Noakes diet has devotees but doctors, scientists and dieticians aren't so sure

The Tim Noakes diet has hit South Africa like the Second Coming.

The 65-year-old Cape Town sports scientist cannot leave his office without being told by ecstatic followers, once they have managed to tear themselves away from rapidly depleting shelves of full-cream yoghurt, almond nut butter and coconut oil, that he has changed their lives.

He addresses packed venues - this week it was Cape Town's Baxter Theatre - of converts to his Banting diet who hang rapturously on his every word.

But it is not the messianic effect he has on people that has sold 90000 copies of his latest book, The Real Meal Revolution, he insists.

"It's because people have tried it and it works.

"I cannot walk out of this room without someone stopping me and saying: 'Thank you, Dr Noakes, I've lost 20kg on your diet.'

"Wherever I go, people stop me and say: 'Thank you, you've changed my life completely.'

"I get e-mails like that every day. One of my best friends, who lost 80kg, thinks I'm God."

God, we are told, looks out for the poor. Medical doctors who work with the poor say his diet is "anti-poor".

"That's garbage," says Noakes. "They haven't studied the facts."

The essential foods are liver, kidneys, eggs and sardines. A young doctor in Mpumalanga followed the diet on R155 a week, he says.

If poor people cannot afford it, blame the government "because they subsidise the food that the poor people eat instead of subsidising the food that will make them healthy. This is the stuff they should be eating."

Should almond butter and grass-fed organic meat be subsidised?

"No, but offal should. It is the healthiest food for humans."

He is doing a clinical trial in the Karoo where poor labourers are given offal "to replace the cheap rubbish they're eating".

"So who is standing up for the poor? Show me the dietician who is saying they shouldn't be eating chips and Coke and let's do something about it? No one."

So maybe he is God. How does it feel?

"Frustrating, because other people don't see what I see."

These "other people" are doctors, scientists and dieticians who warn that the high-fat, low-carbohydrate diet Noakes is peddling could lead to heart attacks, strokes, cancer and dementia.

The Heart and Stroke Foundation South Africa says "decades of research" show that a balanced diet is safest in the long run.

Last week, medical scientists from Stellenbosch University quoted a review of 19 international scientific trials in support of this.

Professor Lionel Opie, world renowned cardiologist and director emeritus at the University of Cape Town's Hatter Institute for Cardiovascular Research in Africa, says following Noakes, whom he calls "charming, persuasive, but wrong", will raise your cholesterol.

"And there is no question that cholesterol in the coronary arteries causes heart attacks."

Noakes's claims for his diet are anecdotal and have no scientific merit, says Opie. "Where's the data, where are the studies, where's the evidence?"

"He hasn't read the literature," retorts Noakes, who was a student of Opie's and claims to venerate him.

"He sticks to what's published in the scientific literature, and there's a whole bunch of information that is suppressed. Why? Because industry controls it."

Noakes's guru is US investigative journalist Nina Teicholz.

"If you haven't read her book The Big Fat Surprise, you're clueless", he says.

"We are being totally manipulated and controlled - by industry, by governments, by the pharmaceutical industry - to believe a particular way. And that is why I am criticised. Not because what I'm saying is not healthy, but because it threatens massive industries."

The food industry has decided that its job is to make profits, not agonise over health. If its addictive processed foods cause obesity and diabetes, so be it.

His critics in the medical profession are in effect paid by the pharmaceutical industry to perpetuate the myth that designer drugs are the answer to the resultant problems. Thus, for example, they promote the use of statins, "the most ineffective medicine ever developed".

He, Noakes, can afford to say this because he is not a professor of cardiology reliant on industry funding.

The medical profession has been "swamped" by the pharmaceutical industry. That is why doctors attack him and that is why he cannot wait to retire in three months' time.

Even he feels "conflicted" because his institute is funded by Discovery Health and "they're probably not happy with what I'm saying".

"I've completely lost respect for my profession. And that's tragic, because I came into medicine wanting to cure patients and that's not what it's about."

Industry will support anyone who promotes its line - any scientist, for example, who says that we are fat because we don't do enough exercise.

"We're fat because we consume addictive high-carb food."

How much has he made from peddling what many see as a counter-myth? R10-million from his books and talks about diets over the years, he says, and every cent has gone to the Noakes Foundation to fund research at the institute. In addition, R600000 in profits from his Revolution book has gone to Operation Smile.

Back to the data, though, or the lack of it.

"There is no long-term data for any diet," he says. "Why focus on this diet?

"Ask the Heart Foundation why it's promoting a diet it started promoting in 1977 on the basis of no proper scientific evidence and which has caused diabetes and obesity."

Without the data, how can he be so sure about his diet?

"Because it's what we ate for three million years."

Opie has made the point that the Palaeolithic diet was very low-fat ...

"Never. Opie hasn't read the literature."

Noakes, on the other hand, has just returned from a "paleo" conference where the main speaker lived with hunter-gatherers in South America for five years and they only shot the fat animals. "What did [South African poet] Louis Leipoldt eat in Cape Town 100 years ago? Hippopotamus."

How long did he live?

"That's not relevant."

It was only when we stopped eating fat that we started getting heart disease and cancer, he says.

"Cancer is a carb-dependent disease. The leading cancer scientist in the United States says if you increase your fat intake, you will not change your cancer risk. If you increase your carb intake, you will substantially increase your cancer risk."

So Noakes, who not long ago was telling us to carbo-load, has a lot to answer for?

"Absolutely. That's why I changed. At least I had the courage."

He cheerfully agrees that his advice may have been fatal. Indeed, he blames it for his diabetes, which almost killed him. He agrees it was "bad science".

Now he wants us to believe that he is practising good science and everyone else bad science? "Yes, because I now see the whole picture."

And, by the way, he never claimed to be right last time. And he does not claim to be right now.

"Scientists are not right. We're never right. All we know is what's wrong; we don't know what's right."

So, although he sees the whole picture, he is not claiming to be right?

"Of course not. I tell my students 50% of what I tell them is wrong."

But we cannot suspend eating, so we have to go with the best available evidence. And the best available evidence is weak.

So half his book may be wrong?

"Absolutely. That's why you have to make up your own mind. Try it and see."

Enough people have done so to convince him he is right. That may only be anecdotal, as opposed to scientific, evidence, "but when you've seen 100000 people get better on this diet, then you start to think maybe there is something to it".

He has treated 100 000 people? "I don't know how many thousands I've seen.

"But go on my Twitter account and read my e-mails and it's just overwhelming."

Any negative feedback?

"Never, never, never."

Because they are dead?

"They're dead because of 69 years of eating the wrong food."