Diabetes and ME

Paula Deen: From Extreme to Mindful Eating with Diabetes

By Michelle May, M.D.

A common reaction to a diagnosis of prediabetes or diabetes is "Oh no! I'll never be able to eat the foods I love again!" Now imagine that you are Paula Deen...a woman whose entire brand is built around food - and not just any food, but food that symbolizes extreme eating.

In this Huffington Post article, Paula Deen: From Extreme to Mindful Eating, I explore the reaction to her diagnosis and share my thoughts about the need for a more balanced approach.

We'd love to know how you've dealt with your diagnosis and how you've managed to find a balance between "all" or "nothing." Please share your thoughts!

 

Mindful Eating and Adding Specific Nutrients

By Megrette Fletcher, M.Ed., RD, CDE

Okay, so maybe you already know that your diet could use some help. The reason your diet is a bit lackluster is often complex. However, the following are the three most common explanations that clients share with me.

The number-one reason: Lack of awareness. You may not really know what to eat, or maybe you simply forget to eat the suggested servings for fruit, vegetables or dairy. There is nothing sinister or evil happening. Life gets busy, and it is easy to get caught up in it.

The second reason: The dreaded food rut. You just eat the same foods over and over again.

The final reason: Availability. There are times you eat foods simply because they are fast and available.

Take a moment and reflect on whether and why your diet is lacking variety or certain nutritents before reading any further. Regardless of your answer, mindful eating can help. It can shine the light of awareness and help you uncover the reason your diet is a bit lackluster.

Did any of the three common reasons ring true to you? If they did, pause again and really check in. Is now the right time for you to make changes? Acknowledge whether you are dealing with a heavy schedule and extra stress. Adding variety to your diet means you have to be open to change. The specific change in question is your willingness to try some new foods. That requires making the time to purchase, cook and eat foods that might not be familiar.

If you are up for the challenge, here are a some simple ideas on how to add more of three important nutrients to your diet.

Three Nutrients Your Diet Needs: Fiber, Calcium and Omega-3

Fiber

Most of my clients would benefit from adding more fiber to their diet. Adding fiber can help you feel fuller longer, blunt blood sugar rise and increase the nutrient density of your diet. Fiber is actually an easy thing to add if you like whole grains, fruits and vegetables. However, if these are not the foods you naturally reach for, consider the following ideas.

• Check out fiber-rich recipes online. My favorite is www.diabetes.org. However, there are thousands of searchable online resources.
• Make a point to choose a fiber-rich food for breakfast such as cooked (not instant) oatmeal (by reading the labels, you will notice that the fiber content of oatmeal varies from 2 to 8 grams). Experiment with high-fiber cereal like Fiber One or Kashi. You can also choose whole-grain breads, deli thins, flat breads or English muffins for breakfast or as part of your lunch.
• Adding fruits with skins or seeds can also add fiber. Examples are any berries, apples, pears or peaches with the skin, grapefruit or oranges. Fruits you eat without the skin are lower in fiber. These include all canned fruit, fruit juice, bananas and melons.
• Having fiber rich whole-grain snacks on hand can also help. Examples include crackers and breads, popcorn, and whole-wheat pita chips.

Calcium

Another nutrient that most people, especially women, need more of is calcium. Calcium-rich foods include milk, yogurt and cheese. These foods have the added benefit of protein, which creates a feeling of satiety, helping you feel fuller longer.

• Include 8 ounces of low-fat milk at lunch or supper.
• Bring yogurt or low-fat cheese to work as a snack.
• Add reduced-fat or part-skim cheese to casseroles or sandwiches.
• If you are not able to eat 3 servings of calcium-rich foods a day, consider taking a supplement. 

Omega 3 Fatty Acids

When you eat mindfully, you may notice the need to switch your thinking, especially about eating fats. For so long, fats have been labeled as “bad.” Research has helped us understand that eating healthy fats are an important step in preventing and managing heart disease. This is why another nutrient most people need more of is omega-3 fatty acids. These are found in cold-water oily fish such as salmon, herring, mackerel, anchovies and sardines. If you have diabetes, the American Heart Association recommends eating fish twice a week.  Omega-3s are also found in flaxseed, walnuts, some eggs and enriched margarines. If your diet is lacking these foods, omega-3 or fish oil supplements may be an option.

Successful New You Resolutions in Ten Strategic Steps

By Michelle May, M.D.

Whether you are setting health goals, personal goals, or professional goals, the key to successful New Year's Resolutions is to create a strategic plan. The following steps will guide you through the goal setting and achievement process.

The Goal Setting Process

1. Assess Your Starting Point: Take an accurate and detailed assessment of where you are presently relative to the goal you would like to achieve.
   
   
2. Consider Your Values: Goals based on your core principles and values will form a passionate attitude!
   
   
3. Dream: Go for areas that inspire and challenge you. Project yourself into the future and write down your ideal scenario.
   
   
4. Define and Clarify: Narrow down your goals to those that inspire you the most. Make them so clear that you can see them, feel them and measure them.
   
   
5. Write it Down: Write your goals in positive terms using detailed words and/or pictures. Put them in a place where you will see them often.
   
   
6. Develop a Plan: Set long and short goals, including a timeline with deadlines. Be flexible and open to new opportunities and paths to your goals but be careful of detours.
   
   
7. Identify Obstacles and Possible Solutions: Expect setbacks and learn to recover from them.
   
   
8. Create a Support Network: Consider identifying an accountability partner to encourage continued progress.
   
   
9. Make it Happen: Periodically assess your progress, adjusting your approach and/or modifying goals as necessary.
   
   
10. Reward Yourself: Small and large incentives will keep you motivated to reach your short and long term goals. Keep in mind that the greatest reward is in knowing that you have done your best!

Best wishes for a healthy and successful 2012!

Guilt: An actual email exchange about blood glucose monitoring

 By Megrette Fletcher, M.Ed., RD, CDE

I got an email today from Will, my 52-year-old patient who started on insulin last week. One evening he made a note that he “ate really bad stuff.” This was followed by a comment on the morning blood glucose reading: “Remember… I ate really bad stuff last night.”

I cannot stress how helpful blood glucose logs are. They piece together three types of information: medication, diet, and activity. Blood glucose logs offer objective information about how these three parts of your diabetes treatment work together.  Unfortunately, these numbers too often create blame, shame, or guilt.

I get a lot of blood glucose logs like Will’s. These are logs that are submitted to me like evidence found at a crime scene: proof of guilt. I analyzed Will’s blood sugars, adjusted his insulin and wrote back with the following comment.

Megrette: “Excellent! This is very helpful information.”
Will: “Thanks. I’m thinking once I get the diet and exercise working it should continue to improve. Seeing my doctor tomorrow before work. Tell him I’m behaving.”
Megrette: “I will tell him that you are trying. That is WAY better than behaving :>)”

When blame, shame, or guilt arrive, they stir up painful emotions, making it difficult to know what change would be effective. In short, blame and guilt do not motivate a person to change, they do the opposite. The following expression sums up this concept perfectly: “The beatings will continue until morale improves.”

So, if the holidays are driving up your blood sugar, stop beating yourself up. Renew your intention to use mindful eating to help manage your blood sugar. Savor that holiday delight instead of feeling guilty about eating it. Check in with your physical hunger versus eating out of habit or responding to the many environmental cues. It is this gentle and consistent effort that brings lasting success because it allows you to enjoy the present moment. 

Handling Holiday Eating and Stress: A Recipe for Success

By Michelle May, M.D.

The holidays can be a stressful time, especially when you are trying to manage your diabetes and holiday eating in the face of all the busy-ness, stress, and food! By undertanding the ingredients that set you up for overeating, you can create the perfect recipe for success and healthy, happy holidays!

Recipe for Overeating

Ingredients:
1 batch, bag, box, or large plate of food
2 tablespoons of deprivation
1 heaping teaspoon of guilt
Sprinkle of shame
Optional: fatigue, stress, resentment, loneliness, boredom

Directions:

1. Run yourself down physically by not sleeping, exercising, eating when you’re hungry, consuming nutritious foods, or checking your blood glucose. Alternatively, wear yourself out by working too hard, being all things to all people, and trying to make everything perfect.
2. Place emotions on medium-high. Cover and simmer; do not allow steam to escape.
3. When you crave something you love, remind yourself that it's bad, fattening, or high in carbs.
4. When your cravings grow stronger, tell yourself that you're bad for wanting bad food.
5. Wait until an influential person such as your grandmother or co-worker insists you eat that food anyway to please them. Alternatively, sneak the food when no one is watching.
6. Sit down in front of the T.V. or choose another activity to distract yourself while you eat.
7. Before eating, garnish the food with guilt. If it’s still enjoyable, stir in some shame to ensure that the food is completely ruined.
8. Eat as quickly as possible to avoid tasting or enjoying the food.
9. You're done when you feel sick and uncomfortable.
10. Repeat steps 1-9 until can't stand it anymore. Try the Recipe for Instinctive Eating.

Recipe for Healthy Eating

Ingredients:
1 or 2 servings of food you love
2 tablespoons of hunger
1 heaping teaspoon each of intention and attention
Sprinkle of trust
Optional: pleasure, enjoyment, celebration, tradition

Directions:

1. Care for yourself physically by getting adequate sleep, exercise, and nutrition.
2. Create a self-care buffer zone by regularly nurturing your body, mind, heart, and spirit.
3. When you’re hungry, consider what you want, what you need, and what you have to eat before choosing food.
4. Decide how you want to feel when you're finished eating; serve yourself accordingly (or adjust the portion if someone else served you).
5. When the food you crave isn’t particularly healthful, omit all guilt and shame and include the desired food in your meal plan. Remind yourself that all foods fit when you practice balance, variety, and moderation.
6. Sit down to eat and minimize distractions.
7. Savor the appearance, aromas, textures, and flavors as you eat.
8. Eat slowly and mindfully for maximal enjoyment from every bite.
9. Stop when you feel content and energetic.
10. Repeat steps 1-9 for the remainder of your life.

Learn how from our new book: Eat What You Love, Love What You Eat with Diabetes: A Mindful Eating Program for Thriving with Pre-diabetes or Diabetes (available 04/01/12). Happy, Healthy Holidays!

Duck Your Cravings: Let 'em float right by!

Post by Michelle May, M.D.

The holiday season officially began with Halloween and will continue right through Valentine's Day! For many people with diabetes, this season is associated with food cravings that can feel overwhelming at times. Many people find that the more they try to resist their cravings, the stronger they grow.

One way to take the power out of your cravings is to imagine them in a neutral way. Here's an example of how to picture your cravings like something that holds no power over you whatsoever.

A Calm Lake, Interrupted

I had a limited view of the lake through the window from where I was sitting. The water was calm and peaceful, when from the edge of the pane, a duck drifted into my awareness. I watched it bob in the middle then float away. The ripples slowly receded back into the lake and it was still again.

Minutes later several ducks paddled in from the other side of the window. They splashed about, apparently struggling for something below the surface. The strongest duck swam directly toward the window, circled several times then paddled back the way it came, followed by the rest.

How like my cravings! They seem to appear from nowhere and capture my attention. The difference is that I’ve never had a seemingly uncontrollable urge to jump up and devour a duck! Instead, I can watch a duck with a detached awareness. I feel curious, even entertained, but uncompelled to take any action. I allow the duck to just drift away, unconcerned about where it goes or when another will emerge.

Duck Your Cravings

Learning to observe your cravings in a curious but uninvolved manner can take the power out them. Try this exercise:

1. The next time you have a craving, stop what you’re doing, close your eyes, and focus on your breath.
2. Observe the craving as if it was a duck, bobbing around in your awareness. Become curious but remain calmly detached as you watch it.
3. If the craving becomes stronger, imagine that is simply paddling toward you.
4. If you feel compelled to stop and eat the object of your craving, smile as you picture yourself chasing down an innocent duck.
5. Practice slowing and deepening your breath as you patiently wait for the craving to turn and float away.
6. Imagine the lake returning to peaceful stillness.

Weight Loss and Diabetes

By Megrette Fletcher M.Ed., RD CDE

A nurse-colleague told me about her recent diabetes diagnosis.  Then she added, “So I decided that I am going to lose 50 pounds.” I could see the excitement in her face switch to a sense of worry in her eyes the moment she asked me, “Do you think that is a good idea?”

Many clients ask that same question. Is losing weight the goal of diabetes self-management? No.  You may be thinking, “But I was told by my physicians to lose weight to control my diabetes.”  The fact is, weight loss is not an action. It is an outcome; a possible result of what you are doing. 

The goal of diabetes self-management is to manage your blood sugars to allow you to live a full and vibrant life.  To achieve this goal, I encourage my clients to stop focusing on an outcome and start focusing on behavors.

What to do instead?  

Shift your intention to becoming more present by pausing and noticing patterns in your food and eating choices.  Ask questions such as “Am I hungry?” or “Would this taste good now?”  instead of giving yourself commands like “You are not allowed that!” or “That is what you have to eat because you have diabetes.”

Become present by asking yourself, "What behaviors can I do that will help me achieve a full and vibrant life?"  It is important to remember that for every one problem there can be many solutions.  Be creative and open to new ideas.  Mindfulness and mindful eating are powerful and effective because you can practice flexibility as you explore new solutions to food and eating challenges.

Explore  these mindful eating practices your next meal or snack.

• Check in and assess your current level of hunger.
  
• Create the intention to eat enough food to fill your hunger not overfill it. 
  
• Slow down, pause and ask yourself -- am I still hungry? Success is more likely if you continue to check in while eating.
• Track your feelings and blood sugars both before and after mindfully eating meals and snacks  Notice any changes.

Weight Stigma Awareness Week: Don’t Measure Your Self-Worth

September 26-30, 2011 is Weight Stigma Awareness Week

By Michelle May, M.D.

While sexism and racism have slowly declined, weightism is on the rise. While it is just as harmful, weight bias is somehow seen as justifiable - or worse, helpful. Those with medical conditions like diabetes may may be particularly vulnerable to stigma related to their weight from employers, health care providers, and people they don't even know.

Is there a bully residing between your ears?

Some people with diabetes internalize this stigma. In other words, the bully moves into their head.

Pause and ask yourself: Do I experience shame about my weight? Am I preoccupied with dieting to try to lose weight? Do I feel guilty about eating? Have I convinced myself that this bullying is justified because it somehow helps me manage my diabetes?

A scale doesn't measure your self-worth.

A scale simply measures the weight of your tissues and substances that are just passing through – none of which have anything to do with your value as a person. Your weight doesn’t accurately measure what’s going on inside your mind, heart, spirit, or even your body! Yet, a number on the scale is given the power to change your mood and affect your behavior, often in unhelpful ways. For example:

Have you ever said…

• I was so good but I didn’t lose any weight. I might as well eat.
• I did so well this week. I deserve a treat!
• I don’t have to weigh in until next week so I’ll splurge now and make up for it later.
• I was terrible this week and I still lost weight. I guess it doesn't matter what I eat.
• I only lost a half a pound. It wasn’t worth it.

Clearly, focusing on weight interferes with your ability to make meaningful, sustainable changes to help you manage your diabetes.  

Let it begin with me

We have a long way to go before weightism is a problem of the past. In the meantime, can you practice seeing your own weight as neutral - simply a number without the power to deflate your spirit and derail your intention to effectively manage your diabetes?

Please share your thoughts.

Enjoying the Taste of Healthy Food

By Megrette Fletcher M.Ed., RD., CDE

Have you ever wondered if you could enjoy eating healthy foods? So many of my clients tell me, “Oh, I don’t like that!” and when I try to learn why by asking, “What don’t you like about this food?” they often get a puzzled look on their face. “The taste!” I will often smile and ask, “Yes, the taste, what about it?” And then, the conversation really begins.

When people begin to eat mindfully, they get to learn what they do and don’t like about a food or an eating experience. Most foods can’t be easily grouped into “like” and “don’t like” categories. Lots of things about a food make up our food preferences. These include taste, after taste, texture and mouth feel. For example, I often share with my clients that I have a strong dislike for the texture of Jell-O, jelly, custard and yogurt. The thing is I know this because I decided to eat these foods mindfully and really become curious as to why I disliked them. Over time, I learned that I do like the taste, but it was the texture that gave me the willies.

This is where mindful eating became so helpful. I began to experiment with the foods, adding granola or fruit or trying to eat them with a crunchy cracker. After making some changes, I began to enjoy eating these foods. I noticed that when I decreased distraction and really focused on enjoying these foods, I could actually savor them. This was definitely a new experience! After years of telling myself I should like creamy, smooth yogurt, but never enjoying the experience, I had to relearn how to eat it. The first step was to let myself change the thing I disliked about the food so I would enjoy eating it.

I started to add fruit, nuts and granola to my yogurt. I learned that I enjoyed foods with a custard-like texture if they were served with something crunchy. Over time, I learned how to change these “less-than-loved foods” so I could enjoy eating them. This ability has helped bring variety into my diet —without resentment, guilt or overeating.

It is important to remember that mindful eating is a very personal journey. You need to bring your own experiences, thoughts, feelings and beliefs to the table. Every choice you make is an opportunity to experience and better understand why you do the things you do and to choose differently next time if it will serve you better. It is a learning process. For this approach to be effective, perfection isn’t necessary. Be kind and patient with yourself; the freedom and enjoyment you’ll discover are well worth it.

Finding Intention in the Still Waters of Mindful Eating

By Megrette Fletcher, M.Ed., RD, CDE

Mindful eating can simplistically be explained as fostering both attention and intention. Don’t be surprised to discover that your intentions are dynamic and shift during the change process. This makes identifying them far more complex than you might initially realize. One minute they are clear, the next minute clouded and uncertain. 

To help you understand why discovering your intention might be helpful, think of intention as similar to the rings in the water that are created from a tossed stone. They start out small, but as they travel, they grow larger and larger until they reach the shore.  Finding the place where the stone entered the water is equivalent to helping you discover the cause of the rings – or the point where change will have the most impact.

It is easy to find the place where the stone entered the water when it is still and calm.  However, when the water is choppy and full of waves, finding that spot is far more challenging. This is where mindful eating can be helpful.

How? Helping you calm the rough waters of life, by pausing, decreasing distraction, tasting food fully and bringing a curious, not critical, attitude to a meal, is often the step that is necessary for awareness to arise. 

Unfortunately, in our busy, information-driven lives, many nutrition session focus only on imparting facts and knowledge without including time to absorb, process and fully understand the impact of a choice. The wisdom associated with knowledge is lost if it does not include reflection to see the effects of a choice. 

Mindful eating helps you see the big picture often enabling you to understand how the simple intention, often creates many unintended ripples.  For example, “grabbing something quick” may be favored because it meets the immediate need of ease or speed. Yet without reflection, you may not notice that these types of foods can be lower in nutrients and lack flavor, resulting in meals and snacks that are not enjoyed. 

After eating this you may think “Why do I eat this? Why don’t I just change?”  However, food selection is complex and unique to each situation and person. There is no  “one reason fits all” answer. Uncovering your intent takes time, patience and often persistence. Yet, when it is discovered, change often follows.

Something to try

At your next meal or snack, intentionally create a pause and ask your self: “Am I hungry?" and "What ismy intention is for making this change?” 

Let the space created by this question be noticeable. Allow yourself to not be sure, to wonder or even face doubt. These are true signs that you are working – making important connections, looking for the spot where the stone entered the water.