The Success of the Banting Diet in S.A.
Prof Hester (Este) Vorster, previous Director of the Centre of Excellence for Nutrition at the North-West University, is a Research Professor in Nutrition at the university, and General Secretary of the Academy of Science of South Africa. Dr Vorster is concerned that the success of the Banting Diet, makes it so much harder to inform the public about the new Food-Based Dietary Guidelines for South Africa, for which she is has been responsible.
Noakes has upset the apple cart. There have been at least five attempts to sink his boat in the last four years. Without success. The ongoing disciplinary procedure, sometimes called the "Banting for Babies Trial" isn't helping to make the case against him. Noakes seems to be going from strength to strength.
Cardiologists Criticize Noakes
After the publication of Challenging Beliefs (2012), eight cardiologists or professors of cardiology joined together to write a public letter objecting to what he wrote. There were two grounds for their complaint.
First, that Noakes denied the value of statins in controlling cholesterol in the blood. Dr. Mpiko Ntsekhe, professor of cardiology at the UCT said; "There is overwhelming evidence of the life saving efficacy of using statins to alter the metabolism of cholesterol." ... "Advising people not to take them is potentially dangerous."
Second, that Noakes goes too far when he recommends in the Banting Diet that people switch to a high-fat and high protein diet. "his diet is contrary to the recommendations of all major cardiovascular societies worldwide." ... "His diet is unproven and may be dangerous for patients with coronary heart disease or persons at risk of coronary heart disease."
I've checked the text of Challenging Beliefs, and Dr Noakes' Banting Diet actually specifies a low-carbohydrate and high-fat diet, and ONLY for those who have insulin resistance. However, and this may be a source of confusion, most doctors would agree with Dr. Jacques Rossouw that insulin resistance affects about 6% of the population, while Dr Noakes claims that insulin resistance is grossly under-diagnosed and affects at least 60% of the population.
Later, Cardiologist Anthony Dalby, in a live debate reported to the Cape Times, decried the Banting Diet as "criminal." (Simlar statements were made about Dr. Robert Atkins.)
Tim Noakes has hit back at critics of his new diet, saying the theory that blood cholesterol and a high fat diet are the causes of heart disease will be one of the greatest errors in the history of medicine.
"It is time to admit that the theory has failed. We need to adopt an open mind if we are ever to discover the real cause [or causes] of the current global epidemic of obesity, diabetes and coronary heart disease, all of which are likely caused by the same factors."
The Heart and Stroke Foundation of South Africa Oppose Noakes
The Heart and Stroke Foundation of South Africa also wrote an open letter in 2012, in support of the cardiologists mentioned above. They say that any diet that reduces kilojoule intake will result in weight loss. They get involved in a silly argument about good fats and bad fats. The sensible part of that discussed replacing saturated fats with unsaturated fats to reduce heart disease risk. (Actually that's not a good idea, it's often increased cancer risk, but 30 years ago it sounded good and was widely accepted.) The silly part was about trans fats, an irrelevant issue. (Noakes is strongly against the use of trans fats.)
They go on to say: "There is no doubt that unrefined or wholegrain carbohydrates are healthy, and protective against certain diseases including cancer."" ... "The real issue is the abundance of refined carbohydrate found in most of the everyday foods we eat. These, together with hidden sugars and fats are the traps found in most processed and convenience foods.
Then they write a strange statement that fully validates what Dr Noakes has said all along. Read this carefully. "In reality, when people cut back on fat, they fill up on foods full of refined carbohydrates (e.g. white bread and sugary drinks) or use fat-free products without the healthy fats and which contain hidden sugars." OK. So we agree, when people eat a low-fat diet, they MUST eat more carbohydrate, because they have to get energy from somewhere.
They go on for several paragraphs claiming that weight control is a complex issue involving many factors including exercise, but not adding anything to the argument.
They make a similar case about heart disease. "Then there is matter of over-simplifying the causes of heart disease. It is common knowledge that the causes of heart disease are multi-factorial, and are not exclusive to only blood cholesterol and a high fat diet as claimed."
The letter is signed by Dr. Bash Mungal-Singh, Chief Executive Officer, of the Heart and Stroke Foundation of S.A.
University of Cape Town Professors Abandon Noakes
Then there was an attempt by four professors at the University of Cape Town to distance themselves from Dr Noakes. They wrote a letter to the Cape Times. They confirmed that 1 in 3 black South African women were obese, which highlighted the importance of the issue. They agreed that the popularity of the Banting Diet proved that it did in most cases allow people to lose substantial amounts of weight.
Their concern was that Dr Noakes was claiming that the Banting Diet could prevent or even reverse a number of serious diseases. In particular they identified his often made claim that Type 2 Diabetes was curable in most people. Dr Larry Distiller, founder and managing director of the Centre for Diabetes and Endocrinology, said there are 4 million people in South Africa who suffer from Type 2 Diabetes, and they should not be told anything that cannot be supported by sufficient scientific literature.
Dean of the Faculty of Health Sciences, Prof. Wim de Villiers, claimed that the Banting Diet was one dimensional, at the expense of healthy carbohydrates, and that a balanced diet must included food from all food groups.
University of Stellenbosch and the Cochrane Collaboration Attack Noakes
Prof. Steyn of the Cochrane Collaboration at the Medical Research council claimed that a formal review of the existing data on weight loss diets was nearly complete and would be released soon. He was referring to the "Naude Report" from Stellenbosch University.
Low Carbohydrate verses Isoenergetic Balanced Diets, for Reducing Weight and Cardiovascular Risk: A Systematic Review and Meta-Analysis. Celeste E. Naude, Anel Schoonees, Marjanne Senekal, Taryn Young, Paul Garner, Jimmy Volmink. (Please download the PDF file it's only 24 pages, and it is readable.)
The background statement reads: "Some popular weight loss diets restricting carbohydrates (CHO) claim to be more effective, and have additional health benefits in preventing cardiovascular disease compared to balanced weight loss diets." The Banting Diet is never mentioned, anywhere in the text. But the whole purpose of the study was to discredit low-carbohydrate diets. Note what Prof. Steyn said before publication.
After publication in the popular press the authors of the study were very happy to decry Dr Noakes and the Banting Diet, claiming that there was no advantage in his diet compared with conventional advise to restrict calories. They declared; "The Banting Diet is no more effective for weight loss than other diets." The results of 19 international scientific trials found the "Banting Diet neither healthier nor better for weight loss than a balanced weight loss diet." This is a serious issue, because it's a deliberate falsification. Here are my comments about the "Naude Report" from Stellenbosch University.