Ketones vs Glucose: What Fuels Your Brain Best? @benbikman

The reason most physicians aren't speaking about this is because they never learned it. I went through the same normal training that everyone had, thinking fat was the problem and saturated fat was the peak of the problem. I no longer believe that at all. The real villain is carbohydrates. And the more refined, of course, the worse they're generally going to be. The problem with the carbohydrate crazed culture is that many people can't moderate. Too much of something will result in a resistance to that something. My attempt in the book why we Get Sick was to try to present an idea that much of chronic dise is not individual origins. It's tempting to think that they each have very distinct origins and thus it's impossible for a person to try to address all of them. It would just be too much, overwhelming. Despite whatever modest differences all of these diseases may have in their origins, they all share one single common origin. And that is.

For those listeners who are new to your work, maybe you could tell us a little bit about how you got into this world of science the first place and how your science and research background maybe brought a little bit of folding that into healthcare system today.

Yeah, yeah. There's the short version of what brought me to where I am now was having already committed to the life of an academic and wanting to become a professor and a scientist. That journey actually started with me studying, well, focusing just on muscle adaptations to exercise. But I very fortuitously stumbled on a paper that had been published in the late 90s, and at the time, this was early 2000s, that documented the degree to which the fat cells actively secrete pro inflammatory cytokines. And that was a mechanism in this early study that detailed how fat cells contribute to insulin resistance. This foundational problem at the time just, I thought, to type 2 diabetes. But that was the beginning. That was the moment where the path I'd been on immediately deviated. And rather than studying muscle adaptations to exercise, I wanted to learn more about the consequences of fat cells getting too big and that also leading to what makes those fat cells get big. In my hope, being a scientist who understands those topics pretty well, is that we are able to translate the best science into practice. But that's where, that's where I think modern day scientists need to be a little humble. I have of course, a lot I could say on the matter of academia and how disappointed I am with higher education and the direction it's gone. But I also have some disappointment for modern medicine, of course. So I don't, I'm not Sparing my, my, my criticism just for my own guys in the lab. To me, medicine is best practiced when you have a group of biomedical scientists whose career is devoted to finding answers to relevant questions. And then those answers are shared with the clinicians who then put them, who give them those ideas, life. Because the clinician is the one who's on the front line. The scientist is not. The scientist is back in the lab or in the research clinic. And so to me, the optimal practice of medicine is one that is supported on the best science and that of course involves the biomedical scientist.

Well, it's interesting, I've been perusing your websites, insuliniq and benbickman.com and it's obvious you've taken your research and scientific background and your inquisitive nature to why we're all getting sick. But you sort of folded it into helping inspire many other people to become proactive in their own health care. And maybe you could tell us a little bit about that part of what you're doing and then we'll dig deep, a little bit into insulin resistance, a little bit of the basic science. I think this is really important to really speak about it at the beginning.

Yeah, yeah. Well, I actually appreciate you, you bringing that up. It was an interesting experience for me after I earned tenure. So everyone of course understands that when you get hired as a professor at a university, you're not done. Your job isn't done. You have about six years to prove to the university that you are worth keeping around and that's tenure and, or whatever university's version of it. And after I received tenure, knowing that my job was fairly secure, I actually, I had a very honest moment of self reflection where I wondered at the relevance of everything I was doing, where I thought I had a valuable knowledge set, which is an understanding of what makes fat cells grow and shrink and why is that a problem when they're too big. I thought that was valuable information and yet I was, I couldn't deny the fact that as I continued to publish peer reviewed papers, no one would ever read them and no one would ever benefit from them. So I was humbled by the irrelevance of academia. It's almost like we're printing monopoly money. It has no value in the real world. It's a currency with only value in the tower, in the ivory tower of academia. And that then led me to ask myself, what can I do? And that was the beginning. This was about 10 years ago, almost not quite where I started putting the outline together of thoughts on a book and then thinking to myself, I want to have a way to share this book. And that was my foray into social media and ultimately the creation of insulin IQ and benvickman.com just efforts to try to share what I consider to be the best knowledge on topics of human metabolism.

And we'll dig deeper into that. But I guess the question is, and maybe this is part of your book, why do we get sick? And maybe you can just give us an overview of that and how important it is that we all work to understand some of the basic science of what's going on in this world.

Yeah, yeah, I really appreciate that question. My attempt in the book why We Get Sick was to try to present an idea that much of chronic disease is not individual origins. Where you look at Cardiovascular disease, type 2 diabetes, Alzheimer's disease, and all the other big ones that scare us, it's tempting to think that they each have very distinct origins. And thus it's impossible for a person to try to address all of them. It would just be too much, overwhelming in why We Get Sick. I present the idea, mind you, of course, supported with significant evidence. Otherwise I never would have come to that conclusion that despite whatever modest differences all of these diseases may have in their origins, they all share one single common origin. And that is in fact a metabolic origin, derivative of a problem in the master of all metabolic hormones, namely the humble hormone insulin. Most people think of insulin as having. In fact, many people think of insulin as just as a drug for people with diabetes. But of course, the truth is it's a hormone. And even then, most people think it has only relevance insofar as it helps control blood glucose. The reality is insulin dictates metabolism at every single cell of the body. And by influencing metabolism that every cell of the body, it actually influences all of these problems, not only the ones I mentioned, but also things like infertility and fatty liver disease and many more. So the idea in why We Get Sick is presenting a kind of a common soil hypothesis that despite their differences, most chronic diseases can in fact be. If you dig down deep enough, you'll get to this foundational cause of insulin resistance. And then the good news is when you recognize the relevance of insulin resistance in chronic disease, it gives you one single target.

All right? If you're not a member of the mighty tribe yet, you must, right, Just go to kilts mighty tribe and become a member. It's free. The whole intention is to bring the community of all humans to learn why this is better than this. And we invite all vegans and vegetarians, Mediterraneans and Carnivarians to Kilts's mighty Tribe. It's a meetup. It's a place to learn while you've been suffering, likely, from this. And you'll feel better on this. But what are the nuances of what you can do to feel better, look better, and live better? Because I've done it. And that's why I created the Mighty tribe, to bring you into the master class. Be the master, my friends, and join Kilts Mighty tribe. God bless. Where have we gone wrong? And I guess the question is, what's the foundation, the basis for why insulin is consistently high and elevated and causing more damage? Specifically talking about what's our dietary habits that have changed over time. And the biggest foundation, we think, is the elephant in the room, but we're just not talking about it. Yeah, in standard medicine.

Right, Right. Yeah. I mean, in fact, to start with the end of your question first, the reason most physicians aren't speaking about this is because they never learned it. And I say that with actually a little bit of compassion, because, one, we can't expect everyone to be omnipotent. As much as I understand human metabolism, I don't understand radiology, you know, for example, or I would be useless in a pathology lab. And so it's not fair to expect a person to know everything, and we only know what we've either learned on our own or been taught. So with that view in mind, you actually presented the question very well by mentioning elevated insulin. There are multiple causes of insulin resistance. And just for the sake of clarity and leaving the audience with the most actionable intel here, I would say that the most common relevant cause of insulin resistance is too much insulin. Now, that that sounds like a little bit of a paradox, or it sounds a little confusing, but it is, in fact, I think, a little intuitive, but also reflective of a fundamental biological principle, which is too much of something will result in a resistance to that something. And, you know, we could look at the metaphor of standing next too close to the speakers at a rock concert. With too much volume comes a deafness to that volume. And so when we have too much of something, caffeine, a drug, antibiotic, when there's too much of it, we become resistant to it. The same goes with insulin. And then, as you noted, that, of course, is heavily influenced by diet. When we are eating a diet that is constantly spiking our insulin, we become resistant to that insulin. And that, of course, then points the finger at carbohydrates, particularly refined Carbohydrates. But even as I say that, people are thinking of carbohydrates that come in a bag or a box with a barcode. And yet this very week, a paper was published where the singular intervention was to have people eat 2 cups of fruit every day. That's all they told them to do, add 2 cups of fruit, fruit to your normal diet. And at the end of the eight weeks, one of the only changes was that they were significantly, statistically significantly more insulin resistant than they were before they started. So even these so called unprocessed carbohydrates are not benign. The more the substance is increasing your blood glucose, the more it's going to increase your insulin. And the more you're doing it more frequently and more dramatically with more sugary or processed carbohydrates, the more you're going to be descending to that level of metabolic purgatory.

Now, as a medical doctor, we're basically taught that Mediterranean diet, lots of fruits and vegetables and three to six meals a day. And I'm just wondering, when you talk about the cups of fruit, might it be that we're just simply telling people to eat too much too frequently or there's too much food in our environment, which is one of our biggest problems? And how do we combat that and make changes to that?

Yeah, yeah, that's, that's a good question. In fact, I even appreciate you mentioning the Mediterranean diet. I can't help but chuckle at. For every one person there is to invoke the term Mediterranean diet, there's a different version of the Mediterranean diet. It's when I lived in Russia many, many years ago, I remember one of the expressions. There are as many types of borscht as there are babushki to make it. So every grandma, every babushka will make her own version of borscht. Every person who mentions the Mediterranean diet will have a different idea in mind. So the intervention here, in fact, one of the comments you made about the frequency of eating, I think, is one thing we've gotten perfectly wrong, where we simply eat too frequently. The more we are eating, especially foods with refined carbohydrates, the more we are going to be spiking our insulin. And insulin will take longer to come down than glucose will. Even if we see glucose come down after three hours or so, the insulin hasn't yet. It's not, it's not done yet. And so many people are spending every waking moment with elevated insulin because they're never giving it time to come down. And, and not to not to say that there aren't some principles of the Mediterranean diet. I'm generally an advocate of whole foods the more the food has been processed. But even as I noted in the study, simply adding fruit to the diet was enough. That singular variable was enough. And then one other comment on carbohydrates. It just happens to be the 1 class of macronutrient that humans have a hard time moderating. Every licensed dietitian. It's almost like when they earn their license, they have tattooed in their brain the mantra of moderation in all things. Stated with an almost religious fervor, as if it's in fact scripture. It's not, although the Apostle Paul I think comes close to saying that kind of idea. But it doesn't work when you talk about addictions. In fact, the nature of addiction suggests an impossibility to moderate. And it is absolute reality, human biology that there are people who are addicted to carbohydrates. And so the more we have a food culture that 1 doesn't want to acknowledge food addiction and 2 is based on those very foods that are addictive, namely carbohydrates, the more we're going to continue to have the problem. And everyone, everyone knows this intuitively. They feel this. No one listening is ever sitting around on a Friday night craving a plate of bacon and eggs. It doesn't happen. They want something sweet and gooey or salty and crunchy. And so the problem with a carbohydrate crazed culture is that many people can't moderate.

How would you define some of these diets? Now? Interesting fact for me, the American College of OB GYN recommends and only about three years ago, in an expert opinion, plant based lean meat, no red meat or very little and red wine included in that diet for pregnant lactating women. So it's no wonder that we're all got it messed up. But okay, so the problem maybe is there isn't a scientific, really a term for what a, a Mediterranean diet is. Is there one for keto or paleo diets? And maybe I'll even say carnivore diet a little bit and throw that in there. Where are we on our scientific definitions on some of these things?

Yeah, right. I think actually in that regard, when we want to drill down to very strict definitions, that is where a ketogenic diet is a clear winner compared to many other diets, not all, but many, because you can in fact quantify adherence, a person can know I'm eating a diet in such a way that is keeping my insulin Levels sufficiently low to enable or allow fat burning to such a point that I'm making ketones that I can now measure in my breath or in my urine or with a finger stick, or nowadays with a continuous ketone monitor where they have it slapped on the back of their arm. So that is one advantage of a ketogenic diet. You can confirm adherence objectively. Similarly, in being the opposite of a vegan diet, a vegan can know they're adhering to the diet by simply not eating anything but plant material. A carnivore can know for certainty that they're adhering to the carnivore diet by only eating substances that come from an animal. Now I know some people will define that even a little further, you know, whether it includes dairy or not. And I'd leave that up to the individual. I have no thought on that. But that is an advantage of say the carnivore diet, where it similar to the vegan, albeit in an opposite fashion. You can know the problem with the Mediterranean in any of those other kind of terms of diet that refer to a specific region or a people or a population, it cannot really be quantified. It's, it's, it's even a little stereotypical to assume everyone in the Mediterranean eats only one particular way, so that that term, it starts to lose meaning. Whereas the others, ketogenic or carnivore or even vegan, heaven forbid someone adopt that diet. And I say that as a scientist, as a biomedical scientist, heaven forbid they adopt such a strategy. But even still there is some clarity in its simplicity.

Well, maybe you can explain that a little bit better about a vegan diet, which is plant based only and herbivorous diet. And why do you make that statement about heaven forbid and what are your thoughts and opinions on that?

My thoughts on that are influenced as both a scientist and, and as an older man who has seen many young women in particular fall prey to this ideology, where if we're being honest in many instances, particularly a young woman, she has adopted a vegan diet as a mask for what is a deeper eating disorder. And that just becomes a pretty patina for something they're struggling with. But a vegan diet, to put it very bluntly, is totally incompatible with human survival. A human simply cannot obtain because of our monogastric digestive system. We do not have the microbiome, the polygastric digestive system of a ruminant. We cannot therefore obtain all of our essential nutrition through plants. It's impossible. There are essential fatty acids and other vitamins like vitamin B12, that are impossible to get from just plants. And so veganism is a privilege of the elite because they must be educated enough to know what they're deficient in and must be wealthy enough to afford the supplements to make up for it. And of course, for all the rest of us, we could just eat a piece of beef and then know that we are getting. And that is the counter that, that ought to be mentioned, that while a vegan diet is in fact deficient in several essential molecules, essential fatty acids, vitamin B12, like I mentioned, heme, iron, in contrast, a carnivore diet will in fact supply everything a person needs. There's nothing missing that is essential as much as people like fiber. And I have even a somewhat warm view on fiber. But fiber is more important. The more a person's eating carbohydrates, the less carbohydrates a person's eating, I submit the less helpful fiber is. I was about to use the word essential, but I caught myself. So a carnivore diet, by being meat based, does in fact provide everything a person needs.

Is a carnivore diet a single diet that you think we can thrive and survive long term without any plants?

Yeah, yeah, I do, yeah. Now, I have to. I would want to preface that answer or insert here a caveat that there are no. I'm. I like to be able to rely on randomized clinical trials. Right. As a basic scientist, that's the standard that I'd like to default to. Well, there aren't any. However, there are published reports, case reports, namely of people adopting carnivore diets. And beyond surviving, they're thriving where people are adopting carnivore diets specifically, most commonly to control autoimmune diseases. That is in fact the area of biomedical research that first really opened my eyes to the use of a carnivore diet. It was something that I had looked at a sort of out of the side of my eye and a bit wary, with some caution, until I knew people who had crushing rheumatoid arthritis or horrific psoriasis across their skin and then to see them sometime later living a life that they thought was impossible in the singular change was adopting a carnivore diet. So I, I want people to know that I am in fact relying a bit on anecdotes, which includes some published clinical case reports. But plants are not essential. Now, I'm not saying someone shouldn't eat them. I want to make it clear that I think someone can have perfectly good health and include carbohydrates. But I also think there are people who are better without having them. That there's something unique about their genetics that has them responding in a, in a, in a hyper sensitive fashion to certain chemicals that are inherent to plants. After all, to, to add to that, everything that's alive wants to live. And so by claw or by chemical, it's going to fight back and attempt to survive.

Observational studies of any significant population that's lived their entire life cycle on purely a carnivore diet. Stefanson may have, may have commented on some of that, but I'm not sure we know that each and every person never consumed other modern foods which might have been brought in or found at some time in their lifetime. Also.

Yeah, that totally. And that's why I really want people to know that. My answer involves a little bit of speculation. There are these populations like the Inuit, like the Maasai tribe in Africa, where we know that people can thrive on at least overwhelmingly meat or animal based products. But the degree to which they're opportunistic and inserting any other things here and there, you know, I think would be pretty naive to assume that's never happening. But I would also add that I think it's important for people to be careful with regards to the population. There's evidence in children with epilepsy raised on very strict ketogenic diets at the time, often that was a low protein diet which show slow growth curves. And so in children I actually have a much warmer view of carbohydrates. And I think that there is a reason to not try to put a kid on a carnivore diet or at least be very smart about it. I think women that are lactating when they adhere to a ketogenic diet, lactation itself is such a ketogenic state that she can get into ketoacidosis. It's one of the very rare instances where a person can get to ketoacidosis without being a type 1 diabetic and having sufficient insulin. So that's another population where she might deliberately want a little more carbs. But that may mean, though, even if the person was still determined to follow a carnivore diet, that may simply mean that they're consuming more dairy. Dairy, after all, does have a fairly high carbohydrate content, all things considered. And I personally actually have a pretty warm view when it comes to dairy and I don't mind if people don't. But I think that could be an instance where a person could be following the letter of the law and say, well, I am actually still carnivore, but I just am relying more on dairy now because I want those carbs and I, I don't, I don't have a problem with that.

Yeah, I, so I always look at paleo, keto and carnivore as high fat diets and consequently our sugars or carbs are lower anyway. And you know, maybe the problem is in our western world it's a lot of fruit, fiber, vegetables, seeds, nuts. Okay. If you're not high fat, but you're still, you know, most people are in plant oils in many cases or they're even in pasteurized milk products. And do you have any thoughts on how pasteurization vs raw on the dairy side might be a plus or a minus?

Yeah, yeah, I do. But, but please everyone know that I'm now going a little outside my area of expertise as a metabolic scientist, so I'm stepping a little adjacent here. But I actually am a fan of raw dairy. I especially when we know it's from a healthy cow. And so I understand the, I understand the general view of wanting to be overly cautious of when it comes to pasteurizing because you know, maybe sick cows could give sick milk. But if these are healthy animals, that's healthy milk. I want and I would want my kids and indee, we often buy milk. So perhaps I'm a little too biased to answer this objectively. In the state of Utah we can buy raw milk and we do it often. We have, we buy raw kefir. There's a local little spot here and just not too far from BYU's campus here where we live nearby, where we can go buy any, basically any version of raw dairy we want. And let me just make a note on fermentation, as I mentioned the kefir, I actually think for me as an adult, I'm done growing and, and so I don't feel the need to consume the milk sugars or the carbohydrates in the milk. After all, when, when mother mammal is making milk, it is a perfect cocktail high in all three macronutrients and that is good for young mammal to grow. Well, I'm, I'm grown. I don't feel the need to have all three. And the power of fermentation, including fermenting dairy or even other plant, plant matter for that case, is that the bacteria will eat the one thing I don't really care to have, which is the carbohydrate, while leaving behind untouched all of the protein and the fat and in fact, adding to that fat by providing short chain fatty acids, which are very beneficial metabolically. So while I go to this little shop and I'm buying raw milk for my kids to drink, and I hope they drink every drop and lick their lips when they're done, I actually am more drinking the raw kefir. Not only because I'm an old man and I have an old man's palate. I like the tartness. I like the bit of a sour little taste to the kefir, but I also just, I like the protein and the fat coming. I don't care to have the milk.

Sugars anyway, for whatever reason, I've never had kefir until this last week. Biopharm. It's perfect timing, tart as can be. And I didn't like it. But interesting enough, it's kind of like, I think about coffee. I hated the bitter taste of coffee at one point and I, I had some conversations with some friends from Scotland, Simon and wife Millie, about that and really fascinating science about the kefir grains. And, and so I'm digging a little bit deeper into this. It's interesting if you look at Pottinger's cats about raw milk or meat, better for the cats than pasteurized. I'm suspicious also that, you know, we've spent so much time consuming pasteurized milk products that the small amounts of the raw may have more benefits. Would you say it probably reflects in the microbiome benefits or are there other things also?

Yeah, I, I suspect the microbiome would benefit, although I'm always reluctant to invoke the microbiome too readily because it' such a big black box. There are so many variables, but I would say you're getting a lot of other helpful proteins, antibiotics, even in the milk, like immunoglobulins that are coming in the raw milk. Evidence that consuming raw products may actually help little kids with allergies and that that could be a part of it.

Well, you know, it's interesting. I've always thought that the, the fat in these products helps kind of suppress the microbes just enough so they're not overgrowing. And probably the bacterial and mold antibacterial and fungal properties may also help keep them, keep them at bay. But not sterile. I recently had a colitis, not sure why. And I went ten days of misery and I took some antibiotics and some ivermectin and then I wound up going right on some raw yogurt and things like that and taking smack Mensis and things like that. I generally have been against the microbiome as good for us, but I do believe that there's. That there's that natural balance because the microbes are everywhere. So then when they're overgrown, they're harmful and undergrown. There's harm in our system also. I'm not sure we know exactly what it is and I agree, the black box. But I think it's something that I have found the raw products and I'm working on kefir right now and see what, what that does for me also.

What, Robert. Mark my words, brother, you're gonna start loving it.

I already know it because I found, I found, you know, yogurt I'm a little bit better at also. And I'm gonna. I've said, okay, I'm going back. I'm gonna have a little bit at a time.

Yeah.

And I'm. I'm not sure what's going to take it, but a friend again, just met Simon and his wife Millie from Scotland. Amazing stuff. They're really the home, it's a homestead up in Scotland. And really doing things that we need to be getting back to the basics because we're not doing those things. You know, I'm curious, you know, for. For people that are curious and whether or not they may be having problems with insulin resistance, what are some of the earlier signs and symptoms maybe that people are finding and, you know, what are some of the diagnostic tests you and your team might recommend and guide and direct them to look at?

Yeah, there are. Thankfully, there are a few tells that a person can rely on, including a little bit of family history. First and foremost, if someone listening to this has a parent that has type 2 diabetes, it is exceptionally more likely that you're going to have it. Now, that's not to say there's a clear genetics to it. There isn't actually, but there's a clear familial inheritance. So it goes beyond identifying a singular gene or even a handful. So while there's no clear genes to it, there is a familial inheritance that cannot be ignored. So if you have a parent with type 2 diabetes, it's very likely you are more insulin resistant than the average individual. Similarly, if you've been told you have high blood pressure and it's been pretty persistent, that is one of the most common manifestations of insulin resistance, for reasons I won't really get into. But suffice it to say, it's just further reflection of what insulin does at the kidneys and at the blood vessels. And when it's not working well, those aren't working as well either, leading to hypertension. One last comment then a person can make before they go in and get their blood drawn. You can even look at your skin, where there are two skin disorders that are often manifested up along the collar line of the neck, conveniently enough, so no need to disrobe to see this. People can often just see this in the mirror, or someone will see it on the back of their neck around the collar line. There are two distinct disorders that a person can have, both of which are a reflection of insulin resistance. One is skin tags. Now a person's gonna know what I'm saying. As I describe it, this is not a mound of skin. It's actually like a teeny little mushroom, almost like a little column of skin just sticking up and kind of bulbing or bulging up. They're very small, but they'll clump together along the neck. People can also have these along their, in their armpits. So skin tags is a sign. And then also in those same areas, but again along the collar line of the neck, a person can have skin that has become both darkened and changed its texture to have a bit of a crunk, a crinkled tissue paper texture. That's a problem called acanthosis nigricans. And again, very common around the neck or the armpits or the groin. And that is also a sign of insulin resistance. But then beyond that, if a person has a friendly physician, or indeed a physician who is sufficiently informed, and they can get their fasted insulin measured. Now everyone note, I'm not saying glucose, I'm not saying a 1C. Those are not the same and they don't tell the same story. Insulin can be elevated a decade or more before glucose levels are elevated. This is the problem with our glucose centric practice of modern medicine. We have such a glucose centric paradigm that we wait for the glucose levels to change. But glucose and insulin are not the same thing. And insulin resistance at its earliest stages is when insulin is elevated, but the glucose is still normal. And so relying on a glucose level to change is late. That's a late marker. Insulin is the metabolic canary in the coal mine. And so if a person can convince their physician to measure their fasted insulin, then ideally you will see that that number is 6 micro units per mil or less. That's a really good sign. If it's up into the mid teens, it may still be okay and you just measured it at a high point. Because insulin does have a rhythm to it throughout a 24 hour cycle, even in the absence of eating anything. There are times when insulin, especially in the morning, where insulin's just a little higher. But then if it's high teens into the 20s, that's a pretty strong sign that your insulin levels are in fact too high. And high insulin is insulin resistan resistance.

Can you explain how insulin resistance impacts the brain energy levels and any other organ system of our body, not just the fat cells?

Yeah. Oh my gosh, yes. In fact, the. The brain is an area of research that has become a focus for my lab and we've now published a couple papers on it and more to come, particularly in the realm of ketones. And ketones are in fact a part of the story. So it has been documented that in young women in their 20s with PCOS, you can actually measure a reduction in brain glucose uptake by up to 10 to 15 or so percent. This is the work of Dr. Steven Cunain at Sherbrooke University. He's published these papers. And that level of reduction of reduced glucose uptake is also correlated with reduced cognition. So in young, seemingly healthy women of normal body weight, but with pcos, polycystic ovary syndrome, you already have the earliest signs of a brain that is starting to go hungry. And that is, in fact, the most. That is the modern and most convincing view of Alzheimer's disease. The old view that it was plaque based was never supported by the research. And in fact, now we know its origins was in falsified data. It was revealed a few years ago that the entire theory of plaques causing Alzheimer's disease was based on falsified data. And, and that was validating for those of us who criticized that view because there were many points of data to suggest it was flawed. And I won't get into it now, but the one perspective that has remained standing is that Alzheimer's is the result, at least in large part, by a brain that's going hungry. And the brain is a metabolic hybrid. It is relying on glucose or ketones at any moment. The difference between the two is that glucose in certain sections of the brain, including those involved in memory and learning, glucose as a gatekeeper, and that is the hormone insulin. Where we often think about insulin as only helping with glucose uptake at, say, the muscle and the fat cells, those same glucose transporters that are responsive to insulin are found in certain neurons of the brain that are very important when it comes to things like cognition. And wouldn't you know it, they can become resistant to insulin's effects. And as those brain cells become insulin resistant, they become less capable of pulling in glucose. And if glucose is the only fuel that's available because the more a person is spiking insulin, the more they don't have ketones in their blood, then the brain is starving even if glucose levels are elevated in the blood. ROBERT it's like a, it's like a metabolic version of the Rhyme of the Ancient Mariner. When I was in sixth grade, I was sent to the principal's office and I had to memorize parts of the poem Rhyme of the Ancient Mariner. It's the stranded sailor who's bemoaning his father fate that he's in part surrounded by water and yet he's dying of dehydration and he, he cries out water, water everywhere, nor any drop to drink. This is like the Alzheimer's brain saying glucose, glucose everywhere, nor none for me. So the brain can't get to it even though the glucose levels are elevated.

Are there times when, or it's maybe explained that sugars and or other chemicals in the plants for eating or oxalates, phytates might also be a contributing factor to insulin resistance?

Yeah, that's a good question. I actually, I'm not sure whether the antinutrients are direct contributors of insulin resistance. In fact, my, my gut reaction is that they're not. So I'm very much, I'm very much an advocate of people scrutinizing anti nutrients. I think that is a very overlooked part of the problem with plants and it's very much a problem that I have with so called plant protein as a supplement in the, in the process of concentrating, concentrating amino acids from say peas which are so deficient in amino acids you need to concentrate a lot of peas, you end up concentrating things you don't want like anti nutrients, not to mention heavy metals like lead and arsenic. But, but the degree to which oxalates or tannins or phytic acids directly cause insulin resistance, I don't think they do. But they certainly cause other problems that I won't get into because they're less metabolic. But nonetheless, that's not to say they're any less real.

I've done a lot of research on and reading really on the glycocalyx and the glycobiome and I came across a paper on hepatogenous diabetes and I'd never heard of that before.

I haven't either.

And interesting about people with hepatogenous diabetes is they have high insulin and Glucose levels and they're skinny.

Problem at the liver.

It suggests a problem at the liver. My theory here is that actually the liver may be the biggest contributor to insulin resistance than we know. And I, I also sort of had the idea that could, could insulin really be a digestive hormone or enzyme that works primarily on the liver? And as liver cellular function drops, glucose levels rise and insulin levels rise and, and it keeps on working to do the work in the liver, but eventually you become cirrhotic enough that you can't make the fat. It's just kind of a theory and an idea that I've been looking at and maybe at some point we can dig deeper into the possibilities and how these other areas, because I imagine that plant sugars could be more glycating and, and I've also, you know, looked a little bit more at post translational modification of a protein and how defective processes in the endoplasmic reticulum and the Golgi may be a big part of the damage that's happening to the insulin molecule or the other neurotransmitters or other post translational molecules that might be, be something there. Have you seen anything on those areas that, that we could talk about?

Yeah, yeah. Well, I, I very much am familiar with the formation of advanced glycation end products and their conse. In fact, one of my good colleagues, Dr. Paul Reynolds and I just published a paper not long ago finding that if you eliminate the receptor for advanced glycation end products, you can prevent diet induced obesity even in animals in a preclinical model. Now, in humans, you can't get rid of that receptor, but the idea would be that the more you're stimulating it with molecules that have been glycated, which of course is a process of spiking glucose. Although fructose actually induces glycation almost up to 10 times more than glucose does. Wow. And so it's not just a matter of glucose, but as you were actually kind of responding to the question, I, I remembered that there are studies showing lectins binding insulin receptors. So another molecule, another plant chemical would directly contribute to insulin resistance. As much as I can't envision, maybe oxalates or phytic acids. Lectins do.

I mean, in our ancient environment, prior to 10,000 years ago, how much glucose did we consume?

Not a lot.

I mean, rare. I mean it was fruits and.

But even then they're not like the ones we eat today.

Right. Rock on. So really this is a modern, modern disease of a drug world because cane sugar Was the contributing product that essentially the explorers explored the world and exploited humanity on a plant sugar based diet which ultimately in our current environment as a sugar addict, it's pretty hard to give up if would be the same as an alcoholic or a tobacco smoker because we are an environment that it's everywhere. And so ask any addict to say oh no to that. It's nearly impossible.

Yep. No, I totally agree. Yeah. This is ubiquitous. And I actually like how you mentioned human almost enslavement where it's, it's the origins or the involvement of the, of big sugar or humans obsession with sugar has led humans to do horrible things to other humans.

Yeah. And, and it's interesting, you know, the, the carnivore diet is sort of one of the most freeing dietary lifestyles to rid yourself of the majority of those that might give you some power to, to be stronger. I believe. I mean for myself when I went carnivore, my power to give up coffee and sugar of any significance or frequency and alcohol was stronger than when I was in the keto. I'm going to say keto Mediterranean world trying to moderate.

In other words, and it's correct.

And it was, was hard as heck and it was keto paleo. I healed better, keto better, carnivore nearly gone. I'm going to run through maybe five or six quick questions. What role does keto and carnivore diet relate to the metabolic benefits in insulin resistance improvement?

Simply the. When we acknowledge that frequent spikes of insulin is the main driver of insulin resistance, then anything that we can do to nourish the body, but at the same time, keeping insulin under control is going to help us eat and have the nutrition we want and need without the potential problem of insulin resistance. So because the ketogenic or the carnivore diet is avoiding the very things that spike insulin the most, you're going to be reversing the problem very, very quickly and certainly preventing it.

Do we have a metabolic spectrum where some people are able to tolerate different or more carbs than others?

Oh, sure, yeah, absolutely. That, that is true. There was a very, very good study done out of Israel that, that found this. They, one of the things I'll not forget is they had people eat ice cream and some people of course had the very expected enormous response. Yeah, well, and I didn't indulge in ice cream every day if I thought I could get away with it. But when you have a haircut like I do, you have to be a little strict about something. And that's that's diet. So some people ate ice cream and had a expected metabolic response. Other people had a very modest metabolic response. A lot of this has to do with muscle mass, physical activity. The more a person's exercising, the more they can get away with it because their, their muscles are simply consuming all that fuel very quickly.

And there seem to be some people, no matter what they eat, they don't gain weight and they say seem to be more metabolically healthy and ultimately we don't know why they eat the same thing.

Yeah, yeah, yeah. So there are people who have differences in their potential to store fat and so they will be leaner and, and there, that is actually not a difference of metabolic rate like many people believe. If anything, it could be a difference in a familial or a genetic deposition or activity of lipoprotein lipase in their fat cells. Some people have, people with obesity have significantly multiples more lipoprotein lipase activity in their fat cells than someone who's lean. And that person who's lean has significantly more activity of lipoprotein lipase in their muscle tissue. So the fat is more inclined to get diverted to burning than it is to storage.

Yeah, so that I've heard something about like in their fat cells, the brown, brown fat tends to heat up a little bit more, metabolize a little bit faster. But, but that's an interesting point you brought up.

Yeah. Differences in brown fat. Also explained there are humans, this is human evidence suggests that people with more and more active brown fat have a resistance to diet induced obesity.

What are some of the biggest misconceptions about keto and carnivore diets?

Yeah, you know, I'd say the most common misconception is that ketones are, some are somehow harmful to the brain. Just to, just for the sake of time, I'll pick the easiest one, the one I've heard the most, that is one I have probably heard the most, that people will say ketone or keto diet will burn your brain. And, and I don't know where that comes from. And then the irony is that ketones are actually probably not only helpful for the brain, but the preferred brain fuel. And just to put a fine point on that, Dr. Cahill, George Cahill, decades ago, maybe the most famous starvation scientist, which is to say no one knows who he is, but he's a legend in that specific realm of research. He documented that if, if blood levels of ketones are, are even half of what glucose is, the brain is getting about twice as Much of its energy from the ketones over the glucose. And so if the brain has any preferred fuel, it's. It's ketones. That's the irony in such a concern.

What are your thoughts about fasting?

Yeah, I'm generally an advocate of fasting, although as a college professor who deals with young women who tend to take the idea of fasting a little too far far I've, I have a little bit of a, some wariness. I think as we get older and leaner, fasting is something we should do less frequently. And indeed as a person gets leaner, the difference between fasting and starvation is how much fat do you have to burn? That's very important. And then maybe one final comment on fasting is as much as people obsess over the length of their fast, that is not the most important variable when it comes to a fast. What you eat when you finish your fast is much more important than how long you fast.

And what's your thoughts on what we should eat when we finish our fast?

Don't spike your insulin. In fact, that is to me the simplest rule there is. I actually define calorie fasts compared to a metabolic fast. That all of the biochemistry of a fasted state that happens when you're not eating anything, no calories whatsoever. I shouldn't say all of the metabolic state, but much of it is mimicked in just a low carb diet or no carb, that when you do eat, focus on what your body actually needs, not what it's craving perhaps. So focus on protein and fat, not the carbohydrates. And in many people, the longer they fast or the poorly controlled their fasting, it's the carbohydrates that they not only crave but that they will binge on when they're done. That's why I say what you eat at the end matters more because many people turn fasting into a binge purge cycle where they, they end up eating all kinds. They eat 15 Krispy Kreme doughnuts only to feel profound shame and, and they determine to do better tomorrow. Just to repeat the whole thing again and again.

I've always said that the conversation of politics, religion and diet seem to have very big similarities where we can't all agree on one thing. And I'm sure the scientific world is not very different than that, but it gives us a lot of great stuff to dig deep into. How do you respond to critics who say low carb diets aren't sustainable?

Yeah, so yeah, people will say that about you know, they'll say, well, I did a ketogenic diet, I lost weight, but I gained it all back when I got off it. And I always sort of laugh at the, I don't mean to be rude, but sort of the stupidity of that kind of view, where of course, of course the benefits of a particular diet are only going to last as long as you're on that diet. And so it's always funny to me because you could say the same thing about someone with fervor jumping onto a vegetarian diet. I was on a vegetarian diet which is generally somewhat nutritionally deficient and I lost weight, but then when I got off it, I gained it back. You could say the same thing, and indeed I will. As much as people want to say, well, there's no long term data on ketogenic diets, there's also no long term clinical studies on vegan diets and yet no one has a hard time promoting that. So I think that's a pretty weak argument.

And anything we do with vigor in a short amount of time often makes us feel better. But it's long term stuff that I think the vegan diet may fall apart and be harder to. Oh yeah, coming from your point of view, with benbickman.com, insuliniq.com if someone is interested in improving their insulin sensitivity, where should they start?

Yeah, well, right, I appreciate you mentioning those resources. Naturally, I would love for people to find some benefit if they need a little more help. BenBickman.com is intended to just be me flexing my muscles as a professor and a scientist and just teaching ideas. And then insuliniq.com was designed with the person who needs the coaching help in mind. But short of that, I would say just change breakfast. Anyone who's listening, who's concerned, start simple. Change breakfast tomorrow. Just let that be at least one meal tomorrow where you don't eat refined carbs, any carbohydrates, perhaps let that be the one meal where you only eat protein and fat. Give your insulin levels the opportunity to stay lower for longer because overnight insulin has been coming down as you've been fasting overnight. So when you break your fast, let that be as far out as possible from the morning where you're avoiding carbohydrates. Focus on the foods you need and that's always going to be proteins and fats and less of what you don't need, namely the carbohydrates.

I grew up on cereals and I had bad adhd, ocd, depression, dyslexia, Couldn't read. And so, you know, I think. I mean, is cereal a whole food that our ancient brothers and sisters ate?

Robert, you are. You're triggering an addict here. Because perhaps, like you, to this day, if there's any one single item that I cannot moderate my behavior with, it's. It's cereal. In fact, to the point that it has influenced my whole family dynamic, people will give me a little compliment when I tell them I make breakfast for my children every morning. It's something I've always done. And they will say, oh, it's because you love your kids so much. Yes, I do. I, of course, adore them. But it's because I don't want cereal in the house because daddy is a little crack cereal addict. And if we have cereal in that pantry, it does not matter how much I know. This is just another testament of the difference between knowledge into action. As much as I know, I will find myself crawling back to that box of cereal, pouring out a little bowl, telling myself, don't do this. And then another voice saying, I'm just going to have a little. When I know I can't just have a little. I can't moderate when it comes to cereal. So I think cereal is. Is meth in a bowl.

Someone equated cereal to Doritos. Just, you know, crack seeds and nuts. And ultimately, we make them taste good, which they have the same harmful effects. How important is exercise? Yeah, or insulin resistance?

Yeah, exercise is very important. Now, not as important as diet. Diet reigns supreme when it comes to improving insulin resistance, but exercise is enormously going to help. The more we're working a muscle, and most importantly, the more we are building our muscle mass, the more we have hungry mouths to feed. And those mouths will happily use glucose. In fact, 80% of the drop in glucose. So if someone's wearing a CGM and they spike their glucose up, 80% of when it's coming down is going into muscle. So the more muscle we have, the more we can correct blood glucose excursions and keep it at a good level. And insulin doesn't have to work as hard. And in fact, during exercise, insulin levels plummet. And so that's a period of the day whenever we're exercising where insulin levels will get very low, because as we activate the sympathetic nervous system that has a direct inhibition on the beta cells producing insulin to directly inhibit insulin production.

Are you a proponent of continuous glucose monitoring, and is that a good way for people to get a track of what's happening in their body?

Yeah, yeah, I am, actually. I think that part of the value of a CGM is that a person doesn't need someone to be wagging their finger at them. They see what's happening in their own body. So I think that a lot of the power of the CGM is a person can see what's happening and they become their own, they initiate their own change because they look at what's happening and they don't want it to happen. And so they start making the changes rather than having to have someone tell them what to do.

And what I found on insuliniq.com is you're empowering people with knowledge and coaching and more. And that's one of the things I think is important in this world of social media and those with experience like yourself, teaching people to empower them directly so we can teach the doctors. That's, I think, one of the important things.

That's one of my great hopes. In fact, of course, you're right there on the front lines and, and I often think that as much as I have value, I hope where the individual hears me say something or teach something and they make a change. If I can convince one physician, then I potentially can impact the lives of hundreds of their patients.

I do believe social media and medicine and what coaching and empowering everyone with the knowledge that took a lot of time and money to go to medical school, residency, and it's all at a fingertip on these devices today, that that's the power. What are the most exciting findings coming out of your lab and other metabolic research right now?

Yeah, yeah. So we're working on a, I'll just mention for the sake of time, one paper that we're, we. I just submitted it for peer review. The very frustrating slow process now where we looked at people who adopted a traditional weight loss diet, namely a calorie restricted diet, and then we compared that to a group who adopted the same calorie restricted diet but simply supplemented with exogenous bhb or they supplemented with ketones, real ketones, bhb. And one of the concerns with a low calorie weight loss, which I'm generally not an advocate of, I generally tell people lose weight just by controlling your insulin, not your calories. But one of the consequences with generally calorie reduced approaches is that you stand to lose muscle mass or lean mass as well. Interestingly, what we found is that the people who just supplemented with a few grams of BHB every day, they maintained their lean mass in the midst of the weight loss. So their lean to fat mass ratio was Significantly better improved over the people that were just doing the calorie restriction. And so that might be. We speculate that it's part of the signaling of BHB at the muscle. BHB is known to defend muscle, and that could just be what we're seeing.

So beta hydroxybutyrate, which is a ketone body, so supplementation with these products may be helpful in those that are, that are seeking a healthier lifestyle.

Yep, that's right. And I would just add, just as a point of clarity, not all ketones are what you think they are. That some people market supplements as ketones, when in fact it's simply an alcohol that can get converted into ketones, although not without some damage to the liver on the way.

So more research and knowledge on that before we jump on that bandwagon. How's your thinking evolved over the years about insulin and nutrition?

Well, I, I think I've, I'll, I'll, you know, briefly repeat myself. My evolution has been to recognize the villain, and it wasn't who I thought it was. I went through the same normal training that everyone had, thinking, thinking fat was the problem and saturated fat was the peak of the problem. I no longer believe that at all. I, in fact, think it's the base of the Food Guide pyramid that led us astray. We had a faulty foundation from the origins. And so the one thing I've learned the most is that the real villain is carbohydrates. And the more refined, of course, the worse they're generally going to be.

If you could change one thing about how we teach nutrition and metabolism and medicine, what would it be?

Yeah, it would be that. In fact, I say that as a guy who just got back from Washington, D.C. in a meeting to discuss the potential to change the dietary guidelines for Americans. It's a very discouraging process. To be perfectly frank, there are so many vested interests involved in all of this that it leaves me somewhat skeptical. As much as I am generally hopeful at this moment in time where we have people who are in charge of certain areas of government that are very disruptive. I think that's a good thing when, when things need to change. And so while I have a sliver of optimism, I know that there's a lot of competing voices, and, and so I, I, I think that the sooner we can incorporate rational nutrition teaching into med school curriculum, the more we accelerate.

The whole thing, because we have to include science and medicine if we want to make a major impact on people's health and wellness. We know that's still a big foundation out there. So. Well, Dr. Ben Dickman, this has been such an insightful conversation and truly one of the foremost experts on insulin and metabolism. And just for everyone out there, if you've enjoyed this episode, make sure to check out Dr. Bickman's book, why We Get Sick and follow his work at his websites. It's benbickman.com and insuliniq.com and as always, if you found value in this conversation, share it with a friend. Leave us a review and help us spread the word about real science based Health. And Dr. Bickman, thank you Ben. Really appreciate you being here and we look forward to continuing following you. Thank you so much.

My pleasure. Thanks so much.