DR BOZ: FROM METABOLIC INSPIRATION TO PEPTIDE PRINCESSES

Hi folks, this is Dr. Rob Cyus. I am the carb addiction doc. And today we've got the most amazing person, Dr. Annette Bosworth. She and I have been buddies for a very long time. And I'm not even going to introduce you because if anybody doesn't know who you are, then they probably leaped aboard Artemis 2 on the way back from the backside of the moon. But everybody on Earth should know who you are. But so great to have you here. And as we were talking just a few minutes ago, our synergy is enormous. Great to have you.

You make the statement, "Metabolic disease is the root of most chronic illness." For [clears throat] sure. And while I fully agree with you, can you expand just a little bit on that and how, where there's this huge cognitive dissonance between the current medical algorithm that is completely oblivious to that statement and is yet is involved in the treatment of patients with medications?

Well, don't don't you also agree that when you've, when you've been in medicine a while, you've got this silo that you live in. And you know, when I was picking which kind of physician to be, uh, internal medicine sounded like a great place to land until I figured out, like, which lane would I want to advance in? Which silo is I going to, you know, climb the ivory tower to get to the, you know, the most elite or most, you know, educated, proficient part of that part of medicine. And I believe that the more towered we get, the more you trust that there must be something more to what they do. That that seems mysterious. That's not my lane. And as I entered into primary care, internal medicine, uh, and exited saying, "I think I'm going to be a mom in this story." So that means I'm not going to chase these ivory towers into pulmonology, critical care, cardio, whatever it was I was going to choose. And it was there that you started to say, "No, no, a primary care internal medicine, you get to have those conversations with these advanced experts for chronic medical diseases."

And the first 12 years of practice, you know, after residency was, you're the primary care internist. Your job is to manage chronic diseases. And you know, my personal passion was always peak brain performance. uh partnering with when anybody could help say, "How would we improve that, you know, broken brain?" I'll put in quotes, whether it's Parkinson's, bipolar, head injuries, you know, TBI, whatever. But here you were kind of gathering the histories and the practices and the best, you know, foot forward in a way that said, "Could I understand what that silo was doing? What this silo was doing?" And and I'm kind of a nerd. I wanted to not refer outside to those specialists until I, everything in my power to to take the case as far as possible. So, what happens over those 10 years is, I mean, a humble study that, well, when you go to that doctor, here's what's going to happen. They're going to do these five things. They're going to write these four prescriptions. They're going to test these three things. And when nothing comes back positive, they're going to send them back to me. And then I get to decide, should I, you know, refer you back to that for that doctor once a year to get the prescription because he's going to forget. They're not going to remember the deep history or that because they're going to see you once a year. It's my job to keep track of that.

So over the course of this decade where I'm just trying to be be great, you know, I want to do a, I want to be great as a physician and I'm like, "The emperor has no clothes." >> Right. Exactly. Exactly. >> These advanced diseases, they do an algorithm. They they follow a checklist. And although it was a checklist that I didn't understand or maybe it was, you know, had the newest and latest and greatest tests, the disease root cause was never what they were chasing. They were chasing what could that branch of medicine do to really, you know, check the box. "We've done everything modern medicine could offer you." And all that was leading to was more doctors, more tests, more prescriptions, and and more disease. Not less disease. I mean, rare did I get to scratch one off the list and say, "Ha, we conquered one." That was not what happened. So I I I think that formative 10 years of saying, "Oh, I I never want to be that have that good of insurance." Like the insurance takes care of all the specialists and they cover all the things. That just gave them the right to send the prescriptions through, the procedures through. And as much as it sounds like advanced medicine, it wasn't an advanced life that was coming out of it.

But isn't it isn't it true that 50, 60 years ago, as humans, we were dealing with things that happened to us. We were dealing with infections. We're dealing with trauma. We, as humans, are very smart. We've combed, certainly in this country, so many of the things that happen to us for which patients have to show up and medication works. We are now suffering more so than in any other era. Diseases that we cause to ourselves either through ignorance or through intention. And there aren't medications that can fix what we do to ourselves. And that is the chronic illness that we're dealing with here, that's metabolic disease.

>> Exactly. If if I had to say one organelle that I want you imagining as we talk over the next hour, it's that inside your cells, that mitochondria. Is it limping along or is it rejuvenating and giving birth to some new fresh mitochondria that will help rescue you out of a chronic disease spiral trap? And boy, that's a silly thing to think about and many people don't think about it. But I think in the game of how do you live your best life? It is that imagery of do do the things you're doing improve that subcellular part of your body or is it just covering up the symptoms uh and not really stimulating that right regenerated growth of health?

I think the the other part, the way I look at this context and I think we share so much synergy here, is that beyond the mitochondria, the mitochondria lives inside of a cell. The whole human body is made up of cells. You and I never see somebody who's perfectly happy and healthy. >> It feels great. Okay. We people come to us or people want to change when they don't feel so good. And the whole being feels crappy. But every cell is in crappy shape. And then the individual organelles are also in crappy shape. So it starts at the organelle. But it affects the entire, the entire uh uh uh person. And that really is what we're dealing with here when we talk about metabolic disease. Not everybody's sick. We sometimes have transient issues. But you're absolutely right is that this is self-induced damage at a cellular level and a microcellular level. And it can be fixed from there forward.

So a large part of the way I look at it is the body is responding. It's defending itself. >> Yeah. From what we do to ourselves. And you can you can't medicate that. But what you do so succinctly is help the person to remove the pressure of the body defending itself and optimize natural function in the human body. And you have a beautiful name that you've used for this. It's called keto continuum. >> Yeah. >> Which is a progressive adaptation model which improves from organelle upward. Can you explain that a little bit and how does somebody understand and begin that process?

As a physician practicing in the metabolic space, I often get asked, "Well, I'm not in ketosis. I can't get into ketosis. My body's not producing ketones." That's okay. You don't have to be producing ketones all the time. But if you ever feel like keto works, but not every day, that there's good days and bad days. That's because making ketones is a complex process naturally in the liver and there's lots of little influences from adrenaline all the way through to your diet. Uh making ketones is tough and it takes time. Well, one of the answers there to augment that is to use Ketone IQ. A slug of this stuff, which I use on a regular basis strategically and episodically, a slug of Ketone IQ gives you ketones on demand. So, it fuels you up. But because it goes directly to the liver, it also affects the liver's ketone production and enhances the ongoing production of ketones. So while you see the spike in ketones if you're measuring them, you stay in relative ketosis at a low level for a prolonged period of time um even when your diet is not optimal. So for mental clarity, for for uh continuous working where you need stamina, this really fits my real-life demands. And I use Ketone IQ together with a carnivore-based ketogenic diet to level off that ketone production and to spike my ketone production when I really need fuel, but I don't want sugar.

Well, I'll tell you that came about after, you know, the first book that I wrote was based on my first patient ever to lead through a ketogenic diet and that was my mother. Um, and as I watched her story and then tried to teach through her story, uh, many people came, you know, knocking on my door saying, "Can you teach me how to do the ketogenic diet?" Well, as you very well know, there's no code for teaching nutrition as a physician. Uh, so I need to find medical problems if I want to do any kind of reimbursement that was associated with that. But more importantly, I'm like, "You don't need to be a doctor to teach this or to learn. I mean, you should you should just this shouldn't be on my plate." But as I unpacked and said, "Okay, so how could I write what what really is this chronic disease process that you're trying to reverse?"

So you have patients like my mom who had had 10 years of cancer. She was 71 years old with six months to live. If she just said, "Forget everything. I'm doing it. I'm I'm checking out." If you you left the world of medicine, you were t you were six months away from a funeral. And so that is a very advanced metabolic problem that didn't start yesterday. That was at least 20 years of the first chronic problem, which then stacks onto the second chronic problem, which is the third and the fourth and the fifth. And I could have put at least 15 diagnoses without exaggerating any of that. Just saying, "Here is what chronic disease does. It stacks on top of the next one." So to reverse that, it is a, there are some people who will go through the first few steps of pushing that chemistry of ketosis into the cells of their body, living there, and then watching the chronic disease reverse. And they don't need this. You know, my mother needed the absolute longest, most intense uh two years of really following through on a strict ketogenic uh chemistry in order to reverse the problem she had. And by the grace of God, we got this unbelievable outcome that then allowed me to teach others saying, "Well, she was super advanced. Let me show you what you would need to do."

So, like anything in medicine, you do not need to go to the nth degree to get the outcome if your diseases aren't as bad. You do, however, need to be able to measure it. This is not a playtime. If you want to go play, go to somebody else's channel. If you're trying to reverse medical problems, it is a measurable process that I will have you learn and calculate every morning. And how long do you need to do that? Well, it depends on how many of those chronic diseases are stacked up in your medical chart or inside your cells, more importantly. So that keto continuum started with everybody has to do these four steps in order to even get that keto chemistry present in their body. But what I learned after that was so many people said, "Boy, I feel great. I do this, you know, two weeks out of every month and I'm maintaining my weight. My blood pressure stayed normal." They really were able to to not be well, not do the full continuum of what my mother needed. But there are so many more people and I think that's really what ends up on my channel is if you need a little bit of a ketogenic diet to reverse your medical problems, you'll probably find that with, you know, m slightly better than a dirty keto diet. But if you have, you know, swollen ankles and uh a heart that doesn't pump as well and blood pressure and a brain fog and a gut that's got some irritability, if you've got the stack of things that that a chronic disease manager of medicine called an internist is going to be collecting, you're probably going to need to be in in the moderate to advanced part of this continuum. And you're going to have to stay there for not six months, but for a couple of years to get these medical problems to go away. And um, of course, when I first started out, that was the theory. Like, I'm pretty sure this is where this is going to lead. Uh, but by God, uh, when patients would use that workbook and use that process, they they would write in was saying, "I I started out with 15 medications. 18 months ago. You've never met me. You've just I've read your book. I've looked at your YouTube channel. I've answered the questions by watching what you're teaching and I am down to three medications and I my doctor can't believe it." Uh, I mean, those are the kinds of things where when you're on a continuum, many people do need to advance.

>> All >> stop you for a second. Here's the frustration. You said, "My doctor can't believe it." I will tell you that most doctors don't want to believe it. >> Oh, that's true too. >> Because it conflicts with everything they do professionally. And so, you know, really what you're explaining is that the keto continuum allows, just like anything else in healthcare, a measured dose response depending on the severity and the longevity of the disease. And and that is the ideal. That there's not a single algorithm. This is what you do. >> Uh, you know, you got heart disease, take a statin. No, there's different grades. There's different. So that is the beauty of this is that it is individualized based on where you are. Not only where you are, but also where you are on a journey of correction.

And then you've, you've seen this when you're in a season of life where you can improve something, but then the next step is going to require you to focus and concentrate and not be full of distractions. Well, sometimes you cannot go to the next step at the season. You need to wait until, you know, the kid goes to college in three months or I get, you know, the next, you know, I finally get Thursdays off for my job or something where you can't just push an individual into success. You have to arrive, look around, say, "Can you take on the next challenge and can you do the next thing?" And I'll tell you, when I first started out on this, I had that absolute irritation that I could not believe these things got better. It was so exciting to me in medicine, like, "Oh, this this is medicine." And when you would hear the feedback from, I mean, they would come to me, I'd say, "You live 500 miles away from me. I'm in the middle of South Dakota. You can't ask me to be your primary care for this. I'll teach you how to do this and then you should go to your doctor." And of course, the first few times there was kind of disgruntledness. But uh, I have a personal mission uh, a personal goal for the next for 2026 and 2027 and that is I want to be the physician that teaches other physicians the amazingness of a ketogenic diet. And I had the naive approach that I thought, "Well, if I put on this online course, I'm sure these doctors are going to come take it." No, that is not what happened. Patients came to take these these these uh courses. But what doctors did pay attention to is when the healthy patient from from their practice showed up and they were better, the doctor said, "What have you been doing?" I mean, that is a moment of transformation. That is what just excites the hell out of me to say, "If they can come and learn about a ketogenic diet and the way they show their physician what's possible is in their life, man, that is a win-win."

>> Oh, I agree with you. There's only two, and again, I'm not being a negative person here, but when it comes to other physicians, the the first group are very excited about something positive happening, but the other group is looking for the zit. Oh, it's not sustainable. Oh, your LDL went all the little negatives to conflict with all the success. The other the problem that also we have with healthcare is everybody in the healthcare space is under incredible duress and also have their own issues. I I read a paper now, it's an overseas paper uh very prevalent that over 50% of healthcare workers themselves have metabolic disease. >> Of course, right? >> Welcome to our population. >> Well, exactly right. I it's a population statistic, but it's very difficult to manage if you're sitting there 300 lb and or you've got your diabetes, how do you not give somebody, how do you give somebody this kind of advice? And I think physician heal thyself is such an important thing. But there's that conflict as well where my society's saying this, I've got this, I don't understand it, I'm taking all these medications. >> I mean, such a conflict of interest. >> Would you go to a dentist who has no teeth? Would you go to a physician who is metabolically broken? And I just think it is our responsibility to not only understand it well enough to be able to live it. U but I mean, and why wouldn't you when you see the freedom that's there? But that is not the dogma that's found uh throughout the halls of medicine right now. It's, "If you do it, you kept it a secret." Now I I see less secretive ketogenic physicians, but for sure in 2015 when I was trying to find one person to say, "Has anybody else seen this kind of improvement?" >> I could. >> No, absolutely.

But let me ask you this. H Have you suffered at all from what I call impostor syndrome? Or how the heck can I be right when everybody else says I'm wrong? Why am I the only soldier in the platoon that's in step? Surely I I still wrestle with that every day. But then our results, >> oh, that's what's amazing, >> reinforced that we're on the right track. >> I mean, truly. I mean, there were two times where in the first year and a half that I just released a sense of sigh that I was like, "Is anybody else doing this?" And like nobody in Sou Falls, South Dakota was doing it. I already had enough of a, you know, like, "I'm not part of the establishment. I'm I'm not that kind of physician. I'm running my own independent practice." So, I don't want to sing from the the rooftops that I'm any more different than them right now. And there are two things that happened. Domino uh had his first metabolic health summit here in Tampa. And I'd never been to Tampa, but I said, "If he is having a conference where scientific papers are being presented about what a ketogenic diet can do." My husband and I, you know, had grandma and grandpa take care of the kids. We hopped on a plane and I said, "Chad, you go down that hallway and take notes and I'm going down this hallway and take notes. I'll see you at the end of the day." And I was delighted with all I was learning. The second thing that happened was um there was a conference in Johannesburg and >> Cape Town. Yeah. >> Cape Town. >> And and Jason Fung was so I bought the lectures and I listened to them and I have goosebumps telling the story because it was such a an enlightenment moment for me. Jason Fung was on stage and he was talking about the reversal of thyroid disease as per, "This isn't what the textbook says, but clearly they don't need this much thyroid medication anymore. Let's take it down again. Let's take it again." And I was in the same learning curve as him, going, "This is not anywhere in my textbook to deprescribe thyroid medication. That's I've never done that in like, what, 18 years of seeing patients? Like, what am I doing? And is anybody?" And when He said this out loud, I was like, "Yes, that's exactly what I'm seeing. There's another person out there with the truth." And it was hidden behind a paywall, you know, that I'm like, "I'm so glad I bought the videos."

>> Yeah, that was an ex that was a turning point, a pivotal conference. I call it the No Conference of I think it was 2014, but absolutely phenomenal. I mean, it was a it was a big deal. So, I and I, you know, obviously it also says that you've been engaged in this. You're not >> just starting, you've been engaged in this for a very very long time. How have uh you personally uh from a health perspective uh you know you started out pretty darn healthy and you've improved. I mean you're looking fabulous >> and uh no I again I it it just is incredible to see how vibrant and fabulous you look. What has your own journey been like? How have you discovered this yourself? And secondly, we both live with people in our home. How do you handle your own evangelism in this space? Because that's what it is with perhaps the impact on other people that may not be quite as ready to embrace this life but you live with them. >> How do you handle that sabotur in your environment or how do you bring the family along?

>> Right. Well, you know, I think that uh that there's a couple things that I think maybe as the mom of the house versus you're the dad of the house. So across every culture on the globe uh whether or not it's in every family but in every culture uh the female is decides what the what the meals are that they're they are in charge of that nutritional architecture for the family. So in when we be when I stepped over this threshold which in secret was trying the ketogenic diet for like four months, couldn't pee a stinking ketone, had about 55 lbs on that was too much after the third baby and then some stress and it was only uh after I walked 22 miles on a ruck on Memorial weekend that I finally peed a stinking ketone. So I'll tell you my first personal journey was again in secret like, "What is this weird thing? Why did did Dom Di Agostino and Tim Ferriss talk about this on their podcast and how are they getting better brain data for the these patients?" So that's where the journey began. So of course, you know, I'm going to try it myself before I can teach somebody how to do it. I cannot seem to make a ketone until I did this extreme, you know, exercise. And then I realized, "Okay, now how do I not I'm never going to have a carbohydrate again. How do I stay in this?" And then it was a few short weeks later that my mother's appointment inside um, you know, CLL was the cancer she had uh a very metabolically driven cancer and um, I just had enough information to be dangerous about cancer and ketones. And when she walks out of the uh pink slip from the oncologist who says, "You're going to have another round of chemo." That last round of chemo took her brain so far offline that the woman who had sewn all of my clothing up until the age of 10 didn't know what a sewing machine was. And we had just gotten her back to sewing. And she's like, "Not doing it. Dead in six months is better than what you just put me through. I'm not doing that again." And I asked this awful question that I said, "Mom, do you trust me?" And she should not have said yes, but it's my mom. >> And she said, "With my whole life." >> And I said, "I'll show you." Cuz she had asked the question, "If it was you, what would you do?" And you've been in my seat long enough that most of the time, well, sometimes you lie. Like you're just like, "This is what the guidelines say. This is what you should do. We've got 15 minutes for this appointment." And I've said guidelines before, but when it's your mom, I answered with an question saying, "Do you trust me?" And I would put yourself in a ketogenic diet and in the six weeks you're supposed to follow up with the doctor where he thinks you're doing chemotherapy. Let's do a ketogenic diet and see what happens. And I had no m space in my mind for, I mean, if we did chemo, her numbers were going to come down by 30%. But I had no space in my mind that if you did the, I mean, the worst version of a ketogenic diet I've ever taught somebody was what I did her. But she was in ketosis. I was in ketosis. And her numbers were 70% better. There was nothing on the books that was going to say that was going to be better. And that started a story that like many people trying to improve their health, she could sprint when her life was on the line.

And then both of us had a little like relax, like, "Okay, I guess we got there. Now what?" And then as soon as we relaxed, the problems came back. The infection, I mean, her her health. Okay. So now we have, how is it that I would take somebody who's, and I praise God for the years of working with addicts, working with alcoholics, and you know, chronic um, you know, drug abuse. How do you change behavior in a way that is sustainable? And it is not an isolation. You do need a community. You need feedback from other people who are struggling with you. And I mean, at the moment, it was my mom had me like nobody else. Even, you know, ketosis was this acidosis thing, the di type 1 diabetics, diabetics get. Yeah. >> So when I look at that journey, that onset was that the stakes were so high in the person I cared so much about and my learning was kind of in a vortex of like, "How can I just take care of this one patient really well?" And you know, the results were amazing. She did reverse not just the problems. I mean, the only thing she ended up on, you know, without at the end of like a four-year period was no chemotherapy, no blood pressure medicines, no metformin. Uh, in fact, the thyroid medication, which had been pretty high, was at like 25 micrograms. And I'm like, >> "I don't even know that we really need them anymore, Mom." But at the I'm like, "Let's just take one battle at a time." And as she improved her processes, um, I mean, that's where the continuum came from. She didn't do all 12 of those things at once. It's that as her health would peak and valley with other complications, we had to stimulate uh, you know, pushing her metabolism for it to improve despite being in a crisis where, you know, at one point a colostomy bag was needed. Like, "Mom, I need you to not eat for a month or or you're going to die." >> Right. Right. What >> And I think, you know, that also brings one of the things I wanted to focus on is the synergy and the we're like two circles that overlap with a lot in the center, but we approach things from slightly different, or we we offer slightly different services to our patient population that are synergistic. We clearly are in agreement with the entire metabolic approach, but you tend um, I've just got I've got a few things here, but you tend to focus mostly on the behavioral regulation, the lifestyle management, the transformation of who you are as a human being, doing some heavy lifting, but changing who you are. I do some of that and as you do some of what I do, but I focus also very heavily on the physiologic side. I tend to see people, you're seeing people who want to change for a particular reason. I see people coming from a major physiologic issue. They've had their heart attack. They've so I still have to respect some of the medication required for that, but can deprescribe and shift them across. There's that synergy. Um, so I kind of focus on the physiology as a testing mechanism. It's easy to get the blood work and just rephrase my interpretation. Um, and that's the mechanistic aspect of health and disease pathways. What other forms of medicine do your patients also need along this journey? I know you you moved your mom out of the way and that was appropriate for her, but it may not be appropriate for everybody. How how do you use traditional medicine and sillery to your program >> because you are an internal medicine doctor, >> right?

I I don't think that anybody gets away like if if people say, "Are you an anti- you know, prescription med physician?" No, I don't think we could be serving the people with as much um uh opportunity to either bridge in a season where they need a little more help than they they did um than 2026. We are in a time where medicine has many great amazing tools. But I I contend that if I if I had to like, what is the goal that I have for anybody who comes into the space of our my influence? It is that I educate you enough so that even if you come to me with 15 medications, that as you get better, uh, the chemistry gets better in your body, the body's, you know, trash gets taken out more, we get less and less and less prescriptions as the metabolic health gets better. And of course, that is never going to happen overnight. That is a, you know, dangerous ous to say, "Let me just take away 15 of those prescription medications." Uh, you're going to hurt yourself. Um, but I also, I did not like that people would say, "Well, I have to see this doctor in order to start." That's a complete BS. You do not need to see me to see that. You educated on if you think you're going to get better in this era of time by depending only on physicians, you are a fool. Uh, you must take ownership of your health problems, your medical problems, what you're doing about it. And to me, I I chose and I think for a couple reasons, maybe survival said, if you can't put if you can't be in the the mindset that you are putting your education of health the highest uh and as you learn within whose ever influ, you know, your practice, my practice, that ownership of your health is the only way you're going to get to the the best last 10 years of your life. If you're depending on medicine today to say, "Let me send you to the GI doctor and the psychiatrist and the endocrinologist and the allergist and the okay, they are never talking as much as they should. They are never as coordinated as you. I mean, I was a physician taking my mother to all these damn doctors and they were terrible and I'm good at this. No, you guys are not talking to one another. Mom, we're not doing what that one just said. He did not read your chart ahead of time." I mean, all this stuff where I'd be like, "No, we're not doing that." But why do you need to read a chart if you've got an algorithm >> that's generic? I mean, that's the that's the challenge. And I understand how healthcare has become a 10-minute visit that you cannot uh individualize care. You cannot have a relationship with your >> And in fairness, when people would come to me, at first I kept trying to think, "I can teach this from the exam room." I can and you know, I'm raising an eyebrow now thinking, "What the heck was I thinking?" There's no way there's enough time to teach this from the exam room. >> Yeah. >> It was only >> And you can't get paid for that time. So there's this economic imbalance and it's easy to prescribe. But you also you you invoke something else and that is the word addiction, which you and I obviously have huge synergy with. And and I think the most important thing is ownership because the last person to recognize they have a problem is the addict themselves because he's so good at distorting reality. How do you or do you try to connect naive patients or naive people with their addiction? Or do they have to come in at least inquisitive about that to start your program?

>> Well, so I I've learned and you know who's taught me this the best is the YouTube algorithm. If on my YouTube channel I mention addiction or I mention uh, you know, mental health uh is why you're not losing weight, nobody clicks. I mean, it's not just that. Um, I mean, I'm being a little polyanna like, "Oh, you should learn the the root cause of why you're doing this and it's going to be your addiction to carbs." Oh my goodness. The people do not want to hear it. They do not like being told that. They think it's not true. >> And I've learned back away. They're not you're not winning any, you know, more flies with honey than vinegar. And you just say, "Just begin. If you think this is not an addiction, I'm not going to mention the word for the first few weeks. But then when you are in that moment of a spiral, I just need something. There's a hedonic drive to just reward me. There is where you can teach about what an addiction, an addictive pattern, addictive feeling, an addictive chemistry really looks like. And now I might have their attention. But to start out, I mean, I used to have an addiction clinic, right? It's internal medicine plus this line of addiction. And when the judge would say, "It's your second DUI or your third DUI and I'm going to uh sentence you to Dr. Bosworth's clinic." So, they're coming into me with this kind of shamed, you know, beaten down. Uh, the judge says you you've got, you know, addiction problems. You've got a >> I just want to stop you for a second. What you just said just poof. You have a sentence. You're being sentenced by the judge to alcohol recovery to a keto. And once you look at that from that miserable deprivation, there's no way on God's earth you're going to embrace it and own it. That is such a salient thing. Sorry, I didn't I just heard that and I thought, "That is brilliant. That is brilliant."

>> So I'm like, if I don't have to do that, I am not taking that l. Because let me tell you how well they did. It was I mean, it was such a a correlation that if they came in with their own desire to say, "I just th these shackles of addiction have taken so much from me. Help me make it go away." Boom. We are on their team. We're on their side. We're marching through how to do that. But as soon as you suffocate them in their face in mud, saying, "You have been sentenced. Society says, 'This is what you're going to need to do in order to not go to jail.'" Oh lord, that was just painful for everybody, for the medical team, for the, you know, psychology team. And when you do that to somebody who's obese and you say, "By God, it's your addiction to carbs that got you so tubby." And you're like, "Okay, okay. Nobody's winning that. But if you could say, you know, there's a way that you can math your way out of this, that you can calculate if you're reversing this problem or not. And it comes with you being brave enough to prick your finger first thing in the morning. We can calculate a little number and you can tell me if you're winning or not. And if not, when you're ready, we're going to go to the next step on that continuum. And you're going to see what it looks like to tighten up your behavior again. And that is the success out of there. And it's not one or two patients. There are I mean, there are thousands of patients that um I mean, they're good for brand, right? I mean, when I I'm a believer. I've been in the church my whole life, but I've also been around the church long enough to know if you want some you want some sinners and hypocrites, come to church. >> Right. And there was a great sermon probably um about 12 years ago uh that really spoke to me that said, "Sometimes you're the best you're the closest version to a Bible anybody's ever going to read." But I mean, looking at your behavior, looking at how you take on the you know, the stresses, the life, the arrogance, all the blessings, the curses, when when they watch you. That's what a biblical um spoken word looks like.

>> And I often think of that when I see people struggling with their weight. Like if you can if you can attract people to say, "I'll help you think through this. I will teach you the things that I've seen on the front lines to say, 'Why are you stuck? And is it fixable?'" And you might not have the strength to do it today, but you're going to have the knowledge to say, "When you can find the space emotionally to make to take the next step, I want it to be worth it. I want you to be able to measure it and then know that it might not be the end, but it's the next layer of improving your health." So sometimes the best version of a carb addict is somebody who's stepped into that space, looked around and said, "Oh, the enemy is me." >> And here's my so that's really where in the >> antithesis to the AA model where it is, "Hi, my name's Joe. I'm an alcoholic." Which is and it's for you and I to see that in somebody is very obvious and very simple, but for them to see it, as you said, it takes time and it takes peeling back certain layers. But it doesn't mean you start that you don't start the journey until you have ownership. That has changed my already right there. I'm going to be implementing that as a transformation in my own practice methodology. So I love that.

Along those lines, um, I was going to ask you what the single biggest misconception about keto is in amongst healthcarees, but I'm going to answer it and ask you if you agree. It sounds like if there's synergy between us that the single biggest misconception about keto is that it is a nutritional problem. >> Is that right? >> What are your thoughts on that statement?

So if I look at what I'm my husband says when I first was trying to teach about this, he's like, "You cannot use the word keto. It sounds ridiculous. It sounds like, you know, nobody understands what you're saying." And when I look at uh trying to kind of pierce through what is it? I mean, where I'm saying, "Don't look at the calories. You forgot a whole layer of stuff called the hormones or the endocrine or the, you know, this is how a body speaks to from cell to cell. This is how a body takes inventory on what you're eating. It doesn't look at the calories. It it it does look at the sources that come in and based on that sources of what you swallowed, a cascade of hormones will happen or not happen. And there in lies the difference between a metabolism that's improving or revving or one that's shutting down and preparing for the end of times." When I look at the ketogenic diet, it is not a it is not a calorie story. It is a hormone story. That if you want them to work correctly, first of all, you need to provide the chemistry that they can work at all. And then you need to remember that stresses are how you strengthen a a hormone. That it can't just prolong. It needs to have a stress and then a recovery phase and a stress and a recovery phase. And stresses happen when you're mentally ready and when your endocrine system has the I mean, if you're, you know, if they if they come into me on this low carb, low calorie, you know, complete shutdown of basal energy expenditure, uh, I mean, the worst thing I can do is ask them to fast. I'm like, "No, you need a bunch of high-fat for at least 10 days. Come back in 10 days." I mean, you got to start by just coating you in oil. Just go bathe in the bathtub of butter. like find the >> I see that sardines behind you right there. Sardines in olive oil. No, you're you're so you prepare yourself for the ease of going longer and longer periods of time without eating, which we call fasting.

>> Um, so along those lines though, if it is, and I fully agree obviously, that this is an addictive, not everybody, it's either a substance abuse or an addiction uh uh continuum. So you start people on the corrective pathway, but there there is really no exit strategy to addiction. There's no time point when the alcoholic can have a beer again and be safe. At least that is my long-term uh even though you may try, you're going to have a we call that a relapse. However, there is a transformation with a keto continuum getting you better. It's a therapeutic arm. But there comes an inflection point where there is now you've done well, you've improved all the markers. How do we sustain this so we don't go backwards? What is your transitional strategy? There's no exit strategy. What what do you use to transition people into a sustainability pattern? How do you do that? What's different?

Well, so first of all, I will, you know, I absolutely love that how connected to the addiction like warped thinking you are are speaking about and that you have taught about your your podcast, your patients all know this very well that when you have an addict show up and say, "Yes, um I I want to know um how long I have to do this before I'm done." And when a patient says that to me at the beginning of a ketogenic diet, I'm just like, "Okay, that there's there's a different mindset that they aren't any and you cannot force them into it." Okay, there is nobody who says, "This is how you do it. Shake your finger. Shame on you. Stop that thinking. Do it this way." You really need to model behavior. I mean, I I do a lot of education on mirror neurons. And I like to tell the time where I remember the first time I absolutely got what mirror neurons did. So, I'm a firstborn female. My husband's a firstborn male. Uh, we met arguing. Uh, we are very intense and we're in the first couple of years of dating and we are um actually we might have even been married. So, we were we practiced this behavior of "I'm right, I'm right, I'm right. I'm right." And we were strong. And there is a moment actually I know we were married because we were in Park City, Utah when this happened. And I am screaming and I am right. And the words that came out of his mouth were, "You're right. I'm wrong." And I get goosebumps every time I say it cuz I can remember the moment. And I was without words. I had never seen that in all of my life that somebody in the middle of an argument said, "You're right. I'm wrong." And I could not have modeled that behavior because I'd never seen it. That's not how my family did it. And that moment of behavior being modeled when I look at some of the biggest traps that happen in addiction, whether it's the alcoholic or drug addict, it's that it isn't that the drug is this, you know, God. It's that the behavior to get around using the drug in the moment is something they don't even have in their tools. That modeled like example of, "You mean you can say you're right, I'm wrong in the middle of an art?" That's not that's not a thing. And to this day, I'm much better at it now, but I I don't think I could have had a life forward had he not modeled that behavior to me. So it get it gets back to what are some of the key things that I really work on. Um, number one, I learned if I'm going to teach this, it should not have anything to do with my medical clinic. It to be in a company outside of medicine. Medicine is way too regulated. And I'm just going to teach it for a short period.

>> Let me stop you for a second. Are you from a personal ethical perspective still able to stand with a foot in both environments? Because I can't. >> I

cannot stand in a conventional algorithm-based lifestyle or or workplace and do what I do for a living because there's a direct conflict.

Oh, for sure. Yeah. Now, my medical practice is completely different than 2015. Uh, but to teach the behavior under a medical malpractice,

Right? Too many rules, too many problems. Go out to this other company and say, "I will teach the ketogenic diet in a place that is going to be intense. It's going to be exactly what I would teach if you had seizures or the kind of cancer my mom did where we needed to rip the band-aid off in a hurry. You need to improve the process, uh, the chemistry within a short period of time. And then at the end, you are going to be in a community of 10 that you are responsible for. We are going to crown you as responsible for your own health. And that small group will carry on without anybody's supervising. The 10 of you have been trained and this is the place where we need the 10 of you to teach one another how the journey looks. Once a week, I, we recommend that you meet. Yeah, it's, you know, welcome to Zoom. And they carry on with that small group just like an AA meeting, just like the, you know, the old-timer alcoholic who shows up and says, "Yeah, you aren't going to ask the next time you get a beer in about a year, but until then, I want you to not say that word out loud. But I want you to just take these next three steps and looking at what journeying through poor metabolic health to better metabolic health and to arrive at a place that is, I mean, there are people who, who really take the cap off of the the the curse of what the, I mean, you should have never gotten better. I, I had another case just this last week where, um, in any part of my practice for 25 years, I've never seen someone reverse those kind of medical problems as quickly as he did. And he just did a DEXA scan where the amount of weight he's lost since the first day of our little class in January is 22 lbs. And the the DEXA scan says you've lost 23 pounds of visceral fat."

Very impressive. Yeah. But but you know, the the we're always impressed by that because we see it. But that is the reality of a successful program. Would you say though that modern healthcare at a time when it's most necessary has lost the ability of what I call SDM, shared decisionm?

And, uh, you know, we've become paternalist, paternalistic. You must do this. In an era of AI where AI is smarter than any darn doctor out there. Amen. And I use it and I tell my patients to use it. Is what you and I do that is so engaging? Not all about sheer decisionm.

It's totally. Yeah. Like, and I think the other part is that I come from a dynasty of hog farmers and, you know, you can say, well, I didn't know a single physician until I was probably 17 years old. I had never met a doctor. I went to the county nurse to get my shots and didn't have to see one. And I look at the intelligence and the and the the roots of hardworking people that know way more about life than I did. And as I think back to say, how would they make those decisions? And they aren't, I mean, they don't need a college degree and a medical degree to get there. They just need somebody to speak truth about what the next decisions are for them. And I do think that's our responsibility as providers that yes, we have messed up medicine like you can't believe. Welcome to America. Uh, but if we're ever going to get it back, it is that the ownership of your health is we crown you as the as the the leader of your health. Uh, not the damn doctor. And if we need tools like ChatGPT or other AI models to be able to say, put your labs in there, ask what they would do. And it's amazing what you learn. These that that kind of empowerment is where, uh, you know, the first step might be the first 50 pounds, but if we have, I mean, I have patients who've lost 180, 180 pounds. It's like, to those steps are not going to be sequential. You're going to have chapters, but if in that process, each step along the way, you're taking mo more ownership of what you should be doing, what's the right thing for you, and your circle of trust is watching the best example of how the next generation should not have this crap of advice and the disconnect between the provider knowing everything and the patient being some lowly, you know, tool that gets told what to do.

Right? And I, I think that is the that is a big, big challenge and it's increasingly a challenge. We the AI market. So I encourage my patients to go to record my visit, put it into AI, and then let's discuss.

Yes. What differences or synergy there is. I'm not afraid of that and I'm happy to be wrong and I'm happy to make changes and corrections. So we use the methodology rather than being afraid of it because AI says this, don't go there, I'm the doctor. I, but the other, the other challenge that we have which is parallel to this and this is a, a very important topic for us to to discuss is that why the hell do anything that's hard work if I can just take a shot once a week? And a large part of the of the ketogenic diet, uh, or the keto, I hate that word, the diet word, but the ketogenic approach that you and I have fostered with our patients over the last decade or so is ultimately geared toward the eye of the needle of not only restoration of insulin resistance but really of GLP-1 resistance. And we didn't know a lot about GLP-1, but it is the controller of both insulin and glucagon. And it really, it's the only drug out there that treats insulin resistance. And what a lot of doctors are doing now is just writing the script and outsourcing to the drug. And everybody sees magic to begin with.

Right? How have you reconciled, um, the landscape of GLP-1s? How do you use them at all? And how do you manage them? How do you work with GLP-1s? Because we've got more coming on, which I want to talk about. But tell me about your thoughts and pros, cons, everything else about the use of GLP-1s because one thing we cannot do in my opinion is tell people don't use them.

Oh, for sure. Because you'll alienate them and off they go. So, how do you incorporate them? How do you use them as your in your practice strategy?

So, let's first say the endorsement 101 is, oh, we're finally in the right lane. We are in the manipulation of hormones, which was always going to be the long-term answer for a, uh, a metabolic or weight loss program. The hormones must be restored to a physiologic or or at least maybe super physiologic, but at least physiologic level. And when you watch what has gone, you know, become more and more and more muted the longer that insulin was high was that well, these hormones had nothing to do. They can't function until that insulin was going to be lower. So now it's been three decades since they've had any blip above, you know, the the most tiny of of surges. They don't have any idea how it feels to have that at, you know, in their body. When I first started, um, you know, so I, I do this thing twice a year where I take people through what I did with my mom, 21 days of an intense ketogenic diet. Uh, it was last year in January where it was the LA, I had had probably, I would say, a dozen patients, um, on a GLP-1 before that. I wouldn't prescribe it until they were in a ketogenic state and I was starting out with these really tiny doses and I'm like, okay, I've got it's like anything when you start to see, um, the improvement, uh, of or the the advent of a new prescription or a new process and you take the history of one patient, then you add the second patient, then you add the third patient, but now you're like four months in. So then you add three or four more and now you've got double the amount of in your head. Well, there came this announcement. It was actually during the 21 day of January's that the government was going to say this, um, uh, that we will no longer honor the, um, the compounding pharmacies to let these prescriptions.

Legal battle between farmer companies and. Yeah. Yeah. It came down and I said, "All right, I've wanted to do this. It looks like it's the last time I'm going to get to do this where it doesn't cost you an arm and a leg. I'll write a prescription for anybody who passes the 21-day, meaning you've got ketones in circulation. You were a good community member and, uh, if you want to do this, I want to see what happens. I'll put as many of you on this as possible. We'll follow you for 12 weeks and we charged them $600 bucks for the whole 12 weeks. I'm like, well, we want to know."

You start with your keto continuum. You there's an entry point where you have to do the heavy lifting and the GLP-1 is ancillary and augments your journey rather than takes, uh, takes the place of it. That is the crucial thing. So tell me, so tell me what happened.

So I, I was trying to, you know, there's no research on how to start this. It's only my my 12, you know, dozen patients that I'd had before this where I said, I don't know how to do this. And I want, I want to start them at a dose that that shouldn't help them, that is so low that that then we raise the dose because then we get to therapeutic. So.

It's this micro dosing is the. Yes. So what does that mean? So if the starting dose is 2.5, I thought we were pretty safe at starting at 0.6 milligrams.

So we have 12 weeks and we're doing these. And that's tepatiide, that's major, that's 2.5. Yeah. Uh, so and we start this and we check in every week to see what's your food noise, how's the side effect, how's this other thing? And of course, what I'm looking for is at the end of four weeks, should I increase the dose? And there we're at steady state by the time that fourth dose hits and should we increase the dose? We got to the fourth week and like 95, 96% of them all said, "Oh no, this is almost too much for me." And I'm like, "What?" And of course, we're having them check their glucose and their ketones first thing in the morning every day. And we've got their chart saying, well, look at the drop in the glucose and the rise in ketones. And for the whole 12 weeks, I mean, a handful advanced their, uh, dose of tepatiide up to 0.9. I think there was two by the end that had.

Which is still substantially below. It's less than half the total dose. Yes. And what you got was this incredible reversal of problems like psoriasis that on the ketogenic diet, we know that this will help you. Your skin is going to get better. But within about three days or three weeks of that tepatiide, it was just enough fat forward, just enough, a little bit like five point lower in their morning fasting glucose that were like, I've never seen it go. I mean, maybe with a round of steroids, you could see the skin get that was incredible.

Uh, and other problems were, um, you know, I'm going back in for the, you know, third round of breast cancer screening. I've had metastasis. I mean, these stories that I, I'm actually afraid to say out loud because I do not want people hearing you're going to reverse all these medical problems with a little tepatiide. No, they were in an advanced ketogenic state. And of course, what's the hardest part is this is not a 30-year-old who, you know, we're trying to reverse habits that are 10 years old. This is a 75-year-old who has 50 years of insulin resistant habits. And now I'm saying your life depends on staying in a ketogenic state for at least two years. How are we going to do that when when the hormone is is so wilted that I am trying to resurrect what a GLP-1 and a GIP do, but we got a 75, you know, 77-year-old working on.

Right. But that's an accelerant. As I said, and the other part also that I'm starting to discover more and more is all the endpoint disease, whether it's Alzheimer's, whether it is or cognitive impairment, whether it's cancer, whether it's pre, uh, uh, infertility, heart disease, it has accelerant benefits on all those diseases. There are people out there that are sick enough that they don't have the luxury of time. They don't have much wiggle room and this act, you know, if you're 20 years old and you're a little overweight, who cares? You don't, I'm not certain you need. But if you have had your heart attack, we don't have that wiggle room.

And so, you know, that is certainly, but it is a synergy. It isn't a replacement. And there's a phrase that, so here's, I, I love what you're talking about there because that's exactly how I use it. Um, and then we can scale up as we need to or have it in the fridge.

Don't use it. Keep it like you keep Tylenol for a headache. If you're doing great, don't use it if you're ketogen. But if you're going on a vacation, if it's Christmas time and you need that little protection, haul it out. And then you can use the very small doses that will help you to protect yourself. But here's the other thing I, I have learned too, is that when you're looking at people who are elder, who've had these chronic diseases, I mean, I think of my mother, she did get this incredible society back, this beautiful life back, but it was hardcore for at least three years before we really were able to be in that safe zone. What I'm seeing now is after that 21-day, they're in advanced state of ketosis, and now we do this extension class for 12 weeks. What we're able to do is almost like resurrect the churn of what should happen with this hormone that's been muted. And so I mean, I don't want you on this forever either. I want you using the medic. I mean, it's expensive as hell. Uh, we think that this tiny little dose is going to get you like.

Let me, let me stop you for a second there. That's a very important point for me. Put a price tag on your health. And then decide it's, and it's becoming cheaper and cheaper. But that is always my argument. Nobody, uh, has any compunction about buying the crystal meth crap at Starbucks, uh, that I call my, but they will have, oh, I don't want to spend $200 bucks on this or $150 bucks.

Perspective. No, no, I, I saying when I put a prescription out there and it's going to cost them $400 or $500, but I now can say at a microscopic dose, this prescription will last you eight months.

Or five months. Yeah. Um, and what I've learned is, um, the goal is you don't have to refill it. That you have really resurrected what this hormone does inside your body. That, um, that you are losing fat mass, not muscle mass. That you've proven that. And maybe, maybe you, you know, save the last vial for a seasons where you're not sure how you're going to do without the training wheels of an extra amount of that hormone.

Uh, I mean, I have some people with brain cancer that I, I'm like, I don't want to stop it. I don't know what is going to h you, you have so much on the line and we have regression of your brain tumor just be just through metabolic health right now because of all the limitations, not because that's what the only, this is all they have left. And to say, well, what should be the, the long-term dose for them? I want them on that for at least another two years.

Well, that's the whole point. It's that's disease specific. You're treating an endpoint problem as well as the insulin resistance that caused the problem. Some people, you're really just trying to to reverse insulin resistance resistance. The end points will take care of themselves like excess weight or type two. But there are people with heart disease, there are people that are in the throws of cognitive impairment or cancer where I think then it is medicinal, like most medications, you're on this for a longer period of time, but it's individualized care. Um, the expectation you want to be at 15 milligrams of tepatiide for the rest of your life is archaic. It's because your body becomes resistant to it.

And, and you look at what the rest of the country can see that this is happening. There are, I mean, there are insurance companies now who say, if you, if you want us to to insure you, we will cart blanc prescribe you tepatiide.

Yeah. Well, it's that and that's taken the place of the statins. But here's my concern. Uh, here in Palm Beach County, which is the world of cosmetics, I mean, there's there's 10 plastic surgeons and 10 lawyers for every regular doctor. [laughter] Um, I've coined the phrase and it's, it's concerning to me. Um, a lot of the people that live in this town, there's so much pressure to aesthetically look good. I call them peptide princesses. They've gone beyond and peptide princes. They've gone beyond just the GLP-1s. They're using growth hormone replacements and uppers. And this is identical almost to the opioid crisis where people originally used opioids for pain. Now they're dependent on it and there's some little dock in a box that is giving you a prescription for a thousand opioid pills and you become dependent on them. More and more I'm seeing people become dependent on their aesthetic on these medications and cosmetic surgery. And there are little peptide shops that have opened up to backdoor sell the stuff in exactly the same way that of the opioids. And because it's accelerating the sale of Mangaro through Eli Lilly or Ompic through Novo Nordisk, they kind of turn a blind eye because it's accelerating this. But I'm very concerned. Oh yeah. That we are developing this peptide industry of now everybody's taking BMP 157 with all this magic and every peptide has magical properties at least by the pitch of the people selling it. What are your thoughts on the peptides and on the industry, this black market industry that's developed for example, just as a last part of the preamble, I'm managing just short of a 100 patients right now who are already taking redatide, which is not even FDA approved. It's available if you're a gym bro, if you're a wealthy tech person or a hedge fund operator, you can get the drug black market and they're coming to me to say, hey, help me out. It was a tough ethical problem, but I'm learning from them because we are slow to endorse it and I, I do like the drug tremendously. I think it, it's the next generation up.

I do think that the script on what that will do to brain repair. That's where I'm like, again, my first. Not only brain, but every cellular response because the glucagon agonide when used appropriately, but it has to be used in my opinion with a high-fat ketogenic diet.

Absolutely. If you don't have that, [clears throat] you can't deny that peptides have been life-changing since the advent of insulin, right? Like, okay, insulin's a peptide. And then you say, okay, how else can we, uh, inject a, a peptide into our bodies and get that kind of transformation?