GLP-1 Microdosing & Metabolic Health with Dr. Ben Bikman

# https://www.youtube.com/watch/vM78Mb_VNcU

00:00:00.000 No text
00:00:00.080 So to me, the best use of this self-discipline in a syringe is to look
00:00:05.200 at it as a temporary enhancement to overcome addictions rather than this is your new normal and you’re going to be
00:00:11.280 drugged for life. What if we’re using GLP-1 medications all wrong? Look, the
00:00:16.800 GLP-1 medications, WGO, Mjaro, Ompic, they are revolutionizing the medical
00:00:22.960 profession of weight loss, right? Like the medical weight loss is beyond anything we’ve ever seen. But what if
00:00:28.560 we’re using them incorrectly? What if to get optimal metabolic health and long-term safety and long-term weight
00:00:35.360 loss, there was a better way to use them? I’m joined today by Dr. Ben Bickman, who’s a professor and
00:00:41.200 researcher at BYU, and he specializes in insulin and metabolic health. And he has
00:00:46.640 a really interesting theory about using these medications as micro doses to help
00:00:51.680 curb cravings for carbohydrates, which will then allow a transition to a
00:00:57.039 healthy low carb diet to allow for longer term success with weight loss, but more importantly, improved metabolic
00:01:04.159 health with very low risk for any side effects and lower cost. Sounds intriguing. Let’s get into the details
00:01:10.720 with Professor Ben Bickman. Well, Ben, welcome back to Metabolic Mind. It’s great to see you again. Yeah. Hey Brad,
00:01:16.400 glad to connect with you. Yeah, I enjoy every opportunity to sit down and chat with you. We had a great
00:01:21.439 interview a while back here on Metabolic Mind, which I I highly recommend people check out. Um, but I reached out to you
00:01:28.000 to circle back and and and talk to you again because of this really interesting article you wrote, this this oped about
00:01:34.400 the use of GLP1’s um sort of micro doing to address cravings. So I want to get into all that
00:01:40.000 No text
00:01:40.079 but before we get into the details tell us a little bit about you know what got you interested in metabolic health to
00:01:46.079 begin with and maybe how that led you to think about GLP1s and so forth. Yeah my journey in towards the well to
00:01:53.840 the point I’m at now all of which of course always a means to an end as a young married guy thinking about how to
00:02:00.719 provide for a future family. uh I I during my master’s degree in exercise
00:02:06.560 science or exercise physiology which really had me thinking that I would have a career devoted to muscle tissue and
00:02:13.440 muscle metabolism but in the course of that thesis work I stumbled on a paper
00:02:18.720 that had just recently been published and this is 25 years agoish at this
00:02:24.239 point and the paper documented a phenomenon that was an absolute
00:02:29.440 revelation to me which is that the fat cells can aggressively secrete
00:02:34.560 pro-inflammatory hormones, which in and of itself was fascinating. The fact that
00:02:40.480 the fat cell was an active endocrine organ. I had no idea of that at the time. I’d never learned that. But during
00:02:46.480 the course then of my dissertation, which was my dissertation work with a
00:02:51.680 man named Lionus Dome, my work was looking at the degree to which inflammation contributes to insulin
00:02:57.760 resistance. And in fact, Lionus at the time, my mentor whom I love and rever to
00:03:03.519 this day, he uh had one of the first grants funded by Johnson and Johnson to
00:03:09.519 look at the effects of these incrretins. And all of the conversation around these gut derived hormones with GLP-1 then and
00:03:16.560 even now still being the most famous was focused on its role as an anti-diabetic.
00:03:20.000 No text
00:03:22.480 But there was this side effect. There was this known phenomenon that people on these drugs tended to just eat a little
00:03:28.480 less and would thus lose a little weight. And that became, of course, the fervor that we find the world enraptured
00:03:35.280 with now, which is this idea that the drugs are weight loss drugs. So, I’ve had my finger on the pulse of these
00:03:41.599 drugs for over 20 years now, but I never could have predicted. In fact, indeed,
00:03:48.720 Brett, if I had, I would have made some more prudent investments to secure my family’s financial future. I never could
00:03:54.799 have imagined the the obsession that has come to surround what was what had long
00:04:01.280 been known as just a pretty effective anti-diabetic. Yeah. I think it’s so interesting to go back in your history and and and the the
00:04:09.280 concept of fat being an endocrine organ and actually being able to secrete pro-inflammatory marker or
00:04:15.599 pro-inflammatory hormones and chemicals and and you’re right that’s not how we’re we’re taught in medical school or
00:04:21.918 or undergrad or you know fat is just something that is stored calories basically excess energy right you don’t
00:04:28.479 it’s not thought of so much as being active um and really interesting concept about you know GLP1s have been on the
00:04:34.479 radar our screen for a long time, haven’t they? We think they’re like a brand new drug, but it’s a brand new
00:04:40.080 formulation and a brand new use. And um there was actually a podcast I heard uh
00:04:45.520 not too long ago about the GLP1s about sort of the history of their development and how it was almost scrapped, like
00:04:51.919 they couldn’t quite get it for a long enough half-life and a high enough dose and like it sounded like it was so close
00:04:57.360 to being scrapped, but then of course turns into the blockbuster medication that it is and and a very effective one.
00:05:03.520 Like we have to be be honest like people are losing more weight on these medications than they’ve lost on any
00:05:10.000 medication in the past. Now the question I would even argue that’s that’s all
00:05:15.280 absolutely amen. They’re very effective. In fact that’s really why I think we
00:05:20.479 need a little bit of a nuanced view. They’re they’re too effective. Right. Right. So let’s talk about that.
00:05:26.000 No text
00:05:26.800 So I was just so the fact that you can say people are losing more weight on these drugs than and any other drug in
00:05:33.600 the history most people would take that as a positive thing I was going to say you don’t necessarily see that as as an
00:05:39.120 overwhelming positive statement. So so help us clarify that. Yeah. Yeah. So my a lot of my view on
00:05:45.440 the the current use of these drugs is is that they are they are a little too much
00:05:50.880 of a good thing. So with with the use of the drug, we need to appreciate what
00:05:55.919 GLP-1 does. And GLP-1 has myriad effects throughout the body. Yes, on the alpha
00:06:01.600 cells of the pancreas, regulating glucagon. Yes, receptors on the
00:06:06.639 intestine regulating the movement of the smooth muscle or in other words, the rate at which food is moving through the
00:06:12.720 gut. But also too, there are effects at the at the hypothalamus in the brain
00:06:18.240 which influence satiety and hunger. In fact, reducing hunger, promoting a sense of satiety. And when you combine that
00:06:25.360 central brain effect of promoting a sense of fullness with the slower
00:06:31.759 movement of food through the intestines, that is a dynamite combination of helping someone just want to eat less.
00:06:38.479 Now, it is a little too much of a good thing where you are starting to get there are
00:06:46.160 enough consequences that have been revealed in the published literature that I’ve I’ve tried to be a voice of of
00:06:52.319 caution, but I I somewhat regret that some people have have assumed that I am
00:06:57.840 just universally opposed. I’m actually not universally opposed. I just think
00:07:02.960 that I am opposed to how they’re currently used, which is that the dose is too high and that they are used they
00:07:10.560 are prescribed with the language being this is a weight loss drug. When when I
00:07:16.479 actually think we we we don’t do the patient any good uh when we describe it
00:07:21.759 as a weight loss drug because we ought to be helping using it in a in a way to
00:07:27.840 improve habits. Now, before I even mention the habit part of it and and my ideal use of the drug, if if used at
00:07:34.880 all, I I I just want to mention that there are consequences to the currently prescribed use of these drugs, including
00:07:42.160 a significantly elevated risk of blindness that just came out within the last month. a two-fold increased risk of
00:07:48.479 blindness. And the consequences on on overall body mass where at a two-year
00:07:54.400 trial found that of the total weight lost, roughly 40% was coming from
00:08:00.960 fat-ree mass. Now, that doesn’t mean it’s all muscle and bone, but it certainly means some of it is muscle and
00:08:07.440 bone. That is sobering in light of the fact that over 70% of patients in the
00:08:13.120 United States get off the drug at two years for whatever reason, cost or
00:08:19.120 access or they get tired of feeling a little nauseous, which is how a person feels when the stomach slows down as
00:08:25.520 much as it does. And what do they gain back? Well, the human body will readily gain back fat, but depending on the age
00:08:32.719 and even the sex of the individual, they may never gain back that muscle and bone mass. even as modest as it was, that’s
00:08:39.599 gone probably for good. And one last nail in the coffin I would say is with
00:08:46.720 with regards to why I’m opposed to these drugs as they’re currently used. It’s
00:08:52.160 the the effect on emotional well-being where we often
00:08:58.800 uh hype up the effect of the food noise where the person’s cravings are gone for
00:09:06.399 for junk food for various foods. And we’ll revisit that in a moment. But what if the reality is that their cravings
00:09:13.760 for many things they used to enjoy are gone? And and what I mean by that is
00:09:18.959 there is an over about a 200% increased risk of major depression in these
00:09:25.279 individuals on the drug versus placebo as well as an over 100% increased risk
00:09:30.320 of anxiety and even suicidal behaviors. So, one way of perhaps more honestly
00:09:37.279 describing the reduced cravings for food they shouldn’t be eating may be to say that you just aren’t going to like
00:09:44.080 anything as much as you used to like. In other words, you have a fel you have a dude who is less interested in getting
00:09:50.800 together with his guys his friends to go bowling or you have a gal who’s less
00:09:55.839 interested in going for a walk around the block with her with her girlfriends from her neighborhood or something. And
00:10:01.839 and so you have people who just may be less interested in all of the things that used to find them to to bring them
00:10:07.200 joy and this may be the reality that explains the significant effect on mood
00:10:14.640 disorders. So that’s why those are some of my main concerns that really I think
00:10:20.800 justify some heavy caution with the current use of the drugs. Yeah, it’s a very interesting point
00:10:26.000 about just less interest in in everything and not just food. I hadn’t seen so much about that. So, it’s very
00:10:32.480 interesting to hear about and and we’ve done content here about the the psychiatric potential impacts with with
00:10:38.240 some studies showing no worsening. Um, but all those studies exclude anybody
00:10:44.160 with any kind of a psychiatric history and those that don’t sort of the real world evidence suggests something
00:10:49.600 completely different that there could be an increased risk for those who are predisposed um to depression or
00:10:54.880 suicidality or whatever the case may be. So, that’s really interesting. But just to to go back to the the muscle loss or
00:10:55.000 No text
00:11:00.480 the the um lean body mass loss, um you know, it sort of highlights that weight
00:11:06.720 loss isn’t necessarily the goal, but improved metabolic health is the goal.
00:11:11.760 And losing fat and gaining muscle is a perfect combination for improving metabolic health, but losing fat and
00:11:18.000 muscle can still improve metabolic health, as these studies have shown. But makes me wonder about the long-term
00:11:24.560 consequences of that with with decreased muscle mass. And then to throw on top of that though, some people are saying,
00:11:30.959 well, it’s the same thing with weight loss surgery. It’s the same thing with severe caloric restriction. You see the
00:11:37.680 same percentage of lean mass loss, so that makes it okay. So I want to get your impression on those two things,
00:11:43.360 both, you know, justifying it that way and also the impact on long-term metabolic health. Yeah. So I I do think it is appropriate
00:11:50.399 to compare the use of the GLP-1 drugs to other very often relied on weight loss
00:11:57.440 interventions like gastric bypass and the um the other one you mentioned it
00:12:03.279 was gastric bypass severe caloric restriction very very low calorie diet. Yeah, yeah, that actually the reason I mention that
00:12:08.880 is just from the scientific perspective which is that it helps us understand how a person is losing this weight even this
00:12:16.480 good weight if you will the lean mass potentially on the drug because it does suggest that it’s not a direct effect of
00:12:22.399 the drug itself but rather an artifact of the fact that they’re just not really
00:12:27.440 eating uh as much as they were before and even maybe what they are eating is being very poorly absorbed. uh that
00:12:34.320 that’s certainly part of the consequence of so significantly slowing the rate at
00:12:39.440 which food is moving through the intestine. And so just that that’s an interesting just point for people to
00:12:44.800 take away from how you phrased the question which is that it does at least bring some comfort to the fact that it’s
00:12:50.639 not a direct effect of the drug for example or in other words it doesn’t mean the semiglutide is somehow directly
00:12:57.120 damaging muscle tissue but again it’s rather just a feature of the overall metabolic millu someone of someone who
00:13:03.600 is perhaps poorly nourishing your body. Yeah, but further it’s not like it’s not
00:13:10.079 like those interventions severely uh severely restricting calories and undergoing gastric bypass don’t have a
00:13:17.279 rebound themselves that we know that the people who attempt to lose weight just through calorie restriction alone with
00:13:24.000 that being the the intention. Uh that’s also the intention that is the mechanism
00:13:29.040 whereby people lose weight on the Biggest Loser game show. And there’s a reason you never see these people again
00:13:35.040 because once they’re off the air, they can’t continue this starvation induced
00:13:40.240 model and then hunger always wins. Moreover, even the rate at which people regain weight with gastric bypass is
00:13:46.959 quite sobering and where they can the they can they can start to out eat the physical restrictions of the gut. what
00:13:54.000 was once a very um small little stomach because of the surgical restriction of
00:14:00.160 it. The the intestines have this remarkable ability to be somewhat dynamic and or plastic if you will and
00:14:06.079 then they can start to stretch out again with repeated stretching and before the person knows they’re back to eating how
00:14:11.920 they were before. With the use of the drug, it’s actually even simpler than that which is that this phenomenon of
00:14:19.920 diminishing returns where you have too much of a signal. In fact, there is evidence to suggest this, although it’s
00:14:25.839 in animals, that with repeated GLP-1 activation, the signal starts to decay.
00:14:31.360 In other words, too much of a signal will result in a resistance to the signal, which is a fundamental principle
00:14:37.440 of biology. Whether it’s cancer biology and chemotherapeutics, whether it’s antibiotics to treat infections and even
00:14:44.720 hormones, too much of a signal will result in the decay or the loss of that
00:14:50.000 signal over time. I mean, GLP1 would be no exception to this. So, we see the diminishing returns of the drug, which
00:14:56.480 is one of the reasons why I would imagine people are getting off it at such a high rate because it just has it
00:15:03.199 stops working like it used to, right? If you’re still getting the side effects and the and the bill to have to
00:15:08.240 pay for it, but not seeing the benefits, why would you continue it? Yeah. Well, so so obviously here at Metabolic Mind,
00:15:10.000 No text
00:15:14.160 we focus on metabolic health and mental health. And the reason why I like to talk so much about these medications is
00:15:20.320 because they do have an impact on metabolic health, but also that as you mentioned, they have direct brain
00:15:26.800 effects. And part of that could be for cravings. Like we know a big part of overeating uh leading to obesity and
00:15:33.760 type two diabetes and poor metabolic health is cravings. Is is just you could say the brain going haywire so to speak.
00:15:40.880 And it’s not necessarily willpower. or it’s not necessarily just, you know, white knuckle it, but your brain is
00:15:46.560 almost being hijacked. So, a lot of what you wrote in this article of maybe a new way to use these GOP ones focused on
00:15:53.920 craving. So, tell us about about that, how how you got into that. Yeah. Yeah, it was a paper. So, I need
00:16:00.000 to give some credit to Arie Astrop uh who is in Denmark and he he has been
00:16:07.040 really at the forefront of GLP-1 research maybe since its inception. I
00:16:12.160 was at an event with him and he had mentioned uh a compelling
00:16:17.440 perspective which now in hindsight seems obvious but it’s not one that I’d considered which is that he had said
00:16:24.079 what if some people just don’t have a sufficient GLP-1 response to food and
00:16:29.360 that’s what’s driving the obesity and that it was an off-hand comment and and I’m sure for him it wasn’t and he was
00:16:35.440 thinking of a dozen studies that that he could readily site although none of which would have been familiar to me
00:16:40.560 because it was such a novel view for me. But to say all this another way, there was a paper published in the journal Gut
00:16:47.199 by Ranganoth at all. And anyone could look this up. It is fascinating what they did in 1996, which Brett was a
00:16:54.480 wonderful year to graduate from high school, class of 96. Um, but also also a
00:16:59.759 fascinating year to make us a seinal discovery in the relevance potentially
00:17:04.959 of GLP1 when it comes to obesity and its origins. Neither you nor I are saying
00:17:11.520 that calories don’t matter, but you and I both have a a more nuanced view, not to put words in your mouth, but that
00:17:18.000 there needs to be an endocrine component that allows the fat cell or that enables the fat cell to even store that energy
00:17:24.640 in the first place. And that would be the hormone insulin. And so when you appreciate the necessity of insulin
00:17:30.240 telling the fat cell to store that energy and then the need for sufficient calories to fuel that storage in into
00:17:37.039 the fat cell, it it does leave you with a unique perspective that has you say,
00:17:42.240 okay, well then what will spike insulin the most? And of course that’s going to be dietary carbohydrates. Now to bring all of this back to GLP-1 in this
00:17:49.360 Ranganoth study in the journal gut in 1996, they took people and separated them into two groups. So we imagine two
00:17:56.000 people. Now, I’m oversimplifying, but one is lean, one is obese, and they eat a carbohydrate heavy meal. The lean guy
00:18:04.080 eats that same amount of carbohydrate and is his brain has told him, “You’re done. You don’t need more.” And so, he
00:18:10.240 pushes the plate away. He’s done. He gets up and he leaves. But his buddy, his roommate, his college roommate, eats
00:18:15.760 that same amount of carbohydrate and he does not get the signal telling him to stop. In fact, not only does he not get
00:18:22.720 the stop signal as GLP1 goes down, which it did at around two to three hours, not
00:18:28.720 only did he not stop, he may want more. And now we have this this I think an
00:18:34.799 alternate a different paradigm here when we look at GLP-1 and its potential utility because what if based on that
00:18:42.160 study and others like it rather than saying we’re going to give you this drug for weight loss the individual thinking
00:18:49.120 it is just a magic intervention that they can still eat whatever they want but the drug is going to help them lose
00:18:55.440 weight which is not true. The drug helps the person lose weight as it changes habits. And what is the habit that it
00:19:01.919 perhaps changes the most when it comes to diet? It is controlling carbohydrate
00:19:06.960 consumption or the cravings. Because within the scope of all of the neurobiology research of cravings, there
00:19:13.360 is no evidence that humans crave fat. There is no evidence that they crave protein. There is significant and
00:19:19.520 consistent evidence that they crave carbohydrates. Now, someone would say, well, with fat makes it even better.
00:19:24.640 Yeah, but still carbohydrates are the thing that they crave the most. And we intuitively know this. No one is sitting
00:19:32.320 down and craving a a hard-boiled egg. You know, a perfect balance of fat and
00:19:37.600 protein. We crave carbohydrates. The the saltier and crunchier the better or the
00:19:43.440 sweeter and the gooer, the best of all perhaps, but it’s going to be a carbohydrate. And so, what if our use of
00:19:49.919 the drug in influences the the conversation that the clinician has with the patient? And that’s maybe to sum it
00:19:56.960 all up in in in a crystallized way here. It would be that I would imagine the
00:19:58.000 No text
00:20:02.000 best use of the drug being a clinician who sits down with the patient and and then explain, you know, the patient
00:20:07.760 doesn’t need to be told they’re overweight or unhealthy because of it. They would know intuitively. And it is important that the clinician acknowledge
00:20:14.080 it and not pretend that having too much body fat is benign. But they say,
00:20:20.640 “Hey, you need to learn uh you need to change the way you’re eating.” And this even comes back to an earlier part of
00:20:26.160 our conversation, Brett, where I said, “As much as you and I can both acknowledge that calories matter, that
00:20:31.520 should not be the beginning of the conversation.” I believe, because that leads to hunger and just pure restriction. What we ought to say is,
00:20:38.960 let’s put you on a a program that’s going to help lower your insulin because when you lower insulin, the body will be
00:20:44.640 burning more fat and metabolic rate will go up. Thus, we say don’t worry about
00:20:49.679 your calories, just control your insulin. And to do that most effectively, control your carbohydrates,
00:20:56.159 which is stop getting your carbs from bags and boxes with barcodes. Whole fruits and vegetables. Enjoy them
00:21:02.159 liberally. Eat them. Don’t drink them, but stop getting these refined ultrarocessed carbs. And then the the
00:21:08.320 seed oil crew would also sh nod their heads to that because that’s how we mostly get our seed oils at the same
00:21:13.520 time with in those packages of refined carbs. Right. So that that puts an extra layer
00:21:18.640 on sort of what you were saying about this study though because you know same time we’re saying that they were craving
00:21:24.799 the or that the the GLP-1 did not go up with um the carbs and they were craving
00:21:30.640 carbs. At the same time they’re not craving probably broccoli and beans or lentils, right? They’re craving the more
00:21:37.200 refined carbs and the processing which is actually really interesting because now you know so many people are
00:21:42.960 focusing on the processing itself and it’s the processing and maybe focusing
00:21:48.080 less on the fact that it’s carbohydrate and it effect on insulin. So there does
00:21:53.120 seem to be like a little bit of a balance but it seems like GLP1 might be the equalizer for that. Do you think it
00:21:59.600 because it addresses both? Yeah. Yeah, that’s I think so. I think so, Brett. I in fact that that question
00:22:05.200 sort of allows me to sort of complete that that this whole long ranting thought which is that I think the best
00:22:12.240 use of the drug is when the clinician tells the patient you need to control your carbs. But there will be some
00:22:18.080 people who will say back to the clinician maybe even having after a after having uh attempted this for some
00:22:23.919 time they will say I just can’t do it. I am trying to control my carbs. Then the clinician can with nothing but empathy
00:22:30.799 say, “All right, to some degree or another, you’re addicted. Now, let’s help you with your addiction.” And so,
00:22:37.039 here is a drug at what we could call a micro dose. You know, a fraction of what
00:22:42.159 it’s commonly used at now. And then I’m going to cycle you on this for, I don’t know, 90 days. Um, and and then during
00:22:49.840 this time, we’ll be checking in with you to determine how well you’re doing at controlling your carbohydrate cravings,
00:22:56.400 the thing that humans crave the most when it comes to nutrition. And many people I have known, this is anecdotal,
00:23:03.280 which pains a scientist to invoke. Um, but I’ve known individuals who do a 90-day protocol and when they wean
00:23:10.720 themselves off, they cycle off the drug, the habits have persisted. And and there is something powerful about that 90 days
00:23:17.679 when it comes to changing habits and breaking addictions. Some people will find that they can get off and they’re
00:23:23.280 and they have a new normal. They’ve they’ve m rewired their habits, if you will. Some people will be good, but then
00:23:30.080 they’ll find the cravings starting to come back. Okay, no problem. Cycle them back on. And so overall my view and the
00:23:37.520 perspective that I attempted to articulate in that article which was a good experience for me, a good exercise
00:23:43.120 to actually crystallize these thoughts. It is that that the drugs are very powerful and thus could be effective at
00:23:50.400 a lower dose if framed in the context of this is a drug that’s helping you control your cravings, not framed as a
00:23:57.600 weight loss drug. And then second, presenting the idea that this is a temporary intervention. You’re not on
00:24:04.559 this forever. So, you need to be deliberate about the habits that you’re changing and the decisions you’re making
00:24:09.840 because in 90 days, I’m going to want to start to cycle you off this to see how well the habits have become a new normal
00:24:14.000 No text
00:24:16.640 for you. So, to me, the best use of this self-discipline in a syringe is to look
00:24:23.279 at it as a temporary enhancement to overcome addictions rather than this is
00:24:28.480 your new normal and you’re going to be drugged for life, right? and not just well here now you’re
00:24:33.840 going to eat less of the standard American diet or now you’re going to eat less of the very high carb diet but
00:24:40.799 rather this is the way to curb your cravings and your addiction so that you can transition to a lower carb lower
00:24:47.200 carb diet which will then impact your insulin and your fat burning and lead you to better metabolic health. And as
00:24:53.760 as you pointed out and and so have I in numerous studies, the weight loss from a ketogenic diet is generally preserving
00:25:01.600 of the lean mass or certainly losing a lot less of the lean mass. So it seems like this is a way to really move
00:25:08.159 towards greater metabolic health. Is that how you see it as well? Yeah. Yeah. Yeah. Right. In fact, that’s
00:25:11.000 No text
00:25:13.679 a great ending there as you said it because earlier you you’d sort of phrase this question of are all weight loss
00:25:20.640 interventions going to result in the same degree of of lean mass loss? And no, if you can be adequately nourishing
00:25:27.520 the body with all of what it needs, vitamins, minerals, etc., and not
00:25:33.120 driving it into an an overt caloric deficit, but yet insulin is low, you are
00:25:40.720 creating an environment that does facilitate uniquely fat loss versus muscle loss. And and so the in fact my
00:25:48.240 lab published a report finding that ketones are actually muscle preserving at as a direct signaling molecule that
00:25:55.919 where beta hydroxybutyrate actually inhibited uh the we gave it the muscles
00:26:01.919 a chemical insult and beta hydroxybutyrate actually made the muscle cells more robust and resistant to
00:26:07.440 injury. So we have evidence right at the level of the cell not to mention the significant commentary of decades of
00:26:14.159 work from Dr. George Cahill who would often refer to ketones as the great muscle preserving molecule that they’re
00:26:20.880 muscle sparing. But yeah, I think it’s not a stretch to then say with a with a ketogenic low carb diet with the
00:26:28.400 intention being I’m just lowering my insulin. I’m not lowering my calories per se. You’re going to find I think
00:26:35.840 yourself in a very superior metabolic environment to promote selectively
00:26:41.120 greater fat loss. Yeah. And I think that’s so important to emphasize that it’s not weight loss, it’s fat loss, especially visceral fat,
00:26:48.159 maintaining lean muscle mass. And you just set it up perfectly for for a way to do that. Fellow mental health
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00:27:15.679 for psychologists and they’re completely free of charge on myc.com. Now, back to the video. Now, you know, a lot of
00:27:20.000 No text
00:27:24.559 studies that involve pharmaceuticals and medications are sponsored and paid for
00:27:29.679 by the pharmaceutical company and that’s why they get done quickly and with, you know, thousands and thousands of people.
00:27:36.960 But for a STE for for what you’re proposing, it probably wouldn’t be to the benefit of the pharmaceutical
00:27:42.559 company because it’s a much lower dose and for a short time as opposed to the current highdose, take it forever, see
00:27:48.640 you later, which obviously benefits the pharmaceutical company. So, do you think labs will start doing research studies
00:27:54.720 on this? They’d have to get NIH funding or or philanthropy funding or whatnot, but do you think more will be doing it?
00:28:00.000 And will your lab be doing it? Yeah. Yeah, good question. So we are currently actually analyzing a data set
00:28:05.279 from a clinic. So I had a clinician reach out to me who has been using
00:28:10.559 lowdose um semiglutide with a combined low carb diet and their results
00:28:16.240 outperform even the reported results of just semiglutide alone. And and again
00:28:21.760 what the patient finds so enjoyable is the fact that they’re not expected to be
00:28:27.360 on the drug indefinitely. I I think that is I think that’s common as as much as
00:28:32.720 we have a culture particularly in the US where people are able to see advertisements for drugs so much more
00:28:38.559 readily than almost any other in any other country on the planet. We we certainly have a more drug friendly
00:28:44.240 culture um in in in clinical care where the patient comes in asking for a drug
00:28:49.840 which is very odd in the rest of the world because they’ve seen an ad but even then I don’t think a person would
00:28:56.880 want to be on the drug indefinitely. So this all comes back to what I mentioned earlier that I think a lot of the value
00:29:02.720 in this alternative paradigm of the use of the drug namely micro doing and cycling is that it changes the the
00:29:11.120 purpose of the drug that the person is looking at it as you are a temporary tool you little syringe to help me learn
00:29:18.480 to change my habits but that still requires some effort on their part. It’s not it’s not depriving them of the
00:29:25.200 benefit of learning that self-discipline which I think is one of the points of life in a kind of grander sense. Um
00:29:31.679 which is to just there’s you know to to me telling my body hey you fleshy
00:29:37.200 tabernacle of of clay. You’re not in charge. I am the part of me that is beyond this this fleshy body. And I
00:29:44.799 don’t like and I think it’s human nature. We don’t like feeling addicted to things. We don’t like feeling dependent on things, even if it is the
00:29:51.840 intervention that’s helping us curb the addiction. We would like to get over both of them. We want to stop using the
00:29:58.480 intervention because we’ve learned to control our addictions. Yeah. Yeah. I think that’s really well said. And I think the way you’re
00:30:05.279 proposing it is is almost like a I don’t know, like a no-brainer. Like why not? Why wouldn’t you try this first, right?
00:30:12.559 Rather than giving somebody a a large dose of a medication that has serious
00:30:18.240 potential side effects and can likely sort of commit them to lifelong use, why
00:30:23.279 wouldn’t you try a lower dose, safer, shorter term to see if it helps kickstart their their own sort of
00:30:30.799 lifestyle changes? And and I’m going to answer my own question here because I think part of that is
00:30:37.360 doctors have sort of become jaded. They’re like, “Ah, diet doesn’t work.” you know, lifestyle interventions don’t
00:30:42.720 work because what they’ve been taught and tried for so long, the eat less, move more, low fat. Yeah. It hasn’t
00:30:49.440 worked for 50 years. Um, so they get sort of jaded. But, but so that’s the other part that’s really important to
00:30:55.200 emphasize of what you’re saying is it’s as a transition to reducing the carbohydrates. So, so yeah, why wouldn’t
00:31:02.159 they do that? I think people should do it more. Well, and I think it’s a combination, you would know, of course, having gone
00:31:07.600 through uh medical training. I think it’s a combination of the the fatigue that a physician may experience, the
00:31:14.080 fact that they can’t bill that time. You get paid for what you can bill, and talking about nutrition might not be
00:31:19.360 something a clinician, a physician is able to get compensated for. So, I really I appreciate that, but at the
00:31:25.919 same time, they might not have even learned anything other than eat less, exercise more. If that if that
00:31:33.440 simplistic mantra worked, we would have solved the obesity problem before it ever started. because we’ve been saying
00:31:38.880 that for 60 years. Obviously, a weight loss strategy that is based on just
00:31:44.080 straight calorie deprivation and restriction and the the the sort of mistaken view of the laws of
00:31:50.000 thermodynamics in a biological system. It does not it does not lead to an
00:31:56.240 actual successful intervention. Well, I I appreciate you coming on and giving us this insight and I think it’s a very
00:32:03.200 interesting thought and and I hope some clinicians will embrace it and try it because it does seem like a much safer
00:32:09.919 and potentially longer term effective solution. Um, so if people want to hear
00:32:12.000 No text
00:32:15.200 more about you, learn about all the work you’re doing, where where can we direct them to go? Yeah. Yeah. Thanks again, Brett. This was great. Yeah. I have two efforts that
00:32:21.919 I really try to stay a high degree of involvement with. One is my education arm which is a professor just thrills
00:32:28.000 me. I like teaching as many people as I can but people people can find me there at benbickman.com
00:32:33.200 and Bickman is just b i km-n benbickman.com and then I’ve also helped put together a coaching effort to help
00:32:39.840 people get through these very kinds of things that we’ve been talking about and that’s people can find that at insuliniq.com.
00:32:45.760 Great. All right. Well, thank you so much Ben. I really appreciate it. Yeah, my pleasure. Thanks, Brett.