Diabetes and ME

Handling Holiday Eating and Stress: A Recipe for Success

2011-12-07T06:22:50-08:00

By Michelle May, M.D.

The holidays can be a stressful time, especially when you are trying to manage your diabetes and holiday eating in the face of all the busy-ness, stress, and food! By undertanding the ingredients that set you up for overeating, you can create the perfect recipe for success and healthy, happy holidays!

Recipe for Overeating

Ingredients:
1 batch, bag, box, or large plate of food
2 tablespoons of deprivation
1 heaping teaspoon of guilt
Sprinkle of shame
Optional: fatigue, stress, resentment, loneliness, boredom

Directions:

Run yourself down physically by not sleeping, exercising, eating when you’re hungry, consuming nutritious foods, or checking your blood glucose. Alternatively, wear yourself out by working too hard, being all things to all people, and trying to make everything perfect.
Place emotions on medium-high. Cover and simmer; do not allow steam to escape.
When you crave something you love, remind yourself that it's bad, fattening, or high in carbs.
When your cravings grow stronger, tell yourself that you're bad for wanting bad food.
Wait until an influential person such as your grandmother or co-worker insists you eat that food anyway to please them. Alternatively, sneak the food when no one is watching.
Sit down in front of the T.V. or choose another activity to distract yourself while you eat.
Before eating, garnish the food with guilt. If it’s still enjoyable, stir in some shame to ensure that the food is completely ruined.
Eat as quickly as possible to avoid tasting or enjoying the food.
You're done when you feel sick and uncomfortable.
Repeat steps 1-9 until can't stand it anymore. Try the Recipe for Instinctive Eating.

Recipe for Healthy Eating

Ingredients:
1 or 2 servings of food you love
2 tablespoons of hunger
1 heaping teaspoon each of intention and attention
Sprinkle of trust
Optional: pleasure, enjoyment, celebration, tradition

Directions:

Care for yourself physically by getting adequate sleep, exercise, and nutrition.
Create a self-care buffer zone by regularly nurturing your body, mind, heart, and spirit.
When you’re hungry, consider what you want, what you need, and what you have to eat before choosing food.
Decide how you want to feel when you're finished eating; serve yourself accordingly (or adjust the portion if someone else served you).
When the food you crave isn’t particularly healthful, omit all guilt and shame and include the desired food in your meal plan. Remind yourself that all foods fit when you practice balance, variety, and moderation.
Sit down to eat and minimize distractions.
Savor the appearance, aromas, textures, and flavors as you eat.
Eat slowly and mindfully for maximal enjoyment from every bite.
Stop when you feel content and energetic.
Repeat steps 1-9 for the remainder of your life.

Learn how from our new book: Eat What You Love, Love What You Eat with Diabetes: A Mindful Eating Program for Thriving with Pre-diabetes or Diabetes (available 04/01/12). Happy, Healthy Holidays!

Duck Your Cravings: Let 'em float right by!

2011-11-04T17:33:30-07:00

Post by Michelle May, M.D.

The holiday season officially began with Halloween and will continue right through Valentine's Day! For many people with diabetes, this season is associated with food cravings that can feel overwhelming at times. Many people find that the more they try to resist their cravings, the stronger they grow.

One way to take the power out of your cravings is to imagine them in a neutral way. Here's an example of how to picture your cravings like something that holds no power over you whatsoever.

A Calm Lake, Interrupted

I had a limited view of the lake through the window from where I was sitting. The water was calm and peaceful, when from the edge of the pane, a duck drifted into my awareness. I watched it bob in the middle then float away. The ripples slowly receded back into the lake and it was still again.

Minutes later several ducks paddled in from the other side of the window. They splashed about, apparently struggling for something below the surface. The strongest duck swam directly toward the window, circled several times then paddled back the way it came, followed by the rest.

How like my cravings! They seem to appear from nowhere and capture my attention. The difference is that I’ve never had a seemingly uncontrollable urge to jump up and devour a duck! Instead, I can watch a duck with a detached awareness. I feel curious, even entertained, but uncompelled to take any action. I allow the duck to just drift away, unconcerned about where it goes or when another will emerge.

Duck Your Cravings

Learning to observe your cravings in a curious but uninvolved manner can take the power out them. Try this exercise:

The next time you have a craving, stop what you’re doing, close your eyes, and focus on your breath.
Observe the craving as if it was a duck, bobbing around in your awareness. Become curious but remain calmly detached as you watch it.
If the craving becomes stronger, imagine that is simply paddling toward you.
If you feel compelled to stop and eat the object of your craving, smile as you picture yourself chasing down an innocent duck.
Practice slowing and deepening your breath as you patiently wait for the craving to turn and float away.
Imagine the lake returning to peaceful stillness.

Weight Loss and Diabetes

2011-10-19T05:31:03-07:00

By Megrette Fletcher M.Ed., RD CDE

A nurse-colleague told me about her recent diabetes diagnosis. Then she added, “So I decided that I am going to lose 50 pounds.” I could see the excitement in her face switch to a sense of worry in her eyes the moment she asked me, “Do you think that is a good idea?”

Many clients ask that same question. Is losing weight the goal of diabetes self-management? No. You may be thinking, “But I was told by my physicians to lose weight to control my diabetes.” The fact is, weight loss is not an action. It is an outcome; a possible result of what you are doing.

The goal of diabetes self-management is to manage your blood sugars to allow you to live a full and vibrant life. To achieve this goal, I encourage my clients to stop focusing on an outcome and start focusing on behavors.

What to do instead?

Shift your intention to becoming more present by pausing and noticing patterns in your food and eating choices. Ask questions such as “Am I hungry?” or “Would this taste good now?” instead of giving yourself commands like “You are not allowed that!” or “That is what you have to eat because you have diabetes.”

Become present by asking yourself, "What behaviors can I do that will help me achieve a full and vibrant life?" It is important to remember that for every one problem there can be many solutions. Be creative and open to new ideas. Mindfulness and mindful eating are powerful and effective because you can practice flexibility as you explore new solutions to food and eating challenges.

Explore these mindful eating practices your next meal or snack.

Check in and assess your current level of hunger.
Create the intention to eat enough food to fill your hunger not overfill it.
Slow down, pause and ask yourself -- am I still hungry? Success is more likely if you continue to check in while eating.
Track your feelings and blood sugars both before and after mindfully eating meals and snacks Notice any changes.

Weight Stigma Awareness Week: Don’t Measure Your Self-Worth

2011-09-27T22:47:27-07:00

September 26-30, 2011 is Weight Stigma Awareness Week

By Michelle May, M.D.

While sexism and racism have slowly declined, weightism is on the rise. While it is just as harmful, weight bias is somehow seen as justifiable - or worse, helpful. Those with medical conditions like diabetes may may be particularly vulnerable to stigma related to their weight from employers, health care providers, and people they don't even know.

Is there a bully residing between your ears?

Some people with diabetes internalize this stigma. In other words, the bully moves into their head.

Pause and ask yourself: Do I experience shame about my weight? Am I preoccupied with dieting to try to lose weight? Do I feel guilty about eating? Have I convinced myself that this bullying is justified because it somehow helps me manage my diabetes?

A scale doesn't measure your self-worth.

A scale simply measures the weight of your tissues and substances that are just passing through – none of which have anything to do with your value as a person. Your weight doesn’t accurately measure what’s going on inside your mind, heart, spirit, or even your body! Yet, a number on the scale is given the power to change your mood and affect your behavior, often in unhelpful ways. For example:

Have you ever said…

I was so good but I didn’t lose any weight. I might as well eat.
I did so well this week. I deserve a treat!
I don’t have to weigh in until next week so I’ll splurge now and make up for it later.
I was terrible this week and I still lost weight. I guess it doesn't matter what I eat.
I only lost a half a pound. It wasn’t worth it.

Clearly, focusing on weight interferes with your ability to make meaningful, sustainable changes to help you manage your diabetes.

Let it begin with me

We have a long way to go before weightism is a problem of the past. In the meantime, can you practice seeing your own weight as neutral - simply a number without the power to deflate your spirit and derail your intention to effectively manage your diabetes?

Please share your thoughts.

Enjoying the Taste of Healthy Food

2011-09-09T06:31:22-07:00

By Megrette Fletcher M.Ed., RD., CDE

Have you ever wondered if you could enjoy eating healthy foods? So many of my clients tell me, “Oh, I don’t like that!” and when I try to learn why by asking, “What don’t you like about this food?” they often get a puzzled look on their face. “The taste!” I will often smile and ask, “Yes, the taste, what about it?” And then, the conversation really begins.

When people begin to eat mindfully, they get to learn what they do and don’t like about a food or an eating experience. Most foods can’t be easily grouped into “like” and “don’t like” categories. Lots of things about a food make up our food preferences. These include taste, after taste, texture and mouth feel. For example, I often share with my clients that I have a strong dislike for the texture of Jell-O, jelly, custard and yogurt. The thing is I know this because I decided to eat these foods mindfully and really become curious as to why I disliked them. Over time, I learned that I do like the taste, but it was the texture that gave me the willies.

This is where mindful eating became so helpful. I began to experiment with the foods, adding granola or fruit or trying to eat them with a crunchy cracker. After making some changes, I began to enjoy eating these foods. I noticed that when I decreased distraction and really focused on enjoying these foods, I could actually savor them. This was definitely a new experience! After years of telling myself I should like creamy, smooth yogurt, but never enjoying the experience, I had to relearn how to eat it. The first step was to let myself change the thing I disliked about the food so I would enjoy eating it.

I started to add fruit, nuts and granola to my yogurt. I learned that I enjoyed foods with a custard-like texture if they were served with something crunchy. Over time, I learned how to change these “less-than-loved foods” so I could enjoy eating them. This ability has helped bring variety into my diet —without resentment, guilt or overeating.

It is important to remember that mindful eating is a very personal journey. You need to bring your own experiences, thoughts, feelings and beliefs to the table. Every choice you make is an opportunity to experience and better understand why you do the things you do and to choose differently next time if it will serve you better. It is a learning process. For this approach to be effective, perfection isn’t necessary. Be kind and patient with yourself; the freedom and enjoyment you’ll discover are well worth it.

Finding Intention in the Still Waters of Mindful Eating

2011-07-30T17:56:00-07:00

By Megrette Fletcher, M.Ed., RD, CDE

Mindful eating can simplistically be explained as fostering both attention and intention. Don’t be surprised to discover that your intentions are dynamic and shift during the change process. This makes identifying them far more complex than you might initially realize. One minute they are clear, the next minute clouded and uncertain.

To help you understand why discovering your intention might be helpful, think of intention as similar to the rings in the water that are created from a tossed stone. They start out small, but as they travel, they grow larger and larger until they reach the shore. Finding the place where the stone entered the water is equivalent to helping you discover the cause of the rings – or the point where change will have the most impact.

It is easy to find the place where the stone entered the water when it is still and calm. However, when the water is choppy and full of waves, finding that spot is far more challenging. This is where mindful eating can be helpful.

How? Helping you calm the rough waters of life, by pausing, decreasing distraction, tasting food fully and bringing a curious, not critical, attitude to a meal, is often the step that is necessary for awareness to arise.

Unfortunately, in our busy, information-driven lives, many nutrition session focus only on imparting facts and knowledge without including time to absorb, process and fully understand the impact of a choice. The wisdom associated with knowledge is lost if it does not include reflection to see the effects of a choice.

Mindful eating helps you see the big picture often enabling you to understand how the simple intention, often creates many unintended ripples. For example, “grabbing something quick” may be favored because it meets the immediate need of ease or speed. Yet without reflection, you may not notice that these types of foods can be lower in nutrients and lack flavor, resulting in meals and snacks that are not enjoyed.

After eating this you may think “Why do I eat this? Why don’t I just change?” However, food selection is complex and unique to each situation and person. There is no “one reason fits all” answer. Uncovering your intent takes time, patience and often persistence. Yet, when it is discovered, change often follows.

Something to try

At your next meal or snack, intentionally create a pause and ask your self: “Am I hungry?" and "What ismy intention is for making this change?”

Let the space created by this question be noticeable. Allow yourself to not be sure, to wonder or even face doubt. These are true signs that you are working – making important connections, looking for the spot where the stone entered the water.

Sensuous Eating: Eating with Beginner's Mind

2011-07-23T13:10:15-07:00

My husband and I just celebrated our 25th anniversary with a two week trip through Italy. He's a professional chef and I've long been fascinated by the European approach to food (and life) so it was the perfect "working" vacation. We were not dissappointed!

Sensuous Eating

I can best describe our trip as "sensuous." Haven't you noticed that somehow everything seems better while on vacation? Before your mind goes any further, remember that sensuous is defined as:

Relating to or derived from the senses.
Appealing to or gratifying the senses.
Readily affected through the senses.
Highly appreciative of the pleasures of sensation.

So why is eating pizza in Italy so much more sensuous than eating a pizza delivered to your door? Because the experience is new. Rather than shifting into autopilot because we've "been there, done that," the appearance, aromas, flavors, and textures are experienced as if for the first time.

In mindfulness, this is called the beginner's mind. With beginner's mind, we are fully present, engaged, alert, curious, and open to discovery.

Going Through the Motions

Most of us eat over 1500 snacks and meals a year so repetition is one reason we check out soon after the first bite or two. We quickly become distracted by TV, work, or driving. We also disconnect when we're using the food for reasons other than nourishment or feel guilty about eating it.

When we are just going through the motions, we don't fully enjoy the experience. We also miss the signals our body sends to let us know when we've had enough (until it's too late!). As a consequence, we feel stuffed but unsatisfied, feeding the eat-repent-repeat cycle.

Love What You Eat

The next time you're hungry, carefully choose a small amount of food and eat it like a young child experiencing that food for the very first time - with beginner's mind.

Look at it closely, feel it, smell it, then taste it.
Notice the texture, temperature, aromas, and flavors as you slowly chew it.
Notice whether you're tempted to pick up the next bite before you're done with the first one.
Be aware of your body's subtle signals of hunger and satisfaction.
If you become bored while eating, try re-engaging all of your senses.
If you're still bored, you are probably done eating.

By treating each bite, food, or meal as though it's the first time you've ever experienced it, there is no room for guilt, shame, or gluttony so eating becomes a sensuous, lovely experience every day. You don't even have to go to Italy (though I highly recommend it!).

What else in your life would benefit from beginner's mind?

How does fiber affect my blood sugar?

2010-07-01T09:01:00-07:00

By Megrette Fletcher, M.Ed., R.D., C.D.E.

Next in our series of posts about how eating affects your blood sugar...fiber.

Fiber is indigestible complex carbohydrate, meaning that your body can’t break down the chemical links between the glucose molecules. Therefore, fiber helps fill you up and increases satiety but doesn’t raise your blood sugar or provide energy in the form of calories. (For a great overview of carbohydrates, read chapter 12 of Eat What You Love, Love What You Eat.)

Fiber also slows down how quickly food leaves the stomach and this helps stabilize blood sugars in two ways.

First, the digestible carbohydrates in foods that also contain fiber are released over a longer period of time, i.e. up to two hours. Carbohydrates without fiber, like juice or soda are referred to as "fast acting" because the glucose is released into the blood stream more rapidly, i.e. 5-15 minutes.
The second way fiber helps with blood sugar control is by affecting how high the blood sugars rise after a meal. Foods with fiber typically don't cause blood sugars to rise as high as foods without fiber. This blunting effect is important for controlling after meal (postprandial) blood sugars.

A final benefit of eating more fiber is that more stable blood sugars help maintain your energy level.

The recommended fiber intake is about 25 to 30 grams a day. Fiber is found in whole fruit, vegetables, whole grains, and legumes (dried beans and peas). Foods that are high in fiber often have the added bonus of being nutrient rich. Some processed foods like cereal, bread, and snack bars may be fortified with fiber.

Mindful eating encourages you to be curious so experiment with adding more fiber to your diet. In the breakfast examples from the last post, How do carbs affect my blood sugar, you could try out a whole grain cereal, substitute whole fruit like blueberries for the juice, or choose a fiber containing lower-carb bagel. There may be other high fiber foods you’d like to try too, like whole grain crackers, stir-fried vegetables, hummus, beans and lentils, and salsa. Explore recipes online www.daibetes.org or in Eat What You Love, Love What You Eat.

Use mindful eating to increase your enjoyment of fiber rich foods. Notice the colors, textures, aromas, and flavors as you eat. The key is to keep an open mind and view this as an opportunity to discover healthful foods that you like.

Next up: How does protein affect my blood sugar?

How do carbs affect my blood sugars?

2010-06-25T14:39:03-07:00

By Megrette Fletcher, M.Ed., R.D., CDE

Take a look at the chart in our last post: How does eating affect my blood sugars? Note that carbohydrates raise blood sugars—but they help stabilize them too. That is because eating too many carbs in one meal and not enough at the next is usually the cause of blood sugar swings.

Here’s why: When you have diabetes, your pancreas may not be able to make enough insulin to process all the carbohydrates you eat at one time. When you eat a large amount of carbohydrates at one meal, your blood sugar will rise. If you don’t eat enough carbohydrate at the next meal, your blood sugar will fall, causing your blood sugar levels to swing. These blood sugar swings often feel draining, lowering your natural energy level.

So how many carbs do you aim for? Ideally, your diet (whether you have diabetes or not) will have about 45-75 grams of carbs eaten three times a day. For a great overview of carbohydrates, read chapter 12 of Eat What You Love, Love What You Eat.)

If you see that your blood sugars are often elevated before lunch, eating less carbohydrate at breakfast may help keep your blood sugar in the target range two hours later. Here’s are two examples of how you could experiment with the number of carbs at breakfast to see how that affects your blood sugar two hours later:

Example # 1:
1 1/2 cups cereal	=	44 grams carbohydrates
1 cup skim or 1% milk	=	12 grams
8 oz juice	=	30 grams
Total	=	86 grams of carbohydrates

Possible changes:
1 cup cereal	=	30 grams carbohydrates
1 cup skim or 1% milk	=	12 grams
4 oz juice	=	15 grams
Total	=	57 grams of carbohydrates

Example #2
Bakery muffin or bagel	=	85 grams carbohydrates
Large coffee w/milk & sugar	=	15 grams
Total	=	100 grams of carbohydrates

Possible changes:
Low-carb bagel	=	45 grams carbohydrates
Large coffee w/milk & sugar	=	15 grams
Total	=	60 grams of carbohydrates

In our next post, we'll see how fiber affects your blood sugars.

How does eating affect my blood sugars?

2010-06-02T08:25:33-07:00

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

In our post, Understanding Your Blood Sugars: A Case for Curiosity, we talked about how blood sugar testing before and two hours after eating can help you learn more about your diabetes. Let's move on to explore the relationship between those blood sugar results and what you've eaten.

In short, if your blood sugars are only elevated two hours after eating, it is likely that your diet is contributing in some way. Before you think “Oh no, I blew it!” remember eating is supposed to cause your blood sugar to rise. We are going to focus on the blood sugars that are above 160mg/dl since that is higher than it should be and therefore, presents you with an opportunity to make a beneficial change.

It is important to see your glucose test results as clues that help you solve the mystery of how eating affects your diabetes. Resist blame, guilt, and restriction. Instead, explore possible connections between what you ate and what happens to your blood sugar.

There are four components of your diet that can effect your blood sugar. These macronutrients are covered in detail in Eat What You Love, Love What You Eat, so review the chapters referenced in parentheses below. They are:

Carbohydrates (Chapter 12)
Fiber (Chapter 12)
Protein (Chapter 14)
Fat (Chapter 13)

This chart is an overview about how carbohydrates, fiber, protein, and fat affect your blood sugar:

How eating affects your blood sugar

	Raises blood sugar	Stabilizes blood sugars	Blunts blood sugar rise	Increases insulin resistance
Carbohydrates	Yes	Yes	No	No
Fiber	No	Yes	Yes	No
Protein	Somewhat	Yes	Yes	No
Fat	No	No	Somewhat	Yes

The following series of posts will look at how each of these macronutrients affect your blood sugar and ideas about changes you can experiment with in your diet.