Dietary fat, dyspepsia, diarrhoea, and diabetes

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Abstract
This paper postulates that fat intolerance is a widespread metabolic disorder characterized by impairment of glucose tolerance caused by excess dietary fat intake, and cured in most cases by the fat-free diet as defined in this paper. Fat intolerance may present as flatulent dyspepsia, surgical disease or disorder in the biliary tract, peptic ulcertion, diarrhoea associated with spasm or diverticular disease of the colon or colitis, or as maturity-onset diabetes mellitus; one, two, or more of these syndromes may occur at the same or different times in the same patient. The dietary fat intake and the effect of the fat-free diet in each of these syndromes have been investigated, and the findings and their implications are discussed. Treatment of disease and disorder in the biliary tract by sphincterotomy of the sphincter of Oddi in a series of 57 cases and of duodenal ulcer by pyloroplasty alone in 50 cases is reported. The results of treatment of duodenal ulcer by pyloroplasty alone in a series of 38 cases are compared with those after vagotomy and pyloroplasty in a similar series of 38 cases. Cure of peptic ulceration by pyloroplasty alone is reported, and vagotomy is considered to be unnecessary. The normal pylorus is defined, and the naked-eye appearances of the pylorus observed during 87 cholecystectomies are reported. The significance of these observations and of radiological abnormalities seen in routine barium-meal examinations of cases of disease or disorder in the biliary tract is discussed. Evidence is presented that the function of and pathological changes in the sphincter of Oddi and the pylorus are affected by the dietary fat intake and determine the absence or presence of abnormality in the biliary tract or of peptic ulceration respectively. The clinical syndromes of fat-intolerant diarrhoea and its association with spasm of the colon, colitis, and diverticulitis, and of abdominal pain due to fat intolerance seen in a series of 17 children, are described as clinical entities. The effect of the fat-free diet on glucose tolerance has been investigated in a series of 65 patients, and the significance of the increased tolerance observed has been assessed statistically. Four hundred and thirty-three glucose-tolerance tests have been performed to assess the change in glucose tolerance in 134 patients who had been on the fat-free diet for periods of 3 months to 2 years as treatment for dyspepsia due to disease or disorder of the biliary tract, peptic ulceration, diarrhoea associated with spasm of the colon, diverticulitis or colitis, obesity, and migraine. Among these patients were 23 who also suffered from diabetes mellitus. Cure of maturityonset diabetes mellitus by the fat-free diet is reported, and evidence is produced to show that it is an acquired abnormality of the metabolism caused by excess dietary fat intake.