Just Read: Tim Noakes and Marika Sboros – Lore of Nutrition: Challenging Conventional Dietary Beliefs

Wow.

I first learned about this story, happening a continent away, about a year ago.

My reaction was:

  • Is this really happening?
  • Over a tweet?
  • Who is Tim Noakes?

Since then, I have learned who Tim Noakes (@ProfTimNoakes) is, as well as co-author Marika Sboros (@MarikaSboros), as I have delved into the latest science around nutrition and connected with many in this community (see: Adventures at Low Carb San Diego )

I still can’t believe this happened over a tweet. So when I learned this book was out I pushed every other book on my list aside.

This story has it all, and not in a good way.

Professional bullying

I have been bullied professionally. My medical ancestors have been too. Still happens to me from time to time. But nothing like this.

I now know that Noakes is an acclaimed physician and scientist, of the highest magnitude (with an H-index of 70 and one of 40 for publications exclusively on nutrition), also an author and change agent. The last two identities seemed to be the ones that didn’t sit well with legacy academia and multiple professions.

The result was a bringing up on charges and a three year trial. Over a tweet. About nutrition.

The story shows that the tweet was the vehicle for a bigger planned action.

The profound misunderstanding of social media

Several experts for the prosecution professed to never have used social media, and it showed. This lack of understanding of how social media works reflects on the reputation of the prosecution, not the defendant. Academia is supposed to bring knowledge to the world, including how communication works. It’s a cautionary tale, whose pitfalls could be avoided by following the advice given by the defendants (see the quote from Nina Teicholz below).

Vorster also criticised Noakes for his ‘inappropriate’ use of Twitter as a communication medium, yet she admitted that she knew little about the popular social network. That was an understatement. Vorster said that she had ‘just sort of looked in Wikipedia’ to find out about it.

Noakes, Tim; Sboros, Marika. Lore of Nutrition: Challenging conventional dietary beliefs (Kindle Locations 5464-5467). Penguin Random House South Africa. Kindle Edition.

Disturbing conflicts of interest

In my mind, the most incriminating evidence against Armstrong was not what he said; it was what he failed to say. Not once did he complain that other cyclists were doping. If he was truly competing without the aid of drugs, surely he should have emphasised repeatedly that he was winning despite competing at a significant disadvantage? But he never did, confirming his guilt – to me, at any rate.

Noakes, Tim; Sboros, Marika. Lore of Nutrition: Challenging conventional dietary beliefs (Kindle Locations 276-279). Penguin Random House South Africa. Kindle Edition.

Big Food vs. Tim Noakes: The Final Crusade | THE RUSSELLS

Noakes showed how dietitians’ associations and their members globally help food and drug companies to ‘health-wash’ products. Health-washing is a particularly iniquitous activity in which companies use dietitians to give a veneer of respectability to their products by suggesting their health benefits.

Noakes, Tim; Sboros, Marika. Lore of Nutrition: Challenging conventional dietary beliefs (Kindle Locations 6318-6320). Penguin Random House South Africa. Kindle Edition.

Indeed, this article written by a registered dietician for the South African Sugar Association. Note the header image.

The Science

You can’t ask for a better reason to fully and completely understand what is known about a topic than to be put on trial for it for 3 years. And when the defendant is an internationally acclaimed scientist, well then…

Even though the prosecution sought to not make this the nutrition trial of the century, they made it the nutrition trial of the century.

And here’s what happened in the last century

Clipping these for convenience and to respect copyright. Peer reviewed analysis is below these.

For a more complete analysis: Cohen E, Cragg M, deFonseka J, Hite A, Rosenberg M, Zhou B. Statistical review of US macronutrient consumption data, 1965-2011: Americans have been following dietary guidelines, coincident with the rise in obesity. Nutrition [Internet]. Elsevier; 2015 May 1 [cited 2017 Dec 4];31(5):727–32.

Another finding of meaning that I learned about was the Israeli paradox (where my family hails from) – a population whose history shows the devastating results of the replacement of saturated fats with polyunsaturated ones. This shouldn’t have happened – Israel was where I tried LCHF eating for the first time, ending my vacation at a lower weight than when I started.

The book alternates between the investigative reporting of Sboros (a journalist by trade) and scientific review by Noakes. I found the contrast in style engaging, especially from an innovator perspective.

On the afternoon of Friday 21 October, with Noakes’s evidence and relentless cross-examination now over, Zoë Harcombe (@zoeharcombe) embarked on the ritual slaughter of many nutrition sacred cows.

Noakes, Tim; Sboros, Marika. Lore of Nutrition: Challenging conventional dietary beliefs (Kindle Locations 6599-6600). Penguin Random House South Africa. Kindle Edition.

Noakes states another book is coming with a deep dive into the science. As it is stated, he has the authority with which to write it:

Noakes himself had spoken for almost 40 hours, showing 1 163 slides and citing 354 publications and other materials, from RCTs to anecdotal evidence. Ramdass broke it down: Noakes had drawn on 47 RCTs; 28 intervention trials/ laboratory experiments; 11 meta-analyses; 77 observational studies; 78 review articles; 24 editorials; 15 books; 48 newspaper articles/ media reports/ blogs; 14 position stands/ statements; 8 letters; 3 videos; and a PhD thesis. In contrast, the HPCSA’s witnesses had come up with little more than a single meta-analysis, the flawed Naudé review.

Noakes, Tim; Sboros, Marika. Lore of Nutrition: Challenging conventional dietary beliefs (Kindle Locations 7187-7194). Penguin Random House South Africa. Kindle Edition.

Ironically, the attempt to quash Noakes spread his ideas farther. Which is what usually happens. If the ideas were wrong, and it was in the best interest of the population to deliberate over them, the strategy to do so was laid out by the defense, in this case Nina Teicholz (@BigFatSurprise):

‘What, then, is the response by experts?’ she asked rhetorically. ‘To deny his work, to make fun of him, to pretend his work is full of errors, instead of reckoning with him and saying: “Okay, here are a number of observations that our hypothesis does not explain. We need to explain it.”’

Noakes, Tim; Sboros, Marika. Lore of Nutrition: Challenging conventional dietary beliefs (Kindle Locations 6943-6945). Penguin Random House South Africa. Kindle Edition.

Empathy

I was trained in the (US) specialty of family medicine (see this series that I wrote: I am family physician, what does it feel like in the decade of the patient), which of the medical specialties is probably closest to interdisciplinary training with the other health professions.

In this story, told from the perspective of the (victorious) defendant, I see the tension between allied health and physician class, who are charged with implementing and creating science-based health policy and interventions.

It’s unfortunate for all, because the tension should really be between “bad health” and “good health.” Easily said by an observer 13,000 km away. In several posts on this blog, I’ve recounted how the US dietary guidelines touched me as a doctor-in-training and as a human. I marvel at how much control was placed in the hands of so few people, with so little control on their behavior.

I thank Noakes and Sboros (and to an extent the HPCSA and ADSA, in the hopes that they’ve learned something) for sharing this story about innovation. This is a most extreme (times 100) version of what most physicians/scientists/professionals will likely experience. Nutrition is that emotional.

Something that Noakes’ wife said to him about all the great people they met along the way (read the quote for yourself 🙂 ) reminded me of my own experience in a professional journey that’s included interacting with transformational leaders who have been ridiculed, sidelined, threatenend. I have said, “I wish this experience on every nurse and doctor in their lifetime.” We will all be better for it.

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