Some unique biologic characteristics of the Masai of East Africa

A possible cause of arteriosclerosis

A new etiology of arteriosclerosis is proposed. This theory has emerged from the inability of current theories to account for the spontaneously occurring disease and from numerous factual anomalies uncovered by recent research. It is suggested that arteriosclerosis is a chronic infectious disease caused by an infestation of blue-green algae, and that the natural history, histopathologic changes, and many apparently contradictory facts associated with arteriosclerosis are explained by such an etiologic agent. If correct, a radical shift in our understanding of the disease is required. Certain observations and forecasts are made based upon this infection theory.

Pathogenesis of cholesterol gallstones

The factors leading to cholesterol cholelithiasis are probably multiple. Although the secretion of bile supersaturated with cholesterol seems to be a common feature among all patients who form cholesterol stones, a variety of pathophysiologic events can produce an increase in lithogenicity. Dietary factors, particularly in the grossly obese, lead to an absolute increase in secretion of cholesterol into bile. Occasionally, excessive loss of the bile salt pool, for example with regional ileitis, may decrease the ability of bile salts to solubilize cholesterol. In many other, subtle alterations in the enterohepatic circulation of bile salts may adversely affect solubility by both decreasing the secretion of bile salts and increasing the secretion of cholesterol. Regardless of its cause, supersaturation of bile with cholesterol appears to be a prerequisite for gallstone formation. However, additional factors within the gallbladder, such as increased secretion of glycoprotein, increased absorption of fluids, infection, and stasis, appear to contribute to the formation of macroscopic stones.

Cholecystectomy and cancer of the large bowel

A matched case control study was conducted in order to determine the association between previous cholecystectomy and the development of large bowel cancer. One hundred and sixty men and 145 women presenting with large bowel cancer were studied. One control was selected for each case matched according to age, sex and date of admission. The medical records for each patient in the study were reviewed for evidence of previous cholecystectomy. No association was found among male patients, but for women an estimate of relative risk of 2.7 was obtained for patients who had had previous cholecystectomy. This association was largely a consequence of the fact that 10 female patients with rectal cancer had had a previous cholecystectomy compared with only of their controls. It is possible that carcinogenic breakdown products of bile salts are most concentrated in the distal portion of the large bowel, but it is difficult to explain why the association should be confined to women only.

Evidence for an association between cholelithiasis and diverticular disease of the colon: a case-controlled study

A prospective case-control study was carried out to determine if there was a true association between diverticular disease of the colon and cholelithiasis. The prevalence of gallstones was higher in 102 patients with diverticular disease of the colon (45%) than in 102 control subjects, matched for age, sex, body weight, and number of pregnancies (22%) (P less than 0.001). The difference was only significant in women. Although these results obtained in hospitalized patients cannot be generalized to the population at large, this study suggests an association between diverticular disease of the colon and gallstone disease. The possibilities of referral bias, detection bias, and chance are considered, and the mechanism of this association is discussed, with particular reference to the role of a fiber-depleted diet.

Milk, serum cholesterol, and the Maasai. A hypothesis

The Maasai of East Africa have been found to have low serum concentrations of cholesterol and a low incidence of cardiovascular disease in spite of apparently very high milk intakes. On that basis it has been frequently suggested that milk contains a "hypocholesterolaemic factor". The hypocholesterolaemia of the Maasai had also been attributed to a genetic adaptation. We feel that the milk intakes reported for the Maasai are excessively high and that the low incidence of cardiovascular diseases and low levels of serum cholesterol may be adequately explained by their variable and generally low energy intakes.

Oral cholelitholysis--cheno versus urso: Japanese experience

The present status of the use of cholelitholytic agents in Japan is presented. Open and double-blind studies of chenodeoxycholic acid and ursodeoxycholic acid are compared with respect to their efficacy and safety. Although the in vitro solubilization of cholesterol with ursodeoxycholic acid seems to be less than with chenodeoxycholic acid, the higher dose of ursodeoxycholic acid which can be used because of the lack of side effects such as diarrhea and elevation of transaminases and a lower lithogenic index of bile obtainable favors ursodeoxycholic acid as an oral cholelitholytic agent at the moment.

Molluscum contagiosum and herpes simplex in Maasai pastoralists; refeeding activation of virus infection following famine?

An epidemic of molluscum contagiosum and oro-genital herpes simplex was observed in Maasai pastoralists of the Rift Valley. It coincided with a period of refeeding following famine, when the relief diet was different from normal milk fare. We propose that refeeding may be an important mechanism for activation of certain viral infections previously suppressed by famine.

Serum cholesterol, triglycerides and heart disease of nomadic and sedentary tribesmen consuming isoenergetic diets of high and low fat content

1. The effects were examined of two approximately isoenergetic diets differing widely in saturated fat content on the levels of serum cholesterol and triglycerides of nomads and non-nomads in eastern Niger. Each person was also examined for clinical and electrocardiographic evidence of heart disease. 2. No significant differences could be found between serum cholesterol and triglyceride levels of 297 Anagamba nomad men consuming 73% energy as fat and 303 Kanouri sedentary men consuming 9% energy as fat. 3. Rheumatic heart disease was common in nomads and four possible cases of ischaemic heart disease were found in sedentary men only.

Gallstones. The present and future of medical dissolution

Adequate concentrations of bile acids and phospholipids are necessary to keep cholesterol in solution in bile. When the amount of cholesterol exceeds the capacity of bile acids and phospholipids to keep the cholesterol in micellar solution, bile becomes supersaturated; then, under appropriate conditions, cholesterol crystals form and gallstones may develop. Current dissolution therapy is aimed at desaturating the bile, thereby shifting the equilibrium of cholesterol from a crystalline phase back toward a micellar state, thus permitting gallstones to dissolve. Chenodeoxycholic acid is the drug being most extensively tested for efficacy in dissolution; at present, it is successful in about 60 per cent of cases. The primary mechanism of action appears to be suppression of biliary secretion of cholesterol. Further experience is needed to confirm the safety of chenodeoxycholic acid, to gain more precision in patient selection, and to determine ideal dose. The role of chenodeoxycholic acid in prophylaxis and in prevention of recurrence needs further study. Other potential agents for dissolution also deserve investigation.

Marathon running and immunity to atherosclerosis

This is an interim report of an on-going study of deaths in 42-km men. The absence of fatal ASCVD in these athletes can not be construed as evidence for the protective role of exercise alone. The ability to run 42 km depends on many factors. Exercise is only one. Avoiding tobacco is another. Dietary factors also play a role. It has not been feasible to remove one of these factors while maintaining the ability to cover the 42 km distance. Some 42-km men claim that megadoses of ascorbic acid protect them from collagen injury. This is supported by animal studies that show increased collagen synthesis proportional to ascorbic acid intake up to dosage levels that would equal 10 grams per day for humans. Their self-selected macrobiotic diet contains a high ratio of peanuts:steak resulting in a high P/S ratio (polyunsaturates/saturates). Dietary manipulation quickly effects their ability to train. Smoking is so rare among these runners that it must be related to specific effects, such as a catalytic agent in tobacco smoke converting linoleic acid into a toxic lipid oxide. Noakes and Opie recently confirmed again (May, 1976) that no cases of "death due to coronary atherosclerosis" have been recorded in marathon finishers. If this holds true for the second 10-year period of this study, then marathon runners will have joined the longshoremen by earning life-long protection against ASCVD. These longshoremen burned 1,876 kcals on the job, equivalent to a 30-km run. Roberts and Straus suggest that many factors can cause atherosclerosis. Only time will tell whether the marathoner is protected from all of them.

35 eggs per day in the treatment of severe burns

A regime involving the dietary management of 8 severely burned patients has been described, the main feature of this diet being the high egg intake. The eggs were given in a variety of forms without any untoward effects and without any distaste being developed. No pathological levels of serum lipoproteins or cholesterol were attained. Serum proteins from an initial low level reached normal values within a relatively short time. It is felt that a high egg diet is a valuable and safe addition in the management of severely burned patients.

[Blood serum levels of immunoglobulins among African children: Seasonal variations and ethnic factors (a study done in Lourenco-Marques among a group of 11-year olds) (author's transl)]

The blood titers of IgG, IgA and IgM and total proteins were determined in October 1971 (dry season) and again in April 1972 (wet season) among girls and boys belonging to 4 ethnic groups: White, Bantu, Indian, Mixed. Parasitic studies were also done. These studies indicate a rise of IgM among the girls and of IgA in both sexes from October 1971 to April 1972. The average IgM titer among the four groups is higher than the one found in the Occident. This is especially notable for the Bantu and the Mixed. The Indian levels exceeded, on the average, the White group's. The average IgG figures are only slightly higher than those found in the literature for Western populations. Genetic influences do not appear to explain the differences found between the ethnic groups. The role of environment is stressed, and parasitic influences are discussed.

Management of gallstones in the aged

Calculous gallbladder disease is the most common indication for intra-abdominal surgery in the elderly. Feeding bile salts may possibly increase the solubility of cholesterol in bile and may cause diminution in the size of radiolucent gallstones, the principal ingredient of which is cholesterol. However, indications for such treatment are still not clear, and long-term effectiveness and safety still have to be evaluated. If the aged patient with gallstones has severe symptoms, is a good medical risk and is not demented, surgical treatment should not be denied because of advanced age. If the patient has "silent" or "dyspeptic" gallstones and is a poor risk or demented, surgical therapy should be postponed at least temporarily, in the hope that medical methods for dissolving gallstones soon will be perfected.