THE MAN WITH ONE EYE AND HIS DISCOVERIES – PART 2


Picture taken from John H. Cummings and Amanda Engineer. Denis Burkitt and the origins of the dietary fibre hypothesis. Nutrition Research Reviews (2018), 31, 115

Burkitt resigned his surgical post in Mulago Hospital in 1964. But he stayed in Kampala for two years as the external scientific staff of the Medical Research Council. He observed that the incidence of some cancers varied considerably in different locations. He was primarily interested in continuing research in occurrence and distribution of cancer in Africa.  But he left Africa mainly because of the changes occurring in post- independent Uganda and returned to London on 14 February, 1966 and continued to work with the Medical Research Council for 10 years.

He never had the idea that diet could have a role in cancer or other diseases. His idea changed when he got introduced to Peter Cleave, a retired Naval Medical Officer, by Sir Richard Doll. This paved the way for his next great contribution to cancer and medicine. Cleave believed that many Western diseases were caused by inadequate fibre consumption. Burkitt was convinced by Cleave’s research and conclusions as Burkitt had not seen these diseases in African medical practice.

Like the similar approach used in Burkitt lymphoma, he used questionnaires and personal visits to test Cleave’s hypothesis. He acquired extensive data on the dietary habits of populations around the world. In 1969, he started his research to complement the epidemiological evidence he got. He studied  the effect of different diets on bowel behaviour, including stool characteristics and bowel transit time. He studied the relationships between diet and the incidence of various disease like obesity, diabetes, ischemic heart disease, diverticular disease, bowel cancer, haemorrhoids, hiatus hernia, varicose veins. Over the next 5 years, he accumulated enough evidence which convinced him that lack of fibre was a determinant of bowel cancer risk and many other diseases.

He regularly went to Africa, while doing these studies. He met a biochemist, Alec Walker, in South Africa in 1969. Walker had studied the diets of black and white South African prisoners.  He came to the conclusion that the African prisoners who consumed a diet high in fibre had a low incidence of diseases such as colon cancer, obesity, gall stones and diabetes compared with their white fellow prisoners who took a refined diet. Walker had also studied bowel transit times and stool weights. Walker and Burkitt shared research findings and published together.

Burkitt presented a paper on his nutritional findings at a meeting in Kampala in 1970. His old colleague, Hugh Trowell, had also attended the conference. He had previously studied nutrition and in 1960, had published a list of diseases rarely seen in Africa but which were prevalent in economically developed countries in a book named 'Non Infective Diseases' in Africa.  Burkitt and Trowell began to work together and they published a number of papers and books on nutrition.

Burkitt used his very high international profile to propagate high fibre diets and exposed the risks of unhealthy Western diets which was rich in fat, sugar and salt and low in fibre.  He gave lectures around the world and published regularly on diet. His crusade on the importance of dietary fibre changed the diet of the Western world. Burkitt came to be known as The Fibre Man.

There was a dearth of literature about fibre written by nutritionists and medical scientists over many years. But how did Burkitt make an hypothesis relating diet and major diseases of Western Culture over a period of only six years?

Will see about the people who instilled the fibre concept in Burkitts mind  in the coming posts.

References:
1.     Davis Coakley. Denis Burkitt and his contribution to haematology/oncology. British Journal of Haematology. 2006:135; 17–25.
2.    John H. Cummings and Amanda Engineer. Denis Burkitt and the origins of the dietary fibre hypothesis. Nutrition Research Reviews (2018), 31, 115

                                                                                          Written by Dr.Priyavadhana

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