With the eminent Professor Tim Noakes facing the wrath of the Health Professions Council of South Africa (HPCSA) for advocating the LCHF diet for all people, this issue has again been dragged into the public domain. What particularly irked the Professional Board for Dietetics and Nutrition in South Africa was his assertion that his diet was suitable for infants. What is the significance of this decision and what are the long-term implications of general adoption of this diet?

A Personal Odyssey

Of the few struggles in my life which I have lost convincingly, by a knockout and not on points, has been my weight. At periodic intervals I would yet again attempt to lose 8 to 10kgs. After six months of excruciating hunger, lassitude and enervation, I would have attained my desired weight level only to regain it within one month thereafter as I resumed my normal eating habits.

After a weight loss attempt at 40, I solemnly declared that I would never ever again attempt to diet. However, back pain in November 2013 forced me to reconsider my implacable opposition to dieting. It was either a case of weight loss or my fourth back operation.

The overriding question was how and not why or when. A short tentative paper entitled Against the Grains by the well-known South African Sports Scientist, Tim Noakes tentatively suggested that perhaps – maybe or even possibly – that the solution to the dieting conundrum was to eat predominately fat as opposed to carbohydrate which he had personally advocated as an “elixir” for all long distance runners.

The book The Diet Delusion by Gary Taubes on the science of dieting, the physiological processes and the scientific tests in support of his contention was suggested by Noakes as light bed-time reading. It was nothing of the sort. Instead it was a 600 page tome of graphs and test results with an attempt at being readable. For instance the chapter on cholesterol runs to 50 pages. Moreover it provides an historical overview of the path taken to arrive at the current received wisdom that the Lipid Theory of Heart Disease implicating fat – lipids in medical parlance – as the dastardly scoundrel in the perpetration of this disease.

The Received Wisdom

The Lipid Theory at its heart – no pun intended – states that:

• Saturated fat raises cholesterol
• Cholesterol causes heart disease

As far as a theory goes, it is both succinct and plausible. In fact it was merely based upon correlation as opposed to genuine hard scientific evidence by its progenitor, Dr Ancel Keys, an American scientist.

How was a dubious theory able to be catapulted into main stream acceptance?

In 1954, the American President, Dwight Eisenhower suffered a heart attack. As a tidal wave of similar attacks was reported across American, it was proclaimed to be an epidemic. Ultimately a Senate Committee under Senator George McGovern was appointed to determine its cause and to recommend what appropriate measures and action should be taken to prevent and mitigate it.

Of all the eminent scientists who appeared before the Committee, one by the name of Ancel Keys was the most convincing. The one graph in particular which impressed the Committee apart from his conspicuous intellect was the correlation between the rate of heart disease per country compared with their consumption of fat. Without a doubt this graph was the clincher, the decisive factor in accepting the Lipid Theory.

What the revered Dr Ancel Keys neglected to explain to the committee was that of his sample of 23 countries selected, he had only displayed the five that fitted his hypothesis. Some which were totally at variance with his theory would never be disclosed until decades later. By then the paradigm had shifted to saturated fat being a reprobate and a callous killer.

A consensus had been created.

In 1984 the Time Magazine advocated that fat was an evil to be avoided. Now it embraces it

Not one shred of scientific evidence was presented to the Committee implicating fat as the culprit. Yet despite the dearth of incriminating data, fat was found guilty and sentenced to be banished from one’s diet.

Over the succeeding decades, from measuring only the total cholesterol which was found wanting as a predictor of heart disease, the test was refined to include HDL, LDL and triglycerides. HDL was designated as the “good cholesterol” and LDL as the “bad cholesterol”. Neither is in fact cholesterol but they are in reality types of blood proteins.

The New Reality

By the 1990s even this supposed elegant classification came became suspect. On further investigation, the “good” versus “bad” classification became tenuous when the composition of each type was found to be more relevant than their designation as HDL or LDL.

Diet chart based upon the Dr Ancel Key’s understanding of the effect of saturated fat on one’s heart

It was now discovered that the key determinant of good or bad was whether the cholesterol was comprised of fluffy material, which was good, and sticky dense cholesterol, which was bad.

In spite of this momentous discovery, what was the reaction by the medical profession?

Exactly nothing.

Moreover in spite of the implication that the fallibility of the received wisdom was being called into question, the scientists maintained their quietitude. That begs the obvious question of why this should be so. One was a technological and resource issue. In the USA at that stage there were only two laboratories with the required equipment to perform such tests. Nevertheless the other – I contend – was more prosaic: the realisation that the whole pack of cards would come tumbling down.

Fat consumption per country compared with their deaths. Note communities with an extermely high fat consumption such as the Inuits do not suffer from heart disease or diabetes

Instead of this new discovery becoming akin to a new research frontier with copious grants flowing into a promising new avenue of investigation, it remained a backwater.

Heretics then entered the field. They suggested that carbohydrates were the cause of heart disease and not saturated fat. Some on the margins even tested the correlation between heart attacks and the cholesterol levels. None was found.

It was at this juncture that the so-called Banting Diet received prominence. On talk shows, these advocates were deemed to be killers and far worse, mass murderers.

Unprocessed fats such as butter are now deemed to be good for one

Then the first hint of a sea-change of seminal proportions in the wings was felt. The first inkling of the mechanism whereby carbohydrate and not fat was the cause of heart attacks was unveiled. The continual imbibing of carbohydrate resulted in the repeated secretion of insulin throughout the day. It was the sustained high levels of insulin in the blood which caused an inflammation of the arteries which in turn oxidised the cholesterol converting the white good HDL cholesterol into “caramelised” brown cholesterol.

For his steadfast defence of the LCHF – low carbohydrate high fat diet – which he now strenuously endorses, Tim Noakes has been hauled before the HPCSA.

In order to silence an ardent critic of theirs, the Professional Board for Dietetics and Nutrition will be forced to present their evidence linking fat to heart disease. Even if they should have the pleasure of winning their case and having Tim Noakes debarred from the medical profession, which is their avowed intention, it will merely create a martyr for the cause of the Banting way of life.

As Noakes’ openly acknowledges, the exact details of the perfect diet will still require decades of investigation. For now only the main principles have been established.

Tim Noakes

What will increased controversy result in?

Additional research.

From being a neglected research topic, it will be deemed as an area worthy of investigation.

Maybe Noakes will lose the battle, but the LCHF brigade will ultimately win the war.

Cheers, Tim cheers.

Sources:

1. Book: The Diet Delusion by Gary Taubes
2. Video: The Lipid Theory