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.

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.

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.

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 21^st 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:

• Low-Carbohydrate versus Isoenergetic Balanced Diets for Reducing Weight and Cardiovascular Risk: A Systematic Review and Meta-Analysis
• The universities of Stellenbosch/Cape Town low-carbohydrate diet review: Mistake or mischief?

•  Reliable systematic review of low-carbohydrate diets shows similar weight-loss effects compared with balanced diets and no cardiovascular risk benefits: Response to methodological criticisms

• 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 Foodmed.net articles have right of reply.