DIABETESSELF-MANAGEMENT

$4.00NOVEMBER/DECEMBER 2010

TYPE 2 DIABETESIN THE FAMILY NEW TOOLS

2010 INTUITIVE

EATING

For subscription information, please call (800) 234-0923. Or for a Free Trial Issue, visit us on the Web at www.DiabetesSelfManagement.com. Reprinted with permission from Diabetes Self-Management, November/December 2010. Copyright 2010 R.A. Rapaport Publishing, Inc.

44 Diabetes Self-Management

enna, a new client, was ex-plaining what she wanted toget out of her counseling ses-sions. She said, I want to love

food again. I want to pop a juicystrawberry into my mouth and notthink about my blood sugar. I wantto enjoy a slice of gooey cake at mysons birthday party, guilt-free. I wantto go to a dinner party and feel freeto eat whatever my friend prepares.

And what stopped her fromenjoying eating? I have diabetes,she said.

This was followed by a pause, asif that sentence explained it allthat a diagnosis of diabetes meansthat food and eating can no longerbe enjoyed.

Jennas concerns arent surpris-ing, given the advice most peoplewith diabetes receive about foodchoices and meal planning. Whenyoure asked to consider the carbo-hydrate content, fat content,glycemic load, and potential impacton your weight of everything youeat, it can be extremely difficult tomaintain a healthy relationship withfood, to truly enjoy eating, and toallow food to nourish you. It doesnthelp when doctors, dietitians,friends, and family members allseem to have something to add tothe topic of how to eat with diabetes.

If the prospect of choosing foodsstrikes fear in you, or if youve triedseveral diabetic diets and none ofthem worked for you in the longrun, weve got some great news:Theres no need to see food as yourenemy, or to carefully restrict youreating. In fact, the opposite is true.The secret to managing your dia-betes lies in learning to celebratefood and its amazing ability to nour-ish you.

Ending the blame game

Chances are youve been pre-scribed a food regimen to helpcontrol your blood glucose levels. Ifyoure like most people, you find ithard to stick with a rigid plan, andif your meal plan excludes certainfoods that you like, you mourn theloss of those foods. Perhaps youvetried to follow your meal plan, onlyto find yourself eating the veryfoods you were told to avoid. Per-haps you were told you needed tolose weight, and even though youshed some pounds, a few monthslater, they returned. You may won-der why you cant just get your acttogether and take better care ofyourself. In fact, if you have Type 2diabetes, you may think that ifyoud done a better job monitoringyour food intake and weight beforeyour diagnosis, you wouldnt be inthis predicament now.

So heres our first piece ofadvice: Dont blame yourself!

Genes play a large role in thedevelopment of diabetes. Were allborn with challenges in our geneticcodeas well as in our life circum-stancesand this is one of the chal-lenges you were dealt. Your bodywas vulnerable to difficulty withglucose regulation, and some com-bination of factors triggered thatgenetic propensity. However, nowthat a diagnosis of diabetes hasmade you aware of your bodystrouble regulating glucose, yourein the drivers seat: You can learnhow to manage your blood glucoseand nourish yourself better. To getthere, you may need to let go ofcertain beliefs that harm ratherthan help you.

INTUITIVE EATINGEnjoy Your Food, Respect Your Bodyby Linda Bacon, PhD, and Judith Matz, LCSW

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45November/December 2010

Changing the diet mentality

In the care and treatment of Type 2diabetes, the value of achieving andmaintaining weight loss has longbeen an unchallenged tenet. Soyou may be surprised to learn thatthere is limited evidence to supportthis emphasis. In fact, evidence sug-gests that the pursuit of weightlosswhich more often results influctuating weight than permanentweight losscan actually be harm-ful, both physically and emotion-ally. It also tends to distract aperson from the behaviors and atti-tudes that really can improve oneshealth, such as eating well, beingphysically active, and cultivating apositive sense of self.

Its true that the majority of peo-ple with Type 2 diabetes fall intothe body-mass index (BMI) cate-gories of overweight or obese.But its also true that insulin resis-tance, one of the main underlyingproblems in Type 2 diabetes,encourages weight gain. In fact,weight gain may actually be anearly symptomrather than a pri-mary causeof the path towardType 2 diabetes.

A short explanation of the sci-ence behind diabetes may helpexplain how this weight gain hap-pens. Insulin is a hormone respon-sible for guiding nutrientsbothglucose and fatout of your blood-stream and into your cells. If youhave diabetes, your pancreas cantmake sufficient insulin and/or yourcells are resistant to insulin, mean-ing they dont respond effectively toinsulins message. In either case,you may have difficulty getting glu-cose into the cells that need it forenergy. Instead, the excess glucoseremains in your bloodstream, a situ-

ation that is believed to contributeto many of the complications associ-ated with diabetes.

In people with Type 1 diabetes,prolonged high blood glucose typi-cally leads to weight loss as the glu-cose exits the body in the urine andthe body begins to break down fattissue for energy. In people withType 2 diabetes (or prediabetes)whose pancreases still makeinsulin, the bodys response to highblood glucose is to make andrelease more insulin, resulting inhyperinsulinemia, or higher-than-normal blood insulin levels. Hyper-insulinemia may promote weightgain in three ways: by causingincreased storage of glucose as fat;by interfering with the action of thehormone leptin, which normallysignals the brain that the body hashad enough to eat; and by increas-ing the pleasure derived from food,even when the body does not needmore calories. Given these mecha-nisms, its not surprising that manypeople gain weight when they haveType 2 diabetes.

Without a doubt, weight loss isvery effective at improving bloodglucose control in the short term.But this doesnt mean that yourhealth will be better off in the longrun. A review of controlled weight-loss studies involving people withType 2 diabetes showed that initialimprovements in glucose controlwere followed by a return to start-ing levels of control within 6 to 18months, even in the few cases whereweight loss was maintained.

What can have lasting positiveresults, however, is developing sus-tainable behaviors. A wealth of evi-dence shows that people of all sizescan substantially improve theirblood glucose control and theirgeneral health and well-being

through healthy behaviorsevenin the absence of weight loss.

Health at Every SizeA new approach to diabetes man-agement that emphasizes wellnessrather than weight is called Healthat Ever y Size (HAES). HAESencourages people to trust theirbody to guide them in makingnourishing food choices and attain-ing a natural weight. The HAESprogram includes three guidingconcepts: Size and self-acceptancerespectand appreciation for the diversity ofbody shapes and sizes, rather thanpursuit of an idealized weight orshape Joy of movementparticipationin physical activity for pleasure andhealth benefits, rather than primar-ily for the purpose of weight loss The pleasure of eating wellintuitive eating based on physicalcues rather than on external foodplans or diets.

Becoming an intuitive eater

Many people who have diabetesfeel betrayed by their body and findit difficult to trust that their bodycan actually support them in eatingwell. However, research shows thatyou can learn to read your bodyssignals and respond to them in aloving, nourishing way. Intuitiveeating means eating what feelsright to you, when it feels right.This approach helps you to reclaimthe pleasure in eating and at thesame time allows your body to helpyou manage your diabetes.

The first step in becoming anintuitive eater is to shift away fromexternal rules about when youshould eat and to learn to listen to

Intuitive eating means eating what feels rightto you, when it feels right.

November/December 2010

your bodys internal cues. We wereall born with the ability to knowwhen we are physically hungry, andyou can reconnect with this naturalsignal.

To identify your physical hunger,pay attention to signals such as anempty or gnawing feeling in yourstomach, a feeling of low energy orlethargy, a headache, difficulty con-centrating, irritability, or persistentthoughts of food.

Each person experiences hungera little differently, and your job is tolearn what hunger feels like to you.Checking your blood glucose levelwhen you feel these sensations canprovide you with valuable informa-tion. If it is low, the feeling you areexperiencing is indeed physicalhunger. If your blood glucose ishigh, your impulse to eat may becoming from an emotional ratherthan a physical trigger, but thatsnot always the case. If for some rea-son your body doesnt have enoughinsulin available to move the glu-cose in your bloodstream into thecells that need it, you may be expe-riencing real hunger. Insufficientinsulin can result from not enoughbeing injected (in those who injectinsulin) or from a pancreas thatsimply cant put out enough to han-dle the level of glucose in theblood. And while food is the best-known contributor to glucose inthe bloodstream, high blood glu-cose can also occur after intenseexercise, as a consequence of aninfection (even one that youre notaware of having), and as a sideeffect of certain drugs.

Having high blood glucosewhen youre feeling hungry, there-fore, is an opportunity to thinkabout whats going on for you atthat moment and to ask yourselfwhether your urge to eat is coming

from a physical trigger or an emo-tional one.

As you become an intuitiveeater, you can experiment with dif-ferent amounts and combinationsof foods and get feedback throughassessing how you feel and check-ing your blood glucose level. If youtake insulin, you can also experi-ment with the dose and timing.

Youll find that responding totrue hunger is one way to put thepleasure back in eating; food actu-ally tastes better when you are hun-gry. To ensure that you can eatwhat you want when you are hun-gry, its a good strategy to alwayscarry a bag of food with you thatincludes a wide range of options.

If you find that you are fre-quently turning to food before youare physically hungry, ask yourself,Can I wait? Remind yourself thatas soon as you are hungry, you willeat. The more you practice listen-ing to your bodys signals andresponding to them, the less youwill feel the drive to eat whenyoure not really hungry. However,if you continue to turn to food foremotional reasons in spite of thiswork, consider doing some furtherreading or seeking counseling tolearn how to manage your feelingswithout reaching for food.

Choosing what to eatJust as its important to move awayfrom external rules about when toeat, its also important to let go ofthe rules about what you shouldor shouldnt eat. Instead, thinkabout what food(s) would feel trulynourishing in your body. By choos-ing foods you like that will alsokeep your body feeling well, youcan end the feelings of deprivationyou may have surrounding food.

When you eat, pay attention to

When you eat, pay attention tohow various foods affect you.

/TM/ The J.M. Smucker Company

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HAS A FLAVORFOR EVERYTASTE BUD.

48 Diabetes Self-Management

how various foods affect you. Notehow you feel physically and mentallybefore and after eating. Check yourblood glucose level before and twohours after eating for additionalfeedback on the foods you chose.The more you do this, the more youwill feel in charge of your eating andyour diabetes care, rather than feel-ing controlled by them.

Here are some examples of howpeople with diabetes are using intu-itive eating in their everyday lives:

Kara experimented with differ-ent types of food as she movedtoward intuitive eating. For lunchone day, she made a burrito filledwith beans, vegetables, brown rice,and cheese. She felt nourished bythis meal, and her energy level feltgreat. Her blood glucose check twohours after the start of this mealconfirmed that she was in anacceptable range. Karas positiveeating experience resulted, in part,from the fact that her meal washigh in fiber from the beans, veg-etables, and brown rice. The fiberboth filled her up and slowed therate of glucose entering her blood-stream, keeping it at a healthy level.Kara was careful to concentrate onhow foods felt in her body, whichguided her to make choices thatsupported her wellness.

Jesse loved to eat fried chicken.However, when he checked hisblood glucose level two hours aftereating a fried chicken meal, it wasover 300 mg/dlwell above thepreferred range of less than 180mg/dl two hours after a meal. Jesserecognized that he had also eatenmashed potatoes, gravy, andcreamed corn because they wereincluded with the meal, notbecause he really wanted them. He

decided that in the future he wouldtune in to what he really wanted,not just eat what was offered. Thenext time he ate fried chicken, hechose green beans and a bakedpotato as side dishes. His blood glu-cose level following this meal was164 mg/dl. Through this process,Jesse learned how his body reacts tovarious foods. He was able to con-tinue eating the foods he loveswhile successfully managing his dia-betes. In the future, if Jesse wantedto eat the mashed potatoes, gravy,and corn with his fried chicken, hecould experiment with eating asmaller quantity of each to keep hisblood glucose level down.

Chris loved to eat bread. Whenshe checked her blood glucose levela couple of hours after eating sev-eral slices from a freshly baked loaf,it was too high. She started to pairthe bread with some peanut butter,which helped keep her blood glu-cose below 180 mg/dl, since fathelps slow the rate at which glucosegets into the blood. Knowing that ahigh-fat snack or meal can cause adelayed rise in blood glucose aftereating, Chris also checked herblood glucose level three to fourhours after her snack to receiveadditional feedback.

Remember the gooey cake thatJenna wished she could eat withoutguilt at her sons birthday party?After several months of practicingintuitive eating, Jenna realized thaton days when she sat around thehouse, eating a piece of cake wouldsend her blood glucose level toohigh, leaving her feeling tired. Butwhen she was physically active, shefelt better, and her blood glucoselevel tended to stay in a healthyrange. So after a wonderful cele-

bration of her sons fifth birthday,she took her dog for a long walk.Her goal is to walk more regularly.For now, though, she is glad toknow that walking helps get glu-cose out of her blood and into hercells without requiring moreinsulin. This motivates her to bemore active and also enables her toenjoy her cake.

Becoming an intuitive eater andlearning how to feed yourself in away that gives you pleasure takessome experimentation. The payoffis the feeling of sustained energythat comes from matching yourhunger with pleasurable, nourish-ing food choices.

Stopping when fullWhen you are hungr y and eatexactly what you are hungry for, itfeels very satisfying. As you eat,theres a point when youve hadenough, and the food no longertastes as good. By paying attentionto this internal cue, you can stopeating when you are full so thatyour body feels satisfied and com-fortable. But keep in mind that ifthere is no physical hunger signalto start eating, there will be nointernal signal to stop.

One thought that may make iteasier for you to put down yourfork or spoon when youve hadenough is that when you are hun-gry again, you will eat againthesame food as you are eating now, orsomething else, if you prefer.

There may be times when yousuddenly feel hungry again eventhough you recently finished eat-ing. This may be because yourinsulin-resistant cells have not yetreceived the energy from the meal.Try making your meals smaller, in

Craving food after a filling meal may meanthat your food choices didnt entirely satisfyyour needs.

51November/December 2010

this case, and eating more fre-quently. Smaller meals will requireyour pancreas to release less insulin,so you may have a better matchbetween the amount of glucosefrom the meal and the amount ofavailable insulin. You will learn intime, based on the way your bodyfeels, how much food is right foryou at a particular moment.

Craving food after a filling mealmay also mean that your foodchoices didnt entirely satisfy yourneeds. Hillary found that when sheate salmon, a plain baked potato,and vegetables for dinner, shewould overeat cookies later in theevening even though she wasnthungry. Upon reflection, she real-ized that while she loved the foodsshe chose, something was missing.In her effort to reduce her fatintake so that she might lose weight,she never felt completely satisfiedafter a meal. She tried having somecheese and crackers before dinnerand found that at the end of themeal she felt comfortably fulleliminating the nighttime overeat-ing of cookies that she didnt reallywant. On the evenings when shedid want something sweet after din-ner, she had some cookies orfruitdepending on what she feltlike eating at the timeandstopped when she felt satisfied.Hillary recently saw her doctor for acheckup and was pleased by herHbA1c test results, which are a mea-sure of blood glucose control overthe past two to four months.

Starting your journey

As you become an intuitive eater,honoring your internal cues andreclaiming the pleasure in eating,you will be in a much stronger posi-tion to make decisions about yourhealth. The transition from a focuson dietary control and weight lossto the HAES mindset, with anemphasis on wellness, will put youin charge of managing your dia-

betes and altering your choices asnecessary.

After six months of learning tobecome an intuitive eater, Jennareported: The best part is that theinternal guidance of my bodys cuesis reliable. I dont feel bad aboutcheating anymore because theresno such thingits just eating! Iveloved getting back in touch with myreal stomach hunger and enjoyingwhat I eat, instead of rushingthrough and eating as much as I cansince, as a large person, Im notsupposed to eat. I find that I feelbetter and have more energy when Ieat healthful foods. I certainly dontdeprive myself, but I do try to payattention to enjoying really goodfood, prepared with love and eatenslowly. My blood sugar readingshave improved significantly, and Imnicer, too!

As mentioned earlier, it takes

time and practice to develop theskills of intuitive eating. Fortunately,there is a large HAES communityand an abundance of resources thatcan support and inform your jour-ney. For specifics, see For MoreInformation, on this page.

We wish you well on the journeyto a healthy, positive, and pleasur-able relationship with food!

Linda Bacon is a nutrition professor,researcher, and author of Health atEvery Size: The Surprising TruthAbout Your Weight. Her personalWeb site is www.LindaBacon.org.Judith Matz is director of TheChicago Center for OvercomingOvereating, Inc., has a private prac-tice in Skokie, Illinois, and is coau-thor of The Diet Survivors Hand-book: 60 Lessons in Eating,Acceptance and Self-Care. HerWeb site is www.dietsurvivors.com.

Learn more about the Health atEvery Size philosophy and aboutresources that can help you reshapeyour relationships to food, weight,and body image on these Web sites.

HEALTH AT EVERY SIZEwww.HAEScommunity.orgThis site gives visitors the opportu-nity to become part of a commu-nity committed to honoring HAESvalues and lists organizations, Websites, blogs, books, and other mediathat support HAES.

ASSOCIATION FOR SIZE DIVERSITY AND HEALTHwww.sizediversityandhealth.org(877) 576-1102The ASDAH is a membership orga-nization of health professionals andlaypersons who promote HAESthrough their employment or vol-unteer work. The Web site has afind an expert feature as well asgeneral information about weightand health.

HEALTH AT EVERY SIZEThe Surprising Truth About YourWeightLinda Bacon, PhDBenBella Books, Inc.Dallas, Texas, 2008www.HAESbook.comWeb site has excerpts of the bookand reviews, as well as purchasinginformation.

THE DIET SURVIVORS HANDBOOK60 Lessons in Eating, Acceptanceand Self-CareJudith Matz, LCSW, and Ellen Frankel,LCSWSourcebooks, Inc.Naperville, Illinois, 2006www.dietsurvivors.comWeb site has information about thebook as well as a link to the DietSurvivors Group blog, tips on start-ing your own Diet Survivors Group,and New Lessons for physical andemotional health.

FOR MORE INFORMATION