Why We Get Sick by Ben Bikman: insulin resistance, and what a sensor can measure
Why We Get Sick argues that one hidden condition, insulin resistance, sits under most chronic disease, and that it runs for years before a glucose test looks wrong. Bikman's advice follows: look past glucose to insulin. The catch is that insulin is not on any consumer sensor, and glucose is. This guide explains his framework, what the evidence supports, what a glucose sensor can and cannot tell you about insulin, and the part Prime Factors can help you measure.
The one idea under the whole book
Benjamin Bikman is a professor of cell biology who runs a diabetes research lab; the book is a scientist's synthesis, written for a general reader. Its thesis is that insulin resistance, cells responding less to insulin so the body makes more, is a common contributor to heart disease, Alzheimer's, cancer, infertility, fatty liver and much else, and that it is far more widespread than diagnosed diabetes. He argues that glucose is the last thing to go wrong: insulin can be high and rising for years while fasting glucose still reads normal. Where the book extends this to dozens of conditions, the extension is Bikman's. The evidence section separately examines narrower claims without treating the book's full causal map as scientific consensus.
Common
In his reading of the data, most adults have some degree of it, most without knowing.
Early
High insulin comes first. Glucose stays normal until the system can no longer compensate.
Reversible
Because it is driven largely by behavior, he argues it responds to behavior, and faster than most people expect.
What raises insulin, in his account
Part II of the book is a list of causes, and Part III turns them into a plan. Five of them are things a person can act on this week.
Carbohydrate, amount and kind
The main dietary stimulus for insulin. He argues for controlling both quantity and quality, with refined carbohydrate and sugar first to go.
Eating frequency and timing
Every meal raises insulin; more meals, more time with insulin high. He favors fewer meals, time-restricted eating, and eating earlier in the day.
Inactivity
Working muscle takes up glucose with less insulin. He treats both aerobic and resistance exercise as direct insulin-sensitizers.
Poor sleep
Short or disrupted sleep is presented as a cause of insulin resistance in its own right, not only a marker of it.
Chronic stress
Cortisol and adrenaline raise glucose and insulin; sustained stress keeps them raised.
His full dietary framework goes further: control carbohydrate, prioritize protein, use fat as the main energy source, and consider ketogenic eating as the intensive version. That is his prescription. Prime Factors does not require any of it.
The measurement problem
Bikman says to look past glucose to insulin because insulin can change before fasting glucose becomes abnormal. But insulin requires a laboratory measurement; a continuous glucose monitor reads glucose every few minutes. Some behaviors he recommends can also change the glucose response, so a sensor can show what happened to glucose when you changed one of them. It cannot establish what happened to insulin. A smaller glucose rise does not prove a smaller insulin response because the two can come apart. A sensor is a behavior-feedback instrument, not an insulin meter.
You cannot see insulin on a sensor. You can see how glucose responds when a behavior changes.
What a sensor can contribute
How glucose responds around meals and movement, with sleep and time of day treated as context, and whether a behavior change produces a repeatable glucose difference.
What a sensor cannot establish
Your insulin level, whether you are insulin resistant, or whether the flatter curve came with less insulin. Those are lab questions.
What the evidence supports
Three of Bikman's load-bearing claims have been measured directly. Here is what the studies show and what they leave open.
Insulin resistance is common
In a national US survey of 8,721 adults, only 12% met all five criteria for optimal metabolic health, and even among normal-weight adults fewer than a third did.
What it does not establish: A prevalence snapshot using cutoffs for glucose, blood pressure, lipids and waist, not an insulin measurement. It supports common; it does not put a number on insulin resistance itself.
Metabolic Syndrome and Related Disorders: prevalence of optimal metabolic health in US adultsMeal order lowers insulin, not only glucose
In 11 adults with type 2 diabetes, eating vegetables and protein before carbohydrate lowered both the post-meal glucose and the post-meal insulin response compared with carbohydrate first.
What it does not establish: Eleven people, one meal, one day. It shows the two can move together under a behavior change; it does not show they always do.
Diabetes Care: food order and postprandial glucose and insulinActivity improves insulin sensitivity
A 2016 review of human studies found that regular physical activity improves whole-body insulin sensitivity, with both aerobic and resistance exercise effective and larger doses generally doing more.
What it does not establish: Insulin sensitivity measured in labs, not on a sensor. The size of the effect for any one person, and how long it lasts without continuing, vary.
BMJ Open Sport & Exercise Medicine: physical activity and insulin sensitivity, reviewThe studies support narrower conclusions: poor metabolic health is common under the survey's definition; meal order lowered glucose and insulin in one small, specific experiment; and regular activity improves laboratory measures of insulin sensitivity. They do not validate Bikman's wider map of conditions or let a glucose sensor stand in for an insulin test.
Measure glucose response, anchor to the lab
Prime Factors overlaps with parts of Bikman's carbohydrate and activity territory. It records three meal-level drivers: what carbohydrate is in the meal, the order you ate it in, and what you did afterwards. Food sequence is a Prime Factors driver rather than one of Bikman's five listed causes, and after-meal movement is narrower than his broader inactivity category. You log the meal, the sensor records the glucose response, and the app turns it into a glucose-load score that can be compared across days. It uses those scores to estimate and project HbA1c, checks the projection against a later lab result, and continues estimating from the meal log after the sensor phase. It does not measure or diagnose insulin resistance.
Strategy
Prime Factors keeps lab HbA1c as the outcome anchor. Bikman would want fasting insulin on the panel too; that is a conversation for you and your clinician, and nothing here replaces it.
Tactics
Carbohydrate Composition, Food Sequence and After-Meal Movement. Sleep and stress are his other two causes; the app records sleep as context but does not treat either as a control lever.
Feedback
Every meal scored, comparable across days, so a change to any of the three levers shows up as a repeatable difference or does not, without waiting for a lab draw.
Prime Factors overlaps with a bounded meal-level part of Bikman's carbohydrate and activity territory. It does not cover three of his five causes and provides no diagnosis. Insulin resistance stays a clinical question, and ketogenic eating stays his prescription.
Start with what you can see
The Starter Program opens with a four-week sensor phase around the meals you already eat. It is designed to build repeated glucose evidence around the meal-level behaviors Prime Factors tracks, show an estimate of where your HbA1c may be heading and support continued meal logging after the sensor phase.
Explore the Starter ProgramArticle notes and medical boundary
This guide explains a public framework and a limited product role. Bikman's map of insulin resistance across conditions is his. The evidence cited here supports narrower findings about metabolic-health prevalence, meal order under one protocol and activity-related insulin sensitivity, not his full causal map. Prime Factors does not diagnose insulin resistance, does not endorse every Why We Get Sick claim, and glucose data should be read alongside other clinical information.
Prime Factors is a behavioral tracking and control system, not medical advice, diagnosis or treatment, and it does not replace your clinician. Do not use this guide to change medication, delay testing, or manage an urgent or unsafe glucose reading. The Starter Program is not currently suitable if you have type 1 diabetes or use insulin.
Sources and attribution
Framework descriptions refer to Why We Get Sick: The Hidden Epidemic at the Root of Most Chronic Disease, and How to Fight It by Benjamin Bikman. The book's positions are attributed to its author; they are not automatically scientific consensus or Prime Factors recommendations. Research links are cited separately.