That statistical significance carried a great impact when I really found it. It’s about my relationship with my wife, my relationship with my children, that is priority number one. So it was more of a research tool would you say and why isn’t it being used clinically? Bret:  Well, that’s clearly the scientist in you; I see you get excited about that. It has its own set of chemicals that have to be added in order to isolate it and in order to quantify it. 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. Dr. Naiman explains. Which is we have all these fears of chronic diseases and we’re treating them in all these distinct ways and there’s another way of looking at them. And I guess there’s a little bit of a debate which some would say it don’t matter and some would say scientifically it absolutely matters. That to me was mind blowing. We are so excited to have Dr. Benjamin Bikman back on the show. Bret:  But you mentioned you do an 18:6, so you won’t eat breakfast. In that fasted state the inability of glucagon to break down glycogen in the liver and to promote ketogenesis in the liver because the liver is glucagon resistant, makes for a brain that starts to suffer from fuel deficiencies. Definitely, and Stephen Thompson did it. de Low Carb MD Podcast instantaneamente no seu tablet, telefone ou navegador - sem fazer qualquer download. Bret:  But we can’t measure autophagy in people, can we? Kristie has prepared a yummy recipe with consideration to Dr. Georgia Ede's food allergies and sensitivities. And so I said plagues of prosperity. 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. But I was also very frustrated and I had to take a moment to clarify and I confirmed it was the student asking me not to show the data because that’s all I ever do. 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”. Now you mentioned autophagy a few times in the description of the insulin to glucagon ratio. Ben:  Well if I did, I stole it from Gary Taubes, who had an article that he called Prosperity’s Plague. Glycolysis gene expression, not at all. And to me, that is the crux of so many genuine eating disorders like anorexia or even bulimia. And then so I did my PhD work with a wonderful scientist at East Carolina University. Ben:  Yes, especially to the point of diagnosed hyperglycemia. 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. It’s a hard thing to say and probably an important lesson when you travel, when you’re in the airport and you see like a slice of humanity and how heavy everybody is. 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. But for me it has always been, “Here are the data. Doesn’t matter. 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. Some people will eat protein and will in fact have massive glucose spiking effect. It does get fairly technical at times I have to admit because he does like to talk about the science and the specifics, but importantly we try and bring it back to how the science can apply to us as individuals in our everyday life. Does red meat really cause type 2 diabetes, cancer and heart disease? Up until that point literally three years ago or so I had no involvement whatsoever. You know, is an 18 – 6 fast good for autophagy or is just low-carb good for autophagy? Then this part of the course is for you. Dr. Ben Bikman, scientist and teacher from BYU, in Provo, Utah, is…well, awesome. I try to share research, whether it’s my own research from my lab or latest published research, or even old research findings. 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. 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. Bret:  Yeah, that’s great … So wouldn’t apply to most people fasting, but for some people who do have trouble fasting, that can certainly be an issue. Don’t restrict protein which we know is necessary. And not about anything beneficial. So, eat these bars, drink this shake, it’s very low protein, ah, but it’s high carb. He lives it, he studies it and he educates physicians about it through his Insulin IQ organization. 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. No. Bret:  That makes sense, but there’s a lot of that out there, isn’t there? And we looked at how insulin sensitivity changed so rapidly in people post gastric bypass. We’re very strict with bedtime. They are still morbidly obese of course one week post bypass surgery and yet they had become very, very insulin sensitive quite quickly. Bret:  So, tell us about the science behind that. So, these multi-day fast, I think they can absolutely have a place and I can deeply appreciate those in the low-carb community who are advocates of it. By that time I’d taken a gradual course in endocrinology, so I was familiar with the kind of stereotypical or prototypical glands; the thyroid gland, the gonads, the pituitary, the adrenal glands, these glands that existed in large part to secrete hormones that would have some systemic effect. But I want them to know that’s on one side of this food balance, and when we indulge in it, it is a treat and we enjoy it and then we know however that it can’t be maintained and it can’t be every day. 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. And so one of the things that I’ve heard you talk about before is this insulin to glucagon ratio especially how it relates to protein. Oh… and if you’re a member, (free trial available) you can get more than a sneak peek at our upcoming podcast episodes here. Ben:  One of the big points of contention was saturated fat should be no more than 10% of total calories. Bret:  Yeah, good point, good perspective. Dr. Ron Krauss helps us understand the nuances beyond LDL-C and how we can use all the available data to help us better understand what we know and do not know about cholesterol. Cholesterol expert Dr. David Diamond and Kristie are making one of her grandmother’s recipes, Hot bacon fat dressing! 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. It is – I detest self-promotion blatantly, so it’s never pictures of me, I don’t like that for me personally. 22:44  Measuring glucagon ratio Learn more about Dr. Bikman. Bret:  One of the things you talk about are the plagues of prosperity. His … I was told by a few medical doctors that it was a miracle that I am alive. 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. Bret:  It’s interesting, because you got there from an academic side. 4-Dr. Benjamin Bikman. Dr. Benjamin T. Bikman is the Associate Professor of Physiology and Developmental Biology at Brigham Young University in Utah. I want my kids someday to go away to college and when they’re living with their roommate and open the fridge they’ll see skim milk and they’ll say, “What’s skim milk?” Or they’ll see low-fat free yogurt. And looking at that point me… forcing myself to say… okay what is the best way to address insulin resistance? And that’s just something I’m very mindful of. I maintained the insulin is the hormone that has two hands firmly gripped on the steering wheel of directing energy but glucagon’s got a hand there. Ben:  Yes, by several times, by multiples. Because as I had started that, I was still just a few months having stepped into the so-called low-carb community. That was it for a while. 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. Not the insulin, it stayed high and it went about three or four times higher mTOR activation, and it was maintained for about three times longer than the leucine. Obviously it’s very difficult to do and reset your metabolic rate. That kind of challenges the whole longevity paradigm with protein being the villain. And it could be that if someone becomes a type 2 diabetic, their alpha cells, the glucagon producing alpha cells have become insulin resistant. Audra Wilford on the experience of using a ketogenic diet as part of treating her son Max’s brain tumor. The information we provide at DietDoctor.com is not intended to replace consultation with a qualified medical professional. Dr. Benjamin Bikman Dr. Benjamin Bikman earned his Ph.D. in Bioenergetics and was a postdoctoral fellow with the Duke-National University of Singapore in metabolic disorders. So I have heard of– I learned of this one person who claimed they would try to fast and they were healthy. Dr. Mowll will read a review and send you the best of the Diabetes Summit in a flash drive as a thank you. Can whatever reverses type 2 diabetes possibly also slow the aging process? Ben Bikman believes wholeheartedly in a low carb diet. But sure enough hyperinsulinemia, at least relative to what the person should be. I faced my own death 3 times. 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? And the greatest beauty of being a scientist is freedom – if I have a question, I can ask it. Specifically, protein has a very different effect on the way the hormones insulin and glucagon work, depending on what diet you’re on. And then dinner is dinner. Ben:  It’s a delicate conversation to have, and for me… I’ll try to focus on the positive, which is, like I’ll joke with my son and my daughters too, I’ll try to be as strong as possible, I’ll say look at daddy’s arm… When I flex my muscle, see it. We talk about insulin like it’s almost like a drug. It is not calorie counting. He is currently a professor of pathophysiology and a biomedical scientist at Brigham Young University in Utah. Ben:  Exactly, and you just can’t get away from that and so they’re going to put up fights. 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. So, are you a fan of sort of intermittent fasting twice a year, three times a year, that kind of thing? And like you said a moment ago, when I show these students the data, what is the common theme of these studies is that it’s calorie unrestricted. And inhibit so-called wasteful processes, like autophagy for example. Bret:  I want to get into all the specifics–. Here’s our second release from Low Carb Breckenridge 2017 conference.This is an intriguing presentation by Dr. Ben Bikman on the benefits of brown fat and the unique role that ketones play in determining energy usage, storage and wastage.. Dr. Benjamin Bikman earned his Ph.D. in Bioenergetics and was a postdoctoral fellow with the Duke-National University of Singapore in metabolic disorders. Prof. Ben Bikman thank you so much for joining me on the Diet Doctor podcast. Can a keto diet help with chronic pain like fibromyalgia, migraines or arthritis? But this person, healthy lean individual that fast… and things really got bad for them, profound headaches, extreme discomfort, they were able to find a physician who did a glucagon tolerance test. And I thought, well how am I talking about it? To me there are instances of what we call– I’ve heard it in a low-carb community and I don’t want to get us off on a tangent so you pull us back if we need to. Bret:  Right, not just a fat store… it’s actually active. Ben:  Yeah, yeah. Consider helping others find it, by leaving a review on iTunes. Ceramides induce insulin resistance in many tissues. So we are here sort of in your backyard, we’re at Salt Lake city, you’re associate professor at BYU. So it was kind of this disconnection in metabolic status. Dr David Jockers is passionate about seeing people reach their health potential in mind, body and spirit. No, no, they’d eat it. Dr. Jockers. 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. How should we eat to fight the global mental health crisis? Insulin resistance is killing us. So we started asking some of these questions. That study, I think it was in ’94, finding that adipose itself can secrete hormones, well, proteins which are hormones in some instances, that opened up a whole new area of interest for me. And that’s partly because my department has enough respect for me that the day will know even when they– if they haven’t overtly agreed with me, they can at least nod their head and say, yeah but I don’t doubt that Ben knows what he is talking about. We open with an in-depth discussion of the f...– Ouça o Episode 110: Dr. Ben Bikman is Back! I don’t want anyone to hear me and think that Bikman’s kids skip down the stairs in the morning ready for bacon and eggs. And interestingly he came to the low-carb world through science whereas most people come to it through a personal experience, a personal connection and then start to learn about the science. I simply just don’t enjoy it. By interacting with this site, you agree to our disclaimer. Ben:  In classic academic settings, ketones are more than just “metabolic garbage”, they’re looked at overtly harmful molecules that should be avoided at all costs. You can listen to the episode via the YouTube player above. I actually will very collegially disagree. Just molecules in their own right, not metabolic garbage. Bret:  So how did that translate to you personally, though? And there’s this whole world of are we promoting disordered eating by promoting a low-carb “restrictive diet”. To me they are different but I think it’s important. And sure enough, if the brain can’t use glucose, there’s only one other fuel, that’s the ketone. But nevertheless to me insulin resistance goes hand-in-hand with hyperinsulinemia. I’ve been feeding them bacon and eggs for years. Whatever the family’s having– Mind you, my family being what it is, it’s never usually high carb it might be moderate, but usually it’s pretty low. Can a strict keto diet help prevent or even treat some cancers, like brain cancer? I still think it’s actually not more than just you basically starve the person for a week and look what happens. So anyway, I’m being too long-winded but learning that the adipose tissue could secrete pro-inflammatory cytokines and that in that obesity associated, or induced inflammation, then could cause insulin resistance, that started my interest in obesity and insulin resistance looking indeed in that paradigm, obesity causing insulin resistance. I don’t want to scare them into eating – if you eat this way, you’re going to look like that person. Ben:  If we were to infuse and doing insulin infusion, well, that glucose– there’s going to be a response to that insulin. Whether it’s a caloric fast or what I call the nutritional fast, it’s still going to be activating autophagy or won’t be stopping it. Dr. Benjamin Bikman is a member of the Levels Medical Advisory Board and the author of Why We Get Sick, which makes the case for insulin resistance and metabolic dysfunction as the underlying cause of many of our modern health problems. Kristie invites Dr. Èvelyne Bourdua-Roy to join her in the kitchen making some delicious “Swedish” meatballs. But there are also forms of insulin resistance with low insulin level. 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. Ben:  It was already back down to baseline. Unless there’s an overt like pathology, with dementia, with migraines. So it was pretty interesting to me this idea of what I like to call a nutritional fast, rather than a caloric fast. So, one of the other things you’ve talked about is ketones as a specific marker, as a specific effect on our bodies. Ben:  And again there would have to be I think some history of a liver– like an overt liver problem; cirrhosis, hepatitis, etc. LCHF and diabetes: science and clinical experience. It’s just rather, you’ve been blessed with a healthy, strong body, let’s keep it that way. JavaScript must be enabled in your browser to log in! So autophagy is a term we hear a lot about lately, a recent Nobel prize– So give us a quick summary of what autophagy is, but more importantly what is the threshold for triggering it.