American Heart Association's Irresponsible News Release of the Intermittent Fasting Study

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Originally published on www.orthomolecular.org by Richard Z. Cheng, M.D., Ph.D.

The American Heart Association (AHA) recently released a news report highlighting a poster presentation that suggested an association between an 8-hour time-restricted eating schedule (intermittent fasting) and a 91% higher risk of cardiovascular disease mortality (AHA 2024Chen 2024). This AHA's news release quickly spread throughout the internet, causing much confusion to the public. However, this preliminary finding has not undergone full statistical analysis or peer review, and the AHA's premature release of such information has been criticized as irresponsible and potentially misleading.

There are several issues with the AHA's poster presentation:

  1. First, it is only a poster presentation of an epidemiological survey study, which has not gone through the required statistical analysis, the necessary adjustments, and a final peer review process before it can be published. For a very influential health organization like American Heart Association to rush the release of such an incomplete study is at the least unscientific and irresponsible to the public and to science.
  2. The study was based on 2 questionnaires covering a period of ~15 years (2003 - 2018), before intermittent fasting or time-restricted eating/time restricted feeding became popular terms. These terms did not become popular until much later. The definition of time restricted eating (intermittent fasting) was not clear to both the surveyors and the respondents. This raises questions about the accuracy and validity of the survey results.
  3. This study compares a group of 414 people who were surveyed only twice during that period between 2003 and 2018 and who reported eating window within 8 hours a day. The reference group was of 11,831 people who were also surveyed only twice during that period and who reported eating window within 12-16 hours a day. Do you remember your daily eating window of last week, let alone of years ago?
  4. The difference in size of the study group (414-person) compared to the reference group (11,831-person) is huge. This requires statistical manipulation to arrive at any meaningful interpretation.
  5. The study has not been adjusted for confounding factors. For example, 27% of the 414-person study group were smokers, compared to 16.9% smokers in the 11,831-person reference group. Smoking status is a major cardiovascular and cancer death risk. This huge difference (27% v. 17%) needs to be adjusted during the statistical analysis before any conclusion can be reached. To release such an immature study to the public is against the scientific merit and is irresponsible at least.

A serious scientific study would have all these factors adjusted and the manuscript peer-reviewed before public release. This AHA poster presentation may or may not survive this rigorous publishing process and hence may not be finally published. The AHA's news release of this intermittent fasting study is premature, misleading, bordering pseudo-science and has caused significant confusion and potential damage to the public.

The American Heart Association's conflict of interest with big food and drug companies is a significant concern, as it can influence the organization's health recommendations (Lauerman 2016). Newly released documents reveal that the Academy of Nutrition and Dietetics, which endorses various food products, has financial ties with companies like Nestlé, PepsiCo, Hershey, Kellogg's, General Mills, and others (Reed 2022). Similarly, the American Heart Association has received millions from fast food and processed food manufacturers (Kaplan 2017). Major pharmaceutical companies donate huge sum of funds to healthcare organizations, potentially influencing their focus on treatment rather than addressing the root causes of diseases like poor dietary choices (Kaplan 2017)Canella (2015) and Yanamadala (2012) both highlight the potential for industry influence in scientific events and the creation of front groups to oppose government regulation. This influence is further underscored by Mialon (2022), who found that 95% of the U.S. 2020 Dietary Guidelines Advisory Committee had conflicts of interest with the food and pharmaceutical industries. The need for regulation in the training and practices of nutritionists is emphasized by Pereira (2016), while Nestle (2013) and Mozaffarian (2017) discuss the threat to scientific integrity and the role of the food industry in nutrition research. Mendelson (2011) also notes the prevalence of conflicts of interest in cardiovascular clinical practice guidelines. These studies collectively underscore the need for transparency and regulation to mitigate the influence of big food companies on health organizations like the American Heart Association.

Numerous studies have demonstrated the potential benefits of intermittent fasting for cardiovascular health, weight loss, metabolic health, brain function, longevity, and even autoimmune diseases and cancer (Sun 2024Cheng 2024). These studies emphasize the positive impact of intermittent fasting on various aspects of health and well-being. From an evolutionary perspective, human ancestors were routinely on intermittent fasting which seems to bestow survival benefits.

I have been practicing intermittent fasting (as part of my integrative and orthomolecular medicine protocol) for myself and have been recommending it to my patients, clients, and audience for more than 10 years with great success (Cheng 2024).


References

1. AHA. 2024. https://newsroom.heart.org/news/8-hour-time-restricted-eating-linked-to-a-91-higher-risk-of-cardiovascular-death

 

2. Chen, M et al. 2024. https://s3.amazonaws.com/cms.ipressroom.com/67/files/20242/8-h+TRE+and+mortality+AHA+poster_031924.pdf

3. Cheng, R. A Clinician's Experience of 15 Years of Intermittent Fasting http://orthomolecular.org/resources/omns/v20n06.shtml

4. Canella DS, Martins AP, Silva HF, Passanha A, Lourenço BH. Food and beverage industries' participation in health scientific events: considerations on conflicts of interest. Rev Panam Salud Publica. 2015 Oct;38(4):339-43. PMID: 26758226.

5. Kaplan, J. 2017. A physician's take on "What the Health" (medicaleconomics.com) https://www.medicaleconomics.com/view/physicians-take-what-health

6. Lauerman, K. 2016.Big Soda sponsored 96 health groups - a big conflict of interest, study says - The Washington Post. https://www.washingtonpost.com/news/to-your-health/wp/2016/10/10/big-soda-sponsored-96-health-groups-a-big-conflict-of-interest-study-says/

"Big soda" sponsored 96 health groups - a big conflict of interest, study says - The Denver Post https://www.denverpost.com/2016/10/10/big-soda-sponsored-96-health-groups/

7. Mendelson TB, Meltzer M, Campbell EG, Caplan AL, Kirkpatrick JN. Conflicts of interest in cardiovascular clinical practice guidelines. Arch Intern Med. 2011 Mar 28;171(6):577-84. doi: 10.1001/archinternmed.2011.96. PMID: 21444849.

8. Mialon M, Serodio PM, Crosbie E, Teicholz N, Naik A, Carriedo A. Conflicts of interest for members of the US 2020 dietary guidelines advisory committee. Public Health Nutr. 2022 Mar 21;27(1):e69. doi: 10.1017/S1368980022000672. PMID: 35311630.

9. Mozaffarian D. Conflict of Interest and the Role of the Food Industry in Nutrition Research. JAMA. 2017 May 2;317(17):1755-1756. doi: 10.1001/jama.2017.3456. PMID: 28464165.

10. Nestle M. Conflicts of interest in the regulation of food safety: a threat to scientific integrity. JAMA Intern Med. 2013 Dec 9-23;173(22):2036-8. doi: 10.1001/jamainternmed.2013.9158. Erratum in: JAMA Intern Med. 2013 Oct 14;173(18):1756. PMID: 23925569.

11. Pereira TN, Nascimento FA, Bandoni DH. Conflito de interesses na formação e prática do nutricionista: regulamentar é preciso [Conflict of interest in the training and practices of nutritionists: regulation is necessary]. Cien Saude Colet. 2016 Dec;21(12):3833-3844. Portuguese. doi: 10.1590/1413-812320152112.13012015. PMID: 27925123.

12. Reed, B. 2022. Revealed: group shaping US nutrition receives millions from big food industry | Nutrition | The Guardian https://www.theguardian.com/science/2022/dec/09/academy-nutrition-financial-ties-processed-food-companies-contributions?trk=public_post_comment-text

13. Sun ML, Yao W, Wang XY, Gao S, Varady KA, Forslund SK, Zhang M, Shi ZY, Cao F, Zou BJ, Sun MH, Liu KX, Bao Q, Xu J, Qin X, Xiao Q, Wu L, Zhao YH, Zhang DY, Wu QJ, Gong TT. Intermittent fasting and health outcomes: an umbrella review of systematic reviews and meta-analyses of randomised controlled trials. EClinicalMedicine. 2024 Mar 11;70:102519. doi: 10.1016/j.eclinm.2024.102519. PMID: 38500840; PMCID: PMC10945168.

14. Yanamadala S, Bragg MA, Roberto CA, Brownell KD. Food industry front groups and conflicts of interest: the case of Americans Against Food Taxes. Public Health Nutr. 2012 Aug;15(8):1331-2. doi: 10.1017/S1368980012003187. Epub 2012 Jun 12. PMID: 22687144.

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