[Dr. Benjamin Bickman]: One of the problems with weight loss goals is saying you need to cut calories in order to get there. Now, I'm not saying calories don't matter. They are relevant, but not the most relevant. And I'm going to talk about evidence to support that.

[Host]: If someone is listening at home now and they have the goal of losing some weight, they want to be in a better physique, be more healthy. Is this conversation going to help them accomplish those goals?

[Dr. Benjamin Bickman]: I'll make sure that they get what they need.

[Host]: Dr. Benjamin Bickman is one of the world's leading metabolic and fat cell scientists. And now he's returned to expose some of the myths surrounding weight loss and the surprising impact that one particular hormone has on our weight, brain, and mental health.

[Dr. Benjamin Bickman]: As a metabolic scientist, I wouldn't want someone to think there is only one way to lose weight. However, I think this is the most practical and simplest strategy, a ketogenic diet. A huge reason is that when you cut carbs, insulin comes down. And insulin as a hormone is the one metabolic hormone to rule them all. Insulin will tell every single cell of the body what it needs to do with energy. And insulin is so determined to store energy that it is directing calories to be stored in tissues like fat or in the liver to make you fat.

[Dr. Benjamin Bickman]: Yeah. But there's more. Ketones are the brain's preferred fuel. It can control anxiety, improve depression. It can help with attention. In fact, the benefits of ketones are so extensive that companies are finding ways so you can drink ketones.

[Host]: And I have a bunch of different exogenous ketone products here, a variety of different brands and a bunch of other things here on the table. So, what the hell is this?

[Dr. Benjamin Bickman]: If someone is interested in a good, smart way of losing weight, try that.

[Host]: This is definitely a prop. It tastes like bleach.

[Dr. Benjamin Bickman]: I'm so sorry. Oh my god.

[Host]: So, for 2026 to be the year where I finally get a grip of my health, and I asked you to make the perfect plan, what would you prescribe?

[Dr. Benjamin Bickman]: So, first of all, I see messages all the time in the comments section that some of you didn't realize you didn't subscribe. So, if you could do me a favor and double check if you're a subscriber to this channel, that would be tremendously appreciated. It's the simple, it's the free thing that anybody that watches this show frequently can do to help us here to keep everything going in this show in the trajectory it's on. So, please do double check if you've subscribed and uh thank you so much because in a strange way, you are you're part of our history and you're on this journey with us and I appreciate you for that.

[Host]: Dr. Benjamin Bickman, at this time of year, the audience that are listening right now are thinking a lot about health and dietary changes that they can make to make 2026 the best year of their life to finally be able to kick that habit. And one of the things that's front of mind, I think, for all of my listeners is their relationship with sugar, with carbs, right? And I guess the second order things that some people might know something about like insulin resistance and all these kinds of subjects. At this particular moment in the year, if you had the ear of millions of people as they're coming into 2026, what is the most important thing that you would say to them?

[Dr. Benjamin Bickman]: Yeah, that's a great question. Within North America, you see a pattern, a rhythm to both weight gain and even insulin resistance as it is quantified throughout the year where in the winter months people gain more weight and are more insulin resistant. Almost like the hibernating bear, which becomes demonstrably more insulin resistant as it gets into hibernation. We non-hibernating mammals actually see an echo of the same thing, albeit more subtly. So, it matters now where physiologically we're more inclined to suffer from the consequences of bad dietary decisions. And of course, with all the holidays, we're more likely to be making those bad dietary decisions. So, my advice would be to structure your indulgences as smartly as you can. you know that you're going to be faced with foods that are delicious and dare I say addictive. Don't rely on your own intuition uh to guide you through eating that know that your temptation to indulge is going to be in some instances perhaps greater than you can control. So, structure your indulgences. Give yourself a distinct period of time where you know you're going to embib in these refined starches and sugars. And then, if necessary, recruit help. Have a family member, have a loved one join you in your plan, and you tell them, "I don't want to gain the same weight I gained last year. I don't want to amplify the consequences of insulin resistance like I did last year. Can you please be my my watchman and help me keep track where today is my day of indulgence or two days and then on that Monday remind me please be my helper um to get back on track. Among the many problems with the modern diet is the constant carbohydrate consumption. It is the one macronutrient that we have the hardest time controlling and I would say it's the one macronutrient that has the most disastrous consequences in the form in which we consume it. Now, of course, carbohydrates is a broad class of food. Some are just fine and some are not. Of course, we more focus on the ones that are not fine. So, my advice would be structure your indulgences, be mindful of what you're doing in that you are not doing yourselves any favor. uh and then recruit outside help because you will not be able to rely on your own intuition to pull you out of what might become the sort of carbind induced coma.

[Host]: Um I did ask thousands of the listeners what dietary changes they had planned for 2026 and what they cared about most. Funnily keto came up number one then cutting sugar then weight loss then fasting more protein whole foods low carb and calorie control. So this is going to be a bit of a road map for me.

[Dr. Benjamin Bickman]: I'm thrilled to hear that order. Like when you put out the histogram and you're looking at the most common responses, the fact that calorie number was at the bottom actually kind of thrills me because this reflects that the tide is turning that over the past decades, 60 plus years, the singular piece of advice when it came to weight loss and metabolic health was eat less, exercise more, which is a purely thermodynamic or a a calorie centric paradigm. just stating nothing else matters other than the energy you're putting in and the energy you're putting out. We can't possibly account for all of the energy in the complexity of the human body. You can have humans eat two meals that are identical in calorie number. So purely isocaloric and there is something called the thermic effect of food. So when we eat right now you and I haven't eaten, we're in a fasted state. Our metabolic rate is say humming along here. If we were to go get lunch and eat something in the hours following just the very act of digesting we have turned up the metabolic engine and metabolic rate would go up a little bit.

[Host]: Metabolic rate meaning

[Dr. Benjamin Bickman]: meaning the total amount of energy the body is is expending. In fact metabolism to I'll come back to this thought in just a second. As a metabolic scientist people don't even understand the word metabolism. Metabolism is underwhelmingly perhaps nothing more but nothing less than the sum of every chemical reaction happening in our bodies. It's just everything that is keeping us alive, that is keeping our neurons firing, my my my muscles moving as I'm animating on the my hands. Everything we're doing is metabolism. And so after we eat, metabolism goes up a little bit. Again, that's called the thermic effect of food. And if you give people two isocaloric meals, so exact same number of calories. That's what isocaloric means. same amount of protein and yet the they differ in their composition of macronutrients with fats and and carbs. So the meal that is lower carb and higher fat, those individuals will have a much higher metabolic rate for hours afterwards than the group that is eating the high carb, low-fat version of that same caloric meal. And that's because insulin insulin as a hormone is the one metabolic hormone to rule them all. It will determine what the body does with energy at every single cell. This is a principle even many very educated clinicians don't understand. They think that insulin only controls blood glucose. That's just the most obvious thing that it does because we can prick a finger and measure it or slap something on our arm and measure the glucose. Insulin will tell every single cell of the body from brain cells to bone cells, liver cells to lung cells, and everyone in between what it needs to do with energy. And insulin is so determined to store energy that it will slow the metabolic engine of the body down in order to store more. And so all of this is my long- winded way of of saying how thrilled I am that this is an audience that is shrugging off the old ideas of a calorie ccentric model of obesity. Because all of these people, everyone's interested in losing weight or maintaining weight, which I admire. That's a good goal. The size of our fat cells matters tremendously. So that's a good goal to want to shrink our fat cells and be healthier. The fact that they didn't put controlling calories as number one and indeed put it at the end suggests that the word is getting around that more I would say better more sound metabolic science is starting to seep through society where they're more interested in controlling their macronutrients. In other words, their carbs and their fats than they are controlling their calories.

[Host]: My brother called you, didn't he?

[Dr. Benjamin Bickman]: He did. Yeah. What did he say? Yeah, he's darling. Well, we we had some wonderful conversations. Um, he was interested as a dad, a middle-aged dad, in in fact indeed checking a lot of the boxes you just mentioned, which is I want to be a healthy dad. I want to live a long, healthy life. One of the problems with weight loss goals is they look at the goal. They look at the weight where they want to get to. They're looking down the down the road and saying, "This is where I want to get, and so I need to cut calories in order to get there." So there are two there are two variables that come into play when it comes to losing weight. And I've already said said this and I'll state it again just to be clear. It's a matter of shrinking fat cells. That's what happens when someone's losing fat mass. It's not that you're losing fat cells. Indeed, you don't want to. That's a topic for another time. But liposuction is a perfect example where you are losing fat mass and yet no health marker gets better. None. Even though you've lost, you could go in and suck out fat cells and you'd say, "I lost 20 pounds of pure fat. I'm now going to go to my doctor and get my blood test and I'm going to be so much healthier." And yet nothing is different. If they were diabetic, they're just as diabetic. So if someone's looking at their New Year's goals, and when I spoke with your brother, it was an echo of this conversation in a way. I said, "All right, you need to shrink your fat cells." Most people only look at the calorie control. The problem with calorie control is that we've seen what it looks like when you only focus on calorie deprivation. And that is in in a word hunger. And there was this within the US there's been this game show over the years called the greatest loser. These people one lose a fantastic amount of weight and yet you never see them again because they gain it all back. So, if your weight loss strategy is based on cutting calories without addressing insulin, which is the other of the two variables, then you're going to be hungry. Dr. David Lewig at Harvard, a friend and colleague and collaborator, he published a report looking at the same kind of dynamic that I outlined a moment ago, two isocaloric or equal calorie meals. And he found that when they ate the meal that spiked insulin, the what he called I think he called it total energy availability. So they measured every calorie molecule in the blood. So ketones, you know, BHB, they measured uh lactate, they measured fats, they measured glucose, and they found that when with the insulin spiking meal, the total energy availability went down.

[Host]: What does that mean?

[Dr. Benjamin Bickman]: Yeah. So in other words, with the increase in insulin, as I noted a moment ago, insulin is so determined to store energy that it is directing calories to go from the blood to be stored in tissues like fat or in the liver to make you fat. But the problem is the brain doesn't have that storage capacity. You know, you could have big fat cells with lots of energy. You could have a liver with tons of fat and glycogen, which is a stored form of glucose, ready to go, but the brain doesn't have a big storage reservoir, and yet it has a high metabolic rate. And so the brain is constantly relying on the energy in the blood that it can use, especially glucose and ketones, the two primary fuels for the brain. And so when you spike insulin, you lower your glucose and you stop your liver from making ketones. So the two main brain fuels have gone down,

[Host]: which is why you get brain fog.

[Dr. Benjamin Bickman]: It certainly lead to some mild cognitive impairment, but it would also drive hunger. And so another group found that if you ate an isocoric breakfast, one low carb, one high carb, the group that was on the high carb breakfast was much hungrier much sooner.

[Host]: Yeah. Yeah. The way I understand that is because I've had a meal that's high in sugar, let's say, or carbs. insulin has come out, it's grabbed all of the energy from my blood. That I just ate. It's stored it all away. And because my brain is getting its energy from the blood as well, my brain is being energy deprived in some way. And so my brain is going

[Dr. Benjamin Bickman]: within an hour or two, you are hungry. Yes. Even though your fat cells might be bigger than they've ever been. So that's the sort of disconnect that you end up having when you're spiking insulin so frequently, you may have hundreds of thousands or even millions of calories stored on your body in your fat cells primarily. And yet the brain is saying, "I'm hungry." We shouldn't be hungry. We have so much energy that we can use, but only if we can access it. And this is where ketones come in. And I hate to change the topic, but if if a person has fat and they can burn that fat, then they're making ketones. And ketones are the brain's preferred fuel. Let's just state that with an exclamation mark. And so if the brain is getting ketones or even if it has access to plenty of glucose, it senses, hey, there's no energy deprivation. We're fine. We don't need to eat. And that's what these studies find. And so back to the conversation with your brother, rather than focusing on calorie number, focus on the other variable, which is insulin. Because if you decide that you're going to start your fat cell shrinking journey, so with the first step, you could say, well, my first step is going to be cutting calories. But if you haven't addressed your high insulin, which you have to have if you've gained weight, it is impossible.

[Dr. Benjamin Bickman]: In fact, this is worth a tangent for just a moment because I can state this so emphatically. You could have all the hormones in the human body and tens of thousands of calories coming in every day. And if you simply remove one single hormone, it is impossible for that person to get fat. Totally and completely impossible. Now, I am a scientist enough that I like to avoid hyperbolic language. I don't want to state anything in the extreme. And yet, in this case, I actually can. I can revel in all of the um the power of this declaration which is you simply wipe out a person's insulin, it is completely impossible for them to get fat. In fact, this phenomenon is so real and so learned if not already known that you have people with type 1 diabetes. Imagine the temptation. Let's say you're a young woman who faces more pressure than her than her young men counterparts. She just gets diagnosed with type 1 diabetes and she has become used to eating whatever she wants and being very very skinny. That is one of the cardinal signs of type 1 diabetes. The person is just losing weight. In fact, the early the ancients thought that as they were making so much urine because another feature of type 1 diabetes in in an untreated state is they urinate a lot. That's what the word diabetes means. It means polyura or a lot of urine for formation. They thought that their flesh, their fat, their substance was turning into liquid and excreting from their bodies. And so the person, this this imagine this young woman, she's say 13 years old. She is super super skinny, which she likes because there's such a pressure to be skinny and she can also at the same time eat whatever she wants. And then but of course she feels miserable and indeed it will kill her. So, she gets diagnosed with type 1 diabetes and she's put on insulin therapy and two things happen. She starts eating less and getting fat. In fact, they gain people will gain so much weight that if they're in the hospital for a few days, they can't leave the hospital with the same clothes they came in. That's not to say they're leaving and then and they're obese, but they can have easily gained 10 pounds, 15 pounds of fat. So this phenomenon is known and you have people with type 1 diabetes who abuse that fact and will deliberately underdose their insulin. So they can eat whatever they want. They could go to a Thanksgiving or Christmas dinner and indulge in all the sweets and just simply underdose their insulin and be as skinny as they want to be. Now there's disastrous metabolic consequences, but it's just a testament to the power of insulin. So to finally answer the question, my advice when I was speaking with your brother and anyone listening, don't have your first step on your fat cell shrinking journey be low calorie because you will find that in short order, hunger will win. And so you'll be right back where you started. Let your first step be I'm going to lower my insulin because as I lower my insulin, I don't have to worry about hunger first of all. Because if you're just focusing on lowering insulin, you can tell the person, and indeed I am, eat as much protein and fat as you want because they have little to no effect on your insulin. So, anytime you're hungry, eat something with protein and fat. Um, and then if you're not hungry, don't eat. But anytime you're hungry, you don't have to, it's not deprivation. It's not hunger, but the low calorie approach is hunger. You're going to be hungry. So lower your insulin by controlling your carbohydrates and and basically whole fruits and vegetables. Enjoy them. And this is part of the conversation I had with your brother.

[Host]: And he called you and told you that he had had positive results following watching this conversation and following your advice.

[Dr. Benjamin Bickman]: Yeah. I think he said he'd effortlessly lost 15 or so pounds uh just without even really worrying about it because you're not having that gnawing hunger.

[Host]: No, but he looks radically different. I have to say he he's dropped a ton of weight and um looks fantastic.

[Host]: when I look back at the conversation we had the top comment on our previous conversation is someone saying I was morbidly obese 68 days ago. I was 280 lbs and pre-diabetic. In these 68 days I cut out sugar and flour entirely. And I reduced my calories to about 1,800 a day. And I'm pleased to know that my high protein, highfat, low carb diet is the right path and my blood sugar is now normal.

[Dr. Benjamin Bickman]: Yeah. Remarkable. I I don't mean to ever come across as saying that there's only one way to lose weight and that anyone listening who uh is interested in weight loss would say, "Well, gosh, it looks like I have to eat a lot of meat and eggs." And yet, you don't. As much as I am an a defender of that view, uh I wouldn't want someone to think there is only one way to lose weight because we could both think of people who adopted a purely plant-based diet and lost weight. Now, I have some significant concerns with that diet long term, but even still, they could say, "Well, I'm eating 100% carbohydrates essentially, and I've lost weight." I'm not saying calories don't matter. They do. But it also makes it a hard long-term strategy. And so if someone can lower their insulin, I' I'd alluded to a metabolic advantage and I'll just revisit that briefly. I'd mentioned already one of these things, which is when when insulin is down, the metabolic rate goes up. And my lab published a report um finding that part of that is through the production of ketones. That when ketones move through the bloodstream and come to our fat cells, they will increase our metabolic rate in our fat tissue by three times. And we did this in humans. We studied fat cells in a petri dish. We studied fat tissue from animal models. And then we studied fat tissue from humans where we actually were pulling biopsies of belly fat from people that were in ketosis or not. And when they were in ketosis, their metabolic rate in their fat tissue was three times higher than when they weren't than the group that was not in ketosis. So this suggests that there's an advantage here that comes from lowering insulin. So as insulin comes down, the person will find that they're just burning weight more easily. And then one other part of that is when you're making ketones, every ketone has a caloric value roughly similar to that of glucose. And so what happens now in ketosis or when ketones are up, you start wasting those ketones from your body that you're breathing ketones out or you're urinating ketones out. And those are calories that are just coming from your body that would have had to be burned through exercise or stored in fat tissue. And yet in the in a low insulin state, that is so antithetical to fat storage that the body just starts literally wasting energy. So every breath they're taking out when they're breathing out ketones, those are calories just coming out of their body.

[Dr. Benjamin Bickman]: Right. Right. Well, I am I'm a great defender of ketones. I think that they have been one of the more uh misunderstood molecules in the body for decades and it is thrilling for me to see an explosion of research in this realm looking at the effects of of ketones in the body. So a ketone is a molecule that the body will make. Um many tissues can make it but if you're measuring it in your blood it's coming from the liver and ketones are a product of fat burning. So when insulin is low, which it must be for the body to make ketones, that's why it's ketogenesis or the genesis or the creation of ketones, to be in a ketogenic state, you must have low insulin. That's required. Um, when insulin goes down, you have two important things happening. First, starting at the fat cell, then going to the liver. When insulin is down, the fat cell is breaking apart its triglycerides, which is the molecule that the fat cell stores as fat. So that's called lipolysis. Lipolysis, lipid breaking or fat breaking. So you have in a low insulin state, the fat cells breaking down as fats. Now those fats are coming to the liver.

[Host]: So in a low insulin state, you mean if I was fasting

[Dr. Benjamin Bickman]: fasting or low carb? Yeah. Within about 16 hours. So if you and I went to lunch and we ate a typical kind of high carb type lunch, a typical lunch with all kinds of macronutrients in it, our insulin would go up and then if we stopped eating then about 16 or so hours later, we would start making ketones. That's a long enough period of time for fat burning to kind of take over. And so the fat cell is breaking down its fat. That fat is going to the liver right here. In fact, so here we don't have a lot of subcutaneous fat on this guy here, unfortunately. So on the outside in the front of the body or around the middle, we have this fat that we can pinch and jiggle. That's the subcutaneous fat. So it would be surrounding in this model for those watching, it'd be surrounding the organs on the outside. That is fat that the body burns very readily. That fat is running to the liver in very short order. So it goes to the liver and now the liver has some options. The liver is the I say that the liver is the soccer mom of nutrient metabolism. It knows what to do with everything. Whether it's lactate or glucose or fats or ketones, the liver can handle all of them. So, the liver is getting a lot of fat from fat cells. And it has some options. It would say, "Well, I can store this fat or I can burn it." And and how does the liver decide? Insulin tells it what to do. And if insulin is down, the liver cannot store fat. it it has to burn it.

[Dr. Benjamin Bickman]: It will not. In fact, the liver, it is so antithetical to fat storage in the liver that you have human studies where people have significant fatty liver disease confirmed through ultrasound measurements and they can just go on a ketogenic or a low carb diet for just a week and if I recall the study correctly, I think it reduced the liver fat by like 60%. And compared and which was significantly more than the high carb version and so even it was the same calories. Once again, just further evidence that calorie number, as much as I don't calories matter, but just they're not number one. They they're they they're relevant, but not as not the most relevant. So, you the the liver cannot hold on to its fat as insulin comes down. It must burn it. And the liver begins within each liver cell, the liver is burning so much fat that it's actually it's burning more than it needs for its own energy. And it's basically, if you'll allow me to speak a little silly, the liver begins to say, "I'm burning more energy than I need. I wonder how the brain's doing." And the brain won't burn fat. The brain will burn ketones. And so the liver starts creating ketones is as its it's its way of sharing the energy with the brain. So a ketone is, to put it very succinctly, a product of the liver burning a lot of fat. Anytime you're burning a lot of fat, you're going to be making ketones. People have heard of the keto diet. Um, when you talk about the keto diet, there's lots of rebuttals. The the stated concern that they would say it's not feasible. You can say that about any diet. You really can. And I don't mean to um push aside people's concerns, but you could say the same thing about someone going on a low-fat, lowc calorie diet. That's not sustainable, and it never is. They always get off it. And so, anytime a person is making a dietary change to improve their metabolic health, every diet works until you stop doing it. Uh that might be a maxim that people can leave with. Um a ketogenic diet because it's not based on hunger. I think has the potential to work. But we know there are people who've done it their whole lives, right? There are people who from childhood adopt a ketogenic diet in order to control their seizures or their their their epilepsy or people will do it to control their migraines. Because if there's one tissue in the body that thrives in the midst of ketones, it's the brain. you can almost throw a dart at a board that lists all of these chronic brain disorders, whether it's schizophrenia, whether it's bipolar, whether it's depression, whether it is um dementia, like Alzheimer's disease. Every one of those instances, there's evidence to show even things like multiple sclerosis. There's instance evidence to show improvements in humans with a ketogenic diet. the brain and to say that in a different way the central nervous system loves ketones.

[Host]: I'm just um looking at some of the people who watched our last conversation and who have left comments on that conversation and there's this one chap here who I'll throw up on the screen called Shanti. Um he says 35 days of keto for the first time ever started on the 2nd of January 2025. It's now the 8th of February and 8 kg or 17.5 lbs gone. So easy and loving my food choices. I'm having no more than 20 gram of carbs per day. I am amazed. Not felt this good since I was a teenager. Another 15 kg to go and I know I'll get there.

[Dr. Benjamin Bickman]: Well, it does work. But but I don't mean to ever, you know, neither you nor I are going to tell anyone everyone listening this is the only way to lose weight. But I think it is the most practical and simplest because the problem with so many weight loss strategies is that it puts you against your own hunger. And hunger always wins. You have to have a weight loss journey that doesn't have hunger being a constant feature. Because if you're imagining this long walk to shrinking my fat cells to what this guy wanted of almost 35 total pounds, I think is what he's going for. If you're carrying hunger, it's like it's like a bag. It's like luggage that you're dragging along on this journey. The chains that you're dragging that are going to make it almost impossible for you to get there.

[Host]: This sounds almost counterintuitive because when people hear that you're not going to have sugar, they assume that you're therefore going to have loads of cravings for it. Mhm. But the remarkable thing I discovered the first time I went on a low carb/ keto diet is I was walking through this mall in Cape Town where where um I live sometimes and I saw this concession stand for like cinnamon rolls. And I thought to myself like I've not had sugar for, you know, I've not had a high sugar diet now for a couple of weeks. I'll just go look at it and see how I feel. And I walked over and looked down at it at a food I would absolutely love and my mouth would water just thinking about it. I looked down at it and I had the emotional urge to buy one was completely gone. And it's hard to explain.

[Dr. Benjamin Bickman]: Yeah. Yeah. You you were able to just look at it and shrug your shoulders. Well, this is this is one of the things where I think the future of as ketone research in humans continues to evolve. I there is already evidence showing profound you can use a ketogenic diet to help people with eating disorders. This these are there are published case studies on this and I think a part of it is when the brain is so nourished and consistently nourished by ketones the brain reaches this new level of of indifference to what it knows might be harmful and and that's in the midst of that answer I have that's kind of loaded where if you're on a ketogenic diet the beauty is fuel is stable ketones are stable even glucose is stable you're avoiding the massive um volatility of of glucose. And as much as so much of of the glucose centric view is only worried about the high glucose, high glucose is harmful that it can induce the glycation of molecules throughout the body where the glucose is literally binding things and and disrupting their function, proteins, fats. So glucose is harmful, but so too is the volatility of the glucose where it's really high, then it's really low, and then it's really high again. That is a roller coaster of energy for the brain where it's you're force-feeding the brain all this glucose and now you're depriving it. It's like it's like a form of abuse on the brain. But when it's a ketogenic diet, it is stable, consistent energy. And so it's not surprising to me that people find they're able to resist cravings better because the brain is able to say to the rest of the body, "No, we don't need that. We're doing fine. We got energy."

[Host]: What about the heart?

[Dr. Benjamin Bickman]: Oh my gosh, that's a brilliant question. So, I would say the brain is number one tissue that thrives on ketones and I'd put actually put the heart as number two. There is a lot of great research. I would refer people to Gary Lope's work and others that I just don't know personally, but I know him. He's at the University of um Alberta in Edmonton. um and he has found and others so I'm going to synthesize their work collectively that when a person's experiencing heart failure it's it's a combination of variables where the heart may not be able to contract well enough to eject the blood it has to work a lot harder for every pump in that case they they have found that the the heart will shift its fuel to start relying on ketones to improve its function but there was a paper just published this here looking at a different form of beta hydroxybutyrate which is the main ketone. Whenever I've been saying ketone, I've been thinking of the molecule beta hydroxybutyrate. When the liver makes BHB or beta hydroxybutyrate, it actually comes in two forms that are mirror opposites of each other in structure. So the way they're built, it's referred to as DBHB or LBH. So in heart failure, the heart muscle itself like the brain starts relying a lot on DBHB as its fuel. Then you would say that begs the question, well what about the L? This paper that was just found used a pig heart model which is actually shockingly close to human anatomy. So it's a pretty good um corlary here. They found that with LBH infused into the cardiovascular system of the pigs, which is a different form of the ketone that the liver makes. Yeah. So the liver is making two types of BHB, DBHB and LBHB. And when they profused the cardiovascular system with LBH, they found that the what's called ejection fraction, so the amount of blood coming out of the left ventricle, which is the part of the heart that's beating blood everywhere. So with LBH, they found that the heart was able to eject 40% more blood for every beat. But now you would say, well, it's just because you're making the heart work harder. No, it was not at all an effect of the heart itself. It was because all of the great arteries like the aorta, right out of the left ventricle will come the aorta, which is the main avenue for moving everywhere. The aorta expanded and all of the great vessels enlarged so much that the heart was now able to beat out 40% more blood with every single beat. So when it comes to someone with heart failure, I think they are among the most they should be among the most interested in testing out the effects of ketones. Uh even as a personal note, I am I tend to be kind of high anxiety, high performance sort of I'm always thinking of something. No surprise that I tend and I don't sleep particularly great and so no surprise that I sometimes have higher blood pressure. I one time measured my blood pressure on a random I went into my dentist and the dentist has now started measuring blood pressure. It was 139 over 90ome and I had never been that high. I couldn't believe it. I'm such a healthy bloke. How on earth is my blood pressure this high? And I thought, well, I'm kind of sleepd deprived. I've had maybe a little too much caffeine that morning or whatever. But it was a concern. And over the next few days, my blood pressure continued to be higher than it had ever been. And of course, I'm getting old enough that I think these things start to matter. I took a shot of as an experiment, seeing this paper that was had just been published in 2025. I took a few grams worth of LBH. I drank it and within about an hour, my blood pressure was like 110 over 70. So, it had this. Now, that's anecdotal. It's an N of one. Maybe I just calmed down enough, but I saw an almost immediate reduction in my blood pressure. And it could be because of what they found, which is that all of the vessels that the heart is beating into, they expanded. And so every with every beat of the heart, the heart was able to eject more blood. And the and the the wider a blood vessel gets, of course, the lower the pressure is. And so that's that could be the mechanism that explains in my case why my blood pressure got fixed so quickly.

[Host]: How did you drink that?

[Dr. Benjamin Bickman]: Yeah. Yeah. So, there are a few different ways. As much as we've been focusing on uh endogenous ketones. So, I'm pointing to my liver, but here's the liver. So, when a person is in a ketogenic state, they're making their own ketones, we would use the word endogenous ketogenesis or they're making ketones in their own body. But it's no surprise that the benefits of ketones are getting so extensive that now there are companies um that are enterprising individuals that are finding ways to get into ketosis without having the rigor of a ketogenic diet. And so you can drink ketones. And that comes in a few different forms. Of course, the form I'm talking about is just straight BHB in in its two in its two versions. You can get it in either version, DBHB or LBH. So, that's just you consuming it in the way your liver makes it.

[Host]: If you looked in my kitchen cupboard over there, you'd probably see, frankly, about 100 different ketone products. Um, obviously, some of them are the same, but there's like 100 different units of ketone products. And here is my ketone reader, which is where I pick prick my finger frequently.

[Dr. Benjamin Bickman]: In fact, you'll be delighted um once you get one. Nowadays, they make them attachable. Really? Yeah. So ketones are so easy to measure, not unlike glucose, that just like people have continuous glucose monitors now in Europe, you can get continuous ketone monitors from where? Next time you're in the UK, get them. You can't get them here yet. They're not FDA approved, but there was a company out of Germany um that sent me one uh called Sai Bio, Si Bio, and you can just strap it on and look at your phone and it's giving you continuous readings.

[Host]: That is incredible. I'm literally going to buy that ASAP. Um, but before I get that, I've been using this little ketone reader here. Which I have no affiliation to at all. Um, and pricking my finger every single day to see my ketone levels when I'm in a in a ketogenic state. You talked about exogenous ketones there. I have a bunch of different exogenous ketone products here. I know some people use ketone salts. I have two different ketone brands here. Okay. So, I've just taken a shot of Keton IQ. Um can you tell me what's going on inside my body now that I've just had one shot of that?

[Dr. Benjamin Bickman]: Yes. Yes. So now your body is taking in that main molecule of ketone IQ which is called 13 butane dol and it's going to get absorbed from your guts into your blood and then from your guts it's going to go to your liver and then the liver will pull in that molecule and rearrange it into BHB and then and then release that into the into the blood which is ketones it will turn it into BHB the ketone. Yep. And now again there are different forms that you can take whether it's the straight 13b butane dial or whether it's an esther. Yeah. So now once the BHB is in the blood it um anytime BHB is in the blood it is both fuel and a signaling molecule. And that last part is often overlooked. We've been over the course of this discussion talking a lot about or I've been referring to the fact that it's a fuel for any any cell with mitochondria, which is everything but red blood cells. Red blood cells are the only cells with no mitochondria. But every other cell of the body will take in BHB, the main ketone, and use it for fuel. Every single cell of the body, and do so gladly. the and it's important to compare the BHB the ketone against glucose in many of the biggest tissues of the body like the muscle or the fat or even the heart glucose can't just come in it needs an escort if you will or it needs permission and that's insulin so there's this regulating step there's this this checkpoint where insulin can say all right you can come in or not because I'm insulin resistant or there's not enough insulin or whatever ketones have no such regulation they just come in if the cell has mito mitochondria, the ketones going in. So that's one effect where the ketone is metabolized as a fuel giving the cell literal energy. Number two is the fact that the BHB can bind to the cell and there are receptors on cells that will sense the BHB then the BHB will tell it to do something. Yeah. Yeah. So it's it's which is really really unique where you have something that is both a calorie source an energy source and it acts like a hormone where it tells cells that's the signaling effect where it tells cells to to do something like a moment ago I'd mentioned how LBH is capable of expanding the great blood vessels in the body well in that regard it's acting as a signaling molecule and increasing the production of nitric oxide which is a great visodilator. All these guys that are taking nitric oxide drugs like Seialis for whether it's erectile function or nowadays guys are taking it to have better blood flow and perform in the gym and have a better workout. Well, LBHB might be kind of the way forward where if you can signal something else but get the same effect without the consequences or the side effects that you get from seialis then that might be one of the strategies and use of LBH in the future.

[Host]: Some people ask me about sex differences in the ketogenic diet or a low carb diet generally. Some people are concerned that low carb diets or ketogenic diets are especially useful for men but might have a different set of complications for women. And we did have a female expert debate on the show where I asked about the ketogenic diet for women and the sort of consensus was that it should be treated differently for women.

[Dr. Benjamin Bickman]: Yeah. Yeah. I app I remember I I tuned into that and I respect it tremendously. I I really appreciate the view that a lot of these gals have advocated for which is that women are not just small men. The differences between male and female of course are enormous. Um that doesn't mean there are differences in everything. So women are very unique when it comes to hormones. They women experience a rhythm of hormones that there is no equivalent in men because of the the reproductive burden if you will or responsibility that a woman has where she will see changes in hormones that can reach thousands of times differences like progesterone levels can change by a thousand times over the course of the ovarian cycle. Estrogen levels will change by multiples. men just don't have that kind of volatility. Those female sex hormones do influence metabolism, but then it matters tremendously which um phase she is in of her ovarian cycle. So if she is in the the first follicular phase, which is a low progesterone, higher estrogen state, what's the first follicular phase? Yeah. So in the in if you look at the female fertility phase, um it is like a 200piece orchestra. It is so dynamic. Whereas men's fertility is like a barberhop quartet. It sounds nice, but it's very simple. So, in the first phase leading up, so she's just had her menration end, now she's starting the beginning of a new cycle. That first phase is called the follicular phase, which is when her ovaries are having some follicles or a future a little egg getting bigger. One will end up becoming the dominant one, but that is creeping in higher higher levels of estrogen. And then she will ovulate with at with the ovulation that what was a follicle in her ovary now becomes what's called a yellow body or a corpus ludium. And so it's called the ludial phase and that is defined by very high progesterone and progesterone changes things. So where I think the conversation in women is very relevant and fascinating is that in the first phase in her follicular phase she is a fat burning machine. You can measure she will get into ketosis faster than her male counterpart and she's burning more fat than her male counterpart. In fact, this is one of the few clinical values where there's a male version and a female version. This isn't very common. Many of the typical metabolic type markers, whether it's glucose or insulin, triglycerides, LDL, cholesterol, they're the same across the sexes with the exception of free fatty acids. So earlier I had mentioned that when insulin is low the li the fat cell is breaking down fat. It's breaking down that fat as free fatty acids. So the free fatty acids in a woman are about 40 or 50% higher than in a man during that first phase. Yes. Especially during the first phase and that's because she's burning more fat and that helps her get into ketosis faster. So if you this has been shown in studies take a male and female have them start a fast she will get into ketosis faster than him. Now during during just during that phase or especially during the phase yeah I I don't know that they compared and controlled for the ludial phase but it's worth noting where I think um fasting and ketogenic diets start to change. So it'll keep going up. Yeah. So just another reading point8. Yep. Is ketosis considered what.5? Technically, but frankly I actually call it ketosis at.3. the moment you can detect it on one of those blood meters that I'd say you're in ketosis and I think 0.3 is the lower limit. So 0.5 is a little bit of an arbitrary cut off but that is the classic view. Um, so in in that in that ludal phase with high progesterone, progesterone is a hunger hormone. And so if she's trying to do a fasting protocol during and her cravings are going to be higher and her uh she's going to be hungrier. And so that's where I think the conversation's very important is that during her ludal phase after she has ovulated, it's going to be harder to stick to a ketogenic diet. And that's where I think it might be prudent for her to be a little generous with herself. um where uh it might get a little more difficult. Now, however, some of the concern with women and ketogenic diets is misplaced. And I would be remiss if I didn't mention a study that answered this question very well in with regards to cortisol. In fact, I'll state this now. I already chatted with the team. I would love to see you bring on a scientist in the UK named Dr. Isabella Cooper. She has published a series of studies in women that are fascinating because of the the intervention that she's done. She's taken women who had been adhering to a ketogenic diet as part of their normal life. Then for 21 days they have to adopt the typical high carb diet of the standard UK guidelines similar to the US about 55% carbohydrate decidedly not ketogenic for 21 days. So more than long enough to detect changes and then they go back to their diet for 21 days and they have blood tests again. And so these are healthy women who go from a ketogenic diet to a high carb diet back to a ketogenic diet. And when they looked at cortisol, when Isabella and her group measured cortisol levels, no statistically significant change at any point. There was just noise and no trend. Some gals had their cortisol go down. Some had them go up. But as a group there was it was just a big messy flat line. And what does that mean? That takes a lot of wind out of the sales of of people who say that a ketogenic diet is a unique stress on women because people want to invoke and they'll say, "Well, cortisol goes through the roof and that's sign of a significant stress." And yet Isabella's own data show that cortisol levels aren't different. that there is no unique cortisol related stress state of a ketogenic diet. So I think it's relevant because it just brings a little nuance to the conversation. Not to say men and women are not different. They absolutely are. But I do believe the the view that a ketogenic diet is uniquely stressful in in women but not men, I think is uh overblown. And and again, I'm relying on Isabella's own data to support that.

[Host]: So, coming into 2026 and I want 2026 to be the year where I finally get a grip of my health, where I finally become the person that I know deep down I could be and I desperately do want to be. And I asked you, Dr. Ben, to make me a plan, the perfect plan, the perfect diet. I know everyone's different, so we're gonna have you gonna have to play with me here a little bit, but the perfect plan for 2026, what would you prescribe as a diet, lifestyle choices? Okay. And I'm going to write it down.

[Dr. Benjamin Bickman]: Yeah. Yeah. So I would um at the risk of sounding too self-absorbed uh I this is I'll kind of describe my own approach as a metabolic scientist but please everyone listening appreciate that I will I'm inserting my own constraints because my approach is kind of that of a guy who knows a lot but is also constrained by my demands in life but I think a lot of people fit into that category. So Stephen if you want to look like a freckled bald wrinkled man this is what you can do. All right. So, first of all, zero to little to no carbs for um breakfast and lunch. Yep. You wake up in the morning. Anyone who's wearing a continuous glucose monitor will find that their glucose levels naturally rise in the morning and that coincides with a mild state of insulin resistance every morning because of changes in cortisol and other hormones. So my view is don't doubly load to the glucose that's already happening by eating in the morning with starchy sugary stuff. So be very strict with all of your meals up until dinner. So just on point one so I'm clear. You're saying no carbs but is there anything that I should be having? Yeah. So any if a person wants to as much protein and fat as they'd like and I would say especially for lunch, let lunch be your biggest meal. Okay. So let's go through those three points. Yeah. Um why as much protein as I can. Yeah. Protein and fat. Okay. Why? Yeah. Because they won't have an insulin effect. And that's the key. Like my approach to staying lean at 50 years old and having my wife like what she sees is keeping my insulin low and and still not being hungry all the time. And so protein and fat are the two macronutrients with carbohydrates being the third. But protein and fat have little to no effect on insulin. Fat has none and protein may have a modest effect depending on some other variables. So you want to keep insulin low. So what would would that breakfast look like? So for me, I actually don't eat breakfast. Uh and and again, this plays into I'm extremely mindful of my family. So that's going to come back again when we get to dinner because we've left that meal untouched for now. In the morning, I make breakfast for my kids every morning. Uh and it's something I remember from my childhood being raised by my dad and he every morning it was just structured. And I think all of my siblings and I have thrived in life in part because of the structure we had at the beginning of every day where we would all eat breakfast together. We would read scriptures very briefly. We'd have a family prayer very briefly and just review the day. And I think that was my dad's way of kind of surviving with so many kids just to sort of check in with everyone. You had nine siblings. Yeah. Yeah. There's nine of us. Yeah. Uh and so we have uh I I'm very big on that. So breakfast is dad's domain and my wife cheers me on. Um, so I make breakfast for the kids and I am sipping on a cup of yerba mate the whole time. Why? Yeah, in part because I like the taste. There's a good GLP1 effect. So, it helps me feel a little more satiated. Um, and it's just a habit. It's a little bit of a perk, a little pickme up. I don't drink coffee. I drink yerba mate instead. What is herb mate? The brand that I get is called Una Mate. And it's a it's a leaf. It's a South American tea basically. And you can get it in any number of ways. This is just a really convenient and good way to get it. So I'm sipping on a cup of it would be someone drinking coffee or tea. I'm taking yerba mate tea. Um so I don't eat for breakfast. I find that I'm not generally hungry for breakfast anyway. And so I may as well keep my fasted state going a little longer. So that's what works for me. And then I would encourage people to have a big hearty lunch because if you have a big hearty lunch, mostly protein and fat, it makes it easier to taper off later in the day. Especially in the evening if people are noticing that they have significant cravings especially for carbs because that's the only thing anyone craves in the evening have a bigger lunch. See if that helps. Okay. And then sometime around either before or after have a good resistance workout. I have my resistance workout in the in fact Stephen I even have to go a little earlier. So, my first thing in the morning is I go on a ruck at 5:00 a.m. I have my weighted vest and these 15lb kettle bells and I hike one mile up a hill and one mile back every morning at 5:00 a.m. And then I get a little work done and just some personal kind of reflection and meditation time, if you will. Then the family wakes up. I'm making breakfast. The family chaos begins. I'm sipping on my yerba mate. Then I go to work. About 10:30 or 11 is the good time for me. I go down to the gym on campus and I do my very brief, very effective, I would say, um, resistance training and then I go into the sauna for 12 to 15 minutes, but in the morning I've done a little ice bath, too. I didn't mention that. I have an ice bath on my back patio, a Maroska Forge, and I love it. It is spectacular. Um, so then I do a sauna session after my workout. Then I go eat my big lunch. Why are you doing the ice bath in this one? Yeah. So, I do I do an ice bath in the morning because it helps me sleep better in the evening. I'm a terrible sleeper. And especially in the northern hemisphere in the winter, the sun isn't coming up till 9:00 or so, 9:00 a.m. And by shocking my body, I get this jolt. And I think it just helps get my clock ticking. And so, by the time evening rolls around, I'm tired and I'm ready for bed. Okay, I'm just doing my ketone test to see where it is. We're probably about 30 minutes off me taking that ketone shot. We'll continue with your day in just two sec. And I'm now at 0.9. It'll keep going. Yep. Yep. So, you were 08 0.9. Next one will be one, but it looks like it's starting to curve a little bit, which isn't surprising. You went up pretty quick and then it's going to curve for a bit. And what's going on in my body right now that I have 0.9 K? Yes. So, that is a unit of measurement called the mill moles. And so, it's looking at the number of molecules basically in a given amount of of your blood. And so you took in that ketone precursor, the liver converted it. It's just continuing to convert it into BHB. BHB being ketones. BHB being the main ketone. Yep. Okay. Yep. And that's making me Well, it's going to make you sharp. Okay. So, your brain is now using those ketones. Your heart would be using the ketones. Um, and your reliance on glucose as a fuel for your brain and your heart would be going down. Wouldn't my hunger be going down? Oh, yeah. Yeah. So, I'm going to be less hungry. But also the benefits of BHB in the brain are are myriad where it's been shown to be an anxolytic. So it can control anxiety. Uh it can control it can improve depression. It can help with attention, memory. I memory. Oh, certainly with cognition. Yes. I've read I read about the studies on dementia patients that Yes. That is it is incredibly we're entering a kind of dawning of an era of ketone research where the number of NIH and NSF funded ketone related projects is wonderful. It's thrilling to see where it's going to be a wonderful decade of a lot of great biomedical research on the metabolism of ketones.

[Host]: I've got this uh pen in front of me. Do you know what this is? That's a GLP-1 medication. A Zmpeek. Ompic. Yeah. I've got an Ampec pen right here. Now, you've told me lots of different ways that I can lose my body fat in 2026, but couldn't I just jab myself with this and my hunger will evaporate and I'll lose fat.

[Dr. Benjamin Bickman]: So that works until it doesn't. By that I mean we have really really good data now. So briefly on GLP1, although I know your audience is probably very familiar with this by now. GLP-1 is primarily a satiety hormone. It'll tell the brain that we're done eating and it will slow down the intestines significantly. So you'll eat food. If you and I were to go eat lunch, again, I've used that a couple times. Our food would be in our stomach for four to six hours maybe. If we injected ourselves with a GLP-1 drug, which puts an artificial amount of GLP-1 in our body, boom, we sh it in. It's some we grab a piece of fat and jab it in. Then it would it slows down people's intestines so much that they'll have food sitting in there for 24 hours. So, one of the things people talk about is what's called ompic burps where they just have this kind of belching bubbling gas because the food is sitting in the stomach for way longer than it's supposed to. So, no surprise the people are less interested in food. GLP-1 tells the brain they don't need to eat as much and slows down the intestines. Now, however, I said it works until it doesn't. There the main thing it helps people do is eat less carbohydrates. It controls cravings particularly. But there was a human paper that found when they followed people for 2 years. It was a beautiful figure. At about 6 months, they found that sweet cravings dropped significantly. A huge reduction in their cravings for chocolate and sweets. At 12 months, it creeped up a little bit, but it was still noticeably below where it started. At 2 years, it was right back to normal. So at two years on the drug, the effects of having them not be interested in that plate of cookies now it's gone. What's going on there? So yeah, it's it's diminishing returns as to invoke a principle of economics. Doing the same thing again and again and again starts to work less and less and less. This we see this manifested in innumerable different ways of medications. So why do our clinicians why does the doctor tell us to make sure we take our full dose of antibiotic? Because if we don't, we give it just enough for the bacteria to become resistant to it. And now next time we would need two times the amount of B of antibiotic we had. So it's it's natural for the human body to become less responsive to a stimulus. And that is so much GLP-1 activation that it's no surprise that the body starts to say, "Hey, you're screaming at me too much and I'm going to become deaf to your signal." So it starts to work less. And in the UK and in the US about 70% of people get off the drug of their own valition at two years. They get tired of being on the drug because it's basically like a constant state of nausea. That's that's kind of how you'd say it works that if you're feeling always a little nauseous, you just don't really want to snack on something and people get tired of feeling nauseous. But another two-year study, two years appears to be kind of a magic timeline, found that of of every every pound they lost, 40% of it was from lean ma from fat-ree mass. What does that mean? So that means 60% was coming from fat, 40% was coming from not fat, including muscle and bone. It would be water as well, but muscle and bone. And that matters because imagine if we have an older woman. Let's imagine a 60-year-old woman who wants to lose weight and goes on a drug. If she's lost weight now and then two years later wants to get off the drug like 70% of people do, she will her fat mass will come right back, but her lean mass may never come back. That muscle and bone may be gone for good. Who is it for? Who who would you recommend definitely does that does it uses it? And for how long with what other supplementation? Yeah, my my recommendation of the drug is to not currently it's being used for weight loss where people just say here, jab yourself with this and you're going to lose weight. Um, and it works. They will absolutely lose weight. But again, the concern being that you're going to uh lose a lot of lean mass at the same time. So my best use of that drug would be using it with two distinct purpose, two two ways, but for one purpose, which is this is a drug that's going to help you learn to control carbohydrates because that's the one macronutrient that people are addicted to. They're addicted to carbs. We eat too many carbs. We're a carb crazed culture. So my view is use these drugs to help people cure their cravings for carbohydrates. But then when I stop taking it, isn't it going to come back? Well, so that's it then. So then you use it in two different ways. One, you use a much lower dose than is currently used. what we could call a micro dose, if you will. Um, so use a lower dose and you cycle it on and off. So what I think people should be doing, and I'm going to talk about evidence to support this in just a second, go 90 days on the drug at a low dose while receiving coaching or counseling on how to use a low carb diet because they will find it easier than ever to control their carb consumption. Then at the end of 90 days, wean them off the drug and say, "Let's see if these habits have stuck." Very often they have. I know many, many people, and again, we're going to be publishing a report on this. I'll touch on that in just a second, who they've done 90-day cycle of a lowdose GLP-1 coupled with coaching on how to do a low carb diet, and they find that their cravings are gone and they don't need to be on the drug anymore. Some people will find that it lasts for a while, and the cravings start to come back. All right. Well, let's cycle you back on and try again. Let's find out what didn't work this time. So, we're about to publish a report. Anyone who wants to see a little more about this, I just encourage them to go to my site, insulinq.com. I'll link it below. Great. Um, but we have done a a collaborative work with a group in Idaho, a clinic in Idaho, where they have done just this. They have people getting low carb counseling with a cycled do low dose of GLP1 and the results vastly outperform those who just rely on the drug. Better fat loss and better retention of muscle mass. And when you say low carb counseling, that's just it's just people like me, you know, me saying, "Stephen, I'd like to go on a low carb diet." You saying, "Okay, great. Let's talk about how you can do it best." Kind of a little bit like what we've been doing, but basically just like a diet coach. Okay. But the results have been fantastic. Um, literally outperforming just the drug trials alone. Over what period of time? Yeah. So, it's now been we have people who have been two to three years. Yeah. We'll publish that soon. It's not submitted yet.

[Dr. Benjamin Bickman]: Oh, yes. Yes. I I'm I I can't believe I didn't mention that. I'm very much an advocate of creatine. In fact, we have a study going on right now on it, which I'll come back to in a second. Um yeah, creatine has been um it's kind of the new thing where its traditional use had been in muscle and then now all of the hot evidence is coming out in the brain. So in the muscle evidence, there's two things to note. In fact, the first one is generic where creatine, not that you're asking this, but people may wonder how it works. Creatine will be taken into a cell and it creates this pool of potential energy called creatine phosphate. Now, earlier I'd mentioned ATP and I'm holding up three fingers because of the three phosphates on that ATP, the triphosphate molecule. When we say contract a muscle or a nerve is sending a signal, you're breaking ATP apart. You're splitting off one of those phosphates. Now, you're left with a diphosphate, ADP. In order to recycle or regenerate the ATP, you need another phosphate molecule. And this is where creatine comes in because creatine has a phosphate now that it can come and give to the ATP. rapidly recycling ATP which means so you're able to restore the energy in the cell sooner which means for me on a daily basis on a daily basis would it' be two things uh in the two tissues of interest one you can get more work out of your muscle in a given unit of time yeah so if you wanted to have a very effective 30-minute workout your rests could be much shorter because of your ability to regenerate ATP or recover but then the newest area of research is what's happening in the brain where creatine has been shown to increase brain energy and there are some incredible human studies finding that you take people with cognitive decline or some form of early dementia. Give them creatine supplementation and over the next few weeks their cognition will improve. So, as much as you have the gym bros who are taking it for muscle, which I'm sympathetic to, I want big healthy muscles, too. Um, more than anything, you and I, we're not getting paid because of our muscles. We're getting paid because of our brains. So, you and I are taking creatine to have bigger, better brains. But in order for the creatine to saturate the brain, you need more. And that's been some of the newest focus where you can get away if you're just taking it for muscle purposes, five grams is enough of creatine monohydrate. And if you want to get it to work for the brain, you need 10 or 15 grams. So quite a bit more. I heard this from another guest I had on the show and I was really shocked um because I didn't think about creatine as being something that could really elevate my cognitive performance. And from the studies that I've read in the research ahead of this conversation, I read that creatine helps your brain stay sharp, especially when you're in a low sleep Yes. mode or when you've been working very very hard. So that's a study. There's a human study that to sleepd deprived people deliberately had them take creatine versus the placebo and then do a series of cognitive tests. No surprise, the sleepd deprived people on placebo did very poorly. They're so tired. They're lethargic. the creatine treatment group performed much better. I heard this and I thought, "Wow, so when I'm like jetlagged or underslept, I should be taking my creatine." Yeah. And so, as an underslept dad, you'll get there soon enough. Um, I take creatine every morning. It is literally the first thing I I drink. It's hard for um I've noticed just in my friendship group when I've talked about creatine, it's sometimes hard to convince women to take creatine because there's a sort of prevailing stereotype that it makes you large. Yeah. Yeah. I wish um cuz then I'd be jacked. No, no, it doesn't. In fact, I think you could make the case that a woman relevant to the cognitive aspects of it should be focused on it more than men. So, there are few chronic diseases that women suffer from more than men and Alzheimer's disease is one of them. So, this is a disease that will affect women almost double or even triple the rate of it affecting men. In so far as the latest evidence shows that at higher doses, creatine helps with cognition, I think every woman, middle-aged and beyond, should be taking creatine daily. And indeed, on the higher end of that dose, because that's the dose you need to help your brain. And I read from one particular study, I think you talked about this on your YouTube channel, that creatine increases strength by up to 10% and power output by up to 15% and reduces muscle damage by 20 to 40% after intense exercise. Yeah. So creatine both acts as an energetic source and it changes gene uh transcription. So there's evidence to show that creatine in muscle stimulates what's called myiogenic genes. Myiogenic genes are those genes that promote muscle protein synthesis and muscle growth. So creatine both energizes the muscle and promotes growth of the muscle. Now a woman may say, "Well, I don't want to get big." You can't get big. The female a female body does not have the right mix of sex hormones to get big muscles. All that will happen is she'll have wonderful healthy strong muscles. She does. No woman ever needs to be worried about getting too big in muscles. It doesn't happen. Why do vegetarians and vegans need to pay more attention to creatine? Right. That is Yeah. So creatine is one of the many things, if you'll pardon me for saying it, that a vegan would need to pay attention to. Um so creatine is a molecule that you can eat. So, if someone's getting a lot of red meat, you could make the case that they don't need to supplement, that they're getting more than enough. But if you're not eating red meat, you may not be getting enough. And I'd say you probably aren't. And there's reason to get it and to supplement. Does creatine have an impact on blood sugar levels? No. Blood sugar spikes at all? No. I would say if someone ever notices, if they're taking a scoop of creatine and they see, then it's probably because you have some maltodextrin in your creatine powder. Do you know I I had my um blood levels done a couple of weeks ago and the doctor said to me that I should be careful because they're seeing high levels of creatine in my kidney. Okay. Yes. So what they would have said is they would have seen high levels of creatinine. That was it. Yeah. But that's important for people to know because that's one of the long-standing attacks against creatine has been a high level of creatinine. That was it. So creatinine is the metabolite of creatine. So when creatine has lived its life and served its purpose, it gets converted into a molecule called creatinine which is actively secreted from the kidneys. Now it's a waste product and the kidneys happily dump it out. Now in an average person, if someone has if you came in and you did a urine test and we found your creatine your creatinine levels were really really high, we would worry, hey, is this a sign of kidney damage? Are your kidneys allowing too much to get filtered? And and it might be a sign of that. However, if a person's taking creatine, it is absolutely guaranteed that they're going to have more creatinine coming out, and that's just because they're metabolizing more of the creatine. There's no reason to be worried about it. You talked about a 5-year study that found zero kidney changes in athletes taking up to 20 gram of which is significant creatine a day. Yeah. There's no evidence. I'm unaware of any study that has shown kidney damage on creatine supplementation. It is what we call in science an artifact where you see a little hint of a problem and assume it's it's actually causing a problem when it's actually just a manifestation of just what you're doing.

[Host]: Ben, I'm going to ask you to close your eyes. I'm ready. Okay. And I'm going to ask you to embody what I'm about to say. Okay. So, suddenly now you are a let's say 35year-old man and your name is Dave and you have one kid. You have a little bit of extra fat around your midsection that you're trying to lose. You've been listening to this podcast for a while. You've heard lots of things. You haven't managed to make huge amount of progress. Sometimes you try and then you bounce right back and you're you're kind of at your wit's end. You really really want 2026 to be the year that you finally prove to yourself, your family, for the sake of your kids and inspiring them to live a happy, healthier future. That you can make a change and you can become the strong, healthy, sexy dad that your family wants you to be and that you want to be. You want to finally prove it to yourself after all these years of struggling, trying, failing. What is what is it that that guy or that woman needs to hear to close out this conversation today, Ben?

[Dr. Benjamin Bickman]: Yeah. Um, I appreciate you mentioning the the the kid. I think you need to have a reason because making change is hard. You have to have a reason that is that is motivating you to do it. That goes beyond yourself. That's I should add that that you'd mentioned a handful of internal motivations. You want to feel better. you want to look better. Those are all valid, but sometimes it's not enough. Have an external reason. And when you're a parent, you have a reason. You have a child. You're living for your child. So, have a reason for doing what you're doing that goes beyond your own motivations and that touches someone else's life. And then two, you need to find a way to control your cravings. I think the more I look at the debates around obesity and weight loss, um, which is so central to looking and feeling better, the more I think you have to learn to control what you're addicted to. And so I would say start with the simplest habit and and change it. So, if this is if if Dave, the 35-year-old dad of one, if he finds that he is starting to drink alcohol in the evening and then he's doing other things too that he doesn't like, stop doing that. Um, and recruit outside help. So, start with one habit you know you should change and change it. And then that can when it comes to changing diet, which is among the hardest things to do for many people, I would say eat a big lunch. Some people don't want to make small changes because they don't feel consequential enough. It doesn't feel like it matters. Yeah. You know, and this is one of the things again I've learned from interviewing so many people is that all of these habits are like at some level interconnected. And actually when you change one, you influence another. I totally agree. And actually huge change in life starts with small steps. And so cutting out the alcohol for example, that's going to have knock-on effects in other areas of life, right? Even like sleep or he will sleep much better. Yes. So multiple studies show that with cutting people have a have a mistaken view of alcohol when it comes to sleep where they they fall asleep faster but then they sleep worse throughout the rest of the night. So there's which then means what? Yeah. So that men So then you wake up the next morning and you're lethargic, you're tired, your cortisol will be higher, you will be more insulin resistant. So, higher insulin levels throughout the day, which means you're going to have cravings, which means you'll have cravings. And every calorie you consume, you're going to be more likely to store it. So, then your body is more efficient at getting fat on any given amount of calories. So, even even something as simple as alcohol, which you and I haven't discussed at all, and and maybe Dave isn't an alcohol drinker, but many people are, uh, that is it has this patina of helping a person's sleep, and yet it absolutely does not. And sleep is a massively relevant variable when it comes to uh metabolic health and weight loss and just feeling well.