So what would you do if you want to get yours from 5.5? Like if you were to put yourself on a plan for the next month to get it down to 5.5, what would you do?

Well, that's exactly what we did.

So there were three of us in the group that had ones that we were a willing to share and B said, okay, I'm going to make a change.

Mine was five, five.

We had one that was five, seven and one that was five, four.

I think those are the three numbers.

And we all said, okay, in the process of improving people, we talk about, you know, I, I call it a keto continuum.

So what are your thoughts on protein, especially when it plays out with hemoglobin A1C? And what are your thoughts on the carnivore diet?

responsibility.

And so I love the complexity.

I love the analytics.

I was really attracted to shock trauma because you could calculate a lot of the answers and it seemed black and white.

And then I had a baby on time as planned, but decided I wasn't going to spend the life there.

I was going to go to outpatient world and be a physician that didn't have 120 hours a week.

Um, and I loved that decision, but I brought to the clinical world of outpatient, a very analytical approach of how do you reverse problems? How do you actually get outcomes that improve the patient? Uh, I quickly learned that if you don't take care of their brain first, you're never going to get the diabetes to be better.

I just

Could you just kind of explain to them if they've never heard of it, what is the Dr. Boz ratio and how could it potentially help them?

First of all, let's make sure that it is the truth.

It's dirty math, people.

Your algebra teacher in freshman year would get really upset if they saw actually what's the curtain behind this little number.

And that is because it uses two different units, a glucose in the body and a ketone number in the body.

That measurement, units of measurement for glucose and ketones don't match, which is how it's dirty math.

I'll tell you where it started and then I'll tell you how it's used in research and as well as in a case like what we just talked about.

And the woman in front of me wasn't her.

So here's what happens after that

ester goes in, though, is that you will see a pretty rapid absorption into the bloodstream.

If you're pricking fingers, you'll see within, I mean, I think esters is like 15 minutes.

I think salts, it's like 20 minutes.

It's really quick on turnaround time to raise blood levels.

But what you care about, what this does is it does peak quickly, but then it does fall quickly.

or the salts have a little better arc of two to four hours that it's going to be in circulation, which does a better job of tick-click open the liver cells, saying, hey, make some ketones, make some ketones.

Every

The experience you think you have something wrong.

Right.

So it's a great it's a great organ to bring into the education kind of environment.

armamentarium for, for keto, because when you're looking at why people choose keto, um, sure there's weight loss, but it doesn't take, but a couple of weeks into this journey to say, wow, my energy feels so much better.

And when you watch, uh, the summary statements about how do you teach about thyroid, think of the thyroid as part of your throttle for energy, your throttle for how your body is running.

And just like any, um, dynamic engine, meaning one that can go faster and slower, there has to be this talking way that says how much energy does your body need and then how much can it supply? If you keep pushing really hard, asking for energy that you can't supply, the engine will have a collapse.

So your thyroid is very important for kind of sensing how much energy is needed to keep the body purring along and meeting the needs.

So How do they know? What tests do they order? What doctor do they see?

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The ketones went up a little higher.

Now we say that Dr. Oz ratio is in the two digits, which is really a reflection that the insulin has dropped, that the effect of insulin has dropped.

It's not just measuring insulin, but when you look at glucose and ketones, those are what insulin really has immediate impact on.

But then this happens.

Over the course of, doc, I'm following your 20 carbs or less.

And I eat them three times a day.

Why is this hyperinsulinemia, that is excess insulin, really a critical factor for well-being?

They needed the

providers, right? Yeah.

And I mean, the things that happened on that mission trip were it woke up my soul.

I remembered what it's like for patients to want their doctor to try.

And even though I felt really mal equipped, like, I can't do this.

I don't know what infections grow in Haiti.

But it wasn't that.

And if you've got to teach it, you've got to really know it.

It's due

... to cancel clinic.

[laughs] And I canceled it, sat in that, in that med school library for three days for like 16 hours each day just really saying, "Why don't, you know, here's what I would do.

Here's how you do this." And I'm a f- I'm kind of afraid to talk about it yet 'cause I don't really, I mean, I have a m- you know, kind of a academic but not, not a professorial, just like a student academic understanding of what this is.

So I say, "Okay, I'm gonna, I'm gonna go onto a ketogenic state." And I get these little strips, and I'm peeing on 'em, I'm peeing on 'em.

There's no ketones.

There's no ketones.

Mm.

So Dr. Boz, introduce yourself and then tell people about the cool research that you're working on.

Sweet.

Well, I try to set the framework appropriately and tell folks that I am from a dynasty of hog farmers.

Fifth generation South Dakotan, first born in my family, and my dad prayed for a boy, and he got me.

And I can tell you that my drive toward medicine was as eager about something I was very curious about equally driven by the way away from hogs.

So I landed in a place where medicine became a gift that I was first in my family to do.

But internal medicine was where I found my people, mostly.

So I would love to hear your take on it.

But how does insulin play a role in all of this, and what is insulin?

So insulin insulates, okay? So think of it as it makes you fluffy.

It makes-- It puts the fat on.

Uh, it's got some other roles too, but we're gonna talk about chronic diseases here, where it's not a scarcity problem.

You, 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.

-a reality show guy.

If you could tell me, what is the real benefit of the deep ketogenic state, and how is it that people don't just naturally get there?

Wow, that's a great question.

That's gonna be a great platform for bouncing off several of these other questions that I can hear coming.

First of all, I do think that our bodies are designed to, to heal.

I, I [laughs] don't think our bodies were designed for 2026.

I think they were designed for about a couple hundred years ago when, when the a- ability to get food and to eat food- Was not the number one thought that everybody holds onto for, I don't know, starting at 7 probably in our culture today, maybe younger.

Uh, and then they just, they feed the brain in a way that it's responding to how we act, but that action has now hijacked us into a lane that t- to push the undo button, to restore health.

I'm really, really excited to hear this.

No.

I mean, that alcohol is, it's a toxin.

And sure, it's got a purpose in our c- culture that you can, you know, make social connections easier and...

But when you're trying to do metabolic health, uh, your sh- your insulin's gonna go up.

It's, it is gonna sabotage the plan.

And i- you know, it's, it is one of the w- like, you can see people graduate at the pin chasers where they come in and, I mean, just like when somebody's trying to not drink booze, they'll think, they'll think, "I can't, uh, I can't believe people are, say they're never gonna drink booze for the rest of their life."

Yeah

... unless they're doing some of the stuff that increases muscle mass, breaks that sweat for 20 minutes, get to zone two at least for 20 minutes in the day.

And it's easier because of the fact that they're now fat adapted.

Yeah.

That third week I have new mitochondria on my side and we have the data for that, right? You can see that they come in crippled.

Um, you know, one of the things I'm going to do my lecture on is to show this man who fasted for 21 days and he came in with broken mitochondria.

Like, and that's the problem with his story is he's flogged the shit out of his body trying to do this.

He took the maximum dose of GLP one of triseptide, the good one, GLP, GIP, the combo one, uh, For two years, didn't lose a pound and had an A1C close to 10 by the time those two years are over.

Why? Because he was a broken...

Like you'd think it would be degeneration of some kind or

A common line for real.

For real.

They're on the phone.

So my grandparents were there.

My dad's an identical twin, and he and the twins lived in a duplex.

My cousins, which you could say my half siblings, because they're identical twins, were right there in that one house.

And at the age of 10, we moved to closer to town so I could ride my bike to school at this point.

You get two

What do you think is most important, boosting the ketones and doing high fat, eating more butter? Or do you think doing aggressive 21-day water fast is going to lower insulin and burn belly fat?

Right.

I think most of the patients who come to my clinic or my channel, they don't have the mitochondria that are healthy enough to fast.

The...

I mean, all the time, I mean, unf- I don't know if it's fortunate or unfortunate, but I think, uh, if you type in sardine, [laughs] you will see my name next to it.

[laughs] Uh, whe- when you look at people who write in and say, "I did a water fast and I did, I got these numbers.

And but then I did a sardine fast and I got these amazing numbers." And they'll say, "Well, which one should you, should I do?" [laughs] I'm like, "Follow the numbers," especially those morning fasting ones.

So you mentioned it earlier, so can you kind of explain how people can do it right now?

Who is she?

Oh, she is just a great story.

Jane had, uh...

Oh, she had pathology with how she thought about food, like many patients.

She (laughs) 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 a history, who have stress, who don't sleep.

And Jane was a great story where all the goodness in the world, it couldn't undo some of that relationship she had with food.

Grandma Rose.