The End of Illness
by David B. Agus, M.D.
My rating: 7/10
To be honest, I was nervous about this book and whether I would agree with the philosophies in it. I had just read Super Immunity which had lots of dogma and recommendations with which I don’t agree. (Book review for that book here). I read the jacket for this book and I wasn’t reassured, but I am determined to read things outside my comfort zone because I believe I can still get something out of a book with views contrary to my own. To be very honest, what threw me off was the blanket recommendation for certain pharmaceuticals (more on this later).
I ended up being very pleasantly surprised by this book and its author. The main premise of the book is to explain the ways in which the author believes (based on research and science along with his opinions) we as humans can be as close to disease-free as possible. It’s about highlighting the importance of disease prevention and the individualization of medicine. If we can learn more about how our own individual bodies function optimally, we can prevent and remediate diseases and live fuller, longer lives.
The style of writing in this book was clear and concise. The author was able to explain things in detail while using understandable language. He seemed to anticipate opposing viewpoints and he addressed them head-on, admitting at times that he isn’t the ultimate authority on everything (I appreciate this)! He made it clear that he was presenting information to the best of his knowledge and the knowledge of current research. He did not come off as pretentious or dogmatic to me. I highlighted below some of the points he made that were notable to me in a positive way:
Bioindividuality
From the start, he talks about a concept I like to call bio individuality, referring to it as “personalized medicine.” This is the idea that each person is chemically and physiologically different, and therefore blanket approaches to diet and medicine cannot work for everyone. Each person has a responsibility to get to know their own health needs, whether it involves self-experimentation with diets and supplements or working closely with doctors and new medical technology- or all of the above! I absolutely love this concept, and who wouldn’t? Medical care and disease prevention tailored specifically to me? Sign me up! Unfortunately (but realistically), he’s not offering some magic bullet, but rather a series of suggestions to maximize individualized approaches to care, and he is advocating for these specific methods. He sums the whole book up in a single phrase: “Get to know yourself.” I can get behind this.
“Science may never cure the the condition or disease that may strike you, and you may not be able to entirely avoid it for whatever reason. But you can most definitely reduce how much it affects you and change how you treat yourself through its progression.” (p. 26)
The author also mentions enterotypes (gut microbiome classifications), and how we may be able to personalize our diets based on how our gut processes food. This is a very interesting concept to me, and I’d like to learn more. It seems that the classification of bacteria in your gut can be determined by diet long-term, so I’m wondering if this is a “chicken or the egg” situation. Can we massage our enterotype via dietary changes, or should we adjust our diet to fit our enterotype, or both? (p. 189) Food for thought.
Germ Theory
Germ theory is the idea that pathogens cause disease and that they can be eradicated from the body if an antidote is found for a particular invader. It defined medicine in the 20th century, and we haven’t been able to get out from under that paradigm since. It’s not a bad one! But it’s not the only one. Though it saved lives, germ theory taught people to blame outside factors for disease- things that must be “fought,” when it may be our own system that needs to be addressed.
The author blew my mind a little by explaining the difference between diseases of “our system” such as cancer or heart disease as opposed to infectious ones, and how we need different approaches to each. Infectious diseases can be treated with the best known and studied interventions. Cases may be somewhat straightforward once a diagnosis is made. However, diseases of “our system” need to be tailored to each individual’s environment within their body. The “system” needs to be restored as a whole, vs. eradicating a foreign invader. This paradigm contradicts how the medical community at large approaches heart disease and cancer, however, which are actually diseases of the system. Instead of focusing on a more holistic approach to healing the body and promoting prevention of a worsened condition, cancer is “zapped” with treatments or cut out, and heart disease is treated with surgery and pills. The author here is not saying we shouldn’t have life-saving procedures performed- not at all. But we often ignore the prevention piece in system disorders and how we can promote the optimal function of our bodies while we receive more conventional treatments. A multidisciplinary approach to individualized medicine seems like it would be the way to manage this holistic approach. Most doctors are trained in allopathic diagnoses and interventions and shouldn’t be expected to also have the knowledge for nutrition, detoxification, mindset work/mental health, movement and other wellness approaches. Unfortunately, it has been my experience that medical professionals take sides: either alternative/naturopathic or conventional/allopathic approaches. A marriage of the two would be ideal to me.
“This is a disaster for medicine because we’re going to get focused on these germs, and we’re going to forget about the system.” -J.B.S Haldane, renowned geneticist, speaking about germ theory in 1923
Vitamins/Supplements
I whole-heartedly agree with the author that a healthy lifestyle starts with food. However, with the depleted nutrients in our soil as a result of monocultures and poor farming practices, our food may not deliver all of the nutrients we think it does. As a result, it is nearly impossible to get all of our nutritional needs from food and drinks alone. Supplementation, even temporarily, may be essential for healing and sustainable wellness. This author disagrees with the concept of taking vitamins and supplements in favor of real, whole foods. I do agree that you can’t out-supplement a poor diet, but I am left wondering if the answer for optimal health lies somewhere in between (such as temporary or cyclical supplementation). Also, it should be said that quality matters when it comes to supplements. I agree that certain supplement delivery methods (e.g. pressed powder pills or those with artificial dyes) are not optimal, but companies like Juice Plus, Garden of Life and Biotics Research show better practices for nutrient absorption and quality sourcing.
“We now have a much better understanding of how well whole foods deliver their nutritional benefits and therefore know that the very concept of a multivitamin as a nutrient delivery system is limited. Consider that a typical multivitamin contains 10 to 25 isolated nutrients, but fruits and vegetables have hundreds of active compounds with a long list of health properties. The vitamin C in a multivitamin is likely just not as effective as the vitamin C in a citrus fruit, where it’s also surrounded by fiber and flavonoids and carotenoids (compounds found in plants that may have protective health benefits when consumed). The combined result of these nutrients working together is what really keeps you healthy.” (p. 175)
I’m just going to leave this here
“In addition to seasonal influenza, a new strain of influenza virus against which no previous immunity exists and that is transmissible human to human could result in a pandemic with millions of fatalities. The swine flu scare that occurred in 2009 will someday be dwarfed by a real epidemic that will spread rapidly through virgin immune systems and kill millions in its path (as happened, for example, in the flu pandemic of 1918, when an estimated 50 million to 100 million people died).” (p. 277) (This book is Copyright 2011, FYI).
Negatives
While I got tremendous value from this book, There were parts of the author’s theories that I still could not fully grasp or just went against what I have been taught as a Nutritional Therapy Practitioner. I am going to highlight them now.
Some Recommendations Don’t Add Up: The author states that vitamins and supplements are artificial and should not be used as a substitute for whole food nutrition. He even goes so far as to say “taking vitamins generically for health makes no sense.” (p. 158). Then he makes blanket recommendations for cholesterol meds and blood thinners.
- Recommends Statins for everyone over 40 years old, especially those with high cholesterol or high C-reactive protein (p. 61).
- I cannot support any blanket recommendation for medications, especially when much of this book talks about bioindividuality and how medicine should be personalized.
- I have heard of and read extensively about the damage to our system that statins can do, and was fairly shocked that a seemingly progressive doctor like Dr. Agus could make such a recommendation. I recommend the work of Jimmy Moore and his book Cholesterol Clarity for more information on this topic.
- Any medication that alters the body’s natural self-regulation of cholesterol should be concerning. I understand the recommendation for those who are high risk for a cardiac event, but if a person’s cholesterol is dangerously high, it is a signal that there are high levels of inflammation in the body. Instead of simply artificially and unnaturally lowering the cholesterol numbers, it seems we should be discovering the source of inflammation and treating the problem at its source.
- Describes aspirin as a panacea of sorts (p. 63)
- This seems like an archaic recommendation from my grandmother’s day. Why would we take an NSAID blood thinner without a specific reason or known risk? Again, why are we putting chemicals into our bodies unless absolutely medically necessary?
- Recommends flu vaccine for all (p. 211)
- This is a personal choice. It is worth reading his reasonings for the recommendation because they are genuine, but everyone must use their judgment. I have no intention of getting into this debate because I truly believe in bioindividuality. Saying everyone should have it goes against that thinking.
We cannot seem to get away from the “FAT IS BAD” trend, and it’s frustrating:
A few comments were made throughout the book implying we should be eating a low-fat or low-saturated-fat diet, which is old and archaic advice at this point. I can’t even get into the manipulated data involved in the original low-fat diet recommendations here; that will be a topic for another day. The author does clarify later in the book that he recommends a “good fat, not low-fat” diet (p. 194), but saturated fat seems to be in the “bad” category for him (and on p. 261 he says to buy 1% over 2% milk). In the author’s defense, he’s not claiming to be a nutritionist, but his whole thesis is about bucking traditional wisdom and advice, so I was disappointed to see continued support for the diet-heart hypothesis.
Conclusion
In conclusion, I encourage everyone out there not to shy away from reading things that you don’t completely agree with. You will most definitely learn something, and it will improve your critical thinking. After all, if you never consider the “other side” of an argument or theory, how can you fairly disprove it or speak to your points? That is not to say you should waste your time with fully discredited materials, either, but there is middle ground here. Sometimes it’s helpful to know that your way of thinking isn’t the ONLY way, and being open-minded means you’re staying away from relying solely on confirmation bias.
Many of my Nutritional Therapy Practitioner textbooks contained information that the Nutritional Therapy Association didn’t fully subscribe to, and those points were clarified to us as students. There simply weren’t enough materials out there that were consistent with all of their stances in the nutrition world. Just because a publication recommends a low-fat diet, for example, doesn’t mean the information on anatomy, etc. isn’t well-presented and valuable. Be conscientious, be alert and always question. This is coming from a Four Tendencies “Questioner”, so that’s me, but critical thinking is key to finding the nuance in truths no matter who you are.