No long-term benefits from intermittent fasting

Dear Dr. Roach: I read a recent headline that said people who fast intermittently have an increased risk of heart disease. Is there merit to this story? K.O.S.

Intermittent fasting is an increasingly common weight-loss strategy. The two most common approaches of intermittent fasting are alternate-day fasting (eating nothing one day, then whatever you want the next) and timerestricted feeding (eating at certain times in the day, usually in an eighthour time frame).

The published data on the benefits of these diets show short-term weight loss (i.e., 12 weeks), but no long-term weight loss (one year), compared with standard dietary advice.

There is evidence of potential harm from intermittent fasting. Studies have shown an increased risk of eating disorders (particularly binge eating). One study showed that disordered eating worsened in those assigned to an intermittent fasting schedule. However, other studies do not show this.

The concern for disordered eating is highest among younger and female populations, who are most at risk of eating disorders, and I advise against intermittent fasting for a person with a history of an eating disorder.

The study you read about was presented as an abstract in the March meeting of the American Heart Association. It is not yet published or peerreviewed, but it did show that people who report an intermittent-fasting diet (specifically those who ate over an eight-hour time frame) were at a higher risk of death from heart disease than those who ate over a 12-16-hour time frame.

However, this wasn’t a controlled study, and it is likely that people who chose a time-restricted eating pattern already had issues that put them at a higher risk of heart disease.

Still, given the absence of long-term benefits, I don’t generally recommend a time-restricted diet or intermittent fasting to my patients.

My colleagues in weight medicine consider intermittent fasting to be an option that helps a subset of people. There are some people who benefit from this type of diet, and as long as they are eating well and are being monitored by their physician, they should continue to follow their diet if it is working for them.

Dear Dr. Roach: As a person who has had vocal cord paralysis after a viral infection, I was fortunate not to need many of the outlined modes of care. However, there was one additional therapy that was utilized within my plan of care — speech therapy. It took a while, but it worked well.

I suppose I may have some lingering weakness. When I experience a new viral upper respiratory infection, I often experience prolonged hoarseness. So, I pull out my exercise sheet once again, practise the techniques and experience the same great results. B.A.

I thank B.A. for writing, as I should have recommended voice therapy for people with vocal cord paralysis, as well as those with other voice issues.

Some ear, nose and throat physicians, speech-language pathologists, respiratory therapists and voice coaches specialize in voice therapy.