsel of

fat.

And estrogen, testosterone, vitamin D,

they're all a derivative of fat, of

cholesterol. And they are They're put

into the fat cells. If you biopsy an

obese woman and say, "Can I see is there

any vitamin D hidden in there? Is there

any estrogen? Is there any Yes, they're

all in those fat cells.

You start to lower their insulin and the

fat mobilizes. So, the hormones that are

naturally communicated between women,

they can actually hear them again. I

mean, that that tribal thing. If a woman

were to stay in a ketogenic state

permanently,

would there be any disruption to her

metabolic health? You mean like me?

Yeah. Like you know, her menstrual

cycles, her

uh yeah, anything.

>> No, I think it's

You're going to find people that it

shouldn't be extreme, meaning I've been

on this for 15 years. The ketogenic

phase is at least 20 out of 30 days

uh in a month the first few years I was

on it. Now at 55 uh menopause in the

last year um I'm like without a ketone,

my brain doesn't work right now without

a ketone. Uh my energy goes to pot. And

I've been walking women through

menopause for 25 years. It is not a fun

story when they're insulin resistant.

So, prepare. Uh have the flexibility of

that mitochondria to use both ketones

and glucose, and that's what a ketogenic

state is. Well, we have 12 cans of

sardines here, and uh I I I wondered why

you you brought sardines. What you

>> Well, yes. That's a hell of a tool.

Why?

So, um when you're trying to help

patients change behavior,

Sorry, the sardine juice has gone on my

iPad.

Uh good luck getting that off.

Yeah, sardines rank for

uh the worst smelling, but they're not

the worst tasting.

Now when it comes to bitter in fish,

they don't have the bitterness that tuna

does. So. Tell me about sardines. Why

why should I be eating sardines? When

you're trying to teach patients, those

stats that you read off a minute ago,

they don't care. They need a very clear

step on how do I begin.

And when you're working with somebody

who cannot seem to get their ketones to

rise, and I give them a whole list of

menus, it's too noisy. Let's take it

down to one food that is high in fat,

high in some of the best fats, high in

protein, it's whole foods, and it's

affordable for everybody under the sun.

Okay, so you do you do you like a

sardine fast? Yeah. So in fact that that

21-day we 21-day is that 3-week course

where I say I will teach you how to do

an advanced ketogenic diet where

everybody will be peeing key or making

abundant ketones.

On day six uh I say all right, the only

thing on the menu for the next 3 days

is sardines.

There's no eating window. You can eat as

much as you want. There's no limit to

the amount. And what I'm pushing them to

do is not only eat a nutrient-dense

food, but I want them to feel satiety. I

want them to feel full. Do I need to be

consuming a lot of fat as well? There's

plenty of fat in there. But I mean

generally cuz what this is one of the

the fat Yeah.

>> things that always puzzles me is I'll

I'll go

say I went a week without eating

carbohydrates.

Sometimes I'm still not in ketosis. And

I think I heard somewhere that it's

because my fat Right. So

>> enough. So Yeah. So again, at the time

you went you went 7 days without eating

hardly any carbs, right? And you still

didn't make a lot of ketones. Okay. So

you had fat on your body?

Yeah. Okay. So why didn't the fat get to

your mitochondria?

Excess insulin. Okay? You had been in a

high insulin state. So if you swallow

the fat, then you can turn it into

ketones. Right now all your fat's locked

under this insulin bed. If you kept

going, it would eventually hit, but

that's painful. I mean I have patients

who do it for 2 weeks. So what you're

saying? You're saying that I need to

have enough fats?

>> Yeah. So if you put the sardines in oil,

uh that's a great high-fat,

high-protein.

Uh it's also a little easier to

masticate the the meat. And you'll have

high-fat, high-protein, and you'll have

beautiful ketones by by 48 hours, maybe

72. And what what is the the composition

of my diet in terms of protein, fats,

and carbohydrates when I'm trying to get

into a ketogenic state? Yeah, I don't

let people get distracted by this,

right? I say look at your finger. If

it's got a high ketone, you have got

enough fat and enough protein uh

and low enough carbs. What most people

have is the story you told. I've been

doing this for 5 days. Why don't I make

any ketones? And the answer is what is

hidden behind the chemistry is too much

insulin.

You've got to have and so that's a great

place to say put the fat up, keep the

carbs low and the ketones will come.

When you say put the fat up, you mean

eat more fatty foods. Give me an example

of the type of shopping list that if I

was trying to get in a ketogenic state

and stay there,

I would have. Yeah, my one of my

favorite things is

pork belly,

more eggs,

beef brisket, ribs. Avocado? Avocado

have beautiful marketing team, but they

do have carbs in them and I've had

people overeat them. Like I have four

avocados today. I'm like, that's

you're on the wrong bandwagon there.

Avocado makes the list, don't get me

wrong, but it's not a diet of mostly

avocado with a sprinkle of chicken

breast. That's not going to get you into

ketosis. The fat has to be higher than

that. Most of the time when I'm really

struggling with a patient who just can't

seem to make ketones, can't seem to make

ketones and they won't do the sardines,

I've said eat butter for a day. That's

100% fat.

Okay, so you can just have increase the

butter or Yeah, you could have that.

Okay, so that Are there carbs in here?

No. No. No, it's just fat. Mhm. Mhm.

And it's not awful,

but it is a great social experiment

where they haven't felt what satiety

feels like in a while. People talk about

net carbs. They say, you know, an

avocado has

12 g of carbs in, but it has 10 g of

fiber, so the net carbs is two. If

you've never had insulin resistant, you

can do it that way. My patients have had

high insulin and I don't play that game.

It's got to be total carbs.

Fiber is for farting.

Do you recognize this photo

of this lady?

Oh, yes.

Who is she?

>> Why, she is just a great story. Jane had

uh

uh she had pathology with how she

thought about food. Like many patients.

She

uh she had food as the way she coped

with a lot of things. And as long as she

was clearing her plate and using that

food, it covered a lot of wounds.

When you start to address some of these

things, I mean, the ketogenic diet

doesn't fail if you just follow the

chemistry. The ketogenic diet fails when

you have humans who've had wounds,

who've had a history, who have stress,

who don't sleep.

And Jane was a great story where

all the goodness in the world it

couldn't undo some of that relationship

she had with food.

Uh so, the first time she one of the

coaches that I used for that 21 day, and

she just has the best outcomes cuz she

was doing the a strong ketogenic diet,

you know, for those 3 weeks twice a

year.

And she decided that after I think the

third class, she was going to do

sardines only for 30 days.

And she writes me at the end of the 30

days, can't believe how great she feels.

And really kind of addressed some of

those demons associated with why she

would eat what she would eat.

And then life hit again, and she put on

some of the weight again. Um she'd used

sardines intermittently. And she called

me and said, "All right, I think I'm

going to do this again. I'm going to

just go on sardines and really have a

some come to Jesus moments on why it why

it is that I do some of the things I

do." I mean, it's a really vulnerable

moment where you can hide those moments.

You can never tell a soul what's really

going on through your mind, and she was

going to address them.

And I said, "Well,

I have a bone to pick with Joe Rogan.

He has said some

inappropriate things about sardines,

like they're arsenic poisoning. So, I'd

like to check a few blood levels in you

before you start." So, I check her

vitamin D, we check her arsenic,

selenium, and a few other things. And

she starts on her sardine challenge her

sardine journey, and she goes 100 days.

100 days of only sardines.

And not only does she first of all, her

vitamin D, she did not take any vitamin

D, she stopped her vitamin. It went from

like the 30s and 40s up to

just maybe over 100, 108 or something.

Uh her selenium didn't do anything

naughty. Her arsenic did not do anything

naughty like Joe Rogan said it would.

And she was able to um

not only shed the pounds, but really

say some truths about why she was eating

so much.

And she confronted the pathology about

why

why is she using food for those other

things?

You know, I do this thing in the 21-day

where I ask them to find their best day

in their life.

And I'm trying to just get them to think

about what does that feel like? What did

What did that look like?

And then we go to the worst day in their

life. And Jane wrote something that

really touched me.

She said, "I don't think I've ever had

the best day of my life."

This was probably the third or fourth

time we'd done that exercise, so she'd

done it in a way where

it didn't bring any extra attention, but

she was she spoke a truth that just

said,

"I've had this fear for so long

that for the first time I'm going to say

out loud that

I'm looking for the best day of my life,

and I feel like I have the freedom to do

it."

That's what happened after 100 days of

sardines. So, if she eats sardines for

100 days,

she's probably not going to get like the

gut microbiome.

She has the best gut microbiome.

Doesn't she need to be eating plants to

Oh, no. Fibers for farting.

So,

you're looking at a gut biome, right?

And so, tell me what you think that is.

Uh lots of bugs that have been feeding

on plants.

Okay, yes. Pooterate has uh has part of

that equation. So, gut biome is the

slime layer inside your gut. It's where

the critters live. It's where they set

up homes and they If you have a really

good slime layer, it's squishy. It's

dense. It's not moth-eaten. It's not

aqueous or water-like. It's squishy.

And when you put plants in there, when

you put fiber in there, it tears that

down. Uh and you say, "Well, fiber's

needed for this because some of those

bugs eat up on the fiber and they put

out some butyrate and that helps these

other bacteria to to grow." You're like,

"Yeah, that's one way to get a good

microbiome." But we haven't been fiber

eaters forever. And when you look at

many of my carnivore patients,

especially when they've got, you know,

some of those little fish scattered into

that carnivore diet, um their symptoms

of irritable bowel, of chronic diarrhea,

of, you know, bloody ulcers

reverse.

Why? Cuz that gut biome got a lot

stronger and a lot healthier. So, the

things that I from doing this podcast

for a long time, the things that I'd I'd

be concerned about if I just ate

sardines for a prolonged period of time,

or really any diet, I guess, for a

prolonged period of time, a narrow diet,

would be

the fiber issue we talked about. Um and

then all the other things that are just

not in sardines. I mean, vitamin C.

Yeah, you still get a lot good vitamin

C. So, vitamin C has different rules

when you go carnivore. What about

magnesium? Yeah, lots of that. Uh

magnesium I still think is one of the

supplements we all need. What about the

sodium overload? Cuz these are very

salty, right?

>> Your sodium churn, how well you use

sodium, is dependent on how well you've

eaten in the last week. So, when you

increase the sodium, those receptors get

better. When you decrease the sodium,

those receptors shut down. That's a That

is an adjustment that everybody will

make. What about things like mercury and

the other sort of metal toxins?

>> Little fish, little problems. You got

the right one for mercury. Again, we

tested that for her, too. 100 days, no

problem.

Are there especially in the can, as

well? I

I think I've got a bit of an issue with

canned food these days because I've

heard so many

>> Microplastics. Microplastic toxins, etc.

I think you're majoring in the minor

leagues there.

That the the amount of benefit that

people get from sardines versus whatever

might be in those in that can. I tell

patients not to worry about it.

And then the last point I said was about

digestive and mood issues because the

that microbiome is so So linked to

brain, absolutely. Serotonin, isn't it?

The the I mean serotonin is in the gut,

but it's it's a huge part of like a

GLP-1, GIP, they're all produced

hormones in the gut that are hugely

impacting your brain. And when you want

GLP-1 to be made, have a strong thick

microbiome. You do not need fiber to do

that. You need butyrate.

Butyrate is that two-carbon

uh fat that comes from Akkermansia, you

know, chewing up the fiber, right? Or

beta-hydroxybutyrate

in your blood.

That's that ketone thing you're got over

there.