The dog that did not bark and other stories from the Nutrition Trial of the Century

The fourth installment of Prof Noakes’ hearing at the hands of the HPCSA began on Monday 17th October 2016, with the delaying tactics we have come to expect from the prosecution. This time, the pro-Forma Complainant, Advocate Bhoopchand, objected to Prof Noakes calling further expert witnesses. Disingenuously, he attempted to make out that this was an unfair move that had not given his team the time to prepare for this further testimony.

Arguments for and against took the entire morning, but were most effectively demolished by Advocate Van der Nest, who pointed out that Bhoopchand had himself surprised the proceeding by calling Prof Willem Pienaar at the last minute, without even the courtesy of any background information, whereas Prof Noakes’ team had provided plenty of background information on the expert witnesses, and done so timeously.

A light-hearted, but telling riposte came from Advocate Van der Nest when tackling the criticism from Bhoopchand that the evidence of the proposed expert witnesses was not relevant to the case. “You can only say something is irrelevant if you have read it,” said Van de Nest. Looking the opposition bench squarely in the eye, he continued: “I’ll bet folding money that the HPCSA’s legal team and all its expert consultants have not read Teicholz’ books or Harcombe’s Ph.D. thesis.” As expected, Advocate Joan Adams dismissed the application.

The three expert witnesses in question winged their way towards Cape Town from all corners of the globe. Zoe Harcombe (Ph.D.), a researcher in the field of dietary health, flew in from the UK; Nina Teicholz, journalist and author of “The Big Fat Surprise”, made her way from New York; while Dr. Caryn Zinn, a South African dietician, specialising in early childhood nutrition, made the long trek from New Zealand.

Noakes sets out to disprove theory that diabetes can’t be reversed.

Prof Noakes eventually resumed his testimony at around 2:45pm, giving him little more than an hour before the obligatory adjournment at 4pm. But what riveting evidence he gave! Noakes had two major themes for the afternoon, the first being the results of a trial in Canada headed by Dr. Sean Mark (and co-authored by Noakes), entitled: “A successful lifestyle intervention model replicated in diverse clinical settings.” Noakes presented this study in answer to critics who accuse him of being skeptical of mainstream research supporting the standard dietary model, but without having conducted his own research.

The study was interesting in that it did not pretend to be a randomised control trial, because, as Noakes pointed out, such trials, though held up as being the gold standard, are actually impossible to conduct without accidentally introducing a whole range of variables that could have an effect on the outcomes of the trial. Both the control and the study group would need to be confined to a prison setting, and the set-up and monitoring of such a study would be prohibitively expensive.

Instead, this study tackled the belief, currently held by diabetes clinicians, that diabetes is basically a progressive disease, impossible to reverse. By applying the LCHF diet to a group of 136 diabetic adults in rural Canada (a subset of 372 participants followed), mainstream medicine would expect no significant positive outcome. Astonishingly, the group showed fantastic improvement across the complete range of markers for diabetes, insulin resistance, and risk of heart disease. For example, the percentage of people in the study with metabolic syndrome dropped from 58% to 19%, and the Triglyceride/HDL-C ratio from 1.36 to 0.84, disproving the hypothesis that the metabolic health of a sample of pre-diabetic and diabetic people cannot be improved by the LCHF diet.

Bad science exposed.

The second major theme in store for the hearing on Monday afternoon was the results of analysis that Prof Noakes and Dr. Harcombe had done to the original meta-analysis that was the basis of the evidence supporting and motivating the charge against him by the HPCSA. The study, by lead author Dr. Celeste Naude, is titled Low Carbohydrate versus Isoenergetic Balanced Diets for Reducing Weight and Cardiovascular Risk: A Systematic Review and Meta-Analysis.

Noakes put up a slide showing that a meta-analysis of selected dietary trials that had been performed by the Cochrane Group of dietary academics at Stellenbosch University showed signs of data manipulation designed to skew the result in the favour of the established dietary hypothesis that fat is less effective for reducing weight and cardiovascular risk. When Harcombe restored the data, the meta-analysis showed unequivocally that the LCHF diet was more effective.

[RMR students of Banting will also observe that forcing the LCHF group in a trial to take in the same amount of energy as the HCLF group partially negates one of the main benefits of Banting, namely that hunger is naturally suppressed when eating LCHF, thus leading to reduced caloric intake and consequent weight loss.]

The dog that did not bark.

Noakes concluded the day with the story of the dog that did not bark. This was a reference to a Sherlock Holmes story, Silver Blaze, in which Holmes deduced that the crime in the story had to have been committed by someone who knew the guard dog well, as it had not been heard to bark at the time of the crime. It was the negative fact, the absence of barking; that was the noteworthy piece of evidence.

In his case, Noakes noted a number of negative facts:

First, none of the protagonists and scientists against him were supporting the Pro-Forma Complainants team, nor seemed to be willing to take the stand and risk having their pseudo-science destroyed.

Second, that the breastfeeding mother in the original twitter conversation was also not a part of the hearing, (apparently she claimed it was a circus).

Third, that he was being charged for a minor skirmish (unconventional advice on breastfeeding) and not for his stand in the major scientific debate – fat versus carbs for energy. Finally, the publication of the meta-analysis that formed the basis for the charge was delayed by eighteen months.

Noakes’ conclusion was that the powerful people in the medical establishment realised that the study on which they were building their case against him was fundamentally flawed.

Thus ended day one.

Readers will be relieved to find here little reporting on Tuesday’s proceedings, because Advocate Bhoopchand, in his cross-examination of Prof Noakes, spent most of the public’s precious time and investment trying to pick holes in trivial aspects of the Twitter conversation. It is hoped that by the time of next week’s newsletter, more material and weighty evidence will have come to light to bring into focus the dark shadows behind this trial of judiciary indiscretion.

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