Current and Past Research Studies


A Qualitative Focus Group Study


This study was an evaluation of a nutrition and health education program on components of metabolic health in women from under-resourced South African communities.



A mixed-methods study


This study was initiated to explore the impact of the Eat Better South Africa Program on metabolic health markers in individuals with Type 2 Diabetes.



A Pilot Study


This pilot study was conducted to understand Childhood stunting and growth impairments in an isolated and poverty-stricken community in the Western Cape.



Evaluation of a nutrition and health education program on components of metabolic health on women from under-resourced South African communities.


Diet-related non-communicable diseases (NCDs) pose a substantial burden in terms of financial cost, morbidity, and mortality. In South Africa there is currently a double burden of infectious diseases and NCDs. Overconsumption of sugar, refined carbohydrates, and poor-quality fats, increases the risk for developing chronic diseases. Families from poor communities are often forced to eat these harmful foods due to a lack of nutrition education, or because they cannot afford or don’t know how to access healthy foods. While poverty is an important barrier to health and education for both men and women, it tends to yield a higher burden in women. There is evidence that low-carbohydrate high-fat (LCHF) diets can improve metabolic health in well-controlled clinical trials where quality food is either provided or where participants have the financial and logistical means to access the foods promoted by this diet. However, one cannot assume that the same nutritional advice will translate to residents of underserved communities, who may not understand the advice nor be able to afford or access the foods promoted by this diet. Women from these communities are often the gatekeepers to healthy food choices for their families, but they are at a particular disadvantage. Eat Better South Africa (EBSA) runs nutrition education programs to teach – predominately women – how to choose affordable healthier foods that are lower in refined carbohydrates and higher in healthy fats to prevent or manage metabolic conditions.



This research aims to optimise the EBSA program for women from underresourced communities and to evaluate its effectiveness for changing dietary behaviour and improving metabolic health. The objectives were: 1) to explore women’s perceptions of the EBSA program and the barriers and facilitators that they faced to change their dietary habits and adhere to the EBSA recommended diet; 2) to conduct community assessments in the under-resourced communities that EBSA planned to run programs, better address women’s needs and explore their willingness to participate in a nutrition and health education program; 3) to assess the effects of the EBSA program on women’s metabolic health and wellbeing through mixed-methods and to explore EBSA’s team perceptions of the program, and 4) to explore health practitioners’ perceptions of the health and nutritional advice recommended by EBSA.



The first part of this project consisted of a qualitative study through focus group discussions (FGDs) with women from previous EBSA programs (n=18) and naïve EBSA participants (n=60).

The second part of the project consisted of a mixed-method evaluation (n=32) of a pilot study on an EBSA intervention to assess health status changes. These methods included qualitative methods (in-depth individual (IDIs) interviews with both EBSA participants and EBSA team members and FGDs with the EBSA participants), and quantitative methods (diet assessment, metabolic health markers and physical activity behaviour) to assess changes before and after the pilot intervention program. The last part of this project consisted of a qualitative IDI study on health practitioners’ perceptions and understanding of a LCHF diet (n=16).

Thematic analysis of the qualitative data was conducted using NVivo 12 software. Descriptive and statistical analysis of the quantitative data was done using Stata 16 and Jamovi.



The first formative study indicated that the EBSA participants’ greatest facilitators and barriers revolved around understanding the educational content and on how to implement the dietary advice. The mixed methods result of the second study, the pilot, indicated that, overall, the women experienced improvements in dietary behaviours and biomarkers related to inflammation, lipids, and glycaemic profiles. Furthermore, the participants waist circumference, weight, blood pressure, triglycerides and HbA1c were significantly reduced, and those changes were sustained six months after the EBSA intervention. Women’s carbohydrate intake was significantly reduced, and their health markers improved despite a slight increase in sedentary behaviour.



Although, currently, some international food guidelines endorse LCHF diets, there is still a considerable amount of confusion and lack of knowledge regarding this diet. This study provided data on the dietary intake and health risk status of women from under-resourced South African communities, and the facilitators and challenges of a LCHF education program to change their dietary behaviour. Results suggested that most participants followed EBSA’s dietary recommendations and experienced health improvements as a result. Follow up data at six months suggested that those changes could be sustainable. For people with diet-related chronic diseases, LCHF diets should be supported by experienced health care professionals who can facilitate optimal nutritional intake. This is the same for any other diet; the evidence for long-term compliance and the sustainability of carbohydrate restriction is currently not yet established. In the absence of this evidence, existing data suggest that it is a legitimate and potentially effective treatment to adopt a LCHF diet as an option for patients to manage and prevent NCDs in under-resourced communities.

A Mixed Methods STUDY (2022 to Current)

Exploring the impact of the Eat Better South Africa Program on metabolic health markers in individuals with Type 2 Diabetes:

Supervisors: Emeritus Professor Tim Noakes, Dr Georgina Pujol-Busquets

Researchers: Yvette Zihhalirwa, Wren Olieslager, Jana Retief, Tarra Petersen

Organisations: The Noakes Foundation & Eat Better South Africa

Collaborators: Dunoon Community Health Centre

Type of support from EBSA: Project Implementation and Research Support



Eat Better South Africa (EBSA), in collaboration with The Noakes Foundation (TNF), aims to evaluate the effectiveness of the EBSA program on the prevention and management of metabolic and non-communicable diseases (NCDs) in under-resourced communities.

The EBSA program is a dietary education initiative to empower people to improve their health by making the best dietary choices available to them. The program emphasises on reducing the consumption of sugar and highly refined carbohydrates and increasing the consumption of healthy fats, as a means of preventing and reversing NCDs such as obesity, Type 2 diabetes (T2D) and cardiovascular disease (CVD).

This study involved the recruitment and enrolment of thirty patients who had previously been diagnosed with prediabetes at the DuNoon Community Health Centre.

Anthropometric health assessments, measurements, blood tests, questionnaires, and in-depth interviews were conducted to evaluate the effectiveness of a 6-week EBSA program, followed by a 12-month support period. The study began with all participants undergoing an informed consent process and completing baseline questionnaires. Additionally, their baseline anthropometric measurements and metabolic health markers were assessed to establish a starting point for the study. During the subsequent dietary intervention period, participants actively engaged in the EBSA program, which included five nutrition education sessions aimed to equip them with the essential knowledge and guidance for making healthy dietary choices. The focus of the dietary intervention sessions was on adopting a low-carbohydrate, high-healthy-fat (LCHF) diet.

To gather further insights and feedback from the participants, in-depth interviews were conducted by an EBSA community coach/facilitator. After the conclusion of the EBSA program, participants recently attended a testing visit where anthropometric and metabolic assessments were conducted. Additionally, a focused group discussion (FGD) was conducted to provide participants with an opportunity to share their experiences and discuss their thoughts on the program. Furthermore, participants will be invited for subsequent testing visits at the six-month mark following the EBSA program, as well as at the one-year follow-up.

These visits will also involve the metabolic and body composition assessments to monitor and track any changes over time, allowing for a comprehensive understanding of the impact of the program throughout the study duration.

A PILOT STUDY (2022 to Current)

A pilot study on Childhood stunting and growth impairments in an isolated, and poverty-stricken community in the Western Cape.

Childhood Stunting and the Posterior Development Outcomes: A Pilot Study on Childhood Stunting in Isolated, rural, and poverty-stricken communities. – The Noakes Foundation

Supervisors: Emeritus Professor Tim Noakes, Dr Georgina Pujol-Busquets

Researchers: Yvette Zihhalirwa, Wren Olieslager, Jana Retief, Tarra Petersen

Organisations: The Noakes Foundation, Eat Better South Africa, Inani StartWell Foundation

Collaborators: Nolungile Educare Centre, Lehloholono Pre-Primary School

Type of support from EBSA: Project Implementation and Research Support and Co-Funding



The Noakes Foundation in collaboration with Eat Better South Africa (EBSA) and the Inani Startwell Foundation aims to assess the impact of a collaborative intervention on childhood stunting and healthy eating patterns among children aged 1-3 years in Gugulethu, Western Cape, South Africa. The Noakes Foundation focuses on improving human health through research on a low carbohydrate high fat (LCHF) diet, while EBSA implements education programs to promote healthier food choices.

The Inani Startwell Foundation produces nutritious food products aimed at eliminating childhood stunting. A total of 200 children at risk or suffering from stunting due to malnutrition, influenced by socio-economic factors such as living in impoverished communities, lack of safety, education, and income, were recruited for the study.

Written consent was obtained from the guardians for their child’s participation, and baseline data on household characteristics and food security were collected through questionnaires to understand the participants’ social and economic context. Prior to the intervention, anthropometric measurements were taken from the participants, and in-depth interviews and observations were conducted with guardians and teachers. The intervention involves providing participants with twice-daily servings of Inani Startwell porridge, a nutrient-dense meal that is higher in protein and lower in sugar, designed to support healthy growth in children.

The porridge is consumed on school premises during morning and afternoon sittings on school days. Additionally, a six-week nutritional education program is implemented by EBSA to enhance participants’ food knowledge and skills. Throughout the intervention period, anthropometric measurements will be taken every two months to monitor the children’s progress. The findings of the study will provide valuable insights into the effectiveness of these interventions in addressing malnutrition, mitigating childhood stunting and promoting optimal growth and development among young children.