Omega-3 in the Clinic: Sardines for 100 Days
OmegaMatters: Episode 46
Hosts: Drs. Bill Harris & Kristina Harris Jackson
Guest: Dr. Annette Bosworth (Dr. Boz).
About this episode: In this episode, Drs. Harris and Jackson talk to Dr. Boz, the professional alias of Dr. Annette Bosworth, an internal medicine physician, assistant professor, author, and keto-focused health educator who’s built a platform—BozMD—to help reverse chronic conditions like obesity, diabetes, depression, addiction, and autoimmune disorders using ketogenic nutrition and “keto chemistry.” She combines her medical expertise with storytelling—from university teaching roles to public features (CNN, Time, Fox News)—sharing practices like the “Dr. Boz Ratio” for measuring metabolic health at home via blood glucose and ketone levels. In this episode, they talk about eating sardines for 100 days and why Dr. Boz uses the Omega-3 Index test with her patients. For more information on OmegaMatters, visit: https://omegaquant.com/omegamatters-broadcasts/
SHOW TRANSCRIPT
Dr. Kristina Harris Jackson (00:00): All right. Welcome to another episode of Omega Matters. This is a “Be Our Guest” episode where we talk to people who are actually testing omega-3s in real people and telling us how it’s going. So today we have Dr. Annette Bosworth, Dr. Boz, and we have worked with her for many years and we’re so excited to have her on to talk about how she uses the testing, and a little bit about yourself. So thank you for coming on.
Dr. Boz (00:39): Well, Kristina, it’s great to see you again, and it is a privilege to be asked to be on your show, and part of your company. I often brag about how much your company has benefited my patients and my ability to cut to the chase, turn into the spin for folks who never want to touch a statin again. And never want to look at an LDL cholesterol. But we still got to talk about the truth of how we help you get better. And yeah we need more folks doing what you guys do. Which is take care of a problem, do it in a really great way, and then be the little guy that exceeds expectations. It’s been amazing to work with your company. Thank you.
Dr. Kristina Harris Jackson (01:19): Thank you so much. And it’s so great to work with and talk to clinicians who have a much broader view of what’s going on with health than we do. We get pretty narrow and focused in the Omegas, but then we can give our learnings to you and you can actually use it. That’s the whole point. So can you quickly give us an overview of what you do and how you work with patients?
Dr. Boz (01:46): Right. Well, so I grew up in South Dakota where you are right now, and where I was for the first 50 years of my life, and that entrance… Oh, and there is one of my favorite people.
Dr. Bill Harris (01:58): Oh stop.
Dr. Kristina Harris Jackson (01:59): There he is.
Dr. Boz (02:05): I was about to joke about you. So when I was applying to medical school, they ask you, “Do you have a letter of recommendation? Do you have anybody that you know that’s a doctor?” And I’m like, I had one doctor in Westington Springs, South Dakota that I knew.
Dr. Kristina Harris Jackson (02:18): Oh wow.
Dr. Boz (02:18): And as I’m applying to medical school, I really had very little idea of what I was saying yes to. But much of that traditional education, and I think we got some of the best education possible in South Dakota. Yankton, South Dakota was where I did some of that medical school training. That is just an excellent way to say it is your responsibility from this point forward to research and be able to answer the questions as the science evolves. So I head off to answer the hardest questions, which turned out to be internal medicine.
And I did that training in Salt Lake City, Utah. Again, another place where we were able to use data in real time in a clinic to say, “How are you doing taking care of that patient?” And as I brought those skills back to South Dakota, practiced in the city of Sioux Falls and worked with the University of South Dakota, School of Medicine, I found it incredibly challenging. Because as you are on the front line saying, “It’s my job to know the science and be able to answer the questions and try to take care of whatever protocols an internal medicine patient is presenting with.” The other part of this is you still have to sell the patient on doing what’s the right thing. (03:33)
There’s a salesman part of being a physician. And I used to snub at my husband that, “I’m not a salesman, I’m a doctor.” But what you’re really doing in front of that patient is so you can research the answer, you can have the understanding of the science. But if you can’t convince the patient that the next five steps are going to be worth the impact. That you’re going to have to say no to something, you’re going to have to struggle through things. You’re going to have to maybe taste a sardine or something that you weren’t raised on. And then that there’s evidence behind it in a way that they can connect the dots and believe you, well you might go crazy being in medicine if you can’t find a way to communicate that that’s attractive to a patient.
(04:21) So my career has been in internal medicine. When I thought I was going to be an ICU doctor, I thought that was the place where well, the patients were intubated, first of all.
Dr. Kristina Harris Jackson (04:33): Yes, complete control,
Dr. Boz (04:36): Right. There was a really great group of thinkers standing around making decisions in a way that I just loved watching and being part of how to do it better each day. But my third year residency, I had a baby and said, “Who the heck’s going to raise this if I go in that world?” So I took all that to outpatient medicine. No regrets, but my analytical desire I said yes to the first job was in Salt Lake City, Utah. And I was outpatient only. It was a bunch of Mormon men who were my partners. And I was taking over the practice of an older Mormon man who was retiring. (05:15)
And about three months in, I could not believe how many women were depressed. So I started screening for depression, that you’re going to get checked in from the front desk with a blood pressure, cholesterol, review your meds, and we’re going to do this nine questionnaire for depression. And I was in the high 300s of number of times I’d screened a patient. We’re at least 10 months into, nine to 10 months into this new practice before I got one, one that was not moderate or severely depressed.
Dr. Bill Harris (05:43): My gosh.
Dr. Kristina Harris Jackson (05:43): Oh my gosh.
Dr. Boz (05:46): My career path-
Dr. Kristina Harris Jackson (05:46): Wow.
Dr. Boz (05:47): … really took off in saying, “What’s the peak? How do we help patients’ brains get better?” And this really came from… This was at the advent of pay for performance. You might have heard that term for physicians bastardized that they’re going to pay you for the generic prescriptions. They’re going to pay you for how many of your statins are generic or your Prozac is generic.
Dr. Bill Harris (06:13): No.
Dr. Boz (06:13):
But the original pay for performance was, of the people that you’re in charge of, what’s their hemoglobin A1C and have you improved it? What’s their body mass index? Is that controlled? What’s their blood pressure? So these were metrics of how well were you taking care of this panel of people? And it was an internal report not to go out to insurance companies. And of course they had really good human psychology that they put you on a list of your partners. (06:40) So I enter into this really seasoned practice. I’m taking over this practice from this retiring physician. And the first report comes out and I’m stacked up against my colleagues and probably about… I think there was like 50 doctors on this, and I was like the worst one. My patient panel had the worst A1C, the worst blood pressure. And so I’m like, “Well, I’m a little competitive.”
Dr. Kristina Harris Jackson (07:03): It’s not going to work. Yeah.
Dr. Boz (07:04): Yeah. And so I start this process saying, “Well, in the ICU we would protocol this. And we would put you on a protocol and we’re going to do this and we’re going to do this. And I don’t care if you’re not coming into the office and I don’t get paid, we’re going to top this list, dang it.” And so we started out unconventional sending handwritten letters to patients saying, “I’m your new doctor. This is what we’re trying to reach for. We really need to check in your blood pressure at home. And if it’s not normal, you need to call the nurse, not come in. We’re going to change things before you see me. We’re going to control blood pressure. We’re going to control metrics.” (07:35)
And of course at the same time, I’m screening all these depressed women. Unbeknownst to me, Salt Lake City, Utah was the number one female depressed market in the country. And I have lots of reasons why that might’ve been, but I didn’t know that. And I remember coming home, it’s probably about four or five months into practice and saying to my husband, “I just think I want an intubated one again. It wasn’t something you’re really trained for. And if you’re trying to get their blood pressure better and they’re depressed, so then you start to turn into this band of, “Well, how could you really get this audience of people better? What am I going to sell them? What do I have to do to convince them to change a few things?” (08:19)
And then can I prove it? Can I prove that if you lean in and you work with me on this, you’re going to feel better? And it turned out mental health was the fastest thing to improve. They didn’t care about their blood pressure. They didn’t care about their hemoglobin A1C. They cared about how they felt. So this began as I was regular internal medicine, really leaning into peak brain performance and what can we do with that? And you don’t get very far along that line without knowing that, well, Omega-3 should be consumed taken consistently. And this time I didn’t have a way to measure it. (08:58)
But dang, if you think it’s hard to get folks in South Dakota to eat those little fish out of a can. You try the ones in Salt Lake City, it was even worse.
Dr. Kristina Harris Jackson (09:06): I mean-
Dr. Boz (09:07): So my career really has started out in Salt Lake, but had that… I mean, it was great for me, honestly, this was really feeding my personality that you were going to compare me to my colleagues on how to strategically work on this list of patients that called me their doctor, and how do we move the needle? If you topped the list, I think you got paid 3 cents better per-
Dr. Kristina Harris Jackson (09:34): Right.
Dr. Boz (09:34): Something really ridiculous. It wasn’t worth the money. It was the status symbol of being the number one at the top.
Dr. Bill Harris (09:39): No.
Dr. Boz (09:41): And I like that. So that’s part a career along the way of being good at internal medicine, but also really finding the things where you could make a difference and move a needle. And the patients return for how they were doing that, what they were doing really made a difference. And when I moved back to Salt Lake City or moved back to South Dakota, joined the… Left the University of Utah, and now I was at University of South Dakota, School of Medicine. And really found the same strategies that I was trying to apply to the patients there in a different culture in a different world, but that the patients were still the same. (10:26)
If you started focusing on the things that the new corporation said, “You should pay attention to this and you should pay attention to this and you should pay attention to this.” It doesn’t matter if the patient doesn’t feel better and if the patient isn’t really collaborating in on what can we do to help you feel better. By the way, you’re going to die quicker if you don’t take care of these other things.
Dr. Kristina Harris Jackson (10:47): But that’s so much more abstract than your day-to-day life. So I think that’s really important what you’re saying.
Dr. Boz (10:54): Yeah. So I think it was the right path for me to end up in a role of an internal medicine where there’s lots of hard problems to solve. But I also blame the comfort of being from a town of 800 people where I started kindergarten with 21 kids. I graduated with the same 21 kids. I know their parents, their grandparents. We knew which lady was sleeping with the neighbor, and which one was sleeping with the preacher. This as a small town USA, and you learned, don’t judge them. Be in their life and be the grace God has put you here to be. (11:32)
But it’s comfortable to be in an intimate relationship with patients. And I really think had I not had that desire to really be to know my patients and to have that back and forth, that you would’ve never reached these goals of how do you get some top award and get sent to the White House? You don’t get that without patients really wanting to be in that relationship. Well, to feel like they’re cared for. And I think South Dakota makes the best doctor because of that.
Dr. Kristina Harris Jackson (12:09): That’s amazing. I haven’t heard that full story. And it really is a great journey. And I think that’s… And then, so now you have your own practice. You’re no longer in South Dakota. But you’re where a lot of South Dakotans end up, which is Florida.
Dr. Boz (12:26): So yeah, 50 years in South Dakota and Covid was a year of death for me. My dad was on peritoneal dialysis that year, and my mom did the dialysis. So you peritoneal dialysis, you don’t have to go into the dialysis center, you can do it at home overnight. And so they were do-it-yourselfers and this worked well. And those years of pesticides, I think was probably the cause for his proteinuria and his demise eventually. So we also go to see my son who’s a freshman in college living in Hawaii, where South Dakota and Hawaii have reciprocities.
Dr. Bill Harris (13:10): oh , is that right?
Dr. Boz (13:12): Yeah. What senator did that?
Dr. Kristina Harris Jackson (13:15): Interesting. Yeah.
Dr. Boz (13:17): And as we went to see him, we had never taken our family to Hawaii. So on March 8th, 2020, we landed in Hawaii and-
Dr. Kristina Harris Jackson (13:27): Oh my gosh.
Dr. Boz (13:28): … our family did not get out of Hawaii for 93 days.
Dr. Bill Harris (13:31): Oh wow.
Dr. Kristina Harris Jackson (13:33): Oh my gosh.
Dr. Boz (13:34): You cannot see a patient even through Zoom if you’re not in the state that you’re licensed. So as my private practice at the time, had no nurse practitioners, no other providers. I now had a problem. And the staff that could much better do their job for hospitals that were paying big money for their skill sets and I… I mean at first we thought it’s been a week, it’s been two weeks. And then we looked at how we might get home. It’s a lottery system. I’m not going to send my teenagers-
Dr. Kristina Harris Jackson (14:06): Oh my gosh.
Dr. Boz (14:06): … one lottery at a time back to South Dakota. And anyway, so by the time we got home, we’re still in quarantine. Eight days later, my dad died. And four months to the day later, my mother died. And that whole mess, my private practice died, and my husband said, “Can we move now?” Never a better time.
Dr. Kristina Harris Jackson (14:33): Wow.
Dr. Boz (14:35): Yeah. So we left South Dakota at a time where death was in our wake and the reset was welcome. So I moved to Florida. I have a private practice here, but we moved during Covid and that private practice needed some paperwork from the federal government and the federal government people were not there. So what should have taken about four months of really paperwork back and forth took almost 18 months.
Dr. Kristina Harris Jackson (15:02): Oh my word.
Dr. Boz (15:02): In the meantime, I solved a problem in my private practice in 2012 that I thought was brilliant. And that is if you’re going to take care of a broken brain, you’re going to start with fixing their sleep. But nobody can fix sleep unless they do some steps. And when they can’t remember and they’re depressed and they really want to lose weight, those rules of how to fix sleep, it’s like Groundhog’s Day. You would keep saying the same thing over and over again. So I had given sleep lectures across the country and I finally put this… I put a sleep lecture, my favorite sleep lecture on YouTube, and it had a handout in it that was like the third grade… You know how preachers leave blanks in the notes when you go to church?
Dr. Kristina Harris Jackson (15:49): Yeah.
Dr. Boz (15:49): It was like, I had a handout-
Dr. Kristina Harris Jackson (15:50): Fill in the blank.
Dr. Boz (15:50): … fill in the blank. We are not talking about the sleep problem again until you’ve watched this lecture, and you’ve filled in the blanks. And if you come to the next appointment and you haven’t done that, I’m going to sit you in the waiting room and we’re going to do it that way. Because I am so tired of telling you the same thing. I can’t go to step two until you do step one. And this really started this online education process of, I need my patients to go to a place because insurance is not going to pay me to tell you this. Again, it would take an hour and clearly you’re not recording memory. So YouTube became a solution for me. (16:22):
So when I landed in Florida, I had the space where I could really pour into that part of what had turned into a business, of how can you educate people with every lawyer saying, “This is not medical advice, this is truly education on how to improve your health?” And the YouTube channel really took off, in part because of a book that I had written and another book that I had written. But mainly because when you’re looking at something where you come to a doctor to say, “How can I lose weight? How can I feel better?” And a lot of those things that the patients back in Salt Lake City, Utah, were not going to care about the things that I wanted them to. We had to help them feel better, so when you say, “Come to me and I’ll teach you how to do that.” Your insurance says-
Dr. Kristina Harris Jackson (17:11): Right.
Dr. Boz (17:11): … “You can take care of a prescription medication, do you order a lab? And if you didn’t do any of that stuff this time, I’m not paying you. Or I’m going to pay you worse than a therapist.” So you learn to do this in a place where they still needed the level of education that I think clinicians have, especially if you’ve been seasoned. And so it became this great partnership to use YouTube to help my patients. And then lo and behold, other patients wanted to learn that. (17:40):
So when I was waiting for that paperwork for the federal government, the channel blew up, and I did something that I had been dreaming about for a long time. And had God gotten me that paperwork before this moment, I would’ve never done it. But we’re at a tipping point where you still have payroll to pay. And I’ve gone through a bunch of savings waiting for this clinic to open. And I’ve always wanted to teach in real time, well specifically an advanced ketogenic diet to a group of patients. (18:17):
Because they come to me one-on-one, their appointments are three to four months apart. They don’t remember what they learned last time. And it’s the same questions that you could have gotten from the book, you could have gotten from an online course you could have gotten from my YouTube channel. But their brains are not healthy enough to connect all those dots on their own. And so I said, “I want to do an online course that is the three-week protocol I use. If somebody comes to me and wants to learn how to do a ketogenic diet for seizures. For if they’re going through a cancer treatment and they’re trying to be in a state of ketosis for enduring the chemotherapy better, the radiation, or even just healing better. (18:58):
Or any other of the brain disorders that I had worked on saying, “Yes, we can help you with that, but you’re going to have a far superior outcome if you’re in an advanced state of ketosis.” I don’t mean you’re buying keto from something on IL-3. You’re actually producing ketones every day, lowering that blood sugar and having the outcomes. So I did the course and it was not fake advertising where I said, “This might be the only time I ever do this, but I have to try this.” So I charged $2,000 a seat, took 200 students for a three-week course, and it was brilliant.
(19:34) It was just brilliant on how what those patients were able to change in their health because they weren’t forever addicted to me. They had the information, and at the end, they were in a small group of small groups that we had in that class that learned the same information. And I mean, I’ve analyzed this a few different times that it would’ve taken me three to four years of seeing that patient one-on-one to transfer the information and the changed behavior that we got in three weeks of that.
Dr. Kristina Harris Jackson (20:07): Wow.
Dr. Boz (20:08): It’s an online course because they’re on Zoom, but it’s a live course where you show up, and then you are in a small group. One hour a day Monday through Friday for three weeks, and it’s brilliant. It’s my favorite thing to do that you might need a physician to teach you some of this, but you shouldn’t try to go to the doctor one-on-one to learn to do a ketogenic diet. And it’s just been a great blessing to say the transformation of, I do it twice a year. It’s exhausting, but it yeah, it is-
Dr. Bill Harris (20:39): And you can’t record it.
Dr. Boz (20:39): … it’s really where you get… Yeah, so twice. I do it right after Labor Day and then right after President’s Day in January-
Dr. Kristina Harris Jackson (20:54): Those are good times.
Dr. Boz (20:55): It’s by far I could do this until I die because it’s that rewarding and it’s just transformational to watch people say, “No, you have to change how you eat.”
Dr. Kristina Harris Jackson (21:06): Yeah. At the end of the day. And just to have the relational piece along with the efficiency and the education, it all just comes together. And what I’m also, we mentioned it’s not the keto that you get sold. You actually are testing people’s levels every day. So you have people do… What do you have them do for the ketogenesis to make sure they’re in it?
Dr. Boz (21:34): We use a little monitor, this Keto Mojo, which hooks up to a dashboard. And we have them check their morning fasting blood sugar, and their morning fasting ketones every morning. And pulling off of the 20 years of how do you change people’s behavior? We use positive peer pressure where you log onto a dashboard and you see your numbers along with everybody else’s in your classroom. So just like I was going to change that I was the worst doctor in that group. They now want to be the worst blood sugar in that group. Or somebody who you eat late at night, well, we’re all going to see it in the morning. You can’t fake your numbers into this dashboard. You have to put blood on the script. So unless you’re going to steal from your spouse, in order to get it to look better, you have to change the behavior.
(22:22) And it’s just been positive peer pressure in a small group of people who are really leaning in to improve themselves. We start out the first week getting goals set, hooking them up to that dashboard. And then on Friday we introduced that there is a major challenge that they’re going to do together. And that is starting on Sunday, we’re going to do a 72-hour challenge where the only thing you eat is sardines.
Dr. Bill Harris (22:49): Really?
Dr. Kristina Harris Jackson (22:50): Oh my gosh.
Dr. Bill Harris (22:50): Wow.
Dr. Kristina Harris Jackson (22:53): It’s like immersion therapy. It’s like-
Dr. Bill Harris (22:55): Wow.
Dr. Kristina Harris Jackson (22:56): … you’re going to find out. You won’t die.
Dr. Boz (23:01): Amen.
Dr. Bill Harris (23:02): Why sardines.
Dr. Boz (23:03): Right. Well, why sardines? First of all, it’s one of those nutrient dense foods. One of the best things to… So who’s the audience of people taking this? Is the severely insulin resistant patients? And it’s almost like when you’ve been in internal medicine so much, you don’t even realize what a non insulin resistant patient looks like anymore because everybody’s insulin resistant, right? But if they’re coming to see me for this expensive and intense course, what they are expecting is that we can lower their blood sugar. And of course when you lower the blood sugar, the insulin lowers and now you can raise ketones.
(23:39): However, if you’ve got that high insulin, your fat is trapped inside your fat cells and it doesn’t necessarily come out for a while. But if you swallow the fat, you will flip those into ketones. So we see that blood sugar lower and the ketones raise, and we see a metabolic burst in those three days. We have some specific rules because, well, they’re humans who don’t want to eat sardines more than anybody else does. But you can’t start the timer of your 72 hours until you take the first bite. Because we had people saying, “I’ll just fast.
Dr. Kristina Harris Jackson (24:12): I’ll fast for so much.
Dr. Boz (24:14): And I said, “No, no, no, no. You’re insulin resistant.
Dr. Kristina Harris Jackson (24:16): It feels good. Yeah.
Dr. Boz (24:17): Your fat is in those cells and-
Dr. Kristina Harris Jackson (24:19): It’s not accessible.
Dr. Boz (24:20): … you’re not going to get them right now. If I charge your body with ketones, guess what happens on day four is now you’ve got the chemistry set that is unlocking some of those resources. We are losing weight. And it’s not just water weight, we are… When we have DEXA scans and we watch to see how… Not everybody in the class gets one, that would be too expensive but… So you look at what happens when people eat a nutrient dense food and you say, “Well, why don’t you use bacon and eggs? Those are nutrient dense foods.” Because people like the taste of those.
Dr. Kristina Harris Jackson (24:55): Right. It’s like the perfect, you don’t want to eat more, but it will satisfy. That’s so [inaudible 00:25:01].
Dr. Boz (25:01): What we are looking for is how can you start to recognize what is hunger? What is boredom? And you live in a season of gluttony for 50 years that it’s so easy to get the resources of food. And when they consume that they don’t even notice that the amount of food they eat. That’s this displacement for other emotions that should have been nurtured along the way. Well, we don’t do that with sardines. We say, “Eat as much as you want. There is no time. You can eat in the middle of the night. As long as we don’t have any other sauces. You can put a little hot sauce on there, but maybe a tiny amount. But no ketchup, nothing with sugar in it.”
Dr. Bill Harris (25:44): No crackers.
Dr. Boz (25:45): And it’s just sardines.
Dr. Bill Harris (25:46): No. Yeah, no carbs.
Dr. Boz (25:48): Yeah. No carbs. No carbs. And what happens the first day is you get some people eating three or four cans, and then the next day you’ll get them eating three cans. And then the rules of the sardine challenge is they have to eat the final can on the 72nd hour. Because what we were having people do is they would fast up to the 72nd hour and then they would glutton out on anything else. I’m like, “No-“
Dr. Kristina Harris Jackson (26:13): Sorry.
Dr. Boz (26:14): “… 72nd hour is sardines.”
Dr. Kristina Harris Jackson (26:16): They figure out every way to hack it.
Dr. Boz (26:18): Yeah, I had to make up these rules after they-
Dr. Kristina Harris Jackson (26:21): I know.
Dr. Boz (26:21): … did this, right?
Dr. Kristina Harris Jackson (26:22): Yeah.
Dr. Boz (26:23): And what was powerful is you’d get to that third day and they knew they had a can to eat at 72nd hour, and you’d have them eating a can of sardines. Like the lowest volume of food possible. And we have like what? So we’ve done the class six times now, 200 times six, so a good 1000 patients. And you see these blood sugars come down and you see these ketones rise. And especially because that satiety is something they now are learning, what does it really feel like to have satiety? By that third day. It’s powerful.
(26:55) And they usually aren’t glutinous if they’ve had the can of sardines. They want you, they think they want chocolate cake, but much like the third week on Semaglutide, maximum dose, they’re like, “Yeah, I don’t want any of that.” There’s a satiety. It’s a hormonal response. Those hormones are made of fat. And your fat has been locked away for so long that even if I burst it to the minimum level of effectiveness, your body that’s 1000 times higher than it’s been for years. So they get to that third day and cannot believe their energy, their mental clarity and their lack of desire for food.
(27:31) And of course, my favorite part is they wake up the next morning with the lowest blood sugar they’ve ever seen since they’ve been checking. The highest ketone they’ve ever seen since they’ve been checking. And it transforms that food was never meant to be this pleasure center. It was meant to be sustainable. And turns out, humans have been eating those low fish for years and years and years.
Dr. Kristina Harris Jackson (27:54): Oh my gosh.
Dr. Bill Harris (27:55): So how, after day three, then what do you… You can’t do a two-week course.
Dr. Boz (28:01): No.
Dr. Bill Harris (28:02): But generally speaking what do you-
Dr. Boz (28:04): No. It’s a great question. So I get this all the time on YouTube. In fact, if I want to do a party trick right now, I just say, if my husband’s around or somebody mentions that I’m on YouTube. I said, “Just go type in the word sardines to Google.”
Dr. Kristina Harris Jackson (28:20): Do you own that? Oh my gosh. I knew you were going to so that-
Dr. Boz (28:25): So I get the question a lot, Bill, that so okay, the sardine challenge is over what next? Well, I do look at their goals like, okay… But most of the people have better in there. I mean, they’re 50, 60 years old. They’ve got 15 meds on their list. They’re saying, “I keep going to the doctor and all I get is more. How do I undo this?” And so if they’re really trying to reverse medications, we want to keep them in that state of ketosis, at least a season, to reduce that fat mass, to reduce those cytokines. To diurese the patient. I mean, all kinds of things that are happening when we can keep that blood sugar lower, the ketones higher.
(29:00): By this point, this is like 10 days into the course, and it’s a 21-day class. They know that, yes, I say 20 total carbohydrates per day is all you should be eating. You’re not healthy, you’re sick. And even if you can’t see you’re sick, I’ll show you what your blood sugars are going to do relative to your classmates in the next 10 days. And then you’re going to see you ain’t the best one in the room yet. If you want to be, you have to stick with this set of rules until we reverse insulin resistance. And that takes a hot minute. You’ve been at it for a decade.
(29:34): So we talk about now they get by that 10th day, that 20 total carbohydrates. Sometimes it’s easier to have zero. And we also know that if you can get… I’ve used this word too, two boluses of food, because I used to call them meals and then people would add snacks. And then I used to say, “A nibble,” and then they would… So if there’s two times during the day where you eat food, we want those to be within a, maybe a six-hour window. Like try not to spread them out too far. Every time you eat, you make insulin, not because you’re eating carbs, but because you’re eating. And that’s what your body, an insulin resistant patient does.
(30:14): And when you put those two boluses of food too far apart, you just have a constant sense of high insulin. Even though you’ve changed the eating, you’re reduced from disaster area where you came in the door. But if you’re trying to reverse medical problems, we’ve got to lower that even further. And so then the second part, which is more challenging, sometimes folks don’t accomplish this while they’re in the class. But we have them take those two boluses of food, and we move them more towards sunrise. I mean, you’re going to raise the insulin every morning when you wake up. That’s part of a natural part of our human cycle. And if you don’t eat them, because you’re… I’m going to put this in quotes, “not hungry” okay that works for a while.
(30:59): But when you’re insulin resistant, what you really care about is you don’t eat after two o’clock in the afternoon. Interesting. You have this extended time where there is a nothing burger that it’s far before sunset. And that no stimulus of insulin, which is called nothing, is what you need in order to really lower that production of insulin over the next several months. And so, those foods are frequently not ones they love. Sardines, another rule that I-
Dr. Kristina Harris Jackson (31:35): Sardines are a perfect example.
Dr. Boz (31:38): Yeah. It’s a perfect example. And when people are struggling, I say, “Well, you can just put this new rule on your menu that you can have what you want before noon. But after one o’clock, the only thing you can eat is sardines.”
Dr. Kristina Harris Jackson (31:53): That’s a good hack.
Dr. Bill Harris (31:53): So let’s just do omega-3 index.
Dr. Kristina Harris Jackson (31:53): I like that.
Dr. Boz (31:57): That is the fun part. Okay so-
Dr. Kristina Harris Jackson (31:58): There we go.
Dr. Boz (31:59): So I’ve had a couple of coaches, so they’ve done this class with me six or seven times. Lost a bunch of weight, but had these chronic inflammatory problems. And I’ll give them care packages or gifts when they coach for me. And of course one of the things I give them is omega-3s. An omega index, what’s your number? And as you know, if they never eat fish, which is most people, and they don’t take a supplement, it’s like four. It’s really low, 4%. And then they do the sardine challenge and they think it’s going to be super high. And I’m like-
Dr. Bill Harris (32:34): Not in three days.
Dr. Boz (32:38): … [inaudible 00:32:36]. Right. I’m glad you had a can for the first time in your life, but-“
Dr. Kristina Harris Jackson (32:41): Right.
Dr. Boz (32:42): And so then they’ll do the challenge afterwards and it’ll still be four.
Dr. Kristina Harris Jackson (32:46): Yeah, that’s correct.
Dr. Boz (32:49): Right. So the first week of that class, we have some special lectures that we get preparing people. But the second and third week we highlight cases. So I pick cases that I think will provide the most education to the audience. And I’ll start with some basic ones, but I always put in there, “What do you know about omega-3s?” And it’s great if they’ve ever tested one, but many times they haven’t. And I talk about how when you’re eating this essential fat, it does this, it does this, it does this. And we go through those benefits. But the power of expecting a, so you’ll have a bunch of people order omega-3s while they’re doing their little tests, and they’ll come back with the threes, but they don’t get the results until after the course is over.
(33:38): And you’ll say, “Well, why didn’t it go up?” And I just think it’s one of those places where we get you feeling better. And you still now need to nourish the body with the kind of substances that are linked to that improved mental health, that decreased cardiovascular risk. So I had one coach say, “All right, I’ve taken this course…” She’s coached the course like three times, and at the end of the class she said, “I’m just going to keep eating sardines until I can’t.” And I said, “If you’re going to do that, do your omega-3 at the beginning.” Her omega-3 was something like, I don’t know, maybe it was a six. So then she eats sardines for a whole month.
Dr. Bill Harris (34:20): Okay, now we’re talking.
Dr. Boz (34:22): And then she did it again, and it came back at mermaid level, like 13. And she lost the weight. She had really struggled with this as some psychological. I mean, the eating problems are almost all linked to mental health issues, right? They’re lonely, they’re depressed, they’re bored, they’re… And so as she was working through a lot of those mental health issues, just eating sardines, because it took out the options. This is just what I do. And she said, she’s just found so much appreciation for the other places she was getting pleasure in her life.
(35:00): And then she checked it and she had this great number, and then she went back to her normal life, and maybe had sardines a few times a week. And then life happened and she put on some weight and she comes back a couple… Maybe it was a year later and said, “Okay, I’m going to have to quit my job because this plantar fasciitis is so bad. I’m a cop or a security guard and I have to walk about eight miles on my shift every night, and I can’t walk.” And she goes, “Before I quit my job, I’m just going to do sardines for three months.” And again-
Dr. Kristina Harris Jackson (35:35): That’s all she eats. She just has sardines or does she have-
Dr. Boz (35:38): And again, at the beginning, so I said, “Oh, we’re going to do some tests this time.”
Dr. Kristina Harris Jackson (35:39): Yeah.
Dr. Boz (35:40): “We’re going check your arsenic level and your lead level and all these things where they say you’re getting all these nasty things from those little fish.” And of course we did an omega-3. And this time, it had been a year, probably a year and a half since the first time she did that challenge. And so her omega-3 index had come down to probably only a nine, which is not bad.
Dr. Bill Harris (35:59): Not bad at all.
Dr. Boz (36:00): Because she continued.
Dr. Kristina Harris Jackson (36:01): Yeah. Still quite good.
Dr. Boz (36:02): Yeah right.
Dr. Kristina Harris Jackson (36:03): But she was having sardines two or three times a week you said.
Dr. Boz (36:04): Two three times a week.
Dr. Kristina Harris Jackson (36:08): Which is she’s maintaining a bit.
Dr. Boz (36:08): Yeah. I contend yeah, when I watch patients who are taking supplements and vitamin D is my favorite example, because I can show this really quickly. When insulin is ruling your body, those fat-based substances, well, they go into storage. They go with everything else, they’re going to be ruled by insulin, and they go in the other quarter. They don’t get to your bone marrow where you make a red blood cell from it. So to know that she had sustained that two to three cans a week, I mean, I thought I didn’t expect it to be that high. But it really reinforced that absorption of nutrient-dense food when your body’s healthy is really efficient.
(36:47): And then your body likes to use this little Turkey. So if it’s available and the insulin’s not on overload, it really does-
Dr. Kristina Harris Jackson (36:54): Interesting.
Dr. Boz (36:55): … get efficiently used. So anyway, she does the 100 days and it must be the top that… In fact, I wrote into your company and said, “Have you ever seen anyone higher than this?” Because she came back at mermaid level again. I think it was almost 15% at 100 days. And her plantar fasciitis went away and has not come back so that-
Dr. Bill Harris (37:18): Wow.
Dr. Boz (37:19): … yeah, really powerful stories of saying using little fish, great idea. Using little fish and knowing that you can measure what it’s doing on the inside and how much better the body works when they can maintain… You know, being in ketosis for the rest of your life, I’m going to lean towards that. I want to see that in my body. But when they’re insulin resistant, putting that goal out there for them can feel daunting. It’s like telling somebody with a third DUI that you’re never going to drink again. It’s like they get a depression.
Dr. Bill Harris (37:54): Yeah. So how do people handle the lifestyle of eating a ketogenic diet socially?
Dr. Boz (38:01): Yeah. Way better than they did in 2015.
Dr. Bill Harris (38:10): More products are available?
Dr. Boz (38:10): Say that again.
Dr. Bill Harris (38:11): More products are available for them? More choices?
Dr. Boz (38:14): I think there’s more community members, more people doing it, is probably the first place. When you’re on chemotherapy and you go to the oncologist and you sit in that chair. What happens with the other people around you is they’re in your therapy session. Going through a life experience and having colleagues, having friends is a huge of sustainability for any life change. Whether or not you want the life change, whether it’s chemotherapy or ketogenic diet. So I think one of the things that we work really hard on at the class is we’re creating those small groups that you guys are going to own at the end of this three weeks. We want you leaning into one another.
(38:53): But having at least one person in the universe who’s also looking at their morning fasting blood sugar, morning fasting ketones. These are not crazy metrics to be looking at, and you don’t need me to do that. But as soon as you start to make up the rules on your own or you say, “I’m healthy enough to deal with that.” And their morning fasting blood sugar goes from the 85 or 90 that we were able to achieve in the class, and now it’s back up to 105. And why? Because they’re eating at seven o’clock at night again. And they’re doing the things that their body is not healthy enough for. So when I look at sustainability for the ketogenic diet, first of all, you’re going to need… Oopsie. Sorry.
Dr. Kristina Harris Jackson (39:31): That’s okay.
Dr. Boz (39:33): You’re going to need the improvement you’ll see in a class, you’re going to take your skills up, set up a little. Like this is a new goal. But you also need a mirror to look at. Somebody in your class saying, oh, they made that mistake too. And then they got back on the bandwagon. So some of the things that maybe I was just designed to teach this class, and I come from a dynasty of hog farmers. So you look at the summer sausage, you look at the meats that were too high fat for anybody to stay on forever. And it’s not that we don’t address that, but there’s a reason that the sardine challenge is in the middle of the class to say, “It’s not the only thing you should be eating.” We do want those fats that are omega and-
Dr. Bill Harris (40:33): Yeah, right.
Dr. Boz (40:33): … they come from fish.
Dr. Bill Harris (40:34): Right.
Dr. Kristina Harris Jackson (40:35): Yeah. I like how you use numbers is really important. And that’s a lot of what we’re doing is people will often say, “Well, I think I’m eating enough. I think I’m eating fish.” But having that really clear number of what’s actually going on in your body and what you said about insulin potentially also being a varying factor for the amount of Omega-3s that get into the red cell. It’s another reason to actually test it and then retest in the future. And then you have that proof to yourself.
(41:08): And for the glucose and ketones, it’s every morning. Or the scale’s every morning that you can really be truer to yourself than how you’re feeling. If you are within a safer space where people are, you have a community with that, and it’s like there’s some judgment taken out of it, but it still, it’s powerful for yourself. I don’t know, I think-
Dr. Boz (41:30): Love the objective right.
Dr. Kristina Harris Jackson (41:30): … it’s really good.
Dr. Boz (41:31): Patients come and say, “Is this krill oil going to raise my… Is it going to help me?” And you look at the brand and say, “I’ve never seen that before. I don’t know.” It’s like, well, do an experiment. Check it. And what you’re checking in that moment isn’t just, are they taking the pill? They’ll tell you if they’re taking the pill. And they think they’re getting all these benefits. But if their insulin is overruling every molecule of their fat that they consume, well, I don’t care how good a brand the krill oil is, you got to start with a metabolic state that you’ve got. And that responsibility becomes with educating, how do you manipulate that?
(42:08): So I found that most physicians now have to have a resource to look at, “Supplement number 1, 2, 3, and 4, doc, which one should I take? “And you kind of just roll your eyes because it is a heavy thing to try and keep up with. But not when it comes to omega-3. You’re like, “No, just measure it.”
Dr. Kristina Harris Jackson (42:28): Just measure it.
Dr. Bill Harris (42:28): Measure it. Right.
Dr. Boz (42:28): And part of what I’m measuring is you the patient and part of what I’m measuring is that product. And we can-
Dr. Kristina Harris Jackson (42:33): Correct.
Dr. Boz (42:34): … put blame where you want, but-
Dr. Bill Harris (42:36): Interesting.
Dr. Boz (42:37): … yeah, I don’t get to argue with sardines. I’m like, there’s Omega-3s in sardines, and they’re right there. And your body’s designed to absorb them. And your metabolism will be better if you eat those. Not all but cracker.
Dr. Bill Harris (42:48): Yeah. Wow.
Dr. Kristina Harris Jackson (42:49): So they’re kind of a perfect little Omega-3 protein, calcium, vitamin D package. You just have to learn how to like them. That’s actually a goal of mine is to learn to like sardines, find a better recipe for it because they’re so… People always think you have to be on a supplement to get to 8%, and it’s really not true. You can easily get there with fish.
Dr. Boz (43:12): I get letters all the time because I tell people to do this. And they’ll say, “I only eating two cans a week. My metabolism is good. My A1C is down, and my Omega-3 is 11, 12.”
Dr. Bill Harris (43:25): Yeah, really?
Dr. Boz (43:26): I think that’s really high.
Dr. Kristina Harris Jackson (43:28): That is really good.
Dr. Boz (43:28): That is.
Dr. Kristina Harris Jackson (43:29): Yeah. For three times a week? That’s excellent. Yeah.
Dr. Boz (43:32): Yeah. So I do think they-
Dr. Kristina Harris Jackson (43:33): So they have a lot of things going.
Dr. Boz (43:34): … [inaudible 00:43:35] efficiency of absorbing, once you get that metabolic state out of so many cytokines, go away and let’s get back to a healthier version.
Dr. Bill Harris (43:45): Yeah. So it sounds like the sardines are going to confuse this thing. But what’s the effect of a ketogenic diet that’s not Omega-3 rich on fatty acid profile, on Omega-3 levels? Do you know?
Dr. Boz (43:57): So you can take me on the seasons where I’ve been good at sardines or I haven’t. When I’m good at sardines, I’ll get mine up to like a… I just did it again last week, but I haven’t had sardines since February, which is when I did the class.
Dr. Kristina Harris Jackson (44:10): Comes in waves.
Dr. Boz (44:14): I blame hurricane homeless, which happened to me here in Florida. But truthfully, I could have eaten sardines.
Dr. Bill Harris (44:22): You could have, right?
Dr. Boz (44:24): But you look at that. And so my numbers when I am less sardines in my menu, but they’re still not terrible. They’re like at a six. So for me, when I do nothing, it’s at a four. Right?
Dr. Kristina Harris Jackson (44:40): Okay. Right.
Dr. Boz (44:40): And before, when I was probably as insulin resistant as every other 50-year-old woman who has had three babies and 30 pounds that didn’t belong, those… I mean, I think I even had a 3.8 once.
Dr. Bill Harris (44:53): Ooh, pushing vegan here. Pushing vegan.
Dr. Boz (44:56): Right, it’s terrible. And so having all those high fat, I eat steak and would do whatever I was doing, but I wasn’t in a ketogenic state in those seasons. And then going keto, obviously the exposure to a persistent ketogenic state, A, allows you to… I mean, I’ve seen that my numbers went up to that six level. But I wasn’t supplementing and I would have sardines very rarely. So I actually think when I look at vitamin Ds, so I’ll use something that I check more frequently than the omega-6 in parallel to explain what I think happens.
(45:36): When somebody comes into me and their vitamin D is 20, 20, 20. And I’m giving them the prescription strength 50,000 units three times a week for six weeks, and it comes back in and it’s 20. I mean, I know the source of vitamin D, they aren’t absorbing it. Or as soon as that vitamin D got in circulation, it went into fat, because they’re really inflamed. And so I had hardly thought of the third option until I had a patient say, “All right, I’m going to go through a strict ketogenic season again. I’m going to be back on board.”
(46:13): And I said, “You struggled with your vitamin D. It’s in that high teens. I’ll buy you six vitamin D tests to check it over the next six weeks. I want you to check it every week.” And the first couple were at 19. But she’s in a full state of ketosis. Morning ketones are 1.9, 2.1. Blood sugars are dipping down into the 80s, which is really good for her. By the third week, we’re in the 30s. By the sixth weeks, she’s in the 80s.
Dr. Bill Harris (46:39): Really?
Dr. Kristina Harris Jackson (46:40): Oh my gosh.
Dr. Boz (46:41): She’s not taking any supplement vitamin D.
Dr. Kristina Harris Jackson (46:44): Yes.
Dr. Bill Harris (46:45): So it’s coming out the adipose tissue?
Dr. Kristina Harris Jackson (46:45): Mm-hmm.
Dr. Boz (46:48): Exactly. So when I’m looking at folks that are losing weight, you can’t account for this. So I don’t talk about it much with my patients, but I know they’re mobilizing testosterone, estrogen. The fats that you’ve been storing and have been under that storage rule of high insulin, like vitamin D, like Omega-3s. Well, they finally get to go to where they’re supposed to, which is-
Dr. Bill Harris (47:13): Interesting. Very interesting. Wow.
Dr. Kristina Harris Jackson (47:15): That is so interesting. And that also, because we do vitamin D tests and sometimes they come back and it’s like, this doesn’t make sense. What’s the key? And that’s yet another thing to ask about is weight status, insulin status, as well as they know. Because it’s the same with Omega-3, sometimes it’s just they’re taking it. They don’t absorb it because they’re not eating with food. It’s just like there are a couple of variables beyond the dose that can really affect an individual’s response. And to be able to explain that I think also really helps the individual feel better about it.
Dr. Boz (47:52): Yeah. Because they start to lose hope that what you’re telling them is ever going to work. Getting back to that, you’re really a salesman in the world of medicine. And when you do these intervention changes… I mean, do you know how many times I wrote on a prescription pad, “You need to exercise three times a week?” Because the American Medical Association said that if I worked on a prescription, it was going to work better. It did not.
Dr. Kristina Harris Jackson (48:18): It didn’t.
Dr. Boz (48:19): And I felt like a fool doing it after the fifth year, and so did my… The patients didn’t listen to me because they expected failure from that approach. So when you’re looking at selling them on an intervention. And you can say, “Watch what’s going to happen in the next…” Vitamin D is an easy one. Omega-3 is just more expensive for them to check it that often, so I back off on that.
Dr. Kristina Harris Jackson (48:43): And it’s slower.
Dr. Boz (48:45): Yeah. And slower, yeah.
Dr. Kristina Harris Jackson (48:46): It’s not a concentration, so it’s going to take longer. But it’s still a really interesting way to use Omega-3 testing and vitamin D testing. And yeah, we’ve just enjoyed having you as one of our champions and a clinician that we always feel like we can reach out to if we have questions about our testing. And it’s been so good to hear all the stories. Do you have anything else that you want to talk about?
Dr. Boz (49:14): Well, I always like to leave Bill by asking this question. Bill, what’s your Omega-3 these days?
Dr. Bill Harris (49:19): Still about 10.
Dr. Boz (49:21): Oh good.
Dr. Bill Harris (49:21): Without sardines.
Dr. Boz (49:25): So I like goals and so one of the goals I wrote down probably about two years ago, “An Omega-3 like Bill Harris.” And I haven’t gotten to 10 yet so-
Dr. Bill Harris (49:37): Well, yeah-
Dr. Kristina Harris Jackson (49:39): Well, after your next sardine challenge, then you could do it.
Dr. Bill Harris (49:43): That’s right. Wow.
Dr. Kristina Harris Jackson (49:44): Yeah.
Dr. Boz (49:45): Well guys, I appreciate it and this was great to be on your case. I want to make sure that you hear me say one more time, I love what your company does. Thanks for helping me help all the folks that I teach and I take care of.
Dr. Bill Harris (49:56): Thank you. Thank you.
Dr. Kristina Harris Jackson (49:57): Thank you so much.
Dr. Bill Harris (49:57): Great.
Dr. Kristina Harris Jackson (49:58): Appreciate it.
Dr. Boz (49:59): You bet.