[2017] Lore of Nutrition: Challenging Conventional Dietary Beliefs

by Tim Noakes

  Fourteen months later, after I had increased the fat content of my diet and begun to use the diabetic drug Glucophage (to better control my errant blood glucose concentration) and to include intermittent fasting, my weight dropped further, to between 80 and 81 kilograms. It has remained here ever since, and all without hunger.

  Even more exciting, my running began to improve, at first almost imperceptibly, but then quite dramatically. On my trip to Stockholm, in one 12-hour period I ran a total of 27 kilometres, including an 18-kilometre run in minus 15 degree Celsius weather. Eight weeks earlier, this would have been unimaginable.

  Within 12 weeks, I had reduced the time for my usual five-kilometre course by six minutes, and my longer 12-kilometre mountainous run by 40 minutes. In April 2011, I ran the Two Oceans 21-kilometre half-marathon 40 minutes faster than the previous year. I failed by just seven minutes to break two hours, and ran two of the final four kilometres at five minutes per kilometre, as fast as I could run in training. Yet, just 14 weeks earlier, I had been unable to sustain a pace of eight minutes per kilometre after only four kilometres of gentle running. Even the winner of the Two Oceans could not have felt as proud as I did at the end.

  During this time, I noticed other changes. My chronic dyspepsia (indigestion), which had become increasingly severe over the past decade, magically disappeared within the first month on the new eating plan. I subsequently learnt that Dr John Yudkin’s group had performed a controlled clinical trial in 1972 showing that a low-carbohydrate diet can cure dyspepsia.13 Interestingly, dyspepsia is one of the most common modern human medical complaints. Treatment for it generates billions of dollars annually in the sale of drugs that do not cure the condition, but merely limit the symptoms to some extent. Now it would seem that the only treatment needed to cure this common problem could be to switch to a low-carbohydrate diet.14 I certainly would have appreciated receiving this information as part of my medical training.

  Next, the regular headaches that I suffered at least once a week and for which I took powerful painkillers disappeared completely. In the almost seven years since adopting the eating plan, I have had to take medication only twice to treat a headache. This is understandable if an allergy to wheat gliadin is a common cause of recurrent headaches, as cardiologist Dr William Davis proposed in his bestselling book Wheat Belly. Or if a majority of common headaches are caused by gluten sensitivity, as neurologist Dr David Perlmutter suggested in another New York Times bestseller, Grain Brain.

  My condition of allergic rhinitis and bronchitis, which I had always considered to be due to a pollen allergy, also disappeared, as did my occasional attacks of post-exercise wheezing (asthma). For 30 years, I could expect a severe attack at least every three to six months of the year. These attacks were each sufficiently debilitating to require treatment with inhaled corticosteroids. In the past seven years, I have had only two mild attacks of rhinitis/bronchitis. Since the only change I have made to my diet in that time was to remove grains and cereals, I must also assume this condition was due to an allergic response to grains or cereals, or both.

  Next, my eyesight improved to the point where I no longer required reading glasses, which I had used since age 15. (This could suggest that my problem with carbohydrates was already present when I was a teenager.)

  My wife became overjoyed when, as I lost fat especially around my neck, I stopped snoring, proving, at least to me, that snoring is caused by carbohydrate-induced fat deposition in the upper throat. Perhaps snoring is just another obvious indication that one is overweight and in need of a dietary change.

  In time, I discovered that many of these conditions form part of non-coeliac gluten sensitivity (NCGS), a malady that has only been properly recognised in the past five years. The condition is caused by an allergic response to gliadin in wheat and may occur in at least 30 per cent of humans without their knowledge.15 The evidence that cereals and grains containing gluten and gliadin may be the direct cause of a wide range of medical conditions conflicts with the current dietary guidelines, which promote cereals and grains as the basis for a healthy diet.

  Over the past seven years of my most important experiment, I have learnt more about nutrition than I did in the previous 41 years of my medical and scientific training.

  Perhaps the most sobering lesson was that this new way of eating is not new at all. It has been around for quite some time – for about three and a half million years, in fact. It therefore makes no sense at all to call LCHF a fad diet. It is the original eating plan, the way nature designed us humans to eat.

  Over time, I came across Gary Taubes’s monumental works, Good Calories, Bad Calories and Why We Get Fat, as well as a New York Times article that he had written back in 2002, titled ‘What if it’s all been a big fat lie?’16 I realised that, like Atkins, Westman, Phinney and Volek, Taubes is one of the most important figures in revealing a dietary history that has been forgotten, perhaps hidden.

  Thus it is in Good Calories, Bad Calories that Taubes rediscovers the story of how Dr William Harvey cured the obesity of 19th-century London undertaker to the royal family William Banting, by prescribing a low-carbohydrate diet. Banting subsequently described the nature of his cure in probably the world’s first diet book, Letter on Corpulence, Addressed to the Public, which he self-published in 1863. In the 1880s, German cardiologist Wilhelm Ebstein wrote two books, Treatment of Corpulence and The Regimen to be Adopted in Cases of Gout, both of which promoted the use of low-carbohydrate diets to the medical profession in Europe. Within another decade, this knowledge had crossed the Atlantic and was the diet that Sir William Osler prescribed for the treatment of obesity in his iconic medical text The Principles and Practice of Medicine.

  I was left with one overriding question: If this information has been in the medical literature since at least 1882, and if it has helped me improve my health so dramatically, why is it not being taught at medical schools across the globe?

  I would find answers to this and other questions only when I began relating my experiment and experience to others.

  I knew at the time that everything I was saying was controversial and that many would disagree with me. It is natural and normal in science – or should be. Science is all about the search for truth, after all, and truth is never static. Loud warning bells ring in my head whenever nutrition scientists say that the science ‘is settled’. It is not in the nature of science ever to be settled. Nor is science ever about ‘consensus’.

  I was well aware that I was directly challenging conventional nutrition ‘wisdom’, particularly South Africa’s influential LFHC dietary guidelines and the powerful vested interests in the food and drug industries that have benefited massively from them. South Africa’s guidelines are based on those that the US introduced way back in 1977, the very same guidelines that American science journalist Nina Teicholz and British obesity researcher Dr Zoë Harcombe showed to be unsupported by robust science when they were adopted, and which remain so to this day.17

  I also suspected that some doctors and dietitians would dismiss my experiment and experience as anecdote. However, all good scientists know that all of science begins with anecdote. And my experience simply adds to a subsequent groundswell of anecdotal evidence coming in from people around the globe.

  The establishment backlash, when it came, was swift, targeted and ugly, and of a startlingly venomous personal nature. Most alarming of all, however, was the impenetrable wall of silence that rose around the science. My critics were either ill prepared or, for reasons known only to them, not prepared to debate the science in public. Soon, though, from behind that wall began to emerge the roots of what looked like an organised campaign to discredit the evidence for LCHF by demonising and defaming me.

  The next chapter chronicles the beginning of the pushback to protect the status quo.

  *I put the word ‘foods’ in inverted commas because, in time, I would discover that most of the foods I had removed from my diet are not real foods. Rather, they are
highly processed ‘food-like substances’, which are all specifically designed to be high in addictiveness – sometimes confused with palatability – and low in nutritional value. The boxed cereals that the world’s most sophisticated advertising campaign had led me to believe were so highly nutritious are, I learnt, just a toxic combination of rapidly digestible carbohydrate laden with sugar. Compared to eggs, sardines and liver – three of the most nutritious foods known to humans – these foods are nutritionally barren. The only thing that sustains them is an advertising campaign that spends more money on the promotion of breakfast cereals than on any other single food group. I now appreciate that a typical bowl of breakfast cereal provides an oversupply of glucose and sugar, neither of which is necessary for human existence. Real foods are those like eggs, meat, nuts, fish, dairy, vegetables and fruits that are unprocessed and which exist in a natural state in our environment. They are foods that ‘have been alive until quite recently’. Only later would I begin to comprehend that, whatever the contrasting advertising claims, foods are processed for two principal reasons, with one shared goal: to sell more of a very cheap product at maximum profit. The industry achieves this by making foods so palatable that they become ‘irresistible’ – a term food marketers choose in preference to the real description, ‘addictive’. The food industry also makes products long-lasting so that they can survive on shop shelves for months, if not years. It took me at least a year to understand why these highly refined, food-like substances are at the core of the epidemics of obesity, diabetes and ill health that have engulfed the world in the last 30 years.

  3

  The Backlash Begins

  ‘In science it’s not a sin to change your mind when the evidence demands it. For some people, the tribe is more important than the truth; for the best scientists, the truth is more important than the tribe.’

  – Joel Achenbach, American science writer1

  My epiphany in December 2010 came a few months after I had completed the first edition of my memoir, Challenging Beliefs. The physical and spiritual transformations that resulted from my dietary change occurred too late for that story to be included in the first edition of the book. In any case, I was still uncertain whether the new way I was eating would become a lifelong commitment or hold any value for others.

  It took me many months to pluck up the courage to take my story to a wider audience. The first chance was a regular column I was then writing for Discovery Health, the company that was generously funding my research and the work of the Sports Science Institute of South Africa (SSISA). In the winter 2011 edition of their health magazine, Discovery, I broke my silence, describing for the first time my initial uncertain steps into the world of the low-carbohydrate diet. The title ‘Against the Grains’ identified the focus – it was a report of how and why I had removed grains and other carbohydrates from my diet.

  In the introductory paragraph, I demonstrated that I already knew that what I was writing would be unpopular: ‘I am not one to shy away from controversy. But I suspect that this column will attract more unfavourable comment than perhaps anything else I have recently written. Yet the message could be life-changing for some.’ The article included the following observations:

  Global obesity rates have risen dramatically since the adoption of the US dietary guidelines, which promote 6–11 daily servings of bread, cereals, rice and pasta.

  Humans have eaten meat for millions of years, but grains for only the last 20 000 years or so.

  Humans developed our large brains by eating ‘high-energy’ foods like meat and fish. ‘Perhaps,’ I quaintly proposed, ‘humans are closet carnivores.’

  Low-carbohydrate diets produce weight-loss results ‘at least as good as those achieved with the traditional low-fat, high-carbohydrate diets’.

  High-protein diets produce satiation, whereas carbohydrates drive hunger. ‘This absence of hunger is more likely to encourage compliance and sustained weight loss (in those eating low-carbohydrate diets). In contrast, there may be an addiction especially to rapidly assimilated carbohydrates like sugar and refined carbohydrates, that drives the overconsumption of all foodstuffs, fat included, and hence leads to weight gain.’

  As a result, ‘it is the unrestricted intake of especially refined and hence addictive carbohydrates that fuels an overconsumption of calories, not a high fat intake as is usually believed’.

  Finally, and in my usual provocative style, I asked why these facts were not apparent to everyone. My conclusion: ‘There is a saying that to find the root cause, follow the money trail. If a low-carbohydrate intake is more healthy than we expect, then why is that fact hidden? The answer is that some very large industries, including the soft-drink, sugar and confectionery industries (all of which produce high-carbohydrate products with minimal nutritional value) do not want us to know this.’

  That final statement would perhaps prove to be truest, since it would lead to the events described in this book.

  One immediate consequence of that first article was that Discovery cancelled my regular column, which I had written for many years.

  By the end of 2011, the message that I had abruptly reversed my dietary advice was beginning to spread across South Africa. My publisher, sensing an opportunity, approached me to add new material to Challenging Beliefs. Bolstered by a growing certainty that I now had a novel dietary message of value for a much larger group of South Africans, I added 35 pages. These are the key themes that I introduced:

  The low-carbohydrate diet cannot be labelled a fad diet, because William Banting described its first successful adoption in the 1860s, more than a century before the real fad diet, advocated by the 1977 Dietary Guidelines for Americans, went mainstream.

  Industries determine what we believe about nutrition. They engineer these beliefs to increase food and beverage sales, not to protect or improve our health. In fact, most of what we have been taught is detrimental to our health.

  Humans can be classified as either carbohydrate tolerant or carbohydrate intolerant (today I prefer the terms insulin sensitive and insulin resistant).

  Dietary carbohydrates, not fat, cause obesity and lead to diabetes in those who are insulin resistant.

  There is no evidence that a high-fat diet is harmful to health.

  Sugar, not fat, is the single most toxic ingredient of the modern diet. It is also the most ubiquitous foodstuff on the planet. (Today I would add that sugar is not a foodstuff; it is a drug.)

  Cholesterol is not the unique cause of heart disease and may not even be an important factor (especially in women).

  You cannot outrun a bad diet.

  Athletes are not thin because they exercise. Rather thinness begets exercise, whereas obesity causes sloth.

  It is possible to exercise and train vigorously while eating a low-carbohydrate diet. (I added the proviso that it was still unknown whether or not athletes could sustain high-intensity exercise if they did not increase their carbohydrate intake both before and during exercise.)

  I concluded with nine health recommendations for those living with IR.

  When I added these ideas in early 2012, I was certain that they were sufficiently correct for me to risk exposing them to a wider audience. I also assumed that because we live in a mature academic democracy in South Africa, these ideas would inspire a grown-up debate in the scientific community, especially among colleagues at my academic home, the Faculty of Health Sciences at UCT.

  As a result of that adult debate, I presumed that my colleagues would warmly embrace whatever was of value in these ideas. Equally, after appropriate joint discussions, we would summarily dismiss any ideas that science subsequently disproved. The outcome would be a better understanding of IR, obesity and T2DM (plus a wide range of other conditions), and the development of better, safer ways to more effectively treat many more patients. How exciting if, finally, we could advocate a simple method to prevent and treat the chronic medical conditions that are destroying healthcare in South Africa as elsewhere.
And in a way that would not bankrupt patients or medical-aid schemes. What could possibly be more rewarding?

  I was in for some rude surprises, the first of which was a series of public criticisms from colleagues at the UCT Faculty of Health Sciences, a faculty that I had first entered in February 1969 and which, in my opinion, I have served honourably ever since.

  The first clear public evidence that my challenge to orthodoxy was sparking intense concern among some senior UCT academics materialised on 13 September 2012, when I was awarded the National Research Foundation’s Lifetime Achievement Award. This is the highest South African scientific award. The citation to the award stated the following:

  This serves to acknowledge Professor TD Noakes who is recognized internationally for his extraordinary contribution to the development of science, what he stands for as a South African, and for the manner in which his work has touched and shaped the lives and views of many South Africans.

  Within minutes of receiving the award, at about 9:30 p.m., my cellphone rang. It was a local news reporter who wished to include my comments in a story he was writing about a letter to be published the following morning in his newspaper.

  Written by a group of Cape Town cardiologists, headed by then UCT cardiology professor Patrick Commerford and including Professor David Marais and doctors Mpiko Ntsekhe, Dirk Blom, Elwyn Lloyd and Adrian Horak, the letter warned that the prescription in Challenging Beliefs of a ‘high-fat, high-protein’ diet for ‘all persons’ is ‘contrary to the recommendations of all major cardiovascular societies worldwide, is of unproven benefit and may be dangerous for patients with coronary heart disease [CHD] or persons at risk of coronary heart disease’.2 In addition, the cardiologists were unhappy that I was ‘questioning’ the value of cholesterol-lowering agents (i.e. statins), because this was ‘at best unwise and may be harmful to many patients on appropriate treatment’.