Keto Consult #2 – Meet John + Keto Weight Loss Plateau + Autophagy for Arthritis

This week I follow-up with Jennifer Marie in our second week of Keto Consults. Jennifer Marie came to me for help overcome her weight loss plateau. Jennifer Marie heads the social media content KetoFriendlyRecipes, where she engages others in the ketogenic lifestyle. She began 18 months ago and attracted more than 500,000 followers.

Recently, Jennifer Marie found herself at a weight loss plateau. She reached to me for help. Together we decided to open the exam room door so you could learn from her personal journey as we break through this plateau.

All of these brains are 60 years old. Which one do you want?

My favorite workshop is a 7-hour course called the Brains of Addiction. The video in that link is a snippet of what I cover in that workshop.

That workshop teaches the audience how to overcome any addiction. Addiction is one of the many chronic illnesses that fills my patients’ rosters. Addiction to alcohol, opioids or carbohydrates matters not. One universal key to overcoming addiction is a strong circle of support.

The American Medical Association termed obesity as a disease back in 2013.

I am an expert in chronic disease management. Jennifer Marie’s addiction prior to keto was food. She is a foodie. Since going keto, her body shed over 55 pounds and she channeled her cooking expertise into keto cooking. Brilliant. And she has the success to prove it. With over a half a million followers, forming a tribe would be easy.

Forming a tribe. Yes. Forming a tribe means forming a support group to help her along the way. A support group for alcoholics is needed to help stay accountable. The same is needed for all forms of addiction. I agreed to medically guide Jennifer Marie through her weight loss plateau. She agreed to form a tribe of at least 3 people. The process of forming real relationships with two other people in her tribe starts the psychological framework needed for change. The act of meeting weekly is one step. The act of sharing truths with people you trust forges the path to sustained change.

Jennifer found her first accountability partner close to home and in her circle of trust. Her husband, John. John started keto six months ago and has lost 50 pounds in that short time.

Last week, I asked Jennifer Marie to strictly follow a 12-hour intermittent fasting regime and track her morning glucose and ketone blood tests to get her Dr. Boz Ratio.

Jennifer Marie shares her easy success with the fasting schedule. Once she got her head around the idea of not eating, she succeeded. Trouble landed when she hopped on an airplane. Her daily routine crumpled for a couple of days as she navigated those days of a very tense schedule away from home. Aside from that, Jennifer Marie fasted for 12-hours each day beginning at 5:30 p.m.

Jennifer Marie learns about her circadian rhythm and her cortisol cycle that starts each morning. About an hour before she awakens, her brain signals the liver with a squirt of cortisol. Cortisol is one of the many fat-based hormones that steadily gets restored during the ketogenic diet. Cortisol permeates the liver to release stored glucose. Each morning, cortisol rings through the liver, triggering the bloodstream to fill with glucose. This circulating glucose wakes us up.

Look at her numbers from the week.

Jennifer Marie’s blood sugars range from the 70s to 90s at the end of her 12-hour fasts. She gets the PERFECT PATIENT star of the week by only having salt and water during the fasting hours. Her corresponding morning ketones hovered between 1.2-2. We use these numbers to calculate her Dr. Boz Ratio. She labeled that column “Percent.” Calculate the Dr. Boz Ratio by dividing the ketones into the glucose number. The lower her Dr. Boz Ratio, the more likely she has the chemistry to lose weight. Jennifer Marie’s plateau will be broken if she keeps the Dr. Boz Ratio less than 80.

Exceding Expectations
I expected her morning sugars to be in the 90-110s range. Most stalled weight loss on a keto diet has higher glucose numbers than Jennifer Marie’s. I was very impressed that her sugars were so well controlled. Her ketone numbers came back higher than expected as well. I expected the ketones to be less than 1.0 in an overweight premenopausal woman with stalled weight loss. NOPE. She wowed me. Her ketone numbers were awesome.
Most of her Dr. Boz Ratios were less than 80. Jennifer Marie lists two outliers.

On Days 6 and 7, she did a considerable amount of walking while in NYC, and it showed in her numbers. Her blood sugar sunk to a healthy 76 on each of those mornings. These low sugars triggered her keto-adapted system to churn out the ketones. BAM! Perfection.

We want low sugars and high ketones to give us a LOW Dr. Boz Ratio. The lower the ratio, the lower the insulin.

  • Insulin kills weight loss.
  • Insulin kills ketosis.
  • Insulin kills autophagy.

I can measure insulin in the lab, but not at home. At the lab, the test has several rules such as no eating before you test. No pooping before your test. No stress before your test. The list goes on and on. Using a surrogate is more accurate than measuring the actual insulin test. The surrogate, in this case, is the Dr. Boz Ratio. The lower that number, the lower the insulin.

Thanksgiving holiday fell into the upcoming week. Jennifer Marie shines through with many of the best low-carb recipes available. Her Thanksgiving table overflows with keto-friendly choices. That is not the case for most of us. Carb-filled foods and beverages litter the buffet line at most American tables.


Approach the meal-of-engorgement by consuming as many high-fat hors d’oeuvres as possible. This early bolus of fat triggers satiation. [The feeling of fullness.] Leave the high-carb items for the end. High-fat foods trigger cholecystokinin, the hormone responsible for shutting down hunger pangs. Add cholecystokinin before the meal, and the chemistry wins. She will eat less. Use this hormonal trick during the holidays.

Jennifer Marie’s holiday indulgence came in the form of a wine glass. Thanks to her strength of keto-adaptation, her morning blood sugar of 90 coupled with the ketones of 1.8 gave her a Dr. Boz Ratio of 50. That is awesome.

She plans to drink her favorite low-carb alcohol over the holiday: Vodka.

Jennifer Marie holds a weapon against sabotage: Dr. Boz Ratio.

This takes the guessing out of her alcohol. This weapon is the knowledge that course-corrects the ship when she falls off. Alcohol stops ketosis. That is a given. She knows she is going to drink Vodka. What she has not known in the past is, “How long does Vodka keep her out of ketosis?” This time, she will know because she checks!

This new curiosity of checking her numbers allows me to push her a bit. I asked her to check and see what the alcohol did to her numbers. Check before the drink. Thirty minutes after the drink. And one hour after the drink. Precisely what did it do to her body chemistry? The point of the ketogenic lifestyle isn’t to withdraw from normal life. It’s a tool to remove inflammation, in order to enjoy the life you love more fully.

Distilled alcohols such as gin, vodka, bourbon, and some whiskeys are more keto-friendly than beers and most wines. All alcohol stops ketosis. If a keto-adapted individual avoids coupling alcohol with carbohydrates, their numbers should bounce back quickly.

It’s easy to want to let loose and revert to old consumption habits during celebrations. But the effects are quick. Swollen fingers and puffy eyes the next day are indications that the body wants to resume to how it felt on those foods and beverages, too. These periods of time are remedied well by intermittent fasting and the use of exogenous ketones to get the liver back into ketosis.

John is Jennifer Marie’s first addition to her support system: her husband. John’s keto lifestyle began six months and 50 pounds ago. Low carb cooking entered his home when his wife flipped that switch about a year prior. He benefited from the low-carb foods but saw additional improvements with keto. Recently, a few health concerns broke his stride of success. A recent surgical complication after sclerosing several varicose veins laid him up for several days with severe pain. In addition, one of the creams caused an allergic reaction. YIKES!

John’s rapid weight loss comes partially from the y-chromosome. Yes. He has more mitochondria in his male body. Burning fat for energy in the furnaces of each of his muscles launches him into first place.

John’s low-carb lifestyle, avoiding sweets and breads, prepared him for success when going keto. He worries that he will struggle with that occasional hamburger on a bun or beers after the overnight police shift during the week.

John and Jennifer Marie contrast in their motivations for keto. Jennifer Marie found keto as a way to lose weight. John, a full-time police officer, wants less pain in his knees and faster recovery from the surgery.

Knees Aging Faster than Expected
John’s new orthopedic specialist mistook him for an 80-year-old by first looking at his X-rays. The doctor walked into the room to see him and walked right back out, disbelieving this young man could be connected to this old-looking set of knees on X-ray. John suffered a series of injuries beginning in high school football and most recently a work-related motorcycle crash.

Overcoming his knee pain happens through autophagy. For a full article on Autophagy, see this post and video. we can get John reaches a Dr. Boz Ratio of less than 40, autophagy is very likely. Autophagy cannot be measured outside of research labs. The rules of autophagy start with low insulin. Low Dr. Boz Ratio = low insulin.

John’s physician recommended that he drop 63 pounds to get to an ideal weight of 150. John’s personal goal weight hangs closer to 195. Currently, he dials the scale up to 213 pounds. We physicians agree. The weight should be closer to 150 if he wants the best life for those cracking, popping knee joints.

The Arthritis Foundation’s formula states that each extra pound of weight puts four pounds of pressure on his knees. Achieving ideal weight would decrease the pain in his knees and possibly avoid any surgery for years to come.

Dr. Boz’s Rx for Keto Success:
Continue with daily blood glucose, ketone, and Dr. Boz Ratio tracking, 12-hour fasting that starts each morning with her circadian cycle.
The quest to find a third member of her tribe continues.
Consume fattier hors d’oeuvres early in the day to promote her body’s production of cholecystokinin during holiday get-togethers.
Limit alcohol consumption to distilled liquors.
Pay attention to the effects of her consumption of holiday food and drinks on her ketosis.

Check his morning blood glucose and ketone levels at least five times over the course of the next week and
Calculate his Dr. Boz Ratio.
Replace his weekend and after-shift beers with distilled liquors.

Check back next week to see updates on John and Jennifer Marie’s progress!

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