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In this week’s episode of the Metabolic Classroom lectures, Dr. Ben Bikman explores the metabolic impact of ADHD medications and whether ADHD itself has metabolic roots.

Ben explains how stimulant medications (like Adderall and Ritalin) primarily work by increasing dopamine and norepinephrine, enhancing focus but also suppressing appetite and stimulating fat breakdown. This can lead to weight loss but may also contribute to binge eating episodes when the medication wears off. Non-stimulant ADHD medications (like Atomoxetine and Guanfacine) affect metabolism in different ways—some subtly improve insulin sensitivity, while others reduce fat breakdown, potentially leading to weight gain.

Beyond medication, Dr. Bikman discusses ADHD as a possible metabolic disorder. Studies show that individuals with ADHD often have reduced glucose metabolism in the prefrontal cortex, the brain region responsible for attention and impulse control. He highlights research linking chronic sugar consumption to dopamine imbalances and brain energy instability, suggesting that modern dietary habits may be worsening ADHD symptoms.

One potential solution? Ketones as an alternative brain fuel. Dr. Bikman shares research on the ketogenic diet as a therapy for ADHD, similar to its use in epilepsy and Alzheimer’s disease. By shifting the brain’s energy source from glucose to ketones, individuals may experience more stable brain function and improved focus. He concludes that ADHD may not just be a neurological condition—it could also be a metabolic issue, and targeting brain metabolism may offer new treatment possibilities.

Show Notes/References:

For complete show notes and references referred to in this episode, we invite you to become a Ben Bikman Insider subscriber. As a subscriber, you’ll enjoy real-time, livestream Metabolic Classroom access which includes live Q&A with Ben, ad-free Metabolic Classroom Podcast episodes, show notes and references, Ben’s Research Reviews Podcast, and a searchable archive that includes all Metabolic Classroom episodes and Research Reviews. Learn more about becoming an Insider on our website: https://www.benbikman.com

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Dr. Bikman’s Metabolic Classroom lecture this week explores the physiological role and implications of GLP-1 (glucagon-like peptide-1) and the GLP-1 receptor agonist drugs used for type 2 diabetes management and weight loss.

Ben begins by explaining GLP-1 as a hormone produced in the intestines in response to food. It plays a vital role in slowing gastric emptying, suppressing glucagon, and regulating appetite by signaling fullness to the brain. These mechanisms contribute to its effects on stabilizing blood sugar and enhancing insulin sensitivity.

He then delves into GLP-1 receptor agonists, drugs that mimic GLP-1’s actions, including semaglutide, liraglutide, and others marketed under brand names like Ozempic and Wegovy. These medications have gained fame for their weight loss efficacy, often leading to reductions in body weight by 15% or more.

However, Ben emphasizes that weight loss involves not only fat but also lean mass, raising concerns about muscle loss and metabolic health. Additionally, he discusses the medications’ side effects, including depression, anhedonia, and potential long-term complications like fat cell development and gallstones.

The lecture also addresses the diminishing returns of these drugs over time, noting that their efficacy in reducing cravings and improving eating control tends to wane after prolonged use. Dr. Bikman highlights that education on healthy eating and resistance training is crucial for maintaining health outcomes, as reliance solely on medication can lead to unintended consequences, such as increased fat regain after discontinuation.

Ben concludes by stressing the importance of combining these drugs with a low-carb diet and resistance training to minimize muscle loss and optimize long-term outcomes. He encourages using the lowest effective dose and underscores the need for lifestyle changes to complement pharmacological interventions.

Show Notes/References:

For complete show notes and references referred to in this episode, we invite you to become a Ben Bikman Insider subscriber. As a subscriber, you’ll enjoy real-time, livestream Metabolic Classroom access which includes live Q&A with Ben, ad-free Metabolic Classroom Podcast episodes, show notes and references, Ben’s Research Reviews Podcast, and a searchable archive that includes all Metabolic Classroom episodes and Research Reviews. Learn more about becoming an Insider on our website: https://www.benbikman.com

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This week, Dr. Bikman’s lecture focuses on metabolic surgeries (also called bariatric surgeries), their mechanisms, and their impacts on weight loss and metabolic health.

Ben begins by explaining the qualifications for these surgeries, which often serve as a last resort for individuals with severe obesity or comorbidities like type 2 diabetes. Common qualifications include a BMI of 40 or higher, or lower BMIs with conditions like hypertension or diabetes. These surgeries aim to address obesity and related health complications when traditional methods, like diet and exercise, fail.

Dr. Bikman describes four primary types of metabolic surgeries: Roux-en-Y gastric bypass, sleeve gastrectomy, biliopancreatic diversion with duodenal switch, and adjustable gastric banding. He explains their procedures, including how they alter digestion, absorption, and stomach size, leading to weight loss through restriction and malabsorption. These surgeries also bring significant hormonal changes, such as increases in GLP-1 and reductions in ghrelin (hunger hormone), contributing to satiety and metabolic improvements.

While these surgeries can dramatically improve insulin sensitivity, reduce glucagon levels, and improve conditions like type 2 diabetes, they come with risks. Nutrient deficiencies, surgical complications, dumping syndrome, and weight regain are significant concerns. Younger patients are particularly prone to weight regain, especially if they don’t adopt sustainable eating habits. Dr. Bikman emphasizes the need for education on managing macronutrients and maintaining long-term behavioral changes.

Ben concludes that metabolic surgeries can be a valuable tool for those with severe obesity and related complications. However, he warns of their limitations and advocates for coupling them with lifestyle changes to optimize long-term success.

Show Notes/References:

For complete show notes and references referred to in this episode, we invite you to become a Ben Bikman Insider subscriber. As a subscriber, you’ll enjoy real-time, livestream Metabolic Classroom access which includes live Q&A with Ben, ad-free Metabolic Classroom Podcast episodes, show notes and references, Ben’s Research Reviews Podcast, and a searchable archive that includes all Metabolic Classroom episodes and Research Reviews. Learn more about becoming an Insider on our website: https://www.benbikman.com

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In this Metabolic Classroom lecture, Dr. Bikman delves into the fascinating metabolic process of autophagy, the body’s natural recycling system that maintains cellular health by breaking down and reusing damaged components.

Ben explains how autophagy is essential for replacing malfunctioning organelles and proteins, thereby preventing diseases such as neurodegenerative disorders, cardiovascular conditions, and even some cancers. Autophagy also plays a crucial role in energy production during nutrient deprivation, highlighting its importance for survival and optimal cellular function.

Dr. Bikman also discusses the relationship between autophagy and metabolic health, emphasizing how impaired autophagic activity in adipose tissue contributes to inflammation and insulin resistance in obesity. He explores its role in longevity, citing evidence that enhanced autophagy can improve health span and lifespan in animal studies.

Additionally, Ben examines how factors like insulin, nutrient availability, and diets such as ketogenic diets regulate autophagy, with ketones having a direct effect on boosting this process.

Throughout the lecture, Dr. Bikman underscores the need for balance in autophagy, warning against excessive or constant activation, whether through pharmacological means like rapamycin or mismanaged dietary habits, advocating instead for natural regulation via nutrient signals.

Show Notes/References:

For complete show notes and references referred to in this episode, we invite you to become a Ben Bikman Insider subscriber. As a subscriber, you’ll enjoy real-time, livestream Metabolic Classroom access which includes live Q&A with Ben, ad-free Metabolic Classroom Podcast episodes, show notes and references, Ben’s Research Reviews Podcast, and a searchable archive that includes all Metabolic Classroom episodes and Research Reviews. Learn more about becoming an Insider on our website: https://www.benbikman.com

Ben’s favorite yerba maté and fiber supplement: https://ufeelgreat.com/usa/en/c/InsulinIQ

Ben’s favorite meal-replacement shake: https://gethlth.com (discount: BEN10)

Ben’s favorite electrolytes (and more): https://redmond.life (discount: BEN15)

Ben’s favorite allulose source: https://rxsugar.com (discount: BEN20)

Ben’s favorite health check-up for women: https://choosejoi.co/drben15 (discount: DRBEN15)

Ben’s favorite health check-up for men: https://blokes.co/drben15 (discount: DRBEN15)

Ben’s favorite exogenous ketone: https://www.americanketone.com (discount: Ben10)

Other products Ben likes: https://www.amazon.com/shop/benbikmanphd

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Dr. Benjamin Bikman delves into the profound relationship between sleep and metabolic health, emphasizing the critical role sleep plays in maintaining insulin sensitivity and overall metabolic function.

Ben explains that deep sleep is a restorative phase during which the body repairs cells, regulates hormones, and improves insulin sensitivity. Poor sleep, however, disrupts these vital processes, leading to hormonal imbalances that elevate cortisol levels and reduce melatonin production.

Elevated cortisol, a stress hormone, promotes gluconeogenesis and insulin resistance, while insufficient melatonin—a hormone essential for regulating sleep—negatively impacts insulin sensitivity and glucose metabolism. This disruption creates a cycle of metabolic dysfunction, increasing the risk of conditions like type 2 diabetes and obesity.

Dr. Bikman highlights actionable strategies to improve both sleep and metabolic health. He stresses the importance of avoiding high-glycemic meals before bed, minimizing exposure to blue light from screens, and maintaining consistent sleep schedules.

He also discusses how ketones, especially in athletes after intense exercise, have been shown to improve sleep efficiency and REM sleep duration.

For individuals struggling with sleep, Dr. Bikman explores the potential benefits of melatonin supplementation and exogenous ketones, underscoring the need for personalized approaches. By addressing evening habits and understanding the hormonal interplay between sleep and metabolism, individuals can take meaningful steps to enhance both sleep quality and metabolic health.

This episode of The Metabolic Classroom provides valuable insights into how optimizing sleep can significantly improve overall well-being.

Timestamps:

(00:45) – Introduction to Sleep and Metabolic Health

(01:22) – Why Sleep is Essential for Insulin Sensitivity

(04:20) – How Cortisol Disrupts Sleep and Metabolism

(08:10) – The Unexpected Role of Melatonin in Metabolism

(19:35) – How Late-Night Eating and Blue Light Harm Sleep

(23:40) – Can Exogenous Ketones Improve Sleep Quality?

(28:20) – Practical Tips for Better Sleep and Metabolic Health

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We sincerely apologize! During the livestream recording, we experienced some technical difficulties between 07:15 to 08:50. Thanks for your patience and understanding.

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During The Metabolic Classroom lecture this week, Dr. Bikman dives into the intricate relationship between salt- and water-regulating hormones and metabolic health.

Starting with a discussion of the renin-angiotensin-aldosterone system (RAAS), he explains how hormones like angiotensin II, aldosterone, and antidiuretic hormone (ADH) are not only critical for regulating blood pressure but also significantly impact insulin sensitivity and fat cell dynamics. Angiotensin II promotes insulin resistance by increasing ceramide production, which blocks insulin signaling, while also enlarging fat cells and inhibiting their breakdown. Similarly, aldosterone exacerbates insulin resistance by enhancing ceramide levels and promotes both the growth and multiplication of fat cells. ADH complements these effects, particularly by inhibiting fat breakdown through its action on specific receptors.

Ben emphasizes the counterintuitive finding that salt restriction, often prescribed to manage hypertension, can worsen insulin resistance, particularly in individuals with metabolic vulnerabilities. Studies highlight that reducing salt intake leads to increased fasting insulin levels, impaired glucose metabolism, and unfavorable lipid changes, such as reduced HDL cholesterol. Additionally, he warns that dehydration, much like salt restriction, activates these same hormonal pathways, compounding their metabolic effects.

Dr. Bikman concludes with a reminder that interventions aimed at improving blood pressure should consider their broader metabolic implications, particularly for individuals predisposed to insulin resistance.

Show Notes/References:

For complete show notes and references referred to in this episode, we invite you to become a Ben Bikman Insider subscriber. As a subscriber, you’ll enjoy real-time, livestream Metabolic Classroom access which includes live Q&A with Ben, ad-free Metabolic Classroom Podcast episodes, show notes and references, Ben’s Research Reviews Podcast, and a searchable archive that includes all Metabolic Classroom episodes and Research Reviews. Learn more about becoming an Insider on our website: https://www.benbikman.com

Timestamps: (approximate)

(01:13) Overview of Salt- and Water-Regulating Hormones

(02:22) How Angiotensin II Influences Blood Pressure and Insulin Resistance

(06:37) The Metabolic Effects of Angiotensin II on Fat Cells

(11:22) Aldosterone’s Role in Insulin Resistance and Fat Cell Growth

(15:57) Metabolic Impacts of Antidiuretic Hormone (ADH)

(29:02) The Counterintuitive Effects of Salt Restriction on Metabolic Health

(33:13) The Role of Dehydration in Activating Metabolic Hormones

(34:51) Conclusion: How Blood Pressure Hormones Influence Metabolic Health

#MetabolicHealth #InsulinResistance #Hypertension #SaltAndHealth #BloodPressure #HormonesAndHealth #DrBenBikman #MetabolicSyndrome #LowCarbLife #Type2Diabetes #KetoLife #HealthyLifestyle #NutritionScience #MetabolismMatters #HealthEducation #FatCellBiology #InsulinSensitivity #SaltIntake #Dehydration #HealthTips

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This week in The Metabolic Classroom lecture, Ben focuses on the relationship between hypertension medications and metabolic health, providing a critical examination of their mechanisms and metabolic implications.

He begins by highlighting the role of insulin resistance as a common root cause of both hypertension and metabolic disorders. Ben explains that while hypertension medications such as diuretics, beta blockers, ACE inhibitors, ARBs, and calcium channel blockers are often prescribed, they each have unique effects on insulin sensitivity and glucose metabolism, which can either mitigate or exacerbate metabolic dysfunction. Notably, some classes of these medications, like ARBs, may improve insulin sensitivity, while others, like beta blockers and diuretics, can impair it, leading to heightened risks for type 2 diabetes.

Ben underscores the importance of addressing the root causes of hypertension—namely, insulin resistance—through lifestyle interventions like low-carbohydrate diets and fasting, which improve both blood pressure and metabolic health. He emphasizes the need for personalized treatment plans that consider the metabolic side effects of medications, advocating for strategies that tackle insulin resistance as a primary approach to improving overall health.

Show Notes/References:

For complete show notes and references referred to in this episode, we invite you to become a Ben Bikman “Insider” subscriber. As a subscriber, you’ll enjoy real-time, livestream Metabolic Classroom access which includes live Q&A with Ben, ad-free Metabolic Classroom Podcast episodes, show notes and references, Ben’s Research Reviews Podcast, and a searchable archive that includes all Metabolic Classroom episodes and Research Reviews. Learn more about becoming an Insider on our website: https://www.benbikman.com

Ben’s favorite yerba maté and fiber supplement: https://ufeelgreat.com/usa/en/c/InsulinIQ

Ben’s favorite meal-replacement shake: https://gethlth.com (discount: BEN10)

Ben’s favorite electrolytes (and more): https://redmond.life (discount: BEN15)

Ben’s favorite allulose source: https://rxsugar.com (discount: BEN20)

Ben’s favorite health check-up for women: https://choosejoi.co/drben15 (discount: DRBEN15)

Ben’s favorite health check-up for men: https://blokes.co/drben15 (discount: DRBEN15)

Ben’s favorite exogenous ketone: https://www.americanketone.com (discount: Ben10)

Other products Ben likes: https://www.amazon.com/shop/benbikmanphd

#MetabolicHealth #Hypertension #BloodPressure #DrBenBikman #InsulinResistance #MetabolicScience #FatCellBiology #Diuretics #BetaBlockers #ACEInhibitors #CalciumChannelBlockers #BloodPressureMedications #HealthTips #DASHDiet #InsulinSensitivity #FatCells #KetogenicDiet #LowCarbLiving #HealthyLifestyle #HeartHealth

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This week in The Metabolic Classroom, Ben explores the effects of a ketogenic diet on thyroid function, addressing concerns that lower thyroid hormone levels observed during the diet may indicate dysfunction.

Dr. Bikman begins by explaining the hypothalamic-pituitary-thyroid (HPT) axis, a regulatory system that controls thyroid hormone production. The thyroid gland produces two primary hormones, T3 (triiodothyronine) and T4 (thyroxine), with T3 being the active form that influences metabolic processes. He emphasizes the concept of negative feedback within the HPT axis, explaining that normal TSH levels generally indicate a well-functioning thyroid, even if T3 levels are lower.

Ben also reviews a commonly cited study that observed decreased T3 levels in individuals following a ketogenic diet. Despite the drop in T3, TSH levels remained normal, suggesting that the thyroid gland was not damaged but rather adapting to reduced metabolic demand. He introduces two key explanations: improved thyroid hormone sensitivity and reduced glucose metabolism. Improved sensitivity means that lower levels of T3 are sufficient to maintain metabolic functions, while reduced glucose consumption on a ketogenic diet lessens the body’s need for thyroid hormone to regulate glucose uptake.

The classroom lecture then delves into the concept of thyroid hormone resistance, a condition linked to metabolic disorders like obesity and type 2 diabetes. Dr. Bikman references studies showing that thyroid resistance is real and measurable, often associated with elevated TSH and thyroid hormones in individuals with metabolic syndrome. He speculates that a ketogenic diet may enhance thyroid sensitivity in these individuals, reducing the need for higher T3 levels.

In conclusion, Dr. Bikman reassures those on a ketogenic diet that lower T3 levels do not necessarily indicate harm. If TSH levels are normal and no symptoms of hypothyroidism are present, the changes may reflect a healthy adaptation to the metabolic state induced by the diet.

Show Notes/References:

For complete show notes and references referred to in this episode, we invite you to become a Ben Bikman “Insider” subscriber. As a subscriber, you’ll enjoy real-time, livestream Metabolic Classroom access which includes live Q&A with Ben, ad-free Metabolic Classroom Podcast episodes, show notes and references, Ben’s Research Reviews Podcast sent to your inbox weekly, and a searchable archive that includes all Metabolic Classroom episodes and Research Reviews. You can learn more about becoming an Insider on our website: https://www.benbikman.com

Ben’s favorite yerba maté and fiber supplement: https://ufeelgreat.com/usa/en/c/InsulinIQ

Ben’s favorite meal-replacement shake: https://gethlth.com (discount: BEN10)

Ben’s favorite electrolytes (and more): https://redmond.life (discount: BEN15)

Ben’s favorite allulose source: https://rxsugar.com (discount: BEN20)

Ben’s favorite health check-up for women: https://choosejoi.co/drben15 (discount: DRBEN15)

Ben’s favorite exogenous ketone: https://www.americanketone.com (discount: Ben10)

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In this week’s episode of The Metabolic Classroom, Dr. Bikman delivers a comprehensive lecture on hormone replacement therapy (HRT), focusing on its role in addressing metabolic health challenges faced by women during menopause.

The loss of estradiol causes fat to redistribute from healthier storage areas, like the hips and thighs, to the abdominal region, where larger fat cells become more insulin-resistant and pro-inflammatory. This shift contributes to systemic inflammation and elevates the risk of cardiometabolic diseases. Ben explains how HRT, particularly with estradiol, can mitigate these effects by improving insulin sensitivity, reducing inflammation, and promoting healthier fat storage patterns.

He also addresses historical concerns about HRT, including risks of blood clots and cancer. Dr. Bikman explains that oral estrogens may slightly increase clotting risks due to their first-pass metabolism in the liver, but transdermal delivery methods like patches and gels do not carry this same risk. Regarding cancer, he highlights how older studies, such as the Women’s Health Initiative, overstated the connection between HRT and breast cancer, particularly when using estrogen-only therapies. Ben emphasizes the importance of evaluating the absolute risks, which are relatively small.

Beyond its metabolic benefits, HRT also shows promise in protecting against conditions like Alzheimer's disease. Ben discusses studies suggesting that HRT, when started early in menopause, may improve cognitive outcomes, preserve brain volume, and reduce the risk of Alzheimer’s, particularly in women with the APOE4 gene. These findings suggest that timely HRT may support brain health alongside its other benefits.

In conclusion, Ben underscores the substantial metabolic and overall health changes women face during menopause and the potential for HRT to improve quality of life, metabolic health, and long-term outcomes. He stresses the importance of individualized HRT plans tailored to each woman’s unique circumstances, allowing for a nuanced approach to mitigating menopause-related challenges.

visit https://www.benbikman.com

Ben’s favorite yerba maté and fiber supplement: https://ufeelgreat.com/usa/en/c/InsulinIQ

Ben’s favorite meal-replacement shake: https://gethlth.com (discount: BEN10)

Ben’s favorite electrolytes (and more): https://redmond.life (discount: BEN15)

Ben’s favorite allulose source: https://rxsugar.com (discount: BEN20)

Ben’s favorite health check-up for women: https://choosejoi.co/drben15 (discount: DRBEN15)

Ben’s favorite health check-up for men: https://blokes.co/drben15 (discount: DRBEN15)

Ben’s favorite exogenous ketone: https://www.americanketone.com (discount: Ben10)

Show Notes/References:

Due to character length constraints, references are not posted here. However, for a complete list, we respond quickly. Please email: [email protected] with your request, and be sure to mention which Metabolic Classroom episode you are referring to, which in this case is “Episode 80 - Hormone Replacement Therapy in Women”.

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During Dr. Ben Bikman’s latest episode of The Metabolic Classroom lectures, Ben explores the metabolic effects of nicotine, emphasizing its influence beyond its addictive properties and its association with lung health and its connection to insulin resistance.

Nicotine, a naturally occurring alkaloid found primarily in tobacco plants, is widely consumed through various products such as cigarettes, cigars, chewing tobacco, e-cigarettes, and nicotine replacement therapies like gums and patches. While most discussions on nicotine focus on its addictive qualities and respiratory impact, Ben highlights its significant effects on metabolism, including interactions with fat cells, insulin, and the nervous system.

Nicotine primarily stimulates the sympathetic nervous system by increasing the release of catecholamines like epinephrine and norepinephrine. These stress hormones activate the “fight or flight” response, resulting in elevated heart rate, blood pressure, and metabolic rate.

Nicotine’s ability to increase lipolysis, the breakdown of stored fat into free fatty acids, often leads to temporary weight loss. However, its chronic use disrupts fat metabolism by impairing mitochondrial fat oxidation, leading to fat cell hypertrophy (enlargement). This enlargement, particularly in visceral fat, contributes to insulin resistance, fatty liver disease, and systemic inflammation.

Ben also examines nicotine’s role in insulin resistance through its activation of specific cellular pathways. Nicotine increases ceramide production, which disrupts insulin signaling by deactivating key proteins essential for glucose uptake. Additionally, nicotine activates receptors like RAGE (Receptor for Advanced Glycation End Products) and TLR4 (Toll-like Receptor 4), which further drive ceramide production and inflammation. This creates a self-perpetuating cycle that exacerbates metabolic dysfunction and promotes chronic insulin resistance.

The classroom lecture highlights the paradoxical nature of nicotine’s metabolic effects. While it temporarily enhances fat metabolism and weight loss, chronic exposure reverses these effects, promoting fat storage, inflammation, and severe insulin resistance. Ben emphasizes the metabolic risks associated with nicotine, especially in the context of rising vaping trends among younger populations. He concludes by urging greater awareness of nicotine’s systemic effects, particularly its hidden role in metabolic health.

visit: https://www.insuliniq.com

Ben’s favorite yerba maté and fiber supplement: https://ufeelgreat.com/usa/en/c/InsulinIQ

Ben’s favorite meal-replacement shake: https://gethlth.com (discount: BEN10)

Ben’s favorite electrolytes (and more): https://redmond.life (discount: BEN15)

Ben’s favorite allulose source: https://rxsugar.com (discount: BEN20)

Show Notes/References:

Due to character length constraints, references are not posted here. However, for a complete list, we respond quickly. Please email: [email protected] with your request, and be sure to mention which Metabolic Classroom episode you are referring to, which in this case is “Episode 79 - Nicotine and Insulin Resistance”.

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