We are writing to ask if you will join us in signing a letter in defense of the science and Professor Tim Noakes of South Africa.

Many of you probably know the story of Professor Noakes. He is a world-famous professor (now emeritus) of Exercise Science and Sports Medicine at the University of Cape Town, who happened to discover that the low-carb diet was highly effective for the treatment of obesity, Type 2 diabetes, and other nutrition-related disease. He became famous in South Africa for promoting the diet—and this led to various forms of retaliation by his colleagues. Perhaps most stunning, however, has been that medical authorities (HPCSA) have subjected Professor Noakes over the past few years to a public hearing, with his medical license hanging in the balance. The charge? Sending a tweet to a breastfeeding mother that she could safely wean her child onto a “LCHF” diet. Specifically he was charged with giving “unconventional advice” that is “not evidence-based."

Prof. Noakes was actually acquitted last April, but the medical board is appealing its own decision. Although there are many disturbing ethical issues surrounding the HPCSA's treatment of Prof. Noakes, this petition will only focus on the fact that his advice IS evidence based and that this evidence is acknowledged by a group of physicians, other health care providers, scientists, and researchers.

To HPCSA:

 We understand that you are appealing the April 2017 acquittal of Professor Tim Noakes. Of the various charges alleged against him was the contention that his “unconventional advice” via a tweet to a breastfeeding mother was “not evidence-based.”[1] The judgement on this point by the HPCSA was that Professor Noakes’ tweet was “not not evidence-based,”[2] or, in other words, that it was evidence-based.

We, the undersigned, set forth in this letter a large body of scientific evidence to demonstrate that the kind of diet favored by Professor Noakes—that is, one lower in carbohydrates and higher in fat than the traditional “low-fat” diet--is, indeed, evidence-based. 

Low-carbohydrate diets have now been tested in more than 70 clinical trials[3] on nearly 7,000 people, including a wide variety of sick and well populations. Thirty-two of these studies have lasted at least six months and six trials went on for two years, enough time to demonstrate the lack of any negative side effects. In virtually every case, the lower-carb, higher-fat diets did as well or better than competing diets.[4]  The cumulative evidence shows that low-carb diets are safe and effective for combating obesity,[5] highly promising for the treatment of Type 2 diabetes,[6] and improve most cardiovascular risk factors.[7]

 Moreover, the best-available data from the U.S. government shows that in 1965, Americans ate 39% of calories as carbohydrates and 41% as fat. [8]  These percentages are what nutrition researchers now consider to be within the realm of a “low-carbohydrate, high-fat” diet. Thus, all Americans, including infants (the population addressed by Professor Noakes’ tweet) were formerly on the sort of diet that he favors. (This was, of course, before the epidemics of obesity and diabetes from which so many nations suffer today.) 

Part of the claim against Professor Noakes was that his tweet responded to a question about weaning an infant child. We understand that the South African pediatric guidelines (2013) advise "From 6 months of age give your baby meat, chicken, fish, or egg every day as often as possible. Give your baby dark green leafy vegetables and orange coloured vegetables and fruit every day.”[9] This advice is entirely consistent with a low-carbohydrate, higher fat diet.

Finally, recent results, published in The Lancet, from the largest-ever and only truly global epidemiological study, called PURE, find that populations with the highest-fat and lowest carbohydrate consumption had the lowest rates of total mortality.[10]

Taken together, these findings firmly support the advice given by Professor Noakes. Further, virtually no rigorous clinical trial data exist to contradict this body of evidence.

Thus, from a scientific perspective, the evidence overwhelmingly supports the idea that a diet low in carbohydrates and high in fat is “evidence based.”

Sincerely,

Dr. Sarah Hallberg DO, MS, FOMA
Medical Director, Medically Supervised Weight Loss
Indiana University Health Arnett
Indiana University School of Medicine
Medical Director, Virta Health
Aspen Institute Health Innovator Fellow

Debra Ravasia, MD, FACOG, FRSCS
Obstetrician/Gynecologist
Diplomat – American Board of Obesity Medicine
PO Box 18426
Spokane, WA, 99208

E. James Greenwald MD
Orthopaedic Surgery
SpecialtyHealth, Reno Nevada. 89511
Associate Professor, Dept of Surgery
Univ. of Nevada School of Medicine

Nancy Noyce MD MPH
Ashland, Oregon, USA
Internal Medicine
The Noyce Clinic for Metabolic Rehabilitation

Dawn Lemanne, MD, MPH
Board Certified Oncologist
Clinical Assistant Professor of Medicine, University of Arizona
Medical Director, Oregon Integrative Oncology
Ashland, Oregon USA

Ann M. Childers, MD, FAPA
Life Balance Northwest LLC
1595 Holly Street
West Linn, Oregon 97068

Mark Nelson, MD
Family Physician (I take of adults, children and infants)
Wheaton, IL 60187

Jasmine Moghissi, MD
Board Certified Family Practice
9401 Lee Hwy, Suite 302
Fairfax, VA 22031
703-281-5560

Christy Kesslering, MD
Board Certified Radiation Oncologist
Medical Director Radiation Oncology
Northwestern Cancer Center Warrenville
Warrenville, IL

John Madany M.D.
Board-certified ABFM
Barrett Hospital and Healthcare
Dillon, Montana

Georgia Ede MD
Psychiatrist
Smith College
Northampton, Massachusetts

Dr Rod Tayler
Anaesthetist
Melbourne
Victoria
Australia

Dr Paul Mason
Concord Orthosports, NSW, Australia
FRACSEP
M.B.B.S. (Hons)
B. Physio
Master Occ. Health

Brett Nowlan
MBChB FACC ABCL RPVI
Cardiologist, Internal Medicine
Bloomfield, CT

Charles Cavo
DO, FACOG, Diplomat ABOM
Medical Director Pounds Transformation
West Hartford, CT. 06107

Peter Brukner OAM, MBBS, FACSP
Professor of Sports Medicine
La Trobe University
Bundoora, Vic 3086
AUSTRALIA

Sean Bourke, MD, FACEP, Diplomate American Board of Obesity Medicine
Co-Founder and Chief Medical Officer JumpstartMD
Portola Valley, CA 94028

Eric J. Sodicoff, MD
Board Certified in Internal Medicine & Obesity Medicine
PMA Medical Specialists LLC
Pottstown, PA
Office Phone# 610-495-2300

Barbara M Buttin, MD, FACOG
Practice Leader, Gynecologic Oncology
Northwestern Regional Medical Group
4405 Weaver Pkwy
Warrenville IL 60555 United States

Mark Cucuzzella MD FAAFP
Professor West Virginia University School of Medicine
WVU Center for Diabetes and Metabolic Health
304-596-5038

Radley Griffin MD
Board Certified Family Physician
Griffin Concierge Medical
Tampa, FL USA

Carol Loffelmann MD FRCPC
Anesthesiologist, Toronto
Cofounder: Canadian Clinicians for Therapeutic Nutrition

Jeffry Gerber, MD, FAAFP
Board certified Family Physician
South Suburban Family Medicine
Denver's Diet Doctor
Denver, Colorado, USA

Barbra Allen Bradshaw, MD FRCPC
Anatomical Pathologist
Abbotsford Regional Hospital and Cancer Center
Co-founder: Canadian Clinicians for Therapeutic Nutrition

Caroline Roberts, MD. Endocrinology
Virta Health. Portland, OR. USA

Robert A. Schulman MD
Director of West County Integrative Medicine
Santa Rosa, CA
Board Certified
Physical Medicine and Rehabilitation
Pain Medicine
Integrative Medicine
Medical Acupuncture

Dr. Jason Fung, Nephrology
Scarborough General Hospital
Toronto, Ontario, Canada

 

This petition has been supported by The Nutrition Coalition, www.nutritioncoalition.us 

 

[1] Full transcript of trial:
http://www.foodmed.net/2017/HPCSA.pdf
[2] Statement on judgement by HPCSA committee chair: http://www.foodmed.net/2017/adams.pdf
[3] Low Carbohydrate Diet Studies: https://docs.google.com/spreadsheets/d/1Ucfpvs2CmKFnae9a8zTZS0Zt1g2tdYSIQBFcohfa1w0/edit#gid=547985667
[4] Johnston, Bradley, Steve Kanters & Kristofer Bandayrel et al, Comparison of Weight Loss Among Named Diet Programs in Overweight and Obese Adults: A Meta-analysis. https://jamanetwork.com/journals/jama/fullarticle/1900510
[5] Bueno, Nassib, Ingrid Sofia Vieira de Melo, et al, Very-Low-Carbohydrate Ketogenic Diet v. Low Fat Diet for Long-Term Weight Loss: A Meta-Analysis of Randomised Controlled Trials. https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/verylowcarbohydrate-ketogenic-diet-v-lowfat-diet-for-longterm-weight-loss-a-metaanalysis-of-randomised-controlled-trials/6FD9F975BAFF1D46F84C8BA9CE860783
[6] Feinman, Richard et al, Dietary Carbohydrate Restriction as the First Approach in Diabetes Management: Critical Review and Evidence Base. http://www.nutritionjrnl.com/article/S0899-9007(14)00332-3/fulltext
[7] F.L. Santos, S.S. Esteves, et al, Systematic Review and Meta-Analysis Of Clinical Trials of The Effects Of Low Carbohydrate Diets on Cardiovascular Risk Factors. http://onlinelibrary.wiley.com/doi/10.1111/j.1467-789X.2012.01021.x/full
[8] Cohen, Even, Michal Cragg, et al. Statistical Review of US Macronutrient Consumption data, 1965-2011: Americans Have been Following Dietary Guidelines, Coincident with the Rise of Obesity. http://www.nutritionjrnl.com/article/S0899-9007(15)00077-5/abstract
[9] Food-Based Dietary Guidelines for South Africa: http://www.adsa.org.za/Portals/14/Documents/FoodBasedDietaryGuidelinesforSouthAfrica.pdf
[10] Associations of Fats And Carbohydrate Intake With Cardiovascular Disease And Mortality In 18 Countries From Five Continents (PURE): A Prospective Cohort Study. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32252-3/abstract