Q&A: Intuitive eating can help people with diabetes improve their relationship with food
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Key takeaways:
- Intuitive eating, a philosophy to help foster a healthy relationship with food, may benefit people with diabetes.
- The technique can help people pay attention to how foods affect blood sugar levels.
Susan Weiner, MS, RDN, CDN, CDCES, FADCES, talks with Bonnie R. Giller, MS, RDN, CDN, CDCES, registered dietitian nutritionist and certified intuitive eating counselor, about the concept of intuitive eating and how patients with diabetes can embrace this approach to help manage their blood sugar levels.
Weiner: What is intuitive eating and what is the diet mentality?
Giller: Intuitive eating is a self-care eating framework that integrates instinct, emotion and rational thought through 10 principles. Basically, intuitive eating is an eating philosophy to help people develop a healthy relationship with food. You eat based on physiological hunger — so physical hunger and satiety cues rather than external diet rules or emotional triggers.
Diet mentality refers to a pervasive cultural belief that weight loss and controlling food intake through restrictive diets is necessary for health and worthiness. Having a diet mentality includes having strict rules around what to eat, when to eat and how much to eat.
This leads to a cycle of dieting, deprivation and, ultimately, overeating or binge eating, which is then followed by guilt and shame. Someone with the diet mentality typically has a list of foods they can and cannot eat, foods they label good and bad, legal and illegal. If they eat something that is on their forbidden list, then they typically tell themselves, “Let me just finish it. I’m going to promise myself to start again tomorrow to start again on Monday.”
Weiner: Is it possible to embrace intuitive eating if you have diabetes? How can you promote a peaceful relationship with food if you’re trying to manage blood sugar levels?
Giller: The answer is yes, absolutely. It’s possible to embrace intuitive eating when you have diabetes. The key is to learn how to integrate the principles of intuitive eating with mindful management of your blood sugar levels, which does involve understanding your hunger and fullness cues. Learn to recognize your body’s hunger and fullness signals and respond to those signals, incorporate the knowledge about carbohydrates and the impact they have on blood sugar, and use that information as data to inform future food decisions, but not in a restrictive way.
Mindful eating is an important part of intuitive eating, in that you pay attention to how different foods affect your blood sugar levels. Instead of labeling foods as good or bad, be flexible. Flexibility is an important part of intuitive eating and gentle nutrition. Be flexible and compassionate with yourself knowing there’s no such thing as perfection. Perfection is not the goal in eating, meal planning or managing blood sugar levels.
Learning about how different foods affect your blood sugar can promote a peaceful relationship with food while trying to manage your blood sugar levels.
Monitoring can provide a lot of feedback, but it’s not a measure of success or failure. That’s a really important piece of this — monitoring blood sugar doesn’t indicate whether you’re successful or failing at diabetes management, but it’s giving you feedback. It is a much more peaceful relationship to have with food when you view it in this way, rather than labeling your management as “good” or “bad.”
Of course, it’s also important to seek support to help those who have diabetes to learn how to incorporate these principles of intuitive eating.
Weiner: What should a person with diabetes know about intuitive eating?
Giller: It’s really important for the person with diabetes to understand that intuitive eating is about tuning into their body’s signals and their needs while also considering what their medical needs are. That includes balancing their intuition with their knowledge, and using the knowledge they have around diabetes management to help guide food choices without being overly restrictive.
Intuitive eating calls for having what we call nonjudgmental awareness — practice awareness without judging yourself about how foods are affecting blood sugar levels.
Again, flexibility is key with intuitive eating, whether somebody has diabetes or not. Flexibility in meal planning and eating patterns is key to avoid any feelings of deprivation, which ultimately might lead to binge eating.
Weiner: What are hunger signals? Why are they important for a person living with diabetes?
Giller: Hunger signals are your body’s way of indicating your need for food and energy. That can include physical cues such as stomach growling. It could be fatigue. It could be lightheadedness, or perhaps even some cognitive cues like difficulty concentrating or feeling irritable and moody.
It’s important for a person living with diabetes to be able to identify hunger cues in what we call the gentle state before getting ravenous to help prevent hypoglycemia. Recognize what your hunger signals are and then being able respond to them can prevent low blood sugar.
Being able to attune to hunger helps to balance overall blood sugar levels, because you’re going to eat in response to hunger before you become ravenous. As you learn to attune to the various degrees of hunger, you will be able to better maintain stable blood sugar levels.
Mindful eating is different than intuitive eating, but it is an important part of the process. Engaging in mindful eating can also help tap into hunger and fullness and reduce the risk of bypassing comfortable fullness and then subsequent blood sugar spikes.
Weiner: What does it mean to make peace with food?
Giller: Basically, making peace with food means inviting all foods into your eating world. Allow yourself to eat all types of foods without guilt or fear. It means eliminating all food rules and letting go of restrictive diets, rules and food labels.
It means trusting your body, trusting your hunger signals and your fullness signals to guide your eating. It means eating without making deals with yourself. Allow yourself to enjoy food and the eating experience without any anxiety and shame. It is a very beautiful experience.
Weiner: Nutrition and food are often the first things discussed when a person is diagnosed with diabetes. What tips do you have for a person to enjoy their food and reduce the guilt often associated with eating?
Giller: Unfortunately, food and nutrition when discussed initially with somebody diagnosed with diabetes is often presented from a good/bad, you can/can’t eat perspective. The first thing to do is to connect those with diabetes with practitioners who teach from a weight-neutral and an intuitive eating lens.
It’s important to decouple food and morality; these two do not go hand in hand. Focus on pleasure by paying attention to the flavors and the textures of the food that makes our eating experience enjoyable and pleasant. Again, practice mindful eating by eating slowly and without distraction to fully savor your food. That allows you to tune into fullness and to stop eating when you’re comfortably full vs. overfull and to have great pleasure without the side dish of guilt.
Another tip would be to make sure you’re eating what you really want to eat, not what you think you should be eating. Have a positive mindset about the experience by incorporating positive self-talk and self-compassion. Work to avoid guilt and negative thoughts about your food choices.
Education is key. It is key to learn how different foods affect your body and your blood sugar and to utilize that information as data to inform future choices that really align with your health and your health goals.
Weiner: How does living with diabetes impact feelings of hunger, satisfaction and fullness?
Giller: Diabetes, if it’s not well controlled, can alter normal hunger signals due to the fluctuation in blood sugar levels. It can also sometimes delay the feeling of fullness leading to overeating and binge eating.
Regarding satisfaction, balancing your blood sugar really can enhance your feelings of satisfaction and prevent the extreme hunger that might come with blood sugar spikes and drops. At the end of the day, being able to attune to hunger and fullness will positively impact satisfaction and pleasure within the meal.
Weiner: Can the use of GLP-1 receptor agonists impact intuitive eating principles for those with diabetes, and how so?
Giller: Yes, GLP-1s affect appetite and digestion, potentially impacting the intuitive eating practices of an individual. GLP-1s will often reduce your appetite and may make it harder to recognize true physiological hunger, especially in the gentle state.
They can also enhance feelings of fullness and cause early satiety, so people who do take these may need to adjust their intuitive eating approach to account for changes in hunger and fullness cues. The mindfulness aspect and having curious awareness is going to be key.
Weiner: How can a health care professional learn more about intuitive eating?
Giller: Start with the book Intuitive Eating: A Revolutionary Anti-Diet Approach by Evelyn Tribole, MS, RDN, CEDRD-S, and Elyse Resch, MS, RDN, CEDRD-S, FAND, which is the foundation of what you need to know. Also, attend workshops, webinars and training programs on intuitive eating to stay updated on the latest research and development that we have in the field, which is continuously ongoing. If a health care professional is interested, they could become a certified intuitive eating counselor.
For more information:
Bonnie R. Giller, MS, RDN, CDN, CDCES, is a certified dietitian nutritionist, certified diabetes educator and certified intuitive eating counselor. She can be reached at bonnie@brghealth.com; website: brghealth.com.
Susan Weiner, MS, RDN, CDN, CDCES, FADCES, is co-author of The Complete Diabetes Organizer and Diabetes: 365 Tips for Living Well. She is the owner of Susan Weiner Nutrition PLLC and is the Endocrine Today Diabetes in Real Life column editor. She can be reached at susan@susanweinernutrition.com; X (Twitter): @susangweiner; Instagram: @susanweinernutrition.
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