Ben Bikman, Ph.D., is a professor and metabolic scientist whose research focuses on insulin, insulin resistance, and metabolic health.
Insulin helps regulate blood glucose and the storage and use of energy. Insulin resistance develops when tissues become less responsive to insulin, requiring the body to produce more of it to maintain normal blood glucose.
Insulin resistance is associated with many chronic diseases, including type 2 diabetes, obesity, cardiovascular disease, and certain forms of cancer.
Bikman emphasizes that insulin resistance can begin long before a person develops type 2 diabetes. Blood glucose may still look normal while insulin levels are already elevated.
His approach focuses on reducing the demand for insulin through carbohydrate restriction, eating adequate protein, exercising—particularly resistance training—and improving sleep and other aspects of metabolic health.
What I find especially useful about Bikman's work is his emphasis on insulin resistance as something worth understanding before blood glucose reaches the diabetic range.
Insulin is a hormone secreted by the pancreas that plays a pivotal role in regulating blood sugar levels. After a meal, carbohydrates are broken down into glucose, which enters the bloodstream. Insulin facilitates the uptake of glucose into cells, where it is either used for energy or stored as glycogen or fat. Insulin resistance occurs when cells in the body become less responsive to insulin, requiring higher levels of the hormone to achieve the same effect.
Over time, the pancreas compensates by producing even more insulin, leading to a state known as hyperinsulinemia. While blood sugar levels may remain normal in the early stages, the persistently elevated insulin levels wreak havoc on the body’s metabolic processes. Eventually, the pancreas may fail to keep up, resulting in elevated blood sugar levels and the onset of type 2 diabetes.
This progression can take years. Bikman emphasizes an important point: a person can have elevated insulin and is developing insulin resistance before conventional glucose tests indicate diabetes. Bikman's work therefore encourages looking at metabolic health before diabetes develops rather than waiting for blood glucose to become markedly abnormal.
According to Dr. Bikman, insulin resistance arises from a combination of genetic predisposition and lifestyle factors. Key contributors include:
1. Poor Diet: A diet high in refined carbohydrates, sugars, and unhealthy fats promotes insulin resistance. Frequent spikes in blood sugar and insulin levels overload the system, diminishing cellular sensitivity to insulin.
2. Obesity: Excess fat, particularly visceral fat around the abdomen, releases inflammatory compounds that interfere with insulin signaling.
3. Physical Inactivity: Lack of exercise reduces the body’s ability to utilize glucose efficiently, increasing insulin resistance.
4. Chronic Stress: Elevated cortisol levels from prolonged stress can impair insulin function and contribute to fat accumulation.
5. Sleep Deprivation: Poor sleep disrupts hormones that regulate appetite and glucose metabolism, exacerbating insulin resistance.
6. Environmental Toxins: Exposure to certain chemicals, such as bisphenol A (BPA), may disrupt endocrine function and contribute to metabolic dysfunction.
Consequences of Insulin Resistance
Insulin resistance affects nearly every system in the body, making it a precursor to a host of chronic conditions. Some of the most significant health consequences include:
1. Type 2 Diabetes: Insulin resistance is the hallmark of type 2 diabetes. As the body becomes less responsive to insulin, blood sugar levels rise, leading to hyperglycemia.
2. Cardiovascular Disease: Elevated insulin levels contribute to high blood pressure, increased LDL cholesterol, and arterial inflammation, which heighten heart disease risk.
3. Obesity: Insulin resistance promotes fat storage and inhibits fat breakdown, perpetuating a cycle of weight gain.
4. Polycystic Ovary Syndrome (PCOS): Insulin resistance is a key factor in PCOS, a condition characterized by hormonal imbalances and reproductive issues in women.
5. Cancer: Chronic hyperinsulinemia has been linked to an increased risk of certain cancers, such as breast and colorectal cancer, due to insulin’s role in cell growth.
6. Cognitive Decline: Insulin resistance in the brain is associated with an increased risk of Alzheimer’s disease, sometimes referred to as “type 3 diabetes.”
Diagnosing insulin resistance can be challenging, as it often develops silently over years. Dr. Bikman emphasizes the importance of early detection to prevent long-term damage. Common diagnostic tools include:
1. Fasting Insulin Levels: Elevated fasting insulin levels can indicate insulin resistance even before blood sugar levels become abnormal.
2. HOMA-IR: The Homeostatic Model Assessment for Insulin Resistance is a calculation that considers both fasting insulin and glucose levels to estimate insulin sensitivity.
3. Triglyceride-to-HDL Ratio: A high ratio of triglycerides to HDL cholesterol is a marker of insulin resistance.
4. Waist-to-Hip Ratio: Excess abdominal fat is a strong indicator of insulin resistance.
5. Glucose Tolerance Tests: These tests measure the body’s response to a glucose load, highlighting impaired insulin function.
Reversing Insulin Resistance
Dr. Bikman’s research highlights that insulin resistance is not an irreversible condition. Through targeted lifestyle changes, individuals can restore insulin sensitivity and improve overall metabolic health. Key strategies include:
1. Adopting a Low-Carbohydrate, High-Fat Diet
Dr. Bikman is a strong advocate for low-carbohydrate, high-fat (LCHF) or ketogenic diets to combat insulin resistance. By reducing carbohydrate intake, the body relies less on glucose for energy, decreasing the demand for insulin. Healthy fats, such as those from avocados, nuts, and olive oil, provide sustained energy without spiking insulin levels.
2. Prioritizing Protein
Adequate protein intake supports muscle maintenance and repair, which is critical for improving insulin sensitivity. Protein also promotes satiety, helping to regulate appetite and prevent overeating.
3. Increasing Physical Activity
Exercise is one of the most effective ways to enhance insulin sensitivity. Both aerobic exercise and resistance training improve glucose uptake by muscle cells and reduce visceral fat. Dr. Bikman particularly emphasizes the importance of strength training for its long-term benefits on metabolic health.
4. Managing Stress
Chronic stress can exacerbate insulin resistance through elevated cortisol levels. Stress-management techniques, such as mindfulness meditation, yoga, and deep breathing exercises, can help mitigate this effect.
5. Improving Sleep Quality
Sleep is critical for metabolic health. Dr. Bikman recommends establishing a consistent sleep schedule, creating a relaxing bedtime routine, and minimizing screen time before bed to improve sleep quality.
6. Fasting and Time-Restricted Eating
Intermittent fasting or time-restricted eating has shown promise in improving insulin sensitivity. By extending the period without food, the body has more time to lower insulin levels and mobilize stored fat for energy.
7. Avoiding Processed Foods and Sugars
Eliminating processed foods, sugary beverages, and artificial additives reduces the metabolic burden on the body and helps restore insulin sensitivity.
This is especially important for anyone with diabetes.
A low-carbohydrate diet can reduce blood glucose rapidly.
Someone taking insulin or medications that can cause hypoglycemia may therefore require medication adjustment.
Medication should not be reduced or discontinued without appropriate medical supervision.
The objective isn't simply to take fewer medications. It is to improve health safely.
The Bigger Picture: Insulin Resistance and Society
1. Education: Raising awareness about insulin resistance and its consequences is critical. Schools and workplaces can play a role in promoting metabolic health literacy.
2. Policy: Governments can support public health by regulating the food industry, promoting access to healthy foods, and encouraging active lifestyles through urban planning.
3. Healthcare: Shifting the focus from reactive treatment to proactive prevention can help mitigate the burden of insulin resistance-related diseases. Integrating metabolic health into standard medical care is essential.
Before learning about insulin resistance, I tended to think primarily about blood sugar.
Bikman's work encouraged me to think about what may be happening before blood sugar becomes abnormal.
The pancreas may be working harder and producing more insulin in order to keep glucose under control.
That makes insulin resistance useful for understanding the progression toward metabolic disease.
Insulin resistance connects many of the subjects in this collection: obesity, Type 2 diabetes, fatty liver disease, cardiovascular risk, and metabolic health.
Ben Bikman's central message is that we shouldn't wait until diabetes appears before paying attention.
By understanding the causes, consequences, and solutions, individuals can take proactive steps to improve their metabolic health. Through a combination of dietary changes, physical activity, stress management, and societal efforts, insulin resistance can be effectively managed and even reversed, paving the way for a healthier future.