Monthly Archives: July 2019

Intuitive Eaters Should Depend on Brain and Stomach

Eating what and when you feeling like eating is one of the attractive aspects of intuitive eating, a program that contradicts traditional instructions about food choices, calorie content, timing of meals and snacks, and portion size. The concept is simple: Pay attention to hunger signals from your stomach, i.e., such as actually feeling hungry, and then eat. Consume what you want and of course, try to make healthy choices, but if you want to eat something that is not particularly nutritious, that is fine, too. Don’t let guilt motivate your decision to eat or not to eat a particular food, and just as important, don’t let emotions affect your eating.

According to Laura Hartung, a registered dietician in the Boston area and one of the proponents of this eating method, you should make sure that your hunger, and not your emotions, is what’s driving you to eat. Indeed, she claims that if you ignore your emotions, you will learn to, ”Choose foods that make you feel energetic and good.” Apparently we shouldn’t be eating out of a need to feel better; i.e. less unhappy, but if we choose the right foods, we will feel better or “good,” in her words.

The intuitive approach makes sense. If we eat only when we are hungry and just as important, stop when we are full, we would or should lose weight and never be vulnerable to overeating. This approach eliminates following instructions in a weight-loss program or eating only pre-packaged calorie-controlled meals or drinks. Indeed we revert, in a sense, to eating as infants do, i.e., responding to signals generated by our bodies to drink to replenish water loss, and to eat to restore calorie loss. And as we become sensitive to these signals, we may even choose foods based on our bodies’ particular needs. For example, when protein or vitamin requirements increase after an infectious illness, we may experience a specific hunger for eggs or oranges. Whether or not the approach will produce significant weight loss is still being investigated. An early report suggests that is does not.

But the intuitive eating approach disregards, or perhaps is not aware of, the relationship between nutrient intake, the brain, performance and mood. The brain, not the stomach, both influences and is influenced by what we eat. Alcohol is a familiar example. Many people feel different after drinking alcohol, either energized, voluble, hypomanic, less stressed, depressed, angry, tired or sleepy. For some, the need to drink is generated by the brain in order to bring about these behavioral states. Should alcohol be eliminated from the diets of intuitive eaters, because drinking is not generated by hunger?

High-fat foods like cheese, sausage, biscuits, ice cream, and cheesecake, so tempting to those freed from the restrictions of calorie counting, are appealing to intuitive eaters. But they may not realize how eating these and other high-fat foods may affect their performance and mood. According to a study by a group of Australian researchers, consuming large amounts of fat at a meal increases daytime sleepiness. The report cited other studies linking sleepiness after the consumption of a high-fat, low-carbohydrate meal.

Shouldn’t intuitive eaters be aware that their food choices might influence their ability to carry out a job requiring alertness and attentiveness?

Intuitive eating’s emphasis on attending only to hunger signals emanating from an empty stomach ignores the possibility that signals from the brain may also be directing the individual’s food choices. Women who experience the mood and appetite changes of premenstrual syndrome (“PMS”) have well-established cravings for carbohydrates, especially sweet carbohydrates. Hunger for these foods does not originate in the stomach, but in the brain due to alterations in serotonin activity. Consuming carbohydrate-rich foods has a well-documented positive effect on the mood and cognitive changes of PMS; women who instinctively (intuitively?) choose carbohydrate foods are responding to brain, rather than stomach, “hunger.”

However, if the premenstrual woman does respond to these brain-based hunger signals, she is not following the objectives of the intuitive eating program, because her food choices are related to her premenstrual mood, not hunger.

Intuitive eating also overlooks the hungers produced by antidepressants, mood stabilizers and anti-psychotic drugs. The urge to eat often occurs even when the stomach is still filled with food, because the drugs seem to weaken satiety signals from the brain. Some patients feel the need to eat another meal an hour or so after completing a previous one.  This side effect of their medication is not related to stomach hunger, and thus eating intuitively is unlikely to help these patients counteract the effect of their drugs on their food intake.

That said, intuitive eating is liberating for so many struggling with excess weight. It tells us to stop paying attention to claims about what foods to eat or avoid, to view foods as not only nourishing, but also a source of enjoyment and to stop mentally calculating calories and their impact on our weight tomorrow.  It brings us all a little closer to the way we should be viewing food.


“Assessing the effectiveness of intuitive eating for weight loss – pilot study,” Anglin, JC, Nutr Health. 2012 Apr; 21:107

 Cao Y, Wittert G, Taylor A, et al., “Associations between Macronutrient Intake and Obstructive Sleep Apnoea as Well as Self-Reported Sleep Symptoms: Results from a Cohort of Community Dwelling Australian Men,” Nutrients 2016, 8(4), 207

Wurtman J, Brzezinski, A, Wurtman R, “Effect of nutrient intake on premenstrual depression,” Am J Ob Gn l989 161:1228

If You Use a Personal Trainer, Will You Also Exercise Alone?

As I was changing in the locker room, a woman entered wiping her face with a towel and sighing, “ Thank God that’s over.“ She sat down on a bench looking exhausted.

“Training?” I asked. “Of course,” she answered.  “I hate it, but I know it is good for me. I would never exercise if I didn’t have to meet with my trainer three times a week. In fact, she is going on maternity leave in a couple of weeks, and I am going to have to force myself to come to the gym.” “So you don’t work out on your own?” I asked.  “Never,” came the immediate answer.

I assumed that she had had been going to the gym only recently and depended on her trainer to teach her how to best use the equipment and balance her strength training with cardiovascular workouts. But no, she had been using this trainer for 5 years and earlier, another trainer associated with a gym to which she used to belong.

Obviously using a personal trainer engaged her in sufficient physical activity to keep her fit and confer all the benefits that regular exercise brings. But I wondered how it was that she could not make the transition to exercising on her own. She was not a beginner, she felt comfortable in the gym and, after so many years, knew the routines her trainer put her through.

Was having a personal trainer preventing her from exercising by herself? She reminded me of dieters who are able to restrict calories, adhere to portion size, avoid unhealthy foods and eat the recommended number of vegetable servings each day only when eating the packaged foods of a commercial weight-loss plan, or when checking daily with a nutritionist or other support individual. Indeed, such a dieter finds it difficult to make the transition into eating in such a way so as to maintain the weight loss while being compatible with the dieter’s normal lifestyle (no one eats diet packaged foods forever). Without supervision, often the dieter can’t or won’t avoid excessive portion sizes, highly caloric foods, or eat the required daily servings of high fiber, vegetables and fruits.

The woman in the locker room confessed that she doubted she would return to the gym until her trainer did because she could not make herself exercise with the same intensity and pain.  I suggested that exercising need not be punitive in order to be effective. Perhaps she might enjoy a class (the gym offered many), use some of equipment like the rowing machine, which she never used with the trainer, or join a group that ran together on treadmills.  The summer weather filled the nearby river with kayakers, and the streets with bicyclists and runners, so exercising outside was another alternative.   She looked unconvinced and soon left.

Exercise physiologists and physical therapists, those professionals with knowledge and experience of how best to exercise without injury, can be extremely helpful for the exercise beginner, for those with special needs such as balance problems, recovery from orthopedic surgery, or someone training for a competitive event like a long-distance bike ride or road race. Yoga and Pilates instructors strengthen our bodies, improve our posture, breathing and balance, and are also important in a comprehensive exercise program. A friend recovering from a minor stroke dedicated two years to working with a personal trainer to improve her stamina, a Pilates instructor to improve her balance, and a water aerobics instructor to strengthen her muscles without risking injury.  These professionals restored what she had lost from her stroke and she met her goal of exercising, finally without their supervision.

But the woman in the locker room had no such goal. She made her trainer responsible for seeing that she exercised, and if the trainer didn’t show up or was unable to work, she didn’t.  Her attitude is not unique. I have many weight-loss clients who told me that they used to work out when they had a trainer, but since they don’t have one anymore, they haven’t been exercising at all.  It is as if all the exercise routines they went through, sometimes for months or even years, had no lasting impact on their desire to exercise to engage in any kind of physical activity.

Is it possible that one reason someone seems unable or unwilling to exercise without supervision is that he or she can’t make the transition from being trained to exercising independently?   Does it occur to the individual walking on a treadmill under the watchful eye of a trainer that he or she could also walk outside? Does the trainer suggest ways in which the client might incorporate more walking rather than driving into a daily routine, or use it as alternate form of exercise on the days training doesn’t occur?  Would the woman in the gym be willing to apply her many hours of doing balance exercises to bike ride, rollerblade, ride a scooter, or participate in a yoga or ballet (barre) class?  Might the arm and back exercises she does in the gym make it easy for her to go kayaking, swim or play tennis or golf?  Would she consider entering running races, or going on walks to raise money for charities since her training has increased her stamina?

There is a saying among athletes: use it or lose it. When exercise stops for whatever reason, muscle mass, stamina, and skill decreases. If the woman in the locker room stops her exercise, she loses something else as well, namely a body fit enough, with sufficient stamina and coordination, to enjoy whatever physical activities she might want to do.  And that is a loss that should be prevented.