Consult #5: Keto, Sleep, & Autophagy

Jennifer Marie struggled with a fever and congestion this week after her traveling schedule wore her down. Like many of us, she found it difficult to make healthy food choices at airports and outside of her regular pattern of life.

Jennifer Marie can thank those ketones circulating around her blood for the added bonus of a hardy immune system. Yep. No one likes the crud. But if those pesky invaders set up a home in your chest, you can thank ketones for a  quicker path back to health. White blood cells born in bone marrow nourished by ketones pack a stronger punch. Whatever bug ails her, the months of ketosis prior to infection strengthen her immune response while keeping her inflammation low.

Grandma Rose showed off to all of us with her improved immune system once she soaked her white blood cells in ketones. For 50 of the 52 weeks prior to starting the ketogenic diet, Grandma Rose added antibiotics to her wilting body. The wimpiest infections won over her dying immune system. After switching her body chemistry and pumping ketones around her 71-year-old system, she flipped that scorecard spending only three weeks on antibiotics. Wow. Despite cancer growing in every nook and cranny of her body, she hardly needed the prescriptions to fight those invaders when ketones policed her system.

When fighting infections, 80 percent of the credit for victory goes to your immune system. When I add antibiotics, that boosts your immune system by only 20 percent. Ketosis gives Jennifer Marie a leg up on current and future invaders.

During Jennifer Marie’s trave, her insulin levels spiked–and ketones dipped. Once home, she sunk further into a rut with this illness. She quit tracking her numbers and simply rested.  GOOD JOB!!

When life hits you with increased stress — whether that’s a disrupted schedule or an illness — the best defense is REST.  Give yourself grace. Stumbles happen. Slow down your pace when that happens. Your body will thank you with a rapid recovery.


While in New York, John’s knees protested from the miles of walking. His distant work-related motorcycle injury growled at him from inside those joints.  The pain meds after the accident sat in the cupboard back home. He stopped them a while ago. Recently his varicose veins procedure triggered all of his aches and pains to flare.

Increased pain always links John to restless sleep. John’s solution: a shot of whiskey before bed. That’s been working out as a viable solution for his pain . . . . until I came along.  His Dr. Boz Ratio stinks the morning after he uses alcohol to sleep.

His nightly alcohol stopped for a few nights. But then he found he could not sleep. HIs disrupted sleep slingshotted his cortisol hormone in the wrong direction. Cortisol controls his stress, blood sugar, and depth of sleep. Elevated cortisol makes it harder for him to lose weight. HIgh cortisol also prevents autophagy. [Check out my article on Autophagy.]

Now we are back full circle.  The reason John agreed to this ketosis adventure in the first place was his knee pain. His goal is to avoid surgery on his knees – or at the very least, put surgery off until he retires. Autophagy could help with this.  Autophagy only happens when those Dr. Boz Ratios hang low — like less than 40. High sugars from the cortisol make that a non-starter.

  • Knee pain happened.
  • Pain led to poor sleep.
  • Poor sleep led to high cortisol.
  • High cortisol led to high blood sugars.
  • High blood sugars prevent knee-autophagy.

Last week I suggested a 10-hour fast from John’s nightly scotch.  This was my first step to wean off the alcoholic as the sleep-inducing, pain-killer. That didn’t work.

How does alcohol impact sleep?

Each night, a well-resting human enters into a short period of slow-wave sleep.

Slow-wave sleep cleanses the brain during short pockets of time throughout the night. Once you sink into this special type of sleep, your brain only stays there for a few minutes.  Slow-wave sleep is the deepest, most sedated sleep our brains get. When you study this, it can almost scare you to learn that you really can’t wake up during this phase of sleep. If you change the diaper of a baby in slow wave sleep, she won’t wake up.  Similarly, an adult can not awaken during a fire alarm if the alarm sounds during this type of sleep. Only after the cycle is complete to they awaken. That’s scary. If our body does not feel safe, the brain will not settle into this magical sleep. If the body is feeling danger, no slow-wave sleep. Certain chemicals prevent our brains from accessing this type of sleep. Other prescriptions promote slow-wave sleep.

During slow-wave-sleep magical things happen. Slow-wave sleep washes the brain of debris that built up over time. This debris is linked to several chronic brain disorders such as Alzheimer’s, Parkinson’s, and increased pain. Slow-wave sleep resets pain receptors. It also stabilizes our mood and enhances our memory. Disrupted sleep worsens our pain, slows down our thinking, grumbles our mood, strains our heart, and weakens our immune system. Sleep only seven hours a night for a week and your brain will perform as if you’ve been awake for 24 hours.  Do that same 7-hours of sleep for two weeks and your brain acts like you’ve been awake for 48 hours straight. Not good.

John’s chronic pain causes inefficient sleep. Inefficient sleep causes weight gain. Weight-gain causes more pain! Alcohol prevents slow-wave sleep. So do the medications that act like alcohol called benzodiazepines.

It seems there’s no way out of this cycle!

Luckily for John, he lives in the time of modern medicine. As an internal medicine physician, I will disrupt his sleep ….. In a good way. The proper selection of medications in this situation will pull his brain into slow-wave sleep. [See my other video on slow-wave sleep.]

Dr. Boz Ratio

The Dr. Boz Ratio (glucose ÷ ketones) of <40. It’ll require a good, day-long fast and a 5 p.m. medication three days in a row. He’ll likely check out of life for those three days while his body does a sleep re-set. But I think he will be pleased with how this impacts his sleep, his pain level and his ability to lose weight going forward.

Be sure to check back next week on John’s progress! I think we all will be impressed.


A viewer asked whether long-term low-carb can cause a drop in T-3 thyroid hormone and whether carb cycling can combat this.

On a ketogenic diet, we remind your body how to use ketones. Ketones require lower insulin. Too much insulin and you will find no ketones. If you’ve been 15 pounds overweight you have a history of too much insulin. If you’ve held that weight for more than a year, your liver is irritated from the elevated glucose. This irritation arose from too many days of elevated insulin. Keep your ketones high and your insulin must be low. Another way said: A low Dr. Boz Ratio keeps the Inflammation away. Thyroids suffer from chronic inflammation too. The best chemistry for your thyroid = chronic ketones.

Keep the carbs low. Keep the ketones high. That makes for a happy thyroid.

About a month into the ketogenic diet, some patients ask for for a “cheat day.” When I prescribe a medication for someone to take every day for a year, I know they will miss some. The same behavior applies to a ketogenic diet. One hundred percent compliance rarely shows up. Carb cycling for thyroid-management should be called “cheat days for thyroid.” I don’t recommend this. You are going to enhance the inflammation. That reverses the repairs going on inside cells of your thyroid.

Instead, show me what a 12 hour fast does to your Dr. Boz Ratio. Get under a ratio of 40. Hit that goal 3-5 times a month. The rest of the time, keep keto and hold 10 hours of fasting before the sun rises.

Can I eat just once a day?

Yes. You can eat once a day, as long as you are careful that you eat enough to be full. The danger of eating once a day is that it’s easy to fall into the old low-calorie patterns. Surges of cholecystokinin and other key fat-basted-hormones happen when the body feels full. This spike and fall are critical to a solid, strong metabolism. Listen to your body. When you eat, eat until you feel full. Then stop.

Have you read my book yet?

Anyway You Can is an amazing resource to guide you on your ketogenic journey.

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