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Dr Burkitt: The Fiber Man
20 Nov 2020
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How do we know that dietary fiber is crucial for human health? And that lack of dietary fiber leads to a slew of modern chronic diseases? Today, this is considered common knowledge. However, the connection between dietary fiber deficiency and myriad chronic conditions was not common knowledge or even standard medical knowledge in the 1960s and 1970s.

Dr Burkitt (1911-1993) is credited with highlighting the role of dietary fiber and giving it a prominent place in our collective consciousness. A biography titled The Fiber Man was published in 1985.

Dr Burkitt was trained as a surgeon. He spent many years in Africa. In 1960s and 1970s, he realized that several modern chronic lifestyle conditions which were commonplace in the West were actually rare in Africa! Which diseases? Atherosclerosis, coronary heart disease, adult-onset diabetes, gallstones, bowel cancer, breast cancer, hemorrhoids, varicose veins, diverticulosis, constipation, and so on. He also observed that the incidence of many of these conditions was low in the West prior to the First World War (1914-1918). However, by 1960s and 1970s, the incidence of these diseases was skyrocketing! And it was skyrocketing in both white and black populations. That led him to believe that lifestyle factors were at play. But what exactly were these lifestyle factors? Dr Burkitt believed that the main factor was the shift away from the unprocessed plant-based diet in rural Africa towards a Western diet rich in animal products and processed foods.

An unprocessed plant-based diet, commonplace in rural African communities, is naturally rich in fiber. In fact, dietary fiber is found only in plants! Animal products (meat, fish, eggs, milk and dairy products) have zero fiber. Whenever we consume an animal product, we lose the opportunity to consume fiber!

Tribute by Dr Peter Rogers
(10 mins, 2023) Denis Burkitt MD, Nutrition Hero | Dr Peter Rogers

Previous version: here.

Interview by Dr McDougall

Article: Denis Burkitt, MD Opened McDougall's Eyes to Diet and Disease (Jan 2013).

"In Africa, treating people who live largely off the land on vegetables they grow, I hardly ever saw cases of many of the most common diseases in the United States and England, including coronary heart disease, adult-onset diabetes, varicose veins, obesity, diverticulitis, appendicitis, gallstones, dental cavities, hemorrhoids, hiatus hernias, and constipation. In 20 years of surgery in Africa, I had to remove exactly one gallstone." — Dr Burkitt

Interview: Dr. Denis Burkitt interviewed by Dr. John McDougall (40 mins, 1990).

Quotes from Dr Burkitt's interview:

Fiber in Scientific Literature:

"In the 1960s, there were only 10 scientific papers a year being published in various journals - veterinary or otherwise - on fiber. Within 12 years, that had gone up to over 500 an year. It was a tremendous explosion." — Dr Burkitt

Diseases caused by Western Lifestyle:

"Most of the common chronic diseases filling the hospital beds in Western countries today are rare or unknown in the third world, were rare even in North America before the First World War, are equaly common in black and white americans, and therefore they have to be due to lifestyle — the way we live — in which case they got to be preventible if we can identify the factors in our lifestyle." — Dr Burkitt

"People in Polynesian islands have very low rates of diabetes, varicose veins, heart disease and so on. But when they go to live in New Zealand with the Maoris and go on to Western culture, within two generations, they even surpass the white people in some of these diseases." — Dr Burkitt

"Pima Indians in the Southern states of America. The Pima Indians now have the second highest rates of diabetes in the world and the highest rates of gallstones in the world. They switched over to the diets enormously after and during the last World War. Whereas other Indian groups in Central America or ?? places are almost exempt of these diseases. So we can't say they are genetic. They got to be due to lifestyle." — Dr Burkitt

Reasons for Western chronic diseases:

"… diseases like atherosclerosis, diabetes, gallstones, bowel cancer, breast cancer, hemerroids, varicose veins, diverticulosis — the countries who don't get these diseases have a diet with far more starch, far more fiber, far less fat, far less sugar, far less salt. And the two major things we need are to eat more fiber and to eat less fat." — Dr Burkitt

"[Our ancestors] ate far more fiber than we do — about five times as much. They ate far less fat and particularly less saturated fat. They ate far more starch, far less sugar, far less salt." — Dr Burkitt

"Over the last century, we're getting better and better at taking fiber out [of foods, through industrial processing]." — Dr Burkitt

"All of these disease which are the major diseases of American hospitals must be viewed as manifestations of maladaptation to a new environment into which the Western man has plunged and which we are not adapted to. We made more change in our diet and lifestyle since the Industrial Revolution from 200 years ago, than our ancestors made in the previous 20,000 years." — Dr Burkitt

Prevention vs Treatmant:

"Medical students are all taught that medicine consists of diagnosis and treatment of disease. There is not much more than lip service paid to the possibility of prevention. A doctor qualifies with the idea of marvelous high technology CAT scans and what-have-you-not for diagnosis and wonderful ways of treatment. But he doesn't qualify with the vision that much of our vision is due to our lifestyle and is really preventible." — Dr Burkitt

"… I felt that we were largely wasting our time treating disease that can be prevented in the first place!" — Dr Burkitt

"… all the emphasis today is being put today on diagnosis and treatment of disease. And yet, we are never going to reduce any disease by early diagnosis or treatment. The only way to reduce disease, other than an infectious disease [via] immunization.. when we come to chronic diseases including cancer, the only way to reduce disease is to identify causative factors and reduce causative factors. But all the money goes into early diagnosis and treatment." — Dr Burkitt

"That's the general concept in the Western countries: whatever is wrong with you, we pour chemicals down your throat." — Dr Burkitt

Dietary Changes: In the interview, Dr Burkitt recommends five major changes to the Western Diet:
  1. Eat far more fiber. "Average American eats 15 grams a day. In much of the third world, we eat over 100 grams." [interview was conducted in 1990; even in 2020, these numbers have not changed much.]
  2. Eat far more starch from potatoes, grains, and so on.
  3. Eat far less fat.
  4. Cut down on salt.
  5. Cut down on sugar.

Note that Dr Burkitt's guidelines are in complete harmony with Whole Food Plant-Based guidelines.

Videos
(2020, 6 mins) Dr Denis Burkitt, the Fiber Man by Dr Hans Diehl

A nice video using simple language to explain what Dr Denis Burktit did: to connect dots between modern chronic lifestyle disesases, bowel movements, bowel transit times, and fiber intake. Worth watching to pick up interesting tidbits of knowledge.

(2014, 4 mins) Dr Burkitt's F-Word Diet

Transcript. An information rich video by Dr Greger summarizing Dr Burkitt's work.

(1990, 40 mins) Dr Denis Burkitt interviewed by Dr John McDougall

An interview with Dr Burkitt recorded in 1990. This is the only video presentation by Dr Burkitt I could find online. Worth watching.

Quotes by Dr Burkitt

In this article, Dr McDougall attributes these quotes to Dr Burkitt:

  • "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."
  • "Diseases can rarely be eliminated through early diagnosis or good treatment, but prevention can eliminate disease."
  • "If people are constantly falling off a cliff, you could place ambulances under the cliff or build a fence on the top of the cliff. We are placing all too many ambulances under the cliff."
  • "The frying pan you should give to your enemy. Food should not be prepared in fat. Our bodies are adapted to a stone age diet of roots and vegetables."
  • "The only way we are going to reduce disease, is to go backward to the diets and lifestyles of our ancestors."
  • "Western doctors are like poor plumbers. They treat a splashing tub 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."
  • "America is a constipated nation... If you pass small stools, you have to have large hospitals."
  • "Western diets are so low on bulk and so dense in calories, that our intestines just don't pass enough volume to remain healthy."

Books and Articles

Books by Dr Burkitt:

Dr Burkitt's biography:

Misc articles:

  • Denis Burkitt and the origins of the dietary fibre hypothesis by John H Cummings and Amanda Engineer, Nutri Res Rev, 31(1):1-15, June 2018.

    Abstract: "For more than 200 years the fibre in plant foods has been known by animal nutritionists to have significant effects on digestion. Its role in human nutrition began to be investigated towards the end of the 19th century. However, between 1966 and 1972, Denis Burkitt, a surgeon who had recently returned from Africa, brought together ideas from a range of disciplines together with observations from his own experience to propose a radical view of the role of fibre in human health. Burkitt came late to the fibre story but built on the work of three physicians (Peter Cleave, G. D. Campbell and Hugh Trowell), a surgeon (Neil Painter) and a biochemist (Alec Walker) to propose that diets low in fibre increase the risk of CHD, obesity, diabetes, dental caries, various vascular disorders and large bowel conditions such as cancer, appendicitis and diverticulosis. Simply grouping these diseases together as having a common cause was groundbreaking. Proposing fibre as the key stimulated much research but also controversy. Credit for the dietary fibre hypothesis is given largely to Burkitt who became known as the 'Fibre Man'. This paper sets out the story of the development of the fibre hypothesis, and the contribution to it of these individuals."

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