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When I worked in East Africa from 1960 - 1965, there was not a single case of breast, colon or prostate cancer, no cardiovascular heart disease and any diabetes seemed relatively mild. Nor was this absence of such diseases due to poor diagnostic facilities. The National Institutes of Health of the USA was specifically interested in this contrast and set up a cancer registry under the late Professor Jack Davis at the Makerere Medical School, Kampala, where I was working. Under Jack's direction, Dennis Burkitt discovered the first virally induced cancer, namely Burkitt's Lymphoma, proving that these people knew what they were doing.
Refined carbohydrates and their ill effects
Cleave regarded refined carbohydrates as the most changed foods of modern people and therefore the ones to which we are most vulnerable in terms of maladaptation. The main examples of refined carbohydrates in Western countries were white flour and sugar (white or brown). By logical reasoning he classified the ill effects of refining into four types. First, reduction in fibre intake leading to constipation and all its ill effects, especially diverticular diseases. Second, concentration of carbohydrate leading to too rapid consumption and too rapid absorption of sugars from the gut, resulting eventually in exhaustion of the pancreatic islets (which secrete insulin in response to absorbed glucose) and hence to diabetes mellitus; overnutrition also leads to coronary heart disease and to overgrowth of certain bacteria in the intestine. Third, stripping of protein leads to peptic ulcer. Fourth, dental caries and periodontal disease are due largely to sticky combinations of sugar and white flour.
The term 'refined carbohydrate' has not become accepted in scientific circles. It is perhaps prone to misunderstanding since it seems to imply that white flour and white rice are 100 per cent carbohydrate (the true figure is about 70 per cent). By lumping together white rice and sugar it suggests that white rice resembles sugar more than it resembles brown rice. Even the term 'refined sugar' means different things to different people. An alternative term 'fibre-depleted food' has been suggested~. I like it because it preserves Cleave's idea of a process which selects for human consumption the calorie-rich, fibre-poor part of a plant and rejects the calorie-poor, fibre-rich part, but the term fibre-depleted has not so far received wide currency.
The thinking of many nutritional and biomedical scientists is limited by a chemistry-dominated approach. They find it hard to accept the simple, physical concept of fibre-depletion or carbohydrate-refining. For example, two recent quasi-official reports on sugars and health have made no reference to the crucial difference between extracted or fibre-depleted sugars and sugars naturally present in fruit and vegetables. Some scientists speak of added as opposed to natural sugars but as I see it, the crucial distinction is between extracellular and intracellular sugars, since it is the presence or absence of cellular packaging which decides how easily sugars are eaten and how fast they are absorbed.
With confusion reigning over the names of the foods themselves it is hardly surprising that the concept of refined carbohydrate-induced disease has made little headway. The term Saccharine Disease has not caught on at all.
Overnutrition
Cleave's last published statement was that overnutrition is now the most dangerous cause of disease in westernised countries.
I believe he was right, because like him I suspect that overnutrition is a major factor in the most important killing disease of our time, coronary heart disease. I also suspect that overnutrition is a major factor in several of our most common cancers -- cancer of the colon, cancer of the breast, cancer of the uterus, cancer of the ovaries and cancer of the gallbladder. There is not space to present all the evidence and arguments. Suffice it to say that cancer experts agree that, in laboratory animals, by far the most effective way of preventing cancer is to reduce calorie intake.
For example if rats are allowed to eat only 70 to 80 per cent of the chow which they would normally eat they become almost immune to cancer. In the wild, animals get very little cancer and, in the wild, they do not overeat. Cleave pointed this out in forthright and vivid language. 'No wild rabbit ever ate too much grass, no wood-pigeon ever ate too much wheat, and no herring ever ate too much plankton'. But caged rats given processed foods do overeat. Given doughnuts and biscuits they actually get fat. Standard laboratory chow is made from milled cereals (already chewed, as it were) and limiting the intake of chow is just a substitute for the natural limitations of having to search out and chew up the food.
Some people react to the calorie-restriction story by saying that human beings cannot be expected to under-eat all their lives in the distant hope of avoiding cancer. Of course they cannot. But people on a typically western diet do not need to under-eat to cut their calories by 20 per cent. All they need to do is to exclude refined sugar (fibre-depleted sugar, added sugar).
Cleave argued that this must be so. In Bristol we have shown that it is so. In two separate sets of experiments involving 2,100 person-days of observation we found that, when people ate to satisfy their appetite on a diet which excluded refined sugar, they unconsciously reduced their calories by 20 per cent on average compared with when their diet contained about lOOg sugar daily (which is about the national average). Another way of interpreting these experiments is to say that when people use sugar in their diet to the extent that is commonly used in this country they unconsciously increase their calorie intake by 24 per cent on average. To judge from the animal data this must increase their risk of cancer. Of course, it must also increase the risk of obesity and of the diseases which go with being overweight, like diabetes, gout and gallstones.
Why does sugar make people take in more calories than they need? Cleave said -- look at a sugar-beet, contrast the difficulty of eating two and a half pounds of sugar beet with that of consuming the five ounces of sugar which can be extracted from it (five ounces being the average daily consumption of sugar in Britain). He exaggerated a little here; average daily consumption of sugar is nearer the equivalent to one and a half pounds of sugar beet, but the point remains-who would eat one and a half pounds of sugar beet a day? Cleave also said -- contrast eating an apple with drinking an equivalent amount of sugar in tea, that is, two teaspoonfuls.
I like the last idea so much that, in l977 with the help of three colleagues, I did an experiment comparing apples with apple juice made from the same batch of apples'. Volunteers were given sugar-equivalent breakfasts consisting of whole fruit or fruit juice and, on a third occasion, puréed fruit. They were asked to rate their feelings of fullness on a scale of 0 to 10 during the three hours after each test meal. As you would expect they felt much fuller after the apples than after the juice, with puréed fruit intermediate. We also found that the sugars in the meal were absorbed most rapidly from the juice and the blood insulin rose highest, while again the purée was intermediate.
Cleave would have predicted these findings because he would have agreed that fruit juices are a very unnatural food and machine-homogenised purée is unnatural too. Sugars should be chewed or eschewed. Otherwise, said Cleave, they lead to 'deception of the taste-buds in the tongue and also to deception of the instinct of appetite (perhaps through lack of distension in the stomach) . . - it is the unnaturalness that governs the deception of the tongue and appetite, and therefore the danger of over-consumption'.
Continued on McCarrison Society website