At The Noakes Foundation (TNF), we are committed to advancing scientific research and community health programs that challenge conventional dietary guidelines, especially in communities most vulnerable to non-communicable diseases like Type 2 Diabetes (T2D), obesity, and cardiovascular diseases. Over the past year, our collaboration with Eat Better South Africa (EBSA) and the Dunoon Community Health Center has brought about significant change, particularly within the Dunoon community in Cape Town.

The majority of patients visiting the Dunoon Clinic are residents of the Dunoon community itself, reflecting the critical role this healthcare facility plays in serving the local population. Dunoon is a densely populated township located in the northern suburbs of Cape Town, South Africa, characterized by a mix of formal and informal housing. Despite ongoing development efforts, many residents face challenges such as overcrowding, limited access to basic services, and high unemployment rates, reflecting the broader socioeconomic disparities present in post-apartheid South Africa.

This clinic, like many others in similar urban townships, often operates under resource constraints while striving to address a wide range of health issues prevalent in the community, including infectious diseases, chronic conditions, and maternal and child health concerns.

This week, the teams from TNF and EBSA had the opportunity to return to the Dunoon Community Health Center to present the results of our year-long study to the clinic’s staff and leadership. The study, conducted in partnership with EBSA, focused on assessing the effectiveness of the EBSA nutrition program in improving metabolic health among T2D patients and those identified as at-risk for diabetes through a mixed-method approach.

Study Overview

The primary objective of the study was to evaluate the impact of a low-carbohydrate, high-fat (LCHF) diet on metabolic health markers in individuals already diagnosed with T2D or at risk. Alongside this, we aimed to explore behavioural changes, and barriers to healthier eating habits, and to assess the sustainability of these changes over time. The program, facilitated by EBSA, provided nutrition education and practical guidance for improving health through dietary changes, all while focusing on food access and affordability. The study, which began in early 2023, recruited participants from the Dunoon Clinic and conducted a year-long intervention involving food education, blood tests, blood pressure and body measurements, diet assessments, focus group discussions, and key informants interviews.

Results in the Community

Participant Demographics:

The study began in March 2023 with 23 participants from the Dunoon community, ranging in age from their mid-40s to late 50s. All participants were either diagnosed with T2D or identified as at-risk based on clinical history. Through a series of 25 EBSA-led sessions over a year, 17 participants completed the program, with 67% attending between 18 to 24 sessions.

Health Outcomes:

• Dietary Improvements: Many participants moved away from refined carbohydrates and sugary foods towards nutrient-dense proteins such as fatty meats, eggs, and healthy fats. Although financial constraints meant that some participants still struggled to maintain these healthier habits long-term, the overall dietary shift was clear. Participants significantly reduced their intake of ultra-processed foods, sugary snacks, and fast foods.
• Blood Markers: Initial tests revealed elevated HbA1c levels, with participants averaging 9.5-9.7%—significantly above the normal range. Following the program, men saw a substantial drop in HbA1c levels immediately, while women experienced a slower, more gradual reduction. However, by the one-year mark, HbA1c levels had returned close to baseline, indicating the need for sustained support in these communities.
• Body Measurements: For women, significant reductions were observed in body weight and waist circumference post-intervention. While men experienced some weight gain, this was often aligned with personal health goals, such as increased muscle mass or improved fitness.
• Blood Pressure: Women saw notable reductions in blood pressure, with systolic readings improving by 13.1 mmHg and diastolic readings improving by 7.6 mmHg. By the one-year follow-up, blood pressure in women continued to improve, while men’s results remained relatively unchanged.

Key Insights

During the group discussions, participants mentioned that they faced numerous challenges, many of which centered on affordability and access to healthier foods. These barriers underscored the importance of community support and long-term educational programs. The emotional burden of managing a chronic condition like diabetes also emerged as a significant factor. Participants shared stories of isolation and stigma, yet also expressed gratitude for the newfound knowledge and support from the EBSA team.

The need for ongoing, accessible education and tools for self-monitoring was evident from this study’s findings. Participants requested more practical tools, like blood sugar monitoring equipment, to track their progress independently. Furthermore, it became clear that group support played a crucial role in sustaining healthier habits, suggesting a need for community-driven models that continue beyond the scope of short-term interventions.

Moving Forward: Next Steps

The presentation at the Dunoon Clinic was a pivotal moment for reflecting on the successes and challenges of the program. As we look to the future, TNF and EBSA will work with the clinic and other stakeholders to develop sustainable models for supporting T2D patients long-term. This includes plans for additional workshops, regular health assessments, and continued access to nutritional education for both patients and healthcare providers.

In the coming months, we will be launching new projects in Dunoon, focusing not only on T2D management but also on broader health challenges facing the community such as HIV/AIDS and Tuberculosis. These initiatives will build on the insights gathered from this study and seek to create even more impactful, scalable solutions for managing diet-related diseases in underserved populations.

We are grateful to the Dunoon Community Health Center, the participants, and our supporters who made this research possible. Together, we are building a future where communities are empowered with the knowledge and resources needed to live healthier lives.

Stay tuned for updates on our future projects and partnerships in Dunoon and other communities across South Africa.