Noakes debate rages on
PROFESSOR Tim Noakes was found not guilty of unprofessional conduct by the Health Professions Council of SA (HPCSA) in April this year. This followed a three-year battle to clear his name after he was charged with unprofessional conduct after he had advised a mother to wean her newborn baby on to a low-carbohydrate, high-fat (LCHF) diet, via Twitter. Claire Julsing-Strydom, former president of the Association for Dietetics in South Africa (ADSA ), lodged the complaint against Noakes and later testified that Noakes had given incorrect medical advice in his tweet, which had not been based on evidence and could be life-threatening. After the not-guilty ruling, The Noakes Foundation (TNF) communication executive Candice Spence penned a piece which was used on April 23 on the Cape Times op-ed page,
to which ADSA president Maryke Gallagher and Nutrition Society of South Africa president Ali Dhansay objected, citing certain statements. The Noakes foundation responded to those objections. The dialogue follows:
Candice Spence: This ruling has far-reaching implications... because it gives the seal of approval to the low-carb high fat (LCHF) diet…
Gallagher and Dhansay: This is a serious misinterpretation of the verdict. The chairperson of the HPCSA Professional Conduct Committee advocate Joan Adams, noted the following in her verdict: “While the Committee is aware of evidence that there is a strong link between diet and a fast growing global challenge on obesity and illness, this Committee cannot pronounce upon the LCHF diet as such or the relationship between infant and adult nutrition.”
TNF responded: In her judgement, Advocate Joan Adams states: “On the facts and all the expert evidence tendered it would appear that the respondent’s advice was sufficiently aligned to prevailing South African paediatric dietary guidelines at the time, such that the only reasonable inference to be drawn is not that the advice was or could be deemed to be unconventional.”
This an indication that the low carb high fat diet is not unconventional. The charge laid by the Claire Julsing Strydom was made on the basis that the information given by Prof Noakes was unconventional and therefore dangerous.
It is therefore reasonable to claim that the low carb diet has been given the ‘seal of approval’, since it is sufficiently aligned to prevailing South African paediatric dietary guidelines. In her judgement, Advocate Joan Adams also states: “While the Committee is aware of evidence that there is a strong link between diet and a fast growing global challenge on obesity and illness…” The committee acknowledged that there is a link between the conventional diet and obesity.
Candice Spence: The Noakes Foundation asserts that dietitians and nutritionists should revise the advice they give their clients, especially diabetics and those with insulin resistance. …It also calls for a review on policy.
Gallagher and Dhansay: It is unclear exactly which policies the Noakes Foundation would like to revise. Dietitians and nutritionists are guided by national and international practice guidelines from the Society for Endocrinology, Metabolism and Diabetes in South Africa (SEMDSA), the International Diabetes Federation (IDF) and the American Diabetes Association (ADA). This call, again, is unfounded. The verdict does not make any judgement on the LCHF diet for adults with diabetes or insulin resistance.
TNF responded: The current advice given by dietitians and nutritionists promotes a diet high in carbohydrates and low in fats. Prof Noakes and his expert witnesses delivered extensive scientific evidence in support of the low carb diet and against the low fat diet, which went uncontested by the HPCSA. The HPCSA was not able to produce any scientific evidence in support of the low fat diet. Therefore, one has to question whether any such evidence exists, and if it did, would this not have been a crucial time to showcase it?
It is on the basis of this, in combination with the irrefutable science presented Prof Noakes, that we argue that health care professionals be guided by prevailing, scientific evidence-based information when treating their patients, and should no longer be promoting information which has no scientific basis and is therefore outdated. It would be far more beneficial for those in positions of influence to focus on the evidence that irrefutably supports the argument, as opposed to looking for any opportunity to desecrate the cause.
In any event, the LCHF diet should be presented to patients as an alternative treatment modality.
Candice Spence: The complainants were not able to produce evidence to support their view that a conventional low-fat diet had advantages over a (sic) LCHF diet.
Gallagher and Dhansay: There was no expectation of the complainant to prove that certain diets were better than others. The hearing was to ascertain whether Prof Noakes acted unprofessionally.
TNF: The HPCSA bore the onus of proving that the LCHF diet was dangerous in order to sustain their charge against Prof Noakes. They were unable to do this.
Candice Spence: The Noakes Foundation feels that the vitriolic attack on Noakes as an esteemed A1 rated scientist has been a massive injustice ….
Gallagher and Dhansay: While we respect Prof Noakes’ academic credentials, he conceded that his A1 rating was not based on any work he did in the field of low carbohydrate high fat diets. His research was on sports science, not nutrition.
TNF: The A1 credential was mentioned in the press release to highlight Prof Noakes ’ overall level of academic accomplishment. He has an H-index of 40, in the field of nutrition. He has published numerous peer reviewed journal articles in the field of nutrition, more than any witness that gave evidence at the hearing.
Candice Spence: The immediate focus of The Noakes Foundation will be to change the dietary guidelines given to people by doctors, dietitians and nutritionists.
Gallagher and Dhansay: Doctors, dietitians and nutritionists will not change their guidelines as a result of the Noakes Foundation’s misinterpretation of the verdict. This is rather presumptuous. The ruling notes, “it deserves mention that this Committee’s purpose and mandate is not to set nutritional or dietary standards for the world. So that counts for all babies.”
A scientific and rigorous process is used to develop international and local dietary guidelines that are regularly revised. The outcome of the inquiry does not mean that these guidelines are wrong.
TNF: The outcome of the inquiry does not mean that those guidelines are correct. It may be that the guidelines will not change. However, an increasing number of doctors, dietitians and nutritionists have rejected the guidelines and have adopted a more critical approach to the guidelines.
It is important to remember that the guidelines are just that, guidelines. These are not treatment protocols or modalities. They are not binding. They have no forces other than as a guide to the public. That is all.
A significant amount of scientific evidence was lead to show that the low fat diet currently endorsed by ADSA is not only bad for human health, but can be dangerous. This evidence went uncontested by the HPCSA.
This should prompt a reconsideration of the current dietary guidelines being implemented in South Africa. TNF manager Jayne Bullen said: “The state of our nation’s health demonstrates that some fundamental changes are necessary to current policy and guidelines. This trial has highlighted some key critical issues. The Noakes Foundation is committed to the truth and to helping to support updated policy and guidelines. We are most keen and willing to work together with all those that have this common interest in supporting our country’s critical health problems, many of which are caused by poor diet and nutrition, all of which are based on the present guidelines.”
Candice Spence: Many health professionals are operating on outdated information …– now it is our commitment to help update them.
Gallagher and Dhansay: The Noakes Foundation’s assertion that this information is outdated is inaccurate. The Noakes Foundation is getting carried away with this commitment, which is based on an incorrect interpretation of the ruling.
TNF: This is not a claim based on the verdict. This is a claim that is true independent of the verdict. In any event, the advice currently given by many health professionals was shown to have no scientific backing. The information is outdated because it has no scientific basis.
No evidence was lead by the HPCSA to show otherwise. It is therefore the duty of all health professionals to familiarize themselves with the most credible and evidence-based science available. The Noakes Foundation will assist with this information sharing in any way we can.