Everyone is born with it. Babies and children know exactly how to use it. But something changes over time, over months and years, as our vast and varied experiences with eating and food accumulate. It gets unknowingly numbed, sometimes obliterated, taken away inadvertently by others, then finally thrown away by our own means. Eventually, most of us forget it’s even there, let alone how to use it to our advantage.

I’m talking about IA. Interoceptive Awareness.

Think about almost any child you know. A 4 year old will get half way through a plate of spaghetti and suddenly stop. “I can’t eat anymore”, or “I’m full” the child will insist. The informed parent will be wise and listen. But the typical parent will often visually look at the amount of food the child ate and feels it is just too little, it can’t be enough. So instead of allowing the child to follow is natural body signals, they insist the plate be finished, or the child take “just one more bite”. And so it begins.

That 4 year old body knows just how much he needs to eat. But he will lose this natural ability if his parent keeps this up.

Well, it’s that time again….New Year’s resolution time. People pledging to lose weight is probably up there as one of the most common pledges. I am not here to promote losing weight as a good goal for everyone, but I do know that lots of people gain weight over the years because they have lost touch with their IA. That means the weight they gained is not normal for them, it was a gradual accident. So let’s talk about IA, what it is, how you lost it and how you can get it back.

Interoceptive Awareness in simple terms is the way your body communicates with your brain about what is going on which helps you understand and decide what your body needs. A simple example is being thirsty. We have all experienced that feeling. You are outside working in the heat, or walking on a hot day. Your mouth feels dry, you feel uncomfortable and somehow you know you need water. That is your body using IA to tell you to drink. It involves a complicated process with your mouth, brain, blood volume etc. integrating signals and monitoring your physiology to make sure you do the right thing to stay alive: drink more water.

The same type of process happens with food and eating. Back in the day when I first became a dietitian in the 70’s scientists really didn’t understand how we knew how much or what to eat. They knew it was complicated (certainly genetics were a factor, as well as culture and environment) but they were just scratching the surface of it all. Leptin was discovered which was a big breakthrough. This messenger was found to actually monitor our fat cells for changes then sending signals to the brain to eat more or less depending on how much fat was there. If you ate too much, leptin would send the signal to eat less. The discovery of leptin was just the start. For those of you who are interested in a more detailed explanation, check out this article:https://www.scientificamerican.com/article/decoding-your-hunger-during-the-holidays/

We now know there is a specific messenger for fat intake, and for carbohydrates (every wonder why you sometimes crave sweets? Chances are you didn’t have enough carbs at your last meal). Yes, your body wants (and needs) balance. Please note that some people have to be on special diets due to medical conditions. Ketogenic diets are sometimes used for patients with seizures. Paying attention to carbs is important for diabetics. There are definitely medical conditions and genetic abnormalities that contribute to an individual who is not able to follow natural body signals. Babies born with Prader Willi Syndrome fail to thrive at birth however then tend to overeat with no shut off later in life and may gain an unhealthy amount of weight if not monitored. These are the exceptions. For most of us, our body signals and IA work fine. We just don’t listen.

Besides having well-meaning parents interfere with our natural ability to listen to our hunger and fullness, when we consciously try to manipulate our eating, especially in extreme ways, over time we really can do damage. I have had many patients in the past say “I am always hungry” or “I am never hungry”. Often, they have slowed their digestive processes and their metabolisms down by skipping meals or restricting, and they lose that feeling of hunger. They have to follow meal plans to get their digestive system and metabolism working again. Even if you have not gone to this extreme, but instead have simply tried to diet by eating less, your mindset gets engrained in a way that gets stuck. Many people simply don’t trust their hunger because the diet mindset tends to be “all or nothing”. Either you are walking around hungry because you are dieting or you are overeating and feeling uncomfortable, throwing caution to the wind because you are off your diet. This on a diet/off a diet lifestyle certainly keeps you disconnected from your natural IA.

So is counting calories, measuring foods or cognitively restricting your food intake the answer? As I have said many times, people do have the goal of losing weight and often do lose weight dieting, however they usually gain it back because they have not even begun to try to work on getting in touch with what their body is telling them. How do you start? Where do you start? One meal at a time. One snack at a time. Here are some tips to get you started.

1. Identify Habits: before you can get in tough with your body signals regarding hunger and fullness you have to work on eliminating the triggers that cause you to eat when you really are not hungry.
   • Do you eat while distracted, such as at the computer, in front of the TV or while talking on the phone?
   • Do you graze all day instead of actually sitting down to a meal?
   • Do you keep food in your car, at your desk, in your bedroom?
2. Designate a place to eat without distraction both at home and at work.
   • To help tune in to your gut messages it is helpful to avoid distraction and pay attention to what you are eating
   • Sit in a chair at a table or counter. Do not stand and eat.
   • Turn off the TV, leave your phone somewhere else, don’t read. Just eat.
3. Designate meal and snack times if possible.
   • Snacking all day instead of eating a real meal can confuse your body. If you are a snacker plan on a breakfast time, ONE morning snack, a lunch time, ONE afternoon snack, a dinner time and ONE night snack
   • If you are a meal skipper and tend to wait until dinner time and after to graze all night INSTEAD plan 3 meals a day and ONE pm snack. Plan a breakfast time, a lunch time and a dinner time. You may not feel hunger since you have been tuning out your signals for too long but they will come back over time. Start small.
   • Be flexible. Eating at the exact same time every day is not the goal. It is the pattern we want to change. Eating within an hour time frame (for example, breakfast between 7 and 8, or lunch between noon and 1 pm) is a good goal. If this is hard for you even within a 2 hour time frame is a start in the right direction.
4. Take time to think about what you want to eat. Sometimes your IA will plant a specific food or foods in your brain and that often means your body needs something. If you have been dieting and have been feeling deprived this may be difficult, but don’t give up. Take the risk, even for one meal a day. Some people feel too guilty letting themselves eat something they consider unhealthy. The goal is not to turn you into a junk food eater. The reality is that once you are in tune with your body, you will realize that you actually rarely crave junk foods as often as you think you will. I recommend if nothing is calling to you strongly, if you really are not craving anything, then try to choose a healthy meal that you really enjoy. Please note that if you are suffering from disordered eating, or have been diagnosed with an eating disorder please consult with your therapist and dietitian before making any changes to your eating. If you feel overwhelmed just thinking about any of this, I suggest even one consultation/evaluation with and therapist who specializes in eating issues.
5. Tune in to your hunger/fullness level. Consider keeping a diary with a record of hunger level before eating and fullness level after eating. A scale of 1-10 is often used with 1 being “starving” and 10 being “stuffed”. A “3” might indicate normal hunger whereas a 4 is just a little hungry and you could wait to eat. After eating, a “7” would be a comfortable normal fullness whereas an “8” would mean eating a bit too much, a 9 definitely getting to uncomfortable. Keeping this record often helps recognize patterns and makes it easier to not eat when not hungry, and to be sure to eat when you are. Remember, this is a very subjective tool and I have known many people who can’t relate to it at all so if this is you, no worries! Just take the time to think about it. Stop and think about how hungry you are before you start eating, and reflect on how full you are after you eat a meal. Eventually you will identify how disconnected, if at all you are to your IA, to your awareness of hunger and fullness. (Note: we are all different with respect to a messenger (PYY) that tells our brain we are full. For some people PYY works really quickly and after eating a certain amount the messenger tells their brain to stop eating. These are the people you may know who just naturally do not over eat. For most people it takes 20 minutes for this messenger to work. For others it is longer. These are the folks who can seem to eat a lot at times but then feel uncomfortable a half hour later, complaining that they ate too much. For this type of person it might be helpful to set a timer for 20 minutes and after a plate of food wait for the 20 minutes before taking seconds. Chances are the fullness will kick in by then and that feeling of being overstuffed can be avoided). Oh, we also know that regular physical activity may help you be more in tune with fullness AND hunger.
6. Appreciate the complexity of appetite. It is not that simple. The complicated neurochemical picture is hard to comprehend. There is so much to know. Did you every hear about NPY, the messenger that tells you to eat and won’t go away unless you eat enough protein? That is why after what you think is a healthy lunch of salad and fruit leaves you wanting more. Have you heard of ghrelin? This messenger also stimulates appetite and is elevated if you don’t get enough sleep! That is why you can’t seem to satisfy your appetite on those days after a late night out. Can you imagine how hard it is for someone with undiagnosed sleep apnea to maintain their normal weight? If you don’t sleep well, talk to your doctor. Finally, our emotions and personal histories make things even more complicated. We now know that pathways overlap in our brain that regulate both food intake and emotions. So if you ever used food to soothe yourself expecting to be able to suddenly be able to “listen to your body” is not realistic. Again, if you believe you are an “emotional eater” it might be wise to seek help.
7. Educate yourself. Intuitive Eating is no longer a new concept and Mindful Eating is something that many people are working on. It is a much better goal than “losing weight”. Moving toward feeling better, feeling and being healthier is a good thing. Check out the website for more info. https://www.intuitiveeating.org/

Happy New Year! Here’s to NOT trying to be perfect, but moving a little bit each day to a more aware, healthier and happier YOU!!!