[2017] Lore of Nutrition: Challenging Conventional Dietary Beliefs

by Tim Noakes

  Noakes had clearly made enemies in the highest echelons of medical and academic establishments. He was probably lucky he wasn’t living in medieval times. His peers would have burnt him at the stake as a heretic for challenging orthodoxy.

  I became aware of cardiologists, in particular, banding together to discredit him. In September 2012, UCT cardiology professor Patrick Commerford and colleagues had co-authored an open letter in which they accused Noakes of ‘Cholesterol Denialism’.1 They described his views on diet as ‘dangerous and potentially very harmful to good patient care’. The previous month, Johannesburg cardiologist Dr Anthony Dalby had been quoted in a media report calling Noakes’s dietary advice ‘criminal’.2

  Noakes has infuriated drug companies and raised many a cardiologist’s blood pressure with his antipathy to the cholesterol-lowering drugs known as statins. Statins are the most prescribed drug on the planet. Drug companies that make them have made billions in profits. Yet research shows that the risks of statins far outweigh the benefits.

  The frequency and virulence of attacks by cardiologists left a lingering impression on me. It’s why I later speculated in Foodmed.net that cardiologists may lie at the heart (pun intended) of the HPCSA’s case against him.

  Cardiologists were not the only ones suggesting that Noakes would end up killing people with his dietary views, and on a scale close to genocide. I found that claim extraordinarily shocking and hyperbolic. After all, I had known Noakes for decades, not personally, but as an interview subject in my journalistic career. I had interviewed him many times, ironically, as it turned out, on the use of high-carb, low-fat diets for athletic performance. I had always found him to be a scientist of formidable intellect, as well as a caring medical doctor. He is charismatic, but I’d never considered that a crime. And anyway, Noakes always appeared to me to be sincere and have integrity of purpose.

  Yet here were all these doctors, dietitians and assorted academics naming and shaming him in public, and the media enthusiastically baying for his blood. I wondered if the distinguished, world-renowned scientist could possibly have gone ‘rogue’.

  I contacted Noakes to ask for a Skype interview. He agreed, and the next day we spoke for hours. I tried hard to keep the scepticism out of my voice as I peppered him with questions. I’m Greek. I gesticulate a lot. My Mediterranean background makes me passionate about issues close to my heart. It also makes me a very bad poker player. It lets my confirmation bias run riot at times. I was trying to understand if Noakes had any solid science to support what he was now proposing.

  He was his usual polite, patient self. He explained that there was nothing new to what he was saying, that the evidence had been there for years, and that those in positions of power and influence over public nutrition advice had either ignored or suppressed this evidence. He directed me to scientific people, papers and places I didn’t even know existed.

  I ended the conversation feeling unsettled. Noakes sounded eminently rational, reasonable and robustly scientific. I started reading all the references he gave me. I read the work of US physician-professors Stephen Phinney and Eric Westman, and Professor Jeff Volek. I read Eades; US science journalist Gary Taubes, author of Good Calories, Bad Calories and Why We Get Fat (and most recently The Case Against Sugar); and one of British obesity researcher Dr Zoë Harcombe’s many books, The Obesity Epidemic. I also read The Big Fat Surprise by US investigative journalist Nina Teicholz. That book thoroughly rocked my scientific worldview, as it has done for countless others.

  The Wall Street Journal said of Teicholz’s book: ‘From the very beginning, we had the statistical means to understand why things did not add up; we had a boatload of Cassandras, a chorus of warnings; but they were ignored, castigated, suppressed. We had our big fat villain, and we still do.’ Former editor of the British Medical Journal Dr Richard Smith wrote about The Big Fat Surprise in a feature for the journal in 2014, titled ‘Are some diets “mass murder”?’ LCHF critics have suggested that prescribing a diet restricted in carbohydrates to the public is ‘the equivalent of mass murder’. Smith gained a very different impression after ploughing through five books on diet and some of the key studies to write his feature. The same accusation of ‘mass murder’ can be directed at ‘many players in the great diet game’, Smith said. In short, he said, experts have based bold policies on fragile science and the long-term results ‘may be terrible’.3

  For her book, Teicholz researched the influential US dietary guidelines, which were introduced in 1977 and which most English-speaking countries, including South Africa, subsequently adopted. She discovered that there was no evidence to support the guidelines’ low-fat, high-carb recommendations when they were first introduced, and that any evidence to the contrary was ignored or suppressed for decades.

  My research into LCHF left me uneasy. As a journalist, I’m a messenger. I began to wonder whether I had been giving the wrong messages to my readers for decades. Had I unwittingly promoted advice that harmed people suffering from obesity, diabetes and heart disease? Among those was my father, Demetrius Sboros, who suffered from heart disease for many years before his death in 2002. Had I given him advice and information that shortened his life?

  I put those worries aside and wrote up my interview with Noakes. The backlash was instant. On Twitter, total strangers called me irresponsible, unscientific, unethical and biased. Astonishingly, some were medical doctors, mostly former students of Noakes. They said that I was Noakes’s ‘cheerleader’, and even accused me of having a ‘crush’ on him. Some said that Noakes must have been paying me handsomely to say nice things about him. (For the record, he has never paid me anything, nor would he think to offer to pay me or I to accept.) Others said I was a ‘closet Banter’, as if that was the worst possible insult.

  At first I was irritated. After all, I had quoted Noakes accurately. I had reflected what critics said about him, to ensure that I gave both sides. And anyway, I readily confess to bias, but only in favour of good science. I’ve always said that if anyone can show me robust evidence that Noakes is wrong about LCHF, I will publish it. Knowing him as I do, so will he.

  Most of all, though, I was shocked at the venom behind the attacks on Noakes. He had simply done what any good scientist does when faced with compelling evidence that contradicts a belief: he had changed his mind. I’ve never seen much sense in having a mind if you can’t change it.

  The attacks against him grew more gratuitously vicious and libellous. Then, in July 2014, researchers at UCT and the University of Stellenbosch published a study in PLoS One that became known as the Naudé review.4

  In August 2014, four of Noakes’s UCT colleagues published a letter in the Cape Times. Dubbed the UCT professors’ letter, it accused him of ‘making outrageous unproven claims about disease prevention’ and of ‘not conforming to the tenets of good and responsible science’.

  After repeatedly being accused on social media of being a ‘closet Banter’, I eventually decided I might as well at least try the diet everyone said I was on. I figured that, like all the other diets I had tried, I wouldn’t feel any different on this one. But then at least I could write honestly to say that LCHF hadn’t worked for me. And it might get some of the trolls off my back.

  It was in late 2014 that I began experimenting with eating LCHF foods. I have obsessive-compulsive tendencies, so when I start something, I tend to go ‘all in’. I observed all the basic Banting rules to the letter. I cut all bread, pasta, pizza, rice, potatoes, chocolates, sweets and other processed carbs from my diet.

  It took about a week before I started noticing changes. The first was mood, in particular the afternoon ‘slump’ that I experienced daily at around two or three p.m. I would always feel suddenly ravenous at that time of the day, like I had to eat something, anything, preferably high carb, if I wanted to live. But on LCHF, the afternoon slump vanished, never to return.

  My sugar and other carb cravings reduced rapidly too. It took at least three days before I stoppe
d longing for my next sugar ‘fix’. I hadn’t ever thought of myself as genuinely addicted to sugar. I knew I had an unquenchable sweet tooth, but I never thought of myself as a real, live sugar addict. Of course, I always knew that bread and other carbohydrate foods turned to glucose in my bloodstream, just as sugar did. But I didn’t see that as a threat.

  I felt other positive changes on LCHF. My energy levels were up. I felt as if I was concentrating better and for longer periods. Most of all, I wasn’t feeling hungry, depressed or deprived with this new way of eating. The only variable that had changed in my lifestyle was the food I was eating. Of course, I know that it is anecdotal evidence, but it made me sit up and take notice.

  Today, while my sugar and carb addiction is well under control, it hovers ever on the periphery of my consciousness. After all, I nurtured it over a lifetime. I sometimes break the rules and fall off the ‘Banting wagon’. However, the benefits have become sufficient positive reinforcement to get me back on track every time.

  It also helps that Noakes and all the other LCHF experts I have since interviewed are open in their views on optimum nutrition. They don’t say that LCHF is the only way or a one-size-fits-all approach. They do say that anyone who is obese, diabetic, has heart disease or has otherwise become ill on a high-carb, low-fat diet should try LCHF before drugs or invasive bariatric surgery. That sounds reasonable and rational to me. They also say that LCHF is a lifestyle, not a diet.

  As I continued my research, it became apparent why so many doctors, dietitians, and food and drug industries want to silence Noakes. He threatens their businesses, reputations, careers, funding and sponsors. And cardiologists and endocrinologists are not the only ones at risk of class-action lawsuits if, or more likely when, LCHF diets become mainstream, especially to treat health problems such as obesity, diabetes and heart disease. All doctors and dietitians may be at risk if it is shown that they knew about LCHF but deliberately chose not to offer it as an option to their patients.

  When the HPCSA eventually charged Noakes in late 2014 with allegedly giving unconventional advice to a breastfeeding mother on Twitter, I began to prepare to report on the hearing. The deeper I dug, the more unpleasant the experience became. In 2015, for example, I was having what I thought was a relatively civil phone call with Johannesburg cardiologist Dr Anthony Dalby. I asked for comment on research suggesting that the diet-heart hypothesis was unproven. ‘If you believe that, then I leave it to you,’ he said, and hung up on me. Other doctors, academics and dietitians followed suit, avoiding my emails, or slamming the phone down if I ever managed to get past their gatekeepers.

  Teicholz told me of similar experiences while doing research for The Big Fat Surprise. In response to a question on fat, an interviewee suddenly said, ‘I can’t talk about that,’ and hung up. Teicholz was shaken. ‘It felt as if I had been investigating organised crime,’ she said. The analogy was apt for her then. It became apt for me too.

  The wall of silence I came up against while reporting on the HPCSA hearing should not have surprised me. I had a good working relationship with Claire Julsing Strydom, the dietitian who laid the initial complaint against Noakes – that is, until I started writing about her role in the whole affair. Strydom was president of the Association for Dietetics in South Africa when she lodged the complaint. Once I began asking uncomfortable questions, she stopped talking to me. ADSA executives and academics have followed suit, clearly acting on legal advice.

  Like many, I enjoy a good conspiracy theory. However, at the first abortive attempt at a hearing session in June 2015, I wasn’t convinced of an organised campaign to discredit Noakes. By the trial’s end, I was.

  Strydom and ADSA deny a vendetta against Noakes. Yet the signs were always there. Another ADSA executive member, Catherine ‘Katie’ Pereira, lodged a complaint with the HPCSA against Noakes in 2014 that was even more frivolous than Strydom’s. During an interview for a newspaper, Noakes had said that he didn’t know of any dietitian who told poor people not to drink Coca-Cola and eat potato crisps. (Most orthodox dietitians I know tell people that it’s fine to eat and drink these products as long as they do so ‘in moderation’.) The journalist made that comment a focus of the published interview. Pereira was offended on behalf of the entire dietetic profession. The HPCSA initially – and sensibly, to my mind – declined to prosecute. Strydom then intervened and pleaded with the HPCSA to charge Noakes. That case is still pending.

  Nevertheless, to me, Strydom and ADSA have always looked more like patsies – proxies for Big Food and other vested interests opposed to Noakes. And this book turned into not so much a ‘whodunnit’ than a ‘why they dunnit?’.

  When I first started writing about Noakes and LCHF, I also wasn’t convinced that he was on the right scientific track, persuasive though his arguments were. I needed time to absorb all that I was learning. That would come later, after I attended the ‘world-first’ international low-carb summit in Cape Town in 2015. The summit was an important pit stop on this remarkable journey with Noakes and many other LCHF experts as my guides. I have learnt much from them about good and bad nutrition science. I have also learnt how best to deal with gratuitous attacks on my character and credibility as a journalist. I have only had the tiniest taste of what his opponents have subjected him to for years.

  I have put into practice the many lessons I have learnt as a student of traditional Chinese and Japanese martial arts under internationally renowned instructor Edward Jardine. One of Jardine’s favourite sayings is: ‘Everything in moderation, including moderation.’ Oscar Wilde said it first, but Jardine says it with deeper wisdom. He teaches that the most important opponent you have to overcome in life is yourself. My training in martial arts has shown me the wisdom in strategic silence: that it is one of the hardest arguments to refute.

  And in The Art of War, Sun Tzu writes: ‘If you wait by the river long enough, the bodies of your enemies will float by.’ This book proves it, and more.

  MARIKA SBOROS

  LONDON

  SEPTEMBER 2017

  Introduction

  ‘In a time of universal deceit, telling the truth is a revolutionary act.’

  – Unknown

  This is the story of a remarkable scientific journey. Just as remarkable is the genesis of that journey: a single, innocuous tweet.

  In February 2014, a Twitter user asked a distinguished and world-renowned scientist a simple question: ‘Is LCHF eating ok for breastfeeding mums? Worried about all the dairy + cauliflower = wind for babies??’

  Always willing to engage with an inquiring mind, Professor Tim Noakes tweeted back: ‘Baby doesn’t eat the dairy and cauliflower. Just very healthy high fat breast milk. Key is to ween [sic] baby onto LCHF.’

  With those few words, Noakes set off a chain of events that would eventually see him charged with unprofessional conduct, caught up in a case that would drag on for more than three years and cost many millions of rands. More difficult, if not impossible, to quantify is the devastating emotional toll that the whole ordeal has taken on him and his family, as critics attacked his character and scientific reputation at every turn.

  At the time, it was open season on Tim Noakes. Doctors, dietitians and assorted academics from South Africa’s top universities had been hard at work for years trying to discredit him. They did not like his scientific views on low-carbohydrate, high-fat foods, which he had been promoting since 2011. His opinions contrasted sharply with conventional, orthodox dietary ‘wisdom’, and the tweet provided the perfect pretext to amp up their attacks and hopefully silence him once and for all.

  Within 24 hours of his tweet, a dietitian had reported him to the Health Professions Council of South Africa for giving what she considered ‘incorrect’, ‘dangerous’ and ‘potentially life-threatening’ advice. To Noakes’s surprise, the HPCSA took her complaint seriously.

  Noakes is one of the few scientists in the world with an A1 rating from the South African National Research Foundation (NRF) for both
sports science and nutrition. In his home country, he has no equal in terms of expertise in and research into LCHF. Few can match his large academic footprint – quantified by an H-index of over 70. The H- or Hirsch index is a measure of the impact of a scientist’s work. Noakes’s impact is significant. He has published more than 500 scientific papers, many of them in peer-reviewed journals, and over 40 of which deal exclusively with nutrition. He has been cited more than 17 000 times in the scientific literature.

  Yet, remarkably, the HPCSA chose to back the opinion of a dietitian in private practice over an internationally renowned nutrition research scientist. They charged him with ‘unprofessional conduct’ for providing ‘unconventional advice on breastfeeding babies on social networks’ and hauled him through the humiliating process of a disciplinary hearing.

  The public quickly dubbed it ‘the Nutrition Trial of the 21st Century’. I’ve called it Kafkaesque. The HPCSA insisted that it was a hearing, not a trial, but the statutory body’s own conduct belied the claim.

  At the time of Noakes’s tweet, I wanted to give up journalism. After more than 30 years of researching and writing about medicine and nutrition science, I was frustrated and bored. People were growing fatter and sicker, and the medical and dietetic specialists I wrote about weren’t making much difference to patients’ lives. Neither was my reporting.

  Then I started investigating and writing about the HPCSA’s case against Noakes. The more questions I asked, the more walls of silence came up around me, and from the most unexpected sources. There’s an old saying that silence isn’t empty, it is full of answers. I found that the silence was loudest from those with the most to hide. I could not have foreseen the labyrinthine extent of vested interests ranged against Noakes, or the role played by shadowy proxy organisations for multinational sugar and soft-drink companies in suppressing and discrediting nutrition evidence.