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

[Karim_Wassef]

that is true.

the body bets heavy when it doesn’t know what’s coming.

once it figures out what the pattern is likely to be, it pulls back and tries to be as conservative as possible.

[KetoCancerMom]

So, even doing OMAD, if not trying to lose weight, you still need to “mix things up”?

[daddyoh]

Question for everybody - if you know, or think you know, or if you’ve read something or if you just want to run outside and shoot guns in the air.

Good questions. Don’t know. I’ve only got a few sets of measurements.
Longer fasts tend to produce higher ketones. Ketones however are lower in the morning regardless because I still suffer dawn effect.

My BG is just coming down (reversing insulin resistance?) so I expect that to improve my GKI ration.

I do assume that going into a fast with minimal carbs consumed the day before that would be a positive affect on ketones. But I normally am <20g/day.

I’ll be interested in other people’s answers.

I’m fasting now (24+ hrs) and will measure just before I break the fast. Hope to go to dinner time but only time will tell if I go longer or break sooner.

[Karim_Wassef]

If you want you body to use more energy than it wants to (conservatively), then you need to mix it up - if you don’t confuse it, then it will figure out the pattern and optimize.

This effect is very long duration. If I eat during the week and fast on the weekend, it figures that out. If I eat 4 days and fast 3, it figures that too. If I OMAD - yup, it’s got me. If I lift at the same time every other day - yup, got that covered too… Imagine a mini-you sitting on your shoulder literally keeping track of everything you do and trying to figure out what you’ll do next… and then reducing your energy expenditure when you do it…

[OldDoug]

Longer fasts tend to produce higher ketones. Ketones however are lower in the morning regardless because I still suffer dawn effect.

My BG is just coming down (reversing insulin resistance?) so I expect that to improve my GKI ratio.

Eric - yes, it makes total sense that longer fasts would bring higher ketone levels. Not sure exactly how long the body would still be running on glycogen from past eating - a day or two? Obviously, extremely low-carb keto eating should mean not much glycogen stored, beyond what the body really thinks is essential - that it will ‘fund’ via the liver making glucose out of fat. Still, after a while I see the “carb stores” being at minimum and the easiest stuff to recycle via autophagy being consumed (if any of that goes to energy) - and at that point the body has to totally concentrate of fat-burning and ketone-making.

I’ve never tested myself for ketones, and don’t have any scientific surveys at hand, but seems to me that one person’s 5 or 6 or 7 is another’s 2.5 or 3. If we are plugging such variable numbers into an “autophagy index,” then I’m wondering how accurate it will be.

Same for glucose - Karim hit a 39, I was at 90 last time after 5 days fasting, and a buddy of mine (severe blood sugar control issues) was still over 200 after 3 days fasting. I don’t see this as totally confounding - higher blood sugar should mean higher insulin should mean lower autophagy. Yet perhaps one should ‘calibrate’ one’s numbers before assuming the level of autophagy?

[Karim_Wassef]

actually I hit 36 and my ketones were only 3.8 at the time… I think that my body actively took that cue to push ketones up into the high 5s after that.

[daddyoh]

Yet perhaps one should ‘calibrate’ one’s numbers before assuming the level of autophagy?

Doug

I think there just is not enough autophagy knowledge available or know yet. I read Megan and Brenda talk about Dr Fung and his fasting patients never needing skin removal. So from this I take that autophagy is real. I’m just assuming that 36 to 54 hrs is enough for now for autophagy.

Already I’m taking away from this discussion the need to mix things up.

[Coffeebarbabe]

Can you share the details of your hacked FMD? How are you doing?

[Herb_Martin]

First, depends on your glucose and glycogen stores when you start deep ketosis diet.

Your liver and muscles store glycogen as well as some other tissues.

Then how must exercise you do – exercise will burn the glycogen in the muscles primarily at first.

Of course it also matters how strict you are, and how efficient your body is at mobilizing fat, so even your fat content, especially in your liver and pancreas.

A big goal for most people will be to clear the fatty liver and fatty pancreas.

Then according to Dr. Boz’s book (and other sources) your tissues will switch over to using fatty acids and burning ketones at different rates. Some will switch early and more completely while others will take months to switch to primarily or even heavily.

As more and more of your tissues switch to burning fat for fuel the excess in the blood, and particularly the spilling into urine (as measured by ketosticks) will likely drop down.

I am fairly new to this part of keto diets (autophagy and measuring blood ketones) so I could be wrong about some of the above.

As of today, end of 5th full fasting day (12 days end of last month):

GKI 1.03 DrBozRatio 19 (BG 78 mg/dL, Ketones 4.2 mmol/L)

This puts me right at the edge of “Deep Autophagy” (and below “Deep Ketos, therapeutic autophagy”) from this table:

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)

For others, my main issue on the previous 12-day fast was keeping my electrolytes balanced. Watch out for that.

Thanks to everyone above for your help and comments, especially Karim_Wassef

[Keto6468]

What is The title of her book?

[Don_Q]

if you know, or think you know, or if you’ve read something or if you just want to run outside and shoot guns in the air.

This may be my favorite question preamble of all time…

[Don_Q]

I think there just is not enough autophagy knowledge available or know yet. I read Megan and Brenda talk about Dr Fung and his fasting patients never needing skin removal. So from this I take that autophagy is real. I’m just assuming that 36 to 54 hrs is enough for now for autophagy.

I’m a member at the IDM clinic, and the weight loss course recommends two 42 hour fasts a week for weight loss. That’s it. They also run a monthly Zornfast of up to 7 days each month, which is encouraged but optional. That level of fasting appears to be enough to trigger the autophagy necessary to deal with excess skin.

[Herb_Martin]

“Anyway You Can: Doctor Bosworth shares her mom’s cancer journey. A Beginners Guide to Ketones for Life”
$10 Kindle, $15.30 paperback
5 out of 5 stars with 655 reviews (nearly impossible to do.)

It’s a bit rambling to be fair, but it’s full of useful info and especially good for people who need more “story” to leaven the technical details.

WELL WORTH the money if you have any interest in Keto, Fasting, Cancer survival (medical), diabetes or metabolic syndrome recovery and avoidance, weight loss, or feeling better.

https://www.amazon.com/ANYWAY-YOU-CAN-Bosworth-Beginners-ebook/dp/B079RLTKS9/ref=sr_1_1_sspa?crid=18I4AVQG0YUY6&keywords=anyway+you+can+doctor+bosworth&qid=1552351291&s=gateway&sprefix=anyway+you%2Caps%2C163&sr=8-1-spons&psc=1

[Don_Q]

The level of blood ketones during fasting - what all controls this? The liver is making ketones from fat, powering most of the body this way. Yet people vary substantially in their blood level, no? I don’t know if it’s generally true, but have heard stories of the ketone level going down over time, apparently as the body gets used to the process and doesn’t produce as much excess.

I don’t really know, I have read some stuff, and I’ve been known to just shoot guns in the air from time to time. Caveats having thus been disposed of, it seems as though one of the important variable in ketone production is adiposity. The leaner you are, faster your body ramps up ketones. Interestingly, the thinner you are, the more lean mass you catabolize as well.

https://onlinelibrary.wiley.com/doi/epdf/10.1002/j.1550-8528.1999.tb00720.x

2. During the first few days of starvation the circulating concentration ratio of 3-hydroxybutyrate (BOH) to ace- toacetate (AcAc), which is an indicator of mitochondria1 redox state, can be as much as 2-fold greater in lean than obese subjects (Figure 5).
3. At similar rates of net splanchnic ketone body produc- tion (or whole body tracer estimates of ketone body pro- duction), lean individuals have higher circulating ketone body concentrations (-80% greater) and a higher ratio of B0H:ACAC (25% to 30% greater) [data from various sources have been summarised by Elia (20)]

@Karim_Wassef, I think this study will be of particular interest to you give your goal of maximizing lean mass autophagy. Take a look at the chart below. “Lean mass” is a nebulous term, but it’s clear from Elia et al. that lean mass catabolism increases the thinner you are (the relative proportions of muscle, connective tissue, etc is anybody’s guess).

[Herb_Martin]

Dr. Fung prefers (according to his videos) a 14 day fast to reset diabetes, metabolic syndrome and such, but note these are medically supervised.

He does 7-days, brings the patient back for blood tests and discussion, then takes them to 14-days if they are good to go.

However, he makes it clear this is NOT the only way and from the latest I’ve seen he doesn’t yet know what is “best” – just that 14-days is fast and gets them to good health quickly.

Alternatives: 1-day and 3-day fasts (he recommends against 2-day specifically.)

Doing this way in short fasts takes longer, more and longer calendar time to clear the fatty liver and fatty pancreas, and reset basal insulin level.

Limited feeding where you go every day for 13 hours plus.

(Why not 2-day: not much advantage over 1-day but most of the unpleasantness – sets people up for failure.)

Supposedly even a 3-day fast will typically clear 70% of a fatty liver, and a 1-day fast gets 70% of that benefit so this would translate to 49% clearance.

These are likely averages and your mileage will definitely vary.

14-days is supposed to clear the vast majority from what I understand but not sure.

One 90+ patient of Dr. Fung did 30+ days. There is a record of 382 days for fasting under medical supervision.

(I am finished day 5 of this fast, following a 12 days fast late last month. No issues, no desire to quit. Only interest in food is intellectual, for the pleasure not the need. Plan is 14 days if I feel good with an eye towards 30+ MAYBE.)

[Herb_Martin]

Dr. Boz’s book (see above “Anyway You Can”) is explicit on the subject of skin removal being unnecessary with autophagy fasting and ketosis weight loss.

She says that her patience have no need of cosmetic surgery to remove skin folds etc.

She contrasts this sharply with those using caloric restriction to lose weight who have this issue when losing large amounts of weight.

I am on a 100-110 lbs weight loss journey so we’ll see what happens to me.
(66 lbs down as of today.)

[Herb_Martin]

I am pretty sure OldDoug is largely correct.

Remember we don’t have a home “insulin” monitor, nothing much practical even in the doctor’s office (though they have expensive lab tests for research.)

We also don’t have an “autophagy” test.

We are using blood glucose as a sloppy proxy for insulin, and now some people have added blood ketones and the Glucose Ketone Index (or alterntive DrBozRatio) as a proxy for both insulin and autophagy.

Previously all we had for ketones was ketosticks which technically measure the spillage of ketones into the urine – in theory you could be producing ketones but using all or most of them.

All of these are proxies for something else we really care about. (Ok, maybe blood glucose has it’s own value.)

Even autophagy – if we could measure it – is a proxy for “improving health, weight loss, or cancer fighting etc.”

This list from the article linked above is likely best read as “statistical” and “approximate” but the best guideline I’ve seen so far:

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)

BTW: The DrBozRation is 18.02 times higher than the GKI because she simplifies by leaving out the conversion from Glucose “mg/dL” to “mmol/L”.

Nothing wrong with that and it’s simpler to calculate in your head as long as you know about this.

She also uses “below 20” for deep autophagy, 20-40, 40-60, 60-80 (possible but less likely autophagy.)

[Don_Q]

Same for glucose - Karim hit a 39, I was at 90 last time after 5 days fasting, and a buddy of mine (severe blood sugar control issues) was still over 200 after 3 days fasting. I don’t see this as totally confounding - higher blood sugar should mean higher insulin should mean lower autophagy. Yet perhaps one should ‘calibrate’ one’s numbers before assuming the level of autophagy?

This a really interesting point. I wonder if a more accurate autophagy scale for folks with type2 diabetes, and a high A1C might be the relative change in glucose vs avg/non-fasted? If the current GKI assumes an average glucose of 100, and your own avg is 150, maybe you add a scaling factor of 1.5 to get a valid GKI?

[OldDoug]

She also uses “below 20” for deep autophagy, 20-40, 40-60, 60-80 (possible but less likely autophagy.)

Herb - great answers and input. Good stuff - I appreciate it. Something really bugs me about quantifying autophagy that way - it leaves the door open for substantially differing numbers for people who’ve fasted the same length of time and have the same insulin sensitivity. I guess it depends on what she’s actually talking about as far as “very deep,” and “therapeutic,” levels of autophagy, etc.

Autophagy is regulated by mTOR and AMPK, and insulin and glucagon affect it too. Not eating protein and carbs is most of the battle - down goes the activity of mTOR and up goes AMPK. This is mostly a function of time, and not dependent on one’s glucose or ketones.

[azpops]

Also a must listen is the 2 keto dudes podcast with Dr. Boz from last Decembers podcast? episode 0143 i think. Definitely a folk hero rebel for me, standing up against the establishment for her patients.