22 Studies Agree: Intermittent Fasting Doesn't Work

0:02 Welcome to Tuesday night.

0:04 Tonight we are talking about a study that came out about

0:07 three months ago by one of the most trusted publications in medicine,

0:11 the Cochran Library.

0:13 This article looked at an extensive review

0:17 for intermittent fasting and asking does it help?

0:21 They looked at a population of people who said we want help losing weight.

0:26 what happens if we use this term called intermittent fasting?

0:31 And the term meant a few things.

0:33 It meant that they were going to have

0:35 they could use the word intermittent fasting.

0:38 They could use alternate day fasting.

0:40 They could use a periodic fasting or even timerestricted eating.

0:45 They followed these patients for over 12 months.

0:48 And from 22 clinical trials, nearly 2,000 students across five continents,

0:54 they said it makes no difference.

0:57 This intermittent fasting does nothing does no better than no dietary

1:03 advice or simply just telling them to do what they usually do.

1:08 So, what's what did they miss?

1:11 2,000 plus patients I've given advice to and followed a protocol using

1:17 intermittent fasting and I can't find a one that didn't lose weight.

1:23 So, tonight we're going to talk about what is missed with intermittent fasting.

1:27 Thanks for tuning in everybody.

1:28 It's great to see some of the normal folks checking in.

1:31 I s I got to press palms with many of you

1:35 over the past weekend when we spent time together in Gatlinburgg,

1:39 Tennessee at Meattostock.

1:42 Uh I'll tell you this was the first real

1:44 Meattostock that I got to attend as in last year

1:46 I attended but had to zip off to a uh

1:50 one of my son's my son's college educa college graduation.

1:54 So this time I spent Friday, Saturday,

1:57 and Sunday morning with uh the folks that gathered in uh in Tennessee.

2:02 Uh if you tuned in last week, you know that I had a a few days

2:06 in Washington DC trying to see can we help lend uh

2:10 our expertise or some of the information that I see

2:13 here on the front lines to make America healthy again.

2:18 And I will tell you when I contrast what I

2:20 saw in Washington DC and what I saw in Tennessee, uh,

2:25 if you are waiting for the government to show

2:27 up and teach you how to be healthy, you're in big trouble.

2:31 Tune in to channels like mine and many of the of the influencers

2:35 that came to Meatstock uh uh to learn from.

2:39 And then God bless the number of people that said,

2:42 "This is the first time I've ever been

2:43 to a conference or a meetup." uh and the energy

2:46 and the enthusiasm and the connections that were made

2:50 by those who just said I'm going to sacrifice time, energy,

2:53 and money to go to middle of the state in Tennessee and really put

2:57 their efforts into uh into the energy of how do we use some of these uh

3:04 these these things that I'm learning that I'm trying to teach on this channel

3:08 that I use in the patients that I see and and so do many other influencers.

3:12 And when they came together and told the stories,

3:14 it was if if I'm going to put my money somewhere on making America healthy,

3:19 it's events like Meattostock.

3:21 So, thank you for those of you that came out and and signed some books with me.

3:25 It's also just uh supported that kind of a conference.

3:29 Well, tonight we are talking.

3:30 Oh, one more thing.

3:31 I do uh I did have after all the travel I've

3:34 had over the last two weeks, I uh I did say,

3:37 "All right, we need a good clean fast." Um,

3:40 and my glucose is 77, my ketones are 4.2.

3:44 And we're going to talk about some numbers tonight and what

3:46 those numbers had to do with uh with this this uh topic.

3:50 Again, looking at intermittent fasting and the headlines

3:53 uh aren't just from the Cochran,

3:55 but there are several other review articles looking at thousand

4:00 tens of thousands of patients that have used intermittent fasting,

4:04 timerestricted eating, and the studies all agree.

4:08 It doesn't work.

4:09 When I asked this of my patients this more

4:11 of the patients that came to the pinch chasers this morning,

4:14 uh I said, "What do you think about that?

4:16 Do you think intermittent fasting works?" And they're like,

4:19 "Well, of course it works.

4:21 Look across this room.

4:22 We all have used that as part

4:24 of the strategy for getting healthier." And indeed,

4:28 I I think nearly every person in that room had used intermittent fasting,

4:33 but it comes at a different angle.

4:35 So, we're going to talk about that tonight.

4:36 I'm going to t start by saying uh that um

4:41 that um fasting that is fake is what I call intermittent fasting.

4:49 That there are some rules about fasting that I'll cover by before the end.

4:53 You'll know exactly what I'm talking about.

4:55 Um but I I had people do a check-in this morning saying,

4:58 "Do you think that intermittent fasting is working for you?"

5:01 And one of the ladies really caught my attention when she said,

5:04 you know, I am doing this because I've had,

5:06 you know, triple uh negative breast cancer.

5:10 I have a a cancer that is very well known to be uh

5:14 glucose dependent and I came across your channel and have followed read some

5:19 of your books and followed some of the the outlines uh or the protocols

5:23 that you've offered and I have done OMAD for 71 days straight.

5:30 Yeah, that's not a few days.

5:32 71 days of sacrificing that she was only eating in this narrow window.

5:37 And my morning sugars still say I am diabetic.

5:41 So, or pre-diabetic, excuse me.

5:43 And that means that the chances that she is inhibiting

5:47 the growth of maybe that new baby breast cancer cell,

5:51 well, that's not the best way for her to to hold

5:54 on to the success that she's had so far.

5:57 that what are the risks of if she's doing this really disciplined

6:02 work but she's not getting the results well is she making a difference

6:06 at all let's hop over let me show you the slides that I

6:09 have to outline this so yeah fake fasting fails because it's superficial let

6:14 me show you what I'm talking about so in my channel uh

6:18 and teaching I look at uh oh let's back up here back up here

6:23 one second a little too quick on the finger there all right

6:26 this chart art is something that I use to teach over and over again.

6:29 But for those of you seeing it for the first time,

6:31 I'm going to do a couple things.

6:32 See this uh glucose is in red.

6:35 The red line here is watching what

6:38 that glucose is doing first thing in the morning.

6:41 And then what it does as she eats the meal,

6:44 her one meal a day, and then what happens after that meal?

6:48 Uh what do those blood sugars do?

6:50 Uh as you can see, the blood sugars stay

6:52 between that 120 and 100 when she's not fasting.

6:55 and the kind of food she's eating doesn't send the blood sugar that high.

7:00 But something about the way she's eating isn't giving her a lowered

7:04 blood sugar that when she wakes up in the morning,

7:07 6:00 in the morning here, uh that blood sugar is still,

7:11 she's right, it's in a pre-diabetic range.

7:13 When you look at her ketones again, ketones over here,

7:17 that blue line, and that is measuring her ketones.

7:20 And when she wakes up in the morning, it's like, yeah, zero, not the 80 here.

7:24 Let's do that again.

7:25 It is 0.2 0.4.

7:29 Like the highest she gets maybe is 0.6 when she's been

7:32 fasting the long when it's been the longest time since she's fasted.

7:36 But what I contend is this is not fasting.

7:41 What she's doing here is restricting the time that she eats.

7:46 And when you look at these studies, part of the problem,

7:49 and they did a really good job of trying

7:51 to normalize this, but part of the problem with people saying,

7:55 "I use intermittent fasting and I'm trying to get

7:58 healthier," is that they're looking at the wrong metric.

8:01 They're looking at the uh the clock and not the human.

8:07 When when I uh lean into this problem uh and you try to say,

8:10 "Well, what is the definition of intermittent

8:13 fasting?" You'll have some people say, "Well,

8:15 it's when uh I restrict my eating from 11 o'clock

8:18 in the morning until 6 o'clock at night." I'm like, "Okay,

8:22 how was that different than what you did before?" Uh maybe a few

8:26 hours different and and when you did that, did you see a difference?

8:30 And we're going to we're going to show

8:31 you some examples of that here in a minute.

8:33 Other people say timerestricted eating is when or excuse me,

8:35 intermittent fasting is when I eat one day and then I don't eat

8:39 the next day and I eat one day and I don't eat the next day.

8:42 And again, the British Medical Journal

8:45 looked at over 99 randomized control trials,

8:48 all looking at these very strict definitions of what is intermittent fasting,

8:53 and it found the same thing that the Cochran review reported,

8:56 which is no difference.

8:58 At a year, there's no difference.

9:00 My friend and colleague Jason Fun has recently

9:03 put out a book called The Hunger Code.

9:06 And in there he talks about, yeah,

9:08 if you're just trying to manipulate your eating by using a clock and you

9:14 are not affecting the hormones that that talk to your brain about hunger,

9:20 well, this isn't going to you're not going to win.

9:23 You're going to struggle just like that patient who

9:25 said 71 days of sacrificing and she she says,

9:30 "I don't think there's any difference between

9:32 what's been happening." And I bet she's right.

9:35 So, let let's uh move back to this.

9:37 So, if you look at uh this is what OMAD looks like.

9:40 She's eating in one section of the day.

9:42 It's somewhere around, you know, 7 8:00 at night.

9:46 Um and it's doing something to her body that is

9:50 never going to result in in an improved process,

9:54 especially for somebody who has uh who has um

9:59 that that the the kind of cancer that she has.

10:03 So if we look at first when people go on to a restriction,

10:08 you know, in this case,

10:09 she first went to one meal a day and I bet it did improve her at first.

10:15 We're going to show you some slides about what happened when she went from three

10:19 meals a day to 20 total carbs per day and then one meal a day.

10:25 That one hour of eating,

10:26 I call it uh all calories in one hour to say let's not parse words here.

10:31 I really if a meal is what we're measuring,

10:34 we also need to talk some other things that sabotage how hormones in the body

10:39 and those satiety hormones get screwed up because anytime

10:44 you adjust to energy going into a patient's body,

10:48 uh it will reach for a homeostasis.

10:51 That happened when you gained weight and it

10:54 also happens in reverse when you lose weight.

10:57 Unfortunately, when you were gaining weight,

10:59 it wasn't nearly as noticeable of how stubborn it is that the body

11:03 definitely wants to return back to whatever it used to be doing.

11:07 Uh, which is why usually they struggle, struggle, struggle,

11:11 and then they give up and say, "No, no, no,

11:13 I'm just most I'm big boned and I'm supposed to be

11:14 this heavy for the rest of my life." That's not true.

11:17 That's not true.

11:18 All right, let's take a look at where this woman started.

11:20 So, we're going to talk about what homeostasis looks like in a body.

11:23 Um, if many of you know that I teach this on a continuum that a ketogenic

11:28 diet isn't just um uh you know packaging or just counting 20 total carbs.

11:34 There are several steps that the healthiest of patients don't need all 12 steps.

11:39 But the sickest of patients almost always need the 12 steps.

11:44 So here's where people start.

11:45 I'm going to point out a few things

11:46 for those of you seeing these slides for the first time.

11:48 Look at that blood sugar.

11:50 160 is what the average blood sugar is.

11:52 They're eating, you know, around 7:00 in the morning, around noon,

11:56 and then around 7:00 when they get home from work at night.

11:59 When they do that, um, uh, and then enter what I call keto continuum number two,

12:06 which is now you have 20 total grams of carbohydrates in a day.

12:10 That is maximum.

12:11 We really need you to do that.

12:13 And when that happened,

12:14 notice that that blood sugar really went down in that setting at the beginning.

12:19 This is what their ketones are.

12:21 And if you've ever, you know,

12:22 if you can remember back to the first week when you tried the keto,

12:25 when maybe you got the keto flu,

12:26 you did all the things right, but the chemistry definitely was changing.

12:30 Maybe you could smell a funny odor on your breath because you were in ketosis,

12:34 but these ketones were in that one to 1.5 range almost all the time,

12:40 and that is when they lose weight.

12:42 there is a huge shift in their chemistry and we can

12:45 measure and predict how well this is going in their body.

12:48 So, as uh as they continue on, there's a few other things

12:52 that I never have patients do when they're at this this level,

12:56 but I want you to look at this and be able

12:58 to predict where the where the equation is going to fail.

13:01 So, we talk about the Dr.

13:02 Bos ratio, which is dirty math.

13:04 We take a the big number of the glucose, divide it by the little number,

13:08 which is the ketones, and we look at uh a Dr.

13:11 B's ratio, her ratio of 125 in a typical long-term story,

13:16 I would tell patients, you're probably not going to lose weight at that level.

13:21 But in those first few weeks of a ketogenic diet, my gosh, they lose weight.

13:25 They lose water, they lose weight, they lose fat.

13:27 And we can calculate it.

13:29 Uh, this Dr.

13:30 Bos ratio is way better than what it was.

13:33 And more importantly, as you're sleeping at night, those ketones remain high.

13:39 you have a motor turned on inside your body that is burning fat.

13:45 And of course, that glucose is, you know,

13:48 down to that 100, maybe even below 100 at this point,

13:51 but not it's still a glucose in the middle of the night

13:54 of a 100 of triple digits is still too high,

13:58 but it's way better than it was in last week for this woman,

14:01 and it it got better.

14:03 So, then this happens.

14:06 this this um homeostasis,

14:09 the body is going to try and return to what it was doing before.

14:12 And the although the blood sugars stay pretty normal,

14:16 those ketones drop back down to that 0.2 to 0.6,

14:20 a very low level or low production of ketones

14:24 has happened because your body returned to the normal,

14:26 regressed to what it was um um was doing before.

14:31 So, here is this patient, three meals a day,

14:34 and they come in saying, "Your diet's not working.

14:36 This protocol is not working." And I say, "Well,

14:39 I think you need to move to the next keto, this next continuum." Oh, yeah.

14:43 Let's calculate that Dr.

14:44 B's ratio to show you exactly what I'm talking about.

14:46 The big number divided by the little number.

14:47 Now, we're at north of 300.

14:49 You are not going to be losing any weight at that point.

14:52 But at the bedtime, at the time when they're sleeping,

14:54 where the most weight loss happens in my patients,

14:58 well, uh, that 100 divided by 0.7 is 142.

15:02 And although that might have been enough to tickle weight

15:05 loss the first couple of weeks of a ketogenic diet,

15:08 this is not enough to stimulate and open up the fat cells,

15:12 stimulate that hormone production, peak uh those hormones,

15:16 finding hormesis, the peak response to a stress.

15:20 None of that is happening at this level.

15:22 And so we say, well, let's move on.

15:24 Let's change this to one, two bololises of food a day.

15:30 And when you say, all right, just keep doing what you're doing.

15:32 I just need you to eat only two times a day.

15:35 This step is a little hard for patients.

15:37 It's not as comfortable as the last few steps uh in the keto continuum.

15:41 Uh but the ketone production rises again.

15:45 Notice that it's now from about, you know, one to 0.5.

15:50 And the glucose is a little less than it was.

15:54 Not a big difference, but enough to say,

15:56 okay, your peak amount of glucose is less.

15:58 Uh, your area under the curve or what's the average blood

16:01 sugar over the last 24 hours is probably a little less,

16:04 which is why that ketone goes a little higher.

16:08 But you'll notice that meal here is like 7 o'clock at night.

16:11 This one's at like 8:00 in the morning.

16:14 And this will be great for about ah you know I

16:18 I tell patients at this two meals per day you get

16:22 a slight improvement but it's nothing like what happened when you first

16:25 came into the ketogenic space and this would be considered uh well

16:30 can we say this was fasting yet this timerestricted eating I

16:34 would say probably not uh I think this is far too um

16:37 far too long in between the two times that they eat

16:41 that I wouldn't call this intermittent

16:43 fasting I wouldn't call this timerestricted eating.

16:46 Maybe you find some people that would say yes to that, but I bet not.

16:49 And this is what happens when most people

16:51 come knocking on the door at the pinchaser saying,

16:54 "All right, what the heck am I doing wrong?

16:55 Tell me how to fix this." Or they finally buy the book to say, "Let me show you.

17:00 It's very clearly written.

17:01 You are not the first one to struggle with this." Those ketones

17:04 will flatline and they're like, "Well, I'm a girl.

17:07 It just is it's it's low." I'm like, "That's no excuse.

17:10 I'm a girl.

17:11 Mine is not that low." It has been.

17:13 I've struggled with this just like anybody else that when

17:16 you go to reverse something, I had a rhythm.

17:19 I had a pattern.

17:20 It was helping.

17:21 And then it wasn't.

17:22 And my ketones were 0.3, 0.2, 0.3, 0.4.

17:26 Like I I did a little dance at 0.5 because I needed to stress the system.

17:32 I needed to stress my system because of the years of insulin resistance.

17:36 And here is timerestricted eating.

17:38 In my teaching, we call this keto continuum number five.

17:42 Uh which means you still have those two

17:44 bololises of food and you now move them within

17:49 a uh a certain window like I start with 8

17:52 hours like uh if you can keep the first bite to the last bite around 8 hours

17:57 usually patients have a pretty good response and then

18:02 quickly they need to go to six hours because

18:04 um because they've been doing this for a while.

18:06 I mean, why is it that this woman who is eating uh only OMAD

18:11 for 71 days wakes up the next morning and her average blood sugars are

18:15 running in the 105 110 range because the hormones behind the scenes have rules

18:22 and she has slid back down into a place where she's not stimulating them.

18:25 You know, if you have read Jason Fun's book,

18:27 which is we'll put a link in the show notes,

18:29 uh a really nice summary of saying, well, how do you manipulate the hormones?

18:34 And in in some cases we can see that um that the the patients will have um they

18:43 will have an improvement uh they will stay

18:46 in that improved area and then they do like what many

18:49 p people do they stop looking at the chemistry

18:53 they are looking at well the non-scale uh celebrations

18:57 like uh those are that that is not nothing

19:00 their waistline got littleler uh they're measuring uh their energy.

19:04 They are celebrating how much better they sleep and then things stall.

19:10 And that's again where if you're trying to reverse a medical problem,

19:13 this woman who came to the pinchasers is not fighting something that's,

19:17 you know, a little bit of playtime.

19:19 She's fighting something that's very severe,

19:22 a breast cancer that is known to be glucose dependent.

19:26 So, how does she get the glucose down?

19:28 And if she's waking up in the morning

19:30 with that blood sugar of 105 to 110, it's not okay.

19:34 It's not going to help prevent the next season of health care problems.

19:38 She was lean.

19:39 She was very articulate.

19:40 She says, "I'm much healthier than I've been

19:42 in the past." But if she is trying to hold

19:44 on to a prevention of what what gives her the best

19:48 chance of not having a recurrence of that cancer,

19:50 she has to fix the chemistry first thing in the morning.

19:53 And whether you call that um timerestricted eating or intermittent fasting,

20:00 um I say you can't use that f-word until

20:04 you reach at least 36 hours of the nothing burger.

20:09 So she had shown up and said, "Okay,

20:11 um if if I look at this intermittent fasting,

20:15 this, you know, OMAD for 71 days, this is my morning fasting sugars.

20:19 It's only when I fasted for 72 hours that I was able to see

20:24 my blood sugar got down to 60 and her ketones went to six.

20:29 I mean, they overshot.

20:31 And what happens when I see ketones overshoot like that?

20:34 Like I haven't eaten in, you know,

20:36 2 and 1/2 days and my ketones are what, three or something.

20:40 Uh they're not six.

20:42 Um, when you see that super production of ketones,

20:46 it means you haven't given a stress to your system.

20:49 That is an overp production of ketones.

20:52 And although it's something to be proud of because

20:53 her doctor's ratio is 10 and she's like,

20:55 "Isn't that the best to get?" I'm like, "Yes, it is.

20:57 Congratulations." That's the first step.

20:59 You're doing a lot of things right.

21:01 We're going to show you numbers of what

21:03 I'm really talking about that when she says, um, I've been doing this fasting.

21:09 I'm doing this OMAD, one meal a day.

21:12 I'm like, no, no, no.

21:13 Let's clean up the language here.

21:15 You can look at other influencers and they can have their rules,

21:17 but when my patients are on this channel or in my books and my uh classes,

21:22 when we use the F-word fasting,

21:25 it has 36 hours a minimum of the nothing burger, salt, water, black coffee.

21:32 And when you look at that extended fasting time, uh,

21:37 when I'm taking care of really sick patients,

21:40 and this woman would be considered a really sick,

21:42 like she looked pretty healthy today,

21:43 but when you come into this space and you're

21:46 looking for how do I get great outcomes, um, you're going to almost all of them

21:51 with years and years and years of that insulin,

21:54 they're going to have to do the nothing burger

21:56 for at least 36 hours to lower that stimulus.

22:00 And by her report she says, "Yeah,

22:02 I got to 72 hours and finally on that third morning my blood sugar was at 60,

22:07 my ketones were at six." That is a really good hermetic stress.

22:12 Meaning the hormones got stressed to reverse the problem.

22:17 But what happens when she goes back to eating?

22:20 Dang, those blood sugars are back to 105 again.

22:23 Let's take a look.

22:25 All right.

22:25 So, the solution is chemistry matters most.

22:31 So, here is this patient.

22:33 Uh, she did a 72-hour fast.

22:36 Uh, I I her blood sugars might have been a little

22:38 higher than that when she was eating the two meals a day,

22:41 and she was eating one meal a day,

22:42 but this shows two meals a day uh the day before she starts her fast.

22:47 And again, fasting starts when you finish a meal.

22:49 So, there's where her fast starts.

22:51 And you can see she's eating nothing here,

22:54 nothing here, nothing here, nothing here.

22:57 And that blood sugar, maybe she didn't quite get there on the first day,

23:01 but over time it gets down into, and she

23:04 really did reach that 60 level by the third morning.

23:07 And gluconioenesis, one of the best ways to predict,

23:10 am I just making glucose from these other products in my body?

23:14 I would say no to that when you were in the 90s.

23:16 I'd say no to that when you're in the 80s.

23:18 I would start to say yes that you're

23:20 at gluconioenesis when you're at 65 or less.

23:23 How do I know that?

23:24 It is human physiology.

23:26 This is the rules of the human body.

23:27 I didn't make them up.

23:28 I'm just the one to teach you.

23:30 But the opposite uh um finding of here was those ketones when she

23:36 started to fast were you know before she started to fast for here.

23:40 I'm not sure why it went up so much there uh in my chart.

23:43 Maybe I u I might have been teaching something else on that day.

23:47 Uh, but she stop she starts fasting and those ketones go from 0.5 up to one.

23:52 And by the time she got done with her fast, it was clear up there at six.

23:56 This is a much more predictable rate when people are doing routine,

24:00 regular 72-hour fasts.

24:03 Now, on this channel, you know that I do not ask you to do

24:06 that for the first several months of a ketogenic diet.

24:08 We are asking you to get those mitochondria into shape.

24:12 Get the behaviors in your life and in a pattern

24:15 where you can predict a much better uh outcome.

24:18 Um when people show up at the pinch chasers,

24:21 I call them the ass over apricot patients where they come

24:24 in and they just want to do everything so quickly their b

24:28 they're like I'm going to fast and I'm I eat no carbs

24:32 and I'm carnivore and I you know sauna six hours a day.

24:36 They're just doing everything and I'm like,

24:38 "Have you been did you just start that?" And they're like, "Yeah,

24:41 I started all the things." And what I can

24:44 predict is that they're human and they're going to crash.

24:47 When you stack too many habits at once that I've

24:51 seen that enough times in addiction recovery that uh

24:54 you're probably not going to find much uh um

24:57 improvement when I look at you in 6 weeks.

25:00 So, let's look at the next um part of what I would ask this patient to do.

25:04 So, here she is.

25:05 Keto continuum number five.

25:07 She's got two meals a day.

25:08 I know she was eating one meal a day,

25:09 but in our patients when we when we say, "All right,

25:12 she's eating a meal somewhere around that like 11

25:15 in the morning and then somewhere around 5:00 at night." So,

25:19 uh, and the ketones aren't terrible.

25:21 Here's the, um, Dr.

25:23 Bos ratio where it's a north of 100.

25:25 the chances that, you know, years into this or months into this, weeks

25:30 into this, that that kind of number is going to get

25:32 her the change of of of chemistry enough hours

25:36 in the day to reverse a medical problem is pretty low.

25:40 Even at night though, she is producing ketones.

25:42 Uh her blood sugar went down.

25:44 This is better than it was.

25:46 Um but this is uh what happens when uh we go to keto continue number six.

25:52 I think it's supposed to slide those closer.

25:55 Um, I think I was supposed to slide that closer to morning, but anyway.

26:00 Um, let's see if that does that.

26:02 Again, at night, the ketones going up a little higher.

26:05 This is again another stress.

26:06 I think the next one shows me this.

26:08 Yeah, this is what it's supposed to do where the the eating

26:11 time of the first meal is first thing in the morning.

26:15 The eating time of the second meal for this one is

26:17 I think before um 3:00 um for sure before uh 5:00.

26:24 And of course, what happened to the ketones is they went from um being uh 1.5.

26:31 I mean, you did get a 0.5 after that second meal there in the afternoon.

26:35 Uh but for the most part, those ketones really get robust.

26:39 Um even at night, she wakes up in the morning with ketones and circulation.

26:44 And when I look at what that metric

26:47 does for uh calculating her improvement, that Dr.

26:51 ratio is going to be tough during the hours when she's eating,

26:54 but she gets this incredible gift that while she's sleeping,

26:57 her body is doing autophagy.

27:00 It is cleaning up a process.

27:01 It is sweeping out the problem.

27:03 And this woman trying to prevent the recurrence of breast cancer

27:07 uh by only eating one hour a day is not achieving that.

27:10 How do I know?

27:11 Her morning numbers are not low enough to stimulate autophagy.

27:15 Those sugars have to be below 100.

27:17 The ketones need to be higher.

27:19 That isn't an accident that shows up um one minute at a time.

27:23 That is a process where um the solution for improving

27:29 her her uh problem uh starts by first understanding.

27:34 You got to check your numbers.

27:35 When you say what should they be?

27:36 Well, there's some ranges about what they should be.

27:39 But for sure, and hopefully what you are seeing in this is

27:42 they need to be better than they were when patients come in.

27:45 And if you've seen some of the um Substack articles of the cases I put in there,

27:49 they come in with diabetes, you know, a blood sugar at 250 every day

27:53 and we lower it to 180, which is not great,

27:58 but it's so much better than before that they make a burst of ketones,

28:02 their body is mobilizing fat,

28:04 and they really are cleaning up the inflammatory problem

28:07 that when I gave advice to this woman this morning,

28:10 I said, "I bet you don't need to fast for 72 hours to get that result.

28:16 But I do think you probably need to put

28:18 a true fast like again less than 36 hours.

28:21 We do not use the f-word.

28:22 You can call it timerestricted eating.

28:24 You can call it keto continuum number four or five.

28:28 Uh it is not fasting.

28:30 Fasting shows up at 36 hours or more.

28:32 Why do I have that rule?

28:33 Because I take care of sick patients,

28:35 patients who've been insulin resistant for decades.

28:38 And it it takes at least a fast of 36 hours to lower the goo of insulin,

28:44 the excessive production of insulin.

28:47 It just takes that long.

28:48 I've had patients where I had a continuous

28:51 glucose monitor on them because I just could not believe that they they were

28:55 still fasting and and didn't produce any ketones.

29:00 like they had so much stored blood sugar that they were 10

29:04 days into fasting and their blood sugar was still north of 150.

29:09 Uh, and of course that's not what I would recommend you do.

29:11 I'd recommend you you follow the keto

29:13 continuum because when I said to this woman,

29:15 what's the best thing you could do to get your chemistry

29:19 to be working as hard as your your discipline and your heart was?

29:22 I mean, to only eat one meal a day for 71

29:26 days and to have such a terrible response from her body,

29:30 it's well, it's heartbreaking.

29:31 It's devastating.

29:32 That's when patients give up when they can't see the results.

29:35 And she just needs to tweak a few things to get those results.

29:38 So, I said to her, um, I want your biggest meal to be in the morning.

29:43 She's like, I'm just not hungry then.

29:44 I'm just not I hear this all the time.

29:45 I'm not hungry then.

29:46 I'm not hungry then.

29:47 I'm like, I bet at the end of those 72 hours you were hungry.

29:51 So, go back.

29:52 Start with a fast if you want to just to push reset on your hunger.

29:57 And when you get to the end of that 72 hours,

29:59 I want you to have the best the biggest meal in the morning.

30:03 Uh have it have some variety of bacon, eggs,

30:05 and whatever else you like to eat, a ketogenic meal.

30:09 And then if you're looking for the the best

30:11 way to reverse this insulin resistance,

30:13 the meal you can have after noon, after the 12:00 noon hour, is only sardines.

30:22 It's a combination between a sardine fast and this uh timerestricted eating.

30:28 But I'll tell you, she probably doesn't like sardines anymore.

30:31 I didn't really ask her.

30:32 Uh but sardines anymore than the rest of my patients do.

30:37 But what happens when you say, "Here's on the menu.

30:39 You can have food at any hour.

30:41 Uh but we're going to start using this as the food you

30:44 have after 12:00 noon." I suspect she's going to have to close

30:48 that eating window about 3:00 or sooner and that if she puts

30:52 that can of sardines in between 2 and 3:00 in the afternoon,

30:56 the satiety and the hormonal response that Jason

30:59 Fun talks about in his new book uh that I've seen in patients over and over

31:04 again that does carry you to the next day.

31:07 and especially where she's been practicing OMAD.

31:10 She's been practicing one meal per day

31:12 for hours and hours and hours or excuse me,

31:15 weeks and weeks and weeks and has these results.

31:18 Uh so my advice for her at the end was you can do fasting.

31:22 It doesn't have to be 72 hours.

31:25 Get it so the blood sugars go down and that you can

31:27 see a uh a response of your chemistry first thing in the morning.

31:32 And then on the days where you eat, instead of just having that one hour a day

31:37 of foods that may or may not be ketogenic, I I think they were in her case,

31:41 but uh one meal a day or OMAD

31:43 doesn't necessarily mean they're doing uh low carbohydrate foods.

31:48 It just means they have one hour of eating.

31:50 In my heart, I think that's one

31:51 of the major reasons why that timerestricted eating,

31:54 why that um uh intermittent fasting, which I call fake fasting,

31:59 uh fasting only starts at 36 hours.

32:01 uh intermittent fasting doesn't give them the results is

32:04 that the foods they're eating are just as important

32:08 as uh the timing of the food and the length of hours that you put food in.

32:13 Getting that insulin to go down requires some major shifts.

32:16 So either fast for up to 48 hours once a week or the major meal

32:20 is in the morning and the second meal is from noon on but is only sardines.

32:26 And I strongly recommend you slow down the um

32:31 the the that you only have the menu be sardines.

32:35 Yeah.

32:36 Uh all right, let me see.

32:37 We've got a couple of announcements that I I am going to make.

32:40 Oh, actually I was going to show you my numbers.

32:42 I had a couple of comments that uh folks

32:44 said to me um over the last uh few days.

32:48 And one of them was, Dr.

32:49 Bos, um why don't you check your ketones every morning?

32:54 And I'm like, well, I did for about 10 years, or maybe it's only eight years.

32:59 Uh, but one of the things that I keep

33:01 a close eye on is I use my continuous glucose monitor.

33:04 So, here I am at 70, my glucose monitor from today, Tuesday.

33:10 Um, here is um my um blood sugar yesterday.

33:15 And when I got home, oh, I did a workout yesterday.

33:19 And so during the workout, my blood sugar went up.

33:21 And I don't know what was there.

33:24 I might have Oh, I was taste I know what it was.

33:26 I had a lozenge of nitric oxide and I don't I

33:30 think it pushed my blood sugar up a little bit there.

33:32 May or may not have.

33:33 I I should check that before I say that out loud on a live show.

33:36 Um but my fasting um um when I got when

33:41 I got home off the plane from where we went, we hadn't eaten that day.

33:46 So, I ate um supper on at 5:00 on that night.

33:50 And then I got in the sauna, which is pretty late for me to be in the sauna.

33:53 Um, but another uh rise there when I was in the sauna

33:56 that I my blood sugars always go up when I'm in the sauna.

33:59 Uh, again, I show you this because um I had somebody say, "Boy,

34:02 when you show your numbers,

34:03 it really helps me see what I should or shouldn't be doing." Um,

34:07 so again, um, if you're interested in a Dexcom, uh,

34:12 it's the only CGM that I recommend because you can calibrate it.

34:16 I find the other ones can be 15 to 20 points off.

34:19 And although it shows you a trend, I'm trying to calculate a Dr.

34:23 Bos ratio from that.

34:25 And if it's 10 to 15 points off,

34:27 you can see by the numbers we just covered, that's not going to be great.

34:31 Um, all right.

34:32 We've got a few questions that you guys have written in for.

34:34 We'll be getting to those in just a second.

34:36 A few other announcements.

34:37 Um, I was trying to think where the next time I speak at is,

34:40 but I don't even know.

34:41 Uh, so I guess I'll save that.

34:44 Uh a couple of praise points for the company uh include

34:48 that we have been uh our our class our six week

34:52 extens our six week class something that we are doing

34:56 for the first time seems to have a really good rhythm to it.

34:59 I got to meet several people who are in the class.

35:02 Uh again when we do the 21-day class that is very intense.

35:06 That's where most of my stories come from.

35:08 That's a place where I visit those rooms

35:11 and answer the questions of every student that's in class,

35:15 but it's a commitment from you of about 15 hours a week.

35:19 That is too much for many people to be able to commit to.

35:22 Uh so the extension class of 6 weeks is twice as long and about a third

35:28 of the hours committed every week to to um what you need to do to succeed.

35:34 So again, uh, great job to my team that's doing that with me and, um,

35:39 yeah, keep praying for everybody involved there.

35:41 Let's get over to your questions.

35:42 Uh, here we go.

35:44 So, Chu, I will pretend I said that right.

35:48 What is the safe glucose number when in high ketosis?

35:52 Uh well, I've seen glucose numbers uh of mine down to as low as I mean,

35:58 I think the lowest I ever measured that I got

36:00 three checks in a row uh looking at point of care.

36:03 Again, when you check the glucose point of care,

36:06 uh it's amazing compared to what it used to be.

36:10 If you go back 15 years, these were not that good.

36:12 These are amazing.

36:14 They are very reliable.

36:15 They are very reproducible.

36:17 But every once in a while, it makes a mistake.

36:19 And so like last week I was uh looking at a blood sugar and I had

36:23 my CGM on so I knew my blood sugar was about 75 and the first reading said 300.

36:28 The second reading said 150.

36:30 And then I went and washed my hands and then came back and and then it said 73.

36:35 So when you're looking at point of care if it doesn't sound right be careful.

36:41 But the lowest blood sugar that I've had

36:43 in that with point of care was 50 was 49.

36:46 49 48 right around in there.

36:48 And I felt amazing because my ketones were seven.

36:51 Again, it is the combination of fuel that your body needs.

36:55 Uh, you know, we had a young gal sign

36:57 up for that extension class who was new to brand,

37:00 didn't know what she was doing, and she's like,

37:02 I am in ketosis, uh, but I get low blood sugars.

37:06 I have reactionary hypoglycemia.

37:08 And I said, yes, that's caused from high insulin.

37:11 No, but my blood sugar can go down to 50 and I just feel terrible.

37:15 And the reason she feels terrible is because she overproduces insulin.

37:19 Why does she do that?

37:21 Because every time her blood sugar got low, she would have some candy.

37:24 And I'm like, first of all, you're not in ketosis because you're eating candy.

37:28 But second of all, it is that reaction

37:31 of a of quickly dropping blood sugar when there are

37:34 no ketones around that give you that um

37:37 that those symptoms of hypoglycemia where you just feel faint.

37:40 you kind of start to sweat and your body's giving

37:42 a signal that there's no other fuel for your brain.

37:45 So, it's trying to get you to lay down.

37:47 When you look at people in ke in a ketogenic space,

37:50 um it's, you know, it's the combination of both fuels.

37:53 As the blood sugar goes down, the ketones go up.

37:57 Uh when you're not checking in, and what was happening with this patient that I

38:01 reviewed today is those glucose molecules are

38:05 staying at 105 even when she's sleeping.

38:08 So, she does not need to make ketones.

38:10 It's not enough of a stress.

38:12 She has to figure out how to lower those blood

38:14 glucose so that she's making ketones while she sleeps.

38:18 And the best glimpse into what happened while she was

38:20 sleeping is that those numbers first thing in the morning.

38:23 Tot test on the toilet.

38:26 So, safe glucose numbers um when you're in a high

38:29 ketosis is what whatever you what you can see.

38:33 um like you're going to have a tough time being if you're a healthy

38:37 human making too low of a glucose when your ketones are in production.

38:43 I mean when people are playing around with injecting insulin then it's

38:46 a whole different other mess that most people probably don't care about.

38:49 So I won't go there.

38:51 All right.

38:51 So uh Kitty says, "How might you help protect from AIB events?

38:57 Is there any uh potential correlation?" So again,

39:00 atrial fibrillation is a um is a uh chronic problem

39:06 of the heart where you stretched out the heart too much.

39:10 Specifically, the top chambers of the heart.

39:12 Now, the bottom chambers of the heart are the really good muscle ones.

39:16 It's the top chambers of the heart that stretch and stretch

39:19 and stretch in part because there's elevated fluid in circulation.

39:25 Uh so you know one of the first thing that this happens

39:28 on a ketogenic diet is you lower the volume of fluid.

39:31 In fact you sometimes lower it too

39:33 much and we're saying put salt in electrolytes.

39:36 Electrolytes drink sole water.

39:37 That first week the keto flu is really you sweeping out

39:41 all those electrolytes with the fluid so quickly that you feel terrible.

39:47 In atrial fibrillation you've spent years with too high of a volume

39:51 of fluid in your body in the circulation of your body.

39:55 Uh so a ketogenic state really does ring out that excess inflammation.

39:59 It also rings out the amount of volume that's being circulated.

40:03 Um and the other part of atrial fibrillation is what what is very often missed

40:09 is a time when patients are collapsing

40:12 their throat at night and holding their breath.

40:15 And when they do that, when they

40:17 have sleep apnnea and they're gasping for breath,

40:20 the pressure inside the lung gets

40:23 so massive because they're holding their breath.

40:26 They're holding their breath way longer than they

40:28 could hold their breath if they were awake.

40:30 And in the process of that, it is causing an incredible amount of fluid buildup

40:36 in the uh right side of the heart where the blood comes back from the body.

40:40 It's about to get oxygenated.

40:42 It's going to try to go into the lungs.

40:44 But this is a pressure system.

40:46 So your the pressure in that atrium in the place where

40:50 that fluid that blood gathers is trying to go into the lungs,

40:54 but the lungs are such high pressure that it can't go in there.

40:57 So they're low on blood volume.

40:59 They're holding their breath.

41:00 Their blood pressure is going higher.

41:02 And the muscle in that atrium is stretching.

41:05 When you stretch that, the nerves no longer touch like they're supposed to.

41:09 The circuit to say lubdub lubdub is run by these nerves.

41:13 But when you stretched out those nerves so much,

41:15 they cannot connect anymore and they start making

41:18 their own little pattern of how they're going to connect.

41:21 So the question you asked was, is there a correlation between the atrial

41:25 fibrill atrial fib events and a ketogenic diet?

41:28 And the biggest connection I point out is you regulate the fluid,

41:33 the circulating fluid so much better when you're in a ketogenic state.

41:38 And again, just like this gal we were pointing out were 71 days of um OMAD,

41:44 what I would love to have known is what was her blood pressure every day.

41:47 And when she first had this really nice control of her chemistry,

41:51 the blood pressure would have been good.

41:52 But as you go longer and longer with the return of of non-

41:57 ketogenic chemistry where the blood sugar is high and those ketones are low,

42:01 it allows that fluid to go back

42:02 into circulation which raises the blood pressure and stretches

42:06 that uh the top chamber of your heart

42:09 increasing the chances of that aphib coming back.

42:12 Uh do I have patients that have written in saying

42:14 my aphib went away when I was in a ketogenic state?

42:17 Yes, I do.

42:18 Uh do I guarantee that?

42:19 No.

42:20 uh if that pattern of arrhythmia has been around for too

42:23 long uh aphib patterns electrical patterns beget the AIB electrical pattern.

42:30 So the longer they're in AIB, the more likely they are to stay in Aphib.

42:34 Uh so the most best advice I could give to you is if you have sleep apnea,

42:38 you have to treat that first.

42:39 Uh second of all is um follow your chemistry.

42:43 If if you're not in a ketogenic state, it's not going to help you.

42:46 All right, next question is from Betty.

42:48 What should your ketones be before you go to bed?

42:52 I wouldn't waste your trip strips on looking at that, Betty.

42:54 There are so many variables about what your ketones are doing.

42:58 Um, you know, I was showed you my my blood sugar there where oh,

43:02 I got in the sauna, my blood sugar went up, so did my ketones.

43:05 When I get in the sauna, they'll they'll they'll stabilize,

43:08 but right after the sauna, my ketones go up.

43:10 Um, I know that if I am stressed like like if you

43:15 look at um I wonder if I can show you that on Sunday

43:18 morning uh that my ketones uh right before I went on stage

43:22 on Sunday which is when I gave that speech uh went up Monday Sunday.

43:27 Oh yeah, let's show you this.

43:29 Um so go to here.

43:32 So here is Sunday morning 12:00 in the morning 3:00

43:35 in the morning 4:00 in the 5:00 in the morning.

43:38 And here is right right when I went on stage.

43:40 So it's 81 when I get on stage.

43:43 No, I went on stage at 10.

43:44 No, I went on stage at 9:30.

43:46 Uh, so by the time 10:00 is there, which is about halfway through my speech,

43:50 my blood sugar's gone up about, you know, 15 points of that's what stress does.

43:54 So I mean, that's a pretty good stress response.

43:57 You should get stressed when you put on a speech for other people.

44:00 And it matters to me.

44:01 You can tell.

44:02 But when you look at all the other variables that you stack up in a day,

44:07 if you're checking ketones right before you go to bed, you're wasting the strip.

44:12 I want to know what did your ketone production do when you slept?

44:16 And you can get a pretty good idea from one of these.

44:18 What was your blood sugar?

44:19 And in those patients doing OMAD, it never goes below 100.

44:23 I mean, maybe it got to 98 somewhere in the middle of the night,

44:25 but then it went right back up.

44:27 And it's that constant glucose production that is increasing

44:30 her risk of uh a tumor that um that loves sugar.

44:36 So I I don't know what your ketones are before right before bed,

44:39 but I wouldn't waste your energy chasing.

44:42 Now, April writes in, "Do you make the hormone uh the human

44:46 growth hormone if you get your blood sugar to 65 or below?

44:51 And would that improve bone density if

44:54 you have osteopenia?" Uh that's a good question.

44:56 Um, all right.

44:57 Let me pull back actually one of the slides here.

45:00 Um, because what I like to teach is I have a couple of slides that or a couple

45:06 of uh um lectures that I don't give outside

45:11 the classroom because people take them out of context.

45:13 But there's a really good lecture inside the classrooms that I

45:16 teach calling the science of fasting and the art of fasting.

45:20 And I go through what your what growth hormone does, what norepinephrine does.

45:25 Um and indeed extended fasting does and there's

45:28 a really good literature on that does change these hormones.

45:32 So April, let me show you this.

45:34 Um let's go keynote here.

45:37 So here uh is day one of somebody doing two meals a day.

45:41 And when you look at um what happened

45:44 at the end of that 72-hour fast when these ketones Oops,

45:48 that's automatically transitioning.

45:50 I'm sorry.

45:50 I'm going to go back to this.

45:51 Um I'm going to go back.

45:54 Hold on one minute.

45:56 Okay, we're just going to leave it on here.

45:57 So, pretend this is filled in with mitochondria.

46:01 What happened here is this start sharp

46:04 rise in ketones while the glucose stayed low.

46:08 And again, it's getting to that gluconioenesis which is 65 or less.

46:12 Uh it is that prediction of having a stable

46:15 glucose while the delta for ketones is on the rise.

46:19 That is probably the be best way for you

46:22 to I mean measuring growth hormone is expensive.

46:25 It's actually rather inaccurate unless you're checking it several

46:28 times during a sequence which is even more expensive.

46:32 Uh so it's a very volatile hormone to to look at.

46:35 I would I've never checked it in a patient

46:37 and I would only gain information and understanding of it

46:41 through somebody's research lab that's checking it multiple times

46:44 in the same patient over the course of several hours.

46:48 So in those spaces where they get to that extended fasting,

46:52 uh you can see the growth hormone rise.

46:54 Now I do not recommend a fast longer than 72 hours.

46:59 Even for me, like 75 hours maybe like essentially that 3-day mark.

47:04 Uh and I like you to get to the morning.

47:07 Like if you're at 69 hours and it's about bedtime,

47:12 I would not tell you to eat at 8 9 10:00 at night.

47:15 I would say go to bed and and break your fast in the morning.

47:18 Meaning always error at breaking your fast in the morning,

47:22 not at the end of the day.

47:23 And I know that's not how people do it, but what you're looking for is

47:25 that stimulus for those hormones like growth hormone,

47:29 which indeed really do help bone density, but also that norepinephrine,

47:33 that euphoric feeling that brains get when they finally arrive at sparking

47:38 some of these really ancestral hormones that come with the opposite of hunger.

47:44 I mean, you're not going to be hungry.

47:45 You really aren't hungry when these are flying high like that.

47:49 And again, I will give praise again for Jason Fun's book.

47:52 Um, I we should probably have a link to that in the show notes.

47:56 Uh, again, um, or go to Dr.

47:58 Bob's favorites page and I have the book club.

48:00 He's part of the book club that I would recommend.

48:03 Um, where he talks about how much the hormonal switch

48:07 in our bodies is really what determines weight loss and weight gain.

48:11 And he does a great job.

48:12 So, give him all the credit and the praise uh

48:15 and the success of what how hard it is to write a book.

48:18 Last one for the day is uh go to questions.

48:22 Here we go.

48:23 Brian says uh should we look at s

48:26 the sardine fast differently from a water fast?

48:29 I had a slide in here about the sardine fast,

48:32 Brian, and then I thought, oh, that's too distracting.

48:34 Um, and when when you look at a sardine fast, um, I mean,

48:41 the really important me metric to measure is what happened to your blood glucose

48:47 when you were eating sardines only

48:49 and what happened to your morning fasting ketones.

48:52 And that spark that that drop in glucose and that rise in ketones

48:56 is really where you start to clean out the trash in your body.

48:59 you start to clean out the um the um you know

49:03 autophagy really replace the broken mitochondria

49:06 with some uh some young phillies, some young healthy mitochondria.

49:10 That's called mphagy.

49:12 And in looking at that transition,

49:15 um many people get the results that they're looking

49:18 for without that without without having to do a water fast.

49:24 Um I I've had a few say, "I never want to do a water fast.

49:28 I only want to do a sardine fast.

49:30 And my answer for them is as long

49:32 as your numbers are good first thing in the morning.

49:35 That when when I see patients saying they they they've learned to love anything.

49:39 And if I tell them they can eat sardines, they eat sardines.

49:42 But now they're eating those sardines at 7 8 9 10:00 at night.

49:47 And although the first day you eat sardines, I let you eat it at any time.

49:50 When you're doing the the plan that I recommended for this lady, it is okay.

49:55 From noon on your menu should be only sardines.

49:58 The morning have the variety of food that you want to have.

50:02 But that eating in the afternoon and later afternoon needs to be small volume,

50:07 you know, nutrient-dense food and something that causes you to feel satiated.

50:12 And there is something miraculous about those little fish that does that.

50:17 So, um, you look at water fasting and sardine fasting only.

50:24 When my patients are too broken, uh, too water fast,

50:28 meaning they don't they don't make any hormones yet.

50:32 You you they're so uh their metabolisms are so slow and so broken

50:38 that if I send them into a water fast that their body just says,

50:41 "Oh, uh, close down every fat cell where we need

50:45 to be in hibernation mode." And it doesn't release the energy.

50:49 Um, it's not an accident that in my 21day

50:52 I have my patients do a sardine fast and succeed

50:56 at that, succeed at the production of ketones

50:59 and then the next week we try a water fast.

51:03 All right.

51:03 Well, uh, signing off again for a great night.

51:05 I will uh, just give again a special thanks

51:09 for anybody who came out to um to, uh, meet.

51:14 If you did come, I would love for you to put it in the comments that you

51:17 attended just to kind of show the other

51:19 people in this community how many people just said,

51:21 "All right, I'm going to go to my first conference.

51:23 I'm going to go to a conference and and that's

51:26 how we'll make America healthy again." All right, guys.

51:29 to see you next.