Dr. Benjamin Bickman, a metabolic scientist, argues that insulin—not calories—is the primary hormone governing weight gain and loss, and that a ketogenic diet is the most practical strategy for sustainable fat loss because it lowers insulin, reduces hunger, and shifts the body into fat-burning ketosis.
Why Insulin Matters More Than Calories
Insulin is the master metabolic hormone: it tells every cell in the body what to do with energy, and when elevated, it directs calories into storage in fat cells and the liver rather than allowing them to be burned.
Calorie-centric weight loss fails because it ignores insulin: two isocaloric meals with different macronutrient compositions produce vastly different metabolic responses—the lower-carb, higher-fat meal results in a higher metabolic rate and less hunger because it doesn’t spike insulin.
When insulin spikes, it drives glucose and ketones out of the blood and into storage, leaving the brain energy-deprived despite abundant body fat—this is why people feel hungry even when carrying excess energy.
It is physiologically impossible to gain fat without insulin: people with untreated type 1 diabetes (no insulin) cannot gain weight regardless of calorie intake, and when given insulin therapy, they gain weight rapidly even while eating less.
Some type 1 diabetics deliberately underdose insulin to stay thin—a dangerous practice that nonetheless demonstrates insulin’s singular power over fat storage.
Ketones: The Brain’s Preferred Fuel
Ketones (primarily beta-hydroxybutyrate, or BHB) are produced by the liver when insulin is low, during fasting or carbohydrate restriction, typically becoming measurable after about 16 hours without food.
The liver cannot store fat when insulin is low—it must burn it, and when it burns more fat than it needs, it produces ketones to share energy with the brain, which cannot burn fat directly.
Ketones serve dual roles: they are both a fuel source and a signaling molecule that tells cells what to do, similar to a hormone.
Unlike glucose, ketones enter cells without needing insulin—any cell with mitochondria can use them immediately.
Ketones provide stable, consistent energy to the brain, avoiding the glucose volatility (highs and lows) that drives cravings, brain fog, and what Bickman describes as a form of metabolic “abuse” on the brain.
BHB acts as an anxiolytic, reducing anxiety and stress hormone signaling in the brain, and has shown benefits for depression, attention, memory, and neurodegenerative diseases including Alzheimer’s.
The heart is the second organ that thrives on ketones: in heart failure, the heart shifts to ketone fuel, and a specific form (L-BHB) has been shown in pig models to increase cardiac output by 40% by expanding the great blood vessels via nitric oxide signaling.
Bickman personally experienced a rapid drop in blood pressure (from 139/90 to 110/70 within an hour) after taking L-BHB, which he attributes to vasodilation.
The Ketogenic Diet in Practice
A ketogenic diet works because it removes hunger as a barrier: by lowering insulin and providing ketones, the brain is consistently nourished, eliminating the cravings and deprivation that cause most diets to fail.
Bickman’s personal protocol for 2026:
No carbs at breakfast or lunch; eat as much protein and fat as desired.
Skip breakfast or keep it very light; make lunch the largest meal to reduce evening cravings.
Dinner is the family social meal—eat whatever the family eats, including carbs if desired.
Stop eating by early evening; never snack at night, as evening hypoglycemia activates the sympathetic nervous system and ruins sleep.
Morning routine: ice bath at 5 a.m. to regulate circadian rhythm, followed by a ruck (weighted hike), then resistance training mid-morning, followed by sauna.
Sip yerba mate instead of coffee—it has a GLP-1 effect that promotes satiety.
Women can do keto but should account for hormonal cycles: during the follicular phase (post-menstruation), women burn fat faster and enter ketosis more easily than men; during the luteal phase (post-ovulation), progesterone increases hunger and cravings, so women should be more generous with themselves during this phase.
Concerns about keto raising cortisol in women are overblown: a study by Dr. Isabella Cooper found no statistically significant change in cortisol when women switched between keto and high-carb diets over 21-day periods.
Keto is not appropriate for everyone: people with insulinomas (insulin-secreting pancreatic tumors) cannot adopt low-carb diets because their unregulated insulin production causes dangerous hypoglycemia when carbs are restricted.
Exogenous Ketones
Exogenous ketones can help people transition into ketosis and mitigate muscle loss during weight loss—Bickman’s lab recently published a finding that BHB supplementation helped humans retain more lean mass during weight loss.
Forms of exogenous ketones:
Ketone salts (BHB bound to sodium, calcium, or potassium).
BHB esters (BHB bound to a precursor molecule, broken down during digestion).
Ketone precursors like 1,3-butanediol (marketed as Ketone IQ), which the liver converts into BHB.
Straight BHB acid in D-form or L-form.
Bickman tested Ketone IQ on camera: his blood ketones rose from 0.3 to 0.9 mmol/L within 30 minutes.
L-BHB specifically shows promise for cardiovascular health through nitric oxide-mediated vasodilation.
Cancer, Sugar, and the Warburg Effect
Cancer cells are glucose-dependent: they rely primarily on glucose (and glutamine) for fuel, a phenomenon known as the Warburg effect, championed by Dr. Thomas Seyfried.
Seyfried’s experiments showed that cancer is a mitochondrial/metabolic disease, not a nuclear/genetic one: transplanting the nucleus of a cancer cell into a healthy cell did not produce cancer, but transplanting cancer mitochondria into a healthy cell did.
Bickman follows a ketogenic diet partly because his mother died of cancer—he views glucose restriction as a way to starve potential cancer cells.
The BBC and other institutions have attacked Seyfried’s work as misinformation, which Bickman sees as an example of institutional resistance to disruptive metabolic science, particularly when it threatens conventional treatment paradigms or pharmaceutical revenue models.
GLP-1 Drugs (Ozempic/Semaglutide)
GLP-1 drugs work by reducing appetite and dramatically slowing gastric emptying (food can sit in the stomach for 24 hours instead of 4–6), but they have significant limitations:
Cravings return to baseline after about two years as the body develops tolerance.
Roughly 70% of people stop taking the drug within two years, mostly due to persistent nausea.
For every pound lost, approximately 40% comes from lean mass (muscle and bone), which may not be regained after stopping the drug—a particular concern for older adults.
Bickman’s recommended approach: use GLP-1 drugs at a low dose, cycled in 90-day periods, combined with coaching on a low-carb diet—this helps people break carb addiction while the drug is active, and many find their cravings remain low after weaning off.
A clinic in Idaho using this protocol (low-dose cycled GLP-1 plus low-carb counseling) has produced results outperforming drug-only trials, with better fat loss and muscle retention over two to three years.
Natural GLP-1 stimulation alternatives:
Allulose (a rare sugar that is non-metabolizable but triggers GLP-1 production in the gut).
Collagen peptides.
Yerba mate.
Supplements and Vitamins
Bickman is concerned that excessive B-vitamin intake may be contributing to obesity: livestock studies show that B-vitamin supplementation can triple the efficiency of weight gain per calorie consumed, and B-vitamins are heavily added to fortified processed foods like flour.
The irony: people take B-vitamins to “boost metabolism,” but metabolic efficiency is counterproductive for weight loss—an inefficient metabolism that wastes energy is preferable.
Supplements Bickman recommends:
Omega-3 (if not eating fatty fish): meaningful for muscle building, not just heart health.
Creatine: 5 g/day for muscle; 10–15 g/day for cognitive benefits. It recycles ATP, improving both physical performance and brain energy. It is especially important for sleep-deprived individuals and for women (who suffer Alzheimer’s at higher rates). Vegetarians and vegans are particularly likely to be deficient. Elevated creatinine on blood tests is an expected artifact of supplementation, not a sign of kidney damage—no study has shown kidney damage from creatine even at 20 g/day.
Collagen peptides: for skin integrity and GLP-1 stimulation.
Ashwagandha: an adaptogen shown to improve sleep and reduce cortisol.
Exogenous ketones (BHB or precursors).
Stress, Sleep, and Alcohol
Poor sleep is a primary cause of stress, which is one of three causes of rapid-onset insulin resistance (developing within hours).
Alcohol worsens sleep quality despite helping people fall asleep faster—it leads to higher cortisol, greater insulin resistance the next day, increased cravings, and more efficient fat storage.
Evening hypoglycemia (from late-night carb snacking) activates the sympathetic nervous system, raising heart rate and body temperature at the worst possible time—when the body needs the calming parasympathetic system for sleep.
Bickman’s sleep-improvement strategy: cut alcohol, avoid eating before bed, consider ashwagandha, and use a CGM to identify personal glucose spikes that correlate with poor sleep.
Testing and Monitoring
Fasted insulin should be added to standard blood panels: a level at or below 7 µU/mL is ideal; combined with glucose, it can be used to calculate the HOMA-IR score for insulin resistance.
Continuous glucose monitors (CGMs) are powerful self-motivation tools: seeing real-time glucose responses to specific foods helps people make lasting dietary changes without external nagging.
CGMs can be stacked with other wearables (like Whoop) to correlate glucose patterns with heart rate variability and stress.
Bickman made his biggest sleep improvement discovery through a CGM: he found that evening glucose spikes were causing his poor sleep, and cutting them transformed his rest.
Testosterone levels should be checked in middle-aged men experiencing fatigue and weight gain—low testosterone is correctable, and cold plunges combined with post-plunge workouts have been anecdotally reported to double testosterone levels.
At-home blood testing services (like Blok and Joy) now allow people to mail in blood samples for comprehensive panels without visiting a clinic.
Final Advice for Someone Struggling to Lose Weight
Have a reason beyond yourself—for parents, the motivation of being healthy for your children can sustain change when self-motivation falters.
Start with one habit: change the thing you know you should change (e.g., cutting alcohol), and let the positive effects cascade into other areas like sleep, cravings, and insulin sensitivity.
Control your carbohydrate addiction first—carbs are the macronutrient people are most addicted to, and addressing this is foundational.
Eat a large lunch to reduce evening cravings.
Recruit outside help—don’t rely on willpower alone.
Get your insulin and testosterone levels checked.
Use tools like CGMs, exogenous ketones, and targeted supplements to support the transition.
