Cardiologists: Noakes really is a ‘public health danger’!


By Marika Sboros

University of Cape Town cardiologists believe that Prof Tim Noakes is a true “cholesterol denialist”. They made the accusation in an open letter to the media in 2012. They say that it holds true today and that Noakes is a danger to the public.

In a previous article, I suggested that cardiologists might be at the heart of the hearing against Noakes. It resumes in Cape Town on October 17.

Cholesterol and hearts have been a focus of the Health Professions Council of SA (HPCSA) case against Noakes. Other bodily organs have also been a focus. So too are South Africa’s low-fat official dietary guidelines.

But it is Noakes’ views on the best diet for heart disease that really get cardiologists’ heart rates rising. Those views are one reason that the HPCSA has charged Noakes with unprofessional conduct for a single tweet. Noakes tweeted that good first foods for infant weaning are low-carbohydrate, high-healthy-fat (LCHF). For more background on the case, click here to read the real beef dietitians have with him.

No change of heart

There’s no evidence that any of the cardiologists who wrote the 2012 letter are directly involved in the trial.

I contacted the authors of the 2012 letter to see if any has had a change of heart in the interim. That’s particularly in the light of evidence on benefits of LCHF diets for heart disease. None has.

The authors are Patrick Commerford, at the time professor of cardiology and head of the cardiac clinic at UCT and Groote Schuur Hospital; Mpiko Ntsekhe, of the cardiac clinic at UCT and Groote Schuur; Dirk Blom, of the lipid clinic at UCT and Groote Schuur ;David Marais, of chemical pathology and clinical laboratory services at UCT’s Health Science Faculty; and UCT cardiologists Elwyn Lloyd and Adrian Horak.

Only three – Commerford, Ntsekhe and Marais – responded via email on their current opinions.

In their 2012 letter, they said that what has Noakes proposed (for treatment of heart disease) was “contrary to the recommendations of all major cardiovascular societies worldwide”. They agreed with some of his opinions but said that the LCHF diet was “unproven”. It may also be “dangerous for patients with coronary heart disease or persons at risk of coronary heart disease”.

They said that Noakes went “too far in suggesting that a switch to a high-fat, high-protein diet is advisable for all persons”.

No one-size-fits-all diet

Interestingly, Noakes’ dietary regimen is not actually high in protein. Rather, it’s high in what he considers “healthy fats”, including saturated. And he maintains that he has not ever said that his diet is right for everyone.  He has said that he recommends it only for those who are insulin resistant or want to lose weight.

But it is Noakes’ views on statins that seem really to get cardiologists really riled up. He has called the “the single most ineffective drugs ever invented”. He has also said that the diet-heart hypothesis was “unproven dogma”.

Click here to read: Don’t swallow whole what doctors say about statins

That hypothesis has been another leitmotif throughout this trial. It says fat in the diet equals fat in your arteries and causes “bad cholesterol”. Their theory is that because cholesterol clogs arteries, it is the major cause of heart attack or stroke (the so-called “lipid” hypothesis).

Dr Mpiko Ntsekhe
UCT cardiology professor Mpiko Ntsekhe

Ntsekhe is now professor of cardiology at UCT and Groote Schuur. In his emailed response, he says that advising people not to worry about their blood cholesterol levels and not to use statins is a form of cholesterol “denialism”.

Competing hypotheses

There is a “very big difference” between the cholesterol-heart (lipid)  hypothesis and diet-heart hypothesis, he says. While most heart specialists believe “strongly in the former”, they recognise that the latter is “contested space”, Ntsekhe says.

Statins’ mode of action is through altering cholesterol metabolism and there is “overwhelming evidence of life-saving efficacy”, he says. Thus, Noakes’ views on statins really do make him a “danger to the public”.

Statins are “central to the medical management and reduction of major adverse cardiac outcomes in patients with all forms of ischemic heart disease”, he says. The same applies to those at significant risk of developing ischemic heart disease.

Advising people not to use them is “potentially very dangerous”.

Benefit for statins

While Ntsekhe attacks Noakes on many points, he agrees that Noakes hasn’t got it all wrong. In the letter, he and colleagues said that Noakes’ views on the contribution of refined carbohydrates to the obesity epidemic were “almost certainly correct”.

However, Ntsekhe says that there is now “very strong evidence” that statins in patients with coronary artery disease improve mortality (they make you live longer). “Multiple placebo-controlled studies confirm this.”

He “still agrees strongly” that as an academic, Noakes should air his views in an academic forum and the medical literature. This would allow his peers to evaluate his views critically and challenge them.

Ntsekhe also “still agrees strongly” that to present “controversial opinions as fact to a lay public in (Noakes’) un-refereed book (Challenging Beliefs) is dangerous”. It is also potentially very harmful to good patient care”.

Last, but not least, Ntsekhe still “strongly agrees” that scientists and clinicians have “an ethical obligation to ensure that the information they impart to their patients and the public at large is correct, in line with best available evidence, and will not cause harm”.

The subtext is that Noakes does not meet that ethical obligation. That ties in with the HPCSA’s attempts to prove Noakes guilty of unethical conduct that so far haven’t been successful.

Scope for harm

Marais,  UCT professor of chemical pathology, says that the open letter aimed to “curb a global switch to a high-fat diet as there was scope to do harm”. Similarly, indicating that statins had no benefit created “scope for harm”. The letter did not go into detail because it was simply to “convey caution to the public”.

It is “important and correct” to say that lifestyle has an enormous impact on health, Marais says. That has “never been contentious”. However, there are many aspects to lifestyle and cardiovascular risk and doctors should “tailor  advice to the individual”.

Marais remains concerned about “generalising about diet and statins”.  People with severe inherited disorders could suffer harm if they followed advice to disregard dietary advice for specific disorders, he says. The same applies if they stopped taking medication (statins) “proven to be of benefit”.

On the fact that Noakes’ diet is not high-protein, Marais says “these diet descriptions seldom define exact quantities”. This makes it difficult to know exactly what the proponents are advocating. For example, “if the fat increases and the carbohydrate decreases, the protein could well increase”.

Commerford is now a UCT emeritus professor and editor in chief of the Cardiovascular Journal of Africa. He commented briefly to endorse all Ntsekhe’s comments and the contents of the 2012 letter.

He also said that the evidence for statin efficacy “has continued to rise over the last few years”.





  1. If eating saturated fat (triglycerides) causes heart disease then dieting off those same saturated fats should also cause heart disease. When you eat saturated fats those triglyceride molecules are too big to be absorbed from the gut into the arteries. So the digestive track breaks them down into three free saturated fatty acids and a glycerol. Those same triglycerides are locked up in your fat cells and are too big to exit into the bloodstream. So just like in the gut your fat cells break apart the triglycerides into free saturated fatty acids and a glycerol. Now it can exit the fat cell to be metabolized. Ok, lets do a thought experiment: you go to your cardiologist and tell him your eating a stick of butter/lard every day. He’s likely to tell you that you’re setting yourself up for heart disease. But, this same cardiologist might tell you to lose 100 pounds over the next year. So you lose it over the next 400 days. You’re losing your body fat at a rate of 1/4 pound per day (2 pounds every 8 days). Reasonable? It just so happens that dropping fat at 1/4lb per day is the equivalent of eating a stick of butter/lard every day. It’s the exact same fatty acids entering the metabolism but from a different pathway. So my question is this: if eating saturated fat causes heart disease why doesn’t dieting off saturated fat not cause heart disease?
    The reality is it has never been shown (proven)biochemically that eating saturated fats increase heart disease. I have learned to have little respect for cardiologists who still hold to the fort heart hypothesis

  2. I’m no longer that concerned about the QUANTITY of my “cholesterol” than its QUALITY. By eating the exact opposite of what the dietician told me I doubled MY HDL and reduced my trigs to 1/10 of what they were. LDL is probably still a bit high but at my age I see that as an advantage. Finally my GP has deleted the statins I no longer take from my repeat prescription, so that’s a step.

    Here’s weird, I went hypERthyroid and that reduced my LDL exactly as much as simvastatin. Would that be recommended as heart-healthy? I doubt it, but nothing surprises me any more.

    • The HPCSA refuses to say. It is funded by members’ fees and of course tax payers’ money, as it is a statutory body. The use of outside lawyers will have sent its costs into the stratosphere. It seems strangely unconcerned about costs in pursuing this case. Makes me think it is being funded by outside interests.

      • If the HPCSA is tax payer funded then, as part of that, ALL their funding SHOULD be completely transparent. It’s preposterous that they accept public funding without full disclosure.

  3. I am more concerned about a Trump victory and what happens to my heart thereafter. No amount of statins will alleviate the pain in my chest with a Donald as President!

  4. I get the impression that the HPCSA is going to go way beyond their original complaint about Prof. Tim Noakes’ advice given in a couple of Tweets over 2 1/2 years ago. Are they allowed to expand their list of complaints like that? If so, that doesn’t seem to fit with any definition of a modern system of justice to me.

    • You make a very good point, Gregg. The HPCSA has done a lot of “amending” of the charge in contravention of its own rule – dropping a word here, adding a date there. Noakes’ legal team has pointed all that out. The HPCSA has just carried on regardless. But it’s really not the worst that it has been up to. I expect more revelations when the trial resumes on October 17. Watch this space.

  5. To make such a glaring, factual error by claiming Professor Noakes recommends “HIGH protein” demonstrates how little these cardiologists actually know about the subject. If these cardiologists have so little precision with this basic fact about Professor Noakes, how we have confidence they understand the scientific research supporting Professor/Doctor Noakes claims?

    I read statins were invented by Japanese researchers. They shelved the idea of commercializing statins when they discovered statins to be bad. Nonetheless, an American drug company subsequently acquired the rights to manufacture statins. Currently, statins sales are a US$3.5 billion a year business. Do cardiologists prescribe statins? Follow the money.

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