The world is changing fast and to keep up you need local knowledge with global context.
The first international low-carb, high-fat, Banting summit in Cape Town from February 19 to 22 was a remarkable event that gathered together top experts from around the globe giving their views and research on food as medicine and medicine as food. They weren’t always in full agreement, but they agreed on some important basics: that saturated fat in the diet is beneficial, not dangerous, and low-carb is the way to go. The summit ended on a high note, with speakers calling for a bottom-up dietary revolution, a return to eating ‘real’, unprocessed, unadulterated, ‘clean’ food – and an end to 40 years of official dietary advice that has no scientific foundation, and that has made people grow fatter and sicker. Summit host was sports scientist Prof Tim Noakes, a pioneer of low-carb, high-fat eating in South Africa, and increasingly in other parts of the world. In a final lecture to the summit, Noakes said the summit was a hopefully a tipping point, dietary advice could be changing soon, and along with it people’s health. I caught up with him after the summit ended. – MS
Welcome to my listeners. With me this evening, I have the doctor who caused all the trouble. He needs no introduction – Prof Tim Noakes. Professor, the Cape Town low-carb, high-fat summit was Karen Thomson’s vision, a remarkable journey that you and these speakers have been on, and it has finally ended. Have you achieved your aim?
Indeed. We achieved our aim for the conference. I think this is, by far, the best conference ever held on this topic. The speakers were astonishing. The information they gave all came together and showed that we all have the same feelings about what needs to be done. We all interpret the science the same way and we realise what needs to be done. It’s not the end. It’s really, just the beginning but it is the most powerful beginning ever experienced in this campaign.
From what I saw, I would heartily endorse that sentiment. Why has it taken so long for this information to get out – the science has been there for a long time?
The science has indeed been there for a long time. I think that it’s been incremental. We’re on the exponential phase of the curve where there’s suddenly a rising interest. Unquestionably, in South Africa what had to happen was the “Real Meal Revolution” had to be written because that then galvanised 160,000 into buying the book. That made us realise that this had now gone viral. We would never have had the courage to arrange this conference, if we hadn’t realised that there is a population out there, wanting this information. That was a real turning point. The fact that I was also criticised in the media was incredibly helpful as well because that galvanised me.
That’s a nice way of putting it.
That galvanised the overseas speakers and in particular, Eric Westman. He was the leader. He said: “We can’t allow Tim to be demonised in his own country and his own town. We have to go and support him.”
Why do you think the reaction to you has been so particularly venomous? Is it cognitive dissonance that you talk about (and you also spoke about causation science)?
I think what’s happened is that science has been taken out of the medical curriculum. When I went into medicine in 1969, science was just taking off in South Africa. The Medical Research Council had just been formed and there was a lot of interest amongst doctors to become scientists. It was really, the start. What’s happening now is that very few doctors want to be scientists. All the science has been taken over by the PhD students.
Unfortunately, it’s possible that the pressure on the doctors to become practitioners and to earn a living is so great that we’ve lost them, and we aren’t really educating them as scientists. I was always more interested in the science than in the clinical practice. There are definitely, two different mental attitudes.
If you’re a clinician, you tend to want to see patients and treat them, and you don’t want to be bothered with where the information comes from and if it’s right or wrong. It’s like: “Just give me the information so I can practice.” I think that’s one of the problems. Then there’s always industry involvement and then there are egos because people have been teaching something and believing it for so long.
I’ve always known that anything I believe could be wrong and should be thrown out as soon as it’s disproven.
It did take you a long time to change your own mind, though?
Indeed. The moment I saw the data/information, I changed within two hours, though. I’d never seen the information and that was the problem. It was hidden. It was suppressed. It was suppressed by what’s happened in the last 20 or 30 years.
I think that science is in a very different place than it was in when I started medicine. It’s become so controlled by industry that that’s the problem. People can’t see beyond the next grant/next study, and who would fund it. I was just, always interested in the truth – researching the truth. I believed that the money would find its own way. I wouldn’t have to worry about that. Now, the science is to chase the money and then it becomes an entirely different focus.
The science behind low-carb, high-fat: I still have many doctors who say the science is not there. Is the science really there?
The science is much more powerful for the low-carbohydrate diet than for the low-fat diet. There is no evidence for the low fat diet and I think we destroyed that. Zoe Harcombe was here and she showed the recent analysis, and I showed all the other evidence, including gold-standard, randomised controlled trials. Then you have Nina Teicholz’s book – The Big Fat Surprise. Everyone should read it. There’s no argument. There is no evidence for the low-fat diet. That’s one of reasons why I asked Michael Eades to come here – because I love the guy, but I love the way he goes back in history. I don’t think anyone had ever shown that.
He showed that the ancient Egyptians were the least healthy population and they were eating the exact diet that we’re told to eat. He presented beautiful evidence at the conference, showing that they were fat, had bad teeth, had osteoporotic bones, and arterial disease.
They ate grains, too?
They ate grains predominantly and they largely avoided meat. They even had a show from the archaeological bone records that that’s exactly what they ate. They weren’t eating much meat and saturated fat and they were terribly sick. Michael Eades said (and he decided this in 1986 or so): “Why do I want to eat their diet? We don’t have to go through that experiment.”
So it’s a game.
That’s what I talked about in my lecture – the coherence. All the information must be coherent. If it’s not coherent, it’s wrong. The fact is that meat intake has been going down in America certainly, since the 1970s and if you compare the 1970s to the 80s, it’s much less. If you put it back over three centuries, meat consumption has just been going down but we’re becoming sicker.
What about heart disease rates?
Heart disease is really related to cigarette smoking. You can put the two curves over each other. Cigarettes came into fashion after the First World War in 1918 and the heart disease rate just started to rise. Smoking prevalence went down after 1960, and it just follows that the heart disease rate followed very closely thereafter. The best predictor of heart disease is in fact, the cigarette consumption. Of course, there are going to be other factors but that appears to be the facto, which has been the most prevalent cause.
The dietary guidelines: Zoe Harcombe‘s study showed that they were without any scientific foundation when they were released in the late seventies and then early eighties. The US has now almost pardoned cholesterol and yet, the same dietary guideline reports still demonises fat. How much progress are we making?
None at all.
That’s what I was thinking.
Until we realise that cereals and grains have to go, we’re not really making a difference. The evidence for cereals and grains is so high that they could cause a range of diseases (as I talked about in my lecture).
Those should certainly go along with carbs. If we’re saying low carbs, we certainly shouldn’t be having high grains?
That’s right. Cereals and grains were promoted as the component of the high carbohydrate diet so we took fat out, and we replaced it with cereals and grains. They gave us the bulk of the carbohydrate consumption, and they’re highly insinulinogenic. They cause insulin secretion/high glucose response. The so-called whole-grains just cause glucose and insulin levels to rise spectacularly.
I hadn’t heard about obesogenic environments before the conference (there was much I hadn’t heard before this conference) – it’s going to take a long while to clean up the obesogenic environments as well.
Indeed, and that’s why we think South Africa has the advantage. I think we can change things in South Africa. I was speaking to Eric Westman and he said there’s absolutely no way he’s ever going to get to speak to government in the United States because there are only lobbyists anyway. The lobbyists prevent change and the lobbyists work to prevent change of the dietary guidelines. They will remain same. They’ll change it for window dressing, but they won’t really get down to the core.
In South Africa, we have such a major problem with our health, though, that we have to do something. We have the solution and it’s up to the people to take the message to the politicians.
In addition, when you went to Parliament you were actually very well received when you introduced Banting as we called it.
Extremely well received by Parliament.
We hope that augurs well?
One outcome was that the President (Jacob Zuma) lost a lot of weight and so did his wife. I’m not sure that it was because they followed the diet, but hopefully, it was.
At least he might be doing something right? You also mentioned that the next thrust might be cancer and carbohydrates, a talk from Dr Gary Fettke from Australia. Could you talk about that?
Yes. Gary’s from Tazmania. He developed a brain tumour three years ago, and that started him thinking and focused his mind. He started looking into the mechanisms causing the production of cancer. He realised that the genetic explanation (that there are chromosomal abnormalities) couldn’t be right because all cancer cells have the same problem with the way they metabolise fuel. Otto Warberg showed in the 1930s that the mitochondria don’t function properly in the cancer cells, and they have to get all energy from the fermentation of glucose. Theoretically, if you starve the cells of glucose, you should do well.
Now, there’s also growing evidence that it’s the cytoplasm (where the nucleus is sitting), which is the problem and that produces the cancer transformation. The cancer cell is not because of one chromosome changing. It’s because the environment in which the nucleus is living is changed, and that induces the cancer change. The theory is that the cancer treatment has been going in the wrong direction as well. It’s been looking for genetic changes. Then you try to kill the cells, but that’s not really, been very effective. We haven’t won the war on cancer.
Despite many millions (if not billions) of dollars spent on cancer research – there seems to be a terrible pattern emerging here?
If you went back 200 years ago, went to traditional societies, and saw the pattern of illness, there would be none of this illness. We wouldn’t even be asking these questions, such as “how do we treat cancer?” Well actually, cancer doesn’t exist. How do you treat heart disease? Heart disease doesn’t exist.
All the NCDs as well?
I can’t get people to understand that – because to them nutrition begins in 1977, and nothing before that is remembered. That’s the tragedy. However, people have to go back. I was glad to see one of the speakers had a quote from a doctor in South Africa from 1923, saying that there was no cancer in the indigenous people at that time. He was a British missionary, so he knew what cancer looked like. Why don’t people see that? The other thing: why don’t people understand that tuberculosis didn’t exist before we brought this diet in, either? Isn’t it possible that tuberculosis had something to do with this diet?
At my university, I know that they have this fabulous centre and these brilliant researchers. They spend R250m per year on tuberculosis research. We’ve not made any impact on the prevention of it, whereas I think that a simple trial of nutrition, where you start treating people properly and feeding them, you would see dramatic results because tuberculosis is a failure of the immune faction. The failure is due to bad nutrition.
Where to from here? This has been a really remarkable journey. You also mentioned that change has to happen from the bottom up because it’s not going to happen from the top down.
This is the first time we had all the leaders in the field. There are one or two more that we could add, but we had a majority of the leaders in the field: people, who’ve been there for a long time, have seen it all, and who’ve been robust. Although they’re not tired, they’re not as active, and what we’ve added are some younger people who are perhaps a bit more active, to drive the message.
I think we’ve reinvigorated the older guys (because I’m one of the older guy, but I’m younger in the field) so I’m talking about youth in terms of years in the programme. I think we’ve energised the older people and they’ve seen now, that what they’ve done for the last 20 or 30 years is now starting to pay off. I’m hoping we reach the tipping point, certainly, in Cape Town and maybe in South Africa.
I should hope so.
That’s the focus and I think that if we can turn South Africa, we can then turn the rest of the world.
Another speaker was Dr Andreas Eenfeldt from Sweden: I thought Sweden was the first Western country to officially, embrace low-carb, high-fat, but it’s not actually true. They took one step forward and two steps backward. Is any country leading the way?
Sweden isn’t. The only thing that Sweden did was that they showed it was legally acceptable to prescribe this diet.
It’s like damning with faint praise.
Almost. That’s why I see this as such an opportunity for South Africa. That’s why we linked it to Chris Barnard and what he did. He decided that he was going to be successful. He was going to change the world. We said: “If he could do it, why can’t we do it?”
What did he say about “if I saved one person’s life in a heart transplant, I could have saved”…
He said: “I could have saved 150 patients with the transplant, but I could have saved 150-million if I’d looked at preventive medicine.” It could have been ten-billion or five-billion, which he could have saved.
I wonder how many people we have lost unnecessarily from bad dietary advice over 40 years?
Look at the longevity statistics in South Africa. They’re just dropping. That’s partly due to HIV, but it’s also now increasing due to very early onset of diabetes so we have an entire generation now. I think that what’s going to happen is that the diabetes rates are going to become 80% or 90% in the communities around Cape Town.
When they don’t have to. It’s very sad.
This is a preventable disease. That’s why I asked those two people to come up to the stage – to show that it is a reversible disease, whereas we teach in medicine that type 2 diabetes gets worse and you have to give more and more medication, and they’ve disproved that.
Andreas mentioned on Twitter that the low-carb, high-fat Summit in Cape Town is going to go to the UK and US. Is it?
Well, Karen just whispered in my ear and she said: “Yes, we’re going to London.”
So Karen has a habit of making things happen.
Exactly – like her grandfather.
That’s Karen Thompson, Professor Chris Barnard’s granddaughter. Well Professor Noakes, thank you very much. We’ve been speaking to Professor Tim Noakes, the UCT Sport Scientist who is leading the Real Meal Revolution.
Cyril Ramaphosa: The Audio Biography
Listen to the story of Cyril Ramaphosa's rise to presidential power, narrated by our very own Alec Hogg.