Benjamin Bikman's Central Hypothesis
In his book Why We Get Sick, Benjamin Bikman presents a powerful argument: many of today's most prevalent chronic diseases, such as obesity, type 2 diabetes, and heart disease, are rooted in a single underlying metabolic issue—insulin resistance. His research and dietary philosophy emphasize that controlling the hormone insulin is the most effective way to restore metabolic health and prevent chronic illness. Carbs, particularly processed ones, play a central role in this mechanism by being the macronutrient with the most significant impact on insulin secretion.
The Misconception of Dietary Carb Necessity
One of the most foundational points Bikman makes regarding carbohydrates is the distinction between blood glucose and dietary carbs. While certain cells, like red blood cells, require glucose for fuel, the body does not have a biological need for dietary carbohydrates. Through a process called gluconeogenesis, the liver can create all the glucose the body needs from other sources, such as amino acids and lactate, even in the absence of dietary carbs. This metabolic flexibility is a key argument Bikman uses to advocate for a low-carb approach, asserting that we can thrive without them.
The Insulin-Glucagon Dynamic
Bikman often highlights the contrasting and critical relationship between insulin and glucagon, two pancreatic hormones that regulate blood glucose.
- Insulin: A storage hormone released in response to rising blood glucose, primarily from carbohydrate intake. It signals cells to absorb glucose, and excess glucose is converted to fat.
- Glucagon: Acts in opposition to insulin, signaling the body to release stored energy. It promotes the breakdown of fat and glycogen and triggers gluconeogenesis when insulin levels are low.
By keeping carbohydrate intake controlled, a low-carb diet helps maintain a low insulin-to-glucagon ratio, a state that mimics fasting. This promotes the mobilization and burning of stored fat for energy instead of continuously storing it. In contrast, a high-carb diet keeps insulin constantly elevated, pushing the body into a perpetual fat-storing mode.
Carbs to Control: Quality Over Quantity
Bikman’s view on carbohydrates is not a blanket declaration of war against them but a call for mindful consumption, prioritizing quality over quantity. He provides clear guidance on which carbs to minimize and which to include in moderation.
Prioritized Carbohydrates
- Above-Ground Vegetables: Bikman recommends focusing on vegetables that grow above the ground, such as leafy greens, broccoli, cauliflower, and zucchini. These are generally lower in starch and have a modest effect on glucose and insulin.
- Fruits (Limited): While fruits contain natural sugars, Bikman suggests limiting intake and focusing on lower-glycemic options like berries, which have a lower impact on insulin levels.
- Fruits vs. Juices: He emphasizes eating fruits whole rather than drinking fruit juice. Whole fruits contain fiber that slows sugar absorption, while juices cause a rapid insulin spike.
Carbohydrates to Avoid
- Refined Sugars and Grains: This includes foods that come "in a bag or box with a barcode," such as candy, sugary drinks, pastries, white bread, and white rice.
- Processed Foods: Snacking foods high in carbs, preservatives, and artificial additives should be minimized or eliminated.
- Starchy Vegetables: If stricter carb control is needed, particularly for individuals with insulin resistance or type 2 diabetes, he advises caution with starchy, below-ground vegetables like potatoes.
Comparison Table: Carb Sources
| Feature | Processed/Refined Carbs | Bikman-Approved Carbs (Whole Foods) |
|---|---|---|
| Impact on Insulin | High insulin spike | Modest insulin response |
| Nutrient Density | Low or minimal nutrients | High in vitamins, minerals, and fiber |
| Processing Level | Highly processed | Minimally processed |
| Fiber Content | Low or absent | High, slows sugar absorption |
| Associated Health Risk | High risk for insulin resistance | Supports metabolic health and insulin sensitivity |
| Satiety | Low, leading to overeating | High, promoting fullness |
Practical Application and Context
Bikman’s approach is centered on a broader metabolic picture that includes lifestyle factors beyond just carbohydrates. He stresses that while low-carb is an effective strategy, it is not the only way to control insulin. Other factors that influence insulin sensitivity include stress management, adequate sleep, and exercise. He views diet as an individual experiment, recognizing that some people may have a higher glucose tolerance than others based on genetics and health history. This personalized approach empowers individuals to find the right balance for their own metabolic health goals.
The Importance of Overall Diet Quality
While controlling carbs is a cornerstone of his philosophy, Bikman's dietary recommendations are not just about removal but also about prioritizing quality foods. Alongside controlling carbs, his guidance includes:
- Prioritizing high-quality, nutrient-dense protein.
- Including healthy fats, such as olive oil and avocados, which have a minimal impact on insulin.
- Avoiding inflammatory vegetable oils and trans fats.
This holistic perspective ensures that reducing carbs doesn’t come at the cost of overall nutrition. By balancing macronutrients in a way that minimizes insulin spikes, the body can shift from primarily storing fat to efficiently burning it for energy.
Conclusion
Benjamin Bikman's stance on carbohydrates is nuanced and rooted in a deep understanding of insulin's hormonal role in the body. He challenges the outdated notion that all calories are equal and posits that the type of food, particularly the quality and quantity of carbs, profoundly affects our metabolic health. By emphasizing the reduction of refined, processed carbohydrates and prioritizing whole food sources like above-ground vegetables and moderate fruits, Bikman provides a clear, evidence-based roadmap for reversing insulin resistance and combating chronic disease. The focus shifts from counting calories to balancing hormones, offering a sustainable path toward better metabolic well-being. For more on the research-backed benefits of a low-carb diet for improving insulin sensitivity, you can explore resources on metabolic health, including insights shared by Bikman on the Levels blog.
