Common Themes: The Chef Evans & Prof. Noakes Controversies, and Robb Wolf vs. North Carolina

As I found myself debating whether to tackle which controversy to publish up first, I kept running into trouble with some background and tangents to discuss one, that really could apply to either case.  And then my good friend [sic] Robb Wolf wrote a blog post about a proposed North Carolina law that seems pertinent as well.  So I'm going to write a post on the commonalities, and then, as time permits, a separate followup post for the Pete Evans and Tim Noakes controversies that raise some similar but distinct issues.

For those who are not aware of what has transpired recently, allow me to summarize:

Pete Evans

Pete Evans is a celebrity chef in Australia who has become popular through cooking shows and such much like Gordon Ramsey or many of the Food Network stars in my country.   Evans has apparently been into nutritionism for some time (activated almonds anyone?), but as recently as 2012, Pete was writing popular cookbooks on making healthy pizza ... (and I'm not talking the cauliflower crust with cashew cheese sort either).  But then Pete caught the paleo bug and has launched The Paleo Way -- an endeavor whole heartedly supported by one Nora Gedgaudas who is somewhat of an icon for some reason in the IHC. Pete teamed up with Charlotte Carr, an Australian actress and voice-over artist and wife of Austrailian Idol winner Wes Carr.  According to her bio, Charlotte is educated in "holistic nutrition" through the Institute of Integrative Nutrition -- an MLM-type online "certification" body with no formal academic credibility where you can learn about every-diet-out-there-known-to-the-modern-world-no-matter-how-whacky ... including paleo  (seriously, this is their sales pitch).  Pete Evans himself is certified by the IIN as a health coach ... I'm sure you're all impressed.

So Charlotte had some issues when her son was born and apparently turned to naturopath, nutritionist and medical herbalist Helen Padarin for help.  Another person involved was Anthia Koullourus  who adapted a DIY liver based baby formula from one developed by the late Dr. Mary Enig of the Weston A. Price Foundation.  Indeed a similar recipe was included in Enig's book co-authored with Sally Fallon Morrell, Nourishing Traditions.  That recipe that can also be found here.   I'm not quite sure why the original didn't raise any eyebrows to date, except that there are a number of key differences (omitted ingredients), and it's a different time, and more mainstream popular advocates bring scrutiny.  So Pete, Charlotte and Helen wrote a book:  Bubba Yum Yum The Paleo Way:  For New Mums, Babies & Toddlers  and they included the liver-based formulavin the 0-6 Months Section.   Along with Charlotte's story, it specifically states:  This formula mimics the nutrient profile of breast milk.  Only it most certainly does not (as I'll discuss in the post on this issue).  This prompted the Dietitians Association of Australia to issue this Media Release expressing concerns over the formula largely centered on potential excesses of certain vitamins.  After temporarily delaying release of the book, the publisher Pan Macmillan has, I believe, nixed the deal altogether and it may be released independently as an ebook or somesuch.  

This has been somewhat of a not much needed disaster for the "paleo label" that may finally be crumbling under the weight of its enormous collective ego supported by a foundation with so many cracks it's amazing it lasted as long as it did.   But many have reflexively jumped to defend the book ... after all, what could be the harm of real food?!   Plus the WAPF-inspired anti-veggie gang is strong here, despite the fact that this is not the issue.  But there are some very real issues here as this is not just a recipe, but one that is being "sold" as a substitute for breast milk.  Claims are being made regarding avoiding or curing autism.  Where should the line be drawn here on such things?  

Tim Noakes

Silly me for not addressing Noakes phenomenon much sooner, but I really thought that everyone was so over the low carb gimmickry that surely nobody would take Banting seriously.  Ahh, but I was wrong.  They don't have nearly the markets of the US, but it seems that what was over long ago here in the States, or has at least waned significantly since the hay days, has found new life in the land down under and now in South Africa.  Professor Tim Noakes carries with him a degree of name recognition and prestige owing to his contributions to exercise science and running.  Recently, apparently, Noakes has had an epiphany of sorts and is now going around promoting his own brand of LCHF.  He makes no bones about this being low carb and high fat through his book The Real Meal Revolution.  I don't know about all of you, but I'm already sick of the #realfood hashtag/mantra ... as if rice and beans aren't real food.  Sigh.  But I digress.  

So in TRMR Noakes makes many of the same bold claims as some who have hijacked the paleo movement -- that our ancestors ate a high fat diet.  Starches and  fruit (except a few low sugar berries) are off the menu, and you are cautioned to not eat too much protein.  Non starchy veggies are allowed and encouraged, as are -- curiously -- processed meats like salami.  This by necessity is a very high fat diet -- 60% if you don't limit protein, likely in the 70+% range of fat if you heed the caution not to eat too much protein.  Also, non-starchy veg are generally so low in calories and carbs that the diet is not likely over 10% carb.  

So Noakes is in trouble with the The Health Professions Council of South Africa (HPCSA) for a tweet he sent out, apparently around a year ago counseling a woman to wean her child onto an LCHF.  I cannot find that exact tweet but have come across a few I'll try to link up in my dedicated post.  There appears to be some confusion over the age of the child.  I've seen six months which would be far more critical, and 18 months which would be less so but still concerning.  The issue really is one of propriety.  And it is a gray area, because IF one presumes a position of authority -- recognized by an accepted governing certification/licensing body or not -- then what is their liability for the advice they give on any sort of individualized basis?  

So again, I'm going to discuss particulars in a separate post, but Noakes is boldly stating that #LCHF is good for weaning babies, and he does so from a position of "authority".  To his credit, Noakes goes by Professor, which is what he is, even though his Wikipedia bio (and Facebook page) show him as an MD = Doctor.  He has not, at least to where I can discern, ever clinically practiced medicine.  And yet, unknowing people may well assume otherwise.    So here's the issue pertinent to this post ... What are (or should be) the rules/guidelines for giving out advice on the internet?  The issue for Noakes is this, not free speech or whether or not a bunch of people have achieved some measure of success "Banting".  By far and away the majority of #WeSupportTimNoakes hashtaggers are posting before/afters of their adult weight loss as if that has ANY bearing on whether such a diet is appropriate for children.

Who is Qualified to Give Nutritional Advice:

Anyone who ever ate food according to some!  I spend a fair amount of time discussing credentials from time to time here, because they are ultimately important.   At some point this really does reach that fuzzy gray area where you probably can't, and likely realistically shouldn't attempt to do anything about it besides debunking the person.  Food Babe comes to mind.  I don't think there's a law that could stop someone like her that would be enforceable without considerable unintended (negative) consequences.  But the proffering of medical and nutritional advice on the internet has gotten very out of hand.  It seems that the very folks you WOULD seek responsible advice from have their hands tied by having to abide by laws and guidelines of their licenses to practice.  Meanwhile those who aren't licensed in some fashion, are free to go about "coaching" and such without any regard to the law so long as they have a disclaimer.  

So there you have two graduates from the Institute of Every Fad Diet Ever Nutritionism Integrative Nutrition and a naturopath taking a recipe of unknown origin -- was it even developed by Enig? -- from an organization with no living scientific leadership (Daniel's diploma mill PhD notwithstanding), having that tweaked by another naturopath, who thought it a good idea to just take out one of the macronutrients entirely, and include it as a breastmilk equivalent in a cookbook?  Then they claim it cures or prevents autism.  Ummm....  Meanwhile, Noakes is running around claiming that Banting (sic) cures diabetes as he continues to manage his manifest disease with a rather high dose of metformin (compared to doses reported in many clinical trials).  But he makes matters worse by extending his "no dietary need for carb" dogma to infants?  Just how irresponsible should someone with an MD (whether or not they practice) and other related degrees be allowed to be before their conduct is brought into question?   Is it worse or better that he has some relevant credentials?  I'm not sure anymore.

What I do know is that I have many friends with legit medical degrees/practices who are frustrated with the amount of practicing of medicine going on out there by chiropractors, accupuncturists, and naturopaths ... oh, and the latest, the PharmD's.  It is astounding how many "Doctors" are chiropractors and naturopaths, not to mention PhDs in what may or may not be relevant disciplines.  Even if you have a doctorate in the field, it is misleading to don the doctor coat when you are not a physician (and likewise doctors need to stop pawning themselves off as scientists if they have zero research experience).  I also believe there needs to be an expiration date on MDs who never practice clinically.  Hey, I can dream, can't I?  

Churchill said that democracy is the worst form of government, except for the other forms that have been tried.  I'd say we could extend that to medicine/health -- that regulation and licensing are the worst form of "governing", except for the other options.  What are those?  No regulation?  No licensing?  

So on that backdrop, I bring you Robb Wolf's latest whine.  But first, some background.  In 2012, a diabetic named Steve Cooksey got himself in a bit of hot water with the powers that be in North Carolina.  To hear Cooksey and his supporters tell it, this was all about free speech and the mainstream attempting to grab and maintain power over people's lives and health choices and shut down his blog.  It wasn't .  For all the issues people have with Big Pharma, can you imagine if there were not all the safeguards in place?  I mean drugs get pulled from the market for unforeseen complications.  Clinical trials can only last so long and are often done in targeted populations on people taking no other medications.  But we know about these things and if drugs aren't pulled they carry warnings, etc.  Not so with supplements ... where half the time you cannot be sure you're even getting what you think you are, or proprietary blends mask the dosages of individual ingredients.  One of the reasons I am supportive of Examine.com is that they have compiled the limited human trials on some suppements and herbals and such so that consumers can make educated choices rather than rely on claims made by financially vested marketers.  

Cooksey was diagnosed with Type 2 diabetes secondary to obesity.  He apparently went on a low carb diet, lost weight, got off meds, and became a "warrior" for the cause.  He started a blog, rails routinely against the ADA and "standard advice" to diabetics all the while touting his own experience as proof.  There are seemingly hundreds if not thousands of similar success stories, of which in all the internet you have a handful of verifiable long term successes.  What Cooksey did was try to  capitalize off of his success by turning advocate and *compensated source* of one-on-one nutritional advice.   What he did not do was go out and get himself the training and license to do so.  You see this is the difference I see between Cooksey and, say, the various and several people who have lost weight on The Biggest Loser and then go out to get training and certifications to be personal trainers.  I cannot just open up a restaurant, gym, massage parlor or hair salon because I've learned how to cook, build my biceps, give a good back rub or style hair in my spare time.  Right or wrong that just is what it is, and why anyone would accept less for matters of health is beyond me.  

Here's what really got Cooksey in trouble:  State Threatens to Shut Down Nutrition Blogger.

Jan. 12, Cooksey attended a nutrition seminar at a church in Charlotte. The speaker was the director of diabetes services for a local hospital.

“She was giving all the wrong information, just like everyone always does — carbs are OK to eat, we must eat carbs to live, promoting low-fat, etc.,” Cooksey said. “So I spoke up.”

After the meeting he handed out a couple of business cards pointing people to his website.

Three days later, he got a call from the director of the nutrition board.

“Basically, she told me I could not give out nutritional advice without a license,” Cooksey said 

Had he not been so brazen as to hand out business cards, I doubt the board would have bothered with his website.  And yet his website is more than just a "this worked for me" thing and clearly veers into one-on-one advice per this marked up commentary.  Feel free to provide links in comments to the eventual resolution to this, but clearly the state of North Carolina is looking to add more clarification and teeth to its licensing laws.  This is not going over well with Robb Wolf.

Academia clearly has it’s place, although I am continually pushed to define or understand exactly what that role is other than protecting hegemony. I put much more faith in markets, self-experimentation and outcome based medicine. That position absolutely FREAKS OUT anyone who is an entrenched academic. Well, tough. Dietetics, as it is currently practiced, is an appalling failure. An auto-mechanic who understands the rudiments of ancestral health is more valuable to our populace than 10,000 RD’s who promulgate the same tired crap. To some degree, this is exactly what is happening. The old guard is getting crushed in a market-based sharing of information and their only response is to make a political/legal power-grab. NOT change their broken, archaic methodology. instead, they work to create a legal barrier that prevents people from sharing simple solutions to complex problems.

Really?  So the purpose of having an RD as a ringleader -- who had to abandon the diet in order to reverse the life-threatening anorexia it re-triggered unbeknownst to the ever-clued in genius Wolf (who had NOOOOOO idea it was occurring right under his nose) -- is what exactly?   This is a self-proclaimed expert in paleolithic nutrition who could not give you a synopsis of the diet he advocates -- the one that cures all these diseases and whatnot as boasted on his website -- if you asked him.  Such is his disdain for academia, but not so much so that he doesn't brag on being a "student of Loren Cordain's".  For the record, I have not seen anywhere that Cordain instructed a class in paleolithic nutrition.  His field was exercise physiology.  If Robb ever took a nutrition class during his brief attempt at graduate school it was of the sort that his PaleoRD took.  These rudiments of ancestral health are MOSTLY LIES as far as I can tell ... I've yet to investigate a claim about an ancestral culture or dietary practice touted by these self-appointed experts that has proven to be mostly correct instead of mostly wrong or an outright fabrication.

For all the "insiders" in medicine and academics, paleo and low carb have failed to make significant inroads into the mainstream because the science simply isn't there.  Wolf has basically stretched his thin resume to the breaking point many times.  By his own admission he was a lab tech for a lab that ran cholesterol panels, and perhaps another that serviced a cancer treatment center.  This translated to "cancer researcher" and "lipid specialist" in past bios and boasts.  He talks a big game about pouring over lipid panels of the Reno911 and counseling some woman in treating her glioblastoma.  Seriously?  No wonder he's scared of this law, if this is really true!  But fear not, unless he's charging a fee or further misrepresenting his credentials, because counter to what his heroine Laura Combs interprets, he's likely safe.

Here is the actual proposed law.  It's long, but please read it.  They are merely stating what I would consider to be reasonable:  You need proper training and licensing to practice medical nutritional therapy.  Folks can still get around this by becomeing "life coaches", "wellness coaches" etc., but no more tantric holistic nutritional detoxification practioners who graduated from the Sanfilippo 21 Day Detox school.   Combs alerts!:

If you used Dr. Natasha Campbell-McBride’s GAPS diet or another food healing path for your kids, you will be breaking the law if share your food strategies with others because you will be offering “Medical nutrition therapy. – The provision of nutrition care services for the purpose of managing or treating a medical condition.” and you are not licensed to do that.

This is a very specific case that may be technically true, but there are giant loopholes whereby changing one or two words here dash the hysteria to the ground.  Beginning on Page 9 Line 32 SECTION 13. G.S. 90-368 reads as rewritten: 33 "§ 90-368. Persons and practices not affected. 

The requirements of this Article shall not apply to: ... jump to Page 10 Line 29

Medical Nutritional Therapy is defined on Page 1 Line 35 Section (3a) as:

The provision of nutrition care services for the 36 purpose of managing or treating a medical condition.

I'm OK with that.   Technically a GAPS parent is OK with sharing with family members, but also technically not with a friend.  However this would prevent a parent from publishing advice for treatment of a medical condition.   Again, I'm OK with that.  There is nothing stopping that parent from guiding their friends and others to licensed individuals who deal with alternate therapies.  That's the key here folks.   Given current laws and enforcement in medicine, there appear to be enough loopholes in the above to give a lot of leeway to those who don't hold themselves out as licensed.  

This "Medical Nutritional Therapy" is a dicey term.  Where do we draw the line?  For example, ketogenic diets are widely accepted for treatment of epilepsy.  I think prescribing one for the treatment of epilepsy should be a medical thing and of necessity involve a medical doctor and licensed dietitians to provide education and training to patients and parents.  How about cancer though?  It is fine for a person to share their experiences and results, but I'm sorry, this is a dicey area and those advocating keto diets as a treatment for cancer are irresponsible.  Do you think Chris Kresser is qualified to treat cancer?  It's bad enough that there are medical doctors peddling unproven therapies, such as Grain Brain Perlmutter and his glutathione for Parkinson's clinics.  At some point I think this needs to get reined in.

Where to Start Fixing the Credential/Credibility Problem

What better place to start than with the children.  LEAVE THEM OUT OF YOUR EXPERIMENTAL BIOHACKING WITH UNPROVEN DIETS.   If you can't spare your own child, then I'm 1000% behind any laws that will prevent you from encouraging others to experiment with their own children, especially if you pretend to be an authority and lie about the evidence supposedly supporting the diet you are advocating.   If there is evidence of efficacy for a diet -- as with keto for epilepsy -- then guess what?  You can seek out and obtain licensed therapy.  Along with that the doctor and others will monitor your progress -- including the very real potential for serious side effects.  

Oh ... and I think it's time Robb went to farm those coconuts and leave medicine and nutrition to those qualified to practice in the field.