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Intuitive eating
We are bombarded with information on ways of eating in normal life and even more during these unusual times we are living in. We read about emotional eating, mindful eating, internal eating, external eating, intermittent fasting as well as intuitive eating. During times when high stress levels are experienced the last thing we want to tolerate is strict rules for specific ways of eating. Intuitive eating almost appears to be a wellcome way of eating if you have to make a choice.
Intuitive eating was originally defined by two United States Registered Dietitians in 1995 who described ten aspects of intuitive eating including a rejection of ‘diets’, a discouragement of labeling foods as ‘bad’, an encouragement to honour hunger, and allow satisfaction with food intake. It is also referred to as normal eating or adaptive eating.
The traditional approach to weight loss has been to restrict food intake (i.e. ‘go on a diet’) and exercise more. Such an approach, however, is generally unsuccessful in decreasing body mass in the long term. Moreover, there is evidence that dieting, and particularly repeated dieting attempts (i.e. ‘yo-yo dieting’), may be harmful to both physical and mental health. Rates of eating disorders, which may have their origin in low-energy diets, appear to be increasing in recent times. Therefore there is an interest in ways of eating that do not emphasise both food energy restriction and exercise.
Intuitive eating is an approach to eating that is based on trusting the body to guide eating decisions rather than trying to adhere to strict rules of weight-loss diets. In summary it refers to eating based on physiological needs, choosing foods that provide what you need for optimal functioning and removing the restrictions of when and what to eat that are common in traditional diets. In other words it is the ability to recognise the physical signs of hunger, satisfaction and fullness (intrinsic eating). A full range of food possibilities is considered when you choose food that you want to eat (extrinsic eating) unless medical reasons need to be considered. The valuation of health and self-care are crucial outcomes and are more important than appearance. It is postulated that the body intrinsically knows the quantity and type of food to eat to maintain both nutritional health and an appropriate weight. This concept is referred to as 'body wisdom'.
Intuitive eating has been found to have a positive relationship with general psychological well‐being, body image and self‐esteem, and pleasure from eating. Additionally, intuitive eating has displayed a negative relationship with preoccupation with food and disordered eating. Despite these psychological benefits, it may be too soon to promote intuitive eating as a health‐promoting alternative to dieting for weight loss and limited benefits to physical health.
Intuitive eating may have psychological benefit for individuals who have experienced negative psychological or behavioural outcomes of dieting in the past (e.g. chronic dieting and disordered eating), particularly because intuitive eating is consistently linked to positive psychological indices Thus, future research might investigate how intuitive eating may help individuals to establish healthier relationships with food and encourage positive feelings about the self, which may increase the ability to adhere to a healthful eating plan and to be successful at losing and maintaining weight. Lastly, intuitive eating may be able to play a role in improving the maintenance of weight loss
It can be concluded that the implementation of intuitive eating does not result in significant weight loss but may aid in weight maintenance, particularly over the long term, as well as in improved psychological health.
Keirns, NG & Hawkins, MAW. 2019. Intuitive eating, objective weight status and physical indicators of health. Obesity Science & Practice, 5(5): 408–415.
Van Dyke, N & Drinkwater, E. 2014. Relationships between intuitive eating and health indicators: literature review. Public Health Nutrition, 17(8), 1757-1766.
Warren, JM, Smith, N & Ashwell, M. 2017. A structured literature review on the role of mindfulness, mindful eating and intuitive eating in changing eating behaviours: effectiveness and associated potential mechanisms. Nutrition Research Reviews, 30, 272–283.
Intermittent fasting
Intermittent fasting is a popular topic. There is a high level of interest in this topic in the scientific community as well as among the lay public and media. The popular press includes numerous publications, blogs, news articles and diet recommendations related to intermittent fasting.
Intermittent fasting is described as periods of voluntary abstinence from food and drink. It is also known as intermittent energy restriction. It is an umbrella term for various meal timing schedules that cycle between voluntary fasting (or reduced calorie/kilojoule intake) and non-fasting over a given period. Intermittent fasting is an eating pattern that includes hours or days of no or minimal food consumption without deprivation of essential nutrients.
It is an ancient practice followed in a variety of different formats by populations globally. The health outcomes of interest are changes in weight and in metabolic parameters associated with type 2 diabetes, cardiovascular disease, and cancer. In other words anything that may contribute to human health.
There are alternatives for intermittent fasting:
Alternate-day fasting: it involves alternating fasting, during which no calories/kilojoules are consumed, and feeding days, during which foods and beverages are consumed ad libitum.
Modified Fasting Regimens (also called intermittent energy restriction: it specifies that energy consumption is limited to 20-25% of energy needs on regular scheduled fasting days. The term fasting in this case is used to describe periods of severely limited energy intake rather than no energy intake. It is the basis for the popular 5:2 diet, which involves energy restriction for 2 non-consecutive days per week and unrestricted eating during the other 5 days of the week.
Time- restricted feeding: This involves daily fasting intervals ranging from 12 to 21 hours. It also involves skipping breakfast; in others words extending night-time fasting until lunch. The long term metabolic benefits associated with this practice are of great public and research interest.
Religious fasting: Fasting is an important practice in many religions, for both spiritual & physical benefits. This regime will not be discussed.
Most fasting regimens reduce the total numbers of hours available for eating and, thereby, may reduce overall energy intake and risk of obesity. Even a single fasting interval in humans (e.g. overnight) can reduce basal metabolic biomarkers associated with chronic disease, such as insulin and glucose.
Data from human studies are limited regarding the positive impacts of time-restricted feeding on weight and metabolic health. There are limited data linking intermittent fasting with clinical outcomes, such as diabetes, cardiovascular disease, cancer or other chronic diseases, such as Alzheimer's disease. Studies in rodents and other nocturnal mammals support the hypothesis that intermittent fasting and restricting the availability of food to the normal night time feeding cycle improve metabolic profiles and reduce the risks of obesity and obesity-related conditions such as non-alcoholic fatty liver disease, diabetes and cancer.
It appears that almost any intermittent fasting regimen can result in in some weight loss but research has not demonstrated that alternate-day fasting regimens produce better weight loss in comparison to standard calorie/kilojoule restriction weight-loss plans.
This is somewhat contradicting to recommendations for weight loss to frequently eat meals to avoid hunger. Some guidelines also advise the consumption of snacks throughout the day. However, current evidence suggests that periods of fasting do not necessarily lead to overeating.
Scientific evidence for health benefits of intermittent fasting in humans is often extrapolated from animal studies, based on observational data on religious fasting (particularly Ramadan), or derived from experimental studies with small sample sizes.
Several lines of evidence support the hypothesis that eating patterns that reduce or eliminate night time eating and prolong nightly fasting intervals may result in sustained improvements in human health. Prolonged nightly fasting (i.e. restricting food intake primarily to daylight hours) maybe a simple, feasible, and potentially effective disease prevention strategy at the population level.
Intermittent fasting regimens may be a promising approach to losing weight and improving metabolic health for people who can safely tolerate intervals of not eating, or eating very little, for certain hours of the day, night or days of the week. Overall evidence suggests that intermittent fasting regimens are not harmful physically or mentally in healthy normal-weight, overweight, or obese adults.
There is, however, a lack of evidence-based support for intermittent fasting to be used to give guidelines and recommendations for public health benefits.
Patterson, R.E. & Sears, D.D. 2017. Metabolic Effects of Intermittent fasting. Annual Review of Nutrition, 37: 371-393.
Patterson, RE, Laughlin, GA et al. 2015. Intermittent fasting and human metabolic health. J Acad Nutr Diet. 115(8): 1203-1212.