By Marika Sboros
Prof Tim Noakes is no fan of South Africa’s official dietary guidelines. That much is clear from the Health Professions Council of SA (HPCSA) second hearing against Noakes, in Cape Town in February 2016.The hearing was another a showcase of twists, turns and oddball tactics.
On Day one, the HPCSA showed its hand, or rather its leaf. It’s one straight out of the book of the dream legal team defending Noakes.
The team includes Noakes’ rottweiler medical doctor advocate, Dr Ravin ‘Rocky’ Ramdass. The HPCSA has acquired its own medical doctor advocate, Ajay Bhoopchand. If there were any expectation of a less combative legal path than the HPCSA has taken so far, Bhoopchand dispelled it.
Bhoopchand declined to tell me whether he has kept up his registration as a doctor with the HPCSA, as Noakes has done. I found that a bit odd. After all, it’s not privileged information or material to the hearing. I only asked out of curiosity.
The HPCSA is the country’s regulatory body established in terms of the Health Professions Act. According to its website, it aims to “protect the public and guide the professions”. Registration in terms of the Act is a “prerequisite for practising any of the health professions with which Council is concerned”. Those health professions include doctors and dietitians.
The charge against Noakes stems from a complaint Johannesburg dietitian Claire Julsing Strydom lodged with the HPCSA against Noakes first in her personal capacity, then in her professional capacity as president of the Association for Dietetics in SA (ADSA). Strydom took strong exception to information Noakes tweeted in response to a question from a breastfeeding mother in which he says good first foods for infant weaning were LCHF (low-carb, high-fat) – in other words, meat and veg.
Both ADSA and Strydom now routinely give that advice which tends to make this case even more peculiar than it has seemed at times.
So what’s really at stake here?
Well, for starters, it does appear to be a turf war as many have suggested. Doctors and dietitians seem to feel that Noakes is trespassing on their turf. ADSA seems not to want Noakes dispensing nutrition advice. And definitely not when it goes against official dietary guidelines in SA. It’s probably not co-incidencce that ADSA members have drawn up the guidelines.
These guidelines are modified for a South African context. However, they are based on the influential US dietary guideline. And like most English-speaking countries around the world, South Africa slavishly follows the US guidelines. British obesity researcher Dr Zoë Harcombe has done research showing the guidelines to be short on science when they were first imposed on an unsuspecting public way back in the late 1970s. They remain so to this day.
ADSA appears to believe that dietitians’ degrees make them best placed to advise the public on nutrition and diet. Many, if not most, doctors appear to collude actively. They are happy to leave dietary advice to dietitians. I heard recently of a cardiologist who told a patient he didn’t have time to advise on diet. Instead, he referred the patient to a dietitian.
— Nutrimetabolomics.UB (@NutriMetabolom) January 20, 2016
Critics point to the effects of orthodox dietitians’ advice and adherence to official dietary guidelines: pandemics obesity, diabetes, heart disease, cancer and more recently dementia. The incidence of dementia is rising so rapidly, doctors are calling it type 3 diabetes because of its links with diet.
Doctors also seem not to want Noakes to spread what can look like “inconvenient truths”. These come in the form of dietary advice that conflicts headlong with conventional medical “wisdom”. In particular, medical specialists start looking jaundiced when Noakes tells patients that obesity is not from gluttony and sloth. It is not from people eating too much and exercising too little.
Noakes also says that food can in some cases be even better medicine than pharmaceutical drugs for weight loss, diabetes, heart disease and even cancer. Food and drug companies that support official dietary guidelines simply don’t want to hear that.
But back to Day One of the February 2016 session of the HPCSA hearing.
Most of the day was taken up with evidence placed on the record by Noakes’ Johannesburg advocate, Michael van der Nest SC. It concerned the HPCSA Fourth Preliminary Inquiry Committee. The committee, chaired by University of the Witwatersrand bioethics professor Dr Amaboo “Ames” Dhai, met for the second time in September 2014 and decided that Noakes should be charged.
Van der Nest referred to emailed correspondence in this regard. Dhai has declined to comment. Through the university, she categorically denies any wrongdoing.
Noakes then began giving extensive scientific evidence on low-carb, high-fat (LCHF) to support his defence that the charge of unprofessional conduct for giving ‘unconventional’ advice that is ‘not evidence-based’ is baseless.
Bhoopchand was soon objecting vigorously, claiming much of the evidence is ‘irrelevant’. He even sought a ruling from the HPCSA Professional Conduct Committee hearing the charge against him, to stop Noakes from giving much of the evidence.
Not surprisingly, the panel chair, Pretoria advocate Joan Adams, was unimpressed with this line of argument. She said her committee could not see how Noakes could be expected to disprove the charge of unprofessional in giving unconventional advice that was not “evidence-based” if he was not allowed to present evidence showing it was evidence-based.
One would have thought Bhoopchand could have worked that one out for himself. But then he is paid to put spokes into scientific wheels turning in the defence’s favour. So he was probably just doing his job.
Noakes was in full sail as he waded into vested interests worldwide. He said there was evidence to show their influence on top scientists and academics. He referred to food industry sponsorship of dietitians’ associatio, (including the Association for Dietetics in SA (ADSA). ADSA’s former president, Claire Julsing Strydom, lodged the complaint against Noakes that led to this hearing.
Another view: CAN YOU TRUST DIETITIANS WHO ARE IN BED WITH BIG FOOD?
Noakes gave evidence to support his contention that ADSA and other dietitians’ associations help food and drug companies to “health wash” products. He said low-fat, high-carb is still the dominant conventional dietary paradigm without any science to back it up. He said it has contributed to global epidemics of obesity, heart disease, diabetes to name but a few.
Noakes took special aim at the sugar industry, although had many other targets, including his own profession. He said doctors told patients diabetes was incurable yet they had the means to reverse it.
“We are practising medicine of failure,” he said. ” I don’t want to practice that kind of medicine.”
He explained why heart disease in future will be treated not by cardiologists, but by hepatologists (liver specialists).
On day six of tthe hearing, Noakes looked at why South Africa’s official dietary guidelines are looking more like “misguidelines”.
Noakes spent much of the sixth day of the Health Professions Council of SA (HPCSA) hearing against him probing the underbelly of these guidelines and finding found them wanting. He said this was especially the case when it comes to guidelines on infant weaning. That’s despite the fact that the guidelines do contain some good information.
Noakes has been busily building a compelling case to show his advice is only unconventional to anyone who doesn’t look at the totality of evidence. After all, it isn’t even in conflict with recommendations in the official dietary guidelines on complementary foods for paediatric weaning, and testimony of the HPCSA’s own expert witnesses, including NorthWest University nutrition professors HH ‘Este’ Vorster and Salome Kruger.
However, it may not be so much what Noakes said as what he did not say that has led to the trial.
South Africa’s dietary guidelines promote meat and vegetables as first foods for infants – and adults. The guidelines also actively promote cereals and grains.
Noakes is no fan of these foods, even in their unrefined versions, for people who are obese or diabetic. He says they are a major contributor to the obesity epidemic and rising levels of type 2 diabetes in children as young as three. He says they have no place in infant or adult feeding. He also says these foods are bad for babies’ brains.
Noakes has also identified what he sees as the biggest and terminal problem with current dietary guidelines globally. Science doesn’t lead them. Industry – food and drug companies – leads them.
The hearing continues in October 2016.