How Banting began – Tim Noakes on history, hope and high-fat

It has been billed as a world-first, a unique health summit and stellar gathering of  low-carb, high-fat (LCHF, aka Banting) nutrition scientists, doctors and researchers from around the globe under one roof at the Cape Town International Conference Centre from February 19 to 22. Speakers at the Old Mutual Health Convention will look at the science, the ongoing controversy, and what works and doesn’t work for nutrition in health and healing. In other words, how best food can be medicine, and medicine can be food, according to the injunction by the ancient Greek sage, Hippocrates.

Tim Noakes
Prof Tim Noakes

The high-fat summit’s host is Prof Tim Noakes, a South African medical doctor and internationally renowned scientist who has generated intense interest and just as intense criticism and visceral attack for changing his mind on the role of carbohydrates in the diet four years ago, in favour of low-carb, high-fat eating. Here, Noakes he gives the history behind the global LCHF movement, background to his own journey, the origins of the Cape Town meeting, background to the speakers, and what he hopes the Summit will achieve: ‘a statement that will be heard around the world’. – MS

By Timothy Noakes

The origins  of the Old Mutual Health Convention can be traced to William Banting and his monograph Letter on Corpulence first published in London in 1862. His was the first description of the successful reversal of (resistant) obesity with a reduced dietary carbohydrate intake.

William Banting
Corpulent British undertaker William Banting – after losing 50lbs!

Predictably William Banting’s book was not eagerly embraced by the medical profession in Britain. Attempts to have his idea published in the leading medical journal, the Lancet, were rebuffed. How possibly could a commoner know that which the medical profession did not? In time professional pressure forced the true creator of Banting’s low carbohydrate eating plan, Dr William Harvey, to write a book in which he stated that the benefits of his diet were not due to an increased fat content but were the result of its high protein composition.

Banting disagreed, stating that the key to his successful weight loss had been the higher fat content of Harvey’s original diet. It was left to German physician and Professor of Medicine at Gottingen University, Dr Wilhelm Ebstein, to publish the definitive description of the original low carbohydrate high fat diet in his 1884 monograph, Corpulence and its treatment on physiological principles. There he wrote:

“This property of fat to produce satiety more rapidly, to diminish the craving for food and abate the feeling of thirst, facilitates to an extraordinary degree the introduction of the modified diet…The permission to enjoy certain things, always of course in moderation, as for instance salmon, pate de foie gras and such like delicacies reconciles the corpulent gourmet to his other sacrifices (which) consist in the exclusion of carbohydrates. Sugar, sweets of all kinds, potatoes in every form I forbid unconditionally.

“The quantity of bread is limited at most to 3 to 3 1/2 oz. a day, and of vegetables I allow asparagus, spinach, the various kinds of cabbage and especially the leguminous, whose value as conveyers of albumen (protein)…is known to few. Of meats I exclude none, and the fat in the flesh I do not wish to be avoided, but on the contrary sought after. I permit bacon fat, fat roast pork and mutton, kidney fat, and when no other fat is at hand I recommend marrow to be added to the soup. I allow the sauces as well as the vegetables to be made juicy, as did Hippocrates, only for his sesam-oil I substitute butter.

 “In spite of all this it would be little to the point to say that I treat the corpulent with fat, whereas I simply vindicate the full claims to which fat is entitled as an article of food” (pp. 43-44).

The result was that when Sir William Osler published his revolutionary textbook, The Principles and Practices of Medicine, in 1892 – considered the first “evidence-based” modern medical manuscript – he included the following: “Many plans are now advised for the reduction of fat, the most important of which are those of Banting, Ebstein and Oertel … Ebstein recommends the use of fat and the rapid exclusion of the carbohydrates. The following is a an example of his dietary (etc)” (p. 1920).

Fad diets

Why is this information important? Because it shows that the carbohydrate-restricted or Harvey/Banting/Ebstein diet is the very first eating plan prescribed for the management of obesity by the world’s most eminent physician of his time. That relegates all subsequent diets prescribed for this purpose, including the modern “heart-healthy” low fat diet, to the status of “fads”, most especially since the cereals and grains promoted by this modern fad diet were first eaten by humans only in the last 2-12 000 years.

Surely it is time for us to acknowledge that a diet based on foods that humans and their ancestors did not eat for more than 99% of our time on earth must be a fad?

All this hidden knowledge raises the important question: Why has it taken 153 years since the publication of the first edition of Banting’s book for this, the first (self-proclaimed) “International Low-Carb Summit”  to be organised?

As a conventionally trained medical doctor, I knew nothing of Banting or Ebstein (other than the eponymously named cardiac abnormality, Ebstein’s anomaly, known to all doctors) until a few years ago. Then by serendipitous chance, I came across the book, The New Atkins for A New You written by Drs Eric Westman, Stephen Phinney and Jeff Volek.

At first I was appalled. How could these three supposedly serious scientists allow their names to be associated with Dr Robert Atkins, the madman who in the 1970s had encouraged us all to eat more saturated fat and less carbohydrate. How dare he! For, thanks to the wisdom of a range of authority figures including the United States Government, we who were properly educated “knew” that this advice could only kill us.

Crucial health message

Jeff Volek, Stephen Phinney
Prof Jeff Volek, left) and Prof Stephen Phinney. Picture courtesy of Ohio State University

But after reading a few pages of their book, I was suddenly less certain. I sensed that Drs Westman, Phinney and Volek were advancing a crucial health message, based on a body of hard science, of which I was completely ignorant. I soon decided to ignore my scepticism, ingrained by 40 years of medical “education” and put their advice to the test.

As they suggested, I embraced the idea that eating fat is a healthy choice, and removed carbohydrates from my diet. Despite my advanced age, within weeks I saw an improvement in my health, well-being and running ability that I can still only describe as astonishing. I knew then that I had to know more.

In time I came across Gary Taubes’s monumental works, Good Calories Bad Calories and Why We Get Fat, and discovered that like Drs Atkins, Westman, Phinney and Volek, Gary is one of the most important figures in the revival of the Banting/Ebstein legacy. In time I discovered that already in 2002 he had published an article in the New York Times entitled What if it has all been a big fat lie?

I was left with one overriding question: If this information has been in the medical literature since 1884, and if it helped me improve my health so dramatically, why is it not taught at medical schools across the globe? One goal of this LCHF health summit is to raise that inconvenient question.

But this summit did not come about because this Harvey/Banting/Ebstein/Atkins/Westman eating plan revolutionised my life.

Karen Thomson
LCHF Summit organiser Karen Thomson

Rather it began as the exclusive vision of Karen Thomson, granddaughter of the iconic Capetonian Professor Christiaan Barnard, the man whose team performed the first successful human heart transplant operation at Groote Schuur Hospital in Cape Town in December 1967 and whose actions inspired me to study medicine at the University of Cape Town.

Karen has heard me talk and had concluded that sugar addiction was an important factor driving her own dietary indiscretions. She adopted a sugar-free, low-carbohydrate diet with great success, even developing a novel intervention programme to treat sugar addiction in those struggling with obesity.

This in turn inspired her book Sugar Free: Freedom from Sugar & Carb Addiction, the launch of which will coincide with the opening of this summit.

Media skirmishes

Having seen the negative consequences of an unconstrained and relentless press interest in the affairs of the Barnard family, she wondered how she could support me in my own skirmishes with the South African media, my own profession and my University Faculty. Her preferred solution was to assemble the international purveyors of dietary truth in Cape Town for a ground-breaking meeting.

Without my knowledge, she invited the North American founding fathers of this meeting to attend: Dr Westman from Durham, North Carolina; Dr Jay Wortman from Alberta, Canada; Dr Phinney from Sacramento, California; and Jimmy Moore from Spartanburg, South Carolina. Without hesitation they all agreed. At first her vision was for a small meeting with just these four speakers.

At first I was uncertain whether or not she was crazy. But in August 2014, I travelled to Melbourne, Australia, and spoke at their Low-Carb Conference organised by Dr Rod Taylor, the doyen of the low-carb movement in the Antipodes, and who will attend our summit. From the warm public response generated by that meeting, I knew that my doubts identified me as the crazy one.

Zoe Harcombe
Zoe Harcombe

The result of that meeting was that another seven speakers – Dr Anne Childers from Lake Oswego, Oregon; Christine Cronau from Brisbane, Australia; Dr Andreas Eenfeldt from Stockholm, Sweden; Dr Gary Fettke from Launceston, Tasmania; Dr Aseem Malhotra from London; (soon to be PhD doctor), Zoe Harcombe from “the Welsh countryside”; and Dr Michael Eades from Little Rock, Arkansas, all spontaneously offered their services at their own cost, simply because they wished to be part of this historic event. But even then our line-up was not yet finalised.

In December on a visit to Cape Town to spend Christmas with his iconic father and Christiaan Barnard contemporary, Prof Sid Cywes, Prof Robert Cywes, now resident in West Palm Beach, Florida called to discuss his experiences using a low-carb diet in the treatment of morbid obesity in children in the US. It did not take long for us to agree that he too must speak at our Summit.

In  January our attention was directed to the internet and an intriguing lecture delivered by Dr Jason Fung from Toronto, Canada. I instantly knew that Dr Fung was an essential addition to our already stellar speaker line-up. But our good fortune had still not ended.

Wish fulfilled

At a dinner in Cape Town, by chance I met former owner and CEO of the Fleet Feet franchise in the US, Tom Raynor. In the course of the dinner, Tom leaned over and asked me: “If there was one additional person you would like to have at your summit, who would that be?” Without hesitation, I said: “That is easy. Gary Taubes (from Berkeley, California)”.

Tom responded “You have your wish. I will fund his attendance at your meeting”.

And so our list of most wanted speakers was complete with perhaps one exception: Nina Teicholz author of The Big Fat Surprise, the most important medical book since Good Calories Bad Calories, had expressed her extreme willingness to attend. But our invitation arrived a few hours after she had committed to other lectures in the US. She will be with us in spirit, if not in person.

Gary Taubes
Gary Taubes

As our list of astonishing speakers continued to lengthen, I finally broached the unmentionable issue that we had both ignored: “So Karen, now that we have all these great speakers, how are we ever going to find the millions that the conference will cost us?”

Karen’s Barnardesque response was: “Prof, you are always the one telling everyone to believe in the outcome. So you should just follow your own advice. Believe in the outcome. It will happen.”

And so of course it did. When we approached Old Mutual as the potential title sponsor,  we were received with unbridled enthusiasm by Dr Peter Bond and his team. Yes, they assured us, they would be the title sponsor of our summit, and would help us make it a very special event. The final part of the puzzle was in place.

What then do we wish to achieve with this LCHF summit? Simple. We wish to make a statement that will be heard around the world. That statement is this:

“The mainstream dietary advice that we are currently giving to the world has simply not worked. Instead, it is the opinion of the speakers at this summit that this incorrect nutritional advice is the immediate cause of the global obesity and diabetes epidemics. This advice has failed because it completely ignores the history of why and how human nutrition has developed over the past 3 million years.

“More importantly, it refuses to acknowledge the presence of insulin resistance (carbohydrate intolerance) as the single most prevalent biological state in modern humans. Persons with insulin resistance are at increased risk for developing a wide range of chronic medical conditions if they ingest a high carbohydrate diet for any length of time (decades).

Armed with this knowledge we have two choices. Either we can continue to ignore the evidence presented at this summit, and go on blaming the obese and diabetic for their sloth and gluttony (that is supposedly the sole cause of their obesity and diabetes). Or, if we are ever to reverse this epidemic that has become the greatest modern threat to human health, we need to admit that we have been wrong for the past 40 years, and must now change.

Road to change

So the choice is between continuing to apply a failed model to a growing global health crisis in the utterly irrational hope that what has not worked in the past will suddenly, miraculously, produce a different result. That as Einstein noted is the true marker of insanity – doing the same thing over and over again and expecting a different result.

But if we have the individual and collective courage, we can acknowledge our insanity, admit our errors and start the healing process by adopting the solutions presented by the speakers at this summit.

So our greatest hope is that this summit will serve as the global tipping point for the final acceptance that what we have prescribed and practiced as healthy nutrition for the past 40 years is not only not based on any good science but tragically has been profoundly damaging to human health on a global scale.

Shortly before his untimely death, Karen’s grandfather Prof Christiaan Barnard wrote that: “I have saved the lives of 150 people through heart transplantations. If I had focused on preventative medicine earlier I would have saved a 150 million people”.

It is our hope that through his unforeseen influence in inspiring this summit, the man who gave South Africa its greatest medical moment in history, will also have his wish – to bring health and healing to billions of humans through the provision of dietary advice that is appropriate because it is scientifically-based; it understands the biological consequences of our human evolution; and it recognises the widespread presence of insulin resistance in most populations across the globe.