© Copyright – 2017 – Athletics Illustrated

In South Africa, a culinary-lifestyle called the ketogenic diet is sweeping across the country in a wave of popularity heretofore unseen. A veritable food revolution is going on and its Pied Piper is Dr. Tim Noakes, the likable and highly-respected research and sports scientist who delivered to us the famous athletics tome, The Lore of Running.

Dr. Tim Noakes

For example, some restaurants have changed their menus to cater to the whims of the dieters. Noakes sells out speaking engagements and has autograph seekers follow him around at public events, like Pilot Fish to a Great White Shark. They showed up to his trial where he defended himself in court for unprofessional conduct – a case he won after a lengthy trial versus the Health Professions Council of South Africa (HPCSA). He published a ketogenic book called the Real Meal Revolution, which is a number one bestseller.

The lifestyle (don’t call it a diet) is now sweeping across Australia and threatens to go global. Currently, in North America, the 100-plus-year-old diet has a growing cult following – you may remember the Atkins diet-fad of the late 1990s to early 2000s – it is based on the same principles, but Atkins was deemed unhealthy in the long run.

In athletic circles, there is talk of unbonkable performances. Noakes, for example, advises 24-time Ironman champion Paula Newby-Fraser and nine-time Comrades Marathon winner Bruce Fordyce among others. The lifestyle is gaining popularity in the elite ultra-running community.

Back in 2012, American Tim Olson, an apparently open low-carber won two 100-mile races including the gruelling Western States Endurance Run. In fact, in that win, he knocked 21 minutes off of the course record, finishing in 14:46:44. The record stands today.

In 2016, Jeff Browning won the Hurt 100 in Oahu and a few months later won the Free State 100K in Meriden, KS, setting a course record at the age of 44, all on a low-carb, high-fat diet. Browning’s regimen is not quite a fully ketogenic diet, more of a cycle-in and cycle-out process with consumption of 80 to 100 and up to 150 grams of carbs in a day when training – the heavier the training, the more carbs – but it is essentially a low-carb diet compared to the typical North American diet.

Then there is Sacramento’s Zach Bitter who owns the world record for the 12-hour run from his performance in the Desert Solstice Track Meet that takes place in Phoenix, AZ. He ran 101.66 miles (163.6K) in that time.

Bitter has won 16 ultra-marathons and finished top-three in four others. He owns eight course records, one world, and three American records, but it appears he is designed to run ultra-distances, for example, his marathon best is sub-elite at 2:31:45. He too is a low-carb athlete.

At first blush, it is a seemingly unconventional method by which to lose weight. It is considered a diet that improves performance for training or racing in ultra-long sports, as the human body can store much more usable fat in comparison to glycogen (blood sugar).

The diet, however, doesn’t come without its detractors. It may inhibit performances that require an intense effort, for example, cross-fitters, sprinters, middle-distance and perhaps up to marathon-distance runners may find that their top-end training and competing becomes impaired, which is a realm of intensity that ultra-runners may not get into.

Most or all scientific studies on sports performance while burning or attempting to burn ketones (not CHO) seem to fall short in regards to length-of-time of study.  Apparently, it takes three weeks or longer to teach the body to burn ketones instead of glycogen and longer – perhaps up to nine months – to become fully fat-adapted. During the intervening time, should the dieter interrupt fat-burning adaptation by eating carbohydrates, they will stall ketogenesis and have to start from the beginning* – the diet requires dedication.

The plan calls for very low-carbohydrate and very high-fat consumption with low-to-moderate protein and a low-to-moderate volume of fibre.

The diet is commonly referred to by its hashtag-friendly acronym #LCHF for low-carb, high-fat. There are more aggressive versions with similar guidelines known as the Banting, Paleo, Atkins, Ebstein and the ketogenic diet, amongst others.

In terms of percentages of macronutrients on an LCHF or ketogenic diet, it may look as per below but can vary greatly and according to Noakes, should be adjusted to suit the individual:

75% fats (from a variety of sources)
15% protein
5% carbohydrate (from above-ground vegetables – as low as 5grams/day)
5% fibre

Some foods that are highly recommended are avocados, coconut oil, full-fat cream, nuts, especially Macadamia nuts, cheese, meats, oils and above ground vegetables. Fruits, most berries, food products made with flour and or sugar are strictly forbidden.

Bagels, wraps, bread, cake, candy, pop, concentrated juice, ice-cream, crackers, chips, muffins, cereals, granola bars are all out.

What is old is new again

William Banting (1796-1878) was a well-respected carpenter and undertaker in Great Britain who also happened to be obese. Until age 65 (1862), he had tried the advice of many experts and physicians and each time he had tried their recommendation, he failed to lose weight. Banting all but gave up.

However, under the direction of Dr. William Harvey, an ear, nose and throat specialist, Banting went on a new diet plan that Harvey had devised to combat diabetes with inspiration from Frenchman Dr. Claude Bernard, who Harvey had listened to at seminars where he was a keynote speaker.

The diet eliminated all “sugar, starch and milk”. For the first time in his adult life, Banting had lost significant weight. It worked so well that Banting wrote an open letter to the public titled, “Letter of Corpulence”. It was a very popular read at the time and hence was born the Banting diet, but awareness of the diet ebbed away as wars caused rations and priorities to shift and practitioners including Harvey were ridiculed and derided to silence for their recommendations; much like the HPCSA attempted to do with Noakes 135 years later.

The diet came under much criticism. The banting diet existed on the fringes for 100 years until the 1990s when the name, as a verb, to Bant, began to be heard again.

During the 1960s and 1970s, the grain industry apparently lobbied the first world governments on the “benefits” of grain and carbohydrate oriented foods. During the mid-1970s food guides began to appear in New Zealand, Australia, America, Canada, South Africa and Great Britain. The guides extolled the virtues of flour-made products, sugar, grains, and fruits – carbohydrate-heavy foods. Fats became the enemy.

The lobbying and conflict-of-interest funding continue today. According to the American Journal of Preventive Medicine, Coca-Cola and Pepsi Co have either or both given money to 96 different health organizations including the American Diabetes Association, the National Institutes of Health, the American Red Cross, and the Academy of Nutrition and Dietetics. The full list is available here.

The dietician who went after Noakes for recommending a nursing mother to wean her baby onto LCHF – hence sparking the unprofessional conduct hearing – Claire Julsing Strydom came under scrutiny for her ties to the grain industry including most notably Kellogg’s, the breakfast cereal maker. Link:https://therussells.crossfit.com/2017/01/05/big-food-vs-tim-noakes-the-final-crusade/

Strydom was fighting Noakes’s LCHF recommendation based on what she was taught in school, just as North Americans were eating a diet that was prescribed by health professionals since the food guides were first published during the 1970s. Apparently, for at least four decades the governments, media and health professionals have had it all wrong.

In 1953, Dr. Ancel Keys, an American scientist, published a study comparing saturated fat consumption and heart disease in seven countries. The short story is that he cherry-picked his data from a set of 22 countries to confirm his hypotheses. It was called the Seven Nation Study and it is considered the catalyst for misinformation that followed since.

Keys “found” a correlation between saturated fats and cholesterol. Apparently, current science has proven that fats do increase cholesterol, but they increased the good HDL cholesterol in balance with the bad LDL cholesterol and within the LDL – low-density lipoproteins – there are two types: bad and not so bad. Apparently, the not so bad, more fluffy and light and less dense LDL cholesterol increases while the other decreases, a test for which isn’t often done, which the results of may even fool the family physician.

According to recent studies, it is refined carbohydrates that cause unhealthy blood profiles to do with cholesterol, not fats and certainly not saturated fats.

Three epidemics: type 2 diabetes, coronary artery disease, and obesity are currently waging war on human health globally. They are apparently caused directly by the over-consumption of carbohydrates and more-so refined carbohydrates, as well as processed foods. Apparently, sugar is the new smoking.

American physicist-turned-journalist Gary Taubes feels that when parents offer children refined sugar, they might as well be giving them cigarettes.

Apparently, Taubes is on a mission to re-frame the way we think about food consumption.

A study from the London School of Economics indicates that eating on conventional schedules, which means three meals per day (and up to six in some circles) and up to 2,500 calories is simply far too much volume; especially considering the average person’s sedentary lifestyle.

One only needs to search YouTube for the many seminars, interviews and TED X Talks from Drs. Stephen Phinney, Jeff Volek, and Tim Noakes amongst others to see that there is a science and medical community drive to change people’s eating habits away from what they refer to as a sugar addiction.

Noakes is not only a scientist and author; he is also a marathon and ultra-marathon runner.

Despite his knowledge and relatively high training volumes, Noakes carried extra weight around his middle. In his 60s he developed type 2 diabetes; something that simply should not have happened to him, based on his propensity for training and understanding of nutrition.

For over 40 years he loyally recommended a carbohydrate-centric diet, based on the South African food guide. Today, he lectures and speaks publicly apologizing for likely harming people over that time. He admits to being completely wrong. He has done a complete 180-degree turn on his dietary advice.

Noakes eats what is essentially a Banting diet – he would prefer if you called it Ebstein – and now has almost no symptoms of his diabetes and has lost all of the pesky extra pounds, in fact roughly 60 pounds in total. He claims his running performances are much better than they were 20 years ago, under the high-fat regime.  All was well for Noakes until he tweeted that dietary advice to a young mother.

In early 2014, when Pippa Leenstra was nursing her 13-month-old boy, her husband suggested that he wanted to try a diet that was currently sweeping South Africa, which was the LCHF plan.

On February 3 Leenstra asked Noakes about the low-carb, high-fat diet by tweeting him, “Is LCHF eating ok for breastfeeding mums? Worried about all the dairy + cauliflower = wind for babies??”

Noakes replied: “Baby doesn’t eat the dairy and cauliflower. Just very healthy high-fat breast milk. Key is to ween baby onto LCHF.”

Strydom, who was the head of the Association for Dietetics saw the tweet and subsequently lost her cool.

Strydom suggested that Leenstra phone her for “evidence-based advice.”

A Twitter war was born as Strydom, at that time, told Noakes, “You have gone too far, be sure that I will be reporting this to the HPCSA.”

The Health Professionals Council of South Africa subsequently charged Noakes with violating medical ethics by giving unproven medical advice on Twitter.

He was charged but was found to not have violated professional conduct in the spring of 2017. It proved to be a long and exhausting case, but he was vindicated in the end.

On athletic performance

The body stores much more fat than it does carbohydrates (CHO). Glycogen or blood sugar-dependent athletes run out of fuel much sooner during sub-maximal distance exercise than do so-called fat-adapted or ketone-adapted athletes.

There does, however, appear to be a price to pay for the no-bonk performance benefits: loss of V02max, to the tune of 5%

“In short, for high-intensity exercise, we know the carbohydrate is the dominant fuel, and it’s been known since Nobel Prize winner Prof. August Krogh published in 1920 that 100% CHO oxidation during exercise is ~5% more efficient than 100% fat oxidation (in other words you will produce ~5 more energy per L of oxygen consumed),” shared Canadian physiologist Trent Stellingwerff, who works with Canada’s best middle and long-distance athletes in various sports.

“Even a small shift towards CHO oxidation during a race might improve a 2:10 marathon time in the order of 60 to 90 seconds! (which for an elite athlete is big).  So, IMHO, any sport that requires a large amount of energy, quickly and efficiently, is much better served through CHO oxidation than fat oxidation in elite athletes during competition.”

But for elite athletes running up to at least the marathon, according to Stellingwerff, one will still need CHO.

“Ketogenic diet will probably decrease ELITE performance all the way past the marathon, not just mid-D.  As for elites, the marathon is still run at 85 to 90% of VO2max or >90 to 95% CHO oxidation, and running economy/efficiency is highly correlated to marathon performance,” added Stellingwerff.

Stellingwerff isn’t the only exercise scientist who is not sold on the ketogenic diet. Ross Tucker, publisher of The Science of Sport website doesn’t like Noakes’s sudden shift away from the scientific process.

“He [Noakes] has abandoned science,” says Tucker.

Tucker is a well-respected scientist who ironically studied under Noakes.

“I feel like he’s drifted away from his rigorous way of thinking and started adopting these increasingly indefensible methods. Hypocrisy, double standards, and cherry-picking—it’s all a bit disappointing,” Tucker told Outside Magazine in 2016.

For ultra-distance and recreational athletes, a low-carbohydrate, high-fat diet seems to be an effective method to avoid the dreaded bonk in prolonged bouts of sub-maximal exercise. For people looking to lose weight, an LCHF plan seems to also be very effective and highly recommended, but not if you are a high-performance elite athlete.

SHOESTRINGS: The ketogenic or LCHF diet plan may sweep through North America in a wave of popularity soon. There is good science to back up the plan if one is willing to stay on it and not yo-yo diet and are not aspiring or elite athletes.

There is preliminary research indicating that not only will a low-carbohydrate, high-fat lifestyle improve your chances of avoiding coronary artery disease, type 2 diabetes, and obesity, it is also an effective way to reduce symptoms of childhood epilepsy and research is currently taking place to see if purported benefits to avoiding or reducing Alzheimer’s, Parkinson’s and Dementia symptoms are valid.

Watch for more science to come out in the near future on the LCHF lifestyle, as the demand for information escalates.

*There are some indications in some studies as well as anecdotal information observed by practicing athletes that when fully keto-adapted and training for over one hour, CHO supplementation (after the first hour) to 30-50 grams can be added to boost performance. Apparently doing so, will not – in this specific case – knock the athlete out of ketosis.