Dr. Annette Bosworth on The Diary Of A CEO Podcast (Transcript)

What are the typical solutions that Medicine 2.0 would offer them?

DR. ANNETTE BOSWORTH: Yeah, especially if they have good insurance.

STEVEN BARTLETT: Yeah.

DR. ANNETTE BOSWORTH: That doctor is going to be with the covered insurance plan and he’s going to say, tell me the symptoms. I have a matching game. I will give you the drugs that will take away that one and take away that one and take away that one.

What is always a downside is, well, play that forward for 10 years, play it forward for five years and are the symptoms gone? No, but it will bridge and hold up the architecture of the body and the human without actually fixing the problem, without actually diving in and say you got some chemistry problems under the hood that you don’t measure and you don’t talk about.

But if you did, even if you’re not perfect, even if you’re 70%, you’re going to find yourself at the age of 54 with vitality and energy and sleeping through the night and not having what every other 54 year old has, which is chronic joint pain, a brain that can only focus for three to four hours without a break, a stamina of endurance and health and joy that falls apart.

STEVEN BARTLETT: So when I’m, you’re 54 years old. When I’m 54 years old, I want to be as young and energetic and articulate and cognitively astute as you are. So what should I be doing now to make sure that I don’t decline, decay in all those areas I described?

The Importance of Meal Timing

DR. ANNETTE BOSWORTH: Well, what did you have for breakfast today?

STEVEN BARTLETT: Yeah, I have not eaten breakfast yet.

DR. ANNETTE BOSWORTH: Okay, that’s not a bad thing. But when you’re 54, you should probably put the calories in the morning, not at night. We know that as you age, the cost of a calorie turns into timing if you eat that food.

One bite of food after 6 o’clock is worth 10 bites of food before noon. So if you’re trying to say, how do I get the best out of the nourishment, but also eating’s fun, if you only get one bite after 6 o’clock and 10 before, move that food towards morning.

When you’re your age, what’d you have for, what’s the last meal you ate yesterday?

STEVEN BARTLETT: Yeah, for dinner I had this cod and I had salad. I also had pasta.

DR. ANNETTE BOSWORTH: Okay.

STEVEN BARTLETT: But I ate pretty late, which is important.

DR. ANNETTE BOSWORTH: What did you have the rest of the day before that? Was that your first meal?

STEVEN BARTLETT: Just a big salad.

DR. ANNETTE BOSWORTH: Was that more towards lunch or noon?

STEVEN BARTLETT: Probably about 4 o’clock.

DR. ANNETTE BOSWORTH: So waited all the way till 4 o’clock to eat. Very common. This is a really common pattern of people doing what we would say, intermittent or time restricted eating. They put that eating window in this, but it’s got that balloon at the end of the day and it really does.

I mean, what you’re stimulating is an excessive production of insulin and you’re going to wake up the next morning. What time did you wake up this morning?

STEVEN BARTLETT: Today I went to bed fairly relatively early for me. I woke up at about 7:30am. Usually it’s later.

DR. ANNETTE BOSWORTH: And do you have, did you have a solid 7, 8 hours of sleep?

STEVEN BARTLETT: Yeah.

DR. ANNETTE BOSWORTH: So during that time you finish eating around 10 o’clock then it sounds like.

STEVEN BARTLETT: Yeah.

DR. ANNETTE BOSWORTH: Okay, so then it’s 7:30. Okay, so 11 o’clock and you’ve got 7:30 in the morning is when you woke up. So that’s about eight hours since you’ve eaten. Your insulin is still churning, especially if the meal was large and there was carbs in it.

So now you’ve got these processed foods late at night and you’re at the beginning of the disease. Right. You’re at the beginning of the chronic inflammatory churn of how do you age faster and faster? You don’t do that. You don’t have high insulin throughout the night.

Understanding Insulin’s Role

STEVEN BARTLETT: So can you explain to me, like I’m a 12 year old, what insulin is and the role it’s playing? Because, you know, I guess we’re focused here on how to, I guess, longevity, aging for a second. But how does insulin play a role in all of this? And what is insulin?

DR. ANNETTE BOSWORTH: So insulin insulates, okay, so think of it as it makes you fluffy, it puts the fat on. It’s got some other roles too. But we’re going to talk about chronic diseases here where it’s not a scarcity problem. You make plenty of it.

And when it’s in excess, it will store energy for when you go through a famine. It will also cause you to grow. Now, grow means get a little fatter. But it also means things like their skin gets a little thicker. They have skin tags.

And what I always think about is what’s going on in their brain. And when that insulin is high for years and years and years, just like yours, because if you didn’t eat the rest of today and then you got up tomorrow morning, it would be about that long after a late meal last night, that’s how long it would take you to say, okay, we’re back down to where we started from or where we should be in the morning.

STEVEN BARTLETT: For someone that’s never heard the word insulin before, there’s some context to give in terms of what it’s doing. So it’s coming out like a transporter and helping put away the sugar, will deal with the excess sugar.

DR. ANNETTE BOSWORTH: Right. So it is what lifts, yeah, it lifts glucose or sugar from the circulation into a cell. That’s its first primary job. But if all the cells are full, their storage is full, it’s going to start to pack it into the liver. Let’s say all those stores are full, too.

This job of insulin, this hormone oozes into every part of your body to say, make sure it’s got fuel, make sure it’s got that sugar. But most people are like what I would guess you are. Most of the time, you aren’t a shortage of sugar, and so it tops things off.

And then it will turn things into fat. It’s too much sugar. They can’t store it. All the storage is full. So you can send the signal out, make me some more cells. I need some more storage units. This guy’s eating more than he thinks he is. And we’re going to be prepared to live through the famine, but in the meantime, turn it into fat. Make him a little fluffier.

STEVEN BARTLETT: Is that the only consequence if high insulin is that I’m going to, I might be a bit more fat?

The Hidden Dangers of High Insulin

DR. ANNETTE BOSWORTH: No, that’s just the one people hear about the most. When you look at chronic disease management, it is the growth of the diseases, of the inflammation, it’s the making of the trash.

So I keep saying you need to take the trash out routinely, which means that insulin, which has been smoldering higher than you think it is because you live in today’s world, because you eat processed food, because you eat super late at night, you don’t go two to three days without eating. You’ve got storage filled in your body.

The high insulin levels in a healthy person hides that the debris is being made and you don’t know it.

STEVEN BARTLETT: It hides it.

The Impact of High Insulin on the Body

DR. ANNETTE BOSWORTH: Yeah. It’s going to put it in between two cells in your brain. It’s going to put in between the skin cells. The trash doesn’t get taken out until the insulin gets lower. And unfortunately, most people have been making buckets of insulin without knowing it.

STEVEN BARTLETT: Why? What are they doing to create buckets of insulin? All the things you said about carbs.

DR. ANNETTE BOSWORTH: Foods that come from boxes and barcodes instead of whole foods, instead of a fat forward diet, which would then push that body into making ketones. So you cannot make a ketone if your insulin’s high.

STEVEN BARTLETT: Are there any signs that I might have high levels of insulin or insulin resistance?

DR. ANNETTE BOSWORTH: Abdominal girth is the first thing. That is the first place that the fat goes. So you do this really great part where you don’t eat until later in the day. How does that feel during the day?

STEVEN BARTLETT: During the day I feel really focused. I actually don’t even know that I’m not eating.

DR. ANNETTE BOSWORTH: So that’s really good. So what I would love to know is show me what your blood sugars are doing during the day and show me if you make ketones. That’ll be the answer.

Is when you have excess insulin, which is this chronic disease maker. It is what makes cancer. It is what makes high blood pressure. It is what makes debris in the brain. Where call it depression or brain fog or Parkinson’s. It’s the aging of the brain.

STEVEN BARTLETT: It’s linked to all of those things.

DR. ANNETTE BOSWORTH: All of those things and that excess insulin nobody tells you about. But the symptoms are, dang, I feel like I got to eat every two to three hours. Their debris or their fuel keeps running out.

When you say, boy, I can eat once at the end of the day and I’m pretty good. My focus stays really good. What I want you to prove is what are your ketones during the day? So when you’ve got a patient who has done that, their ketones will be 0.7, 1.0, and they’re taking out the trash all day long.

Understanding Glucose vs. Ketones as Energy Sources

STEVEN BARTLETT: So there’s these two energy sources, one of them is the glucose, one of them which is from like, you know, eating pasta, which I ate last night. So that probably put a lot of glucose in my bed. I probably had a high glucose spike. And then insulin came out to deal with that.

And then there’s ketones which start to appear when I’m fasting or when I haven’t been eating carbs for a while. And my body’s looking for an energy source.

DR. ANNETTE BOSWORTH: Yeah.

STEVEN BARTLETT: In terms of these two energy sources, there seems to be a lot of hype around ketones. So why doesn’t our body just run off ketones?

DR. ANNETTE BOSWORTH: It will as soon as you’re done lowering your insulin. And insulin grew in these patients. They didn’t know that it was growing high. They went to their blood test and their glucose looked normal.

What nobody checked for years is how much of that insulating hormone did it take to keep the glucose controlled. And that’s where chronic diseases are grown in spades. That’s where autoimmune disorders.

STEVEN BARTLETT: The insulating hormone being insulin.

DR. ANNETTE BOSWORTH: Yes. So that excess insulin for the last decade, had you come into my clinic, we’ll put a label on it, call it PCOS, call it high blood pressure, call it autoimmune problems. All of them are linked to high insulin glucose.

When you want to store it, we put it in a fancy string called glycogen. And it’s just an efficient way to store glucose. But as soon as your body needs it, it will unlock all that sugar back into your access, back for you.

What you don’t realize is, well, how much glycogen you got stored over there, how much is there in storage? And that is what high insulin has been doing. Just put it in storage. Put it in storage.

And then when you stop eating, you’ll know if you emptied out all your stored sugar, which is some of the regular sugar you just ate. But then all this glycogen, this packaged sugar, how empty are you? I don’t know. Have you made a ketone yet? You cannot make a ketone. You cannot burn fat until that tank is empty.

The Timeline for Entering Ketosis

STEVEN BARTLETT: Okay, so I have these glycogen stores, which last for a day or two.

DR. ANNETTE BOSWORTH: Oh, no. Think of it as brown sugar. So you package the sugar really tight and you put it in the back of the drawer and it turned crusty because you never lowered your insulin.

I have patients that are overweight, and we put them on a ketogenic, we put them on a 20 total carbohydrates per day. So super low carbohydrate, it is 15 days before they make a ketone.

STEVEN BARTLETT: Okay, so it could be a while. It could be up to two weeks, for example, before my glycogen stores are empty. And it’s not until my glycogen stores, my glucose stores are empty that my body can start producing ketones.

DR. ANNETTE BOSWORTH: Correct.

STEVEN BARTLETT: So it’s going to exhaust all of those glycogen stores.

DR. ANNETTE BOSWORTH: And.

STEVEN BARTLETT: And then once it’s ran out, it’s going to switch into this ketogenic state, right?

DR. ANNETTE BOSWORTH: Yeah. So think of it as your short term, easy to access sugar has to decrease, and that means your insulin has decreased that hormone. For insulate. They both run in tangents. You decrease your emptying glycogen, your insulin’s going down.

Signs of Insulin Resistance

STEVEN BARTLETT: So how do I know if I have insulin resistance? What are the key signs? You mentioned skin tags. I’ve never heard that term before.

DR. ANNETTE BOSWORTH: Yeah. Skin tags are not moles. So moles, you can feel this bump on your skin. Right. But a skin tag has a neck and like a little mushroom. And it’s the most annoying thing when patients come and say, well, I just tried to cut them all off, but they kept bleeding.

Like, do not cut them off, they’ll fall off when your insulin’s lower. So that’s the first place it’ll be found, in their armpits or places where their skin rubs. So armpits and their groin. And once insulin starts to grow them, it’s like a crop, a crop of little baby cauliflower hanging out in their armpits.

STEVEN BARTLETT: You talked about velvety skin.

DR. ANNETTE BOSWORTH: Yes.

STEVEN BARTLETT: As well being an indicator.

DR. ANNETTE BOSWORTH: Velvety skin is this Latin word acanthosis nigricans, which is a fancy word that means the skin is darker and thicker. So the places that usually happens is the back of the neck. And you’ll hear stories of, I tried to wash my neck. It’s dirty all the time.

It’s not dirt. It is the way the skin is under the curse of high insulin. And you see it in teenagers all the time now. They put on weight and their growth hormones are already doing that teenage thing now. You put high insulin in there and they have this dirty neck syndrome or on the creases of their elbow, it’s just darker here. That is pathology. That’s not normal from high insulin.

STEVEN BARTLETT: You talked about weight changes as well. What’s this thing about hairy toes that I was reading about?

DR. ANNETTE BOSWORTH: Right. So as my patients age, so most of my 55 year olds that have had high insulin, I will tell them, look at your toes, they’re supposed to have hair on them. And when your body has had that high insulin state for a couple of decades now, it will start to say, we don’t send resources to a couple parts of the body anymore.

And the follicles in their toe are one of them. Like, you just stop growing hair on your toes. And there’s an ascending problem with this where the toe starts, then it’s the ankles. Then it’s up to the knees, and they don’t have hair anywhere on their lower extremities. It is a process that started from high insulin.

Insulin’s Impact on Aging

STEVEN BARTLETT: What about aging? You talked about how if you have high insulin, there’ll be an impact on your aging. Now I’m thinking about, you know, I’m getting a couple of gray hairs down, thinking this is because of my insulin levels.

DR. ANNETTE BOSWORTH: I have seen patients that have reversed their gray hair on a ketogenic diet. It blew my mind. They asked me for the reason why that happened, and I thought, well, the cells are healthier that are making your hair. That’s all I got.

Aging is exactly that enemy, which is they are going around the sun with more growing of the trash than they needed. So that high insulin, they don’t know about it. They’ve not produced a ketone in years. And that chronic disease is now difficult to get there, the eye to clean out.

It’s difficult to get that brain trash removed. And you’re supposed to do it every night when you sleep. It’s not supposed to be behind this far. You’re two decades from taking out the trash in your brain that’s aging.

Measuring Ketone Levels

STEVEN BARTLETT: How do I, for a start, even know my ketone blood levels?

DR. ANNETTE BOSWORTH: Well, when a patient first comes in saying, how do I begin? I want them to tell me what they had for their meal and then say, how many carbs do you think that was? Because this education, an apple is 20 grams of carbs, 15 grams of carbs for some of them.

And we’re going to ask you in the first six weeks to take your carb intake down to less than 20, 20 total grams of carbohydrates or less is where we begin. And again, I do this in a medical grade. There are people who play with the ketogenic diet, and there’s people who try to reverse medical problems with a ketogenic diet.

In order to do this. It is not a lazy kind of keto. You have to actually be on the same team as me using data to reverse this medical problem.

STEVEN BARTLETT: And how does one measure their blood ketone levels?

DR. ANNETTE BOSWORTH: Yeah, I think blood is the best. There is a way you can measure them in urine, the burning of fat. If you turn that string of fat into ketones, there are two destinies for that. You either put it into a mitochondria and turn it into energy, or you pee it out.

So especially when they’re early in a ketogenic journey, they overshoot. Evolution said, don’t let them die. Turn that fat into energy, help them through the famine. So the excess ketones they make end up in their urine. We call them ketone strips and they’re cheap and easy and we don’t have to cross that barrier of somebody pricking their finger at the beginning.

So they’re going to pee out ketones every day as long as they’re not chronic insulin resistant.

The Benefits of Ketones for Performance

STEVEN BARTLETT: So if I avoid carbs for a sustained period of time, which could be a couple of days, it could be up to two weeks. Eventually my body’s going to say, listen, we need energy. So it’s going to start burning my fat stores.

DR. ANNETTE BOSWORTH: Yes.

STEVEN BARTLETT: You know, from some of that fat around the midsection, and it’s going to start turning that into ketones, which are a different type of energy. Are there any reasons why ketone as a source of energy is better for me in terms of performance other than the insulin reasons that we’ve talked about?

Like, are there any other parts of my body or my health that benefit ketones?

DR. ANNETTE BOSWORTH: For starters, when you’re burning a ketone, there’s less trash. Okay. It is a cleaner fuel with less byproduct, especially as you age. So you get the longer energy and you have less debris floating around.

You hear the word antioxidants all the time. Well, burning ketones is an antioxidant state. It is a. And it’s in the space where you need it, which is inside that cell. You swallow antioxidants and you have no guarantee that they end up where they’re supposed to.

So, number one, the fuel is reducing trash at a cellular level. It lasts longer and it penetrates through that blood brain barrier to fuel a brain that even if it’s insulin resistant, it can use a ketone.

So the problem with somebody who’s chronic insulin resistance, their brain needs a lot of glucose to stay online. And I can try to get it there, but insulin is constantly fighting that. It’s a war to try and keep the glucose in their brain.

My hack is ketones will go right around that. It doesn’t need the same transporters to get across the blood brain barrier and especially to fuel those cells in the brain. So for performance, name a game where you don’t use your brain. There isn’t one. Right.

If you’re looking at performance to say, let’s begin with the sharpest brains and the most focus, the most discipline, the less impulsivity, all of those things improve when that brain is being fueled with ketones.

Personal Experience with Ketogenic Diet

STEVEN BARTLETT: So let’s focus on the brain part then. So what have you personally noticed. As someone who I assume is in the ketogenic diet right now.

DR. ANNETTE BOSWORTH: Yes.

STEVEN BARTLETT: What have you noticed the variances between when you’re in a keto diet and when you’re not.

The Impact of Ketosis on Daily Performance

DR. ANNETTE BOSWORTH: Right. Well, I’ve been doing this since 2015, so the onset of it was really messy. But the seasons where I would do a great job and then I would think I’m fine. I mean, I can tell you, you see 25 patients in a day and I feel bad for the last five. They’ve got a sluggish brain.

I don’t care how much coffee you’ve got in you, you can’t keep that focus for that length of time. When you’re in a ketogenic state and not in a ketogenic state, the brain power, the concentration, the ability to keep your mood controlled, it is a night and day difference for most people.

But I think especially for me, I’m pretty high energy and when it runs out, I get crabby. And that’s not a good place to be if you’re the patient.

STEVEN BARTLETT: Yeah, I think I’ve noticed that as a podcaster, but I’ve also had a lot of very well known podcasters say the same thing, which is the variance in their ability to speak and articulate themselves and think and sit here for three to four hours having a conversation is night and day when they are in a fasted ketogenic state versus or on a ketogenic diet versus when they are in a higher carb diet. And it’s so profound to me that I almost wonder why more people don’t.

DR. ANNETTE BOSWORTH: Well, it’s insane. One of the best things that I’ve done in 25 years was I went out on a limb and said, “I’m going to try and teach 200 people at once how to do this intense ketogenic diet for three weeks.” It is hardcore. This is not playtime. You’re checking your numbers every day and you’re comparing them to your classmates and what you get to see in this class of 200 people going with an extreme ketogenic diet is the testimony.

You just said, “I cannot believe how good I feel.” By the end of three weeks, they’re naming babies after me. They think this is a miracle. And I’m like, exactly. I mean, when you do it in a group like that, I don’t need to advertise. They tell their friends, they tell their, if you want to be on a ketogenic diet, that really wakes up your brain.

I didn’t think I could do this. I thought I was too old for this level of energy. And it’s there within three weeks of doing it. Right.

Timeline for Experiencing Brain Benefits

STEVEN BARTLETT: How long does it typically take on average for someone to feel those brain benefits from doing the ketogenic diet? Typically, how long does it take you?

DR. ANNETTE BOSWORTH: Me?

STEVEN BARTLETT: Yeah.

DR. ANNETTE BOSWORTH: I rarely go out of it, meaning I might have a couple of days where I fly to LA and have a fancy meal and then I need to be back on it. It just doesn’t feel good anymore. But let’s go to when I was overweight. Okay, so you say, who’s insulin resistant? Any person who’s had a baby. Okay. You have to be insulin resistant to hold that baby for nine months.

Okay. So I had three of them and then the weight never came off on that third one. So here is an insulin resistant person at 40 something years old and I am probably 60 pounds heavier than I am now. In the first time I tried to get into a state of ketosis for nine months. I was about to give up on, why can I not pee a ketone? Why does every, I mean, I’m a doctor, I’m trying to use this for my brain patients, but I’m afraid to tell them about it because I personally cannot pee a ketone.

I mean, I was trying to follow 50 carbs, then I tried to do 30 carbs and then I tried to do none, but I just couldn’t make it long enough into that ketogenic state. And what had happened is at least a decade of high insulin, three babies, full practice, busy life, you know, on call, those kinds of things that are all dangerous if you’re going to try to have a peak brain.

I took my kids on a 22 mile hike around the city on Memorial Day in the name of troops as mental health. And I said, “If I am not peeing a ketone after walking 22 miles, having fasted for a day, then I’m for sure that this diet is a phooey.” So that’s how much energy it took for me to pee a ketone because I was very insulin resistant.

I had been making excess insulin for a decade and I’m a doctor, I should have known that my sugars were fine, my hemoglobin A1C wasn’t bad. But that excess insulin that stored sugar, that stored glycogen, it took forever to get that low. And only after I fasted and then walked 22 miles did I pee a ketone.

So when you ask the question, how long does it take? I do a much better job now of telling people how to get there, because I almost gave up thinking this is junk science.

STEVEN BARTLETT: If you were to eat a high carb meal now and take a couple of days off, how long would it take you to get back into a ketogenic state where you have those brain benefits now?

DR. ANNETTE BOSWORTH: I could probably flip back in within 12 hours.

STEVEN BARTLETT: So that’s how long it roughly takes. For someone who’s got in better metabolic shape, it will take a couple of days. Is there a downside to living in ketosis the whole time? Because people often say when you talk about the ketogenic diet that it’s not sustainable.

Long-Term Sustainability of Ketosis

DR. ANNETTE BOSWORTH: Yeah, I hear that a lot. But I have thousands of patients that have been doing it for years. And what happens is as soon as they exit from the ketogenic diet and they start to feel the trash build up again, meaning the joints that didn’t hurt forever now hurt. The vision that was super clear is now foggy again. The brain that wasn’t irritable and depressive is back to doing those things again.

I mean, it is within a week or two that I like to think of, when you’re in a ketogenic state, you wring out that inflammation and trash in their brain, and the brain is crisp. It is doing a great job. And when you put the sugar back in, the swelling goes back into their brain. Insulin and water flood the body, and it’s almost like a minor concussion. And their brain is not working right, and they now know it.

STEVEN BARTLETT: And is there any other benefits to being in a ketogenic state? You mentioned strength briefly.

Ketosis and Athletic Performance

DR. ANNETTE BOSWORTH: Yeah. So when you’re looking at, do you do weightlifting?

STEVEN BARTLETT: Yeah.

DR. ANNETTE BOSWORTH: Okay. So when you weightlift, how grade your soreness on the day after your lifting day?

STEVEN BARTLETT: If I’ve been using that muscle consistently, there’s no real soreness.

DR. ANNETTE BOSWORTH: Good. So let’s just take a day where you’re pushing it harder, you’re dead lifting harder, and you’ve got a strain in those muscles. One of the key components for repairing that as quickly as possible is to be in a ketogenic state, to take that inflammation way down.

And you probably didn’t need the help of repairing that muscle when you were, you know, 18, 22. But as you get into the 30s and especially into the 40s, the amount of inflammation that tries to help you repair that, it overshoots. And that’s where the chronic pain’s from. That’s where the delay in repair comes from.

So when I look at power and muscle training, the first place I talk to my patients about it is how many days does it take you to get back to feeling good after you’ve had an injury? Let’s be on the side of a ketogenic setting where your inflammation is super low. And when you tear something, which you’re going to tear things, when you’re lifting heavy, the repair part is so quick, the power is a little hard to talk about. If you want me to go there, I can.

STEVEN BARTLETT: Yeah. So is there going to be any impact on my ability to train if I’m in a ketogenic diet? Am I going to be impacted in terms of endurance or strength or power or anything like that?

DR. ANNETTE BOSWORTH: So we looked at this in military people. It’s one of my favorite ones where they are all insulin resistant and we put them on a ketogenic diet and so they’re trying to meet the standards and at a month of being in a ketogenic state, they’ve lost weight, but their power and time didn’t do anything too sexy.

Then you look at those same soldiers at a year, or I think it was six months was the next time they did another big check. And by golly, they’ve lost even more weight and their power is about 20% more than their counterparts. When they get to 18 months of a ketogenic diet, their power is almost 50% more than what their counterparts were.

So let me explain that. As you’re looking at a muscle, it will choose which fuel it wants to use. And when you’ve been glucose using, when you’re on a non ketogenic diet, it’s going to use glucose first to fuel. But if you can train it to use fat in that training, it’s a longer, better fuel with less inflammation and especially in a state where it will use both fuels quickly, that takes time.

I mean, it takes, and what I tell patients is you’ll love me in 18 months. You’ll think I’m pretty great at six months. But if you’re trying to run a marathon and we’re only three to four weeks out, you should not start a ketogenic diet. You’re going to think it’s the worst thing ever. It’s meant to train muscles to use fat and that takes time.

Ketosis and Cognitive Degeneration

STEVEN BARTLETT: And is there a link between some of these cognitive degeneration diseases like Alzheimer’s, dementia, et cetera, and the ketogenic diet? Because I know that there’s been some research that’s underway and has been done to try and establish causality. Is there a link here?

DR. ANNETTE BOSWORTH: Yeah, you know, it’s one of the saddest places where if you look at what patients regret in life, they come into the clinic and they’re already starting to say, “I was driving the other day and I got lost.” And when I hear that we are 15 years too late, it is 15 years of building up trash in that brain that we have to clean out that debris.

And I had the privilege of an amazing story that taught me I don’t have the gift of seeing into the future. Am I going to reverse these Alzheimer’s before they show up? We don’t have the research for it, but I have a lot of clinical experience saying, boy, they are so much better. I don’t know if their memories going to stay this good. We’re only three years into a ketogenic diet, but it’s way better than when it started.

And then I had a Down syndrome patient at 40 years old in my practice. So her mother came to see me first. She said, “I want to try this ketogenic diet. I’ve been helping my daughter, who has Down syndrome. We’ve lost 100 pounds because the doctor said that she might do better if we lost some weight.”

And it’s not an uncommon thing to see. They have advanced insulin resistance and advanced Alzheimer’s earlier in life. So it’s a great place to study Alzheimer’s because they have a more rapid onset of it. So the woman comes, she’s lost 100 pounds. And during that time, her mental cognition got worse. So now she’s got 100 pounds down. But none of those brain things are better.

And I said, “All right, if we’re going to do this with your daughter, we’re going to make sure we’re pricking your finger. It’s not going to be fake. We’re going to do a real ketogenic diet.” So the mom starts on a ketogenic diet, and I think both her and mom are genetically superpowered to make ketones. Cause they have ketones of three within a couple of days, which is…

STEVEN BARTLETT: The average would be like one if I…

DR. ANNETTE BOSWORTH: If they hit one in a few days. I’m thinking, good job. And the mom calls me at the end of the week saying, “Do you think it could possibly, she is, you know, doing the little jobs that she used to do around the house.” And I said, “Well, call me again in a week. Let’s see how she’s doing.”

And the mom goes, “The most profound thing just happened. I’ve taken care of this girl for 41 years. And I asked her the other day if she was doing something she wanted to go to the church with me,” which means she left the house and she was at the church and she was giving her instructions to do this, go around here and put it over there on the, give her a little job.

And she said, “Do you understand?” And the girl replied, “I understand.” I said, “What’s the big deal?” And the mother said she had never said a three syllable word in her whole life. Two syllables is all her brain could ever put together for the first time in her whole life.

Three weeks onto a ketogenic diet and this Alzheimer’s diagnosed patient who had Down syndrome now had a brain that was not only working great, it was doing the best mom had ever seen it. And on a ketogenic diet, not only did she lose about 15 to 20 more pounds, but her world opened up again because her brain, which had Alzheimer’s, no longer had that diagnosis.

The Impact of Ketones on Brain Health and Alzheimer’s

STEVEN BARTLETT: I was looking at some of the supporting studies around this, around the impact that can have on the brain. And studies show that in dementia, especially in Alzheimer’s, the brain struggles to use glucose efficiently. Ketones provide an alternative clean fuel source.

Ketogenic diets can boost mitochondrial function and energy availability in brain cells. Keto lowers systemic inflammation which is linked to slower cognitive decline. Ketones may protect neurons from damage and promote the growth of new neural connections.

And Alzheimer’s is something called type 3 diabetes, which I’ve heard a lot. And ketone improves insulin sensitivity, potentially reducing this risk. And lastly, small studies show temporary improvements in memory and cognition in people with mild cognitive impairment or early Alzheimer’s.

But the evidence is early stage. Long term adherence can be hard and the diet isn’t suitable for everyone. For example, underweight people and people with certain medical conditions. Right, so how do I measure my blood ketone levels? Is that what these devices are here on the table?

DR. ANNETTE BOSWORTH: When I look at giving patients the freedom to say, don’t come to me for the things that you can do at home, first thing is be willing to check data. Okay, so blood way better than any other way to measure this. We’re going to be able to see should we have a contest, which one’s better?

STEVEN BARTLETT: Yeah.

DR. ANNETTE BOSWORTH: Okay, so you want to go first?

Testing Blood Ketone Levels

STEVEN BARTLETT: Okay, so what I’m going to do here is I have a finger prick here which is going to take some blood. It’s going to prick my finger. Then I have this little reader and I also have this little strip here which I’m going to put my blood onto and within a couple of seconds it’s going to tell me how many ketones I currently have in my body right now.

DR. ANNETTE BOSWORTH: And so we’re going to look at that at the same time as your blood sugar, which is how you can measure insulin. It’s the best proxy for saying how high is his insulin? So put both of them in there before you go because then you don’t have to prick yourself twice.

STEVEN BARTLETT: Okay.

DR. ANNETTE BOSWORTH: So a blue one is going to measure the ketones and a brown one’s going to measure your glucose. Okay.

STEVEN BARTLETT: And this device, how much does it cost if people want to buy it at home and start pricking their own food?

DR. ANNETTE BOSWORTH: Yeah, I think there’s a kit that comes with about 50 strips. So you can have ketones and glucose at the same time. I’m guessing it’s around 70 bucks or maybe it’s 60. $70. I, I, they have quite the. I put it all in. There you go. And so they’ll still. It lights on the other one too. Right, Perfect. Okay, so prick your finger. Best to do it on the side of your finger because there’s less nerves there. There you go. Good job.

STEVEN BARTLETT: Okay, so I’m going to put my blood onto this one, which is the keto reader.

DR. ANNETTE BOSWORTH: And it’ll count down.

STEVEN BARTLETT: I think it’s about. My glucose is 86.

DR. ANNETTE BOSWORTH: Takes more blood for the ketone, and.

STEVEN BARTLETT: My ketone levels are 0.9.

DR. ANNETTE BOSWORTH: Okay. So that’s a Dr. Boz’s ratio of 86 divided by 0.9, which is probably 95 or something. 95ish. Right.

STEVEN BARTLETT: So my glucose level’s at 86. Is that high or low?

DR. ANNETTE BOSWORTH: That’s good. So I would say that’s not low, it’s just good.

STEVEN BARTLETT: Okay. And my ketone level’s a 0.9.

DR. ANNETTE BOSWORTH: Right. So when you look at them in comparison, you want to have a blood sugar that’s not triple digit, so that’s very good. And the closer, the higher you are above 0.5, the better the result. So that’s a pretty good number.

STEVEN BARTLETT: So if I’m in ketosis, what reading would I have on this ketone meter?

DR. ANNETTE BOSWORTH: 0.5 or greater. But it would be also that you have that reading without a triple digit blood sugar. So when I look at the combination of them, I do a little math and say your doctor bows ratio is 95. So you are burning fat right now.

STEVEN BARTLETT: Okay.

DR. ANNETTE BOSWORTH: Okay. So that’s a good sign. When I am trying to help people who are trying to undo cancer or autoimmune or brain injuries, they have to have a better doctor bowel ratio than that.

STEVEN BARTLETT: Let’s do your readings. To see where you’re at.

DR. ANNETTE BOSWORTH: All right, drumroll.

STEVEN BARTLETT: 83 and 1.7. How are you at 1.7? What have you done?

The Importance of Meal Timing

DR. ANNETTE BOSWORTH: So I’ve learned that I would love to be 33 again and be able to eat that late at night. You said that? I’m like, oh, it’s been a while since I’ve eaten that late at night. It’s probably the hardest thing to teach my patients, too, is you don’t appreciate how much insulin you make that late at night.

Now, you’re still in a season where you get to just kick your heels and enjoy youth. But at my age, you cannot do that. I can eat in the morning, I can have good calories of high fat and good protein in the morning, and I’ve learned to stop eating somewhere around 3 o’clock in the afternoon. In fact, if I. Yeah, I know.

STEVEN BARTLETT: 3:00 in the afternoon, you stop eating.

DR. ANNETTE BOSWORTH: That’s usually the case. You know what’s really hard, though, is how much of your life is social. You said, oh, there was this dinner party last night and I had pasta. And you’re like, yep, that would be something I have to teach my patients. You have to say no to that.

You cannot be eating at 10 o’clock at night if you want your insulin to not do that debris thing. And boy, when their memory isn’t going well, when their friends are dying of memory problems, I don’t use fear tactics. I don’t think they last very long. But it is such a reality of poor performance that I can’t do that. I cannot eat at 10:30 at night.

STEVEN BARTLETT: What is it about being asleep that causes the sort of deregulation, what is it about it doing it at night?

DR. ANNETTE BOSWORTH: So now it’s going to take that metabolic curve and in order to store all of the part that gets stored, and then turn the part into fat that needs to be tucked away, get back to baseline. It’s going to be eight hours, at least eight hours, which is fine, right?

STEVEN BARTLETT: Because I didn’t eat till. I’m probably not going to eat till 2pm today.

DR. ANNETTE BOSWORTH: Right. Well, you missed one part. The sun will rise. When the sun rises, even if you’re in solitary confinement, you cannot see the sun. Yeah, your brain knows that the sun just went up and cortisol rises, okay?

Cortisol leaves. Your brain goes to the liver and says, you know that stored sugar, that glycogen release, you make glucose first thing in the morning. How much glucose depends on how insulin resistant you are. So you’re going to have an uneaten meal. When you wake up in the morning, glucose has been stored for this purpose. It’s going to wake you up. It’s going to give you the energy when sun rises to fuel you. If you got a bunch stored, you’re going to have a high blood sugar.

STEVEN BARTLETT: Can we check Jack’s ketone levels? I’d like to know where Jack is at.

DR. ANNETTE BOSWORTH: Ooh, let’s do that. What’s Jack do for his?

STEVEN BARTLETT: We’re about to find out.

DR. ANNETTE BOSWORTH: No, wait a minute. Is Jack the one that did the VO2 Max with Peter Attia and you? Well, you know, peak brain performance is my thing. And one of the hardest brains to heal are chronic runners. That trauma thing is real. It’s so hard to explain to them too. If you’re a vegan who runs. Oh, you’re in trouble.

STEVEN BARTLETT: 95% of vegans that listen to this podcast frequently don’t subscribe.

DR. ANNETTE BOSWORTH: Oh, yeah. Well, all right, so glucose is 88. Not too bad. Ketones, Boo. Absolutely. Yeah. That’s an example of. He is making trash. There’s no trash going out.

STEVEN BARTLETT: So his ketone level is what, 0.1?

DR. ANNETTE BOSWORTH: And his blood sugar is 88. So if you take 88 divided by 0.1, it’s a thousand or something? It’s really high. 888, probably. That is a lot of trash being made. When that doctor Boz ratio is high, you can’t take it out.

STEVEN BARTLETT: Do you want to say that’s his face? I mean, I feel like.

DR. ANNETTE BOSWORTH: I just think that when Peter Attia did that and said, oh, I had no idea. I’m like, you could have just checked this first thing in the morning for five days. If you have that kind of a Dr. Boz ratio, you’re insulin resistant. You’re insulin resistant.

You have to be hitting that in a routine, regular interval in life to not have those problems. To have osteoporosis at such a young age, a ketogenic state would not allow that. You would be using resources much better.

STEVEN BARTLETT: He actually did a test. It turns out he doesn’t have osteoporosis.

DR. ANNETTE BOSWORTH: Oh, good. That was shocking. Yeah, you shouldn’t have osteoporosis at your age.

STEVEN BARTLETT: No, I think that was a misreading because of the scanner, but.

DR. ANNETTE BOSWORTH: Right.

STEVEN BARTLETT: But on this point in particular, his ketone levels are 0.1. So he’s basically running off glucose.

Understanding Insulin Resistance

DR. ANNETTE BOSWORTH: All glucose. And so why is that happening? Okay, whatever he ate, the insulin went up. So let’s say he was your exact same eating pattern. He ate last night. He had the six, eight hours of sleep. The cortisol said, oh, the sun’s rising. And it rose his blood sugar a little bit. Okay. When the sugar’s high, you can’t. Your insulin’s going to be high too. You’re not making ketones.

STEVEN BARTLETT: When I did this keto test with most of the team here, they were all around that region. They were in the region of 0.1 ketones in their blood to 0.3.

DR. ANNETTE BOSWORTH: Welcome to my clinic. In 10 years, that is trash being made, never being taken out.

STEVEN BARTLETT: And so you’d say to them, you need to do some fasting. You need to.

DR. ANNETTE BOSWORTH: You need to cut carbs. Yeah. If you’re looking for quick. Okay. If they’re in their 20s, I mean, I have three kids, right. And they have heard this chirp for 10 years. I mean, how I got into this was. My mother was very sick, and she was sick because of a high insulin problem that caused cancer.

So we put her in a ketogenic state and everybody in the family got on board. So here’s three little boys who no longer have candy around. Now they’re in their young twenties, and for the first time, they’re actually listening to say, gosh, mom, one of them is at Georgetown. He has to read for long periods of time for Georgetown Law School.

And he’s like, if I’m not in a ketogenic state, I can’t keep the focus. And I said, well, how are you doing that? At first he tried some of the supplements. Okay. But what really happened was he cut the carbs down and said, I can say no to that because of the sustained brain power.

I mean, it’s really easy in your early 20s to do this, cut the carbs even to 50, but prove to yourself that you made ketones and that return on your dividends is you won’t be seeing me in 25 years.

The Keto Continuum

STEVEN BARTLETT: So you have this idea of this keto continuum. What is the ketone continuum? I read about it. I mean, it’s a book here I have, which you published in 2020, called the ketone Consistently Keto for Life.

DR. ANNETTE BOSWORTH: Right.

STEVEN BARTLETT: So the keto continuum is this 12 step process to get into a consistent keto consistently keto.

DR. ANNETTE BOSWORTH: Yeah. That you’re constantly taking out the trash. The first part is the beginner.

STEVEN BARTLETT: Okay. So the first part, the beginner section, has four stages to it.

DR. ANNETTE BOSWORTH: Right.

STEVEN BARTLETT: What are those four stages?

DR. ANNETTE BOSWORTH: Well, I like to tell patients that you never fall all the way off of the continuum. So the first step is really not keto but it is that they’re eating every two to three hours and if they fall off the wagon, that’s usually where they land. So that’s what most people start at. They’re eating every two to three hours. They are not keeping their carbs less than 20.

Step two is cut your carbs to 20. That’s the only thing I need you to measure. And you’re going to be able to use a ketone strip, you know, measure ketones in your urine and that will ride, you’ll ride a wave. And that ketone production is happening.

The fat based hormones in your body are starting to resurrect. They’re starting to do the things that they need to do and there will be this magical moment in the not too near future where you skip a meal.

The Keto Continuum: Understanding the Stages

STEVEN BARTLETT: And this beginning stage, how long does that last? I’ll put this on the screen so everybody can see the continuum. How long does that initial beginner stage last for people?

DR. ANNETTE BOSWORTH: If they’ve been severely insulin resistant? This is the ones where I’ve said they took their carbs to 20 for two weeks before they peed a ketone. So I use some other steps if that’s how severe that is. But let’s just take the average person that’s not 100 pounds overweight. They’re hitting menopause and they’ve put on 25 pounds.

When they drop their carbs to 20, they’re peeing a ketone by the end of the week and they are missing their first meal by day 10.

STEVEN BARTLETT: Okay, so day 10. And then it says when we get to stage five in the keto continuum, it says 16/8, 168. Is that…

DR. ANNETTE BOSWORTH: Yeah. So then we start to use time restricted eating. Your body will adapt. People say you can’t stay on the keto diet because they go to step four and then they think that that’s all they needed to do.

There are several steps to reversing this problem and you’ll know you have the right step if the ketones are still present in your blood. Your body will adapt though. So we start to say, all right, we’re going to learn some new behaviors. We’re going to learn what the nothing burger looks like at least for 16 hours out of the day.

STEVEN BARTLETT: What does that mean?

DR. ANNETTE BOSWORTH: You do not eat a thing in those 16 hours. Now I give them a little hedge because most people come in like you. They don’t start eating until 2 o’clock in the afternoon and then they eat until 10 o’clock.

And I want them fat forward. I want lots of fat going in. Because insulin resistance, that high insulin state, means they’ve locked or they’ve insulated their fat on their body.

STEVEN BARTLETT: And then we get to stage seven where it says 23/1. Is that fasting for 23 hours a day?

DR. ANNETTE BOSWORTH: Yeah.

STEVEN BARTLETT: And eating for one hour a day.

DR. ANNETTE BOSWORTH: And there’s a little bitty line between 16/8 and 23/1, but there’s a whole bunch of life there. Meaning we don’t actually have patients go from 16 hours of fasting to 23. We have them slide it down by an hour, slide it down by an hour, and then we do that harder thing, which is move it towards sunrise, quit eating so late at night.

Prolonged Fasting and Metabolic Reset

STEVEN BARTLETT: And then the last stage here, so step nine, 10, 11 and 12 is prolonged fasting between 36 and 72 hour fasting.

DR. ANNETTE BOSWORTH: Right. So those folks that have high insulin for 15, 20 years, they’re going to have to do a Nothing Burger for 36 hours in most of them to really give a good reset of their metabolism.

And although you look at other folks saying, “Oh, you should never do that if you’re a woman, you should never do that over the age of 50,” I’m saying you have too much insulin in your body. You have to do that to get the pancreas to make less insulin over time.

Gender Differences in Ketogenic Metabolism

STEVEN BARTLETT: On that point between men and women, are there metabolic differences that need to be mentioned here? Because, you know, when I sometimes when I do ketogenic fasting, my girlfriend, she takes much longer than me to get into a ketogenic state. And I’m wondering if her body is in some way trying to defend the switch.

DR. ANNETTE BOSWORTH: Have you ever seen the reality show Alone?

STEVEN BARTLETT: Oh, no, I’m not.

DR. ANNETTE BOSWORTH: I’m not either. But they drop these people off in the middle of nowhere and they starve them to death. And you watch the fat come off of them and the men, the fat just melts off of them. And the women, they do what your girlfriend does. It just holds onto them that we are designed to have that fat on them.

So asking them to do a ketogenic state, you’ll hear people say, “Oh, it’s going to ruin your hormones. Oh, it’s going to… You can’t do that.” And I would say you can have all those conversations once their insulin is normal.

I have lots of women in childbearing years that are excessive producers of insulin and their vitamin D is low, their estrogen is low, they have hair loss on the top of their head. They have skin tags throughout their body. Or maybe the first sign was they had PCOS. Okay. All of these are a sign that insulin came in and it’s too high in their body.

So lowering it has rules. And if you want to have a baby, carry a baby, have the weight come off after you’ve gestated a baby, have weight not be your enemy during menopause, you have to be making ketones at a routine and regular interval. And start with the food, start with the menus in the kitchen. Don’t run to the gym first.

Hormonal Balance and Ketosis

STEVEN BARTLETT: I’ve noticed in women in my life that they’ve told me that their menstrual cycles become more synced up when they are in a lower carbohydrate diet.

DR. ANNETTE BOSWORTH: Right. Their hormones can hear each other. I mean, when insulin is high, insulin dictates what that sugar does, but it also is the dictator for every morsel of fat. And estrogen, testosterone, vitamin D, they’re all a derivative of fat, of cholesterol, and they are put into the fat cells.

If you biopsy an obese woman and say, “Can I see? Is there any vitamin D hidden in there? Is there any estrogen? Is there any…” Yes, they’re all in those fat cells. You start to lower their insulin and the fat mobilizes. So the hormones that are naturally communicated between women, they can actually hear them again. I mean, that tribal thing.

STEVEN BARTLETT: If a woman were to stay in a ketogenic state permanently, would there be any disruption to her metabolic health?

DR. ANNETTE BOSWORTH: You mean like me?

STEVEN BARTLETT: Yeah, like, you know, her menstrual cycles? Her… Yeah. Anything?

DR. ANNETTE BOSWORTH: No, I think it’s… You’re going to find people that it shouldn’t be extreme. Meaning? I’ve been on this for 15 years. The ketogenic phase is at least 20 out of 30 days in a month. The first few years I was on it.

Now at 55, menopause in the last year, I’m like, without a ketone, my brain doesn’t work right now. Without a ketone, my energy goes to pot. And I’ve been walking women through menopause for 25 years. It is not a fun story when they’re insulin resistant.

So prepare. Have the flexibility of that mitochondria to use both ketones and glucose. And that’s what a ketogenic state is.

The Sardine Solution

STEVEN BARTLETT: Well, we have 12 cans of sardines here, and I wondered why you brought sardines.

DR. ANNETTE BOSWORTH: Well, yes. That’s a hell of a tool.

STEVEN BARTLETT: Why?

DR. ANNETTE BOSWORTH: So when you’re trying to help patients change behavior…

STEVEN BARTLETT: Sorry. The sardine juice has gone on my iPad.

DR. ANNETTE BOSWORTH: Good luck getting that off. Yeah. Sardines rank for the worst smelling, but they’re not the worst tasting. Now, when it comes to bitter in fish, they don’t have the bitterness that tuna does.

STEVEN BARTLETT: So tell me about sardines. Why should I be eating sardines?

DR. ANNETTE BOSWORTH: When you’re trying to teach patients those stats that you read off a minute ago, they don’t care. They need a very clear step on how do I begin? And when you’re working with somebody who cannot seem to get their ketones to rise, and I give them a whole list of menus that’s too noisy.

Let’s take it down to one food that is high in fat, high in some of the best fats, high in protein. It’s whole foods, and it’s affordable for everybody under the sun.

STEVEN BARTLETT: Okay, so do you do like a sardine fast?

DR. ANNETTE BOSWORTH: Yeah. So in fact, that 21 day… 21 day is that three week course where I say, I will teach you how to do an advanced ketogenic diet where everybody will be peeing or making abundant ketones on day six. I say, all right, the only thing on the menu for the next three days is sardines.

There’s no eating window. You can eat as much as you want. There’s no limit to the amount. And what I’m pushing them to do is not only eat a nutrient dense food, but I want them to feel satiety. I want them to feel full.

Fat Consumption and Ketosis

STEVEN BARTLETT: Do I need to be consuming a lot of fat as well?

DR. ANNETTE BOSWORTH: There’s plenty of fat in there.

STEVEN BARTLETT: But I mean, generally, because this is one of the things that always puzzles me is I’ll go say I went a week without eating carbohydrates sometimes. I’m still not in ketosis. And I think I heard somewhere that it’s because my fat isn’t high enough.

DR. ANNETTE BOSWORTH: Yeah. So again, at the time, you went seven days without eating hardly any carbs. Right. And you still didn’t make a lot of ketones. Okay, so you had fat on your body.

STEVEN BARTLETT: Yeah.

DR. ANNETTE BOSWORTH: Okay, so why didn’t the fat get to your mitochondria? Excess insulin. Okay. You had been in a high insulin state. So if you swallow the fat, then you can turn it into ketones. Right now all your fat’s locked under this insulin bed. If you kept going, it would eventually hit. But that’s painful. I mean, I have patients who do it for two weeks.

STEVEN BARTLETT: So what are you saying? You’re saying that I need to eat fat?

DR. ANNETTE BOSWORTH: Yeah. So if you put the sardines in oil. That’s a great high fat, high protein. It’s also a little easier to masticate the meat, and you will have high fat, high protein, and you will have beautiful ketones by 48 hours, maybe 72.

Macronutrient Composition for Ketosis

STEVEN BARTLETT: And what is the composition of my diet in terms of protein, fats, and carbohydrates when I’m trying to get into a ketogenic state?

DR. ANNETTE BOSWORTH: Yeah. I don’t let people get distracted by this. Right. I say, look at your finger. If it’s got a high ketone, you have got enough fat and enough protein and low enough carbs.

What most people have is the story you told. “I’ve been doing this for five days. Why don’t I make any ketones?” And the answer is, what is hidden behind the chemistry is too much insulin. You’ve got to have… And so that’s a great place to say, put the fat up. Keep the carbs low and the ketones will come.

STEVEN BARTLETT: When you say put the fat up, you mean eat more fatty foods. Give me an example of the type of shopping list that if I was trying to get in a ketogenic state and stay there, I would have.

DR. ANNETTE BOSWORTH: Yeah. One of my favorite things is pork belly, more eggs, beef brisket, ribs, avocado. Avocado have a beautiful marketing team, but they do have carbs in them. And I’ve had people overeat them. Like, “I have four avocados today.” I’m like, that’s… You’re on the wrong bandwagon there.

Avocado makes the list. Don’t get me wrong. But it’s not a diet of mostly avocado with a sprinkle of chicken breast. That’s not going to get you into ketosis. The fat has to be higher than that.

Most of the time when I’m really struggling with a patient who just can’t seem to make ketones, can’t seem to make ketones, and they won’t do the sardines, I’ve said, eat butter for a day. That’s 100% fat.

STEVEN BARTLETT: Okay, so you can just have… Increase the butter.

DR. ANNETTE BOSWORTH: Yeah, you could have that.

STEVEN BARTLETT: Are there carbs in here?

DR. ANNETTE BOSWORTH: No, no, no. It’s just fat. And it’s not awful, but it is a great social experiment where they haven’t felt what satiety feels like in a while.

Net Carbs vs. Total Carbs

STEVEN BARTLETT: People talk about net carbs. They say, you know, avocado has 12 grams of carbs in, but it has 10 grams of fiber. So the net carbs is 2.

DR. ANNETTE BOSWORTH: If you’ve never had insulin resistant, you can do it that way. My patients have had high insulin and I don’t play that game. It’s got to be total carbs. Fiber is for farting.

STEVEN BARTLETT: Do you recognize this photo of this lady?

DR. ANNETTE BOSWORTH: Oh, yes.

STEVEN BARTLETT: Who is she?

The Story of Jane’s Sardine Journey

DR. ANNETTE BOSWORTH: Why, she is just a great story. Jane had pathology with how she thought about food. Like many patients, she had food as the way she coped with a lot of things. And as long as she was clearing her plate and using that food, it comforted a lot of wounds.

When you start to address some of these things, I mean, the ketogenic diet doesn’t fail if you just follow the chemistry. The ketogenic diet fails when you have humans who’ve had wounds, who’ve had history, who have stress, who don’t sleep. And Jane was a great story where all the goodness in the world couldn’t undo some of that relationship she had with food.

So the first time, she’s one of the coaches that I used for that 21 day. And she just has the best outcomes because she was doing a strong ketogenic diet for those three weeks twice a year. And she decided that after, I think, the third class, she was going to do sardines only for 30 days.

And she writes to me at the end of the 30 days, can’t believe how great she feels, and really kind of addressed some of those demons associated with why she would eat what she would eat. And then life hit again and she put on some of the weight again. She’d used sardines intermittently.

And she called me and said, “All right, I think I’m going to do this again. I’m going to just go on sardines and really have some come to Jesus moments on why it is that I do some of the things I do.” I mean, it’s a really vulnerable moment where you can hide those moments. You can never tell a soul what’s really going on through your mind. And she was going to address them.

And I said, “Well, I have a bone to pick with Joe Rogan. He has said some inappropriate things about sardines, like they’re arsenic poisoning. So I’d like to check a few blood levels in you before you start.” So we check her vitamin D, we check her arsenic, selenium and a few other things.

And she starts on her sardine challenge, her sardine journey. And she goes 100 days, 100 days of only sardines. And not only does she, first of all, her vitamin D, she did not take any vitamin D. She stopped her vitamin D. It went from like the 30s and 40s up to just maybe over 100, 108 or something. Her selenium didn’t do anything naughty. Her arsenic did not do anything naughty like Joe Rogan said it would.

And she was able to not only shed the pounds, but really say some truths about why she was eating so much. And she confronted the pathology about why. Why is she using food for those other things?

You know, I do this thing in the 21 day where I ask them to find their best day in their life. And I’m trying to just get them to think about, what does that feel like? What did that look like? And then we go to the worst day in their life.

And Jane wrote something that really touched me. She said, “I don’t think I’ve ever had the best day of my life.” This was probably the third or fourth time we’d done that exercise. So she’d done it in a way where it didn’t bring any extra attention. But she spoke a truth that just said, “I’ve had this fear for so long that for the first time I’m going to say out loud that I’m looking for the best day of my life. And I feel like I have the freedom to do it.”

That’s what happened after 100 days of sardines.

Gut Microbiome and Fiber Myths

STEVEN BARTLETT: So if she eats sardines for 100 days, she’s probably not going to get, like, the gut microbiome.

DR. ANNETTE BOSWORTH: She has the best gut microbiome.

STEVEN BARTLETT: Doesn’t she need to be eating plants to…

DR. ANNETTE BOSWORTH: Oh, no. Fiber’s for farting. So you’re looking at a gut biome. Right. And so tell me what you think that is.

STEVEN BARTLETT: Lots of bugs that have been feeding on plants.

DR. ANNETTE BOSWORTH: Okay, yes. Butyrate has part of that equation. So gut biome is the slime layer inside your gut. And it’s where the critters live, it’s where they set up homes. And if you have a really good slime layer, it’s squishy, it’s dense, it’s not moth eaten, it’s not aqueous or water. Like, it’s squishy.

And when you put plants in there, when you put fiber in there, it tears that down. And you say, “Well, fiber’s needed for this because some of those bugs eat up on the fiber and they put out some butyrate and that helps these other bacteria to grow.” You’re like, yeah, that’s one way to get a good microbiome.

But we haven’t been fiber eaters forever. And when you look at many of my carnivore patients, especially when they’ve got some of those little fish scattered into that carnivore diet, their symptoms of irritable bowel, of chronic diarrhea, of bloody ulcers, reverse. Why? Because that gut biome got a lot stronger and a lot healthier.

Addressing Nutritional Concerns

STEVEN BARTLETT: So the things that, from doing this podcast for a long time, the things that I’d be concerned about if I just ate sardines for a prolonged period of time or really any diet, I guess for a prolonged period of time, a narrow diet would be the fiber issue we talked about and then all the other things that are just not in sardines. I mean, vitamin C.

DR. ANNETTE BOSWORTH: You still get a good vitamin C. So vitamin C has different rules when you go carnivore.

STEVEN BARTLETT: What about magnesium?

DR. ANNETTE BOSWORTH: Yeah, lots of that. Magnesium, I still think is one supplement we all need.

STEVEN BARTLETT: What about sodium overload? Because these are very salty. Right.

DR. ANNETTE BOSWORTH: Your sodium churn. How well you use sodium is dependent on how well you’ve eaten in the last week. So when you increase the sodium, those receptors get better. When you decrease the sodium, those receptors shut down. That is an adjustment that everybody will make.

STEVEN BARTLETT: What about things like mercury and other sort of metals, toxins, little fish, little problems.

DR. ANNETTE BOSWORTH: You’ve got the right one for mercury again. We tested that for her too. 100 days, no problem.

STEVEN BARTLETT: Especially in the can as well. I think I’ve got a bit of an issue with canned food these days because I’ve had so many microplastics, microplastic toxins, etc.

DR. ANNETTE BOSWORTH: I think you’re majoring in the minor leagues there that the amount of benefit that people get from sardines versus whatever might be in those, in that can. I tell patients not to worry about it.

STEVEN BARTLETT: And then the last point I said was about digestive and mood issues because the gut microbiome is so, so linked to brain.

DR. ANNETTE BOSWORTH: Absolutely.

STEVEN BARTLETT: Serotonin, isn’t it?

DR. ANNETTE BOSWORTH: The serotonin is in the gut, but it’s a huge part of like a GLP-1 GIP. They’re all produced hormones in the gut that are hugely impacting your brain. And when you want GLP-1 to be made, have a strong, thick microbiome, you do not need fiber to do that. You need butyrate.

Butyrate is that 2 carbon fat that comes from Akkermansia chewing up the fiber. Right. Or beta hydroxybutyrate in your blood. That’s that ketone thing you got over there.

STEVEN BARTLETT: Oh, these things?

DR. ANNETTE BOSWORTH: Yeah, all of them. Hashtag there you go, yes, it’s a beta hydroxybutyrate is what that is going to turn into your circulation. Butyrate is a fat chain that’s two carbons long. That’s what you’re asking that microbiome to say here, this long string of fibers coming along and that little bug is going to eat a piece of it and make butyrate. Two carbons of fat.

That’s one of these things that you’re talking about. You need to have butyrate. You need to have butyrate. That’s what every, every. Why are you even vitamin. You got to have butyrate.

The Diversity Debate

STEVEN BARTLETT: All these experts come on my show and they talk about the importance of having a diverse…

DR. ANNETTE BOSWORTH: I know, I’ve watched a bunch of them. Diverse microbiome. Yes. And what I think.

STEVEN BARTLETT: So it’s not going to be diverse if I’m just eating one thing.

DR. ANNETTE BOSWORTH: Oh yes, it will measure. So that’s the whole point of a microbiome is what, you know, diverse enough to be supportive. I mean diverse enough to have the two chain fat that you want to have in there. I mean go back and look at when our bodies were just eating, you know, fish or carnivore. The beauty of a microbiome is how much it does adjust in every patient.

Essential Supplementation

STEVEN BARTLETT: What about supplementation? What are the key supplements that you don’t live without on a daily basis?

DR. ANNETTE BOSWORTH: Vitamin D turns out to be a really important one. If I’m eating sardines, four or five cans a week, I probably don’t need vitamin D.

STEVEN BARTLETT: But why is it so important? Vitamin D?

DR. ANNETTE BOSWORTH: Yeah. It’s a hormone, right? A hormone that goes and talks to every one of the cells in your body and it tells that cell to be its best version of itself. That hormone goes to the nucleus and it makes that skin cell do something different. It makes your brain cell do something different. It makes your heart cell do something different.

You read all the benefits about vitamin D and you think it’s like, it’s like it does everything, like how can I do all of these things? And the reason why is it is not just a vitamin, it’s a hormone that changes how the cell functions. Unfortunately, it’s made of fat. So if you have high insulin, it gets stuck parked in your fat cells and it didn’t get to the cell.

STEVEN BARTLETT: Is there a link between vitamin D and ketosis and weight loss and insulin?

DR. ANNETTE BOSWORTH: Yeah, it’s actually why I pointed out that when Jane did that hundred day, she’s been struggling with her vitamin D in the 30s or 40s.

STEVEN BARTLETT: Right.

DR. ANNETTE BOSWORTH: But for the best brain, we want it to be of 50. So she starts on the sardine challenge. It’s in the 30s or 40s and she’s supplementing, she’s taking as much as she can. But what’s happening, her insulin was putting it in her fat. She goes on sardines which have vitamin D in them. By the end, her vitamin D was 105, 108, something like that.

So you can see the experts say, don’t go above 100. But I don’t. I don’t have any worry about hers being 108. What happened was she lowered her insulin and now fat can move around in her body like it’s supposed to. And part of that fat isn’t just her estrogen, it was her vitamin D.

STEVEN BARTLETT: She looks like 20 years younger.

DR. ANNETTE BOSWORTH: Isn’t it amazing? You should see how joyful she is. That’s the part that you’re like, what unlocked during those 100 days of, you can say food restriction. But vitamin D went up, insulin went down. And she really said, how many things am I going to comfort in my life from food? And let’s tackle that demon.

STEVEN BARTLETT: Did it stick?

DR. ANNETTE BOSWORTH: Yeah, that’s the cool part.

STEVEN BARTLETT: What about the other supplements that you would not live without?

DR. ANNETTE BOSWORTH: Well, I think the whole world’s low on magnesium. I wish I could…

STEVEN BARTLETT: Magnesium?

DR. ANNETTE BOSWORTH: Yeah. So magnesium is required for every little. It’s like the spark plug in our bodies. It’s a little metal. And it’s how ATP gets recycled. And you need it for almost every enzyme. But our food is low on it, our soil is low on it. You just got to replace it. I use magnesium supplements, but I also have my patients go for a magnesium float.

STEVEN BARTLETT: What’s that?

DR. ANNETTE BOSWORTH: Ever seen pictures of people in the Dead Sea?

STEVEN BARTLETT: No.

DR. ANNETTE BOSWORTH: They’re floating, right? The salinity or the salt level is so high. And it stinks, right? It’s a stinky place. It’s magnesium. So they go in there, they soak in the magnesium, and you’re like, “Oh, my gosh, I feel so much better.” Like, that’s got to be junk science, right? Well, it turns out it’s not. So you can get magnesium absorbed through your skin. And just like, I don’t know, in the 1990s, you’d go rent time in a tanning bed. You can rent time in a magnesium float.

STEVEN BARTLETT: Any of this.

DR. ANNETTE BOSWORTH: So Omega 3, if you’re not doing fish, you can’t go wrong with Omega 3. And you know, Steven, I really push my patients to have ketones around.

STEVEN BARTLETT: When you say ketones, you mean external exogenous ketones.

DR. ANNETTE BOSWORTH: Yeah.

STEVEN BARTLETT: So the word exogenous means external, externally consumed. And there’s some on the table here. I’m an investor in this company, actually, so that’s probably worth saying, ketone IQ. You’ve got some other ones here, which are. What’s this? It’s like a…

DR. ANNETTE BOSWORTH: That’s ketone salts. So this one is just beta hydroxybutyric acid. My husband is deathly allergic to stevia, so I said, I’ll make this one for you, honey. It’s just liquid ketones, okay? No sweeteners, no fillers, nothing.

STEVEN BARTLETT: And is there a difference between taking external ketones through a drink or through the salts or whatever else, versus actually being in the ketogenic state because of your diet?

DR. ANNETTE BOSWORTH: When you make it, it is much more abundant. But when you do what people do, they fall off the wagon, or they’re very insulin resistant, so their body is trying to catch up to equilibrate. You want ketones put back in circulation because it will spark their liver to make ketones.

So it really is a jump start for patients with chronic insulin resistance, chronic problems. We got about six years of getting them to the healthiest version of themselves, as long as they don’t fall off the wagon. So when they are doing okay, and now they need to get back on track, give them a dose of ketones.

And by putting ketones in their circulation like that, by checking their blood, the liver will make ketones. So it’s not just a fuel. They will feel better. It’s a signal for the liver to make more ketones.

STEVEN BARTLETT: But I’m not going to be burning fat then, am I?

DR. ANNETTE BOSWORTH: You will. I mean, again, ketones beget ketones. When you are making ketones, your body makes more ketones. So if you jump start it by swallowing some, you get better tomorrow. Get better tomorrow.

And usually if somebody’s fallen off the wagon, I’ll have them do ketones for like three days. And the fourth day they are on their own again and they’ll stay steady for a couple of weeks and then they’ll have pasta.

STEVEN BARTLETT: That’s why I invested in this company, because I’m actually a co-owner of the business now, because I saw the benefits of having exogenous ketones on a regular basis.

DR. ANNETTE BOSWORTH: Right.

STEVEN BARTLETT: So if anyone wants to try them, go to ketone.com and your brain will…

DR. ANNETTE BOSWORTH: Use it like that.

STEVEN BARTLETT: It’s super fast.

DR. ANNETTE BOSWORTH: Beautiful. Right?

STEVEN BARTLETT: When I use my ketone reader, it appears in about 15 minutes or 20 minutes or so.

DR. ANNETTE BOSWORTH: And their liver then makes more ketones for the next 12 hours. That’s the part that I… especially for my cancer patients or people who are really, I mean, we need ketones high for their… they got chemo tomorrow. They can’t afford to say, go fast for 48 hours. They don’t have the time. So let me help you.

And there’s nothing better than going into that chemotherapy, going into that radiation with a bunch of antioxidants in circulation coming right out of your liver.

Grandma Rose’s Cancer Journey

STEVEN BARTLETT: Explain why that matters. I mean, I’ve got a photo here.

DR. ANNETTE BOSWORTH: Of Grandma Rose.

STEVEN BARTLETT: Grandma Rose?

DR. ANNETTE BOSWORTH: Yeah, that’s my mother. Yes, she is the reason I’m here. It’s been five years. Yeah. 2015, the most stubborn patient walks through the door after 10 years of the best health care I know how to give. And she’s gray, she looks like a zombie, and she’s got big lymph nodes in her neck. You don’t need to be a doctor to know that she’s dying. Cancer is back again.

And we go to see the oncologist and he says, “You need chemotherapy.” And she says, “Like hell. The last two times you did that to me, I didn’t know what a sewing machine was.” And she made all of my clothes until I was the age of 10.

And she’s nervous because she has six months to live if we don’t do something. And she asks me a question that lots of patients have asked me this question. I just sometimes lie. She said, “If it was you, what would you do?” That’s a really emotional question. Because there’s guidelines, there’s rules. Here’s what you’re supposed to do as the doctor. Oh, and it’s your mom.

And I saw what chemotherapy did to her. It was terrible. She didn’t know the grandkids. It was terrible. And we just got her back to functional again. And so I had been reading about the ketogenic diet on brain injuries, and I’d come across a couple of studies on what it can do to a cancer patient, especially an insulin driven cancer patient like she was.

I said, “Mom, do you trust me?” Like a fool, she said, “With my whole life.” We were standing there in the waiting room of the hospital. One way was to schedule the chemotherapy, and the other way was the front door. I said, “Mom, let’s get in the car together.”

I left my car there. I drove to my family farm, which is a hundred miles away, and explained to my mother what a ketone was. And her brain wasn’t working right, so she didn’t quite remember. And we went to the house. We threw out every carbohydrate.

At six weeks with chemotherapy, her numbers were supposed to drop by 30% of her cancer. We didn’t tell the doctor. We just put her on a ketogenic diet and said, “We’ll come back in six weeks.”

So she’s walking through the door of the hospital. It’s six weeks from there, and it is like God has just… the Holy Spirit is rising out of her. She looks amazing. So we go to get her blood drawn. We’re sitting in the waiting room for the cancer doctor. He’s my friend, he’s known me for 10 years, so I’m scared to tell him what we’re about to do.

So we’re sitting in there waiting, and they come and draw our blood again, which either means it’s really good or it’s really bad. And so I get really nervous at the end. We’ve been in that room for about an hour. And I said, “Mom, if he asks you what you’re doing, just shut up. Because I don’t know what to tell him.”

And he walks in and he slides the piece of paper over to me and says, “How did you get her numbers to drop by 70%? There’s no drug on the market that would do that.”

STEVEN BARTLETT: When you say numbers, her cancer numbers.

DR. ANNETTE BOSWORTH: So the chemo would have dropped it by 30%, and the ketogenic diet dropped it by 70% in six weeks. And she went from a 70 year old that looked 100 to a 75 year old who looked 40.

STEVEN BARTLETT: How did your mother get on from that point onwards?

DR. ANNETTE BOSWORTH: Yeah, she lived her best life. I mean, I talk about her being from this little town of 800 people. She was Mary Poppins. I mean, like you don’t have a ladies’ aid unless you’re part of the ladies’ aid in the little small town. You don’t have a Sunday school teacher unless you’re doing the Sunday school. She was in every aspect of this little town and she went back to doing all of it.

And the pandemic hit and there’s a thrift store that she would volunteer at because, well, it’s just a good place to put your time and the community needs it. And while she was at the thrift store, she got Covid and her cancer was of the T cells, which means it’s going to be the first line of defense against Covid and her T cells failed.

The Science Behind Keto and Cancer

STEVEN BARTLETT: Some of the science behind this talks about how cancer cells often rely heavily on glucose for energy, a phenomenon known as the Warburg effect. The keto diet drastically reduces carbohydrate intake, forcing the body to produce ketones for fuel instead. Most healthy cells can use ketones efficiently. Many cancer cells cannot.

So in theory, keto could starve tumors while supporting normal tissue. And they’ve done some animal studies that show it can slow tumor growth in some cancers, especially brain cancers like glioblastoma.

DR. ANNETTE BOSWORTH: Yep.

STEVEN BARTLETT: Enhanced response to radiation or chemotherapy in certain models and reduce inflammation and oxidative stress, creating a less cancer-friendly environment. However, results are mixed. It may also benefit muscle mass and weight stability in patients. Losing muscle from treatment may improve energy levels and mental clarity for some people and could reduce insulin and IGF-1 levels. Hormones linked to cancer growth may improve quality of life when used alongside standard treatments like chemotherapy.

There’s also a list of potential risks which I’ll throw up on the screen. And I guess the summary here is keto may help by lowering glucose and insulin, reducing inflammation and supporting metabolism. But it can be risky if it leads to malnutrition, fatigue or worsened treatment tolerance.

DR. ANNETTE BOSWORTH: When patients… I get a lot of people calling and saying, “Is it going to help my cancer? Is it going to help my cancer?” Steven, I go back to the same thing. The amount of trash that you’ve not been taking out, we have to start.

And when you put them in a ketogenic state, I mean, it really helped her cancer. It really did that Warburg effect. She was a new human within three weeks, but she had a lot of trash to take out. This was a year and a half before she got to be the best version of herself. And it really did return and restore her to health.

When I look at patients now who say, you know, “Am I going to reverse my cancer with a ketogenic diet?” I’m like, “No, but you are going to deal with it a lot better.”

Creating a Better Environment for Health

STEVEN BARTLETT: I guess that’s really what it comes down to. It’s like creating a better environment so that if disease does arrive, obviously there is a, you know, with a lot of diseases, there is a causal element where the way we eat and our lifestyle does create the disease.

DR. ANNETTE BOSWORTH: Right.

STEVEN BARTLETT: But also when that disease arrives, what environment is your body in to deal with it, manage it. And I think a lot about this, I think in part because of the pandemic where for the first time in my fairly young life, I saw that your current physiological environment, so the current state of your body was the single biggest predictor of your outcomes.

DR. ANNETTE BOSWORTH: Amen. Oh, it was terrible.

STEVEN BARTLETT: So I hit 30 years old, and it’s like, well, if you’re currently overweight, your chance of dying from Covid is really, really high. And so I think that was one of the big sort of protagonists in me getting into shape, was realizing that, you know, disease is probably going to happen to me, but how my body responds to it is to be determined.

DR. ANNETTE BOSWORTH: And I look at how much… when you’re asking an elder person to lose weight and you just read something really important there, which is when those ketones are in circulation, it is a signaling agent to make more ketones. But it also signals the body to say, “Don’t use muscle mass as a resource. Go for the fat.”

So you can see this protective… I mean, you take people through chemotherapy and they have, you know, they shed way too many pounds, right? You put them in a ketogenic state and their muscle mass gets higher, preserved their brain function, their ability to handle this. You know, one of life’s most enormous fears is death and that mood stability and muscle mass protection because they’ve got ketones in circulation. Boy, that’s the gift that they need right now in high numbers.

Methylene Blue for Brain Health

STEVEN BARTLETT: What is… I’ve heard you talk about methylene blue for brain health.

DR. ANNETTE BOSWORTH: Ever done that?

STEVEN BARTLETT: No.

DR. ANNETTE BOSWORTH: Oh, my goodness.

STEVEN BARTLETT: What is it?

Methylene Blue: A Powerful Brain Supplement

DR. ANNETTE BOSWORTH: Well, it’s old as dirt, so nobody’s making money on it. But it is a dye. And so if you swallow it you’ll pee blue. But it’s also a bridge for how to help mitochondria move fuel along. So one of the worst parts. You asked me this question about supplements, and I really have a tough time saying which supplements actually get to the cells that the patients are looking for.

There is a really great fact about methylene blue that when you swallow it, it actually was used for malaria treatment or anti-malaria for soldiers. And they would check compliance by making sure that their pee was blue. But when they died at autopsy, they had blue brains and blue hearts. It would dye these organs blue. You say, my gosh, that’s so strange. But, you know, that tells me it got to the cells that it was advertising it was going to get to.

So you look at methylene blue, it’s supposed to supercharge your brain. And I’m like, yeah, yeah, yeah, I’ve heard this before. So I read about it. I’m like, wow, there’s a lot of literature on this. And then I did what I normally do, which is, well, let me take it for a couple weeks. It was amazing. It was amazing. Like, I was floored at how well that little turkey works.

So there’s no money to be made on it. It’s been around as long as dirt. But it’s a powerful brain energizer. Like, it helps the electrical stimulus of the mitochondria in your brain keep energy high. And especially for like, high energy brains. I love it. I’m like, I put that in my morning coffee. Which is where the April fool’s joke, because nobody can see it in their coffee, but they definitely pee blue.

STEVEN BARTLETT: And do you take creatine as well?

DR. ANNETTE BOSWORTH: I do take creatine, yeah. It’s great. Fat brain supplement is awesome.

STEVEN BARTLETT: You do? I do. But my doctor the other day, I think he was suggesting that I might have taken too much.

DR. ANNETTE BOSWORTH: Why?

STEVEN BARTLETT: Some liver scan I had and he…

DR. ANNETTE BOSWORTH: Liver scan or kidney scan?

STEVEN BARTLETT: Kidney scan.

The Truth About Creatine and Kidney Function

DR. ANNETTE BOSWORTH: Kidney scan. So that’s a trick. Don’t fall for that. I mean, I’ve done a couple of big shows on this where creatine is what you’re going to measure kidney function with. When your doctor checked your kidneys, he probably had you pee in a cup and check your blood. Yeah, yeah. So he’s looking at what did you pee out and how clean is your blood. That’s what kidneys do.

STEVEN BARTLETT: You just did a blood test.

DR. ANNETTE BOSWORTH: Okay, well, even the blood test, the trash was looking like it was a little higher because the trash we’re measuring is creatine creatinine, which is made from your supplement. So you put the supplement in and it looks like there’s more trash around. But that’s just the supplement. It’s falsely elevated. It’s not true. Your kidneys did not get hurt by that.

I answer this question probably 30 times a week. I have a standard email saying, here’s what happened. Don’t measure that. There’s other ways he could have measured your kidney that would not have been manipulated by that supplement. What it does for brain function, especially if there’s any ADHD, man, they love it. They just focus for a long period of time.

I mean, it’s got other great findings. Like how often do you fly over to London?

STEVEN BARTLETT: I fly a lot.

DR. ANNETTE BOSWORTH: Yeah. That’s the best part about it is that the jet lag part of it, there’s really good studies on this. Like your reset of sleep is going to be augmented if you take like 20 grams of it after the flight. 10 in the morning, 10 at night. And those are great studies. Like Navy SEALs, sleep deprived. Watch what happens when you add creatine.

STEVEN BARTLETT: A lot of women don’t take creatine because they’ve historically thought of it as like a bodybuilder thing.

DR. ANNETTE BOSWORTH: Right. It’s a brain thing.

STEVEN BARTLETT: And you take creatine every day. How much do you take?

DR. ANNETTE BOSWORTH: So two scoops? Yeah.

STEVEN BARTLETT: Every single day?

DR. ANNETTE BOSWORTH: Every single day, seven days a week. I put my methylene blue in it too. Down at first thing in the morning. I got blue dyed creatine. I mean, those two supplements are just. They blew my mind with the amount of research out there. And then I did them. I mean, I’m not a big bodybuilder. I do some crossfitty kind of stuff three times a week. So there’s that. But I do it for the brain stuff. The brain stuff is really impressive.

GLP-1s and Natural Alternatives

STEVEN BARTLETT: At the moment in society, people are talking a lot about GLP-1s and Ozempic and all this kind of stuff. And I was wondering if there’s any harms or downsides in your view of using these Ozempic, Wegovy, GLP-1 protagonists, antagonists, and if there’s a natural version for those of us that are looking to have less cravings. But we don’t want to take GLP-1s. We don’t want to be injecting ourselves.

DR. ANNETTE BOSWORTH: Yeah. So those hormones are powerful. I mean, if you think that weight loss isn’t a hormonal problem, show up at a medical clinic. They are powerful hormones that hijack people into a healthier or at least a weight loss stage. But when you’re looking at using this powerful hormone, okay, and use it for a short time, use it for a long time, what are the rules? These are brand new.

One of the analogies I use for patients is, Steven, if you wanted to have legs with no hair on them, how would you accomplish that?

STEVEN BARTLETT: Shave them.

DR. ANNETTE BOSWORTH: Right. Because that would be short term, easy and reversible. You would not take chemotherapy. The most powerful, amazing there’ll be. Every hair on your body will be off in the next two weeks. In the short term, they’ll come back. But there’s a price to pay when you’re using a really powerful unit to do something for a vanity reason. So it’s where I like to begin when I talk about GLP-1s. It’s amazing. You will lose fat.

STEVEN BARTLETT: And what do I do instead, then?

DR. ANNETTE BOSWORTH: So there’s great ways to lower GLP-1s or great ways to raise GLP-1s. Right. For starters, when you’re overweight, it suppresses it a lot. So getting the weight off is a huge part of it. That’s why this ketogenic diet is so powerful. We’ll get the weight off, and that will lift naturally the GLP-1s.

STEVEN BARTLETT: Is there other ways to suppress. Well, suppress. I was going to say suppress my appetite, but more to just get rid of the cravings.

DR. ANNETTE BOSWORTH: Well, you’ll suppress the appetite by raising those hormones. So you put in allulose. That’s a great little boost to that. You put in butyrate, whether or not that’s the bug that you were talking about or the supplements. Butyrate increases and stimulates GLP-1 and butyrate.

STEVEN BARTLETT: Just for those that want to know that word again, right.

DR. ANNETTE BOSWORTH: That is what a ketone looks like floating around your blood.

STEVEN BARTLETT: Okay.

DR. ANNETTE BOSWORTH: Yeah. So a ketogenic state will raise those hormones and suppress appetite.

STEVEN BARTLETT: I’ve seen a bunch of studies on that that show that when people are high in ketones, they have a suppressed appetite.

DR. ANNETTE BOSWORTH: Right. And that is linked to the production of some of these hormones, these really great hormones. But you make them naturally. And so it’s not the addiction part, it’s the natural way to make it.

STEVEN BARTLETT: I do find that. Anyway. I find that when I guess it could be something to do with my dopamine receptors as well in my brain. But I find that when I’m in a ketogenic diet, my cravings for the things that I once craved, like, I don’t know, like carrot cake or cinnamon rolls, they just completely seem to vanish.

DR. ANNETTE BOSWORTH: That’s the same thing that happens when you give them that shot, too.

STEVEN BARTLETT: Oh, really? When you give them GLP-1?

DR. ANNETTE BOSWORTH: Yes.

STEVEN BARTLETT: Okay.

DR. ANNETTE BOSWORTH: And I mean, the beautiful part is you’re young, you’ll make a lot of GLP. You’ve already made healthy GLP-1. You’ll hijack and suppress it by being overweight and high insulin. So constantly delivering ketones to your blood, that’s how you keep it high and you don’t end up on the shot, which is expensive and very powerful.

The Role of Motivation in Weight Loss

STEVEN BARTLETT: I always think, you know, when we give people advice on things like weight loss, there’s always a part missing, which is this part about, like, discipline and motivation or whatever one might call it, which is the. Is gives somebody the sort of activation energy to even stick to it. Do you think about this much in your patients? You think about motivation?

DR. ANNETTE BOSWORTH: It’s huge. I mean, again, most people show up because there’s been a recent crisis, somebody died, they had a diagnosis, something broke, they didn’t repair. Well, all of that is true. And I can get them motivated for a little while. And then we have the long game.

You look at that story with a hundred days of sardines, okay? That’s two years into her journey where she finally says, okay, there’s this demon that keeps coming about and I keep falling off for all the wrong, you know, all the reasons everybody else does. And so she commits to this 100 days, and what happens is a whole bunch of things go right. Her hormones go up and she has an amazing story.

But most people are not going to do that. So in my practice, I do say that the smallest dose of these hormones. I’ll help you when you’re struggling. I want you in a ketogenic state before we begin. I can use much less that hormone. And then you have ownership of this, because if I come in and do all of the work again, that’s like every other thing I’ve been doing for the last 20 years. Here’s your symptom. Here’s my diagnosis, here’s the prescription. And I need it to be you that succeeds. Here, I’ll lift you a little bit.

STEVEN BARTLETT: So what do you. Is there any tricks to get someone to be motivated? Is there any. Do you have to focus them on their why?

DR. ANNETTE BOSWORTH: Yeah, exactly. Right. You’re right. That first trick is get out of crisis mode. Okay? Crisis is what brings them in. But to stay the course, you have to get to a very serious moment where you say, what? What motivates me? What? At the deepest heart am I most insecure about that? I’m going to do when all else fails, when everybody else gives up, I’m going to find something that I’m this little farm kid from the middle of nowhere who was, you know, third grade stinky girl, you know, like I was a farm kid. I was a hog farmer’s daughter. I wasn’t the smart one. I wasn’t the, you know, the best one.

I’m going to carry that insecurity with me until the day I die. What has that done? It makes me work really hard when everybody else gives up. Now, finding that for them and using that, using that harness to say, your biggest failure, your biggest insecurity can be your power by reframing it. That why we work on that every time we do that 21 day. Jane, she did that four times before she really got to the core center. Why do you keep doing this? That’s how people stay motivated. It’s a true serum.

The Breaking Point: Corporate Medicine and Fighting the System

STEVEN BARTLETT: I was reading about what happened to you in 2011, 2010, 2011, when you reached what you referred to as your breaking point with corporate medicine.

DR. ANNETTE BOSWORTH: Yeah.

STEVEN BARTLETT: And you had some issues because you were, I think, helping some people who were homeless.

DR. ANNETTE BOSWORTH: Yep.

STEVEN BARTLETT: What do I need to know about that and how has that shaped you?

DR. ANNETTE BOSWORTH: Corporate medicine has lots of flaws and you get tired of answering the same question over and over and over again. So you put some stuff up on YouTube and you start to say, “Here’s the education I wish I could give you.” And this starts to work. But that’s not the path. If you’re into corporate medicine, you’re going to ruffle feathers, you’re going to tick people off.

I left corporate medicine, started my own thing and I’m living out a two year non-compete. Do you know what that means?

STEVEN BARTLETT: That you can’t do medicine for two years?

DR. ANNETTE BOSWORTH: In that same market where they recruited me and they had advertised for me. So you can’t compete with what we just put money into for two years. And they said you can see the homeless and you can see Medicaid.

STEVEN BARTLETT: Medicaid being the government funded medicine program, low income.

DR. ANNETTE BOSWORTH: So I said they don’t know me very well. Those are just as much my people as anybody else. I’m taking care of some Native Americans. They were the ones in the shelters, they’re the ones with the low income. And those teenagers were overweight and they were eating kitty litter, they were eating toilet paper. Their iron was so low the machine couldn’t measure it. So they’re super malnourished.

I started doing what I would do if you had all the money in the world. I took care of these patients. I gave them IV iron.

STEVEN BARTLETT: So you gave them iron, which was expensive.

DR. ANNETTE BOSWORTH: It caused a ruckus. I got put on the radar of somebody that did not like that. So this is the budget. The whole state gets a budget for how much you’re going to spend on each patient.

STEVEN BARTLETT: Yeah.

DR. ANNETTE BOSWORTH: I mean, by expense, it was like $350 per person. That’s not that expensive. But it was. And nobody else was doing it. And I got a sticky note inside an envelope from the state capitol. “Stop doing Cadillac medicine.”

The Medicaid Fraud Accusation

STEVEN BARTLETT: So you were sued eventually.

DR. ANNETTE BOSWORTH: Oh, they call it Medicaid fraud.

STEVEN BARTLETT: Okay.

DR. ANNETTE BOSWORTH: They thought I was wasting Medicaid’s numbers because I was giving IV iron. And I said, “No, I didn’t bill for it. I paid for it.” And when I paid for the medicine for these impoverished patients, they said, “Well, that’s Medicaid fraud.”

So the government tried to sue me for that, and they lost. But now they’re ticked off. They’ve brought me to court, and they lost. And what happened next is a lot worse. I don’t know if you want to hear that. You want me to go there?

STEVEN BARTLETT: Of course.

DR. ANNETTE BOSWORTH: Yeah. Okay. So when you are being investigated for Medicaid fraud, all income stops.

STEVEN BARTLETT: Yeah.

DR. ANNETTE BOSWORTH: Yeah. So I have to come home to my husband and say, “I just can’t give in. I think we need to fight this.” He said, “Okay.” God bless him. He said, “Okay, let’s fight it.”

Have you ever tried to fight the government? That’s very expensive. So they hold off. When you’re under a Medicaid fraud investigation, you get no paychecks. So we have no paychecks to pay payroll, to pay house payments, to do anything for about nine and a half months. Actually, it lasted longer than that.

During that time, we started doing things like we sold the lake cabin, we sold the boats, we sold the extra car. We sold our own house. We moved into a donated RV.

STEVEN BARTLETT: You moved into a car, an RV?

DR. ANNETTE BOSWORTH: Yep. In South Dakota, where there’s 50 below zero weather with three little kids. We actually used, we took our wedding rings in for the last paycheck. I just can’t give in. And then I won. Okay. So Medicaid fraud wasn’t there.

Running for US Senate

But in the midst of that, I said, this was when Obamacare was really happening. And I got asked to run for US Senate. There’s only 100 of those in the country. I run for US Senate, and I did really good. I raised insane amounts of money saying, “I am a doctor that serves the poor. I am a physician that runs their own company. I think I am a great voice to send to Washington, D.C. to make policy about patients and care” as opposed to the other opponents.

But that same attorney general, his best buddy was running against me. And when I am in a mission trip in the Philippines, that has nothing to do with it, but I was on a mission trip in the Philippines, and I left a petition behind. I don’t know how you do it in London, but a petition means if you’re going to run for office, you got to get some people saying they believe in you.

So we needed 2,000 signatures, and we got 6,000 signatures. We submitted them to the state. We think there’s no problem. But then the quarterly earnings come back for a campaign raising. And my opponent had about 70 donors at about $10,000 a pop and had something like $740,000.

I put my earnings in, and they were $780,000. So I outraised him. You have to report to the government whenever somebody gives you more than $200. So his donors are right there on the list. My list is empty because the average size of the donation was $45.

And they know they can’t win with that. I have a grassroots behind me, and that’s when the black cars started showing up in my life. It sounds like I’ve got a tinfoil hat, but it was real.

STEVEN BARTLETT: The black what?

DR. ANNETTE BOSWORTH: The state cars started to show up outside my house. They started to say, “Find something on her.” And I am the first person in the history of the United States of America to be investigated for not witnessing a signature on those petitions.

The Petition Controversy

STEVEN BARTLETT: Okay, so there were these petitions. You had to get 2,000 of them signed, and you had to witness them. So you had to be there when they were signed by people.

DR. ANNETTE BOSWORTH: Well, that’s what it says. And you’re right. It says, “I bear witness.” So as I’m, I left them in my clinic. My staff signed it, the preachers in my clinic signed it, and those signatures were collected while I was in the Philippines.

STEVEN BARTLETT: And so you signed to witness them when you were back from the Philippines?

DR. ANNETTE BOSWORTH: Right. So I didn’t witness them. I just vouched that that’s my sister. That’s the preacher. I know who these people are.

STEVEN BARTLETT: And so they charged you for, they realized that you were in the Philippines at the time, so you couldn’t have witnessed them based on the dates or something. And then they arrested you.

DR. ANNETTE BOSWORTH: 12 felonies.

STEVEN BARTLETT: They gave you 12 felonies.

DR. ANNETTE BOSWORTH: And 24 years in prison.

STEVEN BARTLETT: That’s what they charged you for?

DR. ANNETTE BOSWORTH: That’s what they charged me with. 12 felonies, six counts for each of the six petitions. So there’s 12 felonies, there’s six mistakes, but each mistake counts for two felonies. I mean, if you’re going to make a mistake, there’s one felony when you’re trying to make a statement.

There’s 12 felonies, and you’re the first one in the history of the United States of America to ever have this charge, let alone brought to trial and then found guilty. The trial didn’t happen in my state, my town. It happened in the state capitol, where everybody knew that attorney general, everybody knew the opponent.

The Sentencing

STEVEN BARTLETT: So they tried to get you to serve 24 years in prison?

DR. ANNETTE BOSWORTH: Yeah, they sentenced me to 24 years in prison.

STEVEN BARTLETT: They sentenced you to?

DR. ANNETTE BOSWORTH: Yeah, my kids are sitting behind me. “You are guilty of 12 felonies and 24 years in prison.” And then he says, “But the stack of papers in front of me might be the biggest.” He’d been a judge for 20 some years. And I had patients who had written in saying, “This is the best doctor I’ve ever seen.” I didn’t ask them to write that. They just sent them in.

STEVEN BARTLETT: That moment when you hear that you’re going to be in prison for 24 months, 24 years, oh, God.

DR. ANNETTE BOSWORTH: It is the lowest moment of my life. Because, I mean, I do not like that that story cost the state of South Dakota any money. But I also don’t like that when you oppose the political giants and you stand there with all of the right intentions, that if they need to find something on you, they will.

Six petitions, and we had a thousand extra signatures. There was nothing. This was a nothing burger, but it was enough. And that attorney general said, “Prosecute her to the fullest extent.” And I’m not a martyr. I do things that aren’t right. And if there was a mistake that I made, I would take full ownership. And to that judge, I made, I took full ownership that the attorney general was, he won. I got sentenced.

STEVEN BARTLETT: But you didn’t have to serve the 24 years.

DR. ANNETTE BOSWORTH: He said, “I’ll probate that. I will suspend that.” With the highest number of service hours ever in the state of South Dakota was 500 community service hours serving the poorest patients in the state. And when he said those words, I thought, “Oh, my God, you don’t know who I am. That’s what I’ve been doing.” I was already working in Pine Ridge.

STEVEN BARTLETT: How do you feel about all of this?

A Test of Faith and Character

DR. ANNETTE BOSWORTH: I mean, I think of it as a test. It was a test of, I mean, most marriages aren’t going to make it through that. You’ve got kids, they’ll end up in rehab with that much stress. And I didn’t want that life. I didn’t want that to be my ending.

I framed it different. I said, all right, God, you’re testing me. You’re testing to say, can I be, can I stay true to who it is that you’ve called me to be? That our marriage was incredibly. That’s a lot of pressure.

I mean, I was the number one news story in the whole damn state for three years, running by a mile. I can’t go anywhere without. That’s her. That’s her. My parents were ashamed.

My kids would say, this is the woman that takes me to Haiti. She is Mother freaking Teresa. And now she’s on the front page of a newspaper as a 12 time felon. And your teachers at school say, I read about your mom in the newspaper. I mean, oh, it should have crushed me.

STEVEN BARTLETT: But it didn’t.

DR. ANNETTE BOSWORTH: It did not.

The Turning Point

STEVEN BARTLETT: When did your life begin to turn upwards from that point onwards? When was the moment where things were.

DR. ANNETTE BOSWORTH: Well, the first thing is we appealed that to the Supreme Court. That’s where the big legal bills come from. Like when you’re fighting an attorney general, that’s where. And the Supreme Court said that that attorney general abused his power for at least six of them. And then that judge said, I’ll erase all these because of the work you’ve done.

So the 12 felonies went away during who of them? All of them.

I think on the edge of that story, I work to resurrect people’s health back to a place where they get their best life. And yes, ketones are a really big part of that. But as you look at the relationships you’ve got around your life, take the core ones and nurture them to a place where your best life comes out of those relationships.

Find the purpose that you’ve been designed for and take those relationship with you as you seek that. I know that’s what happened to me. I cared about the ones on the inner circle and I had a one track of this is what I’m designed to do.

Finding Deep Inner Peace

STEVEN BARTLETT: We have a closing tradition. We’re going to ask you a question for the next. And the question left for you is do you have a daily practice to find deep inner peace when you are emotionally triggered? And if so, please share it with the audience.

DR. ANNETTE BOSWORTH: Yeah, I have a devotion that I do every morning that centers me, keeps me in line with my faith. And it’s not that you do it on the bad days, it’s that you’ve got the foundation for doing it on the good days. And there are a daily devotion like upper room is a. This is spiritual devotion for my church.

STEVEN BARTLETT: What does that look like? Is it a prayer?

DR. ANNETTE BOSWORTH: Yeah, it’s a prayer.

STEVEN BARTLETT: And how does that sound?

DR. ANNETTE BOSWORTH: Yeah, it’s usually a scripture and then it’s a prayer that has been paired with that scripture. And again, it’s easy to not do it routinely, but when you practice it on the good days, it’s what lifts you on those really tough days.

And sometimes you forget you’re not the first person to run through these problems. But there are thousands of generations that have taught you how to do life and get through those hard places. And I’m going to use their rules. I’m going to follow what that scripture says and lead for my best life.

Closing Thoughts

STEVEN BARTLETT: Dr. Boz, thank you.

DR. ANNETTE BOSWORTH: Very good.

STEVEN BARTLETT: We are done. I really think I really appreciate so much about you. I appreciate your personality. Well, I incredibly engaging. But I also just, I appreciate that you’ve taken the time to make so much content over on your YouTube channel, which I’m going to link on screen and below now to sort of demystify and break down some of these really complicated subjects that people struggle with.

And they’re looking for someone who they can trust, who has a bit of personality, who can communicate some of these very complicated things to them. And on your channel you talk about everything from the ketogenic diet to many things we talked about today, to the creatine stuff to cancer more broadly, this idea of autophagy and fasting and lots of other things. I mean, everything we’ve talked about today and much, much, much more.

So I highly recommend people go and check your channel out if they would like to learn more. It will be linked below. And you’ve written some wonderful books, some of them that we’ve referenced. We’ve got the Keto continuum, which I’m going to link below as well, this wonderful book called any way you can A beginner’s guide to ketones for life, which talks a lot about Rose and has some wonderful photos of Rose in that book. And we have the Ketone continuum workbook, which is a much more practical.

DR. ANNETTE BOSWORTH: Yeah, it goes hand in hand with the other one. And it’s what I give my patients in the clinic because they got to go through that workbook.

STEVEN BARTLETT: I think a lot of people are looking for exactly that. They’re looking for something that they can follow step by step, which gives them a framework for progress and I guess, in a way holds them accountable, which is exactly what the workbook does.

Thank you so much. You’re helping millions of people. You’ve had a f*ing rough ride. 12 felonies and 24 years in prisoners for something as little as what you did, I think is bizarre, quite frankly. But, you know, it’s a story of inspiration that it didn’t hold you back. And you’ve risen like a phoenix and created so much incredible work. Therefore, that’s benefit so many. So please do keep going.

DR. ANNETTE BOSWORTH: God bless you. Thanks for having me here. I’m really excited to be on your show.

STEVEN BARTLETT: Thank you so much, Dr. Boz.

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