This is Part 2 of a two-part series on the Health Professions Council of SA (HPCSA) hearing against scientist Tim Noakes. Here, I look at the evidence Noakes has presented on SA’s dietary guidelines.
By Marika Sboros
Prof Tim Noakes is no fan of South Africa’s official dietary guidelines. The guidelines were under the spotlight again in the HPCSA’s second hearing against Noakes that took place in Cape Town in February 2016.
The HPCSA has acquired a new advocate, Ajay Bhoopchand. If there were any expectation of a less combative approach than the HPCSA has taken so far, Bhoopchand dispelled it.
The HPCSA is the country’s regulatory body established in terms of the Health Professions Act. On its website, it says that 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 in her personal capacity with the HPCSA in February 2014. Strydom was president of the Association for Dietetics in SA (ADSA) at the time.
She tweeted her “horror” at Noakes telling the breastfeeding mother that good first foods for infant weaning are LCHF (low-carb, high-fat) – in other words, meat and veg.
Both ADSA and Strydom now routinely give that advice. That tends to make this case even more odd than it seems at times.
So what’s really at stake here?
Well, for starters, the hearing appears to be a turf war as many have suggested it is. At heart, it appears that some doctors and dietitians feel that Noakes is trespassing on their “turf”. In particular, ADSA doesn’t want Noakes dispensing nutrition advice that goes against official dietary guidelines in SA. It’s probably not coincidence that an ADSA member (Prof Este Vorster) has drawn up the guidelines.
Click here to read: A TURF WAR OVER AN ‘INCONVENIENT TRUTH’?
These guidelines are modified for a South African context. However, they religiously follow the influential US dietary guideline. British obesity researcher Dr Zoë Harcombe’s research shows that the guidelines were short on science when the US first launched them way back in the late 1970s. They remain so to this day.
ADSA supports the guidelines. It also says that dietitians’ degrees make them best placed to advise the public on nutrition and diet. Many, if not most, doctors support that view and are happy to leave dietary advice to dietitians. I heard recently of a cardiologist who told a patient that he did not 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 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.
Noakes also tells patients that obesity is not from gluttony and sloth. It is not from people eating too much and exercising too little. Noakes says that food can often be 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 message.
Noakes was finally able to begin giving evidence. He presented research on low-carb, high-fat (LCHF) to support his contention that the charge of unprofessional conduct for giving “unconventional” advice is baseless.
Bhoopchand was soon objecting vigorously, claiming much of the evidence is ‘irrelevant’. He sought a ruling from the HPCSA Professional Conduct Committee hearing the charge against him.
Panel chair Pretoria advocate Joan Adams overruled him. She said it was not reasonable to accuse Noakes of giving advice that was not “evidence-based” if he were 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 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’ association, including the Association for Dietetics in SA (ADSA).
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 also said that low-fat, high-carb was still the dominant conventional dietary paradigm in the guidelines, without science to back it up.
Noakes took special aim at the sugar industry, although he had many other targets, including his own profession. He said doctors still told patients diabetes was incurable even though 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 would be treated not by cardiologists, but by hepatologists (liver specialists).
On day six of the hearing, Noakes looked at why South Africa’s official dietary guidelines were looking more like “misguidelines”.
Click here to read: DOCTORS, DIETITIANS MAKE DIABETES A THREAT TO LIFE?
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 that 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 that his advice is only unconventional to anyone who doesn’t look at the totality of evidence. Consequently, the advice that he gave isn’t in conflict with recommendations in the official dietary guidelines on complementary foods for paediatric weaning. It also aligns with testimony of the HPCSA’s own expert witnesses, including Vorster and her North-West University colleague 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. He says that they are a major contributor to the obesity epidemic and rising levels of type 2 diabetes in children as young as three. Noakes also says that these foods have no place in infant or adult diets.
“These foods are bad for babies’ brains,” he says.
Noakes has also identified what he sees as the biggest and terminal problem with current dietary guidelines globally. “Science doesn’t lead them,” he says. Industry – food and drug companies – leads them and that’s a problem for public health.
The hearing resumes in October 2016.