Sunday, August 26, 2007

Intermittent Fasting...Alan Aragon Replies

In the last post I highlighted a bit of the debate about intermittent fasting, posting Alan Aragon's critique of the approach and Bert Herring's refutation of that critique.

Alan Aragon commented on that post and pointed me towards a reply that he had written to Bert Herring's response. In the interests of fairness I've posted it below.

I'd say one thing - I do not think that Aragon is correct in implying that Herring is doing this for the money. His book is available for free download on his site.

In the next post I'll point to another study which indicates that there may be other health benefits to occasional fasting.

Not So Fast, Doc

Bert Herring, MD has an impressive academic resume, much more impressive than mine. He's an accomplished researcher who's worked for the National Cancer Institute, among other lofty positions. This is why it was especially disappointing to see him half-wittedly critique my article on intermittent fasting. His hasty retorts weren't too surprising, after all, my article doesn't put the practice of meal frequency reduction in an infallibly sublime light. Listing both the pros and cons seen in research didn't sit too well with the good doc, who has an obviously vested interest in defending his narrow view.

In contrast to my poker-faced essay, Bert's book The Fast-5 Diet and the Fast-5 Lifestyle emotionally captures the reader even before the table of contents. A hyped-up testimonial from the author himself states that his 20 unwanted pounds "melted away like wax under a blow torch", with his love handles disappearing for the first time. However, he states explicity that this was back in 1995, ten years before he fell off the diet and gained all 20 pounds back. His book was released in 2006, which means he saw the light and wrote a book praising his old diet after yo-yo-ing back into it for a year. Given his own track record with the diet, his personal testimony doesn't hold a lot of weight. But no matter, he has plenty of fans to comfort him (and eachother) through their topsy-turvy dietary travails.

What follows is Herring's critique posted in response to someone in his Yahoo support group, with my comments interjected. Bon appetite.


BH: Although this piece is referenced, it has little integrity and exhibits lots of bias. For example, the author references #15 and 16 as examples of increased hunger when eating "a single meal." Those studies actually looked at the difference between breakfast served as one portion or spread over five,evenly spaced portions, after which the subjects ate lunch. The studies only looked at people over the course of 5.5 hours on 2 days. (One day they ate one way, the other day, the other way.) When the men in the study ate the breakfast in divided portions, they ate less lunch. (#15 studied lean males, #16 studied obese males).

AA: Let me quote my article, "subjects had greater appetite control when pre-test meals were consumed at frequent intervals, in contrast to the same amount of food consumed at a single meal [15,16]. In the ad libitium test meal that followed the pre-test meals, subjects given the single meal consumed on average 26.5% more calories". I don't see what Herring is missing, he basically reiterated the protocol I relayed in my article. It was an acute study on feeding frequency and appetite, I neither stated nor implied anything different. If there are other controlled trials specifically examining meal frequency's effect on appetite control, I'd like to see them.

BH: References 17 and 18 are cited, saying basically that every-other-day fasting and once-a-day eating are impractical because people may not like it. The author does not include, for example, that in reference 18, the people in the study lost 4% of their fat mass in 22 days, their fat metabolism went up by 6 grams per day, and their resting metabolic rate, despite all "everyone" says about it dropping with fasting, did not change from baseline.

AA: Regarding reference 18, again, it seems all I have to do is quote my article to show how Herring glossed over it, missing the very details he claims I omitted. Perhaps if Herring had something to eat, he would've had enough mental focus to read this: "In another 22-day ADF study led by Heilbronn, non-obese subjects lost an average of 2.5% of initial bodyweight [18]. Positive markers of ADF included a decrease in fasting insulin levels and respiratory quotient, indicating an average fat oxidation increase of roughly 15g per day."

BH: Reference 19 is an interpretation of other studies funded in part by the Breakfast Advisory Board, which is an agency of the State of Florida Department of Citrus. The Breakfast Advisory Board is now called the American Breakfast Council, even though it's an agency of the State of Florida created to promote orange juice sales.(link) Another of the authors on the same paper, Judi Adams, is president of the Grain Foods Foundation and at the time was president of the Wheat Foods Council. It's no surprise that this interpretation of other studies came out "pro-breakfast."

AA: It's very convenient to completely write off a 47-study review based on funding source, isn't it. Too bad all research has to be funded somehow, and we're left merely to judge the quality of the research, and how it might contribute to the overall body of evidence for or against the topic in question. Herring also conveniently ignores the rest of the breakfast research I cited. Instead of groping for red flags of funding bias, it would be more productive for his cause to compile a set of human data that's decidedly "anti-breakfast", showing its overall detrimental effect compared to skipping it altogether. I won't hold my breath.

BH: Mr. Aragon spends a lot of time describing how hunger increases with decreasing meals, but disregards (a) that he's looking at a comparison of >3 meals a day to 3 meals a day and (b) his own statement that "hunger disappears" with fasting (which he calls "complete starvation" and then says it "is irrelevant.")

AA: That's flat-out incorrect. How can Herring take the time to criticize my work, yet do it with both eyes closed? My guess - the guy needs to eat something. Stote et al compared 1 versus 3 meals per day, and found a higher level of hunger in the 1-a-day group, which increased throughout the study. As for hunger disappearing in complete starvation, I didn't pull that point out of thin air. I referenced the statement, citing both Johnstone's review and work by Wadden et al. Finally, is Herring implying that very low calorie diets (800 kcals or less) and complete starvation are indeed relevant protocols for either of our target readers? Certainly not mine, anyway.

BH: The next study he quotes (23) refers to people eating six meals a day. I don't see the meaning in including data from a six-meal-a-day study as evidence for or against intermittent fasting.

AA: Herring is so caught up in the idea that I'm out to indiscriminately blast low meal frequency, that his defensiveness impairs his logic. In an article about intermittent fasting, it only makes sense to discuss meal frequency. In line with this, it makes sense to also talk about the temporal distribution of meals. After all, that's the essence of what meal frequency manipulation is all about - altering the timing/distribution of a given intake, whether it's inter- or intra-circadian. Should I have ignored that research indicating the benefit of not delaying your first meal upon waking? Too bad, deal with the data, brush up on your logic some other time.

BH: Mr. Aragon continues, saying reference 24 argues in favor of a post-fast breakfast. My reading of the article doesn't agree -- Layman is favoring more protein in breakfast for those who are eating breakfast and attempting to lose weight. Coincidentally, Layman's work was funded by Kraft Foods, the Cattlemen's Beef Board, and the National Cattlemen's Beef Association.

AA: Nope, wrong again. The section of Layman's article I focused on was entitled "Metabolic Roles of Leucine", where he discussed the duration of the anabolic impact of a meal. It was this section, not the following weight loss section from which I cited his recommendation based on diurnal protein synthesis flux... As for jabbing at the funding source of Layman's review, I don't have too much to say other than I'd rather see an evaluation of the research instead of its convenient dismissal based on funding source. In essence, Herring is discrediting Layman's work, which in my opinion is some of the most influential (and practically applicable) work in the field of dietary protein and amino acid research. I'd be interested to hear how Layman would respond to Herring writing him off on these grounds.

BH: I could go on, but Aragon's article just isn't worth the time. It is a difficult endeavor to pick apart these sorts of scholarly-looking articles, and it takes a lot of time. When you do, you may come to a completely different conclusion than the author. There are parts of Aragon's article I agree with: "Intermittent Fasting Human Research – Interesting But Inconclusive." That is, we don't know all we need to know about it.

AA: Herring's presumption that my article isn't "worth the time" is plainly apparent in his unobjective, incoherent assessment of it.

BH: More study should be done on IF, and on longer-term studies than anything that's been done so far. Part of the problem is that much of the data describing fasting means a prolonged fast -- going without food for three or more days done as one single stretch, one single change interrupting a well-established pattern. IF is an established pattern and relies on adaptations over two months or more, so until we start studying people who are adapted to one form or another, we're not seeing the real changes that can happen.

AA: I agree. To add to this, my hope is that studies would span beyond the observational realm. I'd like to see more comparison trials, to avoid the current trend of people gushing over the results of protocols that had no control group. And if it's not too much to ask, let's see how structured exercise influences the whole mix.

BH: The abundance of misinformation and misguided interpretation means one should be skeptical of ALL nutritional advice (including mine), and especially those who are trying to sell something. The best judge you have is your own body. If somebody's happy doing what they're doing, I see no reason for them to change to Fast-5 or IF or anything. If they're not, Fast-5 or some other variation of IF may be the tool they need to get where they want to be. As Aragon's reference #17 says,

"Although the consumption of 3 meals/d [per day] is the most common pattern of eating in industrialized countries, a scientific rationale for this meal frequency with respect to optimal health is lacking."

AA: That's interesting how he encourages skepticism towards all nutritional advice including his, and especially those who are trying to sell something. Intentionally or not, this statement implies that he's separate from those trying to sell something. Last time I checked, Amazon and Barnes & Noble aren't giving hard copies of his book away for free. As a matter of fact, on top of whatever he's earning from the book, Herring gives those viewing his website the opportunity to donate money to his PayPal account to "cover costs and expand to other topics of personal health management.". Call me a cynic, but that's the oldest trick in the book of cyber-marketing to further profit from the hands of those he's helped see the light.

As for the quote from reference #17, that doesn't contradict any of the key points I asserted in my article. Herring quoting this only consolidates the fact that he read in my article what he wanted to read, and ignored what he didn't... Hey Bert, how 'bout we do lunch?


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