LCHF Diet on Diabetes and Athletes
Last week on the 8th of June we commemorated Noakes Day, a day to recognize The Noakes Foundation’s founder and scientist, Prof Tim Noakes. Prof Noakes is well known for his influences on the scientific community and for his groundbreaking research in South Africa and all around the world. More specifically, he is known for his research on exercise science and sports medicine.
In 2010, he changed his attitude towards the high carbohydrate diet for athletes as he came to the realization that the diet had the potential to harm athletes. Like what has happened to himself, some athletes could eventually become insulin resistant and develop Type 2 diabetes later in their life. Since then, Prof Noakes became one of the biggest promoters of the LCHF diet for the prevention and reversal of Type 2 diabetes and other chronic diseases. In 2018, Prof Noakes was acquitted of all thirteen charges brought up by the Health Professions Council of South Africa (HPCSA) for advocating the LCHF diet online. Furthermore, the LCHF diet is strongly endorsed by Prof Noakes to reverse Type 2 diabetes which he himself was able to accomplish through the implementation of the diet.
Prof Noakes founded The Noakes Foundation in 2012 and with the support of the Nutrition Network (NN) and Eat Better South Africa (EBSA), they work together to educate, advance and understand the role of nutrition. EBSA is a nonprofit organisation working to aid the public healthcare system in local communities through the promotion of nutrition education programs and sustainable dietary changes. NN is an online learning platform for healthcare practitioners and allied healthcare workers seeking to learn more about the LCHF diet. With the efforts of The Noakes Foundation, Prof Noakes aims to fight the stigma created around the LCHF diet and provide the necessary knowledge about the diet in South African communities and worldwide.
Many people will only learn about Type 2 diabetes once they are already diagnosed with the disease and many are prescribed medications instead of focusing on a diet change. Pharmaceutical companies and food companies are mostly the ones that benefit from this misinformation as they continue to profit from people who develop metabolic diseases from their poor diets. The big pharma companies are focused on the treatment aspect of health and lobby about the importance of drugs and medicine throughout the media, however, there is minimal knowledge spread about the importance of prevention of metabolic diseases and the LCHF and ketogenic diet approaches.
A common misconception that Prof Noakes has been battling against in diabetes prevention is that exercise alone can cancel out the risk for metabolic diseases. Exercise has various benefits but living on a high carbohydrate diet consisting of processed and sugar laden foods creates a high risk of developing metabolic diseases that exercise alone cannot prevent. One of the main changes that is needed to prevent such diseases is cutting out these foods since they create an addiction and, as Prof Noakes says on A Whole New Level podcast “obesity is largely based on addictive foods”.
As mentioned before, Prof Noakes was an athlete who developed Type 2 diabetes from consuming a diet high in carbohydrates, which he reversed with the LCHF diet. He now raises awareness among the athletic community of the long-term consequences of high carbohydrate diets. To this day, people still believe carb loading before high-intensity events will improve an athlete’s performance since they will have more glycogen stored and ready to burn. However, Prof Noakes has done extensive research and concluded that in high-intensity exercises, it does not matter if a person is on a high carb or high-fat diet, their performance is likely going to be the same – if they are fat adapted. Thus, this concept of carb loading and creating glycogen storage may be beneficial in the short-term, but eventually it can potentially be detrimental to an athlete’s health as they could become insulin resistant. By following a LCHF diet, athletes can become fat adapted and use fat instead of carbohydrates as their primary fuel which will most likely prevent metabolic diseases in the future. Prof Noakes is trying to change the way LCHF diet is portrayed and set a precedent that it is beneficial to athletes in both short-term and long-term scenarios.
According to Chang et al. (2017), there is some evidence concerning the effects of the LCHF diet on athletes’ performance, depending on the type of exercise. The main benefactors of the LCHF diet are athletes who perform endurance exercises and weight-sensitive sports. A long-term adaptation to the LCHF diet could produce greater metabolic benefits compared to a high-carbohydrate diet. The main benefits include a higher fat oxidation rate, lower carbohydrate oxidation and glycogenolysis, and an increase in VO2 max (the maximum rate of oxygen your body is able to use during exercise). In a study conducted by Volek et al. (2016) on endurance athletes who have been adapted to the LCHF diet for 9-36 months, it was shown that they could reach a maximal fat oxidation rate of 1.5 g/min at about 70% VO2 max. This result is higher than any carbohydrate-adapted endurance athlete has ever reported. In other words, a fat-adapted athlete could be able to use fat as their main fuel source, whereas a carbohydrate-adapted athlete might have to utilize carbohydrate and glycogen reserves prior to their fat. High-level and well-known athletes on the LCHF diet include Paula Newby-Fraser (8-time Ironman winner) and Zach Bitter (ultramarathon runner with World 100 mile and 12-hour record holder). These runners and many others have reported benefits such as improvements in their performance, more control over their body composition, less soreness, and faster recovery. Additionally, in Volek’s study, ultra-endurance athletes on LCHF diets for at least 6 months were able to achieve a higher exercise intensity as they used fat oxidation as their energy source and showed similar muscle glycogen at rest.
Beyond these results, several researchers have suggested that long-term LCHF diets may be just as, if not more, beneficial to endurance performance than high-carbohydrate diets. Therefore, LCHF-adapted athletes may be able to maintain a higher intensity for a longer duration as they preserve muscle glycogen to be used for sprints at later stages of endurance competitions. With the LCHF diet, someone is prone to fat oxidation in the muscles instead of carbohydrate burning, which improves glucose control. Therefore, fat oxidation in the muscles creates a greater resistance to insulin resistance.
In conclusion, Prof Noakes’ theories on LCHF diets and athletic performance have generated both support and controversy within the scientific community. Some studies have shown positive results with LCHF diets in certain endurance activities, while others have not found significant performance improvements. Overall, the research on LCHF diets and athletic performance is complex and evolving. While some athletes have reported positive experiences with LCHF diets, it is essential to consider individual variability, personal preferences, and the specific demands of the sport or activity when determining the most suitable dietary approach.
Chang, C. K., Borer, K., Lin, P. J. (2017). Low-carbohydrate-High-Fat diet: Can it help exercise performance? PubMed Central (PMC). Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5384055/
Clemente, J., Noakes, T. (2023). A low-carb diet may boost exercise performance and health. A Whole New Level [Audio Podcast Episode]. Available online: https://www.levelshealth.com/podcasts/208-a-low-carb-diet-may-boost-exercise-performance-and-health-dr-tim-noakes-josh-clemente
Gifford, B. (2016). The silencing of a low-carb rebel. Outside Online. Available online: https://www.outsideonline.com/health/nutrition/silencing-low-carb-rebel/
Newton, W. (2021). Low carb workout nutrition. Limitless Fitness Coaching and Education. Available online: https://limitlessfitness.com/nutrition/low-carb-workout-nutrition/
Woo, G., Olonan, Z. (2019). Hi, Fat: Challenging Carbohydrates, Brain-body Connection, & Reversing Diabetes ft. Prof Tim Noakes. HVNM [Audio podcast episode]. Available online: https://hvmn.com/blogs/podcast/hi-fat-ft-dr-tim-noakes-ep-114
Volek, J.S., Freidenreich, D.J., Saenz, C., Kunces, L.J., Creighton, B.C., Bartley, J.M. et al. (2016). Metabolic characteristics of keto-adapted ultra-endurance runners. Metabolism. 65:100–110. Available online: https://www.metabolismjournal.com/article/S0026-0495(15)00334-0/fulltext
About the author: Bruno Figueiredo Correa de Araujo
Bruno is a fourth-year undergraduate student at the University of Florida in the United States, studying Health Sciences. He is a pre-medical student, intending to attend medical school and pursue a future career in the field of sports science and orthopedics. He is currently interning with The Noakes Foundation, learning about public health in Cape Town, South Africa and the nutritional approach to chronic disease in under-resourced communities, such as Du Noon and Gugulethu, led by Eat Better South Africa. Bruno is interested in global health, sports medicine, and exercise science. He hopes to obtain a better perspective on the impact of nutrition and diet on someone’s lifestyle and thus create an understanding of how it could impact an athlete’s performance so that in the future he can apply this knowledge in his line of work.