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

September, 2012

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." (Similar 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

July, 2012

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

August, 2014

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

July, 2014

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 "Naudé Report" from Stellenbosch University.

Low Carbohydrate verses Isoenergetic Balanced Diets, for Reducing Weight and Cardiovascular Risk: A Systematic Review and Meta-Analysis. Celeste E. Naudé, 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 advice 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 "Naudé Report" from Stellenbosch University.

The ADSA and the NSSA Jointly Reject Noakes

March, 2016

The Association of Dietetics South Africa and the Nutrition Society of South Africa, join forces and write a four page joint statement on "Low-Carbohydrate Diets." (PDF) without mentioning Dr Noakes or the Banting Diet at all.

"The current available evidence does not support an extreme low carbohydrate diet for reducing risk of disease."

They make the same error the Naudé Report makes by defining low-carbohydrate in a way that suits their purpose. There are three statements. First, that food comes from several sources that provide 100% of your energy. Second, between 45% and 65% of the energy in the diet should come from carbohydrate. Third, that a low carbohydrate diet is less that 45%, and 30% is suggested as a moderate restriction, while 25g per day is described as extreme restriction.

They go on to show that the South African dietary guidelines are similar to guidelines from many countries. (Actually they do themselves a dis-service, the South African Guidelines are much better than any others I've read.)

They try to make several points against saturated fats, they do it badly, showing that they don't really understand fats.

They then state correctly, that "removing saturated fat from the diet and replacing it with refined carbohydrates may be harmful." Exactly. That's why the low fat diet we've been trying to eat for 60 years doesn't work. Dr. Noakes' argument is made precisely, for him. That's the key to Banting's success.

They make a poor and silly case in favour of complex carbohydrates as an excellent source of vitamins and minerals. In fact "healthy whole grains" are a good source of energy, but a very poor source of nutriment, when compared with seafood's, liver, eggs, and dairy products.

Then they talk about infant foods, stating that low-carbohydrate and high-fat diets have been recommended for infants. (Actually by both Dr. Tim Noakes and the NEW pediatric food-based dietary guidelines for South Africa) That guideline suggests continuing to breast feed from six months until 2 years, and feeding the child meat, chicken, fish and eggs every day or as often as possible. So that's a high-fat, low-carbohydrate diet, exactly as Dr Noakes suggested.

"Exclusion of certain foods/food groups from the diet, as is recommended in low carbohydrate high fat diet regimes, increases the risk for nutrient deficiencies. This is a serious concern in infants and young children as such deficiencies could compromise growth, cognitive development and health in general, during a vulnerable life stage." Which is exactly why NOT feeing an infant on grain based foods is a desirable strategy.

The statement makes the excellent point that a low-carbohydrate high-fat diet is more expensive, and that in South Africa poverty is a real concern.

Having made some reasonable points without looking too ridiculous, they then try to attack the main features of the Banting Diet and fall flat on their faces.

There are five statements. The first three of them are incorrect.
(1) Argues that only negative energy balance creates weight loss. (A calorie is a calorie)
(2) Low-carbohydrates diets are not more effective in producing weight loss. (Naudé Review)
(3) On a low-carbohydrate diet people might eat less food and have and energy deficit. (Silly)
(4) Reduced sugar intake especially in drinks is helpful.
(5) Maintaining weight loss requires eating a diet that can easily be sustained.

Finally they plead for the right as health care professionals to advise the public on dietary matters. They oppose "blanket" advice offered to the general public, believing it much better to tailor dietary messages for individuals.

The Baby Food Tweet Trial?

ADSA (Association for Dietetics in SA) president Claire Julsing Strydom laid the charge against Noakes  in February 2014.

The Health Professions Council of South Africa, charged Dr. Tim Noakes in 2015.

The Health Professions Council of SA (HPCSA) which took over the case, had a new lawyer as of February, 2016, and could still not detail the nature of the charges.

The trial began in April 2016, and continued in October, 2016.

New dates for closing heads of argument must be filed by February 22 2017. The parties then have until March 15 to file a reply. The committee would deliberate on the issue and come to a decision between April 6 and 7. Judgment on the matter would be issued on April 21.