By Marika Sboros
The Health Professions Council of SA (HPCSA) has faced its fair share of obstacles in its road to prosecuting scientist Prof Tim Noakes. For example, major obstacle was research showing that negative effects of conventional dietary advice on adults but also on infants in their most formative years.
US investigative journalist Nina Teicholz was an expert witness for Noakes at the HPCSA’s fourth session of the hearing against him in Cape Town on October 25, 2016. She gave explosive testimony, as this first of a two-part series shows.
Why was her evidence so explosive? Well, for starters, 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 babies are LCHF (low-carb, high-fat). In other words, he suggested meat, fish, chicken, eggs, dairy food and vegetables.
In her evidence, Teicholz showed that Noakes’ tweeted opinion was actually evidence-based. Therefore, it was not “unconventional” and “dangerous” scientifically, as the HPCSA was alleging.
Experts could consider his views unconventional in that they conflicted with South Africa’s low-fat, high-carb dietary guidelines these days, Teicholz said. However, they wouldn’t have considered his views unconventional as recently as 1965, as she demonstrated.
A big, fat surprise!
In her testimony, Teicholz drew heavily from her book, The Big Fat Surprise. It’s a seminal, unique work published in 2014. It is also the fruits of 10 years’ research into what one wouldn’t ordinarily think of as a murky world: nutrition science.
Unusually for a lay author, Teicholz has had reviews of her book in top medical journals. The American Journal of Clinical Nutrition (AJCN), a premier journal in the US, has said of The Big Fat Surprise that “every nutritional science professional and all scientists should read (it) as an example of how limited science can become federal policy”.
The AJCN described her book as a “historical treatise on scientific belief versus evidence”.
In The BMJ, former editor Dr Richard Smith was similarly expansive. In a three-page review, Smith said that the book “shook” him. Teicholz had done “a remarkable job in analysing the weak science, strong personalities and vested interests in political expediency”.
The Economist named The Big Fat Surprise the Number 1 science book of 2014 and called it a “nutrition thriller”. Teicholz joked that that’s “probably an oxymoron”.
Murky world of nutrition science
Still, her book is a detailed and fascinating, forensic journey into the murky world of nutrition science. It reveals the policy, personalities, politics and influence of industry in the construction, implementation and maintenance of official dietary guidelines. It is often an ugly picture.
In the book, Teicholz analyses the last 50 years of nutrition policy in the US. This is particularly as it relates to dietary fat and cholesterol. She also looks in depth at the current influential US dietary guidelines the government introduced in 1980. And how the guidelines lacked robust science to back them up.
Teicholz showed how, in the ensuing years, most countries, including the UK and South Africa, have followed the US model.
In her evidence, Teicholz looked at the science to support the guidelines’ low-fat, high-carb recommendations when the US first introduced them. She showed that top scientists knew that there was evidence to the contrary. They simply ignored or suppressed the evidence for decades.
The consequences for public health have been nothing short of tragic, she told the hearing. Teicholz said that the US guidelines have been a major contributor to the pandemics of obesity, diabetes and heart disease.
As an aside, the US Dietary Guidelines Advisory Committee now warns that low-fat diets actually cause atherogenic dyslipidaemia. In other words, low-fat raises the risk of heart disease. Few writers, other than Teicholz, have picked that up.
Just as shocking, Teicholz told the Noakes hearing that official dietary advice deprived infants and children of vital dietary fats needed to absorb vitamins and other nutrients during their most formative years.
More than ‘just a journalist’
The sub-text of her evidence throughout was that the same applied to South Africa’s dietary guidelines.
Critics of Teicholz have often tried to dismiss her as “just a journalist”. Bhoopchand wisely didn’t go there. After all, Teicholz has an impeccable academic pedigree. She studied science and politics at Yale and Stanford Universities (her undergraduate degree is from Stanford, in American studies). She also has a master’s in philosophy from Oxford University in the UK.
Teicholz has told me that her education in political science had served her as well as her courses in science.
“Unfortunately, the story of nutrition policy over the past 50 years is just as much about politics as science, perhaps even more so,” she said.
Click here to read: HPCSA case against Noakes falling apart at the seams
Teicholz told the hearing how her nutrition journey began: with an investigation into trans fats for Gourmet, a food magazine, in 2004. Consequently, this assignment introduced her to the “world of fat”.
“Fat is what we obsess most about in nutrition,” Teicholz said, “how much fat to eat, what fat, good fat, bad fat, low-fat, non-fat.”
Have we ‘got it all wrong’?
Her research into transfat quickly threw up an intriguing possibility. It is that everything we thought we knew about dietary fat “is completely wrong”. And that US nutrition policy had probably gone “completely upside down and backwards as to what we should be eating”.
Teicholz is not given to sweeping statements. She is thoroughly grounded in the scientific method. One of the many strengths of her book is her dogged, critical, independent approach to research. She did not rely on summary statements or review papers. Instead, she went back to all the original papers, sometimes back to the original data.
In many cases, scientists tried to hide their data – some of it published in foreign language publications. Teicholz hunted those down too and got someone to translate the studies professionally.
She interviewed hundreds of scientists, most of them top in their fields in the US and internationally. Some interview subjects said in hushed tones that they “couldn’t talk about fat”. They slammed the phone down. Teicholz wrote that she had found that unsettling and that she felt at times as if she were “investigating the mob”.
The analogy was not lost on Noakes and his lawyers.
In her trial testimony, Teicholz covered the work of US physiologist Ancel Benjamin Keys who studied the influence of diet on health. Keys believed strong that dietary fat caused heart disease. He called his belief the diet-heart hypothesis that became a pillar of US dietary guidelines.
Teicholz showed how his belief still lies at the heart of dietary guidelines across the globe today.
Teicholz also described how, in the 1960s in the US, the only group telling people how to eat and what lifestyle habits to have to avoid a heart attack was the American Heart Association (AHA). The AHA did so firmly under the guidance of Keys.
In 1961, the AHA began advising men not to eat saturated fat and dietary cholesterol. This was the very first official advice anywhere in the world telling people to avoid saturated fat and cholesterol to prevent heart attacks, Teicholz said. “This was where it was all born,” she said.
And from there, as she showed, it spread globally and reached South Africa’s shores.
- Part 2: Why low-fat diets can kill
- Click here for exclusive coverage of The Noakes Trial
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- Main image: Rebecca Read from Pixabay