Cholesterol and Keto (Everything You Need To Know)

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Cholesterol and Keto have been a really big topic for everyone who is doing the keto diet.  I asked Dr. Boz to explain exactly what we should be concerned about when we look at our cholesterol lab results.

Dr. Boz recommends you check your risk for heart attack by using the Framingham Risk calculator.


Where can I get Free Keto Meal Plans?

Keto Free Keto Meal plans by adding your email to our list here:


Keto and Constipation Information Mentioned in the video

Keto and Constipation Notes:  I think it’s also really important to say that Dr. Boz herself has tested this with a blood glucose and ketone meter with many of her patients and none of them reported a spike in insulin!  That’s super important!

Tip:  This is the Keto Mojo blood glucose/ketone meter I personally use and would recommend.


Dr. Annette Bosworth’s Book

Get the book, Anyway You Can by Dr. Boz here on Amazon:


Keto Friendly Recipes Cookbook

You can purchase the Keto Friendly Recipes Cookbook on Amazon too!

Keto Friendly Recipes Cookbook


Why does my cholesterol go up while doing the keto diet?


Cholesterol and Keto Video Transcribed

Here’s the full video transcribed if you prefer to read it instead:


Jennifer Marie: Hey friends, Sunday night. Happy Mother’s Day everybody. Happy Mother’s Day to all the moms, all the moms of fur babies, all the mommy, people who have mom parts naturally and Happy Mother’s Day to you Dr. Boz. How are you doing?

Dr Boz: You too, Jennifer. Happy Mother’s Day.

Jennifer Marie: Thank you, thank you.

Dr Boz: Doing great. I haven’t seen my kiddos today though, that’s kind of a strange Mother’s Day. It works.

Jennifer Marie: Hi Morgana, hi Angela. Hi Chris, hi Skyview. I see people who are, who come on immediately when we are on and I love it. They don’t miss an episode. Happy Mother’s Day to everybody out there. We have a subject that we want to talk about. Let’s talk about cholesterol because cholesterol just seems to be a big, big subject. It’s a big scare. We don’t want people scared and not starting keto but, before we get to our subject, there is a couple things I want to mention. I want to give an update, first of all, on something that happened with my husband that I think would be helpful to the whole audience but, but, but for those of you who may just be joining, maybe you’re just joining for the first time, maybe you don’t know who I am. My name is Jennifer, I run the keto friendly recipes page. I am a big supporter of low carb and keto.

Jennifer Marie: The biggest thing that I do is, in support of the community I sent out weekly meal plans for free with recipes, shopping lists and a meal plan for the week. It’s basically how my family plans for the meals. If you’re not on the list, you might want to get on the list. You can add your email to and that’s, adding your email to my list, be sure to confirm it. That will get you the Friday email with all the freebies that I send out. But the reason why I’m telling you this or the reason why I’m reminding you, if you’re not on the list, is because sometimes I send very helpful free downloads, printables, stuff that helps you on your journey. Get on the list because I have something in the works that I hope to have done next week but it might be the week after. That’s just a teaser for what’s coming. But if you’re keto it will help you.

Jennifer Marie: Okay, let me just tell you Dr. Boz, I don’t know, I don’t remember, we talk so much that I don’t remember if we did a live on this, I think we might have but let’s talk constipation for just a minute because it’s a struggle, the struggle is real and especially when you’re switching your diet it seems like a very normal thing to get constipated. You had a brilliant tip and you had told, I think it was me, I don’t know it could have been somebody else but you told, the plan for constipation on keto, the tip that you gave was to take a spoonful of chia seeds, down it with some water and do it for every hour until you go.

Dr Boz: Right.

Jennifer Marie: I might need you to explain first of all why this is good. The thing that I remember that you told me is that you’ve done lots of testing on this and it does not spike your blood sugar, it does not affect you because it doesn’t even digest in your system, it just basically goes through you but the reason why it helps is because it creates bulk in the colon and it helps you to go. Did I say that right? Is that everything?

Dr Boz: You play a doctor on television, don’t you? Perfect, that’s exactly the right answer. You look at how can you use medications to help people with constipation. Those strategies are to either whip the muscles to [inaudible 00:04:02] the colon or to stretch the muscles. A better answer on keto, the reason they’re not going when they first go keto or if they step up their game is that the bulk of their food is so much less that they’re not stretching their colon, which then it doesn’t have a signal that their body is so used to that way of eating. It will reprogram. Your body is an amazing, amazing how well it will respond. It can definitely unsettle, I’ll say it not nicely unsettle people. God forbid if they have diverticulosis.

Jennifer Marie: Yes. My husband has diverticulosis and the minute I mentioned a seed he’s like, “Nope, nope. That will not happen. I am not taking a seed. I know that it will cause a flame up.” I text Dr. Boz she’s like, “Fake news, fake news.”

Dr Boz: Right. If you look at, first of all pretty much everybody over the age of 45 has some diverticula. Diverticula are little out pouchings that happen when your colon has been under stress and the wall has a weakness. It’s kind of like a tiny baby balloon that kind of puffs out. Once you stretch it out, sometimes it goes and recoils back to its normal look but sometimes it stays there. If you collect a lot of those little out pouchings, you can have danger. In fact, if you have read the book, most of you have read the book Any Way You Can, Grandma Rose’s problem that originally sparked her health, hospital was diverticulosis where one of those little out pouchings got an infection in it. That’s what John is worried about, that’s what patients are worried about. There is an urban myth that if you put seeds in there you’re going to irritate the colon. But it’s just such a minor part of the equation that really you’re just sending fear through the patient without giving them a strategy of how to do this.

Dr Boz: What you want is you want a [inaudible 00:06:10] of stool to move through the colon and to not have little, you don’t want the seed to go in there and sit. Sure. We don’t want anything to go in there. How can you keep the pressure on the inside of the colon low enough and still move the stools along without getting it inflamed or irritated? That is a solid amount of bulk. On a keto diet you can find a lot of carbohydrates to get their bulk up. Especially during a transition they’ll give up. They’ll say, “I couldn’t do it. My bowels couldn’t handle it.” [inaudible 00:06:44] as you watch people go through the ketogenic diet, this is one of the major steps where I’m like, just prepare for this. Have those chia seeds in your house and if you never need them, great. But if you need them, one tablespoon every hour until you have a bowel movement. Essentially what you’ve done is you’ve stacked your colon full of bulk that doesn’t raise your blood sugar. As you do that-

Jennifer Marie: So-

Dr Boz: Go ahead.

Jennifer Marie: John thought it’s going and expand and that did not happen. He was so happy. It took a few hours but it finally happened [inaudible 00:07:24] that worked. [crosstalk 00:07:28]

Dr Boz: Should I refresh? Looks good now.

Jennifer Marie: … Jean says that chia seeds cause her to get stomach pains.

Dr Boz: Make sure to take those chia seeds with a lot of water. That’s one thing. They’re kind of like tapioca, they do swell. That’s what we’re using, we’re using the chemistry as part of the equation and then if your bowels, I mean there’s a lot of changes that go on inside that bowel in the first couple weeks of keto. I would contend when you’re more of an advanced keto, maybe even a carnivore, that the volume of stool is so much less that you really have to kind of graduate into that level of eating. But what’s remarkable is how much stronger the slime layer becomes inside that bowel. That sounds really gross but it’s super important that your body protects itself with this slime layer, that’s how it lubricates the stools to move along. When you’ve had chronic inflammation, which so many of my patients have had on a low carb, excuse me on a high carb diet, that the chronic constipation is another place where that bowel is just swollen and the way it makes the slime-

Jennifer Marie: You know what? I think you do need to refresh because I’m having a hard time hearing you. Go ahead and refresh and just jump back into that link I sent you. Hopefully we can get Dr. Boz back on here as she jumps off for just a second. I hope everybody can hear me just fine. Sometimes we do have these connection issues but it was kind of crazy, John was really scared to take anything with a seed because he had been told by his doctor for so long, “You avoid seeds.” Even seeds as small as seeds for strawberries, broccoli that has the little tips. It can cause some serious issues when you have irritable bowel syndrome and diverticulosis. He was fearful to take it and he did take it. It worked like a charm. He didn’t have any issues when he did it. It worked fairly quickly too. It was very interesting that seeds did it. I love that it doesn’t spike your blood sugar.

Dr Boz: Yes. I’m back.

Jennifer Marie: Awesome, awesome. Let me answer some questions here because I think we missed a bunch as- [crosstalk 00:10:28]

Dr Boz: There was actually, way at the beginning that I want you to-

Jennifer Marie: Melissa says, “Do you take them raw?” Yes, literally he took a tablespoon, he put it in his mouth, he drank a whole cup of water and you have to drink a lot of water because if you ever put them, just put them in a cup with some water and you’ll see what they do. They become slimy, they expand I don’t know how many times their size but you really do need to drink a lot of water with it. Somebody said, “Do you recommend keto for people that have gallbladder removal?” I think we’ve done that one before, haven’t we?

Dr Boz: I have a really good video on my channel too.

Jennifer Marie: We can talk about, I mean the answer was yes because, that’s a whole different subject. That’s going to be a good one for maybe another one. Chia seeds cause me stomach pains. That’s what Jean was saying. “How do I get on the list?” The list, my email list is and just put in your email list, I’ll send you an email. You have to confirm your subscription because you’re getting on my list and I send out one every Friday. Let’s see. “My cholesterol came back borderline high with my recent blood tests.” Okay, we are going to talk about cholesterol. Okay, Dr. Boz, which one did you see that I’m missing?

INTERMITTENT FASTING TALK in the beginning when you want to give up. 36 HOUR FAST RECOMMENDED

Dr Boz: There’s one that was way at the beginning about I’m ready to give up, my glucose was pretty good but I can’t get my ketones up and I just want to make sure that whoever said that, make sure you’re checking blood ketones. Those are the ones you can do a much better job of knowing confidently that the ketones are true. Urine ketones, otherwise known as pee tones, once you become keto adapted, those strips are just not going to show a very high ketone level. Just make sure you’re measuring blood ketones. Then if you’re having trouble getting ketones up, usually they have insulin resistance or they have had lots of stored sugar in their muscles and their liver. Putting your window of eating to be 12 hours before you wake up as nothing, zero for 12 hours and specifically those 12 hours of morning, arise time minus 12 hours. It’s really important if you’re struggling with that.

Jennifer Marie: That was for you Erin Potter. We see from Ohio, that was answering your question about how to get your ketones up. You’re right that’s exactly what you did with me. You started me off fasting, I would stop eating at, I think I started at 7:00 pm and then I moved it up to 5:00 and then I moved it up to 4:00. It really does help to get your ketones up.

Dr Boz: Definitely that was hard, to learn how not to eat in the evening. You say that to people and they’re like, “Is that possible?”

Jennifer Marie: No, I had it all backwards. I was so busy during the day that, when you’re on keto you’re not really hungry or you don’t think about food and especially when you’re busy. I would not eat all day. I would do it backwards. I would not eat all day and then I would eat maybe my one meal but it would be so late in the evening and it would be a gigantic meal and then I’d be tired. I just had to train my body to do it in the morning. Somebody who wakes up, I don’t want to eat in the morning. I enjoy my coffee. I make sure to eat sooner in the day now. But it is a training thing. You do have to get used to it. It is not easy. But it is doable.

Dr Boz: It really makes a difference. Your hormones match better, especially as a woman. If you are anywhere over the age of 40 that is really important to respect that, 12 hours before you wake up, zip it. Don’t do that.

Jennifer Marie: Erin Potter said, “I’ve been intermittent fasting and one meal a day for 2 years.” Wow, is it possible her body is used to doing it? Does she need to switch it up and stress it a different way?

Dr Boz: That would be, she’s ready for a 36 hour fast. I’d want to know morning fastings, what is it Dr. Boz ratio? How low are the ketones and how, because if you’re at one meal a day and you’re reached a steady state metabolism, the stress is, you need to move to a 36 hour fast which really is you have supper one night then nothing the next day but black water, black water, black coffee, water and tea. Then you can have breakfast the next morning but boy, you really need to step into that, graduate your body into that.

Jennifer Marie: Yes.

Dr Boz: During that time, check your numbers. Make sure you check your numbers.

Jennifer Marie: There is something magical that happens at that 36 hour mark. It is not, I struggle with fasting. It is a big deal when I do a 36. It’s a mental thing for me. But there is something magical about that. Could she stress her body with exercise to? To get rid of-

Dr Boz: I would do chemistry before exercise. If you look at, reward, when people are especially at the part when they say, “I want to give up.” Be careful, don’t do that. It is amazing how many things after you’ve been keto and they you go backwards, you’ll be back to keto because you can’t believe how many things work better with that lower state of inflammation and you don’t realize it. Now, the scale is not moving. That’s the part where you say, “If you want the scale to move you need to shift that chemistry to a higher level of performance. That means 36 hour fast. Once she’s mastered that, then I would push her to use resistance training.

Jennifer Marie: Carmen is saying, I think she meant to say Truvia. She’s probably talking about a sugar substitute. “Can Truvia in your coffee stop your fasting?” If you’re going for [inaudible 00:16:17] it needs to be black coffee. Black coffee, water, and pink salt is what I do, all day.

Dr Boz: It is an acquired taste as well. Again, I used to never have black coffee but I’m a black coffee kind of gal now.

Jennifer Marie: I’m not. I’m not. Nope.

Dr Boz: I have lattes with heavy whipping cream a couple times a week.


Jennifer Marie: That’s my thing. No, I’m not there yet. Okay, let’s see. Let’s jump into the cholesterol talk, shall we? I think it’s a big deal. The reason why I think it’s so important to talk about is because in these groups, I run the group low carb inspirations plus keto friendly recipes on Facebook, there’s so much talk and it seems like the new person coming in, they’re always like, “Oh my cholesterol went up.” We’re thinking, “Yeah.” There is some true science behind why it will come up and really what you should be looking for. I think you are the best person to answer this because you understand it perfectly.

Dr Boz: The first thing that I encourage people to say is remember why are you checking cholesterol? You look at the majority of people and they will tell you, “I’m checking cholesterol because I don’t want to have a heart attack.” Oh, it’s a heart attack you’re trying to prevent? Heart attacks have a calculation where we can say what are your risks? If you’re above the age of 30 and you are below the age of 60, we could give you something called a Framingham Risk Calculator which you can use online. Put your numbers in to say what’s your risk of a heart attack. Although that’s not the best calculator if you ask me. When I’m looking at risks for heart attack in my clinic, you want to see the highest predictor of heart disease, the highest predictor of people who die of a heart attack. It is local high insulin.

Jennifer Marie: It is what? Say it again?

Dr Boz: Those with high insulin.

Jennifer Marie: Oh okay.

Dr Boz: Insulin is this, you say diabetics are the ones who are going to die the youngest and give up the most life lost because of their high insulin state. The doctors are the one giving it to them in most cases. When you look at predicting a heart attack though, cholesterol is one part of this equation. That cholesterol isn’t your total cholesterol that we’re looking at to predict a heart attack. We are looking at some other things that do a much better job. For starters, if you’re on keto and you’re saying, “I think I’m going to have a heart attack, I’m worried about eating all this fat.”

Dr Boz: My recommendation is to have them check their cholesterol before they start and then do not look, don’t look again for at least six months. You really want your body getting past this next stage that’s going to happen. The hard part about that is, today’s world, when they go in to get their cholesterol checked, if their LDL is high, if their bad cholesterol is high or if their total cholesterol is high you’ll get a call back from the nurse, you’ll get a call back from the doctor’s office saying, “You need to be on a statin.” It’s a touchy conversation to say, “I know.” What we’re trying to do is lower your risk of a heart attack but you’re going to see some of these numbers go up when you first start on keto.

Dr Boz: Let me describe why that happens. In the setting of the foods that we eat, your body is being nourished by the foods that you eat. When you are on a low fat, high carb, standard American diet, the amount of turnover for your cholesterol is very low. Cholesterol is actually the carrying protein, the carrying process that takes fat from one location to the next. When we look at most people’s cholesterol and I wish you could have tags on their cholesterol floating around in their body because it would tell me how long has it been there. The dangerous cholesterol to have is the one that’s been sitting still inside their blood without a place to go. That is a very common problem when the fat is low and the carbohydrates are high and the insulin is high. In the switch to a ketogenic diet, you’re going to add fat. It’s a high fat diet. When you add fat, now your carriers are going to have a job to do. They’re going to be much busier. You’re going to see an uptick in the total cholesterol. You’re going to see an uptick in the bad cholesterol.

Dr Boz: I’m telling you, don’t look for six months. As your body adjusts to saying, what I really want to know about my ketogenic diet, what I really want to know about my body is, is the cholesterol being transported from one place to the next? It’s not old cholesterol. You’ve heard me talk several times about when things that still in the body is when it gets hard, it gets inflamed, it’s not healthy. When the sugar that gets stored stays there in the liver, we can have cirrhosis of the liver. When the fat doesn’t get moved around, that cholesterol says, “I’ll just hang out in these arteries because there’s no other place for me to go.” When you’re on a high fat diet, your little transporters of cholesterol are now busy. They’re taking it from one, this is why when you’re on the ketogenic diet that hair looks better, the skin looks better, the turnover of cells is happening on a better rate because of that increased fat delivery.

Dr Boz: I would contend that if you’re only looking at these two little things for predicting a heart attack, meaning your total cholesterol and that LDL or bad cholesterol then you don’t know very much about predicting heart attacks. That’s not your biggest enemy. Your biggest enemy is how inflamed is the inside of your body. How much insulin are you producing? How big is your tummy? How high is the blood pressure? These are predictors of a heart attack that do a much better job when collecting all of these points. I would contend, six months of a solid ketogenic state you are going to lower the triglycerides, which are one of the first things to kind of get clogged up when you’re on a low fat, high carb standard American diet. Those triglycerides get more and more inflamed. It’s a sign of high insulin is when those triglycerides are high.

Jennifer Marie: I have a friend that is not convinced of the keto diet. There is no convincing him. He, how do I explain him? He’s built. He’s fit. If you took his waist circumference it would probably be fine. But his cholesterol is horrible. He states, I mean it’s like five times what it should be. I don’t remember the numbers, we were just talking about it but he eats very low fat. He eats like, chicken breasts and a salad with no dressing. You know what I mean? How body builders would eat, very low fat, chicken breasts, vegetables. Just watches everything that he eats. What would you tell somebody like that who has, he swears that his cholesterol is genetic.

Dr Boz: He may be one of the ones who has a higher cholesterol level that is genetically based. It still doesn’t mean that [inaudible 00:24:06]. Again, why is the ketogenic diet something that I would recommend even in someone like that? I’d want him and his doctor on the same page. You don’t want to do this in that setting without having the doctor hold your hand, walk through this, check the numbers but what I would be looking at is, what decade of life is he in? 30s? 40s? 50s? 60s? 70s?

Jennifer Marie: Probably 40s.

Dr Boz: 40s? Okay. You are definitely in that tipping point where when the inflammation has been around for a long time, even when they’re lean, the man who dies suddenly of the widow maker in his late 40s, early 50s, that is very real. When we say, “How can we predict these people?” The answer comes with that highly sensitive C reactive protein that you and I measured in you a few weeks back. The insulin level. You send him to the doctor’s office to get an insulin level and I would say, “Don’t do that. Instead, give him a ketone meter and just say, ‘Check your sugars and your ketones every morning for the next week. When you collect that ketones and glucose combined, that is a predictor of lowering that insulin. The lower that ratio, the lower the Dr. Boz ratio, the lower that insulin.'”

Dr Boz: That’s something that is tangible. That’s something you can say, “Here, the reason I want it low in you Mr. 40 year old with high cholesterol is that if you take your cholesterol, genetic or whatever it’s from and you watch what will it do to your system, it does it 20 times faster if its inflamed on the inside. You can measure those things.” That’s what your highly sensitive C reactive protein is. That’s what your Dr. Boz ratio is measuring. How high is your insulin. Why do I want people to check your numbers, check your numbers, check your numbers? Because I’m an internist, we like to check things. It really is important. It’s not that big of an ask once you get through the barrier. I mean, remember the first time you checked your sugar, you’re like, “I’ve got to do this.” I’m like, “Yep, you’re going to be fine.” Once you’re in power by saying, “Here’s what your body is doing in this situation.” You give the control back to him because he’s like anybody saying, “You don’t understand me, my body is different.” It may be different but let’s measure and see what it really is doing.

Jennifer Marie: That’s why I wanted to bring this up because there could be somebody watching who thinks exactly like that. You do want them, knowledge is power. If they know and can check, I mean nowadays it’s so easy, we can check it ourselves.

Dr Boz: That’s right. You know, the other thing that I tell folks to do in my town, there is a screening test called a coronary artery calcium score. This is a very rapidly firing X-ray of the arteries of the heart. Less radiation than you get with a mammogram. Very low amount of radiation to get the images but you get a specific look at has he had hardening of the arteries already? That is super valuable. You look at cholesterol and what the cholesterol is trying to do is predict the future. If you’ve got a man whose got family history who says, “We have high cholesterol, mine is genetic. It’s five times higher than it’s supposed to be.” For heavens sakes, have him look at his coronary artery calcium score. That tells me where are we at today. Forget the future, if you’re about to have a heart attack let me show you how to decrease this inflammation. I mean, I can show you how to prevent this problem. We can’t afford for you to say, “Oh we’re just not going to look at what it is today.” Coronary artery calcium scores. You can get them done for as little at $50 in my town. Sometimes I’ve seen them as much as $100. That’s no insurance, just saying, “I want to have a scan done.”

Jennifer Marie: Nice.

Dr Boz: Your insurance actually should cover it.

Jennifer Marie: [Gergita 00:27:54] says, “My husband is not keto and his triglycerides came back at 232. Do you think keto is a good idea for him?”

Dr Boz: Perfect. I’d love to know the decade of life he’s in but triglycerides are one of those absolutely first thing I would do is cut down the carbs. Watch what happens when you cut down the carbs. I can remember the first few years of my practice I was a big proponent of the South Beach Diet, which isn’t keto but it’s a lot less carbs or all of your carbs had fiber with them. I could lower their triglycerides, I could tell if they were following the diet just by looking at their triglycerides. Now, it’s like that diet on steroids is what the ketogenic diet is. If you want to take his numbers and make them look perfect, like if he needs life insurance this is how you make the life insurance numbers look great. You go keto for six weeks before [crosstalk 00:28:50] triglycerides won’t be high. Triglycerides come from, it’s the flow of movement of that fat that’s blocked because of the carbohydrates. Now you’ve got this stockpile of fat and the reason it’s stockpiled is because the carbohydrates are blocking the flow of how it’s supposed to be transitioned through the liver and then throughout the transverse system in the body. Absolutely, if you’ve got 230, I like triglycerides less than 100. I love it when they’re in the 70s and 80s. But the only patients that do that are ones that have low carbohydrates and a low insulin state.

Jennifer Marie: Jan says, “Regarding a non-zero CAC score, what do you do for an existing plaque? Is it vitamin K2?”

Dr Boz: Yeah. What she’s saying there is the calcium scores on these coronary artery, calcium if it’s zero you win. It’s a really good predictor that you can go a few years and not have a risk of a heart attack or a very, very low risk of a heart attack. If it’s a non-zero, how high is it? Is it 100, 200, 300, 400? I’ve had patients have it over 2000, at which point I told him, “Don’t move you might have a heart attack.”

Jennifer Marie: Don’t sneeze.

Dr Boz: A non-zero, okay you have a hardening of the arteries. The first thing I would tell them to do is, do you have a good level of vitamin D? Do you have K2, is a vitamin I have tried to get the sauerkraut and the other foods this is high in but I’m telling you, this is one of those I would supplement. K2 is the vitamin that kind of helps route where the calcium should go. It is kind of the policeman for calcium. Where should your calcium be going.

Jennifer Marie: This goes into Luanne says, “What about vitamin D3 and K2 to reverse CVD? How much should we take?”

Dr Boz: Yeah, that gets a little dicey. There is a couple of nutrition experts out there that would say around that 200 mark for the K2. The D3, again it depends on how much sun you get, how low was your vitamin D, you can get the D3s to be 400 three times a day. I’ve seen it at 2000. D3 is one of those that I would be doing that with your doctor. Make sure you’re checking the vitamin D at that point.

Jennifer Marie: When we talked last time and when you had me take it, this is the one that I purchased. I just take one a day I think.

Dr Boz: Again, yours wasn’t coronary artery disease though. Yours was inflammatory [inaudible 00:31:44]. It’s a different population of people we’re trying to target. When they already have calcium found in their score I’m getting up to 200 milligrams. I’ve seen it twice a day. Again, it’s one of those supplements that there is this range that you could take. I like that you take it separately from the D3. I know there are supplements out there that have them in combination. The right answer is about 50 different options there.

Jennifer Marie: Pat is asking, “Will keto help with neuropathy caused by my diabetes?” Did I say that right?

Dr Boz: Caused by my diabetes. Again, neuropathy is, you get to a microscopic level and say what’s happened to his feet or his hands, usually it’s in their feet first, the nerve, think of it as a wire and then around the wire has insulation. The insulation is made of fat. How well you insulated your nerves has to do with how well you supplied that nerve with fat. If you’re a diabetic I can tell you there’s more carbs than there should be. With those high carbohydrates came inflammation and most, the furthest away from your heart are those nerves and the blood vessels in your feet. That inflammatory state, that is chronic, that is in every diabetic, it not only inflamed your feet which makes that fat not as healthy, that insulation around the fat is not as healthy and if you take a biopsy and you look at some of these nerves in neuropathy patients, it’s like a little mouse came in and chewed on the wire, those electrical wires. There’s holes in that electrical conduction. That’s what makes them hurt. It’s like the electricity kind of zips down that wire for the nerve but every time there’s a hole in the insulation it rips out some of the energy and that’s where the pains come from. They do kind of a loop of a circuit in his feet.

Dr Boz: We say, “I’m fat.” Most diabetics are fat. “Why wouldn’t my body use that fat?” This is what cholesterol does. Cholesterol is the movement of that fat to the areas of your body that need to repair. You cannot move the fat if the sugars are too high. If the sugars are too high, everything in that flow of work order stops. Those, the liver says, “I will not use that inflammation, I will not move that fat because of inflammation. I will not register the sugars, I will not be able to deliver the fat to where it needs to go because the sugars are too high.” Just think of it as a stop gap.

Dr Boz: He didn’t do that for a week, he got neuropathy because that has blocked flow of movement of that fat for 20 years, 15 years. To repair it, now you have to say, “Well, go on a ketogenic diet.” That reduces the inflammation and it moves cholesterol around. Now your body is putting fat in the blocked part it couldn’t do with a high carbohydrate diet, you can now do. But you’re going to check your cholesterol and it’s going to be higher. You’re like, “Wait, Doc, I’m on a ketogenic diet. You told me to do this. It was going to help my feet repair the fat but now my cholesterol is higher.” I’m like, “Yes your total cholesterol, your LDL cholesterol is going to move the parts around the body but that’s part of what happens to repair it.”

Dr Boz: The question was, can I repair this neuropathy? Yes, it’s tiny. It takes a millimeter a month. Just think if you’ve got four inches of nerve that have the neuropathy in your feet, think of how many millimeters are in those four inches, think of a millimeter a month but you have to be in a low inflammatory state and a high fat supply, which is what a ketogenic diet is. I hope that answers your question.

Jennifer Marie: We’ve got, I was looking back at comments and I missed some. As we were talking about the chia seeds earlier, Melissa said, “I’ve used chia seeds as an overnight oats recipe” and yes, if you haven’t done that yet, I have, it tastes like oatmeal. You can eat it cold, you can eat it warm but there is actually a recipe in my cookbook for that. It’s on page 17 and there it is. Absolutely delicious. That is a thing but you know what? I missed another question now that I’m looking back and it was at the very beginning. Can infections that your body may be fighting raise your glucose number and decrease your ketones? I think that happened to me. I think when I got sick, didn’t you explain that’s the fuel source fighting, being used because your body is fighting an infection.

Dr Boz: Yeah. White blood cells, they need fuel too. If they’re using, if they need some fuel to fight off the infection, you will see that actually, the other thing it does is you will stimulate cortisol which is a stress hormone saying, “Hey we have a fire to put out and that stress hormone goes to your liver and out comes some of that stored sugar. You’ll see the sugars go up, which then will raise your insulin, which will lower your ketones but you have to deliver the fuel for that infection. What I tend to see happen early in keto users when they get an infection is that that stimulation of sugar will make them have a craving. They get off that bandwagon when they get an infection because the cravings are a little too heavy for them to handle. They’re just, feel like saying no at those times is not as strong as you want it to be.

Jennifer Marie: I cannot find the comment, we have so many comments here but there was another comment and I’m hoping I’m going to ask this the right way that I remember reading it. They were asking, when you fast and you get into this autophagy state, does that help since it’s repairing cells, is it something that can help with scar tissue, do you think?

Dr Boz: Scar tissue is tissue that doesn’t belong there. Let’s take a keloid [inaudible 00:38:09] you know the kind when you have a scar it gets a really big, heavy bump. You say, “Why does that happen?” The keloid is an advanced scar. Let’s just start with that. The advanced scar came from inflammation when the body was trying to repair it. That tissue is alive. If you cut down the tip of a scar, you’ve got this big keloid, if you put a slice into the scar it bleeds. It’s not like, empty tissue. It still has blood vessels, it’s still alive. That scar turns over it’s cells just like anything else in your body. It’s slower because it’s a new piece of your system, new piece of your body. Now that you decrease the inflammation and those skin cells continue to turn over, especially if you can really enhance the growth hormone, which is what autophagy is doing is enhancing, pulsing those hormones, you will find those scars can repair. It’s slow. You don’t say, “Hey I’ve been doing autophagy for one month now, once a week, why isn’t my scar less?” Because it’s a slow, dividing cell.

Dr Boz: What I think is powerful is in my patients who produce keloid, it’s awful. Especially if they are, like a gastric bypass. Now they’re in an inflamed state, they’re in a low metabolic state and now they have this rope-like scar that’s kind of like train tracks around their body. Then they go keto. About six months to nine months later they’re like, “I cannot believe how much my scars have softened.” It’s very rewarding for them. That’s your body trying to repair. That’s why reaching for autophagy once a week, hit that Dr. Boz ratio less than 40 once a week is a steady process of trying to keep that.

Jennifer Marie: Just to remind the people who may not understand or may be new joining us, that ratio is you’re going to take your glucose number, you’re going to divide it by your ketone number and you’re going to get the ratio. Anything 80% or under you’re in weight loss zone. Anything 40% or under you’re in an immune boosting, pretty much in autophagy. Anything 20 or under is amazing and you’re in cancer fighting zone. The lower the better. We have a couple, Janny says, “My total is 252, HDL is 84, LDL is 155, triglycerides are 66, triglycerides went way down on keto.”

Dr Boz: Yep, that’s a sign they’re being compliant. It’s not like an accident. It’s because of what flow is in the body. Boy, it is so amazing how much better their numbers get. There is not a medicine I can prescribe that will lower your triglycerides the way you can with the ketogenic diet. You kick the crap out of all pharma industries by following this plan. The ones that, if you want to have a sneak peek at what your labs are going to look like, check your numbers in the morning. Morning fasting numbers will give you the hint to say how well is your body repairing overnight. You’ll know if you’re going to have a good report because your Dr. Boz ratio has been low, your numbers in the morning have been low. That means the system is doing what we expect it to do.

Jennifer Marie: Definitely. Skyview says, “I had Rocky Mountain Spotted Fever ever since I started keto in 8/18. How is this affecting my ketones?” I don’t even know what that is.

Dr Boz: Rocky Mountain Spotted Fever is an infection from a tick. Rocky Mountain Spotted Fever, I haven’t thought of that in five years but it’s a tick born illness. I don’t understand the question.

Jennifer Marie: She was just wondering if it’s affecting her ketones or how it’s affecting her ketones.

Dr Boz: If she got the infection, I see what she’s saying. She has Rocky Mountain Spotted Fever and she’s on keto. Is this affecting my numbers? Yeah. You’ll have a heck of a, that’s a terrible infection to get over, especially as an adult. It’s really a cortisol stimulating infection because it’s life threatening if they don’t take care of it. I’m sure what she’s doing is she’s taking the medicines to take care of it but it will impact her Dr. Boz ratio, it will impact her system because your body is putting out a major alarm system saying, “Hey we’ve got an infection hanging on here, help me.” Once the infection is gone your body will recover. Hang in there. If she was my patient, I would be doing something like supplementing the ketones to help her through it. Don’t ask your body to do all this while you’re struggling with that kind of infection. Just cheat. Not with carbs, cheat with supplements.

Jennifer Marie: Yeah. In other words, you’re going to hack your body, you’re going to feed it with ketones since your cortisol is up, your ketones are going to have a hard time. Supplement with those ketones, boost those ketone levels so it will help is what she’s saying.

Dr Boz: Right. Supplements are not for everybody but there are times when, boy, it’s really a tough situation. Here you have this patient who is trying to make a good change, it’s probably really healthy for her and then she runs into this unfortunate situation of, bad timing to get Rocky Mountain Spotted Fever. Keep the momentum by just hacking the system until you get through it. Then your body will do what it’s supposed to do.


Jennifer Marie: Awesome. Joanne says, “I just read your recipe book, looks good. Do you minus the fiber or stick to true carbs?” I prefer to stick to true carbs in this book. I put the fiber in, you can do the deductions. I think it’s better you just know what it is straight across the board. If you got the book, I know that some people have not redeemed their freebies yet. If you want to redeem your freebies you need to do that. You can download it, go to\pre order. Use your receipt, put the receipt number in there and then you can get those downloads.

Dr Boz: What a perfect Mother’s Day gift by the way.

Jennifer Marie: Yes.

Dr Boz: Did we plan that? That it was Mother’s Day week?

Jennifer Marie: No.

Dr Boz: I know we’ve been counting down to it but it’s like, “That’s so perfect. Happy Mother’s Day.”

Jennifer Marie: I was going to the store today and I ended up lost, I was on a different side of town and I wanted to go to this store that had a certain thing that I needed. It was only that store and it was the other side of town that I wasn’t used to going to all the time. Anyway, I passed my exit, turned around and came right into a Barnes and Noble. The book just came out so I’m like, “I don’t know if everybody has it yet.” I walked in because I love bookstores anyway. I walked in and there was my book. I was like, “Ah.”

Dr Boz: That’s so cool.

Jennifer Marie: I know. I just grabbed a guy and I was like, “Take a picture of me, please.”

Dr Boz: Yes. Take a picture.

Jennifer Marie: I was like, “Ah.” He’s like, “That’s your book?” He goes, “That’s pretty cool.” Anyway, the guy there goes, “Oh wait you need to sign them all.” Then they put stickers on there, autographed copy. He’s like, “You need to come back.”

Dr Boz: That is super exciting.

Jennifer Marie: You know what the best part was? There was a young person there. She came up and she goes, “You published a book?” I was like, “Yeah I did.” She’s like, “That is so cool.” I think that’s her dream. She just came up and was like, “You did it?” I was, just to see a sparkle in a young person’s eyes to know that you’re just a real person and yes you can do it. I bet she’s going to do it too. It was kind of cool.

Dr Boz: I have goosebumps thinking about that moment. That is so cool.

Jennifer Marie: Yeah, it’s pretty cool. Violetta says she saw it at Sam’s. Yay, awesome. Okay, Lynn if you got it from Amazon there should be an order number you can use. Amazon has an order number and you can redeem it there, no problem at all. Yes, lots of people have sent me pictures of food that they’ve made, pictures of them with the book. You guys don’t even understand, all the emails that I get with the screenshots of where the book is or you’re enjoying it or if you’ve gifted it to somebody, oh my gosh my heart is so full.

Jennifer Marie: I had somebody send me a message that they took the caramel sauce, oh my God I’m going to have to find, I asked her if i could post the recipe she did because she made these bars out of the caramel sauce recipe that I had. She took this to a whole new level and made these bars out of, did she took maybe the cookie recipe and then she took the caramel recipe. The girl is amazing and she’s like, “I keep this caramel sauce in my fridge just to have it. I want you to know that your recipes, although basic, you can really take them and combine them to new levels or you can just have them so you don’t cheat.” I’m going to have to write that up because I was drooling as I saw that picture of what she made. I was like, “No way.” That was kind of cool.

Dr Boz: That’s such a moment. I’m so happy for you. That is, not just coming out but then being able to see it in a local bookstore, that is just beyond.

Jennifer Marie: That feeling happened today. I just, you can’t even explain it. I was so excited and the guy who worked there, I think he was more excited than I was. Then I was like, I get kind of shy. I was like, “Sh, don’t say it too loud.”

Dr Boz: That shyness is going to evaporate right out of you eventually. That’s cool. I’m in awe, that’s so cool to imagine that moment.

Jennifer Marie: It’s pretty cool. That was such a good conversation on cholesterol, on constipation problems. We are definitely solving problems even on Mother’s Day.

Dr Boz: Even on Mother’s Day. Absolutely.

Jennifer Marie: Can you give an update on Grandma Rose?

Dr Boz: Yes. There’s been a few things on Grandma Rose. Today is Mother’s Day and the book that I wrote is about my mom, at 71 had a moment of giving up. They want me to have chemo one more time and I give up. The book shares the story of how we used the ketogenic diet to help her cancer and since the book came out, she’s had a couple more rounds of chemo. The chemo isn’t perfect but it sure worked a lot better with her lower sugars and her high ketones. There was a complication over Christmas time where the chemo was causing some vision problems, to the point where the doctor was like, “If I put a steroid shot inside the eyeball” right. Just sounds awful. It’s not that uncommon of a procedure but it sounds, it’s got a really bad marketing plan. We were avoiding that with her really stepping up, posting her numbers, being accountable, reaching that Dr. Boz ratio of 20 or less is really hard but that’s what a cancer patient should do. She was solid in the 40s and 30s for several months there.

Dr Boz: Her eye was getting worse. We were pretty certain it was from the chemo. About six weeks ago we stopped all the chemo and she was just on the ketogenic diet again and then she was supposed to get a set of numbers done one month being off chemo. This happened last Friday, not just two days ago but 10 days ago if you would. Again, she’s now a month off of chemo, only on the ketogenic diet and she’s just been posting away, really accountable to the process. When she got diagnosed her white count was like, 150,000. Then it was up to 180,000 and then it was, yours is 6,000 okay? When she stopped the chemo last month her number was about 55 or 60,000. It’s doing pretty good, we’re at a pretty good number. She calls me last Friday and said, “The number, my number, my white count number is 10,000.”

Jennifer Marie: Oh my gosh.

Dr Boz: I’m like, “Mom they screwed up the blood.” She’s like, “No they didn’t.” I’m like, since we’ve been keto, since we’ve been doing this it’s never been under 20. To have it at 10, maybe it was 11,000 but somewhere around 10 or 11,000. That’s normal. I’m like, when I was writing the book I did not tell her oncologist what we were doing. We just journeyed, just learning enough to do our own thing and not disrupt anybody else’s life. I said, “Just wait until Dr. McHale reads those numbers. He is going to get on the phone and say, ‘What are you ladies up to now?'” What an amazing result though. Again, the ketogenic diet isn’t a panacea but it really does decrease inflammation. When you look at cancer cells and what they can do and what they can’t do, they can’t adapt. Your healthy cells can adapt. They can use both ketones or glucose. I just must say, she’s turning 75 this year and we’ll be, it’s so rewarding to see how much life has just been present since we’ve done this ketogenic diet and to have a result like that the week before Mother’s Day. We win. Perfect, you win.

Jennifer Marie: That’s awesome. That’s awesome. Debbie just commented, she said her dad who is 93 is cooking keto for her mom, who is 92. They’re using my cookbook, yay. He’s reading your Any Way You Can book. She has already lost 20 pounds in several months and has lost the amount of the same in half the time, too fast I think. He now wants to gain so we are increasing the fat and protein. Don’t want him to lose muscle. They were initially inspired by Dr. Westman and then you two ladies. You guys, we love Dr. Westman. We both have chatted with Dr. Westman, he is amazing. Amazing.

Dr Boz: What a transformation he’s made. He comes from Duke University, he’s got studies behind what he’s done. He’s an internal medicine doctor. We speak the same geek language. He is in a different echelon of publishing different studies and really leading the way for other physicians like me. I reached out to him and he responded to me, too, when I first said, “Am I doing this right? This is a pretty incredible, how did I not know about this?”

Jennifer Marie: His scope of helping out the keto community, I was lucky enough to sit next to him at a conference that we last went to earlier this year but not only that, I had dinner and lunch with his whole team. They are trying to do clinics where if you want to find a keto doctor, you can go through him. It’s called keto clinics. If that is not amazing, to make keto friendly doctors available, I really think it’s going to change the world. I think that those are going to be everywhere. I think it’s still kind of new and people still don’t know but you watch. It will be everywhere and lots of people, when you start hearing it and when you go to the store, you hear little keto this and keto that. People are like, “Oh my God, I tried it” or “I failed.” Here, let me help you. You’re starting to hear it now where a couple of years ago I didn’t even tell people what I was doing. They’d say, “Keto what?”

Dr Boz: The energy to kind of, you start educating saying, “Okay let me go back to what is a ketone.”

Jennifer Marie: Yes.

Dr Boz: Say that again. It really is transformative. You know the 93 year old that doesn’t want to gain weight, I hear that a lot as well. When I switched people to keto and they say, “Can I do this? I don’t want to lose weight.” I’m like, “Don’t look at the scale. Look at the health. If the scale goes down at first when you’re on a ketogenic diet it’s because you have inflammation. That inflammation does not belong there. You can find a way to not lose weight. My mom and I did not lose weight the first six weeks. We had so much to eat. We didn’t lose weight, we both felt amazing but we did not lose weight. Again, the journey of weight loss is because you do really, as your body kind of repairs and that metabolism starts to really get healthy, there are more things than just weight loss that will happen. When I look at folks with chronic inflammation and they are elderly, like a 93 year old saying, “Hey we don’t want dad to lose any weight. Should he be on keto?” Yes. The anti-inflammatory at 93 is really helpful for him. The weight is going to do what it’s going to do. Don’t focus on that. He’ll be fine. We’ll figure that out. Get the inflammation gone first.

Jennifer Marie: Lynn says, she tells students all the time geeks rule the world. Yes they do. Chris D says, “Love both of you ladies, you have helped save my life. I’ve been following you both for over a year.” I don’t know if you know but Miss Chris D is the one who moderates. She’s a huge help to the group. I’ve gotten to know her, in fact she is coming to my house next week. I am super excited. We are both highly passionate about the ketogenic lifestyle but we both love to cook. There will be, I imagine we might do some surprise live videos cooking maybe. We’ll see.

Dr Boz: My team has said I need to come get cooking lessons from Jennifer. I’m like, Jennifer can own that space. [inaudible 00:57:24]

Jennifer Marie: I had people in Sioux Falls, South Dakota say, “Hey you need to come here, do a book signing and a cooking class.”

Dr Boz: I would totally do that. That sounds like something I could be for.

Jennifer Marie: That’s a tall order, cooking while traveling. Wow. [crosstalk 00:57:45]

Dr Boz: … my kitchen.

Jennifer Marie: Good. This has been an amazing conversation as usual. You guys, could you help us out? Let us know what we do, we look at these comments, we try and figure out what our next conversation is going to be, what the next topic that can help the majority of the people and if we see people talking about cholesterol or constipation or something we are going to try and tailor these talks to help you. First of all, let us know in the comments because we do go back and read them, let us know topics you want us to discuss. You can also respond to the email that I send out and ask there. I will tell you that we get a lot. I try to answer most of those. It’s not always the same day or even the next day but they are read by me or somebody on my team. Please, let us know how we can help you. We’re here to provide the information, food from my side, science from Dr. Boz. It’s like we’re the perfect match to help anybody on keto.

Dr Boz: I won’t step in your role, I don’t think you want to step in mine.

Jennifer Marie: No. We hope you have an


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