Prof Noakes: A career characterised by challenging beliefs

I have challenged convention seven times and have been proved right six times. The HPCSA hearing will be the seventh.” Prof Noakes

An in depth look at the nutrition trial of the century (8 – 16 February 2016)

Prof Noakes gets his say.

“You will know the truth, and the truth will set you free” John 8:32

Prof Noakes was charged for giving unconventional advice to a breastfeeding mother (Pippa Leenstra) over twitter when he suggested that she wean her baby onto low-carb, high-fat (LCHF) foods (meat and vegetables) instead of cereal.

Prof Noakes’ trial resumed on 8 February 2016 after not much progress was made last year.

You can read summaries of the trial here and here.

8 February 2016:

Prof Noakes’ advocate Michael van der Nest started off proceedings by referring to e-mail evidence on file that fell into the hands of Prof Noakes’ legal team, by chance, at the last hearing. The e-mail from Wits Professor Ames Dhai (Wits Uni Ethics Prof) told the HPCSA (Health Professionals Council of South Africa) to use an outside legal team to prosecute Prof Noakes. Preliminary Committee member Prof John Terblanche (Noakes’ medical colleague at UCT) asked Prof Wim De Villiers to testify against Prof Noakes. “De Villiers, was the first signatory of a letter UCT academics sent on August 22, 2014, to the Cape Times and other media. The letter’s authors attacked Noakes for promoting LCHF and making ‘outrageous unproven claims about disease prevention’ that were likely to cause serious harm. In the end, the HPCSA did not call De Villiers as a witness.”

Terblanche also suggests in an email that the letter, which he copied and made available to the Preliminary Committee in August 2014, be included as evidence against Noakes.”

Due to the content of the e-mail evidence, it was implied that the UCT and Wits academics conspired against Prof Noakes.

To date HPCSA Preliminary Inquiry Committee chair Wits Prof Ames Dhai hasn’t given reasons why Prof Noakes was charged.

Prof Noakes was also charged with “unprofessional conduct”, which is a serious charge and is usually reserved for doctors who are fraudsters or murderers.

HPCSA Advocate Ajay Bhoopchand said that Prof Noakes’ was not entitled to all of the information that the Preliminary Committee used to charge him. But, Chair Joan Adams disagreed and said that Prof Noakes’ had a constitutional right to information on how the HPCSA Preliminary Committee decided to charge him.

Advocate Bhoopchard said, “If our Prelim Committee acted illegally don’t ask us to do anything about it. Go to the High Court.”

Van Der Nest reiterated upon mention of the e-mail, “E-mails are not personal. There was no privilege violated. The file was made available voluntarily by the HPCSA. There was no breach of rights.”

Adams adjourned the hearing until the following day after Van Der Nest requested that Prof Noakes was given both the reasons for the decision to charge him and the evidence on which the decision was based.

For further information on day one – please read here.

9 February 2016:

Chair Joan Adams ruled that the HSPCA and registrar needed to provide written reasons for Dhai’s Committee decision by 12 February 2016.

Adams said her committee had a duty to try Noakes fairly, and ruled that the registrar of the HPCSA be requested to provide him with the reasons for the decision of the Preliminary Committee of Inquiry chaired by Dhai, to charge him, as well as all documentation on which the committee reached that decision, and to do so by 4pm on Friday, February 12.”

While her committee did not have the power to order the HPCSA to do so, Adams said it would be ‘a travesty of justice’ if the request was denied.”

Psychiatry Prof Willem Petrus Pienaar (bioethicist) took to the stand. His task was to see if Prof Noakes’ actions were acceptable for the medical profession and if he had a doctor/ patient relationship with Pippa Leenstra.

Prof Pienaar was concerned that specialist advice without a consultation could have harmed his profession and that Prof Noakes made an assumption that the mother had had enough information on breastfeeding.

Van Der Nest reminded him that Prof Noakes was charged with unprofessional and not unethical conduct.

It was discovered that Prof Pienaar did not have a twitter account nor did he read nor reflect on the timeline of the twitter conversation as a whole. Therefore, Van Der Nest stated that his opinion, as a fact, did not form any part of the charge.

As Van Der Nest explained to Prof Pienaar, hundreds of millions of people can read a tweet, which doesn’t make them all patients of Prof Noakes.

Van Der Nest reiterated the fact that the breastfeeding mother didn’t ask for confidential advice as she posed the question in the plural, “breastfeeding mums.” He also said that dietitian Marlene Ellmer did the same thing, yet she was not charged but was in fact asked to be an expert witness against Prof Noakes.

Van Der Nest then asked Prof Pienaar whether he agreed with the statement that a doctor/patient relationship began when a patient asked to be treated, and only once a doctor agreed to treat, and his response was, “Yes.”

Van Der Nest said that due to the South African constitution Prof Noakes is entitled to freedom of expression as it is important for mankind that scientists are not muzzled.

Prof Pienaar said, “I merely said that Prof Noakes made a mistake. I wouldn’t like him to be made an example of, but he did transgress.”

Read more on day two here.

10 February 2016:

Prof Noakes took to the stand and went through his CV.

He stated that he is an A1 rated scientist: An established world-leader in exercise science as one discipline and nutrition as another.

His credentials for nutrition are not just based on athletes. Prof Noakes also headed the Medical Research Council Unit involved in nutrition.

He admitted that his one study on the effects of carb metabolism on sports performance came to the wrong conclusion. But, he acknowledged it and retracted it because that’s how science works.

Prof Noakes mentioned that his profession teaches that diabetes is irreversible, yet, he has people who have reversed their diabetes on a high-fat diet.

This study shows that a low-carb diet tops a low-fat diet for weight loss.

Prof Noakes said that his research is cited 1000 times a year. When it comes to the H-index, anything above 20 means that people take you seriously. For nutrition Prof Noakes has a score of 44 and his total H-score is 67.

He stated, “A1 rating in respect of nutrition and exercise science makes you a world authority.”

Prof Noakes was asked if there was anyone in South Africa that was as much of an expert on LCHF as he was and he replied that he had started doing world-first research.

Prof Noakes received the Lifetime Achievement Award from the National Research Foundation for his contribution to sports science research in 2012 (highest award in SA). He kept his A1 rating in September 2015, and he was given the South African gold Medal award for his outstanding contributions to sports physiology.

Prof Noakes has over 60, 000 followers on twitter and he is ranked as the 30th most important obesity tweeter in the world.

Prof Noakes said that he spent a year researching infant nutrition for Raising Superheroes and 40 years before that on biochemistry and physiology. He has been involved in nutrition-related studies since the 1970s. In his opinion, it is one of the best books on infant nutrition. He said that this book is even better than his first book, Real Meal Revolution, which was a runaway best seller.

Every cent from every book he has written, plus lectures, goes to two foundations – the Noakes Foundation and the Foundation for Sports Research.

Prof Noakes said, “I do not prescribe a diet. I tell people to eat real food on the Real Meal Revolution green list. I don't prescribe a diet for pregnant mothers and babies; I just say that LCHF is a biologically proven diet for certain conditions.”

“People try to trap me. I know the difference between I-We questions. I know how to handle them. I don't say you must do what I tell you; I say here's the information. I've been handling I-We questions for 40 years. If a high-fat diet doesn't work, it will very quickly show up on social media. We are moving away from the power of the anointed.”

Prof Noakes was asked whether his tweet could have been construed as medical nutrition therapy to which he replied, “No, it's not specific to people with medical conditions.”

He said that if anyone had asked him for information on ketosis for epileptic infants, he would have referred them to Cath McGaw as she is trained in ketogenic diets for children.

Prof Noakes stated that he stopped practising medicine at least 10 years ago, and the only reason that he kept up with his registration with the HPCSA was for research purposes.

He admitted that it is difficult to give up the personality as a doctor, but he is a scientist and not a doctor any longer, so therefore he acts as a scientist.

He also pointed out that dietitian Claire Strydom (who originally laid the complaint against him) said more on twitter to Pippa Leenstra than he did. Yet he was charged, and she wasn’t.

He became emotional when he said that he would have done anything to avoid the hearing because the effects on his family and wife have been huge.

11 February 2016:

Prof Noakes took to the stand again.

It was pointed out that none of the members of the HPCSA Preliminary Committee who charged him for his tweets had a twitter account.

Prof Noakes said that he had never mentioned that he was a doctor on twitter and had never invited anyone to contact him for help on that basis.

Prof Noakes said that anyone who went onto his twitter profile would have known that he is biased towards LCHF as he makes this very clear.

The charge was stated again “unprofessional conduct for giving unconventional advice on breastfeeding.”

Prof Noakes said that he did not say go onto a LCHF ketogenic diet as that is something very different.

“The HPCSA framed the charge to seem like I gave unconventional advice. I didn’t say wean children onto LCHF ketogenic diets. My tweet was not done in anger – I think carefully about what I say. Science is self-correcting. Ketoacidosis is the condition that can kill diabetics – it is the acidosis and not the ketones. It is VERY different to ordinary LCHF ketogenic diets.”

Prof Noakes admitted that his book “Lore of Running” contained a major flaw in the fact that he promoted a high-carb diet. His “Damascus Road” moment was on 12 December 2010 when he learned that he was wrong. Despite being physically active, running 70 marathons, he still developed type 2 diabetes.

Prof Jacques Rossouw and others believe first you become fat, and then you develop insulin resistance (IR), the evidence doesn't show that. We misdiagnose IR because we don’t know what it is, but it is the most prevalent condition on planet earth.”

Prof Noakes speaks about Insulin Resistance in great detail in his official online Banting Program.

Dietary guidelines do not take IR into account, which is a big problem, according to Prof Noakes.

Humans have a natural desire for fat. We took this desire away by demonising fat in 1977. If you take the fat out of the food, you have to replace it with sugar or people won't accept it. Prof Noakes speaks about the McGovern Committee’s overhaul of America’s eating guidelines in 1977, which led to the food pyramid, in the official online Banting program.

The big change in our diets 200 thousand years ago, which led to bigger brains, was the introduction of nutrient-dense fish.

Teeth can tell you the health of a population. The effect of the diet on Ancient Egyptians resulted in insulin-rolls, “man-boobs” and heart disease.

Since the introduction of grains 12 thousand years ago our brains have shrunk.

You can eat a fairly high-carb diet if you are insulin sensitive and don’t eat a lot of refined carbs (sugars).

The problem with Ancel Keys’ research was that he went out to find evidence to support his hypothesis, which is not the way to do science. It is the worst example of associational studies, and he took data from seven countries, which would have changed if he used 22 countries.

The rate of heart disease increased in the US in the 1950s because Keys said the cause of heart disease was fat, and John Yudkin said it was sugar. Yudkin fought this in the 1970s, but the sugar industry made sure that no one asked the right questions.

The sugar industry supported the funding, and the FDA went with the consensus that sugar was safe. As a result, Yudkin lost his status, and Keys became influential.

“Sugar couldn’t cause heart disease because the sugar industry said it was safe.” For more on this topic and the effects that sugar has on the body, sign up to the online Banting program.

According to Prof Noakes the assumption that saturated fat causes heart disease is perhaps the greatest scientific myth of the century. Our bodies are made up of stable saturated fats.

The truth is there never has been solid evidence that these fats cause disease. We only believe this to be true because nutrition policy was derailed over the past half-century by personal ambition, bad science, politics, and bias.”

He says that the point of his whole testimony is to prove that the “conventional way” is not evidence-based, and his “unconventional way” is stacked with evidence.

Prof Noakes says that it is nonsense to talk of good and bad cholesterol as insulin resistance is a better marker of heart disease. It’s not cholesterol that causes heart disease, but lipoproteins. The type of lipoproteins determines your risk of heart disease.

Prof Noakes then dissected the study by HSPCA expert witness Prof Este Vorster on food products to lower cholesterol. Her statement was wrong, and he provided the evidence to prove it. He said that so much of the scientific evidence of the benefits of saturated fat have been suppressed or conveniently lost, but now that the scientists are looking for it, they are finding it.

There is no evidence that polyunsaturated fats do any good – they actually have the real potential for harm. We have known since the 1970s. No Heart Foundation supports this “evidence”.

For more on good fats and bad fats sign up to the official online Banting program.

Last year the HPSCA prevented Prof Cunane from giving video evidence, and they once again did the same thing. Why?

For more info in the trial thus far, please read here.

12 February 2016:

Prof Noakes took to the stand again.

He declared that there is no science behind the diet-heart hypothesis as you don’t need to eat one gram of carbohydrate. We take advice from the US when they are the most obese nation in the world – it doesn’t make sense.

The best possible science from the past decade now indicates that too many carbs overall – even of the supposedly healthy, whole-grain kind – increase the risk of [obesity, type 2 diabetes, and heart disease] compared with a diet low in carbohydrates.”

He also mentioned that the SA dietary guidelines are no good for diabetics, and he presented the evidence to show it.

“The effect of diabetes and heart disease on arteries is the same. We have always been told that obesity is complex. The food industry likes that because they don’t have to address the real causes.” (Prof Noakes)

Most English speaking countries adopted US dietary guidelines. Non-English speaking countries didn’t and are better off for it.

Carbs drive hunger. Americans did as they were told from 1977 – they ate more carbs, which resulted in the obesity epidemic. It’s the law of unintended consequences. More carbs, vegetable oils and sugar in the diet have helped to drive the obesity and cancer epidemics.

Prof Noakes goes into greater details about the science behind the obesity epidemic in the online Banting program.

Prof Noakes reiterated that Banting is not a “fad diet” as it is the original diet that has stood the test of time. It was the first medical diet prescribed in 1890. Read Banting’s Letter on Corpulence published in 1893, which you can find in the online Banting program.

William Osler, who is considered the “God of Medicine”, wrote Principles and Practice of Medicine in 1892, which was never peer-reviewed.

Prof Noakes reminded the hearing that pate de foie gras is made by forcing ducks to eat carbs – which enlarges the ducks’ livers.

The appestat (the part of the brain that controls hunger) was hi-jacked by certain foods – namely carbs. For more on the function of the appestat – go here.

Prof Noakes said, “In a perfectly regulated system, you don’t get fat because you do less exercise. Obesity is a brain disorder because the appestat fails. The current obesity model is wrong. Insulin is the fat-building hormone, which drives fat into the cells. There is very little glucose in our bloodstream, yet we are always told that it is a crucial nutrient. Obesity is not difficult to understand – understanding how to reverse it, is. An insulin resistant body is resistant to storing excess carbs as liver or muscle glycogen – so it has to store it as fat.”

Prof Noakes presented his theory on the solution to obesity – “it is unconventional maybe, but scientific and evidence-based.”

He said that heart disease won’t be solved through cardiology but through understanding non-alcoholic fatty liver disease.

Prof Noakes also said that he believed that in time cancer and dementia will be understood as diseases of insulin resistance – dementia is already known as type 3 diabetes.

He then quoted Dr Craig Thompson, an authority on cancer prevention, “cancer is a carbohydrate driven disease.”

“We got it wrong for 50 years – obesity, cancer and heart disease epidemics. We must look at the evidence and change.”

There is a new study by the JCEM that non-alcoholic fatty liver disease (NAFLD), arterial damage, heart disease are driven by carbs and insulin and not fat.

“We have a choice in medicine to continue to teach the failed model that caused the obesity and diabetes epidemics or to teach the evidence-based one,” he said.

Prof Este Vorster claims that it is irresponsible to promote a LCHF diet, given the effects of the dietary guidelines (which she created), but Prof Noakes presented a South African study on rural women following the guidelines of low-fat, high-carb – and they are all obese. This should conclude that a high-carb diet is contraindicated.

Diabetes is out of control in the Western Cape. The coloured population has the 2nd highest prevalence, and they are exposed to high-carb, high-sugar diets.

“The current management of diabetes shows that treatment isn’t working. It needs to change. We’ve done it for HIV, why not diabetes?” Questioned Prof Noakes.

Prof Noakes disproved the research by HSPCA expert witnesses Prof Salome Kruger and Ester Vorster on the link between physical activity and obesity.

HPCSA advocate Bhoopchand tried to prevent Prof Noakes from explaining how the food industry influences nutrition advice, but he was overruled.

The same applied when Prof Noakes gave information on the sports drink industry influence.

Prof Noakes has done research with Dr Aseem Malhotra on how the sports drink industry and Coca-Cola corrupt public health messages and manipulate science. Dr Malhotra said, "not only has this advice been manipulated by the food industry for profit but it is actually a risk factor for obesity and diet-related disease."

Prof Noakes also mentioned that Coca-Cola actually buys scientists and doctors and that a US Professor took $500 000 to spin Coca-Cola products. HPCSA advocate Bhoopchand retorted that it was a conspiracy theory to which advocate Rocky Ramdass took him through the hearing record to where the HPCSA expert witnesses brought it up themselves.

Advocate Rocky Ramdass asked, “SA dietary guidelines don't consider the influence of food industry. How is this not relevant to Prof Noakes’ advice?”

From all of this evidence, it is apparent that the food industry played a huge role in the SA dietary guidelines. The food industry and soft drink industry influence your weight, the advice doctors give, and the advice dietitians give.

Chair Joan Adams says, “Influences, forces, powers that drive nutrition and dietary guidelines is relevant.”

Prof Noakes mentioned an SA study on “Big Food” and the influence it played on driving the obesity epidemic through the environment it produces.

He reminded everyone of his previous statement that the food industry bankrolled the scientific papers in the 1970s when it recruited scientists and academics to say that sugar was safe. Sugar is still considered part of a healthy diet today. AMA, SA Heart and Stroke Foundation and Diabetes Association all say so.

Prof Noakes then looked at the sponsors of Association for Dietetics in South Africa (ADSA) to which Claire Strydom is part of – the sugar industry, Huletts, Kellogg’s, etc.

Prof Noakes, “sugar is an unnecessary component of the South African diet. It is addictive, and can’t be eaten in moderation. The three most nutrient-rich food on the planet are chicken livers, sardines and eggs. Those are the foods we recommend.”

A study shows how diabetes rates have risen after the introduction of the dietary guidelines.

Prof Noakes showed a South African Heart and Stroke Foundation diabetes recipe book written by ADSA dietitian and funded by a drug company – which pushes carbs.

For more on today’s trial, read here.

15 February 2016:

Prof Noakes took to the stand again.

He said that Coca-Cola set up a front – Global Energy Balance Network – to control the message about obesity and exercise – but they were exposed.

“People have become high-carb, low-health,” he stated.

In a study done by world authority Nicole Avena in 2008, sugar was put into the same class as heroin and cocaine with regards to neurochemical changes.

Prof Noakes quoted Zoe Harcombe when he said: “an obesogenic environment didn’t just happen, it was created when real food was demonised through food industry influence.”

The food industry made sure they included this addictive substance so that we would overeat.

“Sugar must be taken out of the food supply. There is no reason for it. We have no biological requirement for it and there is clear evidence of harm,” he stated.

Prof Noakes said that the reason why he wrote Raising Superheroes is because currently with the way things are going parents will outlive their children. But, this can be stopped if mom eats healthily from the moment of conception.

The wrong advice on paediatric nutrition has been given because we now have three-year-olds with type 2 diabetes. And this is not because they did not get enough exercise in the womb – it is more likely because they were weaned onto a high-carb diet.

Prof Noakes then provided research to show that cereals are not good first foods for infant weaning.

“Maternal insulin resistance begets infant insulin resistance, which is linked to excessive carb intake during pregnancy. IR in mother and infant sets the child up for arterial damage, which is linked to high-carb diets.”

“Mothers must be given guidelines that high-carb diet is not good during pregnancy if she is insulin resistant.”

There is a big problem with the SA dietary guidelines for infants and adults. Restricting carbs is not outlined in the treatment of diabetes.

Conventional advice is directly linked to increasing diabetes in children. No one has the courage to say that you must restrict carbs.

New data shows that too little fat is causing obesity in children.

There is evidence for carnivore (meat) weaning. Our guts are designed for carnivorous, not plant, eating.

A study, published in October the journal PLoS ONE, examined the remains of a prehuman toddler who died from malnutrition about 1.5 million years ago. Shards of a skull found in modern-day Tanzania reveal that the child had porotic hyperostosis, a type of spongy bone growth associated with low levels of dietary iron and vitamins B9 and B12, the result of a diet lacking animal products in a species that requires them.

The child was around the weaning age. So either the child’s mother’s breast milk lacked key nutrients or the child himself did not consume enough nutrients directly from meat or eggs. Either way, the finding implies that meat must have been an integral, and not sporadic, element of the prehuman diet more than 1 million years ago, said the study’s lead author, Manuel Dominguez-Rodrigo, an archaeologist at Complutense University in Madrid.”

Prof Noakes presented the evidence of the importance of carnivory (meat-eating) for children.

He stated that early infant weaning was led by the infant feeding industry in the mid-1800s – namely Nestle.

The baby food industry had to convince mother and dietitians that their products were better for babies than breastmilk or real foods.

In her book, “Inventing Baby Food”, Amy Bentley, uncovered how the baby food industry changed the dietary landscape by getting doctors and dietitians to endorse “gateway” foods. “Until the late nineteenth century, infants were almost exclusively fed breast milk. By the 1950s, commercial baby food had become emblematic of all things modern in postwar America. But these baby food products laden with sugar, salt, and starch also became a gateway to the industrialized diet that blossomed during this period. Today, baby food continues to be shaped by medical, commercial, and parenting trends. Baby food producers now contend with health and nutrition problems as well as the rise of alternative food movements. All of this matters because, as the author suggests, it’s during infancy that American palates become acclimated to tastes and textures, including those of highly processed, minimally nutritious, and calorie-dense industrial food products.”

Amy Bentley says, “Feeding infants foods such as bland, highly processed rice cereal, puts them on a pathway to a lifetime of consumption of highly processed unhealthy calories, which is one cause of the rising rates of overweight, obesity, and related diseases such as diabetes.”

Prof Noakes reiterated the fact that so much of our science and understanding of nutrition comes from industry-led interventions.

Gabrielle Palmer’s book, “The Politics of Breastfeeding: When Breasts are Bad for Business” “exposes infant feeding as one of the most important public health issues of our time. In her powerful book Gabrielle Palmer describes how big business uses subtle techniques to pressure parents to use alternatives to breastmilk. The infant feeding product companies' thirst for profit systematically undermines mothers' confidence in their ability to breastfeed their babies.”

Prof Noakes referenced Gabrielle Palmer’s book and stated that infant weaning food must complete and not substitute for breastfeeding. Meat and vegetables do that, but grains don’t. “Baby cereals are fake complementary foods. You can dress them up how you like, but they are still fake.”

An article from The South African Journal of Clinical Nutrition also states, (compiled by an HSPCA expert witness Prof Salome Kruger)  “It has been established that, in South Africa, high levels of stunting, growing concerns about overweight and obesity and the poor intake of certain micronutrients in the critical six- to 24-month period are, in part, a consequence of poor breastfeeding and complementary feeding practices, as well as the poor quality of the complementary diet. The introduction of semi-solid foods before four months of age is a common practice. The typical maize-based feeding pattern is low in food sourced from animals, vegetables and fruit and omega-3 fatty acids. Efforts by mothers to improve the quality of their children’s diets by adding energy-rich food to maize meal improves energy intake, but not micronutrient intake.” 

Prof Noakes said, “The South African Paediatric Guidelines recommend the same foods that I advise – meat, fish, chicken and eggs.” Prof Noakes showed that the HPCSA’s own expert witnesses recommended the same as he does for infants: meat, fish, chicken and eggs daily. He also said that cereals have been “health washed”, which HSPCA’s own expert witnesses showed in their research.

Prof Noakes powerfully questioned why breast milk contains so much fat. He reinforced the fact that a baby needs it, and if you eliminate or reduce it, a baby’s brain growth won’t be as good.

Prof Noakes quoted the research by the HPCSA’s own experts stating that “fat is an important part of the diet for infants and young children.” And that according to HPCSA’s experts on infant feeding it is crucial to ensure an adequate intake of fat – which is exactly what he says.

Prof Noakes said, “You can’t sustain the argument that my advice is unconventional, it’s the same as HPCSA’s own experts.”

Prof Noakes said that ADSA’s review of Raising Superheroes shows that his advice is not unconventional. “ADSA warns against vegetarian diets for kids, and advises animal foods and to make sure that fat content is adequate.”

From ADSA on infant weaning, “Foods from animals (meat, poultry, fish or egg) should be eaten daily, or as often as possible to meet protein and iron needs. In infants and young children, vegetarian diets cannot meet nutrient needs, unless nutrient supplements or fortified products are used.”

Research shows that fat intake should not be restricted in children as it increases the risk of obesity and metabolic disorders. “Butter can be more nutritious than low-fat yogurt. An egg is more nutritious than broccoli. At least, that's true for many infants and toddlers, and even children as old as 5 years, all of whom may need more fat in their diets than adults, two nutritionists say.”

Prof Noakes, “SA dietary guidelines don't emphasise enough the importance of fat for infant brains. It is utterly unfair to burden the poor with unhealthy foods. The government to subsidise real food.”

Prof Noakes stated that his advice is actually conventional as it promotes what the WHO and SA dietary guidelines say with regards to animal-source foods.  A guideline compiled by expert witness Hester Vorster, “From six months of age, give your baby meat, chicken, fish or egg every day, or as often as possible. Give your baby dark-green leafy vegetables and orange coloured vegetables and fruit every day.”

Prof Noakes took into account all of the paediatric guidelines from around the world – fat is not seen as the enemy. They all accept its importance for infants. WHO, UK and Canada guidelines for children are all evidence-based and focus on nutrient dense foods from animal sources.

Prof Noakes said that the weaning guidelines in Raising Superheroes are based on sound, peer-reviewed scientific evidence with the aim of developing intelligent children by feeding them properly from birth.

“Nutrition in the first two years determines productivity throughout life.”

From Raising Superheroes, “Breast milk is truly a miracle food. Breast feed exclusively up to 6 months (until weaning begins), then continue for as long as possible, in conjunction with first foods. The longer the breastfeeding, the greater the benefits, especially greater intelligence. A high-fat diet is optimal for brain development in newborn infants, while carbohydrates should be considered a non-essential food stuff – babies during the first two years of life are perfectly adapted to eating low-carb diets. Wean onto real foods, not onto non-foods such as white rice cereal or porridge. Optimum nutrition in the first 24 months of life is critical, and it’s absolutely essential to focus on the foods and nutrients that assist brain development in this time, especially fats, vitamins, iron, iodine, copper, zinc and selenium.”

Prof Noakes mentions in Raising Superheroes, “[They] fail to grasp the point that it is a nutrient-poor high-carb low-fat diet of highly processed non-foods that is causing the obesity epidemic amongst US children. Advising these children to eat high-carb fruits, cereals, grains and porridge, even if iron-fortified, and to limit their fat intake, while not warning of the real dangers of sugar and perhaps wheat addiction, is in my opinion the gateway to adult obesity.” 

Prof Noakes said that there is a fallacious argument for cereals and grains based on the belief that fat causes heart disease. “Anyone who says that cereals and grains are nutrient-rich hasn’t read the literature. Fruits are not full of nutrients as we are told they are. This is misleading the public. 5-a-day advice is not scientific.”

“A child’s bias towards what is considered food is determined by what he/she is weaned onto. Wean onto real food and not “beige” cereal,” he said.

Prof Alan Greene from Stanford University wrote a “White Paper” on why white rice cereal for babies must go. “Ending white rice cereal for babies offers a critically timed, developmentally syntonic approach to reversing the obesity epidemic for coming generations. It is also consistent with the emerging research of epigenetic metabolic programming, environmental acquisition of taste preferences, public health goals, and mothers’ inherent desire to provide optimal feeding for their children.”

Prof Noakes said “Carbs are only a principal energy source if you eat them. If you don’t, fats become your source, as this is the natural state of humans. There is no need to eat carbs, because the liver naturally produces all the glucose you need for brain function.”

HPCSA expert Vorster says that all food groups contribute to dietary adequacy, but Prof Noakes says this can’t be true.

Prof Noakes referred to Grain Brain by neuroscientist David Perlmutter, who says that grains (even “healthy” ones) can cause dementia, ADHD, anxiety, and kill brain cells.

There are many unforeseen consequences of high cereal/ grain intake as researched by Harvard. Dr Alessio Fasano, is one of the leading gluten sensitivity researchers in the world and is responsible for discovering the gluten/leaky gut connection.

“Next to the brain, the intestine is the most intelligent bodily organ. It knows what it will allow in and what it won’t, until it eats wheat. Fasano says that the future of medicine lies in the gut – all disease begins in the gut. Hippocrates said it first. Fasano’s work is novel, unconventional, but it’s novel work that wins Nobel prizes,” said Prof Noakes.

Prof Noakes said that the dietary guidelines must be evidence based, but they are not because they are based on associational studies.

Prof Noakes provided the research to show that wholegrains are no healthier than refined grains with regards to diabetics, metabolic syndrome and insulin resistance.

“Advice to wean infants onto cereals and grains is unscientific – the evidence of harm is strong,” he stated.

Prof Noakes explained again what he tweeted to Pippa Leenstra. He didn’t suggest ketogenic, and he explained again what constitutes low-carb, high-fat for infants. Prof Noakes mentioned that he was one of the first participants in a ketosis study, which was published in the Journal of Physiology in the late 1970s.

“To develop ketosis is difficult, it takes effort. The minute you eat, if it’s some glucose or protein, it obliterates ketosis. Ketone metabolism is critical for survival. There is no need to eat carbs because the liver naturally produces all the glucose you need for brain function,” he said.

Prof Noakes referred to the work of Canadian ketosis expert, Prof Stephen Cunnane, who stated that glucose is not the preferred source for brain fuel. “Without ketones, brain function would be rapidly compromised or muscle protein would need to be degraded to release amino acids that can be converted to glucose. Hence, ketones are an essential alternative fuel to glucose for the brain. Healthy human infants have a large store of fat that is available to make ketones. In infants, slightly elevated blood ketones are present all the time (mild ketonemia) regardless of feeding status. This is not the case with fed adults. In human fetuses at mid-gestation, ketones are not just an alternative fuel but appear to be an essential fuel because they supply as much as 30% of the energy requirement of the brain at that age. Second, ketones are a key source of carbon for the brain to synthesize the cholesterol and fatty acids that it needs in the membranes of the billions of developing nerve connections. The mammalian brain has protected itself from variations in the types and amount of fats we eat by developing the ability to: (i) make almost all the saturated fatty acids and cholesterol it needs; and (ii) exclude most fatty acids (except certain polyunsaturates) and all cholesterol that are present in the circulation and that are available to all other organs (Cunnane, 2001).”

“Hence, in all mammals studied, ketones have two important roles in the brain—they provide a reliable source of brain energy in between feeds, and they provide a major proportion of the lipid building blocks for developing brain cells.”

Prof Noakes said that dietary guidelines must make sure that we maximise brain growth in the first few months of an infant’s life.

Prof Noakes says that Prof Nancy Krebs in the US says that the current paediatric guidelines are not optimum. Krebs concludes that meat will ensure that infants get enough iron and zinc, but says fat should be later reduced. Prof Noakes says that this is not necessary.

Research shows that breastmilk is ketogenic, despite HPCSA expert Prof Dhansay saying it is not.

Prof Noakes said, “Formula milk prevents ketosis. We don’t want that. We want a child exposed to more ketones. Fat metabolism is normal. Why should we want to transition infants to carb metabolism?”

Prof Noakes gave a technical scientific explanation as to why ketosis in infants is a natural state. Therefore, it can’t be dangerous or life-threatening.

For more on today’s trial go here.

Here is some more food for thought.

16 February 2016:

Prof Noakes took to the stand again.

“I take science seriously. We are doing world-class, world-first research to study insulin resistance in athletes and low-carb diets.”

According to Phinney and Volek, world experts, there is evidence that ketone bodies are not just fuel for elite athletes, but also for health. “Most people misunderstand the metabolic effect of ketones, which are byproducts of fat breakdown, and how these ketones can healthfully affect the body long term for weight management and for managing Type-2 diabetes.”

Prof Noakes said that Phinney and Volek say that the ketogenic state may be the healthiest state, but the HPCSA says the opposite.

"People on a well-formulated ketogenic diet maintain normal blood sugar levels because their bodies' learn to use much, much less blood sugar," said Dr Phinney. “As for those who contend that it's risky to cut carbohydrates and boost fats for that long, Dr Phinney asks the rhetorical question: "What risks?" He cites benefits including improved good (aka HDL) cholesterol levels, reduction in inflammation and lower levels of saturated fats in the blood.”

Prof Noakes mentioned that there is a study showing that ketones can improve post-traumatic brain injury cerebral metabolism.

Prof Noakes said, “Dietitians advise high-carb diets to diabetics because the brain needs glucose. They believe carbs are the best source, which is nonsense.”

Prof Noakes said, “Some experts say ketogenic diet is best for infants. I'm not an expert, therefore, I just say that a LCHF diet is enough to produce ketones to build the brain. In the tweet I said, “reduce or eliminate sugar, processed, refined foods from infant's diet, eat real food.”

There was a 1932 study showing the bad effects of dietary change with the introduction of cereal grains on children’s dental health. “Cutting cereals from kids' diet, giving high-fat with lots of Vitamin D prevented new caries and reversed bad teeth. Avoid sugar, grains, and processed foods if you want kids with healthy teeth.”

Prof Noakes reviewed the research by Dr Weston A Price on traditional diets and the effects of modern, industrial diets on dental health.

Price found that the most consistent change that occurred with modernization was the replacement of traditional diets with the “displacing foods of modern commerce.” These foods, according to Price, included white sugar, white flour, white rice, syrups, jams, canned goods, and vegetable oils.

Price verified in the laboratory that the nutrient contents of soil and individual foods were also much higher among the traditionally living groups, and that their saliva donated minerals to powdered bone, a characteristic he had long associated with immunity to tooth decay. In every instance, modernization was associated with a proliferation of tooth decay in the first generation and dental deformities in the second.”

Prof Noakes provided evidence by Dr Caryn Zinn that a so-called “healthy-balanced diet” is nutrient deficient compared to LCHF. Dr Caryn Zinn and other doctors submitted a new proposal for New Zealand dietary guidelines based on current research.

  1. Enjoy nutritious foods everyday including plenty of fresh vegetables and fruit.
  2. Buy and prepare food from whole unprocessed sources of dairy, nuts, seeds, eggs, meat, fish and poultry
  3. Keep sugar, added sugars, and processed foods to a minimum in all foods and drinks.
  4. If you drink alcohol, keep your intake low. Don’t drink if you are pregnant or planning to become pregnant.
  5. Prepare, cook, and eat minimally processed traditional foods with family, friends, and your community
  6. Discretionary calories (energy foods) should:
  7. a) Favour minimally refined grains and legumes, properly prepared, over refined or processed versions, and boiled or baked potatoes, kumara or taro over deep fried or processed potato fries and chips.
  8. b) Favour traditional oils, fats and spreads over refined and processed versions.

“There are round about 27-28 randomised control trials and the low carb-high fat out-performs the low-fat way of eating.” Dr Caryn Zinn says.

Prof Noakes said that anecdote is driving the future of medicine. It gains power if it conflicts with conventional thinking. There is power in anecdotes. One LCHF Banting Facebook group has 160 000 people writing about their experiences.

“There is a wealth of anecdotal evidence on LCHF. Which one can’t and shouldn’t ignore. We must go on to test it scientifically. Our responsibility as scientists is not to ignore the anecdotes from morbidly obese people who have lost weight through LCHF. We must test it,” he said.

Prof Noakes stated that the term black swan means everything you believed before must change. You can’t ignore the fact that a diabetic has reversed his condition through diet. There have been no reported cases of reversing diabetes with medication, but many black swans are reporting reversal with LCHF diet alone.

“A Women’s Health Initiative (WHI) study by the National Institute for Health (NIH) cost $712m and aimed to prove that a low-fat, high-starch diet reduced cardiovascular disease. It showed the opposite and yet convention remains,” said Prof Noakes.

Quoted from the study, “Subsets of the population may not benefit, and may even be harmed, by the substitution of high intakes of carbohydrates, especially refined carbohydrates, for fat in the diet. Particularly given the differential effects of dietary saturated fats and carbohydrates on concentrations of larger and smaller LDL particles, respectively, dietary efforts to improve the increasing burden of CVD risk associated with atherogenic dyslipidemia should primarily emphasize the limitation of refined carbohydrate intakes and a reduction in excess adiposity.”

Prof Noakes said that hunger is not a sign of weakness of character. It’s a biological response to deprivation of certain calories.

Prof Noakes showed South African evidence based on a Stellenbosch review saying that there is no harm from low-carb and yet it was not presented as such.

Prof Noakes said that “Good Calories, Bad Calories” and “Why We Get Fat”, by Gary Taubes, should be required reading for dietitians and doctors.

Prof Noakes said that scientists are no longer the only experts. “Taubes was dismissed as ‘just a journalist’, but he has a Ph.D. He is a brilliant mind.”

“Harvard is the leading nutrition authority, globally, and they are changing their views on nutrition. They are now saying that maybe there is no reason to limit fat intake for adults.”

Another book worth reading by every doctor and dietitian is Nina Teicholz, “The Big Fat Surprise”, as it didn’t bind to convention and looks at all the research.

Zoe Harcombe’s research looking at dietary guidelines states, “The conclusion was that the dietary guidelines were introduced without even having been tested, let alone with evidence having been found to support them.” Here are many more academic studies questioning current dietary advice.

Prof Noakes also said that there is such strong [negative] influence in New Zealand that it is now impossible for dietitians or doctors to promote LCHF.

Australian dietitian Jennifer Elliot was expelled after she wrote a scientific paper that went against convention.

Even the Credit Suisse Research Institute looked at all the evidence and found that saturated fat is not the driver of obesity.

Prof Noakes said that scientists should look at paradoxes. The Credit Suisse report looked at three, France, Israel and Japan. In Israel health has deteriorated probably from eating too many vegetable oils with excess omega 6s.

In the Credit Suisse report it said that doctors and nutritionists show ‘superficial knowledge’ of benefits versus risks of increased fat consumption.

Prof Noakes said that he hoped this hearing will be a turning point. For the first time people will realise that there’s a lot of evidence behind what is being said about LCHF.

Nina Teicholz wrote an article questioning why the 2015 US dietary guidelines did not take into account all of the relevant scientific evidence. “The scientific committee advising the US government has not used standard methods for most of its analyses and instead relies heavily on systemic reviews from professional bodies such as the American Heart Association and the American College of Cardiology, which are heavily supported by food and drug companies.”

Because of Nina’s article, the US Congress wants an independent review of the dietary guidelines process as doubts on scientific integrity have set in.

Prof Noakes said, “We have to be careful what we say is conventional. It can change in 24 hours like is did in the US with regards to the dietary guidelines.”

“What is becoming boring, I hope, is that the evidence shows that conventional phobia around saturated fat is no longer conventional wisdom. The guidelines must change with the evidence,” he said, which echoed HPCSA expert witness Prof Vorster’s words.

“Like in the US, SA dietary guidelines must be reviewed by an independent panel. Advising people to restrict saturated fat has caused harm for over 40 years. This must change to prevent more harm,” said Prof Noakes.

Prof Noakes said that a hazard ratio below 2 was scaremongering. The fact that bacon causes cancer has a hazard ratio of 1.23.

Prof Noakes said that statins are prescribed on the basis of diet-heart hypothesis, but it’s unscientific.

“The HPCSA and ADSA expert witnesses are ethical scientists. It is difficult to admit that you got something wrong and harmed people for decades like I did. But, ethical scientists must do it.”

Prof Noakes then presented the HPCSA’s own document on ethical and professional rules, point number 2.

“Although I don’t practice as a doctor, I have to be informed of my responsibility as a doctor and scientist. The ethical responsibility of a doctor is to offer patients all the options, and not just one convenient one. I act within HPCSA’s own rules to do whatever I can to inform patients fully. If I have special training, I can’t hide it. The HPCSA has no guidelines on doctors on social media, but charges me for flouting the guidelines.”

“The HPCSA has a duty to protect the public and guide doctors, but it has failed me,” said Prof Noakes.

“My career has been characterised by challenging beliefs I thought were wrong. I don’t like to see the perpetuation of things that are wrong and harmful; I will take them on.”

“Two examples of where I took on conventional beliefs and won: Marathon runners immune from heart disease and neck injuries in rugby being preventable, which caused conflict with the second most important man in South Africa, Danie Craven. The first time, I was accused of being unscientific when trying to prove that neck injuries in rugby are preventable. I proved it. ”

“I have challenged convention seven times and have been proved right six times. The HPCSA hearing will be the seventh.”

Prof Noakes also challenged the belief on hydration in marathons. Gatorade pushed the advice to drink a lot, but Prof Noakes said that it wasn’t necessary. By 2009, there were 1600 cases of overhydration. The deaths were preventable, but scientists were bought-in on the drinking guidelines.

Prof Noakes said, “I produced alternative guidelines that went against industry-induced consensuses that were accepted globally. So I wrote ‘Waterlogged.’”

“I did lots of research on carbs in exercise. This shows the bias that happens when industry funds you. I ignored fat as it wasn’t funded. I apologise for missing the influence of fat on energy during exercise. I wasn’t funded to look at fat, just carbs.”

When Prof Noakes started studying exercise science in the 1970s, he was taught that lactic acid caused muscle fatigue, but now he can disprove it.

“We showed that fatigue is an emotion, which is only relative to how close you are to the finish. It is the way that the brain regulates performance. The brain is the key regulator of performance; convention said that muscle determines performance.”

“I’m not a brain expert, but I understood the whole body. I used the totality of evidence to show that the brain and not muscle affect performance the most.”

“I’m never unhappy to be challenged; I love it – that’s the way you learn.”

Prof Noakes questioned when someone who asks for information becomes a patient. David Pocock asked for LCHF info, which he follows, but he has his own doctor and dietitian.

Extreme swimmer Lewis Pugh did not just ask for diet information; he asked for special knowledge and intervention on temperature. So Prof Noakes agreed that Lewis Pugh is a patient.

Prof Noakes stated that convention isn't always right. And if evidence suggests it isn't, we should explore that.

The two questions Prof Noakes is currently researching are: Can type 2 diabetes be reversed? And is it possible to Bant on R30 a day?

Prof Noakes said, “The Eat Better SA campaign results are so successful we may have massive international funding.”

“I don’t believe I will always be right, but I do believe that we must give scientists the freedom to research and decide if they are right.”

“I could have made this hearing go away by deregistering with the HPCSA, but I feel that the pursuit of evidence is perhaps the most pressing moral pursuit of our time. My University, UCT, should have protected me instead of actively humiliating me. They should have said that I have every right to pursue what I believe to be true.”

“I’m working for truth, not just wishing for justice. I’ll make sure it is served,” he ended off.

Panel Chair Advocate Joan Adams adjourned the hearing until 17 – 26 October 2016.

For more on the Noakes trial read here.

It is a privilege to stand by Prof Noakes as the truth about nutrition is uncovered. The revolution has begun and it is only going to snowball. Our aim is to improve 100 million lives – join us as we change the world, one meal at a time.

Information compiled in this document was done with the help from tweets by Marika Sboros. Follow the trial #noakestrial.

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