Keto Consult #3 – Testosterone, Turkeys, and Teachable Moments

In this week’s consult, John shares his second week of Dr. Boz Keto Consults. He navigates his keto lifestyle through the Thanksgiving holiday.

John’s wife, Jennifer Marie, perfected the holiday meals keto-style. What a great gift! A Keto cook lives in his house. Let’s take a look at this week’s journey.

John courageously poked his own finger this past week to check blood sugars. This sounds easy. I have seen brave, strong men whimper at the instruction of checking their blood sugars. Once past the first check, most people sail smoothly. John sailed smoothly.

Let’s look at his numbers.

Consistency is KEY when checking your sugars. First thing in the morning marks the ideal time for checking your blood numbers. I place the blood meter in the bathroom and check them before I get off the toilet each morning. Too much moving around adds variables to the number. These variables complicate how to make sense of them. If you get up, let the dog out, make a pot of coffee and then check your numbers, you added several factors the equation.

Remember that lesson in Chapter 16 of ANYWAY YOU CAN? I asked patients “How big is your liver?”
Never thought about the size of your liver? Liver cells clean the blood of toxins and help regulate energy for the body. If you drink large amounts of booze for several years, your liver makes extra cells to keep up. If you bathe your body in high carbohydrates, your liver cells always see insulin. Insulin COMMANDS those liver cells to store excess carbs. The patients with the biggest livers are not my alcoholics. They are my obese patients — specifically those with a waistline larger than their hipline.

Insulin has been stuffing each liver cell with as much stored energy as possible. Day after day. Year after year their liver followed the orders of insulin. To keep up with the extra demand, the liver made more cells. Eventually, the liver gets inflamed and swollen. That is called NASH. Non-Alcoholic-Steato-Hepatitis. This term refers to fatty livers that are stuffed beyond capacity with stored energy. The energy is in the form of fatty triglycerides. Triglycerides form from excess carbohydrates. Triglycerides circulate in the bloodstream and get stored in the liver. At autopsy, a NASH liver looks fat. Yellow. And it is hard. Stuffed to capacity from excess carbohydrates from the years of extra insulin. NASH

Check those blood sugars first thing in the morning because of cortisol. Cortisol is a hormone that leaves your brain each morning. The hormone signals the liver to release stored energy in the form of glucose. This rise in glucose wakes up your body. The higher your cortisol shoots, the higher your glucose rises each morning.

How high does your glucose go in the morning?

This depends upon the size of your liver.

Doctor, Doctor – Is my liver normal?
I don’t know. Let’s check.

First thing tomorrow the morning – do what John did. Look at your Dr. Boz Ratio. Before you begin your day, check your blood sugar and your blood ketones. Divide the glucose by the ketones.

If the number is less than 80, you are safe. Look again at John’s numbers. All but two of his results are in the SAFE.

Before going KETO his liver was likely stuffed full of triglycerides. Fifty pounds of weight loss relieved much of the pressure on his liver. These first few checks of his morning fasting blood confirm that his liver is performing nicely.

After 22 hours without food, John’s blood sugar rose to 113 the next morning. During the 22 hours, he consumed water and Himalayan rock salt.

Himalayan rock salt? Yes, this is good! It will support hydration while fasting by stimulating water to stay in the blood vessels. John did amazingly well during this 22-hour-fast. He found solid, steady energy and kept busy. He successfully rose to the challenge of fasting for the first time.

Did you doze off and miss the play of the football game after your Thanksgiving meal? It is not tryptophan’s fault. Blame the rise and fall of your blood sugar from the heavy load of carbohydrates. Insulin rises. Your body responds by “insulating” and storing those carbs anywhere it can. The burst of insulin causes a slump in your energy as the system resets. We’ve all felt the brain-fog two hours after a high-sugar food. Not fun.

Flip the switch and become a fat burner. Use ketones for fuel. The first couple of days are tough. Burn that excess sugar in your system. Empty your liver from stored glucose. One keto-day at a time and you will find sustained energy.

What is your WHY?
As your body burns through that fuel those first two weeks, many people drop out of the keto diet. Find your WHY. Why do you want your body fueled with ketones? A good WHY keeps patients engaged through that dip in energy. If it is too much, I encourage patients to supplement with exogenous ketones. This helps so much. Bridge through the struggle.

John’s WHY –

John would like to put off his knee surgery as long as possible. He found the chapter about autophagy inspiring. “You mean if I decrease the inflammation and fuel with ketones, my body will clean up some of that debris in my knee?” Yes.

John sleeps with a CPAP and wants that gone. Years of acid reflux and snoring lead to a foggy brain and constant feeling of fatigue. The CPAP helped reverse those symptoms. Now he has lost 50 pounds. He wonders if he still needs the machine. I told him to keep it for now. We will get there, but not on week two.

John wants to discontinue Adderall. He never had troubles with his blood pressure until he started that medication. The improved focus was welcomed. The added side effect of high blood pressure was not. At a recent doctor visit his blood pressure was 94/70s without the Adderall. When using the medication it ran 130/80. One fast of 22 hours and John noticed how sharp his brain worked. He actually forgot to take the noon dose of Adderall because he felt so good. Adderall has risks too. The long term use can affect the heart and the sleep cycles.

Human hormones are like an orchestra. They pulse and cycle within our body. Any signal from one chemical leads to a change in the others. Like the sounds in an orchestra, nothing happens in isolation. They work together to create something beautiful. Too much of one will drown out another.

In a recent season of life, John’s blood testosterone fell below the needs of his body. His testosterone sank. His brain responded by slowing down and losing motivation for life. Depression can follow. Loss of muscle mass occurs. His waistline grew fat. Low testosterone can be a race to the bottom of life.

Testosterone is one of our FAT-BASED hormones. For years John ate the Standard American Diet. He ate plenty of carbs and avoided fat. Before long his body’s orchestra responded with higher insulin. Higher insulin kept all his fat unavailable. High insulin tucks fat into the storage cells and not in the stream of hormone production. As the trickle of fat all but dried up, so did John’s supply of testosterone.

John’s doctor properly rescued him with prescribed testosterone injections. Those injections restored some of his muscle mass, ignited his brain back into action, and restored his energy. His sex drive improved as well. PERFECTION. Right?

Yes. and NO.

Testosterone leads to estrogen.

Notice the chart above. Fat circulates around the body in the form of cholesterol. The top chemical structure of that chart is cholesterol. Dance your eyes over and down and see if you recognize any “offspring” found in that slide.

Cholesterol is the “Father” of many hormones in our body. I would expect most of you caught these in the list:

  • Cortisol
  • Progesterone
  • Testosterone
  • Estradiol (more commonly known as estrogen.)

Notice the back and forth arrows between estrogen and testosterone.
Injecting testosterone helped John feel better. All of the fat-based hormones are low in John. Not just his testosterone. He entered the doctor’s office after months – maybe years – of sinking hormones. That heroic rescue by the doctor impacted the rest of his orchestra.

For starters, he suffered from excess estrogen. Squirting a bucket of testosterone into John each week will fix those issues with testosterone. Those back and forth arrows mean that the body will easily flip the testosterone into estrogen. The gonads shrink up and the breast tissue overgrows.

Taking a look at the graph. Specifically look at the box labeled C. This reflects the diagram of minute by minute changes seen in how the body regulates testosterone. Pulsating testosterone is normal. Replacement testosterone injections don’t do that. They deliver a steady non-pulsatile pattern. This impacts the effect.

Ahh, the complexity of our body! Men do need some estrogen. But too much is like the Muppets Character, Animal, pounding on a trap set in the middle of a flowing symphony.

Fix hormones with FAT, SLEEP and Lower Dr. Boz Ratios.
A ketogenic diet supports healthy hormone production. Hormones rely on dietary fat to be eaten as a foundation for them to be created. Every hormone on that chart comes from fat. These are essential in our diet to stay healthy.

Stable sleep and blood sugars predict your success, as well. Change your chemistry. This begins with a solid pattern of sleep. Don’t allow awakenings throughout the night to ruin your success.

FASTING: Ignite your Autophagy
Autophagy cleans up debris in our cells. Autophagy can’t be measured in the lab. Best guesses for autophagy correlate with lower insulin. The lower the insulin, the better the chances for autophagy.

On a carbohydrate-rich diet, it takes 72 hours of fasting to reach autophagy. If you are already in a ketogenic state with Dr. Boz Ratios of 80 or less, autophagy can begin as quickly as 12 hours.

Fasting is not a skill for beginners. Don’t do this if you are new. Both Jennifer and John practice a different form of fasting. John stepped right up to a 22 hour fast this week. He felt good during the fast. He denied much of a struggle .. even on the first day. We warned him that the most difficult day of fasting is the first day. Fasting is like flexing your muscles. It takes time and practice. One small step and then another. Too many changes at once will lead to sabotage.

I affectionately call these KETONES-IN-A-CAN. They come in powder form and mix into a drink. The research behind these morsels of energy has impressed me. I was a non-believer that did not use them. Until Grandma Rose got really sick. Then we reached for the supplements and I dove further into the research. These are ketones that you take in a supplement form. The most common is beta-hydroxybutyrate (BHB).

Get the fire of energy burning! BHB salts are a great biohack to support sports and mental performance too! I only let my teenagers use BHB supplements. No other power drinks. JustKETONES-IN-A-CAN.

A great sweet-tasting drink to send them out the door with rather than a chemical concoction “sports drink” that will lead to a fast crash. I like BHB mixed with FAT. They seem to absorb better and I don’t get diarrhea when I add the fat to the powder. My favorite fat to mix in is heavy whipping cream. Of course!

More on BHB supplements soon. Here is a live stream I did about BHB. VIDEO LINK


Be gentle with yourself and chose one thing that will get you closer to your goal.

Listen to yourself and what your hormones are telling you. Pay attention to the cues and signals your brilliant body has been designed to tell you.


  1. Reach for a 36 hour fast.
  2. Keep checking morning numbers for Dr. Boz Ratio.
  3. If he feels sluggish or ill while fasting, check the numbers and then EAT. Break the fast.


  1. Keep up the 12 hours of fasting every day with the 12-hour “window for eating.
  2. One course correction: The timer for the 12-hour window of eating starts every morning at 5:00 AM and ends every evening at 5:00 PM.
  3. If she has alcohol in the evening, the next day she will compensate by starting her fast earlier. For example, if she has an alcoholic drink at 8 PM, she will stop eating the next afternoon at 3:00 PM instead of 5:00 PM

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