PEOPLE WHO INSTILLED FIBRE HYPOTHESIS IN BURKITTS MIND- PART 1 SURGEON CAPTAIN THOMAS LATIMER (PETER) CLEAVE – ‘THE BRAN MAN’

Pictures taken from  John H. Cummings and Amanda Engineer. Denis Burkitt and the origins of the dietary fibre hypothesis. Nutrition Research Reviews (2018), 31, 1–15. Dennis Burkitt. Picture taken from https://mccarrison.com/visionaries/burkitt/

Five most important people who influenced Burkitt on ‘fibre hypothesis’ were

Ø  Surgeon Captain T. L. (Peter) Cleave,
Ø  Dr G. D. Campbell,
Ø  Dr Neil Stamford Painter,
Ø  The Rev Dr Hubert Carey (Hugh)Trowell
Ø  Dr A. R. P. (Alec) Walker.

Among all this, the most influential person was Peter Cleave and we will see about him in this post.

Cleave was known as ‘Peter’ to his friends and colleagues. He was born in Exeter in 16 August, 1906, in a naval family. His father and brother were naval officers. He went to  Clifton College Bristol, then to British Royal Infirmary. He qualified in Medicine from St Mary’s Hospital London in 1928. After completing his medical training, Cleave entered the Royal Navy in 1927 as Surgeon Lieutenant. Between the years 1938-1940, he served as Medical Specialist at RN Hospital, Hong Kong.


He had sacks of bran brought and stored on board to treat constipation among sailors during Second World War, in 1941 while on battleship King George V. Hence he got the nickname `the bran man'. Later, he worked at Royal Naval Hospitals in Chatham (1945-1948), Malta (1949-1951) and Plymouth (1952-1953). 

The Remarkable Vision of Dr.T.L. Cleave and the “Bran Gang” by Celia Haddon in the ‘Health Quarterly’, Sept-Oct 1981, originally in the ‘London times’. Image Credit. Wellcome Images. Wellcome Library reference: PP/TLC/F.6/6:Box 14.

Cleave's sister died at the age of eight years due to perforated appendix. At the Bristol Royal Infirmary, one of his teachers, Rendle Short, had proposed that appendicitis is caused by lack of cellulose in the diet and published the same in British Journal of Surgery titled  ‘The causation of appendicitis’ . Rendle influence on young Cleave might have created an interest in the distribution of diseases worldwide and diet as a causative factor.

Cleave was a natural thinker. He has always been a great admirer of Charles Darwin's writings, which provided him the intellectual framework to his lifelong studies and research with the relationship between diet and health. He was credited by some as the originator of the fibre hypothesis, he saw sugar as the main obstacle to health. He introduced Burkitt to fibre hypotheis and to one another very important concept, that if a group of diseases occur together in the same population or individual they are likely to have a common cause.

Between 1941 and 1962, he worked extensively on causative factors relating to western diet on neoplasms, peptic ulcer, CHD and varicose veins. In 1956, he outlined his belief, that ‘our neglect of natural principles was the root cause of the ills of Western society ’in a paper in the Journal of the Royal Naval Medical Service. This is a long and discursive article. He states two reasons for our change of diet pattern from our primitive people. One is cooking and the other is  concentration of the food by machinery.

According to Claeve, the consequences of  overconsumption of refined carbohydrates, results in ‘…dental decay, peptic ulcer, diabetes, obesity, constipation and intestinal toxaemia’. He describes the possible mechanisms how refined carbohydrates lead to ill-health and mentions ‘fibrous foods’ only briefly in the context of gum disease and ‘removal of carbohydrate pulp’ as contributing to constipation, haemorrhoids and varicose veins but does not at any stage invoke fibre as important. His arguments include historical references, food consumption data, his own observational epidemiology and some physiology but little in the way of experimental evidence. Cancer and CHD is hardly mentioned. He talks about what is healthy diet and concludes that it is the overconsumption of refined carbohydrates leading to such diseases in this paper.

He was already giving dietary advise to his family while he was still at school, but how he developed these ideas even at a young age is surprising.

Cleave book ‘The Saccharine Disease’. Pic taken from amazon.

Cleave retired from the Royal Navy (RN) in 1962 as Surgeon Captain and Director of Medical Research at the RN Medical School. After retiring, he began work on a book the Saccharine Disease. Published in 1966, the first chapter “The Law of Adaptation, Hereditary Defect, Personal Make-up” starts by saying that ‘This work is based on the Darwinian theory of evolution.’ Cleave uses data on sugar consumption worldwide and changes in flour milling practices in the nineteenth century to make the point that the greatest alterations to our diet from the ‘...natural state…’ have occurred quite recently in evolutionary terms with the refining of carbohydrates to produce white flour and sugar. 

He suggests that overconsumption of these carbohydrates is due to their concentrated state in foods and that the rapidity of the change on an evolutionary time scale had led to maladaptation by the body and to a group of diseases, which together he proposes to be a single ‘Saccharine Disease’, the manifestation of which depends on ‘...personal build in the parts of the body affected’. The diseases included in this concept are listed in Cleave’s 1966 edition of this book. Fibre is referred to in the chapter on dental caries and mentioned in the context of bowel habit and of diverticulitis but not in discussion of diabetes, coronary thrombosis, peptic ulcer and infection with ‘B Coli’ where Cleave stresses only on overconsumption of white flour and sugar. Thus in neither the 1966 edition of his book, nor his paper in 1956, does  Cleave implicate fibre.

He has concluded in his book ‘The sachharine disease’ that the diet is based on two rules only, which are (i) Do not eat any food unless you definitely want it and (ii) Avoid eating white flour and white or brown sugar.

This book was good to read, written in simple English,which extensively describes Cleaves description on the various diseases and its relation to diet and it is freely available online. If you don’t have much time, atleast have a look at the last chapter and I am the attaching the link here.  http://journeytoforever.org/farm_library/Cleave/cleave_app_diet.html#diet.

After working in obscurity for many years, in the 1970s Cleave received international acclaim as the father of the dietary fibre hypothesis. His book ‘The Saccharine Disease’, published in 1974, sold thousands of copies. In 1979, Cleave was awarded both the Harben gold medal of the Royal Institute of Public Health and Hygiene and the Gilbert Blane medal for naval medicine by the Royal College of Physicians and Surgeons. In 1986, the British Medical Association finally answered Cleave’s voice  in its report Food, Nutrition and Health, which recommended an increase in consumption of fresh food ,vegetables and whole grains. Dr. Cleave was a 2009 inductee into the Orthomolecular Medicine Hall of Fame.

One of Cleave's most effective advocates was Dr. Denis Burkitt, the legendary cancer researcher. Burkitt's connections with 150 hospitals from various parts of the world enabled him to confirm many of Cleave's epidemiological observations. He could even add to his list of Western diseases which can be attributed to refined carbohydrates. Burkitt acknowledged his friend, stating "Cleave was one of the most revolutionary and far-sighted medical thinkers of the twentieth century, seeing far beyond the small vision of intricate details of individual diseases."

He died on 15 September 1983 at the age of 77. Tributes to 'the Bran man' and 'the father of dietary fibre hypothesis'.

References:

1. John H. Cummings and Amanda Engineer. Denis Burkitt and the origins of the dietary fibre hypothesis. Nutrition Research Reviews (2018), 31, 1–15

2. The Saccharine Disease. Conditions caused by the Taking of Refined Carbohydrates, such as Sugar and White Flour. T. L. Cleave, M.R.C.P. (Lond.)

3. http://www.orthomolecular.org/hof/2009/cleave.html

See you in the next post by yet another person who influenced Burkitt on dietary hypothesis.

                                                                                      Written by Dr.Priyavadhana