It is the sound of silence from friends that is most painful, maintain Professor Tim Noakes and his wife Marilyn.
"I learned the truth – that the greatest hurt comes not from your enemies but from the silence of those you consider your friends," said Noakes. "In my naivety I believed the medical profession to be a caring profession," said his wife.
'Guilty of unprofessional conduct'
For a brief period Noakes was unfairly and mistakenly branded guilty of unprofessional conduct.
It was a Friday afternoon and Noakes was on his way home when he heard about the announcement made by the Health Professionals Council of South Africa (HPCSA). But by the time he reached home it became clear the HPCSA made a cardinal error, he said.
"This 'trial' was never about the tweet"
Noakes has been facing an inquiry over the past year after he advised a mother on Twitter to wean her child on foods low in carbohydrates and high in fat (LCHF), to be in line with the Banting approach. It was lodged by Claire Julsing-Strydom, who was at the time the president of the Association for Dietitics in South Africa.
However, the HPCSA slipped up, stating Noakes was guilty of unprofessional conduct, even before the hearing by its professional conduct committee came to a close.
Noakes is now preparing for a showdown after resolving to take action against the HPCSA. "The timing and the nature of the action is still the subject matter of discussions," his lawyer Adam Pike said.
The dreaded phone call
"I was travelling back from Franschoek with my wife and one of my expert witnesses, Zoe Harcombe and her husband Andy. We had enjoyed a fabulous morning in Franschoek and lunch at La Motte Pierneef Restaurant," explained Noakes as he recalled the moment the news broke.
"On the way home in the early afternoon, we received a phone call telling us that the HPCSA had reportedly found me guilty."
Shortly thereafter messages of support started pouring in from the world over, and after arriving home, Noakes received an email about the HPCSA trying to put out fires.
He felt strangely elated.
"The HPCSA made a cardinal error"
"I immediately understood that this was a major error from which the HPCSA would not be able to recover, however much they tried to spin their error and to apologise. The damage had been done the moment they issued their press release."
Naokes said the fact that the announcement went viral on social media in South Africa and spread across the world within minutes compounded their problem. "It also confirmed the astonishing level of interest both locally and globally in this 'trial'."
To him the HPCSA made a cardinal error. "[It] showed that they had prejudged the outcome 6 months before a decision would be reached. It confirmed to me that this 'trial' was never about providing me with a fair process."
According to him, at all stages, the cards had been stacked in favour of the HPCSA. Noakes noted the council used taxpayer funding for all their costs, they chose the preliminary committee and the final committee to judge the outcome, including deciding to conduct the proceedings as a legal trial rather than a collegial hearing as was the traditional approach.
Honourable moments during the hearing
Noakes said he felt proud to present the science of nutrition and for it to be cross-examined like in a court of law. "This, to my knowledge, is the first time this has ever happened anywhere in the world."
He said he was equally happy to have witness Harcombe and Nina Teicholz argue that there was never any evidence to support the adoption of the 1977 US Dietary Guidelines.
"Teicholz, author of Big Fat Surprise, presented her argument with such conviction that the lawyer for the complainant essentially decided not to cross-examine her – so compelling and irrefutable was her evidence," said Noakes.
He pointed out a crucial point in the hearing was watching Harcombe pick apart all the flaws in the so-called Naude Stellenbosch meta-analysis study of low fat versus low carbohydrate diet studies, which was central to the case against him going ahead.
"She meticulously explained why the 14 meaningful errors in that paper are unlikely due to random chance since almost all favoured the low fat diets. When she corrected those errors, the conclusion of the study was reversed, so that the low carbohydrate diets produced superior weight loss outcomes than did the low fat diets," he explained.
The low carb revolution in SA would have skyrocketed
"Had that finding been correctly reported in July 2014, it is possible that the case against me would never have gone ahead. In addition, if that true outcome had been reported to the general public it is likely that the low carb revolution would have reached an even greater following in South Africa than it has already.
Noakes believes that in the end his team put the current dietary guidelines, and what is being taught at medical schools to doctors and dietitians about nutrition, on trial.
"I think we presented so much compelling evidence – more than 40 hours of testimony including about 6000 pages of scientific testimony – that we were able to show that what is being taught is wrong and is harmful."
A painful realisation
Noakes also highlighted some of the obstacles he had to overcome.
"The low point has been the realisation that this 'trial' was never about the tweet but was a witch hunt, the goal of which was publicly to humiliate me and destroy my credibility as a scientist."
If this had succeeded, he said, it would have been a warning to anyone else who might consider following his lead that it is simply not worth "stepping out of line" and challenging mainstream beliefs.
"Unfortunately a number of astonishing scientists have been silenced in this way in the past 50 years."
Noakes said among them are British scientist Dr John Yudkin, who warned of the dangers of sugar in the 1970s and US scientist Dr Mary Enig who also in the 1970s warned that vegetable oils were dangerous, as they contained trans fats.
"The careers of both were destroyed by their colleagues and by influential scientific bodies who effectively silenced them to the detriment of our health. There are many others. I was not prepared that the same should happen to me."
Marilyn said she found it surreal and unfathomable how this hearing ever came about.
"The hearing has turned out to be an inhumane attack on my husband's integrity"
"It could have been resolved through dignified, collegial discussions with my husband without the need to go the route of a quasi-legal adversarial 'trial', costing huge amounts of money," she said.
"The hearing has turned out to be an inhumane attack on my husband's integrity with the clear intent of humiliating him publicly."
Noakes said, together with Marilyn, he decided to fight his hearing with all his might. "We did so because we knew that what we are saying is the truth, and in the end the truth will always win as Yudkin and Enig showed."
The couple went on to point out what was particularly disheartening.
"The low light was the way in which some of my most senior colleagues, including those from the University of Cape Town's faculty of health sciences – an institution that I have served with distinction since 1976 – turned on me and the manner in which others at the university remained silent, despite the clear injustice that was being done to me," said Noakes.
Marilyn shares these sentiments.
"UCT showed no concern or compassion"
"I am deeply saddened that the senior management of my alma mater, the University of Cape Town, seem to have shown no concern or compassion for my husband's plight," she said.
"[T]he way my husband has been treated by some senior colleagues at the University of Cape Town and elsewhere is anything but caring and lacked any evidence of empathy and emotional intelligence."
In Marilyn's view, they acted without decency, integrity, honesty and even humility.
"This makes me wonder whether or not they are also complicit in the actions against him, even despite my husband having devoting 40 years of his life to UCT."
Prof Bongani Mayosi, dean of UCT's faculty of health sciences, said Noakes continues to be a valued and respected member of staff.
"His contribution to research in the field of exercise science have been widely celebrated and acknowledged – at UCT, nationally and internationally."
Mayosi said after Noakes retired he was appointed as an emeritus professor and senior research scholar.
"As such he continues his low-carbohydrate, high-fat diet research activities and contributes to the education of post-graduate students within the faculty."
Light at the end of darkness
To help her get through the past few months, Marilyn said she draws inspiration by focusing on her two passions – planning and developing their naturalistic-styled fynbos garden and her botanical art paintings – with the generous support of family and friends.
During this taxing period, Noakes said the main challenge they faced were not to lose faith that they would win in the end and that justice would be served, however much they had to suffer to get there.
"We knew that we had to go the full distance or else we would regret it for the rest of our lives. Fortunately we are both fighters who never quit. So there was never any real doubt in my mind that we would make it out to the light at the end of the long months of darkness."
"In the end the truth will always win"
Health24's CyberShrink on Noakes' hearing: