In the early twenty-first century, Human Microbiome Project researchers went “motoring down rivers in the Amazon” and “off-roading in the East African savanna” to capture an image of the gut flora of ancient humans (Velasquez-Manoff 2015).
In the late-1960s, former British colonial doctors plumbed isolated villages and prison populations, using metrics like “stool bulk” to elucidate the etiology (i.e. to ask “where’d this come from?”) of what they called western diseases—a catch-all term for a series of chronic ailments linked to modern food production (Walker 1972).
These stories, separated by half a century, sound curiously similar.
For one, they both feature enterprising research-adventurers from (usually) affluent nations trolling around the geopolitical hinterlands for a kind of ground-zero of human biology. For another, they’re both fixated on figuring out how digestion and elimination are more than just the messy busy-work of living; they’re key arbiters of health.
At mid-century, physicians were alarmed by the prevalence of afflictions of the gut: things like diverticulosis coli, colon cancer, appendicitis, and ulcerative colitis. Startled by the observation that colonic disorders were practically absent in undeveloped regions yet ubiquitous in modern, affluent societies, medical authorities in the 1960s began hypothesizing that the transit time in which food was consumed, digested, and evacuated explained these differences.
Are constipated colons—with their cascade of inflammatory effects—an inevitable by-product of industrialized food systems, they asked? Is constipation an unavoidable feature of modernity? These are questions scientists are asking still.
A colleague (Sebastián Gil-Riaño) and I are developing a project on the digestive research conducted in Uganda and South Africa by a British physician named Denis P. Burkitt, a.k.a. “Dr. Fibre.” Burkitt surveyed the bowel movements, stool size, and diets of black and white Africans, and eventually identified dietary fibre as the key variable for making sense of the absence of “western diseases” among black Africans, and for the chronic constipation of white Africans and affluent peoples of all kinds (Burkitt 1972). So, Burkitt and his colleagues used unexamined and inconsistent racial categories to develop the theory of a direct, inverse relationship between progressive modernization (which looked like wage work, urban living, eating white bread and other commercial food products) and the quality of human digestion and elimination. In other words, the “better” you ate, the worse you pooped. And all those troubled No.2s had serious long-term consequences on your health.
Fun Fact: the connection between disease and digestion gone wrong has lived in the medical imagination since Pharaonic Egypt. However, the preoccupation reached fever pitch after the acceptance of germ theory by the late nineteenth century, which provided a new vocabulary and set of experimental techniques for investigating the effects of what The People’s Medical Lighthouse in 1856 called, “the disease of civilization”—or, constipation (Whorton 2000).
(If germs had been demonstrated to cause putrefaction of organic tissue outside of the body, what could they be doing on the inside, in that teeming cesspool that was the gut?)
When it was learned in the 1880s that gut microbes broke down proteins into compounds that proved toxic when injected into lab animals, a full-blown theory of “autointoxication” was born: or the idea of self-poisoning through undigested matter in the intestines. Autointoxication became a buzzword for many chronic complaints unexplainable by other means (for instance, headache, indigestion, impotence, nervousness, insomnia) and as an explanation for an overall loss of quality of life and longevity–until around 1920, when studies proved that the nasty stuff couldn’t get into your bloodstream.[i]
The general physician’s recommendation to eat more fresh fruits and vegetables and whole grains, to exercise regularly, and to evacuate the bowels promptly warred in the popular constipation-arsenal with solutions that involved less work. All Bran cereal was introduced in the early 1900s and marketed for specifically this purpose. Also newly popular in this period: yeast, yogourt, a host of laxative products, colonic irrigation tools, electrical stimulators, rectal dilators, abdominal support belts, abdominal massage machines—and even a surgical procedure called colectomy, popularized by the celebrated surgeon of London’s Guy’s Hospital, Sir William Arbuthnot Lane. Its purpose was to “streamline” the human “drainage scheme.” Lane was convinced that constipation was a disease specific to urban, industrial civilization–in which living habits “distorted the colon’s anatomy in a way not suffered by (in his highly racist terms) the ‘savage races.’”[ii] So, Dr. Fibre was inspired by this previous work to actually go out and document the link.
Since then, Burkitt’s work has been credited with “chang[ing] the breakfast tables of the western world” (Ferguson 1993). His studies inaugurated what Sebastián and I call the dietary fibre paradigm – a rough period (1970s-present day) when it became good nutritional wisdom to “get more fibre.”
And the marketers scrambled to find new and exciting ways to offer consumers the same old, yummy white bread/rice/pasta (fibre-poor) AND whole grain options (fibre-rich) AND white options with fibre extract stuck in as a supplement (best of both worlds!). Because science would start proving that more fibre not only made you a happier camper when you visited the loo (and all the hours in between), it – for example – decreased blood cholesterol levels, stabilized energy levels throughout the day, and (as scientists have determined more recently) provided more diverse and more beneficial food for your gut microbes: those under-appreciated companions-in-living who are responsible for digesting much of our food, and whom we literally can’t live without.
If this hasn’t sated your appetite, check out some fun media coverage of this 21st century iteration of the DFP in the The New York Times, The Globe and Mail, and New York Magazine. It makes for great bathroom reading.
[i] For more on this delightful dimension of modern history, see James Whorton, “Civilization and the Colon: Constipation as “the Disease of Diseases,” Western Journal of Medicine 173 December 2000, p. 424-427.
[ii] William A. Lane, “An Address on Chronic Intestinal Stasis,” British Medical Journal 2 1913: 1126; William A. Lane, The Operative Treatment of Chronic Constipation (London: Nisbet, 1909), pp. 36-7).