Intuitive Eating & Training: Contrarian Views Through the Lens of an Athlete

Recently, I was invited to a round table discussion on Intuitive Eating and Intuitive Training held by Steve Hall of Revive Stronger with guests Dr Mike Israetel, Dr Gabrielle Fundaro and Miguel Blacutt.

A lot was covered in 90 minutes, but with that said I think every guest would agree that we only scratched the surface of a heavily nuanced and complex topic. Despite the episode having plenty of detailed and informative discourse, we all had plenty more to say. This conversation was merely the beginning of a very necessary and important dialogue between leading experts in the fields of nutritional and exercise science and was the first step in providing free and easily digestible content on the topic.

The discussion was comprised principally by some intellectual, thought provoking and disparaging opinions between Dr Mike and Dr Gab. Stay tuned for the release of this episode on the Revive Stronger Podcast.

After some reflection of what went down I thought it worthwhile to document some of my own perspectives and interpretations of the utility and application of Intuitive Eating (including those mentioned during the roundtable). I will caveat this article by first stating that I am in no means an expert on Intuitive Eating, nor am I well-versed and up-to-date with the literature in the realm of Intuitive Eating.

Please don’t take this piece as a “position stand”, but merely the expression of my opinions, which are predicated upon my experience as an athlete and through a lens of logic and reasoning. an alternative view that is contrary to that voiced by the majority of the evidence based community.

If you want to learn more from professionals in the arena, I’d start with Dr Jake Linardon and Dr Gab Fundaro. If you are unfamiliar with Intuitive Eating, check out this article by Dr Linardon HERE.

Current perspectives on Intuitive Eating

Intuitive Eating (IE) has been gaining a lot of traction in the fitness community and we would be foolish not to look upon the benefits with credence, including:

• Reducing eating disorder symptoms
• Improving relationships with food
• Building awareness with hunger and satiety cues
• Improving perceived body image

With that said, I feel as though some people – particularly athletes – might be using or overusing this approach without realising it isn’t very conducive to their goals, goals that can’t be achieved while remaining weight neutral in the long run (such as gaining muscle mass, reducing body fat, or both). I also think part of this comes down to members of the fitness industry not understanding the principles and expected outcomes of IE. They might understand the body image and eating psychology benefits, but not understand that this behaviour is typically associated with weight stability, and not a tool for performance, weight or body composition change. I think most IE users understand that the premise is built upon eating to biological cues. But, I also think some who don’t fully understand IE are forgetting that it is against our biological interests to carry absurd amounts of muscle mass that will slow us down and make us susceptible to predators, nor is it to be abnormally lean where we wouldn’t outlast a famine. 

So, if either of those physique outcomes are the aim, biological navigation isn’t likely to get you there, some overriding of biological cues will be required. With that said, this recommendation is clearly very contextual toward an individual’s goals. The further to one end of the spectrum and the more extravagant your goals are, i.e. you don’t want to just look like a normal guy or girl on the beach, ye want people to go “woah he’s jacked” or “woah she’s shredded” (and they are perfectly reasonable goals to have) then the less viable IE is going to be for you. Now this doesn’t mean I’m advocating going robot mode and turning off intuition completely, I just don’t think a completely intuitive approach, in the context of IE is a viable option for most athletes, for at least 75% of the training year anyway. A better option for athletes, is likely going to be some form of flexible dietary restraint. However, I think some people make the mistake of thinking that dietary restraint and using characteristics of IE and mindfulness (while not going completely intuitive) need to be exclusive. For example, an athlete can still use mindfulness techniques such as paying attention while eating, chewing slowly, and choosing foods that sit well, within the bounds of dietary restraint.  

Here’s another example. Let’s say you prescribed yourself a known calorie deficit using flexible dietary restraint. You might perceive internally (intuitively) that that level of restriction is too severe because energy levels, gym performance and non-exercise activity levels are being drastically compromised. Subsequently you adopt a more conservative level of restriction, with improved outcomes. So, while it’s not IE per se, there’s a valuable capacity for mindful practices, and paying attention to internal feedback in dietary restraint. This can also be applied in regards to internal feedback based on appetite during the day (e.g. intermittent fasting if ravenously hungry at night) or even allocation of daily macronutrients (e.g. allocating greater chunk of carbohydrates to pre-workout meal if performance suffering).

Perceptions about IE for athletes/bodybuilders in the offseason

It also seems like there is this recent perception that you can’t be considered an advanced athlete, or a proponent of “evidence-based practice”, if you’re not intuitively eating in the offseason. If your offseason just means time away from contest and some down time, then IE could be great. However, if your offseason should be more accurately labelled an “improvement season”, then you should be aware that it’s probably coming with some progress trade-offs against the eating psychology benefits. I do think athletes should get the opportunity to practice IE, however the use in the offseason should be intermittent (and perhaps this means it isn’t actually IE?). If so, let’s then call it practicing of the characteristics of IE/mindful eating. An appropriate time to practice such skills might be during weight maintenance phases while transitioning from a muscle gain phase to a fat loss phase. This could be a good opportunity for the athlete to re-establish the ability to gauge hunger cues and improve relationships with food.

With that said, despite the notable benefits on eating psychology that this period might have, the athlete should be aware that it has the potential to delay attainment of one’s physique or performance goals. For athletes that are investing substantial resources, time and money into a physique related endeavour, or if they are competing at an elite level, extensive time spent where they aren’t progressing physically, might not be a worthy cost. I also think IE should be the goal of retired athletes. There was a study published not too long ago (1) which showed that in retired athletes who were educated on IE, they were able to achieve liberation with their eating, and reduced eating disorder symptoms. Even after years of dietary restraint, debunking the myth that someone might be “broken” after years of chronic dieting.

Research that doesn’t support IE for athletes

In a 2013 weight loss study, one group was prescribed calorie restriction, while the other was given instruction on intuitive eating. (1) At the start of the weight loss phase both groups were losing weight equally. But, once the midpoint was reached, the IE group started eating back the weight loss and by the end of the study the IE group had significantly less weight loss than the calorie restriction group, and even less weight loss that they had at the midpoint of the study. So, keeping in mind that the motivation for the guys signing up for this study was likely weight loss, I think this shows that even when weight loss is the intended outcome, as soon as you distance yourself from your set point or body fat level  (and if you’re navigating based on biological cues) you’re going to encounter a compensatory increase in hunger that will bring you back.

Looking at the research on the female athlete triad and low energy availability in athletes, researchers point out that appetite is not always indicative of an athlete’s food and fuel needs. (2) And, if an athlete with extremely high energy expenditures eats based on hunger cues, they could very likely be doing themselves a performance and health disservice. The research also shows that it’s common for females with low energy availability to not report high hunger levels, with symptoms of low energy availability not being relieved until they undergo a quantified increase in calorie intake, independent of reported hunger. 

In a 2011 “massing” study, one group ate ad libitum (which I know isn’t the same as intuitive eating, but nonetheless we would assume it’s dictated somewhat by hunger cues) and one group received a meal plan via nutritional counselling. (3) After 12 weeks of strength training 4 times per week, the meal plan group added ~3% lean mass while the IE group had no significant change. So, if you’re lifting weights regularly, and I assume trying to achieve some form of adaptation from that training, then IE has the potential to have you spinning your wheels for a bit, even when training is regular and of high effort.

IE is harder in today’s eating environment than it might have been 20 years ago (when IE was conceived)

The standard western diet now consists of hyper-palatable, calorie dense, low cost foods. (4,5) Research also shows that society’s perception of a normal portion size has increased over the last decade. With that in mind, if someone intuitively eats from cheap, delicious and calorie dense food sources readily available at cafeterias, fast food outlets and middle aisles at the grocery store, then they are highly likely to consume a large number of calories in a short amount of time because 1) our perception of what a normal portion size should look like has been distorted and 2) because common calorie dense and palatable foods have a poor satiety value. This means if you’re eating to reach a biological point of satiety via chocolate cake, an enormous amount more calories will be consumed in contrast to the energy required via oatmeal to reach this same point of satiety. 

There was a study published recently that showed the average meal from a non-chain restaurant was around 1500 calories (6), not including drinks, appetisers or dessert. So, if you go to a normal non-chain restaurant, order an average dish, eat intuitively until satiety (which one would assume is somewhere around the complete portion) you could be consuming around 50-75% of your caloric needs to maintain weight in one hit. This means the likelihood of establishing an energy surplus increases substantially unless you’re intuitively compensating with reduced caloric intake in other meals, which is unlikely given the satiety response is poor from calorie dense and super tasty meals. The above situations can result in an energy intake that isn’t indicative of physiological energy needs. I hesitate a guess that one of the reasons for the global obesity epidemic, is the consumption to satiety of these processed, high energy dense, restaurant prepared, tasty foods.

Peak performance and physique development often requires some trade-offs

I think most people are fairly aware that to become an elite athlete some trade-offs will be incurred along the way. For example, risk of scores increasing on an eating disorders exam, or scores for cognitive restraint in an athlete dropping weight for a contest is not much different to the risk of head trauma in an NFL athlete. Sure, we should, (and we can) minimise some of the risks by putting tackling rules in place and modifying helmets, but complete avoidance of head contact just can’t be avoided as long as they want to lace up and play the game. An example trade-off in physique sports is the temporary grinding in a state of low energy availability to reduce body fat before contest. Sure, most of us are aware and understand the health implications of chronic low energy availability or relative energy deficiency syndrome, but does that mean we should advise a higher energy availability diet for the athlete? Well you can, but they sure as hell won’t be in shape on show day. Low energy availability to reach bodybuilding condition is a necessary beast, in the same way dietary restraint is probably needed to optimise physique or performance.

This might be controversial and I hope it isn’t interpreted as me only caring about the physical outcomes (I just ran a 60 person diet study with half of the outcomes being psychological measures if that’s any consolation), but if you’re working hard to reach a competitive or physique goal, I think you need to place the physiological outcomes slightly above the psychological, or at least of equal importance. As an athlete (or a coach working with an athlete) you do what’s needed to get “there”, with the least psychological disturbance that you can. So, even though eating restraint/calorie counting is associated with worse eating disorder symptoms, abolishing risk of psychological disturbance is going to be lower on the ladder of priority compared to reaching the sports or physique outcome itself, which after all is the reason an athlete does what they do. If an athlete wants to compete in a bodybuilding contest, you can’t say to them “we’re going to adopt a weight neutral approach to eating so you don’t develop any eating disorder symptoms and so you have fantastic eating psychology”. That outcome does not sit higher on the priority ladder than the performance or physique outcome.

Using intuition in training

Using intuition and autoregulation in training makes a lot of sense, I don’t think you can dispute that, but having a completely intuitive approach to training will likely be suboptimal. When we say intuitive training what we probably mean is mindful training, in the same way IE isn’t the same as mindful eating. By saying intuitive training, it gives the impression that you shouldn’t encounter any significant training discomfort, in the same way IE shouldn’t cause discomfort from hunger or fullness levels. But, to maximise training adaptations some disruption or physiological stress will be required, and that will be accompanied by some discomfort. If you rack the weights or turn the treadmill off at the first sense of fatigue, where your biology is saying “HEY HEY this is disrupting our homeostasis” then you’re unlikely to make much progress in any fitness parameters. Now again, this doesn’t mean turn off intuition completely, we can still make perceptive and mindful decisions with regards to reps performed using RPE scales, reactive deloads when noticing overtraining symptoms, longer rest times when not feeling ready to perform in the next set. But some overriding of biological cues is going to be required to induce a stimulus for adaptation.

For example, let’s say you planned to do 10 reps of squats with a given load at an RPE of 8, but the reps felt tougher than usual so you autoregulate to 8 or 9 reps instead. Reps 6 through 9 are still going to be dam challenging, and you’ll have to push past the point where your biology is saying “WOAH WOAH we don’t love what you’re doing to our quadriceps here”. Of course that doesn’t mean you throw intuition out the window either and train to failure all the time because our limits are just psychological constructs (BEAST MODE etc etc) that we place on ourselves (cough)…the best approach will probably be somewhere in the middle, where some internal cues are abided by, and some are pushed past.  

To be a successful athlete I think you need to be pretty comfortable with being physiologically uncomfortable at times. If you’re training with the intention to get as big, fast or as fit as possible, the training won’t feel physically pleasurable all the time. During the training, to induce a stimulus you’re going to have to push past a biological fatigue signal or cue that is encouraging you to stop

Benefits of intuition in training might be more appropriate for strength athletes or bodybuilders

When looking at weight training research, it’s fairly clear that doing too much work in close proximity to failure, or beyond failure will probably hinger gains.This doesn’t necessarily apply in sports where performance occurs supra-anaerobic threshold.To improve performance in these sports (rowing, middle distance events, combat sports) this only happens when the anaerobic threshold is increased, and that only happens when doing large volumes of work despite enormous levels of acute fatigue.

Take the Italian rowers for example. They have been consistently the most successful rowing country of all time, and research shows that they are continuously doing the most hours out on the water (120 miles plus per week) compared to other countries, and with some of the most gruelling training schedules in history.There’s no way this training is being guided by biological cues, and I think if you told them to end training when they felt beat up and exhausted and uncomfortable, that’s surely going to happen below the 120 miles per week volume mark.

An athlete can eat without tracking, but that’s not Intuitive Eating

One thing we need to become aware of, is that if an advanced athlete is eating without tracking, it’s likely they have had substantial experience with dietary restraint to reach a body weight or composition goal in the past. In that case even though MyFitnessPal doesn’t need to come out, and they’re not following a meal plan, it shouldn’t be considered IE because it isn’t driven by hunger/fullness cues, they just know what they need to eat because this isn’t there first rodeo so to speak. I think this is a huge misconception among evidence-based bodybuilders, that if they aren’t tracking, then they are eating intuitively (which of course will not always be the case). The way I interpret true IE, is that there isn’t going to be much cognitive awareness or decision-making regarding macronutrient distribution. I think it would be folly to assume that biological cues will guide us to 4-5 40g protein feedings every 3-4 hours, with appropriate carbohydrate distribution for performance. 

Intuitive eating not suitable for those already struggling with eating disorders

Dr Jake Linardon advises against intuitive eating for those struggling with eating disorders. These individuals go through cyclical periods of dieting, bingeing and purging, with extremely disrupted hunger and fullness cues. Thus, telling them to eat what they feel like just isn’t realistic, and is likely to do more psychological harm than good. Dr Linardon instead recommends establishing some external rules first to bring back normalised eating, before IE is considered and implemented.

Summary

So, is IE a good thing? Is it a bad thing?

I think Dr Gab summed it up well when she said the ANSWER comes down to… what you prioritise.

References

1. Intuitive eating among retired athletes, 2017- https://www.ncbi.nlm.nih.gov/pubmed/27715475
2. Calorie restriction vs intuitive eating for weight loss, 2013- https://www.ncbi.nlm.nih.gov/pubmed/?term=anglin+2013+intuitive
3. Research on the female athlete triad, 2017 – https://www.ncbi.nlm.nih.gov/pubmed/?term=anglin+2013+intuitive
4. Nutritional restraint vs ad libitum eating for massing, 2011- https://www.ncbi.nlm.nih.gov/pubmed/21851204
5. Threats to IE in our modern eating environment
6. Calorie contents in restaurant meals- https://jandonline.org/article/S2212-2672(15)01736-0/abstract