5 Surprising metabolic insights from Ben Bikman
In a recent podcast, the researcher who literally wrote the book on insulin, dove deep on glucose, insulin, testing, and diet. Here are five unique things we learned in this episode.
When it comes to metabolic health, most of us have heard the basics: eat less sugar, watch your carbs, and keep your blood glucose stable. But according to Ben Bikman, PhD---an exercise physiologist, metabolic researcher at BYU, and the author of Why We Get Sick, the most complete and understandable book on insulin resistance---the story of insulin and glucose goes far deeper than most people realize. Even though we've talked a lot about glucose and insulin on this blog and A Whole New Level, our recent conversation with Bikman shed new light on the mechanisms of insulin resistance, how we test and track it, and what that means for our daily habits.
Here are five surprising insights about metabolism as well as three practical takeaways from Bikman.
1. Insulin Affects Every Single Cell in Your Body---And That's Unusual
When you hear "insulin," you probably think "diabetes" or "blood sugar." But insulin's reach extends far beyond glucose management. According to Bikman, insulin literally affects every single cell in your body.
"I'm not using the word literally too liberally like my college students do," Bikman clarifies. "I mean literally. Every cell of the body will respond to insulin."
This is actually uncommon for a hormone. Most protein-based hormones only affect specific tissues, but insulin operates as what Bikman calls a "metabolic conductor," telling cells throughout your entire body what to do with energy---whether to store it, burn it, or hold onto it. This universal reach helps explain why insulin resistance can manifest in seemingly unrelated health problems, from infertility to brain fog to high blood pressure.
2. Your Fat Cells Become Insulin Resistant First---And That's Actually Protective
Insulin resistance doesn't start everywhere at once. According to Bikman, your fat cells are likely the first tissue to become insulin resistant---for good reason.
"I firmly believe that the slow march of insulin resistance starts in the fat cell," Bikman explains. When a fat cell undergoes hypertrophy (growing larger rather than multiplying), it reaches a point where it must become insulin resistant to prevent its own destruction.
Think of it this way: insulin tells fat cells to store more energy. But when a fat cell is already stretched to capacity, continuing to respond to insulin would be like trying to inflate an already-full balloon. By becoming insulin resistant, the fat cell essentially stops responding to insulin's storage signal, preventing itself from rupturing.
This explains a puzzling observation: why some ethnicities can be relatively lean yet have higher rates of Type 2 diabetes compared to populations with higher body fat. The difference lies in fat cell behavior. Some genetic backgrounds favor hyperplasia (making more, smaller fat cells), while others favor hypertrophy (making fewer, larger fat cells). Larger fat cells become insulin-resistant more quickly, setting off a cascade of metabolic problems even at lower body weights.
"Small fat cells are very insulin sensitive and anti-inflammatory," Bikman notes, "thereby promoting an even further insulin sensitive state." The takeaway? It's not just about how much fat you have---it's about how your fat cells are storing it.
3. Insulin Resistance Always Comes with High Insulin
Most people understand that insulin resistance means cells aren't responding well to insulin, which could lead to high insulin levels. But Bikman insists that insulin resistance is, in fact, defined by chronically elevated insulin levels (hyperinsulinemia).
"There is no such thing as insulin resistance in the human body without accompanying hyperinsulinemia," Bikman says. "If you remove the hyperinsulinemia, what you think you're describing as insulin resistance is not."
This creates a two-part pathology: the cellular level problem (cells not responding to insulin's signal) and the whole-body problem (too much insulin circulating in the blood). This high insulin can be both a cause and a consequence of insulin resistance.
Too much insulin directly causes cells to become insulin resistant---it's a fundamental biological principle that too much of any signal causes resistance to that signal. But insulin can also spike as a consequence of insulin resistance in other tissues, as your pancreas desperately pumps out more insulin trying to overcome cells that aren't responding.
This is why measuring fasting insulin levels is so crucial. Your glucose levels might look normal on standard tests for years, while elevated insulin is quietly doing damage throughout your body. By the time glucose starts climbing and you're diagnosed with prediabetes or Type 2 diabetes, you've already been dealing with hyperinsulinemia---and its cascade of health effects---for potentially a decade or more.
4. The Standard Pregnancy Glucose Test Is Fundamentally Flawed
If you've been pregnant or know someone who has, you've probably heard about the glucose tolerance test---that unpleasant experience of drinking a sweet glucose solution and having your blood tested afterward. But according to Bikman, this standard test has a serious design flaw.
"It is a standard load of glucose regardless of body type," Bikman explains. "And that should not be the case. It leads to false positives in petite women."
His wife, a petite woman who went through three pregnancies, experienced this firsthand. For a small-bodied woman to clear the same amount of glucose as a six-foot-two woman with 100 more pounds of body mass isn't a fair metabolic challenge. The larger woman has simply more tissue available to absorb and process that glucose, making the test easier for her to pass, even if she has underlying metabolic issues.
"I think that causes a lot of petite healthy women---even low-carb women---to fail that test, but not because they can't handle the glucose well," Bikman notes. "It's just because it's a lot for their small body."
His proposed solution? Make the test body-weight-based---a certain number of grams of glucose per kilogram of body weight---rather than a one-size-fits-all approach.
5. Eating Carbs Before Bed Might Be Sabotaging Your Sleep More Than You Realize
Most sleep advice focuses on the obvious: reduce screen time, keep your bedroom cool, stick to a schedule. But Bikman discovered a surprising culprit behind his own sleep problems through continuous glucose monitoring: bedtime carbohydrates were activating his fight-or-flight response.
"I would go to bed, and I'd be wondering, why am I so hot? Why am I so anxious? My heart is pounding," Bikman recalls. He initially assumed it was anxiety, but "I'm not anxious about anything."
In fact, he was going to bed with high blood glucose from evening treats. "Most people don't appreciate that when you are hyperglycemic, you activate your sympathetic nervous system," Bikman explains. "That's a terrible time to activate the fight-or-flight response when you're trying to go parasympathetic and go to bed."
His advice? If you're going to indulge in a carbohydrate-heavy meal, make it lunch or early dinner. "At worst, it's at bedtime, right? Which, unfortunately, is when most people find they want carbs the most. No one is sitting around on an evening craving protein and fat."
For those struggling with sleep quality despite good sleep hygiene, checking glucose levels with a continuous glucose monitor might reveal an unexpected problem: your bedtime snack could be keeping your nervous system in high alert when it should be winding down.
What Should You Actually Do? Bikman's Three-Part Strategy
To put these metabolic insights into action, Bikman distills his recommendations into three simple principles he calls "manage your macros."
1. Control Carbs
"Stop getting your carbs from bags and boxes with barcodes," Bikman advises. "Whole fruits and vegetables---enjoy them liberally. Eat them, don't drink them, but enjoy them liberally. But the more processed, the more you avoid them."
That's it for the average person. You don't need to go keto or count every gram. Just get your carbohydrates from actual plants rather than things that come in packaging. For someone already dealing with Type 2 diabetes, Bikman notes you might need to be more careful even with high-sugar fruits like bananas and mangoes. But for most people focused on metabolic health, this simple rule covers it.
2. Prioritize Protein
The second principle is straightforward: make protein a priority at meals. Bikman emphasizes getting adequate protein, particularly from animal sources, though he doesn't focus on targets. The key is making protein central to your eating pattern rather than an afterthought.
3. Don't Fear Fat
"Don't fear the fat that comes with the protein," Bikman says. This goes against decades of dietary advice, but it's based on understanding how insulin actually works. Fat doesn't spike insulin the way carbohydrates do, and the fat naturally present in protein sources isn't the metabolic villain it's been made out to be.
Bikman even suggests that some people thrive doing "fat fasts"---consuming small amounts of fat (like butter in coffee or an electrolyte drink) during fasting periods. "In the absence of any other calories, I have found I can fast effortlessly if I add a little butter to a hot drink throughout the day," he explains. While this isn't a "caloric fast," it maintains what he calls a "metabolic fast"---keeping insulin low, which is what really matters for metabolic health.
Beyond these three principles, Bikman recommends a few practical hacks: Consider using apple cider vinegar with meals, try berberine as a supplement, and take a 10-15-minute walk after your most carb-heavy meal. That brief activity can reduce your glucose spike by up to 50% because contracting muscles pull in glucose without waiting for insulin.
The remarkable thing about metabolic dysfunction, Bikman emphasizes, is how reversible it is. In a case study his clinic published, 11 people newly diagnosed with type 2 diabetes chose to follow these lifestyle principles instead of taking medication. Within 90 days, not a single one still had diabetic markers. "You can take someone who has been on this pathway to metabolic hell through purgatory for years," Bikman notes, "and they can get to metabolic paradise in a substantially shorter time than it took them to get to where they are."
Take control of your metabolic health
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