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Updated 23 June 2015

Too much, too soon, Tim Noakes!

Prof Tim Noakes might be a scientist, but the Banting Diet is based on bad scientific reasoning.

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Find a South African who has the disposable income to buy a recipe book, or shop at Woolies. Then ask them what the Tim Noakes / Banting Diet entails...

Chances are that they’ll be able to share a few facts. At the very least they’ll know that it involves cutting carbohydrates and eating more fat. They might even be able to give you details, e.g. how, if you’re “Banting”, you should go for fatty cuts of meat, while steering clear of carbs like bread, breakfast cereals, potatoes and rice.

Read more: What Tim Noakes eats

Now ask the same person what the South African Food-Based Dietary Guidelines (FBDGs) recommend, and chances are they won’t know what you’re talking about. If you’re lucky, they might say that these guidelines revolve around eating a variety of fresh foods every day, focusing on plant foods.

The point is that, thanks to a massively successful marketing campaign, the low-carb-high-fat Banting Diet set out in The Real Meal Revolution (Quivertree Publications, 2013) by sports scientist Prof Tim Noakes and co-authors Sally-Ann Creed, Jonno Proudfoot and David Grier has, in the past year or so, taken South Africa by storm. In turn, the far more nuanced science behind good nutrition has received much less attention.

Dogmatic noise

It’s safe to say that Banting is one of the biggest diet crazes to hit the country in the last few years.

During 2013 and 2014, a significant number of South Africans adopted Noakes’ theory that all carbohydrates are bad for us and that it’s okay to indulge in butter, cream and fatty red meat several times a week. Cauliflower mash (recommended as a carb substitute in many Banting recipes) appeared on shop shelves, South Africa’s first Banting restaurant opened, and Cape Town hosted its first “Banting Bazaar” in December 2014.

Unfortunately, most of us are only vaguely aware of what the rest of our scientific community recommends in terms of healthy eating. Instead of being guided by the South African Food-Based Dietary Guidelines, which are informed by 50 - 60 years of research and which are aligned with national dietary guidelines from Australia, the UK and the Nordic countries, many of us are now passing Noakes’ advice around the dinner table.

If you’re more befuddled than ever before, you’ve got good reason to be. Noakes’ theories have added a lot of dogmatic noise to a world that’s already confused about dieting and healthy eating. And, yes, many of what’s written in his book and said in media interviews are theories rather than known fact, and need to be assessed according to all the evidence available.

ReadCan the 'Banting' diet cause diabetes?

A biased approach

Noakes’ supporters often argue that the sports scientist is the only South African scientist brave enough to communicate the latest science on fat, heart disease, insulin resistance and the risk of eating carbohydrates.

But there’s a difference between cautiously going out on a limb because you’ve independently assessed all the relevant research and making sweeping statements that are based on research that you’ve selected because it supports your predetermined view, while ignoring other relevant research.

Noakes’ advice in terms of saturated fat is one example of his biased approach.

In the journal Annals of Internal Medicine of 18 March 2014, a meta-analysis (a study of studies) did in fact conclude that there’s “no evidence to support the longstanding recommendation to limit saturated fat in the diet”.

But shortly after this study was published, the Harvard School of Public Health issued a warning that “the conclusions are seriously misleading” and that the analysis contains major errors and omissions. (Read this superb article by Dr David L. Katz, President of the American College of Lifestyle Medicine, to learn more.)

What current research is telling us, instead, is that we do need fat in our diets – but healthy plant fats; not more of the saturated fats found in meat and other animal products.

“A central issue is what replaces saturated fat if someone reduces the amount of saturated fat in their diet,” wrote Walter Willett, chair of the Department of Nutrition at Harvard School of Public Health on Hsph.harvard.edu. “If it’s replaced with refined starch or sugar (i.e. refined carbohydrates)… then the risk of heart disease remains the same.

However, if saturated fat is replaced with polyunsaturated fat or monounsaturated fat in the form of olive oil, nuts and probably other plant oils, we have much evidence that (disease) risk will be reduced.”

In short, to prevent heart attacks and strokes, we should be replacing saturated fat with healthier plant fats in the diet, and not with refined carbohydrates like we’ve been doing since the “low-fat” 1980s. This is not only Willett’s opinion; it’s supported by results from many studies among thousands of people that have been systematically combined to produce reliable findings.

When Noakes enthusiastically quoted the above-mentioned study in interviews during the past year, he used it to support his theory that a diet rich in saturated fat is the answer to a myriad of health problems. From Willett’s statement it’s clear, however, that Noakes jumped to conclusions prematurely.

Saturated fat might not be as bad as we once believed, but that certainly doesn’t mean we should throw all caution to the wind and indulge in it. We simply don't have all the answers yet.

ReadExperts warn against Noakes diet

Medical community concerned

Premature as their statements are, Noakes and co-workers managed to convince thousands of South Africans that Banting is the best way to lose weight and prevent certain diseases. A particular sub-section of our population, many of whom are at increased risk for life-threatening non-communicable diseases influenced by diet (e.g. obesity, heart disease, high cholesterol, diabetes and high blood pressure), have been exceptionally eager to put Banting to the test.

In turn, our medical community, health authorities and academics (even Noakes’ own colleagues at the University of Cape Town, who formally distanced themselves from his theories) are very concerned that the Banting Diet is simply not based on good science.

Banters may lose weight because they’re cutting down on kilojoules, and some see certain positive health changes in the short term, but at what cost in the long term? Is it really safe for everyone, including pregnant women and children, as Noakes suggests? And can this way of eating possibly cause the very diseases it hopes to prevent or even increase one’s risk of other diseases?

The answers are still unclear. And, yes, Banting may even be dangerous.

In August 2014, Prof Wim de Villiers and colleagues from the University of Cape Town’s Faculty of Health Sciences sent a letter to the Editor of the Cape Times to warn readers that Banting may result in nutritional deficiencies, as well as an increased risk of heart disease, diabetes, kidney problems, constipation, certain cancers and excessive iron stores in some people.

At a talk hosted by the South African Association for Food Science & Technology and the Association for Dietetics in South Africa in Stellenbosch in November 2014, a University of Cape Town philosopher and a Stellenbosch University dietician and researcher also argued that Noakes’ thinking is biased, and that his theories are off the mark as far as good science is concerned.

Both Dr Celeste Naudé, a dietician and senior researcher from the Centre for Evidence-Based Health Care at Stellenbosch University’s Faculty of Medicine and Health Sciences, and Jacques Rousseau, a philosopher and lecturer in critical thinking and ethics at the University of Cape Town Commerce Faculty's School of Management Studies, picked holes in Noakes’ theories outlined in The Real Meal Revolution as well as his statements in the media over the past few months.

ReadTim Noakes' Eating Plan vs. balanced weight loss diets

Among their criticism was that Noakes “cherry-picked” the science he’s used to support his low-carb-high-fat way of eating. In other words, he’s selectively taken evidence to support his theories, disregarding much else. In this way, he failed to recognise the current international dietary recommendations, all of which are based on comprehensive, objective, independent assessments of the best available evidence, and jumped to very firm conclusions when it was not yet time to do so.

Noakes also applied a “one-size-fits-all” approach, stating that Banting isn’t just for overweight people and diabetics, but for everyone. In turn, scientists worldwide know that, when it comes to therapeutic, individual-level nutrition to overturn overweight, different approaches work for different people.

Making sure a diet is not harmful is essential: one should always keep an individual’s specific risk factors, conditions and circumstances in mind and, if a person is already at risk of disease or has an illness, great care must be taken to work out a diet for them that doesn’t increase their risk further.

Read‘Banting/Noakes diet' discriminates against women

Noakes furthermore oversimplified complex medical science on nutrition and non-communicable-disease risk, singling out single foods (e.g. beetroot, potatoes and rice) as bad, instead of keeping the bigger picture in mind, i.e. that foods are combinations of carbohydrates, fats, proteins, vitamins and minerals, and that these nutrients as well as other lifestyle and environmental factors, interact in numerous complex ways to keep us healthy.

ReadTim Noakes on carbohydrates

A healthy way of eating

So, where does this leave us? If Noakes’ theories aren’t yet confirmed – and may never be – who’s advice should we follow?

The good news is that we don’t have to all understand science to make sense of it all. Worldwide, large, independent bodies have done the work for us. Follow their lead and you’ll have a good chance of following a healthy diet. Your waistline and heart will also benefit.

Here in South Africa, our nutrition experts and authorities take their lead from the USA, UK, Canada, the Nordic countries and Europe, applying their population dietary guidelines – all of which are based on the best scientific evidence from across the world – to our unique circumstances.

To stay healthy in the long term, our experts advise us as a population to keep an eye on our portion sizes and to:

- Enjoy a variety of foods.
- Make starchy foods (e.g. whole-wheat bread, breakfast cereals, pasta, wraps, brown rice and starchy vegetables such as potatoes and sweet potatoes) part of most meals.
- Eat fish (e.g. pilchards and salmon), chicken (without the skin), lean meat (e.g. steak with fat trimmed, lean mince, ostrich) or eggs daily.
- Eat plenty of vegetables and fruit every day.
- Eat dry beans, split peas, lentils and soya regularly.
- Have milk, maas or yoghurt every day.
- Use salt and food high in salt sparingly.
- Eat fats sparingly and choose vegetable oils (e.g. tub margarine, canola oil, olive oil, sunflower oil) rather than hard fats. (Read more about healthy fats on the Heart and Stroke Foundation of South Africa's website.)
- Use foods and drinks containing sugar sparingly, and not between meals.
- Drink lots of clean, safe water.
- Be active.

These are an abbreviated version of the South African Food-Based Dietary Guidelines for Healthy Adults and Children 5 Years and Older (2012). Choosing mostly fresh, whole, minimally processed foods, and limiting highly processed foods and drinks that are energy-dense and loaded with added sugar, salt and unhealthy fats, is a logical conclusion from these guidelines.

Of course, we’re all unique. It’s therefore best to use these guidelines as a general recommendation for disease prevention only and to discuss your specific risk factors and needs with a registered dietician. This is especially important if you already have a condition such as obesity, heart disease, hypertension or high cholesterol.

One last thought: be critical of all the health and diet messages out there – particularly if they come from a minority of scientists, and where they present a “magic bullet” for resolving complex issues.

Read more:

Scheduled high-fat diet may prevent obesity
Protein vs. carbs: the great debate
Tim Noakes backtracks on dairy
Tim Noakes on carbohydrate intolerance
What Tim Noakes eats
Tim Noakes: refined carbs may be toxic

Image: eggs and bacon, Shutterstock

 
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