Tim Noakes: Idiot’s Guide to LCHF and Banting

Picture: THE NOAKES FOUNDATION
By Marika Sboros
Some doctors and dietitians will still tell you a low-carb, high-fat (LCHF) diet is dangerous. That’s despite compelling evidence to show safety and efficacy of LCHF for weight loss, diabetes, heart disease, cancer and even dementia.
LCHF is a global phenomenon. In South Africa, there are more than three million “Banters”, as fans of LCHF regimens are known in that country. Banting pioneer is University of Cape Town emeritus professor Tim Noakes, a world-renowned scientist and medical doctor. Here, in a Q&A, Noakes gives the basics and an Idiot’s Guide to getting started on the LCHF path.
Is LCHF a diet?
No, it’s a lifestyle.
Is your diet’s right for everyone – a one-size-fits-all?
There’s no such thing. No diet is right for everyone. LCHF is best for people with insulin resistance (the inability to tolerate carbohydrate).
Is it correct to call your diet “Banting”?
It’s probably more correct to call it Ebstein – after German physician Dr Wilhelm Ebstein who first made it high-fat. That was the diet Sir William Osler promoted in his monumental textbook: The Principles and Practices of Medicine, published in 1892.
Click here for full coverage of The Trial Of Prof Tim Noakes
Is LCHF a fad?
Anyone who claims Banting or Ebstein diets are fads knows nothing about medical nutrition history. Nutrition did not begin in 1977 as our students seem to be taught.
Is LCHF the same as Paleo?
The Paleo diet is slightly different. It promotes consumption of only those foods that would have been available to Paleolithic man from about 2.5 million years ago to the Agricultural Revolution starting about 12 000 years ago. Foods allowed on Banting but excluded on Paleo are dairy. Paleo allows fruits but Banting excludes many.
What about Atkins?
The Atkins diet is similar to Banting. Perhaps Banting promotes the use of low-carb vegetables rather more than Atkins did, but the differences are trivial. This shows that (i) first priority, and the commonality of all these diets, is to cut carbs and sugar (and vegetable oils) and (ii) whether you go Paleo or Banting or Atkins is determined by how you respond to the different options in the different diets. To find the ideal low-carb diet you need to experiment to see how you respond.
Is LCHF extreme?
It depends what you mean by extreme. Moderation is a smug, puritanical word. No mammal eats in moderation. In nature all diets are extreme: lions eat only meat, polar bears mainly fat, panda bears only bamboo shoots, giraffes only acacia leaves.
Is it balanced?
Balance is what has worked for each of these species for millions of years. LCHF can be extremely low in carbohydrate – the one nutrient for which humans have absolutely no essential requirement, but that depends on how sick you are. In 1977, when we were told to eat diets extremely high in carbohydrates, human health started to fail globally.
Your recommended carb range is <200g to <25g, correct? What are the indications?
It depends how insulin resistant you are and how much exercise you do. If you are completely insulin sensitive (that is, you tolerate carbohydrates well, have low fasting blood glucose, insulin and triglyceride concentrations, low small LDL particle numbers; low HbA1c; high HDL-cholesterol concentrations; and absence of fatty liver) and exercise regularly a few hours a week, then it is can be safe to ingest up to 200g carb per day, or at least until your HbA1c rises above 5.5% . That’ll be time to start reducing the carbs.
On the other hand, if you are profoundly insulin resistant with type 2 diabetes, morbidly obese, or with heart disease, cancer or dementia, you’ll probably do best on a very low-carb diet of about 25 grams carbs per day. This won’t change even if you do more exercise. Exercise is helpful but doesn’t obviate the need to eat very few carbs, even if you exercise for many hours a week.
What carb-fat-protein ratio is best?
It depends how sick you are. If you’re diabetic, we say 20% to 30% protein, 60% to 70% fat, 5% carbs. The sicker you are, the more fat you need because fat is insulin-neutral. The more insulin resistant you are, the more fat you can eat, because even when the pancreas fails, fat is the only fuel you can metabolise safely without requiring insulin. It’s perfect for blood sugar control.
Any weighing of food on your diet?
No. That’s a joke. You can’t predict accurately the absolute calorie content of foods when eaten by humans. You don’t know how many calories each person needs. The only way to work that out is by weighing yourself. If your weight stays stable, you’re eating the same number of calories you are expending. If you’re lean, that’ll probably be the correct number of calories for your body and activity level. There’s no other way remotely accurate enough to measure your calorie needs. We don’t tell people how many grams to eat daily, except for carbs. If you are really sick or markedly insulin resistant, the key is 25g maximum daily.
Is Banting (LCHF) dangerous for babies?
No. It’s common in many traditional societies such as the Inuit in Canada, the Maasai in Kenya. The choice between health and ill health begins with infants as soon as they’re weaned. Babies should not be weaned on to traditional high-sugar, high-carbohydrate processed cereals. The science behind it is in our book, Raising Superheroes.
What does LCHF mean for infants?
Meat and veg because these foods optimise brain development. The infant brain grows at a fantastic rate for the first two years of life. The only way to optimise that growth is foods high in what are called brain-specific nutrients. These are found in highest concentrations in real foods, especially seafood and shellfish, but also in dairy, eggs, liver and meat. They are not found in high-carbohydrate, high-sugar processed foods. Meat, liver and fish alone are babies’ first foods in many traditional societies.
Is Banting for babies low-carb?
No, only compared to traditional high-carb, high-sugar, low-fat guidelines.
What’s all the controversy around ketosis – is it really so dangerous?
Ketosis is a perfectly natural condition in which the liver increases its production of ketone bodies (from circulating fats). Consequently, ketones can substitute for glucose as a fuel for the muscles, heart and brain. Ketosis from intermittent fasting is probably the natural human state. Indeed in the 1500s, Europeans typically ate once a day, not 3-6 times as we now do. We are beginning to realise that ketones have many other beneficial effects beyond simply providing an energy source to replace glucose. Researchers are studying these effects and adding further evidence for unexpected medical values of the low-carbohydrate diet.
Are there different forms of ketosis?
Yes, two important forms of ketosis: nutritional ketosis and diabetic ketoacidosis. They are polar opposites. Nutritional ketosis is one of the most important adaptations in the human body. It allows humans to survive periods of starvation without destroying their brains (from a lack of blood glucose supply). It develops when dietary carbohydrate (and protein intake) is restricted and fat intake is greatly increased in persons who continue to secrete some insulin. Therefore, those are ones who don’t have type 1 (insulin-deficient) diabetes.
Nutritional ketosis is very different from diabetic ketoacidosis. Ketoacidosis occurs in persons with insulin-deficient type 1 diabetes and who are unable to produce even a trace of insulin. It is a life-threatening condition. The treatment is replacement of insulin and correction of the other metabolic abnormalities including the severe acidosis.
How best to define and differentiate nutritional ketosis and diabetic ketoacidosis?
By the levels of blood ketones that occur in either condition: in nutritional ketosis values are seldom greater than 1-2mmol/L and there is no acidosis; in diabetic ketoacidosis, blood ketone values can go as high as 30-50mmol/L (with an associated and life-threatening acidosis). Remember, the ketones are not the danger here; the acidosis is.
How can people get into nutritional ketosis?
To get into nutritional ketosis, you need to reduce your carbohydrate intake to 25g/day, eat less protein and lots of fat. The easiest way to reverse nutritional ketosis within 15-30 minutes is simply to eat some carbohydrate or protein.
Is saturated fat ever a health threat?
It can be, in the presence of a high-carbohydrate/sugar diet that causes elevated insulin concentrations due to the excessive carb intake. Insulin directs an altered metabolism with the formation of the damaging oxidised (LDL) cholesterol that’s probably a key component in heart disease.
What’s the key here?
To eat a diet that keeps blood insulin and glucose concentrations low. That’s because elevated insulin concentrations especially are linked to long-term health problems. We say: eat what your appetite directs you to. Once you cut the carbs we think your brain will tell you if you need more fat or protein. It’s about finding the balance that works for you.
On to LCHF fundamentals: what to cut out?
Bread, potatoes, rice, pasta, pizza, sugar, all grains, cereals, processed, packaged, boxed, adulterated foods, cakes, sweets, biscuits, fizzy drinks, all the addictive things. Anything sweet, starchy has to go, and low-fat foods.
What stays in?
Fat and protein. You can eat fat in relatively unlimited amounts, but only moderate protein. A healthy high-protein diet for humans doesn’t exist. If your diet was 100% protein, you’d get sick and die. You can’t really overdose on fat; it reduces appetite; it’s the best way to get over sugar addiction.
What are good protein sources?
Eggs, full-fat dairy, cheese, yoghurt, fish, chicken – with the skin, not battery fed – and some meat, preferably organic, or at least pasture-raised, not from animals raised in feed lots and fed grains because that destroys the meat’s quality. Meat’s not a main focus, but we like lamb because it’s fatty and pasture fed. Boerewors is fine but without cereal in it, and bacon, preferably not very smoked.
And good fat sources?
Butter, cream – ladle meat and veg with butter; put cream in tea or coffee. Coconut oil is very healthy, everyone should have two tablespoons daily. Avocados, nuts – almonds, walnuts, pecan nuts, especially macadamia nuts, they are like drops of fat. All tree nuts, not peanuts or cashews. They’re legumes, not nuts.
What about vegetables?
All vegetables have carbohydrates; we recommend those with lowest-carb, highest-nutrient content: leafy greens such as kale, it’s one of the most nutritious vegetables; cauliflower, broccoli, they’re on our green list – (in The Real Meal Revolution).
What about 5-a-day fruit and veg?
It’s unscientific advice.
Is it possible to be an LCHF vegetarian?
Yes, by eating a high-fat version – by including nuts, avocados, dairy and other safe oils, like olive oil. But, please, no “vegetable” (seed) oils as these are highly toxic. The problem for vegetarians and vegans is if that they are insulin-resistant, their high-carbohydrate vegan or vegetarian diets could cause weight gain. It could also worsen insulin resistance with time.
Is it possible to be vegan on LCHF?
Well, I know a vegan athlete, a former professional cyclist who eats 80% fat in his diet. He ate lots of coconut oil and avos. It’s an extreme diet that works for him. Clearly, his gut flora can handle it. I know someone who eats only raw meat. We don’t know what the bacteria in their guts are doing, and how those bacteria might compensate for what we might perceive as intake “deficiencies”.
Some people won’t lose weight on LCHF even when they follow the rules rigorously. Why?
The key to obesity control is to understand the role of the human brain homeostat (appestat) that controls energy intake and energy expenditure. For millions of years, the appestat worked perfectly, exactly matching how much we ate to exactly how much energy we expended each day. The controls are so exquisite they must be accurate to within a few calories per day. If not, no human would ever be weight-stable for any length of time.
The appestat works so that if you exercise less on one day, you don’t become fat the next. You simply eat less and maintain the same body weight. Conversely, if you exercise more, you don’t lose weight, you just eat more. Unfortunately, the appestat doesn’t work the other way: if you eat too many calories (because highly addictive, sugar-rich foods have hijacked the appestat) the appestat doesn’t force you to go out and exercise off those extra calories.
So what’s the real magic of ‘Banting’?
The reason Banting works so effectively in so many is because it quietens the appestat so that calorie consumption drops without hunger and weight is lost effortlessly. In most people, the reduction in daily calorie intake is probably in the range of 10% to 50% of daily calories, again without hunger. For some, especially women who have experimented with many different diets over the years, this doesn’t happen. Their appestat function has perhaps been “damaged” by years of calorie restriction and hunger; instead of reducing calorie intakes on LCHF, they actually increase their intakes and gain weight.
In some it seems that instead of producing greater satiety, increased fat intake actually increases hunger, so they eat more and gain weight. The key may be to increase protein intake and reduce the fat intake. Some believe that dairy is especially fattening for this type of individual. It is also important to move progressively to eating less frequently so that at most, you eat one full meal a day with much smaller snack-type meals in between large meals.
How much weight is safe to lose quickly?
Most of those who try Banting respond positively and lose sometimes unimaginable amounts of weight. The greatest amount reported to me has been 150kg! Billy Tosh in Cape Town set another record by losing 83kg in 28 weeks – no one else I know has come close. These people do it by increasing their fat intakes, cutting sugar to zero grams per day and limiting carbs to less than 25 g/day. To achieve this they have to cut out essentially all processed foods and start cooking for themselves.
For those with abnormal appestat function not corrected by carbohydrate restriction, it may be necessary initially not to eat too much fat and to focus more on increasing protein intake and eating less frequently by practising some degree of intermittent fasting.
You’re a fan of intermittent fasting?
Yes! The damaging effect of eating carbohydrates is that it produces an insulin response which is exaggerated in those with insulin resistance. Worse, we now know that every time you over-secrete insulin, your body becomes slightly more insulin resistant. Intermittent fasting does the opposite – by reducing the frequency with which you secrete insulin, intermittent fasting reduces the probability that you will develop worsening insulin resistance leading to type 2 diabetes.
What about alcohol?
It’s a toxin, and slows weight loss on LCHF regimens significantly. We say: first lose weight, and reintroduce alcohol in small amounts if you must. LCHF is a fine line. Thus, if you don’t fall on the right side of the fat, protein, carb ratio, just one apple, a beer or two glasses of wine will put you on the wrong side. In that case, you won’t enjoy the benefits you should from cutting carbs.
No sweet “cheat” treats at all?
A small piece of dark chocolate is fine, but many people can’t eat just one small piece – like smokers who can’t have one cigarette. However, the key is to get sugar out the diet. People don’t understand how addictive sugar is, or what it actually is – not just sucrose, the white stuff. If you can get people down to 25g of carbs a day for a few months with no added sugar, the brain no longer searches for sugar. That’s what makes our diet so successful.
And best snacks?
Nuts, biltong, cheese, coconut – I love coconut chips best of all – and full-cream yoghurt.
Are “cheat days” on Banting really so bad?
Again, it depends on your level of insulin resistance and degree of sugar and carbohydrate addiction. The worse your insulin resistance, the more damaging each cheat day will be to long-term health. That’s because each day increases your level of insulin resistance. If you have a sugar addiction the cheat day ensures the addiction will continue. The analogy is to smoking or drinking. because no addict can continue indefinitely to smoke or drink “in moderation” or on a cheat-day.
Is LCHF only for the rich?
No. Our Eat Better South Africa campaign shows it’s possible to Bant by eating foods that are as cheap as the cheap high-carbohydrate, highly-processed foods that are currently the sole option for many of the poorer South African communities.
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Not to state the obvious, but is it called “The idiots guide to LCHF and Banting” because it is directed at South African dietitians?
Because, you know, they’re “idiots”……
Thank you for posting this awesome article. I search since a long
time for an answer to this subject and I have finally found it on your site. I subscribed to your blog and shared it on my Twitter.
Thanks again for this great post!
I’m past my goal weight and still losing. Should I change my diet?
Hi, any advice for someone who is 8 years post Whipple operation, I am very interested in nutritional ketosis for health benefits, but cannot tolerate much fat. I cannot tolerate coconut milk or cream, and struggle with animal fats. Thanks
Great question. Where are you on the planet?
Hi I’m in Australia. Currently take creon with meals to assist, but still can’t tolerate the fats previously mentioned. Ta
Check out Foodmed.net’s Low Carb World Map for an expert near you who can help. Many do Skype consults as well.
Hi Marika
I’ve been on a low carb diet for 4 years. As a Chinese I thought it would be difficult to give up rice, but after 2-3 weeks, I don’t miss it at all.
The diet is really simple. Just eat fatty meat and above ground vegetables. And thats it.
Tim Noakes is an inspiration. He has such a pleasant and cheerful demeanour about it, always smiling. I wish him the best for his trial. Real science will prevail.
Here’s a Mantra adapted from a hypnotherapist. All you do is when facing food containing more than 5g of carbs/sugar per 100g. Say to yourself “Sugar was yesterday, Sugar was yesterday”
Has anybody tried starting their day with a Bulletproof Coffee ( Google it) (Black coffee, unsalted grass fed butter and MCT Oil (coconut butter will do). Use a stick blender and presto, you have coffee that looks like a cafe latte and will keep you going all morning. You can make it more interesting by adding some cinnamon or cayenne pepper or cardamon. The possibilities are endless. The coffee tastes great.
I know BPC well. It’s all you say.
You do your work a disservice when you call people idiots.
I appreciate your sensitivity. However, I am not calling anyone an idiot. Idiot’s Guide is simply a title commonly used globally to signal specialist information, such as technical, medical or scientific, presented in a way the lay reader can understand and assimilate more easily. That’s why the title works. That’s probably why my Idiot’s Guide to LCHF and Banting continues to be one of the most well-read articles on Foodmed.net – and the good writing too, of course 😉 I won’t be changing it.
Really????
Dr. Noakes warns against consumption of alcohol. However, William Banting, creator of the Banting diet recorded in his book – Letter On Corpulence – his daily menu which included 4-5 glasses of wine plus a shot of whiskey. The diet worked for him.
There is so much conflicting information out there that my head sometimes starts to swim and I lose all desire to change anything. I have been trying to follow a LCHF diet in some form but it has not been going well. I am recently reading that I should avoid all fruit. I thought that could help my sweet tooth. But now I am seeing that nothing but omitting fruit AND all sugar will help me. I definitely know I am a sugar addict.
I don’t understand eating low protein when the suggestions of what to eat include meat, eggs, dairy etc. Can you further explain what low protein means?
And my biggest problem is the fact that I don’t really care for most vegies. I need to learn how to tolerate them, cook them, and enjoy them. No matter what the rest of my diet looks like, not eating many veggies has always been an issue. Knowing I can cover them in butter or cheese has helped.
What about coconut or almond flour in attempts to make some sort of bread?
I appreciate how you feel. There is a huge amount of confusing information out there. Don’t know who told you LCHF is low-protein, but that’s not correct. From my research so far my understanding is: LCHF is moderate protein, not low or high. The recommendation is protein at every meal, roughly the size of the palm of your hand. Carb/veg intake depends on the state of your health and degree of insulin resistance. The sicker you are, the lower in carbs you should go. If you are really sick, then below 25-50g may be recommended, otherwise below 200g. In the beginning, it is often easier to stick to a few foods you know you will enjoy and that meet all the basic requirements of an LCHF lifestyle: 80% fat, 10 to 15% protein, 5 to 10% carbs, depending on your health status. Coconut and almond flours are great for ‘breads’, not easy to work with at first. The Lifebake range of products is fabulous – grain- and sugar-free crackers and ‘toast’, also a granola – available at Dischems. Fresh Earth Bakery http://www.freshearthbakehouse.co.za/ makes a great ‘Banting’ bread. Pick n Pay stocks them and other outlets.
Joan, the information out there other than Banting, lchf, WB-WoE, Perlmutter, etc. is food-industry driven and is unhealthy for humans . And since you’re here, reading I’m sure you have the ability to come to your own conclusion for your personal health and start turning back the clock!
My husband has the same problem. He does not like cooked veggies. Likes salad, but only the common garden salad. Loves fruit and we never though it was a problem to eat to much. He is not overweight and always does a few excersies and likes to walk. He wants to go on this woe.. Any suggestions
Baie interessant en insiggewind om hierdie artikel te lees. Verstaan die Bantingleefstyl nou baie beter. Hoe bevoorreg is ons om Prof Tim Noakes in ons land en as een van ons mense te ervaar en te beleef. Ons waardeer al u navrsing.
Ek het tot die gevolgtrekking gekom dat elke persoon of individu self moet eksperimenteer met hom/haar eie liggaam tov vet, groente en proteïne inname. Dit is nie altyd maklik nie maar ‘n mens moet maar net aanhou en aanhou volgens die riglyne en totdat jy jou eie ratio vir jou liggaam bepaal het.
Ander vraag. Die Xylitol, Stevia ens – is dit nie goed vir ‘n mens op die langduur nie? Ongelukkig is ek ‘n suikerverslaafde en gebruik stevia omdat dit van blare van ‘n plant kom – mens raak die smaak gewoond. Het reeds 31.6 kg in 1 jaar en 4 maande verloor. Voel baie beter en gesond, maar drink nog steeds my nexiam 20 mg vir maag asook ‘n halwe betastopper 5 mg pilletjie vir vinning hartklop. Miskien moet ek my Banting vriendelike GP gaan besoek en dat hy toetse neem. Sukkel net geweldig met krampe in die bene in die oggend voor ek opstaan.
Ook nie meer ‘n kind nie – word 70 jaar in Des. 2016 – voel gladnie so oud nie. Weet nie of dit korrek is nie, maar gebruik Slow Mag vir krampte, help nogal. Ek probeer regtig hard om die suikergewoonte te breek – maar kry dit reg vir so 2 weke en dan is ek terug op stevia.
Nogmaal baie-baie dankie vir die insiggewende navorsing van Prof Noakes en spanlede – dit word opreg waardeer.
Enige voorstelle hoe ek totaal van die suikerverslaafheid ontslae kan raak?
Hi Anne-Marié – apologies for the reply in English … Afrikaans I can read, but replying (beautifully) in it would be really difficult. Regarding the cramps – I would say it might be because of low sodium levels. I had the same problem. I had to increase salt intake, but I also believe you can just soak in epsom salts (take a bath in the stuff – lie in it). That should hopefully help. Regarding sugar – I am also an addict, and it is difficult. Nothing except cutting it cold-turkey helps me … if I try to find replacements then I am still satisfying my sweet-tooth and that always comes back to bite me. Keep healthy snacks around (biltong etc.) and have that when you crave some sugard. I also wholeheartedly recommend the website http://www.dietdoctor.com. Study everything on it … after that you feel like you can conquer anything. I visit it regularly and it helps me stay on track.
Agree with all you say, Fatima. I know the doctor behind http://www.dietdoctor.com, Dr Andreas Eenfeldt. Very smart guy, very open mind! We need more doctors like him in the medical profession. His site is a treasure trove for anyone who doesn’t want to pop pills as first resort. Heartily recommend it.
In regards to cramps you need to stay hydrated also. The more water I drink the less cramping I have. May like to increase your water intake and see if that eliminates some of your cramping.