Lives of the fellows

Kenneth Willoughby Heaton

b.3 August 1936 d.4 March 2013
MB BChir Cantab(1961) MRCP(1963) MD(1968) FRCP(1974)

Ken Heaton was reader in medicine at the University of Bristol. He was born in Shillong, Assam, India, where his father, Philip John Heaton, was working as a missionary. His mother was Anna Ingeborg Heaton née Stenberg. He was educated at Marlborough, then went up to Cambridge, where he gained a BA with first class honours in the natural sciences tripos. Proceeding to clinical studies at the Middlesex Hospital and Central Middlesex Hospital, he was inspired by such physicians as George Hadley [Munk’s Roll, Vol.VIII, p.203], Richard Asher [Munk’s Roll, Vol.VI, p.16] and Francis Avery Jones [Munk’s Roll, Vol.XII, web]. At one of Avery Jones’ teaching rounds, Ken was asked to examine the ankle of a fellow student, Susan O’Connor. This went well, and Ken and Sue were married in 1961, the year they both qualified.

After pre-registration house officer posts, Ken was appointed to the post of medical registrar at the Royal Free Hospital, and then moved to a further medical registrar post at Bristol Royal Infirmary with Alan Read [Munk’s Roll, Vol.IX, p.440]. During this time he spent a year as a research fellow at Duke University Medical Center, North Carolina.

Ken’s research interests began to blossom during these years between 1965 and 1968. While at Duke, he studied bile salts, and continued with this interest for some years. However, another topic had already begun to assume an increasingly important influence on Ken’s thinking. He had become an enthusiastic convert to the ideas of Peter Cleave [Munk’s Roll, Vol.VII, p101]. Cleave had suggested that many of the diseases seen in Western countries (such as heart disease, diabetes, obesity, tooth caries and colonic disorders) were due to the consumption of highly over-refined processed food, for which the human gastrointestinal tract had not evolved, and for which it is not adapted.

After returning to Bristol, Ken was promoted to a post of lecturer in medicine at the University of Bristol, then in 1972 to consultant senior lecturer. Numerous publications on bile salts and gallstones were produced by him at this time, including a monograph Bile salts in health and disease (Edinburgh, Churchill Livingstone, 1972). Postgraduate colleagues came in numbers to work with Ken, to gain experience in research techniques and in writing scientific papers.

Ken thought deeply about the implications of the Cleave hypothesis. There were two different aspects of the food refining process. On the one hand, the refining process removes much of the fibre from food, and on the other hand there is concentration of carbohydrate in the form of white flour and sugar. Refined food is easier to eat, so more tends to be eaten, leading to excess calorie intake. He devised a simple demonstration of the effects of the refining process, by comparing the results of eating whole apples, pulped apples or apple juice. Increasing refinement led to decreased feelings of satiety and more rapid absorption of sugars and a greater insulin response.

It proved a relatively simple matter to study the effects of adding fibre in the form of bran to the diet of volunteers, by measuring intestinal transit times. Next, patients with irritable bowel syndrome were studied and many were found to have slow intestinal transit, which speeded up with dietary supplementation with bran, with a corresponding improvement in their symptoms. This led to a number of studies on irritable bowel syndrome, a common and troublesome disorder of bowel function. At this time (in the 1970s) many patients attended gastroenterology or surgical clinics with symptoms of abdominal pain and variable bowel habit, and the diagnosis of irritable bowel syndrome was made after a series of tests (typically blood tests and barium enema X-rays) had been done and shown to be normal. With his research colleagues, Adrian Manning and Grant Thompson, Ken produced a landmark paper ‘Towards positive diagnosis of the irritable bowel’ (Br Med J. 1978 Sep 2;2[6138]:653-4), showing that a confident diagnosis could be made on the basis of symptoms alone. This study had a global effect, leading to the development of the Rome Criteria for the diagnosis of irritable bowel syndrome. Many further studies were carried out by Ken and his research colleagues, one in particular bringing widespread publicity. The paper ‘Stool form scale as a useful guide to intestinal transit time’ (Scand J Gastroenterol. 1997 Sep;32[9]:920-4) with Steve Lewis was based on a simple observation that the appearance of stools was dependent on the length of time that they had spent in the colon. The resulting Bristol Stool Form Scale, with its accompanying illustrations, has become a widely used practical guide to the assessment of intestinal transit time, avoiding the need for any further tests. Slow colonic transit was shown to affect metabolism of bile salts and oestrogens in such a way as to tend to increase the likelihood of developing gallstones and theoretically even breast cancer.

By 1985, the Cleave hypothesis had become generally accepted, and Ken marked this by editing (with fellow-protagonists Hugh Trowell [Munk’s Roll, Vol.IX, p.533] and Denis Burkitt) a comprehensive 26-chapter book Dietary fibre, fibre-depleted foods and disease (London, Academic).

As well as mentoring a long succession of postgraduate researchers (many of whom became lifelong friends) from all over the world, Ken was a stimulating teacher of undergraduates, and for many years supervised the University of Bristol final MB clinical examination, often, with Sue, entertaining the other examiners with a garden party at his home in Claverham. He was promoted to reader in medicine, though (unaccountably to many people) never to a personal chair.

Outside medicine, Ken had many interests. He had a very happy family life with his wife, Sue, and their three children, Jenny, Philip and John. They lived in a splendid but slightly decaying country house in Claverham, 10 miles south west of Bristol, with a large garden (tended by Sue) and a large lawn (cut by Ken). He loved music, and sang regularly in a choir. He was extremely well read, and became an expert on Shakespeare. In a mammoth project, he read all 42 major works of Shakespeare, looking at Shakespeare’s descriptions of the psychosomatic symptoms experienced by his characters when under stress, the findings being published as papers and a thesis in 2012, the year before his untimely death.

R F Harvey

[BMJ 2013 347 4306; University of Bristol News Dr Kenneth Heaton, 1936-2013 www.bristol.ac.uk/news/2013/9601.html – accessed 23 September 2014]

(Volume XII, page web)

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