Sacred cows dispatched at South African low-carb, high-fat summit

By Marika Sboros

Last month sounds of the slaughtering of sacred nutritional cows could be heard coming from Cape Town International Convention Centre in South Africa – the venue for the first International Summit on low-carb, high-fat (LCHF) diets.

Among those forensically dispatched were such perennials of the dietitians’ lexicon as: obesity is simply the result of greed and sloth; calories in equal calories out (CICO, pronounced psycho); saturated fat causes heart disease, and type 2 diabetes is irreversible.

The summit’s origins lay in a decision in 2009 by Tim Noakes, a medical doctor and professor of exercise and sports science at the University of Cape Town to commit serious professional heresy by doing an about-turn on the role of carbohydrates in the diet, and denying that a low-fat diet is healthy.

Rather than being scientifically curious about why such an eminent researcher was reversing the teaching of a lifetime, fellow academics and colleagues in medical, dietetic and nutritional establishments launched a barrage of personal attacks that continues to this day.

Seeking an antidote to venom

Karen Thomson, granddaughter of the late pioneering heart surgeon, Prof Chris Barnard, and founder of HELP (Harmony Eating & Lifestyle Programme) which helps people overcome addiction to sugar and carbohydrates, was so incensed by the venom directed at Noakes, she decided to find an antidote: She began inviting the world’s top LCHF specialists to South Africa to speak at a summit.

They came in numbers that exceeded all expectations. Summit speakers included nutrition scientists, obesity researchers, a cardiologist, nephrologist, psychiatrist, and bariatric surgeon. All said they came to show support for Noakes, and to spread the word about the science behind LCHF (aka ketogenic aka Banting) diets. Among the 500-odd audience were local and foreign medical doctors, dentists, dietitians, nutritionist, and allied health professionals.

Top summit speaker was Dr Stephen Phinney, a US physician scientist and emeritus professor of medicine at the University of California, Davis, known as the “father of LCHF”, who said the summit was the biggest conference audience he had ever addressed.

Over the four days, the summit steadily demolished deeply held myths about diet, weight loss, and food as optimum fuel for body and mind. Speakers began laying the scientific framework for a gentle, safe alternative to modern medicine’s rampant polypharmacy. A promising, non-drug way to stem the tsunami of obesity, diabetes, cancer and other chronic diseases began to emerge.

Excess carbs drives chronic disease

Canadian kidney specialist Dr Jason Fung and others presented compelling evidence that these chronic non-communicable diseases were not isolated, but all linked to insulin resistance (IR), a metabolic condition driven by excess sugar/carbohydrates in the diet.

The core benefit of the LCHF diet, described by several speakers, is that it is able to reverse IR and probably the disorders it causes, as well as providing optimum energy for endurance sports performers. This is because following the diet involves lowering carbohydrate intake to around 25 grams or below (bringing down insulin) and significantly increasing fat intake. This combination stimulates a condition known as ketosis in which the body starts producing ketones from fat stores. These are energy packets that body and brain can use instead of glucose.

Phinney and others commented that the body’s preferred fuel source was actually ketones, not glucose from carbs, as claimed by conventional wisdom.

Mainstream dietitians also use the word ketosis to describe a related but potentially lethal state called ketoacidosis. Confusion between the two states is one of many stumbling blocks to official recognition of the benefits of low-carb, high-fat diets. Thirty years ago Phinney coined the term nutritional ketosis to describe the beneficial natural energy system and to distinguish it from the dangerous one.

Doctors’ fear based on ignorance

So why are doctors and dietitians still so fearful of ketosis and ketones that they instill this fear in patients? 

‘Ignorance,’ said Phinney: ‘They are classically taught that ketones are “toxic byproducts of fat metabolism”, which they can be but only in extremely high levels, and only in the complete absence of insulin, as in type 1 diabetics, or more rarely in end-stage type 2 diabetics.’

‘Even if there is only a little insulin, ketoacidosis will not occur,’ he said. For the rest, ‘ketosis is a benign state, and ketones (natural chemicals the liver produces in response to fat metabolism) are helpful substrates’.

Other myths still alive and well among doctors and dietitians were also demolished. These included the diet-heart hypothesis (that saturated fat causes heart disease); “a calorie is a calorie” (a calorie from any source – fat, protein or carb, delivers the same amount of energy); and the “energy imbalance hypothesis” (CICO – calories-in equals calories-out) – that people are fat because they eat too much and move too little.

Taking a sledgehammer to carb myths

The expert taking an especially effective sledge hammer on these myths was Zoë Harcombe, a Cambridge University graduate, nutrition specialist and obesity researcher who is currently completing a PhD. She told the summit that for CICO to be true, a law of thermodynamics would have to be violated – effectively sabotaging dietitians’ denials that CICO does the violating.

‘The junk food industry spends billions of dollars annually trying to convince everyone that CICO is true, and a calorie is a calorie,’ Harcombe said, ‘because that makes them automatically innocent of any role in rampant obesity and diabetes rates.’

CICO also took a beating from US science and investigative journalist Gary Taubes, author of groundbreaking books Calories In and Calories Out, and Why We Get Fat. Taubes is co-founder of the Nutrition Science Initiative, a US non-profit organization devoted to reducing the individual, social and economic toll of obesity and related diseases by improving the quality of science in nutrition and obesity research.

‘CICO is the original sin of obesity and diabetes research,’ Taubes said. ‘It has become written in tablets of stone brought down from the mountain, yet it has no science behind it. Obesity has nothing to do with gluttony and sloth.’

Official dietary guidelines to avoid saturated fats came in for an especially heavy pounding from speakers. Harcombe referred to her own major research in the BMJ Open Heart in February, concluding that official dietary guidelines to avoid saturated fats were without scientific evidence when they were in the US in 1977 and in the UK in 1983.

Saturated fat not bad just misunderstood

That advice, she estimated, has adversely affected the health of more than 270 million people, as sky-rocketing rates of chronic non-communicable diseases worldwide clearly show.

Next up at the punch bag was US physician Dr Michael Eades, who has been in full time practice of bariatric, nutritional, and metabolic medicine since 1986. He presented disconcerting evidence on how studies biased against saturated fat worked their way into government recommendations.

British interventional cardiologist Dr Aseem Malhotra was equally scathing about official dietary guidelines and demonisation of saturated fat, but said he preferred to talk of ‘healthy’ rather than just saturated fats into the diet.

Harcombe went to the heart of why dietitians and doctors still give such bad dietary advice: they misunderstand saturated fat.

‘All foods containing fat contain all three fats: saturated, monounsaturated, and polyunsaturated,’ Harcombe said. ‘There are no exceptions. You cannot eat saturated fat without eating the other two fats.’ 

High carb diets bad for the brain

Myths around food and mood, and carbohydrates as essential to the diet were strongly challenged by US adult and child psychiatrist Dr Ann Childers, who has a special interest in improving her patients’ health through diet and lifestyle.

Childers says nutrient-poor, high-carbohydrate, high-grain diets don’t just cause weight gain, they’re not good for body or brain. Carbohydrate foods are not essential or the brain’s best food for mood and cognition. ‘Fats are, including saturated fats,’ she said.

South African-born US adult and paediatric bariatric surgeon Dr Robert Cywes pointed to a disturbing pattern in how public health authorities deal with chronic disease. ‘Sixty years ago, experts sat wringing their hands about the rise in lung cancer, heart disease and emphysema, (all chronic non-communicable diseases – CNCDs), and completely ignored, and in fact argued against, evidence that tobacco was the culprit,’ Cywes said

‘Today they sit wringing their hands about obesity, diabetes, cholesterol and hypertension while pointedly ignoring another “culprit drug” with evidence stacked against it.

‘The most prevalent CNCDs killing us as a species,’ he went on ‘are caused by drugs not well tolerated by human systems: alcohol, tobacco, and the obesogenic drug – carbohydrate.’

Exercise doesn’t help weight loss

LCHF experts are often criticised for downplaying the role of exercise in the energy imbalance theory. All summit speakers agreed exercise was essential, just not proven to be a good weight-loss tool. This directly challenges food companies, which regularly claim that lack of exercise, not food, is responsible for obesity.

Some of the most dramatic moments at the summit came from moving personal accounts of high-fats to treat diabetes, to improve performance for elite athletes, and generally benefit body and mind of ordinary mortals.

Canadian physician Dr Jay Wortman, a public health specialist, and clinical assistant professor at the University of British Columbia’s faculty of medicine, described how he reversed his own type 2 diabetes 12 years ago with a low-carb, high-fat diet, and has been free of any sign of the disease ever since. He also reassured the audience that LCHF regimens were safe for children and pregnant women.

Dr Eric Westman, associate professor of medicine at Duke University’s Medical School’s and an expert on low-carb nutrition, gave an entertaining presentation of the hows and whys of LCHF for weight loss. He donned a white coat, and addressed the audience as an obese patient, taking them step by step through the basics: carbs as low as 20g a day, moderate protein and high fat, all from ‘real’ food – as close to its natural state as possible.

Cancers just love sugar

‘Have you ever seen a bread tree or a pasta tree?’ Westman asked the audience rhetorically. Firmly off the menu was anything processed, refined or containing additives and flavouring.

One of the most exciting – and controversial – presentations was: So you think you need sugar? Your cancer needs it even more! by Australian orthopaedic surgeon Dr Gary Fettke, a senior lecturer at the University of Tasmania who does ongoing research into diet in diabetes, obesity and cancer.

Fettke, a cancer survivor, has done intensive research into metabolic model of cancer therapy, based on the work of Nobel Prize winning German biochemist Dr Otto Warburg in the 1930s. Warburg showed that the preferred fuel source of cancer cells was glucose, and depriving them of glucose could be a treatment method.

Given all the valuable and cutting-edge research presented at the summit, the only pity was little question time, and that doctors and dietitians opposed to Noakes and LCHF stayed away, despite an open invitation to public debate. Their excuses left a lingering impression that perhaps they weren’t sure their arguments would stand up to scientific scrutiny.

Noakes gave a powerful lecture on The Way Forward for LCHF answering his critics, and presenting an impressive summary of scientific evidence for it.

The speakers issued a consensus statement, and a rallying call for a ‘bottom-up dietary revolution’. A top-down approach, they concluded, would never work, given how deeply pharmaceutical and fake food companies are embedded in governments, universities, and their advisors.

Marika Sboros

Marika Sboros

Marika Sboros is a health and medical writer, journalist, editor, and associate editor of, and commutes between London and Johannesburg.
Marika Sboros

Latest posts by Marika Sboros (see all)


  • Thank you for this excellent summary. Re-shared to both G+ and Facebook (Fat Head group).

  • Brilliant! Printed this out to give to all and sundry in my family. I was at the conference not as a medical professional but rather to be an informed follower and advocate of LCHF.

  • It is simplistic to claim that LCHF is right and HCLF is wrong for everyone. For years we have heard people claim that HCLF caused them problems. Of course we heard nothing from the skinny people on a HCLF diet because they were doing fine.

    If you look at the digestion of fat you will discover that the enzyme Intestinal Alkaline Phosphatase (IAP) is involved. You would expect that those with a high level of IAP would do well on a LCHF diet and correspondingly those with a low level of IAP would need to stay away from fat. There is a significant amount of published work relating IAP levels to ABO blood type and secretor status. Highest levels are found in type O secretors. Low levels are found in types A and AB. It also appears that the type A antigen inhibits IAP activity. So it should come as no surprise that many type As have problems with LCHF diets. This has been acknowledged by the Atkins Diet Clinic.

    Genetic studies indicate that types O and B evolved from type A, which then disappeared, only to reappear < 300K years ago. This suggests that the high IAP levels of type O were an evolutionary advantage for the Hunter-Gatherer. When man started to consume cooked grain, at least 100K years ago (well before cultivation started ~10K years ago) type A became an evolutionary advantage.

    So maybe about 40-45% of the population (types A and AB) should be on a HCLF diet and the rest should be on a LCHF diet

  • A good summary by Marika Sboros.

    Mr Gibbs, in England around, say, 1600, there was no refined sugar, no pasta, rice or potatoes. Fruit was only available in the summer. By modern standards it would have been a very low carb diet. I think ‘potage’ was the staple meal, which was a sort of vegetable soup with meat or fish thrown in, if available.

    If 40 – 45% of the population do better on high carbs, they must really have struggled. All dietary guidance from 1820 – 1983 warned against carbs or suggested they be eaten in small amounts. Isn’t the high carb diet a modern aberration that came about from poor science and the false link between fat consumption and heart disease? This is the disaster Ancel Keys gave us.

Leave a Reply

WP-Backgrounds by InoPlugs Web Design and Juwelier Schönmann