“How come no one ever asks if sugary breakfast cereal, grape juice, and white bread w/ margarine is “safe for kids?” We have entered bizarro world when we’re asking if it’s safe for kids to not eat sugar.”
~ Amy Berger
How come no one ever asks if sugary breakfast cereal, grape juice, and white bread with margarine is “safe for kids?” We have entered bizarro world when we’re asking if it’s safe for kids to not eat sugar or carb-load like they’re about to run a marathon. As I explain here, there is nothing — no vitamin, mineral, or other essential nutrient — that you can get from high-carb foods that you cannot get from LOW-carb foods.
This reminds me of the case brought against Tim Noakes. He recommended a low-carb diet to a pregnant woman. Public officials considered it to be a crime against humanity that must be harshly punished. After the first attack on him failed, he was forced to endure a second trial. The government spent millions of dollars persecuting him and he not only proved his innocence but proved that the low-carb diet was scientifically valid. It was the greatest boost for the low-carb diet since Ancel Keys led his crusade against it.
Professor Noakes Found Innocent (Again)!
from Nutrition Coalition
Lore of Nutrition
by Tim Noakes & Marika Sboros
pp. 32-34, Introduction by Marika Sboros
(see more at: The Creed of Ancel Keys)
This is the story of a remarkable scientific journey. Just as remarkable is the genesis of that journey: a single, innocuous tweet.
In February 2014 , a Twitter user asked a distinguished and world-renowned scientist a simple question: ‘Is LCHF eating ok for breastfeeding mums? Worried about all the dairy + cauliflower = wind for babies??’
Always willing to engage with an inquiring mind, Professor Tim Noakes tweeted back: ‘Baby doesn’t eat the dairy and cauliflower. Just very healthy high fat breast milk. Key is to ween [ si c ] baby onto LCHF.’
With those few words, Noakes set off a chain of events that would eventually see him charged with unprofessional conduct, caught up in a case that would drag on for more than three years and cost many millions of rands. More difficult, if not impossible, to quantify is the devastating emotional toll that the whole ordeal has taken on him and his family, as critics attacked his character and scientific reputation at every turn.
At the time, it was open season on Tim Noakes. Doctors, dietitians and assorted academics from South Africa’s top universities had been hard at work for years trying to discredit him. They did not like his scientific views on low-carbohydrate, high-fat foods, which he had been promoting since 2011 . His opinions contrasted sharply with conventional, orthodox dietary ‘wisdom’, and the tweet provided the perfect pretext to amp up their attacks and hopefully silence him once and for all.
Within 24 hours of his tweet, a dietitian had reported him to the Health Professions Council of South Africa for giving what she considered ‘incorrect’, ‘dangerous’ and ‘potentially life-threatening’ advice. To Noakes’s surprise, the HPCSA took her complaint seriously.
Noakes is one of the few scientists in the world with an A 1 rating from the South African National Research Foundation (NRF) for both sports science and nutrition. In his home country, he has no equal in terms of expertise in and research into LCHF. Few can match his large academic footprint – quantified by an H-index of over 70 . The H- or Hirsch index is a measure of the impact of a scientist’s work. Noakes’s impact is significant. He has published more than 500 scientific papers, many of them in peer-reviewed journals, and over 40 of which deal exclusively with nutrition. He has been cited more than 17 000 times in the scientific literature.
Yet, remarkably, the HPCSA chose to back the opinion of a dietitian in private practice over an internationally renowned nutrition research scientist. They charged him with ‘unprofessional conduct’ for providing ‘unconventional advice on breastfeeding babies on social networks’ and hauled him through the humiliating process of a disciplinary hearing.
The public quickly dubbed it ‘the Nutrition Trial of the 21 st Century’. I’ve called it Kafkaesque. The HPCSA insisted that it was a hearing, not a trial, but the statutory body’s own conduct belied the claim.
At the time of Noakes’s tweet, I wanted to give up journalism. After more than 30 years of researching and writing about medicine and nutrition science, I was frustrated and bored. People were growing fatter and sicker, and the medical and dietetic specialists I wrote about weren’t making much difference to patients’ lives. Neither was my reporting.
Then I started investigating and writing about the HPCSA’s case against Noakes. The more questions I asked, the more walls of silence came up around me, and from the most unexpected sources. There’s an old saying that silence isn’t empty, it is full of answers. I found that the silence was loudest from those with the most to hide. I could not have foreseen the labyrinthine extent of vested inter ests ranged against Noakes, or the role played by shadowy proxy organisations for multinational sugar and soft-drink companies in suppressing and discrediting nutrition evidence.
It took a US investigative journalist to join many of the dots I had identified. Russ Greene’s research led to the International Life Sciences Institute (ILSI), a Coca-Cola front organisation. In an explosive exposé in January 2017 , Greene showed how the ILSI has worked to support the nutrition status quo in South Africa, as well as the health professionals and food and drug industries that benefit from it. It has opened a branch in South Africa and has funded nutrition congresses throughout the country. It has also paid for dietitians and academics opposed to Noakes and LCHF to address conferences abroad . *
Of course, it might be coincidence that so many doctors, dietitians and academics with links to the ILSI became involved, directly and indirectly, in the HPCSA’s prosecution of Noakes. Then again, maybe not.
The HPCSA’s conduct throughout the hearing and since its conclusion has been revelatory. To a large extent, it confirms the premise of this book: that those in positions of power and influence in medicine and academia were using the case to pursue a vendetta against Noakes. The trial highlighted the inherent perils facing those brave enough to go against orthodoxy.
Tim Noakes: The Quiet Maverick
by Daryl Ilbury
Into this turgid culture of food and identity stepped Tim Noakes on 5 February 2014, when he replied to a question posted two days earlier on Twitter, addressed to him and Sally-Ann Creed, a nutritional therapist (and co-author with Noakes of The Real Meal Revolution ). It was from a breastfeeding mother, Pippa Leenstra: ‘Is LCHF eating ok for breastfeeding mums? Worried about all the dairy + cauliflower = wind for babies??’ Noakes’s reply was the following: ‘Baby doesn’t eat the dairy and cauliflower. Just very healthy high fat breast milk. Key is to ween [ sic ] baby onto LCHF.’
It’s neither an offensive tweet by any stretch of the imagination, nor does it fall foul of any media law – it’s not libellous and there’s no encouragement of harm to others. People could disagree with him and had a voice to do so; that’s the point of social media: it is a platform for public discussion. And people did disagree, quite vocally, and there were others who supported his advice, equally vocally. Importantly, the question demanded a public, not private, response, which the person asking the question was free to accept or reject. And, as a medical doctor, Noakes didn’t cross any ethical boundaries in replying on a public platform. He didn’t publish any confidential patient information or dispense a diagnosis for a specific patient without seeing that patient; he simply provided generalised nutritional advice based on scientific evidence. Breast milk is high in fat, and there is scientific evidence to support the benefits of an LCHF diet. There is also evidence to the contrary, but, as we’ve realised, that’s science for you. The secret in making sense of science is context, and this is where it clashes with social media.
The character limitation of Twitter is one of its selling points; it demands concise expression, a sub-editor’s dream. It also means that tweets can be short on context, unless accompanied by click-through links to supporting evidence. Therefore tweets can be open to interpretation. However, this misses the main point of the brevity of Twitter messages: they are designed to encourage debate. Whether Noakes should have said ‘Key is to wean a baby …’ as opposed to ‘Key is to wean baby …’ is a matter for retrospective semantic debate. The fact is he provided a broad opinion on a public platform as a scientist and researcher of human nutrition.
Importantly, in her original tweet, to which Noakes replied, Pippa Leenstra never referred to herself or her baby. She spoke of ‘breastfeeding mums’. She was doing the media equivalent of asking a question in a town hall where the discussion was around LCHF. At that moment, Leenstra was a media consumer of medical or health information.
Not everyone saw it that way. One of those was Claire Julsing-Strydom, who at that time was president of the Association for Dietetics in South Africa (ADSA), the professional organisation for the country’s registered dietitians. Julsing-Strydom’s reaction was to register a complaint with the Health Professions Council of South Africa. It was a decision that would effectively threaten to destroy Noakes’s career, and make Julsing-Strydom the focus of a social media witch-hunt.
According to its website, the HPCSA provides the public with the right to request an investigation of any registered health practitioner whom they believe has acted unethically or caused harm. The site includes a downloadable form and an email address for Legal Med, the department within the HPCSA that handles complaints. To make sure that no health professional is a victim of a truculent member of the public with a hefty doctor’s bill in one hand and an axe to grind in the other, there is a due process of investigation and assessment before any measure of disciplinary action is followed. Only the most serious cases demand a professional-conduct committee hearing, which is what Tim Noakes would be called before.
As I said at the beginning of this book, I am not going to go into the trial in detail; instead, I will focus on the following: the complaint, the charge that resulted, two key components in the case against Noakes, and the unexpected outcome of the hearing. The main focus will be on how this was all covered in the media.
By now you know that whereas content is king, context is King Kong, and in this case the context behind the complaint makes for interesting reading, for two reasons: firstly, it shows that Noakes’s tweet was judged in isolation, and, secondly, it suggests that the complaint may not have been thought through.
What most people may not know is that directly after Noakes’s reply on Twitter to Pippa Leenstra, someone else entered the discussion: Marlene Ellmer, a paediatric dietitian and someone well known to Julsing-Strydom. Ellmer tweeted the following: ‘Pippa, as a paeds dietician I strongly advise against LCHF for breastfeeding mothers.’ Leenstra replied by posing the following question to both Noakes and Ellmer: ‘Okay, but what I eat comes through into my milk. Is that not problematic for baby and their winds at newborn stage?’ Ellmer responded by tweeting another message with her email address, encouraging Leenstra to contact her directly. Noakes didn’t do this, which is important to note, as we shall soon see. Leenstra tweeted to Ellmer that she would contact her, and after the discussion played out further with various people providing input, Leenstra tweeted: ‘Thanks, but I will go with the dietician’s recommendation.’ This she did, rejecting Noakes’s LCHF suggestion.
Let’s summarise: at that point Leenstra had posted a question on a public forum, received different opinions, including from two health professionals – one of them a registered dietitian – and been provided with the contact details of one of those professionals with an invite to get hold of her. Leenstra was free to choose which one to follow up with, and she agreed, publicly, to contact the registered dietitian. Theoretically, things could have stopped there.
However, the day after Ellmer’s invite for Leenstra to contact her, Julsing-Strydom entered the discussion and reacted with a tweet directed to Noakes, written thus: ‘I AM HORRIFIED!! HOW CAN YOU GIVE ADVICE LIKE THIS??’ For those unfamiliar with the idiosyncrasies of social media, the use of uppercase letters is normally reserved to express a strong feeling of annoyance, displeasure or hostility. On its own, Julsing-Strydom’s use of uppercase in a tweet is perfectly acceptable; it shows how she must have felt reading Noakes’s tweet, and there are possible reasons for that. Firstly, she had a four-month-old daughter she was breastfeeding, so she had a personal as well as a professional interest in the topic under discussion. Secondly, as she would later testify, she had had a strongly worded engagement the previous month with Noakes over what she saw as his dispensing nutritional advice to breastfeeding mothers during a talk. It’s easy to imagine that for Julsing-Strydom the tweet was the last straw, and so she submitted her complaint, including screenshots of Noakes’s tweet, to Legal Med. The accompanying email read:
‘To whom it may concern. I would like to file a report against Prof Tim Noakes. He is giving incorrect medical [nutrition therapy] on Twitter that is not evidence based. I have attached the Tweet where Prof Noakes advises a breastfeeding mother to wean her baby on to a low carbohydrate high fat diet. I urge the HPCSA to please take urgent action against this type of misconduct as Prof Noakes is a celebrity in South Africa and the public does not have the knowledge to understand that the information he is advocating is not evidence based. It is specifically dangerous to give this advice for infants and can potentially be life-threatening. I await your response. Claire Julsing-Strydom.’
The wording is a little breathless, and the reason for that would emerge in the hearing.
The complaint contains many factors that Legal Med would have considered, but five pertain to focus points covered so far in this book: the limits to the public’s understanding of science, in this case that of human nutrition; the complexity and unreliability of academic research behind that science; the media profile of Tim Noakes, and the idea that he is a ‘celebrity’; that the complaint related to something said within a disrupted media environment; and the suggestion that nutritional advice is a clear-cut case of right or wrong.
What the legal department would have known when they received the complaint was that the complainant was another health professional; this wasn’t just someone with a beef about their proctologist having cold hands. This meant that the complainant would have understood the potential outcomes of submitting her complaint, especially one claiming that an act by a fellow health professional was ‘life-threatening’. The fact of the matter is that Legal Med saw sufficient seriousness in the complaint to investigate.
However, inconsistencies in Julsing-Strydom’s complaint soon came to light. She supposedly submitted it on behalf of ADSA, and yet didn’t make that clear in the complaint. When questioned in the HPCSA hearing that her complaint triggered, she replied that it was the first time she had registered a complaint, saying, ‘I was not aware that this email would actually be, you know, used at this level.’
Now, after 30 years of interviewing people for the media, if there’s something I’ve learnt it’s that the most honest comments are usually unconsidered – made as an aside, when thoughts are wandering, or if a little flustered. Perhaps, I thought, Julsing-Strydom hadn’t really thought through what was going to happen once she submitted the complaint.
Furthermore, a forensic analysis of Twitter timelines and the submission date and time of the complaint shows that Julsing-Strydom publicly expressed her horror on Twitter on 6 February 2014 at 07:48, and sent her email to Legal Med less than an hour later, at 08:47. It’s fair to say that Julsing-Strydom was upset when she wrote that email.
Based on the findings of a preliminary committee of inquiry, the legal department of the HPCSA sent a letter to Noakes on 28 January 2015, saying that he was to be summoned before the Professional Conduct Committee of the Medical and Dental Professions Board. The charge against him was attached to the letter, and it makes for puzzling reading: ‘That you are guilty of unprofessional conduct, or conduct which, when regard is had to your profession is unprofessional, in that during February 2014, you acted in a manner that is not in accordance with the norms and standards of your profession in that you provided unconventional advice on breastfeeding babies on social networks (tweet).’
It is so badly written that it would send any sub-editor reaching for a stiff shot of whisky, so it was invariably presented in the media thus: ‘charged with providing unconventional advice on social media to breastfeeding mothers’.
When I first read the charge, that part about ‘social networks’ intrigued me the most. Providing advice on a public social media platform is an ethical catch-22 for any clinician: if they provide generalised information, they can be accused of not taking into consideration the specifics of the patient; yet if they ask for specifics, they risk encouraging the sharing of confidential information on a public platform. There’s also the ethical conundrum that if they open a consultative dialogue with someone other than a patient, they can be charged with supersession, essentially ‘stealing’ a patient; and for the HPCSA, that is grounds for discipline. How is that for irony?
I sensed confusion in the poorly worded charge. On a hunch I contacted the HPCSA and asked for a copy of their guidelines for how registered health practitioners should engage with the public on social media – if the HPCSA were charging Noakes because of his use of social media, they’d obviously have the necessary guidelines in place. I received the following reply: ‘Kindly note that the HPCSA doesn’t have guidelines around how registered health practitioners should engage with the public on social media.’ The HPCSA was clearly in unfamiliar territory. I thought it didn’t bode well for a speedy, clear-cut course for the hearing; and I was right.
What started on 4 June 2015, and was supposed to be wrapped up in little over a week, would drag on for almost two years, and if its aim was to deliver a swift, unsparing and public reprimand of a dissident scientist, it failed.