There’s no question that the entire world is suffering from related twin epidemics of diabetes and obesity, but there is still much debate over the cause of these issues. Dr. Benjamin Bikman, a professor of Physiology & Developmental Biology at BYU, has looked deeply into the roots of chronic disease. The newly-published Why We Get Sick is his answer.
According to the good professor, diabetes and obesity are only two of a bewildering number of chronic diseases that all stem from the common condition of insulin resistance, a “hidden epidemic” that is at the root of so many of our modern health woes. Insulin resistance is implicated a shocking number of conditions that would seem to be unrelated, from cancer, heart disease and Alzheimer’s to sexual dysfunction, blotchy skin and hearing loss.
Drawing both on Dr. Bikman’s own research and the latest medical literature, Why We Get Sick analyzes what insulin resistance really is, what causes it, and what to do about it (hint: cut the carbs!). The book is both a definitive explanation of the pathogenesis and mechanisms of insulin resistance and a practical manual for improving one’s own health.
We loved the book, and when we asked Dr. Bikman if we could ask him a few questions about his work, we were lucky enough for him to say yes.
It seems to me that perhaps the central problem in the hidden insulin resistance epidemic is the fact that insulin resistance is comparatively difficult to measure. Do you think this will change? Should insulin or insulin resistance measurement ever become part of the standard check-up? Will it?
Yes, I am optimistic that not only will more clinicians start focusing on insulin and deliberately measuring it in the context of insulin resistance, but I also think that we will soon have at-home insulin tests that people can use to monitor their own insulin levels.
I write and read a lot about insulin resistance, but even I was surprised by some of the connections you uncovered in the book. For instance, I didn’t know that insulin resistance may cause kidney stones, migraine headaches and hearing loss. What was the most surprising connection to you?
In fact, the hearing loss (e.g., tinnitus) was the most surprising. I hadn’t even considered that to be a related problem until I was nearly done with the book. I had a conversation with a friend who was struggling with insulin resistance and poor metabolic health and he mentioned his tinnitus and how it seemed to improve as he was changing his lifestyle. That really intrigued me and when I learned of the connection, I wanted to mention it in my book.
Though we’re still learning about how insulin resistance and tinnitus are connected, some of the problem appears to be the high metabolic need of the certain cells in the ear involved in hearing. These cells, due to their high metabolic rate, need a lot of energy and much of this energy will normally come from glucose. However, in insulin resistance, the ability of these cells to get enough glucose for energy breaks down, resulting in cells that don’t work as well, and, by extension, compromised hearing.
It seems like the connections between insulin resistance and heart disease are beyond dispute. Why is this link generally unknown?
I agree—the connection is very strong. I suspect the connection is under appreciated simply because insulin resistance is so rarely explicitly measured. Moreover, the average clinician, while overlooking insulin itself, is waiting for glucose levels to change. Where insulin resistance is the “in-between” with his insulin and normal glucose, it simply goes undetected.
You write about some less-discussed modern triggers of insulin resistance, such as air pollution, petrochemicals and pesticides. Do you have an idea how culpable these factors are in the obesity epidemic (as opposed to lifestyle factors)?
I consider these as “micro causes”—these are the minor contributors that I suspect on their own would not be a sufficient trigger for metabolic disruption, including obesity. However, if you combine these in an environment of poor diet (i.e., high carbohydrate, high refined oils), I believe it would accelerate and magnify the problem.
I was surprised by the mention of one study that showed that participants on an 800-calorie diet lost a ton of weight, but the diet actually resulted in insulin resistance. How does that fit in with our understanding of the condition?
Yes, there is some “tricky” data out there with regards to low-calorie diets and I can only speculate on the unexpected findings. I think that if someone adheres to a very low calorie diet for an extended period, it begins to mimic starvation. Over time, this state is typified by an increase in hormones that directly work against insulin, such as the stress hormone cortisol.
Most of our readers have diabetes, and many have already discovered low-carb diets. What advice would you give to those that are already eating to reduce insulin resistance but want to go the extra mile?
I do consider controlling carbohydrates as the first and essential step to improving insulin resistance—this alone will elicit a meaningful improvement. After this, intermittent fasting or time-restricted eating is likely to yield the most substantial benefits. A person who’s been on a low-carbohydrate diet would likely be well served by “graduating” to, perhaps, an 18:6 fasting regimen.
You note that statins have been shown to cause insulin resistance. The American Diabetes Association is very aggressive in recommending that most people with diabetes should start statin therapy. What’s your opinion?
My opinion on statins is…complicated. I do think they’re over-prescribed with little regard for the very real side effects. If a person has no evidence of coronary artery plaque (as determined via coronary artery calcium score), I think a clinician should be very reluctant to prescribe a statin to a patient, and all the more reluctant if the patient is female. Women appear to be more sensitive to the diabetes-inducing side effects of statins.
As we know, COVID-19 seems to hit people with metabolic dysfunctions very hard. Has the pandemic changed your thoughts about the relevance of your message?
Indeed! The evidence on COVID-19 patients has introduced a completely unexpected angle to the relevance of insulin resistance. Considering that obesity, hypertension, and diabetes are both the three most common pre-existing conditions of interest with COVID-19, as well as indicators of insulin resistance, I feel strongly that in addition to conventional measures to control the disease (e.g., social distancing), we should scrutinize “metabolic measures” as well.