EVERFIT book Review - The End of Illness by Dr. David Agus

Book Reviews, July 29, 2019

While I don't agree with all the advice Dr. Agus presents in this book there is an over arching take home message of "getting to know" yourself in order to take control of your wellness journey that I love. Eat more plants, sleep better, move daily, and put effort into being connected with your tribe.

My latest book has many good points reiterating the importance of taking ownership of your health journey. This is as aspect of health I have covered in the past (https://everfit.co.nz/articles/get-involved-in-your-wellness-journey) The first quote in the book resonated with me - "The part can never be well unless the whole is well." Plato. I believe we need to think more expansively with this concept and include our planet in the whole. Without a functioning "life support system" as David Attenborough has called earth; then how can we hope to be truly well - or look at wellness for our children.  Dr. Agus is a professor of medicine and engineering at the University of Southern California. His research focus is on the application of proteomics* (study of protein composition and function - proteins are not just food but the process) and genomics (branch of biology looking at the structure, function, evolution, and mapping of genes) to better understand cancer and developing new ways to treat. He is a leader in new tech and approaches to personalised health care. He has started wellness companies to try and restructure how the world views health and WELLNESS.

 

*The process that builds the body, maintains it, and modifies it; is an ongoing conversation that's happening within cells, between cells in ALL parts of the body. Proteins are what genes make. PROTEOMICS is about listening in and understanding these life changing conversations. 

The following article are my takeaways from the book and some links to other articles I have written on the enhancing habits that Dr. Agus brings up. It is refreshing and inspiring to read books authored by health care professionals in leadership positions reiterating simple daily habits to enhance health. It's not about "hacks", "silver bullets", and "potions" - it is about the choices that we make on a daily basis, in fact moment to moment. The first step is to understand that we have a choice. Be mindful of the daily process, and don't get swept along with habits that don't serve you. 
Dr. Agus defines health in one phrase - GET TO KNOW YOURSELF. We live in a society with a large amount of generalised information about health. The only way to figure out how it effects you is to apply the knowledge while understanding that your system isn't stagnant; so you will have to tweak habits as you age. Check out my article about getting to know yourself to go a bit deeper on this important subject (  https://everfit.co.nz/articles/to-thine-own-self-be-true )

 

Over the past few years I have had too many friends and family go through a cancer diagnosis. Cancer will soon overtake cardiovascular disease as the greatest killer of human beings if the rates continue as they are. Cancer can be viewed as a great metaphor for everything related to sickness - it's every persons ultimate nemesis when it comes to health and happiness. Cancer is "self generated" - it's our OWN cells that have gone astray. It is not an outside invader. J. B. S. Haldane spoke on health in 1923 basically stating that it is dangerous to assume that "all our ills" originate from the outside world, when in fact they have everything to do with our inside world. Many people suggest that cancer is a modern disease directing blame at pollution, hyper processed food, and environmental toxins. Dr. Agus agrees that these ALL play a part in generating disease but cancer is as old as the human race. Seven Egyptian papyri written between 3000-1500 BC describe symptoms of cancer. There is also mummified remains of a Peruvian Inca that's almost 2500 years old showing signs of melanoma. On a molecular level cancer happens after change to cellular genes. Normal cells are equipped with powerful genetic signals that instruct when and how cells divide to create more. Some genes act like accelerators , others act like brakes stopping growth. In a cancer cell this delicate balance between growth and inactivity is warped. The cell is left without regulation and can't stop growing. Cancer isn't just about uncontrolled cell division - it also EVOLVES - every time new cancer cells are created the cells mutate. So just as resistant strains of bacteria can result from antibiotic use, anti cancer drugs can produce resistant cancer cells! When we see cancer cells dividing without control in an area we name it cancer - if it's in the lung it's termed lung cancer - but that's not what's wrong it's a SYMPTOM of what's wrong. Dr. Agus explains that cancer isn't something you get, it's something the body does. We are probably "cancering" all the time and our body is keeping the issue in check with conversations between our cells. This conversation language is contained in our proteins. Our DNA is static, but the proteins are dynamic. The study of proteomics (as explained above) is a more expansive view of the whole system rather than just looking at the static DNA. Our systems are changing constantly. We are more dynamic, expansive, and complex than how we study disease with test tubes and tissue cultures.

Inflammation is a telltale sign that something isn't right in the body - it's a sign the body is dealing with potentially harmful stimuli. This can be pathogens, damaged cells, irritants, and even psychological trauma. The inflammation response is complex involving the vascular system, the immune system, and various other cells within the specifically injured tissue. The goal is to start healing but when the inflammation is chronic due to disease or prolonged stress it will create system chaos. Research is showing links between inflammation and many disease states including Alzheimers, cancer, autoimmune disease, diabetes, heart disease, and accelerated aging in general (more on inflammation below).

 

One of the ground breaking findings uncovered by the Human Genome Project is that 99.9% of DNA sequences are similar throughout the human population. SNPs (single nucleotide polymorphisms) are variations in DNA sequencing, alterations in the set of genetic instructions that provide markers for our response to disease. These differences DO NOT cause the disease - but are a marker for the relative risk.  Currently we have genetic risk profiles. These include Cancers (breast, colon, lung, prostate), Autoimmune (graves disease, lupus, RA), Vascular (abdominal aneurysm, brain aneurysm), Neurological (Alzheimers disease, M/S), Joint (OA), and Gastrointestinal (Crohn's, celiac disease). The point to remember is if your DNA profile puts you at a higher risk of developing a condition it doesn't map out your fate - if you take control of the environmental side of the equation you can reduce your lifetime risk. DNA governs probabilities NOT destinies. We can't change genetics but we can alter the environment to effect genetics - therefore influencing the expression of the genes. 

Vitamin D
Your skin absorbs absorbs UVB sunlight which triggers a cascade of events that leads to Vit D being activated in the kidneys for use by the body. Vit D is important for maintaining calcium levels and regulates around 2000 genes. Vit D made in the skin lasts for as twice as long in the blood stream as Vit D ingested from the diet - and when you are exposed to sunlight you not only make Vit D but also at least 5 and up to 10 different additional photo-products that you don't get from your diet or a supplement.  You can overdose on Vit D supplementation (e.g mega doses of 10,000 IU per day) but you can't overdose when you receive it from sunlight through the skin. Our bodies have a efficient capacity of producing Vit D from UVB sources. Check out my article about calcium and Vit D ( https://everfit.co.nz/articles/calcium)
Our bodies are equipped with incredible feats of engineering down to a cellular level. Understanding how receptors work is helpful in understanding why supplementation is NOT always useful. A receptor is a protein molecule that's engrained in either the plasma or cytoplasm of the cell. It's what effects the actual attachments of other proteins or molecules to the cell so they can have an effect. The signalling molecules can be neurotransmitters, hormones, pharmaceutical drugs, or toxins. Almost ALL cells and tissue have receptors designed for Vit D. A cell can increase or decrease the number of receptors to a molecule (like Vit D) to change it's receptiveness (sensitivity) to it. Cells do this constantly to maintain a healthy balanced state (homeostasis). Increasing the number of receptors is termed UP-REGULATION, and when they decrease it's called DOWN-REGULATION. This balancing act is the crux of our bodies ability to keep homeostasis. If there is too much of something we DOWN-REGULATE, and when there isn't enough of something we UP-REGULATE. In economic terms this is the law of supply and demand. So when we consume Vit D from supplements and over supply we naturally DOWN-REGULATE and this can have negative effects down the line. Taking ANY supplement without good reason will meddle with the bodies inherent homeostatic controls and could have downstream effects that have not being studied and we don't fully understand. 

 

Vitamin C

The brain has an inbuilt defence system known as the blood-brain barrier (only select chemicals can cross). Vit C can't cross the barrier - but an altered version of Vit C can cross (dehydroascorbic acid). The brain has more of these specific transporters so Vit C levels are 10 times higher in the central nervous system (CNS) than elsewhere in the body. Regulation of Vit C in the brain is essential as it's required to produce the neurotransmitter nor-adrenaline. If you want to get extra Vit C to the brain taking supplements is a waste as most of it will pass through. Vit C is an anti-oxidant (gets rid of free radicals). These free radicals can injure cells at a genetic level linking to neurodegenerative diseases like Alzheimers and Parkinsons. Vit C has a jekyl and Hyde complex when it comes to cancer though - tumors devour Vit C like candy basically Vit C can feed tumors. 
Vitamins are organic compounds (contain carbon) that team up with proteins in our bodies to create ENZYMES - these work to regulate our bodies functionality. 13 specific vitamins have been identified as needed by the body to function well
  • Vit A
  • 8 types of Vit B (thiamin, riboflavin, niacin, pantothenic acid, B6 B12,folacin, and biotin)
  • Vit C
  • Vit D
  • Vit E
  • Vit K
As explained above taking vitamins generically for health makes little sense according to Dr. Agus. If you eat nutrient dense foods you shouldn't need to supplement (the most nutrient dense foods that are also kcal sparse and fibre rich are PLANT BASED WHOLE foods). Taking mega doses could create DOWN REGULATION in our cells creating issues. As Michael Pollan stated in his excellent book "In Defence of Food" - That anyone should need to write a book advising people to eat real food could be taken as a measure of our alienation and confusion. We are eating too much hyper-processed LOW nutrient HIGH kcal food. Our society is now at a point where 70% of adults are overweight or obese with under nourishment from REAL food sourced nutrition. We have lost our connection with REAL food grown in nature and are relying on food made in plants and packaged for maximum shelve life to maximise profits NOT health. The Vit C in a multi vitamin tablet will not be as effective as the Vit C in a citrus fruit where it's surrounded by fibre, flavonoids, phytochemicals, and carotenoids. The whole is greater than the sum of the parts - whole food with the combined, positive compounding effects of these parts is the key to true health. Please eat more plants and not food created in a plant.

 

Antioxidants

An antioxidant blocks the effects of oxidation (a normal biological process that happens with metabolism - turning kcal from food and O2 from air, into energy that the body can use). It's a combustion process and the byproducts are free radicals (molecules that have lost an electron causing them to "bounce" around attempting to steal electrons from other molecules)
this when not balanced can ignite the inflammation process. Free radicals are NECESSARY. They are normal byproducts of critical biological processes, they are used by our IMMUNE system (specifically the granulocytes and macrophages) to kill bacteria, and they act as part of the cell signalling process.
Until the word "anti-oxidant" become part of our terminology (thanks to the supplement and anti-aging industry), it was difficult to sell the benefits of fruits and vegetables - but these are natures way of delivering "anti-oxidants" to us in an easy to use, easily recognised form . Certain vitamins that we can easily get in our diets (A,C, and E) act like "good samaritians" by giving electrons to free radicals freely which breaks the oxidative reaction chain preventing collateral damage these "loose cannons" can do.  Most vitamin studies completed on more than a 1000 people over the last 20 years has shown an INCREASED risk of cancer. The body likes to produce free radicals to attack mis-functioning rogue cells, including cancerous ones. If you block that mechanism by taking copious amounts of vitamins (especially those marketed as antioxidants) you are blocking your bodies natural ability to positively patrol it's cellular makeup. You disrupt a natural protective physiological process that we don't fully understand yet.
Many studies are showing conflicting uncertain results so beware of headlines like "Vit C stops cancer growth" or "Vit E is great to prevent heart attacks". An international team from Boston in 2010 reviewed 9 trails that included 118,000 people. 59,357 took Vit E supplements and 59,408 took a placebo. (no one in the trail took a multi vitamin). It was found that taking Vit E INCREASED the risk of hemorrhagic stroke, but REDUCED the risk of ischemic stroke. These paradoxical findings underline what Dr. Agus's main point throughout the book - when it comes to the intricate multi faceted human body you can't do ONE thing and only effect ONE aspect - taking a drug or a supplement will create a cascading effect on the entire system. The health takeaway - don't buy into shortcuts, hacks, and silver bullets when it comes to nutrition and health, which may do more harm than good. Unless you are correcting a legitimate deficiency or addressing a condition then you don't need to be taking multivitamins and other supplements. 
Fruits and Vege snap frozen are done so at their peak ripeness - generally when they are at their most nutrient rich. Buy fresh (or frozen), local, and better yet grow your own and do some bartering with like minded individuals to maximise your vitamin and mineral intake. 

 

Gut

The importance of having a healthy digestive tract can't be overstated. Emeran Mayer (UCLA school of medicine) has gone into the intimate relationship between the brain and gut - it is so incredible that the gut can be described as the largest sensory organ in the body (check out his book The Brain Gut connection). Michael Gershon (expert in neurogastroenterology) has written a book "The second brain" in 1998.
  • Gut sends info to the brain via the vagus nerve (spinal afferent nerves)
  • the CNS sends info back to the gut ensuring optimal functioning during sleep, fasting, digestion
  • The gut-brain-gut feedback loop is imperative to general WELLNESS incorporating the regulation of many systems. 
  • Gut sends mega info to an area in the brain that is responsible for our feelings of self awareness/wellbeing the health of the gut is a massive factor in our perception of health. 
Inflammation
Inflammation has been linked to our most troubling degenerative diseases - heart disease, Alzheimers, cancer, autoimmune, diabetes, and accelerated aging. Oxidative stress is like a biological type of rusting of organs and tissues (wringling of skin, stiffening of blood vessels, damaging cell membranes). This is a NORMAL process but when it's in overdrive it presents problems. The JUPITER study I (Justifiction for the USE of Statins in Primary Prevention : an Intervention Trial Evaluating Rosuvastatin) was the first to really identify inflammation as the undercurrent to illness. (It confirmed that elevated CRP levels may indicate a risk of future heart attack up to 8 years in advance even if cholesterol is low). DNA repair is VERY energy intensive (possibly the most labour intensive chore that the body performs). When the body is dealing with long term, persisting inflammation (e.g head trauma in sport, bullying, poor sleep, hyper processed diet, septic relationships, lack of forgiveness) it has to redirect the DNA repair energy to the demanding inflammation. When the bodies DNA repair resources are low the body becomes vulnerable to cancer and other disease states. The clear association between inflammation and cancer is real as shown by many studies (Journal of the American College of Cardiology June 2010) suggesting HDL (good cholesterol) may have anti-inflammatory and antioxidant properties. Take charge of your health - and try to mitigate those hidden sources of inflammation (wear comfortable shoes, prioritise sleep. don't exercise when you are sick, keep hyper processed food to a minimum, and forgive people rather than hold a grudge). 

 

Nun Study

One of the best studies ever to be performed on brains was the nun study started in 1986 in Kentucky directed by David Snowden. Nuns are great for long term comparative study due to similiar life experience. In his book "Aging with Grace" (2001) the main finding was is that an upbeat attitude and a mentally active lifestyle offers protection against dementia. It was noted that the vibrancy and complexity of the writing in the Nun's dairies turned out to be one of the best predictors of whether they would go on to develop Alzheimers. The ones who's writing was thick with beautiful prose, and colourful ideas were much less likely to develop neuro-degenerative disease. 

 

Exercise is the fountain of youth

Kenneth Cooper wrote the book "Aerobics" in 1968. There is a sub branch of exercise physiology or physical-activity epidermiology and that's METABOLOMICS - metabolic profiling aiming to find biochemical patterns in people that create disease or a well state. Fit people have greater increases in a metabolite niacinamide (nutrient byproduct involved with blood sugar control) than unfit people. Researches have also found that exercise excited a gene for a nerve growth factor called VGF (small proteins critical to the development and maintenance of nerve cells). in 2008 a group of researches showed that exercise can reverse aging at a cellular level by taking muscle biopsies before and after a 6 month strength training programme in 65 years old's. 
Ideally a well rounded and comprehensive exercise programme includes cardio, strength, and stretching.......each provides unique benefits to the body and our genes and metabolism. Sitting will undo many of these benefits -the biological effects of sedentariness creates negative metabolic changes. Prolonged time sitting (independent of physical activity) has significant metabolic consequenses influencing triglycerides, cholesterol, blood sugar, blood pressure, and the appetite hormone leptin. 
One study showed that blood levels of C-reactive protein were twice as high in people who spent 4 hrs in front of a screen compared to people that spent less than 2. A study published in the 2009 British Journal of Sports Medicine showed that having a low Cardiorespiratory fitness (CRF)  (code for "being out of shape") accounts for a greater proportion of deaths than obesity, diabetes, high cholesterol, hypertension, or even smoking! Sitting for long periods even if you exericse has biological effects that are surprisingly worse than we ever imagined. Exercise lowers stress for 24 hrs so exercise daily to get a coverage of the beneficial effects. The overall health benefits diminish when you go over an hour - this is bad news for ultra endurance athletes that flirt with overtraining. 

 

Timing and schedule is EVERYTHING

Keeping a regular schedule is a pillar of real success. When you break your bodies natural rhythm - you are no longer performing optimally - your state has been disrupted. When something is not planned your system will release cortisol (stress hormone telling our body to hold on to fat - going into survival mode). Our system LOVES predictability, a lack of it is one of the biggest contributors to STRESS. Our system loves homeostasis and it will create drastic change internally to keep it.  Take home message - work out a schedule, stick to it and it will be the platform to launch success in any facet of life. 

 

Sleep is a sentinel of a healthy state.


It directs so many of our bodies hormanal rhythms and cycles that we can't reboot ourselves artifically with drops, pills, potions, and industry driven promises. We need regular, reliable consistent patterns of rejuvenating sleep for our cellular biochemistry to lay the platform for our potential. It is the greatest performance agent and it's FREE.  It consolidates our memories which helps then pick up new skills. It cleans out files we don't require and helps uptake new ones (meditation also helps with this brain reshuffle).  Our appetite hormones Ghrelin (eat) and leptin (don't eat) hinge largely on sleep habits. Ghrelin the GO hormone is released when the stomach is empty, when it's full fat cells usher out the leptin sending a message to the brain that we need to STOP eating. It's the STOP hormone. Sleep deprivation creates a disconnect between the brain and the gut creating the environment for mindless eating. The more quality sleep (7.5-9hrs), (see my article on sleep -https://everfit.co.nz/articles/wholistic-runner-part-2-sleep )  the better the hormone regulation, and the better your WELLNESS. 
  • stick to the same sleep-wake schedule 7 days a week. Regularity is more important than hours.
  • Use the 30-45min before bed to unwind and prepare for sleep. Avoid stimulating activity.
  • Keep gadgets out of the bedroom
  • No caffiene after 1pm, and be cautious of alcohol in evening.
  • Keep your wakeful life on a relatively stable track, and include downshifting (see below)
  • Respect regularity, schedule downtime. Share this knowledge with the next generation. 
Regularity 24-7 is the goal. As a society we learn to suppress our bodies preferred schedule to meet goals that satisfy other areas of our lives but shift us further away from health. 
When the brain is constantly stimulated learning is compromised. In 2008 University of Michigan reaseachers showed massive differences between refreshing the brain in stimulating it. The study showed that people learned significantly better after a walk in nature compared to a walk in a dense urban environment (processing a barrage of information tires the brain). So checking your facebook feed in the line at the supermarket might not be beneficial. Our societies "obsessive hyperconnectivity" is creating problems - difficulties filtering our irrelevant information, and inability to focus on tasks : this can contribute to a lack of productivity, increased anxiety, and mental health issues.  Matthew Richtel (winner of the Pulitzer prize for National Reporting for his articles series "Driven to Distraction") focused his articles on the how technology can alter the frontal lobe of developing children, creating addictive traits. Technology needs to be viewed as food. If we overeat it causes problems, just as if we use technology unproductively and for too much time it can be thought of as junk.  It is estimated 25% of our workdays are in "information overload" creating an environment for dis-ease in our system. It is not sustainable.
"Many of us depend on multitasking as the only way to get everything done. However.....you do an injustise to everything and everyone your're splitting time between. We're sequential beings, not simultaneous. One thing at a time - it's been around as a basic principle since the dawn of time!" Daniel Patrick (author of Consider: Harnessing the Power of Reflective Thinking in Your Organisation)

 

"The saddest aspect of life right now is that science gathers knowledge faster than society gathers wisdom." Isaac Asimov

 

Homeostasis is the bodies paradise. The body is complex but is constantly seeking the simple balanced state of homeostasis. When we place too many forces on it like excessive training (without absorption time), drugs, supplements, inconstant schedules, poor sleep, excessive kcal, hyper processed "food" that our system doesn't recognise as food, conflict in our relationships, and alcohol we break that homeostasis. The body will return there if we just respect the preferred rhythms, and being mindful of what we put in to the body.