University of Cape Town emeritus professor Tim Noakes generates abnormally high levels of venom from doctors and dietitians for a spectacular about-turn in favour of low-carb, high-fat (LCHF) in 2010. Noakes is facing a charge of ‘unprofessional conduct’ for tweeting his opinion to a breastfeeding mother that the best weaning foods for infants are LCHF – in other words, meat and veg.
Here, in the first of an updated two-part Q&A session with me, Noakes makes a tasty ‘real meal’ of critics – and the trial against him. He refers to his new research to be published soon that will challenge conventional ‘wisdom’ once again.
By Marika Sboros
Attacks aimed at Prof Tim Noakes are limited only by the imagination. They are as personal as they are professional in nature: At best, critics call him misguided, at worst a killer quack who flouts the Hippocratic oath. They label his theories on low-carbohydrate, high-fat (LCHF) eating as “bad science”, “dangerous” and “criminal”. He has documented them in the best-selling The Real Meal Revolution that is known as the Tim Noakes Die. ( If you’re thinking of starting on the LCHF path, read my Idiot’s Guide to Tim Noakes. )
Attacks on him intensified with publication of the so-called “Stellenbosch review” in PLoS (Public Library of Science) One in 2014. It’s a meta-analysis of 19 international studies, led by Dr Celeste Naude of Stellenbosch University’s Centre for Evidence-based Medicine.
In its wake, an army of cardiologists, endocrinologists, epidemiologists, the Heart and Stroke Foundation of SA, the Association of Dietetics of SA (ADSA), and the Health Professions Council of SA (HPCSA) popped up, all claiming that Noakes’ “diet” is dangerous.
Next, top UCT academics wrote a letter to a Cape newspaper in August 2014 accusing Noakes of “outrageous, unproven claims about disease prevention”. Prof Wim de Villiers, then dean of Faculty of Health Sciences (now Rector of the University of Stellenbosch) signed the letter. So did Prof Bongani Mayosi, then head of the Department of Medicine (now Dean of the Faculty of Health Sciences) and Dr Marjanne Senekal, then Head of UCT’s Division of Human Nutrition and still with the university.
Emeritus professor, cardiologist Dr Lionel Opie’s signature appears on the letter. Opie has since denied in an email to Noakes that he signed the letter.
The authors attacked Noakes for “maligning the integrity and credibility of peers who criticise his diet for being evidence-deficient and not conforming to the tenets of good and responsible science”.
Good read: NOAKES: LOW-FAT CAUSES HEART DISEASE!
I’ve been in personal contact with De Villiers and Senekal, and email contact with the rest to see if they have changed their minds in the interim. I’ve asked inter alia, if they’ve read the evidence for benefits of LCHF to treat obesity, heart disease, diabetes, cancer and even dementia. (Some doctors now call dementia “type 3 diabetes” because of its links with diet.) So far, they’ve all declined to comment.
Noakes, formerly professor of exercise and sports science and director of UCT’s Research Unit for Exercise Science and Sports Medicine, wrote to the university pointing out that the letter was defamatory. He also explained that there is solid science behind his diet. Ditto for The Real Meal Revolution
With word-of-mouth advertising only, in the first six months after publication in December 2013, his book has sold more 100 000 copies. That makes it South Africa’s bestseller ever. It has sold 250 000 copies so far, and been translated into Dutch, with a German version coming out soon.
The book’s runaway success appears to serve only to infuriate critics.
Noakes donates all royalties to The Noakes Foundation, which he established to research nutrition and challenge scientific dogma. In addition, he has donated more than R1 million to The Smile Foundation that funds the surgical repair of South African children born with the cleft palate deformity.
Ironically, everything Noakes writes in The Real Meal Revolution is in Time magazine’s cover story on the science behind benefits of dietary fat in June 12 2014. That put him ahead of Time. It created something of an inconvenient truth for critics – how to prove him wrong when science proves him right.
Things became even harder for Noakes’ critics last year when the research arm of a multinational investment bank entered the fray. The influential Credit Suisse document entitled Fat: The new health paradigm mirrored conclusions Noakes has been making for the past six years.
So what’s really behind attacks on Noakes? He is an internationally renowned scientist. He is one of few in the world with an A1 by the National Research Foundation – for expertise in both nutrition and sports science. He is also a medical doctor.
Noakes has learned the hard way about the perils of challenging medical and dietetic orthodoxy and the vested interests propping it up.
In Part 1 of a Q&A session, I put the most common criticisms to him:
What changed your mind about carbo-loading in 2010?
I discovered the work of (Eric) Westman, (Jeff) Volek and (Stephen) Phinney that had been suppressed, as described in The Big Fat Surprise, by Nina Teicholz. Those scientists are now friends of mine. It’s no surprise I hadn’t seen their work. I didn’t realise the degree of suppression of the large body of evidence showing the beneficial effects of low-carbohydrate diets for a range of medical conditions. Most especially for those with the most prevalent medical condition across the globe – insulin resistance. That’s condition that I have.
Their book, The New Atkins For A New You, opened my eyes and quite literally saved my life. Had I not discovered that book and converted to the LCHF in 2010, my diabetes would probably by now have been uncontrollable even with high doses of insulin. I now know that the future is not good for the diabetic who is on insulin.
Does the “Stellenbosch review” really prove your diet doesn’t work?
No. The researchers chose to include only those studies that would favour their bias. Thus they included studies that allowed much higher carbohydrate intakes than we promote in the Real Meal Revolution. In addition, they chose studies in which the energy intake of both groups of subjects was equal and controlled. This completely negates the key advantage of the Banting (as LCHF is known in South Africa) diet which reduces hunger.
As a result, Banters can naturally eat fewer calories without being hungry. In contrast those eating calorie-restricted low fat diets – the comparators in the Naude study – are perpetually hungry when forced to eat as few calories as the Banters eat without experiencing hunger.
The study is fatally flawed and that’s why it has not been taken seriously by the international community. In addition the authors ignored published research that contradicted their findings and which showed that subjects eating properly low-carbohydrate diets – that is 20-50g/day and not the 200g/day included in the Naude review – did better and lost more weight than those eating Naude’s “healthy balanced diet in moderation”.
Why do you advocate going so low in carbs?
There is a critical threshold for carbohydrate intake below which you get massive benefits, above which you don’t. Orthodox dietitians don’t understand that. That’s why their advice on weight loss fails. This is a game of “inches”. If you don’t get the carbohydrate intake exactly correct for each individual, the outcome is failure. The same applies to sugar. Since sugar is so highly addictive, you have to remove it completely from the diet or the diet will fail. One cannot eat an addictive substance like sugar “in moderation” any more than one can use cocaine in moderation. It’s either nothing or it’s all.
Do you endorse all protein as good on your diet in The Real Meal Revolution?
No. The Real Meal Revolution is about real food, pasture-fed meats, organic food wherever possible and not processed in any way. People need to read the green list in the book.
Are you a fan of fruit and veg?
Yes and no. The idea that fruit and vegetables are healthy is commercially driven. You can trace it back to the industry in 1995 that promoted the 5-a-day idea without any good science. On the green list, we promote lots of amazing vegetables that are high in nutrients, low in carbohydrates. For example: leafy vegetables, broccoli, cauliflower and kale. These will give you all the fibre you need.
One media report said the only fruit you eat is apples?
I’ve never said that. I don’t eat apples. I only berries – they have the least sugar and most nutrients. My favourite fruit is coconut. I suspect it has some special health benefits.
Is your “Tim Noakes diet” ketogenic?
It can be ketogenic, but doesn’t have to be.
What’s a ketogenic diet?
One so low in carbohydrate and protein (protein will act as a partial carbohydrate), and high in fat, it causes blood ketone bodies to rise.
What’s a ketone?
Any of three natural chemicals produce from fat in the liver in response to a low-carb diet. Instead of burning glucose, the brain cleverly decides: let’s burn ketone bodies. Ketones are probably the most efficient body fuel.
When should a diet be ketogenic?
It depends. The sicker you are, the more ketogenic you need to be. If you have uncontrolled diabetes, if you have epilepsy or perhaps want help to manage cancer or dementia, then you will want to be in more marked ketosis. If you just want to lose weight or run better, your diet doesn’t have to be ketogenic.
You were diagnosed with diabetes three months after starting your LCHF diet. Critics say that proves your diet doesn’t work, and caused your diabetes. Do they have a point?
That’s unbelievable logic: if you do one thing – eat a high-carbohydrate diet for 33 years – then change it for three months, what you did for the previous 396 months is irrelevant. In other words, the diabetes epidemic is from everyone suddenly eating high-fat diets across the globe. Let’s get back to the facts. My father died of Type 2 diabetes which puts me at a 10-fold increased risk. Unfortunately, for 33 years, I followed Diabetes Association guidelines that said as long as I ran my marathons and ate a high-carb diet, I’d never get diabetes. They were wrong – very, very wrong.
Your critics say you take medication for diabetes, which proves your diet doesn’t work. Surely they have a point?
No. I just had to face facts. I was insulin resistant. I ate a high-carb diet for three decades before I started a high-fat diet. Doctors should have made the diagnosis of diabetes years before. I have evidence that was already profoundly insulin resistant at the age of 28. That’s when I was lean, running at least 120km/week and racing marathons.
But I’m my own doctor – the worst thing. I was focusing on my “perfect” blood cholesterol concentration and my reasonable blood glucose levels. I didn’t understand then that one diagnoses diabetes by measuring insulin and HbA1c concentrations. Had I done those simple tests 20 years earlier and changed my diet to LCHF then, I would not have type 2 diabetes now. I would simply just be profoundly insulin resistant. That’s a completely benign condition if one does not eat more than 25g of carbohydrate each day. After diagnosis, I thought I could get by without medication. I spoke to specialists I trust internationally who confirmed the diagnosis of diabetes. He said I should take medication.
So what did you decide?
If I was being treated conventionally but still eating my high-fat diet, I probably could get by without medication. But I want perfect control. I want my glucose to be as good as anyone without diabetes. I’m nearly there. By not eating more than 25 g carbohydrates per day, I do not have any spikes in my blood glucose concentrations even though my normal fasting values may be slightly higher than normal. I think it is the spikes and the associated over-secretion of insulin that causes the widespread arterial damage that kills in type 2 diabetes. So that’s the goal of my treatment.
Critics, including the UCT academics who wrote the letter to the Cape Times still insist your views on LCHF are unscientific and based only on anecdote. Are they right about the anecdote?
No. Science is my lifeblood. I understand the scientific method better than 99.9% of my critics, especially the ones who speak this garbage. It is a measure of their own ignorance and laziness. They are not prepared to read all the literature and especially the information that conflicts with their preconceptions. All of medicine begins with anecdote. Jenner started the vaccination theory based on anecdote. Scientists determine the truth on the basis of clinical trials, personal experience, and what patients tell us. None is more important than the other.
At each level of evidence it is abundantly clear: if you are insulin resistant, there is only one safe diet for you to follow and that is one that is low in carbohydrates. The biological basis for this statement is irrefutable. Those who deny it simply do not understand the biology of insulin resistance and carbohydrate ingestion.
But is there any gold-standard RCT evidence for your diet?
Yes. The first year after I made dietary changes, I didn’t know enough to make definitive statements. I’ve been reading the literature since – everything on both sides. I focused on the high-fat diet; turns out there is solid evidence in favour of it, and none, absolutely none, in favour of the low-fat diet. The evidence for high fat has been suppressed, but has been accumulating; it’s all there, in The Big Fat Surprise.
More importantly with Canadian colleagues we have completed the first large scale trial of this diet in a free-living population in Canada. The results were utterly revolutionary. They are due to be published in a medical journal soon. They show that this diet does things for the health of those with obesity and the metabolic syndrome that conventional medical care simply cannot achieve. Its publication will pose a huge challenge for conventional medicine. I am so keen to see how my critics are going to spin their way out of this one.
Why is that?
It shows that the “healthy” diet they promote is the cause of the ill-health they claim is being caused by “my” LCHF diet. The question for Stellenbosch Rector (Wim) de Villiers and UCT medical Dean Bongani Mayosi is: how will they cope with the publication of this paper. Will they simply ignore it as if it does not exist – as they seem to have done for all the other evidence showing the value of the LCHF diet? And what will Prof (Marjanne) Senekal do with her hospital-wide order that no doctor at Groote Schuur Hospital may prescribe the low-carbohydrate diet for any patient?
What happens when their patients suddenly learn that the only proven long-term solution for their metabolic ill-health is a low carbohydrate diet – not bottles of drugs that do not address the causative mechanisms – insulin resistance compounded and exacerbated by high carbohydrate diets?
I am so glad I got out of this mess six years ago.
- Part 2 – Noakes on why so many physicians are ‘doctors of disease’
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