Diabetes and the Nondiet / Intuitive Eating Approach
In 2012, I was honored to speak to the Seminole Tribe of Florida at a conference held in beautiful Marco Island, FL, right across the bridge from Naples. The conference focused on promoting wellness and providing quality care within the Seminole Tribe of Florida (STOF) Health Centers. I loved their holistic mission:
The Seminole Tribe of Florida's Integrative Health Department exists to provide relationship-centered care in a healing environment that cultivates resilience and engages each person's unique healing abilities.
Right up my alley!
Their mission was to “create a partnership between the patient and provider in the healing process,” taking into consideration all factors that influence health, wellness and disease including body, mind, spirit and community, with the goal of “facilitating the body's innate healing response.”
That sounded like a walking advertisement for the nondiet, intuitive eating approach!
I was off to wonderful Marco Island and Naples, Florida!
Shifting Approaches to Health and Diabetes
The turnout was amazing, and I was thrilled so many were interested. The group had lots of questions, most focused on how to get off the diet-blood sugar rollercoaster, and exactly how “STOP DIETING” was part of that process.
We focused on 2 concepts:
Shift focus from managing diabetes by changing body size or shape to managing diabetes by nourishing the body, fortifying the mind and energizing the spirit.
Stop negative self-talk. Having diabetes or elevated blood sugars is challenging and scary. We don’t need to add judgment to that.
Of course managing type 2 diabetes is about keeping your blood sugar within a stable range. What you eat and how much you move can certainly influence this. The participants were well aware that certain foods could cause blood sugar to spike and that eating too little might make it drop too low. Most tried to avoid certain foods or stick to specific guidelines.
My talk focused on how external guidelines can certainly be useful, but the body can also be a guide, and a very succesful one at that.
An Intuitive Approach to Type II Diabetes
The most important question to ask in diabetes management is how does your body feel when fluctuations in blood sugar occur? This is where the nondiet / intuitive eating approach is so critical because it offers guidelines as to how to read the body.
Unfortunately, many people are disconnected from sensations in the body, such as hunger and fullness cues and how food makes them feel. If so, it can take some time to reconnect with the various subtle clues that let a person recognise blood sugar disturbances.
Although this may require help from a skilled practitioner, there are many steps a person can take on their own.
Diabetes and Becoming Aware of Bodily Sensations Including Hunger and Fulllness Cues
To begin connecting with internal signals of hunger and fullness, the use of a Hunger Fullness Scale is recommended. Many people misinterpret sensations of hunger, especially if they have restricted food intake in the past. Signals such as an empty or gnawing feeling in the stomach, a feeling of low energy or lethargy, a headache, difficulty concentrating, irritability, or persistent thoughts of food can all indicate hunger.
Checking in with the body somatically can be foreign, but those with diabetes have an easier time of this because they can get immediate confirmation as to whether they are on target. When these hunger sensations appear, checking blood glucose level will provide this valuable information. If it is low, the sensations indicate physical hunger. If blood glucose is high, the sensations can mean something other than hunger, but not always.
If the body doesn’t have enough insulin available to move glucose into the bloodstream and into the cells that need it, the experience of hunger is real. Insufficient insulin can result from not enough being injected (in those who inject insulin) or from a pancreas that simply can’t put out enough to handle the level of glucose in the blood. And while food is the best-known contributor to glucose in the bloodstream, blood glucose can be high following intense exercise, as a consequence of an infection (even an as yet undetected infection), and as a side effect of certain drugs.
Having high blood glucose when you’re feeling hungry, therefore, allows the person with diabetes to reflect on what is happening, to be curious. This is an excellent opportunity to learn more about the self, and to determine if the urge to eat is coming from a physical trigger or an emotional one.
As the person with diabetes becomes more intuitive in their management, they can experiment with different amounts and combinations of foods. Matching this with feedback from assessing bodily sensations and blood glucose levels allows the opportunity to draw conclusions not available to those who don’t monitor blood sugar. This also allows the opportunity to experiment with the dose and timing of insulin.
How to Use Bodily Sensations To Guide Diabetes Management
As an example, let’s pick a food that most diabetics are told to avoid, or limit, such as pasta. Will pasta create blood sugar problems? That depends.
Unfortunately, with most approaches to diabetes, pasta is considered “bad,” so when a person eats it, they get stuck up in their head chastizing themselves for eating this “bad” food, feeling guity, perhaps plotting counter measures to undo the “bad.” They are NOT paying attention to the sensations in their body, or if they are, they are chastizing themseves for that as well. They are missing a wonderful opportunity to learn and more easily change their behaviors.
But, rather than getting stuck in negative self-talk if food causes a blood sugar spike, the intuitive eating approach says pay attention! Notice perhaps slowed mental performance, reduced concentration and energy levels, feeling uncomfortable and even changes in mood.
Since most people do not want to experience those symptoms, afterall, they are unpleasant, the symptoms themselves are self-reinforcing to avoid them. Staying present to feeling uncomfortable, while at the same time knowing why the discomfort is present, can help rewire the brain for new behaviors. This is a much faster way to alter behavior than feeling guilty and/or self-loating, which will not rewire the brain for a new behavior. That simply rewires the brain for more guilt and self-loathing.
Changing Behaviors Becomes Easier, More Intuitive
If a person is somatically connected to themselves, if they are able to pay attention and read the body, they can start to make choices from a different place. Choosing foods not because they “have to,” or because someone else told them, but because they want to feel comfortable, and are self-motivated to pick the foods that ensure that comfort.
As such, they intuitively learn to select foods that do not spike blood sugar. They learn that perhaps a smaller portion of pasta with some extra vegetables works perfectly, or adding in some protein helps avoid the blood sugar spike and allows them to feel more energised after a meal.
Eating Disorders and Diabetes
One question I was asked was about diabetes and eating disorders. A large percentage, close to half, of all people with diabetes report having disturbed eating. However, a majority of these individuals do not meet criteria for a formal DSM-5 eating disorder diagnosis.
However, having diabetes, where one must pay attention to the specifics of food when eating place a person at higher risk of experiencing symptoms of an eating disorder such as anorexia nervosa, bulimia nervosa, or binge eating disorder, with binge eating disorder (BED) being the most common among diabetics.
Symptomatic behaviors that can indicate an eating disorder can range from cycling on and off diets, to intermittant fasting to binging serve as warning signs. While these are normative behaviors in our culture, they can indicate a person is struggling, or will be soon.
Compensatory Behaviors in Eating Disorders
For some, these symptoms may be accompanied with a range of “compensatory behaviors.” These may occur when a person eats more than they had planned on eating, or eats foods they were trying to avoid, or can happen after a regular meal or snack.
As the name implies, compensatory behaviors are an attempt to compensate for the amount of food or type of food eaten or to relieve the discomfort and/or guilt. Often, behind compensatory behaviors is the fear of weight gain.
Compensatory behaviors can be as seemingly benign as cycling back on to another diet, but can include self-induced vomiting, and misuse of laxatives, enemas, caffeine or diuretics in an attempt to rid the body of food and liquids. These behaviors are ineffective or only partially effective in terms of removing calories and have potentially dangerous side-effects.
Diabetes and Eating Disorder Treatment
Eating disorder behaviors will directly interfere with optimal diabetes management and expert treatment should be sought if one suspect they are suffering from an eating disorder. This means that an eating disorder treatment team should be involved, including a therapist and nutritionist who specialize in treating eating disorders. Additionally, it is most beneficial if the physician also has experience with eating disorders on the team as well.
While a person with diabetes will always have diabetes, it is possible to fully recover from an eating disorder. The intuitive eating approach described above will not only help a person recover, but will also help prevent an eating disorder.
I recommend the intuitive eating / nondiet approach always be included in diabetes counseling and management.
Off to Explore Marco Island and Naples
What a great group this was. They had lots more questions, but needed to move on to other workshops. They were hungry for a more intuitive approach to diabetes and good health and I was so pleased to present this approach to them.
And, as I know, good health comes in part from enjoying life, so I was off to explore the beauty of Marco Island and Naples, with lots of good feelings left over from this great conference!
About Eating Wisdom and Drs Karin and Hannah
We are two PhD level Registered and Licensed Nutritionists whose passion is to help others escape diet culture and to learn to use their natural, innate Eating Wisdom to, finally, find peace with food, eating and weight.
Check out our course, Intuitive Eating: How to Escape Diet Culture and Become an Empowered Eater,. plus we have lots of info and handouts (including the original Hunger Fullness Scale) at our website, www.EatingWisdom.com. We also offer 1:1 nutrition therapy. Take advantage of our combined 40+ years of experience and reach out today!
© 2012 Karin Kratina, PhD, RD, LDN and Amy Tuttle, RD, LCSW