Keto Consult #4 – Intermittent Fasting, Sleep, & Pain

During this visit, Jennifer Marie and John run into classic ketogenic struggles. Their setbacks have nothing to do with what they’re eating, and everything to do with life.

How do you handle a holiday?

What happens when you can’t sleep soundly or you start having pain?

In Week 4, John and Jennifer Marie learn some bio-hacking. I teach the methods that help take your ketosis from beginner level to a sustainable lifestyle.

Jennifer Marie gives me some advice. She speaks with the authority of an excellent cook with 500,000 fans following her on KetoFriendlyRecipes. Her favorite birthday treat is a keto-friendly Chocolate Chip Cookie Dough Fat bombs. Here is the link:

Do not distract yourself with the drama and expense of a blood ketone meter. Jennifer Marie and John have been at this for months. They were told to use the meter so that I can help them understand why they plateaued. I recommend beginners start with urine ketone strips. They are cheap, portable, and do not hold the barrier to poking your finger.

First, it’s important to get the general rules of keto down before starting to over-analyze the numbers. Here are the basics:

  1. Consume fewer than 20 carbohydrates every day.
  2. Use urine ketone strips to determine whether your body chemistry is shifting.
  3. Keep hydrated and watch for magnesium loss.

For some people, this is all it takes to succeed with a keto lifestyle. Others will plateau and need additional guidance.

The past few weeks I coached Jennifer Marie to adhere to strict periods of fasting. That means no food or beverages for a specified time-period each day. A stalled weight loss on a keto diet often prompts me to restrict their eating hours. This is called time-restricted eating or Fasting.

Fasting can refer to removal of “____.” You can fill in the blank with bread. Or candy. Or fruit.

Fasting is a learned skill. As you remove those items for a period of time, you learn to say, “No.” This is a skill. Don’t beat yourself up if you fail at first. The temptations and tests of fasting can overwhelm the strongest of people. Usually when people “fast from a substance,” they do it for a week or for 40 days during Lent.

Time-restricted eating means you consuming nothing but salt and water during a specified period of time. Usually, the goal initially is to eat nothing for 8 hours. This first step happens while they sleep. To improve your metabolism we need to stretch that section of NOTHING to 10, 12, or maybe 16 hours. The ONLY THING that goes past your lips during this time is salt and water. When Jennifer Marie adheres to this rule, her ketone levels rise.

Remember, Jennifer Marie is only in a month into these consults, yet she has been keto for 18 months. She’s already halfway to her goal of losing 100 pounds.



(93 ÷ 1.3) = 71

Dr Boz Ratio: 71

John extended his fast from 22 hours to 36 hours. Success! He sailed through without a craving for food. Twenty-four hours into his fast his glucose held at 77, and he boasted a blood ketone of 2.1. His Dr. Boz Ratio shined at 36.

The high ketones seemed to keep him from sleeping well. After a restless night of sleep, his morning glucose skyrocketed to 110. His ketones of 1.5, kept his Dr. Boz Ratio at 70. The lack of sleep pushed his cortisol up. Cortisol causes our body to release stored sugar into the bloodstream. With ketones abundantly fueling his body, the best answer is to get out of bed. As he adapts to fasting, these elevated ketones will lessen the cortisol spikes.

The first extended fast is quite a lot like the first week of ketosis. The body produces ketones, yet can’t burn through the fuel as fast as it’s produced. , This gets better with practice. There’s no need to push John too hard, too fast. Slow and steady progress wins this race. I encouraged him to go back to 24-hour fasts. Hold off on longer ones for a while.

Why Salt??
Perhaps one of the oddest behaviors of a keto follower is the use of Himalayan salt. In the early stages of ketosis, when the body is flushing out excess fluids, they take some key minerals with them. Himalayan salt helps replenish sodium, potassium, and magnesium to keep your kidneys functioning. And overcoming the deficit helps you overcome cravings, too.

The body makes lots of changes as it transitions to a ketogenic lifestyle. Some of those changes challenge our mainstream-ingrained thinking quite a bit. One of those changes is how we go about having a healthy bowel. her latest blog

Many patients struggle to pass stools as they transition into keto. Their bowels are used to the bulk of a high-fiber diet. This stretches the intestines and triggers the muscles to squeeze. That squeeze pushes stool along. Keto-eating delivers much less fiber for most Americans. The debate about fiber is a fun one that I won’t tackle on this consult.

SPOILER ALERT: The lower your gut inflammation, the better your gut behaves. “Leaky gut syndrome” often accompanies a SAD diet. Take out those carbs and all that fiber. Soon your slime layer protecting your intestine is thick and hardy.

How do we repair that slime layer? By reducing carbs and adding fat to the diet! By Week 2 or 3, most patients experience more regular bowel movements.

In the meantime, we mimic the bulky, fibrous stools. How? Chia seeds. Chia seeds are small seeds that swell up much like tapioca. They stretch the bowel and have little effect on your glucose. Take 1 tablespoon per hour until you have a BM. Then taper the dose to three times a day for several days. Eventually, you will move those stools without the help of chia seeds.

Healthy Hair = Healthy Body
Other patients experience hair-loss as their bodies quickly adapt to ketosis and shed excess weight. Unlike your lawn, which grows continually, strands of hair constantly die off and fall out as new ones to grow in their place.

Shiny, healthy, thick hair is a direct reflection of the level of the quality of nourishment you are consuming. Many factors determine the condition of a person’s hair. Age, gener, nutrition and stress. Shifting to a ketogenic lifestyle triggers a stress response. It’s not uncommon for hair to thin as the body adjusts to its new fat-fed supply chain.

If a patient remains committed to the ketogenic lifestyle and eats until they are full for three months, they’re often amazed by the health of their new “crop” of hair. After 90 days, hair generally is stronger, more flexible and thicker.

If, after 90 days of ketosis and eating until satiety, your hair continues to fall out, consider adding a collagen supplement. I do not recommend this until this point. That explanation will come in a different post.

I suggested last week that John visit a float spa for his ongoing low back and knee pain. Visitors to a float spa have the opportunity to lie in a tank of warm, magnesium-rich water with no distractions for roughly an hour.

Most Americans lack Magnesium. Magnesium deficiencies link to chronic fatigue, pain syndrome, depression and constipation, just to name a few. Rapid water-loss in the early stages of ketosis causes magnesium levels to dip even lower. Replacing magnesium in the early weeks of a ketogenic lifestyle is critical–especially for help with depression, pain, fatigue and brain fog.

For those who do not have access to a float spa, I encourage twice-weekly soaks in a warm bathtub of water with 6-8 cups of epsom salt. Don’t be stingy with your salt. It takes a lot of salt to impact blood levels. My best guess is that you could replace as much magnesium in one FLOAT SPA for an hour as 12 hours in the bathtub filled with 6-8 cups. I pick the spa version!!

Can I EVER Have a Treat??
Not everyone has willpower of steel like Jennifer Marie. She shared this week that she really missed having pinto beans in her diet and snuck in 3 tablespoons. First of all, bless her for choosing pinto beans as her “sweet treat!” Most patients I see are craving things like cupcakes with a much higher glycemic index!

Tracking her Dr. Boz Ratio (blood glucose ÷ blood ketones) helps Jennifer Marie see the true chemical impact of her splurge. She was pleased to find that her indulgence had little impact on her ratio, and noted that a commitment to intermittent fasting seemed to affect her numbers just just as much or more. The longer a patient has been in ketosis, the less likely an occasional treat is to impact autophagy. Jennifer Marie was rewarded for her long-term positive choices. One of the really cool side effects of the keto diet is learning how to biohack your body, so that rare little indulgences like that don’t upset everything you’ve set in motion.

If a person who is observing the keto lifestyle chooses to indulge on occasion, they can combat a spiral out of ketosis by coupling sugared items with exogenous ketones combined with high-quality salts like the Keto BHB I recently released.

Be careful. Pour too many salts into your gut at once, and you’ll have diarrhea. Ingest too many ketones, and you’ll get the same result.

But I Don’t Have a Gallbladder!
[See my article on this topic.]

Jennifer Marie invented the Beef and Butter Fast, a great learning tool for those who need a crash course in strict keto. Each month, she leads the Beef and Butter Fast 5-Day Challenge.

Last month, she helped 150 followers lose an average of 4.05 pounds apiece by strictly adhering to her plan. The menu of beef and butter has a perfect 80:15:5 ratio of fat, protein and carbohydrates, and participants learn exactly how to make the most of the keto diet in those few days. This is a great teaching tool!

Each day, Jennifer Marie, who is a well-known cook in the keto world, teaches her group how to season their plates to have the best experience. She also offers tips on how they can substitute other items for the beef and butter that’s classically on the menu.

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