Review: VIVIEN HORLER

Lore of Nutrition – challenging conventional dietary beliefs, by Tim Noakes & Marika Sboros (Penguin)

This is a curious book and its title is something of a misnomer. While Noakes’s first book, Lore of Running, is described by reviewers as covering “everything runners, trainers and coaches need to know about running”, Lore of Nutrition is less about nutrition and more about Noakes’s “trial” by the Health Professions Council of South Africa.

Of the 365 pages of the book proper – excluding a forward, two prefaces, a closing chapter, bibliography, notes and an index – 304 pages deal with Noakes and the furious controversy he engendered with the introduction of the Banting diet in The Real Meal Revolution, and just 58 pages with the science of the mode of nutrition he advocates.

And they come virtually at the end of the book. There’s a lot of argument and justification – and some awful medical acronyms – to get through until you come to the beef fat, as it were.

Famously, Noakes was acquitted of the misconduct charges brought against him by the Health Professions Council, but it is as if he’s not sure everyone noticed, and has penned this book, with contributions from health journalist Marika Sboros who covered the hearing, to make sure we know how it turned out.

Which is fine; if this is what he wants to say and Penguin is prepared to publish it. But don’t expect this hefty tome to tell you everything you might like to know about the lore of nutrition, or even of the low carbohydrate, high fat mode of eating.

Noakes, emeritus professor of Sports Science at the University of Cape Town and a medical doctor, is rated as an A1scientist by the National Research Foundation. He is a controversial figure – he describes his style as provocative – and some have labelled him arrogant, but in all fairness he has quite a lot to be arrogant about.

He has run more than 70 marathons and ultra-marathons, and in the years leading up to 2012 had become convinced that conventional medical thinking on how much liquid marathon runners should drink was wrong. Most doctors believed runners should drink as much as possible, even if they weren’t thirsty; Noakes came to the conclusion runners were more likely to be dangerously waterlogged than short of liquid. This is when he fell foul of PepsiCo, makers of the segment-leading sports drink Gatorade. This led, he writes, to many of his sports science colleagues, “especially those funded by PesiCo” to publicly question his intelligence.

He has since been proved right on this hypothesis.

In December 2012 he was finishing his manuscript on this topic – Waterlogged – the serious problem of overhydration in edurance sports. Aged about 62, and finding his own running training to be increasingly difficult, he came across a book called The New Atkins for a New You by three respected American doctors. It said readers could lose six kilograms in six weeks without hunger. This went against all Noakes had been taught, and against the high-carb, low-fat diet he recommended to runners in Lore of Running. But what if the American doctors were right? He decided to give the diet a go.

“Despite my advance d age, within weeks I saw an improvement in my health, well-being and running ability that I can still only describe as astonishing,” he writes. He also lost 2kg in the first week, without feeling hungry. It was his Damascene moment.

He read up on the evidence, and was soon convinced of the efficacy of the low-carb, high-fat diet. He told people to tear up the dietary advice section in Lore of Running, later publishing a new edition promoting the new diet. The rest is history.

Once again his colleagues questioned his theory, but when in 2014 he tweeted advice to a breast-feeding mother that when the time came she should wean her infant on to a low-carb, high-fat diet, all hell broke loose, culminating in his Health Professions Council hearing. He was acquitted of misconduct in April last year.

Much of the book is self-justifying, and if you want the detail of the “he said, she said” it’s all exhaustively here. One great paragraph written by Sboros goes: “Of course Noakes and I are not insinuating that all those who helped the HPCSA are mad, bad people on the payroll or in the thrall of food and drug companies. Many are decent enough, even as they may be ignorant, fearful and suffering prolonged bouts of cognitive dissonance.”

Naturally in the recounting of the evidence in the hearing there was a fair bit of reference to the nitty-gritty of the low-carb, high-fat diet, but I was looking forward to the science section at the end.

And that is truly interesting and convincing to this lay reader.

Essentially, scientists like Noakes who advocate this diet believe that billions of people the world over (something like 60% of the human population) suffer from a condition called insulin resistance caused by a high-carb, low-fat diet, a diet first recommended in the United States’s 1977 Dietary Guidelines.

Insulin resistance, writes Noakes, is “now certainly the most prevalent medical condition in the world, yet is not taught or discussed in most medical schools”.

He and colleagues believe this has led to an epidemic of obesity, type 2 diabetes, high blood pressure, heart disease, stroke, cancer and dementia.

As a result, patients are treated for a range of symptoms of insulin resistance, such insulin for diabetes and pills for high blood pressure, when their various conditions could improve by tackling the underlying cause: insulin resistance.

Earlier this month the medical journal Diabetes Therapy published a peer-reviewed scientific paper reporting the findings from the first year of a two-year study of the management of type 2 diabetes done by the Virta Health company in San Francisco.

In a Cape Town newspaper report on the study published on February 14, Noakes says 218 diabetic patients went on a diet in which carbohydrates were restricted to less than 30g a day. A control group of 87 diabetic patients continued with a high carb diet. The result was that 94% of patients on the low-carb diet had either reduced their insulin use or stopped it altogether by the end of the first year. They also had an average 14kg weight loss and improved blood pressure

By contrast, medication use increased by 9% in the group receiving conventional care.

Noakes writes that this shows diabetes is not, as is commonly believed, “a chronic progressive disease with a dismal future. Instead it can be effectively managed with a quite simple dietary change”.

Noakes writes in the newspaper piece: “Every month another 15 000 South Africans develop type 2 diabetes… this tragic epidemic can be stopped.”

It is hard for lay readers like you and me to know which of the doctors and scientists are right, and by the time the jury is in we might all be dead. But the case made by Noakes and other scientists who advocate the low-carb, high fat diet is very convincing.

• This review also appeared in Weekend Argus on Sunday on February 25, 2018