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UPDATED: Forget the bull. Cape Town sports scientist Prof Tim Noakes is a red rag to a viper. He continues to extract almost unbelievable venom for changing his mind on carbo-loading four years ago, and for supporting the compelling science that has made low-carb, high-fat (LCHF) eating a global phenomenon, and for developing his LCHF diet (aka ‘Banting’ as it is also known, though not strictly correctly). Noakes attracted even more venom as a co-host of the Old Mutual Health Convention, a gathering of 15 of the world’s top LCHF experts at the Cape Town International Conference Centre from February 19 to 22. He is also facing a charge of ‘unprofessional conduct’ after dietitians reported him to the Health Professions Council of SA – for tweeting his opinion that the best weaning foods for infants are meat and veg.
In this Q&A session, Noakes answers his critics – with relish. MS
By Marika Sboros
Criticisms of Cape Town scientist Prof Tim Noakes are limited only by the imagination, and aimed as much at him personally as professionally.
At best, he is called “misguided”, at worst, a killer quack who “flouts the Hippocratic oath”. His low-carbohydrate, high-fat (LCHF) diet is regularly labeled “bad science”, “dangerous” and “criminal”. (For the fundamentals of his diet, and how to get started on it, read my Complete Idiot’s Guide to Tim Noakes Diet. )
Attacks on him intensified in July last year with publication of the “Stellenbosch review”, a meta-analysis of 19 international studies, led by Dr Celeste Naude of Stellenbosch University’s Centre for Evidence-based Medicine, in PLoS (Public Library of Science) One on July 10. An expert army of cardiologists, endocrinologists, epidemiologists, the Heart and Stroke Foundation of SA, the Association of Dietetics of SA, and the Health Professions Council of SA quickly rallied to claim it as proof that Noakes’s diet doesn’t work, and can kill.
Next, top UCT academics wrote a letter to a Cape newspaper accusing Noakes of “outrageous, unproven claims about disease prevention”. Signed by 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, of the Division of Human Nutrition, the missive attacked Noakes for “maligning the integrity and credibility of peers who criticise his diet for being evidence-deficient and not conforming to the tenets of good and responsible science”.
Noakes, professor of exercise and sports science and director of UCT’s Research Unit for Exercise Science and Sports Medicine, wrote to the university, pointing out that the letter was defamatory, and there is solid science behind his diet, for those willing to see it. Ditto for The Real Meal Revolution , although the book’s runaway success serves only to infuriate critics. With word-of-mouth advertising only. In the first six months after publication in December 2013, it sold more 100 000 copies, making it South Africa’s bestseller ever. (All his R500 000 profits so far have gone to the Tim Noakes Foundation set up to research nutrition and challenge scientific dogma.)
Ironically, everything Noakes writes in the book is in Time magazine’s cover story on June 12 2014. That puts him ahead of Time, and creates something of an inconvenient truth for critics – how to prove him wrong when Time says science proves him right.
Also last year, a South African Sunday newspaper reported that Noakes had “changed his mind again” on “Banting”, in particular, on the role of dairy foods – cream and yoghurt – in his diet. He hadn’t done anything of the sort. He made that clear to the author of the report in emailed correspondence, yet the newspaper went ahead anyway, choosing not to let the facts interfere with a “good” story. The paper also gave Noakes its ultimate insult: “mampara” (idiot) of the week.
So what’s really behind attacks on Noakes, a medical doctor and a scientist rated A1 by the National Research Foundation, whose areas of expertise include both nutrition and weight loss? Why is he regularly misquoted in media, even by reputable journalists who don’t bother to speak to him?
He has probably just learned the hard way about the consequences of going against prevailing medical orthodoxy.
In this Q&A session, I put some of the criticisms to him:
Does the “Stellenbosch review” prove your diet doesn’t work?
No. The researchers have no clue. Their study is flawed. They ignore published research that contradicts their findings, and they haven’t reviewed low-carb studies. They think a low-carb diet provides 200g or more carbs – up to eight times as much as we propose at 60g.
Why so low in carbs?
There is a critical threshold for carb intake, below which you get massive benefits, above which you don’t. Orthodox dietitians don’t understand that. That’s why their advice on weight loss fails.
Is your “Noakes diet” just another high-protein “Atkins” in disguise?
No. Some people don’t read what I say; they make up their mind, then fit what they think I’ve said into it. It is high-fat, low-carb, and moderate-protein only. The diet can be ketogenic, but doesn’t have to be.
What’s a ketogenic diet?
One so low in carbohydrate and protein (protein will act as a partial carbohydrate), and high in fat, it causes blood ketones to rise.
What’s a ketone?
A natural product of the liver in response to a low-carb diet. Instead of burning glucose, the brain cleverly decides: let’s burn ketone bodies. Ketones are probably the most efficient body fuel.
When should a diet be ketogenic?
It depends. The sicker you are, the more ketogenic you need to be. If you just want to lose weight, or run better, your diet doesn’t have to be ketogenic.
What changed your mind about carbo-loading?
I discovered the work of (Eric) Westman, (Jeff) Volek and (Stephen) Phinney that had been suppressed, as described in The Big Fat Surprise, by Nina Teicholz. It’s no surprise I hadn’t seen it – I didn’t realise the degree of suppression. Those scientists are now friends of mine. The book opened my eyes.
What was wrong with my health: I was insulin resistant and eating a high-carb diet before I started a high-fat diet. The diagnosis of diabetes could have been made then, but I’m my own doctor – the worst thing. I didn’t want to believe evidence for my diabetes, but it was there all along.
You were diagnosed diabetic three months into your diet. Critics say that proves your diet doesn’t work, and caused your diabetes?
That’s unbelievable logic: if you do one thing – eat a high-carb diet for 33 years – then change it for three months, what you did for the previous 396 months is irrelevant. In other words, the diabetes epidemic is from everyone across the world suddenly eating high-fat diets. So, let’s get back to facts: my father died of Type 2 diabetes which puts me at a 10-fold increased risk. Unfortunately, for 33 years, I followed Diabetes Association guidelines that said as long as I exercised and ate a high-carb diet, I’d never get diabetes. They were very, very wrong.
Your critics say you take medication for diabetes, which proves your diet doesn’t work. Do they have a point?
No. I had to face facts. I thought I could get by without medication. I spoke to specialists I trust internationally, who confirmed the diagnosis of diabetes, and said I should take medication. If I was being treated conventionally, but still eating my high-fat diet, I probably could get by without medication, but I want perfect control. I want my glucose to be as good as anyone without diabetes. I’m nearly there.
Critics, including the UCT academics, say there’s no science behind your diet, only anecdote. Is that correct?
No. Science is my lifeblood. I understand the scientific method better than 99.9% of my critics, especially the ones who spread this garbage. All of medicine begins with anecdote. Jenner started the vaccination theory based on anecdote. Scientists determine the truth on the basis of clinical trials, personal experience, and what patients tell us. None is more important than the other.
Is there proper gold-standard evidence for your diet?
Yes. The first year after I made dietary changes, I didn’t know enough to make definitive statements. I’ve been reading the literature since – everything on both sides. I focused on the high-fat diet; turns out there is solid evidence in favour of it, and none, absolutely none, in favour of the low-fat diet. The evidence for high fat has been suppressed, but has been accumulating; it’s all there, in The Big Fat Surprise.
Do you endorse all protein as good on your diet?
No. The Real Meal Revolution is about real food, not processed in any way. People need to read the green list in the book. It talks about real meats and dairy products from pasture-fed animals and that are not highly processed.
Are you a fan of fruit and veg?
Yes and no. The idea that fruit and vegetables are healthy is commercially driven, and can be traced back to the industry in 1995 that promoted the 5-a-day idea without any good science. On the green list, we promote lots of amazing vegetables that are high in nutrients, low in carbohydrates, such as leafy vegetables, broccoli, cauliflower and kale, and give you all the fibre you need.
One media report says the only fruit you eat is apples?
I’ve never said that. I never eat apples, only eat berries – they have the least sugar and most nutrition.
Your diet’s high saturated-fat content gets most up expert noses. UCT cardiology professor Lionel Opie, Wits University endocrinology professor Derick Raal, and the Heart Foundation say there’s proof saturated fat causes heart disease. Raal says your diet risks killing some people. Who’s right?
No one has ever proven cholesterol in the blood causes heart disease. It’s an unproven hypothesis, an assumption based on epidemiology, and destroyed by Nina Teicholz inThe Big Fat Surprise. I would like to know which studies prove it, because Nina shows there aren’t any. Oxidised cholesterol is the problem, but isn’t measured when patients are advised on diet.
Could your diet kill, as Johannesburg cardiologist Dr Anthony Dalby claims?
No, because saturated fat has nothing to do with heart disease. If the Heart Foundation, the Stellenbosch researchers, dietitians and others who say it does, want to be scientific and credible, they should acknowledge there’s no evidence. Eventually they’ll have to admit they are wrong, that taking fat out of the diet and replacing it with sugar has caused the obesity epidemic. The Heart Foundation in particular is accountable; the longer it takes to acknowledge the evidence, the worse the repercussions, including unnecessary deaths, over time.
Do you claim your diet cures heart disease?
No. I claim it is curative for metabolic syndrome that ups the risk of chronic disease, including diabetes and heart disease). If you have the syndrome, and cut out carbs, you’ll go into remission, because you reduce all the risk factors, including hypertension, high blood glucose, high blood triglycerides, but more importantly the small dense LDL cholesterol particles in the blood, and inflammation.
Do you say your diet is right for everyone?
I’ve never said that. What I have said is: it will benefit you, if you are insulin resistant, and in my view, most people are these days. I also say if you avoid processed foods, focus on fats, and eat real food from the greenlist (in The Real Meal Revolution), your health will benefit. I’ve never said it any other way.
Why are so many people insulin resistant?
Probably an evolutionary adaptation that had biological value – people with the genes were more likely to survive. The genes have always been there. The negative consequences were not expressed until the introduction of high-carb foods, highly processed and laden with sugar. That turned insulin resistance into an epidemic of obesity and diabetes.
In a UCT debate with you, epidemiologist Prof Jacques Rossouw, at the US National Heart, Lung, and Blood, supports the diet-heart disease hypothesis, and statins, which you call the “most ineffective drugs ever invented”. Does Rossouw have any points?
This is a man who has spent $700 million of American taxpayers’ money in a clinical trial lasting eight years, and proving that cutting fat from the diet had no beneficial effect whatsoever on the health of post-menopausal women. I was the first to show, and publish in the SAMJ (November 2013), that his own data showed that women with established heart disease, who reduced their fat intake, were more likely to suffer subsequent heart attacks than women with heart disease who continued their conventional, higher-fat diet. He showed the same for patients with diabetes. Neither he nor anyone else was brave enough to admit to these inconvenient findings. If only a tiny fraction of the money he spent had been spent on studies of high-fat diets, we wouldn’t be having this debate.
Why do you say that?
When you spend that magnitude of other people’s money, and disprove your own deeply held dogmas, you should admit: “I was wrong. Reducing fat in your diet may make you worse.” It takes courage to say that. Instead, he says the opposite. That’s not science. It’s religion.
Dr Raal says your view of statins is “potentially life-threatening” statement for patients with familial hypercholesterolaemia who’ve had a heart attack or bypass surgery. Dr Dalby calls it “criminal”. Is it?
No. It’s criminal to prescribe drugs to people that they don’t need, and are shown to cause harm.
A dietitian told me one of her patients developed fatty liver disease after starting your diet. She says the woman probably had a predisposition, but your diet would have triggered it. Could it?
No. The dietitian clearly doesn’t know fatty liver disease is caused by excessive carbs, not dietary fat.
Do you say your diet cures cancer?
No. What I have said is cancer is a carbohydrate-driven disease. Cancer cells are proven to be utterly glucose dependent. Some cancers can get their glucose from protein, but cancer cells have to get glucose from somewhere.
Is that your opinion?
No. It’s in the work of (German physiologist and medical doctor) Otto Warburg who won the 1931 Nobel Prize of physiology and medicine. We just kind of forgot that, because cancer research went in a completely different direction.
We invested billions of dollars into drugs to kill cancer cells. Scientists who got it wrong have driven the research, but won’t admit it. They plod along, trying to cure cancer according to a model that clearly doesn’t work.
Is there support for your view that the model doesn’t work?
Yes, world authorities, including Dr Craig Thompson of the Memorial Sloan Kettering Cancer Centre. In a YouTube video of a 2011 talk on cancer, he says in effect: “If I encourage you to eat a high-fat diet, it won’t change your cancer risk one iota. If I encourage you to eat carbohydrates, it will.”
What’s the future of cancer research?
Scientists must realise cancer is a nutritional, carbohydrate-dependent disease, and need to work out ways to starve cancer cells of glucose. The person who does that will win the Nobel Prize.
What’s really behind the attacks on you?
It goes to the core of medical practice, and threatens massive industries. We are being manipulated and controlled – by governments, the pharmaceutical industry, the food industry – to believe one way. The current pharmacological model has taken over medicine, allows patients to get sick, and only then treats them with one or other chemical. It’s a model that clearly doesn’t work, because it doesn’t try to understand what first caused disease. Without that knowledge, medicine is powerless to prevent disease. This model makes us doctors of disease, not health. I have no respect for doctors who dismiss the nutritional approach to disease prevention without even reading the literature. I came into medicine wanting to cure patients, but that’s not what it’s all about.
What’s your message:
Poor nutrition is the single greatest driver of chronic ill health. We’re fat because we eat too much addictive high-carb food, not because we eat too much fat and exercise too little. The food industry is committed to making profits, not promoting health living. It doesn’t care that their addictive, processed foods cause heart disease, obesity and diabetes. Until we recognise that, our profession can’t reverse the crippling burden of chronic ill health caused by these nutritionally based diseases. It takes courage to refute the commitment of medical fraternities and governments to the saturated-fat theory. Future generations of people will continue to avoid saturated fat and suffer health consequences, because those who are part of that Establishment are too scared to admit they’re wrong, and the diet-heart theory is disproven dogma.
A final word?
We humans are the only mammals that suffer from chronic ill health. One critic suggests it’s because we are the only animals clever enough to manufacture our own food – and stupid enough to eat it.
- This column is continually updated since first publication, to include recent criticisms of Prof Noakes
- Prof Jacques Rossouw was invited to respond via email when this article was first published, but did not respond.