Dr Boz: Fix Insulin Resistance Once & For All (10 COMMON Symptoms)

looking across the room now, you can diagnose insulin resistance from across the room in most people. If you fart on the way to the lab, you changed your insulin. Dr. Anette Bosworth, she's a bestselling author of "Any Way You Can" and an expert in fixing the world's most chronic diseases. She will help you get your life back, and it starts with eating more fat. I've never known insulin to be anything but the hormone that puts weight on my patients, that ages their brains, that crystallizes their arteries, really makes them crispy and stiff—the opposite of what you want if you want to be healthy.

A patient of mine, 71 years old, her 10 years under my care was with a cancer growing in her white blood cells. She'd been through chemotherapy a couple of times, and the last time she went through chemotherapy, her brain went offline. She says, "What would you do if it was you?" This patient was my mom. I've been reading about this diet that is great for brains, but there is some research that says if we put you in an advanced ketogenic state, it might be good for your cancer. When the reports came back, it showed that her cancer had dropped by 70% just by being on a ketogenic diet. Insulin is what caused my mother's cancer. You have to be in a state of ketosis; you have to be strict. That's why I put so much energy into saying you're not on the ketogenic diet if you're not checking the ketones and finding those little turkeys in circulation. You have to be there in order to get these benefits.

This is ketones for life. You recommend for your patients sometimes to have a butter-only day. Why? Oh, it is the best experiment! First of all, this episode with Dr. Anette Bosworth was a topic I've never discussed on this health podcast: insulin resistance. Now, I'm guessing if you're watching this episode, you will know somebody that is insulin resistant or maybe you're insulin resistant yourself. By the end of this episode, you'll know the exact signs to look out for. Now, this information is not what you'll hear from big food or big pharma, so if you're learning from and enjoying these episodes, please hit the subscribe button, and by doing so, you can help millions more people hear this message.

Now, let's get into the episode with Dr. Annette Bosworth. Dr. Bos, welcome! Thank you for having me. I am so excited to be your reader. Now, you are an internal medicine doctor, and you have thousands of patients that come to you with a wide variety of problems. It could be things like brain disease, diabetes, heart problems, autoimmune conditions, obesity, and all of these chronic health problems come from one big problem, which is hidden. That problem is insulin resistance. So today, Dr. Bos is going to share her 25 years of experience and talk about how you can fix insulin resistance, the early visible signs that you need to know, and also why you might need to have a butter-only day.

So, Dr. Bos, my first question: if somebody has just clicked on this video and they're thinking, "I have so many health problems; I don't know where to start," why should they first look at insulin resistance? Well, if you're looking for the best first step forward in today's modern world, where you want to stay out of my clinic—I am an internal medicine clinic, and I take people to the grave with lots of medications and chronic medical problems—if you're looking for the best avoidance for that, the stimulator for every one of those diseases comes from this whisper of insulin that grows and grows into a roar, but it never tells you from the front page. It is this internal message that you can find the answer: do you have this, do you not, without a lot of fanfare, without a lot of labs, and the reversal of it is absolutely in your court. You do not need to see me to reverse it, to keep track of it, to measure yourself, to say, "Am I doing better than I was?" Those messages of avoidance for me—I wish I could have told patients 15 years ago—the number of funerals and gravesites, you know, tissues full of tears—I have a lot of regret for that. I did not use this message then; I filled their bodies full of prescriptions, their chronic diseases got worse, and in honor of them, we're here to keep you from knowing me.

Absolutely. So if we're treating the insulin resistance, which is the root cause of so many chronic health conditions, as Dr. Bos is saying, you don't have to be on these medications. A lot of doctors, they will prescribe pills first; they'll try to look at the diet, but they'll prescribe pills first. Let's talk about what insulin resistance is, and to understand that context is first very important to understand what insulin is and the role it plays in the body.

So insulin is this wonderful dictator of a hormone in your body, and again, you can't live without it. You know, when you look at my ability to prescribe you insulin to try and, you know, play the endocrine god within your body, we didn't have that option in 1920. It was in that era, in that decade, where insulin came into our world of medicine that we could give it to people without it. Those diabetics, those type 1 diabetics that were just emaciated, they were wasting away from the inside out because that little dictator, that little hormone, is in charge of getting glucose or carbohydrate-based fuel inside your cell. Although that carbohydrate is not required in the human diet, you do need this hormone to get some of that fuel in the cells. Without it, to run solely on fat, without the access to that insulin gives those cells to use some carbohydrates, you're going to die. You're going to die a very young death, and your body will eat itself from the inside out. So that's what life looks like without it, and indeed it was a horrific death. When we look at some of the rescue missions of the 1920s and 30s, where insulin came to these people who didn't have it, the doctors were the heroes; they really did save their lives.

But from that point forward, the use of insulin and the excessive production of insulin has grown and grown and exploded in the last 30 years. Our bodies make a little bit of insulin when glucose comes into our systems. In fact, they make insulin whenever food comes into our system to store certain ones for future use of that fuel and then to be able to mobilize fuel in the right direction using the highest priority. When insulin is at the right levels, nobody calls it evil, but as in all of my medical career—I'm 25 years into seeing patients—I’ve never known insulin to be anything but the hormone that puts weight on my patients, that ages their brains, that crystallizes their arteries, really makes them crispy and stiff—the opposite of what you want if you want to be healthy.

And that insulin is sneaky. The first wave of it makes the cells inside the internal organs in those cells a little bit more crabby. As the insulin signal gets a little louder, then the cells themselves get crabby, and then the organ systems get crabby. Only then can you start to see the symptoms of, you know, looking across the room. Now, you can diagnose insulin resistance from across the room in most people because it's not a subcellular or a cellular or maybe even a one-organ problem; it has encompassed their body. The outward signals of having too much weight, having swelling in their ankles, having that sluggish mind where their brain just isn't crisp, there isn't, you know, responding as robustly as they should—especially if you get them after they eat a meal and they do that sluggish thing brains do that you're like, "No, no, no, no! How do I make it go away?" That insulin resistance is ubiquitous; it's everywhere. It's in 12-year-olds; it's in 95-year-olds.

The reversal of it is not as simple as you want it to be, meaning there's a lot of temptation and a lot of cultural things that we have become accustomed to that if you're going to try to not be on the side of insulin resistance, stay out of my clinic. You might need a friend; you might need somebody to help do this with you. I love that you say that support is so important, especially if you want to go into the solutions, which we're going to get to. And also, you mentioned three of those early symptoms, which we're going to talk about—10 of them, so there's more to come.

So you mentioned the insulin—the hormone—it is a master hormone; it is required. But then we have elevated levels of insulin, and then we have a term called insulin resistance. I think many people have heard of insulin resistance, but maybe they don't know exactly what the mechanism in the body is. Can you explain that?

Yeah, so the beginning part of that insulin was to get the fuel in the right spots. At the beginning of that message, there was one little listening device, one receptor that was saying, "Yep, my cell that I'm living in needs this fuel." But as the noise for and the signal rises, the amount of insulin your body is making rises in response to the excessive amount of processed foods and carbohydrates that we're consuming. Long gone is the time where teenagers eat a couple of times a day. They come from the era where food was going in every couple of hours, and indeed, without that food, their bodies got crabby. That insulin—that glucose—lowered their insulin; it was a little lower, and that was the right move.

But in our lack of, you know, the comfort crisis, don't let them feel uncomfortable; give them what they want. Our culture keeps putting those processed foods, giving them a snack. As you added that food, as you added all of those sequential carbohydrates—not for one or two times in life, but every day, every day for that age, seven, eight, nine, ten, up into those teenage years, each month after month that you did that, you raised the production of how much insulin your body was going to make because you kept putting a bunch of carbohydrates in the blood. Your blood can only hold about a heaping teaspoon worth of sugar, so every time you overate—and my gosh, they're great; they're designed to make you eat more—so you would consume more than that tablespoon full or teaspoon full of sugar. Every time you push the limit, your insulin would rise a little bit more, and it whispers; it doesn't tell you this is happening. Parents think they're doing the right thing, and now they've got a teenager with acne all over their back, cystic acne in armpits because we've added hormones to, you know, hormones of their sex hormones to this insulin hormone, which also dictates how our fat-based hormones work.

I mean, the most common conversation that I have with moms is, "How do I get my teenager to do this?" because they're so resistant to changing food. I say, "Tell them one week of keeping their carbohydrates under 20, and their acne will be down by 90%." And their mothers are like, "Do you know how valuable that is to my teenager?" Because it is a ubiquitous problem in teenagers—the amount of acne, a core response of excessive insulin, that inflammatory response of insulin rising over the last 10 years. Now, when they eat that graham cracker, they make three, four, some ten times as much insulin as they would have made in, you know, in a season where they were only eating a couple of times a day—maybe, you know, in a growing season, three times a day.

But adults, I say, you never need to be eating that many times a day; you're just overstimulating the insulin. To reverse your problems becomes, well, you're going to need me eventually if you don't reverse the problems. I wanted to focus on the effect of insulin and insulin resistance on chronic health problems because the commonest cause of death is heart attacks and strokes. If people understand how insulin resistance actually causes plugging in the arteries, if you could explain that, that would help them understand the solution.

So can you explain how elevated insulin is going to cause atherosclerosis, arteriosclerosis, which is hardening of the arteries, causing heart attacks and strokes? Yeah, so I will tell you this process is not as glib as, "Oh, go get your cholesterol checked. If your cholesterol is high, you're going to have hardening of the arteries." What a disservice we've done to our patients to say, "Check that bad cholesterol, and if it's high, that's how you're making a heart attack." I would be, you know, I tell my patients it has very little to do with what your cholesterol number is. In fact, it has almost nothing to do with the cholesterol you're eating if it's in the setting of a diet that is low in stimulating insulin.

So that insulin resistance was this noise of ten times the amount of insulin being produced when you eat that same snack that you would have eaten before you had insulin resistance. Now, this hormone—the dictator of all hormones—is insulin. It's going to tell your testosterone what to do; it's going to tell your estrogen what to do; it's going to tell your growth hormone what to do. All of them are at the dictatorship of this insulin, and now your insulin has a commanding voice. You consume that food that has, let's say, it has saturated fat in it, and it's in the setting of a bunch of carbohydrates with that high insulin, which is what made the carbohydrates stimulate that insulin.

The ability to move that fuel into the place where you store it is healthy; you've got easy—you can easily do that. But as you look at the carrying units that are going to circulate that fat throughout your body, they also are looking for their entrance back into your liver. When you look at the recycling of our cholesterol, that's really what we should be focused on. If I could have a blood test that measured how long have you been circulating that cholesterol in your blood waiting to get recycled, then I could tell you, "Are you at risk for a heart attack?" instead of just measuring, "What's your LDL cholesterol?"

So as I look at the inner lining of those arteries—if I could be inside your blood vessels and say, "Let's see, does Reena have a risk for heart disease?"—sitting inside your blood vessels, what you would look for is who's around you. If you have particles of fat circulating around you that are crusty, they're oxidized, they've been in circulation for a couple of days waiting to get recycled, that is a neon sign that your body will say, "You know what? We give up; we're never going to get recycled back into the liver. Let's just help out the liver and store you in this little pocket under the skin in your artery."

As that little fat gets deposited under the skin in your artery, yes, it might cause a little bump if you get a few of them in there, but as soon as it's in there, it actually looks just like a pimple in that kid with acne. It's inflamed; it would be tender if I would touch it. What's happening under the hood, underneath that skin, is your body says, "Holy Hannah, this does not belong here! Get this out of here!" Your immune response comes in and says, "Oh my goodness, what is this doing here?" Your body will attack it; it will find the friends to say, "Get it out of here! This is not good! Why isn't it in the liver?"

If there's only one pimple in your whole body, your white blood cells, your immune system will remove it, and you'll never know what happened. But that's not how it works. That level of high insulin was ten years in the making, maybe 20 years in the making, and now that process of recycling fat is so broken that you have millions of those little pimples happening throughout the arteries of your body—from your brain to your toes, to your heart, to your organs—and your immune response is saying, "I am overwhelmed! I can't get to all of them!"

As a consequence, the longer they peck away trying to undo this fat that is in the wrong spot, it should not be there. It leaves behind some calcium; that's almost like the waste product of your white blood cells coming in to say, "I'm the hero; I can take care of this." But now it leaves behind a remnant of, "Uh-oh, now we've left some crystallization, some mineralization in the spot where inflammation used to be." Over time, that hardening of the arteries doesn't just happen in your coronary arteries—the ones that go to your heart—that is the rate-limiting to life, so everybody cares about that. But it's happening throughout the body; it's happening to your tongue and your fingers and your toes and your brain.

When we look at that chronic disease process and we judge you by, "Let's put dye in your coronary arteries and see how narrowed are those," I'm like, "Dang, they are some pretty important inches of real estate when it comes to hoses and your arteries." But it's not the only ones; it is throughout your body that this has been happening. It's a universal process.

So I think, you know, when I hear and when I'm trying to educate patients of where to focus, you know, they really don't like to hear that their LDL cholesterol is too high, that that one marker that the American Heart Association has done a great job of saying, "Hey, everybody, pay attention to that!" And I'm saying, "I want you to look over there. I want you to wake up in the morning and prick your finger and tell me what is your blood glucose." If it's in the two-digit range at less than 100, we're going to say, "All right, now we're going to check it every day for 10 days." If every day for 10 days your blood sugar is less than 100 first thing in the morning, we're doing a pretty good job of saying probably not terribly insulin resistant, unless you've got some of those outward signs where you've got a nice large tummy that looks like you're pregnant or you've had that female 15 pounds that you just can't seem to get rid of.

So those outward signs will give me a couple other hints that there's a place to focus. Let's focus on getting those pounds off instead of saying, "Doc, do I have an LDL cholesterol that's running in the 130s?" And the commercials say it should be less than 100. I tell them, "Stop focusing there; focus on the prevention of that." Because when you look at the hardening of arteries, if you wait until they are bathed in insulin for three decades and then you ask me to help you get the calcium out of your arteries, you got the wrong focus. We got to undo that monster called high insulin before we can ever make an impact on what your cholesterol is doing.

As Dr. Bos mentions, one way to fix insulin resistance is to monitor your blood glucose because if your blood glucose is constantly elevated, it is a sure sign that you have insulin resistance. But I do want to point out this is just one part of overall health. Another very important aspect of a healthy body is brain health, and it's not just what you eat; it's your thought patterns and also dealing with stressful situations in life. That's why I have BetterHelp as a sponsor of today's video. BetterHelp will connect you to a licensed therapist who is trained to listen to you and give you unbiased advice.

Through my life, there have been different stages where I needed extra support, and more recently, I needed support dealing with my dad's terminal brain disease. I found this particularly beneficial because sometimes you don't want to speak to your family or your friends, maybe out of judgment or maybe they might not understand. The best thing about BetterHelp is that you can do it all from your phone or computer via video call, phone call, or messaging. It is the easiest way to connect yourself to a therapist, and they'll match you to a professional that has years of experience helping people with struggles just like yours.

So if you'd like more support, just head to betterhelp.com/5minutebody or choose 5 Minute Body on the sign-up page and get a special discount on your first month. It's not just heart attacks and strokes, and the reason why I wanted you to explain that is because people would come to you or any doctor with a problem, and it's important to understand this is universal. This is not just specifically in the body in a specific artery; it's inflammation caused by predominantly insulin and insulin resistance.

It also affects the endocrine system. I also wanted to focus on this because depending on who's watching, they might think, "Well, I don't really have a heart problem or a brain problem, but I do have a hormonal problem; I do have a thyroid problem." How does insulin resistance affect the endocrine system, which is your hormonal system?

Yeah, so one of my favorite ways to teach this is actually to look at insulin-resistant patients. One of the other tests that I like to say is, "Do you have a problem? Let's look at your vitamin D." Vitamin D is actually a hormone, a fat-based hormone that you can test without my permission. There are tests throughout Amazon or that you can prick your finger, look at your blood, test, put your blood on a little sponge, mail it in, and say, "What's your vitamin D?" It should be above 50. Health brains need it to be about 50. But if you want to see if insulin is roaring, that insulin dictates what happens to fat-based hormones.

So vitamin D is one of those fat-based hormones, and when I have patients coming to me saying, "You know, I have a few problems, but really this vitamin D has been low, and I'm trying to get it to be higher. I'm taking all these supplements, and I can't seem to make it raise," now instantly in my mind, I know that the cause is almost always not that they're not swallowing, you know, repeatable pills; it's that their insulin—the dictator of what happens to fat in your body—is saying, "Put it in storage, put it in storage." As soon as that vitamin D is in circulation, it will then be dictated to by your excessive amounts of insulin and stored in your fat.

When we watch, we take fat biopsies and say, "Let's just see how much of the testosterone, estrogen, and vitamin D—three of the easy-to-measure fat-based hormones—are found in the fat cells." The first time I read the study, I thought, "I didn't know that! No wonder my insulin-resistant patients—this was probably about 15 years ago—where I'm like, 'Oh, this is why they cannot get their vitamin D elevated.'" They were my diabetic patients; they were injecting insulin, and I was giving them vitamin D on one, you know, one part of the day, and I was giving the dictation that the commanding instruction to put that vitamin D in their fat cells.

If it's in your fat cell, it is not circulating to be able to help your brain do what it's supposed to do, your heart do what it's supposed to do. I love that teaching point because vitamin D is something many people, you know, they know what their numbers are; they hopefully care about it. It is an incredibly important hormone that goes into every cell, binds with the nucleus of every cell, and depending on the cell, will depend on what protein does that cell make.

So your vitamin D does certain things in your eye cells, different things in your heart cells, different things in your brain cells. You'll think when you read about vitamin D, "It must be snake oil," because it affects so many things, but it's because that hormone goes into the nucleus and helps to transcribe proteins based on the cell. So once people understand that, they do want to know their vitamin D. I am, you know, my CL has a hyperfocus on repairing broken brains. Again, you can't do that with high insulin levels. This is how I got into this space so deep; I can't fix their Parkinson's disease without—I can't even impact their Parkinson's when their insulin was that high.

One of the most powerful hormones that was going to help their brain was I have to have their vitamin D above 50, and when they had high insulin, I couldn't do it. It was after that study where I say, "Oh, that biopsy was filled with the fat-based hormones that I'm trying to deliver to their brain, and it is getting parked in the ditch of their fat cells." I think once patients understand, there's another great story I had with a patient who had just come to one of my support groups, and I said, "Well, you're new to this; I would love for you to do an experiment with me."

Looking at your medical records, it appears you've been insulin resistant for at least a decade. We looked at the labs, but we also—the weight had been there for at least a decade, and his profile was gorgeous. He had this nice big round tummy; he could have profiled for Homer Simpson and had the perfect shape. I said, "I know that looking at these labs that your vitamin D is probably in that fat in your tummy. Do you take vitamin D?" And he's like, "No, no, I don't do that." I'm like, "Okay, I don't want you to take vitamin D, but I will sponsor your next eight vitamin D tests every other week while you go on a strict ketogenic diet—one that I know lowers that insulin."

It is the antidote; it is the enemy of insulin resistance to stop putting in so many carbohydrates. He was game; he wanted the tummy to go away. I said, "Not only will this help you be really compliant because I'm going to be doing this experiment on you, but your vitamin D will rise." Here's where it's coming from: it will be in circulation. That vitamin D doesn't like rot or go bad; it stays there. When your fat cells open up and they are no longer shackled by the commanding voice of insulin that says, "Store fat, store fat, store fat," as that insulin gets better, gets lower, you now have a crop of fat cells that are no longer in that concentration camp. They are now free to open up their resources, and as his weight loss happened, his vitamin D rose as he did not take any vitamin D.

I think that's one of my favorite teaching lessons of here's a demonstration of real-life medicine. You can do this on yourself if you have insulin resistance and you have low vitamin D, and you go on a strict ketogenic diet. I remind people you are not on a ketogenic diet if you're not checking to see if you're making ketones. A ketogenic diet is not decided by your thoughts that you're in ketosis; you must prove that ketones are in circulation. As long as that's the case, we're going to be emptying those fat cells; we're going to be improving those fat-based hormones, those sex-based hormones. Wow, do I get the privilege of watching people have an awakening for what happens when their bodies go without that when they have way too much insulin.

And then this surge of improved sex drive, better hair, better skin, vitamin D is flowing again. They'll say, "Oh, it must have been you, doc." I'm like, "Really? It was just the absence of that insulin." It's amazing when you actually eat more calories, you eat more fat, moderate protein, and we're going to talk about ketosis and a ketogenic diet after the signs that you might have insulin resistance.

But Dr. Bos, you wrote an amazing book, "Any Way You Can: The Beginner's Guide to Ketones for Life." I know why you wrote that book, but can you share what was your inspiration for that book?

Well, that is a great story! Yeah, so I actually lost a bet to my husband to write that book. So I have happily been married now for almost 30 years, and if you've been married anywhere close to that long, when your husband, when your spouse tells you to do something, it's usually the last thing you want to do. But this story was happening in my life where a patient of mine, 71 years old, had been under my care, and I'm not bragging when I say I really love my patients; I take good care of them, and this one was no exception.

But her 10 years under my care was with a cancer growing in her white blood cells, and she'd been through chemotherapy a couple of times. The last time she went through chemotherapy, her brain went offline to the part where when she got done with chemotherapy, she was a seamstress, and she didn't know what a sewing machine was. So here's my clinic with peak brain performance, and this woman's brain is offline. Now, we did get it back working, but it was at least six months before that was even close to measurable that this was a version of her previous self.

She walks through the door; it's been a few months since I've seen her, and you don't need to be a doctor to know that the ashen look on her face, the dullness in her—she looked like a zombie. To see her cancer was back, so at the oncologist, it was like one in 500 of her white blood cells was functional; the rest of them were deformed and not able to do their job. 70 out of the last 52 weeks had been filled with antibiotics because her white blood cells were so poorly functioning.

It is a moment where I had this question a lot in my practice. You might have asked this question to your doctor where they say, "If it was you, what would you do?" And I'll be honest, sometimes I lie. If I'm having a bad day, if I just don't have the energy to tell them my personal truth, I will tell them what the guidelines say. Now, most of my patients know me well enough to know when that's happening, but it's an emotional place where we should all be rested enough and in a resilient enough place that anytime a patient asks you that question, I would love to tell you that I give the perfect answer, but I don't always.

But this patient was asking me what to do. She had a six-month survival plan if she didn't do chemotherapy. She did not want to go through that again; she did not want that offline brain again. And by God, she was doing everything I'd asked her to; she was the perfect patient. And she was refusing chemotherapy, and I'm standing there with her as we look at the assignment to go get chemotherapy, and she says, "What would you do if it was you?" This patient was my mom, and at 71 years old, I knew better than to lie.

I said, "Mom, you know, I'll be honest, another round of chemotherapy is going to put you in a place that you may not come back from." I've been reading about this diet that is great for brains, which was why I was reading about it, but there is some research—this is in 2015—that says if we put you in an advanced ketogenic state, it might be good for your cancer. Now, I didn't tell her any of that because she would have said, "What? You're speaking a different language." I said, "Mom, do you trust me?" And she said, "With my whole life."

We got in the car together; we drove 100 miles to our family farm, and we avoided the chemotherapy. We cleaned out the cupboards for all carbohydrates so she didn't have any temptation. I said, "Mom, this is going to be difficult. Giving up carbohydrates at 71 is like giving up a friend, and I'll do it with you. I'll go on a ketogenic diet with you so we can do it together." It made all the difference; she wasn't alone. My kids got put on a ketogenic diet; my husband went on a ketogenic diet, and our journey together as a family was—I think we struggled with it more than she did.

I call her, you know, this was in 2015; we didn't do FaceTime or any kind of looking, so I'm on the phone with her, and I can just hear this youthfulness in her voice. I thought, "Wow, maybe I'm wanting it; you know, maybe it's me. My brain's working better; I feel better." You know, we live 100 miles apart, so we don't get to see each other that often. She comes back six weeks later, and you know she's been great. We didn't lose any weight, but we felt amazing.

As she walks through the door for the oncology person, I was like out of a movie—like backlit by sunlight. Her face was just glowing, and the only other clue I knew that we were headed in the right direction is I was that doctor writing the prescription for antibiotics 50 out of the last 52 weeks, and she had not asked for antibiotics in the last six weeks. We were hoping that her chemotherapy would have blunted that cancer down, dropped it by 30%. You know, cut it in half would have been a miracle, but we had no place in our brain that when the reports came back, it showed that her cancer had dropped by 70% just being on a ketogenic diet.

Of course, the doctor's like, "What are you doing?" Before he walked in, he's my friend, and I said, "I mean, I knew she was—I knew she looked better. I said, 'You know, Mom, if he asks what we're doing, just shut up. I don't know what to tell him. I'm really nervous about manipulating your health like this and putting your life at risk, and just shut up.'"

So we get through this moment where her ketogenic intervention had really helped her cancer. I think that gets you to like the fourth chapter of the book. What really happened was this resurrection of a woman at 71 years old who acted 90, and that's not her spirit. My image of my mother is Mary Poppins; she had abundant energy, and life was magical growing up with her love. That woman was long gone; my kids hadn't seen her in at least half a decade.

I am so happy to report that she stayed on a strict ketogenic diet. I learned more about the ketogenic diet and became now what I would call an expert on the ketogenic diet because of her—my first patient, which was my mom. The book I wrote tells her story but also is a basic set of lessons of, "Here's how you screw it up; here's what most people screw up; here's why you should care." It's more than just weight loss; it is how can we get our bodies to live in this removal of inflammation.

I know that word "inflammation" is used so much today that people kind of tune it out, but it is that message; it is that process that insulin is what caused my mother's cancer—the insulin resistance where it was at least 10 to 15 times higher than it should have been for 15 years at least. When we put her on that ketogenic diet, her insulin went down, her ketones went up, and the body started sweeping out the inflammation that was causing her to be the zombie that was robbing her of being Mary Poppins.

You know, that book—I self-published it and thought no one would read it, and it's sold over a million copies. So I just think how much Grandma Rose's story has helped other people. It's important to say because I'm glad that you mentioned that insulin resistance is linked to cancer. I think people, again, they think cancer is something that I'm just going to die from; I can't do anything about it. But with a ketogenic diet, which we'll talk about ketosis and also spotting the insulin resistance in the first place, you can prevent all these chronic health conditions.

Let's talk about signs and symptoms—early signs that you can visibly see in your body. This is kind of fun; I have 10—well, I have nine here, but you mentioned some earlier, but let's spell them out one by one. The first one is increased body mass index, right?

Yeah, so that hormone is telling your body, "Store fat, store fuel, store fat." When we look at folks being overweight, if you go back 200 years ago, this was not that common of a problem. You had to be a very elite person of our society to get enough of that processed sugar to be able to have enough of the fat on your body to be insulin resistant. People beat this metric up like, "Oh, I'm big-boned," or, "Oh, that metric doesn't work because I have an excessive amount of muscle mass." I'm like, "You're one in a thousand. I mean, that's not the norm, and I'm glad you have excessive muscle mass, but there is still a very good metric behind most people using body mass index."

Body mass index, which takes your height and your weight and says when you get out of the green zone, when you get above 25, you're insulin resistant; you're storing too much fat, and the ability to remove it because you live in 2024 is, yeah, you have too much insulin, too much processed foods that have allowed you to put that squishy layer on your body. So body mass index is number one, and you can make the argument where you put the fat gives me a little more understanding, but I try not to parse those words. Just being overweight today says you got too much insulin; you got to lower the insulin.

Here's the rules. Okay, next one is skin. Why is skin an early sign, an early warning sign of insulin resistance?

So there's a couple of classic med student questions that I think are great for people to notice. There is a process that the skin responds to when it's been exposed to high insulin. So again, insulin does a lot of things. One of the things that I haven't mentioned on this podcast is that it's a growth hormone; it makes things grow. One of the things that grows is skin.

So the first easiest thing that you can see across the room is anybody with a skin tag. If they've got their hair up and they've got a skin tag on the back of their neck, they say, "Oh, it's from my collar." I'm like, "No, it's your collar plus insulin that's been around for a long time." They're like, "Oh, it's from my seams under my armpits." I'm like, "No, it's from the insulin."

And then maybe your seam is stimulating it, meaning the friction that happens in the places where you grow skin tags. Well, that happens to everybody. You must add the secret ingredients of excessive amounts of insulin to grow those skin tags, and it is a very phenomenal process when people say, "I didn't think that I could reverse my skin tags." Because they don't care about those; by the time they're coming to see me, they've got heart disease, they've got a brain that's not working, they've got a heart that's failing, they've got a liver that's full of fat. Skin tags do not even make the list for the first seven or eight visits, but when they accidentally fall off, it is the top of their list.

Like, "I've had those things forever!" And I'm saying that was your warning; that was one warning that your body was making excessive insulin. There's another process that is a Latin word for a velvety-looking skin, and I point to the back of my neck because it's often this place that's on the back of the neck, and it's more prominent; it's easier to see in people with dark melanin, higher melanin in their skin.

So you'll often see, you know, mothers and sons saying, "No, I, you know, it's not clean," and it's as clean as anybody else's skin, but it's skin grown in a bath of insulin. These are teenagers that have excessive amounts of—they have the skin tags, they have the velvety skin under their armpits and on the back of their neck, and they'll get it in the folds of their thighs as well. When you look at the number of years spent with high insulin, just looking across the room at the folds in their elbows, the back of their neck—if you happen to see their armpits, they have a brown hue that is related to that high level of insulin, and it is a tell-all.

As you said, all those things—I was checking myself, so when I was listening to all these signs, I was looking at, "Okay, I don't have anything here. Fantastic!" The next one is hilarious: thumbprint test on the shin.

Yes! Well, so again, insulin in excess shifts the chemistry of your body. One thing you can think about is that when the insulin resistance is happening, you're holding glucose in circulation too long, and as a result, that glucose holds on to water. So you are circulating more water than you need to be when you're insulin resistant, and your body will leak. You can't hold that much liquid in your veins; it will seep out.

So what we're looking for with this test is the tissue—the fluid that's found between the cells in your tissue. I'm not talking about when you cut and those out comes blood; I'm actually saying if you've ever seen—if you've ever had a pimple and the pimple pops, and then out oozes this kind of serum-y, see-through stuff, part of that is interstitial space. There's this pressurized system throughout your body that's really kind of hard to measure except on your shin.

So if you go to the bony part of your leg below your knee, and you look—that's where the bone should be—and you take your thumb and you push on the bone. When I do this to patients, they often say, "Ow!" So you're pushing hard enough to actually take the capillary to whiten the tip of your thumb. You're going to hold that thumb in your shin for 30 seconds, and then you're going to take your thumb out.

Now, if an indent is left remaining in that spot, you have fluid in the interstitial space, which is a huge sign of you've got insulin resistance, dude or dudette. That area of your body, first of all, doesn't have fat in it; you are not pushing on fat. Even if you say, "Well, I have fatty ankles," I'm like, "No, no, no, no! I'm not talking about that; I'm talking about this fascia, this kind of like Saran wrap that usually goes around muscle layers and compartments of your body. That's not fat over the bone; that is fluid, and that fluid does not belong there."

The longer it's there, the more it's there gives me a signal of here's a history lesson in a hurry: how long has this patient been insulin resistant? You push on that shin print, you hold for 30 seconds, and then you pull that thumb up. If there's a dimple that stays there, that is insulin resistance.

The next one is swollen ankles.

Yeah, almost along those same lines. When patients get done with the day and they say, "Boy, you know, my ankles collect water throughout the day," yeah, gravity will do that, but not if there's not excessive insulin around. That excessive insulin caused your body to have a decreased amount of the lymph circulation, as well as the same problem that caused that shin print, and that was excessive fluid is there.

By golly, it goes away. In fact, one of my favorite things when I do check-ins for a support group is people who say, "I have ankle bones again!" That's one of the benefits of doing a ketogenic diet and being in ketosis and eating more fat.

Okay, let's get to number five: hairy toes. Is that a sign that you have insulin resistance or that you don't?

Yeah, so you want hairy toes; you want hair on your toes. I know ladies will do things to make them look lovely, but it's actually a signal about microcirculation in one of the most distal parts of your body from the heart. So as your heart's doing its job, it's going to sacrifice parts of the body when you're not healthy.

Years of not having that excessive insulin—if you go back to those pimples on the inside of the blood vessels, as that's happening to the bigger blood vessels, it's also narrowing those tiny blood vessels, and it will pinch off that peripheral delivery of blood. When you do that, the tissue—the real estate on the other side of that part that got pinched off—was the hair follicles on your toe. The hair stops growing.

Now, I'll have patients who—the hair on the toe is actually one of the last parts to stop growing. You'll often see that the distal part of the leg right above the ankle is also a place that stops growing hair. You cannot guess what the number one answer is when I point this out to patients. Guess what they think it is?

What do they think it's their socks?

Um, you wore socks for 60 years that didn't take the hair off the bottom of your legs. Why do you think it's taking the hair off the bottom of your legs now? It's not your socks; it's that the vessels that go to that part of your body are clogged and not working, and the hair follicles were the first to be sacrificed.

Let's go to the next one, which is change in speech, especially after eating carbs.

Yeah, so I'm a brain person, right? Watching how brains function and what they do in different states of energy is like second nature to me. When somebody's eating and they're insulin resistant, so they've got pretty good glucose fuel happening at the beginning of the meal, and then about maybe even 15, 20 minutes after the meal, the insulin is going to be the highest, which is pushing all that glucose out of the circulation. Hurry up, get it out of the circulation, and it's a relative drop in glucose.

During that time, you can see their speech is slower. Now, I'm exaggerating it here for effect, but it's remarkable. You watch somebody's cadence of delivering those words, and when that swelling is what's really happening in the brain, the insulin causes the glucose to shift; the water will follow it. That's what that swelling of the brain is like a concussion, and it also changes the cadence at which they can articulate. They just can't push the words out as fast, and it is recognizable.

When they stop changing that blood sugar so much, when they go on a ketogenic diet, you can just hear it in their voice—much like that phone call I had with my mom, you know, six or eight days into this ketogenic. You're like, "Oh my gosh, she just sounds youthful; she's back to normal." You can see that in patients where they've left normal; this is clearly not normal.

Okay, similar to feeling tired after eating carbs if you have fatigue.

Yeah, that's exactly the same thing—similar process. It really is; it's a brain thing. I mean, that shift in fuel also results in a shift in what the brain—if you could do a functional MRI after a high carb spike and an insulin response to it in an insulin-resistant patient, you're going to see parts of the brain just shut off. It's not you saying, "Oh, I'm carb drunk." You really are concussed; you've got a brain contusion from excessive amounts of sugar.

I think most people feel tired after eating carbs, especially fruit. I'm going to ask you about fruit later. Okay, these are sexual function—erectile dysfunction.

Yeah, so I think that's one of my most popular YouTube videos, and I will credit my husband to this. If you're trying to get the attention of men, you should just tell them the same thing you told me: "If you keep gaining weight like this, your penis isn't going to work." Like, "Huh?" That does get the attention of boys. They come in; they don't care about the, you know, 20 inches of hoses that run through their heart, but they do care about what goes into the however many inches of genitals.

Those arteries are the same; they are the same pimples, they are the same calcification, they are the same processes that decrease how an erection can be firm enough for penetration as the blood supply is now compromised to that heart muscle. Those are the same pathology; it's just different parts of the real estate.

You know, I also, you know, when one of the other benefits—when people are in this very high insulin state, yes, the hardening of the arteries is one thing, but they'll come into me and say, "Hey, my testosterone's low." The first thing my brain is, is, "Well, it's probably all in your fat cells. If you would just change your chemistry, we could empty it, and you would be getting testosterone injections from your own fat over the next six months."

But they'll ask, say, "Oh, I need testosterone injections," and I'm like, "Here's what's going to happen with that. There's this dictator called insulin, and when I put testosterone—this fat-based chemical—in your body, it's under the dictatorship of that hormone. Your hormone is so high that I don't care how much testosterone I give you; you're going to still put about a third of it into your fat cells. The other two-thirds you're going to get to use, but as you watch what happens to that testosterone process, the effect of their sex drive will initially be improved, but then it flatlines.

Now we have a problem; now you're dependent on my testosterone in order to have any sex drive, and you didn't do much to reverse that insulin resistance in the last six months. The last one I want to ask you about is the Dr. Bos ratio because that is how you can detect if you have insulin resistance. You don't need a lab, but you do need a little device. Can you explain what that is and how somebody can test?

Right, so I arrived at this Dr. Bos ratio kind of by accident, and I'll go back to my mom. So again, she's 100 miles away from a hospital, and she's not unlike many of my patients in South Dakota, where they live distant from—we've been social distancing for 200 years. That ability to have them go check in insulin, well, it came after a 40-minute car ride, and then they waited in the lab, and it's never first thing in the morning.

That insulin is very sensitive; it's a volatile hormone that changes dramatically. I mean, I would tell patients, "If you fart on the way to the lab, you changed your insulin." You know, it is super responsive to what's going on in your body, and I'm going to make a bunch of decisions based on where that's at. So God forbid you happen to suck on a cough drop or you do something on the way to the lab; now you just screwed up my insulin test, and it's kind of expensive, so we're going to use that to judge you for the next year. No, that's not going to work.

Instead, let's look at the two molecules that insulin is most the commander of that are very volatile and accessible, and that is how much is your glucose and how many ketones are in your blood. So first thing in the morning, I have patients prick their finger and say, "Here's my glucose, and here's my ketones." I'll be honest; I got this information from the glucose-ketone index, which is where cancer researchers across the globe use to predict, "Are we impacting the growth of cancer? Are they in autophagy?"

I'm trying to teach my mom how to take glucose, convert it to millimoles, and do a bunch of math, and she's like, "Uh-uh." I said, "Okay, Mom, we're just going to do dirty math. We're going to have the glucose in one metric; we're going to have the ketones in the other. I want you to take the big number, the glucose, and divide it by the little number, the ketones, and I'll convert it for you."

So if you take the big number, the glucose, and you divide it by the ketones, and your doc—we call this the Dr. Bos ratio—it's dirty math for glucose-ketone index. But if the Dr. Bos ratio is less than 100, many people lose weight. If it's less than 80, a whole bunch—I mean, it's hard not to lose weight. First thing in the morning, that Dr. Bos ratio is 80. When I'm trying to reverse things like autoimmune problems or I'm really helping them with reversing some heart disease, I want that Dr. Bos ratio to be 40 or less.

And then finally, if you're one of my seizure patients, we're trying to prevent seizures with a ketogenic diet, or you're like my mom and they are in the midst of fighting cancer, I want that Dr. Bos ratio to be 20 or less. So what is this number really predicting? It is predicting how much insulin are you making today. As you watch people reverse insulin resistance, this is the hardest part. If I'm only measuring the metric of insulin, it's really difficult to assess, "Well, how well does that affect your glucose in your body?"

That's the goofy part about insulin resistance. As you're on your—when they're on the way up of making insulin resistance, that insulin rises, and they do get a little worse, a little worse, a little worse, but they don't get, you know, no APB goes out that this just happened inside your cells, and a very secretive process happens on the way down. As you're lowering the glucose, insulin lowers, and as that insulin stays low, your ability to make ketones—which is the mobilization of fat and turning that fat into fuel—activates, and you can see it. You can judge this; you can see it on your own. You do not need me to do this, but you do need a meter.

Yes, so you don't need a doctor, Dr. Bos. I'd love to see you anytime, but we just have a simple device. Okay, let's talk about ketosis because that is the way to fix insulin resistance, whether that be you have diabetes, dementia, cancer, heart disease, depression, autoimmune conditions. Maybe fixing that would fix the autoimmune condition.

I'll tell you the first time I saw that in a patient, I thought I was actually just on an interview the other day with Dr. Fung, and I told him the story. Dr. Fung was one of the first brave souls to step out into the universe and talk about a ketogenic diet and how fasting is probably the best answer once you're keto-adapted. He was talking about thyroid disease.

I had bought the lecture series from a conference in Cape Town, South Africa, and it's like 2014-2015—a super long time ago. I remember seeing Jason Fung on this lecture, and he said something that I was seeing in my patients that I didn't know how to explain. That is, you have an autoimmune disease; that means your body was attacking the thyroid. Your immune system screwed up and labeled your thyroid as the enemy, and it's pecking away at it, and you're just screwed. You're going to need thyroid medicine forever; you're going to need to see me forever. This is not undoable.

Yet people on a ketogenic diet, when they were persistently in ketosis, I was overtreating their thyroid. So I'd lower their thyroid meds; they'd come in, you know, six weeks later, I was still overtreating their thyroid. I'm like, "Dang, let's just stop your thyroid med. We lowered it three times; maybe it's not a problem anymore." In my mind, I'm like, "That's just not true. I've never seen that before."

I'm like, "When I saw Jason Fung say that lecture, he's like, 'I didn't know what to do with this at first, but I'm telling you, I see this, and I'm not crazy. I have labs to prove this.'" I'm like, "I have the same; I see the same thing." And then my heart broke. I mean, one of the worst autoimmune disorders that I've seen witness is Crohn's disease, where that gut is being attacked by the immune system—all sorts of colitis and Crohn's disease, different parts of the gut that the immune system attacks.

They were young; they were 21 years old, and they were typical South Dakotans working hard, wanting to go party, do their life at 21 years old, and their gut was under a warfare. It was just a bloody mess. I can remember I was a medical student at the time, and the doctor before we walked in to see the patient, he's like, "You know, this kid just won't take our advice. We want to cut the colon out. If we cut the colon out, this would all be better. Yes, he would need a colostomy bag, but you know, he's just going to have to take our advice."

Of course, I'm pretty naive, like, "Well, why wouldn't the knucklehead take your advice? I mean, of course, that's the only option there is." He got super sick; his colon swelled shut, so now, you know, we're going to see him in the hospital, and he's like, "See, I told that kid if he didn't do it, he was going to have to," you know, all glib, and they didn't mean it, but nobody likes to see your patient die.

That autoimmune problem—in the years of seeing what a state of ketosis can do—that immune system is being revved up by a growth hormone. The growth hormone is excessive amounts of insulin, not for a week or two, but over and over and over again. It's screaming at your white blood cells to overproduce, and the error actually produces easier when that inflammation, when all that swelling that I was talking about, is chronically at the cellular level.

When you reverse that, when you take away the swelling by being in a persistent state of ketosis, oh my goodness, I have seen people reverse their Crohn's disease, reverse their ulcerative colitis—stuff I didn't think was possible. I mean, it was actually an emotional—this is selfish to say, but it was an emotional thing for me to say, "Oh my God, that kid was right; there was another answer. We were wrong."

To know that the immune problems—I mean, autoimmune problems—they are happening younger; they're happening more often. They're happening, I mean, and if you come to my prescription pad and say, "How am I going to treat that?" Well, I'm just going to shut down your immune system. We're going to give you an immune modulator, which is a lovely word to say we're just going to weaken your immune system and then say, "Now don't get a virus, and don't get exposed to this."

If you have herpes, it's going to flare, and all this stuff that is like, "Yep, that's our plan for life." Instead of saying, "Or you could remove the excessive insulin, and you could bathe those cells in ketones." That process allows the reversal. Now, it's not right away. One of the best parts of that Jason Fung woman, he's like, "It started happening about eight months after patients said, 'I just don't want to get out of ketosis. I feel so good.'"

It was those patients that said that he said, "And then the thyroid kind of gave me a right hook. Nobody told me you could reverse a thyroid problem of autoimmune origin. Nobody told me you could reverse autoimmune origin causing ulcerative colitis, Crohn's disease, rheumatoid arthritis, these other problems." Indeed, you have to be in a state of ketosis; you have to be strict. That's why I put so much energy into saying you're not on the ketogenic diet if you're not checking the ketones and finding those little turkeys in circulation. You have to be there in order to get these benefits, but for those patients, it is a lifeline.

Let's talk about how to get into ketosis because I think people—some know, and some don't know. Can you walk us through how you can get into ketosis to get those good ketone numbers?

Yeah, so there's a hurry-up-and-do-it kind of way, and then there's the way that you do it, and you're there for life. So I like to talk about the Dr. Bos brand as not the first time they've tried keto, but we like to think it's the last time that they'll want to, you know, adventure into the ketogenic diet because you'll stay there.

I do think this is—not everybody has to stay there to have the best health. I'm going to stay there because I get the unfortunate point of view that, well, that's what life looks like when it doesn't have ketosis. So a persistent life with ketosis is not only a good example for my patients, but it's a better life. When we see people, I call them my "ass over apricot" people. They come in and say, "I'm going to do everything you tell me to, Doc. I'm going to do it perfectly," and they drop their carbohydrates to 20.

They don't know a thing about what's about to happen. They flush out a bunch of extra fluid; their shin thumbprint on their leg goes down; they lower their blood pressure. Sometimes they pass out by day two because they lower it so quickly, so fast. By day four, they can't poop and say, "This diet is terrible." So that's what "ass over apricot" looks like.

What I do and when I teach in my books and when I teach to people who come to see me is you must do a couple of mental shifts. Number one, why are you doing this? If your reason is for a skinnier waistline, probably not going to be a good enough reason to stay the course. I'm going to have you look a little deeper. You know, one of the predecessors of my life, you know, pre-seasons of my life was to work with patients with addiction.

When people would show up and say, "I'm here to take care of my addiction because the court service officer and judge have mandated me to do it," I was just like, "You need to find a different doctor unless you want to find a deeper reason for being here. We're not your team." I think the same thing goes for a ketogenic journey. If you're here to lose 10 pounds and then you're done, we're not your team; we're way too complicated for that.

But if you're saying, "I want to show the next generation how life can be done, how you can age without these problems," we're your team. We start with mindset; you really need to know what you're saying goodbye to and what you are dreaming for. So we set that framework. The second thing we do is you must clean out the cupboards the day before you start, and you have to share that picture with a friend.

You do this even if you have a husband and even if you have kids because this process of saying you're going to eat over here, like in a ketogenic way, and then no one else in your sphere of influence is going to be with you on that journey—we just think that's ridiculous. We think that there is, you know, families do things for a reason because somebody needs help. If you're not vulnerable enough to say, "Husband, I am struggling. I need the last 30 pounds off. I can't sleep; my sex drive is terrible. I want to do this," that relationship and addressing some of those issues—we foster that on this team because it matters.

If you're doing this and you're the outsider in the family, it will only alienate the process. By gosh, if you're the mother, if you're the matriarch of the home—which across the globe, women, that's our job is to set the tone for what the nutrition is in a family—your children, I mean, I'm all about peak brain performance. My kids had keto; they were—and not like I was crazy keto. I was like, "No, if you're eating and I'm paying for it, this is what we have in our home. We don't have cereal; we don't have bread; we don't have processed food."

Sure, do we have Easter, you know, a treat on Easter? Do we have a Christmas treat? Oh yeah, on Christmas, but not on a random Saturday because that's what great moms do. No, it's not. This life that I'm teaching you to eat, this palette that I'm introducing you to will set the tone for what you want for life. As your mom, this is my job.

So we have that conversation, and if people don't want to do that, find somebody else. There's lots of people that teach a halfway ketogenic diet. This is ketones for life. When we do that, we say, "All right, we're going to start this—the timer on the—you're going to start it, but it came after you shared the photo that your pantry was empty. The carbs are out of your sphere of influence; you've got your few partners that are going to either try to do this with you."

Even if you fail—and many do the first few times—they do not realize how addictive, how much dopamine you get out of that surge of glucose that is showered with excessive insulin and then making that insulin resistance perpetuate. As we look at how—once all that is—once I have the right audience, and these are the people that I really do want to say, "Let me show you how to do this for good," we walk them through and say 20 total grams of carbs per day—not net carbs, 20 total.

I usually feed them a couple of ideas for the first few days because people are a little wigged out. You're going to get up in the morning; you're going to have eggs with the actual yolk, and you're going to cook it in some butter. You can have some sausage or bacon with it—no toast, no almond anything—just bacon and eggs. Eat them, and then you can put some, you know, some salami or some hard salami in your snack for lunch, and you could have some cheese.

Again, that's a little bit of the food that you can have for lunch—other things we show them how to do. For supper that night, we want you to go to like a Buffalo Wild Wings and have hot wings with blue cheese—no beer and no breading. That kind of shows them there's some really great satisfying foods that are in your world. You don't need to, you know, reinvent your life, but they're out there. They're high fat, they're low protein, or excuse me, high fat, low carb, and medium protein.

At the beginning, all we care about is that they don't have carbs in them. We push them to really embrace the fat because there is quite a fear that this is way too fatty, and you'll often find that some people have been low-fat for so long that they have a sausage, eggs, that, you know, buffalo wings with blue cheese, and then they get a bunch of fatty diarrhea because their gut's ability to absorb the fat is so out of shape, but they just pooped it right out.

We're like, "Just hang in there; it'll go away. You're going to wake up your gut here in the next two or three days. Just keep eating." Really, what we find is to not limit their foods at all. We want them finding out what things on their palette taste good, and because they've come from this low-fat world, they kind of forgot how great some of this food tastes.

Then they start to realize how much they really did like the processed carbs, and that I think is the journey of the long game. So step one is to be mindful and set that mind frame up for what it looks like to do this. As they step through those first three days, I know I have a workbook that I used to give to patients, and now I say you don't need to see a doctor to do a ketogenic diet, but it really prepares them.

Day one, this is going to happen; day two, this is going to happen; day three, on day four, we talk about poop because if you're going to have the shift in your bowels where you didn't hear me talk about a lot of vegetables on those first few days, most of the time they overeat the vegetables so much on those first few just because they're craving the carbohydrates that I really pushed them for this high fat—mostly carnivore plus eggs, whatever that is in carnivore these days.

Really, I ask them to just find what tastes good, and if they are coming into the ketogenic diet like most people, the way your bowels have been moving for the better part of a decade is to stretch the colon, and there are stretch receptors in your colon that cause the peristalsis, the contraction of that colon to move the stool along. But if we don't have fiber, your body has to use a different mechanism, and it's built in; you've got it there, but it might be a little sleepy, and that's where constipation shows up on that third day and fourth day.

We say we have a fix; here's what you do. So I can walk you through that if you care, but we can talk about that. I want to talk about fat because you recommend for your patients sometimes to have a butter-only day. I'm fascinated; why?

Oh, it is the best experiment! First of all, let's just place this—the scene. Let's say you're a month and a half in; you've done this ketogenic, kept those lot carbs to less than 20 or less, and now we have you, you know, we're done peeing on a peton strip. We actually have you pricking your finger with glucose and ketones, and if we're fighting insulin resistance, what's happened in that six weeks is you used to make five cups of insulin. Well, now you're making four.

In the first, you know, couple weeks of making four cups of insulin, your cells were a little confused. The ketones came to rescue them; they delivered the energy; you got through that, and now your body is reset. So now the sergeant of arms does not need to scream as loudly to get the job done. There's still an excessive amount of insulin there to reverse that. We got about a year and a half of timeline before that's gone, but they get to this place where, "Doc, my ketones used to be like 2.5, 3, you know, three or four, and now they're like 6.5. I can't get my ketones to rise."

Indeed, it is a place where we said, "All right, this is the real crux about what happens with insulin resistance. I'm doing your ketogenic diet, and I don't feel nearly as good as I did that first couple of weeks. It's not working for me anymore." I'm like, "Let's just do an experiment for the next day. I want you to check your ketones and glucose three times a day for the next three days." That's not normal; we don't usually make them prick that much, but I want you to eat only butter today.

For breakfast tomorrow morning, so 24 hours, I want you to eat butter. By gosh, when they eat just fat, they eat just fat, what's what happens is, of course, there's no carbs in that, and the stimulus to produce insulin is now really—so now they've gone from four cups of insulin, and now they produce three. The next thing that happens is this way; their body is already in shape to make ketones, so we don't have to wait three days like we did when they first started the ketogenic diet before their body is making ketones.

Within 24 hours, boy, they have a ketone number of, you know, 2.4, and you know, they're back in that level where the brain is flooded with a bunch of ketones; their energy is good again, and they're like, "Oh, so the answer is to eat butter the rest of my life." I'm like, "Not quite, but this is a great teaching moment to say you're still making excessive insulin. What the butter did was lower the insulin from wherever you were to this new low, and you could do that by, first of all, you were satiated; you felt good."

People think it's easy to eat butter, and I'll tell you, by the end of the first stick, it's a little—you're like, "Oh God, I don't want another bite of butter ever again." But what's happening is this excessive amount of fat that's going in keeps them from snitching or craving, and it doesn't stimulate insulin. Now you've got a lower insulin, another wave of ketone improvements, and ketones in circulation beget more ketones.

So when you do that surge like that, now you've got a grace period of at least a week where they're going to have production of ketones better, so they can tighten up. There are all kinds of little things we can do after the butter to keep them in the good zone, but that's why we do that.

I wanted to ask about ketosis and fasting because I think people hear many different things. They think, "What should I do? What's more important, ketosis or fasting?"

Oh, that's a nice question! So I'm going to start with the answer to someone who's never been on the ketogenic diet. If they've never been on a ketogenic diet and they ask, "What's better, fasting or being in ketosis?" I'm going to say ketosis every time. The production of ketones really is this fountain of youth; your body is repairing when those ketones are on the rise.

When you look at somebody who's coming into a fasted state or they're going to try to fast and they are not in ketosis, they have this high insulin. They're like pretty much 90% of the planet—insulin resistant and they are not a standard American diet, whatever you want to call it. The amount of time they have to fast to get to ketosis is like 72 hours, and to ask somebody to fast that long, first of all, they're going to hate it. I mean, the amount of chemistry shifts that people go through when they stop eating and they are in a high insulin state, it's a heck of a roller coaster ride; it's not fun.

So if they have never been in a state of ketosis, I would say, "Go for it! You should be in ketosis." But when I look at people who are on a ketogenic diet and they're trying to reverse their insulin resistance, I remind them it took you a couple of decades to get here, and you kept inching that insulin up because of the persistent behavior.

Now, as you are trying to inch it down, it's going to plateau. The way you inch it down to the next level is to go long enough that you shift a chemistry. You shift the chemistry—like personally, I fast every week. You know, when my mom and I started that story in 2014, I had three babies, and I worked way too hard, and I was pudgy, and I had all the problems I was trying to prevent from happening in my patients.

So I'd been insulin resistant for at least a decade. That's thanks be to God for children; that's what you need to have in order—you got to be insulin resistant to carry babies, so I'm happy that it happened. But I didn't want it to be happening anymore, and I really realized after I was in a state of ketosis how easy it was to plateau when you're just being a normal person.

So it was only by adding fasting on a regular basis that I was able to take that insulin resistance down. It probably took me 60 years to reverse the insulin resistance, and I, at first, was fasting intermittently. I would go 48 hours here, 48 hours there, and I think it was 2017 when I just started doing it every week. I would start fasting on my show; I'd fast for 72 hours, and I got that by looking at what the data was that I really wanted to burst my growth hormone, and I wanted to, you know, increase the brain.

Do all the things that are very well documented with a state of fasting, but only if the insulin's down. You do not get those benefits of a surge of norepinephrine, a surge of—without that premise that your chemistry set can produce the ketones, that you can get past that cortisol level and burst the growth hormone, the norepinephrine. You can't do that in a high insulin state.

So in those with insulin resistance, if they're in a state of ketosis and then they add fasting, I would contend that they don't add fasting randomly; they find a rhythm to it. You fast to a certain chemistry set; you fast to an increased Dr. Bos ratio. You know, reaching that level of burst metabolism gives you the first—it gives you the ownership. Your body has rules; they're not like your wives; they're not like your kids. You have a different journey, so know what your journey is and don't reach for the clock to measure how you're doing. Look at your metrics, and it really does take out the confusion.

Last question for you: people love supplements. You mentioned vitamin D; I'll ask you about vitamin D, but I'll first ask you about magnesium. Why is that important for the brain?

Oh my goodness, magnesium is important for every single cell, but it's mostly that when you look at the mineral that people have a consequence of when we ring out that inflammation, we flush it out with a bunch of fluid. Especially in a state of ketosis, you don't have that excessive fluid around, and what got washed away is the one that was right at the edge of normal anyway, which was magnesium.

As magnesium percolates back through the body, not only is it helping an incredible number of enzymes do their job, it's also helping muscles to contract, brains to relax. That depth of sleep—that, you know, being a physician that studies brain repair—I need them to get into the depth of sleep where the dishwasher is washing off

To have this ability to cope, you know today's commodity is how well can you deal with stress, change, life differences, setbacks, and even successes. Brain performance is related to how well you can make the proteins inside your brain that are needed to function, and vitamin D is critical at producing that. To me, it was the sneaky setbacks that you see patients suffer with after 25 years in medicine. Yes, insulin resistance is one of those gnarly, sneaky things that the patient did not get the memo on that it was happening. But the other one is mental health issues. They have a strong identity of who they are, and what seeps into their ecosphere is a brain that cannot function like it used to because it isn't nurtured, hasn't been sleeping well, and doesn't have the nutrients to actually build the neurotransmitters that we're asking them to use. Vitamin D is a critical part of that.

For many years, I've said 50 is the number I don't want to be below 50. Now I'm below 50 all the time. I'm terrible at taking supplements, but I keep reaching for it, and I have all kinds of new little tricks I keep trying to keep my vitamin D okay.

Is there anything that is pertinent to your work that we didn't cover in this episode that you would like to discuss? I think there's one thing that I would say, and I'll let you decide if it's pertinent to your audience. When I entered into medicine, I chose to be an internist because it was the kind of doctor who was really advanced in how they were answering questions. When my parents would ask me questions, I didn't like the feeling of answering a little bit. I loved going all the way to the bottom of the understanding: here's what the answer is.

As you look at that job of physicians to educate patients, to really bridge the understanding of what is wrong with you, why is this happening, and you shouldn't get the patient addicted to you in the process—like, "Oh, you need my prescription medication in order to feel better." That's a bunch of hoy; that's not how the human body is supposed to work. If we're really doing our job, as I transitioned into this strange world of educating through a YouTube channel, my popularity of my clinic became overwhelming. In fact, there were times where I was like, "I can't tell people I actually see patients," because all that happens is the phone goes off the hook, staff can't get their job done, and people call the Better Business Bureau because we didn't answer the phone. I'm like, "No, I can't handle all of it."

So, I recently moved to Florida. I moved during the pandemic; life happened. I moved from South Dakota, where I'd been for 50 years, and now I said, "I'm going to do my life here in Florida." When I did that, there were some hiccups in how the federal government registers a medical clinic when the provider is moving, and the paperwork looked like we were either doing something fraudulent or something went wrong. Of course, Washington, D.C., is shut down, so the people to undo the paperwork were kind of absentee, or that's what it felt like to us. The paperwork to start my clinic was super delayed here in Florida.

I did something that I know was God helping me. I don't know that I would have had the courage to do this had I not been boxed in a corner. What am I going to do? I still have payroll to pay, right? I've had this idea for a long time that patients, when they would come to see me for addiction, didn't get better because of the prescription I wrote. They didn't even get better because the super great therapist walked them through their life trauma. No, they got better based on how well they attended the support group.

I have often said, you know, these chronic diseases come to see me. Their Medicare will pay for them to see the doctor for chronic diseases once every 12 weeks for that chronic problem. Now you get 20 minutes of my time four times a year, and you think that's enough interface for me to help you get over this? It doesn't work. I mean, it's just not a formula for improving you. I said, "I think if we had a class where I showed them what I do with patients who have the most severe problems—the seizure patient who needs a strict ketogenic diet, the cancer patient like what my mom needed—you need to stay the course, Mom. This is what you need, and you can't do it alone. I'll do it with you."

I said, "We're going to have a class that's live, where it's three weeks, and we may never do it again. We are going to do what I do in the clinic over what would take probably two to three years to get done on a one-to-one basis, but in a group setting, we get it done in 21 days."

Arena, I think it is the best medicine I've done in 25 years. When patients join that class, they show up with broken metabolisms and a minor understanding of what the ketogenic diet can do or does. Twenty-one days later, they have a support group that's been trained by us. You all know the rules now; there's no arguing over the rules. You got them answered completely. By the time that course was over, you own the group. That's your problem and your journey. That transfer of responsibility, I think, is very important in the health of people. You need to take ownership of this, not your medical team.

When we watch, we're about to start our third year of this, which will be our fifth class of this, and the number of people that have been healed by being in that support group—they do it all on their own after class. I mean, I'm trying to get to the right side of Heaven someday, and I swear to God, the work we do in that class is the best work we've done.

That's wonderful. I'm going to leave all the links for Dr. Bos, the support group, and the books because you have two books: "Any Way That You Can: A Beginner's Guide to Ketones for Life," and you also have "How to Stay Consistent on a Keto Diet," because that's also the other problem—you have to stay consistent on a ketogenic lifestyle. All the links are going to be in the show notes of the description of this video.

But Dr. Bos, thank you for this master class on insulin resistance, ketosis, and how to live an awesome life. If people want to find you, apart from your support group, where can they find you?

YouTube's the best place to land. From there, you'll hear all the goodies that we do. But thank you for highlighting insulin resistance, and I really just want to praise the work you do. I've been watching your show, and it's just getting all the accolades it deserves because it is a great collection of speakers. I'm honored to be part of this.

Thank you for joining me on this episode with Dr. Annette Bosworth. If you're learning from and enjoying these episodes, please hit the Subscribe button. That is an excellent zero-cost way to support this free health podcast. If you have a question for me or a recommendation for a guest speaker, please leave that in the YouTube comments, as I check every single one. You can also find me on other social media accounts. I'm on Instagram and on X, formerly known as Twitter, under the name of Five Minute Body. I generally share different information from what you'll see here on YouTube. I share health tips and advice that I hear from the best experts.

Finally, if you love this episode, you'll also enjoy another episode I did with Dr. Georgia Eid. Dr. Eid is a 25-year Harvard psychiatrist, and she's specifically interested in nutritional therapy pertaining to brain health. Dr. Eid asserts that you can reverse brain diseases like Alzheimer's and dementia, but also mood disorders like anxiety and depression, with diet. It comes down to eating saturated fat and increasing your cholesterol. Dr. Eid will also talk about the role of different medications, including statins, and how they affect the brain, as well as the role of spices—particularly a certain spice—and how that affects your brain.

Finally, thank you for your interest in root cause healing, and I'll see you next week.