Live Like a Girl with Dr. Mindy Pelz - How the Ketogenic Diet Affects Your Hemoglobin Levels - With Dr. Boz

Episode Date: July 25, 2022

For full show notes, resources mentioned, and transcripts, go to: www.drmindypelz.com/ep131/ To enroll in Dr. Mindy's Fasting membership, go to: resetacademy.drmindypelz.com This episode is about our hemoglobin levels and the importance of examining our bloodwork.  Dr. Boz was born into a farming family in rural South Dakota, inheriting hard work and the expectations that all things are teachable. Throughout her medical training and career, she applied her inheritance to teach patients through storytelling and practical application of medical jargon. She has been featured on CNN, Time, U.S. News & World Report, Fox News, & more. As an Assistant Professor and Internal Medicine Doctor, she helps students and patients combat chronic diseases like obesity, diabetes, depression, addiction, and autoimmune problems. Through the DOD Counter-terrorism, she teaches how to optimize brains & bodies with practical neuroscience. Her favorite way to teach is through storytelling. Her debut book, ANYWAY YOU CAN, told the story of what happened when her 71-year-old mother, dying of cancer, asked, "Doc, What would you do?" In the book ketoCONTINUUM, Dr. Bosworth uses David's story to capture your curiosity and teach you how to stay consistently keto.  Please see our medical disclaimer.

There is a very strategic way that if you want to have long-term best outcomes, brains must be healed. Mental and physical brain must be healed first. That spiritual role is not an absent part of medicine. It is truly part of healing. Resetters, Dr. Mindy here. And I am on a mission to teach you just how powerful your body was built to be. This podcast is about giving you the power back and helping you believe in yourself again. Let's jump in.

On this episode of the Resetter podcast, man, did I have the joy of talking with Dr. Baz. So for those of you who don't know who Dr. Baz is, she is another one of those powerhouse women that are out there trying to change the metabolic world. And she has a very popular YouTube channel. I highly recommend you go check it out. and where she talks a lot about the power of not only the ketogenic diet, the power of fasting, and she has an incredible autophagy ratio that she calls the Dr. Baas ratio that you'll hear about

in this episode for us to understand when we are in autophagy. Now, her background is as a medical doctor. You'll hear her story here in the beginning where she, her specialty was internal medicine and she got so frustrated with prescribing medications and not making a real true impact on people's metabolic health that she started studying concepts like the ketogenic diet and fasting and autophagy and started implementing these strategies into her patient's care and got incredible results you'll hear those stories in this episode. So she is a huge heart on a big mission and brings to the conversation that we all have been discussing not only here on the podcast, but on all my social media sites in my reset academy.

And that's really what do we want our blood sugar to be at? What do we want our ketones to be at? How do we measure autophagy? why we should look at our blood work, specifically a measurement like hemoglobin A1C, what do we want those measurements to be at? These are so many questions that so many of you ask me. And I feel like this discussion took it to a whole other level. So I'm really excited to bring this conversation to you. We're doing something really unique where if you all have questions about what you heard in this podcast interview, please go and write us a review on iTunes and ask your

question in the review. We will be taking those questions and then Dr. Bos and I will be doing a live on both of our YouTube channels together to answer your questions. So this is a conversation I've been wanting to bring to you for so long. I'm really excited to get into your hands. and now as questions come up, I want to make sure that we answer them on both of our YouTube channels. So as always, I hope this changes your life. I hope this inspires you to keep fasting, keep diving into the ketogenic diet. But most of all, I hope this conversation gives you the power back and is one more notch in your ketogenic belt and to understanding just how powerful this body is that you're living in. Enjoy.

Here's where I want to start. And just, you know, my audience, for those of you listening, if you don't know Dr. Baz, you are going to love this conversation. And one of the things I want to say that's really fun about connecting with you is that you and I are both educating on YouTube, which is a whole another platform to educate on. And I, for me, I feel like having a mission and a focus of what I'm trying to do with my videos really, really keeps me on point. And I see that in you too. So can you start a little bit about your mission and why you are putting these videos out on YouTube? Because it is not for your own self.

I know that. Right. Yeah. I was looking at the budget, the halfway through the year for YouTube. And I'm like, it is not a money generator. No, it's not for that. Definitely. Absolutely. No, honestly, I, I think it helps as a way of introduction to just the answer to the question has roots into my soul. I am a hog farmer's daughter. I've castrated more pigs than you've probably eaten. I have a, I'm fifth generation farm daughter. And I can remember the day that I didn't want to raise hogs for my whole life.

I wanted something bigger. I wanted out of here. This town is too small, 800 people, 21 in my kindergarten class, the same 21 in my high, my senior class. What I was missing, dreaming about was this drive to just not be there. And that drive led through lots of long hours of becoming a physician, something I had no mentorship for. I had no idea what I was saying yes to.

And praise be to God. had just enough scholarships at the right time to get the bills paid and then get into medical school. And it was life-changing. It was truly a different world that I knew I wasn't going to do hog chores, but there was a lot of this world that was not lovely. I had worked in a nursing home, aging wasn't the problem, taking care of humans, loving on them. That's not the problem. The side effect of growing up in a community of 800 people is you hold a huge responsibility, whether you want to or not about being a community member. And are you helping the community or are you not?

I don't know how to not think that way. Yeah. As a young budding physician, there's this choice point in the second year of medical school that says, what kind of physician do you want to be? I'm like, oh my goodness, another life decision. And I can look around to see these other physicians now as role models. And I knew that the internal medicine team,

they were super nerdy. They did not have much of a personality, but they knew all the answers to the questions my parents were asking. And the elders that I knew and loved whenever I wanted to answer their questions, I knew that I should be asking an internist to figure that out. So as I became an internal medicine physician, I had these aspirations of if you go to, you know, internists don't have a good marketing team.

It's a terrible name like you take care of the internal part. Yeah, it is a horrible name. Very vague. Right. And you're like, what? But what it really boils down to is that we are the problem solvers. We're supposed to have the most complex problems that we think about at the deepest level of science plus medicine plus mind, body, spirit. And translate that into if you go to an internist and they can't figure out what's wrong with you, you're going to die.

Ooh. Yeah. Yeah, that's a huge responsibility. Mm-hmm. And so I love the complexity. I love the analytics. I was really attracted to shock trauma because you could calculate a lot of the answers and it seemed black and white. And then I had a baby on time as planned, but decided I wasn't going to spend the life there.

I was going to go to outpatient world and be a physician that didn't have 120 hours a week. And I loved that decision. But I brought to the clinical world of outpatient, a very analytical approach of how do you reverse? problems? How do you actually get outcomes that improve the patient? I quickly learned that if you don't take care of their brain first, you're never going to get their diabetes to be better. And I became what most internists are is the management of chronic problems. And there is a very strategic way that if you want to have long-term best outcomes, brains must be healed. Mental and physical brain must be healed first. That spiritual role is not an absent part of

medicine, and it is truly part of healing. But if you wanted to reverse them quickly, you could, at least I was taught, that you could write a lot of prescriptions. And about the third or fourth year into what I thought is a very exciting outpatient career, we were doing really amazing things. And I'd been invited to the White House for taking care of a patient population that was very impoverished, but was getting outcomes at strategically low cost. And it was because of this analytical thing I was doing in the outpatient world, but outside of those innovative lanes in medicine, I was matching patients to prescriptions. If you have this symptom, I give you this pill. If that one doesn't, if that pill doesn't work, then I, then I give you a different

pill. If those two pills don't work, then I test these three things, then I give you either that pill and this pill. And it was just a matching game of these prescriptions. And it was awful. Yeah. This is not what I want. This is terrible. Right. And then you get into the pay for performance in medicine, which a lot of great things when you looked at the theory, but the application of it became, if you have this, if they have this diagnosis in their chart, you must have them on these prescriptions. And you're like, no. Like they were telling you what to prescribe. I got paid to do that. I mean, you're your Medicare Medicaid. You're now getting incentivized. A few more pennies. It wasn't a lot, but you don't get into medical

school, if you're not competitive. And I'm very competitive. Right. There you go. So I'm like, I want to be the best. Yeah. The best is the one who matches them up the easiest.

Well, send out an email. Send out an APB. You don't need to see me to get on the prescription. And then you just see medicine is broken. Like I would, I can remember the first time I got written up when they're telling me I have to have this game of match up the patients to all these prescriptions. And again,

this is, you know, 2002, 2005, right? in that zone. And I'm, you know, still writing statins for every LDL cholesterol. It's over 160 and, you know, doing all the things the rules say. But there was a patient in there that was a young mom. I'd seen her every year for the last five years. And she was fine. She's raising her babies and doing a good job of being a good mom. And she needed her thyroid refilled. And she had no symptoms, no troubles. And she writes in saying, can't you just refill it? And I said, well, here, go to the lab, get your blood tested. And I'll send you a portal message. And you. And I'll send you a portal message. you know, secure and private, that about what the labs are.

And if it's fine, what we feel for a year, you come in when you need to see me. And I got taken up to the highest level in the shiny shoes of the corporate medicine saying, uh, uh, uh, uh, and in fact, they said, that's illegal. What? What's illegal? Like, you cannot write a prescription without seeing the patient. I said, yes, I can. Yeah.

Yes. what my degree is for. Right. And so, of course, it came down to that you couldn't collect the copay if I just did the lab. And we don't make money on labs. People think we make money on labs. No, the labs make money on labs. I make money when I see you.

And I'm a thinking doctor, so I don't make that much money. They don't not pay you for thinking. They pay you for cutting or procedures. And when you say they, you mean the insurance companies, just so people are clear that that's driving those decisions. Right. Insurance companies have a pay for performance, but it's incentivized by the government's pay for performance.

And it had a great initial thought, which was, let's measure physicians for their outcomes. I'm like, okay. And then the outcomes got bastardized because they said, well, if they, let's just do the easy analytical thing because there's so many doctors, we wouldn't want to actually know the physician and their practice. let's put a spreadsheet together to say, if their A1C is this, are they on these, are they on insulin? Right.

If they have a diagnosis of diabetes, do you have them on a statin? No questions asked. Yeah. Right. It's just a one-to-one, one pill, one problem situation. Yeah. And so my mission. Yeah, is to not do that.

Your mission is to not do that. I started so many prescriptions in the first 18 years of seeing patients before I flipped my clinic to a ketogenic-based, start with a diet before you start with pills, that I want to stop as many prescriptions in the next 20 years as I started in the first. And that's a lot of prescriptions. Yeah, I heard you say that. I just want to say that I heard you say that at KetoCon. And I, I too am one of those people that I just think about the community nonstop.

I think I just, I'd like to think about myself a little bit more, but I can't. I get more of a dopamine rush trying to help other people. And so when I heard you say that at ketocon, that you're trying to get people off prescript, as many prescriptions as you put them on, I was like immediately in love with you. And like this, these are the kind of messages that need to get out there. And the second thing that you said that really blew my mind is that in the ketogenic world, we talk so much about mitochondria and ketones. But I love what you have to say about.

hemoglobin A1C and the red blood cell. And I feel like that conversation needs to be brought to the surface. So can you talk a little bit about why hemoglobin A1C, it can, if we could just look at that number and understand that number, we could end chronic disease. Well, it truly dovetails into the story I just told where, again, I was definitely, one of the biggest judgments you had was how low could you get your A1Cs for these patients with chronic illness. In the first, algorithm, it was only diabetics and getting them below six was like considered impossible. And of course, if you're only using prescription medications, you never could get them there. You couldn't wait, wait, pause for a second.

You can't get a patient below six on a prescription medication. Yet we know like below five is for longevity. Yes, absolutely. Okay, I just didn't want to lose that point because that's huge. Go ahead. And I'll tell you, who knows this is every actuary table, every, every lab that, or insurance, well, if they want to, if they get to sweep labs, you give them permission to sweep labs from your EMR, electronic medical record.

And that means that even if they weren't the one that paid for it or ordered it, it's in your history, and they can plot your life expectancy based on A1C. and especially, I mean, it is so linear of the health problems that are associated with it that when we can get it below five, you win. If we can get it to 4.5, that's my personal goal. You win the amount of longevity and improvements in the way the system can transition from one fuel to the next, can repair an injury, can suppress the growth of a cancer. All those things seem like woo science until you really look at the association of the chronic,

number of blood sugar. What is the chronic blood sugar? And so when you learn about what a hemoglobin A1C is in medical school, and then you get out into the real world and you see doctors being really passionate, like, hey, you got to get this better. You got to get this better. And I can remember, just you've got to get this number down. And it wasn't the incentives that were doing it. It's because if you watch this number, it is such a correlation for who's going to have a heart attack in the next year, who's going to have a stroke for the next year, who's going to break their hip in the next year? I mean, it predicts life.

So when you look at the first time I ever explained it to medical students, I thought, oh, I should write that down. And I just put out the video in this, like my speaking season this year was all teaching about hemoglobin A1-Z. It was awesome, too, by the way. It was such a good talk. So you say, hey, guess what? These hemoglobin are proteins.

They are proteins that are designed to carry the most valuable commodity in your body oxygen to the tissues. Because if you just let oxygen float willy-nilly inside the blood, it's going to dissolve into the closest cell. It's going to go oxygen is wanted by every cell. And it can't function without it. The delivery of the oxygen is related to, well, how well do your red blood cells get it there? So in part, that is, are your blood vessels blocked with a bunch of, calcified plaques? Do you have low red blood cell count in the name of anemia? Is your, are your red blood cells wimpy and really tiny because you're low on iron. And so there's several places where you can say, well, the delivery of your of the oxygen is based on that. But more importantly, how many of

these proteins do you wipe out day one in a blood sugar that's too high? And that's because red blood cells, unlike many other cells in the body, they do not have a nucleus. They do not have mitochondria, they are permeable to glucose, meaning the glucose can come in and out of that red blood cell without anybody helping it. Nothing stops it. Like your muscle cells, you got to lift it in there. Your brain cells, you got to lift it in there. You've got a receptor that's going to take it from the outside to the inside. But red blood cells are not like that. They're permeable. They are openly permeable to glucose. So as the glucose, the concentration in your blood is the same concentration that's inside that red blood cell. And if that glucose gets too close to a hemoglobin,

splat. It lands on the hemoglobin and like gum to the bottom of your shoe, it is stuck for the life of that hemoglobin. Oh, wow. Yes. So that red blood cell is going to last 100 days, 120 days in most of us. And until you recycle it through the spleen and you tear down all the parts and then rebuild it in the bone marrow, that glucose is in the parking spot that's supposed to carry oxygen. And now you can't, you wipe that out for the full 120 days. And I just want to point out so that people understand, if you can't get oxygen into your red blood cell, tell us what, like fatigue, pain, like all these things that people are dealing with. So explain that piece. So as the oxygen goes inside that red blood cell, the red blood cell goes,

to every part of your body. So the first one that I think of is in a diabetic, you will know that when they get a sore on the bottom of their foot. And everybody says, what's your A1C? What's your A1C? What's your A1C? And it's because every doctor knows that if we want to fix that sore on the bottom of their foot, we need the white blood cells to get oxygen.

Well, how are we going to do that? We need to know that the red blood cells getting to that infection are giving them oxygen. We need to know that the tissue that is necrotic, that is rotting for all other purposes, is going to get oxygen so that it can repair. So that the skin cells that are supposed to weave through and reset that wound, it needs oxygen. That it's tingling and the nerves hurt is because that nerve needs oxygen. And it is delivered by that red blood cell.

So when the red blood cell is full of sugar and it's carrying seats for oxygen, oxygen are all filled with gum. They're gumed up. Your delivery is lower. You cannot have me, the amount of energy it just takes to run your brain, your heart, your immune system. The exchange of how do I, you know, take care of that little nick in the, in the lining of a nerve that's on your left arm because you were living.

Something goes wrong every day in these cells and the way you repair it has to do with how well the oxygen is delivered to those mitochondrial. and that is based on your average blood sugar. Step one. Crazy. So now my brain's going to all different kinds of places. So do you know the cellular danger response? Have you heard that about that?

Tell me. So the cellular danger response is when physical, emotional, chemical stress comes into the cell, that it gets stuck in a fight or flight type situation. And so the mitochondria stopped making ATP. they actually make a signaling molecule that sends out information to all the other cells and says, hey, we have a crisis here. And so you need to shut down energy production.

And in that moment, all of your amino acids, all your minerals, all your vitamin reserves get depleted. So I'm curious if that's exactly part of what's happening here. You gum up that red blood cell. And now the body, if you're not getting oxygen into other body parts, you're going to have to start pulling not only your reserves, your vitamin, your mineral reserves, but you're also going to have to work a lot harder because your cells may be in this danger response. Do you feel like that would be accurate? Yeah, when you look at that, that gumming up of the

proteins that are inside of red blood cell, it's called glycation or glucose that gets laid on stuff it doesn't belong. And although we can specifically measure the protein hemoglobin because it has this, you know, three-month lifespans. We can check it frequently, you know, every month until we get it to where we want it to be if we wanted to, knowing that we are measuring what is the last 90 days, what is the last 90 days? And if people are truly improving, even though, you know, traditionally doctors would have you measure it every three months. But I find that it's too long between checks that patients lose focus of what they're doing. And checking it monthly allows you to say, hey, whatever you're doing is going the wrong direction. We need the average

glucose to be less month after month because it is also a predictor of how much glycation happened to, oh, that tennis elbow that really keeps hurting and you can't seem to get it better, that white blood cell setting that they can't seem to release the cytokines and pull in the other troops to help you fight off that infection, or it gets glycated in the on position and now you're just spewing out cytokines and that's called a cytokine storm in ways. And although glycation is a minor point of why some of those things happen, it is a chronic and stable delivery of excess sugar around the body, glycating the parts that you don't want glycated. And when you look at a mitochondria that's not working right and you get into that cellular

turnover, that mitophagy or the shutdown of a mitochondria and the rebirth of a new one is when a mitochondria says, hey, I'm tapping out. I can't go. Glacation will do that to a mitochondria. So you watch how many things get paused and, you know, the body will stop you. It sees danger in pushing a subset of what should be corrective functions that are in the wrong chemistry set to correct them. And I can tend to go ahead.

And I think what's so interesting, again, I love the tennis elbow analogy, because so many people don't realize that the pain they're experiencing is lack of oxygen getting to the area to be able to heal it because of the diet that you're on that's causing too much glucose. Like, we don't make that connection. And we think of hemoglobin A1C and I love everybody's walking around with our CGMs on now. And we're starting to see this change. But we have thought of hemoglobin A1C and insulin, fasting insulin, fasting glucose, as only something diabetics look at.

But what I hear you saying is this is your tennis elbow. This is your dementia, your Alzheimer's, your memory loss. This is your menopause symptoms because you're not getting oxygen to these areas. It's totally exactly right. I mean, in fact, one of the hardest parts about knowing the pathology that's linked to hemoglobin A1C as an internist, you can see chronic disease 20 years before it's coming. When you're hanging out of the 5.7 and people say, hey, I'm below six. I'm like, you're 40.

You should be at 4.7, not 5.7, which is an average blood sugar from like 90 to an average blood sugar of just under 125. So those differences are a huge amount of extra sugars floating around every minute of every day that is glycating things that are aging your body faster than they should. And even despite exercise and, you know, when, when the A. C is elevated and that that predictor is how fast will you age. That's, you know, so all these,

so all these people that are like biohacking and getting in and out of cold and plunges, what I hear is those are great if you want to like slow down aging, but let's start with the basics. Amen. What should, yeah, what should your hemoglobin be?

So talk a little bit about what we've thrown out some numbers here. So under what would, what ideal is 4.5. And what is considered you better get to work? Yeah. So 4.5 is my goal for me. Again, I actually, so let's back up one second saying, can you test your A1C? That has been off the books with the exception of a couple kits that were on Amazon for a while,

but they were very specific to say you're going to have to test a few times. You're going to want to test over the course of so many months. But until May 1st, 2022, we didn't have a home point of care test. And I actually co-branded, meaning I said, I want to support this company to get this information out. Again, we did not a big moneymaker, but it's a huge information place for people to go and say, can we improve their life? Yes, if they know they're A1C. And so they, it's one of those tests where you prick the finger and you drip the blood onto the card. And then the card gets sent into an analysis.

They break and look at the hemoglobin and the percentage of glycation at the a alpha, hemoglobin at the one position. Anyway, that's what hemoglobin A1NC stands for. The point is, is that's always been off the books unless you wanted to pay cash to the doctor. But then again, remember, if you do that, your insurance company does get to know what that number is. They want to know. They may not pay for it for you. But if it comes back high, especially above 5.5, they will plot you.

They are, you are plotted. And so I, by definition, you signed the waivers. I got to give them that information. And what do they do with that information? It's an actuary table. It's a, it's a prediction of disease and how much you're going to charge for your insurance. That's part of the link to. So they'll come get you later financially and you don't even realize it. Is that what I hear? Yeah. Yeah. Crazy. Okay, where do you get, where do you get this test? Well, bosmd.com is where I, I've just put it on my website probably three weeks ago. And honestly, I did not, I did not know that it was one of my good friends, uh, from, medical school, when I was teaching medical school in Sioux Falls, South Dakota, his company has been looking at point of care to the patient with omega-3 and omega-6 fat. So if you've ever seen that omega-quant where you test what types of fats have you swallowed in the last three months,

they're looking at red blood cells and they're trying to see, do you have any trans fats in your bone marrow? Do you have any trans fats in your red blood cells? And they measure that by this test that you give them your red blood cells and they run the analysis. It's a cool test. It's really cool test. Yeah. It's way better than a cholesterol test. This is what I say, when you want to see if you're actually eating the kind of fats at

the rate that you need to be, this is one of the core measurements that I have them do. And you don't need to involve me. You can go order the test on your own and get the results. And if you never want to tell me because they are awful, then you don't have to tell me either. You're in charge of your. And I really find that that transfer of information, of responsibility is where we've should have always been that you should care about this. I can scold you, but that's not going to change your behavior long term.

Your insurance company can charge you higher money, but again, that doesn't change behavior long term. That internal drive to be a healthier version of you, that's what we're trying to inspire in all this. Yeah. You know, one of my favorite statements that you made at keto con is that you don't need a doctor to do the ketogenic diet. And, you know, when you stop and you understand how intelligent the body is, you'll

stop giving your power away to doctors. You'll see your doctors as health coaches guiding you to take the right steps, not as the end-all be-all to telling you what's going, you know, what you need to do next. So I love that. The innovation of companies like Omega Quant and other ones that are out there saying, get the doctor out of the way. I don't want to be, any good doctor with their salt is going to say, you got a problem. Let me tell you what I know about the human body and let me teach you. That education factor was always supposed to be number one. And I mean, you've now turned me into a robot that could match up symptoms and numbers and labs and numbers that's an algorithm. You don't need me for that. Right. The education of showing you how to

care for you, how to be in relationship and how to inspire people to change behavior, that is what a physician was supposed to do. And it's long been bastardized. I think it's amazing. I always say, You know what? I used to say to people all the time that, you know, I'm not the doctor that stands up here and looks down on you. I'm the doctor that's going to link arms with you and we're going to walk together to where you need to go. And at the end of the day, we need people to know that it wasn't the doctor that healed you. It wasn't the medication that healed you. It's not even the ketogenic diet that healed you. You tapped into your body's own ability to heal you. And if everybody took their power back, it would be a whole, we would have a whole different health care world,

don't you think? Oh, yeah. I mean, one of the best. things that I know you do a lot of teaching on that I think links right into A1C is when people come back and they have a higher number than they think they should, I talk to them about, look, your body is designed to do some things you're not doing. And one of those is to go without food, to have the exercise inside yourselves without food. And, you know, one of the most derailed conversations that I continue to see people have is that if you're a female, And anywhere in that 30, 40 reproduction range, you should not be fasting. And I keep thinking, no, your little ovaries don't want to be glycated any more than your

red blood cells did. And that production of really good endocrine health comes with lowering the A1C. You cannot lower it any faster than what I practice in my life and what I encourage my followers to do, which is you should get to a metabolism. And not everybody gets there right away. Some people took me a couple years to fast every week. to have a fasting cycle once a week. We don't use the word fasting until you're at least 36 hours without food.

Ah, cool. Now you're talking my language. Right? I actually, so it's really interesting when I pitched Fast Like a Girl to the publishers, several people were like, I don't think people want to do longer fast. So in Fast Like a Girl, I go through six different level fasts from 13 hours to 72 hours. And I talk about the different benefits and how, why you would want to do a longer fast. for hormonal production. So it's all about hormones and women and fasting. But to your point,

I want everybody to realize, I'm going to spend the rest of my life trying to get people to use some longer fast because we can do exactly, undo exactly what you're talking about so quickly. So one of my questions to you is if red blood cells replenish themselves every three months, what happens when you throw a 36-hour fast in there? Do they rejuvenate? Do you? Do you? you get rid of the old ones? Like how does that work? Yeah. So the life of the red blood cell doesn't change based on the fasting. But what you really can see happen is you lower the average blood sugars, that most of the patients come in and they're really looking at me after a couple of decades of overeating or eating processed foods in a way that their average blood sugars have

risen to an A1C of, you know, 5, 7, 5, 6, you know, even up into the 6es. And so that's an average blood sugar in the, you know, 120s to 130s to 140s. That's crazy. And again, that is a great way to get dementia. If you're looking at brains that, again, you got to heal the brain before you heal anything else. If you spend life with an average A1C that high, you cannot reverse the problem. You have to get that A1C down.

So how do you do that? Right. Yeah. How do you do it? Right. And I think your program and my program are almost like where they're almost identical where you look at I lower, I tell patients 20 total carbs or less. That's where we start. Again, I'm taking people in a place where I want to reverse medical problems.

We're not playing around. We're trying to reverse medical problems. Yeah. If you want to do that, you got to get the carbs down, total carbs down to less than 20. Is that net carbs? Yeah. Yeah. It's, you know, I first, when I was first in this, I, I, I said that word, but I had some exceptions. and the sad part is, is every time I did that, the numbers were stall, they would not get better. And so if you're really looking at reversing illnesses, that's the goal here. Then I need you to limit this. We have to undo what you've been doing for the last couple decades, probably. Right.

So as you look at that, then we take them to that first wave of keto. Everybody feels so much better. And I call it the, it's ride the chemistry wave. You can eat three times a day as long. Limitless. Yeah. I call limitless. It's like, you can.

You can, like, did you ever see that movie with Bradley Cooper, you know, where he takes a pill and all of a sudden you can speak five languages? I'm like, you don't need Bradley's pill. You just need some ketones. And you'll soon see that you've been living in a body that wasn't working at its best. Yeah, exactly. And when they are metabolically healthy to get that chemical rise, to get that wave of ketones, I'm like, just ride that ketone wave. You'll come back. We'll show you what to do next. You'll come back. Enjoy it. It's like, it's like, enjoy it. drug trip. You just enjoy it. We'll let you know when you arrive back home. And some people, it's even dirty keto that they get that wave with.

But I'm like, yeah, but that's not going to last forever. Your body will adapt. And I think that's really where when you look at the chronic trajectory of why does a ketogenic diet continue to improve, if you've got some of these parameters, it is adults shouldn't eat more than two meals a day. We weren't designed to do that. We've done that for modernization reasons of all the wrong reasons, actually. Yep. It's into a work schedule better.

You get a break, all the things that you shouldn't have given credit for eating. But now that you've got these chronic medical problems, eating twice a day is one thing. But now I really need your numbers. I need you following your metabolism. And this is where, you know, the Dr. Boss ratio came from. Yeah, it's going to say, talk about that. It's a great ratio. And so talk about the ratio.

Yeah. You know, this was when I was helping my mom fight her cancer. So we needed a high metabolic stimulus to really get the outcomes I was reading about in these papers. She was a 71-year-old woman who'd been through 10 years of cancer, and she was 40 to 50 pounds overweight at that time, had done all the wrong things to try and lose the 20 pounds she had lost. So she was metabolically very sick. And as we are on a timer now, because we got a cancer that's about to take her life and she has said, I am not doing chemo anymore. one of the places I needed to stay on track was I couldn't let her stall for months on end. I needed to know exactly when this wave of chemistry was over.

And when that's done, then I need you to step up your metabolism. So by looking at what her glucose level was, I mean, glucose is this great molecule that we can measure a point of care. But it has several things that are telling it what to do. And one of the loudest things that's telling what to do is insulin. And it would be great if we can measure insulin in a point by point care. But even if we did, it's incredibly volatile when you're checking patients insulin. I used to do this in all the patients. I've stopped doing it because if they fart right before the insulin is gone, I got a higher number.

If they're stressed, if they didn't sleep well, if they have a difficult drive to the lab, the cortisol raises that. And now if it's high, I can't trust that it's high because of a stress situation. So I need several points of care. And it's like $80 a pop. So I don't like testing insulin because of its volatility. But it's one of those places in medicine where if we could look at the one, the two molecules that insulin really is the commander over,

it is your glucose and your ketones at the same time. And so if you have a glucose of 100, it doesn't tell me where the insulin is. But if you have a glucose of 100 and ketones of 1.5, I know your insulin's low. And so that's where the Dr. Baas ratio comes from. If you have a glucose of 100, and your ketones are 0.5. Now I know your insulin's high. So again, we take glucose and we divide by the ketones.

And originally, I tried to get my mom to do the glucose ketone index. But in America, we have these crazy units for glucose and different ones from ketones. And so I'm like, mom, I need you to convert this to the glucose to the other metrics. And then I need you to divide by this to get the ratio of the ketones down to 1.0. And my mother's like, I don't know. I am, you know, it was way beyond what she could do in the mental state she was in. It's not that she doesn't know numbers or couldn't, you know, couldn't have done that in a different time of her life, but she was sick. And so I said, all right, mom, we're going to do some, we're going to do some dirty math.

Just take the big number and divide by the little number. And I'll calculate what they should be. And that's where the doctor boss ratio came from is it's mismatched math, but it's so easy for patients to do this. Yeah. The lower your number, the lower your insulin. Yeah. And so what do we want that number to be? Right. If you want to lose weight, got to keep your doctor bars ratio below 100.

I mean, we know very easily from all the patients we've seen that if you can get that Dr. Bals ratio under 100, you're going to lose weight. So you need like when you say under 100, it's glucose divided by ketones. And that should be 100. Okay. So if you had a glucose of 100 and a ketone of one, then you would have a doctor Bows ratio of 100. And that would be a weight loss one. If you had a glucose of 100 and a ketone of 1.2, now you have a Dr. Bowles ratio of 80.

And when I want, yeah, right, and I want to help them at a, if I'm trying to reverse diabetes, I'm pushing them to get that to an 80. But when I'm looking to really improve their metabolic health in the setting of an autoimmune disorder, which is, again, a very primitive part of our, very deeply protected part of our brain or our body, I need that Dr. Baas ratio to get to 40. which is really a GKI of one to two. So when you're using the scientific papers out there, it's a glucose of 100. And now you've got a ketone of, what would be, 1.8? Okay. I love this.

And that will push that doctor's ratio down to 40. But if I'm working with the patient who's got a seizure disorder or is in a cancer protocol, I need their doctor's ratio to be 20. So that means there's sugars, are usually running in that 60s and 70s, maybe 80s, and now I got a ketone of two to three to keep that Dr. Bos ratio of 20 years. What does it look like to eat to get like you're going to have to fast? I really feel like this is why I love about fasting is it's the fastest path to get those ketones.

And then what are you eating? Are you eating meat and fat? Yeah. So essentially, I mean, the first few lectures I went to this, they had patients that were actually following the protocol. It's going to gross out your people, but it's totally telling you that you're going into a land that either you're going to be really disciplined or you're going to use some of the hacks. The discipline is these were seizure patients of or they were glioblastoma. So they had a brain cancer. The glioplastoma had either been radiated or removed. And if they didn't keep their ketones at that doctor ball's ratio of 20 or less or a GKI of one to one, they had a seizure. So they had incredible compliance. So they were eating things like millworms because they're super high fat.

Oh, insects. And insects are packed with protein. My friend Bill Schindler, who was at Ketocon, if you've heard him, he's a huge fan of bringing insects back. Oh, yeah. I think it's still one of my favorite, if you're going to use a flour, use cricket flour. Be careful to shellfish.

But outside that, when you're looking at hacks, so they would do things like extreme levels of fat. But if you're really looking at a diet that doesn't include insects. I mean, we may have them weigh their food. We usually want them having 500 grams of food. That's not a lot of food. And it's this fatty meat is what makes the list to keep their fat high enough and that the protein replaced enough. Crazy.

Bone marrow. Yeah, bone marrow is on the on the menu. A lot of liver patets mixing it with the fats from the animal, the liver plus the fat, really good. and it's flavorful. They like that. The other places that get a lot of return for bite for bite is organ meat, but also small fish. So sardines make the list because they're, you know, I mean, they're in a can and I don't like to cook. So I'm going to more of the sardines. So you open up some patte, some liver patte and then, you know, your dessert is sardines.

Yes. And you get to live. Your reward is you get to live. I do that. Yeah, honestly, it truly is a level of metabolism. When I have people chirping, oh, I can't give this up, I can't give this up. You know, it only takes that perspective of saying, would you like to see the other patients that I'm taking care of, where they are, you know, 500 grams or less of food per day? They're on this for the next four months.

And one day off, shows their numbers. You know, I'm a big proponent that you live in the 21st century with lots of options for medicine. our medicines work a ton better if you can remove the inflammation from the body. And that's really the ketogenic diet should be called anti-inflammatory diet, but that word's been, you know. Right. It's almost like optimal health. Like when we say optimal health, people are like, yeah, yeah, I want that, but we don't really know what it is. So when we say anti-inflammatory, again, I feel like it's just too vague.

How long do you need to stay? So let's say I have it, let's say I have an autoimmune condition. It's managed well. I'm not really like something like Hashimoto's. I'm not like going to die from it right away. But I do want to work with this Dr. Baas ratio. So I want to try to see if I can get it to 40. How long do I need to stay at 40?

Or is it like do you dip in every time you're in 40, you're accelerating healing? Yeah. So the truth is, is that every time you dip to a certain number, you do ignite autophagy. Again, autophagy is not something you can take a picture of. It's got really great science around it. there's not a lab test that shows you you're in autophagy. There is a chemistry set that is very highly correlated to autophagy. And that is a lower blood sugar with a low inflammation and a higher amount of ketones.

So again, a Dr. Boss ratio of 20, we know a really good statistical chance that you're in autophagy. 40, you get a pretty good chance, like 30 to 40 percent of the people we think are in autophagy. And, sorry, 70 percent of the people are in autophagy. And when you get to 80, we think it's about half the people are in autophagy. So it's not that you can't get in autophagy at 80. It's that we have a much higher guarantee, the lower the number gets. And the outcomes really seem to be matching with that. So when people say, how long do I have to do this?

And I'm like, well, how long did it take you to make it? Right. Now, that's a tough place for them to go because often their autoimmune thing went on for years before it was diagnosed or it's smoldered in the, you didn't have a celiac antibody. You just had all the symptoms and you knew if you took the weed away, you felt better. But you didn't start making the antibodies until this body turned on this gene. And now you make the antibodies. So now my blood test is positive.

Now I can put the diagnosis in your medical chart. But it doesn't mean that the disorder wasn't brewing for years before that. Yeah. So to turn it off, we need to recycle things. We need to have a zone of none for a while. So the parts that I am really careful to advise because people go a little wacky when they start hearing, I need to calculate. They get obsessed.

Yeah. And I'm like, you need to be the tortoise, not the hair. We're trying to find a rhythm of your life that you can stick to unless we're fighting cancer. Okay. And if we're in that zone where cancer fighting is, it just changes the game. So outside of that, I want you to find a zone that you can live in. And I think that's where when I look at the workbook that I use for my patients, I wrote a book called keto continuum. This is what the second book I wrote. The first one was the story of my most, stubborn patient my mother any way you can. And a great love story between a daughter and mother. Yeah. It truly has blessed me in helping more people. I mean, she, that story has helped so many people. Yeah. Yeah. But he don't continuum is what I left on the cutting room floor when I was trying to write that and I was trying to implement this into my clinic. And then I had the tsunami of people that wanted to see me as a doctor. And I'm like, you do not need a doctor to do this. And so writing it down helped. a lot of people use the book, take it to your own doctor, teach your doctor. Teach your doctor. Oh, my gosh. I say that all the time on my channel. I'm like,

send your doctor here. I put the science down below. Yes, it's exactly right. Like, it isn't that much of a, you know, biochemistry is hard for every doctor. It's one of the top and difficult classes in medical school. But it is, this is not advanced biochemistry. This is pretty basic stuff about metabolism. And a couple of glances back into that chapter book and they're going to be fine. But they need a reason why. They need an, and not a scolding, shaming kind of, you should know this. You're a terrible doctor. Doctors don't like to hear that either. We have a lot of stuff to keep up with. Agreed. This place of saying, hey, doc, look, I'm doing this. I've lost this weight. I've been following this workbook. Here's my workbook. And I tell him, just listen to the story of David,

who is a patient in my practice, that he screwed up everything. He gave me every teachable moment in his case to say, let me show you how not to do it and why. And then the workbook that says, the ultimate way where I, you know, there are 12 different places that you can, you know, where I walk people along a continuum. That's where keto continuum comes from. And where do they get the book? Oh, Amazon is one place. You can go to bosmd.com. We sell it there too, but Amazon allows you to leave a review. And I don't have a publisher. So if they buy it, please leave me two. Yeah, reviews are, I think people don't understand the power of a good review

for any author is really appreciated. It's awesome. I had no idea. It did that much for awareness. When the news aren't there, you can't talk any third party like Amazon or anybody to putting you in a cycle. You got to have a reason. Let me ask you this question. The other thing you finished up your Ketocon talk with is something that was really like near and dear to my heart, which is, we've been in this pandemic for two years now without any mention of what we can. can do metabolically to be able to keep our immune system strong. Can you talk as we finish up the conversation?

Can you talk a little bit about where this glycation played in with the cytokine storms and with COVID? Yeah. It's a huge part of this. I mean, in fact, during the process of writing the lectures for those videos and also just really honing how do you speak and deliver this in an eight-minute YouTube video, it was so motivating to me to say it's not an accident that when you want to predict who's going to struggle with COVID-19, A1C was a direct correlation.

It was a linear correlation that the higher it was point by point by point. Third decimal point, it still was linear. If you have a high hemoglobin A1C, the cytokines get stuck. And much to what you were talking about earlier in the show where you get this cellular stress, shutdown of mitochondria, resources that are locked away, you get in, you get like the on switch turned on for the pheromones of, of white blood cells. And they're cytokines, but it's a pheromone, if you would, saying, hey, I have an infection. I need help. And the best responses from our body is the delta. Whatever your number's at, you want it to peak really high

and then come back down. And it's that difference of what is your baseline noise? level for cytokines and then the peak when something happens so that you can recruit your friends and neighbors to help you with this infection. And when you look at cytokine storms, what is essentially happening on a basic level is you have so much noise that when an infection comes along, it kind of burps the level just a little bit and it's not enough signal to put in the white blood cells, but it was enough signal to raise more of the cytokines to produce and more of them to produce. So it's this low chronic raising of the cytokines. and then they live there.

And to reverse it, you need to stop, stop eating. You need to fast as long as you're metabolically healthy to do that. And what I find is the patients who really needed to fast, they were eating 250 carbs a day before COVID. And now they hear, I should fast to do better. Like, your metabolism isn't correct. Yeah, you got to do more. Yeah.

And those are the places, patients where you, I mean, the only outcomes that I've seen, I mean, sometimes you'll get a winner who will fast and their body will do what it's supposed to do and their cytokines do come down, but they smolder for a long time. Inducing a ketogenic state by exogenous ketones is what several of the places have done. And they have the in IV form now and had a couple of trials where they're infusing them into an IV process. With somebody who has a in a cytokine storm? Oh, that's brilliant.

Oh, my gosh. I love that. have you see did you see the research this is one thing i went to youtube and i was like shouting this was the research was showing that if you have two cells one that is a glucose a sugar burner and one that's in a state of autophagy that if a virus comes into those cells they can't live off your own energy off there they don't have their own energy so they have to live off of you so if you go into a cell in a state of autophagy it stops down stops viral replication absolutely Absolutely. Yes. One of the mechanisms that does is it kicks out iron from that cell.

And now the iron inside the cell is depleted, which is like a kamikaze for the cell, but it's also a kamikaze for the virus. So there are built-in mechanisms that are absolutely correlated to, again, Dr. Bowles ratio. Get the glucose down. Yeah, it's going to say. Yeah. Yeah. When you are plotting who's going to do a better job, that GKI absolutely mattered, that glucose ketones in circulation, which one is your system using, infusing, the body with ketones would induce, just like an injection of vitamin D would induce some of the outcomes and the proteins that we know are part of being healthy. But in a moment of crisis, I mean, you can't fix the problem immediately, but you can. There are several of the ICU doctors

who went out on a limb and injected like 100,000 units of vitamin D toxic in anybody's measurement. Maybe it was 50,000. I don't know. It was a lot. It was, yeah. Do you ever see this? Oh, I've heard this. Go ahead. Say what you're going to say. And these patients lived.

They were on ventilators. They're like last ditch effort. They're not going to live. And there is something about the transcription that happens outside of the DNA in a nucleus that is supplied with abundant vitamin D. And so again, another place where, well, where is all that vitamin D? Well, it's stuck in your fat cells. It is totally being run by insulin.

So when you look at that cytokine storm and what other. the things are associated with it. Cidokine storm was was associated with a higher A1C, a higher body mass index, a higher fat mass, a higher amount of insulin chronically, so insulin resistance, and a lower amount of vitamin D, a lower amount of ketones ever being used in the last 30 days. All of these metrics are, are, there's no prescription that I can get you to get you in 24 hours. Yeah. You got to eat right. Yeah, you can, and you can do it for yourself. So, oh my gosh, since I swear, I want to respect your time, but I could like sit here for like three hours and discuss this with you. So I just need to say a couple of things before the show ends and that is that there are very

few people that make my life easier. When I send them to listen to things and I said, just go listen to Dr. Mindy. She does a ton of this coaching. I am not the only one saying this, but you're teaching. I mean, it really dovetails into helping my patients. And any person who does that is you're going to heaven. Oh, thank you. Well, and vice versa.

I'm all about collaboration, and I feel like we, you know, what I love and where I geek out with you is like, we're some of the only women that are on YouTube discussing this. And I, we used your ratio for autophagy in my academy one time to try to get into help people figure out how to get into autophagy. So yeah, I'm all about collaborating with you. I just love what you're doing. And yeah, let's change the world together. Amen. Good job. Well, thanks for inviting me on. I'll get to see this again soon. Yeah, okay. I'm going to ask you one more non-glucose ketone question,

but probably the most important thing we can talk about before we close this down is, do you have a gratitude practice? And if so, what is it? All right. So I have a pattern of fasting each week. And I struggled to fasting a long time. Just again, like anybody, the mind-blowing part when you first go into that. And I've been going to Bible study and doing my thing that I like to do to nurture me,

but I kept failing at my fasts. And I learned that if I start the fast by documenting and really having the person that I focus on. So it's usually somebody that I'm caring for in my practice. Maybe it's somebody in my family. But I have learned every week. I fast every week. Now, sometimes I fail. But for the last four years, I think I've missed like maybe a dozen weeks for not fasting.

And the goal is 48 hours and 72 hours at least once a month. But I never make it if I skip the gratitude. The fasting is so correlated to what's in my heart. And that if I document that, I also can see it in a numerical. That was really good for my analytical brain. Like, all right, God's saying, thank you. If you remember all the blessings that you've got towards you. You know, you're making me actually tear up now because one of the things that I love

about fasting is that it quiets the noise in your brain and you can hear so much more about who you are and how you want to show up in life. It's more than just a health tool. It is a total spiritual tool. So, oh my gosh, just love that. So thank you for this is going to be. I think our audiences hopefully will love that we geeked out together. And you guys, if we're going to put this out and then Dr. Bos and I are going to go live on YouTube together and have more fun. So thank you for not only who you are, but for what you're doing to change the world. This is just, yeah, it's incredible. We need more doctors like you.

So so grateful. Thank you so much for joining me in today's episode. I love bringing thoughtful discussions about all things health to you. If you enjoyed it, we'd love to know about it. So please leave us a review, share it with your friends, and let me know what your biggest takeaway is.