Every day one watches the queues outside hospitals for free food grow longer. Men, women and children wait patiently for a meal, perhaps their only assured calories of the day. Contrast this with the food advice that includes almonds, Greek yoghurt, fish, protein shakes, extra virgin olive oil. It is from within these perspectives that we need to approach ‘Sick Nation: Inside India’s Lifestyle Disease Epidemic and How to Fix It’.
In a country facing some of the world’s highest burden of non-communicable diseases like diabetes, cardiovascular disease, fatty liver, and related metabolic disorders, insulin resistance (IR) is an important, often under-recognised, contributor to this epidemic, which makes the book undeniably relevant.
The author’s emphasis on early, preventive awareness rather than late-stage disease management is commendable, even if prevention has been a core concern of public health medicine for centuries. The tone, anecdotes and phrases such as “Today, we exist in perpetual feast mode” make complex ideas accessible to a lay audience.
However, when ‘Sick Nation’ describes itself as a scientific investigation, we need to be careful. Scientific inquiry follows a defined path: hypothesis formulation, systematic data collection, ethical approval, peer review, and reproducibility. What is presented instead is a blend of personal experimentation and “experiments” conducted on volunteers, the latter being particularly concerning as there is no clear mention of ethical oversight, informed consent, or review.
The book draws attention to IR as a unifying metabolic disturbance that cuts across multiple non-communicable diseases, which is highly pertinent in an Indian context, though some caution is warranted. Scientific literature emphasises that IR is multifactorial, shaped by genetics, early-life nutrition, socioeconomic conditions, physical activity, inflammation, pollution, etc. Therefore, while important, positioning IR as a singular enemy risks oversimplification.
While the author’s accent on metabolic dysfunction is important, the claims that it is overlooked by specialists but identified by alternative practitioners, should be interpreted with care. Differential diagnosis and clinical management are complex processes and differences in training, such as a short-term metabolic health coaching programme versus 10-plus years of medicine/endocrinology education, represent distinct, potentially complementary, forms of expertise.
The book’s narrative, when sticking to fundamentals, is persuasive; prioritising lifestyle optimisation aligns closely with long-standing medical/public health advice.
Much of the dietary advice mirrors the principles of the extensively studied Mediterranean diet, shown to be associated with cardiovascular and metabolic benefits. However, this evidence was generated from long-duration observations of large populations.
The book advocates reducing carbohydrates, which is a sound advice in general. In India though, where carbohydrates provide over 62 per cent of total energy intake for many, largely through affordable staples such as rice and wheat, it is a bit complicated.
Evidence-based culturally grounded alternatives already exist. Cereal-pulse combinations such as rice and dal in approximately a 3:1 ratio provide complete amino acid profiles while remaining affordable. Traditional preparation methods, including fermentation, sprouting, and cooking-cooling starches, can lower glycaemic index and improve nutrient bioavailability without increasing cost.
This brings us to the book’s most consequential limitation in my opinion. Although the author briefly critiques “clever food industry marketing”, the analysis stops short of addressing details — the broader system, aggressive corporate advertising, urban food deserts, policy failures, work conditions that erode sleep and physical activity. By focusing on individual behaviour, the book risks legitimising, justifying, or exonerating the systems that are responsible.
To its credit, ‘Sick Nation’ raises awareness of IR, emphasises prevention, communicates accessibly, and encourages reflection on modern lifestyles. Its clarity and urgency are its strengths. However, headings such as ‘Standard Medical Advice Will Fail You’ risk undermining trust in evidence-based care.
To be fair to the author, a physician is probably not the best reviewer for a book that blends personal experience, metabolic coaching, science and public health. That said, physicians are trained precisely to critically evaluate scientific proof, causality and ethics.
In a country where metabolic disease coexists with hunger, meaningful conversations about health must look beyond individuals to systems that shape everyday choices. ‘Sick Nation’ provides a clear and accessible narrative, but it could benefit from a deeper engagement with realities that shape health for large sections of the population.
— The reviewer is Head, Department of Pharmacology, PGI