Carole Freeman:
Benjamin Bikman earned his PhD in bio engineer. Every time I read it in my head, I can say it, and then I can’t say it out loud, bioenergetics, and was a postdoctoral fellow with the Duke National University of Singapore studying metabolic disorders. Currently, his professional focus as a scientist and professor at BYU is to better understand the origins and consequences of metabolic disorders, including obesity, diabetes, with a particular emphasis on the role of insulin. He frequently publishes his research in peer reviewed journals and presents at international science meetings. Welcome, Dr. Bikman.

Dr. Bikman:
Carole, thank you so much, delighted to have the time with you to talk about anything human metabolism.

Carole Freeman:
Excellent. I’m so thankful that you’re taking the time. I know you’re on your whirlwind stay at home book tour right now. I can’t imagine how busy you are, but this is… I can’t tell you how excited I was when I found out that this book came out because this is the book that we need. This is the book that everyone in this world needs to read. I’m not even joking about that, because, oh my gosh, the whole keto world that I’ve been in, this is the underlying piece, and a lot of people really miss it. I appreciate you being here. Thank you so much.

Dr. Bikman:
Well, my pleasure. In fact, thanks for pointing out the book. Really, to me, that book is the reason for keto. Whether people know it or not, at least to me, keto is used because of how effectively and how rapidly it improves insulin sensitivity, fighting insulin resistance, which itself is so fundamental to so many chronic diseases. That’s why so many things get better on keto. It’s because you’ve controlled your insulin.

Carole Freeman:
Wonderful. Wonderful. Well, let’s start out with the basics, if you don’t mind, because I know you speak a lot of professional conferences, but we’ve got just average people here. Let’s start out with some basics so that we can… These are things that we talked about and needs to be refreshed constantly, because they’re just not topics that people are used to hearing about in school. Let’s start with the basics. What is insulin?

Dr. Bikman:
Insulin is a little hormone that is… It is in fact quite small, that is flowing through… I mean, quite small compared to other hormones, even. It’s flowing through our blood. It comes from the pancreas, and then moves all through the body, and literally tells every cell in the body to do something. Every cell in the body has insulin receptors. That is not that common among hormones, where every single cell is affected. There are others, but insulin is one of them. The general theme of insulin is telling cells to store things, take in energy and store it and make something with it.

Dr. Bikman:
It’s anabolic. It’s building things up, so if all of us have insulin flowing through our blood right now, unless the person is a type one diabetic, that is a disease of no or too little insulin because the cells in the pancreas that make the insulin are getting destroyed. That’s the autoimmune disease. But other than that, it’s a hormone flowing through our blood. We most typically identify it or recognize it with its effects on glucose. The most common effect of insulin is to lower glucose, but that’s not fair to insulin. It does a lot more than that.

Carole Freeman:
It’s a much bigger player. A silly question, is insulin bad? Should we get rid of all of our insulin?

Dr. Bikman:
It is not bad. When people don’t have it, like untreated type one diabetes, it is lethal. Within weeks to months, you’ll die, so you must have this hormone. It is simply in our environment. We have too much, and so the hero becomes the villain.

Carole Freeman:
Well, I fear that insulin may go down the same path that cholesterol did for a while, right? Like, “Cholesterol is bad. We should get rid of all of it,” and the same thing is [crosstalk 00:04:58] insulin.

Dr. Bikman:
That’s right. We want to make sure that we’re being… I want to make sure I’m being nuanced in how I talk about this. It is not just an outright villain. Like, people, there’s more dimensions to this character here. Like I said, in normal levels, insulin is our friend. In the levels most people have it, it is not their friend. It’s gone beyond.

Carole Freeman:
Those of you that are watching right now, go ahead and put your comments or your questions for Dr. Bikman in the comments. I’m going to get to those very shortly. I just wanted to set some foundational things here with him first for you. Go ahead. I know some of you have to leave early, too, so go ahead and put your questions in there. Heather, I’ve grabbed your question already as well too. Don’t worry, we’ll get to that. The next logical step here then is what is insulin resistance? That’s also a concept that’s a little tricky for people to understand.

Dr. Bikman:
I’m thrilled you’re asking, because it is so necessary to understand insulin resistance to then appreciate its role in other diseases. Insulin resistance is really two things together, well, in every case. It is that insulin isn’t working the same way it used to throughout the body, so some of the body cells aren’t responding to insulin like it normally does, like they used to. Then second, this phenomenon of not working well is coupled with too much insulin being in the blood, so what’s called hyperinsulinemia, so hyperinsulinemia, too much insulin and insulin not working the same way before throughout the body, those are the two sides of the coin, which is insulin resistance itself.

Carole Freeman:
Nice. Do you mind if I indulge you in my analogy I use for explaining what insulin resistance is?

Dr. Bikman:
Lay it on me.

Carole Freeman:
I want to see if you’ll love it. I equate it to a fire alarm. When blood sugar gets too high, insulin is that fire alarm telling the cells, “Quickly do something. Take this [inaudible 00:07:01] to get it down to normal levels.”

Dr. Bikman:
Yes.

Carole Freeman:
But just like if we heard a fire alarm right now, both of us, the first time we heard it, we would take it very seriously. We would evacuate the building. But if we came back, and then two hours after that we heard another fire alarm, okay, maybe the second time again we’d take it seriously. But if every two hours or maybe every 30 minutes, we started to hear another fire alarm, we just get to like, “This is getting ridiculous.” We’d start to ignore it. We just go about our work. But what if there really was a fire every 30 to 60 minutes? The fire department would have to get more creative. They would have to come up with a louder fire alarm.

Carole Freeman:
They would have to have bells. They would have to have lights, and maybe go so far as having glittered cannons coming out like, “No, no, really, really, it’s another fire, I promise. Take it seriously.” That’s the analogy I use to explain what happens is the cells just start to… They get overwhelmed with this constant fire alarm signal, and they just start to ignore it because they got work to do otherwise.

Dr. Bikman:
That’s perfect. In fact, what I like about your analogy is that you’re also touching on the causes of insulin resistance. The main cause, as I identify it, is too much insulin. It’s funny because someone just heard me describe too much insulin as being part of insulin resistance. It is, but too much insulin, just along with your analogy, is one of the causal factors. It is a fundamental feature of biology. Too much of a stimulus will result in a resistance to that stimulus. The cell or the body will start to… Just like what you said, it will start to stop listening.

Dr. Bikman:
It won’t hear it as well as before. That’s almost a survival mechanism. “There’s too much of this. I have to stop responding to it.” Some cells do stop responding. Some don’t. They now then suffer just because there’s too much insulin telling them what to do. I like your analogy because it highlights the cause, but it also therein highlights the solution. If too much insulin is what’s driving insulin resistance, one of the key solutions is then lowering insulin.

Carole Freeman:
Yes, so we need to stop setting our metabolism on fire or trying to set it on fire.

Dr. Bikman:
Yes, that’s right.

Carole Freeman:
How do we know if we’re insulin resistant?

Dr. Bikman:
I like to joke that there’s an at-home test that you can take, and that is just, “Are you a little overweight, and do you have high blood pressure?” If someone has hypertension and they’re overweight, it’s very likely they have insulin resistance. I say that with some degree of confidence simply because hypertension is almost always a result of insulin resistance. It isn’t always, but almost always, and so if we couple the hypertension along with someone who’s a little overweight, it’s very likely to be insulin resistance. That’s the easiest way.

Dr. Bikman:
The most definitive way, of course, is actually getting a blood test. You can measure your insulin, or you combine your insulin, your glucose into the HOMA, H-O-M-A, equation. There are other ways. In fact, another one that’s convenient for people, if anyone has had a recent blood lipid test, take the triglyceride number divided by your HDL number. The triglycerides divided by HDL, if it’s less than 1.5, it’s a very good sign that you’re very likely insulin sensitive. If it’s higher than that number, if it’s getting up into the twos and beyond, then you’re very likely insulin resistant. Those are the best ways.

Carole Freeman:
I love this tip, actually, because a lot of my clients, they actually have to fight their doctor to do an insulin test. It’s crazy making that there’s a very simple test, and they get met with things like, “Oh, your insurance isn’t going to cover it,” but it’s not even that expensive of a test.

Dr. Bikman:
No.

Carole Freeman:
It’s like $26. This is a good one, because pretty much every doctor would be willing to run a lipid panel, and so we can use this as a proxy. That’s so great. I love that. Probably everyone already has that one, so optimal numbers, so one of the things… As I was listening to your books, I listened to it, and then I read it. One of the notes I wrote down that blew me away was that one point higher in insulin makes you 20% more insulin resistant. Can you break that down a little bit, and let us know what does that really mean?

Dr. Bikman:
Yes. If someone is coming in for regular checkups, let’s say, and the physician is friendly enough to this idea and measuring insulin, if you detect consistent rises in insulin, even modest, it’s that much more correlated. It is correlation with insulin resistance. The likelihood of you developing full blown insulin resistance just starts to magnify. It starts to grow. But still touching back on your analogy, insulin resistance is in a way, aptly defined as a disease of too much insulin. That is what type two diabetes is in actuality.

Dr. Bikman:
Type one diabetes is a disease of too little insulin. Type two diabetes is a disease of too much. What they have in common is that neither disease can control blood glucose very well. They’re both very intolerant. They cannot metabolize this molecule particularly well. In one hand, it’s because there’s not enough insulin to clear it. On the other, it’s because insulin isn’t working well enough to clear it.

Carole Freeman:
I love one of the things in your book. You came up with a really cool, succinct way of covering your dietary recommendations for reversing insulin resistance. Number one is control carbs. Number two is prioritize protein. I love the alliteration with these.

Dr. Bikman:
Yes, thank you. That was very deliberate.

Carole Freeman:
Number three is filled with fat, meaning the rest of your calories come from fat.

Dr. Bikman:
Yep. I’m very fat friendly just because it is the macronutrient with the least and often no effect on insulin. If we can appreciate the paradigm you and I just outlined that too much insulin is causing insulin resistance and the solution is to lower it, well, then the obvious way to lower it is just don’t eat anything, but that can’t… I mean, that’s not totally sustainable. Of course, you got to eat something at some point, so why not focus on the macronutrients, especially fat but also protein that have little or no effect on insulin? Eat those two together the way God intended, and just keep the carbohydrates in check.

Carole Freeman:
Now, I want to stop here and point out that your number two recommendation here is to prioritize protein. It’s not filled with fat first, prioritize protein. Would you agree that one of the biggest mistakes that people in the low carb and keto sphere do is that they restrict protein in trying to reverse insulin resistance that they go too far, and protein gets the…

Dr. Bikman:
Get the shaft?

Carole Freeman:
Yeah.

Dr. Bikman:
In fact, that was part of the reason I laid it out the way I did. I didn’t like what I was seeing where there were people who were getting a lot of their calories from just MCT oil. I thought, “We have gone too far when we’re drinking fat to get our calories because that wouldn’t happen in nature.” Fat comes with protein. That’s how these foods come. The best protein sources come with fat. Positioning it the way I did, it was basically my way of saying when you put together a real meal, focus on the protein, but acknowledge that this is going to come with fat.

Dr. Bikman:
I may add fat to it. I may be putting butter on my steak or on my chicken or whatever. Good. Do it that way. Don’t say, “I’m going to have a bowl of butter, and I’m going to add protein into my butter.” I just didn’t want to… which is almost how some people look at it. I just didn’t quite like what I would see from time to time, and so that’s why I put it the way I did.

Carole Freeman:
Well, just like everything, all things in balance, and so we’ve got people that have just taken this message too far that we need to minimize insulin altogether. Do you have any comments on the idea that some people really think that fat is just this free food, and since it doesn’t have an insulin response, that it’s fine, and we can eat as much as we want of it? [inaudible 00:15:53].

Dr. Bikman:
Well, I do think that we can be pretty liberal with it. I really do. I say that just because I’ve seen it. I’ve seen it work with people, where they don’t fear fat. They eat it very liberally, and they are just shedding pounds. Part of that is quite simply that if you’re keeping insulin low, you have a higher metabolic rate, and so if the person’s getting all that calorie from the fat, they are clearly getting it out. They’re clearly burning it. The energy has gone up. We have two ways that the body deals with those states of almost pure fat consumption, which again, I don’t think is natural, and I don’t encourage it.

Dr. Bikman:
But fine, let’s just go with it. One is what I just mentioned. If you’re keeping insulin low, metabolic rate is higher, even to the point of it being almost 300 calories a day higher than if you’re spiking insulin. That is a meaningful amount of calorie difference. But second, if you’re eating fat, and you’re keeping insulin low, you’re making a lot of ketones. Ketones are in one form eliminated from the body. When we convert ketones to acetone, which we do, we are breathing it out, or we’re urinating it out. Just appreciate then what a ketone is.

Dr. Bikman:
A ketone is a piece of metabolized fat. This was a fat molecule that we either had to store, or we had to burn. Well, we just wasted it. We just dumped it from the body, and that is energy. Ketones have an actual caloric value, and so we’re just pushing these calories back out into the universe, and we didn’t have to store them or burn them based on our metabolic rate. We just wasted them.

Carole Freeman:
I think I caught a key that you said there that maybe makes a big difference is that when your insulin is low optimal levels, then the fat amount is not something you have to worry about. Whereas perhaps when somebody still has pretty high insulin level, you’d go out to get that down lower.

Dr. Bikman:
Well said. Well said. Even still, I wouldn’t want someone to misinterpret. I am not advocating just eat fat anytime as much as you want. No, I just think that is unnatural. Eat fat with protein the way that they’re supposed to come together.

Carole Freeman:
I love that. I was listening to your keto connect interview today, the last couple of days. I just really love that, using an ancestral template of how does food come in nature. It was a big aha. Proteins and fats come together naturally in foods. Protein generally doesn’t come with the high amount of carbohydrates in food.

Dr. Bikman:
That’s right. That’s right.

Carole Freeman:
All of you out there listening, trying to think of a food that’s high protein and high in carbs, it just doesn’t exist, or maybe somebody is going to come up with some bizarre something, but-

Dr. Bikman:
It’s not common. It’s not common.

Carole Freeman:
Yes. Pam is actually asking here… Let me put this one on the screen here. Pam is asking, “How do we know when our insulin levels are just right?”

Dr. Bikman:
Pam, if you go get an insulin test and your insulin levels are at six micro units per mil or lower, then that’s perfect. Now, I will say there is some variability. Every hormone, there is a pattern to insulin. Again, every hormone has a cyclical pattern throughout the day, and insulin is no exception. If you see that it is even double that, if it’s in the low teens, it could still be okay. You might have just caught it at the peak. But if you get a low number like six and below, then you’re great.

Carole Freeman:
We also already got the proxy measurement too, the triglycerides divided by HDL, and you have that below 1.5.

Dr. Bikman:
I’d like to joke that’s the poor man’s method, but it’s very accurate.

Carole Freeman:
That’s great. Let’s see. Where are my leave offs and my questions here? Let’s see. Here’s a fun one. What are some of the mistakes, or what should people not do when they’re trying to reverse their insulin resistance?

Dr. Bikman:
I would say don’t drink smoothies. That’s something. I know that we love smoothies. I get it, but that is a terrible way to take food. Not that drinking food is inherently a problem. It’s just when you’re making a smoothie out of fruits and vegetables, you’re thinking you’re getting all this wonderful stuff, but you’re not. Don’t make smoothies. When it comes to fruits and vegetables, which I do consider is generally fine, with my first rule of control carbs, I basically just say, “Fruits and vegetables are fine, although there’s some nuance there, but eat them don’t drink them.”

Dr. Bikman:
Too many people just want to drink them. Don’t do that. Don’t do it that way. Don’t try to… I guess a second piece of advice, let protein and fat come together. They’re supposed to come together. Eat them together.

Carole Freeman:
The only smoothie we’ve designed to have in our life is mother’s milk, and that’s [crosstalk 00:21:07] early in life.

Dr. Bikman:
Yes.

Carole Freeman:
Otherwise, we should be eating our food the rest of our life.

Dr. Bikman:
Yep.

Carole Freeman:
Mother’s Milk is the original smoothie.

Dr. Bikman:
It sure is. It’s the perfect thing for growth. It is high in all three macros.

Carole Freeman:
Oh my gosh, I had a total tangent here that’s related, but there’s this new series on Netflix called Unwell. One of the segments is about these people that are consuming breast milk as a cure-all is the next thing.

Dr. Bikman:
Oh my goodness.

Carole Freeman:
It’s the next thing.

Dr. Bikman:
Oh my goodness. I saw once there was a place that they made ice cream from human breast milk.

Carole Freeman:
It’s weird that we think that’s gross, but [crosstalk 00:21:47].

Dr. Bikman:
I know. I know.

Carole Freeman:
Let’s see. I had a question come in on Instagram earlier yesterday, too. Colt Milton at SuperSet your life is asking what types of protein cause the biggest insulin release?

Dr. Bikman:
That is a good question. It does depend on the amino acid profile. Us talking about how protein can have an insulin spike, it would be more accurately stated as various amino acids have higher insulin spike. I can’t exactly remember that is a good question. If I remember correctly, it’s going to be dairy protein, and then I think chicken or something like that. But if you’re eating that protein, even still, in the context of low carb, the insulin effect is less.

Carole Freeman:
Well, and I remember Dr. Michael Eades talking about as well some research probably at Low Carb Denver last year about how the more refined and processed a protein is, the more effect it has on influence and other ingredients too.

Dr. Bikman:
Yes, that’s exactly right.

Carole Freeman:
All right. Well, shout out to Dr. Eades’ protein power.

Dr. Bikman:
He’s awesome.

Carole Freeman:
Heather, let’s see. I grabbed her question here. Her question is at the end of this. She says that, “I’m very curious. Does insulin resistant… Does it have any genetic component, or are we all equally susceptible?”

Dr. Bikman:
No, it absolutely has a genetic component. Absolutely. In fact, people don’t really know this, but type two diabetes, which is insulin resistance, is much more genetic than type one is. It’s much more likely that if a parent is type two diabetic, that they will have a sibling or a child or a parent, whereas type one just pops up, and typically has nothing to do with any kind of familial inheritance. Yes, there’s absolutely a genetic component. I would say much of that genetic proclivity or tendency to become insulin resistant is probably fundamentally a difference of people’s fat cells.

Dr. Bikman:
In other words, how do your fat cells grow? Do your fat cells grow through just getting big, which is hypertrophy of the fat cell, or do they only get modestly big, and then they start to multiply, which is hyperplasia of the fat tissue or fat cells? If you genetically are more inclined towards hypertrophy, and many people are, then you will become more insulin resistant than otherwise. We see this in ethnicities like Indians, Asian, Indians. They have a profound tendency to become insulin resistant, and there is much more adipocyte hypertrophy, for example.

Dr. Bikman:
There is no doubt a genetic component, but I would hate to say this and have Heather or anyone else be discouraged by it. No, even if you have a genetic tendency, we know this is something you can fight extremely well by changing diet. I do mean extremely well. These are changes where people can have profound improvements in insulin sensitivity in just days, including to the point that they start getting off medications. Don’t let that discourage you. There’s very much a genetic component, but that doesn’t mean you can’t fight it.

Carole Freeman:
Excellent. I want to back up and talk a little bit more about protein, because early in the keto days, everyone was super worried about protein. I know that there are still a group of people out there that are really worried about protein. But can you share with us why is it that we don’t have to worry about protein intake so much on low carb or keto to reverse insulin resistance like we thought we did?

Dr. Bikman:
Yes. I mentioned this a moment ago. It really is dependent on the underlying glucose levels, that if you take in these amino acids in the midst of high glucose, it will amplify the insulin spike from the glucose alone. It’ll bump it up even higher than before. In contrast, if there’s no influx of glucose, and glucose is at base levels, then there’s a modest insulin spike from the amino acids alone, but it is in fact significantly more modest, but it’s there it happens. It’s really just dependent on whether the body needs to make new glucose.

Dr. Bikman:
If you’re eating protein, and you’re not eating glucose, the liver has to be turning on gluconeogenesis or making glucose from scratch basically. If insulin spiked, that process stopped. Insulin inhibits gluconeogenesis, and so it’s just the cleverly designed system which basically tells the body, “Look, I’m eating protein. I can have some modest insulin spike just letting my body know where to put the amino acids, but it can’t go too high, because if it does, I can’t keep making glucose from gluconeogenesis.”

Carole Freeman:
It sounds like it’s part of the wisdom of the way the body was designed is that, again, we pointed out the fact that protein and sugar or carbs don’t exist in foods together. It’s not a natural state to eat high carb, high protein food [crosstalk 00:27:22].

Dr. Bikman:
That’s right.

Carole Freeman:
It would make sense that our body starts to dysregulate, and it doesn’t like that combination together.

Dr. Bikman:
A lot of people will think that they’re being clever by stacking protein and insulin together, or protein and carbohydrate. They’ll say, “Well, I’m getting more of an anabolic effect. I’m going to get bigger muscles because of this.” It doesn’t happen. There’s human studies to show that if you eat protein, you’ll get a particular rise in muscle growth. If you eat protein with glucose, it doesn’t get any bigger than the protein alone, but that stands in contrast to what you see with protein and fat. When protein and fat are consumed together, you do get an additive anabolic effect compared to just the protein alone, so once again, pointing the finger at just nature doing it best, which is protein and fat.

Carole Freeman:
Well, I know that Colt Milton at SuperSet your life is going to be really interested in that last point because he’s into bodybuilding. I know that he’s going to be really interested in that part.

Dr. Bikman:
Good.

Carole Freeman:
I loved also that you cover in your book, I’ll just show it again here, why we get sick. I love that you talked about the role of salt in insulin resistance.

Dr. Bikman:
Yes.

Carole Freeman:
Can you touch on that a little bit for us?

Dr. Bikman:
Well, isn’t that an unexpected aspect of it all? We’ve been told for so long that salt is one of the enemies. Like saturated fat, we need to avoid it at all costs. It is interesting to note that insulin plays a role in telling the kidneys what to do with what they filter, including salt. On the flip side of this, elevated insulin stimulates the kidneys to hold on to too much salt and water, and so blood pressure starts to climb and the person has hypertension. In contrast, if a person stops eating salt, because it is such an essential molecule in the body, then the kidneys start to do everything they can to hold on to whatever salt they can.

Dr. Bikman:
Because of the mechanism I just mentioned, which is insulin helps the kidneys hold on to salt, one of the unintended consequences of restricting salt is the insulin goes up. Then you see this real phenomenon where severe salt restriction actually starts causing insulin resistance.

Carole Freeman:
Oh my gosh, all these things, the last 50 years of nutrition, we just [inaudible 00:29:38] it all on its head.

Dr. Bikman:
We got it so wrong.

Carole Freeman:
I apologize every day to people. I mean, I wasn’t personally responsible, but I sure shared a lot of that misinformation [crosstalk 00:29:51].

Dr. Bikman:
Same. Same. I was a personal trainer during my master’s degree about 20 years ago. I hated it, by the way, but I would spelt the same kind of nonsense. I look back into, and shudder to think how much more effective I could have been had I known then what I know now, but that’s of course, the theme of life. I would have made all kinds of different decisions.

Carole Freeman:
A little bit of Microsoft investment in the early days.

Dr. Bikman:
Right.

Carole Freeman:
But then we wouldn’t have you doing this amazing work you’re doing now.

Dr. Bikman:
That’s true.

Carole Freeman:
I’m glad you didn’t invest in Microsoft early on.

Dr. Bikman:
I would retire. I would have been in a sailboat somewhere by now.

Carole Freeman:
Let’s see. Oh gosh, here’s another really great question. This is a long question here, but I’ll summarize it for you. Basically, this is somebody who has a lipedema in her lower body. From what I understand, you actually can have some of your cells genetically in your body can be different levels of insulin resistance than others. For example, people with lipedema, those cells are more insulin resistant than the other cells in their body. She has noticed that she gets water retention in that part of her body with excess of salt, with alcohol consumption.

Carole Freeman:
She’s wondering how is it… She’s already lost 40 pounds. How is it that you can continue to improve insulin resistance with lipedema?

Dr. Bikman:
Unfortunately, lipedema is pretty poorly understood. All I will add to this is this idea that this lady, she probably also has a higher expression of lipoprotein lipase in those fat cells. Very briefly, lipoprotein lipase is the actual enzyme that tells the body where to store fat. Insulin tells the body how much fat to store. LPL works with insulin, but it determines where we store fat. That is generally very genetic, not exclusively. We can manipulate it somewhat through diet, but it is genetic where women who are putting fat in some of these awkward places like ankles, lower legs, or back of the arms, that is because of a higher expression of lipoprotein lipase.

Dr. Bikman:
The sad reality is there’s nothing you can do really. I’m getting a little off topic, but in those places where the body has the selective deposition of fat, because of lipoprotein lipase expression, that will be the very first place fat goes, and that will be the very last place that comes from the person. In this lady, perhaps, if she wanted to cut that fat out, she would have to get almost to the point of having a six pack 10% body fat before she’d start to really lose the fat around her ankles.

Dr. Bikman:
The lipedema, I can’t really speak to. I don’t know too much about it, but I would say even then, it’s fat cells that just have more LPL.

Carole Freeman:
I theorized that since insulin resistance influences salt retention and fluid retention, that perhaps [inaudible 00:33:09]. I have another lady as well that has the same lipedema in her lower body. She has the same thing where she tends to be a little more salt sensitive, and it causes more fluid retention there. I’m wondering if it’s related to the fact that because those cells are more insulin resistant, they’re retaining fluid much more than other tissues in the body.

Dr. Bikman:
Yes. If someone is retaining water, that is a sign of insulin resistance in general, I would say the fact that they’re noticing it more in the limbs. That could indicate just more of a blood pressure problem or an actual limb problem. That edema is basically fluid that has left the blood and hasn’t made its way into the lymph vessels, to the lymphatic circulation. That is edema. There could be that there’s some mismatch there, including hypertension. Frankly, pushing the water out more readily than it can be pulled into the lymphatics or fat blocking lymph flow as well.

Dr. Bikman:
But yes, water retention in general is a sign of the body’s insulin resistant. The high insulin is not allowing the kidneys to let the water go.

Carole Freeman:
Another adjunctive thing we’ve had for them that’s worked well is doing lymphatic massage to help get that fluid back up to where it should be in the body, so it can be excreted too.

Dr. Bikman:
Yes.

Carole Freeman:
These are people that have been following low carb keto for several years now too, so all right. Let’s see. Here’s another one from Heather, “Regarding the discussion with too much hormones resulting in the cells stop listening, is that also what happens with adrenal fatigue?”

Dr. Bikman:
This is a tricky answer, because as a scientist, I have to say there’s no evidence to even support that adrenal fatigue is a real phenomenon. I do say that with caution, because science doesn’t always know everything. But I guess I would have to just say I don’t know how real adrenal fatigue is. As a scientist, I’m a little skeptical because I don’t know of data to fully support that idea. But let’s say it is, just if for no other reason than to be diplomatic, let’s say that adrenal fatigue is real. That is a big assumption.

Dr. Bikman:
I want everyone to know that I’m saying it that way. Then yeah, probably, it could be that these chronically elevated levels of cortisol are resulting in a reduction in the sensitivity to cortisol. But to counter that thought, even as I say it, it doesn’t happen in actual cortisol syndromes like Cushing syndrome or Cushing disease. The cortisol continues to just wreak absolute havoc on the body. Adrenal fatigue, I wish I could answer that with more optimism. I don’t know that it’s a real thing, but I do know it’s a popular thing.

Carole Freeman:
I went back to university, which is all about, “Here’s your adrenal fatigue. It’s a thing. Here’s the herbs to treat it and all that,” but there was a podcast I listened to from Rob Wolfe, where he interviewed a naturopathic doctor, and he kind of spun that whole thing on its head. He basically showed that what we think of as adrenal fatigue is actually just inflammation that’s suppressing the optimal function of the adrenal gland, and it ties right in with insulin resistance [crosstalk 00:36:55].

Dr. Bikman:
I could buy that definition. I could absolutely buy into that, that this is actually a consequence of chronic stress mixed with some inflammation. Yes, I think that would probably… I could get behind that definition. The idea of adrenal fatigue are the adrenal glands are just stopping working.

Carole Freeman:
I’ve seen that. I mean, my own past story, which I won’t get into now, I had all the symptoms of adrenal fatigue, but as soon as I started low carb keto, the symptoms went away immediately, and so we’re like, “The adrenal fatigue is a real thing.” Kemp says like, “Oh, it takes six or 12 months to heal it,” but as soon as we drop insulin down significantly, the body starts to work the way that it should, and then the adrenal fatigue evaporates. It goes away.

Dr. Bikman:
I’m interested though. This Heather Brown gal, is this a picture of Heather? Is this you running a fricking iron man?

Carole Freeman:
She does. Yes.

Dr. Bikman:
That’s incredible. You don’t have adrenal fatigue. You just have fatigue, [crosstalk 00:37:53]. I hate to break it to you.

Carole Freeman:
She says she did her math. Triglycerides and HDL are exactly the same, so it’s easy math for her. She’s at 1.0.

Dr. Bikman:
You’re sitting pretty.

Carole Freeman:
Cassie, she did get her insulin measured with her doctor.

Dr. Bikman:
That’s great. Eight is great. It really is. In fact, one of the original studies, I came to the number six that I came to, was looking at at eight was a good number from a study from the University of Arizona. That insulin with that glucose, you’re doing great.

Carole Freeman:
Cassie also has been following low carb keto for about four or five months now and has also dropped a significant amount of weight too.

Dr. Bikman:
Frankly, Cassie, I wouldn’t be surprised if very often your insulin levels are in fact six or lower. Like I said, there’s always a little bit of shifting around there.

Carole Freeman:
Dr. Bikman, I heard somebody speaking somewhere that five was good and three was optimal. Is that just going too far then or?

Dr. Bikman:
No, I’d be interested… I’m curious where you would have heard that or seen that. No, I wouldn’t disagree with that. I know lots of people that actually after being keto for a while, their insulin is one and two, and they’re perfectly healthy. That is a pretty strict cutoff, I would say that. I don’t think we need to be that extreme.

Carole Freeman:
I know for Cassie that when she got the result of eight, she said it was actually very motivating for her, because as women, we’re told the scale is king but to have this other health marker that she’s shooting towards like, “If I can get this down one or two more points,” for her, that was very motivating.

Dr. Bikman:
Good. Good. Well, that’s a good number. Cassie is doing fine.

Carole Freeman:
Good job, Cassie. Heather’s reporting back that, “Thank you for the question. You answered that very well.” Here’s somebody else asking about, “Will you have him talk about exercise?” Let’s see. I know he wrote about specific types of… Somebody’s read your book. This is great. I know he wrote about specific kinds of training being best for lowering insulin. Curious his thoughts about yoga. Is it the best to hold a pose, like a plank, until you can’t any longer, which is to failure rate?” Let’s talk about exercise.

Dr. Bikman:
I’m happy to. Yes. In fact, the older I get, and the more I am doing more calisthenics-based workouts, the more I appreciate the power in picking a pose, especially at near maximal tension, and holding it, and so including various yoga poses. When I say point of maximal tension, I mean, find… I don’t know enough about yoga to know what poses would fit with this. But let’s say, for example, I want to work my biceps, I would lay on the ground in a push-up type position, but then put my hands so that my hands are actually down by my waist, and then push myself up like that, and then hold it, so my arm, my biceps are maximal tension.

Dr. Bikman:
In contrast, I could put all my weight on my body with my arms bent like this, and then be pressing a handstand, but focus, hold the position when my muscle is at almost maximal stretch, and hold that there. As long as you go to failure, it doesn’t matter how you did it. You’ve done the single best thing you can for your muscles.

Carole Freeman:
That’s your next book is then how to get fit and toned and hillier. I think, that’s [inaudible 00:41:47]. By the way, that’s [crosstalk 00:41:47].

Dr. Bikman:
How to get swole, written by a man who’s frankly a little scrawny.

Carole Freeman:
Pam’s got another good question here. Let’s see. How do you recommend getting additional salt intake? Salt, shots, supplementation or other methods?

Dr. Bikman:
Well, this might be a boring answer. I would just say salt your food. I hate to… That’s anticlimactic, I know. Well, let me elaborate, though, a little bit. I am an advocate of salt. I love the Redmond Real Salt people. Personally, I know them. I think they’re fantastic. Boom. I would say having said that, one of the drawbacks of all these sexy salts that we have these days is that we may not be getting enough iodine. There was some wisdom behind adding iodine to salt once upon a time. It’s because the consequences of not having enough iodine are absolutely disastrous.

Dr. Bikman:
If you start to run out of iodine, then you run out of your thyroid hormone, although we do have a reservoir of thyroid hormone in our blood that we can start to call on. But if you run out of that stuff, the consequences on your brain are disastrous. As adults, we could overcome it and get out of that brain fog. If it happens in a kid, it is potentially irreversible, the brain damage, the delay, the brain delays that the kid will experience. Make sure in the midst of all these wonderful salts that we have these days that you are finding ways to get iodine.

Dr. Bikman:
If you’re eating a lot of seafood, you’re going to get iodine. Otherwise, I would say just get on to Amazon and buy a little potassium iodide dropper, and take one little drop a day, and you’ll get all you need. But if you aren’t getting iodine, good luck with normal thyroid function, and then the brain will be the first tissue to suffer once you start running out of thyroid hormone. You will if your iodine is deficient.

Carole Freeman:
Oh, great, so we don’t have to do the table salt with dextrose in it to get the iodine [crosstalk 00:43:53].

Dr. Bikman:
Good point. That’s right. Good point. Good point. Just find other ways to get iodine, and there are plenty. Again, if you eat seafood, you’re fine, but we don’t eat seafood really, so make sure you get it.

Carole Freeman:
Excellent. All right, last call for questions everyone who’s watching right now. Let’s see if I can pull out one more. Let me look through my notes of all the questions I wanted to ask you. We talked about optimal amounts. What is insulin? Let’s see. In your book, you talked about basically how insulin resistance is tied to pretty much every chronic illness and disease and condition that we’re suffering from, which makes a lot of sense, because even in our lifetime, we can remember that there weren’t this epidemic of autoimmune conditions.

Carole Freeman:
All these people weren’t allergic to every food that they ate, and all those things. Just in a snapshot, can you explain how is insulin resistance related to all these problems we’re suffering from?

Dr. Bikman:
If we remember the definition of insulin resistance, which is insulin isn’t working quite the same way, but there’s too much of it at the same time, then we start to… We can almost go from top to bottom. The brain does become insulin resistant, and it can’t get enough glucose to meet its energy needs, and so it starts to suffer. You see that not only with Alzheimer’s disease, but you actually do see the brain doesn’t get enough glucose in Alzheimer’s disease. You see it also with migraine headaches, which is why when you fill that energetic gap by giving the brain ketones, which it can use perfectly well, the brain suddenly gets better.

Dr. Bikman:
They may never have another migraine again as long as they’re in ketosis. The brain, the heart starts to suffer where the insulin resistance is promoting heart growth, so they have this cardiomyopathy or the failing heart. The blood vessels are too constricted, and we have too much blood, and so we have hypertension. The liver is constantly being inundated with this insulin signal to make more fat, and so the liver can develop fatty liver disease. The gonads, I mentioned the infertilities in women and men with PCOS and erectile dysfunction respectively.

Dr. Bikman:
Our muscles as they become insulin resistant, they can start to experience sarcopenia or muscle wasting. Same with bones, joints, and skin and on and on. It matters.

Carole Freeman:
Yes. Too much is not a good thing.

Dr. Bikman:
The nice thing about it is that once we acknowledge the role of insulin resistance behind so many of these chronic diseases, then we acknowledge that we don’t have to try to treat every disease as an individual problem. We can address the core problem, and the rest of the things will start to take care of themselves.

Carole Freeman:
It’s beautiful. It’s lovely how just this dietary change I get to help people with makes this huge difference of head to toe, everything gets better in them, so it makes sense. All right, this person is asking, “Dr. Bikman, can you explain the connection with high cholesterol, heart disease and insulin resistance?” I picked a three-second topic. Right?

Dr. Bikman:
Yeah, that’s not an easy one, but I’ll take a crack at being brief. Let’s look at it from the perspective of LDL, where LDL cholesterol may matter, emphasis on may. There are studies to show that it is correlated with heart disease. There are studies to show that it is not. Let’s say that it is, or how can we reconcile these disparate findings? It could be that looking at just LDL cholesterol number doesn’t tell us what we need to know. Maybe what we need to know is the LDL diameter. The smaller, more dense LDL particles are thought to be able to physically invade the blood vessel wall more easily than a larger, more buoyant LDL particle, because we can have the spectrum of size.

Dr. Bikman:
Insulin resistance pushes an LDL pattern B or a small dense LDL, which is thought to be more atherogenic. I guess I’ll just leave it at that.

Carole Freeman:
For those of you in the… Well, everybody here is in the membership, but I’ve got a cardiology nurse coming on next month for our guest expert so we can ask that person a lot more too. Let’s see. Cassie is asking, “Dr. Bikman, do you have any thoughts, pros, cons of dairy products?” What do you have?

Dr. Bikman:
I do of course have thoughts. I always do. I’m very thoughtful, which is a nicer way to say I’m very opinionated. I’m very thoughtful, so I have thoughts. I think in adults, I do think… Well, the evidence is actually pretty favorable that you can have adults drink more dairy, and it’s helpful for weight loss. I do think there’s something to be said for the lessons of our ancestors that we forgotten. Once upon a time, if an adult was drinking dairy, I think often, it would have been fermented. Anytime we had these foods that we were holding on to, it’s fermented.

Dr. Bikman:
What is the power of fermenting dairy is that the bacteria only eat the starches or the sugars, so it eats the lactose, and all it leaves behind is the protein and the fat. To my delight, with my palate, it leaves these tart little short chain fatty acids, which give anything that’s fermented that tart flavor. It’s because of the short chain fats that the bacteria pump out after eating the starches and the sugars. I think as adults, there’s a lot of power in fermented dairy, although normal dairy is probably also fine, but I do think dairy is, as we said, a food for growth.

Dr. Bikman:
It is a beautiful system in mammals, where mom makes this perfect cocktail of all three macronutrients, and it helps the baby grow as quickly as possible. Whole fat dairy in children, I’m absolutely in favor of. Full fat dairy in adults, I would just say, “Well, maybe you need to be careful with, and then focus more on the fermented dairy like yogurt or kefir or sour milk, those options.”

Carole Freeman:
Real sour cream, right?

Dr. Bikman:
That’s right.

Carole Freeman:
Nice. All right. Cassie’s got another one, a really good one here, too. How likely is it that we can get our mainstream medical field to start testing insulin resistance? She says that when she brought her labs back, it was normal, and the range is zero to 24.9.

Dr. Bikman:
I know. I know. That’s part of the problem. We’ve overlooked insulin for so long that we don’t even have a consensus number. I confessed this in the book very explicitly. Yes, so it is part of the problem. When do I think it’ll happen? I have no idea. But honestly, that is part of what I hope is a takeaway from the book if I am naive enough to kid myself that it’ll have some lasting impact. An impact I hope it does have is that there will be medical practitioners. There will be people in positions of power within medicine, that they will start to say, “You know what? Yep, we’re going to make this part of our routine number, a routine checkup.”

Dr. Bikman:
Then with that, just growing mountain of data, we can come closer and closer to really identifying what is a good consensus. Where do we want people to be?

Carole Freeman:
Right now, those lab range is normal. It’s just basically like, all the tests they’ve done, this is where the numbers fall between, right? We can actually have some research to look at, “Here’s healthy people. What are their numbers? Here’s people that have other things going on.” I’m curious then with your book coming out, have you had any kickbacks from the middle community, or have you had any stories of physicians that have had their eyes opened?

Dr. Bikman:
No. No. None. None, but I will say over the years that I’ve been preaching this message, I have, over the years, received good feedback. My favorite audience is actually healthcare practitioners. When I can speak to nurses and doctors or health hospital administrators, that is my favorite group of people, because when they see the data, as I outline it, just study after study, they appreciate it. They are glad to know. I think that’s an important… It’s important for me to remember but all of us, lest we look at our doctor or nurse and think, “Oh, they’re so ignorant. They’re so reluctant to change. They’re so egotistical about it.”

Dr. Bikman:
I’ve seen these seemingly egotistical, rigid, people change very, very quickly when they actually see the data. Everyone has a reluctance to admit they don’t know something. I think in medicine, maybe that’s perhaps more of a problem than elsewhere, but we only know what we’ve been taught or we’ve taught ourselves. In my experience, when these healthcare practitioners see the data, it leaves an impact on them, and then I like to think I’ve left that group… left them with a conviction to measure insulin.

Carole Freeman:
That’s great. That’s really hopeful and optimistic. That speaks to that psychology of when we believe something to be true for a long enough period of time, it takes a mountain of evidence to change that.

Dr. Bikman:
Yes.

Carole Freeman:
Thank you for putting that mountain of evidence together for us in your book, but also the work that you’re doing too. Dr. Bikman, where can people find you on social media, websites?

Dr. Bikman:
Thank you. I am fairly active on social media, not as active as I sometimes wish I were, but then I wish I weren’t active on it at all another time. People can find me at benbikmanphd. Bikman is just spelled B-I-K-M-A-N, no C, benbikmanphd. I just share research on human metabolism, nothing personal ever. It’s not my jam. Then I have a website where you guys can… I will start providing blog content and maybe even video content, and that’s gethlth.com, H-L-T-H. While you’re there, I won’t mention any more than this. You can also look into a low carb shake that a couple of my brothers and I have made.

Dr. Bikman:
The fact is I think there’s just always something to be said for something convenient. That really is the purpose. We just wanted to make a better low carb shake, and so we did. Anyway, you can learn more about it there.

Carole Freeman:
All right, I’m sure we’ll have some people checking that out. People always want to check out shakes. Thank you so much for taking the time out your busy schedule for being here.

Dr. Bikman:
My pleasure.

Carole Freeman:
Thank you for answering everyone’s questions. Really, really great stuff. I’m just so grateful to you. The work that you’re doing is really, really important in this world.

Dr. Bikman:
Well, that’s nice. Thanks so much. Thanks again for the invitation. I had a great time. Thanks [crosstalk 00:55:15]. Thanks, everybody, for the questions. Thanks, guys.

Carole Freeman:
Yeah. [crosstalk 00:55:18]. Thanks, everyone. We’ll see you again soon. Bye.