University of Cape Town emeritus professor Tim Noakes loves challenging convention and being challenged. ‘It’s when I learn,’ he says. Noakes has challenged conventional ‘wisdom’ seven times in his distinguished career. He has been proved right six times. He expects the same to happen when he goes back on trial in October 2016 in his latest challenge: to conventional ‘wisdom’ on diet. In the second of a 2-part series, he reveals what really drives him. – Marika Sboros
By Tim Noakes*
Click here to read: NOAKES IN HIS OWN WORDS: ‘WHY I CHOOSE TO GO ON TRIAL’ – PART 1
(iii) My campaign to prevent deaths from over-drinking during prolonged exercise
In 1981 I received a letter from a lady requesting my help after she almost died during that year’s Comrades Marathon footrace. At the time, the only “conventional” theory was that athletes do not drink enough during exercise.
It would have been assumed that her dire condition was because she had drunk too little during exercise. The lady wrote to me because I was then the medical editor of the magazine, SA Runner, and my function was to write a monthly column offering free “advice” to runners.
Intrigued to discover what had happened, I initiated a 30-year research program (that is still ongoing) to answer that question. As a result, I became an acknowledged international authority on fluid and electrolyte balance during exercise.
By 1991, we had provided definitive scientific proof that this never-before-described exercise condition from which she suffered, was caused by over-drinking of fluids for many hours with abnormal fluid retention. Fifteen years later, we had established the biological mechanism that explains why only some who over-drink either at rest or during exercise develop this condition.
I had yet to understand the exact biological mechanisms involved. But already by 1983 I was almost certain that over-drinking caused this condition. I began to warn that unless athletes were educated against over-drinking during exercise, fatalities would occur. I even predicted that these deaths would first appear in female runners in marathon races in the US.
As I had predicted, the first such death from over-drinking occurred in a female marathon runner in California in 1993. That was a tragedy which by then we had proven was utterly preventable.
In 2012, my book Waterlogged: The Serious Problem of Overhydration in Endurance Sports was published. It records my 30-year battle to convince athletes that they should not listen to the “conventional” advice to drink “as much as tolerable” during exercise.
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Waterlogged evaluates all the relevant published scientific studies. It concludes simply that athletes should drink only when they are thirsty and then only as much as they need to curtail their thirst. Much of the research that has advanced this understanding was undertaken in our laboratories.
In 2015, opposition to this idea finally capitulated. Now, athletes are advised to do what I said in 1983 – drink only to thirst during exercise. The dangers of following the previous “conventional” advice to drink “as much as tolerable” is now acknowledged. That this warning comes 30 years after I first spoke it, is a measure of how long it takes established medical practice to adopt “unconventional” ideas that were correct all along.
There is no doubt that without our work, many more athletes would have died needlessly from this completely preventable condition. In 2006, the influential American publication Runner’s World included this work as one of the 40 “most important peoples or events” in the previous 40 years in the sport of running. The work also earned an international award for research on water and medicine.
My stand on the Waterlogged issue is an excellent example of what I achieved by standing up against “conventional” advice. Already in 1983, I began to offer “unconventional” advice to South African athletes at all costs to avoid over-drinking during prolonged exercise such as the Comrades Marathon.
As a result, there has never been a death from over-hydration in a South African runner. (One death occurred in the military in 2012, in a recruit who died from a combination of heatstroke and over-hydration. We have since published the full details of this unique case since it occurred in a military exercise that we were studying).
Had I remained quiet and allowed South Africans to receive only the “conventional” drinking advice being given in the US from the mid-1980s to today, there could potentially have been tens, perhaps hundreds, of deaths in the Comrades Marathon alone.
(iv) Evidence that exercise is regulated by the brain and is not limited by fatigue in the skeletal muscles (caused by lactic acid).
When I began my career in the exercise sciences in 1981, the (only) model of fatigue promoted in 100% of all textbooks around the world was one in which the development of lactic acidosis in the exercising muscles limits exercise. I soon realised that this model does not explain a number of common, easily observable phenomena.
Over the next 30 years, we have produced a body of evidence that irrefutably disproved this too simple theory. In its place, we developed an alternate model – The Central Governor Model of Exercise Regulation. This is now widely, if not yet universally, accepted as the more correct model. In this model, it is the brain which regulates exercise performance specifically to ensure that we do not harm ourselves each time we exercise.
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Acceptance of this new model has completely changed the teaching and research in the exercise sciences around the world.
(v) The need for managed periods of rest for South African professional rugby players.
In 2004, I was appointed medical consultant to the South African Rugby Board with special responsibility to work with Springbok coach Jake White in preparing the team for the 2007 Rugby World Cup.
In April of that year, I told Mr White that the key to the team’s success would be to ensure that the best 22 players “peaked” on the night of the World Cup Final. I warned him that to achieve this we would need to limit the amount of rugby that each player played especially during the final 12 months leading into the competition.
As described in his best-selling book, In Black and White, Mr White agreed. As a result, he almost lost his job in December 2006 when, on my advice, he rested selected key players by not including them in the End of Year Tour to Europe. Both Mr White and I were relentlessly criticised in the press and on the internet for following this plan.
But because I understand the relevant biology, I “knew” (as I had written extensively in Lore of Running) that it is simply not possible for the human body to survive the stresses to which our professional rugby players are exposed and still to be expected to produce peak performances in the matches that really matter.
In May 2007, again on my advice, Mr White withdrew key Springboks from the overseas leg of the Tri-Nations tournament. Again on my advice, he sent them home to rest. Many greeted this decision with disbelief.
In the end, the team that I had advised reached the day of the Rugby World Cup Final with 30 fit players ready for selection. The chosen 15 played the full 80 minutes of the game without substitution (other than for a brief blood injury), a feat that has not ever been achieved in a Rugby World Cup Final, before or since. The team dominated the game winning comfortably.
In an interview later, Jake White was asked why he put so much faith in one person’s opinion “against that of his superiors and seemingly the entire nation”. White responded: “I had full faith in what Tim said, because I knew he genuinely wanted South Africa to win. I always had the feeling in every meeting that he genuinely wanted to find ways in which we could have the edge over the opposition. He never gave me a reason to doubt him”.
Asked whether he thought by apparently challenging authority, I was interested purely in drawing attention to myself, White had this to say: “He was always composed when providing input. He never said to us, ‘Don’t do it like that, do it like this’. He always gave options and the pros and cons of both options”.
White also referred to a quality he felt I possess, and which he considers rare: being comfortable with having my views and counsel challenged by others: “It’s that intrinsic belief that if you want to find the leading edge in sports science you have to test theories and challenge principles – even your own. And he’s brave enough to do it”.
Passionate as I am about South African rugby success, I am even more passionate about promoting dietary changes that will make all South Africans more healthy.
(vi) The rotary action in cricket batting
On a lighter note, I encouraged Bob Woolmer to write the book I co-authored, Bob Woolmer’s Art and Science of Cricket. During the writing, I discovered the evidence, accumulated by Tony Shillinglaw (who by chance lives in Birkenhead – the suburb in which my parents lived before coming to Africa) that the greatest cricket batsman of all time, Sir Donald Bradman, used a different technique than that conventionally taught in the usual cricket coaching manuals.
I now have a PhD student, Habib Noorbhai, who is researching this topic. His first study established that 70% of the greatest batsmen of all time used elements of Bradman’s “unconventional” technique. A cursory analysis of almost all the best South African batsmen at the moment – Hashim Amla, AD de Villiers, JP Duminy, David Millar, Riele Rossouw, Quinton de Kock – show that they also defy the conventionally taught method and follow more nearly the Bradman method. Of the top South African batsmen, only Faf du Plessis is more “conventional”.
It is clear that any young cricketer coached to play cricket according to the conventional method has essentially no hope of ever becoming a professional batsman at international level.
This is an excellent example of how a “conventional” and accepted dogma continues to be taught even though the clear evidence available to anyone who watches cricket shows that it cannot be correct. The result is that only those who do not follow “convention”have a chance of achieving international success in cricket batsmanship.
(vii) Reversal of my position on the value of high carbohydrate diets for athletes and for long term health
In 1986, I published the first edition of my book, Lore of Running, in which I promoted the idea that a high-carbohydrate diet is essential for superior athletic performance and heart health.
I continued to promote a high-carbohydrate diet until my “Damascene” moment in December 2010, when I began to experiment with eating a low-carbohydrate diet. I then discovered that I had developed type 2 diabetes. That was as a result, in my opinion, of my genetic propensity (my father died from the complications of arterial disease caused by diabetes) and my eating a “healthy” high-carbohydrate diet for 33 years.
From reading the published literature, I concluded that I would be able to avoid the worst of the diabetic complications only if I ate a very restricted carbohydrate diet (less than 25g of carbohydrate per day).
Since then, I have exhaustively researched the science behind the low-carbohydrate diet including purchasing and reading well over 100 books on the topic and thousands of scientific articles.This exposure introduced me to ideas that, like most modern doctors around the world, I had not been taught during my medical training, as described in Challenging Beliefs and in The Real Meal Revolution.
Here are the 7 simple messages for the promotion of which The Noakes Foundation exists.
- Insulin resistance is the commonest medical condition present in a majority of the world’s populations;
- Those with insulin resistance who eat high carbohydrate diets develop persistently elevated blood insulin concentrations;
- Persistently elevated blood insulin concentrations (hyperinsulinaemia) over many years are the direct cause of many of the chronic medical maladies that currently plague modern societies;
- Obesity is a disorder of abnormal fat accumulation driven by hyperinsulinaemia (in those with insulin resistance eating more carbohydrate than their insulin-resistant bodies can handle);
- Obesity cannot occur without an associated dysfunction of the brain appestat that determines when we are hungry and regulates how much we eat;
- Dysfunction of the appestat is caused by the addictive, highly processed, industrial diet that has become the global norm since the 1977 Dietary Guidelines that demonised real foods as being “unhealthy”, paving the way for the current global epidemics of obesity and type 2 diabetes;
- The reversal of these conditions requires that we promote the consumption of real foods that do not cause hyperinsulinaemia and appestat dysfunction.
I believe that South Africa’s future prosperity a depends in large measure on whether or not we understand these messages so that we stop promoting dietary ideas that, in my opinion are the cause of grave ill health to the majority.
In conclusion: I have taken the position on diet that I do because of a deeply felt conviction that someone in South Africa has to stand up to what I, and a growing band of scientists and doctors globally, perceive to be poorly conceived dietary recommendations based on poorly conducted science.
The result, in my opinion, is a monumental error, arguably the greatest in the history of medicine, and which has had very serious consequences for our national and global health.
I believe that change will only occur through the action of those most affected – the global community suffering as a result of this incorrect advice. My commitment to this cause is such that I have formed (and funded the start-up costs) of The Noakes Foundation that receives all the (past and future) monies from The Real Meal Revolution and other of my activities.
The Foundation’s immediate goal is to raise enough money to provide R2 million per year in perpetuity to support South African research to discover the optimum nutrition. The work that we fund will be rigorously independent and transparent as all data collected in our funded trials will be provided to the global scientific community via the internet.
The goal is not to “prove” that I am correct but to advance knowledge by discovering truths that will improve the nutritional health of all South Africans.