Simple Hypertension. Gout. Hiatus Hernia. Acne Rosacea
ALTHOUGH the taking of refined carbohydrates is by far the most important cause of over-consumption, as has been set out in this work, it is not the only cause. Another cause lies in the common occurrence of people eating when they are not hungry, and the conditions that this leads to are not in the author's opinion basically manifestations of the saccharine disease.
The important question of eating in the absence of hunger has been carefully described in Chapter X, on peptic ulcer, and of the examples set out there perhaps the best is seen when people eat in the company of others, especially if this is attended by the taking of alcohol. One is reminded of the huge meals, accompanied by the drinking of large quantities of port, that took place in past generations, as in the times of the earlier Georges. But there is no need to go back to these extreme examples; the fact is that even today in communal feeding a great deal of food is eaten chiefly because it is there, or for an ulterior motive not connected with the appetite as, for example, in many businessmen's lunches.
Simple Hypertension and Gout
The apoplexy and gout so commonly recorded amongst earlier generations ('our forefathers used to chalk their billiard cues with the knuckles of their fingers') were certainly not basically caused by the consumption of refined carbohydrates, which, as we have seen, was enormously less then than now. Nor has there been any explosive rise in the incidence of apoplexy and gout since the end of the past century, which has been so typical of appendicitis, peptic ulcer, coronary thrombosis, and other saccharine manifestations. It has also to be remembered that refined carbohydrate foods undergo a relatively complete combustion in the body compared with protein foods like meat, fish, and eggs. They therefore leave little work for the kidney to do in excreting metabolic end-products, and so would not be expected to lead to undue wear in that organ, which wear plays a part even in simple hypertension. Nor, as regards gout, are they of themselves heavy direct producers of uric acid in the way that protein foods are.
The author has not therefore included simple hypertension and gout as basically saccharine conditions. He considers they are essentially caused by the type of over-consumption set out above, however much this is aggravated by the other type of over-consumption (from taking refined carbohydrates). He is well aware that amongst primitive peoples, on a very simple, natural diet, these conditions are rare, but that is equivocal as regards the basic causation, for eating without hunger is rare in them too.
Another condition considered here to be due to over-consumption through disregard of the appetite -- eating in the absence of hunger for what is eaten -- is the ordinary sliding hiatus hernia. As was stated in Chapter X, physiologists have shown that the emptying time of the stomach is largely determined by the degree of hunger present when the meal is eaten, and, as the author has pointed out elsewhere, [1, 2] just as the oesophageal sphincter contracts strongly in a fast emptying time, so it will relax in a sluggish one. And it is this relaxation that the author submits allows the oesophageal reflux ('acid eructations' and 'heartburn') that initiates, and is always the hallmarked symptom of, hiatus hernia.
The author reached the above conclusion over hiatus hernia through considerations of natural principles and through many years' practice in naval hospitals, where the dyspeptic symptoms of acid eructations and heartburn were commonly encountered. The reason for the commonness of these acid eructations in the Navy lay, in his opinion, in the eating without hunger likely to occur in life at sea, with communal routine meals on the one hand and frequently restricted exercise in ships on the other. (Hiatus hernia itself is, however, seldom seen in the Navy, since the majority of ratings leave the Service at the age of 40 -- i.e., many years before hiatus hernia often presents itself clinically.)
He learnt that the alleviation of reflux unquestionably lies in teaching the patient only to eat when he is hungry -- including hungry for that particular food. [Hunger by itself, but not for that particular food, is not so relevant. Thus, a skilfully cooked pork chop, considered a difficult food to digest, will, if eaten with real hunger for it, become like a ship sunk without trace; whereas a pint of milk, considered an easy food to digest, will, if taken without hunger for it, 'lie like a ball on the stomach' for an hour or two afterwards and cause abundant eructations.] In connexion with eating only in the presence of hunger, it is always more accurate to make this decision before going to the table, as set out in the diet card at the end of this work.
The author therefore contends that hiatus hernia is secondary to chronic oesophageal reflux -- i.e., it is the result of reflux, not the cause of it. This contention of the author's, reached by natural considerations and clinical experience, has received support from a very different angle -- a surgical one. K. S. Mullard,  as the result of surgical experience comprising over 700 operations for this condition, has come to the conclusion, as he has stated in his Hunterian lecture on the subject, that hiatus hernia is in most cases primarily a functional, not an anatomical, condition, and has directly supported  the author's contention above.
As regards the actual mechanism of production of sliding hiatus hernia (which is so much less important than the cause, as advanced above), the author has always considered that the reflux produces intermittent (and therefore not radiologically easily demonstrable) enlargement of the oesophagus, with consequent enlargement of the hiatus in the diaphragm. This has very recently been shown to be quite possible.  Alternatively, the unnatural act of eating without true hunger could upset the tonal balance between the circular muscle in the oesophagal sphincter and the longitudinal muscle in the oesophagal wall, for K. S. Mullard  has shown how big a part this latter muscle plays, through pulling up the oesophagus and proximal part of the stomach, in the production of a sliding hiatus hernia.
Whichever mechanism was proved right (and the first is far the simpler), it would be essential to realize, as already said, that eating without hunger can only really be revealed by consulting the appetite before going near the table. From his experience, also, the author is confident that acid eructations are often a far more delicate indication of reflux than is retrosternal pain (heartburn).
The author cannot support that straining at stool plays any part in the causation of hiatus hernia.  In the first place, if this were the case the condition would be expected to be associated with other hernias,  and with chest conditions causing chronic cough, but this is not the case, though reflux can itself cause some inhalation-infections in older people. And in the second place, in his experience, regulation of the bowel, including by unprocessed bran, makes no difference whatever to the occurrence of the eructations (reflux).
Before leaving the subject of oesophageal reflux, it is worth noting that any acid eructations occurring through the above mechanism are always at their most acid after the eating of concentrated sweetstuffs. This is because there is nothing in such foods to neutralize the gastric acid, as explained in Chapter X, on peptic ulcer. Therefore, though such foods do not provide the mechanism, they aggravate its effects. Sweetstuffs, it is hoped, would largely be avoided by readers of this work, but very acid eructations may follow the taking of even such a natural food as dates -- though it will be remembered (Chapter X) that these concentrated fruits are not natural to the white races. If, therefore, white people eat a concentrated fruit like dates, they will be wise to take them with a glass or more of milk, with which they form a delightful combination. The same is true in many cases even of the less concentrated banana.
Finally, hiatus hernia does not occur amongst non-Westernized peoples, as has recently been cogently set out by D. P. Burkitt and P. A. James,  but as in the case of hypertension and gout, described above, this is equivocal as regards the mechanism of causation. So is the frequent co-existence of obesity.
In the author's opinion acne rosacea is also related to acid eructations, through their producing a reflex flushing of the skin over the nose and cheeks. This effect is magnified if the regurgitations are unduly irritant, as from imperfectly buffered gastric acid, as he has set out in his work on Peptic Ulcer, or from strong alcohol, hot tea, etc. Certainly he has found that this distressing complaint can be alleviated by the avoidance of eating in the absence of hunger, and of drinking cups of hot tea, and glasses of alcohol, both of which are normally taken without any relationship to hunger whatever.
1. Cleave, T. L., Campbell, G. D., and Painter, N. S. (1969), Diabetes, Coronary Thrombosis, and the Saccharine Disease, 2nd ed. Bristol: Wright.
2. Cleave, T. L. (1971), Brit. Med. J., 4, 50
3. Mullard, K. S. (1972), Ann. R. Coll. Surg. Eng., 50, 73.
4. -- (1971), Brit. Med. J., 4, 236.
5. Wolf, B. S. (1973), Am. J. Roentgenol., 117, No. 2, 231.
6. Cleave, T. L. (1973), Lancet, 2, 268.
7. Mullard, K. S. (1973), Ibid., 2, 451.
8. Burkitt, D. P., and James, P. A. (1973), Ibid., 2, 128.
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