By Marika Sboros
I’ve watched with mild amusement how the Health Professions Council of South Africa (HPCSA) is conducting its case against Prof Tim Noakes. It has charged him with unprofessional conduct. That’s a charge it usually reserves for doctors who have done something, really, really bad. Its most recent, high-profile case was against the man dubbed “Dr Death'” – apartheid era cardiologist Dr Wouter Basson. But could Noakes really be SA’s next Dr Death?
Basson is the apartheid-era cardiologist who ran the government’s chemical and biological warfare programme. His “duties”, according to allegations, included poisoning people with lethal cocktails of muscle relaxant and other drugs, on the whim of the ruling Nationalist Party. Some of those people died.
Basson got off all murder and attempted murder charges in South Africa, as many of events took place in Namibia, formerly South West Africa, thus outside the country’s jurisdiction. The HPCSA found him guilty of unprofessional conduct in 2013, but has yet to decide on a suitable sanction. (UPDATE: The HPCSA is itself in complete disarray. A ministerial task team in 2015 found that it was riddled with incompetence and its top three executives were unfit to hold office.)
So what exactly did Noakes do that makes the HPCSA put him in the same category as SA’s own “Dr Death”? It can seem an anticlimax to that say he tweeted n response to a breastfeeding mother’s question on best foods for infant weaning. Noakes is a medical doctor and one of few scientists in the world with an A1 rating for expertise in nutrition and sports science. He said that good first foods are low-carb, high-fat (LCHF). In other words, meat, full-fat dairy and veg.
Johannesburg health writer Patricia Sidley has an MA in bioethics and health law from the University of the Witwatersrand. She is no fan of Noakes. However, she describes the HPCSA’s action against him as “idiotic” – only in slightly more profane language.
Sidley finds it “strange” that the HPCSA let the charge get this far. The president of the Association for Dietetics in SA (ADSA) Claire Julsing Strydom started it by complaining to the HPCSA about Noakes’ tweets in February 2014.
However, it was probably not so much what Noakes did say that so “horrified” Strydom that she reported Noakes to the HPCSA. It’s probably more about what he did not say. Firstly, he did not advise cereal.
Strydom and ADSA have for years promoted cereal for babies based on official dietary guidelines. Those are the same high-carb, low-fat, guidelines British obesity researcher Zoe Harcombe exposed in a meta-analysis in the BMJ Open Heart in February 2015 as without a shred of scientific evidence when authorities imposed them on an unsuspecting public in 1977.
Research fingers the same guidelines as contributing to epidemics of obesity, type 2 diabetes and heart disease. (UPDATE: The guidelines are under scrutiny in the US and UK, not so much in SA, except in this trial.)
Secondly, ADSA and Big Food companies consider LCHF for infants, children, adults, or anyone at all as “dangerous”, “deadly” and “unscientific”. (For a more objective view read Good Calories, Bad Calories by Gary Taubes, and Big Fat Surprise by Nina Techolz.)
Interestingly, no paediatricians in SA reported Noakes for the tweet. And in 2014, 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.
However, Pringle Bay registered dietitian and ADSA member Tamzyn Murphy Campbell says that that’s “suboptimal”. “It is highly-processed, high-glycaemic index, often sugar-packed and contains anti-nutrients that interfere with nutrient absorption.” she says.
Murphy Campbell is one of few registered dietitians in SA who has embraced LCHF for young children and babies. She doesn’t call LCHF a diet, because “that makes it sound like a fad”. “It’s a lifestyle,” she says, “a way of eating healthily.”
So what’s really motivating Strydom and the HPCSA in this case?
I would like to give their sides side at length here, but both aren’t talking much. Strydom has repeatedly refused to answer questions – including on links with food companies. She won’t say if “Banting” as LCHF is known in SA, has been bad for ADSA members’ business.
She even stonewalled questions with no material relevance to her case against Noakes. Strydom even said that HPCSA has “advised” her not to talk to the media as the inquiry is “sub judice”.
I pointed out that sub judice does not apply, as anyone with even a rudimentary knowledge of the legal process in SA knows. The HPCSA is a statutory body, not a court of law. I also pointed out that the HPCSA hasn’t given Noakes the same instruction. Its 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 that sub judice is a “refuge”, a “vague term people who don’t want to talk to the press throw around”. 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 said that LCHF was dangerous, not because of low-carb or weight-loss issues. He says that 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 said.
The results won’t play out in the short term. They will play out in 10, 20 years, he said. “You can feel great, lose weight, have less diabetes, but the long-term effects are unknown, and appear to be adverse.”
On research showing traditional societies, such as the Inuit, have eaten LCHF for centuries without a high incidence of heart disease, Dalby said: “That’s not proof.” Japanese traditional diets have protein and carbohydrates but very little saturated fat, and also show little heart disease, he said. “We need a lot more evidence in every respect than these off-the-wall diets that we see.”
Saturated fat is simply “not a great thing to recommend”, Dalby said. The “best advice” is that saturated fat should be no more than 10% in the diet.
When asked for comment on evidence to show saturated fat does not cause heart disease, Dalby ended the conversation abruptly. “If you believe that, I leave it to you,” he said, and put down the phone.
Strydom and ADSA have mostly remained resolutely behind the HPCSA’s sub judice curtain. That’s except for the odd public statement about the HPCSA case really being all about Twitter. Strydom replied through Twitter in 2015, directing me to ADSA’s Guidelines on Infant Nutrition, posted on April 27.
These guidelines mostly support Noakes’ advice, and no longer routinely advise cereal as a first food for infants. Cereal is still there as an option in “fortified foods” or as supplements if needed or prescribed. That will please ADSA sponsors. It adds credence to a theory doing the rounds on social media about organised campaigns. One is that Strydom and ADSA are proxies for Big Food and Kellogg’s in a “war” against LCHF because it’s bad for business.
Also read: WHY SO MANY DIETITIANS HAVE ‘HITS’ SYNDROME
That got me looking into ADSA’s sponsors. Consumer group Grass Action did an investigation recently showing cereal maker Kellogg’s to be a major sponsor of ADSA. Other sponsors include Nestle, Woolworths, Unilever, the sugar industry – via Equisweet, a sweetener product made by Hulett’s. Coca Cola is there too for nutrition education events – which can sound like an oxymoron.
Kellogg’s doesn’t just sponsor ADSA. It has staff who are ADSA’s executive committees. They include 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.
ADSA’s new president, Maryke van Zyl, is a consultant to Woolworths, and worked full-time for them in 2009.
Of course, the close ties of ADSA executives with food companies are not an exclusively South African phenomenon. And Strydom is on record saying that sponsorship doesn’t equal endorsement of products. However, research uncovers a far less pretty global picture. Just as with the drug industry, studies that the food industry funds tend to produce results that please the industry. Ditto for dietitians in bed with food companies.
On his HealthInsightUK blog, British investigative health writer and author Jerome Burne has written a scathing critique of “cuddly dietitians in the cosy embrace of industry fatcats”.
“Declarations of interest by individual researchers are obviously important but they are peripheral,” Burne says. “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 2015 in the BMJ (British Medical Journal), by British writer, freelance journalist Jonathan Gornall. Titled Sugar: spinning a web of influence, it reveals the “true nature of the relationship between industry and (UK) nutritional experts”.
Burne says Gornall’s analysis sets out in “impressive detail just how total is the industry’s dominance over what passes for public health food policy in the UK”.
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. it also looks at why they have engaged 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.
Another view: DIABETES CAN BE CURED! A DOCTOR’S PERSONAL JOURNEY
But back to what Strydom and ADSA hope to achieve in charging Noakes. Sidley says the action will “stifle scientific debate and narrow the space within which scientific argument can occur”. If the 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.
Noakes is characteristically bullish. In an interview with EWN’s Stephen Grootes, he said that Strydom’s action was“possibly the best thing that’s ever happened to medicine in the past 10 or 20 years”. How so?
He says the HPCSA will have to investigate not just him, but “what dietitians are teaching the South African public about nutrition”, and the scientific basis – or lack thereof. It will have to rule on the science around porridge as a first food for infants. That’s if it manages to prove that suggesting meat and veg for infants constitutes “unconventional advice” and “unprofessional conduct”.
Noakes has been researching infant nutrition for some years now. He told Grootes that porridge was “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”. Animal-based foods provide these nutrients in excess. Cereal-based foods, such as porridge, do not, he said.
Campbell agrees. She says that 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.
“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 says LCHF represents no 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 practises what he preaches about LCHF. Wortman put himself and his family on LCHF after he was diagnosed with type 2 diabetes. That was more than 12 years ago.
In an email to me Wortman says his son Alex, 15, has eaten LCHF since age 2. He and his wife weaned daughter Isabelle, 6, the product of an “LCHF gestation”, onto LCHF foods. They gave her 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 “terrified” of LCHF. 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 only 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 who 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, Cywes 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.”
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”.
Sidley points out that doctors already charge for telephone consultations with patients, and increasingly use digital media.
There is an “enormous amount of activity going on electronically on Twitter and other social networks”, she says. Doctors, dietitians, nutrition specialists and therapists are constantly giving opinion, information and advice. Quite when that free flow of information morphs into “consultation”, diagnosis and treatment between doctor and patient, is murky.