Dr. Bikman dropped so much wisdom in this one — especially around how too much dietary fat isn’t the problem. What was your biggest “aha” moment from this episode? Let’s unpack it together 👇

Lauren are you new to youtube? How all of a sudden, here you are with he best minds in this space? Congratulations!

All her doctors are the best if the best. Her channel is gonna skyrocket. Bless you from italy

Dr. Bikman said he hasn't seen anyone gain weight on carnivore. I have, but it was desired weight gain. I had started carnivore to relieve pain from inflammation (and have been slowly losing weight; I'm down about 45 lbs in three years). My daughter is severely mentally handicapped and has several other health problems. I'd been having trouble getting her to eat - she'd eat a little one day, and then eat nothing the next day. She was down under a hundred pounds and looked like a famine victim - she's small, only 5'2" and fine-boned, but that was still too low. I put her on carnivore, too, and within weeks she was eating every day again and starting to gain weight. She gained about seventeen pounds, getting up to a reasonable weight for her size. In the last three years, I've tried to add things back into our diet several times, and each time she has had adverse effects (and so did I). Twice, she's gone back to not being able to eat, and has lost several pounds again, then regained it once she recovered by eating just meat. (I'm not happy about those losses of weight, but I think we are beginning to get a grip on what triggers it.) What I think is that carnivore allows the body to heal and recover to a normal weight, whether that involves losing weight, or gaining it.

Great interview with Dr. Bikman. He’s so intelligent and eloquent.

Dr. Bikman discusses lipotoxicity, a metabolic condition where the accumulation of excess fat (lipids) in non-fatty tissues—such as the liver, heart, muscle, and pancreas —disrupts normal cell function and leads to cell death or organ dysfunction.

He clarifies the specific type of fat that causes lipotoxicity, and how it relates to diet, particularly the  carnivore diet, and insulin resistance.

Dr. Bikman notes lipotoxicity is not caused by eating fat (like a ribeye). He emphasizes that the body typically burns dietary fat, especially when insulin is low.

True lipotoxicity is caused by the cell's accumulation of a specific type of fat called ceramides.

When ceramides accumulate, they cause two main problems:

1. Insulin Resistance, where insulin signaling cascade, preventing the hormone from working.

2. Mitochondrial Dysfunction, where cellurar mitochondria are forced to separate, which increases oxidative stress or "pollution" from the cells' energy engines.

Most stored fat in tissues (like in fatty liver) is triglycerides, which Bikman notes are "metabolically inert" and not inherently harmful. This is supported by the "athlete's paradox," where lean marathon runners have high levels of fat in their muscles yet are exquisitely insulin-sensitive.

For a cell to create the harmful ceramides, it needs the building blocks (fats) and a signal to direct those blocks into ceramide formation. The three primary signals that cause insulin resistance (and thus drive ceramide formation) are:

1. Chronically Elevated Insulin (Hyperinsulinemia), where too much insulin is a signal to store fat and promote ceramide accumulation.*

2. Inflammation

3. Stress Hormones (Cortisol and Epinephrine).

Dr. Bikman addresses why some people on a carnivore or very low-carb diet may see unexpectedly high blood glucose or A1C levels:

1. Elevated Glucose (Glucagon Response): The increase in blood glucose is likely due to an exaggerated glucagon response to dietary protein. Glucagon is insulin's opposite; it works to increase blood glucose.

2. Misleading A1C : The A1C test measures glucose and the lifespan of red blood cells (RBCs). A meat-rich diet may make RBCs more resilient and longer-lived. A longer lifespan increases the statistical likelihood of them becoming glycated, which could result in a false positive elevated A1C, even if the person is metabolically healthy.

Lipid Markers are Poor Predictors :  Dr. Bikman has a low enthusiasm for traditional lipid markers like LDL, Apo B, and LP(a) as predictors of heart disease, citing studies showing they are not as predictive as metabolic markers like Type 2 diabetes.

Focus on CAC : Dr. Bikman strongly favors the Coronary Artery Calcium (CAC) score, which directly measures hard plaque in the arteries. He acknowledges that if someone on a carnivore diet sees their CAC score go up, they should pay attention and perhaps monitor the composition of their fats, focusing on less saturated fat (or more monounsaturated/omega-3s such as fish oils).

Note: The Coronary Artery Calcium test is not covered by most insurance plans in the U.S., but out-of-pocket costs for the test are $100-400.

Dr. Bikman is always so clear and thorough in his explanations - I really enjoy listening to him as I learn a lot.

This video needs to be seen by every single person on a ketogenic diet. So clear. And answers so many questions many carnivores have with A1c climbing long term. Perfect. So glad I clicked on.

I heard Dr Nadir Ali speak about lipotoxicity due to south East Asians having a lower fat threshold like myself.  My numbers were beautiful for years. Until now.  I remained very lean eating a higher fat Ketogenic diet, but numbers to a big turn for the worst except my fasting insulin 2.9.  I dropped my fat intake, and my glucose improved surprisingly. My triglycerides dropped 40 pts in 5 wks.   I never would have believed it, but dropping the fat improved my metabolic markers.  

I appreciate you Dr Bikman, and I follow you a lot, but I have to disagree with you regarding eating fat.  There is such a thing as eating too much fat regarding their personal fat threshold.  I suggest you watch one of Dr Nadir Ali’s podcasts regarding lipotoxicity.

The GOAT of metabolism! Thank you for your precise questions for him!

Great interview!  Love Dr. Bikman so much❣️

Love Dr Bikman. So informative.

Note to Professor:

Any answer u provide is never too long... the more info u choose to share with ur audience, the better informed become the masses with proactive nutrition behavior. Thx for not dumbing down the science u share...

Keep reading & GL....

After carnivore for 3 months my A1c was 6.0 and fasting insulin was 3.5.  For 2 yrs prior i had been strict keto, checking glucose daily (no issues).  No cheating, strict all the way around.  I’m now back to keto!

This was a very timely video, especially his discussion of rising fasting blood sugar in low carbers at 8:40, which we've seen ourselves.

I eat keto. Steak. Etc. I added sweet potatoes and fermented food and bit of fruit.  Avocado..Cucumber..was vegan for 20 years and got sick. My friend is vegan and doesn't believe in keto and hates to eat meat etc. Meanwhile im a happy eater. He says hes happy eater but how can he be happy when eating soy .lol. soy taste like dirt lol. I love my grass fed beef. Eggs ..cheese. bacon. I smile 😊lol..im 71 and feel 50 lol

Thanks to both of you 😊

Hey 👋 I love your channel and story. Thanks for doing this for us. Absolute awesomeness!

A bit complicated, may need to watch again ... but I love Ben Bikman!

I like this guy. Have more of him.