131- How Insulin Impacts Your Weight Loss Journey with Dr. Ben Bikman

Bryan Carroll: [00:00:14] when asked the majority of the population has some sort of weight loss goal they would like to achieve. Whether it is just a couple of pounds or a couple hundred pounds, which always brings up the question of why people start to pack on extra body fat in the first place.

This often leads us into the research around metabolic health and what factors can influence the development of conditions such as obesity or diabetes, and while checking your glucose levels is pretty easy to do and is relatively inexpensive. It might not be the best measurement for risk factors for diabetes or obesity.

What's up everyone. I'm Bryan Carroll and I'm here to help people move more, eat well and be adventurous. And today I have dr. Ben Bikman on the show to talk about the important markers we need to focus on for weight loss and controlling diabetes. It walks us through a ton of valuable information in this episode.

So let's jump straight into the interview. Dr. Ben Bikman earned his PhD in bioenergetics and was a postdoctoral fellow with the Duke national university of Singapore and metabolic disorders. Currently his professional focus as a scientist and associate professor at BYU is to better understand the role of elevated insulin in regulating obesity and diabetes, including the relevance of ketones in mitochondrial function.

Thank you for coming onto the show, Ben, 

Dr. Ben Bikman: [00:01:38] Hey Bryan, thanks for reaching out and thanks for the invitation. Glad to be on here. 

Bryan Carroll: [00:01:43] Yeah, I'm excited to chat with you, especially as we started diving into insulin and the response within the body. But before we do that, let's talk more about, you know, who are you let's learn more about your background.

Dr. Ben Bikman: [00:01:55] Yeah, sure. So I guess the most important part of who I am as a husband and a father, but that's the kind of boring stuff, but it is priority. Number one, everything else I do is just to make me better in those two categories or in those two aspects of who I am. But beyond that, I am primary teaching role as a professor is to teach a class called pathophysiology, which is basically the sick body.

So it's the students by the time they've come to me, they have learned about, they've learned how the organ systems work, how the liver works, the lungs, the heart, et cetera. Then they come to me and we look at how. How these organs are working when they're not working well. And that actually really influenced teaching that class influenced my perspective as a scientist because I lawn I've long been studying this condition called insulin resistance.

It had been years already by that time. And, and then I was seeing how relevant it was and all of these other disorders that, that I never would have imagined that the connection. So that's actually, what was the basis of the book that we can get into later? But yeah, so that's my professional. I'm a scientist who studies metabolic health.

I study fat cells, energy use in the body. And, and then as a, as a professor, I teach that course that I already outlined. Perfect. 

Bryan Carroll: [00:03:18] And, so it's interesting that you talk about insulin because a lot of people, they talk about blood sugar levels and whatnot in the body. And insulin is just one part of the response in regulating blood sugar levels.

But you like to go a lot deeper into insulin. So first off, can you talk about what is insulin and what is its purpose in the body? 

Dr. Ben Bikman: [00:03:38] Yes. Yeah. Insulin is a hormone that is flowing through our blood all the time at varying levels. And I do mean all, all the time. Even if someone it's not getting any carbohydrate or a fasting and not eating anything, there's always insulin.

That's trickling from the pancreas and moving through the blood. Unless we're talking about a type one diabetic and type one diabetes, that is a disease of no insulin. That is the primary disorder. So they have to of course, treat themselves with insulin injections. So that's the hormone itself. The purpose of insulin is multiple it's myriad.

There they're almost there, there are too many purposes to really feasibly outline. I would say that the most obvious. Is the one you already mentioned in that insulin is a regulator of blood glucose levels, but it's almost, and I can elaborate on that more, but yeah, I would just say ahead of that, it's a little unfair to insulin because it actually has its hand in thousands of chemical reactions and it does different things that literally every single cell in the body, it doesn't matter whether we're talking about obscure neurons in the brain, brain liver cells.

the cells of the gonads, like the testes or the ovaries or the bones or the joints or the muscles, every single cell in the body has insulin receptors. And thus insulin is telling it to do something and whatever that's, something is depends on the cell now. Having said all that, insulin's primary role, as we classically understand it is to regulate glucose.

If glucose levels start to go up, that is not healthy. If it stays high, indeed, it's actually lethal. If it stays too high for too long, it can kill you. And so insulin comes up and it basically opens doors. In cells of the body, like muscle cells and fat cells, most, especially in, so doing it's these glucose doors, and then the glucose can come rushing from the blood move into those tissues and then glucose levels come back down and then insulin will come back down having done in this case, it's job, at least one of its jobs.

So that's insulin. And, but that paradigm is pretty good, important, because it helps us start to get some insight into just how relevant insulin is insofar as insulin's. One of insulin's main jobs is to control glucose. You had mentioned that people typically look at blood glucose and that. Perspective is, is part of, what's put us in this kind of terrible metabolic situation that we find ourselves in.

And that's most obviously appreciated in the context of the disease type two diabetes, so where someone could be coming into the clinic. And they're only liver looking at their glucose levels that the, the physician, the nurse, the doctor's office is only looking at their glucose and year over year, glucose is staying normal.

But insulin is big, is having to work harder and harder and harder with every passing year. And so they have normal glucose, but they have dramatically elevated insulin. Indeed. Insulin is several times higher than it was before. This situation of high insulin and normal glucose is insulin resistance in a nutshell, because we only look at the glucose levels.

We ignore the insulin, we don't detect it. And then it's only 10 or 20 years later. Now the body has become so resistant to its own insulin now, and that can no longer control glucose and the glucose levels start to climb. And then we didn't checked it as type two diabetes. That's the problem. We look at it as a glucose problem.

We look at these metabolic diseases orders as glucose disorders. When we should be looking at them as insulin disorders. If we look at them as insulin disorders, we are not only actually looking at the origins of the disease and actual cause of the disease, but we detect it years earlier than we would otherwise.

Bryan Carroll: [00:07:29] And so if someone is suffering from high insulin levels for decades, at some point, can they basically get like some type of pancreas, but Teague where it just can't keep pushing out insulin? 

Dr. Ben Bikman: [00:07:42] Yeah, yeah. Yeah. So there is this idea, con very, very commonly expressed that in type two diabetes, the glucose has started to go up because the, the pancreas has petered out.

It's like, like you're saying, it's basically run out, run out of steam. It can't do it anymore. And so the insulin levels drop and then the glucose levels spike. There is some truth to that, but let me kind of go back to this kind of pantomiming it all out. This is the original paradigm. I'm just sort of run of the mill insulin resistance, normal, totally normal glucose, but elevated insulin.

The glucose levels can start to climb when the insulin is still absolutely elevated. The insulin hasn't budged, it's kind of reached the ceiling of maximum output from the pancreas. Even still glucose has started to climb. So the hyperglycemia starts, the high glucose starts even in the midst of the elevated insulin.

And then eventually in some type two diabetics, the insulin can come down to let's say here. And then the glucose levels spike even more, but what's important in type two diabetes. It does not go to here. You know, zero is, I'm kind of acting this out. Although Bryan, I should ask actually are even, are you even using video for the 

Bryan Carroll: [00:08:55] podcast?

Dr. Ben Bikman: [00:08:56] Oh, here I am making a fool of myself, but at least it's helping you understand. So all the listeners haven't been able to see me moving my hands all around, but hopefully my dialogue has. Has filled in the blanks and you can use your imagination of a bald freckled guy waving his arms around. Yeah. So, so the idea is in type two diabetes and it is, it is, I would say kind of partly myth, that the pancreas gives up and it stops making insulin.

That is not true. There is always making insulin in type two diabetes, and indeed it stays several times higher than it was when it compared to normal conditions. So the insulin, the bank, the pancreas does not give out or give up and in Peter out that that is, that just doesn't happen. That is what happens with type one diabetes.

It does not happen with type two. 

Bryan Carroll: [00:09:45] So if someone goes in for a standard lab, tests, lab work, there's always a glucose, component to it where they check your fasting glucose, but usually, insulin is not checked. So what are your favorites, insulin, lab tests that you like to run and what are you looking for with that?

Dr. Ben Bikman: [00:10:02] Yeah, you're exactly right. Bryan insulin is not commonly measured and that is, I think, A tragic oversight on our part. It's a tragic oversight of, of conventional medicine, but it, it just goes back to the kind of glucose centric paradigm that we have in medicine. We just look at the glucose and we just assume insulin is going to track with glucose.

So why measure insulin? If your glucose is measured, where your insulin will be too. And that is just not the case. So how, what can someone do the most obvious solution is to just measure your insulin? And if insulin is somewhere under that, just be generous and say, it's under, you know, around 10 micro units of, of per mil of blood.

And that's a common measurement or common unit in the U S if it's under 10 micro units per mil, the person's generally doing all right. And their insulin sensitivity is very likely quite good. Now, however, as we just mentioned, it is uncommon to get insulin measured from a blood test. And so an alternative.

Is, readily available and it is actually still fairly effective, in that is the looking at some of the lipids. That are commonly measured on a blood panel or from a blood test. So what a person does is look at their triglyceride level and they divide it by the HDL cholesterol level or number. So that triglyceride number divided by HDL cholesterol.

If that dividend, if that, if that number. that you get from that ratio of triglycerides divided by HDL. If it is less than 1.5, that's a good sign that indicates a person is very likely insulin sensitive. If it's higher than that 1.5 cutoff, that's a, that's a warning sign or even a bad sign that the person is likely insulin resistant.

Bryan Carroll: [00:11:52] So if you see those, that ratio coming back on your standard lab tests, and then that could be a good at time to, further tests, insulin, or would you go straight into, we have a problem here. 

Dr. Ben Bikman: [00:12:05] Oh, yeah, I think that's pretty safe. That's a, that's a very good one warning light. and it's time to make an intervention.

It's it tracks very well with insulin resistance. but I mean, certain up a person certainly could then insist on getting insulin, but I would say don't wait for that to come in and start making some changes. Okay. 

Bryan Carroll: [00:12:23] is there an, I don't know if this is even possible, is there any way in possibly in the future when someone tests their blood sugar or glucose levels with that, you know, their fingerprint, if that would also check for insulin levels?

Dr. Ben Bikman: [00:12:38] Ah, that is, that is a long pursued item. Bryan is extremely. it, it, it is, it is a Holy grail of, of diagnostics. No, I don't. I see that day coming soon. The difference being it is easy to measure a nutrient. In the blood from whole blood, like, like glucose or ketones or lactate where you prick the finger and you can have enzymes on that little stick and it'll then give you a number.

It will quantify it as a number of an amount of that molecule in the blood. When it comes to any hormone, insulin included, there is just no rapid at-home way to do that from whole blood yet. I'm sure the day will come. but it's not going to be soon. Bummer. 

Bryan Carroll: [00:13:24] Yeah. If only. Yeah. So you had mentioned, you know, when insulin is going through the system, then your body is basically trying to open up cells and you said muscle cells on fat cells to try and push the glucose somewhere and out of the bloodstream and into those cells.

is it, is it more likely to go to a fat cell than a muscle cell or are they equal and then what happens? Like, can they be overfilled. 

Dr. Ben Bikman: [00:13:50] Yeah, that's a great question. just because of normal body mass levels and metabolic rate muscle is the main consumer of that glucose. It is the key glucose sink or disposal.

Of course. However, if someone has much more fat mass, then than fat begins to consume more and more of that, and indeed fat cells take up. A very hearty amount of glucose and are very inclined to store it. Fat cells will convert it into, into fat, to be stored in the liver helps along with that process, the liver will also pull in glucose and convert it to fat when insulin is high and then release that fat as triglycerides actually to be carried on.

On LDL cholesterol molecules. So, there, there is muscle is the main consumer of that glucose, but of course, fat consumption. And was that well, the muscle can't really become over full with energy. at least. That's a tricky question. I mean, energy itself is a difficult concept to define when it comes to biological organisms.

but so let's, so the muscle cell, it, it doesn't really get too full because it's just using energy so readily, although it can store glucose as glycogen and it can store fat as triglycerides. It does both. and then it uses those. The fact cell in, in stark contrast has a very clear, adverse response to excess energy if we want to call it that.

and I'll elaborate. So if one is consuming, Sufficient calories. So they have enough energy to store and insulin is elevated. Then the body will be storing energy. Those are two, I would say critical factors. There must be sufficient calories to store and insulin must be elevated telling the body to store the energy because that's one of insulin's less appreciated, roles or effect in the body.

Insulin tells the body what to do with energy and. What that message is to virtually every cell is store energy. Now, if we're telling fat tissue to grow, you know, if someone's eating enough and insulin is elevated, then we're going to start storing energy as fat, our fat tissue. You know, you could take someone, you could take two guys in your gym.

You're pinching both of their bellies as they're getting fatter. And you're seeing it growing, growing that guy's belly is getting big and that guy's belly is getting big. They can be getting fat through two different ways. But often it's a bit of a mix of both of these processes. So I wouldn't want someone to hear me describe this and think that it's going to be totally one or the other, but just for the sake of simplicity, I'll describe it that way.

you can have someone who's getting fat by, by making more fat cells. That's a process called hyperplasia. And so we would say these are hyperplastic fat cells. That just means we're getting more and more cells. What's important about that is that none of the fat cells ever become too big. They always have room to continue to grow.

And because insulin is so good at telling fat cells to grow these fat cells never get very big. They always have vacancy because there's always more cells moving in. And so they keep growing and they keep responding to insulin and the fat cells stay very insulin sensitive. That's a good thing. And so the rest of the body stays very insulin sensitive as a result because the fat cells are typically the first cells to fall.

So to speak when it comes to insulin resistance in contrast another way of getting fat through hypertrophy. So the individual fat cell number is set. There are no more fat cells than before. It's just that each individual fat cell then as a result is, is that each individual fat cell is growing bigger and bigger.

That is hypertrophy. So we would say those are hypertrophic fat cells. And as the hypertrophic fat cell is essentially reaching maximum size. It knows it cannot grow any bigger, but because insulin is still high because of how the person is eating insulin keeps telling the fat cell to grow bigger. So the only thing that fat cell can do in order to survive is stop listening to insulin.

And so the fat cell becomes insulin resistant. And so even at, even though insulin is telling it to pull in fat and make more fat, it starts to leak fat out. That is something normally insulin would tell a fat cell not to do insulin inhibits fat breakdown, but this hypertrophic fat cell says to hell with you insulin.

I need to start releasing some of this fat that you're force feeding me to take in. I'm going to start leaking some of it out that is an insulin resistant fat cell. And now as it is leaking out this fat. And it's leaking out other molecules, as a result of that, getting to over full to fat itself, you know, the fat fat cell, then the rest of the body starts to become insulin resistant, but it all started the first domino to fall was the hypertrophic fat cells.

And those fat cells get, you know, four or five times bigger than normal fat cells do. And again, insulin is just, it is essential to that process. 

Bryan Carroll: [00:19:07] Interesting. So if it's leaking, if the fat cell is leaking out fat, is that where the triglycerides start to become more elevated on blood? 

Dr. Ben Bikman: [00:19:16] no. No, because the, the, the, what the fat is the fat that the fat cell is leaking is free fatty acids, not triglycerides.

And that, that is an important distinction. Although, I don't know that it's sufficiently important to elaborate beyond this. So the elevated triglycerides are coming from the liver. The liver is packing up glucose and fat and, and, and packaging them into triglycerides and then releasing those into the blood.

Whereas the fat being leaked from the fat cell is broken down triglycerides in those, in that case are just free fatty acids. Got it. 

Bryan Carroll: [00:19:54] So as the body becomes insulin resistant and the muscle fibers and the muscle cells are also becoming insulin resistant. Can you start to get fatigue if you're not actually able to get that energy that you need, if into your muscle cells?

Dr. Ben Bikman: [00:20:11] Yeah. Yeah, that's a good question. the muscle is remarkably greedy and remarkably capable getting the energy that it needs. So even if a muscle is insulin resistant, it is so determined to get an energy that is, it starts working or, or contracting like if someone gets up and starts walking, for example, just the contraction.

Of the muscle cell opens those same doors that insulin normally opens. And so the muscle, like I said, is so greedy for energy, that it has insulin independent. Ability to pull in glucose or insulin independent glucose uptake. Now that however is not the case with the tissue, like the brain, for example, where if the brain starts to become insulin resistant, it's glucose uptake is compromised somewhat, and then the brain can sense this energy reduction and then stimulate you to eat more.

This is based on some of the work by a guy named David Ludwig. Out of, from Harvard, he has some cool studies on that and a neat book called always hungry, that I would refer people to. 

Bryan Carroll: [00:21:17] So the brain gets starved of energy and is trying to tell you to eat more food. 

Dr. Ben Bikman: [00:21:22] even though good that's relevant, that's relevant because the brain is thinking the body's running out of energy, but we're actually swimming in a sea of energy.

We have hundreds of thousands of calories stored as fat. We have plenty of glucose in the blood. There's no reason for the brain to send or to, to, to think, that there's a need for energy. There's no reason for the brain to drive us to want to eat more. It's just, it's not getting the right messages.

Bryan Carroll: [00:21:49] Hmm. Yeah. So it's impacting the entire body at that point. Yeah. Right. That's right. So for people that are becoming obese and that I, you know, they're becoming more and more resistant, what can you do to help them to start to establish a better energy, balance in their body start reducing that insulin spawns and start reducing the glucose in their 

Dr. Ben Bikman: [00:22:13] system?

Yeah. Yeah. I would say, one way to help kind of get off that rollercoaster is to become more metabolically flexible, and that's a. A kind of clever sounding term. And what I mean by that is the person needs to help. Their body, remember how to burn glucose and fat. And so that is the idea of metabolic flexibility, glucose in the blood and fat in the blood are the two main fuels for the body.

You know, really fueling virtually what every cell is doing, to, to maintain its its functions. And so by extension, those are the key fuels for the body. Most people because of chronically elevated insulin and insulin resistance, they're stuck in, they're stuck burning glucose as the primary fuel.

Even when they're fasting, they're still, you know, they could go six or eight or 12 meals, a 12 hours after a meal, and they're still really burning much more glucose than the average person. And in the average person's case who doesn't have high insulin, although the average person, now it does actually have I, insulin is insulin resistant.

So let's just not, I won't say average in an insulin sensitive person. They eat a meal. They go to glucose burning mode for a couple hours, and then a few hours later they've shifted to fat burning where fat is now providing most of the energy for their bodies. So they're flexible in that they can shift between these two primary fuels.

So if someone wants to get out of that, Metabolic inflexibility, the being stuck in glucose burning mode, they need to lower their insulin and the solution is actually quite simple. It is, it is to simply avoid the foods that spike insulin the most, because the insulin is elevated as a result. A lot of the foods that the person is constantly bringing into the body.

And if these foods are rich in starch and sugar, Which will convert into blood glucose. Then insulin has no choice, but to stay elevated then as the body becomes progressively insulin resistant, the insulin continues to stay elevated and continues to go higher and higher. So the key to, to break that cycle is to simply.

Cut or, or let me rephrase that. It is to control carbohydrates and avoid the most insulin spiking glucose spiking carbohydrates, focus on the more fibrous like vegetables, especially. And then even I would say most fruits. I could say that just to be diplomatic. And then, and then now all of a sudden glucose levels can come down.

Insulin can come down and the body's sensitivity to insulin starts to get better. And then they can start shifting between fuels again, they're metabolically flexible 

Bryan Carroll: [00:24:54] again. So people's glucose responses can, from person to person can be different for the same food. So is that same idea going to happen with insulin as well?

Dr. Ben Bikman: [00:25:05] Oh yeah, absolutely. Yes. Yes. So you could take someone who's very insulin sensitive and they eat a bagel. Their glucose and insulin levels come up and down and they're right back down to normal. In two hours, you take someone who's insulin resistant, the exact bagel, the same bagel, not the exact one that, that other guy just cause he already ate it.

They eat equal a comparable bagel in their blood insulin and glucose can be elevated for four hours and have gone three or four times higher than the other guys. 

Bryan Carroll: [00:25:32] So what about a stress response? Say someone has like a food allergy sensitivity, anything like that? They consume that food. Now they have a stress response in the system as well.

How does that influence this whole paradigm? 

Dr. Ben Bikman: [00:25:45] Yeah. So stress is absolutely relevant when it comes to glucose control and insulin levels. Any stress, actually, whether it is a disease stress, whether it is emotional stress or, or a physical stress like sleep deprivation or poor sleep, all of those, any stress event in the body is, is typified by an increase in the stress hormones, and those stress hormones.

The main stress hormones are cortisol and epinephrine or adrenaline. that's another name for it. Those one of the key actions of those hormones is to increase blood glucose and that's so that that's why a poor night of sleep. You wake up the next day. Those stress hormones are higher. Your blood glucose is absolutely going to get higher.

That's also why you get out of bed that next day. And your, your blood pressure is going to be higher it's because the stress hormones have kind of amped up your, your sympathetic nervous system. It's clique, it's keeping your blood pressure higher. So a stressful response will drive up blood glucose. And if it is, if it is a chronic stress, you know, where cortisol and epinephrine are always being spiked, then the body does start to become insulin resistant.

In fact, quite quickly, quite quickly. 

Bryan Carroll: [00:26:58] Hmm. Interesting. Okay. So the other question, so a lot of this is in response to someone that is working their way towards becoming a type two diabetic. What about those with type one diabetes? How does this change for them? 

Dr. Ben Bikman: [00:27:15] Yeah, so with type one diabetes, it is a unique situation where they are exquisitely aware of every little piece of insulin that they put in their bodies, because it has to come from their syringe.

One of the great myths of type one diabetes. One of the great tragedies is the type one diabetics are told, eat whatever carbohydrates you want. Just cover it with insulin. They'll say so if you want to eat that chocolate cake, you do it by golly. And just make sure you put in enough insulin to cover that sets up a type one diabetic or daily failure.

It is, it puts them on this roller coaster of. Of these incredible peaks of glucose. And then these deep drops in glucose and it makes the type one diabetic puts them on this rollercoaster of constantly trying to achieve normal glucose levels that they almost never do. The truth is in either type one diabetes, which is a disease of too little insulin or type two diabetes, a disease of too much.

Those are both States of poor response to glucose or a glucose intolerance. The body isn't metabolizing glucose very well anymore in those diseases. So don't so, so avoid it. Control it don't matter your diet on the one macronutrient that your body is having a hard time clearing. And thankfully there is zero biological need for glucose consumption in humans, humans have zero imperative, zero.

There's nothing essential about dietary carbohydrates, all the glucose that we have in our blood that we need to live because we do need glucose in our blood. We make the liver can make everything we need. It is an absolute myth. for anyone to state that the body needs to eat carbohydrate, that should not be confused with that myth should not be confused, confused with the fact that the body needs glucose in the blood.

And it can make all that it needs. So again, I wouldn't want to be misunderstood. I'm not telling people to not eat any carbohydrate. I'm not saying that, but if someone like this is a diabetic or worried about a diabetic cares for a diabetic, don't let the one macronutrient. That they can't work with.

Well, be the bulk of it diet instead of focus on protein and fat, which have minimal little to no effect on glucose and thus little to no effect on insulin. You know, in other words, you, you would have to give the insulin injections can just. Plummet in a type one diabetic, they may go, it I'm taking 50 or 60 units of insulin down to 10 and you know, one or two shots for the whole day.

And they're good to go. That is phenomenal change in their lifestyle, not to mention financial savings for that person. And this has been published. We know that as a type one, diabetic adopts a low carbohydrate diet that is higher in protein and fat, they spend almost all the time in normal glucose range, normal glycemia, and for a type one diabetic, that is the goal.

And it is hard to do when your, when your diet is based on carbohydrates. Yeah. A 

Bryan Carroll: [00:30:22] couple of years ago, I was in a bookstore and I was going through the, you know, the nutrition and health section. And I found, I believe it's the American diabetes association. they had books in there and so I was curious.

I'm like, okay, let's see what. They're talking about what type of recipes they have and it's all these super high carb. I didn't see a single recipe that was less than a hundred grams of carbs. 

Dr. Ben Bikman: [00:30:45] It's a racket, Bryan. It, yeah, it is an unethical racket. And I can only assume that that has become the dogma for that organization.

I hate to say this lest I be accused of kind of being a. Tin foil hat nutjob, but there must be some financial incentive for them to continue to promote such an. An asinine view in one that has been shown to be false in 1987, one of the most famous diabetes researchers, which is to say a man who's not famous at all.

He published a paper revealing that if you put a type two diabetic on a diet that yeah, perfectly adheres to the policies of the American diabetes association and they haven't really changed. They get worse. We know it, we know that it happens. And I would encourage anyone who curious about this. Look up studies on pub med or Google scholar look up randomized trials, putting people on low fat diets, which is the typical dogmatic approach.

It's low fat, low calorie. Have them compare that find studies compared low fat with low carb diets and the low carb diet wins every single time. Yup. 

Bryan Carroll: [00:32:01] Yeah. Anyone that has, diabetes could probably tell you that they are paying a lot of money out of pocket for the treatments that they have to go through.

And that's why the insurance as well. So there's definitely a financial backing involved there. 

Dr. Ben Bikman: [00:32:15] Yes, yes. Yes. Well said they're there. We have to be cynical when it comes to advice that is so clearly defined reason. 

Bryan Carroll: [00:32:23] Yup. so let's see, where do we want to go with this? Cause? So insulin has a huge impact on our health.

It's something that is not. Being checked enough. we should start looking at that, but we do have the triglycerides and HDL number that we can start looking at. If we do have, just regular standard, lab work that we can take a look at. we're starting to recognize that we might have some type of insulin response, that could become more problematic.

You've given some ideas on ways to start controlling that. and you've also talked about, you know, carbohydrate grates are not necessary. They can be helpful in certain ways, like getting your veggies and that type of stuff, but consuming excess glucose can have a lot of impact for people that will say are a lot heavier there, you know?

Their lifestyle is eating an unhealthy way. How do you get them to start making those changes when they've spent most of their life, not eating that way, not living a certain way, but they're getting to that point where they're recognizing, like I have a health crisis and I needed to take care of this.

Dr. Ben Bikman: [00:33:36] Yeah. Yeah. So I appreciate you bringing this up. So to me, the concepts, the principles of improving insulin sensitivity and all the benefits that come with that, like weight loss, improved cognition, you know, improved, improved thinking, improved lipid levels, lower heart disease, risk improved fertility.

These principles are, are simple. And in fact, let me even express them, simply control carbohydrates, prioritize protein, and then fill all remaining calories with fat. I mean that, to me, that is the trifecta, a simple rule for each of the macronutrients. These are simple ideas, but they are not easy because the one that very first pillar of control carbohydrates.

Immediately starts to deal. I believe with individual addiction, this is the thing that people crave. It's the carbohydrates. It's, it's something that is, you know, no one is sitting around on a Friday evening watching a show at home thinking I want a plate of scrambled eggs, you know, or boy, really, I really just need a Serling steak right now.

It doesn't happen. People don't crave protein and fat. They crave something sweet and gooey or salty and crunchy. And that is going to be built on easily or, or very processed carbohydrates, easily digested, starches, and sugars that is going to spike glucose and then subsequently spike insulin. So we're dealing with addictions and so.

When it comes to the, to these food addictions, there is no great advice. At least I don't believe there is. maybe I would simply in, in all humility offer one because I do appreciate the challenge here. It would be this cliche response. Don't shop hungry. If you can win the battle, the dietary battle, if you can win that battle in the grocery store.

Then you're going to win it at home because when you are craving that food on a Friday evening or anything, any evening that doesn't have to be weekend. If you're craving something junky on any in any evening, which is almost always when the cravings really kick in, if it's not in the home, you're going to weather storm.

You're gonna fight that temptation so much better than you would otherwise, if it is in the home and you got that pantry chock full of junk. Good luck. You'll lose that fight every night. It takes incredible amount of discipline. Not that some people don't have it. There are absolutely people who can get through that.

But if we're talking about someone who is metabolically unhealthy or wait, I, I very much, I suspect there is an underlying addiction there. And I do say that with nothing compassion. I am, I really do mean that, it just means. The sooner a person can be honest about their, their addictions with food.

Then the sooner they can start to address it. And again, I believe one of the most practical ways to address it is make sure you've eaten something really good and healthy before you go shopping. you know, based on those three principles, eat some steak and eggs, then go shopping and, and you will just have so much better discipline and you won't bring it into the home.

Cause once it's in the home every evening, it'll be calling out your name and, and it will be drawing you to it. What 

Bryan Carroll: [00:36:53] a good point. Cause I mean, we really healthy, but if we go to the store and we are hungry, everything, it looks amazing. So we're just like, we have a list, stick to the list. Don't look at anything else, but it definitely calls to you for 

Dr. Ben Bikman: [00:37:08] sure.

Evans and, and it's, it's deliberate, you know, it's at the ends of the aisles. You can't. Even if you're shopping around the outside of the grocery store with where all the good stuff is and avoiding the middle part of the grocery store, you can't help, but see those things on the ends of the aisles. And if you're hungry, even me, as long as I've been doing it.

And as much as I know, you know, my brain is shouting at me. Don't put that in the cart. You big idiot, but I just grab it and I think, yeah, it's going to be okay. I can control myself, but I know there's a little part of me that says, no, you can't, you just put a box of cereal in nothing. You're going to eat that whole bloody box this evening.

And I can easily, when it comes to cereal, I can, I can eat above my, my body weight. I can, I can eat up and do a different weight class. I think. 

Bryan Carroll: [00:37:54] Well, the other thing we know is they make those foods very addicting and this with a satisfying crunch and then the melt off and yeah, they, they know how to, 

Dr. Ben Bikman: [00:38:05] it's a science man.

Bryan Carroll: [00:38:07] Yup. Well, Ben, is there any other things that you want to make sure we touch on before we wrap 

Dr. Ben Bikman: [00:38:12] up here? Well, I would say I appreciate that. I appreciate the time here and another kind of audience for me. you guys, anyone listening, you've been, you've been given a sort of primmer, a little elementary version of what insulin resistance is.

I, let me emphasize the relevance of this. it is the single most common health disorder in the world. Most definitely the most common health disorder in the U S potentially affecting up to 88% of all adults. And that is a shocking number. The problem why it's so dangerous is that we don't recognize it.

We mistake it for all of these other chronic diseases. We look at the person who has infertility or early stage Alzheimer's disease, or, Or hypertension and we think, well, they just have hypertension or they just have, you know, budding Alzheimer's disease. No, no, they don't. They actually have insulin resistance and all these things you're seeing are simply manifestations of the insulin resistance.

So. Question, what you think you know about your health and, and, and assume, or wonder whether there might be some underlying insulin resistance and you will probably very much, you'll probably be quite accurate in that, and then start addressing the insulin resistance. And then you will be pleasantly surprised as the disease that you thought had nothing to do with insulin resistance suddenly starts to get better.

And, and, you know, like, as I said, We kind of touched high level stuff here. Anyone who wants to learn more about it? I actually, I did devote an entire book to it, highlighting, defining what is insulin resistance, presenting the scope of the problem, discussing and reviewing all the diseases that come from it, and then even what to do about it.

You know, a whole section of the book, what to do, what to do with that insulin resistance. And the name of the book is why we get sick and it's, you can buy it anywhere. 

Bryan Carroll: [00:40:04] Well, people can find you on Twitter and Instagram at Ben Bickman PhD. you also have a product. Do you, do you want to talk about that?

Dr. Ben Bikman: [00:40:13] Oh yeah, sure. Yeah. Thanks. so I don't want to sound like a shill here, so, I'll, I'll mention it and try to be objective about it. one of the challenges of adopting a low carb diet, is, is that you have to eat real food and that that's actually a good challenge, but it is a challenge. And so I, to me, I just confess, I kind of just like shakes and, and so I think there's always room for a shake because people either like them or they just like the convenience of them.

So I'm working with two of them, my brothers and I have, I have a lot of brothers, so only two of them. the three of us we designed and made a low carb, high fat, high protein shake, you know, built on what I, I believe to be the best science, the best ideas, the best ingredients. and anyone who wants to learn more about it, please go to a website called get health and health is spelled H L T H.

It's kind of a fun way to spell it. Get health H L T h.com to learn more and to see what it is. It's 

Bryan Carroll: [00:41:12] pretty amazing. Cause I believe you have 27 grams of protein and 27 grams of fat in the shake, which is, I mean, I don't think I've ever seen that in any other type of shoe 

Dr. Ben Bikman: [00:41:23] and I don't think you have either.

It's very deliberate actually on that one to one. What you noted was this exact one to one of protein and fat by mass. And that's roughly what you see in an egg. You know, egg is about one to one by mass of protein of fat. The reason I built a shake on that, on those two pillars is that. In nature. Protein always comes with fat.

It always does. It never comes alone. And protein and fat together actually stimulates greater muscle growth than protein alone. This is published in humans. If you give a human, a protein load, you get a bump in muscle growth after a workout. If after the workout, you give them protein and fat in a one to one ratio like we do, like we did with the shake, you get a bigger muscle bump.

Of muscle growth beyond the protein alone, something additive, or even synergistic about the two of them together. And that's why we built it the way we did. And of course, because of the fat is very satisfying. It's satiating, which makes it really a meal. It, we didn't want it to just be looked at as a protein, shake it as a meal shake.

It's built to be that it's just built also to keep your glucose in, check something. We have firmed repeatedly. And, and thus keep insulin in check and then help the body just stay in that, greater state of fat burning. So, 

Bryan Carroll: [00:42:45] not only are you helping out the insulin resistance, you are also putting on more muscle 

Dr. Ben Bikman: [00:42:50] that's right?

Yep. 

Bryan Carroll: [00:42:53] Yep. Well, thank you so much for coming on. You had a lot of fantastic information. We'll have to have you back again in the future and we can keep that deeper and deeper. So thank you. 

Dr. Ben Bikman: [00:43:04] Yeah, no, my pleasure, Bryan. Thanks again for reaching out. I had a great time. I hope the listeners have learned a thing or two.

Bryan Carroll: [00:43:09] I warned you that this episode had a lot of valuable information and hopefully you were able to get at least a couple important. I'll get some information out of the show. Remember the entire show notes with transcripts can be [email protected] slash one three one. So you can refer to any of the links or conversation pieces that we had.

And if you know of anyone who would benefit from this information, then make sure to share this episode with them. These health markers are something everyone really should be aware of and have tested on themselves. So they at least have a good baseline to refer back to. Next week, we will continue with the weight loss theme.

So let's go learn about my guests, dr. Lydia Alexander. I am here with dr. Lydia C Alexander. Hey, Lydia, what is one unique thing about you that most people don't know? 

Lydia Alexander: [00:44:02] I am training to be a certified culinary medical specialist. And so what that is as the medical chef. 

Bryan Carroll: [00:44:09] Ooh. What, what entails being a medical chef?

Lydia Alexander: [00:44:12] Well, it entails a whole bunch of training. That's, both, you know, dietary so that, you know, in the purview of registered dietician and also in the kitchen, which is, as a chef. And so what we do is we look at disease processes and how to reverse them or improve them, based on someone's. someone's medical conditions.

So if you have cancer for instance, and it depends on the type of cancer, we would look at dietary patterns that may be more beneficial for you. the same for say, for diabetes and, and, and some other, 

conditions that may be inflammatory. And so it would look at, you know, arranging dietary patterns around that.

Bryan Carroll: [00:44:51] And what is your favorite meal that you've made so far? Then 

Lydia Alexander: [00:44:55] my favorite meal, I would say my favorite go-to and also low cost meal, because I think of, you know, ways for my patients. Like, you know, what you can do that would be reproducible when actually be making as a. spaghetti, you know, spaghetti and meat sauce with a combination of, Turkey or chicken and, and lentils.

And so, and so the, the meat sauce is actually kind of like a 50 50 split between those and, and, and were plates a lot more, a lot more fiber, you know, the, and, nutrients. As well as, as vitamins then, at the end, the straight up meat sauce. And it's also really, really affordable. 

Bryan Carroll: [00:45:37] And what will we be learning about in our interview together?

Lydia Alexander: [00:45:41] We'll be learning about the specialty of obesity medicine and, and how, treating the roots, not the fruits, of, of obesity, and all the chronic diseases that we see in the United States, is really the key for, for long life and, and healthy and healthy life.

Bryan Carroll: [00:46:02] In a, what are your favorite foods or nutrients that you think everyone should get more of in their diet?

Lydia Alexander: [00:46:08] I would say, my favorite. my favorite foods and nutrients are, vitamin D for one, but you can get a lot of that from the sun. So that's an interesting nutrient. And if you can see the sun, so maybe not today and, and then, B12. And so for those who I have a, I'm a purely vegetarian and even a nondairy non-ag diet, I really liked nutritional yeast.

So that would be an interesting, you know, food. to, to throw in there. And within that, I'm, I'm really into just spicing it up with, with a lots of herbs and lots of spices to create interesting dishes, with whole foods overall in 

Bryan Carroll: [00:46:49] what are your top three health tips for anyone who wants to improve their overall wellness?

Lydia Alexander: [00:46:54] they would be to focus on neat. To think about what is some, you know, what are some, quick, you know, nutritional food hacks that you can incorporate into your interior week. And, and, and to, you know, maybe start with, you know, with, with breakfast or, or changing up a snack, you know, those 3:00 PM snacks when, you just need something to grab and go, and maybe finding a, you know, finding something that's, you know, more whole food forward.

During that point in time, 

Bryan Carroll: [00:47:25] you'll want to hear about her pillars of health for weight loss. So until next week, keep climbing to the peak of your health.