Nibbling versus gorging: More Meals May Mean More Health.
A Guidelines Paper for General Public
Lea Countryman & Brian Morgan
Spring 2005
A paper for Health Magazine
In an era of bigger is better, and fast seals the deal, the notion of smaller meals
spread out throughout the day may seem difficult and time consuming. But when it
comes to health, smaller meals throughout the day may very well turn out to be a
prescription for a healthier life. Americans eat on average, 3.12 meals a day. Is this
enough? How does the frequency of one’s eating affect general health? And does it have
an effect on body weight, heart disease or even cancer?
Much today is being written about diet and nutrition, most of which focuses on
what to eat, but little attention is being given on how to eat. Indeed, whether it is “better”
to eat many small meals a day or have fewer large meals is a common question.
Comparing the potential benefits of nibbling and of gorging has been the focus of much
animal and human research, but no clear consensus has emerged. Varied conclusions
from research show that this issue is unresolved and requires more attention (see Tables
1,2,3). Some research has found a connection between nibbling as a meal pattern and
decrease in weight (11). Other studies have shown that fewer meals taken throughout the
day leads to weight gain (3). Risk for Cardiovascular disease may be decreased by
increasing meal frequency because of the reduction of harmful cholesterol in the blood
(12,16). But another group of researchers found that increasing meal frequency does not
decrease harmful cholesterol and therefore does not reduce the risk of heart disease.
1
When it comes to colon cancer, increasing meal frequency can be very harmful. In fact
research has found increasing meal frequency can increase the risk of colon cancer by
50% in men (18).
The research is scattered; some studies found benefits and some found no benefits
from increasing meal frequency. Although many studies showed no benefits there seems
to be greater support in favor of meal frequency for overall improvement of health. The
following examines the research on meal frequency for each individual health category:
obesity, cholesterol, heart disease and colon cancer.
Will Eating More Often Make You Thinner and Healthier?
Most of us know our country is in trouble when it comes to our weight. Nearly
two-thirds of adults in the United States are overweight and more than 30 percent are
obese (National Institute of Diabetes and Digestive and
Kidney Diseases 2003). What may come as a surprise, is the
alarming rate at which people are losing their battle with
obesity. According to a recent report, the number of
individuals considered morbidly (people with a BMI of 40
or higher) or severely obese (people being 100 lbs over
Body Mass Index (BMI)
is a scientific way of
relating weight in lbs to
height in inches. BMI is
commonly used as a
measure of persons
obesity. However it does
not differentiate between
body fat and muscle. So a
person with a high BMI
may not be obese.
weight) rose from 1 in 200 adults in 1986 to 1 in 50 in the year 2000 (4). To make
matters even worse, the number of people with a BMI of 50 or greater escalated from 1 in
2,000 to 1 in 400 during this same time period (4). Statistics like this are frightening
when you consider the health consequences of being overweight or obese. We now know
a laundry list of risk factors associated with obesity such as type II diabetes, heart
2
disease, high blood pressure and limited mobility, which can seriously threaten how long
and how well people live.
Nibbling throughout the day is showing to be a good way to regulate weight and
loose unnecessary fat. According to a recent report, people who eat more frequently will
be thinner (11). This study of 499 people monitored the effects of overall caloric intake
and exercise. They found that, on average, participants ate just under four meals each
day (3.92). Men ate an average of 2,259 calories daily, and women ate 1,641 calories
daily. People who reported eating four or more times per day were 45 percent less likely
to be obese than those who reported eating three or fewer times each day. In addition,
people who skipped breakfast were 4.5 times more likely to be obese than people who
regularly ate breakfast. This could be because the study found that on days participants
skipped breakfast they ate more. Perhaps we are like ravenous wolves that if deprived of
food for a long time, and are then presented with food, eat as if they may never see food
again. This could be because of the body’s natural survival instinct; if food is scarce,
you’d better stuff yourself as best you can, because you don’t know how long it will be
before you will find food again.
In addition, the International Journal of Obesity & Related Metabolic Disorders
reported that frequent meals reduced appetite by 27%! This could be very beneficial for
people trying to lose weight and eat a more healthy diet. The study was conducted using
two groups of healthy overweight men. One group had a large breakfast, then the second
meal five hours later, with no snacking in between. The second group ate the same
amount of same food but divided it into five meals, given hourly. After both groups had
completed the five hours they were given an “all you can eat” meal, and which group ate
3
more? Yes, the gorgers. These studies suggest that increased meal frequency can reduce
the risks of obesity appear to be very promising.
However there is other research that does not agree with these findings. A review,
conducted by Bellisle F, et al. (1997), examined many studies, which observed the
relationship between meal frequency and obesity (2). This review argued that many of
these studies found that there was little or no effect of meal frequency on obesity. Also
the studies much like the ones mentioned above, which did find that increased meal
frequency lessened the risk of obesity, were criticized by this review for showing weak
evidence of this relationship. In addition, subjects may have been under reporting what
they ate leading to insufficient data. The review concluded that there is insufficient
evidence that weight loss can be attributed to the number of meals a person eats per day.
However, some of the experimental failings of the studies reviewed by Bellisle F, et al.
were addressed with greater rigor by the subsequent Ma Y, et al study (2,11). In addition
most studies on obesity and meal frequency attempt to isolate the element of meal
frequency, yet stress, physical activity, and pre-existing eating tendencies have a large
effect on the participants. More research with a more realistic approach and greater
populations is needed to see if meal frequency is in fact the main element that effects
weight loss, or if other elements also contribute. Regardless it appears for now that
increasing meal frequency is beneficial for weight loss.
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Obesity Research (Table 1)
Research which found that eating
more meals has Positive effects
on Obesity
Ma Y, et al 2003
Found: The more meals that the
subjects ate per day (greater than
3) decreases the risk of obesity
Bray GA 1972
Found: The more meals that the
subjects ate per day decreased
obesity and the fewer meals the
subjects ate per day increased the
risk of obesity
Research that displays meal
frequency has Negative or No
Effect on Obesity
Bellisle F, et al. 1997
Found: There is no evidence that
weight loss is affected by the
number of meals you eat per day.
This chart compares different research on the effects of the number of times per day you eat with
the risks of obesity.
Will Eating More Often Lower Risk for Cardiovascular Disease?
Our blood carries cholesterol in the form of low-density lipoproteins and highdensity lipoproteins. LDL’s (low density lipoproteins) are a form of
cholesterol which if found in large quantities are harmful to the body.
They are a leading contributor to cardiovascular disease because of
their sticky nature. Where as HDL’s (high density lipoproteins) are a
form of cholesterol that are not considered harmful in the same way
LDL- low-density
lipoproteins
transport cholesterol
in the blood, but
LDL’s are more fat
than protein and
stick to each other
and your tissues,
which is very
dangerous.
LDL’s are. Many Americans are facing problems with high amounts
of LDL’s and coronary heart disease as a result.
Studies are showing that increased meal frequency can reduce LDL
HDL- high-density
concentrations in the blood as long as total caloric intake is not
lipoproteins transport
cholesterol in the
increased (7). In fact nibbling can decrease total cholesterol HDL
blood. They are equal
parts lipid and protein
and LDL, but raise the HDL/LDL cholesterol ratio (12). When 19
and it does not stick to
each other and your
females were either given three meals per day or nine meals per day
tissues.
for two weeks, there was a significant decrease in LDL levels 6.5% (1).
5
However Murphy MC et al. 1996, found no change in cholesterol amounts for
healthy young women with increased meal frequency (13). In addition they found that
HDL amounts were increased on the gorging diet (3 meals/day) versus the nibbling diet
(12 meals/ day). One strength of this study was that there was intense control over the
diet that people ate. The studies that found benefits in LDL cholesterol levels from
increasing the number of meals they ate per day did not have such rigorous restrictions
and control over their subject’s diets. It is important to note that this study was conducted
over a two-week period with females age 22-23. This is a limiting factor because it only
looked at very young females and it also could have been conducted over a longer period
of time to show that these results stay constant.
Figure 1
Reductions in LDL and Total Cholesterol Levels
With Increasing Meal Frequency
0
Percent
Change in -5
Cholesterol -10
Level
-15
LDL Cholesterol
Total Cholesterol
Jenkins et al.
Arnold et al.
Study
This graph is a comparison of two of the studies that found more meals per day could mean lower
cholesterol levels for harmful LDL cholesterol and total cholesterol. Both of the studies found that there
were significant reductions in percentages of LDL and total cholesterol in their subject’s blood when they
ate more meals per day as seen from this graph.
Heart disease is the leading cause of death in America today and rising; meal
frequency may help remedy that problem. Fabry (1964) and his group from
Czechoslovakia examined 279 men, ages 60-64, for the consequences of nibbling diets
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under normal living and working conditions (8). It was found that obesity, cholesterol
and heart disease increased as the frequency of meals decreases. In a
Ischemic Heart
Disease (IHD)- is
a form of heart
disease caused by
a blockage of
blood to the heart.
later study conducted in 1968, the Czech group surveyed 1133 men
ages 60-64 and found that ischemic heart disease (IHD), IHD was
decreased for subjects who nibbled versus gorged. They found a
distinct relationship with meal frequency from 30% in the group who ate 3 meals or less,
with those who ate 5 meals or more who only had 20% with IHD (9). In another study
seven healthy men consumed identical diets as three meals per day or as 17 meals per
day. Studies found that risk for cardiovascular disease was reduced by 9.9% (see Figure
1) (10). However, this study is limited by its small population and that it only compared 3
meals /day to 17 meals per day. Although they are extremes, it is not realistic for a person
to eat 17 times in a day. More research is needed that could be practically applied to the
general public, as in 5-7 meals per day. But it seems that heart disease and cholesterol are
very closely associated and that decreased cholesterol leads to a decrease in risks for
heart disease. Therefore spreading the times you eat food, throughout the day may help
reduce risks for heart disease.
Cholesterol and Cardiovascular Disease Research (Table 2)
Research which found
that increased meal
frequency had Positive
effects on cholesterol
levels and CVD
Titan MO, et al. 2001
Found: More meals per
day decreases the
concentrations of total
cholesterol and LDL
cholesterol in men and
McGrath SA & Gibney
MJ 1994
Found: More meals per
day has a positive effect
on raising HDL
cholesterol levels and
7
Edelstein SL, et al.
1984-87
Found: More meals
per day might result in
reduced levels of
cholesterol
women
More Positive Research
decreasing LDL
cholesterol levels
Arnold LM, et al. 1993
Found: 9 meals per day
compared to 3 meals per
day reduced LDL and
HDL cholesterol levels
by 8.1% and 4.1%
Jenkins DJ, et al. 1995
Found: A nibbling diet
lowered both LDL and
HDL levels when
compared to a control
diet
Fabry P, et al. 1968
Found: More meals
per day lowers the
risk of Ischameic
(blockage related)
heart disease
Research that displayed
increased meal
frequency had Negative
or No Effect on
cholesterol levels and
CVD
Murphy MC, et al. 1996
Found: There was no
change on LDL
cholesterol
concentrations with a
nibbling diet. Also a
gorging diet increased
the HDL cholesterol
levels.
This chart compares differences in research for cholesterol levels and cardiovascular disease. For
the most part the research suggests that that increasing meal frequency can reduce LDL cholesterol levels
which can be harmful and cause blockages in arteries, especially arteries involved in heart function.
However, there is some research which did not find eating more meals per day to be beneficial in
decreasing LDL levels.
Can I Get Colon Cancer From Eating More Often?
Colorectal or otherwise known as colon cancer is the second leading cause of
cancer death in the United States (15). And although nibbling may improve such health
factors as obesity and heart disease studies show that increased meal frequency may lead
to an increased risk of colon cancer (6,18). Researchers have found that by increasing
meal frequency the colon is exposed to more bile acid and therefore has a higher risk of
cancer (18). In addition, decreasing meal frequency down to one to two times per day
decreased the risk of colon cancer by 50%. However, for women increasing meal
frequency had no effect on colon cancer (see Figure 2) (6,18).
Figure 2
8
Comparison of the Risks of Colon
Caner for Men and Women
80
Percent 60
Risk of
40
Colon
Cancer 20
Males
Females
0
1,2
3,>3
Number of Meals Per
Day
This graph is a general representation of the findings of the two studies which examined the effects of meal
frequency and colon caner risk. As you can see from the graph the males who ate 3 or more times per day
had a 50% increase in the risk of getting colon caner. Also the female subjects had no significant
differences in the risk of colon cancer between different meal frequencies.
*This graph is just a representation to show the general trend of the findings of these studies and does not
show the actual data from the studies.
The research found that there was no positive effect of increasing meal frequency
on colon cancer; all effects were negative. In addition this research is limited only to
colon cancer. No research has been found which suggests that increasing meal frequency
would increase the risk for other types of cancer. Therefore men with a family history of
colon cancer should be wary of an increased meal frequency, eating pattern. But there
seems to be no negative for women to nibble away when it comes to risk of colon cancer.
Colon Cancer Research (Table 4)
Research which found that
increased meal frequency had
Negative effects on the risk of
Colon Cancer
Coates AO, et al. 2002
Found: Men who ate fewer meals
per day (1-2) had a decreased risk
of colon cancer by 50%
compared to those who ate 3 or
9
Wei JT, et al. 2004
Found: Men who ate fewer meals
per day (1-2) had a decreased risk
of colon cancer by 50%
compared to those who ate 3 or
more times per day. Meal
more times per day. Meal
frequency did not appear to have
frequency did not appear to have
an effect on colon cancer risk in
an effect on colon cancer risk in
women.
women.
Both of these studies found that an increase in the number of meals men eat per day can have a negative
effect on their risk for colon cancer. Although this is very important for men, the research did not show the
same pattern for women and suggested that meal frequency does not have an effect on colon cancer risk.
Nibbling versus Gorging
So is it better to eat three square meals per day or more as in five or six? There is
some research that shows that increasing meal frequency has no effect on health factors
such as obesity and cholesterol, and can in fact increase the risk of colon cancer in men.
However, as shown above there seems to be a greater body of evidence in support for
increasing meal frequency due to the positive health benefits such as decrease in obesity
and a decrease in cholesterol. Most of these studies point clearly to the need for
additional research. A larger number of participants and the inclusion of variables
strongly influenced by human behavior, physical activity, diet, and stress might provide a
better understanding of eating frequency on overall health.
At the current time, it seems that eating more than the average 3.12 meals per day
is beneficial for one’s health! It comes down to risk versus benefit, and when it comes to
nibbling versus gorging, nibbling appears to be a better strategy.
The Real Deal
Although the research on meal frequency in encouraging, nutrition experts
caution that increasing meal frequency without increasing total energy intake can be a
daunting task for most. According to Sarah Garner, RD, a weight loss expert in Denver,
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the general population is exposed to conflicting messages about dieting. She fears that
consumers may get more confused than ever if they attempt to increase how many times
a day they eat while changing what they are eating. Garner says that, even when clients
are committed to improving their health, it is difficult to alter a lifelong habit of loading
up on empty calories from sodas and junk food at three major meals.
So is increasing meal frequency a realistic goal for those trying to improve
health? Some experts doubt, but they add the caveat that altering one’s diet in the right
direction may still be helpful. According to Walford, increasing meal frequency by even
a moderate amount (1-2 more meals /day) can provide some of the benefits of a more
nibbling approach (16).
In light of such findings, creating a more frequent meal plan, in addition to
watching what one is eating, and obtaining adequate physical activity may be a realistic
goal. Although beneficial at any age, moving toward a lighter more frequent diet and
leaner body can be important, especially as people grow older. Studies have found that
being over weight in middle age (35-45) can cut as much as 3 years off a human’s life
expectancy (Caruso 2003). Overall nibbling your way through life seems to be a good
way to decrease the risk of many health problems but more research must be done on
meal frequency in relation to cancer. Perhaps you can implement a nibbling pattern to
your life and find a healthier you.
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References:
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three or nine meals on plasma lipoproteins and glucose metabolism. Am J
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2. Bellisel F, McDevitt R, Prentice AM. Meal frequency and energy balance. Br
J Nutr. 1997 Apr; 77 Suppl 1: S57-70.
3. Bray GA. Lipogenesis in Human Adiopose Tissue: Some Effects of Nibbling
and Gorging. J Clin Invest. 1972 March;51(3):537-548.
4. Brink, s. 2003. America’s Expanding Waistline.
USNews.com,www.usnews.com/usnews/issue/031027/health/27fat.b.htm.
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October 21, 2003.
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of Coverage for Colorectal Cancer Screening to Enhance Early Detection.
Clinical Issue Brief: http://www.gastro.org/pubPolicy/issueBriefs/urges.html.
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Frequency of eating and concentrations of serum cholesterol in the Norfolk
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physiologic, hematologic, hormonal, and biochemical parameters in humans
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