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Heart disease theory an error - Noakes

Professor Tim Noakes. Picture: Antoine de Ras

Professor Tim Noakes. Picture: Antoine de Ras

Published Sep 17, 2012


Cape Town - Tim Noakes has hit back at critics of his new diet, saying the theory that blood cholesterol and a high fat diet are the causes of heart disease will be one of the greatest errors in the history of medicine.

“It is time to admit that the theory has failed. We need to adopt an open mind if we are ever to discover the real cause [or causes] of the current global epidemic of obesity, diabetes and coronary heart disease, all of which are likely caused by the same factors.”

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The Cape Times reported on Friday that six top doctors and academics said Noakes had gone too far suggesting that a switch to a high fat and protein diet was advisable for everyone. They also said his advice might be dangerous for anyone with or at risk of heart problems.

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 a turnaround on his previous views toward carboloading – instead promoting a high protein, high fat and low carbohydrate diet.

In a letter to the Cape Times, Noakes gave a scientific explanation why a low fat diet had no proven role in the prevention of heart disease. “It is time that cardiologists began to teach this fact in our medical schools,” he wrote.

The doctors’ warning came as Noakes received a lifetime achievement award for his research in sports science by the National Research Foundation.



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Professor Patrick Commerford et al’s letter to the Cape Times (“Noakes goes too far,” September 14) refers. As I wrote in Challenging Beliefs, a 2010 meta-analysis of studies involving 347 747 subjects, published in the American Journal of Clinical Nutrition, found “no significant evidence for concluding that dietary saturated fat is associated with an increased risk of coronary heart disease or cardiovascular disease”.

A 2011 report from the Cochrane Collaboration, an organisation that is independent of the pharmaceutical industry, found that “there was no clear evidence for dietary fat changes on total mortality or cardiovascular mortality”. Thus the scientific evidence is clear: a low-fat diet has no proven role in the prevention of (coronary) heart disease. It is time that cardiologists began to teach this fact in our medical schools.

So if a high-fat diet does not cause heart disease then what does?

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In carbohydrate-intolerant subjects, like myself, a low-fat/high-carbohydrate diet produces all of the following abnormalities some of which are causally linked to arterial damage and heart disease:

1. Elevated blood glucose, insulin and glycated haemoglobin (HbA1c) concentrations. The best predictors of heart attack risk are blood HbA1c and random glucose concentrations. Elevated values in diabetics increase heart attack risk 7-fold. In contrast, an elevated cholesterol concentration increases heart attack risk about 1.3 fold, a value low enough in statistical terms to be potentially spurious.

2. Low blood HDL-cholesterol and high triglyceride and uric acid concentrations.

3. Increased numbers of small, dense LDL-cholesterol particles. In contrast a high-fat diet increases the number of large, fluffy LDL-cholesterol particles that are not related to heart attack risk.

4. Elevated blood Lipoprotein (a) concentrations.

5. Obesity and, in my opinion but as yet unproven, elevated blood pressure.

6. Elevated ultra-sensitive C-reactive protein concentrations indicative of a whole body inflammatory state.

7. Elevated blood homocysteine concentrations (due to dietary deficiencies in folic acid, vitamin B-6 and B-12 found in eggs and meat).

If the cause of heart disease was truly known (as is the cause of HIV/Aids) then the condition should have disappeared with the promotion of the so-called “heart-healthy prudent diet” and the annual prescription of tens of billions of dollars’ worth of cholesterol-lowering drugs globally.

Yet one of the leading causes of death in the US is now chronic heart failure caused by coronary heart disease. To service its burgeoning heart disease problem, the US now requires twice the number of cardiologists currently in practice (17 000). If current dietary and therapeutic advice was effective, cardiology and cholesterol-lowering drugs should be going the way of the dinosaur. Instead both are major growth industries. No wonder both fear “cholesterol denialists”.

In 1900 when most Americans cooked in lard and ate a diet full of butter and dairy produce, pork and saturated fat in meat (but low in sugar and processed foods), heart disease was so rare that their most famous cardiologist, Dr Paul Dudley White, encountered his first case only in the 1920s (although the disease has since been described in grain-eating Egyptian mummies). Today in a nation that has replaced animal fats and dairy with “healthy” carbohydrates, heart disease, like obesity and diabetes, is rampant.

With regard to statin therapy, I advise anyone who does not have established heart disease or genetic hypercholesterolaemia, and who is either already taking or considering using cholesterol-lowering drugs, to read The Great Cholesterol Con (2006) by Anthony Colpo. This book should also be required reading for all my colleagues who are prescribing these drugs or who plan to do so in the future.

The theory that blood cholesterol and a high-fat diet are the exclusive causes of heart disease will, in my opinion, prove to be, like the miasma theory, one of the greatest errors in the history of medicine.

It is time to admit that the theory has failed. We need to adopt an open mind if we are ever to discover the real cause(s) of the global epidemic of obesity, diabetes and coronary heart disease.

Professor Tim Noakes

University of Cape Town and

Sports Science Institute of SA




Case against statins

Prof Patrick Commerford et al’s letter (“Noakes goes too far”, September 14) states that “Noakes’s questioning of the value of cholesterol-lowering agents, or statins, was at best unwise and could be harmful to patients”. Here is an alternative position:

As doctors in the 1990s we learned that atherosclerosis was caused by high cholesterol and that statin tablets reduced cholesterol and so protected us from heart attacks. It was easy – “you are what you eat”.

The first shock to this theory came in a meta-analysis in 2000 when Mike Pignone et al showed that although statin tablets reduced heart attacks they did not cut overall mortality. So you might not die of a heart attack, but you wouldn’t live any longer.

The second shock was when Jeppeson et al showed in 2001 that half |of all heart attacks happen to people with normal cholesterol.

This meant something else was |going on besides high cholesterol to cause heart attacks.

The answer came initially from a study by Paul Ridker in 1998 showing that men with inflammation in their arteries were at much higher risk of heart attacks than other men.

This meant that inflammation was more important than raised cholesterol in developing a heart attack.

But if inflammation was causing heart attacks, why were statin tablets that lowered cholesterol so useful?

The JUPITER study gave us the answer by showing that a statin tablet would both reduce inflammation and cholesterol. This means that if the arterial wall is not inflamed then cholesterol will tend not to stick to it.

So if it is inflammation and not absolute cholesterol levels that we are fighting, then wouldn’t it be more prudent to use an anti-inflammatory to prevent heart attacks?

In 2006, Pignone got back into the ring to show that for the average person who was at moderate-to-low risk for a heart attack, Aspirin was more effective and more cost-effective than statin tablets at reducing heart attacks.

This is part of the background to the thinking that consuming oil is not the evil that we thought it was, that statins are not the cure-all we once thought and that inflammation and sugars have a lot to answer for in the fight against obesity, heart attacks and diabetes.

Dr Duncan Carmichael

Head: Anti-aging Clinic

Sea Point



Lifestyle choice is key

Cholesterol denialism, yes please! The various cardiologists are trying to compare Aids with cholesterol which is likely to confuse the public further. Cholesterol is an important chemical made by the body which performs various important roles such as a precursor to oestrogen and testosterone. We don’t need Aids but certainly need cholesterol.

Unfortunately there has been so much press about the harm that cholesterol does that people are often unaware that it has a good side. Too much cholesterol is a marker for possible future cardiovascular problems, but is often exaggerated resulting in a lot more people being on statins than necessary. This is of course great news for the pharmaceutical companies whose profits are bolstered by people being on permanent drug therapy.

High cholesterol is nearly always a result of poor diet and lifestyle and can often be corrected provided the patient is willing to increase exercise and change his diet. Instead people often choose the drug option recommended by conventional medical practitioners believing there are minimal side-effects and that they are putting their lives at risk if they don’t take them.

Actually if you speak to people who are on statins they commonly mention increased fatigue, muscle weakness and muscle ache. The reason for this is physiologically known and is due to the fact that statins not only block cholesterol formation but also the formation of CoQ10. CoQ10 is important for energy metabolism and reduced levels lead to less energy for muscles. The cardiologists say the side-effects are benign but they affect quality of life.

Statins have their place but let’s get away from this idea that cholesterol is bad and that statins should be used. High cholesterol is nearly always a result of Western lifestyle choices and people should look at changing their lifestyle rather than subscribing to drug therapy.

Mike Purvis

BSc Complementary Therapies,

Diploma Nutritional Therapy

Hout Bay

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