by Tim Noakes
In an exposé on Katz in 2016, Greene concluded:
Katz has managed to live two lives, one as a paid junk-food apologist, the other as an independent source for public health information. But what makes his story more remarkable is that he successfully played both roles under a single name. And the media and government failed to adequately vet him for conflicts of interest, all the while promoting his work to the unknowing public. Thanks to the CDC [Centers for Disease Control and Prevention], US taxpayers provided the ‘core funds’ for Katz’s research.
Logically and physically, only one Dr. David Katz can exist. His public health persona may be a facade, but the million-plus he has accepted from junk food companies remain matters of fact.19
Interestingly, on her website, Strydom acknowledges that she is one of 120 members of the council of directors for the GLiMMER (Global Lifestyle Medicine Mobilizing to Effect Reform) Initiative, the goal of which is to be ‘a global voice devoted to disseminating and applying what we know for sure about health promotion and disease prevention’. GLiMMER’s founder is Dr David Katz, who advocates a low-fat diet and maintains that saturated fat is not good for health.20
Katz would not be the first industry-sponsored nutritionist to be invited to speak in South Africa on the benefits of a ‘plant-based’ diet. In April 2014, Strydom invited Sylvia Escott-Stump from the East Carolina University Department of Nutrition Science to speak at the annual Nutritional Solutions Continuing Nutrition Education (CNE) Event. When interviewed by Strydom, Escott-Stump opined:
The cause of obesity is multifactorial and it is truly impossible to pinpoint a single cause … Ideally, it is recommended to consume a typical daily intake based on the general food based dietary guidelines which includes 45–60% of total energy per day from carbohydrates … The high protein, low carbohydrate diet does not make physiological sense … The brain and red blood cells require a constant supply of glucose … In summary, eliminating a key macronutrient such as carbohydrate is quite detrimental as the body needs a steady supply for various purposes.21
The interview, which appeared in the South African Journal of Clinical Nutrition (SAJCN), ended with the following disclosure: ‘Kellogg Company of South Africa was one of the executive sponsors at the 2014 Nutritional Solutions CNE. This sponsorship made it possible for Ms. Sylvia Escott-Stump to travel to South Africa to present at this event.’
In 2012, when Escott-Stump was its president, the US Academy of Nutrition and Dietetics issued a press release opposing New York City’s plan to ban the sale of sodas and other sugary beverages larger than 16 ounces in restaurants and entertainment venues.22 Their opposition is understandable when you know that AND was sponsored by Abbott Nutrition (makers of infant formulas), Coca-Cola, Kellogg’s, Mars, PepsiCo and Unilever to the tune of $3 million in 2011. On one occasion, Escott-Stump famously appeared wearing Coca-Cola red to promote Coca-Cola at a 2012 Coca-Cola event in her role as AND president.23
Strydom’s tweets also exposed her ignorance of the nature of dietary fats. On 19 February 2014, she wrote:
@MarikaSboros I will still not advocate a diet made up of 60–75% saturated fats. Show me the evidence that shows this extreme is good!!
Regardless of the fact that the Banting diet does not promote eating 60–75 per cent saturated fat, the reality is that all foods contain three types of fat in different proportions (Table 8.2), so that it is impossible to eat a diet that is 60–75 per cent saturated fat – unless you lived on coconut oil or ghee alone.
Table 8.2 Fatty acid profile of commonly eaten fatty foods
Fatty acid profile
Saturated
Monounsaturated
Polyunsaturated
omega-7, omega-9
Total
omega-6
omega-3
Saturated fats
Chicken fat
31%
49%
20%
Depends on feeding
Duck and goose fat
35%
52%
13%
Depends on feeding
Lard (pork)
40%
48%
12%
Depends on feeding
Palm oil
50%
41%
9%
9%
0%
Tallow (beef or mutton)
55%
40%
5%
Depends on feeding
Ghee
65%
31%
4%
Depends on feeding
Coconut oil
92%
6%
2%
2%
0%
Monounsaturated fats
Avocado oil
12%
70%
13%
12%
1%
Olive oil
13%
75%
12%
10%
2%
High oleic sunflower oil
7%
78%
15%
15%
0%
High oleic sunflower oil
9%
83%
8%
8%
0%
Polyunsaturated fats
Peanut oil
18%
48%
34%
34%
0%
Canola oil
5%
57%
35%
23%
12%
Sesame oil
15%
42%
43%
43%
0%
Cottonseed oil
26%
18%
54%
54%
1%
Sunflower oil
10%
35%
55%
65%
0%
Soybean oil
17%
25%
58%
51%
7%
Safflower oil
8%
17%
75%
75%
0%
Flaxseed oil
9%
18%
73%
16%
57%
One final tweet from Ellmer is of interest. On 2 July, she tweeted:
@miridavdm @ProfTimNoakes Mirida it is not safe to continue banting whilst pregnant. We don’t have the studies http://t.co/c8Nsd4vLt4
She admits that ‘we don’t have the studies’, so on what grounds does she draw the conclusion that Banting is unsafe during pregnancy? Recall that by the time the HPCSA hearing came around, Ellmer had become rather less certain of her conviction that the LCHF diet is dangerous to infants. In fact, she was then so uncertain that she decided not to testify.
True to her word, Strydom submitted a formal complaint to the HPCSA in the form of an email sent at 08h47 on Thursday 6 February 2014. It read:
To whom it may concern.
I would like to file a report against Prof. Tim Noakes. He is giving incorrect medical (medical nutrition therapy) on twitter that is not evidence based. I have attached the tweet where Prof. Noakes advices [sic] a breastfeeding mother to wean her baby onto a low carbohydrate high fat diet.
I urge the HPCSA to please take urgent action against this type of misconduct as Prof Noakes is a ‘celebrity’ in South Africa and the public does not have the knowledge to understand that the information he is advocating is not evidence based – it is especially dangerous to give this advice for infants and can potentially be life threatening. I await your response.
Kind regards,
Claire Julsing Strydom
The HPCSA forwarded the complaint to me on 20 February 2014. It is absolutely clear that, in contrast to what Strydom said under oath during the hearing and subsequently on Twitter and in the media, this complaint did not come f
rom ADSA, of which she was president at the time. It came directly and solely from Strydom. This was made clear in all the correspondence I received from the HPCSA, which always listed the complainant as ‘Ms CJ Strydom’. Additionally, the email complaint was sent less than two and a half hours after Strydom tweeted asking Leenstra to contact her ‘for evidence based advice’ – both the tweet and the complaint therefore arising before 9 a.m. This allowed no time to consult with ADSA, let alone for them to approve a complaint that was to be made on their behalf.
My initial reaction to the complaint was that it was utterly ludicrous. How could a dietitian, who claims in her lectures and blogs that everything she does is ‘evidence based’, lodge a complaint without a single academic reference to support her contention?
I sent a four-page response on 2 May 2014. By this stage, because I considered the complaint so absurd, I had not consulted anyone about what I should write. I simply could not conceive that such a trivial, unscientific rant could ever be formulated into a charge against me.
Dear Ms Mngadi,
Thank you for the registered mail of the 20th February 2014. The letter includes the complaints of Ms Claire Justing [sic] Strydom relating to a Tweet I made on 05/02/2014. My tweet included the statement: ‘Key is to wean baby onto LC HF’. I have sent a copy of this correspondence also by registered mail.
Ms Strydom claims that I am ‘giving incorrect medical advice …. that is not evidence based’. She claims that I am guilty of ‘misconduct’ as this advice is potentially life-threatening. She asks that the HPCSA takes urgent action against me.
As I understand the legal process, it is not sufficient for the prosecution simply to make a claim as does Ms Strydom in this case, that what I have said is ‘not evidence-based’. Rather Ms Strydom must provide the evidence-base to prove that my comments are ‘life-threatening’. This is particularly important as she has made this claim publically [sic] on Twitter so that I, as the aggrieved party, might have grounds to take legal action against her for unprofessional conduct with respect to public statements about the competence of another medical professional. In providing this response, I do not forego my options in that regard.
Unfortunately Ms Strydom does not provide that ‘evidence-base’ for her belief; thus she has no case. The basis for her complaint is null. The reason she cannot provide that ‘evidence-base’ is simply because no such evidence exists. There are no randomised controlled clinical trials (RCTs) comparing the long-term effects of weaning babies onto the high carbohydrate low fat diet that she prescribes or its converse which I believe is the only healthy option. There are certainly no clinical trials showing that my approach is ‘life threatening’. In the absence of that evidence, Ms Strydom is in the invidious position that she has publicly attacked a professional colleague without being able to provide the scientific evidence to support her potentially defamatory and certainly unprofessional statement.
The reason why she believes that babies should be weaned onto a high carbohydrate diet is simply because that is the dogma she has been taught in her training as a South African dietician. But to elevate that dogma to established truth requires that the appropriate RCTs be performed. In their absence, neither she nor I can be certain of what is the best diet on to which one should wean a child. As a result we are allowed to come to our own conclusions, based on our professional experience and training, and it is perfectly in my right to conclude that her advice is wrong and that children should not be weaned in the manner she has been taught.
The logic for my position is an extension of my argument (with which the HPCSA has publicly expressed its disagreement) that a high carbohydrate diet is the single most important factor driving the obesity and diabetes epidemic in this country and indeed globally. I have partially developed that argument in our new book The Real Meal Revolution. It is too complex to argue fully here. However I do submit another document from colleagues (attached) that in my opinion is the single most clearly stated counter-argument to the current dietary guidelines that Ms Strydom and all South African dieticians are taught.
I frequently make the point, emphasized in our book, that the novel high carbohydrate low fat guidelines which Ms Strydom promotes were adopted in the United States in 1977 without an adequate evidence-base and purely to bring down the price of food and maximize the wealth of North American farmers. The evidence that these guidelines were driven by political/economic considerations alone without concern for their long-term health consequences is absolutely clear in the published record. It is most unfortunate that in her training, Ms Strydom appears not to have been exposed to this evidence. If she were, she might have a different opinion of the veracity of what she has been taught.
But with regard to the weaning of children, my arguments are the following:
1. In his book Nutrition and Physical Degeneration, Weston Price reports historic data showing the remarkable health of traditional societies eating traditional foods. In a European context he reports the astonishing health (and absence of common diseases like diabetes, obesity, tuberculosis and dental caries) in Swiss people living in the isolated Loetschental Valley (before the 1940s when the modern high carbohydrate diet first reached that population). The people in that valley lived on rye, dairy products and the meat of cattle. Thus the entire population ate a low carbohydrate diet. The same findings were reported for persons living in the outer Hebrides (Scotland) in which oats replaced rye and the main source of protein and fat was the abundance of fish. In both populations, the children were extremely healthy. In Africa the Masai live on a very low carbohydrate diet as do the Inuit in the Arctic. There are no reports that the limited carbohydrate intake of the children in those populations is ‘life threatening’. If it were, the populations would not have survived as all the children would have died.
It is notable that when these populations adopt the modern ‘healthy’ diet promoted by Ms Strydom and others, they become remarkably less healthy than when they ate their traditional high fat low carbohydrate diets.
2. Humans have absolutely no essential requirement for carbohydrate. There is no human disease caused by carbohydrate deficiency. Carbohydrate in the body serves only 2 functions – it is either used as a source of energy or it is stored as fat. There is no other option.
The human body has a great capacity to produce all its energy (at rest) from the oxidation of fat. There is no need for humans at any age to ingest carbohydrate in order to provide their bodies with ‘energy’.
3. A deficient intake of either protein or fat is associated with disease and ill health. These conditions are well described and common in malnourished South Africans. Malnourished South Africans and those with obesity and diabetes (including children) are NOT eating a low carbohydrate high fat diet. They are eating a high carbohydrate low fat diet. Sooner or later this fact will have to be acknowledged and the dietary advice given to South Africans will have to change. Until that happens South Africans will continue to grow yet fatter with higher rates of diabetes and other related diseases.
4. There is growing evidence that the first 1000 days of the child’s life are crucial determinants of his or her long-term health and intelligence. During this period of rapid brain development, the greatest need is for a high fat intake to maximize brain growth. Carbohydrates, because they provide only energy and substrates for fat accumulation, cannot provide the key nutrient (fat) necessary for optimal brain growth. Thus the probability is that providing the growing child with a high carbohydrate diet in the first 1000 days of his or her life could rob the child of vital nutrients necessary for maximizing brain growth. Thus the prescription of a high carbohydrate low fat diet in the first 1000 days of life might reasonably be described as ‘life determining’, if not actually ‘life threatening’.
Indeed there is an urgent need to study the effects of the almost absence of fat in the diets of the poorest South Africans on their brain development and subsequent intellectual development. Or conversely the eff
ects of low carbohydrate high fat eating on the brain development of those South Africans who are the most deprived.
5. Each generation of children (including South Africans) is becoming progressively fatter. Whilst the argument favoured by South African dieticians is that this is because children are simply becoming lazier and are eating too much fat, the evidence does not support this. Why is it that this effect is present already in children of 1–2 years? It cannot be because they are doing too little exercise and eating too much fat since there is no population in South Africa, other than those individuals who have recently converted in the past year or so, eating a high fat diet (and children are not physically active until they start walking).
Rather the evidence points to this being a generational epigenetic effect in children. Epigenetics refers to the effects of environmental factors which alter the way in which our genes act. Thus the argument is that mothers advised to eat high carbohydrate diets produce an intra-uterine environment in which the fetus becomes accustomed to frequent elevations in blood glucose and insulin concentrations every few hours. This, it is argued, sets up the metabolic profile (and perhaps conditions the brain) that favours the development of obesity and perhaps diabetes. Next if the infant is not breast-fed, it will be exposed to more carbohydrates in formula milk. Then according to Ms Strydom’s advice the infant will be weaned onto a high carbohydrate diet which must further continue the epigenetic programming caused by frequent oscillations in blood glucose and insulin concentrations, thereby increasing the probability for obesity and diabetes in adulthood (and with the further disadvantage of sub-optimum brain development).