Wednesday, January 30, 2013

Does New Study Settle the 3 Square vs. 6 Small vs. the 8 Hour Diet Debate?

So this month yet another study in a never-ending line of studies looking to compare the impact of meal frequency on fullness and biochemistry came out. This one suggested that small frequent helped decrease energy intake in normal weight men.

Honestly I pretty much disregard all of these studies.

Not because I'm doubting or questioning their results, just that I don't think their results really matter.

What I mean is that all of these studies fail to address the practical aspects of living with their recommendations, and as a clinician, that's really all that matters to me.

I've seen people controlling calories, loving life and preserving health with 6 small meals daily. I've seen people do the same on 2, 3, 4, and in some cases even 1 meal a day.

Regardless of the research that comes out, what matters more than what a physiology paper says is how you personally feel.

In my office we do tend to start people on small and frequent meals and snacks. But if that doesn't suit or help the individual we'll shift to 3 square meals. We've also recommended the intermittent fasting style that's suddenly finding some traction on the diet book shelves.

You need to find a life that you enjoy, and just because a new study or diet book suggests there's a "better", or "right", way, if you don't happen to enjoy it, it just isn't going to work.

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18 comments:

  1. I wonder if frequent feedings cause more dental caries and periodontal disease, compared to 2-3 meals a day. It's possible that coating the teeth with carbohydrates 5 times a day promotes dental disease.

    (Yes, I could do a Medline search at PubMed, but I'm too lazy.)

    -Steve

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  2. RE Steve - I've had multiple dentists tell me it is the frequency of teeth's exposure to fermentable carbohydrate that determines tooth decay, (Sugar being the worst offender of course...but also starches) more than total amount of fermentable carbohydrate teeth are exposed to. This is one of the main reasons I'm not a big fan of high meal frequencies. Dental health is VERY important, and I think an oft neglected area of concern when designing or implementing eating plans. Any eating plan which increases rates of dental decay significantly is de-facto sub-par in my opinion.

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  3. Sharon8:16 am

    So this study took two whole days with 20 men and fed one group on an alternate day one meal and then lunch four hours later. The second group on alternate days ate the same amount of calories but was eating every 60 minutes and was less hungry (by around 60-80 Kcal) at the lunch buffet? Gee........what a shock. If I was eating every 60 minutes, I'd probably be less hungry too. Real life implications....you might SNACK on junk every 60 minutes, but no one is going to prepare healthy food divided up into little portions like that for an entire day. Wonder how much was spent on this amazing study? :-((

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    1. Anonymous5:24 pm

      Fine, I'll bite..

      It's really impossible to imagine having a healthy snack every 60 minutes instead of junk every 60 minutes? It's impossible to imagine spending 5 minutes in the morning or evening to prep things like grapes (rinse well, dry, toss in tupperware), veggies (rinse and peel a carrot and chop into slivers), and a few almonds to go into your work bag along with your lunch, instead of eating junk every 60 minutes? I personally agree that snacking every hour is a bit onerous, but if you're going to be eating that often anyway, healthy food doesn't need to be a much bigger time commitment!

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  4. Anonymous9:28 am

    There are many reasons why eating regularly (at least three meals, with possibly 2-3 snacks) is beneficial. Fueling the body throughout the day improves energy level and mood and significantly reduces the odds of getting too hungry and overeating later in the day. People who eat breakfast tend to have a higher fibre intake and higher nutrition intake overall, in addition to improved concentration and energy. Drinking a lot of water and chewing sugarless gum can help maintain healthy teeth in addition to flossing every day.

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  5. I'm so glad to see this post! All these studies for so many people simply become like a distraction. For people who deal with their weight for years and decades, falling into this trap of believing there's some new study or tip or small change or supplement that holds the key---it all ultimately distracts them away from looking at their own lives and making real world practical changes that will work FOR THEM.

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  6. Anonymous9:58 am

    I've found that eating small frequent meals doesn't work for me and believe me I've tried. I have been following something similar to the 8 hour diet for the last 6 months and this has been the key to keeping my weight where I want it. I only eat between the hours of 12:00 and 8:00, period. I have been on Weight Watchers for the last 2 years and am maintaining a 35 pound weight loss. When I eat breakfast I want to eat all morning. When I don't eat till noon then I am able to control the number of calories I consume on a daily basis. I do work out every morning in a fasted state and I do take BCAA while fasting and that seems to take care of the hunger. I have my body fat measured regularly and I am maintaining my muscle mass and losing fat. I agree that you need to find what works for each individual. This has been the key to finding something I can live with on a long term basis.

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  7. I think the macro-nutrient content (among many other factors) of the meals that are consumed will have a large part to play in how many meals people need to consume to be satisfied. I wonder if Anonymous 9:58AM ate a breakfast with mainly protein and fat whether they would reduce the desire to continue eating throughout the morning? I can imagine a carbohydrate-rich breakfast leading to this type of issue.

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  8. I'm glad you said it! People fall for study results all the time - but you really do need to find something that works for you and stick to it! Simple! Glad we got a health professional on our side (registered dietitian side!)

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  9. Liana5:52 pm

    You mentioned that you've recommended intermittent fasting at times. Could you say a bit more about this or point to some reading/info? thanks

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    1. There are two main styles (and I'd bet many others I'm not aware of). Martin Berkhan's Lean Gains which at its barest may be described as 16 hours off eating followed by 8 hours on, and Brad Pilon's Eat. Stop. Eat. which can be described as 1 or 2 24hr fasts a week interspersed with thoughtful eating. Go on and have a peek!

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    2. Liana6:09 pm

      thanks! I will.

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    3. Mark Sisson and others also advocate listening to your body and simply not eating if you aren't hungry but in a less regimented way than Pilon or Berkan suggest. For instance, if you aren't hungry at breakfast, you simply take a pass, or maybe have a coffee or tea and be on your way.

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    4. Yoni, when I click on the links, it says the page I'm looking for doesn't exist on the blog.

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    5. Anonymous12:50 pm

      Yoni, I'm impressed that you pulled out LeanGains. You're more current with what the performance oriented people are reading than I thought! I was under the impression that you mostly concentrated on the general public/weight loss side of things.

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  10. Not sure what that happened. Should be www.leangains.com and www.eatstopeat.com

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  11. Hi Dr. Freehoff

    I can appreciate how what you face dealing with patients matters more to you than just published research. That is an enromously important point that most bloggers ( who are not medical doctors) do not consider at all.

    A doctor with vast experience (30 years plus etc.) who has seen something happen time and time again in patients counts for something. Their intuition counts as well. That is somehting non- doctor laymen, as well as people who are strictly research scientists working in a laboratory cannot truly appreciate.


    Sometimes the way things pan out in the real world is different. Medicine is just as much an art as a science. I can appreciate the art part.

    Tak care,
    Raz

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  12. I very much agree with you: the diet that works is the one suiting the person and their unique preferences. Too many people, however, prefer to go after the latest popular diet, instead of recognizing their own individual needs.

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