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The Truth About Fat Storage & Ketones

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Dr. Benjamin Bikman answers questions about why we get fat and how to increase metabolic rate to burn fat

Dr. Ben Bikman Answers

Dr. Ben Bikman

Discover how low insulin levels influence fat storage and ketone production, and what this means for fat loss and metabolic health.

When Dr. Ben Bikman answers a listener’s question about eating fat with low insulin, he explains in simple terms how the body’s ability to store fat essentially “shuts off” when insulin is low, forcing the body to burn more fat, produce more ketones, and even waste some calories through breath and urine, highlighting why insulin control is central to fat loss and metabolic health.

Summary

In this short Q&A video, Dr. Ben Bikman addresses whether eating more fat than the body needs will lead to fat storage or ketone burning when insulin levels are low. He explains that most weight loss research is confounded because calorie reduction usually lowers carbohydrate intake and insulin at the same time, making it hard to separate calorie effects from insulin effects. Drawing on both historical and recent research, he argues that when insulin is low the body cannot store fat, so it increases metabolic rate, burns more fat, and raises ketone production, with some ketones (and their calories) being excreted through breath and urine. He concludes that to truly understand fat gain we need more hypercaloric studies comparing high fat and high carb diets under controlled conditions, but the mechanistic evidence strongly supports insulin as a key driver of fat storage.

Summary

  • Dr. Bikman highlights that traditional weight loss studies make it hard to distinguish the roles of calories versus insulin, because cutting calories usually reduces carbohydrates and insulin simultaneously, creating a major confounding variable in obesity research.
  • He argues that to truly understand why people gain fat, researchers must study hypercaloric diets and deliberately attempt to make subjects gain weight, comparing high carb low fat versus low carb high fat overfeeding while tracking fat gain and metabolic changes.
  • When insulin is low, he states that the body cannot store fat efficiently, so the excess fat is instead burned as fuel, leading to an increase in metabolic rate and greater overall energy expenditure even at the same calorie intake.
  • He cites evidence that low insulin states, including very low carb diets, raise metabolic rate in both historical studies and more recent work, such as research showing higher metabolic rates when meals have fewer carbohydrates but equal calories.
  • As insulin falls and fat burning rises, ketone production increases because insulin is one of the main signals that turns off ketogenesis, so with less insulin there is less inhibition of ketone formation.
  • Elevated ketones have caloric value, and when ketone levels rise the body begins eliminating ketones in breath and urine, so every ketone excreted represents calories that are effectively being dumped and not stored as fat.

Video description

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Dr. Ben Bikman responds to a question about fat storage and ketone production in the absence of insulin.

Ben explains that when insulin levels are low, the body cannot store fat and instead increases its metabolic rate, leading to fat being burned. Dr. Bikman highlights that low insulin promotes ketone production, and these ketones are eventually excreted through breath and urine, effectively eliminating calories.

Dr. Bikman points out the limitations in weight loss research, emphasizing the need to study hypercaloric diets to better understand fat gain mechanisms.

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Transcript Summary

Question about fat and low insulin

Sherry asks whether, in the absence of insulin or with low insulin (but not type 1 diabetes), eating more fat than the body needs will lead to storing the excess as fat or burning it as ketones, and Dr. Bikman says he appreciates the question because it hits a central problem in obesity science. He notes that much of his frustration with the biomedical literature on weight loss stems from the fact that nearly all studies are designed around weight loss, which makes it very difficult to determine if outcomes are driven by caloric restriction or by changes in insulin.

Limits of calorie-focused weight loss studies

He explains that when someone eating a standard American diet is put on a low calorie diet, they do not just eat less fat but less of everything, including carbohydrates, which naturally lowers insulin. Because insulin falls whenever overall intake (and especially carbs) declines, he argues that there is a huge confounding variable in these studies, making it impossible to draw solid conclusions about whether calories or insulin are the dominant driver of obesity.

Need for hypercaloric research

To truly answer why people get fat, Dr. Bikman says researchers should flip the usual approach and attempt to make subjects gain fat in controlled, hypercaloric experiments rather than focusing exclusively on calorie reduction and weight loss. He suggests comparing a hypercaloric low fat diet with a hypercaloric low carb diet to see which produces more fat gain, but notes that so far this has only been done in a single clinical case study in one individual, leaving the field with limited data.

Why low insulin blocks fat storage

After setting up this context, Dr. Bikman answers that when insulin is low it is impossible to store fat because insulin is the key hormone that allows fat storage to “work,” so without insulin the body must burn the fat instead. He describes two primary mechanisms for this: the body raises its metabolic rate to dispose of energy it cannot store, and it ramps up fat burning pathways, which in turn fuel ketone production.

Evidence that low insulin raises metabolic rate

He says this rise in metabolic rate with low insulin has been well established for about a century, including classic studies showing much higher metabolic rates when insulin is low or absent. More recently, he cites research by David Ludwig in non-diabetics, where participants were given two meals with the same calories but different fat to carbohydrate ratios, and the lower carb meal (with lower insulin) produced a higher metabolic rate.

Ketone production and calorie loss

With insulin down and fat burning up, the liver makes more ketones because insulin is a major signal that turns off ketogenesis, so when insulin is low there is less ability to shut down ketone production. He explains that ketones carry caloric value, and when they accumulate, the body eliminates them in breath and urine, so each ketone excreted represents calories literally leaving the body rather than being stored as fat.

Transcript Summary

Context of the listener question

Sherry in the absence of insulin or low insulin and not type 1 diabetes and you eat more fat than the body needs will the body store this excess as fat or burn as ketones Sherry I like that question and I appreciate it um one of the things that has frustrated me with regards to biomedical literature that has studied weight loss is that it’s always in fact studied weight loss this results in people not knowing is it calories or insulin because if you cut calories you take an individual who’s eating a standard American diet and then you put them on a low calorie diet they actually are eating less carbs than they were before as well we commonly think that all of a sudden they’re just eating less fat no they’re eating less of everything guess what happens to insulin when you’re eating less of everything insulin goes down so there is this unavoidable enormous confounding variable that prevents solid conclusions from any study that has ever tempted to tease out the caloric versus insulin view of obesity.

Why we need to study fat gain

Now why do I say that it’s because you’re touching on the other end which I appreciate I think to truly answer and understand the question of why we get fat we need to try to make people fat we need rather than doing low calorie studies that compare uh low fat to low carb or the caloric view or the low insulin view we need to try to make them fat and see which of these two diets a high hyper chloric lowfat diet or a hyper chloric low carb diet which can result in the least amount of fat gain this has been done and published but only in an n one single study and it was a clinical case of one single individual and so we are limited in what we can do.

What happens when insulin is low

So to answer the question now with all of this if insulin is low it is impossible to store fat it simply cannot work and thus um the body Burns it uh and it does so through um two primary mechanisms one it increases its metabolic rate this is very well established and we’ve known this for about a hundred years if insulin is low or absent metabolic rate is much much higher even more recently David lwig has found this and non-diabetics give people two different meals that are the same in calorie number but differ in the fat to carb ratio the lower the carbs of course the lower the insulin and the higher the metabolic rate so you have an increased metabolic rate allowing the body to get rid of what it cannot store but at the same time as you’re burning more fat because insulin is down you’re making more ketones because there’s nothing to turn ketogenesis off or there’s less ability to turn it off because insulin turns it off and when ketones are high ketones have a caloric value and when you’re making ketones you start eliminating Ketone so every Ketone that’s coming out in the breath every Ketone that’s being excreted in the urine those are calories that are just directly dumping from the body okay.

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