Insights from the dissemination of a poster presentation of a non-peer-reviewed/unpublished manuscript, which turned into a press release by the AHA & used by mainstream/social media, causing grave concern to millions of people globally
This story does not include health advice. It is for information, inspiration, and awareness purposes.
On 25 December 2019, the New England Journal of Medicine said, “Evidence is accumulating that eating in a 6-hour period and fasting for 18 hours can trigger a metabolic switch from glucose-based to ketone-based energy, with increased stress resistance, increased longevity, and a decreased incidence of diseases, including cancer and obesity.”
On 19 March 2024, a non-peer-reviewed and unpublished manuscript in a brochure format going to the public and press, thanks to a press release by the American Heart Association, created public fear as the news indicated Intermittent Fasting increases heart disease risk by 91%. Considering the global impact of cardiovascular diseases killing millions of people, no one would take such important news from major outlets lightly.
I read the press release carefully and downloaded the poster in PowerPoint format. Author Victor Wenze Zhong, Ph.D., did the scientific duty of calling by clearly adding a warning sign for the user of the poster.
Here is what Dr Zhong, the lead researcher of the manuscript, said:
Please keep in mind that these findings are preliminary and have not been peer-reviewed. Interpreting or reporting these findings should be done extremely carefully. There are certain limitations to this observational study. The average of 2-day dietary recalls may not accurately estimate the usual eating duration. Self-reported data are prone to measurement errors. Residual confoundings cannot be ruled out. Importantly, the link between 8-hour eating duration and cardiovascular mortality is an ascension, not a causal relationship, and this positive link still needs replication in other studies. We recommend that you wait until the peer-reviewed paper is published before reporting. [I bolded critical points]
Surprisingly, on 18 March 2024, Medical News Today said, “8-hour time-restricted eating linked to a 91% higher risk of cardiovascular death,” with the first line,
“People who follow one of the more popular time-restricted eating strategies, 16:8 intermittent fasting, may have a higher risk of cardiovascular disease and death than those who don’t fast or employ other fasting techniques, according to a new study.”
Not surprisingly, on 20 March 2024, the New York Times said,
“Is Intermittent Fasting Bad for Your Heart? Here’s What We Know.” Fortunately, the reporter mentioned that it had not been published yet. The article also made a correction of a mistake on 21 March.
Suddenly, social media platforms were engulfed in a deluge of alarming posts, warning users of the supposed lethal dangers of intermittent fasting. The virtual space became a battleground of heightened emotions, with messages urging people to beware and guard their well-being at all costs. It was a tumultuous tempest brewing in a digital teacup, unleashing chaos and uncertainty across cyberspace.
Fortunately, Forbes posted an informative and calming article, “Claims That Intermittent Fasting Increases Death Risk By 91% Are Premature.” The article warned,
“Not so fast. You may have seen headlines and social media posts claiming that a scientific study has linked intermittent fasting to a 91% higher risk of death from cardiovascular disease. However, a closer look at this study that was presented at the AHA reveals a buffet of limitations that make such claims premature.”
The reporter made a humorous comment, saying,
“It’s sort of like the difference between participating in a pre-season scrimmage and a regular-season football game. Getting on to the field during a pre-season scrimmage doesn’t mean that you will eventually make the roster for the regular season.”
Many scientists, medical doctors, and psychologists in my circles said that the storm was caused not by the authors of the study but by the American Heart Association creating such a dramatic post in their Newsroom on 18 March 2024.
Dr. Kevin Berry, a respected and seasoned medical doctor with a subscriber base of 3 million viewers, created to YouTube video to address the issue. He expressed his deep concerns in a carefully crafted video while reassuring the public. He also invited scientists, clinicians, and journalists to approach the information cautiously and avoid inciting panic.
Here’s why I wrote this piece passionately and with care.
New readers might wonder why I wrote this piece and what my credentials are to write it. The motivation behind this piece stems from my extensive personal experience and deep immersion in fasting for health and performance purposes, which has become a lifestyle choice for me.
As a skeptic turned advocate, I have practiced various forms of fasting for over thirty years, starting with simple meal skipping like breakfast and incorporating one-meal-day plans and periodic long-term fasts, which helped me to reverse my prediabetes and abdominal obesity.
These practices have profoundly impacted my health and cognitive abilities like no other intervention. Motivated by these transformative experiences, I have delved into an exhaustive study of fasting literature, including papers, books, videos, podcasts, and seminars, exploring its metabolic, hormonal, cellular, neurological, and immunological effects.
Moreover, I have witnessed the positive outcomes of fasting on many people within my social/professional circles, including across global health and fitness communities.
Recognizing fasting as an integral aspect of diverse cultures and religions throughout history, I gained insights from personal journeys and scholarly exploration, including anthropological studies. I haven’t encountered any culture or religion that sees fasting as dangerous except for children, sick people, and pregnant/breastfeeding women.
In my network, numerous scientists, clinicians (including medical doctors), and biohackers embrace various fasting protocols to enhance their personal well-being and frequently advocate tailored fasting regimens for their clients.
I met numerous cardiologists and metabolic health professionals advising their patients to use customized fasting to suit their needs. There are numerous types of fasting, and there is no single solution meeting everyone’s needs. Besides, fasting does not suit the needs of some people and can even be dangerous for some people with underlying health conditions such as type I diabetes or unmanaged type II diabetes.
Public figures like medical doctor Dr. Jason Fung (on his best-selling books about diabetes and cancer) and social media passionately advocate fasting for metabolically broken people. Cardiologist Dr. Pradip Jamnadas even made a viral video on YouTube titled “ How Fasting and Diet Can Prevent Heart Disease Especially for High-Risk Patients like South Asians.”
Still skeptical?
Consider the case of board-certified cardiologist Dr. Jack Wolfson, who successfully addressed the health concerns of an obese patient at high risk of heart failure, alleviating their apprehensions about surgery through the implementation of intermittent fasting and diet. Here is the link to the educational video of Dr Wolfson on YouTube.
My 5 Candid Questions to the Researchers of this Paper and the American Heart Association as a caring health advocate and a Virtual Peer Reviewer
As I peer-reviewed hundreds of scientific papers for the last forty years, I’d like to pose these questions to improve the quality of your paper as a virtual peer reviewer who cares about your research.
I am sure you followed a methodology, and I trust the rigor of your quantitative research, but my questions related to the qualitative aspect for enhancing the interpretation of your research and informing the public what your findings mean to them.
1 — How do you reconcile the fact that a practice widely recognized as the most efficient tool for improving insulin sensitivity can seemingly increase the risk of heart disease? Given that insulin resistance is a known root cause of cardiometabolic disorders, how do these findings align with established knowledge in this area?
2 — Considering that this practice has been shown to initiate autophagy, leading to the healing of damaged arteries, reduced inflammation, and improved cardiovascular health, how do you explain its purported association with increased heart disease risk? Given that atherosclerosis resulting from excessive lipids and chronic inflammation is a well-established cause of heart disease, how do these outcomes fit within the broader context of cardiovascular health?
3 — In light of evidence suggesting that this practice effectively lowers blood sugar and blood pressure, traditionally viewed as beneficial for heart health, how do you interpret its reported association with an elevated risk of heart disease? Given that elevated glucose levels and hypertension are widely recognized as major contributors to cardiometabolic disorders, how do these findings challenge existing understandings of cardiovascular risk factors?
4 — Can you provide insights into how a practice that provides alternative energy to the heart and brain in the form of ketone bodies, thereby lowering oxidative stress and chronic inflammation, might paradoxically increase the risk of heart disease? Considering that oxidative stress and chronic inflammation are well-established contributors to cardiometabolic, cellular, and neurological disorders, how do these findings reshape our understanding of the interplay between metabolic processes and cardiovascular health?
5 — How do you reconcile the reported benefits of this practice in improving mitochondrial health through mitophagy with its purported association with an increased risk of heart disease? Given that damaged mitochondria are recognized as a major root cause of cardiometabolic disorders and premature aging, how should these findings inform our understanding of the role of mitochondrial health in cardiovascular health and longevity?
A Hypothetical Scenario for the Public to Unethically Prove that “Exercise Can Cause Heart Disease 100%” in a Month or Even a Week
In this hypothetical scenario, I aim to illustrate the potential for a biased narrative to expedite a study's publication and generate public alarm very quickly, like in a week.
Please note that this demonstration is purely for informational and awareness purposes, highlighting how research can be manipulated and published without proper peer review and adherence to ethical guidelines. Therefore, the unethical nature of this scenario is not endorsed or supported in any way.
If I were to proceed with publishing this paper, my initial step would involve scouring extensive datasets documenting instances of fatalities among various groups engaging in strenuous physical activity. You might search my article titled Let’s Discover Millions of Free Datasets on Google to learn more about it.
This would include examining cases of runners who suffered fatal heart attacks during marathons or intense training sessions, bodybuilders whose deaths were linked to both excessive exercise and the use of steroids, weightlifters who experienced fatal injuries due to improper technique or overexertion, and athletes who succumbed to heart-related issues during competitions or rigorous training regimens.
Additionally, I would investigate incidents involving individuals participating in extreme sports or endurance challenges, where the risk of adverse cardiovascular events may be heightened.
This quantitative data will give me thousands of people who died from cardiovascular disease due to exercise. Following the collection of quantitative data on individuals who suffered cardiovascular-related deaths attributed to exercise, I would utilize various statistical methodologies to analyze the dataset thoroughly.
This process would involve applying sophisticated statistical tools to extract meaningful (deceptive) insights and trends from the vast pool of information.
Subsequently, I would leverage these findings to craft visually compelling graphics, incorporating scientific terminology to enhance their professional appearance and appeal.
With meticulous attention to detail, I would then compose a comprehensive report, utilizing scientific jargon to present the data analysis in a manner that may impress readers unfamiliar with the nuanced context surrounding these cardiovascular fatalities.
After completing the research paper, I would craft a captivating title, "Exercise Can Cause Heart Disease 100%,” to grab attention and highlight the purported findings. Subsequently, I would pursue publication in a journal, potentially utilizing the option of paid publication services, if necessary, to expedite the publishing process.
Additionally, I would seek to generate publicity by engaging a social media influencer to promote the study through press releases, enhancing its visibility and reach within the broader public sphere.
I trust that this hypothetical scenario is a valuable example of how the public and media outlets should approach and interpret information disseminated by researchers, particularly concerning public health matters. Please keep in mind that moderate/tailored exercise is excellent for cardiometabolic health, so if you hear anything against it, be careful.
What are the impact and implications of such an unethical and non-peer-reviewed paper on public health?
While the hypothetical scenario may appear far-fetched to some, it reflects a reality understood by scientists, academics, clinicians, and other professionals involved in research and publication.
This situation highlights the critical importance of robust peer review processes and adherence to ethical standards, which are integral to reputable journals like Nature, Science, Cell, Neurology, JAMA, and the New England Journal of Medicine.
These rigorous standards help ensure published research's integrity, reliability, and credibility, protect the quality of scientific discourse, and advance knowledge in respective fields.
The impact of an unethical, non-peer-reviewed paper on public health can be significant and far-reaching. It can potentially lead to misinformation, confusion, and even harm to individuals’ health.
Such an unethical paper may sow seeds of doubt and skepticism among the public regarding the credibility of scientific research and expert recommendations. This erosion of trust can undermine efforts to promote evidence-based practices and policies to improve public health outcomes.
Moreover, disseminating misleading or inaccurate information through non-peer-reviewed channels, such as social media or unvetted publications, can contribute to spreading myths and misconceptions about health-related topics. This can lead people to make decisions based on flawed or incomplete information, potentially resulting in adverse health consequences.
From a broader perspective, publishing unethical and non-peer-reviewed papers can also affect public health policy and resource allocation. Decision-makers rely on robust scientific evidence to inform policies and allocate resources effectively.
If misinformation or flawed research is given undue attention, it may influence policy decisions in ways that are not supported by the best available evidence, leading to suboptimal health outcomes at the population level.
Conclusions and Takeaways
The saga of the purported link between intermittent fasting and increased heart disease risk is a cautionary tale, highlighting the need for rigorous scientific scrutiny and responsible dissemination of research findings.
The dissemination of unethical and non-peer-reviewed papers can undermine trust in science, perpetuate misinformation, and have negative implications for public health policy and practice.
This situation emphasizes the importance of rigorous peer review processes, responsible science communication, and critical appraisal of research findings to safeguard public health.
As we navigate the complex landscape of health information, here are some practical tips for researchers, publications, journalists, and the public.
For Researchers
1 — Uphold the highest standards of scientific integrity, including rigorous study design, transparent methodology, and meticulous data analysis.
2 — Prioritize peer review and ethical clearance to ensure the validity and credibility of research findings.
3 — Exercise caution when interpreting preliminary or observational data, recognizing the limitations and uncertainties inherent in such studies.
4 — Facilitate open dialogue and collaboration within the scientific community to evaluate and refine research findings before publication critically.
For Publications and Media
1 — Prioritize quality over quantity, emphasizing the importance of thorough peer review and adherence to ethical guidelines in the publication process.
2 — Provide clear and accessible information about study methodologies and limitations to help readers contextualize and interpret research findings accurately.
3 — Cultivate a culture of responsible journalism, prioritizing accuracy, objectivity, and integrity in reporting health-related news and research findings.
For the Public
1 — Approach health-related information with skepticism and discernment, seek out reputable sources, and consult with qualified healthcare professionals for clarification.
2—Be vigilant against sensationalized or alarmist headlines. Verify the accuracy and credibility of news reports before accepting them as fact.
3 — Advocate for greater transparency and accountability in scientific research and publication practices, promoting the dissemination of accurate and reliable information.
Adhering to these principles and promoting a collective commitment to scientific rigor and ethical conduct can mitigate the spread of misinformation, uphold public trust in scientific research, and advance our collective understanding of health and well-being.
On a personal level, fasting has notably enhanced my cardiovascular health, as affirmed by my trusted cardiologist, who happens to be a close friend. Regular tests conducted since my 50s consistently reveal remarkable improvements in my heart health following each extended fast.
Apart from improving my many biomarkers, my resting heart rate notably decreases, and my heart rate variability significantly improves, much to my cardiologist’s astonishment. He wants to create a case study of my fasting regimen for cardiometabolic health and publish it in a peer-reviewed journal as an information source.
Furthermore, he attributes my optimal blood pressure and blood sugar levels to my balanced and nutritious one-meal-a-day regimen, a dietary approach he himself adopts. We both have an insulin-sensitive and fat-adapted body with excellent cognitive abilities in our older years.
So, do you reckon an observational study suggesting intermittent fasting is dangerous could sway our convictions? Not in a million lifetimes!
Thank you for reading my perspectives. I wish you a healthy and happy life.
If you found this story helpful, you may also check out my other articles on NewsBreak. As a postdoctoral researcher and executive consultant, I write about important life lessons based on my decades of research and experience in cognitive, metabolic, and mental health.