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WESTERN DISEASES--Trowell and Burkitt, 1981 comparison to traditional diets

This book is first among works on the conditions of populations that don’t eat the western high sugar diet.  The book has sections—each written by a physician who worked there--on 19 societies for which there were reliable records of their health issues.  This evidence base was used to compare them to those who are on the high sugar diet.  This books forms a foundation for conclusion that have emerged in the last 2 decades that finger first as causes of the diseases of the western diet the sugar fructose (one half of sucrose—table sugar—and 55% of HFCS) which causes insulin resistance and the dysregulation of our weight control system and much more.  A second less significant cause is the polyunsaturated fats that end up in cell membranes and become rancid therein. 

I have prepared in summary the major points relevant to our health disaster.  Note, the authors of this book subscribe to the medical beliefs of their era as to the role of salt, saturated fats, and cholesterol. 

Note: Denis Burkitt discovered a new Lymphoma based on his observations children with swollen jaws in Uganda  in 1957.  The condition was named Burkitt's lymphoma.    

Western Diseases:  their emergence and prevention—1981  Trowell and Burkitt

Edited by doctors H.C. Trowell and D.P. Burkitt both formerly of Maketere University Medical school and Mulago Hospital, Kampala Uganda.   It is a collection of 27 articles by 34 contributors.  The editors have over a half century of teaching medicine in East Africa, and Burkitt has travelled widely visiting hospitals in all five continents. Forward p X, they recommended that the current US diet [Mc Govern Commission on US diet] be altered:  the proportion of energy derived from carbohydrates (starchy foods) should be doubled and it should be derived from whole grains, the portion of energy derived from sugar and fat should be considerably reduced, likewise salt.  This book supports these recommendations. 


Summary of chapters:


1.   Faults: the authors blame for the high rate of cardiovascular disease salt, saturated fat, cholesterol, and hypertension.  However, that list is not based on science, but marketing goals.  Thus they ignore the debate over carbs and fats,


2.   Doctors from 60 hospitals in 13 countries in sub-Saharan Africa replied to questionnaires asking for their impressions based on personal experience of the order of emergence of these diseases (appendicitis, varicose veins, large bowel tumors, hiatus hernia, deep vein thrombosis, pelvic phlebitis, and diverticular disease of the colon.  Appendicitis is very rare, of 71 hospitals, 71% saw less than 1 case per year, and only one reported over


4.  Hodgkinson et al (1967) and others observed that both protein and glucose can increase the rate of urinary calcium excretion and Lemann et al (1969) noted that the glucose effect was exaggerated in calcium stone formers.    Sucrose [table sugar] added supplements to a standard diet increased the frequency and magnitude of diurnal peaks of urinary calcium concentration in a majority of subjects.  Urinary oxalate excretion is increased concomitantly so that the formation product of calcium oxalate.   Kang et al. (1977) observed … that the ingestion of sucrose by laboratory animals resulted urinary excretion in a diffuse interpapillary glomerulosclerosis and that urinary excretion of N-acetyl-Beta-glucosaminadase, an indicator of renal tubulary damage, p. 64


5.  Multiple sclerosis various theories, one is that the exposure to a slow viral agent must occur before the age of 15 for most cases, there are other progressive diseases which cause the degeneration of the human brain, such as Kuru, & Cruetzfeld-Jakob are such diseases p 74.  Experiments show it to be transferrable agent, e.g. 4 out of 7 scientists developed MS from handling brain tissue from vicitims. 


7.  Cancer:  Vitamin A reduces risk of cancer, lung and stomach, p 104.  Overall, it is a quite disappointing chapter.  Native populations get cancer, but few stats are given.  [JK’s insertion: in 2017, Prof. Lustig in the Complete Skinny documentary points out that insulin and IGF are for some cancers essential.  Breast cells, which lack IGF receptors, develop cancer at 2 to 3 times other breast cell types.  Lustig also points out that the dysregulation of insulin is pathogenic for Alzheimer’s disease and psychiatric conditions.]


8   Eskimo means raw meat eater.  They eat from the stomach of Caribou and rabbits the greens in therein.  They chew spongy bone for the calcium.   Menarche is now 2 years early than 100 years ago, p 121.  Eating raw meet preserves the little vitamin C in it.


9.  Gallstones:  not a significant conditions. 


10.  Brazilian Indians, ~40 tribes observed; there was no cardiovascular disease, no obesity, no diabetes or pre-diabetic levels of serum glucose, 2 skin cancer, 2gynaecological cancers, and a 4year old with undifferentiated testicular cancer. 


11.  Australian aborigines, not suitable because of their eating refined flour and sugar.  Chapter’s author didn’t use earlier hospital records mainly because they didn’t live medical facilities.


12.  Papua New Guinea, agriculture, sweet potatoes, (Ipomoea Batatas), some 24 varieties are grown in the clan’s territory, takes about 10 months to mature.  Taro is limited (Colocasia esculenta), introduced in the last two generations,  90 subjects ate over 90% sweet potato, non-tuberous vegetables was under 5%.  A similar heavy dependence on a single vegetable staple HAS BEEN REPORTED FOR OTHER HIGHLNAD COMMUNITIES.  Chemical composition of the sweet potato varied widely.  Protein from 1 to 1.9% wet weight, fiber 1.25 to 3%, and calories from 112 to 155 kcal/ 100 edible portion.  Male daily intake 2,300 kcal, females 1,770 kcal.  Males consumed 25 g protein, females 20 daily & AND FIBER WAS 25 AND 20 G respectively.  Very low intake of protein, fats, and refined carbs and a high intake of complex carbs.  Population increase of 2.7% per years, birth rate of 42/1000, and death rate of 15/1000 for Murapin population.  43% of population died before the marriage age—Vines reported an infant mortality rate for several populations of 127/10000.  Subjects of the present study are typical of other Papua New Guinea population in that their body weight reaches a maximum between the age of 20 and 29… 59.8 kg in males and 59.9 for females.  By the seventh decade the average body weight has decreased by 13.3 kg or 23.23 percent in the case of men and 13.5 kg or 25 percent in the case of women p.175. Even in Western populations, the lean body mass in adults falls progressively with advancing age…. Their figures indicate that between the third and seventh decades there should be a reduction of 16.4% in the body mass of male subjects and 8.5 percent of females,… The contrast is more marked in the case of women, females in the present study experienced a weight reduction of 25 percent compared with a loss of 8.5 percent predicted on the basis of Forbes and Reina’s data (Sinnett et al., 1973; Sinnett 1977a) p. 176.    Malaria:  In the present population malaria was uncommon.  Examination of thick blood films yielded a parasite rate of lower than 0.4 percent and none of the subjects had splenic enlargement or anemia…. The low prevalence rate of malaria is not surprising in view of the high altitude (2,600 m) p 176.  Atherosclerosis is uncommon p 178.  No subjects showed evidence of Parkinson’s disease or of previous cerebrovascular accident p 180.  Clezy (1974) drew attention to the fact that the rate of colon and rectal cancer was low … reporting a rate per 100,000 being 0.6 for males and 0.2 for females for cancer of the large bowel.  By contrast… cancer of the colon and rectum per 100.000 population as 41.6 in the United States of America … 3 to 5 for Ugandans p 183    


13.  Uganda West Nile District:   Millet is the staple grain, similar to wheat nutritionally.  Sugar and salt were commonly purchased until 4 years ago economic hardship hit.  Obesity was rare, now among the more affluent is common, especially women.  Study based on one hospital in the West Nile region (the country is divided by the Nile River).  Type 2 diabetes wasn’t diagnosed until the 50s, and ischaemic events are starting to emerge among the Bantu in the 1970s.  Stools are large and soft, passed twice daily, and it is regarded as alarming if a day is missed at p. 191.  Cholesterol gallstones have never been diagnosed, at p. 192.  Ulcers have never been diagnosed.  “This seeming peculiar pattern of non-infective disease in the West Nile Ugandans is similar to that seen formerly in many rural hospitals in the less developed areas of Africa” at 192. 


14.   Zimbabwe (Rhodesia):  Colon and rectum cancers are about 1/10 that of Europeans, rough estimate, which they attribute to fiber in their diet, p 200, Ulcerative colitis 0 vs 27 for Europeans, comparing 2 hospitals, kidney stones 54 to 588 p 201. Diverticular disease is a Western disease rarely encountered in Zimbabwe p 200


15.  Pacific Island. The price paid for civilization has been high for the people who have enthusiastically embraced our Western lifestyle. 


16.  New Zealand, Maori and Pacific Polynesians¸nothing to add.


17.  Israeli Migrants:  nothing to add.


18 South African Black, Indian and Coloured Populations, nothing to add.


19.  Hawaii ethnic groups, nothing to add.


20. Japan, nothing to add.


21.  Twain and China:


Strokes:  rate of 11.6/1000 males in the 55 to 64 age group, and 25.8 for those over 65 years of average.  Twain strokle rate for males in the same two groups were 21.1per thousand and 74.0 respectively.  These figures are higher than comparable figures from 9 other countries and suggest the prevalence of stroke in Taiwan is extremely high.  Those who were originally found to be hypertensive and hadn’t received antihypertensive drug, 10.4 per cent of them had died from stroke, but among the non-hypertensives, only 0.5 had died from stroke, a 21-fold difference at p. 356.  They found that in the stroke patients hemorrhage caused death in 71.4 per cent and infarction 24.7 percent.  [In the US the figures are the opposite, with 15% hemorrhage and 85% ischemic.]  In the cerebral hemorrhage cases the cerebral arteries shows a more severe degree of atherosclerosis than did the coronary arties.  …those dying from infarction showed a greater degree of cerebral atherosclerosis than those dying from hemorrhage.  In the control group of 102 non-stroke autopsies 60.8 percent were found not to have any atherosclerosis of the coronary arteries and 39.2 percent were found to have a mild degree only, at p 357 from Lue et al 1973.  The total mortality rate for cardiovascular disease has risen from 49.8 per 100,000 in 1952 to 74.4 per 100,000 in 1975 [cigarettes increase would account for that possibly.  The high rate of stroke and the low rate of heart attack is an anomaly that I have with 2 days of effort not been able to find a plausible solution.  Stroke has remains “a leading cause of death and disability” at 2006. “ Stroke is the most prevalent cardiovascular disease in Japan…. ICH (intracranial hemorrhage) was still more common than ischemic stroke as a cause of death in Japan… As was common in the Asian population, lacunar stroke was the leading subtype (38.8%), followed by atherothrombotic (33.3%) and cardioembolic stroke (21.8%) ” at 2013. ]   


Burkitt &Trowell’s second book of far less interest on  

Western diseases, their dietary prevention reversibility, 1994, Temple and Burkitt.  The 1994 book focuses on the causes of the conditions in 1990, rather than a survey of the conditions of aboriginal societies, like the earlier book, which did far less speculation.  Their acceptance of the then and still popular demonizing of fats, cholesterol, salt hypertension reduces the value of this book.  Of interest is the chapter on Dietary Fiber, which question whether it is bulk or contractual force that makes the difference.  Of limited value because of lack of concern for insulin resistance (unaware of the work of Joseph Kraft),non-alcoholic fatty liver disease  NAFLD, liver dysfunction, and the role of sugar.  Having the wrong answer as to causes of the age-related diseases of blocks a search for better answers.  References of interest:  Cleave and Campbell’s Diabetes, Coronary Thrombosis and the Saccharine Disease [sugar] (1966).  This book lead to Trowell and Burkitt editing in 1975 Refined Carbohydrate Foods and Disease, which found that dietary fibers was very protective.  [I doubt fiber’s value because of the confounding variable that those on a high-fiber diet are more likely to eat less of the processed foods and thus the liver toxic fructose.  I am not convinced that a lower insulin spike because of a delay in stomach clearance is healthful, because the slower stomach clearance entails a longer period of elevated insulin. S of now I haven’t seen dispositive work on this issue.  And since intestinal bacterial metabolize fiber, the affect upon intestinal flora re risk factors has not been adequately studied for me to come to an opinion.  That intestinal flora has become a proposed cause for many conditions parallel many examples of bad science promoted by media and industry to deflect investigators from arriving at the best answers.]

Conditions covered--Notes by JK from Wikipedia:  [Pelvic phleboliths]  phlebolith is a small local, usually rounded, calcification within a vein. These are very common in the veins of the lower part of the pelvis, and they are generally of no clinical importance. When located in the pelvis they are sometimes difficult to differentiate from kidney stones in the ureters on X-ray. [1]

Phleboliths in the pelvic region are present in about 44.2% of people and are more common in females (50.1%) than males (37.3%). The amount of phleboliths increases with age and they also appear more often on the left than on the right side of the pelvic region.[2] Phleboliths outside the pelvic region appear in about 2% of the population. https://en.wikipedia.org/wiki/Phlebolith

A hiatus hernia is a type of hernia in which abdominal organs (typically the stomach) slip [upward] through the diaphragm into the middle compartment of the chest.[2][1]  https://en.wikipedia.org/wiki/Hiatus_hernia