The Diary of a CEODr. Annette Bosworth: Why insulin fuels chronic disease
Through structured ketosis, glycogen depletion, and Dr. Boz blood ratios; Bosworth links brain fog to insulin trash and her sardine challenge
CHAPTERS
- 0:00 – 5:10
Sardine Challenge And The Case For Ketosis
Bosworth opens with her notorious ‘sardine challenge’ and frames ketosis as the key to fat loss, muscle preservation, reversal of some visible aging, and better brain performance. Steven introduces her as an insulin‑resistance specialist and sets up the central claim: excess insulin is a core driver of chronic disease, and sustained ketone production can transform health within a year.
- •Sardine challenge: three days eating only sardines to rapidly induce ketosis.
- •Bosworth reports patients seeing reversal of gray hair, better focus and energy in ketosis.
- •She asserts chronic high insulin underlies high blood pressure, cancer, and brain debris linked to depression and neurodegeneration.
- •Her clinical goal is to push patients into a robust ketogenic state rather than adding more medications.
- 5:10 – 19:40
What An Internist Sees: Chronic Disease, ‘Trash’, And Medicine 2.0
Bosworth explains internal medicine as long‑term puzzle‑solving for complex chronic illnesses, contrasting ‘Medicine 2.0’ symptom management with metabolic root‑cause reversal. She lays out her thesis that many subtle complaints—brain fog, midlife weight gain, joint pain—reflect accumulated cellular ‘trash’ from years of high insulin and missed ‘rules of being human’.
- •Internal medicine handles multi‑system, long‑term conditions where ‘the buck stops’ when answers are unclear.
- •Medicine 2.0 excels at keeping people alive with drugs but rarely reverses underlying metabolic dysfunction.
- •Signals of trouble: extra belly fat, persistent brain fog, reduced attention span, chronic pain, low joy.
- •Bosworth positions routine ketone production as a way to ‘take out the trash’ several times a month or more.
- 19:40 – 31:30
Insulin 101: How Late‑Night Eating Ages You Faster
Using Steven’s own eating pattern as an example, Bosworth illustrates how meal timing and composition spike insulin overnight, accelerating aging. She explains insulin’s core role in shuttling glucose and driving fat storage, and why late, carb‑heavy dinners keep insulin elevated well into the next day, even after sleep.
- •Older adults should front‑load calories earlier; late eating is metabolically expensive.
- •Bosworth claims one bite after 6 pm is like ten bites before noon in metabolic impact.
- •Insulin’s jobs: move glucose into cells, store excess as glycogen or fat, and stimulate growth (including thicker skin and skin tags).
- •Morning cortisol releases stored glycogen, giving an ‘uneaten meal’ of glucose upon waking—amplified if you’re insulin resistant.
- •Persistent high insulin overnight means no fat burning and ongoing ‘trash’ accumulation.
- 31:30 – 34:30
Hidden Insulin Resistance: Skin Tags, Hairless Toes, And Dirty Necks
Bosworth details physical signs of long‑standing insulin resistance that often precede diabetes. She describes how excess insulin alters the skin, hair growth, and fat distribution, and links these seemingly cosmetic issues to deeper metabolic and vascular damage.
- •Skin tags (little stalked growths, especially in armpits and groin) often fall off when insulin drops.
- •Acanthosis nigricans: dark, velvety skin on the neck and flexures indicates chronic high insulin.
- •Progressive loss of hair from toes up the legs reflects impaired circulation and long‑term metabolic damage.
- •She reports patients whose gray hair partially reversed on strict keto, attributing it to healthier hair follicles.
- •Bosworth reframes aging as decades of unremoved cellular ‘trash’, especially in the brain.
- 34:30 – 44:30
Glucose vs Ketones: Draining Glycogen To Unlock Fat Burning
The discussion turns to energy substrates: glycogen, glucose, and ketones. Bosworth explains why many people never reach meaningful ketosis despite ‘doing low carb’ for several days, due to massive glycogen stores and entrenched insulin resistance—especially after pregnancies or years of overeating.
- •Glucose is stored as glycogen; high insulin packs glycogen densely (‘brown sugar in the back of the drawer’).
- •Some obese patients on 20 g total carbs/day need ~15 days to produce measurable ketones.
- •Ketones cannot be produced while insulin is high and glycogen stores are still full.
- •Urine ‘peetone’ strips detect excess ketones early, before the body efficiently burns them.
- •Bosworth’s own experience: as an insulin‑resistant doctor post‑pregnancies, she needed a day of fasting plus 22‑mile walk to finally see ketones.
- 44:30 – 57:10
Why Ketones Feel Different: Brain Performance, Mood, And Recovery
Bosworth outlines why ketones subjectively feel so good: they burn cleaner, create fewer reactive byproducts, and feed the brain even when insulin signaling is impaired. She and Steven compare cognitive performance on keto vs high‑carb days, and she describes group interventions where people experience dramatic improvements within weeks.
- •Ketones generate less oxidative ‘trash’ and act as an in‑cell antioxidant state.
- •They bypass insulin‑dependent glucose transport into the brain, rescuing energy supply in insulin‑resistant neurons.
- •Clinically, Bosworth notices better focus, mood control, and less irritability when in ketosis, even after long clinic days.
- •She reports 3‑week intensive keto classes where participants routinely exclaim at newfound energy, mental clarity, and mood.
- •For training and recovery, ketosis reduces inflammation and speeds muscle repair, though power adaptations take months of fat‑adapted training.
- 57:10 – 1:10:20
Long‑Term Keto: Sustainability, Performance, And Aging
Addressing concerns that keto isn’t sustainable or harms performance, Bosworth shares data on military personnel whose power increased after prolonged keto adaptation and her own decade‑long experience. She maintains that once people feel the difference, they naturally avoid high‑sugar episodes that bring pain, brain fog, and mood swings back.
- •Short‑term (1 month) keto may not improve power or times; substantial benefits emerge at 6–18 months.
- •Adapted muscles efficiently use both fat and glucose, yielding up to ~50% more power versus controls at 18 months in one military cohort.
- •She argues there’s no inherent downside to being in ketosis most of the time; the ‘downside’ is how bad you feel when you go back to high sugar.
- •Many patients notice joint pain, blurred vision, and depressive symptoms return within 1–2 weeks of leaving ketosis.
- •Older adults, especially post‑menopausal women, often find their brains and energy now require ketones to feel normal.
- 1:10:20 – 1:21:40
Ketones And Cognition: Dementia, Down Syndrome, And ‘Type 3 Diabetes’
The conversation dives into dementia and Alzheimer’s, which Bosworth and Steven both frame as ‘type 3 diabetes’—a state where brain glucose utilization fails while ketone utilization remains. Bosworth shares a striking Down syndrome case where strict keto improved both weight and cognitive function, potentially reversing an Alzheimer’s diagnosis.
- •Bosworth says by the time patients report getting lost while driving, they are ~15 years into brain trash accumulation.
- •She lacks randomized trials proving prevention but has many clinical cases of improved memory and function on keto.
- •Down syndrome patients offer a window into accelerated Alzheimer’s; one 40‑year‑old woman improved dramatically on keto, including saying her first three‑syllable word (“I understand”).
- •Steven summarizes research: in dementia, brains struggle to use glucose; ketones support mitochondrial function, reduce inflammation, and may protect neurons.
- •Evidence is early and adherence is challenging; keto isn’t appropriate for everyone (e.g., underweight, certain medical conditions).
- 1:21:40 – 1:31:00
Measuring Metabolism: Glucose, Ketones, And The Dr. Boz Ratio
Bosworth demonstrates how to use a dual glucose/ketone meter, interprets Steven’s and her own numbers, and introduces the Dr. Boz ratio as a practical marker for fat burning and therapeutic ketosis. A team member’s low ketones illustrate how common it is to be entirely glucose‑dependent.
- •Devices cost roughly $60–70 for a starter kit with strips, and blood measurements beat urine for accuracy.
- •Steven’s readings: glucose 86 mg/dL, ketones 0.9 mmol/L (ratio ~95) – indicates active fat burning.
- •Bosworth’s readings: 83 and 1.7 (ratio ~49) – deeper ketosis, achieved by early‑day eating and stopping around 3 pm.
- •A staff member at 88 and 0.1 (ratio ~880) exemplifies high insulin/glucose reliance and ‘lots of trash being made’.
- •Bosworth suggests 5 days of morning measurements to diagnose insulin resistance and track improvements.
- 1:31:00 – 1:44:00
Keto Continuum: From Carb Cutting To Multi‑Day Fasting
Bosworth walks through her 12‑step Keto Continuum, a structured roadmap from standard eating to advanced fasting. She describes how each phase builds metabolic flexibility, lowers insulin, and increases the frequency and depth of ketosis, especially for those with long‑standing insulin resistance or serious illness.
- •Step 1: conventional pattern—eating every 2–3 hours, no carb limits.
- •Step 2: drop to <20 g total carbs per day; use urine ketone strips; many see ketones within a week and skip their first meal by ~day 10.
- •Intermediate steps: implement 16:8 fasting, then gradually shorten and shift the eating window earlier.
- •Step 7: 23:1 one‑meal‑a‑day fasting, achieved by sliding the fasting window down an hour at a time.
- •Steps 9–12: 36–72‑hour ‘nothing burger’ fasts periodically to aggressively lower insulin in those with 15–20 years of high insulin.
- •Women and older adults often need these deeper fasts despite popular fears; Bosworth prioritizes getting insulin normal first.
- 1:44:00 – 1:54:00
Sex Differences, Hormones, And Menstrual Health On Keto
They discuss how men and women differ in fat loss and metabolic adaptation, and how insulin resistance affects sex hormones. Bosworth pushes back on the idea that keto wrecks women’s hormones, arguing instead that high insulin is already wrecking them and keto can restore communication between hormones.
- •In survival‑type situations (e.g., ‘Alone’ TV show), men lose fat quickly; women’s bodies defend fat more strongly.
- •High insulin traps estrogen, testosterone, and vitamin D in fat cells, contributing to PCOS, low vitamin D, hair loss, and cycle issues.
- •Lowering insulin mobilizes stored fat and the hormones within, letting the endocrine system ‘hear itself’ again.
- •Steven notes women reporting more synchronized, regular cycles on low‑carb; Bosworth credits improved hormonal signaling.
- •She herself, at 55 and post‑menopausal, now feels her brain and energy ‘don’t work right’ without ketones most days.
- 1:54:00 – 2:10:00
Sardines, Fiber Controversy, And The 100‑Day Sardine Experiment
Bosworth explains why she uses sardines as a therapeutic food: simple, cheap, nutrient‑dense, and nearly carb‑free. She recounts a patient, Jane, who did 100 days of only sardines, significantly improving weight, vitamin D, and emotional relationship with food. She then challenges mainstream views on fiber and the microbiome, arguing that butyrate from ketones can substitute for fiber‑driven butyrate.
- •Sardines are high in fat, protein, omega‑3s, vitamin D and low in cost and carbs—ideal for a no‑decision keto reset.
- •Her 3‑day sardine fast has no calorie limit, only food restriction, to teach satiety and force ketosis.
- •Jane, a coach with deep emotional eating patterns, did 100 days of sardines: vitamin D rose from 30–40s to ~108 without supplements; arsenic/selenium stayed safe; she lost substantial weight and confronted psychological drivers of overeating.
- •Bosworth dismisses concerns about fiber deficiency, saying ‘fiber is for farting’ and emphasizing gut healing in carnivore and low‑fiber patients.
- •She contends gut diversity can be supported via butyrate from ketones (beta‑hydroxybutyrate) rather than solely from plant fiber fermentation.
- 2:10:00 – 2:26:00
Supplements: Vitamin D, Magnesium, Creatine, Methylene Blue, And Exogenous Ketones
They move into adjunctive tools. Bosworth highlights vitamin D as a hormone trapped in fat when insulin is high, magnesium as a universal cofactor, creatine as a brain and jet‑lag aid, and methylene blue as an old drug that enhances mitochondrial function. They also discuss exogenous ketones as a bridge back into ketosis, especially around chemo.
- •Vitamin D acts as a hormone that instructs cells; obesity and high insulin sequester it in fat, leaving blood levels low until insulin falls.
- •Jane’s sardine‑only period normalized vitamin D, suggesting better fat mobilization with lower insulin.
- •Magnesium is chronically low due to depleted soils; Bosworth uses oral forms and magnesium float tanks for absorption.
- •Creatine supports brain function, focus, and sleep‑cycle recovery after jet lag; standard kidney labs can be falsely elevated in creatine users.
- •Methylene blue is an old malaria drug and dye that preferentially accumulates in brain and heart, boosting mitochondrial energetics; Bosworth uses it herself.
- •Exogenous ketones (drinks/salts) raise blood BHB quickly, improve subjective brain function, and signal the liver to produce its own ketones—useful after dietary lapses or before chemo sessions.
- 2:26:00 – 2:35:00
Keto, GLP‑1 Drugs, And Natural Appetite Suppression
With the rise of Ozempic and related GLP‑1 agonists, Bosworth compares pharmacologic appetite suppression to keto‑induced hormonal changes. She cautions that powerful drugs used for vanity weight loss resemble using chemotherapy to remove leg hair—overkill with potential unintended consequences—when natural GLP‑1 boosting via ketones and butyrate is available.
- •GLP‑1 agonists profoundly reduce cravings and food noise but are expensive and potent hormones with unknown long‑term tradeoffs.
- •Bosworth prefers to use the smallest doses possible, on a short‑term basis, and only after patients have established ketosis.
- •Natural GLP‑1 boosting strategies include achieving regular ketosis, increasing butyrate (through ketones or gut production), and possibly using sweeteners like allulose.
- •Steven notes that in ketosis his desire for sweets like carrot cake or cinnamon rolls almost vanishes; Bosworth says that’s the same phenomenon GLP‑1 injectables create.
- •Her aim is for patients to harness their own hormones so they never need chronic injections.
- 2:35:00 – 2:48:00
Motivation, Purpose, And The Psychology Of Staying Keto
Recognizing that information alone doesn’t guarantee adherence, they discuss motivation, identity, and deep ‘why’s. Bosworth emphasizes that people usually start keto after a health crisis, but long‑term success depends on addressing emotional wounds and core insecurities, as Jane did through her sardine commitment.
- •Most people start serious change because of acute pain: diagnosis, death, or a frightening health event.
- •To sustain change, Bosworth has patients do exercises identifying their best and worst days and their deepest insecurities.
- •She encourages reframing core wounds (e.g., feeling not smart or attractive enough) into fuel for discipline and perseverance.
- •Her 21‑day programs weave in these psychological components, not just macros and numbers.
- •She wants patients—not doctors or drugs—to be the primary agents of their own success.
- 2:48:00 – 3:12:00
Political Prosecution, Felony Charges, And Rebuilding A Life
In a stark, personal section, Bosworth recounts leaving corporate medicine, treating poor and Native American patients more aggressively than the state liked, and being investigated for Medicaid fraud over IV iron treatment she paid for herself. After that failed, political adversaries targeted her during a US Senate run, ultimately convicting her on twelve felonies over petition witnessing technicalities, sentencing her to 24 years before suspending the sentence.
- •She left corporate medicine, served homeless/Medicaid patients, and gave IV iron to severely anemic teens, triggering accusations of ‘Cadillac medicine’.
- •Despite paying for the iron herself, she was accused of Medicaid fraud; the government lost that case.
- •During a Senate run where she outraised a powerful opponent with grassroots donations, she was prosecuted for not personally witnessing petition signatures signed while she was abroad.
- •She was convicted on twelve felonies and nominally sentenced to 24 years in prison—later suspended in favor of 500 hours’ community service, which she was essentially already doing.
- •The Supreme Court later ruled the attorney general abused his power for at least half the counts, and the judge wiped all felonies.
- •She describes profound financial and emotional strain—selling her home, living in an RV, pawning wedding rings—but frames it as a test of faith, marriage, and mission.
- 3:12:00
Faith, Daily Practice, And Closing Reflections
In the closing segment, Bosworth answers a question about finding inner peace when emotionally triggered. She shares her daily devotional practice that grounds her in faith, explains how historical and scriptural guidance helps her navigate adversity, and Steven recaps her work and resources for viewers wanting to go deeper.
- •Bosworth maintains a daily devotional habit: scripture plus prayer, practiced on good days so it’s available on bad ones.
- •She views herself as part of a long lineage of people who’ve faced hardship and uses that perspective to stay centered.
- •Steven highlights her YouTube channel, books ‘Any Way You Can’ and ‘The Keto Continuum’ plus its workbook, as step‑by‑step guides.
- •They underscore that keto, measurement, and mindset are tools to reclaim healthspan and cognitive function, not quick fixes.
