Noakes, low-carb, high-fat on trial: will the evidence ruin a good story?

The Health Professions Council of SA (HPCSA) hearing against University of Cape Town emeritus professor Tim Noakes is running in Cape Town from February 8 to 17. Noakes is charged with unprofessional conduct after Johannesburg dietitian Claire Julsing Strydom, then president of the Association for Dietetics in SA (ADSA), laid a complaint against him for two tweets in which he told a breastfeeding mother that meat and veg were good first foods for infants. Here, Cape Town science and business writer Rob Worthington-Smith looks at the narrative at the heart of this pec case, one that has developed in nutrition science without much scientific evidence to back it up. He also looks why so many dieticians, doctors, academics, and the food and pharmaceutical industries still cling to this faith-based narrative as if their life – more likely their careers – depend on it. Worthington-Smith’s research is pointed to the vested interests behind the durability of this narrative. He raises the questions of whether it’s time for the narrative to change, or whether those interests will do what they do best: prevent the evidence from ruining their good story. – Marika Sboros

By Rob Worthington-Smith

Money Food
What’s behind the low-carb, high-fat controversy? Is it a case of ‘follow the money’?

The first article in this series examined the first of the two main charges against Prof Tim Noakes, namely that he acted unprofessionally in giving nutritional advice over Twitter. The obvious fact is that Twitter is a social media forum and not a private and confidential doctor’s consulting room. This being common knowledge for users of social media, it is unlikely that the tribunal will find Noakes guilty of any such misconduct.

The second charge relates to the unconventionality of the advice he offered, in particular that he advised that a weaning infant would benefit from being introduced to a low-carbohydrate, high/healthy-fat (LCHF) diet. Conventional dieticians offer a variety of reasons why the LCHF diet is dangerous for most of us – and certainly dangerous for a weaning infant.

Amongst the reasons given are that the body would suffer from keto-acidosis, that too much fat could lead to clogged arteries, that certain minerals and vitamins would be missing from such a diet, and of course that the body would be missing out on the main energy metabolic pathway, ie the making of glucose from carbohydrate-rich food. In addition, there is a societal concern – staple foods are generally grains, regarded as being a relatively cheap source of good nutrition.

Read also: Revealed! The REAL beef dietitians have with Tim Noakes and Banting

Conventional dieticians and health practitioners have the benefit of a powerful narrative that has become a belief system, not only here in South Africa, but across the world. It goes something like this:

Rob Worthington-Smith
Rob Worthington-Smith

Rich nations introduced rich foods. We ate more and more fat-rich foods and exercised less, aided by modern conveniences and TV. Gluttony (too many calories in) and sloth (too few calories out) are responsible for the obesity epidemic, heart attacks, depression and various other ailments. The only way to get ourselves out of this mess is to eat less and exercise more, and in particular, eat less animal fat, because it clogs the arteries with cholesterol.

The narrative is then embellished by the food industry: Start the day with a healthy fortified cereal (courtesy of Kellogg’s or Tiger Brands); eat plenty of fruit during the day. Eat as little red meat as possible and make sure you eat plenty of healthy greens – salads and vegetables. Cut out animal fat, cut out salt and drink eight glasses of water every day.

Upon this platter, an army of nutritionists has added a wide array of expensive supplements, from minerals to vitamins.

This narrative has taken on the force and momentum of a religion, providing opportunities for more fundamentalist views to become almost mainstream – save the planet and prevent animal suffering by going vegetarian, or even vegan.

These are noble sentiments and certainly lend weight in the case against the evil, blood-letting hunter.

The advocate of the traditional dietary guidelines can also sound like a moderate, for who could fail to support the concept of a “balanced diet” – ie one that recommends a variety of foods from each of the major food groups – carbs, proteins and fat – on the plate?

Amazingly, this faith-based narrative has actually strengthened even as our species has become exponentially fatter and sicker (obesity rates in South Africa are about ten times what they were a generation ago).

How is it that Noakes sees an obese emperor in the “altogether”, while the profiteering tailors (Big Food and Big Pharma) continue to encourage the cheering crowd to marvel at the ailing man and his debilitating high-carb, low-fat diet?

Read also: Cancer and red meat – fleshing out the hype 

The challenge facing the hearing is to interrogate the science on both sides of the debate. The adjudicators will have to cast aside the weight of convention propping up the high-carb case, while on the other hand they should demand solid evidence in support of the LCHF case.

Expert witnesses from the Association for Dietetics in South Africa (ADSA) have presented their narrative and emphasised their belief in their dietary guidelines for a “balanced diet” (interestingly, the only evidence presented in support of the guidelines was the existence of the same guidelines advocated by their peers in other countries).

Tim Noakes
Prof Tim Noakes. Picture courtesy of the Noakes Foundation

Now it is the turn of Prof Tim Noakes. Can he present solid evidence that disproves the science behind the traditional guidelines, and/or solid evidence that proves that the low-carb, high-fat diet is not merely a weight-loss programme with dangerous implications in the long term, but the healthiest diet for most of us?

Having reviewed much of the 1,600 pages of evidence presented in the defence’s “discovery”, it is clear that the weight of evidence overwhelmingly supports the LCHF hypothesis.

Even if one applies prejudice in favour of the high-carb diet and cherry-picks evidence that supposedly supports it, such studies that have been done are inconclusive on closer inspection.

Further, many of these studies have been sponsored by food or pharmaceutical corporations and institutions, making it not surprising that they often come to conclusions that run counter to the evidence. 

Most of Noakes’ allotted time will be spent presenting the evidence for the LCHF diet. On this basis, the hearing/tribunal should have no choice but to exonerate Noakes and reject the case against him.

Read also: Why is Big Food in bed with dietitians? Follow the money!

However, if the history of medicine teaches us anything, it is that evidence is rarely allowed to spoil a good story, especially when that story is supported by billions of dollars advertising the ‘health’ messages that accompany modern, processed foods and pharmaceuticals.

Back in the early 19th century, for example, Ignaz Semmelweiss, a Viennese doctor at a maternity hospital, discovered that the reason why mothers whose babies were being delivered in a certain ward were dying, was because they were being attended to by doctors who had been conducting autopsies and arrived at the labour ward with dirty hands. Mothers attended to by clean midwives rarely suffered infection.

However, his counter-narrative (that all attending physicians should wash their hands thoroughly, or risk killing their patients) was no match for the prevailing, accepted wisdom that doctors could do no wrong. It took twenty years and thousands of unnecessary deaths before the narrative changed in favour of hygienic practices. Tragically, Semmelweiss had by this time died in a mental institution, a lone voice, confined to a padded cell.

Thus, it will not be good enough for Noakes to present the evidence. Not even 1,600 pages of evidence will, on its own, change the narrative. His task is to craft a more compelling narrative in the minds of every stakeholder group: ordinary citizens, medical doctors, dieticians, hospitals, the medical insurance industry and even the decision-makers at the helm of major food manufacturers.

UK editionNoakes’ batting record is thus far patchy: Having suffered a severe setback at the hands of his own colleagues and peers in academia, Noakes tackled the challenge at the grass-roots level, with the publication of the Real Meal Revolution and Raising Superheroes. These books became best-sellers, the former selling around 200,000 copies and the latter currently topping the reading charts.

Further, the number of citizens who claim to be on a healthier life path through the LCHF diet, now runs into many thousands. These people are living the contrarian narrative, some understanding the underlying science, some with religious zeal. Such is the nature and power of narrative.

The next article will present this unconventional narrative, the story that underpins the LCHF diet. This is not Noakes’ story; it belongs to many heroic scientists and researchers that have fought hard – and most often in vain – against the incoming tidal wave of corn starch, margarine and processed carbs. But there is no better researcher-scientist in the country to have taken up the challenge of interrogating the entire body of science (and pseudo-science) that has been written on this subject, than  Noakes.

Be prepared for a wild ride, one that starts right here, in the wilds of Africa, three million years ago. To be continued.

  • Rob Worthington-Smith is a science and business writer. While his day job is to analyse companies’ non-financial capitals for the responsible investor, he also pursues a wide range of interests including evolutionary biology and behavioural economics. Rob enjoys the challenge of bringing perspective to contentious issues, such as the moral landscape, how to address inequality in a developing economy, progressive approaches to education, parenting (as a widowed, single parent of four), and the science and pseudo-science behind health and nutrition. Rob holds a BSc Honours degree in Agricultural Economics from Stellenbosch University. Disclosure: Whilst as yet undecided on every aspect of the issue, Rob is currently working with Prof Tim Noakes to bring perspective and balance to the current debate on dietary guidelines.