The association between dietary fibre deficiency and high-income lifestyle-associated diseases: Burkitt's hypothesis revisited

Abstract

In 1969, Denis Burkitt published an article titled "Related disease-related cause?", which became the foundation for Burkitt's hypothesis. Working in Uganda, he noted that middle-aged people (40-60 years old) had a much lower incidence of diseases that were common in similarly aged people living in England, including colon cancer, diverticulitis, appendicitis, hernias, varicose veins, diabetes, atherosclerosis, and asthma, all of which are associated with lifestyles commonly led in high-income countries (HICs; also known as western diseases). Following Cleave's common cause hypothesis-which suggests that if a group of diseases occur together in the same population or individual, they are likely to have a common cause-Burkitt attributed these diseases to the small quantities of dietary fibre consumed in HICs due mainly to the overprocessing of natural foods. Nowadays, dietary fibre intake in HICs is around 15 g/day (well below the amount of fibre Burkitt advocated of >50 g/day-which is associated with diets from rural, southern and eastern sub-Sahalean Africa). Since Burkitt's death in 1993, his hypothesis has been verified and extended by large-scale epidemiological studies, which have reported that fibre deficiency increases the risk of colon, liver, and breast cancer and increases all cancer mortality and death from cardiovascular, infectious, and respiratory diseases, diabetes, and all noncardiovascular, non-cancer causes. Furthermore, mechanistic studies have now provided molecular explanations for these associations, typified by the role of short-chain fatty acids, products of fibre fermentation in the colon, in suppressing colonic mucosal inflammation and carcinogenesis. Evidence suggests that short-chain fatty acids can affect the epigenome through metabolic regulatory receptors in distant organs, and that this can reduce obesity, diabetes, atherosclerosis, allergy, and cancer. Diseases associated with high-income lifestyles are the most serious threat to health in developed countries, and public and governmental awareness needs to be improved to urge an increase in intake of fibre-rich foods. This Viewpoint will summarise the evidence that suggests that increasing dietary fibre intake to 50 g/day is likely to increase lifespan, improve the quality of life during the added years, and substantially reduce health-care costs.

A High-Fat Diet Increases Gut Microbiota Biodiversity and Energy Expenditure Due to Nutrient Difference

“…Although researchers have proposed for centuries that diets might contribute to obesity, systematic studies of the diets have only become a subject of interest in recent decades [ 3 ]. The Western diet is characterized by a high intake of meat, fat, and deep-processed, low-fiber carbohydrates [ 4 ]. Between 1998 and 2009, the mean daily dietary fiber intake in the USA was significantly lower than the recommended adequate intake, and individuals with obesity ingested significantly less dietary fiber than healthy individuals [ 5 ].…”

A potential probiotic- Lachnospiraceae NK4A136 group: Evidence from the restoration of the dietary pattern from a high-fat diet

“…Whether the short-term dietary pattern shift from HFD to a balanced diet could correct HFD-induced colonic dysbiosis and reverse adverse physiological alterations still requires further investigation. The lack of ber intakes is also associated with the HFD-induced gut dysbiosis [27,28]. The short-chain fatty acid (SCFA)producing bacteria such as Lachnospira, Akkermannsia, Bi dobacterium, Lactobacillus, Ruminococcus, Roseburia, Clostridium, Faecalibacterium, and Dorea was a signi cant decrease in human receiving low ber diet [29,30]..…”

Weight Reduction by the Low-Insulin-Method—A Randomized Controlled Trial

“…Such excessive, carbohydrate-rich nutrition in combination with low physical activity (as part of a poor lifestyle) supports the development of overweight, obesity and cardiometabolic diseases like type 2 diabetes mellitus [ 2 ]. Starch-free and complex carbohydrates (e.g., fibre from whole grain) are associated with a longer life expectancy [ 3 ] and reduced blood glucose levels [ 4 ]. However, the consumption of less complex carbohydrates leads to an insulin secretion, which not only mediates the uptake of glucose from the blood into the cells, but, already at a lower concentration by a factor of 6, stops lipolysis for several hours [ 5 ].…”