By Marika Sboros
Something about scientist Prof Tim Noakes and his views on the role of carbohydrate and fat gets the Health Professions Council of SA very hot under the legal collar.
The fourth session of the HPCSA hearing against Noakes began in Cape Town on October 17. Some nutrition experts – and legal analysts – have suggested that so far, the evidence shows that Noakes is streets ahead of the HPCSA prosecution team. Its lawyers appear to be careering into one dead end after the other. Particularly when it comes to nutrition.
Noakes told the hearing that humans have “absolutely no essential requirement for carbohydrate”. There is no human disease that a deficiency of carbohydrate causes, he said. Carbohydrate in the body serves only two functions. It is either used as a resource of energy or it is stored as fat, he said. “There is no other option,” Noakes said. That applies to weaning for infants as well.
HPCSA advocate Ajay Bhoopchand didn’t like that one bit. In cross-examination, he said that a low-carb diet for infants was dangerous – and by implication, so was Noakes. Here is the final of a two-part review of the hearing so far.
Human body designed to fail?
Noakes dismissed Bhoopchand’s view of carbs out of hand. He said Bhoopchand was introducing “a new model of human physiology to suggest that the human body is designed for failure”.
He was suggesting that humans evolved over three million years to fail; and that when there were no carbohydrates, children would die because they did not have an alternative fuel.
“That clearly doesn’t happen,” Noakes said.
“We are around, we are the survivors of all the generations before us. Humans are designed to survive. If there is no carbohydrate the body will produce ketones and that is how you will survive. We survived because of ketosis.”
After all, humans have only been eating cereals, grains and other carbohydrate foods for 12,000 years. That’s a drop in the evolutionary ocean, he told the hearing.
The HPCSA has charged Noakes with unprofessional conduct for giving unconventional advice to a breastfeeding mother on a social network (Twitter). That was for a single tweet in February 2014. Noakes tweeted that good first foods for infant weaning are low-carb, high-fat (LCHF).
Johannesburg dietitian Claire Julsing Strydom just happened to be on Twitter at the same time. She reported him for the tweet to the HPCSA the next day.
Strydom was president of the Association for Dietetics in SA (ADSA) at the time.
Click here to read The real beef dietitians have with him.
In cross-examination, Bhoopchand put it to Noakes that the saturated fat content of LCHF was dangerous. He said there was no science showing safety or efficacy. He also said that this was particularly risky for patients with familial hypercholesterolemia.
Noakes pointed out again that just as much as there are no definitive long-term data showing safety and efficacy of LCHF diets to treat and prevent serious disease, the same applied to high-carbohydrate, low-fat diets.
“It’s the nature and limitation of nutrition science,” he said.
Experts to buttress the evidence
UK obesity researcher and public health nutritionist Dr Zoë Harcombe, and US science and health advocate Nina Teicholz, are two of his expert witnesses. They will present evidence to support his views. They will also show that data do not support the model on which Bhoopchand has relied in his cross-examination.
Noakes’ third expert witness, New Zealand-based Dr Caryn Zinn, will testify on her experience as a registered dietitian. She has been using LCHF for adults, children and for enhanced sports performance for many years, without any ill effects.
Noakes told the hearing: “I submit that I am here because I understand that type-2 diabetes is the most important public health challenge in the world. There are 400 million people with type-2 diabetes as of today. There are 30 million people with HIV. Type 2 diabetes is tenfold greater than the issues of HIV and we kind of ignore it.”
Recent evidence in the British Medical Journal showed that in one year, US companies making diabetics drugs paid an astonishing $100 million to the doctors who prescribed diabetes medication in just 306 hospitals, he said.
Doctors ‘bribed’ to prescribe diabetes drugs?
Noakes said the evidence is clear that medical treatment for type 2 diabetes “simply does not work”. Treating patients with insulin makes no difference to their outcome, he says. Yet insulin is one of medicine best-selling drugs.
Noakes is as critical of insulin as of statins. He told the hearing that drug companies are having to “bribe” doctors prescribe drugs “that do not work”.
Noakes has consistently contended that insulin resistance lies at the heart of pandemics of obesity, diabetes and heart disease. The cost to healthcare systems is significant and shocking, he said.
In the UK, the direct cost of obesity to the National Health Service is more than £6 billion annually. Directly and indirectly, type-2 diabetes costs £20 billion. In the US, the cost of types diabetes reached $245 billion in 2012. Without appropriate action, these costs will are likely to double over the next 20 years.
“Those are frightening numbers because they are going to bankrupt not just medicine but the nation.
The remedy couldn’t be simpler or cheaper: carbohydrate foods cause the release of insulin the body, Noakes said. Over time, this leads to insulin resistance in susceptible individuals, he said. “Restricting carbohydrate can reduce and reverse signs of insulin resistance. It also allows people to reduce or do away with medication altogether to treat the condition.”
Spotlight on medical students
Yet medical and dietetic students were not taught much, if anything, about insulin resistance at medical school and university, he said.
Noakes finds it particularly frustrating that many scientists dismiss significant anecdotal evidence out of hand. “All of science begins with anecdote,” he said.
He quoted Albert Einstein: “No amount of experimentation can ever prove me right; a single experiment can prove me wrong.”
Bhoopchand suggested Noakes should not have made public health statements about nutrition without knowing what the population was eating.
Noakes asked: “Well sir, when did I ever make a public health statement on this?”
Bhoopchand held up Raising Superheroes, of which Noakes is co-author, and asked: “Is this not a public health statement?”
Noakes replied drily, “No, it’s a book.”
Bhoopchand appeared to meander far from the charge in many of his questions to Noakes. He contended at length that The Real Meal Revolution’s “green list” of recommended foods was “elitist”. Noakes conceded that some of the foods were expensive and some even “exotic”.
Cheap, nutritious foods
However, he drew attention to offal, sardines, pilchard, eggs, dairy products and vegetables that are within most people’s reach.
— Karen Thomson (@HELPdietSA) February 12, 2016
And anyway, the physiological principle remained regardless of where it was written, Noakes said. That principle was to eat high-fat, moderate-protein foods and cut out cheap cereals, grains and sugars.
Bhoopchand, rather bizarrely, I thought, argued that Noakes had a responsibility to tell people to eat cheap foods in line with South Africa’s official dietary guidelines. Chief among these are maize and “pap”.
Noakes said that he could not do that “in all conscience”. He had to be “true to the science. That is my nature,” he said. “If (science) says to me the food (people) are eating is wrong, I am not going to shut up.”
Maize and other grains and highly refined, processed foods might be cheap but their cost in terms of health effects on people, was high, he said. The socio-economic costs of these foods in terms of skyrocketing healthcare costs, absenteeism, lost productivity, stress on families, was significant.
Which diet is costly?
As a result, the really expensive diet was the high-carb, low-fat diet that official dietary guidelines recommend, not LCHF.
Click here to read: Idiot’s guide to LCHF
Noakes said that changing people’s dietary habits was an important part of the work of Noakes Foundation that he established to do independent nutrition research. The Foundation runs the Eat Better South Africa (EBSA). EBSA “starts with the poorest people who have been forgotten, absolutely forgotten by everyone”, he said.
He told the hearing that the EBSA worked with people in Mitchell’s Plein, Ocean View and elsewhere. The campaign has also devised LCHF diets costing between R15 and R30 a day.
“People have changed their diets, got rid of the grains and sugar, reversed symptoms of metabolic syndrome and in some cases been able to stop medication. We are a small group of people trying to change this country because we know it has to start right at the bottom.”
When all else failed, Bhoopchand suggested that Noakes had brought the hearing on himself.
“We are in fact here, millions of rands later because you did not pay adequate attention (to his written response to the HPCSA Preliminary Inquiry Committee that looked into Strydom’s initial complaint).”
Who failed whom?
Noakes replied: “We are here because the Preliminary Committee of Inquiry did not do its job.
Click here to read: Turf war over an ‘inconvenient truth’? PART 1
“I am glad I can put this on record and ask why the Committee did not, as it is mandated in its own rules, have a preliminary meeting where I was able to defend myself? And why the committee is anonymous, disappears and costs me millions of rands without giving me the right to defend myself?
“You have to ask the question: How was that possible? It was not my fault that the HPCSA, whose job who is to look after the profession – and I am part of that profession – and to protect the public, has not done its job properly.
Bhoopchand then suggested that Noakes wanted “special treatment” because of his status as an A1-rated scientist. That was the closest Noakes came to losing his temper.
“Absolutely not, that is just laughable. I am taking a deep breath,” he said. “I ask for nothing different than common decency. And you are saying common decency does not exist in the (HPCSA) and in the medical profession.”
Incriminating email chain
Noakes took special aim at the conduct of members of the HPCSA Preliminary Inquiry Committee that made the decision to charge him. The chair was University of the Witwatersrand head of medical bioethics Prof Amaboo “Ames” Dhai.
Noakes referred to an incriminating trail of email correspondence his legal team uncovered and entered as evidence at the February hearing session. It suggests highly irregular conduct by Dhai and other members of her committee. They include UCT emeritus professor of surgery John Terblanche and UCT psychiatry professor Denise White. White is now president of the South African Medical Association (SAMA).
Interestingly, SAMA invited Noakes to speak at its annual conference on October 22, 2016 but later withdrew the invitation. Despite her position as president of the organisation, White claimed not to know the reason.
In the emails, committee members went far beyond their remit not just in charging Noakes but in seeking to ensure that the case against him succeeded. One email refers to Noakes as “a high-profile celebrity” and says that the HPCSA should “expedite” the case against him. In another, Terblanche suggests Prof Wim de Villiers (then dean of UCT Faculty of Health Sciences, now vice-chanellor of Stellenbosch University) as an expert witness against Noakes. (De Villiers won’t say if the HPCSA asked him, but he did not appear.)
Bhoopchand dismissed this evidence as “conspiracy theory”. Thus, he said, Noakes was “probably not objective” about the committee’s conduct.
Noakes countered: “Do you know where the term ‘conspiracy theory’ comes from? You see, I was alive as you were in 1963 when (US president) John F Kennedy was murdered. The US Central Intelligence Agency (CIA) used the term conspiracy theory because they did not want anyone asking questions about what happened to Kennedy.
“So whenever you hear the word conspiracy, you have to be cautious. You must ask first: ‘Who spread the idea about a conspiracy theory?’.” (Bhoopchand, in this case.)
Noakes told the hearing that he did not believe in conspiracy theories. “I believe in the truth. Is there a conspiracy against me? I don’t know. I don’t care.”
He repeated that the HPCSA had clearly not gone through normal procedures in prosecuting him. “ I put the question back to you: Is it because I am a ‘celebrity’ that I am here? I am not a celebrity, I am a scientist.”
Noakes was highly critical of research literature on nutrition that industry funds. Industry-funded research was more often than not “profoundly biased”, he said. Noakes freely admitted that he had fallen into the same trap in his own career. He had agreed to do industry-funded research. “For 33 years, I couldn’t see my bias. I like to think I am an extremely ethical person, but I couldn’t see it,” he said.
Noakes said researchers needed to assume that every industry-funded study was suspect unless proved otherwise.
He also said that food and drug industries had “hijacked” evidence-based medicine. They are part of the reason that medicine today was “not working”.
Noakes also raised concerns about Strydom and ADSA’ links with food industries and doctors in their pay who promote unscientific dietary advice.
- Click here to read Part 1 of this review
- Click here for full, exclusive coverage of The Noakes Trial
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