Tim Noakes: Supreme Master of Exercise Physiology #SANE

Tim Noakes

Jonathan: Hey everyone, Jonathan Bailor back. Folks this is going to be one for the ages. We are joined by literally the Michael Jordan of exercise science. One of the most distinguished researchers in the world, literally when it comes to exercise science. He is both an M.D. and a PhD. He has got bunch of other qualifications, he is the co-founder of the Sports Science Institute of South Africa. He is the author of Lore of Running, which we will discuss today as well as the book Challenging Beliefs and he has authored more than 450 scientific publications and he has more than 12,000 citations, like I said, he is basically the Michael Jordan of exercise science, Professor Timothy Noakes, welcome to the show.

Tim: Thank you Jonathan, that’s really kind of you. I don’t know what Michael Jordan would say, but that’s very flattering, thank you.

Jonathan: Tim, your work certainly speaks for itself, you’ve been doing this for decades and are known as an innovator, so if you don’t mind, certainly you captured some of this in your book Challenging Beliefs, but could you just tell us the story, how did you develop such a prolific career in this arena?

Tim: Well, I fortunately started knowing nothing, I think that was it. I did my medical training and during my medical training, I realized that I wasn’t really cut out to be a practicing doctor because I was much more interested in the science and writing the book rather than learning a textbook of knowledge. So, no sooner had I finished my hospital training that I went straight into research and I was fortunately exposed to some really brilliant minds, particularly Lionel Opie who is head of our cardiologist teaching at the University of Cape Town and we formed a very strong bond and it has been likewise for the last 45 years or so.

So, I went into research because I wanted to find out things and we originally had absolutely no equipment nothing and I just knew that we had to look at what was important in the environment and I fell into studying ultra marathon runners because we had the Comrades Marathon which had between 2 and 5000 runners in those days in the 1970s and it was a 56-mile race and there was no other race in the world that had so many competitors, you must remember this is long before the Ironman came along and we simply started studying ultra marathon athletes and we started studying their nutrition and their fluid balance and that kind of led into all sorts of other things. My good fortune was that we had no facilities to do anything. We had absolutely no knowledge and we just said “well this is an open field, let’s go for it” and I think that was I didn’t get bugged down becoming an expert in one area and looking for example at smaller and smaller and smaller bit of science. I was really interested in a totality of the field and that allowed us to be innovative in a whole bunch of areas and eventually came to the conclusion that the mind is terribly important in exercise performance and had I been a muscle physiologist or a respiratory physiologist, I would never have come to that conclusion because I would have concluded that my specialty, be it lungs or heart, was what was central to human performance. But because I had no basis, I just looked to the data and look at all the information and we just make the model, got better and better and eventually realized actually the brain is in charge of everything, so the brain must be the regulator. I was very inquisitive and I had no training and I think those were two key advantages that I had in the field.

Jonathan: Tim, it is a bit ironic that often times ignorance can lead to the most revolutionary scientific innovations.

Tim: Exactly because unfortunately what happens in science is that you follow the beliefs of your teachers and it becomes ingrained in you and then it becomes dangerous to conflict with them. I was chatting to a guy from Copenhagen and August Krogh won the Nobel Prize in 1910s for studies of capillaries and this guy has discovered that August Krogh was probably wrong, but how do you live in Copenhagen and try to take on one of the greatest scientists ever produced in Denmark and that’s his problem, everyone else believes something else because Krogh told them its true and he doesn’t believe it and says he has got a difficult time ahead of him.

Jonathan: Tim, certainly you have decades of challenging just what is the tradition and coming at it from a very objective and open-minded scientific approach. It seems that we continue especially in the area of nutrition, also in the area of exercise to have the mainstream perpetuate that which was proposed 50 years ago. Just because it was proposed 50 years ago, how do we make this change, how do we bring the mainstream back up with the modern science of exercise and human performance?

Tim: Well the answer is that we just have to have a lot of funerals, as some great physicist said that “science progresses funeral to funeral.” The reality is that the young people of the future and we have to teach them what we think is wrong and so this is why we think it is wrong and may be this is a better explanation. I would compare to contrast two examples, first is the idea that muscles become anaerobic and that cause lactic acid and that causes fatigue, which was what I was taught early on and I was really one of the firsts to say actually it is more complex that brain is regulating and I got it completely wrong. I knew the brain was the organ, the explanation I gave was utterly wrong, but the point was I did say the brain is the regulator which was the important thing. Now people might say, well you are wrong on this than the other, but the key was I said the brain is what’s important.

Now the people who said I am wrong were the heart specialists and the lung specialists who spent their lives in an academic career believing and proving supposedly that the heart or the lungs limited performance. So you had academic egos to overcome, but eventually those people die and these new students come along and that’s all replaced and that’s what happens. The problem in nutrition is quite different because there are very strong commercial forces which are driving what we believe whereas if fatigue is caused by lactic acid or caused by the brain has no commercial value whatsoever. So, there is no commercial interest, but in nutrition, there is massive commercial interest and industry, as you know only too well, chooses the scientist that will push the industry argument whether it is the truth or not and that’s what happened. So, nutrition is being directed by industry not by the science and that makes it very much more difficult to overturn.

Jonathan: Just focusing on may be what would be a little bit easier and certainly that which you are most known for and that’s exercise physiology, could you tell us a bit more about the work you are so well known for which is that the brain is really the area to examine when it comes to physical performance.

Tim: What happened when we started doing exercise testing, we had the most rudimentary equipment and so we did the most rudimentary studies and one of the teachings at that time was that if you take an athlete and you make them run on a treadmill faster, faster, and faster, they reach a point where although they can run a little bit faster, their oxygen consumption does not go up and that is supposed to indicate that the heart has reached its maximum capacity to transport oxygen to the muscles. The only problem was that we did our tests with this rudimentary equipment and we couldn’t find this evidence that the oxygen consumption had reached its peak value. It always seemed to be going up when the athletes stop.

So, I concluded well they can’t have stopped because they ran out of oxygen because we can’t see that and so we started writing papers questioning this idea that you reach this plateau in oxygen consumption. And in 1987, I was invited to speak at the American College of Sports Medicine on that very topic and I said something else is stopping exercise, it is not that you are running out of oxygen and at that time I thought it was the muscles contractility, in other words the muscles were becoming weak for some reason. Then in 1996, I was asked to give the J.B. Wolfe Lecture at the American College of Sports Medicine and there because I wasn’t the specialist I said what can I give a lecture on that will influence or interest a lot of people and I said I thought there were five areas in teachings in the exercise science which were clearly wrong to me, there wasn’t enough evidence and the first one was that you reach this plateau in oxygen consumption and the second one was that muscles become anaerobic during exercise.

I presented the evidence showing that that’s not the case and then I had this brainwave and I said actually what’s happening is that the body is regulated so it doesn’t fail because these models are failure models. In other words, you get tired because the body fails and that’s completely contrary to the teaching of normal physiology and normal physiology and I am essentially physiologist, we teach that everything in the body is tightly regulated, homeostatically regulated, so it doesn’t go out of certain range of values, but what exercise physiologists were saying that’s fine at rest, but during exercise it doesn’t happen. Exercise, the system breaks down and you collapse. I realized that can’t be the case and was very simple. It was simply that I work with heart patients on a regular basis and have done so for 40 years and we exercise them and they don’t all drop dead which they should if there is no control.

They very seldom have a problem during exercise, so I figured well there must be something regulating that and then of course people exercise vigorously in the heat and yes, some people developed heat stroke, but the vast majority, millions and millions don’t and so what’s remarkable it’s the millions who don’t develop heat stroke is remarkable. It is not the fact that two or three do develop heat stroke and then finally I had an interest in mountain climbing and climbing Everest and people, sure people die on Everest, but the majority don’t and so, there must be some regulator that is making sure that it is safe for you to exercise even at extreme altitude on Everest.

So, I came to the theory that the body is a tightly regulated system and the only regularity that we know of is the brain. So, I then said the brain must be in control and regulating exercise performance and that of course was greeted with derision by all my colleagues and eventually over the years we expanded the model and we were able to show all the evidence in the literature which shows that humans pace themselves and as soon as you see pacing during exercise you know that the brain is regulating the system because pacing you chose within a few seconds of starting exercise and that can’t be because the muscles have got too much lactic acid, it must be because the brain has chosen to start exercise at that work rate.

Even better indicate of this model is that when you get near the end of exercise, you speed up till you have an end spot and upon the end spot if you fatigued and the muscles are anaerobic or they’ve run out of glycogen and the answer is they can’t, it has be a regulated process. So, I think today that most exercise physiologist would agree that it is a regulated process and that the brain must be involved and the argument is my model of how the brain works correct or not, but we have moved beyond saying it’s an unregulated failure process, no it has to be a regulated process.

Jonathan: Tim, how can we see a similar shift. I love that you used the term homeostatically regulated. I love that you were talking about the brain being in control and I love that you have dedicated your life to reflecting this proven science in the field of exercise physiology and I am curious if you have any opinions on how we can show the similar model which is being born out literally every week in research around the weight regulation and nutrition about the homeostatic regulation, the involvement of the hypothalamus, the involvement of our “second brain” or gut bacteria studies showing that transplanting gut bacteria from one animal to another will make that other animal lean out regardless of the quantity or quality of calories it consumes.

Parabiotic tests where the introduction of hormones from a lean animal into an obese animal causes the obese animal to lean out again regardless of its quantity or quality of calories and we all get this, we understand intuitively that every biological organism seeks out homeostasis in every area of life, but historically for exercise before you came around, we ignored that fact and even currently in the nutrition arena the vast majority of “experts” continue to ignore the homeostatic regulation of body composition, how do we make that shift?

Tim: Sure, you are quite right. Until three years ago I had not seen nothing about nutrition, not even I decided to look into my own weight control and changed my own nutrition and started reading that I began to pick up on all the information you have and I am certainly not as much of an expert as you are on all those topics, but what is obviously clear is that for three million years humans regulated their weight very carefully and then it’s really in the last 30 years that the homeostate in the brain has gone haywire and the obesity is clearly in my view due to altered homeostatic control of food intake and that’s the case not even expenditure because the expenditure is not the problem and so for example, the best example I can give is that the American certainly are doing less exercise, but it is like about 100 calories or may be even it is 200 calories a day, less energy expenditure, that cannot cause obesity.

It is absolutely impossible for that to cause obesity because in the homeostatically regulated system, all you do is you just eat 200 calories a day less of food and so you regulate homeostatically. So the key has to be that the homeostat has become damaged and that damage comes with the 1977 dietary guidelines in which we replaced fat with carbohydrate. My own opinion is now having read the stories about the Inuits and the Plains Indians in America and in South Africa the hunters, particularly the bushmen, the sand bushmen, hunters, it is very clear to me that they sort out fat, that was the key that they wanted to eat was fat and I think what’s happened in the last 30 years, but increasingly for the last 100 years is that we’ve replaced fat in the diet with sugar and refined carbohydrates and I was reading Stephenson’s work on living with the Inuits in the 1920s and he makes the point in his book The Living Arctic that the key change which he noticed originally in the 1920s was that we were replacing fat in the diet with sugar and the sugar was becoming the driver of our appetite, not fat.

That is my view that as soon as you take fat off the diet, the homeostat starts to fail for whatever reason, it may well be the gut flora has changed, it may be that the fat acts in the brain in a particular way, but whatever way, we’ve destroyed the homeostat and the key is the reduction in fat and increase in total carbohydrate consumption with an emphasis on sugar and refined carbohydrates in flour. So, that’s the evidence and the only thing I can say to change people’s opinions is I say we are trying to change one person one meal at a time and the beauty of changing your diet to reducing the carbohydrate content and replacing it with fat is that you lose your hunger and that is what is so exciting for people is that they can suddenly control their food intake and they are not always hungry and I think certainly when I was eating lots of carbohydrates as an athlete, I was always hungry and the food controls your life.

It is an addiction, but now I have completely lost that addiction and I am almost never hungry, in fact I am so un-hungry that I often worry am I eating enough. That is the concern and since I starting promoting this diet in South Africa and became attached to it, a lot of people have written to me, in fact over 100 people wrote me and they said information about themselves the weight they lost and how they felt and I have actually put together a scientific paper and it is based around five case reports where people just had miraculous cure, there were just absolute miracles. One guy lost 80 kilograms, that is close to 200 pounds in seven months and it was just astonishing and other people cured their diabetes and everything and I know Robert Atkins described that in 1972, so we are not describing anything new, but the point was that 100 people most of them said this was the easiest thing they ever did in their lives and the key is that they no longer fear food because they are now controlling the food, the food is not controlling them and we just have to get more and more people to realize that you don’t have to be a slave to food. You can be in charge, but you can’t be in charge as long as you are eating this high carbohydrate, high refined high sugar diet.

Jonathan: The thing that is so profound about that Tim and I think I hope that we are approaching a tipping point because as you have shown in your work it is one thing to have a compelling theory, it’s another thing to have a compelling theory and be able to show the mechanisms that make it true and I think that’s what you’ve done so well and as we get deeper into understanding like the hypothalamic regulation and when we do animal studies where we show…nimal studies are interesting because it eliminates all these other variables like emotions and so we can just say in a mammalian model if we for example introduce this one form of gut bacteria, metabolic disorders reverse themselves without any change in the food quantity being consumed.

So, we start to see there are these underlying mechanisms when you can start to demonstrate these mechanisms like it is not just magic, it is not that fat is magical, it is that a diet that is higher in fiber that is higher in healthy fats, that is higher in protein actually activates different neurological and bacterial pathways and you are literally making your body work in a different way and do you think that is, the reason I really want to speak with you is you are essentially an example of how to convert the scientific community so may be could I just try to recruit you to do the same thing for nutrition?

Tim: Well, certainly in South Africa I am know as ‘the madman.’ I have completely lost it as far as some of my colleagues believe and in fact they forced a debate on me in December last year in which my own faculty tried to expose me as crank and fortunately I survived that one and because I survived, because I didn’t lose. I actually was able to get just enough information to make people start questioning and in South Africa this high fat diet is called “The Noakes Diet” which of course it isn’t. It goes back to 150 years and that certainly is not my diet, but I think that South Africa is going to tip in the not too distant future because we also have major obesity, diabetes problems and we don’t have the wealth that United States has and we have to address the issue and we are about to start our own National Health Insurance which we have never had.

We have never had a National Health Insurance Program and it will be bankrupted by diabetes and obesity, so it is pointless starting it knowing that it is going to be a failure unless we address the nutrition and what I have learnt in the last three years and this is completely contrary to what I have learned as a medical student. I believe that at least 80 percent of chronic ill health is related to nutrition and thank goodness for all the Americans who I have read in the last three years who are providing all this information as you said. I really think America leads the world in the research that has been done in this field and getting that information out.

To me it’s abundantly clear that the gut flora is where the future of medicine lies and if we don’t address gut flora, you can’t address most of the chronic ill health and the model that I was raised on was that there is pill for every disease and that just doesn’t work. All of chronic medicine that I was taught is palliative. You still die from the same disease. If you have diabetes, you can take your insulin, you can take your Glucophage, metformin, you still are going to die of diabetes, you are still going to have the arterial damage, you are still going to lose your legs and the only way that you might save yourself is by changing your nutrition and medicine never says that it is a palliative profession.

Our patients believe that they are getting better taking those pills and they aren’t. The beauty of the internet is that in 10 years time the whole world will know that medicine is palliative, yet there are ways you can actively do something for your health, but to do that you have got to eat properly and you have got to get away from the addictive foods as we’ve discussed.

Jonathan: Tim, it is a challenging problem because just last night I was digging into the recent research around, I am going to completely destroy the name of the gut bacteria, so I am not even going to try to say it, but there is a specific form of gut bacteria that bunch of researchers out in Belgium have been studying extensively and they have found amazing differences between obese mice genetically in both diet induced as well as non-obese mice in terms of the levels of certain hormones as well as the levels of certain gut bacteria, but here is the challenge Tim, is if you read the study and I am actually going to quote directly here and then I will dig into why this becomes challenging.

“We demonstrated that confusing bacteria name treatment reversed high fat diet induced metabolic disorders including fat mass gain, adipose tissue inflammation, and insulin resistance.” Now rewind, we demonstrated that the reversed high fat diet induced, but again here is the challenge, even this literature, the high fat diet they are talking about is the cafeteria diet that is garbage fat, so we still have this challenge of like even someone who is let’s say back in the old model would read this study and say “See it is the high fat diet is the problem.”

Tim: Jonathan I am so glad you raised it because I am going to give you two little stories. I was at a meeting on obesity and genetics in United Kingdom recently and they were talking about how they were going to change genes to save us from all becoming fat. I said but it is an environmental problem. If you get the environment right you don’t have to change your genes. Then someone mentioned high fat rats, I said but that doesn’t apply on humans. If you put humans on a high-fat diet, they lose diet and the whole audience turned around and looked at me as if I was mad and they said “who are you, where did you come from, what are you saying this?” Anyway we sort of settled that down.

So then they said I suppose you are a proponent of Atkins, I said no, actually I am a proponent for inventing [indiscernible 25:44] diet which was developed in London right here because the meeting was in London, in 1862, but anyway the next that happened to me and this is the point that we really need to emphasize, a person from my own university wrote to me and she said she was doing studies on arterial function in rats. She said they could never get their rats fat on a high fat diet. It was only when they gave them syrup that they got fat and if you look at the diets that the rats eat, they are usually given sugar, sucrose in water to make them fat, it is not a pure high fat diet and I suspect that is not the high fat that is causing the obesity in these rats.

In the rat model you have to overfeed them on refined carbohydrates and sweet carbohydrates to make them fat and I suspect with my long experience just like the plateau phenomenon in exercise physiology in 1970 you could not publish your paper if you didn’t say that we saw the plateau phenomenon in 100 percent of our patients or athletes and we didn’t see it so we didn’t say it. I will bet you that the methodology has evolved that people are reporting that it is high fat diet that is causing obesity in these rats because that was what was said 15, 20, 30 years ago, but they are also slipping in the carbohydrates because the carbohydrates are what is driving the obesity in the rats not exclusively the fat.

Jonathan: Tim, that is such a key point because for example, we see all these epidemiological studies that show that for example the group that ate higher fat had higher incidences of X, Y, Z disease versus the completely vegan or vegetarian or other group and the key thing to keep in mind is again I don’t think you or I or any other advocate here is saying eat a bunch of refined garbage fats that also come with them or have with them a bunch of processed starches and sweeteners. That is a completely different high fat diet than the high fat diet we are talking about and two conflate the two them is just patently wrong, would you agree?

Tim: Absolutely correct, I couldn’t agree with you more and I eat 70 to 80 percent fat diet and I am the thinnest of ever been and I am back to almost the weight, well in fact I am lighter than I was when I was rowing in 1972 to 1973. That was when I was in my peak rowing weight. That is true rowing weight, I was probably 84, I am now 81 and I am slightly heavier than when I was a schoolboy at say 77 and so I brought my way right back to where I was in my 20s by eating 70 percent to 80 percent fat, so don’t tell me that fat makes you fat, it’s absolutely the opposite.

Jonathan: It’s unfortunate Tim because I think we all understand intuitively that the quality of the macro-nutrient matters right even advocates of a higher carbohydrate diet generally with a few noteworthy exceptions, say we should get our carbohydrate from certain sources like vegetables and like from fruits, not from refined sugar and that’s definitely different than saying eat a high carbohydrate diet where 60 percent of your calories are coming from processed starches and sweets, why can’t we give the same obvious acknowledgment to when we say eat a higher fat diet, we are talking about eating a natural whole food sources of fats, high in Omega-3s, high in healthy saturated fats, high in mono-unsaturated fats from natural nutrient dense sources not the “high fat diet” that the average American eats because one, it is actually not that high in fat, it is sub-50 percent calories from fat and two, the fat sources are dramatically different.

Tim: I absolutely agree with you and that’s the message we have to get out, but the problem I have when I speak about this and I always say, I said that I am on three weights. I’m weight when I have a high carbohydrate diet, I weigh much lighter when I have a high protein low fat diet and on the lightest when I cut the protein and the carbohydrate and eat more fat and then people just say but that’s not possible because we know fat makes you fat, so that’s we have to get over that one as well and people are absolutely amazed that the way to lose weight is to eat more of the good fats that we described.

Jonathan: Tim, I think may be you should quote Uffe Ravnskov when those people tell you that fat makes you fat and tell them well watch out because green vegetables also make you green.

Tim: Yes, I must remember that one indeed.

Jonathan: Well, Tim I literally have an entire list of questions that we didn’t even get to because we’ve been having such a great conversation, so I truly hope we can have you back on the show because your influence not only me as an individual but obviously on the entire scientific community is quite legendary and it has been just an absolute pleasure chatting with you today.

Tim: Thank you very much and thank you for your incredibly intelligent questions and let’s hope that we can get together again because this message, we have to get this message out. I was in New York three weeks ago and one of the guys from Microsoft was speaking and he said that the United States has to sort out its budget deficit within the next 10 years if it is to survive as a viable nation and he said at the same time they have to address the burgeoning medical cost because unless they sort that out they cannot solve the budget deficit. So, the whole future of United States of America is threatened by the obesity/diabetes epidemic which is threatened by the dietary guidelines that we are currently prescribing. So, we have 10 years to get this message out there and tell people to change their diets.

Jonathan: Tick-tock, tick-tock the clock is ticking, but folks the good news is we have Professor Timothy Noakes on our side fighting the good fight. So Tim, thank you again so much for joining us while it is a little bit bleak right now I think we have a hopeful future because we have people like you fighting that good fight, so I appreciate it.

Tim: And you. Let’s not forget your contribution as well. So, thank you very much Jonathan.

Jonathan: Thank you Tim and listeners I hope you enjoyed today’s chat as much as I did. Please, if you want to get more information on Tim, just do a web search, there is no shortage of information and his most recent book is called Challenging Beliefs. Wonderful publication and remember, this week and every week after; eat smarter, exercise smarter, and live better. Talk with you soon.

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