[2017] Lore of Nutrition: Challenging Conventional Dietary Beliefs

by Tim Noakes

  It took a US investigative journalist to join many of the dots I had identified. Russ Greene’s research led to the International Life Sciences Institute (ILSI), a Coca-Cola front organisation. In an explosive exposé in January 2017, Greene showed how the ILSI has worked to support the nutrition status quo in South Africa, as well as the health professionals and food and drug industries that benefit from it. It has opened a branch in South Africa and has funded nutrition congresses throughout the country. It has also paid for dietitians and academics opposed to Noakes and LCHF to address conferences abroad.*

  Of course, it might be coincidence that so many doctors, dietitians and academics with links to the ILSI became involved, directly and indirectly, in the HPCSA’s prosecution of Noakes. Then again, maybe not.

  Many people suggested that I write a book about Noakes’s trial, for a trial it was. I was the only journalist to cover all six sessions over 25 days. I sat through all the evidence from the HPCSA’s six witnesses. I listened as Noakes and his three witnesses testified. Noakes himself spoke for almost 40 hours, showing nearly 1 200 slides and citing 350-odd publications and other materials. I also saw first-hand the toll the trial was taking on him, even as he was strong in scientific and academic spirit.

  And when – and out of the proverbial blue – Noakes invited me to co-author a book he was writing on the trial, I accepted in a heartbeat. I knew it would be a remarkable journey, even if it was not one of his choosing. Thus, I became one of this book’s two narrators. Noakes provides the background to the HPCSA hearing and discusses the all-important science behind the LCHF/Banting diet. He speaks passionately about why he champions this lifestyle despite the constant persecution and efforts to silence him. I cover the hearing and the hype from my perspective as a journalist and an outsider.

  The HPCSA’s conduct throughout the hearing and since its conclusion has been revelatory. To a large extent, it confirms the premise of this book: that those in positions of power and influence in medicine and academia were using the case to pursue a vendetta against Noakes. The trial highlighted the inherent perils facing those brave enough to go against orthodoxy. It is in Noakes’s DNA as a scientist to seek truth and challenge dogma. He has done it many times before and has been proved right every time. I have no doubt that this time will be no different. On this latest journey, he has demonstrated the unflinching courage, integrity and dignity that are his hallmarks as one of the most eminent scientists of his time.

  The trial has also become an object lesson in unintended consequences on social media. It is not only social media marketing gurus who must come to grips with the pleasures and pitfalls of networking in the disruptive digital era. Social media is a double-edged sword: an invaluable tool for building reputations, careers, businesses and livelihoods, but with the potential to be equally destructive.

  With his invitation to be a co-narrator on this journey, Noakes reignited my passion as a journalist. For that, I am grateful. I am also grateful for the privilege of travelling this road with him and meeting the many other brave scientists, writers and activists who are his companions and supporters. They don’t all speak with one voice. All are forging a powerful new path in nutrition science, one that puts patients before profits. As a journalist, I choose to tread this irresistible path. As a scientist, Noakes is destined to be on it.

  * Russ Greene, ‘Big Food vs. Tim Noakes: The Final Crusade’, The Russells, 5 January 2017, available at https://therussells.crossfit.com/2017/01/05/big-food-vs-tim-noakes-the-final-crusade/

  PART I

  THE LOW-CARB REVOLUTION

  1

  The Low-carb Summit

  ‘He that takes medicine and neglects diet, wastes the time of his physician.’

  – Ancient Chinese proverb

  When I flew from Johannesburg to Cape Town on 19 February 2015, I had a feeling I wasn’t on just another assignment. I was in for a real scientific treat. I was off to the Cape Town International Convention Centre to cover a health summit that the organisers had billed as unique. They said it could change the world for the better, nutritionally speaking. They had brought together under one roof, from all corners of the globe and for the first time on an international stage, 15 experts in the science and controversy behind the low-carbohydrate, high-fat lifestyle being used to treat and prevent the life-threatening chronic diseases plaguing South Africa and the rest of the planet.

  Professor Tim Noakes was to be the conference host. The organiser and visionary behind it was beautiful South African former model Karen Thomson. Thomson is a recovered alcoholic, and a former cocaine and sugar addict. She is also the bestselling author of Sugar Free! 8 Weeks to Freedom from Sugar and Carb Addictions, in which she documents her personal experience of the ravages of addiction to alcohol and various types of ‘white stuff’, and recounts her recovery. Her grandfather was the late heart-transplant pioneer, Professor Christiaan Barnard. It was Barnard and his team’s actions that first inspired Tim Noakes to become a medical doctor.

  Thomson first heard Noakes speak about sugar and addiction in the same breath in a TV documentary in 2014. It was as if he had shone a light on the darkness of her addictions. Before then, she had no idea that there was such a thing as sugar addiction. Many doctors and dietitians wedded to conventional nutrition ‘wisdom’ insist that there isn’t. Thomson realised that she had replaced her addiction to alcohol and cocaine with sugar and other carbohydrate foods – these were her new drugs of choice. She was determined to quit her sugar habit for good.

  Thomson contacted Noakes about opening a sugar addiction centre, and the two bonded instantly. Thus, she began her LCHF journey with Noakes as her guide and mentor. He inspired her to write the book and develop the Healthy Eating & Lifestyle Program in 2012. HELP was the first of its kind in the world, a 21-day, in-patient programme that treats sugar and carbohydrates as an addiction using an LCHF nutrition approach.

  The real driver behind the Cape Town LCHF summit was Thomson’s distress and growing fury at the venomous personal and professional attacks on Noakes in the media. The feeding frenzy had grown more intense in the wake of the announcement that the Health Professions Council of South Africa intended hauling him in for a disciplinary hearing. The HPCSA had charged Noakes with unprofessional conduct for his February 2014 tweet to a breastfeeding mother, in which he advised weaning babies onto LCHF foods.

  The public attacks on Noakes brought back painful memories for Thomson. ‘I knew what it was like to grow up in a famous family and have total strangers take swipes at us in the media,’ she told me. ‘When I was 10, a newspaper published an interview in which the reporter said awful things about my grandfather. It upset me deeply. I never forgot it. It’s not right that people can just say these things about someone and the media publish them to sell more newspapers and get more visitors to their websites.’

  Thomson wanted to do something constructive to counter the attacks on Noakes. What better weapon, she thought, than good science. Her vision started out small. She would hold a one-day seminar and invite a few experts from abroad to speak up for Noakes by presenting the scientific evidence for the LCHF lifestyle.

  To this end, she invited the two men widely acknowledged as the ‘fathers’ of the LCHF movement in the US: Professor Stephen Phinney and Dr Eric Westman. She also invited Canadian physician Dr Jay Wortman and American LCHF blogger Jimmy Moore. All immediately accepted.

  From there, Thomson’s vision took on a life of its own. She and Noakes started inviting other LCHF experts from around the globe. Low Carb Down Under had invited Noakes to speak in Melbourne, Australia, in 2014. His reception there was positive and in stark contrast to the criticism back home. Australian doctors, among them Low Carb Down Under co-founder Dr Rod Tayler, expressed a desire to attend Thomson’s seminar.

  The stellar list of speakers that Noakes and Thomson eventually assembled included internationally renowned medical doctors, scientists and researchers. Among the medical doctors were a card
iologist, a nephrologist, a psychiatrist, a bariatric surgeon and an orthopaedic surgeon. All said they would come, many at their own expense, to show support for Noakes and to spread the word to the world about the growing evidence for the safety and efficacy of LCHF diets.

  The only invited expert who couldn’t attend was Nina Teicholz, the US author of The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet. Her invitation arrived just a few hours after she had committed to another event. She told Noakes and Thomson that she would be with them in spirit.

  At a dinner in Cape Town before the conference, Noakes met the former owner and CEO of the Fleet Feet franchise in the US, Tom Raynor. Raynor leaned over and asked: ‘If there was one additional person you would like to have at your summit, who would that be?’ Without hesitation, Noakes replied: ‘That’s easy. Gary Taubes.’ Taubes is an American science writer and the author of bestsellers such as Good Calories, Bad Calories, Why We Get Fat and What To Do About It and The Case Against Sugar. Raynor responded: ‘You have your wish. I will fund his attendance at your meeting.’

  Response to the conference was positive and exceeded even Thomson’s expectations. The growing list of speakers and delegates wanting to attend required a venue change. She chose the Cape Town International Convention Centre, which is not exactly cheap. Noakes broached the issue, which he and Thomson had blithely ignored until then, of how they would finance the conference. He had visions of them both ending up seriously out of pocket, if not impoverished.

  Thomson is a glass-half-full kind of person. She had no such reservations. She gave Noakes what he called a ‘Barnardesque response’. ‘Prof, you are always telling everyone to believe in the outcome,’ she told him. ‘So, you should just follow your own advice. Believe in the outcome. It will happen.’

  And happen it did. Thomson and Noakes managed a coup of sorts. They secured significant financial support from a wholly unexpected source: the country’s top international investment, savings, insurance and banking group, Old Mutual.

  Old Mutual was an inspired choice of partner for the venture. It ensured that the summit avoided compromising ties with Big Food and Big Pharma, and any other companies or people with a vested interest on either side of the divisive nutrition debate.

  Old Mutual chief medical officer Dr Peter Bond was keenly aware of the risk the company was taking in supporting the conference and, by association, Noakes. From the outset, the conference was a direct challenge to orthodoxy and the powerful vested interests behind conventional nutrition ‘wisdom’. Bond therefore chose his words very carefully in his opening address to the conference. Old Mutual was ‘not endorsing a particular diet or way of eating’, he said. The company was simply acknowledging that health crises around the world, including in South Africa, showed that ‘new approaches are necessary’. There was a need to ‘elevate preventative medicine to the level it deserved’, and to not only do it, but, more importantly, also have the desire to do it. ‘We have clearly failed to date,’ Bond said.

  He presciently added: ‘We believe that when you get the right critical mass behind the topic, you can make big changes and difference. Part of the reason this conference is taking place is the contribution towards a critical mass behind preventative measures which will alter the course of serious non-communicable diseases [NCDs] that affect people in this country.’

  Old Mutual executive general manager Marwan Abrahams was more direct: ‘We are extremely proud to be associated with this conference and to have the calibre of thought leaders that we have in this room today.’

  The conference eventually became known as the Old Mutual Health Convention, although many referred to it informally as the Cape Town low-carb summit. With so many speakers, Thomson extended the conference programme to four days: three for health professionals, and the fourth and final day for the lay public.

  All doctors, dietitians and related healthcare practitioners have to register with the HPCSA in order to practise in South Africa. The HPCSA requires its members to update their professional knowledge and skills each year, and to this end has implemented a Continuing Professional Development (CPD) programme. Healthcare practitioners are required to accumulate 30 CPD points annually. With the calibre of speakers and the content of their presentations, Thomson easily secured 19 CPD points from the South African Medical Association (SAMA) for conference attendees.

  It wasn’t long before around 600 people had registered. More than 400 of them were health professionals – local and some foreign medical doctors, dentists, dietitians, nutritionists, psychologists and complementary medicine practitioners.

  But the conference nearly didn’t happen.

  Nine days before the scheduled 19 February opening, SAMA withdrew the CPD points after a group of ADSA dietitians objected. They cited the by-now oft-repeated canard that there is no evidence base for the safety or efficacy of LCHF diets. The paradox, of course, was that evidence was exactly what the summit would provide for the first time in South Africa. Without CPD points, many of the 400 health professionals would no longer be willing or able to attend the event. Thomson and Noakes faced the prospect of the summit’s imminent collapse, with all the financial implications.

  The dietitians, however, did not anticipate Thomson’s fighting spirit. Through her lawyer, she instructed SAMA that its withdrawal of the CPD points was ‘irrational, unlawful and falls to be set aside as an unjust administrative action’. She pointed out that a SAMA official had informed her in writing that she could market the conference as one for which CPD credits would be available. She would therefore apply for an immediate urgent injunction from the High Court for reinstatement of the CPD points.

  SAMA was not exactly an unbiased or disinterested party on this occasion. On the contrary, it was riddled with conflicts of interest and bias against Noakes and LCHF.* UCT psychiatry professor Dr Denise White (since deceased) had been a member of the HPCSA Preliminary Committee of Inquiry that had made the decision to charge Noakes over his tweet. White had a long association with SAMA and, in fact, would be elected as its president in October 2015.

  SAMA wisely backed down in the face of Thomson’s threat of an urgent interdict, reinstating the points and granting two more. In trying to sabotage the conference, the dietitians had helped Thomson gain extra CPD points. It was the first of many lessons in unintended consequences for die-hard opponents of Noakes and LCHF.

  In the build-up to the summit, Thomson issued an open invitation to all Noakes’s critics to attend for free and debate the science with him and other experts. She even offered to cover the travel costs of those who felt they could not afford it. Among those she invited were the authors of the UCT cardiologists’ and academics’ letters published in 2012 and 2014 respectively (see Chapters 3 and 5). Thomson also invited Strydom.

  Unsurprisingly, none accepted the invitation to debate the science at the summit, coming up with a variety of excuses. The blanket avoidance of public debate took on a coordinated air.

  The conference themes were many and varied. Chief among them were alternative theories on the causes of obesity, diabetes, heart disease and many other NCDs (also called lifestyle diseases) that are now epidemic across the globe. In particular, the conference looked at the role of insulin resistance. Speakers showed how these diseases, which they say would be better described as nutritional diseases, are just the tip of the iceberg and that underneath them all lies IR. They also demonstrated the role that a high-carbohydrate diet plays in laying the groundwork for IR to develop in susceptible individuals.

  With little preamble, speakers embarked on the ritual slaughter of sacred nutrition cows. Chief among them was the diet-heart hypothesis that saturated fat causes heart disease. Another was the calories-in, calories-out (CICO) model of obesity, which holds that people are fat because they eat too much and move too little.

  The diet-heart hypothesis and CICO are the pillars on which the influential official Dietary Guidelines for Americans rest. The guidel
ines were another major focus of the conference. In particular, speakers looked at the available science, or rather lack thereof, when the US introduced the guidelines in 1977.

  Gary Taubes was one of the first to dissect CICO at the conference and reveal its terminal flaws. In his presentation, titled ‘Why we get fat: Adiposity 101 and the alternative hypothesis of obesity’, he argued that the global epidemics of obesity and diabetes were not caused by people eating too much and moving too little, or ‘human weaknesses such as ignorance or indulgence’. Calling CICO the ‘original sin’ of obesity research and the ‘biblical equivalent of greed and sloth’, Taubes said that research now shows that the key driver of obesity is hormonal imbalance. In particular, science has identified dietary carbohydrates that drive insulin, which in turn drives fat.

  Swedish physician Dr Andreas Eenfeldt, who is known as Sweden’s Diet Doctor, was equally critical of CICO. Eenfeldt is the visionary behind Sweden’s biggest and fastest-growing health blog. He is also the author of Low Carb, High Fat Food Revolution: Advice and Recipes to Improve Your Health and Reduce Your Weight. After eight years of successfully treating obese and diabetic patients with LCHF diets, Eenfeldt quit his medical practice in 2015 to run his website in the hopes that by reaching more people, he could change the status quo. In order to stay free from advertisements, product sales and industry sponsorship, his blog is fully funded by the public via an optional membership.

  Eenfeldt told the conference that CICO is like saying a ‘Homer Simpson virus’ has spontaneously spread across the world. It doesn’t make sense to say that people have suddenly become lazy gluttons, he said. According to him, CICO is little more than marketing. It’s what the junk-food industry wants us to believe.