The Metabolic Link

Join us for a FREE live Q&A with Dr. Salcedo on September 10 at 9:00 AM PT / 12:00 PM ET and ask her your questions directly. Register here.
What if the uterus is an end organ, responding to insulin and inflammation the same way the heart, kidneys, and liver do?
Dr. Andréa Salcedo is a board-certified OBGYN (DO, MPH, FACOG) and associate professor at Loma Linda University School of Medicine whose research and clinical practice, which she calls conscious gynecology, examine gynecologic disease through a metabolic lens.
In this episode she walks through the evidence that uterine fibroids share progenitor cells with atherosclerotic plaque, why she now teaches residents that fibroids are cardiovascular disease of the uterus, and how high insulin acts at the level of the brain stem to block ovulation. The conversation also covers her clinical observations on fasting insulin thresholds by body type, the renaming of PCOS to PMOS, what hormonal contraceptives do and do not treat, the role of chronic stress and adversity in gynecologic disease, and the four insulin-resistant transitions of a woman's life.
Questions Answered in This Episode:
Why are uterine fibroids being reframed as cardiovascular disease of the uterus?
Can the menstrual cycle function as a metabolic vital sign?
How does insulin, acting as a stress hormone, shut down ovulation?
Is there an optimal fasting insulin for reproductive health, and does body type change the answer?
What does the shift from PCOS to PMOS change for diagnosis and treatment?
What happens to insulin resistance in perimenopause, and was the Women's Health Initiative misread?
Viewers will come away with a physiological framework that treats heavy periods, fibroids, irregular cycles, and PCOS as early signals of metabolic dysfunction rather than isolated hormone problems.
Special thanks to the sponsors of this episode:
✅ Genova Connect: Get 15% off any Genova Connect test kit with code METABOLICLINK here.
✅ Cowboy Colostrum: Get 25% off your entire order with code METABOLIC here.
✅ Zocdoc: Find and instantly book a top-rated doctor here.
✅ fatty15: Get 15% off a 90-day starter kit with code METABOLICLINK here.
More Links
Live Q&A with Dr. Salcedo, September 10, 9:00 AM PT (free): register here
Dr. Salcedo's website: consciousgynecology.com
Dr. Salcedo on YouTube: @consciousgynecologist
Dr. Salcedo on Instagram: @consciousgynecologist
Paper: The uterus is an end organ: a preliminary study of the association between abnormal uterine bleeding and hyperinsulinemia (Menopause, 2025)
Paper: Therapeutic Carbohydrate Restriction as a Metabolic Modality for the Prevention and Treatment of Abnormal Uterine Bleeding (Nutrients, 2023)
Dr. Salcedo is speaking on chronic stress, adversity, and gynecologic health at the Ketogenic Foundation conference
The Metabolic Initiative (expert lectures, CME, ad-free episodes, live Q&As; first 7 days free): membership.metabolicinitiative.com
In every episode of The Metabolic Link, we'll uncover the very latest research on metabolic health and therapy. If you like this episode, please share it, subscribe, follow, and leave us a comment or review on whichever platform you use to tune in!

You can find us on all your major podcast players here and full episodes are also up on our Metabolic Health Summit YouTube channel!

Find us on social: 
Instagram
Facebook
YouTube
LinkedIn
Please keep in mind: The Metabolic Link does not provide medical or health advice, but rather general information that does not serve as a substitute for a licensed healthcare professional. Never delay in seeking medical advice from an appropriately licensed medical provider for any health condition that you may have.

Today we are doing something we have never done before.
Once a month, members of The Metabolic Initiative get an hour to put their own questions directly to the scientists and clinicians at the forefront of metabolic health. Those sessions stay inside the platform. This one does not.
After Dr. Ben Bikman joined us for episode 100, the questions kept coming. So we invited him back to sit with Dr. Dominic D'Agostino and MHI co-founder Victoria Field for a live member Q&A, and for the first time we are releasing the full session publicly.
What came out of it: GLP-1 medications and the muscle loss debate, and how Ben's own position on these drugs has shifted. Insulin resistance and ceramides. Exogenous ketones, and when they may actually be useful. Metabolic approaches to cancer and the glucose ketone index. Exercise timing. Type 1 diabetes. Cortisol and fat distribution. Supplements.
Questions Answered in This Episode:
The muscle loss debate around GLP-1s has become polarized. Should clinicians be worried about muscle loss, muscle function, or neither?
If you were diagnosed with cancer, are there any metabolic therapies you would start immediately?
How long can it take for ceramides in adipose tissue to resolve — and insulin resistance to improve?
Bioidentical D-BHB exogenous ketones are substantially more expensive. What is the value proposition over other forms?
GLP-1 receptor agonists consistently raise resting heart rate. Is that something to be concerned about?
Are there any emerging approaches to improving the management of type 1 diabetes?
What happens metabolically, and to fat cells, glucose and ketones, when taking corticosteroids?
This is the kind of conversation we host every month inside The Metabolic Initiative, alongside expert presentations from our conferences and a library built entirely around metabolic health and therapy, with CME credit available on eligible content for healthcare providers.
If you want to be in the room for the next one, the first seven days are free. membership.metabolicinitiative.com
Special thanks to the sponsors of this episode:
Genova Connect: Get 15% off any Genova Connect test kit with code METABOLICLINK here.
Cowboy Colostrum: Get up to 25% off with code METABOLIC here.
More Links
Dr. Ben Bikman's website: benbikman.com
Insulin IQ: insuliniq.com
YouTube: youtube.com/@benbikman
Instagram: @benbikmanphd
In every episode of The Metabolic Link, we'll uncover the very latest research on metabolic health and therapy. If you like this episode, please share it, subscribe, follow, and leave us a comment or review on whichever platform you use to tune in!

You can find us on all your major podcast players here and full episodes are also up on our Metabolic Health Summit YouTube channel!

Find us on social: 
Instagram
Facebook
YouTube
LinkedIn
Please keep in mind: The Metabolic Link does not provide medical or health advice, but rather general information that does not serve as a substitute for a licensed healthcare professional. Never delay in seeking medical advice from an appropriately licensed medical provider for any health condition that you may have.

Ketogenic and low-carbohydrate diets often focus on a specific carbohydrate target: keep your net carbs under 30 grams. But as registered dietitian and certified diabetes educator Franziska Spritzler demonstrates in this presentation from Metabolic Health Summit, a carbohydrate target is not a therapy. Effective implementation means a full assessment of medical history, medications, labs, food preferences, lifestyle, and the motivation that will carry a patient through year one and beyond.
Spritzler specializes in low-carbohydrate and ketogenic nutrition and has extensive experience helping people use these approaches to improve metabolic health. The creator of lowcarbdietitian.com, she walks through the practical decisions clinicians face: when a ketogenic diet is warranted versus a more flexible low-carbohydrate approach, why she recommends 1.2 to 1.8 grams of protein per kilogram rather than the RDA's 0.8, how to manage medication adjustments for patients at risk of hypoglycemia or hypotension, and how to handle electrolytes, carbohydrate counting, sweeteners, and plant-based variations without losing the patient along the way.
Questions Answered in This Episode:
• What actually separates a ketogenic diet from a low-carbohydrate diet, and when does the difference matter?
• Why is the protein RDA too low for long-term metabolic health, and what range does Spritzler recommend instead?
• Who should avoid ketogenic diets entirely, and why are most contraindications manageable with closer supervision?
• How should medications be monitored and adjusted when a patient begins carbohydrate restriction?
• Should patients count net carbs or total carbs, and why are packaged "net carb" labels unreliable?
• Can a ketogenic diet be done as a vegetarian or vegan?
A practice-tested blueprint for turning carbohydrate restriction from a prescription into a therapy patients can sustain.
Special thanks to the sponsors of this episode:
✅ Genova Connect: Get 15% off any Genova Connect test kit with code METABOLICLINK here.
✅ iRestore: Get a special discount on the iRestore Illumina Face Mask with code LINK here.
✅ fatty15: Get an additional 50% off a 90-day subscription starter kit with code METABOLICLINK.
✅ Zocdoc: Find and instantly book a top-rated doctor here.
More Links
• Franziska's website: lowcarbdietitian.com
• The Metabolic Initiative (expert lectures, CME, ad-free episodes, live Q&As; first 7 days free): membership.metabolicinitiative.com
In every episode of The Metabolic Link, we'll uncover the very latest research on metabolic health and therapy. If you like this episode, please share it, subscribe, follow, and leave us a comment or review on whichever platform you use to tune in!
You can find us on all your major podcast players here and full episodes are also up on our Metabolic Health Summit YouTube channel!
In every episode of The Metabolic Link, we'll uncover the very latest research on metabolic health and therapy. If you like this episode, please share it, subscribe, follow, and leave us a comment or review on whichever platform you use to tune in!

You can find us on all your major podcast players here and full episodes are also up on our Metabolic Health Summit YouTube channel!

Find us on social: 
Instagram
Facebook
YouTube
LinkedIn
Please keep in mind: The Metabolic Link does not provide medical or health advice, but rather general information that does not serve as a substitute for a licensed healthcare professional. Never delay in seeking medical advice from an appropriately licensed medical provider for any health condition that you may have.

Join us for a live Q&A with Dr. Ben Bikman here.
For the 100th episode of The Metabolic Link, Ben Bikman, PhD, professor of cell biology and physiology at Brigham Young University and author of Why We Get Sick, returns for a milestone conversation with co-hosts Dominic D’Agostino, PhD, and Victoria Field. Together, they examine what clinicians are measuring, what conventional approaches may be missing, and how the science of metabolic health continues to evolve.

Bikman argues that the clinical picture of metabolic health remains glucose-centric and lipid-heavy while the earliest signal, elevated insulin, goes unmeasured. He explains why women stay insulin sensitive at far higher body fat than men and what menopause takes away, why visceral fat is misunderstood, and how a fatty liver can be miscounted as lean mass on a DEXA scan. That last point is why he now says he was wrong about GLP-1 drugs, and why he thinks they should be prescribed as something other than weight loss medication.

Questions Answered in This Episode:

• Why does standard bloodwork detect metabolic dysfunction so late?
• Why are women more insulin sensitive than men at the same or higher body fat?
• What actually changes metabolically during menopause?
• Is visceral fat inherently dangerous, or is something else going on?
• Why did Dr. Bikman change his position on GLP-1 medications?
• Should GLP-1 drugs be prescribed as weight loss drugs at all?

This milestone episode offers a rigorous, physiology-first look at where metabolic science stands today, and what researchers and clinicians may need to examine next.

Thank you for listening, watching, sharing these conversations, and helping us reach 100 episodes. We’re incredibly grateful to have you as part of this community.
Special thanks to the sponsors of this episode:
Genova Connect: Get 15% off any Genova Connect test kit with code METABOLICLINK here.
Cowboy Colostrum: Get up to 25% off with code METABOLIC here.
iRestore: Get a special discount on the iRestore Illumina face mask with code LINK here.
More Links
Dr. Ben Bikman's website: benbikman.com
Insulin IQ: insuliniq.com
YouTube: youtube.com/@benbikman
Instagram: @benbikmanphd
Featured study: White Matter Lipids as a Ketogenic Fuel Supply in Aging Female Brain: Implications for Alzheimer's Disease
In every episode of The Metabolic Link, we'll uncover the very latest research on metabolic health and therapy. If you like this episode, please share it, subscribe, follow, and leave us a comment or review on whichever platform you use to tune in!

You can find us on all your major podcast players here and full episodes are also up on our Metabolic Health Summit YouTube channel!

Find us on social: 
Instagram
Facebook
YouTube
LinkedIn
Please keep in mind: The Metabolic Link does not provide medical or health advice, but rather general information that does not serve as a substitute for a licensed healthcare professional. Never delay in seeking medical advice from an appropriately licensed medical provider for any health condition that you may have.

What can 21 days of continuous glucose and ketone data, recorded during a 1,000-mile cycling journey, reveal about managing type 1 diabetes on a ketogenic diet?
Dr. Ian Lake is a UK-based primary care physician who has lived with type 1 diabetes for more than 30 years. After two decades of conventional high-carbohydrate management, he adopted a very low-carbohydrate, ketogenic approach and began examining insulin not simply as a glucose-lowering medication, but as a metabolic hormone whose requirements are influenced by nutrition, exercise, sleep, circadian rhythm, hydration, and stress. His new book, Shifting Gears, documents the ride and the lessons he took from it.
Dr. Lake treated the journey as a 21-day personal experiment, wearing continuous glucose and ketone monitors while consuming roughly 20 grams of carbohydrate per day. In this conversation with Dr. Dominic D’Agostino, he shares what his data showed: an average ketone level near 1.2 mmol/L, daily insulin requirements declining from the mid-20s of units to around 16, and an episode in which glucose and ketones rose together after he had taken too little insulin.
Dr. Lake describes how, in his case, one unit of insulin brought his ketones from approximately 3.0 to 0.9 mmol/L within about 20 minutes. He and Dr. D’Agostino use the experience to explore the distinction between nutritional ketosis and diabetic ketoacidosis, the essential role of adequate insulin, and why ketone readings must always be interpreted alongside glucose levels and clinical context.
They also discuss insulin sensitivity during prolonged exercise, the practical challenges of adjusting insulin during endurance activity, and research suggesting that fat-adapted athletes may sustain high rates of fat oxidation at relatively high exercise intensities.
Questions Answered in This Episode
What did 21 days of continuous glucose and ketone monitoring reveal during a ketogenic, 1,000-mile cycling journey?
How did prolonged endurance exercise affect Dr. Lake’s daily insulin requirements?
How is nutritional ketosis different from diabetic ketoacidosis, and what role does insufficient insulin play in DKA risk?
What did Dr. Lake observe when his glucose and ketones began rising at the same time?
How might fat adaptation influence fuel use and endurance performance?
What are the practical limitations of continuous glucose and ketone monitoring for real-time insulin decisions?
This conversation offers a rare look at 21 consecutive days of glucose, ketone, insulin, nutrition, and exercise data, while also emphasizing that Dr. Lake’s experience is an individual case, not a substitute for personalized medical supervision.
More Links:
Shifting Gears, Dr. Lake’s book, on Amazon
Type1Keto, Dr. Lake’s site featuring the book and the Zero Five 100 project
Special thanks to the sponsors of this episode:

✅ Zocdoc: Find and instantly book a top-rated doctor here.
✅ fatty15: Get an additional 50% off a 90-day subscription starter kit with code METABOLICLINK.
✅ Toups and Co: Get 25% off your first order with code METABOLIC.
In every episode of The Metabolic Link, we'll uncover the very latest research on metabolic health and therapy. If you like this episode, please share it, subscribe, follow, and leave us a comment or review on whichever platform you use to tune in!

You can find us on all your major podcast players here and full episodes are also up on our Metabolic Health Summit YouTube channel!

Find us on social: 
Instagram
Facebook
YouTube
LinkedIn
Please keep in mind: The Metabolic Link does not provide medical or health advice, but rather general information that does not serve as a substitute for a licensed healthcare professional. Never delay in seeking medical advice from an appropriately licensed medical provider for any health condition that you may have.