This transcript is brought to you thanks to the hard work of Joell Abbott.

One question, three answers. 

Do you think people with weight to lose need to consider calories if they are experiencing a long plateau when eating a ketogenic diet? 

First up is my friend Richard Morris. 

We’ve actually touched on it in the recording today. 

Do you think people with weight to lose need to consider calories if they are experiencing a long plateau when eating a ketogenic diet? 

So reducing your calories will guarantee to reduce your what? It doesn’t all come off body fat. If you eating fewer calories than you need to be satiated, then by definition you don’t have enough energy from body fat. And so you need to find energy from other sources. And there are two easy places that your body can get energy from and it gets some approximately linearly, you will be using lean tissue. So you’ll be throwing the furniture on the bonfire to keep yourself warm. So burning lean tissue in your body and you will be also reducing your metabolic rate because you know, the other easy way to find calories is to make them a cost savings. So you furlough a few processes like growing hair, growing fingernails,  lots of things that are, you know, these are necessary. But you know, if you didn’t do them for one day, your body could probably justify doing that. And so what happens when you eat fewer calories than you need for satiation is that your metabolic rate slows and it becomes harder to calorie restrict. And that’s why people go off. So yeah, definitely having less calories will definitely reduce your weight. It’s probably not the best way to do it. Yeah. 

It is actually, and for women, something that often gets turned off is menstruation.

 Of course fertility. Yeah.

I remember somebody talking a while ago, they say your body’s very clever and it doesn’t think this is a healthy environment in which you should get pregnant, so it’s going to turn off menstruation so that you can’t get pregnant.

 It turns off fertility in men and women. It’ll turn off your sex drive as well. That’s a big old warning sign.  It will lower your testosterone if you’re a man and it’ll turn off your sex drive. 

 We don’t want you to reproduce. Thanks. You’re not healthy. 

Yeah, exactly. There’s definitely  lots of cost savings that can be made. I mean people can lose 400 to 800 calories a day in metabolic rate drop just by putting pressure on the caloric intake and it, the body fat, can only release energy at a certain rate. It’s roughly 31 and a half calories per pound of body fat per day. When you have a caloric restriction that is so great that it puts pressure on that, and you can no longer be getting the energy from body fat for one reason or another, then you know you’re going to get it from these other places. 

I’ve heard you talking about this before about how the fat person can’t, just literally can’t, access that fat cause you hear people saying, “ No, don’t eat high fat and you should be eating less fat if you’re trying to lose weight or you should be eating the fat on your body instead.” But there’s only a certain point that that’s gonna work too, isn’t it? It’s not just this absolute sliding scale where you can minimize the fat. You eat right down to a really, really low percentage and automatically dial that percentage up to be taking it off your body instead doesn’t work like that. 

No,  thin people can’t fast. You’ll find that a lot of people who are quote unquote healthy and shirtless on Facebook are not able to fast for more than a day. And the reason why is because once they’ve gone through all of the energy in the lipoprotein, they have no energy coming in because theyhave no ability to supplement their daily energy intakes from body fat. So yeah, that’s the case. But there are other reasons why you won’t be able to use fat. SI have 20 kilos of body fat, so roughly 44 pounds,  I can produce about 1,275 calories per day. So that’s not too bad. I mean, 1200 calorie day, that’s not too bad. So I can fast for as long as I want. But somebody who has, let’s say, 10 pounds of body fat on their body, they can only produce 300 or 315  per day. That’s not enough energy to be able to run your day. So that person is now going to be reducing their metabolic rate as much as they can. So they’ll go from a metabolic rate of 3000 down to a metabolic rate of maybe 1200 and then how do they make the extra savings, they start burning lean tissue. So that’s a really bad situation to be in. The other reason that you might not be able to use body fat is if insulin is high. There are people who even though they’ve lost a lot,  80 to 70 pounds of body fat, they still have high levels of fasting insulin. Insulin has two effects when it comes to getting energy from storage into use. The first is that insulin will basically tell your fat cells, we are going to concentrate on glucose now. 

So I want you to Hoover up all of the lipids, all of the energy in circulation, or I want you to get all of the, the fats out of circulation and store them. And I want you to pull as much glucose as you can. Alsouot of storage because we’re focusing on glucose. So that’s like  the signal that insulin gives the fat cell. So you know if your insulin is high, even when you eat nothing. If your fasting insulin is high, if it’s about 14, your fat cells are just sucking up all of that energy that they can, irrespective of how much energy you have available to you. And this explains the paradox of why the fat man is hungry all the time and has no energy to do anything that’s at the source. And then the other part is at the sink for energy insulin will prevent you from being able to get fatty acids into your mitochondria, which be used for energy. 

And there’s a bunch of ways that that happens. But in a type two diabetic, in somebody who’s hyperinsulinemic, they could have a 50 fold inhibition over normal person in terms of getting fat from circulation into their mitochondria to be burned. This is part of the reason why people who are hyperinsulinemic have really high triglycerides because they can’t use fat for energy. It just pulls in their circulation. They can no longer store itin their body fat because their body fat is full to capacity, but they’re not burning it. As soon as you drop insulin enough that they can burn their body fat or burn the energy, the fatty acids that are pulling in their circulation, all of a sudden their triglycerides drop. So if your insulin is high, that may be impacting how fast or the rate that you can burn fatty acids. And so these are all factors that, people think, oh, you know, if I’ve got 10 pounds of body fat on me, that’s roughly, three and a half thousand calories per pound of body fat. So I’ve got 30,000 calories, I need to go do 30,000 calories of exercise and then [I’ll have zero pounds of body fat on me. It doesn’t work that way. It’s a very complicated picture. 

So does how insulin sensitive or resistant you are, is that going to impact then how much you can pull from your body fat? So for someone like me who had, so basically I was twice my weight so I had 140 odd pounds of excess body weight. I wasn’t insulin resistant. I’ve always stayed quite insulin sensitive. My blood markers were always quite good. Does that mean that, and maybe that was why something like a very highly restrictive procedure like the gastric sleeve would work well, would I be the kind of person who could pull more from my body fat 

So hyperinsulinemia goes hand in hand with insulin resistance? Hyperinsulinemia just means you have high insulin and you have high insulin. There’s an argument over whether high insulin causes insulin resistance or insulin resistance causes high insulin. My attitude is that it doesn’t really matter. They both affect each other and they both contribute to each other and once you get started on this, it’s a sort of a Jacob’s ladder. It just never stops. If you’re not insulin resistant, then you’re able to lower insulin based on the signals of what you eat and so you would be able to, you probably with a caloric restriction, you are probably able to get to a lower body weight than somebody who was insulin resistant went through the same process. 

Right. But I would be able to pull more from my body fat. When you talk about the ability of only being able to pull so much, if you’re much more insulin sensitive, you can pull more so you can actually be someone who potentially could benefit when you’re wanting to lose weight from reducing calories a bit. 

Yes, definitely. If you, if you’re insulin sensitive, then you have access to more fat, more fat as fuel to turn into energy and if your insulin sensitive and your insulin is low, you’re in a wonderful state. You know? If you’re insulin sensitive and you go on a ketogenic diet, what happens generally is that you lose a lot of weight, then you get down to normal body weight very quickly. If you’re insulin resistant and you have high, high underlying fasted insulin levels, then you will alight at a higher body weight, you will plateau at a higher body weight. And then it’s just a matter of working out what tissue is causing the insulin to be high. Certainly, once you’ve lost 30, 40 pounds of body fat, it’s no longer a physical capacity limit on your body fat that’s caught. It’s not insulin resistance and your body fat that’s causing your insulin to be high. 

It’s another issue that’s doing the damage. It could be your hypothalamus, it could be your pancreas, could be your liver, could be muscles, it could be your immune system is also able to modulate insulin secretion. So yeah, all of these things. So as that point, this is why my advice is keep calm and keto on, get to your plateau and then keep calm keto on, and you know, at enough time at that weight  you’ll find what issue was doing the damage. And you know, it could be sleep, it could be, there’s a bunch of things that you can do. Yeah. Relaxation. They’re all part of keeping calm and ketoing on. But you know, I suggest not to calorie restrict, but if you’re naturally insulin sensitive, if you’ve done a fasted test and you can get down to four or lower, go for it. Calorie restrict. Yeah, give it a go. 

I think there are so many other things to consider before you do that. So yes, if you know in your heart of hearts that you’re eating too much, and I don’t like to really pinpoint it as calories, but you’re just taking in too much energy. If you know you’re have a tendency to over do with certain kinds of foods, you eat too much of them. I know I do. So if you know that you’re taking it, you can calorie restrict in the sense that you can reduce your intake a bit. May be by limiting the things that you know you have a tendency to overeat. But going past that, no, there’s more likely going to be something else that’s going on. Yeah. And like you say, once you start reducing your calories too much, then you’ll start seeing other things that happen. And that’s that certainly something that happened with me and it’s so typical in the weight loss surgery community that they should actually say you are going to suffer significant hair loss between months three to six and then it should start coming back month six to nine. But it’s so typical. But it interesting actually that it seems very typical in the keto community. Now. Do you think that that’s just a byproduct of natural calorie restriction because people often tend to end up eating fewer calories when they’re eating ketogenically because their appetite goes down? Or do you think there’s another mechanism going on there too? 

There’s a lot of chicken and egg issues here. One of the things that will signify your body to make cost savings and those cost savings will cause your body to stop growing here. Telogen effluvium where all the hair that is probably going to fall out over the next year decides all to do it in one week. Um, you know, all the follicles. So, uh, all of those things happen when you have an energy shock. Now when you first go ketogenic, you are not fat adapted, but you’re not giving you body carbohydrates. So you are actually giving it a shock. You’re actually giving it not enough energy. So it has to adapt. 

Oh, right. So it’s not so much about the calories, it’s just the shock to switching that fuel source. 

Yeah. It doesn’t happen to everybody. Some people are able to, some people are more adaptable. 

It does seem to happen a lot. 

Yeah. But if it doesn’t happen to you when you first go here to check then you know, seven, eight, nine months down the road when you hit your plateau and then you decide, well, I’m gonna reduce my food intake because you know, I’ve been increasing my food intake as I got closer to my plateau, which is, this is Steven Finney’s argument. This is his four charts. This is what he’s saying. As you get closer to your ultimate plateau, you start to eat more calories spontaneously and he’s explaining how the homeostasis works to alight you on that plateau. If you then decide, “Oh well, I mean obviously eating too much, I’m going to eat less” and then you eat less and now you have an energy deficit. If you didn’t lose hair in the first days of Keto, that’s when you’re going to lose, a lot of hair and you know, your fingertips will be cold. And you know, I’ve heard of people with toenails and fingernails falling out and all sorts of uh, lack of energy. It’s just, you know, and then fertility cost savings, women stop their menstruation and men lose their sex drive. And you know, there’s all these kinds of things that happen when your body is in an energy deficit in an emergency. essentially it’s a three alarm emergency. 

And you talked about eating to satiety and you seem to have that dialed in very well. And it’s something that I struggle with and I know a lot of people do and I think that’s where you potentially have to start looking at restriction, but not really restriction of calories, but restriction of certain food types. Because as soon as I dial in a stricter diet, which is not an, I’ve counted the calories, it is not low on calories at all. But when I stick very much, probably cut out things like dairy, things like nuts, nut flours, treat type things with sweeteners in if I eat very basically, and really nice and high fat, just protein and simple vegetables and lots of fat. I do find my appetite comes down a little bit, but those calories are up there. I doubt I come in at less than 2000 today, but yet my weight will start coming down. So it is sometimes, I think, about being a little bit restrictive but not actually with the calories actually about different foods. 

Totally agree. We can be mindlessly eating food that has a little bit of carbohydrates in it and if we eat too much of it, we could be any more carbohydrates than we really know about. And so that’s why if you’re in that state and you want to work out what’s happening, it’s always a good idea to start a food diary so that you’re mindfully eating and that way you keeping track of things. But you know, we tend to sort of fall into this trap as humans of trying to find magical molecules or in terms of pills. He’s a magical molecules or magical foods that you can eat as much of and not gain weight. You know, celery has negative calories, you burn more calories chewing. So people eat. It’s horrible stuff, you know. But we tend to get into this situation where we think, Oh, you know, they must be good foods and bad foods. 

They must be magical foods that have a high satiety and must be foods that have a low satiety. One of the things that has the highest satiety is just getting enough fat. Energy. It’s highly satiating. Or ketones exogenous, ketones are extremely satiating. And the reason why is because we have energy at the cellular level, so we’re not energy deprived at the cellular level because ketones, we can get energy from no matter what our insulin status is. Another example is when I wake up and I’ve been fasting three days, I am satiated like nothing else. Waking up, eating nothing, you know? So where does nothing sit on the satiation index of satiating foods? Nothing is the most satiating, one of the most satiety foods that I’ve ever had. But it’s all in context. I mean, satiation is not an emergent property of food. It’s an emergent property of humans in a particular context. And this context is having adequate energy at a cellular level. 

And fat just gets picked on because it’s so much more calorie dense. You know, it’s more than twice just a bit more than twice the calories of the equal amount of carbohydrates or protein isn’t it? So it always gets picked on and you will see in certain groups, well, you know, you need to start reducing your fat, you know, don’t eat fat bombs and don’t put fat in your coffee. And things like that. And to a certain extent, I do agree with that, but not for the same reason. I don’t agree with reducing it because of the caloric content. It goes back to the food group things. It goes back to making it a little less palatable when you make it really palatable by adding sweetener to fat and making fat bombs and flavors and things like that. So it basically becomes sweets that are just delicious that you can pop for ages if you just give somebody a lump of butter. And also actually to a certain extent, putting it in a drink, it goes down in a different way. 

Yeah. Liquid calories have a different mechanism for satiation. 

Yeah,exactly. But eating fat when it’s attached to a pork chop or you know, eating lumps of butter, you literally can’t do, it’s not that palatable is it? I mean it’s delicious, but it’s not palatable in the same way as when you’ve turned it into a sweet. 

You’d be surprised there’s, there’s a lot of people on the internet who think that there’s a whole bunch of people out there drinking pure butter. 

Yeah. It’s actually, we’re literally putting these sticks of butter in the coffee. I love that meme that has a stick of butter, literally sticking out of a cup of coffee. And the first thing that I think when I look at that, well that’s not a hot cup of coffee. 

Yeah, exactly. I like adding butter to vegetables. I follow Sara Halberg’s principle of never eating vegetables without some fat. 

It’s making them palatable. 

Yeah. But you know, I don’t need a lot of butter. Although I did have Hollandaise today. I made myself some protein, bread company pancakes and I made little pikelets. So pikelets are about sort of like English muffin size. 

Yeah, they’re like squished crumpets, aren’t they pikelets? 

Exactly. And I had two of them for dinner. One had ham, a poached egg and Hollandaise. That was an eggs Benny and the other one had spinach and salmon, poached salmon and a poached egg and Hollandaise as well. So that was an eggs Florentine 

Nice. What’s it called when there’s salmon’s  on it, it’s not a royale or something?  

Eggs Florentine. Oh, might be Royale. Yeah. Cause it’s spinach…

When the salmon’s on there. Florentine is the spinach but I’m not sure what it is. When it’s the salmon. I do eat a lot of butter, I have to say. I do eat a lot of butter. I love it. In my scrambled eggs, I slather it on vegetables. But um, yes, it’s all about the context for me. It’s what you’re mixing it with. Absolutely. Obviously intrigued. Actually I will let you go in a minute. That lupin flour and I’ve been reading about this and trying to find out what the carb content of things is quite big in Australia, isn’t it? Yes. It’s one of these new emergent low carb flours. 

Lupin is a legume like peanuts. It’s closely right here to peanuts. And so people who have peanut allergies can often have allergies to Lupin. But Lupin is aflower that’s used in the protein bread pancakes I was talking about. And there are three varieties is a European variety that’s been the French variety that’s been eaten for thousands of years. And there’s a South American variety as well. And then there’s Australian variety of sweet Lupin doesn’t actually have sugar in it. It’s just called sweet because of the flowers. The Australian variety is slightly less allergenic. Australia has really high peanut allergies. We have more peanut allergies amongst kids than almost anyone anywhere in the world yet.  You know, we have very high rates of asthma and a lot of these, autoimmune diseases, but Lupin is a less allergenic than South American and European versions. But, somebody I just posted on Facebook a nice breakfast, so I had, and I got called to task about promoting lupuin. That’s one of the reasons why I don’t want to be a Keto dude anymore because I was just having breakfast. You know, I wasn’t promoting Lupin and I don’t have a problem myself with allergies. And so, you know, anyway, it was a delicious breakfast. 

It’s reminded me, actually, I do have a jar. It cropped up in Lidl, it was Spanish week, so presumably they’re Spanish lupins, but not the flour but the actual lupins in a jar. I used to love tuna and butter bean salad. And so I’m envisaging making a similar thing with these lupin beans because they do seem to be very low in carbs. And I don’t know what they taste like. They might taste disgusting, but I must crack open the jar and see what they’re like. 

So I uh, I’m in the process of making some ham stock from the ham we had over from Christmas and I’m going to use French blue lentils with that to make a ham and split pea soup using French lentils.

French blue lentils. What so not green lentils then what are blue lentils? 

I don’t know. They’re just the lowest calorie legume that I can find. 

Interesting. 

They’re not quite low in uh, actually not low in calories,  but low in carbohydrates. 

Oh, I’d be interested to know. I’ve never heard of them considering I’m in France. Ah, probably lentils are the things that normally crop up, but uh, blue lentils. Right. I should be straight on Google now cause I do like to have those things occasionally. They’re the kind of things, before I started keto, when I was more moderate carb, I would have a few things like quinoa and lentils and things like that. I do potentially like to have them occasionally. 

[I have just asked Google and there appears to be no such thing as French blue lentils. French lentils are what I think of as Puy lentils. They are indeed relatively low in carbs and stay nice and firm when cooked. They are very popular in France and you can usually buy Pet lentil salads in the supermarket which is basically lentils cooked with some onion and maybe garlic, bacon, stock, etc.]

Right. Well, thank you very much. Fabulous having, this extra bit. 

You’re welcome. Daisy. It’s a pleasure, as always.

This transcript is brought to you thanks to the hard work of April Ihly.

Welcome back Annette, to another ask Dr Boz where we will get to the ask Dr Boz question from the get go. 

Absolutely. I’m so happy to be back. Thanks for having me back. We will tackle questions. We will not tangent onto a Dr Boz-Daisy duo. 

Well don’t make promises you can’t keep because I’m sure we will end up going off on tangents, but we’ll try and keep on track at least to start with. 

Perfect. 

Okay. Shuffling my papers. So this is back to April where we started last time with the story of getting some help for her mum who has early onset Alzheimer’s and that was a really good development and that’s happening now. She’s getting them and by all accounts it’s a good thing and it’s helping. But April’s questions, she has a few. “Can a small fatty umbilical hernia self-repair on Keto. I feel like mine has improved since I started.”

Okay, let’s talk about umbilical hernia. So again, a hernia is an opening or a defect in the lining of a space in your body. So we’ll use the word inguinal hernias. And those are mostly associated with males. You can have an inguinal hernia as a female, but it’s much more rare and you can have an umbilical hernia. The inguinal hernia is the space where the testes actually left the abdominal cavity and go into the the genitals during birth. And if that lining gets too much pressure, it will pop open a connection between the scrotum and the abdominal wall. And I use that as an example to explain what happens with umbilical hernia because it’s much easier for people to visualize these two spaces having a connection. 

When it comes to umbilical hernia, you’re supposed to have a seal all the way around the inside of your abdomen. When you were in your mother’s womb, you were getting your nutrients and food through this vein and artery combination through your belly button. That cord got sealed and was supposed to completely adhese and scar off any opening. But if your tummy got big, if you have a weight problem, and you can even see this in little babies, if they have those cute little full tummies. If the scarring didn’t happen at the time of birth, you’ll see that the edge never could find its partner to seal. In their umbilical hernias, we worry only if the tissue comes through that opening and get stuck. So it’s actually safer to have a large umbilical hernia as opposed to a small one. A small one, if the tissue kind of pops through this little tear or this lack of adhesing, of sealing, and then the tissue on the other side gets kind of irritated and happens to swell too big to pull back into the tummy, that’s when you have a problem. 

I’m a big proponent of the less surgeries you have in life, the better you’ve done. So when I look at the need for an umbilical hernia, if you’re a swimsuit model, we can help you. If your hernia is stuck, it’s super painful, like it’s going to cause gangrene and die, it’s going to be an emergency, so it’s not like, oh, it’s a little tender. Nope, it got stuck as the tissue left the abdomen and got stuck on the other side of that opening. So when we look at can an umbilical hernia improve or repair, let’s just unpack that a little bit further. As the mass inside your abdomen gets less with the weight loss associated with the Ketogenic Diet, you’ll see that the pressure pushing through that little opening is now much less and the hernia will kind of retract back into the abdomen.

Will the scar ever seal shut? 

No. That time it’s torn. There’s nothing stimulating it to connect back together. But is it an emergency? Should you have to go under the anesthesia to get your umbilical hernia repaired? For your brain’s sake, I would say no way. I mean, every time, especially a patient with high inflammation, so if you’ve had an overweight tummy enough to cause an umbilical hernia, if you’ve been struggling with high insulin states of Metabolic Syndrome or God forbid, full diabetes, your brain doesn’t need any help with destroying or putting stress on those brain cells. Anesthesia, every time we do it, you have a cognitive hit. I don’t care what age you are, but if you’re inflamed, if you have high inflammation in your system, the cognitive hit is higher. So I would not sacrifice brain cells to repair an umbilical hernia unless your whole income comes from being a swimsuit model and you need that little bulge to not be there. That’s how I would answer that question. 

So yes, basically, yes, it’s not ever going to repair, but it’s going to get significantly better. 

Right. Good answer. Way To summarize what I just rambled on about. 

Okay. Another problem she has, although by all accounts from her update, it has got better. But I think this is an interesting one and this is a question I see from other people, so I do think it would be interesting to address it. When I fast, I feel great and the longest was 40 hours. The problem is that I feel awful when I start eating again. I’ve been slowly incorporating foods back in after a fast that no matter how slow or what foods I try, I always feel horrible for days. It’s only when I start eating again and not while I’m fasting. I want and need to fast, but I’m developing a fear of eating again afterwards. What might be causing this? And I know from my own experience, I don’t have as much of a problem as that, but certainly when I start eating again, I how should we put this politely? Have to run to the bathroom? And that always happens with me always when I start eating again and it’s something I know that’s going to happen, so obviously I plan for it, but this, I can see how this going on would just become a self fulfilling prophecy, if nothing else. But I have heard many other people saying the same thing. The fast is great. It’s when they start eating again that they have problems. 

There’s a few things, I’ve seen this multiple times as well, and here’s the advice I give folks. First of all, I would start with, as you look at a GI system that’s been shut down, which is what happens during fasting, it really slows down the movement, the gas, all of the secretions are much slower. You’re going to restart it when you start eating again. And the first wave usually does end up with an urge to go to the bathroom. One of the better ways to do that is to make sure that that first bit of food is high salt and warmth. So I recommend leading that first moment of breaking a fast with warm, salty broth. That nutrients is great, the salt is great, it tastes really good. And that kind of leading syndrome of there’s a lot of bone broth that does really does get absorbed before it ever gets to that large intestine. 

So you can see, even though the wave of peristalsis starts to send the wave down the gut, it’s much less if they lead with that. Second of all, you can talk to many of the people who’ve had gastric surgery for weight loss that they will have, I wouldn’t call it a full dumping syndrome where it’s a lot of diarrhea, but I would call it like a high like reflexive trigger for their peristalsis when they start to eat again. And I haven’t seen anybody successfully train out of that. So you’ve cut the nerves when you did that surgery and there’s a part in there that’s going to have this high almost reflex. And when you start eating, when you’re eating all the time, the reflex gets worn out and it’s not, you don’t have the diarrhea, but when you’ve had a pause and then you restart it, the wave goes from top to bottom and they end up at the toilet. 

That may fit to some people, but that, uh, is not uncommon. The third thing that I’ve seen that’s really important when thinking about what do you do to break a fast is consider whether or not what you’re eating is something you’re allergic to. And specifically, I point out lectins, I didn’t even know what lectins were before before the ketogenic diet, but you know, from bell peppers to peanuts to even jalapenos have some lectins in them. If what you’re eating are these wonderful ketogenic foods, but they are high in lectins, I have been amazed at how many of my patients when they cut out lectins, and really they did carnivore for about a month, so almost no vegetables, no peanuts, said my diarrhea went away. And so what I’ve reverse engineered is to say it is essentially an intolerance for lectins. And many of my celiac patients or gluten intolerance, even if they’re not full celiac, really have an insensitivity to when they consume a lectin, they get very loose stools and they get more of a spasm in their gut and they do a beautiful kind of movement and absorption process. 

And then the fourth one is what I do, which is when I’m done fasting, I feel the need to celebrate. So I will eat too much. And even though I’ve gotten a lot better at it, it probably took me like 50 times fasting to say you do not deserve a celebration. It is not that big of a deal. You are going to be fine. So the amount of food at first, try not to celebrate after a fast. And again, this is a goal, so keep working towards it. But if you celebrate with fasting, by eating a large volume of food, you’re going to pay the price. Your gut is just not goingto handle that as well. 

Yeah. Interestingly, I find it a good way to reset my satiety signals a bit, actually. I’m the opposite. I can’t eat much. The first meal I have is always a lot smaller than I would normally have, so I go the other way. But yeah, I know for some people the temptation is to eat all the things. 

If you’ve ever done one that’s been like four or five days, that’s the ones where I really mess it up and like I’ve only done that a few times. Usually I do a 48 hour, maybe a 72 hour, but 36, 48 are much more normal in my life and I’ve don’t have as much celebration. But boy, the times where I’ve pushed it, you’d think it was like a wedding or something.

It’s funny how our brains have to compensate. Yes. Okay. This is the big one, really. This is the main one. “I’ve around 200 pounds to lose. I’ve had some great non-scale victories, but Ihave lost no weight at all.” That’s got to be really frustrating, right? If you’ve got all this weight to lose when you’re over a certain size, that’s the assumption that you think that the weight is gonna drop off fairly quickly. At least to start with. “I’m not in it just for the weight loss and while my inflammation is down, it’s still really bad. I’m under 20 grams of carbs a day, at least 95% of the time and always under 30. I know I need to be patient and stay the course, but what are some potential reasons why I’m not losing the swelling and inflammation?” And I’m going to go on with along update now. 

That was her original question. I’ve pulled these questions from a list we had way back when we did the first ask Dr Boz and so I got an update from April to see where she’s at now. “My main question is why are my blood sugars still so high and why am I not losing the inflammation and weight, although that’s not my entire focus, after being Keto for so long?” Because of course she’s now, she’s been doing it for quite awhile. “I’m 46, menopausal and have severe sleep apnea and use a CPAP machine every night. I average about seven hours a night during the week on the weekends I often end up sleeping 10 or 12 hours to make up for what I’ve missed during the week. I don’t set an alarm. I just naturally sleep longer. I know I need more sleep during the week, but I always wake up around seven hours. 

There’s been a lot of stress in my family over the last two years. There hasn’t really been a break between incidents. My dad passed away three days before Christmas in 2016 from stage four renal failure, liver failure and diabetes. His heart gave out. My mom had not yet been diagnosed with Alzheimer’s but could barely take care of herself, so my sisters and I took that on. It was a huge source of contention for awhilewhile we figured out how to move forward. In the meantime, one of the family members was getting more and more toxic and dealing with them became an unavoidable nightmare. I’ve done what I can to remove them from my life, but they keep dragging out things that I have to be involved in, so I’m not completely free from that obligation. Mum was recently moved into a care facility. It’s a good one, but there are still stresses in dealing with that. 

Work isn’t really stressful, but there are times when it is. I’m also switching careers, so I’m dealing with learning a completely new career while still doing my current job. I started Keto in April, 2017 or what I thought was Keto. I think it was more low carb than Keto. I was told eat low carb and low fat because I had a lot of fat on my body. I started real Keto in June, 2018 after finding and devouring all the 2 Keto Dudes episodes. I had a relapse over the holidays. I was depressed because I had hardly lost any inflammation. My blood sugars were still ridiculously high and of course I hadn’t lost a single pound. I recommitted in January this year and purchased a ketone glucose meter to start tracking. I attempted fasting but my body didn’t respond well after the fast when I started eating again. Eventually I got over that and was able to fast without too many side effects. 

I tried to get the optimal Dr Boz ratio, but even after fasting for 69 hours, I was still way off. I went mostly carnivore in February. Still couldn’t hit the ratio. Ketonesrarely went over 0.5, they were at 0.1 or 0.2 most of the time and blood sugar still in the high one nineties regardless of how long I fasted or what I ate or the time of day. Recently I started an experiment. I eat only beef, usually ground beef or steak, butter, salt and water. I got a host of labs done beforehand, fasted. Waiting for the results to come in. My insulin a couple of weeks ago was 19.2 which is in range, thankfully. I plan to do labs periodically to compare. So far this seems to be helping as I’ve lost eight pounds in 12 days and my GKI is slowly improving.” She believes that cortisol is to blame, at least in part for her constantly high blood sugars. 

“I get a 40 to 50 point spike in the morning around two hours after I wake up and take my first reading. The result is the same whether I’m just driving to work or laying around the house relaxing.” She does tend to eat late in the evenings, but she’s tied to that because of her work schedule, sometimes doesn’t eat before 9:00 PM. She knows this is detrimental, but she doesn’t believe it’s the only cause, but she is trying to make changes so that she can eat a bit earlier. So that’s a long update, but quite a bit of information in there that I thought might be useful. 

Right. I took notes, so I was trying to keep track of what my thought processes were. So you can tell she’s watched some of the videos on my channel because she knows about checking those blood sugars with the blood ketones. She’s clearly making ketones, which is powerful to just reassure this is a better metabolism than she’s been at. And then to know that there’s a 200 pound excess mass on her body. To hear the words, I have sugars in the one nineties after multiple hours of fasting and when I checked my blood tests and I only had an insulin of 19 as I was fasted, which is in this normal range, I would actually tell her that she has undiagnosed diabetes. So whether she knows that or not, I don’t know if that’s part of the journey. I didn’t hear that in her presentation. But when your body has diabetes, it has, the efficiency for processing the glucose is broken, which is what causes the brain to deteriorate, the heart to deteriorate and the scramble inside the body to find a place for glucose. That when you have a blood sugar of 190 and your body’s only producing that lower amount of insulin, that is a mismatch. The insulin should have been higher in her case. You’ll say, but doc, the range of say, you know, if you can get it below five, you’re doing great, so 19 isn’t awful. Like those are with normal blood sugars. You should have produced more insulin to put away that sugar to get it out of the bloodstream, because that sugar is what is inflaming your system. It is what it is aging your blood vessels in your brain. So when I look at what would I do in a case like this, I would look at an A1c. 

I bet you it’s, she’s not making enough insulin anymore. Her cells for producing insulin have either fatigued or just cannot produce enough insulin for the mass of her body. So what do you do? She’s doing a lot of things right, like to reset and to encourage her, is her metabolism really is the key to fixing this. Running her body’s metabolism on a fat-based platform as opposed to a glucose based platform, she’s heading there. Looking at weight loss in a diabetic, it’s difficult. That is almost the taboo. We say you can’t lose weight. You’re a diabetic. Now, that’s not true. But it’s so hard when they do not understand their own glucose ketone ratios, that without monitoring that you will be so frustrated. You will think I’m doing everything right. I’m doing all the rules correctly. I can’t fix the problem. I can’t lose weight. I don’t know if you’ve watched any of the videos I’ve done, but there’s a type one diabetic that I followed on my show and again, so she doesn’t make any insulin and she comes with an average sugar around 300 at the beginning of this journey. 

Now her sugars are around 100, 110, but if she fasts, which she’s done the last couple of months now, it’s the only time she’s been able to lose weight and she’s like, why is it that when I fast, I can do that? Number one, we cut her insulin in half because we don’t want her blood sugar to drop too low. But number two, the ability when you lower insulin, especially if you’ve been given the same dose everyday, everyday, boom, you drop it down, you now give permission for those fat cells to open up and release their stored energy. You’ll say, well, you know, why can, you know, what is it about producing a ketone that has to do with insulin? The state your insulin is at is goingto be pretty stable. Yes, it goes up and down when you eat, but the average number is going to be plus or minus 10 and your pancreas will keep that level at that certain range until a sudden drop in food or a rise in energy demands happen. 

When the sugars change, the insulin can change and that drop in insulin allows your fat cells to provide the ketones, to provide the source of, you’re trying to lose weight, the weight comes from emptying a fat cell. You cannot empty a fat cell when the insulin stayed the same. You have to drop the insulin. So in a type one diabetic, we dropped the insulin during her fast and she’s able to lose weight. Well, doc why don’t you just drop her insulin the whole time? Because her sugars would be too high. It’s a very difficult thing to navigate to help her with the weight loss and then keep lowering the insulin steadily over time to match what her glucoses are. In a case like what you’ve described, the first thing I would start with is, there’s a drug called metformin and it’s out there. 

If you’ve been in the Keto world awhile, you’ll hear that it’s gonna have some impact on mTOR and cancer prevention and longevity, but it’s a diabetic medication. That’s what it was first put on the market for and it’s not insulin, but it does improve the efficiency of taking sugar from the blood and putting it inside the cells. So in a case like this where she’s doing all these things right, I would augment her body’s ability to do that with a prescription of metformin. I sometimes use that in people who say, I just want to help the sugars be better controlled. And even if they make plenty of insulin and they’re not, metformin, it doesn’t hurt you, doesn’t lower your blood sugars too much. It just gets them from the bloodstream inside a cell easier. And that’s really where she’s struggling. 

The next thing I would consider is really getting her a continuous glucose monitor for a two week experiment because it would be very powerful to see what is the range of her sugars. And if the sugars are all hanging out between 150 and 200 or 150 and 250, you’ve got to get on board with an internal medicine or primary care family practice doctor to address the lowering of the sugars with added insulin. And that’s gonna sound like the enemy at first. But trust me, you gotto control the sugars in order for the inflammation to be better. If she was trying to avoid that, avoid being an insulin dependent, and this would be a type two diabetic even though it’s from fatigue of insulin production that we’re kind of stuck with here. We look at matching her cortisol. I mean that is incredible amount of stress. 

Her stress level is powerfully overriding the production of releasing glycogen, releasing sugar from storage. So that’s part of where all of this sugar stuff has come from. So what I would say is she knows what I’m going to say cause she said, I already tried this. I know I’m doing this wrong. So especially women over 40 and I do this because I get a ton of messages from them saying, Dr Boz, I’m at a stall, I can’t lose weight. And you know that woman over 40 I’ll say, allright, you see what time the sun comes up, you have eight hours to eat. And it’s because that sun comes up and your brain sends a signal to release cortisol, which tells the liver, give me some of that stored sugar called glycogen. And your sugars go up and the energy in your body rises while you’re asleep and that’s what wakes you up in the morning. 

You will have a churn of extra cortisol for the next six to seven hours after that. So we say sunrise plus eight hours is your eating window. Even if you say, but I don’t eat in the morning, I fast. I’m like, yeah, but you didn’t tell your brain and your liver that, you didn’t tell the sun that. And so keeping the calories low during that time is a great way to burn those sugars. Have black coffee, continue to fast during that time, but set the timer to say, I need your big meal to be before that eight hours is up. What she needs, she’s like, well I can’t do that with my work. I’m like, get a doctor’s note. Find a way that you’re not eating after that. Because what’s happening is even if she’s eating the most ketogenic meal, she is still producing cortisol every time she eats. 

And like, what? Like she’s in a high stress state so she is churning another wave of cortisol by eating, you know like, okay, so I need only one wave a day. We can’t stop the sun from coming up. So that’s goingto be the one wave of cortisol we use and as that wave takes its time and goes up and down by the end of that eight hours. That’s why I like them eating in the middle of the afternoon, that two to three o’clock when they’re stuck with a stall, I need them to eat. I need them to have high fat. I need them to eat to satiety. They’re fully satiated and then I need them to have none after that. That is difficult. It is a social time to eat. It is a very challenging goal. So to wake up tomorrow and ask her to do this is kind of unlikely, but if we say, all right girl, wegotto back it off the edge. 

You’re going to start with, thereis no food after seven o’clock at night. Even if you work the night shift, I need you to respect that. You gotto find a way to get the food in before seven o’clock. If you don’t, find a way to fast until the next morning. My husband teases me because I tell him when he wants to eat late at night, honey, your clock will reset and he uses this against me whenever I want to do that late at night, your clock will reset, but it will. If you can push through that wave of hunger after that seven o’clock hour and once you’ve mastered seven o’clock, then we’re going to back you to six o’clock and we’re going to keep going back until you can get your eating to be within the eight hours after sunrise and you will reverse the problem. 

You will start using energy as fat cells. You see it already in the times where you’ve successfully fasted and I would contend that that has been your lifesaver. I mean that by you’re not, I mean to have the body mass that, that you’ve struggled with and then to see that your sugars have been in the 190 long enough that we have some sort of insulin production fatigue, like the insulin is not meeting the demands of your body. It says the algorithm is advanced. We are at the later stages of a diabetic journey. We can help with Metformin, but nothing will be as powerful as her honing in the hours that she eats. Fasting is one of those way`s she can do that, but putting the food to match the sun is going to be super important. 

Yeah. As you’re speaking, I’m trying to think of a practical way that she’s going to be able to do this. She obviously has this problem. I think she finishes work maybe around seven. This is why by the time she’s got home, yeah, and even prepared something quickly, it’s difficult, but I’m thinking so, okay, so what is the solution here? Obviously weekends, no problem. Can follow a plan at the weekends where you’re saying, so really all her food needs to be in before, what, three, four o’clock in the afternoon? 

That would be amazing. But again, if you start her there, that could be too heavy of a goal. 

Yeah, absolutely. And I get what you’re saying about moving it back. All I’m thinking is that during the week that’s not goingto be possible, even from that 7:00 PM. But what I’m thinking is maybe, especially if she could incorporate some fasting days during the week, that obviously completely solves the problem, but also potentially being open to maybe going for the breakfast and lunch option. I think it might be difficult to have much of a meal at work, so maybe the big meal being the breakfast. I don’t know, I mean it’s a real massive change isn’t it? It’s a big jump to go from one thing to the other, but maybe.

Here’s a couple things I’ve done, because I’ve actually had this same scenario in my clinic where I’ve said, all right, let’s fail upwards. Let’s improve upwards. 

I’m thinking of that push back. I’m sort of sitting in her position saying, well, I don’t get home, I don’t leave work until seven how am I supposed to eat my meals before seven you know, what can I do? 

So, right. Yeah. Planning and having that break at work to eat your meal at work those are great ideas and they could work, but it is a different approach. What I would contend was if she gets to 7:00 PM and she just cannot imagine not eating, I would encourage her to do exogenous ketones. I would make a shake of ice and ketones and sip on that. It is fuel. It will enhance her metabolism. It is not sugar that goes in with, I mean she’s got plenty of sugar happening. That’s the problem actually. She’s got really high sugars. So when we fail upwards, if we add ketones to her situation and say, okay, we want you not eating anything at all, but if you’re goingto put something in, we’re going to add something that over the next couple of days you will have a stronger metabolism because you put more ketones in to burn for your metabolic health than you wouldhave had, had you, I mean, even if she wouldhave fasted, her ketones will still be at a lower level until she gets that metabolism rising. So when I say fail upwards, it’s not perfect. I would love a whole script and put her into like a, you know, calculate what she should do and follow the rules specifically. But when the enemy is us, you say, allright, what could she do that would feel good to her? And you know, those exogenous ketones, mix them with a little cream if she needs to have, you know, some fat with it. If it happens to be MCT, it’s even better. So now she’s got two ways her body’s adding ketones. It’s going to be the energy or the fuel she needs and it will become this mindset that says, if I want to eat, I have to do that before seven o’clock. 

Or the only option I have left on the table is to add ketones without food. And that has worked amazing. Like I have two people. I’m thinking in mind that it did improve. It took about three weeks for them to say I figured it out, but I only figured it out because I did it with that messy version where I couldn’t not eat, I wasn’t strong enough to fast, but I put in ketones and by about the fifth day they start thinking in a different way. They start strategizing and the next choice was better and the next choice was better. Now they don’t do those exogenous ketones at all, but for bridging that, it really did help her. The two I’m thinking about saying, oh look at that. You got home from work, you did not carb crave. You did not even like ketoglutton, you know like they’re, everything I eat is Keto, doc.And like I know, but you’re putting in so much mass, I can’t get to tap into the stored fat cells that you’re trying to lose for weight. And if you want to do that, we have to shift the metabolism. So fail upwards and that will shift it. 

Yes, because ultimately like you’re saying, if you’re goingto ride that cortisol wave and eat while you can, and if the only time you can eat at home and have that meal is breakfast, ultimately that’s going to be your goal is fasting and breakfast during the week with meals into the afternoon at the weekends. But you’re right, it’s just that massive jump. But if you can bridge that gap and then get to a place where you’re doing something that works, even if you thought it couldn’t work into your schedule, but if it’s goingto get you where you want to go. You know, this is a big problem that she’s got to solve, isn’t it? 

And it’s not uncommon. 

There’s only so many ways to do it. 

It’s a great question because she’s doing everything right. She’s invested to understand her own body chemistry and she can see that there’s a problem. She has sugars in the 190 range. That’s diabetes. There is a break in metabolism. If I could get a reign on this, if she could get the numbers down, if I could get her to fast for a month, okay then we’d be fine, but that doesn’t fit life. Look at all the stress she’s had. Look at the lack of sleep. You know her support system is obviously good enough to do as much as she’s doing. So asking her to be the perfect results. That’s ridiculous. There’s no chance for longterm success by saying, oh honey, if you just fast for the next 40 days, you’re going to be fine. 

She can stay off of insulin longterm, if we can shift her metabolism to a higher ketone base and essentially what she’s going to be doing is we want her using the calories stored in those fat cells so it will become a lower calorie ketogenic diet is what will, because she’s already keto adapted. As long as we can keep the ketones burning, the size of her meals will get smaller and those are conscious choices, but also subconscious because she feels good. That does play a part. I don’t usually talk about a calorie restricted ketogenic diet unless I’m talking with seizure patients, cancer patients, or in a situation like this where I really need a metabolic boost in her system to keep her off of injectable insulin. So pushing to bridge that eat during the cortisol phase and once you kind of find the rhythm that you’re now eating in that eight hours after sunrise, that’s when we would talk about now we want your meal sizes to be smaller. And the reason why is I need to tap into the calories you’ve stored as fat. That’s how get the weight loss gone. That’s how your insulin needs will be less when your body mass is less. It’s a three step process here. 

Well, hopefully she can see a way through this and start seeing a change because I really feel for her. I’ve seen how hard she works and as you’ve seen, you know, she’s a smart cookie. She’s worked out a lot of these things for herself. She knows where the issues are and she works really, really hard at it, you know, and is prepared to be very restrictive in what she eats to work really hard to do the work with the tracking and all sorts of things. And it’s just must be so, so frustrating. I really do feel for her. 

Well, I do hope she’s got a support system of people encouraging her because that, I mean, had she not taken on Keto in the last chapter, she wouldhave been in an ICU somewhere with a completely failed pancreas. So she needs to know that the choices she made to make this shift have been life altering even though she can’t see the disaster that would’ve happened. I’m certain of it. 

That’s very true actually. Yes. That’s a very good perspective, is to actually see what feels like such small steps forward as actually really massive leaps. 

From where it shouldhave been, right, where she was headed. 

Right. Okay, so this is another one that’s in the ballpark of where we’ve been talking and I know is something that you’re really passionate about and that’s brain injuries. This is from Sarah. Sounds like they’ve been a bit unlucky in their family. “I have so enjoyed your episodes with Dr Boz. With her experience with brain injury, it would be helpful for me and my family if she could address concussions and how Keto helps them to heal. I have had at least two in my life. My son had a serious concussion a few years ago when he was 16 and now my daughter also. She has just turned 16. They are both soccer players. I watched the brains of addiction video you posted. Thank you. Does a concussion leave defects in the brain such as the ones in the pictures you showed? Does Keto help heal these holes over time?” 

I love this question. I do this workshop called Brains of Addiction: From Trauma to Repair. And the foundation of that format is an 8 to 10 hour course, which sounds like a lot, but people are so hungry for this exact question. And it may at first sound like I’m goingto talk a lot about addiction, but I really spend time talking about the traumatic injuries to our brain and what we know about healing them. There are many parallels to addiction, but her kids at 16 and 16 having concussions, she is near and dear to my heart for, for being passionate about, how I think of the job as moms is, it’s my job to develop your brain to the highest level and make sure you’re not in my basement at 30. And I think of that as what is the, what are the foundational rules for brains and repairing them, as you guide your teenagers through these injuries. 

Because when they have a concussion, there is very good evidence you can see on those videos that I’ve talked about, that the brain no longer conducts messages through the sections that are swollen or concussed and as long as that swelling repairs and completely goes away, you can see that brain awaken. But if you want the biggest enemy for a concussed brain, there are two that are so common in our teenagers today. Number one, they have an unstable bedtime and it’s too late. They are pushing their brains to be awake too late. They are stimulating their brains with screens for at least two hours before going to bed, and the depth of sleep needed to repair the brain, specifically making something called BDNF, brain-derived neurotrophic factor. That protein is what repairs our brains. And if you’re not getting that good teenage 10 hours of sleep, especially after an injury, you are inhibiting the brain’s ability to repair.

Because they’re forced to get up early as well, aren’tthey? I’ve heard people talking about this, we should really be starting teenagers at school much later. 

I would actually say that it, shifting that to an earlier bedtime is just as easy for our society to do and actually probably plays forward in the neural programming better than starting their school day later. I say this as a mom of teenagers where it would be perfectly easy for me to have them start later, but I’m saying I want their brains to play forward with the best neuro programming and that really does say getting their head to bed earlier, showing them the respect needed for repair of a brain. But the other major enemy out there is sugar. And when watching a teenager’s brain go up and down in sugar production, unbelievable how damaging that is for a scar that’s already swollen in their brain. 

In that brains of addiction video, you’ll see a picture of a diabetic and that diabetic hasn’t, doesn’t have an alcohol problem, they don’t have a drug problem, they haven’t had concussions, that is simply from their diabetes. And it is the swelling that happens in their brain and stops the conduction of messages going through because of the repeated swelling from high blood sugars. So to get that concussed brain to repair, pushing their brain to use ketones over glucose, very important. Number two, bedtimesof the whole family. If you want a teenager to do something, telling them to do it without doing it yourself, good luck. So now you have 16 year old brain injured teenagers who are going to be moody and irritable because that’s the journey they’re in. But I would contend that their moodiness and irritability grow worse every time you stop the maturation or the maturing process of their brain, which happens with a concussion. 

But it also happens when they have poor sleep, when they have excessive sugars go up and down. My youngest son is a wrestler and between him or his buddies, whenever they have concussed brains, I’ve had consults in the homes of his friends saying, all right family, I know this is hard, but all screens need to be off by seven o’clock at night. If you have something you need to watch, you can put it off till tomorrow. No screens in the bedroom. Everybody’s phone goes in the basket at seven o’clock. 

Wow. That is hard. 

What is powerful though is, and some of them did the Ketogenic Diet. Others supplemented the ketones to get the family onboard and then has actually graduated to a very sustainable ketogenic lifestyle for that family. But it wasn’t easy at the beginning. And that commitment to say, when you see the suffering that happens longterm with concussions, it’s powerful how many brains don’t return to normal because they aren’t given the six months time to repair. So you say, well, how long do you have to do this? If it’s a teenager, it’s a six month process of getting that inflammation out and allowing their brain to return back to the normal growth pattern and for heaven’s sakes, don’t let them get another head injury in the meantime, so that can mean a limited amount of the sport activity until they graduate. I can’t emphasize enough how powerful it is when the families choose to engage in those treatment programs versus not. In that first couple chapters of my book, I talk about these brains of kids who had seizures and then years later, you know they get put on the ketogenic diet because they’re the misfits. They didn’t fit the treatment protocol, they didn’t respond to the prescription medications, and we have a couple of autopsies from these seizure kids that are now in their seventies or eighties and they’re at autopsy. Their brains are beautiful. 

That’s not how it’s supposed to be. That environment of low inflammation, specifically fed by a high fat diet is a powerful repair process for the human brain. Getting those kids to journey onto that type of eating, they have temptations at every turn. It can be really difficult. So showing them the process and the progress by sharing some of the stories from that book or looking at some of those youtube videos, that’s how these moms motivated their kids to get on board. Because what they were saying was ridiculous and no, no way. But just looking, saying, hey, you’ve got a brain that had this injury. If we want it to repair, here’s the rules. We need really good sleep and the sugars have to be low. You can’t be carving up day after day after day. It’s gotta be a Ketogenic Diet. Very good question, though, because I get that a lot. 

So there is hope then. 

Yes. 

You know when you’ve seen these scary videos with all these pictures of holes, what you’re saying is that you can heal them.

Absolutely. And I think that’s the part that when people say, why would the average person look at a doctor Boz ratio or what, you know, getting that glucose and dividingmy ketones, why would you look at these numbers? That sounds kind of geeky. I give them affirmation that says, no, you have a really important repairing process that’s happening every day in your brain. And some of the injuries we don’t know about, they’ve led to chronic depression because the scar never healed from that injury long ago. Andyousay, well doc, it’s been 30 years. Can I do anything about it? Like yeah, stay in Ketosis for three to six months as an adult and watch what happens. And you’re like, what? No cheat days. I’m like, no, no cheat, that we’re repairing a brain here. And again, if I, if I have that as the leading conversation with somebody who going into the ketogenic diet, I can often lose them. It sounds impossible, but once people have been keto adapted and they really feel the positives and the energy and the focus and the improvement they have with a Keto diet, and then they say, are you saying that if I do a really good job of this for three to six months, that my old brain injuries have a chance of healing? And I’m saying yes, but it has to be a steady chemistry environment for them to repair. And that wins the conversation. 

Right. And it all starts becoming more feasible and doable, doesn’t it? When you start feeling better. You know a lot of people start Keto and they think they could never eat this way for the rest of their lives, but they actually start doing it and realize how delicious it is. And yeah, this could be a lifestyle. This is not just a diet. And I feel great to boot. 

And if you ever didn’t remember that, you felt great, itt’s that first time where you binged saying, I have done a great job for several months and then they have, you know, carb up and you’re like, oh, I’m heavy, I’m swollen. I can’t get my ring off. I just feel my joints hurt again. It didn’t take long for all that to come back and then suddenly you say, well, it wasn’t that bad of a list of foods. Actually they were pretty good. So if you’re saying that I could journey in that direction and feel that good, now you have other reasons why they stay the course and they hop on the bandwagon quicker and yeah.

Well that’s why people tend to stay. I find a lot of people start from a weight loss perspective and might see it as short term, but they start to feel so good and that’s what keeps them, that’s why they stay the course, is for the health benefits. 

Absolutely. And that is a real improvement in the conversations that even were happening at the time where I was first writing this book where I couldn’t hardly find anybody to sit still and say, no, no, no, this is my plan for a life. Is that safe? And now you hear all the evidence of improved telomere length and improved longevity and brain function and you know, repair. You know, you look at the of national sports physicians that attend these metabolic health summits or conferences because they want to enhance the repair process of their athletes on the team. That’s the difference between and win or lose, is how quickly they can repair and nothing beats the anti-inflammatory state of a ketogenic athlete. You can hardly find a national athletic league, from my standpoint, that doesn’t at least talk about the ketogenic diet being part of a good option for their athletes. 

Right. I mean you could call it, that could be another name for keto couldn’t it? Anti inflammatory diet. 

Yes, andin fact my husband does not like theword ketone. He thinks it’s too sciency and so when I was writing writing the book, he’s like, you’ve got to come up with a better name than Keto. It just sounds like chemistry. And I’m like, it’s because it is honey. 

That’s not a bad thing. 

So one of my options was, well I can call it the anti-inflammatory diet, but that’s just so many syllables over and over again, I don’t think it works. So I agree with you. 

This is a question from Shelly and is about tinnitus. It’s short and sweet. “Do you have any experience of healing tinnitus with Keto?” I can instantly tell that she hasn’t read my book because I put together a list of things that surprised me when I had implemented the Ketogenic Diet in my internal medicine practice and done it for other reasons, but I had the first two patients that came back and said, you know that ringing in my ears that I’ve had forever and ever and you gave me these meds and we tried this and that and nothing really worked? I was afraid to tell you because I thought it would come back, but it really is gone. And that really landed in their journey about three months into the real journey. And I say that importantly. At first they were a little bit Keto, meaning they’d checked a couple of urine Keto strips and they had turned pink and then they fell off the wagon and then they went back on and then they carb cycled where they did good job during the week but had a bunch of beer on the weekend and then something, in each of their stories it was different, something pushed them to say, all right, I just need you to give me three months of not screwing this up. You can do this. It’s better than anything else we have. And if this doesn’t work, we can take you to surgery. So they manned up, girled up, whatever, and did it. 

And they took their doctor Boz ratio, meaning they’dcheck their sugars and their ketones and really monitored that they were in ketosis and it wasn’t that great of a ratio. They had a Dr Boz ratio of like under 120, so not terrifically wonderful. Just pretty good. And it was constant. 

I was going to say, it’s that consistency thing that you were talking about before, just being in Ketosis for a block of time. 

Right. And you know, it’s, it’s that same thing. What would you pay to take away that buzzing in your ear? And it’s haunting. I mean I have spent hours and tons of time just trying to crack the puzzle of why it happened and what, and really, I have come back to after years of, you know, struggling with this, is they have kind of an arthritis, if you would, in their ear. 

I was goingto ask you, isn’t it one of those things, is it difficult to pin down exactly what it is, what causes it? 

Right. So you’re conducting a sound when it’s not supposed to conduct. So I always tease my kids which substance conducts sound the best? Air, water or a solid? And sometimes they’ll get it right. Sometimes they won’t. And I said it’s a solid and if you put your ear on the railroad tracks and you could hear the train coming. You remember how they used to do this and that? Okay. Put your ear on the railroad tracks. Is the train coming? You could hear it on the rail long before you could ever hear it in the airwaves. You look at telephone wires. I mean they conduct sound. So you look at your ear and the same thing happens. 

It’s got a fluid that sound conducts through and that’s inside the inner ear conducting the sound, moving that energy into a nerve that gives you a sound that your brain knows what it is. If you now crystallize that or it gets a hardening, now the sound conducts quicker and faster at the slightest movement. That’s why sometimes you can say doc it seems to be my pulse. Like, yeah, the movement of that blood creates a vibration and sound is a vibration. So I need you to stop conducting that sound. I need you to block that out. But they can’t. It’s signaling too high from their baseline. So to undo that means the swelling in the other parts of the ear need to reduce. So you need to remove the water and remove the inflammation from the inner ear. Well, you can’t unless you’ve got the whole body’s anti-inflammatory, or removal of inflammation happening. 

And in some people they get lucky enough where if there is some crystallized or hardening or calcification that’s happened in the inner ear, the swelling now isn’t surrounding that crystal. And so the solid crystallized compartments don’t touch anything else and that’s when the sound stopped. It’s super sciency and kind of gets into a microscopic level. But I hope you can imagine like as soon as there’s nothing conducting the sound, as soon as you separate the water from the crystal, you have no more ringing in the years. Well that is, that’s a advanced level of your removal of inflammation. It’s on the inner part of your ear. So we had to keep them in Ketosis for several weeks in a row. I didn’t do it for that reason. We were doing ketosis three months for other reasons and they came in on their own saying, guess what? And like no way. And then then I’ve had a few other patients do the protocol. They have to stay in that zone, they have to stay in ketosis. And then of course, like anybody, a couple of them fell back off. The swelling came back. Boom. 

I was just gonna say, I bet it comes back full force.

Oh yeah. You look at those kids who had the seizures and they stayed on the ketogenic diet because every time they weren’t on a ketogenic diet, they had a seizure. It was forced compliance. And so when people say, oh, shucks, like if I go off, I have my ringing in my ears back. I instantly compare it to that. I’m like, this is nothing compared to a seizure. You can do this. And it gets a little easier. Besides, if they get their autophagy, there is a chance that they can recycle those crystals, recycle that arthritis. And I don’t over promise that, but I’ve been very impressed with, the longer they’re lean with ketosis, the less orthopedic surgeries I am referring for. 

Oh, that’s really interesting. You start to worry that you’re gonna sound a bit like a broken record though, don’t you? Because it’s like any kind of condition somebody mentions Keto, but seriously, if any condition is an inflammation disorder, it’s going to help isn’t it? 

Yes. I look at my clinic and think what would it not help? Because it does, it sounds like a panacea. You’re over promising, this is never goingto work. And you’re like, no, no, really. You just have to link it to inflammation for the science to be broken down. And the longer I do this, the more I see. Yup. That has an inflammatory component as well. From brain health to heart health to arthritis. Yep. Inflammation is in all of them. And it speckles not just an internal medicine clinic, pretty much every clinic for primary care. That’s why you see more physicians saying, alright, teach me how to get my patients wrapped around this. And the more we can educate them, the better the outcomes have turned out. So I highly encourage the woman who wrote that in to go check that chapter out in my book. I do write about that story of the patients in that book because it was shocking to me. Like who knew? 

Yeah. Wasn’t something you were expecting. I forget which speaker it was. It might have been Dr Westman, at the conference at Denver. And he was talking about all these different parts of medicine and how not necessarily Keto specifically, but changing sort of health and lifestyle certainly in that direction should be a primary care, because it impacts all these different branches. 

He is one of my heroes, Dr Westman. He is internal medicine as well. So he has this kind of sorting of how he thinks about problems that matches the way I think about problems. And if you talk about beacons and leaders in my world, he is one of my favorites. So I just would say any lecture where he’s been talking about sorting of improving the health of your body, check it out on youtube because I’m gonna bet it matches what we just talked about here. 

You absolutely have to get to the conference at Denver. I thought of you while I was there. It was just, it was amazing. It’s the first time I’ve been to a conference like that that’s so full on turnover of speaker after speaker after speaker. You know, hard and fast, sort of half an hour presentations and I thought, wow, my brain is just going to shut down because it’s going to be overload and I’m just gonna have to zone out by about two o’clock cause they start really early as well. 

Yes, we internists. Any physicians, you have rounds, and early, absolutely. 

So the day kicks off really early and also the clocks wound back. So it ended up being like ridiculously early on the Sunday. I was actually fine with it because of the jet lag. So I was fine being up early but I really thought it would be just too much. You know, for someone like you, you’d love it. But actually it was fine. They really got the pace of thelectures going well. So it just, it was so stimulating and interesting. I could see you there really, really enjoying it. So you must, you must go next year. 

I’m looking forward to the next year. I truly have been in hiding waiting for this decision from the medical board saying I just, I don’t want to have any reason to take any media or take any attention. And so hiding was safest, but I was envious of, and waiting for the lecturers to come out on YouTube so I could watch them myself and have not been disappointed. Very, very powerful presentations and conference. 

Absolutely. I really enjoyed it. It was fantastic. I guess you’re going to be all the conferences next year then?

I’d like to be, yes. I told my husband I’m going to become a Keto junkie starting now. 

There are worse things. Well, thank you so much. We still have some questions, but they’re going to have to wait for another episode, but I will keep them here and I will try and get you back soon to go through the rest of them. 

Well, Daisy, I just want to say thank you so much for having me on your podcast. I really find the format of the discussions and just the tone of how you connect with people very attractive. So thanks for including me on your list and I look forward to more episodes. 

Well, thank you for coming back and I look forward, too. Thank you Annette. 

You betcha.

This transcript is brought to you thanks to the hard work of Michelle Richter

Welcome back Annette to the Keto woman podcast, how are you doing today?

Daisy I am so happy to be back on your show. It’s great to hear you and see you again.

It’s really nice to see you. What the listeners don’t know is we’ve actually spent the last two hours together trying to sort out an absolute catalogue of disasters when it comes to audio.

I think I’m cursed. You know, the process of recording my own voice has become a sabotage in my own universe, like at least 50 times since the last time I’ve spoken to you. It’s me. I swear it’s me. 

It’s me too ’cause I’ve had audio problems this last week or two as well, so I’m hoping that we’ve hit our quota now and things are gonna turn around the other way. 

Nothing better to forge a friendship than to struggle together, so we are good. We are besties. 

Absolutely. Well why we’re talking about things turning corners, congratulations are in order. Well done for finally winning the battle and getting your license back. 

Right you know, the season of having a journey that your perseverance is tested and your stamina to stay the course and not be brushed away by a storm that just seems to just rise month after month, it is a time of deep breathing for me that says, okay, let’s forge forward. I think your audience was the first at.. Your audience was the first place I spoke of my challenges to fight for my medical license, and it is remarkable to be able to say that I had 12 felonies reversed….. removed, and in that process, I actually did keep my medical license the whole time. It’s what is un…. It’s difficult to explain to the world, but in the process of the judicial system, I did say, nope, this has nothing to do with the practice of medicine and this is not justice. And by a year and a half, oh gosh, we’re four years later from that moment. This past month, the medical board did not just reverse all of the claims that the attorney general’s office was pushing for, but I mean all but apologized for like, there is no ding on my license. There are no patient complaints. The month before this happened, they ordered me just to leave the state and I was prepared to do that. Just, okay, just give me a chance to start over, this is too heavy. And you know, I walked into a board hearing that is super scary, not allowed for public viewing, which to me seems even more frightening with the story that I’ve been through. And at the beginning the attorney general said, we want her license, we want it completely. And when we walked out of there, the medical board said, nope, you can’t touch her license. There’s no harm that should come to her. She doesn’t need to leave the state. Some of the other goofy demands that they were asking were all denied by the board and I was allowed to walk out of there, actually, I ran out of there saying go! So it is, you know, as a physician who is committed to educating my patients and really pouring into the intimate journey that is the privilege of being a physician. I really think God knew what he was asking me to strengthen in these last few years to say, I’ve got a different path for you than I would have taken had I not gone through that stress. 

I wrote a book, first of all, I was never going to write a book. That takes a much slower pace, you know that protected time to mentally process and write down and edit and think. That doesn’t happen in a busy practice that the story happens to be lifesaving for my mother. Yeah, that’s a blessing that I’ll take that. You can take my medical license. I’ll take the story that I’ve had in the last few years and watch what strengthens me as an educator, as a provider, as a daughter, as a mother, as a wife. And those moments couldn’t have happened if the pain of what was in the backdrop hadn’t forced me to look at a different direction. And so you say in this silver lining is a path forward now that yep, I have a clear medical license and now I get a choice point to say, well what is it that I want to do at this stage of my life? And that’s a gift.


Yeah, I just can’t imagine the overwhelming nature of it. This sounds like a silly thing to say and it is a silly thing to say, but I was taken to court once to a tribunal for my dogs allegedly barking. And it sounds completely trivial in comparison and it is completely trivial in comparison, but the only reason I mention it is that was massively stressful for me. Massively stressful. And that was a tiny little thing in comparison to what you’ve been through for so long. I mean, that was, you know, a relatively short, a few months out of my life and it was constant migraines and constant stress. I couldn’t sleep all the rest of it. Well, this is everything about your life. This is you, this is part of you and it’s been going on for years. I mean, I just can’t imagine you must be sort of in this place where you almost can’t, you don’t know how to feel I must imagine. There must be a massive sense of relief, but also this sort of sense of purpose in this battle that you’ve been going through is suddenly over. And I can just imagine you being a bit sort of lost at sea and I don’t quite know what to feel. 

There’s a boogeyman that’s been looking over my shoulder watching every moment, you know, I’m not exaggerating when I say I’ve had black vans outside my house for the better part of four years on and off and that does something to you. I have kids I’ve had.. I’m almost afraid to tell the stories because it sounds ridiculous, but in that I have really learned that there is a foundation of strength that comes from my faith, seeing I can’t see where this is going, but I know that there is a bigger plan and that I wasn’t given these talents to waste them. And if it means that I’m supposed to change course and my medical license goes away, I’ll find a way to use the skills that I’ve been given and honour that gift by using it. I don’t think I could have said that four years ago. I know I couldn’t have, I would’ve said, oh, somebody’s coming after me? Why I haven’t done anything wrong. And then so it doesn’t matter, here’s how life plays out and the stress is something that, you know, I have three sons who went through some very formative years in the last four years because of their age that they witnessed, this is what it looks like for a marriage to make it through a difficult chapter. This is what it looks like to keep a unit of a family together and the whole world seems to push or exploit or stress the family and say… It would have been easy, and I did have days where I’m just like, I’m staying in bed nothing. I mean, I’m just going to stay right here. But that was rare. Most of the days I got up, I found strength in my purpose and my faith to say, nope, I have a purpose. I am supposed to use it and if I don’t use it, that’s when the enemy really wins. And I can’t even express that the last, I mean it’s only been a couple of weeks, mind you, the three and a half weeks before that, I was scrambling to get licenses in any other state. So to now not be ordered out of the state. It’s almost like, I’m not sure where I told myself don’t make any decisions for two months. Just pause, I’ll keep going for the license in other states in hopes that I have options. But I will tell you I just was planning that there would not be a medical license at the end of that. The hearing wasn’t supposed to happen for several weeks. I mean we were planning on a medical license because the hearing was going to happen after I got a medical license in another place.

So we got this 10-day warning, 13-day warning that says, nope, prepare your case. Be ready to present, it’s a trial in front of the medical board. And yeah, we had lots of layers of protection around us for all the right reasons. And I’m super excited to just move on to the next chapter and I get to carry with me the blessing of becoming an expert in the ketogenic diet. Not because I had this fore planned journey, but because it landed right here in front of me and I embraced it, I was incredibly curious, I dove deep. So now I get to go forward with that talent, that skill on top of having a medical license. I mean, there’s just a lot of authority that comes with that, that I don’t know which way I want to use that, but to remove it without honest cause. So yeah, to have that assignment or that, burden without a cause was what really said OK, there’s bigger injustices in the world, I’ll find a journey forward. So, to march forward with the skillset of being an expert in the ketogenic diet and being an internal medicine physician licensed in the United States, there’s lots of opportunities. There’s lots of places I can find a rewarding path forward.

You did laugh at me. One email I sent, I said I guess they’re not going to actually apologize. You did laugh.

Like my resources and four years, you know, it’s actually longer than that but since the arrest, it has been four years. 2014 was when I was arrested, it’s 2019, so five years. Gosh, who’s counting I guess. So five years since the arrest, four years since the trial and yeah, it totally changed the trajectory of my career forever. You can’t undo that,

But like you say, maybe for the better. It’s cost you an awful lot of money and an awful lot of stress and heartache. 

Yeah, if you would have said to me, Dr Bosworth, what would you pay to prevent your mother’s death , to restore her life completely. I couldn’t have found a number big enough. So when I look at the price paid, it still is this journey that says I became an expert because I was caring about the most important patient in my world, which was my mom and God had provided me the space to sit still and serve that one patient completely. And now because of that, the ripple effect of the number of people that have read my book, read her story, seen the way I explain the science to her and what we needed to do for her. It’s helped more people than I could have ever helped in that many years. So yeah. What a blessing.

Isn’t it strange how things work out sometimes.

Yeah. I think it’s also the look like I have had other colleagues go through some serious tragedies in the last few years, you know, addiction affecting their families and you know, despite them knowing how to help them can course correct, burying children. And you say, you know in all that midst of pain, can you find the motivation to look for the opportunity? And I really have to give my husband the, I mean cause there are days where I was like, forget it, I’m going to go like I don’t even know what, like I grew up on a farm, I guess I’m going to go do hog chores, I mean I was returning back to the primary thinking that I had as a 10 year old girl and it was his guidance, his words at a time where the depth of sorrow and pity and patheticness was very all consuming saying, are you going to choose this answer or are you going to look around and say what other opportunities find it, fill it. I do think no matter what you’re going through, it’s tragic, but can you stop and say what is the purpose for the pain and when you can find that there’s life in that there’s life. I don’t mean like a martyr. That’s not it at all. It’s saying, okay, I’m here. What could I do? And it’s those types of paradigm shifts that make the heroes of our world saying despite the tragedy, it would have been easy to give up and say you win, I’m done. Instead I wrote a book, I pushed publish, which was the bravest moment, probably the whole event saying, can I show people what I’m thinking? I’ve already been chastised for that in respects to standing up and saying our community needs a different voice of people creating healthcare for the underserved, for the people in my community, let me add my voice to that and to look at the push I got to say silence, discredit her and then to come up with, oh by the way, this is going to be outside the normal stream of medicine and we’re going to ask you to stand alone because there’s not a lot of people saying this message and then do it with the confidence to say no, look what it did to my mom. Number one person that I will show you a story where she wasn’t young, she wasn’t spry, she had all kinds of problems and yeah, just this last month she has for the first time at now today’s her birthday, so 75 years old. She has normal white blood cell count. 

Wow.

Yes.

That’s a nice birthday present, take that.

Yes, off of chemotherapy has been and and she feels amazing. So that’s a win. I’ll take it.

That really is win well, nice News. Yes. Well, after that emotional catch up. 

Yes heavy, I’m so glad I did it without tears.

We’ve been wanting to get you back on the show for another Ask Dr Boz episode or two. I get asked all the time when you’re coming back on and I know how busy you are, so thanks for coming back on to give us an update and to share a bit more of your knowledge with us.

Excellent, I’m happy to be here. This is my favourite, favourite dialogue. So thanks for inviting me, Daisy. It truly is an honour to be on your show.

Oh, thank you.
Well, I thought we’d start with a message from April. She’s got some questions, but she’s had a really good update of late too. so I’ll just read out what she says. First, you’re amazing, Dr Boz. I’ve listened to your book and have been recommending it. My sister is taking your recommended pages to my mom’s doctor who has early onset Alzheimer’s. So this was a while ago, and there’s actually a really positive update to this story because the carers were refusing to give April’s mum the exogenous ketones that you’d recommended that might help and I think you sent her some studies or an article or some such to give to the doctor to help try and persuade them to write a prescription basically. Following your advice and using the information, they got a doctor to effectively write a prescription, so she is now being given exogenous ketones by her carers. Isn’t that great? 

Oh my goodness that is amazing. You know, the brain process of how much we’ve learned, you know, really was one of the first places that got my curiosity. There was kind of this collection of listening to a doctor, Dom D’Agostino explain seizure patients and preventing seizures for scuba divers. And that coincided with a patient whose mother was being treated for a brain tumor and she was trying to say, what can I do to help her? So those two parts were the first inklings that I used to get my curiosity started in the ketogenic journey. And then it was a much deeper dive of watching the repair of a brain from concussions to chronic migraines to memory problems. And you know, I look at the articles that were needed to help her providers see what is in the literature. But I mean, I’ve been that physician so busy that I didn’t take time for the latest updates because how could you possibly keep up with them all?

And so you have your sources where you try to, you know, get the summary points of, you know, what they shared at the conference or what’s the latest literature. But summary points don’t necessarily really motivate you to change behaviour unless it’s got some pretty promising stories. You’re going to be using this frontline, please convince me that this is the right thing to do. So to somehow think that you could take a problem that I’ve told patients for the better part of two decades, hey, you can’t reverse that memory problem, she’s stuck. And now I’m saying, wait, wait, wait. We now have evidence that says we see the energy gap for people with dementia, especially if they’ve been overweight, if they’ve had high insulin, if they’ve had metabolic syndrome. And I’m telling you as an internist, practically every one of my 80-year-old people has had a chapter of that, unless they’re really lean. And even some of those have had it, but most of the folks have had a season of being overweight. And when you look at their fuel for their brain, it’s all glucose. It’s all sugar. And your brain can’t make fuel. It has to haul it in. So the little receptors, the little trucks at the blood brain barrier are pulling in the glucose and then your brain runs only on glucose. So as soon as you get that two-hour, three-hour mark, while you’re not sleeping to ask your brain to work, you’re going to sink, you’re going to have the munchies, you’re going to have that shaky feeling. That’s brain saying, hey, I need some fuel. I’m trying to send you a message. When we saw that in as little as four days, of a strong high amount of ketones in that blood, the blood brain barrier, will take those ketones along with glucose. Glucose is one truck that’s getting pulled over the blood brain barrier, but ketones were also being transported into the brain and within four days we dropped the need for so much glucose and we took ketones from a zero need, up to a majority of the brain was processing and using ketones. Four days. That’s remarkable. I had no idea we could do it that quickly. The study was done where they practically put them in a jail cell to get them to eat this really high fat diet like it’s more of an advanced ketogenic diet than I probably have ever done. It is the prescribed level for a seizure patient, so it’s like super advanced and in the real world you’re going to have a tough time getting people to do that, especially when they’re going from carb fuels to ketones. They’re going to have withdrawal. But when we could see their brains uptake that quickly, anybody in the industry said, oh my goodness, put the ketones in the blood and watch what happens. And as I’ve used that for my patients with memory, I mean, they’re in nursing homes and you say, okay, what’s the worst thing that’s going to happen If I give you a supplemental ketones for the next two weeks? Maybe they’ll get a little diarrhea when we first started. Okay, let’s do it, bring the patient back in two weeks and I cannot tell you the heart stopping transformations of people that I just had assigned to the rest of their lives to be in a nursing home that adding ketones improve the quality of their life, improve their memory. That two weeks was the first awakening where their depression was less, their concentration was better, their energy was better. And what the studies have continued to say is when we see memory problems, one of the major thought patterns throughout their brain studies and biopsies at death and you know lots of people looking into what’s going on is there’s an energy deficit that we’re just barely meeting the needs of the brain’s energy by only using glucose.

And of course with that two hour window, the danger of a two hour window is, and especially in some way with memory problems, is you’re going to constantly be running out so the brain will just shut down when you added Ketones, not just for a one time dose, but now you’ve got a body who’s burning them most hours of the day, you end up with a whole awakening of their mitochondria, of the metabolism inside the brain that was offline. It was done like we don’t have any fuel, we’re shutting down, and they did, they just barely trickled that metabolism alive. So it’s like a dormant Mitochondria. To wake it up and then fuel it for a good five to eight hours on a ketone as opposed to the flash energy of a glucose. These brains stuck in memory problems, have a new lease, have a new return, and what a rewarding moment as a physician, but also as community members for people who I know have suffered with that, just loneliness of what happens when you get dementia. It is a tough road from the moment they get that until they die and it’s lonely. It’s really hard to understand what it’s like to not have that memory and to restore that even in a partial way, and I’ve had two of them return out of the nursing home back to their homes. That’s amazing. Right? The rest of them, you know this literature, I actually really was able to master the, and ask some of the questions before I started advising it to patients when I was at the metabolic health summit and that was in January, February of 2019 and it really has changed my approach to those who are struggling. In addition to that, there’s other like places where I’ve had a couple of moms coming in. Life is hard, husband’s struggling, been put in a treatment program. Now she’s running teenagers, single parenting wondering what’s gonna happen with their marriage. Really stressful times, right? And she wants to be on an antidepressant. I know I took it probably 15 years ago after I had one of the kids and I took it for probably six months and it seemed to help and I just need anything. And I’m like, you know, here’s the prescription. We can try that again. But it’s going to take two weeks for that prescription to start working to improve those brain chemistries. In the meantime, take exogenous ketones and watch what happens to the energy in your brain. And I’ve had that story probably six times since February since I got home from that conference and not one of the six ended up on the antidepressant. They were taking exogenous ketones and the restoration of their mental focus, their mood and their energy was so much better on an over the counter supplement that they chose not to add the antidepressant and it’s there, they can fill it any time. It’s not going to hurt to have both of them, but wow, that’s freedom to say, look what we can do in such a quick time what we changed the fuel of your brain, and this is somebody who started out saying, mom, I don’t know if these exogenous ketones are, right? You should just make your body make them. And I think a lot of people in the space said those words and so I adopted it as well. But you start to see some of the literature on what we can do to change the cell metabolism and this is just the organ of the brain. There’s now evidence that the heart uses ketones, and again that was something I was told no, the heart uses glucose. No cardiac cells are using when you tag the ketone in a pet scan, if you would, you can see that the cardiac muscles are using those ketones for fuel. And again, that was news to me. So, what a great time to be in this space of stopping more prescriptions than I start. That’s awesome. 

Yes, it’s interesting actually the podcast I’m editing, I always do it behind the cut and I completely forget where my timeline is with what show’s going out and what show’s been out and where I am with it, so I just say it how it is in the moment rather than trying to remember where I am. But the podcast I’m editing now, which in my timeline is going out tomorrow, but which would have been out before this one comes out, is a guy talking about, that’s his passion, talking about heart disease and working with ketones and how that all works. That just made me think of that when you were talking about it just now. So I think you’ll find that interesting but I find the whole subject of exogenous ketones a tricky one.

Yes.

Mainly because a lot of the examples I see it is in the weight loss side, which I think it’s actually counterproductive for, but I’ve always thought they have their uses and particularly with this question of dementia, you know, I’ve spoken to people who’ve got elderly relatives and they really want them to start eating Keto and producing their own ketones, but easier said than done. And it seems to be a really typical thing for people with dementia have really strong cravings for carbs, which presumably because their brain is starving for wanting that glucose all the time, it’s driving those cravings and being not in a good frame of mind, literally, it’s almost impossible for them to stick to that way of eating. So that’s a prime example of a good time to start pumping in exogenous ketones to get you into that place where you might actually then be able to start producing your own as well.

Absolutely. 

Then you know, if you can be pumping them in to get them to the level you need them and then start producing them endogenously as well. Well, that’s got to be a perfect storm.

Right, I mean, I look at the approach that as an internal medicine doctor, our team, our tribe of internists, we are about the long game. We are about chronic health problems and how do you get out 20 years and see that we did make an improvement. You know, how do we prevent problems? How do we take a chronic problem and undo it? And it is not uncommon where you show up in my clinic and there are so many disasters unfolding at once that that’s where the prescriptions become easy. You know, take blood pressure. We know this has to be controlled in order for your brain to not be swollen under that high blood pressure, that the risk of a heart attack has to be controlled in order for us to reverse the risk. So we write the prescription, but it is not meant to say, okay, now you’re on the prescription for the rest of your life. No, it was meant to say, let me prevent the danger that you’re in that you’re walking into and now let’s work on getting you healthy. And I think those last few words have been lost in the practice of medicine. You give me 20 minutes to take care of all the disasters you’re about to fall apart. Maybe I get 40 minutes on a good day with you. I barely can assess what chronic problems we’re talking about and then how do I use the prescriptions that have the evidence base to get you the most improvement for the quickest amount of time with the least amount of side effects. We don’t even get to the part that says, now how do I make you better? There’s no space for that, but that is the core. That is what we are trained to say. What can I do to say, now I’ve got the disasters, I’ve got a you know, finger in the dike that is not going to flood over and kill the patient in the next few weeks.

Now how do I get them better? And I really look at that kind of parallel when I’m looking at exogenous ketones. Take the woman who’s got depression, overwhelmed with stress, you know, more things on her plate than she was ever signed up for. And I say, Yep, we can use an antidepressant, I can see you’re stressed. We’ll make sure there’s nothing else that’s causing this with some lab tests. But oh, by the way, let’s change the fuel in your brain and within three to four days, you’re going to feel a difference to ask her to change her diet, take out the carbs, remove the cravings. Yeah, you gotta just sit in that room. There’s no way I’m going to ask her to change her diet today. She has way too many other things to deal with. And you know, in that respects of understanding the science, there were two other studies presented at the metabolic health summit that specifically talked about when ketones were available for the blood brain barrier. When they were present, the brain began to prefer them. And again, that’s backwards from what I was told, glucose is the primary fuel for the brain. Glucose is what your brain needs, you can’t live without glucose. All of that stuff came from the metabolic health of brain and heart cells. So you look now that says, oh, you are wrong. We see that they metabolize ketones. In fact, when the ketones were available, the brain preferred the ketones. Again, that was new news to me. But how it plays forward in my practice is to say, we got a lot of work to do. Let’s get you feeling better. Let’s stop the up and down of your emotions because your fuel goes on and off with that insulin resistance that’s at your blood brain barrier. Let’s fuel you with a steady supply. And then we’re going to walk through how do we lower the carbohydrates? How do we clean out those cupboards? How do we change the way you think about fat versus carbohydrates? And had I started with that, they would have walked out the door saying, nope, can’t handle it. But if you start with saying, I can make you feel better in as little as four days as according to the evidence and now I have you feeling better. And we say, what can you handle next? What can you handle next and those cravings much easier to handle when your brain already has been practicing using ketones before I take away the chocolate cake at night and you say, well, are you saying that they can have ketones and chocolate cake? And I’m saying, absolutely. That’s how we start you to hauling that fuel into the brain. And then once the ketones are available to the Mitochondria, they are preferring the ketones, once they begin to metabolize them. Once the ketones were inside the blood brain barrier, they got metabolised, they got used, they got burned as energy and that was the first little on switch for that specific mitochondria. Tomorrow when you add them, he’s going to use them and maybe his neighbour. And then you’ve got the stable fuel that’s not going up and down. Suddenly saying no to bread is not such a ridiculous ask. You’ve got a stable brain fuel as a platform to build off of these other changes. And this is again, mind blowing for people. You know, I don’t even feel, I look back and say, where did I get a negative taste in my assortment of tools for exogenous ketones? And it was the literature I was reading when I first wrote that book, which was, Yep, we can do this. There was a fight over, is it racemic or ketones or non-racemic and can you use, it was kind of all this science that they were all excited about fighting over it and nobody really talked about improving symptoms really well. There was a battle going on. I wasn’t sure what it was talking about. As I continued to listen and I watched two experts debate the case, I’m like, yeah, I think you guys are fighting over something that never shows up in my clinic. Just come to my clinic. I have depressed women, I have people whose brains aren’t working well. I have people whose hormones have been turned off for years because they’ve been on a low-fat diet and there’s been nothing to make those hormones from. If you’re telling me that I can use a supplement to get them on the right path and then I have supplement until you get this mastered and then we can stop the supplements. That’s a plan that says I get them feeling better, I get them eating better and I lower their inflammation, maybe not as dramatically as I would want to do it in a perfect utopia, but utopia was long gone for many of these patients and the option to change their thinking. I mean most people aren’t going to go to my YouTube page and spend 20 hours watching all of the information. They’re going to say, what does she recommend and then follow it and if you don’t get them feeling better in short order, they won’t stay at the post. I look at other things that I’ve, you know when you first went on the ketogenic diet where you perfect for the first year?

When I first went on it, when I’m still on it, I am the most far from perfect person you’ll ever meet. But the thing that I’ve been thinking about as you’ve been talking about this, I struggle with exogenous ketones and the reason I struggle with them is because certain companies and the way they sell them leaves a bad taste in my mouth, that’s the element that I struggle with. There is an element to them, the whole racemic debate, you know how our body responds to it. That I also am a bit concerned about and I don’t know what’s gonna happen with long-term studies and all the rest of it. That is a bit of a concern. I’ve never had an issue with using them as treatment for something like Alzheimer’s, I’ve always known that that’s a very good use. What’s been interesting going on in my mind as you were talking about these women coming to you depressed and wanting to go on antidepressants, well, I mean, as you note, depression is something that I struggle with a lot and it goes up and down and it’s been a struggle for me the last month or so it’s been quite difficult and I know that when I start pumping out enough ketones, I will start feeling a bit better. It won’t necessarily completely sort out the depression, but it will help and, I know that and I know it takes a certain amount of time and I can usually force myself into that if I’ve gone off the wagon a bit, if things have gone wrong for me, if everything’s sort of gone into a spiral, I know how to start turning that spiral, or the other way is to start producing ketones. But it is difficult and the only reason I pushed through it I suppose is because I have the experience multiple times of knowing that it will work. But I know how difficult it is for me being in that frame of mind, having the experience and the knowledge to know that it will help to eat a certain way. But for someone who’s feeling all those things, who someone tells them, oh, you could feel a lot better, you know, your depression could be a lot better if you started eating Keto. Well it’s true, the chances are I probably would. But if you also understand how that person is feeling, just like you were saying, they can’t do it right, they can’t do it. It’s the same conversation I’ve had with you and other people about the weight loss surgery, the place I was in, of course I could have done it without, but in the place I was in, I couldn’t. And it’s the same with depression. So if you’re looking at exogenous ketones, the way you’re talking about using them is this short term emergency medication, if you like, that’s just going to lift you up to the place where you can start handling lifestyle changes that will then start seeing you through for the years to come for the rest of your life, but you start talking about those kinds of changes now and it doesn’t seem that much. Oh, you know, is it really going to kill you to stop eating bread and to stop eating cake and all the rest of it? What actually at the moment, yes It feels like it would kill me. You’ve got to be in the right frame of mind to be able to handle that and if giving someone exogenous ketones could just, like throwing someone a buoyancy ring out there who’s drowning, if it can just get them up high enough to start making those changes, then yes, that’s something I can on board with.

Right. So the other place that I look at that is, you know, take my journey beginning of this podcast shared an incredible depth of struggle and I am a very disciplined person. I know the science that would say if you fell off the wagon, if you’re not feeling good just fast for a few days, you’ll be back on the wagon. And I’m like, no, I can’t do it. But as soon as I would add exogenous ketones and especially since I’ve been reading the evidence over the last year when I would find myself having a glass of wine, it would really slow down my thinking for the next day and part of that is just being in a slump for as long as happens with the story. But then knowing that when I would take some exogenous ketones, it would at least give me three hours of really good mental focus and what I found was at the end of that mental focus, you know, ketones are an appetite suppressant so I wouldn’t be hungry. I get why the people are using them for weight loss. They are an appetite suppressant. I didn’t take it for those reasons, but do I use food to comfort me when I was sad? Yes. When I was scared, did I use food to like be the soothing agent because it’s easy and accessible and there are currently no laws against that one. You know, of course. Unfortunately having been insulin resistant, like most of the women my age, that ignited the return of inflammation, the return of a sluggish brain and it didn’t take but three or four days of not following the rules. Now I’m off the bandwagon. It’s just, it’s too hard and I can’t find the energy to get back to the right place again. At first. I know I looked at every single one of these exogenous ketones has a sugar substitute in it. They’re kind of a nasty taste without that, they’re a salt. And at first that was, the sugar substitute that I kept pushing against. Like okay, I could have the ketones, but I wouldn’t want the sugar substitute with it because it would make a sweet taste. And once I have a sweet taste and I want more, at least that’s what I told myself. But then I started doing okay, I have some on supply that when I feel like I’m in a slump, I’m gonna mix it with a little bit of cream and ice and I’m going to sip on it. Just a few tablespoons worth. And I would check my blood ketones and they would be like 5.6 like I never got that high ketones when I was fasting, or at least not a 48 hour fast or something. But what would happen is that it wouldn’t just help me for that moment, the rest of the day I would have less cravings, I would make better choices with my food, and then the next day would be a little easier and the next day it would be a little easier. So if I look back at the perfect Keto diet, it would have black coffee instead of coffee with heavy whipping cream. Well, I liked the heavy whipping cream. I like the butter in my coffee. It tastes good to me. And that satiety is something I needed to practice for the first, I think, I mean, I still do that, but amazingly, that’s become my comfort now. And I don’t think I could have completely arrived at satiety from these high fat foods had I kept those sugar substitutes too heavily invading my world in my first year of a ketogenic diet. But I would make the exception with exogenous ketones because of how much it did shift my metabolism. It did improve my energy, my mood did get better, and then it wasn’t just me. I thought, okay, maybe that’s just me, and you go to the conference to say, oh my goodness, look, they studied that. It wasn’t just me. Yeah. 

It’s really hard and I still really struggle. I still really do struggle with them and I think it comes back to the sales methods of some companies and the claims that are made and, and that’s always going to be a problem for me, but if I hear stories of people using them in specific intelligent ways, there’s someone I want to interview who’s doing research into the use of a specific type of exogenous ketones, I believe for treatment of Migraines, obviously that’s something else that interests me. So it’s there use it. If it’s used in a particular way, then possibly I am open to that. I still, I do. I really, really struggle just because I see so often it being sold as this magic pill, take these things and you’re going to lose weight, take these things and so many people take them and gain weight because ultimately, you’re just pumping this extra energy source in there and so you’re not going to lose weight. But somebody else, like you were saying, can take it in a certain way and it helps them. Oh, it’s, oh you can tell can’t you. Yeah. You can see the expression on my face, I really do struggle just because I suppose it’s also having been that person who is so vulnerable to that being sold that magic pill and a very expensive one at that. I’m the kind of person who will grab onto that. I think I might’ve been one of these people who bought Raspberry ketones. Remember those things that were sold because they told you nothing to do with exogenous ketones. Completely different thing. But because I was sold the hype that I would lose weight by taking them and it was just another thing and I know exogenous ketones are a different thing, but it still falls into that category a bit and a lot of people are sold them and take them and for nothing. Oh, and I don’t like that. 

Here’s the perfect, as you’re speaking, what I have in my head is I imagine the woman who comes in and says, Yep, I’m new to the community. I would like a new doctor. I’ve been on Prozac for 25 years and I introduce the idea that Prozac was never designed to be 25 years of anybody’s life. It was meant to help you in a season where you are having a difficult time and as soon as that season was stable enough to help you work on the ways to restore your neurochemistry to its optimum production, we should have done that. As many times as I’ve had that conversation, it’s almost tearful that the woman says, nobody told me that. Nobody told me that I was done with it or I could be done with it. How do I do that? And I see the same errors as, and I did it to like quickly filing exogenous ketones as this gimmick, like you should do it the hardcore way. I look at my heroin patients and say, you shouldn’t use the suboxone to get off of heroin. You should just suck it up and suffer. And you’re like, yeah, they’re going to fail. They’re going to return to their addiction. It is real. And you say, let me help you. Not for the rest of your life, but for a season for this chapter that says, I’ll show you. But that really becomes the responsibility of those who are talking about it, educating about it, saying this wasn’t meant to be the rest of your life. It is meant to say. If you think you’re going to go from no carbohydrates and no alcohol for the rest of your life, I’m here to tell you no human on Ketogenic Diet does that. You’re going to have times where you relapse, where you have struggles, especially after you felt how good life can feel when you are following the process. Let me get you back on board as quickly as possible, not for the rest of your life. And I think that voice of educating correctly is my responsibility as a physician who is rooted in how do we take the science and apply it to these chronic behaviours to change one behaviour in the next best level. And then we take the next behaviour to the next best level. And that’s the root of internal medicine, improving chronic disease with the steady sustainable outcomes. I see them as a tool for people struggling for people screwing it up for people having mental slumps. And for the folks who are saying, let me just see what it would be like, how would I feel if I was on a Ketogenic Diet? And I tell them, I want you to sip on exogenous ketones for two weeks. Don’t change anything about the way you eat. And they come back saying, all right, how do I do this Keto Diet? Cause this was the best two weeks of my life. Usually it’s like a week. They’re like the, this past week has been amazing. You know like welcome to the Keto Diet. Let me show you the rules. 

Tricky. I am open to be persuaded in certain cases, but again I guess like you say, it’s not something that, not something that you’d recommend to everybody. It comes down to the individual doesn’t it? And working out what the best way forward for them is and yes, if you put someone in front of me and you could 100% guarantee that the only way that they would be keto in six months was to spend two weeks taking exogenous ketones. Yeah, I mean I would take that option. Right?

Yeah. I look at that saying, I don’t want to take blood pressure medicine. I don’t want to take, you know, I’ve had this conversation. If you think doctors aren’t salesman, you just haven’t been in the exam room long enough to say, I know don’t want to take a pill, but let me show you the risk you’re taking. I can help you get there. Not Today, it’s going to take us time. You have this thing called human behaviour and that doesn’t change on a dime. It changes gradually, one notch in the right direction. And there are rare stories like my mom who said, okay, I’ll do this, and we did it together. She changed on a dime. She’s now three years out and in the best chapter of her life. Honestly, that’s the rare story.

Yeah, absolutely. And I do think that endogenous is always going to trump exogenous.

One of my other major things I tell you about the brain, the anti-seizure and those, plenty of experiments done on exogenous ketones there. But when you look at how can we, you know, repair Alzheimer’s, can we prevent Alzheimer’s? Can we take that brain injury from a concussion 30 years ago and do the best we can at, you know, fixing what we could. And that gets to the whole art and science of autophagy. Well, we don’t have evidence that autophagy can be as predictable with exogenous. That needs to be your own system. But that comes with even more of saying no to food and fasting and watching your ratios, watching those glucoses and those blood ketones to say, could you get there? And if you open with that discussion, you’re going to lose your audience. They’re going to say, forget it. It’s just a wacky diet that I can’t do and it’s off and then they’ll be disparaging and off they go for never to enter that thought again. So, you know, I look at it as I do with any patient that comes in struggling with the chapter of life. My responsibility is to understand the science and to bridge it with their life and to not have expectations that they can do some kind of magical fairy dust and make everything perfect but improve one thing and then watch how that improves the next thing. And those moments add up just like the other ones do, where they did one tough decision, then they made another bad decision and now they got 15 bad decisions they’re making every day. We’ve got a ways to go. So I look at that as this journey gets better. How can I help you with the first few steps and sometimes telling them what the last few steps look like. Saying the word fasting to some of my new patients. I’m like, don’t do that. You’re going to scare them. 

No, don’t do that.

So yeah. 

And it’s also that it’s not something, you know, is being clear both yourself as the person who’s talking about it, but for the person who’s potentially taking any of these supplements, that it’s not something that you should be taking for a long time. I mean, you’re talking to somebody who was on Prozac for 20 years for what? For nothing. You know, it was no good at all really for me. And the same with these things that seemed to work really well for say two weeks. So the automatic response from a lot of people is what are just stay on that then.

Right? 

Forever.

Yeah.

Rather than, no, this is to get me to a place where I feel capable to do the harder work to make it long-term sustainable. 

Yeah. Because if you go back to the chapter where you were taking Prozac for 20 years, had someone said to you, Hey, are you ready to stop it? I usually don’t hear people saying, oh my goodness, I have to be on it. Usually they’re like, oh, that’s a thing, I can do that? And that education I think is the key to successfully navigating and not being stuck. I don’t want people on exogenous ketones for the rest of their life. I want their bodies working better. I don’t want people on Prozac, Paxil, Zoloft, any of those for the rest of their life, but when they are super depressed, if that was all I had, I’m going to help you with that and then say, all right, now let’s work on your sleep now let’s work on your nutrition now let’s work on your boundaries. You know all that you know, life things that are not in a script but are super important for the long-term outcome. I think it’s a great discussion to have though, and I find the Gal who we are talking about, whenever I put the videos about the brain science on my YouTube channel or wherever I’m talking about them, if you’ll look in the corner, you’ll see the author, you go to Google, you type in that author, you can have the access to the article too. That’s what she did. She printed out the article and took it to her doctor. I’m like, this isn’t my idea. I’m just being the conduit to explain it to you. Why would we care about this? We do care about this. It is a powerful transformation for taking folks for the last 30 years that have been inflamed with a chronically sinking mental function and giving them some hope to say, can we awaken those cells to burn a different fuel? And the answer is yes. Don’t make them lift the whole burden by themselves. The first step out of the gate.

Ah, interesting discussion. It’s not where I saw this going actually.

Well, sometimes science does that to me too. Like, oh, I was planning on this outcome and here’s what I got. 

Well, you know what’s gone and happened. I haven’t even gotten to April’s question yet. We’ve gone on a massive tangent and come to what is going to be the end of the first ask Dr Boz, except we haven’t got to the ask Dr Boz bit yet. 

Well I will contend that even if we didn’t answer her question, we will get to it in the next one and know that this discussion that we just had is the root of so many of the questions that come into my Facebook and my YouTube page and I have failed to respond to them. So, uh, I do think you’re going to see an audience who gets educated by the conversation and we will definitely address the question in the next recording. 

We will do so. Thank you very much for that and we’ll see you back here next time. 

God bless you. You Bet.

This transcript is brought to you thanks to the hard work of Dawn Michelle.

You’ve spoken a bit before about how Will cooks up all these tasty things. And I’d forgotten actually when you mentioned just now that last year at Ketofest it was just those samples that you were bringing that you hadn’t set up the company at that point. I’d completely forgotten that. I was thinking in my head that you already had it then, but how did you come to that? Was that part of the supportive process, him experimenting with making foods for you to have, is that how it all started?

Absolutely. I feel like some people would take the carnivore, purist approach and they’re like, well, I can be the healthiest by eating just meat and vegetables. And so, I’m not going to risk anything. Perhaps I’m a little bit of a risk taker in that sense because I know that I have a sweet tooth and I used to have a pretty serious food addiction that I let run my life. So, I don’t want to ever go back there. But, if I can have tasty things that I can enjoy and let my sensual pleasures, you know, really, indulgent without going nuts and getting back into food addiction, then doesn’t that enrich my life? 

Do I need to be a purist in aesthetic and deny myself pleasures for no reason? I don’t think I do. So there are some healthy ways that I found to add tasty things back into my life besides not saying that the meat and vegetables is not tasty, but I really like a good Keto ice cream if I can enjoy a good Keto ice cream without messing up my health. So, for instance, Halo Top, you’ve tried it, right?

I have never tried Halo Top, actually. The only ice cream that I’ve tried in the states is Rebel ice cream at Ketofest last year. I’ve never tried Halo Top. I gather it’s got some not-so-great ingredients in it.

It does have some not-so-great ingredients in it. Now, the founder of Halo top was actually a Redditor, participant on the Keto sub-Reddit. So, I felt like I personally chatted with him on there. So, I did try it back in 2016 and sure, some of the ingredients were sketchy and the ice cream wasn’t a hundred percent great. Now I understand it wasn’t like a ton of sugar, a little bit of sugar, but it wasn’t awesome. 

And so, there were some things that, I was curious about, sweeteners that I felt did not have any sort of negative health impact. Actually, this was a problem because as a part of diabetes and monitoring my blood glucose. I could see that a lot of the supposedly okay sweeteners out there that weren’t counting as sugar, were actually terrible for me. These people are lying. Sorbitol, maltitol, mannitol, isomaltitol, isomalto-oligosaccharides, all these things listed under the sugar alcohols category. Most of them, I could see spike my blood glucose. Erythritol was okay, erythritol was fine.

That seems to be one of the universally accepted by most people not to give them digestive issues and things like that as a one that’s available to most people. Most people seem to get on okay with erythritol, don’t they?

Yeah. Yeah. I think erythritol is okay, and the taste is pretty good. I mean, it’s not exactly sugar and it doesn’t cook like sugar.

No. That’s the problem with it. And a lot of people don’t like the cooling effect it has on everything. I find that in some things you make, you don’t get that cooling effect. And I actually don’t mind it that much, but I know that’s a complaint that a lot of people have with it.

Well, it’s okay.

Exactly, it’s okay.

And then sucralose, Splenda, aspartame, saccharin, all these chemicals, I researched them, and you know, there’s nothing saying that they literally cause cancer. Okay, there is a little bit, but not much. But there are plenty of research showing that aspartame is linked to migraines. Sucralose and saccharin are linked to leaky gut, intestinal irritable bowel disease. If you use them on a regular basis, then your chances of developing these conditions seem to go up, or at least, there’s lots of research showing that they’re linked. And then even petri dish research showing that they do cause the epithelial lining cells to develop gaps, which is literally leaky gut disease. So, I don’t want any part of those. I mean occasionally a little bit, whatever, it’s not going to kill you, but still not healthy.

That’s the thing. It comes down to what you just said is the regular use thing, isn’t it?

Yeah. I think no one’s going to die from having the occasional bit, but regular use, daily use, definitely have been shown in some research. Not a lot of research, but some research to be problematic. And then I’m not really a big fan of the taste of stevia.

No, me neither.

I like monkfruit. Have you tried that?

I haven’t. I’ve never tried it. No, it’s not something I can get here.

Oh dear. Well, I like monk fruit. It’s not exactly the taste of sugar, but it has a nice kind of clean sweetness to it, which, I find pleasant. It’s not a sugar, you can’t cook with it.

That’s often the problem isn’t it? You actually, for most things you’re making, unless you’re sweetening something like coffee, for example, you need that bulk. You need the actual mass of sugar, in inverted commas, in whatever you’re making. That plays a part every bit as much as the sweet flavor does, doesn’t it?

Well, in fact, I mentioned that I was corresponding with the Halo Top founder, Justin Wolverton, on Reddit and I was asking him, why do you put sugar in your Keto ice cream? It seems to defeat the purpose, right? He’s like, well, originally, I started with a very Keto purist sort of a recipe. And he’s driving around with his little sample pints to different places and trying to find a place that would manufacturer the ice cream for him. And the problem was that his mix would freeze in the lines, which I think as you know, like you try making a Keto ice cream with erythritol or swerve or what have you, and you put it in the freezer, and it freezes solid as a rock. You know, if you have any leftovers after you’ve made your batch. Sugar alcohols freeze solid. And he said the property of sugar that is essential for the ice cream is that it lowers the freezing point so that it stays soft in the lines of the manufacturing equipment but also then in the freezer. So, you don’t want to have to have a pint of ice cream that you pull out of the freezer and have to sit on the counter for 20 minutes.

Although, I have to say this is one of my slight bugbears with people who go on about ice cream freezing solid, which I have to say it is a thing with erythritol. It freezes really solid. But, you can take it out and leave it in the fridge for half an hour and then by the time you come to eat, it softened up a bit. But, people talk about this being completely scoopable from the freezer. Well, my favorite ice cream has always been Haagen-Dazs. That was my Achilles heel. That was the ice cream that I always used to have. Now, that is not scoopable straight out of the freezer. I’m not sure freezer is on a low, or shall we say high, I suppose setting. It comes out solid. You watch the adverts for Haagen-Dazs and even on a lot of the containers they recommend you have to take out and you have to leave it sitting on the counter for five to 10 minutes before it becomes that sort of perfect scoopable texture. So you know, it isn’t just a Keto ice cream thing. Although I have to say that I’ve been making a vanilla chocolate chip ice cream with allulose. You’ll be pleased to hear it was the very allulose you brought to Denver for me.

Excellent.

And, I have to say, you’re absolutely right. It is perfectly scoopable straight out the freezer and it’s very delicious. I have been enjoying it every day since ice cream season.

I think that now that I’ve gotten into the business, there’s just a number of properties of sugar and also allulose that I’ve come to appreciate. Lower freezing point, crystallizing, are just the tip of the iceberg really. Providing that crystalline structure, for instance. We’re trying to make fudge. The consistency of fudge is hugely important. Well, forget trying to do that with erythritol. It’ll come out in sort of icy shards.

It crystallizes, doesn’t it?

It does. And you know, you’re not going to do it with sucralose. That would be disgusting. Or stevia or anything like that. But if we can crack allulose fudge. We’re going to trial a couple of things at Ketofest this summer. We have actually started making a nut bars using allulose caramel. And allulose caramel, wow, it’s so good. And it provides this nice kind of stickiness that, makes these nut bars just delightful. I haven’t quite figured out how to package them to be honest. But, right now we’re just using craft paper bags and a little parchment paper and I’m distributing them at our local farmer’s market and people are just mad for them.

That sounds delicious. How did you end up at allulose? You started saying there was this progression of different sweeteners that you tried. How did you end up at allulose because it wasn’t, and it’s become a bit more known now, but presumably, I mean, when you first stumbled across it, you must’ve almost stumbled across it? How did you find out about it in the first place?

It’s sort of my hobby to, become on top of the literature of, sweeteners and their health impacts because I wanted to know for sure. Because I used to drink sweetened diet sodas, instead of water all the time. Diet Coke, Fresca all these different things. And I wanted to know what health impact they had. And a lot of people said, you know, if you follow the science that there is no problem, really. Its people who say these chemicals are bad for you, they’re just chemo-phobes but there’s no solid science behind it. I’m like, well, you know, I’m not sure. 

I tried it actually a couple of years ago, I went on a sweetener moratorium for two weeks. I am dropping all the sweeteners out of my life, zero everything, just coffee, black coffee, water, tea. But nothing that has any sweeteners. And I was checking my blood glucose the whole time and it had a huge impact. I didn’t realize, I mean, not huge, maybe five to 10 points on my baseline blood glucose. And it dropped. And I lost weight. So clearly these sweeteners were having impact on me and I didn’t realize it. Even though they’re supposedly zero calorie and supposedly safe.

It’s not all about the calories though. That’s where it comes down to, isn’t it? Or even sometimes the immediate impact on blood sugar, it just goes to show that all these other things that they can potentially have this ripple effect that could end up causing you to gain weight or not lose weight or whatever it is. That’s the issue you’re dealing with.

Absolutely. There’s a lot of other issues and it’s not just blood glucose or insulin. Also, they talk about cephalic phase insulin response. Well, if something just tastes sweet or you’re thinking about something sweet, you’re going to get that cephalic phase insulin response, for sure.

The other thing I find is that it stimulates appetite too.

Absolutely. After I did this two-week sweetener moratorium, I talked about it on my Facebook page and some of my friends were like, you know, that’s very curious. And I’m like, how about you all, do two more weeks with me and I’ll go two weeks more. Once I got past the first 10 days, the first 10 days were rough. I was super addicted. Daisy, I was like struggling. I was thinking, oh God, I really want MiO in my water, or I really want Diet Coke. And I was biting my nails. I was gritting my teeth, but it got easier. And after those first two weeks, I was like, I’ll go another two weeks. 

So, I got a bunch of friends to try it as well, and they were also type two diabetics. So, they gave it a go and two of them couldn’t do it. They dropped out right away. They were like, no, I love my Diet Coke, can’t give it up. One of them dropped out after three days because she got dehydrated. She realized that without the stimulus of the sweetness driving her to drink, she wasn’t drinking, and she got dehydrated and her electrolytes are messed up. So, she had to go back to it. So it wasn’t that she was addicted, but it was more of an electro-chemical imbalance that her body had just become adjusted to, I guess. And then the rest of them stuck through the whole two weeks. And what they found, about half of them found, that it did drop their baseline blood glucose by 5-10 points. And half of them found that it had no impact except to deprive their life of the pleasure of diet soda drinks. So, they went right back to it. 

So, I think it’s very individual. I think some people are going to see a reaction if they cut the sweeteners out. But I think it depends on the sweetener too. So, I started doing more research back to allulose. I’m like, well, obviously there’s more to the sweetener thing than I thought. And I started learning about all the different kinds of sweeteners and high intensity sweeteners versus bulk sweeteners, sugar alcohols, different sugars. And, I did find this new sweetener, well not new, allulose. Allulose is a rare sugar. It’s been around. It occurs in nature and so they’ve been doing research on it for decades and interestingly in 2015, they figured out a way to produce it commercially using an enzymatic process. So now it’s similar to erythritol. Erythritol is produced from cornstarch. They take cornstarch and they do a series of chemical reactions and you get erythritol.

Sometimes it comes from birch bark as well. Is that right?

If you buy it commercially, do you honestly think that there are giant factories out there stripping birch trees of their bark?

I don’t think there are giant factories, no. I have noticed that the occasional product does say it comes from birch as opposed to the usual. The usual is cornstarch, isn’t it?

Yes. I don’t know if anybody is actually out there stripping birch trees of bark, Daisy.

No, I mean it kind of seems a bit of a laborious and not very helpful for the birch trees.

Cornstarch I think is where 99% of the stuff comes from. And I don’t know about the other 1%.

There are some very naked birch trees somewhere. That’s the 1%.

The erythritol birch orchards in southern France I hear are beautiful this time of year. So allulose is found naturally in figs and jackfruit and raisins, maple syrup. And I suppose, prior to this discovery, the way they made it was by squeezing figs or jackfruit and then refining from there. But now they have discovered a way to make it from corn syrup. So, using corn syrup in a series of fermentations and refining and whatnot. So now it’s commercially available and the research on it, unlike the research on sucralose, the research on sucralose is all about does it really cause intestinal bowel disease, or does it just make the symptoms worse if you already had it? It’s all bad, there’s nothing good. 

But the research on allulose is crazy good. We’ll see it being used in a much larger way over the population. Maybe some people will end up having negative reactions. But right now, the research is on people and also dogs, rats, tapeworms, planaria. The research is 100% positive. It increases insulin sensitivity. It decreases postprandial blood glucose response. It helps people lose weight. It helps people with their hepatic fatty liver deposits. It seems to be a health boon in almost every way. It increases GLP-1 secretion, one of the talks at low-carb Denver got into the incretin hormones. And so GLP-1 secretion is good, it’s sort of a counter hormone to insulin. The important thing is it tastes just like sugar. I mean almost, its 70% as sweet as sugar. But the chemical properties that it has in terms of crystallization and freezing point and bulk and various other, mouthfeel and and aftertaste are very similar to sugar. The fact that it’s less sweet is a problem.

I actually quite like the fact that it’s not as sweet as sugar. So this ice cream recipe that I been playing around with over the last few days is actually just an adaptation of a Mary Berry recipe. I’ve made a few tweaks, but I’ve pretty well just subbed out the sugar for allulose at the same amount. So that has effectively made it 70% as sweet. It’s not as sweet as the original recipe. And actually, less so because I changed some of the quantity ratios so effectively it was even less than that. But that I think is a good thing for most people, especially people who’ve been on Keto for a little while. Their sensitivity to sweet increases quite a lot. 

So actually, having something that’s a bit less sweet, 70% is quite a nice sort of drop in sweetness. Isn’t it? I think anyway that’s what I find. I find the problem with quite a lot of Keto products, especially things like cookies. I found the ones I’ve tasted anyway are so ridiculously sweet. They’re too, too sweet. You want to drop that sweetness down because when things are too sweet, you can’t actually taste the flavors of the ice cream or the cookie or whatever it is you’re eating. Can you?

Yeah, I agree. I feel like I’ve just had a mouthful of sugar alcohol and that’s pretty good. Yeah, it’s interesting. I’ve been doing a lot of direct sales every weekend. I’m going to the local farmer’s market with Will and we’re giving away samples and trying different recipes and seeing how people like things. And these are people that are farmer’s market patrons, so most of them are not Keto, although I’ve been very happy to meet some Keto people there that are just delighted to meet other Keto people. We could do the secret Keto handshake. And they buy lots of my stuff and they love it, which is great. But just the general populace, I pitch this as healthy, all natural, mostly organic, vegan and soy free, dairy free, gluten free, etc. So, it appeals to a lot of the general populous there that go to the farmer’s market and they are not used to having something that’s natural and sugar free. And so, when I say that they’re a little suspicious, they’re like, so is this going to tastes like crap?

Yeah. Cause that’s the usual payoff, isn’t it? That’s what usually happens. It ticks all these boxes. It’s really good for you, it’s good for the environment, it’s good for all this, but it tastes like pants.

And that’s what they expect, to taste like pants. And then their eyes light up like, oh, this is really good. Is it really, is it really sugar free? There’s gotta be sugar in it. I’m like, no, it’s really sugar-free. So, it’s great having that feedback. I’ll ask them for like their critique, would you change anything? Well actually, I really liked it. It’s not as sweet as I was expecting. I was expecting it to be really sweet, but it’s not, and I really like that. So, I think even the average American consumer, at least the people that attend the farmer’s market are wanting things that assault their taste buds at a lower intensity.

That’s true actually. I think, yeah, a lot of it is just a case of that’s what’s available. I have a friend I cook for quite a lot. One of the things he really likes about the desserts that I make, that they are less sweet. It’s something he always comments on. He said, you know, I really enjoy the things you make because they’re not overly sweet. I can taste the chocolate, I can taste the coconut, I can taste, the flavors that are in it. And he really likes and comments on the fact that it’s not as sweet as something he’d buy it Tesco’s or whatever. So, I think you’re right. I think actually that most people wouldn’t complain about things being less sweet in general.

I think the only problem with allulose from my perspective, well it’s expensive. But also, people do have, depending on their gut biome and the amount of allulose they eat, some people do seem to have, I’ve experienced this myself, just literally explode. Something you mentioned, erythritol is pretty well tolerated. Some people have a reaction to erythritol.

I think that’s true, actually. And I think if you haven’t had any for a while and you go back to it, that happened to me with the first batch of ice cream that I made. I hadn’t really had any sweetener like that for a while. And I don’t know whether it was that or whether it was something else I ate, but I didn’t feel at all well. Actually, I was sick, and I wasn’t well at all, but have been fine with it since. 

I’m the kind of person that will push through it when it comes to ice cream, I’m going to test it the next day. I’m not going to believe that that ice cream made me out. I’m gonna try it out the next day. If maybe I’m ill three days in a row after eating the ice cream, then I might decide to drop it, but when it comes to ice cream, I’m going to keep pushing through and it’s been fine since you’ll be, you’ll be pleased to know. In fact, I had it for breakfast this morning. That’s the only problem with me when I make things like that, and I can’t make them too often because I do tend to overeat them a little bit. But yes, I can certainly attest it that it works very well in ice cream, incredibly well actually, at least in the recipe that I made.

Excellent. I’m really looking forward to Carrie Brown coming out with allulose ice cream recipes. I know she’s been experimenting.

Yes, she’s right on the brink of, I don’t know what it’s going to be. I don’t know whether it’s going to be a general adaptation that you can use in all her existing recipes or whether it’ll be a whole new bunch of recipes where it’s different for each flavor. I’m not sure yet, but apparently, yes, she’s right on the brink of, of having perfected. I know when she first tried just subbing the allulose for the xylitol in it, it didn’t work. She said it tasted okay. It was the texture. She said it was kind of crumbly, an odd sort of texture. And you know what a perfectionist is. So, she’s not going to put it out there until it’s right. But I know she’s been working very hard on it because a lot of people don’t like using xylitol. So, she’s been working very hard on allulose alternatives.

Yay! I can’t wait. Will makes allulose ice cream for us and he has sometimes really just hit the money, where it tastes to me just as good as Haagen Dazs. But his flavors are vanilla or chocolate. And, Carrie’s are Baskin Robbins, Haagen Dazs and Ben and Jerry’s, all one excellent chef woman.

Incredible range of flavors. I’m very simple with mine as well. I usually start with vanilla, but I did put some chocolate chips in. It’s very delicious. I will send you the recipe when I’ve perfected it. I will share it with everyone. Like I say, it’s not really my recipe at all. It’s Mary Berry’s recipe that I have Ketofied, but it is delicious, and it absolutely stands up to Haagen Dazs, and as Haagen Dazs connoisseur, I think that tells you something. We need to know where to find you and all your delicious candy. And presumably, I know you send your candy out mail order, presumably these other products that you’ve teased us with are not at that stage yet by the sounds of it.

I invite everybody to hit me up on Facebook either, be my personal Facebook buddy or our company Facebook page is Moons Grove Farms. We’re also on Instagram and I have a website, it’s moonsgrovefarms.com. We’re on Amazon, Etsy, and that’s it. Well no, there are a few stores that are stocking us, but nothing nationwide yet, although I have dreams.

What is only been a year, less than a year.

Much less than a year because after Ketofest I got my butt in gear and started putting the company together. But wow, there’s a lot of work involved, and it took me awhile to get everything all in order. I don’t know if we have time for a story about Amazon.

Well I was just gonna ask you actually, because I know you had some hideous problems with Amazon, didn’t you?

I did. Now 50% of all online commerce goes through Amazon. So, I knew that if I’m going to sell anything online, we gotta be on Amazon.

Yeah. You’ve got to be in bed with them, really haven’t you if you want your products out there on a big scale.

So, I went through all the proper steps. I got FDA approval for my products. We have a commercial kitchen, we have packaging and nutrition facts labels and professional photographs, the whole thing. An Amazon representative helped me set up and everything was good. We flipped the switch, we started selling. The first couple of days people love this stuff. We’re getting five-star reviews. And then my account’s been suspended, and it was right before Thanksgiving. I’m like, but there’s people that need my candy for their Christmas presents and stuff.

That is the worst possible quarter, isn’t it? That’s the quarter that everyone goes on about. That’s when you make all your money.

So, they say. And my Amazon representative is like, well, I don’t see what’s wrong. I’m sure it will be resolved really quickly. I’m like, okay, I love Amazon. You guys are the best. You will fix it. Okay. So, a few days go by and I get no notice. Well, we’ve permanently suspended your account because of extra high cancellation rates. I’m like, I haven’t had any cancellations. So how could it be an extra high cancellation rate because my cancellation rate is zero. And the sales rep said oh, they must’ve made a mistake. I’m sure they’ll clear up. 

Another week goes by and nothing. And then he said I’ll talk to my boss. And the boss tried talking to the boss, the other department that did the suspensions and the boss was like, I don’t know, they won’t return my email. So, they went back and forth another couple of weeks and now it’s Christmas. Well, this is all messed up. And then the guy he’s like, well, I’m sorry, I don’t know what to say. So, I hired a lawyer. In fact, I read a story. It was in the New York Times about how Amazon was doing wrong to sellers, which still continues, and how sellers have had to resort to different means to try and get Amazon to treat them right. And one of the people in the story was a lawyer in Atlanta who has fought with Amazon on a number of occasions. So, I contacted him, and he took me on and he happened to have a direct connection to Jeff Bezos. So, he wrote Jeff Bezos, and it took a few weeks to get a response, and we never got a direct response from Jeff B. But I got a call from the Amazon suspension department. They are like, hi, Jeff Bezos asked us to look into your case and you’re un-suspended. Good luck selling on Amazon. So, I don’t know what I did wrong, if anything.

So, no explanation and it took that kind of wrangling to get switched back on.

Yup. About three months and a lawyer and Jeff Bezos’s personal intervention.

And you miss that fourth quarter of sales.

Totally. So, I don’t know. But I’m happy to be on Amazon, so, thank you Jeff, I guess.

Thumbs up to Jeff.

It gave me a very deep appreciation of today’s economy. They got the power.

Absolutely. Yeah. That is the problem, isn’t it? There’s nothing much you can do when computer says no. So, you’re going to be at Ketofest with your candy. Well, I suppose it would be difficult. It won’t be like the local farmer’s market. You won’t be able to bring fudge.

No, you’re wrong about that. I’ve been talking with, our Ketofest organizers and, the local health department and there won’t be a problem. I am definitely bringing some new products to Ketofest. Hopefully we will have the fudge recipe down. We have a fudge recipe down. It’s just not shelf-stable. It has to be refrigerated. It’s amazingly good. You don’t have to worry about eating too much of it because it’s so rich, you have like a little square.

That sounds like a challenge. Your candied ginger, what is that supposed to be? Two servings.?

Three actually.

Well a bag easily is just one serving for me, and I can easily do two bags. You’re talking to a little bit of a greedy piggy when it comes to things like that. So, I’m not sure one little square with fudge with suffice for me.

By the way, we’ve changed how we are making the ginger and the orange, number of the peels actually, in response to getting some more experience making it and selling it. So, I think it’s much better now. And if you tasted the ginger or the orange before, I’d be really curious to get your reaction this year because I think it is loads better. Will says he is ashamed.

I think there was a difference in some that you very kindly sent me home with a huge amount of candied ginger, which I won’t embarrass myself by telling you how quick that can seem to go, but there was a difference. Some of them were a lot sort of thicker cut and juicier, I think that’s what you were saying. It’s moved more towards that. Yeah, definitely brilliant.

And they also seem to be hotter.

Which is not a problem for me. I was speaking to Karen Ogilvie and I don’t think she can eat more than one or two pieces, they’re too hot inside now. Love it. I tell you what does really temper it, what I’ve discovered if you eat, I’m just showing myself out now to be such an absolute pig. But if you eat the candied ginger, and I love it hot, I don’t mind that it absolutely sets my mouth on fire. The hotter, the better as far as I’m concerned. But if you eat it with super dark chocolate, the chocolate tempers the heat. I don’t know why there’s some kind of synergy between the two that it takes the heat out of it.

Nice. I gotta try that.

I can’t explain why it tastes very good. I mean, chocolate covered candied ginger is just delicious anyway, but for some reason it takes the heat out.

We’re working on that.

Yeah, I remember you saying that.

We’re working on incorporating the dark chocolate covered orange rinds and ginger.

Very delicious.

So, I figured out we’re going to change the packaging on the ginger. We’re going to call it nuclear ginger and put skull and crossbones and flames. So, people really understand we’re serious. This is spicy ginger.

And a lot of people like that. They like the challenge as well, don’t they, or eating hot? And funnily enough, I’m actually not the kind of person who likes, I like a bit of heat in a curry say, but I don’t like the super-hot curries. If it’s too hot for me, I can’t taste it. But when it comes to your ginger, I just love the heat in it.

I made a small child cry at the farmer’s market. We were giving out samples and the mom tastes it. She was like, oh, this is really good. She gives a sample to her kid. The kid starts crying. Oh God.

I hope you didn’t video that one.

I’m like, I’m so sorry. The four-year-old won’t come back and buy any candy from me anyways. So that’s fine. And I laugh about it now, but yeah, we’re gonna re-label that nuclear ginger. And the lime, if we continue making the lime, we’re going to call it lime jerky because we can’t make those lime peels soft and chewy. There’s just no way. We’ve tried different things. It just doesn’t work. So, it’s hard jerky-like candied lime peels. I don’t know. Some people may love the flavor. So, when I proposed that we stop making it, they’re like, “No!”. But a lot of people aren’t expecting it to be so tough and it’s really, super hard. So, I don’t know. But the nut bars are incredible, and I can’t wait to bring them to Ketofest and let people sample them there.

Oh, I cannot wait to sample them. I shall let everyone know what they taste like.

Excellent. It’ll take a while for me to wrap up and get FDA approval and do the nutrition facts labels and the packaging and get them on the website, but I’m happy to be able to take them to Ketofest and distribute them in person.

Yeah. Well something for us, Ketofesters to look forward to.

Among other things. I can’t wait. Bacon bar!

All the things.

All the things.

Yeah. Hog roast. The plaza square on the Saturday is just going to be full of all sorts of delicious things to eat.

And demos. I’m actually doing a cooking demo with Karen Ogilvie.

You are? And what have you finalized on? You’re doing muffins, aren’t you?

We’re doing muffins. Actually cupcakes. I’m not sure of the technical difference between muffins and cupcakes.

I’m not sure, icing maybe.

Icing, that’s it. So, we have muffins where we’re going to be including diced candied orange peels from Moon’s Grove Farms. Of course, if people want to make it without that, that’s fine. But then we have this lovely dark chocolate allulose fudge icing that we’re going to be swirling on top of those things. And also, we’re still tinkering with the recipe for either a sour cream lemon or sour cream lime cake with a cream cheese icing on top. Frosting, buttercream, cream cheese, something like that. Anyway, we’re playing with it right now. When I say we, I mean Will is playing with the recipe right now. And we are really excited, Karen and I, to do this cooking demo. It is going to be a lot of fun. Karen and I are actually, in theory, starting a podcast. We keep trying to make time for it. It’d be Keto book bookclub and if we can get that launched before Ketofest, I will be thrilled to, pleased as punch to hope that people have a chance to listen to it. I think a Keto book club is something whose time has come.

I do, I’m very excited about it. We’ve been talking about it, haven’t we behind the scenes for a while. You told me about it quite a while ago. And yes, I think it will be a great format. Like you say, it’s not something that’s out there already. It would be a great new podcast I think for the Keto universe.

I’m excited about it. And now that Karen’s schedule is freed up a little bit, with her son not being in school, she has less errands and running around and PTA business to do, so we’re gonna hit it pretty hard, in theory.

Perfect. I can’t wait for that. That sounds like you’ve laid down the gauntlet there. That will be nice to be telling everyone at Ketofest that it’s launching.

That’s right, Karen. Karen and I are both psyched and we both have busy lives so it’s hard to fit it in. I have no idea how you do it, Daisy. You are a super woman.

I was just going to say, yeah, obviously I know what it’s like in it seems like a huge challenge and it is very daunting when you’re starting because there’s so much to organize to launch it in the first place. That’s the thing. And there’s this other element that holds you back a little bit because you know that once you’ve started, you’ve got that commitment. If you’re doing a weekly podcast, as soon as you put the first one out, that means you’ve got to be putting one out every single week. And yes, it is a big commitment. I mean now that I do every part of it myself, I’ve worked out that each episode takes a minimum of a day and a half, probably closer to two days really, to produce the hours episode that you listened to, and all the things that go with it. So, all the social media and the show notes, everything that goes into producing and promoting that episode. Yeah, and it’s the best part of two days’ work. You’re taking on quite a lot. I mean it’s good when there are two of you, obviously you can share the load a bit and as everyone knows by now, I think, I’m a bit of a bit of a perfectionist nut job when it comes to editing. So, it probably does take me a lot longer than it does for other people.

Maybe. I’ve certainly heard some podcasts out there that clearly have not had professional editing of any sort. So, maybe a certain amount of sloppiness is acceptable.

It’s finding the balance. Yes. It’s that whole don’t let perfection be the enemy of good thing. It’s the finding the balance between the two. And I’m getting there, I’m getting to the point where I’ll leave in a lot more of the things that I used to just get so super-involved in taking out.

I don’t think I’ve ever heard bad sound on your podcast, at least to the extent that like I’ve been like irritated by it or anything.

I should hope not. I had good training. I was brought up in the Carl Franklin and Brandon Wen school of podcast editing, so very good training. Absolutely.

Very cool. I’m just delighted if we can get this podcast launched and I say if, because both Karen and I do lead busy lives and have obviously other irons in the fire. I think that terrific fun and I love reading books about Keto, as does Karen. So why not help other people?

And as does the community, I think. It will be very needed. I not sure if needed is the right word. Do we ever need anything? I think it’s a podcast that people will be very interested in and will also enjoy being involved in as well. That’s the thing with the book club, isn’t it? That the listeners can become involved in it and be part of it.

And we can have discussions about what does this part mean? Did you try this recipe from this Keto book? Is this Keto author insane? That kind of thing. It’ll be fun.

I think it’s a fantastic idea. And you know, good for the authors as well. It works in all different angles, isn’t it? Promoting their books to the community, getting feedback from the community. Everyone wins. Can’t wait for the Keto book club podcast.

Yeah. I’m psyched. Did you hear that, Karen? Let’s do it.

She’s gonna love you for this.

We’re going to have a great time together, Karen and I.

You are, absolutely. Obviously, I do my podcast on my own, but I do like the dual presenter podcasts. It’s interesting. Obviously, they have their guests on, but it’s interesting seeing that synergy between between the two hosts and often that’s entertaining in itself.

Well, I think Karen and I have different perspectives on things. So, we can inform and engage each other and hopefully our listeners.

Absolutely, can’t wait. So, we’re at that point in the show where I ask you to leave us with a top tip.

Okay, my top tip is if you have not tried intermittent fasting, try it. Trying to get more in touch with my body’s signals for when I’m actually hungry and when I actually want to eat has been an incredible change in my health and my approach to food. Divorcing myself from eating because it was expected and there’s food available. It’s time to listen to my body and say, I think that I don’t need to eat because I’m not actually hungry, and then not doing it. It has been so empowering. So, if somebody is looking to take their Keto practice to the next level, they should try it. It is almost as hard as just starting Keto in the first place, to take control. Not really change how much food I eat, but just listening to my body about when I eat it and saying this is what hunger is, this is just emotional, I want something in my mouth. It has been a real game changer for me.

Yes, I do think it does really help dial in those signals. I found the same. I’m definitely a bit of a grazer, especially when I’m at home and I know the difference, because I can be out gardening on a job all afternoon and I don’t feel the need to be eating all the time, yet when I’m at home and the fridge is there and just, oh, I’m hungry. But I’m not hungry, I know I’m not hungry, I know it’s just I want to pick, because I know there’s some cheese in the fridge or there’s some ice cream in the freezer or whatever it is. Yes, to actually go for period of time without food and to really get properly hungry. It does really help I think if you’re one of these people that struggles with head hunger versus real hunger.

You know what it is for me? I realized eating something feels vaguely productive. Like I have done something, I’ve accumulated resources for my body. So, at a kind of emotional intuitive level, it lowers my stress level a little bit because I have packed on some more resources. So, I’m not going to starve. Nothing to do with physical hunger, just emotional satisfaction because I’m not going to starve today and it has to do with maybe food insecurity or something, but it doesn’t have anything to do with physical hunger. So being able to tell myself I’m going to direct that need to do something productive into a different thing that is also satisfying. Maybe doing a little house cleaning, maybe, buying something on Amazon, doing some gardening that also satisfies that.

It’s weird how you have so much time on your hands when you don’t eat as well, don’t you? I mean, I found that a bit when I was doing my carnivore experiment. How much more time there was, and I can remember when a friend came out to eat, he obviously wasn’t eating carnivore, so I had to prepare some vegetables and things for him and it was like, blimey, this all takes so much time. My rack of lamb ribs or something, it was just a case of taking it out of the fridge, putting it in the oven, taking it out the oven, eating it. The extras that I had to do for him. But obviously it’s a whole new level when you’re fasting, you’re not eating at all. And I know that whenever I do fast, I’m not very good. I need to get a fasting routine. It’s those days when you’re not eating, it’s like, oh, this extra time on your hands when usually you’re either preparing, cooking or sitting down and eating that food. It actually takes up quite a chunk of your day, doesn’t it?

Yeah, absolutely. Or I’ll be out on a business trip with colleagues who obviously are not Keto or fasting. And it’s a good third of the day that’s spent sitting, eating, getting food, going into a restaurant, whatever it is. Even more than a third of the day. And if I say, you know, guys, I have to make up an excuse, so it doesn’t sound weird but I’m not eating with you. I’m just going to go back to my hotel room and get some work done. That gives me back so much time and I need it. Because I’ve got a lot going on in my life, Daisy. Woo. So, it works out pretty well.

Yeah. Busy women just as you were saying, you’re just going to try adding a podcast to that. Good luck finding the time.

Better time management. Of course, I cannot neglect my partners or my family or the garden or the pets or anything. So, it’s a matter of priorities.

Yeah, I have the advantage there. I just have my dogs and cats really. I don’t have to think about entertaining other humans. Now I do keep forgetting to ask people, so I will just throw it in at the end here. What your Keto looks like on an average day when you’re not fasting, obviously.

Definitely. Black coffee or sometimes with a little bit of heavy whipping cream. And about the coffee, I’m serious about coffee. I’m nuts about it. We have our own home roasting machine. We import beans from either Costa Rica or Tanzania. We got some lovely Tanzanian peaberry right now. So, we roast our own beans, grind them. We have an espresso machine.

Because the roasting is important, isn’t it? Sort of the temperature of the roasting and how long you roast it all really affects the flavor, doesn’t it?

Absolutely. So, you have different roasting profiles that change the temperature of the roast throughout the roast cycles. Fresh roasted is totally different than stuff that was roasted a week ago. If you’re buying stuff in the stores in little bags, it might’ve been roasted a month ago and wow, that’s very different. So, the fresh roasted beans changed my life. I’m fully caffeinated now, Daisy.

So, when you say its worlds apart flavor-wise, but what is that difference?

Well, it actually changes if you have coffee that’s been roasted within the past 24 hours. The notes of the coffee are more floral, more bright, has this dimension to it that goes away. A lot of the essential oils evaporate within that first 24 hours. A lot of out-gassing so, it’s less acidic after 24 hours. It’s different. The chemical composition is different.

So just like wine then really, it’s the difference between having a Beaujolais Nouveau to having something that’s been aged for however long.

That’s it. Exactly. And some people will say, some Beaujolais are too young, or they don’t have that depth of character. So, it’s not always the case that fresh roasted is better. It’s different and sometimes I really love it, but sometimes letting the roast sit for at least 24 hours to out-gas and mature a little bit. Then that first 24 hours to a week period. I think that’s where you have the richest flavor and then maybe after a week a lot more of the oils have started to either mature or evaporate a little bit. So, the flavor is less intense. 

Anyway, that’s how my day starts. Cup of fresh roasted coffee and water, tea. I have 20 different kinds of herbal teas that I love. I don’t do soft drinks with any of those nasty sweeteners. We have seltzer often; I love seltzer or other kinds of naturally sweetened things. Not naturally sweetened, naturally flavored, like little bits of lemon juice or lime juice or whatnot. And then food wise, a little left over from last night maybe for lunch if I feel like it. Or we have chickens, so eggs are pretty common for a meal, either hard-boiled or scrambled. Or I’ll make a quick frittata. 

And then dinner, Will has usually cooked some large piece of meat that we’ll slice. He just roasted a smoked brisket, nice chunk of beef brisket on hickory wood, also a rack of ribs. So, he’ll come up with something and sometimes he gets super creative and comes up with some crazy dish. He did Indian butter chicken last night with cauliflower rice and a salad and a Keto coleslaw sweetened with allulose. But some days it’s just burger, patty of ground beef with cheese and bacon, then the salad. And honestly that’s the best.

It sounds pretty handy having a live-in chef.

It really is. I highly recommend it.

So, I mean overall, as we mentioned earlier. Fairly simple really, it sounds like you’re a two meal a day as well, that that seems to be the most common pattern. I think two meals a day.

Generally. Yes. Sometimes one, sometimes none, but generally two.

And so, when you fast, do you have a regular fasting routine? You talk about intermittent fasting and for how long do you fast?

Generally, I will do food-less Mondays. Where I just hate Mondays. So, I don’t want to sully Mondays by doing anything pleasant like eating. I just want to have full, pure hatred for Mondays. So, that’s it. No food Mondays and then, generally I’ll eat, either breakfast or lunch, but not both. And then dinner. That’s it. Nothing fancy.

One of the things that is quite often leveled against fasting is that, you know, I’ve heard the argument that people just make up for it. They compensate on the days they’re eating and eat twice as much. But I found the absolute opposite actually the day after. If I fast, I tend to fast for either 24 or 36 hours. And certainly at least the first meal I have is probably half the normal size. I tend to find that I eat less on the day after I’ve fasted, not more.

I think that it kind of re-calibrates my appetite and stomach to not eating. And so, you can’t really just go right back in and have a huge meal. I’ve done five-day fasts on a number of occasions. I think for health purposes it’s great to really get that deep into autophagy. So, I think maybe once a quarter to do that, but not for weight loss purposes. Because I did find that, after five days of fasting that in the weeks afterwards that I did have a heightened appetite. So, I don’t think those longer fasts, for me anyway, helped me lose weight. But a short fast, food-less Mondays, skipping breakfast or even skipping breakfast and lunch sometimes. That doesn’t seem to move the dial for me one way or the other, it just helps. I think it keeps my system more insulin sensitive to do it occasionally. Sort of like exercising, which I should do more of. I have a treadmill desk. I work from home; I use the treadmill desk every day. And I love it. I highly recommend it. That’s my other top tip. Intermittent fasting and get a treadmill desk if you work from home.

I’ve never heard of treadmill desks. I’ve heard of standing desks, but I have not heard of treadmill desks.

Standing desks actually don’t do that much good for you because you’re just standing still. You’re just standing. I mean, it’s maybe a little better than sitting, but maybe not. Because you’re still just standing there, still. It’s not natural. It’s not natural for people to be sitting or standing in a still position for long periods of time every day. Walking is natural. So, I have a treadmill and I have a hutch that goes over the treadmill and my laptop sits on top of the hutch. I don’t do super concentrating work there. So, if I’m working on software and coding or writing, no, I have to sit down cause you need to concentrate. But for surfing, answering email, doing Facebook, the treadmill desk is perfect.

Interesting. I’m going to be imagining whenever I read one of your Facebook posts, while she was watching this, she was walking on her treadmill desk.

Very frequently.

Well, it’s been wonderful catching up with you and finding out a bit more about you. Thank you very much for sharing your time with me.

Oh, I thank you for sharing your time. It’s delightful, you’re one of my heroes and, I’ve just been squeeing inside this whole time. I love what you do, Daisy.

Thank you very much. And I look forward to that hug at Ketofest.

Me Too. Me Too.

See you soon.

See you soon.