And that was right on the tail of work coming out of Harvard in the early ’90s, finding that adipocytes, fat cells, secrete pro-inflammatory protein, cytokines. And so when I was thinking about how to structure a conversation about protein I thought, let’s look and see what happens in the insulin to glucagon ratio. But there are others, and in fact it’s frustrating for me to even remember, there are others across campus in different departments who have been very upset with my perspective and have made life a little difficult. Benjamin … And so I can’t say exactly where that cutoff is, but I would say if someone’s keeping their insulin at essentially fasting levels, autophagy is running. They are still morbidly obese of course one week post bypass surgery and yet they had become very, very insulin sensitive quite quickly. You can listen to the episode via the YouTube player above. People that were getting hundreds and hundreds if not over 1000 calories per day in oils added to their drinks and I thought that is not healthy. Bret:  So how did that translate to you personally, though? – Introducing, Dr Ben Bikman, Associate Professor at BYU who does research on obesity and metabolism. My sincere plea – here are a handful of clinical studies that put people on saturated fat diets that were up to in one study 50% of all calories coming from saturated fat. Can whatever reverses type 2 diabetes possibly also slow the aging process? Is there such a thing as an optimal diet? Is lower insulin the key to better brain health? Yeah, but I just enjoy eating. Actually a shake that I’m involved in making called Best Fats, I’ll put that in there with some eggs and that’s my kind of– that will be lunch and I’ll keep it in the fridge. Ben:  But admitting that I don’t know it all, more of the scientist in me. Ben:  One of the big points of contention was saturated fat should be no more than 10% of total calories. This information comes from Dr. Benjamin Bikman. And if I see, do I have the tools to answer that question? Are you confused about what a plate of keto food should look like? One actual randomized clinical study. This episode is great for anyone who wants to learn more about how diet, exercise … We know when you’re saying something it’s based in science, it’s based in academics, and if we find a way to apply it to our lives, then it should work and make sense. And this is documented in the literature where they inject a small dose of glucagon and then the expected effect is to see an increase in glucose. BYU is about 30 miles south of here in Provo and my lab at BYU is a metabolism research lab. That’s not going to be my regret. In all sincerity, please show me the study that number that the dietary guidelines are based on, that saturated fat should be no more than 10% of calories. By interacting with this site, you agree to our disclaimer. This episode is a break from our interview-style — I'll take the mic for the whole show and discuss the science behind intermittent fasting and fasting-mimicking diets, also known as FMDs. We are so excited to have Dr. Benjamin Bikman back on the show. In the seventh episode of Diet Doctor Podcast, Megan Ramos, co-director at IDM program, talks about intermittent fasting, diabetes and her work together with Dr. Jason Fung at the IDM clinic. Can a ketogenic diet be used in cancer treatment? Ben:  Yeah and one important caveat there and that sets back to protein. So, you’ve got to be kind of clever about how you’re talking about stuff, and so I did in fact very humbly and sincerely scrutinize the way I talk about things and thought, maybe I can be a little more respectful. Ben:  It was already back down to baseline. Bret:  One of the things you talk about are the plagues of prosperity. But anyway, our fear of ketones means people don’t want them at all. So a failure to respond to the exogenous glucagon confirmed this glucagon resistance. And I can look at that and nod my head and give them a thumbs up, but I’m not as much a fasting guy, I’m an insulin guy, and I’m thinking there may be other benefits of the fasting, like just breaking an addiction for food, realizing you don’t have to have that when you think you do. Can a keto diet help with chronic pain like fibromyalgia, migraines or arthritis? And we are splitting hairs, but I actually still think it’s important, because at least to me, I don’t know… I’m not comfortable citing or invoking the term insulin resistance if insulin is low because if we were to give that person a bolus of insulin, that’s going to work. Can a strict keto diet help prevent or even treat some cancers, like brain cancer? I don’t personally like the low-carb waffles that I make, but my kids do so I make it for them, and that would be something I don’t eat and I don’t bring anything with me. Bret:  Right, for me it was more seeing it worked in my patients and then looking into the evidence and then realizing it’s not as clear-cut as it was being portrayed and then, like you said, once you open your eyes you can’t go back. But anyway, yeah, it was an uncomfortable growth, but it was not my personal experience in… you know, experiencing this incredible burst of health. And how can we treat it? But I consult with a supplement company, Unicity, which is great, and then I also have my Insulin IQ group. But I hated the idea that it was only the professor who was talking about a low-carb diet that was triggering an eating disorder. He is currently a professor of pathophysiology and a biomedical scientist at Brigham Young University in Utah. Ben:  I would say that’s true. Bret:  Yeah, that’s an interesting point. His half-hour lecture is linked at the end of the article. Specifically, protein has a very different effect on the way the hormones insulin and glucagon work, depending on what diet you’re on. Learn how to do a keto diet right, in part 1 of our video course. And doing it from a science standpoint that you’re not going to be the zealot promoting things above and beyond what the science says, you’re always going to come back to the science. Now one last comment about glucagon, as people are getting introduced to that perhaps for the first time, there is a phenomenon I almost hate to bring this up called glucagon resistance and that could be instances of– when people have had liver damage like a hepatitis, like an actual infection. I began work with PhD students on Ceramides and Mitochondrial Function, in 2012. We are so excited to have Dr. Benjamin Bikman back on the show. Prof. Ben Bikman thank you so much for joining me on the Diet Doctor podcast. April 22. And what we see in the instance of a low-carb adapted, fat adapted individual who takes a glucose load and now their glucose tolerance appears to be worse. I had I just gotten involved in Twitter for example and in the social media in general. Benjamin Bikman earned his PhD in Bioenergetics and was a postdoctoral fellow with the Duke-National University of Singapore studying metabolic disorders. In fact, Bret, thanks for bringing it up. But again we’re making some connections here, then perhaps we could take that one step further to say it’s probably a person who is going to have an insulin to glucagon ratio that isn’t favorable. It’s the antithesis of starvation. So, anyway, to your point… to your question rather, I think the vast majority of the metabolic benefit that comes from a low-carb diet is that the insulin is controlled. I am a retired person. But sure enough hyperinsulinemia, at least relative to what the person should be. And that’s a case where it does not exist and you can say it’s been a human experiment without going to the IRB to tell everybody to do a 10% saturated fat, because we don’t have that study. Yeah, there’s much more to that. Bret:  Right, I think that’s an important point and it’s kind of hard to bring up in a politically correct way, to say look at us and look at some of your friends’ parents and compare us. Please, show me. Bret:  So that just the fact that the pancreas isn’t responding by increasing the insulin output for that glucose load means it’s glucose unresponsive, not that the cells are resistant to insulin. Bret:  Yeah, that was a great description, and I love you, the scientist, you know the science but also the practicality of it, and it has to fit into life and there’s much more to consider with you as a role model, with you as a father, with you as a teacher, and promoting something that could trigger problems with eating disorders or sort of a body appreciation disorder. Bret:  Yeah, alcohol or fatty liver. And naturally I had a whole discussion focused on insulin resistance. Bret:  Yes, so tell us about insulin resistance. Is increasing protein intake on low carb a good or bad idea idea in terms of weight and health – and why? And there are general reference ranges, but it is a separate beast entirely, for reasons that I confess I don’t know, something about the biochemistry of the molecule itself; it requires a totally separate vial of blood. Prof. Ben Bikman:  Dr. Bret Scher, delighted to be here, thank you. It is a disease of– as much a disease… at least when we think about the general systemic consequences, what it’s doing to the body… It is as much a disease of… as insulin isn’t signaling very well, so the resistance part of it versus hyperinsulinemia. And is a keto diet always the best option? In those instances those are the very small group of people who– and I emphasize this, it is a small group of people who genuinely have this, but that’s when someone who might start fasting and things get very bad for them. I’m terrified of somehow contributing to someone’s eating disorder.  9:45  Responding to anti low-carb people But nevertheless the insulin to glucagon ratio does give an overall reflection of is the body in a fed or a fasted state. But when it is someone who claims to know what I think without ever actually talking, I don’t have any tolerance for that kind of silliness. Dr. Ken Berry wants us all to be aware that much of what our doctors say may be a lie. Show me where I’m wrong.”. So, even then, firstly I was looking at ketones as no more than an inverse indicator of what insulin was, because if insulin is low, ketones are elevated. Bret:  Yeah, and it’s a very important question because an issue that comes up all the time is do I need to be in ketosis? He sort of came the other way and I think that makes him fairly unique but also fascinating. And what I mean by that what’s happening… the cell is able to almost check its inventory and know that the pieces within the cell, what we call organelles, the mitochondria, the endoplasmic reticulum, the lysosome, the peroxisome, any parts of the cell inside of it, the cell can do an inventory and recycle those. I could appreciate those P values for what they were. Diet Doctor Podcast #63 with Ben Bikman, PhD. And so, the people who are pointing the finger at mTOR and implicating protein as the mediator, I say that’s bonkers. So we are here sort of in your backyard, we’re at Salt Lake city, you’re associate professor at BYU. Dr. Benjamin T. Bikman is the Associate Professor of Physiology and Developmental Biology at Brigham Young University in Utah. People will sometime say you adopt a low-carb diet and develop physiological insulin resistance and I actually don’t agree with that. Ben:  And again there would have to be I think some history of a liver– like an overt liver problem; cirrhosis, hepatitis, etc. And that has been an unexpected journey but one I’m so grateful for, sort of stumbling into this area. Dr. Eric Westman at the Low Carb USA 2016. It’s about my relationship with my wife, my relationship with my children, that is priority number one. Dr. Ron Rosedale at Low Carb Vail 2016. We don’t have cereal, they never eat cereal for breakfast, ever. I know a lot of our listeners have kids and probably wrestle with this. And that’s just something I’m very mindful of. Why is insulin so important for us to control? That statistical significance carried a great impact when I really found it. And so, even in that sense insulin is good, but protein is too, and I’m sure some people listening to me will be like, Ben, I’m not saying protein’s bad, even though I’m studying it. So what’s a good way for the average person to think about insulin resistance and how it impacts their health? Ben:  Yeah, yeah, so for me, personally, I don’t enjoy multi-day fast. If someone wants to activate autophagy and inhibit mTOR, scrutinizing insulin will give them a bigger bang for their buck than scrutinizing protein. That might be a sprinkling in there, but to me, it is mostly controlling insulin. I’ll wake up around 5:30, maybe five, and work on the book a bit and then the kids will start to wake up at 6:30. This is one of my top three favorite podcast interviews, ever. No, she wasn’t. Ben:  Yeah, but you can understand. -jaksoa podcastista Low Carb MD Podcast heti tabletilla, puhelimella ja selaimella. But the more we try to pin the protein as the culprit, the more we’re missing the true villain, and that is insulin or hyperinsulinemia. Could protein restriction on a low-carb or keto diet cause problems? If someone is normally going to be a four units, micro units, and there are 10, 10 could be in fact pretty reasonable for someone else. This is what I want this healthy strong body, for me, daddy, mommy wants a healthy strong body, we are trying to do this by eating these kinds of things. But back to my story I would see in these low-carb studies some calling it ketogenic, and I would kind of look at that with a little bit of a grimace and think oh, ketones are bad, so I don’t want to study that or I don’t want to look at that study. That led on to the role of Ceramides in Sarcopenia (degenerative loss of skeletal muscle mass). Of course it’s in the effort of keeping the cell optimal, but it is still breaking stuff down; it is catabolic. And so I said plagues of prosperity. I was already healthy, I was very active, eating generally pretty well even though on the wrong kind of direction, but still, like I said, manifesting enough self-control to avoid junk food which already put me in some pretty comfortable territory. Then he found the power of low carb nutrition and began helping his patients in ways he never thought possible. Calorie restrict… that promotes longevity and the intermediate event would be it’s because it’s promoting autophagy. I really do. The ketones provide, you know– 80 % of the benefit of low-carb is from insulin control. 42:09  Limiting carbs or aiming for ketones? [4:51] Dr. Bikman talks about his recent talk at the Low Carb Breckenridge event, as well as about the ratio of glucagon to insulin and people's fear of proteins due to gluconeogenesis. I mean that’s that kind of rigmarole, we’ll do a little prayer and then I’ll read or whatever and lay by them and hold their hand for a long time. Ben:  Right, what I might sometimes do depending on what I made for breakfast, I’ll bag it up and take it to my office, but it depends. So, you have to be able have these moments of activating mTOR, inhibiting autophagy, promoting anabolic processes. Ben:  Insurance definitely wouldn’t pay for it. In humans of course we don’t have any evidence to confirm that, but that’s a lot of the rationale behind the caloric restriction studies. About five years ago… yeah… by this point… sort of started kind of moving into looking at ketones as independent signaling molecules. Ben:  Yeah, yeah. But essentially, my wife and I have been able to – mind you, it’s still such a battle – the kids want junk food. Think about an ischemic hypoxic heart; there’s less oxygen and it can maintain ATP production. Join me for a fascinating interview about his new book, The Case for Keto. That’s just not part of the snacking system. Do we have to fast for five days to trigger autophagy? Bret:  You can’t un-see it, exactly. The idea that the adipose tissue is an endocrine organ. I don’t want to scare them into eating – if you eat this way, you’re going to look like that person. Join free for a month to get instant access to this and hundreds of other low-carb TV videos. And glucagon being sort of counterbalance the opposite of that. Listened to this wonderful podcast yesterday. Bret:  Making fat more metabolically active. Contact. And looking at that point me… forcing myself to say… okay what is the best way to address insulin resistance? Kristie Sullivan struggled with her weight for her whole life in spite of trying every diet imaginable, but then she finally lost a 120 pounds and improved her health on a keto diet. Just molecules in their own right, not metabolic garbage. Dr. Benjamin Bikman - 'Flipping the Switch: From Insulin Resistance to Type 2 Diabetes' Type 2 Diabetes. We don’t have bread, we don’t have sandwiches for lunch, we don’t have crackers. If so, they’d be always catabolic. I once tried a two-day fast and I just did not enjoy it. Kristie cooking keto with Dr. Georgia Ede. But there are also forms of insulin resistance with low insulin level. And they all want to show off their muscles, or wherever, but I’m a terrible example, of course, I’m a pretty teeny guy. Bret:  Yeah. ... On a low carb diet high fat diet, we are eating but we are mimicking the state of fasting ... A lot of people are scared to eat protein on a ketogenic diet and instead people eat a lot of pure but this is not found in nature. Could excessive protein in the diet be a problem for aging and cancer? You need insulin, here’s your syringe. Because I think it’s such a controversial topic now. And maybe someday it’ll backfire, maybe someday they’ll get out of the house, but they’ll also know that they’re healthy and they’re fit kids, they know that. We’re very strict with bedtime. So, they know it, as much as they might fuss about it. The higher that ratio is getting the more it is indicative of a fed state. Bret:  But we can’t measure autophagy in people, can we? Dr. Mercola Interviews Benjamin Bikman on the Physiological Effects of the Ketogenic Diet April 15, 2019 by Brian Robert Hyland , posted in Mercola View on YouTube It was– which again, as an academic it made that transition both more uncomfortable because I thought I knew what I knew, but also gave me much more conviction because once I’d seen what I consider the reality, I couldn’t un-see it. Jimmy Moore talks about the greatest insight that made it possible for him to get rid of 80 stubborn pounds (36 kg) without hunger. On the one hand, we’re eating all the vegetables, all the meat, all the eggs, all the cheese. So it was pretty interesting to me this idea of what I like to call a nutritional fast, rather than a caloric fast. In our forty second episode we talk to Dr. Ben Bikman on the topic of protein and insulin response. Bret:  I want to get into all the specifics–. I was enthusiastic about it as well. And mostly, we’re hearing it from the vegan community or the vegetarian community because they tend to be more anti-protein, but in theory, on the superficial level, it makes sense. It is not calorie counting. I mean, it is overwhelmingly a negative connotation to the ketones. Insulin is anti-catabolic in certain instances like at the muscle it is anti-catabolic and yet it is anabolic in other places like the adipocyte. Those aren’t the same thing necessarily. Bikman, it’s uncomfortable for me when you talk about low-carb diets because it triggers my eating disorder.” Now, first of all, if I could go on a tangent, I hate that there’s been the birth in this generation of the term “trigger”. Bret:  But I think it would be helpful for some people to know, what is my insulin to glucagon ratio and would that affect the amount of protein I can handle? Learn more about Dr. Bikman. I do tend to be a very boisterous, somewhat rambunctious speaker, especially when I’m trying to keep my students engaged for two hours… I have a two-hour lecture period. Because glucagon will mobilize the glycogen from the liver. So, my perspective… my paradigm had been how can insulin stay as low as possible? Listen to Dr Benjamin Bikman, scientist and expert on metabolic disorders, explain the basics of insulin and insulin resistance, why it matters and what we can do about it. Consider helping others find it, by leaving a review on iTunes. No, so there is… you only have these kind of surrogates, but I would strongly submit– the insulin to glucagon ratio is a great surrogate. It is “I can’t get that calorie into my system, I need to restrict the energy”. Dr. Priyanka Wali tried a ketogenic diet and felt great. And there was some delightful studies; it was kind of an amalgamation of studies but largely based on the work of Roger Unger from UT Southwestern. It’s family. And then I was seeing, as I started to look through the human clinical data studies that would refer to ketogenic diets. Ben:  Yeah, so as a general introduction, autophagy is a process whereby the cell– I’m going to use this term and I hate to say it, but it kind of stays young. I’m aware enough to know that at the end of my life, I’m not going to regret if I wasn’t in the lab enough, you know. Twitter, and social media and all over the place, people who just want to promote their belief, dig in their heels to defend their religion, so to speak, without really having an open mind to look at the other side and look at the literature and… that can be frustrating, I’m sure, for you. I make breakfast, I’m in charge of breakfast, and we kind of rotate. Professor Ben Bikman has studied these questions in his lab for years and he is one of the foremost authorities on the subject. And it could be that if someone becomes a type 2 diabetic, their alpha cells, the glucagon producing alpha cells have become insulin resistant. 37:10 Traditional cancer therapy and the ketogenic diet 42:09 Limiting carbs or aiming for ketones? ‎Benjamin J. Bikman, Ph.D., a world renowned metabolic research scientist, is a popular speaker on human metabolism and nutrition. It has its own set of chemicals that have to be added in order to isolate it and in order to quantify it. These are guys who’ve lost phenomenal amounts of weight and they just find they can’t help but talk about it because they’re so enthusiastic in a way and I’m not even, They have a conviction that I don’t, because they felt it, I never really felt it, I just had the academic conversion. He also worked for the company Insulin IQ and he is a scientist, he is a true scientist at heart, I think you’ll appreciate that in this discussion. But for me it has always been, “Here are the data. That was it for a while. Dr. Angela Poff at the Low Carb USA 2016. Without a doubt, when I’m lying in my bed at night, I’m not stewing over my decisions I made at work, you know. So not to be– Gary is far more eloquent than me, but I thought I can say that better. And to this point, we’ve published the one paper looking at how ketones improve or reduce the oxidative stress from muscle cells and maintain increase, enhance muscle cell survivability. Here’s a clinical study, another one, another one, another one. So, that’s pretty fascinating. Insulin resistance is killing us. If your muscles can't use stored glycogen, is it then a good idea to eat a high-carb diet to compensate for this? The full presentation is available (with captions and transcript) with a free trial or membership: Why you shouldn’t fear protein on keto – Dr. Benjamin Bikman. Dr. Unwin was on the verge of retiring as a general practice physician in the UK. Part 2 of eating keto with Kristie: Build a keto plate. The use of intermittent fasting (IF) and a ketogenic diet (KD) is an effective and sustainable alternative to a standard care approach in the treatment of type 2 diabetes. I’d heard the sentiment… hearing people adopting low-carb diets and their obsession with… drinking oil, literally drinking oil. But if I’m looking at fasting as a tool to lower and improve the insulin to glucagon ratio, which is in fact kind of how I look at things, I think there is a more comfortable way to do this, that is more sustainable. It’s a term that gets thrown around a lot and I’ve talked about before on this podcast that can be confusing for some people. If I let them ice cream, they’d eat it all the time of course. So I'll do a blend of fasting, low-carb diet, and then cycling in and out of a strict ketogenic diet. 49:00  A day in the life of Ben Bikman But more and more realizing or appreciating insulin’s firm control over biochemistry that ketogenesis is an indicator of controlled insulin, and that was my initial appreciation. Ben:  That was the first I’d ever heard of that sort of situation. Ben:  So the talk that I gave a year or so ago was the first time I’d mentioned the insulin to glucagon ratio and it was in the context of protein. If you eat a ketogenic diet your insulin to glucagon ratio is around 2. There are other variables too, but insulin is the elephant in the room. After watching the podcast interview above, you’ll undoubtedly realize he is a force of knowledge in the world of insulin, type-II diabetes, metabolic disease, and using a low-carb or ketogenic diet to combat them. Ben:  Yeah, you’re right, so we are in my backyard. So, are you a fan of sort of intermittent fasting twice a year, three times a year, that kind of thing? As I sort of told my academic background at the beginning, I really had come into this conversation academically, professionally through the lens of how can someone best control their insulin. And I don’t really give them opportunities in the house to get away from that. So it was more of a research tool would you say and why isn’t it being used clinically? I faced my own death 3 times. Ben:  Now when I’ve been able to actually sit down with some of these people who’ve disagreed with me, almost– I think not almost, without exception, it ends up being an amicable, friendly conversation and there can at least be a sentiment of let’s agree to disagree, which I’m okay with, I really am.

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