Lore of Nutrition: Challenging conventional dietary beliefs

by Tim Noakes

It came in the form of an email advertising a new book, The New Atkins for a New You by doctors Eric Westman, Stephen Phinney and Jeff Volek. The book promised ‘The Ultimate Diet for Shedding Weight and Feeling Great’,

I wondered how I had missed all the work from which Dr Eric H. Kossoff MD, director of the Ketogenic Diet

Center in the Division of Pediatric Neurology at Johns Hopkins Hospital, Baltimore, Maryland, had concluded: ‘In more than 150 articles, these three international experts on the use of low-carbohydrate diets to combat obesity, high cholesterol, and type 2 diabetes have led the way in repeatedly proving how a low-carbohydrate approach is superior to a low-fat one.’12

There would be no more bread, potatoes, bananas, rice, porridge or boxed breakfast cereals, including muesli. No more fruit juices or soft drinks. No more cakes, sweets, chocolates, ice cream or, indeed, any desserts. I would slowly remove all sugar and other sweeteners from my tea and coffee. I would focus on seven foodstuffs: meat, fish, eggs, dairy produce, nuts, leafy vegetables and a restricted range of low-carbohydrate fruits, mainly berries. And so

experiment of my life.

For that first lunch, I snacked on biltong (a form of dried meat, similar to beef jerky in the US, which is a delicacy in South Africa), cheese and high-fat nuts, especially macadamias. These would become my staple snack foods. I soon added tinned fish, especially pilchards and sardines, chicken and dairy products in the form of butter, milk, cream, cheese and full-cream yoghurt. I ate little fruit and vegetables to be...

Despite my advanced age, within weeks I saw an improvement in my health, well-being and running ability that I can still only describe as astonishing. The first obvious change was that my enthusiasm for running returned. Within a week, I could not wait to exercise each day, slow and wobbly as those first runs continued to be. I could feel the changes in my body and they were telling me that something remarkable was happening.

During this time, I noticed other changes. My chronic dyspepsia (indigestion), which had become increasingly severe over the past decade, magically disappeared within the first month on the new eating plan. I subsequently learnt that Dr John Yudkin’s group had performed a controlled clinical trial in 1972 showing that a low-carbohydrate diet can cure dyspepsia.

Next, the regular headaches that I suffered at least once a week and for which I took powerful painkillers disappeared completely. In the almost seven years since adopting the eating plan, I have had to take medication only twice to treat a headache. This is understandable if an allergy to wheat gliadin is a common cause of recurrent headaches, as cardiologist Dr William Davis proposed in his bestselling book Wheat Belly.

Or if a majority of common headaches are caused by gluten sensitivity, as neurologist Dr David Perlmutter suggested in another New York Times bestseller, Grain Brain.

My condition of allergic rhinitis and bronchitis, which I had always considered to be due to a pollen allergy, also disappeared, as did my occasional attacks of post-exercise wheezing (asthma). For 30 years, I could expect a severe attack at...

each sufficiently debilitating to require treatment with inhaled corticosteroids. In the past seven years, I have had only two mild attacks of rhinitis/bronchitis. Since the only change I have made to my diet in that time was to remove grains and cereals, I must also assume thi...

My wife became overjoyed when, as I lost fat especially around my neck, I stopped snoring, proving, at least to me, that snoring is caused by carbohydrate-induced fat deposition in the upper throat. Perhaps snoring is just another obvious indication that one is overweight and in need of a dietary change.

Over the past seven years of my most important experiment, I have learnt more about nutrition than I did in the previous 41 years of my medical and scientific training.

Thus it is in Good Calories, Bad Calories that Taubes rediscovers the story of how Dr William Harvey cured the obesity of 19th-century London undertaker to the royal family William Banting, by prescribing a low-carbohydrate diet.

I was left with one overriding question: If this information has been in the medical literature since at least 1882, and if it has helped me improve my health so dramatically, why is it not being taught at medical schools across the globe?

In Deadly Medicines and Organised Crime, Danish physician and former Big Pharma insider Peter Gøtzsche writes: ‘The pharmaceutical industry does not sell drugs. It sells lies about drugs.’3

That two journalists without any formal training in medicine – Gary Taubes and Nina Teicholz – could write the three most important general medical books of the past few decades, far more important than anything any cartel of academic cardiologists has yet contributed to the public discourse, is further evidence that traditionally educated professors do not hold a monopoly on medical wisdom.

Carbohydrates stimulate hunger, whereas fat and protein satiate it. After 40 years of practice, I think we can finally recognise the traditional dietary guidelines for what they are: a complete failure. As the saying goes, ‘however beautiful the strategy, you should occasionally look at the results’.

Another example: How can you prescribe a high-fat diet knowing that it will cause blood cholesterol levels to rise and must therefore increase heart-attack rates? There is actually no evidence that cholesterol

causes heart disease. Instead, as I argue in Chapter 17, the introduction of population-based screening for blood cholesterol concentrations is what leads to arterial disease, because it teaches doctors and dietitians to prescribe high-carbohydrate diets (and statins) to people with normal (i.e. below 7.5 mmol/L) blood total cholesterol concentrations but who are insulin resistant. Prescribing high-carbohydrate diets for those with IR can produce only one result: an epidemic increase in T2DM, with its associated scourge – disseminated obstructive arterial disease of all the key blood vessels in the body. Another question came from an industry-funded hypertension expert: How can you say that statin drugs are so ineffective when ‘we know’ that lowering blood cholesterol concentrations with statin drugs reduces heart-attack risk by at least 30 per cent? My counter-questioning made me realise that the expert had not been taught the difference between the relative (30 per cent) and absolute (~1 per cent) benefits supposedly provided by these drugs.

In particular, he contradicted the pessimistic outlook of orthodox doctors and dietitians towards T2DM. They see diabetes as a chronic, degenerative condition that increases the risk of heart disease, kidney problems, blindness and amputation.

Noakes challenged this thinking, as well as the orthodox medical model that has diabetics taking drugs for the rest of their lives. Optimism in the face of a T2DM diagnosis was a key theme of his evidence. Noakes has never called LCHF a ‘cure’ for diabetes. He has, however, said that it is a safe, effective and cheap method that can reverse all the symptoms of the condition.

Noakes related how devastated he was when he realised that his father had died not because he was not getting enough glucose to his brain, but because he had disseminated (widespread) arterial disease, which is now recognised as the cornerstone of diabetes.

Reginald Noakes would also have had NAFLD, commonly known as ‘fatty liver’, although no one knew it at the time. Noakes presented robust research showing that high-carbohydrate diets cause NAFLD in people who are insulin resistant/diabetic. He also showed that NAFLD causes blood-fat abnormalities, and that it is these blood-fat abnormalities that, together with high blood insulin levels and inflammation, lead to disseminated arterial disease. Thus, he showed that T2DM is ultimately a condition of progressive, disseminated arterial disease. It progresses over decades, he told the hearing. It leads ultimately to complete obstruction of blood flow to the eyes, kidneys and lower limbs. The consequences couldn’t be more severe: blindness, kidney failure and gangrene (and eventually amputation) of the limbs. This same arterial disease can lead to heart attacks and strokes, although these represent a ‘fundamentally different process’.

Noakes said that hepatologists (liver specialists), and not cardiologists, would probably be the ones to treat heart disease in the future. It was the first of many gauntlets he’d throw to cardiologists in his evidence.

Another theme in Noakes’s evidence was the diet-heart hypothesis that saturated fat causes heart disease. The hypothesis, which became a pillar of the HPCSA’s case against him, is the platform on which drug companies built the multibillion-dollar statin industry. Statins are cholesterol-lowering drugs. They are also the world’s most prescribed drugs. It’s an understatement to say that Noakes is no fan of statins.

While evidence shows th...

may have some use in secondary prevention (i.e. after a first heart attack or stroke), they don’t work well for primary prevention. They also come with a long list of side eff...

‘Carbs and insulin are driving obesity,’ Noakes stated, ‘not saturated fat.’ When food-makers took saturated fat out of the diet, he said, they had to replace it with something to make food more palatable. That something was sugar and carbohydrates, two highly addictive substances.

It is true that heart-attack rates have been falling in some countries since the late 1960s. Some

scientists claim that this is proof that the low-fat diet prevents arterial disease. But Noakes offered an alternative explanation in his evidence: a reduction in smoking in these countries has reduced the number of patients experiencing the sudden plaque ruptures that cause heart attacks and strokes, he said. But while fewer people are dying of heart attacks, many more are developing T2DM as a consequence of LFHC diets. The disease burden of arterial disease has therefore simply shifted to the obstructive form found in T2DM. If the low-fat diet really prevented arterial disease, it should also have prevented the now much more prevalent obstructive form found in type-2 diabetics.

hearing. ‘Insulin resistance, which I have, is the most prevalent medical condition in the world and we do not teach it in our medical schools. That is wrong and that is partly why I am here today.’

For proof, they cite the fact that Noakes still takes medication (metformin) to control his blood sugar.

Noakes explained that the reason why he still takes medication despite improving all his symptoms by eating LCHF foods is because he wants perfect blood sugar control. In this way, he hopes to further increase his

chances of avoiding the grim fate that befell his father. He therefore chooses to add an appropriate dose of metformin.

There was already a solid Brazilian meta-analysis and review from 2013 to show that very low carb/ketogenic diets were superior to low-fat diets for long-term weight loss.9

He pointed especially to the work of Professor Stephen Cunnane on the importance of ketones for infants’ developing brains.11 Noakes said that infants are born naturally in a state of ketosis. He showed that there is something about breast milk that makes it a ‘ketogenic food’, despite its relatively high carbohydrate content – along with its high fat content, of course. Researchers are not yet clear why, he said. Furthermore, as much as 25 per cent of the newborn’s basic energy requirements in the first several days of life come from the use of ketones. Just as convincing is the finding that the foetus has a capacity to produce its own ketones independent of what its mother provides.

Noakes also waded into the inappropriate influence of industry on nutrition advice. He added to compelling research from around the globe showing the insidious influence of food companies – especially the sugar and soft-drink industries – on top scientists and academics. Noakes referred to food-industry sponsorship of dietitians’ associations worldwide, including ADSA.

Health-washing is a particularly iniquitous activity in which companies use dietitians to give a veneer of respectability to their products by suggesting their health benefits. An offshoot is what is known as astroturfing, which is just as sinister in intent. In an allusion to fake grass (AstroTurf), astroturfing has a specifically political connotation. In a Content Technologies study guide, Doris A. Graber defines it in terms of political campaigns: ‘The goal of such a campaign is to disguise the efforts of a political or commercial entity as an independent public reaction to some political entity – a politician, political group, product, service or event.’13 In nutrition science, astroturfing denotes campaigns or organisations that claim to act in the consumer’s interest when their real aim is to benefit food, soft-drink or drug companies.

Research shows that companies such as Unilever, Nestlé and Coca-Cola have embraced astroturfing to create the impression of genuine, grassroots movements to peddle their corporate agendas. Coca-Cola is a particularly egregious example. Research in 2016 showed that the company spent $118.6 million on health research and partnerships in the US between 2011 and 2015. That included funding for a group criticised for downplaying the role of sugary drinks in obesity.14 While it is tempting to finger companies such as Coca-Cola as the sole guilty party, the issue is more complex. As Leslie noted: ‘If, as seems increasingly likely, the nutritional advice on which we have relied for 40 years was profoundly flawed, this is not a mistake that can be laid at the door of corporate ogres. Nor can it be passed off as innocuous scientific error … It suggests instead that this is something the scientists did to themselves – and, consequently, to us.’15

Noakes told him: ‘Unfortunately, sir, you are forgetting that if you raise people on maize, there are costs to us, as taxpayers, because what you are producing is a population that is unhealthy. The rates of obesity and diabetes, cancer, hypertension, dementia are rising exponentially and we are paying those costs. Those costs are not included in what we provide to our poor people. If you were to do an analysis of what is the real cost of providing and weaning onto maize, you would discover, sir, that [the conventional LFHC diet] is an incredibly expensive diet.’

‘Tim’s Angels’.

British obesity researcher and public health nutrition specialist Dr Zoë Harcombe, US science journalist Nina Teicholz, and New Zealand–based nutrition academic Dr Caryn Zinn arrived in South Africa amid a hearing that was growing more Kafkaesque with each session.

In one report on the hearing, I described the Angels as all slender, gorgeous, glamorous women, highly intelligent and packing heavy scientific weaponry.

All the Angels have impeccable scientific pedigrees. Harcombe is a Cambridge University graduate in mathematics and economics. She has spent years researching nutrition. Her doctoral thesis, on the evidence for the introduction of dietary fat recommendations in the US and the UK in 1977 and 1983 respectively, earned her a letter of commendation as well as a PhD. Her thesis is a fascinating nutrition science ‘whodunnit’, in which she looks at why the official dietary guidelines in the US, the UK and elsewhere are woefully inadequate, unscientific and yet still persist. Harcombe co-authored a much-cited meta-analysis in the BMJ’s Open Heart in 2015, which

showed that evidence from RCTs did not support the introduction of the dietary guidelines in the US and the UK in the late 70s and early 80s. ‘Dietary recommendations were introduced for 220 million US and 56 million UK citizens by 1983, in the absence of supporting evidence from RCTs,’ the authors concluded.1 Harcombe followed that meta-analysis with another in the British Journal of Sports Medicine in 2016, showing that evidence from prospective cohort studies does not support current dietary fat guidelines.2 She has also authored many books, among them The Obesity Epidemic. Teicholz took pre-med courses at both Yale and Stanford, graduating from the latter with a major in American studies. She also has an MPhil from Oxford University in the UK, and was the first journalist elected to Phi Tau Sigma, the elite American honour society for food science and technology. She is best known as the author of the international bestseller The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet, which is widely acknowledged by doctors and scientists as a seminal contribution to the understanding of nutrition and disease, and the politics of nutritional science.

In her book, Teicholz documents the, personalities, politics and history of nutrition science, and shows how the belief that dietary fat, especially saturated fat, causes heart disease was enshrined in the public consciousness in English-speaking countries by health authorities. The Big Fat Surprise is the first mainstream publication to argue that saturated fats – found in dairy, meat and eggs – do not cause disease and can actually be considered healthy. So influential has Teicholz become that in 2015 the Canadian senate invited her to give an hour of testimony on the findings of her book to its committee charged with overseeing the country’s dietary guidelines. Some months later, the committee announced that the dietary guidelines would need a complete overhaul – a process that is now well underway. The USDA followed suit in 2016, inviting Teicholz to give testimony on how to improve nutrition policy. She also helped convince the United Sta...

of Technology Faculty of Health and Environmental Sciences and a registered dietitian and director of a private practice. She graduated from UCT with an honour’s degree in nutrition and dietetics. She also has a master’s degree in sports nutrition and a doctorate in weight loss from AUT. While she is an expert in sports nutrition and LCHF for optimum athletic performance, Zinn specialises in ‘diabesity’, a term coined by doctors for the twin global epidemics of diabetes and obesity. With more than 21 years’ experience as a nutritionist and registered dietitian, Zinn’s views on diet have evolved alongside the research and science of nutrition. Many experts have ‘got it all wrong with existing high-carb, low-fat guidelines’, she says. Zinn is a ‘whole-food’ advocate. She believes that everyone can benefit from eating foods that are lower in carbohydrate and higher in healthy fat than the current guidelines recommend. She has done ground-breaking work on hyperinsul...

Fat’s IN, Sugar’s OUT. All of Tim’s Angels had relevant expertise in all the issues pertaining to the case against Noakes. Despite this – or perhaps because of it – the HPCSA’s legal team did its best to clip their wings and prevent ...