Contagion Versus Terrain Theory: What if the Two Intermingled?

EDITOR’S SUMMARY: Both germ (contagion) theory and terrain theory have been presented, as well as a harmonizing theory. The question remains: Is disease caused by germs AND a diseased state, or does one reign over the other? If this article raises questions for you, it’s a story well-thought out. Perhaps asking if microbes from the outside, along with your body’s ecosystem, can work in tandem with each other, is the more compelling question. It’s A Voice for Choice Advocacy’s job to unfold a variety of viewpoints, not to choose for you. That we leave up to you.

You may have grown up with the idea that germs cause disease. Washing hands and staying away from those who are sick have been commonplace tips to avoid catching a cold. There was a time, however, when the notion of disease-causing germs wasn’t the predominant medical belief it is now. This idea once competed with another concept called terrain theory. This theory suggested disease manifested in your body, or terrain, due to an imbalance in your internal system. 

germ vs. myth theories

Germs: Microscopic Living Things: Fungi, Bacteria, Viruses, Parasites

Germs as the source of disease: The concept of invisible mechanisms triggering illness is an old idea. It was first described in 1546 by Italian physician Girolamo Fracastoro, and came to be known as contagion theory. It would be centuries before contagion theory gained popularity. Between 1850 and 1920, through the work of Louis Pasteur, Robert Koch, and other scientists and physicians, the idea evolved into modern-day germ theory. This theory states the cause of disease is microscopic organisms, called germs, that invade your body.

Germ theory wasn’t embraced from the start, but several factors led to it becoming the dominant idea in medicine. Pasteur had support and funding from the French government, which helped popularize his belief that germs were the cause of disease. He acquired a reputation as the father of modern immunology in part through his work in creating a vaccine for anthrax; although now it’s known he stole the anthrax vaccine from rival M. Toussant, a veterinary professor, who was finally recognized as the true creator in 1998.

Another factor in the adoption of germ theory was the Flexner Report of 1910, funded by the Rockefeller and Carnegie Foundations. This report set the standards for medical education in the United States, creating the current research-focused approach used in medical schools today. But it also led to the closing of nearly 80% of all complementary and alternative medical schools in existence at the time, because these schools didn’t align with the laboratory-based model of medicine expected by Abraham Flexner, the report’s author.

Once germ theory ascended to mainstream thinking, it became the foundation for all of modern medicine, practiced by doctors, and espoused by medical organizations such as the U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO). Germ theory also helped stoke the fires of fear around disease. This dread stretched back centuries, as a result of a history of epidemics, such as the Black Plague and the Spanish flu. In fact, the term “virus” was derived from the Latin word for poison, reinforcing the idea that microorganisms are a threat to your health, and should be feared.

This panic was on full display during the COVID-19 pandemic, as people rushed to stock up on essentials, such as toilet paper, while governments implemented lockdowns to prevent the spread of disease. The antiquated tactic of quarantines had been used for centuries as a defense against epidemics. Ironically, this fear only increased your body’s susceptibility to disease. Under modern medicine’s application of germ theory, your salvation lies in avoidance, vaccines, disinfectants, antibiotics, and other drugs designed to kill germs. Pasteur naturally espoused this solution, as the drugs produced in his Pasteur Institute generated significant income. This made his organization a progenitor of the modern biotech company. Similarly, today’s pharmaceutical firms benefit from germ theory, helping the industry generate nearly $2 trillion in 2022 drug sales.

In fact, medicines have garnered a reputation as “magic bullets” against disease, a term coined by Nobel Prize-winning physician Dr. Paul Ehrlich, who invented a drug to treat syphilis in 1909. But throughout the last century of medicine, magic bullets have proven rare, and adding to this is the fact over 90% of drugs have ten or more side effects. In addition, drugs can adversely affect the beneficial microbes your body needs to stay healthy. For example, research shows antibiotics damage your gut microbiota, which are the beneficial microorganisms living in your intestinal tract. This microscopic ecosystem, collectively called the microbiome, is not only essential for digestion, it also influences other aspects of your well-being, including your emotional state and brain health.

And drugs cause thousands of deaths every year with that death toll on an upward trajectory over the past twenty years. Prescription opioids alone resulted in nearly 17,000 deaths in 2021, while death from all drugs that year approached 107,000. Moreover, germ theory doesn’t explain why some people catch an illness while others exposed to it remain healthy. For instance, at least a third of people exposed to COVID-19 remained symptom-free, and no medical explanation under germ theory alone can explain why.

This fact was pointed out back in 1968 by Dr. G.T. Stewart, Professor of Epidemiology and Pathology at the University of North Carolina, Chapel Hill, who stated

“The germ theory of disease—infectious disease is primarily caused by transmission of an organism from one host to another—is a gross oversimplification. It accords with the basic facts that infection without an organism is impossible and that transmissible organisms can cause disease; but it does not explain the exceptions and anomalies. The germ theory has become a dogma because it neglects the many other factors which have a part to play in deciding whether the host/germ/environment complex is to lead to infection.”

Dr. Stewart has a point when he stated the concept of germs causing disease was an oversimplification. Getting sick isn’t as straightforward as catching the germ, and you’re done for. That’s where terrain theory comes into play, since it takes into account the fact that the health of your body plays a role in how well you can ward off sickness.

In addition, technological advances have allowed scientists to gain deeper understandings of how the microorganisms living in your body affect health. Even the often maligned virus is now known to play a key role in your well-being, since viruses contribute to how human reproduction and the nervous system work. This new understanding of human interdependence with microorganisms, and the need to keep your microbiome in balance, combined with the recent COVID-19 pandemic, helped to create a resurgence in terrain theory.

Let’s remember, however, in the 1800s, Hungarian physician, Ignaz Semmelweis, made a groundbreaking discovery. While in charge of the obstetrics clinic at Vienna General Hospital, he sought to understand the high rate (over 13%) of women dying from postnatal childbirth fever. Finally making the link from germs to disease, and then finding a solution, here’s what he found

“Semmelweis connected the dots. Medical students regularly dissected cadavers. And often they came directly to the obstetrics ward from the dissection room to deliver babies. They did not wash their hands because no one knew about germs in 1847, and no one understood the need for surgical hygiene. Midwives did not do dissections and so they were not bringing infectious material to their patients. Could childbed fever be prevented by removing the contaminants from the medical students’ hands?

So Semmelweis instituted a cleansing procedure, required of all students and staff at his clinic, whereby they had to wash their hands in a solution of chlorinated lime before assisting maternal patients. Within a short time, the mortality rate dropped from 13% to 2% and was now the same in both clinics.”

body's role in terrain theory

Terrain Theory: The Workings of Your Body

In the medical freedom community—”you do you; I’ll do me” when it comes to making decisions about what goes in and on your body; otherwise seen as body autonomy—there is an idea that some (but not all) people have. There is a belief that terrain theory suggests that germs, i.e. microorganisms don’t exist. This is an incorrect assumption about the philosophy of traditional terrain theory, and does not represent its essence. However, some voices insist there is a “new” terrain theory that suggests there are no such things as viruses or contagious microbes.

Terrain theory was first articulated by Louis Pasteur’s contemporary and rival, Pierre Jacques Antoine Béchamp. While Pasteur promoted the idea that disease came from outside your body, Béchamp believed susceptibility to disease was the result of your body’s internal condition, which he called your terrain. In terrain theory, microorganisms both benign and potentially harmful reside in your body at all times. It’s only when your internal health, which includes your microbiome, deteriorates and becomes vulnerable, does it create the conditions for harmful microbes to rise unchecked and cause illness. Hence, disease is a symptom of internal imbalance as much as it is the cause of your issue.

The mechanisms that create an imbalance in your terrain are varied. It could be due to poor nutrition. In the 1930s, dentist and researcher Weston A. Price linked nutrition’s impact on your body’s well-being after he recognized the Standard American Diet (SAD) was causing a decline in oral health, another part of your body reliant on a healthy microbiome. He traveled around the world to study the oral health of indigenous people since they were not exposed to Western foods, discovering that they were healthy, compared to Americans consuming the SAD.

An imbalance in your terrain could also be the result of exposure to toxins. Many foods are routinely sprayed with pesticides, so unless you eat only organic ingredients, you’re consuming some of these toxins. Also, many municipalities add fluoride to drinking water in an effort to prevent cavities, often produced by the high levels of refined sugar consumed as a part of the SAD. But this fluoride comes from the waste byproduct of the fertilizer industry, and as such, contains toxins such as arsenic and lead.

Some folks discount terrain theory as pseudoscience, yet a sea change is slowly happening wherein more therapies targeting the health of your terrain, and not solely the illness itself, are being adopted. According to the American Hospital Association, a growing number of hospitals now offer complementary and alternative medicine (CAM) services, from only 8% in 1998 to over 40% in 2011. These services include acupuncture, chiropractic care, homeopathy, herbal medicine, and massage therapy. All have the impetus to improve the health of your body from a source level, rather than simply eliminating symptoms.

Terrain theory forms the foundation for functional medicine as well, which makes sense since this medical discipline focuses on uncovering root causes of health issues. This means functional medicine practitioners take a holistic approach, and look toward dietary and lifestyle changes to support your body getting back into balance. And functional medicine is growing in popularity, as practitioners expanded from over 5,000 in 2010 to nearly 40,000 in 2020.

A growing chorus of voices are also embracing and promoting terrain theory. Darin Olien, health expert and co-host of the award-winning Netflix docu-series, “Down to Earth with Zac Efron,” espouses the theory, stating:

“Our future doctors are learning about drug interactions and not about healthy eating and medicinal foods. The whole medical community has turned and flipped on its head and the real science of how the body works has been eliminated. The profit center and the wide eyes of pharmaceutical industries were created. There is profit in fighting and treating the symptoms of disease with drugs. But there is no profit in growing your own food and nourishing and healing your body through nutritional choices.”

Dr. Andrew Kaufman, a natural healing consultant, said of terrain theory:

“It allows us to identify what may be the true cause of the illness, which in my experience is generally either some toxic exposure, some missing nutrition or a combination of both. If we can discover the underlying causes, then we can design a therapy or we can correct the problem to prevent it from happening again. The other major part of it that would change how you think is that realizing that when you’re experiencing the symptoms of an acute illness, that’s actually your body healing. If you try to suppress those symptoms with a variety of medications and such, you’re actually suppressing the body’s healing.”

According to the book, “The Contagion Myth: Why Viruses (including “Coronavirus”) Are Not the Cause of Disease,” by Thomas S. Cowan M.D., and Sally Fallon Morell, the well-being of your body’s terrain can be addressed by looking at four factors: the quality of the water you drink (which interestingly raises a question about germs), the food you eat, the level and types of toxins you’re exposed to, and exposure to electromagnetic fields (EMFs)—environmental pollutants emitted from electronic devices, such as your mobile phone or microwave oven.

If the terrain model of medicine piques your curiosity, you can seek out a functional medicine doctor. They will dig into your body’s nutritional needs for a perspective on health that differs from a conventional, symptoms-focused approach. Certainly, conventional treatments have their place based on individual health needs and values. But reliance on pharmaceutical drugs alone doesn’t make you healthy. You still need to integrate physical activity, consume a clean, nutrient-rich diet, reduce stress, and get sufficient high-quality sleep. 

From Dr. Lauren Deville, naturopathic doctor, in “Germ Versus Terrain Theory”:

“Another way to understand this: Dr. Rudolph Virchow, the Father of Modern Pathology, said, ‘“If I could live my life over again, I would devote it to proving that germs seek their natural habitat – diseased tissue – rather than being the cause of dead tissue. In other words, mosquitoes seek the stagnant water, but do not cause the pool to become stagnant.”’ 

That said, if you want to test your body’s high-functioning ability to ward off viruses that may or may not exist, walk into a room of kids with measles, and stay a while. You might not have a fighting chance, and then again … maybe you will. From NIH: StatPearls Publishing, “Rubeola (Measles)”:

“Rubeola, also known as measles, is a type of infectious disease. It is caused by a virus that is transmitted via person-to-person contact as well as airborne spread. Due to its mode of transmission and its ability to remain airborne for a prolonged period, individuals become easily infected. Its high contagiousness and its inherent infective efficiency result in continued yearly multiple outbreaks worldwide.” 

germ terrain duality theory

The Kaleidoscope: Looking Through a Non-Black and White Lens 

Perhaps coming to a conclusion about germs and terrain is not as clear-cut as you might have thought. What if embracing the idea that there is a “dance,” that a co-mingling between theories might make sense? If the absolute belief that one theory is right and the other is wrong doesn’t sit well, consider sprinkling one with spice from the other.

As the late Steve Jobs encouraged

“Don’t be trapped by dogma — which is living with the results of other people’s thinking. Don’t let the noise of others’ opinions drown out your own inner voice. And most important, have the courage to follow your heart and intuition.”

Germ theory posits that the microbe coming from outside of you will “get you” no matter the state of your health. Treatment will come after the fact (of illness) in most cases. Unless of course you consider attempts at avoidance from germs, aka staying away from sick or symptomatic people, or people altogether, as “treatment.” Traditional terrain theory proposes that while pathogens do exist, the state of your health, particularly your immunity, including pH levels (acid/alkaline spectrum) in your blood and saliva, etc., will determine if you get sick or avoid the downfall. 

Further defined, your body’s terrain must be in an “optimal state,” with defense mechanisms working effectively to fight off microbes. Bugs aside, terrain theory’s stance is that the state of your health is entirely up to you (taking into account environmental factors). In this case, treatment points toward “prevention.” The time to take action in regards to your lifestyle (diet, activity, stress, sleep, connections, creative outlet …), and influence on your health would be now, well before any storm of bacteria or viruses touch down upon you.

What if it’s the interplay between the environment of your terrain, and the consequence of germs finding their way inside you, that determines your ultimate state of wellness or disease? From this lens, both germs and terrain are responsible for your health. From Juniper Publishers, JOJ Nursing and Healthcare: “The Differences Between the Germ Theory, the Terrain Theory and the Germ Terrain Duality Theory”:

Introducing “Germ Terrain Duality Theory:”

  • “There are two causal agents—the microorganism and the anatomical/physiological terrain. BOTH equally important neither factor is primary or secondary”
  • “To prevent disease we have to «build defences» AND create health”
  • “Recognizes importance of immune system in fighting disease”
  • “Disease arises from germs sometimes within and sometimes without [outside] the cells of the body
  • Micro-organisms are generally to be guarded against, but not at the expense of the terrain
  • Microbes feed on damaged and dead cells, but have other functions too
  • Micro-organisms change their shapes and colors to reflect the medium/terrain condition
  • Every disease is associated with a particular micro-organism AND condition/set of conditions
  • Disease is caused by a complex interplay between germs and the inherent anatomical/ physiological integrity of the body cells
  • Acknowledges existence of microzymas but debates whether they are fully alive or semi alive, regards microzymas however to be the basic unit of living things, not necessarily of life per say
  • Acknowledges importance of body ph in health and disease
  • Acknowledges major role of cell anatomy/ physiology
  • Proposed by Seun Ayoade. You have to create a healthy body AND treat the symptoms. Distinguishes Clearly Between Diseased And Damaged Tissue” 

Take what serves you and discard the rest. Find a groove that works for your sensibility, and don’t succumb to anyone else’s persuasive efforts to enlist you into their thinking. If you want to learn more about these theories, take a deeper dive into the research, talk to a well-trusted, informed, non-judgmental friend, peer, or mentor, and most of all, let your intuition weigh in. Claiming a place of “just don’t know” is fine too. Who says you need to know? However, what you very well might have to decide, is whether to lean into prevention as healthcare, and what type at that. Will you work to avoid “catching bugs,” choose to build your immune function and overall health, neither, or both?  


If you’ve found value in this article, please share it!

To support the research and health education of AVFC editorial, please consider making a donation today. Thank you.