Denis Burkitt was a surgeon who made two influential contributions to medicine in his medical career. His first, while working in Uganda, was the cause and eventual treatment of sarcoma in the jaws of African children which was later named Burkitt’s lymphoma.
His next contribution to medicine was based upon observational research in Uganda which led him to be known as the Fiber Doctor. He even wrote a book Don’t Forget fibre in your diet: to help avoid many of our commonest diseases which became an international best seller, which was published in 1979. Burkitt (1982) explained that many western diseases hardly exist in developing countries and provided examples including “coronary heart disease, diabetes type II, gallstones, diverticular disease of the colon, appendicitis, hiatus hernia, colorectal cancer, varicose veins, haemorrhoids, venous thrombosis, obesity and hypertension” (pg. 1013). His observations led him to believe that our diets may be the largest determinants of the diseases that western cultures experience. Stool mass seems to be an indication of disease. The smaller the sool, or fecal mass, the more disease is present. Fiber consumption increases fecal mass and as Burkitt (1977) explains:
Moreover, a similar physiological characteristic exists in all communities with a high prevalence of these disease, namely, the evacuation of small firm stools and retarded passage of fecal content through the large bowel. In contrast, none of these diseases is shown to be common in communities where large, soft stools are customarily passed (pg. 556).
Figure 2. The Scoop on Poop (2015). Retrieved August 23, 2016.
Dr. Burkitt believed that the diseases that commonly occur in western nations were dietary diseases. He felt that the foods used to fuel our bodies either contributed to or prevented disease progression. Burkitt (1982) further went on to state that “in view of the fact that all these diseases can be shown to be either directly or indirectly related to the alimentary tract it seems reasonable to consider that the environmental factors most likely to be responsible are dietary” (pg. 1013). Based upon the assumption that diseases manifested themselves differently among various populations consuming different diets, he postulated that genetics, though vital, may not play as drastic a role as thought. Burkitt (1982) generally disregarded genetics as a possible factor for these common disease states as dietary patterns and stool passage seemed to be a greater indicator of disease however, he stipulated that it is predominantly the environment and dietary patterns that lead to or prevented disease, however, this doesn’t necessarily always mean that genetics should not be discounted (p. 1013).
Northern populations consumed more animal flesh compared to those near the equator where fruits and vegetables were more readily available and abundant. Burkitt (1982) discerned that those in western civilizations who experienced the common western diseases consumed more animal protein than plant protein. Western civilizations consumed three times as much fat via animal protein consumption, while fiber consumption was three to five times lower than in developing countries. The lack of fiber consumption was due the western civilizations limited consumption of starchy vegetables, it was also noted that salt intake was dramatically increased in western civilizations as well, vs. those in developing countries. (pg. 1013-1014). While fiber is just one critical component of diet he also realized that men and women should limit their consumption of animal flesh. According to Burkitt (1982), “meat consumption should also be reduced since 40% of even lean red meat as produced currently for human consumption consists of fat. Moreover, meat is the most uneconomical of all ways of providing satisfactory nutrition” (p.1015).
Other scientific papers he published referenced the link between dietary fiber and disease states such as diverticulitis. For example, he made the link between decreased fiber intake and the rise of diverticulitis. According to Painter and Burkitt (1971), “diverticulosis appears to be a deficiency disease caused by the refining of carbohydrates which entails the removal of vegetable fibre from the diet. Consequently we consider it to be preventable” (pg. 450). Burkitt (1977) also stated, “since the incidence of most disease is determined more by environmental than by genetic factors, they are potentially preventable” (pg.556). Denis Burkitt realized our diet and lifestyle, not necessarily genetics, played a significant role in disease development and progression. In regards to diverticulosis Painter and Burkitt (1971) wrote, “This dramatic increase in incidence occurred in only 70 years and cannot possibly be explained on a genetic basis” (pg. 450). Dr. Burkitt felt evolutionary changes did not occur within a matter of a few generations and a couple decades, he felt this was too quick a time frame for genetics to make such a monumental shift. Painter and Burkitt (1971) realized “this dramatic rise in the incidence of diverticulosis has occurred only in economically developed countries, whose diet has changed only recently in the time scale of human nutrition” (Pg. 451).
Temple and Burkitt (1993) came to recognize that:
Over the last three decades, the concept of Western disease has become well established. Medicine has approached this group of diseases by searching for new cures but has achieved relatively little success we argue that medicine should now accept the failure of this strategy and place a major emphasis on prevention (p. 37).
Burkitt (1977) hypothesized that increased fat consumption as well as a decrease in overall fiber consumption within the human diet could potentially result in an increase in colorectal cancer. Increasing fiber within the diet increases stool size and thus “changes in fat and in fiber probably both alter fecal bacteria. However carcinogens are formed, they will be more concentrated and therefore more likely to be effective in the small-volume stools associated with fiber lack” (p. 558). Burkitt (1977) also understood that while a fiber deficient diet is not the main contributing factor, it is one of many (P. 559).
Today, almost 40 years after his recommendation to consume more fiber in our daily diet, according to Clemens, Kranz, Mobley, Nicklas, & Raimondi, (2012), more than 90% of Americans do not meet the required fiber intake (p. 1390). The amount of fiber we should be consuming, according to the United States Department of Health and Human Services and the United States Department of Agriculture listed in the 2015 – 2020 Dietary Guidelines for Americans, ranges from 14–28 grams per day for women, and 14–31grams a day for men (p. 97). Dr. Burkitt had speculated, 40 years ago, that there may be a connection between the consumption of fatty meat and colorectal cancer risk. According to the International Agency for Research on Cancer (2015), which is a part of the World Health Organization, red meat has been listed as a probable cause of colorectal cancer as well as pancreatic and prostate cancer while processed meat is listed as carcinogenic to humans. Consumption of processed meat, 50 grams or more has been linked to an 18% increased risk of colorectal cancer. Fifty grams is about three strips of bacon or one hotdog. http://www.iarc.fr/en/media-centre/pr/2015/pdfs/pr240_E.pdf.
A few famous quotes from Denis Burkitt:
“Western doctors are like poor plumbers. They treat a splashing tube by cleaning up the water. These plumbers are extremely apt at drying up the water, constantly inventing new, expensive, and refined methods of drying up water. Somebody should teach them how to close the tap.”
“Western diets are so low on bulk and so dense in calories, that our intestines just don’t pass enough volume to remain healthy.”
“America is a constipated nation…. If you pass small stools, you have to have large hospitals.”
“The only way we are going to reduce disease, is to go backward to the diets and lifestyles of our ancestors.”
“The frying pan you should give to your enemy. Food should not be prepared in fat. Our bodies are adapted to a stoneage diet of roots and vegetables.”
“The health of a country’s people could be determined by the size of their stools and whether they floated or sank, not by their technology.”
To learn more about Dr. Burkitt Click here, this link also contains a video of Denis Burkitt https://www.drmcdougall.com/misc/2013nl/jan/burkitt.htm
Dr. Burkitt’s F-Word Diet: https://nutritionfacts.org/video/dr-burkitts-f-word-diet/
References:
Bouvard, V., Loomis D., Guyton K. Z., Grosse, Y., Ghissassi F. E., Et. al. (2015). Carcinogenicity of consumption of red and processed meat. The Lancet Oncology, 16 (16), 1599-1600. Doi: http://dx.doi.org/10.1016/S1470-2045(15)00444-1 or http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(15)00444-1/abstract
Burkitt, D. P., Western diseases and their emergence related to diet, The South African Medical Journal June 1982(4) 1013-1015.http://archive.samj.org.za/1982%20VOL%20LXI%20Jan-Jun/Articles/06%20June/4.11%20LIFESTYLE%20AND%20DISEASE%20-%20WESTERN%20DISEASES%20AND%20THEIR%20EMERGENCE%20RELATED%20TO%20DIET.%20D.P.%20Burkitt.pdf
Burkitt, D. P., Are our commonest disease preventable? Preventive Medicine 1977 (6) 556-559. https://www.researchgate.net/publication/22541221_Are_our_commonest_diseases_preventable
Clemens, R., Kranz, S., Mobley, A. R., Nicklas, T. A., Raimondi, M.P., (2012),. http://www.ncbi.nlm.nih.gov/pubmed/22649260
International Agency for Research on Cancer World Health Organization (2016, June 24). Retrieved from http://monographs.iarc.fr/ENG/Classification/index.php.
Painter, N. S., Burkitt D. P., Diverticular Disease of the Colon: A deficiency Disease of Western Civilization, British Medical Journal May 1971 (2) 450-454. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1796198/pdf/brmedj02261-0052.pdf
Temple N. J., Burkitt, D. P., (1993) Towards a new system of health: The challenge of western disease. Journal of Community Health (18) Pg 37-47. https://link.springer.com/article/10.1007%2FBF01321519?LI=true
U.S. Department of Health and Human Services and U.S. Department of Agriculture. (2015). Dietary Guidelines for Americans. Retrieved August 11, 2016, https://health.gov/dietaryguidelines/2015/resources/2015-2020_Dietary_Guidelines.pdf
Figure 1. Famous Irish Scientists (2009). Denis Parsons Burkitt. Retrieved August 23, 2016. Retrieved from online http://famousirishscientists.weebly.com/denis-parsons-burkitt.html
Figure 2. The scoop on poop (2015). Retrieved August 23, 2016. Retrieved from online https://www.drcarney.com/articles/entry/the-scoop-on-poop
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