I don’t know about you but I like hearing stuff that I already agree with. Movies and books written for my worldview? Yes please! A hot take that confirms every bias I already have!? Delicious! And yet… This past week, I came across a piece of research that had the audacity to disagree with my biases. To disconfirm them! It stated that time-restricted eating (TRE) increases the risk of cardiovascular death. But wait. Isn’t fasting supposed to good for us? Isn’t that what all health influencers offer up as gospel these days?
I will admit that the claim does not make intuitive sense to me. Nor does it fit with what I believe to be true. I hate it, in short. And yet… The knee-jerk responses in the comments sections have got me thinking; everyone magically becomes a research methodology expert when they don’t like what the research says. So, maybe our first impulse shouldn’t be to cover our ears and shout “No!” when we don’t like something — even if we think it’s deeply flawed. We should be curious, shouldn’t we?
Here’s the headline that got everyone’s internet underwear in a twist: 8-hour time-restricted eating linked to a 91% higher risk of cardiovascular death.
Here are the takeaways according to the American Heart Association:
It’s not an official study; it’s the abstract from a conference and has not yet been peer-reviewed. It is interesting and bears more investigation. Absolutely. However, it’s also fair to argue that the release of this as a news item is wildly premature. Especially because there is a fair bit of research on this stuff and none of it shows the kind of drama we see here. It’s also worth noting that it’s not an amazing study design. For starters, dietary food recall is notoriously shaky.
All that being said…
Let’s just pretend… for a moment… that this isn’t absolute bollocks. That there is a signal being amplified here — and it’s one that we’d previously missed. The question isn’t whether you believe this (or how intensely) because this is just a thought experiment. The question is what would it all mean if true.
Well, for starters, fasting for health is pretty new on the human timeline. For most of existence, things have been the other way around. And we do have evidence to show us that caloric restriction is a stress. So, is fasting a luxury or a hardship? The answer, of course, is that the dose makes the poison.
Luxury: Doing a cold plunge with your friends and then going back to your career as a knowledge worker
Hardship: Living in an uninsulated, unheated home in the winter and then labouring outside to survive
Luxury: A $10K ****Navy SEALS-themed retreat where you get shouted at by ex-special operators and chest-bump your golfing buddies
Hardship: Basic Underwater Demolition School — where you try to escape the 80-90% fail rate and/or drowning
Luxury: Intermittent fasting for health optimization
Hardship: Starvation
The researchers, to their credit, didn’t have an obvious confirmation bias here. They assumed that they’d see a lower risk of mortality from TRE. They saw no change in cancer or all-cause mortality HOWEVER… they did see an increase in the risk of cardiovascular death for the general population — and particularly in individuals with cardiovascular disease (CVD) or cancer.
Is it possible that people already undergoing significant physiological stress did not have the adaptive bandwidth to tolerate the additional — and avoidable — stress of fasting? That doesn’t seem wild to me. There might be a net benefit to caloric restriction to these groups over the very long-term but what is the cost-benefit ratio here for short-term stresses? To me, that’s one of the questions worth asking.
So, while I mostly expect that this data can’t/won’t be replicated, I will also make a slight course correction based on what it could mean because it’s actually pretty easy to do so — and feels like an upgrade in perspective. My beliefs will change as new evidence comes out because… well, that’s science, innit?
P.S. Here’s the whole thing
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