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Elisa D'Urso Fischer
As dietitians working with OO, we have seen examples of just how well this approach works for people with medical concerns. We'd like to share some of these experiences with those of you dealing with similar concerns. The most common health issue we address with our clients is diabetes. Here are two examples:
One diabetic client, Ann, had been working with the OO approach for almost two years. She was no longer binge eating but had never paid close attention to identifying and stopping at the first signs of fullness. She was trying to maintain normal blood sugar levels without medication. Therefore, it was important to eat just what her body physically needed; no more and no less. We discussed how stuffed felt vs. full. Ann experimented with stopping after different amounts of food to see what felt most comfortable.
Ann also began checking her blood sugar three to four times a day especially if she felt different in any way. She kept a running tally of what and when she ate. She started to identify a particular kind of tired feeling when her sugar was elevated. She noticed another kind of higher energy feeling when her blood sugar was in the normal range. We tried to identify any particular foods or combinations of foods that contributed to high or low blood sugar levels. For example, we noticed that richer foods eaten late in the evening correlated with high morning blood sugars.
The blood sugar readings began to feel like numbers on a scale, so it was important for her to learn to look at this information objectively. Neither the food nor Ann were good or bad; it simply did or didn't leave her feeling well. We discussed how stress and physical problems like fever or pain can increase blood sugar, and how activities like walking can lower it. Again, it was not a matter of being good or bad, but understanding how the body works, and striving to find the calm caretaker within who would be attuned to her needs. By tuning in to what she wants to eat and how much is satisfying, Ann is successfully managing her diabetes.
Another client needed insulin to maintain normal blood sugar levels. It is important to recognize that if the body's insulin is significantly ineffective or inadequate, diet alone simply is not going to work and some kind of medication is necessary…
Paula, a 40-year-old who has had diabetes for five years, began seeing the dietitian at a time when her physician advised her of the need for insulin to maintain more normal blood sugar levels. Now with a support team of a dietician, a therapist (leading an OO group) and a psychiatrist, she began to put to rest the doubt she had about integrating OO and diabetes. The messages she received from all three reinforced one another.
With encouragement, Paula began more frequent testing of blood sugar. Her views of diabetes changed as she learned that sugar is not a forbidden food. As with all food, it is a matter of the quantity her body can handle. From the records she kept on her blood sugar, she could now say she knew steak and pasta were foods that elevated her blood sugar. She could observe that eating smaller amounts of food at night (which might include a sweet) gave her a more restful night's sleep and a lower blood sugar in the morning. Fearful that insulin would mean great restrictions on her life, Paula interviewed diabetics who were on insulin as to how they coped day to day with their self care. She was relieved to learn that she could monitor her blood sugar and give herself insulin injections any time, any where and therefore have her freedom. When dining out she could carry premeasured insulin, check her blood sugar in the car and give herself the injection in the privacy of a bathroom stall, before eating, so she could continue to eat at restaurants with her friends; an important activity for her.
Over a six-month period, Paula became more assertive and confident in her dialogues with her physician. She would prepare for a potentially emotionally charged visit by focusing on what she needed to get out of the visit and by making a list of questions she wanted to ask. As Paula felt more support from health professionals and more secure with her new views on diabetes, she was able to make a relatively smooth and successful transition to insulin medication. In many ways, she is far calmer about her diabetes and notices that she is stopping when full more frequently than in the past.
We have seen that when you listen carefully to your body, you can trust it. Working with a dietitian may help you to recognize more clearly how food works in your body, but there is no need for or benefit to rigid rules around food. Even traditional organizations like the American Diabetes Association have recognized the need to legalize all foods, including sugar, to help normalize symptoms as you strive to feed yourself in a nourishing and satisfying way.
Elisa D'Urso Fischer and Marianne Evans-Ramsay are registered dietitians practicing in the Chicagoland area.