The theory that blood cholesterol and a high-fat diet are the causes of heart disease will be one of the greatest errors in the history of medicine, Prof Tim Noakes said on Monday in a letter published in the Cape Times.
“It is time to admit that the theory has failed. We need to adopt an open mind if we are ever to discover the real cause [or causes] of the current global epidemic of obesity, diabetes and coronary heart disease, all of which are likely caused by the same factors,” Noakes wrote.
His letter is a response to a letter of a team of Cape Town specialists and academics, published in the Cape Times on Friday, where they said that he had gone too far suggesting that a switch to a high-fat and high-protein diet was advisable for everyone. They also warned that his dietary advice (published in his book Challenging Beliefs) could be dangerous for patients with heart disease or people at risk of developing heart problems.
In his letter, Noakes, a professor of exercise and sports science and head of the Sports Science Institute of SA, gave a scientific explanation why a low-fat diet had no proven role in the prevention of heart disease:
"As I wrote in Challenging Beliefs, a 2010 meta-analysis of studies involving 347 747 subjects, published in the American Journal of Clinical Nutrition, found 'no significant evidence for concluding that dietary saturated fat is associated with an increased risk of coronary heart disease or cardiovascular disease'.
"A 2011 report from the Cochrane Collaboration, an organisation that is independent of the pharmaceutical industry, found that 'there was no clear evidence for dietary fat changes on total mortality or cardiovascular mortality'. Thus the scientific evidence is clear: a low-fat diet has no proven role in the prevention of (coronary) heart disease. It is time that cardiologists began to teach this fact in our medical schools.
'The way of the dinosaur'
"If the cause of heart disease were truly known (as is the cause of HIV/Aids) then the condition should have disappeared with the promotion of the so-called ‘heart-healthy prudent diet’ and the annual prescription of tens of billions of dollars’ worth of cholesterol-lowering drugs globally," he continues.
“Yet one of the leading causes of death in the US is now chronic heart failure caused by coronary heart disease.
“To service its burgeoning heart disease problem, the US now requires twice the number of cardiologists currently in practice (17 000). If current dietary and therapeutic advice was effective, cardiology and cholesterol-lowering drugs should be going the way of the dinosaur. Instead both are major growth industries. No wonder both fear 'cholesterol denialists'."
So if a high-fat diet does not cause heart disease, then what does?
According to Noakes, in carbohydrate-intolerant subjects, like himself, a low-fat/high-carbohydrate diet produces abnormalities (such as elevated blood glucose, insulin and glycated haemoglobin (HbA1c) concentrations, low blood HDL-cholesterol and high triglyceride and uric acid concentrations) some of which are causally linked to arterial damage and heart disease.
With regard to statin therapy, Noakes advises anyone who does not have established heart disease or genetic hypercholesterolaemia, and who is either already taking or considering using cholesterol-lowering drugs, to read The Great Cholesterol Con (2006) by Anthony Colpo. "This book should also be required reading for all my colleagues who are prescribing these drugs or who plan to do so in the future.
"It is time to admit that the theory has failed. We need to adopt an open mind if we are ever to discover the real cause(s) of the global epidemic of obesity, diabetes and coronary heart disease," he concludes.
- (Compiled by Birgit Ottermann, Health24, September 2012)
What are your thoughts on this debate? Send your comments to email@example.com with "Tim Noakes" in the topic line.
Tim Noakes called a 'cholesterol denialist'
Tim Noakes on carbs
Infographic: the paleo revolution
Protein vs. carbs: the great debate
Tim Noakes: refined carbs may be toxic
SSISA: what constitutes a healthy diet in 2012?