Comments to Prof. Noakes’ report by Dr. van Velden


Thank for the comments. I would like to add some clinical information in this regard.

It should be made quite clear that a low CHO diet might be the preferred diet for people with insulin resistance. Prof Noakes has a family history of DM, and has probably got genetic abnormalities (SNP) which might put him at risk for DM.. The low CHO/high fat and protein diet cannot be applied to everyone. This was not clear in the TV interview.

The proposed diet is highly acidic, and people with impaired renal function will develop metabolic acidosis because of the compromised ability of the kidneys to excrete the high acid load. The modern Western-type diet is deficient in fruits and vegetables and contains excessive animal products, generating the accumulation of non-metabolizable anions and a lifespan state of overlooked metabolic acidosis, whose magnitude increases progressively with ageing due to the physiological decline in kidney function. In response of the state of diet-derived metabolic acidosis, the kidney implements compensating mechanisms aimed to restore the acid-base balance, such as the removal of the non-metabolizable anions, the conservation of citrate, and the enhancement of kidney amoniagenesis and urinary excretion of ammonium ions.

This has got many clinical implications such as osteoporosis and the metabolic syndrome. The final word on the Atkins diet has not yet been spoken; the Paloelithic diet was high in protein and fat, and low in CHO. The epidemic of DM could be linked to the high refined CHO diet.


Tim Noakes is a good friend of mine, and I do not want to contradict him. I do not think it was his intention to criticise the nutrition profession, but his remarks do have a great impact on society as a whole.

Our main concern is that it sounds like he is advocating a diet high in saturated fat. We can live with a low CHO diet, but we certainly need more poly-unsaturated fats, as well as mono-unsaturated fats and oils. We have to place more emphasis on functional foods for health reasons.

As a sports physician he should know that if you exercise at more than 80% V02 max, you certainly need glucose as an energy source; this will not stimulate a hypoglycemic attack, and the athlete cannot rely on the fat stores alone to fuel the muscles. Sedentary persons should cut down on all refined carbohydrates, and most certainly people with insulin resistance because high insulin levels is detrimental to health. Insulin in excess promote obesity, and is a growth hormone that damages the endothelium of arteries.

There are much more to say about the Atkins diet, but we must put the facts into perspective.

I hope that we will be able to solve this unfortunate situation.