This episode concerns our hemoglobin levels and the importance of examining our bloodwork.
Dr. Boz was born into a farming family in rural South Dakota, inheriting hard work and the expectations that all things are teachable. Throughout her medical training and career, she applied her inheritance to teach patients through storytelling and practical application of medical jargon. She has been featured on CNN, Time, U.S. News & World Report, Fox News, & more.
As an Assistant Professor and Internal Medicine Doctor, she helps students and patients combat chronic diseases like obesity, diabetes, depression, addiction, and autoimmune problems. Through the DOD Counter-terrorism, she teaches how to optimize brains & bodies with practical neuroscience. Her favorite way to teach is through storytelling.
Her debut book, ANYWAY YOU CAN, told the story of what happened when her 71-year-old mother, dying of cancer, asked, “Doc, What would you do?”
In the book ketoCONTINUUM, Dr. Bosworth uses David’s story to capture your curiosity and teach you how to stay consistently keto.
In this podcast, How the Ketogenic Diet Affects Your Hemoglobin Levels, we cover:
Why is it so important to take care of the brain?
What happens if you can’t get oxygen into your cells?
The importance of knowing your monthly hemoglobin A1C
How to lower your A1C levels through diet
The correlation between high A1C and inflammatory cytokines
Why Is It So Important to Take Care of the Brain?
If you don’t take care of the brain first, you will never get better. Especially when it comes to diabetes, brain health is everything. As an internist, Dr. Boz would work on managing the chronic problems of her patients. If you want long-term outcomes, the brain must be healed first. The spirit also needs to be addressed when it comes to healing the body. The medical system is broken. When a doctor gives you a specific diagnosis, they need to match you up with a particular prescription. Unfortunately, insurance companies are measuring physicians for their outcomes, and those outcomes got bastardized.
What Happens if You Can’t Get Oxygen Into Your Cells?
As the oxygen goes inside the red blood cell, the red blood cell goes to every part of your body for repairs. People with diabetes will get sore on the bottom of their feet. If you complain about soreness on the bottom of your foot, you want the blood cells to get oxygen. The doctors will need to know if the red blood cells are getting to that infection with enough oxygen because the skin cells need oxygen to go and fix that wound. Also, the nerves need oxygen delivered by the red blood cell. When the red blood cell is full of sugar, you won’t have enough energy or oxygen to fix your injuries.
The Importance of Knowing Your Monthly Hemoglobin A1C
Hemoglobin A1C (hbA1c) measures your average blood sugar from the past three months. Your red blood cells carry oxygen to your tissues using a protein called Hemoglobin A. The higher your blood glucose, the more glucose sticks to the hemoglobin A1C protein. Ideal hemoglobin is 4.5. Until May 1, 2022, we didn’t have a home test for your hemoglobin. You can improve your life if you know your A1C. Until recently, you haven’t been able to get these scores unless you pay a doctor in cash or go through your insurance. Check out this Average Blood Glucose Test to learn more about testing your glucose at home.
How To Lower Your A1C Levels Through Diet
The life of the red blood cells doesn’t change based on fasting. However, fasting will help you lower your average blood sugar levels. Many of Dr. Boz’s patients have been eating processed foods for decades. Their average A1C will be above 5.7 or even 6.0. With an average A1C that high, you cannot reverse the problem. Getting A1C down will be the first course of action. Dr. Boz will tell her patients to eat 20 grams of carbs or less each day. Adults shouldn’t eat more than two meals a day. The only way you will lower your A1C is by consuming less processed foods, eating fewer carbs, and eating fewer meals.
The Correlation Between High A1C and Inflammatory Cytokines
If you have a high hemoglobin A1C, the cytokines get stuck. Then, your pheromones get turned on and signal to the body that there is an infection and you need help. The best response from our body is the delta. Whatever your number is, you want it to peak high and come back down. When you look at cytokine storms, you have so much noise. So, you won’t have enough signal when an infection comes along to call the white blood cells. Instead, you will signal the cytokines to produce and have more of them produce. To reverse this process, you need to stop eating and start fasting.
Dr. Mindy So here’s where here’s where I want to start. And I just, you know, my audience for those of you listening, if you don’t know Dr. Baz, you are going to love this conversation. And one of the things I want to say that’s really fun about connecting with you is that you and I are both educated on YouTube, which is a whole nother platform to educate on. And I, for me, I feel like having a mission and a focus of what I’m trying to do with my videos really, really keeps me on point. And I see that new too. So can you start start a little bit about your mission? And why you are putting these videos out on YouTube? Because it is not for your own self? I know that
Dr Boz right? Yeah, I was looking at the budget to halfway through the year for YouTube. And like, it is not the money generator. No,
Dr. Mindy it’s not. It’s not for that. Definitely. Absolutely.
Dr Boz No, honestly, I think it helps us way of introduction to just the answer the question has, has roots into into my soul. I am. I am a hog farmer’s daughter, I’ve castrated more pigs and you’ve probably eaten I have a I’m fifth generation farm daughter. And I can remember the day that I didn’t want to raise hogs for my whole life. Bigger I wanted out of here, this town is too small 800 people 21 In my kindergarten class, the St. 21. In my high school, my my senior class, what I was missing, dreaming about was this drive to just not be there. And that drive went through lots of long hours of becoming a physician or something I had no mentorship for I had no idea what I was saying yes to. And praise be to God, I had just enough scholarships at the right time to get the bills paid, and then get into medical school. And it was life changing. It was truly a different world that I knew I wasn’t going to do hog tours. But there was a lot of this world that was not lovely. I had worked in a nursing home aging wasn’t the problem taking care of humans loving on them. That’s not the problem. The the side effect of growing up in a community of 800 people is you hold a huge responsibility whether you want to or not about being a community member. And are you helping the community or are you not? I don’t I don’t know how to not think that way. Yeah. As a young budding physician, there’s this choice point in the second year of medical school that says, what kind of physician Do you want to be like, Oh, my God, another life changing life decision. And I can look around to see these other physicians now as role models. And I knew that the internal medicine team, they were super nerdy, they had, they did not have much of a personality. But they knew all the answers to the questions my parents were asking. And my, you know, the elders that I knew and loved. Whenever I wanted to answer their questions, I knew that I was should be asking an internist to figure that out. So as I became an internal medicine physician, I have these aspirations of, of if you go, internist don’t have a good marketing team. It’s a terrible name, like you take care of the internal part. Yeah,
Dr. Mindy it is a horrible day. very vague,
Dr Boz right? You know, like, what, but what it really boils down to is that we are the problem solvers, we’re supposed to have the most complex problems that we think about at the deepest level of science plus medicine, plus Mind, Body Spirit, and translate that into if you go to an internist, and they can’t figure out what’s wrong with you, you’re gonna die. Oh, yeah.
Dr. Mindy Like, yeah, that’s a huge responsibility.
Dr Boz And so I love the complexity, I love the analytics, I was really attracted to shock trauma, because you could calculate a lot of the answers and it seemed black and white. And then I had a baby on time, as planned, but decided I wasn’t going to spend the life there. I was gonna go to outpatient world and be a physician that didn’t have 120 hours a week. And I loved that decision. But I brought to the clinical world of outpatient, a very analytical approach of how do you reverse problems? How do you actually get outcomes that improve the patient? I quickly learned that if you don’t take care of their brain first, you’re never going to get the diabetes to be better. And I became what most interests are is the management of chronic problems. And there is a very strategic way that if you want to have long term best outcomes, brains must must be healed, mental and physical brain must be healed first. That spiritual role is not an absent part of medicine. It is truly part of healing. But if you wanted to reverse them, quickly, you could I’m at least I was taught that you could write a lot of prescriptions. And about the third or fourth year into what I thought as a very exciting outpatient career, we were doing really amazing things. And I had been invited to the White House for taking care of a patient population that was very impoverished, but was getting outcomes at a strategically low cost. And it was because of this analytical thing I was doing in the outpatient world. But outside of those innovative lanes, in medicine, I was matching patients to prescriptions, and you have this symptom, I give you this pill, if that one doesn’t, if that pill doesn’t work, then I then I give you a different pill. If those two pills don’t work, then I test these three things. And then I give you that pill and this pill. And it was just a matching game of these prescriptions. And it was awful. Yeah, this is only one, this is terrible, right? And you get into the pay for performance in medicine, which Ah, great things when you look at the theory. But the application of it became, if you have this, if they have this diagnosis in their chart, you must have them on these prescriptions. And you’re like, No,
Dr. Mindy like they were telling you what to prescribe. I
Dr Boz hate to do that. I mean, your Medicare, Medicaid, you’re not getting incentivized a few more pennies. It wasn’t a lot. But you don’t get into medical school. If you’re not competitive. And right, there you go. So I’m like, oh, I want to be the best. Yeah, I mean, the best is the one who matches them up the easiest, well send out an email send an APB, you don’t need to see me to get on the prescription. And then you just see medicine is broken. Like I remember the first time I got written up, when they’re telling me I have to have this game of match up the patients to all these prescriptions. And again, it’s just night, you know, 2002 2005, right in that zone. And I’m, I’m, you know, still reading statins for every LDL cholesterol. It’s over 160. And you know, doing all the things that we’ll say, but there was a patient in there that was a young mom, I’d seen her every year for the last five years, and she was fine. She was raising her babies and doing a good job of being a good mom. And she needed her thyroid refilled. And she had no symptoms, no troubles. And she writes in saying, Can’t you just refill it? And I said, well, here, I’ll go to the lab, get your blood tested. And I’ll send you a portal message, you know, secure and private, that about what the labs are. And if it’s fine, we’ll refill for a year you come in when you need to see me. And I got taken up to the highest level in the shiny shoes of the corporate medicine saying. And in fact, they said that’s illegal. What? What’s illegal, like, you cannot make a prescription without seeing the patient? I said, Yes, I can.
Dr. Mindy Yeah. Yes, what my degree is for, right.
Dr Boz And so of course, it came down to that you couldn’t collect the copay. If I just did the lab, and we don’t make money on labs, people think we make money. No, the labs make money on labs. I make money when I see you. And I, I’m a thinking doctor, so I don’t make much money. They don’t pay you for thinking
Dr. Mindy or procedure. And when you say they you You mean the insurance companies just so people aren’t clear that may that’s driving those decisions,
Dr Boz right? Insurance companies have a pay for performance, but it’s incentivized by the government’s pay for performance. And it had a great initial thought, which was, let’s measure physicians for their outcomes. Like, okay, right. And then outcomes got bastardized, because they said, Well, if they just do the easy analytical thing, because there’s so many doctors, we have to, we wouldn’t want to actually know the physician and their practice. Let’s put a spreadsheet together to say if they’re a one c is this. Are they on these? Are they on insulin? Right? If they if they have a diagnosis of diabetes, do you have them on a statin? No questions asked.
Dr. Mindy Yeah, right. It’s just a one to one one pill one problem situation. Yeah.
Unknown Speaker And so
Dr. Mindy my mission, yeah, is to not do that. Your mission is to not do that. I started
Dr Boz so many prescriptions in the first 18 years of seeing patients before I flipped my clinic to a ketogenic based start with a diet before you start with pills. That I want to stop as many prescriptions in the next 20 years as I started in the first Yeah, I
Dr. Mindy I heard you say that. I just want to say that I heard you say that at Kido con and I too am one of those people that I just think about the community nonstop. I think I just I’d like to think about myself a little bit more, but I can’t I get more of a dopamine rush trying to help other people. And so when I heard you say that at keto con that you’re trying to get people off prescript there’s many prescriptions as you put them on. I was like immediately in love with you And like this, these are the kind of messages that need to get get out there. And this the second thing that you said that really blew my mind is that in the ketogenic world, we talk so much about mitochondria and ketones. But I love what you have to say about hemoglobin a one C, and the red blood cell. And I feel like that conversation needs to be brought to the surface. So can you talk a little bit about why hemoglobin a one? See it can, if we could just look at that number and understand that number, we could end chronic disease?
Dr Boz Well, it truly dovetails into the story I just told where again, I was definitely one of the biggest judgments you had was Hello, could you get your A onesies? For these patients with chronic illness? In the first algorithm, it was only diabetics and getting them below six was, like considered impossible. And of course, if you’re only using prescription medications, you never could get them there.
Dr. Mindy But couldn’t wait, wait, pause for a second you. You can’t get a patient below six on a prescription medication. Yet we know like below five is for longevity? Yes, absolutely. Okay, I just didn’t want to lose that point. Because that’s huge. Go ahead. No, and
Dr Boz I’ll tell you who knows, this is every actuary table, every every lab that are insurance, well, if they want, if they get to, they get to sweep labs, you give them permission to sweep labs from your EMR, electronic medical record. And that means that even if they weren’t the one that paid for it or ordered it, it’s in your history, and they can plot your life expectancy based on a onesie. And especially mean it is so linear that of the health problems that are associated with it that when we can get it below five, you win, if we can get it to 4.5. That’s my personal goal, you win the amount of longevity and improvements in the way the system can transition from one fuel to the next can repair an injury can suppress the growth of a cancer, all those things seemed like whoo, science until you really look at the association of the chronic number of blood sugar. What is the chronic blood sugar. And so when you learn about what a hemoglobin it wants to see us in medical school, and then you get out into the real world, and you see doctors being really passionate, like, Hey, you gotta get this better, you gotta get this better. And I can remember, just got to get this number down. And it wasn’t the incentives that we’re doing it is because if you watch this number, it is such a correlation for who’s going to have a heart attack in the next year who’s going to have a stroke or an extra who’s going to break their hip, and next year, it predicts life. So when you look at the the first time I ever explained it to medical students, I thought I should write that down. And I just put out the video in this, like my, my speaking season this year was all teaching about hemoglobin valency. It was
Dr. Mindy awesome, too. By the way, it was such a good talk.
Dr Boz So you say hey, guess what your these hemoglobins are proteins, they are proteins that are designed to carry the most valuable commodity in your body oxygen to the tissues, because if you just let oxygen float willy nilly inside the blood, it’s going to dissolve into the closest cell is going to go oxygen is one of by every cell and it can’t function. Without it. The delivery of the oxygen is related to well, how well do your red blood cells get there? So in part that is, are your blood vessels blocked with a bunch of you know, calcified plaques? Do you have low red blood cell count in the name of anemia? Is your are your red blood cells wimpy and really tiny because you’re low on iron? So there’s several places where you can say, well, the delivery of your of the oxygen is based on that. But more importantly, how many of these proteins do you wipe out day one in a blood sugar that’s too high. And that’s because red blood cells, unlike many other cells in the body, they do not have a nucleus. They do not have mitochondria, they are permeable to glucose, meaning the glucose can come in and out of that red blood cell without anybody helping it. Nothing’s Oh, I don’t like your muscle cells, you got to lift it in there. Your brain cells, you got to lift it in there, you’ve got a receptor that’s going to take it from the outside to the inside. But red blood cells are not like that they’re permeable. They are openly permeable to glucose. So as the glucose, the concentration in your blood is the same concentration that’s in the inside that red blood cell. And if that glucose gets too close to a hemoglobin, splat, it lands on the hemoglobin and like gum to the bottom of your shoe. It is stuck for the life of that hemoglobin. Oh, wow. Yes, so that red blood cell is gonna last 100 days, 120 days in most of us and until you recycle it through the spleen and you tear down all the parts and then rebuild it in the bone marrow. It’s that glucose is in the parking spot that’s supposed to carry oxygen. And now, you can’t you work that out for the full 120 days.
Dr. Mindy And just I just want to point out so that people understand if you can’t get oxygen into your red blood cell, tell us what have like, T pain, like all these things that people are dealing with. So explain that piece.
Dr Boz So as the oxygen goes inside that red blood cell, the red blood cell goes to every part of your body. So the first one that I think of is, is in a diabetic, you will know that when they get a sore on the bottom of their foot. And everybody says, What’s your a onesie? What’s your agency? What’s your agency, and it’s because every doctor knows that if we want to fix that sore on the bottom of their foot, we need the white blood cells to get oxygen, how are we going to do that, we need to know that the red blood cells getting to that infection are giving them oxygen, we need to know that the tissue that is necrotic, that is rotting, for all other purposes, is going to get oxygen so that it can repair so that the skin cells that are supposed to weave through and reset that wound, it needs oxygen, that it’s tingly in the nerves hurt is because that nerve needs oxygen, and it is delivered by that red blood cell. So when the red blood cell does is full of sugar, and it’s carrying seats for oxygen are all filled with gum, they’re gummed up, your delivery is lower, you cannot have any amount of energy it just takes to run your brain, your heart, your your immune system, the exchange of how do I you know, take care of that little nick in the in the lining of a nerve that’s on your left arm because because you are living something goes wrong every day in these cells and the way you repair it has to do with how well the oxygen is delivered to those mitochondria. And that is based on your average blood sugar. Step one,
Dr. Mindy crazy. So now my brains go into all different kinds of places. So do you know the cellular danger response? Have you heard that about that? Tell me. So the cellular danger response is when physical emotional chemical stress comes into the cell, that it gets stuck in a fight or flight type situation. And so the mitochondria stop making ATP, they actually make a signaling signaling molecule that sends out information to all the other cells and says, Hey, we have a crisis here. And so you need to shut down energy production. And in that moment, it all of your amino acids, all your minerals, all your vitamin reserves get depleted. So I’m curious if that’s exactly part of what’s happening here, you gum up that red blood cell. And now the body if you’re not getting oxygen into other body parts, you’re going to have to start pulling not only your reserves, your vitamin, your mineral reserves, but you’re also going to have to work a lot harder, harder, because your cells may be in this danger response. Do you feel like that would be accurate?
Dr Boz Yeah, when you look at that, that gumming up of the proteins that are inside a red blood cell. It’s called glycation or glucose that gets laid on stuff that doesn’t belong. And although we can specifically measure the protein, hemoglobin because it has this, you know, three months lifespans, we can check it frequently, you know, every month until we get it to where we want it to be if we wanted to, knowing that we are measuring what is the last 90 days, what is the last 90 days, and if people are truly improving, even though, you know, traditionally doctors would have you measured every three months, but I find that it’s too long between checks that patients lose focus of what they’re doing. And checking it monthly allows you to say, hey, whatever you’re doing is going the wrong direction. We need the average glucose to be less month after month, because it is also a predictor of how much glycation happened to oh, that tennis elbow that really keeps hurting and you can’t seem to get better that white blood cell setting that they can’t seem to release the cytokines and pull in the other troops to help you fight off that infection. Or it gets glycated in the on position. And now you’re just spewing out cytokines in what’s called a cytokine storm and ways and although glycation is a minor point of why some of those things happen. It is a chronic and stable delivery of excess sugar around the body. gleich eating the parts that you don’t want glycated? Yeah, when you look when you look at a mitochondria that’s not working right and you get into that cellular turnover that might tafa G or the the shutdown of a mitochondria and the rebirth of a new one is when a mitochondria is says hey, I’m tapping out I can’t go. glycation will do that to a mitochondria. So you watch how many things get paused and you know the body will stop you it’s he’s dangerous and pushing As a subset of of what should be corrective functions that are in the wrong chemistry set to correct them
Dr. Mindy I contend go ahead and I think what’s so interesting again I love the the tennis elbow analogy because so many people don’t realize that the pain they’re experiencing is lack of oxygen getting to the area to be able to heal it because of the diet that you’re on that’s causing too much glucose like we don’t make that connection. And we think of hemoglobin a one C and I love everybody’s walking around with their CGM Zhan now and we’re starting to see this change. But we have thought of hemoglobin a one C and insulin fasting insulin fasting glucose as only something diabetics look at. But what I hear you saying is this is this is your tennis elbow, this is your your dementia, your Alzheimer’s, your memory loss, this is your menopause symptoms, because you’re not getting oxygen to these areas.
Dr Boz That’s totally exactly right. In fact, one of the hardest parts about knowing the pathology that’s linked to hemoglobin, anyone see, as an internist, you can see Chronic Disease 20 years before it’s coming when you’re hanging out with a 5.7. And people say, Hey, I’m below six, I’m like, you’re 40 you should be at 4.7, not 5.7, which is an average blood sugar from like 90 to an average blood sugar of just under 125. So chances are a huge amount of extra sugars floating around every minute of every day. That is glycated things that are aging your body faster than they should. And even despite exercise and you know, you know when when a when c is elevated, and that that predictor is how fast will you age? That’s
Dr. Mindy so all these. So all these people that are like biohacking and getting in and out of cold plunges what I hear and so those are great if you want to, like slow down aging, but let’s start with the basics. When should yeah, what should your hemoglobin be? So talk a little bit about what we’ve thrown out some numbers here. So okay, under what what ideal is 4.5? And what is considered you better get to work?
Dr Boz Yeah, so 4.5 is my goal for me again, I actually. So let’s back up one second saying can you test array one, see, that has been off the books with that, with the exception of a couple kits that were on Amazon for a while, but they were very specific to say you’re gonna have to test a few times, you’re gonna want to test over the course of so many months. But until May 1 2022, we didn’t have a home point of care test. And I actually co branded meanings that I want to see for this company to get this information out. Again, we’re not a big moneymaker. But it’s a huge information place for people to go and say, can we improve their life? Yes, if they know they’re a onesie. And so they it’s one of those tests where you prick the finger and you drip the blood onto the card, and then the card gets sent into it. And an analysis may break and look at the hemoglobins. And the percentage of glycation at the A alpha hemoglobin at the one position anyway, that’s what hemoglobin Island C stands for. The point is, is that’s always been off the books, unless you wanted to pay cash to the doctor. But then again, remember, if you do that your insurance company does get to know what that number is. They want to know they may not pay for it for you. But if it comes back high, especially above 5.5, and they will plot you they are plotted. And so I by definition, you signed the waivers, I gotta give them that information.
Dr. Mindy And what did they what did they do with that information?
Dr Boz It’s an actuary table. It’s a prediction of disease and how much you’re going to charge for your insurance. It’s part of the link to so they’ll
Dr. Mindy come get you later financially and you don’t even realize it. Is that what I hear? Ya, Yeah, crazy. Okay, where do you get? Where do you get this test?
Dr Boz Well, basundi.com is where I just put it on my website probably three weeks ago. And honestly, I did not it did not know that it was one of my good friends. from medical school, when I was teaching medical school in Sioux Falls, South Dakota, his company has been looking at point of care to the patient with with Omega three and Omega six fat. So if you’ve ever seen that omega quant where it were they you test what? What types of fats Have you swallowed in the last three months? They’re looking at red blood cells, and they’re trying to see Do you have any trans fats in your bone marrow? Do you have any trans fats in your red blood cells? And they measure that by this test that you give them your red blood cell analysis? It’s a cool test. It’s really cool test. Yeah, it’s way better than a cholesterol test. This is what what I say when you want to see if you’re actually eating the kind of fats at the rate that your needs need to be. This is one of the core measurements that I have them do and you don’t need to Follow me, you can go on to the test on your own and get the get the results. And if you never want to tell me because they are awful, then you don’t have to tell me the price, you’re you’re in charge of your. And I really find that that transfer of information of responsibility is, well, we should have always been that, yes, you should care about this, I can scold you, but that’s not going to change your behavior long term. Your insurance company can charge you higher money. But again, that doesn’t change behavior, long term, that internal drive to be a healthier version of you. That’s what we’re trying to inspire. And
Dr. Mindy I, you know, one of my favorite statements that you made at keto con is that you don’t need a doctor to do the ketogenic diet. And you know, when you stop and you understand how intelligent the body is, you’ll stop giving your power away to doctors, you’ll see your your doctors as health coaches guiding you to take the right steps, not as the end all be all to telling you what’s you know, what you need to do next. So
Dr Boz the innovation of companies like Omega quant and other ones that are out there saying, Get the doctor out of the way I don’t want to be in any good doctor with their salt is going to say, you got a problem. Let me tell you what I know about the human body. And let me teach you that education factor was always supposed to be number one. And you’ve now turned me into a robot that could match up symptoms and, and numbers and labs and numbers. That’s an algorithm I don’t You don’t need me for that. The education of showing you how to care for you how to be in relationship and how to inspire people to change behavior. That is what a physician was supposed to do. And it’s long been bastardized.
Dr. Mindy Wow. Amazing. I always say, You know what I used to say to people all the time that you know, I’m not the doctor that stands up here and looks down on you. I’m the doctor that’s going to link arms with you. And we’re going to walk together to where you need to go. And at the end of the day, we need people to know that it wasn’t the doctor that he’ll do. It wasn’t the medication that he’ll do. It’s not even the ketogenic diet that he’ll do. You tapped into your body’s own ability to heal, heal you. And if everybody took their power back, it would be a whole we would have a whole different health care world, don’t you think?
Dr Boz Oh, yeah, I mean, one of the best things that I know you do a lot of teaching on that, I think links right into a one C is when people come back, and they have a higher number than they think they should. I talked to them about Look, your body is designed to do some things you’re not doing. And one of those is to go without food, to have exercise inside yourself without food. And you know, one of the most derailed conversations that I continue to see people have is that if you’re a female, and anywhere in that 3040 reproduction range, you should not be fasting. And I keep thinking No, your little ovaries don’t want to be glycated any more than your red blood cells did. And that production of really good endocrine health comes with lowering the agency, you cannot lower it any faster than what I practice in my life. And what I encourage my followers to do, which is you should you should get to a metabolism, not everybody gets there right away. Some people took me a couple years to fast every week to have a fasting cycle once a week, we don’t use the word fasting until you’re at least 36 hours without food.
Dr. Mindy Cool. Now you’re talking my language. I actually so it’s really interesting. When I pitched fast like a girl to the publishers, several people were like, I don’t think people want to do longer fast. So in fast like a girl, I go through six different level fasts from 13 hours to 72 hours, and I talk about the different benefits, and how why you would want to do them for hormonal production. So it’s all about hormones and women and fasting. But to your point, I want everybody to realize I I’m going to spend the rest of my life trying to get people to use some longer fasts because we can do exactly undo exactly what you’re talking about so quickly. So one of my questions to you is if if red blood cells replenish themselves every three months, what happens when you throw a 36 hour fast in there? Do they rejuvenate? You get rid of the old ones? Like how does that work?
Dr Boz Yeah, so the the life of the red blood cells doesn’t change based on the fasting them but what you really can see happen is you lower the average blood sugars, that most of the patients come in. And they’re really looking at me after a couple of decades of overeating or eating processed foods in a way that their average blood sugar’s have risen to an A one C of, you know, 5756 even up into the sixes, and so that’s an average blood sugar in the 120s to 130s to 140s. That’s crazy. Again, that is that is a great way to get dementia. If you’re looking at brains that again, you got to heal the brain before you heal anything else. If you let if you spend life on average day wants to see that high. You cannot reverse the problem. You have to get that agency down. So how do you do that?
Unknown Speaker Right? Yeah, how do you do it? Right. And I think
Dr Boz you’re program and my program are almost like we’re they’re almost identical, where you look at, I lower I tell patients 20 total carbs or less, that’s where we start. Again, I’m taking people in a place where I want to reverse medical problems. We’re not playing around, we’re trying to reverse medical problems. If you want to do that, you got to get the carbs down. I told her it was down to lesson 20.
Dr. Mindy Is that net carbs? Yeah, yeah,
Dr Boz it’s, you know, I first when I was first in this, I said that word, but I had some exceptions. And, and the sad part is, is every time I did that the numbers was stalled. They would not get better. Yeah. And so if you’re really looking at reversing illnesses, that’s the goal here, then I need you to limit this, we have to undo what you’ve been doing for the last couple decades, probably. Right. So as you look at that, then we take them to that first wave of keto, everybody feels so much better. And I call it the ride the chemistry wave, you can eat three
Dr. Mindy times a day, as long as it’s less. Yeah. It’s like you can like Did you ever see that movie with Bradley Cooper, you know, takes a pill and all of a sudden, you can speak five languages. I’m like, you don’t need Bradley’s pill, you just need some ketones, and you’ll see that you’ve been living in a body that wasn’t working at its best.
Dr Boz Yeah, exactly. And when they are metabolically healthy, to get that chemical rise to get that wave of ketones, I’m like, Just ride that ketone wave, you’ll come back, we’ll show you what to do next.
Dr. Mindy Enjoy it. It’s like a drug trip. We’ll let you know when you arrive back home.
Dr Boz And some people that it’s even dirty keto that they get that wave with, but I’m like, Yeah, but that’s not that’s not gonna last forever, your body will adapt. And I think that’s really where when you look at the chronic trajectory of why does a ketogenic diet continue to improve? If you’ve got some of these parameters? It is, adults shouldn’t eat more than two meals a day. We weren’t designed to do that. We’ve done that for modernization reasons of, of all the wrong reasons, actually, yep. It’s an old work schedule better, you get a break all the things that you shouldn’t have given credit for eating. But now that you’ve got these chronic medical problems, eating twice a day is one thing, but now I really need your numbers, I need you following your metabolism. And this is where, you know, the doctor baz ratio came from
Dr. Mindy Yeah, it’s gonna say talk about that. It’s a great ratio. And so talk about the ratio.
Dr Boz Yeah, you know, this was when I was helping my mom who fight her cancer cells, when we needed a high metabolic stimulus to really get the outcomes I was reading about in these papers. She was a 71 year old woman who had been through 10 years of cancer. And she was 40 to 50 pounds overweight at that time, had done all the wrong things to try and lose the 20 pounds she had lost. So she was metabolically very sick. And as we are on a timer now, because we got a cancer that’s about to take her life, and she has said, I am not doing chemo anymore. One of the places I needed to stay on track was I couldn’t let her stall for months on end, I needed to know exactly when this wave of chemistry was over. And when that’s done that, I need you to step up your metabolism. So by looking at what her glucose level was, I mean, glucose is this great molecule that we can measure point of care, but it has several things that are telling it what to do. And one of the loudest things it’s telling you what to do is insulin. And it’d be great if we can measure insulin and a point by point care. But even if we did, it’s incredibly volatile. When you’re checking patients insulin, I used to do this all the patients I’ve stopped doing it because if if they fart right before the insulin, I got your number. If they’re stressed if they didn’t sleep well, if they have a difficult drive to the lab that cortisol raises that. And now, if it’s high, I can’t trust that it’s high because of a stress situation. So I need several points of care. And it’s like $80 a pop. So I don’t, I don’t like testing insulin because of its volatility. But it’s one of those places in medicine where if we could look at the one the two molecules that that insulin really is the commander over it is your glucose and your ketones at the same time. And so if you have a glucose of 100, it doesn’t tell me where the insulin is. But if you have a glucose of 100, and ketones a 1.5, I know your insulin is low. And so that’s where the doctor baz ratio comes comes from. If you have a glucose of 100, and your ketones are point five, now I know your insulin is high. So again, we take glucose, and we divide by the ketones. And originally, I tried, I love this, right? I tried to get my mom to do the glucose ketone index, but in America, we have these crazy units for glucose and different ones from ketones. And so I’m like, Mom, I need you to convert this to the glucose to the other metrics, and then I needed to divide by this to get the ratio of the ketones down to 1.0. And my mother’s like, I don’t know, I am, you know, way beyond what she could do in the mental state she was in it’s not that she doesn’t know numbers or couldn’t, you know, couldn’t have done that in a different time before. My wife, but she was sick. And so I said, Alright, Mom, we’re gonna do some, we’re gonna do some dirty math, just take the big number and divide by the little number. And I’ll calculate what this should be. And that’s where the doctor boss ratio came from is, it’s mismatched math, but it’s so easy for patients to do this. You say? The lower your number, the lower your insulin? Yeah. And so what do we want that number to be? Right? If you want to lose weight, gotta keep your doctor first ratio below 100. I mean, we know very easily from all the patients, we’ve seen that if you can get that Dr. Baz ratio under 100, you’re gonna lose weight. And
Dr. Mindy you need like your when you say under 100, it’s glucose divided by ketones, so that should be 100.
Dr Boz Okay, so if you had a glucose of 100, and a ketone of one, then you would have a Dr. Baz ratio of 100. And that would be a weight loss one, if you had a glucose of 100 and a ketone of 1.2. Now you have a doctor baz ratio of 80. And when I want, yeah, right, yeah, and I want to help them at a if I’m trying to reverse diabetes, I’m pushing them to get that to an 80. But when I’m looking to really improve their metabolic health in the setting of an autoimmune disorder, which is again, a very primitive part of our very deeply protected part of our brain, and our body, I need that Dr. Baz ratio to get to 40, which is really a GTI of one to two. So when you’re using the the the scientific papers out there, you’re it’s a glucose of 100. And now you’ve got a ketone of over 1.8. Okay. And that will push that that Dr. Baz ratio down to 40. But if I’m working with the patient who’s got a seizure disorder, or is in a cancer protocol, I need their doctor baz ratio to be 20. So that means their sugars are usually running in that 60s and 70s, maybe 80s. And now I got a ketone of two to three, to keep that Dr. Baz ratio
Dr. Mindy on to your last what does it look like to eat to get like you’re gonna have to fast I really feel like this is what I love about fasting is it’s the fastest path to get those ketones. And then what are you eating? Are you eating meat and fat?
Dr Boz Yeah, so essentially, the first few lectures I went to this, they had patients that were actually following the protocol, this is going to grow out your people, but it’s totally telling your you’re going into a land, that you’re going to be really disciplined or you’re gonna use some of the hacks. A discipline is, these were seizure patients have, or they were glioblastoma. So they had a brain cancer, glioblastoma either been irradiated or removed. And if they didn’t keep their ketones at that Dr. Baz ratio of 20 or less, or GK I have 121. They had a seizure. So they had incredible compliance. So they were eating things like mealworms because they’re super high fat.
Dr. Mindy Oh, insects, and insects are packed with protein. My friend, Bill Schindler, who was at keto con if you’ve heard him, he’s a huge fan of bringing insects back. Oh, yeah,
Dr Boz I think it’s still one of my favorite if you’re going to use a flower use cricket flower, be careful to shellfish but when you’re hacks, so they would do things like extreme levels of fat, but if you’re really looking at a diet that doesn’t include insects, I mean, you we haven’t weighed their food we usually want them having 500 grams of food as not a lot of food. And we it’s just fatty meat is what makes the list to keep their fat high enough and that the protein replaced enough. Crazy bone marrow. Yeah, bone marrow is on the on the menu. A lot of liver pet tase, mixing it with the the fats from the animal, the liver plus the fat really good. And it’s flavorful, they like that. The other places that get a lot of return for bite for bite is organ meat, but also small fish. So sardines make the list out because they’re, you know, I mean, they’re in a can and I don’t like to cook so.
Dr. Mindy So you open up some pate some liver pate, and then you know your dessert is sardines. Yes. And you get to add you get to live, your reward is you get to live. Right do that.
Dr Boz Yeah, honestly, it truly is a level of metabolism. When I have people tripping, oh, I can’t give this up. I can’t give this up. You know, it only takes that perspective of saying would you like to see the other patients that I’m taking care of where they are, you know, 500 grams or less of food per day. They’re on this for the next four months and one day off show sense their numbers. You know, I’m a big proponent that you live in the 21st century with lots of options for medicine. Our medicines work a ton better if you can remove the inflammation from the body. And that’s really the the ketogenic diet should be called anti inflammatory diet, but that we’re
Dr. Mindy you know, that it’s almost like optimal health like when we say optimal health, people like Yeah, yeah, I want that. But we don’t really know what it is. So when we say anti inflammatory again, I feel like it’s just too vague. How long do you need to stay? So let’s say I have, let’s say I have an autoimmune condition, it’s managed well, I’m not really like something like Hashimotos. I’m not like gonna die from it right away. But I do want to work with this Dr. Baz ratio. So I want to try to see if I can get it to 40. How long do I need to stay at 40? Or is it like, do you dip in every time you’re in 40? You’re accelerating healing?
Dr Boz Yeah, so the truth is, is that every time you dip to a certain number, you do ignite autophagy. Again, a toffee G is not something you can take a picture of, it’s got really great science around it, there’s not a lab test that shows you you’re in autophagy, there is a chemistry set that is very highly correlated to autophagy. And that is a lower blood sugar, with a low inflammation and a higher amount of ketones. So again, Dr. Baz ratio of 20, we know we know really good statistical chance that you’re in autophagy 40, you get a pretty good chance, like 30 to 40% of the people we think are in autophagy. And are sorry, 70% of the people are in autophagy. When you get to 80, we think it’s about half the people are going to talk to you. So it’s not that you can’t get in on top of G and ad it’s that we have a much higher guarantee, the lower the number gets, and the outcomes really seem to be matching with that. So when I when people say how long do I have to do this? And I’m like, Well, how long did it take you to make it right now that’s a tough place for them to go. Because often their autoimmune thing went on for years before was diagnosed or it smoldered in the you didn’t have a celiac antibody, you just had all the symptoms. And you knew if you took the wheat away, you felt better. But you didn’t start making the antibodies until this body turned on this gene. And now you make the antibodies. So now my blood test is positive, and I can put the diagnosis in your medical chart. But it doesn’t mean that the disorder wasn’t brewing for years before that. Yeah. So to turn it off, we need to recycle things we need, you have a zone of none for a while. So I’m really careful to advise because people go a little wacky when they start here. And I need a calculator to calculate and they get obsessed. Yeah, yeah. And I’m like, You need to be the tortoise, not the hare, we’re trying to find a rhythm of your life that you can stick to, unless we’re fighting cancer, okay. And if we’re in that zone, where cancer fighting is just changes the game. So outside of that, I want you to find a zone that you can live in. And I think that’s where when when I look at the workbook that I use for my patients, I wrote a book called Kido continuum. This is what the second book I wrote. The first one was the story of my most stubborn patient, my mother anyway, you can and great love story between my daughter’s mother. Yeah. It truly has blessed me in helping more people mean she that story has helped so many people. Yeah, yeah, but Kido continuum as well, I left on the cutting room floor when I was trying to write that. And I was trying to implement this into my clinic. And then I had this tsunami of people that wanted to see me as a doctor, and I’m like, You need a doctor to do this. So writing it down helps because I think a lot of people use the book, take it to your own doctor, teacher, doctor, that teacher,
Dr. Mindy doctor, oh, my gosh, I say that all the time on my channel. I’m like, send your doctor here. I put the science down below.
Dr Boz Yes, it’s exactly right. Like it isn’t that much of a. You know, biochemistry is hard for every doctor. And it’s one of the top difficult classes in medical school. But it is it is this is not advanced biochemistry. This is pretty basic stuff about metabolism. And a couple of glances back into that chapter book, and they’re going to be fine. But they need a reason why they need an and not a scolding, shaming, kind of you should know this. You’re a terrible doctor, don’t doctors don’t like to hear that either. We have a lot of stuff to keep up with a grade this. Hey, Doc, look, I’m doing this. I’ve lost this weight. I’ve been following this workbook. Here’s my workbook. And I tell him just listen to the story of David who is a patient in my practice that he screwed up everything he gave me every teachable moment, in his case, to say, let me show you how not to do it and why. And then the workbook that says the ultimate way where I you know, had their 12 different places that you can you know that where I walk people along a continuum? That’s where kedo continuum comes in. And where do they get the book? Oh, Amazon is one place you can go to buy them d.com We sell it there too. But Amazon allows you to leave a review. And yes, I don’t have a publisher. So if they buy it, please leave me
Dr. Mindy two reviews or I think people don’t understand the power of a good review for any author is really appreciated.
Dr Boz That’s awesome. I had no idea it did that much for awareness. Right. And when users aren’t there, you can’t you can’t find any, any third party like Amazon or anybody to put in, you know, in a cycle you got to have rise.
Dr. Mindy Let me ask you. Let me ask you this question. What the other thing you finished up your keto CON talk with is something that was really like near and dear to my heart, which is, you know, we’ve been in this pandemic for two years now, without any mention of what we can do metabolically to be able to keep our immune system strong. Can you talk as we finish up the conversation? Can you talk a little bit about where this glycation played in with the cytokine? Storms? And with COVID?
Dr Boz Yeah, it’s a huge part of this. I mean, in fact, during the, you know, the process of writing the lectures for for those videos, and also just really honing, how do you speak and deliver this in an eight minute YouTube video, I was so motivating to me to say it’s not an accident that when you want to predict who’s going to struggle with COVID, 1981, C was a direct correlation. Yeah, it was a linear correlation that the higher it was point by point by point, third decimal point, it still was linear, of if you have a high hemoglobin, anyone see, the cytokines get stuck, and much to what you were talking about earlier in the show, where you get this cellular stress shutdown off mitochondria resources that are locked away, you get in you get like the on switch turned on for the pheromones of, of white blood cells, and their cytokines there. But it’s a fair amount, if you would, saying, Hey, I have an infection, I need help. And the best responses from our body is the delta, whatever your number is at, you want it to peak really high, and then come back down. And it’s that difference of what is your baseline noise level for cytokines, and then the peak when something happens so that you can recruit your your friends and neighbors to help you with this infection. And when you look at cytokine storms, what is essentially happening on a basic level is you have so much noise, that when an infection comes along, it kind of burps the level just a little bit. And it’s not enough signal to put in the white blood cells. But it was enough signal to raise more of the cytokines to produce and more of them to produce. So it’s this low chronic raising of the cytokines, and then they live there. And to reverse that, you need to stop, stop eating, you need to fast as long as you’re metabolically healthy to do that. And what I find is the patients who really needed to fast, they were eating 250 carbs a day before COVID. And now they hear oh, I should fast do better. Like you got your metabolism isn’t correct. Yeah. Yeah. And those replacement patients where you mean the only the only outcomes that I’ve seen, I mean, sometimes you’ll get a winner who will fast and it’ll their body will do what they’re supposed to do. And they’re cytokines do come down. But they smolder for a long time. Yeah, inducing a ketogenic state by exogenous ketones is what several of the places have done in they have the IV form now and had a couple of trials where they’re infusing them into an IV process
Dr. Mindy with somebody who has a say, in a cytokine. Storm. Oh, that’s brilliant. Oh, my gosh, I love that. Have you seen Did you see the research, this is one thing I went to YouTube. And I was like shouting this was the research was showing that if you have two cells, one that is a glucose, a sugar burner, and one that’s in a state of a toffee G, that if a virus comes into those cells, they can’t live off your own energy off there. They don’t have their own energy, so they have to live off of you. So if you go into a cell in a state of a tapa, G, it stops down stops viral replication.
Dr Boz Absolutely, yes. One of the mechanisms that does is it kicks out iron from that cell. And now the iron inside the cell is depleted, which is like a kamikaze for the cell. But it’s also a kamikaze for the virus. So there are built in mechanisms that are absolutely correlated to, again, Dr. Baz ratio, get the glucose down? Yeah, it’s gonna say, Yeah, but yeah, when you are plotting who’s going to do a better job, that GK I absolutely mattered, that glucose, ketones in circulation, which one is your system using, infusing the body with ketones would induce just like an injection of vitamin D would induce some of the outcomes and the proteins that we know are part of being healthy? But in a moment of crisis? You mean, you can’t fix the problem immediately? But you can. There are several of the ICU doctors who went out on a limb and injected like 100,000 units of vitamin D toxic and anybody’s measurement. Maybe it’s 50,000? I don’t know. It’s a lot. It was. Yeah, you do see this?
Dr. Mindy Oh, I’ve heard this. Go ahead and say what you’re gonna say.
Dr Boz And these patients live, they were on ventilators, they’re like last ditch effort, they’re not going to live. And there is something about the transcription that happens outside of the DNA in a nucleus that is supplied with abundant vitamin D. And so again, another place where, oh, where’s all that vitamin D? Well, it’s stuck in your fat cells. It is totally being run by insulin. So when you look at that cytokine storm and what other things are associated with it. cytokine storm was was associated with a higher agency, a higher body mass index, a higher fat mass, a higher amount of insulin chronically. So insulin resistance, and a lower amount of vitamin D, a lower amount of ketones ever been used in the last 30 days? All of these metrics are are, there’s no prescription that I can get you to get you out. 24 hours. Yeah,
Dr. Mindy you got to eat, right? Yeah, you can, and you can do it for yourself. So, oh, my gosh, said, I swear, I want to respect your time, but I could like sit here for like three hours and discuss this with you. So I
Dr Boz just want to say a couple of things before the show ends. And that is that there are very few people that make my life easier when I send them to listen to things. And I said, just go listen to Dr. Mindy, she does a ton of this coaching. I am not the only one saying this. But for teaching. I mean, it really dovetails into helping my patients and any any person who does that is you you’re going to have been
Dr. Mindy thank you well, and vice versa. You know, I’m I’m all about collaboration. And I feel like we you know what I love and where I geek out with you is like we’re some of the only women that are on YouTube discussing this. And I we used your ratio for a toffee G in my academy one time to try to get in to help people figure out how to get into a tapa G. So yeah, I’m all about collaborating with you. I just love what you’re doing. And yeah, let’s change the world together.
Dr Boz Amen. Good job. Well, thanks for inviting me on again soon. So yeah,
Dr. Mindy okay, I’m gonna ask, I have to ask you one more non glucose ketone question, but probably the most important thing we can talk about before we close this down, is do you have a gratitude practice? And if so, what is it?
Dr Boz Alright, so I have a pattern of fasting each week. And I struggled with fasting a long time. Just again, like anybody the mind going part when you first go into that, and I’ve been going to Bible study and doing my thing that I like to do to nurture me. But I kept failing and my fasts, and I learned that if I start to fast by documenting and, and really having the person that I focus on, so it’s usually somebody that I’m caring for, or my practice, maybe it’s somebody in my family. But I have learned every week, I fast every week, and sometimes I fail, but for the last four years, I think I’ve missed like probably maybe a dozen weeks for not fasting, and the goal is 48 hours and 72 hours, at least once a month. I never make it if I skip the gratitude, the fasting is so correlated to what’s in my heart. And that if I document that, I also can see it in a numerical that was really good for my analytical brain. Alright, God said thank you, if you if you remember all the blessings that you’ve
Dr. Mindy had. You know, I just You’re making me actually tear up now because one of the things that I love about fasting is that it quiets the noise in your brain, and you can hear so much more about who you are, and how you want to show up in life. It’s more than just a health tool. It is a total spiritual tool. So oh my gosh, I just love that. So thank you for this is gonna be I think our audiences hopefully will love that we geeked out together and you guys if you went we’re gonna put this out and then Dr. Baz and I are gonna go live on YouTube together and have more fun. So thank you for not only who you are, but for what you’re doing to change the world. This is just Yeah, it’s incredible. We need more doctors like you’re so so grateful.