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The nutrition gloves have come off again. This time it looks suspiciously like Big Food in general and Kellogg’s in particular squaring up through its dietitian proxies against emeritus University of Cape Town professor Tim Noakes and low-carb, high-fat (LCHF). I’ve been watching with amusement, and more than a little mystification, the flurry of recent ‘news’ reports announcing that the Health Professions Council of SA is investigating Noakes for ‘unprofessional conduct’. ADSA (Association for Dietetics in SA) president Claire Julsing Strydom laid the charge against Noakes in February 2014. The hearing will take place early June. No one can accuse the HPCSA of acting in a hurry.
Precisely what ‘unprofessional conduct’ Noakes, a medical doctor, nutrition and sports scientist (rated A-1 by the National Research Foundation), is alleged to have committed is a revelation. Spoiler alert: it’s about as mundane as you get, although it puts Noakes in the same category of offenders as apartheid cardiologist ‘Dr Death’ – Wouter Basson. Noakes has been demonised since he did the unthinkable (to many doctors and scientists) in 2009: admitted he’d got things wrong, apologised profusely and headed off in a completely new direction. Read on to find out what Noakes has done now. – MS
By Marika Sboros
So, the Health Professions Council of South Africa (HPCSA) is investigating Prof Tim Noakes for “unprofessional conduct”. You could be forgiven for thinking Noakes has gone nuts and done something really, really bad.
After all, the HPCSA has so far reserved that charge for doctors who’ve done something really, really bad to patients – sexually abused them, exploited them financially, caused physical or mental harm, disfigured or maimed them for life, or in a worst case scenario, killed them.
Patricia Sidley, a Johannesburg health writer with an MA in bioethics and health law from Wits University, is no fan of Noakes. However, she finds it strange that the HPCSA has let the charge laid by Association for Dietetics in SA (ADSA) president Claire Julsing Strydom in February 2014, get this far – given that its most recent, high-profile case of unprofessional conduct is against “Dr Death”, Wouter Basson.
Basson is the apartheid-era cardiologist who ran the government’s chemical and biological warfare programme. His “duties” included poisoning people with lethal cocktails of muscle relaxant and other drugs, on the whim of the ruling Nationalist Party. (The HPCSA is yet to decide on a suitable sanction against Basson. He got off all murder and attempted murder charges, many of which took place in Namibia, formerly South West Africa, thus outside HPCSA jurisdiction.)
The HPCSA in effect puts Noakes and Basson in the same category of offenders. Sidley describes that as “idiotic” – in slightly more profane words.
But back to Noakes’ alleged “unprofessional conduct”.
It can seem anticlimactic to say he tweeted his opinion in response to a mother’s question on best foods to wean her infant. Did Noakes advise the mother to give the infant poison – drip-feed unrefined sugar (that spikes the hormone insulin), or undiluted fresh fruit juice (that’s high in liver-straining fructose) straight into the baby’s veins? No. He advised low-carb, high-fat (LCHF) foods that include meat, full-fat dairy and veg – and not to give cereal.
Therein probably lie the two nutritional rubs at the heart of Strydom’s charge : Firstly, she and ADSA members, dietetic associations worldwide, and the multinational cereal and other food companies that sponsor them, aggressively promote cereal for infant weaning, despite evidence showing it mostly makes babies fat.
It is advice dietitians have disseminated globally for decades, based on official dietary guidelines. The same high-carb, low-fat, guidelines British obesity researcher Zoe Harcombe and US scientists exposed in a meta-analysis in the BMJ Open Heart in February as without a shred of scientific evidence when they were imposed on an unsuspecting public in 1977. The same guidelines fingered in scientific research as contributing to epidemics of obesity, type 2 diabetes, heart disease, and other chronic diseases sweeping the planet.
Secondly, ADSA and Big Food companies consider LCHF for infants, children, adults, or anyone at all, to be the closest yet to a nutritional antichrist. They regularly denounce it as “dangerous”, “deadly” and “unscientific”.
(For a different view, a one-stop source of the science behind LCHF, complete with references, read Good Calories, Bad Calories and Why We Get Fat, by US author Gary Taubes, and Big Fat Surprise by US author Nina Techolz.)
Interestingly, no paediatricians in SA expressed outrage at Noakes’ tweet. And recently, the Canadian Paediatric Society, in a joint statement with Health Canada, Dietitians of Canada and the Breastfeeding Committee for Canada, issued the same advice.
The statement also offers the option of iron-fortified cereal, but Pringle Bay registered dietitian and ADSA member Tamzyn Murphy Campbell says it’s “suboptimal”.
“It is highly processed, high glycaemic index, often sugar-packed and contains anti-nutrients which can interfere with nutrient absorption.”
Murphy Campbell, nutrition editor and writer for Health Intelligence, who also works for Solal supplement company, is one of few registered dietitians in SA, and growing numbers internationally, who has embraced LCHF, including for young children and babies. She prefers not to call LCHF a diet, because “that makes it sound like a fad. It’s a lifestyle, a way of eating healthily.”
So what’s really motivating Strydom to see Noakes’ tweeted opinion not just as different from hers, but worthy of the most serious charge against a medical doctor?
I would dearly love to give her side at length here, but Strydom isn’t talking. Through ADSA’s PR company, Liquid Lingo, Strydom repeatedly refused to answer questions – including on links with food companies and whether “Banting” as LCHF is known in SA, has been bad for ADSA members’ business.
She even stonewalled questions with no material relevance whatsoever to her case against Noakes. Till after the hearing, she said, because the HPCSA has “advised” her not to talk to the media as the inquiry is “sub judice”.
I pointed out sub judice doesn’t apply, as anyone with even a rudimentary knowledge of the legal process in SA knows. It only applies in a court of law. The HPCSA is a statutory body, not a court of law. I also pointed out Noakes hasn’t been given that same “advice” by the HPCSA, and the HPCSA call centre told me, rightly, it does not instruct parties to disputes of this nature not to talk to the media because it can’t.
Sidley says sub judice is just a “refuge”, a “vague term thrown around endlessly by people who don’t want to talk to the press”. After all, even “lawyers are on air all the time talking about their cases these days”.
Oddly enough, a few days before I spoke to Strydom, she gave an hour-long TV interview, with top Johannesburg cardiologist Dr Anthony Dalby. Both described LCHF as “dangerous” and likely to cause untimely death.
Dalby, at least, was prepared to have a phone chat with me, albeit brief. He says LCHF is dangerous, not because of low-carb or weight-loss issues, but because it “contravenes the best medical advice we have” in its high saturated fat recommendations.
“We have recorded that patients develop very high, or moderately high cholesterol levels,” Dalby says.
The results won’t play out in the short term that “this diet has been pushed around”, he says. It will play out in 10, 20 years: “You can feel great, lose weight, have less diabetes, but the long-term effects are unknown, and appear to be adverse.”
In response to whether long-term effects are seen in traditional societies, such as the Inuit who ate LCHF for centuries without a high incidence of heart disease, Dalby says: “That’s not proof.”
“Japanese traditional diets have protein and carbohydrates but very little saturated fat, and also show little heart disease,” Dalby says. “We need a lot more evidence in every respect, in relation to recommended diets, and these off-the-wall diets that we see.
“At the moment the best advice is guided by experts who advise that saturated fat should be reduced to no more than 10% in the diet.”
Saturated fat is “not a great thing to recommend”, Dalby says.
In response to my suggestion there is evidence to show saturated fat does not cause heart disease after all, Dalby ended the conversation, saying: “If you believe that, I leave it to you.”
Strydom, in remaining resolutely behind the HPCSA’s sub judice curtain, adds credence to a theory doing the rounds on Twitter that she and ADSA are proxies, witting or unwitting, in Big Food’s and particularly Kellogg’s “war” against LCHF, because it is bad for business.
That got me looking into ADSA’s sponsors. A recent investigation by the consumer group, Grass Action, shows cereal maker Kellogg’s to be a major sponsor, as it is of dietitians’ associations worldwide. Other sponsors include Nestle, Woolworths, Unilever, the sugar industry – via Equisweet, a sweetener product made by Hulett’s – even Coca Cola for nutrition education events, which can sound oxymoronic.
Kellogg’s doesn’t just sponsor ADSA, it has staff on ADSA’s executive committee: Linda Drummond, Kellogg’s nutrition and public affairs manager; Cheryl Meyer, Kellogg’s nutrition assistant.
Strydom consults to Kellogg’s. On her business website, Nutritional Solutions she says she has presented “nutrition intervention programs and nutrition presentations for various organisations including Kellogg’s”. She is quoted in a press release promoting a Kellogg’s cereal product, along with chum Drummond – who also consults to Nutritional Solutions.
Maryke van Zyl, ADSA’s in-house PR, consults to Woolies and used to work full-time for them in 2009.
Of course, ADSA execs’ close ties with food companies are not an exclusively South African phenomenon. And Strydom is on record saying sponsorship doesn’t equal endorsement of products. However, research uncovers a far less pretty global picture. Just as with the drug industry, studies funded by the food industry tend to produce results that please the industry. Ditto for dietitians in bed with food companies.
On his HealthInsightUK blog, brilliant British investigative health writer and author Jerome Burne has written a scathing critique of “cuddly dietitians in the cosy embrace of industry fatcats” . He makes an observation Strydom and ADSA executive committee members might find uncomfortable: “Declarations of interest by individual researchers are obviously important but they are peripheral. However, once you get on some board or committee you probably shouldn’t have any commercial links at all.”
Burne’s post follows an extensive forensic analysis in February in the BMJ (British Medical Journal), by another brilliant British writer, freelance journalist Jonathan Gornall.
Titled Sugar: spinning a web of influence, Burne says Gornall reveals the “true nature of the relationship between industry and (UK) nutritional experts”. It leaves an impression of dietitians’ relationships to food companies that is anything but sweet in effects on the public’s health.
Gornall’s analysis, Burne says, sets out in “impressive detail just how total is the industry’s dominance over what passes for public health food policy in the UK”, and just how comprehensively and miserably the government’s “responsibility deal” has failed.
Gornall says his investigation gives “a clue to why so many global companies with nutritionally contentious products feel the need to fund research and invite public health experts onto their advisory boards and into their boardrooms as consultants — and why they have been prepared to engage in the UK with the government’s ‘responsibility deal’: it can be found in two of the most recent annual submissions to the Securities and Exchange Commission in the US.”
Gornall’s analysis is UK-focused but globally relevant. The findings implicate international food and drinks manufacturers and the dietitians in their pay.
“How can it be right,” Gornall asks, “for a researcher attempting to establish whether or not ingredient X is harmful to accept funding to do so from the manufacturer of ingredient X?
“Would society consider it acceptable if the salary or expenses of a judge ruling on a legal dispute were paid by one of the parties?”
But back once more to what Strydom hopes to achieve in charging Noakes. Her action, Sidley says, will serve to “stifle scientific debate”, to “narrow the space within which scientific argument can occur”.
If HPCSA does Strydom’s bidding, it will go down “a very dangerous road, and set a very dangerous precedent”.
“I think the case itself holds out dangers for the public in the use of new technology,” says Sidley.
Strydom’s charge also seems aimed at freedom of expression, and not just Noakes’. Days after I put questions to her, she sent an urgent notice to all ADSA members about the HPCSA “advice”, presumably encouraging them also to keep mum.
Noakes is characteristically bullish. In a recent interview with EWN’s Stephen Grootes, he says Strydom’s action is “possibly the best thing that’s ever happened to medicine in the past 10 or 20 years”.
The HPCSA will have to investigate not just him, but “what the South African public are being taught about nutrition”, and the scientific basis – or lack thereof, Noakes says. It will have to rule on the science around porridge as a first food for infants if suggesting meat and veg constitutes “unconventional advice” and “unprofessional conduct”.
Noakes has been researching infant nutrition for the past two years, and told Grootes porridge is “not an ideal food”, not just because it is fattening. Infants need food in their first two years of life that provide critical “brain–specific nutrients”, Noakes says. “Animal-based foods are proven to provide these nutrients in excess. Cereal-based foods, such as porridge, are not.”
Campbell agrees. She says no dietitian will (or should) contest that the one nutrient a baby runs out of by six months is iron, and that the best source of bioavailable iron is meat. (I think she gives orthodox dietitians too much credit, but that’s just my opinion.)
“Meat, liver and fish are babies’ first foods in many traditional societies, and they were on the right track,” she says. The worst foods? “Wheat-based cereals and those with added sugars” – which means most baby cereal products on the market.
Campbell doesn’t believe CHF represents any danger to babies and children, or anyone else: “I haven’t seen any research to indicate this is dangerous. Traditional societies have done so without any known adverse effects, indication a long history of safe use.”
Canadian physician Dr Jay Wortman has researched traditional societies, and like Campbell, his family is on LCHF.
In an email to me last week he says his son Alex, now 14, has eaten LCHF since age 2. Daughter Isabelle, 5, the product of an “LCHF gestation”, was weaned on LCHF when she stopped breastfeeding – pureed vegetables with butter, olive oil and cheese, pureed meat sauces with lots of fat.
He says doctors and dietitians who fear LCHF are simply “misinformed”.
Murphy Campbell says most dietitians are “absolutely terrified” of the words “low-carb”. They don’t understand that most children who follow LCHF don’t need to restrict carbs drastically to “ketogenic levels” – defined for adults as below 50g to 60g daily, she says. The carbohydrate level in LCHF for babies and children is thus only relatively low, compared to conventional dietitians’ advice
South African-born US paediatric, adolescent and adult bariatric and transplant surgeon Dr Robert Cywes is an LCHF specialist, and has treated carbohydrate addiction for over 15 years. He has operated on about 6000 people. In patients before and after surgery, he has had more than 800 000 encounters with fat people.
“You’d be an idiot if you don’t learn from that,” Cywes says.
In an email to me, he says the HPCSA faces “an opportunity for scientific truth rather than a challenge to Noakes’ integrity. He has the humility and the science to be very persuasive.”
A Johannesburg lawyer suggested in a news report ADSA might argue its dietitians alone are “qualified” to give dietary advice. That thought on its own reeks of arrogance and territoriality, without drowning the poor HPCSA in a flood of charges against doctors, including cardiologists, who regularly dish out nutrition advice to patients.
In the end, Strydom’s action presents the HPCSA with an unenviable task – navigating a “ whole new world of medicine, including diagnosis, intervention and delivery of information that is changing electronically”.
“Doctors already charge for telephone consultations with patients, and increasingly use digital media,” Sidley says.
There is an “enormous amount of activity going on electronically on Twitter and other social networks”, she says, with doctors, dietitians, nutrition specialists and therapists constantly giving opinion, information and advice. Quite when that freeflow of information morphs into “consultation”, diagnosis and treatment between doctor and patient, is murky.
If Strydom hopes the HPCSA will stem that freeflowing tide in cyberspace, my guess is that’s likely to require a higher power than Moses ever had in parting the sea.
- UPDATE: ADSA president Claire Julsing Strydom replied through Twitter, directing me to the association’s Guidelines on Infant Nutrition, posted on April 27, the day before this blog. These guidelines appear to say ADSA and its members support Noakes’ advice, and no longer routinely advise cereal as a first food for infant weaning, though cereal is still there as an option. I have asked for clarification and confirmation from ADSA.