Many in South Africa with an interest in their personal nutrition probably know that I have been called before a hearing of the Health Professions Council of South Africa (HPCSA) to face the charge that I acted unprofessionally because I gave “unconventional advice” on social media (Twitter). Originally it was argued that the “advice” I gave was dangerous but that component of the charge has since been dropped, to be replaced by a more general charge that I breached ethical rules.
The hearing began on Thursday 4th June 2015 but as the HPCSA committee hearing the complaint was incorrectly constituted, the case has been postponed until November 23rd 2015 to allow time for a legally appropriate committee to be assembled. At issue was the HPCSA requirement that, as a General Practitioner, my actions must be judged by my peers in the discipline in which I am registered (General Practice), not by other health professionals, including dietitians. At our specific request the hearing has also been extended to last for 7 days (not the 2 days as originally scheduled) because we require a minimum of 7 days to present the totality of our case.
Given the long delay until the hearing commences, I thought it appropriate to clarify a few points especially as they may relate to The Noakes Foundation and the goals of what we want the Foundation to achieve in the long term. I restrict myself only to that which I think is appropriate to discuss now, that is, before the “trial” begins in earnest.
Point 1. I, my family and my legal team consider this a very important matter. Given the high level of public interest we believe that this matter must be properly defended.
The reality is that I am no longer involved in a medical practice and therefore do not require to be registered with the HPCSA. When first “charged” by the HPCSA, I could have terminated my registration as a General Practitioner and the case would have gone away (as if I am not registered as a medical practitioner, I no longer fall under the legal jurisdiction of the HPCSA). But I chose not to do this for a number of important reasons that will become apparent during the course of the November hearing.
Point 2: The hearing has nothing to do with The Noakes Foundation.
One of the aims of The Noakes Foundation is to promote an alternate to the incorrect nutritional advice that has been promoted since 1977. The hearing, in my view, provides the opportunity to explain why we believe the conventional dietary advice is harmful for many, beginning with our children.
However the trial has nothing to do with The Noakes Foundation. Thus the Foundation cannot and will not be involved in funding the (large) costs of the trial. Rather I alone will be personally accountable for all the costs incurred by my legal team in the trial.
Fortunately a significant number of my legal team have donated their time pro bono. Without that support we would not have been able to present our case as strongly as we will. I am indebted to my legal team for their generosity that will make a robust defence possible in this case. They believe, as do I, that this is a watershed case for both South Africa and indeed the world and which cannot be approached in a haphazard way with inadequate planning and resources.
Legal matters are not cheap and it will be interesting in time to learn how others in this case are funding their legal costs.
Point 3: If science is to continue progressing, it must always be open to address the “unconventional”.
I often ask audiences: Why do we have Universities (and other institutes of research and higher learning)? For if we really did know “everything”, why should we bother investing money in (what would be) a useless pursuit (of new knowledge)?
This usually convinces the audience that perhaps we don’t know everything and perhaps there is a need for at least some scientists to push the boundaries of knowledge by being “unconventional”.
The reality is that no great scientific advance has ever been made but that it was once considered “unconventional”.
The point perhaps is that what may at one time appear to be “unconventional” advice might very soon become the accepted mainstream “conventional” idea.
Point 4: In my 40-year career in science I have advanced 7 “unconventional” ideas. So far I have been proven correct in 6. The jury may still be out on the seventh – the low carbohydrate diet – but opinions on that are changing rapidly.
The outstanding feature of my scientific career has been my promotion of ideas that are originally considered “unconventional” but which ultimately becomes conventional mainstream teaching. These examples are covered more fully in my book Challenging Beliefs.
- Marathon running does not provide immunity from fatal coronary heart disease
I began my career in science by investigating the hypothesis promoted by a Californian pathologist Thomas Bassler that anyone who completed a 42km marathon foot race would immediately earn life-long immunity from coronary heart disease. This theory became extremely fashionable in the early 1970s at that time that the popularity of marathon running arose, seemingly spontaneously, around the world.
After a three-year search for the evidence, in 1979 we published the definitive disproof of this theory in one of the world’s premier medical journals, The New England Journal of Medicine.
(ii) The prevention of catastrophic neck injuries in rugby
In 1980 Capetonian Chris Burger died after he had broken his neck in a Currie Cup rugby match played in Bloemfontein. When researching the literature of rugby injuries, I discovered that there were very few prospective studies of rugby injuries published at that time. (A prospective study is one in which a population is studied for a prescribed time into the future and the number of medical events occurring during that period are recorded). In response in 1982 I initiated the first of a number of prospective (and retrospective) studies recording injuries in South African rugby players. Two of the studies subsequently received Publication Awards from the South African Medical Association. In time the knowledge from these studies led to the publication of our book, Rugby Without Risk, co-authored with Morne du Plessis.
Today as a result of that campaign, South Africa has perhaps the best educational program for the prevention of rugby injuries of any rugby-playing country. My contribution to that success is now frequently acknowledged by the South African rugby authorities and was the subject of an article in the British Medical Journal (Student Edition).
(iii) My campaign to prevent deaths from over-drinking during prolonged exercise
In 1981 I received a letter from a lady requesting my help after she had almost died during her participation in that year’s Comrades Marathon footrace. At the time the only “conventional” theory was that athletes do not drink enough during exercise. So it would have been assumed that her dire condition was because she had drunk too little during exercise. The lady wrote to me because I was then the medical editor of the magazine, SA Runner, and my function was to write a monthly column offering free “advice” to runners.
Intrigued to discovery what had happened I initiated a 30-year research program (that is still ongoing) to answer that question. As a result, I became an acknowledged international authority on fluid and electrolyte balance during exercise.
By 1991 we had provided definitive scientific proof that this never-before-described exercise condition from which she suffered, was caused by over-drinking of fluids for many hours with abnormal fluid retention. Fifteen years later we had established the biological mechanism that explains why only some who over-drink either at rest or during exercise develop this condition.
Although I had yet to understand the exact biological mechanisms involved, already by 1983 I was almost certain that over-drinking caused this condition. So I began to warn that unless athletes were educated against over-drinking during exercise, fatalities would occur. I even predicted that these deaths would first appear in female runners in marathon races in the United States.
As I had predicted the first such death from over-drinking occurred in a female marathon runner in California in 1993; a tragedy which by then we had proven was utterly preventable.
In 2012 my book Waterlogged: The serious danger of overdrinking during endurance exercise was published. It records my 30-year battle to convince athletes that they should not listen to the “conventional” advice that athletes should drink “as much as tolerable” during exercise.
Waterlogged evaluates all the relevant published scientific studies that are relevant to this claim and concludes simply that athletes should be advised to drink only when they are thirsty and then only as much as they need to curtail their thirst. Importantly much of the research that has advanced this understanding was undertaken in our laboratories.
In 2015 opposition to this idea finally capitulated. Now athletes are advised to do what I said in 1983 – drink only to thirst during exercise. The dangers of following the previous “conventional” advice to drink “as much as tolerable” is now acknowledged. That this warning comes 30 years after I first spoke it, is a measure of how long it takes established medical practice to adopt “unconventional” ideas that were correct all along.
There is no doubt that without our work, many more athletes would have died needlessly from this completely preventable condition. In 2006 the influential American publication Runner’s World included this work as one of the 40 “most important peoples or events” in the previous 40 years in the sport of running. The work also earned an international award for research on water and medicine.
My stand on the Waterlogged issue is an excellent example of what I achieved by standing up against “conventional” advice. Already in 1983 I began to offer “unconventional” advice to South African athletes that they should at all costs avoid over-drinking during prolonged exercise like the Comrades Marathon. As a result of this early and appropriate advocacy of “unconventional advice”, there has never been a death from over-hydration in a South African runner (although one death has occurred in the military in 2012 in a recruit who died from a combination of heatstroke and over-hydration. We have since published the full details of this unique case since it occurred in a military exercise that we were studying).
Had I remained quiet and allowed South Africans to receive only the “conventional” drinking advice that was being given in the United States from the mid-1980s to today, there could potentially have been tens, perhaps hundreds, of deaths in the Comrades Marathon alone.
But by being “unconventional” I prevented this from happening.
(iv) Evidence that exercise is regulated by the brain and is not limited by fatigue in the skeletal muscles (caused by lactic acid).
When I began my career in the exercise sciences in 1981, the (only) model of fatigue promoted in 100% of all textbooks around the world was one in which exercise is limited by the development of lactic acidosis in the exercising muscles. I soon realized that this model does not explain a number of common, easily observable phenomena.
Over the next 30 years we have produced a body of evidence that has irrefutably disproved this too simple theory. In its place we developed an alternate model – The Central Governor Model of Exercise Regulation – that is now widely if not yet universally accepted as the more correct model. In this model it is the brain which regulates exercise performance specifically to insure that we do not harm ourselves each time we exercise.
Acceptance of this new model has completely changed the teaching and research in the exercise sciences around the world.
(v) The need for managed periods of rest for South African professional rugby players.
In 2004 I was appointed as medical consultant to the South African Rugby Board with special responsibility to work with Springbok coach Jake White in preparing the team for the 2007 Rugby World Cup.
In April of that year I told Mr White that the key to the team’s success would be to insure that the best 22 players “peaked” on the night of the World Cup Final. I warned him that to achieve this we would need to limit the amount of rugby that each player played especially during the final 12 months leading into the competition.
As described in his best selling book In Black and White, Mr White agreed with this principle and as a result almost lost his job in December 2006 when, on my advice, he rested selected key players by not including them in the End of Year Tour to Europe. Both Mr White and myself were relentlessly criticized in the press and on the internet for following this plan.
But because I understand the relevant biology, I “knew” (as I had written extensively in Lore of Running) that it is simply not possible for the human body to survive the stresses to which our professional rugby players are exposed and still to be expected to produce peak performances in the matches that really matter.
In May 2007 again on my advice Mr White withdrew key Springboks from the overseas leg of the Tri-Nations tournament and again on my advice sent them home to rest. This decision was again greeted with disbelief by many.
In the end the team that I had advised reached the day of the Rugby World Cup Final with 30 fit players ready for selection. The chosen 15 played the full 80 minutes of the game without substitution (other than for a brief blood injury), a feat that has not ever been achieved in a Rugby World Cup Final, before or since. The team dominated the game winning comfortably.
In an interview later Jake White was asked why he could have put so much faith in one person’s opinion “against that of his superiors and seemingly the entire nation”. White responded: “I had full faith in what Tim said, because I knew he genuinely wanted South Africa to win. I always had the feeling in every meeting we had that he genuinely wanted to find ways in which we could have the edge over the opposition. And he never gave me a reason to doubt him”.
Asked whether he thought by apparently challenging authority, I was interested purely in drawing attention to myself, White had this to say: “He was always composed when providing input. He never said to us, ‘Don’t do it like that, do it like this’. He always gave you options and the pros and cons of both options”.
White also referred to a quality he felt I possess and which he considers rare – that is, being comfortable with having my views and counsel challenged by others: “It’s that intrinsic belief that if you want to find the leading edge in sports science you have to test theories and challenge principles – even your own. And he’s brave enough to do it”.
Passionate as I am about South African rugby success, I am even more passionate about promoting dietary changes that will make all South Africans more healthy.
(vi) The rotary action in cricket batting
On a lighter note, I encouraged Bob Woolmer to write the book that I co-authored with him – Bob Woolmer’s Art and Science of Cricket. During the writing of the book I discovered the evidence, accumulated by Tony Shillinglaw (who by chance lives in Birkenhead – the suburb in which my parents lived before coming to Africa) that the greatest cricket batsman of all time, Sir Donald Bradman, used a different technique than that conventionally taught in the usual cricket coaching manuals.
I now have a PhD student, Habib Noorbhai, who is researching this topic. His first study establish that 70% of the greatest batsmen of all time used elements of Bradman’s “unconventional” technique. A cursory analysis of almost all the best South African batsmen at the moment – Hashim Amla, AD de Villiers, JP Duminy, David Millar, Riele Rossouw, Quinton de Kock – show that they also defy the conventionally taught method and follow more nearly the Bradman method. Of the top South African batsmen only Faf du Plessis is more “conventional”.
It is clear that any young cricket coached to play cricket according to the conventional method as described in the popular cricket coaching manuals, has essentially no hope of ever becoming a professional batsman at international level.
This is an excellent example of how a “conventional” and accepted dogma continues to be taught even though the clear evidence available to anyone who watches cricket, shows that it cannot be correct. The result of this dogma is that only those who do not follow “convention” (usually as a result of pure chance) have a chance of achieving international success in cricket batsmanship.
(vii) Reversal of my position on the value of high carbohydrate diets for athletes and for long term health
In 1986 I published the first edition of my book Lore of Running in which I promoted the idea that a high carbohydrate diet is essential for superior athletic performance and is also necessary for heart health.
I continued to promote a high carbohydrate diet until my epiphanous moment in December 2010 when I began to experiment with eating a low carbohydrate diet. I then discovered that I had developed type 2 diabetes as a result, in my opinion, of my genetic propensity (my father died from the complications of arterial disease caused by diabetes) and my eating a “healthy” high carbohydrate diet for 33 years. From my reading of the published literature I concluded that I would be able to avoid the worst of the diabetic complications only if I ate a very restricted carbohydrate diet (less than 25g of carbohydrate per day).
Over the past 4 years I have exhaustively researched the science behind the low carbohydrate diet including purchasing and reading well over 100 books on the topic and thousands of scientific articles.
This exposure introduced me to ideas that, like most modern doctors around the world, I had not been taught during my medical training. As described in Challenging Beliefs and in The Real Meal Revolution these ideas can be reduced to just three.
- Insulin resistance is the commonest medical condition present in a majority of the world’s populations.
- Those with insulin resistance who eat high carbohydrate diets develop persistently elevated blood insulin concentrations.
- Persistently elevated blood insulin concentrations (hyperinsulinaemia) over many years are the direct cause of many of the chronic medical maladies that currently plague modern societies.
- Obesity is a disorder of abnormal fat accumulation driven by hyperinsulinaemia (in those with insulin resistance eating more carbohydrate than their insulin-resistant bodies can handle).
- Obesity cannot occur without an associated dysfunction of the brain appestat that determines when we are hungry and regulates how much we eat.
- Dysfunction of the appestat is caused by the addictive, highly processed, industrial diet that has become the global norm since the 1977 Dietary Guidelines that demonized real foods as being “unhealthy”, paving the way for the current global epidemics of obesity and type 2 diabetes.
- The reversal of these conditions requires that we promote the consumption of real foods that do not cause hyperinsulinaemia and appestat dysfunction.
Those are the 7 simple messages for the promotion of which The Noakes Foundation exists.
I believe that the future prosperity of South Africa depends in large measure on whether or not we understand these messages so that we stop promoting dietary ideas that in my opinion are the cause of grave ill-health to the majority.
I have taken the position on diet that I do because of a deeply felt conviction that someone in South Africa has to stand up against what I, and a growing band of scientists and doctors globally, perceive to be poorly conceived dietary recommendations based on poorly conducted science. The result in my opinion, is a monumental error, arguably the greatest in the history of medicine, and which has had very serious consequences for our national and global health. That these consequences and their causes are obvious (to me) but apparently not to many others, continues to inspire me daily to keep bringing the message to more and more people around the world. For I believe that change will only occur through the action of those most affected – the global community suffering as a result of this incorrect advice.
My commitment to this cause is such that I have formed (and funded the start-up costs) of The Noakes Foundation that receives all the (past and future) monies from The Real Meal Revolution and other of my activities. The Foundation’s immediate goal is to raise enough money to provide R2 million per year in perpetuity to support South African research to discover the optimum nutrition. The work that we fund will be rigorously independent and completely transparent as all data collected in our funded trials will be provided to the global scientific community via the internet.
The goal is not to “prove” that I am correct but to advance knowledge by discovering truths that will improve the nutritional health of all South Africans.
The Foundation has much work to do.
And that is an exciting prospect.