Timothy Noakes is Chair of Exercise and Sports Science at the University of Cape Town, South Africa — and he will be speaking at Diabetes Innovation 2013. He has Type 2 diabetes and has made a very public about-face in nutrition recommendations. His book on running — a perrennial best-seller — had recommended a high-carbohydrate diet, but Noakes, an ultramarathoner, realized the diet was harming him, and also realized that he had developed T2D. He credits Jeff Volek — another Diabetes Innovation speaker — and others with bringing him to realize that for himself and for other people with diabetes a high-carbohydrate diet is a dangerous thing.
As far as I am concerned it is clear cut, the evidence in my view is that the more insulin resistant you are, in other words the more you are likely to have diabetes, or if you have diabetes there is no question, you do not need carbohydrates in the diet and the less carbohydrates you eat the healthier you will be. To me there is no debate; the problem is that in my view the drivers of the high carbohydrates diets are political and economic. They are not medical and scientific and unfortunately the solution of this problem is a political one — it’s not a medical solution.
Please have a listen to our wide-ranging conversation, touching on diabetes, diet, and the politics and economics of the food supply.
Listen in to our conversation (press play); read the transcript below.
Interview with Tim Noakes
Chair of Exercise and Sports Science, University of Cape Town
David Harlow: This is David Harlow with Diabetes Innovation and I am speaking today with Tim Noakes who is Chair of Exercise and Sports Science at the University of Cape Town, South Africa. Thanks for joining us Tim.
Timothy Noakes: Thank you for having me David, it’s great, I appreciate it very much.
David Harlow: So what I know about your work is that you are a co-founder of the Sports Science Institute of South Africa. You head the Medical Research Council, the University of Cape Town Research Unit for Exercise, Science and Sports Medicine and I would say you have also done a fair amount of first person empirical research in this field. Your bio says you have run over seventy marathons and ultra marathons. Well what’s the most extreme ultra marathon that you have ever run?
Timothy Noakes: We have a race called the Comrades Marathon in South Africa it’s just fifty six miles, but it’s a very hilly fifty six miles and that’s kind of if you want to be something in South African sports you have to run the Comrades Marathon. So we don’t think a standard twenty six mile marathon is far enough, we have to double the distance and add a few miles and then that proves you are a real runner.
David Harlow: Great.
Timothy Noakes: It’s a race that has been going since 1921. It is shown on national television for 12 hours, it’s kind of the Super Bowl of South African sports and it’s just a national event when the day, this nation comes to stop towards this race.
David Harlow: Well that’s wonderful; I hope you keep doing that for many years. So what is the connection between your interest in exercise and nutrition and the work that we are talking about at Diabetes Innovation?
Timothy Noakes: Well, it’s really quite simple. In 1985 I published my first edition of a book called Lore of Running and this thing became one of the most popular books just on running and it’s considered to some extent the bible of the sport and it’s been through four editions now and each of them expose more, expounded more that carbohydrate is crucial for your ability to run and of course for your health and so the last edition in 2002 that’s exactly what it said. If you are not eating carbohydrates fifty to sixty to seventy percent of your diet you must eat carbohydrates in order to run well. The other problem was that I was following that diet and getting progressively slower in my running and fatter and ultimately developed type 2 diabetes, which I realized somewhat later and then I had this epiphanous moment when I decided something had to change and I fortunately was exposed to the low-carbohydrate work of Dr. Jeff Volek and his colleagues and one day I decided, okay I am doing so badly eating all these carbohydrates surely I can’t be worse, let’s cut the carbohydrates and turn to a high fat diet as provided by Dr. Volek; so I did that and the results were dramatic. I lost twenty kilograms of weight and I subsequently decided I had type 2 diabetes and needed treatment, but my diabetes is quite well-controlled on Metformin and this low-carbohydrate diet and then I realized I had to say sorry that I have been misleading people for so long telling them to eat the high carbohydrate diet and so my conclusion is if you’re like me and you have a family history of diabetes, my father died of a disease, his brother died of the disease and it’s clearly come directly through to myself and my own children. I realize that we all have insulin resistance or carbohydrate intolerance and for us we must restrict the amount of carbohydrate we eat in our diet and the more we restrict the better we do and so that is what I am trying to say. I am trying to say sorry, I was wrong, certainly carbohydrates are okay for some people but for the vast majority in my view, you can’t eat too much carbohydrate or you are going to run into trouble in the long term.
David Harlow: Well that must be a difficult step to take to backtrack on such a public statement of a position and I imagine that this is grounded not only in your own experience but in other research as well?
Timothy Noakes: Indeed. So when I read the first book that I was directed to and I read Dr. Volek’s work particularly and I remember reading his, the book that he had written with Drs. Westman and Phinney and it’s said it was a new diet for the new year and it’s hit a hundred and seventy five publications on low carbohydrate diets and how effective they are and I said but that’s completely wrong. How would I have been able to practice and go through medicine and being a sports scientist and not know any of this research and I was embarrassed that I knew nothing about the research and when I read it, it became very clear to me that there is a huge body of evidence that the high carbohydrate diets are not healthy for many people whereas the low carbohydrate diets are helpful and as a result of that I came across Gary Taubes’ book, Good Calories, Bad Calories and when I read that that just complete — the scales fell from my eyes and I said how could you have been so misled and then I started promoting these ideas and you’re quite correct — I was very, very heavily criticized in South Africa, but over the last two years I think the position is changing and people are saying he may be wrong, but it’s not because there is no science in the sense of what I was saying, there is no science, he is just talking nonsense. Now they say it may be wrong but it’s actually science to justify some of his statements.
David Harlow: So is there a scientific debate on this issue or is it a pretty clear-cut question as far as you are concerned?
Timothy Noakes: As far as I am concerned it is clear cut, the evidence in my view is that the more insulin resistant you are, in other words the more you are likely to have diabetes, or if you have diabetes there is no question, you do not need carbohydrates in the diet and the less carbohydrates you eat the healthier you will be. To me there is no debate; the problem is that in my view the drivers of the high carbohydrates diets are political and economic. They are not medical and scientific and unfortunately the solution of this problem is a political one — it’s not a medical solution.
David Harlow: So when you say political that brings to mind some recent developments here in the United States. Number one, earlier this year the American Medical Association over the objection, the counter recommendation of the study committee on the issue pronounced obesity to be a disease — one issue and another issue is that some local Governments in the US are taking steps to control food, portion size and composition and ingredients in fast food that’s being served and I am wondering when you say that this is a political issue are you thinking in terms of classification of obesity as a disease for example, are you thinking about control on the food supply, on what restaurants can and cannot serve, what do you see as the issue there?
Timothy Noakes: It is so complex because it’s almost impossible — One has to regulate the types of food that are sold, the processed food, because obesity really results from hunger and obese people are always hungry, and they are hungry because their hunger is driven by addictive foods but also by high carbohydrates diets and the more addicted you are to the foods, the more obese you will be. So the only way you can correct obesity ultimately is to take out addictive foods from the food chain and basically all processed foods essentially are designed to be addictive, so that means to really correct and prevent obesity and diabetes you have to take on the processed food industry and those are some of the biggest companies in United States of America and no politician has the courage or the will to do that.
David Harlow: Some of them have been making a lot of noise lately about trying to work on substitutes for salt for example in order to sort of create the same, the same effect on the human brain in terms of wanting another chip, wanting another whatever, but it’s not sodium or it’s low, low sodium so as to reduce the physiological problems associated with that, is that a productive line of work do you think?
Timothy Noakes: No, that’s a stopgap that’s trying to prevent more legal action being taken and political steps are being used to stop it. You just got to take processed foods out of the food chain, that’s what you have to do, you have to get back to eating real foods that that we have evolved on over millions of years. This industrial diet that we are eating today is a direct cause of the problem and you can’t make processed foods healthy that’s essentially the problem.
David Harlow: So given the greater distance from farm to table these days for many of us is that, do you think it’s a practical solution, how is that going to work, for example, for large urban areas?
Timothy Noakes: You are absolutely right, you know I am not really a food economist and so I can’t address that question, but as a biologist I just know that the solution is what you describe. We have to get the raw foods that can be cooked by people who understand how to cook and prepare their own food into their kitchen and however we do that I do not know but until we do it we cannot reverse the increasing diabetic epidemic.
David Harlow: In this country and elsewhere around the world there is a growing movement for community based agriculture and small farms in urban areas even in order to move in that direction, I guess the question as you say for the food economists is how to really scale that movement in a way that doesn’t disrupt the distribution of food?
Timothy Noakes: And then of course you have the problem that most of the food is raised on corn anyway. The feed lot animals and those aren’t particularly healthy either so it’s a real problem; you also have to go back to traditional methods of farming.
David Harlow: Right, so another element here is sort of the classification of obesity as a disease as I mentioned by the American Medical Association going against its own study committee recommendation, what are your thoughts on that, do you think that’s helpful in terms of focusing attention on the problem or is it not helpful?
Timothy Noakes: I am not sure it’s helpful because you know there is a direct cause and that’s excessive hunger, so obese people are always hungry and you have to address why they are hungry and they are hungry because they are eating high carbohydrate diets which are nutrient poor and particularly addictive foods as well and they are insulin resistant so that, that’s a combination and this is complete curable if you sort those problems out. So I am not sure that making it’s a disease is going to advance the cause in anyway, it kind of now it says actually there is nothing we can do for it, the patients cannot be helped and that’s wrong because obesity is completely curable even morbid obesity – and I’ve seen cases with my own experience following this diet and encouraging people to follow this diet, we have had some dramatic results and so we can’t let this become a disease that is considered to be incurable. I think we have, we know what causes it, we should address those issues. I think my point is this what I discovered is that fast foods cause obesity or what industry wants us to believe is that the patients are the cause of the obesity and the patient doesn’t do enough exercise and that’s completely wrong, so we transfer the guilt to the patient rather than to the cause which is the processed food industry.
David Harlow: So what sorts of conversations do you hope to have at the Diabetes Innovation Conference, so what are the sorts of people you are looking forward to meeting there?
Timothy Noakes: Well because I have a direct interest in my own diabetes I would be very interested to see if there are any other additional methods for controlling my blood glucose concentration because one has to be selfish at some time. However, my real interest is to try to promote the idea that it’s impossible to control diabetes if you don’t eat a low carbohydrate diet, that it’s abundantly clear to me that you cannot reduce the long term complications in either type 1 or type 2 diabetes in people eating high carbohydrate diets as prescribed by the American Diabetes Association. Once you get diabetes you have to cut your carbohydrates to the absolute minimum, 25 grams a day is all you can afford to eat and under those circumstances I believe you might be able to reduce the complications in diabetes. The clear evidence is that if you continue to eat two hundred or three hundred or four hundred grams of carbohydrates a day you will develop the complications of diabetes regardless of how much insulin or Metformin or whatever you take and there is so much clinical evidence that is the case that we have to finally come and say listen the way we are treating diabetes isn’t working and it’s because we haven’t changed the main driver of the problem which is the diet.
David Harlow: And so at bottom this is really an issue that requires behavior change of some very deep-seated behaviors and so the question is how do you motivate people to make those changes which can be so difficult to do. Some folks are looking at digital aids, mobile health aids, smartphone apps; do you see those as useful, do you see other approaches to behavior change as productive? What is successful in your mind?
Timothy Noakes: Well, I think that you have to consciously get the idea that carbohydrates are killing you and that’s what I have done in my own case. I think you can reprogram your brain to not to see carbohydrates in your environment or if you do see it, you see it as something that’s negative. So I think that people first have to be given the message that carbohydrates are what kill you in diabetes, but they are not getting that message at all, the message they are getting at the moment is diabetes is an incurable disease and all we can do is give you more insulin or more Metformin, but your glucose control is going to get worse because your pancreatic function is going to get progressively worse and you will get the complications of diabetes and you will die from those complications — that’s the message, it’s not worth doing anything. What the message we have to give out is that there is an option and it is a low carbohydrate diet. That doesn’t mean to say you are definitely going to get through your complications but it’s probable and therefore you have every incentive to do it. We have to give that message, clear-cut message, which we aren’t giving and once you give that message then people can make their choices and the reality is that omitting carbohydrates from the diet is actually not that difficult because the diet is actually delicious if it’s prepared properly and I personally what I have done, I have this condition myself and when I see carbohydrates I feel ill and so the thought of putting carbohydrates in my mouth makes me ill before I’ve even done it and you can reprogram yourself and I suspect that that’s the way we need to teach people. There must be some behavioral conditioning to, in which people just begin to despise carbohydrates because they see them as killing themselves.
David Harlow: Well we will have to set you up with a test kitchen at the conference so you can share some good low carb recipes with the rest of us. Well, thank you very much, I have been speaking with Dr. Timothy Noakes. This is David Harlow with Diabetes Innovation.