Tim Noakes on carbohydrates

Originally published in the Daily Maverick.

In one of my first columns on Daily Maverick, Michael Pollan and his food rules (“the whiter the bread, the sooner you will be dead”) were used to illustrate the modern obsession with eating “healthy” food, or orthorexia. Pollan is an example of a celebrity nutritionist, who – while not necessarily offering harmful advice – could be accused of simplifying things to such an extent that what starts as sound advice mostly ends up being accepted on faith or as dogma.

Recently, South Africa’s sports-science guru Tim Noakes has been receiving plenty of media coverage following his about-turn on matters dietary. Many of you will recall Noakes as an advocate of carbo-loading, especially for athletes. But even those of us who aspired to complete a 10km shuffle had little to fear from the carbohydrate. Until now, where for many of us our fondness for carbohydrates “is an addiction that is at least as powerful as those associated with cigarette consumption and some recreational drugs like heroin”.

In general it’s a good thing to see scientists change their minds, because it’s evidence of the scientific method at work. When the evidence changes, so should our views. But such is the current fear of food, manifested in daily articles about epidemics of obesity and the various ways we’re killing ourselves through what we eat, that it’s sometimes a little easy to join the next dietary fashion without thinking enough about whether we’re convinced by the evidence rather than by the hysteria.

A form of cultural amnesia is apparent in most dietary programmes – they spawn books and instructional DVD’s, but are quite often simple revisions of advice we’ve heard before, packaged under a different name with a different guru’s face on the cover. But if the advice is good and presented in a way that doesn’t encourage mindless obedience, us non-specialists could certainly benefit from knowing about what – in this instance at least – appears to be somewhat of a breakthrough moment for dietary knowledge.

The breakthrough is not Noakes’s and he’s the first to admit that, citing William Harvey and William Banting, and more recently Robert Atkins and Gary Taubes as those who introduced him to the concept that most of us would apparently lose weight and live healthier lives on low-carbohydrate diets. I say “apparently” not only because I haven’t tried it myself, but also because the evidence for Noakes’s claim doesn’t seem nearly as convincing as he’d like us to believe.

While some philosophers of science (like Nancy Cartwright [pdf], for one) disagree, the gold-standard in science is generally held to be the RCT, or randomised controlled trial. In an RCT, subjects are randomly allocated to receive one or another of the different drugs or interventions being tested, and those subjects are then treated differently only in respect of differences that are intrinsic to the different treatments under comparison.

In the case of an RCT evaluating different diets, you’d therefore want to ensure that you control for factors like how much exercise subjects in each cohort do, and your randomised selection of subjects into those cohorts should have ensured a balance between other factors that could influence the outcome of the treatments being compared (whether you know about those factors or not).

For diet – and specifically, comparing diets with varying proportions of carbohydrates – two recent RCT’s are relevant here. In 2009, The New England Journal of Medicine (360,9) published a study by Frank Sacks (pdf) and others, in which four diets were tested on 811 overweight adults. The subjects were randomly assigned to one of four diets, where “the targeted percentages of energy derived from fat, protein, and carbohydrates in the four diets were 20, 15, and 65%; 20, 25, and 55%; 40, 15, and 45%; and 40, 25, and 35%”. The subjects were then monitored for two years to determine the short- and longer-term effect of these four diets.

Their results? “Any type of diet, when taught for the purpose of weight loss with enthusiasm and persistence, can be effective.” To put it more simply, “reduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize”. So, if Sacks and his research collaborators are to be believed, eating less is the important thing rather than what you eat – at least when it comes to weight-loss.

Russell de Souza’s research (published this year in The American Journal of Clinical Nutrition) involved 424 subjects randomly allocated to diets involving 25% or 15% protein; 40% or 20% fat; and 65% or 35% carbohydrates. Again, the authors note that the subjects “lost more fat than lean mass after consumption of all diets, with no differences in changes in body composition, abdominal fat, or hepatic fat between assigned macronutrient amounts”.

Of course, Noakes might be different, and he’d know as well as anyone that a diet that works for one person might not work for all. He in fact claims that he is different (and suggests that many of us might be) in being “carbohydrate resistant”, which brings with it a predisposition to developing adult-onset diabetes. And again, this might be true – but we haven’t yet seen an RCT which compares the effects of various diets on only people who are carbohydrate resistant.

It therefore seems premature – even unjustified – to speak of this diet in such unequivocally positive terms, not to mention introducing the language of moral panics in the form of our hypothetical “addiction” to carbohydrates. As Ben Goldacre (and others, I’m sure) have pointed out, anecdotes are not data, and the bulk of the data available right now suggest that the main problem is simply that we eat too darn much.

Speaking of which, another concern with diets such as this presents itself. Much as you’ll usually find anti-vaccination idiocy represented in the middle-class but rarely by the poor, a diet like this seems quite out of reach to anyone struggling to find money to feed themselves and their families. We’re told to avoid bread, rice, pasta and potatoes in favour of eggs, fish, meat, dairy products and nuts (only some nuts – peanuts and cashews, among others, are evil nuts).

So, above and beyond wondering whether the Noakes diet is evidentially justified, rather than being yet another example of a celebrity-led fad, it’s also somewhat discomfiting on a political level. The increasingly obese poor might after all end up inheriting the earth, simply because there’s no space left on it for anyone else.

See the Daily Maverick link at the top for a range of comments on this column. One particularly worth highlighting, and pasted below, is a response from Prof. Noakes.

Jacques,

By focusing on the evidence or lack thereof that a low carbohydrate diet is an effective means of losing weight you miss a couple of important points. These points are more fully described in the most recent edition of my book, Challenging Beliefs. First, my personal interest in the low carbohydrate diet relates to my predisposition to develop diabetes; my substantial weight loss on this eating plan is an unexpected bonus but it is not the reason why I have committed to this eating plan. The scientific evidence is absolutely clear – it is the persistent consumption of a high carbohydrate diet by person like myself with a genetic predisposition to develop diabetes because we are carbohydrate-resistant that ultimately causes us to develop that disease. The prevention and correct treatment of the condition is also blindingly obvious and proven in the literature – it is a diet that restricts the total carbohydrate intake to as few grams a day as possible, preferably less than about 50 grams per day. Yet sadly this is not the advice that predisposed people like myself or indeed those who already have the disease are likely to receive. I wish someone had told me this 20 years ago. I do not want others not to know this information if it can save them from the disastrous consequences of this awful disease.

Thus my interest in publicizing this eating plan is not to be just another “celebrity fad diet”.

Second, for 33 years I ate the so-called heart healthy, low fat, high carbohydrate “prudent” diet – the same diet that did not prevent the development of all the complications of diabetes in my father. Yet in retrospect, all that diet did for me was to make me fat, lazy, increasingly closer to developing full blown diabetes whilst all the time destroying my running ability. When I finally discovered that these unpleasant symptoms were not caused by aging but by my high carbohydrate “healthy” diet, I was naturally somewhat surprised. Thus in advocating this alternate eating plan, I have been careful to stress that the key benefit is a dramatic increase in the quality of life – something that the scientists have not measured. So I am now able again to run as I did 20 years ago and for me this is very important. I also have a level of energy that I remember having 40 years ago. In addition I have delayed the progress of my pre-diabetes. Those are the benefits that I have enjoyed by restricting my carbohydrate intake. Whatismore, daily I receive a wad of emails from grateful South Africans indicating how much better they feel and how their quality of life and often their sporting performances have improved simply by reducing their carbohydrate intakes as have I. So you see, it is not just about weight loss.

Third you glibly say that “we simply eat too much”. I agree – but why? Lions don’t eat too much; nor do any other free-living mammal that I know (other than our cats and dogs whose health is unfortunately also being undermined by the provision of a so-called “science diets” that forces these carnivores to eat high carbohydrate diets – diets for which their evolution has not prepared them). Why is it then that lions know exactly how much too eat so that they do not become fat and lethargic and unable to hunt? Could it be because they have a perfect appetite control – something that humans have always had but have suddenly lost in the past 30-40 years as the global diabetes and obesity epidemic has increased exponentially?

You see what I have learned, as confirmed by all those who successfully adapt to this low carbohydrate eating plan, is that we rapidly lose our hunger and feel satiated all the time (since fat and protein satiate whereas carbohydrates drive hunger in many people). No longer do we spend our days hunting for addictive high carbohydrate meals that fail to satisfy hunger for more than a few hours. As a result we reduce our energy intakes by at least a third without ever feeling hungry. So we lose weight and return our body masses into the safe and healthy range without any effort. Nor do we need to exercise to maintain that weight loss (although because we now again have the energy we enjoyed at a younger age, we also become more active). The reality is that for many of us the only way to bring our appetites under control is completely to avoid carbohydrates and to return to our former evolutionary state as predatory carnivores.

Also not considered in your analysis are the health benefits of simply eating less – there is a large body of evidence showing that eating less increases life expectancy in a range of mammals. Thus eating too much of anything carries health consequences with it.

So as you personally assess whether or not you should be eating fewer or more carbohydrates, you can see that it is not simply a question of whether or not you want to lose weight. It is about quality of life and for how long you want to live. If those issues are important to you then you need to question whether or not you can improve what you eat, perhaps by eating a diet that is not as full of carbohydrates.

But if these issues are of no consequence to you – if you personally are happy to spend your life “shuffling through a 10km” – then be my guest. But don’t condemn your readers to what nearly happened to me simply because you failed to research the topic as exhaustively as this complex topic requires.

Timothy Noakes

 

Giubilini and Minerva on abortion and infanticide

As submitted to the Daily Maverick

To regard something as permissible does not necessarily entail that you’d like to see it encouraged, or to become a widespread practice. It’s also not necessarily the case that simply entertaining a possibility in thought or speech means that you are favourably inclined towards that possibility. But we seem to sometimes forget this, becoming nearly as offended by someone merely thinking or speaking about that which we find abhorrent as we would had they actually committed the act in question.

In the Journal of Medical Ethics, Alberto Giubilini and Francesca Minerva recently suggested that if abortion is permissible, infanticide (in certain cases) might also be. The public reaction – and also the reactions from other bio-ethicists – seemed to suggest that Giubilini and Minerva had been spotted introducing toxic feeding formula into the supply chain of their local maternity ward.

Their view, in short, is this: many of the existing instances in which we consider abortion justifiable hold equally for an infant, at least during a short period after birth. The authors don’t define the period in question, but this is irrelevant to the questions of principle and consistency that they raise. If, for example, an abnormality such as perinatal asphyxia is discovered only after birth, how is it that ending that life is now considered intolerable where the same severity of abnormality would have justified abortion six months earlier? I can’t do the article justice here, so please read it before assuming their position to be obviously wrong.

Of course many would find it shocking to imagine that compelling arguments for infanticide might exist. Some might even be shocked or horrified that people spend their time coming up with these arguments. For the most part, though, the arguments aren’t new – Michael Tooley and Peter Singer, among others, have said similar things in the past.

Tooley wrote “Abortion and infanticide” in 1972, though, so it’s mostly only those of us who studied philosophy who got to hear these arguments, because it was difficult for these sorts of texts to get widespread attention without the assistance of platforms like Twitter, Facebook and blogs. Consequently, it was also more difficult to foment the kind of moral outrage now being directed at the authors, including death threats and questions regarding when, if ever, it’s too late to consider (belated) infanticide for ethicists.

An increasingly common response to ideas we don’t like seems to be attempts at censorship, or the application of threats in pursuit of silencing, rather than debate. Debate and discussion should always be our preferred option though, because it can result in either the weakening of the viewpoint you’re contesting, or in giving us the opportunity to realise that we are wrong and should change our minds. If Giubilini and Minerva’s views are mistaken, in other words, we should be able to say why this is so.

Those who are opposed to abortion in general are obviously not challenged by their views, in that if abortion is impermissible, infanticide would clearly also be. (The authors use the term “post-birth abortion”, for reasons that are made clear in the paper, but this seems mostly to be in an attempt to avoid completely thoughtless outrage.) However, for those of us who think abortion in general permissible, the paper is usefully provocative in asking you to consider which features of the two cases make one permissible and the other not.

One feature which makes the cases very different is quite possibly simple human emotion, and the ability to make more dispassionate decisions with regard to a foetus than an infant. And while it’s common for philosophers to note this, and simply move on as if this human frailty is something to regret – certainly not a factor that should unduly influence our conceptions of right and wrong – I do think this is an important feature, and that Giubilini, Minerva and those that want to defend their views need to take it into account.

While I do think it’s true that we should aspire to being as rational as possible, this doesn’t mean that all non-rational or even irrational motivations are always flaws to be regretted and eliminated from our repertoire of responses. In this case, the disposition to value life (and especially life that is now exemplified in a fully-formed human rather than something more developmental) is in the majority of cases good for us and therefore perhaps a candidate for respect and encouragement rather than scorn.

Extending the range of beings that it’s permissible to kill, or the phases of development where they no longer count, serves as a signal to those of us who are living and aware of being so. The signal is one that lacks empathy for the majority of the population, who have the same fears as everyone else but often lack the resources to articulate those fears in the language of intellectuals. One could perhaps say that it would be ideal for us to be less sensitive and precious about killing and letting die, but this would only be on one model of the ideal human – the one that resembles a purely logical Spock more than it does any of the humans we actually know, and ourselves are.

The point is that both sides of debates like this are (at the margins at least) premised on caricatures of humanity. I do think it’s true that many cases of potential infanticide are no different from cases where we consider abortion justified. So to my mind, it’s true that we’re being inconsistent in being repelled by the former and not the latter. But to make this case in a way which presents both the foetus and the newborn as fleshy objects of logical analysis also misses something, namely the sorts of adult humans we’d like to be, and the sort of world that conduces to becoming that sort of adult.

We’re understandably reluctant to end lives, even though these are not the lives of persons. That reluctance is plausibly a virtue worth reinforcing, rather than trivialising. Yet we should be able to talk about these things without fear of death-threats, and without those discussions being hijacked by the likes of Glenn Beck as evidence of a “progressive” agenda to introduce eugenics.

Moral outrage is not a sufficient justification to shut people up, especially when those people could be pointing to an inconsistency in our reasoning we’d benefit from knowing about. We also don’t want the boundaries of debate to be set by those who are most strident, where death threats or accusations of eugenics become effective techniques in argument.

A level of despair at how quickly emotive topics such as this descend into that sort of name-calling is understandable and justified. But having these conversations is nevertheless important, and the reactionaries can’t be allowed to win through the rest of us simply not showing up to argue with them. So, Giubilini, Minerva, and others like them should keep asking these difficult questions. But even when the responses seem hysterical, let’s not forget that there might well be something to be said for remembering that we don’t only live in our heads, but in bodies, families and communities too.

Also see Keenan Malik and Peter Singer’s responses.

Woo-woo fest comes to Wits

As published in Daily Maverick

Did you know that “millions of people in SA have had their own personal experience with ETs and UFOs”? If you didn’t, Michael Tellinger has arranged a conference just for you, this November in the Linder Auditorium at the University of the Witwatersrand. It must be true, seeing as one of South Africa’s most prestigious universities is hosting the conference.

John Edward is coming to eat your brain

As submitted to The Daily Maverick

Somewhere out there, a reader named Sally has just suffered a terrible loss. Or maybe it’s Samantha, or Sarah – anyway, something that has an “s” sound in it. Her husband – actually, perhaps only a family member, or … well, someone close to her has recently passed. His name was John, or maybe Joseph? It’s something starting with “J”, anyhow, although that might be his nickname.

So what if prejudice is ‘natural’?

As published in Daily Maverick

Only a very brave or a very foolish person would be prepared to claim that they had no prejudices. I’m not talking about the conscious decisions we make to discriminate, for these are often justified, but the relatively thoughtless, perhaps instinctive, preference for one sort of thing over another, whether that thing be a type of animal, a football team or a variety of insect.

Patrick Holford’s feel-good quackery

As submitted to The Daily Maverick.

At times it appears alarmingly easy to be considered an expert in any given field. This is sometimes the case even when objective criteria for expertise are available, and you manifestly fail to meet them. Granted, there are some fields of knowledge where consensus is difficult to reach, and where equally qualified people can have opposing viewpoints. But this is rare, and (thankfully) becoming steadily more rare.

Patrick Holford supports Malema!

No, not really. I was just trying the TimesLive and Sunday Times strategy for getting hits, whereby you headline a piece with something very misleading, perhaps even false. But it is at least partly true that Holford supports Malema, because Holford cares about all of us – especially our health, which he believes he can improve via dietary advice, and of course via your purchasing of his various branded products.

Unfortunately for some of us – particularly the ones with HIV, Holford also endorses the notion that “AZT is potentially harmful and proving less effective than vitamin C” – a notion which comes from Dr Raxit Jariwalla, who works for the Matthias Rath Foundation. I’ll write more about this next week for The Daily Maverick, but in the meanwhile, here are the places to avoid if you don’t want to hear Holford giving bad advice, or run into any his cultish supporters. Or, the places to flock to, if you intend to heckle.

Though, if you do intend to heckle, you should know that you’d be disagreeing with at least some experts in dismissing Holford’s credentials. On his website, in the section on “What the experts say”, there’s this:

Patrick Holford is one of the world’s leading authorities on new approach to health and nutrition.

The expert in question? The Daily Mail.

Thanks to Twitter user ORapscallion for alerting me to the visit of this quackmeister, and of course to Radio702 / CapeTalk567, who I hope are spending this ad revenue on AIDS-related charities. I mean, surely they must be, being behind the #LeadSA campaign and all.

Static on the radio

As submitted to The Daily Maverick

Just how much should radio stations, newspapers and magazines pander to the ignorance of some of their audiences? There is surely some merit to the notion that if you have a platform, where it could well be the case that the opinions of listeners and readers are shaped by what you air or print, you have some responsibility to not mislead them?

PowerBalance and the war on woo

As submitted to The Daily Maverick

There is a pestilence of woo sweeping the land. While some versions of pseudoscience, mysticism and general quackery are fairly constant insults to our sensibilities (Rhonda Byrne, Oprah, homeopathy, and chiropractic treatment are examples), others seem to go in and out of fashion like spinning tops and yo-yo’s used to do.

T4ProBalance – if you want headaches, burns and allergies

As many of you would know, I recently (on behalf of the Free Society Institute) submitted a complaint to the Advertising Standards Authority regarding PowerBalance bracelets and their particular brand of woo. Next up should surely be the scamsters who sell T4 ProBalance bracelets, who offer you 4 “technologies” in their magic bracelet. Four whole technologies, starting at just R369! Here’s what you get:

  • Bioenergetic scalar energy
  • 1200 negative ions
  • 100% surgical silicone
  • Antitstatic [sic]

That “antitstatic” alone is surely worth the price. But if you’re still not convinced, take a look at what the “benefits of T4 Pro Balance bracelets are“:

Alongside “power”, “focus” and “recovery”, they offer “burns”, “allergies” and “fatigue”. Oh, and don’t forget that “depression” you’ve been yearning for. Their website is a bit light on independent double-blind studies (i.e. there are none), so it’s unclear whether these bracelets are a good thing to wear on balance. But I suppose we have to assume that you get enough of the good stuff to outweigh those scarier-sounding “benefits”.

Or, alternately, what this shows is that they are simply too lazy, exploitative, incompetent or stupid to worry about details like having a poorly edited website. When you have fans defending the product saying things like “mabey [sic]you should look into something called science”, it seems that it doesn’t really matter what the website says. As P.T. Barnum reminded us, “there’s a sucker born every minute”, and those who sell these magic bracelets will keep on shamelessly exploiting those suckers for as long as they are able.