[2017] Lore of Nutrition: Challenging Conventional Dietary Beliefs

by Tim Noakes

  I soon realised that I was up against a solid, seemingly impenetrable wall of opposition to what I was proposing. What I found most difficult to understand was not the reluctance of my colleagues to consider anything that went against conventional nutrition ‘wisdom’, but rather the venom with which critics began attacking me personally and publicly. They seemed intent not just on shooting the messenger, but also on savagely slaying and flaying the messenger publicly until not a shred of my scientific reputation remained intact.

  It was as if they were intent, for no rational reason that I could fathom, to maintain the status quo for treatment protocols, in particular for obesity, diabetes and heart disease. Those treatment protocols are based on the pharmaceutical model of disease. They demonstrably do not work, as global epidemics of all those conditions have shown. They have worked only to fill the coffers of the drug-makers.

  I was challenging those vested interests. It is probably no surprise then that within a year I had become the focus of a concerted effort to humiliate me publicly by showing first the South African public, and then the rest of the world, that I had lost my mind, had turned my back on science and had become a ‘medical impostor’, a quack and a danger to the public.

  At that stage, I had no idea who or what was behind the campaign to discredit me. It was not long before I began to see a game plan emerging: with my scientific legacy destroyed and appropriately humiliated in the court of public opinion, the critics would effectively silence me. And ensure that no one else would ever again risk doing what I had done.

  The coordinated attacks would continue relentlessly for the next six years. Many would originate from medical and dietetic colleagues at UCT – the very same university that I had served with honour and distinction for more than four decades.

  The attacks against me began to take on a curiously cultish and religious tinge. Critics said I had morphed into a medical messiah, an evangelist no longer interested in the pursuit of the truth of hard science. I was now a ‘zealot’ on a ‘crusade’, using ‘extremism’ to ‘demonise’ sugar, ‘bend’ patients to my will and force my views on them.

  They said I was practising ‘bad’ or ‘pseudo’ science by oversimplifying complex issues such as obesity and by promoting a ‘fad’ diet. For someone who developed the ‘complex’ model of exercise regulation, they said that I should ‘be horrified with such reductionistic, simplified thinking’.

  They began to predict that my end was nigh. As a result of all my considerable failings, and because of ‘significant doubt and criticism from the scientific community’ about my views on nutrition, my scientific legacy was under serious challenge and was unlikely to survive.

  A former PhD student got in on the act, even advising me how I could still escape the trap into which my manifest professional and personal character weaknesses and failings had somehow impelled me. He said I needed to curb the passions and enthusiasms that were driving me ‘to extreme viewpoints on complex phenomena’. I should become ‘more nuanced, less dogmatic’ and more conciliatory towards doctors practising their particular form of medicine – even though it was one I realised was killing people.

  A leitmotif in all these attacks was that I had ‘lost my way’; that orthodox doctors and dietitians were on the ‘right path’ of ‘balanced, healthy, high-carbohydrate, low-fat diets’. They needed urgently to do something drastic to bring me ‘back into the fold’ and save the public from my madness.

  Critics said I should ‘stop resorting to weak anecdotes that constitute poor science’ because they undermined my position. Instead, they counselled me to ‘apply the rigour of scientific thinking that shook so many fallacies in fatigue and dehydration to your OWN arguments. Your good messages will be stronger for it.’

  Not surprisingly, cardiologists who are intellectually and commercially wedded to the diet-heart and lipid hypotheses were prominent critics. They included UCT cardiology professor Patrick Commerford. He led a group of Cape Town professors and cardiologists who wrote an open letter to the media in 2012, calling me a cholesterol denialist and a ‘danger to the public’. Johannesburg cardiologist Dr Anthony Dalby expressed similar sentiments, predicting that I would end up killing people with my diet, which is, in his opinion, ‘criminal’.

  Endocrinologists took particular exception to the message I was beginning to promote. It was one I thought would excite all doctors: that type-2 diabetes mellitus is not necessarily a chronic degenerative condition. Not all diabetics would need to take drugs for the rest of their lives and risk blindness, kidney failure, heart disease and limb loss. Simple dietary change could control the condition and, in some cases, eliminate the need for medication altogether.

  You would have thought I was telling patients to commit slow suicide, so virulent was the response to the evidence I was trying to share.

  Another critic even suggested that were I to wake up to the error of my ways, South Africa could become ‘the first nation to reject hyped up, fad/cultish thinking and become the world leader in healthy eating, with balance’. Ironically, I guess in a nutshell that is pretty much what this book is all about.

  Attacks were not always from deep inside the medical or dietetic professions.

  Professor George Claassen is the brother of former Springbok rugby captain Wynand Claassen, and the son of the 1961 winner of the Comrades Marathon, George Nicolaas Claassen. In his academic career, Claassen was professor and head of journalism at the University of Stellenbosch.

  In his book Quacks, Whims and Disease,10 originally written in Afrikaans, Professor Claassen devoted two of the first nine text pages to what he presumably meant as a dispassionate analysis of why I had become a quack. The problem with my opinion on the low-carb, high-fat diet, he said, is that it is ‘widely reported … without performing any clinical tests or double-blind experiments’. He then argued that my scientific publication on the self-reported data of 127 subjects11 was a classic example of ‘confirmation bias’. By way of explanation, he said that because the subjects lost weight and improved their blood sugar concentrations after adopting the diet, it was ‘confirmation bias’ to conclude that the weight loss and improved blood sugar concentrations were a result of the dietary change.

  The logic of his argument continues to elude me, as it probably escapes others in the scientific nutrition community globally. However, that is how Professor Claassen explained it in his book.

  One thing sets Professor Claassen apart from many other critics: he clearly knows the value of covering his back. He concluded his summary of why he had afforded me quack status with the following: ‘The final word has yet to be spoken about the Noakes dispute. Sometime in the future clinical research may show him to be correct, but by following the incorrect scientific route he has set himself up for accusations of quackery that have damaged his reputation.’

  Over the following six years, a host of prominent South African doctors and medical and scientific organisations would echo many of these sentiments and add their own creative words of negative criticism. The attacks are all detailed in Chapter 7. Perhaps the most personally devastating, however, was the letter to the Cape Times from UCT and my colleagues in its Faculty of Health Sciences in 2014. The concluding paragraph stated: ‘UCT’s Faculty of Health Sciences, a leading research institution in Africa, has a reputation for research excellence to uphold. Above all, our research must be socially responsible. We have therefore taken the unusual step of distancing ourselves from the proponents of this diet.’

  A month later, the HPCSA would use that letter to charge me with unprofessional conduct. My public humiliation was, it seemed, complete.

  The end result was that in a few short years I had been reduced in the public mind and in the mind of my profession from a world-leading scientist in exercise science and nutrition to a quack embarking on a voyage of personal destruction. Others might argue that I had become the most publicly humiliated doctor in South African medical history.

  In this book I
try to understand how, and more importantly, why this happened. How was it possible for me to spend 40 years becoming a world-leading scientist, only to descend into quackery within a few short months? And all, as I will explain, because I chose simply to change my mind when I realised that the evidence, as I understood it, had changed.

  At first I did not realise it, but gradually a perplexing idea crept into my mind, an idea that, with time, would take on sinister implications: while all I had done was change my opinion in response to my altered understanding of the evidence, my colleagues in the medical and scientific professions had, in response, begun to act as if they were party to a communal vow of silence. It was as if they had been forewarned of dire consequences should they ever express even an inkling of support for my opinions. Would they face immediate academic excommunication should they suggest that, just perhaps, my new dietary ideas be treated with a degree of deference, befitting my status as a highly rated scientist, and not with unreserved contempt?

  And so the thought popped uninvited into my mind that my critics were acting as if they were loyal to a medical and scientific omertà.

  Omertà is the Italian word for ‘manhood’, but it more popularly refers to the code of silence taken by members of the Mafia. In its extreme version, it is the vow that Mafiosi take in refusing – to the death – to talk about criminal activity and give evidence that would be helpful to the authorities investigating organised crime. I had begun to feel as if I was starring in a B-grade Hollywood gangster movie set in the medico-scientific world.

  Of course, I am not the first to compare modern medicine and its pharmaceutical-science model to organised crime. Danish physician Dr Peter Gøtzsche did it first in a ground-breaking book, Deadly Medicines and Organised Crime: How Big Pharma has Corrupted Healthcare.12 It is a compelling, disturbing read; perhaps the most disquieting book about my profession that I have ever read.

  So I begin this book by detailing the case that my colleagues and assorted hangers-on have made against me. It began in the media and ended in a sensational 26-day ‘trial’ brought against me by the HPCSA on a charge of disgraceful professional conduct. I have become the first medical scientist in modern medical history to be prosecuted for his views on nutrition.

  Not for nothing has the public dubbed the case against me ‘the Nutrition Trial of the 21st Century’. They have compared me to Galileo.

  The case against me shows in stark relief what happens when a familiar scientist dares to threaten convention. This is especially the case if that convention is built on the exploitation of science for commercial gain.

  A large part of my contribution to this book describes why I believe what I do. It explains why I believe so strongly in the science that I was prepared to subject myself to the stresses of this campaign, despite the intense emotional discomfort it caused me, my wife and our children – not to mention the exorbitant financial costs that we incurred. By simply deregistering as a medical doctor, I could have made the trial go away. The HPCSA would no longer have had jurisdiction over me. The dietitian who first complained about me for a single tweet would have had no recourse.

  In retrospect, embarking on this journey was not something my family and I did lightly. We certainly did not choose it. But once our enemies threw down the gauntlet in the most public way that they did, my wife and I were not going to go quietly into the night. Our opposition, the prosecution, has learnt that to their considerable cost. If ever there was an illustration of the lesson in unintended consequences, then the case against me is the classic example.

  My message to you, dear reader, is that all people are entitled to their own opinions. But not to their own set of facts. So do not believe what you want to believe. Believe what the facts tell you is the truth.

  For in the context of junk diets, embedded scientists, corrupt – or simply ignorant – doctors and dietitians, human health and omertàs, what you believe about your personal nutrition will determine not just how you live, but also how you die.

  TIM NOAKES

  CAPE TOWN

  SEPTEMBER 2017

  Preface

  ‘Those who will not reason, are bigots, those who cannot, are fools, and those who dare not, are slaves.’

  – Lord Byron, English poet

  In 2014, I began researching and writing about Professor Tim Noakes and his nutrition ‘Damascene moment’, as he calls it. At the time, I was a vegetarian and had been for more than 25 years. Actually, I wasn’t a ‘real’ vegetarian for all those years. With a perfectly straight face, I would tell anyone who asked that I was a ‘biltong-eating vegetarian’. If you don’t know what biltong is, you’re not South African. It’s our dried-meat version of American beef jerky, only nicer – at least to me.

  I wore my ‘no meat’ badge with pride for my health’s sake. I also studiously avoided dairy products, including cheese and yoghurt, which I loved. I refused to eat low-fat yoghurt, though. My Greek background makes it an oxymoron. I actually loathed the taste of many low-fat foods. However, thanks to expert advice and my own research, I was firmly fat-phobic.

  I stuck to low-fat, high-carbohydrate foods because doctors and dietitians I trusted told me I should. In fact, they said everyone should eat that way. They said that it would significantly reduce the risk of life-threatening lifestyle diseases, such as obesity, diabetes, heart disease and even cancer. With the wisdom of hindsight, I now marvel at how ignorant and blindly trusting I was, especially considering my natural scepticism – and cynicism – as a health journalist.

  I believed in the diet-heart hypothesis that saturated fat causes heart disease as if it were gospel. Cardiologists I trusted said it was written in stone. I believed them. Why wouldn’t I? They were clever, omniscient creatures – god-like, really. They had lots of fancy letters after their names. I was fully in the thrall of eminence-based medicine. I never thought to question their conventional nutrition ‘wisdom’. I therefore avoided ‘fad’ diets. I knew about Atkins. I believed it to be a ‘dangerous fad’ because cardiologists told me it was. And anyway, it seemed counterintuitive that you could eat fat to get thin. It seemed reasonable that fat in the diet would equal fat in the arteries.

  I wrote about many different diets and tried most of them – for well-being, not weight loss. I was never overweight, although I was also never happy with my weight. It always seemed to yo-yo. I wasn’t a slave to the scale. Instead, my clothes were my slave master. When they grew too tight, as they often did, I immediately ate less. I would simply starve myself into submission. I believed wholeheartedly in the calories-in, calories-out model of obesity. I arrogantly believed that obese people were mostly just slothful gluttons. They ate too much and moved too little – at least that’s what the experts said.

  I tried a vegan diet once, but found it too much like hard work. In my hippie incarnation, I tried the macrobiotic diet, eating lots of grains. I liked the idea of plant-based diets, but never felt good on them. I also tried an Ayurvedic diet. Ayurveda is the ancient Indian traditional healing system that promotes eating according to ‘doshas’. I loved the delicious Ayurvedic desserts, especially rice pudding. I also once ate only raw food for five months – fresh fruit, vegetables, nuts and seeds. But I was always hungry.

  Once or twice a year, I went on punishing water-only fasts. I believed the promise of a ‘detox’ to my system that would leave me ‘good and clean and fresh’ – much like the soap-powder commercial. I would feel grim for a day or two on water only. Then I would become energised, literally out of nowhere. The longest I ever lasted was eight days. I emerged looking cadaverous, but feeling fine. However, as soon as I reverted to my ‘normal’ low-fat, high-carb way of eating, my energy levels dropped and any weight I had lost piled back on.

  None of the diets made me feel good physically or even mentally. If anyone had told me that the real fad was the low-fat, high-carb diet I was eating, I would have instantly suffered a severe bout of confirmation bias. Confirmation bias is when we discount
or ignore any evidence that flatly contradicts a deeply held belief. US physician and LCHF specialist Michael Eades tells me that confirmation bias suffuses us all – including him. It’s how we manage the bias that counts, he says.

  I didn’t even know that I had confirmation bias until I started researching LCHF, or ‘Banting’ as it’s known in South Africa. As far as I was concerned, I was doing all the ‘right’ things according to conventional nutrition ‘wisdom’. Feeling below par was normal for me. Over the years, I put my frequent mood swings down to pregnancy, motherhood and menopause, then just age. After all, the ‘experts’ say that ageing and declining health are constant companions. Those are the same experts who tell patients with type-2 diabetes that their condition is chronic, degenerative and irreversible. (This book proves that it isn’t.) I never made the connection between what I was eating and how low I often felt in body and mind.

  Of course, I knew about Noakes. He is, after all, one of the most well-known and well-respected South Africans in the global medical scientific community. Recently retired UCT deputy vice-chancellor Danie Visser has called him a ‘force in the world’. Former South African Comrades Marathon king Bruce Fordyce has described him as ‘a national treasure, one of the most important South Africans of all time’. When I first heard about his spectacular about-turn on nutrition in 2010, I was in and out of the country and unable to focus on the story. I thus only began to research Noakes and his new ideas on dietary carbs and fats in early 2014, and then mainly because of what people were saying about him in the media.

  His peers in the medical profession (Noakes is also a medical doctor) were making statements that seemed to me to be defamatory. Even academics at UCT and other universities appeared to be defaming him with impunity. They were demonising him using cultish, religious terminology. They called him a zealot, a heretic, messianic, a ‘celebrity’ scientist, a quack peddling dangerous snake oil to unsuspecting followers. They painted a picture of him as dangerous and devilish, the closest thing to a nutrition antichrist that modern medicine has ever seen. They said that he had lost the scientific plot and was practising pseudo-science.