A round-up by Charles on ZIOH of the chapter about Fiber in Gary Taubes's book Good Calories Bad Calories:http://forum.zeroinginonhealth.com/showthread.php?tid=1418
GCBC Chapter 7: Fiber Pages 122-124
George McGovern’s Senate Select Committee on Nutrition and Human Needs held its first hearing in April 1973 and the sugar and refined carbohydrates hypotheses were very much alive. None of the staff member who organized the hearing worked for the committee three years later when the Dietary Goals were drafted. More importantly, McGovern nor his congressional colleagues could reconcile what they heard from the assembled experts with what they already believed about the nutritional evils of modern diets.
McGovern’s presidential run and defeat causes plans to change on the 1972 hearing which would have dealt with dietary fat, cholesterol and heart disease but once they returned to debate these issues, John Yudkin’s book Sweet and Dangerous and its subject seemed to be the most urgent.
Aharon Cohen, George Campbell, and Peter Bennett, an NIH epidemiologist who worked with the Pima Indians of Arizona, all testified. Bennett’s research revealed the highest incidence of diabetes ever recorded at the time. Half of the Pima over thirty-five years-old were diabetic. Bennett questions whether the issue was just sugar or the amount of calories due to the excessive amounts of carbohydrates. Walter Mertz, chairman of the USDA Nutrition Institute, testified along with Carol Berdanier, who explained the particular havoc that refined sugar played with her laboratory rats, which had high blood sugar, triglycerides, diabetes, and they died at an early age.
The committee found the sugar and diabetes arguments compelling and requested suggestions on how American could lower the 120 pounds of sugar consumption down to the 70 pounds in accordance with George Campbell’s research.
When the subject went to heart disease, controversy arrived. Aharon Cohen, Peter Cleave and John Yudkin all testified that there was no direct relationship of dietary fat to heart disease. McGovern questioned whether people with high cholesterol were even at risk. He found it hard to believe because this information contradicted that which he learned from his doctor!
This exchange was instructive:
McGovern: “Are you saying that you don’t think a high fat intake produces the high cholesterol count? Or are you even saying that a person with high cholesterol count is not in great danger?
Yudkin: “Well, I would like to exclude those rare people who have probably a genetic condition in which there is an extremely high cholesterol. If we are talking about the general population, I believe that decreasing the fat in the diet is not the best way of combating a high blood cholesterol…I believe that the high blood cholesterol in itself has nothing whatsoever do to with heart disease.”
McGovern: “That is exactly opposite what my doctor told me.”
Sociologist William Isaac Thomas observed in the 1920s that “if men define situations as real, they are real in their consequences.” It’s basically difficult to entertain an alternative view if you have already convinced yourself that something is undisputable. By the early 1970s any potential cause of chronic disease had to be reconciled with the existing belief that dietary fat was the primary cause of coronary heart disease. The “refined carbohydrates” hypothesis could not be reconciled with the dogma.
This attempt to reconcile the evidence that diseases of civilizations did not appear in populations relatively free of Western influences, with Keys’ hypothesis was the platform for the fiber hypothesis of Dennis Burkitt.
GCBC Chapter 7: Fiber, pages 125-128
Denis Burkitt was a former missionary surgeon in Uganda in 1947. In the early 1960s he earned his renown. The Washington Post called him “one of the world’s best known medical detectives” for his studies of a fatal childhood cancer that came to be known as Burkitt’s lymphoma and would be the first human cancer ever linked to a viral cause. In 1966, Burkitt returned to England and worked as a cancer epidemiologist for the Medical Research Council. Richard Doll told him about Cleave and his saccharine-disease hypothesis. Burkitt met with Cleave and read Diabetes, Coronary Thrombosis and the Saccaharine Disease which he found revolutionary. He toured the United States and found American blacks in hospitals who were often obese, diabetic, or atherosclerotic and noted that these conditions were nonexistent in the Ugandans Burkitt treated.
Burkitt used his own network of 150 African rural hospitals that mailed him monthly cancer reports. He asked them about the appearances of chronic diseases and the results of his surveys confirmed the basics of Cleave’s hypothesis. Because of the scale of his inquiry he was able to amass “anecdotal multiplied by a thousand” compared to Cleave. Burkitt also had the necessary reputation that Cleave did not.
Burkitt’s fiber hypothesis was based originally and in its entirety on Cleave’s saccharine-disease hypothesis but rather than claiming that the diseases of civilization were based on an addition to our diet, he argued that they were based on the subtraction of the fiber from those evolutionarily ideal diets. This subtraction led to constipation and ultimately to the diseases of civilization. This fiber deficiency was caused by either the removal of fiber during the refining of carbohydrates or by the consumption of refined-carbohydrates in lieu of the fibrous bulky roughage we should have been eating.
The fiber and refined carbohydrate hypotheses were photographic negatives of each other but the fiber hypothesis caught on immediately upon appearing in the journals even though the refined-carbohydrate hypothesis was the only one of the two capable of explaining the actual evidence. The fiber hypothesis was consistent with Keys’ hypothesis whereas Cleave’s and Yudkin’s was not. It resonated with the nation’s countercultural leanings toward diets heavy in vegetables, legumes and cereal grains.
Burkitt believed he could draw a direct line of causation from the absence of fiber in refined carbohydrates to constipation, hemorrhoids, appendicitis, diverticulitis, polyps, and finally malignant colon and rectal cancer.
Burkitt theorized that removing the fiber from cereal grains would slow the “transit time” through the colon thus providing more time to inflict damage on the surrounding cells but it was conceivable that the over consumption of refined carbohydrates would increase the bacterial flora of the stool and that in turn could lead to carcinogens being metabolized by the bacteria out of “normal bowel constituents.” Burkitt could offer no explanation for why this might cause appendicitis but he was confident (read: believed) that some combination of all these factors played a role.
In July 1969, Burkitt was studying stool characteristics and he visited Alec Walker, a fellow stool examiner, who ran the human biology department at the South African Institute of Medical Research. He studied the rising tide of chronic diseases in urban Bantus in South Africa. Walker dismissed the refined-carbohydrates hypothesis and simultaneously acknowledged that Bantus developed chronic disease only after they moved into the city and began consuming “more white bread, sugar, soft drinks and European liquor.” He linked the rural Bantus low mortality rate to their low bowel motility, a characteristic “largely lost” among Western societies. Burkitt was emboldened by this and devoted his efforts to stool characteristics and bowel behavior hoping to scientifically associate fiber deficiency, constipation and the presence of chronic diseases.
This is the work that led to the fiber hypothesis and its present place in our national consciousness. In 1972, Burkitt and Walker published an article in the Lancet supporting their theory and discussing their measurements of transit time and stool characteristics in twelve hundred people. As you can imagine, the diets of rural people where the “natural amount of fiber” was present, lead to large, soft stools traversing the colon rapidly. However, in industrialized areas, they found small hard stools which according to them played a causative role in bowel-related disorders.
Within two years, Burkitt extended his hypothesis from appendicitis, diverticulitis and colon cancer to all chronic diseases of civilization. In the process, Cleave’s refined-carbohydrate hypothesis of saccharine diseases was transformed into Burkitt’s fiber hypothesis of Western diseases.
Burkitt had a close association with Harold Himsworth who you’ll remember was responsible for Elliott Joslin’s belief that sugar and other carbohydrates were not responsible for diabetes. Himsworth related a Sherlock Holmes story where Holmes stated “The whole clue, as I see it, to this case lies in the behavior of the dog.” And Watson said, “But sir, the dog did nothing at all.” “That,” said Holmes, is the whole point.” In this case, fiber was not there so Burkitt became motivated by the simple expediency of emphasizing the positive benefits of fiber rather than the negative effects of sugar and flour which seemed like a hopeless cause. As Alec Walker said, “Sugar is simply an integral part of the daily diet and emphatically is here to stay.” It was easier to say “Don’t forget fiber in your diet than to say “Don’t eat sugar, flour, white rice and drink less beer.”
Now this is the thing that made me quite angry to read. How did you feel when you read this portion? How many times have I seen something on television or in print espousing the goodness of fiber and its importance in our diet? If you get rid of refined carbohydrates, you don’t need this stupid fiber. It’s indigestible so why bother? These guys, Burkitt and Walker, basically robbed Peter Cleave’s hypothesis just because they had big reputations in the medical community. The work Burkitt did with lymphoma can’t be understated, but this is ridiculous. Perhaps if he researched that lymphoma a little further, he might have found that the cancer he studied was also caused by refined carbohydrate consumption. He built a great reputation by coming up with a novel way to treat and detect a symptom but he failed to recognize the cause which was staring him in the face. Instead, he changed it to suit his own purposes. His own quote is instructive: “Cleave, Campbell and others had been written off as cranks. Now, just because there happened to be a Burkitt’s lymphoma, when I said ‘What about looking at this’ people listened to me when they hadn’t listened to far better guys.”
It’s important to remember while reading this book that science and the scientific method have been invoked to show how unscientific this whole business is. The conventional wisdom on diet and nutrition is based on such flimsy evidence and golf course deals over lunch. It’s built on observations in the market place and assumptions and pure dogma. It is hardly based on anything scientific. It gets me riled up each time I review this chapter.
If yesterday’s post wasn’t bad enough, it gets worse. Hugh Trowell was also a missionary physician who spent thirty years in Kenya and Uganda. He was part of a number of British doctors who watched three million people undergo rapid “westernization.” Just as in all isolated populations, the diseases of civilization were noticeably absent. Trowell noted in 1929 Kenya that the people were as thin as “ancient Egyptians” (at least the pictures on their hieroglyphs). However, when they dined with the native tribes, they always left food at the end of the meal and fed it to their domestic animals suggesting that their emaciated appearance was not caused by food shortages or low-calorie diets.
During World War II, Trowell noted that British nutritionist tried to fatten Africans in the British Army but were unable to do so. It remained a mystery. However, by the 1950’s, fat Africans were common. Trowell himself noted the first clinical disease of coronary heart disease in 1956, in an African living in England who ate a Western Diet for twenty years. (This reminds me of what Gomer Pyle used to say, “Surprise, Surprise, Surprise!”) In 1970 Trowell returned to East Africa and described “an amazing spectacle.” The towns were full of obese Africans and there was a large diabetic clinic in every city. The twin diseases (obesity and diabetes) were born about the same time and were then growing together.
Burkitt and Trowell were friends since the 1940s in Uganda. In 1970, they worked on Burkitt’s fiber hypothesis and a textbook called “Western Diseases.” According to them, obesity could be induced by the fiber deficiency in the Western Diet. Over the course of a few decades we unknowingly eat 4 percent more calories than the natural inherited evolutionary figure and therefore gain weight. Later investigators added on to this idea suggesting that fibrous bulky foods were more filling and they took longer to chew and digest which supposedly led to a decrease in calories consumed. Today, we’re told to increase our fiber so that we’re fuller longer and we’re encouraged to eat “complex carbohydrates” which supposedly raises our blood sugar slowly and aids digestion. Don’t be fooled by this nonsense.
For heart disease, Trowell borrowed Keys’ notion that carbohydrates protect against heart disease. However, to be fully protective they must have the full compliment of fiber. (Isn’t that the dumbest thing you’ve ever read?)
Trowell explained that more attention would have been paid to Cleave’s hypothesis had he “not dismissed completely the role of saturated fats” in heart disease (Burkitt later said as much). So both fat and fiber could now be blamed. Cleave and Yudkin told us the same evidence could implicate refined carbohydrates and sugar. Burkitt and Trowell called their fiber hypothesis a “major modification” of Cleave’s work but they never actually addressed the reasons Cleave identified refined carbohydrates as the problem to begin with. Why did the Masai, Samburu, the Native Americans of the Great Plains and the Inuit not have these chronic diseases when they clearly ate no fiber prior to their nutrition transition?
Trowell relied on an old faithful, “Special ethnic groups like the Eskimos adapted many millennia ago to special diets, which in other groups not adapted, might induce disease.” Of course they did! Guess they never heard of Vilhjalmur Stefansson who adapted to the Inuit quite quickly – that’s for later…