25/02/2024

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The 10 Principles of Intuitive Eating for Diabetes — Registered Dietitian Columbia SC

The 10 Principles of Intuitive Eating for Diabetes — Registered Dietitian Columbia SC

This blog post was written by Kate Bennett, an associate dietitian at RHN. She works with clients in person at our Columbia, SC office and virtually, and is accepting new clients.

As a certified intuitive eating counselor, I’ve run into a lot of people who believe intuitive eating isn’t for them for one reason or another. I frequently hear this from people with diabetes. This makes sense, because most people are told to follow a strict “diabetic diet” when they are first diagnosed. Although having a chronic condition like diabetes can be a barrier in trying to eat more intuitively, and often means having to pay more attention to certain aspects of eating and nutrition, it doesn’t mean intuitive eating is off limits. It may look differently for you, but you can still eat intuitively with diabetes. In fact, applying the principles of intuitive eating can not only help promote a more peaceful relationship with with your health condition, but it can also serve as a tool for blood sugar management.  

So, what should someone with diabetes know about intuitive eating? Let’s explore each of the principles of Intuitive Eating and discuss how someone with diabetes can adapt them to their specific needs.

The 10 Principles of Intuitive Eating for Diabetes

Principle One: Reject the Diet Mentality

The first principle of intuitive eating is to reject the diet mentality, which asks us to recognize that diets not only don’t work, but they also cause harm, damaging our relationship with food, disconnecting us from our bodies, and negatively impacting our physical and mental health. To reject the diet mentality, we make the decision to actively disengage from dieting and diet culture, which as a sidebar, is an active process and not a one time decision.

For people with diabetes, this can feel impossible. When diabetes is diagnosed, a “diabetic diet” is almost always prescribed. This vague instruction often leads to scouring the internet for help, and leaving you feeling more confused when you see there are thousands of so called “experts” out there claiming their diet is the “right” diabetic diet. The truth is, there is no one universally agreed upon way to eat for diabetes – even the American Diabetes Association recommends multiple eating patterns and encourages people to find what works for them. With diabetes, there are no rules that are so black and white that you can’t have flexibility with your eating. In fact, allowing flexibility can be the best thing for your blood sugar in the long run (see the principle on making peace with food!).

That said, people around you can make it hard to reject the diet mentality since everyone seems to have their own beliefs about how to best manage diabetes, and often don’t hesitate to share! Working on setting boundaries around what you are comfortable talking about can help reduce the confusion around what to eat. Moving away from the noise might help you to better tune into your own needs and figure out what feels good for you.

Principle Two: Honor Your Hunger

This principle of intuitive eating is all about learning to identify the signs of hunger – not just ravenous hunger! – and responding to those signs with food. Diabetes is often treated with restrictive diets that force people to ignore or suppress hunger in order to stick to the plan. However, hunger is not the enemy – it’s a powerful tool for fueling your body. Hunger can be an early sign that blood sugar is starting to dip, an indicator that your body needs food. Responding to earlier signs of hunger can prevent more extreme dips in blood sugar. By eating at the first signs of hunger, you’re also more likely to make an intentional choice with food, rather than impulsively grab the quickest thing possible to get your blood sugar up. This can lead a blood sugar “roller coaster,” which can make it feel like you’re chasing hunger all day, and may be harmful for long term diabetes management.

Another intuitive eating for diabetes challenge is that some people with diabetes don’t feel hunger cues very well. When blood sugar is elevated, it can diminish hunger cues, even if your body needs food. Another challenge occurs when someone has gastroparesis, a long term side effect of diabetes that delays stomach emptying. While it may feel contrary to intuitive eating, in these situations it may be helpful to have a loose schedule for eating. Intuitive eating is integrating body knowledge and brain knowledge, and there may be times you need to lean more heavily into one versus the other!

Principle Three: Make Peace with Food

Trying to manage diabetes can feel like you are at war with your body and food, and for those with more advanced diabetes, it can feel like a full-time job. Over time resentment can build towards food, especially if you’ve been trying to follow strict diets to manage blood sugar. Maybe you long to enjoy food, but feel like you are cursed to always see food as the enemy?

Even with diabetes, you can make peace with food. This principle involves putting all foods on the same playing field – no one food is better than the other food. It also involves giving yourself permission to eat the foods you love. This can sound confusing for someone with diabetes, who has been told to avoid certain foods that raise their blood sugar. Keep in mind, making peace with food doesn’t mean that all foods are nutritionally equal. There may be certain foods that impact your blood sugar more than others, some foods you want to prioritize and others that you want to deprioritize at times. That said, even if a food was certifiably “unhealthy,” does calling it bad and making it off-limits actually help you engage with it in a healthy way? Probably not! It’s much more likely to lead to a restrict-binge pattern of eating.

As I mentioned in principle one, there is no one “diabetic diet.” You can have foods like sweets, bread, pasta, and other carbohydrate-containing foods. I encourage you to notice how you experience them when you aren’t placing judgment on yourself for eating them. You’ll begin to discover a way of eating that feels good for you! Remember, when carbs become the “forbidden fruit,” you may obsess over them and find it difficult to feel satisfied from other types of food. When you incorporate them regularly, you take them off the pedestal and can begin to eat them in a way you feel good about.

Principle Four: Challenge the Food Police

Food police are people who overreach their own personal ideologies around food and weight and push them on to others. Because we live in a world where diet culture is the social norm, the food police show up everywhere and prey on people with diabetes. The food police can make you doubt yourself and feel like you can’t feed yourself without looking to others for their “expertise.” Overtime the food police voice of others can become a voice inside your own head, making it impossible to peacefully eat the foods you enjoy without berating yourself if it doesn’t align with what you’ve been told about how you “should” eat. Considering there’s thousands of voices out there sharing conflicting advice about what’s right or wrong, it can become near impossible to find something to eat that doesn’t trigger the food police!

Remember that other people don’t know your body, blood sugar numbers, or appetite more than you. Different people have different food needs, both from a nutrition and emotional standpoint.

So how do you challenge the food police? You don’t have to have all the knowledge in the world on diabetes to set boundaries! Some helpful phrases: 

  • “While I appreciate your concern, I prefer to receive advice from my doctor/dietitian on management my help.” 

  • “I don’t like to discuss my diet or health with others.” 

  • “Sorry to stop you, but I find talking with others about diets only confuses me more and I prefer to listen to my body for guidance.”  

Principle Five: Discover the Satisfaction Factor

Many of my clients with diabetes feel like they aren’t allowed to enjoy food. This belief makes sense given how nutrition for diabetes is often discussed. I remember as a young dietitian a doctor instructing a patient newly diagnosed with diabetes that “if it tastes good, spit it out!” How disempowering is that?

I remind my clients that everyone has the right to enjoy tasty food. Not only that, but discovering the satisfaction factor can be helpful in managing blood sugars long term. The more you allow yourself to savor and enjoy your food, the less likely you are to experience intense cravings and obsessive thoughts. When you plan out your meals, even if you are prioritizing nutrition needs, think about what might add the pleasure factor. Here’s some examples:

  • Instead of baked chicken breast, brown rice and steamed broccoli, try roasted, skin-on chicken breast with a tasty rub, brown rice or white rice cooked in broth for flavor, and garlicky sautéed broccoli topped with some parmesan cheese.

  • Instead of a plain salad topped with grilled chicken, throw on flavor boosters like sharp cheddar cheese, flavored toasted nuts, olives, sun-dried tomatoes, and crumbled bacon. Choose a yummy salad dressing and pair it with crusty bread!

  • Instead of a bowl of plain oatmeal for breakfast, top it with yummy fresh fruit, a drizzle of honey, some warming spices, and a scoop of full fat Greek yogurt or a drizzle of cream.

Principle Six: Feel Your Fullness

Just as hunger signals that it’s time to eat, the feeling of fullness lets us know we’ve had enough fuel for the time being. A major part of intuitive eating is listening to hunger and fullness cues to guide eating. Considering how restrictive diets are pushed on people with diabetes, you might be surprised to know that eating intuitively is actually associated with better blood sugar control!

That said, for some people with diabetes, the side effects of the condition can impact these cues. For example, gastroparesis (delayed stomach emptying) can cause early satiety (i.e. feeling full before you’ve eaten enough food). For others, nausea associated with high or low blood sugar can impact cues. When we work with people with diabetes, we help them navigate these challenges using things like smaller, more frequent meals and snacks, and identifying foods they better tolerate.

Principle Seven: Cope with Your Emotions with Kindness

Food can serve as a tool for mitigating challenging emotions. This is fine sometimes, but when employed every time (particularly during stressful periods of life!), people with diabetes are likely to experience more variations in blood sugar. Stress management is huge when it comes to blood sugar management, since stress can impact your blood sugar regardless of it’s impact on eating. Taking care of yourself goes beyond just paying attention to what you’re eating. It can be helpful to come up with ways to cope with your emotions with and without food – here is a blog post on building a self-care toolbox.

I encourage you to practice lots of self-compassion with this principle. Having a chronic disease can be stressful in its own right. You don’t have to manage it perfectly. Practicing acceptance that there will be bad days as well as better days can help decrease stress. 

Principle Eight: Respect Your Body

This principle of intuitive eating is usually discussed in the framework of size acceptance. It’s about knowing your here-and-now body deserves love and kindness, and that respecting your genetic blueprint is a more peaceful way to live than spending your life trying to shrink your body. We can also look at this principle through the lens of a diabetes diagnosis.

Many people feel anger towards their body and themselves for having diabetes. It’s important to remember that diabetes is a highly heritable condition, and even though there are preventative measures, genetics may account for up to 80% of the risk of developing diabetes. Having diabetes is not your fault. I repeat: having diabetes is not your fault!

If you feel anger towards your body for having diabetes, you aren’t alone. It’s easy to compare ourselves to others, and maybe even feel it’s unfair that you have diabetes. It’s OK to let yourself feel those feelings! At the same time, can you still treat your body with respect by engaging in self-care behaviors like getting enough sleep, doing things you enjoy, and regular medical check-ups?

Discovering other people with diabetes might be helpful for body respect. I really appreciate the accounts @bodyposibetes and @milkandhoneynutrition.

Principle Nine: Movement—Feel the Difference

This principle of intuitive eating is all about building a healthier, more pleasurable relationship with movement, and identifying non-calorie burning reasons to move your body. Exercise is a great way to improve blood sugars and insulin resistance. That said, even as someone with diabetes, you deserve to engage with movement in an enjoyable way – not only as a tool for lowering blood sugars. Forcing yourself to engage in movement you despise isn’t sustainable and can erode your self-trust. Physical activity doesn’t have to be hardcore if that’s not what you enjoy. If you enjoy going for walks, walking after meals has been shown to be a great way to decrease blood sugar.

And remember – physical activity is just one component of health, you can work towards other self-care behaviors while still figuring out how physical activity works best in your life. 

Principle Ten: Honor Your Health with Gentle Nutrition

If there’s one takeaway from this blog post it’s that there is no one “right” way to manage diabetes. Part of honoring your health is paying attention to your own unique health needs. For people with diabetes, some attention to carbohydrate intake is necessary. But what makes it gentle nutrition rather than dieting and deprivation? Gentle nutrition allows you to be flexible with food, while dieting demands you follow strict rules. A loosely structured approach to eating can help you manage your blood sugars without feeling deprived. I dive a little more into gentle nutrition for diabetes in this blog post on non-diet nutrition for diabetes.

One thing I’ve noticed among my clients with diabetes is that there is often a pressure to manage diabetes with food rather than medication. There’s many understandable and valid reasons to not want to take a medication, and we are big believers in making autonomous decisions about health over here at RHN! That said, let’s not let societal stigma about medications be one of those reasons you decline diabetes medication. Taking medication can allow for more flexibility with food and nutrition, and you can still work on healthy eating skills while taking meds. With nutrition and medication for diabetes, it’s not one or the other!

Having a chronic condition like diabetes means it’s something you will be navigating for the rest of your life. When it comes to nutrition, it’s important to consider whether a change you’re making is something you can sustain for the rest of your life. If not, it might not be a healthy change for you. When I work with people who have diabetes, we get curious about what works for them with food, both for their blood sugar levels and their mental health.

Conclusion 

I hope this brief run-down helps you to see more clearly that intuitive eating can be one helpful tool for navigating diabetes. Even though food is just one aspect of diabetes management, it is often the most overwhelming. Finding freedom in your food choices can be an important way to alleviate the stress of diabetes and Intuitive Eating is one way to find that food freedom.  While intuitive eating might look a little different for someone with diabetes, it is still one tool in your toolbox!