Good Calories, Bad Calories (20 page)

Hoffman could not explain away the observations that physicians like Schweitzer and Hutton had made around the world and that both he and Wil iams had documented so comprehensively. In 1914, Hoffman himself had surveyed physicians working for the Bureau of Indian Affairs. “Among some 63,000

Indians of al tribes,” he reported, “there occurred only 2 deaths from cancer as medical y observed during the year 1914.”

“There are no known reasons why cancer should not occasional y occur among any race or people, even though it be of the lowest degree of savagery or barbarism,” Hoffman wrote.

Granting the practical difficulties of determining with accuracy the causes of death among non-civilized races, it is nevertheless a safe assumption that the large number of medical missionaries and other trained medical observers, living for years among native races throughout the world, would long ago have provided a more substantial basis of fact regarding the frequency of occurrence of malignant disease among the so-cal ed

“uncivilized” races, if cancer were met with among them to anything like the degree common to practical y al civilized countries. Quite to the contrary, the negative evidence is convincing that in the opinion of qualified medical observers cancer is exceptional y rare among primitive peoples.

Through the 1930s, this evidence continued to accumulate, virtual y without counterargument. By the 1950s, malignancies among the Inuit were stil considered sufficiently uncommon that local physicians, as in Africa earlier in the century, would publish single-case reports when they did appear. One 1952 article, written by three physicians from Queen’s University in Ontario, begins with the comment “It is commonly stated that cancer does not occur in the Eskimos, and to our knowledge no case has so far been reported.” In 1975, a team of Canadian physicians published an analysis of a quarter-century of cancer incidence among Inuit in the western and central Arctic. Though lung and cervical cancer had “dramatical y increased” since 1949, they reported, the incidence of breast cancer was stil “surprisingly low.” They could not find a single case in an Inuit patient before 1966; they could find only two cases between 1967 and 1974.

These missionary and colonial physicians did often diagnose tumors and other diseases of civilization in local whites, and among natives who were working for European households and industries. In August 1923, for instance, A. J. Orenstein reported in the British Medical Journal on his experience as a superintendent of sanitation for the Rand mines in South Africa: “In a series of one hundred consecutive necropsies on native mine laborers conducted by myself in the latter part of 1922 and the first two months of 1923, two cases of carcinoma were observed—one was carcinoma of the pancreas and glands of the neck in a native male of the Shangaan race, age about 40, the other was a case of carcinoma involving practical y the whole of the liver, in a native male of the same race, age about 25.” The reports from these physicians were a reminder of how dramatic the course of the disease could be, and evidence against the argument that sophisticated diagnostic technology, unavailable in these outposts, was required to diagnose cancer. In 1923, George Prentice, who worked in Nyasaland, in southern central Africa, described one native patient with an inoperable breast tumor in the British Medical Journal: “It ran an uninterrupted course,” Prentice wrote, “completely destroyed the breast, then the soft structure of the chest wal , and then ate through the ribs; when I last saw the negress in her vil age, I could see the heart pulsating. That was just before her death.”

The absence of malignant cancer in isolated populations prompted questions about why cancer did develop elsewhere. One early hypothesis was that meat-eating was the problem, and that primitive populations were protected from cancer by eating mostly vegetarian diets. But this failed to explain why malignancies were prevalent among Hindus in India—“to whom the fleshpot is an abomination”—and rare to absent in the Inuit, Masai, and other decidedly carnivorous populations. (This hypothesis “hardly holds good in regard to the [American] Indians,” as Isaac Levin wrote in 1910. “They consume a great deal of food [rich in nitrogen—i.e., meat], frequently to excess.”)

By the late 1920s, the meat-eating hypothesis had given way to the notion that it was overnutrition in general, in conjunction with modern processed foods, lacking the vital elements necessary for health, that were to blame. These were those foods, as Hoffman put it, “demanding conservation or refrigeration, artificial preservation and coloring, or processing otherwise to an astonishing degree.” As a result of these modern processed foods, noted Hoffman, “far-reaching changes in bodily functioning and metabolism are introduced which, extending over many years, are the causes or conditions predisposing to the development of malignant new growths, and in part at least explain the observed increase in the cancer death rate of practical y al civilized and highly urbanized countries.”

White flour and sugar were singled out as particularly noxious, because these had been increasing dramatical y in Western diets during the latter half of the nineteenth century, coincident with the reported increase in cancer mortality. (They would also be implicated in the growing incidence of diabetes, as we’l discuss, and appendicitis.) Moreover, arguments over the nutritive value and appeal of white flour and sugar had been raging since the early nineteenth century.

Flour is made by separating the outer layers of the grain, containing the fiber—the indigestible carbohydrates—and virtual y al of the vitamins and protein, from the starch, which is composed of long chains of glucose molecules. White sugar is made by removing the juice containing sucrose from the surrounding cel s and husk of the cane plant or sugar beet. In both cases, the more the refining, the whiter the product, and the lower the vitamin, mineral, protein, and fiber content. The same is true for white rice, which goes through a similar refining process.

This might seem obviously disadvantageous, but white flour had its proponents. It was traditional y considered “more attractive to the eye,” as Sir Stanley Davidson and Reginald Passmore observed in their textbook Human Nutrition and Dietetics (1963). It was preferred by bakers for its baking properties, and because it contains less fat than wholemeal flour it is less likely to go rancid and is more easily preserved. Mil ers preferred it because the leftover bran from refining rice and wheat (as with the molasses left over from refining sugar) could be sold profitably for livestock feed and industrial uses.

Nutritionists also argued that white flour had better “digestibility” than whole-meal, because the presence of fiber in the latter prevented the complete digestion of any protein or carbohydrates that were attached. White flour’s low protein, vitamin, and mineral content also made it “less liable than whole meal flour to infestation by beetles and the depredation of rodents,” as Davidson and Passmore wrote.

It wasn’t until the mid-nineteenth century that white flour became suitably inexpensive for popular consumption, with the invention of rol er mil s for grinding the grain. Until then, only the privileged classes ate white flour, and the poor ate wholemeal. Sugar was also a luxury until the mid-nineteenth century, when sugar-beet cultivation spread throughout the civilized world. In 1874, with the removal of tariffs on sugar importation in Britain, sugar consumption skyrocketed and led to the eventual development of the biscuit, cake, chocolate, confectionery, and soft-drink industries. By the beginning of World War I, the English were already eating more than ninety pounds of sugar per capita per year—a 500-percent increase in a single century—and Americans more than eighty pounds. Not until the mid-twentieth century did mechanical rol ers begin replacing hand-pounding of rice in Asian nations, so that the poor could eat polished white rice instead of brown.

Explorers would carry enormous quantities of white flour, rice, and sugar on their travels and would trade them or give them away to the natives they met along the way.*27 In The Voyage of the Beagle, Darwin tel s how the expedition’s members persuaded Aborigines in Australia to hold a dancing party with “the offer of some tubs of rice and sugar.” As early as 1892, the Barrow Eskimos were already described as having “acquired a fondness for many kinds of civilized food, especial y bread of any kind, flour, sugar, and molasses.” These foods remained primary items of trade and commerce with isolated populations wel into the twentieth century.†28

Until the last few decades, the nutritional debate over the excessive refining of flour and sugar had always been about whether the benefits of digestibility and the pleasing white color outweighed any potential disadvantages of removing the protein, vitamins, and minerals. In late-nineteenth-century England, the physician Thomas Al inson, head of the Bread and Food Reform League, wrote: “The true staff of life is whole meal bread.” Al inson was among the first to suggest a relationship between refined carbohydrates and disease. “One great curse of this country,” wrote Al inson, “is constipation of the bowel which is caused in great measure by white bread. From this constipation come piles, varicose veins, headaches, miserable feelings, dul ness and other ailments…. As a consequence pil factories are now an almost necessary part of the state.” Al inson’s chain of cause and effect from white bread to constipation to chronic disease was given credibility in the late 1920s by the innovative and eccentric Scottish surgeon Sir Arbuthnot Lane in a book entitled The Prevention of the Diseases Peculiar to Civilization. The hypothesis would hold a tight grasp on a school of British medical researchers for decades to come.

The preferred explanation for how sugar, white flour, and white rice might perpetrate disease emerged from a great era of nutritional research in the early twentieth century. In 1912, the Polish-born biochemist Casimir Funk coined the term “vitamine” (the “e” was later dropped) and speculated that vitamins B1, B2, C, and D were necessary for human health. During the next quarter-century, researchers continued to discover new vitamins essential to health and identified a host of diseases—such as beriberi, pel agra, rickets, and scurvy—as caused by specific vitamin deficiencies. Beriberi results from a deficiency in thiamine (vitamin B1), which is lost in the refining of polished rice and white flour. This led to the suggestion that even a disease like cancer could be a kind of deficiency disease, caused by vitamin starvation, as the journalist (and future homeopath) J. El is Barker cal ed it in his book Cancer: How It Is Caused, How It Can Be Prevented (1924).

The Scottish nutritionist Robert McCarrison was perhaps the leading proponent of the hypothesis that the chronic il nesses of civilization could be attributed to “the extensive use of vitamin-poor white flour and to the inordinate use of vitamin-less sugar.” McCarrison had founded a laboratory in India that would later become the National Institute of Nutrition and had spent nine years working in the Himalayas, “amongst isolated races far removed from the refinements of civilization,” as he explained in a 1921 lecture at the University of Pittsburgh. “During the period of my association with these peoples,”

he wrote, “I never saw a case of asthenic dyspepsia, of gastric or duodenal ulcer, of appendicitis, of mucous colitis, or of cancer, although my operating list averaged over 400 operations a year.” McCarrison attributed their good health to several factors, including a diet of “the unsophisticated foods of Nature.” “I don’t suppose that…as much sugar is imported into their country in a year as is used in a moderately sized hotel of this city in a single day,” he said.

McCarrison’s research included a comparative study of the diets and physiques of the disparate populations and religious groups on the Indian subcontinent. The “physique of northern races of India,” McCarrison wrote, “is strikingly superior to that of the southern, eastern, and western races.” Once again, he attributed the difference to the vitamins and nutrients present in the northern-Indian diet but not elsewhere. They ate wel -balanced diets, with milk, butter, vegetables, fruit, and meat—and ate their wheat ground course as wholemeal flour, which “preserves al the nutrients with which Nature has endowed it.” “White flour, when used as the staple article of diet,” wrote McCarrison, “places its users on the same level as the rice-eaters of the south and east of India. They are faced with the same problem; they start to build up their dietaries with a staple of relatively low nutritive value.” He also fed rats and mice in his laboratory on diets of these different populations and reported that the rats fared best on those diets containing “in abundance every element and complex for normal nutrition” and fared worst on those “excessively rich in carbohydrates, and deficient in suitable protein, mineral salts and vitamins.”

By World War I , this rising tide of research on essential vitamins led the United States to decree that mil ers had to enrich white flour with vitamin B, iron, and nicotinic acid. In England, the government acted in similar fashion a decade later. The concept of “protective foods,” containing the requisite protein, vitamins, and minerals for a healthy diet—fresh meat, fish, eggs, milk, fruits, and vegetables—now became the orthodox wisdom. During a century of debate, no one seems to have considered whether the properties of these refined foods—flour, sugar, and white rice—could have an impact on human health other than through the protein, fiber, vitamins, and minerals removed. Thirty years later, that would turn out to be the case, but by that time much of this original research on diseases of civilization would have been forgotten.

DIABETES AND THE CARBOHYDRATE HYPOTHESIS

The consumption of sugar is undoubtedly increasing. It is general y recognized that diabetes is increasing, and to a considerable extent, its incidence is greatest among the races and the classes of society that consume most sugar. There is a frequently discussed, stil unsettled, question regarding the possible role of sugar in the etiology of diabetes. The general attitude of the medical profession is doubtful or negative as regards statements in words…. But the practice of the medical profession is whol y affirmative.