Why “Test and Replace” Isn’t The Answer

These days I’m obsessed with biodynamic farming. Conceptualized by Rudolf Steiner in the 1920s, it considers soil fertility, plant growth, and livestock care as ecologically connected tasks, emphasizing the use of manure and compost from the farm cycle, and excluding artificial chemicals. Instead of conventional test and replace algorithms that check levels of calcium, nitrogen, and other minerals in the soil and advocates replacing them with lots of synthetic inputs, the biodynamic approach treats animals, crops, and soil as a single system, relying on a closed loop cycle of animals grazing and then fertilizing the soil to grow healthy plants and maintain a strong and productive ecosystem.

Many of the patients I see in my practice arrive with thousands of dollars worth of testing. They show me complicated pie charts, carbon cycle diagrams, and long lists of enzymes and reagents with shading from green to red to indicate high and low levels, as well as analyses that indicate they’re allergic to virtually everything. Almost always there’s a shopping bag full of supplements with broad and bodacious claims for restoring health. But despite all this testing and replacing, they’re still not well.

Sustainable health, like sustainable agriculture, is an art rather than a science, and except in specific circumstances where we have reason to believe there may be deficiencies (like a patient with Crohn’s disease of the ileum who can’t absorb B12), test and replace works about as well in the medical field as it does in agriculture. Focusing on specific nutrients in the form of supplements without taking stock of the big picture – namely the health of the food you’re eating and how and where it’s grown – isn’t in my experience a viable way to restore health, profitable though it may be for those doing the testing and replacing.

The food writer Michael Pollan’s seven words still constitute some of the best medical advice out there: eat food, not too much, mostly plants. And I’ll add an additional seven of my own: make sure it’s grown in good dirt!

By: Robynne Chutkan, MD, FASGE