Intuitive Eating vs. Carbohydrate Restriction

I'm going to preface this post by saying that I realize there are a number of registered dietitians ( including several whom I consider friends as well as colleagues) who favor intuitive eating for the treatment of obesity and can provide many testimonials as to its effectiveness.  I admire their work and do not want to take anything away from the success they have had with this method.

Intuitive Eating is an approach to developing a healthy relationship with food. Created by registered dietitians Evelyn Tribole and Elyse Resch, Intuitive Eating involves listening to your body, becoming attuned to hunger and fullness cues, and consuming a wide variety of foods. No foods or food groups are off limits, and people are encouraged to honor their hunger and eat what they desire, be it berries or brownies, although trying to make primarily nutritious choices  is also advised.

While Intuitive Eating has proved very successful for many, it's my belief that there are a number of individuals for whom it is not the best choice. One of the "10 principles" outlined on the Intuitive Eating website is "Honor Your Hunger."  The description of this principle reads "Keep your body biologically fed with adequate energy and carbohydrates. Otherwise you can trigger a primal drive to overeat."  While I agree that  adequate (albeit somewhat reduced) energy/caloric intake is crucial to preventing a profound drop in basal metabolic rate,  I have a different take on the need for "adequate carbohydrates." In fact, I would argue that in many cases carbohydrates are what may trigger the drive to overeat. The reasons for overeating are complex and involve not only behaviors but also hormones like insulin and leptin, which are highly responsive to the type and quantity of food consumed. 

There is a growing body of research suggesting that reducing carbohydrate intake may result in improvements in blood sugar control, appetite, and insulin resistance. Leptin also plays a role in appetite and obesity. It is released by fat cells under the direction of insulin, which is produced in largest amounts following carbohydrate intake. Once leptin enters the brain, its effects include appetite reduction, satiety, and an increase in metabolic rate. Interestingly, the obese tend to have higher leptin levels than those of normal weight, which has led researchers to hypothesize that they are resistant to leptin. This theory suggests that leptin resistance prevents the hormone from reaching the brain, confounding one's attempts to regulate intake and facilitate weight loss. In 2004 researchers discovered that elevated triglycerides block the transport of leptin into the brain.  Many studies have demonstrated that reducing carbohydrate intake, especially refined carbohydrates, leads to significant decreases in serum triglycerides, and a recent study implicates high carbohydrate intake in the development of leptin resistance and obesity. To be honest, I am not very knowledgeable about leptin and leptin resistance but plan to review more research on this issue, as I find it extremely interesting.

While I truly appreciate the philosophy behind the Intuitive Eating approach to making peace with food and accepting a person's genetic body shape, I feel that telling someone that no foods are off  limits may not be best  for everyone. Advising somebody with impaired blood glucose regulation to eat whatever they feel like eating may result in unstable blood glucose levels. In the leptin-resistant obese, encouraging high intake of trigger foods (which often contain large amounts of the very macronutrient that perpetuates their struggle to modulate intake) may lead to a vicious cycle of overeating, rebound hunger, and overeating again.

I am a person for whom an intuitive eating approach would probably not work. I'm extremely regimented, and counting calories  every day has allowed me to maintain a 30-lb loss for more than 25 years. Although carbohydrate restriction didn't come into play for me until about a year and a half ago when I began experiencing elevated post-meal blood sugar, limiting carbs has allowed me to see first hand  what getting blood glucose levels  under control can do.  I long ago resigned myself to feeling somewhat hungry at times after dinner when I'd consumed my allotment of calories for the day.  I'd  adapted to chronic mild caloric restriction (a healthful practice, particularly with respect to longevity) but retained some of the feelings of hunger that accompany it. Once I began following a low carbohydrate diet, I was amazed at the  increased satiety I experienced without any change in my total energy consumption, which remains somewhere between 1400-1800 calories every day. I can honestly say that after a meal I simply do not feel hungry anymore.

I feel strongly that a low-carbohydrate diet should not be characterized as a "fad diet" that is too difficult to maintain. I have met many people and read hundreds of online accounts of those who have lost weight and maintained their loss  long term by following  a low-carbohydrate plan which allowed them to regulate their energy intake. In some cases, these losses are 100 pounds or more. The number of people who have achieved excellent blood glucose control on such plans is no less impressive.  A low-carbohydrate diet can include many healthy, luxurious, highly palatable and satiating foods; the assertion that it will result in feelings of deprivation is misguided. I personally plan to continue eating low carb for the rest of my life. However, I understand that this lifestyle is not for everyone. I would never tell anyone that they "had to" eat low carb in order to lose weight. There are many people who reach their goals by following a vegetarian or vegan way of eating,  and as I stated initially, Intuitive Eating has worked brilliantly for others.  I think that's terrific! We are all unique and our responses to food are highly individualized.

I realize that the majority of people reading this have had favorable outcomes with carbohydrate restriction, but for the reader who has been unsuccessful with low carb and would like to try an Intuitive Eating approach, I know several dietitians who specialize in this area I could refer you to (use the Contact Me page). My goal as a dietitian is to make sure that people find a way of eating that works best for them in order to achieve their own goals.
 


References:

1. Boden G, et al. Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with Type 2 diabetes. Ann Intern Med. 2005 142:403-411
2.Westman EC, et al. Low carbohydrate nutrition and metabolism. Am J Clin Nutr. Aug 2007; 86(2): 276-284
3. Spreadbury I. Comparison with ancestral diets suggests dense acellular carbohydrates promote an inflammatory microbiota, and may be the primary dietary cause of leptin resistance and obesity.  Diabetes Metab Syndr Obes. July 2012; 2012(5):175-189
4. Lopes IM, et al. Effects of Leptin Resistance on Acute Fuel Metabolism after a High Carbohydrate Load in Lean and Overweight Young Men. J Am Col Nutr. Dec 2001; 20(6)
5. Banks WA, et al.  Triglycerides induce leptin resistance at the blood-brain barrier. Diabetes.May 2004;53(5):1253-60
6. Hansen, BC. Calorie restriction: Effects on body composition, insulin signaling, and aging. J Nutr. 2001:131, 900S-902S