#89 Ask Dr Boz - Part 3


Originally published at: https://ketowomanpodcast.com/ask-dr-boz-part-3-transcript/

This transcript is brought to you thanks to the hard work of Michelle Richter

Welcome back Annette to the Keto woman podcast, how are you doing today?

Daisy I am so happy to be back on your show. It's great to hear you and see you again.

It's really nice to see you. What the listeners don't know is we've actually spent the last two hours together trying to sort out an absolute catalogue of disasters when it comes to audio.

I think I'm cursed. You know, the process of recording my own voice has become a sabotage in my own universe, like at least 50 times since the last time I've spoken to you. It's me. I swear it's me.

It's me too 'cause I've had audio problems this last week or two as well, so I'm hoping that we've hit our quota now and things are gonna turn around the other way.

Nothing better to forge a friendship than to struggle together, so we are good. We are besties.

Absolutely. Well why we're talking about things turning corners, congratulations are in order. Well done for finally winning the battle and getting your license back.

Right you know, the season of having a journey that your perseverance is tested and your stamina to stay the course and not be brushed away by a storm that just seems to just rise month after month, it is a time of deep breathing for me that says, okay, let's forge forward. I think your audience was the first at.. Your audience was the first place I spoke of my challenges to fight for my medical license, and it is remarkable to be able to say that I had 12 felonies reversed….. removed, and in that process, I actually did keep my medical license the whole time. It's what is un.... It's difficult to explain to the world, but in the process of the judicial system, I did say, nope, this has nothing to do with the practice of medicine and this is not justice. And by a year and a half, oh gosh, we're four years later from that moment. This past month, the medical board did not just reverse all of the claims that the attorney general's office was pushing for, but I mean all but apologized for like, there is no ding on my license. There are no patient complaints. The month before this happened, they ordered me just to leave the state and I was prepared to do that. Just, okay, just give me a chance to start over, this is too heavy. And you know, I walked into a board hearing that is super scary, not allowed for public viewing, which to me seems even more frightening with the story that I've been through. And at the beginning the attorney general said, we want her license, we want it completely. And when we walked out of there, the medical board said, nope, you can't touch her license. There's no harm that should come to her. She doesn't need to leave the state. Some of the other goofy demands that they were asking were all denied by the board and I was allowed to walk out of there, actually, I ran out of there saying go! So it is, you know, as a physician who is committed to educating my patients and really pouring into the intimate journey that is the privilege of being a physician. I really think God knew what he was asking me to strengthen in these last few years to say, I've got a different path for you than I would have taken had I not gone through that stress.

I wrote a book, first of all, I was never going to write a book. That takes a much slower pace, you know that protected time to mentally process and write down and edit and think. That doesn't happen in a busy practice that the story happens to be lifesaving for my mother. Yeah, that's a blessing that I'll take that. You can take my medical license. I'll take the story that I've had in the last few years and watch what strengthens me as an educator, as a provider, as a daughter, as a mother, as a wife. And those moments couldn't have happened if the pain of what was in the backdrop hadn't forced me to look at a different direction. And so you say in this silver lining is a path forward now that yep, I have a clear medical license and now I get a choice point to say, well what is it that I want to do at this stage of my life? And that's a gift.

Yeah, I just can't imagine the overwhelming nature of it. This sounds like a silly thing to say and it is a silly thing to say, but I was taken to court once to a tribunal for my dogs allegedly barking. And it sounds completely trivial in comparison and it is completely trivial in comparison, but the only reason I mention it is that was massively stressful for me. Massively stressful. And that was a tiny little thing in comparison to what you've been through for so long. I mean, that was, you know, a relatively short, a few months out of my life and it was constant migraines and constant stress. I couldn't sleep all the rest of it. Well, this is everything about your life. This is you, this is part of you and it's been going on for years. I mean, I just can't imagine you must be sort of in this place where you almost can't, you don't know how to feel I must imagine. There must be a massive sense of relief, but also this sort of sense of purpose in this battle that you've been going through is suddenly over. And I can just imagine you being a bit sort of lost at sea and I don't quite know what to feel.

There's a boogeyman that's been looking over my shoulder watching every moment, you know, I'm not exaggerating when I say I've had black vans outside my house for the better part of four years on and off and that does something to you. I have kids I've had.. I'm almost afraid to tell the stories because it sounds ridiculous, but in that I have really learned that there is a foundation of strength that comes from my faith, seeing I can't see where this is going, but I know that there is a bigger plan and that I wasn't given these talents to waste them. And if it means that I'm supposed to change course and my medical license goes away, I'll find a way to use the skills that I've been given and honour that gift by using it. I don't think I could have said that four years ago. I know I couldn't have, I would've said, oh, somebody's coming after me? Why I haven't done anything wrong. And then so it doesn't matter, here's how life plays out and the stress is something that, you know, I have three sons who went through some very formative years in the last four years because of their age that they witnessed, this is what it looks like for a marriage to make it through a difficult chapter. This is what it looks like to keep a unit of a family together and the whole world seems to push or exploit or stress the family and say... It would have been easy, and I did have days where I'm just like, I'm staying in bed nothing. I mean, I'm just going to stay right here. But that was rare. Most of the days I got up, I found strength in my purpose and my faith to say, nope, I have a purpose. I am supposed to use it and if I don't use it, that's when the enemy really wins. And I can't even express that the last, I mean it's only been a couple of weeks, mind you, the three and a half weeks before that, I was scrambling to get licenses in any other state. So to now not be ordered out of the state. It's almost like, I'm not sure where I told myself don't make any decisions for two months. Just pause, I'll keep going for the license in other states in hopes that I have options. But I will tell you I just was planning that there would not be a medical license at the end of that. The hearing wasn't supposed to happen for several weeks. I mean we were planning on a medical license because the hearing was going to happen after I got a medical license in another place.

So we got this 10-day warning, 13-day warning that says, nope, prepare your case. Be ready to present, it's a trial in front of the medical board. And yeah, we had lots of layers of protection around us for all the right reasons. And I'm super excited to just move on to the next chapter and I get to carry with me the blessing of becoming an expert in the ketogenic diet. Not because I had this fore planned journey, but because it landed right here in front of me and I embraced it, I was incredibly curious, I dove deep. So now I get to go forward with that talent, that skill on top of having a medical license. I mean, there's just a lot of authority that comes with that, that I don't know which way I want to use that, but to remove it without honest cause. So yeah, to have that assignment or that, burden without a cause was what really said OK, there's bigger injustices in the world, I'll find a journey forward. So, to march forward with the skillset of being an expert in the ketogenic diet and being an internal medicine physician licensed in the United States, there's lots of opportunities. There's lots of places I can find a rewarding path forward.

You did laugh at me. One email I sent, I said I guess they're not going to actually apologize. You did laugh.

Like my resources and four years, you know, it's actually longer than that but since the arrest, it has been four years. 2014 was when I was arrested, it's 2019, so five years. Gosh, who's counting I guess. So five years since the arrest, four years since the trial and yeah, it totally changed the trajectory of my career forever. You can't undo that,

But like you say, maybe for the better. It's cost you an awful lot of money and an awful lot of stress and heartache.

Yeah, if you would have said to me, Dr Bosworth, what would you pay to prevent your mother's death , to restore her life completely. I couldn't have found a number big enough. So when I look at the price paid, it still is this journey that says I became an expert because I was caring about the most important patient in my world, which was my mom and God had provided me the space to sit still and serve that one patient completely. And now because of that, the ripple effect of the number of people that have read my book, read her story, seen the way I explain the science to her and what we needed to do for her. It's helped more people than I could have ever helped in that many years. So yeah. What a blessing.

Isn't it strange how things work out sometimes.

Yeah. I think it's also the look like I have had other colleagues go through some serious tragedies in the last few years, you know, addiction affecting their families and you know, despite them knowing how to help them can course correct, burying children. And you say, you know in all that midst of pain, can you find the motivation to look for the opportunity? And I really have to give my husband the, I mean cause there are days where I was like, forget it, I'm going to go like I don't even know what, like I grew up on a farm, I guess I'm going to go do hog chores, I mean I was returning back to the primary thinking that I had as a 10 year old girl and it was his guidance, his words at a time where the depth of sorrow and pity and patheticness was very all consuming saying, are you going to choose this answer or are you going to look around and say what other opportunities find it, fill it. I do think no matter what you're going through, it's tragic, but can you stop and say what is the purpose for the pain and when you can find that there's life in that there's life. I don't mean like a martyr. That's not it at all. It's saying, okay, I'm here. What could I do? And it's those types of paradigm shifts that make the heroes of our world saying despite the tragedy, it would have been easy to give up and say you win, I'm done. Instead I wrote a book, I pushed publish, which was the bravest moment, probably the whole event saying, can I show people what I'm thinking? I've already been chastised for that in respects to standing up and saying our community needs a different voice of people creating healthcare for the underserved, for the people in my community, let me add my voice to that and to look at the push I got to say silence, discredit her and then to come up with, oh by the way, this is going to be outside the normal stream of medicine and we're going to ask you to stand alone because there's not a lot of people saying this message and then do it with the confidence to say no, look what it did to my mom. Number one person that I will show you a story where she wasn't young, she wasn't spry, she had all kinds of problems and yeah, just this last month she has for the first time at now today's her birthday, so 75 years old. She has normal white blood cell count.



That's a nice birthday present, take that.

Yes, off of chemotherapy has been and and she feels amazing. So that's a win. I'll take it.

That really is win well, nice News. Yes. Well, after that emotional catch up.

Yes heavy, I'm so glad I did it without tears.

We've been wanting to get you back on the show for another Ask Dr Boz episode or two. I get asked all the time when you're coming back on and I know how busy you are, so thanks for coming back on to give us an update and to share a bit more of your knowledge with us.

Excellent, I'm happy to be here. This is my favourite, favourite dialogue. So thanks for inviting me, Daisy. It truly is an honour to be on your show.

Oh, thank you.
Well, I thought we'd start with a message from April. She's got some questions, but she's had a really good update of late too. so I'll just read out what she says. First, you're amazing, Dr Boz. I've listened to your book and have been recommending it. My sister is taking your recommended pages to my mom's doctor who has early onset Alzheimer's. So this was a while ago, and there's actually a really positive update to this story because the carers were refusing to give April's mum the exogenous ketones that you'd recommended that might help and I think you sent her some studies or an article or some such to give to the doctor to help try and persuade them to write a prescription basically. Following your advice and using the information, they got a doctor to effectively write a prescription, so she is now being given exogenous ketones by her carers. Isn't that great?

Oh my goodness that is amazing. You know, the brain process of how much we've learned, you know, really was one of the first places that got my curiosity. There was kind of this collection of listening to a doctor, Dom D'Agostino explain seizure patients and preventing seizures for scuba divers. And that coincided with a patient whose mother was being treated for a brain tumor and she was trying to say, what can I do to help her? So those two parts were the first inklings that I used to get my curiosity started in the ketogenic journey. And then it was a much deeper dive of watching the repair of a brain from concussions to chronic migraines to memory problems. And you know, I look at the articles that were needed to help her providers see what is in the literature. But I mean, I've been that physician so busy that I didn't take time for the latest updates because how could you possibly keep up with them all?

And so you have your sources where you try to, you know, get the summary points of, you know, what they shared at the conference or what's the latest literature. But summary points don't necessarily really motivate you to change behaviour unless it's got some pretty promising stories. You're going to be using this frontline, please convince me that this is the right thing to do. So to somehow think that you could take a problem that I've told patients for the better part of two decades, hey, you can't reverse that memory problem, she's stuck. And now I'm saying, wait, wait, wait. We now have evidence that says we see the energy gap for people with dementia, especially if they've been overweight, if they've had high insulin, if they've had metabolic syndrome. And I'm telling you as an internist, practically every one of my 80-year-old people has had a chapter of that, unless they're really lean. And even some of those have had it, but most of the folks have had a season of being overweight. And when you look at their fuel for their brain, it's all glucose. It's all sugar. And your brain can't make fuel. It has to haul it in. So the little receptors, the little trucks at the blood brain barrier are pulling in the glucose and then your brain runs only on glucose. So as soon as you get that two-hour, three-hour mark, while you're not sleeping to ask your brain to work, you're going to sink, you're going to have the munchies, you're going to have that shaky feeling. That's brain saying, hey, I need some fuel. I'm trying to send you a message. When we saw that in as little as four days, of a strong high amount of ketones in that blood, the blood brain barrier, will take those ketones along with glucose. Glucose is one truck that's getting pulled over the blood brain barrier, but ketones were also being transported into the brain and within four days we dropped the need for so much glucose and we took ketones from a zero need, up to a majority of the brain was processing and using ketones. Four days. That's remarkable. I had no idea we could do it that quickly. The study was done where they practically put them in a jail cell to get them to eat this really high fat diet like it's more of an advanced ketogenic diet than I probably have ever done. It is the prescribed level for a seizure patient, so it's like super advanced and in the real world you're going to have a tough time getting people to do that, especially when they're going from carb fuels to ketones. They're going to have withdrawal. But when we could see their brains uptake that quickly, anybody in the industry said, oh my goodness, put the ketones in the blood and watch what happens. And as I've used that for my patients with memory, I mean, they're in nursing homes and you say, okay, what's the worst thing that's going to happen If I give you a supplemental ketones for the next two weeks? Maybe they'll get a little diarrhea when we first started. Okay, let's do it, bring the patient back in two weeks and I cannot tell you the heart stopping transformations of people that I just had assigned to the rest of their lives to be in a nursing home that adding ketones improve the quality of their life, improve their memory. That two weeks was the first awakening where their depression was less, their concentration was better, their energy was better. And what the studies have continued to say is when we see memory problems, one of the major thought patterns throughout their brain studies and biopsies at death and you know lots of people looking into what's going on is there's an energy deficit that we're just barely meeting the needs of the brain's energy by only using glucose.

And of course with that two hour window, the danger of a two hour window is, and especially in some way with memory problems, is you're going to constantly be running out so the brain will just shut down when you added Ketones, not just for a one time dose, but now you've got a body who's burning them most hours of the day, you end up with a whole awakening of their mitochondria, of the metabolism inside the brain that was offline. It was done like we don't have any fuel, we're shutting down, and they did, they just barely trickled that metabolism alive. So it's like a dormant Mitochondria. To wake it up and then fuel it for a good five to eight hours on a ketone as opposed to the flash energy of a glucose. These brains stuck in memory problems, have a new lease, have a new return, and what a rewarding moment as a physician, but also as community members for people who I know have suffered with that, just loneliness of what happens when you get dementia. It is a tough road from the moment they get that until they die and it's lonely. It's really hard to understand what it's like to not have that memory and to restore that even in a partial way, and I've had two of them return out of the nursing home back to their homes. That's amazing. Right? The rest of them, you know this literature, I actually really was able to master the, and ask some of the questions before I started advising it to patients when I was at the metabolic health summit and that was in January, February of 2019 and it really has changed my approach to those who are struggling. In addition to that, there's other like places where I've had a couple of moms coming in. Life is hard, husband's struggling, been put in a treatment program. Now she's running teenagers, single parenting wondering what's gonna happen with their marriage. Really stressful times, right? And she wants to be on an antidepressant. I know I took it probably 15 years ago after I had one of the kids and I took it for probably six months and it seemed to help and I just need anything. And I'm like, you know, here's the prescription. We can try that again. But it's going to take two weeks for that prescription to start working to improve those brain chemistries. In the meantime, take exogenous ketones and watch what happens to the energy in your brain. And I've had that story probably six times since February since I got home from that conference and not one of the six ended up on the antidepressant. They were taking exogenous ketones and the restoration of their mental focus, their mood and their energy was so much better on an over the counter supplement that they chose not to add the antidepressant and it's there, they can fill it any time. It's not going to hurt to have both of them, but wow, that's freedom to say, look what we can do in such a quick time what we changed the fuel of your brain, and this is somebody who started out saying, mom, I don't know if these exogenous ketones are, right? You should just make your body make them. And I think a lot of people in the space said those words and so I adopted it as well. But you start to see some of the literature on what we can do to change the cell metabolism and this is just the organ of the brain. There's now evidence that the heart uses ketones, and again that was something I was told no, the heart uses glucose. No cardiac cells are using when you tag the ketone in a pet scan, if you would, you can see that the cardiac muscles are using those ketones for fuel. And again, that was news to me. So, what a great time to be in this space of stopping more prescriptions than I start. That's awesome.

Yes, it's interesting actually the podcast I'm editing, I always do it behind the cut and I completely forget where my timeline is with what show's going out and what show's been out and where I am with it, so I just say it how it is in the moment rather than trying to remember where I am. But the podcast I'm editing now, which in my timeline is going out tomorrow, but which would have been out before this one comes out, is a guy talking about, that's his passion, talking about heart disease and working with ketones and how that all works. That just made me think of that when you were talking about it just now. So I think you'll find that interesting but I find the whole subject of exogenous ketones a tricky one.


Mainly because a lot of the examples I see it is in the weight loss side, which I think it's actually counterproductive for, but I've always thought they have their uses and particularly with this question of dementia, you know, I've spoken to people who've got elderly relatives and they really want them to start eating Keto and producing their own ketones, but easier said than done. And it seems to be a really typical thing for people with dementia have really strong cravings for carbs, which presumably because their brain is starving for wanting that glucose all the time, it's driving those cravings and being not in a good frame of mind, literally, it's almost impossible for them to stick to that way of eating. So that's a prime example of a good time to start pumping in exogenous ketones to get you into that place where you might actually then be able to start producing your own as well.


Then you know, if you can be pumping them in to get them to the level you need them and then start producing them endogenously as well. Well, that's got to be a perfect storm.

Right, I mean, I look at the approach that as an internal medicine doctor, our team, our tribe of internists, we are about the long game. We are about chronic health problems and how do you get out 20 years and see that we did make an improvement. You know, how do we prevent problems? How do we take a chronic problem and undo it? And it is not uncommon where you show up in my clinic and there are so many disasters unfolding at once that that's where the prescriptions become easy. You know, take blood pressure. We know this has to be controlled in order for your brain to not be swollen under that high blood pressure, that the risk of a heart attack has to be controlled in order for us to reverse the risk. So we write the prescription, but it is not meant to say, okay, now you're on the prescription for the rest of your life. No, it was meant to say, let me prevent the danger that you're in that you're walking into and now let's work on getting you healthy. And I think those last few words have been lost in the practice of medicine. You give me 20 minutes to take care of all the disasters you're about to fall apart. Maybe I get 40 minutes on a good day with you. I barely can assess what chronic problems we're talking about and then how do I use the prescriptions that have the evidence base to get you the most improvement for the quickest amount of time with the least amount of side effects. We don't even get to the part that says, now how do I make you better? There's no space for that, but that is the core. That is what we are trained to say. What can I do to say, now I've got the disasters, I've got a you know, finger in the dike that is not going to flood over and kill the patient in the next few weeks.

Now how do I get them better? And I really look at that kind of parallel when I'm looking at exogenous ketones. Take the woman who's got depression, overwhelmed with stress, you know, more things on her plate than she was ever signed up for. And I say, Yep, we can use an antidepressant, I can see you're stressed. We'll make sure there's nothing else that's causing this with some lab tests. But oh, by the way, let's change the fuel in your brain and within three to four days, you're going to feel a difference to ask her to change her diet, take out the carbs, remove the cravings. Yeah, you gotta just sit in that room. There's no way I'm going to ask her to change her diet today. She has way too many other things to deal with. And you know, in that respects of understanding the science, there were two other studies presented at the metabolic health summit that specifically talked about when ketones were available for the blood brain barrier. When they were present, the brain began to prefer them. And again, that's backwards from what I was told, glucose is the primary fuel for the brain. Glucose is what your brain needs, you can't live without glucose. All of that stuff came from the metabolic health of brain and heart cells. So you look now that says, oh, you are wrong. We see that they metabolize ketones. In fact, when the ketones were available, the brain preferred the ketones. Again, that was new news to me. But how it plays forward in my practice is to say, we got a lot of work to do. Let's get you feeling better. Let's stop the up and down of your emotions because your fuel goes on and off with that insulin resistance that's at your blood brain barrier. Let's fuel you with a steady supply. And then we're going to walk through how do we lower the carbohydrates? How do we clean out those cupboards? How do we change the way you think about fat versus carbohydrates? And had I started with that, they would have walked out the door saying, nope, can't handle it. But if you start with saying, I can make you feel better in as little as four days as according to the evidence and now I have you feeling better. And we say, what can you handle next? What can you handle next and those cravings much easier to handle when your brain already has been practicing using ketones before I take away the chocolate cake at night and you say, well, are you saying that they can have ketones and chocolate cake? And I'm saying, absolutely. That's how we start you to hauling that fuel into the brain. And then once the ketones are available to the Mitochondria, they are preferring the ketones, once they begin to metabolize them. Once the ketones were inside the blood brain barrier, they got metabolised, they got used, they got burned as energy and that was the first little on switch for that specific mitochondria. Tomorrow when you add them, he's going to use them and maybe his neighbour. And then you've got the stable fuel that's not going up and down. Suddenly saying no to bread is not such a ridiculous ask. You've got a stable brain fuel as a platform to build off of these other changes. And this is again, mind blowing for people. You know, I don't even feel, I look back and say, where did I get a negative taste in my assortment of tools for exogenous ketones? And it was the literature I was reading when I first wrote that book, which was, Yep, we can do this. There was a fight over, is it racemic or ketones or non-racemic and can you use, it was kind of all this science that they were all excited about fighting over it and nobody really talked about improving symptoms really well. There was a battle going on. I wasn't sure what it was talking about. As I continued to listen and I watched two experts debate the case, I'm like, yeah, I think you guys are fighting over something that never shows up in my clinic. Just come to my clinic. I have depressed women, I have people whose brains aren't working well. I have people whose hormones have been turned off for years because they've been on a low-fat diet and there's been nothing to make those hormones from. If you're telling me that I can use a supplement to get them on the right path and then I have supplement until you get this mastered and then we can stop the supplements. That's a plan that says I get them feeling better, I get them eating better and I lower their inflammation, maybe not as dramatically as I would want to do it in a perfect utopia, but utopia was long gone for many of these patients and the option to change their thinking. I mean most people aren't going to go to my YouTube page and spend 20 hours watching all of the information. They're going to say, what does she recommend and then follow it and if you don't get them feeling better in short order, they won't stay at the post. I look at other things that I've, you know when you first went on the ketogenic diet where you perfect for the first year?

When I first went on it, when I'm still on it, I am the most far from perfect person you'll ever meet. But the thing that I've been thinking about as you've been talking about this, I struggle with exogenous ketones and the reason I struggle with them is because certain companies and the way they sell them leaves a bad taste in my mouth, that's the element that I struggle with. There is an element to them, the whole racemic debate, you know how our body responds to it. That I also am a bit concerned about and I don't know what's gonna happen with long-term studies and all the rest of it. That is a bit of a concern. I've never had an issue with using them as treatment for something like Alzheimer’s, I've always known that that's a very good use. What's been interesting going on in my mind as you were talking about these women coming to you depressed and wanting to go on antidepressants, well, I mean, as you note, depression is something that I struggle with a lot and it goes up and down and it's been a struggle for me the last month or so it's been quite difficult and I know that when I start pumping out enough ketones, I will start feeling a bit better. It won't necessarily completely sort out the depression, but it will help and, I know that and I know it takes a certain amount of time and I can usually force myself into that if I've gone off the wagon a bit, if things have gone wrong for me, if everything's sort of gone into a spiral, I know how to start turning that spiral, or the other way is to start producing ketones. But it is difficult and the only reason I pushed through it I suppose is because I have the experience multiple times of knowing that it will work. But I know how difficult it is for me being in that frame of mind, having the experience and the knowledge to know that it will help to eat a certain way. But for someone who's feeling all those things, who someone tells them, oh, you could feel a lot better, you know, your depression could be a lot better if you started eating Keto. Well it's true, the chances are I probably would. But if you also understand how that person is feeling, just like you were saying, they can't do it right, they can't do it. It's the same conversation I've had with you and other people about the weight loss surgery, the place I was in, of course I could have done it without, but in the place I was in, I couldn't. And it's the same with depression. So if you're looking at exogenous ketones, the way you're talking about using them is this short term emergency medication, if you like, that's just going to lift you up to the place where you can start handling lifestyle changes that will then start seeing you through for the years to come for the rest of your life, but you start talking about those kinds of changes now and it doesn't seem that much. Oh, you know, is it really going to kill you to stop eating bread and to stop eating cake and all the rest of it? What actually at the moment, yes It feels like it would kill me. You've got to be in the right frame of mind to be able to handle that and if giving someone exogenous ketones could just, like throwing someone a buoyancy ring out there who's drowning, if it can just get them up high enough to start making those changes, then yes, that's something I can on board with.

Right. So the other place that I look at that is, you know, take my journey beginning of this podcast shared an incredible depth of struggle and I am a very disciplined person. I know the science that would say if you fell off the wagon, if you're not feeling good just fast for a few days, you'll be back on the wagon. And I'm like, no, I can't do it. But as soon as I would add exogenous ketones and especially since I've been reading the evidence over the last year when I would find myself having a glass of wine, it would really slow down my thinking for the next day and part of that is just being in a slump for as long as happens with the story. But then knowing that when I would take some exogenous ketones, it would at least give me three hours of really good mental focus and what I found was at the end of that mental focus, you know, ketones are an appetite suppressant so I wouldn't be hungry. I get why the people are using them for weight loss. They are an appetite suppressant. I didn't take it for those reasons, but do I use food to comfort me when I was sad? Yes. When I was scared, did I use food to like be the soothing agent because it's easy and accessible and there are currently no laws against that one. You know, of course. Unfortunately having been insulin resistant, like most of the women my age, that ignited the return of inflammation, the return of a sluggish brain and it didn't take but three or four days of not following the rules. Now I'm off the bandwagon. It's just, it's too hard and I can't find the energy to get back to the right place again. At first. I know I looked at every single one of these exogenous ketones has a sugar substitute in it. They're kind of a nasty taste without that, they're a salt. And at first that was, the sugar substitute that I kept pushing against. Like okay, I could have the ketones, but I wouldn't want the sugar substitute with it because it would make a sweet taste. And once I have a sweet taste and I want more, at least that's what I told myself. But then I started doing okay, I have some on supply that when I feel like I'm in a slump, I'm gonna mix it with a little bit of cream and ice and I'm going to sip on it. Just a few tablespoons worth. And I would check my blood ketones and they would be like 5.6 like I never got that high ketones when I was fasting, or at least not a 48 hour fast or something. But what would happen is that it wouldn't just help me for that moment, the rest of the day I would have less cravings, I would make better choices with my food, and then the next day would be a little easier and the next day it would be a little easier. So if I look back at the perfect Keto diet, it would have black coffee instead of coffee with heavy whipping cream. Well, I liked the heavy whipping cream. I like the butter in my coffee. It tastes good to me. And that satiety is something I needed to practice for the first, I think, I mean, I still do that, but amazingly, that's become my comfort now. And I don't think I could have completely arrived at satiety from these high fat foods had I kept those sugar substitutes too heavily invading my world in my first year of a ketogenic diet. But I would make the exception with exogenous ketones because of how much it did shift my metabolism. It did improve my energy, my mood did get better, and then it wasn't just me. I thought, okay, maybe that's just me, and you go to the conference to say, oh my goodness, look, they studied that. It wasn't just me. Yeah.

It's really hard and I still really struggle. I still really do struggle with them and I think it comes back to the sales methods of some companies and the claims that are made and, and that's always going to be a problem for me, but if I hear stories of people using them in specific intelligent ways, there's someone I want to interview who's doing research into the use of a specific type of exogenous ketones, I believe for treatment of Migraines, obviously that's something else that interests me. So it's there use it. If it's used in a particular way, then possibly I am open to that. I still, I do. I really, really struggle just because I see so often it being sold as this magic pill, take these things and you're going to lose weight, take these things and so many people take them and gain weight because ultimately, you're just pumping this extra energy source in there and so you're not going to lose weight. But somebody else, like you were saying, can take it in a certain way and it helps them. Oh, it's, oh you can tell can't you. Yeah. You can see the expression on my face, I really do struggle just because I suppose it's also having been that person who is so vulnerable to that being sold that magic pill and a very expensive one at that. I'm the kind of person who will grab onto that. I think I might've been one of these people who bought Raspberry ketones. Remember those things that were sold because they told you nothing to do with exogenous ketones. Completely different thing. But because I was sold the hype that I would lose weight by taking them and it was just another thing and I know exogenous ketones are a different thing, but it still falls into that category a bit and a lot of people are sold them and take them and for nothing. Oh, and I don't like that.

Here's the perfect, as you're speaking, what I have in my head is I imagine the woman who comes in and says, Yep, I'm new to the community. I would like a new doctor. I've been on Prozac for 25 years and I introduce the idea that Prozac was never designed to be 25 years of anybody's life. It was meant to help you in a season where you are having a difficult time and as soon as that season was stable enough to help you work on the ways to restore your neurochemistry to its optimum production, we should have done that. As many times as I've had that conversation, it's almost tearful that the woman says, nobody told me that. Nobody told me that I was done with it or I could be done with it. How do I do that? And I see the same errors as, and I did it to like quickly filing exogenous ketones as this gimmick, like you should do it the hardcore way. I look at my heroin patients and say, you shouldn't use the suboxone to get off of heroin. You should just suck it up and suffer. And you're like, yeah, they're going to fail. They're going to return to their addiction. It is real. And you say, let me help you. Not for the rest of your life, but for a season for this chapter that says, I'll show you. But that really becomes the responsibility of those who are talking about it, educating about it, saying this wasn't meant to be the rest of your life. It is meant to say. If you think you're going to go from no carbohydrates and no alcohol for the rest of your life, I'm here to tell you no human on Ketogenic Diet does that. You're going to have times where you relapse, where you have struggles, especially after you felt how good life can feel when you are following the process. Let me get you back on board as quickly as possible, not for the rest of your life. And I think that voice of educating correctly is my responsibility as a physician who is rooted in how do we take the science and apply it to these chronic behaviours to change one behaviour in the next best level. And then we take the next behaviour to the next best level. And that's the root of internal medicine, improving chronic disease with the steady sustainable outcomes. I see them as a tool for people struggling for people screwing it up for people having mental slumps. And for the folks who are saying, let me just see what it would be like, how would I feel if I was on a Ketogenic Diet? And I tell them, I want you to sip on exogenous ketones for two weeks. Don't change anything about the way you eat. And they come back saying, all right, how do I do this Keto Diet? Cause this was the best two weeks of my life. Usually it's like a week. They're like the, this past week has been amazing. You know like welcome to the Keto Diet. Let me show you the rules.

Tricky. I am open to be persuaded in certain cases, but again I guess like you say, it's not something that, not something that you'd recommend to everybody. It comes down to the individual doesn't it? And working out what the best way forward for them is and yes, if you put someone in front of me and you could 100% guarantee that the only way that they would be keto in six months was to spend two weeks taking exogenous ketones. Yeah, I mean I would take that option. Right?

Yeah. I look at that saying, I don't want to take blood pressure medicine. I don't want to take, you know, I've had this conversation. If you think doctors aren't salesman, you just haven't been in the exam room long enough to say, I know don't want to take a pill, but let me show you the risk you're taking. I can help you get there. Not Today, it's going to take us time. You have this thing called human behaviour and that doesn't change on a dime. It changes gradually, one notch in the right direction. And there are rare stories like my mom who said, okay, I'll do this, and we did it together. She changed on a dime. She's now three years out and in the best chapter of her life. Honestly, that's the rare story.

Yeah, absolutely. And I do think that endogenous is always going to trump exogenous.

One of my other major things I tell you about the brain, the anti-seizure and those, plenty of experiments done on exogenous ketones there. But when you look at how can we, you know, repair Alzheimer's, can we prevent Alzheimer's? Can we take that brain injury from a concussion 30 years ago and do the best we can at, you know, fixing what we could. And that gets to the whole art and science of autophagy. Well, we don't have evidence that autophagy can be as predictable with exogenous. That needs to be your own system. But that comes with even more of saying no to food and fasting and watching your ratios, watching those glucoses and those blood ketones to say, could you get there? And if you open with that discussion, you're going to lose your audience. They're going to say, forget it. It's just a wacky diet that I can't do and it's off and then they'll be disparaging and off they go for never to enter that thought again. So, you know, I look at it as I do with any patient that comes in struggling with the chapter of life. My responsibility is to understand the science and to bridge it with their life and to not have expectations that they can do some kind of magical fairy dust and make everything perfect but improve one thing and then watch how that improves the next thing. And those moments add up just like the other ones do, where they did one tough decision, then they made another bad decision and now they got 15 bad decisions they're making every day. We've got a ways to go. So I look at that as this journey gets better. How can I help you with the first few steps and sometimes telling them what the last few steps look like. Saying the word fasting to some of my new patients. I'm like, don't do that. You're going to scare them.

No, don't do that.

So yeah.

And it's also that it's not something, you know, is being clear both yourself as the person who's talking about it, but for the person who's potentially taking any of these supplements, that it's not something that you should be taking for a long time. I mean, you're talking to somebody who was on Prozac for 20 years for what? For nothing. You know, it was no good at all really for me. And the same with these things that seemed to work really well for say two weeks. So the automatic response from a lot of people is what are just stay on that then.




Rather than, no, this is to get me to a place where I feel capable to do the harder work to make it long-term sustainable.

Yeah. Because if you go back to the chapter where you were taking Prozac for 20 years, had someone said to you, Hey, are you ready to stop it? I usually don't hear people saying, oh my goodness, I have to be on it. Usually they're like, oh, that's a thing, I can do that? And that education I think is the key to successfully navigating and not being stuck. I don't want people on exogenous ketones for the rest of their life. I want their bodies working better. I don't want people on Prozac, Paxil, Zoloft, any of those for the rest of their life, but when they are super depressed, if that was all I had, I'm going to help you with that and then say, all right, now let’s work on your sleep now let's work on your nutrition now let's work on your boundaries. You know all that you know, life things that are not in a script but are super important for the long-term outcome. I think it's a great discussion to have though, and I find the Gal who we are talking about, whenever I put the videos about the brain science on my YouTube channel or wherever I'm talking about them, if you'll look in the corner, you'll see the author, you go to Google, you type in that author, you can have the access to the article too. That's what she did. She printed out the article and took it to her doctor. I'm like, this isn't my idea. I'm just being the conduit to explain it to you. Why would we care about this? We do care about this. It is a powerful transformation for taking folks for the last 30 years that have been inflamed with a chronically sinking mental function and giving them some hope to say, can we awaken those cells to burn a different fuel? And the answer is yes. Don't make them lift the whole burden by themselves. The first step out of the gate.

Ah, interesting discussion. It's not where I saw this going actually.

Well, sometimes science does that to me too. Like, oh, I was planning on this outcome and here's what I got.

Well, you know what's gone and happened. I haven't even gotten to April's question yet. We've gone on a massive tangent and come to what is going to be the end of the first ask Dr Boz, except we haven't got to the ask Dr Boz bit yet.

Well I will contend that even if we didn't answer her question, we will get to it in the next one and know that this discussion that we just had is the root of so many of the questions that come into my Facebook and my YouTube page and I have failed to respond to them. So, uh, I do think you're going to see an audience who gets educated by the conversation and we will definitely address the question in the next recording.

We will do so. Thank you very much for that and we'll see you back here next time.

God bless you. You Bet.