Why We Get Fat: the Bikman Interviews
- Thomas P Seager, PhD
- Sep 20
- 7 min read
Updated: 2 days ago
Ben Bikman PhD explains the role of insulin in fat cell growth and mitochondria for sex health, including erectile dysfunction & pregnancy
Summary
Ben Bikman, author of Why We Get Sick (Bikman 2020), explains how insulin impacts body composition, describing the indispensable role of insulin in the metabolism of fat cells in Episode 3 of the Uncommon Living podcast.
Hyperinsulinemia occurs when muscles and other cells in the body become insulin resistance, which causes the pancreases to overproduce insulin.
High levels of insulin interferes with fat metabolism, encouraging growth of white fat cells by increasing storage of triglycerides.
Every leading cause of death from chronic illness in the United States is associated with insulin resistance, hyperinsulinemia, and the resulting metabolic dysfunction.
Cold plunge therapy increases insulin sensitivity, restores fat-burning metabolic pathways, can resolce erectile dysfunction in men, and improve birth outcomes in pregnant women by avoiding complications of insulin resistance like gestational diabetes and pre-eclampsia.
One leading cause of death in the United States is not from chronic illness. It's iatrogenic injury, or death by medical error.
Metabolic dysfunction is "Why We Get Sick"
Brigham Young University Biology Professor Benjamin Bikman PhD is one of the world's foremost experts on the action of insulin in the body. In this book Why We Get Sick (Bikman 2020) he describes the connection between insulin resistance and the leading causes of death from chronic illness. Heart disease, stroke, Type 2 diabetes, non-alcoholic fatty liver disease, and cancer all originate in insulin resistance. Moreover, reproductive disorders, including erectile dysfunction, polycystic ovarian syndrome (PCOS), several complications that can emerge during late-stage pregnancy including pre-eclampsia and gestational diabetes are also closely associated with the metabolic irregularities that are characterized by insulin resistance.
However, the epidemic that precedes death from chronic illness is obesity. Although insulin resistance can coexist with lean body composition (Kay 2024), it is much more common for obesity to precede presentation of chronic illness--which begs the question "Why do we get fat?"
The oversimplified answer is that we eat more food calories than we burn off from exercise and resting metabolic rate. The dominant theory of body composition relies on a hypothetical energy balance called the Calories-in-Calories-Out (CICO) hypothesis. According to this approach, cold plunge therapy might be effective fore weight loss because of the way it boosts metabolism via thermogenesis. However, in Calories and Cold Exposure, I wrote about why that doesn't work for long-term weight loss.
Hyperinsulinemia is Why We Get Fat
In Episode 3 of Uncommon Living, Bikman challenged the oversimplified CICO hypothesis, clarifying that the insulin is the master regulator of metabolism. When insulin levels are high, it interferes with muscle metabolism and drives energy into growing fat stores instead. Without insulin, fat cells cannot grow. According to Bikman, it is chronically elevated insulin (hyperinsulinemia) that drives fat cell expansion and promotes metabolic disease.
Ketones are a Metabolic Superfuel
When dietary carbohydrates are scarce, the body switches from glucose metabolism to fat metabolism, and insulin levels remain low. Ketones are an intermediary product of fat metabolism. They provide fuel for the brain during periods of fasting or low-carb dieting and stimulate fat metabolism. Bikman notes that while ketones are sometimes feared due to associations with diabetic ketoacidosis (which is rare and dangerous in Type 1 diabetes), in healthy individuals ketosis supports metabolic flexibility and resilience.
In Ice Bath for Fast Keto I explain how cold plunge can trigger ketone production by activating the sympathetic nervous system, clearing glucose from the blood, and boosting free fatty acid release from fat cells. This metabolic switch accelerates ketogenesis for hours, even after a short ice bath.
How can we care for our mitochondria?
In my article Cancer Originates in Defective Mitochondria, I describe four routes to mitochondrial injury:
excess and incessant carbohydrate consumption,
poor light hygiene, which may interfere with melatonin production in the mitochondria and leave mitochondrial DNA vulnerable to damage from reactive oxygen species (ROS),
seed oils, which get incorporated into cell and organelle membranes and disrupt charge transport for ATP production, and
environmental toxins, like heavy metals, that poison mitochondria.
Bikman points out that metformin, the most popular and profitable drug prescribed for Type 2 diabetes, is a mitochondrial toxin. Specifically, he describes research showing that metformin will reverse the mitochondrial benefits of exercise. Bikman's insight led me to call a long-time Morozko customer who was taking metformin and having trouble getting his blood glucose readings down. His medical doctor recommended increasing his metformin dose.
I asked him if he'd consider discontinuing his metformin altogether, based on the study Bikman cited. My customer confessed it had never occurred to him, but he didn't see anything to lose so he'd give it a shot.
It worked, and I wrote about the results in Quit Metformin to Better Manage Blood Glucose.
Longevity gurus lack scientific standing
Bikman has very little respect for longevity "gurus," and for good reason. It's very difficult to conduct human trials in longevity. Humans are such long-lived creatures, that it would take decade to gather data on what therapies extend healthy life-span in human beings. For that reason, longevity studies are conducted using animal models, like lab mice or rabbits. The only consistent finding in those studies is that carbohydrate restriction consistently lengthens lifespan. Speculation about how ultimately returns to the mitochondria, and the adverse effects of excess carbs on mitochondrial function.
To circumvent the research problem of long lifespan in human beings, and to test whether successful interventions in animals can be extrapolated to human beings, many researchers use intermediate markers of biological age. That is, they attempt to calculate expected lifespan of a human subject using markers like telomere length or DNA methylation. In What Is Aging? Chronological vs Biological I described several of these markers and why I don't think they are an improvement on chronological age. Basically, I think the problem is that they all measure materials within the body, while life depends instead on energy flows. In my view, the better the energy flow, the better the life. Material markers, and especially those markers focused on the nucleus rather than the metabolism, aren't much good for assessing the state of energy flow in the body. Only energetic markers can do that.
Cold plunge during pregnancy
In our interview linked below, Bikman explained that insulin resistance is a normal, healthy physiological state during pregnancy, because the growth hormone from the placenta interferes with the normal action of insulin. However, just because a woman is insulin resistant during pregnancy does not mean it's normal for her blood glucose levels to be high. It only means that more insulin is needed to maintain stable blood glucose levels during pregnancy.
The danger during pregnancy is that physiological (healthy and normal) insulin resistance can go too far, and turn into a pathological insulin resistance that manifests as pre-eclampsia or gestational diabetes. Cold plunge therapy, especially during late-stage pregnancy, can improve insulin sensitivity, reduce swelling, support sleep, help enable light exercise like walking, and is associated with improved birth outcomes. I wrote about the metabolic benefits of cold plunge therapy for pregnant women in Cold Plunge During Pregnancy and Ice Bath Eases Pregnancy and talked about some of the women I know who have used it to their advantage.
Viagra vs ice bath (for erectile dysfunction)
Because we know from Ice Bath for Better Sex that mitochondria are responsible for the vasodilation that allows blood to flow to the penis to support an erection, it makes sense that cold plunge therapy would help maintain stronger, longer-lasting erections.
For example, Viagra works by stimulating mitochondria to produce nitric oxide that signals vasodilation for increased blood flow throughout the body, including the penis. It may be that Viagra works a little like metformin, by overcoming insulin resistance at the expense of the mitochondria, whereas cold plunge works by supporting mitochondria. That may be why Viagra can result in disturbances of eyesight, and fails to result in long-lasting mitochondrial improvements, despite its short-term benefits. Nonetheless, Viagra use is associated with improved long-term health outcomes resulting from better circulation, and it is even prescribed sometimes for infant who have suffered hypoxic brain injury as a way to restore blood flow and mitochondrial function.
Bikman and I agree that if you can stimulate your body to do what it's supposed to do for itself, that's better than taking a drug to do it for you.
Testosterone is another good example. Testosterone replacement therapy can cause a man's gonads to atrophy, making him dependent on steroid injections for the rest of his life. By contrast, both Bikman and I have seen a big boost in our total testosterone blood labs resulting from our practice of cold plunge therapy. In Cold Plunge Protocols to Boost Testosterone I explain how you can do the same.
Overdiagnosis & iatrogenic injury
There is one leading cause of death that does not originate in insulin resistance. It is called iatrogenic injury, which means "caused by a physician." Another term is "medical error" (Makary 2025) and it refers to mistakes that medical doctors make in the care of their patients that lead to death. These could include surgical errors, drug allergies or interactions, other adverse reactions to medications, or one of the most serious errors called overdiagnosis, which refers to diagnosis (and typically treatment) of healthy patients with conditions that they don't have. Depending on which database you cite, iatrogenic injury is either the first or third leading cause of death in the United States (Makary & Daniel 2016, Null et al. 2011).
How can this possibly be?
Dr. Gilbert Welch wrote a brilliant book called Overdiagnosed: Making People Sick in the Pursuit of Health (Welch et al. 2011) that explains how technologies and diagnostic standards for early detection increase iatrogenic errors, cause unnecessary medical interventions, and can ultimately kill people.
References
Bikman B. Why We Get Sick: The Hidden Epidemic at the Root of Most Chronic Disease--and how to Fight it. BenBella Books; 2020 Jul 21.
Kay AJ. 2024. Ice Baths and Ketosis Reversed My Type 2 Diabetes. Morozko Journal. Feb 2024. https://www.morozkoforge.com/post/ice-bath-carnivore-diabetes-keto
Makary M. Blind spots: when medicine gets it wrong, and what it means for our health. Bonnier Books UK; 2025 Feb 6.
Makary MA, Daniel M. Medical error—the third leading cause of death in the US. Bmj. 2016 May 3;353.
Null G, Dean C, Feldman M, Rasio D, Smith D. Death by medicine. United States: Axios Press; 2011.
Welch HG, Schwartz L, Woloshin S. Overdiagnosed: making people sick in the pursuit of health. beacon press; 2012 Jan 3.
About the Authors
Thomas P Seager, PhD is an Associate Professor in the School of Sustainable Engineering at Arizona State University. Seager co-founded the Morozko Forge ice bath company and is an expert in the use of ice baths for building metabolic and psychological resilience. Ben Bikman, PhD, is a Professor of Cell Biology and Physiology at Brigham Young University and one of the world's leading experts on the action of insulin in the human body.
nice the comments are back, i enjoy these random articles, interesting research.