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Take charge of diabetes self-management

Eat What You Love

"Eat What You Love, Love What You Eat with Diabetes: A Mindful Eating Program for Thriving with Prediabetes or Diabetes," by Michelle May, M.D., and Megrette Fletcher, MEd, RD, CDE (New Harbinger, 243 pages, 2012, $17.95)

Tom Laue, Executive Editor

Michelle May and Megrette Fletcher, doctor and dietitian, turn typical diabetes care inside out. Usual rigid rules say: Eat only certain food. Eat only when you're "supposed to." Weigh, measure, count, and record everything – or you could go blind or lose a leg! "Failure" can trigger guilt. So you eat more to comfort yourself, feeding a vicious cycle.

The pair argues there's a much better way, not guided by imposed restrictions but by "mindful eating" that puts you squarely in charge of your diabetes self-management and yields far more satisfying results. They note mindful eating is simple, though not always easy, but it has powerful benefits governed by your own, inner actions once you master it.

In an interview, former family physician May says she has been using mindful eating to help people break free of yo-yo dieting for the last 13 years. Eat What You Love, Love What You Eat with Diabetes was born when Fletcher, a certified diabetes educator and registered dietician told her, 'Most of my diabetes patients are yo-yo dieters all grown up!' May wondered, "Why would we expect people to suddenly be able to follow a rigid diet just because they have been diagnosed with diabetes?"

Mindful eating is "staying focused and fully present in the moment, making you aware of what you're thinking, feeling, and experiencing. This is what it means to truly love what you eat." You're not eating fast or while distracted by TV or the Internet. Mindfulness, in fact, can be applied to everything you do, they say – talking, walking, working – as well as for the management of pre-diabetes and diabetes.

'Mindful eating' basics, results

One key to mindful eating success: Eat when you're hungry. Sound too simplistic? The authors understand this reaction and point out true hunger is "your fuel gauge" and consists primarily of physical symptoms – growling or grumbling stomach; gnawing, empty, or hollow feeling; irritability; shakiness; light-headedness; weakness; loss of energy, etc. Yet we often eat because food is in front of us, when we're emotionally upset, or for other non-physical reasons.

How do we change eating habits without giving up any of the foods we love? "An important mindfulness skill is awareness of one's physical sensations, thoughts, and feelings" – what they call a "body-mind-heart scan." By pausing and observing what's going on inside you right then, "you will learn whether hunger is physical or caused by 'head hunger.' This is anything other than true hunger. By pausing to become fully present and mindful, you will be better able to identify your true needs."

To help you practice "mindful eating," they provide a hunger and fullness scale. With "1" being ravenous (too hungry to care what you eat), "5" satisfied (not hungry, not full), and "10" sick (ill, in pain, or both), you can learn to identify exactly where your hunger and fullness levels are and act accordingly.

Ramona (one of many patients quoted throughout the book) tries to break the habit of eating by the clock, even if she and her husband aren't hungry. After using the hunger and fullness scale, she says, "Now, if one of us isn't hungry, we just wrap it up to have for lunch or dinner the next day, when we'll actually enjoy it."

May says don't become a fanatic about anything, such as always waiting to become hungry before you eat. "Deprivation is a powerful trigger for eventual overeating. If you want a cookie offered by a co-worker, you can have it."

May says mindfulness principles apply to physical exercise, as well. "The goal isn't perfection. It is important to do what you enjoy and not use exercise as a punishment for over-eating."

Am I Hungry?

Through May's "Am I Hungry? Facilitator Training Program," trained facilitators conduct mindful eating workshops nationwide. More than 300 have been trained so far. One is Judy Kolish, who instructs selected Blue Cross and Blue Shield employees in the method. Like Fletcher, Kolish is a registered dietitian and certified diabetes educator.

"I used to teach a more restrictive approach for people with diabetes," she says. "It didn't work, which is why I switched to this. It's no longer about control, but about being in charge. It's about balance and using mindfulness to take charge of your decisions. No perfection needed."

She adds, "It's also about improving your quality of life so you can maintain a near-normal blood sugar level. But it is a process. It takes time and effort. It is relearning eating for nourishment and enjoyment, while maintaining blood sugar management."

Learn more at Diabetes and Mindful Eating.