Why We Get Sick

Why We Get Sick argues that a single, largely unmeasured disturbance sits upstream of a remarkable share of modern chronic disease, and that the disturbance is insulin resistance. Benjamin Bikman, a biomedical scientist who studies metabolic function, contends that the condition is far more common than diabetes statistics suggest, develops silently over years, and is rarely tested for until the damage it reflects is already established.

His mechanism is that insulin resistance and the compensatory high insulin levels that accompany it are not merely markers of metabolic trouble but active contributors to it. He traces the consequences organ by organ — cardiovascular and blood pressure effects, fatty liver, reproductive and hormonal disruption, kidney and nerve involvement, effects on bone and muscle, and contributions to cognitive decline and some cancers. The causes he identifies are elevated insulin from dietary pattern and frequency, inflammation, oxidative stress and ectopic fat. The response follows logically: reduce the stimulus by lowering carbohydrate intake and eating less often, improve insulin sensitivity with exercise, protect sleep, and correct the inputs rather than medicate the outputs.

It is written for general readers willing to follow a mechanistic argument, and it is one of the better popular explanations of metabolic physiology available.

On the evidence, this book deserves to be taken seriously. Insulin resistance as a central feature of metabolic disease is mainstream physiology, not a fringe position, and the case that it is under-recognised and under-tested is fair. The proper caveat is about strength of claim rather than direction. For conditions such as type 2 diabetes, fatty liver and cardiovascular risk, the causal argument is strong. For Alzheimer's disease, certain cancers and some of the other conditions discussed, the relationship is associational and the mechanisms are still being worked out, and Bikman states these links more firmly than the current evidence settles. Carbohydrate restriction has solid trial support for glycemic control, though it is one effective approach among several.