By Marika Sboros

Top doctors and scientists in the US, Canada and Australia have signed an open letter to the Health Professions Council of South Africa. They want the HPCSA to stop prosecuting scientist Prof Tim Noakes for allegedly tweeting “unconventional advice” that was not evidence-based. They provide evidence to show that his tweet was evidence-based and thus not unconventional.

Among the signatories is Australian cricket team physician Dr Peter Brukner. Brukner is a professor of sports science at La Trobe University.

Others include leading US, Canadian and Australian endocrinologists, obesity specialists, obstetricians and gynaecologists, oncologists, orthopaedic surgeons, anatomical pathologists, nephrologists, internal medicine specialists, anaesthetists, psychiatrists and researchers.

They have disseminated the letter as a petition. At last count there were more than 9000 signatures. (Editor’s note: the number is now above 11,000.) Many of those are doctors, other health professionals and scientists.

The HPCSA is appealing its own committee’s comprehensive not guilty verdict for Noakes. That was in April 2017 on a charge of unprofessional conduct. The appeal takes place at its Pretoria offices from February 21 to 23, 2018.

The HPCSA has objected to a request by Noakes’s lawyers to introduce new evidence. It shows that dietitians from the Association for Dietetics in South Africa (ADSA) had inside help from the HPCSA to set him up.

In a related move, South African paediatric surgeon Prof Alastair Millar has called the HPCSA’s case against Noakes ” madness and wasteful”.

“It makes one ashamed to be listed on the HPCSA register as a medical practitioner.”

Prof Alastair Millar

It beggars belief that the HPCSA has the “audacity” to spend R10m on trying to rubbish the opinion of one of its own. This opinion,  by all scientific evidence’ was “sound dietary advice”, Millar said.

That’s especially significant given the obesity epidemic that is “obvious for all to see, every day all around us”, he said.

Millar calls for “sense to prevail”. He expressed the hope that HPCSA Chair Dr T K S Letlape and Vice Chair Dr R L Morar would “be persuaded to halt this madness and wasteful expenditure”.

A driver of the petition is Dr Sarah Hallberg. Hallberg is Medical Director, at Indiana University Health Arnett. She is also Virta Health Medical Director.

Hallberg was lead author of a peer-reviewed Virta study that  Diabetes Review published recently.  It is a one-year trial showing that a low-carbohydrate, ketogenic diet puts 61% of patients with type 2 diabetes into remission.

The petition letter notes “many disturbing ethical issues” in the HPCSA’s treatment of Noakes. However, it focuses on the charge that Noakes’s  tweet  was “unconventional advice”

In it, he said that good first foods for infant weaning are LCHF (low-carb, high-fat). The HPCSA claimed that this was unconventional because it was “not evidence-based”. And because it conflicted with South Africa’s dietary guidelines for infants and adults.

Thus, the HPCSA claimed that the tweet was “dangerous”.

No danger

The petition letter states that Noakes’s tweet is, in fact, evidence-based. All signatories acknowledge this fact.

Dr Sarah Hal1berg

They present a large body of scientific evidence with references for LCHF diets.They say that researchers have now tested low-carbohydrate diets in more than 70 clinical trials on nearly 7,000 people. These include a wide variety of sick and well populations.

Thirty-two of these studies have lasted at least six months and six trials went on for two years.

“That’s enough time to demonstrate the lack of any negative side effects,” the letter’s authors say.

And in virtually every case, the lower-carb, higher-fat diets did as well or better than competing diets.

Thus, the cumulative evidence shows that low-carb diets are “safe and effective for combating obesity“. These diets are also highly promising for the treatment of type 2 diabetes. And they improve most cardiovascular risk factors, the authors say.

Moreover, the best-available data from the US government shows that in 1965, Americans ate 39% of calories as carbohydrates and 41% as fat. These percentages are what nutrition researchers now consider to be within the realm of a “low-carbohydrate, high-fat” diet.

Therefore, all Americans, including infants (the population Noakes’s tweet addresses) were formerly on the sort of diet that he favours.

“This was, of course, before the epidemics of obesity and diabetes from which so many nations suffer today,” the authors say.

LCHF aligns with SA’s paediatric guidelines

They note that LCHF aligns closely with South Africa’s paediatric guidelines. (Editor’s note: All the HPCSA’s expert witnesses against Noakes conceded that fact in their evidence.)

The guidelines currently advise: “From 6 months of age give your baby meat, chicken, fish, or egg every day as often as possible. Give your baby dark green leafy vegetables and orange coloured vegetables and fruit every day.”

“This advice is entirely consistent with a low-carbohydrate, higher fat diet,” the authors say.

As well, results from the PURE study that The Lancet published recentlysupports Noakes’s advice. PURE is the largest-ever and only truly global epidemiological study. It shows that populations with the highest-fat and lowest carbohydrate consumption had the lowest rates of total mortality

Taken together, these findings “firmly support” the information Noakes tweeted, the letter’s authors say. Further, “virtually no rigorous clinical trial data exist to contradict this body of evidence”.

Thus, from a scientific perspective, the evidence overwhelmingly supports a diet low in carbohydrates and high in fat as “evidence-based”.

The US-based Nutrition Coalition has supported the petition.

  • I am co-author with Prof Tim Noakes of Lore of Nutrition, Challenging Conventional Dietary Beliefs (Penguin 2017). I am contributing author to Healthy Eating, The BIG Mistake by Dr Verner Wheelock (Columbus 2018)
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