Original story by Narina Exelby
A win for banting?
Professor Tim Noakes, author of the bestselling book The Real Meal Revolution and advocate for the high-fat, low-carbohydrate diet (LCHF), has been taken to task by the Association for Dietetics in South Africa (ADSA), who lodged a complaint with the Health Professionals Council of South Africa (HPCSA) of unprofessional conduct against him for advising a woman to wean her baby onto a high-fat, low-carb diet on Twitter.
The concern was referred to the HSPCA to adjudicate in February 2014. Following a preliminary hearing last year, the HSPCA decided to convene an inquiry into the conduct of Professor Tim Noakes. They will then rule on the matter.
The advice he gave is not considered to be in accordance with both international (WHO Guiding principles for complementary feeding of the breastfed child) and national (South African Paediatric Food Based Dietary Guidelines) feeding guidelines for infant and young child-nutrition. Furthermore, giving one-on-one nutrition advice on social media to a patient who has not been assessed, as well as providing information outside of the scope of practice for which you are registered with the council is in contravention of the HPCSA ethical guidelines.
Fast-forward to today, April 21 2017, and Professor Tim Noakes has officially been found not guilty of misconduct by a professional conduct committee.
Noakes held his head in his hands for a few seconds after being found not guilty and told News24 shortly after that he was “elated” with the outcome.
Watch his reaction here:
The infamous “Tim Noakes” diet is South Africa’s favourite dinner-party topic — or still is. Do you know all the facts? Does Noakes? Is there really no risk? And our most burning question: does it really work for women? Women’s Health got off the fence to investigate the food crusade that has turned so many into fat converts…
Prophets tend to be known for predicting cataclysmic events – the coming of the Messiah, for example, or the end of the world. It’s not often that their prophecy is that carbs could kill you and through fat shall ye be saved. But that is pretty much the message being spread with great enthusiasm by prophet-in-chinos and sports scientist, SA’s own Professor Tim Noakes.
Noakes is not the first person to speak out against the evils of carbs and the unfair demonisation of fat in our diets. His beliefs are predated and supported by many other scientists in both the US and UK, who claim that fat is not the cause of the epidemics of obesity, diabetes and heart disease, as we’ve believed for decades. The difference is that Noakes is not just a scientist; he is also a charismatic public figure and his message is being devoured (with lashings of butter) by an audience who will believe what they want to believe, which is that his “miracle” diet will work for everyone.
For the benefit of those who have not been to a dinner party in the past year, Noakes has been cast as the authority at the centre of what he calls a food “revolution”. His diet contradicts everything we’ve been told about healthy eating, saying you can have all the butter and bacon your heart desires, and not only will you not clog your arteries, but you’ll be thin too! And being the tjop-and-steak loving nation that we are, the movement has amassed an almost devotional following, while dieticians call for less zeal and more science.
But despite the lack of long-term studies, the critics’ biggest weapon, Noakes has a lot going for him. Firstly, he’s advocating something totally counter-intuitive – surely eating fat can’t help you lose weight? – that’s much more interesting than being told to eat less and exercise more. Secondly, he’s a highly convincing speaker and, thirdly, much of what he says is true. Carbohydrates do stimulate your appetite and we’re eating more than ever before. Noakes’s hypothesis is that it is this excess carb consumption that has caused the epidemics previously blamed on fat. Noakes’s epiphany was the result of having himself lost 11kg in eight weeks by following a diet low in carbohydrates and high in fat. More than just losing weight, he managed to cure a series of minor medical conditions and his running improved so much that he was getting results he’d achieved 21 years earlier. That’s some diet. And the best part, say the converts, is that while excess weight drops off, you’re also full of energy and don’t ever feel hungry.
“I’m loving it and have lost weight! Feeling great,” Lebo Motsepe wrote when we asked WH readers if anyone had tried a low-carb, high-fat (LCHF) diet. “Currently trying it and loving it. Not craving carbs at all,” said Kamesh Padayachee Malan. And: “It’s fantastic – fewer cravings and it’s easy to follow,” said Lindi du Plessis.
But the real story here is that this is not just another fad diet to get you ready for bikini season; it’s the kind of extreme paradigm shift that can offer the morbidly obese a second chance at a normal life. And for anyone who has lost a family member to complications of chronic diabetes, there is a powerful emotional resonance. But blind faith can come at a cost.
As with most diets that promise fast weight loss (especially those involving lots of bacon and butter), LCHF has garnered huge support, including a slew of spin-offs and marketing hooks in industries keen to cash in on the cult. Healthy food chain Kauai, who built their business on fast and freshly-made wraps and sandwiches, have partnered with Noakes and his Original Eating team to introduce and promote alternatives for carb-conscious customers.
Over at Woolworths, tempting displays of pasta and sauces have been appearing in the front of many stores as they try to offload carbs while scrambling to keep up with the demand for full-fat Greek yoghurt and cauliflower – two key ingredients in the LCHF fridge. Earlier this year saw the launch of the magazine Lose It!, featuring the Noakes story and LCHF recipes, but perhaps the biggest driver of the movement is the book The Real Meal Revolution, which Noakes co-authored and which has sold around 100 000 copies to date – it was reprinted eight times in less than a year. Referred to by food editors (without irony) as the “Red Bible”, it features recipes for smart carb swaps such as cauliflower “rice” and courgette “noodles”. And yes, Women’s Health was one of the first SA titles to run an extract of it in November 2013. (We like a good refined carb swap as much as the next person!) A second volume is in production, with an even more brilliant marketing angle: budget-friendly LCHF, since one of the criticisms of this way of eating (all meat and no potatoes) is that it is prohibitively expensive.
While Noakes has said that the diet will be of most benefit to you if you are insulin resistant (which, he also says, is most of us these days), nutritional therapist Sally-Ann Creed, who co-wrote Real Meal with Noakes, athlete adventurer David Grier and chef Jonno Proudfoot, says “it can be followed by everyone.” She has personally followed a LCHF diet for 20 years and says that it cured a number of allergies and her anxiety attacks. “For women, it means better blood sugar control, less body fat and improved moods.” “This is the diet that humans have been eating for 3.5 million years,” says Noakes. “Studies of traditional societies eating LCHF diets showed that they were remarkably healthy, without any heart disease, diabetes or cancer. But this changed the moment they were introduced to modern industrial foods.”
You’ve heard it before: our nutritional evolution has been our downfall. Our bodies are designed to be active and to process the natural foods our ancestors lived on. But then they started to grow crops andeat more grains, and became more sedentary. Agriculture advanced to the point at which plants were genetically modified and the food industry evolved to create foods that barely resemble anything “real” Our bodies haven’t evolved to cope with these changes.
But were our ancestors really healthier than we are now? Two million years ago the average lifespan of Australopithecus, who lived around the Cradle of Humankind in Maropeng, might have been about 15 years, says Professor Francis Thackeray, former director of the Institute for Human Evolution at the University of the Witwatersrand (now associated with the Evolutionary Studies Institute at Wits). But that doesn’t mean they were unhealthy – they were dodging sabre-toothed predators, remember? Chemical analysis of fossil teeth shows that our ancestors had a diet that included plant material (probably fruit, nuts, roots or tubers), with some degree of protein. “The protein is likely to have been obtained from the meat scavenged from carcasses of animals killed by carnivores, or from insects such as termites,” notes Thackeray. “A lesson learnt from the study of Australopithecus is that a healthy diet can be associated with the consumption of protein, combined with some degree of carbohydrates from plant foods, but not in excessive amounts.”
READ MORE: 9 Reasons Why You Need Carbs In Your Diet
The Enemy: Carbs
LCHF diets are nothing new. They’ve been around since the 1860s, when a British doctor put an obese undertaker, William Banting, onto an eating plan that banned carbs and sugar, with spectacular results. Since then, we’ve had Atkins, Paleo, Dukan – and now large chunks of chunky South Africa are “doing Noakes”.
“I prefer to call it ‘Banting’, as that’s the name attached to the original diet from 1862,” says Noakes. The difference though, is that Noakes’s version is more extreme – restricting carbohydrates even more than Banting does and promoting high fat consumption. This is also where it differs from Atkins, which promotes high protein and low carbs.
However, tedious as it may sound compared to a thrilling Noakes sermon, the fact is that not all carbs are created equal. Drastically reducing your intake of unrefined carbs is “one of the most negative aspects of this approach,” says one of the LCHF movement’s more vocal opponents, Prof Marjanne Senekal, head of the Division of Human Nutrition at UCT. “Unrefined carbohydrates are essential for health,” she says. “The fibre, micronutrients and other compounds in legumes, unrefined cereals, vegetables and fruit contribute to the prevention of heart disease, diabetes and cancer.” “You should be eating unrefined, healthy carbs,” agrees Kerryn Gibson, a dietician specialising in sports nutrition at Kings Park Sports Medicine Centre. “That’s how we’re wired, which is also why the LCHF diet is so effective in terms of weight loss – you’re rewiring your metabolism. But that also means that if you cheat, or can’t sustain it, you will regain the weight you lost. And more.” Several studies support this, showing that after a period of two years there is no significant difference in the weight-loss benefits of following a LCHF diet compared to a healthy, balanced meal plan (although weight loss is initially faster). More troubling is that some suggest the long-term health effects could include heart disease, osteoporosis, kidney disease and even depression.
Professor Lionel Opie, director emeritus of UCT’s Hatter Institute for Cardiovascular Research in Africa, who taught Noakes as a student and is among the world’s foremost scholars of heart disease, went so far as to say that the danger of following this diet for an extended period was that it could “impair cerebral function”. Some people will lose weight initially, says Senekal, but there is the possibility that your body composition could change. “Low-carb intake results in liver glycogen and muscle protein breakdown to produce the glucose the brain needs to function,” she explains. “The more extreme the diet, the more muscle you lose and the bigger the chance that your metabolic energy needs are reduced (your metabolism becomes slower), which makes it much more difficult to maintain your weight once going ‘off’ the diet.”
Interviewed on Carte Blanche in June, Opie said that there would be no harm in “Noakesing” for a short period to lose weight, but in the absence of data from long-term case studies – a concern echoed by all Noakes’s critics – he advocates the Mediterranean diet as a scientifically-proven way of eating healthily. The trouble with this approach is that Noakes is not advocating LCHF as a quick fix – he believes it should be “an eating plan for life”. Which is where things get a little fanatical: “There is belief,” says Opie, “but there is no data.”
The Gospel According To Tim
If you’re keeping up with the dinner-party circuit, you’ll know that in 1986 Noakes published a book called Lore of Running, in which he proposed that athletes carbo-load before endurance events. His message now is the exact opposite of this. He maintains that the only essential nutrient we get from carbohydrates is glucose, but both fats and proteins can be broken down to release a compound that your liver converts to glucose. (Senekal points out that it is exactly this increased exertion by the kidneys and liver that raises concern about kidney disease.) Eliminate almost all carbs from your diet, says Noakes, and you’ll remove the excess glucose that gets stored in your body as fat, as well as avoiding the health complications that arise from having high sugar levels.
The result? You’ll be healthier and you’ll lose weight. One of the arguments to support his radical change of heart is Noakes’s and others’ belief that we’ve been duped all along into believing that fat would make us fat. In 1977, the United States Dietary Goals for Americans (USDGA) was passed, and a high-carb, low-fat diet became the recommended standard – the moment sales of corn grits hit the roof. But, it emerges now, these dietary goals were based on a flawed study conducted by Dr Ancel Keys, an American physiologist whose influential research linked the amount of saturated fat in subjects’ diets with an increased risk of heart disease due to raised cholesterol and clogged arteries. Keys, who appeared on the cover of Time in 1961, now appears to be the prophet who got it wrong. His legacy is what Noakes calls “lipophobia” and a nation of obese diabetics. Back in the day, Keys told Time: “People should know the facts. Then if they want to eat themselves to death, let them.” Rounding out the conspiracy, Noakes maintains in The Real Meal Revolution that the USDGA guidelines, which recommend six to 11 servings of refined carbs (rice, cereal, bread and pasta) a day, were influenced by “powerful commercial and political forces to ensure growth of US farming through the industrialisation of corn and soy production.” In other words, corn growers weren’t making money, so the US government ensured everyone started eating their corn…
Unlike the US guidelines (and most dieticians WH spoke to), the LCHF diet recommends choosing animal source foods over most vegetables, fruit, wholegrains and legumes. (Sally-Ann Creed outlaws chickpeas too.) This is because fat is an excellent source of energy – one unit of fat contains twice as much energy as one unit of carbohydrate – and Noakes believes we were wrong to cast it out of our diets so unceremoniously. Citing Keys’ flawed research, he says: “The simplistic focus on blood ‘cholesterol’ as the key risk of heart disease is wrong and bad for our health.”
So Who Will Be Converted?
“I’ve seen success stories and I’ve had a few reports of women who have actually gained weight,” says Gibson. “From a psychological point of view, it’s far more difficult for women as we tend to have more complicated relationships with food. Men tend to respond better to stricter guidelines, whereas women may cheat and comfort eat. I’ve seen couples on it where the man loses weight, but the woman either doesn’t lose anything or gains because of the high fat content.” “There are healthier and safer ways to lose weight and achieve those health goals,” says Carey Main, a dietician in private practice who won’t recommend the diet to patients, given that so little is known about its long-term effects. Gibson supports this: “I would never suggest it to clients due to the lack of long-term studies, but if the client suggested it, I’d help with monitoring it. And I would suggest following it for a few months only.”
Like most healthcare practitioners, Gibson also advocates exercise as part of any weight-loss plan, but Noakes isn’t saying you need to sign up for a half marathon at the same time as you adopt his diet. It doesn’t matter how much exercise you do, he says – what matters is your inborn biology. “If you’re insulin resistant and continue to eat a high-carb diet, your long-term health will be poor.” (You need a blood test to determine if you’re insulin resistant.) But, and this is the bottom line, the LCHF diet calls for drastic changes, which many people might find difficult to sustain, says Dr Vash Mungal-Singh, CEO of the Heart and Stroke Foundation South Africa. “You need to be honest about how disciplined you can be,” she says. “You need to be willing and motivated, and understand your reasons for wanting to follow it,” agrees family physician Dr Gail Ashford, who has a special interest in metabolism and nutrition.
Ashford, who describes herself as a “real food advocate and LCHF considerate”, believes that following a LCHF diet would benefit people with insulin resistance, IBS, anxiety disorders, migraines, recurrent sinusitis, allergies, eczema, reflux and those on antiretrovirals.
Also, before you stock up on bacon and cream, take a look at your family tree. “People with known risk for cardiovascular disease, such as someone with a history of high cholesterol, shouldn’t consume saturated fats at such high levels as it will increase their risk further,” says Mungal-Singh. If you’re considering a LCHF diet, have a full cholesterol test done before you begin and monitor your cholesterol levels regularly.
Gibson supports this: “There are outliers in any study,” she says, “but there is also scientific evidence that fats affect your heart and your cholesterol.” Mungal-Singh says that the new findings do not change their recommendations to replace “bad fats” (saturated and trans fats) with good ones (mono and polyunsaturated fats). “Increasingly, we’re learning that we can’t focus on a single nutrient in our diet and must look instead at the ratios and quality of all the nutrients as a whole. It’s like baking a cake, which is about all the ingredients in their correct forms and quantities coming together to create the recipe.” This sounds terribly reasonable and also has the advantage of being based on scientific data, but, as Bryan Walsh wrote in a recent issue of Time: “Sometimes research is no match for a strong personality.” He wrote this in the piece, “Don’t Blame Fat”, published on 23 June. He was referring to Keys, the US physiologist who got it wrong. Whether history will repeat itself remains to be seen.