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Interoception, mindful eating & the pleasure of food

23 Jun 2022

lifestyle

This is part 2 of a series on mental health & diet, one of the health goals in the doctor's kitchen app. We dive into our ability to sense internal body sensations, the pleasure of food, mindful eating practices, the main take-aways from nutrition research and some barriers to healthy eating.

Listen to the full episode “#155 Pleasure, Food, Interoception and Mental Health with Dr Rupy” here or on your favourite platform.

In the first part, we looked at routes connecting diet and mental-wellbeing, protective nutrients and eating patterns, as well as foods to reduce. Listen to part 1 “#145 Eating for Mental Health with Dr Rupy” here.

A lot of findings from nutrition research have been part of previous generations and cultures. We are now understanding why they work. So there is an intuition when it comes to food, some ways to know what our body needs without having to follow the latest scientific findings.

Let’s dive into our ability to listen to our internal organs through the cues and signals they send and look at food through a more integrative lens, considering the pleasure associated with eating and sharing meals. We also asked our lovely newsletter subscribers to share their experiences looking after their mental health, the barriers they face and some practical tips to integrate this knowledge into everyday life.

Interoception – sensing what’s going on in the body

When we asked newsletter subscribers for tips to make healthy habits easier, some of you talked about being aware and listening to information and cues from the body:

Ché – “Eating intuitively and listening to your body cues”

Djela – “Something I came to realise is that all these mental health practices are related to information. And from moment to moment on a daily basis the choice as to where this information is coming from – from the outside or a bit more awareness and conscious attention paid to information coming from the inside. And obviously a conversation between the two sources of information. So this is something I’m looking for a bit more as I continue these practices.”

This sensing of what’s going on in the body is called interoception. It’s an emerging field of neuroscience and psychology.

The other side of the word is exteroception – our ability to sense the outside world including vision, touch, hearing, smell and taste.

Interoception is sensing internal body sensations – how the brain senses, interprets and integrates what happens in our organs.

Researchers observed dysfunctional interoception in many mental health conditions. Having an anxiety disorder, depression, mood disorder, or an eating disorder often comes with difficulties in sensing what is going on inside the body. (Khalsa et al. 2018)

What does it means to sense body signals?

There are two aspects to interoception:

1/ How the brain senses what happens in our organs

What happens in other organs is represented in the brain. Our heart beats, for example, but also the movements of the stomach. These signals influence neural activity, which guides feelings, cognition and emotional state. (Khalsa et al. 2018)

Neuroimaging studies found that spontaneous brain activity depends on the slow electrical rhythm generated by the stomach. Gastric signals are integrated within specific regions of the brain and can modulate brain responses associated with cognition and perception. (Richter et al. 2017)

One channel by which these signals are communicated to the brain is via the gut microbiota – this community of microbes in the gut that we talk about a lot. Alterations to the gut microbiota impact the function of major brain centres. (Bonaz et al. 2021)

We know about the role of diet in shaping the gut environment, especially the gut microbiota. A diet poor in nutrients and rich in processed foods can cause alterations and excessive inflammation. Inversely, a diet rich in protective nutrients and fibre from whole foods can promote a healthy gut environment. So could the food we eat shape gastric signals that guide neural activity, emotions and feelings?

The second part of interoception is our ability to pay attention.

2/ How the brain listens, interprets and responds to internal signals

Paying attention can be challenging – we are continuously being distracted by external stimuli. In a context that pushes us to be constantly available, grind, push harder and go increasingly faster, it can be difficult to find pockets of time to pause and pay attention to body sensations.

But why does it matter?

Studies have found that interoceptive awareness could influence our eating behaviour – what, when and how much we eat. The representation of internal body sensations, including from the digestive system, allows cognitive and emotional processes to align and adapt, which allows our behaviour to align with the activity of our internal organs. (Bonaz et al. 2021)

Most research looks at how much we eat rather than what we eat. But results suggest that people with mental health conditions have a decreased ability to sense body signals which modifies their eating behaviour. They struggled to listen to cues of hunger and satiety. (Simmons et al. 2017)

We might see these effects extend to food choices as well. It could be that a good ability to sense body signals increases healthy food choices and maybe even specific nutrient sources needed by the body.

The research is still sparse so these are hypotheses based on the available evidence. But it is interesting to see where the field of interoception crosses paths with nutrition and mental health.

Improving our awareness of body cues

Researchers suggest therapies and strategies aimed at improving awareness of mind-body connections. They are practices that we talk about a lot. For example, mindfulness-based stress reduction, yoga, meditation and movement-based treatments. They could improve awareness of body cues by attending to sensations of breathing, cognitions and other body states. (Khalsa et al. 2018)

The pleasure of food

Eating is not simply ingesting a mixture of nutrients. Otherwise, we would all be eating astronaut food. But food is not only a tool for health. It’s also an important pleasure in life, allowing us to connect to others, the present moment and nature.

This is something some of you talked about when you shared tips to make healthy habits easier:

Mercy: “Have fun cooking. Eat vibrant, colourful foods that are nutrient-dense and have fun with that. Be curious. Cook something you cook all the time in a different way, explore the endless possibilities of what one ingredient can turn into”

This idea expands on the Epicurean view of eating as a pleasurable experience derived from the aesthetic appreciation of the sensory and symbolic value of food. And it goes hand in hand with moderation, health and wellbeing.

Researchers define the experiential pleasure of food as a sustainable expansion of this philosophical approach. It is the lasting cognitive and emotional value that we get from savouring food as a multisensory, communal, and cultural experience. (Batat et al. 2019)

It involves all the steps around food:

  • Anticipation of food events
  • Creation
  • Degustation
  • Remembrance

This is something we talked about in an episode with Julia Samuel. She told us about food and sitting around a family meal as a powerful way to connect, form memories and create a sense of love, safety and security.

The pleasure we get from food can be summarised by 5 principles:

  • Sensory
  • Sharing
  • Sociocultural meaning
  • Symbolism
  • Storytelling

Appreciating the pleasure of food can be difficult in our current context where healthy food decisions are still very much characterised by the sacrifice of pleasure for the sake of long-term health. We are often encouraged to exercise restraint: to resist the siren call of tempting foods by shifting our attention away from internal body signals, such as hunger, arousal, and salivation. Instead, we are encouraged to focus on health goals and objectives, completely ignoring the sensory pleasure that food procures. This messaging around healthy foods can make us under-appreciate foods labelled healthy, going as far as feeling less full when eating them (cf. The milkshake study). It has also created a food culture that perceives food as a guilty decadence, reserved only for special occasions.

I want to help shift this strict separation between health and pleasure because I believe in food as a positive route to well-being, joy and health. And it starts with self-awareness and acceptance of the sensory pleasures of eating and nourishing our bodies, instead of focusing externally on avoiding perceived temptations.

We can use the pleasure of food as an ally to healthy eating. This is also one of the objectives of the app. The recipes are created to be full of flavours and textures, while also being rich in a variety of nutrients. We present instructions with a Mise en Place image of all the ingredients on the table to practice mindful cooking and really appreciate the process of transforming raw ingredients into delicious meals.

How we eat – mindful eating practices

Enjoying the pleasure of food can be challenging to apply to real-life situations. It’s hard to find the time to enjoy the experience of eating when you only have 30 minutes to eat, have children who require your attention or are already overwhelmed by the stresses of life.

In the past year, we have heard a lot about mindfulness and how to integrate it into our lives. There are no golden rules that work for everyone and it can be hard to stay consistent with them but the benefits are undeniable. And we can benefit from mindfulness around food as well. We can use mindfulness and creativity to make eating a pleasurable experience that improves our mental state and overall health.

Some quick and easy tips to make meals mindful and enjoyable:

  • Create an enjoyable relaxing eating environment

To help cultivate positive emotions around food and signal to the nervous system a shift to ‘rest and digest’. Try clearing the table, putting away distractions, using your favourite plate, table cloth, napkin, lighting a candle, etc.

  • Take 3 deep belly breaths before eating

To help you relax and ground yourself in the present moment to prepare your digestive system to receive and digest food.

  • Pay attention to the way you sit

Take some time to sit comfortably with your feet grounded on the floor, not slouching to let your stomach space to digest the food.

  • Appreciate what it took to bring this food to your plate

Who was involved in the growing process and production, the sun and soil it took to grow the food, and where in the world it came from.

  • Enjoy the sensations

When you’re cooking, serving, and eating your food, be attentive to colour, texture, aroma and sound. Taste the individual ingredients and seasonings.

  • Journaling

If you like journaling, you can try adding a mindful eating section to your journaling practice to increase mind-body awareness. Thinking about:

“How do I feel before, during, and after a meal?”

“Am I salivating before placing food into my mouth?”

“Can I remember the flavours and textures of the food I had”

Main take-aways from nutrition research on diet & mental health

1/ Eating plenty of fruits and vegetables every day, especially leafy green vegetables like kale and spinach, berries, carrots, and oranges high in vitamin C and carotenoids

As you’ve heard many times, we need at least 5 portions each day, just over a third of the food we eat daily, but we should really be aiming for 10 portions of vegetables and fruits per day. On a plate, 1 portion looks like 1 whole medium fruit like an apple, half a cup or two handfuls of small fruits like berries, half a cup of vegetables like broccoli, carrots, kale. That’s excluding starchy vegetables like potatoes, yam, plantain, and cassava, that count as carbs.

In practice, you can add onions, spinach and tomatoes to your morning eggs. If you have no time, cherry tomatoes, frozen onions and spinach require no chopping or preparation. You can roast a mix of veg like broccoli, onions, brussel sprouts, squash with your favourite spices to eat as a side dish. You can chop them into huge chunks and throw them in the oven. There are loads of quick and easy recipes on my website and the Doctor’s Kitchen app for inspiration.

2/ Getting enough omega-3 fatty acids

In the first part, we talked about studies on omega-3 fatty acids and the risk of depression. Although we know about its essential role for brain function, most of us don’t get enough omega-3. It is recommended that we get 2 portions of fish a week, including 1 portion of oily fish like mackerel, salmon trout, or herring. One portion is 140g. There is the issue of pollutants so no more than 2 portions a week is best to get the benefits and prevent buildup. You can also use quality omega-3 supplements if you do not eat oily fish. Plant sources include some oils including flax, walnut, soy, seeds and nuts, especially walnuts.

3/ Foods rich in magnesium, zinc and iron-rich

Magnesium is found in leafy greens like spinach, nuts, seeds, beans and whole grains. Zinc and iron are often found in similar foods, such as nuts, seeds, beans, lentils, meat and shellfish.

Some barriers to healthy eating

Let’s open up about some barriers to eating healthier and healthy habits in general, especially when struggling with mental health..There are more depending on who you are, your background, and where you live. But this is to start the conversation and allow us to face and embrace what can get in the way of our good intentions.

  • Lack of time

Many of you mentioned a lack of time due to the pressure of work, social or family life.

  • Discipline

Ginny: “The temptation to think that one time won’t hurt which can make you slip into bad habits and not follow your good intentions”

There is a balance to find between discipline and flexibility to allow life to happen, with kindness and self-compassion. Judgment and self-criticism won’t help you stick to those habits in the long term. So when it comes to discipline and committing to supportive practices, self-awareness and self-understanding matter. Being intentional about times when we don’t stick to some of our habits to do something else and observing how we feel. It can even help us reaffirm why we started practising meditation or morning stretching or daily walks in the first place.

  • Feeling overwhelmed and taking too much on

Rachael: “Anxiety, times when you think you don’t have the time, there’s too much else to do, you feel overwhelmed. Everything speeds up and you don’t take the time to press pause and step back even if these are the times when you need it most.”

  • Our current food environment– what’s available to us, what’s easier to get our hands on and also what is added to the food we buy

With the lack of time we talked about and often feeling at full brain capacity, we want to reach for the easiest food to eat. In supermarkets, these are processed snacks and ready-meals that are boosted with unnecessary sugar, salt and fats so we never feel satisfied and always want more. This is a billion-dollar industry where food multinationals fund labs worldwide to find the best way to make food sound, smell and taste good at the lowest cost and by stripping all the nutrients food is usually made of. The good thing is that we are more and more aware of this and it is slowly changing. But it also makes healthy food choices difficult.

Patience & compassion

As expressed by some of you:

Nsjma: “Do what you can and be glad that you’re doing something.”

Rachael: “Be compassionate with yourself. Try and meet yourself where you are and give yourself a break when you need them.”

The solution is not to shame or blame ourselves and others for what we eat. Rather, we are here to support each other and better understand what works for each of us on our unique path.

If you feel like you have integrated these tips into your daily life, you could start thinking about how to share what you’re learning with someone in your circle. Suggesting protective foods to add, easy food swaps, sharing information and being there to listen, with empathy, patience and understanding. Starting with yourself, what you’ve learned and experienced and why you want to share that with them.

So what can make healthy habits easier and more enjoyable?

Tips to make healthy habits easier & more enjoyable

  • Increasing convenience

Having frozen greens, pre-cooked beans and grains ready to go when you need a quick meal.

  • Starting small

In the first part, we talked about a study where just 100g extra of fruits and vegetables significantly reduced the risk of depression.

A good quote for the following by Thich Nhat Hanh:

“The seeds that are watered frequently are those that will grow strong.”

Little additions can make a big difference in the diversity of nutrients you’re getting in a day or a week. This can look like choosing a mix of different beans for your chilli, adding spinach to your stew or adding mixed berries to your porridge. It can also look like choosing whole foods where possible and checking labels for unnecessary ingredients. You don’t have to change your whole diet overnight or cancel your favourite meals. Rather, it means looking for simple tweaks or additions that have a big impact on your gut and mind.

  • Consistency

Rachael: “Finding pockets of time where you can be consistent with the things that help you”

  • Flexibility and finding alternatives rather than restricting what we can eat

Sonia: “Flexibility in our diet. Not being restrictive and diabolising food groups to avoid developing an unhealthy relationship with food. Finding healthy alternatives to respond to cravings: sweet or salty? smooth or crunchy?”

We talked about the nocebo effect before. Demonising or fearing certain foods can also have a negative impact. Our mindset toward food is essential. It’s important to cultivate the pleasure of eating foods that nourish us and make us feel good and see all this knowledge and research as fascinating steps to understanding ourselves. Rather than rules, obligations and restrictions. We are on a global investigation to figure out what helps us feel better and think clearer. And that can be fun and interesting.

  • Finally, remember that this is a process, not only on an individual level but as a society

We are slowly deconstructing years of false science claims about nutrition. This means eating healthier can be hard in our current context where the options presented to us are often what we need to reduce or avoid. So, we need patience and trust in the process.

Food is one piece of the puzzle when it comes to mental health. It is how we nourish the garden that is our mind but other forms of care are needed to help us flourish.

What does mental health care look like to you?

Share under my latest Twitter post what you do to nourish your mind every day. This community is about sharing knowledge and helping all of us find what works for us, as unique individuals.

References

INTEROCEPTION

Review article on the role of interoception in Mental health

Khalsa et al. 2018: Biological Psychiatry; Interoception and Mental Health: A Roadmap

Interoception, hunger, satiety, obesity

Simmons et al. 2017: Current opinion in psychology - Interoceptive Contributions to Healthy Eating and Obesity

Review article

Bonaz et al. 2021: Trends in Neuroscience - Diseases, Disorders, and Comorbidities of Interoception

Neuroimaging study

Richter et al. 2017: NeuroImage - Phase-amplitude coupling at the organism level: The amplitude of spontaneous alpha rhythm fluctuations varies with the phase of the infra-slow gastric basal rhythm

THE PLEASURE OF EATING

Batat et al. 2019: Journal of Business Research – The experiential pleasure of food: A savoring journey to food well-being.

Kringelbach et al. 2015: Flavour - The pleasure of food: underlying brain mechanisms of eating and other pleasures

DAILY REQUIREMENTS

Omega-3

https://www.heartuk.org.uk/low-cholesterol-foods/omega-3-fats

Zinc, iron, magnesium

https://www.nhs.uk/conditions/vitamins-and-minerals/others/

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