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

(Herb Martin) #42

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

(Karen) #43

What is The title of her book?

(Windmill Tilter) #44

This may be my favorite question preamble of all time…:+1:

(Windmill Tilter) #45

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) #46

“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.


(Windmill Tilter) #47

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.:yum: 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.


  1. 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).
  2. 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) #48

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) #49

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) #50

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.)

(Windmill Tilter) #51

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?

(Doug) #52

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.

(joseph) #53

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.

(Doug) #54

Nick, lower insulin is definitely good for autophagy, but I think the whole GKI thing is so nebulous and variable that it gets trumped fairly fast by not taking in nutrients. Regardless of what one’s blood sugar and blood ketones are, not eating protein means the body is gonna have to start scavenging. We don’t store much at all… Outright fasting or at least having no protein and carbs is a large part of getting autophagy increased. The effect of ketones and blood sugar (plus insulin and glucagon) - who knows how much autophagy is really affected here?

(Eric - The patient needs to be patient!) #55

I’m enjoying this thread a lot and am learning a lot. My challenge is the dawn effect and really persistently higher BG even when fasting and measured in the afternoon. These used to be ~90 and recently I have seen 75, 80 and 85 on occasion.

This morning I did these measurements within 15 mins of waking and no liquid or anything.

My morning fasted BG used to be 120 to 130 mg/dL. So It is improving. I’ve yet to try ACV or Berberine or anything like that. Patience is my friend. Also the trend is my friend. I still have significant adipose fat and think as that thins and I continue to fast my fasting BG will go down.

at 65 yo I’m in this for the rest of my life and will continue to be patient on scale and NSV. I have genetic reasons to want stronger autophagy and as mentioned above the proxies we have are not very good and informing us. So I’m going to trust that fasting, resistance training and keto will eventually help me via autophagy.

(Karim Wassef) #56

Most of my grandparents died of cancer except for the one who ate so little, she was nearly always fasted. She lived into her late 90s.

I think it takes time for the liver and pancreas to start using glucagon and making ketones at a high enough level to allow glucose to drop. I didn’t quite get there until I fasted for 12 days. Keto alone didn’t cut it. IMF and OMAD wasn’t enough. Even three day fasting could barely move the needle that I’d shoved so hard into insulin mode for 4 decades.

I had to convince my organs that this is not the same.

(Herb Martin) #57

The table with “very deep autophagy” and “therapeutic autophagy” is from Seyfried’s article which I think bears re-reading and a pub search for newer references which I have just begun.

The Google scholar search [ therapeutic autophagy ] is a good place to start:
Therapeutic Autophagy scholarly articles

Adding “measure” and/or “monitor” is promosing.

I think we can neither make to much of GKI (or DrBozRatio) because they are likely “statistical” in any case (e.g., you are LIKELY to be in autophagy if you are in a particular range) nor dismiss them as irrelevant or too idiosyncratic.

If you get those deeper ranges for GKI the likelihood is you are in autophagy.

If you don’t, you can work towards it the best you are able – especially if you are a diabetic with a high basal insulin level that won’t cooperate.

But do note, even in this case, if your glucose is HIGH you aren’t likely burning ketones. Almost all of your tissues will favor the glucose that is clearly present.

Thanks for the link (E0143).

I salute all of these doctors who are willing to tell the truth to patients despite the medical community “standards” – this is no a very serious issue in my opinion as these doctors get severely persecuted simply for giving advice outside the accepted protocols EVEN IF THE RESULTS ARE GOOD.

If you read Dr. Boz’s book you’ll see she got there through the effort of saving her mother’s life – what we all would do facing THAT situation. (And they made some mistakes because she judged it unwise to try to convince her medical colleagues who were treating her mother. This is NOT a criticism, as it was very understandable and a big row might have made things worse in her opinion.)

Sean Baker has his license attacked (and temporarily gave it up, it’s been restored in the last few weeks). I believe he is honest in the story he told on Joe Rogan (and elsewhere). To summarize: He was doing shoulder replacements, started helping patients using nutritional therapy which attacked the hospital profits. They “reviewed” his surgeries and found he did non-standard replacements that were SUCCESSFUL but pushed him out over it anyway.
(Sean is now a highly visible carnivore & worth following on Twitter.)

daddyohEric - Carbs suck the health out of life.
I think you are fine at 35 hours, and will see this improve in the next 3-4 days most likely.
I don’t have a high normal blood glucose, but it took me until the 5th day fasting (beyond 100 hours) to see really good GKI numbers.

Today is Fasting day #6 and great numbers for me:

  • Down 17lbs in 5.5 days,
  • Glucose 72
  • Ketones 4.9 (my highest so far)
  • GKI 0.82 DrBozRatio 15 (deep autophagy according to Seyfried and Boz)
  • Feeling great (and not hungry)

Delighted actually.

(Paul) #58

Just found your posting and find it really interesting as I am in a similar situation

69 years old and have had insulin resistance for a number of years now

I do take berberine as I don’t like metformin or any other controlled drug but I do suffer from the dawn phenomenon

Bizarrely I can go to bed with a bg of 5.8 and wake up in the morning with a bg of 7 or 8

Missing breakfast this can even go up to 9 by lunchtime, which is a scary rise but I’m pretty convinced but this is just the liver dumping sugar into the bloodstream, and because the insulin level has dropped through fasting it’s not there to push the blood levels down and that hopefully my insulin level will be very low
I have just ordered an insulin test which is about 39 pounds not too bad , and i intend to fast through until lunchtime and then do the test as I think blood high daytime glucose, when in a fasting state maybe a red herring. I will let you know how that test goes.
In the meantime it’s low carb high fat and jogging every other day

(Herb Martin) #59

That actually isn’t bizarre. With insulin resistance, you almost certainly have a fatty liver (and pancreas) so your liver is releasing glycogen as glucose during the night.

It’s a well known and expected phenomenon.

I presume you are giving your glucose numbers (in the above post) using mmol/L which requires multiplying by about 18 to get the numbers we usually use in the US (mg/dL) with 100 being more or less ‘normal’.

It’s this sort of issue that leads Dr. Jason Fung to try to get patients through a 2-week (medically supervised) fast to clear the fatty liver and fatty pancreas (from my understanding of what he says.)

Strongly recommend the videos (and books perhaps but I’ve only started reading him) of Dr. Fung.

The ones where he is speaking to doctors are far better in my opinion, because he gives more technical details.

However, if you have friends/relatives who don’t want the technical depths then he has a LOT of really good videos on how and why to fast without the biochemistry details.

Right now, Fung and Bosworth (Dr. Boz) are my favorites on Keto & Fasting though there are quite a few others about as good on just keto.

For reference, my wife and I are 66 (hadn’t mentioned that earlier.)

(Eric - The patient needs to be patient!) #60

I think berberine is a natural form of metformin. Just so you know. Let us know how the insulin test comes out. I did my fasting insulin in September and it was 14.6 (range 2.0-19.6 uIU/mL). I’ll do this again at 12 to 18 months from the date of this lab test. My primary care doctor encouraged me to get a insulin test directly. Said my insurance would not pay for it and likely lab corp would be $$$ if they bill my doctor.

(Paul) #61

Yes that all seems to fit logically. Just checked out Dr Fung’s vods. I did try low fat high carb as per Dr McDougall, but it started to bring on diabetic neuropathy, and so I definitely don’t want to go down that route.
I have started on OMAD, which I am fine with, but it seems contradictory that eating high fat low carb once a day would clear the liver out.
Any ideas on that? I dont have medical supervision for a 2 week fast. I have done 5 days, but never progressed more than that.