Any person interested in type 2 diabetes (T2D), whether a biomedical researcher, a public health worker, a practicing diabetologist or a diabetic himself, should read this book with interest, irrespective of whether you end up agreeing with the author or otherwise. This is because the book shakes your beliefs and makes you think and rethink.

The book Doves, diplomats and diabetes is much more than one more addition to the large number of books on diabetes being published every year. It asks fundamental questions for which there are no answers. It refers to experiments that should have toppled down the existing theories about diabetes but for some strange reason they havent. For example it is currently believed that in an insulin resistant state, suppression of insulin production or inadequate compensation by beta cells results into rise in blood sugar. Experiments have been performed independently by different people. They show unanimously that if insulin production is experimentally suppressed in an insulin resistant state, instead of blood sugar rising, insulin sensitivity increases and blood sugar remains normal. This and several other experiments including tissue specific insulin receptor knockouts raise doubts as to whether a combination of insulin resistance and beta cell dysfunction is necessary and sufficient cause of diabetes. The book challenges everything that we think we know about diabetes. The arguments are made in such a way that even a staunch believer starts doubting what he/she knows about diabetes. To give just a few examples, serious doubts are raised as to (i) whether obesity is the real cause of insulin resistance, (ii) whether insulin resistance causes compensatory hyperinsulinemia or hyperinsulinemia comes first and there is compensatory insulin resistance (iii) whether insulin resistance is really central to the pathophysiology of T2D (iv) whether hyperglycemia is the cause of diabetic compliations.

While in science it is always prudent to doubt and challenge existing theories since this practice helps in strengthening the theories. I suspect something else is likely to happen in this case. The challenges are so formidable that the theories look like collapsing. While I am not yet prepared to give up existing theories, I feel convinced after reading chapter 3 of the book that there is something seriously wrong with our current understanding of diabetes.

The author appears to be happy with the assumption that the current theories have collapsed and builds up an alternative synthesis. This is a serious effort that we cannot dismiss right away. The new synthesis which the author calls a hypothesis first and slowly climbs up to claim a paradigm shift, claims that the origin of type 2 diabetes is in brain and behavior, not in diet and obesity primarily. This is a very intricate argument somewhat difficult to grasp in its entirety and therefore I would avoid writing it here. It is certainly worth reading the original and then deciding whether to agree or differ. But the author ends with a different note. Rather than agreeing or differing right away, he says do more research to test the ideas, which I can see is the right approach.

So my recommendation: a must-read, though not necessarily must-agree book.