This trial has finally concluded and Professor Tim Noakes has been totally vindicated by the panel that was set up to deliver the verdict. To any impartial observer who was following the various twists and turns over the past three years this conclusion was inevitable because the “prosecution” case was pathetic while the defence was absolutely rock solid. In particular, it provided very convincing evidence to show that a diet low in carbohydrates and high in healthy fats (LCHF) is consistent with good health and a low risk of developing chronic diseases, especially Type 2 Diabetes (T2D). It is over a year since I posted this blog, which explains the background. However for a much more detailed explanation of these events, which will take you right up-to-date, I recommend the excellent website of Marika Sboros at http://foodmed.net/
Marika has been present at all the sessions and provided a stream of tweets so that a world-wide audience was able to follow the proceedings. She did an amazing job, which many people found invaluable.
Tim Noakes is Emeritus Professor at the University of Cape Town where he had a distinguished career in Sports Science and established a world-wide reputation. He has made many notable contributions to research in this field. Even more significantly he has been actively involved in a number of campaigns to alter policies by companies and organisations which were having a damaging impact on the health of those competing in different sports. These are described in his book “Challenging Beliefs: Memoirs of a Career” (1). One example is “dehydration” which was portrayed as a serious risk to long distance runners and was the basis for the promotion of a range of branded drinks, including Gatorade. Runners were encouraged to drink as much as possible in order to prevent dehydration and ensure that any threat to health was prevented. However as research conducted by Professor Noakes demonstrated there is genuine risk that those who drink excessively will develop a condition of low blood sodium concentration which is referred to as Exercise Associated Hyponatraemia (EAH). In extreme cases, the cells in the brain are permanently damaged and therefore death is inevitable.
Regrettably the sports drink industry was not prepared to accept the implications of these findings. Instead Gatorade funded scientific research with the specific objective of producing results which raise questions about the validity of the Noakes conclusions. The company also sponsored the American College of Sports Medicine (ACSM) which produced drinking guidelines in 1987 and 1996 which were extremely beneficial to Gatorade. Even more sinister, scientists funded by Gatorade exerted influence on the editorial boards of many of the leading publications in exercise sciences. As a consequence, it was very difficult to publish any results which were in conflict with the official Gatorade Line. Here is a quote from “Challenging Beliefs”:
“That was certainly my experience—most of the papers we submitted to those journals controlled by the Gatorade group thinkers were returned smartly, usually with antagonistic reviews informing us that we had no idea how the body works during exercise in the heat, or how much athletes should drink during exercise in the heat.”
Although the campaign against Gatorade began in the early 1990s it was not until 2007 that the ACSM finally made the appropriate changes to drinking guidelines. It is interesting to note that the US Military took action in 1998. By December 2010, Prof Noakes had obtained information about 1,660 cases of EAH of which 12 were fatal.
In 2010 Prof Noakes was concerned about his personal health and discovered that he had developed T2D. This had happened despite the fact that he was physically fit, being an active runner himself, and had been following the conventional dietary guidelines which recommended limiting the consumption of saturated fat (SFA) and eating plenty of complex carbohydrate-containing foods. He decided to examine the relevant research and much to his surprise reached the conclusion that his T2D was almost certainly caused by the consumption of excess carbohydrates. Further investigations convinced him that the existing dietary guidelines were fundamentally flawed. At this point he made his views public and significantly admitted that as an advocate of the guidelines he had got things wrong in the past. He continued to express his opinion. In 2014 in collaboration with several colleagues he published “The Real Meal Revolution” (2) which explained the rationale which justified his revised stance on the dietary guidelines and presented the scientific case for a LCHF. The book itself is a marvellous compendium of the basic science, dietary advice and illustrated dishes/recipes which comply with LCHF guidelines. The science and nutrition is explained clearly and concisely. The rationale which underpins the case for a diet which is LCHF comes across clearly and logically. But what really makes a difference is the absolutely stunning photographs of attractive dishes that are truly mouth-watering. It is no surprise that the book has been a best-seller for over 20 weeks in South Africa. Total sales are well over 100,000. There is not the slightest doubt that the impact has been enormous.
On the other hand, there has been an enormous backlash from many scientists and health professionals who seem to regard the official conventional guidelines as sacrosanct. For example, in August 2014, Prof Noakes received a highly critical letter from his academic colleagues in the University of Cape Town: Prof Wim de Villiers Dean of Faculty of Health Sciences, Prof Bongani Mayosi, Head of Department of Medicine, and emeritus professor, cardiologist Dr. Lionel Opie, and Dr. Marjanne Senekal, associate professor and Head of Division of Human Nutrition. Here are some extracts from the letter:
- “Currently the long term safety and health benefits of low carbohydrate, high fat diets – such as Atkins, Paleo and South Beach, and in which Banting falls – are unproven, and in particular whether it is safe in pregnancy and childhood.”
- “There is good reason for concern that this diet may rather result in nutritional deficiencies, increased risk for heart disease, diabetes mellitus, kidney problems, constipation, certain cancers and excessive iron stores in some individuals in the long term.”
- “Diets like the Banting are, however, typically ‘one dimensional’ in focus. They promote increased intake of protein and fat containing foods at the expense of healthy carbohydrate containing foods, and focus on adherence to a limited food plan.”
- “It is therefore a serious concern that Professor Timothy Noakes, a colleague respected for his research in sports science, is aggressively promoting this diet as a ‘revolution’, making outrageous unproven claims about disease prevention.” (3).
Needless to say, these allegations are essentially baseless and all were absolutely demolished by Prof Noakes in his presentation at the Low Carb Summit in Cape Town in February 2015
In February 2014, Claire Julsing Strydom, who was president of the Association of Dietetics in South Africa (ADSA) made a complaint to the Health Professions Council of South Africa (HPCSA) about a tweet by Prof Noakes which suggested to a breast-feeding mother that she should wean her infant on to a diet which was LCHF (4). The apparent allegation was that this was “unprofessional conduct”.
Here is the actual tweet:
To any rational person, it is difficult to see anything objectionable about this tweet but the complaint was the start of a saga which has yet to reach a conclusion.
Apparently what upset the president of ADSA was the advice to have a diet which was low in carbohydrates and high in fat. It is standard practice for the dietitians to advocate a diet which contains a substantial amount of carbohydrates.
What is unbelievable is that the HPCSA took this complaint seriously and arranged for a hearing at which the charges would be considered.
The initial hearing was planned for June 2015 but never got off the ground because the judging panel was not properly constituted. It eventually started in November 2015 when the case against Prof Noakes was presented. It was adjourned until February 2016 when he finally had the opportunity to answer the charges against him. After 5 days in the witness box, the hearing again adjourned. It will resume later this year in October.
This hearing has all the hallmarks of an Inquisition. The case against Prof Noakes has been an absolute shambles and his legal team, which is acting pro bono, has made mincemeat out of the expert witnesses. They have demonstrated appalling ignorance and seem to rely on assertions and dubious science to construct any kind of viable case.
My purpose here is simply to alert everyone interested to these events in South Africa. Those who wish to find out more information about what exactly has been happening should read the excellent articles by Marika Sboros which can be accessed from the link in this reference (6). I also must commend Marika who has attended every session and reported the key points in a series of tweets which provided a running commentary to a world-wide audience. These can be accessed on Twitter@MarikaSboros
The significance of these hearings cannot be over-estimated. This is a crucial issue which has ramifications for the global community. There is absolutely no doubt now that the dietary guidelines which were formulated in the USA in the 1970s are fundamentally WRONG! The advice to reduce the intake of healthy SFAs and increase the consumption of complex carbohydrates is one of the primary reasons why T2D and obesity are so damaging to public health. Unfortunately because the World Health Organisation and many national nutrition policies took the lead from the Americans this has become a world-wide issue. As a consequence, millions, if not billions, of people are suffering severe disablement and are dying prematurely.
Achieving a change which will effectively reverse the recommendations will be extremely difficult. The food and pharmaceutical industries benefit enormously from the status quo. ADSA receives substantial sums of money from a number of multi-national food companies and there are suspicions that some of these were instrumental in pushing for the charges against Prof Noakes to be actioned. What is undoubtedly true is that the widespread acceptance of LCHF would cause a reduction in the sales of many food products that are currently very profitable. As sugar sweetened beverages are a major source of dietary sugar, it is evident that LCHF represents a significant threat to these products. There are reports that Coca-Cola has paid millions of pounds to British scientific research and healthy eating initiatives to counter the claim that its drinks cause obesity (7).
The “cholesterol theory” is a key plank in the official dietary recommendations, specifically to reduce the SFAs and increase the polyunsaturates (PUFAs). It is also fundamental to the case used by the pharmaceutical industry to justify the use of statins. But this has been completely discredited by a number of robust studies. Nevertheless both food and pharmacy companies continue to defend it with vigour because it so crucial to current business strategies.
The other big hurdle is the fact that so many researchers and academics are convinced their reputation will be tarnished if the current policies are overturned. There are few with the confidence and integrity of Prof Noakes to announce publicly they have been wrong in the past and as a consequence have had to change their stance. Instead, as the letter above demonstrates so aptly, they defend their position with the tenacity of a religious zealot. Even worse they launch unreasonable hysterical attacks on those who attempt to put things right.
There is no doubt that the events in Cape Town are just one battle in the war to re-draft official nutrition policies around the globe. In the last 5 days of the hearing, Prof Noakes has provided a comprehensive demolition of the rationale which underpins these policies. If he is finally cleared of these ridiculous charges it will represent an important step forward.
It is evident that it is not enough to present a case which is constructed on sound science. As Gallileo discovered anyone who attempts to change an established way of thinking will be faced with very powerful forces which will use every trick in the book to defend what is perceived as a serious threat.
It would have been easy for Prof Noakes to walk away from this by simply declaring that he no longer practices as an MD. However he chose to face up to the challenge in the hope that the allegations cannot be sustained. He deserves tremendous thanks for doing so and hopefully he will be fully vindicated. He certainly has a distinguished track record, which is a convincing reason for believing he will be successful when the verdict is reached.
- T Noakes with M Vlismas (2012) “Challenging Beliefs: Memoirs of a Career” Zebra Press Cape Town ISBN 978 1 77022 459 9
- T Noakes, S-A Creed, J Proudfoot & D Grier (2014) “The Real Meal Revolution: Changing the World, One Meal at a Time” Quivertree Publications (Original South Africa edition)