22 Studies Agree: Intermittent Fasting Doesn't Work

Welcome to Tuesday night. Tonight, we are talking about a study that came out about three months ago by one of the most trusted publications in medicine, the Cochran Library. This article looked at an extensive review for intermittent fasting and asking, does it help? They looked at a population of people who said, "We want help losing weight. What happens if we use this term called intermittent fasting?" And the term meant a few things. It meant that they were going to have, they could use the word intermittent fasting. They could use alternate day fasting. They could use periodic fasting or even time-restricted eating. They followed these patients for over 12 months. And from 22 clinical trials, nearly 2,000 students across five continents, they said it makes no difference. This intermittent fasting does nothing, does no better than no dietary advice or simply just telling them to do what they usually do.

So, what did they miss? 2,000 plus patients I've given advice to and followed a protocol using intermittent fasting, and I can't find one that didn't lose weight. So, tonight we're going to talk about what is missed with intermittent fasting. Thanks for tuning in, everybody. It's great to see some of the normal folks checking in. I got to press palms with many of you over the past weekend when we spent time together in Gatlinburg, Tennessee, at Meatstock. Uh, I'll tell you, this was the first real Meatstock that I got to attend, as in, last year I attended but had to zip off to a, uh, one of my son's, my son's college educa college graduation. So, this time I spent Friday, Saturday, and Sunday morning with, uh, the folks that gathered in, uh, in Tennessee. Uh, if you tuned in last week, you know that I had a, a few days in Washington D.C. trying to see, can we help lend, uh, our expertise or some of the information that I see here on the front lines to make America healthy again? And I will tell you, when I contrast what I saw in Washington D.C. and what I saw in Tennessee, uh, if you are waiting for the government to show up and teach you how to be healthy, you're in big trouble. Tune in to channels like mine and many of the, of the influencers that came to Meatstock, uh, uh, to learn from. And then, God bless the number of people that said, "This is the first time I've ever been to a conference or a meetup." Uh, and the energy and the enthusiasm and the connections that were made by those who just said, "I'm going to sacrifice time, energy, and money to go to the middle of the state in Tennessee and really put their efforts into, uh, into the energy of how do we use some of these, uh, these, these things that I'm learning that I'm trying to teach on this channel that I use in the patients that I see and, and so do many other influencers." And when they came together and told the stories, it was, if, if I'm going to put my money somewhere on making America healthy, it's events like Meatstock. So, thank you for those of you that came out and, and signed some books with me. It's also just, uh, supported that kind of a conference.

Well, tonight we are talking. Oh, one more thing. I do, uh, I did have, after all the travel I've had over the last two weeks, I, uh, I did say, "All right, we need a good clean fast." Um, and my glucose is 77, my ketones are 4.2. And we're going to talk about some numbers tonight and what those numbers had to do with, uh, with this, this, uh, topic. Again, looking at intermittent fasting and the headlines, uh, aren't just from the Cochran, but there are several other review articles looking at thousand, tens of thousands of patients that have used intermittent fasting, time-restricted eating, and the studies all agree. It doesn't work. When I asked this of my patients, this more of the patients that came to the Pinch Chasers this morning, uh, I said, "What do you think about that? Do you think intermittent fasting works?" And they're like, "Well, of course it works. Look across this room. We all have used that as part of the strategy for getting healthier." And indeed, I, I think nearly every person in that room had used intermittent fasting, but it comes at a different angle. So, we're going to talk about that tonight. I'm going to start by saying, uh, that, um, that, um, fasting that is fake is what I call intermittent fasting. That there are some rules about fasting that I'll cover by before the end. You'll know exactly what I'm talking about. Um, but I, I had people do a check-in this morning saying, "Do you think that intermittent fasting is working for you?" And one of the ladies really caught my attention when she said, "You know, I am doing this because I've had, you know, triple, uh, negative breast cancer. I have a, a cancer that is very well known to be, uh, glucose dependent, and I came across your channel and have followed, read some of your books, and followed some of the the outlines, uh, or the protocols that you've offered, and I have done OMAD for 71 days straight. Yeah, that's not a few days. 71 days of sacrificing that she was only eating in this narrow window. And my morning sugars still say I am diabetic." So, or pre-diabetic, excuse me. And that means that the chances that she is inhibiting the growth of maybe that new baby breast cancer cell, well, that's not the best way for her to to hold on to the success that she's had so far. That, what are the risks of, if she's doing this really disciplined work, but she's not getting the results? Well, is she making a difference at all? Let's hop over. Let me show you the slides that I have to outline this. So, yeah, fake fasting fails because it's superficial. Let me show you what I'm talking about. So, in my channel, uh, and teaching, I look at, uh, oh, let's back up here. Back up here one second. A little too quick on the finger there. All right. This chart is something that I use to teach over and over again. But for those of you seeing it for the first time, I'm going to do a couple things. See this, uh, glucose is in red. The red line here is watching what that glucose is doing first thing in the morning. And then what it does as she eats the meal, her one meal a day, and then what happens after that meal? Uh, what do those blood sugars do? Uh, as you can see, the blood sugars stay between that 120 and 100 when she's not fasting. And the kind of food she's eating doesn't send the blood sugar that high. But something about the way she's eating isn't giving her a lowered blood sugar that when she wakes up in the morning, 6:00 in the morning here, uh, that blood sugar is still, she's right, it's in a pre-diabetic range. When you look at her ketones again, ketones over here, that blue line, and that is measuring her ketones. And when she wakes up in the morning, it's like, yeah, zero, not the 80 here. Let's do that again. It is 0.2, 0.4. Like the highest she gets maybe is 0.6 when she's been fasting the long, when it's been the longest time since she's fasted. But what I contend is this is not fasting. What she's doing here is restricting the time that she eats. And when you look at these studies, part of the problem, and they did a really good job of trying to normalize this, but part of the problem with people saying, "I use intermittent fasting and I'm trying to get healthier," is that they're looking at the wrong metric. They're looking at the, uh, the clock and not the human. When, when I, uh, lean into this problem, uh, and you try to say, "Well, what is the definition of intermittent fasting?" You'll have some people say, "Well, it's when, uh, I restrict my eating from 11 o'clock in the morning until 6 o'clock at night." I'm like, "Okay, how was that different than what you did before?" Uh, maybe a few hours different, and, and when you did that, did you see a difference? And we're going to, we're going to show you some examples of that here in a minute. Other people say time-restricted eating is when, or excuse me, intermittent fasting is when I eat one day and then I don't eat the next day, and I eat one day and I don't eat the next day. And again, the British Medical Journal looked at over 99 randomized control trials, all looking at these very strict definitions of what is intermittent fasting, and it found the same thing that the Cochran review reported, which is no difference. At a year, there's no difference. My friend and colleague Jason Fung has recently put out a book called The Hunger Code. And in there he talks about, yeah, if you're just trying to manipulate your eating by using a clock and you are not affecting the hormones that that talk to your brain about hunger, well, this isn't going to, you're not going to win. You're going to struggle just like that patient who said 71 days of sacrificing, and she, she says, "I don't think there's any difference between what's been happening." And I bet she's right.

So, let, let's, uh, move back to this. So, if you look at, uh, this is what OMAD looks like. She's eating in one section of the day. It's somewhere around, you know, 7, 8:00 at night. Um, and it's doing something to her body that is never going to result in, in an improved process, especially for somebody who has, uh, who has, um, that, that the kind of cancer that she has. So, if we look at first, when people go on to a restriction, you know, in this case, she first went to one meal a day, and I bet it did improve her at first. We're going to show you some slides about what happened when she went from three meals a day to 20 total carbs per day and then one meal a day. That one hour of eating, I call it, uh, all calories in one hour, to say, let's not parse words here. I really, if a meal is what we're measuring, we also need to talk some other things that sabotage how hormones in the body and those satiety hormones get screwed up because anytime you adjust to energy going into a patient's body, uh, it will reach for a homeostasis. That happened when you gained weight, and it also happens in reverse when you lose weight. Unfortunately, when you were gaining weight, it wasn't nearly as noticeable of how stubborn it is that the body definitely wants to return back to whatever it used to be doing, uh, which is why usually they struggle, struggle, struggle, and then they give up and say, "No, no, no, I'm just, most I'm big-boned and I'm supposed to be this heavy for the rest of my life." That's not true. That's not true.

All right, let's take a look at where this woman started. So, we're going to talk about what homeostasis looks like in a body. Um, if many of you know that I teach this on a continuum, that a ketogenic diet isn't just, um, uh, you know, packaging or just counting 20 total carbs. There are several steps that the healthiest of patients don't need all 12 steps. But the sickest of patients almost always need the 12 steps. So, here's where people start. I'm going to point out a few things for those of you seeing these slides for the first time. Look at that blood sugar. 160 is what the average blood sugar is. They're eating, you know, around 7:00 in the morning, around noon, and then around 7:00 when they get home from work at night. When they do that, um, uh, and then enter what I call keto continuum number two, which is now you have 20 total grams of carbohydrates in a day. That is maximum. We really need you to do that. And when that happened, notice that that blood sugar really went down in that setting at the beginning. This is what their ketones are. And if you've ever, you know, if you can remember back to the first week when you tried the keto, when maybe you got the keto flu, you did all the things right, but the chemistry definitely was changing. Maybe you could smell a funny odor on your breath because you were in ketosis, but these ketones were in that one to 1.5 range almost all the time, and that is when they lose weight. There is a huge shift in their chemistry, and we can measure and predict how well this is going in their body. So, as, uh, as they continue on, there's a few other things that I never have patients do when they're at this, this level, but I want you to look at this and be able to predict where the where the equation is going to fail. So, we talk about the Dr. Bos ratio, which is dirty math. We take the big number of the glucose, divide it by the little number, which is the ketones, and we look at, uh, a Dr. B's ratio of 125. In a typical long-term story, I would tell patients, you're probably not going to lose weight at that level. But in those first few weeks of a ketogenic diet, my gosh, they lose weight. They lose water, they lose weight, they lose fat. And we can calculate it. Uh, this Dr. Bos ratio is way better than what it was. And more importantly, as you're sleeping at night, those ketones remain high. You have a motor turned on inside your body that is burning fat. And of course, that glucose is, you know, down to that 100, maybe even below 100 at this point, but not, it's still a glucose in the middle of the night of a 100, of triple digits is still too high, but it's way better than it was in last week for this woman, and it, it got better.

So, then this happens. This, this, um, homeostasis, the body is going to try and return to what it was doing before. And the, although the blood sugars stay pretty normal, those ketones drop back down to that 0.2 to 0.6, a very low level or low production of ketones has happened because your body returned to the normal, regressed to what it was, um, um, was doing before. So, here is this patient, three meals a day, and they come in saying, "Your diet's not working. This protocol is not working." And I say, "Well, I think you need to move to the next keto, this next continuum." Oh, yeah. Let's calculate that Dr. B's ratio to show you exactly what I'm talking about. The big number divided by the little number. Now, we're at north of 300. You are not going to be losing any weight at that point. But at the bedtime, at the time when they're sleeping, where the most weight loss happens in my patients, well, uh, that 100 divided by 0.7 is 142. And although that might have been enough to tickle weight loss the first couple of weeks of a ketogenic diet, this is not enough to stimulate and open up the fat cells, stimulate that hormone production, peak, uh, those hormones, finding hormesis, the peak response to a stress. None of that is happening at this level. And so we say, well, let's move on. Let's change this to one, two boluses of food a day. And when you say, all right, just keep doing what you're doing. I just need you to eat only two times a day. This step is a little hard for patients. It's not as comfortable as the last few steps, uh, in the keto continuum. Uh, but the ketone production rises again. Notice that it's now from about, you know, one to 0.5. And the glucose is a little less than it was. Not a big difference, but enough to say, okay, your peak amount of glucose is less. Uh, your area under the curve or what's the average blood sugar over the last 24 hours is probably a little less, which is why that ketone goes a little higher. But you'll notice that meal here is like 7 o'clock at night. This one's at like 8:00 in the morning. And this will be great for about, ah, you know, I, I tell patients at this two meals per day, you get a slight improvement, but it's nothing like what happened when you first came into the ketogenic space. And this would be considered, well, can we say this was fasting yet? This time-restricted eating? I would say probably not. I think this is far too, um, far too long in between the two times that they eat that I wouldn't call this intermittent fasting. I wouldn't call this time-restricted eating. Maybe you find some people that would say yes to that, but I bet not. And this is what happens when most people come knocking on the door at the Pinch Chasers saying, "All right, what the heck am I doing wrong? Tell me how to fix this." Or they finally buy the book to say, "Let me show you. It's very clearly written. You are not the first one to struggle with this." Those ketones will flatline, and they're like, "Well, I'm a girl. It just is, it's, it's low." I'm like, "That's no excuse. I'm a girl. Mine is not that low." It has been. I've struggled with this just like anybody else that when you go to reverse something, I had a rhythm. I had a pattern. It was helping. And then it wasn't. And my ketones were 0.3, 0.2, 0.3, 0.4. Like I, I did a little dance at 0.5 because I needed to stress the system. I needed to stress my system because of the years of insulin resistance. And here is time-restricted eating. In my teaching, we call this keto continuum number five. Uh, which means you still have those two boluses of food, and you now move them within a, uh, a certain window, like I start with 8 hours, like, uh, if you can keep the first bite to the last bite around 8 hours, usually patients have a pretty good response, and then quickly they need to go to six hours because, um, because they've been doing this for a while. I mean, why is it that this woman who is eating, uh, only OMAD for 71 days wakes up the next morning and her average blood sugars are running in the 105, 110 range because the hormones behind the scenes have rules, and she has slid back down into a place where she's not stimulating them. You know, if you have read Jason Fung's book, which is, we'll put a link in the show notes, uh, a really nice summary of saying, well, how do you manipulate the hormones? And in, in some cases, we can see that, um, that the patients will have, um, they will have an improvement, uh, they will stay in that improved area, and then they do like what many people do. They stop looking at the chemistry. They are looking at, well, the non-scale, uh, celebrations like, uh, those are, that, that is not nothing. Their waistline got littler, uh, they're measuring, uh, their energy. They are celebrating how much better they sleep, and then things stall. And that's again where, if you're trying to reverse a medical problem, this woman who came to the Pinch Chasers is not fighting something that's, you know, a little bit of playtime. She's fighting something that's very severe, a breast cancer that is known to be glucose dependent. So, how does she get the glucose down? And if she's waking up in the morning with that blood sugar of 105 to 110, it's not okay. It's not going to help prevent the next season of healthcare problems. She was lean. She was very articulate. She says, "I'm much healthier than I've been in the past." But if she is trying to hold on to a prevention of what, what gives her the best chance of not having a recurrence of that cancer, she has to fix the chemistry first thing in the morning. And whether you call that, um, time-restricted eating or intermittent fasting, um, I say you can't use that f-word until you reach at least 36 hours of the nothing burger. So, she had shown up and said, "Okay, um, if, if I look at this intermittent fasting, this, you know, OMAD for 71 days, this is my morning fasting sugars. It's only when I fasted for 72 hours that I was able to see my blood sugar got down to 60 and her ketones went to six." I mean, they overshot. And what happens when I see ketones overshoot like that? Like I haven't eaten in, you know, two and a half days, and my ketones are what, three or something? Uh, they're not six. Um, when you see that super production of ketones, it means you haven't given a stress to your system. That is an overproduction of ketones. And although it's something to be proud of because her doctor's ratio is 10, and she's like, "Isn't that the best to get?" I'm like, "Yes, it is. Congratulations." That's the first step. You're doing a lot of things right. We're going to show you numbers of what I'm really talking about that when she says, um, "I've been doing this fasting. I'm doing this OMAD, one meal a day." I'm like, "No, no, no. Let's clean up the language here. You can look at other influencers, and they can have their rules, but when my patients are on this channel or in my books and my, uh, classes, when we use the F-word fasting, it has 36 hours a minimum of the nothing burger, salt, water, black coffee." And when you look at that extended fasting time, uh, when I'm taking care of really sick patients, and this woman would be considered a really sick, like she looked pretty healthy today, but when you come into this space and you're looking for how do I get great outcomes, um, you're going to almost all of them with years and years and years of that insulin, they're going to have to do the nothing burger for at least 36 hours to lower that stimulus. And by her report, she says, "Yeah, I got to 72 hours, and finally on that third morning, my blood sugar was at 60, my ketones were at six." That is a really good hormetic stress. Meaning the hormones got stressed to reverse the problem. But what happens when she goes back to eating? Dang, those blood sugars are back to 105 again.

Let's take a look. All right. So, the solution is chemistry matters most. So, here is this patient. Uh, she did a 72-hour fast. Uh, I, I, her blood sugars might have been a little higher than that when she was eating the two meals a day, and she was eating one meal a day, but this shows two meals a day, uh, the day before she starts her fast. And again, fasting starts when you finish a meal. So, there's where her fast starts. And you can see she's eating nothing here, nothing here, nothing here, nothing here. And that blood sugar, maybe she didn't quite get there on the first day, but over time it gets down into, and she really did reach that 60 level by the third morning. And gluconeogenesis, one of the best ways to predict, am I just making glucose from these other products in my body? I would say no to that when you were in the 90s. I'd say no to that when you're in the 80s. I would start to say yes that you're at gluconeogenesis when you're at 65 or less. How do I know that? It is human physiology. This is the rules of the human body. I didn't make them up. I'm just the one to teach you. But the opposite, uh, um, finding of here was those ketones when she started to fast were, you know, before she started to fast for here. I'm not sure why it went up so much there, uh, in my chart. Maybe I, uh, I might have been teaching something else on that day. Uh, but she stop, she starts fasting, and those ketones go from 0.5 up to one. And by the time she got done with her fast, it was clear up there at six. This is a much more predictable rate when people are doing routine, regular 72-hour fasts. Now, on this channel, you know that I do not ask you to do that for the first several months of a ketogenic diet. We are asking you to get those mitochondria into shape. Get the behaviors in your life and in a pattern where you can predict a much better, uh, outcome. Um, when people show up at the Pinch Chasers, I call them the ass over apricot patients, where they come in and they just want to do everything so quickly. Their b, they're like, "I'm going to fast and I eat no carbs and I'm carnivore and I, you know, sauna six hours a day." They're just doing everything, and I'm like, "Have you been, did you just start that?" And they're like, "Yeah, I started all the things." And what I can predict is that they're human, and they're going to crash. When you stack too many habits at once, that I've seen that enough times in addiction recovery that, uh, you're probably not going to find much, uh, um, improvement when I look at you in six weeks.

So, let's look at the next, um, part of what I would ask this patient to do. So, here she is. Keto continuum number five. She's got two meals a day. I know she was eating one meal a day, but in our patients, when we, when we say, "All right, she's eating a meal somewhere around that like 11 in the morning and then somewhere around 5:00 at night." So, uh, and the ketones aren't terrible. Here's the, um, Dr. Bos ratio where it's a north of 100. The chances that, you know, years into this or months into this, weeks into this, that that kind of number is going to get her the change of, of, of chemistry, enough hours in the day to reverse a medical problem is pretty low. Even at night, though, she is producing ketones. Uh, her blood sugar went down. This is better than it was. Um, but this is, uh, what happens when, uh, we go to keto continuum number six. I think it's supposed to slide those closer. Um, I think I was supposed to slide that closer to morning, but anyway. Um, let's see if that does that. Again, at night, the ketones going up a little higher. This is again another stress. I think the next one shows me this. Yeah, this is what it's supposed to do where the, the eating time of the first meal is first thing in the morning. The eating time of the second meal for this one is I think before, um, 3:00, um, for sure before, uh, 5:00. And of course, what happened to the ketones is they went from, um, being, uh, 1.5. I mean, you did get a 0.5 after that second meal there in the afternoon, uh, but for the most part, those ketones really get robust. Um, even at night, she wakes up in the morning with ketones in circulation. And when I look at what that metric does for, uh, calculating her improvement, that Dr. Bos ratio is going to be tough during the hours when she's eating, but she gets this incredible gift that while she's sleeping, her body is doing autophagy. It is cleaning up a process. It is sweeping out the problem. And this woman trying to prevent the recurrence of breast cancer, uh, by only eating one hour a day is not achieving that. How do I know? Her morning numbers are not low enough to stimulate autophagy. Those sugars have to be below 100. The ketones need to be higher. That isn't an accident that shows up, um, one minute at a time. That is a process where, um, the solution for improving her, her, uh, problem, uh, starts by first understanding. You got to check your numbers. When you say, "What should they be?" Well, there's some ranges about what they should be. But for sure, and hopefully what you are seeing in this is they need to be better than they were when patients come in. And if you've seen some of the, um, Substack articles of the cases I put in there, they come in with diabetes, you know, a blood sugar at 250 every day, and we lower it to 180, which is not great, but it's so much better than before that they make a burst of ketones, their body is mobilizing fat, and they really are cleaning up the inflammatory problem. That when I gave advice to this woman this morning, I said, "I bet you don't need to fast for 72 hours to get that result. But I do think you probably need to put a true fast, like again, less than 36 hours. We do not use the f-word. You can call it time-restricted eating. You can call it keto continuum number four or five. Uh, it is not fasting. Fasting shows up at 36 hours or more." Why do I have that rule? Because I take care of sick patients, patients who've been insulin resistant for decades. And it, it takes at least a fast of 36 hours to lower the goo of insulin, the excessive production of insulin. It just takes that long. I've had patients where I had a continuous glucose monitor on them because I just could not believe that they, they were still fasting and didn't produce any ketones. Like they had so much stored blood sugar that they were 10 days into fasting and their blood sugar was still north of 150. Uh, and of course, that's not what I would recommend you do. I'd recommend you follow the keto continuum because when I said to this woman, "What's the best thing you could do to get your chemistry to be working as hard as your, your discipline and your heart was?" I mean, to only eat one meal a day for 71 days and to have such a terrible response from her body, it's, well, it's heartbreaking. It's devastating. That's when patients give up when they can't see the results. And she just needs to tweak a few things to get those results. So, I said to her, um, "I want your biggest meal to be in the morning." She's like, "I'm just not hungry then. I'm just not, I hear this all the time. I'm not hungry then." I'm like, "I bet at the end of those 72 hours you were hungry. So, go back. Start with a fast if you want to just to push reset on your hunger. And when you get to the end of that 72 hours, I want you to have the best, the biggest meal in the morning. Have it have some variety of bacon, eggs, and whatever else you like to eat, a ketogenic meal. And then, if you're looking for the best way to reverse this insulin resistance, the meal you can have after noon, after the 12:00 noon hour, is only sardines." It's a combination between a sardine fast and this, uh, time-restricted eating. But I'll tell you, she probably doesn't like sardines anymore. I didn't really ask her. Uh, but sardines anymore than the rest of my patients do. But what happens when you say, "Here's on the menu. You can have food at any hour, uh, but we're going to start using this as the food you have after 12:00 noon." I suspect she's going to have to close that eating window about 3:00 or sooner, and that if she puts that can of sardines in between 2:00 and 3:00 in the afternoon, the satiety and the hormonal response that Jason Fung talks about in his new book, uh, that I've seen in patients over and over again, that does carry you to the next day. And especially where she's been practicing OMAD. She's been practicing one meal per day for hours and hours and hours, or excuse me, weeks and weeks and weeks, and has these results. Uh, so my advice for her at the end was, you can do fasting. It doesn't have to be 72 hours. Get it so the blood sugars go down and that you can see a, uh, a response of your chemistry first thing in the morning. And then on the days where you eat, instead of just having that one hour a day of foods that may or may not be ketogenic, I, I think they were in her case, but, uh, one meal a day or OMAD doesn't necessarily mean they're doing, uh, low carbohydrate foods. It just means they have one hour of eating. In my heart, I think that's one of the major reasons why that time-restricted eating, why that, um, uh, intermittent fasting, which I call fake fasting, uh, fasting only starts at 36 hours, uh, intermittent fasting doesn't give them the results is that the foods they're eating are just as important as, uh, the timing of the food and the length of hours that you put food in. Getting that insulin to go down requires some major shifts. So, either fast for up to 48 hours once a week, or the major meal is in the morning, and the second meal is from noon on, but is only sardines. And I strongly recommend you slow down the, um, the, the that you only have the menu be sardines. Yeah. Uh, all right, let me see. We've got a couple of announcements that I, I am going to make. Oh, actually, I was going to show you my numbers. I had a couple of comments that, uh, folks said to me, um, over the last, uh, few days. And one of them was, "Dr. Bos, um, why don't you check your ketones every morning?" And I'm like, "Well, I did for about 10 years, or maybe it's only eight years." Uh, but one of the things that I keep a close eye on is I use my continuous glucose monitor. So, here I am at 70. My glucose monitor from today, Tuesday. Um, here is, um, my, um, blood sugar yesterday. And when I got home, oh, I did a workout yesterday. And so during the workout, my blood sugar went up. And I don't know what was there. I might have, oh, I was taste, I know what it was. I had a lozenge of nitric oxide, and I don't, I think it pushed my blood sugar up a little bit there. May or may not have. I, I should check that before I say that out loud on a live show. Um, but my fasting, um, um, when I got, when I got home off the plane from where we went, we hadn't eaten that day. So, I ate, um, supper on at 5:00 on that night. And then I got in the sauna, which is pretty late for me to be in the sauna. Um, but another, uh, rise there when I was in the sauna that I, my blood sugars always go up when I'm in the sauna. Uh, again, I show you this because, um, I had somebody say, "Boy, when you show your numbers, it really helps me see what I should or shouldn't be doing." Um, so again, um, if you're interested in a Dexcom, it's the only CGM that I recommend because you can calibrate it. I find the other ones can be 15 to 20 points off. And although it shows you a trend, I'm trying to calculate a Dr. Bos ratio from that. And if it's 10 to 15 points off, you can see by the numbers we just covered, that's not going to be great. Um, all right. We've got a few questions that you guys have written in for. We'll be getting to those in just a second. A few other announcements. Um, I was trying to think where the next time I speak at is, but I don't even know. Uh, so I guess I'll save that. Uh, a couple of praise points for the company, uh, include that we have been, uh, our, our class, our six-week extens, our six-week class, something that we are doing for the first time, seems to have a really good rhythm to it. I got to meet several people who are in the class. Again, when we do the 21-day class, that is very intense. That's where most of my stories come from. That's a place where I visit those rooms and answer the questions of every student that's in class, but it's a commitment from you of about 15 hours a week. That is too much for many people to be able to commit to. Uh, so the extension class of six weeks is twice as long and about a third of the hours committed every week to, to, um, what you need to do to succeed. So, again, uh, great job to my team that's doing that with me, and, um, yeah, keep praying for everybody involved there. Let's get over to your questions. Uh, here we go. So, Chu, I will pretend I said that right. What is the safe glucose number when in high ketosis? Uh, well, I've seen glucose numbers, uh, of mine down to as low as, I mean, I think the lowest I ever measured that I got three checks in a row, uh, looking at point of care. Again, when you check the glucose point of care, uh, it's amazing compared to what it used to be. If you go back 15 years, these were not that good. These are amazing. They are very reliable. They are very reproducible. But every once in a while, it makes a mistake. And so, like last week, I was, uh, looking at a blood sugar, and I had my CGM on, so I knew my blood sugar was about 75, and the first reading said 300. The second reading said 150. And then I went and washed my hands and then came back and, and then it said 73. So, when you're looking at point of care, if it doesn't sound right, be careful. But the lowest blood sugar that I've had in that with point of care was 50, was 49. 49, 48, right around in there. And I felt amazing because my ketones were seven. Again, it is the combination of fuel that your body needs. Uh, you know, we had a young gal sign up for that extension class who was new to brand, didn't know what she was doing, and she's like, "I am in ketosis, uh, but I get low blood sugars. I have reactionary hypoglycemia." And I said, "Yes, that's caused from high insulin." No, but my blood sugar can go down to 50, and I just feel terrible. And the reason she feels terrible is because she overproduces insulin. Why does she do that? Because every time her blood sugar got low, she would have some candy. And I'm like, "First of all, you're not in ketosis because you're eating candy. But second of all, it is that reaction of a, of quickly dropping blood sugar when there are no ketones around that give you that, um, that, those symptoms of hypoglycemia where you just feel faint. You kind of start to sweat, and your body's giving a signal that there's no other fuel for your brain. So, it's trying to get you to lay down." When you look at people in ke, in a ketogenic space, um, it's, you know, it's the combination of both fuels. As the blood sugar goes down, the ketones go up. Uh, when you're not checking in, and what was happening with this patient that I reviewed today is those glucose molecules are staying at 105 even when she's sleeping. So, she does not need to make ketones. It's not enough of a stress. She has to figure out how to lower those blood glucose so that she's making ketones while she sleeps. And the best glimpse into what happened while she was sleeping is that those numbers first thing in the morning. Tot test on the toilet. So, safe glucose numbers, um, when you're in a high ketosis is what, whatever you, what you can see. Um, like you're going to have a tough time being, if you're a healthy human, making too low of a glucose when your ketones are in production. I mean, when people are playing around with injecting insulin, then it's a whole different other mess that most people probably don't care about. So, I won't go there.

All right. So, uh, Kitty says, "How might you help protect from AIB events? Is there any, uh, potential correlation?" So, again, atrial fibrillation is a, um, is a, uh, chronic problem of the heart where you've stretched out the heart too much. Specifically, the top chambers of the heart. Now, the bottom chambers of the heart are the really good muscle ones. It's the top chambers of the heart that stretch and stretch and stretch, in part because there's elevated fluid in circulation. Uh, so, you know, one of the first things that this happens on a ketogenic diet is you lower the volume of fluid. In fact, you sometimes lower it too much, and we're saying, "Put salt in electrolytes. Electrolytes. Drink sole water." That first week, the keto flu is really you sweeping out all those electrolytes with the fluid so quickly that you feel terrible. In atrial fibrillation, you've spent years with too high of a volume of fluid in your body, in the circulation of your body. Uh, so a ketogenic state really does ring out that excess inflammation. It also rings out the amount of volume that's being circulated. Um, and the other part of atrial fibrillation is what, what is very often missed is a time when patients are collapsing their throat at night and holding their breath. And when they do that, when they have sleep apnea and they're gasping for breath, the pressure inside the lung gets so massive because they're holding their breath. They're holding their breath way longer than they could hold their breath if they were awake. And in the process of that, it is causing an incredible amount of fluid buildup in the, uh, right side of the heart where the blood comes back from the body. It's about to get oxygenated. It's going to try to go into the lungs. But this is a pressure system. So, your, the pressure in that atrium, in the place where that fluid, that blood gathers, is trying to go into the lungs, but the lungs are such high pressure that it can't go in there. So, they're low on blood volume. They're holding their breath. Their blood pressure is going higher. And the muscle in that atrium is stretching. When you stretch that, the nerves no longer touch like they're supposed to. The circuit to say lub-dub, lub-dub, is run by these nerves. But when you've stretched out those nerves so much, they cannot connect anymore, and they start making their own little pattern of how they're going to connect. So, the question you asked was, is there a correlation between the atrial fibril, atrial fib events and a ketogenic diet? And the biggest connection I point out is you regulate the fluid, the circulating fluid, so much better when you're in a ketogenic state. And again, just like this gal we were pointing out, were 71 days of, um, OMAD, what I would love to have known is what was her blood pressure every day. And when she first had this really nice control of her chemistry, the blood pressure would have been good. But as you go longer and longer with the return of, of non-ketogenic chemistry, where the blood sugar is high and those ketones are low, it allows that fluid to go back into circulation, which raises the blood pressure and stretches that, uh, the top chamber of your heart, increasing the chances of that A-fib coming back. Do I have patients that have written in saying, "My A-fib went away when I was in a ketogenic state?" Yes, I do. Do I guarantee that? No. If that pattern of arrhythmia has been around for too long, A-fib patterns, electrical patterns beget the A-fib electrical pattern. So, the longer they're in A-fib, the more likely they are to stay in A-fib. So, the most best advice I could give to you is, if you have sleep apnea, you have to treat that first. Second of all, is, um, follow your chemistry. If, if you're not in a ketogenic state, it's not going to help you.

All right, next question is from Betty. What should your ketones be before you go to bed? I wouldn't waste your strips on looking at that, Betty. There are so many variables about what your ketones are doing. Um, you know, I was showed you my, my blood sugar there where, oh, I got in the sauna, my blood sugar went up, so did my ketones. When I get in the sauna, they'll, they'll stabilize, but right after the sauna, my ketones go up. Um, I know that if I am stressed, like, like if you look at, um, I wonder if I can show you that on Sunday morning, uh, that my ketones, uh, right before I went on stage on Sunday, which is when I gave that speech, uh, went up. Monday, Sunday. Oh, yeah. Let's show you this. Um, so go to here. So, here is Sunday morning, 12:00 in the morning, 3:00 in the morning, 4:00 in the, 5:00 in the morning. And here is right, right when I went on stage. So, it's 81 when I get on stage. No, I went on stage at 10. No, I went on stage at 9:30. Uh, so by the time 10:00 is there, which is about halfway through my speech, my blood sugar's gone up about, you know, 15 points. That's what stress does. So, I mean, that's a pretty good stress response. You should get stressed when you put on a speech for other people. And it matters to me. You can tell. But when you look at all the other variables that you stack up in a day, if you're checking ketones right before you go to bed, you're wasting the strip. I want to know what did

Your ketone production do when you slept? And you can get a pretty good idea from one of these. What was your blood sugar? And in those patients doing OMAD, it never goes below 100. I mean, maybe it got to 98 somewhere in the middle of the night, but then it went right back up. And it's that constant glucose production that is increasing her risk of uh a tumor that um that loves sugar. So I I don't know what your ketones are before right before bed, but I wouldn't waste your energy chasing.

Now, April writes in, "Do you make the hormone uh the human growth hormone if you get your blood sugar to 65 or below? And would that improve bone density if you have osteopenia?" Uh that's a good question. Um, all right. Let me pull back actually one of the slides here. Um, because what I like to teach is I have a couple of slides that or a couple of uh um lectures that I don't give outside the classroom because people take them out of context. But there's a really good lecture inside the classrooms that I teach calling the science of fasting and the art of fasting. And I go through what your what growth hormone does, what norepinephrine does. Um and indeed extended fasting does and there's a really good literature on that does change these hormones. So April, let me show you this. Um let's go keynote here. So here uh is day one of somebody doing two meals a day. And when you look at um what happened at the end of that 72-hour fast when these ketones Oops, that's automatically transitioning. I'm sorry. I'm going to go back to this. Um I'm going to go back. Hold on one minute. Okay, we're just going to leave it on here. So, pretend this is filled in with mitochondria. What happened here is this start sharp rise in ketones while the glucose stayed low. And again, it's getting to that gluconioenesis which is 65 or less. Uh it is that prediction of having a stable glucose while the delta for ketones is on the rise. That is probably the be best way for you to I mean measuring growth hormone is expensive. It's actually rather inaccurate unless you're checking it several times during a sequence which is even more expensive. Uh so it's a very volatile hormone to to look at. I would I've never checked it in a patient and I would only gain information and understanding of it through somebody's research lab that's checking it multiple times in the same patient over the course of several hours. So in those spaces where they get to that extended fasting, uh you can see the growth hormone rise.

Now I do not recommend a fast longer than 72 hours. Even for me, like 75 hours maybe like essentially that 3-day mark. Uh and I like you to get to the morning. Like if you're at 69 hours and it's about bedtime, I would not tell you to eat at 8 9 10:00 at night. I would say go to bed and and break your fast in the morning. Meaning always error at breaking your fast in the morning, not at the end of the day. And I know that's not how people do it, but what you're looking for is that stimulus for those hormones like growth hormone, which indeed really do help bone density, but also that norepinephrine, that euphoric feeling that brains get when they finally arrive at sparking some of these really ancestral hormones that come with the opposite of hunger. I mean, you're not going to be hungry. You really aren't hungry when these are flying high like that. And again, I will give praise again for Jason Fun's book. Um, I we should probably have a link to that in the show notes. Uh, again, um, or go to Dr. Bob's favorites page and I have the book club. He's part of the book club that I would recommend. Um, where he talks about how much the hormonal switch in our bodies is really what determines weight loss and weight gain. And he does a great job. So, give him all the credit and the praise uh and the success of what how hard it is to write a book.

Last one for the day is uh go to questions. Here we go. Brian says uh should we look at s the sardine fast differently from a water fast? I had a slide in here about the sardine fast, Brian, and then I thought, oh, that's too distracting. Um, and when when you look at a sardine fast, um, I mean, the really important me metric to measure is what happened to your blood glucose when you were eating sardines only and what happened to your morning fasting ketones. And that spark that that drop in glucose and that rise in ketones is really where you start to clean out the trash in your body. you start to clean out the um the um you know autophagy really replace the broken mitochondria with some uh some young phillies, some young healthy mitochondria. That's called mphagy. And in looking at that transition, um many people get the results that they're looking for without that without without having to do a water fast. Um I I've had a few say, "I never want to do a water fast. I only want to do a sardine fast. And my answer for them is as long as your numbers are good first thing in the morning. That when when I see patients saying they they they've learned to love anything. And if I tell them they can eat sardines, they eat sardines. But now they're eating those sardines at 7 8 9 10:00 at night. And although the first day you eat sardines, I let you eat it at any time. When you're doing the the plan that I recommended for this lady, it is okay. From noon on your menu should be only sardines. The morning have the variety of food that you want to have. But that eating in the afternoon and later afternoon needs to be small volume, you know, nutrient-dense food and something that causes you to feel satiated. And there is something miraculous about those little fish that does that. So, um, you look at water fasting and sardine fasting only. When my patients are too broken, uh, too water fast, meaning they don't they don't make any hormones yet. You you they're so uh their metabolisms are so slow and so broken that if I send them into a water fast that their body just says, "Oh, uh, close down every fat cell where we need to be in hibernation mode." And it doesn't release the energy. Um, it's not an accident that in my 21day I have my patients do a sardine fast and succeed at that, succeed at the production of ketones and then the next week we try a water fast.

All right, Well, uh, signing off again for a great night. I will uh, just give again a special thanks for anybody who came out to um to, uh, meet. If you did come, I would love for you to put it in the comments that you attended just to kind of show the other people in this community how many people just said, "All right, I'm going to go to my first conference. I'm going to go to a conference and and that's how we'll make America healthy again." All right, guys. to see you next.