by Tim Noakes
Feedback from the conference was generally positive. Many doctors and dietitians who attended said that the compelling science that the speakers presented was a game-changer. The barbs that did come were from the few LCHF critics in attendance. One was Jacques Rousseau, a lecturer at the UCT Faculty of Commerce. I make a detour here to talk about Rousseau because of his family background and his active opposition to LCHF and Noakes. His father, Professor Jacques Rossouw, is a UCT graduate who works for the National Institutes of Health (NIH) in the US. He is also one of Noakes’s most implacable foes.
Rousseau has an honours degree in philosophy and a master’s in English. He has co-authored a book with clinical psychologist Caleb Lack, titled Critical Thinking, Science and Pseudoscience: Why We Can’t Trust Our Brains, and he writes a personal blog called Synapses. Rousseau lectures on critical thinking and ethics.
I first became aware of Rousseau in 2014. By then he had written 15 blog posts attacking Noakes. That number has since nearly doubled. I can probably count myself lucky that Rousseau devoted only one nasty post to me, and only after I started writing about Noakes. In my opinion, he demonstrates an unhealthy obsession with Noakes and LCHF science. Recently, though, Rousseau has begun back-pedalling, as have many other LCHF opponents in the face of the evidence. He now plaintively claims that he always said that Noakes could be right. He also claims never to have accused Noakes of bad science. Yet in a blog post from 2013, titled ‘Lessons in bad science: Tim Noakes and the SAMJ’, he did just that, accusing Noakes outright of practising bad science.10 Three days later, in a post titled ‘More lessons in bad science (and reasoning) from Noakes’, Rousseau again accused Noakes of willingly ignoring the ‘basic principles of good science’.11
Rousseau’s critics on social media have at times questioned why he does not declare his significant conflict of interest (that his father is Professor Jacques Rossouw) when attacking Noakes. Rossouw’s antagonism towards Noakes is well known and is covered elsewhere in this book (see Chapter 4). Critics have also challenged Rousseau (junior) on why he spells his name differently from his father. I once asked him about it via email. I found his explanation naive at best. He said that he changed his name legally 25 years ago because he did not want anyone to link him to the country’s then ruling National Party, the architects of the apartheid regime that had made South Africa the pariah of the world. I wondered if Rousseau genuinely believed that people automatically assumed that anyone with an Afrikaans name supported apartheid.
Then there is Rousseau’s wife, Dr Signe Rousseau, an academic in the same faculty as him at UCT. She has a doctorate in film and media. In 2015, she wrote an article in the journal Food, Culture & Society titled ‘The celebrity quick-fix: When good food meets bad science’.12 No prizes for guessing who she thinks is practising bad science. In the article, Signe parrots much of what her husband says about Noakes. Like him, she invokes a straw-man argument against Noakes, claiming that the sole evidence Noakes uses to advocate the LCHF diet is anecdotal. Thus: ‘As the revelation about his personal health may suggest his initial evidence was based on a sample of one – himself.’ She doesn’t think to mention her conflict of interest: that she is the daughter-in-law of Professor Jacques Rossouw.
Both Rousseau and his wife appear oblivious of the fact that Noakes adopted the LCHF diet only after extensive research of both the scientific and popular literature. And Rousseau appeared not to understand much of the scientific evidence presented at the Cape Town conference. Afterwards, he made much about the fact that some speakers preferred to talk of a ‘healthy-fat’, rather than a ‘high-fat’ diet, as if he thinks Noakes is promoting a high intake of unhealthy fats.13
Critics of the summit predicted from the outset that it would be an LCHF ‘echo chamber’. It was anything but. The speakers agreed on some major points of LCHF theory, but disagreed on others. They differed in how low in terms of carbohydrates LCHF diets have to go for maximum benefit. All agreed, however, that LCHF is not a fad diet. The real fad, they said, is the low-fat, high-carb diet prescribed by the official guidelines for decades. None of the speakers said that LCHF is a one-size-fits-all way of eating.
Some differences turned out to be little more than semantics. Harcombe, for example, said that she does not call the nutrition advice she promotes ‘LCHF’. However, she also said that when people eat ‘real food’ – unprocessed, unadulterated food that is as close to its natural state as possible – they tend to eat LCHF.
The only criticism of the conference that stood up to any scrutiny was a lack of question time for the audience. That was mostly a function of speakers having so much science to present and contextualise. The speakers made up for it, however, by making themselves available during breaks and over lunchtime to answer questions.
The conference produced a consensus statement, which all speakers signed – except for Taubes, as he had engagements that meant he could not stay until the end. The statement read:
The mainstream dietary advice that we are currently giving to the world has simply not worked. Instead, it is the opinion of the speakers at this summit that this incorrect nutritional advice is the immediate cause of the global obesity and diabetes epidemics.
This advice has failed because it completely ignores the history of why and how human nutrition has developed over the past three million years. More importantly, it refuses to acknowledge the presence of insulin resistance (carbohydrate intolerance) as the single most prevalent biological state in modern humans.
Persons with insulin resistance are at an increased risk of developing a wide range of chronic medical conditions if they ingest a high carbohydrate diet for any length of time (decades).
Noakes closed the summit on 22 February with a powerful presentation. Titled ‘The way forward’, it was a compelling mix of the personal, professional and scientific. In it, Noakes showed who he thinks is really practising junk science and endangering people’s health.
‘The key problem,’ he said, ‘is that both sides believe the facts sit with them. Either they are right or I am right. We can’t both be right.’
The right thing to do, Noakes said, is to look at all the evidence and especially the quality of the evidence. That’s good science, according to the rules laid down by the late Sir Austin Bradford Hill, the man revered as the ‘father of medical statistics’. Scientists who choose to ignore the RCTs and other evidence that dispute their theories are not practising good science.
Since Bradford Hill’s death in 1991, many researchers have ignored his criteria and ‘flipped into a model of junk science’, said Noakes. These scientists ‘are more interested in getting funding and more work, not making people healthier’. They have dropped the bar to the lowest level of performance achieved in a cross-sectional (associational) study. This means that just about anything can be proved to cause something. It demonstrates a move from hard science to junk science.
‘We have generated a whole discipline of nutritional science [ignoring Bradford Hill’s criteria],’ said Noakes, ‘and we wonder why we have got it all so very wrong.’ He then quoted British physicist Stephen Hawking, who is clear on what to do if the facts don’t fit the theory: ‘Abandon the theory.’
Noakes also quoted from Hawking’s book In Black Holes and Baby Universes and Other Essays: ‘In practice, people are very reluctant to give up a theory in which they have invested a lot of time and effort. They usually start by questioning the accuracy of the observations. If that fails, they try to modify the theory in an ad hoc manner. Eventually the theory becomes a creaking and ugly edifice. Then someone suggests a new theory, in which all the awkward observations are explained in an elegant and natural manner.’14
Noakes said that the Cape Town conference had exposed the creaking, ugly edifice of conventional wisdom on nutrition, and had explained an alternative in an elegant and natural manner.
For Noakes, the summit was ultimately the realisation of a dream. ‘It allowed us to make the message gl
obal and to show people the facts about nutrition, fats and carbohydrates in the diet,’ he said afterwards. Taubes said that the summit gave ‘validity’ to those attending – a platform to ‘entertain the idea that something they may have believed all along was wrong and that there is a better way of doing it’.
‘We have two choices,’ Noakes said in his closing remarks. ‘Either we can continue to ignore the evidence presented at this summit, and go on blaming the obese and diabetic for their sloth and gluttony [that is supposedly the sole cause of their obesity and diabetes]. Or, if we are ever to reverse this epidemic that has become the greatest modern threat to human health, we need to admit that we have been wrong for the past 40 years, and must now change.’
Experts, Noakes said, can continue to apply a failed model to a growing global health crisis in the ‘utterly irrational hope that what has not worked in the past will suddenly, miraculously, produce a different result’. That, as Einstein noted, is the true marker of insanity – doing the same thing over and over again and expecting different results.
Alternatively, said Noakes: ‘If we have the individual and collective courage, we can acknowledge our insanity, admit our errors and start the healing process by adopting the solutions presented by the speakers at this summit.
‘Our greatest hope is that this summit will serve as the global tipping point for the final acceptance that what we have prescribed and practised as healthy nutrition for the past 40 years is not only not based on any good science, but tragically has been profoundly damaging to human health on a global scale.’
Noakes ended his presentation with a quote from Professor Christiaan Barnard: ‘I have saved the lives of 150 people through heart transplantations. If I had focused on preventative medicine earlier, I would have saved 150 million people.’
Noakes said that it was his hope that Barnard, the man who gave South Africa its greatest medical moment in history, would have his wish posthumously: ‘That is to bring health and healing to billions of humans through the provision of dietary advice that is appropriate because it is scientifically based. It understands the biological consequences of our human evolution. It recognises the widespread presence of insulin resistance in most populations across the globe.’
At that, the assembled delegates and speakers from around the world gave Tim Noakes a lengthy standing ovation. Harcombe later noted: ‘There was hardly a dry eye left in the house.’ It augured well as Act I in the coming drama, the Kafkaesque ‘Theatre of the Absurd’, as I later called the HPCSA hearing against Noakes.
* In 2016, SAMA invited Noakes to speak at its annual conference. A few weeks later, an embarrassed SAMA executive called Noakes to say he was no longer invited. Then president Denise White claimed not to know why her organisation had uninvited him.
** Noakes is not alone in believing that his views on statins lay at the heart of the attacks on him by cardiologists, and were why so many doctors so enthusiastically aided the HPCSA in prosecuting him.
2
The Most Important Experiment of My Life
‘When my information changes, I change my mind. What do you do, sir?’
– John Maynard Keynes, British economist
When I matriculated from a Cape Town high school in December 1966, all of my classmates, and the girls with whom we associated, were lean – with one exception: a larger boy who would today be labelled obese. So uncommon was his appearance that we assumed he had a rare disease, perhaps cancer.
We were, of course, the generation that would become known as the Baby Boomers – the children of the so-called Greatest Generation, the generation that had fought the war against Nazism and had returned to build the most prosperous period in human history.
Because our parents had lived through the deprivations of a world war, they were necessarily frugal. There was no excess and there was no waste. Our parents fed us the foods on which their parents had raised them – in my case, good, wholesome, real farm foods.
In our adolescence, we Baby Boomers spawned the hippie movement. We grew up on the music of Elvis, the Beatles, the Rolling Stones and the Byrds, and the folk poetry of now Nobel laureate Bob Dylan, and Simon & Garfunkel. We were surrounded by leanness. It was not because we exercised to excess. On the contrary, there were no commercial gyms, and our generation had yet to discover the joys of marathon running. That would happen only after 1976.
Today, when I speak to matriculating high-school students in South Africa, I see quite a different picture. Leanness is uncommon except, paradoxically, sometimes in the pupils at wealthier schools. In the schools serving the poorer communities, the outlook is depressing. Adolescent obesity is rampant.
Global trends in the same period match my personal experience of the complete transformation in the appearance of the youth of today, compared to the norm 50 years ago.
When I completed my undergraduate medical training at UCT in 1974, fewer of our patients were obese, and T2DM was an uncommon condition. I recall treating only one case of diabetic ketoacidosis in the six months of my medical internship, and I observed very few limb amputations as a result of diabetic peripheral artery disease (PAD).
Today, the situation is entirely different. Indeed, my home town of Cape Town is at the centre of an escalating South African T2DM epidemic. What could possibly have happened in the intervening four decades?
The answer, it turns out, is not difficult to uncover. It is predicted in at least seven published works by credible medical scientists over the past century: Englishmen Major General Sir Robert McCarrison MD DSc (Nutrition and Health), Dr Thomas L. Cleave (The Saccharine Disease) and Professor John Yudkin (Pure, White and Deadly); Scotsman Dr Walter Yellowlees (A Doctor in the Wilderness); Canadian Dr Weston Price (Nutrition and Physical Degeneration); American Dr Benjamin Sandler (How to Prevent Heart Attacks); and South African Dr George D. Campbell (Diabetes, Coronary Thrombosis and the Saccharine Disease). Of these books, only those by Price, Yellowlees and Yudkin are still readily available.
As far as I can tell, none of these books are prescribed reading for either medical or dietetics students, yet the totality of the proof that they present is compelling. It is so convincing that anyone with a mind even slightly open to the authors’ inconvenient conclusions would have to ask why they were never presented with this evidence, and why they have been so thoroughly misinformed. I review the work of these pioneers in Chapter 16, and look at why it does not make sense to accuse ancient foods of suddenly causing the epidemics of modern diseases currently sweeping the globe.
Perhaps Yellowlees’s book provides the best personal narrative of how dramatically the diseases to which modern humans are now prone have changed in the past 50 years.
Yellowlees graduated in medicine from Edinburgh University in 1941. He served with the Royal Army Medical Corps during the latter years of the Second World War, winning the Military Cross for outstanding bravery ‘for tending the wounded under heavy fire … and for being the last to leave the battlefield’. For 33 years after the war he worked as a medical practitioner in a traditional, rural Scottish farming community, retiring in 1981.
In 1993, he wrote his autobiography to record the precipitous deterioration in the health of the community he had served. He wanted to explain what he considered to be the real causes of this decline, and to express his frustration that no one in his profession seemed particularly concerned to expose them. ‘If a GP lives up to the traditions of his calling,’ Yellowlees wrote, ‘he must forever seek to understand why this particular patient is suffering from this particular complaint.’1
The modern approach is quite different. Doctors now have another option: they can continue to take, as Yellowlees put it, the ‘much wider view which encompasses not only the patient’s disease, but his way of life, food, relationships and environment. The latter attitude, in the Hippocratic tradition, assumes that health is the normal inheritance of mankind and seeks to know what has gone wrong to disturb that inheritance.’ Or they
can view the patient’s illness as ‘an unfortunate happening, a haphazard quirk of fate’.2
In choosing the first option, Yellowlees discovered a perplexing paradox. He struggled to understand why, during the 20th century, ‘thanks to better sanitation, clean water, preventive inoculation and improved housing, the incidence of infective diseases caused by bacteria or viruses has greatly diminished’, yet, in his own medical lifetime, he had personally observed a dramatic increase in the incidence of degenerative diseases, the so-called diseases of lifestyle, which he concluded could not be conveniently rationalised by ‘better methods of diagnosis or the ageing of the population’.3
His conclusion was that this alarming deterioration was the result of a change in diet, as sugar, refined flour and processed foods had replaced the traditional foods on which his people had lived for centuries:
Food and drink, highly processed and degraded by a multitude of additives, consumed by an ever expanding urban-based population inevitably brings a heavy load of degenerative disease. In Scotland, especially, refined sugar and constipating white flour are still consumed in huge quantities. Obesity and diabetes are rife; the overall incidence of cancer increases.4
Yellowlees was not one to desert the battlefield before the last shot had been fired. Like many of us, he wanted to understand why something so obvious to him was apparently beyond the understanding of almost all others.
There were, he wrote, three reasons for the ‘wilderness of confusion’ about the true causes of the rising ill health he encountered in rural Scotland and which mirrored my experiences in Cape Town, South Africa. The first, he suggested, was ‘the frailty of human nature on the part of scientists, engaged in nutrition research, who get hold of an idea and refuse to accept any evidence, however compelling, which casts doubt on its veracity’. The second was ‘the dominant role of commercial interests in determining the dietary habits of consumers, as well as in shaping developments in agriculture and in medical practice’.5