[2017] Lore of Nutrition: Challenging Conventional Dietary Beliefs

by Tim Noakes

  The special place of maize in the traditional South African diet

  Maize has a special place in the South African diet and formed a key ingredient in the debate over whether or not I had acted unprofessionally by suggesting that LCHF foods are the ideal complementary foods for weaning.

  As shown in Figure 16.4, maize is a Central American, not a traditional African, cereal. It was introduced to the east coast of South Africa by Portuguese sailors in the 1500s,35 and was adopted as an agricultural crop by local Xhosa-speaking persistence farmers, but not to any great extent by European settlers.

  The discovery of diamonds in the north-eastern Cape in 1867 and gold in the Witwatersrand in 1886 dramatically increased the number of people attracted to the South African interior. Their requirements for food, especially for the mineworkers, rapidly outstripped local production. The solution was to import maize from Lesotho. But beginning in the 1930s, South African farmers began to invest in maize production, especially in what would become known as the Maize Triangle, extending from the North West province in the west to Swaziland in the north-east and to the northern borders of Lesotho in the south. At the end of the Second World War, government subsidies to these farmers caused a boom in maize production, so that today locally grown maize accounts for 40 per cent of South Africans’ dietary energy intake,36 the seventh highest in the world.

  Interestingly, Hester Vorster and Salome Kruger, two of the HPCSA’s expert witnesses, are from North-West University, which sits comfortably within the Maize Triangle. The university is actively involved in maize-based research.

  Under cross-examination in the hearing, Vorster argued that the reason why the South African paediatric nutritional guidelines do not mention that carbohydrates are an essential dietary element for infants between 6 and 12 months was because it was obvious – the majority of South Africans just know that maize is the complementary food of choice for infant weaning.

  But maize can never be a complementary food, because it does not complement breast milk by adding that which breast milk lacks. Even when fortified, maize lacks decent amounts of brain-essential nutrients. And where are the RCTs confirming the effectiveness of maize as a complementary food for weaning? Neither Vorster nor Kruger produced any such evidence.

  If maize only entered our food chain very recently (about 1930), what did South Africans eat before?

  This raises a further question, one for which I have struggled to find an answer: What did the Nguni tribes, who entered South Africa from the north between AD 600 and 1 400, and who gave rise to all current ethnic groups in South Africa – specifically the Zulu, Xhosa, Ndebele and Swazi peoples – eat?

  It is clear that until the last century, cattle (and perhaps goats) played a central role in Nguni culture. Zulu-speaking South Africans in KwaZulu-Natal revered the Nguni cattle. By 1824, for example, Shaka Zulu’s royal cattle pen contained 7 000 pure white Nguni cattle.37 Similarly, when the original pioneers arrived in Zimbabwe (then Rhodesia), they reported that the country was ‘teeming with cattle that were, apparently, in good health and were immune to local diseases’.38

  In The Abundant Herds, Marguerite Poland writes:

  Before 1850, there were an estimated four to five million Nguni cattle in what is now KwaZulu-Natal. Indeed it could have been said that, so immense was the number of cattle, idaka liye lahlaba ezulwini (the kraal-mud was splashed up to heaven), but war, disease, political unrest and the introduction by whites of their own cattle, led to a decline in numbers so that a decade ago only about 100 000 pure Ngunis remained. In 1879, at the close of the Anglo-Zulu War, in which the power of the Zulu Kingdom was broken, Sir Garnet Wolseley ensured the end of the Zulu royal herds by slaughtering and confiscating what remained.39

  There is also ample evidence that cattle were critically important to the health of Xhosa-speaking South Africans living in the Eastern Cape (then British Kaffraria).

  In 1856, on the basis of a spiritual encounter, the AmaGcaleka prophetess Nongqawuse informed her uncle that to rid their people of the oppressive British colonial influence, the AmaGcaleka had to slaughter all their cattle. At the time, many of their herds were plagued with ‘lung sickness’, possibly introduced by European cattle. In return, Nongqawuse prophesied, the spirits would sweep the British settlers into the sea, and the AmaGcaleka would be able to replenish their granaries and fill their kraals with more beautiful and healthier cattle. Nongqawuse’s uncle duly informed Paramount Chief Sarhili of his niece’s prophecy.

  Historians estimate that the AmaGcaleka killed between 300 000 and 400 000 head of cattle between 1857 and 1858. In the aftermath of the crisis, the population of British Kaffraria dropped from 105 000 to fewer than 27 000 due to the resulting famine. If cattle and dairy produce had not been a key food of the AmaGcaleka, this famine would not have happened.

  Another event proving the importance of cattle to Xhosa- and Zulu-speaking South Africans was the destruction caused by the rinderpest virus that swept through Southern Africa between 1896 and 1897, killing an estimated 2.5 million cattle. So catastrophic was the event that, in December 1896, the German physician Robert Koch, considered the father of modern bacteriology, arrived in Cape Town, where he worked for three months perfecting a cure.40

  The effects of this disease on the future health of South Africans would, in retrospect, prove catastrophic. As historian Charles van Onselen notes:

  The loss of large numbers of cattle caused considerable social and economic distress in African communities. With the disappearance of the source of meat and milk, Africans experienced considerable hardship and, in some cases, starvation … the impoverishment of Africans caused by rinderpest contributed to the growing proletarianisation of Africans and the process of labour migration.41

  The end result was a tragic repeat of what befell the Plains Indians* of North America, who lived exclusively on bison and who, in the early 1800s, were among the world’s tallest and healthiest humans.42 In 1877, Lieutenant Scott, a US cavalry scout, wrote about the Cheyenne scouts, who had led to the defeat of General Custer at the Battle of the Little Bighorn in 1876:

  … they were all keen, athletic young men, tall and lean and brave, and I admired them as real specimens of manhood more than any body of men I have ever seen before or since. They were perfectly adapted to their environment, and knew just what to do in every emergency and when to do it, without any confusion or lost motion. Their poise and dignity were superb; no royal person ever had more assured manners. I watched their every movement and learned lessons from them that later saved my life many times on the prairie.43

  Scott also noted that the Crow, the enemies of the Cheyenne, hunted bison once a week from large herds and that their camp ‘was full of meat drying everywhere. Everybody was carefree and joyous.’44

  Others reported that the American Indians were free of the diseases that afflicted European settlers, including diabetes, cancer, heart disease and most infectious diseases: ‘It is rare to see a sick body amongst them’; they are ‘unacquainted with a great many diseases that afflict the Europeans such as gout, gravel and dropsy, etc’; ‘While cancer is occasionally met with in primitive [sic] races, it occurs so seldom among the American Indians for instance, that this race may be considered practically immune from this disease’; and ‘In bodily proportions, color, gesture, dignity of bearing, the race is incomparable. It was free from our infectious scourges, tuberculosis and syphilis … probably free from leprosy, scrofula and cancer, and it is safe to say that nervous prostration was unknown to the [American] Indian.’45

  The expansion of the settlers west of the Mississippi after 1860 foretold the end of the Plains Indians’ free and healthy existence, for the settlers exterminated the bison, replacing the carnivorous diet of the Plains Indians with the modern industrial diet. As a result, diabetes and obesity are now rampant among their descendants.46 Essentially the same has happened in Southern Africa, and for the same reasons.

  In South Africa, the
rinderpest epidemic drove rural South Africans to the cities, where they invariably got work on the mines. The wealth generated by their work was used to fund the production of maize, which then became the staple diet particularly of those living and working on the mines in the Maize Triangle.

  My conclusion is that if we travel far enough back in the history of the Nguni peoples, who entered Southern Africa in the last 1 000 years, we will find that animal produce constituted a significant proportion of their diet. And why not? The countryside teemed with wild game, even before the Nguni domesticated their cattle. Since the development of mining, which led to the industrialisation of South Africa over the last 100 years or so, that diet has been replaced by one in which maize is the single most important contributor. I would, therefore, argue that the ill health of so many South Africans can be traced directly to these historical events.

  But in my trial, I learnt that those responsible for drawing up the South African dietary guidelines have little interest in exploring these facts. Which raises the question: Why? The answer can be found in the fact that humans were very healthy before they began eating the modern industrial diet with its high amounts of sugar, refined grains, trans fats and vegetable oils.

  The health of the mid-Victorians living in England between 1850 and 1880

  The mid-Victorian period between 1850 and 1880 is now recognised as the golden era of British health. According to P. Clayton and J. Rowbotham,47 this was entirely due to the mid-Victorians’ superior diet. Farm-produced real foods were available in such surplus that even the working-class poor were eating highly nutritious foods in abundance. As a result, life expectancy in 1875 was equal to, or even better, than it is in modern Britain, especially for men (by about three years). In addition, the profile of diseases was quite different when compared to Britain today.

  The authors conclude:

  [This] shows that medical advances allied to the pharmaceutical industry’s output have done little more than change the manner of our dying. The Victorians died rapidly of infection and/or trauma, whereas we die slowly of degenerative disease. It reveals that with the exception of family planning, the vast edifice of twentieth century healthcare has not enabled us to live longer but has in the main merely supplied methods of suppressing the symptoms of degenerative disease which have emerged due to our failure to maintain mid-Victorian nutritional standards.48

  Figure 16.7

  Comparison of causes of death in mid-Victorians living in England and Wales in 1880 compared with modern data from 1997. Note the large increases in deaths from cancers and diseases of the circulatory system, with reductions in deaths from infections, and parasitic and ‘other’ diseases. Redrawn from P. Clayton and J. Rowbotham, ‘How the mid-Victorians worked, ate and died’49

  This mid-Victorians’ healthy diet included freely available and cheap vegetables such as onions, carrots, turnips, cabbage, broccoli, peas and beans; fresh and dried fruit, including apples; legumes and nuts, especially chestnuts, walnuts and hazelnuts; fish, including herring, haddock and John Dory; other seafood, including oysters, mussels and whelks; meat – which was considered ‘a mark of a good diet’ so that ‘its complete absence was rare’ – sourced from free-range animals, especially pork, and including offal such as brain, heart, pancreas (sweetbreads), liver, kidneys, lungs and intestine; eggs from hens that were kept by most urban households; and hard cheeses.

  Their healthy diet was therefore low in cereals, grains, sugar, trans fats and refined flour, and high in fibre, phytonutrients and omega-3 polyunsaturated fatty acids, entirely compatible with the modern Paleo or LCHF diets.

  This period of nutritional paradise changed suddenly after 1875, when cheap imports of white flour, tinned meat, sugar, canned fruits and condensed milk became more readily available. The results were immediately noticeable. By 1883, the British infantry was forced to lower its minimum height for recruits by three inches; and by 1900, 50 per cent of British volunteers for the Boer War had to be rejected because of undernutrition. The changes would have been associated with an alteration in disease patterns in these populations, as described by Yellowlees (Chapter 2).

  The health of traditional societies eating their traditional foods

  India

  Major General Sir Robert McCarrison, who died in 1960, is remembered as one of the very first to understand the essential role of proper nutrition in human health.50 He wrote that ‘the greatest single factor in the acquisition and maintenance of good health is perfectly constituted food’:

  I know of nothing so potent in maintaining good health in laboratory animals as perfectly constituted food; I know of nothing so potent in producing ill health as improperly constituted food. This, too, is the experience of stockbreeders. Is man an exception to a rule so universally applied to the higher animals?51

  ‘So it is,’ he continued, ‘that research has provided, or is providing, an explanation of the fundamental fact that a diet composed of natural foodstuffs, in proper proportion one to another, is the paramount influence in the maintenance of health [my emphasis].’52

  This statement is profound; so profound that it has yet to make any impact on the teachings and practices of modern (allopathic) medicine, which, aside from the obvious nutritional deficiency diseases like scurvy and pellagra, ignores the role of nutrition in ill health, preferring rather the use of pharmacologically active agents to suppress disease symptoms, seldom producing cures.

  McCarrison was the first to study the effects of nutritionally deficient diets in different animal models, establishing how particular nutritional deficiencies caused specific medical conditions, including goitre, cretinism and beriberi. On the advice of 1932 Nobel laureate Sir Charles Sherrington, McCarrison spent the bulk of his medical career as Director of Nutritional Research in India. There, as Sherrington had suggested, he set about studying the diets and health of the different Indian peoples.

  He wished to understand how different dietary patterns across the Indian continent produced peoples with different body shapes, physical abilities and disease patterns, and the possible role of nutritional deficiencies in determining these characteristics. ‘Indeed, nothing could be more striking than the contrast between the manly, stalwart and resolute races of the north – the Pathans, Baluchis, Sikhs, Punjabis, Rajputs and Maharattas – and the poorly developed, toneless and supine people of the east and south: Bengalis, Madrassis, Kanarese and Travancorians,’ he wrote.53

  McCarrison noted that the Pathans are meat-eaters, whereas the Bengalis, Madrassis and Kanarese are, for the most part, vegetarians:

  As we pass from the north to the east, south-east, south-west and south of India, there is thus a gradual fall in the nutritive value of cereal grains forming the staples of the national diet, this fall reaching the lowest limit amongst the rice-eaters of the east and south. There is also a gradual fall in the amount of animal protein, animal fats and vitamins entering into these diets.54

  He concluded:

  The poorer classes, according to the degree of their poverty, drop out, in part or in whole, the more expensive or less easily obtainable items: milk, milk products, animal fats, legumes, fruit and vegetables. So that as the people are poorer and poorer their diets are more and more cereal in nature, more and more imbalanced, more and more depleted of animal protein, animal fats, vitamins and essential nutrients.55

  A key weakness of this poor diet, he observed, ‘takes the form of an excessive richness of the food in carbohydrates’.56

  McCarrison’s key conclusion was that differences in physical appearance and physical vigour between the different Indian populations could be explained by the extent to which their diets were nutritionally adequate, especially in terms of animal proteins and fats. The overriding problem was not gross dietary deficiencies (‘complete want of certain food factors’), but rather the ‘combinations of such insufficiencies’.57

  What is so remarkable is that the LFHC nutrient-poor diet of the rice-eating southern India
ns that McCarrison described is not too dissimilar to the ‘prudent’ diet advocated by the US dietary guidelines. Should we really be so surprised that our health has deteriorated so dramatically since we adopted a diet that more closely resembles that of the poorer Indian peoples?

  McCarrison concluded the following overall:

  The newer knowledge of nutrition has revealed, and reveals the more with every addition to it, that a chief cause of the physiological decay of organs and tissues of the body is faulty food, wherein deficiencies of some essentials are often combined with excess of others. It is reasonable, then, to assume that dietetic malnutrition is a chief cause of many degenerative diseases of mankind. However this may be, it seems clear that the habitual use of a diet made up of natural foodstuffs, in proper proportions one to another, and produced on soils that are not impoverished is an essential condition for the efficient exercise of the function of nutrition on which the maintenance of health depends. This, combined with the proper exercise of the body and of its adaptive functions, is mankind’s main defense against degenerative diseases: a bulwark, too, against those of infectious origin. Such, at least, is the conclusion to which my own studies in deficiency disease have led me.58

  Another forgotten Indian nutrition researcher, S.L. Malhotra, was the chief medical officer of Western Railway in Mumbai (formerly Bombay). From that office, he studied the rates of hospital admission of railway employees in different regions of India. He showed that the incidence of acute heart attacks was seven times higher in the rice-eating Indians living in the south than among the Punjabis in the north, who ate 8 to 19 times more fat, chiefly of animal origin, and about 9 times more sugar.59