Article from Noseweek Magazine, February 2018. Article by: Dr David Klatzow
The backlash against Prof Tim Noakes’s ideas about nutrition is just the voice of vested self-interest argues Dr David Klatzow
In 2013 Emeritus Professor Tim Noakes, then still head of the University of Cape Town’s Sports Science Centre, contributed just one chapter to a bombshell of a book, The Real Meal Revolution, which quickly soared into the book-sales stratosphere. Its dietary recommendations rapidly found traction with the South African public and anecdotal reports of success flooded in. The book’s message was that most people would be well-advised to abandon the widely recommended high-carbohydrate/low-fat diet and switch to the exact opposite: a low-carbohydrate/high-fat diet.
From the early Seventies, the received wisdom dispensed to patients by dietitians and cardiologists was that high fat was a recipe for heart attacks and a high cholesterol level in the blood was the harbinger of a heart attack. Noakes himself subscribed to that view. In fact, he kick-started his career as a popular author in 1985 with a book titled The Lore of Running (It went into its fourth edition in 2003), soon followed by The Lore of Cycling. The books advocated a high-carb diet. Noakes has since gone on to say: “If you’ve got Lore of Running, tear out the section on nutrition.”
So, how come Noakes is now scandalising his colleagues by arguing that the entire dietary edifice should be turned on its head; that all the “eminent” cardiologists and dieticians had got it. wrong and were, in fact, promoting a diet that actively harmed many of their patients?
Noakes explains: “Originally I was taught, as part of my medical training, that a high-fat diet was dangerous for your arteries and heart – the standard paradigm subscribed to at the time by UCT’s cardiology department. But then, on 12 December 2010, I was given a book by Eric Westman called The New Atkins for a New You. I had just done some blood tests on myself and discovered I had Type 2 diabetes. So I decided to try Westman’s low-carb diet. Within days I started losing weight, felt better – and my blood glucose dropped remarkably to normal.
“Westman’s book was filled with scientific research references which had never been mentioned in our curriculum at medical school. I started to read them and found there was a substantial medical constituency that did not hold the standard view dispensed at UCT. My own further research confirmed their findings.”
It is surely a mark of integrity if a scientist is prepared to change his view on being presented with new data -but to contradict the so-called received medical wisdom of the day is a perilous exercise, as many before Tim Noakes have discovered.
An early example is that of Hungarian physician Ignaz Semmelweis, who discovered that he could reduce the high death rate from childbed fever by the simple expedient of washing his hands in chloride of lime before examining the patient. His colleagues, outraged by the suggestion that they themselves were infecting their patients by their lack of hygiene, launched a concerted campaign against him, mostly by way of attacks on the man, rather than his argument – a common response when outsiders, and more especially insiders, challenge the gurus of medicine.
In the less-distant past, we have seen a number of standard medical teachings overturned in quite spectacular fashion. Hormone replacement therapy (HRT) for postmenopausal women has been shown to have severe cardiovascular consequences. Mutilating — even life-threatening -gastric surgery for stomach ulcers has been replaced with a short course of antibiotics. The brutal, radical mastectomy once routinely prescribed with absolute conviction by UCT’s professors of surgery to treat breast cancer – leaving the unfortunate patient in a permanent state of distress – has been replaced by a far less radical lumpectomy, with better long-term outcomes.
Overall of this, the professors of medicine preside in a god-like way. These are the leaders of medical research and their word in a given department is law. God help you if you express a dissenting opinion. Barely 20 years ago, those women who dared question the prescribed radical mastectomy were told by the presiding professors at Groote Schuur Hospital to “go elsewhere for treatment and never return”.
Medical research has in my view entered an era where to accept its findings blindly, is dangerous; all its findings must be seriously questioned and if accepted, then only with caution. You do not have to take my word for it. The distinguished Dr Marcia Angell, the former editor of the pre-eminent New England Journal of Medicine (NEJM), has had reason to warn: “It is simply no longer possible to believe in much of the clinical research that is published or to rely on the judgement of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion which I reached slowly and reluctantly over my five decades as editor of the NEJM” (New York Review of Books, January 15, 2009.)
The various bodies who have conspired to discredit Noakes have, it would appear, significant vested interests in the whole debacle
Her view was echoed by Richard Horton, editor of The Lancet in the 11 April 2015 issue of that pre-eminent medical journal: “The case against science is straightforward: Much of scientific literature, perhaps half, may simply be untrue. Afflicted by studies with small sample size, tiny effects, invalid exploratory analyses, flagrant conflicts-of-interest, together with an obsession for pursuing fashionable trends of dubious importance, science has taken a turn towards darkness.”
Into this snake pit, Noakes has ventured, suggesting that any number of self-important professors of medicine may inadvertently have been harming their patients for the past 40 years.
The trigger point came in February 2014 when a Twitter user asked Noakes the following question: “Is LCHF [low-carb, high-fat] eating OK for breastfeeding mums? Worried about all the dairy + cauliflower = wind for babies?” Noakes tweeted back: “Baby doesn’t eat the dairy and cauliflower, just very healthy high-fat breast milk. Key is to wean baby on to LCHF”.
This simple exchange saw Noakes dragged before the Health Professions Council of South Africa (HPCSA). Within 24 hours of the tweet, a dietician, and president of the Association for Dietetics in SA (Adsa), Claire Julsing Strydom, had lodged a complaint with the Health Professions Council of South Africa (HPCSA) accusing Noakes of giving “incorrect, dangerous and potentially life-threatening advice”.
To everyone’s surprise and to the lasting shame of the HPCSA, they took it seriously. These proceedings lasted more than three years – and, indeed, have still not ended (there is an appeal pending).
Noakes is not alone in promoting the low-carbohydrate high-fat (LCHF) diet. Swedish diet blogger and best-selling author Dr Andreas Eenfeldt promotes the same notions. So, too, do American cardiologist Professor William Davis in his book Wheat Belly, and many other well-informed and eminent physicians. (Many more references are to be found in Nina Teicholz’s book, The Big Fat Surprise, published in 2014.)
Of great relevance to the current case, and further demonstrating just how far behind the times South Africa’s health establishment has become: Sweden’s Dr Eenfeldt has had the way cleared for him by a predecessor, Swedish family physician Dr Annika Dahlqvist. In 2006, two dieticians reported Dahlqvist to Sweden’s National Board of Health and Welfare (NBHW). The dieticians felt that advising people with diabetes to eat fat was unacceptable and would result in the patients getting sick.
The NBHW deliberated for two years, reviewing the science. They had it in their power to censor Dr Dahlqvist or even revoke her medical licence. But in January 2008 the NBHW exonerated Dhalqvist completely, even stating that low-carb diets can today be seen as compatible with scientific evidence and best practice.
It should be obvious that the purveyors of junk food such as Kellogs and Coca-Cola have a vested interest in pushing their carbohydrate-loaded products. They are also at the forefront of demonising fats to distract attention from carbohydrates, especially sugar.
As significant, although perhaps less obvious: many of the bodies that have conspired to discredit Noakes share these vested interests. It simply requires taking a closer look at the sponsorships they receive from the likes of Kellogs and Coca-Cola (through innocuous-sounding front organisations such as the Association for Dietetics in South Africa, and the International Life Sciences Institute), and the large research grants from drug companies that the medical faculties at all our universities have come to rely upon.
These research grants have plenty of strings attached. It has been long known that the best indicator of the outcome of a research trial is the interests of the sponsors and funding organisations. One only has to look back to the ’50s to find “learned” physicians denying the link between smoking cigarettes and lung cancer. No prizes for guessing that the funders were the big tobacco companies.
For at least four decades cholesterol has been vilified as the cause of heart attacks. One of the biggest money-spinners for the drug industry happens to be a class of drugs called statins. These cause a lowering of blood cholesterol and are considered by the anointed professors of medicine to be an all-around good thing. It follows that if you believe that cholesterol in the blood should be kept low then these are the drugs of choice. But what if cholesterol and blood fat are not the real cause of heart disease? And what if statins make no difference to the effort of curbing or preventing heart disease; what if they are actually harmful to the patient?
Suggestions like these would not go down well with the establishment. The drug companies who make literally billions from the sale of these noxious drugs and who have a vested interest in maintaining the belief that fat in the diet and blood cholesterol are the villains of the story are unlikely to take this heresy lying down.
In their recently published book, Lore of Nutrition, Noakes and his co-author reputed medical writer Marika Sboros, conclude that it is these interests that lie behind the campaign against Noakes. In a concluding chapter, Sboros sets out to name and shame all the doctors, dieticians, and academics who used their power and positions to embark on sustained campaigns attacking both Noakes’s character and professional reputation.
The authors have good reason to believe that the battle is being fought by proxy combatants: the medicine departments that get large grants from the front organisations are themselves part of the shady war. The parties who have been ranged against Noakes have failed to declare their serious conflicts-of-interest in this respect.
That is the elephant in the room. In the debate by the high panjandrums of medicine, it gets not the slightest mention. The pompous, self-important high-ranking members of academic medicine pontificate to their staff and the pontifications then filter down as gospel truth to the students and medical graduates.
Totally ignored is the very obvious fact that the avalanche of metabolic disorder, obesity, heart disease, arterial disease and Type 2 diabetes seems to originate from the 1960s, just when the food triangle was turned on its head and carbohydrates were promoted as the most important component of our diet, to the virtual exclusion of meat, dairy and fat. Five decades of population studies are surely enough to show that this is where the problem lies.
The high personages in medicine have come to share some of the features of long-term financial gurus who often get it wrong quite spectacularly, but carry on as though nothing much has happened.
As mentioned, HRT was widely prescribed to post-menopausal women. While short-term benefits were undeniable, the long-term damage to women’s health has now become obvious.
During my stay in the surgery department at Witwatersrand University, gastric ulcers were treated according to the dictums of Prof D J du Plessis: “Cut them out!” The treatment consisted of savage surgical mutilation of the upper gastrointestinal tract, producing three generations of gastric cripples. This is not an understatement. The profession fought tooth and nail to discredit two young Australian upstarts who dared to suggest at a medical conference that a bacterium was the cause of gastric ulceration. At Du Plessis’s instigation, they were laughed out of the conference.
Undaunted, the pair went on to show that Helicobacter Pylorum was the culprit and, happily, today the treatment for gastric ulceration consists of a course of antibiotics and some stomach acid inhibitors. No longer do you have your stomach and digestive tract all but surgically removed and vital nerves severed, with all the resulting digestive chaos.
The two Australians, Barry Marshall and Robin Warren, gained the Nobel Prize in Medicine. (At Wits Du Plessis’s ulcer regime is forgotten and he is, quite rightly, acknowledged to have been an extremely talented surgeon responsible for schooling three generations of surgeons of high repute.)
In an astoundingly uncollegial way, Noakes’s colleagues at the University of Cape Town medical school wrote a joint letter to the Cape Times on 22 August 2014. The letter was signed by Prof Wim de Villiers, then Dean of Medicine at UCT who is now Rector and Vice-Chancellor of Stellenbosch University; Prof Bongani Mayosi, head of the Department of Medicine at Groote Schuur Hospital and UCT; Prof Lionel Opie (now emeritus); and Associate Prof Maijanne Senekal, head of the UCT’s Division of Human Nutrition in the Health Sciences faculty.
In the letter, they accuse Noakes of maligning the integrity and credibility of his peers. This is a bit rich; I was not aware that entering into the scientific debate and voicing a dissenting opinion was tantamount to maligning colleagues who hold a different view.
Turning to Noakes’s HPCSA hearing, it has had all the appearances of a witchhunt, poorly thought out and likely to discredit the organisation. Before the appointed tribunal, the charges against Noakes failed on every point. The prosecuting legal representatives of the HPCSA failed to appreciate the subtle difference between cross-examination and examining crossly.
It would also appear that they and their witnesses were poorly prepared. They were driven to make major concessions under the probing cross-examination of Noakes’s senior counsel, advocates Mike van der Nest and Rocky Ramdass. In contrast to the evidence presented by the HPCSA – if it could be called scientific evidence at all — Noakes was able to bring an avalanche of data-based evidence supporting the LCHF diet.
It seems that the prosecution team was confused between ketoacidosis, which is a dangerous medical condition, and ketosis, where the body uses ketones derived from burning fat to supply energy. This is quite harmless, as demonstrated recently by Dr Otto Thanning when he swam the English Channel on the “Noakes diet”, using ketones as his source of energy – incidentally making it into the Guinness Book of Records. That’s how dangerous ketones are for you.
Noakes pointed out material errors in a paper by Dr Celeste Naude of the Centre for Evidence-based Health Care at Stellenbosch University’s Faculty of Medicine and Health Sciences. But, says Noakes, these have yet to be adequately addressed.
This was the slender evidence that launched the prosecution. What if it is wrong?
The other major prosecution document – prepared by one “Rossouw” – is alleged by Noakes to actually show the reverse of what it purports to prove. Its author, despite being able to attend, mysteriously did not do so, thereby avoiding being pitted against Noakes and his counsel. Probably a wise move.
In the last chapter of Lore of Nutrition titled “Closure”, Sboros speculates that the HPCSA hearing — which has run up legal bills in excess of RIO million against him – might not have happened at all were it not for the inflammatory open letter to the Cape Times attacking Noakes in 2014, which was signed by the four UCT professors.
How and why did parties with little or no knowledge of the details of Noakes’s work, such as Professor John Terblanche, a former head of surgery at UCT, and Professor Denise White, a psychiatrist (now deceased), choose to become involved, unless it was part of the general umbrage taken at a cheeky puppy suggesting that anointed members of the club could just possibly be wrong?
Equally mysterious: why did some of the prosecution witnesses fail to declare their vested interests upfront? Why were the front companies and sponsors not declared to the tribunal? Many would consider this to have been sharp practice.
This trial may yet turn out to be a repeat of the trial of Galileo all those centuries ago when he dared argue that the earth revolved around the sun and not the other way around as then believed.
Let’s hope the popes and cardinals of medicine don’t take as long to find out that Noakes was right all along.
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