Diabetes and ME

Diets Don’t Work - Even If You Have Diabetes

Post by Michelle May, M.D.

If you’re like most people, you have a hard time sticking to a diet. It probably didn’t get any easier just because you have diabetes. Let’s look at why restrictive diets aren’t the answer for most people.

Your Body is Programmed to Survive

Your body has a primitive survival mechanism that helps your body adapt to limited periods of starvation. When you go on a significantly restrictive diet you’ll lose water, fat, and even muscle—particularly if you are not exercising regularly. If you return to your previous eating habits, your body quickly replaces its fat stores. But unless you are actively exercising, you will not regain the majority of the muscle tissue you lost during the diet. Ultimately, this causes you to have a lower metabolic rate, a higher body fat percentage, and more insulin resistance than before the diet. This explains the irony that most people are less healthy than before they tried to diet.

Deprivation Can Lead to Cravings

But it’s not just your body that rebels when you diet. Your mind rebels too. When certain foods are forbidden, you may begin to feel deprived which can lead to powerful cravings. When you finally give in to the cravings for these “bad” foods, you feel guilty and out of control. You may give up the diet and binge on the foods you’ve been missing. This often leads people to develop a painful “love-hate” relationship with food. Of course, most people with diabetes blame themselves when the diet fails, but in reality, dieting itself is to blame.

Diets Ignore the Rest of You

Another problem is that diets focus on what and how much to eat and don’t address why people eat in the first place. Many people eat or overeat because of environmental triggers such as appealing food, automatic meal times, or learned messages like “clean your plate.” Restaurants, break rooms, holidays, and vacations are full of tempting “bad” foods that aren’t allowed on a diet. You can deal with it while your motivation is high, like when you were first diagnosed with diabetes or when your doctor says your A1C is way too high, but in the long run, you may feel that changing your diet to manage your diabetes just isn’t worth it.

In addition, many of your urges to eat may be triggered by emotions such as stress, boredom, loneliness, sadness, or anger. Since these emotional triggers didn’t go away when you were diagnosed or by imposing a strict set of rules, you may try to cope with them by eating the “allowed foods.” In other words, you never really give up emotional eating or learn other coping skills, so when the diet is over, you go right back to eating the way you did before. This is a problem because diabetes doesn’t go away.

At this point you are probably thinking, “If diets don’t work, what am I supposed to do?” The real solution lies in relearning to trust your innate ability to know when and how much to eat so you can begin to eat in a way that fuels your body, mind, and spirit.

Next post: What to do instead of dieting...

Mindful Eating and Hunger When You’re On Medications for Diabetes

By Megrette Fletcher, M.Ed., R.D., C.D.E. and Michelle May, M.D.

The purpose of mindful eating is to become aware of your own personal experience. Tuning into your body, noticing how it changes, learning how hunger feels, and becoming aware of which foods satisfy your hunger best are all part of mindful eating.

You can build on this awareness by recognizing changes in your blood sugar, learning how your diabetes medications can influence your blood sugars, and becoming more attuned to what that feels like. Preventing a problem like significant hypoglycemia, rather than just treating it, is another important way that mindful eating can help improve your management of your diabetes.

What is the difference between hunger and hypoglycemia?

Hunger is often the first symptom of a decrease in your blood sugar. It is simply your body's way of telling you that you need fuel. Review Dr. May's previous post about hunger. If you're not able to identify hunger, you may also have difficulty identifying low blood sugar (hypoglycemia). 

Hypoglycemia is defined as a blood sugar of less than 70 with or without symptoms, or a blood sugar of 80 or less with symptoms. If your blood sugar is below 70, or below 80 with symptoms, you need to consume carbohydrate (usually 15 grams, for example, 4 ounces of juice or soda or 6 saltine crackers) as advised by your health care provider. (If unable to consume carbohydrate by mouth, call 911 immediately.)

It is important to know that having diabetes does not cause hypoglycemia. However, some of the medications used to treat diabetes can cause low blood sugars. Examples of these medications include insulin, glyburide, glipizide, Amaryl, Starlix, Prandin, or combination medications such as Metaglip. Low blood sugars may occur between meals, with meal skipping, after activity, or when your diabetes medication peaks. Diabetes medications are an important part of treatment. Work with your health care provider to make adjustments to your medications and lifestyle if you are experiencing hypoglycemia.

Symptoms of hypoglycemia (low blood sugar)

The symptoms of hypoglycemia can vary and may include hunger, difficulty concentrating, headache, shaking, irritability/anger, sweats, dizziness, anxiety, confusion, and unconsciousness. 

Early symptoms of low blood sugar simply indicate that it is time to eat. Mild symptoms can make it difficult to continue your current activity and live your life fully because you feel poorly. Severe hypoglycemia can become very serious and must be recognized and treated.

If you're on medications that cause hypoglycemia, then repeated episodes can blunt the symptoms of low blood sugar, making it even harder to recognize them. As a result, the severity of the hypoglycemia worsens over time.

If you are not able to feel a low blood sugar before it “hits,” it is called hypoglycemia unawareness. Mindfulness and mindful eating can help you manage your diabetes by helping you become aware of these symptoms sooner, alerting you to a possible problem.

Steps to Increasing Your Awareness of What Your Blood Sugar Feels Like

Become curious. Check in and ask yourself, “Do I feel any different when my blood sugar is below target? Are there any signs or clues that my blood sugar is low or dropping?” Observe for specific symptoms of low blood sugar. Common symptoms include hunger, shaking, sweats, difficulty concentrating, confusion, irritability/anger, or anxiety.

Test your blood sugar. Since no two people experience low blood sugar the same way, test your blood sugar more often for a week or two. Check it at various times and when you suspect it might be low. 

Talk with your healthcare professional. Find out whether you are taking a medication that could cause a low blood sugar. If you are, ask your doctor, “Does this medication have a peak or a time when I should check my blood sugar?”

Record your blood sugars and look for patterns. Did your reading make sense to you? Did you think, “Wow! I didn’t think it would be that!” Take a moment to write the reason you think your blood sugar was low (or high) in your blood sugar log,including information about when, what, and how much you ate, and details about your physical activity prior to the episode. A quick note is better than relying on your memory.

Always take your detailed blood sugar log with you to your appointments. This will help you have more effective conversations with your healthcare team because it you are able to show them how your diabetes treatments—diet, activity, and medications—are working.

Contact your healthcare provider if you have had two or more low blood sugars in a week. If you are experiencing low blood sugars, review your diabetes medications, diet, and physical activity patterns with your health care provider.

The goal of diabetes self-management is to improve your health. Mindful eating helps by increasing your awareness so you can play an active role in your healthcare.

Hunger is the Best Seasoning

By Michelle May, M.D.

You were born knowing exactly when and how much to eat. Hunger is your body's way of telling you that you need fuel. By reconnecting with your instinctive signals, you can better manage your food intake and your blood sugars without obsessing over every bite of food you put in your mouth.

Perhaps you've ignored hunger for so long that you've forgotten how to recognize it. Maybe you even blame hunger for weight gain and see it as the enemy. Perhaps you confuse hunger with all the other reasons you eat, like mealtime, boredom, stress, or tasty food. At the same time, you may have learned to ignore the feeling of satisfaction so you eat until you’re stuffed and very uncomfortable. Perhaps you "clean your plate," "never waste food," and "eat all your dinner if you want dessert," instead of stopping when you've had enough.

Reconnecting with your hunger signals helps you manage your diabetes. Here's how: 

• You'll eat less food when you're eating to satisfy physical hunger than if you eat to satisfy other needs. Think about it. If you aren't hungry when you start eating, how do you know when to stop? When the food is gone of course!
• You’re more likely to choose foods that nourish you. If you aren't hungry but you're eating because you are sad, mad or glad, what kinds of foods do you want? That's when you’re more likely to want chocolate, cookies, chips, or other snacks and comfort foods.
• Food actually tastes better when you're physically hungry. Hunger really is the best seasoning—so you eat less but enjoy it more.
• You’ll feel more satisfied because food is great for reducing hunger but not so great for reducing boredom, stress or other triggers.
• You’ll notice you’re hungry before you get too hungry and that decreases overeating!

Trust Your Gut Instincts

To break out of the pattern of eating on autopilot, get in the habit of asking yourself, "Am I hungry?" every time you feel like eating. This simple but powerful question will help you recognize the difference between wanting to eat and needing to eat. Look for symptoms like hunger pangs, gnawing, growling, emptiness, low energy, shakiness, or headache. Notice that hunger is physical. It's not a craving, a thought or a temptation. By focusing on hunger as your guide, you can become your own internal expert about when, what and how much to eat.

Food for Thought

• What specific signs of hunger do you usually have?
• What other thoughts and feelings do you confuse with hunger at times?
• What else could you do besides eat when you feel like eating even though you’re not hungry?

One final thought: If you’re not sure you’re hungry, you’re probably not.

Read the next post, Mindful Eating and Hunger When You're on Medications for Diabetes, for important information about hunger for people on insulin and other diabetes medications that can cause hypoglycemia.

What is mindful eating and how can it help my diabetes?

Learning about Taste 
by Megrette Fletcher, M.Ed, RD., CDE

Mindful eating can mean many things. Some might think mindful eating is simply paying more attention to what, when, or how much you eat. For others, mindful eating means slowing down, chewing your food more slowly, and really trying to savor the bite in your mouth. Mindful eating can be all of this and much more. 

When mindfulness (which I'll loosely define as choosing to be aware of your current experience) is combined with eating, there is a major shift in the way you think about food. Instead of focusing on what you can’t eat or what you should have eaten instead, stop and just observe what is present in you.

“Huh? That sounds too simple! All I have to do is just pay more attention?” Actually, it can be quite challenging because paying attention is a skill. Learning a new skill requires practice; the more you practice, the better you become at it.

Unfortunately many people with diabetes have been told to eat less, taught to count carbohydrates, and made to feel guilty when their blood sugars are high. Having someone ask you to think about the bite in your mouth and decide if the food you are eating actually tastes good seems almost irrelevant!

“Wait a second. You want me to taste my food now?” Exactly! Mindful eating is becoming aware of information that is available only to you. For example, at your next meal or snack, take a moment and notice how the food really tastes. Why? Because there is no test, instrument, or machine that can measure how a food tastes to you. The only way to know if something tastes good to you is to taste it and notice.

People with diabetes sometimes start a mindful eating practice to help them eat less. If that's why you are interested in giving mindful eating a try, begin by checking in to see how a food tastes as you take each bite.

My clients are surprised when I ask them to try to notice the flavor of the food they are eating. People often think they love a particular food but there are lots of reasons why the same food won't always taste as good. You could feel rushed, not hungry, excited by the conversation--or something as simple as having recently brushed your teeth. Sometimes the way the food is prepared simply isn’t appealing to you. Unless you take a moment to notice this, you may mindlessly eat something that really doesn’t even taste good.

For the next several meals, take a bite and try to really taste the food. Rate it on a scale of 1 (not very good) to 10 (wonderful). Continue doing this with each bite. Become curious and ask yourself lots of questions. What do you enjoy about that bite? Is it delicious because it's warm and chewy? Refreshing because it's cold and crisp? Eating food that tastes good is a wonderful reason to keep eating.

Mindful eating can help you see that the enjoyment of food changes as you eat. Something that tastes good at first may lose its appeal after a few bites. Noticing this shift can help you place your fork down, recognizing that you aren't stopping because you have to but because you want to when the food no longer tastes wonderful to you.

In another post we will talk about fullness and how to use these two pieces information to begin to change the amount and types of food that are consumed.