Zoë chats with Dr Ben Bikman about the use and effects of GLP-1 Agonists – Zoë Harcombe

Bio

Benjamin Bikman earned his Ph.D. in Bioenergetics and was a postdoctoral fellow with the Duke-National University of Singapore in metabolic disorders.  Currently, his professional focus as a scientist and professor (Brigham Young University) is to better understand the role of elevated insulin and nutrient metabolism in regulating obesity, diabetes, and dementia. In addition to his academic pursuits, Dr. Bikman is the author of Why we get sick and How not to get sick.

Show notes

Ben and I first met at the Breckenridge low-carb conference in 2019. He was an immediate superstar on the presenting circuit. Ben explained that he’s a professor and lecturer, as well as a scientist, and the need to keep several 20 year olds entertained and educated has resulted in his engaging presentation style.

I think you’ll love this hour. We started off talking about Ben and his daughters seeing Taylor Swift in Amsterdam and ended up talking about how to balance positive messages on healthy eating without encouraging eating disorders. This is a minefield that parents of girls especially have to navigate.

I could talk to Ben about so many things – protein, exercise physiology, insulin resistance etc, but I wanted to talk to him today about the weight loss drugs that have exploded onto the market. Ben agreed that explosion was the right word. He has never before seen such a reaction to, and claims for, a drug.

We went through the science in a really understandable way:

– What did gastric bypass surgery teach us about incretins (gut hormones)?

– What happens to type 2 diabetes (T2D) within days of gastric surgery? Even before weight has been lost.

– What is GLP-1? What does it do? If it supresses glucagon and glucagon helps with breaking down fat, how does it achieve the weight loss that we are seeing?

– The primary drug being administered is semaglutide (brand names being Ozempic and Wegovy). How do they achieve weight loss? How did a drug for T2D become a drug for obesity? (At a higher dose – Ben mentioned the dose several times; it clearly concerns him.)

– What are the effects of semaglutide? i) Gastric emptying is slowed – what are the implications of this (some fatal). ii)  Fat breakdown (lipolysis) in fat cells. (But also an increase in the number of fat cells).

– 70% of people stop these drugs within 2 years. What are the implications for weight regain? For loss of lean tissue and regain of fat mass? For having an increased number of fat cells, now crying out to be fed?

– In what circumstances could the drugs be used to great effect? (Spoiler alert – to help adapt to a keto way of eating, which could then have sustained benefits long term).

– Many claims are being made for these drugs beyond T2D and obesity (heart disease, cancer, brain health ) – are they fair?

This elicited an interesting answer and led to a discussion about insulin resistance (IR), the prevalence thereof, Ben’s book writing, different signs of infertility with IR in men and women and how different ethnicities develop obesity and diabetes differently. This really was a very informative and engaging hour -we hope you enjoy it.