Dr Boz: Reverse Insulin Resistance Once & For All [EAT THIS]

0:00 Most of my patients, if they eat an apple, their insulin will be high for the next 2 days. Insulin dictates where fat goes. And to control it, you don't go check your insulin. But what you can do is to check the two molecules that it is very closely tightly linked to. And you can do that at home. Dr. Bos is a worldrenowned expert. She'll teach you how to reverse insulin resistance in days with one food. This man is 65 years old. He comes in and he said, "I fasted for 21 days." His ketones after 21 days, 0.7, and the blood sugar was still triple digits. That's failing. That is a failed metabolism. We're going to have you do sardines. And so, here he is. He gets to the end of the sardine challenge. And by God, his numbers look great.

0:48 He's like, "I'm never eating anything again except sardines." There's someone watching right now, what should they do in their shin to know that they have elevated insulin? Take your thumb and look at it. You've got a thumbnail and it should hurt a little. So, iodine, what do you think? This is a nutrient that you have to have to survive. If you're watching this, you're likely struggling with one or more of the following challenges: stubborn weight gain, diabetes, depression, or even an autoimmune condition. And most doctors will simply tell you, eat less or load up on superfoods to fix your issue. But my guest today, Dr. Annette Bosworth will prove why that's wrong. It's not about calories, it's about insulin resistance. In this episode, Dr. Bos draws on her 25 years of clinical experience. She'll share how

1:34 you can spot insulin resistance without expensive labs, including a simple test involving your toes. We're also going to discuss the butter trick and the sardine trick to literally stop insulin resistance and the surprising supplements that actually spike your insulin. And I was taking one of them. And if you're like me and you want to take control of your health when doctors can't, a very easy step is to hit the subscribe button because next week I'm sitting down with Dr. Mindy Peltz to discuss how fasting can help you burn dangerous visceral fat faster than Ompic. So Dr. Bos, my first question, if somebody's just watching this, they look down, they have belly fat, they feel fatigued, they can't sleep properly, why do you think they should first focus on their insulin? It is the hidden layer. I mean it it is such a panacea for chron growing chronic

2:26 medical problems and it starts in their 20s when they didn't have screaming problems like you know joint pain or brain fog or big fat tummy. They had this little bitty whisper that wasn't great and they blew it off cuz they're 20. Who thinks about chronic problems when you're 20? Uh and if I could synthesize uh their story back to the you know people say take the medical problem back to its roots find the or original story or original problem. And I tell patients that show up at 50 years old saying I can't lose this weight. I can't get this off. It's must be a hormonal problem. I'm like yep and it started when you were 22. I mean that's where you can start measuring. It's 22. And they're like I was fine at 22. When you look at the chronic nature of insulin,

3:16 and I mean excessive insulin, insulin, you have to have it to live. But it's the excessive production of it for the last 50 years based on how we live and how we eat that says it's your enemy. Too much of it is your enemy. And to control it, you don't go check your insulin. You would never be able to check it often enough to really help the patient understand the problem. But what you can do are check to check the two molecules that it is very closely tightly linked to your glucose and your ketones. And you can do that at home. Very very easy. I think people would love to test their fasting insulin. But as we know doctors don't like to test it so easily. So if we can test our ketones and our blood glucose, also known as the Dr. Boss ratio which we'll talk about that is

4:07 going to help people spot their high insulin and fix it. I want to talk about the worst food that somebody is eating right now today because you see so many patients they're probably eating some foods that you're like why are you eating that? What is stopping their results and driving belly fat? So let's profile them. We got a 40-year-old. they've been overweight for at least 10 years and they might have had some early success weight loss because they changed the d their diet from something to something but now they're flatlined. If I look at that patient, the most common thing uh and again this is not a follower of my channel cuz they would know better. It's powderized food. So the food that comes in powder form now if you reconstitute it into the shape of a Cheeto or something processed food then everybody's like of course that's bad for you. But when you say, "But

4:56 it's powderized protein or it's powderized fat." And I tell them there are people who are healthy enough to eat that and not get the consequences. But most of the people who come into my world that powdered that, you know, pulverized protein is super t so tiny you could never chew protein to that small of a level or that pulverized fat even. uh it leads to excessive production of insulin because you powderized it because it's such a fine particle number or particle size that um that's a mistake where they're like I thought that was healthy. I thought that was healthy. I'm like it used to be but you've been at this too long and your insulin is so it's trigger happy.

5:42 You produce it when you shouldn't. And you so the number one I thought I was being healthy and she said to stop that it's powderized protein. Yeah. So if somebody's trying to increase their ketones and also trying to get healthy, we should not be having protein powder or a beef isolate protein like one that's pure organic. There's like one ingredient. I know the ingredients. Dr. Boss, is that not correct? I wouldn't let them do that. I mean there are people who get healthy enough that they can return to that. But here's what I would ask you to do is I just do an experiment on yourself. So have your powderized protein and then get up first thing and I want you to o t test on the toilet. Test what your morning fasting glucose is. Your morning fasting ketones first thing.

6:29 Don't fuss around and make the coffee and walk the dog or just test on the toilet. Prick that finger and see the numbers. What that number teaches me is what was your metabolism doing when you were sleeping. Now, you can't actually measure that, but you get the closest approximation when you at that when you look at those morning fasting numbers. And don't just do one day because sometimes you don't sleep well or there's other reasons numbers don't look perfectly. Give me like four days of eating that powderized protein, you know, say nothing else after lunch except your powderized protein. Uh, and then wake up the next morning and see what your numbers are. And if you are healthy enough, if you are not super insulin resistant, then your blood sugar is going to be in the 75 to 80 range and your ketones are going to be like 08 to 1.8. I mean, they're in that

7:17 range of really good churn of fat metabolism was happening while you sleep and your blood glucose really got down to the nater of of healthy and that will still be there on the toilet. We'll see it. What I see is if we say, "All right, now give me another size uh of really good protein, really good fat." We're going to have you do sardines. Sardines turn out to be this really great protein that you don't pulverize. You chew it. Your mouth does the mastication of, you know, mushing up the food. But the size of the particle is much larger than what they when you find in industry. I mean, if you want to see a a protein powder that clumps, guess how much that sells? not. Uh so you get the value in our in our society by having these smooth textures and uh you know,

8:06 of course they'll add a little extra taste. Maybe if they don't, but you've got one ingredient, they probably didn't add anything extra. But that the size of that protein from you chewing uh is is way less number of particles stimulating the production of insulin. And now you have a different equation. Now look at your morning fasting glucose, morning fasting ketones. And if you are healthy enough, the numbers are going to be the same. You're going to have morning ketones in that, you know, 8 to 1.8 range. You're going to have morning glucose in that, you know, 75 to 80 range. And that's not what you usually see. Okay. So, we spoke about the worst food, which is protein powder. So, it's not sugar. It's probably like protein powder. Cuz people probably watching

8:51 this, they already know, okay, I shouldn't eat sugar. I shouldn't have grains. But, they're probably doing the protein powder. So, when it comes to people wanting to lower their insulin, this leads to your um amazing patient story. What do you think is most important? Boosting the ketones and doing high fat, eating more butter, or do you think doing an aggressive 21-day water fast is going to lower insulin and burn belly fat? Right. I think most of the patients who come to my clinic or my channel, they don't have the mitochondria that are healthy enough to fast. I mean, all the time. I mean un I don't know if it's fortunate or unfortunate but I think uh if you type in sardine you will see my name next to it. Uh when you look at people who write in and say I did a water fast and I did I got these numbers and but then I did a sardine fast and

9:39 I got these amazing numbers and they'll say well which one should you should I do? I'm like follow the numbers especially those morning fasting ones. when I look at patients who come in and they test my um like protocol uh and protocol wasn't built because I made it up. I watched enough patients say, "Okay, they're failing. They're failing. They're failing." And uh I, as I said before we started, there's this great story where I I have a bunch of great stories. My year of 2026 is to try and tell really deep science-based stories of the patients I've seen. And this was my first article of the year. It's I've been on stage once to tell this man's story because and it it is super attracting because it's so counterintuitive. Uh the people that I told it to

10:24 about a month ago were clinicians and scientists and the jaw-dropping results were it just it blows your mind to think can that be true? So this man is 65 years old and he is a day trader. He sits um he comes in and he said, "I fasted for 21 days, 21 days water only fast." And the blood sugar was still triple digits, 107. And at the end of that 21 days, anybody who's in a healthier, pretty healthy state should have ketones of two, three, four, five. I mean, they should be really fat, moving fat so quickly. his ketones after 21 days of nothing burger. Salt and water. That's

11:11 all he had. 0.7. That's That's failing. That is a failed metabolism. And the harder you push, the worse your body does. And he ruined so many things in those 21 days. His cells completely crumbled. In fact, the in intracellular organels of his mitochondria just died. And now he has a whole, you know, generation of them missing from the formula of how do we get him healthy again. The story begins on this man where he is a pretty good disciplined engineer uh and he's early 50s um and his doctor said, "You've got diabetes and he has an A1C of 6.5 to prove it." The doctor said, "Here's the medicines. Here's what you do." And the guy said, "Uh-uh, not doing this."

12:00 Uh he goes home, he gets on the internet, he finds the co my colleague Dr. Fung and Dr. Fun says, "If you want to stay out of my dialysis center, if you if you want your kidneys to not die, fast, fast for extended periods of time." So this man starts fasting and somewhere online or in a book somewhere, he he said, "If the if the calendar said the first of the month, the second of the month, the third of the month, all the way up to the seventh day of the month, I will only have water and salt." when the calendar says eight, then I can go back to eating. And so he does this the first time and his blood sugars go down and he he just he feels great. He's got this euphoric sense of what happens when you fast. Um but as soon as he went back to that other, you know, normal eating, his blood sugars were back up to 140 on average. So he does it again

12:48 and he does it again and 18 months later the man lost the weight that he was looking for and he took that hemoglobin A1C down from 6.5 which is diabetic to 5.5 which is clearly not diabetic anymore. Not even pre-diabetic. Uh in that setting he was winning. Everything was looking good. He felt good. He's like I showed you doctor and then he fell off a building and broke both legs. So, he had a setback. That's called a setback. Uh, but that's a massive setback because he was an active guy and he had mobility and he had the mental discipline and energy to do something like a water fast. But two broken legs and now you're not only in a hospital to get them repaired, but you get into an institution afterwards because you can't, you know, go to the toilet yourself. So, he's in

13:37 uh immobile for eight months and surrounded by the best-in-class medicine people that don't fast. For heaven's sakes, you can't do that. You're repairing a bone. Uh you you need to eat the processed food that's on the menu at this, you know, rehab center for other people with injuries. And by golly, he gets to the end of that um um two at least I think it was it took him a year to get right back up to 6.5. So he's surrounded by all the doctors and he says,"Oh my gosh, my diabetes is back. Um, what's the best medicine that you have for me, doctor?" And he goes, "Well, in indeed I have a brand new drug recently on the market called Tzepide, which is one of the GLP-1 GIP agonists. Great drug when used correctly. And here's this man who's just barely back walking

14:27 again. And they start him out on the tiny dose and a few weeks go by and it doesn't seem to be doing anything. So they dial it up a little bit. And they dial it up and dial it up and dial it up and they get him on the maximum dose 15 milligrams injected into his tummy, his belly fat every week for two years. And during that time, no weight loss. And his hemoglobin A1C ends up to be 10.9. Yeah, that's a blood sugar north of 220. But not only does he have diabetes, he has rip roaring diabetes and he is really disappointed in medicine. They went into that doctor thinking things were going to be better, uh, knowing he hadn't lost any weight, but the drug should have taken care of the labs at least, right? So, he's on on the way home from the doctor, super disappointed, and he throws the pen out the window saying, "It cost me, you know, like

15:16 $1,300 a month, even with his insurance, and it's not doing anything. I'm going to go back to what worked." But by now, he's a little older. He is 65 and that's where uh it's 2025. Um, oh yeah, it was last spring. What am I thinking? And he says, "Okay, I'm going to do that thing that all you told me not to do, but I'm I'm back to, you know, being in control of my healthcare and I'm going to fast." And he gets to the end of 72 hours and his blood sugars are still north of 200. And so he says, "Well, I'll just do it a little longer." So he gets to 7 days, and the blood sugars are still too high, and they're still too high. and he gets to 21 days before the blood sugar is 107, which is not great for 21 days, but it's way better than what he was doing before he ate.

16:01 And what happened to him was he felt terrible. When I see people who have healthy metabolisms, whose mitochondria are being activated and they're really, you know, igniting autophagy, which is the clean up of the debris, but mitophagy is the mitochondria who is maybe I I describe them as crippled. They just can't perform under the stress. And if the if you've got this nice strong disciplined engineer who just pushes harder and says, "I did this before. It's going to work. It's going to work." and he just keeps fasting. His body isn't ready for that. And he was failing. He was failing so badly that if I had to imagine how many mitochondria did he lose in 21 days of fasting and you can see it in the numbers, they aren't getting fat uh oxidized. They aren't moving

16:48 that other fuel through the cells. They're just, you know, mobilizing blood sugar. And he feels awful. So, here he is saying, "Okay, I'm doomed. this is how the rest of my life is going to go. There is no hope. I've done everything possible, the highest medication, the best in class for two years. That didn't do it. I fasted for, you know, just shy of a month. And that didn't do it either. And when he came into our class, uh, again, we do a three-week class of the protocol that I would use if you're a seizure patient, if you're a cancer patient. Meaning, we don't have a lot of time to fuss around. I need your attention. If you want to see how to do this, here's the steps. uh we only have a few students in the class because I want special attention paid to them. And this guy came in pretty grumpy. He didn't like that the co, you know, the cost of the class was

17:36 more than he wanted to pay. And he was like, "Is this going to work?" And he's, you know, typical engineer saying, "Prove it. Prove it. Prove it." And um the first week he's like um why aren't I making better ketones? Why aren't I making better ketones? And his ketones were like8, which was way better than he got in the first 21 day. But what's he doing in that first week? He is got a 80% fat diet and he thinks, you know, this can't be working. This has to be wrong. So his mind is not as in his in this as he's grumpy. He's definitely grumpy. Uh and he's disappointed is what's really happening. He is he wants the rest of his life to have vitality to be alive. He's super smart. Why can't he mask his way out of this problem? And I get it. So I I kept, you know,

18:24 there the students are divided into groups of 10. And I kept telling this goes, just have lots of grace for him. He is definitely grumpy and I don't really know him well enough. He's just one of the few engineers that says, "My blood sugar is still 200. My blood sugar is still 170. And why isn't it better? I'm six days into your class and why?" I'm like, "Calm down. We're trying to make some mitochondria here. Give it a little minute." And so then at the end of the first week after they've had 20 total carbohydrates or less, that's the only thing I want them counting and I really want them fat forward. They have to be eating highfat. And then we said, "All right, mister. All you get on the menu for the next 3 days is sardines." At the end of the sardine challenge, we have blood sugars in the 140s and we have ketones at like 1.8. So, you know, looking at that Dr. Dr. Bos ratio meaning I've really lowered his insulin. Uh that insulin reduction which you

19:15 think well what isn't that what you lowered when he wasn't eating anything. I'm like no you didn't. There was such a stress response going on in those patients that the body is like literally sending off an alarm bell saying we're not eating now. I don't have access to the fat. There's this problem and this the between the cortisol and that just chronic illness. They are not healthy enough for fasting. And so here he is. as it gets to the end of the sardine challenge. And by God, his numbers look great. He's like, "I'm never eating anything again except sardines." I'm like, "No, no, no. Go back to your menu. Uh, and then we'll get you through this next week." And now we're going to do a water fast. And he's like, "Water fast? I just did that for 21 days. That doesn't work for me." I'm like, "Trust the process. Trust the process. You weren't making ketones when you

20:02 did that last water fast. And you don't have to you you don't have to do the full 72-hour fast. It's like that's the ultimate challenge in that in that class. 36 hours you can do and you just tell me how you feel at 36 hours and then we'll go from there. And at 36 hours he's like I actually feel pretty damn good. And you can tell in his numbers cuz now his ketones are like 2.5 and his blood sugar is like under 100 for the first time. Oh no it wasn't under 100. It was under 120 which is you know getting into that at least he's now pre-diabetic instead of diabetic. Um, and by the end of a 70, he did make it 72 hours of water fasting. He did not think he was going to do that at the beginning. And now his ketones are north of four and his blood sugar, I think the lowest it got was in that 110 115 range. I mean, to take such a severely ill patient in, you know,

20:54 September 1st is essentially when we met him. and by January 1st to have not only all of those uh medical problems reversed, but to have them I mean in the evidence of one of the most crippled parts of his body, the place distal to the brakes in his leg, which the heart's going to have to help with, the lymph's going to have to help with your metabolism, but his shin, I can see his shin bone. Now, that is bragging rights. That's incredible for this patient. Now, as we've discussed so far, insulin resistance is at the root cause of most of your chronic health issues. And the very first step to fix it is to significantly reduce your carbohydrates, sometimes to under 20 grams a day. But as you do this, your body goes through a major transition. And you might experience some side

21:40 effects like headaches, nausea, fatigue, and even cramping. And this is where salt is so important. Now, I want you to be very generous with your salt in every meal and in your water. But if you still feel these side effects, you really need a precise balance of electrolytes, including sodium, potassium, and magnesium. And that's why I'm so proud to have Element as a sponsor of this episode. I personally use Element because it has a sciencebacked ratio with no nasties and no preservatives. And I use the raw unflavored pack. It's a teal color, and I add it to my coffee and my water during the day. And especially, I add it after a heavy workout. And if you prefer flavors, they have plenty of great ones to choose from. And right now, Element is offering my viewers a free sample pack on every order. So, you'll get eight single servings of their most popular

22:27 flavors to try for free. So, if you want this, just head to drinkelement.com/theprimalodcast. How much weight did this patient lose? Because we spoke about the HBA1C. Uh we spoke about other outcomes, but he wanted to lose weight and he was on a little GLP1. How much weight did he lose? Yeah. So, uh, he started that 21-day fast at 260 lbs and again didn't he lost some weight, but then as soon as he stopped the fast, it came back on. So, he came into our class at 251 lbs. So, a few pounds down. He'd been, you know, following the channel on YouTube and doing a few little things. By the time he got to September, he was 230 lbs. So, now you've lost 20 pounds during that 21-day fast. And I will, people say, "Ah, it's just water weight." Absolutely. It was water

23:15 weight. His legs were filled with it. So, we're down about 20 pounds in September. Uh in October, he gets down to 224 and then for some reason or another he doesn't weigh himself in November, December. He said, "I want to weigh myself January 1st." Take a guess what his weight was if he was 224 in October. 180. So close. 190. He got under the in the room. Pretty awesome. Yes. Can I just tell you like this is a major teaching point and I know that you love teaching Dr. was um for somebody watching and you've they've heard this whole story right now and it's a major point even in your history see like so many patients why is this important for the person watching to understand about insulin you know the the difficult part you know you said earlier

24:02 doctors don't like to check insulin it's because it's not it's it's not just a one point in time insulin and I think you know when we have point of care glucose or like the continuous glucose monitors that we use for to teach patients and they start to see the volatility in glucose. I mean take that times 10 when you're looking at the volatility in insulin. So they come in fasting and you know if their doctor you know they they put on their best dress and their best outfits for the doctor to see them and they do their best to make their blood work look good. Like okay I'm going to really fast. I usually don't fast. I usually have a nibble before I go to bed or this or that, but they, you know, oh, I'm getting blood test done tomorrow, so they're perfect and they wake up and their insulin isn't bad because they haven't stimulated it. Uh, when we look at,

24:51 uh, the hidden messages behind insulin is that 20year-old eating processed food, just living in America 101, drive-thru, you know, not not even bad food, just not great food. Uh, it's in abundance. It's late at night. It's coupled without as much activity in our lives. They don't look unhealthy, but the insulin is doing its its evil job of being in excess. And I mean to me, you know, I had a 24 year old come in saying, I want somebody to prescribe meepatide and I see you do this. I am only 10 pounds overweight and I've gone to every online person saying tell me uh that

25:36 I can have uh trappepide. I look like the lady in all of your marketing. Uh I can I want to lose the last 10 pounds and I've watched your channel. I want you to tell me I want would you give it to me? I said I'll write you the drug as long as you blog about it and you have to do everything that I tell you. So she's she's 120 pounds. She's not overweight, but she does have um she's like, "Well, my, you know, I'm out of college and my jeans don't fit as tight and I I my brain's a little foggy and my energy seems So, she's telling me all these things that insulin is doing." And I look at her shinprint and I'm like, it's it's not anything close to our our other patient, but there's a little hint there. And I'm like, "Okay, here's the rules. You have to do exactly

26:24 what I tell you to do, and I will write you the prescription for this." And she's like, "Yes, because I went online and I told uh the truth to 10 of these providers and they wouldn't provide it for me. They said I have an eating disorder and I I want to try this drug." Like, "Okay." So, she I says, "Here's step number one. You're going to have to go get your labs done." And I do all the labs I would do if you were a 40-year-old itches. What are your liver enzymes? What's your kidney function? What's your hemoglobin A1C? Um, you know, what are all the things? And then we're going to go get a body scan done. So, she doesn't have diabetes. Um, but she does have a little bit of protein coming out of her kidneys, a very bad sign of high insulin. And her liver enzymes are just slightly outside the range of normal. Now, Rita, this is a 24 healthy, glowing young woman

27:15 who just is having a few of these little insulin side effects. Oh, my energy's low. I've put on a few pounds. I just feel a little sn. And then there's these times where if oranges are in front of me, I'll just eat the whole thing. You're like, "Okay, I've done that. I've done that. What? Oh god." So, there's a little bit of behavior in there that says she's craving for food. Uh, which is another classic sign for the insulin's higher than you think it is. And as soon as you lower the sugar, you'll overshoot and then you'll want more and you overshoot and you want more and you overshoot. And so they they chase the the buzz that happens with with um carbs like what you find in oranges today. So she mean she gave me enough hints that I I kind of knew where the cards were going to play. All right. So she I said, "You got to go on a ketogenic diet. You got to show

28:03 me every morning fasting glucose, fasting ketones. What is um what's your what are your numbers? And you got to be in ketosis before I will write the prescription for the drug." Uh so she, you know, gets prepared. and she writes the first blog about how she's going to do these she did these labs, she did her dexo. The results aren't back yet, but um now she's going keto. She goes keto and despite me saying salt, salt, salt, salt, she gets the keto flu. Now, in my mind, that's another sign that that insulin's been higher than you think it is. And I've just slammed it down. Okay, insulin it does these sneaky little things, right? And when they've had them for 25 years, slamming it down in my 50-year-old who's on three, you three blood pressure medicines,

28:49 okay, we can have problems. But this is a 24 year old. Her blood pressure is fine. But as soon as you take away the carbohydrates and you have her on a highfat, high carb or high pro, highfat, medium protein diet, um, I mean, it takes her like two days to make a good ketones and now she's got them. And then she has the keto flu, which tells me you just diared. just rung out the tiny little insulin driven inflammation that our other patient had. So high you could see it from across the room. So I know I'm winning. So then she gets the prescription for the drug and before she ever injects the first one, she's like, "Gosh, I just can't believe how I don't crave any food. I just can't believe how much better I'm sleeping. I've lost a couple of pounds." And I'm like,

29:36 "Really? Now you have that $400 drug in your hand. Uh you sure you want to do it? Oh, of course. Like, okay. So, uh so then, um she gets the first injection in and like most young women, if you've had chronically elevated insulin, um and you go on a ketogenic diet and nowide, you know, again, I start her on 0.3, like half the dose that I started this other guy on. So such a tiny dose you can't spit it. I mean it's like one teardrop of drug. Uh and she said within a day I was having my period. And I'm like that's another thing that insulin does. Okay. If when you lower it you are going to see your fatbased hormones, estrogen, testosterone, progesterone do things that they

30:24 have been trapped under the veil of what insul insulin dictates where fat goes. Those fat-based hormones have been under that dictatorship. And then she has this spotty bleeding when she thinks, you know, she gets online and says, "It must be the drug. I I I gave the drug and it's I've been bleeding for three weeks." And I'll let you uh if you go to our Substack, you'll get to hear how her story turns out cuz But Reena, I I said yes to this young woman because this is this is the craze that you see in America. Like if you're 50 and older, one of four of them have been on a GLP1. That's crazy. If you take the whole adult population, it's one in eight. And when you go online to these the mills of GLP1 and they just start you way out at too high of a dose and you get all the side effects, um, but you don't change the types

31:14 of food you're eating, the timing that you're eating. You you aren't decreasing the insulin. You already got the insulin monster going. And it only takes that highly particleized food that um you know processed food that sure you eat less of it when you're on these GLP1s. But it's a I mean it's a profound difference when you say eat the whole foods, eat the highfat and the protein. Give me that in a ketogenic state. And then you know watch how naturally this young woman is going to make GLP-1 even if she you know decides to go forward with the experiment. You're like that's what insulin does. That's fascinating. And I was just thinking that every single person wants to go on a GLP1, but if they just change what they eat. Yes. The the switch happens. Um so you highlighted

32:02 two patient stories there. One older gentleman, very very challenging. And then a younger female that might look like me. I'm not I'm not that young. I'm 42. Um however, however, it's a teaching point to understand that insulin does not just um affect older people. It's anyone starting from the age of 20. Now, in your conversation, you mentioned some weird signs that people could know that they have elevated insulin. Um, periods, the sh the the thumb on the shin. I pressed my shin. It's like really nice and tight, but people can do that. Can you explain? So, someone watching right now because they're just like holding their phone watching you and listening to you. What should they do in their shin to know that they have elevated insulin? Right. So, there's a couple things that I tell people to do. Take your thumb and look at it. You've got a thumbnail. Okay, your

32:48 thumbnail looks a little pink. And if you take that thumbnail and you push it on your knuckle, it should turn white when you push hard enough. Like that's what So the pressure that you're going to use has to turn the thumbnail white. Okay? So that's how hard you push. And then you want to push along the bone of the shin. So people not in the muscle, along the shin bone. And when people have swelling, that bone is might be a little harder to like pinpoint. But the key is there are sheets of fascia. Think of them as like saran wrap, you know, under the skin. There is no fat. Okay? This is not fat that you're pushing against. This is fluid in the space that it doesn't belong. And there's multiple reasons that it ends up there. But when you can push on that that enough

33:35 to turn your thumbnail bed white and you hold it for 30 seconds and it should hurt a little. So you know you're doing it right if you do that. Mine wasn't hurting. Okay. Yeah. 30 seconds it should hurt. Yeah. And then when you lift it up, okay, close your eyes and just see if you can feel the shinrint. Uh I mean when I have medical students, when I teach medical students how to do this, you can grade it. But the when I teach patients to do it, I say just close your eyes. Can you feel the dimple? Uh, and then you can have other ways you say, "Oh, how long did it take for the dimple to go away?" You know, 30 seconds, a minute. In our m and our our day trader, it took him I mean, it took like 10 minutes and you could still see where the print was. So, the time that it takes for the fluid to go away, it should never have an imprint, first of all. But when you're trying to

34:22 measure, am I getting better? You know, look at it at 30 seconds after you've lifted it and say, is it gone? um when you first lift it up it should have nothing but if it has something you know tell me what it is at 30 seconds can you feel it at 30 seconds can you feel it at a minute and so that's just a way to measure am I getting better like is the blood pressure getting better you can use numbers there when you're looking at shin print you're looking for did the indentation you know return to non-pelpable you couldn't feel it when your eyes were closed within 30 seconds within a minute got it so people can do that at home so if you're looking at a patient Basically, I want people to look in the mirror and know like I have high insulin. I need to do something about it. What should they look at on their face, their armpits, their elbow to see that they have high

35:08 insulin? Well, the skin things are great because it it is you can look it across the room. Uh you know that you know this the show House, the doctor who's snarky, uh but he's kind of like, you know, Detective Holmes in the I love that show. and he would look across the room and say all the the diagnoses that he could see on a patient. It's a game he played. Uh so you can do that. You can see that the skin in the folds of the skin uh it turns more brown, more dark. And so if you already have brown skin, it gets a little browner. Uh in fact, sometimes you look at the back of the neck and say you just need to wash that off, but it doesn't wash off. Uh the darkness in your armpits and in the the folds of your groin all become darker. One of the places that on a physical exam that

35:55 um I we would methodically document is under the folds of a woman's breast. Again, there's no sun coming there. It shouldn't be brown. And when that fold lays on another layer of skin, so the breast touches the the the chest cavity or the chest wall, uh you'll also have some abrasion that causes uh the skin tags to happen. Again, those are not normal. Those are a a direct consequence of uh having high insulin, but what comes before the skin tags can be this little bitty just dusting of brown. So, I'm butt white and so mine would be just a tiny little darkness in a place where there's no sun. You're like, "Oh, that's just me being tan." No, no, no. This is on your armpits, under your breasts. The sun's not getting there. Uh so, that's one thing across the

36:45 room. But you know, one of my one of the earliest signs is they'll have higher blood pressure than they than they are supposed to. That's like an easy thing across the globe. You can get your blood pressure taken. And I mean, insulin resistance, what's one of the first signs is that blood pressure is higher than it should be. I mean, today all the guidelines would tell you we want that top number to be in the one teens. We want the bottom number to be in the 70s. you know, low 70s would be great. I mean, don't get anywhere near 80. And when you're young and healthy, that is not going to be normal. I mean, it's going to be normal for it's not going to be abnormal for like a decade. But just like this 24 year old did not know her insulin was high. If she came into

37:31 me, you know, first baby 32, you know, you know, in about a decade and she got that high blood pressure during pregnancy, what my first thought would be, oh, she's had high insulin for a decade. for a decade. Mhm. Wow. So someone if someone can't lose weight, they can't get pregnant, they have some sort of symptoms that they come to you for, it can be 10 years in the making that they have high insulin. Absolutely. Which, you know, the best part about that is, you know, you're going to Okay. One of the ways to test on your own, right? Let's say you're I I have some friends. I live in Florida now, right? So, I have all these neighbors that have relatives in Cuba, and of course, the lights are out and electricity is like, "How do you how do you know uh if they're healthy?" I'm like, "Well, you know, looking at um um their blood pressure uh is okay, but maybe they

38:21 don't know how to take blood pressure." I'm like, "Well, put them on a ketogenic diet and just give me three days." Okay, give me five days when you're in Cuba because you need to have salt, but give me five days on a ketogenic diet. Do you feel better? So what was trapping that brain from the energy uh from the the fat being the fuel to those brain cells to the fuel to your heart cells? Uh we deliver on that within that you know third fourth fifth day for most people. Now our patient at the beginning of this conversation he was so sick. Uh I was happy to hear he he felt good like by the sixth week of knowing him. But most people and they get in the ketogenic state and within three days they're like hot damn I do I feel good. I mean that's the best way to say was I insulin

39:10 resistant? Yes, you were insulin resistant. That's what that looks like. And there's so many people in our community that we don't have to keep you know the whole population is insulin resistant. From my point of view, it's like everywhere you look, you have to work so hard to not be insulin resistant that, oh, that's just normal. Everybody feels better on the keto diet for the first three days. I'm like, yep. Uh because their insulin was high before they started. So, why don't we talk now about how to get into a start a ketogenic diet the right way according to Dr. Bos. Um, you talk about 95% of people do keto wrong, highfat wrong. What mis what is the number one mistake that they're doing? Number one mistake when they do keto is uh they I call it ass over apricot. They

39:57 go all in, tumble down, go all the way to the the most extreme. They get on my YouTube channel, they hear that I fast 72 hours a week and they're just like that's what I'm going to do. And I'm like, stop that. You got to pick up the cells along the way and train them how to know what to do with a ketone and know how to make a ketone. And so the book I wrote is called Keto Continuum because you don't have to do all the steps in the continuum if you're healthy enough, but you definitely need to do the first few steps to be able to activate that chemistry set inside your own body. I mean, what did our patient at the beginning of this story do wrong? He did ass over apricot. He just said, "I am going to fast for 21 days." And you're like, "Okay, that did not help. You made it worse." Um,

40:44 what he should have done is step into a state of ketosis. And like I said earlier, I have patients who say, if the only thing you can do is sip on BHB for the next week, then do it. Keep eating your pasta and drinking your wine. But right now, you can get at least the heart using ketones, the brain using ketones. When those vital organs are using ketones, your liver will make its own ketones even when you're eating carbs. Now, it quickly shuts off when you stop drinking the BHB, but you can ignite the chemistry set. Um, and then of course what happens is they can't believe how much better they feel. And for the first time, they're willing to say, "You mean I shouldn't buy cereal?" Like, "No, you should not buy cereal." Even keto cereal, Dr. B? No. Damn. Now,

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42:20 grass-fed tallow which is naturally packed with vitamins's A, D, and K2. The great thing is there is no nasties. There is no preservatives. There's no fake stuff. There's just stuff that your body actually recognizes. And I've been using the unscented soap every single day. It's incredibly gentle and doesn't strip your skin's natural barrier. And if you're in the US, great news. Our new USA store is now open, which means faster shipping and cheaper prices. And for the next 7 days, get up to 30% off our new shampoo bars and body wash. Just head to the primal.com/shampoo or use code shampoo at checkout. I've also linked them in the description. So, basically what you're saying is don't rush into it. Do it step by step. Can we talk about the three I've got three or four steps here so that people can just generally go into this in a nice smooth way and not have the

43:09 you know crash that people get. So the first thing is to track insulin not calories. Don't count calories. Why? If you lead with prick your finger in the morning usually I lose my audience. So as much as I I love the data that I show on my channel and I I use for my patients. If I'm in the wild and saying what's the first step? If it's not, prick your finger. But it is by urine ketone strips. And what you're going to look at is I want you to be able to check your urine ketones. Tinkle on this little strip every morning and tell me if you're in ketosis. But the first week, I just want you count. I don't want you to change anything about what you do. I want you to get the chronometer app. I still think that's the best one for measuring uh accuracy in carbohydrate counting. That's the one we teach. And it's free. So just get on there and figure it out. And you do not want to have you you want to look at how many carbohydrates you start with. And if I'm being

43:59 nice, I tell them to cut by 50. Cut by 50 until you get to 20 total carbohydrates per day. Now, I like ripping the band-aid off a little faster than that because I think changing behavior takes focus and concentration. So, just like if I was helping an alcoholic stop drinking, um when the judge sends him to me, he's focused and concentrated. So, we can change some behaviors. When I'm when people are, you know, tickling their brain with could I could I do a ketogenic diet, I get them swallowing the ketones, uh, if they're willing. Um, but if the steps are what are the first three steps is check your number of carbohydrates before you ever begin because most people do not appreciate how many carbohydrates. They say, "Oh, 20 carbs per day. I can do that."

44:47 I'm like, "An apple has 18." Can I just tell you I literally just spoke to Dr. Georgia Eid yesterday and then I was talking about fruit and foods to eat and not to eat and I was asking about apple and then she said well it depends as you would say if somebody's metabolically flexible. I said but Dr. E has got 20 gram of carbs in one apple and Dr. Boss, you're saying to eat 20 grams a day, but one apple has so I think people can calculate, wow, I probably shouldn't be eating an apple if I want to lose weight and drop my insulin, right? I mean, you might be healthy enough for that. So, you could test yourself. If you wake up in the morning and your glucose is in the 70s and your ketones are above around one, then the apple did not stimulate that much insulin in you. But most of my patients, if they eat an apple, especially if they eat it after two o'clock in the afternoon,

45:35 their insulin will be high for the next two days. I mean, it it is impressive how broken their insulin producing system is. It's just revved. So, they can't afford to tickle it when we're first starting that they I mean, you just 20 total carbohydrates per day. If you're looking for success, you it's not net. It is absolutely start there. And you people can relax it in in their future healthier state. That doesn't mean in a week you can start eating car, you know, eating an apple. You've been making too much insulin for a decade. I mean, probably a decade. So, I need the little cells in your pancreas to be in low insulin production mode for like 90 straight days.

46:22 That means you cannot have an ice cream binge in the middle. The timer starts over. Those little cells are going to replace to the maximum number of insulin that they had to produce in their lifespan. So let's say the cell lasts for 6 weeks. It's going to still take a memory. Okay, it's time for me to die. I'm going to make two replicas of myself. What's the maximum amount of insulin that I had to pay make in the last 6 weeks and it will replicate that copy of those old cells. So it's that's why it takes so much time and energy to to you know and discipline. I mean discipline isn't my favorite word to use. a community of people saying, "Let me show you how to do this. Let me show you other things to do besides eat." Uh, like you've got to create a life that's that's rich and it's attractive, that's filled with vitality, not just scold and shame them into the rules of

47:10 a ketogenic diet. That's why Dr. Bos, what you do is so important because your live classes, everything that you do, it's so important. Your YouTube channel, all your messages, which is so clear and simple because it's not discipline, it's just community being around like-minded people. And that's why we're going to Meattock as well so that we can be around. Yes, I just It'll be the first time we meet in person, isn't it? Yes. Yes. I think it will. So, so that was the first rule. So, very, very simple. Track insulin, not calories under 20 grams of carbs. Don't eat an apple. Next rule is don't eat after dark. Now, Jason Fun, I love him, but you know, he does talk about that you can shift your eating. You know, earlier is better, but you can just do an intermittent fasting window. But why do you say try to shift it really early? Why is that better? Yeah, naturally as we age, um, our bodies become more insulin resistant at night, even healthy,

48:02 like I'm pretty healthy. But if I want to mess that up, give me 3 days of eating after 6:00 and watch how high my blood sugars are the next morning. I mean, it is not like, oh, in six weeks I'll I'll incre No, within days my my blood sugars in the morning will rise. looking at any human that eating earlier in the day, eating during daylight uh is um is is going to be the rule I put out for patients just to make it simple. But I have some patients who are so stinking insulin resistant. Uh and they've had it for so long that their last bite of food is by one o'clock in the afternoon and by golly, their blood sugars in the morning are 75. they really are able to lose the weight to really improve. And people say, "But I'm not hungry in the morning."

48:50 I'm like, "You will be on about day three." If you do not eat after 1:00, you might not get there the first day, but you will be by day three. Just let your body adjust to that new rule. Okay. Um, rule number three, which is simple, the Dr. Bos ratio. So, you mentioned it earlier. So, can you kind of explain how people can do it right now? Right. Yeah. So, this rule came because I was helping my mother who's a wonderful woman, but her brain was not doing well. She'd been on chemotherapy. She'd had some um major life setbacks and I'm trying to calculate how to get her ready for the next round of chemotherapy. She was in a in the hospital. She was really sick. And of course, the units of measurement uh in the way we measure glucose, we do deciliters

49:36 uh or milligrams per deciliter, not millim moles per liter. And so, I needed you to convert this and do this. and then get them into 1:1 ratio so that the mill moles of of ketones were one and that the glucose was okay. She looked at me like you're nuts. I said, "All right, mom. Uh, let's just do dirty math and you're going to take the big number in the American units and you're going to divide it by the little number." And that Dr. Bos ratio is just another mathematical way to do a GKI, which is a lot more math. And it's not difficult. It's just you got to calculate it. When looking at that, both of those numbers, what they're measuring is how how how what is the relative impact of insulin in that body right now? And let me unpack that, Reena. In somebody

50:22 like our patient when he was fasting for 21 days and had that high cortisol state, the impact of insulin was still very high in his body. If you reverse 10 years before that when he first did the uh story of Dr. fun where he was fasting for eight days straight and then eating and fasting for eight days straight. His insulin on the first day of his fast was still very insulin resistant. By not eating for eight days, he had lowered lower lowered the impact of insulin. So the even though the amount of insulin was less, less less less less. Um it was the first month it got a little better. The second month it got a little better. the third month. By the 18month month, yes, he was lowering his blood sugar, but the overall impact of what insulin was doing inside the cell,

51:07 which is really what we are trying to reverse in insulin resistant patients. It isn't just okay lower their insulin. It's lower how how sensitive the cell is to hearing the insulin. And that's what a Dr. Bos ratio is measuring. So that's what a GKI is measuring. So for instance, you take that gentleman and he was able to fast for seven days and then he would eat and his insulin would go right back up. I mean he would make a bunch of it. He was very insulin resistant. He could stop his body from making it by not eating for those seven days when he was in his healthy phase, but he was still very insulin resistant. It took him a year and a half for the cells to not be so noise, you know, to be so resistant to that amount of insulin. And the reverse happens when I have a patient uh who would come to see me in the early part of my career and I put them on insulin and

51:56 at first 10 units of longing acting insulin would work but then it took 20 and then it took 30 and to ever undo that I have to I have to decre I mean it wasn't that they needed three times the insulin because the we did the math wrong they needed three times the insulin because the cells became more and more and more resistant to the insulin and if you were watching the Dr. Dr. B's ratio during those times I mean their Dr. B's ratio they mean the higher the ratio the higher the insulin uh resistance. So you know when I started them on 10 units of insulin their their ratio would have been um you know you know let's just say they're they're medium for insulin resistant after being on 10 units for 6 months. Now it's a little more insulin resistant. After being on insulin for four

52:43 years now we're very insulin resistant. So, we're building the insulin resistance by giving them the drug, but you don't need me to do that. You just need to eat a bunch of carbs. So, when I look at um that Dr. Bos ratio and people come in and say, "Gosh, I came into your program and I did so good and I had these great Dr. Bos ratios and everything was, you know, butterflies and unicorns and then I did everything the same and the numbers just my doctor boss ratio is terrible." I'm like, "Yes, you got healthier. Your insulin resistance is better." And now you need to give another stimulus to your metabolism. That's a fast, that's a sauna, that's a decrease eating window. So what worked initially improved your insulin resistance for a little bit and you'll see it in that decreased Dr. Bos ratio. But as your body gets used to the new rules, the Dr. Bos

53:33 ratio goes up again, meaning you're still insulin resistant. We can measure it and it might only take two cups of insulin to do the damage now. And when you started, it took two and a half cups of insulin. So, we have less insulin, but it's how well do the cells hear the message from insulin and they hear it better, but you still make a bunch of it. And that's where this by looking at that Dr. Boss ratio first thing in the morning, you're measuring how well does your body listen to insulin. And you know, people have seasons. Like I have a couple patients who had a major eye surgery that they were counting down to and they come into the program and they do all the things and they're doing pretty good and they get to the the eye eye surgery and they did great and now they're on the other side of it. So the urgency is gone but and they say, "Oh, my doctor ratio has just not been

54:22 the same since surgery." And I'm like, "Yeah, but maybe that's as good as you can do right now. I in order for us to sweep that back into a really good repairing reversing medical problem. Dr. Bos ratio, you're going to need to put in some you're going to put in some work and right now you're healing from a very serious, you know, eye surgery. Take it easy. You're you're stable, but the ladder to better is still ahead of you. So, I mean, people say, "Oh, you chase numbers." Yes, numbers are how you know what your body is doing. You don't have to have perfect numbers forever. I don't have perfect numbers every day either, but it is the numbers that tell me how far off have I gone. Perfect. So, if somebody wants to uh push up their Dr. Buzz ratio, like maybe it's

55:07 like stalling a bit, some tricks that we can do um to kind of increase your metabolic rate. You like to sometimes tell your patients to eat butter only. No protein, no carbs, just eat butter. Are they going to have a heart attack? Why do you do that, Dr. Vos? Why do you say that? Yeah, there's a one lesson I'm usually teaching them in that in that time and it is the word satiety. Like satiety is a hormonebased response of feeling full that satiation. It is very primal. You know you're done. You cannot eat another bite. And especially in my people who like I need to have so much protein and I'm like your numbers are not showing you you're not reversing problems right now. You are in a very low ketogenic state. And although if you're healthy, you could stay there, you're

55:56 not healthy. You're still 70 pounds overweight. Watch what happens when you eat just butter. And they're like, "Ah, just like you, it's going to be a heart attack." I'm like, "No, I'm looking for satiety." And those those hormones that cause your body and brain to say, "I just can't eat anymore. it is they're all based on the consumption of fat which is you know choleaccytokinine and you know the peptide y and ckk all these hormones that say yes I'm done eating I'm full um and they're fat-based and I have many patients who've just not felt that like so eat butter all day every for the whole day I want you to eat butter maybe two days of it because they're stubborn like I want you to rate do you feel full and you I mean to awaken some of So people can't make these hormones,

56:45 they just have been in such a high insulin state that they haven't felt that. So by eating butter for 2 days, you are able to wake up some of these fat-based uh responses like you swallow fat and so now finally you're making choleysin and all the things that do help you feel full that the high insulin state wouldn't let you do. So by the end of the butter experiment, I'm like that's the feeling we're chasing. you know that you're in a proper uh chemistry set when you say, "Gosh, I got to the end of that steak or whatever they're eating." And I felt this sensation of not needing to eat anymore. And when when I see some of the mistakes carnivores make, they'll say, "Eat until you're full." But they don't have the hormonal surge to feel full. Two days of butter.

57:34 That's what I'm chasing. That's what I want you to feel. And when they have no protein in the way, nothing else in the way, the butter gets. I mean, it's much easier to talk them into butter than sardines usually. So, I want to ask sardines. Um, which is better? Doing the butter fast, sardine fast, which is better? Uh, if I'm if I'm teaching satiety, nothing beats butter. Like, if you don't know what it feels like to feel full, if you are a carnivore that overeats, I can show you what it feels like to feel full with butter, and it's much easier to sell them on that. But if you're trying to live a life, uh, I'm going to sell fish to you every day. Those little bitty fish have, you know, all of the nutrient density. Uh, they are high fat content. I mean, I'm telling people, even if you buy them in water, put the oil on. You want them in oil. You want them with fat. And that,

58:23 um, that, you know, high protein, you know, you're not pulverizing that protein into little bitty particles. You're chewing it. And you've got enough fat in there to shut off the hunger. Um, so sardines for the long game, uh, butter for if I'm teaching, what's what does it feel like to feel full? Hey, I like that. The short game and the long game. What about a game to trick your brain into more focus? A/4 cup MCT MCT oil. Does that work? Oh, it does. But be careful, you can get diarrhea. Oh, there meaning the cells that absorb MCT. Meaning if you have pure C8C10, meaning eight carbons or 10 carbons is the fat chains I'm talking about, not C12. When it's eight

59:08 or 10 carbons or less, you absorb that fat. You do not digest it. But if you're a baby keto person and you haven't been practicing absorbing that fat, it'll come out the other end and you'll see it in the toilet. So, a/4 cup of MCT is a lot. Um, but my gosh, when you do put it in your system, it does turn into a really high ketogenic state. The part that I I'm a big, you know, repairing brains is what my ethos is for my my medical practice. Uh when I look at the people who have C8 to drive the um production of ketones high, yes, you get really good ketone numbers with C8, but C10 crosses the bloodb brain barrier and is a direct fuel into the astroytes of the brain and is

59:53 especially found for improving that cognitive function for anybody who's struggling from a concussion or chronic diseases of Parkinson's or Alzheimer's. So C8, C10 is still by far the best combination of fats for saying, can I get those in my circulation and most importantly, can I get them to my brain? If you want to buy C8 or C10, is there certain brands like is there something that you'd look for? Cuz I haven't seen C8 and C10 to buy. I sell it. Oh my god, Dr. B, that's awesome. What is your I'll leave the link for your uh website in the um show notes that people can Yeah, cuz I mean I'd never like I do this for a living. Never I never heard of like

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