Naudé Review: toxic brew of mistakes, mischief against Noakes?


By Marika Sboros

The Naudé Review by South African scientists, published in PLoS One in 2014, was once the foundation of medical and dietetic opposition to low-carb, high-healthy-fat (LCHF) foods. It is under international scrutiny once again in the Health Professions Council of SA (HPCSA) case against scientist Prof Tim Noakes.

Dr Celeste Naudé

The Naudé Review is named after lead author Dr Celeste Naudé, a nutrition academic at Stellenbosch University. Her co-authors include Stellenbosch dean of Faculty of Health Sciences Prof Jimmy Volmink, UCT associate professor of nutrition Marjanne Senekal and Liverpool School of Tropical Medicine researcher Prof Paul Garne.

They all seem to be hoping that their SAMJ response puts the scientific dispute to bed. If they are hoping for that, then their hope is fond.

The researchers claim that they made no mistakes and no mischief in their study debunking LCHF  and the credibility of scientist Prof Tim Noakes who pioneered it in South Africa. They don’t use those exact words. However, Noakes and British obesity researcher Dr Zoë Harcombe say that’s the gist of their letter that the SAMJ has just published.

Prof Tim Noakes

Noakes and Harcombe published their analysis of the review in the SAMJ in December 2016. They found major errors. Therefore, they concluded, the review findings are “not robust”. That’s scientific speak for wrong.

Noakes and Harcombe don’t use the words “scientific fraud” – yet. Instead, they  diplomatically asked: “Mistake or mischief?” However, if the errors were not honest mistakes, then mischief is a euphemism.

So, are these academics giving “alternative facts” to try to silence Noakes? Why should you (or anyone) believe the Naudé authors when they say there was no monkey business against Noakes?

Vested interests at work?

The problem is the seminal role that the review played in the HPCSA’s case against Noakes. It gave the authors a significant, vested interest in fudging whether there was any “mischief”. At the very least, until the HPCSA’s case against Noakes is over. (Scroll down for links to all the studies.)

It’s common knowledge by now that the HPCSA has charged Noakes with unprofessional conduct for a single tweet to a breastfeeding mother in February 2014. Three years later, the case is still dragging on.

It resumes in Cape Town on April 3 and 4, 2017 for legal argument from both sides. The Chair of the Professional Conduct Committee hearing the charge against Noakes Pretoria advocate Joan Adams,  will rule on April 21, 2017.

Science and destiny

The Naudé Review and the HPCSA trial appear to go so well together, it’s no wonder the dietitians might have seen it as destiny in actions.  However,  there’s a charged background to the Naudé Review. And the deafening silence from the vice-chancellors of the universities to the claim of “mischief” tends to speak volumes.

Click here to read: Proof that SA scientists tried to smear him?  

In the SAMJ letter, the authors create the impression they have addressed all the errors, which Noakes and Harcombe have identified. They haven’t – at least not as I understand it. And if I’m right, then they have either made more “honest mistakes” or more “mischief”.

Just one example: the authors say that they “used data from intention-to-treat analyses (and only if not reported … used data from per-protocol analyses)”. They also say that they “did not report values the wrong way around”. Even with my glasses on, I still see their numbers as the wrong way around.

For the rest, I don’t see any rebutting of errors.

Naudé et al also insist that they studied low-carb diets. However, as Harcombe pointed out, they did not. She has speculated that that’s likely the result of their well-documented support for industry-led, high-carb, low-fat dietary guidelines. The researchers seem chronically unable to understand what a low-carb diet is and is not.

A scientific Groundhog Day?

The authors suggest that Noakes and Harcombe have themselves erred and “show lack of understanding of current methods in evidence synthesis”.

Yet the National Research Foundation recently renewed Noakes’s A1 rating as a scientist, making him one of the few in the world with that rating. In other words, Noakes is an acknowledged world authority in his research fields: both sports science and nutrition.

Harcombe, who recently completed her Ph D, is a specialist in nutrition and obesity research.

The Naudé reviewers say that they “welcome scrutiny and comments”. They say that having considered (Noakes and Harcombe’s criticisms) “carefully”, they “stand by” their review results. The researchers “also report that in overweight and obese adults randomised to low-carbohydrate or iso-energetic balanced diets, there is probably little or no clinically important difference in average changes in cardiovascular risk factors for up to two years”.

They appear stuck in a scientific Groundhog Day. They appear, as a contact on Twitter has reflected, to be giving “alternative facts”.

Thus, the Naudé Review authors probably intend their letter as a distraction from their real intention.

Click here to read: ILSI ‘queenpins’ trying to nail him? 

My guess is their intention is the same as that of anti-Noakes media responses to the study. These hailed the study in 2014 as “debunking Banting” and discrediting Noakes. Yet the Naudé Review never mentioned Banting or Noakes.

The authors never bothered to correct the impressions.

It’s likely the same reason that a mainstream media report on the SAMJ letter also immediately trumpeted it as giving Noakes a “fat lip” in the “Banting wars”. Where that headline comes from is anyone’s guess.

Shaky pillar of case against Noakes

But there’s another reason that the Naudé Review authors may be unwilling – or unable – to admit to any mischief.  The Health Professions Council of SA (HPCSA) has used it as the pillar of its case against Noakes.

Dietitian Claire Julsing Strydom

That’s not just my opinion. It’s straight from a dietitian “horse’s” mouth, so to speak  – Johannesburg dietitian Claire Julsing Strydom herself. Strydom set off the “Nutrition Trial of the 21st Century”, as the public has dubbed the HPCSA case against Noakes, by lodging a complaint against Noakes.

In her evidence at the November 2015 trial session, Strydom had special words to say about the Naudé Review.

Strydom said that she and “many big organisations” were waiting for the Naudé Review. That raised the question why and for what were they waiting? To make public statements about Noakes and LCHF diets, she said. Who were those organisations? Strydom never said.

Noakes and his legal team may have missed a trick in not asking.

Still, you didn’t have to look far to find who those organisations were and are. You just have to look at all the big organisations that responded quickly and positively to the review in the media in 2014. Among them were the HPCSA, the Heart and Stroke Foundation of SA and, of course, the Association for Dietetics in SA (ADSA). Strydom was ADSA president at the time.

And of course, Naudé Review author, UCT nutrition professor Marjanne Senekal. Senekal went on to become a consultant to the HPCSA in its ongoing quest to nail Noakes.

Why all the secrecy?

The review featured frequently in evidence by the HPCSA’s expert witnesses against Noakes. One was North-West University nutrition professor Hester “Estee” Vorster. She did so in a secret report the HPCSA Preliminary Committee of Inquiry commissioned in July 2014. I say “secret” because the Committee didn’t bother to let Noakes see Vorster’s report before charging him, despite their legal obligation to do so.

In it, Vorster refers to the Naudé Review before it was published the very next month.

That report was part of evidence in the HPCSA trial against him, which his legal team undermined with embarrassing ease.

The first response from Naudé Review authors was to ignore my emailed requests for comment. Instead, they sent a statement to a Cape Town newspaper a few weeks later. In it, they said that Harcombe had conceded in her evidence for Noakes at the October 2016 hearing session that she was wrong about their study. I don’t know if Senekal told them that (she also isn’t saying) as she was consulting at the hearing. However,  it’s simply not true. All her colleagues have to do to find that out is to read the trial transcript.

You don’t have to take my word for the implications of the dietitians latest foray against Noakes. Read the three articles below and make up your own minds:

  • I have emailed Noakes and Harcombe for comment. They say that they will comment at an appropriate time. I have emailed all the Naudé Review authors for comment. So far, none has replied. All those mentioned in articles have right of reply.





  1. This all reminds me a bit of how Frank Hu dissociated himself from the results of the Patty Siri-Tarino metastudy which he co-authored along with Ron Krauss.He made himself look either dumb or devious since the same ground had already been covered in an earlier but not well known metastudy by Andrew Mente

    and since by several others. Redoing “science” over and over again until you get the results you/your sponsors require isn’t science

    Thanks to Robb Wolf for retweeting this one

  2. Just over three years ago I started LCHFing (Cannot abide the word Banting) after reading the Real Meal Revolution. There is no question that the impact on the markers for Metabolic Syndrome was dramatic with all 5 such markers improving in the context of weight loss of 25KG. I maintained very strict LCHF until about 4 months ago when I fell off the wagon and indulged my undoubted sugar addiction. Once again the impact was dramatic with immediate weight gain of about 7 KG. Having said that I always remained aware of the impact of sugar. Interestingly my blood tests have not reverted to my pre LCHF days although there has been some slippage. I have now shed 3 KG of that regained weight.

    My point is that I have now visited the extremes and complete subservience to LCHF is undoubtedly problematic from the point of view of long term maintenance even for those with very strong discipline. It should all be more about balance unless your health is in absolute terminal disarray. I believe that the message needs to change slightly with far more emphasis on the avoidance of added sugar and minimising the intake of processed food containing sugar. Advice to avoid processed food completely like bread and the odd muffin or chocolate simply guarantees eventual failure.

    Getting the balance right takes three to four years after which the important message should be:

    Avoid all ADDED sugar
    Minimise but do not exclude the odd piece of bread or muffin of chocolate
    Enjoy the odd potato or other similar carb rich natural foods
    Keep fit
    Manage your blood pressure

    Most important of all…..try and find ways to encourage the scientific and dietary community to work together rather than score points off each other to the detriment of all the metabolically disabled

    • Anton, I agree with much of what you say, particularly about sugar.

      We’re all different and some people clearly do find bread and muffins hard to resist, but it’s not everyone. Since I started eating LCHF I feel in control of my appetite and not the other way around. I no longer want sugar, bread or muffins. Maybe I’m lucky not to have that sugar addiction.

      As for the ADSA, what an incompetent organisation. They’re a scientific laughing stock. The idea that Zoe Harcombe admitted she was wrong about their study is ridiculous. Are they entirely dishonest or entirely incompetent?

      • Probably the most important goal of the global health industry is to create awareness of the fact that sugar is a highly addictive substance and encourage parents, in particular, to guard their children against the dangers of this addiction. Parents know full well that drugs, tobacco and alcohol are addictive substances and are very proactive in guarding their children against these toxic substances. The same tying needs to happen with sugar

  3. It is remarkable the time and energy and resources invested in attempting to keep the public at large ignorant of the benefits of low-carb, high-fat. Looking at it purely from a layman’s perspective, since when is it a crime to advise people to eat healthily? Refined carbohydrates and sugar are just about POISONOUS to one’s system. Patrick Holford was forced to “tone down” his advocating of Vitamins..he would not e able to practice otherwise. I’ve just finished watching a Ted-x talk by Dr Sara Hallberg. There are many, many, others who advocate LCHF.

    The ignorance amongst medical professionals is astonishing, and one can only wonder at what motivates those who engage in this kind of un-informed idiocy. The anecdotal evidence alone is overwhelming. Prof Noakes is a hero for standing up to Big Pharma and their idiotic, conscience-free, well-paid mafia.

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