February 7, 2023

I had the opportunity to sit down with Dr. Benjamin Bikman for a discussion on all things related to insulin resistance. In this clip we discuss what really causes insulin resistance.

Like you said you are one of the experts in insulin resistance and metabolic flexibility and there’s been a lot of chatter um in the internet world of things with nutritionists doctors that say that insulin resistance is actually um that we may need a little bit of carbohydrates for insulin sensitivity so too low of diets without carbohydrates can cause insulin

To not work well and so it’s not ideal and then there’s some people that say actually nowadays it’s really the pufas that are causing the insulin resistance um or that the cells itself are becoming insulin sensitive because of the excess pufas which then make people gain weight and then some people are like no it’s the you know sugar insulin model i figured

We should ask the expert you know what is causing insulin resistance right yeah in fact judy your your question there you brought up a lot of things like the difference between insulin resistance and glucose tolerance and and now uh the the origins of insulin resistance itself so briefly i’ll answer that um that question directly um insulin resistance just so

The audience has and looks at it the way i do insulin resistance is really a coin with two sides now the coin that i would be holding this allegorical coin would be called insulin resistance and this is the insulin resistance that we see in the human body whether it is those more clinically relevant cases of pathological insulin resistance or whether it’s the

Physiological insulin resistance that happens during puberty and during pregnancy but regardless any time we’re calling something insulin resistance in the body it’s this coin with two sides on one side is the fact that insulin isn’t working the same way that it used to so the hormone insulin isn’t able to do all the things it used to at some of the cells of

The body emphasis on some of the cells most of the body cells respond to insulin as well as they ever did so it’s not like it’s a global or universal phenomenon within the body but the other side of that coin is hyperinsulinemia or chronically elevated blood insulin levels these two things will always come together compromised insulin signaling and chronically

Elevated insulin itself whether again whether it is a pathological insulin resistance that’s making the person sick or whether it is the physiological insulin resistance which is helping that boy or girl grow very rapidly during puberty or whether it’s helping mommy’s body and baby to bee’s body grow in order you know throughout the pregnancy in both in all of

These instances it’s the combination of those two variables or both sides of the coin you can’t have one without the other so that’s insulin resistance just by way of a common definition then the origins of insulin resistance as you note is very very debated so i in an effort to try to simplify it and distill what i believe all the data suggests into the simplest

Concept i think one way of looking at it is looking at insulin resistance as being a result of primary causes or a result of secondary causes with regards to primary causes these are very these are stimuli that can cause insulin resistance independent of anything else and it can cause it all around the body at every at various cells fat cells muscle cells liver

Cells etc brain cells and so the there are three primary causes of insulin resistance as i defined it and and by that i mean you can take humans and and isolated cells and if you expose them to all three of these things that i’ll mention in a moment then they’ll become insulin resistant and they that is elevated levels of inflammatory proteins so inflammation

Elevated levels of stress hormones i mean that’s cortisol and epinephrine and then lastly chronically elevated levels of insulin so inflammation stress and insulin now inflammation and stress are so widely thrown around these days you know in pop culture everyone wants to blame everything on stress or blame everything on inflammation and so i’m being very careful

Using those words but when we can detect elevated levels of inflamed inflammatory proteins or hormones then the body will become insulin resistant as a direct result same with those stress hormones cortisol and epinephrine everything else can be fine but if those hormones are up for too long and then the body starts to become insulin resistant and then what i

Believe is the most relevant because you can change it so quickly is the chronically elevated insulin where too much insulin is causing the body to become resistant to it so those are the primary causes and then the secondary cause i believe is something like linoleic acid this is a prime example of that because you can’t treat cells with like muscle cells with

Linoleic acid and then they become insulin resistant it doesn’t happen the same with with neurons in the brain it doesn’t happen what can happen is that linoleic acid now linoleic acid can do all kinds of bad things in the body from these refined seed oils but just for the to see it through the lens of insulin resistance i believe it’s secondary because when

The fat cells start to accumulate linoleic acid it forces the fat cells to grow through a process called hypertrophy and when the fat cells are each individually getting too big rather than multiplying in number then those bigger or hypertrophic fat cells become insulin resistant and so the in other words the seed oils can promote insulin resistance through the

Body but it would be in part due to what it’s doing at the at the fat cells by making the fat cells grow in a harmful way and then the fat cells are promoting the insulin resistance throughout the body so to sum it up primary causes inflammation stress and insulin itself and then secondary causes like linoleic acid from refined seed oils could you have a scenario

Where the primaries are relatively normal but then the secondaries are enough that it can cause insulin resistance or would some of the primaries have to be occurring that’s a great question um i i don’t think you could cause insulin resistance with just seed oil i don’t because as much as linoleic acid is going to provoke promote a fat cell to grow through

Hypertrophy you would still have to have some signal to tell the fat cell to grow with something like insulin for example so so you’d have to yeah you’d have to because the fat cell linoleic acid alone is not going to force the fat cell to grow a fat cell can only grow if it has a growth signal in the form of insulin so i think you’d have to kind of combine those

Where you’d have elevated insulin now even in a in a body you could have elevated insulin it would be promoting fat growth either through hypertrophy or hyperplasia and hyperplasia is a healthy way to get fat paradoxically where each fat cell stays quite modest but you just have more of them anyway it’s a long-winded way of saying i i don’t believe linoleic acid

Alone is sufficient to cause insulin resistance there would have to be some other stimulus promoting the growth of the fat cell like the elevated insulin or cortisol which also can induce fat cell growth in certain parts of the body okay so then what if i’m hearing you correctly it seems like factors like stress and inflammation in the body and just you know

Lifestyle has a bigger role on insulin resistance um than maybe some of the dietary intake oil just specific to maybe linoleic acid those are more almost more important because let’s say your diet is clean likely you’re eating meat based and you’re maybe having some veggie veggies occasionally but you know mostly whole foods but if your insulin is still high

Or you have some bit of inflammation maybe sometimes it can be the stress is that like something lifestyle related can that be oh yeah okay yeah yeah for sure yeah so like with stress um something as simple as a bad night of sleep which i know very well with little kids um it’s if someone sleeps poorly one night they will have demonstrable detectable insulin

Resistance the next day that is something that can be quantified in in a lab and it is entirely a result of the elevated cortisol because of the bad sleep now thankfully that very kind of rapid onset insulin resistance can be corrected by just one good night of sleep but you can imagine all of these variables coming into play in the average person where the

Average individual has terrible sleep habits they have terrible dietary habits where they’re eating refined starches and sugars every two or three hours their insulin is elevated all the time and they may or may not be exposing themselves to foods or chemicals that are aggravating their immune system and thus increasing inflammatory proteins and to top it all

Off in addition to those primary causes they’re eating their carbs from bags and boxes with barcodes which means that the fats in them will always be seed oil that’s high linoleic acid so it is just an absolute perfect storm of variables that are coming into play to create insulin resistance and i think it’s important for me to emphasize that as much as i’m

Talking about stress inflammation insulin and even linoleic acid is all distinct in their ability to induce insulin resistance in our environment you simply have all of them yeah and so trying to tease them out or rank order them which one’s worse i can’t do that i don’t know of any studies that have attempted to you know say which one is worse than the others

And i would almost say it doesn’t matter we have all of them

Transcribed from video
What Really Causes Insulin Resistance? Carbs? PUFAs? – Dr. Ben Bikman By Nutrition with Judy