“Express Gratitude to the Universe or a Higher Power”
This episode is about insulin, glucose, and your fasting questions.
Benjamin Bikman earned his Ph.D. in Bioenergetics and was a postdoctoral fellow with the Duke-National University of Singapore in metabolic disorders. Currently, his professional focus as a scientist and professor (Brigham Young University) is to better understand the role of elevated insulin in regulating obesity and diabetes, including the relevance of ketones in mitochondrial function.
Outside the lab, Dr. Bikman is a devoted husband and father and enjoys nothing more than traveling and adventuring with his wife and three children.
In this podcast, Insulin: Everything You Need To Know, we cover:
The differences between pathological insulin resistance and physiological insulin resistance
Does estrogen play a role in storing too much body fat?
The reason you shouldn’t break your fast with an insulin-spiking meal
Why glucagon is the ultimate hormone when it comes to fasting
The correlation between muscle mass and insulin resistance
The Differences Between Pathological Insulin Resistance and Physiological Insulin Resistance
Insulin resistance is not just an individual problem, but this is a world problem. Pathological insulin resistance is the kind that we are all afraid of because it’s contributing to cancer, Alzheimer’s, heart disease, infertility, and other terrible things. Pathological insulin resistance causes disease, whereas physiological insulin resistance helps the body be healthy and strong. You will be in a unique metabolic state if you follow a low-carb diet because you are exquisitely insulin sensitive. There are two stages where we become more insulin resistant at puberty and pregnancy; it’s from hyperactive explosive growth. When someone gets pregnant, there is tissue demand to grow a uterus, placenta, and breast tissue. Also, having more body fat will help develop and feed the baby until they are independent. Insulin resistance is a tool the body can use at the right time.
Estrogen Prevents The Body From Storing Too Much Fat
Women commonly think estrogen is fattening, but that’s false. Estradiol, the primary estrogen, is very lipolytic; it prevents the human body from storing too much fat. Estrogen tells the body where to store fat, not how much fat to store. Women tend to have naturally higher levels of free fatty acids in their blood than a man does because she’s constantly burning or mobilizing more fat than men. In contrast, progesterone is the fat of pregnancy; it works with insulin to ensure that the body stores more fat. Interestingly, progesterone is so eager to store fat that it will stimulate greater hunger. Hunger will exactly match progesterone levels.
Don’t Break Your Fast With An Insulin-Spiking Meal
It takes sixteen hours of fasting for the beta cells to start scrapping their stored insulin. When insulin levels drop, the body will start letting minerals and electrolytes leave with water from the blood. If you’re taking salt and water, this will help mitigate this phenomenon. When you spike your insulin dramatically, it now starts pushing potassium into cells. You can risk developing hypokalemia or low blood potassium; this can kill you. This isn’t common during a two or three-day fast. Instead, this is more likely to happen after fasting for a week or two. All in all, don’t break a fast with an insulin-spiking meal. Otherwise, you will be flirting with a potentially lethal imbalance of electrolytes. Break your fasts with protein and fat.
Glucagon: The Ultimate Fasting Hormone
Glucagon and insulin keep each other in check. Glucagon is the fasting hormone; it’s the wonderful opposite of insulin. Whatever insulin wants to do, glucagon wants to oppose it. Glucagon will stimulate glycogenolysis in the liver, breaking down stored glucose and releasing it into the blood. Glucagon wants to increase glucose by inducing glycogenolysis in the liver. It also activates ketogenesis in the liver. Suppose someone notices during a fast that they are getting high glucose and high ketones; they might, in fact, want to get their insulin checked. Increased glucose and high ketones could mean a defect in insulin production. In an average healthy person, glucose shouldn’t be climbing during ketosis.
The More Muscle You Have, The Faster Glucose Will Drop
Muscles eat the lion’s share of glucose. When you eat a bagel, 80% of the glucose goes to the muscle. If you have more and more muscle, you will drop glucose much faster. Having more muscle makes you more insulin sensitive. Insulin will knock on any door that it can. The more muscle you have, the more places glucose has to go. The less muscle you have, the longer it will take for you to clear the glucose because insulin won’t have as many places to tuck the glucose away. Also, remember that you can grow muscles bigger and faster by taking fat and protein compared to just protein alone. One gram of protein for every pound of your ideal body weight is a good recommendation as long as you eat fat with it.
Dr. Mindy So I really again, I just want to thank you for coming back. Yeah, we I feel like I’ve talked about insulin resistance from every angle I possibly can. And I also feel like the world is waking up. And they’re starting to see that insulin resistance is not just an individual problem, but this is a world problem. Would you agree with that?
Dr. Ben Bikman Oh, completely? Yeah, I mean, I am like, let’s make sure we bring that up. I’ve given talks on insulin resistance literally around the world, for good reason. Because as much as we, no one loves to rag on the US as much as Americans do. And that doesn’t go. I mean, that even includes things like insulin resistance, where we think we’re the worst in the world. And we’re not, I’m not even sure we’re in the top 10. When it comes to countries with the worst insulin resistance and type two diabetes, virtually every country in the Middle East is higher than us. Mexico is higher than us, some countries in Southeast Asia. So yes, this is absolutely a global phenomenon, unfortunately.
Dr. Mindy Yeah. Interesting. That’s It’s so interesting to hear you say that Americans, we bash America, that
Dr. Ben Bikman Oh, more than any other izes me other countries. I’ve lived around the world. I’m not I’m originally from Canada, born and raised. So I am able to look at this country with somewhat of a foreigners eyes and appreciate it like only foreigners can to be perfectly frank. Americans love to hate their own country, which is kind of remarkable to me, and I’m an American. And now and I love it. I’m grateful for it.
Dr. Mindy Yeah, I do feel like when it comes to the food industry, and what we’ve done to our health, that that is one of the biggest things we like to hate ourselves for.
Dr. Ben Bikman Yeah, well, and rightly so. Of course. Yeah. I mean, there are all kinds of dimensions to this that go well beyond what you and I want to talk about right now. But absolutely. Our one of the beautiful things of capitalism and democracy, which is these two are always intimately connected, which the United States has been such a beacon of for so long, is that there is this relentless pursuit for profit. And that is, I do not say that as a bad thing. Unlike most academics, I am vehemently opposed to communism. But it’s a there is a counter to that, or an aspect of this, which can be a little more sinister, which is, you don’t really you might not care as much what is happening to when this product is consumed, as long as it is, you know, helping the investors, you know, so to speak. But yeah, I mean, it’s definitely something where our innovation in the United States has been so remarkable, in so many wonderful ways. But our innovation to make food more processed and more palatable, is not one of the things we should be proud of.
Dr. Mindy So well said so well said. So okay, so explain to the people who are listeners who maybe didn’t hear the first episode when I brought you on last year. And I want to encourage everybody to go back and listen to that. What is insulin resistance? How would we explain that? And then the second part, I want to ask that question, why is it getting so much press? Why do so many people are so many people starting to care about it?
Dr. Ben Bikman Yeah, yeah, insulin resistance, the best analogy I can think of is thinking of insulin resistance as a coin, that I’m holding a coin, and I’m calling this coin insulin resistance, but it has two sides. The first side is in fact, cells becoming resistant to insulin effect, not all cells of the body, though, insulin resistance in the body is happening when some of the body’s cells aren’t responding as well to insulin. So that’s like specific to the cell in a given cell. However, we flip that coin over, it’s part of the same coin. And then we have the phenomenon of hyperinsulinemia, or chronically elevated insulin. Unfortunately, especially in the low carb realm, people don’t realize that these always come together. To make this point perfectly clear to put as fine a point on this as possible. There is no such thing as insulin resistance in the human body. Without hyperinsulinemia, there must be elevated insulin, I’m gonna say this in reverse. Now, for there to be insulin resistance, you cannot pull the two apart. They are on their own distinct phenomenon, one cell not responding as well to insulin and to insulin levels being chronically elevated in the blood. But in the case of the whole body, they are absolutely inseparable. Now, I mentioned that in the low carb community, we get this so wrong. And that’s because people have started to invoke this idea of physiological insulin resistance, as if, and they will say, a low carbohydrate diet can create physiological insulin resistance, as if they’re being clever While they’re neither being clever nor informed, it’s just utterly incorrect. There is, in fact, such a thing as physiological insulin resistance. It happens in pregnancy and puberty. And that is when the body has become insulin resistant for a good reason, which is in these instances to facilitate rapid growth.
In the case of pathological insulin resistance, which is what you and I talked about on the first episode, and everyone go watch it, that’s the kind that we’re all afraid of, because that’s the kind that’s contributing to breast and prostate cancers, and Alzheimer’s disease and heart disease, infertility, and all these other terrible things that none of us want. But even still, as different as pathological insulin resistance is and causing disease and physiological insulin resistance isn’t helping the body be healthy and strong. They are both the same thing, in that it is both altered insulin signaling at certain cells and to higher insulin levels. Now, to help wrap up my rant as quickly as possible in the low carb realm, people will say physiological insulin resistance thinking they’re being eloquent and clever, when again, there’ll be neither. They’re just wrong. But what does happen because insulin levels dropped precipitously on a low carb diet. And thus, how can there be insulin resistance there is not an indeed, if you inject that person with insulin, they are so insulin sensitive that they will die from hyperglycemia and the lack of ketones. So it’s it’s It boggles the mind to say this. However, the truth of the situation, and where the uninformed, think it’s physiological insulin resistance is that if you take one person who’s eating a standard American diet and have him drink 50 grams of glucose, his glucose levels will come up. And assuming he’s a healthy insulin sensitive person, which is a bit of an assumption, his glucose levels will come up and down in two hours. A nice, neat curve, however, take another lean healthy person who’s following a low carbohydrate diet, and his glucose levels, mate will come up and they’ll stay up a little longer and take a little longer to come back down, which does in fact, look like a glucose pattern you would expect in someone who is insulin resistant. But that’s not what’s happening here. The unique metabolic state in someone who has been following a low carb diet is that they are exquisitely insulin sensitive, they’ve just become somewhat glucose intolerant, temporarily, thankfully, but that has everything to do with the production of insulin, the beta cells, so when someone, when someone goes and eats a bagel, they will have what’s called a biphasic insulin release, there is this immediate release of insulin, and then it starts to curve and then it’s met with a bigger second wave. So there are these two phases of insulin secretion. The first phase is the release of all of the insulin that the beta cells have already made, and they have on hand that they’ve made and that’s packaged up and ready to go, the moment there’s an increase in glucose, that’s the first phase in the beta cells, we’ll run through that very quickly. But at the same time it’s running out of it’s already made stored insulin, it’s already ramped up all of the metabolic machinery in the factory to make a whole new shipment of insulin. And that’s the second phase. What happens with either fasting or low carb diet, there’s so little glucose coming in, that there’s so rarely any big glucose spike, but the beta cells are looking at all of this preformed insulin that’s kind of clogging up the it’s cluttering up the cell. And it thinks, Well, I don’t need all this stuff anymore. I don’t need preformed insulin, because we consume so little glucose, that I can just handle any glucose load by making the insulin from scratch, and just shipping it right out the moment it’s produced. And thus, the beta cell, who is determined to be efficient with its use of space. Much, much to my delight, I’m the same way it looks at all the cluttered insulin that says I don’t need it anymore, I’m gonna get rid of it. And it simply breaks it down into its basic little protein amino acids and just recycles it into something else. But that’s the problem, if you will, were someone who had been adhering to a low carb diet, they eat a bunch of glucose and it takes them longer to clear the glucose not because they’re insulin resistant, but because they have temporarily gotten rid of that first phase of insulin. In that state. They only have the second phase and so it just takes a little longer for the insulin to get up to where it needs to get into clear the glucose but have that same low carb adapted person eat that exact same carbohydrate heavy snack or meal six hours later, and the first phase is back in they’ll clear the glucose like gangbusters. Oh, how’s that for a ridiculously over explained definition of insulin resistance?
Unknown Speaker I have so many thoughts on that. I have never
Dr. Ben Bikman heard way too much. So
Unknown Speaker no, I was like, my brain was like following you every step of the way and going what? Good go Uh,
Dr. Mindy so I have two questions that I want to say out of what you just said, One, I can’t let the comment go by that we become more insulin resistant at puberty and pregnancy. Yep. Why is that?
Dr. Ben Bikman Yeah, yeah, so those are the two, the two peas and physiological insulin resistance as I like to describe them. And as I teach them to my graduate students, So insulin is anabolic, it wants to promote growth. And, and so that’s so you look at these two stages of what could only be described as just hyperactive explosive growth, you know, a little kid is growing, growing, growing, they hit puberty, and boom, and then they plateau, while you take the average mature woman, like, you know, an adult woman, well, her growth is done, but then get she gets pregnant, and all of a sudden, the tissue demands to grow the uterus to grow a placenta to grow breast tissue, and even to grow more fat, to make sure that there is an kind of a metabolic insurance plan to carry the pregnancy full term. And then to breastfeed the baby afterwards, which, of course, would have been done in nature, you know, historically, always. So having more body fat is this kind of metabolic insurance, in the event that food becomes a little scarce, let’s just pack on whatever we can right now. So that we can feed, grow the baby and feed the baby all the way until the baby’s independent. So, so here, you hear you have an adult female who’s totally done growing. And now all of a sudden, you have this explosive growth because she has to get ready for this baby. And insulin comes up and helps. So it’s so in both instances, despite their differences, what they have in common is that it is it is the two periods of the most explosive growth, the human experiences. So insulin by becoming insulin resistant, in some cells of the body. And by having higher insulin, you can basically direct so the higher insulin is telling the body to make more stuff and store it. And some of the body cells are super sensitive to that insulin, and thus, they can experience that explosive, anabolic metabolic processes. You know,
Dr. Mindy this is the thing about the human body that continues to put me in awe is that it’s always doing the right thing at the right time. And yet the symptoms that we get, we villainize I mean you talk any young, female and puberty and you’re like, hey, you’re more insulin resistant. Like nobody wants to hear that. Yeah,
Dr. Ben Bikman yeah. Yeah, no, that’s right. Well, what’s interesting too, just because we’re talking about ladies, is to note the effective of prototypical female sex hormones like progesterone, and estrogen on metabolism, where women will commonly think that estrogen is fattening, but that’s just absolutely false estradiol, the main estrogen is very lipolytic. It’s very much preventing the female body from storing too much fat. All estrogens are doing is telling her body where to store fat, fat, not how much to store, which is why if I had a man and a woman come into my lab, and we did a fat biopsy from the fat by their belly button, and put it into a little dish, gram for gram, the fat from the woman is breaking down and burning more fat. I mean, burning is not the right word in this case, but it’s breaking down, it’s undergoing more like pollicis than the fat from the man is. So this is a very in which is why women tend to have naturally higher levels of free fatty acids in her blood than a man does. Because she’s constantly burning or mobilizing more fat than the man is an extra dial helps that happen. But in stark contrast, progesterone is a fat that is well that is the fat of pregnancy, it’s pro gestation. And it works with insulin to make sure the body is storing more fat. And interestingly, progesterone is so eager to store fat that it will stimulate greater hunger, which is why in a normal menstrual cycle, when progesterone is high, a woman will very very commonly and this is not my experience. This is published research. She will hunger will go up hunger will almost exactly match progesterone levels. So progesterone levels climb and then come down throughout the month. normal normal satiety hunger signals and then boy hunger is bigger, bigger, bigger, and then it subsides again, it just goes with progesterone completely. Yeah. And I would
Dr. Mindy I speak for every woman out there. The answer to that is yes.
Dr. Ben Bikman Yeah, yeah. Yeah. Good. Well, I MND, just so everyone knows, I sometimes get a lot of heat. Like I’ve seen people make comments like, oh, great, another white, straight man talking about women’s you know, whatever. I’m not pretending I know what it’s like, just so everybody knows right now, you know that. We’re just not pretending. Yeah. But just based on published research, I can speak on this with some authority.
Dr. Mindy The other thing I really feel like is that just that comment alone, and I it’s actually something that I say a lot to my community Which is when you’re hungry the week before your period, stop villainizing yourself stop, you’re not undisciplined. It’s because prep progesterone is going to require more glucose. And so you know, it’s natural. Now let’s just pick the right food for you to eat. It doesn’t mean you so well said. Right? You don’t sit on the couch. But you do have to give yourself grace. Because your human body wants more glucose. And I think that’s so powerful. Yeah, cool. Okay, my second question, because we’re gonna get this a lot is in the first and that the beautiful opening comments you had, if you go on a three day water fast, if you go on a 48 hour water fast, something a little bit longer, and your pancreas is getting rid of the insulin it doesn’t need. If when you bring food back in, will there be a temporary appearance like glucose is tied because of what you said, We’re that totally system. Yeah, okay. And
Dr. Ben Bikman all the all the more reason, all the more reason to be careful with how you break your fast, which is why I’m always saying how you end a fast is much more important than how long you fast. So don’t eat something that demands a dramatic insulin response for two reasons, one for the reason we just described, which is you’re not going to clear the glucose very well, you know, kind of warm up the pancreas. Again, if you’re going to get into carb, heavy foods start easy. But then second, this is very uncommon, and virtually, I would say probably impossible, certainly unheard of, on an order of like a two to even three day fast. But there is a phenomenon known as refeeding syndrome, you already have already talked about this.
Dr. Mindy Talk about breaking fast all the time, and how important it is. So please, well,
Dr. Ben Bikman then this then this is worth taking a moment to explain. But it sort of follows along with that sentiment just from a moment ago, which is you don’t don’t expect your pancreas to work too hard, and expect it to produce insulin that you haven’t been asking it to produce for the last 24 to 48 hours or 72 hours. Because all it takes is about 16 hours of fasting for the beta cells to start scrapping their stored insulin. So this is a pretty quick phenomenon. But there, when When insulin levels start to drop, which they do during a fast the body starts to more rapidly, I want to make sure I explained this correctly, the body will start letting minerals go, it’ll start letting electrolytes leave with the water from the blood. And this is why the person’s blood pressure will tend to go down. Um, now of course, if you’re taking salt and water, this will help mitigate this phenomenon. But even still, insulin comes down. And as it is the body’s more rapidly dumping electrolytes in the urine. It’s just a natural phenomenon. However, when you spike your insulin really dramatically, you start not only are the kidneys still dumping some of the minerals, they don’t get the message immediately, it takes them a few hours to start conserving minerals again. But what happens when insulin spikes is within seconds of insulin hitting the blood, it now starts pushing particularly potassium into cells. So as insulin is coming to cells, part of its pulling into the cell is potassium. And so the person can actually run the risk of developing hypokalemia or low blood potassium. And that is, in fact, a very lethal, I mean, it can kill you situation. Now again, this is not common on the order of even two to three day fast. It’s usually this was studied in very long, like week to week type fasts under, you know, strict kind of academic clinical supervision. But even still, it’s nevertheless a reminder for us to not end a fast with an insulin spiking meal or snack. Because not only is that going to be challenged on the pancreas in that moment and take it make it harder for us to clear the glucose. And so we’ll be hyperglycaemic for longer but two, we just start flirting with this potentially lethal imbalance and electrolytes.
Dr. Mindy Yeah, it’s so well said so what would be the ideal meal to break a fast with? Yeah,
Dr. Ben Bikman yeah, so it protein and fat at the risk of oversimplifying it, just because there is one I mean, for myriad reasons. Let’s see how many I can think of off the top of my head one proteins and fats are what’s essential. So why not end your fast with what you literally have to be eating essential amino acids and essential fatty acids. And to you will help mitigate the insulin burden because proteins and fats have little to no effect on insulin respectively. And so it just helps, you know, kind of wake the pancreas back up in removing it. Because the pancreas has been a little quiescent or still during the world the beta cells have been during the fast because it’s the fasted state and insulin is Not the hormone of the fastest, say this the hormone of the Fed state. So you eat something and kind of warm the beta cells up, as you start getting more and more to higher carbohydrate meals.
Dr. Mindy What would you say the hormone of the fasted state is?
Dr. Ben Bikman Ah, that’s a very, very good question. So there are a lot of ways I could answer this. But I will highlight one that I think has classically been discussed enough. But I’ve over the past few years tried to shine a light on it. And that’s glucagon I think you and I’ve talked about before, but glucagon. Glucagon is a hormone of the fasted state. And I like to talk about it because in a way, it’s such a wonderful opposite to insulin, that essentially whatever insulin wants to do, glucagon wants to oppose it. In a in a beautiful yin and yang, you know, there has to be a counter here, each keeping the other in check. It’s a wonderful check and balance. But there are multiple other hormones that also would reflect a fasted state. So as much as I mentioned, in glucagon, I could just as much justifiably have mentioned epinephrine, or cortisol or growth hormone, all of those climb during the fasted state, because what they all have in common all for the hormones I’ve just mentioned, glucagon, epinephrine, cortisol, growth hormone, they are all totally different. from totally different cells move totally differently in the body, and affect different cells differently throughout the body. What they all have in common is that they all increase glucose, released from the liver, that every one of these three total, through totally different mechanisms come to the liver, and tell the liver either to break down its glycogen to release his glucose and or stimulate the liver to undergo gluconeogenesis to basically pull in lactate, which is mostly what it does this with and turn it into glucose and release it back into the blood. That’s an important thing for us to appreciate. Because as much as I just said a moment ago that fats and proteins are what’s essential, thus implying that dietary carbohydrates are not and they aren’t essential. To many people hear that statement, and either willfully or ignorantly misunderstand it, to imply that blood glucose isn’t necessary. That is not true. In fact, blood glucose is so essential that the liver has all of these wonderful signals that force it to make blood glucose, which is proof positive in the fact that we start fasting and all our glucose levels do is go to normal, they just hover around 70 to 80 milligrams per deciliter, because the liver is so good at making sure it stays there. And that itself is evidence of the fact that the body is vigorously defending that glucose range, whether the glucose is pushing up or getting pushed down, it wants to bring it back into that range. And there are some cells of the body that absolutely have to have glucose. And I’m not going to say the brain because we don’t really know that we know that the red blood cells, red blood cells must have glucose, there is literally no other option, because any other nutrient option can only be burned into mitochondria. Well, red blood cells don’t have mitochondria. So they literally can use nothing else, unlike the brain, which can shift over to using ketones and even lactate as a fuel because it is so enriched with mitochondria. But red blood cells, they absolutely have to have glucose. And that’s one of at least one reason why blood glucose is so critical. And even again, stepping further back, why it’s such a blessing that liver has such a profound ability to provide all the glucose the body needs.
Dr. Mindy So does that explain why? And I we get this question so often from our community, when people are fasting, they can see their blood sugar go up, and their ketones go up? How is that possible?
Dr. Ben Bikman Yeah, yeah, in fact, let’s just invoke glucagon. Because glucagon plays a part in both of those, so too, does epinephrine. I like glucagon more. So, glucagon is has two, two seemingly counter. Well, it’s actually literally the effects you just mentioned. One is that glucagon will stimulate glycogenolysis at the liver, thereby breaking down stored glucose and increased releasing it into the blood, increasing glucose, although it shouldn’t ever go too high, because then insulin starts to work against it to push it back down. So if someone sees an increase in glucose during a fast that’s a little uncommon, a little uncommon, but it might suggest that they’re kind of I hate that I may give birth to a sentiment that lives longer than I ever intend to, but maybe they’re a little glucagon dominant, you know, so to speak. That can be a word. I know. I know. Yeah. But But essentially, but even then, the remember that there’s a lot of hormones that want to do this. But I’m only invoking glucagon because it’s simply relevant to both glucose and and ketones. But remember, on the glucose raising side, there’s glucagon growth, hormone, cortisol, epinephrine. So any one of those could be providing to a little too much of an upward pressure on the glucose. But as that’s happening, insulin will wake up from its fasted resting state and start pushing it back down. But even still, glucagon is going to want to increase glucose by by inducing glycogenolysis. At the liver, it also activates ketogenesis at the liver, because when insulin is low, and then glucagon amplifies, this delivers burning so much fat, that it actually ends up burning more fat than it needs to meet its, then it needs to meet its own energy needs. And so here’s the amount of energy that the liver cells need. And because insulin is low fat is basically providing all of that energy. But because insulin is low, it can’t stop burning fat. And so now it’s kind of surpassed what its actual energy needs are in that extra, if you will, is what gets kind of shunted into ketogenesis and starts turning into ketones.
Dr. Mindy So are you are you in ketosis? If your blood sugar is going up, and your ketones are going up?
Dr. Ben Bikman Well, normally you wouldn’t. But if if glucagon were too high, relative to insulin, like what happens in type one diabetes, that’s exactly what happens in type one diabetes. Insulin is very, very low. Glucagon is too high, because it doesn’t have insulin to inhibit it. And then you, then you can have this state where you have both high glucose and high ketones.
Dr. Mindy Okay, and and as long as they’re not too high, it’s not a dangerous place. It’s the literal them and it can be looked at as positive because the liver is breaking down the stored sugar, which ultimately allows the liver to function better.
Dr. Ben Bikman Yeah, yeah. But maybe there is something maybe I should kind of end that answer with is if someone notices during a fast that they are getting really high glucose and really high ketones, they might in fact, want to go get their insulin checked. Yeah, that might be a warning that there is in fact a defect in insulin production, or, you know, even beta cell number like, you know, hinting at some degree of type one diabetes, because in the average healthy person within with no hint of beta cell problem. Glucose shouldn’t be climbing. Maybe a little certainly during an exercise. It should just be ketones are coming up. If they’re both going up, and they kind of keep going, go get your insulin checked.
Dr. Mindy And is there somebody asked on are you on the receptor podcast YouTube channel? Is there a way to measure insulin a home test? Or is it only a no? Why not? No, no be able to create that? Oh,
Dr. Ben Bikman you you can’t even you can’t even imagine how, how competitive and determined multiple labs are around the world. A truly, truly to nano. I mean, forget about the idea of a continuous insulin monitor. I mean, we’re a decade away from that at least. But just to kind of miniaturize the ability to take a few drops of blood on like a little insulin meter, like we would have ketones or glucose. Oh, no, no, we are I’d say we’re still that’s probably five or six years away. There are so many technical hurdles with trying to measure a hormone. You can’t do that with any hormone.
Dr. Mindy I know that because what I’ve been saying is they need to do it for women where they put like a continuous glucose monitor on them. If we had something that showed where our hormones were at.
Unknown Speaker Somebody needs to come up with that. That would be amazing.
Dr. Ben Bikman Yeah. And then it would send the alerts to the husband’s phone. That’s right.
Dr. Mindy around you, you can Hey, like progesterone is coming in.
Unknown Speaker So I’m snacky. Buffet, so have dinner
Dr. Ben Bikman ready? Yeah.
Unknown Speaker Would that be great?
Dr. Ben Bikman Oh, my gosh. You You said it. I’m not being a misogynist. You said it. i
Unknown Speaker And I’m hoping if I keep saying it, there’s gonna be some researcher out there. That’s gonna know and they’re gonna be like, Yes, let’s go make that so every woman is demanding it. Okay, have you heard of the term fat
Dr. Mindy toxicity?
Dr. Ben Bikman Never. But I can’t wait to hear what it is.
Unknown Speaker Okay, I can’t wait to tell you and this
Dr. Mindy is what I learned. It is. A doctor is I don’t know his first name, but his name is Dr. Gregory. And this question was actually asked on our YouTube channel. And I went and watched his theory on it. Here’s his theory is that insulin resistance starts in the muscles that there is a resistance factor. It doesn’t start in the liver. It doesn’t start in the pancreas. It starts in the muscles. The muscles become insulin resistant and then it progresses to the liver and then it progresses to the pancreas and then you have type two diabetes.
Dr. Ben Bikman No He’s he’s wrong. So I don’t know him i so i Maybe I want to be polite in all sincerity. That’s just not true. But But what is but But even still, before I break that down and point out the flaws in that? Where does where does the fat come into that? Does he say that the muscle becomes insulin resistant because it gets to loaded with fat? That’s exactly okay. So what he’s doing there, whether he knows it or not, is invoking a principle of what we call in the realm of like, I’ve published papers on this. So I can’t speak with some authority, what we call lipo toxicity, which is, he’s just kind of made it a little more of a palatable term because someone might not know what lipo means. But that lipotoxicity was this idea born a couple of decades ago. And again, my postdoc work focused explicitly on this, it was in still is one of the more world famous labs studying lipotoxicity. But the idea is that the muscle cell or any cell, I’m not even gonna invoke muscle, because I’m going to come back to that and pull that idea apart in a second. The idea is a cell accumulates fat and becomes insulin resistant because of it.
There is some truth to that idea. But I don’t know if most people appreciate it. So the most common form of storing fat is in the form of triglycerides, and triglycerides will bubble together in create what’s called a lipid droplet. And you can detect this, of course, very readily in a fat cell. If you look at a fat cell under a microscope, like we could, we could walk across the hallway right now to my lab, and we’re growing fat cells in a petri dish, we could look at the fat cells, and you basically they look like they’re a big bubble, because all you see is this huge lipid droplet, which consists entirely of triglycerides. And within each cell, it just when you zoom into the cell, magnified as much as you can, and just looks like a big bubble in the cell. It’s this big lipid droplet of triglycerides. Triglycerides can be stored in the liver very, very readily. They can also be stored in the muscle. But triglycerides do not cause insulin resistance, they don’t contribute to it whatsoever. They’re totally inert. However, there is a type of fat called Sara minds. And anyone who wants to go to Google type in Dyckman ceremony, you can find the numerous papers I’ve published on this topic. Sarah mites are a type of fat. But the problem with saying that is there are hundreds of 1000s of different types of fats, really, so there are like, ceremonies are kind of the the mother molecule in a family of fats called the single lipids, named after the enigmatic stinks, because for so long, we didn’t know what they did at all. But we know that Sara minds will make a cell insulin resistant. But even still, we’d have to say, Well, how did the ceremonies get there? What induces their accumulation? Well, things like cortisol, things like inflammation, things like chronically elevated insulin will induce the accumulation of pheromones in a cell, and then the cell has become insulin resistant. Now, however, to try to point the finger at one particular tissue is very problematic, because there are a lot of assumptions that have to go into that. So his assumption that it starts in the muscle, he can’t say that. There are but but there are advocates in my realm as actual practicing biomedical scientists who study insulin resistance, there are a pools, there are advocates of this muscle first theory, they’re advocates of the liver first theory, then there are advocates, you know, with who say that it’s a fat first theory. But regardless, each theory has evidence to support it. My evidence is better than the other guys. But But But nevertheless, it really does depend on the stimulus. Because if I took a random person and infuse them with cortisol, slowly, slowly giving them a chronic kind of boost and cortisol levels, I would detect insulin resistance concurrently, in fat cells in muscle cells and liver cells in neurons, none would have proceeded the other, they all would have gone at the same time. Similarly, if we took the average individual and started infusing a base level of pro inflammatory cytokines, of course, you have to be very careful doing this. But even still, you would start detecting concurrent insulin resistance throughout the body, there would be no way to say this tissue went first. No, because the same stimulus is happening at all the cells and they’re all becoming insulin resistant. My view is very much in the average individual who is becoming insulin resistant through their diet is that it’s happening due to chronically elevated insulin. And the elevations in insulin are promoting fat cell hypertrophy. And when a fat cell undergoes hypertrophy, two terrible things happen. One, the fat cell becomes insulin resistant in an effort to control its own growth, and so it starts leaking free fatty acids, and second, it becomes pro inflammatory to try to increased blood flow, because as every individual fat cell is undergoing hypertrophy, they’re getting pushed further and further away from blood vessels. And thus they become hypoxic. And to try to correct that hypoxia, they start secreting a whole catalogue of pro inflammatory proteins, some of which will help induce more blood vessel growth, many of which will simply start promoting insulin resistance throughout the rest of the body. So to try to point the finger at one particular tissue, you’re doomed to be laughed at, because everyone else will have evidence like I’m laughing at him a little bit. You’re doomed. But But I very much think the fat cell is the first to become insulin resistant. And then once the in this is reflected, remember, insulin resistance is When insulin is elevated, but glucose is normal. And then once the insulin resistance has moved to the liver, the muscle and the alpha cells of the pancreas will start producing too much glucagon. Now, you can no longer control glucose, and the glucose starts to climb. And now you have transitioned from insulin resistance, which is pre diabetes into full on type two diabetes, which is both elevated insulin and elevated glucose, because in type two diabetes, insulin does not become deficient, it does not go to zero. If this is true type two, insulin has gone like this, they were insulin sensitive and insulin was really low, then it starts to climb up really high. And then it can drop a bit. But it never drops to the level that it used to be. It’s still multiples higher than it ever was before, it just came down from where it used to be at its peak. If it actually goes down to basically zero, they now have actually just coincidentally developed type one diabetes later in life, which can happen, it can which had nothing to do with having had type two diabetes, they are two totally separate diseases.
Dr. Mindy So on the topic of muscles, I do want to come at this from a different angle, because one of the trends that we’re seeing right now is a lot of people increasing protein, and they’re doing it to increase muscle. And then when we look at the effectiveness of muscle on insulin sensitivity, understanding is that there’s more muscle you have the more insulin receptors you have. Is that Is that a good trail of thought? And
Dr. Ben Bikman should we Oh, totally.
Dr. Mindy Yeah. Should we be highlighting protein? Is that the hero of the insulin day?
Dr. Ben Bikman Yeah, what a wonderful question. So there’s a lot of dimensions to this. One is that no question, having more muscle makes you inherently more insulin sensitive, just because muscle is the main it is the lion’s share either of glucose. So when we’ve gone and eaten that bagel, glucose has come up, what is it comes down 80% of where that is going is to the muscle. And so if you just have more and more muscle, well, then that just means you’re dropping that glucose that much faster. Because insulin comes, starts knocking on any doors that can and there’s so much muscle, well, the insulin is like going through a crowded neighborhood. It’s like an apartment building, knock, knock, knock open up, here’s the glucose, glucose glucose. And so the glucose drops, the less muscle you have, the longer it’s going to take for you to clear the glucose because insulin just doesn’t have as many places to tuck the glucose away and out of the blood. Now, then to move into the discussion of protein, I think the conversation has gone too far. Interesting. As much as I am a long advocate of protein. Indeed, I was defending protein before many were in the low carb keto space, because I saw the trend to just be eating fat, fat, fat, fat, fat, and I thought that’s not natural for everyone to just be drinking MCT oil all the time. In nature, protein and fat come together, we pull them apart sometimes. And I’m not saying that’s not warranted, like in any animal fat, like butter, or ghee, or whatever. We’ve pulled it from the protein that was meant to come with it. But then the fat from the fatty fruits like coconuts, olives, avocados, of course, there was no protein there in the first place. And that’s just the fat. But protein is not meant to be consumed without fat in nature, there is zero instance of protein existing without Feck. It doesn’t happen. And so in our hubris, we think we know so much, we’ve pulled the two apart in our obsession and love of protein. Well, I love protein, too, and I get it. And I think we ought to prioritize it. But it should come with the fact that naturally wanted to come with it. When protein and fat are consumed together, we digest the protein better literally, by by using bile acids, it actually facilitates protein digestion. And second, it’s more anabolic. You can grow muscles bigger and faster by taking fat and protein compared to just protein alone.
Dr. Mindy Interesting. So do you would you say that one gram of protein for every body, pound of body weight is an over estimation of what to know?
Dr. Ben Bikman No, that’s probably that’s probably okay because Have it unfortunately, as much as I align myself with America, the US now I still think metrically because of my Canadian roots. So
Dr. Mindy we’re a worldwide audience. I should have tried. Yeah,
Dr. Ben Bikman good. So usually around. Yeah, it won’t quite be that high, but about one and a half grams per kilogram of ideal body weight, which is going to, which is almost going to be one gram per pound. That’s kind of getting close. And in fact, I would even be fine with that. But yeah, I’m okay with that number. I really am. I would just emphasize, let the fat come with it. Don’t like my fear in us prioritizing protein, which we are justified in doing protein is amazing. But I just don’t like the idea of people just eating a spoon of way, you know, or something. There should be fat that is coming with that protein, you will digest it better, and it will be more anabolic than otherwise.
Dr. Mindy Interesting. Okay, one of the other questions that was really common on our YouTube channel was about kids, how to how are we dealing with the obesity issue that we’ve got growing and kids and one of the questions came from a parent of like, and I can say that, I mean, my kids are grown now. But the peer pressure when they’re in middle school, high school, they go to everywhere they go is a carbohydrate, sugar saturated experience. How do you how do we navigate this one?
Dr. Ben Bikman Yeah, yeah, well, I love this, because I as much as I am a scientist, I am a husband and father lightyears above anything else, by way of priority. So I think about this a lot, and just how easy it is, you know, we want our kids to to enjoy life, and we want them to be able to have treats that is totally natural. And moreover, we just get freaking exhausted from all their whining when they want, you know, a bag of goldfish crackers, or whatever the hell they’re asking for. But for me, I in fact, it’s funny, we’re talking about protein, because that’s actually how I frame this. I don’t I’m very much mindful of the fact that I have, I have two little daughters. And I never want them to think too much about food. You know, I never want them to be so obsessive just because of the tendency to develop an eating disorder. And so I never want to, I don’t say, nobody can eat. We don’t eat that in our home. We never eat that kind of stuff. No, it’s Have you had some protein, huh? That’s what I always ask of you. Alright, you want you want a little bowl of goldfish crackers? Because goldfish is like meth to kids, right? Like, that’s okay. Yeah, you’re hungry. You haven’t eaten in a while? Sure, you can have some goldfish. But have you had some protein, go eat some protein. Here’s we got some cheese sticks. We got some beef sticks, we got some yogurt. And each of my kids some cottage cheese, whatever it is. Eat some protein first. And of course, my kids. None of them like the same thing, right? Because that would be too easy. So my one daughter will eat some cheese sticks. My other daughter really beef sticks, and my son will eat cottage cheese. And each of them thinks any of the others are just utterly disgusting. So you never never get the wrong thing to the wrong kid. Yeah, right. Yeah. But just go eat some protein. Okay, you’ve had all right now. Yeah, go ahead. Have some have some goldfish. I don’t care. I do care. But I just mostly care that they learn what real nutrition is. And I’ll make sure that I kind of mentioned that I’ll say, like, especially to my son, but even my daughter’s, hey, you’re doing some acrobatics, or you got lacrosse, you really need some muscle. Don’t waste some your stomach on the junk. Get that protein in there first. And you can really get your muscles and bones strong. And then if you need some extra energy. Okay, go ahead. So that’s kind of how I frame it. And I am in no way this, you know, Peridot paragon of good parenting. But that’s how I’ve tried to frame the conversation. And it seems to work. To be to be perfectly honest, it does seem to work for the most part, which again, don’t say no, you can’t have that. That’s just junk. It’s like, alright, yeah, well, that’s a treat, can you have some protein first, just so your body really knows that it needs to grow some muscle and some bone. And that that works?
Dr. Mindy Yeah. And I would, I would say, you know, my kids are grown now. But we did a lot of those kinds of conversations as well as like educating them, but also being very fluid with it, because you do not want to have them created an eating disorder app. You
Dr. Ben Bikman don’t want to be too rigid.
Dr. Mindy Ya know? What would you say? If somebody goes into the doctor’s office, they’re given a diagnosis of pre pre diabetes or type two diabetes, diabetes, and they’re told it’s genetic. What would you say to that?
Dr. Ben Bikman Yeah, yeah, I would say it very well could be all the more reason to fight that much harder. That would be the second part of this because there’s no question genetics matter when it comes to insulin resistance and type two diabetes, no question. It’s very much a fact that if someone has a parent who has type two diabetes or insulin resistance, they You will absolutely have a higher risk. No question. That doesn’t mean you give up. All that means is you have to work a little harder, unfortunately. And that means that means everyone ought to be very compassionate in this regard. Not only never judging the other person, because we cannot know what their genes and circumstances are, regardless of that, just always trying to be a help, rather than a hindrance. But but all the more but yes, a person who has been told this genetics, it probably is. But that doesn’t mean it’s hopeless. Right? Not at all.
Dr. Mindy So would you buy the theory? If you live the same lifestyle as your parents? Did, then? Yes, you’re more predetermined, but if you change totally, yeah, I love that. Totally. Yeah. Yeah. Awesome. Okay, last question. Because I want to respect your time, and this one has nothing to do with insulin, although I can talk insulin ready. Without you all day. We are doing a theme of gratitude this year on my podcast. Do you have a daily gratitude practice? And if so, what did it what is it? And what are you the most grateful for this year in 2022?
Dr. Ben Bikman Yeah, yeah, so I do. And this is easy for me, because I’m very religious person. And so I very much acknowledge in my faith, a higher power. So yeah, I, I pray, I have personal prayer every day, which is always gratitude, and a family prayer, which, honest, honestly, that has been one of the over the life of our little family now. The most touching, connecting moments, just being together, literally kneeling together and praying as a family, the kids, it turns into a spontaneous little wrestling match, it’s it, then it turns into a game of UNO or whatever. But a prayer is in our home, and always starts with what we’re thankful for. And then at various times in my life, I’ve kept a journal, which is, which is, in a way been kind of a gratitude journal, as well, just acknowledging these, these blessings, as I would call them, or just fortunate events, or whatever we want to call them. So yes, I very much have a practice of gratitude. And it’s something I believe in, for the health and well being of every soul on the planet, the need to acknowledge the good things in our lives and express gratitude for them to, to the universe or a higher power when relevant, and then even more importantly, or just as importantly, to individuals in our lives. Yeah. And then the second part of your question, what I’m the most grateful for this year, there’s, of course, a lot that I would say about my family, but just for the sake of being unique, I won’t say my wife and children. I would, I’ll say this, I’m grateful for my job, actually, I’m very, very sympathetic to people who don’t have the stability that a tenured professor does. I am very, very grateful to have the kind of career I do, for many reasons, but in this case, is things are getting so unstable, and have been for a while and it could very well get worse. To be a tenured professor is a very, is a very big thing for me to be grateful for the moment. That’s a very practical point of gratitude, but it’s very real. Yeah. And
Dr. Mindy it’s a beautiful gratitude. And what I’m going to do is dovetail on that because this is how we started off this conversation, which is and does the world need your teachings now more than ever, as the world is waking up to the fact that we’re so many people are insulin resistant. So I’m gonna encourage everybody who follows me to go follow you because you do a mazing job of explaining insulin resistance and inspiring us So Ben, I’m, I appreciate it. Yeah, super grateful for you and go go grab some dinner with your family.