Author: Caitlin Hildebrand, MSHAIL, MSN, AGPCNP-BC, NP
If you, or a loved one, have been diagnosed with diabetes, it can feel as if your world has been turned upside down. Foods that might have been cherished favorites for your whole life can suddenly feel like they are forbidden, or dangerous. Well meaning health care clinicians may provide guidance that seems like a foreign language, or impossible to follow. You may begin to fear foods that you once loved, or feel a deep need to rebel, and claim back your own sense of autonomy and joy through food. Or both.
As an Integrative Nurse Practitioner, most of my patients with diabetes fall into three approaches to eating, and often move back and forth between them.
- First, those who follow their dietary recommendations to the tee, feel a great sense of accomplishment in doing so, but may live with considerable food fear.
- Second, those who try to eat as they are advised to, but frequently fall short, and feel plagued with guilt.
- Third, those who choose to rebel, deciding that they’ll eat whatever they want, whenever they want, and risk the consequences. Mindful eating can help us avoid the limitations of all these phases, which can cause an emotional and physiologic rollercoaster ride.
With mindful eating, we seek to be present with the sensory experience of hunger and satiety, to eat when we are hungry and stop when we are full. While this is generally excellent advice, this becomes confusing when you may have received guidance about how often, and how much, to eat to manage diabetes. Some diabetic medications do need to be eaten with food, or held if you skip a meal. Avoiding low blood sugar is indeed important, and may require you to eat when you are not yet hungry, especially if you are preparing to be active. Still, at least checking in with your hunger level before eating is a key step towards eating in alignment with your body’s needs.
However, what I find most valuable about mindful eating for diabetic management is how it helps us tune into the difference between physical hunger and psychological or emotional hunger. Indeed, a great question to ask yourself, whether you have diabetes or not, is “What am I truly hungry for?” If it is a hug, a break, novelty or companionship, food will not be the answer. Whether you have a diabetes-friendly food, like protein or healthy fat, or a less advisable one, like processed sweets, neither will truly satisfy. The quality or the quantity of the food will not truly matter because it will not feed your deeper need.
Asking yourself “What do I need more of right now?” can help you make a mindful choice that honors your body, mind and spirit. It provides a more positive and sustainable strategy than focusing on what you cannot or should not have, which reinforces the negative mindset and the deprivation values of Diet Culture. Perhaps what you truly need is a stretch, a chance to vent, or a peaceful walk in nature. Using the acronym HALTS, originally created for helping people in recovery from substance abuse, can provide a useful framework. Pause and ask yourself “Why am I feeling the desire to eat?” and kindly consider halting if you are eating for any of the letters other than H.
H - Hungry
A - Angry and/or Anxious
L - Lonely
T - Tired
S - Stressed and/or Sad.
This is valuable for all people, but especially those who tend to turn to food when bored or otherwise uncomfortable. By tuning into what we really need, we can prevent overeating, which can lead to risky blood sugar elevations, especially when done frequently.
Research shows that it is very common for all people to practice “reward-driven” eating, eating for pleasure or relief rather than hunger1. When this happens in small quantities or infrequently, it likely has no health consequences. However, when we eat in this way the majority of the time, we risk missing key nutrients and not giving our bodies what they need to be optimally well. With diabetes, this can have a major impact on blood sugar control, and overall cardiometabolic health. Thankfully, research also shows that practicing mindful eating can be as effective at managing diabetes as conventional diabetic eating and exercise recommendations.
Lastly, the most important component of mindful eating is remembering that it is not meant to be another “diet tool.” It is instead rooted in mindfulness: being present with the present moment, with less judgment, and more loving kindness. Therefore, while paying attention to hunger and fullness is a core part of mindful eating, even more impactful is holding ourselves with compassion, reducing negative self-talk and seeking to appreciate our bodies not for what they look like, but what they enable us to do. When we shift our thinking to this more body positive approach, we are less likely to throw in the towel when we make a choice that is not in alignment with diabetic recommendations. Therefore, we can choose to care for ourselves in a way that is not just pleasant for the moment, but also provides protection against risky and uncomfortable diabetic complications.
Overall, whether you have diabetes or not, asking yourself “What am I truly hungry for?”, “What do I need more of right now?” and “Why am I feeling the desire to eat?” can help you make a mindful choice that is compassionate and sustainable. It allows room for eating for both fuel and joy, and can make life, not just this mouthful, sweeter and worth savoring.
Caitlin Hildebrand, MSHAIL, MSN, AGPCNP-BC, Nurse Practitioner, RYT500, is Clinic Director in Integrative Health at the San Francisco VA, where she practices Integrative Medicine and Primary Care, teaches yoga and mindfulness, and developed and leads a Mindful and Intuitive Eating program for veterans and staff.
NP Hildebrand began her career in inpatient psychiatric nursing, including on eating disorders units. She has taught
for numerous healthcare organizations and conferences throughout the US, and published the book "Un-Less: Mindful Journaling for Body Positivity, Mindfulness and Unconditional Self Love". She has a breadth of knowledge in health and wellness, with a Medical
Fellowship from the Weil Center for Integrative Medicine at the University of Arizona, Bachelors' degrees in Psychology and Nursing, from Swarthmore College and University of Pennsylvania, Masters in Nursing and Healthcare Administration from University of
Pennsylvania and UCSF, is a PhD candidate at the University of Colorado in Veteran and Military Healthcare, and is an assistant Clinical Professor for UCSF.
She graduated with a Yoga Alliance Certification from Yoga to the People and Holistic Yoga Coach training from Purusha Yoga School. She also completed group facilitator training from the Center for Mind-Body Medicine and UCSD Center for Mindfulness, and coursework in trauma focused yoga from Veterans Yoga Project, Inversions at Baptiste Yoga and Yoga for Grief at The Center, all in San Francisco.
She lives in the San Francisco Bay Area, near the Russian River, with her husband and cat, under the redwoods.
You can find more about her in her webpage: Hom Heaven Health
- Mason., A., Epel, E., Kristeller, J., Moran, P., Dallman, M., Lustig, R., Acree, M., Bacchetti, P., Laraia, B., Hecht, F. & Daubenmier, J. (2016b) Effects of a mindfulness-based intervention on mindful eating, sweets consumption, and fasting glucose levels in obese adults: data from the SHINE randomized controlled trial. Journal of Behavioral Medicine, 39(2), 201–213. https://doi:10.1007/s10865-015-9692-8
- Miller, C., Kristeller, J., Headings, A. & Nagraja, H. (2014). Comparison of a mindful eating intervention to a diabetes self-management intervention amongst adults with type 2 diabetes: A randomized controlled trial. Health Education & Behavior, 41(2), 145-154. https://doi.org/10.1177/1090198113493092