Since Professor Tim Noakes first started discussing his new dietary beliefs he has been inundated with queries regarding his promotion of the low carbohydrate lifestyle. Thus if you send an e-mail enquiry to him you are likely to get back a letter that he has prepared. It addresses a lot of the queries that people have about the diet and is a very worthwhile read. I’d like to go through the letter today and also give my interpretations. Remember I’m not a doctor or medical professional, nor do I have any training as a dietician or in the field of nutrition; I’m just your regular garden-variety guy trying to make sense of an incredibly complex and often bewildering topic.

The second edition of Challenging Beliefs will be out around May and discusses the dietary ideas.

The letter is entitled “Novel Dietary Ideas – Professor Tim Noakes” and starts off:

Thank you so much for your email inquiring about the low carbohydrate lifestyle that I currently follow and have adopted for life.

Last week I received more than 200 requests for information and since I do not have an additional secretary to manage this correspondence, I am unable to answer each letter individually. I have therefore prepared an outline letter which explains why I think that those who, like me, are carbohydrate-resistant (CR) (or pre-diabetic with a family history of diabetes) can improve their health significantly by substantially reducing the amount of carbohydrate they eat. It may be that many others will benefit from this eating plan but at present I conclude that it is those who are the most CR who will benefit the most. In time I think we will learn that you do not have to have CR to benefit from this eating plan, but I am not prepared to make that conclusion just yet.

Although many asked for specific diets, I am reluctant to give such advice. I prefer to give general advice and ask that you please consult a dietician by taking this letter to him or her and asking for help in constructing a healthy eating plan, whilst sticking within the guidelines I suggest.

I am very pleased that Prof Noakes makes this point: that a diet is a personal thing that must be tailored to the individual, you can’t just copy and paste from one to another. Age, chronic illness, allergies, lifestyle, budget and personal preference must all come in. That is why the internet can be so dangerous, I’m sure a million sites out there will give you a cast-in-stone plan. They don’t have a clue whether you have kidney disease (high protein is not recommended), are allergic to nuts, have lactose intolerance, can’t afford to eat salmon twice a week or absolutely have to have a bit of chocolate every now and then. I know it may seem like a waste of money, and many dieticians are very against a low carb plan, but there is no substitute for qualification and education. I think this is an absolute essential if you have chronic conditions.

So the first point is that this is not a diet, it is an eating plan for life – it is a life style. If you wish to lose weight and improve your health by changing your eating for a short time only, this is not the way to go. Once you go down this eating route you have to stick with it for life. Because if you start eating this way and successfully lose weight, you will regain that weight and more should you go back to eating the way you did before – that is if you go back to eating the food choices that caused the problem in the first place.

What I take from this is that it is essential that you make the diet sustainable, ensure it is a feasible lifestyle for you. This is where I think a bit of the psychology comes in, sure there is the bit about willpower and influencing yourself, but also I think there is something about being just plain happy! If I were to cut out chocolate, beer and wine I would be the most miserable bugger around. I know they don’t fit in 100% with the low carb life style, but if I cut them out there would come a day when I’d fall back into old ways and probably binge. Life is too short to not have some of the things you enjoy, overall you will still be living healthier, but you’ll be feeding your soul as well as your body, now that’s a perfect diet!

The point is that if you are like me, your metabolism does not work very well when fed too much carbohydrate. And this is not going to change regardless of how much weight you might lose or even how much exercise you might do. For those of us with CR, our metabolism is the problem and if we want to do the best for our bodies then we have to change FOREVER the nature of the foods that we eat. But I argue that this change is much easier than most would ever believe. Unfortunately it is also the advice that many dieticians will be the least likely to give you.

So if you are not ready to make a change that you will continue for the rest of your life, then it is probably best that you do not begin it in the first place.

A change in lifestyle like this is probably akin to coming off a hard drug and getting your life back together. It is the nutritional version of Trainspotting! This is going to require more than just willpower. It will require getting the support of friends and family, finding your weaknesses and temptations and employing reward systems, negative imagery, even a sponsor that you can call in times of weakness to really rewire your brain and your body for this lifestyle. If you are laughing at me for being so dramatic about it, let’s put money on the table that with just pure willpower you won’t make this change for life; you’ll last a few weeks, maybe a few months, but bad habits and our society of food will get you back eating French Fries and slurping milkshakes. Just think of all the other diets that you’ve left by the wayside!

For to change you have to rid yourself of an addiction for eating easily assimilated carbohydrates – an addiction that is at least as powerful as those associated with cigarette consumption and some recreational drugs. As you know, it is not easy to give up addictions, and like all addictions, addicts have to take each moment of their recovery one day at a time. In a sense those of us who are unable to metabolise carbohydrates are never cured of that addiction. We are always in recovery. We have to take each new day of our cure, one day at a time.

See? I wasn’t just being over dramatic!

But if, like me, you are convinced that you have a really good reason to change (in my case to avoid dying from diabetes – the fate that struck my father and his brother) and are prepared to change what you eat for the rest of your life, then you may be up for the challenge. Please note also that this is not a fad diet – the reason that it works so well is because there are solid biological reasons why it has to produce a successful outcome if followed properly by those with CR.

The second point is that this eating plan requires some discipline to be successful. As I have said, it takes discipline to insure that we do not relapse into our former addiction.

Those who really benefit the most are those who have the greatest reason for and desire to change. I changed initially because I did not want to develop diabetes so I had a very good motivation to start. Then I discovered that once I had got rid of the addictive food choices, I felt so good on this eating plan that I would never want to go back to my old eating ways.

I also think it takes more than just discipline. That US soldier who cracked and shot a whole lot of civilians was apparently an excellent troop, he had discipline in buckets, but the pressure and the situation got too much for him. Now I’m not likening the atrocities of war to everyday life, but psychologically we all go through extreme pressures and stresses that can make us crack. I promise VitalSmarts doesn’t pay me anything, but Influencer and Change Anything could be very helpful books for this lifestyle change.

So now I have two reasons to stay with this eating plan – long-term health and the feelings of renewed youth.

The point is that the greater your reasons to change, the more probable it is that you will be successful.]

The third point is that the only discipline you require is very simple: you must severely restrict the intake of the following foods. I have found it easiest simply to remove all from my diet.

• Sugar (must be completely removed from your diet)
• All sugary drinks including cola drinks and sweetened fruit juices
• Bread
• Rice
• Pasta
• Potatoes
• Porridge
• Breakfast Cereals
• Some high energy fruits like bananas
• All confectionary – cakes and sweets
• Desserts
• Artificial sweeteners and products containing these products (like “diet” colas)

I think I can hear you all shedding a tear; Thus the need for discipline, desire to change and a framework to support the change. This ain’t Kansas no more! I haven’t found out the reasons behind the artificial sweeteners though, and need to look into that.

You should also be wary of so-called “low fat” options, yoghurt especially, since these are laden with sugar and so are less healthy than the full fat options. In fact you need to check all the foods that you eat. You will be astonished in the number that contain hidden sugar.

I think that most dieticians would agree that none of the foods listed above is essential for health and some like sugar and other refined carbohydrates are definitely unhealthy. Some dieticians argue that whole grain cereals should be included because they are “healthy” but I have had difficulty finding whole grain cereals that have not been heavily refined. It is also clear that allergies to cereals are commoner than is realised.

This refined carbs and simple sugar is a matter that I think everyone can get on board with and there seems to actually be some consensus in the literature (hallelujah!). See my post on simple sugar for more information.

However, the real point is that if you are as CR as I am, one has to make choices of (i) how much carbohydrate one wants to eat each day – I limit myself to about 50 grams a day as that is the amount that allows me to regulate my body weight effortlessly without hunger – and (ii) which carbohydrate sources will provide that 50 grams. I have chosen to get my 50 grams of carbohydrate from vegetables and dairy produce, not whole grain cereals. Others might make a different choice.

As a result, I restrict my food choices to the following food and beverage groups:

• Eggs
• Fish
• Meat – organic or grass fed, not processed
• Dairy Produce – milk, cheese and yoghurt – all full cream
• Vegetables – mainly leafy, low carbohydrate sources
• Nuts – macadamia and almonds especially but no peanuts or cashew nuts as these are high in carbohydrates
• Fruits – very occasionally and then only those which have a lower carbohydrate content like apples and berries
• Water, Tea and Coffee (all unsweetened!)

If you look at that list it does seem very daunting, as our meal plans don’t really fit into this. Gone is the ubiquitous potato, the cereal in the morning and the sarmie for lunch. My biggest problem is breakfast as I would be ill if I were to eat eggs, yoghurt or any meat before 9am!

I also currently supplement my eating with omega-3 capsules (1.6g per day). The value of omega-3 supplementation seems to be universally accepted. I am also experimenting with supplementation of a range of vitamins but this is still a work in progress as is my choice of the best vegetables and salads.

I do not believe that I have the final answers and am continually reading the scientific literature and the internet and tweaking my diet. I will continue to modify my eating by studying the literature, eating differently for periods and seeing if I notice any differences in how I feel, in my blood markers and in my running performances. But the basic pattern of avoiding carbohydrates remains intact.

I think this is a point that everyone should be aware of, Prof. Noakes is basically running a live experiment on himself. What he experiences will not translate to everyone so please be aware of your own body and how you are feeling, and don’t take risks, especially if you are chronically ill. See your doctor first. The other thing is that this literature is largely available to the public. Using Google Scholar instead of regular Google you can search the online journals (and all of them are these days) and even if you don’t get the whole article for free you will almost always get the abstract, which outlines the findings. Thus the public is empowered with access to the body of literature that used ot be only kept in dusty university libraries.

Obviously it is stupid to go to the trouble of changing one’s eating plan but continuing to do other behaviours that are unhealthy. So smoking is not allowed and lots of exercise is encouraged – 30 to 60 minutes a day of sweating exercise on most days of the week. Proper sleep and control of stress are obviously very important as well. My experiment has shown me that I can do any amount of exercise I wish without increasing my carbohydrate intake (I walked 6 hours on the mountain on Sunday and race up to 21km without needing any more carbohydrates than the 50 grams a day that is already in my diet).

Prof. Noakes does say in his new book that the jury is still out on endurance events such as ultra-marathons and extended extreme events like multi-day challenges.

I am also aware that we are all different and whereas too much carbohydrate and cereal and too little fat and protein in the diet was clearly my problem, there are others who may have trouble with dairy produce or meat and may find it difficult to eat enough of these foodstuffs to replace enough carbohydrate in their diets for there to be a noticeable difference in the way they feel.

However, I think that the problem I have – CR – is much more common than is generally acknowledged. So I appreciate that whereas some will not find this eating plan of much help, a much greater majority of people who have always struggled to control their weight when following the conventional “heart healthy: low fat diets, will find their lives altered dramatically as did I when I made the switch. I also think that more people than is currently realised develop minor medical complaints as a result of eating grains, cereals and highly refined carbohydrates and they too will benefit from this change. Indeed, one reason one feels so good on this eating plan may simply be because it removes the currently unrecognised toxic elements found in the highly processed foods that are commonly eaten.

It will be very interesting to see advice that comes out to tailor this type of diet for lactose intolerance, food allergies, vegetarians and vegans. I think the challenges and costs may make it impractical for many of these individuals.

There are a number of reasons why I think you should consult a dietician first. If he or she is disinterested in these ideas, then you must keep shopping around until you find someone who is prepared to consider all the evidence.

First, we need to inform that profession that we are unhappy with the conventional advice that many continue to give us. If it has not worked for us perhaps it is time for the profession to consider that the traditional “one size fits all” “high carbohydrate, low fat, healthy heart” approach to nutrition is not the best solution for all.

Second, we need to make sure that more dieticians are exposed to the evidence for the value of high protein/high fat/low carbohydrate diets. We are approaching a tipping point when the value of theis eating plan will become universally acknowledged. The Scandinavian countries – which already have the healthiest people in the world – are rapidly adopting this eating pattern to the extent that Norway has run out of butter! (Norwegians have always eaten high fat diets and are perhaps the world’s healthiest nation).

Two points here. I would hope that dieticians have to undertake a continuing professional development (CPD) path to keep their qualifications. Accountants do, my ophthalmologist certainly does, and dieticians hopefully do not see themselves as a cushy profession that can just take the bucks once university is over. I have no idea if they have to keep up to date or not (legally), but the impact that they can have on an individual’s health should mandate this. Thus these CPD seminars and conferences could be the perfect forum to debate new evidence. The second point is that if there is a rapid shift to this diet the agricultural and food supply chain will probably not be able to cope, food security I already a huge issue. If we all start demanding Macadamia nuts, salmon, meat and butter this will become a socio-economic nightmare!

Third, a dietician will be able to insure that when eating from this restricted grouping of foods you are optimising your intake of vitamins and minerals.

I do hope this information is of great assistance and wish you well on your journey to renewed vigor and health. Take great pride in your achievement. And please share your journey with others so that the message can go throughout South Africa and so improve the health of others like you and I.

Best wishes

Professor Timothy Noakes, OMS

MBChB, MD, DSc, PhD (h.c.)

Discovery Health Professor of Exercise & Sports Science at the University of Cape Town

So there you have it. I think the letter is great because it goes into a lot more detail than the radio and TV interviews. So make up your own mind and most importantly, when in doubt consult, your doctor that is! If you’ve enjoyed this post please share it with your social network using the LIVEsharing tab on the left or the sharing buttons below.