Thursday, April 3, 2008

Intuitive Eating - Book by Evelyn Tribolet and Elyse Resch

I recently finished reading this book and found a lot of extremely useful information in it and wanted to provide a summary of the main points of the book and to point out one or two areas where I do not agree with their conclusions. I definitely recommend reading this book. The authors, both of whom are registered dieticians, define Intuitive Eating as eating what you want without experiencing guilt. They state that we can eat intuitively by listening to our bodies' hunger cues and levels and by not denying ourselves. They discuss their philosophy that dieting does not work, but in fact sets us up for massive cravings and feelings of guilt and failure when we give in and eat more than we think we “should”.

They spend a good amount of time discussing the outlook of those on a diet, which they define as a form of self-imposed deprivation or starvation. This is so because in order to lose weight, we must create a calorie deficit, thereby creating a period of what our under-fed body may interpret as a mini-starvation, to which it responds by intensely asking for more food. Hunger is a real biological urge, it is strong and it necessary to keep us eating, alive and healthy. When we are extremely hungry, we can more easily succumb to an intense bout of overeating as a normal response to the body’s call for more food.

The book asks us to learn what we want to eat, and then eat it. We are counseled to learn what it feels like to measure our hunger level and then eat until we are no longer hungry, but not overstuffed.

These are all good pieces of advice. However, there seems to be a philosophy that if we do this, all of a sudden, we will stop eating too much, start eating the right foods and that magically the weight will start falling off our bodies.

I don’t believe this. I think if we want to lose weight, we need to understand as much as we can about nutrition, and then deliberately create a calorie deficit to achieve it. Yes, we need to know what we like to eat and then give ourselves permission to eat it and enjoy it without guilt. At the same time, if what we want is a high calorie/low nutrition item, we need to have only a little of it and not very often. There must be thought and knowledge behind our choices as well as Intuition and we must take deliberate action to set the stage for a larger energy burn than calorie intake. Yes, we should eat what we want within the realm of all the healthy choices available – right up to the point of meeting our calorie goal. Knowing that number is just the facts, ma’am. We know we’re going to be a little bit hungry because we are intentionally creating that deficit.

Buried in a couple of small sentences in the book is the author’s acknowledgement that some people need to lose weight for health reasons, and that for those folks it may be necessary to embark on a calorie deficit scheme (not a diet).

That being said, the authors offer a lot of really good information about how to identify what foods we love, how to make peace with food and how to overcome emotional overeating. Their discussion of what they call the “Diet Backlash” sheds light on some of the reasons we have a hard time changing our eating habits (especially in reducing the amount of food we eat) as well as modifying the thought patterns that may have kept us stuck for so long.

One quote that sticks out is this one: “Chocolate starts to take on the same emotional connotation as a peach.”

Some key concepts:

1. There is a strong and very real, biological urge to eat. We are hardwired to want to get enough nourishment in the form of food; this food keeps us alive. We are supposed to get hungry and when we are hungry, we are supposed to eat. That’s the biology of it. They refer to Maslow’s hierarchy of needs, and state that “Food and energy are so essential to the survival of the human species that if we don’t eat enough we set off a biological fuse that turns on our eating drive both physically and psychologically.” (More information about Maslow)

2. Deliberately restricting calories in order to lose weight can in and of itself, can cause our brain to stimulate a very strong urge to eat more, because our bodies think they are getting starvation rations. “Dieting is a form of short-term starvation. When you are given the first opportunity to really eat, eating is often experienced at such intensity, that it feels uncontrollable, a desperate act. In the moment of biological hunger, all intentions to diet and desire to be thin are fleeting and paradoxically irrelevant.” In addition, when calories are restricted, you can start to obsess about food.

3. The Diet Backlash. The authors discuss the phenomenon that happens sometimes when we are starting to think about going on a diet, where the mere contemplation of the diet brings on the urges and cravings that sabotage us. They have found that we can fall into what they call “The Last Supper Syndrome” where you gorge on food, and especially your trigger foods, right before you start a diet because you think that it will be your last supper – you think that you will never be able to eat again.

4. We need to rebuild our trust in ourselves with food. They urge us to experiment with foods, trying new foods and revisiting old favorites, so that we truly understand what foods we love and what we don’t like at all. Once we know what we love, we should eat those foods. I would definitely agree with the concept of this, but would add that in many cases we need to retrain our taste buds so that we can learn to love foods that are healthy and shy away from foods that are not. I don’t agree that this will be automatic. Rather, I believe we need to take a deliberate stance in changing our taste, and that once we have made progress, to eat those foods we have taught ourselves to love and that are healthy.

The authors put forward ten principles of Intuitive Eating, which are:

1. Reject the diet mentality
2. Honor your hunger
3. Make peace with food
4. Challenge the Food Police
5. Feel your fullness
6. Discover the satisfaction factor
7. Cope with your emotions without using food
8. Respect your body
9. Exercise – feel how good it makes you feel
10. Honor your health

Principle 1 – Rejecting the Diet Mentality

We are urged to give up the notion of dieting, because it self-imposed calorie restriction can trigger overeating. When we believe that we won’t be able to eat again, it’s harder to stop eating once we begin. Dieting can cause us to ignore our hunger cues because we are deciding whether we “deserve” to eat based on our mental calculations of what we’ve already eaten that day. They offer the following set of questions for us to use when we are deciding what or whether to eat:

1. Am I hungry?
2. Do I want it?
3. Will I be deprived if I don’t eat it?
4. Will it be satisfying?
5. Does it taste good?

Of these questions, the one that most intrigued me was the third – “Will I be deprived if I don’t eat it?” If we believe we will feel deprived by not eating the object of our desire, we may end up eating more of something else in a futile attempt to conquer our feeling of deprivation. Principle 3 expands on the feeling of deprivation.

Principle 2 – Honor Your Hunger

Here the authors further discuss our biological drive to eat and our requirement to get adequate nutrition. We need enough energy to fuel our bodies, which we can only get from food. Learning how to honoring the biological signals our body sends when hungry starts the process of learning to trust ourselves with food. The book offers is a great discussion about how the body uses carbohydrates, reminding us that we need to eat carbohydrates. “The brain, nervous system and red blood cells rely exclusively on glucose for fuel”, which we get from carbohydrates. In addition, they urge us not to get too hungry and talk about reasons why we may not recognize real hunger – we may drink water or tea or diet drinks to trick our body for a while, or we just deny hunger until we get used to it. They suggest that we go no longer than five waking hours without eating as a guideline for paying attention to our biology if we have become numb to what honest hunger feels like.

Principle 3 – Make Peace with Food

In this principle, we are exhorted to give ourselves “unconditional permission to eat”. The authors discuss the paradox that once we allow ourselves to eat whatever it is we want our intense urges to eat will abate. Here we must learn to trust ourselves to be able to eat reasonable amounts of whatever foods it is that we don’t allow ourselves to eat, and thereby have strong cravings for. We may find that previously forbidden foods become undesirable once we are allowed to eat them, especially if those foods are available whenever we want them. We learn to trust ourselves with food, since self-trust may have been damaged by early eating experiences, especially if our parents attempted to over-control what we ate.

The authors connect our feelings of being deprived of food to emotions in other parts of our lives: “Deprivation is a powerful experience both biologically and psychologically. Psychological forces wreak havoc with your peace of mind, triggering cravings, obsessive thoughts, and even compulsive behaviors. If you are someone who has also experienced deprivation in areas outside of food, such as love, attention, material wants, etc, the deprivation connected to dieting may be felt even more intensely for you.”

Principle 4 - The Food Police

The Food Police are defined as internal censors that induce guilt by engaging our thoughts in self-criticism. The authors urge us to challenge the thought patterns that engage us in disapproving finger-pointing: “Negative self-talk often makes us feel despair. The feeling of despair can trigger sabotaging behaviors.” We can be incredibly hard on ourselves; I have certainly been much more critical of myself than anyone else ever has been critical of me.

Suggestions for combating the food police:

· Replace black and white thinking (should, must, ought to) with statements that give you permission to eat, such as “I can have anything that looks good to me.”
· Replace pessimism with positive statements, “I desire healthy foods.”
· Become aware of the actual thoughts you are having about food and eating.

Principle 5 – Feel Your Fullness

This principle directs us to listen to the signals that our body sends as we are eating so we can more easily determine when we are approaching getting full and have fulfilled our biological need for the food. The primary tool for this principle is the pause, where we ask ourselves whether we will continue eating. Anyone who has been a member of the Clean Plate Club, as I was, has been taught to ignore our fullness in order to finish all the food on our plates.

Some specific suggestions for pausing:

1. Does the food still taste good?
2. How full are you – how much food is in your stomach?
3. Don’t feel obligated to leave food on your plate.
4. Eat without distraction – do nothing else while you are eating.
5. Reinforce a conscious decision to stop – for example, push your plate forward a bit in the classic “I’m done” maneuver.
6. Defend yourself from obligatory eating by telling the food pushers “no”.

Principle 6 – The Satisfaction Factor

The idea behind this principle is that eating should be a pleasant and sensual experience, and that the more satisfying we find it, the less we will be compelled to overeat or make poor food choices. When we slow down and savor our food, eating what we really want to eat, we can “discover the pleasures of the palate”. We are exhorted to set the stage so that we are eating in a relaxed atmosphere, avoiding tension to whatever extent possible. The authors tell us: “If you don’t love it, don’t eat it, and if you love it, savor it.”

Principle 7 – Cope with Emotions Without Using Food

I have been an emotional eater, and have found that coping with my emotional states without resorting to food was one of the big challenges of my own weight loss. I have eaten when sad, anxious, frustrated, annoyed, lonely and especially, bored. I did this even knowing that food couldn’t possibly be the answer to my emotional upsets. And even knowing that I would beat myself up with guilt and shame for overeating. I have also used food as a reward when happy about something.

The authors tell us how to determine if we’re eating emotionally (we probably already know): “If you find that you’re doing quite a bit of eating when you’re not biologically hungry, then there’s a good chance that you are using food to cope.” They offer the following suggestions for changing an emotional eating pattern:

1. As yourself if you are biologically hungry? If the answer is “Yes”, then you should eat. If not, then ask yourself what is the emotional you are experiencing and what you really need instead of food. If you need help, ask for it. (This last one can be very difficult sometimes, speaking for myself.)
2. Find another way to nurture yourself other than eating. For example, you could take a wonderful bubble bath or go get a massage.
3. Deal directly with your feelings by writing in a journal, talking to a friend, pound the crap out of a pillow. Finally, if we are very troubled and unable to cope with our feelings alone, we can seek the help of a therapist.

Principle 8 – Respect Your Body

So many of us, and especially women, do not respect our bodies and in fact, we spent a great deal of time internally criticizing each and every part of our body that does not meet the “ideal” standard. Intuitive Eating urges us to “accept your genetic blueprint” and learn to honor our bodies and treat ourselves with respect.

One thing the authors recommend, that I do not agree with, is to stop using external assessment tools, such as weighing ourselves or measuring ourselves. Although I understand why they recommend this, which is that by using these tools we can set ourselves up for failure and can use a “bad” measurement as a reason to beat ourselves up, at the same time there seems to be some evidence that those of us who have reached a healthy weight have an easier time maintaining it if we continue to get on the scales. I find that weighing myself helps me keep myself honest, and as long as I stay within a weight range of five or six pounds, that’s good enough. Also, if we are exercising regularly, and especially if we are doing resistance training, knowing measurements is essential to tracking our progress in gaining muscles and losing fat.

What do the authors mean by “respect”? They tell us to:

1. Treat your body with dignity.
2. Meet your body’s basic needs
3. Make your body comfortable

In addition, they list some words of wisdom that we can tell ourselves to combat negative thoughts we may have about our body:

1. My body deserves to be fed.
2. My body deserves to be treated with dignity.
3. My body deserves to be dressed comfortably and in the manner I am accustomed to.
4. My body deserves to be touched affectionately and with respect.
5. My body deserves to move comfortably.

Principle 9 – Exercise

This chapter tells us about the health benefits of exercise and asks us to focus on enjoying how our bodies feel when we exercise, instead of using exercise for its ability to burn calories as part of a weight loss plan. The authors spend some time debunking the “carbs are evil” camp, explaining that carbohydrates are the premier fuel of exercise. Note that they don’t tell us to load up on carbs, just that we don’t have to shy away from a healthy mix of nutrients, including carbs. In addition, we are specifically told to include strength training to encourage muscle growth, as “muscle is metabolically active tissue that helps keep your metabolism revved up.”

Principle 10 – Honor Your Health

Here the authors discuss nutrition and how we can select healthy foods, while at the same time picking what tastes good to us. They point out that there is merit in variety, moderation and balance, and tell us that “balance is intended to be achieved over a period of time. It does not have to be reached at each and every meal…It is consistency over time that matters.” Their nutritional advice is very similar to the best such advice you can find just about anywhere. Finally, I love this quote: “In matters of taste, consider nutrition, and in matters of nutrition, consider taste.” Yes, healthy foods do taste good!

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