[2017] Lore of Nutrition: Challenging Conventional Dietary Beliefs

by Tim Noakes

  10.E.V. Lambert, D.P. Speechly, S.C. Dennis et al., ‘Enhanced endurance in trained cyclists during moderate intensity exercise following 2 weeks adaptation to a high fat diet’, European Journal of Applied Physiology and Occupational Physiology 69(4), 1994: 287–93; J.H. Goedecke, C. Christie, G. Wilson et al., ‘Metabolic adaptations to a high-fat diet in endurance cyclists’, Metabolism 48(12), 1999: 1509–17; E.V. Lambert, J.H. Goedecke, C. Zyle et al., ‘High-fat diet versus habitual diet prior to carbohydrate loading: Effects of exercise metabolism and cycling performance’, International Journal of Sport Nutrition and Exercise Metabolism 11(2), 2001: 209–25; L. Havemann, S.J. West, J.H. Goedecke et al., ‘Fat adaptation followed by carbohydrate loading compromises high-intensity sprint performance’, Journal of Applied Physiology 100(1), 2006: 194–202.

  11.A.L. Carey, H.M. Staudacher, N.K. Cummings et al., ‘Effects of fat adaptation and carbohydrate restoration on prolonged endurance exercise’, Journal of Applied Physiology (Bethesda, Md: 1985) 91(1), 2001: 115–22; N.K. Stepto, A.L. Carey, H.M. Staudacher et al., ‘Effect of short-term fat adaptation on high-intensity training. Medicine & Science in Sports & Exercise 34(3), 2002: 449–55.

  12.E.C. Westman, S.D. Phinney and J.S. Volek, The New Atkins for a New You (New York: Fireside, 2010), xi.

  13.J. Yudkin, E. Evans and M.G. Smith, ‘The low-carbohydrate diet in the treatment of chronic dyspepsia’, Proceedings of the Nutrition Society 31(1), 1972: 12A.

  14.S.D. Pointer, J. Rickstew, J.C. Slaughter et al., ‘Dietary carbohydrate intake, insulin resistance and gastro-oesophageal reflux disease: A pilot study in European- and African-American obese women’, Alimentary Pharmacology & Therapeutics 44(9), 2016: 976–88. Austin GL, Thiny MT, Westman EC, et al. ‘A very low-carbohydrate diet improves gastroephageal reflux and its symptoms’. Digestive Diseases and Sciences 2006; 53(8): 1307–1312.

  15.C. Catassi, J.C. Bai, B. Bonaz et al., ‘Non-celiac gluten sensitivity: The new frontier of gluten related disorders’, Nutrients 5(10), 2013: 3839–53.

  16.G. Taubes, ‘What if it’s all been a big fat lie?’, New York Times Magazine, 7 July 2002, available at http://www.nytimes.com/2002/07//magazine/what-if-it-s-all-been-a-big-fat-lie.html (last accessed 31 July 2017).

  17.See N. Teicholz, The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet (New York: Simon & Schuster, 2014); Z. Harcombe, ‘An examination of the randomised controlled trial and epidemiological evidence for the introduction of dietary fat recommendations in 1977 and 1983: A systematic review and meta-analysis’, PhD thesis, University of the West of Scotland, March 2016.

  Chapter 3: The Backlash Begins

  1.J. Achenbach, ‘Why do many reasonable people doubt science?’, National Geographic, March 2015.

  2.M. Jones, ‘Noakes goes too far – doctors’, IOL, 14 September 2012, available at http://www.iol.co.za/lifestyle/noakes-goes-too-far---doctors-1383310 (last accessed 31 July 2017).

  3.P.C. Gøtzsche, Deadly Medicines and Organised Crime: How Big Pharma Has Corrupted Healthcare (Florida: CRC Press, 2013).

  4.G. Orwell, Nineteen Eighty-Four (London: The Folio Society, 2001).

  5.J.D. Abramson, H.G. Rosenberg, N. Jewell et al., ‘Should people at low risk of cardiovascular disease take a statin?’, BMJ 2013;347:f6123.

  6.Ibid.

  7.D. Newman, ‘Statins given for 5 years for heart disease prevention (with known heart disease)’, The NNT, 2 November 2013, available at http://www.thennt.com/nnt/statins-for-heart-disease-prevention-with-known-heart-disease/ (last accessed 31 July 2017).

  8.Abramson, Rosenberg, Jewell et al., ‘Should people at low risk of cardiovascular disease take a statin?’; Newman, ‘Statin drugs given for 5 years for heart disease prevention without known heart disease’; D. Diamond and U. Ravnskov, ‘How statistical deception created the appearance that statins are safe and effective in primary and secondary prevention of cardiovascular disease’, Expert Review of Clinincal Pharmacology 8(2), 2015: 201–10; M. de Lorgeril and M. Rabaeus, ‘Beyond confusion and controversy: Can we evaluate the real efficacy and safety of cholesterol-lowering with statins?’, Journal of Controversies in Biomedical Research 1(1), 2015: 67–92; M. Rabaeus, P.V. Nguyen and M. de Lorgeril, ‘Recent flaws in evidence-based medicine: Statin effects in primary prevention and consequences of suspending the treatment’, Journal of Controversies in Biomedical Research 3(1), 2017: 1–10; R. DuBroff, ‘Cholesterol paradox. A correlate does not a surrogate make’, Evidence-Based Medicine 22(1), 2016: 15–19.

  9.M.L. Kristensen, P.M. Christensen and J. Hallas, ‘The effect of statins on average survival in randomised trials, an analysis of end point postponement’, BMJ Open 5(9), 2015: e007118.

  10.Newman, ‘Statins given for 5 years for heart disease prevention (with known heart disease)’; A.L. Culver, I.S. Ockene, R. Balasubramanian et al., ‘Statin use and risk of diabetes mellitus in postmenopausal women in the Women’s Health Initiative’, Archives of Internal Medicine 172(2), 2012: 144–52.

  11.X. Huang, A. Alonso, X. Guo et al., ‘Statins, plasma cholesterol, and risk of Parkinson’s disease: A prospective study’, Movement Disorders 30(4), 2015: 552–9.

  12.Abramson, Rosenberg, Jewell et al., ‘Should people at low risk of cardiovascular disease take a statin?’; R.F. Redberg and M.H. Katz, ‘Healthy men should not take statins’, JAMA 307(14), 2012: 1491–2; R.F. Redberg and M.H. Katz, ‘Statins for primary prevention: The debate is intense, but the data are weak’, JAMA 316(19), 2016: 1979–81; A. Malhotra, J. Abramson, M. de Lorgeril et al., ‘More clarity needed on the true benefits and risks of statins’, Prescriber, Dec 2016: 15–17.

  13.J.P. Ioannidis, ‘More than a billion people taking statins?: Potential implications of the new cardiovascular guidelines’, JAMA 311(5), 2014: 463–4.

  14.DuBroff, ‘Cholesterol paradox. A correlate does not a surrogate make’.

  15.Ibid.

  16.B. Lown, ‘A maverick’s lonely path in cardiology (Essay 28)’, Dr Bernard Lown’s Blog, 10 March 2012, available at https://bernardlown.wordpress.com/2012/03/10/mavericks-lonely-path-in-cardiology/ (last accessed 31 July 2017); P.J. Podrid, T.B. Graboys and B. Lown, ‘Prognosis of medically treated patients with coronary-artery disease with profound ST-segment depression during exercise testing’, The New England Journal of Medicine 305(19), 1981: 1111–6; T.B. Graboys, A. Headley, B. Lown et al., ‘Results of a second-opinion program for coronary artery bypass graft surgery’, JAMA 258(12), 1987: 1611–4; S. Jabbour, Y. Young-Xu, T.B. Graboys et al., ‘Long-term outcomes of optimized medical management of outpatients with stable coronary artery disease’, American Journal of Cardiology 93(3), 2004: 294–9; T.B. Graboys and B. Lown, ‘Good outcomes in coronary artery disease without invasive procedures’, Archives of Internal Medicine 166(12), 2006: 1325, author reply 26.

  17.S.C. Knipp, N. Matatko, H. Wilhelm et al., ‘Cognitive outcomes three years after coronary artery bypass surgery: Relation to diffusion-weighted magnetic resonance imaging’, The Annals of Thoracic Surgery 85(3), 2008: 872–9.

  18.D.G. Katritsis and J.P. Ioannidis, ‘Percutaneous coronary intervention versus conservative therapy in nonacute coronary artery disease: A meta-analysis’, Circulation 111(22), 2005: 2906–12. See also A. Malhotra, ‘Too much angioplasty. Stenting offers no prognostic benefit over drugs in stable coronary disease’, BMJ 2013;347:f5741; A. Malhotra, ‘The whole truth about coronary stents. The elephant in the room’, JAMA 174(8), 2014: 1367–8.

  19.Podrid, Graboys and Lown, ‘Prognosis of medically treated patients with coronary-artery disease with profound ST-segment depression during exercise testing’.

  20.A. Malhotra, R. Redberg and P. Meier, ‘Saturated fat does not clog the arteries: Coronary heart disease is a chronic inflammatory condition, the risk of which can be effectively reduced from healthy lifestyle interventions’, British Journal of Sports Medicine 51(15), 2017: 1111–2.

  21.Lown, ‘A maverick’s lonely path in cardiology (Essay 28)’.

&nbs
p; 22.J.A. Ambrose, M.A. Tannenbaum, D. Alexopoulos et al., ‘Angiographic progression of coronary artery disease and the development of myocardial infarction’, Journal of the American College of Cardiology 12(1), 1988: 56–62; W.C. Little, M. Constantinescu, R.J. Applegate et al., ‘Can coronary angiography predict the site of a subsequent myocardial infarction in patients with mild-to-moderate coronary artery disease?’, Circulation 78(5 Pt 1), 1988: 1157–66.

  23.Graboys and Lown, ‘Good outcomes in coronary artery disease without invasive procedures’.

  24.Lown, ‘A maverick’s lonely path in cardiology (Essay 28)’.

  25.T.D. Noakes and J. Windt, ‘Evidence that supports the prescription of low-carbohydrate high-fat diets: A narrative review’, British Journal of Sports Medicine 51(2), 2017: 133–9.

  26.M. Stilwell, ‘Is Tim Noakes the Malema of medicine?’, Mail & Guardian, 21 September 2012, available at https://mg.co.za/article/2012-09-21-00-is-tim-noakes-the-malema-of-medicine (last accessed 31 July 2017).

  27.Ambrose, Tannenbaum, Alexopoulos et al., ‘Angiographic progression of coronary artery disease and the development of myocardial infarction’; Little, Constantinescu, Applegate et al., ‘Can coronary angiography predict the site of a subsequent myocardial infarction in patients with mild-to-moderate coronary artery disease?’.

  28.K. Sliwa, J.G. Lyons, M.J. Carrington et al., ‘Different lipid profiles according to ethnicity in the Heart of Soweto study cohort of de novo presentations of heart disease’, Cardiovascular Journal of Africa 23(7), 2012: 389–95.

  29.A. Sachdeva, C.P. Cannon, P.C. Deedwania et al., ‘Lipid levels in patients hospitalized with coronary artery disease: An analysis of 136,905 hospitalizations in Get With The Guidelines’, American Heart Journal 157(1), 2009: 111–7; M.D. Miedema, R.F. Garberich, L.J. Schnaidt et al., ‘Statin eligibility and outpatient care prior to ST-segment elevation myocardial infarction’, Journal of the American Heart Association 6(4), 2017: e005333.

  30.B.H. Roberts, The Truth About Statins: Risks and Alternatives to Cholesterol-lowering Drugs (New York: Pocket Books, 2012), 97–8.

  31.A.L. Stock and J. Yudkin, ‘Nutrient intake of subjects on low carbohydrate diet used in treatment of obesity’, American Journal of Clinical Nutrition 23(7), 1970: 948–52.

  32.See endnote 8.

  33.A.P. DeFilippis, R. Young, C.J. Carrubba et al., ‘An analysis of calibration and discrimination among multiple cardiovascular risk scores in a modern multiethnic cohort’, Annals of Internal Medicine 162(4), 2015: 266–75.

  34.Ibid.

  Chapter 4: The Centenary Debate

  1.A. Dreger, Galileo’s Middle Finger: Heretics, Activists, and One Scholar’s Search for Justice (New York: Penguin Press, 2015), 262.

  2.B.V. Howard, L. van Horn, J. Hsia et al., ‘Low-fat dietary pattern and risk of cardiovascular disease: The Women’s Health Initiative Randomized Controlled Dietary Modification Trial’, JAMA 295(6), 2006: 655–66.

  3.J.M. Shikany, K.L Margolis, M. Pettinger et al., ‘Effects of a low-fat dietary intervention on glucose, insulin, and insulin resistance in the Women’s Health Initiative (WHI) Dietary Modification trial’, American Journal of Clinical Nutrition 94(1), 2011: 75–85.

  4.J.E. Rossouw, J.P. du Plessis, A.J. Benade et al., ‘Coronary risk factor screening in three rural communities: The CORIS baseline study’, SAMJ 64(12), 1983: 430–6.

  5.K. Steyn, M. Steyn, A.S. Swanepoel et al., ‘Twelve-year results of the Coronary Risk Factor Study (CORIS)’, International Journal of Epidemiology 26(5), 1997: 964–71.

  6.Ibid.

  7.C.E. Naudé, A. Schoonees, M. Senekal et al., ‘Low carbohydrate versus isoenergetic balanced diets for reducing weight and cardiovascular risk: A systematic review and meta-analysis’, PLoS One 9(7), 2014: e100652.

  8.The lecture was subsequently published. See T.D. Noakes, ‘The 2012 University of Cape Town Faculty of Health Sciences Centenary Debate’, SAJCN 28(1), 2016: 19–33.

  9.J.A. Cutler, J.D. Neaton, S.B. Hulley et al., ‘Coronary heart disease and all-causes mortality in the Multiple Risk Factor Intervention Trial: Subgroup findings and comparisons with other trials’, Preventive Medicine 14(3), 1985: 293–311; X. Pi-Sunyer, ‘The Look AHEAD trial: A review and discussion of its outcomes’, Current Nutrition Reports 3(4), 2014: 387–91.

  10.T.D. Noakes, ‘The Women’s Health Initiative Randomized Controlled Dietary Modification Trial: An inconvenient finding and the diet-heart hypothesis’, SAMJ 103(11), 2013: 824–5.

  11.J.E. Rossouw and B.V. Howard, ‘Noakes misses the point’, SAMJ 103(12), 2013: 882.

  12.T.D. Noakes, ‘WHIDMT: Rossouw and Howard blatantly miss the point’, SAMJ 104(4), 2014: 261–2.

  13.J.E. Rossouw, ‘The diet-heart hypothesis, obesity and diabetes’, SAJCN 28(1), 2015: 38–43.

  14.B. Unal, J.A. Critchley and S. Capewell, ‘Explaining the decline in coronary heart disease mortality in England and Wales between 1981 and 2000’, Circulation 109(9), 2004: 1101–7.

  15.A. Sekikawa, Y. Miyamoto, K. Miura et al., ‘Continuous decline in mortality from coronary heart disease in Japan despite a continuous and marked rise in total cholesterol: Japanese experience after the Seven Countries Study’, International Journal of Epidemiology 44(5), 2015: 1614–24.

  16.M. Murata, ‘Secular trends in growth and changes in eating patterns of Japanese children’, American Journal of Clinical Nutrition 72(5 Suppl), 2000: 1379s–83s.

  17.N. Nago, S. Ishikawa, T. Goto et al., ‘Low cholesterol is associated with mortality from stroke, heart disease, and cancer: The Jichi Medical School Cohort Study’, Journal of Epidemiology 21(1), 2011: 67–74.

  18.P. Cheng, J. Wang, W. Shao et al., ‘Can dietary saturated fat be beneficial in prevention of stroke risk? A meta-analysis’, Neurological Sciences: Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology 37(7), 2016: 1089–98.

  19.E. Vartiainen, P. Puska, J. Tuomilehto et al., ‘Changes in risk factors explain changes in mortality from ischaemic heart disease in Finland’, BMJ 309, 1994: 23–7.

  20.J. McCormick and P. Skrabanek, ‘Coronary heart disease is not preventable by population interventions’, The Lancet 2(8615), 1988: 839–41.

  21.Ibid.

  22.P.V. Luoma, S. Nayha, K. Sikkila et al., ‘High serum alpha-tocopherol, albumin, selenium and cholesterol and low mortality from coronary heart disease in northern Finland’, Journal of Internal Medicine 237, 1995: 49–54.

  23.S. Nayham, ‘Low mortality from ischaemic heart disease in the Sami district of Finland’, Social Science & Medicine 44(1), 1997: 129.

  24.C. Stout, J. Morrow, E.N. Brandt et al., ‘Unusually low incidence of death from myocardial infarction: Study of an Italian American community in Pennsylvania’, JAMA 188(10), 1964: 845–9; S. Wolf, R.C. Herrenkohl, J. Lasker et al., ‘Roseto, Pennsylvania 25 years later: Highlights of a medical and sociological survey’, Transactions of the American Clinical Climatological Association 100, 1989: 57–67; B. Egolf, J. Lasker, S. Wolf et al., ‘The Roseto effect: A 50-year comparison of mortality rates’, American Journal of Public Health 82, 1992: 1089–92.

  25.Wolf, Herrenkohl, Lasker et al., ‘Roseto, Pennsylvania 25 years later: Highlights of a medical and sociological survey’, 58.

  26.S. Wolf, ‘Mortality from myocardial infarction in Roseto’, JAMA 195, 1966: 142.

  27.Wolf, Herrenkohl, Lasker et al., ‘Roseto, Pennsylvania 25 years later: Highlights of a medical and sociological survey’, 67.

  28.Ibid., 66.

  29.Egolf, Lasker, Wolf et al., ‘The Roseto effect: A 50-year comparison of mortality rates’, 1092.

  30.Ibid.

  31.D. Yam, A. Eliraz and E.M. Berry, ‘Diet and disease – the Israeli paradox: Possible dangers of a high omega-6 polyunsaturated fatty acid diet’, Israel Journal of Medical Sciences 32(11), 1996: 1134–43.

  32.D.S. Ludwig, ‘Lifespan weighed down by diet’, JAMA 315(21), 2016: 2269–70.

  33.M. de Lorg
eril, S. Renaud, P. Salen et al., ‘Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease’, The Lancet 343, 1994: 1454–9; M. de Lorgeril, P. Salen, J-L. Martin et al., ‘Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: Final report of the Lyon Diet Heart Study’, Circulation 99, 1999: 779–85.

  34.K. Okada, M. Gohbara, S. Kataoka et al., ‘Association between blood glucose variability and coronary plaque instability in patients with acute coronary syndromes’, Cardiovascular Diabetology 14, 2015: 111–23.

  35.Rossouw, ‘The diet-heart hypothesis, obesity and diabetes’, 43.

  36.C. Ford, S. Chang, M.Z. Vitolins et al., ‘Evaluation of diet pattern and weight gain in postmenopausal women enrolled in the Women’s Health Initiative Observational Study’, British Journal of Nutrition 117, 2017; 1189–97

  37.Ibid., 1196.

  38.D. Williams, ‘Innovative disagreement’, Leader.co.za, 27 February 2013, available at http://www.leader.co.za/article.aspx?s=23&f=1&a=4279 (last accessed 1 August 2017).

  39.C. Bateman, ‘Inconvenient truth or public health threat?’, SAMJ 103(2), 2013: 69–71.

  40.American Diabetes Association, ‘Statistics about Diabetes’, available at http://www.diabetes.org/diabetes-basics/statistics/ (last accessed 1 August 2017).

  41.J.R. Kraft, Diabetes Epidemic & You (La Vergne: Trafford Publishing, 2008).

  42.C. Crofts, ‘Understanding and diagnosing hyperinsulinaemia’, PhD thesis, Auckland University of Technology, 2015, available at http://aut.researchgateway.ac.nz/bitstream/handle/10292/9906/CroftsC.pdf?sequence=3 (last accessed 1 August 2017); C. Crofts, G. Schofield, C. Zinn et al., ‘Identifying hyperinsulinaemia in the absence of impaired glucose tolerance: An examination of the Kraft database’, Diabetes Research and Clinical Practice 118(8), 2016: 50–7.