Hi, I’m Dr. Boz. Welcome to my channel! If you’re new to my website and the ketogenic diet, I recommend the playlist: All Things Keto. That playlist starts with the most common questions people have at the beginning of the ketogenic journey. It takes you, step-by-step, through those hiccups and best practices for going keto.

If you’ve been at this ketogenic diet for a while, you are in the right place. This article is the first of many titled: Keto Consults with Dr. Boz.

As a physician, patients share intimate stories of how they struggle. Our relationship grows when I meet them at their struggle. This series is just that: meeting people where they are struggling on a ketogenic diet.

In the video above, you will meet Jennifer Marie. Following episodes will introduce her husband, John. We’ve invited you to join us in the exam room as we tackle the struggles and successes of her ketogenic journey. Some parts focus on their ketogenic diet. We also address issues that sabotage their progress.

Jennifer Marie has been on the ketogenic diet for 18 months. Jennifer Marie shares free recipes on her website, Low Carb Inspirations and puts out weekly FREE meal keto plans at www.mealplanbuddy.com

Jennifer Marie lost 50 pounds in her first several months of keto, but can’t seem to lose any more. Her goal is to lose another 50 pounds. We are going to help her do that.

John is Jennifer Marie’s husband. He’s been on the ketogenic diet for just under six months. He joins us in episode 2 and had sweet success with his weight loss. John has run into some different problems. The struggles shared by Jennifer Marie and John are oh-so-common.

This information found in this series of articles and videos isn’t to replace your primary care physician. The personal relationship with your doctor cannot be substituted through this education. When my patients struggle, I walk through those problems with them – just like your doctor will. Leaving out your medical team can prove disastrous. Please do not do that.

Jennifer Marie and John have courageously offered to be a live case study of the ketogenic diet. Dial into each post, as we open the exam room door to you.

Give Jennifer Marie and John your support. Ask questions about what they’ve done and what they’ve succeeded at. Use their story to educate you.

We will improve health, one ketone body at a time.

Thanks for checking in.

Dr. Boz

CONSULT #1: Meet Jennifer Marie

Jennifer Marie found my book, ANYWAY YOU CAN, while researching the ketogenic diet. She leads over 500,000 followers on her social media network, including her Facebook page, KETO FRIENDLY RECIPES.

Jennifer saw great keto-success losing a pound a week for the first year. Now, 50 pounds down, she’s plateaued. She teeters on “One-der Land”– tipping that scale just under 200 pounds, only to hop right back over the threshold again.

Jennifer Marie asked for help shedding another 50 pounds. Jennifer Marie’s curiosity coupled with courage drew me into her story. Her passion to teach others about a ketogenic matched mine. Jennifer’s charisma shines through in each of her cooking lessons. She uses cooking the way I use science to motivate change in her audience. Jennifer Marie understands the diet but misses some key moments that would course correct her problem.

I can help her. Let’s begin.cons of gastric bypass

Jennifer Marie first battled her weight in her early 20s. Frustration and disappointment lead her to weight reduction surgery before the age of 30. Like many, the surgery prompted weight loss, but she finds herself in her 40s with all the weight again.

Jennifer Marie began keto in February 2017. She purchased a bottle of urine ketone strips and, within four days, she’d turned her first stick pink. For the first two to three months, she used these sticks to prove to herself she was on track.

Knowing the number of days it took for Jennifer to register ketones on her strip is a good measuring stick for her initial health—specifically, her insulin resistance—as she entered the ketogenic lifestyle. Thanks to years of being overweight, she lived with far too much insulin. That insulin tucked away extra sugars into her liver. As long as she stayed low-fat, high-carb, the sugars remained stuffed into the liver. Knowing how long it took her liver to spin ketones out of her mitochondria helps me understand her situation. The longer she’s been stuffing sugar into her liver, the higher the level of insulin resistance. The longer her body has bathed in excess insulin, the longer it takes to produce ketones.

I can also look at her liver by watching how long it takes for her ketone level to recover after a slip-up. In order to do that, she needs to gather the numbers.

CHECK YOUR NUMBERS
I asked Jennifer to go out and buy a measuring tool. This tool measures both blood glucose and blood ketones.

I don’t recommend patients purchase blood monitors right away. First steps for keto is to produce ketones in their urine. We use the non-invasive urine ketone strips. They put them in their pocket and check their urine 2-3 times a day. Perfect. And simple.

Jennifer Marie needs to take this to the next level to understand her plateau. Checking her blood numbers is not forever. However, fast, real-time feedback holds the accountability key. She will learn what foods are spiking her insulin and sabotaging her weight loss.

HOW DO WE MEASURE INSULIN?
We don’t. We will estimate insulin based on a ratio of glucose divide by blood ketones. I call this the Dr. Boz Ratio.

That ratio indicates the likelihood that an individual can attain autophagy—a state in which your body is able to destroy bad cells on its own.

Take a look at the slides at the end of this article comparing the numbers of several patients calculating their Dr. Boz Ratio.  For a further lecture on this topic, check out this video.

Insulin kills autophagy. Insulin kills weightloss.

As expected, Jennifer Marie’s first glucose/ketone test showed that her body is adapted to using ketones or glucose as her fuel. Her morning blood glucose was 67 mg/dl, and her blood ketones were 1.5 mMol.

Jennifer’s initial ratio was 44.67. This is a great place to be!

The next morning, her glucose = 80, ketones = 1.0 and ratio = 80 (80 ÷ 1.0) suggested she likely could lose weight at this level, but I was not overly confident. At the Dr. Boz Ratio of 80, she is on the cusp of the numbers. Remember this ratio is used to guess her insulin levels. If we want to be SURE she loses weight, I’d prefer the ratio be less than 80.

I didn’t eat from 7 PM to 9 AM – How is my sugar still that high?
ANSWER: Complex.

First, Jennifer Marie’s sugars are WAY BETTER than most of my patients’. Her sugar is well under 100 and sends me a strong signal that we are going to have an easy time fixing her problem. When similar patients present for help with weight loss and their morning fasting sugars hang around 110 or even into the 120s, it’s a long road to success.

I did warn Jennifer Marie to carefully check her numbers FIRST THING in the morning. No lollygagging around before she checks. Promptly poke your finger while you sit on the toilet to empty your bladder in the morning. Prick your finger right after awakening.

To improve her ratio, we really needed to focus on raising her ketone level. With this in mind, I advised Jennifer Marie to stop eating 12 hours before her cortisol spikes each morning.

HUH? Why does cortisol spike?
Cortisol is a steroid hormone that surges shortly before we wake up each morning. This hormone signals the body to release some stored sugar into the blood. The energy found in that morning dose of sugar wakes you up. This marks the beginning of her day. The beginning of her METABOLISM.

To lose weight, Jennifer Marie must empty out the stored glucose in her liver for several hours before that surge of cortisol hits. This means NO FOOD OR CALORIES for 12 hours before that cortisol squirts into the bloodstream and wakes her up. Nothing except water and salt–not even medication–within 12 hours of her waking time.

BEEF AND BUTTER FAST™

At this point in the consultation, a lightbulb went off for Jennifer Maire. She authored an article sharing her brilliant idea to only eat beef and butter. She called it the Beef And Butter Fast. The article went viral as it helped launch people stuck in a plateau on the ketogenic diet. The folks were stalled in their weight loss and this 4 day fast ignited their weight loss again. As Jennifer Marie reflected on her history with these carnivore fasts, she suddenly understood why she lost weight so easily.

Jennifer Marie noted the fullness and satiety when only eating beef and butter. She became easily satiated earlier in the evening and naturally created a longer overnight fast! Check out the article and full experiment here: www.beefandbutterfast.com

Physiology of Beef and Butter Fast™
When you have a brain that’s been fueled mostly by carbohydrates, your fat-based hormones dwindle. You need fat around to make these fat-based hormones. Cholecystokinin is one of these powerful fat-based hormones. Cholecystokinin signals the gallbladder to secrete bile into the intestines at the same time it tells the brain: STOP EATING. The more fat you eat, the louder this signal gets. This hormone is only triggered by the consumption of fat. Not from carbs.

As people transition to keto, they eventually transition to OMAD –one meal a day. It’s important th at those who are on the ketogenic diet eat to satiety–fullness–at that meal. This feeling of fullness comes in part from Cholecystokinin. For a full recap of Cholecystokinin, read this article.

Dr. Boz’s Rx for Jennifer Marie This Week:

In order for Jennifer Marie to overcome her plateau, I’ve asked her to focus on two things for the next week:

1. She needs to accomplish a true 12-hour fast every night.
2. Check her blood glucose and blood ketones every morning. Our goal is to hit a Dr. Boz Ratio of less 80.

Check in next week for a follow-up.