by Tim Noakes
‘Food manufacturers,’ Yellowlees observed, ‘equipped with their immensely powerful weapons of mass advertising, join the fray; they do so either openly to the consumer or through a more subtle approach to doctors and dieticians by financing research, publications or conferences.’6
The HPCSA trial against me bears brutal testimony to the extent to which this has happened in South Africa.
As to the third reason, Yellowlees suggested that the medical profession had capitulated in the face of these commercial forces. Doctors, he argued, ‘are meant to be scientists and science is supposed to reveal the truths of the material world’. Instead, they have forsaken Christian values and become too scared to be deemed either ‘judgmental’ or ‘moralizing’. The result:
The third and daunting part of my wilderness is the spiritual darkness which, in the second half of this century, has cast a deepening shadow over all our affairs. By darkness I mean the loss of loyalty, honesty, integrity and decency without which human transactions revert to the violence and inhumanity of the beast. These sad trends follow the retreat of Christianity and the rise of humanist false prophets who preach the supremacy not of God, but of human reason; they seek to rule the world, not by God-given wisdom, but by the power of money.7
Finally, he asked: ‘Are doctors to remain silent when they believe the truth is being perverted?’8
Perhaps the major error that I made after December 2010 was to imagine, like Yellowlees before me, that my first professional responsibility was to expose those medical or scientific ‘truths’ I believed to be false. It never occurred to me that my colleagues and peers would react to the outcomes of my personal search for truth as if they had sworn an oath of silence, a scientific omertà aimed at suppressing the evidence I had accumulated for a new nutrition paradigm.
When I experienced what I call my Damascene moment, I had no inkling of the descent into a spiritual wilderness it would precipitate, or of the heartlessness and lack of humanity I would experience at the hands of many of my senior professional colleagues. But, as one of my favourite rugby coaches always used to say, in the toughest of times when all appears lost, ‘it is what it is’.
It helped that I had learnt a lot from sport – especially that you play every moment as if your life depends on it until the final whistle; only then may you stop. That is the way I have learnt to live my life. It is what led Winston Churchill to implore of the British people, including my parents, in the darkest hours of the Second World War: ‘Never give in. Never, never, never, never – in nothing, great or small, large or petty – never give in, except to convictions of honour and good sense. Never yield to force. Never yield to the apparently overwhelming might of the enemy.’
In the face of scientific evidence, it was simply not an option to yield to dogmas on treatment methods that clearly were not working to improve people’s health.
So this is my story.
I have spent my scientific life conducting experiments on others. I began perhaps my most important experiment, on myself, when I was already 61 years old.
On the evening of Sunday 12 December 2010, I put the final touches to a body of scientific work on which I had toiled for almost 30 years. It was the 27th and final revision of a manuscript that would appear as the book titled Waterlogged: The Serious Problem of Overhydration in Endurance Sports. My last act of the day was to email the final version of the manuscript to my American publisher.
That research had brought me into direct conflict with PepsiCo, one of the iconic companies in the US, because I had challenged a body of scientific thinking used to promote the sale of their segment-leading sports drink, Gatorade. As a result of my unpopular opinion, many of my sports-science colleagues, especially those funded by PepsiCo, had publicly questioned my intelligence.
My response was to write a massive tome in which I laid out the whole truth, as it appeared to me, in minutest detail. Happy that my completed manuscript properly presented my iconoclastic position, I switched off my computer and retired to bed.
The sense of release was extraordinary. I was certain that the facts presented in the book would prove that I was not the one who was crazy. More importantly, the mountain of evidence I had collected would, I was sure, reduce the risk of more endurance athletes dying from the potentially fatal but entirely preventable condition called exercise-associated hyponatraemic encephalopathy that I and my colleagues had been the first in the world to describe. Our research had established that these deaths are the result of a belief in a false model of how the human body works, a model that had been skilfully marketed as a global truth, not, in my opinion, to promote athletes’ health, but to increase sports-drink sales.
In the middle of the night, my brain woke me with a new instruction: ‘Get up tomorrow morning at 6 a.m. and run,’ it said. ‘And make sure that you run on most days for the rest of your life.’
I have learnt to trust my subconscious brain’s infrequent instructions. The last time my brain spoke to me so directly was in March 1968, when it instructed me to apply for admission to the medical faculty at UCT. Besides marrying my wife, Marilyn Anne, that was the most important decision of my life.
So shortly before 6 a.m. on Monday 13 December 2010, I dutifully rose from my bed, dressed in my running gear and dragged myself half-asleep around the shortest (five kilometres) and flattest running route in my neighbourhood. I had never stopped running, but over the years I had begun to run progressively less. By the time I completed Waterlogged, I was running only about 20 kilometres each week, very slowly. That, compared to the 120–220 kilometres per week I had often run in preparation for my favourite ultra-distance race, the 88-kilometre Comrades Marathon. Running had simply become too much of an unpleasant effort. I continued only because I believed it was good for my health.
On that flat, five-kilometre run, only with the greatest difficulty was I able to average seven minutes a kilometre, even when running at an average heart rate of 135 beats per minute. Worse, it felt as if the two tiny rises along the route took more out of me than the monster hills of the Comrades Marathon ever did. By the final kilometre, I had slowed to eight minutes, little better than a fast walk. Clearly, something had to be done if I was going to run on most days for the rest of my life. I might be over 60, but I was not as old as those few tiny hillocks made me feel that Monday.
I resolved that to run better, I would have to begin by losing some of the extra weight I had accumulated, especially over the previous 10 to 15 years. But in my youth, I had only ever lost a significant amount of weight when training extra hard for many, many months. Even then, despite any weight loss so hard achieved, I would regain it all within a few weeks of returning to my more normal training. Indeed, my 41 years of running, including over 70 marathons and ultra-marathons, had taught me that, while running produces a wide array of physical and emotional benefits, sustained weight loss is definitely not one of them.
I already knew from personal experience that the conventionally prescribed weight-loss diets are ineffective because they work only when people are sufficiently active to burn all the extra (redundant) calories needed to satisfy exaggerated hunger. But the moment their activity level returns to a more sustainable level, hunger returns, and they tend to ingest more calories than required and rapidly regain all the lost weight. No one had ever bothered to tell me that perhaps the excessively high carbohydrate content of my diet was driving my hunger. And so, always hungry, I was perpetually eating more calories than my body really needed, except for those few months of my life when I was able to burn off the excess carbohydrate calories by training for two or more hours a day.
I also knew that even when I was able to lose some weight using this conventional, exercise-more, eat-less approach, the process was unbearably slow and frustrating, requiring mammoth amounts of discipline and will power. That is to be expected of a treatment prescribed to punish the slothful and gluttonous obese.
As a result of my own experience, and like m
ost of my medical colleagues who were unable to regulate their body weights, I had never felt sufficiently confident to express any opinions on the causes, treatment and prevention of obesity. Nor could I make any sense of the voluminous obesity literature. Instead I chose to ignore the topic, leaving it to the experts. The proof is that there is no reference to any methods of weight loss in any of the first four editions of Lore of Running, which I wrote between 1981 and 2002.
And so, as I struggled through that final kilometre on the morning of 13 December 2010, pondering my dire state, I really had no idea how to address my growing obesity and declining health. I was now much older, less physically able and indeed unwilling to train for up to two hours a day as I would have 40 years earlier. I was beginning to think that only divine intervention could save me.
Providence was close at hand, for at that very moment the sole solution to my predicament was finding its way to me via the internet.
It came in the form of an email advertising a new book, The New Atkins for a New You by doctors Eric Westman, Stephen Phinney and Jeff Volek. The book promised ‘The Ultimate Diet for Shedding Weight and Feeling Great’, and claimed that it would allow me to lose six kilograms in six weeks ‘without hunger’. Since I was scheduled to speak to a group of elite Swedish ultra-marathon runners in Stockholm in a few weeks, the idea was attractive. What if I could lose six kilograms by the time I appeared before that lean, athletic audience?
My initial curiosity was short-lived, soon to be replaced with dismay. I was appalled that these three supposedly serious scientists could allow their names to be associated with Dr Robert Atkins, the madman who, in the 1970s, had encouraged us all to eat more saturated fat and less carbohydrate, wilfully misleading the world with his dangerous dietary non-science. I knew this to be true because it is what I had been taught since 1976, when I began my scientific education in Professor Lionel Opie’s heart research unit at UCT. Thanks to the wisdom of a range of authority figures, including the US government, those of us who were properly educated ‘knew’ that this advice could only kill us.
I knew that, beginning in 1972, Atkins had caused a global stir with his book Dr Atkins’ Diet Revolution, in which he proposed that the healthiest diet was one that included as much fat, including saturated fat, as one’s appetite dictated. His book sold more than 10 million copies, but it garnered Atkins few medical friends. Instead, he was demonised and his diet labelled a fad. Every heart association on earth and all the world’s most eminent cardiologists hastened to inform us that the Atkins high-fat diet was the direct cause of heart disease.
Undeterred by collegial disdain and his growing notoriety, Atkins developed a money-losing medical practice specialising in weight loss on New York’s Upper East Side. I would later learn that his clinic, highly successful at curing obesity and T2DM, was sustained by the proceeds from his book sales. Criticised for not using that money to study the effects of his revolutionary diet, in the early 2000s Atkins began funding the research of Westman, Phinney and Volek. That research would ultimately lead to their book and the email in my inbox announcing its publication.
Putting aside my dismay, I realised that regardless of what I might think or know about Dr Atkins, I also knew that all three authors are exceptionally good at what they do. Take, for example, Stephen Phinney, an outstanding and innovative scientist who in 1983 published the world’s first scientific study of the effects of long-term adaptation to a high-fat diet on human exercise performance.9 Inspired by that research, our exercise-research group at UCT had been among the first to perform similar studies.10 My former PhD student, Professor John Hawley, also contributed a series of significant studies in the early 2000s.11
But there was another, even more important reason why I had great faith in Phinney and his colleagues. Shortly after the publication of Phinney’s original paper in 1983, I had received a call from Paula Newby-Fraser, an expatriate Zimbabwean then plying her profession as an Ironman triathlete in the US. She had just heard of Phinney’s study and wanted to know what I thought of it.
‘It makes logical sense,’ I told her. ‘Why don’t you try it?’
I meant that she should add more fat to her diet, not that she should abandon carbohydrates. Three decades later, after Newby-Fraser had dominated the world of Ironman triathlons, winning a total of 28 Ironman races, including the World Championship in Kona, Hawaii, an unmatched eight times, and after she had been selected as the Triathlete of the 21st Century, she told me that the recommendation to eat a carbohydrate-restricted, high-fat diet was the single most important piece of advice she had ever received in her athletic career.
The irony, of course, is that while Paula Newby-Fraser was becoming one of the world’s greatest endurance athletes, following, on my advice, a high-fat diet, in Lore of Running I was advising all athletes to eat high-carbohydrate diets. Can I explain this? The answer is no.
So, on the balance of the available evidence, I decided to give the authors of The New Atkins for a New You the benefit of my scepticism. Perhaps Westman, Phinney and Volek had sold out to commercial interests, as is common. But what if they were also correct? What if they had discovered a truth hidden behind others’ dogmas and conflicts of interest? Phinney especially had advanced knowledge, having studied a high-fat diet in athletes. What could I possibly lose by investigating their claims more fully?
I got up from my desk and drove the three kilometres to the nearest bookshop to search for their book. Fortuitously, there was a single copy. I was home within 20 minutes, and began reading despite a healthy scepticism. I still doubted that anyone could seriously propose weight loss ‘without hunger’. After all, we all ‘know’ that there is one absolute when it comes to dieting: to lose weight, you must submit to perpetual hunger. Regardless of the scientific credentials of the three authors, I was fairly certain that their outrageous assertion would prove to be bogus, and that the whole thing would be just another fad diet.
After reading a few pages, I was suddenly less certain. I sensed that Westman, Phinney and Volek were advancing a crucial health message, one based on a body of hard science of which I was completely ignorant.
An hour later, I had read enough to suggest that here was something worth considering. I wondered how I had missed all the work from which Dr Eric H. Kossoff MD, director of the Ketogenic Diet Center in the Division of Pediatric Neurology at Johns Hopkins Hospital, Baltimore, Maryland, had concluded: ‘In more than 150 articles, these three international experts on the use of low-carbohydrate diets to combat obesity, high cholesterol, and type 2 diabetes have led the way in repeatedly proving how a low-carbohydrate approach is superior to a low-fat one.’12
By lunchtime, I had read enough to make my Damascene decision: I would ignore my scepticism, ingrained by 40 years of medical ‘education’, and put the advice of Westman, Phinney and Volek to the test.
As they suggested, I embraced the idea that eating fat is a healthy choice. I immediately stopped eating the carbohydrate-laden ‘foods’* that I had consumed in increasing amounts after I began running seriously in 1972, leading to my full adoption of the low-fat, supposedly heart-healthy, ‘prudent’ diet after 1977. That LFHC diet was the same one that I had described in Lore of Running as the essential dietary basis for all great athletic achievements.
All that was now in the past. A new future beckoned.
There would be no more bread, potatoes, bananas, rice, porridge or boxed breakfast cereals, including muesli. No more fruit juices or soft drinks. No more cakes, sweets, chocolates, ice cream or, indeed, any desserts. I would slowly remove all sugar and other sweeteners from my tea and coffee. I would focus on seven foodstuffs: meat, fish, eggs, dairy produce, nuts, leafy vegetables and a restricted range of low-carbohydrate fruits, mainly berries.
And so began probably the most important experiment of my life.
For that first lunch, I snacked on biltong (a form of dried meat, similar to beef jerky in the US, which is a delicacy in South Afr
ica), cheese and high-fat nuts, especially macadamias. These would become my staple snack foods. I soon added tinned fish, especially pilchards and sardines, chicken and dairy products in the form of butter, milk, cream, cheese and full-cream yoghurt. I ate little fruit and vegetables to begin with, and had yet to discover the value of eggs and organ meats such as liver, kidneys, hearts and brains. I was unable immediately to remove all the sugar from my diet – it would take another 14 months before I could finally drink tea and coffee without added sugar. It was another five years before I stopped adding milk to my tea.
Despite my advanced age, within weeks I saw an improvement in my health, well-being and running ability that I can still only describe as astonishing. The first obvious change was that my enthusiasm for running returned. Within a week, I could not wait to exercise each day, slow and wobbly as those first runs continued to be. I could feel the changes in my body and they were telling me that something remarkable was happening.
Within the first seven days, my weight had dropped from 101 kilograms to 99 kilograms. Remarkably, as Westman and his colleagues had promised, I had absolutely no hunger – whenever I felt like eating, I would snack on biltong, cheese or nuts. A few mouthfuls and I would be ready to continue without the need to think about food again for another few hours.
Within two days, I had lost any cravings for the ‘foods’ that I now choose to avoid. Instead, the nutritious foods that had become the focus of my eating satisfied my hunger in a way that I could not remember since my youth. I now realise that I had simply rediscovered the foods of my childhood.
Three weeks later, at the start of 2011, I was down to 96 kilograms – a loss of five kilograms in three weeks. By the time I arrived in Sweden five weeks later, my weight had fallen to 90 kilograms for a total loss of 11 kilograms in the eight weeks I had been on the eating plan. I had dramatically exceeded Westman and his colleagues’ improbable promise of six kilograms in six weeks. They were clearly not selling snake-oil nutrition science. Thereafter, my rate of weight loss slowed substantially. I reached an initial plateau weight of 86 kilograms at the start of June 2011, a weight loss of 15 kilograms after just 24 weeks on the eating plan.