Marika Sboros on Tim Noakes, Banting myth, madness and magic

Prof Tim Noakes and Karen Thomson
Prof Tim Noakes and Karen Thomson

By Marika Sboros 

The first international low-carb, high-fat summit  in Cape Town in February was a moveable feast for body and brain, a virtual construction site for nutrition science. It demolished deeply held myths about diet, weight loss, food as optimum fuel and medicine for body and mind.

It built dreams of a gentle, safe alternative to modern medicine’s rampant polypharmacy to stem the tsunami of obesity, diabetes, and other chronic disease epidemics sweeping over the planet.

It gave scientific evidence against conventional wisdom that diabetes is an irreversible condition that requires drugs for optimum control.

The summit was hosted by Cape Town sports scientist Prof Tim Noakes, a pioneer of low-carb, high-fat (LCHF, aka Banting, aka ketogenic) in South Africa, and organised by Karen Thomson, granddaughter of the late pioneering heart surgeon, Prof Chris Barnard.

Attendance by speakers and delegates was high. It exceeded expectations, given fierce and vicious medical, dietetic and academic establishments’ resistance to LCHF – and Noakes – in South Africa. They haven’t yet forgiven Noakes for an about-turn on the role of carbs in the diet in favour of LCHF four years ago. They have relentlessly attacked him ever since for challenging conventional medical and dietetic wisdom.

Antidote to venom

Therein lies the genesis of this unique event: a vision of the irrepressible, vivacious and ever gracious Thomson, founder of HELP (Harmony Eating & Lifestyle Programme) to overcome addiction to sugar (carbohydrate).

Thomson was so incensed by the venomous attacks on Noakes, she decided an antidote was needed: she invited the world’s top experts in LCHF to attend a summit in South Africa, to present the science, and stand up for Noakes.

Thomson and Noakes quickly assembled a stellar group of speakers from across the globe, all highly respected, many internationally renowned medical doctors, scientists and researchers specialising in obesity and LCHF. They included a cardiologist, nephrologist, psychiatrist, bariatric surgeon and an orthopaedic surgeon. They all said they came to show support for Noakes, and to spread the word to the world about growing evidence for LCHF.

Prof Stephen Phinney
Prof Stephen Phinney. Picture: Louis Hiemstra

Among more than 500 participants were local and foreign medical doctors, dentists, dietitians, nutritionists, psychologists and complementary medicine practitioners who attended three days for professionals. The fourth day open to the public was similarly packed.

Summit speaker Dr Stephen Phinney, a US physician scientist and emeritus professor of medicine at the University of California, Davis, known as the “father of LCHF”, said the summit was the biggest conference audience he had addressed so far.

Even food at the summit venue, the Cape Town International Conference Centre, was a coherent element that supported the scientific content: delicious satiating meats, bacon wraps, biltong, fish, nuts, cheeses, yoghurt (full-fat of course) and low-carb vegetables  – all LCHF staples, designed to keep blood sugar levels stable.

Diet doctor

Dr Andreas Eenveldt
Dr Andreas Eenveldt, Sweden’s ‘diet doctor. Picture: LOUIS HIEMSTRA

Summit speaker Dr Andreas Eenfeldt, Sweden’s “diet doctor”, was so impressed with the culinary offering, he declared it “the best food I’ve eaten at any conference, ever”. It gave delegates a literal taste of another major summit theme that was particularly eloquently expressed by Canadian kidney specialist Dr Jason Fung: the insulin theory of obesity and diabetes.

Fung and others presented compelling evidence that the epidemic of chronic conditions facing the world today – cardiovascular disease, obesity, diabetes, even dementia – is just the tip of the iceberg. Underneath them all lies the driver: insulin resistance (IR), a metabolic condition in which the body becomes increasingly unable effectively to use the insulin it produces in response to excess sugar/carbohydrates in the diet.

Fung’s presentation was particularly fascinating: he looked at how resistance develops in a biochemical system that is designed to resist it. He concluded that just taking anti-biotics is the precursor to developing anti-biotic resistance, and vaccines are the precursor to vaccine resistance, so insulin is the precursor to insulin resistance.

British obesity researcher Zoë Harcombe, another summit speaker, has described that logic as “inarguable”.

Fung said he now advocates a dietary intervention to diabetes as first resort – what he calls the “rational, natural approach”.

Phinney’s talks underpinned the insulin theory, and focused on another major summit theme, one which he has spent more than 30 years researching: nutritional ketosis (a metabolic state induced by dietary carbohydrate restriction). He coined the term 30 years ago because of confusion and fear around ketosis, ketones, and ketoacidosis, a very serious condition that can be fatal.

So why are doctors and dietitians still so fearful of ketosis and ketones and instill the fear in patients?

Ignorance, said Phinney.

He said doctors and dietitians are classically taught that ketones are “toxic byproducts of fat metabolism”, which they can be, but only in extremely high levels and in the complete absence of insulin such as  in type 1 diabetics, or more rarely in end-stage type 2 diabetics.

“If there’s even a little insulin, ketoacidosis can’t happen,” Phinney said. For the rest, ketosis is a benign state, and ketones (natural chemicals the body produces in response to fat metabolism) are “helpful substrates”.

Phinney, Noakes and others reiterated their view that humans actually have no need for ingested carbohydrate – still a controversial view in medical and dietetic circles.

Diet-heart hypothesis

Other myths that came in for a thorough demolition job were the diet-heart hypothesis (the demonisation of saturated fat in the diet as the cause of heart disease), the idea that “a calorie is a calorie” ( the body can’t and doesn’t distinguish calories), CICO (calories-in, calories-out), and the “energy imbalance hypothesis” – that people are fat because they eat too much and move too little.

Zoë Harcombe
Zoë Harcombe

Harcombe, a Cambridge University graduate, and nutrition expert who is currently completing a PhD, told the summit that for CICO to be true, the second law of thermodynamics would have to be violated. The junk food industry spends billions of dollars trying to convince everyone that CICO is true, and a calorie is a calorie, because that makes them “automatically innocent” of any role in rampant obesity and diabetes rates, she said.

US science and investigative journalist Gary Taubes, author of groundbreaking books on the science of nutrition, Calories In and Calories Out, and Why We Get Fat, was similarly dismissive. Taubes is co-founder of the Nutrition Science Initiative, a non-profit organisation devoted to reducing the individual, social and economic toll of obesity and its related diseases by improving the quality of science in nutrition and obesity research.

He said CICO is the “original sin” of obesity and diabetes research. It has become “written in stone, passed down from the mountain”, yet it has no science behind it. Obesity has “nothing to do with gluttony and sloth”, Taubes said.

Eenfeldt agreed that “it just doesn’t make sense that people have become fat and lazy Homer Simpsons overnight”.

Another major summit focus for demolition was official dietary guidelines. Harcombe presented results of her own research, a meta-analysis of the evidence for dietary guidelines with UK and US researchers, published in the BMJ Open Heart a week before the summit. The conclusion: official dietary guidelines were without scientific evidence when they were introduced in the US in 1977 and in the UK in 1983.

That advice has adversely affected the health of more than 270 million people at the time, as sky-rocketing rates of NCDs worldwide shows, and that number is likely to have risen to billions in the interim, Harcombe said. She has not surprisingly been criticised personally and professionally for the study, since it goes to the heart of powerful vested interests. She and her team are unrepentant.

Saturated fat bias

US expert Dr Michael Eades, who has been in full time practice of bariatric, nutritional, and metabolic medicine since 1986, presented even more disconcerting evidence on how studies biased against saturated fat have worked their way into government recommendations.

Christine Cronau, an Australian nutritionist and best-selling author of The Fat Revolution, said official dietary guidelines have in effect made us all part of modern medicine’s “biggest failed health experiment”.

Dr Aseem Malhotra
Dr Aseem Malhotra. Picture: LOUIS HIEMSTRA

British interventional cardiologist Dr Aseem Malhotra was similarly scathing about dietary guidelines, particularly on sugar and carbohydrate intake, and demonisation of saturated fat. He said efficient healthcare demanded informed doctors and patients, and referred to “seven sins” identified in research as contributing to a lack of knowledge on both sides:

  • Biased funding of research – research funded because it is likely to be profitable, not because it is likely to be beneficial for patients
  • Biased reporting in medical journals
  • Biased reporting in the media
  • Biased patient pamphlets
  • Commercial conflicts of interest
  • Defensive medicine
  • Medical curricula that fail to teach doctors how to comprehend and communicate health statistics.

Presentations looked at why unscientific dietary advice continues to be disseminated.

South African-born US adult and paediatric bariatric surgeon Dr Robert Cywes pointed to a disturbing pattern: ‘Sixty years ago, experts sat wringing their hands about the rise in lung cancer, heart disease and emphysema, (all chronic non-communicable diseases – CNCDs), and completely ignored and argued against the evidence that tobacco was the culprit,’ Cywes said.

Today they sit wringing their hands about obesity, diabetes, cholesterol and hypertension while the world ignores the “culprit drug”.

“ The most prevalent CNCDs killing us as a species are a consequence of drugs not well tolerated by human systems: alcohol, tobacco and the obesogenic drug – carbohydrates,” Cywes said.

LCHF experts are often criticised for undermining the role of exercise as part of the energy imbalance theory. All summit speakers said they weren’t saying exercise is not helpful for health. It is – just not for weight loss.

Canadian physician Dr Jay Wortman, a public health specialist, and clinical assistant professor at the University of British Columbia’s faculty of medicine, spoke about how he reversed his own type 2 diabetes 12 years ago by going on a low-carb, high-fat diet, and has been free of any evidence of the condition ever since.

Wortman and others addressed concerns about safety of LCHF regimens in children and pregnant women – they don’t believe there are concerns, as traditional diets prove. They point out that while there are no studies proving safety, there are also no studies proving safety of official, low-fat, high-carb dietary advice  in pregnancy and for children. You just have to look around at the many fat pregnant women and fat babies to spot the perils, that include  “marinading” the developing foetus in insulin, as Fung told the summit.

Another inspiring personal story came from American Jimmy Moore,  the only lay person on the speakers’ panel. He described himself as “just a guy who changed his life forever” in 2004 by making the decision to lose the weight that was literally killing him.  At 32, and weighing 410 lbs, he ditched the carbs, increased the fat, and a  year later, had shed 180 lbs. He hasn’t looked back. Moore now runs  the Livin’ La Vida Low-Carb blog, to help others.

Dr Eric Westman
Dr Eric Westman

Dr Eric Westman, associate professor of medicine at Duke University’s Medical School’s Department of Medicine, and an internationally renowned expert on low-carb nutrition and ketogenic diets, gave a novel presentation to the public on LCHF in action to achieve weight loss.

He donned a white coat, and addressed the audience as an obese patient, taking them step by step through the basics of LCHF for weight loss and maintenance thereafter.

He emphasised the basic elements: carbs low as 20g a day, moderate, protein and high fat intake, and an overall summit theme that is key to LCHF eating: real food, as close to its natural state as possible, in other words, not processed or refined, with additives, flavourants, etc.

“Have you ever seen a bread tree or a pasta tree?” Westman asked the audience rhetorically.

Cholesterol, OMG!

Statins, the most prescribed drugs on the planet,  were another focus of the summit. Dr Jeffry Gerber, a family physician known as “Denver’s Diet Doctor”, took special aim at the cholesterol-lowering drugs in a lively presentation titled, Cholesterol OMG!. In his practice, he addresses health, cardiovascular risk and nutrition, including low-carb, paleo and primal diets, and says lowering cholesterol isn’t always smart. Gerber believes that statins will be “gone in 10 years”.

One of the most exciting – and controversial – presentations to the summit was So you think you need sugar? Your cancer needs it even more! by Australian orthopaedic surgeon Dr Gary Fettke, a senior lecturer at the University of Tasmania who does ongoing research into the role of diet in diabetes, obesity and cancer.

Fettke, a cancer survivor, looked at the science behind the metabolic model of cancer therapy, based on the work of Nobel Prize winning German biochemist Dr Otto Warburg in the 1930s, and posited LCHF, ketogenic dietary regimes as an adjunct to orthodox treatment options in future.

Other presentations looked at food and mood, and dispelled another myth dietitians tend to cling to: that carbohydrates are essential to the diet because they raise serotonin levels and make you “feel good”.

Dr Ann Childers
Dr Ann Childers. Picture: LOUIS HIEMSTRA

US adult and child psychiatrist Dr Ann Childers specialises in nutrition and mental health, and told the summit that nutrient-poor, high-carbohydrate, high-grain diets don’t just contribute to weight gain, they’re not good for body or brain. Carbohydrates are not the brain’s best food, Childers said. Fats, including saturated fats, are best.

One twit on Twitter said she hoped the conference would not be “an echo chamber”. It wasn’t. Speakers agreed on most, but not all, major points of LCHF theory. They all agreed that LCHF was not a fad. Fettke said the only fad diet was the one we’ve all been eating for the past few decades.

Speakers differed in how low a low-carb diet had to go for maximum benefit. None came even close to suggesting a one-LCHF-diet-size that fits all.

Some differences were little more than semantics,  though you wouldn’t know it from the breathtaking speed with which some bloggers pounced on them. One example: Malhotra said he prefers to speak of healthy rather than saturated fats, and that research currently shows Mediterranean diet is healthy – as long as it is high-fat.

Some bloggers gleefully reported as if it were a sign of Malhotra’s closet opposition to low-carb and Noakes. They were wrong on both counts: Malhotra said he would not support a high-carb Mediterranean diet. In  October 2013, he published an article in the BMJ: Saturated fat is not the major issue , that became one of the most read and impactful medical journal articles in the world for that year. He is vocal in his support for Noakes.

Old Mutual

Anti-Noakes bloggers also leapt on a comment by Dr Peter Bond, chief medical officer of Old Mutual, the company sponsoring the summit: that the company was “not endorsing any particular diet or way of eating”. And quite right too.

Dr Peter Bond
Dr Peter Bond

It’s  not in the global life assurer’s job description to endorse diets, and the summit was not on the Tim Noakes’ LCHF diet, documented in the best-selling book, The Real Meal Revolution, or any other. It was designed as a health summit investigating research around optimum nutrition, with a special focus on LCHF.

Old Mutual would never have sponsored the summit – and to the generous tune of a million rand or more, I’d hazard a guess – if it did not respect Noakes and want to be associated with him.  Bond is savvy and bright enough to appreciate growing evidence in favour of LCHF, and to spot a possibly winning scientific horse when he sees one in the race for effective therapies to beat NCDs in future .

Bond said health crises around the world, including in South Africa, show that new approaches are necessary: “There is clearly a need to elevate preventative medicine to the level it deserves, and not only do it, but, more importantly, have the desire to do it,” he said. “We have clearly failed to date.”

No argument there!

The only pity about the summit was a lack of question time, and that doctors and dietitians opposed to Noakes and LCHF stayed away, despite an open invitation to public debate. Excuses left the lingering impression that perhaps they weren’t so sure their arguments would stand up to scientific scrutiny.

One anti-Noakes blogger did get in, with his female sidekick. Both made predictably bilious, ill-informed comments and ad hominem (when science fails you, play the person not the ball), demonstrating ubiquitous ignorance of LCHF and the scientific method.

The summit started looking more and more like the global tipping point for LCHF speakers expressly hoped it would be. Noakes gave a powerful closing lecture on The Way Forward, answering critics, and giving evidence for LCHF.

The summit ended with a rallying call from speakers for a bottom-up dietary revolution. A top down approach will never work, they said, given how deeply embedded pharmaceutical and fake food companies are with governments, with universities, and with advisors.