Kaitlin Day, RMIT University and Sharayah Carter, RMIT University

Intermittent fasting has gained popularity in recent years as a dietary approach with potential health benefits. So you might have been surprised to see headlines last week suggesting the practice could increase a person’s risk of death from heart disease.

The news stories were based on recent research which found a link between time-restricted eating, a form of intermittent fasting, and an increased risk of death from cardiovascular disease, or heart disease.

So what can we make of these findings? And how do they measure up with what else we know about intermittent fasting and heart disease?

The study in question

The research was presented as a scientific poster at an American Heart Association conference last week. The full study hasn’t yet been published in a peer-reviewed journal.

The researchers used data from the National Health and Nutrition Examination Survey (NHANES), a long-running survey that collects information from a large number of people in the United States.

This type of research, known as observational research, involves analysing large groups of people to identify relationships between lifestyle factors and disease. The study covered a 15-year period.

It showed people who ate their meals within an eight-hour window faced a 91% increased risk of dying from heart disease compared to those spreading their meals over 12 to 16 hours. When we look more closely at the data, it suggests 7.5% of those who ate within eight hours died from heart disease during the study, compared to 3.6% of those who ate across 12 to 16 hours.

We don’t know if the authors controlled for other factors that can influence health, such as body weight, medication use or diet quality. It’s likely some of these questions will be answered once the full details of the study are published.

It’s also worth noting that participants may have eaten during a shorter window for a range of reasons – not necessarily because they were intentionally following a time-restricted diet. For example, they may have had a poor appetite due to illness, which could have also influenced the results.

Other research

Although this research may have a number of limitations, its findings aren’t entirely unique. They align with several other published studies using the NHANES data set.

For example, one study showed eating over a longer period of time reduced the risk of death from heart disease by 64% in people with heart failure.

Another study in people with diabetes showed those who ate more frequently had a lower risk of death from heart disease.

A recent study found an overnight fast shorter than ten hours and longer than 14 hours increased the risk dying from of heart disease. This suggests too short a fast could also be a problem.

But I thought intermittent fasting was healthy?

There are conflicting results about intermittent fasting in the scientific literature, partly due to the different types of intermittent fasting.

There’s time restricted eating, which limits eating to a period of time each day, and which the current study looks at. There are also different patterns of fast and feed days, such as the well-known 5:2 diet, where on fast days people generally consume about 25% of their energy needs, while on feed days there is no restriction on food intake.

Despite these different fasting patterns, systematic reviews of randomised controlled trials (RCTs) consistently demonstrate benefits for intermittent fasting in terms of weight loss and heart disease risk factors (for example, blood pressure and cholesterol levels).

RCTs indicate intermittent fasting yields comparable improvements in these areas to other dietary interventions, such as daily moderate energy restriction.

So why do we see such different results?

RCTs directly compare two conditions, such as intermittent fasting versus daily energy restriction, and control for a range of factors that could affect outcomes. So they offer insights into causal relationships we can’t get through observational studies alone.

However, they often focus on specific groups and short-term outcomes. On average, these studies follow participants for around 12 months, leaving long-term effects unknown.

While observational research provides valuable insights into population-level trends over longer periods, it relies on self-reporting and cannot demonstrate cause and effect.

Relying on people to accurately report their own eating habits is tricky, as they may have difficulty remembering what and when they ate. This is a long-standing issue in observational studies and makes relying only on these types of studies to help us understand the relationship between diet and disease challenging.

It’s likely the relationship between eating timing and health is more complex than simply eating more or less regularly. Our bodies are controlled by a group of internal clocks (our circadian rhythm), and when our behaviour doesn’t align with these clocks, such as when we eat at unusual times, our bodies can have trouble managing this.

So, is intermittent fasting safe?

There’s no simple answer to this question. RCTs have shown it appears a safe option for weight loss in the short term.

However, people in the NHANES dataset who eat within a limited period of the day appear to be at higher risk of dying from heart disease. Of course, many other factors could be causing them to eat in this way, and influence the results.

When faced with conflicting data, it’s generally agreed among scientists that RCTs provide a higher level of evidence. There are too many unknowns to accept the conclusions of an epidemiological study like this one without asking questions. Unsurprisingly, it has been subject to criticism.

That said, to gain a better understanding of the long-term safety of intermittent fasting, we need to be able follow up individuals in these RCTs over five or ten years.

In the meantime, if you’re interested in trying intermittent fasting, you should speak to a health professional first.

Kaitlin Day, Lecturer in Human Nutrition, RMIT University and Sharayah Carter, Lecturer Nutrition and Dietetics, RMIT University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Australians have used commercial creams, lotions or gels to manage our skin’s sun exposure for nearly a century.

But why we do it, the preparations themselves, and whether they work, has changed over time.

In this short history of sunscreen in Australia, we look at how we’ve slathered, slopped and spritzed our skin for sometimes surprising reasons.

At first, suncreams helped you ‘tan with ease’

Sunscreens have been available in Australia since the 30s. Chemist Milton Blake made one of the first.

He used a kerosene heater to cook batches of “sunburn vanishing cream”, scented with French perfume.

His backyard business became H.A. Milton (Hamilton) Laboratories, which still makes sunscreens today.

Hamilton’s first cream claimed you could “
Sunbathe in Comfort and TAN with ease”. According to modern standards, it would have had an SPF (or sun protection factor) of 2.

The mirage of ‘safe tanning’

A tan was considered a “modern complexion” and for most of the 20th century, you might put something on your skin to help gain one. That’s when “safe tanning” (without burning) was thought possible.

Sunburn was known to be caused by the UVB component of ultraviolet (UV) light. UVA, however, was thought not to be involved in burning; it was just thought to darken the skin pigment melanin. So, medical authorities advised that by using a sunscreen that filtered out UVB, you could “safely tan” without burning.

But that was wrong.

From the 70s, medical research suggested UVA penetrated damagingly deep into the skin, causing ageing effects such as sunspots and wrinkles. And both UVA and UVB could cause skin cancer.

Sunscreens from the 80s sought to be “broad spectrum” – they filtered both UVB and UVA.

Researchers consequently recommended sunscreens for all skin tones, including for preventing sun damage in people with dark skin.

Delaying burning … or encouraging it?

Up to the 80s, sun preparations ranged from something that claimed to delay burning, to preparations that actively encouraged it to get that desirable tan – think, baby oil or coconut oil. Sun-worshippers even raided the kitchen cabinet, slicking olive oil on their skin.

One manufacturer’s “sun lotion” might effectively filter UVB; another’s merely basted you like a roast chicken.

Since labelling laws before the 80s didn’t require manufacturers to list the ingredients, it was often hard for consumers to tell which was which.

At last, SPF arrives to guide consumers

In the 70s, two Queensland researchers, Gordon Groves and Don Robertson, developed tests for sunscreens – sometimes experimenting on students or colleagues. They printed their ranking in the newspaper, which the public could use to choose a product.

An Australian sunscreen manufacturer then asked the federal health department to regulate the industry. The company wanted standard definitions to market their products, backed up by consistent lab testing methods.

In 1986, after years of consultation with manufacturers, researchers and consumers, Australian Standard AS2604 gave a specified a testing method, based on the Queensland researchers’ work. We also had a way of expressing how well sunscreens worked – the sun protection factor or SPF.

This is the ratio of how long it takes a fair-skinned person to burn using the product compared with how long it takes to burn without it. So a cream that protects the skin sufficiently so it takes 40 minutes to burn instead of 20 minutes has an SPF of 2.

Manufacturers liked SPF because businesses that invested in clever chemistry could distinguish themselves in marketing. Consumers liked SPF because it was easy to understand – the higher the number, the better the protection.

Australians, encouraged from 1981 by the Slip! Slop! Slap! nationwide skin cancer campaign, could now “slop” on a sunscreen knowing the degree of protection it offered.

How about skin cancer?

It wasn’t until 1999 that research proved that using sunscreen prevents skin cancer. Again, we have Queensland to thank, specifically the residents of Nambour. They took part in a trial for nearly five years, carried out by a research team led by Adele Green of the Queensland Institute of Medical Research. Using sunscreen daily over that time reduced rates of squamous cell carcinoma (a common form of skin cancer) by about 60%.

Follow-up studies in 2011 and 2013 showed regular sunscreen use almost halved the rate of melanoma and slowed skin ageing. But there was no impact on rates of basal cell carcinoma, another common skin cancer.

By then, researchers had shown sunscreen stopped sunburn, and stopping sunburn would prevent at least some types of skin cancer.

What’s in sunscreen today?

An effective sunscreen uses one or more active ingredients in a cream, lotion or gel. The active ingredient either works:

• “chemically” by absorbing UV and converting it to heat. Examples include PABA (para-aminobenzoic acid) and benzyl salicylate, or

• “physically” by blocking the UV, such as zinc oxide or titanium dioxide.

Physical blockers at first had limited cosmetic appeal because they were opaque pastes. (Think cricketers with zinc smeared on their noses.)

With microfine particle technology from the 90s, sunscreen manufacturers could then use a combination of chemical absorbers and physical blockers to achieve high degrees of sun protection in a cosmetically acceptable formulation.

Where now?

Australians have embraced sunscreen, but they still don’t apply enough or reapply often enough.

Although some people are concerned sunscreen will block the skin’s ability to make vitamin D this is unlikely. That’s because even SPF50 sunscreen doesn’t filter out all UVB.

There’s also concern about the active ingredients in sunscreen getting into the environment and whether their absorption by our bodies is a problem.

Sunscreens have evolved from something that at best offered mild protection to effective, easy-to-use products that stave off the harmful effects of UV. They’ve evolved from something only people with fair skin used to a product for anyone.

Remember, slopping on sunscreen is just one part of sun protection. Don’t forget to also slip (protective clothing), slap (hat), seek (shade) and slide (sunglasses).

Laura Dawes, Research Fellow in Medico-Legal History, Australian National University

This article is republished from The Conversation under a Creative Commons license. Read the original article.