Aetiology of duodenal ulcer: an investigation into the buffering action and effect on pepsin of bran and unrefined carbohydrate foods.

IT has been suggested that the refinement of staple carbohydrate foods may be a major aetiological factor in accounting for the appearance and the rising incidence of duodenal ulcer, both in Western countries and in developing countries, during the present century (Cleave, 1962, 1974). Cleave postulated that this may be due to loss of buffer in the staple carbohydrates as a result of the removal of bran by milling or the loss of protein by other methods of processing as in the preparation of manioc (cassava) and the manufacture of white sugar. He lays particular emphasis on the value of protein as a buffer. It is also suggested that the buffering effect of protein may be enhanced as it is digested and broken down into polypeptides, peptones and amino acids (Levy and Siler, 1942). Cleave's hypothesis fits in with the situation in rural India where duodenal ulcer is common in the south and in parts of Kashmir, Assam and Bengal, areas in which milled rice is the staple food, and is rare in those areas of the north where the staple diet is unrefined wheat. Duodenal ulcer is also common in those areas of the south where cassava replaces rice. In Mysore the author found a lower incidence amongst those whose staple diet was ragi (Eleusine coracana), an unrefined millet. The incidence, how-