#102 – Insulin resistance and how it affects each of us differently (Dr. Ben Bikman & Austin McGuffie)

For many of us, insulin-spiking foods are part of our daily routine. Unless we’re paying close attention, we may not realize how much insulin we’re giving our bodies and how that affects our overall health. Content creator Austin McGuffie, AKA Metabolism Mentor, sat down with Levels advisor Dr. Ben Bikman to talk about what insulin resistance is and what it means for our metabolic health. They talked about how to approach weight loss as a daily habit, how gender, age, and ethnicity play into insulin resistance, and why managing your insulin intake matters.

05:04 – Keeping insulin low

Low insulin is a manageable approach to weight loss since it directly corresponds to diet and daily habits.

Weight loss, for me as a middle-aged bald guy who wants my wife to find me attractive, I got to stay kind of lean. I just want to keep my insulin low. And that’s a complicated story where someone hears me say that and thinks, “Ben’s just saying the only solution to weight loss is low insulin.” I’m not. I’m not really saying that. There’s an energy approach and an insulin approach. I just think the low insulin approach is more sustainable. But basically, I know that if insulin is low, a fat cell has no choice but to be breaking down fat. Lipolysis cannot be blocked if insulin is low. So anyway, myriad reasons, all of which come back to one central simple idea, which is how can I keep my insulin low? And then, in my own life, that typically means I am very, very strict with breakfast for myself. I’m very, very strict with lunch, and I’m fairly liberal with dinner because dinner is the social meal. I want to eat that with my family. I don’t want it to be weird. And so dinner will be kind of whatever the family has planned.

11:05 – Eating protein first

When coaching kids through making decisions about their food, it helps to talk about growing strong by prioritizing protein.

If they want one of those kinds of treat-like snacks, I say the exact same thing. “Hey look, you’re hungry. You’re growing. Oh man, I love that you’re getting so big and strong. It’s awesome. Can you eat a little protein first? When have you had some protein?” And I just focus on the protein, knowing that all the protein sources that we have in the house come with fat, and that’s my view of fat. Let fat come with the protein. And in some instances, we add a little if it’s like adding butter to something, of course, but even still, I have the exact same strategy as you. And I just want them to know that in our home, we prioritize some things. And I’ll just tell them, I’ll say, “Look, you want these muscles. You just got back from lacrosse practice. You just got back from karate practice. Man, isn’t it awesome to work those muscles? You need some protein. Those muscles need some protein.” And so I always try to put that in context, like, you’re growing. Your body is recovering. You’re trying to build muscle. I love it that you want that snack. You’re hungry, and you need some energy to grow. That’s great. Let’s put some protein in there first, and then let’s go that route.

13:34 – A lesson on fat cell growth

Humans develop fat cells as they are born and throughout early childhood, with their number of fat cells stabilizing by adulthood.

So the short and skinny of it is that when we’re born, we have a rapid degree of fat cell growth, and it’s kind of this kind of negatively sort of accelerating curve where there’s a lot of fat cell development and it starts during infancy. And then it keeps rapidly, it’s still going during childhood, starting to taper off during adolescence. And then typically, by the time we finish adolescence, the number of fat cells we have is generally what we’re going to keep. This has been shown out in human overfeeding studies where weight gain is a function of hypertrophy, not hyperplasia. And those are the two processes whereby a body is gaining more fat, each individual fat cell is growing, hypertrophy, or the fat cells stay rather modest in size, they’re just multiplying, so hyperplasia.

26:14 – The first form of insulin resistance

One type of insulin resistance is when insulin is injected into the body and the cells don’t receive it as effectively as they should.

To understand insulin resistance, we have to understand that it comes as a pair of problems. Always it comes in two forms. The first is the obvious form, which is what earned its name in the first place, which is when you had cell biologists treating an organism or a cell with insulin, like actually putting insulin into the system and seeing that the insulin wasn’t working as well. That gives rise to the definition of insulin resistance, per se, where insulin isn’t working the same way that it used to. Now, that is not a universal phenomenon. The body has all kinds of different cells and every cell responds to insulin, literally every cell. There’s no exception. Every cell in the body has insulin receptors, little doors on the surface of the cell that only insulin can come knock on. In some of those cells, insulin isn’t knocking as well as it used to, or the cell isn’t hearing the knocking door.

27:31 – The second form of insulin resistance

The other part of insulin resistance is hyperinsulinemia, when blood insulin levels are elevated.

Then the second part of insulin resistance, the other side of this coin, it’s a coin that we call insulin resistance. One side is the altered insulin signaling as a hormone telling the cell to do things. It’s just not doing it quite as well as it used to. The other side of the coin is that blood insulin levels are elevated. So hyperinsulinemia is the term for that. You cannot have the first side of that coin without the other side of that coin. You can have it the other way around, which is why I’m not explaining it that way and I won’t get into that, but you cannot have insulin resistance without hyperinsulinemia. That’s a problem when we start looking across the body.

29:57 – Elevated insulin causes insulin resistance

Elevated insulin causes insulin resistance, based on numerous scientific studies.

What I can say with absolute certainty is that elevated insulin causes insulin resistance. That has absolutely been shown in isolated cells. Like I could grow muscle cells in a dish, increase the insulin in the dish, and it’ll start to become insulin resistant. You can prove it in rodents, which has been done, and in humans. We know that in all three of these biomedical models, cells, rodents, humans, chronically elevated insulin will cause insulin resistance, full stop. That is absolutely known. No debating it.

31:23 – Lower your insulin intake

Changing your eating habits to reduce your insulin intake is the easiest way to rapidly change your insulin levels in your body.

I think in most people, it is the chronically elevated insulin because they eat every two hours and they’re eating insulin spiking starches and sugars. So for me, while all three of those are primary causes of insulin resistance, I put my money on the hyperinsulinemia as the best strategy, because that’s the one you can start to change immediately. If you tell someone, “Lower your stress and lower your inflammation,” they’re going to say, “Great. How do I do that? Now I’m more stressed.” And so it’s harder to do. But if you can change the insulin, you can grab that lever really, really firmly and pull that thing down in just a few hours, insulin starts to come down, the body starts to become more insulin sensitive.

36:04 – Type 2 diabetes follows a familial pattern

If you have parents with type 2 diabetes, you are 50-60% more likely to develop it compared to someone who doesn’t have parents with the condition.

This gets into the realm where it becomes muddy water because there isn’t a single gene mutation. If you and I went and did a 23andMe, or one of those kind of popular genetic testing services you can do, there is no one gene that says, oh man, boom, you’re going to get type two diabetes. It’s a much more complicated collection of mutations. They’re not even mutations. They’re just different variants of certain different genes. So, genetics matter, though. In fact, despite not having a clear genetic signature, type two diabetes follows a familial pattern of inheritance or genetic, if you will, much more than type one. People always think that type one is really a genetic disease. It isn’t really. It’s much more kind of a random mutation, a spontaneous mutation that triggers, activates someone’s autoimmune system or makes the autoimmune system more inclined to fight itself. But with type two diabetes, it is much, much tighter. Like if a person has a parent who has type two diabetes, they have like a 50 or 60 percent greater chance of developing it compared to someone who has a parent who’s neither parent has type two diabetes. So it’s much, much stronger of a familial inheritance.

38:15 – The genetics to get metabolically sick

Everyone has the cellular structure and ability to get sick from too much insulin, whether their family has a higher propensity for it or not.

Basically, every single person on the planet has the genetics to get fat and metabolically sick. And it was a survival mechanism, presumably, because it allowed us to get fat when we had the opportunity and to rely on that fat when we didn’t have food coming in. The problem nowadays is that same inclination to allow us to weather the metabolic storms in the past has created a constant metabolic storm where there’s never that famine period to allow our bodies to kind of burn through what we’ve been storing over the winter. It’s just constant feeding, feeding, feeding. And so everyone to some degree has the genetics for that, everyone to some degree. Whether it is manifested in an exaggerated obesity like you’d maybe get in a Caucasian more readily, or whether it’s a modest degree of weight gain like you’d get in someone of Chinese ethnicity, the consequences are still the same. The overall fat gain may be different, but it’s all taking us to the same end, which is poor metabolic health.

41:16 – Control carbs, prioritize protein, don’t be afraid of fat

In general, keep insulin levels low and stable by avoiding packaged and processed foods, eating lots of fruits and vegetables, and pairing protein with fat.

Control your carbohydrates. Don’t get your carbohydrates from bags and boxes with barcodes. And eat them, don’t drink them. So fruits and vegetables, my view on it is eat as many as you want. Eat fruits and vegetables. Don’t have to count. Don’t worry about it, but don’t drink them as a juice and don’t get them in some kind of processed, packaged form. Two, prioritize protein. Get animal protein and try to get around one and a half grams per kilogram of ideal body weight, and so meat and eggs. Those are just staples. And then third, don’t be afraid of the fat that comes with that protein. And if it’s a very, very lean protein, I know this is very conflicted nowadays, and a lot of prominent voices are saying, “No, it’s just protein and don’t worry about anything else.” That’s unnatural. The best proteins in the human diet over centuries, eons, have been animal proteins and animal proteins that come with fat. It was only in the last 100 years that we started eating chicken. Certainly in the US, the trends for eating chicken went from like nothing to the most common meat we eat. It’s because we became afraid of fat. Our ancestors had chickens because we wanted the eggs, and eggs have a lot of fat. That’s how we should eat them. Fat and protein come together. In our hubris, we’ve tried to pull them apart, and I don’t think that’s appropriate. So control carbs, prioritize protein, don’t be afraid of fat.

Dr. Ben Bikman (00:06):

Elevated insulin causes insulin resistance. That has absolutely been shown in isolated cells, like I could grow muscle cells in a dish, increase the insulin in the dish and it’ll start to become insulin resistant. You can prove it in rodents, which has been done, and in humans. We know that in all three of these biomedical models, cells, rodents, humans, chronically elevated insulin would cause insulin resistance, full stop. That is absolutely known. No debating it.

Ben Grynol (00:39):

I’m Ben Grynol. Part of the early startup team here at Levels. We’re building tech that helps people to understand their metabolic health. And this is your front row seat to everything we do. This is a whole new level. If you’ve heard the term insulin resistance before, you’ve very likely heard the name, Dr. Ben Bikman. He’s author of Why We Get Sick, and he’s also very close to Levels. He’s one of our advisors. Well, Austin McGuffie, who’s also a friend of Levels and very much a content creator that we work with on a regular basis, well, the two of them sat down and recorded a podcast on all the thought leadership that Dr. Bikman puts forth.

Ben Grynol (01:30):

They started off talking a lot about family. They talked about metabolic health and kids. And they ended up going pretty deep into all these different facets of metabolic health; fat cells, how they develop and change over time, things like insulin resistance. What does it mean, and how can we think about it? Why is it actually important for people at any age to pay attention to things like insulin and insulin resistance? What do gender and hormonal differences have to do? What do age differences have to do? And what does ethnicity have to do with insulin resistance? There’s a great conversation and there’s always so much to learn from Dr. Bikman. Conversations could go on, in Austin’s words, for hours and hours, and there’d be tons to learn. So love listening to the episode, and anyway, no need to wait. Here’s Austin.

Austin McGuffie (02:22):

First of all, I just want to let you know that this is a huge honor for me, because I used to be a personal trainer, and one of my clients had triglycerides through the roof. Blood sugar was crazy. And it kind of took me off my path of helping people build muscles, learn more about their metabolism. And Why We Get Sick was my introduction to pretty much everything about metabolism. And it was just written in such a friendly way. I think listening to your videos on YouTube helped me to read it in your voice.

Dr. Ben Bikman (02:51):

Yeah. [crosstalk 00:02:52].

Austin McGuffie (02:52):

Made it definitely easier to understand. So thank you for such a great book.

Dr. Ben Bikman (02:56):

My pleasure. That’s so nice. I’m thrilled to hear you-

Austin McGuffie (02:59):

[crosstalk 00:02:59] everything. Yeah. It’s awesome. So actually, I know that we’re going to get into a lot of the science, but first, I want to acknowledge you as a human being, as someone who has all this information, but was wondering if you could kind of take us through a day in your life where you have all this information about metabolism in your head. What are some of the decisions that you make on a daily basis that make for your metabolic health?

Dr. Ben Bikman (03:22):

What a fun question. That’s fun. It’s a bit different from what I’m normally asked. Frankly, Austin, that’s certainly something I think a lot about overwhelmingly. My mind is centered on my wife and kids. I mean, I just have to say that up front, I mean, just so people know that very little of my time is spent wondering about these kinds of issues. As much as I love it, the fact is, man, life is complicated, and I’m always thinking about, all right, how’s my wife doing? What do I need to do there? How are my kids doing? What do I need to do there? And then there’s a little sliver, and at church, what am I doing with church? And then there’s a little sliver of all right metabolism. Now, I’m all in. Now, let’s open that little sliver up and-

Austin McGuffie (04:02):

Go for it.

Dr. Ben Bikman (04:03):

… zoom in on it. Then it really is, it’s simple, I think. Not to say that it’s easy, because simple and easy are not the same thing. But largely, my motivation, my singular motivation is understanding insulin. And then in my own life, what am I doing to help my insulin stay low? Because so many things can get worked out with just that one paradigm. If a dietary paradigm has an insulin-centric view, it is going to do all the things that people are talking about nowadays. You want to prolong… You want your brain to work a little better and use energy better. Well then keep insulin low. That’s a staple strategy for almost every kind of intervention that we’ve found for improving brain health.

Dr. Ben Bikman (04:51):

You want to activate autophagy. There’s all these complicated stories around autophagy. Well, good luck activating autophagy if your insulin is elevated. It cannot happen. It is antithetical to this. Weight loss, for me as a middle aged bald guy who wants my wife to find me attractive, I got to stay kind of lean. I just want to keep my insulin low. And that of course complicates, that’s a complicated story where someone hears me say that and thinks, Ben’s just saying the only solution to weight loss is low insulin. I’m not. I’m not really saying that. There’s an energy approach and an insulin approach. I just think the low insulin approach is more sustainable. But basically, I know that if insulin is low, a fat cell has no choice but to be breaking down fat. Lipolysis cannot be blocked if insulin is low.

Dr. Ben Bikman (05:40):

So anyway, myriad reasons, all of which come back to one central simple idea, which is how can I keep my insulin low? And then in my own life, that typically means I am very, very strict with breakfast for myself. I’m very, very strict with lunch, and I’m fairly liberal with dinner because dinner is the social meal. I want to eat that with my family. I don’t want it to be weird. And so dinner will be kind of whatever the family has planned. If one of my kids has planned dinner, if mom is making it, or if I’m making it, it’s not just…

Dr. Ben Bikman (06:12):

I mean, if left to my own devices, it would be steak and vegetables every day, but the kids don’t want to do that, and I don’t want to force them to do that. So when it’s pizza, we’re having pizza, and I might just sometimes eat the toppings or I might eat the whole thing, and I don’t even care. Dinner is with the family, whatever it is, but then everything else, I try to be super buttoned up, super tiny. And that’s my way of taking what I know and putting it into practice in the life of a middle aged family man.

Austin McGuffie (06:39):

Right. So of all the things that you do to keep insulin low, is there anything that requires a little bit more willpower than anything else?

Dr. Ben Bikman (06:48):

Oh yeah. Yeah. That’s a great follow up. Yeah. For sure, it is not falling in, not indulging in the witching hour of the day, which is the evening for me. That is my absolute weakest time. As much as I know, it’s just such a wonderful example of the difference between what you know is right and then actually doing it. That’s relevant to all of human behavior. There’s that disconnect on occasion where I know I shouldn’t do this and yet you fall into it. And dare I even say that’s kind of an addictive sort of habit. Well, my addictions, if you will make it so that I crave junk food in the evenings. Like if we have cereal, a box of cereal…

Dr. Ben Bikman (07:32):

For example, this is funny, the audience will get a kick out of this, it was St. Patrick’s Day, and we bought lucky charms for the kids, and they never have cereal. They never have cereal like that. It’s always a homemade breakfast with lots of eggs, some bacon, and I’ll make waffles and crepes, but it’s always super high protein and high fat with relatively lowered carb for the kids. But we got lucky charms on St Patrick’s Day. Of course, the kids loved it. They had fun and it was fun. We had some leftover lucky charms that night. Well Austin, I’m telling you, man, when there is cereal in the house-

Austin McGuffie (08:05):

It’s calling your name.

Dr. Ben Bikman (08:06):

… it’s calling my name. And it is like, I’m like chewing on my knuckles kind of to try to deny myself that temptation. But that’s just kind of from my old, it’s really a habit that I picked up when I was a college student, that just became a habit. You’d come home from the… You’d go to the gym with your roommates, come home and eat three bowls of cereal, whatever. And that’s to this day, it’s 25 years gone almost, and it’s still something that just sort of every night, it kind of calls out. So that’s the hardest thing, it’s evenings. I could look at that indulgence, that treat any other time of the day and I’m totally indifferent to it. It doesn’t tempt me at all until we’ve had dinner, we’ve cleaned up, the kids are kind of in bed. It’s just kind of quiet time around nine o’clock, because all the kids are in bed by 9:00, and that’s just for mom and dad’s sake. We want the kids to go to bed so they can sleep, but mom and dad need some downtime.

Austin McGuffie (09:00):

Absolutely.

Dr. Ben Bikman (09:00):

And then it’s like, I need a bowl of cereal, and the world will end if I don’t have it. And so anyway, my solution, I just don’t have it in the house. We just don’t keep cereal in the house, not for the sake of my kids, but it’s for dad, because daddy is a little addict, and I admit it. We said we can’t have it in the house. So that’s my strategy. My strategy to control that addiction, which is very real to me, it’s that I just don’t get it in the house. I’m stronger at the grocery store than I am in the home in the evening.

Austin McGuffie (09:27):

Absolutely. That’s me too. I have a pretty bad sugar addiction myself. It’s not cereal, it’s candy. So anytime there’s candy around me, and I don’t realize it’s like a week later and I realize I’m in this candy just mania, and I look up.

Dr. Ben Bikman (09:40):

Well, you come out of your candy coma. Yeah.

Austin McGuffie (09:44):

It’s like, I don’t feel good. So I have kids myself. I have four kids between the ages of three and nine. And one of the things that I hear often from them is I’ll suggest like, hey, you want this treat, like a granola bar or something. And I know the damage that a granola bar can add to your blood sugar levels if you eat on an empty stomach. But I’m also not crazy to the point where I just want to take it away all together. So it’s like, well, hey, why don’t you try some of this protein and fat first, and then you can enjoy that. I get the eye rolls. And then it’s like, “Why do you care so much about my blood sugar?” I want to know what the atmosphere is like in your home for your kids being like you know how important it is to keep insulin low, how do you kind of coach your kids through making those types of decisions for themselves?

Dr. Ben Bikman (10:29):

Yeah. Very, very similar actually to what you do. I also don’t want to have a home where the kids look at food as forbidden. I don’t want them to leave the home someday and then just go bonkers. They go hog wild because they say, “I never have had a single chocolate bar in my whole life. Now I’m going to go insane with chocolate bar.” So I didn’t ever want it to be that restrictive. So one, we don’t have a lot of junk food in the house, but we will occasionally get some kind of granola bars for the kids that they might work into their lunches, and that’s just sort of when they eat it, they know that they’re not snacking on it, but nevertheless, we’ll have some snacks, but typically, not many.

Dr. Ben Bikman (11:05):

But if they want one of those kind of treat-like snacks, I say the exact same thing. “Hey look, you’re hungry. You’re growing. Oh man, I love that you’re getting so big and strong. It’s awesome. Can you eat a little protein first? When have you had some protein?” And I just focus on the protein, knowing that all the protein sources that we have in the house come with fat, and that’s my view of fat. Let fat come with the protein. And in some instances, we add a little if it’s like adding butter to something, of course, but even still, I have the exact same strategy as you. And I just want them to know that in our home, we prioritize some things. And I’ll just tell them, I’ll say, “Look, you want these muscles. You just got back from lacrosse practice. You just got back from karate practice. Man, isn’t it awesome to work those muscles? You need some protein. Those muscles need some protein.”

Dr. Ben Bikman (11:49):

And so I always try to put that in context, like, you’re growing. Your body is recovering. You’re trying to build muscle. I love it that you want that snack. You’re hungry, and you need some energy to grow. That’s great. Let’s put some protein in there first, and then let’s go that route. That’s so just like you said.

Austin McGuffie (12:06):

Yeah. I think in those adolescent years, obviously nutrition is very important, because not only is what we eat making up our entire biology and our brain is grown during that time, but actually just saw that you made a recent post on your Instagram page. Thank you for posting more, by the way. I know you just [inaudible 00:12:23] to doing that. You even shared some really good information.

Dr. Ben Bikman (12:26):

Austin, hey, it’s a chore. I’m not kidding. I don’t mean to be dramatic about it, but that is something that I do disdainfully. I have such a disdain for social media, and it also… My kids don’t have it, and they literally bits band. They don’t get it. No smart phones, no social media until they’re graduated from high school. Hopefully it doesn’t blow up in my face. But I have such a disdain for social media, but I also appreciate that this is a tool. And so that’s why. So every Monday, I tell myself, I got to make a video, I got to make a video. And I just sort of force myself and hype myself up into doing it. So thanks. I’m glad it’s [inaudible 00:13:05].

Austin McGuffie (13:05):

Yeah. No. It’s working. I’m sure one of the reasons it’s so disdainful is because you’re talking about such nuanced topics, but you have to do it in less than a minute. And of course, you get bombarded with all kinds of questions. And I have a few questions myself. You actually just did a post recently about fat cell accumulation, and a period of time in our lives when that is happening. I was hoping you can kind of talk more about that.

Dr. Ben Bikman (13:27):

Oh yeah. Oh glad to. Yeah. It’s impossible to convey everything I’d want to, but I never know what’s going to really resonate with people. Yeah. So the short and skinny of it is that when we’re born, we have a rapid degree of fat cell growth, and it’s kind of this kind of negatively sort of accelerating curve where there’s a lot of fat cell development and it starts during infancy. And then it keeps rapidly. It’s still going during childhood, starting to taper off during adolescence. And then typically, by the time we finish adolescence, the number of fat cells we have is generally what we’re going to keep. This has been shown out in human over feeding studies where weight gain is a function of hypertrophy, not hyperplasia. And those are the two processes whereby a body is gaining more fat, each individual fat cell is growing, hypertrophy, or the fat cells stay rather modest in size, they’re just multiplying, so hyperplasia.

Dr. Ben Bikman (14:22):

Now, in all its full color here, females do have a greater propensity for hyperplasia, particularly in the gluteofemoral fat. That’s the fat on the thighs and the butt, basically. And that’s because estrogen, estrogen provides a hyperplastic signal to those fat cells. So if a woman, even if she’s an adult now, she’s a woman, I would say, well, the fat cell number is set. However, if there is sufficient energy and sufficient insulin to tell her body to store more fat, then she can activate more hyperplasia at the gluteofemoral fat pad. Now much to her chagrin, means her thighs and butt are getting bigger. However, that’s also why a female will very, very often be fatter, have more fat, that’s a more polite way, have more fat than a male and yet be healthier, because hyperplastic fat cells, which are smaller, are much healthier. They’re much more insulin sensitive and they’re less inflammatory. And maybe I’ll come back to those two points in just a second.

Dr. Ben Bikman (15:28):

But suffice it to say, whereas typically an adult has a set number of fat cells, in women, it actually can fluctuate a little more based on estrogen levels. And then that level is fairly static throughout the life of the individual. And then when they get to around the age of 65 or so, then fat cell number actually starts to go down. Now, even throughout this adulthood period, fat cells are not immortal. That’s a common misconception. Even on college campuses, you’ll have an atomist or cell biologist say fat cells are immortal. You have a bunch of 20-year-olds groaning, “Oh, that sucks.” And the professor gets a laugh from the 100 students. That’s just not true.

Dr. Ben Bikman (16:04):

Fat cells are long lived though. They live for about 10 years, but during that kind of static phase, for every one fat cell that dies, it’s simply replaced by another, until later age, around 65 or so, it starts to come down, and we aren’t replacing fat cells anymore. So now our fat cell number goes down. Now to the lay audience, they’d say, well, that’s a great thing. I want to get rid of my fat cells. You don’t actually. We don’t want to get rid of fat cells. We want our fat cells to shrink. We don’t want to lose a fat cell number, because what happens is the person’s reaching that now reduction in fat cell stage, if they’re still eating a diet that is sufficiently high in energy and insulin spiking that is wanting their body to store the same amount of fat they had, like overall fat mass, then as you’re losing fat cell number, of course the remaining fat cells are picking up that energetic slack and they all undergo hypertrophy.

Dr. Ben Bikman (17:00):

Now, to finish the story, back to the two things I’d mentioned with how women can have more fat and yet be metabolically healthier than men, which is universally the case, it’s that when a fat cell starts to hypertrophy, once it gets to around four or five times bigger than normal, which is about like 100 micrometers, which is pretty considerable for a cell, it has reached a point of maximum dimension. It simply can’t get bigger without suffering consequences, even potentially bursting, which would be very, very unhealthy. And so it starts to become resistant to insulin, because insulin tells fat cells to grow, and it’s basically the fat cells saying, “Hey, insulin, I’m as big as I can get. You’re elevated because the body keeps putting in these insulin spiking foods. I have to stop listening to you. So you’re trying to get me to hold onto my fats. I’m not going to do it anymore, and I’m going to start letting some go.”

Dr. Ben Bikman (17:54):

So fats keep coming in, but now they’re coming out at the same rate, if you will. So the fat cell stays big, but static. It doesn’t get any bigger. And so one, it became insulin resistant. And then two, as each individual fat cell is growing several times beyond what it used to be, they’re pushing each other further and further away from blood vessels. And the fat cell starts to become hypoxic or low oxygen because it’s just too far. And so it starts releasing these pro-inflammatory cytokines in order to help stimulate the growth of new blood vessels. So it’s trying to correct the hypoxia.

Dr. Ben Bikman (18:31):

Now the tragedy though, Austin, in this whole paradigm, which has gone longer than I had intended is that the fat cell, as it undergoes hypertrophy, it becomes insulin resistant and pro-inflammatory. Both of these are things it’s doing to preserve its own life. But the consequence is it’s making the rest of the body suffer. So the fat cells efforts at survival end up hurting the rest of the body. But anyway, that’s the several minute primer on fat cell growth, how fat tissue can expand through two different processes and one’s better than the other.

Austin McGuffie (19:04):

Right. So assuming that the majority of… It sounds like the majority of fat cell growth is happening in our adolescent years. How does that, I guess set us up for what is called metabolically healthy obese in the future if fat cells are… Okay. So I know you said women are more prone to being able to store fat because of estrogen.

Dr. Ben Bikman (19:29):

They’re more prone to hyperplasia. Yeah.

Austin McGuffie (19:31):

More hyperplasia. Exactly. So hyperplasia can still happen after those adolescent years.

Dr. Ben Bikman (19:36):

Yep. In a woman, especially, but Austin, this is a sliver. There was a study… This is a sliver of the population, another sliver. So within the whole realm of people that gain enough weight to become obese, there is a study years ago that concluded that only about 15% of those obese individuals have fat gain that is accounted for by hyperplasia. That overwhelmingly, it’s hypertrophy. Now, if we go back to that 15%, these are the kind of anomaly group, the paradoxical group, where they are overweight and often fantastically overweight. These are the individuals who can get to 600 pounds. The vast majority of us could never get this. You and I, if we started overeating our guts out, we could never get to 600 pounds. And this is true for almost everyone. They simply do not have the genetics that would allow them to undergo that degree of hyperplasia.

Dr. Ben Bikman (20:33):

Some people do. Oddly enough, it’s actually more commonly people of Northern European or kind of stereotypical Caucasian ethnicity who can get fatter and stay healthier, because genetically, they’re just a little more prone to have that hyperplasia. And these are the individuals who will have typically normal blood pressure. They will not have type two diabetes, and they’re healthier than you would expect. They’re not healthy. I’m not going to say healthy. I’m not going to say metabolically healthy and yet obese, because it isn’t. But they’re healthier than you’d expect as opposed to say someone of Chinese ethnicity.

Dr. Ben Bikman (21:12):

And this is something I looked at during my postdoctoral work in Singapore down in Southeast Asia, where you could have a Caucasian European background and compared that to a Chinese background, and they were both gaining fat at the same rate, well that Chinese guy is going to start suffering the consequences of that weight gain far, far earlier. He’s only gained 10 or 15 pounds of fat and he’s already getting increased blood pressure, he’s already getting insulin resistant. Fatty liver disease is already coming. Whereas the Caucasian European guy, he’s doing fine. Put another 50 on him before he starts to notice those same consequences.

Dr. Ben Bikman (21:49):

And then African ethnicities tend to be kind of somewhere in the middle. They can hold fat a little better than Asian, Chinese ethnicities, but not quite as well as Caucasian Northern European. And there could be some interesting evolutionary reasons for that, that if you’re more fairer skin, probably your ancestors came from a Northern or a climate closer to the poles where it’s good for making a lot of vitamin D, so maybe there’s an advantage to getting fatter more easily just for thermal regulation, but be that as it may, there are differences across the populations, but even still the majority of people who gain fat, gain fat through hypertrophy, which is why they get sick from it. And then it’s that narrower portion of the people who gain a lot more fat, 15% of the people who are in the obese category who are gaining fat more through hyperplasia. And it’s a trade off because yeah, they’ll stay a little healthier, but they’ll also get fantastically overweight much more easily than anybody else.

Austin McGuffie (22:45):

That makes a lot of sense. And that’s interesting, because I think that we’re in the middle of seeing some beauty standards in this country shift where carrying more weight is sometimes desire. I’m not sure if you’ve heard this, but well, maybe you have, especially on social media, there’s this thing where everybody is trying to get thick. They want to gain weight. Then they will probably prefer to have higher estrogen levels to store more fat in their thighs, in their butt. But I wonder as that has become more of an acceptable beauty standard, what are the long term implications of carrying more fat?

Dr. Ben Bikman (23:18):

Yeah. Well, the vast majority of these people, even though they’re women, they’re still going to have hypertrophy, because that study I cited earlier where it’s only 15%, that was across all sexes. So it’s not like women are immune to the consequences of weight gain. It’s a complicated issue, of course. And I appreciate that you and I need to speak about it delicately so that we don’t have an angry mob coming after us.

Austin McGuffie (23:41):

Right.

Dr. Ben Bikman (23:41):

Because while I do think there’s something inherently valuable for appreciating your value as a human, and your value as a human, I’m very religious, but even religion aside, everyone has an inherent value. And I think any rational person, atheist or believing person would agree to that to some degree, I would hope. And so that I think should be separate from your physical form, your capability that what you’re able to do with your body. However, in my worldview is largely formed by this idea of responsibility, and that entails a degree of discipline.

Dr. Ben Bikman (24:21):

And now we’re getting into the delicate domain. I’ll even put that to the side. Scientifically as a biomedical scientist, I can in no way condone that someone would, that they would want to be gaining weight because it’s a new kind of cultural phenomenon of just love yourself and let’s all gain weight. I think they’re more going to be catastrophic consequences, because it’s one thing to love yourself at any size, but it’s another to pay for it or to have the country you’re living in paying for your accepting of your body shape. And again, everyone listening, I know this is so, so delicate and I don’t-

Austin McGuffie (24:56):

It is.

Dr. Ben Bikman (24:57):

… want to sound judgmental. As a biomedical scientist who only looks at the data, I can just rely on that and say, the consequences of this are not going to be good if this trend continues and grows.

Austin McGuffie (25:09):

Right. And so with that being said and moving away from a bit more sensitive topic, our [inaudible 00:25:16] group-

Dr. Ben Bikman (25:15):

Yeah. That’s for getting me canceled,

Austin McGuffie (25:18):

We’ll be canceled together. I stand behind you. So when we talk about weight gain, one of the things that I learned from your book was that insulin resistance is at the root of several of the things that are plaguing our society, including weight gain. And I talk about this a lot on my own personal social media, and most of the people that I have these conversations with have absolutely no idea what insulin resistance is. I was wondering, coming from an expert, if you were speaking to I don’t know, a 10-year-old, how would you explain insulin resistance?

Dr. Ben Bikman (25:51):

Yeah. Shoot. To a 10-year-old, that’ll be tough. Let’s say high school student. Can I do that?

Austin McGuffie (25:54):

Let’s go for that.

Dr. Ben Bikman (25:55):

That’ll be a little easier. A 10-year-old will be a little too tough. To a 10-year-old, I’ll just say, “Hey, let’s play some Nintendo Switch, which is what I do with my nine-year-old. Yeah. So insulin resistance is misunderstood even in the metabolically minded community, even in the circles that you and I are hanging out in, it is misunderstood, and it is thus invoked improperly. To understand insulin resistance, we have to understand that it comes as a pair of problems. Always it comes in two forms. The first is the obvious form, which is what earned its name in the first place, which is when you had cell biologists treating an organism or a cell with insulin, like actually putting insulin into the system and seeing that the insulin wasn’t working as well. That gives rise to the definition of insulin resistance, per se, where insulin isn’t working the same way that it used to.

Dr. Ben Bikman (26:48):

Now, that is not a universal phenomenon. The body has all kinds of different cells and every cell responds to insulin, literally every cell. There’s no exception. Every cell in the body has insulin receptors, little doors on the surface of the cell that only insulin can come knock on. In some of those cells, insulin isn’t knocking as well as it used to, or the cell isn’t hearing the knocking door. That’s the first part of it. But it’s important to remember in light of the second thing I’ll mention in a moment that it’s not a universal thing. It’s not like insulin isn’t working everywhere. Some cells aren’t responding as well to insulin as they used to, but some are responding perfectly to insulin still. And I’ll have an example in a second.

Dr. Ben Bikman (27:31):

But then the second part of insulin resistance, the other side of this coin, it’s a coin that we call insulin resistance. One side is the altered insulin signaling as a hormone telling the cell to do things. It’s just not doing it quite as well as it used to. The other side of the coin is that blood insulin levels are elevated. So hyperinsulinemia is the term for that. You cannot have the first side of that coin without the other side of that coin. You can have it the other way around, which is why I’m not explaining it that way and I won’t get into that, but you cannot have insulin resistance without hyperinsulinemia.

Dr. Ben Bikman (28:04):

That’s a problem when we start looking across the body. For example, to the two forms of infertility in men and women are perfect examples of this. The most common form of infertility in females is a disease called polycystic ovary syndrome, and that is entirely a result of the hyperinsulinemia, the backside of the coin, if you will. And that’s because insulin is telling some cells in her ovaries to make less estrogens and more testosterone. It’s inhibiting the conversion of testosterone into the estrogens. That’s a conversion. All estrogens come from testosterone, and insulin is stopping it.

Dr. Ben Bikman (28:40):

Now, normally, insulin is really low. So it’s only inhibiting that conversion very, very little to the point of being irrelevant. However, in insulin resistance when insulin is elevated, it’s inhibiting too much. Now her ovaries are releasing too much testosterone, not enough estrogens, and the ovulatory cycle isn’t working, and she fails to ovulate, and now she has infertility. And again, that was all a consequence of the hyperinsulinemia.

Dr. Ben Bikman (29:05):

In men, it’s a consequence of the insulin resistance of his blood cells. And as the blood cells are becoming insulin resistant, they can’t make as much of a molecule called nitric oxide. And nitric oxide is a potent vasodilator, which a man needs for normal erectile dysfunction. He’s got to move blood. He needs the blood vessels to expand, but he can’t do that. His blood vessels become insulin resistant, and now he has erectile dysfunction, the most common form of infertility in men. So two totally different problems, but housed under the same realm of infertility, but both consequence of each of the two different sides of the insulin resistance coin.

Austin McGuffie (29:44):

Yeah. That’s interesting, almost like what came first, the chicken of the egg? Was it hyperinsulinemia that caused insulin resistance, or was it insulin resistance that caused the hyperinsulinemia? Do we know?

Dr. Ben Bikman (29:56):

Well, that’s a wonderful question. Yeah. Yeah. We do to a degree, because it is a complicated circle. And then once it’s going, it’s impossible to know where it started. And so you have to just do this through interventional studies. But what I can say with absolute certainty is that elevated insulin causes insulin resistance. That has absolutely been shown in isolated cells. Like I could grow muscle cells in a dish, increase the insulin in the dish, and it’ll start to become insulin resistant. You can prove it in rodents, which has been done, and in humans. We know that in all three of these biomedical models, cells, rodents, humans, chronically elevated insulin will cause insulin resistance, full stop. That is absolutely known. No debating it.

Dr. Ben Bikman (30:40):

Now, however, there are other inputs that can cause insulin resistance, like chronically elevated stress. If you’re stressed and you have elevated epinephrine and cortisol, those can cause insulin resistance on their own. And then that’s causing insulin resistance. And then the insulin starts to climb to try to overcome it. Well, that started in the other direction then. And the same with inflammation, if a body has inflammation, then it will become insulin resistant, whether it’s because the person is fighting an infection, whether they have an autoimmune disease, it doesn’t matter. Immunity is activated. Inflammation is up, and that means the body starts becoming more insulin resistant. And then the insulin would go up as a result of the insulin resistance. So it can go both ways.

Dr. Ben Bikman (31:23):

But I think in most people, it is the chronically elevated insulin because they eat every two hours and they’re eating insulin spiking starches and sugars. So for me, while all three of those are primary causes of insulin resistance, I put my money on the hyperinsulinemia as the best strategy, because that’s the one you can start to change immediately. If you tell someone, lower your stress and lower your inflammation, they’re going to say, great. How do I do that? Now I’m more stressed. And so it’s harder to do. But if you can change the insulin, you can grab that lever really, really firmly and pull that thing down in just a few hours, insulin starts to come down, the body starts to become more insulin sensitive.

Austin McGuffie (32:05):

Right. So we haven’t made it to the point where we’re able to continuously monitor insulin just yet. We’re hoping for that soon, but we know that glucose is a pretty good indicator of where your insulin levels are. So people that are eating insulin spiking foods, it’s safe to say that these are also glucose spiking foods, right?

Dr. Ben Bikman (32:23):

100%. Yep. That’s the reason I love… That’s why I’m an advocate of a CGM-

Austin McGuffie (32:28):

Likewise.

Dr. Ben Bikman (32:30):

… yeah, because it tells you something that a static glucose measurement can’t. Like if you’re going in for your annual wellness visit and you prick your finger and measure your glucose, well, that’s glucose after fasting for 12 hours. I want to know what’s happening in real time. And sure enough, if a person is indulging, that glucose is going to be all over the place for hours. And then by the time it’s… I mean, even before it starts to settle down, they’ve done it again, and it starts to settle down, they’ve done it again. And so the more someone is looking at their CGM and they’re just seeing nice flat lines, then you’re doing all right.

Austin McGuffie (33:00):

That’s interesting. I want to know, and I’m doing a little bit of an experiment myself. So I monitor my glucose as well with Levels. And I’ve started doing an experiment with my family members. So I’ve got my mom and my dad and four brothers.

Dr. Ben Bikman (33:12):

Good for you.

Austin McGuffie (33:13):

Yeah. We have a group chat, and everybody is… My brother ate oatmeal this morning and his glucose spiked by like 60 points. And so he’s all [inaudible 00:33:20].

Dr. Ben Bikman (33:20):

And the thing is, Austin, the thing is people say he could have been talking to his doctor perhaps, and the doctor would have said, “You need to control your glucose.” “What should I do?” “You should eat oatmeal. Something like oatmeal.” With the best of intentions, and then you measure your CGM and you say, “Oh my gosh,” that to me is such a value of the CGM because you can’t unsee it. And that kind of information is going to lead to a behavior change. You don’t have to now go to your brother and say, “You should stop eating oatmeal.” He’s going to be the one to say, “Oh man, I should really stop eating oatmeal.”

Austin McGuffie (33:50):

Exactly. That’s exactly what he said. Well, he said, “I’m never eating oatmeal without protein or fat again.” But I want to know, there is studies that show that oatmeal, they say it’s heart healthy and it contributes to stable blood sugar. I’m still baffled by, I don’t understand how… When I first started monitoring my glucose, I was shooting up into 160 milligrams per dec, consistently eating oatmeal. How is that considered to be heart healthy and proven to be something that stabilizes blood sugar when we’re seeing the exact opposite?

Dr. Ben Bikman (34:21):

Yeah. Well, I don’t know. You may know something I don’t know. I’ve not seen claims about blood sugar control in any kind of label. When you buy the oatmeal container, it’ll always have the little heart healthy. I’ve not seen anything from the American Diabetes, so I actually can’t speak to that, but they say, they’re able to claim it’s heart healthy because in human studies, it has been shown to lower LDL, compared to a standard, I’m sure compared to the other guys who are eating lucky charms for goodness sake. But they could say, well, based on a standard American diet or compared to a standard American diet, this was heart healthy because it lowered LDL, and that would be enough. Then the American Heart can give it its little stamp. And then they can advertise that. And the American Heart will get its payment for being able to use their name.

Dr. Ben Bikman (35:07):

But that’s why I don’t think anyone… That’s how they could justify it and claim that it’s heart healthy, which I still don’t agree with. But that’s how they get away with it. I don’t know how there’d be any claim that it’s going to stabilize blood sugar. That to me would be totally baseless.

Austin McGuffie (35:23):

Right. That’s interesting. So another thing that I’ve come across with experiments with my family members is how much of a role genetics play in glucose control. So I have some family members who are actually diabetic, but as far as my immediate family, everybody’s blood sugar, it looks like it’s pretty much in stable range. I was the first one to monitor my blood sugar. I thought I was special. My blood sugar was normal. Everything was perfect. Everybody else gets attached and everything is perfect. So are there any studies or is there anything out there that kind of shows how genetics, or to what degree genetics contribute to glucose control?

Dr. Ben Bikman (36:00):

Yeah. There are a lot. Yeah. Now, unfortunately, there is no… This gets into the realm where it becomes muddy water because there isn’t a single gene mutation. If you and I went and did a 23andMe, or one of those kind of popular genetic testing services you can do, there is no one gene that says, oh man, boom, you’re going to get type two diabetes. It’s a much more complicated collection of mutations… They’re not even mutations. They’re just different variants of certain different genes. So genetics matter though. In fact, despite not having a clear genetic signature, type two diabetes follows a familial pattern of inheritance or genetic, if you will, much more than type one. People always think that type one is really a genetic disease. It isn’t really. It’s much more kind of a random mutation, a spontaneous mutation that triggers, activates someone’s autoimmune system or makes the autoimmune system more inclined to fight itself.

Dr. Ben Bikman (36:59):

But with type two diabetes, it is much, much tighter. Like if a person has a parent who has type two diabetes, they have like a 50 or 60 percent greater chance of developing it compared to someone who has a parent who’s neither parent has type two diabetes. So it’s much, much stronger of a familial inheritance. But again, there’s no clear genetic pattern. But there are differences across ethnicities. And you noting, it is awesome that your family is doing so well is awesome because the black community is one of the, certainly in the US, and this has been… There are some incredible studies that have looked at migrating communities from Africa to the US, for example, the same thing has been done for Asian communities, even to a degree with European. I mean, it’s not like I’m…

Dr. Ben Bikman (37:45):

I’m a white guy. I’m from Canada, but it’s not like my ancestors are from the US. They’re from Scotland and Ireland and Israel and everywhere else. Basically, bring them to the United States and eat this Western diet and they’re going to be worse off. But the studies done in the black communities and Asian communities, oh my gosh. Well even, you know what, I mean, everybody, whether you’re Hispanic, black, Asian, white, it doesn’t matter. We’re all more nuanced than just that, even of course, which I wish we would explore a little more often. But yeah, there are… Basically, every single person on the planet has the genetics to get fat and metabolically sick. And it was a survival mechanism, presumably, because it allowed us to get fat when we had the opportunity and to rely on that fat when we didn’t have food coming in.

Dr. Ben Bikman (38:33):

The problem nowadays is that same inclination to allow us to weather the metabolic storms in the past has created a constant metabolic storm where there’s never that famine period to allow our bodies to kind of burn through what we’ve been storing over the winter. It’s just constant feeding, feeding, feeding. And so everyone to some degree has the genetics for that, everyone to some degree. Whether it is manifested in an exaggerated obesity like you’d maybe get in a Caucasian more readily, or whether it’s a modest degree of weight gain like you’d get in someone of Chinese ethnicity, the consequences are still the same. The overall fat gain may be different, but it’s all taking us to the same end, which is poor metabolic health.

Austin McGuffie (39:15):

Right. So speaking of communities, my personal mission is to educate my community on the implications of the standard American diet on our metabolic health. And one of the things that I hear often just recently is I got diabetes because this runs in my family. I want to know what your thoughts are on the… I mean, obviously there’s validity to the fact that it might run through the family. But what would you say to somebody who really believes that they are pretty much destined to develop a metabolic disease because it runs in their family.

Dr. Ben Bikman (39:47):

Right. Right. Oh, well, I say you fight it. There’s no question. There’s no question. And this should be abundant opportunity for empathy. There’s no question that there’s a familial inheritance to this. That if mom and dad or mom or dad struggled with this, you are going to struggle with it too. But that’s not a reason to give up the fight. Our genes and our circumstances matter tremendously, they absolutely do. And it behooves all of us to always remember that and show proper compassion. But that is never a reason to give up the fight. It just means that person is going to have to fight a little more. And so if there are those of us… Austin, if you’re able to look at your own situation and say, I don’t have to fight quite as hard as someone else, all the more reason to jump in the fight with them and pull them along and not leave them alone to do it.

Dr. Ben Bikman (40:32):

But yes, it is true that some people will have the justification to say, “This runs in my family,” and we can say, “Oh man, that’s too bad. You’re going to have to fight a little harder. What can we do? Well, how can I help?” There’s always strength in numbers. There’s strength in the community. And as the world’s getting increasingly polarized, oh man, if for no other reason, then metabolically, let’s just come back together to just help pull each other along. So that would be my response to it. Yep. Genetics and circumstances matter, but choices trump everything.

Austin McGuffie (41:02):

Yeah. So of those choices, what would be the top three things, or just three things only, what could you do to continue to fight?

Dr. Ben Bikman (41:08):

I’ll try to not give the kind of boring ones that everyone expects me to say, but I would say, well, actually, I’ll say this, I’m going to base them on the macronutrients. I have a lot of things I could mention, but control your carbohydrates. Don’t get your carbohydrates from bags and boxes with barcodes. And eat them, don’t drink them. So fruits and vegetables, my view on it is eat as many as you want. Eat fruits and vegetables. Don’t have to count. Don’t worry about it, but don’t drink them as a juice and don’t get them in some kind of processed, packaged form.

Dr. Ben Bikman (41:39):

Two, prioritize protein. Get animal protein and try to get around one and a half grams per kilogram of ideal body weight, and so meat and eggs. Those are just staples. And then third, don’t be afraid of the fat that comes with that protein. And if it’s a very, very lean protein, I know this is very conflicted nowadays, and a lot of prominent voices are saying, “No, it’s just protein and don’t worry about anything else.” That’s unnatural. The best proteins in the human diet over centuries, eons, have been animal proteins and animal proteins that come with fat. It was only in the last 100 years that we started eating chicken. We used to keep… Certainly in the US, the trends for eating chicken went from like nothing to the most common meat we eat. It’s because we became afraid of fat.

Dr. Ben Bikman (42:27):

Our ancestors had chickens because we wanted the eggs, and eggs have a lot of fat. That’s how we should eat them. Fat and protein come together. In our hubris, we’ve tried to pull them apart, and I don’t think that’s appropriate. So control carbs, prioritize protein, don’t be afraid of fat.