John Murphy, for MDLinx | with comments/edits by Dr. Saleeby, MD
Intuitive eating sounds so simple that it’s hard to believe it can help you maintain a healthy weight: Eat what you want, but only when you feel hungry, and stop eating when you are no longer hungry (not when you are full). A subtle but rather important distinction between not feeling hungry and feeling full. Here’s what it’s about and how it works.
Intuitive eating, simply put, means eating when you feel hungry and stopping when you are not hungry any longer.
Intuitive eating was defined nearly 25 years ago by two registered dieticians—Evelyn Tribole, RDN, and Elyse Resch, RDN. They define intuitive eating not so much by what it is as by what it isn’t. It isn’t an “eat-this-not-that” kind of diet. It isn’t even a diet, at least not in the same mold as the Grapefruit Diet, the Atkins Diet, the South Beach Diet, the Paleo or the Keto diet, or any of those.
In fact, it’s more of an anti-diet. I usually say that diet is a four-letter word and when patients ask, I usually defer a specific diet and get them to read books on nutrition, not just the latest fad diet of the day. You don’t count calories. You don’t eliminate any particular foods. You don’t follow any schedule, table, or program. According to Tribole and Resch, intuitive eating is a reaction to “diet culture and weight obsession.”
“There is not a single long-term study that shows that weight-loss dieting is sustainable. Study after study shows that dieting and food restriction for the purpose of weight loss leads to more weight gain,” Tribole writes. “Worse—the focus and preoccupation on weight leads to body dissatisfaction and weight stigma, which negatively impacts health.”
Its originators make it very clear that intuitive eating is not intended to be a weight-loss method. Instead, they describe it as a “weight-neutral model.” You may not lose weight, but intuitive eating shouldn’t cause you to gain weight, either. But in fact you are likely to lose weight given any other obstructions such as inflammation, abnormal hormone HPA-axis disruptions, stress, lack of sleep, etc. have been eliminated.
“Rather than focus on weight, the focus of [intuitive eating] is on cultivating healthy behaviors, period. Bodyweight is not a behavior,” according to Tribole.
Emerging research appears to support this. In a systematic (the link for those readers wanting to see the article directly: https://www.sciencedirect.com/science/article/abs/pii/S0195666315300635), independent researchers concluded that intuitive eating “was associated with less disordered eating, a more positive body image, greater emotional functioning, and a number of other psychosocial correlates that have been examined less extensively.”
10 tenets of intuitive eating
Instead of counting carbs, adding up points, or going on intermittent fasts, people who get on board with intuitive eating follow a list of 10 principles of Intuitive Eating (https://www.intuitiveeating.org/10-principles-of-intuitive-eating/) that serve as guidelines for the process. The first principle must be tackled before any of the others. But after the first one, the rest can be done in any order.
- Reject the diet mentality.Tribole and Resch use the term “diet” to describe fad diets, celebrity diets, restrictive diets, etc. They say these leads to yo-yo weight loss and gain, loads of unnecessary stress, and thinking of foods as either “bad” or “good.”
“Throw out the diet books and magazine articles that offer you false hope of losing weight quickly, easily, and permanently,” they write. Clinging to even a sliver of this false hope prevents any chance of undertaking intuitive eating.
- Honor your hunger. Do you feel hungry? Then it’s time to eat. Recognize the biological signal of hunger and “honor” it, the authors advise.
The trick is to distinguish the internal physiologic cues of hunger (termed “interoceptive awareness”) from emotional cravings for food. This may take time, and some people can do it more easily than others. Not to worry—strive for progress, not perfection, the authors say.
- Make peace with food. Food is not the enemy. “Give yourself unconditional permission to eat. If you tell yourself that you can’t or shouldn’t have a particular food, it can lead to intense feelings of deprivation that build into uncontrollable cravings and, often, bingeing,” they write. And then bingeing leads to unwarranted guilt. The diet for your blood-type is a bunch of hooey as there are millions of genetic factors that are in play other then your ABO blood type; avoidance of nigh-shades is exaggerated and overrated; and finally all wheat is not bad, the decade old avoidance at all cost of gluten has led to the consumption of Gluten Free (GF) products that may actually be more harmful.
- Challenge the Food Police. Because of dieting’s rules and reprimands, the Food Police have set up a perimeter deep in a dieter’s psyche. The Food Police tell you that you’re “bad” for eating that piece of chocolate cake and you’re “good” for eating your spinach. When the food police start legislating dietary demands in law that is very dangerous and frankly unconstitutional.
“The Food Police monitor the unreasonable rules that dieting has created,” Tribole and Resch explain. Ignore the Food Police. Better yet, chase them away. Vote the proponents for a nanny state for food laws out of office.
- Respect your fullness. Get familiar with the feeling of satisfaction (no longer feeling hungry). Know when your hunger has gone. “Pause in the middle of a meal or food and ask yourself how the food tastes, and what is your current fullness level?” the authors advise. If the food does not taste good any longer like flavor ranked as 100% or A+ then STOP. If you are no longer hungry, push the plate away, even if it is still 1/3 full. You will not be hurting starving children in China as your parents eluded to when you were 5-years old.
- Discover the satisfaction factor. Take pleasure in eating. It can be a “powerful force in helping you feel satisfied and content,” write Tribole and Resch. And when you do this, you’ll notice that it takes much less food to tell you you’ve had enough. Eating in many cultures is a social event. Fast Food in the Western world destroyed this. Get back to Slow Food where partaking in food for nutrition is coupled with a meal with friends and a social experience. This socialization around food is very health for the body and mind. In Italy where social meals are taken very seriously and can go on for hours they formed the Slow Food Society and there are hundreds of conviviums all over the world now (https://slowfoodusa.org/ for more on that organization). I was a founding member of a convivium in Savannah, GA and Conway, SC back in the day and am a member of the Charleston Slow Food group.
- Honor your feelings without using food. Everyone gets feelings of anxiety, loneliness, boredom, stress, and anger. “Food won’t fix any of these feelings,” they assert. “If anything, eating for an emotional hunger will only make you feel worse in the long run.” You’ll not only have to deal with problem causing the emotion, but also the discomfort and discontent from overeating.
- Respect your body. “Just as a person with a shoe size of eight would not expect to realistically squeeze into a size six, it is equally as futile (and uncomfortable) to have the same expectation with body size,” Tribole and Resch write. So, don’t be unrealistic and overly critical about your body shape. In an era of body consciousness and body dysmorphic syndromes, one has to be happy with them selves from the inside out. Don’t let the model on the cover of Vogue magazine dictate what you should look like; most of those folks are not healthy on the inside.
- Exercise—feel the difference. “Forget militant exercise. Just get active and feel the difference,” they advise. Focus on how being active makes you feel—do you feel more positive, more energized? Bullying yourself to go out for a 5-mile run to burn X number of calories is just not as motivating. CrossFit and other bootcamp exercise program are not ideal for the vast majority of folks and can actually be dangerous and counterproductive. Walking, cycling, swimming and light weight training is probably the best. In some cases, avoiding the gym may be safer to avoid exposure to germs and those topical hormone resides left on gym equipment. Overtraining can stress out the HPA-axis for many folks and the ones who get that bid dopamine rush (exercise addicts) may be most susceptible to injury.
- Honor your health with ‘gentle nutrition.’ You don’t have to eat a perfect diet to be healthy. “It’s what you eat consistently over time that matters,” Tribole and Resch explain. “Make food choices that honor your health and taste buds while making you feel well.”
For your own benefit, ignore this particular benefit
Even though intuitive eating specifically disregards weight loss, it might indeed help an individual lose a few pounds. For instance, some researchers have shown that Intuitive Eating is associate with Lower BMI (https://onlinelibrary.wiley.com/doi/abs/10.1002/oby.21440).
“This is relevant for health practitioners who are concerned that letting people eat whatever food they desire (unconditional permission to eat) would lead to weight gain,” Tribole acknowledges. But she cautions that promoting intuitive eating as a method of weight loss can undermine and interfere with the process—and even backfire on those who try it.
So, like all things be careful and not every recommendation works for everyone. There are many factors to take into account and it is the personalized and unique recommendations that Functional Medicine practitioners provide for their patients that work best versus the EBM large clinical studies that back “one size fits all’’ recommendations that tend to permeate our current healthcare system. Remember the large double-blind placebo controlled clinical trials are an average signal for maybe thousands included in a trial and the results are a statistical average; but as an individual patient do you fit into that average, possibly not. So, providing guidance to a single patient based on a large-scale study must be used with caution. This is has been stated by physician and neuro-researcher Srini Pillay, MD in some of his writings and interviews.