THE WRITE STUFF

IT TOOK me many months to pluck up the courage to take my story to a wider audience. The first chance was a regular column I was then writing for Discovery Health, the company that was generously funding my research and the work of the Sports Science Institute of South Africa (SSISA). In the winter 2011 edition of their health magazine, Discovery, I broke my silence, describing for the first time my initial uncertain steps into the world of the low-carbohydrate diet. The title Against the Grains identified the focus – it was a report of how and why I had removed grains and other carbohydrates from my diet.

In the introductory paragraph, I demonstrated that I already knew that what I was writing would be unpopular: “I am not one to shy away from controversy. But I suspect that this column will attract more unfavourable comment than perhaps anything else I have recently written. Yet the message could be life-changing for some.”

The article included the following observations:

Global obesity rates have risen dramatically since the adoption of the US dietary guidelines, which promote 6-11 daily servings of bread, cereals, rice and pasta.

Humans have eaten meat for millions of years, but grains for only the last 20 000 years or so.

Humans developed our large brains by eating “high energy” foods like meat and fish.

“Perhaps,” I quaintly proposed, “humans are closet carnivores.”

Low- carbohydrate diets produce weight-loss results “at least as good as those achieved with the traditional low-fat, high-carbohydrate diets”.

High-protein diets produce satiation, whereas carbohydrates drive hunger. “This absence of hunger is more likely to encourage compliance and sustained weight loss (in those eating low- carbohydrate diets). In contrast, there may be an addiction especially to rapidly assimilated carbohydrates like sugar and refined carbohydrates, that drives the overconsumption of all foodstuffs, fat included, and hence leads to weight gain.”

As a result, “it is the unrestricted intake of especially refined and hence addictive carbohydrates that fuels an overconsumption of calories, not a high fat intake as is usually believed”.

Finally, and in my usual provocative style, I asked why these facts were not apparent to everyone. My conclusion: “There is a saying that to find the root cause follow the money trail. If a low-carbohydrate intake is more healthy than we expect, then why is that fact hidden? The answer is that some very large industries, including the soft-drink, sugar and confectionery industries (all of which produce high-carbohydrate products with minimal nutritional value) do not want us to know this.”

That final statement would perhaps prove to be truest, since it would lead to the events described in this book.

One immediate consequence of that first article was that Discovery cancelled my regular column, which I had written for many years.

By the end of 2011, the message that I had abruptly reversed my dietary advice was beginning to spread across South Africa. My publisher, sensing an opportunity, approached me to add new material to Challenging Beliefs. Bolstered by a growing certainty that I now had a novel dietary message of value for a much larger group of South Africans, I added 35 pages. These are the key themes that I introduced:

The low-carbohydrate diet cannot be labelled a fad diet, because William Banting described its first successful adoption in the 1860s, more than a century before the real fad diet, advocated by the 1977 Dietary Guidelines for Americans, went mainstream.

Industries determine what we believe about nutrition. They engineer these beliefs to increase food and beverage sales, not to protect or improve our health. In fact, most of what we have been taught is detrimental to our health.

Humans can be classified as either carbohydrate tolerant or carbohyd r a t e intolerant (today I prefer the ter ms insulin sensitive and insulin resistant).

Dietary carbohydrates, not fat, cause obesity and lead to diabetes in those who are insulin resistant.

There is no evidence that a high-fat diet is harmful to health.

Sugar, not fat, is the single most toxic ingredient of the modern diet.

It is also the most ubiquitous foodstuff on the planet. (Today I would add that sugar is not a foodstuff; it is a drug.)

Cholesterol is not the unique cause of heart disease and may not even be an important factor (especially in women).

You cannot outrun a bad diet.

Athletes are not thin because they exercise. Rather thinness begets exercise, whereas obesity causes sloth.

It is possible to exercise and train vigorously while eating a low-carbohydrate diet. (I added the proviso that it was still unknown whether or not athletes could

sustain high-intensity exercise if they did not increase their carbohydrate intake both before and during exercise.)

I concluded with nine health recommendations for those living with IR (insulin resistance).

When I added these ideas in early 2012, I was certain that they were sufficiently correct for me to risk exposing them to a wider audience. I also assumed that because we live in a mature academic democracy in South Africa, these ideas would inspire a grown-up debate in the scientific community, especially among colleagues at my academic home, the Faculty of Health Sciences at UCT. As a result of that adult debate, I presumed that my colleagues would warmly embrace whatever was of value in these ideas.

Equally, after appropriate joint discussions, we would summarily dismiss any ideas that science subsequently disproved. ‘IN THE context of junk diets, embedded scientists, corrupt – or simply ignorant – doctors and dietitians, human health and omertas, what you believe about your personal nutrition will determine not just how you live, but also how you die.’ – Tim Noakes In December 2010, Professor Tim Noakes was introduced to a way of eating that was contrary to everything he had been taught and was accepted as conventional nutrition ‘wisdom’. Having observed the benefits of the low-carb, high-fat lifestyle first-hand and after thorough and intensive research, Noakes enthusiastically revealed his findings to the South African public in 2012. The backlash from his colleagues in the medical establishment was as swift as it was brutal and culminated in a misconduct inquiry launched by the Health Professions Council of South Africa. The subsequent hearing lasted well over a year, but Noakes ultimately triumphed, being found not guilty of unprofessional conduct in April. In ‘ he explains the science behind the low-carb, high-fat/Banting diet and why he champions this lifestyle despite the constant persecution and efforts to silence him. He also discusses at length what he has come to see as a medical and scientific code of silence that discourages anyone in the profession from speaking out against the current dietary guidelines. Leading food, health and medical journalist Marika Sboros, who attended every day of the HPCSA hearing, provides the fascinating back story to the inquiry, which often reads like a spy novel.

The outcome would be a better understanding of IR, obesity and T2DM – Type 2 diabetes – (plus a wide range of other conditions), and the development of better, safer ways to more effectively treat many more patients. How exciting if, finally, we could advocate a simple method to prevent and treat the chronic medical conditions that are destroying health care in South Africa as elsewhere. And in a way that would not bankrupt patients or medical-aid schemes. What could possibly be more rewarding? I was in for some rude surprises, the first of which was a series of public criticisms from colleagues at the UCT Faculty of Health Sciences, a faculty that I had first entered in February 1969 and which, in my opinion, I have served honourably ever since.

The first clear public evidence that my challenge to orthodoxy was sparking intense concern among some senior UCT academics materialised on September 13, 2012, when I was awarded the National Research Foundation’s Lifetime Achievement Award. This is the highest South African scientific award. The citation to the award stated the following:

“This serves to acknowledge Professor TD Noakes, who is recognised inter- is an eyeopener and a must-read for anyone who cares about their health. This is an extract from the book. nationally for his extraordinary contribution to the development of science, what he stands for as a South African, and for the manner in which his work has touched and shaped the lives and views of many South Africans.” Within minutes of receiving the award, at about 9.30pm, my cellphone rang. It was a local news reporter who wished to include my comments in a story he was writing about a letter to be published the following morning in his newspaper. Written by a group of Cape Town cardiologists, headed by then UCT cardiolo g y Professor Patrick Commerford and including Professor David Marais and doctors Mpiko Ntsekhe, Dirk Blom, Elwyn Lloyd and Adrian Horak, the letter warned that the prescription in Challenging Beliefs of a “high-fat, high-protein” diet for “all persons” is “contrary to the recommendations of all major cardio-vascular societies worldwide, is of unproven benefit and may be dangerous for patients with coronary heart disease (CHD) or persons at risk of coronary heart disease”. In addition, the cardiologists were unhappy that I was “questioning” the value of cholesterol-lowering agents (ie, statins), because this was “at best unwise and may be harmful to many patients on appropriate treatment”. What struck me most about the cardiologists’ open letter to the media was its timing. As a result, the front-page story in the following morning’s issue of the Cape Times was not about my being awarded South Africa’s most prestigious science award. Rather it was all about my supposedly unprofessional behaviour in expressing opinions that conflicted with those of the anointed UCT cardiologists. Was the timing of this letter mere coincidence, or had it been planned? The gist of their complaint appeared to be that the simple act of questioning their cohesive professorial dogma was contrary to the Hippocratic Oath because it might harm patients. Yet one thing my Damascene moment had shown me was that it is our collective failure to question the causes of the global obesity/T2DM epidemic that is truly harming our patients and our nation.

I continue whimsically to believe that the function of universities is to advance knowledge, not to insulate professorial opinions from external scrutiny and thus institutionalise what I call the power of the anointed. I believe the very reason why universities exist is because we do not (yet) know everything. If we did, we would have no reason to invest so much in such costly institutions.

My opinion as an educator is that we are unlikely to foster future generations of inquisitive doctors and cardiologists wishing to improve standards of medical care through innovation and change if we follow these cardiologists’ reactionary educational approach. I can think of no favourable outcomes of attempts to suppress the opinions of those with whom we disagree – other than to protect the interests of those who have benefited from the surge in chronic diseases, including heart disease, over the past 100 years.

In the following months and years, the warning that the LCHF/Banting diet “might” damage health would become the di s t i nct ive, re c ur r i ng theme rallying the attacks directed at me by my professional colleagues. Of course, anything “might” cause anything. The role of science is to discover what causes what. That is why we have universities, and why universities employ professors: to advance our diligent search for truth by considering any and all opposing opinions.

I interpret these professional attacks as a measure of the extent to which the pharmaceutical industry has captured our profession.

Those whose careers have become partially or wholly dependent on a close relationship with the marketing arms of pharmaceutical companies simply will not tolerate anyone who dares question either the need for or the efficacy of any therapeutic intervention involving pharmaceutical products or related medical interventions.

Athletes are not thin because they exercise Of course, anything might cause anything