Wishing You a Mindful Holiday Season
The holiday season is a blessed mixture of festive times enjoyed with family and friends, and the often stressful times of coordinating schedules, balancing work, family and social obligations. For friends and family with diabetes, the holidays can also be stressful due to difficult choices about what, and how much, to eat - balancing emotions around healthful restraint and guilty indulgence. How do we overcome these challenges, in order to move beyond the stress and more deeply experience the intention of the holiday season?
Mindfulness is a time-tested practice to remain joyful through life’s challenges. While “mindfulness” has many definitions (some new, others dating back thousands of years), most of us have an inner sense of what “mindfulness” implies. (Try experiencing it now by bringing your awareness to your body position, your breath, and your surroundings.)
Welcome to Mindfulness
Generally defined, mindfulness is a state of calmness in which you can experience and process your emotions into intentional actions, rather than reacting with emotional reflex. Mindfulness can be applied to ourselves, and others in our lives. Although mindfulness is more typically described as a helpful tool to respond and cope with our emotions (and the emotions of others), mindfulness can also be applied to other areas of life, including food, exercise, and our service to others.
Is Mindfulness practice helpful for diabetes?Most would agree that including more mindfulness in daily life is a good practice to cultivate. But does being more mindful, have a measurable impact on factors that are important to people with diabetes? Is there evidence of a health benefit vs. simply making us nicer people? Although research continues to investigate mindfulness interventions for diabetes, the existing evidence suggests some benefits. Several programs have been evaluated in diabetes, including mindfulness-based stress reduction (MBSR) for stress, and programs focused on “mindful eating”, i.e., focusing mindfulness lessons on eating behavior specifically, not for general well-being or stress reduction per se.
One of the first studies of mindfulness in diabetes was a pilot trial published by Rosenzweig and colleagues in 2007.1 In their study, a group of people with type 2 diabetes was invited to participate in a MBSR program in order to determine its impact on their hemoglobin A1c (HbA1c), blood pressure, body weight and measures of mood and depression. After just a month HbA1c was reduced by ~0.5%, blood pressure fell 6 mmHg plus mood and depression scores improved.
Focusing specifically on mindfulness eating, Miller and colleagues reported the results of their randomized clinical trial evaluating a mindful eating program (MB-EAT) compared to a “Smart Choices” self-management program for people with type 2 diabetes. 2,3 In their 3-month pilot trial, MB-EAT was more effective for reducing intake of toxic trans fats, increasing fiber intake and reducing sugar intake. Both programs resulted in significant HbA1c and weight reductions, as well as, improvements in mood and self-efficacy. Interestingly, the MB-EAT program contained much less specific nutrition education or guidance on diet, rather it focused on the relationship participants had with their food. The program also helped bring participants’ awareness to their state of mind before and during meals times, including the emotional and physical cues that lead to hunger.
Recently van Son and colleagues published their research on mindfulness for stress reduction in diabetes. 4 In their randomized trial, “Mindfulness-based Cognitive Therapy” was compared to a no treatment/standard treatment group in 139 people with types 1 and 2 diabetes. After 8-weeks, participants assigned to the mindfulness program had lower stress, reduced anxiety, and increased quality of life. The investigators did not find any beneficial changes in blood sugar control, or reductions in diabetes-specific distress.
These few studies provide important “proof-of-concept” support for mindfulness-based interventions for reducing stress and anxiety in people with diabetes. The results also support the concept that how and why we eat may have important effects on our health, including impacting our ability to make healthier food choices- even without being educated on specific dietary approaches. This concept is mirrored by Diabetes Action-supported research by Oberg and colleagues demonstrating emotional eating scores were highly correlated with HbA1c, and beneficial changes in eating behavior correlate with improvements in blood sugar.5
When we stop to think about it, isn’t this rather intuitive? I suspect nearly all Americans know, in general, which types of food are “bad” for you. Does anyone look at fried, colorless potatoes and think they are healthy? Or gobble down a half-dozen doughnuts and actually feel good about their health benefits? I doubt it. Once we bring our awareness to the benefits or harms we create for ourselves in our decisions, it is easier to make healthier choices and help others do the same.
In addition to its potential benefits for stress, anxiety and diabetes self-management, mindfulness appears to also have benefits for people with obesity, elevated cardiovascular disease risk, and may improve immune function.
Are there other health benefits of Mindfulness?
Research in obesity:
*Dalen and colleagues evaluated a mindfulness intervention in a group of obese men and found after 3 months, mindfulness practice improved weight loss, binge eating, depression, perceived stress, and C-reactive protein (a measure of inflammation). 6
*Kidd and colleagues evaluated a mindful eating group intervention in underserved women who were obese and found mindfulness training improved motivation for weight loss. 7
Research in Cardiovascular Disease:
*Although not a formal clinical trial, our research team published a case report describing a patient’s experience in which MBSR training reduced her blood pressure from “stage 2” (>160/100) to the normal after 11-weeks. 8
*Hughes and colleagues conducted a randomized, controlled trial of MBSR, compared to progressive muscle relaxation (another mind/body practice for stress reduction), for high blood pressure. 9 After 8-weeks, MBSR resulted in significant reductions in both systolic (-4.8 mmHg) and diastolic blood pressure (-1.9 mmHg), greater than reductions achieved from progressive muscle relaxation.
*Similar benefits on blood pressure were measured by Parswani and colleagues when they evaluated MBSR in men with coronary heart disease. 10 In their 3-month trial, people randomized to MBSR had significant reductions in anxiety, depression, perceived stress, blood pressure (-2.8 mmHg systolic/ -1.9 mmHg diastolic), and body mass index (BMI).
Research on Immune Function:
* Fang and colleagues conducted an uncontrolled clinical trial to determine if increasing mindfulness would benefit markers of immune function. 11 After an 8-week MBSR training, measures of stress and overall distress were reduced in the MBSR group, which correlated with reduced C-reactive protein (CRP). In addition, natural killer cell activity, i.e., the immune cells that survey for cancer and viral infection, increased after MBSR training.
I recently walked into the waiting room of a massage therapist’s office, and hanging on the wall was a small poster that recommended: “Don’t wait. Meditate.” What a concept? How many minutes in a given day are we waiting to be somewhere else, or be doing something else? We wait in traffic, at stoplights, in lines at the grocery store and ATM. We wait for other people to do their jobs (always other people), for dinner, and wait for the kids to fall asleep… lots of waiting. Yet for most of us, not much meditation happens in these moments because we are already consumed by what’s ahead … as soon as the waiting stops. Many also complain they don't have enough time for themselves because our lives are consumed with other people and their problems.
Creating more mindfulness.
What if you were able to reclaim those minutes of time spent waiting for yourself? We often forget about the here and now. Each second takes a second to pass us by- whether we are agitated or relaxed. Making the choice simply requires a little training, and to set the intention.
There are numerous formal training programs, i.e., MBSR, and retreats that teach mindfulness practices, and many books on the topic. However, I’m pragmatic, so here are a few tips get you on your way to greater mindfulness (not necessarily in order of importance):
The holiday season is the perfect time to practice mindfulness! Please nourish yourselves and help those you love find nourishment also. Each moment provides a new opportunity to water a positive seed, or a negative seed, within yourself or others. It helps to be mindful.
- Slow down. A second takes a second, relaxed or anxious.
- Chew your food. It improves digestion, absorption, and satisfaction with eating!
- Find your breath. The mind controls the body, and the breath controls the mind.
- Scan your body. Observe points of tension and let them go.
- Rediscover your senses. Touch. Taste. Look. Listen. Smell. Your senses provide nourishment (as do food, learning, work, and a spiritual practice).
- Reflect before responding. 3 seconds creates the difference between mindful and emotional.
- Discover (or re-learn) your sources of nourishment. We all benefit from each other’s inner brightness.
- Practice forgiveness. We all do the best we can, and sometimes we make mistakes.
- Give thanks. For nourishment, for life, for breath.
- Create joy. Is there a higher purpose?
In health, Ryan Bradley, ND, MPH
“Every living being in the world is made from the same stuff. We each have positive seeds and negative seeds. Depending on our environment and on our own actions, thoughts, behavior, and speech, we water certain seeds more than others, and as a result we seem to be one way or another; but in reality we all have the same seeds. “ - Sister Dang Nghiem in Healing12
Ryan Bradley, ND, MPH is a naturopathic doctor, clinical researcher and epidemiologist in San Diego, CA. He is Assistant Director of Research at the National College of Natural Medicine in Portland, OR. In addition to his research, he is a practicing clinician specializing in natural and integrative approaches to treating type 2 diabetes, chronic kidney disease and heart disease at Pacific Pearl La Jolla.
- Rosenzweig S, Reibel DK, Greeson JM, et al. Mindfulness-based stress reduction is associated with improved glycemic control in type 2 diabetes mellitus: a pilot study. Alternative therapies in health and medicine 2007;13:36-8.
- Miller CK, Kristeller JL, Headings A, Nagaraja H, Miser WF. 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 2012;112:1835-42.
- Miller CK, Kristeller JL, Headings A, Nagaraja H. Comparison of a Mindful Eating Intevention to a Diabetes Self-Mangement Intevention Among Adults With Type 2 Diabetes: A Randomized Controlled Trial. Health education & behavior : the official publication of the Society for Public Health Education 2013.
- van Son J, Nyklicek I, Pop VJ, et al. The effects of a mindfulness-based intervention on emotional distress, quality of life, and HbA(1c) in outpatients with diabetes (DiaMind): a randomized controlled trial. Diabetes care 2013;36:823-30.
- Oberg EB BR, Allen J, McCrory MA. CAM: Naturopathic dietary intervention for patients with Type 2 diabetes. Complementary Therapies in Clinical Practice 2011;17:157-61.
- Dalen J, Smith BW, Shelley BM, Sloan AL, Leahigh L, Begay D. Pilot study: Mindful Eating and Living (MEAL): weight, eating behavior, and psychological outcomes associated with a mindfulness-based intervention for people with obesity. Complementary therapies in medicine 2010;18:260-4.
- Kidd LI, Graor CH, Murrock CJ. A mindful eating group intervention for obese women: a mixed methods feasibility study. Archives of psychiatric nursing 2013;27:211-8.
- Oberg EB RM, Bradley R. . Self-directed Mindfulness Training and Improvement in Blood Pressure, Migraine Frequency, and Quality of Life. . Glob Adv Health Med 2013;2:20-5.
- Hughes JW, Fresco DM, Myerscough R, M HMvD, Carlson LE, Josephson R. Randomized controlled trial of mindfulness-based stress reduction for prehypertension. Psychosomatic medicine 2013;75:721-8.
- Parswani MJ, Sharma MP, Iyengar S. Mindfulness-based stress reduction program in coronary heart disease: A randomized control trial. International journal of yoga 2013;6:111-7.
- Fang CY, Reibel DK, Longacre ML, Rosenzweig S, Campbell DE, Douglas SD. Enhanced psychosocial well-being following participation in a mindfulness-based stress reduction program is associated with increased natural killer cell activity. J Altern Complement Med 2010;16:531-8.
- Nghiem SD. Healing. Berkeley, CA: Parallax Press; 2010.