Dr. Boz [Annette Bosworth, MD] - REVERSE Heart Disease with Autophagy

Have you heard that your clogged arteries are not reversible? Well, that isn't true. You can reverse heart disease with autophagy, but you must understand the rules or you could make things worse. Before I can teach you how autophagy reverses heart disease, we must understand how heart disease happens in the first place.

Heart disease happens inside the arteries of your body and the arteries going to the muscle of your heart. These arteries are like any other artery, filled with a layer of muscle, an endothelial layer, and a very special spot where the fat builds up inside the walls of your artery. That is heart disease. Most people who tune into the show or join my clinic to do the ketogenic diet arrive with arteries that are filled with disease. Fortunately, it takes years for this pathology to start getting worse and get to the point where you have a heart attack, so we usually have time to reverse this.

To stop heart disease, you must stop hardening the arteries, stop putting pimples inside the arteries, and restore your endothelium. Hardening of the arteries happens right here in this layer of muscle. When the blood pressure has been high for not just a couple of weeks but for years, this muscle layer thickens and decreases the size of the tunnel that the blood flows through. To reverse the thickening of that muscle, you must decrease the blood pressure by lowering the blood sugar, which also leads us into step two: decreasing the number of pimples found in your arteries.

Those pimples are not there because you ate too much cholesterol or high fat. They're there because you had an excessive amount of sugar for too long. In times of high blood pressure and high blood sugar, this excess fat can't end up in your liver to be recycled. Instead, it ends up here in this layer of the artery, and as that fat accumulates, you will find pockets of ripening fat. That pimple is the future heart attack. This cap right over the pimple is important. It should not be thin, but rather a thickened cap. By decreasing the blood pressure and decreasing the blood sugar, you restore number three: your endothelium.

Look at these arteries side by side. You'll notice that this one has a very thin cap over that pimple. As the blood sugar and blood pressure decrease, you'll see the inflammation in this pimple decline as well, and that's when that cap can thicken and restore the protective layer that keeps that pimple from erupting into your circulation.

The final measurement for heart disease is this layer on the inside of the tunnels of your arteries. This is called your endothelium, and there's a magical protective layer called a glycocalyx that keeps that fat in circulation and not in the walls of your artery. When that endothelium is damaged, your race to heart disease is a lot quicker, and to undo it, we must lower the inflammation. This leads us to autophagy.

Autophagy is the recycling of the proteins and the wasted debris in your cells that shouldn't be there in the first place but definitely accumulates on your path to a heart attack. Autophagy is the reversal of this process, and we can measure it best by looking at the Dr. Bos ratio. The Dr. Bos ratio is based on the glucose-ketone index. In America we use two different units, and we use "dirty math" to get to the Dr. Bos ratio. It really is a simplified version of the GKI: you take the glucose and divide by the ketones. This measurement reflects the availability of the two fuels your body needs to survive, but more importantly, in autophagy you are lowering that glucose while boosting the ketones. The lower your Dr. Bos ratio, the better your autophagy.

When measuring autophagy, I tell patients there's a really high chance of autophagy when that number is less than 40. When they're between 40 and 80, there's a probable chance of autophagy, and when they get that number north of 100, there is a very unlikely chance that their body is recycling those proteins and removing the debris causing their heart disease.

I use this graph to explain what's going on in the patients who come into the ketogenic diet. We have glucose over here on the left side and ketones over here on the right, and we are going to watch what their glucose is doing throughout the day. At the beginning of this story, most people do not eat less than 20 total carbohydrates a day, and as a result their blood sugars are much higher for most of the hours during the day. The lower consumption of carbohydrates drops those peak blood sugars in all three meals of the day, and that decreased amount of fuel offers the patient a new fuel: a wave of ketones enters their circulation, and their body feels great during the first season of the ketogenic diet. But that fuel fades as the body adjusts. When they decrease their meals to two times per day, once again ketones return to the scene, and that wave reminds them why they're on the ketogenic diet.

As the body adjusts to this new rule, we now must narrow the eating window to keep that metabolic stimulus present, keeping the glucose lowered and the ketones high, again trying to reach that Dr. Bos ratio of 40 or less to push autophagy and reversal of heart disease. The final stimulus to their metabolism, based on food timing and choice, is to move that eating window as close to sunrise as possible. All of these steps, including lower carbohydrates, decreased eating during the day, and earlier meals, stimulate the production of ketones at a more stable and constant rate.

As patients practice the habit of eating twice a day, keeping that eating window narrow and earlier in the day, they may see a slump in the ketones again. This is when we start to pull on a different lever of their metabolism, and that's the lever of what happens when their body has to tolerate and offload heat. In other words, spending time in a sauna stimulates the production of energy through their mitochondria. Stimulating the mitochondria happens when you expose the body to heat, and in order to survive, the body must offload the heat. A similar process happens when we exercise. Using sauna and exercise, those mitochondria get a workout, and during that time the production of ketones is much more reliable, especially if they keep the rules of low carbs, a tiny eating window, and earlier eating in the morning.

Step number two that I recommend for autophagy is a sardine fast. It usually happens at this stage of the metabolic development of the patient, where their ketones have sunk again and they're having a difficult time raising them. Three days of only eating sardines is a fantastic way to decrease food volume, increase protein and fat, and lower blood sugar while raising ketones. In other words, it stimulates autophagy.

Take a look at this case study. I took 200 of my students and followed them closely for 19 days. At the beginning of the study, they arrived with rather broken metabolisms, definitely not in a place of autophagy. As we lowered their carbohydrates, taught them about an eating window, and then moved that eating window to the morning, we saw a dramatic drop in their glucose and a production of ketones as they stabilized at about day seven. We then pushed their metabolism with one food. Yes, we said 72 hours of only sardines was one other way we could push autophagy. You'll notice that the spike in ketones and the drop in glucose happens over those 72 hours as they reset. Right after that, we challenged them again at the end of the study to do a water fast of salt and water only, for up to 72 hours or however long they could handle it. Everyone in the class dropped their glucose over these 19 days, boosted their ketones, and of course improved their autophagy.

I can pack a lot into a video, but if you really want the steps on how to help your heart disease reverse with autophagy, join me for a Master Class twice a year. If it's during that time, click here for that free Master Class. If it's not during that season, I have all my patients start with Consistently Keto, the online course that teaches the steps. I'll see you inside.