Lessons in bad science – Tim Noakes and the SAMJ

As I’ve said before, Professor Tim Noakes might well be right in his advocacy for a low carb, high fat diet. Whether he is right or wrong is however – to some extent, at least – a separate issue from whether he’s providing an example of sound scientific reasoning in reaching the conclusions he does.

It’s understandable that people outside of science, academia, or any overtly evidence-based work might confuse personal experience, anecdotes and badly drawn samples for good evidence. However, the principles of scientific reasoning (even as taught to first-year students, as I’ve done for years), remind us of these and other common errors. Once you know about confirmation bias, you shouldn’t flaunt the fact that you deploy it, but rather regret that you (like everyone) are prone to quite typical errors.

As a practitioner of evidence-based something-or-other, you’d know and understand counter-intuitive things, for example that a conclusion can sometimes be the correct one, regardless of how poor the argument for that conclusion is. And, that a good argument can sometimes result in a false conclusion.

Most important, perhaps, is that you’d know of the various resources we have for making it more likely that we reach the correct conclusion, and you’d know of the sorts of errors to avoid because they tend to lead us to false conclusions. And given that you care most of all for getting closer to the truth of the matter, you’d be aware of your responsibilities to set an example to others of sound reasoning about science – especially if you are perceived to be an authority figure.

When a scientist like Noakes seems willing to ignore most of these principles in favour of promoting a conclusion – through whatever support comes along – he doesn’t sound passionate, committed, maverick and so forth. He sounds like a quack (and sometimes, even a conspiracy theorist, at least when citing some of the reasons why his “obvious” (to him) truths are somehow not adopted by everyone). To Noakes, all research that disagrees with him is “industry-funded” or otherwise tainted, but never treated as counter-evidence.

Among those that Noakes has quoted in support of either his view or his approach to science are the evolution-denier and proponent of scientific racism that is Louis Agassiz, and the anti-vaccine Weston Price Foundation. He’ll tweet links to pieces arguing that carbohydrates might have played a role in the Newtown shootings. And when challenged on whether his approach is sound, he says things like this:

Worst of all, he doesn’t seem to really understand what the stakes are, even as he speaks of a decades-old diet lie that is apparently killing us all. He’s embraced the false dichotomy that we have a choice between the “orthodox” dietary advice (that is harming us) and his model (that will make us thin, cure diabetes and so forth). On his model, choosing option B (his model) has no risks, even though we have no long-term data regarding the possible harmful consequences of a high-fat diet.

This doesn’t mean people won’t be persuaded by Noakes. They will be and are being persuaded in their droves, thanks partly to positive short-term results on the diet, and also to some very engaged PR on Twitter, radio, magazines and television. But they’re also being persuaded because – like most people – they are prone to overstating the value of anecdotes in supporting a conclusion.

The fact that they are persuaded is not, however, further evidence for your conclusion.

Yet, according to Noakes, perhaps it is. And sadly, South Africa’s flagship medical journal, the SAMJ, has published a Noakes paper that is a textbook example of bad science in this and other ways. Somehow, this paper got through peer-review, but I can pretty much guarantee you that if we did a Sokal-type experiment, submitting this under fictitious names, it would never get published. It’s solely on the basis of the authority of the “name” of an acclaimed scientist that it was published as a study, rather than on the letters pages or somewhere less notable.

Here’s the 140-character summary of why this shouldn’t have been published as a study, or made it through peer review:

Basically, the “study” is confirmation bias run amok. If I were a UFO conspiracy theorist, and led a society dedicated to discussing our abduction experiences, the letters I might receive from prospective members might appear to me to be further evidence that UFOs exist. But I’d be wrong. They’re not, because my letter-writing audience are self-selected (we can predict, in advance, that they are likely to share my conclusion) and unreliable (they are offering anecdotes, and we have no idea how reliable their testimony is).

People who try the “Noakes diet” to no effect will not write letters to him saying so. And as for those who do write, we have no knowledge (or control) over any other factors relevant to their weight-loss experiences. It’s plausible that someone trying a new diet will, for example, also be motivated to exercise more – but we can’t control for that.

In response to these and other criticisms on Twitter, Noakes asked his critics why we were focusing on the anecdotes, rather than the controlled trials that agreed with the anecdotes. But this again misses the point – one wouldn’t need the anecdotes to make the case if the data did so already. To include the anecdotes means that you see them as adding some value, and you shouldn’t do so.

It’s not everyone else’s job to defeat your anecdotal evidence (that should never even be presented). It’s your job to gather non-anecdotal evidence. And if you don’t have that as yet, it’s not someone else’s responsibility to get it for you, as in comments like

(This, because of another elementary principle of scientific reasoning, namely the burden of proof.)

To wrap this up: I agree that a trial is needed. But there’s a different issue at stake also, and this is that Noakes is encouraging incompetent and pseudoscientific thinking on matters of science, and encouraging a cultish adherence to a model that hasn’t yet been scrutinised in full, and for which we have no long-term data. This is irresponsible, and an abrogation of his responsibility as a scientist and an educator.

But these are no doubt all irrelevances to Noakes, even perhaps evidence of bias or conspiracy. After all, at the end of the day, the ultimate evidence is remarkably elegant: the thinnest person in the argument wins, and obese people can’t be right.

P.S. Prof Noakes has left a substantial comment below. Unfortunately, it does his cause absolutely no good, as I explain in this follow-up post.

  • Jonathan Witt

    *applause*

  • Don’t knock it till you’ve tried it I always say.

    • Don’t knock what? This post is explicitly not about the diet.

      • Sure, it’s a post about how Prof. Noakes and his lack of evidence to stand by the diet he firmly believes in. Isn’t the diet the crux of the matter though?

        Mandela was in prison for 27 years, but Apartheid was the reason behind it. Maybe that analogy is a bit far fetched and out of context, but hopefully you understand the point I’m trying to make.

        Prof. Noakes has received a lot of flack and maybe he doesn’t have all the answers, I do feel he is fighting for what he believes in and if that’s all he’s got going for him at the moment, I wish him all the best.

        • Geoff

          Wow. Just. Wow.

        • DarylT

          Whereas you should be properly disturbed by his pseudo scientific approach. He’s aligning himself with such notable luminaries as Gary Taubes and many others who see fit to misrepresent the facts in pursuit of their own views or agenda.

          The next time you hear someone claim that Ancel Keys cherry picked the data for his 7 Countries study from among 22 countries take that as a red flag they are either ignorant or dishonest, or at least guilty of repeating the ignorance and dishonesty of others. Both Gary Taubes and Prof Noakes have done this. This appears to be part of an ongoing cholesterol denialism and confusionism and should not be considered as science, or even as credible as an alternative interpretation of the data, it is lies, plain and simple.

          • Oukie Lekudo

            Utter rubbish. The Keys study was completely false, and the SBU have shown that all studies like that are false. Oh, and yes, the Swedish HAVE now changed their recommended diet guidelines – but not by the SBU. The anti-fat denialists claimed that SBU stated they would not change the guidelines. Again rubbish – the SBU did NOT state that the guidelines wouldn’t be changed, only that they were not the people who did it. They did the research on which the new guidelines are based. And the new guidelines match the significant rise in butter consumption that has already occurred in Sweden, which has been accompanied by a FALL in heart disease. The SBU have shown conclusively that Keys was lying in his research, and stated as plainly as possible that the “cholesterol” theory is the “utmost quackery”. So who is right – a highly respected group of independent scientists studying “tens of thousands” of recent studies which show that saturated fats do not cause heart disease; or “experts” whose research is paid for by the statins drug companies and who will suffer irreparable loss of income if their theory is questioned = the American Heart Association.

  • mattblackZA

    I love this piece. A lot.

    Dr Noakes seems a lot like the guy who claims the British Royal Family are aliens. Nice idea, just not fully fleshed out.

    • Gareth Nortje

      Very funny analogy! Agreed.

  • Stuart Theobald

    Nice work. You should read Noakes’ muffins on Popperian theory in his latest book. Then ask him again about burden of proof.

    • Please tell me that “muffins” is autocorrect for “musings”?

  • Paul Dey

    Confused – what’s been published in SAMJ (in the forum section) is a collection of anecdotal evidence that calls for a random control trial; I struggle to see the issue with this? Or is his outlook on twitter the actual issue?

    • The issue is that if non-anecdotal evidence for the same conclusion exists (as he asserts), that evidence would be sufficient by itself. So, either it doesn’t exist, and he needs to rely on the anecdotal evidence (which teaches a bad lesson regarding scientific reasoning), or it does exist, but he thinks that the anecdotal evidence adds weight to the conclusion (which it doesn’t, as he should know). The Twitter quotes simply support the claim that he is motivated to demonstrate a certain conclusion to be true, rather than caring for the truth in the abstract.

      • George

        There’s another explanation; that South African health authorities will only modify their approach after a trial carried out in South Africa.
        Evidence, however good, from other countries is not valued.
        This kind of parochialism is common. The US authorities won’t change their guidelines because some approach has been proven to work in Russia.
        Even small countries like New Zealand seem to have come from Missouri.

  • GerritTonder

    Worth watching: Biggest medical myth of all times http://www.abc.net.au/catalyst/stories/3876219.htm

  • GerritTonder

    Jacques I do not understand your arguments. First you said a paper must
    be peer-reviewed and when Noakes’s paper was peer-reviewed you queried
    the reviewers. Noakes has more than 450 peer-reviewed papers and that is
    a lot. When Howard and Ingraffea published a paper on climate change in
    a peer-reviewed journal, their paper was torn apart by pro-fracking
    scientists. Clearly you are anti-Noakes regarding his views and I guess
    that if he published even 5 more peer-reviewed papers on the subject you
    will tear it apart

    • Gerrit, I’m sorry you don’t understand my arguments. In a neat symmetry, I’m likewise mystified by your comment. Peer-review is a good thing, and therefore desirable, but it’s not foolproof, especially when not blinded (as this couldn’t possibly have been, given how well-known Noakes and his views are). Noakes has a long and illustrious career, yes – but that doesn’t merit a permanent exemption from very ordinary and uncontroversial standards of scientific enquiry.

  • noodle

    Thanks for this. I had a bit of a twitter conversation with Tim Noakes/ Ann Childers about celebrity endorsement along the same lines. I’m very much not a nutrition expert, but look for evidence to support theory so was uncomfortable with method of promotion. Really disappointed with their responses.

  • Hugh du toit

    I started having doubts about Noake’s scientific credebility when he called match fixing at the last world cup rugby without any real evidence. Agree entirely with this piece – the scientific method towards establishing facts is not a natural thing and needs to be defended in this time of growing conspiracy thinking and celebrity worship

  • Tim Noakes

    What is really so funny is that this is a report of how 127 people felt their lives
    had been dramatically improved by following a particular diet. Included
    were 14 who claimed they had been “cured” of Type 2 diabetes –
    confirmed in 3 cases I investigated further. To my knowledge the SAMJ has never
    before carried a report in which patients with an “incurable”
    condition (type 2 diabetes) were cured of that condition. One doctor who had
    told his wife he would be dead in 7 years because he had 5
    “incurable” conditions, was completely healed of all conditions (no
    more medications required) when he restricted his carbohydrate intake.
    Everything else he had ever tried (according to his conventional medical
    training) including treatment by the best medical specialists in Cape Town had
    done little for his health. Naturally this medical practitioner who had never
    in 57 years been exposed to this information (why not?), concluded that the
    dietary advice I gave him had produced a “miracle”. He now includes
    this method in his treatment options for his patients with
    obesity/diabetes/metabolic syndrome. He now informs me at least monthly
    of how much success he is having with this dietary treatment for these
    patients.

    I wrote the article to alert my colleagues to the fact that there is a simple
    dietary option that might be able to reverse the very conditions that our
    profession finds so difficult to treat – obesity, type 2 diabetes, metabolic
    syndrome. I also referred to the extensive scientific literature showing why
    and how this dietary intervention does and should work for people with these
    conditions. The explanations are simple, obvious and proven. But then perhaps
    you need a training in the medical sciences to understand those mechanisms,
    Without some understanding of biochemistry, it is not possible to follow
    that argument. What one cannot understand, one naturally dismisses as
    irrelevant.

    At no point in the article is the claim ever made that this is an attempt at a
    scientific proof of a particular diet. That is why the title includes the words
    – Occasional Survey. It is simply a group of case reports showing that some
    patients achieve remarkable cures for their intractable medical conditions
    simply by following advice, the key point of which is that it normalises
    hunger. For the truth is that these patients are not dying of obesity
    etc, so much as they are dying of hunger. Once their hunger is controlled by
    simple dietary advice, they can start to cure the conditions caused by the
    overconsumption of addictive, highly processed, carbohydrate-rich foods (made
    worse by their insulin-resistant state).

    I have been in science long enough to understand how people try to divert
    attention from the message. I wrote about this extensively in Challenging
    Beliefs. First they always question the methods. The methods I used in this
    study are entirely appropriate for the extremely limited goals of this paper.
    That simple goal was to show that some people benefit dramatically and in some
    cases miraculously from this simple advice. Whether or not they would have
    benefitted equally from other advice is utterly irrelevant since I am not
    trying to prove (in this article) that one treatment is better than another. Of
    course I would guess that 100% of the 127 had all tried the conventional advice
    and it had failed for them. But I only made that claim if I it was supported by
    the information I had.

    A key point about South African medical ethics is that if there is more than one
    treatment options it is ethically unacceptable for a South African practitioner
    to prescribe only one. My ethical responsibility as an educator and
    scientist is to bring the attention of my colleagues to the established fact
    that there is more than one option for the treatment of obesity, diabetes and
    metabolic syndrome and that the scientific evidence for this is well
    established in the literature (as recently accepted by the highest Swedish
    medical authorities). The reasons why this information is not taught more
    widely across the world is not material to this article and whether or not
    there is a conspiracy is not relevant. The point is that students in South
    Africa (as in most other countries) are currently taught only one side of a
    two-sided story. As far as patient care is concerned, that is unethical.

    Three years ago I decided that it my ethical responsibility to acknowledge
    publicly that my advice on high carbohydrate diets for runners, widely read in
    Lore or Running, was wrong for those with insulin resistance/type 2
    diabetes/metabolic syndrome since it would contribute to their ill-health in
    the long term as it has to mine. This article is one outcome of that admission.
    I could have kept quiet and hidden my error but I chose not to.

    Now that this article has been published in the SAMJ (and I have spoken about it at
    the most recent SAMA conference), South African medical practitioners, perhaps
    for the first time, have been exposed to the evidence that there is an
    alternative option that they might like to consider in future for the treatment
    of these conditions. The result is that if the 127 patients reported here
    are any indication, many patients in South Africa with these conditions will be
    offered another treatment option that before they would not have been offered.
    I suspect that many will do much better on that therapy than if they continue
    to follow advice that does not work (for them).

    So this focus of this discussion should not be about whether or not I am a good
    scientist who understands what is and what is not good science.
    Fortunately in science, there are simple markers of our standing as
    scientists that are based on hard measureables and not on the opinions of
    others. These are the h-Index and the number of citations. Anyone who
    wishes to determine my status as a scientist is welcome to find those numbers
    and what they mean. Those are measures of scientific influence over a
    life-time, not as the result of one single good or bad article.

    It is sad that this article which should be a celebration of how simple dietary
    advice may be able to reverse intractable medical conditions in some people (it
    would have been valuable even if it had reported just a single
    “cure”) has been used by some to argue what a dreadful scientist I
    am, who is trying to push some sort of devious agenda that has no scientific
    basis.

    My agenda is clear. I want my profession to teach more than one option for the
    management of obesity/diabetes/metabolic syndrome and to understand that our
    current dietary advice is in my opinion the cause of so much of our ill-health.
    I have spent 3 years researching this topic and am happy that the scientific
    evidence supporting this position is as powerful as any evidence I have touted
    in the past (see Challenging Beliefs). However the topic is much more important
    that anything I have ever tackled since it is the single most important medical
    problem in the world and is currently out of control and getting worse by the
    day.

    What this paper shows it that there may be simple answers for what seem to be
    intractable conditions.

    That is why the final sentence of the article calls for a properly funded and
    designed study to test the hypothesis (not proof) advanced by the finding of
    this Occasional Survey. I would be only too happy if that trial disproves
    me. But if it shows that a carbohydrate-restricted diet can reverse intractable
    obesity and some cases of Type 2 diabetes, then we will have shown that the
    causes of the obesity and diabetes epidemics are much simpler than we believe
    and that we might be able to do something to protect our future generations
    from these diseases. Of course, it there is a conspiracy, then it will do all
    it can to insure that we do not ever make that finding.

    Perhaps we can move the debate forward by focusing on what this paper actually found
    and how that might be of value in trying to understand what is causing the
    obesity and diabetes epidemics globally. Then we will be making a positive
    contribution to the future health of the world.

    Thanks for the opportunity to express myself more fully and I look forward to your contribution to that agenda should you think it sufficiently important.

    • Zig Gibson

      Tim, please tell me you haven’t published an article on what some people have told you happened to them by and claim this as a scientific article. Please tell me this isn’t true…..

      And saying things like your citation count from previous articles validates you as a scientist when you discuss anything you feel now….

      And saying it is better in science to be relevant than wrong……

      Incredibly sad stuff – all of your lessons abut good science of two decades ago you used to pontificate about, you are now absolutely violating yourself, and you have become a parody of all you used to criticize…..

      Terribly sad – someone that used to view you as a force for good now feels ill when reading stuff like your rebuttal above and about the contents of your SAMJ ‘article – is this the sad fighting against the dying of the light to stay in the spotlight as long as possible no matter what? Let it go and enjoy retirement with gardening or something like that – you can do no harm that way to either others or yourself….

      Zig

      • Tim Noakes

        Thanks Zig. Really appreciate your concerns and kind comments. Knew I could always rely on you for good advice. How’s your science going?

        • Jc carter

          Obviously as poorly as yours. Anecdotes are for diet books.

        • Zig Gibson

          Pretty good Tm – I keep on trying hard to focus on what is true rather than what is relevant, in contrast to what you say above, and am living the dream.

          Its not too late to go back to the glory days when science was about the science itself rather than debating stuff which has actually been said before many times in the media and social networks……

          Look back at your great articles of the 80’s and 90’s and try and find some balance and hopefully calmness – fighting the world about populist science issues which in a circular way have been debated so often will get you lots of media spotlight but not much else….

          Zig

      • Peter Cherry

        I find it amazing that supposed scientists like Dr. Rossouw are prepared on the one hand to defend the current dietary guidelines which are truly based on bad Ancel Keys science, and simply wrong assumptions, made 50 odd years ago, and yet deride Noakes for the same. Real hypocrisy in my opinion. But actually I couldn’t care less what the naysayers think. Thanks to Noakes I’ve found a way to control my diabetes completely. I wonder if the eventual apologies will be delivered with the same intensity as is the venom currently dispensed

        • Mark Dean Brown

          Reread and rethink. Rossouw is not arguing against the diet, he is arguing against the “evidence” Noakes is using to promote it. #fucktard

          • Oukie Lekudo

            Rubbish. Rossouw is of course attacking the diet, because the diet – right of wrong – attacks the accepted wisdom in medicine that cholesterol causes heart disease [and that saturated fats are behind this], and that the way to “cure” this is to pay doctors to give you expensive statins. If Noakes turns out to be right, the income of the “heart doctors” will fall sharply. That is why they are attacking Noakes so virulently. Exactly the same was done with Barry Marshall when he tried to show that antibiotics rather than Zantac cured stomach ulcers – for 4 years he was blocked from publishing his research based on peer groups [funded of course by the drug companies]. He might never have been published if he had not taken the drastic step of going to the media after infecting himself with the bacteria he had discovered and then curing it with antibiotics not Zantac. Noakes similarly infected himself with carbs, and cured himself with fat. The study in this case is following after the media frenzy, rather than before with ulcers. It will be interesting to see who gets the Nobel prize as Marshall did. I doubt it will be the High Carb people if any honest Swedes are involved.

    • Concerned!!

      Ever heard of the PLACEBO EFFECT???

    • Gareth Nortje

      This paper regarding hubris seems relevant:

      Hubris syndrome: An acquired personality disorder? A study of US Presidents and UK Prime Ministers over the last 100 years

      http://brain.oxfordjournals.org/content/132/5/1396.full

  • Catherine Collins

    Great review. I’m the ‘Obese Dietitian’ who Noakes and Malhotra dismissed on the basis of BMI. I’ve been thin, and now in my mid-50’s I’m overweight for a number of reasons far too boringly predictable to define here. Who knows what my weight will be next year? Up? Down? The same?

    I’m fully aware of the health risks/benefits of normal/ overwt/ obesity, but actually my clinical knowledge and ability to ‘translate’ the medical/nutritional science into ‘what does it mean for me’ for the public is totally independent of my percentage body fat, and has no influence on the advice I give. A practice familiar with every Registered Dietitian across the world.

    My concerns about Malhotra’s article are the same as summarised by your article. In addition I had concerns about cherry picking data to match hypothesis (using cholesterol/statin evidence from Japanese populations that may not be transferable to the Western diet), and an anecdotal news report from UCLA’s newsroom (ref 18) used to justify his opinion-masquerading-as-fact that LDLcholesterol should be dismissed as a risk factor for cardiovascular disease.

    Ad hominem attacks cheapens the debate and prove the commentator has lost their argument and must flail about to find some aspect to justify for their comments.

    Tim Noakes is the SA version of Aseem Malhotra and John Briffa, two UK doctors who mock those with less aesthetic appearance as to their credibility to give advice. As I’ve tweeted to Briffa and Malhotra before, that I should be a ‘thin dietitian’ in order for me to have credibility is akin to stating an oncologist must have had cancer in order to provide effective, evidence based care.

    Like Briffa before him, I doubt that Malhotra and Noakes could suggest what BMI is an acceptable threshold at which my opinions would be considered valid. What if I had a normal BMI of 22.5- achieved by being an active bulimic? Or have a beautiful body achieved on a 600kcal a day such as various rather attractive actresses admit to? Would Briffa/ Noakes/ Malhotra ignore the health issues of such practices adopted to achieve an ideal body in order to assign I was a more credible commentator?

    My goodness, there’s plenty of comments I could make about the physical appearance of these guys but I’m not really interested in doing so, preferring to keep matters professional by criticising their misleading and disingenuous comments which are far more significant to address.

    I’ve tweeted both Noakes and his university, the University of Cape Town, to ask if BMI of the researcher is a prerequisite factor in validating clinical research. I pity female UCT students with BMI>25 being tutored by Noakes, and whether he sets aside his prejudice to objectively assess research projects. Now that would be a credible piece of research for a UCT Psychology major student: ‘Does BMI of female students bias marking by self-opinionated Sports Professors?’

    • Thanks for commenting, and for the support, Catherine. It’s my university also, which is why this is of such concern to me.

      If you’re watching on Twitter, Noakes and others have mentioned studies that indicate that people are reluctant to take dietary advice from overweight people. The sad thing about this (I mean the attempts to defend this ad hominem argumentation) is that of course this might be (probably is) true – but what people happen to do is often a very poor guide to what they should do. And those of us who care for doing things right shouldn’t join in with the bad practice.

      In short, it’s fairly obvious that (currently) being overweight could make your job more difficult for you, in that people might use it as a handy way to dismiss your advice. But what you’d expect from fellow medical professionals is support for the idea that it’s the science that talks, regardless of the appearance of its spokesperson. Instead, you received a playground taunt from Noakes, and one he’s now perverting science to defend, in citing studies that show “everyone does it”.

    • Tim Noakes

      Dear Catherine.

      I apologise for the offence I have obviously caused. The tweet was out of character and was the response to my frustration with a range of your statements which in my opinion are not evidence-based. Saying that the opposing position is based on “anecdotes” indicates that you have not read the literature. Also I wondered why you do not consider that perhaps your weight problem is exactly because of the advice you want us all to follow. I also thought that Dr Malhotra should have had a chance to debate you on the BBC News. But let us move on.

      So my question: Have you tried cutting your carb intake to less than 50g/day? I did that and lost 20kg with absolute ease as have so many of the patients who follow this advice. Might be an interesting experiment for you to try? Cutting wheat was also a key change as that rid me of a range of allergic conditions, the cause of which I did not understand before. That new GMO wheat is a real issue of concern for generalized inflammation, weight gain and ultimately brain damage and dementia. I think dietary guidelines that continue to promote a high wheat intake are very damaging to our health.

      I remain concerned that your organization, the BDA, has such close ties with the industries that are producing the addictive processed foods that many of us believe are at the root of the obesity epidemic.

      Because what I learned is that if you cannot control hunger, you cannot control your weight. And those processed foods are highly addictive and destroy the proper functioning of the brain appestat.

      Kind regards and again my heartfelt apologies. But please do consider what we are trying to say. If current dietary advice was perfect, humans would not be in the dire straits in which we now are. I become despondent as I see more and more people getting heavier and heavier and the solution (to me) seems so simple.

      Best wishes,

      Tim Noakes

      • Zig Gibson

        Absolutely astonishing the irony that you are giving a dietician dietary advice, Tim when you have absolutely no training as a dietician, you have never published a conventional study supporting the diet or practices of which you ‘preach’, and base it on your own anecodatal evidence and ‘reading of the literature’ which is done with your own personal bias. Scientists are regarding you more and more as a ‘kook’ because of the lack of scientific method behind your advice, and because of just the above – giving advice such as above in such an arrogant way. If this is your idea of an apology, you perhaps also need to do some diversity and discriminatory training, as you don’t seem to understand how offensive your remark was, or this reply…..

        Zig

      • carbsane

        Millions have tried losing weight on LC diets for over 40 years now. The inescapable TRUTH is that LC has NO greater success rate for maintaining that weight loss than any other approach.

        Gary Taubes’ “science” on how carbohydrates are particularly fattening through the actions of insulin on mutinous fat cells is flawed. That is putting it nicely.

        Men your age seem to do well on this diet to lose a bit of weight. Young people and women especially tend to do rather worse in the long haul. I have a list of anecdotes collected through my blogging and my own experience where LC has proven harmful.

        • Carbsane, I’ve been asking all the Noakes defenders to keep responses in topic (ie not the diet), so it’s only fair that the same request be made to his detractors. Let’s not be personal, please.

          • carbsane

            I just came across this response today or I would have responded sooner. I would like to state that I see no personal attack in my comment, and to the degree it is personal in nature at all (e.g. mentioning Noakes’ age), that is relevant to the diet and the topic (anecdotal evidence). For whatever reason, middle aged men seem to fare the best on this diet, and I could even dig up a quote from Gary Taubes that he would like his first study to be in men for that very reason (this was from before he formed NuSI if memory serves). I’m only perhaps a few years younger than Noakes is so for me to be taking a dig at him would be pretty silly.

        • Tim Noakes

          Point is that weight loss requires that hunger is reduced and calorie intake falls. Whatever achieves that will produce the desired result. But in carb-overload society in which we currently live, avoiding carbs is more likely to be successful in producing this effect.
          The insulin story is secondary. The key is what different foods do to the brain. Clear that many foods in the modern industrial diet are addictive.

          • yngvai

            Dr.Noakes,

            The appetite suppressant effect of low-carb diets has little to do with the decrease in carb intake, and mostly to do with the high protein intake. The science is pretty clear on this. There is plenty of data showing similar appetite suppressant effects for high protein, moderate to high carb, low fat diets. So it is incorrect to claim that avoiding carbs is responsible for the effect.

            • Mark Dean Brown

              You’re the missing the point. This is not about the diet.

            • yngvai

              My response was specifically to Tim Noakes’s comment, not the article in general. So yes, it is about the diet.

      • Catherine Collins

        thanks Tim. For what I’m not sure.

    • charl

      to a laymen I understand Noakes logic wrt to the comment. if you know how to cure obesity/ovrwght disease then why not lead by example

  • GingerNinja

    If Professor Noakes’ intention is to create a bit of a storm, get LCHF prominently in the news, raise hackles and stir emotions – then he has succeeded! That he may have done so at the expense of his own reputation, bit of a maverick move, that’s pretty brave. Fact is, this is a polarising debate, there appears no “grey” area. We KNOW we need RCTs — but are fighting against the tide there: perhaps he is starting the revolution?? I don’t know: but I am prepared to fence-sit (and get shot at by both sides!) for the moment. That prominent thinkers and philosophers and writers (such as Jacques is) are taking this topic head-on and writing about it, and receiving reams of comments….its pushing this very topic to the forefront of SA minds/consciousness. Perhaps this needs to happen more often for more topics in more than just the sphere of health/diet??? Get us REALLY thinking about things??? Contrary to common beliefs I do think that Saffers are really clever, insightful folk, and robust debate would be enjoyed by many.

    • Tim Noakes

      If Saffers were all in robust health, there would be no need for this debate. The fact that we are getting sicker all the time should perhaps, just maybe, raise the question: Is it at all possible that the dietary guidelines which have now become the conventional wisdom, might be a contributing cause?

      That is all that people like myself, Dr Biffa and Dr Malhotra, amongst many others around the world, are daring to ask.

      Surely the response should be – you know you may have a good point. We don’t have all the answers so perhaps we should consider it.

      Instead the pretty much universal response is to shoot the messenger.

      • George Claassen

        Prof Noakes sounds more and more like the pseudoscientists who under the guise of ”science” propagated leeches as the solution to every illness – without evidence. He talks about people being cured and this reminds me of Benny Hinn’s “curing” of the blind and the lame…again without evidence.

        • Zig Gibson

          Couldn’t agree more George if I have read Tim’s rebuttal above correctly, which each time you read it ‘reads’ worse – I could not believe Tim’s rebuttal talking about people with ‘incurable diseases’ being cured because of ‘his ‘diet’ – a ‘sales technique’ that has so often been used in the sale of ‘snake oil’ by ‘quacks’, or by ‘Messiah complex’ people who believe they have ‘godlike’ powers and that their word should be taken as ‘gospel’ by the masses, or that they alone have the power to cure the world… And that’s before reading the astonishing stuff about ‘South African’ medical ethics……

          • Tim Noakes

            See my response above. Irony is that to cure themselves most patients had to stop listening to the “godlike” “Messiahs” that gave them “scientifically-proven” advice that caused their problems in the first place.
            The only snake oil that we are selling is the restriction of carbohydrate. Can’t make much of a living doing that.

            • Zig Gibson

              So if you are selling only the ‘restriction of carbohydrates diet’, what happened to the ‘fat is good’ / no problems with cholesterol argument that you were giving a few months ago Tim – have you toned this astonishing part down which has been the second component by necessity of the extreme diet you advocate?

              And tell us, why you say you have been reading and getting involved in this area for THREE years now and you still haven’t done a RCT trial yourself and are asking for this in your rebuttal above? After all the telling to us that you need data to provide an argument, why three years and still no randomised trial done yourself……

        • Tim Noakes

          Read the SAMJ article. There is evidence. Ask the patients who were “cured” what they think of the “scientifically based evidence” that made them sick in the first place. Would you like some names to contact? Some of them are cited in Real Food Revolution. This is what one said: “Thank you for believing in yourself enough to have the guts to go out to the wider community, refute some of your previous work and believe so much in your new research that you are prepared to take the criticism that is bound to be thrown at you etc”.
          Privilege to have changed your life for the better.

          • Zig Gibson

            So TIm, can the people who listened to your advice that carbohydrates were the best for 28 years before having this ‘epiphany’ sue you for providing false advice to them which potentially would them sick as you say above all those years you said CHO was great. And if you were so wrong for 28 years, why should people suddenly believe you are right now, particularly when all you are giving people as backing science is anecdotes from people that contacted you with positive outcomes?

      • Zig Gibson

        Its an extreme irony for someone who claims when people disagree with you that they are ‘shooting the messenger’ Tim – you seem to say everyone that disagrees with you is in the pay of big agencies, and name and shame good scientists in a way that is embarrassing. The article above is stating that your science methods you are currently using is shocking, nothing more and nothing less……

        Zig

    • Zig Gibson

      Your answer is one of the reasons academics are saying ‘what the heck’ GingaNinja – there is nothing new in Tim’s arguments that haven’t been raised countless times in the last few decades in the circular manner – it is just an extreme diet and so many people are saying ‘woaw’, there is the middle ground, that grey area – which is a balanced diet, balanced calorie intake with energy output, and a balanced lifestyle. And all of this has been written before. Its like me as an integrative neuroscientist at the end of my career taking an extreme opinion on climate change, and shouting loudly about my views on it in every media outlet possible, and suddenly starting to feel, and people perceive that I am an expert in the subject, because of all this media ‘shouting’…

      • charl

        a balanced diet, balanced calorie intake and even a balanced lifestyle isn’t possible with carb addiction and insulin resistance. saving lives can’t wait for peer reiewed journals. very sick people don’t have time to wait for the studies/RCTs. we are the studies and we are the proof that is needed. this isn’t rocket science, although scientists would have us think we need their advice and scentific research to understand our bodies. only since food companies started marketing their mass produced GM laden sugar drenched products did we need science to sell us what is healthy and what isn’t. it’s process failed to reveal the truth

  • GingerNinja

    Thanks for responses to my earlier comment, Tim and additionally Zig. After following the LCHF debate peripherally for a while, I was present at one of Tim’s talks: he mentioned authors who have indeed reported on this debate over the decades and I went out and read them: Taubes, Volek, Kessler…I found myself reading Taubes and oscillating between being utterly gobsmacked at the way we, the global populace, have been manipulated….(whether LCHF is good or bad – let’s be honest, big pharma and big cereals exist) and struggling to wrap my traditionally trained brain around this wholly new approach to food. The anecdotal evidence is indeed that and is strong: so, yes, I tried LCHF and was remarkably impressed with it. On a limited budget I soon found what I believe to be one of the most prominent limitations: cost. Whether it can be sustainable for the greater population is hard to say: avocados, nuts, salmon etc (naturally I use mere examples) are indeed more pricey than the “beige” foods. My long and laborious point is that i DO think there is merit to this particular lifestyle. Being involved in lifestyle research myself, I have learnt to recognise the value of the qualitative reports by individuals alongside the quantitative results: we are not automatons. Quality of life is an important outcome. No, I cannot base my entire hypothesis on the qualitative, BUT it happens that the experiences of the participants may provide valuable insights.
    In this debate I did feel the one point I felt very uncomfortable with was the personal comment against the British dietician: as a female, weight is not a comfortable arena; and the plight of post-menopausal weight gain has become very clear to me and I have some level of sympathy for women who hit ~50 odd and suddenly can’t really control their weight as they might have. But Tim has admitted he probably should have thought twice about making that comment – and point out one person to me who hasn’t made a slip up like that in the heat of the moment??! Zig – isn’t science all about that: its the “truth” at any one point – if more information comes to light that suggests that that ‘truth’ needs a revisit: isn’t THAT science? I fail to recognise why he should not be able to say “i was wrong’ and that ‘new evidence is coming to light’ — at least he is standing up and admitting a change in thoughts/understanding/evidence for treatment, rather than blindly hiding behind a belief…..how would we ever advance understanding that way? (So the issue of sueing becomes a little unnecessary, surely?).

    • deWorde

      I agree with you that the comment about size was uncalled-for and was glad to see Tim Noakes respond with an apology. There’s been a lot of science published in recent days which feeds into this debate – for example, a very recent paper published in a Scandinavian journal turning received wisdom about the dangers of fats on its head. What interests me is that no-one seems to have taken note that this was called an “Occasional Survey” which is a term I come across occasionally trawling through scientific papers – in other words, it’s NOT an RCT and doesn’t claim to be. Journals are perfectly entitled to publish papers that muse about topics of interest – as has happened regularly in the BMJ and Lancet – or call for further research in an area.Trials cost money; money has to come from institutions or funding agencies or pharma, all of which are going to be reluctant to upset their current bandwagon, as is natural. That’s why I have time for Taubes: he has set up an institution which will be doing trials – and I note that even a sceptical doctor of obesity praised the design of their first proposed trial. Be interesting to see that result.

    • Mark Dean Brown

      Surely science is not just making new claims, but also backing them up by hard evidence which can be relatively objectively found by others as well? Yes, perhaps the discourse around our diets should change, but should it be change for change’s sake or change for the better? How will we know it’s better or worse until it is proven?

  • GerritTonder

    To all the anti-LCHF believers: The proof is in the eating. Try is out yourself and you will be astonished with the results (weight loss, increase of your HDL, lower triglycerides, much more energy, etc., etc).

    • Gerrit – stick to the issues, please. You’re simply making my case for me, in demonstrating that evangelism can impact on thinking. This post isn’t about the diet.

      • Jacques, what is it about then? Are you trying to discredit Noakes, to downplay his academic contribution? Is attacking the methodology (and the rude behaviour) a way of distracting attention from the message?
        What outcome would you like to see?

        I read your opening disclaimer that “whether he is right or wrong is a separate issue”, but am still in the dark as to what YOUR point really is.

        I think it is indefensible that the “Slimmer’s Choice” yoghurt sold in Woolworths is (by weight) 10% sugar, yet it’s sold as a health product because of it’s low fat content. THAT is the outcome of the traditional dietary advice we are being given, and in my opinion, and in the view of a growing number of people that advice is dead wrong.

        I would encourage you to do an experiment on your own body, and stop eating bread, pasta, muesli and all the other high-carb, low fat junk that we are told to eat, and try instead eating animal fat from healthy pastured animals, coconut oil, tree-nuts, butter, oil-rich fish, eggs etc and see how you feel and see what happens to your weight and to your cholestrol levels.

        • It’s about all the meaning of all the words above this comment section, and those in the follow-up post. My point is that good methodology is worth promoting, because bad methodology tends to lead us to error. This post – and the follow up – details how even the most illustrious amongst us can fall prey to intellectual failures of various sorts.

          Your last two paragraphs are, again, on an entirely different issue.

          • I have since read your follow-up post, and commend you on the rigour with which you critique Tim Noake’s methodology.
            Fair play.

            You are also entitled to write on whichever subjects you choose, and are perfectly entitled to move on and never revisit this topic again.
            But I think a more interesting story than the scientific rigour of 1 “Occasional Survey” is why we have potentially been given such bad dietary advice for so long. It’s easy to dodge that question by once again saying ‘it’s not about the diet,’ it’s about the quality of the science’, but by that same reasoning perhaps we (maybe even you) should be taking a closer look at the quality of the science that advocates low-fat diets?

            There are some alternative voices, some even being published in respected journals – take a look at this as an example – http://www.bmj.com/content/346/bmj.f3199.full?ijkey=1TXPysXB1S7DCIB&keytype=ref

            • And that would be exactly where you’re wrong. It can’t be more important, or a more interesting story, because no matter how important this one scientific controversy is, what I’m talking about is the foundation of *all* scientific thinking. To stick with the example of LCHF, if it were demonstrated or argued for in a way that *also* meets the standards I’m talking about (along with the experiences of people like you), then *nobody* could fail to be convinced.

              In other words, you’re talking about a battle involving one application of the scientific method. I’m talking about the war against bad science, in general (that doesn’t mean *bad conclusions*, but *bad method*).

              So, I’m not dodging anything, and it’s rather sad that people don’t get that. The fact that other science – including low-fat trials – might be bad is a separate issue, in that two wrongs would not make a right.

      • Max McGee

        So, Jacques, are you playing Harvey Spector of Dietetics? Attack the man not the case? You’ve changed the topic away from the facts a number of times and requested that it stay focused on the manner in which he said it rather than what he said. When someone slates the Prof, you’re down with that. When someone says, ‘hey this actually works’…no no no we’re not talking about what he said here, we’re slamming the way he said it. If we talk about WHAT he said, we’d have to give him credit. Everyone from this point on, only post if you have nasty things to say about that guy who has just made a relevant world changing point. If you have the balls to read past your dad’s life work and investigate further than your father’s very own unproven Gospel perhaps you’d find yourself blushing a little

        • An utterly incoherent comment. I never attack the man, I attack the method. I never change the topic – I insist on my right to write on the topic I chose, and not the topic you ask me to. If you read the comments more carefully, you’ll find me asking a supporter *not* to make this personal, i.e. about Noakes.

    • Harald

      I just read most of the comments in this conversation. What I take home is that a certain person called “Zig” seems to be jealous on another one called “Tim”. Now scientific categories are used by Zig to hit Tim other over the head and question his integrity and credibility. For me that is little helpful because I don’t really care about the scientific reputation of either of them.

      I am more interested in whether the diet works or not. (also because I know that big companies can produce plenty of scientific, fact based, empirically sound reports that give “scientific proof” that their particular product is the best of all and solve all problems . . . . Scientist have always been the whores of the powerful – with no intention to say something bad about real whores).

      I experienced Tim Noakes here in Windhoek when he presented his book at “hotel Thule” and I believed him. So I bought the book and tried the recommendations. It worked. Thank you !

      But anyway just a remark to what people think is “truth” or “scientific truth”: My experience is that it does not exist, just like there is no “free market” anywhere. It all depends on what vision the person/company/society has and chooses to promote. During the Hitler regime in Germany, hordes of “sincere” professors developed systems to give “scientific” proof that people who where of other ethnic or genetic origin them themselves and/or the current holders of power, are less “intelligent”, less valuable, less whatever than themselves. They followed the whole procedure: measuring the skulls of huge numbers of people (dead or alive) and compare them with huge numbers of people of the ethnic/genetic group that was in power by that time. The result was overwhelming: Arians are superior to the rest of the world ! Luckily the rest of the world hit these scientific idiots profoundly over their superior knuckles. Does the scientific community in RSA possibly share some of this type of “Science” ?

      By that time it was life-dangerous to openly have a different opinion, therefore this racist “scientific” nonsense was what most people believed and few dared to challenge.

      Tim Noakes chooses to challenge some hitherto widely accepted nutritional principles, which have beed developed 30-40 years ago by people with scientific reputations and the financial power behind them to give “scientific” proof that they are “right”. The result of applying these principles is that we have entire populations (like in USA) who are in majority obese and sick and growing numbers of people in many other countries who are following suit because the associated lifestyle is called “development” and “progress”.

      Thank you, Tim, for doing what you believe in and for sharing that with me so that I have a chance to try it out myself. I lost three kg in a week without exercise and I feel great ! I can now choose to believe what I want to choose to believe and act accordingly. Be that “scientific” or whatever, for me that is the truth that matters.

    • Marthelize

      Hi Gerrit. I tried it. I gained 5kgs in three weeks. And I’m pretty clued up, so yes, I did it right. A family member was on it. Lost 25kgs but then went off it (she found it unsustainable, problems like constipation became horrible) and gained 45kgs, not by pigging out but merely by going back onto what most consider a normal diet. Two examples of many where it either didn’t work, or backfired. The exact anecdotal evidence that Noakes uses. So can I now publish a scientific article against it?

      Jacques is right though, you completely missed the point of the post, which simply supports the impression that acolytes of LCHF become so obsessively protective of their prophet that they don’t really listen to what the rest of us are trying to say.

  • Gerrit van Tonder

    Jacques may I ask if you are related to dr. Jacques Rossouw whom debated Noakes in the Great Centenary Debate?

    • Yes, I’m his son. Another reason why I’m not commenting on the details of the science.

      • Tim Noakes

        But isn’t that a bit disingenuous since your father has been promoting the low fat diet since at least 1980 (CORIS Trial in the Western Cape, South Africa).

        Wouldn’t it be fair to look at the quality of the evidence that produced the 1977 dietary guidelines that he accepts as “proven” and so has been promoting ever since, especially as I and many others claim that that evidence is pretty much non-existent?

        To prove that I alone am the bad scientist in this debate, you need to look as carefully at that evidence to prove that I am completely wrong also in that belief. This would support your claim that I am “insane” (since all I believe is wrong).

        Without that evidence your proof that I am “insane” becomes less certain.

        • You mean the study that spanned 14 years and 1600 participants, with multiple scientists doing a variety of analyses on them? Yes, Prof Noakes, those seem obviously comparable to a write-up of 127 self-reported anecdotes.

          I’ve never claimed you’re the only bad scientist. I’ve claimed you talk like a pseudoscientist. And here, you’re doing it again, while also sounding like an awfully small *person*.

          • Tim Noakes

            Actually not.

            See I was part of that study (I headed up the exercise component – invited by your father to take that responsibility – obviously at the time he must have thought that I had some scientific credibility) and if you recall the group (town) that showed the largest effect was the control town (Swellendam) that did not receive either the intervention (Robertson) or a partial intervention (Riversdal). At the time your father concluded that this was because of all the information that Swellendam received by way of the general media and this had over-ridden the effects of the targeted intervention. Of course the opposite might also be true – that the intervention was either useless or actually did harm.

            No. What I was asking for, was the scientific evidence on which your father based his long-term support for the diet-heart hypothesis and on which he built his life’s work and which, as a result, will determine his remembered legacy.

            • And as I’ve told you, I’m not qualified to speak on that. If you can point me to a paper of someone else, which relies as much on anecdote and faith, I’d be as critical of it as I am of your approach.

              Really – at least try to engage, rather than simply evangelise. Your “look – over there!” style of argumentation can only convince disciples. And again, I hope you’re right, and you might well be so.

      • Lorne Morrow

        But, perhaps, it might be the first thing you should have disclosed in your original post and this post as well. After all, expecting researchers to disclose funding is a currently expected practice. A familial relation might be perceived as an influence equal in strength to the influence of funding. If you are questioning one man’s methodology (I am glad you are because debate improves thinking) then you should probably strive to demonstrate superior method.
        I think the bigger question not discussed here is whether “good” science can be exercised on human subjects. Maybe new definitions or parameters of method have to be employed. My father used to say, “You can’t bet on a 2-legged horse.” Of course he was referring to corruption in sport & betting, but is it possible that we cannot apply the same pure method to the human organism that we apply to studying the effectiveness of, say, a new epoxy used in automobile paint? [I am a lay person – I own a gym & a running store so I apologize if I am way off base]
        BTW – being from Canada and not a member of academic circles, I would never have made the connection between you & your father on my own because you spell your surname differently. I think that even more reason for the disclosure.

        • Sorry, Lorne, but I can’t agree. I shouldn’t be expected to kowtow to the lowest-common denominator thinking on this, and draw attention to what is a complete irrelevance. If I do, and we all do, we’re collaborating in lowering our standards as to what matters and what doesn’t.

          My post – this one and the previous one – focus exclusively on things I’ve been studying and teaching for 22 years, namely critical reasoning. If I had made it about the diet, or about Noakes himself, then the disclosure would certainly be merited.

          But on what the post talks about, I don’t rely on anything to do with their history (or current involvement/exchanges). Introducing my family is a distraction tactic, and amounts to “poisoning the well”, in that it’s an illegitimate way to cast doubt on my argument without needing to deal with the argument.

          Having said that, I certainly agree that it would have been advisable on political and rhetorical grounds, in that now more attention is being paid to it than would otherwise have been.

          • Lorne Morrow

            Thanks for your reply Jacques. I somewhat understand your claim that your posts were exclusively on critical reasoning, except for the fact that Noakes & his methods were your examples of poor reasoning.
            At this point, I think politics might trump being right. Tit for tat is not furthering either man’s work. I am not suggesting that you retract anything. But, as a critical thinker, I believe that the ball is in your court to find a positive wrap-up to this dialogue. It seems to have gone off the rails slightly.

  • Tom Short

    Seeing two fantastic scientists resort to what can only be described as childish slating is the true ‘sad’ point of this thread…

    • Mark Dean Brown

      Is it slating or open and democratic discussion? Would you prefer them shaking hands on the golf course?

      • Tom Short

        I stick by my ‘slating’ remark. At least two of the ‘replys’ are very petty. I expected better off such influential figures.

        • Tom Short

          Replies*

  • Chris

    I think this is getting entirely misconstrued from Jacques point: scientific method. He states at the very beginning that Noakes may be right or wrong, the issue is with the quality of the evidence to support his claims. If you want to tell me that a LCHF diet cures dyslipidemia, type 2 diabetes and cardiovascular disease, then show me blood lipid profiles, oral glucose tolerance test results, blood insulin profiles and angiograms. Test LCHF against any form of standard dietary recommendations and show me it is superior. Control people’s activity, or at the very least account in some way for it. But don’t give me a collection of self-reported “evidence” and expect it to convince me as a scientist, and that I believe was Jacques point. This is not an attack on Noakes or the LCHF diet. Public health is certainly an important and emotive area, and I can completely understand Noakes’ frustrations that something he believes has the potential to drastically change human health is constantly debated and argued against. If I developed a drug I believed could sure cancer, and gave it to some patients and they all went into remission (ignoring that I’d be shot for not going through clinical trial procedure) then I may well jump up and down and yell at everyone to give it out before more people died. But there would be inquiry, there would be demands for evidence, and there would be a need for proper, verified scientific veracity – the whole reason clinical trial programs exist. And people may needlessly die in the meantime if it turned out to be true. But for the greater good of not giving people false hope, or not subjecting them to a long term complication and greater suffering, this is the way that it is.

    If I put out a public call to anyone who believes the world is flat and get 127 responses that say yes, would you doubt the curvature of the world? I look out the window and it looks pretty flat, the others in my office confirm this, maybe this is an “obvious” truth we have missed, because we believed others for too long? That is obviously a hyperbolic example but is at it’s core the debate at hand…

    • Thanks Chris, that’s exactly it. As I say in the follow-up post, I’d even hope that Noakes’ conclusions turn out to be correct,

    • Tim Noakes

      But Chris this has been done. We know that LCHF outperforms the standard diet in correcting all coronary risk factors. That is in the literature. I referred to that in my paper.

      Why can’t you see the evidence when it is so well documented in proper trials reported in decent journals?

      This all suggests that something is wrong. When the evidence is there and everyone continues to deny it, one has to ask the question: Why?

      • Chris

        Tim, thanks for taking the time to respond. My comment, as I expressly stated, was not an attack on you or the diet, the issue is with the contents of your article. In your discussion you say it yourself that the average weight loss from that group of reports was far greater than the average reported in controlled studies of high carb diets. You go on to say that meta-analyses show LCHF to be “at least as effective or more effective” as high carb diets at promoting weight loss, and “at least as effective as the HCLF in improving all common parameters predicting coronary heart disease”. That to me does not equate to “We know that LCHF outperforms the standard diet in correcting all coronary risk factors”. I am not against the LCHF diet, and I am not proposing that it has no capacity to help people. What I am against is what I feel is ‘sensationalist science’, where some amazing results are reported from entirely uncontrolled circumstances – a fact which you acknowledge repeatedly in your paper. I would love to write an article that focused on the results that best supported my hypothesis, at the expense of results that didn’t (how many people are there in SA on the Noakes diet who haven’t emailed you because they didn’t achieve any result? You can’t possibly know, can you?). But I expect that paper would be rapidly thrown out by any worthy editor, let alone make it to peer review and then be accepted.
        I am denying nothing, I am saying that I agree with Jacques your article had a complete lack of scientific process and hypothesis testing, and cannot be considered as evidence.

        • Tim Noakes

          Thanks Chris for lowering the temperature somewhat.

          I still don’t understand what was “sensational” in what I wrote in the paper other than the quite remarkable outcomes for a number of patients (who had not been helped by standard medical advice). Whether or not others do or do not respond as well is not relevant to this. The point is that this group of patients were not helped by standard medical advice and only responded when they did that which was the opposite of what they had previously been told.

          The point is that there is an unknown number of patients who will show the same response. I see it as my responsibility as a medical scientist/practitioner to inform my colleagues that they may have patients who will benefit from quite different advice than they are currently providing. One might argue that I would be remiss not to provide that information (by devoting a considerable amount of time to collating the data and writing the paper).

          The only claim made in the paper was that these data proved the need for an RCT that would aim to disprove the hypothesis that for persons with insulin resistance, a low carbohydrate diet might be more effective that pharmacotherapy in “curing” or reversing these conditions.

          From my knowledge of the literature I believe that the biology is clear and the evidence is in – and was perhaps already shown by Dr Reaven at Stanford in the 1960s. If you have insulin resistance (metabolic syndrome) and you limit your carbs, you will improve all your coronary risk factors since it is the repeated insulin/glucose spiking (and the carbohydrate load to the liver) that is causing the metabolic abnormalities. That is essentially a no-brainer.

          Of course if you have another reason for your disorder, then the low carb diet may be no more effective than a standard, calorie-restricted diet.

          But if you are insulin resistant and you choose to continue eating a high carbohydrate diet, then you will run into trouble in the long term. And this includes not just obesity and diabetes but as we now know, cancer and dementia including Alzheimer’s disease.

          My frustration is that this simple point which I first made in Challenging Beliefs (which began the furore) is still not acknowledged.

          We fail to make the point that insulin resistance is a common abnormality and is the most likely explanation why people become sick when they eat high carbohydrate diets.

          Yet the treatment appears to be so very simple.

          That is the truly sensational realisation.

          • Chris

            I appreciate your views and as I said in my first comment can understand that you probably feel as though you are banging your head against the proverbial brick wall. The reason I call the article sensational is that you have to consider that your average person will buy into an idea expecting an outcome. If their expectations are met, they are satisfied. But the people who are likely to have emailed you are the one’s whose expectations were far exceeded. I have a car to travel to and from work every day, it has served this purpose well, but I have not contacted Nissan to let them know. If I had driven every day this year one one tank of gas, I would probably have written them effusive thanks for their marvelous advances in efficiency. The point of that example is to highlight that your cases are self selected, and highly likely to be outliers. Those people are more likely to want to write to you and express their thanks for helping their lives. That is the entire point for RCTs in the first place, to expose the general effects of something. You have data only selected from one end of a bell curve, but like the classic disclaimer on any television infomercial: “individual results may vary”.
            I think the case results are absolutely fantastic and nothing should be taken away from that; merely that the scientific rigor was lacking to say the least. Again your response seems to me to indicate that you view this discourse as an attack on the diet, which it isn’t.
            To put an entirely different context to it, what about a different example. You’ve researched and written on hydration and performance quite extensively so how would this strike you: If I were to promote the idea that alcohol is performance enhancing for endurance running, I think I would be dismissed by the vast majority runners, but there would be a few who would give it a go. Of those few, again the vast majority would likely see no benefit or a decrease in performance, but with physiology being marvelously complicated as it is, there would be some who saw a benefit (either in actual performance or with alcohol addling their brain so they felt better). So I may get some responses confirming that indeed alcohol helped running performance. Would you then accept an article I wrote in which I used those few cases to contend that alcohol may prove a superior beverage choice to the traditional water? Based off uncontrolled inferences and a lack of knowledge of what the total sample of people who tried it was? I feel confident in assuming your answer would be “absolutely not”. I have no knowledge of what other changes were made to their hydration protocols, meaning any difference seen could be in no way related to the alcohol at all. I have not compared it to a similar cohort adopting a traditional strategy. I have not controlled their training etc etc. Multiple variables that drastically affect the interpretation of the findings.
            I absolutely admire when scientists have the guts to refute their own previous claims, to go against popular notions in favour of ideas which may have extreme promise even if they aren’t currently favourable. To challenge beliefs and question ideas is what makes science progress, and people such as yourself are absolutely necessary for this progress. But it is also necessary that we uphold the many demands of good science and academic rigor, otherwise we surely lose credibility?

            • Tim Noakes

              So to summarise you are unhappy that this was not an RCT and I should not have published it since it is a selective population and some will expect a sensational result and when they do not get that result, they will be upset.

              Recall that no where in the article does it claim to be an RCT.

              Of course you conveniently forget that many (including medical practitioners) who read the article and who follow its advice (and use it in their practice) will get good results in an unknown percentage of their patients.

              So had I not done this work, an unknown number of (insulin resistant) people would continue to get the wrong advice that will keep them on the path to obesity, diabetes, cancer and dementia.

              Since we do not know the number of people who will benefit vs the number who will be (psychologically) harmed by the publication of this article, we actually do not know whether my writing the article has caused more harm or good. That we can only judge in the future, in many years time.

              So none of this proves that I am a bad (“insane”) scientist – which seems to be the focus of this blog since that is its title.

              I am also not sure that it really impacts on my scientific credibility since I have never claimed that the study was an RCT which “proved” a specific hypothesis.

              All very confusing.

            • The word “insane” appears three times on this page – and all three occurrences are in your comments, yet you use quotation marks, which might give a reader the impression that I had called you insane.

              The title of the post also means something quite different to what you imply – it says you are offering lessons in bad science. In other words, it refers to a case, not a person.

              All very disingenuous.

            • Chris

              I’m aware the article doesn’t claim to be an RCT, however it claims to be evidence for the need for an RCT which simply isn’t true. And that is a seperate argument to whether there is indeed evidence for the need for an RCT. You seem to be perpetually twisting everything that is said to be either about you personally or about the LCHF diet. The focus of this blog is indeed bad science, your article just happened to be the example of it. You could prescribe or promote absolutely anything, and you would see some people benefit. The key point is that the sample you have is self selected from those who benefited enough that they felt the need to contact you. That is likely to be a small number of the total number of people who did indeed benefit. And we have no idea what proportion of the total number of people to have tried LCHF those people are. The fact that there are 127 people who’ve shown a benefit is evidence of one thing, and one thing only: those people’s ability to write you an email. Can you tell me exactly what their dietary regimes were, down to the last macronutrient? Can you assure me that the change in their diet was not simply a catalyst for them to become more active, thus they expended more energy? Can you tell me that there were no other outside influences that could potentially act as a confounding variable? You can’t, and you say so yourself in the article. Which begs the question of why did it get published? If we can’t say anything other than these people got amazing results and said they were on LCHF then what exactly can we say?

              Let’s add some numbers to the equation: the population of SA is what, 50 million people? Let’s say 0.01% of them have tried out the LCHF diet, that’s 5000 people. 127 of those are included in your report, which is about 2.5% of the number of people who tried LCHF in this example. And I think to estimate only 5000 people have tried LCHF is a drastic underestimation. So you’re calling for the need for an RCT based off the experiences of an small percentage of the total LCHF sample, and an extremely small percentage of the total population. And that all assumes that those 127 strictly adhered to your LCHF diet without changing anything else to affect their weight or health. That’s entirely too many assumptions and unknowns for the scientist side of my brain to say “this is evidence for LCHF diets”. You can replace LCHF diets with any intervention you choose, it’s not about the diet. Does it honestly make sense in your mind for that to be published in a medical journal? If so then I think we have simply found a fundamental disagreement on what the content of a medical journal should be. In which case we should agree to disagree, and I wish you all the best in continuing this area of research.

            • Luc Evenepoel

              Chris, you are raising an excellent point. LCHF advocates, from Atkins to all the acolytes after him, give all the credit of the LCHF diet to LCHF eating. In their conclusions, they could very well be confusing cause and correlation. When obese people lose weight, their cardiovascular risk parameters improve irrespective of the mode of weight loss: LCHF, HCLF, calorie restriction, or even cocaine abuse or contracting tuberculosis. The weight loss itself is the main contributor to improved health, a.o. through a decrease in the body’s pro-inflammatory response, and although this is a well established fact in the medical literature, it never gets mentioned in the conclusions of a LCHF article.
              As medical professionals, we would absolutely love there to be a magic cure for obesity, even if it is LCHF. This diet certainly performs well short term (months), but there are no data on its long term safety (decades) so most of us are reluctant to shout from the roof tops that this is the way to go. This short term – long term dichotomy never finds its way in conclusions of a LCHF article either. Long term efficacy is equally questionable. The attrition rate is very high, much higher than with other diets. LCHF is easy and simple enough, until a plate of cookies is put in front of you. And it is expensive, well outside the budget of the lower socio-economic classes, which is the population group where obesity prevalence
              is the highest. To be fair to his readers and science, Noakes should have mentioned this in his discussion. As he writes it now, LCHF looks almost too good to be true. And we all know what that means.
              To illustrate that LCHF’s success is about more than LCHF eating, I refer to the second case study (obese man lost 75 kilos). He was one of the patients in our bariatric (weight loss) surgery program, but dead scared of this operation. At the end of one of my motivational talks to the bariatric surgery support group, he asked me if what I presented could be an alternative to the surgery. He then voluntarily withdrew from the bariatric work-up (contrary to what Noakes writes, the anesthesia had never been deemed too dangerous for him – I know, because I am anesthetist on this program) and had a close look at this life. He was a restaurant critic, admitted being a glutton, often boasting about the amount of
              food he could put into his body. He did an assessment of his past eating habits, his food choices, his portion sizes and his alcohol- and cooldrink consumption. He attended a support group, took up some physical activity and went on LCHF. He also put in some effort and discipline. LCHF had been a stepping stone, one of many wheels to keep his weight control in gear. He lost 75 kilograms, but realises the most difficult part is to keep the weight off. He still attends the support group, makes a point of keeping good habits and eliminates all refined carbs, sugar, alcohol and excessive and bad fats from his diet. Endocrinologists and dietitians have for decades been prescribing LCHF for selected patients, but if this opportunity is not taken to change bad habits, the weight returns, including ill health. Even something as drastic as bariatric surgery cannot be successful long term if patients go back to their mistakes of the past. Noakes has been lambasted for his freestyle science in
              his SAMJ article. If he had included something like the full and real story of Case 2 instead of making LCHF look like a miracle cure, he would have found more acceptance for his freestyle, and his readers would have benefited from a more realistic look at the diet he believes in. He still wouldn’t have scored high marks for design and methodology, but he would have made more of us reflect
              on the merit in his message. And that’s after also a reason why we read medical journals.

            • Great comment, Luc – thanks for taking the time to leave it.

            • Liesl Jobson

              And please don’t forget that dead people tend not to write fan mail. So did any people die on this diet? Just something more we don’t know.

            • Luc Evenepoel

              There are anecdotal reports of people dying on Atkins, but the details cannot be verified. What we do know however, is that LCHF can give rise to severe electrolyte- and fluid imbalances. If anyone takes up this diet, it should be done under strict supervision of a medical doctor. Even Atkins admitted that in his book.

            • Catherine Collins

              The work of a scientist – whether social, clinical or nutritional, is to challenge beliefs through such carefully crafted, ethically approved, sufficiently powered trials that their results (even allowing for confounding factors) can be viewed as sufficiently robust as to make a difference to what is known about a subject. The identification of both H pylori bacteria, and its role as a significant cause of stomach ulcers, was an example of such paradigm shift in medical belief underpinned by very sound scientific research.

              For a media hungry for the key to human immortality or at the very least an intact body and brain until the moment of death, any advice related to chronic diseases of ageing is guaranteed column inches and airtime. But the difference between scientists with integrity is that they qualify their research to the public in both their findings and the implications of their work. An excellent example just this week was of Professor Julie Williams, who appeared on BBC Breakfast TV in the UK highlighting the research leaps in Alzheimer gene mapping, whilst carefully identifying how diet, lifestyle and environment may have as great a role to play in gene activation. As an example of how to educate the public on a health subject it was a textbook example. Unfortunately, it isn’t available to view on the BBC channel, but you can get a measure of her approach here http://bit.ly/HnPhuq

              Contrast that with what are basically no more than personal opinion articles published almost simultaneously in the BMJ (Malhotra) and the SAMJ (Noakes) and you can see the exquisite difference in presenting science vs non-science / nonsense. Column inches and media exposure are virtually guaranteed for those wishing to buck the science out there – but unlike the H pylori experiments, the audience are given personal opinion, schmaltzy anecdotes about ‘saving’ someone by application of that non-science, and conspiracy theories levelled at the scientists who dare to challenge messianic beliefs.

              I cannot think of a single UK nutrition professor (and there are a rather large number of them, with worldwide kudos in their field – think Marinos Elia, Susan Jebb, Alan Jackson, Tom Sanders amongst them) who would denigrate the careful epidemiology and clinical trial research to become a media tart.
              That some are willing to put soundbite above science is disheartening.

              Whether Rousseau has familial interest in nutrition research is irrelevant, and another example of an ad-hom attack on an individual making a valid comment about both poor science and the reporting of it. Whatever ‘Rousseau senior’ found decades ago would only be of interest to me now if current findings supported it. If not, it would be obsolete data, along with blood letting and diagnosing illness using the humors.

              Perhaps it is time, in this media-frenzy world of soundbites and supposition, to demand that medical journals take some responsibility for fuelling such debates. Both journals will manage to segue around the nonsense being promulgated by in Malhotra’s BMJ article claiming ‘personal opinion’, and in Noakes’ case ‘an observation’. I can’t vouch for the press release that accompanied Noakes’ article, but Malhotra’s press release sexed up the story to a level suggestive of fact. The journals have themselves a case to answer in allowing such poor quality work to be published.

            • Well said.

  • Mark Duncan_info

    Sounds like a classic Personal Crusade based on family bias… “tall poppy syndrome” … “crab in a bucket”

  • “for which we have no long-term data”

    It is for the high-carb low-fat diet that we’re only now beginning to get long-term data. The high-carb low-fat diet came into only fashion/favour a few decades ago.

    In any event, perhaps time to stop trolling Dr Noakes already?

  • Max McGee

    Jacques, did you read this part of the article? Before you slate someone’s methods of ‘bad science’ (publicly) perhaps you should read the entire text. The title being assisted with the term ‘occasional survey’ which clearly states that it was never proclaiming to be a scientific study. Furthermore, the comment below which was cut and pasted out of the ‘bad science’ clearly states that it is NOT an RCT. Well done for wasting yours and everyone else’s time and providing some great reading. I’m sure your father is really proud of your speed reading ability, which obviously runs in the genes considering the speed with which he must have run through the low fat high carb hypothesis before preaching it as gospel.

    “The study has several potential limitations.
    First, all data are self-reported and were not
    verified but it is unlikely that all participants
    would fabricate this information. Second,
    there is no record of exactly what each
    person ate. Third, all reports describe
    only short-term outcomes. To collect this
    information as part of an RCT involving 254
    subjects would have been very costly.
    Despite these substantive limitations, this
    information challenges current conventional
    wisdom (widely taught at medical schools);
    the higher fat content of the LCHF diet (i)
    must cause weight gain because of the higher
    energy density (per g) of fat than of either
    carbohydrate or protein; (ii) will either cause
    abnormal or worsen already abnormal lipid
    profiles, and (iii) will worsen blood pressure
    and blood glucose control. The data also
    suggest that the macronutrient composition
    of the diet is the key driver of weight gain
    and obesity.”

    • I did, thanks. Something doesn’t have to be an RCT to suffer from questionable methodology.

  • Mark Dean Brown

    It’s
    a shame that not one of Prof. Noakes’ supporters have actually responded to what the article was
    about. Jacques Rousseau did not dispute or support the effectiveness of a
    low-carb diet, in fact, he admits he does not have the expertise and
    makes this clear numerous times. The issue here is the lack of
    scientific evidence to back up Prof. Noakes’ claims and more
    specifically, those he published in the South African Medical Journal
    (SAMJ). The SAMJ is not a health magazine, it is a scientific
    publication which is respected by many doctors and can be referenced in
    future research, so the inclusion of subjective individual experiences
    with no scientific research to back up their claims has important
    ramifications. What if someone felt their cancer, HIV/AIDS was cured by
    this diet as well? Is that science? Call it an “Occasional Survey” or
    whatever, but when a respected academic like Tim Noakes publishes
    something in a respected medical journal, it has authority and people
    not familiar with the details (like myself until reading this article
    and I would think most people) will trust it and possibly endanger
    themselves by drawing wild conclusions like that this diet could cure
    their diabetes. When there are no facts to back that up, I personally
    consider that to be unethical.

    • Max McGee

      Mark, you should also read the comment below.
      Also, it is a medical journal. A journal which clearly allows doctors (which Noakes happens to be) to note their experiences.
      If you read the whole article you will notice that the states clearly that is is not a scientific study and actually points out the weakness in evidence.
      Why is everyone so grumpy about an article that raises queries? There were suggestions as to what it might mean and even suggestions that 127 people may have fabricated data for the data (although it is highly unlikely).

      What is unethical is taking the Hippocratic oath, then discovering something that may save people’s lives, then withholding it because you’re worried you’ll look like a douche.

      • Tim Noakes

        Thanks Max. Could not have said it better myself.

        Pity I have to be made to look like a douche just because I raised a few inconvenient questions.

        Nice if we could move the debate on to address those inconvenient questions which was the point of the article.

        • sparrowtwin

          Fair point. Would love to see a debate with a few cardiologist and dieticians. We need to keep shifting the paradigm to reach the truth if we ever can get there.
          On a side note, my wife is a dietician and your name has become almost a swear word in my home! LOL. Not quite, but I’ve been doing LCHF diet against my wife’s advice and its great. Losing kgs and feeling strong. but alas my marriage is more important than my diet, so I may have to meet her in the middle.
          Keep challenging the norms and thanks for taking a few on the chin for the rest of us.
          PS Which pages of “The Lore of Running? must I tear out?

    • Tim Noakes

      And if there are data to back up that claim?

      • Mark Dean Brown

        Then this layman would suggest you provide research to back it up, specifically scientific research which uses accepted and verifiable means to draw a conclusion. Surely you would want it tested and tested again by others to back up your claims and to enable this diet to go mainstream?

  • Carl

    I don’t know Jacques. What is the definition of bad science?

    1) Christianity had major splits after the Gutenberg press because people could read the Bible for themselves for the

    first time. In the last decade we got online Bibles so it was even more accesible to evaluate what priests were telling

    us through all the centuries and a sort of Cambrian explosion of information is happening currently where people make

    decisions on what they read/investigated themselves with their laymen education. Now people question the Bible which can

    only be a good thing. If you (Not you JR) believe in God, good for you, but at least you made up your own mind and I

    think that’s the point. And there is no scientific proof that a higher-whatever does not exist and also no proof that it

    does, therefore it is actually more scientific to be an agnostic.

    2) Scientists/dieticians need to be able to explain their work in laymen’s terms because we end up using the products,

    so the argument of “you’re not a scientist” is not acceptable. It’s like the Emperor’s Clothes – if you’re not worthy

    you won’t see it. That’s BS.

    3) If Tim Noakes is evangelizing then the AGW people are evangelizing as well and I know you’re with the consensus

    group. And the AGW consensus group keep changing their sealevels to something more dramatic in the media with the

    hysterical warnings (Christian hysterical warnings = If you die tomorrow you’ll go to hell).

    4) You have to admit (because there are many examples) that scientists are influenced by incentives. It happens in any

    industry and we see it every day. What exactly makes science immune to stuff that happens in industries like

    construction firm colluding, bread companies, sugar? It happens. Scientists aren’t gods. Though you mentioned it’s not

    fool-proof.

    5) Since the information explosion, people have become more and more sceptical of ‘common knowledge’ and you can’t blame

    them. People catch on to conspiracy theories much more quicker these days because of actual conspiracies, lies,

    deception that have been uncovered in let’s say the last 2 decades. I saw an old cigarette ad the other day of a doctor

    promoting Camels because they’re the GPs choice. If consensus was anything to go by, you would’ve been in that group

    because no scienctific consensus back then was against it.

    6) People can stand together in promoting a false theory and still win. Just look at apartheid.

    People are losing trust in the status quo. And Tim Noakes swallowed his pride and questioned the status quo. How often,

    Jacques, do you see public figures admiting their errors? Someone needs to push the argument and Tim Noakes is one of

    those who are doing it. He is stepping on toes and Jacques, you should know what stepping on toes feel like.

    I’m of the conviction that most public figures don’t make decisions based on human rights like they say, but rather on

    money. Look at Syria. 100 000+ people dead and all these ‘human-rights-sensitive’ governments are dragging their feet.

    Not to even mention Blair and Bush in the past. ‘Scuse the pun, it’s a sick world.

    Tim Noakes has a point. The science is there. Cholestrol DOES cause heart attacks. The carbs aggrivate the arteries and

    the cholestrol tries to heal it, thereby building up (bacause you keep eating loads of carbs) and therefore blocking the

    arteries. It’s not the cholestrol that kills you. It’s the carbs.

    You car can’t be blamed for speeding. It’s your foot that pushes down on the accelerator.

    Now, there’s no science or peer-reviewed articles or big words here in my post. Just logic. Am I as a laymen dead wrong?

    But there has been science all along that prove cholestrol is not to blame.

    http://www.theactuary.com/archive/old-articles/part-4/life-3A-heart-of-the-matter/

    • Justin

      Wow! as a recent but avid reader of health topics, I have been amazed at the controversies and general noise in this field. For me this is not an academic matter, I desperately want to regain my health (weight, lipid profiles etc etc). So I have developed a high level of skepticism for each and every argument. Certainly I have given up looking for the one definitive proof that would answer all my questions, mostly because it doesn’t seem that scientists even agree on which are the valid questions.

      Looking at this debate, which is ostensibly not about the case for LCHF, rather the lack of rigour in Noakes “science” I ask myself:
      Why would there be such concern over Noake’s scientific methods if the message was right?
      Why does the concern (of Noakes’ logic) relate to this specific subject of LCHF rather than say “running lore”?
      Why does the challenge apply to Noakes in isolation rather than others in the field for example Taubes?
      Given Noakes’ turnabout on carbs (after carb-loading) theory, is he likely guilty of “confirmation bias”?
      Are these assertions made about Noakes’ “poor science” properly proven in random controlled trials, or just commentary and allegations?
      Could there be any hidden motivation possible for the debate, and who started it?
      Would this debate be likely if Noake’s theory was obviously wrong?
      What is the usual reaction to an inconvenient truth, vs an inconvenient obvious error?
      I bet there a number of other good questions to ask – these are examples.

      You can see how the public may find this very confusing. I am not waiting for this science to settle. Suffice to say I have used this method to pick a horse for me – with excellent results on weight trigs hdl HbA1c. No longer prediabetic. Obviously pure luck of course. No prizes for guessing either.

    • Mark Dean Brown

      You start by comparing science to Christianity (without a hint of irony), and from there it’s downhill all the way. Good job.

  • Iacchus Dionysus

    There is an important distinction between science and scientific method versus decision-making and decision-making method. Diet advice is about decision-making. Decision-making has to take place even in the absence of scientific proof, one way or the other. A court, for example, must make a decision on the information available–it cannot postpone decision-making to await a collection of peer-reviewed RCT experiments. Eating is the same. One has to eat pending definitive science, which is plainly lacking in the field of nutritional and health. So anecdotes may not be “scientific,” but they are valuable information for the purposes of decision-making and adaptation over time. Cultures acquired useful lore through experience long before scientific method was devised.

    Personally, I have leaned to ketone-rich LCHF because the science I have reviewed generates more plausible argument in its favour and gradual adaptation in my diet has improved my health markers and signs of aging in every respect, from softer skin to more mental energy. If it is placebo effect, so what, I ‘m sticking to eat because a “balanced” diet (even with no processed foods) was starting to turn my hair gray six years ago, which reversed and stayed reversed. My dietary shift occurred, ironically, because I was introduced to some cheeses I greatly enjoyed and became concerned about consumption of saturated fat. So I sought to determine how much would be safe, saturated fat being deemed harmful by health guidelines. The further I got down the rabbit hole of nutritional and metabolic science, the less convincing I found the edicts against saturated fat to be and the more convincing I found the arguments in favour of LCHF. These are arguments not proofs. I am a mathematically trained lawyer, so assessing strength of argument is what I do. Scientists can debate scientific method, but decision-making and policy is a different ball game, driven by plausibility and risk-taking. It is risk-taking to follow the status quo of a so-called “balanced” diet (a question begging adjective in the world of argument–“I submit the plaintiff’s and defendant’s rights should be “balanced””–would get one laughed out of court). Given the trajectory of chronic disease, it looks more and more like a “balanced” diet is the riskier diet. This is not a scientific observation; it is a decision-making move in a situation to establish onus of proof where one has to make health-affecting decisions in the face of imperfect, much less than scientific information. This is what is “relevant.” Science provides experimentally crafted narratives to be interpreted as input into decisions, but life cannot and will not wait for answers from science.

    • Tim Noakes

      At last some sanity. Thanks Iacchus. How did cultures acquire folklore before the scientific method evolved?

      In his recent book The Paleo Manifesto, John Durant makes the point that the Jewish people following their hygiene code described in the Mosaic Law had an “unprecedented tenacity for life”, not because those laws had been proven by laboratory-based RCTs but presumably because they were based on multiple observation of many anecdotal experiences over thousands of years which were then consecrated into laws of behaviour. Thus the concept of contagion was understood long before the action of infective agents was ever considered.

      As you say, we have to make decisions on what to eat on the basis of incomplete evidence. The most compelling evidence I have seen is that provided in Weston Price’s monumental book Nutrition and Physical Degeneration. He showed that when traditional peoples ate the foods with which they had evolved (before the Agricultural Revolution), they had few if any of the modern diseases that have been on the rise since our industrial diet replaced those locally-produced foods.

      Thus the conclusion seems clear – the more industrialized the diet you eat, the sooner you die, and the longer the period of your ill-health.

      Replacing industrial food with real foods, which is the heart of the LCHF eating plan, seems the most obviously clever choice.

      • SuperGDZ

        Maybe you want to re-think your example – http://www.nbcnews.com/id/15689591/#.UuELx9L8Lcs.

        The statement “the more industrialized the diet you eat, the sooner you die” is manifestly at odds with the increased longevity of people living in industrialised societies.

    • Peter Britz

      Iacchus’ analysis is brilliant and game-changing, as it brings a new dimension into this debate – broadening the discourse from science methodology to decision making both at individual and societal level. I am amazed at how the Noakes diet issue polarises opinion with NO middle ground. Really intelligent people are quite disturbed by the passions the debate evokes. Tim has got right up the noses of the medical establishment with his popular style. But one has to look at what is NOT being said by his medical establishment critics. Quietly and pervasively we have a societal nutritional and health crisis on our hands which is central to Tim’s concern. Obesity and so on is at an all time high with our increasing access to, and dependence on, industrial food. Why is this not stimulating outrage and debate? Especially in the medical fraternity. The current debate is framed within science method rules and medical ethics practitioners who feel Tim has stepped outside of his doctor’s ethical mandate. But what does the silence in the medical fraternity on the public health crises say about our societal institutions which are supposed to deliver public health? Here Iacchus points the way as we need to consider how narratives on the governance of nutritional policy and public health are negotiated. To obtain these answers the discourse thus needs to broaden from medical ethics to a wider institutional analysis of how narratives are formed and how governance of food and public health is negotiated.

      • Luc Evenepoel

        Peter, the medical fraternity is not missing that elephant in the room. Obesity is a mind bogglingly complex problem, but we keep making the mistake trying to solve it with simple measures. LCHF is such a measure. It’s like seeing wind energy as the cure-all for global warming. LCHF certainly has merits, and any well-informed medical professional accepts that. However, to extrapolate from short term data that there is a long term benefit, is not only unscientific, it is also unwise and possibly dangerous. LCHF studies run over months, and indeed show that they are more successful for weight loss than other diets. Those patients are never followed up long term (years or decades), because those studies would be far too costly. As an analogy: smoking for a few months is probably harmless. But can you conclude from that that everybody can safely light up life long?
        Atkins became an extremely wealthy man from his diet. He certainly had the financial means to conduct such a study, but never did. Why? We can’t know for sure, but as a medical doctor he must have realized that in the long term his diet did not work, because we live in a real world, not in a laboratory. In the previous version of his book, it takes him 174 pages to write a sentence that should have been on page one: ‘You should ask yourself why you have become overweight’. I bet his patients did not become obese from eating too much pumpernickel. Look in the medical literature, and look around you in the real world, and you’ll notice why we get overweight: too large portions (our current portions are 1.5 to 5 times larger than what is recommended, but we don’t realize that because they are the only portions we see), red meat, processed meat, potato chips, french fries, refined carbs, sweet, desserts, cool drinks, alcohol. We eat not only out of hunger, but for social, cultural, emotional and yes, hedonistic reasons, and often because we just see some food lying around. I can go on and on.
        Half of the world’s assets are directly or indirectly related to food, creating fabulous wealth. Those companies are not going to give up trying to make people eat more. They spent billions on figuring out how much sugar and salt to put in every conceivable food stuff, from baked beans to instant soups to fish spreads, so their product becomes more palatable than the competitor’s and hence will sell better. We don’t even spend a tenth of that amount of money on nutritional education. The medical fraternity keeps fighting for your health, but against such powerful lobbyists you can understand that the fight is not easy.
        Now if in the middle of all this, a miracle cure is proposed, that, to make it even more sexy, goes against conventional thinking, the lay person obviously welcomes this with open arms. LCHF is such a cure. However, all we know is that it is safe and effective SHORT term. No sufficient or unequivocal data on long term.
        So rest assured, we are doing our utmost to give you the most up to date and unbiased information about health. But we don’t believe in miracles. We believe in science.

        • Peter Britz

          Thanks Luc, good perspective and very helpful. I completely agree about the education part. I am am not in the medical or nutritional field so don’t know what institutions exist to influence and develop policy, but it seems to me that not enough is being done in public spaces to promote advice on healthy eating. I am appalled by the unhealthy choices families in the queue in front of me in P&P make out of ignorance of the long-term consequences for their health. As you say, civil society is up against very powerful corporate interests which use every means from product R&D to advertising media to hard-wire their products into lifestyle and culture. Coca-cola voted SA’s top brand (and top in community and environmental contributions as well) makes high sugar consumption a ubiquitous part of every day family and community life. Similar to the nostalgic Volkswagen adverts which link their various models to family histories and narratives. So my point is, what tools are the medical fraternity using to fight for our health through education and awareness? If public and community narratives influencing food choice are shaped by these very powerful corporate interests, what is being done by public good institutions to promote constitutional rights to good health and nutrition? For examples, what are we teaching about food and nutrition in schools?

          • Luc Evenepoel

            Most people know that broccoli is healthier than a Mars bar. We teach children at school, have nutritional information labels on food packaging, write profusely in the press and on the Web. Frustrated by so many patients and staff members coming to tell me about their new miracle cure for weight loss, I even thoroughly researched the literature about what works and what doesn’t to lose weight and keep it off (and put those finding together in a book). All that is to little avail. We are up against an obesigenic world where food is everywhere, and cheap
            (the average household nowadays spends 20% of food; it used to be 70% half a century ago). We are up against lobbies. We are up against biology, making us prefer foods that are fatty, salty or sweet. And we are up against reluctant policy makers, who don’t want to commit political suicide by cleaning out the food Augias stable.
            And we are up against sensationalized science. LCHF is part of that. Noakes cherry picks his findings, extrapolates, draws conclusions that cannot be substantiated, defends himself with case reports and short term studies. He’s not totally wrong. But ‘not totally wrong’ is hardly the same as ‘right’. That’s what this whole blog stream is about.

  • Dave

    Why do you go out of your way to describe someone as an evolution-denier? It has no bearing on your article and only serves to entrench that the naturalistic worldview is the accepted foundation for sound scientific endeavours, in all areas of scientifice research and practice, which is certainly debatable.

  • Charles Maggs

    Noakes is wrong on nutrition. He was wrong before and he is wrong now. We should not listen to him. He does not have the capacity to be right. Nothing in the way he approaches nutrition has changed since he promoted the carb diet. His flat way of viewing food persists he has simply chosen to change what he thinks the bad things are. Until he can develop the means to view nutrition in a 3 dimensional manner all that he espouses is going to be flawed. If he had the capacity to correctly interrogate and research this in the first place he would have never have promoted the carb diet as best for athletes. Sure weight loss does occur with high protein – meat based diet – I had a friend at university in 1980’s who used it to slim down in summer – It doesn’t make it a balanced or healthy diet. If he wants to choose a coronary over slow death by diabetes it is his business but as a professional who has been wrong before he has no place giving dietary advice.

  • George

    What is the difference between an anecdote and a case study? A case study is one person’s experience where the results are reliable and reported in detail. Case studies are an important contribution to medical progress. In fact they are essential to informing good medical practice. So to call every n=1 an anecdote is disingenuous and misses the distinction between the science of science itself and the artful science of medicine. “We know it can work because it worked” is a good enough argument on its own merits.
    the provenance of the case studies is weak, but this limitation is discussed (it’s probable that Noakes has more data than that included in the short summaries).

    “It’s plausible that someone trying a new diet will, for example, also be motivated to exercise more – but we can’t control for that.”
    It’s also more than plausible that a successful diet will make someone more active. We all know the lethargy that comes from eating a stodgy meal. Does credit then go to activity or diet? It depends on one’s so-called “paradigm”; if one thinks calories are all-important, as opposed to food quality, then all credit goes to activity.

    Other points are valid enough, though I don’t know Weston A. Price’s own attitude to vaccination, strongly suspect he was vaccinated where possible on his travels, and in any case don’t see the relevance to a discussion of diet. Newton was a mystic and alchemist but no-one uses this to discredit his ideas on planetary motion.

    Agassiz died in 1873 and Noakes is using him as the correct source for a quote everyone knows – for goodness sake get a grip. We won’t be allowed to quote Shakespeare if this goes much further.

    Noake’s paper ends “A randomised controlled clinical trial is urgently required to disprove the hypothesis that the LCHF eating plan can reverse cases of T2DM, metabolic syndrome and hypertension without pharmacotherapy.”
    You don’t say that if you think you’ve just provided proof of a hypothesis.

  • charl

    what evidence exists to show that a carbohydrate diet is healthy, what studies were done to adopt our current food beliefs? why should we wait for science to tells what we have done throughout our existence until profit came into the picture? don’t try slow down a movement because the rules of science say it isn’t being done correctly. people’s lives are being affected by profit making companies who don’t care about nutrition.

  • charl

    what evidence exists to show that a carbohydrate diet is healthy, what
    studies were done to adopt our current food beliefs? why should we wait
    for science to tells what we have done throughout our existence until
    profit came into the picture? don’t try slow down a movement because the
    rules of science say it isn’t being done correctly. people’s lives are
    being affected by profit making companies who don’t care about
    nutrition.

  • katrina

    When McGovern approved the new food policy, he was urged to wait because the evidence for the food pyramid was lacking. He responded by saying he couldnt afford to wait for the evidence, because the people of America needed guidelines on how to eat NOW.
    After a few decades of eating like that, the USA and indeed the rest of the world, are in trouble.
    My concern is that now we want to swing the other way. Once again, perhaps, not with all the longterm evidence…

    Having said that, nothing makes me lose weight as well as LCHF. Having battled overweight since childhood, i have spent 25 y looking for a cure. Weightwatchers, weighless, and all the fad diets… Even Atkins didnt work, because of too much protein. But LCHF does.

    I had dinner 5 hours ago. A cup of ostrich mince and a cup of green veg. Because the ostrich is lean, i added a 30 g lump of butter to it. I didnt finish it. Three quarters through, I suddenly felt stuffed. I am still not hungry. Before I would’ve been halfway into a HaagenDaz ice cream by now. But this feeling of satiety is amazing. The relief of not feeling the permanent compulsion to eat is amazing. It has changed my life. But i am only a lonely case study…

    • Howard Stasin

      If the medical fraternity would accept the fact that “industrialised man” and “post agricultural” man (and woman) didn’t appear out of thin air, the discussion would get a whole lot simpler.

      Our forefathers (millions of them) ate a certain way for millions of years. Contrary to popular belief, their lives weren’t short sharp and brutal. Sharp and brutal but not necessarily short, if you take out the effect of infant mortality due to mainly violence. Certainly not filled with disease.

      Just Google “Evolutionary Forensics” or “archaeological forensics ” and read the latest research.

      Most of the foods conventionally eaten are industrial waste products, or selected for the fact that they are cheap, easy to produce or store well. – bran, wheat, cotton seed oil, canola oil, rice.

      Eating an ancestral diet just happens to virtually coincide with eating LCHF.

      We have fallen so in love with interventionist medicine that we have lost sight of the effect of input!

      There will never be a random double blind placebo trial for eating meat, fat and roots. Who will sponsor it? How would you monitor it? It’s already been tested by our ancestors! Just go look for the evidence in the fossils.

      Anecdotes are all you will get, so use them.

    • Carel Steenekamp

      I have been overweight for 40 years, so I ask in good faith: are you still a LCHF follower, 7 months later?

  • Emma Shears

    He completely ignores, independent, real research done by Professors of Nutritional biochemistry, who just happen to have published over 400 papers in real peer reviewed journals. Research done on real people, in a real environment involving over 1 million people and over a 30 year period. He told me personally, that he would not read the work, as he read the critisisms of the work on Google!! Nice science Tim. The main critic is a 23 year old woman with an honours degree in English! I suppose a degree in spin doctoring holds more weight than several degrees and 50 years in nutritional science.

    • Claude Destefano

      Hey I’m all for the sheep not following the great advice and work from Tim Noakes. Just helps me have the edge over the fat and unhealthy sheep. Now go eat a mars bar and a jolly good spag bowl.

  • Colleen

    Tim Noakes diet has changed my life immeasurably. No more headaches, no more reflux, no more bloating, skin about ten years younger, no desire for junk food, massive increase in energy, memory improvement and more but I won’t bore you. I no longer need my proton pump inhibitors, anti depressives, migraine medication and am preparing to stop my anti cholesterol medication. My respect for GP’s decreases daily. Thank you Tim Noakes – for helping me to recover real life again.

  • For information, to any who might have subscribed to comments on this post: Gerrit van Tonder, who commented frequently in this thread, died of a heart attack earlier this week, aged 61. My sympathies to those who were close to him.

  • Judit

    I don’t care what all the stiffs said at that university. I have familial hypercholesterolemia and it brought my numbers down from 13 to 6. I am staying on this diet and will go to these arrogant cardiologists (arrogant they are – have never met a friendly one) to check my mechanics. They can have my lancet numbers before them and they’ll still shake their heads and shrug me off when I say that I get kidney failure from statins. I cannot afford to go off my totally Ketogenic diet. And as for Tim Noakes, he has NEVER said it was HIS diet. He just sort of championed it in this country – thank G-d! Some thoracic surgeons in the states are seeing the light. One is donald miller and I’ve just found another one at http://thecureforheartdisease.net/the-cure.php huge kudos to them. Wish they were HERE. Hey and NO-ONE is forcing anyone to eat this way. It’s a hallelujah moment for some of us. Go and enjoy your bread and toss your cookies but it’s not for me. I have a real disease which needs dramatic measures – and those measures have panned out well for me.

    • Eric Boyer

      exactly, Mr Noakes is late to the party, and being an American, having never heard of him, like a dummy, i went low carb, turned all my bad numbers around and dropped 80 pounds since December 10, 2016. I guess I’m just an amusing anecdote.

  • As with ANYTHING even vaguely medicinal, the Noakes diet will be good for some, will do nothing for others, and may even harm some. But knocking evidence-based medicine / science on the basis of a pile of self-reported anecdotes…I’ll stick with the statins, I think. Great post, Jacques!

  • DarylT

    Thankfully some sanity at last.

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  • David
    • Which is actually not true, as I explain in later post in this series. Try reading the actual report yourself, instead of sharing a link to a blogpost about it.

      The report is a) by a advisory body, who can’t even make policy; and b) says that while a LCHF diet is best for short-term weight loss, they regard a range of diets as equally good in the long term.

      • David

        So you do, in actual fact, have a viewpoint on the diet itself: “which is actually not true”. I knew you were hiding behind Mr Noakes’s anecdotes and methodology all along; it’s the diet itself that’s the real issue, isn’t it? Please, ser, do not suggest I have not read the report, just because I only posted a link.

        • No, the headline of what you linked to is not true. Try harder.

          • David

            No need. When someone can declare the current dietary recommendations a “success” and still get support from most of the fraternity then there’s just no need. You have to remember that most of the population actually listen to advice given by medical doctors, and this type of out-of-hand and up-front denialism is, to my mind, not on. You obviously learnt the story of the words “and yet it moves” in your first year physics class, but did you spot the trap therein? An open mind would be more appreciated by all.

        • No, the headline and content of the thing you link to is “actually not true”. Try harder.

      • Oukie Lekudo

        Oh really? The newest Food Based Dietary Guidelines of Sweden actually do suggest much higher fat consumption than the standard Western model. Based on the SBU research they also make no comment on reducing saturated fat e.g butter. Trying to damn the earlier research by stating that the SBU ‘can’t even make policy’ is bizarre! A key finding of the SBU was that so-called studies proving saturated fats were linked to heart disease were clearly bad science and that studies proving the opposite have been deliberately ignored by the mainstream medical “experts” like the AHA because it threatens their income from prescribing statins..

        • Erm, no. Read the report yourself. Here’s a quote:

          “As a high intake of saturated fat is considered to involve a risk of cardiovascular disease, this has raised the question of whether a low carbohydrate diet could increase the risk of coronary artery disease, stroke, etc. Metaanalyses of randomised
          studies have been carried out and indicated that the risk of cardiovascular events is reduced when saturated fat is swapped for unsaturated. However, a number of the studies included had shortcomings which make them more difficult to interpret, and none of them have specifically examined low carbohydrate diets. This means that it is not possible to draw any conclusions on the link between low carbohydrate diets – irrespective of fat content type – and cardiovascular morbidity. The precautionary principle could be applied here. This may result in restraint on the intake of saturated fat when advice is given on low carbohydrate diets, as long as the documentation on the long-term effects is so inadequate.”

          So, they do comment, and they do say that even though the science is inconclusive, they’d err on the side of being cautious about saturated fat. And, they are not a policy-making body. It’s “bizarre” that you think pointing out this fact has any bearing on damning any research.

          • Sindi

            Have the entire lot of you ever considered the amount of frustration and ill feelings you would spare yourselves if you grew the hell up and did something other than bicker like a bunch of old biddies? I stumbled on this site not knowing what it was really about and I am truly disgusted.
            And as for you, Dr Noakes, your diet changed the way I see myself and live my life. Thank you for that. But to find you on a messy site like this bickering right along???? Maybe you need to go for a long walk and think of something more constructive to do with your time. All of you.