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Forget the bull. To some doctors, dietitians and nutrition scientists, University of Cape Town sports scientist Prof Tim Noakes is a red rag to the viper. He extracts almost unbelievable venom for his high-fat, low-carb diet, documented in his best-selling book, The Real Meal Revolution. It began with changing his mind on carbo-loading nearly four years ago, and turned him overnight into the closest thing to a medical devil incarnate. In this Q&A session with me, Noakes answers his critics – with relish. MS
By Marika Sboros
Criticisms levelled at Prof Tim Noakes are limited only by the imagination, and aimed as much at him personally as professionally. At best, he has been called “misguided” and “irresponsible”, at worst, “medicine’s Julius Malema”, and a quack who “flouts the Hippocratic oath”.
His high-fat, low-carbohydrate (HFLC) diet is regularly labeled “dangerous” and “bad science”.
Yet Noakes, director of the University of Cape Town’s Faculty of Health Sciences Research Unit for Exercise Science and Sports Medicine, isn’t saying anything new; the information on which his HFLC diet and book, The Real Meal Revolution, are based, is grounded in solid science. It is what top medical scientific minds internationally have been saying for years, and most recently in March 2014, the large international study of 600,000 people’s diets, by scientists at Cambridge University in the UK: saturated fats are not the healthy bogey we’ve been led to believe they are; they are not behind sky-rocketing rates of heart disease and obesity after all. (Read Garry Taubes’s brilliant investigative work in 2011, Why We Get Fat .)
The runaway success of The Real Meal Revolution, published in December 2013, appears to have served only to infuriate Noakes’s critics even further. With word-of-mouth advertising only, it has sold 100 000 copies in South Africa just six months, making it the country’s bestseller ever.
Ironically, everything Noakes writes in it, is in Time magazine’s cover story on June 12, headlined: “Eat Butter – scientists labeled fat the enemy. Here’s why they were wrong.” That puts Noakes six months ahead of Time, and creates an inconvenient truth for critics: how to explain why he is so wrong when Time is so right.
National Geographic has also weighed in, with an article in its June 20 issue posing the question “Is Fat Our Friend?” So far, science shows it is a friend indeed, and one sorely in need.
So what’s really behind the attacks on Noakes? After all, he is both a qualified medical doctor and a scientist with an A1 rating – a global leader who has won most of the major science awards in South Africa. Diet and nutrition are firmly among Noakes’ many areas of expertise and research.
It doesn’t help that Noakes is regularly misquoted in the media, by journalists who haven’t spoken to him, who don’t bother to correct their errors, and in so doing, break two of journalism’s cardinal rules. At heart, though, it’s more likely that Noakes has learned the hard way, as many others have before him, about the consequences for those foolhardy enough to go against prevailing medical orthodoxy.
In this Q&A session, I put the criticisms to Noakes:
Is your “Noakes diet” just another high-protein “Atkins” in disguise?
No. Some people don’t bother to read what I say; they make up their mind, then fit what they think I’ve said into it. It is not high protein. It is high fat, low carbohydrate and moderate protein only. The diet can be ketogenic, but doesn’t have to be.
What’s a ketogenic diet?
One that is so low in carbohydrate and protein (protein will act as a partial carbohydrate), and high in fat, it causes blood ketones to rise.
What’s a ketone?
Ketones are a natural product of the liver in response to a low-carb diet. Instead of burning glucose, the brain very cleverly decides: Let’s burn ketone bodies. Ketones are probably the most efficient fuel in the body.
When should a diet be ketogenic?
It depends. The more sick you are, the more ketogenic you need to be. If you just want to lose some weight, or run better, your diet doesn’t have to be ketogenic.
Have you said your diet is right for everyone?
I’ve never said that. What I have said is: it will benefit you, if you are insulin resistant – and in my view, most people are these days. I also say if you avoid processed foods, focus on fats, and eat real food from the green 
list (in The Real Meal Revolution), your health will benefit. If you are insulin resistant, it is absolutely clear you must reduce your carbohydrates or your long-term health will suffer. That applies to everyone. I’ve never said it any other way.
Why are so many people insulin resistant these days?
Probably an evolutionary adaptation that had biological value – people who had the genes were more likely to survive. The genes have always been there. They allowed us to survive. The negative consequences were not expressed until the introduction of high-carbohydrate foods, highly processed and laden with sugar. That turned insulin resistance into a widespread epidemic of obesity and diabetes.
Do you claim your diet is the cure for heart disease?
No, I can’t claim that. I can claim it is curative for metabolic syndrome (a cluster of risk factors that ups the risk for chronic diseases such as heart disease, cancer, diabetes, etc). If you have the syndrome, and cut out carbs, you will go into remission, because you reduce all the risk factors including high blood pressure, high blood glucose, high blood triglycerides, low HDL, but more importantly the small dense LDL cholesterol particles in the blood, and inflammation.
Has anyone ever proven that saturated fat causes heart disease?
No, it’s a completely unproven hypothesis. In fact, no one has ever proven that cholesterol in the blood causes heart disease. It’s an assumption based on epidemiology, and is destroyed in The Big Fat Surprise (the New York Times best seller by US investigative journalist Nina Teicholz) .
Have you ever said your diet is a cure for cancer?
No. What I’ve said is that cancer is a carbohydrate-driven disease. Cancer cells are proven to be utterly glucose dependent. Some cancers are able to get their glucose from protein, but the point remains cancer cells have to get glucose from somewhere.
Is that view original?
No. It’s in the 1931 Nobel Prize of physiology and medicine that went to (German physiologist and medical doctor) Otto Warburg, for discovering that cancer cells can only burn glucose. We just kind of forgot that, because cancer research went in a completely different direction.
What direction was that?
We invested billions of dollars into drugs to kill cancer cells. The research is driven by scientists who got it wrong, but won’t admit it. They just keep plodding along, trying to cure cancer according to a model that clearly doesn’t work.
Is there much support for your view that the model doesn’t work?
Oh absolutely. It is the view of world authorities, such as Dr Craig Thompson of the Memorial Sloane Kettering Cancer Centre. There’s a YouTube video of a 2011 talk where he tells his audience to the effect: “If I encourage you to eat a high-fat diet, it won’t change your cancer risk one iota. If I encourage you to eat carbohydrates, it will.”
You were diagnosed as diabetic three months into your diet. Does this prove, as your critics say, your diet doesn’t work, and is dangerous as it could have caused your diabetes?
That’s unbelievable logic: that if you do one thing (eat a high-carb diet) for 33 years, then change it for three months, what you did for the previous 396 months is irrelevant. In other words, the reason for the diabetes epidemic is that everyone across the world has suddenly started eating high-fat diets. So, no, let’s get back to the facts: My father died of Type 2 diabetes. That puts me at a 10-fold increased risk of diabetes. Unfortunately, for 33 years, I followed guidelines of the Diabetes Association who told me that as long as I exercised and ate a high-carb diet, I would never get diabetes. They were very, very wrong.
What made you change your mind about carbo-loading?
I finally discovered the work of (Eric) Westman, (Jeff) Volek and (Stephen) Phinney, that had been suppressed, as fully described 
in The Big Fat Surprise. It’s no surprise I hadn’t seen it – I just didn’t realise the degree of suppression, even though those scientists are now friends of mine. The book opened my eyes. I realised what was wrong with my health: I was insulin resistant and eating a high-carb diet. That was before I started eating a high-fat diet. The diagnosis of diabetes could have been made then, but I’m my own doctor – the worst thing. I didn’t want to believe the evidence for my diabetes, but it was there all along.
Your critics say you have to take medication for your diabetes which proves your diet doesn’t work. Do they have a point?
No. I just had to face facts. I had my glucose levels tested, and initially thought I could get by without medication. I spoke to specialists internationally, people I trust, who confirmed the diagnosis of diabetes, and said I should take medication. If I were being treated conventionally, but was still eating my high fat diet, I would probably be diagnosed as pre-diabetic, and probably could get by without medication. But I want perfect control. I want my glucose to be as good as anyone without diabetes. I’m nearly there.
Do you endorse all protein as good?
No. The Real Meal Revolution is all about real food, not processed in any way. People need to read the green list in the book. It talks about real meats and dairy products that are from pasture-fed animals and are not highly processed.
Is it correct that you are not a fan of fruit and veg?
Yes and no. The idea that fruit and vegetables are healthy is commercially driven, and can be traced back to the industry in 1995 that promoted the 5-a-day idea without any good science to back that claim. On the green list, we promote lots of amazing vegetables that are high in nutrients and low in carbohydrates, such as leafy vegetables, broccoli, cauliflower and kale, and give you all the fibre you need.
One media report said the only fruit you eat is apples?
I never said that. I never eat apples, because they are sweet, and not the most nutritious. The only fruit I eat are berries – they have the least sugar and the most nutrition.
Do people get bad breath on your diet, as South African epidemiologist Prof Jacques Rossouw, now at the US National Heart, Lung, and Blood Institute’s Cardiovascular Science division, said during the Great Centenary Debate at UCT with you (in December 2012).
Yes, depending on how ketogenic the diet is. It’s socially unacceptable, but easily managed – and a small price to pay for significantly better health.
He also mentions constipation?
Absolutely not a problem if you are eating fibre from veg, and lots of fat from coconut oil that is a laxative. Psyllium husks work for me. I have perfect bowel function. I eat a low-carb bread made with psyllium husks, a product made in Cape Town. The woman who makes it says she would never have produced the product were it not for me. She has this nice little business that is doing very well, and helping people be healthier.
Rossouw is one of your most vocal critics, who is wedded to the diet/heart disease hypothesis, is a fan of statins (which you call the “ single most ineffective drugs ever invented”), cites lots of research, including his own, (in the debate and elsewhere) and clearly believes your diet is potentially harmful. Does he have any points?
This is a man who has spent $700million of American taxpayers’ money in a clinical trial that lasted eight years, and proved that cutting fat from the diet had absolutely no beneficial effect whatsoever on the health of post-menopausal women. In fact, I was the first to show and publish in the SAMJ (November 2013), that his own data showed that women with established heart disease, who reduced their fat intake, were more likely to suffer subsequent heart attacks, than women with heart disease who continued to eat their conventional higher-fat diet. He showed the same for patients with diabetes. Neither he nor anyone else was brave enough to own up to these inconvenient findings. When you spend that magnitude of other peoples’ money, and disprove your own deeply held dogmas, you have to say: I was wrong. Reducing the fat in your diet may well make you worse. Instead, he continues to say the opposite. That, unfortunately, is not science. It is religion.
Why do you think Prof Rossouw does that?
The reasons are described in the Big Fat Surprise: it takes personal courage to refute the commitment of the American medical fraternity and the US government to the low-fat theory. Instead, future generations of people will continue to eat a low-fat diet and suffer the health consequences, because those who were part of that Establishment are all too scared to admit they were wrong and that the diet-heart theory is now a disproven dogma.
But your critics say the only evidence for your diet is anecdotal. Is that correct?
Science is my life blood. I’m an A1 rated scientist who understands the scientific method much better than 99.9% of my critics, especially the ones who spread this garbage. All of medicine begins with anecdote. Jenner started the vaccination theory based on anecdote. Scientists determine the truth on the basis of clinical trials, personal experience, and what patients tell us. None of these things is more important than the other. For the first year after I made dietary changes, I didn’t know enough to make definitive statements. I’ve been reading the literature for the past four years – everything on both sides of the fence. I particularly focused on the high-fat diet; it turns out there is so much information in favour of the high-fat diet and none, absolutely none, in favour of the low-fat diet.
That must present a problem for your critics?
Yes. They now have to face facts presented in Big Fat Surprise: that the science they believe in does not exist; that the evidence I write about, and have assessed, has been suppressed. It’s all there. The evidence has accumulated, despite the work of people like Prof Rossouw, who got all the money, and made sure it was spent exclusively on studies of low-fat diets. If only a tiny fraction of that money had been spent on studies of high-fat diets, we wouldn’t be having this debate. Prof Rossouw might have won a Nobel Prize. He must be ruing his lost opportunity for medical immortality.
What’s the future of cancer research?
Scientists must realise that cancer is a nutritional disease and carbohydrate-dependent, and will need to work out ways to starve cancer cells of glucose. The person who does that will win the Nobel Prize. Cancer scientists who continue to say it is not caused primarily by nutritional factors will be left behind. It’s their choice.
What’s really behind the attacks on you?
Many reasons, but probably because what I say goes to the core of the practice of medicine. It has been taken over by the current pharmacological model that allows patients to get sick and only then treat them with one or other chemical. It’s a model that clearly doesn’t work, because it doesn’t try to understand what caused the disease in the first place. Without that knowledge, medicine is powerless to prevent disease. So this model makes us doctors of disease, not health.
What’s your message:
Poor nutrition is the single greatest driver of chronic ill health. Until we recognise that, our profession will be unable to reverse the crippling burden of chronic ill health caused by these nutritionally based diseases. Humans are the only mammals that suffer from chronic ill health. One critic suggests it’s because we are the only animals clever enough to manufacture our own food – and stupid enough to eat it.
*Prof Jacques Rossouw has been invited to respond
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