Intuitive and Mindful Eating in Type 1 Diabetes

We live in a society where fashion, social media and advertising play an important role in our relationship with food. Phrases such as “eating healthy” and “controlling your weight” can also affect our relationship with food. 

Type 1 diabetes (T1D) is a chronic illness in which diet plays an important role. Because the pancreas no longer secretes insulin, people with T1D must count the carbohydrates every time they eat and inject insulin accordingly. In addition to carb counting, people with T1D may face situations where the only way to keep their blood sugar within the target range (e.g., in hypoglycemia) is to eat carbs, or where they receive stigmatizing comments related to food (e.g., “You shouldn’t eat that because you live with T1D”).

Paying so much attention to food, sometimes from a very young age, can lead to losing sight of the balance of food, the pleasure of eating, the signals of hunger and satiety, and complicate the relationship with food. 

In this context, it can be interesting to look at the concepts of intuitive eating and mindful eating. 

What are those concepts?

Intuitive eating and mindful eating share some characteristics, but they are fundamentally two different approaches to the act of eating. Here are their main points:

Intuitive eating involves listening to your body and its hunger and satiety signals, and deciding when and what to eat based on this feedback. The goal is to reconnect your bodily sensations and to free yourself from restrictive diets and food rules. Eating intuitively means:

• Eating your fill: learn to recognize and respect your body’s hunger and satiety signals and eat accordingly.
• Eating guilt free: free yourself from the guilt associated with food and focus on satisfying your needs.
• Satisfying your cravings: eat foods that you like and that give you pleasure, without judgment or restriction.
• Connecting with your body: learn to pay attention to your bodily sensations and to make food decisions accordingly (e.g., choosing a comfort food if that’s what you need).
• Practising self-indulgence: remember that intuitive eating is a learning process, and it’s okay to make mistakes.

On the other hand, mindful eating revolves around being present in the act of eating and focused on the sensations, smells, tastes and textures of the food. The goal is to let go of distractions such as television or social media and focus on the act of eating. The key principles of mindful eating include:

• Focus: focusing on the food and the present sensations without distractions.
• Awareness: paying attention to the sensations of hunger, satiety, pleasure and satisfaction that come with the act of eating.
• No hurry: eating slowly, savouring the food and taking the time to enjoy the different textures and flavours.
• Curiosity: staying curious and open-minded about food and exploring new foods and flavours.
• Self-compassion: letting go of the guilt and shame associated with food and focusing on the pleasure and satisfaction it can bring

Can these principles be applied to T1D?

It may seem contradictory to monitor the carbs you eat while also listening your needs, sensations and cravings. Yet, these concepts can be applied in all situations, including living with T1D.

Intuitive or mindful eating can be done in a way that is compatible with your diabetes and that isn’t harmful to your blood sugar. Monitoring your blood sugar, counting carbs and considering how foods impact your blood sugar are still necessary. 

These approaches can help you to gain confidence in your food choices and allow your body to send signals about when, what and how much to eat. They promote mental health and physical health as a whole.

Benefits in the management of type 2 diabetes have been shown (e.g., improved blood sugar levels, weight loss), but few studies have been conducted in relation to T1D. However, a study conducted in a group of teenagers with T1D showed that glycated hemoglobin (HbA1c) levels were better in those who practised intuitive and mindful eating. 

In practice

Here are a few tips to better understand how to apply intuitive and mindful eating in your everyday life. With an intuitive or mindful eating approach, you’d decide on a meal based on how hungry you are rather than on the number of carbs. “What do I really feel like eating?” Will I feel restricted if I choose something else? Once you’re settled, you can adjust your insulin dose and when you take it. If you are unsure of how much you’re going to eat, you can start with a small dose and then take more later.

Then, take the time to savour the food consciously (without distractions) by eating slowly, putting down your utensils between bites and chewing well. There’s a delay before the body starts sending signals of satiety. You must listen to these signals and stop eating whether or not there’s any food left in your plate. 

These approaches also involve letting go of any judgments you might have about food, including those related to carb counting. This means you must challenge the idea that carbohydrates are inherently bad because they affect blood sugar levels. You’re free to eat carbs, and you adjust your insulin according to the carbs you’re eating exactly for this reason! 

The notion of “forbidden foods” is non-existent in intuitive and mindful eating. In fact, restricting a particular food or food group can make you crave it even more. This could lead to you losing control over this food and eating it beyond a comfortable feeling of satiety, for fear of running out. 

Intuitive and mindful eating approaches promote awareness of your dietary needs and body sensations, which can help you develop a healthier relationship with food. This is particularly beneficial in the context of T1D, where there’s a focus on food. Don’t hesitate to talk to a nutritionist if you’re interested in these approaches and want to learn more.

References :

• Miller, Carla K et al. “Comparative effectiveness of a mindful eating intervention to a diabetes self-management intervention among adults with type 2 diabetes: a pilot study.” Journal of the Academy of Nutrition and Dietetics vol. 112,11 (2012): 1835-42. doi:10.1016/j.jand.2012.07.036
• Soares, Fabíola Lacerda Pires et al. “Intuitive eating is associated with glycemic control in type 2 diabetes.” Eating and weight disorders : EWD vol. 26,2 (2021): 599-608. doi:10.1007/s40519-020-00894-8
• Irwin, Ashley et al. “Mindfulness, disordered eating, and impulsivity in relation to glycemia among adolescents with type 1 diabetes and suboptimal glycemia from the Flexible Lifestyles Empowering Change (FLEX) intervention trial.” Pediatric diabetes vol. 23,4 (2022): 516-526. doi:10.1111/pedi.13334
• Wheeler, B J et al. “Intuitive eating is associated with glycaemic control in adolescents with type I diabetes mellitus.” Appetite vol. 96 (2016): 160-165. doi:10.1016/j.appet.2015.09.016