[2017] Lore of Nutrition: Challenging Conventional Dietary Beliefs

by Tim Noakes

  Finally after reading all the literature and seeking the advice of dieticians who promote weaning onto a high fat diet, I advised my son and daughter to raise their children on low carbohydrate high fat diets. As a result both my grandchildren are lean, alert, infrequently ill and with seemingly endless energy. Indeed they mirror all the benefits that I have achieved from following this eating plan. There is no evidence that my grandchildren are suffering as a result of this advice. Instead it appears quite the opposite. I am very happy that the one key benefit of this eating approach will be that they will not become obese and diabetic which must be the single greatest threat to their future health.

  I look forward to the day when the HPCSA will call for an investigation of the veracity of the ‘evidence base’ on which South African dieticians are currently being trained and its effect on the obesity and diabetes epidemic that is crippling the health of this nation.

  I remain,

  Yours Sincerely,

  Professor T.D. Noakes OMS

  MBChB, MD, DSc, FACSM, (hon) FFSEM (UK)

  As supportive evidence, I included a recently completed criticism of the New Zealand dietary guidelines, written by colleagues at the Auckland University of Technology (AUT).24 I believed that I had said enough in my reply for any rational committee to dismiss the complaint. In any case, I knew that the HPCSA rules mandated that, before I could be formally charged, I had to be given the opportunity to present more complete arguments to a preliminary inquiry committee, which would then decide whether or not the matter should be taken further.

  I was certain that on the basis that I had answered a ‘we’ question – as is my constitutional right and fully compliant with the HPCSA’s own rules – and had given accepted international advice for weaning infants onto animal products as the ideal complementary foods (see Chapter 12), the complaint would be thrown out within a few hours.

  How wrong I was. Behind the scenes, unimagined by me, things were beginning to hot up. Very soon my life would undergo a radical change.

  *Greene lists the known amounts of money paid to Katz by various food companies for his consultancy or research support: Chobani (yoghurt) paid him $3 500 an hour to serve as an expert witness in a sugar lawsuit; The Hershey’s Company paid him $731 000 to study the health benefits of cocoa; PepsiCo (Quaker Oats) paid him $633 000 to study the health benefits of oats; and KIND paid him $154 000 to promote ‘low-sugar’ KIND Bars. In addition, Katz has served as president of the Coca-Cola-funded American College of Lifestyle Management and was hired by Big Sugar as an expert witness in the defence of Refinery 29 (Western Sugar Cooperative, et al. vs Archer-Daniels-Midland, Inc., et al.).

  PART II

  NUTRITION ON TRIAL

  9

  The Hearing: June 2015

  ‘Objectivity does not exist. It cannot exist. The word is a hypocrisy which is sustained by the lie that the truth stays in the middle. No, sir. Sometimes truth stays on one side only.’

  – Oriana Fallaci, Italian journalist and war correspondent

  When the first attempt at a hearing against Professor Tim Noakes rolled round in Cape Town in June 2015, it was easy to spot his supporters. They were dressed in bright-red T-shirts, the colour of the cover of Noakes’s book The Real Meal Revolution. It had sold more than 160 000 copies in its first six months, making it South Africa’s bestselling book ever. It quickly became the ‘bible’ of Banting, as the low-carbohydrate, high-fat lifestyle has become known in the country.

  The book’s success had infuriated doctors, dietitians and academics alike. Among them was dietitian Claire Julsing Strydom, who had reported him to the HPCSA in February 2014 for what the public had dubbed the ‘Banting for babies’ tweet. As Noakes’s legal team would later note in their closing argument, these health professionals were furious with him not only because they disagreed with him on the science for optimum nutrition, but also because the public appeared to be listening more to Noakes than they were to them. In other words, they were losing influence, and business, to Noakes. The Real Meal Revolution thus appeared to be one of the reasons why Noakes’s critics were so keen for the HPCSA to silence him.

  Ironically, Noakes is only one of the book’s four co-authors. He wrote a single chapter on the science for LCHF. A common criticism doctors and academics throw at Noakes is that the evidence he presents in The Real Meal Revolution has no value because it has not appeared in a peer-reviewed journal. This is simply not true: the evidence for LCHF that Noakes presents in the book and elsewhere has appeared in respected medical journals, including those that are peer-reviewed.

  And, of course, Noakes is not alone in writing or contributing to bestselling books on medical and nutritional science. Objectively, then, the attacks on Noakes for his contribution to The Real Meal Revolution have no scientific basis. They reveal nothing more than his critics’ determination to discredit him, by fair means or foul.

  Before the June 2015 hearing, I wasn’t convinced of an organised campaign to discredit Noakes. I thought it was more likely a symptom of the chronic incompetency that has infected the HPCSA in recent years. That day, after watching its legal team at work in the hearing, however, I came away convinced that something was rotten in the state of the HPCSA.

  As a journalist, I’m always aware of my ethical responsibilities when reporting on any dispute or court case. When I was training to be a journalist, lecturers drummed into me the need for accuracy, fairness, balance and objectivity. Accuracy, fairness and balance are not that difficult to get right – if all sides are prepared to talk to you. When one side refuses to talk, or lies, or deliberately feeds you misinformation, accuracy, fairness and balance become difficult, though not impossible, to achieve. Objectivity is another matter altogether, and not just for journalists. I began to understand that more as I covered the Noakes hearing.

  I was the only journalist to cover all the hearings sessions, from June 2015 to the dramatic day that the verdict was delivered in April 2017. That did not just give me unique insight and perspective; it also gave me headaches trying to be accurate, fair, balanced and objective. From the outset, the HPCSA wasn’t talking – or at least, it never said anything material. The same applied to ADSA and its former president, Strydom.

  Objectively, I saw big problems with Strydom’s complaint about Noakes’s tweet, in which he said that the key is to wean infants onto LCHF foods. In her complaint to the HPCSA, Strydom alleged that the tweet was life-threatening to infants. That was pure emotion, and emotions are ephemeral creatures. But the biggest problem I had with Strydom’s ‘horrified’ response to Noakes’s tweet was that she provided no science whatsoever to support it.

  Scientists consider objectivity as central to research – or at least the good ones do. It’s the reason for valuing scientific knowledge. After all, as Polish-American psychoanalyst Helene Deutsch once said: ‘The ultimate goal of all research is not objectivity, but truth.’ Scientists also see objectivity as the basis for the authority of science in society. Historians say that the idea of objectivity as an absolute arose during the 20th century, when people venerated science. Objectivity does not reign quite so supreme in other areas of endeavour – history among them.

  An article in the 1996 edition of Kleio: A Journal of Historical Studies from Africa looked at whether historians can be truly objective. The author concluded that they could not be, since historians can’t reproduce the past to test hypotheses. He went on to examine what history is, and thus what kind of objectivity is possible among historians. One answer lies in the article’s title: ‘Absolute objectivity the ideal; perspectivism the reality’.1

  While historians may baulk at the comparison, the work of a journalist is not unlike that of a historian. Objectivity bedevils both.

  Washington State University communications professor Richard Taflinger even went so far as to say that, for journalists, objectivity is an ‘unrealisable dream’. In a commentary on ‘The Myth of Objectivity in Journalism’, Taflinger wrote
:

  The oft-stated and highly desired goal of modern journalism is objectivity, the detached and unprejudiced gathering and dissemination of news and information. Such objectivity can allow people to arrive at decisions about the world and events occurring in it without the journalist’s subjective views influencing the acceptance or rejection of information. Few whose aim is a populace making decisions based on facts rather than prejudice or superstition would argue with such a goal.

  It’s a pity that such a goal is impossible to achieve. As long as human beings gather and disseminate news and information, objectivity is an unrealizable dream.2

  When I set off on my journalistic path, it couldn’t have been more different from the one on which I now travel. I started off as a hard-news reporter on the now-defunct, anti-apartheid Rand Daily Mail. That was during the worst excesses of the apartheid era in the late 1970s and early 1980s. Because of my interest in politics, religion and the state, I often volunteered to cover the court beat. The political trials were the most interesting and demanding from a journalistic perspective. These cases were the grim legacy of oppressive racial and security legislation that was a hallmark of the ruling National Party regime, when capital punishment was a pillar of the country’s judicial system.

  As a journalist, I found it difficult to stay ‘objective’ when injustice stared me in the face, as was the case in most political trials. I managed to be balanced and accurate when reporting on cases involving the death penalty, and I mostly managed to be fair to both sides. Objective? Not so much, as the state trampled, literally and figuratively, on people and their basic human rights on an almost daily basis.

  Among weapons that the regime invoked to suppress political opposition was the doctrine of common cause. As legal experts will tell you, the doctrine originates in English law. The general idea is that when a group of people participates in an unlawful activity in which someone is hurt or killed, all those involved may be held ‘jointly liable’. As an American law professor explained it, in South Africa, the Appellate Division had so ‘vastly expanded the common purpose doctrine in political cases’ that many accused were ‘sentenced to death despite having only a trivial role in a crime’.3 ‘Guilt by association’ became a deadly web in which the state caught and killed off many of its opponents.

  Thus, I had an early baptism of fire in the full might of the state and the use of the law as a weapon – aided and abetted by compliant judges and attorneys – to prosecute and persecute those who got in its way. It was almost a relief when, in the mid-1980s, I changed professional direction. I moved from the unpredictability of hard-news reporting to feature writing. I gravitated naturally towards research and writing on health and lifestyle. But it didn’t take long to realise that I had not left religion and politics behind. Both infect lifestyle, health and nutrition.

  This became increasingly apparent as I covered the Noakes trial and uncovered those behind it. Politics infests the debate around the role of sugar and other carbohydrates in the diet – South African researchers said as much in a review of the evidence in the Bulletin of the World Health Organization in 2003:

  The development of a dietary guideline for ‘sugar’ has been fraught with conflict and political pressure, both locally and internationally. These conflicts seem to arise primarily from the twin imperatives: the formulation of appropriate public health policy and the protection of commercial sugar interests. Both have fundamentally influenced the content and process of this debate.4

  Interestingly, the authors acknowledge the fundamental link between sugar and obesity; however, they also go on to make a strong case for the inclusion of sugar in the diet. Even more interesting is that one of the authors is Professor Nelia Steyn, head of the Division of Human Nutrition at UCT. Steyn’s opposition to Noakes and LCHF is well documented. She has received funding from the sugar industry for her research, and actively supports the role of sugar in the diet.5 She also has links to the International Life Sciences Institute, as US investigative reporter Russ Greene discovered. Greene has revealed links between the ILSI and many doctors and academics connected directly or indirectly with the HPCSA’s case against Noakes.6

  On 22 May 2014, the HPCSA’s Fourth Preliminary Committee of Inquiry met to consider Strydom’s complaint and Noakes’s explanation. ‘Fourth’ in this case simply denotes the HPCSA’s committee that deals with complaints about the conduct of medical professionals. When the HPCSA receives a complaint against a health professional, it first goes before the relevant board. If the board decides that it is serious enough to require an investigation, the complaint is forwarded to the relevant preliminary inquiry committee. In Noakes’s case, as he is also a medical doctor, the complaint went first to the Medical and Dental Board and then to the Fourth Preliminary Committee of Inquiry. After two days, the committee felt it did not have enough before it to decide whether or not Noakes should be charged, and set a date for a second meeting on 10 September 2014. At that meeting, the preliminary committee decided that Noakes should be charged with unprofessional conduct for giving unconventional advice to a breastfeeding mother on Twitter. (How the committee came to its decision became a fascinating trial within the trial. It involved academics at both Noakes’s alma mater, UCT, and the University of the Witwatersrand. See Chapter 11 for details.) The official charge sheet read as follows:

  That you are guilty of unprofessional conduct, or conduct which, which when regard is had to your profession is unprofessional, in that during February 2014, you acted in a manner that is not in accordance with the norms and standards of your profession in that you provided unconventional advice on breastfeeding babies on social networks (tweet).

  The HPCSA only got around to giving Noakes notice of the charge four months later, in January 2015. A hearing was scheduled for June.

  By the beginning of 2015, the HPCSA’s decision to charge Noakes, and his decision to contest the charge, was common knowledge. It was also common knowledge to anyone with even a basic understanding of LCHF what Noakes was actually saying in his tweet. He was suggesting that foods such as meat, fish, chicken, eggs, dairy and vegetables are good for infants. It’s the same advice that both Strydom and ADSA now routinely give for infant weaning.

  From the outset, I found the HPCSA’s decision to charge Noakes with unprofessional conduct peculiar. After all, the HPCSA usually reserves such a charge for practitioners who have committed really serious offences, such as sexual misconduct, theft, grievous harm or causing the premature death of patients. The HPCSA does not have any ethical rules governing doctors’ conduct on social media. As such, the charge was unprecedented.

  The HPCSA’s most high-profile charge of unprofessional conduct to date had been against Dr Wouter Basson, nicknamed ‘Dr Death’ by the press. Basson was the apartheid-era cardiologist who ran the ruling National Party government’s chemical and biological warfare programme. His ‘duties’ allegedly included concocting lethal cocktails of muscle relaxants and other drugs, which the government then used against its opponents.

  Basson got off all murder and attempted murder charges in a criminal trial in 2002. In 2006, the HPCSA eventually charged him with unprofessional conduct. The case dragged on until 2013, when the HPCSA’s Professional Conduct Committee found Basson guilty on four aspects of the charge against him. The HPCSA has yet to decide on a suitable sanction, and Basson continues to fight the ruling on the grounds of bias on the part of the committee that heard the charge against him.

  In Noakes’s case, it appeared to me that the HPCSA was using its full might to prosecute a world-renowned scientist for little more than his views on butter, eggs, bacon and broccoli. He had not advocated infanticide. His tweet was not a code for mass murder.

  The HPCSA is a statutory body and the country’s regulatory agency. Its brief is to protect the public and guide health practitioners. As such, its hearings are not meant to be adversarial. They are set up to be dispassionate, impartial inquiries aimed at getting to the truth
of a matter. There was nothing dispassionate or impartial about the HPCSA’s reaction to Noakes’s tweet and the lengths to which its legal team went to load the panel that heard the charge against him.

  An aggravating factor in the case against Noakes was incompetence within the HPCSA. Over the years, the trickle of complaints that practitioners, professional associations and academic training institutions had lodged against the HPCSA had become a tsunami. In February 2015, the minister of health, Dr Aaron Motsoaledi, set up a government task team to investigate the HPCSA. The report was damning in the extreme. The task team found the HPCSA to be in a state of ‘multi-system organizational dysfunction’ that had prejudiced both practitioners and the public. Three of its top executives – the chief executive officer, chief operations officer and head of legal services – were found to be unfit to hold office. They would not cooperate with the task team, and they refused to stand down. The CEO was eventually replaced.7

  Ironically, the chair of the government task team was UCT cardiology professor Bongani Mayosi, then head of the Department of Medicine. Mayosi was an author of the UCT professors’ letter, published in a Cape Town newspaper in 2014. In it, the academics made what many consider to be damaging, inflammatory and highly defamatory claims against Noakes. Inter alia, they accused him of ‘aggressively promoting’ LCHF as a ‘revolution’, making ‘outrageous unproven claims about disease prevention’, not conforming to ‘the tenets of good and responsible science’, and breaching the university’s ‘commitment to academic freedom’ (see Chapter 5).

  From the outset, all the authors of that letter also refused to talk to me. As a journalist, the walls of silence I kept hitting just piqued my interest even more. I had to find other sources of information and evidence behind the hearing. And when it finally commenced on 4 June 2015, it was a revelation, though not in the way that the HPCSA had likely intended.