Last week, a number of you alerted me to research that says intermittent fasting carries a higher risk of dying from heart disease. I appreciate everyone who sent this to me because it means you want me to live. To everyone who saw that story and didn’t send it to me – I kindly ask that you reflect on what a monster you are. There are less tragic ways to stop getting this newsletter.
As soon as I read the story, I knew I’d write about it because while journalists are to be admired for many things – confirming facts, holding the powerful accountable, keeping people safe – one thing few of them are good at is science. When you combine journalists being bad at science reporting with scary headlines guaranteed to generate clicks, you get reports that will have you believing we are all moments away from death (only for some reason we’re not all keeling over all the time how weird.)
This story in Forbes was better written than most.
Here’s a snippet:
“The safety of intermittent fasting, a popular strategy to lose weight by limiting food intake to certain times, was called into question by a surprise finding from research presented at a medical meeting.”
It was a surprise finding because most of the research says fasting – which people have been doing for thousands of years without going all Sanford and Son – is good for you.
The article continues:
“Limiting mealtimes to a period of just eight hours a day was linked to a 91% increase in risk of death from heart disease in the study, which was released on Monday in Chicago. The American Heart Association published only an abstract, leaving scientists speculating about details of the study protocol. The study was reviewed by other experts prior to its release, according to the AHA.”
Normally when you drill down to the data in a scary health story, it says something like “eating oranges more than three times a week increases the risk of heart disease from .4 percent to .7 percent.” It’s always a paltry increase. But it’s an increase, which justifies headlines like, “Oranges linked to increased death,” and “The silent killer in your soccer cooler,” and “Avoid this common murder food.” Instead of a .3 percent increase, this story says 91 percent, which is one of the highest percentages there is under 100 percent.
But where did they get that number? The study used self-reported data, which is not the best data because humans are forgetful and sloppy and many have poor memories (not you and me, obviously, but other human beings.)
The conclusion drawn by the research could be true. It could be the case that eating the way lots of and lots of healthy people eat could increase risk of heart disease, sure. But what “self-reported” means as a news consumer is that you should view the research with some skepticism.
Matthew Herper, a medical innovation reporter for Stat News, gave this research and the coverage it received the treatment it deserved.
“The news is everywhere in my social news feeds this morning: A popular fad diet is apparently lethal, scientific research says. Specifically, a study found that caloric restriction, also known as intermittent fasting, has a 91% higher risk of death due to cardiovascular disease.
“Except scientific research doesn’t say that — and not only should you not be worried about this study, you shouldn’t be wasting brain glucose thinking about it. Even including that 91% number, which you’ll remember, caused me pain, because I don’t think this result should be remembered.”
Just going to pause here and say we need more angry science reporters.
“The study is a type of nutritional research that is notoriously weak, and right now it’s only available as a press release. It’s not clear from the many, many news articles on the study whether reporters actually viewed the data that will be presented at an upcoming research meeting held by the American Heart Association.”
Seriously, if there was an angry science reporter podcast, I’d subscribe.
“So how am I, a science journalist, confidently dismissing this research? It’s based on observational research, and one lesson from more than 20 years of reporting on health and medicine is that one should be very skeptical of observational research, especially when it is about nutrition.”
If you sometimes read news articles for health advice, I highly recommend you read Herper’s entire piece as a health news literacy primer.
Here’s the nuance missing from those other reports: “People who choose to be on a diet, or those who stay on it, might be fundamentally different from those who don’t in ways that we cannot measure. Perhaps people go on time-restricted diets because they are worried about their health. Perhaps the people who stay on such diets have bodies that work differently than those who can’t fast that long. Perhaps, for whatever reason, the people who were on the diet were different from those who were not simply by random chance.”
And, you know, how many of them were measuring those eight-hour fasts accurately?
“Researchers try to counteract these possibilities by ‘controlling for’ the risk factors they know, like body weight and biological sex or gender or age. But the problem is that researchers can only control for the factors they can identify.”
What’s the risk of publishing research that does not account for a host of critical real-world factors? The risk is — do we really need to give your Uncle Bill who is convinced he knows more about vaccines than the county health director even more reasons not to trust the health establishment?
“Studies like this, and press coverage of them, can make people more skeptical about the things that we do know in medicine. People tend to think of science as a process where scientists do studies and find out the truth. But it’s more accurate to say that each study helps to make us a little less wrong, and a little more certain about what the truth might be. We live in a vast realm of darkness in which we have found scattered gems of truth.”
“This was a neat finding that should tell people working in nutrition to look harder at this topic. For everyone else, it doesn’t really say anything at all.”
Slay, king.
Slay.
How are you – a busy person who cares about your nutrition – supposed to know what health news to trust? If you’re serious enough to dig in and find the original research, what you want to see are randomized controlled trials. These are the gold standard trials, which … treat people like human guinea pigs. Well, half of them. The other half THINK they’re guinea pigs. It’s all very dignified.
I stopped fasting because it was creating an energy imbalance that left me feeling run-down every night. My body was saying – nope, doesn’t work. I trust that more than I trust randos filling out health questionnaires for researchers who take them at their word so they can send a press release to reporters who never look at the data.
Drum roll, please...
Starting weight: 187
Last week: 177
This week: 177
Goal: 170
Feeling: Attitude is everything. Attitude is everything. Attitude is everything.
Shoutouts
Laura wrote in response to my piece about embracing the plateau: I can totally relate. I actually made an appointment with my doctor last year because I was convinced there was something wrong. Your thyroid is fine, he said. You're doing all the right things, he said. It just takes time. I wanted to punch him (not really, I've never hit anyone, but it sounded like a plan).
And then something just clicked and little by little I started to lose weight. It has taken a year to lose 20 pounds, which is just slightly more than your half pound a month. I like quick results, but this also taught me that this is how I need to eat for the rest of my life, not just for a diet. Whatever I end up weighing is where I am supposed to be, although I'm still shooting for ten more pounds.
I feel good. I follow WW and stay within my points. I get a good workout three times a week. When it's not raining my husband and I like to hike on weekends. I can live like this the rest of my life and not feel like I am missing out. If there is something that I really want, I take half and feel satisfied. But it has taken me years to get to this point. What I am trying to say is that I agree: attitude is everything.
Keep at it. Find a way of doing this that you can maintain for the rest of your life, and then you will be where you are supposed to be. I don't mean to sound like an expert, but I've dieted my whole life.
I maintained this week....but yesterday I gained a grandson. I consider this a win for the week.
Laura – that’s the best news about “gaining” a couple pounds ever : ) Congrats to your family.
When it comes to nutrition headlines, I generally roll my eyes and say “Salt and eggs,” which have gone from healthy to unhealthy to healthy at least six times in my life. For health headlines, I take the aforementioned salt by more than pinches due to a rather scary thing I was told once: I knew a man who audited the research studies at a major American hospital, and he said every single study he looked at had glaring flaws. We certainly live in interesting times.
When I commented on this article about intermittent fasting, i really wasn't thinking about the 91% and dying from heart disease. I'm healthy and I believe my eating habits are healthy (now). What jumped out at me was the part about nobody skipping dinner. When I tried fasting I found I was eating the same amount of food, only starting a little later in the morning. I ate the same amount for dinner, usually at 6:00pm. It doesn't make sense to eat the largest meal of the day right before plopping myself on the couch for the rest of the evening. I need to find a way to eat dinner at 6am.
I gained a pound this week. Ugh. This is really hard.