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Nutrition in Clinical Medicine: Introduction

In 1957, a surgeon named Denis Burkitt first encountered a puzzling form of childhood cancer. The condition, which came to be called Burkitt’s lymphoma, caused a massive swelling of the jaw and was often fatal. But Burkitt noticed something peculiar: The disease followed a geographic pattern, never appearing far from the equator and the east coast of Africa. He painstakingly identified the cause–a virus (now known as Epstein–Barr) transmitted by an insect vector–and then found an effective treatment.1 His lifesaving work was acclaimed throughout the world of medicine.

Soon thereafter, Dr. Burkitt set his sights on larger medical epidemics, whose solutions were hidden in a much bigger geographical puzzle. He noticed that the great bulk of diseases occurring in the Western world–heart disease, diabetes, obesity, and many others–were surprisingly rare in rural Africa. During 20 years of surgical practice in Africa, he removed only 2 gallbladders, something he might have done on a single morning in any London hospital. Many other conditions, from appendicitis to colon cancer, were rare in Africa, but common in Europe. He ruled out genetics as the main explanation, because people moving from one country to another eventually assumed the same risks as the populations in their adopted homes.

Burkitt proposed that the culprit was diet. In Europe and the Americas, diets bore no resemblance to an African diet rich in whole grains, legumes, vegetables, and fruit.  On the contrary, they were fiber–depleted and laden with fat, cholesterol, and sugar. His work, and that of other medical pioneers, launched a major rethinking of the fundamental causes of illness. Previously, nutrition had been thought to play a fairly minor role in health. Yes, there were rare deficiency states, such as pellagra or scurvy, but these were little more than details on medical school examinations. The major killer diseases were thought to have more to do with genes and bad luck than diet. But this new breed of researchers held that nutrition was decisive. It was a fundamental contributor to the major diseases that filled doctors’ waiting rooms throughout the Western world.

Burkitt proposed that health authorities should spend less time dealing with the results of bad diets and more time encouraging people to change the way they eat. To continue to treat illnesses while ignoring prevention, he said, was like a plumber mopping up a kitchen floor rather than turning off the tap in an overflowing sink. A new focus on nutrition and prevention could turn the tide in the epidemics of our time.


Nutrition in Clinical Medicine: Evolving Knowledge in Nutrition >>