Controversial or hard questioning?

During my recent visit to Cape Town, my disappointment for not racing the full version of the Cape Argus (road closures due to severely destructive mountain fires) was more than balanced by the hour long chat I was fortunate to hold with Prof. Timothy Noakes at the Sports Science Institute of South Africa (SSISA). Prof. Noakes is an eminent but controversial sport scientist, now retired, who has a personal track record in long distance running and marathon culminating in his popular publication ‘The Lore of Running’. He also successfully supports the Springbok national rugby team. I won’t delve into his background much in this post as others have already done the due diligence and appraisal of his philosophies on diet, as found here. I’ve touched on diet and macro-nutrition before, so this probably feels like an extra level of complexity…but I believe that having EVEN more knowledge and info will ultimately help mete out what is valuable and even sound advice. Meeting one of the diet industries ‘outliers’ or ‘anomalies’, Prof.Noakes’ controversial stance and antagonistic questioning of pretty much every current physiological principle, has given me more confidence in my own beliefs on the subject, not because I necessarily agree with him……but mainly because it shines light in the nooks and crannies, many scientists are too afraid to explore.

I say ‘controversial’ as Prof.Noakes is a big advocator of the ‘hi-fat, lo-carb‘ diet revolution and has devised the Noakes diet synonymous with Paleo, as set out in his book the Real Meal Revolution. The Noakes diet is based on ‘Banting’ , named after an obese chap William Banting who lost lots of weight under the care of Dr. William Harvey. His drastic weight loss was achieved purely by cutting out calorie dense carbohydrates, which you can read more about here.

The greater ingestion of fats from dairy and animal products is perceived from somewhat ‘tenuous’ historical evidence to be detrimental to human health…think atherosclerosis and coronary heart disease demonstrated by the Framingham Heart study, although now the conclusions seem to be based on erroneous statistical analysis and the misinterpreted biochemical nature of cholesterol, lipoprotein chylomicron carriers and HDL/LDL ratios.

Prof. Noakes told me that he was historically ‘lulled’ into the ‘hi-carb’ camp over the years, but delved deeper into the rationale put forward by the likes of Stephen Phinney, Jeff Volek and Peter Attia. Many other names; Ivor Cummins and Nina Teicholz a have since joined the ‘sphere’ with their own take on the issues, with an interesting slideshow on Vitamin D. I’ve never seen so much pseudoscience literature to flood the shelves as the explosion of evidence associating high carbohydrate diets with obesity and coronary heart disease is fast becoming more apparent. Whether actual calories or the types of calories contributes to either or both directly is still under debate. (viz Gary Taubes: Good Calories Bad Calories). The other side of the Noakes diet coin to high-fat is low-carb, where cereals should be excluded and many-plant based foods (high starch tubers, potatoes etc) minimised, which may be pro-inflammatory, think gluten and celiac disease.

I am unsure whether I concur with Loren Cordains 1999 article on Cereal Grains: Humanity’s Double-Edged Sword which highlights an association between autoimmune disease and the prevalent consumption of Wheat, Maize, Rice and Barley (as the top 4) by the global population over recent agricultural revolution maligned with human dietary and metabolic evolution. Prof. Noakes seems to favour this and excludes cereals from his diet recommendation in the same way Paleo does. But this led me on to ‘The China Study’ a now dated observational assessment which may still hold water against the naysayers. I will quote from Wikipedia….

“The book is loosely based on the China-Cornell-Oxford Project, a 20-year study – It looked at mortality rates from cancer and other chronic diseases from 1973–75 in 65 counties in China; the data was correlated with 1983–84 dietary surveys and blood work from 100 people in each county. The research was conducted in those counties because they had genetically similar populations that tended, over generations, to live and eat in the same way in the same place. The study concluded that counties with a high consumption of animal-based foods in 1983–84 were more likely to have had higher death rates from “Western” diseases as of 1973–75, while the opposite was true for counties that ate more plant foods”

So it seems that, if the evidence has been flawlessly analysed or interpreted, which is rarely ever the case (time for the sciency bit….even with only a 1 in 20 chance of an observation being random (i.e. p<0.05), if it were a true difference…the actual probability of a false predictive rate is more than 33%, as explained here). In other words, regardless of the design of a study, if the strength of the evidence between two groups or two trial interventions (in this case diets or prevalence of disease, controlled for demographic variables) equates to a statistical significance of less than 5% of the time that the difference results purely by random chance…that result will still be misleadingly wrong 33% of the time. Slightly confusing, but an important mathematical flaw which many reserchers are unwilling or unable to integrate in their findings.

From this statistical caveat alone it is extremely hard to appraise any evidence appropriately from a study, as there are just so many variables involved. As the more evidence is searched for, the greater the chance of finding an ‘erroneous’ statistically significant effect. Which I have explained before and is a commonly known statistical issue.

Which brings us back to what applies best to the individual athlete and their preference. It looks to me that we can highlight several issues…

• Is animal based or plant based protein better or necessary for human nutrition?
• Is plant based nutrient dense food / fibre protective against common chronic diseases?
• Are dairy products partly responsible for elevated cholesterol/ lower HDL and heart disease?
• Are cereals and grains pro-inflammatory?
• Is individual response/ preference to fat or carbohydrate fuelling important?

Will these questions ever be answered fully? Probably not. Will the confusion and squabbling continue within the industry to capitalise on consumerism? Probably so. Is it as simple as years of vested-interest from the industry demonising dietary fat as bad to favour high-carbohydrate diets which have thought to contribute to the obesity epidemic? The evidence does seem to be mounting. One thing is for certain, more and more of my athlete clients and friends are arming themselves with as much info and making very educated decisions about their personal nutrition, with a handful supporting successful endurance training and competition on neo-vegan diets, as exemplified by the online high-carb, fruit advocate and celebrity DurianRider. Interestingly, and more confusingly, our decisions on diet can potentially impact our behaviours, to include or exclude more ‘risky’ behaviours. Just because someone eats ‘healthily’ doesn’t mean they are a saint in other departments! I’m sure the food industry capitalises from public confusion, but one thing is for sure, never has there been such an abundance of human disease and poor metabolic health. I personally favour a pescatarian diet, although slip from time-to-time but have never struggled with weight or muscle tone since my university days.

In my opinion, I believe it is important to find what works for you as quickly as possible and then tweak what you need to on a trial-and-error basis. Be consistent, test only small changes in diet/ composition over weeks/ months. Changes in training will either serve to complement or hinder your response, so be prepared to consider the complexity of both concurrent elements.

Once you hone in on a winner, and how your body works/ reacts you can then really get to grips with pushing your so-called ‘genetic’ limitations and take your training to the next level!

One of my next posts will touch on personal nutritional mapping, fuelling and recovery with some of the contemporary ideas shared at the GSK HPL webinar for its scientific community.