BOOK REVIEW: Why We Get Sick

If you only read one book on health and nutrition, make it Why We Get Sick by Dr Benjamin Bikman.

Dr Bikman is a research scientist whose work concentrates on insulin. He also teaches. Why We Get Sick: The Hidden Epidemic at the Root of Most Chronic Disease — and How to Fight It has the comprehensiveness of a working scientist and the clarity of a good teacher. Dr Bikman also has various lectures available on YouTube which are well worth watching.

Why We Get Sick is organised into three parts — The Problem (8 chapters), Causes (5 chapters), The Solution (5 chapters) — with regular insert boxes to expound on salient points. The book is essentially about the nature and causes of insulin resistance and how to (re)achieve insulin sensitivity. That is, make your cells properly responsive to insulin rather than improperly resistant to it.

The “calories in, calories out” theory of obesity is simplistic and profoundly misleading, as what we eat, and how often, affects how much we eat and how much energy we expend. In other words, what we eat, and how often, affects the hormonal balance of the body which then affects whether we store fat in our bodies or use it up. The prime mechanism determining which way our body goes is through our insulin response. Insulin is a hormone with a range of effects but it is primarily about managing our glucose levels.

Eating frequently drives up insulin levels. Eating carbohydrates drives up insulin levels. Fat does not generate a significant insulin spike. Protein with fat only generates a small insulin spike. Carbohydrates drives up insulin. Protein with carbohydrates drives up insulin.

A diet of fat and protein has minimal insulin effect. There are essential fats, there are essential proteins, there are no essential carbohydrates. Fat (if not seed oils or trans fat) is your friend, carbohydrates are not. For most people, a metabolically healthy diet is mostly (good) fat. The sugar you consume is far more likely to be turned into body fat than is the fat you eat.

So, if you follow the standard official nutrition guidelines and eat 4–6 regular meals and snacks a day of mostly carbohydrates, you are setting yourself up for developing insulin resistance.

What are some of the consequences of developing insulin resistance? Obesity, hypertension, heart disease, cancer, neurological conditions including Alzheimer’s, kidney disease, accelerated ageing and infertility. In other words, all the chronic diseases that increasingly plague our species can be largely traced back to insulin resistance. They are all conditions largely generated by metabolic ill-health.

Susceptibility to insulin resistance is partly genetic, partly some stress and environmental factors, but predominantly diet.

In Part I: The Problem: What is Insulin Resistance and Why Does It Matter? Dr Bikman takes us through what insulin resistance is (Chapter 1) and then, chapter by chapter, various health consequences.

Insulin resistance is the cells of the body becoming insulin resistant: that is, less and less responsive to insulin levels, which have to get higher and higher to have their required effect of regulating glucose levels in the body, especially the bloodstream. The more insulin there is flooding your system, the more food is turned into fat. This can be subcutaneous fat (under the skin) or visceral fat (in the thorax, especially around organs such as the liver).

Visceral fat is much worse than subcutaneous fat in its harmful health effects. It is also much less visible. Dr Bikman has a nice passage where he explains that fat you can jiggle is better than fat you cannot.

In Part II: Causes: What Makes Us Insulin Resistant in the First Place? Dr Bikman takes us through the causes of insulin resistance. The influence of age and genetics (Chapter 9), the causal role of hormones (Chapter 10), the interaction between obesity and insulin resistance (Chapter 11), the role of inflammation and oxidative stress (Chapter 12), and lifestyle factors (Chapter 13). Yes, you should get regular sleep (depending on you, 5–7 hours a night). Yes, you should exercise regularly.

Having laid out the full disaster, in Part III: The Solution: How Can We Fight Insulin Resistance? Dr Bikman takes us through the eminently practical (and inexpensive) things we can do to get back to good metabolic health. Eat less carbohydrates and fast regularly. In other words, do what you can to give your body a rest from being flooded with insulin.

As someone who has lost 39kgs (85lbs), and is no longer pre-diabetic, through doing precisely that, I am a believer.

Dr Bikman explains that a low-carb diet does mean you need to eat more salt. Often, when you are hungry, it means your body actually wants water or it wants salt. Having too little salt is more dangerous to your health than too much.

A tip not in the book: salted black coffee. Salt cuts bitterness, so salted black coffee can be a no-calorie, no-insulin affect, flavour-hit that blunts hunger cravings.

Dr Bikman has a nice explanation of the difference between fasting (not eating) and starvation (consuming your own muscles). If you have visible fat, and have no unusual health conditions, you can fast safely, though you may have to keep your salt intake up. He mentions the famous case of the seriously obese Scot who, under medical supervision, fasted for 382 days, consuming only water and minerals. Fat is stored energy, so body fat is what you consume when you fast.

Humans are designed to fast: that is why we are the fat ape. (Ever seen a picture of a chimpanzee with no fur? They are a bundle of muscle.) Breakfast is a hugely overrated meal, and often made up of foods bad for our metabolic health.

So, exercise regularly, eat whole foods, avoid processed foods (and seed oils), cut the carbs and adopt a mild fasting regime. The (inexpensive) path to metabolic health. Why We Get Sick concludes with a clear guide on how to do this.

And no, don’t drink fruit juice, that is flooding your body with sugar (and a particularly metabolically unfortunate sugar, fructose) generating an insulin spike. In fact, generally avoid drinking your calories.

Clear, informative, practical, based on good science: if you only read one book on health and nutrition, make it Why We Get Sick.