The Noakes Trial, Two Years Later
By Marika Sboros, July 6, 2020
On June 8, 2020, the second anniversary of a strange scientific saga in South Africa rolled around. On that day in 2018, scientist Professor Tim Noakes was found not guilty in the "Nutrition Trial of the 21st Century", as the public dubbed it.
Noakes, an MD and University of Cape Town (UCT) emeritus professor, won the second of two decisive victories against his regulatory body, the Health Professions Council of South Africa (HPCSA).
The HPCSA's Appeal Committee dismissed its own lawyers' objections and upheld in full its first committee's comprehensive ruling for Noakes in April 2017. That ruling exonerated him completely on all 10 aspects of a charge of unprofessional conduct.
The appeal ended the HPCSA's unprecedented, multimillion trial of Noakes that it had dragged out for more than four years. Its ruling reverberates down medical, nutrition science and food- and drug-industry corridors of power globally to this day.
It effectively endorsed Noakes's right to freedom of speech as a scientist and the evidence for low-carbohydrate, high-healthy fat (LCHF) therapies. It vindicated his vigorous opposition to South Africa's industry-led, high-carb, low-fat Food-Based Dietary Guidelines (FBDGs). The FBDGs closely follow the influential US guidelines that launched in the late 1970s and are currently under revision.
In closing argument, Noakes's legal team eloquently described the trial as "a world-first prosecution and persecution of a distinguished, world-renowned scientist simply for his scientific opinions on nutrition".
That was not hyperbolic.
Others called it "Kafkaesque" and "Theatre of the Absurd". That was for all the twists, turns and delaying tactics the HPCSA employed trying to find Noakes guilty of anything at all on a charge of unprofessional conduct.
The charge arose after Johannesburg dietitian Claire Julsing Strydom reported Noakes to the HPCSA for a single tweet in February 2014. Noakes tweeted that good first foods for infants are LCHF (low-carbohydrate, high-healthy-fat). In other words, meat, fish, chicken, eggs and dairy. That aligned fully with South African and international paediatric dietary guidelines then and now.
Despite that, Noakes's tweet so “horrified" Strydom that, within hours, she had reported him to the HPCSA.
It was soon clear that Strydom wasn't acting alone or objecting only to his views on infant nutrition. She and her backers wanted the HPCSA to stop Noakes giving any medical or dietary advice at all for all ages if it went against orthodoxy.
They particularly wanted to stop Noakes undermining the FBDGs in favour of LCHF and ketogenic diets to treat and prevent life-threatening diseases of lifestyle. Chief among these: obesity, type 2 diabetes, heart disease, even dementia diseases and some cancers.
Increasingly, Noakes and LCHF were looking like threats to livelihoods. Those were reasonable-enough fears given lucrative revenue streams flowing from the pharmaceutical model of disease. And from industries propping up the repeat business of sick-care that keeps people fat, sick and coming back for more.
During the trial, Noakes's lawyers called Strydom "a disgruntled dietitian". They said that she was annoyed that the public was listening more to him than to her.
Noakes's UCT cardiology colleagues had a similar beef (pun intended) with him. They began attacking him way back in 2012 in a letter to the media, objecting vociferously to his views on nutrition versus drugs for cardiovascular disease. They also strenuously opposed him on blockbuster cholesterol-lowering drugs known as statins.
These cardiologists support the pillar on which South Africa's fat-phobic FBDGs still firmly rests. It is the unproven (many say "thoroughly discredited") diet-heart hypothesis that saturated fat causes heart disease.
In their evidence, Strydom and other witnesses denied collusion and that Noakes had been set up. Extensive, uncontested evidence on public record showed otherwise. It was clear that Noakes's trial was a territory war. And that all sides had South Africa's FBDGs in their sights.
The guidelines were first published in the South African Journal of Clinical Nutrition (SAJCN) in 2001 with a helpful gist:
Be active;
Make starchy foods the basis of most meals;
Eat dry beans, peas, lentils and soy regularly;
Chicken, fish, meat or eggs can be eaten daily;
Drink lots of clean, safe water;
Eat plenty of vegetables and fruit daily;
Eat fats sparingly;
Use salt sparingly;
If you drink alcohol, drink sensibly;
Use foods and drinks containing sugar sparingly and not between meals.
The authors revised them once only, in 2012, again with the gist to show changes – unless you blinked:
Enjoy a variety of foods;
Be active! (authors' emphasis);
Make starchy foods part of most meals;
Eat plenty of vegetables and fruit every day;
Eat dry beans, split peas, lentils and soya regularly;
Have milk, maas (a fermented milk product similar in consistency to yoghurt, popularly consumed across South Africa) or yoghurt every day;
Fish, chicken, lean meat or eggs can be eaten daily;
Drink lots of clean, safe water;
Use fats sparingly;
Choose vegetable oils, rather than hard fats;
Use sugar and foods and drinks high in sugar sparingly;
Use salt and food high in salt sparingly.
The central image illustrating the guidelines left no doubt about industries the authors endorsed above all others: the powerful breakfast cereal and grain industries.
The guideline authors declared funding sources: the South African Sugar Association and the Meat Board; the food industry and Dry Bean Producers Organisation funded their delegates to guideline meetings; the UN FAO (Food and Agricultural Organisation) and International Life Sciences Institute (ILSI) jointly funded a group of South African delegates to "share the South African experience with eleven other African countries during a workshop in Harare in October 1999".
ILSI and the sugar industry were like viruses all over this trial. That should have been red flags to the HPCSA – unless it saw checkered victory flags.
ILSI was notable for the number of office-bearers, members and hangers-on involved. The HPCSA's first "expert" witness against Noakes was the FBDGs' lead author, NorthWest (formerly Potchefstroom) University dietetics professor Hester "Estee" Vorster. Vorster and another witness against Noakes, Cape Town paediatrician Dr Muhhamed Ali Dhansay, are former ILSI executives with sugar-industry links.
UCT dietitian academic Dr Marjanne Senekal, a colleague of Noakes and an associate professor in the Health Sciences Faculty, was similarly conflicted with sugar industry and ILSI links. Senekal agreed – or offered, it was never revealed – to be a consultant to the HPCSA. That was once it was clear its case against him was terminally flawed.
Senekal and UCT saw no ethical dilemma there. She had already gone public on her views about Noakes and LCHF in a letter to the media in 2014, penned with three other prominent UCT professors.
Other disturbing features of Noakes's trial made it unprecedented. These included "highly irregular" (a legal euphemism for unethical) conduct against Noakes by a leading medical ethics professor at the University of the Witwatersrand.
Most disturbing, perhaps, was exposure of the extent of the global scourge infecting all of South Africa's top universities. It is the unedifying, potentially fatal phenomenon of academic bullying – or academic mobbing as it is popularly known. It continues to this day.
In the end, despite establishment forces' deep pockets, Noakes achieved many of the objectives he set out to achieve. He has successfully shaken South Africa's FBDGs' foundations to their core. The trial became an object lesson in unintended consequences on and off social media for those mobbing him. Many of his critics' public voices have become muted, although some mobsters are mostly still mobbing.
Noakes also set off a bottom-up revolution in South Africa by the public and patients battling chronic disease. Millions of South Africans now take responsibility for their health. They ignore the guidelines and demand evidence-based dietary advice.
LCHF is not quite mainstream but it is moving in that direction. He exposed many "inconvenient truths" behind conventional medical and dietary "wisdom".
More cardiologists in the country now support low-carb but most are still saturated fat- and keto-phobic. Growing numbers of GPs and dietitians ignore the guidelines. They do what experts say is ethically correct: they offer LCHF and keto diets as therapeutic options where appropriate for diet-related illness.
They put patients before profits. And they practise an evidence-based mantra: Diet-related problems require diet-related solutions, not drugs, as first resort.
Noakes could, of course, have made the trial go away before it could happen simply by deregistering as a medical doctor. That meant the HPCSA would not have had jurisdiction over him.
After all, he had not practised clinical medicine for 15 years at the time. He only kept up his registration for scientific research purposes.
However, he wanted to stand up for the evidence, for his own, extensive scientific legacy at UCT (his alma mater) and against the many academic and other bullies involved.
Given the ferocity of the HPCSA's case against him from the outset, it was clear that it would simply have gone ahead with a hearing against him anyway, behind closed doors. And found him guilty - the verdict it was after from the start.
The appeal ruling's comprehensively innocent verdict was the final nail in the coffin of the HPCSA's ill-judged case against him.
At the time, Noakes welcomed the ruling as everything he hoped for – well, almost everything. He and his lawyers always expected that the decision would go his way. But as with litigation globally, there are and were no guarantees.
The case placed heavy professional and emotional burdens on him from the outset. The worst moments, the “nadir”, was when the HPCSA began presenting its case, Noakes said. It exposed the "pettiness and incivility of the prosecution”.
It exposed “the hostility of the expert witnesses and the banality of their arguments”. It laid bare the shocking levels of deceit and mendacity to which members of the HPCSA, ADSA and assorted university academics were prepared to sink. All to silence one man.
Noakes recalls having “troubled, weird dreams” and sleepless nights before the appeal ruling. He has slept like the proverbial baby since.
Tim and Marika at a very successful book event.
*Marika Sboros is a South African journalist, editor and co-author with Professor Tim Noakes of Lore Of Nutrition, Challenging Conventional Dietary Beliefs (Penguin 2017), revised, updated as Real Food On Trial, How The Diet Dictators Tried To Destroy A Distinguished Scientist (Columbus 2019). She edited and contributed to Healthy Eating: The Big Mistake: How modern medicine has got it wrong about diabetes, cholesterol, cancer, Alzheimer’s (Columbus 2018) by Dr Verner Wheelock. She is also founder and editor of Foodmed.net.