CrossFit/PALEO doctor Tim Noakes could lose medical license over FALSE advise

coach d wrote:

Let's not forget that Noakes is the same fruitcake that came up with the "central governor" nonsense. I remember some rather heated debates at ACSM conferences something like 10 years ago. I threw my copy of Lore of Running away back then as the work of a non-scientist, and it appears to me that the guy is not stable and veers from one oddball concept to another. The low carb/paleo stuff is just another instance of that.

Telling a nursing mom to go on a high fat low carb diet can do real damage. In my mind, that should be grounds for at least a malpractice suit, if not removal of medical license.

While I am not a central governor fan (the name was updated to anticipatory response I believe), it is an idea worth exploring. To say he is not a scientist is ridiculous. Most of Lore is still what we widely accept (not to mention the information on early runners and pedestrians is a great read)

What is your evidence that LCHF could damage a nursing mom. Do you have data to support that? Studies showing the harm?

He was also the guy that showed that the hydration recommendations instituted by many organizations including ACSM were more damaging and led to an increase in hyponatremia.

I think diet is very tricky. Most of the information we take as gospel was gathered in flawed manners (Taubes reported this years ago). Also the current US recommendations have little science to back them. From a non-scientific viewpoint we have gotten more obese since the introduction of low fat diets.

We know far more about short-term dietary changes than lifelong ones. We draw a lot of conclusions from surveys and mortality data. Taubes has started a foundation to do actual science on diet. The information is coming out slowly as it does with science.

There are folks questionning if LDL plays any role in heart disease for instance.

A quote from Noakes that I like is 50% of what we teach is wrong but we do not know what 50%.

Ross Tucker's article does not offer a scintilla of evidence for or against Noakes's position, only suggesting that a one-sided position (one kind of diet is the best one) cannot be correct. I don't know whether Noakes's position has anything to it, though I suspect our diets (mine, certainly) are way too skewed to the carbohydrate side, but you know if you read Noakes that he looked at a lot of evidence before changing his mind.

Thank you Luv2run for a rational perspective on all of this.

Runningart2004 wrote:

I eat 3-4 eggs a day, everyday, red meat just about everyday... But also chicken and veggies and fruit

Total chol is 175. HDL 63.

Only a deluded person would think that is good.

My total cholesterol is in the low 120's and I'm somewhat older than you are.

luv2run wrote:

From a non-scientific viewpoint we have gotten more obese since the introduction of low fat diets.

McDonald's is low fat???

The obesity craze has been fueled by trans fats, corn syrup, and high fat fast food.

Heart attack territory wrote:

Runningart2004 wrote:

I eat 3-4 eggs a day, everyday, red meat just about everyday... But also chicken and veggies and fruit

Total chol is 175. HDL 63.

Only a deluded person would think that is good.

My total cholesterol is in the low 120's and I'm somewhat older than you are.

Your cholesterol is borderline too low. Low cholesterol is correlated with cancer.

“Can you wonder that one sometimes becomes quite despondent about whether it is worthwhile trying to do scientific research in matters of health?”

http://www.theguardian.com/society/2016/apr/07/the-sugar-conspiracy-robert-lustig-john-yudkin

The courts must be bored down there. But it is interesting how a diet's validity will be proven or not in a court. Pass the popcorn.

Here's another thought. Did anyone inquire on the health of the mom and baby?!

If this commission was in Canada instead, would it round up thousands of Inuit women for child abuse raising children on a high-fat diet?

Actually... wrote:

luv2run wrote:

From a non-scientific viewpoint we have gotten more obese since the introduction of low fat diets.

McDonald's is low fat???

The obesity craze has been fueled by trans fats, corn syrup, and high fat fast food.

The problem with fast food is not that it is high fat. Fat is good for you, especially sat fat.

The problem is that it is high carbs. Buns, potatoes, sugar in drinks... all those carbs are causing the health problems.

Avoid any carbs, and eat as much red meat as you can. And you will be buff.

I've heard Tim Noakes speak at a seminar in Glasgow a few years back, mostly about over hydration and the role of drinks manufacturers. Saying he is not a scientist is ridiculous and much of the theory section of Lore of Running is littered with mainstream scientific references. The training sections are just lifted from other authors I think.

He does have some pet theories like the central governor that are seen as a bit cranky but I wouldn't throw his book away just because you disagree with that bit. I dip into it all the time and its usually immediately obvious whether the page you are reading is a summary of mainstream science or not.

Just another self-serving nutbag, is Noakes (note the Larry Rawson sentence structure) as is TV;s Dr. Oz.. Anything for a buck. Gawd bless Amerika!

Just wanted to clarify a few things and share a couple of opinions on this diet issue.

First, the reason my article didn't get into the meat (ahem) of the low carb high fat diet is two-fold.

1. The article was originally commissioned for a national newspaper here in SA. Word limited to 1200, and readable to a general population who have no specific expertise on biochemistry, nutrition etc. So it had to be short, and conceptual.

2. I'm not an expert in cardiovascular disease, diabetes, nutrition, endocrinology - all subjects that you need some mastery of to properly pass yourself of as an expert in. I'm reluctant to get into specific topic debates because of that, not because I can't pick up half a dozen journal articles and read for myself, but someone who has spent 30 years of their life researching X will more often than not know the nuance and insight about X that you do not. I dare the world would be a better place if people didn't speak so much about stuff they're not really experts in.

Anyway, I do have some specific thoughts on the diet and Noakes' position.

First, the meta-analyses, which I do trust, though some say they're tools for big corporates to drive agendas (I have little time for such conspiracy theories), suggest that a Mediterranean Diet has the best long-term outcomes, both in terms of weight loss and cardiovascular diet. This is a diet that is not necessarily low carb, but it is a diet low in refined sugars. It's also high in certain types of fats - unsaturated. I've seen a few reviews, and a few papers, comparing outcomes of people both healthy and ill on various diets, and this is the best performing diet.

Second, there is plenty of evidence, from pretty solid studies, that low carbohydrates diets DO have significant weight loss benefits early on. The mechanism for this, at least at first, is a ketosis-induced loss of fluid, which is to say, it's not "real". However, after that, there's still some benefit, because you've basically removed an entire food group from your shopping basket or cupboard. That is, you now have so few options that your overall energy intake goes down, and you eat less, and lose weight.

The diet is also helpful because proteins in particular are satiating, and so the problem of feeling hungry all the time is diminished. As a result of all this, people wishing to lose weight do succeed when they eliminate ALL carbs from the diet. At least at first.

Because therein lies the catch - I've yet to see a study that shows that one diet beats another over a long period of time. Over 12 months, maybe. Over 3 months, certainly. But over 2 years, no. Trials and meta-analyses show that diets which are matched for calories perform the same, regardless of how they're made up. In other words, you can cut the carbs, and you might see early progress, but after 2 years, you gain back a lot of what was lost, and you're not better off than someone who just cut everything by 30% and took in the same calories.

There's also a matter of endocrinology and biochemistry. I don't think anyone knows yet how the body responds to calorie restriction. And make no mistake, low carb diets are heavily restricted. Tim Noakes was eating a meal, perhaps 800 to 1200 Cal, every 36 hours, at one point. We had him document his diet over 2 weeks, and his average daily intake was 1200 kCal. That's incredibly low. It's no wonder he lost weight.

However, there are questions about how much this affects one in the longer term. That's why the research trials show no overall effect on different diets.

In terms of fats, as I said in the article, it's becoming increasingly obvious that not all fats are bad. But we did know this - I remember as a 13 year old reading Runners World and articles were being written about plant oils, and avocados, and fish oils and how beneficial they were. I see articles every week saying the same thing, and how long term studies show that fat intake predicts good health PROVIDED it is the good fats.

I also see articles showing associations between processed meats and saturated fats and disease and early death. The point there, is that scientific consensus is that not all fats are good either.

That's why it's so reckless to swing from the one extreme (all carbs are bad) to the other (all fats are bad). It's just stupid. A bit of nuance goes a long way.

The link between cholesterol and heart disease is one that I'm not familiar enough to offer an opinion on, other than to say that I think that in some populations, it's likely to be different to others. Id' therefore be cautious about demonising carbs and replacing them with fats for everyone.

Finally, I remember one very obvious example of how this wrong thinking can cause problems. At one point, Tim discovered that cancer cells thrive on sugar. Ergo, he started promoting low carb diets as a means to treat or avoid cancer. All good and well, except cancer is not so simple. There are some cancer cells that thrive and do better in the absence of sugar. Same advice, totally different outcomes.

So if I sum it up, I disagree with pretty much everything Noakes has done in terms of how he is arguing this. There's too much conspiracy theory, too much anecdote, to much "religious fervour". Hubris and hamartia. And that was the point of my original article.

However, I also disagree, and think Noakes is wrong on the following:

1. The mechanism for weight loss on a LCHF diet is not what he thinks. It's initially fluid, and then calorie-related for most.

2. I have doubts about the sustainability of the weight loss in many - the studies and reviews all say pretty much the same thing - long-term, it doesn't much matter for weight changes.

3. I don't agree that all fats are equally healthy. And I don't think all carbs are equally bad. Sugar, yes. But others, no. The Mediterranean diet success shows this pretty well, in my opinion, and those are pretty good studies. I also refer to a study on baked potatoes, in which people either added them or did not to a diet that was low in carbs, high in fat, like Noakes advises. Turns out that the appetite control was improved when you ate potatoes, and that has long term implication too. Point is, if you demonise ALL carbs, or ALL Fats (as was done before), then you miss out the chance to moderate and improve a general position. I think Noakes and many others are doing this.

I do agree that we need to consume less sugar. That would, of course, reduce our carbohydrate intake, and we'd shift to a different overall diet composition. No problem with that at all.

The exception, of course, is many of you reading this. As athletes, sugar is the most readily available source of fuel. Elite athletes who participate at a high intensity are far better off consuming a diet that provides readily available fuel, especially when they are training. And that's why studies by Burke and Hawley and co find that elite athletes fare so poorly on a paleo type diet. In the short term, they suck on the diet. No energy, lethargic, underperformed, overtraining.

In the long term, maybe they'd improve, but real high intensity exercise (I'm not talking Ironman here, even marathon, though the very best are at the high intensities) requires simple sugars. So then they're good.

point is, nothing is all good, or all bad. And arguing such is stupid, and ultimately doesn't optimise anything.

Ross

I was one of those (I think the one) who spoke of anticipatory regulation - it was in fact the title of my PhD, which I did under Noakes.

I used that, and avoided any reference at all to the Central governor name, because I realized over the 4 years of my PhD how polarising and offensive Tim had been about the central governor concept.

There's nothing wrong with it at all, and calling Tim a fruitcake for coming up with it betrays a lack of understanding of what he actually proposed. Yes, he pitched it in a way that insulted a lot of people, and the primary error there was to tell other people what they said, and why they were wrong. They responded by dismissing him entirely, which is never a good approach to take when you want to get to the truth.

But Tim was very polarising about it. he created "camps", the Central governor camp vs the peripheral fatigue camps, and then basically told everyone which camp they belonged in! They objected to how they were being pigeon-holed, some of them justifiably, but it was too late. The battle lines were drawn, and as a result the ideas he came up with did not get nearly as much traction as they deserved.

Here too, much like in the diet debate, Tim was absolutely right - the brain does regulate exercise intensity, it does protect the body against what he called "Catastrophic failure". These are indisputable truths, and you'd be a fruitcake not to recognise it.

however, there are complex interactions in play too. There is without question some peripheral fatigue, where the muscle becomes unable to contract even with the same signal from the brain. There is also 'failure' of athletes who go out too hard and then 'blow' - regulation is not the perfect system that we (I was as guilty as anyone) wrote about early on. We do become hypoglycaemic, we do overheat. These things would be predicted not to exist if a central governor was all there was.

We know this, and knew this all along, but Tim did not want to acknowledge it because the "Central governor camp" was all about it being the brain, not the muscle. (this is not unlike his and others approach to diet - there are some people who thrive on fat, others who suffer and need carbs. Refusing to recognise BOTH groups is to choose blindness. Why do that?)

So Tim's central governor theory, or any other name you want to call it, was a massive contribution to the field of fatigue and performance. It entitles him, along with his hydration theories, to be listened to when he speaks on diet. However, the history also says that we must careful to avoid extreme opinions that choose A over Z, when there's an entire alphabet of possibilities in between. And that's why, in diet, just like central governor and fatigue, Tim says things that are true, some that are disputed, and some that are just false. Figuring out which is which is nearly impossible, and that's why the whole debate is ultimately unhelpful.

Going back to fatigue, there were scientists who did amazing research showing peripheral contributions to fatigue. But when I wrote up my PhD studies, early on, we didn't ever acknowledge their work, because they were "the bad guys, over there in the muscle camp". How stupid!

The end result was that we didn't acknowledge them, and they didn't recognise our work. Meanwhile, the true and complete understanding of fatigue was sitting there in the middle, requiring that both sides or camps came together to combine their knowledge, so that the world might be better off as a result of "INTEGRATION".

Instead, we got DESTRUCTION, and that's what is happening in the diet discussion - you have some in the LCHF Camp, who put basically everyone else in the Sugar camp, and the truth, the things that are most likely to help the most people around the world, are somehow lost in the "fight" that shouldn't be a fight.

If I'd collaborated and recognised the value of what others were doing in the field of fatigue and performance, then WE, the collective, would be more knowledgable about fatigue than we are today. I didn't, so we all lost.

Hence, my appeal to Noakes, Teicholz, Malhotra etc - don't make the same mistake for nutrition. It just holds us back relative to where we could be. We are walking, when we should be running.

Ross

Ross Tucker wrote:

Just wanted to clarify a few things and share a couple of opinions on this diet issue....

Ross

Best post I've seen on here in half a decade.

Ross Tucker wrote:

I'm not an expert in cardiovascular disease, diabetes, nutrition, endocrinology - all subjects that you need some mastery of to properly pass yourself of as an expert in. I'm reluctant to get into specific topic debates because of that...

Perhaps this isn't something you want to weigh in on, but do you see anything to suggest that what Tim Noakes did in advising a nursing mother and weaning infant to go on the paleo diet is actually dangerous? In my admittedly limited understanding of the hearings, that's what's at issue isn't it?

Bingo! "The Inuit Paradox" is a perfect account of high fat / low carb eating.

Stench Detector wrote:

If this commission was in Canada instead, would it round up thousands of Inuit women for child abuse raising children on a high-fat diet?

Angry Willy wrote:

Bingo! "The Inuit Paradox" is a perfect account of high fat / low carb eating.

Walrus meat (raw) has basically 45% FAT, 55% protein. Zero carbs.

It doesn't get much healthier than that - basically zero risk of CVD or diabetes.

(they get these diseases now because of imported GRAIN based foot)

I didn't read all the posts, but did anyone point out that Noakes is not at all associated with either CrossFit or Paleo?

Low Carb High Fat, the approach he's into, is not the exact same thing as Paleo, although they have overlap.

I've followed him closely and followed the trial in November, but I didn't follow it when it picked back up.

Noakes himself has backed off LCHF a bit. He used to say "eat the fat and throw away the meat", but now says you need more protein to maintain muscle mass.

I don't totally agree with him and find him to be one of those smug "everyone is stupid and wrong and I'm smart and right" guys, but I think it's ridiculous that they put him on trial. Different physicians are going to have different opinions.