Unleash Your Mood & Memory Potential

Annette Bosworth, MD

I really think metabolic health is only for physicians who are filled with curiosity. If you can satisfy your curiosity in medicine easily, don’t walk into this chapter because of hunger. I really was sitting, thinking about the first season where I put this much energy behind what I was already doing, which was plenty. I have plenty of work to do. I did not need another side job, which was, Oh, well, how would that play out in my brain injury patients? How would that play out in my 18-year-olds that are 100 pounds overweight already? It’s that metabolic curiosity, as I took on that first wave of, well, what do you mean, ketosis? You mean ketoacidosis. I mean, that’s where I started. 

Mindy Pelz, DC

Yes. I mean, that’s a common place.That’s a very common start to the whole ketone compensation for sure.

Annette Bosworth, MD

I think, one of the places where you watch what drives people, and I think their roots of origin have a lot to do with that. When you look at my roots of origin, I am a hog farmer’s daughter. I grew up as a farm kid in a small class of 21 kids. I can remember being in the sixth grade and knowing that I was not expected to go to college because farm kids don’t do that. Well. It didn’t matter that I had, okay, grades, not great grades at the time because, well, farm kids didn’t do that. That was not expected. There was a transformational moment where I identified as well. I do what everybody’s expecting. I’m a farmer’s daughter. I work hard. I don’t get in trouble at school. There was this little voice that said, Well, you must not be smart enough to do that. My dad sits me down in the seventh grade at my little school. You went from K through sixth? In seventh grade is when the, like, the big kids did their thing. It was the advent of the seventh grade year. My dad sat down and said, Do you want to know a secret? What’s about to happen to you? 

Mindy Pelz, DC

Oh my gosh! 

Annette Bosworth, MD

Really? And he goes, No one will ever look to see what your grades were before the seventh grade. It’s a reset. I couldn’t believe he was saying this. He’s like, I’ve seen you. You’re really smart. This is something my dad does not, he did not help with homework. He did not care if I got a great grade on my spelling test. It didn’t matter, nothing. But he said, No, you can push reset.  At that moment, I decided I was going to be smart. I was going to get the grades that I knew I could get. I transitioned from the average to the top of the class and made the honor roll six weeks later. But that story of origin: How did I go from not being, not applying myself, maybe you could say, but also just following the expectations of what the world was saying? Here’s what your track is: I’m saying no; I’m not going to do that. I watched that story play over and over again in my life where, yeah, look at the number of kids that go to college that want to be a doctor. There were 500 that sat there in that biology class, one on one. The professor said two of you will make it to medical school if you’re lucky. Then I found that the only way that you could sustain the level of increasing knowledge that really was taken at each level was a genuine curiosity; you had to have that. I think that is how I got into metabolic health. The curiosity of, Oh, could this really help better than Lamictal or whatever?

Mindy Pelz, DC

Right, then the drug you were prescribing. Your background was as an internist. You were like a family practice style.

Annette Bosworth, MD

Right?

Mindy Pelz, DC

Were you doing all of that without addressing metabolic health? Like, were you seeing things come in before you could actually really dive into getting to some root causes?

Annette Bosworth, MD

I think as an internist, one of the staples is you dive deep and you don’t settle for little answers. Now, most people spin that off into a different organ, like you are an internist that becomes a cardiologist or an internist who becomes an endocrinologist. So you kind of sub segment that you’re going to take care of this piece of the pie. Staying in general internal medicine was a choice that I made when I said no to becoming a pulmonologist, an intensive care physician, which still had lots of attraction. But I didn’t know who was going to raise this little baby I had in my arms. It looks like enough to do. My husband quickly reminded me, You get that you’re trading one of the most lucrative paths in medicine. You are the least lucrative.

Mindy Pelz, DC

He didn’t know the heart. Maybe he didn’t truly know the heart of the woman he had married.

She was on a mission. To do something big.

Annette Bosworth, MD

But I found that looking at internal medicine, it didn’t take long for me to, I mean, I think it was like within a couple of months of outpatient practice that, No, we just can’t throw medication at this. That’s not going to do it. To truly be based in, my first job was pay for performance. It’s a job where I got a better grade; nothing like competition to get me going, actually. I got a better grade if my patients lost weight; I got a better grade if their depression was controlled; I got a better grade if they had a sleep score.

Mindy Pelz, DC

Seems on first glance that seems pretty good though. I mean, is it based on medication or changing lifestyles?

Annette Bosworth, MD

Honestly, the first job I had was based on a lifestyle. It was truly, It wasn’t just a query that an insurance company ran to say, Are you on generic Prozac or are you on the branded form? That’s what it turned into about eight years later. It was so offensive, like, Oh my God, whittle down my practice to that? No, I’m not doing this. I think metabolic health, it really is a place where somebody who really likes the advanced, How does this fit together? It isn’t a casual conversation, even if you’re trying to really lift people through the education that happens. What a great place to be in the last five years! But from the place where I entered it, I felt very alone, like there’s a difference between trailblazing and being proud of that. Then the crickets: why is no one else doing this? It’s lonely.

Mindy Pelz, DC

It’s very much so. I mean, even in the short time that I’ve been teaching fasting to the world, I can really see that more and more people are like, Okay, wait, help me understand it. They don’t just want it spoon-fed to them. They just want to help me understand why this works and where it works for me. Do you feel in the lens that you are seeing health through, we know we’re in a metabolic mess? Hopefully, people listening understand that. But do you feel like women are at a disadvantage metabolically than men are?

Annette Bosworth, MD

Well, it’s a great question. I look at adolescents today as the first place that I see such a striking difference between entering my practice 25, six years ago and how, yes, there were some overweight kids that left pediatrics and came to internal medicine, but they were rare. Now, the amount, just the amount, of obese children that are spending, first of all, they never have peak development of their brain. Their brain growth is blunted because of the constant smothering in insulin from being overweight. You take that disadvantage that their hippocampi are smaller, they are not as connected, their sleep is not as deep, and their addiction to processed foods, they reigns over their, over all of their growth, their bone development, and specifically their brain development.

Mindy Pelz, DC

I just want to say one thing on that point. Do you know that I recently heard that we’ve got something like 80% of our youth are unfit to serve in our military?

Annette Bosworth, MD

Oh, it’s incredible to watch them.

Mindy Pelz, DC

Because of that. When we look at that when you bring it to a brain perspective, especially when dealing with the female girl teenage brain, but just the ramifications of this metabolic mess that stems from processed foods are beyond somebody being obese. It is so much bigger than that. I think that. I just wanted to highlight that because it’s easy to look at it and say, Oh, that somebody, a teenager, has got an extra 50 pounds on her. But what you just said about the hippocampus that’s mood and memory. When you get a smaller hippocampi, like, Holy cow! What does that mean for the long term of your life?

Annette Bosworth, MD

Right. I used to have this adolescent team that I would get to do their continued education. It was a volunteer thing. I loved doing it, and they were all from homes that they didn’t have parents around. Call it foster homes, call it a shelter, whatever. They were so uneducated about how important sleep and not swelling your brain, like not having a car injury enough. They would look at trauma as the first thing that they connected to. But I’m like, Oh, no, when you don’t develop that, you surrender your chances of success. They would say, Oh, what do you mean, I can’t succeed if I don’t do it your way? I am like, No, success is being defined as relationships that last over time. Not just fleeting relationships but long-term relationships. Success at being resilient. When setbacks hit you, do you have the ability to process through stress, which is a resilience? Then third is the rate at which you can acquire a new skill and put it into long-term memory. Again, hippocampal development is one of the key components to that. When you have a short, stubby little hippocampi, your chances of success go down.

Mindy Pelz, DC

You can’t do those three things.

Annette Bosworth, MD

Exactly.

Mindy Pelz, DC

Just so we don’t lose people. Repeat those three things again, because this is huge for the future of our young for sure.

Annette Bosworth, MD

Yes, short, stubby hippocampi, the reason success evades them is number one: their relationships are blunted. They have a much higher chance of discarding relationships after a short term. Number two, they are unable to recover from the setbacks that every human life is going to have, so resilience is part of what happens and that interconnectedness of the hippocampus. Then the third one is, How well can you acquire a new skill? Take on this new memory, which is what new memory is, and then get it into your prefrontal cortex so that you can use it long-term. All of those are severely blunted when the development of the hippocampus is blunted. It is absolutely blunted when they spend especially overweight from puberty through those first couple of years in their twenties. A good decade where insulin is high in nearly every teenager except the ones in my house and friends that I yell at. Maybe the rest of them we’re unless you’ve got really diligent leadership in the world of nutrition, and even the diligent ones they’re afraid to say the things that teenagers really need to hear, which is, No, you do not need that food. 

Mindy Pelz, DC

What does that do for the aging hippocampus? Because we know that Alzheimer’s starts with the plaquing in the hippocampus. What does that mean? As you age, and specifically, I want to tie it in to women and hormones in the sense that if we go into our menopausal years and we’ve already got this insulin-soaked hippocampus, glucose-insulin-soaked, where it’s shrinking, it’s plaquing, and now we’re losing estrogen and progesterone, what is that going to do for our mental health?

Annette Bosworth, MD

One of the ways I love to teach about the hippocampus, especially women, is that, well, they used to do this. In the show Survivor, okay. Who doesn’t know Survivor? Right. Where they put you on this island and you’re with these strangers and strategy and survival, and tactics for how quickly you can learn things are going to be part of who wins. But did you know that if you were going to bet on the winners of Survivor, I think it was like the first, I don’t know, 16 seasons, when the hippocampi were measured so that you could predict the winner by the longest, thickest hippocampus. 

Mindy Pelz, DC

Crazy.

Annette Bosworth, MD

Isn’t that great? You look at the skill set you say, What does the hippocampus have to do with that? I usually use this, mood and memory, two M’s. Your mood and memory. Mood being one of the key things when you walk into a moment of stress, when you look at how well your brain regulates your mood, the hippocampus is very much in charge of that. Just like if you were on Survivor and you walked in with a smoking hot body with a cute little bikini, that is a handkerchief, really. That smoking-hot body is going to get you a few points for the first couple of days. But if you have a hippocampus that is underdeveloped or swollen, especially from several of the things that control your hippocampus, your mood will be irritable. 

As much as that other race or even your fellow women will forgive you because you’re smoking hot on the first couple of passes, they are not going to forgive you when you fly off the handle and cannot regulate your emotions. That is especially when a period comes or menstruation hits during your survivor, and now your mood swings higher and lower. It’s even more of a range of emotions during that week, and you can’t regulate it. When you can’t regulate that emotion, your attraction to other human beings becomes less and you get voted off the island. 

That happens in the human race, too. If you’re on a team of people and you show up to my job and you are crabby to my patients, I’m going to send you home. I’ll give you a pass once, maybe twice if you’re smoking hot, meaning if you do a really good job and all these other areas. 

Mindy Pelz, DC

And you have a good smile, it’ll work on the first day.

Annette Bosworth, MD

If you keep flexing that you cannot regulate your mood. You cannot deal with whatever outside job issues are now impacting the way you work on my team. You’re going to get fired. You’re going to be voted off the island. Those emotional regulations are highly dependent on what was happening during the developmental stages of that hippocampus. When their lives were upset. Again, several of the teens that I would have the privilege of advising, the parents disappeared. Mom slept with a neighbor, Dad ended up in jail. I mean, all kinds of disruption for what’s predictable in life. Now you’re asking this teenager to say, Now I need your mood to be stable. I need you to focus through college. I need you to acquire skills in the workforce. Well, all of that is going to blunt the development of their hippocampus.

Mindy Pelz, DC

So how would we know? Like, how would you know if your hippocampus I mean, again, if you’re a 45-year-old woman listening to this, how would you know yourself having a smaller hippocampus? How would you know your child? There has to be a way we can recognize this before it completely diminishes.

Annette Bosworth, MD

Well, the best way is a functional MRI, but that’s a little spin. You really kind of need a reason to do that. You can measure the volume of each part of our brain with the advent of how beautiful the pictures of the brain have become over the last 30 years. But again, two ways to look carefully at how well your hippocampus is working are mood and memory. Looking at the history over time, if you’re a 45- or 50-year-old woman, have you had depression? You asked earlier, Do I think that women have a disadvantage in the metabolic world? Yes. Our bodies are designed to bear children, and in order for that child to gestate, to be in that womb, and not have a compromised birth, your hormones and endocrine will advance toward insulin resistance. That’s expected. You’re supposed to do that. During that time, it’s going to do amazing things to these fat-based hormones that are linked to your mood, so your estrogen is going to do one thing and your progesterone is going to do another. This is all expected during the time when you’re pregnant, and then after pregnancy, in the next two weeks, there is a tidal wave of decrease in those hormones. How well your brain copes with that is in part related to what’s the health of your hippocampus.There’s a great study out there that looks at after 12 weeks of being moderately depressed. I would joke with some of my colleagues, saying, Who the heck sees them as moderately depressed? I mean, I say severely depressed. They don’t even have to tell me. 

Mindy Pelz, DC

They don’t go to their doctor’s office when they’re moderate.

Annette Bosworth, MD

No. So looking at moderately depressed, 12 weeks and the size of the hippocampus atrophy went from whatever size they were to about 30 to 40% decreased. Then some of them continued to stay there, and over time they got smaller and smaller. The worst ones, the ones who had the tiniest, littlest, most pathetic-looking hippocampi, were people with fibromyalgia, with chronic pain, and depression. You say, Well, what links all of those things? Because fibromyalgia turns into a whole other story of how do you diagnose that and how are you confident about it? Well, it has plenty of problems in its history of how it’s come to be diagnosed, and then, well, how do you treat that? What is fibromyalgia? Fibromyalgia is a depressed state. Their brain isn’t functioning and isn’t as joyful as it isn’t appropriately sad when it should be. Again, the fluctuation of what is joy and what is sadness should be regulated in the brain and should match the life. Okay. It doesn’t mean you’re never going to feel sad. It just means match the life.

Mindy Pelz, DC

That’s in the hippocampus.

Annette Bosworth, MD

Yes.

Mindy Pelz, DC

Yes, go ahead. Number two.

Annette Bosworth, MD

Number two is that your depth of sleep is also very much linked to the health of your hippocampus. When that brain did not sink into stage four sleep, the deepest of sleeps, the repair process that should be happening inside that hippocampus was almost zero. The shorter that, the slow wave, deep sleep. Again, an adult brain, a healthy adult brain only gets 12 minutes of that a night. It sinks down for just a few two three minutes. Then it wakes up to make sure the heart is beating. There’s no saber-toothed tiger around, and then it will take time. Anyway, you acquire about 12 minutes in a night where the brain really washes itself. Then there’s the special cells inside the hippocampus that, during that really deep sleep, they’re like stem cells, much like you can cut off the liver and it grows back. Cut off a cervix, it grows back. Okay. You can destroy a hippocampus. As long as there’s a few cells left, it can grow back. That was not what my textbook said when I went to medical school. That is new information over the last 20 years.

Mindy Pelz, DC

Your textbooks also probably said that all the cranial bones were fused together. I remember that was a big debate decades ago.

Annette Bosworth, MD

Details, details. Right. As you look, though, that hippocampus and its impact on. Are they somebody with a smaller hippocampus? Well, how well has your sleep been? People who sleep well and I don’t mean they take Ambien to sleep; I mean on their own, they’re able to shut their brains down, sleep through the night, not waking up three or four times. They wake up in the morning feeling rested and restored, not once a year but routinely 29 days out of 30. That’s what they do. They have a mood that they can keep it together. It matches the outside of their lives. They have sleep that’s deep and reparative and when you look at the other major predictor, which I think women have a significant disadvantage of in today’s world, is that your hippocampus is highly linked to malnourishment. So you think, Well, we have all the food access in the world; how could we be malnourished? But I’ll tell you, one of the key things to measuring malnourishment is to look at iron replacement in a brain or in a woman. In a woman’s brain, where you start menarche much sooner than we’ve had over the last couple hundred years. Now you’ve got a period starting at eight years old, nine years old. Then they have periods every month. 

Mindy Pelz, DC

We’re losing it. We’re losing iron every month.

Annette Bosworth, MD

There’s a great little equation I had the teenagers do with saying, All right, I made boys and girls do this. How many periods in today’s world, when a young girl has. If she started her periods at ten? How old would she be when she has the same number of periods that were estimated in somebody 250 years ago? I reminded them that they didn’t really start menarche until about 12 or 13. They were actually married rather young; 16 was not an uncommon age to be married. Maybe periods until then. Then it was important to quickly start having babies.

Then they’re pregnant, obviously not having periods. Then they nurse a baby full-time for two years. They have, on average, two periods before the next time they’re pregnant. Of the 15 kids they’re going to have over those next 40 years, 30 years, whatever, that several die, and several don’t make it past the age of five. We show them the number of periods. Take a guess what the girl is and what her age is in today’s world. If she starts at ten when she maxes out for the total number of periods, she would have had 250 years ago. 

Mindy Pelz, DC

Oh, my gosh. I’m going to say, 40.

Annette Bosworth, MD

Yes, 21. Yes. By the age of 21, she’s had as many periods in a lifetime that she would have had in a lifetime 250 years ago.

Mindy Pelz, DC

What? Are we having less periods then? Is that the total or are we moved or our cycle getting shorter?

Annette Bosworth, MD

No, you get a lifetime of them at the age of 21.

Mindy Pelz, DC

Yes. Are we losing that much more blood? What is the cause of that?

Annette Bosworth, MD

Yes. It’s socially inappropriate to get pregnant at 16 now.

Mindy Pelz, DC

Got it. So they’re not. I got it. Oh, okay. They’re not, because they were delaying pregnancy or not having it at all.

Annette Bosworth, MD

Right.

Mindy Pelz, DC

We’ve been through our periods much quicker, which is affecting our iron balance because we’re short every month. If we’re low in iron now, we’re affecting the hippocampus, which is going to affect our mood and memory.

Annette Bosworth, MD

What are the other great places to see that what happens when anemia, or even before they get anemic, just they get iron deficient, is that there is a part of the brain that is supposed to rapidly grow in those, but that 18-, 19-, or 20-year-old female brain. That’s the same area of the brain that is responsible for advanced math, engineering, and some of the more male-dominated career paths in our society. There are a couple of studies to look at. Is it because there’s a smaller development in that area, and can we link that to iron deficiency? Although the studies were small, I was very happy to read them. Yes, look at that. There is a connection there.

Mindy Pelz, DC

Fascinating. Would it behoove a woman, especially as she goes into her 20’s and 30’s to get regular iron checks, knowing that that could actually impact her brain function?

Annette Bosworth, MD

Right. Well, personally, if I have all sons, this is theoretical in my world. But if I had a teenage daughter, I would stop her from having a period. I would make her body pretend it’s pregnant.

Mindy Pelz, DC

Fascinating. So she’s not losing as much iron?

Annette Bosworth, MD

Yes. You can do that with your medications today. Watching the compromise her brain has, trying to keep up with iron. It’s not easy, especially when they lose blood every month. The other thing that is very difficult is that as soon as they get slightly low on iron, it does change the interconnectedness of how the brain is wired during those years. Even if they want to have their period from 26 years on, while your brain’s in this hyper development, No, anemia isn’t a good idea. Getting pregnant is really not a good idea either. You can have a, this sparks plenty of debate to say you put them on birth control?

Mindy Pelz, DC

Well, everything sparks debate right now. But what do you think about one of the things I’ve been thinking about with the menstrual cycle: is it our form of detox? It’s how we shed and get rid of what no longer serves us every month. If we stop it to help even out the iron levels and improve brain health, what’s the downside? There’s got to be a consequence to that.

Annette Bosworth, MD

Well, you go back to what evolutionarily was programmed in women is that detox happened much less routinely. 

Mindy Pelz, DC

Yes. Because they were pregnant all the time. You are right, but the toxic load is less.

Annette Bosworth, MD

Yes, the toxic load is less. When people ask me what form of birth control I would work on, I would say, Decrease the amount of chemical you put in the woman. I think the IUD that delivers progesterone to the inside of the lining of the womb is the least toxic, the highest amount of delivery for the right place. The rest of the body gets to keep doing; it still can ovulate and still can do the things that it would have done otherwise. 

Mindy Pelz, DC

I would agree with that. Let’s go then again to the 40-year-old woman as her cycle is winding down, and we’ve got this hippocampus that is really going to be the root of how her brain functions between that and the prefrontal cortex for the rest of her life. What does she need to know about keeping her hippocampus in good health so that she can not only keep her memory up, but she can keep her moods up, and people still want to be around her; they’re not all running away from her?

Annette Bosworth, MD

Yes.

Mindy Pelz, DC

I think we’ve really localized here. What part of the brain that needs our attention as a woman is going through that hormonal loss.

Annette Bosworth, MD

Right. When you watch the amount of mood fluctuations in a teenager, the mirror effect can happen when you’re removing those hormones from a woman’s brain that’s fully developed and dependent upon estrogen’s presence. As a young woman watching, I remember, women would come to me and want help with this. All I kept thinking was, This is the most horrible thing to do to a woman. 

Mindy Pelz, DC

Oh, yes. Until you go through it, it is a little bit like, wow, what is that?

Annette Bosworth, MD

I have tried to be one of them, take the season of life you’re in with grace. I’m 51 right now. I can live this journey, but I’m happy to say I’m not in menopause yet. I don’t want to go there yet because what happens is how much it changes the way your brain retains and how much it’s very estrogen-dependent.

Mindy Pelz, DC

Actually, I’ve actually looked recently at maps of the brain to really try to understand where the most amount of estrogen receptor sites are in the brain. They’re all over the brain. But the hippocampus, the amygdala, and the prefrontal cortex, those are three of the biggest areas, which are the powerhouses. Which are the powerhouses of our brains. Where does metabolic health come into that picture? Because if you go sliding into those menopausal years and you’re in an insulin-high state, what’s going to happen to that part of the brain?

Annette Bosworth, MD

Well, I just would start by saying, kudos for your presentation that you just said earlier in this, that if you’re going to get it together as a woman, for heaven’s sake, do it before menopause.

Mindy Pelz, DC

Yes, that is my cry right now. I’m like, please, women of 20 and 30, listen to me. I see you as a 53 year old woman. What you’re about to go into and you can really help yourself if you look at your lifestyle.

Annette Bosworth, MD

I mean, again, our design was never to live this long. Okay? I don’t mean 53. I mean, we are living into our 80s and 90s, and that’s what’s missing. When you interview, especially on an intimate level, what do you miss? It is the ability to be, well, 100% woman, which is filled with the checklist that I’ve had for 30 years now, or however long I’ve been using my adult brain. It is that compassion, that emotion, that makes us women. I am tenderly appreciating, again, this side of the transition into menopause, knowing that, well, if I wasn’t supposed to use my brain for the last 30 years, why would you do that to me? No, don’t do that to me.

But to watch how poorly women check out of it in their 30s and in their 40s when they live with a chronically high insulin state, because that was how estrogen was ever going to get to your brain and be in that right spot in the first place. When the burden on a human body of highly processed foods day in and day out is where they never take a pause from that. They are constantly putting in the highest number of particle sizes that we’ve ever had, our highest number of particles, and the smallest particle sizes of food that we’ve ever had in our evolution. We do that at a price that says your insulin will be in some way too high over the course of even half a dozen years of eating that way. Keeping that at a steady state, meaning you spent high. It’s been high, and you’ve got that middle that won’t go away. Yes, I know that you’re exercising like a dog. It’s not coming off. It’s because you’ve got a hormone that’s not correct. You’ve got to get the insulin down. You have to get the insulin down before anything else goes right.

Mindy Pelz, DC

Yes. Do you think this is key? I think that too many health care practitioners and doctors get this wrong. The discussion has all been around estrogen, progesterone, and testosterone, and we’re trying to balance those. But to your point, you cannot balance those if you don’t balance insulin. Why don’t we start with that part of the conversation instead of HRT? I mean, this is not bashing HRT or bioidentical, but I feel like it’s this huge elephant in the room that we are not addressing.

Annette Bosworth, MD

If everybody came in like you, which is, Oh, you’ve got that under control now, I could do something. You now let me take the advanced amount of education and studies that we have on estrogen and testosterone. I had a patient come in when I first moved to Tampa, and he said, I just started seeing this doctor who is giving me testosterone shots because my testosterone is low and he is like 100 pounds overweight. I’m like, It’s not going to do much. He was like, Oh, like you’re like, your testosterone is better. I should come to you. I’m like, No, it has nothing to do with where you get your testosterone. It’s that part of your body that made you 100 pounds overweight, is the part that will dictate where your testosterone ends up.

Yes, you’re going to get the shot of testosterone, and you’re going to feel good for a few days or even feel better over the course of the next six months. But then guess what your body does? It accommodates that, and it will store it if I tag it. If I look at a scan, where did your testosterone,  It does not concentrate in your testes, buddy. It’s in your fat cells, and it’s going to be there until you lower insulin.

I think I’ve said this; I don’t know if I’ve said it to you, actually, but one of the other fat-based hormones, and I put that in quotes because we call it a vitamin, is vitamin D. When people are super low on vitamin D, they’re like, Doc, I can’t get it up. Doc, my vitamin D is low. I’m taking all these supplements. What am I doing wrong? I’m like, Well, first of all, it’s a fat-based hormone. It is going to be under the superpower of insulin. If you have chronically high insulin, you can test your vitamin D on your own. All right, I’m going to put you on a ketogenic diet. You’re going to do it my way; no fake news. You really have to follow the rules. We’re going to check your vitamin D on week two, week three, and week four. You watch that vitamin just come up, and you’re like, But I’m not taking it. I’m like, I know you’re emptying a few fat cells that are filled with these fat-based hormones. You come to me and say, Do I need to peak bioidentical? Do I need to peak up horse urine? Do I need to peak on beans? I’m like, It’s the wrong conversation. Whatever we choose to put in your system, when you have this much insulin, you’re a pin-up. That’s a boy’s statement, whatever.

Mindy Pelz, DC

You do live in a house full of boys; we’ll give you that. Do you think that as women approach 40, when we know the perimenopausal years, it’s really happening at 35 even now? Do you think that the single most important measurement is hemoglobin A1C for how you’re going to weather through menopause? Or is there more that you would look at?

Annette Bosworth, MD

It’s such a big one. It’s really hard to put that at the top.

Mindy Pelz, DC

I know.

Annette Bosworth, MD

Somebody asked me the other day when I would check somebody’s cholesterol, which is a very similar question to what you’re asking because cholesterol, when you start on a high-fat, low-carbohydrate diet, it’s going to change. If you’re measuring it during the time when everything’s changing, then I just get to see a bunch of noise. You’re asking to be a magician to say, What’s it doing? I don’t know. I need about ten more points of data before I can really make any sense out of this. I think a very similar thing happens as you look at that. The attrition of production of estrogen happens after we hit a peak, whatever. Some of us are 35, and they start hitting menopause in their early forties, but hopefully it doesn’t do it that soon. Let’s hope you make it into your forties before you start to produce less and less estrogen.

But if you’re also saying the production of your estrogen is as high as your body can make it at the season you’re at, but so much of it is under the dictatorship of insulin, if you stabilize what that’s doing, if we get that blood sugar down, at least you have three months in a row that your hemoglobin A1C is, maybe they’re not all as perfect students as you. Maybe they went to 5.8 or 5.9 or 5.4. But that’s still much more than the 7.8 and seven that I have for diabetics. Right? They get three months in a row where they’re in the five or six range. Now at least I know you’re insulin-stable. Because if you come in to me and you’ve been on the ketogenic diet or you’ve been on a low-carb diet for four weeks, and then we happen to check some hormones, but it’s in the flux of what’s going to happen naturally when you decrease insulin. It’s just like asking me to check cholesterol within the first few weeks of being on a ketogenic diet. All I get to see is noise. I need way more data points in order for you to tell me what’s going on in there. But doctors don’t do that, just like getting a continuous glucose monitor. You can have that argument. Is it worth it? It’s a lot of money. I mean, if you look at cash paying, it’s 800 bucks a month for the good one. But what happens in one month of training, for watching what you do when you eat at 9:00 at night, when you eat at 10:30 at night, when you have that I had a sin, that was I was out when I had my continuous glucose monitor, and it was balsamic vinegar that I knew it.

Mindy Pelz, DC

Is it spicy?

Annette Bosworth, MD

Well. It was very sweet. 

Mindy Pelz, DC

A little bit of sweet in it? Yeah.

Annette Bosworth, MD

Yeah. Somebody sent this to me as a gift and I just thought, Oh, it’s balsamic vinegar. It’ll be great. I knew when I tasted it. Oh, I like this way so much. 

Mindy Pelz, DC

Again, if we’re looking at what I’ve been trying to do with the female brain and I’ve as I’ve been out, and I know you get this as well. When you’re out in the world, when you’re looking at all the comments on YouTube, you’re looking at the cries of so many women. It’s everybody trying to find, what’s that one thing that’s going to help the female brain as it ages? But what I’m gathering from what I’m hearing as you’re going through this conversation is that it’s insulin.

Annette Bosworth, MD

Yes. It’s such a heavy hitter. Every cell is dictated by this hormone, and then our other hormones are controlled by that hormone. It’s such a superpower inside the body that I want to focus on something less than insulin because it’s easier. That I could give it up, it could be, put a patch, put a cream, they all feel better.

Mindy Pelz, DC

It’s a lot easier. .

Annette Bosworth, MD

Because they have hope. Until you get that insulin down, we aren’t going to make it. We’re not going to move the needle. They spent a lot of money. They spent a lot of time. If you’re going to spend money and time on a place, start a support group on how you eat less. How do you actually get through a 36-hour fast once a week? How do you find the rhythm of that? If you’re looking in your 30s and 40s to say, How do I get to be doctor Mindy by the time menopause hits? It isn’t going to happen with a little less carbohydrates in a day. It’s going to have to be some days where you really push your metabolism. You take those mitochondria, and you give them a workout. That workout happens when no food enters in the mouth, which then lowers the insulin. Now they’re asking your mitochondria to do something totally different, something it hasn’t probably done in years, which is to be using a ketogenic fuel, a ketone-based fuel. That’s step one. 

Mindy Pelz, DC

It’s so well said. I want to highlight something that you said that I think you and I really unite on, which is that there are two ways into this ketogenic system. One is through changing the carbohydrate load and switching out your fats, and the other is through fasting, and you can do them all. But I have found that if we teach people how to fast first, then the changes of food become much easier. We start to crave better foods. Actually, the door for me into the ketogenic diet is fasting, and then we can come back and fill in with a better diet. Have you found something similar?

Annette Bosworth, MD

Remember when we had that podcast with Jason Fong’s assistant, Meghan Ramos? Yes, I don’t know if she’s still the assistant. But she had now run the show of their fasting protocol. She reminded me when I heard this first approach that when diabetics would come in and they were like, You’re going to lose a toe, we’ve got to put you on dialysis. They would start them with seven days of fasting.

Mindy Pelz, DC

They were hardcore, by the way, she and Jason were. When people are like, Oh, who would not  want to do a three-day water fast? Don’t follow Jason and Megan, because they’re putting some very sick people into very long fasting, getting incredible results.

Annette Bosworth, MD

Yes. One of the things that I don’t use that approach, but it gives me the right answer here, is the perspective that, Oh, the human body is so adaptable. If you have somebody who’s in your partnership or in your world of influence and is asking you to start out with a fast, it’s not going to kill you unless you’re on insulin, and then be careful. But we have work to do. But it’s also that sixth grade moment where my dad sat down and said, No one’s going to know what your grades were before sixth grade, and the identity that people have that they can’t go without food, that they’re so addicted to food that how could possibly you do that? Now it’s a different way you look at yourself because you just got through that. You just did that. You did hard things, or one hard thing. I think knowing that sweeping them into a vortex of change begins with knocking on, What do you have in your mind of what’s going to happen, and whatever you’re envisioning is probably going to happen? If we can switch that and get you to address that, this is really possible. We can do this together. I think that’s the psychological approach to when people end up in a pattern of life and no one reminds them that this was a choice. Stepping in and saying, All right, start with a fast; I don’t care how you start. Maybe being an intern is too long where we do chronic disease management. That’s what I like. The tagline is, We have really poor marketing people for internal medicine. First of all, nobody knows what it means to be taking care of the internal organs. 

Mindy Pelz, DC

Isn’t that just the whole body? Isn’t an intern a code for,  we do everything?.

Annette Bosworth, MD

Right. But chronic disease management is really what we’re supposed to do. If I do my job right, you shouldn’t notice the things I’m preventing; that would be perfection. Again, underappreciated in today’s world. One of the approaches I use is to, especially at the front door, I teach them what a carbohydrate is. You don’t understand how you’re sabotaging this. Yes. Your plate of green vegetables sounds like a really good idea until you look at all the other stuff that came with it. That’s a lot of carbohydrates, even though it’s better. We’re going to, and you’re going to see improvements. But if you want to see the long-term outcomes, you’ve got to learn what carbohydrates are.

Mindy Pelz, DC

What I’ve been doing on that one is I will actually say nature’s carbs or man-made carbs.

Annette Bosworth, MD

Oh, that’s good.

Mindy Pelz, DC

Because I feel like we have to separate when we say carbohydrate. You can’t put a piece of bread and a salad in the same conversation, even though they both have a carbohydrate load. When you’ve got that fiber, it’s going to have a different spike to your blood sugar. Let’s just separate those two out because it’s really those man-made processed carbs that we want you to get rid of. It’s in those nature’s carbs that we see some really good things for the microbiome, of course, not all the time, but in a proper especially if you’re going to cycle it to a woman’s menstrual cycle, we’ve got to lean in to nature’s carbs when we need it for gut health, when we need it for progesterone production, things like that.

Annette Bosworth, MD

Yes. The beauty of how well that body adapts, I love Shawn Baker’s approach on this, where he had really gone through the studies of how much fiber should be there and how one study proved this and one study proved that they are opposite ends of the spectrum. They’re both saying that they’re right. The beautiful part is that when we stop putting so much processed food into it, you can get pretty darn good outcomes with several of the approaches of how much fiber, how low a fiber, and how damaged it is, especially the immune system. At the beginning of our story versus how far along are they in already reducing that inflammatory process by the changes they’d made before talking to us? I really find the power of when teaching these things, the integration into what that does for your mind, what that does for your self-talk, what it does for your gut biome, and what it does for your menstruation. They aren’t isolated conversations. This is a human subject that totally has the flexibility to be able to give you a really healthy outcome if we get several of the hormones correct. To me, the first one that has to be fixed is insulin. You’ve got to get that down in order for all the other ones to make even a slight. That’s why when people say, I tell them no fiber, and I tell them this many grams, and the next one says, Yes, but all of them had a less stimulus of insulin. That’s why everybody had an improvement at that stage.

Mindy Pelz, DC

Yes, Well said. Have you ever seen somebody go into the ketogenic diet and where you’re actually making ketones? Maybe they’re at .06 or.07, and they feel horrible. Because to me, when I go into that ketogenic state, I’m like buzzing. I want to stay there. Yet I see a subset of females primarily who, when they go into that state, they actually, their energy tanks and their bodies actually go into a worse place. Have you ever seen that? If so, I think it is.

Annette Bosworth, MD

Again and again. It’s why, when you look at the approach that I use, I start out with lowering their carbs to 20, but they can eat as much fat and as much as they want to for the first season. How long that season lasts has to do with their hormones. If you come into the ketogenic, you’re saying, I’m going to do keto; I’m supposed to feel amazing, and they just crashed. I mean, like, tumble ass over apricot into the ketogenic diet and say, I’m here; I’m doing everything right. I feel awful. I’m like, no kidding. Because what has been depleted in your system for the last however long you’ve been on a high carb diet, a high insulin state, is that you don’t have any of those hormones like cortisol, like the other policies to kind of the part that makes us feel full when we eat. You don’t even have dopamine to have a surge and relax. That makes us feel good and then back down to normal, then feel good, then back down to normal. That’s when the fluctuation between hormones is so slight because, that’s taking the state of cortisol again, another fat-built hormone.

When they’re under that high stress, that low sleep, and that high insulin state of cortisol level, that should be this marked as one because of their chronic high stress. It has crept up and crept up to a level of four. When you were one, if you would peak at a five, you would feel the stress that is associated with a peak in cortisol. Then it goes back down to the one. But because your high-stress life is now living at this much far to abundant level of hormone production, you’re going to feel terrible as I try to lower this over the course of the next six weeks. When they come into the ketogenic diet and especially if they don’t eat enough fat, the fat is all tucked into their fat cells. That’s behind the curtain of insulin. One of the strategies for having them eat as much fat as possible, it’s not forever. I try to tell them that at the beginning because, like, this is awesome. And I am like, I know. Because they do, you want to get them feeling good as quickly as possible. When they go in, I’m eating OMAD, and I’m eating for 23 hours a day. I’m not eating anything, and then I’m just stuffing myself. I’m like, That’s not going to work. Your endocrine system has to be healed first. The only way that you can turn that fat-based hormone back on is when your body has access to fat. Every morsel you’re eating gets suffocated with insulin and tucked into your fat cells. So, you don’t get to get any out of your fat like Mindy does when she fasts or what I do when I fast; you only get the fat that is between the mouth and the part where the liver processes it into the next step, and if you skip that, you’re going to feel awful.

Mindy Pelz, DC

You’ll need to add fat in. Then for that process. What are your thoughts, just so because this still permeates the world. What do we think is saturated fat? Like, are we trying to stay away from it?

Annette Bosworth, MD

Yeah, I would not. I would eat as much as you want. 

Mindy Pelz, DC

Yeah. Okay. Did everybody hear that? This is the point. Okay. What do you do? Yes, MCT oil is taken off, coconut oil. There are some saturated fats that are amazing. This conversation of saturated versus unsaturated added is not a helpful conversation when it comes to the ketogenic diet.

Annette Bosworth, MD

No. Especially when they’re first starting on the ketogenic diet. Just take estrogen. If estrogen is in the ditch and you are, let’s say, premenopausal, this is why this is one of the motivators. Let’s say I can put you on a hormone, but the amount of hormone I’m going to have to put you on in order to overcome what you’re going to do, which is push it into your fat cells, you’re going to like me more now. It’s all about liking me, but you’re going to like you more when you figure out that you stop producing so much of that insulin, so we can use the estrogen that’s present. In order to resupply all of these fat-based hormones, you need fat. Let’s start with the ones that we’ve been eating for thousands of years and taste good. Let’s get them feeling well because as soon as that brain is in the process of using triglycerides, using strings of fat to fuel, you now have an advantage, which is a patient that’s not so depressed, a patient that’s not so wilted in the mind. 

Mindy Pelz, DC

Those are nature’s fats, by the way, I was just thinking that some like it’s we’re back to things that came from nature not horrible. Anytime, man gets a hold of it, we manipulate it. Now we’re insulin resistant.

Annette Bosworth, MD

I sent my kids to the store the other day, and I said, Bring home some blue cheese. We were having chicken wings, and I said, I don’t want the one that’s not refrigerated. You’ve got to go to the place where there’s a refrigerator. They came home with one that wasn’t refrigerated, and I’m like, I want you to look at what’s the first thing on that ingredient list? It’s sunflower oil, one of those saffron. Maybe it is; either way, it’s a seed oil, and, Oh, it just tasted awful. Where I say, No, throw it away; Go back to the store and get the right damn thing.

Mindy Pelz, DC

Another thought that I’ve had is that as a woman’s brain is adapting to the loss of hormones, we actually need to look at other things, other neurochemicals that can support healthy brain function. A ketone. A ketone is a hell of a fuel for the brain. The way I look at it is that after 40, every woman I mean, before 40, every woman should be in ketosis and be working on the ketogenic diet. But after 40, it really becomes imperative because we’ve got to get that brain filled with something as it loses estrogen and progesterone.

Annette Bosworth, MD

Yes. The other thing that you do a great job of teaching about is how powerful connecting to oxytocin is. Again, another endocrine which should be, not doing much until it needs to do its job, and then it should peak. That whenever you or most people teach about it, they think of the time when you nursed a baby. Again, a figure, a euphoric place that, if you’ve never experienced it, it’s really hard to put into words what that feels like.

Mindy Pelz, DC

Yes, That is great.

Annette Bosworth, MD

This love is so strange. I don’t have a measuring stick for it. Then you say, Oh, there’s a whole bunch of other ways you make oxytocin besides nursing your baby, and you should practice those. You should practice loving yourself. I also think of that in today’s world, where I’m totally guilty of this. So it’s going to come out a little bit hypocritical. Pushing as hard as I’ve been pushing since I figured out I can show, I can be just as good as anybody else. I can get into medical school. I can get into it.

Mindy Pelz, DC

That’s your dad’s fault. Let’s just blame it on your dad. We’ve got to blame it on one person. Let’s go after your dad!

Annette Bosworth, MD

If you want to look at over dominance of work ethic, he definitely pushed that on me. But the purity of that was to find out, What is it that I get joy out of? What is it that if you took away all of the social status of being a doctor, a teacher, or a professor, you would say, No, I really love it. When that moment I’m trying to get something complicated across to somebody else who doesn’t have the years of education, and it clicks, and they walk out the door saying, I can do that. I’m better. I understand that. That’s a personal one for me where it’s weird; most people are not going to get joy out of that. But to find that place in your life, you say, All right, if I’m only on this earth for another few years and I, God’s mission says, What are you supposed to be doing with this life? May I please have some oxytocin as I do it? May I please, this is what I love to do and then get to do it.

Mindy Pelz, DC

Yes. I actually think you bring up a really good point: that one thing that we don’t give enough credit to is the joy of service to others, the joy of helping others. It can be something as simple as a smile to somebody that we talk a lot about gratitude and how important it is to be a kind person. But hormonally, what’s happening? You are surging oxytocin, which is lowering cortisol. When cortisol goes down now, you become insulin-sensitive. Now you can actually balance your sex hormones. We don’t give it enough credit; you’re absolutely right.

Annette Bosworth, MD

Yes. When people come in and say, Antidepressants. I need it. I have this depression, and my pill will offer you some reuptake inhibition, and it’s going to take the hormones that are circulating in your brain and they’re going to keep them in that synapse a little longer. But the real joy is to find what happiness was built from, which is to go out and serve someone. I mean, be the person who walks across the street and says, You need some help with that? It’s a complete stranger. You’re going to get nothing for it. They’ll probably yell at you. They might even spit on you. But the act of doing what is a service to another person is where, that’s how you measure happiness. How many times did you do that today? When you’re seeking that return of happiness, which if you’ve been postpartum, if you’ve had times where life, the brain injuries, swollen brains, whatever reason that didn’t work right, you’ll do nearly everything to say, Just get me back to that place where I feel better. I don’t care if you call it Prozac. I want you to help me. There isn’t a place where I can go and say, Here, I’m going to have you make your brain make some oxytocin. It doesn’t work like that. It is through these choices and these acts of service that, again, they don’t fit into them. Did I get all the points the insurance company said I was going to get for being paid for performance? Did I get their blood pressure, check their body mass, and did I teach them that acts of service are going to be way more powerful than my Prozac now?

Mindy Pelz, DC

Well said. I was at a book signing for my book a couple of weeks ago, and it was at Barnes & Noble in L.A. in West Hollywood. There were a group of women there. One of the women came up to me and told me this long story about how, her doctor, she was diagnosed with breast cancer. Her doctor told her there was nothing she could do with lifestyle. She should just go through chemo and radiation. She stumbled upon my YouTube, discovered how to fast according to her hormones, and after a series of like six months to a year, the cancer was completely gone. Her doctor was like, I don’t know what you did. I didn’t understand. He was completely complex. He didn’t get it. He was like, What the heck happened? But I tell you all this to say that, joy, for me and that moment that woman didn’t exchange money with me, she didn’t she just read my book and watched a free platform on YouTube because you and I really share this common heart connection of like, we got to shout louder, we got to get this to more people, and when a person you’ve never met changes their life with your information.

Annette Bosworth, MD

It’s true, yes.

Mindy Pelz, DC

Is life, that is joy, that is oxytocin. You can’t give me a better drug than that.

Annette Bosworth, MD

Amen. That’s totally real. Amen. Good job. Congratulations on the success! I’ve been watching your numbers, they’re fantastic. I’m so glad that you’re in. That’s beautiful.

Mindy Pelz, DC

What I love is that women are taking it, they’re doing book studies, and they’re really gathering together to get more oxytocin. It’s been incredible. Let me finish up on this last question. Okay, we have a metabolic problem. How are we going to get out of it?

Annette Bosworth, MD

I have a dream. I have a dream that’s doing medicine differently than I’ve done it for the first 25 years. That is, you can’t. I can take one person at a time through this story. Let me show you your numbers. Let me teach you about ketone. Let me show you how to break your finger. Let me show you this. Let me show you all the steps of that. They do not get it when I do it one-on-one. I remember learning this, but addiction medicine was never going to be successful one-on-one. They had to see other people in the journey with them that suffered with them, that abused worse than them, abused less than them, and abused younger than them or older. I had to have the comparison of where I am on this path. Then I just need to get out of the way. I needed to collect them and keep them out of the ditch with whatever my role would be in that. Then watch what happens when a group of people determined to say, I’m not going to be a slave to alcohol anymore; I’m not going to be a slave to fill in the drug. As I look at this transition where I get a choice point to say, How do I fit into helping people with addiction? Because, again, internists see them one at a time. We see them for long amounts of time. We talk about a lot of problems. But when I look at the success of transforming a group of people, I’ve done the class twice now. I have the data from it. I’m super excited to say that this is where I’m going to put my stakes. This is around where I put my dream. You don’t get better when you do this one-on-one. You get better when you do this in the community. If your community is three weeks with us twice a year, that’s what we’re going to do it. We hope that with every tool that you can spark out of our little classroom. You can go to your own community with your sister and your brother and your coach’s wife, and the people in your world that need somebody to say, metabolic health. It is kind of nerdy. It’s a lot of complicated places that you can get stuck in. There aren’t always answers to, but to deliver it is pretty darn easy. 

You do not need to be a doctor or see a doctor to get it done. But having that group of people is much like the Christmas cards that I would get from people who had been through several addiction programs and finally, for whatever reason, were stuck. Years later, they wrote to me. I’m sixteen years from using alcohol because of what you taught me. I’m 12 years from using cocaine, 12 years from pornography, and 15 years from using marijuana, and I don’t I can hardly tell you their names except for the cards they send him. I say that isn’t because of what I did inside an exam room. That’s because of what happened inside a group of people where you work on a behavior change, that I’m sad that we didn’t know this as well as we should have. I’m sad we’ve screwed it up for the last 50 years, but that’s no longer the excuse. We have plenty of data. We have plenty of success. We have plenty of evidence that what really needs to happen inside a change of health is that your mitochondria need to be healthier. That means you cannot feed them processed food day in and day out from the age of birth. I think you should do it in a group. 

Mindy Pelz, DC

That’s a paradigm buster. I think you’re onto something there because I’ve seen the same thing where when I gather a small group together, we actually can make, we can go faster and farther because you have the support. You see people behave better. They don’t they don’t hold on to their limiting beliefs as much.

Annette Bosworth, MD

Right.

Mindy Pelz, DC

I’m like, you go, girl, because. Let’s break that paradigm apart. There’s so much in our medical world, we have to keep everybody’s medical information in a silo. We’ve got to be in a room, in a treatment room that’s enclosed and everything we’ve set up in the health care system has been to do it alone.

Annette Bosworth, MD

Alone.

Mindy Pelz, DC

You just nailed it on the head. Let’s start doing it in the community. Now let’s bring a tool like the ketogenic diet and fasting. Now we have a door into changing this.

Annette Bosworth, MD

That’s where I think my stake is going to be for a while. 

Mindy Pelz, DC

Off you go!

Annette Bosworth, MD

This is my plan.

Mindy Pelz, DC

I love it. Well, I just thank you so much. I literally have every conversation with you, I walk away and I’m just I feel so filled up. I love your heart as much as I love your brain. I’m going to add on to what your dad said and just say your heart carries you so far and I wish we were neighbors. I wish we lived in the same town together because we will just sit in the backyard and geek out on this kind of stuff.

Annette Bosworth, MD

Oh, I’d come to L.A. for your book signing. So, you should, I wish I had to know about that.

Mindy Pelz, DC

Well, I’m coming a bunch to Florida this year, so I’ll let you know. 

Annette Bosworth, MD

I don’t travel much but, yes, that’ll be great. Thank you. Thank you again for your leadership. What you’ve done in this community, too, is truly just it’s hard to walk away from the traditions that our mentors told us. This is how you do your world, my world. As I have had to have a little remorse over, I’m just not going to do it that way. I don’t have any regrets. But it was saying goodbye to the safety zone of how others have done it. I just want to say, other stories like yours where you say, No, I’m not the only one out there doing it differently. Success can work. I appreciate your leadership for that.

Mindy Pelz, DC

Oh, thank you. I just adore you. I’m going to tell everybody, go to your YouTube channel, because you and I have this fun little YouTube connection as well. You can go check out Dr. Boz on your YouTube anywhere else. I mean, you have a great website, too.

Annette Bosworth, MD

YouTube’s great. That’s my favorite place. You can get drowned in too many places. I focus a lot on YouTube and I sprinkle in a few other places.

Mindy Pelz, DC

And that you’re amazing. Thank you so much. I appreciate you. 

Annette Bosworth, MD

You bet. Thanks, Dr. Mindy.