Prescription for a better British diet.
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Biomedical subjects
Publications and source records attributed to H Trowell.
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Fundamental studies of the laxative action of wheat bran were undertaken in the United States in the early decades of the 20th century. Walker in South Africa extended these studies among African blacks and later suggested that cereal fiber protected them against certain metabolic disorders. Trowell in Uganda elaborated this concept with regard to the rarity of common noninfective diseases of the colon. Another stream of inquiry stemmed from the hypothesis of Cleave who postulated that the presence of refined sugar, and to a lesser extent white flour, caused many metabolic diseases, while the loss of fiber caused certain colonic disorders. Meanwhile Burkitt had collected massive evidence of the rarity of appendicitis and many venous disorders in rural Africa and parts of Asia. In 1972 Trowell proposed a new physiological definition of fiber in terms of the residue of plant foods that resisted digestion by alimentary enzymes of man. Southgate has proposed chemical methods to analyze the components of dietary fiber: cellulose, hemicellulose, and lignin.
The rarity of diabetes mellitus in rural Africans and the increased incidence in urban Africans suggested that high-fiber, high-carbohydrate diets might protect against diabetes. Conversely it has been suggested that low-fiber starchy food is a diabetogenic factor in susceptible human phenotypes. Many years ago experimental studies demonstrated that carbohydrate tolerance was increased in healthy adults if they ate high-carbohydrate diets but was decreased if they ate high-fat diets. From 1940 in England and Wales, diabetes death rates reported only those who died directly from diabetes mellitus; all cardiovascular complication deaths were excluded. Standardized diabetes mellitus death rates in England and Wales fell from 1941 until 1954 to 1957 by 55% in men and 54% in women. These years coincided with the production of high-fiber National flour. These data suggested the dietary fiber hypothesis of the etiology of diabetes mellitus, namely that fiber-depleted starchy foods were diabetogenic and conversely that high-fiber starchy foods were protective. Recent experimental studies of diabetic hyperglycemic men have shown that high-fiber, high-carbohydrate diets cause remission of diabetes mellitus in many men who had been treated previously by oral agents of moderate doses of insulin, but not those who had previously received large amounts of insulin.
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Crude fiber (CF) is the residue of plant food left after extraction by dilute acid followed by dilute alkali. Dietary fiber (DF), a new term, is the residue of plant food resistant to hydrolysis by human alimentary enzymes. DF is composed of cellulose, hemicellulose, and lignin; these constituents are not reported in food tables. For instance, whole wheatmeal has DF about 11%, CF about 2%. It is suggested that a new term, dietary fiber complex (DFC), should include all substances of DF plus all chemical compounds naturally associated with, and concentrated around, these structural polymers. CF supplies from starchy staples, wheat and potato, in England and Wales were probably stationary from 1770 to 1860, fell greatly from 1860 to 1910, rose during food controls in 1942 to 1953, and declined slightly from 1954 to 1970. It is postulated that fiber is a protective factor against certain colonic disorders, such as diverticular disease, and certain metabolic diseases, such as ischemic heart disease, diabetes mellitus, and obesity. These three diseases had changing trends of mortality rates in England during the food control years. Westernization of African diets is accompanied by a large fall in CF from starchy foods and vegetables and an increased prevalence of the same three diseases.
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