Dhru Purohit Show - Sugar Is Making Us Fat, Tired, and Sick (Rebroadcast)
Episode Date: December 6, 2021This episode is brought to you by InsideTracker and ButcherBox. Most of us hear the term “metabolic health” and think it only applies to our ability to burn food and manage our weight. And while t...hose are certainly big pieces of metabolic health, it also impacts everything from our cardiovascular health to cognition, mood, infertility, and so much more. That’s because our metabolism is actually our body’s ability to create energy and this happens all over the body. If our energy production in the brain is hindered, we could have memory loss; if it’s not functioning properly in muscle cells, we may see chronic pain—and the list goes on. In today’s mini-episode, Dhru speaks with Dr. Benjamin Bikman and Dr. Casey Means about why insulin resistance has become so prevalent, and what makes us insulin resistant in the first place. They discuss how our diet and lifestyle have fundamentally changed in a way that greatly impacts how we regulate blood sugar, and how it’s wreaking havoc on our metabolic health. They also talk about how to reverse and prevent insulin resistance through specific diet and lifestyle modifications, and how we can use continuous blood glucose monitoring to dramatically improve our health. Dr. Benjamin Bikman is a renowned metabolic research scientist, and a popular speaker on human metabolism and nutrition. He is the author of Why We Get Sick, which offers a thought-provoking yet real solution to insulin resistance and how to reverse pre-diabetes, improve brain function, shed fat, and prevent diabetes. Dr. Casey Means is a Stanford-trained physician, Chief Medical Officer and Co-founder of metabolic health company Levels, and Associate Editor of the International Journal of Disease Reversal and Prevention. Find Dhru’s full-length conversation with Dr. Benjamin Bikman here: https://lnk.to/dhru-154/ and Dr. Casey Means here: https://lnk.to/dhru-170/. This episode is brought to you by InsideTracker and ButcherBox. InsideTracker looks at everything from metabolic and inflammatory markers to nutrients and hormones. Traditional lab tests can be hard to read on your own, but InsideTracker makes their results easy to understand and provides tips on how to use food first for optimal nutrition. Right now, they’re offering my podcast community 25% off. Just go to insidetracker.com/DHRU. When I made the leap from being a vegetarian back to eating meat, my biggest focus was quality. With ButcherBox, I know I’m serving the people I love the highest quality clean protein, which means no inflammatory fats, antibiotics, or weird toxins. ButcherBox has a variety of different boxes, and you can choose your box and frequency. For a limited time, you can sign up today and get 2lbs of ground beef free in your first box plus $10 off by going to butcherbox.com/dhru. Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit megaphone.fm/adchoices
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Coming up on this week's mini episode of the Drew Perrault podcast.
So insulin resistance is this, it really is an epidemic that is the single most common
health disorder in the world.
In the U.S. alone, it affects potentially up to 88% of adults.
So this is a problem that is just phenomenally relevant.
Have you ever gone to your doctor for your normal annual physical?
And after sitting with them for 10 minutes, they quickly look at your labs and tell you,
hey, everything looks normal.
Keep it up and I'll see you again next year.
Maybe even give you a nice little pat on the back.
I can't tell you how many listeners the podcast
have told me that they've had this exact experience
and how honestly how frustrating it can be.
Now, we all know that normal isn't always optimal.
Just because something's not wrong
doesn't mean that we feel great.
So traditional medicine is great at finding out
when something is blatantly wrong.
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Hi everyone. I'm Melanie, producer of the Drew Pruitt podcast. For the month of December,
we're going to be rebroadcasting our most popular mini episodes every Monday.
Today we're rebroadcasting our mini episode with Dr. Ben Bickman and Dr. Casey Means.
And we're talking about why insulin resistance has become so prevalent, what makes us
insulin resistant in the first place, and how to reverse and prevent insulin resistant.
through specific diet and lifestyle modifications.
I hope you enjoy it.
Hi everyone, Drew Prode here.
Most of us hear the term metabolic health.
And we think it only applies to our ability
to burn food and manage our weight.
And while those things are certainly big pieces of metabolic health,
it also is so much bigger than that.
Metabolic health impacts everything
from our cardiovascular health to our cognition and brain health,
our mood, infertility, and so much more.
That's because our metabolism is actually our body's ability
to fundamentally create and use energy.
And if there's dysfunction there,
that can lead to a whole host of chronic inflammation
and ultimately chronic disease.
If our energy production in the brain is hindered,
we could have memory loss.
If it's not functioning properly in the muscle cells,
we may see chronic pain and the list goes on.
My guest on today's mini episode is
Dr. Benjamin Bickman and Dr. Casey means,
and they talk to us about why insulin resistance
has become so prevalent
and what makes us insulin resistant in the first place.
They discuss how our lifestyle and our diet
have fundamentally changed the way
that greatly impacts how we regulate blood sugar
and how this whole process is wreaking havoc
on our metabolic health.
They're all connected.
They also talk about how to reverse
and prevent insulin resistance through specific dietary and lifestyle modifications and how we can
use a continuous glucose monitor to dramatically improve our health. I've been using one and it's been
fantastic. Let's listen in starting with my interview with Dr. Benjamin Bickman, a renowned metabolic
health research scientist and a popular speaker on human metabolism and nutrition. He's the author
of the newly released book, Why We Get Sick, which offers a thought.
provoking yet real solution to insulin resistance and how to reverse pre-diabetes,
improve brain function, shed fat, and even prevent diabetes.
So insulin resistance is this, it really is an epidemic that is the single most common
health disorder in the world.
In the U.S. alone, it affects potentially up to 88% of adults.
So this is a problem that is just phenomenally relevant.
And it is very close levels in some places even worse.
In virtually all of the countries in the Middle East and North Africa, they have worse metabolic health than adults do in the U.S.
China and India are very close to this.
This is a problem that is just spreading around the world as what was once a so-called Western diet is really becoming the global diet, unfortunately.
So just to help people appreciate just how widespread this is, insulin resistance.
is really, let's go back to that glucose insulin paradigm.
So someone who's constantly spiking their glucose is constantly spiking their insulin.
And the insulin will lag behind.
So you and I are wearing our continuous glucose monitors.
We'll see our glucose come up and down.
Let's just say it gets back to normal within two hours.
Insulin doesn't come down that quickly.
Its effects will linger and it will then slowly come down after the glucose.
So eventually the person gets to a state where this incessant stimulus
with insulin starts to make the body resistant to insulin because that is a fundamental principle
of biology. Too much of something will result in a resistance to that something. So as the body is
swimming in a sea of insulin, insulin's always elevated. It starts to need more and more insulin
to get the same effect. But then we get to this paradigm that I said I'd come back to where the person
has normal glucose levels, but they have vastly elevated insulin. This right here,
here is a perfect kind of textbook state of insulin resistance.
Insulin is working well enough, despite needing several times more than we had before,
to keep the glucose at a normal level.
Unfortunately, because we look at metabolic health almost strictly through the lens of glucose
control, we have the patient coming in year after year, and we see that their glucose is
normal.
Glucose is normal, so you're fine.
You don't have any metabolic problems.
But if we shifted this paradigm away from the glucose-centric model to appreciate the relevance of insulin, we would have detected 10 or 20 years earlier that the insulin is several times higher than it should be.
But then we only detect the problem once the body has become so resistant to its own insulin that insulin can no longer keep glucose in check and now the glucose starts to climb.
Now we detect the problem clinically.
now we diagnose them as having some metabolic problem like type 2 diabetes.
So the tragedy in continuing to focus on glucose as the primary metabolic marker
is that we diagnose the problem, the true problem,
for years, even decades later than we could have.
But that same glucosentric paradigm also causes us to treat problems worse.
We aren't addressing the true problem.
So for example, back to this paradigm of the glucose,
being low and insulin high, eventually the glucose is climbing. Now we detect the problem.
And conventional medicine would say, well, let's just lower your glucose by any means,
including pushing your insulin up to even higher levels than you could get on your own.
And so we give the type 2 diabetic insulin therapy or drugs that stimulate even greater
release of insulin from the pancreas. So we push the insulin up to super physiological levels
and now we drive the glucose down to normal.
the evidence, the proof that that paradigm is so problematic is in the fact that when we do that
with a type 2 diabetic, despite the excellent glucose control, they get fatter and sicker and die
faster than they did before.
And I mean it.
Their risk of Alzheimer's goes up by double relevant to the brain.
Their risk of heart disease mortality, triples, their risk of cancer mortality doubles to the
same degree that Alzheimer's doubles.
So we are making them fatter and sick.
sicker than before, and we're doing it in the midst of much better glucose control.
Because it's not the glucose, it's the insulin.
So insulin resistance, again, to define it maybe more explicitly, is that insulin isn't
working normally at all the various cells in the body, and insulin levels themselves
are elevated.
That is an essential aspect of true insulin resistance.
Insulin is high, but it's not working the same way that it used to.
sort of the two pillars of insulin resistance. And then the effects are myriad. It's far beyond
just being relevant to type 2 diabetes. Right. It's not a whole host of things inside of the book
that insulin can be connected to you because I think, again, people are listening to this.
You're like, well, I'm not really worried about type 2 diabetes and I feel like I'm pretty healthy,
but you talk about erectile dysfunction. You talk about migraines. Let's just take those two as
categories of things that a lot of people suffer from, how could insulin resistance be connected
to those two as an example? Yeah, yeah, I love that you bring those up. Yeah, in fact, there was a
manuscript that mentions in the title that something like is erectile dysfunction, the earliest
symptom of insulin resistance in men. And this is a function of a failure of insulin to regulate
blood vessel control as well as it could before. So normally, insulin will flow across a capillary,
these teeniest of the blood vessels
and tell the blood vessels to dilate.
It'll tell them to get bigger.
Of course, that is essential for male fertility.
We have to have that insulin-induced vasodilation
for a man to be able to be fertile.
The failure of insulin,
so as those capillaries,
those little blood vessels become insulin resistant,
now the blood vessels can't dilate.
It can't increase blood flow,
and now the man fails at fertility.
His most essential event with his physiology,
his erection is no longer, he is no longer capable of it.
But if we extend that same blood vessel observation throughout the body,
we also can explain why insulin resistance is the single most common explanation for hypertension.
So someone is coming into the clinic with normal glucose levels,
yet insulin resistance,
then the physician indicates that the person has high blood pressure or hypertension,
they will just give the person a blood pressure medication,
which will control blood pressure,
but it's not addressing the fundamental cause of the problem,
which is the insulin resistance.
If that physician, having detected hypertension,
asked, I wonder what the insulin levels are,
he or she would detect elevated insulin, sign of insulin resistance,
and then say, let's address the insulin resistance,
and that will correct the hypertension,
and, of course, consequently correct the erectile dysfunction.
But even in women, I won't elaborate anymore beyond this,
the most common infertility in women is polycysticovarion,
and at its core is a disease of insulin resistance.
It is a metabolic problem at her ovaries,
preventing the ovaries from making the normal amount of estrogens,
preventing ovulation.
So infertility in men and women is fundamentally rooted in insulin resistance.
And then with migraines, as we move up to the brain,
this is actually the case in migraines, in epilepsy,
and in Alzheimer's disease,
and all three of those seemingly totally unrelated neurological disorders,
central nervous system problems, is an energy deficit.
Briefly, the brain has, as we noted earlier, a very high energy demand.
It is an energy hog all the time.
Even when we're sleeping, the brain has a surprisingly high energy demand.
Because of the average diet, the global diet being high in carbohydrates and high insulin,
the brain is forced to get all of its energy from glucose, virtually 100%.
And we can come back to this idea later with the alternative fuel not being available,
and that's ketones, but that's a bit of a shift in topic.
But the brain has a high energy demand, and because of conventional eating,
glucose is the only viable fuel for the brain.
Some of the brain's glucose uptake will be mediated by insulin, not all of it,
But insulin facilitates some of the glucose that will get to the brain to meet the brain's energy demands.
But as the brain starts to become insulin resistant, that demand, that actual glucose availability is deficient.
We have a little energetic gap.
The brain can't meet all of its energetic needs from glucose.
And thus, a pathology starts to present itself.
Alzheimer's disease, we can detect this.
And this is like truly detectable in humans.
We can detect in Alzheimer's, epilepsy, and migraines, the brain isn't getting the same amount of glucose as we see the brain getting in a control human who doesn't have one of those pathologies.
And so as the brains become insulin resistant, it's preventing, again, the brain from getting its energy from glucose.
And now we have a problem manifesting.
But that is why if we can improve insulin sensitivity at the brain by dietary manipulation, we start to correct.
to that problem. In the case of migraines, there are studies from the 1920s, for heaven's
sakes. I mean, we're talking almost 100 years ago. We have evidence of a physician putting
patients with migraine headaches onto low carbohydrate diets. And it is profound what this
physician noted in this manuscript, highlighting the effect that each individual subject, something
that just doesn't really happen these days. And almost all of them, it said, upon entering
ketosis, which is the state that I've been alluding to and haven't really defined yet,
but basically a low-carb diet, upon adopting a low-carbohydrate diet, which is the best way
to improve insulin sensitivity, the migraines cease entirely.
And that's a common phenomenon where a person will go, either they stop having migraines
completely or they go down to like a tenth of what they were before.
And I've seen this even right here in my department at my university.
I had a colleague who heard me elaborating on this phenomenon.
And he went from having two serious migraines a week to having about two a year.
And it's almost always because he indulges in something, spikes his glucose levels to a high level,
and then has the migraine kind of returning.
So with migraine headaches, as we see with other neurological disorders,
it's likely at least part of it. Part of it is at least explained by an energetic deficit.
There is a gap in energy that the brain can't make up for in an insulin-resistant state.
That once we address the insulin resistance, we start to address that energetic gap,
and then the disorder starts to improve.
My next guest, Dr. Casey Means is a Stanford-trained physician,
chief medical officer and co-founder of the metabolic health company Levels,
an associate editor of the International Journal of Disease Reversal and Prevention.
Her mission is to maximize human potential and reverse the epidemic of preventable
chronic diseases by empowering individuals with tech-enabled tools that can inform, smart,
personalized, and sustainable dietary and lifestyle choices.
Dr. Means talks to us about the concept of continuous blood glucose monitoring, which I'm a huge fan of,
something that Dr. Means is pioneering with her company levels to make more accessible for the
mass market. And how we can use that data to truly, truly personalize our diet and lifestyle
for optimal health. Let's listen in. For me, I've chosen to be on a Whole Foods plant-based diet
because it just achieves a lot of the things I want in my body for getting me the substrates
that are going to lead to optimal biologic cellular function in my body. So it
gives me the antioxidants I need. I get tons of fiber to help my microbiome be healthy. I'm getting
lots of phytonutrients. I get omega-3s from nuts and seeds, et cetera. And so to me, it's just what
helps me feel great and helps me really optimize what I know about cellular biology. But the reality
is that even with a diet that feels very, very healthy and whole, there can be collateral damage. And
what I mean by that is you might be eating lots of healthy foods, but they still might be causing,
you know, massive glucose spikes in your body. And so for me, glucose monitoring has helped me just
really tailor this diet that I love and adore and make it not have that collateral damage
and just make it as finely tuned for me. And so what that looks like personally is that I've been
wearing a continuous glucose monitor for about 18 months and I've been using them in my patients for
a couple of years at this point. For me, it means there's certain foods that I'm kind of eliminating,
so I really don't eat a lot of grains. They just spike me so high. I don't eat oatmeal. I've
minimized some of the big spikers for me, which are grapes, corn, sweet potatoes, and rice,
and I'm getting a lot more fat, protein, and fiber. So I eat a lot of beans, and when I do,
I put extra fat and fiber and protein on them. So I'll put beans with like tahini and chia seeds and
flax seeds and things like that. I'm eating a lot of nuts and seeds and green leafy vegetables. I'm
minimizing sort of the starchy vegetables. And so, and I'm definitely choosing my fruits really
carefully. I've found a number of fruits that don't spike my glucose at all. I tend to eat less ripe
fruits now. So instead of eating a super ripe juicy pear or peach, I'll eat sort of a less ripe
version of it, and that tends to do a lot better. And then I always pair my fruit with fat and fiber. So it's always
going to have almond butter and chia seeds on it, or I'm going to put it with some full fat,
cashew milk, yogurt or something like that. So what it's done for me is help me figure out how to
pair foods properly and just really not eat carbs all by themselves. And for me, that allows me to
eat 200 plus grams of carbs per day and barely ever have a glucose elevation. It's pretty much just
generally flat and stable all the time, but that's been quite a bit of experimentation. And then I would
say the second thing is aside from just food pairing and learning how to, you know, mix carbs of fats
and proteins and fibers, I'm also really thinking a lot about food timing. So I've definitely condensed
my sort of evening window during the day so that I can't give my body and my pancreas a break from
insulin production. I try to eat earlier in the day. We tend to process carbohydrates better
earlier in the morning and in the early afternoon as compared to evening time because at night,
our body produces melatonin from the pineal gland to help us go to sleep and, you know, get tired,
but that also affects the pancreas and actually makes us to create less insulin. And so
for the same amount of carbohydrates, you're going to be less quick to bring them into the cells
at night as you are in the morning. So that's something interesting to experiment with another
I could interject on that point.
It's also reminiscent of the fact that, you know, growing up, I was around people that fasted all the time in my tradition.
It was part of the Hindu and my mom's from the Jane tradition.
It's a big part of those traditions is fasting.
And interestingly enough, a lot of the fasting that people would do would be in the evening.
Here in the U.S., we sort of have this culture of fasting in the morning that's become a thing.
But, you know, talking with Walter Longo and his team, they were like, well, most of the
cultures around the world, they actually fast later on at night because they need that healthy
fat and maybe some of those carbs in the morning to power their brain and then they do better,
you know, it's just interesting to see the different patterns out there.
It's so interesting. It's also really interesting to see how the science now is catching up
with the traditional wisdom. You know, we're actually now being able to show molecularly what
a lot of these traditions have been saying forever. And I agree with that firmly. If you're
going to fast, I tell people, you know, don't stop eating at nine.
p.m. and then just your fasting means that you're not eating until one p.m. the next day. That's going to be, in my
opinion, a lot less effective as stopping eating at 5 p.m. and then just starting eating earlier in the
morning the next day because of the hormonal cascade that's happening at night with melatonin.
And another point there is that when we eat carbohydrates late at night and we're basically setting
ourselves up to not sleep well. So high carbohydrate meals late in the evening are associated with
insomnia. And many of our customers have seen that when they eat something high carb late at night,
like a dinner with bread and then a dessert, they'll just see their glucose bouncing around all
night. And we know, and actually Ben Bickman's written about this, that when that happens,
it actually elevates our body temperature. So when our glucose is bouncing around, it has an
effect on our blood vessels and makes it harder for us to release heat and actually raises
our body temperature at night. And that is associated with poor sleep quality. So
yeah, definite life hack, you know, just don't eat your carbohydrates at night. Eat them in the
earlier part of the day and stick to a higher fat, higher protein meal in the evening if you're
going to eat, if you're going to eat later for sure. So that's a big one. And then, you know,
just making sure that you're eating during times when your body's prime to process glucose properly.
And that means when you're not under stress, ideally if you've moved before or after the meal,
so a walk before or after the meal or an exercise, you know, close to meal time. And, you know,
and ideally eating higher carb meals on days that you've got in good sleep. One poor night of sleep
can make us more insulin resistant. You can take healthy populations of people and deprive them of
sleep for just a few days. There's a study that looked at healthy young men who for six days
got four hours of sleep per night. And they went from healthy glucose to just pre-diabetic in that
amount of time. So you just don't want to be eating your big carb meals on days when you haven't
gotten good sleep. So all of those learnings, yeah. I added one more point to that. Sorry to interrupt,
but just to solidify that point, I didn't sleep well last night. And I woke up this morning,
I checked my levels and my meter. And I was at the highest all week of where my morning
blood sugar was. I was hot. I ate my carbs a little bit too late last night and I was tossing and
turning a little bit and I'm trying this experiment where I had my air filter off from my room and
through a whole host of things, I woke up with the highest starting blood sugar that I had when I
started in the morning. That is so interesting and yeah, and not that super surprising. Those carbs late
at night can just send us on a total roller coaster. But yeah, so long story short, those are all the
things that have helped me figure out how to do vegan and do plant-based without this collateral
damage of the glucose spikes. And it is very holistic. And I really love about this tool that because
so many factors go into how we control glucose, it actually becomes a biofeedback tool for so much
more than just food. It's actually a biofeedback tool for all these other factors like stress, exercise,
and sleep. And I think to your point about your morning glucose being much higher, I think we kind of
think because of the way that metabolic conditions are diagnosed in our country, you know, you go and
you get a finger-stick glucose. And if your blood glucose is above a certain level, they say you're
pre-diabetic. And if it's above a higher level, you're in the diabetes category. But I think what
people don't realize is that that actually, that number can bounce around massively day-to-day
based on what we're doing. I've had indulgent Saturdays where my average glucose,
is 10 points higher than on the day before and including my fasting glucose.
And so you can imagine if you're doing that type of day, day after day after day, you're
going to move in that direction.
But being able to see how much variability there is with just certain choices like eating
carbs late at night, it's really empowering because you're like, oh, I can just change that
and, you know, get things lower.
So that's super interesting that you notice that.
And then also map it out to how you feel because everybody's used to the fact of,
especially if you were traditionally working in the office environment or, you know, that three o'clock time period where you feel like your energy starts to crash.
You can't focus the same way people in, let's say, corporate America, start reaching for sweets, right?
They write, and even people that are not working that are working at home, taking care of kids, other stuff, running around, doing all the things that they need to do, especially in this day and age with COVID and homeschooling.
And then you get to that three o'clock time period.
If you have not managed your blood sugar well and your glucose well, you hit.
these patterns where you're just like, I just feel like shit. I don't like the way that I can focus
right now. And now, you know, are you craving things or are you artificially boosting yourself
back up to get, you know, to almost in a way medicate, right? So how much of your cravings
are just you actually miss foods and how much of them are driven by biological needs where your
body is tricking you to reach for that sweet or that thing that maybe isn't the best for you.
Yeah, I think it's absolutely the latter. We don't, we don't actually need to eat every two hours. You know, people have gone 30, 40 days not eating. You know, Walter Longo's work looks into this, you know, and it's, we don't need. It's very much a physiologic sort of addictive response that we have. And we're trying to sort of fill up the tank very quickly because we're not metabolically flexible and we're not able to get that energy we need from bat. We're running out of glucose, you know, and our body's kind of panic. And so,
The more that we can train our bodies to what I like to call be metabolically fit,
the more we can just sort of balance out those peaks and valleys throughout the day.
And I think what is under-recognized is that our glucose swings that are happening all day long,
up and down, up and down, up and down, the standard American diet,
that projects directly onto our up-and-downs in our day subjectively.
It maps on to our energy fluctuations, our mood fluctuations,
our brain fog fluctuations.
You'll start to see as you track this stuff that,
oh, I can actually have a much more stable day subjectively
and psychologically and energy-wise if I keep things stable.
And that's amazing because I think that's what we all want.
We want to feel in control and we want to feel stable.
And that starts with keeping our glucose under control.
There is no perfect diet for everyone.
We've often talked about this on the show.
and even healthy foods like sweet potato or too much cassava or a lot of the healthy-ish foods that we see in the aisles of whole foods and other natural grocers may cause a blood sugar spike in one person, but maybe not in someone else.
Seeing this information in real time lets us make better decisions with immediate payoff for how we feel, as well as long-term protection against chronic disease.
Thanks for tuning in for this week's mini-episode.
We'll see you next week.
