Dr. Benjamin Bikman Landscape

My guest today is scientist Dr. Benjamin Bikman, author of Why We Get Sick. He is a leading metabolic research scientist, author of ‘Why We Get Sick,’ and a member of The Golden 30 (the list of the most influential health leaders who are driving the needle for podcasters). His work focuses on the things that disrupt or accompany metabolic disorders, like obesity, type two diabetes, and dementia. Ben discusses his appreciation for having healthy glucose levels but how important it is for us to focus on maintaining our insulin sensitivity and the long-term health impacts if we become insulin resistant. Dr. Bikman communicates a very clear path to managing some of these challenges based on science and what continues to show up in his research. He has created a brand called HLTHcode in an effort to support us in our fast paced lives with some of the right nutrition. Dr. Bikman offers a lot of information and helpful takeaways in this episode. Enjoy.

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“If we could shift our view to insulin and tracking a patient’s insulin levels over the years, we could detect the problem ten years or even more before the glucose ever changes. Because we’re only looking at glucose, they may have already developed three other so-called chronic diseases before the glucose ever starts to change if it ever changes at all. If we shifted the paradigm to look at insulin instead and then have a strategy based on lowering insulin through lifestyle management, not only can we detect the problem in its earliest stages. It’s an insulin problem, it’s not a glucose problem. We can also treat it better.”

“The same people who advocate these low protein diets to live longer, their own data has found that over the age of 65, the people that eat the least amount of protein have the highest mortality. That doesn’t work with the paradigm. If we have to keep protein low to age well, then why do the oldest among us die the most as they start cutting protein? It’s because the whole paradigm, in my view, is built on a false idea. The problem isn’t protein, the problem is insulin.”

My guest is Dr. Benjamin Bikman. His research focuses on the mechanisms that mediate the disruptors that cause and accompany metabolic disorders. To put that in English, things like obesity, type 2 diabetes, and dementia. He has been focusing on the emphasis on insulin resistance and the disruptive mitochondrial function and how this plays out.

What I appreciate about this is, yes, it is hard in the world that we live in. We have stressful lives. We sit too much. We have to make time to exercise. Our food system is wonky and processed. It’s still on us to figure out how we navigate this. Someone like Dr. Bikman, who is a scientist, is going to show you what he’s seeing in the laboratory.

He’s going to talk to you only about the science and what shows up. The other flip side of that is he has an opinion and he’s willing to stand by it like what’s working and what’s not working. For a lot of us, sometimes that’s hard to hear but that’s the only way. The truth will help us and give us real tools so that we can be more successful.

We had a great conversation also about ketones, what’s happening, and how that works. For me, it’s this, let’s focus on what are the real solutions. We know what the problems are. He does a simple, beautiful, and scientific job at that. I learned a lot, I was reminded a lot, and I was inspired. So much of it is in our hands. Enjoy.

Dr. Bikman, thank you so much for joining me. Where are you in the world?

I’m in Utah, up in the Rocky Mountains at Brigham Young University.

How many kids do you have?

Three kids.

You have only a few. You only have a couple.

It’s a little disappointing where I’m from. In Utah, most people have 5 or 6.

I have a lot of good friends that have more.

We’re a bit of an anomaly, unfortunately.

I want to dive right in. Do you know what I was thinking about when I was doing this research? I was thinking that we hear so much about diabetes, insulin, and insulin resistance that we almost feel consciously and culturally we know what it is. When you start to break down the relationship between glucose and insulin, you realize that most of us don’t understand exactly what’s happening. Maybe how we can start is you start in one area and then dove deeper into the research you’re doing now. Maybe you could share that and then we can get into some of the specifics.

You mean my academic journey, if you will?

Yeah. What I have found many times in these conversations is that when you’re seeing things showing up or you’re seeing something way down streamed as a byproduct of this one thing over and over, a lot of people will change course because they go, “We’re going to go deeper to the cause because a lot of the symptoms are leading back to the same place.”

My academic journey is maybe typical but it was certainly interesting and unexpected for me. When I first learned that people were still doing research into nutrient metabolism and human physiology, it was an absolute revelation to me. I had no idea when I was an undergraduate that people were still doing experiments to better understand the way the bodies work.

My inclination was to pursue studying muscle because I had been in exercise science. I went in to get a Master’s degree in exercise physiology thinking my career will be to better understand how the muscles adapt to stimuli, why they get bigger, what is prompting that growth, and working better. Towards the end of my Master’s degree, I stumbled upon this paper because I was interested in looking at how exercise altered inflammation. That got me into this realm of inflammation.

I then find one paper that talks about how when fat cells start to grow, they become pro-inflammatory and start releasing these pro-inflammatory proteins called cytokines. These cytokines then start flowing through the bloodstream causing insulin resistance and that then would lead to type 2 diabetes. In my mind, it created this incredible and beautiful bridge between obesity and diabetes, these twin epidemics that we see around the world.

The idea that the fat cell was increasing inflammation, which was causing the insulin resistance, which itself is the foundation of type 2 diabetes, connected these problems that we knew were going together where one was up and so was the other and one went down and so did the other go. The idea that inflammation was a primary connection between these two and it was because the fat cell was starting was mind-blowing.

[bctt tweet=”Eat when you’re hungry. If you’re not hungry, don’t eat.”]

That immediately shifted my interest away from exercise and the muscle to understanding insulin resistance. What are the origins? Why is it coming up? How does it start to settle in the body? What are the consequences? It’s been this ongoing learning much to my gratification realizing that insulin resistance, yes, is foundational to type 2 diabetes. If it was only relevant to type 2 diabetes, that would be of value but much more limited. When you realize that insulin resistance is fundamental to both Alzheimer’s disease and infertility in men and women and heart disease and certain cancers, then the scope of the problem starts to come into view and we realize how prevalent this problem is. That makes it all the more relevant, of course.

Over 80% of adults are vulnerable. The thing that’s interesting is we always hear about the American diet but we’ve exported that everywhere. You did some research in Singapore. You’re saying that this is worldwide. In fact, some Middle Eastern countries, India, North Africa, and some other countries, they’re quite vulnerable. The obvious is processed foods and we don’t move around as much. We all know this.

Could we look at, for example, the Middle East or North Africa? What have they changed in their diet that’s impacted them greatly? In the US, we have such an abundance of processed foods that we can understand it’s in everything. Inflammatory oils are in everything. It’s in every dressing, it’s in every chip, it’s in everything. Maybe they would be an interesting group to look at. What things have changed for them that now they’re vulnerable as well?

There is a wonderful amount of material to unpack there. If I were to, as succinctly as possible, think through how to best explain it, there would be a lifestyle component to this, no question. That’s more than processed foods. It is more complicated and I’ll elaborate a little bit. It’s also genetics. Some ethnicities have differences in how fat cells grow. I’ll come back to that one because it’s a pretty compelling view.

With regard to diet, we’re eating the wrong foods too frequently. To hear me say that, people may nod their heads sagely and say, “Of course, that’s the way it is.” We don’t realize how pervasive this ideology is. People with type 2 diabetes are told to not only eat a diet that is predominantly carbohydrates, which is insane.

A clinician is looking at a person with type 2 diabetes, which is insulin resistance gone extreme, and they would say, “Your blood sugar levels are too high.” Where does that blood sugar come from? It comes from the starches and the sugars that we’re eating. Why would we tell them to continue to put more of the nutrients in that they’re having a hard time metabolizing? They’re having a hard time clearing that nutrient. Nevertheless, we tell them to eat a diet that’s 50%-ish carbohydrate and we tell them to eat six meals per day.

I want you to keep going because it’s it is complex. First of all, when people go to medical school, they don’t have a ton of time to learn about nutrition. It’s been said 1,000 times, there’s only so much time to learn so many things. By the time something is in practice, it’s out of date probably by two years or something. Why are we telling them? Is it because we’re saying stay away from fat?  Why are we telling them to eat six times to stabilize supposedly that blood sugar?

Gabby, I’m thrilled that it doesn’t make sense to you because it doesn’t make sense. The only justification in that paradigm is that you truly believe that fat is the problem in the diet, which we can come back to and I’d be delighted because that’s silly. This is a cynical take. Everyone will pardon me for sounding like I’m a cantankerous old bugger. It is a great way to make sure the patient is more dependent on certain medications to force them to control their blood sugar and that diet is contributing to the problem.

You need some external pharmaceutical intervention to try to correct it. That’s a hot take but it is a great way to make sure that they are taking more drugs more frequently. Unfortunately, in that way of eating, by forcing glucose up all the time, you’re forcing insulin up all the time. A person is spending every waking moment and well into their sleeping moments in a state of elevated glucose and elevated insulin.

Elevated glucose is another thing to touch on. There are three primary causes of what makes the body insulin resistant. I already said inflammation is one of them. This can be even with autoimmune diseases. If someone has an autoimmune disease and their immune system is turned on, they will be more insulin resistant during that period of time.

Stress is also a cause of insulin resistance and that’s the stress hormones like adrenaline and cortisol. The most common reason a person is going to have those elevated is that they sleep poorly. One bad night of sleep is enough to so substantially increase your stress hormones the next day that you’re demonstrably insulin resistant that next day.

Thankfully, a good night of sleep will wipe it out and get back to normal. The other cause is chronically elevated insulin. The more the body has elevated insulin, the more it becomes resistant to that insulin. That’s reflective of a fundamental biological principle. If there’s too much of something, the body will become resistant to that something. It’s reflected all across nature.

What we’ve done now is merge all of them into our current lifestyle, whether it’s the Middle East. I’ll come back to the genetics component. Around the world, we have people that are eating mostly refined sugars and starches as the primary calorie in their diet. They’re eating it repeatedly throughout the day, never giving time for the insulin to come back down to baseline. We spike it for breakfast. Right as it’s about to come down, we do it again with the mid-morning snack and then lunch and then snack and then dinner, and then snack.

Because we’re going to bed with elevated glucose, we sleep significantly worse. A lot of people go to bed and feel like they’re anxious and their heart is racing and they’re hot, anxiety has nothing to do with it. We know that hyperglycemia activates the sympathetic nervous system, the fight or flight response. The heart is beating heart and the blood pressure is high. You’re not anxious about anything. You just wired your body to stay awake two hours longer and sleep poorly because you’re too hot.

All of these come together to say insulin is elevated all the time. That’s going to cause insulin resistance. You’re sleeping poorly so your stress hormones are up, that’s going to cause insulin resistance. The inflammation aspect is somewhat variable. Some people may suffer from it and some people wouldn’t. Nevertheless, we’ve already got 1 or 2 of these fundamental causes and the body is more insulin resistant as a result.

The genetics component, to be very brief, although it’s such a big topic. I would want everyone to know that this is debated in the realm of insulin resistance. There’s an active vibrant discussion on which tissue of the body becomes insulin resistant first. What is the first domino to fall and bump into the rest? Some people advocate that it’s the muscle. Some people say it’s the liver. Some people, and I’m included, say that it’s the fat cells that go first. Of course, we are the right ones and everyone else is wrong.

Dr. Benjamin Bikman caption 1

Dr. Benjamin Bikman – My basic rule on that is if the carbohydrates come from a bag or a box with a barcode, be careful with it. Whole fruits and vegetables, eat them and enjoy them. Don’t drink them, eat them, and enjoy them.

The problem with the fat cell or the unique aspect of the fat cell is how we get fat. You can’t tell this from looking at a person. Let’s imagine we had two individuals and they were old college roommates and they get back together ten years later. I’ve been a professor for over ten years and I’ve seen this happen. Students are all lean, they brag about how much they can eat and abuse their bodies. Sure enough, I see them ten years later and they’re not so lean anymore.

You can have two guys who have gained both twenty pounds of fat but they’ve gained it through two totally different processes. In both instances, what they have in common is that they both have twenty pounds more fat on their bodies. One guy was getting fat through a process called adipocyte. The adipocyte is a fat cell. Adipocyte hyperplasia is a process where right as a fat cell is starting to grow, it multiplies and we get a new fat cell. It keeps creating more and more fat cells but they all stay modestly sized, which is a healthy fat cell.

The fat tissue is much bigger but it’s working well. It’s insulin sensitive and it’s not inflammatory. Those are problems with the other form of getting fat. This is how most people get fat, particularly in various ethnicities across the world like Asia. Chinese ethnicity will do this and people in the Middle East. In this case, the number of fat cells is rigidly set. The body stops making more fat cells. This is how most people around the world get fat, which is why metabolic problems are prevalent.

The fat cells stay set in number but each individual fat cell starts to grow significantly. That’s a process called adipocyte hypertrophy. Hypertrophy versus hyperplasia. With hypertrophy, the fat cell can get to a point that’s ten times the volume of a normal-sized fat cell. Once it starts to reach this point of maximum dimension, two things go wrong that end up tipping it from a happy and healthy fat cell to a sick and angry fat cell and that is hypoxia and insulin resistance itself.

I’ll start with the second one briefly because I’ve already taken too long on this. When the fat cell has reached ten times its size, it knows it cannot grow anymore. If it continues to grow, it will start to fall apart. Insulin is high in this person’s body because they keep eating refined sugars and starches. Insulin continues to tell a fat cell to grow. I will make the statement clear, it is impossible. Under no circumstance in any organism from fruit flies to humans and everything in between, it is impossible for fat cells to grow unless insulin is elevated. It cannot happen. It’s impossible.

The fat cell has reached this point of maximum dimension, insulin is high, and it’s continuing to tell the cell to grow. The fat cell knows it can’t. I’m being silly in how I’m describing this. The fat cell, to ensure its survival, stops responding to insulin. Insulin is trying to tell the fat cell to hold on to all of its fat. Now it starts leaking out. It’s become insulin resistant in order to ensure that it doesn’t continue to grow and burst. It becomes insulin resistant to ensure that it survives. It starts leaking out all these fats into the bloodstream as a result.

The second problem is different. As the fat cells are getting bigger and bigger, they’re pushing each other further and further away from capillaries, from blood. A cell must be in very close proximity to capillaries, to the blood flow. It needs oxygen, it needs to give up its CO2, it needs nutrients, and it needs to dump its metabolic wastes into the blood to be eliminated from the body. As the fat cell has become pushed too far from the capillary because they’re all getting big, it becomes what’s called hypoxic. It’s running low on oxygen.

In order to ensure its own survival, the hypertrophic fat cell will start releasing pro-inflammatory proteins. This comes back to what put me on this pathway in the first place. Some of those inflammatory proteins don’t activate immune pathways like we classically think of them as doing but they will stimulate the growth of new blood vessels. That’s a process through a protein called Vascular Endothelial Growth Factor or VEGF.

It’s trying to survive at all costs. It’s dumping this whole bunch of pro-inflammatory proteins. Only one of them is trying to solve the problem to grow new blood vessels. Even that, the fat cell is trying to survive. It’s trying to say, “I need more blood or I’m going to become necrotic. I’m going to start to rot away and die and that’ll be bad for the body. Let’s grow new blood vessels. The fact that I’m also dumping a bunch of these other pro-inflammatory proteins into the body, that’s not my problem. Everyone else has to deal with that.”

To come all full circle back to your question, it’s a global problem. Some areas of the world experience this more readily than others not only because of diet, which is indeed global. We’re all eating the same way nowadays, unfortunately. There are some pockets of people that have the perfectly wrong genetics where their fat cells grow almost exclusively through hypertrophy. They have little to no hyperplasia capacity, which is the fat cell staying healthy.

You say that there’s also a domino effect. When the fat cell starts to release, it’ll go to the bones and the muscle. What does that look like?

It’s those two things. When the fat cell becomes hypertrophic, it starts releasing a lot of free fatty acids into the bloodstream. At the same time, these pro-inflammatory signaling molecules are cytokines. The combination of those results in other cells all around the body, everywhere from top to bottom. These molecules from the fat cells will signal these other cells of the body to start making a molecule called ceramide.

Ceramide may sound familiar because some lotions, soaps, or shampoos have ceramides in them because they can help those cells retain more water and be more luscious and beautiful. That’s not the same as a cell making a lot of ceremonies within the cell itself. Not to get to biochemical but when ceramides are accumulating in a cell and when insulin comes to the cell to try to tell the cell to do something, then it gets disrupted. Ceramide blocks that effect.

What’s important about insulin resistance is that it’s a problem with two aspects to it. On one hand, we have insulin resistance like we classically think of, which is a cell that isn’t responding well to insulin. Not all cells experienced that. Only some cells become resistant to insulin. Now we may think, “That’s a good thing.” It’s not great in light of the second part of insulin resistance, which is that insulin levels are higher in the blood.

There is no such thing as insulin resistance without elevated blood insulin levels. Now that becomes a problem with the few cells that still respond well to insulin. The insulin is telling them to do too much. A perfect example of that is infertility. In women, the most common form of infertility is polycystic ovary syndrome, PCOS. Her ovaries respond perfectly well to insulin but there’s too much insulin in the body when the body’s insulin resistant. High levels of insulin will inhibit the ovaries’ ability to convert androgens into estrogens. All estrogens were once androgens.

It all comes from testosterone in men and women. Ovaries convert that much more rapidly than testes do, of course. Insulin blocks that process. Her ovaries are trying to take all this testosterone but can’t turn it into estrogens. The testosterone ends up being higher in her body and her estrogen is too low. Now she doesn’t ovulate. Insulin resistance is a coin with two sides. Some cells aren’t responding well to insulin but it’s also hyperinsulinemia or chronically elevated insulin in the blood.

You wrote a book, Why We Get Sick. I always find it interesting when we isolate everything. With lifestyle, it’s like, “My relationship has nothing to do with my health or how I sleep or because I work fifteen-hour days.” The information is all out there talking about holistic. People want to gag when they hear the word holistic. The fact is it’s all connected.

[bctt tweet=”One of my great focuses as a human being is this constant desire to check my addictions.”]

The thing you talk about is this may show up as diabetes too but it also could be infertility. I’m going to go on a limb and say I’m sure there are certain cancers and things like that. People think these are all separate lanes. Maybe it shows up one way for me and a different way for you. For me, this is important for people to pay attention to.

Imagine the things that we can be in charge of. I’ve heard you say that more than 80% of some of the health issues that we have are probably avoidable. It’s overwhelming. When you get stuck behind that eight ball, the insulin stays high. Now you’re not sleeping and then you’re overeating. All of these things can be a byproduct of this.

I want to remind people that sometimes these small little steps and changes can either help you back away from something or avoid something. There’s inevitably somebody reading this who’s wearing a glucose monitor. It would be great if you could break it down for us. Because your glucose goes back down, it doesn’t necessarily mean that the insulin has caught up with that process.

You touched on many relevant points here. Before I go about the systemic consequences a little more of insulin resistance, it is important to understand that insulin and glucose are not the same things. It’s obvious when we say that. Everyone will roll their eyes. Of course, we know they’re not the same thing. One is a nutrient, glucose. One is a hormone, insulin. They’re not the same. People conflate the two because controlling glucose is insulin’s most famous effect. We’ve conflated the two.

Unfortunately, the reason it’s often not diagnosed or rather misdiagnosed is that we are looking at the wrong marker. Our obsession with glucose is not to say that it doesn’t have value and certainly a CGM, a Continuous Glucose Monitor has value. It can correct behaviors and help people understand what’s going on and when it’s going on.

We have looked at metabolic health through a glucose-centric lens for centuries. It was only within the last decades that we’ve been able to measure insulin and even know what insulin is. The focus is slowly shifting as it should. The problem with us only looking at glucose is that while someone’s becoming more and more insulin resistant over the years, insulin is going higher and higher. It’s enough to keep the glucose in check. That process is still working pretty well.

It’s during this phase of normal glucose but elevated insulin that a lot of other problems can start to happen. They develop hypertension. Almost every case of hypertension is a result of insulin resistance, which is why you fix the insulin resistance, and the blood pressure drops quickly. People have to get off their blood pressure medications in 2 or 3 days. It’s such a rapid effect.

Imagine someone opens up their medicine cabinet every morning, they take their diabetes pill, they take their infertility pill, and they take a pill for their migraines perhaps. They may look at these as three unrelated problems. They say, “These are three distinct problems and they have nothing in common.” Yet they do. That was certainly a point I wanted to make in my book. It was to help people understand that while, yes, every disease has its own individual inputs or causes. Every chronic disease does have at least one thing in common.

I’m not saying it’s the only variable that matters. If we can know that there’s one common variable across all three of those diseases I mentioned, diabetes, infertility, or migraines. Rather than treating them separately with three pills that have side effects that you may not want, you would start to ask yourself, “Maybe I should improve my insulin resistance.” That will start to resolve those three problems.

That paradigm that is glucose-centric makes us miss the mark. If we could shift our view to insulin and track a patient’s insulin levels over the years, we could detect the problem ten years or even more before the glucose ever changes. Because we’re only looking at glucose, they may have already developed three other so-called chronic diseases before the glucose ever starts to change if it ever changes at all.

If we shifted the paradigm to look at insulin instead and then have a strategy based on lowering insulin through lifestyle management, then not only can we detect the problem in its earliest stages but then we can also treat it better. It’s an insulin problem, it’s not a glucose problem. Rather than trying to ignore the insulin or even pushing it higher to try to control glucose, we focus all efforts on lowering insulin.

That paradigm is relevant because, in type 2 diabetes, that’s when the insulin has been elevated and they’re still insulin resistant. Now they can’t control their glucose very well even though there’s a lot of insulin in their body in type 2 diabetes. Some clinical view, the prevalent one, is that we have to lower the glucose at all costs. Let’s push the glucose down by giving them even more insulin, by giving type 2 diabetic insulin therapy or insulin treatments.

Now they’re giving themselves insulin shots every day pushing the already high insulin to even higher levels. The more aggressively a type 2 diabetic uses insulin to control glucose, even though they may have perfect glucose levels, it increases their risk of dying from heart disease by three times. They increase the risk of dying from cancer by double. All while maintaining a good glucose level. These are not glucose problems, they are insulin problems but we’re not looking at the right marker.

I’m always fascinated when people have information and they see us doing the same behaviors over and over. I know there’s a system in place. It’s like, “Don’t take that vitamin. Why don’t you take this pill instead?” I get the whole business around it. We know that and we see that in insurance, pharma, and all of it. I’m interested in reminding people and empowering them to take charge.

I also want to say that I learned something interesting in doing some research around this where you say migraines can also be a byproduct. I’ve never heard that before. If you have high blood pressure and a bit of belly fat, that is a strong indication that you are moving in or are in the zone of being insulin resistant. I want to bring that out because I’ve heard the one but I certainly never heard about the migraines. You are clear in the book, Why We Get Sick. By the way, I want to encourage people because you do even have quizzes in the book. People can go in there and do self-exploration.

It’s the professor in me, Gabby. I couldn’t help it. I needed a pop quiz.

It’s awesome. With no wrong answer, that’s my kind of quiz. It’s like, “Everybody, prioritize protein and healthy fat.” I’ve talked about this. I can imagine how much you’ve talked about it. I respect someone’s path if they’re vegan or vegetarian. It’s not my path. Even within there, how do you get that protein and things like that?

It’s out there. We’ve all heard it. Maybe we could take a look at a plate and say, “This is what we mean.” Also, discuss some of the oils. I don’t think that we think there’s such a culprit. We’ve accepted that sugar is. Somehow, we haven’t gotten our heads around how dangerous the oils are. When you say focusing on muscle, focusing on protein, and healthy fats, in your own life, what does that look like?

Dr. Benjamin Bikman caption 2

Dr. Benjamin Bikman – We should be responsible for what’s being eaten in the home and when to some degree. We’re the ones doing the grocery shopping so we need to take that seriously.

It’s great. This helps people start to formulate a resolution. So far, when they hear us talking about these things, it’s a bit of a dreading horror story. If it’s a horror story, it’s at least one with a happy ending because it is responsive to lifestyle changes, particularly food. Food is the elephant in the room. What we eat and how frequently we eat are massively important. Of course, we’ve got it all wrong.

You pointed out sugar. Refined starches and sugars are heavily problematic because the moment those get into the bloodstream, insulin levels will skyrocket to ten times what they would have been a moment before. They’ll stay elevated for up to four hours depending on how insulin sensitive the person is. By then, they’re already putting something back in the system to spike it back up again. Refined starches are clearly a problem.

My basic rule on that is if the carbohydrates come from a bag or a box with a barcode, be careful with it. Whole fruits and vegetables, eat them and enjoy them. Don’t drink them, eat them, and enjoy them. That’s the way to do that one. Prioritized protein is my second rule. Probably like you, I’m very much an advocate of animal protein.

Because I’m a scientist and I know the data very well that shows, by every metric, animal protein is superior to plant protein. We absorb it better and it has a better amino acid profile and it has less metals in it. It’s one of the inconvenient truths that a lot of plant proteins have high levels of lead and arsenic. We artificially make a plant give us protein. It’s such a poor protein source that we end up getting stuff we don’t want. I understand like you that some people will make that choice for other non-health reasons perhaps and you can argue with that.

The next one in my rules is don’t fear fat. We have had such a fat-phobic culture ever since around the ‘60s or so. It’s only grown and it has worked. If you look at dietary patterns in the United States, our consumption of saturated fats from any source but from beef and dairy has plummeted over the last 200 years but especially over the last 50 years. The war on saturated fat has grown. Now the war on meat is continuing to grow and you see that everywhere.

Our consumption of beef has plummeted and saturated fats in general. At the same time, you look at the consumption of soybean oil in particular, which is the primary seed oil of these refined oils and now pervade our diet. That went from nothing 100 years ago to being the single most commonly consumed source of fat in the human diet. We get more of our fat from soybean oil than any other source of fat.

I invite anyone that the next time they go buy something, a product at a store, turn it around, and look at the ingredients. If it has any fat in it at all, I almost guarantee it’s going to be one of these refined seed oils or the so-called vegetable oils. There’s nothing vegetable about them, they’re seeds. Because it’s difficult to extract oil from seeds, it’s a chemically heavy process that puts chemicals in there that we don’t want.

By their very nature, these oils are susceptible to a process called peroxidation. I’m getting ahead of myself. Turn it around, look at the label, and it will have soybean oil, corn oil, canola oil, or some other form of refined seed oil. These seed oils are problematic among many problems and there are a lot of them. I focus more on the metabolic side rather than the cardiovascular or the cancer side. There are concerns in all of those areas.

On the metabolic side, as these fats accumulate in fat cells, and they do readily, they force the fat cells to grow through hypertrophy. Back to that point of origin problem. The more fat cells grow through hypertrophy, the more problematic it becomes metabolically. These seed oils are uniquely problematic to the fat cell and to many other things like heart disease and cancers for reasons that I won’t get into. They’re abundant. They’re ubiquitous. The only way to start cutting back on seed oil is to stop eating processed foods. If you’re not eating processed food, you’ve essentially eliminated these from the diet.

If you go to a restaurant, they’re not cooking with high quality, even fancy restaurants. The other part of this is you don’t want to make it overwhelming for people that you’re like, “I’m going to push the entire message out because it’s too overwhelming. I’ll never be able to have fun. I’ll never be able to go out and eat with my friends.” You can control it. Make your salad dressing at home. If you do eat a salad out, ask for olive oil on the side. Even though some of those are mixed with other oils, that’s the way it is because it’s cheaper. I have a quick question, how do we feel about pumpkin seed oil or Pepito’s walnut? Are those okay?

In general, seed oil is going to be a concern. I don’t know the fatty acid profile of pumpkin oil. The fatty acid molecule of concern is a molecule called linoleic acid. It’s that particular fat that gets converted to these more harmful peroxides that will be problematic not only in the fat cell but in other cells in other processes. Nut oils tend to have lower levels of linoleic acid. Even though they will have other unsaturated or polyunsaturated fats, it’s lower in that linoleic acid than the seed oils per se.

Pumpkin seed, I don’t know. I’ve never seen the fatty acid profile. Anyone could do their own brief homework. Open up a web browser and type in pumpkin oil fatty acid profile and I bet you’d find a list of it. Linoleic acid fat is a fat that would maybe identify as 18:2. If it’s 18:2, that’s the fat you want to be careful with and you want it to be as low a level generally as possible.

Coconut oil, what is that if I looked it up?

Coconut oil is dynamite. Coconut oil is almost totally saturated fat. Historically, people would say, “Never eat coconut oil.” It’s almost totally saturated and then they’ll say you’ll die from heart disease. There’s never a single paper that’s been published to show that. Indeed, in contrast, there are papers to show that by deliberately including coconut oil in people’s diets and not changing anything else, they will lose more weight and their lipid profile will get better.

There’s a study going on in Malaysia looking at the effects of coconut oil as antiviral therapy. The main fat in coconut oil is a unique fat. It’s a twelve-carbon saturated fat. It’s a medium-chain triglyceride. The interesting thing about the medium-chain fats that you get from coconut or goat dairy, any goat products are enriched with medium-chain fats. The body has almost no capacity to store them.

We can’t absorb it.

It gets into the blood but you can’t store it. You can only burn it. The body is forced to burn these fats so they become more ketogenic, which makes them therapeutic for Alzheimer’s disease but I won’t get into that yet. It’s antiviral. That twelve-carbon called lauric acid is known to kill viruses. It may have an antiviral therapeutic role as well. I’m a huge advocate of coconut oil. Lest anyone get confused, the seed oils are not the same as the fruit oils or fruit fats.

I’m a great defender of natural or ancestral fats, the fats that we’ve been eating for millennia. That is, of course, animal fats. We’ve been eating animals forever. The second is fruit fats. That is when our ancestors simply would have needed to get the flesh of the fruit, namely the coconut, the olive, or the avocado. Not from the seed or pit of it if there was one there at all but rather the flesh of the fruit and press it. You press it and now you have oil. We’re well-adjusted. Those are a healthy profile of fats and we should eat them liberally. It’s the seed oils that are problematic. It’s not the same as fruit fats.

The thing is by avoiding the fats in our diet, we’re never satisfied and it usually probably leads to overeating. The other part of the fat is you do get satisfied, you feel full, your brain is fed, and then you move on. You have that different steady energy. I want to talk about this. You talk about starting your day with a certain amount of protein. Is it 30 grams? Is it something like that?

[bctt tweet=”From the age of around 20 to around 65, metabolism stays flat across the board. The metabolic rate does not change.”]

Personally, I do caffeine with fat in it. I won’t eat till lunch. I have a million questions within this question. I’ll do one at a time. For women, I’m learning that fasting isn’t maybe quite as great for us as it is for you, especially if you’re a high-performance and active woman. It’s not the best. Also, we need to consume more protein across the board anyway. Do you find at least in what you’ve been noticing that that is consistent? I’m not talking about fasting for either weight management or whatever.

I was talking to a friend of mine and the other thing is that fasting as an interesting tool is pulling in the reins. Do you know how you can get loosey-goosey sometimes? All of a sudden, you’re like, “I’m over here.” Maybe using fasting is like, “I’m using this to tighten up and get everything back in.” That’s cool. In general, if you ate three conscious meals, are we seeing that women need more protein? Also, maybe it is a different situation for men and women with fasting.

First of all, let me preface this by saying I agree completely. Your sentiment was perfectly expressed. You said fasting is a good way to check yourself. To me, that is one of the true values of fasting beyond any metabolic or cardio-metabolic effect. One of my great focuses as a human being is this constant desire to check my addictions. It’s to be able to recalibrate almost daily and say, “What habits am I starting to engage in that are going to get harder and harder or more and more destructive for me if I don’t turn them back?”

When it comes to diet, in that regard, fasting even benefits beyond food. There’s a true soul benefit. I’m a religious guy unapologetically. I believe we have spirits or a part of us that goes beyond the mass of cells that we are. Maybe that’s the best way to say it. There’s something more to humans than just the lump of cells that we are.

Maybe it’s our self-awareness or whatever it may be. Fasting allows us to snap it all back into focus to a degree where we can check our trend or tendency towards potentially destructive habits. I know, for certain, when I’m fasting, I am a much more patient father. I can say that definitively. When I am fasted, I’m much calmer. With my kids, I am much slower to react in anger. I’m much more even-tempered, which goes beyond the metabolic.

I’m like a psycho.

My wife’s the same way.

I tell my kids, “You want something? You have food right now. You have some food to offer me right now?”

With an offering for mommy or get the hell away.


That’s how my wife is. Fasting is our culture. She will say I’m not fasting. I’ll fast easily, it’s no problem. That almost comes to your second part of this, which is the difference between men and women. I’m delicate in answering this question because I know there’s a lot of enthusiasm for the topic. I am only aware of one study in humans that has looked at the effect of fasting between men and women and found a difference between them. I’m only aware of one study. If anyone knows of others that I don’t know, I would love to know. Find me on social media and share it with me.

This one study did find that women in the first 6, 8, or something like that of a 24-hour fast had a relatively greater increase in cortisol than men do and men had none. Cortisol is a stress hormone. That’s problematic. A few hours later, it went to normal and then stayed normal for the remainder of the fast.

This isn’t to say that there are no differences in the response. This is something that people don’t like to hear nowadays although I suspect your audience will be fine with it. There are profound differences between men and women that extend throughout the entire body. As a cell biologist, I have to simply admit that’s the case. I’m not a sociologist so I can say these things that are based in reality. With fasting, there is a known alteration.

From that one study, at least, which is the only one I’m aware of, it ends up settling back down. Fasting can be therapeutic for women, I know that it can be because I’ve seen the metabolic benefits of it. I also acknowledge that everyone’s an individual. We know for a fact that there is a heightened stress response if we want to call it that midway through fast. We know there’s a difference between men and women, they do respond differently.

Thus, I would never tell a gal, “It’s all the same.” It’s not. I wouldn’t want a gal to hear that and use that as justification to never fast because it can be healthy. I fear sometimes that the difference between the sexes in this regard will enable an excuse. I don’t quite think it should be used as an excuse. We acknowledge the difference but I still think there’s value in doing it. Maybe less frequently, maybe not as long certainly but don’t say no completely.

I appreciate the extra point of view beyond checking yourself. We are obsessed with food, I can speak to it. It’s like, “What am I going to eat? What did they eat?” When we take that off the table and we quiet that down, to your point, we get a deeper check-in with ourselves and with everything and everyone around us. There’s something to be said for stepping back from these things. It’s not that they’re mindless but we need to eat. There is an entertainment element. There’s an indulgence element. It’s like being still, which is one of the hardest things there is. I genuinely appreciate that.

Can we slide over to two other things? I want to take advantage of your expertise. We hear about ketosis and autophagy. When is it happening? You want to get there. You don’t want to be there all the time. Adaptability, being able to burn most things for fuel, and being able to access and burn fat as fuel is important. Being able to not just be in ketosis all the time seems unrealistic. Can you explain exactly what is ketosis and, in your opinion, the best way to approach what that looks like if you’re not getting ready to train for a 100-mile run or you’re trying to lose 50 pounds let’s say?

I’m thrilled that you brought this up because I can speak with a fair degree of authority on the topic. I’m glad for people to hear it from a self-proclaimed authority because there’s so much wrong thinking. As I answer this question, I don’t want someone to look at me as a table-pounding advocate of a ketogenic diet or ketosis in general. I will defend it because there are so many who attack it without knowing the details behind it. There are many myths around it.

A ketone, to explain it up front, is essentially a piece of fat that’s gone partway through this process of getting burned. To back up even one more step, the human body is a metabolic hybrid. At any moment, we have two primary fuels that we’re shifting between. We are burning blood sugar or we’re sugar burning, glucose, or we’re fat burning. It’s a mix of those two fuels at any moment.

The singular variable that dictates which fuel is being used is insulin. There’s no other way to explain it. We could try to explain it in other ways like I’m working out or I am sleeping or I’m eating. In the end, it still comes back to insulin. Insulin dictates which fuel is being used. If insulin is elevated, the body’s in sugar-burning mode.

If insulin is down, the body shifts to fat burning. If we stay at that point for about 12 to 16 hours with low insulin, the liver mainly, at this point, is burning so much fat that it can’t stop burning fat because insulin is low. Insulin dictates fuel use throughout the entire body. Insulin tells the cells of the body what to do with the energy that it has. That’s one reason why a fat cell cannot grow without elevated insulin, it simply doesn’t know what to do with the energy.

Dr. Benjamin Bikman caption 3

Dr. Benjamin Bikman – One bad night of sleep is enough to so substantially increase your stress hormones the next day that you’re demonstrably insulin resistant that next day. Thankfully, a good night of sleep will wipe it out and get back to normal.

Back to the liver. If insulin has been low for about 12 to 16 hours, the liver cell has continued to burn so much fat that it has reached the point where it’s burning more fat than it needs to burn for its own energy. This excess fat burning is what turns into ketones. A ketone is simply the fat that’s been burning and then the liver cell says, “I can’t stop breaking down fat but I no longer need it for my own energy. I’m going to dump this molecule now out into the bloodstream.”

Thankfully, the body will use ketones greedily, especially the brain. The moment ketones hit the bloodstream, the brain starts consuming them higher than any other organ in the entire body. My lab has published work on this topic. From human brain tissue from people who died, these were tissue donors. Studying the brains of people who died with Alzheimer’s disease and without, I can say this with absolute authority, the brain loves ketones. The problem with Alzheimer’s is the brain becomes all the more desperate.

The problem with these neurological disorders like migraines, Alzheimer’s, and epilepsy is that the brain can’t get enough energy from glucose. If it has ketones, the problem goes away. Epilepsy will stop completely and maybe never have another seizure. The migraines will stop and they may never have another migraine as long as they have ketones in the blood. In Alzheimer’s disease, you can’t reverse it but you improve it in real-time.

In real-time, you have them do a cognitive test. Give them some ketones to drink or something and then you have them do the test again and they immediately score better on every metric. They can speak better. They can get themselves dressed a little better. They can perform some other cognitive tests better. A ketone is simply a piece of fat that was burned by the liver and now the liver has so much that it now starts sharing it with the body and then the rest of the body starts using it as fuel. Happily, there’s no problem with using ketones.

The power of a ketogenic diet depends on the context. For example, if someone is overweight and they have type 2 diabetes, the value of a low-carb diet where it’s lowered insulin enough that is now ketogenic, it’s not necessarily in the ketones itself. The value of a ketogenic diet in the context of being overweight and diabetic is that you lower your insulin a lot.

If someone’s measuring their ketones and they detect ketones, they know for certain that their insulin is low. Also, they know that they’re burning fat like gangbusters. You cannot make ketones unless you’re burning fat at a high rate. It is proof positive. They know they’re going to be losing weight and they know they’re going to be becoming more insulin sensitive.

Clinical study after clinical trial has proven that a ketogenic diet in humans will improve insulin sensitivity vastly superior to a low-fat diet, which is the prevailing paradigm. It is incredibly effective. If we shift the clinical context away from overweight, diabetic, or migraines to Alzheimer’s disease, then the value is in fact in the ketone itself. Yes, you’re improving insulin sensitivity, which will help the brain get more energy from glucose because it’s not able to use glucose well when it becomes insulin resistant. At the same time, you’re giving it this backup fuel, the ketones.

When we start to fast, Gabby, most people have this myth that the brain prefers glucose. You must eat 120 grams of glucose per day because all that is what you need to fuel the brain. That is silly. It’s such a silly idea. Yet, I have colleagues who continue to press this ridiculous notion. We know that after about a 24-hour fast that the brain is getting about 70% of its energy from ketones. Well over half, 3/4 of its energy is coming from ketones and it shifts readily.

If we measure the level of ketones compared to glucose in the blood, maybe ketones get to around 1 or 2 millimolar. Whereas glucose is about five millimolar. We may have 5 to 2 times as much glucose in the blood. Even still, the brain has shifted to us about 3 to 1 of its energy from the ketones even though it’s less than the glucose that it has access to. If the brain prefers any fuel, it prefers ketones.

You talk about how greedy the brain is. Even when we’re sleeping, it is demanding.

It is one of the high metabolic rate organs. There’s a trifecta, a trinity of high metabolic rate organs. The kidneys blow everything out of the water. The kidneys are a ten times higher metabolic rate than anything. They are busy. They do so much every moment. It’s the brain and then it’s the heart, those are the tissues that you don’t turn off. Of course, if we get up and exercise, the muscles skyrocket and that’s an X factor there. In a rested state, muscles are low. The brain is a high metabolic rate organ. It is always hungry.

I’m a believer in eating food and doing the right things. Trying first to do it through food. Do you know how they have these ketone drinks now? There are certain brands. I don’t drink alcohol. The only way to do it is in a shot because they don’t taste great.

It tastes like rocket fuel.

Let’s say someone’s being pretty sensible about their food and trying to do the right things. Would there be a benefit to doing a shot of that?

I don’t believe there’s a metabolic benefit. If someone’s going to do it for weight loss or improving their diabetes, I would say it’s not worth the cost. However, if they have a cognitive impairment like early Alzheimer’s or full-blown Alzheimer’s, I would say it’s absolutely worth the cost. For migraines or epilepsy, where the ketone is a therapeutic molecule in their blood, then I would say absolutely. If you take a shot of that, it would be worth the expense. In the other instances where the ketone is a secondary benefit to overall lowering insulin through diet, I would say it’s not as worth it.

Let’s talk about autophagy because everyone wants to get into that. I have a pretty informed audience. In the simplest way, you’re having this opportunity to scrub all your nonworking or dirty cells and getting on with it. How long does it take to get into autophagy? It takes a bit, doesn’t it?

Gabby, what a delightful question because I love bursting bubbles. Maybe because I’m a cranky old bugger at my core. Let me preface this by saying it appears that if someone can be experiencing the majority of the day in a state of autophagy, that will promote longevity. I can say that because there are animal models, insects, and other experimental models that we can use in a lab that have confirmed that phenomenon. It’s not too much of a stretch to translate that and assume it applies to humans too.

I wouldn’t begrudge anyone making that and I would agree with it. Activating autophagy is probably a good way to delay chronic disease and stay healthy longer but we have zero way of measuring autophagy. In a clinical typical case, you cannot measure it. Having said that, lest everyone gets discouraged. Everyone, laugh at me for a second because I’m the guy with the hammer and I see this nail of insulin is everywhere. Insulin controls autophagy.

Gabby, I bet your audience, being as informed as they are, have heard about mTOR and a fasting-mimicking diet that’s become popular. That idea is based on autophagy and it’s based on the fact that when the intracellular protein mTOR is turned on, it turns off autophagy. If you can turn down mTOR, autophagy is turned on. Generally, you’ll have overall better health and presumably, you will age better. Presumably, because we’ve never shown this in humans.

[bctt tweet=”It is important to understand that insulin and glucose are not the same things. People conflate the two because controlling glucose is insulin’s most famous effect. “]

I would agree with that view. If we can spend most of our time in a state where mTOR is turned down and hen autophagy is higher, that’s probably beneficial. That has led people to take this wrong step into saying, “That’s why we should avoid protein.” To me, the moment they say that, the record player scratches. Why did you go that way with it? Why vilify protein?

You can take the most mTOR-activating amino acids like leucine. Leucine is the most anabolic mTOR-activating amino acid. If you compare it to insulin, insulin will activate mTOR much higher than leucine will. Insulin will stick around a lot longer in the bloodstream than leucine will. If it’s a 1-to-1 direct effect, insulin spikes mTOR more but then it turns it on for longer. If we were to take a load of Leucine, which can be beneficial for muscle growth after workouts, the leucine comes up and down in the blood in about 45 minutes. It’s on and it’s off. It’s up and it’s down.

If you eat a starch that’s going to spike your insulin, your insulin is going to be high for 3 to 4 hours depending on how healthy you are. That’s a lot of mTOR activation that we probably didn’t want perhaps with regard to longevity and autophagy. As much as people have a part of the story right, which is autophagy is probably good in humans probably. It’s probably healthy to keep mTOR turned down. Not all the time. Otherwise, you’d never have any growth of tissue and muscle and bone. It would all shrink away and waste away. We need mTOR to be on and off at certain times.

I would say, the majority of the time, keep it turned low. How do we keep it turn low? Avoiding protein to me is a silly way of doing it and it comes at a cost. The same people who advocate these low protein diets to live longer, their own data has found that over the age of 65, the people that eat the least amount of protein have the highest mortality. That doesn’t work with the paradigm. If we have to keep protein low to age well, then why did the oldest among us die the most as they start cutting protein? It’s because the whole paradigm, in my view, is built on a false idea.

The problem isn’t protein, the problem is insulin. That is why insulin resistance, across every animal or insect model if you turn down the insulin, the animal will live longer. In humans where we can’t measure people for their whole lives, we know that one of the most consistent features across what is called familial longevity. Grandma and grandpa lived long, mom and dad lived long, and the children lived long. The most common feature is that they’re all insulin sensitive. If you’re insulin sensitive, your insulin levels are low. In this particular case, that means mTOR is turned off more than it’s turned on. Theoretically, there would be more autophagy.

For example, if someone measures their ketones every morning and finds that they’re in at least a mild state of ketosis, even if they then go on to eat. Gabby, in the morning, depending on what you ate that day before, let’s assume you had a mixed macronutrient meal at around 6:00 and you had carbs, fats, and proteins in it but otherwise had eaten well the whole day. By the time you wake up and you’re sipping your buttered coffee or whatever it may be, you would be in a state of ketosis. In my mind, that is proof that you’re in a state of autophagy.

While you cannot measure direct autophagy, if you have a modest amount of ketones in the blood, that means you have had low insulin. Insulin is a great inhibitor of autophagy. You’ve removed that great inhibitor. I don’t think it’s too much of an assumption to conclude that you have had some autophagy going on in that period of time.

Dr. Bikman, I want to ask you and then I want to move to the plate itself. I’ve had the good fortune coming from athletics and it parlayed and then you go, “You got momentum.” I live with a person who’s conscious. I’ve had it easier. Let’s say someone didn’t inherit good lifestyle habits maybe your children are going to get from you. They go into young adulthood. They go to college, they study, they eat fast food at college, and now they’re out in the working world if they’re fortunate and they’re not stuck at home.

It’s like the student that comes back ten years later. Someone goes, “This feels overwhelming. I don’t know a starting point. The doctors already told me I’m going to be n medication.” For the most part, can we unravel slowly different lifestyle changes if we’ve got the patience and the strategy? It’s not just about having the information, you have to have the practice and strategy in place. For you, what have you seen? I want to remind people because they do get overwhelmed so then they quit before they start.

It’s a combination of wrong information and that then translates into wrong habits. I appreciate you mentioning my kids. It’s very much important to me, especially since my oldest daughter is getting into high school. For her, adolescence is in full swing and she only has a couple more years of it. That’s an important time. If a person can get through adolescence with a generally metabolically sound body, it’s much more likely they’re going to keep that for the rest of their lives.

Adolescence is a critical time and so it behooves us, parents, to take it seriously on behalf of our kids. Not that we can control all their habits. Believe me, I’m acutely aware of that. We should be responsible for what’s being eaten in the home and when to some degree. We’re the ones doing the grocery shopping so we need to take that seriously.

Check our own behaviors and understand that our kids are going to see what we’re doing. They’re going to eat what and how we’re eating. We need to model the behaviors we want in that regard and in every other regard too. I very much appreciate the way you frame this. The ideas that I’ve presented are simple but implementing them is anything but. When we start dealing with habits and, dare I say, addictions, it becomes tricky. We need a support group. We need to have a clear strategy.

For me, in my home, the way I frame the conversation is because I’m mindful of my daughters and, as a college professor, I’m mindful of the trend for young women to develop eating disorders, it worries me a lot. I don’t want my kids to ever hear me talking about food in a heavily restrictive way. Lest it ends up working against them and me. I always focus on what I want them to eat rather than scolding them for eating something else. We have indulgent foods in the home, maybe not as much as others. We have it though. We have chips, for example.

Which ones do you do?

It’s random ones.

There are a few that do avocado, coconut, or whatever. My youngest daughter is probably the age of your oldest. I agree with this because what I have found is to be a good example, cook at home. I have girls that are like, “You want to eat Chick-fil-A? Knock yourself out.” By the way, it’s two bites in and they never finish anything. They get through it.

Something happens also. It’s almost a social currency with young people. When they’re little, it’s candy. When they’re older, it’s weird, fast foodie things that it’s like, “Get through that.” You have no food taboo. I have seen it work on my other two where I believe you’re having that at your house. You have to be so careful with the girls too because you can’t be like, “You know what that’s going to do to you.” I appreciate that.

People have to understand this isn’t about being like, “We don’t eat this.” We choose to eat this over here. I’ve said this a lot. I taught my kids early what’s food and what’s fun. You got to know the difference when you’re eating. You talk about the misinformation and people think, “I’m eating this microwaved organic food that is good for me.” Then they don’t realize there’s no nutrition in it and it has vegetable oil or whatever.

If someone’s down though, they’re at the starting point, we’re going to say to them, “You got to walk and you got to start to move your body. We’re not even gonna go there.” Those fat cells that now have crowded themselves away and are offloading the insulin now and it’s moving to these other places, is there a way that there is an opportunity truly to march that back?

Dr. Benjamin Bikman caption 4

Dr. Benjamin Bikman – Refined starches and sugars are heavily problematic because the moment those get into the bloodstream, insulin levels will skyrocket to ten times what they would have been a moment before.

Absolutely. I fear that most people, due to wrong ideas, end up adopting the wrong strategies. There are two ways to improve insulin resistance, one is low energy. You simply start putting less energy into the body. Because fat cells are filled with energy, its calories, the less energy is coming in, the more the fat cell is mustering because the body has to get access to that energy. That’s all fat cells are, it’s stored energy.

The other strategy, and I’m going to talk about both of them, is low insulin. They’re not the same even though low insulin will go with low energy. The problem with the low-energy view is if a person is looking at their insulin-sensitizing better metabolic health journey, if they start their first step with a low-energy or low-calorie step, they’re going to be hungry. They immediately start working against their own hunger.

Some people who have a natural discipline can do it. Some people can do it. They can go on that low-fat diet, eat a portion of their food, and then push the rest away. There are those people who have that uncanny discipline. I am not one of those people. My wife is but I’m not. I don’t think most people are either. Most people, if they start their journey in this deprivation hunger state, hunger will always win.

That’s why you never see a reunion tour from that TV show The Biggest Loser because they lose such a fantastic amount of fat through such deprivation. They are so hungry, they’re exercising so much, and then it breaks. They snap and they gain it all back so you never hear from them again. The low energy step, not that it doesn’t have value, works for a time but they usually will step back and then even maybe further back. Not that it doesn’t have value, it does, but one that we come back to.

The first step should be they tell themselves, “My poor metabolic health or other problems that don’t seem to be metabolically related, my infertility, or my blood pressure is probably a result of chronically elevated insulin and insulin resistance. My first step is going to be lowering my insulin.” They do that best with my first cardinal rule, control carbohydrates. Focus on whole fruits and vegetables. You don’t even need to count them. At least at the first step, that first low insulin step, stop getting refined starches and sugars. Eat as much protein and good natural fats from animals and food sources as you want.

Anytime you’re hungry, eat if it’s following those rules. Control carbs, prioritize protein, and don’t feel fat. Eat when you’re hungry. If you’re not hungry, don’t eat. That becomes easier and easier. If the first step is I’m going to lower my insulin, the value of that is when insulin comes down, the body starts to shift from sugar burning to fat burning. As it shifts to fat burning, it needs to start breaking down its own stored fat for fuel.

That is important because the brain has no capacity to store its own energy unlike the liver, the muscle, and fat cells. All of those big busy tissues have a lot of energy stored in them. If we stop eating immediately, they would have plenty of energy and they’re fine. The brain has no capacity to store energy. If it sensed that energy in the blood is starting to drop, it will tell the body, “We need to eat because I’m sensing a reduction in energy.”

As a person, if they jump full-in into low energy, they run the risk of putting their brain working against them as they get hungry. If the first step is low insulin, they’re burning fat, they’re making ketones, and the brain has all the energy it needs, and they’re not hungry as often. As they’re becoming more insulin sensitive and they’re becoming used to using their own stored energy for fuel, now they’re in a better position to take that next step, which is a lower energy step.

The first step is if you’re hungry, eat but focus on proteins and fats and control your carbs carefully. Not even that you need to count them. Focus on fruits and vegetables in a whole form, don’t drink them. Once you’ve adapted to that first step, after a few weeks, you’re in a good position to say, “I’m not as hungry as often as I used to be because I’m burning my own fat for fuel. I’m going to start fasting.”

Gabby, maybe they adopt that strategy that you have and I have a very similar one. I find that it is effortless to fast through breakfast. They may start to say that rather than eating three square meals, they may say, “I’m going to pick a meal on one end of the day.” Cutting out dinner, of course, I don’t advocate it because I’m such a family guy. I believe there’s such value to social interaction. It’s weird if you’re the only person who’s not eating with everybody else. Anyway, however they do it, they will take that next step.

You like cutting dinner at least 3 or 4 hours before you go to bed. I want to bring that up. You are a big advocate of do not eat 3 or 4 hours before bed. Let’s say someone’s a couple and they don’t have a bunch of kids yet. I would say cut dinner. Push lunch a little later and cut dinner because that has that other interesting benefit of better sleep.

100%. The evidence is clear. It’s multiple studies now that people who fast through dinner have consistently better metabolic outcomes. It’s socially awkward. You and I, we’re family people. My advice is fast through breakfast, have a big filling lunch, have a more modest dinner, and then you’ve tapered off. After dinner, you grit your teeth and do your best not to eat in the evening so that you can go to bed at a lower calmer metabolic state and you’ll sleep so much better.

I appreciated that. I want to ask one last question and then I want to talk to you also about Gethlth.com. I get a lot of people because I’m middle-aged. It’s hard to get your head around it.

I had my birthday. 45 never looked so good on a freckled, bald, and scrawny dude. I tell myself that, Gabby.

You say how smart you are. You’re like, “But I am smart.”

When I have to convince people of the value of my argument, when you look like this, you got to sound clever.

I’m trying to figure out what my next move is. I’m tall. I can clean the top of the fridge. There are two things. You bring up the lipid panel. There’s a way with your triglycerides and dividing it. I didn’t want to miss this opportunity. Maybe you could inform people. The more people can be specific about what they’re trying to ask for, it’s helpful.

If anyone leaves this conversation with an appreciation of insulin resistance and that it matters and then you want to know where you are, you get your blood test. Ideally, I would say there are two things you could measure. One is to try to convince your physician or your clinic to measure your insulin. Get your fasting insulin measured.

If you’re fasting insulin, it’s six micro units per mil. Those are the units. If it’s six or lower, that’s a good sign that you’re insulin sensitive. Like all hormones, insulin has a circadian rhythm to it. It’s possible that you may be insulin sensitive but you get a number that’s a little higher, maybe it’s 10 or 11 but you hit the peak. The second one that you mentioned is all the more relevant. The value of the triglyceride to HDL ratio, triglyceride divided by HDL, is that you’ll always get those numbers.

[bctt tweet=”Animal protein is superior to plant protein. We absorb it better and it has a better amino acid profile and it has less metals in it.”]

If you can’t convince your clinician to measure your insulin or you’ve recently had a blood test, I guarantee you can find your triglycerides and your HDL cholesterol. Take your triglycerides and divide them by your HDL cholesterol. That shifts a little bit across ethnicities but 1.5 is in the middle range. If it’s below about 1.5, that’s a good sign that you’re insulin sensitive and your risk of a heart attack in the near future is low. Of course, if the number is higher than 1.5, that’s not only an indication of insulin resistance but also an increased cardiometabolic or a risk of heart disease.

Thank you. It’s important. Middle age, everybody thinks it’s like a death march and a death sentence for your weight and for all these things. Yes, of course, certain hormones are changing and are different. It’s the accumulation. If we’ve been living this way our adult life and we’re 30 years in, to me, it feels like it’s more about that. Of course, wrinkles are wrinkles and skin is skin and that’s going to do what it does. You talk about this, if we have these other areas of our health in check, even that will age better.

Has anything shown up though that if someone is living a pretty good healthy lifestyle, maybe they’re not on a bunch of medication? They’re not regularly taking aspirin and Advil on a regular basis. It’s not good for you. Is there something that we’re seeing in middle age that you go, “This sometimes shows up.” Women will say, “I’m eating air and I am continuing to gain weight,” and things like that.

Wouldn’t you know it, there are differences between men and women. Let me address one thing at the outset where there isn’t a difference and that is metabolic rate. One of the most common complaints is that we get older, we get middle-aged, and we say, “I gained twenty pounds because my metabolism slowed down.” A gal will say, “I went through menopause and I gained weight because my metabolism slowed down.” That doesn’t happen.

From the age of around 20 to around 65, metabolism stays flat across the board. The metabolic rate does not change. The weight gain that we are experiencing is not because the metabolism has slowed down. I would say there are other variables. It’s likely that insulin is climbing as we’re eating differently and we’re losing muscle mass. we’re losing the most insulin-sensitive tissue in the body, our muscles. It consumes most of our glucose.

Because people have such an aversion to resistance exercise, especially women, unfortunately, don’t want muscle. They’re willing to go on an elliptical for 45 minutes and waste 45 minutes of their life. That’s a little bit of a hot take. It’s not a total waste. It’s good for their heart but they’re certainly doing nothing to improve muscle mass. We need to try to increase our muscle mass and maintain it across both sexes. With women, in particular, hormones matter enormously. Because it’s such a remarkable shift in sex hormones, it’s not surprising that there’s a consequence to this.

Is that what they’re calling it?

I got to be careful, Gabby. I once spoke about this on Instagram real and I had these ladies who were angry. I had the goal to talk about women going through changes and I’m like, “I’m not a woman. I’m not pretending to be but I’m familiar with the subject.”

You are a scientist. I’m going to get off topic quickly for a second. Laird is a surfer. He spent his whole life in the ocean. He made a comment and someone goes, “Sharks, are there ways to avoid them?” He goes, “This and that.” Also, if you’re a woman and if you’re on your cycle, that’d be a good time not to maybe go in the water because they have senses on their skin, sharks do, that sense per million drops of water. They sense the blood molecule. People were pissed.

“How dare you?” It’s unfortunate.

I don’t want you to dance around it. It is what it is. It is a big shift and it’s awesome. It’s all amazing. The fact that we have these seasons and times and all of these amazing things should be celebrated. How do we navigate it easier? Let’s say we’re having this astonishing shift.

I said remarkable.

I have other words for it.

Whatever we want to call it, there’s a pretty stark difference. What’s often misunderstood is that estrogens are friendly metabolically. Most people don’t appreciate this. At any given moment, in a man or a woman, the woman’s burning about 40% more fat than the man is by way of the entirety of her energy. Women are fat-burning machines.

The response may be well then why are women fatter than men by design? A woman is supposed to have more fat. It’s because more is going into her fat cells at any moment. Estrogens, in particular, ensure that there’s always a lot coming out. At any moment, there’s 40% more fat coming from her fat cells than there is coming from his fat cells. That is predominantly estrogen-dependent.

Estrogen doesn’t tell the body to store fat, it tells the body where to store it, not how much. That’s why little boys and little girls start to look different. Although we’re trying to muddy those waters nowadays. They look different because of sex hormones. Her estrogens start to tell her body where to store her fat, not how much, but where.

Another sex hormone that becomes shifted with menopause is progesterone. When progesterone spikes, which it isn’t always, during the ovulatory cycle, it does stimulate hunger and fat storage. A woman will be hungry at a time in her cycle. This is well documented. I’m not speaking with firsthand experience.

250 more calories a day should be during that time of her cycle.

Progesterone is primarily driving that because it wants the body to store fat. Progesterone is saying, “You might get pregnant right now.” It is after all the hormone of gestation. It wants the body to start storing fat because mommy bears such a remarkable metabolic burden of childbearing. The husband, of course, has a role but it’s quick and it’s wonderful and then he plays a helpful role later. With mommy, she bears that burden and her body needs to know, “Do I have enough fat to get through this?”

I’m sorry to go on a tangent quickly. People think about the hormone leptin and only think that it has to do with hunger. Leptin is made from fat cells and it starts puberty in children. If there’s no leptin, there is no puberty. Women need more leptin than men do because it’s her brain’s way of saying, “Do we have enough fat to even want to even think about getting pregnant? Once we commit to that, it’s going to be a long metabolic burden of growing this beautiful little baby. We have to grow more tissue.”

The mom has to grow tissue. She has to grow this whole little baby with her own energy. Historically, she has to feed that baby for another year almost. Leptin is the brain’s way of saying, “Do we have enough energy to be fertile?” Because men don’t bear the metabolic burden, they can get to a fantastically low body fat level and still have plenty of leptin for normal sperm production and testosterone production. In a woman, as she starts to get leaner and leaner, even at a modest body fat for a guy, she may start to have too little leptin to have ovulation going and it shuts off. I’ve gone too far off with menopause.

That’s important because it should be celebrated. The system is incredible and the miracle of what it can do. Instead of me saying, “Why isn’t my body fat as low as Lairds?” It’s understanding, “Am I at a healthy place for me?” Teaching our young people this. If a woman is in menopause or she’s already gone through menopause and she is feeling that, “Let’s make sure we’re having enough protein. Grab some weights and bang some iron.”

Dr. Benjamin Bikman Book

Why We Get Sick

People can say whatever they want. You get tired. Maybe you’ve raised some kids and you’ve worked. You sometimes get a little blah. Also, you talked about spiritual practice. It’s also reminding people that it’s all wrapped up. I have to find things to do for fun. I could be working, kids, and then whatever. It’s people realizing that also impacts our waistline. Is there anything else if we want to support her if she’s saying, “How do I get this last little bit off?” Have we missed anything?

In fact, to finish that thought and to come back to the theme of everything I talked about. If you eliminate the sex hormone production from the ovaries or eliminate the ovaries entirely, every animal and every human female will get fatter. The overall net effect of the sex hormones from the ovaries is a beneficial effect. As she loses that protective effect and becomes more susceptible to weight gain due to the loss of those helpful hormones, all the more reason to make sure your insulin is in check.

At that same window of time, something I haven’t talked about at all, in traditional human life, we make fat cells through infancy, childhood, and adolescence. As we end adolescence, the number of fat cells we have is set until around 70 or 75 years old. Not that the fat cells are immortal. That is not true, they’re not. A fat cell is long-lived though. For every ten years, when one fat cell dies, it’s replaced by one fat cell for that 50-year span.

It’s such a remarkable coincidence that as she’s going through menopause, she’s also starting to now lose fat cells. That sounds good and it can be. I’d like to believe, for men and women, when our fat cell number starts to drop, that can be a benefit but it depends on how we leverage it. If we continue to eat the same way we were before the fat cell number was dropping, that means the remaining fat cells now have to carry a bigger burden of energy storage.

If we can couple that period of our lives where our fat cell number starts to cut with leaning into these dietary changes and we have a little more time, life is maybe a little less stressful, the kids are grown, our jobs have slowed down, or whatever, what a perfect opportunity to say, “I’m going to double down and make sure I’m controlling my insulin. As my fat cell number starts to go down, I’m going to make sure the fat cells shrink or stay small so that my metabolic health is going to be better than ever or as good as it’s ever been.” In the midst of frustration, there’s opportunity in both sexes.

You are serious about making protein a priority that you’ve created a company to provide a quick and trustworthy answer for people who either can’t figure out how to get the protein. You have everything else on your plate. How did you come to create Gethlth and offer the products? I’d like to ask you about protein products. We even barely mentioned it here, not drinking our calories, eating our calories, and having things that don’t have fiber. I always encourage people to make sure they’re having fiber. With the protein powders, how did you arrive at filling this gap?

Thanks for pointing it out. As I was learning more and more as a scientist and a professor, it is a glorious job. When you get paid to be curious, it’s such a cool thing. I can just be asking myself questions and then either find the answers from work other people have done or I say, “There’s never been an answer to this question. I’m going to find the answer in my lab with my research students.” We do the studies then.

Overall, as I was finding more answers to important metabolic questions, I thought, “Is there not an opportunity to turn this into solutions to real-world problems?” The more people want to start controlling carbohydrates and focusing on protein and fat, the more they do have to eat real food. That is a wonderful thing. Eat at home and cook your meals. It’s glorious but it takes time and it takes planning.

As a practical aspect to it, there’s always something to be said for convenience. That’s what ultimately gave rise to the Hlth Code shake. I thought, “Let’s look at the data. What’s the best mix of proteins to fats? What are the best carbohydrates like fiber, soluble fiber in particular?” We put all those things in with some of my favorite things like apple cider vinegar, which is an enormous metabolic boost, it’s wildly unappreciated, and then some probiotics. All of these things were sprinkled into this.

Unfortunately, we came into being right before the pandemic. what a heck of a time to try to bring things to life. It’s been okay. It made us lean. It’s been a fun challenge and a fun opportunity for me as a scientist to say, “Here’s an idea. I want to now come down from the ivory tower of academia, so to speak, and then put this idea into the real world.”

There are a lot of things wrong with academia nowadays. Parents, be careful where you send your kids to school and what they’re learning. In all sincerity, there are many terrible ideas that have worked their way into academia and have been validated. Even in science, too often, we slip into this tendency to say, “Here’s an idea and I’m going to publish a paper that no one will ever read and it will never benefit someone’s life.” I’ve always had enough of an appreciation not only for capitalism but also for ideas that I wanted to say, “Can an academic idea come to life in a tangible, beneficial, something that can help someone’s life?” That’s ultimately what was the impetus for Hlth Code.

I appreciate the idea that someone can go, “Yeah but I’m too busy to do this. You’re telling me this has a good distribution of carbohydrates, proteins, and fats. Thank you.” Being sensitive to taste. If people go to the site, it’s Gethlth. There are savings offered on the site for first orders.

There are lots of great blog posts. People will love the articles that we put there. I’m a professor at my heart. I very much wanted this. Even if someone doesn’t want to get the shake, go read the articles and you will love them. There’s so much cool stuff.

I appreciate your passion for this because these are great. I know a lot of this stuff but even for me, I’m like, “I could do better.” It’s these great achievable reminders. Also, it’s not just a reminder because it’s like, “Here are the whys. Let me give you the whys. This is what we’re seeing.” Someone like you who spends this much time talking about it and sees the importance. Thank you for your time. Maybe we could remind people besides Gethlth all the places that they can find you.

Gabby, thanks so much. This was so much fun. Truly, I admired your athletic pursuits in the past. It’s a pleasure to be able to talk with you about this stuff. I’m pretty active on social media. People can rest assured, it’s never pictures of me with my shirt off as glorious as that may be. It’s never pictures of me doing stuff with my family. That’s no one’s business but my own. It’s always me sharing the latest study that’s been published or it’s me doing a little 60-second video about how fat cells grow and shrink or how Alzheimer’s disease is an energy problem and not a plaque problem. People can find me on most social media channels with the handle @BenBikmanPhD.

Ben Bikman, Hlth Code. If anybody wants to catch up, your book is Why We Get Sick and you dive into that and there’s a questionnaire. Also, you said something interesting. You talked about other indications like skin tags maybe by the neck or the armpits. There’s a lot of information in your book that will get people asking themselves questions. Thank you. Thank you for your time. To everyone reading, thank you.

Gabby, this was great. This was my pleasure, such a treat.

Thank you so much for reading this episode. Stay tuned for a bonus episode where I go deeper into one of the topics that resonated with me. If you have any questions for my guests or myself, please send them to @GabbyReece on Instagram. If you feel inspired, please hit the follow button and leave a rating and a comment. It not only helps me but it helps the show grow and reach new readers.

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About Dr. Benjamin Bikman

Dr. Benjamin Bikman Headshot

A fast-paced lifestyle and even faster food make it challenging to eat a healthy diet. Combined with decades of misinformation and rapidly changing opinions, it’s become nearly impossible to know what to eat (or not eat) for proper health. As a researcher and popular speaker on the topics of human metabolism and nutrition, Dr. Benjamin Bikman has seen the terrible impact a poor diet has on the health of people worldwide. His advice to the many requests he’s received has been consistent: science shows that human health and metabolism thrive when we prioritize protein and healthy dietary fats, and limit our consumption of carbohydrates. To help people achieve their best health, Dr. Bikman and the co-founding team of nutrition and industry experts created HLTH Code Complete Meal. Carefully formulated to optimize health, this delicious shake is also more convenient and affordable than virtually any meal that you could make or purchase.