ADSA – dealing with defeat in ‘Nutrition Trial of the 21st Century

By Marika Sboros

If defeat is best seen through the lens of a life lesson, the leaders of the Association for Dietetics in South Africa (ADSA) aren’t keen to learn anything.

ADSA has lost its bid to silence Prof Tim Noakes on the evidence for benefit of low-carb, high-fat (LCHF) diets. In response to online criticism that ADSA has become a “dietary dinosaur”, current president Maryke Gallagher has employed the services of a self-styled “crisis manager” – Hewers Communications CEO Neeran Naidoo. (Pictured above.)

Clearly, the organisation’s executives see the need for judicious reputation rehabilitation.

Gallagher has made it clear that ADSA will continue to dish out low-fat, high-carb dietary advice based on the South Africa’s official dietary guidelines.

That’s despite the Health Professions Council of SA’s  (HPCSA) comprehensive not guilty verdict on 10 points on the charge of unprofessional conduct against him. The ruling came down on April 21, 2017. The HPCSA’s Professional Conduct Committee set up to hear such charges made it clear in the ruling that his tweet was neither unconventional nor dangerous as the HPCSA alleged.

From the outset of this case, the public quickly dubbed the HPCSA’s hearing against him the “Nutrition Trial of the 21st Century”.

All over a single tweet

The hearing started after former ADSA president Claire Julsing Strydom, set off the HPCSA hearing against Noakes. In February 2014, Strydom reported Noakes for a single tweet  that good first foods for infants are LCHF.

Critics have taken to Twitter and Facebook to complain about ADSA’s involvement in the HPCSA’s protracted prosecution of Noakes .

Immediately after the not guilty verdict, ADSA released a public statement absolving itself of any responsibility in prosecuting Noakes. Naidoo has asked Foodmed.net to run the statement in full and we have agreed. (Scroll down to see it below.)

Click here to read: Real beef dietitians have with him!

Interestingly, Gallagher refused to clarify ambiguities and inconsistencies in the statement. She did so, she said, because Foodmed.net’s questions would “provoke debate” and “harp on the past”.

Who said anything about ‘extreme’ LCHF?

One question to Gallager was on ADSA’s statement that “current scientific evidence does not support an extreme low-carbohydrate, high-fat diet for babies”.

Yet Noakes did not tweet “extreme” LCHF for infants.

Gallagher would also not elaborate on why ADSA ignored all the evidence that Noakes and his expert witnesses presented at the hearing. It is all available on public record in the hearing’s transcripts. The HPCSA’s prosecution team and expert witnesses did not contest the evidence.

Noakes alone presented his evidence over 6000 pages, 1200 slides and more than 340 publications and articles on LCHF. His presentation also includes RCTs (randomised controlled trials) that scientists consider the “gold standard: of modern research.

In a recent newspaper opinion piece, columnist Andrea Burgener said that Noakes’ victory was “sadly, not based on a real understanding that (he) is better informed on nutrition than those hauling him over the coals”. It was also not based on an understanding that his advice on fats versus carbohydrates was “scientifically correct”.

Who should have been on trial?

Noakes “should not have been on trial”, Burgener said. Instead, “the whole damn mess that’s led to our dietary guidelines” should have been on trial.

Dietary advice that dietitians have handed out over the last decades “is hardly based on good science”, she said. For example, proper evidence linking higher saturated fat intake to heart disease or shorter life “simply doesn’t exist”.

Increasingly, journalists, doctors, biochemists and others who research the field, understand this, Burgener said. “For all sorts of reasons, including one called conflict of interest, our dietary advisors just don’t want to know.”

The public needs more information about how those involved in turning a Twitter complaint into a fully-fledged disciplinary hearing are also those defining our dietary guidelines, Burgener said. There also needs to be transparency about their financial links to institutions such as Coca-Cola, Kellogg’s and the South African Sugar Association.

“It might change our minds on whether we feed our kids bacon or bran flakes in the morning if we knew more.”

Below is ADSA’s statement, followed by the questions that Gallagher declined to answer – and a few more that cropped up since:

What ADSA believes

The Association for Dietetics in South Africa’s (ADSA) former president Ms Claire Julsing-Strydom submitted a complaint about Professor Tim Noakes to the Health Professions Council of South Africa (HPCSA) in 2014 on behalf of ADSA regarding what it considered unconventional infant nutrition advice.

ADSA lodged the complaint after Professor Noakes advised a mom via Twitter to “ween” (sic) her baby on to a low-carbohydrate, high-fat diet.

ADSA believed, at the time, that the advice:

• Was not based on current scientific evidence;
• Contradicted international and local guidelines for complementary feeding that organisations like the World Health Organisation has adopted;
• Could negatively affect a baby’s health, growth and development; and
• Was via Twitter without an examination or consideration of the baby’s health or age and therefore nutritional needs.

ADSA also considered it risky if other moms on Twitter took the same advice. Professor Noakes did not advise the mom to continue with breastfeeding, which undermined its importance.

For these reasons, ADSA considered the advice unconventional and requested the HPCSA to investigate further.

HPCSA’s role

The HPCSA is a statutory body to regulate registered healthcare practitioners and protect the public. The HPCSA considered the complaint and decided to hold an inquiry into what it considered “unprofessional conduct” that was “not in accordance with the norms and standards of your profession” and that Noakes “provided unconventional advice on breastfeeding on social networks (tweet/s).”

ADSA has lodged other complaints to the HPCSA to adjudicate in the past. Most cases are resolved mutually without the need for a detailed inquiry. It was never ADSA’s intention for this matter to span over three years and to progress to a hearing.

The HPCSA follows a specific disciplinary process for all complaints. This case has gone through all the necessary steps and couldn’t be resolved or concluded in the preliminary inquiry phase. The HPCSA has autonomy on the type of inquiry it wished to institute and ADSA has co-operated fully with their decision.

The formal hearings began in June 2015 and continued in November that year. The inquiry continued in February and October 2016. The hearings have now been concluded and the HPCSA has issued its verdict.

ADSA’s fears

ADSA was concerned, when lodging the complaint in 2014, that a strict low-carbohydrate, high-fat diet for babies would not meet all the nutritional needs of a growing child. Current scientific evidence does not support an extreme low-carbohydrate, high-fat diet for babies.

@notonlythetruth @MarikaSboros @ProfTimNoakes @Maryke_WW Public knows that @ADSA_RD are not the experts & are conflicted by industry. Here is how ADSA apparently treats SA’s diabetics. pic.twitter.com/e9OIj8mKzq

— Macro Four (@MacroFour) May 4, 2017

When foods rich in carbohydrates such as whole grains and legumes are avoided and other carbohydrate food sources such as dairy, fruits and vegetables are restricted, the diet can become deficient in certain essential nutrients, such as vitamin C, B1, B3, B6, folate, magnesium and fibre.

Because infants and young children are considered a vulnerable group, the potential for nutrient deficiencies is a serious concern. Deficiencies can compromise growth and cognitive and physical development. Restrictive diets for babies with medical conditions should only be followed under strict medical supervision with monitoring by suitably trained and registered healthcare professionals.

Dietary guidelines for feeding babies are developed by organisations such as the World Health Organisation and the United Nations Children’s Fund (UNICEF), based on a strong body of evidence. In South Africa, the Department of Health has adopted these recommendations. We also have Paediatric Food-Based (sic) Dietary Guidelines backed by technical support papers published in 2013. This is a widely accepted scientific approach to child nutrition.

The risks of experimenting with a baby’s development are immense and the long-term effect of low-carbohydrate, high-fat diets for babies is currently unknown. ADSA believed that the advice provided by Professor Noakes was against accepted common practice. The concern for the health of babies was ADSA’s primary interest when ADSA lodged this complaint.

Doctors on Twitter

The use of social media for professional purposes does pose interesting questions, especially for dietitians and other health care practitioners. While social media may be appropriate for generic public health messages such as how to reduce salt or sugar consumption in diets, social media may not be advisable for providing specific individualised, clinical nutritional advice to vulnerable groups such as babies, where little is known about their health and medical history.

ADSA does recognise that social media provides significant opportunities for public health information and for use by health care professionals. However, clear guidelines are required to guide and regulate patient interaction outlining the use and limits of social media by health practitioners.

“ADSA accepts the verdict and we are relieved that the hearing has finally been concluded. We welcome the precedent this case provides on what we considered unconventional advice. The case also sets a precedent about the use and limits of social media by health professionals.

“For ADSA this hearing was never about winning or losing, or standing for or against Professor Noakes. It was about protecting the health of babies and future adults,” said Maryke Gallagher, President of ADSA.

“We will study the verdict in detail and decide what implications this case has for ADSA and dietitians. We also call on the HPCSA to provide guidelines for health professionals’ use of social media in their practice,” said Gallagher.

ADSA’s advice in future

ADSA and its members will continue to provide dietary advice that is evidence-based and in line with guidelines provided by the national Department of Health and international bodies such as the World Health Organisation. A scientific and rigorous process is used to develop international and local dietary guidelines, and the outcome of the inquiry does not mean that these guidelines will now change.

ADSA will consider new approaches and practices based on scientific evidence that has been adopted by credible health organisations.

“Many dietitians and members of ADSA have been worried about the allegations made during the course of this inquiry that dietitians are unfairly favouring big food companies because they sponsor the organisation. ADSA wants to assure those concerned that we will never compromise ADSA’s independence as a result of corporate sponsorship.

“ADSA is a registered not-for-profit organisation (NPO) and relies in part on fundraising to sustain its work. In 2016, we received 63% of income from members. Our sponsorship policy is clear on non-influence by sponsors. We do not endorse any brand, product or retail chain.

‘No conspiracy’

“There is no conspiracy between Big Foods and dietitians to sell unhealthy food to South Africans. A healthy population through well-balanced diets is what we strive for,” said Gallagher.

It is very unfortunate that the professionalism and integrity of a number of nutrition scientists in South Africa has (sic) been unfairly questioned during this inquiry. It is ADSA’s hope that the reputation of nutrition professionals and dietitians as nutrition experts will be restored.

Despite the negative sentiment, ADSA believed it had a responsibility to enquire about an issue that had such significant consequences for dietitians and other health professionals.

“We respect Professor Tim Noakes for his work as a sports scientist. He is a well-respected A-rated scientist and is respected in academic circles. His work is pioneering and he has always tested conventional thinking. But, we have differed with Professor Noakes on this issue.

“We have no personal gripe with Professor Noakes. Our concern has always been about the health of babies,” said Gallagher.

This hearing has been rather divisive with strong views expressed on both sides. The debate has raised significant awareness about the importance of nutrition, which is positive. Health, wellness and nutrition should concern everybody.

But the ebb and flow of this divisive nutrition debate and the inconsistent nutritional advice provided over many years have also confused South Africans. That is unfortunate.

“I’m pleased this is over and we can now focus on other urgent nutrition challenges we have in South Africa,” concluded Gallagher.

Questions without answers

Here are some questions that Foodmed.net put to Gallagher, all of which she has declined to answer:

• ADSA says that it “respects” Prof Noakes for his work as a sports scientist. What of his pioneering work in nutrition science? (Noakes is one of few scientists in the world with an A1 rating for both sports science and nutrition. The rating acknowledges him as world authority in both disciplines.)
• ADSA claims to give “evidence-based” advice based on South Africa’s Dept of Health and World Health Organisation guidelines. Is ADSA aware of research showing that these guidelines are umbilically linked to US guidelines? And that the US guidelines were without any science when authorities in that country first launched them in 1977?
• ADSA’s statement talks of evidence that “credible organisations” have adopted. What about the extensive body of evidence that Prof Noakes and his witnesses presented at the hearing and the credible organisations that have adopted these?
• Presumably, ADSA endorses the guideline that Prof Hester “Estee” Vorster wrote to “make starchy foods basis of all meals”? What are the study refs, particularly RCTs to support that recommendation?
• And what “current evidence” supports low-fat, high-carb for babies?

 

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