John H Cummings

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• OBE, MA, MSc, MB ChB, PhD, FRCP, FRCP (Ed) R Nutr
• Professor Emeritus at University of Dundee

Whatever else that was on Denis’ mind early in 1968, he was still very much involved with work on his lymphoma. A safari to Ghana in West Africa early in the year started in Accra where he was treated like royalty. Met at the airport by Cofie George and members of the Burkitt Tumour Project, he was taken straight to the VIP lounge where he was surr...

The voyage, which gave Denis time for reflection, did not help him decide on his future although did provide the first step in opening his eyes to the world around him. The ship, MV Glenshiel, sailed from the Royal Albert Dock London on November 12, 1938, with a crew of many races and around 25 passengers some of whom were missionaries heading for...

The fibre story propelled Denis to celebrity status in a way that his discovery of the lymphoma had not done. A rare tumour of African children may not quite have captured the imagination of his new audience so fervently as did dietary fibre. Whilst fibre might have been viewed as just another dietary fad, the surgeon from Africa with no training i...

Five years after agreeing with Hugh Trowell that they should write a book on fibre together, Refined Carbohydrate Foods and Disease was published in 1975 by Academic Press [1]. When Cleave read it, he was furious and wrote a quite graphic letter to Denis, in his inimitable style incorporating red ink, capitals, underlining and unconventional spacin...

The UICC meeting was to be about ‘Tumours of the Lympho-reticular System in Africa’ to which category Denis’ jaw tumour syndrome clearly belonged. He and two colleagues from Makerere made arrangements to travel together taking the opportunity to gather more data on tumour incidence on the way. However, it was clear that the South African delegates...

The first year at Trinity was to be life-changing for Denis. He arrived in Dublin on Saturday October 5, 1929, for the start of the Michaelmas term in the car of Captain and Mrs Newenham, his aunt and uncle from Coolmore, County Cork. On arrival his college room was not available, so they went to a show at The Gaiety Theatre and stayed in the stand...

Denis was now a District Medical Officer for His Majesty’s Colonial Medical Service heading to a part of the world with which he was already familiar through his army service. He was posted to Lira, the administrative and commercial centre of the Lango District in the Northern region of Uganda, where he had sole responsibility for the health of abo...

Denis graduated Bachelor of Medicine, Bachelor of Surgery and Bachelor of Obstetrics (BAO) from Trinity in June 1935 having graduated BA in 1933. He now embarked on the postgraduate training that every doctor follows to turn him into a fully competent and experienced medical practitioner with some specialist training. The first posts to which newly...

Denis’ diaries are a more or less continuous daily record from 1923 until a few days before his death in March 1993. They give a, mostly brief, written account of 70 years of his life consisting of a summary of what he did, whom he met, his travels, family life, the weather and occasionally his thoughts. They are factual rather than philosophical....

Denis’ early years at Mulago were spent dealing with a huge clinical workload, leaving little time for considering the cause of any of these problems. He did little research although continued to observe the differing patterns of disease he saw in Africa compared with those he had managed as a surgeon in England. He was also able to turn his engine...

Denis was already almost 32 years old but his role as medical officer in the army was not allowing him to develop surgically. Nor had he seen anything of the war, despite being in the army for over 2 years. On arrival in Kenya, familiar to him from Uncle Roland’s stories about his life there, he was immediately posted to Mombasa, on the coast. Atta...

Denis was born into a family with strong ecclesiastical roots where service abroad, in whatever profession, was an accepted norm. He would acquire a faith that would at times motivate his whole being and be important in his decision to work in Africa. But what about the robin? Is the early study of this familiar garden bird the reason why wholegrai...

Back into routine Denis had immediately to start preparation for a very important meeting. From February 5 to 8, 1958, the Association of Surgeons of East Africa was to meet in Kampala where, apart from organising the clinical day, Denis was due to present a paper on his jaw tumours, almost a year since he had seen the first case on the ward with H...

In Denis’ own words [1]: ‘One memorable morning in 1957, Dr Hugh Trowell, the physician in charge of the pediatric ward at Mulago Hospital, who was by that time well-known for his pioneering work on Kwashiorkor, called me, the surgeon on duty, for consultation on a child. His face was massively swollen, with bizarre lesions involving both sides of...

Background: Previous systematic reviews and meta-analyses explaining the relationship between carbohydrate quality and health have usually examined a single marker and a limited number of clinical outcomes. We aimed to more precisely quantify the predictive potential of several markers, to determine which markers are most useful, and to establish...

Diversity of sulfate-reducing bacteria, their substrates in the intestine, metabolism of molecular hydrogen, and their trophic relationship with other microorganisms were characterized. Mucosal bacteria of the colon and the role of intestinal microbiota in disease development were described. Microbial communities and hydrogen sulfide concentration...

For more than 200 years the fibre in plant foods has been known by animal nutritionists to have significant effects on digestion. Its role in human nutrition began to be investigated towards the end of the 19th century. However, between 1966 and 1972, Denis Burkitt, a surgeon who had recently returned from Africa, brought together ideas from a rang...

Bacteria belonging to the normal colonic microbiota are associated with the etiology of ulcerative colitis (UC). Although several mucosal species have been implicated in the disease process, the organisms and mechanisms involved are unknown. The aim of this investigation was to characterize mucosal biofilm communities over time and to determine the...

Most people try and eat 'healthily' because they believe that food has an important part to play, alongside other lifestyle changes, in maintaining health. With the advent of the functional food concept it has become clear that foods can be used not only to prevent disease, but also to treat it. Thus the role of food and drugs overlap and are both...

The present paper summarizes the consensus views of a group of 9 European clinicians and scientists on the current state of scientific knowledge on probiotics, covering those areas where there is substantial evidence for beneficial effects and those where the evidence base is poor or inconsistent. There was general agreement that probiotic effects...

Crohn's disease is an inflammatory illness in which the immune response against gut microorganisms is believed to drive an abnormal immune response. Consequently, modification of mucosal bacterial communities, and the immune effects they elicit, might be used to modify the disease state. To investigate the effects of synbiotic consumption on diseas...

The colonic microflora is an organism that performs a variety of unique activities. It is more important to evaluate these activities than to analyze bacterial composition in terms of genera, species, or strains. Unless the bacteria translocate, it is the activities of the colonic microflora that affect colonic and systemic physiology and not the b...

There is impressive evidence from epidemiological and experimental studies that dietary fibre derived form vegetables, fruit and wholegrain cereals protects against and may be useful in the treatment of a wide range of diseases. However, while there is some evidence of benefit of extracted and synthetic fibres in terms of lowering levels of cardiov...

David Southgate will always be known for his work on the composition of foods and the compilation of food tables, and for his innovation in the field of dietary carbohydrate analysis, especially dietary fibre, in which he was the natural heir to McCance and Widdowson, with whom he worked in his early years.

Viable counts of anaerobic bacteria increased distally from the right to left regions of the human colon. A wide variety of cell-bound glycosidases were detected in the bowel and their specific activities were generally greater in the right colon. High levels of enzymes associated with the degradation of endogenously produced glyco-proteins were fo...

Dietary fibre, measured as non-starch polysaccharides by the Englyst technique, has been determined in 178 fruits, vegetables and nuts. Detailed results are given for total dietary fibre, soluble and insoluble, cellulose, non-cellulosic polysaccharides and constituent monosaccharides for each food. Values are compared to those found in McCance and...

carbohydrates, human nutrition, chronic diseases, FAO, WHO, scientific update

The energy values of carbohydrates continue to be debated. This is because of the use of different energy systems, for example, combustible, digestible, metabolizable, and so on. Furthermore, ingested macronutrients may not be fully available to tissues, and the tissues themselves may not be able fully to oxidize substrates made available to them....

Dietary carbohydrates are a group of chemically defined substances with a range of physical and physiological properties and health benefits. As with other macronutrients, the primary classification of dietary carbohydrate is based on chemistry, that is character of individual monomers, degree of polymerization (DP) and type of linkage (alpha or be...

Sulphites are widely used food additives that may damage health, hence limits are set on their use. They are excreted in urine as sulphate, along with sulphate derived from sulphur amino acids. Dietary intakes of sulphites are hard to determine, so we have tested the utility of urinary nitrogen:sulphate ratio as a biomarker of inorganic sulphur (IS...

THE HUMAN LARGE INTESTINAL ECOSYSTEM The adult human colon typically contains over 200 g of digestive material (Banwell et al., 1981; Cummings et al., 1990; 1992), with the average daily output of faeces in Western countries being approximately 120 g (Cummings et al., 1992). A large proportion of this is microbial cell mass with bacteria comprising...

Prebiotics are short-chain carbohydrates that alter the composition, or metabolism, of the gut microbiota in a beneficial manner. It is therefore expected that prebiotics will improve health in a way similar to probiotics, whilst at the same time being cheaper, and carrying less risk and being easier to incorporate into the diet than probiotics. To...

The principal phyto-oestrogens (PO) in food are isoflavones, lignans, coumestans and prenylated flavonoids, with isoflavones and lignans being the most commonly found in UK diets. Until recently obtaining accurate data on the PO content of foods was hampered by lack of suitable analytical methods and validation techniques. Furthermore, although PO...

Coeliac disease is a lifelong intolerance to the gluten found in wheat, barley and rye, and some patients are also sensitive to oats. The disease is genetically determined, with 10% of the first-degree relatives affected and 75% of monozygotic twins being concordant. Of the patients with coeliac disease 95% are human leucocyte antigen (HLA)-DQ2 or...

The Process for the Assessment of Scientific Support for Claims on Foods (PASSCLAIM) had the following principal objectives: • to evaluate existing schemes which assess scientific substantiation; • to produce a generic tool for assessing the scientific support for health claims for foods; • to establish criteria for markers which can be used to exp...

Ulcerative colitis (UC) is an acute and chronic inflammatory bowel disease of unknown aetiology, although bacterial species belonging to the normal colonic microbiota are known to be involved in its initiation and maintenance. Several organisms have been linked to the disease; however, mucosa-associated bacteria are more likely to be involved than...

Ulcerative colitis (UC) is an acute and chronic inflammatory disease of the large bowel with unknown aetiology. The immune response against normal commensal microorganisms is believed to drive inflammatory processes associated with UC. Therefore, modulation of bacterial communities on the gut mucosa, through the use of probiotics and prebiotics, ma...

Review of studies of diet and ulcerative colitis (UC).

Foods consumed in order of food sigmoidoscopy scores (FSS)[43].

Proposed dietary advice for ulcerative colitis patients[44].

Permitted levels of sulfite in the UK.

Food sigmoidoscopy score (FSS) calculation example for red wine (NB incomplete data set used).

Background The relapsing nature and varying geographical prevalence of ulcerative colitis (UC) implicates environmental factors such as diet in its aetiology. Methods In order to determine which foods might be related to disease activity in UC a new method of dietary analysis was developed and applied. Eighty-one UC patients were recruited at all...

We investigated the feasibility of increasing ursodeoxycholic acid (UDCA) in the enterohepatic circulation of pigs by administering living bacteria capable of epimerising endogenous amidated chenodeoxycholic acid (CDCA) to UDCA. We first demonstrated that combining Bifidobacterium animalis DN-173 010, as a bile salt-hydrolysing bacterium, and Clost...

Dietary fibre, principally the non-starch polysaccharides of the plant cell wall, is an important component of our diet. After more than 30 years of research into the many and varied claims for its benefits, it is now clear that fibre has uniquely significant physical effects in the gut and in addition through fermentation is a major determinant of...

The mucosa associated flora of the large intestine is important in determining mucosal function although what controls its composition is unknown. This study has determined the effect of the prebiotic carbohydrates oligofructose and inulin on the mucosal flora. An in vitro chemostat model of both planktonic and surface associated bacteria was used...

To study the variation in genistein + daidzein intake over a 6-month period and test the reliability of 24 h urinary isoflavones as a biomarker of exposure over time. Dietary genistein + daidzein intake was assessed at various time points throughout six months in 15 healthy subjects. Group 1 (n=8) followed nonsupplemented diets and Group 2 (n=7) to...

Background The current study assessed the value of spot urine and plasma samples as biomarkers of phyto-oestrogen exposure. DesignTwenty-one subjects, aged 21–76 (9 males and 12 females) completed the five-week intervention study. They provided spot urine and plasma samples at the start of the study, weekly samples for four weeks while eating a da...

Sulfiting agents are widely used as food additives. Limits are set on their use in foods because they may adversely affect health. Sulfiting agents are excreted in urine as sulfate, which is indistinguishable from sulfate derived from sulfur amino acids. The objective was to assess the contribution of inorganic sulfur to urinary sulfate excretion a...

The etiology of ulcerative colitis (UC) is unknown, but evidence links it to bacteria belonging to the normal colonic microbiota. The aims of this study were to characterize bacteria colonizing the rectal epithelium, and to investigate whether significant differences existed in UC. Rectal biopsy specimens were obtained via endoscopy from 9 patients...

The gut and immune system form a complex integrated structure that has evolved to provide effective digestion and defence against ingested toxins and pathogenic bacteria. However, great variation exists in what is considered normal healthy gut and immune function. Thus, whilst it is possible to measure many aspects of digestion and immunity, it is...

Desulfovibrios produce sulphide, which is toxic to colonic epithelial cells. These bacteria have previously been linked to ulcerative colitis. Traditional methods of culturing these organisms are slow, and often unreliable, while molecular approaches are either non-quantitative or lack sensitivity. To develop a sensitive method for quantitating des...

Estimating intake of phyto-oestrogens (PO) is difficult because there is inadequate information on the PO content of foods. Development of a biomarker of intake is therefore necessary for carrying out epidemiological studies. We aimed to validate a newly constructed PO database, containing more than 600 values assigned to foods by using duplicate d...

Probiotics and prebiotics are the sort of therapy that most patients with inflammatory bowel disease (IBD) wish for. They are without significant side effects, except possibly an increase in gas with prebiotics, and so far, appear to be entirely safe. However, are they effective? More than a dozen studies using probiotics in IBD have now been repor...

The mucosa in ulcerative colitis (UC) is replete with antibody producing plasma B cells and polymorphonuclear leucocytes (PMN). This combination of effector cells requires a crosslinking antigen to evoke an antibody driven PMN inflammatory response via their Fc receptors. The stimulus for activation is thought to be commensal bacteria colonising th...

Dietary fibre, principally the non-starch polysaccharides of the plant cell wall, is an important component of our diet. After more than 30 years of research into the many and varied claims for its benefits, it is now clear that fibre has uniquely significant physical effects in the gut and in addition through fermentation is a major determinant of...

PASSCLAIM1 – Gut health and immunity Francisco Guarner Hospital General Vall d’Hebron Digestive System Research Unit Passeig Vall d’Hebron 119–129 08035 Barcelona, Spain Erika Isolauri University of Turku Department of Paediatrics PO Box 607 20520 Turku, Finland Daphne Pannemans Former ILSI Europe Avenue E. Mounier 83 Box 6 1200 Brussels, Belgium C...

Hydrogen sulfide (H2S) and methanthiol (CH3SH) have been implicated as bacterially derived toxins which may be damaging to the gut mucosa. The addition of nitrate and metals that bind sulfide could potentially reduce the concentrations of these toxic gases. In this study, the effects of iron, zinc, bismuth and nitrate on free H2S concentrations in...

Convincing evidence from both animal models and the study of patients with ulcerative colitis (UC) implicates the intestinal microflora in the initiation and maintenance of the inflammatory processes in this condition. Despite this, no specific pathogen has been identified as causal and the disease is widely believed to occur as the result of a gen...

The toxic, bacterial metabolite sulfide is implicated in ulcerative colitis. Ulcerative colitis patients taking 5-aminosalicylic acid-containing drugs have lower fecal sulfide levels than those not taking these drugs. The effects of sulfasalazine, balsalazide, olsalazine, and 5-aminosalicylic acid on sulfide production were studied in a three-stage...

Ion-exchange chromatography (IEC) for sulphate determination in matrices such as wine is complicated by the coelution of organic acids but can be achieved with the correct column, a bicarbonate mobile phase and conductivity detection. The traditional sulphite assay involving acid distillation is laborious and requires large sample volumes. Conseque...

The film forming properties of a commercial aqueous ethylcellulose dispersion (Surelease) mixed with a range of ratios of an amylose/butanol complex in the presence of a range of concentrations of a plasticiser has been studied by measuring the minimum film forming temperature (MFFT). Contrary to what was to be anticipated from the literature, it w...

Taking live bacteria by mouth to improve health (probiotics) is not intuitively rational yet it is a practice with a long history. As interest in the effects on health of the intestinal flora has developed, along with major advances in the technology for studying it, so has come a new interest in establishing the true benefits of probiotic therapy....

Handbook of Dietary Fiber. Edited by Susan SungsooChoo, and DreherMark L.. New York: Marcel Dekker Inc. 2001. £158/€255. ISBN 0-8247-8960-1 - Volume 88 Issue 2 - John Cummings

The defining effect of prebiotics is to stimulate selectively the growth of bifidobacteria and lactobacilli in the gut and, thereby, increase the body's natural resistance to invading pathogens. Prebiotic carbohydrates may also have additional, less specific, benefits because they are fermented in the large intestine. The prebiotic carbohydrates th...

Polymorphic N-acetyltransferase genes (NAT1 and NAT2) determine rapid or slow acetylation phenotypes, which are believed to affect cancer risk related to environmental exposure. Black South Africans have a unique incidence pattern of environment-related cancers, but genetic characteristics of this population are mostly unknown. In this study, we co...

Prebiotic carbohydrates selectively stimulate the growth of bifidobacteria and lactobacilli in the human colon. These bacteria form part of the gut's inherent defence against invading pathogens. To test the effectiveness of fructo oligosaccharides in preventing travellers' diarrhoea. A total of 244 healthy subjects, travelling to high and medium ri...

Prebiotics, as currently conceived of, are all carbohydrates of relatively short chain length. To be effective they must reach the cecum. Present evidence concerning the 2 most studied prebiotics, fructooligosaccharides and inulin, is consistent with their resisting digestion by gastric acid and pancreatic enzymes in vivo. However, the wide variety...

Hydrogen sulfide is a luminally acting, bacterially derived cell poison that has been implicated in ulcerative colitis. Sulfide generation in the colon is probably driven by dietary components such as sulfur-containing amino acids (SAAs) and inorganic sulfur (eg, sulfite). We assessed the contribution of SAAs from meat to sulfide production by inte...

Hydrogen sulphide is produced in the human large intestine by the bacterial reduction of dietary inorganic sulphate and sulphite and by fermentation of sulphur amino acids. Sulphide may damage the colonic epithelium and has been implicated in the pathogenesis of ulcerative colitis. The accurate measurement of sulphide in biological samples, particu...

Butyrate oxidation within the colonocyte is selectively inhibited by hydrogen sulphide, reproducing the metabolic lesion observed in active ulcerative colitis. To study generation of hydrogen sulphide by sulphate reducing bacteria (SRB) and the effects of 5-aminosalicylic acid (5-ASA) in patients with ulcerative colitis in order to identify a role...