Dr. Eric Westman: It is my great pleasure to introduce Zoë Harcombe.
My followers are a fairly sophisticated group. They suffer through my tedious going-over of papers and insist on evidence. I’m teaching them how to look at papers. I learned recently at a conference that any animal work on a particular enzyme didn’t replicate in humans. I’m also very human-centric in the research that I go over.
I wanted to have you on early because you go back in terms of looking at this information for diet and health in general. I hope by the end of this interview, all of my people will follow you and get the information that you’re summarizing. For people who don’t know who you are, tell us a little bit about yourself.
Background
Dr. Zoë Harcombe: My name is Zoë Harcombe. I went to Cambridge University and did Maths and Economics. I’m a bit of a numbers person, definitely numbers rather than languages. My interest in this whole field started when I was a teenager and my brother was diagnosed with type 1 diabetes. That was a real shock to the whole family. It was classic juvenile type 1 diabetes. He lost a stone (14 pounds or ~6 kg) in a couple of weeks. Why it even took two weeks to diagnose, I don’t know; it was just so obvious. Sending his little sister down to the shop to buy bottles of pop, and no sooner had I taken some home, he’d finished the other ones and he wanted me to take back the bottles to get the money back. I mean, it was just classic. I would then help him inject insulin, so I saw the equal and opposite of insulin, sugar, glucose. I didn’t start studying it then, but it was in the back of my mind that this is all quite interesting.
My real interest started when I was up at Cambridge University in the late ’80s, and people were starting to become more weight-aware. You’d get people looking at one-calorie drinks which had just come out. For the younger people in your subscribers, they were truly disgusting, those first low-calorie drinks. They were horrible. They would make low-fat yogurts and all this low-fat fake food. And again, I didn’t make the connection at the time with the US dietary guidelines and Senator McGovern and all; that was going to be down the road. But I did have this interest in obesity. I’d never met anyone who wanted to be obese, and yet it was starting to take off like an airplane. And it was kind of like, why is this going on?
I then did what my mom would call a “proper job.” I left Cambridge, went into management consultancy because that’s what you do when you don’t know a single thing about business; you get charged out at 500 quid an hour to tell someone else what to do with their business. It’s just hilarious, but that’s what was happening in the ’90s. I had a really nice career. I worked for Mars, big food. I worked for GSK, a big pharma company. I worked for the Welsh Development Agency. I’ve done marketing, training, and manufacturing. I’ve worked all over the world. Had a great first career, and ended up as vice president of human resources for big companies. When the financial crash hit in 2008 and 2009, I got an opportunity from the company I was working for at the time. They were going to get rid of quite a few of the more expensive people, which was the management team people. My husband, Andy, and I went away for a couple of days and thought, shall we do this? Should we take this leap from this lovely, secure big salary, bonus, nice pension, and go and do what we really love doing, which is diet, health, trying to help people get better health, and so on?
We took the plunge and we’ve never really looked back. You never earn what you earned then, but we’re just so much happier and more fulfilled. Career two has been diet and health, but from the numbers, analytical side: where is the evidence in nutrition and why do we tell people to do all these different kinds of things? I guess what I’m most known for now, I do talks at conferences with you and people like us, but then I’ve also been doing this “Monday Note” as it’s become known. We’re going to hit issue 700 this year, which is incredible. I’ve been doing this since 2010, every Monday, apart from Christmas Day. I do this note and I just take an academic paper. It might be one from last week saying animal protein is rubbish and plant protein is so much better for you. I just go to the paper and I give you five bullets of the exact summary. There are 2,000 words, slightly longer to unpack. But I look at it so you don’t have to look at it and then you can sway your mother-in-law – “I’m not killing your darling boy by giving him red meat and butter, quite the opposite.” That’s what I do now.
Looking at Saturated Fats
Dr. Eric Westman: Fantastic. It’s important to consider the source. Consider the source of information, especially on the internet these days. Your background is impressive and really explains why you can do such a thorough review of things and spot the wheat from the chaff, the good from the weak science. You first got my attention when you were looking at saturated fats. You gave me your PhD thesis. When you first got into this, you looked at saturated fats and health, right?
Dr. Zoë Harcombe: There was a little bit of background before then. I got into this whole thing because I was fascinated by obesity. That started at Cambridge and it just didn’t go away. I just got more and more fascinated as more and more people around me were becoming obese and more and more people clearly didn’t want to become obese. I’d actually written a mainstream diet book in 2004, called Why You Overeat? When All You Want Is to Be Slim. It was trying to answer that million-dollar question. I did that while I was still an HR director. That did a lot better than I expected, because my publisher said, “The average book only sells a couple of thousand copies.” I thought, “That’s okay.” But it sold a few more than that. Then the publisher said, “Can you do another one?” So I wrote one called Stop Counting Calories & Start Losing Weight. I was very much interested in the obesity angle, and to understand why something starts happening, something must change. It’s the laws of the universe, isn’t it? For something to change, something must change. Unless a force is acted upon, it will stay in a stable state. And something was clearly changing.
I remember going back in because it’s the math, it’s the logic, what’s going on here, what’s the answer to the puzzle? And we didn’t eat more and do less, which is what the traditional argument was. We just didn’t. You go back and look at the evidence in terms of actual calories reported and you say, “Maybe people weren’t reporting them faithfully.” It’s like, “Yeah, but we’re still eating a few hundred fewer than we were before we were obese and we’re doing more.” When I was a kid, nobody was doing gym, yoga, aerobics, running up and down on the spot step machines and all that. Nobody did it. It just didn’t happen. So it did make sense. I looked back and I said, “Okay, something did change,” and that was the dietary guidelines. That was in 1977.
Particularly if you look at the US graph, there’s an inflection around 1976 to 1980, and it just takes off like an airplane. When you home in on it and you say, “Right, what happened there?” If we didn’t eat less, eat more and do less, what would happen? And then you see that there was this summit that was held by Senator McGovern, who of course was a failed presidential candidate, and they want to leave their mark in another way. He was asked to understand why people weren’t getting enough nutrition in the US. It was a look at poverty. He was like, “Ah, I’m done with that. I now want to set a diet for the whole of America. I want to really leave my mark.” And he really did leave his mark, because he’d been on a preening low-fat boot camp just before he’d come in to preside over this committee. He was going in with his own personal bias. If you’ve been eating the standard American diet and then you go and have a whole food, low-fat, high-carb diet or whatever, you’ll still do quite well in the short term. He’s bringing his bias in. I wanted to understand those dietary guidelines, why they were introduced, and was there evidence to introduce them at the time.
In 2009 when I stopped doing the HR director work – we’d been working like a hundred hours a week and I thought, “I’m sure I can write for a hundred hours a week,” and suddenly I had more than a hundred thousand words on obesity in my book, which was much more heavyweight than the diet books. That really got me interested. I was looking at things like the Seven Countries Study and Framingham and all these classic studies started really getting into it. You start a PhD without actually knowing what your PhD question is. That’s my experience and the experience of other people. I thought, “I’m going to be doing something on the Seven Countries Study.” As it turned out, the Seven Countries Study was just part of Chapter Two, which is your review of the literature. I realized what I really wanted to understand was why we introduced those dietary guidelines. It takes you right back to the beginning of the 20th century and the Russian pathologist. They were doing autopsies on men; it was always men, men who died suddenly. They didn’t even really know the term heart attack until about 1948. They’re opening them up, they find they’re a little bit clogged up. And of course, at the scene of the damage, you’ve got lipids, you’ve got cholesterol, you’ve got fats, phospholipid proteins, and all the rest of it. So they’re like, “Oh, it must be cholesterol that clogged them up.” So then they started trying to feed bunny rabbits cholesterol, and of course, they clogged up because bunny rabbits are herbivores and cholesterol only comes from animals. I mean, there were just so many errors.
Wind forward and you’ve gone from this idea that cholesterol is the problem. Ancel Keys was the big nutritionist of the time around the 1940s, and 1950s. He quite quickly said, “No, no, it’s not actually cholesterol.” He tried feeding humans massive amounts of cholesterol and nothing happened. He then famously said, “Look, it’s not cholesterol. Unless you’re a rabbit or a chicken, it’s not a problem.” And then he said, “But I think it’s fat.” He did that Six Countries Graph, which everyone confused with the Seven Countries Study, which is completely different. He said, “Look, there’s the relationship with men dying from heart attacks, aged like 48 to 50 something, rather narrow range, and the fat intake. I think that’s it.” He was told, “No, no, no, you didn’t include all the countries and there’s actually 20 countries.” That was his background. He goes into the Seven Countries Study thinking it’s fat. It’s not cholesterol; it’s fat.
The Null Hypothesis
Dr. Eric Westman: You would have learned in your PhD research training that a more appropriate way to look at the evidence is to try to disprove something. You don’t go into the world and find what you want and then say, “See, it’s what I wanted to see.” So just from the beginning, it smacks of unscientific methodology.
Dr. Zoë Harcombe: Yeah, I mean, you get taught the null hypothesis approach. The minute you think OJ Simpson is guilty, you look for OJ Simpson to be guilty. The null hypothesis says to you, “Right, prove that he’s not guilty.” All you’ve got to prove is that he’s not guilty. If you just can’t find anything to show that he’s not guilty, then he might be guilty. But don’t do it the other way around because you’re going to go with bias. If someone had stopped me at the start of the PhD and said, “What do you think you’re going to find?” I don’t plan ahead, so you would have stopped me in my tracks. I don’t even know what I’m having for tea tonight. That’s how little I plan ahead. I would probably have said, “I’m expecting to find a relationship between heart disease and dietary fat intake in men, maybe women as well, maybe of a certain age. But I don’t know how strong the relationship is going to be.” But they introduced these guidelines in the name of trying to help men with heart disease. I think they must have had some good evidence at the time. That’s probably what I would have said.
And then the PhD was done in four parts. So first of all, I said, “Right, let me pretend I’m the dietary committee back in 1980,” when they set the dietary guidelines for Americans on the back of that 1977 Senator McGovern work. Let’s assume I’m the committee and I’m looking at all the evidence available at the time. I want to look at all the randomized controlled trial evidence because that’s going to be the best evidence. But I’m also going to look at all the population study evidence because there were some really important population studies, like the Seven Countries Study, Framingham, Woodill, Sydney Heart Study, Oslo Heart Study, and that kind of thing. There were some important ones for me to look at. We’ve got this technique now which they kind of did have at the time, but it wasn’t that well known, which is systematic review and meta-analysis. That’s the highest level of evidence when you’re looking at academic evidence. So, systematic review, you go through all the literature. You don’t cherry-pick. You just get everything, whether you like it or not. You just get all the studies, and then you pull them together in this statistical technique called meta-analysis. And out pops a result that basically is the strength of the relationship between the two things that you’re looking at. I did that, and there was no evidence whatsoever. No evidence whatsoever.
Dr. Eric Westman: At the bottom of that evidence-based methodology is expert opinion, where we just kind of all know it to be true from whatever. That’s really what it was, wasn’t it? By modern-day methodology, there really wasn’t sufficient evidence to create these U.S. guidelines.
Dr. Zoë Harcombe: It wasn’t. And the ignorance at the time… I remember when I was looking at the population studies and the really big one, the one that dominated the others, was the Seven Countries Study because it was so big and it involved these seven countries and 16 cohorts. I read every single word of the 20 volumes of that study. Keys used to talk about saturated fat, and the examples that he would give were things like cakes and ice cream. And it’s like, well, they contain saturated fat, but then strawberries contain saturated fat. Not many people know that. So don’t blame the saturated fat for what the sugar in the cake and the ice cream did. There was just so much ignorance.
For the final part of my PhD, I said, “Okay, that was 1980. We’re not in 1980.” I was coming up to 2015. I was going to be defending my PhD in 2016, so let’s look at all the evidence that’s available now. And of course, she then got things like the Women’s Health Initiative, you had the Minnesota Coronary Survey that had finally been published. And so I pulled all the evidence again, systematic review, meta-analysis, zero evidence either in randomized trials or population studies. There is just no evidence for introducing those guidelines: none, zilch. It’s astonishing. And yet, as you say, we all know that fat clogs your arteries. Fat causes heart disease. Saturated fat is even worse than dietary fats. People don’t even know where saturated fat is found. The ignorance is just nuts.
The Involvement of Industries in Dietary Guidelines
Dr. Eric Westman: It’s kind of like the sun going around the Earth. I mean, we see it every day. That was shocking to me as well. I have to just mention Gary Taubes. The first half of Good Calories, Bad Calories was another very influential piece for me to read to have the scales fall from your eyes and you say, my goodness, there really isn’t evidence for this widespread activity which is pushing out guidelines. Looking back, wasn’t it really a lobbying of companies? Why would McGovern have done this?
Dr. Zoë Harcombe: I’ve given that some thought. When you’re told something that is just wrong and for which there’s no evidence, there are only ever two reasons for that. One is incompetence, and the other is conflict. So the person telling you that information is either ignorant, and they just don’t know what they’re talking about, or they’re conflicted in some way, and therefore, they want to tell you something because their academic funding depends on them telling you that kind of thing. I think at the beginning, McGovern had gone in with his own bias. Nick Mottern was a vegetarian, so he was quite happy that things were going that way.
Dr. Eric Westman: May I comment on that? Because even to this day, those who are in the ultra-low-fat, high-carb camp, the Ornish, McDougall, they’ve always said it’s their way or the highway, it’s the only way. So maybe McGovern was duped into thinking that this was the only way to do it. I review videos today of that bias coming in, and then they forget to say, “There are a lot of ways to be healthy. Let’s not make all Americans do something without some evidence before.” So I don’t know. I guess I always try to see the glass half full; I hate to say someone is incompetent. Maybe they’re just not fully educated, fully informed.
Dr. Zoë Harcombe: I think it started as biased; he’d been on a low-fat camp. I think it started that way. But I think then big business just becomes such an issue. Of course, we’ve got to put this in the context of the brilliant work that Belinda Fettke has done. She traced the whole concept of “Why cereals?” Where did that whole message come from back in the 1800s? You’ve got John Harvey Kellogg, think Kellogg cereals. Graham crackers, Sylvester Graham was around at the time. There was this whole Seventh-Day Adventist movement at the time, and they thought that men, particularly, consuming animal foods was the height of wickedness; they were going to become all lustful and aggressive and violent. If they had any meat, they were going to be these evil monsters. So everyone should have cereals instead. But of course, they were developing cereal companies, so that was in their interest. Wind forward to the late 1970s, 1980… Imagine you’re a Kraft fake food kind of company, and you see that the American guidelines that are going to influence the rest of the world are starting to say, “I think you should be having cereals for breakfast and not eggs. I think you should be having low-fat, high-sugar yogurts that we can put a real high premium on rather than that nice natural yogurt that comes from the farmer.” I mean, you just wouldn’t be able to believe it. You’d just jump on the bandwagon, wouldn’t you? “Right, here’s a low-fat spread. Here’s a low-fat yogurt. Here’s a high-sugar cereal. Let’s start putting nutrients in cereals and all the rest of it.” I think then it just became more and more conflicted.
Where Did This Influence Come From?
Dr. Eric Westman: The interface then between the medical world is, we got no training in nutrition. It would be interesting to sleuth out how that changed because if you don’t have doctors trained in looking for good nutrition, they’re just going to follow what everyone else does. You learn about nutrition from the TV ads… as a doctor. The Seventh-Day Adventists and the religious influence is still there today. It hasn’t gone away. But how did they have so much influence? Why would we have a guideline at all? My understanding is there wasn’t one before.
Dr. Zoë Harcombe: Yeah, there wasn’t. You‘d have to go back to World War II. Particularly in the UK, there was rationing because Europe was having a much worse time of it than the U.S. The U.S. wasn’t in at this stage. Rations were introduced, and you could have a certain amount of butter and a certain number of eggs and grams or ounces of sugar, as it was back then. That was the first time the government said, “This is what you’re going to eat.” But it was, “This is all that we can give you because we’re at war and we can’t get the foods anymore. We’re busy making ammunition and all the rest of it.”
Why did they even need to mandate it? I mean, there’s news in the UK today that they’re going to be banning smoking and banning this, that, and the other. There’s part of me now just saying, “Look, we’re grown-ups.“ People know the harms of these things. You can still parachute jump, you can still go off skiing. We can take some risks in our life. Some people are more risk-takers than others. And where do you go next? Do you ban alcohol? They‘d love to ban red meat and butter and cream. I’m kind of supporting the smokers at the moment because I’m thinking, if I don’t back up the smokers, then they’re going to come for the meat-eaters soon. It‘s just a slippery slope of control that we’ve got to fight.
Insulin Versus a Low-Carb Approach
Dr. Eric Westman: Having been on the medical public health side, we argue that if there’s a small reduction of risk and death and we multiply it over millions of people, we’ve saved millions of lives. There‘s always the tension between public health and personal health. I’m not upset, having grown up with parents who smoke and I have experienced the consequences of secondhand smoke from childhood, and that was my field. I got indoctrinated into the idea that we should tell people not to smoke as doctors. But now you have me questioning the deep beliefs that I’ve known to be true forever – like fat is bad – and now I know it’s good, or the breast cancer screening might not be as great. This is great, but these are uncomfortable things we’re about to learn.
Did your brother gain weight using insulin?
Dr. Zoë Harcombe: No, no, he didn’t. We came from a very sporty family. My mom was a sports teacher and my dad was an engineer, but they both played hockey competitively. They played sports like squash and badminton.
Dr. Eric Westman: Did your family know about the low-carb approach for type one?
Dr. Zoë Harcombe: No, but the advice at the time was actually not too bad. I remember being dragged into the local hospital. I was going back up to the shops to get some more fizzy pop because that was the most thirst-quenching for my brother. I got home and there was a note from Mom on the doormat saying, “Just had to rush Adrian to hospital.” The next thing I knew, my dad was coming home early from work and he was taking me to the hospital. I remember this doctor saying, right guys, your life is now going to change. You’ve got a type one diabetic, he’s going to be injecting with insulin twice a day, so your diet is going to need to change.
They didn’t say low-carb at the time by any means. Although my parents and my roots are in Wales, my parents had moved to the Northeast at some point in their lives, and the Northeast was very much a high tea culture. The eating over there is appalling. At 4:00 in the afternoon, you’d have Battenberg cake, sandwiches, and scones with cream and jam – it was a very sweet, carby meal. The idea was that you had your main meal at lunchtime, where you might have a stew and a meat, but then you had all of this stuff in the evening that you probably weren’t going to use up before you went and had some more cereal and whatever for breakfast the next day. The doctor‘s message was very much that that needs to go. I remember then that our meals did become more what Granny would cook. It was more liver and onions, fish on Fridays, roast beef on Sundays. We settled into much more of a routine of, it’s Saturday, it must be curry. But it was a mince with pineapple on the side, and it did change things. I look back now, Adrian certainly stopped eating sugary stuff and biscuits, and my mom used to bake on a Sunday morning. That stopped. She wasn’t making a couple of cakes for the week and some nice shortbread biscuits. She was a good cook, so all of that stopped. It was very much that he really should be having three meals a day, and he’s going to inject a couple of times a day, and you really need to make sure he doesn’t have a hyper or a hypo (glycemic) episode. We were trained to spot the difference between the two.
Over time, as he was seeing dietitians, of course, it wasn’t very long before he was shown that thing that I call the “eat badly” plate. It’s the UK’s healthy eating guide, and it’s a plate that is just almost entirely carbohydrate. Spot the red meat? You won’t find it. Spot the full fat? Struggle. I mean, all the fats, polyunsaturated fat, it’s just evil. That was designed by the fake food industry, 100%. Public Health England allowed them to do it. That was another story that I broke. I did a British Journal of Sports Medicine article when I realized where that came from. Who designed a plate like that? How could Public Health design such a bad plate? Then you realize that public health actually appointed industry reps to design the plate. You could not make that up. That’s when you know that it’s not ignorance anymore; it’s just complete conflict.
Saturated Fat and Heart Health
Dr. Eric Westman: I went to an international meeting of dieticians and nutritionists with a lot of public health people, and it was so biased toward the plant-based thing that everyone talks about today. It was like with religious zeal that they said you couldn’t have red meat and all the terrible things. Even thousands and thousands of people that are meeting all with this belief system and bias. From obesity then, the saturated fat in your PhD thesis, I think you concluded that there was no relationship between saturated fat and heart disease or health, or what did you find?
Dr. Zoë Harcombe: Just nothing. No evidence whatsoever, either at the time the guidelines were set or looking at all the evidence today. The two guidelines are: you should have no more than 30% of your calories in the form of total fat and no more than 10% of your calories in the form of saturated fat, and there was just no evidence whatsoever for either one of those. I was starting to look at facts about that. I need to get down to Ground Zero when I do this stuff, so I find myself thinking what is fat anyway? What is fat found in? You find interesting little fat tidbits, like the only food that I can find that doesn’t even have a trace of fat is sugar. Table sugar. And people say, well, that’s ridiculous. Go to the USDA database and put in a kilo of lettuce, and you’ll find that there’s a trace of fat. There’s a trace of fat in strawberries and apples. There‘s a decent amount of fat in things like grains and legumes. It starts to become measurable, let alone before you get into olive oil and coconut oil, which of course are 100% fat.
The next really interesting fact about fat that I found was that everything that contains fat contains all three fats. You‘ll talk to dietitians who will confidently say, “Red meat is full of saturated fat.” I put up a slide at conferences. I have a 100-gram piece of raw meat, and then you look up what it actually is. I color 71% of it blue. So 71% is water. Then you color 21% yellow. 21% is protein. You’ve got a slither of ash and minerals. That’s about 1%. And then you’re left with 7 percentage points, which is fat. And of those 7 percentage points, 2 are saturated fat on a typical steak that you can find on the United States Department of Agriculture all foods database. Saturated fat is literally the last thing that a steak is, and the dietitians are confidently saying, “Meat is full of saturated fat.” They just don’t know what they’re talking about. My other little favorite fact about fat is that when you go to the food groups, if I can remember, you’ve got meat, fish, eggs, dairy, fruits, vegetables, grains, legumes (which is your beans and pulses), and then I put nuts and seeds together. Nine food groups there. Your only food group that has more saturated than unsaturated fat is dairy products. Then you come across all these articles saying, “Dairy’s great, we really need to worry about saturated fat.”
Dr. Eric Westman: But food groups are a governmental construct. When someone says it’s not a balanced diet, yes, it is. That goes back to my background. I had a couple of nutrition-related doctors, and one of them was Jim Anderson at Kentucky State University, who was known as the “Bran Man.” He had people eating tons of fiber, and it helped. It wasn’t palatable. I then went from Kentucky to Duke to do training in clinical trials, and I called back to say that I had a couple of patients do the Atkins diet, and it really worked. What do you think about that? Dr. Anderson thought for a moment, and he said, “Well, I’m not really a big fan of that diet, but it is a balanced diet.” And so even a diet devoid of carbohydrates is balanced in terms of micronutrients, minerals, and vitamins. Fast forward to today, Jeff Volek at Ohio State gets up and says, “If you’re doing a low-carb diet, carbohydrate is not a macronutrient, because you’re not eating it.” So anyway, the idea that you’re drilling down to reality rather than what everyone perceives it to be. We’ve been drummed through marketing; if we start to hear the same thing over and over again, we start to believe it.
Dr. Zoë Harcombe: I’m just thinking about the U.S. plate. It came in around the time of Obama, where you’ve got dairy and then I can’t remember the rest of it, but I think it’s fruit and then there’s protein. That’s not a food group, that’s a macronutrient. Your protein is in everything other than sucrose and oils.
Is There Hope?
Dr. Eric Westman: Unfortunately, it seems to me that the messaging has gotten so diluted that, at least to the end user, the U.S. guidelines are kind of irrelevant. But it still has a lot of influence on institutions like schools and government food programs. Is there any hope to undo the idea that a school has to follow a guideline?
Dr. Zoë Harcombe: You’ve got the conflict. I love that Good Calories, Bad Calories book just the same as you did and I remember chatting to Gary about this, and he’s saying, I think he puts this in the book: If you are a practitioner and you advise a low-fat diet, you’re not going to get in trouble. You’re not going to get sued. Your patient might get diabetes and obesity and high blood pressure and all the rest of it, but you’re not going to get sued. You were following the guidelines. But you try to do the right thing by your patient, and you end up like Gary Fettke, having a 4-year war with Australian dietitians who are funded by Sanitarium, which really does link back to the Seventh Day Adventists, because he dared to say, “Don’t eat sugar.”
The Tim Noakes Trial
Dr. Eric Westman: How did you get involved in these sort of silly but epic battles that doctors outside of the U.S. had – Gary Fettke in Australia, and Tim Noakes in South Africa?
Dr. Zoe Harcombe: The Tim Noakes situation was really interesting, actually, because he joked that it was the most expensive tweet in history. If people go on my site, there’s loads of articles on there where I documented the trial and I explained how it all came about. You’ll be able to see the tweet, what the person tweeted, and it was just someone he didn’t even know, and he didn’t even spot it for a while. Someone waved at him on Twitter and said, “Hey, Prof, I’m breastfeeding, worried about something or other.” Tim comes back and says, “Remember it’s you eating it, not the baby, the key is that when you’re not breastfeeding, think about low-carb, high-fat, something like that, because you had 140 characters then.” At the time, that was kind of shorthand for saying, “You’re going to find the nutrients in the things that are low-carb, high-fat.” So meat, fish, eggs, and dairy, particularly the whole fat and oily fish and red meat and all. That’s where you’re going to find the good stuff. He doesn’t think anything of it, but it was absolutely clear that the South African dietitians, who also have conflicts with fake food – I’ve done a post on that – they were just looking for something, and you can imagine them in this room, like, “Do you think this is the one? Do you think we’ve got enough here to go after him?” They really were looking for trouble. And then, sure enough, he got this complaint from this dietitian called Claire Julsing-Strydom. She filed a complaint, and then the wheels were set in motion and the Health Professionals’ Organization of South Africa, which is the body that regulates doctors, started getting involved, and they were looking at trying to take away his medical license.
He actually hadn’t practiced as a medical doctor for quite some time because he’d been this academic. He had more papers to his name than almost anybody else in the whole world. He was so highly rated as an academic but they wanted to go after him anyway. Tim knew that I did these dissections, and we’d met. I met you for the first time when we did the Cape Town conference in February 2015, which Karen Thompson organized. She was the granddaughter of Christian Barnard, who did the first heart transplant, and he was a sort of mentor to Tim, so that’s how everyone hooked up. Tim apparently was impressed with some of this fat stuff I was talking about in my presentation, and he used some of it in Real Meal Revolution, which was really flattering. He realized that a paper had been written by the Cochrane Group down in South Africa that had been trying to provide evidence against him so that they could then pursue this case on the back of this tweet. He got in touch with me and said, “This thing has been published, can you look at the paper for me because I need to find a floor in it to be able to take it down because they’re using it to take me down.”
I remember having to look at it, and then I dropped him a note back, saying, “At what point do I stop? I’m finding so many flaws. How many do you want?” And he’s like, “This is music to my ears. Just write one of your dissections on it.” I went back and said, “Right, there are 14 quite major errors.” We did a rebuttal to this paper, and then they came back and said, “We don’t like your rebuttal.” So we went back even stronger. When it got to go to court, Tim could just have backed down and said, “I don’t need this. I’m 60 something or whatever, I got a lovely wife, a lovely life, I’m going to retire soon anyway.” But he wanted to put the dietary guidelines on trial, and he got these two fabulous lawyers who said, “We’re going to do it for you on a no-win no-fee basis. We’re up for the fight.” It just snowballed from there.
Suddenly, he was saying, “Will you come over and be an expert witness?” He wanted Nina Teicholz to go over as an expert witness, and Caryn Zinn from New Zealand. I never met Nina, but I loved Nina. I loved her book. I felt like I knew her, but we hadn’t met. And I felt the same about Caryn. I was down there early because it was when they finished interviewing or interrogating Tim, I’m going to be on next, so I needed to be there for the whole two weeks. Every day I’m going in, and I’m having butterflies, my tummy’s churning thinking, “Oh, today is going to be the day.” And then it wasn’t. It was just horrendous. And then Nina came down at the end of the first week. So we all met for dinner that first evening, and Nina was like, “Tim knows everyone. He knows Eric Westman, he knows Jeff Volek, he knows Steve Phinney, why is it me, you, and Caryn?” I was laughing, and I said, “I asked exactly the same of the lawyers when I first met them. Why us three? We’re very flattered. The lawyer, I won’t say his name, who was coordinating the whole thing, said, “Let’s just put it this way. The judge is going to be much more impressed by you women than she would be by any men.”
Dr. Eric Westman: You were the angels.
Dr. Zoë Harcombe: We were the angels. She loved girl power, so she was running this tribunal. She turned out to be the most fabulous character, I think she and Tim have now actually become friends. But at the time, we had no idea. She was presiding over a completely objective, fantastic procedure. She was brutal if anyone was out of line, our side, their side. She was formidable. But her partner sat in the back of the courtroom each day, knitting, watching the whole proceedings. A courtroom in South Africa is not like a courtroom in London or maybe California. It’s not, “Quiet, please,” and we stand when the judge comes in – we have people going in and out and getting a bucket of popcorn and going back in and watching the next session. It was just hilarious.
Dr. Eric Westman: It’s important to keep in mind that this was a Professional Standards Court. It wasn’t a civil case where you pay money, or a criminal court where you would go to jail. It was basically battling for his license. Thank you, Professor Noakes, Caryn, and Nina for doing that. I had that same thought. Why didn’t he just brush this off? When we were there in Cape Town for the meeting, I got to meet him and his wife. I had 10 years of research and clinical evidence and then I borrowed a lot from Dr. Atkins, Dr. Eades, all these other doctors – I have to say that it was the art of it, I think, was the personal word of mouth that this (a low-carb or keto diet) is okay, this is going to be safe. Because again, it’s like we’re violating what everyone has taught us. In general, doctors are a pack mentality; you get called out if you’re too radical in medical school. So, he got exonerated, right? It took several years.
Dr. Zoe Harcombe: He had the complaint at the time we went down for the South Africa conference, but we didn’t know that then. I think a lot of pulling the conference together was actually Karen saying, “The Prof needs a bit of support at the moment.” They’d had some hearings, then I was down there with Nina and Caryn in October 2016. The judgment came out, and then, of course, the HPCSA (Health Professions Council of South Africa) appealed the judgment. The original panel was five people, so he had to get a majority. He had to get three votes in favor. It was 4-1 at the first hearing. They appealed again, and of course, the council could actually pick the judge, pick the panel, pick the charges, pick the venue. I mean, there is no way he should have won. For the appeal, I thought there’s no way he can win the appeal if they can pick everyone, and they only have to get two out of three this time to find against him, he’s not going to win the appeal. He did, incredibly, win the appeal. But the thing I would like to say, actually, is that we’re all really grateful to him, and he’s going to put the guidelines on trial. None of us should underestimate what they went through. Particularly Marilyn (Prof Noakes’ wife), because when your husband is being attacked in that way and he’s your universe, your hero, he went through four years of hell, that guy, and he put on a super brave face. He’s talked about it in conferences since and told it quite objectively, but nobody should underestimate what he was going through at that time.
I’ll leave on a funny note because the other really funny thing was when we were in this court session, you had a different room for each of the councils, so we would go back to the defense area, and they would go back to the prosecution area. We had these separate rooms, but we would walk past the lunch to get to our room. You would go to get your lunch, and then you go over to your room. They had their high-carb low-fat lunch, and we had ours the other way around, low-carb high-fat, and they kept coming over to see what our lunch was, and they were like, “Oh, this looks really nice,” because we think that looks really good. I know it must’ve looked so much nicer, it was all South African meats and yogurts and cheese and all the rest. I mean, ours was so much better, so they were all wandering over and seeing what we were up to, and I think a couple of people afterwards did actually start eating a little bit more like we did because we were all super slim, we were super healthy, we didn’t fall asleep straight after lunch, which they did. We were just energetic all day long, so we had an impact. We definitely did.
Dr. Eric Westman: Very interesting. Tim Noakes could have gone back to exercising and writing books on that, but no. Maybe it was that experience or just a new evolution, but I’m so proud that the Nutrition Network and his group came out with what is really the phenomenal textbook of carbohydrate restriction, it’s called Ketogenic. To put something like that into words is a heroic effort. I put together papers and small self-help books, but this was a great contribution.
As I am reminded, there’s no doctor in the U.S. that has been sued for promoting an Atkins diet. Correct me if I’m wrong. Dr. Atkins was sued once at the end of his career, but no doctor to my knowledge ever since, and I’m told that it’s because the U.S. system is a tort-based system – there has to be proof of harm. And so may all the people who are harmed by keto diet, low-carb diet stand up, please.
Gary Fettke went through a similar story. He’s an orthopedic surgeon who got tired of cutting off people’s toes and legs and said, “You know, why do people get this? It’s diabetes.” He started telling his patients not to eat sugar and he gets in trouble there. And great that you mentioned Belinda Fettke – that’s Gary’s wife – who then started sleuthing out the Seventh Adventist influence that even to this day influences the food in Australia. That was shocking to me.
Dr. Zoë Harcombe: That was a mama bear defending her husband, wondering who are these people who are going after my man, and why are they going after my man? She realized they’re all in bed with cereal companies. Of course they’re not going to tell you to have eggs for breakfast.
Dr. Eric Westman: I’m so glad you explained the politics at the courtroom in South Africa because I wondered why I hadn’t been called! I’m glad to know that people can go to your site to read the details of the trial. It was put into a movie, wasn’t it? A documentary film?
Dr. Zoë Harcombe: I did a presentation on it. It was all done and dusted by the time I got to the Denver conference in 2017. I remember saying to Jeff and Rod, “You’ve got me all the way over here from the UK, I’m going to do a half an hour on my PhD Dietary Fat Guidelines, do you want a half an hour on the Noakes trial?” That was a real hot topic at the time. They said yes. There’s a half-hour video. I do it in quite a funny way because I’m trying to mask the fact that this wasn’t funny at times.
Watch the full video here.