Good Calories, Bad Calories

The world is gradually going carbohydrate. That is because there are more people than there have ever been before (one would like to add “or ever will be again”) so there must be more food. You can get about eight times as many calories from an acre of corn as you can from the flesh of pigs fed on this same corn. Because of population pressure, certain sections of the world are progressively using more of the vegetable and less of animal materials. This means that the carbohydrates, from sugar and cereals particularly, are increasing steadily in quantity. One does not need to view this with alarm, but it is not amiss to point out that this tendency is not the best road to health. Not that starches and sugars are harmful, but they are low in the essentials we must have for good health. If the proportion of carbohydrates is high then the amount of something else of greater importance is low. Nutrition is a six-way teeter-totter. Have you ever tried to balance such a device?

C. C. FURNAS AND S. M. FURNAS, Man, Bread & Destiny: The Story of Man and his Food, 1937

Chapter Five

DISEASES OF CIVILIZATION

The potato took 200–250 years, in spite of organized encouragement, to become accepted in England. It took only fifty years in Ireland. Maize and cassava have come to be accepted in parts of Africa in considerably less time…. Tea, white bread, rice and soft drinks have entered many African dietaries in even shorter time and the extent to which they have spread and their consequences to nutrition have been rather severe.

F. T. SAI, Food and Agricultural Organization regional nutrition officer for Africa, 1967

ON APRIL 16, 1913, ALBERT SCHWEITZER arrived at Lambaréné, a small village in the interior lowlands of West Africa, to establish a missionary hospital on the banks of the Ogowe River. Attended by his wife, Hélène, who had trained as a nurse, he began treating patients the very next morning. Schweitzer estimated that he saw almost two thousand patients in the first nine months, and then averaged thirty to forty a day and three operations a week for the better part of four decades. The chief complaints, at least in the beginning, were endemic diseases and infections: malaria, sleeping sickness, leprosy, elephantiasis, tropical dysentery, and scabies.

Forty-one years after Schweitzer’s arrival, and a year and a half after he received the Nobel Peace Prize for his missionary work, Schweitzer encountered his first case of appendicitis among the African natives. Appendicitis was not the only Western disease to which the natives seemed to be resistant. “On my arrival in Gabon,” he wrote, “I was astonished to encounter no cases of cancer…. I can not, of course, say positively that there was no cancer at all, but, like other frontier doctors, I can only say that if any cases existed they must have been quite rare.” In the decades that followed, he witnessed a steady increase in cancer victims. “My observations inclined me to attribute this to the fact that the natives were living more and more after the manner of the whites.”

As Schweitzer had suggested, his experience was not uncommon for the era. In 1902, Samuel Hutton, a University of Manchester–trained physician, began treating patients at a Moravian mission in the town of Nain, on the northern coast of Labrador, or about as far from the jungles of West Africa as can be imagined, in both climate and the nature of the indigenous population. As Hutton told it, his Eskimo patients fell into two categories: There were those who lived isolated from European settlements and ate a traditional Eskimo diet. “The Eskimo is a meat eater,” he wrote, “the vegetable part of his diet is a meager one.” Then there were those Eskimos living in Nain or near other European settlers who had taken to consuming a “settler’s dietary,” consisting primarily of “tea, bread, ship’s biscuits, molasses, and salt fish or pork.” Among the former, European diseases were uncommon or remarkably rare. “The most striking is cancer,” noted Hutton on the basis of his eleven years in Labrador. “I have not seen or heard of a case of malignant growth in an Eskimo.” He also observed no asthma and, like Schweitzer, no appendicitis, with the sole exception of a young Eskimo who had been “living on a ‘settler’ dietary.” Hutton observed that the Eskimos who had adopted the settlers’ diet tended to suffer more from scurvy, were “less robust,” and endured “fatigue less easily, and their children are puny and feeble.”

What both Schweitzer and Hutton had witnessed during their missionary years was a “nutrition transition,” a term now commonly used to describe a population’s Westernization in diet, lifestyle, and health status. The World Health Organization recently described the current version of the nutrition transition this way: