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In this week’s episode of the Metabolic Classroom lectures, Dr. Ben Bikman explores the metabolic impact of ADHD medications and whether ADHD itself has metabolic roots.

Ben explains how stimulant medications (like Adderall and Ritalin) primarily work by increasing dopamine and norepinephrine, enhancing focus but also suppressing appetite and stimulating fat breakdown. This can lead to weight loss but may also contribute to binge eating episodes when the medication wears off. Non-stimulant ADHD medications (like Atomoxetine and Guanfacine) affect metabolism in different ways—some subtly improve insulin sensitivity, while others reduce fat breakdown, potentially leading to weight gain.

Beyond medication, Dr. Bikman discusses ADHD as a possible metabolic disorder. Studies show that individuals with ADHD often have reduced glucose metabolism in the prefrontal cortex, the brain region responsible for attention and impulse control. He highlights research linking chronic sugar consumption to dopamine imbalances and brain energy instability, suggesting that modern dietary habits may be worsening ADHD symptoms.

One potential solution? Ketones as an alternative brain fuel. Dr. Bikman shares research on the ketogenic diet as a therapy for ADHD, similar to its use in epilepsy and Alzheimer’s disease. By shifting the brain’s energy source from glucose to ketones, individuals may experience more stable brain function and improved focus. He concludes that ADHD may not just be a neurological condition—it could also be a metabolic issue, and targeting brain metabolism may offer new treatment possibilities.

Show Notes/References:

For complete show notes and references referred to in this episode, we invite you to become a Ben Bikman Insider subscriber. As a subscriber, you’ll enjoy real-time, livestream Metabolic Classroom access which includes live Q&A with Ben, ad-free Metabolic Classroom Podcast episodes, show notes and references, Ben’s Research Reviews Podcast, and a searchable archive that includes all Metabolic Classroom episodes and Research Reviews. Learn more about becoming an Insider on our website: https://www.benbikman.com

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Dr. Bikman’s Metabolic Classroom lecture this week explores the physiological role and implications of GLP-1 (glucagon-like peptide-1) and the GLP-1 receptor agonist drugs used for type 2 diabetes management and weight loss.

Ben begins by explaining GLP-1 as a hormone produced in the intestines in response to food. It plays a vital role in slowing gastric emptying, suppressing glucagon, and regulating appetite by signaling fullness to the brain. These mechanisms contribute to its effects on stabilizing blood sugar and enhancing insulin sensitivity.

He then delves into GLP-1 receptor agonists, drugs that mimic GLP-1’s actions, including semaglutide, liraglutide, and others marketed under brand names like Ozempic and Wegovy. These medications have gained fame for their weight loss efficacy, often leading to reductions in body weight by 15% or more.

However, Ben emphasizes that weight loss involves not only fat but also lean mass, raising concerns about muscle loss and metabolic health. Additionally, he discusses the medications’ side effects, including depression, anhedonia, and potential long-term complications like fat cell development and gallstones.

The lecture also addresses the diminishing returns of these drugs over time, noting that their efficacy in reducing cravings and improving eating control tends to wane after prolonged use. Dr. Bikman highlights that education on healthy eating and resistance training is crucial for maintaining health outcomes, as reliance solely on medication can lead to unintended consequences, such as increased fat regain after discontinuation.

Ben concludes by stressing the importance of combining these drugs with a low-carb diet and resistance training to minimize muscle loss and optimize long-term outcomes. He encourages using the lowest effective dose and underscores the need for lifestyle changes to complement pharmacological interventions.

Show Notes/References:

For complete show notes and references referred to in this episode, we invite you to become a Ben Bikman Insider subscriber. As a subscriber, you’ll enjoy real-time, livestream Metabolic Classroom access which includes live Q&A with Ben, ad-free Metabolic Classroom Podcast episodes, show notes and references, Ben’s Research Reviews Podcast, and a searchable archive that includes all Metabolic Classroom episodes and Research Reviews. Learn more about becoming an Insider on our website: https://www.benbikman.com

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Learn more about becoming an Insider: https://www.benbikman.com

This week, Dr. Bikman’s lecture focuses on metabolic surgeries (also called bariatric surgeries), their mechanisms, and their impacts on weight loss and metabolic health.

Ben begins by explaining the qualifications for these surgeries, which often serve as a last resort for individuals with severe obesity or comorbidities like type 2 diabetes. Common qualifications include a BMI of 40 or higher, or lower BMIs with conditions like hypertension or diabetes. These surgeries aim to address obesity and related health complications when traditional methods, like diet and exercise, fail.

Dr. Bikman describes four primary types of metabolic surgeries: Roux-en-Y gastric bypass, sleeve gastrectomy, biliopancreatic diversion with duodenal switch, and adjustable gastric banding. He explains their procedures, including how they alter digestion, absorption, and stomach size, leading to weight loss through restriction and malabsorption. These surgeries also bring significant hormonal changes, such as increases in GLP-1 and reductions in ghrelin (hunger hormone), contributing to satiety and metabolic improvements.

While these surgeries can dramatically improve insulin sensitivity, reduce glucagon levels, and improve conditions like type 2 diabetes, they come with risks. Nutrient deficiencies, surgical complications, dumping syndrome, and weight regain are significant concerns. Younger patients are particularly prone to weight regain, especially if they don’t adopt sustainable eating habits. Dr. Bikman emphasizes the need for education on managing macronutrients and maintaining long-term behavioral changes.

Ben concludes that metabolic surgeries can be a valuable tool for those with severe obesity and related complications. However, he warns of their limitations and advocates for coupling them with lifestyle changes to optimize long-term success.

Show Notes/References:

For complete show notes and references referred to in this episode, we invite you to become a Ben Bikman Insider subscriber. As a subscriber, you’ll enjoy real-time, livestream Metabolic Classroom access which includes live Q&A with Ben, ad-free Metabolic Classroom Podcast episodes, show notes and references, Ben’s Research Reviews Podcast, and a searchable archive that includes all Metabolic Classroom episodes and Research Reviews. Learn more about becoming an Insider on our website: https://www.benbikman.com

Hosted on Acast. See acast.com/privacy for more information.