1201: Benjamin Bikman | Insulin Resistance Is Killing Half of America

24:16What's the villain here? Yeah, right. Yeah. So that question touches on what are the kind of cardinal causes of insulin resistance? I believe that there are three actually worth noting. I will mention them in order of increasing importance. Two causes are relevant, but they're also things that you can't control too readily, which is stress and inflammation. Stress, and I define that as a professor who teaches endocrinology, so a class in hormones, stress is really defined by the elevation of the two primary stress hormones, adrenaline. In the US, we call it epinephrine, actually, epinephrine and cortisol.

24:54So those two hormones, when they're up, they will promote insulin resistance. But there's only so much you can do. You know, like if someone says, well, my cortisol is up, what can I do? We'd say, well, calm down. And they'd say, well, now I'm even more stressed because I can't calm down. You know, so as much as it's a variable, it's also one you can't really, it's a lever you can't really control very well. The next one is inflammation. Inflammation causes insulin resistance, but again, that's a slippery lever. You can't really move it very well. It depends on some variables that may be outside of your control.

25:25But thankfully, both of those are more modest than the main one, which is the one you asked the question with, which is insulin itself. A fundamental feature of biology is that too much of something will generally result in a resistance to that something. And then that brings us to insulin. If we are living a lifestyle and eating a diet that is constantly raising our insulin, the body starts to become resistant to that signal. And then what we then can logically just come to the conclusion of asking what spikes insulin the most, and that's, of course, starches and sugars. So refined carbohydrates, I point the finger solidly at that as the primary culprit, that we have a culture of not only eating all the time and drinking, in the case of like the bubble tea, it's a perfect example, where we eat and drink refined starches and sugars almost all day.

26:17Certainly, as far as insulin is concerned, it is all day because it will take insulin anywhere from three to four hours to come down after someone's had a big carb heavy meal. The average individual worldwide at this point, from the Middle East to East Asia to Southeast Asia to North and South America, Europe and everywhere, the average individual spends every waking moment in a state of elevated insulin. Insulin has come down overnight, just to put all this in perspective. Overnight, we've been fasting just because we've been asleep, ideally. We wake up in the morning and the global first thing in the mouth is going to be something sugary and starchy.

26:55Again, it doesn't matter where you are. That's become common. And so we spike our insulin. And then a couple hours later, we do it again with a mid-morning snack. We do it again more dramatically with a big lunch and then an afternoon snack and then a dinner. And then, of course, we need a snack or two in the evening. And so it is several hours into our sleeping moments before insulin finally comes down. And so that's why I say insulin matters more than the other variables, but then it matters even more because it's also one that you can immediately start to change by just cutting out those carbs.

27:26Insulin resistance might shorten your lifespan, but these sponsors will make your remaining years a little bit more comfortable. We'll be right back. If you're wondering how I managed to book all these great authors, thinkers, creators every single week, it is because of my network, the circle of people I know like, and trust. I'm teaching you how to build the same thing for yourself for free over at sixminutenetworking.com. Yeah, you're not booking guests for a podcast, but the course is about improving your relationship building skills, inspiring other people to want to develop a relationship with you.

27:52And the course does all of that in a very easy, non-cringy, down-to-earth way. There's no awkward strategies or cheesy tactics. It's all practical stuff that'll make you a better connector, a better colleague, a better friend, a better peer. And six minutes a day is all it takes many of the guests on the show to subscribe and contribute to the course. Come on and join us. You'll be in smart company where you belong. You can find the course again, all free at six minute networking.com. All right. Now back to Dr. Benjamin Bickman. Let's say that we get blood work done pretty regularly for Americans, which is what annual or something, if that, right.

28:26I do it every probably 10 weeks, but that's because I'm terrified of death. But, uh, uh, and also because I spent my whole life not caring and not paying attention. And now I'm trying to make up for lost time and I'm experimenting with things, but that's neither here nor there. But so from my point is most of us are not paying attention to this stuff or we get blood work and our doctor goes, looks fine. And you go, all right, you don't really know that he meant looks fine for a 60 year old man, even though you're 24, right? You're within the normal range and that's all you care about. Are there other non-obvious signs that listeners should watch out for or viewers, I should say as well.

29:01What if we're tired all the time or I've got a bunch of weird marks appearing on my skin? I mean, is there some kind of obvious thing that we can see with our eyes? So let me just reiterate the first point and revisit it just briefly. I would strongly encourage anyone who can to get their fasting insulin measured. So next time you go in actually for a lab test, try to buck the trend of insulin never being even discussed and say, hey, can you check that box there and actually measure my insulin? And if you can get a clinician to do that for you, you want to see your insulin somewhere below about six micro units per mil.

29:35So if you see that lower number, single digits, that's a really, really good sign that you're insulin sensitive. If you aren't able to convince your clinician to measure insulin, then look at your lipid markers. Take your triglycerides number and divide it by your HDL cholesterol number. And if that ratio, the triglycerides divided by HDL is less than around 1.5, even better, less than one, that's a really good sign that you're insulin sensitive. And so your metabolic health is going to be somewhere good if that number is down by close to one or even lower. Now, if you aren't relying on a blood test, then actually you mentioning the skin is a good one.

30:13Skin is a window to the metabolic soul. And interestingly, you can see the two most common skin features right around the collar line of the neck. One of them is a condition called acanthosis nigricans, which is a term, a complicated term, referring to the skin changing in both texture and color. And with the color, it simply starts to get a little darker, pigmented. And so the melanin expression starts to change a little bit and the skin gets a little darker. Now, depending on the ethnicity, it might be hard to tell if the skin is darker, as the skin may naturally be darker across ethnicities.

30:49But thankfully, that's where the other part of this comes in, which is that the skin also starts to take on the form of like a crinkled tissue paper. So it's a very kind of wrinkled, deep wrinkled, crinkled skin. And you can very much see that and feel it. So that's one skin condition. There's another one commonly called skin tags. It's like a teeny little column of skin just jutting right up. And people probably can, they know what I'm talking about. They've seen it before, but it's these small little, well, little mushroom stalks of skin. And they're small, but you'll see them kind of dangling up like almost like a teeny little finger poking up out of the skin.

31:25And those are both very common manifestations of insulin resistance. Thankfully, they're also ones that can go away quite quickly as the insulin resistance improves. Yeah, that's good to know. What was the, by the way, I'm looking at my blood work now. What was the two things you divide into one another, triglycerides, and what was the other one triglycerides divided by HDL okay so this is old blood work but 40 divided by 60 if that's below one and a half that's great let me try this right now 40 divided by 60 0.66 oh yeah you're laughing that's great oh that makes me feel better I wish I tested insulin that's a very very good sign yeah tell me about and I'm sure you have a whole rant on this but tell me about GLP-1 agonist aka ozempic and stuff because isn't this why people isn't insulin what this was originally four.

32:10Yes. So these semaglutide, which is the main drug that has been now labeled as Ozempic and Magovi, and there are a few other drugs. If anyone is wondering about the drug, if you are looking at a drug and it has the ending of glutide or utide, it's going to fall within this family of drugs, which is mimicking the actions of a hormone that we all make in our intestines called GLP-1. So we all make GLP-1. It's a hormone and it has beneficial effects for metabolic health. One effect is to help improve blood sugar, to help blood sugar control by telling the liver to hold on to glucose and not be releasing it into the blood.

32:47But as GLP-1 levels go up, there are these other effects that help with appetite. One is that it will slow the movement of food through the intestines, so you just feel fuller for longer. And then second, complementing that, is that GLP-1 as a hormone will tell the brain, it will activate satiety centers in the brain. So the brain will be at that top level telling the body, hey, we're not hungry. We don't need to eat. So those complement each other quite well. So all of that was leveraged into these new drugs, like semaglutide being the main one. What's interesting is that while I have very strong reservations about the current use of these drugs, I believe they're used too readily for the wrong purpose and at too high of a dose.

33:29And the purpose matters because when we talk about these drugs, we talk about them as weight loss drugs. And that may give the person this mistaken view that as long as they're injecting, they're good to go and they don't need to worry about anything. And I think that's the wrong way of looking at it, which leads to problems of people having profound nausea and even depression and suicidality. Those are all increased risks with the use of this drug. And I think it's because it's too much of a good thing. Now, if you'll allow me, let me kind of make a different use case for the drug. There was a paper published in 1996, which documented the GLP-1 response in humans to eating a high carbohydrate meal and a high fat meal.

34:11And they noticed differences and they looked at the subjects of the study based on whether they were lean or obese. And when lean and obese people ate a high fat meal, the GLP-1 response was very similar. It had a lot of overlap. So one way of interpreting that would be to say that whether you're lean or obese, if you eat a high-fat meal, you get a roughly equal degree of satiety. And as much as GLP-1 is a satiety hormone, it makes us feel full, makes us want to eat less, then that is going to be equal regardless of your body fat. Can I guess the rest of this? Please. So the fit people versus the obese people eating a high carb meal, the satiety was wildly different.

34:52And the people who were obese were not satisfied after eating even a high carb meal. Yeah, exactly. So in fact, there was literally, Jordan, there was no response. When they looked at the GLP-1 response to the high carb meal, it stayed within the normal range and it did not reach a point of statistical significance at all in the obese people. Whereas in the lean group, it went fantastically high and stayed elevated for about three hours. And so all of this is to say that we should have empathy, that if we are sitting at a table and we're going out for pasta and garlic bread, someone is going to eat a certain amount of that and feel full, in part because of GLP-1.

35:26Someone's going to eat a certain amount of that and not feel full and simply be looking around for the next plate of pasta and garlic bread. So to me, that suggests a better way of using these drugs because if we can then say to the person, you have a carb problem. And let's face it, people who are overweight, obese, and diabetic, no one is sitting around craving a plate of bacon and eggs. It doesn't happen. They're not wanting a stick of butter to be chomping on while they're watching a show on a Friday night. That's interesting. Yeah. They want carbs. Carbs are the one macronutrient that humans crave and, dare I say, have addictive tendencies towards based on many conventional definitions of addictive behavior.

36:11They seek it. They crave it. They regret it when they can't moderate. It is all these aspects of addiction. So we say to them, let's give you this drug to help you learn to eat differently and have a different relationship with food. And we're going to start it at a lower dose, what you could even call a micro dose. and we're going to put you on a 90-day cycle. Remember, this isn't a weight loss drug. So we frame it properly. We say, this is a drug to help you control your carbohydrate cravings or addictions, depending on the person. And then we check on them. We say, how are you doing? How are your carb cravings working?

36:46They're getting a little better. And as they start to learn to change their habits and learn what it feels like, 90 days is enough for many people to actually cure an addiction. And so around at 90 days, let's wean them off. Let's cycle off the drug and let's see whether some of these habits have stuck. And some people they have, and I know this from just anecdotal evidence of people I know. Other people, it sticks for a while, maybe a month or two, and then it starts to fade and their habits are returning and they're starting to gain weight again. Then we say, all right, let's cycle you on again.

37:16Is that in part because they didn't build habits? They were just injecting a weight loss drug and they were like, they didn't go to change their diet. When it comes to addictions, I am admittedly a little out of my wheelhouse where I can't articulate necessarily the variables that might go into one person being able to change habits and one person not. That's true. But even still, I think it's important that we frame the conversation outside the context of just weight loss. And we say, this is a drug to help you change your habits. And then the person is more mindful where in the evening, if they are now starting to crave five bowls of cereal, they will remember, hold on, wait, I'm taking this drug to help me control these carb cravings.

37:55And I think there's something to be said for that little bit of placebo kick, where if they're thinking about the drug in the proper framework, I believe firmly that they're going to get a little more help. I'm glad you brought up the satiety thing, because it's really easy for people to kind of be mean to overweight folks and be like, you just need to try harder. But I know from going on a diet and losing all that weight myself without drugs. I was talking to a bodybuilder who diets for contests. He was describing how hungry he was at certain calorie levels. And I was like, I don't really experience that.

38:27I'm a little hungry, but then I just hit my 1400 or I was at like 1300 calories for a while, which is ridiculous. And he's like, and you didn't get angry and, you know, kick the dog and try to bash the door down and rip the refrigerator off its hinges. And I was like, no, I just went to sleep. And he's like, you have a superpower for controlling your hunger. And it made me realize that like, if I didn't have that, I just would have eaten chocolate covered rice Krispies or whatever the heck we got in the pantry here for the kids until I hit my 2 ,500 calories or something, I would have busted my diet.

38:56And so any sort of drug that can help people change their habits, I think is fair. I want to push back a little, play devil's advocate, maybe a little bit too. Even if you took GLP-1 forever, semaglutide, whatever, forever, isn't that still healthier than being obese? Because obesity, reading your book, it just basically is one of the worst things that can ever happen to your body. So unless these drugs kill you in some other way, and even if they do, maybe it's kind of better to still live with that and then not be obese. Because like maybe you lost some bone and you lost some muscle and you need to work on that.

39:28But you don't have high blood pressure. You don't have joint pain. You don't have cardiac issues or whatever. You don't have social stigma that you're dealing with. You don't have confidence issues. You're doing like It kind of seems like even the worst GLP-1 ozempic addiction is better than being 100 pounds overweight. That's a really, really good counter. As a scientist, just to help everyone appreciate it, I'm one of those old-fashioned scientists where I just pursue truth. To be a good scientist, and I hope I am one in all humility, I hope I am one, you have to be prepared to dump every theory you have the moment the data proves you wrong.

40:05And so you have to be humble and open-minded to counter points. what would be the counter to that? So first of all, I don't know. In the absence of data, I can't say whether it would be better, but the data we do have are pretty clear. If you tell someone you're going to be on this drug for the rest of your life, it's telling that 70 % of users of these drugs in the United States get off the drug of their own volition at two years. They don't want to keep taking it. They basically say, I'd rather be fat. Oh, nevermind. I spoke too soon. I thought you meant it worked. Do they get off the drug? Not, I'd rather be fat.

40:38No, no. Well, I mean, maybe some people would say, well, I lost the weight I wanted. Now I'm off. But they gain it all back within a year. That's very clear. I see. In fact, they end up fatter because of the muscle and bone loss, which will not come back. The fat mass rebounds fantastically quickly. So 70 % of users, they get off the drug at two years of their own choice. Now, coincidentally, at that same two-year period, a study was published just within the past few months, finding a 200 % increased risk of major depression in these people that go on the drug compared to placebo, a 100 % increased risk of suicidal behavior.

41:15So there is something about these drugs where they would rather be fat than feel the way they're feeling. And so maybe one way of articulating this, now this is my own opinion here, as much as we talk about these drugs as, and I don't even mean for this to sound like I'm universally opposed. I hope I've articulated what I think is a use case for these drugs. Yeah, it doesn't sound like you are. So one way of looking at the drug, as much as we put a very favorable light on it by saying, this drug helps you control your cravings and you crave these carbohydrates less. Maybe if we're being a little more honest, we would say, this drug makes you less interested in things you used to be interested in.

41:57And a person was interested in carbohydrates and snacking on salty and crunchy and sweet and gooey foods, which is good to control. But they might have also been interested in going and playing pickleball with their friends. Now they don't really care to do that as much as they used to. They might have been interested in getting together with the girlfriends and going on a walk around the block every evening, and they don't really do that anymore. Maybe the more honest view is that this drug reduces your interest in life and things that you used to be passionate about. Yeah, that's scary. In fact, that totally jibes with something I'd read about these a couple of months ago, which is that they might have a role in treating certain addictions.

42:36I don't know if you've seen this data, but it was something like they were using GLP-1 antagonist for addiction, which totally makes sense if you look at carbs as an addiction, and then you realize it makes people depressed because they're not as interested in other things they were interested in. Well, heroin is one of those things, or alcohol is one of those things, or cocaine. Exactly. In fact, that evidence is part of why I articulate the view the way I do. I see. I'm very familiar with the fact that it can be use to control addictions. And that's why I think it works the way it does. It makes you less interested in the foods you used to crave, but it also makes you less interested in the other things you used to enjoy.

43:07Yeah, that's scary, man. There's a lot more with insulin resistance that I'd love to cover. We're going to blast through some of this stuff super fast, I think. But brain health was something I wasn't really expecting. Memory, learning, insulin resistance in the brain. You even mentioned that Alzheimer's is sometimes called type 3 diabetes. Can you speak to that a little bit? Yeah, it is. Yeah. It's scary. But again, I would say there's some good news because I think there's something empowering about realizing that so many of these scary chronic diseases have a metabolic core. There's a good news there because you can do something about metabolic health rather than just feeling helpless as you descend into cognitive decline.

43:45So the brain is no exception as every tissue in the body suffers in insulin resistance. Most people don't appreciate the fact that the brain, in order to get enough glucose to meet its energetic needs, it requires insulin to be working well. And so as the brain tissue becomes insulin resistant, now insulin comes and knocks on the doors of these neurons, asking the doors to open up so the glucose can come in to fuel the neuron. The doors don't open. There's no answer to insulin. And so as you improve insulin sensitivity, you enhance the brain's ability to get glucose. Now there's another part to it because as you also improve insulin sensitivity, your insulin levels come down.

44:25And as insulin comes down, the body starts burning more fat. And when the body burns more fat, it makes more of something called ketones. And ketones are a very favorable fuel for the brain. The brain loves ketones, to put it in a silly way. In fact, if the brain has a preference for either glucose or ketones, it chooses ketones. If it has equal access to both from the blood, like 70 % of its energy will start coming from ketones if the ketones are available. Even when the ketones are at lower levels than the glucose, just evidence of how much the brain prefers ketones. And when you give a cognitive decline brain ketones, cognition improves.

45:09This has been now shown in multiple studies, human studies, where you take people with Alzheimer's disease, kick them into ketosis by, say some exogenous ketones, some ketone supplements. So rapidly get them into ketosis, have them repeat some cognitive tests and they'll do better. Depression is one of the symptoms of Alzheimer's disease. It's not just memory, but it is all a manifestation of the brain starting to go hungry or the brain starting to starve because it can't get enough glucose because of insulin resistance. And because people are spiking their insulin all the time, they're never making ketones.

45:41So you want to give the brain a shot of ketones. I know that insulin also affects testosterone, own sperm. There's erectile dysfunction ramifications here. I will say when my A1C slash insulin resistance, triglycerides, cholesterol, all that stuff went down and got healthier, my hormones went way up on their own. And I read in your book, this was a slap across the face for sure. Fat tissue in a way acts like an ovary in terms of aromatization and hormones. Can you tell us what that means? Because that was, man, if you told me that, I wouldn't have gotten fat in the first place, I think. Yeah, yeah, yeah.

46:14No, I mean, you definitely start thinking of like a scene from Seinfeld, like the man's ear or the bro, where the guy is starting to store fat in a way that is less manly than it used to be. You actually expressed the perfect term here. Aromatization is the term to refer to the actions of an enzyme called aromatase. And aromatase, its purpose is to take testosterone and convert it into estradiol, which is the main estrogen. Estrogen is actually a little family of hormones. It's not one single hormone. But it's a little known fact that all estrogens were once testosterone in males and females. It's just ovaries do this more than testes do.

46:49One of the many, many unexpected effects of insulin is to inhibit aromatase. So as much as aromatization is attempting to convert testosterone into estradiol in a man that's happening less than it is, of course, in female counterparts, But the bigger a man is getting, the bigger his fat cells are getting, the more the fat cells actually are expressing this enzyme aromatase. This enzyme that you think is just one related to the gonads in sex hormone production in the testes and the ovaries absolutely begins to express itself at higher amounts and at ever greater activities in the fat cells of the person as they're getting fatter and fatter.

47:26This is important, though, because it changes the perspective. We have a perspective, which is that you're fat because you are low T. In fact, in most men, it's actually probably the exact opposite. You are low T because you have too much fat. And as you reduce your fat, you reduce the aromatization. And now your testes and all that hard-earned testosterone they're making can remain as testosterone the way the testes intended it to be without the fat cell taking it in and And hijacking it and sending it out as estradiol, making you less manly, literally, physically. So the more we cut back on fat cell mass, just fat mass, the more the testes are able to do the job they want to do, which is just fill the body with manly testosterone.

48:13Interesting. Yeah, I love the way you put this. I think also erectile dysfunction, I get a lot of letters for our Feedback Friday segment instead of Vice segment. I am quite disturbed by the number of 20, 25-year-old men who have erectile dysfunction. And at first I was like, stop watching so much porn. You know, if you can't get it up for your girlfriend. But that's a gross oversimplification probably. Look, I'm not going to say that's not a problem because it's definitely a problem. Agreed, agreed. No, I'm glad you noted that though. Yeah. Because I do think it's an important part of our culture where the more we indulge in this kind of behavior and assume it doesn't have any consequences, the more ignorant we are.

48:49And the more we're hurting these young men, they need to know that the more you're exposing yourself to pornography, the harder it's going to get for you to have a normal sexual relationship with a real human. A hundred percent. From a science perspective, we're not evolved to have a thousand sexual partners at any point in our life. Even, you know, Genghis Khan probably had his own issues as a result from that. Right. But now like a guy who's in high school and has a phone can access a new virtual sexual partner every single day. Oh, no, Jordan, it is sobering. It makes me ache for these young men.

49:20Yeah. I think about at the risk of really sounding kind of weird, growing up in a little farm town in Alberta, if you wanted to try to look at something inappropriate - You got to drive to town. You literally couldn't find it. In our little town, we had one little gas station, no dirty little magazines were sold there. Oh, I see. You literally couldn't find it. Now the idea of a young man having it in his phone, man, these boys have to have a level of discipline that we didn't need in the early, mid 80s, you know, when I would have been, or even late 80s, when I would have been at my peak of curiosity of these kinds of things, late 80s, I guess, early 90s.

49:55I'm so grateful I didn't have access to it. It's a good point. I got access to internet porn in what, like college? And I was like, well, okay, but I also have a girlfriend. So like, you know, I was going to choose the real one. But pornography aside, I get these letters from these guys that I think is part porn brain, right? They can't get it up without porn or something like that. But I also think that they have other physical issues. And it never occurred to me that it could be the canary in the coal mine of insulin resistance because of the hormone thing. Can you speak to how that might affect our manhood?

50:28Absolutely. So we already touched on the testosterone aspect, and that does matter. Testosterone is a relevant part of normal erectile function and fertility in men. But we don't even need to go that far. We can actually just come right back to insulin resistance. It's a little known effect. One of insulin's additional effects is to act on the endothelium of blood vessels. The endothelium is the innermost lining of the blood vessel. So think about every blood vessel as a hose, a tube, and then the innermost layer is the endothelium. When insulin comes to the endothelium and binds its own receptors on the endothelium, it will stimulate the production of a molecule called nitric oxide.

51:05The nitric oxide will permeate through the blood vessel and tell the blood vessels to expand. And so that's a process called vasodilation. And it is an essential part of normal erectile function that insulin acts in those blood vessels to stimulate this increased blood flow to enable normal erectile function. If insulin isn't working well in insulin resistance, it isn't, then those blood vessels stay constricted. In fact, this is so well known to be connected that there was a paper published by physicians maybe 10 or 15 years ago, and the title of it was really telling, where it said something like, is erectile dysfunction the earliest manifestation of insulin resistance in otherwise healthy men?

51:50I think that might literally be the title of the manuscript, just suggesting that there's this incredibly relevant metabolic component to this hormone that we used to think of as only being relevant to blood sugar. No, it also regulates even something like erectile function. And then in women, we have the balanced other side, which is polycystic ovary syndrome. Is that PCOS? PCOS. I keep hearing about this. That's the most common form of infertility in women. And once again, it's a consequence of insulin resistance affecting the ovaries' ability to produce sex hormones, which prevents her from having a normal ovulation cycle, and she has PCOS as a result.

52:27So both of the most common forms of infertility in men and women within their respective spheres still have the same metabolic core. Studies show that patronizing our sponsors reduces cortisol and improves dopamine. Citations needed, but in the meantime, here are some ads. If you like this episode of the show, I invite you to do what other smart and considerate listeners do, which is take a moment, support our amazing sponsors. They make this show possible. All of the deals, discount codes, and ways to support the show are searchable and clickable over at jordanharbinger.com slash deals. If you can't remember the name of a sponsor, you can't find the code, email me, jordan at jordanharbinger.com.

53:00I'm more than happy to surface codes for you. It is that important that you support those who support the show. Now for the rest of my conversation with Dr. Benjamin Bickman. You cover in the book air pollution and insulin resistance, aging, cancer, even lack of sleep making us insulin resistant or light exposure at night. It's kind of like all the stuff we kind of knew we had to do for some reason for health generally turns out to all kind of be connected to insulin. It's really wild. That's exactly right. And this is why when I attempted, like I mentioned a little while ago, when I wanted to try to step out of academia and say, okay, do any of my ideas actually matter in the real world?

53:42Because if scientists are being honest with ourselves, publishing a peer-reviewed paper in a scientific journal doesn't change the world. It doesn't do anything. No one will ever read it. Spoiler alert. I was going to say, nobody's reading it. Even my own dad isn't going to read those papers. They're so irrelevant to the lay audience. So when I was first imagining what are my best ideas to articulate to help people be healthier, it was to just bring awareness to this one problem because of how common it is and because of how relevant it is with so many diseases coming from it. But just to be clear, I don't want someone to roll their eyes and think, okay, Ben believes that insulin resistance is the singular cause of all ills.

54:18No, there are other noxious stimuli that would play into chronic diseases that would totally be going around insulin resistance entirely. But if we know that so many of these chronic diseases do come from one single thing, that is empowering, like I've said, because then we can just address that one single thing, knowing that all these other things are going to get better. It was really sort of disgusting and eye-opening about the section of the book where you talked about how fat cells essentially belch toxic stuff into your blood. Yeah. It's unfair. There's your body betraying you, right? It's pumping out hormones you don't want.

54:53What was the other thing? Cytokines or something? Cytokines, yeah, exactly. What are those? Yeah, so cytokines are basically hormones that promote inflammation. Okay. And when the fat cell is getting really, really big, that's why I said the smaller fat cells are anti-inflammatory, not only because they're not releasing these pro-inflammatory hormones, but they are actually literally releasing hormones that dampen inflammation. So they're turning it in the opposite favorable direction. But the bigger the fat cell gets, the more it is vomiting out these pro-inflammatory hormones that we call cytokines.

55:24Once you read books like this, you're just like, oh my gosh, I had no idea how important it is to change it. like you just think like you get a little bit fat, it's not good for you, maybe it's a little bit of extra pressure on your heart, your organs. You're like, ah, I'll lose the weight later. You don't realize that having extra fat is just, you have fueled up an entire system of dangerous and unhealthy hormones, chemicals, byproducts that is just 24 seven chugging into your body. It's like you might as well have a drip feed of diesel fuel into your right arm. I mean, it's not quite that bad, obviously, but it's just really scary to think about.

55:58Because again, you kind of think like, oh, I'm a little overweight, you know, whatever. What's the big deal? I'll lose it later. You don't realize it's doing damage every minute that you're alive. It is a drip. In fact, that term, it's so well identified in obesity that they call it subclinical chronic inflammation. It's subclinical because you're not coming in with some overt infection or you can't look at the person and say, boy, you have a lot of inflammation. And yet all of those levels are higher than normal. And so it is chronic. It's subclinical because it's not obviously causing clinical consequences, although it is subtly contributing to a host of them.

56:34Once you're a diabetic, is it possible to get off insulin ever? Or it probably depends on the type of diabetes, right? If your pancreas doesn't work, I mean, that's just... 100 % depends, yeah. So if it's type 1 diabetes where you don't have the beta cells that make insulin, then you're on insulin for life. That doesn't mean there still isn't something to consider in all of this conversation. In fact, the same rule applies that if you are having to inject a lot of insulin to control all the carbs you're eating, the more you're injecting insulin, the more you have all the same consequences we've just been talking about, which is too much insulin driving insulin resistance and chronic disease.

57:08So the same rule applies. You just can never get off insulin entirely. You always need some. Now, in type 2 diabetes, that's absolutely the case that you can fully reverse the disorder. If it's true type 2 diabetes and not some form of type 1, to be clear, then you are always making insulin. It's just a matter of you've demanded too much insulin from your body for too long, and now you just need to recalibrate, if you will. We published a paper a couple years ago with a local clinic where we took 11 individuals with newly diagnosed type 2 diabetes, every definition of type 2 diabetes they had, and within just 90 days of a low-carbohydrate diet.

57:47And mind you, one that did not require them to count their calories. It was simply eat as much protein and fat as you want. Just keep your carbs to this level per day. Count the grams of carbs you eat. So you don't have to be hungry. If you're hungry, eat. Just focus on proteins and fats. Within 90 days, every single one of these 11 people had reversed their type 2 diabetes by every clinical marker. There was no evidence of the disease whatsoever without ever having taken a single medication. That's crazy. I mean, sample size 11 is what people are going to say. So yeah, we need more. Yeah. So we published it as a case study, but you're seeing larger case reports and studies done, more actual clinical studies done by groups like Virta, V-I-R-T-A.

58:29Virta Health has really been on the forefront of expanding this practice of looking at things like type 2 diabetes and saying, this is a disease of you basically eating too much carbs and you just can't control your blood sugar anymore. And if you can't control your blood sugar, then let's just eat less. of it. Wow. This is really interesting, but it's great because what it means is you can take control of this and you might even be quite far gone down this road. You can still turn it back and reap all the benefits, especially to your brain and body. And again, it's part of your brain, right? I think a lot of people might go, I don't care what I look like.

59:03And now it's like, oh, there's a lot more going on than what you look like. You're going to end up with Alzheimer's or Alzheimer's, dementia, other kinds of body issues that, you know, your penis isn't going to work. Guys are like, wait a minute. Yeah, I want that thing to work. Yeah. I thought, okay, I'm overweight. At least I can take care of myself. Not for long there, buddy. Not for long, you can't. It's not going to work. It's not going to work at all. Yeah. So get things going on here. Wow, this is quite powerful. I mean, just restricting your carb intake is just from somebody who went on a major diet a few years ago, like I told you before, if I only had to count my carbs, but I could eat as much protein and fat as I wanted, that's an amazing diet.

59:40That's really not hard to do. It works. Because chiefly, the calorie restriction is the issue, right? That's the part that makes you hungry. But if you can just eat chicken and you're good, that's amazing. Or even hamburger. Make some hamburger patties and eat those hamburger patties. That's a diet that literally I think anybody could follow. The problem being how addicted to carbs are you? Yeah, right. The concept is so simple, but the implementation might not be. There are some people who just with that knowledge are able to say, okay, I'm in, I'm committed. That was me, yeah. You might be one of those people.

1:00:09Yeah. But there are a lot of people we know where those carbs are calling. It's like a little siren call every evening, tempting them to jump off the ship and drown themselves in five bowls of cereal. I mean, that's when you got to get out the atomic habits, James Clear stuff, right? And like not have it in the house and like make it so that your DoorDash requires you to log in every time you want to order something and all that stuff to get rid of the carb temptations. Have a locking cupboard that if your wife wants to eat Cheetos, So she can, but you can't get in there. Yeah, but also recruit help.

1:00:40If you can, mind you, sometimes the people we love end up sabotaging our efforts because they see you making a change that they don't want to make yet or they're not prepared to. But insofar as you can, people listening who have a goal here, recruit help. Ask your friend or family, loved one, express some of these concerns and say, can you follow up with me? I've mentioned now a couple of times having bowls of cereal. That is like crack cocaine to me in the evening. I will go through this pattern of like an addict where I will say, well, I'm just going to have one little bowl. This is so me. Knowing that I'm not going to stop at one bowl.

1:01:13If I could stop at one bowl, that would be fine. But I don't. I will not stop eating those frosted mini wheats until I have them coming out my nose. Yep. And so I've told my wife over the years, if you see me go to the pantry, but again, we don't buy it very often because I know I can't control myself. But I'll tell her, Cheryl, if you see me going to the pantry, you stop me. Yeah. I'm going to be a little tiffy about it. I'm going to be a little angry. That's right. But I'm never mean, but don't care. You never care about how I feel about anything. Don't care now. Don't start now. So you're in charge.

1:01:45Yeah, you just tell me to stop. And it has helped. Man, I'm the same way. I'll be done eating. I'll be at my calorie thing because I still count the calories. I'm not the guy who can eyeball the food, even though it's just the numbers higher now. And I'm like, oh, there's Captain Crunch in the pantry? Oh, man. I want a handful of that. So I take a handful and I'm like, that's kind of a small handful. Let me get a bigger one. Well, and I need a little milk just to help wash it down. And you can't put that in your hand. So you put that in the bowl and you're like, that doesn't look like very much.

1:02:10I could probably put another handful in there and then a little bit more milk. And then suddenly I'm eating a whole bowl of Captain Crunch at 9.30 PM. And you're just like, how did I get here? I know. I know. That's what I mean. That's why I say it's like a true addict where you know you don't want to do it. But this is another reason why I rage against this mantra, moderation in all things. And I think that's the thing that the dietician likes to say because they don't want to say that some foods are worse than others for some reason. I don't know what's in their brains that make them not able to admit that.

1:02:40But moderation in all things is one of the most horrific ideologies when it comes to addictive habits. Would we ever tell an alcoholic friend if we're going out for drinks, hey, just we're going to go out for drinks. Why are you drinking milk? I say that as a Mormon boy who does drink milk when I go out with buddies. And we'll say, hey, why are you drinking? Just come have a beer. Well, I can't. I'm an alcoholic. Well, then just have one. How stupid is that? So St. Augustine, funny for a Mormon boy like me to quote a Catholic saint, St. Augustine said, which is brilliant and beautifully articulated, abstinence is easier than perfect moderation.

1:03:19For some of us, we need to acknowledge I'm an addict to these carbs. And so it's easier for me to never even start eating than it is to stop eating. So just don't even start. I routinely say, why did you buy the big box of this for the kids? And my wife's like, for the kids, huh? And I'm like, I don't need you enabling me. Yeah, no, your dynamic might be the same as mine. My wife and I, I can have a pint of Ben and Jerry's or a pint of Haagen-Dazs, one for me and one for my wife. She has this alien-like ability to pop the lid off and daintily eat five or six bites, put the lid on and put it in the freezer.

1:03:54Can't relate. I can't relate because not only am I going to go to the bottom of my pint, but I'm going to be wondering when she looks away so I can go finish hers too. That's right. I want to just, I want to taste a couple of those too on the other side. Yeah, exactly. Yes. So folks obviously should talk to their doctor before they go on diets of any kind, probably, but yeah, lower slash cut out the carbs and stop buying them and things like that if you can and see if your insulin, your fasting insulin levels change. That's the metric we're looking at in the blood. Absolutely. What about artificial sweeteners?

1:04:22Like if I'm drinking a Diet Coke, is this spiking my insulin and is that bad? Yeah, good question. No, no. So it depends on the sweetener, but with Diet Coke, very explicitly, aspartame does not increase insulin. And so drinking a diet soda, even nowadays, more and more of the sodas have sucralose in them too. So if it's a zero drink, rather than just diet, then it has some aspartame and sucralose. I personally don't like the taste of sucralose. It's a little too sweet for me. So if I want an indulgence and I absolutely sometimes do. I will drink a diet Dr. Pepper and there was no effect on a CGM or on insulin whatsoever.

1:04:59Now that's not to say all sweeteners are benign. Stevia is maybe the best one most consistently. As long as Stevia has been around, there's like never been a single negative paper published about it. Aspartame is fine. Stevia is fine. Monk fruit extract is fine. Erythritol is fine. But then some of the other alls do have a mild insulin effect, which can have consequences where it might make you a little hungrier after. And so my view on sweeteners is if a person eats something that has been sweetened with a sweetener, and if it makes you a little hungry after, then it's one you should probably avoid because it probably is spiking your insulin.

1:05:36And mind you, some people can have a different response based on their microbiome. The microbiome actually can metabolize some of these sweeteners in different ways. So it gets more complicated than most people want to think. But, you know, I should have actually mentioned a sweetener Allulose is one that far from making you feel hungry, increases GLP-1 significantly. RX Sugar, for example, makes a bunch of allulose products. You're going to feel more full. So that's something I've used in the past in the evenings when I have some cravings. I'll eat a little sweetened allulose bar or something, and it'll be pretty effective for appetite control.

1:06:08So not all sweeteners are created equal. You might have to send me a link to your favorite allulose sweetened bar because I've never heard of that. I want to try that. And I'll put it in the show notes because I think people are going, wait, there's a bar I can eat that will make me not want to eat more stuff. after that. That's pretty useful. What's one habit you changed after seeing your own data? That's a great question. In fact, data is the right way to frame it because I did some of these changes I made based on data that I saw from wearables that I had on monitoring my sleep and at the same time monitoring my blood sugar levels with a continuous glucose monitor.

1:06:39Maybe the one habit that I've changed that has helped me the most overall, including and most especially my sleep habits, and I've long been a terrible sleeper, has been not spiking my blood glucose before I go to bed, actually. I would wonder why I would be lying there in bed. My heart would be racing. It'd be beating hard and I'd be hot and like I'd sweat so much. I'd be so hot. And I didn't know that I was going to bed hyperglycemic every night. And hyperglycemia actually stimulates the sympathetic nervous system. That's the aspect of our nervous system that gets us ready to run and engage in something physical.

1:07:16Well, that's a terrible time to activate your sympathetic nervous system when you're trying to sleep. And so the one habit I changed the most based on data, my own, was really avoiding glucose spiking foods in the evening. Easier said than done, but I've shifted to other habits. Yeah, Mr. Cereal Bowl. Exactly. That is easier said than done. Yep. It's funny. What's one thing you changed? No, I stopped eating carbs in the evening. Didn't we just talk about how you eat cereal every night? That's good to know though. But that helped me with my motivation, honestly. That's good. Because when I started thinking about the lingering consequences of my poor sleep, it became a little more stark.

1:07:54Where before it would just be, hey, Ben, you're losing your six pack. You're going to get a little chubby. Well, that's so subtle that I could justify it. But when I really acknowledged, now this is making me really chronically sleep deprived and I feel miserable all the time. Yeah. That gave me a little extra push to actually help me make some differences. I'll wrap with this. If you could allocate, let's say,$100 million of NIH money tomorrow, what study would you run? That's an awesome question. I would do the opposite of all of these weight loss studies. So there's still a very ongoing raging debate about the nature of obesity, where some people will say it's just purely calories.

1:08:31Some people will say, no, it's just purely hormones, namely insulin. And my view is that it's actually a little bit of both, that a fat cell needs to be told to get fat, which is what insulin does, and it cannot without that signal. But at the same time, it has to have those calories to fuel that growth. So you can't have it either way. The problem is all the studies that have been done to try to answer that question, is it a calorie problem? Is it a hormone problem? Have been weight loss studies, which introduces a tremendously relevant confounding variable, which is when you take the average person and say, you're going to go from your standard American diet to this low fat diet, high carb, it's actually still fewer carbs than it was compared to the standard American diet.

1:09:12So in both diets, you actually have both lower calorie and lower insulin, because even though this one over here is low fat but high carb, it's still fewer carbs than it was before because you're making them eat so much less. So you've never been able to answer the question on any of these weight loss studies, is it a calorie problem or is it an insulin problem? So to answer the question better, we actually have to do a weight gain problem, which is try to make people fat and have them on two different diets. Say, hey, you're going on a high carb version of this high calorie diet. You're going on a ketogenic version, a low carb, high fat version, but it's high calorie.

1:09:49And we're going to see which one makes people fatter. That then would answer the question much more definitively. And I would argue much more convincingly of what is it that makes us fat? Because trying to answer what makes us fat by doing weight loss studies is the wrong way to answer it. And it's going to continue to lead to confusion. So we need to actually make people fat and see which one is harder to get fatter on. That's a good point. I hadn't even thought about that. Wow. It seems like somebody would love to fund something like that. I don't know how the grant process works. Oh, man, Jordan, it's so frustrating to get grants.

1:10:20It's maybe the one part about being a professor I hate them. As a scientist, I hate the most. Yeah, I'm sure you're not alone. It is so difficult. It just seems like if we could figure out what don't drug companies want to know what makes people fat? Don't exercise companies want to know what makes people? It seems like a lot of people would be able to use these results. Well, yeah, but you say a drug company. But the problem is there's no money to be made if it is just a matter of control your carbs. I see. I would argue that the fact that there's nothing to patent is why these kinds of studies have not been done.

1:10:47That totally makes sense. You're right. If the answer is, hey, eat less junk, they're going to go, well, wait a minute. I can't put a label on that. I can't sell that to your insurance company. Yeah, you're right. You're kind of stuck. You have to raise that money yourself. The good news is it probably won't cost$100 million. Oh, it'd be less. Yeah. Yeah. But more than I can fund at the moment. Yeah. Someday. Yeah, man. Got to call those Walmart Mormons, see if they can cut you a check. You got to start rallying the big BYU alumni base. That's right. Dr. Bigman, thank you so much. This is fascinating.

1:11:15I, you know, whenever I look at the nutrition stuff, I'm always like, oh, am I going to be interested in this nutrition thing? And then it's always just endlessly fascinating. I really enjoyed this conversation, man. Thank you so much. I did too. This was great. Yeah. Thanks so much for having me on. What happens when the only way to survive is to lie so well, you forget who you really are. FBI veteran Scott Payne went undercover with one of the most dangerous biker gangs in the country and almost didn't make it out. This is the way I was trained. And this is what I think. Anytime you are something that you're not, pretend to be something that's opposite of you for a long period of time, especially in deep cover, generally one or two things is going to happen.

1:11:53You're either going to slip up and they're going to catch you or you're going to become it. Because there's so many horror stories and undercovers, it sucks that the same mistakes are being made today that were being made in the eights. You got a small department, you got somebody just running the undercover, but that person is also the case agent who is going to get promoted if the case succeeds. I'm not saying people are going to do the wrong thing. It's just a bad foundation. I guess people is kind of my business. Even as an investigator, at the end of the day, you need to be able to sit down with somebody and have a conversation with them and gather intelligence, get information.

1:12:30Because if all else fails and computers shut down and phones, that's great. It's all good stuff, but it's all human intelligence. and you just need to be able to talk to people. You got to be believable. And this is where a lot of people think about undercover. And when I'm out training and speaking, I mean, I'll ask, what do you think undercover is? Some people say acting. I go, okay, what else do you think it is? Lying. Pretending to be something you're not. The true definition of undercover work is you're forming relationships that you're most likely going to betray. That sucks if you look at it that way, but you need to be able to figure out a way you're going to do it and rationalize it in your mind so it doesn't have an adverse impact on you.

1:13:08Go inside basement strip searches, a brotherhood built on betrayal, and the psychological damage that still lingers on episode 1120 of The Jordan Harbinger Show. Man, there was a lot we didn't even get to. It's really more than just how fat you are. It's how you store it. How do we know if we have that? Dex a scan, I suppose. You know, is it between my organs? Is it outside? Is it subcutaneous? Pants don't fit. Can't see penis without mirror. I mean, good rules of thumb, but maybe not the best heuristic. I've actually had people ask before if I had diabetes because I am peeing constantly. I know some of you can relate.

1:13:43It turns out I'm just really well hydrated. But if you also are not well hydrated and you pee constantly, check that insulin resistance. The book goes over a lot of other topics related to insulin resistance. Autophagy, which is cell death, evolutionary context, early onset puberty, obesity, cancer, aging, air pollution, even lack of sleep can make us insulin resistant. Basically, a lot of things that make us unwell, at first at least, lead to insulin resistance. It's really quite fascinating and alarming. So if you are insulin resistant, if that's what your blood work shows, I highly recommend getting that under control because, man, the downstream effects from that are just, as you heard on the show, horrible, lethal, insert adjective here, really not something you want to face.

1:14:25All things Benjamin Bickman will be in the show notes on the website. Advertisers, deals, discount codes, ways to support this podcast, all at jordanharbinger dot com slash deals. Please consider supporting those who support the show. Also, our newsletter, very engaged you all are with this. That was a weird way of Yoda way of saying it. Anyway, the idea is to give you something specific and practical that'll have an immediate impact on your decisions, your psychology and your relationships in under two minutes. We make it a good fast read. It's out almost every Wednesday and it's a great companion to the show.

1:14:55Jordan Harbinger dot com slash news is where you can find it. Don't forget about six minute networking as well over at sixminutenetworking.com. I'm at Jordan Harbinger on Twitter and Instagram. You can also connect with me on LinkedIn. And this show, it's created in association with Podcast One. My team is Jen Harbinger, Jace Sanderson, Robert Fogarty, Tata Sidlowskis, Ian Baird, and Gabriel Mizrahi. Remember, we rise by lifting others. The fee for the show is you share it with friends and you find something useful or interesting. The greatest compliment you can give us is to share the show with those you care about.

1:15:23If you know somebody who's interested in health, maybe is worried about their insulin, maybe needs to get in better shape, definitely share this episode with them. In the meantime, I hope you apply what you hear on the show so you can live what you learn, and we'll see you next time.