#104 Dr. Ben Bikman: How To Reverse Insulin Resistance Through Diet, Exercise, & Sleep
Dr. Ben Bikman, a professor of physiology and developmental biology at Brigham Young University, explores insulin resistance as a root cause of chronic diseases. He details dietary culprits, environmental factors, and actionable strategies for improving metabolic health, including insights on GLP-1 agonists.
Deep Dive Analysis
17 Topic Outline
Introduction to Insulin Resistance and Dr. Ben Bikman
Hidden Insulin Resistance with Normal Glucose Levels
Detecting Insulin Resistance with CGMs and Skin Signs
Insulin Resistance as a Root Cause of Chronic Diseases
Obesity, Ectopic Fat, and the Origins of Insulin Resistance
Insulin's Diverse Roles Beyond Glucose Control
Dietary Fats, Carbohydrates, and Insulin Resistance
Metabolic Advantages of Low-Carb Diets and Exercise
Impact of Meal Timing and Frequency on Insulin Sensitivity
Environmental Factors and Medications Affecting Insulin Resistance
Strategies to Reverse Insulin Resistance in 90 Days
Supplements for Improving Insulin Sensitivity
Fat Cell Dynamics: Hyperplasia vs. Hypertrophy
GLP-1 Agonists: Mechanisms, Dosing, and Long-Term Effects
Insulin vs. Glucose: Drivers of Accelerated Aging
Key Biomarkers for Predicting Biological Aging
Practical Takeaways for Improving Metabolic Health
7 Key Concepts
Insulin Resistance
A state where the body's cells, particularly muscle, liver, and fat tissue, become less responsive to insulin, requiring the pancreas to produce higher and higher levels of insulin to maintain normal blood glucose. This often develops silently for years before blood sugar abnormalities become apparent.
Glucose-Centric Paradigm
The conventional clinical approach to monitoring metabolic health primarily by measuring blood glucose levels, often overlooking elevated insulin levels (hyperinsulinemia) which are an earlier indicator of insulin resistance.
Acanthosis Nigricans
A skin condition characterized by darker, crinkled, tissue-paper-like skin texture, typically around the neck folds. It is a strong visual indicator of insulin resistance, regardless of skin pigment.
Ceramides
A type of lipid molecule that, when accumulated in tissues, can directly block insulin signaling pathways (specifically phosphorylation events like AKT activation). Elevated ceramides are implicated as a direct cause of insulin resistance, unlike inert triglycerides.
Hyperplasia (Fat Cells)
The process of increasing the *number* of fat cells. Some ethnicities and women tend to store fat this way, which allows for more fat storage without individual fat cells becoming excessively large and dysfunctional.
Hypertrophy (Fat Cells)
The process of individual fat cells *increasing in size* rather than number. This leads to larger, sicker fat cells that become insulin resistant, hypoxic, and pro-inflammatory, contributing more significantly to metabolic dysfunction.
GLP-1 Agonists
A class of drugs (like semaglutide) that mimic the naturally produced gut hormone GLP-1. At lower doses, they primarily inhibit glucagon, helping control blood glucose. At higher doses, they delay gastric emptying and activate central satiety centers, leading to reduced appetite and weight loss.
17 Questions Answered
Yes, millions of people are in a 'pre-pre-diabetes' state where insulin levels are persistently elevated to keep glucose in check, flying under the radar of conventional glucose-centric tests.
CGMs are most useful for monitoring dynamic glucose changes; if glucose levels aren't back to normal within about two hours after a carbohydrate-heavy meal, it suggests a problem.
Acanthosis nigricans (darker, crinkled skin, often around the neck) and skin tags (small, mushroom-stalk-like growths, often around the neck or armpits) are strong indicators.
Insulin is a powerful hormone affecting every cell in the body; insulin resistance leads to some cells under-responding and others over-stimulated due to high insulin levels, contributing to conditions like Alzheimer's, PCOS, fatty liver, and hypertension.
While obesity is linked to insulin resistance, the relationship is nuanced; insulin resistance can arise quickly from stress, inflammation, or too much insulin, or slowly from fat tissue dysfunction, particularly when fat cells grow in size (hypertrophy) rather than number.
Insulin regulates fat storage, inhibits the enzyme aromatase (affecting testosterone-to-estrogen conversion), influences nitric oxide production (affecting blood vessel dilation), and impacts appetite regulation and inflammation.
Refined carbohydrates and sugars are primary culprits, causing insulin spikes. Saturated fats can be problematic in the context of a high-carb diet but less so with low-carb. Seed oils are generally harmful but not a primary cause of insulin resistance.
Eating multiple small meals a day, especially starchy or sugary ones, can lead to chronic insulin elevation. Fewer meals (2-3 per day) with longer breaks, and eating earlier in the day, are generally better for insulin sensitivity and sleep.
Yes, even one bad night of sleep can cause acute insulin resistance by elevating stress hormones like cortisol and epinephrine, which directly impair insulin signaling.
Studies show diesel exhaust particles can lead to fatter fat cells even with calorie-matched diets, and vaping particles may harm mitochondrial function. While impactful, these are generally lower-tier concerns compared to diet and exercise.
Yes, statins can increase type 2 diabetes risk in women, corticosteroids promote rapid weight gain by activating stress pathways, and atypical antipsychotics often lead to weight gain by affecting satiety centers.
Clinical reports show that significant improvements, such as reversing type 2 diabetes (A1C from 8.9% to 5.6%), can be achieved in as little as 90 days through dietary and lifestyle interventions.
Yes, apple cider vinegar can reduce hepatic gluconeogenesis and stimulate AMPK, improving glucose control. Exogenous ketones can act as signaling molecules, improving metabolic markers and satiety.
Subcutaneous fat (under the skin) can grow through hyperplasia (more cells) or hypertrophy (larger cells). Visceral fat (around organs) primarily grows through hypertrophy due to limited space, leading to larger, sicker, more inflammatory fat cells that contribute more to insulin resistance and disease.
These drugs inhibit glucagon, delay gastric emptying, and activate central satiety centers, leading to reduced appetite and food intake.
Persistent chronic mTOR activation by high insulin levels (inhibiting autophagy) and high glucose levels (causing glycation and sorbitol accumulation) are key drivers, with insulin often considered the main villain and glucose its partner.
Fasting insulin (ideally <6 micro units/mL), triglyceride to HDL ratio (ideally <1.5), and uric acid (lower is better) are strong indicators of metabolic health and predictors of longevity.
28 Actionable Insights
1. Address Insulin Resistance as Root Cause
Recognize insulin resistance as a common origin for most chronic diseases, simplifying the approach to improving overall health and longevity by focusing on this core issue.
2. Measure Fasting Insulin Annually
Request a fasting insulin measurement as part of your annual blood tests, as it’s the earliest indicator of insulin resistance, often decades before glucose levels show a problem. Aim for levels below six micro units per mil for optimal metabolic health.
3. Control Carbs, Prioritize Protein, Fat
Adopt a dietary strategy to control carbohydrate intake by focusing on whole fruits and vegetables (mindful of sugary/starchy ones), prioritize protein, and consume natural fats accompanying protein sources without fear. This approach effectively lowers insulin and promotes fat burning.
4. Optimize Breakfast to Control Insulin
Change your breakfast habits to avoid early morning insulin spikes, which can disrupt metabolic flexibility. Either fast through breakfast (consuming only non-caloric drinks) or choose low glycemic load vegetables, berries, protein, and fat to extend the insulin-low state until lunch.
5. Prioritize Sleep to Prevent Insulin Resistance
Ensure adequate, quality sleep, as even one night of poor sleep significantly elevates stress hormones like cortisol and epinephrine, leading to acute insulin resistance. Good sleep is fundamental for maintaining metabolic health.
6. Build Muscle for Glucose Clearance
Engage in strength training to build and maintain muscle mass, as muscle is the body’s largest consumer of glucose. More muscle provides a significant metabolic buffer, helping to clear glucose from the bloodstream more efficiently and improving insulin sensitivity.
7. Control Insulin Before Calorie Restriction
Prioritize lowering insulin levels through dietary changes before strictly cutting calories for weight loss. This approach leverages metabolic advantages like increased metabolic rate and ketone excretion, making calorie reduction more sustainable and preventing rebound hunger.
8. Avoid High-Fat, High-Carb Combinations
Eliminate diets that combine high amounts of saturated fat with refined carbohydrates, as this combination is uniquely detrimental to metabolic health, promoting fat storage, insulin resistance, and adverse cardiovascular outcomes.
9. Eat Whole Foods, Avoid Processed
Focus on consuming whole, unprocessed foods and minimize items from bags and boxes with barcodes. This strategy naturally eliminates refined starches, sugars, and seed oils, which are primary drivers of insulin resistance.
10. Prioritize Strength Training to Failure
If time is limited for exercise, prioritize strength training and aim to reach muscle failure during your sets. This method offers superior improvements in insulin sensitivity compared to aerobic training for the same time investment.
11. Exercise After Meals to Blunt Glucose
Incorporate 10 to 15 minutes of physical activity, such as a walk, immediately after your largest or most carbohydrate-heavy meal. This ’exercise snack’ can significantly reduce post-meal glucose spikes and the associated insulin response.
12. Avoid Evening Snacking
Refrain from eating snacks in the evening, especially sugary ones, as going to bed with elevated blood sugar can activate the sympathetic nervous system and increase body temperature, leading to disrupted sleep and compounding metabolic issues.
13. Stop Eating Hours Before Bed
Aim for a minimum three to four-hour gap between your last meal and bedtime. This allows for complete digestion and prevents hyperglycemia and fullness from interfering with sleep quality and metabolic recovery.
14. Lower Insulin for Metabolic Advantage
Understand that maintaining low insulin levels promotes two key adaptations: a higher metabolic rate (burning 200-500 extra calories daily) and calorie excretion through ketones. These benefits provide ‘metabolic wiggle room’ to prevent fat storage and manage weight.
15. Target Visceral Fat with Epinephrine
To specifically reduce visceral fat, engage in activities that increase epinephrine, such as high-intensity interval training (HIIT) and deliberate cold exposure. Visceral fat cells are more responsive to these sympathetic nervous system activators.
16. Use Apple Cider Vinegar Before Meals
Consume a couple of tablespoons of apple cider vinegar diluted in water before your most starchy meal. Its acetic acid content helps reduce hepatic glucose production and stimulates AMPK, improving glucose uptake and lowering post-meal glucose curves.
17. Explore Exogenous Ketones
Consider supplementing with exogenous ketones to gain some benefits of ketosis, such as improved metabolic markers and appetite control, without strictly adhering to a ketogenic diet. This can be a viable approach for those seeking ketone benefits.
18. Check Skin for Insulin Resistance
Regularly inspect your skin, particularly around the neck and armpits, for signs like darkened, crinkled patches (acanthosis nigricans) or small skin tags. These are strong visual indicators of insulin resistance that can improve with lifestyle changes.
19. Monitor Post-Meal Glucose Response
Utilize a continuous glucose monitor (CGM) to track dynamic glucose changes after meals. If your glucose levels remain elevated for more than two hours after a carbohydrate-heavy meal, it suggests a potential problem with insulin sensitivity.
20. Eat Smart for Metabolic Health
Prioritize intelligent food choices to achieve and maintain leanness and overall metabolic soundness. A well-considered diet is generally more effective for long-term metabolic health improvements than exercise alone.
21. Front-Load Your Daily Calories
Structure your eating schedule to consume the majority of your calories earlier in the day, such as having a substantial breakfast and lunch. This meal timing strategy can lead to better metabolic outcomes and improved insulin sensitivity.
22. Low-Carb Allows More Saturated Fat
If you are consistently following a low-carbohydrate diet, you can generally consume more saturated fat without negatively impacting insulin resistance. This is due to altered metabolic pathways that reduce endogenous saturated fat production.
23. Prioritize Low Glycemic Carbs
Focus on consuming carbohydrates with a low glycemic load, such as cruciferous vegetables, berries, and citrus fruits, as they have minimal impact on insulin response. Individuals with type 2 diabetes should exercise caution with very sugary fruits.
24. Avoid Insulin Therapy for Type 2
For individuals with type 2 diabetes, be aware that insulin therapy, while lowering glucose, can paradoxically worsen overall metabolic health by increasing hyperinsulinemia, leading to more fat gain and higher risks of heart disease and cancer.
25. Microdose GLP-1s for Habit Change
If using GLP-1 agonists, discuss with your clinician a microdosing and cycling approach, framing the medication as a temporary aid to help rewire eating habits and control cravings, rather than a lifelong weight loss solution. The goal is to establish sustainable independent habits.
26. Consider Berberine for Insulin Sensitivity
Explore berberine supplementation as an effective way to improve insulin sensitivity.
27. Sustain Habits for Lasting Health
Recognize that any improvements in metabolic health achieved through lifestyle changes will only persist as long as those changes are maintained. Consistency and adherence to new habits are crucial for long-term benefits.
28. Manage Social Media Engagement
Be mindful of the time and energy invested in social media, as it can be a ‘black hole.’ Adopt a ’light touch’ approach to engagement to prevent it from negatively impacting other aspects of your life.
9 Key Quotes
The skin is a window to the metabolic soul.
Dr. Ben Bikman
Hunger always wins.
Dr. Ben Bikman
You can't out-exercise bed.
Dr. Ben Bikman
High-fat, high-carb is the worst combination for every outcome.
Dr. Ben Bikman
The more a person has a dietary ideology that's just simply based on the idea of don't get your carbs or don't get your food from bags and boxes with barcodes, you're getting rid of both the refined starches and sugars and the refined oils.
Dr. Ben Bikman
The single most predictive variable of my glycemia in any given day is how did I sleep.
Dr. Ben Bikman
Insulin is like a fertilizer for fat cells.
Dr. Ben Bikman
Insulin will promote aging by, by an, in a persistent chronic mTOR activation.
Dr. Ben Bikman
The Joker, the main villain is the insulin. And then the glucose would be like Harley Quinn, sort of Joker's right hand gal in this case.
Dr. Ben Bikman
2 Protocols
90-Day Insulin Resistance Reversal Protocol
Dr. Ben Bikman- Control Carbohydrates: Eat whole fruits and vegetables liberally. If type 2 diabetic, be mindful of the most sugary or starchy fruits (e.g., tropical fruits like bananas, pineapples, mangoes) and starchy vegetables (e.g., those that grow in the ground).
- Prioritize Protein: Ensure adequate protein intake.
- Don't Fear Fat: Consume fats that naturally come with protein, as they aid protein digestion and anabolism.
- Optimize Meal Timing: Stack meals earlier in the day, or at least consume the bulk of calories earlier. Avoid eating within 3-4 hours before bedtime.
- Engage in Exercise: Do any exercise you enjoy and will consistently do. If time is constrained, prioritize strength training to failure. Perform 10-15 minutes of physical activity (e.g., walking) after your biggest meal to blunt glucose spikes.
- Consider Supplements (Optional): Apple cider vinegar (a couple tablespoons before a starchy meal) and exogenous ketones can support metabolic health.
Microdosing GLP-1 Agonists for Habit Change
Dr. Ben Bikman- Consult a Clinician: Discuss with a physician or expert.
- Start with a Low Dose: Use a very low dose (e.g., 0.05-1 milligram per week) of GLP-1 agonist.
- Focus on Habit Change: Frame the drug's use as a tool to help control cravings for refined sugars and starches, rather than solely for weight loss.
- Monitor and Cycle: Use for a defined period (e.g., 3 months) to help rewire eating habits. Cycle off to see if habits have stuck, and cycle back on if needed, always maintaining low doses.