Mindful Eating: Empowering patients with diabetes to take charge of their diet

One of the commonest conversations that happen in my office every day is during the initial consultation with someone who has diabetes, answering questions like "What can I eat? What do I need to stop eating?". Addressing these queries is very important because unanswered, they represent a heavy burden for the patient. In fact, feeling unable to closely follow a "good" meal plan (or feeling unsupported in one's attempts to follow one) leads to significant "diabetes distress". Often there is frustration amongst family members, who complain that the patient with diabetes does not follow the rules, or "indulges" in sweets, rice and other "banned" items. This environment makes things more difficult for the person living with diabetes because they feel trapped between a set of restrictions imposed by their healthcare providers and a set of "police" at home to enforce the rules!  

In my clinical practice, I don't give people weight loss diets or diabetic diets. I encourage them to eat mindfully. What does this mean? It means tuning into the body for signs of hunger and fullness, to understand where the urge to eat is coming from.  Is it a craving? Is it an environmental trigger? Is it emotional eating? Is the person eating out of pure habit or under social pressure? Are they forcing themselves to eat on a fixed timetable (even if not hungry) because they were once told that people with diabetes need to eat "every so and so hours"? Are they able to differentiate between true physical hunger (when the body is hormonally ready to process fuel) and a hunger that is triggered by a falling blood sugar (hypoglycemia) from specific diabetes tablets or insulin? In teaching mindful eating, I don't place any rules on the patient. They get to decide whether, why, when, what, and how much to eat. Does that sound too lenient? People often feel afraid to trust themselves (or their loved one with diabetes) to make effective choices, but that is where they need help: in developing the presence of mind that is needed to change old habits. The principle of encouraging patient empowerment is the foundation of Diabetes Self-Management Education (DSME) as advocated by the American Diabetes Association (ADA) and the UK National Health Service (NHS). 

Yes, changing habits is tough. Falling into old habits is easy. I don't believe that patients are purposely trying to make themselves sick! They are just struggling with the burden and responsibility of living with diabetes. That's where we as health care providers need to stand ready to help patients get back on their feet. With an approach of believing in patients and teaching them how to take more effective care of themselves, this process gets easier with time (and dieting gets harder with time!). 

There is a major need for health education to be provided by trained health professionals, nutritionists, and dietitians. A lot of misinformation and confusion exists around latest food fads, uric acid, macronutrients (carbohydrates, fats, protein) and micronutrients (vitamins, minerals, supplements etc). People can see for themselves the difference between a serving of poha and a whole wheat chapati by checking their own sugars. By helping them tune into their own body, learn basic nutritional facts and observe various fluctuations in blood sugar through self-monitoring, the patient can learn how to balance eating for pleasure along with eating for health. 

The difference between mindful eating and a restrictive diabetic diet lies in the fact that mindful eating empowers the patient to make flexible decisions through the challenges of life. Putting someone on a  diet that says to avoid rice, "sweets", "anything white" or "everything fried" automatically creates cravings and (even worse) guilt if they finally respond to their cravings. Life circumstances aren't the same every day. It should be no surprise then, that it is impossible to live under cookie cutter restrictions long-term. Sadly, when a person gives into their cravings, the system labels the patient as the wrongdoer. 

Often, people are eating without even realising there was a trigger or without paying attention. They go into autopilot mode, eating mindlessly without noticing the experience of what they ate. The food is gone before they even realise it and they don't feel truly satisfied from the meal! If they feel unsatisfied by the food, they may end up eating more, trying to create the satisfaction they had hoped for. Usually, this backfires. Our fast paced life and rapid innovation with processed food have resulted in a mismatch between what we are doing and what our body needs. This is where mindful eating helps. 

Just as yoga can go beyond a stretch routine to become of a way of living, similarly mindful living is a way of being. It is about bringing one's awareness back into the present moment. Mindfulness (present moment awareness) has origins in the ancient cultures and teachings of wise ancestors from centuries ago. As a person learns to ask themselves questions like "How full am I feeling as I eat this rice?", "How does the texture of the mithai feel?", "What thoughts and feelings triggered me to eat?" or "Does this taste as good as I had imagined?", they learn to eat with their full attention devoted to the entire experience of the present meal. Through this self-enquiry, they learn to practice more effective self-care through tapping into their inner wisdom. They might learn to look for other ways to remedy boredom or stress besides simply eating. They would learn to eat the foods they love (as a true "foodie" would!) while also taking care of themselves in body, mind, heart and spirit. Mindful eating is one way to get closer to meeting our true needs, and in the process gradually allows us to live our lives more fully. 

Dr. Roshani Sanghani is a Consultant Endocrinologist at PD Hinduja National Hospital, Mumbai, where she is the founder of the Diabetes Self-Management (DSM) Clinic and runs India's first "Am I Hungry?" Mindful Eating Workshops.