Lore of Nutrition: Challenging conventional dietary beliefs

by Tim Noakes

Keeping with the paediatric guidelines, Harcombe said they contained one problematic element in that they recommended starchy foods as key complementary foods for infants. ‘Without that, it would be excellent advice for infants aged 12 to 36 months,’ she said. In Harcombe’s opinion, the introduction of starchy foods was unnecessary. Every time people eat starchy foods, she explained, they miss the opportunity to eat more nutrient-dense foods. And that exacerbates the risk of childhood obesity.

Harcombe spent much of her evidence on the currently unproven diet-heart hypothesis that saturated fat causes heart disease.

‘Ignorance’ is probably the best word to describe public opinion on dietary fat, Harcombe said. She gave the hearing a mini lecture on the composition of fats, explaining that there are three ‘real’ fats: saturated, monounsaturated and polyunsaturated. All foods that contain fat – olives, avocados, meat, fish, eggs, dairy, etc. – contain all three types, no exceptions. Only dairy products have more saturated than unsaturated fat – ‘not that any real fat is better or worse than any other’, she said. Ironically, red meat has far less saturated fat than oily fish and even olive oil, yet the experts still tell people to avoid eating red meat. They also regularly give messages that seem to suggest that it’s possible to avoid saturated fat, for example, and increase consumption of polyunsaturated fat, Harcombe said. This is especially the case with recommendations to replace animal fats with vegetable oils or fats.

‘It becomes a very complex exercise to try and swap some of them out,’ Harcombe said.

The only really hazardous fat that is truly ...

consumption is trans fat, she said. Trans fatty acids, or trans fats as they are more commonly known, are artificial industrial fats. They are created in a process that adds hydrogen to liquid vegetable oils to make them more solid (see Chapter 7). Under cross-examination, Bhoopchand suggested that Harcombe had erred by not pointing ...

‘Nature makes foods either fat- or carbohydrate-based. Rarely does it put the two together,’ she said. It is therefore unhelpful to set targets for macronutrients because, inevitably, when you set a limit of 30 per cent fat, you also set the recommendation of 55 per cent carbs. Instead, Harcombe said it would be more helpful if experts gave the same advice that Noakes gives: ‘Just tell people to eat real food.’ Harcombe’s armoury for undermining the evidence-base for ‘conventional’ dietary advice in South Africa was extensive. She used data from her meta-analysis published in Open Heart in 2015 to show that there was no evidence from RCTs at the time the US government introduced its guidelines to 264 million Americans.4 There was still no evidence when the UK and most other English-speaking countries, including South Africa, slavishly followed suit. The UK essentially did a ‘U-turn in dietary guidelines’, Harcombe said. In 1969, the advice was to avoid fattening farinaceous (starchy) foods. In 1983, people were told to base their meals on these foods.

Harcombe had evidence at her fingertips; she showed a slide of the association’s long list of sponsors, which have included Nestlé, Unilever, the sugar industry and Coca-Cola. ADSA executives deny any influence from sponsors. Harcombe, Teicholz and many others have pointed out that – just like drug companies – food companies don’t sponsor organisations that don’t promote their products.

Harcombe went on to review and thoroughly undermine the Seven Countries Study, Dr Ancel Keys’s seminal study underpinning the US dietary guidelines. Keys’s own data did not support his conclusions about the link between dietary fat and coronary heart disease, Harcombe said. ‘The dietary information in the Seven Countries Study is

scant,’ she noted. Keys also erred by not considering factors such as cigarette-smoking, sedentary behaviour, obesity and relative weight in people with CHD. Furthermore, the Seven Countries Study wasn’t even a dietary study, although Keys presented it as such. And as an inter-country study it provided ‘the lowest form of evidence’. ...

This, Harcombe said, brings practitioners back to ‘advising real food’. One obstacle is that many so-called experts still confuse saturated fatty acids with processed foods, she said, before listing the primary sources of saturated fat in the American diet as pizza, desserts, sweets, tacos and ready meals. These are not real foods, she said. If those preaching conventional ‘wisdom’ would just tell people not to eat processed, junk foods, ‘we could find agreement. But call it what it is. Stop calling it saturated fat, because it is predominantly junk.’

Harcombe also stated that dietitians’ associations globally should not have any compromising links with the food industry.

Teicholz analyses the last 50 years of nutrition policy in the US as it relates to dietary fat and cholesterol, and reveals how an idea about fat and health became official policy despite all the evidence contradicting

One of the strengths of her book, and thus of her evidence for Noakes, is that Teicholz did not rely on summary statements or review papers in her research. Instead, she went back to all the original papers, and sometimes to the original data. In many cases, she found that scientists had tried to hide their data, sometimes even publishing it in foreign-language publications to make it more difficult to access. Teicholz hunted those down too, and found professionals to translate them for her. She attended conferences and interviewed hundreds of top scientists from all over the world, as well as many leading food-industry executives. Teicholz described how she was met with silence in unexpected places when asking certain questions. Interview subjects would say ‘I can’t talk about fat’ and abruptly end the conversation. She said that sometimes experts were so reluctant to

talk that she felt as if she were ‘investigating the Mob’. The analogy is not inappropriate, as the case against Noakes has shown.

it. As Harcombe had done, she showed how fatally flawed his Seven Countries Study was from the start, because he had cherry-picked the countries that were included. Good science, she said, requires randomisation – a way of selecting things randomly to avoid bias. In selecting countries for his study, Keys did not use randomisation. He deliberately avoided countries such as Switzerland, Germany and France, where he knew that people ate lots of saturated fat, yet had low rates of heart disease.

Despite all its flaws, the Seven Countries Study became ‘extremely influential’ and is still widely cited today, Teicholz said. But while large and seemingly persuasive, it is still only observational. ‘It’s a basic principle of science that observational studies can only show association but not causation,’ she said. Causation requires clinical trials, preferably RCTs.

Dr John Yudkin,

‘Prominent nutritionists combined with the food industry to destroy his reputation, and his career never recovered. He died, in 1995, a disappointed, largely forgotten man.’10 (Big Sugar loomed large in the wings of the case against Noakes, as Russ Greene’s 2017 exposé showed.11)

Teicholz also presented evidence on the safety and efficacy of low-carb diets. There have been more than 74 RCTs, virtually all on Western populations, including at least 32 that lasted six months or longer, and three that lasted two years. (RCTs are considered the gold standard when it comes to judging whether there are any adverse side effects.)

These trials have all established the efficacy of the low-carb diet for fighting obesity, diabetes and heart disease. Some official bodies are now in fact taking notice of the risks of low-fat diets, Teicholz said. In 2015, for example, the Heart and Stroke Foundation of Canada lifted the cap (as a percentage of calories) on saturated fats.

For the past five years, she has used LCHF in her practice for adults and children with no adverse side effects. Zinn said that she prefers to talk about low-carb, healthy-fat – rather than high-fat – foods. LCHF is about eating ‘real’ food, she said. Like Noakes, Harcombe and Teicholz, she believes that when people eat real food, they tend naturally to eat fewer carbohydrates and more fats.

ages. She and her postgraduate students have led studies on hyperinsulinaemia that demonstrate how a substantial subset of the population with normal glucose curves (supposedly

healthy) have elevated insulin levels. This could be the start of chronic disease, she said.

She also dismissed the HPCSA experts’ contention that cereals fortified with iron are beneficial for infant weaning. She argued that the advice to make starchy foods the basis of a child’s main meals could, in fact, cause malnutrition. That’s because phytates (antioxidant compounds found in wholegrains, legumes, nuts and seeds, and that bind to certain dietary minerals) reduce the bioavailability of important nutrients, such as iron, zinc and the B vitamins. Zinn admitted that in the past she had ‘unthinkingly’ advised parents to feed infants cereals fortified with iron. ‘It never occurred to me to ask why infants would need cereals fortified with iron when meat is available and a very good source of iron,’

‘In fact, a well-formulated LCHF diet provides even better nutrients and more fibre than a mainstream low-fat diet.’ Harking back to what she had said previously about starchy foods and phytates, she argued that there is a far higher risk of micronutrient deficiency in infants raised on baby cereals and carbohydrate-based foods, because the phytates in these foods compromise infants’ levels of essential vitamins and minerals.

Zinn addressed another issue that the HPCSA experts had flagged as a potential problem with LCHF: possible vitamin A toxicity from excessive liver consumption. She showed that this concern is irrational.

Vorster herself had said ...

Africa follows the WHO’s paediatric guidelines, which advise ‘fish, meat, eggs, liver every day and as much as possible’. Liver is one of the best food sources of bioavailable iron and vitamin A, but you’d have to eat enormous amounts of liver daily to suffer vitamin A toxicity, Zinn said. And because liver is ‘not the sexiest food … you usually have to combine it with meat to make it palatable, especially for infants’. If vitamin A toxicity occurs at all, it is usually from dietary supplements (synthetic vitamin A), not real food sources, Zinn said. She knew of only one reported case of infant death due to vitamin A toxicity. It involved a synthetic preparation of 90 000 internat...

Zinn told the hearing that she is

now embarrassed to say that she used to teach her students that low-carb diets were bad because ketosis was dangerous. This was largely due to confusion around nutritional ketosis and ketoacidosis.

‘Ketones occur naturally in the body and are safe,’ she said. ‘Infants default into a state of ketosis when they are born. They need ketones for optimum brain development in their early years.’ And while ketogenic diets could be ‘extreme both for adults and for children’, nutritional ketosis is ‘not something that you can reach easily at all’. Zinn agreed under cross-examination

Noakes and his Angels that multinationals with vested commercial interests exert significant influence on the guidelines. It was telling that the HPCSA had been unable to answer these allegations, Ramdass said, and that it had failed to address the significant conflicts of interest of its witnesses. Strydom, Vorster and Kruger are all members of ADSA, which has been, and in some cases still is, sponsored by Kellogg’s, Nestlé, Unilever and several other food companies, including Coca-Cola.

In summary, Ramdass submitted that ‘conventional’ dietary advice: is based on poor or non-existent science; has no scientific validity; is the antithesis of what is good; has contributed to the diabetes and obesity epidemics; is disease-causing rather than disease-preventing; and requires moving from the conventional towards a new conventional.

Reproduced from W.L. Voegtlin, The Stone Age Diet, New York: Vantage Press, 1975, pp. 44–45

My conclusion is that humans evolved as obligate fat-eaters, and our biology is dependent on eating diets high in fat and moderate in protein, with carbohydrates providing only that balance of calories that cannot be obtained from readily available fat and protein sources.

All this evidence demonstrates that fish and animal produce are essential to optimise human brain development. Only fish and animal produce contain the necessary brain-specific nutrients16 in high concentrations; these nutrients are not present in appropriate concentrations in cereals and grains. That is why meat and fish – and not cereals and grains, however much they might be ‘fortified’ – are the only suitable complementary foods.

25 per cent of which is cholesterol. The presence of a blood–brain barrier that prevents the passage of large molecules (such as dangerous bacteria or viruses) directly from the bloodstream to the brain also means that any large molecules needed to construct those fats cannot reach the brain directly. The solution that human evolution conferred was to use ketone bodies for this purpose.

Ketone bodies are produced by the liver whenever

blood insulin concentrations are low, and fat, not carbohydrate, is being used as the principal energy fuel. Ketones are small, water-soluble molecules that can cross the blood–brain barrier and be used to build the complex fat molecules (like cholesterol) that comprise a large proportion of the human brain. In this way, ‘Humans co-opted a trait that was previously an adaptation to cope with periods of starvation, into our defa...

especially our conversion from hindgut fermenting hominins to carnivorous Homo sapiens dependent only on a functioning small bowel for the digestion and absorption of our nutrient-dense, predominantly animal-based diet – adequately explain why the obesity/T2DM epidemic was bound to happen when modern humans switched to a diet that derives most of its energy from carbohydrates.

And that is exactly what happened after 1977 when we were told that, to protect ourselves from heart attack, we had to replace most of the fat in our diet with carbohydrates.

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

Malhotra also compared rates of gallstone formation (cholelithiasis) – seven times higher in the north than in the south;61 peptic ulceration,62 including the effects of wheat or rice diets in recovery;63 gastrointestinal cancers64 – more stomach and colon cancers in the south, more liver and gallbladder cancers in the north; and varicose veins, which were more common in those living in the

south.65

Africa also includes ethnic groupings that chose to eat different diets either predominantly carnivorous or plant-based. In 1931, J.B. Orr and J.L. Gilks compared the health and physical attributes of the Akikuyu, a ‘vegetarian tribe’ eating predominantly cereals supplemented with roots and fruits, with the ‘largely carnivorous’ Masai, whose diet comprised milk, meat and raw blood. Compared to adult Akikuyu, adult Masai were about five inches taller, 23 pounds (10 kilograms) heavier, and 50 per cent stronger when tested with a hand dynamometer. In addition, bony deformities, dental caries, anaemia, pulmonary conditions and tropical ulcers were much more prevalent in the Akikuyu, whereas rheumatoid arthritis and ‘intestinal stasis’ were more common in the Masai.68

When the diet-heart hypothesis began to attract serious attention in the 1960s, some scientists wondered about the health of the carnivorous Masai and Samburu tribes of Tanzania and northern Kenya. If the diet-heart and lipid hypotheses were true, these groups would exhibit high blood cholesterol concentrations and rampant rates of heart disease. But neither proved true: both tribes had low to normal blood cholesterol concentrations and an apparent absence of coronary heart disease, although, interestingly, the Masai did have ‘extensive atherosclerosis but very few complicated lesions’.

Complicated lesions occur when the arterial plaque ruptures. Thus, the apparent immunity to heart disease in the Masai must be because their diet and lifestyle protect them from coronary artery plaque rupture, not from atherosclerosis.

Another nomadic population eating the same diet as the Masai and Samburu, the Anagamba of eastern Niger, also had low blood cholesterol concentrations despite eating a diet comprising 73 per cent fat.70 Interestingly, and seemingly forgotten, the Anagamba’s blood cholesterol concentrations were no higher than those of the Kanouri, who ate an LFHC diet of millet and sorghum, and deriving just 9 per cent of calories from fat.