Issue 136 book review lore of nutrition

BOOK REVIEW

LORE OF NUTRITION CHALLENGING CONVENTIONAL DIETARY BELIEFS Review by Ursula Arens Writer; Nutrition & Dietetics

TIM NOAKES AND MARIKA SBOROS PUBLISHER: PENGUIN BOOKS 2017 ISBN: 978-1776092611 AMAZON: KINDLE £9.99, PAPERBACK £14.99

Ursula has a degree in dietetics, and currently works as a freelance nutrition writer. She has been a columnist on nutrition for more than 30 years.

I love the science of nutrition and I love reading books. What could be more enjoyable than reviewing nutrition books; something I have been privileged and delighted to do for many years

52

But this book has been a grinding hard uphill task and a slap-in-theface challenge. Never has reviewing a book left me so sad and confused. It is a very difficult book for dietitians, (although difficult is never a reason not to do something, of course.) The Lore of Nutrition is a pivotal text for any within our profession who want to delve deeper into many of the debates on diet currently splashed across old media and new media. Whatever opinions you have before reading this book, you will be changed and you will be better able to address and understand some of the critiques of dietetics.

The book is a blend of science writing, autobiography, dramatic court proceedings, all woven around fierce debates about diet. Professor Tim Noakes is now a nutrition celebrity. He is a man of intelligence and integrity and together with journalist Marika Sboros, he presents his case for the populationwide adoption of the Low Carbohydrate High Fat (LCHF) diet. Be warned: there is some danger of conversion.

The in-a-nutshell summary is that Tim Noakes, Professor of Exercise and Sports Science at the University of Cape Town in South Africa and prolific producer of top-rated scientific data, had a ‘damascene moment’. He decided that his many previous books and research

www.NHDmag.com July 2018 - Issue 136

papers supporting carbohydrate fuelling of sports were completely wrong. His scientific U-turn was confusing and alarming for professional colleagues and huge respect for him turned to public denunciation and aggressive hounding. A tweet he sent supporting LCHF as a weaning diet was the hair-trigger that led the Association for Dietetics in South Africa (ADSA) to formally make a complaint to the Health Professions Council of South Africa (HPCSA). The court case was a three-year battle (through expensive lawyers) between Tim Noakes and the South African dietetic profession. In April 2017 the verdict, ‘Not Guilty’, was announced and South African dietitians were left financially drained and publicly humiliated. This book is the winner’s account.

About half of the book, pages 5-200, is about the Low Carb revolution. This section describes the early career of Tim Noakes, his sudden and dramatic professional U-turn on carbohydrates and the increasing antagonism from his colleagues. Academics at the University of Cape Town strongly opposed the views he expressed in professional arenas, but were even more condemnatory when he wrote a chapter in a bestselling cookery book: The Real Meal Revolution. When Tim Noakes

was invited to address a health committee at the South African Parliament, colleagues were furious. A public debate was held at the University, where he pitched against Professor Rossouw, who led the most expensive-ever trial examining low fat diets; the US Women’s Health Initiative (WHI) study. Clearly the debate did not settle disagreements, so a flurry of letters were sent from the University to national South African media, warning about the errant Noakes.

An increasing band of Tim-supporters organised and funded a Low Carb conference in February 2015 and suddenly nutrition professionals in South Africa had to address issues raised about low carbohydrate diets on a daily basis in every clinic.

The next section of the book, pages 201-304, is entitled, ‘Nutrition on Trial’. There are many descriptions about the court hearings from June 2015 to closing arguments in April 2017.

Dietitian readers may consider skip-reading these sections, although actually legal aspects of debate provide the most vital descriptions of the-how and the-why decisions are made when medical professionals are in dispute. Was the Tim Noakes tweet unprofessional? Judgments were ‘No’, because health professional communication via twitter was not defined in HPCSA articles.

Another reason for the verdict was because his response was to a ‘we’ not ‘I’ question (the category of breastfeeding mothers and to-beweaned babies rather than the individual case), so a doctor-patient relationship was not proven.

The 99% of scientific information about LCHF diets presented at the trial describing populationwide benefits or risks in adults relating to weight or diabetes control, was ruled not relevant to the charge (inappropriate advice for weaning).

Tragically, there is now legal record against the profession of dietitians, although many important issues of professional practice could not be considered in this case.

The final section, pages 305-379, is a review of the science on LCHF diets, and Tim Noakes’ concluding thoughts after the trial. There are many long and detailed descriptions of benefits of LCHF diets and sharp critique of conventional advice supporting low fat diets. Of course Tim Noakes cherry-picks (he cannot be accused of high-carb cherry-eating, of course). I was

alarmed about his observation within the WHI study of significant increased (relative) risk of further heart attack in women consuming low fat diets who had previously suffered a heart attack, compared to women on placebo/normal diets.

Most shocking was the defending statement by Professor Rossouw that this was a printing error, so not mentioned in the abstract.

Tim Noakes challenges current practice on many things: benefit of low fat diets, links between dyslipidaemias and heart disease risk, advice to athletes on hydration, advice on population-wide salt reduction, benefits of statins in primary prevention of heart disease, the validity of the concept of Calories In Calories Out (CICO), benefits of ‘wholegrain’, and many other consensus themes within healthcare. He claims that 60% of the (South African) population is insulin resistant and that significant carbohydrate reduction is the only way to prevent this and treat this.

Dietitians are not bad, says Tim Noakes.

But they are over-influenced by the intricate web of industry-led ties that blind and bind their professional practice. Their responses to professional challenges are, ‘kneejerk.’ Many dietitians are decent enough although, ‘… ignorant, fearful and suffer from prolonged bouts of cognitive dissonance.’ And dietitians are incestuous: ‘a coterie of mostly privileged white females from similar middle-class cultural and conservative backgrounds; a closed shop of mostly friends, or friends of friends.’ A final barb is that many appear to be, ‘undeclared vegetarians or vegans pushing planet-based agendas: without evidence and with significant industry ties.’

This book is about the before and the after and the ‘meat’ of the biggest trial brought by the profession of dietitians. The trial was triggered by questions of the-who and the-how of nutrition advice, driven strongly by legally defining of doctor/dietitian-patient relationships, and whether previous practice rules apply in social media messaging.

The scientific debates on low fat or high fat diets are still wide open, but an obvious conclusion is that these should be battled in every venue, bar law courts (even bars near law courts are OK). www.NHDmag.com July 2018 - Issue 136

53