Metabolism and insulin with Dr. Ben Bikman

Podcast Summary by Dr. Payton Busker, PT, DPT 

Dr. Ben Bikman (who prefers to go by Ben) was on this week’s episode of Fit Body, Happy Joints! Ben is a metabolic scientist. He describes himself as “a scientist and a professor. [He teaches] Pathophysiology, which is the sick body, and Endocrinology, which is the study of hormones. [He is] the director of the Diabetes research lab and that reflects [his] professional research interests which is to understand metabolic disorders”. 

Shannon and Ben dive into all things insulin sensitivity and metabolism in this episode. Ben breaks down why we should all improve our insulin sensitivity and his educated opinions on how to do it. He also breaks down some myths about metabolism and talks about burning calories. 

This blog post will serve as a summary of some of the highlights from this episode! 

What is considered optimal metabolic health?

Ben purports that optimal metabolic health occurs when the body is (1) insulin sensitive and (2) a body has low insulin levels for the majority of each day. He believes that optimal metabolic health can be defined as when hormones and biochemical processes are working well. He notes that elevated insulin levels disrupts these metabolic processes and thus pushes individuals further away from metabolic health. 

What is Insulin?

Insulin is a hormone that circulates within the blood. Ben notes that insulin has an effect at every single cell of the body as each cell has insulin receptors. Metabolic health is jeopardized when one develops insulin resistance.  

Insulin resistance occurs when 

1. Insulin isn’t working well at at least some of the cells of the body 
2. Blood insulin levels are elevated 

Ben explains that insulin resistance plays a role in nearly every chronic disease. He goes into the details as to how insulin resistance plays a major role in infertility from both the female and male perspective. 

Can people who look “healthy and fit” have insulin resistance issues?

Ben says YES. And that we should all be concerned with optimizing our insulin levels. He notes that this common issue is much more prevalent than people realize. 

He specifically touched on a comparison of women with and without PCOS who were the same exact weight. He notes that the primary difference found between these two groups was insulin resistance at the fat cells. 

Someone’s size cannot overtly determine their metabolic health.  

How can you improve insulin sensitivity?

Ben notes that the first step is actually shrinking fat cells. He states that there are two ways to do this and he expresses which he feels is the more effective and long-term approach. 

1. Low Energy

AKA cutting calories. He holds no punches in his opinion of this method and states that there is a major roadblock to success with this method: HUNGER. Ben says that “hunger always wins” and proposes that we are creating “the perfect failure”.   

2. Low Insulin: 

“Control carbohydrates. Prioritize protein. And don’t fear fat.”

He suggests that one’s carbohydrate sources should primarily come from fruits and vegetables. He states that the processed carbohydrates are the cause of the major insulin spikes- not protein and fat consumption. 

He proposes that within this framework and by following the 3 guidelines, one is able to truly listen to their hunger cues.

Ben states that when insulin levels are decreased, a fat cell “cannot help but to shrink”. He points to his own laboratory studies in which fat cells are monitored in petri dishes. Ben states that the fat cells do not grow until insulin is added into their environment. 

Ben notes that once someone reaches a plateau with fat loss through the “low insulin” framework, they may need to implement fasting. 

Fasting and cortisol levels

Ben proposes that beginning with the low insulin approach prepares one’s body to better tolerate being in a fasted state/using one’s own fat storage for fuel. 

Ben notes that the idea that fasting significantly increases cortisol levels, especially in women, has been “wildly over blown”. He speaks to only 1 study in human beings in which a spike in cortisol (greater in women than men) was found. However, he states that the spike was very acute (about a day) and did not have long-term effects. 

He notes that if cortisol WAS elevated in the long term by fasting, this would be an issue as increased cortisol causes increased insulin resistance. 

How can exercise improve insulin sensitivity?

Ben states that muscle is the primary consumer of glucose in the body. He explains that when we exercise/activate our muscles, they become even hungrier for glucose and can bypass the need for insulin to let glucose into the muscle. He describes this method as a “backdoor” approach. 

He also explains that as we exercise, “counter-insulin hormones” or “insulin-inhibitors” enter the scene including glucagon, growth hormone, cortisol, and epinephrine. 

When one stops exercising, these hormones should begin to subside. However, we can run into trouble when these levels (especially cortisol levels) do not decrease. As mentioned earlier, chronically elevated cortisol levels lead to increased insulin resistance. 

How do we avoid this? Avoid over-exercising. We should be doing enough to make tangible changes in muscle mass, but not so much that we are overloading our systems with cortisol. 

How does muscle adaptation factor into insulin sensitivity?

More muscle mass=more glucose deposit sites and insulin-responsive tissue.

Calories In, Calories Out

Ben notes that it is impossible for us to accurately account for all of the calories coming in and all of the calories going out. He explains that there is no way to “know how much of what we’re eating actually is turning into available energy in the blood”. 

On the calories out front, Ben proposes that we do not have an accurate way to truly determine metabolic rate. 

“Yes calories matter, but it is almost pointless to try to focus on them because you cannot account for them”.  

Ben also brings this back to hunger. He notes that the more we focus on being in a calorie deficit, the hungrier we are going to be. And as we discussed earlier, hunger will always win. 

Does cutting calories reduce your metabolism?

Although Ben explains that, yes, reducing your calories reduces your metabolism, he also notes that it really doesn’t matter in regards to one’s weight loss. He speaks to a study that highlighted that one’s metabolic rate did not have an affect on how much weight or fat an individual gained. Ben proposes that it is actually what people are eating that changes and, therefore, has an affect on their weight/fat gain. 

Shannon states “So we shouldn’t be asking ‘how can I improve my metabolism?’. We should be asking ‘how can I improve my insulin sensitivity?’” Yes! 

Eating before and after exercise

Ben is a proponent of fasted workouts + continuing to fast after the workout is complete to achieve optimal metabolic health. He states that if one feels like they have to eat after a workout, that they should focus on consuming proteins and fats for muscle recovery + growth. 

He argues that there is not a specific window of time that someone should eat protein after a workout in order to receive the benefits, but rather a “barn door” of time. Ben points to the work of Dr. Stewart Phillips to solidify this hypothesis. He notes that Dr. Phillips has demonstrated that as long as someone is getting adequate protein within a 24-48 hour period, they will have no issue with muscle growth. 

Where to find Dr. Ben Bikman 

 You can find Ben on Instagram @benbikmanphd. Be sure to check out his book here!