A diagnosis of diabetes changes everything. It frequently changes a person’s perception of himself and of his health. The demands of diabetes care can also change a person’s daily routine. A diabetes diagnosis is almost always accompanied by suggestions from health-care providers for lifestyle changes. And it may also be accompanied by a desire on the part of the person with diabetes to make such lifestyle or other changes in his life.
But change, even when desired, can be stressful. Sometimes it’s not clear how or even what to change to achieve goals such as weight loss, blood glucose control, or feeling less anxiety about having diabetes. This is where mindfulness—the act of being aware and paying attention to the current moment—can help. Mindfulness enables a person to tune in to how he feels physically and emotionally at any moment, and that information can guide his response to a given situation. Perhaps most important, it allows him to change his response from his habitual, automatic reaction to a response he chooses. These skills can be useful in all realms of life and may be of particular use when it comes to eating behaviors.
While “paying attention” may sound simple, in fact it can be challenging to do in daily life. One reason it’s so difficult is that although the brain has a huge capacity to notice and observe, it is also bombarded with a constant flow of stimulation and information.
To better understand the forces competing for the mind’s attention, it is helpful to consider three categories of awareness: sensory experience, knowledge, and emotional states.
SENSORY EXPERIENCE consists predominantly of smells, sounds, colors, and tastes. It also includes noticing any physical feelings, such as a sense of wellness, strength, or fatigue, or symptoms of high or low blood glucose levels, such as trembling, sweating, or blurry vision.
KNOWLEDGE is the ability to recall facts and learn new concepts. For example, a person may have learned that there is carbohydrate in bread. When he applies this knowledge to create a meal, then notes his experience, this information can be transformed into wisdom, or understanding gained through direct experience. Each person has a unique body of accumulated wisdom that is an important aspect of that person’s mental awareness.
EMOTIONAL STATES consist of feelings such as joy, contentment, anger, or anxiety. Typically, feelings change over the course of an experience.
Because these three primary sources of information are always “in play,” the brain is constantly engaged. So while there are plenty of internal and external stimuli to be aware of, sorting out which are important and which are not can be very difficult.
Most people cope with “information overload” by focusing on any one thing for only a moment. Over time, people become accustomed to varying levels of environmental or mental distraction. This perpetual shifting of focus becomes a way to “look” at something but never really “see” it.
Imagine you are out for dinner, eating a salad, and enjoying the flavors and textures in your mouth. Suddenly, something—the odor of another diner’s entrée, perhaps, or your dining companion’s conversation—causes your mind to leave the salad and focus on something else. Although you continue eating your salad, your experience of eating it has changed: You are now only barely aware of how it tastes, whether or not you’re enjoying it, and how full you are.
According to psychologist Ronna Kabatznick, Ph.D., author of The Zen of Eating: Ancient Answers to Modern Weight Problems, “The experience of anticipating the future or reliving the past can cause a person to distance himself from the direct experience, which leaves most of us lost in the world of thought while we do our most basic tasks: eating, walking, washing the dishes—whatever it is, we are not present.” In fact, says Kabatznick, “It is rare for us to be conscious of whatever is happening in our lives.”
Not being conscious of the present moment while eating can lead to overeating and, simply, to not enjoying the meal. Tuning in to the present moment while eating, therefore, can have multiple beneficial effects. But there are a lot of conditions that get in the way of enjoying food.
Donna Gleeson, M.O.Ed., R.D., a dietitian at the Elliot Center for Weight and Health in Manchester, New Hampshire, offers some specifics: “I see stress in people’s lives as a real issue that mindfulness can help.” Gleeson says that it is important to learn how much time someone can devote to eating, because if a person feels that he has to eat in a rushed manner, it is harder to be present. He is likely to be thinking about his next task, phone call, or deadline. Additionally, a person who eats quickly may be less likely to check in with his body’s signals, such as a feeling of fullness, which can take up to 20 minutes to come about. When the person belatedly realizes that he overate, feelings of guilt and uncertainty about his ability to change often follow. These feelings often result in his losing the will to keep trying.
Learning to eat mindfully may have particular benefit for people with diabetes. According to Ruth Quillian-Wolever, Ph.D., Health Psychologist and Clinic Director at the Duke Center for Integrative Medicine, there are more benefits to mindful eating than just enjoying the meal. At the North American Research Conference on Complementary and Integrative Medicine in May 2006, Quillian-Wolever presented the results of a study on how mindful eating decreased insulin resistance. In the study, conducted with Jean Kristeller, Ph.D., and others, 140 people were divided into three groups. The people who participated in the nine-week, mindfulness-based eating awareness program had less insulin resistance after meals, meaning that their bodies were able to use insulin (and absorb glucose) more efficiently. This result indicates that these participants actually metabolized food differently than the group that received traditional weight-loss education. This benefit may be related to an increase in the relaxation response, which is a by-product of mindfulness that decreases stress.
Dean Ornish, M.D., author of Dr. Dean Ornish’s Program for Reversing Heart Disease says, “Emotional stress plays an important role in just about all illneses, both directly and indirectly. For example, emotional stress makes arteries constrict and blood clot faster, which, in turn, may cause a heart attack. Also, people are more likely to smoke, overeat, drink too much, work too hard, and so on, when they are feeling stressed.” Ornish’s program is the first to offer documented proof that heart disease can be halted or even reversed by lifestyle changes.
Ornish’s program encourages a more mindful approach to food and eating. When a person deepens his awareness during a meal or snack, he can increase his confidence about his ability to respond to his body’s cues of hunger and fullness. Meals offer a relatively short period of time during which to practice paying attention, usually 3 to 30 minutes. Ornish likes to remind people considering change that “Even a few minutes a day can make a big difference.”
Principles of mindful eating
There is no single way to start eating mindfully. However, The Center for Mindful Eating, a nonprofit, nonreligious organization created by a group of mindfulness experts, offers the following four principles of mindful eating:
1. Allow yourself to become aware of the positive and nurturing opportunities that are available through food preparation and consumption by respecting your own inner wisdom.
2. Choose to eat food that is both pleasing to you and nourishing to your body by using all your senses to explore, savor, and taste.
3. Acknowledge your responses to food (likes, neutral, or dislikes) without judgment.
4. Learn to be aware of physical hunger and fullness cues to guide your decision to begin eating and to stop eating.
These principles and more information about the center are available online at www.tcme.org.
Getting out of the blame habit
Allowing yourself to focus on what is good about eating can dramatically change your eating experience, says Donald Altman, author of The Art of the Inner Meal: The Power of Mindful Practices to Heal Our Food Cravings. “If you can learn to eat without shame and blame, it can open the door to the awareness of what you are feeling. If you are hungry and craving, just know that is present. If you are restricting, know that you are restricting.”
Ruth Quillian-Wolever agrees that for anyone to begin a mindful eating practice, he has to become more aware of judgment. This requires both practice and patience, but it is doable. Quillian-Wolever says, “The more people practice, the more they will be able to apply the skill of eating nonjudgmentally.”
Dr. Kabatznick adds, “Everyone thinks she is supposed to be perfect, but that is not the point of becoming mindful. It is the commitment to return to the bite, the moment, the direct experience of eating. That is the intent of a mindfulness practice. No matter how many times we leave the experience and no matter how many times we judge ourselves, we make a commitment to return to the direct experience of eating.”
Altman reminds us that “eating is something you do every day. There is always another meal.” The opportunities to practice being mindful while eating, therefore, are numerous. Altman also suggests that taking the time to feel grateful for food often transforms the eating experience. He says, “The second we bring gratitude into eating, there is a shift into sacred space—it connects us to all the people who brought us this food. It can bring a sense of cooperation into the eating experience. Just having a sense of gratitude gives us a space, a moment to transcend that impulse or craving.”
Quillian-Wolever’s research showed that mindful eating training helped participants in two ways. First, it promoted awareness, which aided a person in knowing whether he was eating for reasons other than to nourish his body. Second, having a mindfulness practice can assist a person in finding new ways to address emotions without using food to cope. Quillian-Wolever says that a person can learn a lot by taking a moment and exploring what hunger and fullness actually feel like. She suggests focusing on the internal experiences of eating and the physical feelings that are present. She also suggests trying to separate those experiences and feelings from any judgments, such as “this is a good hunger” or “I shouldn’t eat so quickly.” Mindful eating training can help a person recognize that the labels “good” and “bad” and “should” and “shouldn’t” are judgments, which can distract from the experience of eating.
Other experts agree that having the ability to become aware of what happens during a meal offers great benefit. “Health is a process of transformation,” says Susan B. Lord, M.D., Director of the Food As Medicine training program at the Center for Mind–Body Medicine in Washington, DC. “Part of the process is to have the person understand what food means to them. Mindfulness is an important tool to do this. It helps people understand how they view food. When people become mindful, via a guided meditation or other techniques, they become aware.”
Becoming more mindful can help with other areas of diabetes control, too. Rather than reacting to things such as high blood glucose levels the same old way each time, taking a moment to tune in to your emotions before taking action can open the door to a wider variety of responses. By not operating on automatic pilot, you may be able to view knowledge and facts more objectively, without feelings of fear or shame.
Molly Kellogg, licensed clinical social worker and registered dietitian, notes that an objective viewpoint “may enable you to see where to modify the choices around your diabetes management so it works for you.” She further notes that “when a person does this, it becomes a thought-out decision that feels better, more in control.” And becoming aware of what you can control is a big step toward changing habitual, potentially harmful patterns around food and health.