Welcome to the sardine challenge. So, the only thing on the menu for the next 3 days is sardines. I challenge you to try and eat three of those cans in a day because that's a hell of a tool to help you get into a ketogenic state.

And when you're in a ketogenic state, it helps burn fat, muscle mass gets higher, preserved. I've seen patients that have reversed their gray hair and that brain performance, concentration, and energy. All of those things improve. And so, I'm going to teach you how to do an advanced ketogenic diet.

Dr. Annette Bosworth is the insulin resistance specialist. With over two decades of experience, she's discovered that the key to your health isn't more treatments. It's to get into a ketogenic state.

Most people have been making buckets of insulin without knowing it. But when you have excess insulin, it's a chronic disease maker. It is what makes high blood pressure. It is what makes cancer. It is what makes debris in the brain, which is linked to depression, brain fog, Alzheimer's, and Parkinson's. And so to reverse the high insulin state, I really push my patients to do the ketogenic diet. And what unfolds is your best life ahead within a year. Like I really rescued my mom from the edge of death.

Dr. Annette Bosworth or should I call you Dr. Bos. What is it that you know and believe and understand that you think the general public doesn't know believe and understand?

that most of the reasons people come to see me could be reversed if they knew how to make ketones on a regular basis. So, I'm an internist. Uh that means uh if you go to an internal medicine doctor and we don't know what's wrong, you're going to die. We take care of tough puzzles and we do this over long management, chronic disease management.

So, I've got 25 years of studying chronic problems that deteriorate the quality of life. Lifespan, health span, both go in the toilet when you're chronically seeing me. And you could abort all of that destiny if routinely you were making ketones.

So So you're basically a chronic illness doctor.

Chronic disease management is absolutely it. You know, I love the way uh Peter Aia uses medicine 2.0, which is what we are the masters of managing it, making sure the prescriptions are there, making sure you are treating all these problems. The internist being one of your best buddies cuz you're having to see them routinely. You got to get the meds refilled. You got to check for the side effects. It's a mill.

What is medicine 2.0 in your definition?

Yeah. So, I can keep you from dying from childbirth and infections. And I have an antidote for every one of your symptoms. We are in a world where medicine has answered a lot of problems. Little things like high blood pressure. Little things like it's a few extra pounds around the middle. Little things like brain fog. Oh, my eyes are aging. All of these are signals that your body has made more trash than it cleaned up. And there were some rules to humans that you missed.

And for for my listeners that have clicked on this conversation, what are they going to get out of giving us their time and staying with us and listening to this? What is the end goal going to be for them in their lives?

Listening to the way I talk to my patients and teach them the steps how to reverse the medical problems that you've already got on the roster. And by doing that, the freedom is to be the kind of grandparent that you dreamt of, but you've surrendered can't be there anymore.

And what is the list of predicaments or illnesses that are relevant here?

Most common one is being overweight and a brain that's not working right. What really is behind all of the patients I've seen for 25 years is we're working on peak brain performance. Even if you don't think about that, that's what I think about. So when you come in and you're 55 years old and I can see the worry of Parkinson's headed your way, super young is 55 years old with Parkinson's. That is a brain that's got too much trash and you don't know it yet.

And I mean in the history of Dr. Bos versus Parkinson's, Parkinson's has like 3,500 patients. I have zero. Parkinson's wins every time. And the the biggest moment of people who have chronic problems under the hood is they have no idea that it's coming. And once that lands, the reversal is much worse.

seeing it 10 years before it's supposed to be there. This is a gift of saying, "Let me show you how to undo that. Back away from the edge." It's that brain function that you're going to miss the most when it doesn't work. And it's linked to all of these things like the arthritis, the, you know, weight around the middle, the high blood pressure, the severe uh connection to mental uh approach, meaning you can say depression, but people say, "Oh, I don't have that diagnosis." I'm talking about a brain that doesn't want to engage, that doesn't find joy in their life anymore because it's been too many years since they took out the trash. Let me show you how to take out the trash. And you're going to have to do it a few times, but what unfolds is your best life ahead within a year.

So, you're going to teach me how to take out the trash.

Yeah.

The trash in my own brain.

Yep.

And if I take out the trash in my own brain, how is my life going to be better?

You live in the 21st century where there's lots of processed foods and lots of ways that your body did things without telling you. So any injury that you've had, like a joint injury that keeps coming back every time you injure it, it it is a little easier to injure the next time. Is there a ring around the middle that's more more than pinch an inch? Is there a uh distance in time where you say, "I can focus for this many hours, but I can't do it for this many hours anymore." Those are all places where if you did this, if you were able to say, "Don't stop taking out the trash." Several times a year, several times a month, if you ask me, then you never have to come into this world that I just see people, they're they're in quicksand. They're up to their waist and getting them out. They need a real lifeline.

So, can you explain to me like I'm a 12-year-old what insulin is and the role it's playing because you know I guess we're focused here on how to I guess longevity aging.

So, insulin insulates. Okay. So, think of it as it makes you fluffy. It makes you it puts the fat on. Uh it's got some other roles too, but we're going to talk about chronic diseases here where it's not a scarcity problem. You you make plenty of it. And when it's in excess, it will store energy for when you go through a famine. It will also cause you to grow. Now, grow means get a little fatter, but it also means things like their skin gets a little thicker. They have skin tags.

And what I always think about is what's going on in their brain. And when that insulin is high for years and years and years, uh, just like yours, because if if you didn't eat the rest of today and then you got up tomorrow morning, it would be about that long after a late meal last night, that's how long it would take you to say, "Okay, we're back down to where we started from or where we should be in the morning."

For someone that's never heard the word insulin before, there's some context to give on in terms of what it's doing. So it's coming out like a transporter in helping put away the sugar or deal with the excess sugar.

Right. So it is what lifts Yeah. It lifts glucose or sugar from the circulation into a cell. That's its first primary job. But if all the cells are full, their storage is full, it's going to start to pack it into the liver. I mean, let's say all those stores are full too. This job uh of the of insulin, this hormone oozes into every part of your body to say make sure it's got f fuel. Make sure it's got that sugar.

But most people are like what I would guess you are. Most of the time you don't you aren't a shortage of sugar. And so it feel it tops things off and then it will turn things into fat. It's too much sugar. They can't store it. All the storage is full. So you can send the signal out. Make me some more cells. I need some more storage units. This guy's eating more than he thinks he is. And we're going to be prepared to live through the famine. But in the meantime, turn it into fat. make him a little fluffier.

Is that the only consequence of high insulin is that I'm gonna I might be a bit more fat.

No, that's just the one people hear about the most. When you look at chronic disease management, it is the growth of of the diseases of the inflammation. It's the making of the trash. So, I keep saying, you know, you you need to take the trash out routinely, which means that insulin, which has been smoldering higher than you think it is because you live in today's world, because you eat processed food, because you eat super late at night, uh you don't go two to three days without eating. You've you've got storage filled in your body. The high insulin levels in a healthy person hides that the debris is being made and you don't know it.

It hides it.

Yeah. It's going to put it in between two cells in your brain. It's going to go in between the skin cells. The trash doesn't get taken out until the insulin gets lower. And unfortunately, most people have been making buckets of insulin without knowing it.

Are there any signs that I might have high levels of insulin or insulin resistance?

Abdominal girth is the first thing that is the first place that the fat goes. when you have excess insulin which is this chronic disease maker. Uh it is what makes cancer. It is what makes high blood pressure. It is what makes debris in the brain where call it depression or brain fog or Parkinson's. It's the aging of the brain.

It's linked to all of those things.

All of those things. And that excess insulin nobody tells you about. But the symptoms are, dang, I feel like I got to eat every two to three hours. Uh their debris uh or their fuel keeps running out.

So, how do I know if I have insulin resistance? What what are the key signs? You mentioned skin tags. I've never heard that term before.

Yeah, skin tags are not moles. So moles, you can feel this bump on your on your skin, right? But a skin tag has a neck and like a little mushroom. And it's the most annoying thing when patients come and say, "Well, I just tried to cut them all off, but they kept bleeding." I'm like, "Do not cut them off." They'll fall off when your insulin's lower. So that's the first place. It'll be found in their armpits or places where their skin rubs.

You talked about velvety skin. As well being an indicator.

Velvety skin is this Latin word acanthosis nigricans which is fancy word that means the skin is darker and thicker. So the the places that usually happens is the back of the neck. And you'll hear you know stories of I tried to wash my neck. It's it's dirty all the time. It's not dirt. It is the way the skin is under the the curse of high insulin. And you see it in teenagers all the time now. They put on weight and their growth hormones are already doing that teenage thing. Now you put high insulin in there and they have this dirty neck syndrome or on the creases of their elbow. It's just darker here. Uh that is pathology that's not normal from high insulin.

What's this thing about hairy toes that I was reading about?

Right. So, as my patients age, so most my 55year-olds that have had high insulin, I will tell them, "Look at your toes. They're supposed to have hair on them." And when your body has had that high insulin state for a couple of decades now, it will start to say, "We don't send resources to a couple parts of the body anymore." And the follicles in their toe are one of them. Like, just stop growing hair on your toes. And there's an ascending problem with this where the toe starts, then it's the ankles, then it's up to the knees. and they don't have hair anywhere on their lower extremities. It is a process that started from high insulin.

So there's these two energy sources. One of them is the the glucose. One of them's which is from like you know eating pasta which I ate last night. Um so that probably put a lot of glucose in my my blood. I probably had a high glucose spike and then insulin came out to deal with that. And then there's ketones, which start to appear when I'm fasting or when I haven't been eating carbs for a while and my body's looking for an energy source. So, why doesn't our body just run off ketones?

It will as soon as you're done lowering your insulin. And I mean, insulin grew in these patients. They didn't know that it was growing high. They went to their blood test and their glucose looked normal. What nobody checked for years is how much of that insulating hormone did it take to keep the glucose controlled. And that's where chronic diseases are are grown in spades.

Glucose, when you want to store it, we put it in a fancy string called glycogen. And it's just an efficient way to store glucose, but as soon as your body needs it, it will unlock all that sugar back into your access back for you.

What you don't realize is, well, how much glycogen you got stored over there? How much is there in storage? And that is what high insulin has been doing. Just put it in storage. Put it in storage. And then when you stop eating, you'll know if you emptied out all your stored sugar, which is some of the regular sugar you just ate, but then all this glycogen, this packaged sugar. How empty are you? I don't know. Have you made a ketone yet? You cannot make a ketone. You cannot burn fat until that that tank is empty.

Okay. So, I have these glycogen stores which last for what, a day or two?

Oh, no. Think of it as brown sugar. So you package the sugar really tight and then you put it in the back of the drawer and it turned crusty because you never lowered your insulin. I have patients that are over overweight and we put them on a ketogenic we put them on a 20 total carbohydrates per day. So super low carbohydrate. It is 15 days before they make a ketone.

Are there any reasons why ketone as a source of energy is better for me in terms of performance other than the insulin reasons that we've talked about?

For starters, when you're burning a ketone, there's less trash. Okay? It is a cleaner uh fuel with less byproduct especially as you age. So you get the longer energy and you have less debris floating around. You hear the word antioxidants all the time. Well, burning ketones is an antioxidant state. It is a and it's in the space where you need it, which is inside that cell.

It lasts longer and it penetrates through that bloodb brain barrier to fuel a brain that even if it's insulin resistant, it can use a ketone. So the problem with somebody who's chronic insulin resistance, their brain needs a lot of glucose to stay on online. and I can try to get it there, but insulin is constantly fighting that. It's a war to try and keep the glucose in their brain. My hack is ketones will go right around that. It doesn't need the same transporters to get across the bloodb brain barrier and especially to fuel those cells in the brain.

So, for performance, um I mean, name a game where you don't use your brain. There isn't one, right? you're you're gonna if you're looking at performance to say let's begin with the sharpest brains and the most focus, the most discipline, the less um impulsivity. All of those things improve when that brain is being fueled with ketones.

So, what have you personally noticed as someone who I assume is in the ketogenic diet right now?

Yes. Right. Well, I've been doing this since 2015. um when you're in a ketogenic state and not in a ketogenic state, uh the the the brain power, the concentration, the ability to keep your mood controlled is is just it is a night and day difference for most people.

And is there a link between some of these cognitive degeneration diseases like Alzheimer's, dementia, etc., and the ketogenic diet? Cuz I know that there's been some research that's underway and has been done to try and establish causality. Is there a link here?

Yeah. You know, it's one of the saddest places where if you look at what patients regret in life, they come into the clinic and they're already starting to say, "I was driving the other day and I I got lost." And when I hear that, we are 15 years too late. It is 15 years of building up trash in that brain that we have to clean out that debris.

And then I had a Down syndrome patient at 40 years old uh in my practice. So her mother came to see me first. She said, "I I want to try this ketogenic diet. Um, I've been helping my daughter who's has Down syndrome. We've lost 100 pounds uh because the doctor said that she might do better if um if we lost some weight and it's not an uncommon thing to see. They have advanced insulin resistance and advanced Alzheimer's earlier in life.

So, the woman comes, she's lost 100 pounds, and during that time, her mental cognition got worse. So, now she's got 100 pounds down, but none of those brain things are better. And I said, "All right, if we're going to do this with your daughter, we're going to make sure we're pricking your finger. It's not going to be fake. We're going to do a real ketogenic diet."

cuz they have ketones of like three within a couple of days, which is the average would be like one if I if they hit one in a few days. I'm thinking, good job. And the mom calls me at the end of the week saying, "Do you think it could possibly work this fast? She is she's, you know, doing the little jobs that she used to do around the house." And I said, "Well, call me again in a week. Let's see how she's doing."

And the mom goes, "The most profound thing just happened. I've taken care of this girl for 41 years. And I asked her the other day if she was doing something. She wanted to go to the church with me, which means she left the house and she was at the church and she was giving her instructions to do this, go around here and put it over there in the give her a little job. And she said, "Do you understand?" And the girl replied, "I understand."

I said, "What's the big deal?" And the mother said she had never said a three syllable word in her whole life. Two syllables is all her brain could ever put together. For the first time in her whole life, three weeks onto a ketogenic diet. And this Alzheimer's diagnosed patient who had Down syndrome now had a brain that was not only working great, it was doing the best mom had ever seen it. And on a ketogenic diet, not only did she lose about 15 to 20 more pounds, but her world opened up again because her brain, which had Alzheimer's, no longer had that diagnosis.

So how do I measure my blood ketone levels?

I mean when I look at um uh giving patients the freedom to say don't don't come to me for the things that I that you can do at home. First thing is be willing to check data. Okay. Okay. So, blood way better than any other way to measure this. We're going to be able to see. Should we have a contest? Which one's better?

my glucose is 86. And my ketone levels are.9.

That's good. Uh so I would say that's not low, it's just good. Right? So when you look at them in comparison, like you want to have a blood sugar that's not triple digit. So that's very good. And the closer the higher you are above 0.5, the better the result. So that's pretty good number.

So if I'm in ke ketosis, what reading would I have on this ketone meter?

0.5 or greater. But it would be also that you have that reading without a triple digit blood sugar. So when I look at the combination of them, I do a little math and say your Dr. ratio is like 95. So you are burning fat right now. Okay. So that's a good sign.

83 and 1.7.

How are you at 1.7? What have you done?

So, I've learned that I would love to be 33 again and be able to eat that late at night. I can eat in the morning. I can have good calories of high fat and good protein in the morning and I've learned to stop eating somewhere around three o'clock in the afternoon.

So, you have this idea of this keto continuum. What is the ketone continuum?

So, the keto continuum is this 12step process, to get into a consistent keto. Consistently keto. Yeah. That you're constantly taking out the trash. The first part is the beginner.

Well, I I like to tell patients that you never fall all the way off of the continuum. So, the first part the first step is really not keto, but it is that they're eating every two to three hours. And if they fall off the wagon, that's usually where they land. So, that's what most people start at. They're eating every two to three hours. They are not keeping their carbs less than 20. Step two is cut your carbs to 20. That's the only thing I need you to measure. And you're going to be able to use a ketone strip, you know, measure ketones in your urine.

Okay. So, day 10 and then it says when we get to stage five in the keto continuum, it says 168 168. Is that

Yeah. So, then we start to use timerestricted eating uh where I want I mean we're going to your body will adapt. People say you can't stay on the keto diet because they go to step four and then they think that that's all they needed to do. There are several steps to reversing this problem and you'll know you have the right step if the ketones are still present in your gut in your blood. Your body will adapt though. So, we start to say, "All right, we're going to learn some new behaviors. We're going to learn what the nothing burger looks like at least for 16 hours out of the day."

And then we get to stage seven where it says 231. Is that fasting for 23 hours a day and eating for 1 hour a day?

And the there's a little bitty line between 168 and 23 in1, but there's a whole bunch of life there. Meaning, we don't actually have patients go from 16 hours of fasting uh to 23. We have them slide it down by an hour, slide it down by an hour, and then we do that harder thing, which is move it towards sunrise. Quit eating so late at night. And then the last stage here, so so step 9, 10, 11, and 12 is prolonged fasting between 36 and 72-hour fasting.

Well, we have 12 cans of sardines here and uh I I I wondered why you you brought sardines with

Well, yes. That's a hell of a tool. When you're trying to teach patients, those stats that you read off a minute ago, they don't care. They need a very clear step on how do I begin. And when you're working with somebody who cannot seem to get their ketones to rise, and I give them a whole list of menus that's too noisy, let's take it down to one food that is high in fat, high in some of the best fats, high in protein, it's whole foods, and it's affordable for everybody under the sun.

Okay. So, you do you do like a sardine fast?

Yeah. So in fact that that 21 day I mean 21 day is that three-week course where I say I will teach you how to do an advanced ketogenic diet where everybody will be peeing ke or making abundant ketones. On day six uh I say all right the only thing on the menu for the next three days is sardines. There's no eating window. You can eat as much as you want. There's no limit to the amount. And what I'm pushing them to do is not only eat a nutrient-dense food but I want them to feel satiety. I want them to feel full.

What about supplementation? What are the key supplements that you don't live without on a daily basis?

Vitamin D turns out to be a really important one. It's a hormone, right? A hormone that goes and talks to every one of the cells in your body. and it tells that cell to be its best version of itself. Unfortunately, it's made of fat. So, if you have high insulin, it gets stuck parked in your fat cells and it didn't get to the cell.

Well, I think the whole world's low on magnesium. Magnesium. Yeah. So, magnesium is required for every little It's like the spark plug in our bodies. It's a little metal and it's how ATP gets recycled and you need it for almost every enzyme. But our food is low in it. Our foods, our soil is low on it. You just got to replace it.

And you know, uh I Stephen, I really push my patients to have ketones around.

What? When you say ketones, you mean external exogenous ketones. Yeah.

When you make it, it is much more abundant. But when you do what people do, they fall off the wag again or they're very insulin resistant, so their body is trying to catch up to to equilibrate, you want ketones put back in circulation because it will spark their liver to make ketones. So it really is a jump start for patients with chronic insulin resistance, chronic problems.

Grandma Rose. Yeah. That's my mother. Yes. She is the reason I'm here. It's been five years. 2015. the the most stubborn patient walks through the door after 10 years of the best health care I know how to give. And she's gray and she looks like a zombie and she's got big lymph nodes in her neck. You don't need to be a doctor to know that she's dying. Her cancer was back again.

And we go to see the oncologist uh and he says, "You need chemotherapy." And she says, "Why Cal, the last two times you did that to me, I didn't know what a sewing machine was." And she made all of my clothes until I was the age of 10. And she's nervous because she has 6 months to live if we don't do something. And she asks me a question that lots of patients have asked me this question. I just sometimes lie. She said, "If it was you, what would you do?"

I said I had been reading about the ketogenic diet on brain injuries and I'd come across a couple of studies on what it can do to a cancer patient, especially an insulin driven cancer patient like she was. I said, "Mom, do you trust me?" I'm like a fool. She said with my whole life.

We didn't tell the doctor. We just put her on a ketogenic diet and said, "We'll come back in 6 weeks." So, she's walking through the door of the hospital. It's 6 weeks from there. And it is like God has just the Holy Spirit is rising out of her. She looks amazing.

And he walks in and he slides the piece of paper over to me and says, "How did you get her numbers to drop by 70%. There's no drug on the market that would do that. her cancer numbers, so the chemo would have dropped it by 30% and the ketogenic diet dropped it by 70%. In 6 weeks and she went from a 70-year-old that looked 100 to a 75year-old who looked 40.

I think on the edge of that story, um I work to resurrect people's health back to a place where they they get their best life. And yes, ketones are a really big part of that. But as you look at the relationships you've got around your life, take the core ones and nurture them to a place where uh your best life comes out of those relationships. find that purpose that you've been designed for and take those relationship with you as you seek that. I I know that's what happened to me. I cared about the ones on the inner circle and I had a one track of this is what I'm designed to do.