The following is an extract from the new book Lore of Nutrition by Tim Noakes and Marika Sboros:
I have written many books and most have taken years, even decades, to complete. The Real Meal Revolution, however, which I co-wrote with nutritional therapist Sally-Ann Creed, adventure runner and chef David Grier, and chef and aspiring endurance athlete Jonno Proudfoot, took just five weeks in July/August 2013. It is the book that has caused me both the greatest pleasure and the worst pain. For while the book would sell in excess of 250 000 copies in South Africa, and set off the Banting Revolution in this country, it would be the direct cause of the worst moment in my entire academic career: the publication of the letter signed by four University of Cape Town professors, three of whom were long-standing colleagues of mine at the time.
Nothing short of miraculous
In retrospect I now realise how inconvenient the publication of The Real Meal Revolution in November 2013 was for those who, behind the scenes, were busily sharpening their knives in anticipation of my early elimination. They were waiting for the Naudé meta-analysis, which would play a pivotal role in the HPCSA’s decision to charge me. The study, which should have been published in February 2013, was now already nine months overdue.
During that time, I, their intended quarry, had published an article in the SAMJ that would become one of the journal’s most-read articles of all time. I wrote it after receiving letters from people who had changed their diets to LCHF. Some of the letters contained stories that were nothing short of miraculous, so I decided to collate and analyse the best 100 or so for a scientific publication in the SAMJ.
I was careful to make the point that this was an ‘occasional survey’, not definitive evidence, and that it had significant limitations. Thus, I began the discussion acknowledging that:
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.
It was probably the next sentence that really caused the trouble. ‘Despite these substantive limitations, this information challenges current conventional wisdom (widely taught at medical schools),’ I wrote. I was perhaps still too naive to appreciate that, in the educational climate of today, one does not challenge what is taught at medical schools.
Five 'miracle' cases
Further, to indicate that I at least understood that this was not conventional research, I concluded the abstract with the sentence: ‘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.’
The high point of the paper for me was the chance to describe five ‘miracle’ cases that at the time challenged what I had been taught about medical care for patients with T2DM.
Billy Tosh lost 83 kilograms in 28 weeks and reversed his hypertension and T2DM. The solution was simple, he said: absolutely no sugar, no processed foods and less than 25 grams of carbohydrates per day. He concluded that the LCHF diet had ‘saved’ his life and that ‘label reading has opened my eyes to the almost criminal levels of carbs in everyday processed foods and the propensity of these foods to cause weight gain’.
Brian Berkman also reversed his T2DM and lost 73 kilograms over 18 months by adopting the LCHF eating plan, limiting his carbohydrates to less than 25 grams per day and avoiding all sugar. He concluded: ‘I totally subscribe to the view that sugar and carbohydrates are drugs to the body. I was an addict.’
Dr Gerhard Schoonbee, a 57-year-old rural general practitioner, had warned his wife that he did not expect to reach his 65th birthday because of the effects of his T2DM. He also had hypertension, a high blood cholesterol concentration, sleep apnoea and constant fatigue. In May 2012, he read about the LCHF diet, adopted it, lost 25 kilograms in eight months and cured himself of all his afflictions so that he no longer needed any medications. He now prescribes the LCHF diet for his patients of all social classes.
100 days experiment
A 23-year-old mother began to eat addictively after the birth of her first child. Her weight ballooned to 120 kilograms and she developed T2DM. She adopted the LCHF diet, lost 45 kilograms and reversed all diabetic symptoms. She concluded: ‘for the life of me I don’t know why I struggled so much [to control my weight] since it really isn’t that difficult. It was more of a lifestyle change for me than a diet.’
Thirty-seven-year-old Simon Gear, a lifelong runner, was finding it increasingly difficult to control his weight. To activate weight loss, he decided to run nine marathons in nine weeks, culminating in the 2012 Two Oceans 56-kilometre ultra-marathon. Instead, his marathon running caused him to gain three kilograms. He finished the ultra-marathon two minutes short of the official cut-off time, in 6 hours 57 minutes and 57 seconds, in 7 668th place. He sought my advice, and after much persuasion agreed to experiment with the LCHF diet for an initial 100 days. He lost 2 kilograms in the first week and a total of 15 kilograms over the next seven months. Most of his weight loss occurred when he was running the least. On 16 March 2013, he completed the Two Oceans 56-kilometre ultra-marathon in 3 hours 59 minutes and 42 seconds, in 208th position, nearly three hours and 7 460 positions better than his performance 12 months earlier.
Simon concluded: ‘The weight loss enabled my training, not the other way around. I feel like I have won my life back.’ He had discovered, in the clearest possible way, that it is not possible to outrun a bad diet.
When my father battled with T2DM, dying a diminished man as a result of the complications of disseminated obstructive diabetic arterial disease, my medical training allowed me to hide behind a false reality. I believed that some outcomes in medicine are just inevitable: that people with T2DM are predestined to become progressively sicker until they die an awful death. That is just the way it is.
Liberating and hopeful
But here were four people with T2DM telling me that it does not have to be this way. By just changing their diets, they had managed to reverse all their symptoms. It seemed a reasonable assumption that as long as they continued to follow the LCHF eating plan and their new lifestyle, they would not necessarily die from the arterial complications that had claimed my father. As someone with T2DM, I found this information profoundly liberating and hopeful. That we might finally have an intervention that could truly help patients with T2DM was a revelation. I assumed that my colleagues and peers would embrace the article as an exciting opportunity to try something new to address a problem for which we did not have a solution.
After all, there was nothing to lose, as current treatment methods are pretty ineffective. Imagine, I thought, how much good we could do if we offered this simple, cheap intervention to the millions of South Africans suffering from these harmful chronic diseases. Finally, we could offer hope to our patients with T2DM.
I was underestimating the power of the omertà.
The response was immediate and, in retrospect, predictable. Within a day or two of the article’s publication, then editor of the Mail & Guardian Nic Dawes tweeted to the effect that it was a disgrace for the SAMJ to publish this type of article in the guise of ‘science’.
Lore of Nutrition by Tim Noakes and Marika Sboros can be purchased in all good bookshops.
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