Vacation nutrition

    Sometimes my patients raise concerns about their nutrition over a vacation or another time when they are off their typical schedule. My instinctual response is to assure them that vacation represents a small minority of their life, and to not give it too much importance. But that answer does not really address the core fear. The bigger worry behind this is the fear of loss of control. When you are on your routine, it is easier to stay in control. You can set up your life to make sure you always have the specific food you need when you need it. You can avoid every triggering situation. You can avoid people who might have "forbidden" foods or talk about disallowed topics. It seems that the real work is to be open to all possible circumstances and the real human likelihood of imperfection. 

Reasons my patients want to make healthy lifestyle changes

• so I can be around to play with my grandchildren
• to lower my risk of a heart attack
• to improve my blood sugar
• so I can have an easier time climbing up the stairs
• to have more energy
• to improve my mood
• to have less nausea
• to have less bloating
• so I don't eat until I am uncomfortably overfull
• to feel better
• so I can walk further without getting out of breath
• to improve my blood lipid levels
• to feel stronger
• to feel good
• so I can take care of myself
• because only I can do this for myself

Non-hunger reasons we eat

• tiredness
• boredom
• anxiety
• restlessness
• pleasure-seeking desires
• habit
• social setting that encourages eating
• location
• eating customs
• "last supper" mentality
• rebound from food restriction

    Which of these have you experienced recently? 

Hunger and Satiety: When to eat and when to wait

     Many of us have grown out of touch with knowing when to eat. Babies tend to be good at crying for milk when they are hungry and stopping to eat when they are satisfied. As we get older, other influences encourage us to eat. We are coaxed to finish our dinners, offered sweets as rewards, and we start using pleasurable foods to calm our nerves. It takes a lot of relearning to get back to that "baby" state of eating when hungry and stopping when full.

    One way to reteach ourselves this skill is with the use of a hunger and satiety scale. With this scale, we can rate our current state and have prespecified points that correspond to "time to eat" and "time to stop eating." We will use a 10 point scale. Let's put "starving" at 1 and "uncomfortably full" at 10. If you at a 1, you have waited too long and allowed yourself to be too hungry. If you are at a 10, you might have stomach discomfort or pressure in your abdomen from the quantity of food eaten. At the midpoint, near 5-6, is where you are neither hungry or full. You could eat without making yourself uncomfortable, and you could wait longer and not be too hungry. Around 3 on this scale is where you feel hungry and ready to eat, but not ravenously hungry. This is a good time to seek out something to eat and begin a meal. The meal can continue until you reach about an 8 on the scale. At this point you are comfortably full, but not overstuffed. Based on this scale, we want to remain in the range of 3-8. This prevents us from getting too hungry or uncomfortably overfull. 

    At first, knowing when to eat out of hunger and stop when full will be a conscious effort. It will take effort to remember to check in with your inner hunger and satiety cues. You might sometimes forget, and then later notice that you allowed yourself to get ravenously hungry or uncomfortably full. With practice, you will remember more frequently to notice your inner hunger and satiety signals to help you remain in the 3-8 range. And with even more practice, it will become second nature. 

How to improve your eating with mindfulness practices

• When you are deciding what to eat, take into account how you will feel after the meal—what you think will help you stay satiated, how much you need to eat to be satisfied but not overfull, and what will be comfortable in your stomach without GI discomfort.
• Sit down while you eat.
• Don’t multitask while you eat. Don’t watch TV or videos, don’t read.
• Focus your attention on the eating experience. Note the different sensations: the aroma, what the food looks like, the taste, the texture, the mouthfeel, the temperature.
• Consciously slow down your eating. Put your utensil down between bites. Allow yourself to taste every bite.
• Once you are finished your portion of food, give yourself 15 minutes to allow the satiety signals to get to your brain. Then you can make a decision if and what you should eat next.
• When you have an urge to eat, notice if it is driven by hunger, boredom, stress, loneliness, habit, socializing, or another cause.