Noakes goes too far - doctors

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Professor Tim Noakes, professor of sports science and exercise at the University of Cape Town, says it's not carbohydrates we should be loading, but protein and fat.

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Cape Town - Sports scientist Tim Noakes goes too far in suggesting that a switch to a high-fat, high-protein diet is advisable for everyone, say six top doctors and academics.

It may, in fact, be dangerous for anyone with or at risk of heart problems, they say, adding in a letter to the Cape Times (full text below): “Having survived ‘Aids denialism’ we do not need to be exposed to ‘cholesterol denialism’.”

The six signatories of the letter were doctors Patrick Commerford (professor of cardiology and head of the cardiac clinic at UCT and Groote Schuur Hospital), Miko Ntsekhe (of the cardiac clinic at UCT and Groote Schuur Hospital), Dirk Blom (of the lipid clinic department of medicine at UCT and Groote Schuur Hospital), David Marais (of chemical pathology and clinical laboratory services at UCT’s Health Science Faculty), and cardiologists Elwyn Lloyd and Adrian Horak.

Noakes, a professor of exercise and sports science and head of the Sports Science Institute of SA, launched an updated edition of his book, Challenging Beliefs, earlier this year, which contained an abrupt turnaround on his previous views toward carboloading – instead promoting a high protein and fat, low-carbohydrate diet.

The doctors’ warning comes as Noakes received a lifetime achievement award for his research in sport science, at the National Research Foundation awards ceremony on Thursday night in Milnerton.

Speaking to the Cape Times from there, Noakes hit back, saying some of the signatories had attended his presentation on the subject at UCT in July and none of them had the courage to say he was wrong:

“None of them got up. It will be interesting to hear them say what I’m wrong about. There was a nutritionist, Dr Priscilla Steyn, who stood up and said I simplified the issue. But I’m happy to give a talk again.”

In their letter, the six said Noakes’s new views contradicted “many aspects of conventional wisdom and accepted medical practice”.

They said that some of what he said might be true and that “his views on the contribution of refined carbohydrates to the obesity epidemic are almost certainly correct”.

“However, we believe he goes too far in suggesting that a switch to a high-fat, high-protein diet is advisable for all persons.”

They said that such a diet might have allowed him to lose weight and run faster. “But its widespread implementation is contrary to the recommendations of all major cardiovascular societies worldwide, is of unproven benefit and may be dangerous for patients with coronary heart disease or persons at risk of coronary heart disease.”

His questioning of the value of cholesterol lowering agents, or statins, was at best unwise and could be harmful to many patients.

“To present these controversial opinions as fact to a lay public, in his un-refereed book, is dangerous and potentially very harmful to good patient care.”

The doctors said they understood some patients were placing their health at risk by discontinuing statin therapy and their prudent diets on the basis of this “expert opinion”.

“Scientists and clinicians have an ethical obligation to ensure that the information they impart to their patients and the public at large is correct, in line with best available evidence, and will not cause harm,” the doctors concluded. - Cape Times

FULL TEXT OF THE LETTER (Cape Times, September 14, 2012)

In his book Challenging Beliefs, Professor Tim Noakes takes issue with and contradicts many aspects of conventional wisdom and accepted medical practice. Some of what he says may well be true and his views on the contribution of refined carbohydrates to the obesity epidemic are almost certainly correct.

However we believe he goes too far in suggesting that a switch to a high-fat, high-protein diet is advisable for all persons. Such a diet may have allowed him to lose weight and run faster but its widespread implementation is contrary to the recommendations of all major cardiovascular societies worldwide, is of unproven benefit and may be dangerous for patients with coronary heart disease or persons at risk of coronary heart disease.

Further his questioning of the value of cholesterol lowering agents (statins) is at best unwise and may be harmful to many patients on appropriate treatment. The very strong evidence is that statins in patients with coronary artery disease improve mortality (they make you live longer). Multiple placebo-controlled studies have confirmed this.

Generic statins are now cheap and should be widely used. The side-effect profile of these agents is benign and there is general agreement that their benefits far outweigh any minor risks associated with their use.

Noakes is welcome to his views. As an academic it would be appropriate for him to air these and to debate them in an academic forum and the medical literature where they could be critically evaluated and challenged by his peers.

To present these controversial opinions as fact to a lay public, in his un-refereed book, is dangerous and potentially very harmful to good patient care.

We understand some patients are placing their health at risk by discontinuing statin therapy and their prudent diets on the basis of this “expert opinion”. Having survived “Aids Denialism” we do not need to be exposed to “Cholesterol Denialism”.

Scientists and clinicians have an ethical obligation to ensure that the information they impart to their patients and the public at large is correct, in line with best available evidence, and will not cause harm.

Patrick Commerford

MB ChB FCP(SA) FACC (Professor of Cardiology and Head Cardiac Clinic UCT and Groote Schuur Hospital)

Dr Miko Ntsekhe

MD PhD FCP(SA) FACC (Cardiac Clinic UCT and Groote Schuur Hospital)

Dr Dirk Blom FCP(SA)

PhD Lipid Clinic Department of Medicine UCT and Groote Schuur Hospital

Professor A D Marais FCP(SA)

Chemical Pathology, Clinical Laboratory Services, UCT Health Science Faculty

Dr Elwyn Lloyd MD FCP(SA)

FACC Cardiologist

Dr Adrian Horak FCP(SA)

Cardiologist

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