Dr Boz Calculates levels of autophagy using blood sugar/blood ketones ratio

(Barbara) #10

I am happy to report, on my 2nd attempt at my hacked FMD, I’m getting ketones of 5 after one day and 7’s the remaining days. I plan to repeat this 5 day FMD/25 day refeeding for 5 months and hope I see some lasting benefits.


I recently listened to a Peter Attia podcast episode called “Nothingburger” where he fasted for a week, sandwiched between two weeks of keto.
Peter took lots of bloods pre, post and during this n=1 experiment.
His stated aim was in part to see if there was any biomarker that could indicate autophagy was occurring or had occurred.
The question has not been definitively answered but Peter did note a massive increase in his serum uric acid level following the 7 day fast.
As the only things that will put up se uric acid are increased ingestion of fructose, ethanol or protein, none of which he was doing as he was fasted,
Peter surmised that the rise reflected increased autophagy. The elevation was from breakdown of waste nitrogenous products from cells during autophagy.
Following fasting, the uric acid level returned to normal prefasting levels.


(Karen) #12

Could it have been muscle. Protein from his own muscles.?


He said he didnt think he lost any lean mass in terms of muscle mass, although that is subjective.
It was just an interesting observation and could well be a biomarker of autophagy.

(Jane) #14

Are you sure? Shouldn’t it be “insulin sensitivity”?

(Bunny) #15

You would have to ask Chris Kresser? I miss-linked on that post (too late to edit)…sorry about that!

Here is the source:

When “Normal” Blood Sugar Isn’t Normal (Part 2)

BTW: I think what he (Chris) is talking about or is referencing is physiologic insulin resistance (skeletal muscle tissue i.e. “glucose sparing?”) rather than pathological insulin resistance (hepatic e.g. NAFLD)?

Like in this chart here (…with a progressively lower HOMA-IR score your becoming “highly insulin sensitive”):

Why do I have consistent high blood glucose readings while fasting?
New Study: Prolonged Fasting Induces Physiological Insulin Resistance!
Protein consumption. Keto vs Zero Carb
(Lori Nehring) #16

I have listened to Dr Boz, and she has talked about how important it is to get at least 8 hrs of sleep a night and to quit eating early. I get up at 5:00 AM and have always been a night person (also have insomnia at times, awake until 3:00 AM - alarm off at 5:00 AM, get to work @ least 12 hr days. Over & over. I thought I was doing great😉)
I started Keto Jan 2, 2018. I lost 74.8lbs by Feb 2019, but had been stalled a few months up & down a few pounds. I am 60 years old, not diabetic, but have autoimmune problems. I still want to lose 60 more lbs. I was perplexed why I was stalled, as I was eating well within my macros. My morning Blood glucose was at times 114! I FINALLY decided I was going to REALLY try Dr Boz recommendation. She said your liver can’t flush and adrenals cant heal if you constant inundate them with “work.” SO, I quit eating at 5 or 5:30 EVERYDAY. Nothing but water passes my mouth. I make myself sleep by 9:00 PM, so I can get 8 hrs of sleep by 5AM. I have done this 2 days now. Yesterday upon rising, my BS= 88, KET=1.9, This morning BS=78, KET=2.5 = 31 ratio.
I’m so excited to see how this will help me. I notice, when I wake up, I am FULL of energy.
Try it. it hasnt been hard!
PS, It’s a Sunday, so I slept in a bit.

(Karen) #17

Are you losing weight? I find the ratio idea interesting. I get enough sleep and it’s pretty solid. I need to eat a bigger meal at 5:30. I’m getting hungry.

(Eric - The patient needs to be patient!) #18

Your Dr Boz ration is great. Your GKI ratio it is 78/18/2.5 = 1.73. https://perfectketo.com/track-your-glucose-ketone-index/

I go to bed between 8:30 and 9:00 most nights because I’m in the gym by 5 am. Some days, especially after 24hrs of fasting, the ketones wake me up early.

I’m trying to eat earlier but wife and I both work and we like to eat together. The social pressure results in later eating. But she is working into keto so maybe we can just agree that we will find a way to eat earlier or even eat alone.

Fasting has helped by BG go from 130 in the am to 101. During the day I have seen it be 85,95,103 recently. Ketones are usually 1.4 or so. I did have a day with much better numbers. I will have to go back and see in my logs when I finished eating the night before that day.

(Karim Wassef) #19

I use this method too but I ratio it down to a 0-10 scale and track it over months of fasting and keto. It works for me!

(Karen) #20

How much does testing cost? how often do you test?

(Eric - The patient needs to be patient!) #21


I use a keto mojo meter and the ketone strips are $1 and the BG strips are 10 cents. I took several baseline measurements with IF 18/6 and similar and some with a few EF at 26 hrs.

Now I will measure when I exceed 26 hrs significantly. I’m interested in some of my extended fasts being strong autophagy fasts so I want to get my Dr Boz Ratio to below 40 or my GKI value to be <2.2.

So tomorrow I will get to at least 48 hours and will measure at 48. TOmorrow I don’t have the luxury of pushing beyond 48 for social / family reasons. But next week if I’m not near or below 2.2 GKI I will just fast longer. At least that is the plan.

It is not yet easy for me to get there because my BG still wants to be slightly elevated even at 36 hrs fasted I have seen it at 101. I have also seen it at 80. BTW - Yes I am <20g carbs. My gluconeogenesis engine wants to generate more glycogen than I need.

(Karim Wassef) #22

I measure 5 times a day… morning and evening and then before weightlifting, after weightlifting and before eating, and then after eating

-measure 1

-measure 2
-measure 3
eat OMAD
-measure 4

-measure 5

If I do anything special like sauna, UV, or cold baths, I measure before and after so I can determine the effect. I use the Precision Xtra blood ketone and glucose. Costs $1.50 for ketone and glucose, so $7.50 a day

but I also fast many days so I replace my food with measure . I’ve been doing this for months so I can see the trend over different events. I use Glucose / Ketone / 18 and then created 5 bands for myself:

0-1 very deep autophagy
1-3 deep ketosis - therapeutic autophagy
3-6 moderate keto - functional weight loss
6-9 low keto - weight maintenance
9-12 (or higher) - no ketosis, highly anabolic (fat or muscle depends on demand)

(Karim Wassef) #23

These are my results over the last few months. I haven’t uploaded and updated for a few weeks but I can do that if it helps anyone.

(Eric - The patient needs to be patient!) #24

This is awesome. Do you GKI numbers go to the lower range only when fasting or at other times?

(Karim Wassef) #25

I usually fast 3 days a week, so it’s spiky (obviously). That’s why you can see my GKI going from 9 (red) to 1 (blue) in 48 hrs… fasting keeps the trend going and forces my body into deep autophagy

Also, it used to be easier in earlier keto… now, it’s hard to get to ketones above 5 without multi-day fasting. I’m planning on a 40 day + fast, so we’ll see how that goes.

I will add that the GKI index can sometimes be artificially low because ketones drop post workouts while glucose doesn’t change much. I don’t know how to interpret this, but it’s an observation.


Here is a video that talks about GKI: https://www.youtube.com/watch?v=UmDoiCDYQHY&feature=youtu.be

and here is a calculator: https://keto-mojo.com/pages/glucose-ketone-index-gki

I dont know if this is relevant to op, sorry if not

(Eric - The patient needs to be patient!) #27

I calculate both ratios so that I don’t have to worry about whoever I am speaking to knowing one and not the other.

(Herb Martin) #28

I wrote the following before reading all of the comments – which do seem to confirm most of my suppositions. At the risk of confusing someone, the post is as originally written but I am going to re-read Karim’s info which is very helpful (though I don’t fully understand his graph yet) and additional references to GKI.

About minute 22-26 in Dr. Boz’s linked video Autophagy and Glucose Ketone Ration
Glucose Ketone Ratio needs to have UNITS specified to keep this straight.
Glucose in mg/dL makes 100 a sensible reading
Ketone in mmol(/L) is what makes sense with the numbers you are giving.
Seyfried uses a conversion factor with these units rather than a straight ratio but then doesn’t give a set of clear targets (that I’ve found) but seems to want cancer patients at less than 1.0

So Seyfried’s Glucose Ketone Index (GKI) looks to be a factor 18.016 (Glucose to mol conversion) smaller than Dr. Boz Glucose Keto ratio. (His 1.0 would be her 18 or approximately 20)
Both of these would be different numbers of either of the 2 measurements were using different units.
Seyfried’s paper comes with a spreadsheet link for calculating his GKI, and giving all the conversions.

Being math oriented it is confusing me so my guess is that it will confuse others – or they will get it correct by accident or wrong by reading meters differently.

My current levels from #CarnivoreDiet onto a 70 hour fast were:
Glucose 103 mg/dL
Ketones 0.9 mmol/L
= Seyfried GKI of 6.41
= Dr. Boz ratio of 114

(Which seems quite a bit higher than I expected though I may be well adapted to ketones at this point rather than having trouble making them
Also, even were my Glucose to drop to 80, it would still miss as a longshot autophagy indicator.

On a side note:
At 70+ hours of a water fast, I’m dropping weight by the kilo, about 3 lbs per day, and this is following losing 50+ lbs and being on Carnivore or Keto diet for many months (8+)

My Ketostick is going moderate to large almost immediately even though the (new) meter shows only 0.9 mmol.
(nominal 40 second developing time on the ketostick)

I have been using the sticks for decades to gauge ketosis so having such seemingly poor correlation is confusing.

(Herb Martin) #29


Where did the table originate?
It doesn’t look to be a simple conversion from GKI to Dr.Boz and I didn’t find it (yet) in the original reference on GKI from Seyfried.
Going to follow the other references in case it is one of those.

Thank you, and thank you for posting all of the above info and personal logs.