Noakes diet particularly dangerous for Afrikaans population

The Heart and Stroke Foundation of South Africa points out that the fats promoted in Noakes’s popular The Real Meal Revolution cookbook are mostly “bad fats” like saturated animal fats like lard and butter.
In a recent article in The Times, a cardiologist lambasted Tim Noakes' popular diet but how do you know who to listen to?
In a recent article in The Times, a cardiologist lambasted Tim Noakes’ popular diet but how do you know who to listen to?

Noakes, a renowned sports scientist based at the University of Cape Town, claims that the high-fat diet he promotes reverses all known risk factors for heart disease.

As a result, some patients with high cholesterol have exchanged their cholesterol-lowering medication (called statins) for the LCHF diet, with detrimental results.

Cardiologist Dr Anthony Dalby describes Noakes’ advice to heart patients to exchange cholesterol-lowering drugs for his diet as “criminal”.

International obesity expert Professor Tessa van der Merwe says there are “many health risks connected with the LHCF diet”.

It could exacerbate heart disease, worsen diabetes and osteoporosis and cause gall and kidney stones, says Van der Merwe, honorary Professor of Endocrinology at the University of Pretoria.

“If you have got familial hypercholesterolemia (FH), the chances that you will develop a sinister cholesterol profile is a reality,” she adds.

FH is caused by a genetic disorder that causes high LDL (“bad”) cholesterol. It is particularly common in the Afrikaans-speaking population, where there is a 1:70 occurrence in comparison to a 1:500 in the general population.

[quote float=”left”]”Average age of death for a man with untreated familial hypercholesterolemia is 43 years, and 85 percent of them will not reach the age of 60″

The efficacy of the LCHF diet also came into question when a recent review by Stellenbosch University researchers showed that people following a low-carb diet achieved similar weight loss to those on a low-fat diet (see box).

Dalby was involved in a heated exchange with Noakes at a meeting convened by Discovery Health recently. He says one of his patient’s blood cholesterol levels more than doubled (from 5.1 to 12.9) when she dumped her statins for Noakes’ diet.

But when the 39-year-old woman returned to a normal diet and resumed her medication her cholesterol dropped substantially to 7.3.

Statins are particularly important for the genetic FH.

“Statins make a tremendous difference in heart disease risk in people with FH, as they will not be able to control their cholesterol through lifestyle,” says Prof David Marais, a lipidologist with the University of Cape Town.

“Research shows that the average age of death for a man with untreated FH is 43 years, and 85 percent of them will not reach the age of 60,” Marais told Health-e News.

“Genetic disorders that lower LDL concentration are associated with lower risk. In persons with the common range of cholesterol, there is a definite association with risk but other factors such as age, smoking, hypertension, obesity and others, may predominate in their contribution to risk so that intervention with cholesterol lowering treatment will not have as large an impact as it has in the very high risk of FH,” says Marais.

Average Nutritional composition Noakes’ LCHF diet Balanced diet
Carbohydrates 10% 50%
Protein 20% 30%
Fat 70% 20%

 The devil you know

[quote float=”right”]“The whole concept of insulin resistance being the root of all evil comes from a poor understanding of metabolic and biochemical pathways”

Noakes admits that the LCHF diet raises cholesterol levels in about one in three people, but does not consider it a health risk. He disputes that blood cholesterol levels cause coronary heart disease.

Instead of cholesterol, Noakes blames insulin resistance (IR) for heart disease. IR is a condition in which the body produces the hormone insulin but does not use it effectively so it cannot process glucose effectively. This causes high blood sugar. Carbohydrates, which turn to glucose in the body, are usually restricted when a patient suffers from IR to control blood sugar levels.

Noakes believes that most people today are IR and would thus benefit from cutting carbohydrates from their diet and replacing it with saturated (animal) fats.

Noakes’ theory on cholesterol contradicts the current medical view on coronary heart disease prescribed by international health authorities like the World Health Organisation, and the Heart and Stroke Foundation.

Marais says there is more than enough scientific evidence to show that impact of blood cholesterol on coronary heart disease.

“The whole concept of insulin resistance being the root of all evil comes from a poor understanding of metabolic and biochemical pathways,” Van der Merwe told Health-e News.

“An elevated insulin level purely means that your pancreas is stimulated by the capacity of your body to over secrete insulin. It doesn’t mean to say that you have IR. IR only becomes a reality when you’ve developed glucose intolerance… and the glucose is spilling over into the blood stream,” said Van der Merwe.

She also criticizes Noakes for publishing a disclaimer at the back of his book, The Real Meal Revolution, exempting him and his co-authors from any responsibility for its readers’ actions.

“We, as medical professionals have to accept responsibility. If I put my name onto a script for a patient, I have to take full responsibility for the advice that I give that patient. If you make certain health claims in your book it is not good enough to put a single sentence at the end distancing yourself from the consequences,” says Van der Merwe.

An edited Afrikaans version of this article first appeared in the Beeld and Die Volksblad newspapers. An English version also appeared in KwaZulu-Natal’s The Witness newspaper.

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8 Comments

  1. Wha-at? AND Indians, And Ashkenazi Jews. Equally. Plus we DON’T all have the mutation. I do, and as for me and mine, LCHF halved my cholesterol for first time in my life. AND, Dr. Noakes told me to STAY ON MY PILLS (but of course statins will kill me). There is professional jealousy towards this man, such as never been seen before. It’s very unfair. You ppl who promote Low Fat have not stood the test of time. since the 70s DB2 has skyrocketed and so has atherosclerosis. You all know that! And YOU don’t have any science to boot. There are now hundreds of specialists who have seen the results on this.

  2. In my opinion, when your reporter pointed out that current medical views are prescribed by The Heart and Stroke Foundation, it would have been more balanced if she pointed out that the sponsors of HSF (as found on HSF website) are Willowton, Unilever, Tiger Brands, Spur and Oceana Brands. You may know them better as the suppliers of: Willowton – Sunshine D, sunfoil, d’lite margerine, NuVolite; Unilever – Flora, Stork, Rama; Tiger Brands – Albany bread, All Gold, Jungle oats, Koo, Tastic Rice; Spur – we all know what they supply; Oceana Brands – fish oil. In my opinion, your reporter also needed to point out that The Heart and Stroke Foundation, to my knowledge and according to the video insert, requested the “study” done through Stellenbosch University. Your reporter should be asking the questions, as I do, why would The Heart and Stroke Foundation do anything to upset their sponsors, and why we cannot trust a study to be non-biased if it was indirectly sponsored by the above companies?

  3. Dear Beatie, thank you for taking the time to comment on the article.

    I would just like to correct your statement on the Stellenbosch-study. Here is the link to the original article published in the academic journal, PLOS ONE — where the authors account for all the sponsorship of the study — and The Heart Stroke Foundation isn’t one of them:
    http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0100652

    The authors mention that they undertook the study after a request by the Heart Stroke Foundation for more information on the topic, but there was no sponsorship, and as the scientific process requires, also no further involvement by the Heart and Stroke Foundation.

    A respected journal like PLOS ONE would also never publish a “sponsored” report.

    I know this because after the first of these accusations surfaced I had to investigate my sources.

    In my article I also referred to the Heart and Stroke Foundation’s international body, and not just the South African component – which will not be influenced by local funders.

    Thanks again for your comment, I think it was important to address a rather large misconception about the Stellenbosch University study.

  4. Wilma, thank you for your article. I was interested when the first article about HFLC appeared on this website and I took some time to go through the actual Stellenbosch article. What astounded me about the study was that their definition of what a low-carbohydrate diet looks like is quite flawed as table 6 describes. Typically all studies (except for one, which I will get to) tested diets with 20-40% of daily calories as carbohydrates against controls with 50%+ carbohydrates in diets.

    Eating 20-40% carbs is by no means a ketogenic or “low carb” diet! From now on I will refer to this bunch as the “moderate carb group” because they in no way a low-carb group. This in my view makes this a highly flawed study because no actual low-carb diet was tested!

    The one study cited that did show promise was Lim (2010) with a prescription of 4% of total calories in carbs. The trouble with including that study however was that according to the adherence coefficient shown on table 9, it was the study with the worst adherence of all! The numbers produced by the study are therefore not very telling although I must note that the low carb group, despite their laziness still managed to lose more weight than the control group.

    Incidentally another finding in that study was that there are no significant differences in terms of cholesterol between the Moderate Carb and the High carb groups (not that it matters when explaining risk you know).

    Finally I want to point you to another study published n the same website which found major weight loss and other benefits for patients with type 2 diabetes or prediabetes (read:insulin resistance) on a very low carbohydrate diet.

    http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0091027

    True to form some of these patients no longer needed medication and in general lost more than double the weight of their counterparts. Its interesting how these findings go directly against the findings of the Stellenbosch study, yet I haven’t seen it cited anywhere.

    I think people should stay on their statins and pills for now (especially if you have that awful genetic mutation), but judging on the results literally everyone I know who has tried this diet has achieved, I think there’s something worthwhile there.

  5. I personally don’t believe it is professional jealousy against Prof Noakes. He is attracting criticism from all aspects of the health industry – from the conventional medical profession to the nutritionists. He is attracting criticism because he is badly researched and he is using his own health as a yard stick for everyone else. Proper science is not based on the anecdote of one person.

    Just ask yourself this one question: which culture or nation in the world eats in this way and is healthy with longevity? In other words, find a culture/nation that has healthy bowels, brains and bellies who live a long and healthy life. There are none.

    This irresponsible diet is merely a re-hashed weight loss Atkins diet. Period. It is unsustainable for many reasons, setting aside the health arguments. It is expensive and it promotes commercial production of animals (despite the promoters who say get grass-fed animals). He promotes processed meat as well (chourizo sausage and bacon to name but two).

    “Carbohydrate resistance”? Is there really such a thing?! No!!!!! All fruits and vegetables have some form of carbohydrate in them. Should we now ditch fruit and veg?! Huh?! Really?!!

    Yes, ditch the unhealthy refined carbohydrates such as commercial bread, pasta etc but healthy carbohydrates such as sweet potato, brown rice, pumpkin and butternut are HEALTHY FOODS!!!

    As with most medical doctors, Prof Noakes is NOT a nutritionist and has not done his research thoroughly enough.

    People with gout, arthritis, acid reflux and digestive problems should NEVER attempt this type of diet. It’s acid-forming and pro-inflammatory. Anyone who has or has had cancer should never be on this diet.

    When Prof Noakes cannot control his own diabetes and is on Metformin, how can anyone trust his advice? Has he tried a whole food, plant-based diet to reverse his diabetes?! No! Yet enlightened doctors and nutritionists are doing this every single day of the year! It’s not difficult.

    Those who try this diet and bring their cholesterol down are those people who don’t increase their serum cholesterol via meat but via REFINED CARBS. Yes, refined carbs will ELEVATE cholesterol. Most people don’t increase their serum cholesterol via ingested cholesterol. But if you ingest refined sugar, alcohol and refined flour IT WILL.

    I simply cannot believe how wrong Noakes is – I agree with the doctor who said it’s criminal. It most certainly is.

    • It is so sad to see people jumping to conclusions without any knowledge or PERSONAL EXPERIENCE. I suffered from Type 2 Diabetes Mellitus, Hypertension, Obesity, Sleep apnea, Atrial Fibrillation and Gout more than 2 years ago. I started on the Low Carb High Fat Diet and within 3 months all my problems were gone. My lipid profile improved, my kidney function returned to normal and I felt 15 years younger. Since then I have helped numerous people to improve their health dramatically by following the advice. This lifestyle is sustainable and affordable for people suffering from the Metabolic Syndrome.
      Shotofhealth, you talk about Carbohydrate Resistance, which is the wrong term. It is Carbohydrate intolerance and Insulin Resistance.

      • Dr Schoonbee this is as you well know the experience of many many people. However as the anointed intellectuals keep telling you and me, you simply have no idea what is good for you, only they do.

        Every article I see condemning Noakes is annotated with many positive personal experiences of those who found the diet worked. Yet all the anointed do is keep burying their heads in the sand plying their same old tired dogma on diet and health.

        This website seemingly has an article every few days taking aim at Noakes, dissecting every and each statement for semantics in a clear attempt to evade any possibility that their may be some efficacy to the LC lifestyle.

        You know the established norm is in trouble when 1000’s of individuals attest to the efficacy of a diet each time the anointed try to discredit it.

  6. The real problem with this article is the amount of psuedo-speak which masquerades as fact. Statements meant to damn the Noakes diet are disclaimed with “ifs” and “could”. I could get run over by a car if I cross the road is hardly a scientific statement but this is what the intellectuals use as evidence of their potency. It’s quite fallacious to condemn Noakes for using a disclaimer in his book, which by the way is about as standard as you can get, and then making vague statements with many ifs and could’s to disclaim your own statements.

    Further making a statement like “more than enough scientific evidence to show that impact of blood cholesterol on coronary heart disease” may be factually and relatively correct, but is absolutely wrong without the relative context of the diet within which this observation is made. The only really correct scientific statement to use against Noakes would be ,”in the absence of carbohydrate in the diet or very low carb diets (under 50g a day), high cholesterol has been shown to raise heart disease. I am quite certain that all the studies which are referred to here are for high carbohydrate diets (200g and more a day), many of which are probably of the refined high glycemic variety.

    It is also quite laughable that the esteemed doctor should state that “we as a profession accept responsibility”. Anyone who has had family die after operation and pointless medical examinations, which can be linked to the procedure, have no recourse to a profession which simply refuses to accept responsibility. There simply is no responsibility, only a wall of arrogance and denial.

    Noakes may have some flaws in what he says, and I do not agree with everything I have heard him say. However he is questioning some long held and possibly flawed beliefs, and challenging the established monopoly on these views. This in itself is positive and progressive. Where dogma dressed up as science is allowed unlimited exposure only folly prospers.

    Two things in the modern post internet world are unsettling for the intellectuals. One is that people have the ability to see competing views (always dubbed as unscientific by the intellectual monopolists) and secondly that in so doing people are able to exercise personal liberty, which to those unclear on what that is, means personal responsibility for actions taken. Never more is this more obvious than a supposedly clever intellectual doctor making emotional statements like “criminal” when his views are contradicted. Does such an emotional outburst have a place in intellectual debate?

    As an aside I recently returned from a 10 year spell in the UK, to South Africa, and am astounded at the number of clearly obese and sickly looking people I see in this country. There has been a clear movement in lowering health over the last 10 years, and clearly Tim Noakes played no role in this. We have had more funding and more drugs for 30 years now and all one can observe in SA is an increasingly sick population, and for this we are advised to do more of the same which got us here.

    It is rather fun though to watch as the establishment becomes more and more unsettled by the exposure of the contradiction of their dogma. For many years they got away with this but the tide is slowly turning, for the better! The market place for ideas is once again open for business and not monopolised by the few who regard themselves as having superior knowledge. Things will never quite be the same for them.

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