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Intuitive Eating vs. Carbohydrate Restriction

10/8/2012

14 Comments

 
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

14 Comments
Dan Brown link
10/8/2012 02:25:47 am

Franziska,
Very good explication of the "take exception" POV, for those of us who are glucose intolerant, or developing insulin resistance, or of the genotype that is susceptible to the above and are overweight and gaining -- which includes millions and millions (10s of millions) of people around the world.

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Franziska link
10/8/2012 03:56:19 am

Thank you so much, Dan! Appreciate your comments and support.

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Amber link
10/8/2012 05:36:41 am

This is a great article. I would like to argue with one point, though. I don't believe that chronic mild caloric restriction, as defined by being slightly hungry much of the time is healthy. Hunger is there for a reason.

CR may be healthy compared to eating to a satiety on a standard American diet, but that's not the best we can do. It seems that all of the putative mechanisms of the benefits derived from calorie restriction are also triggered by ketogenic diets without calorie restriction. Moreover, caloric restriction has potential disadvantages that ketogenic diets do not, including loss of muscle and bone mass, inadequate production of sex hormones, inducing loss of libido and other problems, and mood disturbances.

Here are just a couple of relevant references:
Common mechanisms of CR and ketogenic diets: THE NEUROPROTECTIVE PROPERTIES OF CALORIE RESTRICTION, THE KETOGENIC DIET, AND KETONE BODIES http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2649682/
Risks of CR: Caloric restriction in humans: potential pitfalls and health concerns. http://www.ncbi.nlm.nih.gov/pubmed/16226298

Reply
Franziska link
10/8/2012 07:04:26 am

Hi Amber,

Thank you so much for your response. I'll admit that I don't know as much about the adverse effects of caloric restriction as I'd like, so I greatly appreciate your sharing those links with me. Great website, by the way!

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Dan Brown link
10/8/2012 10:02:31 am

Franziska, your parenthetical comment,"a healthful practice, particularly with respect to longevity, with respect to your personal advocacy of a "chronic mild caloric restriction," recalls in my memory some modern research that supports that observation; however, from the titles of the references you list, it is not obvious to me if your source is one of those cited. I'm thinking of blogging on this subject and wonder if you can point me to a source. I believe Taubes covers it in GCBC, but do you have another?

Reply
Franziska Spritzler link
10/8/2012 11:26:44 am

Hi Dan,

No, I didn't cite any studies for that assertion but should have. Thanks for the reminder :)

I've now cited one study (No. 6) regarding caloric restriction. I think you may also find the first article referenced in Amber's comment very useful.

Reply
gibson girl
10/10/2012 10:36:33 am

I agree that what works for one doesn't necessarily work for another. At 62, I'm still learning what works for me. I found if I eat a protein breakfast of whole foods that I go an average of five hours without thinking about food. I'm also losing weight, having made that change from waiting until noon to have a meal. Who knew? My calorie intake probably changed because I'm not munchy in the evening because of this. It's as close to intuitive eating that I have ever been. Carbohydrates without fat and protein definitely trigger me to eat more.

Thank you for this topic. I enjoy your blog!

Reply
Franziska link
10/10/2012 11:20:28 pm

Thanks so much for your comments, gibson girl! Great to hear that you've found your own unique way of eating -- it's what we should all aspire to!

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Nan link
10/23/2012 03:26:13 am

Absolutely agree. I am happy for anyone who finds peace with troubling parts of life, if that leads to better health. For me carb restriction is that peace.

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Franziska link
10/23/2012 11:58:22 am

Thanks for your comments and insight, Nan!

Reply
Melanie Thomassian link
10/26/2012 01:26:52 am

Hi Franziska,
I find it so encouraging to read your article. I am also a registered dietitian, and sometimes I read things that other dietitians have written and I feel they come across as being very close-minded in their advice.

I also believe a lower carb diet is helpful, and this is a view I have come to through my own research and case studies.

I love what you say at the very end, "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." I totally agree with that. Flexibility is really important as we help people attain their life goals.

I look forward to reading more articles from you :-)

Reply
Franziska link
10/26/2012 12:43:17 pm

Thanks so much for your kind words and feedback! I'm always happy to find out about other dietitians who think outside the box and realize that a one-size-fits-all diet mentality is very misguided. Fantastic website, by the way! :)

Reply
Stephen Ferguson link
11/18/2012 02:58:54 am

I think that intuitive eating only really works as part of a low-carb diet. Refined carbohydrates confuse your appetite into responding to sugar rushes and dips (which your metabolism didn't evolve to deal with). Once you reduce your carb intake, you can begin to trust your appetite as a measure of your actua energy need, which is the real basis of intuitive eating. I think that's really why low-carb diets are so effective (much more that the Taubesian insulin hypothesis).

Reply
Franziska link
11/18/2012 05:41:36 am

Hi Stephen,

I completely agree with you on this. Unfortunately, some people who follow a low-carb diet continue to overeat despite improvements in blood sugar regulation, but I think this is the exception rather than the rule. For most, it appears considerably easier to consume an appropriate amount of calories for weight loss or maintenance using a low carb approach.

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