Most Replayed Moment: The First Warning Signs Of Insulin Resistance! Check Your Skin For This

What if the first signs of insulin resistance are already visible on your body? Dr Annette Bosworth, also known as Dr Boz, is a physician and author whose work focuses on metabolic health, insulin resistance and ketogenic nutrition. In this moment, Dr Boz explains how chronically high insulin can quietly affect the body long before many people recognise there’s a problem. She reveals the surprising physical cues, the differences between men and women, and walks Steve through the 12 step keto continuum - a protocol for lowering high insulin. Listen to the full episode here! Spotify: https://g2ul0.app.link/NkamPsZlI5b Apple: https://g2ul0.app.link/plY8uI1lI5b Watch the Episodes On YouTube: https://www.youtube.com/c/TheDiaryOfACEO/videos Dr Boz: https://bozmd.com/ Sponsors - Function Health: https://functionhealth.com/DOAC

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:04Steven Bartlett?

  So when I'm, you're 54 years old. When I'm 54 years old, I want to be as young and energetic and articulate and cognitively astute as you are. So what should I be doing now to make sure that I don't decline, decay in all those areas I described?

• 0:22Speaker 01

  Well, what did you have for breakfast?

• 0:23Steven Bartlett?

  Today?

• 0:23Speaker 01

  Yeah.

• 0:25Steven Bartlett?

  I have not eaten breakfast yet.

• 0:27Speaker 01

  It's okay, that's not a bad thing. But when you're 54, you should probably put the calories in the morning, not at night. We know that as you age, the cost of a calorie turns into timing. If you eat that food, one bite of food after six o'clock is worth 10 bites of food before noon. So if you're trying to say, how do I get the best out of the nourishment, but also eating's fun? If you only get one bite after six o'clock and 10 before, move that food towards morning. When you're your age, what did you have for, what's the last meal you ate?

• 1:03Steven Bartlett?

  Yesterday?

• 1:03Speaker 01

  Yeah.

• 1:05Steven Bartlett?

  For dinner, I had this cod and I had salad. I also had pasta.

• 1:11Speaker 01

  Okay.

• 1:12Steven Bartlett?

  But I ate pretty late, which is a big thing.

• 1:13Speaker 01

  What did you have the rest of the day before that? Was that your first meal?

• 1:16Steven Bartlett?

  Just a salad, just a big salad.

• 1:18Speaker 01

  Was that more towards lunch or noon or?

• 1:21Steven Bartlett?

  Probably about four o'clock.

• 1:22Speaker 01

  So waited all the way till four o'clock to eat? Very common. This is a really common pattern of people doing what we would say intermittent or time restricted eating. They put that eating window in this, but it's got that balloon at the end of the day.

• 1:33Steven Bartlett?

  Yeah.

• 1:33Speaker 01

  And it really does, I mean, what you're stimulating is an excessive production of insulin. And you're going to wake up the next morning. What time did you wake up this morning?

• 1:43Steven Bartlett?

  Today? I went to bed fairly, relatively early for me. I woke up at about 7:30 AM.

• 1:49Speaker 01

  Oh.

• 1:49Steven Bartlett?

  Usually it's later.

• 1:50Speaker 01

  And do you have, did you have a solid seven, eight hours of sleep or how?

• 1:54Steven Bartlett?

  Yeah.

• 1:55Speaker 01

  So during that time, you finished eating around 10 o'clock then it sounds like?

• 1:59Steven Bartlett?

  Yeah.

• 1:59Speaker 01

  Okay, so then it's seven.

• 2:00Steven Bartlett?

  A bit later.

• 2:01Speaker 01

  Okay, so 11 o'clock and you've got, 7:30 in the morning is when you woke up. So that's about eight hours since you've eaten. Your insulin is still churning, especially if the meal was large and there was carbs in it. So now you've got these processed foods late at night and you're at the beginning of the disease, right? You're at the beginning of the chronic inflammatory churn of how do you age faster and faster? You don't do that. You don't have high insulin throughout the night.

• 2:26Steven Bartlett?

  So can you explain to me, like I'm a 12 year old, what insulin is and the role it's playing? Cause you know, I guess we're focused here on how to, I guess longevity, aging.

• 2:36Speaker 01

  Yeah.

• 2:37Steven Bartlett?

  For a second, but how does insulin play a role in all of this? And what is insulin?

• 2:40Speaker 01

  So insulin insulates. Okay, so think of it as it makes you fluffy. It makes you, it puts the fat on. It's got some other roles too, but we're going to talk about chronic diseases here where it's not a scarcity problem. You, you make plenty of it. And when it's in excess, it will store energy for when you go through a famine. It will also cause you to grow. Now, grow means get a little fatter, but it also means things like their skin gets a little thicker, they have skin tags. And what I always think about is what's going on in their brain. And when that insulin is high for years and years and years, just like yours, because if, if you didn't eat the rest of today

• 3:24Speaker 01

  and then you got up tomorrow morning, it would be about that long after a late meal last night. That's how long it would take you to say, okay, we're back down to where we started from or where we should be in the morning.

• 3:36Steven Bartlett?

  For someone that's never heard the word insulin before, there's some context to give in terms of what it's doing. So it's coming out like a transporter and helping put away the sugar or deal with the excess sugar?

• 3:46Speaker 01

  Right, so it is what lifts, yeah, it lifts glucose or sugar from the circulation into a cell. That's its first primary job. But if all the cells are full, their storage is full, it's going to start to pack it into the liver. I mean, let's say all those stores are full too. This job of the, of insulin, this hormone oozes into every part of your body to say, make sure it's got fuel, make sure it's got that sugar. But most people are like what I would guess you are. Most of the time, you don't, you aren't a shortage of sugar. And so it fills, it tops things off and then it will turn things into fat. It's too much sugar, they can't store it, all the storage is full. So you can send the signal out, make me some more cells. I need some more storage units. This guy's eating more than he thinks he is.

• 4:31Speaker 01

  And we're going to be prepared to live through the famine. But in the meantime, turn it into fat, make him a little fluffier.

• 4:40Steven Bartlett?

  Is that the only consequence of high insulin is that I'm going to, I might be a bit more fat?

• 4:44Speaker 01

  No, that's just the one people hear about the most. When you look at chronic disease management, it is the growth of, of the diseases, of the inflammation. It's the making of the trash. So I keep saying, you need to take the trash out routinely, which means that insulin, which has been smoldering higher than you think it is because you live in today's world, because you eat processed food, because you eat super late at night. You don't go two to three days without eating. You've, you've got storage filled in your body. The high insulin levels in a healthy person hides that the debris is being made and you don't know it.

• 5:20Steven Bartlett?

  It hides it?

• 5:21Speaker 01

  Yeah, it's going to put it in between two cells in your brain. It's going to put it in between the skin cells. The trash doesn't get taken out until the insulin gets lower. And unfortunately, most people have been making buckets of insulin without knowing it.

• 5:37Steven Bartlett?

  Why? What are they doing to create buckets of insulin? All the things you said about.

• 5:42Speaker 01

  Carbs, foods that comes from boxes and barcodes and bags instead of whole foods, instead of a fat forward diet, which would then push that body into making ketones. So you can't, you cannot make a ketone if your insulin's high.

• 6:02Steven Bartlett?

  Are there any signs that I might have high levels of insulin or insulin resistance?

• 6:07Speaker 01

  Abdominal girth is the first thing that, is the first place that the fat goes. So you do this really great part where you don't eat until later in the day. How does that feel during the day?

• 6:17Steven Bartlett?

  During the day, I feel really focused. I actually don't even know that I'm not eating.

• 6:20Speaker 01

  So that's really good. So what I would love to know is show me what your blood sugars are doing during the day and show me if you make ketones. That'll be, the answer is you, when you have excess insulin, which is this chronic disease maker, it is what makes cancer. It is what makes high blood pressure. It is what makes debris in the brain where, call it depression or brain fog or Parkinson's, it's the aging of the brain.

• 6:45Steven Bartlett?

  It's linked to all of those things.

• 6:46Speaker 01

  All of those things. And that excess insulin, nobody tells you about. But the symptoms are, dang, I feel like I gotta eat every two to three hours. Their debris or their fuel keeps running out. When you say, boy, I can eat once at the end of the day and I'm pretty good. My focus stays really good. What I want you to prove is, what are your ketones during the day? So when, when you've got a patient who has done that, their ketones will be 0.7, 1.0. And they're taking out the trash all day long.

• 7:19Steven Bartlett?

  So there's these two energy sources. One of them is glucose, one of them is, which is from like, you know, eating pasta, which I ate last night. So that probably put a lot of glucose in my, my bed. I probably had a high glucose spike and then insulin came out to deal with that. And then there's ketones, which start to appear when I'm fasting or when I haven't been eating carbs for a while and my body's looking for an energy source.

• 7:39Speaker 01

  Right, yeah. So think of it as your short term, easy to access sugar has to decrease. And that means your insulin has decreased. That hormone for insulate, they both run in tangents. You decrease, you're emptying glycogen, your insulin's going down.

• 7:55Steven Bartlett?

  So how do I know if I have insulin resistance? What are the key signs? You mentioned skin tags, I've never had that term before.

• 8:02Speaker 01

  Yeah, skin tags are not moles. So moles, you can feel this bump on your, on your skin, right? But a skin tag has a neck and like a little mushroom. And it's the most annoying thing when patients come and say, well, I just tried to cut them all off, but they kept bleeding. I'm like, do not cut them off. They'll fall off when your insulin's lower. So that's the first place. It'll be found in their armpits or places where their skin rubs. So armpits and their groin. And once insulin starts to grow them, it's like a crop. A crop, a little baby cauliflower hanging out in their armpits.

• 8:34Steven Bartlett?

  You talked about velvety skin.

• 8:36Speaker 01

  Yes.

• 8:37Steven Bartlett?

  As well being an indicator.

• 8:38Speaker 01

  Velvety skin is this Latin word, acanthosis nigra cans, which is fancy word that means the skin is darker and thicker. So the, the places it usually happens is the back of the neck. And you'll hear, you know, stories of, I tried to wash my neck. It's, it's dirty all the time. It's not dirt. It is the way the skin is under the curse of high insulin. And you see it in teenagers all the time now. They put on weight and their growth hormones are already doing that teenage thing. Now you put high insulin in there and they have this dirty neck syndrome. Or on the creases of their elbow, it's just darker here. That is pathology, that's not normal from high insulin.

• 9:21Steven Bartlett?

  You talked about weight changes as well. What's this thing about hairy toes that I was reading about?

• 9:25Speaker 01

  Right, so as my patients age, so most of my 55 year olds that have had high insulin, I will tell them, look at your toes. They're supposed to have hair on them. And when your body has had that high insulin state for a couple of decades now, it will start to say, we don't send resources to a couple of parts of the body anymore. And the follicles in their toe are one of them. Like just stop growing hair on your toes. And there's an ascending problem with this where the toe starts, then it's the ankles, then it's up to the knees. And they don't have hair anywhere on their lower extremities. It is a process that started from high insulin.

• 10:02Steven Bartlett?

  So you have this idea of this keto continuum. What is the ketone continuum? I read about it, I mean, it's a, it's a book here I have, which you published in 2020 called The Keto Continuum: Consistently Keto for Life.

• 10:17Speaker 01

  Right.

• 10:17Steven Bartlett?

  So the keto continuum is this 12 step process.

• 10:20Speaker 01

  Right.

• 10:21Steven Bartlett?

  To get into a consistent.

• 10:22Speaker 01

  Consistently keto, yeah, that you're constantly taking out the trash. The first part is the beginner.

• 10:27Steven Bartlett?

  Okay, so the first part, the beginner section has four stages to it.

• 10:30Speaker 01

  Right.

• 10:31Steven Bartlett?

  What are, what are those four stages?

• 10:33Speaker 01

  Well, I like to tell patients that you never fall all the way off of the continuum. So the first, the first step is really not keto, but it is that they're eating every two to three hours. And if they fall off the wagon, that's usually where they land. So that's what most people start at. They're eating every two to three hours. They are not keeping their carbs less than 20. Step two is cut your carbs to 20. That's the only thing I need you to measure. And you're going to be able to use a pee tone strip, you know, measure ketones in your urine and that will ride, you'll ride a wave. And that ketone production is happening. The fat based hormones in your body are starting to resurrect. They're starting to do the things that they need to do. And there'll be this magical moment in the not too near future

• 11:18Speaker 01

  where you skip a meal.

• 11:20Steven Bartlett?

  And this, that beginning stage, how long does that last? I'll put this on the screen so everybody can see.

• 11:26Speaker 01

  Sure.

• 11:26Steven Bartlett?

  The continuum. How long does that initial beginner stage last for people?

• 11:30Speaker 01

  If they've been severely insulin resistant, this is the ones where I've said, they took their carbs to 20 for, for two weeks before they pee to ketone. So I use some other steps if that's how severe that is. But let's just take the average person. That's like not, they're not 100 pounds overweight. They're hitting menopause and they've put on 25 pounds. When they dropped their carbs to 20, they're peeing a ketone by the end of the week. And they are missing their first meal by day 10.

• 11:57Steven Bartlett?

  Okay, so day 10. And then it says, when we get to stage five in the keto continuum, it says 1680, 168. Is that?

• 12:05Speaker 01

  Yeah. So then we start to use time restricted eating where I want, we're going to, your body will adapt. People say you can't stay on the keto diet because they go to step four and then they think that that's all they needed to do. There are several steps to reversing this problem. And you'll know you have the right step if the ketones are still present in your blood. Your body will adapt though. So we start to say, all right, we're going to learn some new behaviors. We're going to learn what the nothing burger looks like, at least for 16 hours out of the day.

• 12:35Steven Bartlett?

  What does that mean?

• 12:36Speaker 01

  You do not eat a thing in those 16 hours. Now, I give them a little hedge because most people come in like you. They don't start eating until two o'clock in the afternoon and then they eat until 10 o'clock. And I want them fat forward. I want lots of fat going in because insulin resistance, that high insulin state means they've locked or they've insulated their fat on their body.

• 12:59Steven Bartlett?

  And then we get to stage seven where it says 23, one. Is that fasting for 23 hours a day?

• 13:05Speaker 01

  Yeah.

• 13:05Steven Bartlett?

  And eating for one hour a day?

• 13:06Speaker 01

  And the, there's a little bitty line between 16, eight and 23 and one, but there's a whole bunch of life there. Meaning we don't actually have patients go from 16 hours of fasting to 23. We have them slide it down by an hour, slide it down by an hour. And then we do that harder thing, which is move it towards sunrise. Quit eating so late at night.

• 13:26Steven Bartlett?

  And then the last stage here, so, so step nine, 10, 11 and 12 is prolonged fasting between 36 and 72 hour fasting.

• 13:37Speaker 01

  Right, so those folks that have high insulin for 20, you know, 15, 20 years, they're going to have to do a nothing burger for 36 hours in most of them to really give a good reset of their metabolism. And although you, you look at other folks saying, oh, you should never do that if you're a woman, you should never do that over the age of 50. I'm saying you have too much insulin in your body. You have to do that to get the pancreas to make less insulin over time.

• 14:01Steven Bartlett?

  On that point, between men and women, are there metabolic differences that need to be mentioned here? Because you know, when I, sometimes when I do ketogenic fasting, my girlfriend, she takes much longer than me to get into a ketogenic state. And I'm wondering if her body is in some way trying to defend the switch.

• 14:17Speaker 01

  Have you ever seen the, the reality show Alone?

• 14:20Steven Bartlett?

  Oh no, I'm not a reality show guy.

• 14:22Speaker 01

  I'm not either, but they drop these people off in the middle of nowhere and they starve them to death. And you watch the fat come off of them and the men, the fat just melts off of them. And the women, they do what your girlfriend does. It just holds on to them. That we are designed to have that fat on them. So asking them to do a ketogenic state, you'll hear people say, oh, it's going to ruin your hormones. Oh, it's going to, you can't do that. And I would say you can have all those conversations once their insulin is normal. But I have lots of women in childbearing years that are excessive producers of insulin and their vitamin D is low. Their estrogen is low. They have hair loss on the top of their head. They have skin tags throughout their body. Or maybe the first sign was they had PCOS.

• 15:07Speaker 01

  Okay, all of these are a sign that insulin came in and it's too high in their body. So lowering it has rules. And if you want to have a baby, carry a baby, have the weight come off after you've gestated a baby, have weight not be your enemy during menopause. You have to be making ketones at a routine and regular interval. And start with the food, start with the menus in the kitchen. Don't run to the gym first.

• 15:35Steven Bartlett?

  I've noticed in women in my life that they've told me that their menstrual cycles become more synced up when they are in a lower carbohydrate diet.

• 15:43Speaker 01

  Right, their hormones can hear each other. I mean, when insulin is high, insulin dictates what that sugar does, but it also is the dictator for every morsel of fat. And estrogen, testosterone, vitamin D, they're all a derivative of fat, of cholesterol. And they are, they're put into the fat cells. If you biopsy an obese woman and say, can I see, is there any vitamin D hidden in there? Is there any estrogen? Is there any, yes, they're all in those fat cells. You start to lower their insulin and the fat mobilizes. So the hormones that are naturally communicated between women, they can actually hear them again. I mean, that tribal thing.

• 16:23Steven Bartlett?

  If a woman were to stay in a ketogenic state permanently, would there be any disruption to her metabolic health?

• 16:31Speaker 01

  You mean like me?

• 16:32Steven Bartlett?

  Yeah, like, you know, menstrual cycles have, yeah, anything.

• 16:37Speaker 01

  No, I think it's, you're going to find people that it shouldn't be extreme. Meaning I've been on this for 15 years. The ketogenic phase is at least 20 out of 30 days in a month, the first few years I was on it. Now at 55, menopause in the last year, I'm like, without a ketone, my brain doesn't work right now without a ketone. My energy goes to pot. And I've been walking women through menopause for 25 years. It is not a fun story when they're insulin resistant. So prepare, have the flexibility of that mitochondria to use both ketones and glucose. And that's what a ketogenic state is.

• 17:20Steven Bartlett?

  I want to speak to the business owners listening and watching right now. I know what it's like to be personally responsible for every decision. I founded my first company at 21 years old and honestly, the pressure can be immense. It's the kind of mental load that takes its toll below the surface. I recently did some tests through our sponsor, Function, which got me thinking about that invisible impact. I found that I had low levels of omega threes. I had deficient levels of vitamin D, probably because I sit inside this dark room all day. And that has totally changed how I construct my day going forward. I get up in the morning and the first thing I now do is I go for a walk outside in the sunshine, in part to help my vitamin D levels increase, but also because it helps to reset my circadian rhythm. With Function, you can check your brain health, your aging, your stress and so much more.

• 18:05Steven Bartlett?

  They provide over 160 lab tests for what is equal to a dollar a day and member pricing on advanced imaging. Head to functionhealth.com/DOAC to join and use code DOAC25 for a $25 credit. What you just listened to was a most replayed moment from a previous episode. If you want to listen to that full episode, I've linked it down below. Check the description. Thank you.