Why We Get Sick – Interview with Dr. Ben Bikman

Why We Get Sick – Interview with Dr. Ben Bikman

Why We Get Sick – Interview with Dr. Ben Bikman

Check out the video on Why We Get Sick – Interview with Dr. Ben Bikman.
We're alive what's going on everyone we are here with a great interview if you haven't heard of him dr. Ben Bickman hmm he does a lot of actual speeches and you can search through my Google right here is the results you'll get tons of he's actually on screen now to actually touch tons of speeches these are really good to watch YouTube videos all of his talks.

He does that's where we first came across him and talks a lot about insulin he actually has a book that is going to be out soon in July so this is an advance copy it's coming out in July though it's called why we get sick I've skimmed through it videos eaten a few pages at the back but we're gonna talk to him and we also interviewed him on.

Our podcast yeah this was a while ago this was a few years ago but how is it going dr. Benedict men yes hey Matt mega thanks it is going very well what a treat to be talking with you guys again yeah so since we last talked sounds like you're doing a lot of the same kind of research and talks on insulin I remember when we first saw your speech it was a.

Low carb record rejection to us and now you're talking about glucagon which is often forgotten when it comes to people just I guess a lot of people doing a keto diet they're really stressing about insulin as like the key factor of their dietary choices do you think that's a good good mindset to be and just constantly keep an insulin low is that a.

Good goal through diet absolutely in fact if I were to sum up my entire perspective on nutrition optimal nutrition and health and disease it would be that kind of one idea how can you nourish the body while keeping insulin in control as often as possible absolutely I think the if the more if someone is coming to a low carb or.

Ketogenic diet with insulin in mind they're doing it the right way the the the impetus for that talk where when we met up in spoke afterwards looking at the role of protein and the relevance of glucagon there was because I was getting the impression that too many people were just focusing on ketones and and then then that was.

Leading to kind of bizarre behavior of you know just drinking oil for you know half of all their calories in the day and and deliberately avoiding protein and so I wanted to add a little nuance to that conversation by by emphasizing that the the fear of protein because of its insulin spiking effect is one not fully understood because it's a bit of a.

Nuance but then too we have to appreciate this other hormone namely glucagon that will tend to offset some of the negative effects even of that little modest effect from the protein spike especially in the context of a low carb diet so do you mind really quickly just jumping out back to that ratio and like how they play off of one another.

Yeah yeah so if yeah so briefly I wanted to help people appreciate protein in the context of a low-carb diet by framing it in this conversation of insulin and one of its counter hormones and emphasis on one insulin is so powerful at what it does that it actually takes several hormones to offset or to counter insulin one of the main ones is glucagon and.

Where insulin wants to promote the growth of a fat cell glucagon will promote the shrinking of a fat cell through lipolysis where insulin wants to pull in glucose into the liver for example or other tissues glucagon wants to dump that glucose out back into the blood so in in so let's keep going insulin wants to inhibit ketogenesis.

Glucagon activates ketogenesis so when someone eats protein they do have an increase in insulin although the the magnitude of that increase depends on the underlying glycemic level or their glucose levels or whether they're eating that protein with glucose which doesn't really happen in nature very much my new protein usually comes with fat but.

Nevertheless if someone has high glucose levels and they be protein there's a substantial insulin effect that's real it happens it amplifies the insulin effect from the glucose alone someone needs protein in the context of a low-carb diet there's a modest insulin effect and it's matched by an increase in glucagon and so the actual ratio of.

Insulin glucagon stays intact they both go up at the same time as opposed to eating something like pure glucose then you just get a rise in insulin you get a reduction in glucagon and so now the insulin the glucagon ratio putting the body in this and this state of wanting to store energy and shift just to glucose burning or sugar burning that's.

That that's going to be more predominant really because of what's happening with that insulin glucagon ratio so the book why we get sick when does it come out exactly I do yeah July 21 it's actually one of my children's birthdays and so I have this beautiful little daughter of mine convinced that it's because of her so the title question I guess why do we.

Get sick it's the answer seems to be insulin resistance so I guess how does that develop in a human being I guess over the course of their lifetime yeah yeah that's a excellent question so the purpose of the book was really kind of being my my main thesis as a scientist which was we are not we are overlooking the most critical feature of health eat.

Clinically and personally we if we're not looking at insulin resistance in the context of these chronic diseases we are not we are very likely not looking at the chronic disease correctly or at least appreciating all of its facets and thus not treating it as effectively as we could so case in point with the progression of type 2 diabetes the.

Progression of type 2 diabetes which is one of the most common diseases in the country over time insulin is climbing as the body becomes progressively more insulin resistant and I'll mention that causes met is that you asked about in just a sec the body insulin is climbing but it's able to keep blue coasts in control.

You know but it's becoming more and more resistant to its own insulin and eventually the body becomes so resistant to its own insulin but now it can't make anymore even though it's still very high and now ten or twenty years later now the glucose starts to climb that conventional medicine doesn't care about the insulin the the physician isn't even.

Looking at the insulin and the patient isn't even asking about it not thinking about it it's only once the glucose starts to climb that we that conventional medicine will detect the problem but unfortunately that glucose centric paradigm of type 2 diabetes also it leads us to not only detect the problem.

Much too late or much later I should say but we also treat it much worse because if we're just looking at looking at it as a glucose problem and we don't care that we would say you just need to start taking insulin therapy or we're gonna give you a drug to boost up your insulin even more it was already high and it always is and type 2 diabetes now we.

Push it up even higher and hey look at that glucose level we get it right back into normal range but we know that the more aggressively we have to treat type 2 diabetes by giving them more insulin their risk of dying from heart disease is tripled the risk of dying from cancer is doubled and they're typically going to gain about 20 pounds in the first six.

Months so we make them sicker we make them fatter we kill them more but hey their glucose levels are great it's not a glucose problem is to give someone additional insulin for this for type 2 diabetes is the goal ever to get them off of it or is it like this no just a lifetime Wow okay yeah that's but that's that you can say that about any of the.

Medications so we with regard to type 2 diabetes are almost any chronic disease the medication is never solving a problem it isn't a permanent fixture and the only change will be increasing the dose throughout their lives so last year working with a clinic here in a neighboring city by by my university we we actually took 11 women that had just.

Been diagnosed with type 2 diabetes and we gave them a choice we said you can choose drug and and it will be never-ending this because and that's part of the part of the problem is we kind of give the person a myth well you can kind of continue to eat the way you want and just cover it with insulin or make sure you take your.

Medication so that's what we explained you can we can you can go on a medication therapy and and it'll just stay with you the rest of your life or you can choose a meeting with some diet coaches and you're going to try a low-carb diet all 11 of these women and this was a case study elected to do the low carb diet and within 90 days the.

Diabetes was gone he had lost on average of 18 pounds their blood pressure had come down their glucose levels were totally normal that's in Matt that kind of gets to your question if where does insulin resistance come from there are multiple factors that really come into this sleep deprivation or stress because it.

Actually is kind of derivative of it so stress chronic stress like cortisol and epinephrine can induce insulin resistance inflammation can if someone has an underlying inflammatory disorder or a sensitivity to food that can cause it and then there are a couple others but I'll just get to the main one in my mind and that is chronically elevated.

Insulin we know this happens we can do this in humans we've done this to cells if a cell is chronically exposed to elevated insulin it will reduce its sensitivity to insulin and that's a fundamental biological feature if an organ if a human if we if we're exposed to something it's not going to kill us but it's eliciting a response in us for.

Too long we will become resistant to that response so take for example caffeine if someone's very caffeine naive a little bit of cab given one cup of coffee and they feel it but give them two years now that one cup of coffee that won't do anything anymore now they need three cups same with alcohol and the same thing happens with drugs or.

Insulin as well too much insulin will create a resistance to the insulin and so that really is that really gets to the heart of diet and scrutinizing diet if a person wakes up in the morning they're in some levels have finally come down overnight and unfortunately we sugar a breakfast is one of its like a dessert in most homes.

Right people will have breakfast and it's a bowl of sugary cereal a piece of toast with Jam and a glass of orange juice you know it's terrible they spike their insulin and their insulin may start it may only come down three hours later but before it's even had a chance to come down they spike it again with the mid-morning snack they spike it.

Again for lunch and the afternoon snack etc because we're told to eat high carbohydrate foods we're told to eat six little meals per day that is a wonderful way to make sure our insulin is elevated every waking moment and then insulin resistance follows and it is relevant a study just published within the last year finds that eighty eight percent of.

Adults in the US are considered metabolically unfit because of them having at least one feature of the metabolic syndrome but the metabolic syndrome you know high glucose high blood pressure high triglycerides well HDL those are all derivative of insulin resistance the metabolic syndrome used to be called the insulin resistance.

Syndrome so almost all of us adults are insulin resistant and our lifestyle is either the culprit or it can be the cure we've just got to change it yeah so the idea that the blood sugar is like a lagging indicator how long is it from like diabetic levels of insulin till it starts showing up in the blood sugar readings because most people know like.

You test like 120 or whatever then you have diabetes so like how what's the time there yeah yeah so we can detect changes in insulin ten years before this is published but so I say we as the scientific community or clinical community you can detect changes in insulin sensitivity ten years before the glucose changes so imagine what that.

Means for a patient they're coming in and the patient's gaining weight they have high blood pressure and and the the average clinic clinician because they're they just don't know any differently they'll say well it's time to give you a blood pressure medication but you don't have diabetes because your glucose looks if they were to stop and check the.

Insulin levels I am they would they would find the problem and in fact in stores hypertension is particularly relevant if someone has high blood pressure it's very likely they have insulin resistance and then let's say so a healthy person no real risk for diabetes or any of these metabolic issues for that person is it ideal and.

There's a couple of questions in the chat kind of pertaining to this is it ideal to always really focus on keeping your insulin low or could it be beneficial and even like maybe good for longevity to occasionally spike your insulin especially like in the context of like trying to build muscle post workout stuff like that does it ever.

Makes sense to intentionally spike your insulin every so often or should you just always really keep it low yeah that's a good question and I have to speculate a little bit just because there aren't data to definitively answer that but I appreciate the question I don't know of any benefit to deliberately spiking insulin but I would.

Say it's hard to not get at least some bump for example if someone's feeding zero carbohydrates they are still going to get a modest insulin bump just from eating the steak you know eating the hamburger they're going to get an insulin pump it's just not going to be a you know a spike it's not gonna go up 10 times and stay up for two hours it's.

Interesting framing that in the context of longevity because some of the most compelling as compelling as it can be in humans which is to say it's not particularly compelling but it's the best out there some of the compelling data is looking at longevity through the lens of a protein called mTOR you guys have of course heard of mTOR the idea is.

That you want to keep em toward down and in so doing you allow the cell to be frequently going through a tapa g so the cell is keeping itself young unfortunately some of the main voices in that space of longevity and mTOR they point the finger at protein because protein will activate mTOR but the great misfortune there is that insulin spikes.

MTOR far more than any amino acids from protein do and so if you want to keep em tore down then then control your insulin and you can get em tor spikes just from eating protein or even exercising and that'll have enough of an anabolic effect in the muscle to do what to do what the person wants I so to kind of sum that up no I don't think.

There is a good reason to be deliberately spiking insulin in fact in the context of just muscle health there are studies to show that adding dextrose or pure glucose to a protein load does not result in any greater effect on muscle protein synthesis over the protein alone so stacking protein and glucose does not amplify the proteins.

Effects now I just have to say just to be to finish that thought if you add protein and fat together so protein gets a muscle benefit and then the protein and fat gets even a significantly greater bump above that it's almost like nature knew what it was doing when it put protein and fat together in like every natural source of protein that.

Helps the protein work better but aside from like the synthesis going on in the body and like the science behind it the glucose itself could like boost your workout or your performance and in that sense could that be beneficial yeah yeah absolutely if someone is what I my thought on this is well I guess two thoughts one I am not opposed to.

Carbohydrates in principle absolutely not I so someone who's low carb or ketogenic this idea of cycling carbs in although that can look very differently for different people I'm totally fine with that in fact I kind of do it that way not by design but just by the fact that I'm a father and I have a family and it's just.

Hard to be keto all the time it's just not really feasible daddy my grilled cheese yeah that's right that's right I mean I'm not gonna disrupt a family dinner because of my dietary restrictions and I don't want to impose it on the family that oh my kids too to look at food that way I want them just to be smart about any real food.

So cycling carbs in I'm totally in favor of that kind of strategy but it is often overdone of course and a low-carb well yeah deliberately spiking insulin there's not a lot of upside to it but to an athlete if you are competitive or you need a deliberate performance you know then then undoubtedly carbs are gonna help.

You do that especially the higher the intensity the more the benefit to putting in carbs however for the rest of us I'm a middle-aged guy who's just exercising this state fit I do not I don't think there's a reason for me to be spiking in glucose I don't have to get that kind of next level of performance so for those of us that are.

Just sort of Podesta average exercisers not to say that we're wussy about it they're not we're not performing at a very elite level or even moderately elite I don't think there's an upside to it okay and then what about some of these supplements this is probably when I was like I think we're maybe going a little overboard with like the.

Constantly obsessing over low insulin levels I was like Tim Ferriss he takes metformin I think and then I saw a lot of people just like healthy people taking berberine is another one that's just like lowers insulin what are you thinking about those do those make sense for looking like me pretty healthy person to take no no especially not.

Metformin I let me be extremely clear there are data in humans to show that if you a human takes metformin their exercise capacity is compromised metformin is then what's on there yeah it's because metformin is actually a mitochondrial poison isn't that funny but but actually totally accurate metformin works because it mildly.

Damages the mitochondria and in the process it ends up activating a protein called a NPK and a NPK is kind of the opposite of M torque earlier we mentioned that mTOR just wants to grow things that wants the cell to grow that's good we want it to be on sometimes and the good thing is exercise and protein can do that it's meant to.

Come up and down ampk does not want things to grow it wants to break things down including fat and glucose or glycolysis so by mildly kind of damaging the mitochondria metformin will increase NPK and in the process increased glucose use and in that sense it works and is successful but because it also damages the matoke Andreea if.

You're hoping to rely on those mitochondria to get a good exercise performance you have compromised it and this is quantifiable in humans so it's not even speculated we know it works and so in that sense taking a metformin especially in a healthy person they try to lower insulin from five micro-units tooth order three that's bonkers I don't.

Recommend it at all now those other kind of polyphenol compounds like berberine I don't they don't really have much of an effect anyway so if someone wants to take them I wouldn't discourage them from taking it but I would also say if they're taking berberine while they're eating their bagel is not going to do a lick of difference if they're eating a.

Low carb diet already and once again the berberine isn't going to do anything ok so I guess a lot of people asking about how do you solve like most people are kind of in the situation where they have some level of insulin resistance so what do we do about that yeah yeah good question it really so in the book I explained this kind of in the last.

Section you know the way I sort of structured the book it was what is insulin resistance and why does it matter and then where does it come from and then lastly kind of what to do about it I tried to be diplomatic in that sense and it's but yet nevertheless scientifically justified I believe you can come to improving.

Insulin sensitivity through quite a spectrum you can be carnivore and get significant improvements in insulin sensitivity so zero carb or you can be 100% carb and go vegan which I do not advocate that's a tangent but nevertheless you could do it and and you could also have improvements in insulin sensitivity what they have in common is.

That they are avoiding processed foods and that's typically why I think carnivore would win not to mention just by being nutritionally complete whereas vegan is nutritionally deficient by by multiple metrics but if they're both avoiding process foods which again is easier for the carnivore than the vegan there's lots of.

Crappy vegan foods then they're going to have an improvement if they're avoiding the refined carbohydrates and the refined seed oils like soybean oil they're going to really have eliminated the two biggest culprits in the diet and their insulin sensitivity will be improved now the vegans gonna have to supplement of course because they'll be.

Deficient in other ways that the carnivore wouldn't but that's the kind of common ground now interestingly one of the features of going on on any of these kind of whole food type diets whether it's carnivore or vegan is it is food it's real food so the person has to now be taking time to plan the meal and to do the grocery.

Shopping and to make the meal that's a wonderful thing it is good that whole food would become the base of this strategy to improve insulin sensitivity but it is less convenient and it was actually with that idea in mind by way of solutions and convenience solutions with a couple of my older brothers and I have seven of them so it was just two of.

Them two of my older brothers encountering this inconvenience we just thought let's make a convenient shake that has the best animal proteins and the best fruit fats and so if someone wants to learn more about it I won't elaborate too much here they can go to a website get health and health is spelled H lkh get health h LT h calm and in fact.

There's a coupon code for any of your listeners all the keto connect listeners type in KC for keto Connect 10 and get 10% off yeah no no it effectively taught me marketing I would have marketed this better yes so I was I was the scientific mind just to create the justification or the formula for the shake and it really is just an effort to address the.

Solution that you that you mentioned that when you one of the bet the best thing to do is eat just real whole food but there's always room for just something that is quick and convenient and nutritious and good tasting and so the complete meal shake just really helps fill in that niche are those who are looking for something.

Yeah I'm sharing it on screen here right now we got sent it we'll be trying this in a product review coming up we haven't actually tried it yet yeah next month I'm very excited to try them no but yeah need the convenience because it's hard to go because most people eat one or two meals per day like takeout Chipotle subway stuff like that.

Yeah so for sure that it's an easy way to do it yeah yes so typically for me I often will just have a cup of tea for breakfast and and because that's a meal as a family as a family guy I can not be breakfast I can fast through it and no one even notices I always make breakfast for the kids that something the dad does in our.

Family so I'm up I make breakfast for the kids and that's all different kinds of breakfasts I will just have a cup of tea and then lunch will often be the shakes if it's quick and convenient then it's dinner with the family that's fun yeah the protein is equal grams of 27 grams of fat and protein and usually the shape that we've seen are just like 40.

Grams of fat and like 10 grams of proteins yeah exactly so that's I wanted it to be nutritional and and based on actually the study I mentioned earlier was kind of a justification for that balance where I mentioned that study looking at muscle protein growth and the protein had an effect and the fat and the protein together had a significantly.

Greater effect that came in a 1 to 1 ratio by mass in fact just what you see in an egg which I consider you like the most perfectly packaged food 1 2 1 by mass not by calorie but by mass and that's how we built the shake it was built on that foundation of those 2 macronutrients fats and proteins which are both essential in the diet and.

Happened to have the lowest effect on insulin and I've done tests with my continuous glucose monitor and my ketone leader and it is been Bickman approved metabolically speaking so I wanted to talk about I found the last chapter or two of this book pretty cool some of this stuff you were talking about just for sort of like the plan for correcting.

Insulin resistance you got some micro nutrients and vitamins list if you in the back some interesting ones so you have like the basics magnesium vitamin D zinc calcium but then you have chromium and zapping yeah those stood out to me as being that thing chromium think about much yeah oh no not at all and those are those almost there are a whole other.

Level when it comes to micronutrient where the levels that you need are substantially lower but it becomes relevant just as people are eating more more processed foods these really are becoming deficient micronutrients in the diet and there's this whole idea of soil depletion or nutrient depletion from the soils all the more reason just to eat.

Real food and and maybe all the more reason to focus on an animal food animal source foods because the animal can concentrate many of these micronutrients so the more a person is issuing animal foods and unfortunately eating processed foods they really will be deficient in these micronutrients including these obscure ones like chromium and other.

Yeah yeah yes cysteine similar similar to chromium it's something that you will get it's just increasingly difficult as we eat more and more fake foods then some of the vitamins that people don't appreciate you know vitamin D is its champion in fact vitamin D ought to be talked about not only in the context of insulin sensitivity but also with Koba.

19 given its role of altering cope with 19 access into the cell potentially by disrupting its entry point but nevertheless that's you know I'm not a coconut keen expert I'm just a expert on human biology yeah well I don't know off the top of my head what the levels would be but the effect is compromised insulin effect so these micronutrients are.

Molecules that just appear to be necessary as cofactors or other regulators in the process of insulin coming to the cell and then actually getting the cell to do what insulin wants it to do and of course that depends on the cell type which is really part of what's explored in the book we talked about insulin at a big level its.

Effect on muscle and maybe fat Kish – but insulin affects the brains it affects the kidneys they'll deliver the the gonads and the testes and the ovaries and that's that's part of why insulin resistance is so relevant to so many unexpected disorders because insulin is insulin affects every cell of the body and if we've changed what.

Insulin is doing we've potentially changed the physiology in every organ but that also becomes kind of liberating knowledge if someone's taking a medication for their migraine headaches their blood pressure and their infertility it is incredibly likely that they could get rid of all of those medications just.

By improving their insulin sensitivity through their diet yes I'm looking at the chromium a little excerpt you have here and it says within six weeks of taking oral chromium picolinate the insulin resistance was significantly improved so were these they didn't test beforehand that they were like low chromium low and chromium those patients.

At all it was just like no matter what your status was supplementing chromium health no Matt in fact I can't remember the specifics of that study but no I that would only that would most certainly only apply if someone came in moderately deficient I I'm certain of it there's not going to be if someone had sufficient chromium levels but again I.

Don't know that you can even really quantify that certainly not personally um it would have to be some clinical or academic tests if you have sufficient chromium then things are gonna be fine okay and then you have a little section on fats here which I'm always interested to get perspectives on so you have saturated fats in quotes good.

Monounsaturated fats good polyunsaturated fats caution so we talked about polyunsaturated fats a lot but monounsaturated fats how much of those should we be getting because to me monounsaturated fats mostly if you're thinking more of like an ancestral perspective I feel like we wouldn't have gotten a ton of those so what's your.

Thoughts on just like a fat fatty acid breakdown for a good yeah yeah so I actually don't I don't think we should actually have cut-offs and and I never recommend any someone to target an amount of fat my thoughts on fat in fact in the end of the book I kind of give these pillars of whatever strategy they're gonna take try to.

Adhere to these pillars and it was control carbohydrates prioritized protein that's the one thing I think we you should kind of ensure you're getting enough of and then fill with fat and and that Phillips back part of it as simply as as a person is just focusing on their protein they're going to get fat because fat comes with protein now we've kind of.

Adjusted that by focusing on chicken we didn't used to eat chickens we would eat the chicken egg now we eat the chicken and that's a pretty substantial change and so like chicken being extremely lean they almost no fat I don't think that's that's not the best way to try to get your protein get protein the way get protein with fat now mat to your point.

About a monounsaturated fats the ancestral fats according to me our fruit fats and animal fats and the animal fat one is an easy one to understand but even the fruit fats our ancestors from millennia we've been eating olives and we've been eating coconuts it's because our ancestors would have simply the highest level of technology they needed.

They get the fat from those two fatty fruits would just be to physically compress it and in olives its requires so little compression you just step on it and I actually did that on an olive press when I was studying abroad in Jerusalem 20 years ago it was really cool but even coconuts once you cracked it.

Open that's the hardest part you dig out the flesh and once again you just simply press it so those especially the olive oil that's a primary a primary source of monounsaturated fats but even animal fats are a mix of saturated and largely monounsaturated and eat like eighteen one the same fat from olive oil so we would get a monounsaturated fats even.

From animal sources always no animal source fat is always just saturated it is a mix it may be mostly saturated and that's good that's fine there will always be some monounsaturated so I don't recommend targeting any particular level just eat real food it'll come with it yeah okay and then I wanted to talk you have a section in.

Here about cortisol and fat storage so that's like people say the stress hormone yeah you have the Don phenomenon yes so if we look at cortisol strictly through the lens of fat metabolism or fat fat tissue physiology it is pretty interesting so someone there is a disorder and it's a terrible disorder called Cushing.

Disease where someone has chronically elevated levels of cortisone not because of stress or because of a tumor or some other endocrine defect it is just flooding in the body the adrenal glands are flooding in the body with cortisol this results in this odd shift in fact tissue so you would take let's take a typical woman she will have fat on her.

On her arms there on her butt or hips what starts to happen or her thighs what will start to happen in this instance and it's just more dramatic in a woman because she typically will store less fat centrally than a man would anyway so it ends up being more dramatic of an effect that fat like it starts to kind of migrate into the trunk.

Including the face this pattern of fat kind of migration for lack of a better word happens because cortisol has contrasting effects of bat tissue on the periphery on the peripheral on the limbs than it does on the the fat cells in the center of the core of the body specifically cortisol will activate lipolysis on fat cells of the distal of.

The limbs and then we'll activate lipo Genesis or the lipo genic pathways in fat cells on the trunk now I can't speak to the evolutionary reason for that I just don't know why that would happen but it does the facts the fat from the fat cells moves from the fat cells on the arms or the legs and it gets stored in the fat cells on the centre of the.

Body and and up into the face as well so there's this interesting fat shift now in the context of insulin resistance one of its main actions in fact really one of its primary effects is to increase blood glucose it will strip the liver of all of its glycogen it will strip the muscle of all of its protein in order to send those amino acids to.

The liver to undergo gluconeogenesis so cortisol wants to increase glucose insulin wants to lower glucose and they're both very powerful hormones so this chronic elevation in cortisol it's resulting in chronically elevated well a glucose which of course is going to result in chronically elevated insulin resistance so someone with high and the.

High insulin will facilitate the fat cell growth even more because insulin really does stimulate lipogenesis of fat cells so it all these this kind of metabolic storm it creates results in when cortisol is chronically elevated it really does just wreak havoc when it comes to metabolic health yeah yeah so really the best thing is sleep and and.

That's it's maybe funny for me to say that to you guys experiment experimenting with or experiencing brand new Parenthood because I am only now really getting back into good sleep habits now that my youngest is 7 and but it started with my beautiful little kids I'd always been a perfectly fine sleeper and I just felt so guilty when Cheryl.

Would have to wake up with the kid at night and she would breastfeed the baby and if the baby was still upset I said I will take over the moment baby if baby's upset but you baby he's been fed I'll I'll take over but unfortunately you know mommy could just sit there in a rocking chair and nurse the baby into the pen of doze I can't.

You know because if I'm holding baby at that point it's because baby's upset and so I would be amped up and totally awake nevertheless good sleep habits is the best way to lower cortisol and then some of the other things that we can't really control like bad relationships you know at work or in the family that's there's not a lot there's not an easy answer.

There my one thought is to give someone some hope it would be to learn to practice breathing breathe control and to activate you know the more someone can develop a tolerance the co2 and control their breathing and doing breath holds and the more they activate the parasympathetic nervous system and that will very well lower.

Cortisol but easier said than done I'd get it totally but if this person's experiencing stress because of something they can't control and my strong recommendation is control breathing and there's a book actually someone could check out a book called oxygen advantage by Patrick McKeon he really goes into that in detail it's pretty compelling.

You and I already shared the same haircut don't worry you'll be like me no time for veteran thing was so what about the dawn effect so that way your course net high when you wake up is blunting that with a meal like something that you surely in the day versus late in the day or is not like just naturally you should write that out yeah oh absolutely.

There's no way to avoid it um when you start to wake up you will part of the part of that process of waking up or getting near to waking you up is an increase in cortisol and and it serves a purpose we think you know this is always us kind of trying to wonder why the body was designed the way it was we don't know but we speculate and we think part.

Of the reason for this increase in glucose through cortisol is to feed the brain as it suddenly comes back online you know our metabolic demand the brains metabolic demand while we're sleeping it's lower we get up we start thinking we start talking we're looking at things where processes processing things the brains metabolic demand will climb and.

The brain will readily use glucose of course it also uses ketones perhaps even more readily but nevertheless it will the glucose is there it can feed the brain while it's waking there is no way to to get rid of that there's no reason to want to get rid of it it's a very modest bump in glucose and insulin resistance to me because you are mildly.

Insulin resistant in the morning that is a reason to avoid sugary starchy foods because you're already a little insulin resistant you're already have higher than normal cortisol which is wanting to increase glucose don't make it worse so Megan you'd said right it out absolutely I think if someone is going.

To pick a meal too too fast through because and you should fast on either end of the day to really make it count you want to take advantage of that sleeping fasting period or fasting while you're sleeping where insulin is coming down so you're my strong recommendation is either fasting through breakfast or through.

Dinner because I have a family and because we're all social animals as humans fasting through dinner isn't ideal fasting through breakfast becomes pretty simple to do and you're not make Madonn phenomenon even worse although I think I want to say it's worse you're not miss a Serb aiding that effect and so what if you have really poor sleep so.

Like I'm waking up four five six times a night and I wake up then my cortisol is that a lot higher than it would normally if I had a good night of sleep and in that case is having you know a fatty coffee maybe what some college some protein in it to like help is that beneficial at all oh yeah yeah I think so um so let me.

Yeah I should clarify I don't think yes is so first of all your question it will increase your cortisol even one bad night of sleep partly through cortisol will result in demonstrable insulin resistance the next day you know we can actually detect this in people we've poked them and keep them awake throughout the night as was done in.

These clinical studies they are more insulin resistant the next day so whether it's being poked in a laboratory or being yelled at by a beautiful little baby whatever it is we're gonna be awake will have more cortisol we will have higher insulin resistance it one of the dangers of fasting through breakfast is it might generate a bigger insatiable.

Hunger later and so I think something like a little a couple grams of a fat in like a tear or a coffee I think is totally warranted in adding collagen that's that's gonna do nothing to make things worse so that helps take the edge off the hunger absolutely do it no I would strongly recommend it so a lot of people in town are asking like if.

They're in the situation they have type-2 diabetes there aren't tons of medications for it what do you do in that situation yeah well I'm gonna be thorough here and cautious I would say talk to youth doc yeah but because I'm not a physician and I'm a scientist he has have heard me joke about this before I can kind of say.

This sort of thing I would say change your lifestyle and and then keep in touch with your doctor insofar as it's extremely likely you're going to start needing to change your medications and this is documented Jason found with his fasting work has published this looking at the rate of D prescription but typically with even within the first day.

Or so if they're on insulin therapy they have to cut down their insulin dose by half but again this is not a prescription I'm not giving advice but this is published dr. Eric Westman at Duke University found this they have to cut their insulin dose by half within the first day often within the first couple days they have to cut their blood.

Pressure medications it's not cut them out entirely because their blood pressure now that insulin is low the kidneys are finally able to get rid of all this stuff they've been holding on to and as they get rid of all these extra electrolytes and the tab lights then the blood volume will come down because water will go out with it and.

Blood pressure can drop quickly and if they're on a blood pressure medal start to feel very faint and they'll be kind of blacking out when they're standing up so the insulin dose has to change the blood pressure medication has to change those are actually probably the two biggest ones again I'm not telling anyone what to do here but it's very.

Likely that if someone would like on medication with type 2 diabetes if they start to adopt a low-carb diet they're gonna have to change something and part of their discomfort in the first few days part of it may be derived from them taking medications when they no longer need to yeah so that's like you really gotta be with your doctor yeah yeah yeah.

Yeah you you really want to and that's gonna be a delicate balance because the average clinician might not like the a low-carb diet so maybe the person just as I'm changing my diet I'm not feeling very well can I meet with you to discuss medication changes or something like that.

What about polyphasic sleep uh yeah um so I am unaware of any evidence to suggest polyphasic so so like breaking sleep up is going to have any demonstrable effect on insulin resistance it really I think at the risk of kind of copying out it would just be a matter of did you are you rested and some people even when I slept well.

Before kids I still would wake up and and have a little time about thirty minutes to maybe even an hour would just kind of take me to kind of wind back down so I kind of have always slept that way I am amazed that people can go to sleep and sleep and not really move for eight hours that's unfathomable to me yeah but I would say we all probably do.

You have naturally some differences in our sleep patterns and I don't think there's any reason to worry if a person wakes up and they feel fine then don't worry that you woke up in the night that's gonna be less relevant yeah when I was in college I was like looking into this every hour a little bit protocol where you sleep for 20 minutes every.

Three hours oh that sounds crazy to me which results in like a little I think under three or four hours of sleep per day but I was reading like reviews on this and apparently it's really like strenuous the first three days trying to get into it but then you eventually just start like passing out and waking up and if.

You you only get like REM sleep for those 20 minutes I don't think that's healthy not at all even if it doesn't affect insulin resistance I mean human evolution human evolution how good is it gonna be if man I'm just close to getting my kill that it's gonna feed me my family for a week but I this time for me though.

And that's just it's crazy and then a good question we haven't really talked much about this at all but what about like the types of carbs say say you want to incorporate some incorporate some like fructose versus different types of sugars versus starches like most people conventional wisdom kind of says fructose is the worst especially for.

Keto because it goes right to the liver prevents ketone production what do you think if you do want to add say like a hundred grams of carbs what should the sources be yeah yeah I would say as I would say glucose focus on starch not fructose because fructose has no real benefit metabolically it and that's part of the irony of these exercise drinks.

You look at Gatorade nowadays I remember when Gatorade used to taste like crap you didn't want to drink it because it was just electrolytes and glucose and glucose doesn't really have a taste it's the fructose that we taste and muscle can't use fructose so why are you taking it anyway so I don't advocate ever loading up if someone has a target.

For glucose for carbs don't waste your carbs on fructose focus on the glucose and let that come from a starch which can control the rate of release rather than just your pure glucose so something like a potato or or even you know wheat I guess it kind of kills me to say that but uh let me take that one back I would say don't focus on.

The grains focus on the starchy vegetables if you want to get it something like a potato so these are gonna have other other stuff come with it yeah so like the tropical fruit well yeah actually yes me it would be and if someone's a type-2 diabetic I would also say don't um fruit is the candy of the diabetic and they can overdo it but if.

This is a healthy person who just is kind of doing low carb but they're healthy then sure fruit can absolutely work even the tropical fruits like bananas pineapples mangoes the most sugary of them if someone just want that's the sweet and I'd say focus on berries instead and even some even citrus fruits that I.

Think that's times gets a no-no and I don't know that I totally agree with it you know what do you make of the idea of like lemon juice in the mornings apple cider vinegar in the mornings yep yep I think it's fantastic in fact when I take my my shake that you guys have there when I take the vanilla.

I always put in a teeny bit of cinnamon but I will sometimes add a little cinnamon to my yerba madhe I am an advocate of cinnamon because it improves insulin sensitivity and I love the Cape he's apple cider vinegar I'm a huge advocate of which again is why we put some in the shake interestingly enough but apple cider vinegar.

We don't really appreciate this it's actually a fact apple that acetic acid is the shortest of the fatty acids in the diet it's that it's the shortest of the short chain fats and we know in diabetics if you give a diabetic two tablespoons of apple cider vinegar not directly don't do a drink they mix it in water or club soda it will significantly.

Lower the glucose and the insulin response to a carbohydrate heavy meal so it has a very real effect and it also stimulant real health is that just because it aids in digestion or what's going on there yeah I don't know actually I love I love that you asked that question and I wish I had an answer I've seen the improvement just that we.

Know it happens in humans we know that it improves it okay and then the last question I guess we're running up on an hour here people asking about like stimulants and cortisol mainly caffeine being the big one most people take but I guess nicotine could be one – or just any kind of stimulants what do you like how does that mix with cortisol yeah so.

You can increase cortisol but me actually I have a colleague just two doors down from me who studies mTOR and PK and muscle physiology and we did this big grand animal study looking with caffeine thinking there's gonna be a cortisol spike and it's gonna cut down on the muscle recovery because cortisol just damages everything basically wrecks.

The muscle and it didn't happen it didn't happen at all it was so underwhelming we were thinking this is going to be such a cool no no it did nothing so my thought on on caffeine is one it is an addictive drug so I always think someone should monitor their behavior part of my ID on nutrition and and even just living is I.

Don't want to ever be addicted to something I don't I don't drink coffee at all partly because of that and partly just due to religious reasons oddly enough and when I drink tea I avoid more caffeinated teas I just don't like the idea of becoming addicted to things but I will say diet dr. pepper is one of my absolute indulgences I just try to keep.

That in check and I really do like if it's a morning here in Utah where very few people drink alcohol there it's funny because there are these little kind of gourmet soda shops where you can come in and get all these color little additions to soda there's this one and it is delicious it's a diet dr. pepper based one I got it like three mornings.

In a row like a 44 ounce and I looked at one morning I'm coming in I'm thinking what the hell am i doing what the hell about to come you know I'm addicted and so I mean it's real and I was every morning does that week I was waking I'm thinking oh I can't wait to go and get and I knew right then there was this little moment.

Of self-awareness that said Ben you're doing it you're becoming addicted and I would say no I'm not but yeah that's what an addict would say you know and I think you know I'm going through this whole thing so I stopped and I said I'm only gonna let myself have this drink one time a week so Saturday morning we get done cleaning the house you know the.

House is all and span I go on a jog or whatever I'm gonna go get my treat and that's my reward last time we talked to his diet spray I still I still kind of like that I confessed but and this one drink at this little soda shop to died Dr Pepper drinkin is a little like the huckleberry thing and one and the lime oh my yeah but I'm not gonna go get.

One what it's not behind you so don't tip stop making me talk about it and then actually I have a quick personal question but it's really the cortisol so I I was on prednisone for a couple of years and I know that like really it jacks up your cortisol levels and so the damage that's been done there is that not like reversible but can that.

Just be like corrected over time oh yes most most surely yes so so prednisone to be clear prednisone isn't going to increase your body's natural cortisol if anything it might actually lower it cred Mazzone itself is a cortisol analog or mimic yeah yeah it sounds like you knew that so but nevertheless when someone's taking a steroid to control inflammation.

Which cortisol does very well that's part of its damage actually long-term on the body that's why someone will start to break down their collagen and they will have poor wound recovery because cortisol or anything that mimics it like prednisone it will lower the body's immune response or compromise it yeah so when someone's taking these.

Anti-inflammatory steroids they they can expect to gain weight yeah they may have to be a little more careful accordingly they may have to be a little more careful but yes absolutely really the moment you stop taking that medication cortisol will get the act the functioning amount of cortisol is going to go back to normal and now it's just.

Giving your body the time to basically lose the weight that the prednisone made you gain but immune function is going to go back to normal I don't know of any evidence to suggest there's going to be a lingering effect but I do think that these drugs are sometimes over prescribed and and the patient doesn't fully know the metabolic consequences of.

The drug and once though I do think prednisone and dexamethasone these are these are drugs these cortisol mimics that that we really need to be careful with and then can that break down muscle oh absolutely yes so it's gonna do everything cortisol did which is make the body more insulin resistant which is facilitate that game and because it.

Wants to increase glucose at all costs it will strip the muscle of its protein to get those amino acids to go to the liver to make new glucose that really is when events one of cortisol or it's similar molecules that the identical drugs its main effects is to increase glucose and it'll strip the muscle to do that the fact that it has.

Anti-inflammatory effects that's that's the clinical outcome we want when we give the drug but every drug has side effects it really is just that it's it's a balance is one of the side effects something that is going to help me in this case and then you have to know there gonna be other negative side effects that you don't want but you.

Can't avoid yeah this has been great so where can the people go to find more more of your talks and stuff yeah yeah so you'd mention it earlier met I've done several talks at this point and I always enjoyed it is fun as a scientist to be able to share science with with just general people that aren't scientists so any Google search for.

Victim envy I am again you'll immediately start finding with some of my talks I'm I'm pretty active on social media but it's all in the context of science it has never just never me with doing stuff with my family it's never me with my food that's just not my brand if you will it's just me sharing science on human metabolism and people can find me.

At van Bickman VI km a an in-between PhD that's on Instagram and Twitter and Benjamin Bickman PhD on on Facebook and then and then I'll start doing more blog and video content on the get health site again that's get HL th com yeah definitely a good place to start is the YouTube talks that he does he does presentations slideshows all that.

Talking about this topic basically so check those out and the book why we get sick July 21st yeah it's available for pre-order now on audible and you know hard copy no I did not see I know I was actually a little bummed but but the guy I got to pick the guy who did the voice and he was awesome he has a really similar kind of cadence.

And inflection like I do because some of these authors some of these readers the narrators have a really professional voice isn't but that's terrible s not me it's got to be a guy with some action to his voice so anyway it's a great guy but it's available on Amazon Barnes and Noble anywhere so yeah go ahead go get it and you'll do yourself a.

Favor thanks so much thank you guys this was great and congratulations I'm terrible things are going so well thanks alright everyone that's gonna do it I'd try out the lake so it's flickering did you notice that yeah but that was fun yeah I almost liked this lighting better yes no I'm sorry oh we took you off screen already okay yeah so that is.

Gonna do it for today we got a video coming in a half hour that you can check it out
Why We Get Sick - Interview with Dr. Ben Bikman
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