Diabetes and Mindful Eating

A Little Wiser

By Megrette Fletcher, MEd, RD, CDE
Co-Author of Eat What You Love, Love What You Eat with Diabetes

Anne was newly diagnosed with diabetes when she came to her appointment. She sat in my office and began to tell me what she was looking for from the session. As I listened, I got a sense of what Anne needed. 

During her life, Anne has made many, many different attempts at changing her diet. In the past, the reasons were to “be thin” or “be fit,” but they all seemed to revolve around appearance. She told me, “This time it is different!” which I thought might mean she was willing to dig a little bit deeper into the WHY of eating. When I asked her, “So, why do you think you eat?” she looked at me and explained that she was an emotional eater. 

In Chapter 4 of Eat What You Love, Love What You Eat with Diabetes, we talk about how our thoughts and beliefs are often a big part of our food and eating choices. What people often don’t realize is that we have the ability to change how we think. This is why mindful eating is so powerful. It isn’t telling you what to do, it is asking you WHY are you making this specific choice. What is interesting is that when people begin to ask questions, they actually change how the brain works. 

A month had passed when Anne came for her follow-up. She was relaxed as she began to share what she had learned in the last four weeks. Her numbers were improving, but still not in target.  

I asked, “Are you worried about this?”

“No.” Then she added, “I can see they have come down almost 100 points, which feels good!”

“How is the food and eating going?” I asked.

“Better, but not perfect. I thought about it and I think I need more support. I decided to use the plan you and I came up with and attend a weight-loss support group called TOPS (Take Off Pounds Sensibly), which meets weekly.”

“Is that helpful?” I inquired.

“Yes, it is. I think I am too hard on myself. It is funny, but the other day I learned that my grandson is moving away and all I wanted to do was eat. I remembered the conversation we had about emotional eating and the mindful eating cycle. I asked myself:  Am I hungry? Which I wasn’t, so I decided to do something else. I think it was the first time in my life that not eating in response to my emotions was actually a choice.”

“Wow! That is really a powerful awareness.” 

Anne continued, “What surprised me even more was when I shared the story at the group. I noticed that I think about food differently. I really have so much to learn about diabetes, but you know, I just feel smarter.”

I nodded in agreement, saying, “Maybe what you are feeling is a little wiser.”

She laughed a bit and agreed, repeating softly, “Wiser. Yeah, that feels right.”

How do you use MyPlate when you have diabetes?

By Michelle May, M.D.
Co-Author of Eat What You Love, Love What You Eat with Diabetes

For those already familiar with the concepts of mindful eating and intuitive eating, you understand the challenges of applying these non-restrictive approaches when someone has specific dietary needs or a chronic condition that is impacted by what you eat (as if there are any conditions that aren't impacted by what you eat!).

In fact, it's one of the most common questions I get from audience members and other health professionals when I present on mindful eating: "But what do you do when you can't eat what you love because you have diabetes?" they ask.

My answer: People will eat what they love anyway so you might as figure out how to balance eating for enjoyment with eating for nourishment - and in this case, for optimal blood glucose management.

All Foods Can Fit

We know (as you do) that rigidity just doesn't work long term so we simply aren't interested in giving people a bunch of unsustainable rules to follow. Instead, like many other health professionals, we fully embrace the "all foods can fit" philosophy using the principles of balance, variety, and moderation. Mindful eating is perfect for learning how to eat what you love in moderation while eating a varied and balanced diet. (Our recent series of posts on the debate about butter vs. margarine is a good example of how mindful eating is applied to complex nutrition questions.)

As you can imagine, while we were writing Eat What You Love, Love What You Eat with Diabetes, we had many long conversations about how to balance our non-restrictive approach with the goal of achieving target blood glucose levels. We were nearly finished with the first draft of the manuscript when the launch of MyPlate was announced. First it was "Argggghhhh!" then it was "Aha!" We quickly agreed that this simple visual icon of a balanced meal was a practical way to convey complex nutrition information for a healthy diet. So we went back to the drawing board - literally!

Eat What You Love, Love What You Eat with Diabetes Plate

Unfortunately MyPlate doesn't yet have a version for people with diabetes (or allow significant modification of the original graphic), so we designed a new Eat What You Love, Love What You Eat with Diabetes Plate to help people with diabetes apply MyPlate tools. Download Eat What You Love Love What You Eat with Diabetes Plate with Tips

As you can see, the key difference is that we put the foods that contain a significant amount of carbohydrate (grains and starchy vegetables, fruit, and dairy) in the upper right quadrant of the graphic. (Each serving is approximately 15 grams of carbohydrate.) This helps readers adjust the total amount of carbohydrate they eat at each meal or snack so their carbohydrate intake doesn’t exceed their body’s ability to process the glucose.

Mindful Meal Planning

As we say in chapter 7, Mindful Meal Planning, "Our goal is to teach you what you need to know about nutrition to manage your blood glucose and keep yourself healthy. Simultaneously, we want to give you a flexible approach to eating that is enjoyable and sustainable."

Since people eat food, not macronutrients, we like the plate planning method. Here's a brief summary of some of the key concepts for mindful meal planning that we explain throughout the Nourish chapters in the book. (PLEASE, don't take this out of context; WHAT you eat is only one part of the Mindful Eating Cycle!)

1. Start by picturing your meal and visually dividing your plate in half.
2. Fill the left half of your plate with salad and other low-carbohydrate vegetables.
3. Divide the other half of your plate in half again and put lean protein in the bottom section.
4. Your carbohydrate choices - grains, starchy vegetables, fruit, and dairy - go in the top right.
5. A carbohydrate choice contains approximately 15 grams of carbohydrate. Adjust the number of servings for your carbohydrate goal.
6. Add healthy fats in moderation for flavor, satiety, and more stable blood glucose levels.
7. If you are having dessert, replace one or more of your carbohydrate choices with the desired sweets.

From this foundation, we build a mindful all foods can fit approach. And yes, that does include sweets and desserts! (Watch for a blog post about that coming soon.) With awareness of nutrition and meal planning techniques, you can design flexible meals and snacks that are nourishing and satisfying and that help you keep your blood glucose in the target range.

Experiencing Health

By Megrette Fletcher M.Ed, RD, CDE
Co-Author of Eat What You Love, Love What You Eat with Diabetes

It had been about a year since I last saw Richard. He came into our session as would any friend I hadn’t seen in a while. Light chatter filled the air as I gathered the necessary information about medications and blood pressure. When this was finished, I settled into my seat and listened to Richard tell me of his life.

“I don’t know why I stopped,” he began. “I was doing great last year and then, I stopped. Weird as that is, when I started to see my numbers and weight increase, I didn’t start back again either. Do you know why?”

To begin, it is normal to get off track. Richard’s question about why he didn’t just start back again is an excellent one to ponder. There are lots of possible answers, many of which we explore in chapter 22 of Eat What You Love, Love What You Eat with Diabetes. In Richard’s case, what I already knew about him is the following:

Richard is a really smart guy who is gifted with numbers. He is a thinker, and for him, life is wonderful if all the numbers and behaviors “add up” and “make sense.”  Eighteen months earlier, he had been introduced to the mindful eating cycle. It made sense to him to eat when he was hungry and stop when he was full. He understood that by checking in with his hunger before a meal and eating with the intent to meet this level of hunger, he would likely stop overeating. It seemed logical, so he tried it. What he really liked about this plan was the numbers made sense. His blood sugars responded when he honored his hunger, falling into target. He began to exercise, returning to the gym on a consistent and regular basis. Soon his A1c was below 6.5 mg/dL, and his weight had dropped more than 25 pounds. When we parted 12 months ago, Richard felt healthy and in charge of his diabetes. 

Yet, when I asked why he stopped using the mindful eating cycle, he said, “The numbers were in target so I figured I was okay.” With that response, I had a suspicion what the problem was. 

Health is an experience. Health is not a number. It is not a weight, a blood sugar, a cholesterol level or A1C test. When individuals begin to eat mindfully, they begin to notice their direct experience with food and eating. When individuals begin to exercise mindfully, they begin to notice their direct experience with exercise. When I asked Richard about his experience with exercise, he stated in a somewhat surprised voice, “But I LIKE to exercise!” So I asked, “What was your experience when you ate more mindfully?” and he smiled, his voice soft as he remembered that “I liked it. I felt better. It wasn’t about a number then, was it?”

To which I confimed, “No, it wasn’t.”