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As a registered dietitian, I frequently work with folks that have a diabetes diagnosis. And during my consults with them, I find that most are surprised to learn that they can enjoy all foods–even with diabetes! One common concern in people with this condition is that they’ll no longer be able to eat the foods they love again, or that they’ll be stuck having to follow a boring, bland eating pattern. Not so! In this post, I’ll talk about how intuitive eating and diabetes CAN go hand in hand–and how you can have your cake and stable blood glucose levels as well (yes, really!).
What is diabetes?
Diabetes mellitus is a health condition where the body is unable to metabolize glucose (sugar) effectively, which means that it ends up circulating in the blood. In turn, excess sugar that is not used as energy can start binding to our organs, causing diabetes related diseases, such as kidney damage and heart disease.
With diabetes, the pancreas either doesn’t produce any insulin, or doesn’t produce enough of it. Insulin is a hormone that allows sugar to enter our cells to be used as energy. It sort of works like a pay toll that lets cars through in a controlled fashion. In very simple terms, when there’s no insulin produced, the sugar you obtain from foods can’t be converted into energy. When there’s not enough insulin produced, the body will only be able to handle certain amounts of it; the rest stays circulating in the bloodstream, damaging tissues.
There are two types of diabetes:
- Type 1 Diabetes: As we’ve just learned, insulin is a hormone that ushers glucose out of the bloodstream and into cells where it can be used for energy. Someone without diabetes would produce insulin like they’re supposed to, but someone with type 1 diabetes needs insulin injections because their bodies stop producing enough on its own.
- Type 2 Diabetes: In this type of diabetes, the body may be producing insulin, but sometimes not in enough quantities. Cells can also becomes resistant to insulin, which is another characteristic of type 2 diabetes.
What causes diabetes?
Although there many factors that may cause diabetes, this is predominantly a genetic condition. While diet culture, with its fear mongering messages, may have you believe it’s due to being “overweight” or eating “unhealthy foods”, genetic predisposition to developing diabetes plays a key role. While weight cycling and internalized weight stigma can contribute to increasing the risk of type 2 diabetes, it ultimately affects people of all sizes.
And although the foods we eat can impact blood glucose levels, these values can also change with diabetes, due to factors such as:
- Certain medications
- Lack of sleep
I mention this because it’s important to avoid placing blame on yourself or your food choices when your blood glucose levels aren’t just where you want them. Later on, we’ll learn how to take on an objective role with respect to our blood values and the wealth of information they can provide us.
It’s also worth mentioning that you don’t have to become smaller in order to effectively manage your diabetes. It is completely possible to improve blood glucose, cholesterol, and blood pressure through health-promoting behaviors–even if there’s no change in the number on the scale.
The main purpose of diabetes management is to maintain blood sugar at adequate levels. This in turn decreases the risk of developing diabetes related health complications, such as eye, kidney and heart disease. There are many ways to manage your blood glucose levels, for example, through:
- Stress management
- Sleep quality
Any of these approaches, or a combination of several, can be used to effectively manage diabetes. You and your healthcare provider can work together to see what’s the best course of action for YOU. However, since what you eat can greatly impact your blood glucose levels, we’ll now explore how a non diet approach to diabetes works.
Does intuitive eating work with diabetes?
Many people believe that you have to follow a rigid diet that eliminates all carbohydrates and pleasurable foods order to effectively manage your blood sugar levels. However, intuitive eating (ie. using your own body wisdom to nourish yourself) has been found to be beneficial in diabetes management. Intuitive eating involves awareness of the physical and emotional sensations experienced while eating–or in a food-related environment. In fact, intuitive eating and mindfulness based interventions have been shown to contribute to diabetes management by:
- Improving A1C levels (the lab test that shows how well managed your blood glucose has been for the past 3 months)
- Improving blood glucose levels through emotional eating management
- Reducing binge eating behaviors
- Improving blood glucose control during and after pregnancy in women with gestational diabetes.
Thus, intuitive eating, and mindful eating practices, “may be an effective intervention for increasing awareness of hunger and satiety cues, improving eating regulation and dietary patterns, reducing symptoms of depression and anxiety…”, in diabetes management, as this paper explains. This in turn is beneficial when making behavioral changes that support diabetes management. As this other recent paper states: “Eating intuitively, especially in accordance with body needs may be associated with lower chances of type 2 diabetics having inadequate glycemic control”.
We also need to take into account that individuals’ blood sugar responses to different foods can vary widely, and that there’s really no such thing as a “universal diabetes diet”. This makes intuitive eating and diabetes an advantageous combination. An individual needs to explore what works for them and what doesn’t in order to improve their blood glucose management. And given that very few people can follow a restrictive eating pattern long term, it makes sense than an intuitive eating approach is better for achieving stable blood glucose levels.
What is Intuitive Eating?
Evelyn Tribole and Elyse Resch, the pioneers of IE, define intuitive eating the following way: “Intuitive Eating is a self-care eating framework, which integrates instinct, emotion, and rational thought and was created by two dietitians, Evelyn Tribole and Elyse Resch in 1995. Intuitive Eating is a weight-inclusive, evidence-based model with a validated assessment scale and over 100 studies to date“.
Intuitive eating is the opposite of dieting. Did you know we’re actually born intuitive eaters? We are not bombarded with societal messages about body image and food as newborns. We’re later conditioned by diet culture to unlearn our natural hunger and satiety cues. The 10 principles of intuitive eating are the following:
If you want to learn about intuitive eating and how to get started on this food freedom journey, check out this post 👇🏻
In short, intuitive eating helps you to develop a much more satisfying relationship with food and your body. It teaches you to trust your ability to meet your own needs, distinguish between physical and emotional hunger, and ultimately develop body wisdom.
Benefits of an anti diet diabetes approach
An intuitive eating and anti diet diabetes approach may be beneficial for those who have this conditions for numerous reasons. To start, self-efficacy is a strong predictor of successful diabetes management. Intuitive eating promotes just that: it offers support, encouragement and non-judgment when it comes to eating.
When first diagnosed with diabetes, many people feel confused about dietary choices and may develop food fears. They may also be dealing with the social stigma and guilt associated with having a diabetes diagnosis.
Learning to honor yourself and your own needs, plus trusting your own body and what it needs, can be empowering for someone who is coping with this condition. It can be a great weapon against the diet culture stigma placed on people with diabetes. It’s also helpful to know that research backs up these claims. In fact, intuitive eating practices have been “associated with lower….glycemic index during nutrition interventions”, as this paper explains.
Some of the benefits you can reap by practicing intuitive eating and mindfulness based strategies for managing your diabetes are:
- Developing sustainable, long term lifestyle changes versus restrictive, temporary eating patterns
- Enjoying the foods you love without binge eating or food guilt
- Approaching blood glucose monitoring with curiosity instead of fear or judgement
- Incorporating regular, enjoyable movement versus punishing exercise
- Becoming proactive at preventing health problems associated with uncontrolled blood glucose management
At the end of the day, an anti diet approach to diabetes helps you to be your own “expert” when it comes to what works best for you and your health management.
How can intuitive diabetics eat?
As expected, there are some differences in eating intuitively with and without a diabetes diagnosis. For example, if you have diabetes, it may be necessary to check your blood sugar (before and/or after meals), count carbohydrates to bolus insulin if that’s part of your treatment plan, plan for meal/medication timing, and consider what foods may help stabilize your numbers. However, these numbers and ranges don’t have to go through a filter of judgement. By approaching your levels with curiosity, you’ll have a better, objective understanding of how your blood glucose levels behave and what you can proactively do to manage them.
Intuitive eating encourages you to notice, without judgement, how a particular meal or snack impacts you. For example, let’s say your morning blood glucose levels are higher than usual. Instead of panicking or blaming yourself for having “done something wrong”, an anti diet approach to diabetes management invites you to objectively evaluate what could be contributing to these numbers. Maybe you didn’t get enough sleep, have been feeling stressed out, or are going through a period of illness–all of which can impact blood glucose levels.
Maybe upon exploring, it turned out you had a high carb food close to bedtime (such as crackers by themselves). You can use this information as just that–data that can help you make adjustments in your eating patterns for better blood sugar management. Perhaps pairing those crackers with some almond butter may be helpful next time in order to help avoid a sugar spike and promote stable blood glucose levels.
Another setting where intuitive eating and diabetes management may be useful is the case that your blood glucose levels drop below your baseline normal. Putting on your detective cap, you can investigate if maybe adding certain portions of carbs to your salmon salad could result in better meal satisfaction and stable blood glucose levels.
Tips for intuitive eating and blood glucose management
As you become an intuitive eater, you can experiment and learn through different types and amounts of food, while checking for feedback on how you feel and how your blood glucose levels respond accordingly. You can also learn to time your meals and insulin administration more effectively, if that’s part of your treatment. This way, you get to discover what actually works for YOU– versus having everyone else and their grandma asking if you really “should” be eating that! Here are some useful strategies:
- Assess your hunger: As one of the principles of intuitive eating, learning to determine your physical hunger signals (which are different from emotional or boredom eating cues) is key to knowing when your body needs food. This post will teach you all about how to read your hunger signals, in case you’re interested. Checking your blood glucose levels while you experience these physical signals can also provide you with valuable information. If your blood sugar is low, then it’s definitely time to eat! If it’s elevated, you can explore whether it’s due to an emotional trigger (emotions can disrupt glucose levels) or physical causes (such as not having an appropriate enough dose of insulin, the side effects of certain medications or an undiagnosed illness/infection). Getting in touch with your hunger cues can be very beneficial in feeding your body when it needs it (versus mindlessly eating) while helping you effectively manage your blood glucose levels.
- Choose your foods mindfully: Yes, you can enjoy all foods–even with diabetes! You’ll just have to be a bit more conscious of how certain foods and amounts affect you. One place to start is by checking in with yourself emotionally before you make a food choice. You can also check your blood sugar before and 2 hours after your meal (aka, paired glucose testing), which will provide you with valuable information on how particular foods and amounts impact your blood glucose levels. For example, let’s say you had a bowl of pasta with meatballs for lunch and 2 hours afterwards your blood sugars are high. Does this mean you can’t eat your beloved pasta anymore? No! It means that maybe eating a bit less of the pasta next time (coupled with additional protein, fats and/or fiber sources) will make it easier for your body to metabolize. Here’s where curiosity, non judgement and objective data gathering can help you make foods choices that feel good and support your blood glucose levels. Likewise, maybe eating bread alone makes your blood sugar spike up, but pairing it with a fat like avocado can help slow down the rate at which glucose enters the blood.
- Respecting your fullness: Just like learning to read your hunger signals is an important step towards eating intuitively, respecting your satiety cues is just as significant. Especially since food just doesn’t taste as good when you’ve reached this point! Many of my patients find that honoring their fullness cues helps them determine when they’re feeling satisfied and comfortable during a meal. Reaching satisfaction relevant during meals. If you still feel the urge to eat even when you’re not hungry, maybe your meal just didn’t hit that satisfaction target. In that case, playing detective once again can reveal what may be missing here. Maybe adding extra fiber, protein or fat (for example, adding veggies, avocado, nuts, seeds, beans and legumes, meats, fish, cheese, yogurt, or plant based oils) can help you feel more satisfied. Or maybe just mindfully allowing yourself those cookies or slice of cake is what does the trick. Remember, by giving yourself unconditional permission to eat all foods aids in said foods losing any obsessive power over you. They’re just food, and you can discover that you feel satisfied with a comfortable portion, instead of uncontrollably bingeing on “forbidden” foods.
- Find joy in your movement: As we’ve just learned, intuitive eating invites us to tune into how our bodies feel in response to certain foods. That also applies to physical movement, aka exercise. Regular physical movement can provide you with a myriad of health benefits, including effective diabetes management. When we’re on the move, our bodies use up energy, and that energy mainly comes from–you guessed it–glucose. Which in turn helps our bodies use it up more effectively and keep our blood glucose levels stable. But what if you just hate exercise? That’s where intuitive movement comes in. By learning what type of movement feels good for YOU, it’ll be more likely that you’ll want to incorporate it into your lifestyle. Joyful movement considers any type of movement valid. Whether it’s dancing in your living room to gardening to swimming–whatever makes you feel good works!
Intuitive eating and diabetes resources
Remember, it can take time, practice and patience to develop the skills of intuitive eating. Here are some resources to get you started.
One of the best books I’ve found on intuitive eating and diabetes management is Eat What You Love, Love What You Eat with Diabetes by Michelle May, MD and Megrette Fletcher, MEd, RD, CDE. Along with teaching you how to gain trust around eating and your diabetes self management, it also guides you through some very important standards of care by the American Diabetes Association for self management such as:
- Disease prevention
- Glucose monitoring and testing
- Managing high and low glucose levels
- Managing medications
- Problem solving
Intuitive eating and diabetes management may require the support of a healthcare provider to help you navigate your own particular nutrition and blood glucose needs. Here is the list of HAES aligned providers that can help you in your journey.
And of course, you can also reach out to me through this link for my virtual non diet consultation services!
If you’ve been diagnosed with diabetes, or if you have a family history of the disease, it can be hard to know how best to manage your blood glucose levels. With so many different diets and eating patterns out there, knowing where to start can seem daunting. But don’t worry! Intuitive eating principles are an excellent way for people living with diabetes (or those at risk) to enjoy food without feeling restricted by their diet – and they work very well as a tool for managing blood sugar naturally. All that’s required is some careful thought about what foods may help manage your glucose levels most effectively, then implement these changes gradually over time until intuitively-eating for better blood glucose management becomes second nature!
Hi! I’m Melissa, Registered Dietitian and mother of two dragons. When I’m not talking nutrition you can find me rolling around the floor with my kids, sewing, crafting, cooking or missing the 90s (seriously, music just isn’t the same). Read More…