Dear Kayla,

What are your thoughts on reports saying that OMAD is associated with increased mortality due to Cardiovascular disease?
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Cheers,

Stephen
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Dear Stephen,

Years ago, when I was constantly researching weight loss (but not actually losing weight), I would dig into the studies behind the attention-grabbing headlines. I usually came away disappointed on several fronts. First of all, the headline was usually an exaggeration of what the study found. The study itself was lackluster: many times they had small sample sizes, short-time frames, or were not well controlled. Worse yet, the results were not actually exciting. So what do I think of the reports about OMAD being associated with increased mortality due to cardiovascular disease?

I couldn’t find headlines that targeted OMAD specifically, but rather condemned eating windows smaller than 8 hours. I’m going to assume you’re referencing the study done by Meng Chen et al. Here are some of the headlines:

• This Popular Diet May Raise Your Heart Disease Death Risk by 135%, New Study Says (eatingwell.com)
• 8-hour time-restricted eating linked to a 91% higher risk of cardiovascular death (American Heart Association’s website)
• Meal Skipping and Shorter Meal Intervals Are Associated with Increased Risk of All-Cause and Cardiovascular Disease Mortality among US Adults (Actual Study)

Notice how the claims get tamer, the closer you get to the study. “May raise your heart disease death risk by 135%” for the “news” article. “Linked to a 91% higher risk of cardiovascular death” on the AHA’s website. And then “Associated with Increased Risk of All-Cause and Cardiovascular Disease Mortality” when you get to the actual study headline.

But let’s set that aside. What’s really important here is the actual study.Did Meng Chen and his fellow scientists go out and study two groups of people over a significant period, one which consistently practiced intermittent fasting, and one which did not, and then compare those two groups? No. No. A thousand times, no.

The scientists in this study used the National Health and Nutrition Examination Survey (NHANES) that was done by the CDC from 2003-2018, looked at that data, and then drew conclusions based on that.

So what we really need to know is: how was that survey conducted? Here’s a quick summary:

1. Participants were asked to do a 24-hour recall of their food intake at a Mobile Examination Center, based on their memory, and nothing more.
2. 3-10 days later, a second interview was done over the telephone, again, asking the participant to do a 24-hour recall of their food intake.

For a moment, let’s put aside some troublesome issues:

• Memory: people forget what and how much they ate
• Honesty: people fudge about what they ate because to be truthful would be embarrassing (I speak from experience.)
• Intent: the survey did not collect any data regarding people’s reasons for eating (or not eating)

The much larger problem, to my mind, is that Chen et al took a person’s 2 24-hour recalls, which took place in the span of less than two weeks, and then made a huge assumption: that those eating patterns were accurate, and that they continued on like that consistently, for the next 15 years. People are not very consistent, especially when it comes to eating. Patterns vary widely over time.

To put it bluntly, this study didn’t study people who practiced intermittent fasting. To my knowledge, there has been no long-term study of people who consistently practice intermittent fasting.

Headlines are meant to grab your attention. Conclusions get exaggerated or words are played with so that they hit a nerve. There’s a phrase in journalism: if it bleeds, it leads. Ultimately, news organizations want to sell papers (or advertisements) and the way they’ll do that is if they get you to click and read. One of the best ways they can get you to click is if they make you worried or afraid.

Unfortunately, that tendency to be intrigued by the negative gets manipulated to the hilt by news organizations, social media companies, and yes, even scientists. Scientists desperately need funding. One way to get more funding is to present your study in a way that makes it seem pressing and important. Dr. John Ioannidis is a physician and a scientist, and in 2005 he wrote an essay titled, “Why Most Published Research Findings Are False.” Twenty years later, he says it’s STILL true. (Here’s another related video.)

In conclusion, I don’t pay attention to the headlines. I pay attention to my own results and health. That said, I encourage everyone to do their own research and come to their own conclusions.

Sincerely,

Kayla

PS: If you’d like to see a full description of the NHANES survey’s methodology, you can read all about it on the CDC’s website here: CDC’s Documentation of the NHANES survey method. Direct quote from website: “All NHANES participants are eligible for two 24-hour dietary recall interviews. “The first dietary recall interview is collected in-person in the Mobile Examination Center (MEC) and the second interview is collected by telephone 3 to 10 days later.”

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