[2017] Lore of Nutrition: Challenging Conventional Dietary Beliefs

by Tim Noakes

  Instead, Dhai was on a different mission, as the contents of the now infamous file – the ‘dodgy dossier’ – revealed. She wanted the HPCSA to expedite the case against Noakes. She deemed him a threat to public health because of his ‘high profile’. She therefore chose the opinion of the one person she could be fairly certain would support her view: North-West University nutrition professor Hester Vorster. Vorster was perhaps the South African academic with the most to gain from discrediting Noakes and burying the LCHF/Banting diet. As the author of the 2013 revision of the South African Food-based Dietary Guidelines, Vorster stands to lose the most from a move away from cereal- and grain-based high-carbohydrate diets to the LCHF lifestyle that Noakes advocates. Headlining the guidelines is her edict that we should all ‘make starchy foods part of most meals’.10 Besides her obvious conflict of interest, Vorster was demonstrably one of the least qualified South African academics to give an opinion on the complaint that her former student, dietitian Claire Julsing Strydom, made against Noakes.

  Within the first five minutes of cross-examination, Advocate Dr Rocky Ramdass had blown Vorster’s cover. He established that her undergraduate degree in home economics does not qualify her as a dietitian; that she has no other qualifications or training in dietetics; that she has never practised as a dietitian or treated a single patient; and, more importantly, that she has done no research on the LCHF diet. Vorster also has no expertise in ethics, knows little about social media and doesn’t have a Twitter account. What Vorster does have is a long history of research funding from SASA and involvement with the Coca-Cola front company, the ILSI.

  As US investigative journalist Russ Greene showed, Vorster was not the only one with this type of clear conflict of interest. Many, if not most, of the doctors, dietitians and academics involved in the HPCSA’s case against Noakes have links with drug companies and/or the sugar industry in general, and the ILSI in particular.

  Alternatively, the HPCSA could have just read the South African Food-based Dietary Guidelines. If they had done so, they would have read that: ‘From six months of age, give your child meat, chicken, fish or egg every day, or as often as possible.’11 That was essentially what Noakes recommended in his tweet to breastfeeding mother Pippa Leenstra. Both Vorster and her North-West University colleague, Professor Salome Kruger, should have seen that.

  As we have shown in this book, the trial was never about infant feeding. The Naudé review clearly demonstrated that. It was also not about Noakes’s conduct as a medical doctor on social media. After all, he hasn’t practised clinical medicine for more than 15 years. Furthermore, the HPCSA doesn’t have any guidelines for health professionals on social media. So how could the HPCSA go after Noakes for breaching non-existent guidelines?

  Instead of relying on the acutely embarrassing testimony of Stellenbosch psychiatry professor Willie Pienaar, the HPCSA could have referred Noakes’s tweet to Dr Brenda Kubheka of the University of the Witwatersrand’s School of Public Health. In a recent editorial in the SAMJ, Kubheka clearly distinguishes between providing generic and patient-specific advice on Twitter: ‘It is advisable that professionals share generic information online and avoid responding with direct medical advice to individuals.’12 Which is exactly what Noakes did in responding to Leenstra’s ‘we’ question.

  In Tim Noakes: The Quiet Maverick, Daryl Ilbury considers the ethics of the tweet that started all the trouble. He concludes:

  It’s neither an offensive tweet by any stretch of the imagination, nor does it fall foul of any media law – it’s not libellous and there’s no encouragement of harm to others. People could disagree with him and had a voice to do so; that’s the point of social media: it is a platform for public discussion … Importantly, the question demanded a public, not a private response, which the person asking the question was free to accept or reject. And, as a medical doctor, Noakes didn’t cross any ethical boundaries in replying on a public platform. He didn’t publish any confidential patient information or dispense a diagnosis for a specific patient without seeing that patient; he simply provided generalised nutritional advice based on scientific evidence.13

  Had the HPCSA followed this approach, they could have resolved Strydom’s complaint in less than an hour. Instead, the HPCSA deliberately turned a single, innocuous tweet into a trial that lasted more than three years and cost millions of rands.

  Which brings us to the most inexplicable imponderable: Leenstra’s deafening silence. She was ostensibly the mother of a potential victim, yet the HPCSA did not call her to testify. Leenstra made it clear in media interviews that she thought the whole thing had become a circus. If the HPCSA had called her, she would have had to tell the truth: that she had no doctor–patient relationship with Noakes. In fact, if Leenstra’s tweet was not a set-up from the start, as some suggest, she might have said that she didn’t even know that Noakes was a doctor. His Twitter profile makes no mention of it, and his public profile is that of a scientist, not a doctor. Leenstra would have had to say that she hadn’t tried to get a free consultation or medical advice out of Noakes; that all she did was ask Noakes for information and he gave it. End of story.

  We speculated from the outset that this trial was a turf war between Noakes and dietitians. That leads to another major imponderable: Strydom’s real motivation for going after him. It clearly wasn’t his tweet, as evidence on the record at the hearing showed. Proof was found in an email chain that Noakes’s instructing attorney, Adam Pike, uncovered in July 2017 after making a freedom-of-information request to ADSA under the Promotion of Access to Information Act.

  Among other things, the emails show that Strydom and her successor as ADSA president, Maryke Gallagher, had Noakes, and not his tweet, firmly in their sights. In one email in June 2014, Strydom appeals emotively to the HPCSA about ‘The Tim Noakes problem’ and his ‘bashing of the profession’. ‘We need intervention from HPCSA as a matter of urgency,’ she writes. Strydom also says that ADSA needs the HPCSA’s ‘much bigger clout’. In its replies, the HPCSA indicates that it will oblige.

  Ironically, Strydom presents as proof of the ‘bashing’ a January 2014 media report that is highly critical of dietitians. However, Noakes is not the one doing the bashing. The article, by Gary Watson, is also highly supportive of Noakes, which clearly infuriated Strydom.14

  This would account for emails in which Strydom encourages another ADSA executive to lodge a complaint against Noakes with the HPCSA in July 2014. Catherine Pereira’s grounds were even more frivolous than Strydom’s: outrage at Noakes opining that he didn’t know of any dietitian who tells people in poor communities not to drink Coca-Cola or eat potato crisps. In reality, Strydom had no proof that Noakes had ever said anything remotely antagonistic towards any dietitian personally, because he hadn’t ever done so.

  The emails Pike uncovered show that it was the publication of The Real Meal Revolution in 2013 that really caused an uproar among some dietitians. The book had stimulated a public uprising against the advice that dietitians regularly dished up. The public was demanding proof of their claims that the Banting diet was dangerous. All they could come up with was what Watson exposed: nothing at all, although he put it in stronger language. Watson’s article appears to have been the tipping point that set Strydom and Gallagher on their quest to muzzle Noakes: the public wouldn’t accept their explanations for why Banting wasn’t brilliant. Instead of thinking of a properly scientific answer, they tried to shoot the messenger of The Real Meal Revolution. They thought that if they cut off Noakes’s scientific head, they would stop the revolt.

  ADSA clearly had Noakes in its sights for years. It took the freedom-of-information request in mid-2017 by Noakes’s lawyers for ADSA to give up an email chain. In one email, Strydom begged the HPCSA to expedite the case against Noakes. She appeared to assume, oddly though correctly enough, that the HPCSA would automatically do her and Gallagher’s bidding.

  What also stands out as an imponderable is the ethics of the connection b
etween Strydom and the HPCSA’s Dietetics and Nutrition Board member: North-West University nutrition professor Edelweiss Wentzel-Viljoen. In an email on 4 June 2015, Wentzel-Viljoen apologises to Strydom for not being able to disclose the HPCSA’s ‘plan’ for Noakes. The fact that there was a ‘plan’ suggests the HPCSA’s bias towards a guilty verdict from the outset. She says that the HPCSA’s legal department told her she was not allowed to tell Strydom about the ‘plan’. One could reasonably have assumed that as a Dietetics and Nutrition Board member, Wentzel-Viljoen would have been cognisant of her responsibility to act without prejudice towards a fellow health professional.

  Yet another imponderable is why the HPCSA chose so speedily and enthusiastically to enter the turf war on the dietitians’ side. After all, HPCSA hearings are supposed to be dispassionate inquiries into the truth of a matter.

  In an email on 11 July 2015, Gallagher makes similar emotional appeals to the HPCSA’s registrar, Dr Buyiswa Mjamba-Matshoba, for assistance against Noakes. She states that ADSA used its ‘limited budget’ to appoint a firm of specialist attorneys on a ‘watching brief’ over the HPCSA proceedings. Quite why ADSA needed lawyers to watch over them is anyone’s guess, since Strydom and Gallagher were not facing charges.

  But Gallagher doesn’t stop there. She says that ADSA’s attorneys had ‘to date assisted [HPCSA prosecuting counsel Advocate Meshack Mapholisa] with preparation for the hearing’. In reply, Mjamba-Matshoba sees nothing unusual or inappropriate in ADSA’s lawyers assisting the HPCSA to build a case against Noakes. If proof were needed that the HPCSA had colluded with ADSA from the outset, Gallagher provided it in her emailed letter.

  Gallagher’s comments in that email are a prelude to later dissembling and semantic gymnastics in claims that ADSA had never lodged a complaint and had no vendetta against Noakes. Gallagher has tried claiming that ADSA only ‘sought guidance’ from the HPCSA on the conduct of health professionals on social media. The emails show that to be untrue. Furthermore, the HPCSA has no guidelines for health professionals on social media. If Gallagher had indeed asked the HPCSA for guidelines, she would have learnt as much.

  Both Strydom and Gallagher also show inordinate anxiety over whether the HPCSA was throwing sufficient resources behind its efforts to succeed against Noakes. They make clear their desire for a guilty verdict.

  The emails therefore also show how remarkably apposite were comments made by Advocate Michael van der Nest for Noakes in closing arguments. He described Strydom as a ‘disgruntled dietitian’ who was angry because the public seemed to be listening to Noakes and not to her. He also said that the tweet was just a pretext for the HPCSA and ADSA to go after Noakes.

  Strydom and Gallagher can look like the prime movers behind Noakes’s trial, as both are food-industry consultants. However, they could not have succeeded without a little help from strategically placed friends within the HPCSA, such as Wentzel-Viljoen. She tried to get onto the HPCSA’s Professional Conduct Committee to hear the charge against Noakes, and saw no conflict of interest in her well-documented opposition to Noakes and LCHF. She was happy to be a fox guarding the hen house. She only recused herself after Noakes’s lawyers forced her to do so.

  This leads to another imponderable: would the hearing have happened without so many ‘cuddly dietitians in the cosy embrace of industry fat cats’? British health writer Jerome Burne used that phrase to describe the antics of dietitians in his own country.15 He could just as easily have been talking about South Africa.

  In this book, Noakes and I have named many dietitians, doctors and assorted academics who contributed, directly or indirectly, to the HPCSA’s prosecution of him. The list is not exhaustive, but it is long. So long, it may be tempting to think that it’s not possible for so many doctors, dietitians and academics to be out of step. We have shown that it’s both possible and probable.

  Of course, Noakes and I are not insinuating that all those who helped the HPCSA are mad, bad people, on the payroll or in the thrall of food and drug companies. Many are decent enough, even as they may be ignorant, fearful and suffering prolonged bouts of cognitive dissonance. As Noakes has proved, it takes courage to change your mind when you’ve believed and taught wrongly for decades.

  We have also shown the intricate web of industry-led ties that bind the dietitians, doctors and academics who have tried to bully Noakes into silence. All have careers, reputations, livelihoods, funding, sponsors and/or businesses to protect. Noakes and LCHF threaten them all. For proof, you only have to look at the knee-jerk responses of ADSA dietitians and HPCSA witnesses to the bestselling The Real Meal Revolution, of which Noakes is a co-author. Vorster, Kruger and another HPCSA expert witness, Dr Muhammad Ali Dhansay, attacked his chapter on the extensive science for LCHF, claiming that the evidence he presented was ‘not peer reviewed’. Yet much of the evidence is from peer-reviewed journals. More bizarrely, all freely admitted that they hadn’t even read it. They seemed to take the book’s commercial success as a personal affront.

  That pointed to another imponderable: would the hearing have happened if Noakes had not contributed a chapter to The Real Meal Revolution?

  But perhaps the biggest imponderable of all may lie in yet another incestuous web: ADSA’s leadership profile. ADSA’s executive committees throughout this case have comprised a coterie of mostly privileged white females from similar middle-class cultural and conservative backgrounds, a closed shop of mostly friends, or friends of friends. Many appear to be undeclared vegetarians or vegans, or at least strongly pushing planet-based agendas, without any evidence and with significant industry ties of one sort or another. What if the leadership had been more open, less overtly conflicted and more reflective of the diversity of South Africa’s population and scientific views on diet and nutrition? What if they were not all so irrationally fat- and red-meat-phobic?

  After the UCT professors’ letter, Noakes took the view that moves were afoot to isolate him from his colleagues and destroy his scientific reputation. He had two choices: he could defend himself, or he could terminate his registration as a medical practitioner with the HPCSA. This would have been without consequence, because he hasn’t practised as a medical doctor for more than 15 years and has no plans to do so again. But the public might have interpreted this as evidence of guilt. So it was never really an option. Noakes had no choice but to defend himself to the best of his ability.

  When Noakes asked me to co-author this book, I accepted in a heartbeat. As a journalist with a hard-news background, I knew it would be a dream opportunity. I would get to delve into and document the murky world of medicine, nutrition science and academia in South Africa. I knew it would be another step on a remarkable journey. It would be a chance to expose the many doctors, dietitians and academics in the thrall, if not the pay, of food and drug industries. I would also get to reveal the many health professionals who put patients before profits, and the price they pay for having the courage to do so.

  Noakes possesses many qualities that enticed me to travel with him on this journey: not just his formidable intellect, but also his honesty and integrity. To the uninitiated, Noakes can at times seem almost brutally honest. But as the Jewish proverb goes: ‘When con men meet a legitimately honest man, they are so bewildered that they consider him a greater con man than themselves.’

  On this journey, I witnessed first-hand the nightmare that Noakes endured. I saw the pillar that enabled him to handle the ordeal with the strength, courage and dignity that he did: his family – wife Marilyn, son Travis and daughter Candice. Noakes describes Marilyn’s support as ‘absolutely critical’. He says that the actions of those intent on ‘breaking’ him followed the classic CIA modus operandi: first isolate the individual from his colleagues, and then from his spouse. ‘They might have been able to do the former; they were never going to achieve the latter,’ he says. ‘I and my family have emerged changed but stronger from the experience.’

  Noakes has had many ‘angels’ helping him on his journ
ey, among them his expert witnesses, Dr Zoë Harcombe, Nina Teicholz and Dr Caryn Zinn. Despite the best efforts of the HPCSA’s expensive team of external lawyers, Tim’s Angels stood firm. Their evidence was the angelic and scientific equivalent of landmines, which they exploded in the faces of the HPCSA’s witnesses.

  Perhaps the real turning point in Noakes’s fortune was earlier, when his hyper-energetic instructing attorney, Adam Pike, took charge, and advocates Dr Rocky Ramdass and Mike van der Nest SC offered their support pro Deo. I call them ‘Tim’s Avenging Angels’. From that moment on, there was only ever going to be one outcome – the one that Advocate Joan Adams delivered on 21 April 2017.

  Noakes says of his legal team: ‘Rocky, Mike and Adam are three of the most honourable, upstanding and outstanding people I have ever had the privilege to meet.’ To him, Ramdass is ‘Brother’ Rocky, a devout Hindu who epitomises the Vedic definition of a man of God: ‘Softer than the flower, where kindness is concerned; stronger than the thunder, where principles are at stake.’ To the HPCSA, Noakes says that his entire legal team was ‘stronger than the thunder’. To him and Marilyn, ‘they were softer than the flower’.

  Then, of course, there are the many LCHF scientists and doctors and many millions of Banters who continue to speak up for Noakes worldwide.

  Noakes’s lawyers are very much ‘old-school’ in their approach to law and in their dedication to fighting injustice. They saw the HPCSA’s prosecution of Noakes as stifling legitimate scientific debate and eroding his constitutional right to freedom of speech. All looked forward to a vigorous scientific debate in the hearing. All were to be bitterly disappointed. They saw the case as veering between farce and Greek tragedy. As an arguably ‘old-fashioned’ lawyer, Van der Nest had demanded to see the science to build the case for his client. Noakes gave it to him in spades. Yet when it came to Noakes’s cross-examination, as Van der Nest argued, the HPCSA simply ignored vast swathes of the scientific material. He saw the ultimate irony in the HPCSA’s argument contending that the scientific material was irrelevant because it related to adults. The reality appeared to be, he said, that the HPCSA simply could not answer Noakes’s scientific evidence.