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Zhong said it’s not clear why his research found an association between time-restricted eating and a risk of death from cardiovascular disease. He offered an observation, though: People who limited their eating to fewer than eight hours per day had less lean muscle mass than those who ate for 12 to 16 hours. Low lean muscle mass has been linked to a higher risk of cardiovascular death. Cardiovascular and nutrition experts who were not involved in the analysis offered several theories about what might explain the results. Dr. Benjamin Horne, a research professor at Intermountain Health in Salt Lake City, said fasting can increase stress hormones such as cortisol and adrenaline, since the body doesn’t know when to expect food next and goes into survival mode. That added stress may raise the short-term risk of heart problems among vulnerable groups, he said, particularly elderly people or those with chronic health conditions. Horne’s research has shown that fasting twice a week for four weeks, then once a week for 22 weeks may increase a person’s risk of dying after one year but decrease their 10-year risk of chronic disease. “In the long term, what it does is reduces those risk factors for heart disease and reduces the risk factors for diabetes and so forth — but in the short term, while you’re actually doing it, your body is in a state where it’s at a higher risk of having problems,” he said. Even so, Horne added, the analysis “doesn’t change my perspective that there are definite benefits from fasting, but it’s a cautionary tale that we need to be aware that there are definite, potentially major, adverse effects.” Intermittent fasting gained popularity about a decade ago, when the 5:2 diet was touted as a weight loss strategy in the U.K. In the years to follow, several celebrities espoused the benefits of an eight-hour eating window for weight loss, while some Silicon Valley tech workers believed that extreme periods of fasting boosted productivity. Some studies have also suggested that intermittent fasting might help extend people’s lifespans by warding off disease. However, a lot of early research on intermittent fasting involved animals. In the last seven years or so, various clinical trials have investigated potential benefits for humans, including for heart health. “The purpose of intermittent fasting is to cut calories, lose weight,” said Penny Kris-Etherton, emeritus professor of nutritional sciences at Penn State University and a member of the American Heart Association nutrition committee. “It’s really how intermittent fasting is implemented that’s going to explain a lot of the benefits or adverse associations.” Dr. Francisco Lopez-Jimenez, a cardiologist at Mayo Clinic, said the timing of when people eat may influence the effects they see. “I haven’t met a single person or patient that has been practicing intermittent fasting by skipping dinner,” he said, noting that people more often skip breakfast, a schedule associated with an increased risk of heart disease and death. The new research comes with limitations: It relies on people’s memories of what they consumed over a 24-hour period and doesn’t consider the nutritional quality of the food they ate or how many calories they consumed during an eating window. So some experts found the analysis too narrow. “It’s a retrospective study looking at two days’ worth of data, and drawing some very big conclusions from a very limited snapshot into a person’s lifestyle habits,” said Dr. Pam Taub, a cardiologist at UC San Diego Health. Taub said her patients have seen “incredible benefits” from fasting regimens. “I would continue doing it,” she said. “For people that do intermittent fasting, their individual results speak for themselves. Most people that do intermittent fasting, the reason they continue it is they see a decrease in their weight. They see a decrease in blood pressure. They see an improvement in their LDL cholesterol.” Kris-Etherton, however, urged caution: “Maybe consider a pause in intermittent fasting until we have more information or until the results of the study can be better explained,” she said. Aria Bendix
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