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In this week’s lecture, Dr. Bikman explores the metabolic origins of acne, challenging the conventional view that acne is purely a skin issue. While acne is often attributed to excess oil production, clogged pores, bacteria, and inflammation, Ben highlights how metabolic factors—especially insulin—play a significant role.

Insulin directly stimulates sebaceous glands, increasing oil production, and also triggers the release of androgens (such as testosterone), further worsening acne. Additionally, insulin resistance promotes inflammation and hyperkeratinization, both of which contribute to acne severity.

He explains that puberty naturally induces a state of insulin resistance, which helps drive growth and development. However, when combined with modern high-carbohydrate diets, this physiological insulin resistance can be exacerbated, leading to severe acne in some teenagers. He also discusses the role of insulin-like growth factor 1 (IGF-1), which is stimulated by high insulin levels and is known to increase sebum production and accelerate skin cell turnover, worsening acne conditions.

Ben then presents compelling research on metabolic-based acne treatments, including the use of metformin, an insulin-sensitizing drug that has shown promise in reducing acne, particularly in conditions like PCOS. He also highlights dietary interventions, particularly low-carbohydrate and ketogenic diets, which have been found to significantly reduce acne severity by lowering insulin and improving skin health. One study found that young women on a ketogenic diet saw a 33% reduction in acne severity and a 50% improvement in skin quality within just 45 days.

He concludes that acne is not just a cosmetic issue but a metabolic condition that can be managed through dietary and lifestyle changes. While conventional acne treatments address symptoms, tackling insulin resistance through proper nutrition provides a long-term solution. He encourages those struggling with acne to focus on cutting out refined carbohydrates, prioritizing protein, and embracing healthy fats to regulate insulin levels and improve skin health.

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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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