By Marika Sboros
I’ve been thinking: could cardiologists be at the heart of the case against world-renowned scientist Prof Tim Noakes? The pun is intentional. Noakes really does seem to raise cardiologists’ blood pressure into the stratosphere with his views on low-carb, high-fat (LCHF).
Noakes’ trial on a charge of unprofessional conduct resumes in Cape Town from October 17 to 26. That was for two tweets saying good first foods for infant weaning are LCHF. In other words, he was advising meat, eggs, dairy and veg.
The Health Professions Council of SA, assorted academics and doctors (especially cardiologists), and Association for Dietetics in SA (ADSA) dietitians think that advice is rotten. Here’s what UCT cardiologists say about Noakes and his reply:
In a letter to the Cape Times in 2012, top UCT cardiology academics accuse Noakes of “cholesterol denialism”. They say his views are “dangerous and potentially very harmful to good patient care”.
In reply, Noakes says the theory that blood cholesterol and a high-fat diet are the exclusive causes of heart disease will prove to be, “like the miasma theory, one of the greatest errors in the history of medicine”. He says it’s time for doctors to admit that the theory has failed.
“We need to adopt an open mind if we are ever to discover the real cause(s) of the global epidemic of obesity, diabetes and coronary heart disease,” Noakes says.
Here’s the UCT cardiology academics’ letter in full, followed by Noakes’ reply:
“In his book, Challenging Beliefs, Professor Tim Noakes takes issue with and contradicts many aspects of conventional wisdom and accepted medical practice. Some of what he says may well be true and his views on the contribution of refined carbohydrates to the obesity epidemic are almost certainly correct.
“However, we believe he goes too far in suggesting that a switch to a high-fat, high-protein diet is advisable for all persons. Such a diet may have allowed him to lose weight and run faster but its widespread implementation is contrary to the recommendations of all major cardiovascular societies worldwide, is of unproven benefit and may be dangerous for patients with coronary heart disease or persons at risk of coronary heart disease.
Click here to read: STATINS: MAD, BAD WORLD OF CHOLESTEROL DRUGS
“Further, his questioning of the value of cholesterol-lowering agents (statins) is at best unwise and may be harmful to many patients on appropriate treatment.
“The very strong evidence is that statins in patients with coronary artery disease improve mortality (they make you live longer). Multiple placebo-controlled studies have confirmed this.
“Generic statins are now cheap and should be widely used. The side-effect profile of these agents is benign and there is general agreement that their benefits far outweigh any minor risks associated with their use.
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“Noakes is welcome to his views. As an academic, it would be appropriate for him to air these and to debate them in an academic forum and the medical literature where they could be critically evaluated and challenged by his peers.
“To present these controversial opinions as fact to a lay public, in his un-refereed book, is dangerous and potentially very harmful to good patient care.
“We understand some patients are placing their health at risk by discontinuing statin therapy and their prudent diets on the basis of this ‘expert opinion’. Having survived ‘Aids Denialism’ we do not need to be exposed to ‘Cholesterol Denialism’.
Click here to read: Noakes and ‘trial by ambush’
“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 signatories to the letter at the time are Patrick Commerford (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 Hospital), Dirk Blom (of the lipid clinic department of medicine at UCT and Groote Schuur Hospital), David Marais (of chemical pathology and clinical laboratory services at UCT’s Health Science Faculty), and cardiologists Elwyn Lloyd and Adrian Horak.
Here is Noakes’ reply to UCT cardiology colleagues’ 2012 letter in full:
“As I wrote in Challenging Beliefs, a 2010 meta-analysis of studies involving 347 747 subjects, published in the American Journal of Clinical Nutrition, found ‘no significant evidence for concluding that dietary saturated fat is associated with an increased risk of coronary heart disease or cardiovascular disease’.
“A 2011 report from the Cochrane Collaboration, an organisation that is independent of the pharmaceutical industry, found that ‘there was no clear evidence for dietary fat changes on total mortality or cardiovascular mortality’. Thus the scientific evidence is clear: a low-fat diet has no proven role in the prevention of (coronary) heart disease.
“It is time that cardiologists began to teach this fact in our medical schools.
“So if a high-fat diet does not cause heart disease then what does?
“In carbohydrate-intolerant subjects, like myself, a low-fat, high-carbohydrate diet produces all of the following abnormalities some of which are causally linked to arterial damage and heart disease:
- Elevated blood glucose, insulin and glycated haemoglobin (HbA1c) concentrations. The best predictors of heart attack risk are blood HbA1c and random glucose concentrations. Elevated values in diabetics increase heart attack risk 7-fold. In contrast, an elevated cholesterol concentration increases heart attack risk about 1.3 fold, a value low enough in statistical terms to be potentially spurious.
- Low blood HDL-cholesterol and high triglyceride and uric acid concentrations.
- Increased numbers of small, dense LDL-cholesterol particles. In contrast, a high-fat diet increases the number of large, fluffy LDL-cholesterol particles that are not related to heart attack risk.
- Elevated blood Lipoprotein (a) concentrations.
- Obesity and, in my opinion but as yet unproven, elevated blood pressure.
- Elevated ultra-sensitive C-reactive protein concentrations indicative of a whole body inflammatory state.
- Elevated blood homocysteine concentrations (due to dietary deficiencies in folic acid, vitamin B-6 and B-12 found in eggs and meat).
“If the cause of heart disease was truly known (as is the cause of HIV/Aids) then the condition should have disappeared with the promotion of the so-called ‘heart-healthy prudent diet’ and the annual prescription of tens of billions of dollars’ worth of cholesterol-lowering drugs globally.
“Yet one of the leading causes of death in the US is now chronic heart failure caused by coronary heart disease. To service its burgeoning heart disease problem, the US now requires twice the number of cardiologists currently in practice (17 000).
Click here to read: Noakes in his own words: Why I choose to go on trial
“If current dietary and therapeutic advice were effective, cardiology and cholesterol-lowering drugs should be going the way of the dinosaur. Instead, both are major growth industries. No wonder both fear ‘cholesterol denialists’.
“In 1900, when most Americans cooked in lard and ate a diet full of butter and dairy produce, pork and saturated fat in meat (but low in sugar and processed foods), heart disease was so rare that their most famous cardiologist, Dr Paul Dudley White, encountered his first case only in the 1920s (although the disease has since been described in grain-eating Egyptian mummies).
“Today in a nation that has replaced animal fats and dairy with ‘healthy’ carbohydrates, heart disease, like obesity and diabetes, is rampant.
“With regard to statin therapy, I advise anyone who does not have established heart disease or genetic hypercholesterolaemia, and who is either already taking or considering using cholesterol-lowering drugs, to read The Great Cholesterol Con (2006) by Anthony Colpo.
“This book should also be required reading for all my colleagues who are prescribing these drugs or who plan to do so in the future.
“The theory that blood cholesterol and a high-fat diet are the exclusive causes of heart disease will, in my opinion, prove to be, like the miasma theory, one of the greatest errors in the history of medicine.
“It is time to admit that the theory has failed.
“We need to adopt an open mind if we are ever to discover the real cause(s) of the global epidemic of obesity, diabetes and coronary heart disease.”
What I find interesting about this correspondence is that the UCT letter clearly breaches the HPCSA’s code of conduct. The code says one health professional should not denigrate another by name. The doctors are probably just lucky Noakes did not complain to HPCSA about it. Ditto for the many dietitians who have similarly maligned him.
Still, one would have thought the HPCSA could have shown a little initiative. After all, one of its stated functions is to “guide the profession”. It could have whispered in these doctors’ ears that it is unedifying, not to mention unprofessional, to attack a colleague in the media in this manner.
Which brings me back to who may be behind the HPCSA’s case against him. Dietitians appear to be prime movers. Johannesburg dietitian Claire Julsing Strydom set the ball rolling with her “horrified” reaction to advice Noakes gave on Twitter. Oddly, that’s advice Strydom and ADSA routinely give.
However, ADSA and its dietitians are likely to be proxies. And cardiologists do seem to have a really big problem with Noakes. Johannesburg cardiologist Dr Anthony Dalby is another who is on record saying that Noakes could be killing people with his LCHF advice.
Interesting too, is that Noakes’ UCT colleagues published another denigrating letter against him in the Cape Times in 2014.
Click here to read: Noakes: backlash begins as UCT ‘big guns’ fire wildly
Signatories to that letter include head of Faculty of Health Sciences at the time, Prof Wim de Villiers, and nutrition associate professor Marjanne Senekal. That letter also includes signatures of two cardiologists: Prof Bongani Mayosi and emeritus professor Lionel Opie. Opie has since denied that he signed it. In an email to Noakes, he said he was in hospital undergoing major surgery at the time.
De Villiers, Mayosi and Senekal have all declined to comment, despite repeated requests.