I am sure many readers will be familiar with the “trial” of Professor Tim Noakes by the Health Professions Council of South Africa (HPCSA), which has just been completed. Essentially Noakes has been accused of various aspects of misconduct on the grounds that he has advocated the benefits of diets low in carbohydrates and high in fat (LCHF). Anyone who would like to learn more about the background, details of the various sessions and the implications should refer to the numerous blogs by Marika Sboros that provide comprehensive coverage (1). Suffice it to say that Noakes was completely vindicated by the verdict. He and his supporters had presented a very powerful case to justify his stance and in addition had demonstrated convincingly that the evidence base used to formulate conventional dietary recommendations is full of holes.
By contrast the HPCSA position was extremely weak and the legal team struggled to find credible experts to support their case, was effectively demolished by the defence advocates.
After such an overwhelming defeat, one would expect that any reasonable individuals would accept the result and adjust their position. But not a bit of it. As Marika explains, the approach adopted by the Association for Dietetics in South Africa (ADSA) seems to be to carry on as though nothing has changed (2). The ADSA President Maryke Gallagher has made it clear that dietitians will continue to base on their advice on the official recommendations that promote diets, which are low in fat and high in carbohydrates (LFHC). Even more bizarre, the HPCSA has decided to appeal the verdict. How on earth can anyone understand this attitude? Clearly the advice has to be based on an evaluation of the relevant science. The “trial” has been the first time that the available evidence has been subject to a thorough, independent and objective assessment. The various other exercises have been fundamentally flawed because of conflicts of interests, which mean that they are invalid. As most of those involved are would profess to be scientists, we have to ask: “Why are they so intransigent?”
To anyone looking at the issues dispassionately, there are compelling arguments that an LCHF diet is consistent with good health and that the allegations that it is dangerous to health are groundless. Similarly, the dangers of a diet high in sugar and carbohydrates for many are well-founded.
I have struggled to come to terms with what appears to be irrational and alien to a genuinely scientific approach. In a totally different context, my colleague, Richard North, has proposed the term “constructive ignorance” to describe this type of behaviour. Here is how he defines it:
“There was a time – a long time ago – when I thought that information was the antidote to ignorance. All I had to do, I thought, was to get to the right people and tell them what they needed to know – the correct information – and all would be well with the world. Only latterly did I identify what I came to call “constructive ignorance”, after “constructive dismissal”, where people quite deliberately foster a state of ignorance. Largely, I surmised, they have adopted their narratives and need to protect them with a wall of ignorance. Otherwise, they crumble under the assault of facts, and their holders are faced with the inconvenience of having to rebuild them.” (3).
All of this seems to be a very apt description of those who were responsible allegations made against Noakes. It seems that their views have become a part of their personality. Any criticism of these views is regarded as an attack on their character. As described above, they would “crumble” and then have to “rebuild”. Yet the reality is that a genuine scientist would expect to have to do this regularly. Applying the scientific method means that we are continually attempting to break down hypotheses. So when we find that this happens, we have discard it and devise a new one. This must apply just as much to the practitioners as it does to those who are the sharp end of the research.
Much nutrition and medical knowledge is wrong
It is not unusual for new undergraduates to be told at an introductory lecture that half of what they will learn while studying is WRONG, but the problem is that the teachers do not know which half that is. It follows automatically that graduates should be constantly re-assessing their knowledge. It is inevitable that new evidence and ideas will emerge, which makes it clear some of their “facts” are faulty. Hence adjustments have to be made.
Unfortunately there are many who successfully graduate and then go on to professional careers but completely disregard this advice. However I do appreciate that there are some who were never given the advice in the first place. Nevertheless the fact remains that new knowledge and concepts are arising all the time. As a consequence, existing positions have to be re-evaluated and altered. It is also essential to determine if policies and strategies are working effectively. If they are not, perhaps the original rationale used to devise them has been faulty. Unfortunately this rarely is acknowledged in the field of human nutrition. The classic example is Type 2 Diabetes (T2D) where despite overwhelming evidence that the conventional advice is not working. Essentially this is to reduce the consumption of fat and increase that of complex carbohydrates. Despite the mass of research and the thousands of individual case histories that this makes the condition worse, the authorities persist with the same old policies.
It is highly relevant to contrast this with the field of animal nutrition. Because farmers and researchers have tight control over what farm animals are fed and the production such as milk or eggs is carefully monitored, it soon becomes evident if things are working or not. As we all know only too well, this does not happen with humans, which makes it very easy to find excuses for why some nutrition strategy is a failure.
Another useful analogy is with engineering projects. If a building falls down or an engine blows up, then there is an investigation to find out what was the actual cause so that steps can be taken to prevent a repeat. There is no hiding place for whoever was responsible for the mistake in the first place. It is therefore unfortunate that although millions of people are adversely affected by inappropriate dietary advice, there is unlikely to be a catastrophic disaster (like Grenfell Tower) that would force the authorities to take action. However make no mistake, the human impact is undoubtedly very much greater.
The attitude of those who have persecuted Professor Tim Noakes is completely unacceptable. It really is time that those in the field of human nutrition showed a degree of open-mindedness and humility.