Dr Mccullough Transcripts
transcript to 55min podcast any-way-you-can-ketogenic-diet dr boz and dr mccullough
Let's get real, let's get loud on America Out Loud Talk Radio. This is a McCullough Report, and I'm Dr. Peter McCullough. Wow, you can't believe who I got in the studio today, Dr. Annette Bosworth. I tell you, Dr. Bos, people tell me there's no way you're gonna get her. There's no way.
I tried, oh, I tried so hard to get her email and phone number. Nope, nope, nope, couldn't do it, couldn't do it. And sure enough, I broke through. I'm not gonna tell you who actually kind of gave me the goods. But we broke through. We have Dr. Bosworth on. Dr. Bosworth, welcome to the show.
Thank you. It's actually an honor to talk to you and to be part of your show. Thank you for inviting me, Peter.
Well, you got on our radar screen because people tell me, you know, you have really generated a following. So out of the, you know, you're kind of young and kind of high energy. I think you've just attracted such a big following out there in medicine. And well, just tell us a little bit about your background.
Yeah, so yeah, I think the best compliment I ever had from one of my internal medicine attendings was, you have far too big of a personality for an internist. That's why I said, I think that's good. Hold on, let me cough really quick. I am fighting a little virus of my own. Hold a second. So Dr. Boz...
It's a little sick, everybody. She's going to come back. Now, listen, you've put up with me coughing. We'll talk about that. So I'm in pretty good shape. I got my wellness company jacket on. I just changed from my, I'm still in my office, but I changed from my clinical jacket. So the wellness company keep us well. Okay.
So take it off. Where'd you go? Where'd you grow up and everything? Yeah.
I grew up on a farm in South Dakota in a town with 800 people. K through 12 in one building, started kindergarten with 21 students, graduated with the same 21 students. It's really hard for most people to conceptualize what does rural America really look like. Yeah, that was it.
Wow.
Yeah. When people say, why did you become a doctor? I'm like, I hated hog chores.
So out of the 21 people in your class, how many went to college?
Almost all of them. Oh, good.
Good. And then where'd you go to college?
You know, the only place there was University of South Dakota. Yeah, honestly, I was the first person in my family to go to a four-year college. My parents had done two-year colleges. And I was at this thing called an assembly. When your whole school comes to listen to somebody speak, we call it an assembly.
And I was in the seventh grade. And there was the Adams family, which was a girl and boy that I had seen in Sunday school and some of the other town activities, had come back after college. And they were giving an assembly about some of the things you should consider when going to college.
And they give this long talk and at the end, I'm one of the first ones to raise my hand and said, well, what's your job? And they kind of looked at each other and said, well, they had majored in like trombone and some other horn instrument and didn't have a job.
And it was the first time that I'd put together that, oh my goodness, if I don't pick, I mean, you don't just get a job if you go to college. And I remember riding my bike home on this dirt road and I'd picked up Time Magazine from the end of the driveway,
which is about a half a mile driveway. I'm riding it, no hands, reading that in Time Magazine, if you studied to be a physician, not only did you have a high job satisfaction, this was again back in like 1987 or 1985. Right. but you also had a high likelihood of having a job.
So I said, I came home that night and said, well, I think I'm going to do this.
And out of the 21, were you the only doctor?
Only physician, but there's a nurse, there's a guy who runs his own architecture firm. We've got a lawyer. So pretty, pretty motivated. I think, you know, you get in a vortex of people that are pushing for the next, several business owners do well. And, you know, I don't know,
small towns have a special something where you feel a responsibility that if you don't do it, it doesn't get done.
It's true. I graduated from high school in Texas. And at the time, it was a small town. I kind of grew up, you know, to be um a suburb of dfw area but at the time it was rural we had about 200 kids in my
graduating class about 20 went to college and i was the only doctor so um so that's how it um that's how it came out Now, you know, I had a chance recently, not recently, but like in the last 10 years, my daughter graduated from high school and it was really fun because the kids all
went across the stage. Now things are much different. Maybe a thousand kids graduating, virtually everybody going to college, right? So all the kids went back and it was almost, they were almost alternating. Comes up and I'm going to college to be a doctor. The next one said, I'm going to be a lawyer.
I'm going to be a doctor. I'm going to be a lawyer. And I was rolling my eyes at my wife saying, you know, here we go. You can just tell the kids have these ideals. And this one kind of lanky kid comes up and he goes, I'm running a landscape company when I finish.
And we said, that kid is going to make the money.
I will tell you, I have three sons. The youngest one is graduating from high school this year, and I discouraged any of them from going into medicine. I took them on mission trips, and they really helped and learned what service work was and did a lot of hands-on. I mean,
I think as much as you can in 2020-ish, taking your kids to work isn't work with HIPAA and all the things that America does, but boy, when you did service work, you could bring them along and they could count ibuprofen and take a blood pressure. So I think that part of medicine,
and they really are respectful for how hard it was to go from where I was and the statistics, especially now that they're in college, that, wow, that was a long shot. But man, we are like the most regulated people in the whole country now.
Well, we're definitely the most educated and vetted. So none of your kids chose medicine?
Well, I don't know. They're all... 24, 21, and 17. But if I had to guess, they're all boys, and I don't know. I don't want to, you know, throw the gauntlet down, but it's, you know, it's a... I work a lot harder than dad does.
I was one of three boys and both my brothers went into business. They did very well. And they always kind of looked at me like I was flogging myself. Right. So I was on call. I was working weekends. I was just whatever. They just didn't understand this.
It fits with it's way better than farming. I love this job. I love what I do. I love the intimacy of being in people's lives and really helping them through some key decisions. What I, you know, I think many times and I've heard this from medical students I've been, you know,
assistant professor and taught students in Haiti and really found they do have a genuine desire to be excellent and be of service and be in that community identity. But it is... yeah you can just whip the good parts right out of them if they're you know as they
grind through this process of taking med students and turning them into physicians in a lot of corporate medicine that i think detaches them from the ownership of the
of the relationship it's true now true confessions my son um followed my footsteps he went to baylor undergrad he went to ut houston school of medicine now he's a resident in pittsburgh So I just talked to him on Sunday night, and I'm just trying to feel him out in the conversation about how exciting it is,
what he did that was why this is important, and keeping the focus on medicine and hopefully defocusing on the corporatization part of it. You're right, because the core fundamentals, it's a wonderful job. So you went to the medical school there in South Dakota as well, right?
Yep. Yep, there was way too many years spent in Vermilion, South Dakota. Population like 10,000 when school was out and 15,000 when school was in. It's, yeah, very small town. But honestly, one of the third year fellowships was a pilot study that was... there's a word for it where they, you,
instead of doing pediatrics and then internal medicine and surgery, it was continuity. Continuity. And I think a lot of them do it now, but it was before Harvard did it. It was the pilot study. And then once adopted, once we performed it, then Harvard adopted that same deliverance of putting that,
that responsibility of how do you find the answer? How do you see what medicine has today? Not just the get through this curriculum, go to the next one, go to the, get through the curriculum, but really use the case to teach you how to study. And yeah.
Boy, I really give a lot of credit to that on how it shaped what I do day to day. Like even through a COVID pandemic of how do you weigh the risks and benefits of what's happening in front of you and use some good scientific logic of saying what is right? How do you do the next step?
And I don't claim to have done it right, but I sure tried hard.
I try to every day be sure I learn something. New things every day, like considerable amounts. So the other day, a patient complained that the pharmacist told him about some side effect of the drug. And it seemed to me like the pharmacist was exaggerating a bit, but I wanted to check myself as an old drug.
So I pulled the package insert and I read the package insert again, just to make sure I'm grounded. on the side effects to make sure I didn't miss anything. And it's just, it's constantly working like that. So you did your residency also in South Dakota?
Nope, I headed out of town after that.
And then where'd you go?
Salt Lake City, Utah, University of Utah.
Oh, okay. So yeah, so that's the big time. So I left, I went to South, I went to Baylor undergrad, then Southwestern. Then I went to the University of Washington in Seattle, which is very similar to Utah. So there was several of my co-residents became fellows at Utah and vice versa. So great. Right.
No, I love the my favorite rotation there was shock trauma. I was sure I was going to be an intensivist. I loved one of the reasons I picked Utah was they had at the time one of the residencies that used all electronic medical records. Right. That could be a cuss word.
I just think the skill set of learning that and finding a way to study yourself and not just, you know, call it the enemy or the demon that it gets identified as. I've never touched a paper chart. I think that process of how does the computer help you cover the 70% and you be
responsible for the 30% or something similar to that for the amount of volume that you're supposed to be analyzing and collecting on patients. And I loved it. I think some of my, I think I was the luckiest person alive to get the residency in Salt Lake and the attendings that, yeah, truly shaped who I became.
And then I worked really hard because now you've got, you know, the competition to get into medical school is one thing, then to get into residency and now a fellowship is that, you know, this, you know, super elite. How do you, I don't think I can study any harder.
I don't think I can get any smarter, but I'm from the Midwest and I can work harder. So I gave a little slave labor to the sleep lab and, you know, put my name in the hat for the fellowship of intensive critical care.
And then I had a baby, I mean, a planned baby, but a little sooner than we were planning. And seven days into holding that baby, I said to my husband, you know, that fellowship that I was so excited about taking, I don't think I'm going to do that. My husband's like,
you get that you're trading one of the most lucrative parts of medicine for one of the least lucrative. And we still have all those student loans. You know, I have, No regrets. He doesn't either. Outpatient internal medicine is what I chose. I remember showing up to the clinic the first day and said, I'm not seeing patients.
I will not see patients using a paper chart. You need to get me a computer. I just came from one of the best trained EMR processes and you're in the same system as them. I am not going to write with pencil and paper about this patient.
get me a computer hooked up to the EMR for the first day of clinic. So I was their first doctor to do that and really, you know, worked through some, you know, best practices and really did some leadership roles of how do you integrate, you know, electronic processing of data with seeing patients.
And where was this in that?
It was actually right there in Sugar House, which is such a cute little name. But it's a it's a suburb of Salt Lake City. So it's almost like between Salt Lake City and the university. So I was like right where I was.
OK, things that I at all comfortable, you know, picking up the phone and asking questions or right there. And, you know, I kind of morphed over the next decade of peak brain performance, which is really what was attractive to that shock trauma. How do you, you know, what is that when that brain is injured?
How do you get peak brain performance out of that? So a lot of mental health, a lot of, you know, concussion, you know, physical trauma, emotional trauma, Parkinson's, bipolar, sleep disorders, you know, a lot of things that were culminating in this pattern of, You know, finding a niche, I suppose, in medicine that really was enjoyable to me,
but still was a general practitioner. And about a, you know, about a decade into this story, my mother gets CLL. And I'm the oldest of three. My husband's the oldest of three, that same within about a month and a half, his dad has a heart attack. His mom gets diagnosed with breast cancer. So, you know, we,
we pile at home to South Dakota and on the way home, uh, we vowed we were never going to move back to South Dakota, but here we are back in South Dakota. And I said, don't worry, honey, the life expectancy of the problems they have isn't long, but we'll be okay. We'll be, um,
Yeah, it was COVID that finally took the lives of the last of them, actually.
Both of them?
Both of them.
Wow. Wow. And that was in South Dakota, huh?
Yep.
Yeah.
You know, what got me into the ketogenic diet was... I was actually listening to a podcast between Tim Ferriss and Dom D'Agostino. And Dom D'Agostino was talking about some of his research he was doing with Navy SEALs and the non-rebreathers that would not leave that trail of bubbles to
identify their location to the enemy and how disastrous the seizures were to prevent and the Depakotes wasn't doing much and lithium can, you know, some of these medications make them slow in their reflexes if they were trying to use medications to suppress that seizure disorder. And, you know, he's like, what about this ketogenic thing?
And as I'm listening to the podcast, I mean, I haven't heard this word since medical school. And I'm thinking he's saying, you know, my brain hears ketoacidosis. I mean, here's the dangerous thing that happens with insulin dependent diabetics. And And then I, you know, you're listening a little closer, like, okay, he just said it again.
And that's not the word he said, what is he talking about? And really he had gone through this protocol of what are some of the major processes that you should do to improve and get peak brain performance, which is what my whole clinic was.
And I was just checklist right on spot on for what he was talking about until this one thing, a ketogenic state. And I'm like, what is he talking about? Like, I do not understand him. And of course I got to open up a textbook and look up what, what do you mean? Seizures used to, you know,
have a, you know, ketogenic state is one of their primary ways to treat them and how much that, you know, then it has some theories and there's, there's some pretty old texts that, oh yeah, it's anti-inflammatory. It's, you know, less swelling in the brain, injury repaired seizure goes on and on and on.
And everything I read, I'm like, I get a little more nervous. Like, I like to take pride that I, you know, I kind of know what I'm doing. How is it I know nothing about this? How do I know nothing about this? Except for like ketoacidosis, which is like this awful thing that people die of.
I mean, at this time, I'm running my own clinic and I do a lot with brains. And I am secretly very embarrassed. I don't know anything about this. And so I do something that no business owner should ever do, which is I close the clinic for three days and say, I just need to go to the library.
I just, I couldn't focus. I couldn't handle it. I was like, how can I know nothing about this? And I spend, you know, get a whole collection of things I read and do some of it. And now I've got this stack of paperwork that I'm going through and it takes me several months,
but I kind of churned through what I found and And along the way, there's some papers from MD Anderson and how they're using a ketogenic state for some glioblastomas and what the cancer process, why that might be more beneficial for patients going through. And then, wow, you never live from a glioblastoma is like what my mind says,
like these are really dangerous. And how did you live? And they didn't have surgery? Or the surgery was so successful. They couldn't like, it was, it was like, did you have the diagnosis wrong? It was shocking. So I'm like, okay, so, you know, information's trickling in and now it's Memorial day in South Dakota. And, um, I'm,
you know, not telling anybody about this, but I'm going to try to figure out how to be in a ketogenic state. And I'm probably 40 pounds overweight, you know, three kids, a full practice lot, you know, lots of things aren't ideal. And I can't seem to pee a ketone to save my life.
These ketone strips must be bad. I got another bottle. Couldn't pee a ketones. I'm like two weeks in going, well, how low do you need to get these dang carbs to get to pee a ketone? And of course, what I know now is I was rather insulin resistant. Even if I,
my labs hadn't been checked or my blood sugar wasn't, you know, awful, but it was taking a lot of insulin to keep that blood sugar control.
Hmm.
And now I was doing a ruck pack for mental health of soldiers for Memorial Day. And we were going to hike around the city of Sioux Falls, which is 26 miles. So the kids and I get up at like five at four o'clock in the morning.
We start on this hike and I'm like, by golly, I'm going to pee a ketone by the time this is over. And all three of the kids don't make it the whole way, but the oldest one does.
And the first thing I do when I get back from that 26 miles is I go to see, am I being ketones? I'm like, all right, you're in ketosis. It took 26 miles of walking to do it. And that was, I was like, how do I not go out of it?
How do I keep, anyway, so I'm really self-experimenting, trying to figure this out. And by now it's 10 years or seven years since mom's diagnosis. And she's had a couple of rounds of chemotherapy. She's now 71. And well, she gets the best Western medicine because I'm watching over everything she does.
I know every one of her doctors and yeah. You know, she does. She has the best medicine that Western medicine could offer. And she walks through the door. We're going to go see her oncologist together. And she's gray. And you can see a big lymph node in her neck.
And you can see she just looks like a zombie. Not moms. And so I don't have to do much guessing. For the past year, I think I'd be given 50 out of 52 weeks she'd been on antibiotics. I mean, her T cells are really where the infection was or the cancer was proliferating.
So I had no initial defense against infections. And so he walked through the door and I mean, her white council, like 500,000, one in 500 of them are functional. They're all, you know, dysmorphic and not doing their job. And of course my friend, my previous attendee, but now colleague says, yes, here's the pink slip to go, um,
to go get more chemo. And it's South Dakota, so he gives the pink slip, but we're gonna get this in this rural satellite place, which is near my farm and a hundred miles away. We walk out of the room and my mother asks me something that, well, patients ask all the time,
and I like to tell the truth, but it's one of those things where you try to tell the truth while trying to follow the guidelines. Doctor, if it was you, what would you do? And you try to thread the needle of saying, here's what it is I would do. But now it's your mom. What would you do?
Because she has said, I am not going through that again. The last time you gave me that chemotherapy, she's made every one of my clothing until I was 10 years old. She didn't know what a sewing machine was. That's ridiculous. That is a lot of brain injury.
It takes us six months to get proficient and then another year before she's really, I feel like she's got it back, got her game back on. And she's like, I'm not doing that again. I will not do that again. And so by this time, I've read quite a bit about what happens in a ketogenic state with,
and there wasn't a lot, but it was like, gosh, that's very curious. how much that insulin stimulus, that growth hormone, growth factor like hormone stimulates the growth of things that don't belong growing. And she was clearly insulin. I mean, she had all the signs of insulin resistance.
And I said, so she said, well, if it was you, what would you do? We're standing in the hallway of the hospital. One path is to go set up the chemo and the other one's the front door. And I said, mom,
I'd walk out that front door and I would do a ketogenic diet for six weeks and see what happens. And so we left my car in the parking lot of the hospital. We drove a hundred miles back to the family farm. We threw out so many carbs and they were lovely carbs that every ladies aid thing
in little town, Plankington will say that's the peach jam and it's this and it's rhubarb and... Mom, no, you can't have it here. You can't have it near you. I'm telling you, you can't have it near you. We get a one shot at this.
And it was the most ridiculous way to do the ketogenic diet, but it was keto. I don't think either of us lost a pound during it. And I said, I'll do it with you. And You know, so there's no FaceTime at this point in our journey. But I get a,
so she gets me back to Sioux Falls and I, you know, I call on her, you know, sending her updates of what my, what's your little ketone strip look like? So we're both in ketosis, we're both in ketosis. And I talked to her on the phone about a week later and she sounds different.
And I thought she was calling to ask for a refill of the antibiotics because that's where this is the routine. And she didn't mention it. So I didn't bring it up. And now we're another two weeks out and we haven't asked for it. Now it's six weeks later. We're ready to follow up with the oncologist.
And it's that thing. You send the prescription out. Somebody else takes care of the chemo. As long as they don't hear from the patient, it must be nothing wrong. So we're walking back in here and we get those labs drawn again. In the best case scenario, that chemotherapy was going to lower those white blood cells 30%.
And that was going to be a success. So she walks through the hospital door to meet me for this appointment and she looks amazing. Like she is not gray. She has a little skip in her step. Like, wow. And again, it didn't lose a pound, but there is something much better about her.
And we haven't had a stinking carb. Like I'm afraid to have a carb because of what had happened to me a few months before.
How many weeks now? Six. Six weeks. Okay. And then what did the blood test show?
So they had to draw it twice. So I knew it's either really good or really bad.
Right.
But so they ran it twice. The white count had dropped by 70%. Wow. And you can hear the attending out in the, you can hear the oncologist saying, where's the chemo report? And you can hear the nurse, I don't think she got it.
And just before he walks in, I'm like, mom, if he asks any questions, just shut up. I don't know what to tell him. I mean, it's a friend of mine. I don't want to fight with him, but I'm like, I know what you're going to say.
And I just think, you know, so he's like, well, if you didn't get chemo, what did you do? We changed our diet. And I'm like, just hold his face. Don't say anything, mom. I don't know what to tell him. and so he's like well whatever the hell you're doing keep it up I'll see you in six weeks
Well, listen, we're going to take a break right here. So Dr. Boz has gotten our attention with keto and the ketogenic diet, a vignette on herself, where she finds herself, she loses some weight ultimately, but her mom and then this basically form of an adult lymphoma leukemia dramatically improves. But let's take a break here.
You're listening to the McCullough Report. Let's get real. Let's get loud on America Loud Talk Radio. This is the McCullough Report. I'm Dr. Peter McCullough. Dr. Boz, now we have to back up and to our audience who's never heard the word keto before, you've got to explain carbohydrates, proteins, fats, ketones.
What are the three circulating ketones and what in the world is a ketogenic diet?
Right. Well, you know, as this story was happening, my husband, I kept putting sticky notes like, I mean, mom's brain didn't work very well. So I'm having to like back down and say, let's explain this in a way that she's going to understand and that I'm not going to lose my audience, audience of one, right?
And so I'd have these sticky notes of, okay, I think I can introduce this. I think I can introduce this. And then I'd trade it out and say, okay, I'm going to do it this way. Kind of almost like preparing an academic lecture for, you know, how do you ramp somebody up to a chemistry lesson on ketones?
And it's my mom. She doesn't want to know about that. And so I had all these sticky notes around and my favorite analogy is actually to compare the fuels in our body to a campfire. And when you look at the fuel, where's that energy burning at? It's in our mitochondria and our cells,
which is the powerhouse of your cells, where your energy goes from a resource of fuel to energy. And if the resource of fuel is carbohydrates, well, those carbohydrates are known for burning fast and quick. Actually, if you burn a lot of them, you'll put off a lot of debris.
There's a lot of inflammatory process when only carbohydrates are burned through those mitochondria. And the best imagery, I think, is the kindling or a bunch of leaves or, you know, pine needles that you put in a pile and you light a match to it. And it is pretty. Woo!
That feels good to be on a bunch of carbs going into your brain. Just like the sparkles that go up in the air as you light up a match of a kindling. But there's a lot of smoke in the air. There's a lot of debris that, you know, filters into the sky because it's a dirty fire.
If you move up the chain a little bit and we say, well, what happens when we use protein as a source of fuel? And well, proteins like, you know, you swallow some proteins, you break them down to amino acids, and then you put them back together as proteins on the other side.
But when you look at proteins as a fuel for energy, it's much like sticks, right? in a fire meaning you know it's that middle size stick that you got to keep putting stuff in it's a lot of energy to put that in but it it burns with less debris than
those pine needles did but it's a lot of effort to keep that fire burning you can't really take a break you got to keep feeding it and it doesn't ever turn out to be that great of a fire it doesn't you know nice warm fire not what you get
So now let's move up to the mothership of fuel in our body, which is fat. So fat in the form of fatty acids circulate through our body through a bunch of lipoproteins and every cell knows how to burn fat. And when you compare that to the analogy of a campfire, it's like burning a really dense log that.
that log is not always easy to get lit, but once it's burning, it will light the next one and it will light the next one and it will light the next one. And the debris in the air is not so much. It doesn't all, also doesn't take a lot of maintenance to keep that,
campfire going when people are on a ketogenic diet using fat as their fuel that eating pattern goes from a lot of a lot of noise where they're eating every couple of hours they have to a lot of energy put in to the fuel going in and especially in
today's world where processed is the it's the word in front of every food that most of us eat it now is a fat delivered diet a high in fat Without the carbohydrates. At first, it's a little noisy. It's a little hard to get the rhythm right. But boy,
by the time we get to the second and third week and especially that fourth week, you can put a meal in that's, you know, at the beginning of four hours, the end of four hours, and they really don't need any more fuel for the day. And what's happening is their mitochondria have really changed.
Instead of those powerhouses having a lot of sparks and farts out the side, a lot of wasted reactive oxygen species, what you now find is that mitophagy or that trade-over of improved mitochondria are happening deep in their muscle cells, deep in their astrocytes, their brain cells, their cardiac cells.
And that the energy for fuel is just like what happened when my mom walked through that door that... She wasn't gray. There was life. There was energy that just radiated. That's the mother that I remember. And that energy source is in the absence of carbohydrates. Your body will always burn that kindling first.
It will always ignite those pine needles first. So you can't turn that fat into your fuel until you're done with the glucose. And what I see as an internist is these chronic diseases are on the bedrock of an elevated insulin amount. And depending on how long it takes to find them,
how long it takes to get their attention, well, is the A1C elevated? Is their blood sugar elevated? I don't know. I know their insulin is because they have every chronic disease possible that is growing things that shouldn't, growing inflammation, growing, you know, atherosclerotic disease, growing, you know, tau proteins in their brain.
That aging process has a bunch of mitochondria, you know, farting and sparking around their body, speeding up that aging process and really, well, keeping an internal medicine clinic busy.
Well, that's for sure. I think we get agreement. It's hard to break people's habits, but agreement that Certainly the starch. When I take carbohydrates, I always divide it into fiber and starch. Fiber is soluble and insoluble. You can't break it down. It's fiber. That's the reason why it's called fiber. And then there's starch.
Starch is sugar molecules linked together. It's pretty simple. Flour is sugar molecules linked together. You can take a diabetic, a diabetic coma and put a graham cracker under their tongue and you revive them because the starch is sugar. And the average American diet is 60% starch. 60% of calories come from starch.
So starch is anything made out of flour and then potatoes and rice. That's pretty simple. And what I explain to patients is that, listen, it's 60% of your calories to begin with. It's not a good source of fiber, has no essential amino acids, no essential fatty acids. It And it's not a good source of vitamins.
I mean, you're just pretty much it's just filler. And the question is, in the next obese person in front of us, do they need more filler? And the answer is no. So if you can actually get that out of the diet, like that's a big step forward.
That's a huge step forward. But I'll tell you, to take this, you know, one of the taglines that I've put under the Dr. Bob's brand is reversing medical problems. Like, how do you reverse them?
Right. Well, that's been going to ketosis. That's that's a whole different like step beyond getting the carbs out. That's actually changing the body's chemistry. And I can always tell when a patient is ketotic because I can smell it on their breath. I'm pretty convinced my dog is ketotic most of the time.
It's just the way we have her kibbles and she really can't tolerate. Now, having said that, she's a very cute cockapoo who's 15 years old and is in great health. She goes on four-mile walks with my wife and I can smell it. I've had some patients this week who are ketotic. Just to level set for the listeners.
Carbohydrates, which are sugar and starch, That's four kilocalories per gram. Protein is four kilocalories per gram. Fat is nine kilocalories per gram. But ketones, which are these intermediary energy sources that the body has to produce, are seven kilocalories per gram. And they come in three varieties. So there's beta-hydroxybutyrate, acetoacetate, and acetone. as the three ketones.
So how does one do this in their diet to the point of becoming ketotic? How does that happen?
Well, you know, that section where I couldn't quite pee a ketone, that was where I kept holding on to the fiber. So it wasn't until I did net carbs or didn't think net carbs, but total carbs, which included included fiber.
So even an apple would keep you out of ketosis. Oh, yeah, absolutely. Wow.
So 20 total carbohydrates a day is where, I'll tell you, Peter, one of the most transformative, I mean, teaching the ketogenic diet, watching the amount of medical problems that I could, that I've been writing prescriptions, like 20 prescriptions in a patient that's 70 years old is not uncommon.
Yeah.
And you're like, that's ridiculous. That's ridiculous. There's no way my prescriptions are doing anything for them except draining their bank account and putting all of the trust that I'm going to fix them with these prescriptions. So as you say, well, let's, let's get down to a much more core. Sorry, that's a kid, a 17 year old kid.
Sorry. If they want to cut that out. Let's get down to the core issues of what happens to a medical, a chronic medical condition. And, you know, the truth is 40 pounds overweight, three kids in tow, I'd probably been insulin resistant. I mean, you have to be insulin resistant to hold onto a baby.
That's part of the physiology of pregnancy. And so each pregnancy, I, you know, didn't quite get the weight back to where I wanted it to, you know, working late hours, pushing hard, not really taking good metabolic care of my brain and health. I'm just showing everybody else how to do it.
And now baby number three and a, a transformation of a little bit of a weight problem too. I don't know how to get this weight off. And of course I've seen it in patients over and over and over again. And I'm like, I've got to figure this out. I've got to figure this out.
And it wasn't until, and I couldn't pee a ketone. Like you can get guys to pee a ketone, but if you've had three babies, You're in your 40s.
Let's explain peeing the ketones. So it's actually taking some urine and checking to see if the ketones are being filtered in the urine, right?
Right, yeah. So that's the easiest way to, and that was the other part about one of the things Dom D'Agostino was saying is I have seen every fad diet as an internist, especially an internist working in Utah where it's like the supplement capital of the world or something. I'm like, I am sure it's a fad diet.
I was sure of it. And then you hear him saying, well, you have to actually measure this. It's coming out the other end. The way you eat will change which fuel you're using in your blood. And when your fatty acids arrive at the liver, the liver has specialized mitochondria that can make this thing called a ketone.
A ketone has two destinations. You cannot store it. That is not one of those two destinations. You can either burn it in a mitochondria as energy or you pee it out. So especially at the beginning, your body will, as an evolutionary state of survival, when carbohydrates are low,
it's going to overshoot the production of ketones to make sure there's enough fuel around when those carbohydrates got low. So as your carbohydrates go low, your blood glucose decreases and your body says, hey, we need to reach to this other source. Send some of those strings of fat to the
liver and let's get some ketones in circulation and those ketones water soluble can slip across the blood brain barrier they can uh you know really have the power of delivering energy to that mitochondria and if you don't use it oh you're gonna
you're gonna pee it out so so can an average person get these strips and check
Yeah. So in every pharmacy you've got, I mean, think of a type one diabetic that checks their urine ketones. You know, I think the big mistake I see folks make is those little bottles, they'll start on the ketogenic diet. They'll be measuring that P-tone strip. So a ketone from your urine, a P-tone.
and they will do great for a week and they'll put that shelf, that bottle on the shelf, and then something throws them off course and they'll fall off the wagon and they'll say, boy, I felt better on that diet. I'm going to go back on it.
But it's been about a month and a half since they've checked it. And now those strips are bad. So the danger is the strips are cheap, but once you expose them to air, they really don't last very long.
Okay. And just to kind of keep us on time, Quickly walk us through a typical day of a ketogenic diet. What would you eat?
I've been at this for six, seven, eight years now. Morning coffee is black. It used to be not black. It used to have some fat in it, but now it's black. that I will have usually egg bites from Starbucks. There are a couple of carbs in there, but they're very convenient.
So eggs and bacon are very common for my breakfast. If I am, if I usually try to eat in a six hour window, so I try to finish by the mid afternoon and no food when the sun goes down.
Okay. So what else would you eat? What would be lunch and dinner through the rest of the day?
You know what? My favorite thing to talk about is, I thought I had a can sitting here. It's a can of sardines.
Okay.
When's the last time you've eaten a can of sardines, Peter?
Okay. So a can of sardines. What else?
Salmon is another one, but steak, steak is a great one. So is Polish sausage. So you're looking for protein that's got high fat. Some of the things that I push people away from is like a chicken breast, which is really high in protein, but not so much fat. You can look at the little dummies,
drummies that are the chicken wings, and that's got a lot more fat that's associated with the protein. So those are some.
So any plant sources of fat at all?
You know, I don't do that as much, mainly because the folks I'm taking care of, they've been around the sun a few times.
Okay.
Quite the food addiction. Once we start adding a lot of, as soon as the carbohydrates come back, I just see them overeat. Until they get down to their ideal body weight, we really try not to do that.
Right. Okay. So eggs and bacon, basically kind of meat and sausage through the day. No fruits or vegetables at all.
So like cream spinach is a really good one. Think of your vegetables as a way to deliver fat to their gut. So cream spinach is a good one. Brussels sprouts with.
Okay. And what would be the total calories in a day for you?
You know, I don't have them count calories.
No, I'm not asking what you have. What you I'm asking you, how many calories in a day would you eat?
Well, I haven't looked at that in literally seven years. Wow. Okay. Yeah, 20 total carbohydrates I look at. Okay. I mean, my beta cells in that pancreas, they will know how to make insulin.
I know, but I'm just trying to get a sense. Are you eating a little bite of, I mean, is this like an 800-calorie diet and you have a little bite of something? I'm just trying to get a sense of it.
So yeah, you know, when I've done this in the past, again, I've been coaching patients to lose weight and get their body mass index down for 15 years, 18 years before I started the ketogenic diet. And I said, no, when you feel full, you're going to stop eating.
And there are people who overeat the ketogenic diet, but I'll tell you what the diagnosis is. They have an eating disorder. They really have an addiction that food is how they comfort. Yeah. When they, when they don't, It is amazing the tipping point where they don't feel hunger.
Well, let me ask you about that. Do you feel hunger on a daily basis?
So I actually do fasting once a week of about 60 hours without eating. And so I start on Sundays. We'll have a family meal on Sundays. I don't eat on Mondays. And then I don't usually eat until after I get home from my show on Tuesdays.
So I'm still fasting from, you know, I think I'm at 69 hours or something of fasting.
But you wouldn't know in a typical day how many calories you eat.
You know, I don't count the calories.
I know you don't count them, but you wouldn't know? I mean, just you wouldn't have a guess? I haven't looked at it.
I don't know. So we could, we could put it into a calculator. I can tell you what I eat. I mean, I would eat a good size T-bone. I would eat, I love Polish sausage. This is one of my favorite things from, I grew up on a hog farm. So maybe that's it. The calories are high.
I mean, at least 2,500 calories in a day. What? Really? When I eat, I eat well. I eat to satiety.
Wow.
Between 1,800 and 2,500 calories in a day. Okay. I've been doing this for seven years. Okay. One of the highest returns of that is I truly do not pay attention to the calories.
Yeah, I get it. I get it. So when you graduated from high school, I don't know if you'll be willing to say this on the air. When you graduated from high school, what did you weigh?
I think probably 120. Okay.
And your lifetime maximum, not pregnant?
Not pregnant, probably 160. Okay.
120 to 160. And where are you now?
Like 135. Yeah.
So there's a good one of the modern day epidemiologic studies assess this. And I'll think about it wasn't cardio, but I'll think about in a second. And about 10 percent of people are within maybe 10 or 15 pounds of their high school weight. And so most of us have a weight journey.
So when I graduated from high school, I weighed 140 and my lifetime max was 206. And right now I'm probably about 159, 155, something like that. And so there's very few people that can recover their weight down to get it back within that zone, which I think is fascinating. Well, we've learned a lot about ketogenic diets.
I want you to tell our audience a little bit about your show. And I think you also have a book or materials, right? Just tell us a little bit more about.
Yeah. So I'll just do a little bit more about like the brand. I did not mean to have a YouTube channel. My kids think it's pretty cool that I do that now. but actually they'd never watch it, but they did for a hot minute think it was cool.
I actually started putting stuff on YouTube because I was frustrated that I couldn't take the time to educate the patients on the things they needed to learn. The exam room time was too high of a commodity to run the number of patients through to pay the bills. So I said,
you can't come see me again until you go watch this YouTube video and I need you to fill in the blanks of this piece of paper. So I know you watched it. And so I'd put up another one and I put up another one.
So I started solving problems that were happening in my private practice to get peak brain performance. Sometimes I got to watch it two or three times. Great. It's cheap. It's open access. And I really found the joy in medicine where, oh, finally, we get to go to the next part of this process of helping you.
When it came to what happened with the ketogenic diet, that book, that journey I was going through, those sticky notes that I was putting all over the mirror. How many years you've been married, Peter?
35.
Yeah.
So I'm just under 30. And my husband kept saying, you should write a book. You should write a book. And I'm like, last thing I'm going to do is write a book. Anyway, I lost a bet to my husband and wrote the dang book. And self-published it. I'm done. 12 people are going to read it.
Is that it? Can you grab it so we can see it?
It's behind you. It's not here. Let me grab it. It's right around the corner.
Come on, Dr. Boss.
I know, right? Yeah, that's a bad on brand.
So Dr. Boss is getting her book, which she should have had ready for Dr. McCullough's show, but she's doing... She's normally the person running the show, not the person being interviewed. But she's going to fill us in. Now she's asking her husband to get it. And she's got a cold, so she's been very good.
We've been talking to Annette Bosworth, who's an internist. I must have been top of her class at URC South Dakota. Went to URC Utah, which is a really strong president. Okay, here we go.
Yeah, so first book is called Any Way You Can. Oh, there we go. Any Way You Can.
Wow. Who's on the cover?
So that's my mother. And then that's the little, this is on a chemo day. And she looks very overweight there. Yeah. I don't know if you can see how.
And is that, is that like your, your son or daughter there?
Yeah. So that's my youngest son. Okay. Graduating from high school now. So that's the journey. So that's her at the end of the end of the book. Again, back to healthy looking grandma Rose. So that book sold like 250,000. Nice. Nice.
Very hard in the book world. Yeah.
Right. So honestly, I think her journey has helped so many people that I can't do anything except say, praise God. It's been a blessing.
From the time she hit that first round of the ketotic diet, how long did she live?
Oh, she lived for four, five years after that.
And at the time she started, the white count was 500,000? Okay, so you really got something there. Okay, good, good. And what's the other book?
The other book is what happened when the book came out. I thought 12 people would read it. And I was done with fighting with my husband. And then it just took off. And then people kept trying to come see me and learn to do the ketogenic diet.
I'm like, you do not need to see a doctor to know how to do this. And I'm an independent, you know, private practice. My staff was saying, you cannot allow one more patient in this practice. We need another provider. We need another provider. We need another provider. So the Keto Continuum is actually another book.
This is the workbook, but it comes with a book and a workbook. And there's audio books too, because you know what I find is that peak brain performance is a lot of patients don't want to read. So they list the book and fill out the worksheets that I do with patients.
And, you know, I transplanted my life after COVID here to Florida. And I'll tell you the most rewarding thing I've done in 25 years was when I couldn't get all the processing paperwork as I moved from one state to the next done as quickly as I wanted.
But I still had to pay rent and do the life that comes with living, trying to do a practice. And so I threw down a gauntlet to my team and said, you know what? I've always wanted to do an online course where you live walk people through what
it is to do the advanced ketogenic diet in a short period of time. Show them what we do. So it's a 21-day course. I do it twice a year. It's very intense, but it's almost like grand rounds in the morning. I have patients from the classes showing what their journey's been.
Every single one of them pricks their finger in the morning showing glucose and blood ketones on a dashboard to everyone. So there's a lot of positive peer pressure to really watch what happens when you lower your blood sugar and you raise the ketones. And we'll walk you through it.
I mean, Peter, it's the best medicine I've done in years.
Now, do most people who sign up for the course, are they obese? Oh, yeah. I mean, all of them are insulin resistant. So real quickly, we hardly have any time left. So if you were to name the top five benefits of the ketogenic diet, what are they?
Peak brain performance, number one. Reversal of depression, anxiety within a four-week time, like better than Prozac. You get a drop in blood pressure, something that you can get off of blood pressure medicines without so much blood sugar. Okay. And then, of course, probably, I don't know, a tip between autoimmune, what reversal of autoimmune versus the weight loss.
The weight loss is nothing compared to what the freedom from these chronic health problems is.
Okay. And then what would you say would be the downsides?
You're going to have to fight your demons. Addiction is real. When you go to change people's behavior, there's a lot of that primary family of origin and what happened and how you learned how to be loved with food and love others with food. And there's a better way to find dopamine than carbs.
And then how about anything else? Constipation?
You know, it goes away. I've learned a lot about how bowel peristalsis and what happens when fiber is minimal, but when the inflammation is low, when they really just don't have that irritable bowel, it's amazing.
It's way easier.
It's way easier.
How about cholesterol panel blood tests? How do you prepare people for that?
Yeah, you know... I push them to the higher level of education. Like we don't talk about good and bad cholesterol. We talk about your lipoproteins and what size they are and how many you have and ApoB and, you know, what's your homocysteine and your C-reactive protein and looking at all of those
inflammatory markers that your C-reactive or your hemoglobin A1C, your average blood sugar matters most. Get that average blood sugar down. When that A1C is 5.0, that's the goal for my patients is 5.0. you know, 5.1, I'll let you get away with it. But you want average pressure control.
Wow, we are out of time. Annette, I was going to ask you about recently, you know, a revelation you had online. We're going to have to leave that for another time because we've learned so much about the ketogenic diet. We've learned a lot more about you. And yes, everybody, she is young and dynamic and so amazing.
Dr. Boz, Dr. Annette Bosworth, thank you so much for joining us on the McCullough Report.
Thank you for having me. I really feel honored to be here.
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