The role of sugar and carbohydrates in ill-health

By Dr. Mercola

Dr. Tim Noakes, a well-respected scientist, researcher, physician and professor at the Division of Exercise Science and Sports Medicine at the University of Cape Town, South Africa, is one of the world’s foremost experts on low-carb diets. In fact, he was instrumental in getting the low-carb diet revolution off the ground.

He’s also an accomplished athlete. As a long-distance endurance runner with 70 marathons under his belt, he had long promoted high-carb diets, himself consuming 400 grams of carbs a day or more when preparing for a race.

Eventually, he discovered this wasn’t the best way to improve athletic endurance and health, and ended up writing a number of popular books on low-carb diets.

From High to Low Carb

Noakes graduated from medical school in 1974. At the time, he was also running, and this was when the high carbohydrate diet really started to become popularized.

Following the advice of one of his professors at the cardiology unit where he worked, he changed to a high-carb diet and began promoting it in his writings, including the book, “Lore of Running,” which was widely read.

“There it says that you must eat lots of carbohydrates for both health and performance. I continued to do this for 33 years until 2010,” Noakes says.

One day in 2010, he went for a run and had one of the worst runs of his life. He also admitted he was overweight, which didn’t help. By chance, that same day he received an advertisement for Dr. Eric C. Westman’s book, “The New Atkins for a New You: The Ultimate Diet for Shedding Weight and Feeling Great.”

It claimed you could lose 6 kilos (13 pounds) in six weeks, which he didn’t believe because he’d tried many diets and none worked. Despite that, he bought the book, and within two hours of reading, he realized he’d had it all wrong all this time.

“I decided then and there that I was going to go low-carb. I started at lunchtime on that day. I’ve been on that diet now for the last six years. I’ve dropped 20 kilograms (44 pounds) in weight. My running returned to what it had been 20 years earlier,” he says.

“I subsequently discovered that I have type 2 diabetes because of a strong family history and all these carbohydrates. But I’m glad to say today all my blood tests are within the normal range. I am taking medication. But … in six years with diagnosed diabetes, I have not worsened.

In fact, I’m probably slightly better than I was six years ago, which is completely contrary to what would happen if you followed conventional advice. Anyway, I decided that I’d start reading. I read all your work. I read all the books. I started doing research.

That convinced me that this is a really important change that we need to promote throughout the world. Clearly, the diabetes and obesity epidemics started in 1977. It’s caused by the dietary guidelines. I slowly began to understand [how] industry has driven the bad guidelines …

I also do intermittent fasting. I only eat between lunchtime and … 8 p.m. … I found that that’s been really helpful. It’s about a 16-hour fast and an eight-hour period where I eat.”

Diet Revolution Leads to Legal Wrangling

In 2013, Noakes published “The Real Meal Revolution: Changing the World, One Meal at a Time,” which turned into the best-selling book ever in the history of Southern African literature. The success of this book produced major changes in dietary understanding in Southern Africa.

Alas, its success also led to legal action being taken against him by the Health Professions Council of South Africa, which is a professional medical licensing and regulatory board. The action came after he posted low-carb advice to a pregnant woman on Twitter.

As a result, the president of the Association for Dietetics in South Africa wrote a long letter to the Health Professions Council, challenging his ability to practice medicine.

“It is so bad that my own university dissociated itself from me,” Noakes says. “At my hospital, Groote Schuur Hospital, you are not allowed to prescribe a low-carbohydrate diet for any condition. You’re not allowed to discuss the diet among the doctors.

If you do practice it or if you were to prescribe it, something would happen to you. That’s how strong the movement against it is. It’s absolutely astonishing. The worst bit for me actually wasn’t the trial and being accused of malpractice and so on. The worst bit was my university.

The dean of medicine wrote to the local newspaper and said they dissociated themselves from my views and all those who support the low-carbohydrate diet.

Of course, they had no evidence for it, but here I’d worked at this university for 35 years or so, and was one of the better-known scientists. That they could do that was absolutely astonishing. But … it does seem that industry was strongly involved.”

Overwhelming Evidence

During the hearing, he presented five and a half days of testimony about the low-carb diet. He was also cross-examined for three and a half days. Then for another three days, expert witnesses were heard, including Nina Teicholz, Zoe Harcombe and Caryn Zinn, all three of whom presented a remarkably sturdy case for its use.

“For example, when Nina — [who] wrote the book ‘The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet’ — when she finished, the lawyer for the prosecution could not cross-examine her.

He just threw up his hands and quit. He didn’t have anything to say. Zoe Harcombe was the same. She has just completed her Ph.D., showing there was never any proven evidence to change the dietary guidelines in 1977.

She presented her Ph.D. thesis. Again, the evidence is absolutely overwhelming. The end result is that we’ve had 23 days in court so far, and we won every single moment for 23 days.

We won everything. They have not been able to pin one thing on me. I think it’s the first time in history that a diet has been put before a legal jury to decide whether or not it’s true.”

The final decision, more than three years after the Tweet was posted, was that Noakes was found not guilty of misconduct.

It remains to be seen whether the health professional council, the statutory party that took action against Noakes, will have to change their nutritional guidelines and update all nutrition and dietetics teaching in South Africa. As noted by Noakes, “That could be a huge moment for South Africa and perhaps for the rest of the world.”

Corporate Influence

At the request of CrossFit founder Greg Glassman, investigative journalist Russ Greene visited Noakes in South Africa. He went through all the transcripts of the trial, and then began digging into the backgrounds of all the expert witnesses testifying against Noakes. Most of them turned out to be linked to an organization called the International Life Sciences Institute (ILSI), which is a Coca-Cola funded organization.

ILSI is basically a front-group for the beverage industry, and has links to Monsanto, Pfizer, Unilever and, in the past, the tobacco industry. Green wrote an exposé, “Big Food vs. Tim Noakes: The Final Crusade,” which is posted on his website, therussels.crossfit.com.¹

“It’s an amazing exposé, which suggests there was a coordinated effort in South Africa to bring me [down] and that it was driven by industry. The reason was we were getting too close to questioning the role of sugar and carbohydrates in ill health. We haven’t proved it, but there’s enough evidence out there to suggest there were things behind the trial that one would not have thought about,” Noakes says.

Beverage Industry Hurt Athletes With Manipulated Science

This isn’t the first time Noakes has taken on big industry. In 2010, he published “Waterlogged: The Serious Problem of Overhydration in Endurance Sports,” a book exposing how industry influences science, and how the beverage industry has influenced the drinking guidelines for athletes.

He wrote the book because he was angry about people being hurt as a result of these manipulated guidelines. While rarely discussed, exercise-associated hyponatremia — drinking too much or overhydrating — actually contributes to many unnecessary deaths. Noakes explains:

“When I started running marathons in the 1970s, we didn’t drink during races. In fact, I ran a 56-mile race and I think I had four drinks. You’d have a drink every hour and you would literally swirl your mouth out with water and that would be about it. No one came to any harm. Then in about 1974 I began actively to promote drinking during marathon races. I became very active in South Africa saying there was not enough fluid available to marathon runners …

By 1981, the race … had a drinking station every mile. They had 56 drinking stations in a 56-mile race. At the end of that race, a lady was unconscious. She was hospitalized … Her blood sodium concentration had fallen. She wanted to know what had happened. She said, ‘Maybe I took too little sugar or salt during the race. What should I do about it?’ I said, ‘I have no idea.’

I then decided to investigate. Over the next 10 years, we were able to show that … she had overdrunk fluids. She’d retained the fluids, [which] caused her brain to swell, [causing] her to go unconscious. She’d remained unconscious for four days. We provided definitive evidence that it was overdrinking that caused the problem.”

In 1993, the first American marathon runner died from overhydration. Still, in 1996, the American College of Sports Medicine, funded by Gatorade, produced new drinking guidelines stating that dehydration is the killer when you exercise, and you should drink “as much as tolerable” during exercise.

Other deaths followed, all of which were completely unnecessary. In 2002, a young female runner died shortly after completing the Boston marathon. Cause of death: water intoxication. As recently as last year, two American football players died from overhydration. An estimated 3,000 athletes have also been hospitalized for hyponatremia, but fortunately almost all have survived. Yet, there have been at least 16 completely unnecessary deaths of which we are aware.

How Industry Controls Information

Finally, in 2007, the American College of Sports Medicine revised their guidelines to what Noakes had suggested, which is that you should drink to thirst.

“It took a lot of time to change. The only reason we could change was because two scientific journals in the entire world were independent of the sports drink industry. [The] industry … makes sure its key opinion leaders, who have funds to do research, also happen to be the people who draw up the guidelines, whether they be dietary, cholesterol or drinking. In addition to that they are the main reviewers of journal articles.

Over a 10-year period, we would submit papers and I knew they went to exactly the same reviewers every time. It didn’t matter which journal we sent them to … But there were two journals that were independent, the British Journal of Medicine and the Clinical Journal of Sports Medicine. They published our work. I always knew that if there were two journals open to our papers … we would win in the end. In the end, we did win, because in the end all that matters is the truth.

But if those two journals had also been controlled, if they’d had the same editorial boards, we wouldn’t have ever done it. That was how I learned that is how industry controls information. They actively do it. They actively support people to make sure that only guidelines that benefit industry are ever published.”

With Fewer Carbs, You Don’t Need Insulin

One of the absolute worst things conventional medicine does is treat type 2 diabetics with insulin. This only exacerbates the problem. The key to treating and reversing type 2 diabetes is to cut down on net carbs, replacing them with high amounts of healthy fats and moderate amounts of protein. Noakes has researched reversal of type 2 diabetes in South Africans, coming to the same conclusion.

“It seems to me that provided you remove the carbohydrates, you don’t need the insulin,” he says. “We’re looking at the whole body … [W]e’re looking at every organ in the body that we believe has been influenced by type 2 diabetes.

We’re seeing how they differ in people who reversed their type 2 diabetes on this diet, versus those who continue to be treated with standard therapy, including insulin … [This has] not been done anywhere else in the world. It’s just the most exciting work I can think of.”

Removing net carbs is only one side of the equation, though. That will reverse the insulin resistance, but equally important is having the ability to burn fat as your primary fuel. Paradoxically, driving your insulin level too low can result in a rise in blood sugar. The reason this can happen is because the primary function of insulin is not to drive sugar into the cell, but to suppress the production of glucose by the liver (hepatic gluconeogenesis).

In situations like this, eating a piece of fruit, for example, will actually lower your blood sugar. This is what happened to me, as I went a bit too extreme in my ketogenic approach. That got me to explore this whole process, eventually concluding that continuous ketosis may not be a wise long-term approach.

You actually need this cycling, where you go through a one-day-per-week fast and one or two days a week of feasting, where you eat maybe 100 or 200 grams of carbs. Noakes is planning clinical trials with type 2 diabetics where they will be looking at these kinds of variations.

Are Carbs Bad for All Athletes?

It’s worth noting that some athletes may not perform at their best on a ketogenic (high-fat, low-carb diet). I believe that if you’re doing ultra-endurance events like marathons, the ketogenic diet is the way to go. But for high-performance spurt, interval types, it might not be your best bet. It’ll help you from a health perspective, but it may not optimize your performance like it will for long-distance running. Noakes weighs in on the topic, saying:

“I say the ideal diet for sports is the one that’s ideal for life as well … I spent 20 years of my life studying glucose metabolism in the body during exercise. The question I want to know is, how can adding a little bit of carbohydrate make you run faster? For example, if you ingest carbohydrate during exercise, because you’ve got plenty of fat on board, why would you need a little bit of carbohydrate?

To some extent, I think the carbohydrate effect is a drug effect, particularly during exercise. If you’re taking carbohydrates, I think it’s acting like a drug, because metabolically, I can’t see how it would make any difference. It’s really interesting.

When we do these studies, we take people on high-carbohydrate diets and we put them on a high-fat diet. The performance does come down. But I wonder to what extent, as to the withdrawal of the drug effect as much as a metabolic effect … I think even if you’re cycling the Tour de France, you don’t need more than 200 grams of carbohydrate a day.”

Insulin Resistance Is the Real Killer

According to Noakes, “[I]nsulin resistance is the real killer and … we need to understand that … [the] main driver [of chronic disease] is insulin resistance and a high-carbohydrate diet.”

Unfortunately, most medical schools around the world still do not teach medical students about insulin resistance, and one of the primary reasons for this is because medical schools are strongly influenced by the food industry, which wants you to believe that eating fat is dangerous and eating sugars and grains (net carbs) is healthy.

Neither is true, but these ideas are driven by financial motives. We need to remember that diabetes is one of the greatest growth industries in the world. If it can be reversed or prevented by a relatively simple dietary change, then that industry collapses.

“What I would like to dedicate the rest of my time to is trying to get medical schools to change the focus of the teaching of nutrition and to admit that we failed by telling people to eat a high-carbohydrate diet, and that we have to replace that with an understanding that carbohydrates and insulin resistance are the problem. The broad range of diseases that we see is linked to that,” Noakes says.

“There’s a paper in the Journal of American Medical Association … Chinese people with diabetes were compared to Chinese people without diabetes. The risk for all the common chronic diseases was two to three times greater. It was frightening. There wasn’t a condition that wasn’t listed there.

We have to realize we’re heading toward a disaster because we don’t understand that you must treat insulin resistance with a low-carbohydrate diet. Unless we do that, we’re not going to address the health of our nations … We used to be very lean. That’s what we’re designed to be. We have to somehow get back to that original state, because humans are … not designed to be fat.”

Sugar Addicts Are Particularly Intolerant to Carbohydrates

While I believe limiting protein is just as important as cutting carbs, Noakes believes restricting carbs is the primary key for diabetics. As for how much carbohydrate is too much, we agree that an ideal limit for health is 25 grams of net carbs per day. My recommendation for diabetics is stricter than his, however, as I recommend a maximum of 15 grams of net carbs per day until your insulin resistance is resolved.

Noakes suggests a range of 25 to 100 grams, depending on your levels of exercise and of insulin resistance, with 25 grams being the maximum for those with marked insulin resistance/Type 2 diabetes. He also notes that people with sugar addiction or carbohydrate addiction who are morbidly obese tend to be incredibly intolerant to carbohydrates, and need to be particularly mindful not to exceed 25 grams of net carbs.

“The people that I’ve helped lose 80, 100 kilograms, that’s 160 to 200 pounds, they literally cannot eat 26 grams of carbohydrates. They have to stick to 25. Once they get up to 50 grams … they move back toward the addictive nature,”Noakes says.

“They start to eat more carbohydrate, and very quickly, they’re eating 100, 200, back to 400 grams. People don’t understand that if you have a real weight problem and you’re morbidly obese, you’ve really got to be strict 25 grams and no more. I think it’s the same with type 2 diabetes. You’ve got to stick to 25 grams.”

Dr. Noakes was one of the experts I sought to help edit my new book “Fat for Fuel” for accuracy. Unfortunately, he was in the middle of his trial and could not edit it. However, there is little doubt in my mind that “Fat for Fuel” is the finest resource you can obtain to give you the practical details of how to implement the strategies that Noakes discusses.

To Learn More, Join Me at My Upcoming Live Lectures

There are many professionals or others who would like to dive deep into the details and if you fall in that category, I want to offer you some opportunities to learn more. On June 14 and 15, 2017, I will be in Colorado Springs for the SopMed’s third medical ozone and ultraviolet light therapy training. The 14th I will be giving a three-hour course that goes into many of the details that are not discussed in my new book “Fat for Fuel,” either because I learned of them later or there was not room to fit them in the book.

If you are specifically interested in nutritional ketosis, there will be a large number of experts lecturing at the Low Carb USA event in San Diego August 3-6. I will be one of the speakers along with Gary Taubes and Stephen Phinney. You can see the entire list of invited speakers lower on the page. The Early Bird Special, which saves you $100 on the ticket price, ends on April 30.

I am also speaking in Florida in November. If you are a physician and are interested in learning about how you can use the ketogenic diet and other therapies for cancer, heart disease, Lyme and neurodegenerative diseases like Alzheimer’s and Parkinson’s, please be sure and come to our ACIM conference in Orlando, Florida on November 2 through 4 at the wonderful Florida Conference and Hotel Center.

If you are a patient, there will be a separate and less expensive track on the same date and location.  However, you will need to come back to this page in a few days as the registration page for the event is still not up. The Early Bird Special, which saves you $100 on the ticket price, ends on April 30.