Dr. Boz [Annette Bosworth, MD] - Beginning Keto Diet: Part 1- The first 3 days

Hi, I'm Dr. Bosworth, back again today, and we are recording three videos to explain what is the chemistry going on inside your body when you start from burning all carbs or all glucose and transition to a keto-adapted body, adapting your body to burn fat. This happens in five very specific phases. We're going to go through these in three video parts and begin with the first two phases in this video. This information came from the studies of the 40-day fast, where patients entered into this study and lasted 40 days before they ate again. With each of these phases, you're going to hear me talk about what time it is in the fasting schedule, what the body is using for sources of fuel, and I pay special attention to what the brain is being fueled by.

Let's start with phase one. Using this graph, we're going to walk through each of these phases, and this helps you follow the different curves and the different biomarkers that we're talking about. The time at the bottom of this scale is 0 to 4 hours, and you go through this many times in your life, many times in a day, actually, every time you eat. Your body fills that blood and that circulation with glucose from the foods that you eat. That glucose is burned over the next four hours. If you choose to eat again at the four-hour mark, you will start phase one right back over again. Most patients go through phase one three to four times a day, depending on how many times they eat. Phase one can last up to four hours, but if you have a snack at two hours, you start phase one over again. In phase one, your body is running completely off of glucose. This study showed that they had not seen ketosis in months or years. The brain, along with the rest of the body, is running simply on glucose. If you'll notice the glucose burned per hour, how many units of sugar are you burning per hour? It can start as high as 400 after you first eat. Put in a hearty dose of orange juice, and your body will soar that sugar up and burn it as fast as possible. As the glucose amount decreases in the system, the rate that you burn it decreases as well. At the end of the four hours, you're burning less than 25 grams per hour.

Let's move to phase two. Phase two happens when all that blood sugar that you just consumed has run out and your body needs to tap into its storage. The fastest place you grab glucose out of storage is your liver. The liver stores a molecule called glycogen, which is stored sugar, and it is designed so that it is very easy and quick to grab that stored sugar in the liver and use it as quickly as possible. In phase two, we think about emptying your liver. How long does phase two last? Asked another way, how much storage have you got in your liver? Asked even a third way, how big is your liver? I bet you've never thought about that. Your liver has the unique ability to build cells upon demand. If you've been taxing your liver with excessive duties over the last 15 years, your liver kept up with those needs. For example, if you drank excessive alcohol for the last fifteen years, your body, specifically your liver, added cells inside the liver to process that alcohol. In many ways, the same thing happens with glucose. When you've eaten excessive amounts of carbohydrates, your body puts those carbohydrates into the quickest storage it can find, and it turns to the liver. If your liver is full, some of that will go into fat, but your liver also gets the signal that it needs more cells. In my experience, when I find patients with the largest livers, they're not alcoholics. They're actually carb addicts. They've been eating excessive amounts of carbohydrates for 10, 15, 20 years, and their liver did its job. It kept up with demands, and it grew and grew and grew. The term for this in the medical clinic is a fatty liver. Those patients who have diabetes, or prediabetes, or insulin resistance, all have a liver that's been overtaxed with too many carbs. The liver is doing its job in making more cells, but it grows. So how long will those patients stay in phase two? It depends on the size of their liver. Some folks have been 15 to 20 pounds overweight for five years, and it can take two days to get that liver to be empty.

So phase one ends and phase two begins, usually in the middle of the night. For most patients, they wake up the next morning, and I want to know: did you empty your liver last night? That sounds like a funny question, but I'm really looking to see did you get to the end of phase two. Wake up in the morning and check that morning fasting blood sugar. What am I really looking at? I'm looking at how empty you got your liver. If your morning fasting sugar is between 55 and 85, you emptied your liver. But if you wake up in the morning and your sugar is around a hundred, or a hundred and five, or heaven forbid 120, you didn't empty your liver, and you're well on your way to diabetes. If that number is a hundred and twenty first thing in the morning, you can stamp your medical chart with diabetes. That's how we diagnose it. Essentially, diabetes is those patients who aren't emptying their liver every night.

Let's go back to those patients who have really extended livers. They've been 40, 50, even a hundred pounds overweight for the better part of a decade. They wake up the next morning, and their morning fasting sugars are 120, 130, 115, and they continue to fast. For some of them, it has taken two weeks of fasting before that morning fasting sugar gets below a hundred. In those cases, often patients don't make it. They say, "Forget it, I want nothing to do with this diet." That's why on a ketogenic diet, we ask you to eat the kinds of foods that don't fill your liver, and that is 80% fat. Add carbohydrates to a liver that's overly stuffed, and I guarantee your system makes way too much insulin. You've been practicing that storage for a long time. Even a whiff of carbohydrates, 30 carbohydrates a day, is a whiff to most people, and their body will overproduce insulin. Many patients in the second or third week of ketosis say, "Doc, I just can't seem to lose weight," and often I'll find that their morning fasting sugars aren't below a hundred. They haven't been emptying their liver. The biggest mistake I see in those patients is that they've been using artificial sweeteners. In their system, their body is overcharged and oversensitive to insulin, and they make it without hardly trying. One taste of sweetness on their tongue, and their sugars shoot up, as does their insulin. Insulin locks down their fat cells, and they can't lose weight. This is the plateau that most of my patients with insulin resistance hang out in.

So if you look carefully at this chart, you'll see that the polka-dotted line in the blue section of phase two shoots the sugars up per hour, and then it crosses down before you can enter into phase three. I need your liver empty. How long does that take? It depends on how many sweeteners you're putting into your system and how big your liver is. Phase two ends when your liver is empty.

That's enough for the first two phases. We'll move on to phases three, four, and five in the next two videos. Thanks for tuning in, and if you want to learn more about this, subscribe to our channel or check out the book that I wrote. Any way you can. Until next time, signing off. Dr. Boz.