How Food, Fasting & Lifestyle Can Transform Your Metabolic Health & Reduce Your Risk of Disease with Dr Ben Bikman #582
Dr. Ben Bikman, a scientist and expert in insulin and metabolism, discusses how insulin resistance is a global health problem linked to numerous chronic diseases. He explains its causes, visible signs, and practical lifestyle strategies, including diet and fasting, to lower insulin and improve metabolic health.
Deep Dive Analysis
13 Topic Outline
Defining Insulin Resistance and Its Widespread Impact
Global Scale and Causes of Insulin Resistance
Ethnic and Genetic Differences in Fat Storage
Why Focusing on Blood Glucose Misses Early Warning Signs
Visible Skin Clues Indicating Elevated Insulin
Practical Strategies for a Low Insulin Lifestyle
Fasting and Metabolic Differences Between Men and Women
Understanding Metabolic Flexibility and Inflexibility
Smart Carb Approach and Meal Timing for Insulin Control
Monitoring Tools: CGMs, Lumen, and Ketone Production
Benefits and Applications of Exogenous Ketones
Holistic View of Health and Personalizing Interventions
Final Advice for Improving Metabolic Health
8 Key Concepts
Insulin Resistance
A two-part problem where cells become less responsive to insulin's effects, and blood insulin levels (hyperinsulinemia) are chronically elevated. This state disrupts metabolic processes throughout the body, leading to a wide range of chronic health problems because insulin is the master metabolic hormone.
Hyperinsulinemia
The condition of having chronically elevated blood insulin levels. It is the second, crucial part of insulin resistance, and it is what drives many associated diseases, as high insulin tells fat cells to grow and disrupts overall metabolic function.
Personal Fat Threshold
The maximum amount of fat a body can hold before it starts to suffer metabolic consequences. This threshold varies significantly by ethnicity, with Caucasians and African ethnicities generally having a higher threshold due to their ability to make more, smaller fat cells, while East and South Asians have a lower threshold due to storing fat in fewer, larger cells.
Metabolic Syndrome
A constellation of five interconnected problems: elevated waist circumference, hyperglycemia, hypertension, low HDL, and elevated triglycerides. This syndrome was formerly known as the insulin resistance syndrome, indicating its strong link to poor insulin function.
Metabolic Flexibility
The body's ability to efficiently switch between burning sugar (glucose) for fuel after a meal and burning fat for fuel during a fasted state. This flexibility is determined by insulin levels; high insulin promotes sugar burning, while low insulin promotes fat burning. Inflexibility means being 'stuck' in sugar-burning mode, leading to hunger despite ample fat stores.
Ketones
Molecules produced by the liver when the body is burning fat for fuel. They serve as an essential fuel source, particularly for the brain, which can derive up to 70% of its energy from ketones even when glucose levels are higher. Ketones are proof positive of fat burning and also have direct signaling effects that reduce inflammation and improve mitochondrial function.
Acanthosis Nigricans
A skin problem characterized by darker, velvety patches of skin with a crinkled texture, most commonly found around the collar line of the neck, armpits, or groin. It is a strong visual indicator of hyperinsulinemia, resulting from aberrant skin growth and melanin production due to chronically elevated insulin.
Skin Tags
Small, stalk-like protrusions of skin, often appearing in areas where skin rubs, such as the neck, armpits, or groin. These are aberrant growths of skin cells that serve as another strong indicator of insulin resistance and chronically elevated insulin levels.
9 Questions Answered
Insulin resistance is a state where cells don't respond well to insulin, leading to chronically elevated insulin levels (hyperinsulinemia). Because insulin is the body's master metabolic hormone, its dysfunction disrupts energy regulation in cells throughout the body, impacting nearly every system from fat storage to aging and increasing the risk of numerous chronic diseases.
Poor metabolic health is a global epidemic; in the United States, 88% of adults show signs of at least one component of metabolic syndrome. While US obesity rates are high, many countries in South Asia, East Asia, and the Middle East have even higher rates of type 2 diabetes, indicating a widespread problem beyond just weight.
Ethnicity and genetics influence how fat is stored. Caucasians and African ethnicities tend to make more, smaller fat cells, allowing them to store more fat without immediate metabolic consequences. In contrast, East Asians, South Asians, and Hispanics have a lower ability to create new fat cells, leading to existing fat cells growing much larger, which makes them insulin resistant and pro-inflammatory, increasing disease risk even at modest body fat levels.
Blood glucose is a late marker for metabolic dysfunction. Insulin resistance often presents as elevated insulin levels with normal glucose for 5-10 years before glucose begins to rise. Relying solely on glucose measurements means missing early warning signs and delaying intervention, as many chronic diseases are problems of elevated insulin, not elevated glucose.
Two key skin signs are acanthosis nigricans (darker, crinkled, velvety skin patches, often on the neck, armpits, or groin) and skin tags (small, stalk-like skin growths in similar areas). Both are strong indicators of hyperinsulinemia and potentially advanced insulin resistance, though they are reversible with improved metabolic health.
To lower insulin, focus on controlling carbohydrates by prioritizing whole fruits and vegetables and avoiding refined sugars and starches found in processed foods. Additionally, be liberal with protein and healthy fats, as these macronutrients have minimal impact on insulin and blood glucose levels.
Fasting gives the body a break from elevated insulin, allowing levels to come down. Even 'mini-fasts' of four hours between meals can be beneficial. Lowering insulin through fasting not only improves insulin sensitivity but also increases metabolic rate and promotes ketone production, which aids in fat burning and overall metabolic health.
Yes, women's metabolism is influenced by their menstrual cycle. During the follicular phase (leading up to ovulation), women are more insulin sensitive and burn fat more readily, making fasting potentially easier. However, during the luteal phase (after ovulation), elevated progesterone can promote hunger and induce physiological insulin resistance, making fasting more challenging.
Exogenous ketones are ketone bodies (like beta-hydroxybutyrate) consumed as supplements, rather than produced by the body. They can provide benefits such as enhanced athletic performance, improved neurological function (e.g., for cognitive decline, seizures, migraines), and aid in weight loss or adapting to fasting, even for individuals not on a strict ketogenic diet.
22 Actionable Insights
1. Prioritize Lowering Insulin
Adopt a low-insulin strategy for metabolic health and fat loss by focusing on dietary changes that keep insulin levels down, rather than just calorie restriction. Lowering insulin increases metabolic rate and promotes fat burning, offering a metabolic advantage.
2. Control Carbohydrate Intake
Reduce consumption of refined sugars and starches, especially those from ultra-processed foods (‘bags and boxes with barcodes’). Prioritize whole fruits and vegetables to minimize glucose and insulin spikes, allowing for periods of lower insulin.
3. Prioritize Protein and Fats
Be liberal with protein and healthy fat intake in your meals. These macronutrients have minimal impact on insulin and blood glucose levels, helping to maintain a low-insulin state and promote satiety.
4. Practice Mini-Fasts Between Meals
Space your meals at least four hours apart, avoiding snacks in between. This allows your body periods of lower insulin, which improves insulin sensitivity and gives the body a metabolic break.
5. Aim for 24-Hour Fasting
Work towards being able to fast from calories for 24 hours. A healthy adult should be able to do this without significant effort; inability may signal metabolic inflexibility.
6. Check Visible Insulin Resistance Signs
Look for physical signs such as acanthosis nigricans (darker, crinkled skin, often on the neck) and skin tags (small skin protrusions, often on the neck, armpits, or groin). These are strong indicators of insulin resistance and are reversible with lifestyle changes.
7. Monitor Key Metabolic Biomarkers
Regularly check fasting insulin (aim for under 6), HbA1c (under 5.4, ideally 5.2), and triglyceride to HDL ratio (under 1.5) to objectively assess and manage your metabolic health. These markers provide a clearer and earlier picture of risk than glucose alone.
8. Use Continuous Glucose Monitor (CGM)
Consider using a CGM to observe in real-time how different foods and drinks affect your blood glucose levels. This immediate visual feedback can drive significant behavior change and personalize your dietary choices.
9. Use Lumen for Fuel Tracking
Experiment with a Lumen device to track your body’s fuel source (fat vs. carb burning) and use this feedback to adjust evening carbohydrate intake and meal timing. This can help reinforce beneficial habits like earlier dinners and mindful carb consumption, promoting overnight fat burning.
10. Define Deeper Health Motivation
Identify a strong, personal reason for improving your metabolic health that extends beyond just weight loss (e.g., family, longevity, quality of life). A deeper motivation will provide stronger and more sustainable drive for making lifestyle changes.
11. Change Breakfast Habits Immediately
Alter your breakfast habits starting tomorrow by either fasting through it (with non-caloric drinks, possibly with a dab of butter for ease) or by consuming a breakfast that controls carbs, prioritizes protein, and includes healthy fats. Breakfast is often the easiest meal to change socially and can significantly impact your metabolic state for the rest of the day.
12. Frame Weight Loss as Fat Cell Shrinking
When pursuing weight loss, mentally frame the process as shrinking your fat cells rather than merely reducing overall body mass. This aligns with the physiological reality of fat loss and can help with mindset.
13. Integrate Structured Fasting (If Needed)
If initial low-insulin dietary changes are not sufficient for your goals, consider integrating more formal structured fasting protocols. This can further support fat loss and metabolic health.
14. Women: Adjust Fasting to Cycle
Women should be mindful that fasting may be harder during the luteal phase (after ovulation, before menstruation) due to progesterone’s hunger-promoting effects; be kind to your body during this time. Fasting may be easier during the follicular phase (leading up to ovulation) as the body is naturally burning more fat.
15. Consider Exogenous Ketones for Benefits
Explore supplementing with exogenous ketones (specifically Beta-Hydroxybutyrate or BHB) for potential benefits in cognitive function, athletic performance, neurological disorders, and to facilitate easier fasting. Ketones are a preferred fuel for the brain and can enhance metabolic rate.
16. Choose True BHB Ketone Supplements
If supplementing with exogenous ketones, ensure you are getting actual Beta-Hydroxybutyrate (BHB) in its salt or acid form, rather than alcohol precursors. BHB is the main ketone in the blood and these forms are effective without needing conversion by the liver.
17. Athletes: Use Exogenous Ketones
Athletes on high-carbohydrate training regimens can consider exogenous ketones to gain an additional fuel source and potential performance advantage. This provides extra fuel that they might otherwise be deprived of due to their carb-heavy regimen.
18. Explore L-BHB for Heart Health
Investigate supplementing with the L-form of Beta-Hydroxybutyrate (L-BHB) for potential benefits in increasing cardiac output. L-BHB has been shown to increase cardiac output by 40% by dilating arteries, reducing the heart’s workload, which may be relevant for heart failure patients or athletes.
19. Ketones May Help Gout
Individuals suffering from gout may consider exploring ketones. Ketones have been shown to undo inflammation caused by uric acid, potentially offering rapid improvement for gout symptoms.
20. Cold Immersion for Visceral Fat
If you have more visceral fat (belly fat), incorporate interventions like cold immersion (ice baths) and exercise. These activities increase epinephrine/adrenaline which specifically targets visceral fat for breakdown.
21. Cold Immersion for Mental Well-being
Consider daily cold immersion (e.g., ice baths) to improve mental calmness, reduce anxiety, enhance sleep quality, and help regulate your body’s circadian rhythm. Cold exposure can act as a ‘wake-up’ signal and improve sleep pressure by evening.
22. Don’t Justify Poor Habits
Even if your current metabolic markers are optimal, avoid using them to justify poor lifestyle habits, especially if you are young. Poor habits can still lead to future health problems, even if current markers are good.
8 Key Quotes
Skin is a window to the metabolic soul.
Dr. Ben Bikman
Insulin is the master metabolic hormone. It is the one hormone to rule all others.
Dr. Ben Bikman
Metabolic health is best defined as looking at the degree of insulin resistance.
Dr. Ben Bikman
The size of the fat cell is what determines the metabolic consequences of that fat tissue.
Dr. Ben Bikman
Diseases are a result of the elevated insulin. These are not diseases of elevated glucose; they're problems of elevated insulin and the insulin resistance that typifies that state.
Dr. Ben Bikman
The human body does not have hundreds of thousands of calories. Indeed, the liver only has about 2,000 calories stored as glucose that it can share with the body.
Dr. Ben Bikman
Ketones are proof positive of fat burning.
Dr. Ben Bikman
Knowledge is not the same as implementing.
Dr. Ben Bikman