Nov 14, 2013

A Superb Interview w/ Prof. Timothy Noakes on High Fat Diets, Hydration, and Challenging Conventional Wisdom.

Welcome Readers!  Today I have the privilege and honor of sharing a back and forth that I had with Dr. Timothy Noakes of Capetown, South Africa. If you are big into exercise physiology, running/endurance sports or high fat/low carb diets then you probably know of or have heard of Professor Noakes! Dr. Noakes is a brilliant man and when he speaks, I listen. He is a passionate man and has strong feelings but he is also passionate about science and is no stranger to challenging beliefs or conventional wisdom.  He is infinitely curious and questions everything. Two hallmarks of a great mind.  I hope you all enjoy the interview and are able to take one or two things from it!

Me: Welcome Professor Noakes! I know you have been a man of many hats but could you give us a little background about yourself for the readers?

Professor Noakes: I trained as a medical doctor at the University of Cape Town and during my training I realized that health, sports medicine and exercise physiology really interested me rather more than did the standard medical curriculum.  So during my training I was more interested in how medicine related to sport rather than the information I was meant to be learning.  I perceived that medicine was spending a lot of money on the management of chronic disease without appearing to be particularly successful.  In addition, I realized that athletes were not getting much care from medicine and it seemed to me that the future of medicine lay more in prevention by promoting healthy lifestyles and exercise and, as a consequence, I realized that sports medicine would become increasingly more important.

Me: So you are quite the figure head in the exercise science community and are well known for your research publications and books. Can you tell us how your views on nutrition for athletes have changed over the years?

Professor Noakes: I started running and researching in the 1970s when the idea first became popular that a high carbohydrate diet is essential for superior athletic performance.  I continued to believe that even though some of our research did not agree with that conclusion.  For example, we performed a placebo controlled trial of carbohydrate loading and showed that it had no effect on performance during a 100km time trial.  That should have perhaps warned me that the evidence for the benefits of carbohydrates might be slightly less good than I believed, but unfortunately I didn't take notice at the time.

My big change came when I changed to a low carbohydrate diet and immediately became profoundly more healthy.  In addition, my running improved dramatically and so I realized that perhaps my devotion to the high carbohydrate diet, as described in my book Lore of Running, was perhaps misplaced.

It then became apparent to me that some of us are carbohydrate intolerant or insulin resistant and for us carbohydrate is analogous to a poison and the less carbohydrate we eat the better our health will be.  So my change occurred because of personal experience and the tremendously improved health I have enjoyed since I cut carbohydrates to less than 25g a day.

Me: I have heard you mention in some podcasts that you sometimes go long periods of time without eating or feeling hunger. This sounds a lot like intermittent fasting(IF) that by intent or an effect of how satisfying your diet is now? Do you support the practice of IF?

Professor Noakes: I think that humans are designed for intermittent fasting because we would not have been eating all the time when we were hunter gatherers.

I think that if you are able to fast intermittently it tells you that your metabolism is perfect because you are burning fats and not needing to top up your carbohydrate reserves all the time.

I have observed that athletes do during racing what they do during training.  In other words, if they are carb adapted they tend to have an addictive eating behaviour in which they eat carbohydrates every 3 or 4 hours.  As a consequence, when they involved in athletic competition they follow the same plan in that they must be forever re-stocking their carbohydrate stores or perhaps stimulating their brains with carbohydrate.  On the other hand, if you are fat adapted the further you go the higher your blood fat levels rise and the more effective your fat metabolism becomes.  So you need less carbohydrate as a result.

Me: Can you guide us through what an average day of eating is like for you?

Professor Noakes: I no longer plan to eat meals.  I rather eat one large meal every 24 hours.  So during days I will either have a big breakfast or a big lunch and occasionally a big supper, although I prefer not to have big suppers as that affects my blood glucose control rather adversely.  So I will try to get most of my calories in in the morning, at breakfast or at lunch.  A big breakfast for me would therefore be eggs and bacon and sausages, tomatoes, onions and, if I still need to fill up, I would take dairy produce, particularly cheese and occasionally some yoghurt.  That would then see me through the day and I would perhaps snack at lunch time with some cheese, macadamia or almond nuts (or both) and perhaps some dried meat (known in South Africa as biltong but in your country as jerky).  Then at night I would probably have salmon with vegetables prepared by my wife.  The only sweet items that I eat are strawberries and blueberries.  As a treat in the evenings I will occasionally have full cream yoghurt with berries or full fat cream with strawberries.

Once every 3 days I will fill up with a large salad and liver.  Thus I eat vegetables every day but I load up once every 3 days by eating my fill of vegetables.  I am adapting my diet to eating more offal and when I can cook for myself I will include much more offal in my diet.

The point of all this is that I am eating about two-thirds of what I used to eat and I eat essentially no carbohydrates and nothing sweet.  As a result I have lost 20kg of weight and this has naturally had a huge effect on my lifestyle.

Me: How has your changing of or should I say challenging of beliefs on nutrition and hydration impacted your relationship with peers and colleagues?

Professor Noakes: Most of my peers and colleagues hated me for my position on hydration.  The reason was that it exposed them as being critically dependant and, as a consequence, manipulated by the sports drink industry.

The same is happening now on the nutrition story.  There are so many conflicted scientists and I would expect them to be very angry with what I am saying.

But the reality is that the truth will come out one day and if we want to be healthy ourselves it is better that we learn that truth earlier in our lives rather than later.

So I am not really upset by my colleagues responses.  It is expected.  Science, after all, is not about popularity and consensus.  Science is about disproving hypotheses and, as a consequence, moving closer to the truth.  The great threats to truth are ego, narcissism and conflicts of interest.

Me: I have had issues related to having conflicting views with peers related to these same idea you have any advice for people or other professionals that may find themselves isolated when disagreeing with popular opinion/conventional wisdom?

Professor Noakes: I think in research and in science you have to understand that consensus is the basis for mediocrity.  If you want to make a difference you have to see what no-one else sees and what no-one else thinks.  If you are all thinking the same then the probability is that you are all wrong.

So you have to have confidence and be comfortable in being a maverick.  What sustains me is reading more and more and trying to get closer to the truth.  The more you read the more you realize generally that most of what we believe is nonsense and a very simplistic explanation of what is the real truth.

With regard to the nutrition story, I didn't go public until I had read for at least a year, by which time I was very comfortable that there was something in the low carbohydrate diet story.  Two years later I am more than convinced that the high carbohydrate diet is the single greatest disaster that has struck humans since the development of agriculture.  That it is not true and is damaging our health is so blatantly obvious once you read enough.  I also appreciate that for the high carbohydrate diet to be adapted there had to be complete brain washing of our profession and of the general public.  This stands as an achievement equally by what Hitler did in Germany in the 1930s and what the politicians in my country did in the 1940s and beyond.  The brainwashing techniques that have been used are identical to what happened in Germany and in South Africa.

Me: So you support a low carb/high fat diet for health and endurance athletes and some people do not have an issue with seeing the logic there. However, some people think this is an impossible diet strategy for athletes involved in sports like American basketball or football. What are your thoughts?

Professor Noakes:  Fortunately I think that this diet would be ideal for American basketball and football players.  Certainly Kobe Bryant and the LA Lakers are now on the diet and Bryant reports that he has more energy as a consequence.  I would think that many of the American football players who are carbohydrate intolerant and who are frankly obese as a consequence of their high carbohydrate diets would do much better on a high fat, high protein, low carbohydrate diet since they would maintain their optimum muscle mass and would not need to carry so much fat on their bodies.

There is growing evidence that this diet doesn't affect explosive exercise performance and that some people get even stronger when they follow this diet, probably because they remove some toxic components of the high carbohydrate diet.  Alternatively, it may be that the high carbohydrate diet is nutritionally deficient.

On the other hand, researchers in my laboratory are looking at the role of fructose in inhibiting the normal mitochondrial adaptations that occur with training.  What these studies are showing is that fructose specifically, but also glucose taken in large amounts from refined carbohydrate sources, may have negative effects on mitochondrial function and adaptations to training.  This then would explain why some people improve their athletic performance dramatically once they get off the high carbohydrate diet and include fats in the diet.

Me: The same thought process from the previous question is often applied to hydration strategies for the non-endurance sports like American football. Do you still recommend the ad libitum drinking strategy for these types of athletes? My personal opinion is that many athletes and coaches dangerously rely upon excessive drinking, thinking that it will negate the need for proper work to rest ratios to prevent heat illness during practices or events.

Professor Noakes: I definitely recommend ad libitum drinking strategies for all athletes, including and especially those involved in non-endurance sports like American football.  There is a real risk that if you are playing American football and training intermittently you could quite easily over-drink.  I agree that it is quite inappropriate to think that drinking negates the need for proper work to rest ratios to prevent heat illness during practices or events.  The easiest way to prevent heatstroke is simply to rest enough between bouts of exercise.  During this time body temperatures drop dramatically and the risk of heatstroke then becomes zero.  In contrast, drinking to excess only increases the risk that exercise associated hyponatremia will develop.  In addition, exercise hyponatremia can be fatal.

Me: I work with collegiate athletes as an athletic trainer and disordered eating is rampant among young athletes. Issues with body image, counting calories, supplement abuse and binge eating are very prevalent. Do you think there could be any connection between this behavior and the conventional nutritional advice ingrained in them?

Professor Noakes: I agree with your idea that if you tell people to eat carbohydrates they will be incessantly hungry and as a consequence will have to use abnormal eating behaviours to control their weights.  In addition, I think that high carbohydrate diets have negative effects on our brain function and our mood states.  Once you are on a high fat, low carbohydrate diet it is so easy to regulate your weight that you don’t have to worry anymore about counting calories.  On this diet your weight is absolutely constant as long as you keep your carbohydrate intake down.  My weight is rock-solid constant regardless of how much exercise I do or don’t do.  If I stop training for a month my weight will be exactly the same at the end of the month as it was at the start.  Similarly, if I do heavy training for a month my weight will probably go up 500g because of added water and muscle.  But those old massive changes that occurred when I was doing lots of running but eating a high carbohydrate diet are definitely a thing of the past.

Me: There are some big names like Timothy Olson and Joe Friel that have been experimenting with LCHF...Do you think there has been any progress in changing conventional wisdom about LCHF? What about change related to hydration strategies?

Professor Noakes: I think that the low carbohydrate, high fat diet is gaining traction all the time because it is the diet that is most effective for the majority of humans who are insulin resistant.  So the older you are and the more insulin resistant, the better you do on this diet.  So I think that as more athletes try the diet and improve dramatically as a consequence of adopting the diet, then it will become the mainstream in due course.  I actually think that there are more athletes doing it than will admit.  One of the reasons why they won’t admit it is because it allows them a competitive advantage over athletes who continue to train on high carbohydrate diets.  So they are not too keen to let everyone else know how well they are doing and why.

Me: What major obstacles do you see preventing further progress and do you have any ideas for moving forward?

Professor Noakes: I think we are approaching the tipping point in nutrition in that the general public is finally realizing that they have been scammed and conned for the last 40 years into eating diets that made some people very wealthy but the rest of us very unhealthy.  Every day I hear more people talking on this topic in South Africa and globally and I can only presume that the low carbohydrate movement is like a virus that is spreading rapidly through the communities.  I suspect that there will be a couple of events, which one can’t really predict, which will have a massive effect in changing ideas.

One finding would be if it was shown that the cholesterol lowering drug, statins, are more dangerous than anyone believed and I think that we are approaching that time soon.  I suspect that the statins cause significant memory loss and dementia and may well promote diseases like diabetes more than we presently know.  They may also be related to other more obscure neurological diseases.  Once it becomes known that taking statin drugs is very dangerous for your health then people are going to ask, well why did we start taking them in the first place?  Then they will see that there was an absolute lack of evidence for us to change our diets in 1977, when the US dietary guidelines were first brought out.  Once people realize that the 1977 US dietary guidelines were driven by political motivations, not by concerns for our individual health, then we are moving ever closer to a revolution and an angry backlash to all those who told us that a high carbohydrate diet was important for our health when in fact, in my opinion, the high carbohydrate diet is very damaging for our health.

The problem is that the pharmaceutical industry and the processed food industry are not going to quit easily so there will be a long battle, which will be orchestrated by the pharmaceutical industry and the processed food industry to try to continue misinforming the public about what is and what is not a good diet.  So people are going to have to be clever and realize that they have been misled and when they finally do there will be the release of a lot of anger.  I would not like to be on the receiving end of that anger!

Me: What advice would you give to somebody considering a LCHF diet and are there any glaring mistakes that you see people make when attempting such a diet/lifestyle?

Professor Noakes: I have just participated in writing a recipe book for low carb, high fat diets.  The book is called The Real Meal Revolution and will be out this month in South Africa.  There I explain how you should adapt to this diet.  In my view, you should cut out the obvious sources of carbohydrate, which we simply don’t need in our diets, including bread, potatoes, rice, pasta, pizza, all sweets and delicatessens, etc.  Then you have to go to work at cutting out added sugar and that takes a little longer because the sugar addiction is extreme and in my case it took 14 months before I was able to get rid of sugar.  As a result I have not eaten a sweet product in the last 3 years.  Once you start getting rid of all those foods then you should start cutting your daily carbohydrate intake, probably starting at about 120g a day and then reducing slowly and seeing how you respond.  If you have severe insulin resistance or morbid obesity or other medical conditions like high blood pressure or diabetes, then you are going to have to get down to 25g of carbohydrate a day.  That takes time but becomes easier the longer you do it.  I am currently eating probably 25-40g of carbohydrate a day and find it very, very simple.  I have absolutely no compulsion to eat carbohydrates anymore and, in fact, have an aversion to them.

I hope you all enjoyed the interview with Professor Noakes and I want to once again thank him for his time. He is definitely a busy man but isn't above taking the time to talk with somebody like myself. I really respect and appreciate how approachable he is. If you are interested in reading more from Professor Noakes he has many published research articles which you can find on PubMed or below I have listed some of his books! I myself am looking forward to his aforementioned upcoming book! The Real Meal Revolution.


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