HPCSA pins its hopes on this man to nail Noakes

Advocate Ajay Bhoopchand

By Marika Sboros

Health Professions Council of SA (HPCSA) advocate Ajay Bhoopchand has spent two days cross-examining Prof Tim Noakes. He hasn’t got far in achieving any major concessions. He still has time but will he be the one to nail Noakes?

Prof Tim Noakes

The HPCSA is clearly pinning all its hopes on him. The HPCSA brought him in as a part of team of outside lawyers once it became clear that its case against Noakes was failing.

Bhoopchand appears to be keeping for last his attempt to force concessions from Noakes on two studies. Both are key to the HPCSA’s case against him.

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. He tweeted that good first foods for infant weaning were LCHF.

In his cross-examination so far, Bhoopchand has challenged Noakes on his qualifications. He has also challenged Noakes’ expertise in nutrition in general and infant nutrition in particular. He said that Noakes was a medical doctor but not a paediatrician, neonatologist or dietitian. And that had not practised clinical medicine since 2000.

Noakes easily batted off those challenges. He told the hearing that currently he was one of few scientists with an A1 rating globally for both exercise science and nutrition. It wasn’t possible to be expert in sports nutrition without also having expertise in nutrition for all ages, he said.

Twitter and doctors under the spotlight

Bhoopchand appeared to have missed the point that clinical experience on its own is not always irrelevant. Noakes pointed out that clinicians relied heavily on research that academics generate to support and implement their practice.

Bhoopchand also spent an inordinately long time on the suitability of Twitter for health professionals. He conflated it with face-to-face interaction between doctor and patient. He also said Twitter was not suitable for doctor-patient consultations.

If his sub-text was a suggestion that Noakes really was in a doctor-patient relationship on Twitter, it withered under legal scrutiny.

As a result, Noakes had a field day with Bhoopchand’s views on Twitter. He pointed out that all HPCSA’s expert witnesses admitted that they knew little to nothing about Twitter. The same applied to members of the HPCSA’s Preliminary Inquiry Committee that first decided to charge him.

Click here to read:  ‘Dog did not bark’ – proof of his innocence?  

Anointed power wanes

Noakes said that Bhoopchand did not understand the “new world” of social media. It was the “future of medicine”, he said. It meant that the “power of the anointed” was giving way to the “wisdom of the crowd”.

Bhoopchand also tried butting heads with Noakes on the evidence for low-carb, high-fat (LCHF) foods. He suggested that a 1995 French study Noakes had presented showed that it was protein, not carbs, that made babies fat.

Noakes speedily despatched that. He gave Bhoopchand a mini-lecture on the difference between association and causation. He also covered at length the inbuilt limitations of associational research.

But it is Noakes’ evidence on two other studies that Bhoopchand will likely be keen to undermine.

One is a study by researchers at two of South Africa’s top universities – Cape Town and Stellenbosch. The HPCSA has based its whole case on that study. Noakes has said that the study was fatally flawed. If that is the case, then so was the HPCSA case against him.

The study is titled Low carbohydrate versus isoenergetic balanced diets for reducing weight and cardiovascular risk: a systematic review and meta-analysis. It has become known as the “Stellenbosch Review” and the ” Naudé Review”. That’s after lead author Dr Celeste Naudé of Stellenbosch University’s Centre for Evidence-based Health Care. However, it’s actually a Stellenbosch-UCT-Cochrane Collaboration review.

Secret report

It is a review of 19 studies, including randomised controlled trials (RCTs). HPCSA expert witness Prof Este Vorster referred to it in her special report that the HPCSA Preliminary Inquiry Committee commissioned. The committee kept the report secret from Noakes and used it to charge him.

UCT Prof Marjanne Senekal, left, and North-West University Prof Este Vorster
UCT Prof Marjanne Senekal, left, and North-West University Prof Este Vorster

In his evidence in chief, Noakes told the hearing that “some important people in this trial are involved in that paper”.

Co-authors of the study include Dr Jimmy Volmink, a former colleague of Noakes’ at UCT. Volmink is now dean of Stellenbosch Faculty of Health Sciences. Another co-author is Dr Marjanne Senekal, associate professor of nutrition at the University of Cape Town.

Senekal is now a consultant for the HPCSA against Noakes. She is co-author of the “UCT academics letter” to the media in 2014. Her colleagues included former UCT dean of the Faculty of Health Sciences, Prof Wim de Villiers, now Stellenbosch vice-chancellor. Noakes’ lawyers consider the letter highly defamatory.

Click here to read the  academics letter and his response.

Flaws and bias

Noakes told the HPCSA hearing that he and British obesity researcher Dr Zoe Harcombe had done their own analysis of  Naude’s review. It has gone through the peer-review process and been accepted for publication by a medical journal. It showed that the review was flawed and biased from the outset against the low-carbohydrate diet.

Noakes also presented evidence that the researchers intended to publish their study in February 2013 but only did so in July 2014. He speculated that this may have been because results were “not what they really wanted”. They had to  “ do something to make the results more acceptable”.

That’s a “big jump”, Noakes told the hearing,  because “we all trust everyone and I am a scientist and I trust people to be honest”.

In it their analysis, Noakes and Harcombe question just how the authors of Naude’s review manage to make so many important errors and not spot them in time.

“Because remember,” said Noakes, “ when you sign your name on the paper you are accountable for the errors.”

Harcombe will be an expert witness for Noakes and will give detail on the errors.

Cochrane Institute going down the wrong path?

Noakes told the hearing that Naudé had recently been appointed to lead the Cochrane Nutrition with guidance from an international advisory board.

“This person, who may have made serious errors in this paper, is now being charged with the responsibility of running this Cochrane Institute,”  he said.

She may have bias against low-carbohydrate diets, Noakes continued. It was, therefore, probable that she would reflect that bias in her position at the Cochrane Institute.  Its vision, he said, was that Cochrane would be the “independent globally recognised go-to place for nutrition systematic reviews.

“Cochrane Nutrition will support and enable evidence-informed decision-making for nutrition policy in practice by advancing the production use of high-quality, globally-relevant, nutrition-loaded Cochrane reviews. Therefore, (Naude) will be deciding the future of nutrition in South Africa and this organisation will be determining it,” he said.

The second research in Bhoopchand’s sights is a joint Canadian-South African lifestyle intervention study. The lead author is South African-born Dr Stephan du Toit who now lives and works in British Columbia in Canada. Noakes is a co-author of the study and has identified implications for the HPCSA charge against him.

He pointed out that De Villiers, in the UCT academics letter, had said that LCHF would damage the health of adults who go on it.

First boost for LCHF

“We are the first people in South Africa to provide absolute evidence for a diet that works and that is the difference: (LCHF) is the diet that works.”

Data from the Canadian study showed that the high-carbohydrate diet people were eating was the more likely cause of their metabolic syndrome, he said. And that cutting carbs reversed it.

If the study had tested a drug “people would be signing up to give us a Nobel Prize because this effect is profound”, Noakes said. “We have affected every single risk factor of the heart disease on this diet and it is the diet that did it.”

Yet few experts have taken any notice of the diet. Noakes speculated that this was because  “no-one is going to make money out of putting people on a high-fat diet”.

He referred to what Canadian media have reported as a “bombshell report” by a senate committee of Canadian senators calling for a total overall of Canada’s food system.

“These are totally independent senators who have no connections to other outside interests,” he said.

Noakes referred to the work of US expert Dr John Ioannidis, who he called “an absolute genius a professor of medicine at Stanford University”. Ioannidis has written eloquently on where evidence-based medicine has gone wrong. His implication was that “perhaps medicine is not as helpful to humans as it might be, Noakes said



  1. What actually needs to happen now is for the panel to take charge of this hearing and set deadlines for everyone. No more long winded repetitive cross questioning by either side. No more long winded answers to questions. It should be made clear to all concerned that this has gone on for far too long and that there will be no more extensions of the hearing beyond 26 October. Whatever point is reached by that date will be the end and the panel will then weigh up all the evidence and reach a decision.

    I have attended brief spells of the current hearing and I heard nothing new.
    This should be about the health of all South Africans but instead it has become a contest of egos. Enough.

  2. I support Prof. Noakes 100%, have been on the lchf for over a year and lost 18kg’s. My blood pressure used to be 140/90 is now 120/80 I am 46 years old, my blood sugar is normal, healthier than ever and my confidence boosted! I don’t crave sugar or any starchy food. Had my fair share of ridicule, and stuck by LCHF. And a couple of people had to swallow their own words! Just to add my cholesterol also came down! Happiest I have been in a very long time! GO PROF. NOAKES. I’ve got your back!!!!

  3. It’s not up to Tim how long this farce takes! He is being cross examined and the advocate keeps going over and over the same ground in order to waste time and prevent the witnesses testifying – raising the prospect of yet another adjournment and more expense! Scandalous!

  4. I support Tim Noakes 100%. I have participated in the banting (LCHF ) life style for over a year now and have lost 35 kgs and never felt better. I also conducted a lot of my own research on the matter on the internet and kept an open mind of both arguments for and against , and in hundreds of docs and articles that i have read ….my conclusion is Tim Noakes is correct……Tim you have my fullest support.

  5. Was on meds for type 2 for years getting worse and they wanted me to go on insulin.. Went sugar free and low carb and high fat and guess what…Normal sugars and my new Dr has said my next HBA1C should confirm what he calls in remission. LCHF works just wished and found out sooner. The person who initiated this circus should go and hang her head in shame.

  6. I am a 64 year old female who has suffered from digestive problems all my life. I have benefitted tremendously from a low carb diet. No more indigestion or heartburn and more energy that has enabled me to up my physical excercise.
    I wonder if this trial has anything to do with big pharmaceutical business, those who produce heartburn medicacation? I care for old people and every single one of them is prescribed serious digestive medication.
    Another thing, what will happen to the Pap an Bread industry if, on mass, low carb is taken seriously in SA?
    Just asking.

    • Maria, if low carb became standard, as effectively it was for our grandparents, when caution was advised about carbohydrates, shares in the pharmaceutical industry would plummet. And all the junk food producers would be hit equally hard. That’s why it’s in their vested interest for their friends in the dietitians association to pursue this vendetta. It probably seemed like a good idea at the time, but it’s been folly built on stupidity. I can’t quite work out if dietitians genuinely believe the nonsense they feed to the public or whether they’re just following orders. All the good dietitians, like Caryn Zinn and Zoe Harcombe have to work outside of our official health systems.

  7. Dare I suggest that Tim should try and create space for his expert witnesses who must still take the stand. In other words Zoe Harcombe and Nina Teicholz. Tim and Mr Boopchand are tediously re-plowing well worked ground which has been thoroughly churned up over the course of the hearing to date. It has all been said and it is in the record for those who must consider the evidence. No need to keep rehashing it all. In other words keep your answers as short and sweet as possible. The future of LCHF in South Africa is in play

  8. Thank you to all the brave people promoting the truth about what really can make us healthy rather than continuing to promote symptom relief as a first measure. There are so many forces who have financial interest that it is a wonder we can ever get at the truth but it seems it is here, finally. It is so refreshing and inspiring to see.

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