Prof Tim Noakes and Karen Thomson
By Marika Sboros
The first international low-carb, high-fat summit held in Cape Town in February was a moveable feast for body and brain, and a virtual construction site for nutrition science.
It demolished deeply held myths about diet, weight loss, food as optimum fuel for body and mind, food as medicine, and medicine as food.
It built up dreams of a gentle, safe alternative to modern medicine’s rampant polypharmacy to stem the tsunami of obesity, diabetes, and other chronic disease epidemics sweeping over the planet.
The summit was hosted by Cape Town sports scientist Prof Tim Noakes, a pioneer of low-carb, high-fat (LCHF, aka Banting, aka ketogenic) in South Africa, and organised by Karen Thomson, granddaughter of the late pioneering heart surgeon, Prof Chris Barnard.
Attendance by speakers and delegates was high. It exceeded expectations, given fierce and vicious medical, dietetic and academic establishments’ resistance to LCHF – and Noakes – in South Africa. They haven’t yet forgiven Noakes for an about-turn on the role of carbs in the diet in favour of LCHF four years ago. They have relentlessly attacked him ever since for challenging conventional medical and dietetic wisdom.
Antidote to venom
Therein lies the genesis of this unique event: a vision of the irrepressible, vivacious and ever gracious Thomson, founder of HELP (Harmony Eating & Lifestyle Programme) to overcome addiction to sugar (carbohydrate).
Thomson was so incensed by the venomous attacks on Noakes, she decided an antidote was needed: she invited the world’s top experts in LCHF to attend a summit in South Africa, to present the science, and stand up for Noakes.
Thomson and Noakes quickly assembled a stellar group of speakers from across the globe, all highly respected, many internationally renowned medical doctors, scientists and researchers specialising in obesity and LCHF. They included a cardiologist, nephrologist, psychiatrist, bariatric surgeon and an orthopaedic surgeon. They all said they came to show support for Noakes, and to spread the word to the world about growing evidence for LCHF.
Prof Stephen Phinney. Picture: Louis Hiemstra
Among the more than 400 delegates were local and foreign medical doctors, dentists, dietitians, nutritionists, psychologists and complementary medicine practitioners who attended three days for professionals. The fourth day open to the public was similarly packed.
Summit speaker Dr Stephen Phinney, a US physician scientist and emeritus professor of medicine at the University of California, Davis, and “father of LCHF”, said the summit was the biggest conference audience he had addressed so far.
Even food at the summit venue, the Cape Town International Conference Centre, was a coherent element that supported the scientific content: delicious satiating meats, bacon wraps, biltong, fish, nuts, cheeses, yoghurt (full-fat of course) and low-carb vegetables – all LCHF staples, designed to keep blood sugar levels stable.
Diet doctor
Dr Andreas Eenveldt, Sweden’s ‘diet doctor. Picture: LOUIS HIEMSTRA
Summit speaker Dr Andreas Eenfeldt, Sweden’s “diet doctor”, was so impressed with the culinary offering, he declared it “the best food I’ve eaten at any conference, ever”. It gave delegates a literal taste of another major summit theme that was eloquently expressed by Canadian kidney specialist Dr Jason Fung: the insulin theory of obesity and diabetes.
Fung advocates a dietary intervention to diabetes – what he calls the “rational, natural approach”.
Other speakers, including Noakes, presented compelling evidence that the epidemic of chronic conditions facing the world today – cardiovascular disease, obesity, diabetes, even dementia – is just the tip of the iceberg. Underneath lies insulin resistance (IR), a metabolic condition driven by excess sugar/carbohydrates in the diet, and in particular refined carbohydrates.
Phinney’s presentations underpinned the insulin theory, and focused on another major summit theme, one which he has spent more than 30 years researching: nutritional ketosis. He coined the term 30 years ago because of confusion and fear around ketones, ketosis induced by dietary carbohydrate restriction (nutritional ketosis), and ketosis caused by absence of insulin – a condition known as ketoacidosis that can be fatal.
So why are doctors and dietitians still so fearful of ketosis and ketones that they instill the fear in patients? Ignorance.
Phinney says doctors and dietitians are classically taught that ketones are “toxic byproducts of fat metabolism”, which they can be, but only in extremely high levels and in the complete absence of insulin that occurs in type 1 diabetics, or more rarely in end-stage type 2 diabetics.
For the rest, ketosis is a benign state, and ketones (natural chemicals the body produces in response to fat metabolism) are “helpful substrates”, he says.
Diet-heart hypothesis
Other myths that came in for a thorough demolition job were the diet-heart hypothesis (the demonisation of saturated fat in the diet as the cause of heart disease), the idea that “a calorie is a calorie” ( the body can’t and doesn’t distinguish calories), CICO (calories-in, calories-out), and the “energy imbalance hypothesis” – that people are fat because they eat too much and move too little.
Zoë Harcombe
Zoë Harcombe, a Cambridge University graduate, nutrition specialist and obesity researcher who is currently completing a PhD, told the summit that for CICO to be true, the second law of thermodynamics would have to be violated.
The junk food industry spends billions of dollars trying to convince everyone that CICO is true, and a calorie is a calorie, because that makes them “automatically innocent” of any role in rampant obesity and diabetes rates, Harcombe said.
US science and investigative journalist Gary Taubes, author of groundbreaking books on the science of nutrition, Calories In and Calories Out, and Why We Get Fat, was similarly dismissive. Taubes is co-founder of the Nutrition Science Initiative, a non-profit organisation devoted to reducing the individual, social and economic toll of obesity and its related diseases by improving the quality of science in nutrition and obesity research.
He said CICO is the “original sin” of obesity and diabetes research. It has become “written in stone, passed down from the mountain”, yet it has no science behind it.
Obesity has “nothing to do with gluttony and sloth”, Taubes said.
Eenfeldt agreed that “it just doesn’t make sense that people have become fat and lazy Homer Simpsons overnight”.
Another major summit focus for demolition was official dietary guidelines. Harcombe presented results of her own research on the topic, a meta-analysis of the evidence for dietary guidelines with UK and US researchers, published in the BMJ Open Heart a week before the summit. The conclusion: official dietary guidelines were without scientific evidence when they were introduced in the US in 1977 and in the UK in 1983.
That advice has adversely affected the health of more than 270 million people at the time, as sky-rocketing rates of NCDs worldwide shows, and that number is likely to have risen to billions in the interim, Harcombe said. She has not surprisingly been criticised personally and professionally for the study, since it goes to the heart of powerful vested interests. She and her team are unrepentant.
Saturated fat bias
US expert Dr Michael Eades, who has been in full time practice of bariatric, nutritional, and metabolic medicine since 1986, presented even more disconcerting evidence on how studies biased against saturated fat have worked their way into government recommendations.
Dr Aseem Malhotra. Picture: LOUIS HIEMSTRA
British interventional cardiologist Dr Aseem Malhotra was equally critical of the diet-heart hypothesis, official dietary guidelines and the antics of food and pharmaceutical industries.
Malhotra said efficient healthcare demanded informed doctors and patients. He referred to “seven sins” identified in research as contributing to a lack of knowledge on both sides:
Biased funding of research – research funded because it is likely to be profitable, not because it is likely to be beneficial for patients
Biased reporting in medical journals
Biased patient pamphlets
Biased reporting in the media
Commercial conflicts of interest
Defensive medicine
Medical curricula that fail to teach doctors how to comprehend and communicate health statistics.
All were explored as sub-themes throughout the summit
Malhotra is consultant clinical associate to The Academy Of Medical Royal Colleges and science director of Action on Sugar, a group of 23 medical specialists working to achieve consensus between the British government and food industries to reduce added sugars in food products.
In 2013, he published a report in the BMJ in 2013, titled: The dietary advice on added sugar needs emergency surgery.
Cholesterol, OMG!
Christine Cronau, an Australian nutritionist and best-selling author of The Fat Revolution, said official dietary guidelines have in effect made us all part of modern medicine’s “biggest failed health experiment”.
Dr Jeffry Gerber, Denver’s Diet Doctor. Picture: LOUIS HIEMSTRA
Dr Jeffry Gerber, a family physician who is known as “Denver’s Diet Doctor”, took special aim at statins in a lively presentation titled, Cholesterol OMG!. In his practice, he addresses health, cardiovascular risk and nutrition, including low-carb, paleo and primal diets, and says lowering cholesterol isn’t always smart. Gerber believes that statins will be “gone in 10 years”.
South African-born US adult and paediatric bariatric surgeon Dr Robert Cywes pointed to a disturbing pattern: Sixty years ago, experts sat wringing their hands about the rise in lung cancer, heart disease and emphysema, (all chronic non-communicable diseases – CNCDs), and completely ignored and argued against the evidence that tobacco was the culprit, Cywes said.
Today they sit wringing their hands about obesity, diabetes, cholesterol and hypertension while the world ignores the “culprit drug”.
“ The most prevalent CNCDs killing us as a species are a consequence of drugs not well tolerated by human systems: alcohol, tobacco and the obesogenic drug – carbohydrates,” Cywes said.
LCHF experts are often criticised for undermining the role of exercise as part of the energy imbalance theory. All summit speakers said they weren’t saying exercise is not helpful for health. It is – just not for weight loss.
Canadian physician Dr Jay Wortman, a public health specialist, and clinical assistant professor at the University of British Columbia’s faculty of medicine, spoke about how he reversed his own type 2 diabetes 12 years ago by going on a low-carb, high-fat diet, and has been free of any evidence of the condition ever since. He also addressed concerns about safety of LCHF regimens in children and pregnant women – traditional diets show there is no concern.
Another inspiring personal story came from American Jimmy Moore, the only lay person on the speakers’ panel. He described himself as “just a guy who changed his life forever” in 2004 by making the decision to lose the weight that was literally killing him. At 32, and weighing 410 lbs, he ditched the carbs, increased the fat, and a year later, had shed 180 lbs. He hasn’t looked back. Moore now runs the Livin’ La Vida Low-Carb blog, to help others.
Dr Eric Westman
Dr Eric Westman, associate professor of medicine at Duke University’s Medical School’s Department of Medicine, and an internationally renowned expert on low-carb nutrition and ketogenic diets, gave a novel presentation to the public on LCHF in action to achieve weight loss.
He donned a white coat, and addressed the audience as an obese patient, taking them step by step through the basics of LCHF for weight loss and maintenance thereafter.
He emphasised the basic elements: carbs low as 20g a day, moderate, protein and high fat intake, and an overall summit theme that is key to LCHF eating: real food, as close to its natural state as possible, in other words, not processed or refined, with additives, flavourants, etc.
Bread tree?
“Have you ever seen a bread tree or a pasta tree?” Westman asked the audience rhetorically.
One of the most exciting – and controversial – presentations to the summit was So you think you need sugar? Your cancer needs it even more! by Australian orthopaedic surgeon Dr Gary Fettke, a senior lecturer at the University of Tasmania who does ongoing research into the role of diet in diabetes, obesity and cancer.
Fettke is also a cancer survivor. He looked at the science behind the metabolic model of cancer therapy, based on the work of Nobel Prize winning German biochemist Dr Otto Warburg in the 1930s, and posited dietary intervention, in particular an LCHF, ketogenic diet, as a possible cancer treatment of the future.
Other presentations looked at food and mood, and dispelled another myth dietitians tend to cling to: that carbohydrates are essential to the diet because they raise serotonin levels and make you “feel good”.
Dr Ann Childers. Picture: LOUIS HIEMSTRA
US adult and child psychiatrist Dr Ann Childers specialises in nutrition and mental health, and has looked at the effects of nutrient-poor, high-carbohydrate diets, and high-grain diets in particular. These don’t just contribute to weight gain, they’re not good for body or brain, Childers told the summit. Despite what dietitians say, carbohydrates are not the brain’s best food. Fats are, including saturated fats, she said.
One twit on Twitter said she hoped the conference would not be “an echo chamber”. It wasn’t. Speakers agreed on some major points of LCHF theory, but not others. They all agreed that LCHF was not a fad. Fettke said the only fad diet was the one we’ve all been eating for the past few decades.
Speakers differed in how low a low-carb diet had to go for maximum benefit. None suggested there was a one-LCHF-diet-size that fits all.
Some differences turned out to be little more than semantics – though you wouldn’t know it from the breathtaking speed with which some bloggers pounced on them. One example: Malhotra said he prefers to speak of healthy rather than saturated fats, and there is research to show Mediterranean diet is healthy – as long as it is high-fat.
A couple of bloggers gleefully reported that as if it were a sign of Malhotra’s closet opposition to lo-carb, saturated fat in the diet, and Noakes. They were wrong on all counts: Malhotra said he would not support a high-carb Mediterranean diet. In October 2013, he published an article in the BMJ: Saturated fat is not the major issue , that became one of the most read and impactful medical journal articles in the world for that year. He is vocal in his support for Noakes.
Old Mutual
Anti-Noakes bloggers also leapt on a comment by Dr Peter Bond, chief medical officer of Old Mutual, the company sponsoring the summit: that the company was “not endorsing any particular diet or way of eating”. Quite rightly so.
Dr Peter Bond
It’s not in the global life assurer’s job description to endorse diets, and the summit was not on the Tim Noakes’ LCHF diet, documented in the best-selling book, The Real Meal Revolution, or any other. It was a health summit that looked at research around optimum eating for health, with a special focus on LCHF.
Old Mutual would never have sponsored the summit – and to the hefty tune of a few million rand at that – if it did not respect Noakes, and if it wasn’t aware of the growing power and popularity of Banting not just in Cape Town, but worldwide, and growing evidence in favour of LCHF as a nutritional horse to back in the race for effective therapies to beat NCDs in future.
He acknowledged that health crises around the world, including in South Africa, show that new approaches are necessary: “There is clearly a need to elevate preventative medicine to the level it deserves, and not only do it, but, more importantly, have the desire to do it,” Bond said.
“We have clearly failed to date.”
The only pity about the summit was that doctors and dietitians opposed to Noakes and LCHF stayed away, despite an open invitation to public debate. Excuses left the lingering impression that perhaps they weren’t so sure their arguments would stand up to scientific scrutiny.
One anti-Noakes blogger did get in, with his female sidekick. Both made predictably bilious, ill-informed comments and ad hominem thereafter, demonstrating their usual ignorance of LCHF and the scientific method.
The summit started looking more and more like the global tipping point for LCHF that Noakes expressly hoped it would be. Noakes also gave a powerful lecture on The Way Forward, answering his critics, and giving all the evidence for LCHF.
The summit ended with a rallying call from speakers for a bottom-up dietary revolution. A top down approach will never work, they said, given how deeply embedded pharmaceutical and fake food companies are with governments, with universities, and with advisors.
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