Episode 143: Ben Bikman on the roles of insulin and ketones in metabolic function
STEM-Talk
Diabetes and Insulin Resistance - Aha Moment
Ben Cohen: I had viewed insulin resistance as simply being the mediator between obesity and type two diabetes. As the body was gaining fat, we knew that type two diabetes was also going up almost one for one, the risk of it. He says his own lab efforts in part focus on cognition and brain energy use. "I want a part of them to think when they're looking at their patient might the problem for which I'm about to prescribe a medication be a result of insulin resistance"
Today’s episode features the author of “Why We Get Sick,” Dr. Ben Bikman, a biomedical scientist at Brigham Young University.
Ben is known for his research into the contrasting roles of insulin and ketones as key drivers of metabolic function.
In “Why We Get Sick,” Ben takes a deep dive into insulin resistance and metabolic health. The book particularly focuses on the role that insulin resistance plays in many of today’s most common diseases: heart disease, diabetes, cancer, and Alzheimer’s.
Ben and his colleagues at the Bikman Lab investigate the molecular mechanisms behind the increased risks of disease that accompany obesity and excess visceral fat. Much of the research at the Bikman Lab particularly focuses on the etiology of insulin resistance and how it disrupts mitochondrial function.
In today’s interview, STEM-Talk cohosts Drs. Ken Ford and Dawn Kernagis talk to Ben about:
- How insulin resistance is tied to multiple chronic diseases.
- The relevance of ketones in mitochondrial function.
- How so many of our modern chronic diseases are self-inflicted and driven by insulin resistance.
- How many of the hallmarks of aging are a consequence of insulin resistance.
- The theory that the longest-lived people are likely the most insulin sensitive.
- The benefits that occur with carbohydrate reduction as a result of increasing insulin sensitivity.
- Ben’s thoughts about the degree of intermittent fasting needed to induce autophagy in humans.
Show notes:
[00:02:32] Dawn begins the interview asking Ben about his early life growing up in a small farm town in southern Alberta, Canada, as one of 13 children.
[00:02:48] Dawn asks Ben what he was like as a kid and what made him stand out from his 12 brothers and sisters.
[00:06:01] Dawn asks about Ben’s mother’s influence and how she wanted her sons to be Renaissance men.
[00:08:29] Ken asks about Ben’s experience as a Church of Jesus Christ of Latter-Day Saints Missionary in Samara, Russia.
[00:15:18] Dawn mentions that while Ben went into his undergrad majoring in exercise science, he wasn’t that interested in science at the time. It wasn’t until he began working on his master’s degree at BYU with Dr. Will Winder that he developed a true interest in science.
[00:19:49] Dawn asks Ben how he ended up at East Carolina University for his Ph.D. in bioenergetics.
[00:21:42] Ken mentions that Ben, after completing his Ph.D. moved to Singapore for his postdoc work at the Duke National University of Singapore. Ken asks how that came about.
[00:25:49] Dawn mentions that Ben is well-known for his work on insulin resistance, stemming from his time at East Carolina when he realized that insulin resistance is tied to many different chronic diseases. Dawn asks what was Ben’s ah-ha moment that led him to focus his research on insulin resistance.
[00:27:49] Dawn mentions that much of Ben’s work is focused on the role of elevated insulin in regulating obesity and diabetes, as well as the relevance of ketones in mitochondrial function. Dawn asks if it is correct that Ben has been on a sort of mission as a professor to teach a new generation of doctors and nurses how insulin resistance works, and why it is so relevant in terms of chronic disease.
[00:29:56] Ken mentions that Ben began to take his message about insulin resistance beyond the classroom, appearing on podcasts and making YouTube videos, and also giving a speech to the student body at BYU, titled “The Plagues of Prosperity” making the case that the human race is currently eating itself into metabolic disarray.
[00:32:31] Ben’s book “Why We Get Sick” points out that historicall, people got sic because of infectious diseases. In modern times, due to sanitation, vaccines, and antivirals, that is less of an issue. Today more people are afflicted by chronic illnesses, many of which are related to metabolism. Dawn explains that the overarching message of the book is that these diseases are, in part, self-inflicted, and partially driven by insulin resistance and hyperinsulinemia. Dawn goes on to say that while it is fairly well-known that insulin resistance plays a role in cancer, heart disease, and diabetes, many people may not know that it also contributes to neurological disorders, reproductive health, kidney disease, gastrointestinal disorders, and even reduced muscle mass, bone loss, and even hearing loss.
[00:34:42] Ken explains that Ben has often pointed out that many of the hallmarks of aging are partially a consequence of insulin resistance. Ben has also pointed out in his book the theory that the longest-lived people are likely the most insulin sensitive. Ken asks Ben to elaborate on this.
[00:41:36] Ken mentions that in Ben’s book, he explains that there are three primary causes of insulin resistance, the most obvious one being chronically elevated insulin levels. In addition to this, however, the second category is stress hormones including cortisol and epinephrine. The third cause is inflammation. Ken asks Ben to elaborate on these three causes.
[00:45:15] Dawn asks Ben to talk about why our healthcare system has a glucose-centric view of metabolic health.
[00:50:26] Ken points out that there’s a lack of consensus on what optimal levels of insulin should be. He also points out that most Americans do not have optimal levels of insulin since most are metabolically unhealthy. Ken asks Ben for his thoughts on what a person’s optimal level of insulin should be.
[00:53:34] Ken brings up the problem with the reliance on “normal” readings since unhealthy people skew the average and therefore what is considered normal. Ken asks Ben to talk about how this leads to people who are ketogenic being flagged by their physicians because their insulin levels are low according to their charts.
[00:59:25] Dawn asks Ben why he believes building and using muscle is a key component in the fight against insulin resistance.
[01:01:03] Dawn mentions that Ben advises people to control carbohydrates, prioritize protein, and “fill with fat.” Dawn asks about the numerous benefits seen with carbohydrate reduction via increasing insulin sensitivity and lowering hyperinsulinemia.
[01:03:55] Ken asks Ben to give a quick primer on the process of autophagy, with respect to intermittent fasting.
[01:07:54] Ken mentions that a lot of the research about autophagy and fasting uses rodent models. Autophagy is activated much more quickly and to a much greater extent in rodents than in humans. In light of that, Ken asks Ben if we know to what degree intermittent fasting induces autophagy in humans and how long a fast would have to be to incur that effect.
[01:11:01] Ken asks Ben to explain how the standard American diet drives fat storage in the body and slows a person’s metabolic rate.
[01:16:53] Dawn brings up that recent studies have shown that ketones are not only viable fuel sources for all cells with mitochondria but are also legitimate signaling molecules that elicit advantageous changes in inflammation, cognition, oxidative stress, and more. Additionally, ketones may be relevant metabolic fuel in the context of physical activity and athletic performance. Dawn mentions that further exploration of this can be found in episode 94 of STEM-Talk with John Newman on the topic of beta-hydroxybutyrate, or BHB, and episode 54 with Briana Stubbs on the topic of ketones and athletic performance. Dawn goes on to mention that in a paper published by Ben in 2018, in a special issue of the International Journal of Molecular Science, Ben wrote about the effects of ketones on metabolic function. He reported on the results of a study that sought to shed light on the specific effects of the ketone body BHB on muscle cell mitochondrial physiology. Dawn asks Ben to walk listeners through the results of this study and its implications.
[01:20:54] Ken mentions that looking at the role of ketones on the maintenance of muscle, it appears that ketones have less of an anabolic role and more of an anti-catabolic role, which produces a strong protective effect against sarcopenia. Ben talks about this.
[01:23:02] Ken mentions that we could make a serious dent in our obesity and type-2 diabetes epidemics if people would think more seriously about insulin and if more physicians tested for it. Ken asks Ben what research, in this regard, are he and his colleagues excited for on the near-term horizon.
[01:27:03] Dawn shifts topics to ask Ben what his exercise routine looks like.
[01:30:29] Dawn closes the interview by asking Ben if he still plays any instruments.
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