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Updated 10 December 2015

Tim Noakes to defend Banting for babies

Professor Tim Noakes tells Health24, why all of us, including children, should follow a low-carbohydrate, high-fat diet, despite some experts warning against this controversial lifestyle.

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Professor Tim Noakes sleeps well at night, despite his coming hearing before the Health Professions Council of South Africa (HPCSA) after advising a mother on Twitter to wean her child on foods low in carbohydrates and high in fat so that it’s in line with the LCHF “Banting” approach.

Read: Tim Noakes to face inquiry over 'Banting' tweet

Noakes is a sports scientist who caused a stir in 2012 when he backtracked on his own advice and decades-long dietary view that a diet high in carbohydrates and low in fat is healthy. In fact, he now blames this diet for the global rise in lifestyle diseases, such as obesity, diabetes and heart conditions.

'Now I can sleep peacefully at night'

"I fronted up four years ago and said I was wrong and that my advice to follow a high-carbohydrate diet harmed people and would continue to cause harm if I didn’t admit my error. Now I can sleep peacefully at night."

Yet Noakes is still perplexed by the fact that healthcare workers and the public at large fell for the low-fat diet “lie” for so many decades, noting that a combination of fear, ignorance, commercial interests and an inability to admit that we were wrong could be at play.

There is the fear that if we are wrong, said Noakes, that we could have done much harm.

“So it is better to pretend that we were right and so not face that prospect,” he said.

"Then there is also the issue of commercial influence. Selling cheap carbohydrates in processed foods is highly lucrative. The concept of returning to eating ‘real foods’ is very threatening to many livelihoods," said Noakes.

'Banting is safe for everyone'

Despite there not being enough clinical evidence to prove that an LCHF diet approach is beneficial for adults and children, he maintains that Banting is safe for everyone.

"All humans should eat real foods with less carbohydrate and more fat and protein – and all the other nutrients found in nutrient-dense real foods – and avoid processed foods."

Referring to the tweet from last year that will see Noakes face a two-day hearing by the HPCSA, he said: "The choice between health and ill health begins with our infants as soon as they’re weaned."

Noakes believes that children should not be weaned on to traditional high-sugar, high-carbohydrate processed cereals, which, he said, will ultimately contribute to them eating highly processed foods later in life. As infants our taste is conditioned by our early exposure to what he calls “non-foods”.

Health24 asked him why he believes children should be weaned on to LCHF foods.

Optimising the infant brain

"The infant brain is growing at a fantastic rate for the first two years of life and the only way to optimise that growth is to provide foods that are high in what are called brain-specific nutrients," said Noakes.

"These are found in highest concentrations in real foods, especially seafood and shellfish, but also in dairy, eggs, liver and meat. They are not found in high-carbohydrate, high-sugar processed foods.”

Noakes said breast milk falls short of a very important brain-specific nutrient.

"Breast milk is a good source of many nutrients for the infant brain, but it is iron deficient and iron is a crucial brain-specific nutrient. Meat and liver are the best sources of iron; much better than iron-fortified cereals. Iron absorption is poor from cereal-based foods, however much they are enriched," he said.

"If you want to maximise your infant’s future prospects, you need to maximise his or her brain growth during those crucial first two years. You can't do that with a high-carbohydrate, cereal-based diet lacking in the real foods promoted by the LCHF/Banting diet.”

Real foods vs fake processed foods

He said this concept is promoted in his book The Real Meal Revolution. "The aim of our Real Meal Revolution is to encourage the public to understand that they will be healthier eating real foods and not fake, industrially processed foods, and this need to begin from birth."

Professor Marjanne Senekal, head of Human Nutrition at the University of Cape Town, pointed out that the arguments put forward by Noakes do not address the question of the healthfulness or appropriateness of the LCHF diet for weaning infants and young children, but rather focuses on the importance of eating unprocessed foods.

"It is very important to note that there is no evidence to support the recommendation of an LCHF diet as a healthy option for infants and young children. In fact, exclusion of certain foods and food groups from the diet as is recommended in LCHF diet regimes increases the risk for nutrient deficiencies.

"This is a very serious concern in infants and young children as such deficiencies could compromise growth, cognitive development and health in general," she warned.

Why no food groups should be excluded

Senekal did however share Noakes' sentiments on processed foods. "I agree that avoiding processed and especially ultra-processed foods is important for health, but what needs to be added is that no food groups should be excluded or extremely limited in the process."

She noted that the proposed, evidence-based South African Paediatric Food Based Dietary Guidelines, promoted by registered dieticians and nutritionists, recommend breastfeeding for the first six months of life and then the introduction of complementary foods at six months with breastfeeding for up to two years of age.

"These foods should include meat, chicken, fish or egg every day, or as often as possible, as well as green leafy vegetables and orange-coloured vegetables and fruit every day. From 12 months onwards starchy foods should form part of most meals with a focus on unrefined starchy foods.

"Once the child is fully weaned, he/she should receive milk, maas or yoghurt every day. Very importantly, it is recommended that sugary drinks and high-sugar, high-fat salty snacks should be avoided," she advised.

The importance of weaning

The main purpose of weaning is teaching a child to accept a new texture and how to eat, said Kerryn Gibson, a dietician specialising in paediatric nutrition.

"The texture of weaning foods is extremely important to get right in order for foods to be accepted and easily swallowed by infants. This factor often determines the type of food used."

Gibson said an LCHF diet as promoted by Noakes is not always easy to prepare in a way that is acceptable to children.

Read: Noakes' 'real food' may not be kid friendly

"Children are at the best of times fussy eaters and will go through different stages of food acceptance and rejection. Their food intake must be allowed to be flexible and to accommodate their taste changes and stages of development."

She told Health24 that carbohydrates must not be excluded from any infant or child’s diet.

"They provide valuable energy, vitamins and fibre. Carbohydrates must however be from real, natural and unprocessed foods. Good examples include sweet potato, potato, rolled oats, cooked porridge, legumes, fresh fruit and fresh vegetables."

Registered dietician Lila Bruk, from Lila Bruk & Associates, also expressed concern about excluding certain foods for infants.

Carbohydrates ‘extremely important’

"The key to healthy weaning is a variety of foods, a good balance of healthy proteins, unsaturated fats and unprocessed starches and fresh fruits and vegetables. Eliminating food groups should simply not be done in this vulnerable group," she said.

"A healthy, balanced diet for infants includes foods from all the various food groups to ensure that they get all the nutrients they need." Bruk said this is the only way to ensure a full complement of all the important nutrients.

"By following an LCHF diet, our children would miss out on sufficient B-vitamins, fibre and antioxidants that are sorely needed for their early development. Carbohydrates are our primary source of glucose and thus are extremely important for the body's functioning. Therefore, I would strongly advise against an LCHF diet for babies and toddlers."

Bruk also took issue with Noakes' use of the term "real foods". "This implies that only foods that fit into his LCHF recommendations can be considered ‘real’. However, we could also use other foods as early weaning foods that may not fit into his ideal.”

Examples of these are fresh fruit, vegetables such as pumpkin, carrots and squash, and brown rice, oats, quinoa and yoghurt, she said. "These can all easily work into a weaning diet without the heavy focus on fat."

A potentially dangerous experiment

Parents also need to bear in mind that in early weaning, an infant has very few teeth. "To expect them to be able to consume the green leafy vegetables, berries and meats comfortably is challenging,” Bruk said.

She cautioned that fat could threaten the kilojoule requirements of infants. "Fat is very satiating and thus there is a good chance that the infant will get full too quickly and thus not be able to consume their full kilojoule requirements," Bruk said.

With no studies on the long-term effects of an LCHF diet in infancy, Bruk warned that any recommendations could be a potentially dangerous experiment that most mothers would not want to risk.

"Without proper long-term cohort studies, we are unable to ascertain the effect an LCHF diet would have on our children's health. It is highly unethical to use our children as guinea pigs in this respect," she said.

The HPCSA hearing will take place on June 4 and 5 in Cape Town.

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