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An Epidemic of Absence: A New Way of Understanding Allergies and Autoimmune Diseases
A brilliant, cutting-edge report on the rise of autoimmune disease—and the controversial new “worm therapy” that scientists are embracing to treat it.
Whether it’s asthma, Crohn’s Disease, or food or pollen allergies, everyone knows someone who suffers from an autoimmune disorder. But why are they on the rise? Science writer Moises Velasquez-Manoff offers a new and controversial way of thinking about autoimmune disease—one that may foster a paradigm shift in the way we think about health and hygiene. In the early twentieth century, the dawn of improved hygiene, water treatment, vaccines, and antibiotics saved countless lives, eradicating diseases that had plagued humanity for millennia. But in the wake of this triumph, a new threat arose: The human immune system began to malfunction. A growing body of evidence suggests that the very steps we took to cure these maladies have also eradicated organisms that once kept our bodies in balance. To combat this “epidemic of absence,” a group of scientists has begun deliberately reintroducing parasitic worms—helminthes—to calm the immune system of their hosts. This book takes a close look at the scientists at the vanguard of “worm therapy,” which has been proven to not only preempt immune malfunction, but to send a number of disorders—from Crohn’s Disease to multiple sclerosis to asthma—into remission. Exploring the greater context of rampant immune system dysfunction in the developed world, and its implications for developing countries, Velasquez-Manoff offers an eye-opening and elegant portrait of science’s new view of the human organism.
400 pages, Hardcover
First published September 4, 2012
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Displaying 1 - 30 of 143 reviews
December 4, 2012
Have you ever wondered why rates of certain diseases, such as autism, asthma, rheumatoid arthritis and diabetes have increased drastically in the last few decades in the US? This book provides a provocative new insight into a possible common cause, and it is one I would not have imagined: modern life -- it's cleanliness, small families, C-sections, industrialized food - has decimated the diversity of species and total number of organisms in the human microflora, and this decimation has upset our complicated immune system. In fact, it has perhaps disabled an important part of the immune system which the author refers to as "the suppressor arm," which is critical to keeping auto-immune diseases in check.
I was of course familiar with the "hygiene hypothesis," but this book takes that basic idea much further, illustrating how the absence of common parasites, which used to infect nearly everyone from infancy on, in the guts of developed world humans is wreaking havoc. Velasquez-Manoff reviews many interesting studies, all very recent - to illustrate his findings.
Some readers may find the going a little dense in parts. The book is long, but if you are interested in biology and health, you may find it fascinating, as I did. There is one chapter toward the end about people who are reinfecting themselves with helminths which strays from a strictly science-journalism view, but which is also fascinating. Overall, the book is a serious overview of the medical world's newest discoveries about the relationship between parasitism, commensalism and immune function, written for the lay audience.
I was of course familiar with the "hygiene hypothesis," but this book takes that basic idea much further, illustrating how the absence of common parasites, which used to infect nearly everyone from infancy on, in the guts of developed world humans is wreaking havoc. Velasquez-Manoff reviews many interesting studies, all very recent - to illustrate his findings.
Some readers may find the going a little dense in parts. The book is long, but if you are interested in biology and health, you may find it fascinating, as I did. There is one chapter toward the end about people who are reinfecting themselves with helminths which strays from a strictly science-journalism view, but which is also fascinating. Overall, the book is a serious overview of the medical world's newest discoveries about the relationship between parasitism, commensalism and immune function, written for the lay audience.
March 2, 2015
Wow wow wow, this book is so interesting! Like any other Grand Unified Theory, I will take it with a grain of salt. I do not plan to run out tomorrow and infect myself with hookworms in hopes of curing my MS. (Though I'd totally sign onto a clinical trial, if one pops up in my RSS feed.) But it's a well-written, well-documented explication of a huge, plausible, and fascinating set of ideas.
This book reads like a great detective story. I could not put it down. I'd recommend it to any science nerd.
This book reads like a great detective story. I could not put it down. I'd recommend it to any science nerd.
January 16, 2022
"paradigm shift
noun
1.a dramatic change in the paradigm of a scientific community, or a change from one scientific paradigm to another.
2.a significant change in the paradigm of any discipline or group:"
- dictionary.com
"3.a phrase used so often, for smaller and smaller shifts in thinking, that it now means nothing more than 'new'."
- ross' opinion
Nonetheless, I'm going to say it here. Moises Velasquez-Manoff (hereafter referred to as "MVM") presents this book to document a paradigm shift in medical science. It's ongoing, it's controversial, it's hard to accept even in the face of overwhelming evidence, and its ramifications are far-reaching.
The basic idea: our immune system needs something to do. If you don't give it something to do, it will attack tree pollen, or pet dander, or your own intestines (including beneficial microbes within that help to prevent obesity). Sometimes called "the hygiene hypothesis", MVM introduces us to another term for it, "the old friends hypothesis". In this context, microbes (and other parasites such as intestinal worms of one sort or another) which have been infecting humans for tens or hundreds of thousands of years, have adapted to us, and we to them. They are not so virulent as to kill off their host, or even make them materially more vulnerable to succumbing during periods of extreme privation, because for most of their cohabitation with humans, the latter have lived in small hunter-gatherer groups or tiny farming villages. Measles, for example, would never thrive in such an environment, because it would soon kill off all the members of such a small human group, and then die itself.
In the last few thousand years, though, humans have begun to live in much larger groups. Thus, the more recent microbes who have arrived in the human ecosystem have no incentive to settle down and behave. If they kill everyone in this town, it is of little concern to them because they will have spread to the next, and anyway there are cities far too large to be entirely depopulated in this way; there will always be someone new to spread to. It was in response to such "recent arrivals" that the modern medical emphasis on hygiene and anti-microbials developed, and that has been an unqualified good in terms of human life expectancy.
However, MVM takes us on a tour through twenty years or so of research that shows that the pendulum has perhaps swung too far in the direction of purging ourselves of such hangers-on, such that we now rid ourselves not only of measles, mumps, and rubella (and tuberculosis and small pox and...), but also of those microbes (bacteria, viruses, worms, etc.) which our ancestors have carried inside themselves for eons. Recognizing that this might cause a problem, requires thinking of the question, "what microbes should a human harbor?". To ask the question at all implies that the answer is not, "none".
MVM himself has an auto-immune disorder, one which results in his having lost all of his hair (even down to eyebrows and eyelashes) before he reached adulthood. Thus, his interest in the question is not entirely intellectual. He also has seasonal allergies severe enough to impact his quality of life (most of Austin can relate).
The book begins and ends with his own experience, intentionally introducing worms into his intestines to see if they can rebalance his immune system (believe it or not there are a lot of people doing this, and one treatment which has been FDA-approved and thus costs thousands of dollars now). The bulk of it though, is a tour of the recent (and occasionally not-so-recent) scientific and medical research which has led to it.
Ideally, to test the "old friends" hypothesis, you would take a homogenous group of people and assign them randomly to one of two groups. One group would live with the same load of bacterial, viral, and worm infection which most of humanity has labored under through most of our history (although with immunizations against the "new enemies" of measles, mumps, polio, etc.). The second group would be de-wormed, disinfected, and cleaned up. One group would work on farms, often encountering animals of other species (and their spoor), the other would work in offices. One group would get dirt under their fingernails, the other would use antimicrobial soap. One group would eat plants from the garden and drink unpasteurized milk, the other would eat triple-washed plants from the grocery store and drink pasteurized milk. After twenty years, you would know if the "old friends" hypothesis was true, by comparing the risk of allergy and autoimmune disorders in both groups.
Such an experiment has not exactly been run, but then there is little need. Industrialization has repeated it again and again, in one country after another, as the hygiene and antimicrobial medicines come to first the upper urban class, then the middle class, then finally the lower income strata. In country after country, we can chart the rise of hay fever, asthma, Crohn's disease, Type 1 diabetes, and multiple sclerosis, which hits first the upper urban class, and last the rural poor, if it gets to them at all.
MVM is at pains not to sound like a wild-eyed zealot. Like those who reject vaccination, or advocate the administering of purified water for a variety of ailments, the idea that microbes are necessary for us and modern medicine has Gone Too Far, sounds like one motivated more out of an aversion to technology than a basis in science. In order to make sure we understand this is not where he comes from, he takes us on an at times exhaustive look through the research of one accredited scientist, doing work at major universities or research centers, and published in reputable journals, after another, after another, after another. The reasons why the "old friends" hypothesis is not only compatible with evolutionary theory, but almost required by it, are revisited many times.
I appreciate his caution and attention to detail. It is also undeniably the case that many things which seem to be so in one isolated study, do not hold up when examined by other researchers doing similar work. However, there was one point at which I felt somewhat of an urge to skip ahead. "Ok, I get it, there's a whole lot of science backing this up."
For the most part, though, this is all to his credit. Suggesting that we should exert ourselves LESS in the medical war against microbes, is a quite disturbing idea. How we could determine what to do is not even clear, for those of us not yet willing to go out and intentionally infect ourselves with worms of one kind or another. There are a few less drastic measures that do recommend themselves, though:
1) soap, shampoo, and detergents do not need to be anti-microbial. Their task should be to clean.
2) antibiotics are for those with bacterial sicknesses, not something to take whenever you have a cold or flu (which are caused by viruses). They will not help with the cold or flu, but they may kill off some of the "old friends" living in your gut or elsewhere in the ecosystem we call a human.
3) spend more time in the garden, forest, and petting zoo, or farm if you can manage it.
4) watch this field, it is progressing rapidly, and our understanding next year is likely to be substantially different than our understanding today. A paradigm shift worthy of the name.
noun
1.a dramatic change in the paradigm of a scientific community, or a change from one scientific paradigm to another.
2.a significant change in the paradigm of any discipline or group:"
- dictionary.com
"3.a phrase used so often, for smaller and smaller shifts in thinking, that it now means nothing more than 'new'."
- ross' opinion
Nonetheless, I'm going to say it here. Moises Velasquez-Manoff (hereafter referred to as "MVM") presents this book to document a paradigm shift in medical science. It's ongoing, it's controversial, it's hard to accept even in the face of overwhelming evidence, and its ramifications are far-reaching.
The basic idea: our immune system needs something to do. If you don't give it something to do, it will attack tree pollen, or pet dander, or your own intestines (including beneficial microbes within that help to prevent obesity). Sometimes called "the hygiene hypothesis", MVM introduces us to another term for it, "the old friends hypothesis". In this context, microbes (and other parasites such as intestinal worms of one sort or another) which have been infecting humans for tens or hundreds of thousands of years, have adapted to us, and we to them. They are not so virulent as to kill off their host, or even make them materially more vulnerable to succumbing during periods of extreme privation, because for most of their cohabitation with humans, the latter have lived in small hunter-gatherer groups or tiny farming villages. Measles, for example, would never thrive in such an environment, because it would soon kill off all the members of such a small human group, and then die itself.
In the last few thousand years, though, humans have begun to live in much larger groups. Thus, the more recent microbes who have arrived in the human ecosystem have no incentive to settle down and behave. If they kill everyone in this town, it is of little concern to them because they will have spread to the next, and anyway there are cities far too large to be entirely depopulated in this way; there will always be someone new to spread to. It was in response to such "recent arrivals" that the modern medical emphasis on hygiene and anti-microbials developed, and that has been an unqualified good in terms of human life expectancy.
However, MVM takes us on a tour through twenty years or so of research that shows that the pendulum has perhaps swung too far in the direction of purging ourselves of such hangers-on, such that we now rid ourselves not only of measles, mumps, and rubella (and tuberculosis and small pox and...), but also of those microbes (bacteria, viruses, worms, etc.) which our ancestors have carried inside themselves for eons. Recognizing that this might cause a problem, requires thinking of the question, "what microbes should a human harbor?". To ask the question at all implies that the answer is not, "none".
MVM himself has an auto-immune disorder, one which results in his having lost all of his hair (even down to eyebrows and eyelashes) before he reached adulthood. Thus, his interest in the question is not entirely intellectual. He also has seasonal allergies severe enough to impact his quality of life (most of Austin can relate).
The book begins and ends with his own experience, intentionally introducing worms into his intestines to see if they can rebalance his immune system (believe it or not there are a lot of people doing this, and one treatment which has been FDA-approved and thus costs thousands of dollars now). The bulk of it though, is a tour of the recent (and occasionally not-so-recent) scientific and medical research which has led to it.
Ideally, to test the "old friends" hypothesis, you would take a homogenous group of people and assign them randomly to one of two groups. One group would live with the same load of bacterial, viral, and worm infection which most of humanity has labored under through most of our history (although with immunizations against the "new enemies" of measles, mumps, polio, etc.). The second group would be de-wormed, disinfected, and cleaned up. One group would work on farms, often encountering animals of other species (and their spoor), the other would work in offices. One group would get dirt under their fingernails, the other would use antimicrobial soap. One group would eat plants from the garden and drink unpasteurized milk, the other would eat triple-washed plants from the grocery store and drink pasteurized milk. After twenty years, you would know if the "old friends" hypothesis was true, by comparing the risk of allergy and autoimmune disorders in both groups.
Such an experiment has not exactly been run, but then there is little need. Industrialization has repeated it again and again, in one country after another, as the hygiene and antimicrobial medicines come to first the upper urban class, then the middle class, then finally the lower income strata. In country after country, we can chart the rise of hay fever, asthma, Crohn's disease, Type 1 diabetes, and multiple sclerosis, which hits first the upper urban class, and last the rural poor, if it gets to them at all.
MVM is at pains not to sound like a wild-eyed zealot. Like those who reject vaccination, or advocate the administering of purified water for a variety of ailments, the idea that microbes are necessary for us and modern medicine has Gone Too Far, sounds like one motivated more out of an aversion to technology than a basis in science. In order to make sure we understand this is not where he comes from, he takes us on an at times exhaustive look through the research of one accredited scientist, doing work at major universities or research centers, and published in reputable journals, after another, after another, after another. The reasons why the "old friends" hypothesis is not only compatible with evolutionary theory, but almost required by it, are revisited many times.
I appreciate his caution and attention to detail. It is also undeniably the case that many things which seem to be so in one isolated study, do not hold up when examined by other researchers doing similar work. However, there was one point at which I felt somewhat of an urge to skip ahead. "Ok, I get it, there's a whole lot of science backing this up."
For the most part, though, this is all to his credit. Suggesting that we should exert ourselves LESS in the medical war against microbes, is a quite disturbing idea. How we could determine what to do is not even clear, for those of us not yet willing to go out and intentionally infect ourselves with worms of one kind or another. There are a few less drastic measures that do recommend themselves, though:
1) soap, shampoo, and detergents do not need to be anti-microbial. Their task should be to clean.
2) antibiotics are for those with bacterial sicknesses, not something to take whenever you have a cold or flu (which are caused by viruses). They will not help with the cold or flu, but they may kill off some of the "old friends" living in your gut or elsewhere in the ecosystem we call a human.
3) spend more time in the garden, forest, and petting zoo, or farm if you can manage it.
4) watch this field, it is progressing rapidly, and our understanding next year is likely to be substantially different than our understanding today. A paradigm shift worthy of the name.
May 24, 2013
Well I'm only a quarter of the way through, but for someone with a background in health sciences, this is really interesting. Moises looks at the tradeoff from chronic endemic infectious disease to chronic autoimmune disease (allergies, asthma etc). Our bodies are hardwired to fight off infections from overcrowding, worms, TB, Polio, Malaria, eating poo etc - so when we remove all that with modern medecine and bleach our bored immune systems attacks itself. In terms of health economics; money lost through autoimmune and allergy is just as substantial as money lost through cancer.
What does this mean? Go outside and eat poo? Well in a way, it does. The author deliberately infects himself with hook worm to try and result in a 'healing' of his unfortunate total body hair loss through an autoimmune disease. I flicked through to the end of the book. He is still bald so I'm guessing it didn't work. Its compelling and interesting reading, but all attests to some of my personal reasons for moving back to the land for its health giving properties. And the POO!
What does this mean? Go outside and eat poo? Well in a way, it does. The author deliberately infects himself with hook worm to try and result in a 'healing' of his unfortunate total body hair loss through an autoimmune disease. I flicked through to the end of the book. He is still bald so I'm guessing it didn't work. Its compelling and interesting reading, but all attests to some of my personal reasons for moving back to the land for its health giving properties. And the POO!
December 9, 2015
An extremely well written and organized book.
The author has taken a huge amount of material and presented it in a logical and lucid manner.
He also is possibly the only popular health writer with intellectual honesty.
He doesn't use "composite" characters,
and when he doesn't use a persons real name,
he always gives the name of the persons doctor, where he works,
and the city.
Fact checkers can verify everything.
The story is both exciting and scary.
Exciting, in that maybe we are on the path to finally understanding & treating autoimmune diseases.
Scary, in that some of the treatments, like regular worm infections,
give one shivers.
Everyone says mothers milk is better than cow milk.
But no one says why.
I'd guess it's because mothers don't pasteurize their breast milk,
and that if people older than infants could drink "raw" milk,
it would be better for us.
It makes me angry that the gov. makes in almost impossible to buy raw milk.
In my entire life, I've never seen it for sale.
The author has taken a huge amount of material and presented it in a logical and lucid manner.
He also is possibly the only popular health writer with intellectual honesty.
He doesn't use "composite" characters,
and when he doesn't use a persons real name,
he always gives the name of the persons doctor, where he works,
and the city.
Fact checkers can verify everything.
The story is both exciting and scary.
Exciting, in that maybe we are on the path to finally understanding & treating autoimmune diseases.
Scary, in that some of the treatments, like regular worm infections,
give one shivers.
Everyone says mothers milk is better than cow milk.
But no one says why.
I'd guess it's because mothers don't pasteurize their breast milk,
and that if people older than infants could drink "raw" milk,
it would be better for us.
It makes me angry that the gov. makes in almost impossible to buy raw milk.
In my entire life, I've never seen it for sale.
October 20, 2012
My ex-wife (and a few people in her family) has ms and at least one of my kids with her has autism, and there's two chapters on the relationship between these two as auto-immune diseases with (currently) no cure, so I was very interested in this book, which takes a look at those two and asthma and allergies (all of which are relatively new to the human race, and looks at these things from an evolutionary perspective, and he looks seriously at one solution that sounds crazy: worm therapy. When I was a kid people took de-worming medicine if your mom discovered (horrors) that you had WORMS, and this has largely disappeared as a concern in public discourse... as asthma, allergies, autism and ms increase incredibly every year... WHY? I am an English teacher, but this book was interesting to me as a "layman" reader about what is missing in today's (especially urban--we don't see so many of these problems in rural areas, in less industrialized countries..) society: parasites, things found in going "back to the land..." I don't pretend to fully understand it all, but this fine science writer synthesizes much current theory about this stuff and heads us in a useful direction... I hope.
January 17, 2018
This is not cutting edge or scientific in ANY way. people who think this is real hard science are simply confused about what hard science is.
This book deserves 0 stars.
This is a book written to justify and explain how a Christian Scientist (religion not a science) journalist decided to to try cure his illness set with parasitic worms. The 'facts' and articles put forth and discussed within the pages of this unique book are only showing one tiny side of the real truth.
The extremely strong bias of this author is unmistakably clear. I strongly dislike books that claim to be scientific yet are clearly aggrandized and slanted by extreme bias.
This book deserves 0 stars.
This is a book written to justify and explain how a Christian Scientist (religion not a science) journalist decided to to try cure his illness set with parasitic worms. The 'facts' and articles put forth and discussed within the pages of this unique book are only showing one tiny side of the real truth.
The extremely strong bias of this author is unmistakably clear. I strongly dislike books that claim to be scientific yet are clearly aggrandized and slanted by extreme bias.
May 15, 2019
Supercool detective story on the history of immunity disorder with a goal to discover the roots of the problem. Unhappy ending, but some notes of hopes for a brighter future, if we start to live in harmony with our ecosystems.
June 1, 2013
"Modern diseases" is a phrase sometime used to describe human health problems that appear to be reaching epidemic proportions in the modern world. In fact, there appears to be a correlation between how advanced a civilization is and the numbers of these diseases in that population. Medical conditions such as autism, allergy, irritable bowel syndrome, chronic fatigue syndrome, Crohn's disease, eczema, asthma, obesity, and many others are included in the list. A satisfactory explanation for this finding is yet to be presented. Worse yet, most of these conditions are extremely difficult to treat medically speaking. A person so affected may go to great lengths to seek relief. This book opens with examples of such people intentionally having themselves infected with parasitic worms---whipworms, tapeworms, roundworms, etc. The premise of the book is that the modern human has learned how to get rid of microbes that have lived in and on the human body for many centuries of evolution. We have done the job so well using chorination of water, antibiotics, antimicrobial soaps and gels, etc that our immune systems no longer have the sparring partners (such as worms) that they have always had in the history of humans and therefore develop abnormally. For example, an abnormal immune system can lead to an attack on the strawberries you had for lunch---i.e., a food allergy. Or altering the microbial population living in your intestinal tract will lead to an inability to control one's weight, etc. This book is an excellent, in depth but accessible look at the evidence supporting the idea that getting rid of our "old friends" by being too hygienic is at least partly responsible for many of these conditions. The author consulted over 8000 references/scientific studies and presents 300 of these in his selected bibliography. It is clearly evident that it is a serious attempt to assimilate as much of the current research as possible into a unified concept. He has succeeded admirably. Anyone studying immunology/microbiology, medically treating these conditions or afflicted with one or more of these conditions would benefit from reading this book. The author does not claim to have all the answers but when the only useful treatment available for some people is to intentionally infect themselves with worms, it is clear that we need to think "outside the box" and this book does an excellent job of showing one way to do that.
March 5, 2020
As someone living with Crohn's Disease and a rising grad student eager to enter the world of dietetics & immunology, this book could not have come at a better time in my life. This book explores a rather unconventional, "new science" explanation for the rising rates of allergies and autoimmune diseases in the U.S. and other developed countries. Perhaps we're too "clean" for our own good - smaller families, bigger living spaces, processed foods, C-sections, heavy antibiotic use and an over sterilization of the human race & our ecosystem have altered the inhabitants of our microflora. Our immune systems haven't evolved as fast as our sanitary reforms. Our immune suppressors are slipping with the disappearance of our "old friends."
The book was incredibly interesting. If you enjoy medical mysteries, I'm sure you'll love this. While I'm not racing to infect myself with a hookworm any time soon, this unique perspective boosted my excitement for school in the fall. I can't wait to one day contribute to this line of research as an RD. The anecdotes of the men and women navigating the Hookworm Underground were especially heart breaking. I pray to see these horrible illnesses cured one day, or at least treatments continue to be optimized.
The book was incredibly interesting. If you enjoy medical mysteries, I'm sure you'll love this. While I'm not racing to infect myself with a hookworm any time soon, this unique perspective boosted my excitement for school in the fall. I can't wait to one day contribute to this line of research as an RD. The anecdotes of the men and women navigating the Hookworm Underground were especially heart breaking. I pray to see these horrible illnesses cured one day, or at least treatments continue to be optimized.
October 24, 2019
I felt very mislead with this book...and it just felt so very long. It starts out with the author going to get these curable hookworms to help cure his autoimmune diseases, but it doesn't pick back up at that scene until the very last chapter of the book. The 400 pages in between are all research, DNA patterns, testimonials, facts for or against helminths (a type of hookworm), and basically how it is all our own fault that MS, Rheumatoid Arthritis, and etcetera exist. (He seems to believe it is solely because we created the Malaria Vaccine and that is the reason that we all have these diseases.) I'm not arguing whether this guys is smart or a complete idiot. But I am arguing that I was very let down by the book because I wanted to go on the journey with him from the outskirts of Tijuana, Mexico, to him having the hookworms in his body, and finally making his own choice of whether they work. Basically if you are a science person you might like this, if not you will be bored to tears. This was the first book of the year I thought I might not finish.
July 24, 2020
★★★½
The author offers a new theory about the increase of allergies and autoimmune diseases that I have only seen very little about so far. It makes a lot of sense to me that not every parasite or illness is bad for us. Certain illnesses primed a child's immune system and we're now seeing the negative effects of them not having that priming anymore due to vaccines. In this book, the author touches more on parasites and worms and how some have actually helped people reverse their autoimmune disease/allergies. The germ theory which lead to cleaning up and destroying/removing everything that can potentially harm us may be doing more harm than good.
One big takeaway I got from the book is that mom matters most (as one chapter is called). Mom's health has a huge impact on the baby's health (dad's too, actually). I enjoyed reading the background and history of a range of topics related to his theory including about the microbiome. It also made me even more excited to be living on a farm as he explained the benefits of it for children especially and how it lowers their chances of developing allergies and autoimmune disease.
The author offers a new theory about the increase of allergies and autoimmune diseases that I have only seen very little about so far. It makes a lot of sense to me that not every parasite or illness is bad for us. Certain illnesses primed a child's immune system and we're now seeing the negative effects of them not having that priming anymore due to vaccines. In this book, the author touches more on parasites and worms and how some have actually helped people reverse their autoimmune disease/allergies. The germ theory which lead to cleaning up and destroying/removing everything that can potentially harm us may be doing more harm than good.
One big takeaway I got from the book is that mom matters most (as one chapter is called). Mom's health has a huge impact on the baby's health (dad's too, actually). I enjoyed reading the background and history of a range of topics related to his theory including about the microbiome. It also made me even more excited to be living on a farm as he explained the benefits of it for children especially and how it lowers their chances of developing allergies and autoimmune disease.
May 23, 2018
Though it has a few too many anecdotal cases for my taste, the author has a refreshing attitude of skepticism and always tries to follow them with more rigorous studies. In the end, I was left with the feeling that this is a promising field, but that it would be premature to take action. Was hoping for some more direct recommendations, but better a cautious reaction than pseudoscience.
December 17, 2019
The hygiene theory of autoimmune diseases could be described a whole lot better. The author relies too heavily on anecdotal data. Moreover, the author should have done a whole lot more research on autism before trying to write about it. I've seen great reviews of this book but, TBH, I don't understand them at all.
November 29, 2012
Wow. Having read a whole body of research and literature purporting to disprove the 'clean hypothesis' of autoimmune disease, my views were challenged and effectively changed by this book. In it, Moises Velasquez-Manoff, a sufferer of autoimmune disease himself, presents a historical perspective of human-parasite coevolution interspersed with arguments and anecdotal evidence that give new perspective to the so-called diseases of modernity. His work opens up a relativly new and arcane body of knowledge and therein derives insight into human-parasitic symbiosis and its relation to diabetes, Crohn's disease, Colitis, autism, etc.(imagine parasites and bacteria replacing corticosteroids and biologics at your next doctor's visit...) His underlying postulation? A nuanced approach to reintroduce bacteria and parasites into humans shows exciting promise in preventative thearpy and treatment of autoimmune diseases and, moreover, may be a necessary approach to hamper down the formidable challenge we face in light of both the dramatic rise in prevalence as well as our largely ineffective attempts thus far to control these diseases the world over.
What makes Velasquez-Manoff's work so compelling is without a doubt the nuance he employs to each of his cases. Many of the challenges to the clean theory all reduce to a simplistic weighing of the pros vs. cons of parasitic habitation in humans, leading inevitably to the conviction that humans are much better off now than one hundred or even one thousand years ago. While many of these arguments are justified in numbers, and thus true at face value, Velasquez-Manoff goes beyond the surface in every case to demonstrate that nuance is key: the types, combinations, prevalence and maintenance of organisms in the human gut reflect millenia of specific ethno-geographic evolution. Put another way, individuals are genetically unique and the parasitic approach to treating the infinite manifestations of autoimmune diseases must reflect this. By paying close attention to the delicate nature of the evolutionary human-parasite coexistence,we have already seen exciting results. It may just be possible to turn parasite back from foe to friend without sacrificing most of the health benefits derived from parasitic cleansing.
Overall an incredible book that offers great insight into what might be a watershed moment--parasites, helminths, probiotics and all--in the public health approach to autoimmune disease and its disturbing rise worldwide.
What makes Velasquez-Manoff's work so compelling is without a doubt the nuance he employs to each of his cases. Many of the challenges to the clean theory all reduce to a simplistic weighing of the pros vs. cons of parasitic habitation in humans, leading inevitably to the conviction that humans are much better off now than one hundred or even one thousand years ago. While many of these arguments are justified in numbers, and thus true at face value, Velasquez-Manoff goes beyond the surface in every case to demonstrate that nuance is key: the types, combinations, prevalence and maintenance of organisms in the human gut reflect millenia of specific ethno-geographic evolution. Put another way, individuals are genetically unique and the parasitic approach to treating the infinite manifestations of autoimmune diseases must reflect this. By paying close attention to the delicate nature of the evolutionary human-parasite coexistence,we have already seen exciting results. It may just be possible to turn parasite back from foe to friend without sacrificing most of the health benefits derived from parasitic cleansing.
Overall an incredible book that offers great insight into what might be a watershed moment--parasites, helminths, probiotics and all--in the public health approach to autoimmune disease and its disturbing rise worldwide.
May 5, 2013
Honestly, this is the most interesting book I've read in awhile. I found myself as riveted as if it were a fast-paced novel. I love popular science books like this--so interesting you don't miss escapist fare to read it.
Even if you don't suffer from, or know anyone who suffers from, autoimmune, immune, asthma, or allergic disease (unlikely, if you live in the industrialized world), there is a wealth of information in this book. It deals with human evolution--or, more specifically, human coevolution with a diversity of microbes. In order to deal with this constant onslaught from the environment, the human immune system evolved to regulate its interactions with these foreign invaders, even reaching a tolerance with them. Some of these microbes become commensal or even mutualist, and the immune system has even "outsourced" some of its functioning to the microbiota in the gut that we evolved with.
Now, in the absence of these microbes, our own internal environment has become as lacking in diversity and damaged as our external one. Our immune systems, evolved to deal with a flood of soil and animal microbes and parasites from the womb, are becoming dysregulated. Even the obesity epidemic--though of course lifestyle and diet changes play a role--can be seen as a result of immune system dysfunction. Because the gut is in a constant state of inflammation, and the immune system isn't properly regulating it, it pushes the gut microflora out of balance. Without the proper balance, the pancreas exhausts itself and becomes insulin-resistant, which forces the person to overeat, and usually the wrong things, which continues to starve the microflora and feed the cycle of inflammation, etc. So then obesity becomes not just a disease of lifestyle, choice, or at best, "bad genes", but of profound immune and metabolic dysfunction.
Some patients have taken matters into their own hands, traveling to foreign areas to deliberately infect themselves with certain types of human parasites, long eradicated in the "sanitized" developed world. While the results offer only anecdotal evidence, it is compelling data.
This book is a must-read for any in the healing arts, or for physical technicians (doctors) who want to do the best for their patients, not just treat in the way dictated by insurance policies.
Even if you don't suffer from, or know anyone who suffers from, autoimmune, immune, asthma, or allergic disease (unlikely, if you live in the industrialized world), there is a wealth of information in this book. It deals with human evolution--or, more specifically, human coevolution with a diversity of microbes. In order to deal with this constant onslaught from the environment, the human immune system evolved to regulate its interactions with these foreign invaders, even reaching a tolerance with them. Some of these microbes become commensal or even mutualist, and the immune system has even "outsourced" some of its functioning to the microbiota in the gut that we evolved with.
Now, in the absence of these microbes, our own internal environment has become as lacking in diversity and damaged as our external one. Our immune systems, evolved to deal with a flood of soil and animal microbes and parasites from the womb, are becoming dysregulated. Even the obesity epidemic--though of course lifestyle and diet changes play a role--can be seen as a result of immune system dysfunction. Because the gut is in a constant state of inflammation, and the immune system isn't properly regulating it, it pushes the gut microflora out of balance. Without the proper balance, the pancreas exhausts itself and becomes insulin-resistant, which forces the person to overeat, and usually the wrong things, which continues to starve the microflora and feed the cycle of inflammation, etc. So then obesity becomes not just a disease of lifestyle, choice, or at best, "bad genes", but of profound immune and metabolic dysfunction.
Some patients have taken matters into their own hands, traveling to foreign areas to deliberately infect themselves with certain types of human parasites, long eradicated in the "sanitized" developed world. While the results offer only anecdotal evidence, it is compelling data.
This book is a must-read for any in the healing arts, or for physical technicians (doctors) who want to do the best for their patients, not just treat in the way dictated by insurance policies.
May 4, 2013
Based on what I have read on this chapter, I found out that worms and environmental exposure gives a lot of help on getting rid of diseases and allergies. We can't just skip from the dilemma of having such kinds of diseases with just one take of a medicine. Getting rid of these diseases starts as early as in the mother's womb. Being exposed to diverse microbes while pregnant build a strong immunity for unborn child. And that diverse microbes can be acquired more on farm with the farm animals and cowsheds that can't be found at cities.
I have learned on this chapter that complete eradication of microbes around will just increase the risk of developing diseases and allergies. Being clean doesn't mean that you are safe from harmful diseases. It's fine being clean with yourself, but not being exposed into diversity of microorganism will lower the immunity. Protection that can acquire naturally is better than modern chemicals that we thought are better.
This book so far gives wide explanation about auto immune diseases and allergies. Hookworms, parasites and microorganisms play an important role for these diseases. Our common understanding that these creatures of the earth are harmful to the human body is different from what this book is saying. As some evidences showed on the book, they are the major factors that help cure those diseases. Immunity is an important thing that we should have to protect ourselves from those harmful diseases. And strong immunity is widely abundant in an environment with diverse microbes such as farm. As our world gets modernized, the risk of losing these helpful microorganisms is rising. And so the risk of developing diseases and allergies has big chance too. It's not bad to be exposed on diverse microbes once in a while, after all we only want to be free from diseases.
I have learned on this chapter that complete eradication of microbes around will just increase the risk of developing diseases and allergies. Being clean doesn't mean that you are safe from harmful diseases. It's fine being clean with yourself, but not being exposed into diversity of microorganism will lower the immunity. Protection that can acquire naturally is better than modern chemicals that we thought are better.
This book so far gives wide explanation about auto immune diseases and allergies. Hookworms, parasites and microorganisms play an important role for these diseases. Our common understanding that these creatures of the earth are harmful to the human body is different from what this book is saying. As some evidences showed on the book, they are the major factors that help cure those diseases. Immunity is an important thing that we should have to protect ourselves from those harmful diseases. And strong immunity is widely abundant in an environment with diverse microbes such as farm. As our world gets modernized, the risk of losing these helpful microorganisms is rising. And so the risk of developing diseases and allergies has big chance too. It's not bad to be exposed on diverse microbes once in a while, after all we only want to be free from diseases.
October 25, 2012
This book follows the hygiene hypothesis but takes it to the next level. Are we so clean now, a sign of civilized peoples, that we have inadvertently become too clean for our own good? He explains that yes, we have been throwing out the baby with the bath water, from the wide use of antibiotics, from the massive campaign to deworm all over the world, to the removed clean urban/suburban life that devoids us of contact with good old dirt. He talks extensively about the underground worm therapy phenomenom and the questions that this may answer in understanding allergies, asthma, and autoimmune diseases in the developed world. He links them all to the lack of exposure to good bacteria that can still be found the the dirtier conditions of the undeveloped world. He correlates this to the extensive data on undeveloped world's low rates of these diseases that dominate the developed world. The trend is startling, as he makes a strong case to why these diseases are related to our lack of microbiota in our gut. One interesting link is how the microbiota and diversity of in our gut is deeply influenced in the womb, and how that can directly impact our susceptibility to allergies, astham, and even autism. He talks about inflammation and how the body's immune system becomes more successful in anti-inflammation tendencies when it is primed with exposure to certain bacterias early on in life.
February 17, 2015
This is an interesting book about the rise of autoimmune diseases as a result of treatments that have eradicated small irritants that kept the immune system strong. Most auto immune diseases are unknown in third world countries where most in the population are continually infected by a small colony of whip worms native to their area of the country. The worms provide a slight inflammation that triggers special antibodies to fight the infection. That response keeps the host from developing other larger infections such as M.S., certain cancers, asthma, crohn's disease, autism, and many other diseases.
Children who frequently spent time at a young age in barnyards around cattle, pigs, and hay brought home microbes on their clothes and even in their hair. The innate immune systems of farmers and farm children have double the abundance of a protein called CD14, which helps the body recognize harmful endotoxins and three times the normal levels of toll-like receptor 2 as people in 'clean' environments. Therefore they are markedly less likely to develop allergies to naturally occurring irritants. Microbial richness in day cares, homes with indoor pets, and large families also modified the risk of allergies but not of childhood diseases.
There is a strong correlation between children who get mononucleosis and those who later develop multiple sclerosis.
Children who frequently spent time at a young age in barnyards around cattle, pigs, and hay brought home microbes on their clothes and even in their hair. The innate immune systems of farmers and farm children have double the abundance of a protein called CD14, which helps the body recognize harmful endotoxins and three times the normal levels of toll-like receptor 2 as people in 'clean' environments. Therefore they are markedly less likely to develop allergies to naturally occurring irritants. Microbial richness in day cares, homes with indoor pets, and large families also modified the risk of allergies but not of childhood diseases.
There is a strong correlation between children who get mononucleosis and those who later develop multiple sclerosis.
March 7, 2013
If you have or know anyone who has allergies, asthma, IBD, MS, autism, or any autoimmune disorder, you must read this book. Well written, objective, and packed with scientific data and accounts of experiments/clinical trials, this book presents a completely new way to look at autoimmune diseases that you have probably never heard about, but is being actively pursued in the scientific community. The thesis may sound crazy at first (that autoimmune diseases appeared and proliferated as we became more removed from nature's parasites, viruses, and bacteria), but it is well explained and backed up by a wealth of evidence. For the theory that self-infecting with worms can halt or reverse auto-immune disorders (worm therapy) I appreciated that the author provided anecdotal and study evidence from both sides, instead of solely cases that resulted positively. It is a dense book and takes time to get through the whole thing, but it is well-written and I think an important read in order to learn about what's happening in the scientific community (something your General Practitioner probably doesn't know about), especially if you or someone close to you suffers from auto-immune diseases.
August 21, 2013
This book took me quite a long time to read and my pet name for it became "Worms and Germs." Overall, I enjoyed the read and thought parts of it were fascinating, but at times the scientific writing was just too technical for me (and I'm a girl who loves good science writing). A little more layman's language would have been helpful.
The basic premise of this book is that our immune system evolved over many thousands of years to interact with certain bacterias and helminths (worms) and in their absence in our modern world we've seen a whole host of autoimmune problems including allergies, asthma, MS, cancer, developmental disorders, etc. The author reviews study after study that demonstrates how worms or microbiota in our guts helped us stave off other problems. Now, the author does go the extra length of purposely infecting himself with worms in Mexico at the beginning of the book; he almost lost me there but I hung in.
I wish that I had more medical knowledge so I could better evaluate everything I was reading; it seemed like a compelling argument. If only I had been tending pigs or infected with worms while pregnant with Darwin maybe he wouldn't have food allergies:)
The basic premise of this book is that our immune system evolved over many thousands of years to interact with certain bacterias and helminths (worms) and in their absence in our modern world we've seen a whole host of autoimmune problems including allergies, asthma, MS, cancer, developmental disorders, etc. The author reviews study after study that demonstrates how worms or microbiota in our guts helped us stave off other problems. Now, the author does go the extra length of purposely infecting himself with worms in Mexico at the beginning of the book; he almost lost me there but I hung in.
I wish that I had more medical knowledge so I could better evaluate everything I was reading; it seemed like a compelling argument. If only I had been tending pigs or infected with worms while pregnant with Darwin maybe he wouldn't have food allergies:)
February 2, 2015
This is such a critical health topic, given the major uptick in large populations afflicted by autoimmune diseases. The author isn't a scientist, but reviewed much research which is admirable; I wish he'd written a tighter book instead of wandering through this material.
Anecdotal and wordy accounts of using hookworms and other worms to treat autoimmune diseases is thought-provoking, yet the storytelling of various cases leaves me wondering what percentage of people have actually benefitted from it? Given that the author's book jacket photo shows him bald, I assume his worm treatment didn't work? The writing is long winded, describing multiple interviewee's eyebrows and other stray tangential details. I hoped to better understand the science behind autoimmune diseases and potential treatments, but this book did not provide that level of understanding (until a bit after p. 244?). The info on microbes and cleanliness is not novel and it's presented in a folksy manner. The last chapter implies a conclusive outcome, entitled "The collapse of the superorganism, and what to do about it" but then he admits his own lack of concrete recommendation. Disappointing.
Anecdotal and wordy accounts of using hookworms and other worms to treat autoimmune diseases is thought-provoking, yet the storytelling of various cases leaves me wondering what percentage of people have actually benefitted from it? Given that the author's book jacket photo shows him bald, I assume his worm treatment didn't work? The writing is long winded, describing multiple interviewee's eyebrows and other stray tangential details. I hoped to better understand the science behind autoimmune diseases and potential treatments, but this book did not provide that level of understanding (until a bit after p. 244?). The info on microbes and cleanliness is not novel and it's presented in a folksy manner. The last chapter implies a conclusive outcome, entitled "The collapse of the superorganism, and what to do about it" but then he admits his own lack of concrete recommendation. Disappointing.
April 11, 2013
I am of two minds about this book. On one hand, as a person w/asthma, allergies and a family tree riddled with both. it was interesting, engaging, and the author presents many compelling stories of ppl helped by Helminth therapy. However, as a scientist, I am leery. The author does spend some time discussing the cons of Helminth (hookworm) therapy, but comparatively, it's VERY little. I have no doubt the changing env't in the modern era has confused our immune system and disrupted our micro biome, but I think, at times, the author mistakes correlation for causation, particularly with respect to cancer. In the wrong hands, this book could lead someone to believing Helminth therapy is a 'cure all', to the exclusion of modem medicine. Many of the chapters were repetitive, and some seemed to offer only anecdotal evidence. This book is worth a read, as long as the reader understands the author is quite biased and that Helminth therapy is still, mostly unproven.
June 13, 2013
A very readable, yet quite technical, explanation of the connection between allergens and parasites. The rate of allergy and autoimmune disorders has rapidly increased since the Industrial Revolution -- but not in still-developing countries. This author believes that at least some of that increase can be explained by the absence of what used to be endemic infections of hookworms, pinworms, and other parasites. Apparently, they provide protection from allergens and stimulate the immune system in a beneficial way.
His chapters on worm therapy and its effects on autism, multiple sclerosis, and Crohn's disease are extremely interesting.
I found the book fascinating and didn't want to put it down. Obviously, there is fodder for more research here.
His chapters on worm therapy and its effects on autism, multiple sclerosis, and Crohn's disease are extremely interesting.
I found the book fascinating and didn't want to put it down. Obviously, there is fodder for more research here.
June 30, 2013
I join the others who flag this as a best book of the year. Very dense with important ideas well supported by research, it goes way beyond simplistic descriptions of the hygiene hypothesis to paint a complex and frankly terrifying picture of how the autoimmune epidemics we currently are experiencing grow from disrupting the symbiotic relationships we have evolved with.
June 20, 2015
This book has great information to share; however, it misses the opportunity to provide it to the widest audience possible in that there are times when the repetition and high-level droning make the reader lose interest. I truly wanted to learn more, and I did, although the process was interrupted by a series of naps.
November 8, 2012
A broad mix of science, questionable science, speculation, inferences and conclusions based on anecdote and opinion, while ignoring or minimizing the potentially very harmful effects of parasitic infection and zoonoses, especially in children.
August 7, 2016
Really impressive and interesting work. I learned a lot. I'm not about to infect myself with hookworms, but fascinating stuff.
December 4, 2023
Solid attempt at a "grand unified theory" of the role and function of our immune system and how humans, in their attempts to industrialize and control the planet, have kind of screwed up how our own system works and now we have all these "new" issues especially around allergies and autoimmune diseases. Basically, another way in which humans have screwed things up.
Is there overreaching here? Probably when you're trying to tie together the underlying causes of most allergic, autoimmune, neurological, and gastrointestinal diseases... But the gist is, the immune system evolved to help your body co-exist with the main issues that it faced as it was evolving -- various bugs, parasites, viruses, and bacteria.
When the system loses one of those jobs (e.g., fewer bugs around, no parasites on the regular), it gives itself a new job and that can be taking an aim at what's next on its "to address" list, parts of you! So up go the incidence of allergies and autoimmune diseases. And if you're willing to go on this books ride, also thanks to an immune system without a well known enemy with whom to work with, you might even end up with autism, depression, stomach cancer and more.
Well documented at the time (book was published in 2012) and I went to the website to see what updates might exist. Surely we've learned more in the last 10 years since just about every podcast is now talking about the microbiome, but alas, I didn't see anything that provided a significant update. Anyway, perhaps Velasquez-Manoff could pen an update be it an article or book since his original "GUT" was pretty interesting...
Is there overreaching here? Probably when you're trying to tie together the underlying causes of most allergic, autoimmune, neurological, and gastrointestinal diseases... But the gist is, the immune system evolved to help your body co-exist with the main issues that it faced as it was evolving -- various bugs, parasites, viruses, and bacteria.
When the system loses one of those jobs (e.g., fewer bugs around, no parasites on the regular), it gives itself a new job and that can be taking an aim at what's next on its "to address" list, parts of you! So up go the incidence of allergies and autoimmune diseases. And if you're willing to go on this books ride, also thanks to an immune system without a well known enemy with whom to work with, you might even end up with autism, depression, stomach cancer and more.
Well documented at the time (book was published in 2012) and I went to the website to see what updates might exist. Surely we've learned more in the last 10 years since just about every podcast is now talking about the microbiome, but alas, I didn't see anything that provided a significant update. Anyway, perhaps Velasquez-Manoff could pen an update be it an article or book since his original "GUT" was pretty interesting...
Shelved as 'did-not-finish'
February 24, 2020I started this book while pregnant with my second child, and unfortunately did not have time to finish before (nor after) he was born. But the parts that I did read were well written and interesting!
The main reason I picked up this book was to gain insight into allergies. My daughter has a peanut allergy, and I am always hoping to learn more about its cause and possible remedies. In addition to skimming certain chapters, I also consulted the index in the back to read as much of the peanut-pertaining parts as possible.
A few notes, definitely not comprehensive:
- A mother's exposure to allergens during pregnancy may impact/trigger food allergies. (So if you want to prevent your children from having allergies, go work on a farm while pregnant!)
- Exposure to allergens via vulnerable skin may impact/trigger food allergies. (Ex: peanut oil in lotions used on babies might accidentally teach their immune system to later react when eating peanut butter.)
- The good news is, epigenetic changes can be modified moving forward.
- Omega-3s (taken while pregnant) may help protect children from allergies.
The main reason I picked up this book was to gain insight into allergies. My daughter has a peanut allergy, and I am always hoping to learn more about its cause and possible remedies. In addition to skimming certain chapters, I also consulted the index in the back to read as much of the peanut-pertaining parts as possible.
A few notes, definitely not comprehensive:
- A mother's exposure to allergens during pregnancy may impact/trigger food allergies. (So if you want to prevent your children from having allergies, go work on a farm while pregnant!)
- Exposure to allergens via vulnerable skin may impact/trigger food allergies. (Ex: peanut oil in lotions used on babies might accidentally teach their immune system to later react when eating peanut butter.)
- The good news is, epigenetic changes can be modified moving forward.
- Omega-3s (taken while pregnant) may help protect children from allergies.
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