Monday, June 11, 2012

How Many Meals a Day Should You Eat?

"Should" is such a strong word.

Looking to the evidence base isn't much help either as there's plenty of evidence to support pretty much each and every eating style, modality, and diet.  Moreover, I'd argue that even if the evidence did firmly fall into the camp of one style or diet being "the best", that wouldn't change the fact that following it may prove non-enjoyable (and hence non-sustainable) to many.

"Should" presumes that everyone is the same. Same genetics, same co-morbidities, same lifestyles, same likes, same dislikes, same, same, same.

The thing is we're not all the same.

In my practice we tend to start people on 3 meals and 2-3 snacks a day, all inclusive of protein and at least 300 calories a meal and 100 a snack. We do that because experientially with us, for a great many folks, that spread has proven helpful in reducing cravings, hunger and struggle, and for busy people with jobs and young families, it's often more practical than larger, less frequent meals.

But it's not useful for everyone!

We have other folks on 3 square meal a day regimes.

I've even suggested an intermittent fasting (IF) style 2 meals a day to folks whose lifestyles and struggles suggested they may be well suited to it.

And as far as dietary style goes we've had Paleo folks, classic low-carb'ers, vegetarians, vegans, low-fat fanatics and certainly everything in between.

In my clinical practice, I'm not married to anything other than a person living the healthiest life they can honestly enjoy.

Those folks who firmly believe everyone "should" be doing things a certain way? That there's one "right" way to diet; one "right" way to eat; one "right" form of exercise; one "right" road to health?

I think they're wrong.

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  1. Alexie7:44 am

    Perhaps what's more important than the (culturally determined) number of meals is whether there's a routine around them.

  2. I think it's important to emphasize that the number and frequency of meals has no meaningful impact on metabolism. While some people may do better on that regimen for behavioral reasons, the myth that eating more frequently speeds up your metabolism does more harm than good.

  3. Christina RD9:25 am

    I'm a mental health dietitian and the majority of clients I see who are struggling with their weight eat very little during the day, often just coffee, and they are completely starving by dinner and they snack excessively after dinner when they are sedentary for the evening. It is very difficult to convince people that eating regular meals will help them lose weight. If you allow yourself to get too hungry you will not make very healthy food choices. Blood sugar drops every 4-6 hours after meals. Your energy level, mood, concentration etc is enhanced by regular meals. People who eat breakfast tend to have higher fibre and calcium intakes. It's called "break fast" because it's the longest the body goes without getting fuel. You can't manage to get all your fruit and veggies if you don't eat until five pm. I am working on making a handout now with charts to show how your activity level is higher throughout the day and how you should fuel as you go with regular meals, rather than only eating when you are sitting at night.

  4. Christina RD9:29 am

    Found this on WebMD:

    According to research, skipping meals, especially breakfast, can actually make weight control more difficult. Breakfast skippers tend to eat more food than usual at the next meal or nibble on high-calorie snacks to stave off hunger. Several studies suggest that people tend to accumulate more body fat when they eat fewer, larger meals than when they eat the same number of calories in smaller, more frequent meals. To teens, especially teenage girls, skipping breakfast may seem like a perfectly logical way to cut down on calories and lose weight. It's important for moms to educate their kids about the importance of the morning meal and the role it plays in maintaining good health and preventing obesity.

    1. Anonymous10:23 am

      Why just moms educating?

    2. "Several studies suggest that people tend to accumulate more body fat when they eat fewer, larger meals than when they eat the same number of calories in smaller, more frequent meals."

      Here's one study (Stote KS, et al, 2007) that shows something different in a 1 vs 3 meals comparison:

      "Subjects who completed the study maintained their body weight within 2 kg of their initial weight throughout the 6-mo period. There were no significant effects of meal frequency on heart rate, body temperature, or most of the blood variables measured. However, when consuming 1 meal/d, subjects had a significant increase in hunger; a significant modification of body composition, including reductions in fat mass; significant increases in blood pressure and in total, LDL-, and HDL-cholesterol concentrations; and a significant decrease in concentrations of cortisol."

      (Note on the change in BP, in the study the BP was taken in the late afternoon for the 1m/day and early morning for 3m/day, so circadian rhythm explained as the possible reason for that change. Cholesterol change not be explained.)

      So no real changes in weight and actually better fat mass reduction in the lower meal frequency at maintenance levels.

      I agree that people who skip breakfast AND eat more overall because of increased hunger/cravings will gain more weight overall. For that reason skipping breakfast is a bad idea.

      However that's not to say if one can control hunger and rebound eating on lesser frequency of meals that it is worse, as there is no solid science to back that claim up. In fact you may find better overall results with lesser meal frequencies when looking at glucose and insulin responses overall.

      I start my day with coffee and coconut oil, keeps me full, then I eat 2-3 meals after lunch. Works for me, and people should find what works for them.

  5. I think this is a very important post. Trying to dismiss the furtive guilt that many people feel about various foods, body weight etc.

    Engage the brain...think...about eating as a pleasant activity engaged in mindfully. Not just stuffing food into one's mouth while doing something else.

  6. From an ancestral perspective, the requirement to eat every couple of hours would not be particularly advantageous. And culturally, the 5-6 meal pattern is very, very recent.

    People managed to not have wild blood sugar swings without their 100-calorie snack packs 100 years ago. I think it's worth considering a WOE that enables us to do the same!

    1. Fortunately we now have the luxury of focusing on "thrive" instead of just "survive"!

    2. Not sure that having to be concerned about crashing because you're sugar-dependent is "thriving" though.

  7. Long before worrying about the number of meal, they should get off all sugars, fructose,lubricants and grains. That leaves meat and vegetables. After their appetite stabilizes, then you can see where they are at. Getting off sugars, fructose, lubricants and grains is enough for many to lose considerable weight. Selling the total get off approach is where the difficultly lies, but it greatly reduces appetite. All fruit must also go for some of us.

  8. I find meals that enable me to eat every 6-8 hours are best, and a little bit of fat and protein and whole grains go a far way. If I need to snack, I eat fruit and/or nuts. I tried eating lots of little meals, too inconvenient, more prep than I like, and I ended up eating more. I generally keep dinner as the smallest meal of the day, and eat a few fruits at this time.

  9. Anonymous11:01 am

    I'm enjoying how many people are leaving diet advice as comments given your post.

    1. It just proves his point that there are no cookie cutter solutions to weight loss and everyone has to figure out what works best for them.

    2. jrochest12:50 am

      And not just diet advice, but prescriptive diet advice: "This is the ONLY! WAY!"

  10. Anonymous12:41 pm

    As Yoni says, it's a good place to start because it is usually helpful, and then you go from there. Maybe obesity is increasing partially because people aren't finding time for healthy planned meals!

  11. Anonymous1:46 pm

    Dr. Freedhoff,

    Can you share how you used IF in your practice?

    1. So far no one's taken me up on trying IF.

      Using Martin's style in terms of structure but whenever I suggest patients just haven't felt it doable for their schedules/lives.

    2. Anonymous6:52 pm

      I use Martin's IF (about 1.5 yrs now), and what I've found is only a loss of a couple of pounds, but visibly (and measurable) less circumference around my waist and thighs. I was normal weight to start and am not a gym bunny, but at almost 40, was getting squishy as my body composition changed. It SO fits my schedule and I always found eating regularly throughout the day a PIA.

    3. Doyen1:39 pm

      I've done the '2 meals a day' thing and it has worked quite well for me. From the time I wake I wait 6 hours, then I eat my largest meal. (roughly 1000-1200 calories) From there it is 5 hours until my next meal which is smaller. (roughly 500-600). So I am effectively fasting for 19 hours each day.

      At all other times no food, only plain water. (Although I do give myself more latitude to eat more often on Sundays, which allows me to rid myself of any cravings.)

      I started in January of 2010, and since then I have dropped almost 110 pounds, and went from a BMI of 45 to just under 31.(I'm 184cm tall)

      I've hit a plateau now, and what used to be a drop of a pound a week over two years has dropped to a pound a month now in year 3. So it would seem this kind of eating plan would only be effective for those who are at the higher end of the scale.

      However I plan to continue this style of eating indefinately, since I have no problem tolerating it, and I don't eat 'special' foods. I consider this my 'normal' way of eating, and I don't find myself hungry at other times of the day.

  12. What's just as important is to consider what you are eating. Many healthy snacks throughout the day is better than a few binge sessions of fatty foods. You also need to consider your activity level. If you are very active you will need more food to keep your energy level up.

  13. Anonymous2:19 pm

    Exactly my thoughts. I do best on lots of vegetables, lean meats and reduce my fats, watch my carbs. I don't find I really require snacks. I do tend to want snacks if I'm tired, so if it's possible, when I have a craving, I should likely take a nap. This being said, even though I eat this way, I'm still very overweight. The only time I lost weight was when I starved myself (read: measure your lettuce). Of course, weight all came back. So, I'm resigned to being as healthy as I can be.

    1. Can you take up a sport or activity that may help? Totally anecdotal, but at 54 I took up rowing. I believe it changed my life. I have made some fast friends and, almost incidentally I'm in great shape. Still on the top of the healthy BMI scale, but who cares! I got fit, my knees are in the best condition they've been in years and I found a fun activity.