Professor Tim Noakes is a renowned, A1-rated scientist with special interests in exercise science and nutrition. He has published over 750 scientific books and articles including his most recent book ‘Lore of Nutrition’. Prof Noakes has received numerous awards for his works, including the Lifetime Achievement Award from the National Research Foundation of South Africa. He is now an Emeritus Professor at the University of Cape Town and frequently delivers talks and lectures at events across the world. After much research into the efficacy of international dietary guidelines, Prof Noakes concluded that a low carb, high fat (LCHF) diet (often called the Banting diet in South Africa) is preferable and founded the Noakes Foundation in 2012 to help bring about change in this area. This talk was given at the Public Health Collaboration conference 2018 at the Royal College of General Practitioners in London.

With this talk being centred on his personal journey, Prof Noakes gives a brief account of how he developed a passion for running and how ended up researching in the field of exercise science. This brings him on to a paper he produced, the results of which he says could have allowed him to diagnose his insulin resistance (or type 2 diabetes) in his twenties rather than in his fifties. This paper, in which Prof Noakes was himself a subject, showed his glucose levels rose sharply with intense exercise, despite high insulin levels, on a high carbohydrate diet, whereas this response was blunted on a low carb diet. Following this and a string of other studies on carbohydrate metabolism, Prof Noakes became a world authority on the subject.

Many endurance athletes choose to fuel their bodies with carbohydrate during events because of traditional carb-loading practice. Sports gels are products that are often used as a source of carbohydrate to keep the athletes going during an event, and Prof Noakes helped to produce the world’s first. He explains that he “couldn’t see the elephant in the room” when considering fuelling the body during exercise. While focusing on carbohydrate as a fuel source, he overlooked the huge potential energy source in stored body fat, which holds tens of thousands of kcal, even in the leanest athletes, compared to the ~2000 kcal in glycogen (the body’s carbohydrate store). By tapping into one’s fat stores effectively, Prof Noakes explains, one can complete an endurance event without eating at all.

Emerging studies on fat adaptation inspired Prof Noakes to begin researching high fat diets and performance himself. However, he says he drew incorrect conclusions from some of these studies, as he couldn’t let go of the old carb loading paradigm. For example, one study assumed a high fat diet with carb loading to compromise sprint performance, where other conclusions such as varying pacing strategies should’ve been considered. Another study Prof Noakes performed showed no difference in performance between carb loading and placebo groups. Regardless, this study concluded that carb ingestion may offset otherwise detrimental effects – a conclusion that Prof Noakes admits he should not have been allowed to make. He notes that a lot of bad science is done in this way, and it is partly down to the biases created by industry funding.

Prof Noakes recalls how his own father died a horrible death from improper management of his type 2 diabetes and opines that the incorrect advice around diabetes management is what killed him. Even today, most guidelines for people with diabetes still cite carbohydrates with every meal as a necessity. Prof Noakes says that a number of books on low carbohydrate diets (including Atkins) finally swayed him to start personally restricting his carb intake, after which he notes his running improved remarkably.

After starting to advocate a LCHF diet, Prof Noakes wrote a book (Challenging Beliefs) to acknowledge his change in thinking. He says it was at this point that he started to come under fire for his beliefs. His University later attempted to pressure him into withdrawing a publication describing 127 cases where LCHF diets had been used to manage obesity and other conditions. Following this, he produced another book (The Real Meal Revolution) which helped to change thinking around nutrition in South African, but also attracted negative attention from some dieticians.

This leads Prof Noakes to his trial versus the Health Professions Council of South Africa (HPCSA). The trial came about after a dietician reported Prof Noakes for ‘misconduct’ for answering a general question about nutrition on Twitter. The HPCSA claimed that he was giving inappropriate medical advice and abusing the doctor-patient relationship. Prof Noakes addresses each of the points that were raised by his opposition including the doctor-patient relationship and the scientific validity of the information he provided. In the end, with the help of an amazing team of people, Prof Noakes won the trial which lasted four years in total. He notes that the trial probably brought awareness of the LCHF diet to a larger audience.

Since the filming of this talk, Prof Noakes has been found, once again, not guilty of misconduct, following an appeal from the HPCSA after the first ruling.

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