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Intermittent fasting associated with increased risk of early death

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Re: Intermittent fasting associated with increased risk of early death

#41

“Among participant with three meals per day, a meal interval of ≤4.5 hours in two adjacent meals was associated with higher all-cause mortality.” So people who ate three meals a day ALSO fared poorly? Am I reading that right?

None of us are reading it right yet. We're not interpreting the "Hazard Ratios" - whatever those are. Until someone comes along and explains it (or uses chatGPT/bing to explain it), there's no point to form opinions about these results.

In addition, we need to know what percentage of the people were doing fasting, in order to determine if the HRs are statistically significant. That claim a 95% confidence ratio, but is that true?

If we're not able to do this kind of simple checkup on the data, we will just confuse us even more when we find another paper that adds even more naunce and complexity to the issue. That's how people become anti-science. Because we don't understand /this/ work, this work causes us cognitive dissonance. And because we don't understand this work, our dissonance is even worse next time.

I hope a kind statistician comes along and help our thread about by explaining the numbers and what they really mean in terms of death risk and life expectancy.

Re: Intermittent fasting associated with increased risk of early death

#42
post #11

Likely this is because people who are dieting are overweight. This is looking at damaged people and then drawing a conclusion. Pretty good chance these people would have died similar deaths regardless of diet. Better study would compare them to a control group to determine if risk went down or if life expectancy went up.

This is the elephant in the room with MUCH of the healthcare system. They report drug X or treatment Y resulted in a 40% improvement of outcome for patient. But what they don't say is people who didn't take the drug but avoided obesity and excess Alcohol, Drugs, Tobacco had a 70% better outcome.

Is it really an elephant in the room?

Every time I’ve had a (luckily mild!) issue they’ve suggested lifestyle changes.

Re: Intermittent fasting associated with increased risk of early death

#43
post #34

literally nothing in the article mentions anything about fasting, intermittent or otherwise. This post should be flagged/removed.

Having a meal period There are many intermittent fasting protocols including multi-day fasts which have been shown to prolong life in mice. But daily fasting is included in those protocols.

A lot of health hype has focused on Daily Time-Restricted feedings. This kind of IF is typically characterized by a daily meal period of 8 hours or less, with only water or snacks under 50 calories allowed during the rest of the time.

This is supposed to promote changes like reducing insulin resistance, but there are questions about the hype vs truth of this.

Re: Intermittent fasting associated with increased risk of early death

#44

Earlier quoted context omitted.

I don't think intermittent fasting is 'weight loss dieting' In my limited personal experience, it's not obese people i see doing intermittent fasting - it's more like the keto crowd.

My experience tells me the exact opposite. I lost more than 20kg thanks to IF. I would not have done it, if it would not mean I will lose weight.

Keto-crowd and weight-loss crowd have a massive overlap. If you get into keto for fat loss these days, you will almost certainly encounter IF ideas and will likely try some form yourself. I have.

Re: Intermittent fasting associated with increased risk of early death

#45
post #34

literally nothing in the article mentions anything about fasting, intermittent or otherwise. This post should be flagged/removed.

Having a meal period There are many intermittent fasting protocols including multi-day fasts which have been shown to prolong life in mice. But daily fasting is included in those protocols. A lot of health hype has focused on Daily Time-Restricted feedings. This kind of IF is typically characterized by a daily meal period of 8 hours or less, with only water or snacks under 50 calories allowed during the rest of the t…

Like I said.... the linked article literally says nothing about "fasting." Feel free to quote the part that mentions it. It only discusses "meal skipping." No mention of snacking.

> ...snacks under 50 calories allowed during the rest of the time.

This is not fasting. Even just 20 calories is generally expected to stop the fast. 50 calories would definitely stop the fast.

Re: Intermittent fasting associated with increased risk of early death

#46

The data was based on behavior between 1999-2014, which means it was behavior that almost certainly was not health motivated since intermittent fasting wasn't popular then. So I think you have to ask: why were these people skipping meals? I think there are a lot of possible explanations and they are all potential confounds. Like, one obvious reason people skip meals is that they don't have time. If you don't have tim…

I pulled up the full paper. As you speculated, people who skip meals are quite different from people who don't, in ways that might be relevant to overall health outcomes:

> As shown in Table 1, compared with participants with three meals per day, participants eating fewer than three meals per day were more likely to be younger, men, non-Hispanic Black, with less education and lower family income, current smokers, heavy alcohol drinkers, higher physical activity levels, lower total energy intake and lower diet quality, food insecure, and higher frequency of snacks.

They control for these factors in the statistical analysis, to different extents in three different models:

> Model 1 adjusted for age, gender, and race and ethnicity. Model 2 additionally adjusted for education, income, smoking status, alcohol intake, physical activity levels, total energy intake, HEI-2010 score, household adult food insecurity status, and snacks frequency. Model 3 further adjusted for baseline diabetes, hypertension, hypercholesterolemia, CVD, cancer, and BMI status, because these variables may be mediators between meal frequency, intervals and timing, and mortality.

This is an issue. Controlling for the variables in the model helps somewhat, but it's inevitable that the populations are also different in other relevant ways that are not captured in the covariates (e.g. stress levels).

They're also reporting dozens of results (18 in Table 2, another 18 in Table 3, 12 in Table 4) but doing no correction for multiple testing. Given that many of the confidence intervals only barely exclude 1, this is an issue.

Finally, and most damning--the effects almost entirely disappear if they exclude people who had cancer or cardiovascular disease at the beginning of the study. This is hidden in the supplementary material of the paper, not discussed at all within the main body of the paper. Of the effects cited in the abstract the only one that survives excluding people who had cancer or cardiovascular disease at baseline is that people who skip breakfast appear to have higher risk of cardiovascular disease-related mortality.

Given that the study is labelled "prospective" and one of the outcomes studied is death from cardiovascular disease, IMO it is dishonest to not note that the claimed effects disappear if you exclude people who already had cardiovascular disease when the study started.

Re: Intermittent fasting associated with increased risk of early death

#47

The data was based on behavior between 1999-2014, which means it was behavior that almost certainly was not health motivated since intermittent fasting wasn't popular then. So I think you have to ask: why were these people skipping meals? I think there are a lot of possible explanations and they are all potential confounds. Like, one obvious reason people skip meals is that they don't have time. If you don't have tim…

Like how "1-2 drinks per day" was healthier than none... because a lot of the people in the "none" category were teetotaling because they were chronically ill, and once you correct for that, the apparently-beneficial effects of that daily glass of wine vanish.

Re: Intermittent fasting associated with increased risk of early death

#48

The data was based on behavior between 1999-2014, which means it was behavior that almost certainly was not health motivated since intermittent fasting wasn't popular then. So I think you have to ask: why were these people skipping meals? I think there are a lot of possible explanations and they are all potential confounds. Like, one obvious reason people skip meals is that they don't have time. If you don't have tim…

I pulled up the full paper. As you speculated, people who skip meals are quite different from people who don't, in ways that might be relevant to overall health outcomes: > As shown in Table 1, compared with participants with three meals per day, participants eating fewer than three meals per day were more likely to be younger, men, non-Hispanic Black, with less education and lower family income, current smokers, hea…

> people who skip breakfast appear to have higher risk of cardiovascular disease-related mortality.

I'd bet this behavior it correlates with late-night eating.

Re: Intermittent fasting associated with increased risk of early death

#49
It's incredible to see how this site turned from valuable feedback in the comments to well...this.

Half of the comments making assumptions that you can not make on the data provided, the other half seems to be IF Crusaders trying to justify their own "healthy" eating behavior as if their life depends on it.

Here is a very simple thing to do when you don't understand a paper or how to interpret it. Send the Authors a mail and ask politely if they could help you understand their work better. There are multiple E-Mail Addresses provided from the Authors.

Seriously "I feel great when I stop eating by 2 PM" is a fun comment, but feeling great and being healthy are not exactly correlated.

I climbed Everest once and my body started dying at about 26000 feet, it felt amazing, still I was literally dying.

Maybe I should just take a break from reading HN comments, it's not like it used to be.

Re: Intermittent fasting associated with increased risk of early death

#50
post #6

Earlier, on HN I read that it improves lifespan and now it is associated with early death.

Not the same thing... Also there can't be scientific evidence that anything improves lifespan.

I think there’s ample evidence that seatbelts and airbags save lives, thereby improving lifespan as compared to the control (same number of car trips).

Similarly, avoiding or ceasing of habitual smoking of cigarettes has ample evidence for lifespan improvement.

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