Happy International Women’s Day! Last week, while I was still attempting to battle the germs that took up residence in my house, I received a really interesting question from one of my faithful readers, PG. I would like to take a moment to thank PG for being a loyal reader, but more importantly, I would like to thank her for her tireless support and encouragement. As you may guess, dear readers, PG is a person very close to my heart. So, when I received this question, I knew I had to craft a worthy response.
The Question: “How important is it to eat meals on a schedule?”
Answer: It is important, but not the only consideration.
While a simple question on the surface, the answer is a bit complex and I hope that I can help alleviate some of the confusion. The central point of complexity is that scheduled meals can refer to ‘three squares a day’, but it can also refer to scheduled mini-meals, which typically occur every 3-4 hours. Overall, scheduled meals, regardless of frequency, encourage meal planning. This typically results in better overall food choices in contrast to the mindlessness of a grab-and-go approach. Additionally, scheduled meals encourage dining together, which provides social and familial interactions (when technology isn’t involved). Family meals, in particular, offer a wide host of benefits, especially for the children involved. Numerous studies show reduced risk of obesity, better nutritional choices, better decision making, and improved communication skills (including expanded vocabulary). Purely from a practical standpoint, dining with others favors adherence to a three-meal plan. Our society is set to this standard. If you work out of the home or attend school all day, you probably noticed that your day is not set up to accommodate a different eating pattern. However, when you look specifically at scheduled mini-meals, the argument centers on promoting stable blood sugar and a slimmer waistline, particularly among those who have metabolic disease or a propensity to it.
In a large study (n=1560) appearing in The American Journal of Clinical Nutrition, where the cohort was lifted from the 2002 Nurses’ Health Study, irregular breakfast eating patterns increases risk for Type Two Diabetes (T2D). The risk was further increased with individuals who ate frequently throughout the day, but were not consistent breakfast eaters. Regular mini-meals in healthy subjects who monitored and held their caloric intake at a constant, did show reduced risk of T2D. These findings bolster the argument in favor of scheduling meals, regardless of frequency. However, they emphasize the importance of breakfast. You will also find that scheduling meals is consistent with recommendations for patients with metabolic conditions. Widely accepted lifestyle recommendations for diabetics (including gestational diabetics) and those with metabolic syndrome support scheduled eating patterns. The preferred eating style, in this instance, is scheduled mini-meals. Post-prandial (post meal) glucose testing numbers in such individuals show substantial improvement with regularly scheduled well-balanced meals, control of caloric intake, and regular exercise. But Rie, you may ask, what if I do not have diabetes or a metabolic condition?
An April 2015 research study appearing in the Journal of the Academy of Nutrition and Dietetics (n=2,696) revealed that even healthy individuals who ate regular mini-meals had an overall lower BMI and an improved dietary quality. If we are only looking at meal scheduling as a 3 vs. 6 question, the evidence gives an edge to a 6 mini-meal approach. (Note: To determine your caloric needs for each mini-meal, take your total daily caloric allowance and divide by 6.)
Now, let us take a look at unscheduled eating patterns in comparison to the 3 or 6 meal schedule. Some suggest that scheduled meals are not in-sync with our biology and evolution, pointing to our long history of hunting-and-gathering and feast/famine. These individuals tend to embrace intermittent fasting as a way to mimic these ‘ancestral patterns’. Unfortunately, I could not find much in terms of peer-reviewed research to support or dismiss these last claims. The studies that do address intermittent fasting are generally too small and brief to make any recommendations to the general population. However, in theory, intermittent fasting may provide a benefit for healthy individuals, as it naturally produces a calorie deficit. (Caloric restriction, within reason, is associated with lower incidences of disease and improved longevity.) As an additional note, just because something was common during a long span of history, it does not mean it is favorable or even desirable. However, a far more compelling argument for unscheduled meals, is that it encourages mindfulness (aka “intuitive eating”) and prevents overeating by encouraging individuals to pay attention to hunger cues.
Intuitive eating is a relatively new concept, at least in terms of research. However, the principles are mostly based on common sense, where one eats when learns to eat when hungry and stop when satisfied. Literature reviews indicate that individuals who utilize intuitive eating patterns have a lower BMI. Researchers also suggest that intuitive eating reduced the prevalence of disordered eating behaviors in teens. It may also help individuals with a history of eating disorders and is frequently a component of a multi-pronged recovery plan. This suggests that there are psychological benefits, as well, likely because it removes the emphasis on caloric intake. However, this approach may not work for everyone. Individuals with certain conditions, like gastroparesis (delayed gastric emptying), may find that they are never hungry and therefore struggle to identify when they need to eat.
So, now that I have gone on for a while, you may wonder what it all means. In short, if I had to offer a general recommendation for the population, I would advise utilizing a scheduled meal structure, favoring a 6 mini-meal approach. The key here is crafting well-balanced eating and portion control. Here are some mini-meal suggestions and other tips to get you started (Note: The advice is aimed at nurses, but is entirely practical for any busy individual). However, I believe that it is also essential to incorporate intuitive eating principles. I find that far too many people eat simply because it is time. If an individual is consistently overriding hunger cues, because it is a scheduled meal time, it is far more likely that they will overeat in general.
In my personal life, as someone at high risk for T2D, I favor scheduled smaller meals (at 3-4 hour intervals). If I eat only 3 times a day, I do not feel my best. I am lucky enough that when I am working out of the home, I have the ability to have a small snack outside of my scheduled lunch (where I eat another small snack). I also make sure that I set my eating pattern to coincide with an evening family meal to gain the benefits I discussed previously. However, I also take care to listen to my hunger cues. If I am not hungry, I don’t eat. I also make sure to avoid eating when I am overly distracted (that means I don’t eat while I am conducting research, watching a program, or running out the door).
This is what works for me, but it will not necessarily work for you. I suggest that anyone looking at making changes to their diet (including meal scheduling) discuss this with their primary care physician or schedule an appointment with a registered dietitian so you can craft an eating schedule that works best for your particular needs and goals.