Fat: Why it Matters and What to Do About It with Ben Bikman | The Metabolic Link Ep. 35

The script introduces the Metabolic Health Summit 2024, held in Clearwater Beach, Florida, and welcomes attendees to the 'Metabolic Link' podcast. Dr. Bman, a bioenergetics expert and professor at Brigham Young University, is introduced as the speaker. His focus is on understanding the role of insulin and nutrient signaling in metabolic disorders like obesity, diabetes, and dementia. Dr. Bman is also an author and co-founder of health code. The talk's title is 'Fat: Why It Matters and What to Do About It,' aiming to explore the significance of fat in health and disease.

Dr. Bman discusses the fat cell's role in metabolism, highlighting the problems associated with the global rise in metabolic diseases linked to insulin resistance. He explains the two primary ways fat mass grows: hypertrophy, where fat cells enlarge, and hyperplasia, where fat cells multiply. The issues with hypertrophic fat gain include cells reaching their maximum size, leading to insulin resistance, and hypoxia, or oxygen deprivation, which triggers a release of pro-inflammatory cytokines. The 'personal fat threshold' concept is introduced, suggesting that individuals have different limits to fat storage before metabolic issues arise.

The speaker delves into the paradox of fat cell size's impact on metabolic health, using the example of Caucasian and South Asian populations with the same body fat percentage. Despite equal fat mass, South Asians have more hypertrophic fat cells, which are associated with lower insulin sensitivity and higher insulin levels. This observation helps explain the higher rates of type 2 diabetes in South Asians compared to Caucasians, despite lower obesity rates.

Dr. Bman explores the factors influencing fat cell growth and reduction. He emphasizes the necessity of both elevated insulin and sufficient energy for fat cell growth, as insulin signals the cell to store energy. The speaker also discusses the hormonal regulation of fat storage, explaining how hormones like insulin communicate the body's overall needs to individual cells, preventing them from acting selfishly.

This section focuses on the hormonal aspects of fat cell growth and reduction, particularly the role of insulin. Insulin is shown to activate the intake of glucose and free fatty acids into the fat cell while inhibiting the release of stored fat. The speaker uses examples from his lab's experiments with fat cells to illustrate that without elevated insulin, fat cell growth is impossible.

Dr. Bman discusses scenarios where energy levels and insulin levels vary and their effects on fat cells. He explains that even with abundant energy, if insulin levels are low, fat cells will shrink due to increased energy expenditure and energy wasting. Conversely, if energy is restricted but insulin remains high, it creates a theoretical problem for the body, particularly the brain, which relies on a constant supply of energy.

The speaker addresses the severe consequences of insulin overdose and the importance of insulin levels in maintaining life. He explains that in cases of low energy intake, insulin levels must decrease to prevent the brain from being deprived of its energy sources. The discussion also touches on the flawed approach of many studies comparing low-calorie to low-insulin diets, emphasizing the need to account for the confounding variable of insulin levels.

Dr. Bman challenges conventional obesity research by suggesting that instead of focusing on weight loss, studies should investigate weight gain. He proposes hypercaloric diets and measuring which diet is more resistant to weight gain, thus providing insights into the endocrine origins of obesity. The speaker also highlights the need for more case studies and the importance of understanding the hormonal and energetic factors in fat cell dynamics.

In the final paragraph, Dr. Bman introduces a method to assess fat cell sensitivity without a biopsy. The Atopo Insulin Resistance (ATPO IR) index is calculated by multiplying insulin levels by free fatty acids, with different thresholds for men and women. This index can indicate whether an individual's fat cells are insulin-sensitive, providing a non-invasive way to gauge metabolic health.