Every few months, we'll bring you guys up to date with what books and other things that we've been reading lately.
Andrew - Unconventional Medicine by Chris Kresser
As a full-time graduate student, the concept of “pleasure reading” falls along the same lines as the concepts “disposable income,” “free time” and “stress-free”–it doesn’t happen that often! So anytime that I get the chance to kick back and read something simply because I want to and not because it is an assigned reading is always something I look forward to.
Over this past winter break, I created a goal for myself to read at least 3 books. Between catching up with old friends, holiday obligations and stuntin in Miami for New Years, I ended up with 2 out of 3, which I will consider a success. Of the 2 that I did read, one that that really stuck out to me was a book titled “Unconventional Medicine: Join the Revolution to Reinvent Healthcare, Reverse Chronic Disease, and Create a Practice You Love” by functional medicine doctor Chris Kresser. While the book is geared mainly towards doctors, it does a great job of painting the picture of our current HC crisis and ways that we can fix it. Full disclosure, this is a Chris Kresser household. I have been following Kresser’s work ever since I became interested in the ancestral health movement back in 2011, and he is one of the main people that I use to guide my health behaviors. So needless to say, I was pretty hyped when he decided to finally drop his book last December.
Anyway, the overarching premise of the book is that our current model of healthcare in the United States is extremely flawed, and unless wholesale changes are implemented, will crumble under its own weight in less than 50 years. One of Kresser’s main arguments is that our current system is antiquated. He discusses how our HC paradigm first evolved during a time when acute diseases were prominent (typhoid, tuberculosis, pneumonia). However, today our HC landscape has shifted dramatically, where 7 of the top 10 causes of death are now chronic conditions (CVD, cancer, lung disease). And unlike acute problems, chronic diseases are more difficult to manage, expensive to treat and usually last a lifetime. In other words, they don’t lend themselves to the “one-problem, one-treatment” framework that we had in the past. Additionally, most patients today now have more than 1 condition, see more than 1 doctor and have more than one 1 treatment that often go on for decades. Overarching, Kresser argues that our current model is outdated and needs to be brought up to date. Some eyepopping statistics from the book:
Kresser suggests that our current HC system is destined to fail for 3 main reasons: misalignment between our genes and environment; wrong medical paradigm for chronic disease; current HC model doesn’t support preventing or reversing disease.
#1. Misalignment between our genes and environment – Kresser notes that before farms and factories took over, most of human history was lived eating a hunter-gather diet and lifestyle. Our modern diet has little resemblance to what our ancient ancestors ate, and he suggests that our genes have not been able to adjust to these changes. For example, for most of human history, humans ate mostly meat and fish, wild fruits and vegetables, nuts and seeds, and some starchy plants and tubers. Nothing was processed and nothing came in a box. Today, the top 6 foods in our diet are: grain-based desserts, bread, sugar-sweetened beverages, pizza, alcohol and chicken–mostly fried. Kresser argues that this sudden shift has resulted in a diet that is pro-inflammatory, low in nutrients and a main reason for our modern diseases.
In terms of lifestyle and behaviors, Kresser argues that those are out of whack too. For example, our increased exposure to artificial light (being indoors, on our phones during bedtime, etc.) has severely thrown off our circadian rhythms and contributed to elevated chronic cortisol levels, which has shown to be responsible for some pretty harmful conditions long-term. Here, Kresser also argues that we are hard-wired to seek out calorically dense rewarding foods, because back in the day, it would have been considered an advantage. Then, those calories would have prevented us from starving, as our brains were set up to live in an environment of food scarcity. Now, with McDonald’s and Starbucks on every corner, we are still programmed to eat this way, hence the strong misalignment between our behaviors and genetics.
#2 Wrong medical paradigm – Kresser argues that our current HC system is based more on managing symptoms rather than treating root causes and reversing diseases. As I mentioned earlier, when our medical paradigm first came about, the most prevalent diseases were acute. Now that most people are dealing with chronic diseases (and sometimes 2 or more diseases), our system is not equipped to handle the complexity and thus the inefficient model of care. For example, in today’s system, someone will go into a doctor’s with a number of issues related to diet (e.g. diabetes, obesity), and leave with drugs for insulin and lowering blood sugar. While these drugs will treat the problem in the short term, they will not fix the problem. And since one chronic condition often leads to others, you end up creating more problems because you haven’t addressed the root cause to begin with. In essence, you are simply rearranging chairs on the deck of the Titanic, you’re still going to go down at the end of the day!
#3 Our current model doesn’t support preventing and reversing diseases – Our current HC system is simply not set up to help with the complexities of our health. For one, the quality of care sucks! The average visit in the US is just 12 minutes, with newer doctors typically only spending around 8 minutes. Such brief engagements don’t allow enough time to really examine important diet, lifestyle and behavioral issues that are causing our symptoms. Today’s doctors aren’t trained to work collaboratively with their patients. And even if a doctor does make a suggestion, recent research is showing that simply having knowledge and education is not enough, real behavior change relies on social support and networks–those of which the doctor is usually not a part of.
So how do we fix this mess? For his solution, Kresser proposes the ADAPT framework. This model consists of 3 axioms: 1. a functional medicine approach, which is focused on preventing and reversing, rather than simply managing chronic disease; 2. an ancestral diet and lifestyle, which recognizes the fact that we out of line with our genetics and environment, and that environment is a primary cause for chronic disease and; 3. a collaborative practice model, which offers doctors a structure that better supports delivering an ancestral diet and lifestyle intervention to their patients. He spends the rest of the book going into detail with the ADAPT framework and offers up solutions of how we implement it on a larger scale.
My thoughts on the book:
I think that Kresser is spot on with everything here. As a current public health student, and someone who is soon going to be intimately involved with trying to solve these issues, I’m already seeing the implications firsthand. One of the most shocking things that I noticed working with HC practitioners and other professionals is how in the dark most of them are when it comes to the solutions that Kresser is proposing. Because our system is based primarily on Western ideals of biomedicine (one which privileges systematic processes and an assembly line approach to treating conditions), there is not a lot of space for critical thinking and innovative mindsets to flourish and come up with different solutions. The system has become so specialized and isolated that practitioners only focus on their own sector of medicine, and thus the entire human organism (mind, body spirit) does not get examined holistically. So when one axiom (say, the mind) affects another (say, the body), there is not a system set up to address it.
The problem has gotten so bad that I think if we really want to create sustainable, long-term change, we have to completely blow up our current system and retool what we think a HC system should look like to begin with.
Over the past few elections, there has been more of a push to get Americans access to affordable HC. With Obamacare initially starting the conversation and now Trumpcare emerging as one of the country’s most debated political topics, everyone is up in arms about how to create more widespread coverage. Although in my opinion we are screwed either way, as arguing for more care is simply a political move that doesn’t address the real problem at hand–the system itself. Giving people more access to a system that is antiquated and broken does more damage than good. That would be like giving someone with a hangover more access to alcohol to temporarily solve the problem (e.g. think mimosas at Sunday brunch to treat Saturday night’s transgressions) instead of prescribing rehydration and rest.
Ultimately, I would like to see us take our money and resources that we allocate towards HC coverage and see it spent elsewhere. Current costs are already ridiculous and quickly getting unmanageable. For example, HC insurance premiums alone have risen 26% since 2009 and in 2016, U.S. HC spending rose 6%, its largest since 2007. Additionally, we continue to waste billions annually on mis-diagnosed treatments, over-prescribed medications and other bureaucratic inefficiencies. I think that we have to start looking upstream more, and tackle health problems before then even get to the “treatment” stage to begin with.
Similar to Kresser’s model, I think that we have to bite the bullet and pay extra for preventative care up front. Off the top of my head, here are my quick and dirty solutions to solving the problems:
What’s your take on our current HC system? Is there hope, or are we doomed as Kresser says? Leave your thoughts in the comments below.
Jared - A New Earth by Eckhart Tolle
When it comes to learning new things or reading new books, I seldom will read a book from cover to cover. Since becoming a dad, running my business and wanting to spend as much time as I can moving outdoors I have become very intentional about what I read and watch. Right now I’m taking a break from reading and focusing more on being. I tried listening to Unconventional Truth by Chris Kresser but it completely put me to sleep, so I have switched to reading A NEW EARTH by Ekhart Tolle and it’s exactly what I need right now. We always have things to do, places to go and we never take the time to just be. We are consumed with doing. I see in most of my professional circles there is an insatiable hunger for knowledge. People keep filling up their brain or book shelves with content. It's everywhere but content doesn't become wisdom without experience. When you learn something new its important to take time and let it integrate.
It's crazy to me that people run around all day long and never take time to connect with themselves. It’s almost as if we are scared to be with ourselves. We quickly switch on the Instagram, Facebook or tinder looking to be filled up and It only creates more dissatisfaction. Since reading Ekhart I’ve spent more time being still or focusing on my breathing, or connecting to nature. I can’t tell you how transformative it has been. I’m more calm, I have more creative ideas and I am finding I enjoy the simple things. Sometimes learning is important, but other times it can create more clutter. The phrase paralysis by analysis comes to mind. I prefer to be a minimalist in all things.
Try and take 5 minutes everyday to do what your dog does and do nothing. Embrace it and see how it makes you feel.