As part of launching our “No-diet Diabetes” program, I sat down this week with our fabulous dietitian Elizabeth Lagasse, RD to ask questions about why you should never focus on losing weight to manage prediabetes or diabetes. If you have been feeling frustrated by your failed attempts to drop weight to manage your diagnosis, this interview should give you renewed hope and start to remove the shame.
Liz, why is it so important NOT to diet or totally cut out sugar when managing diabetes?
Elizabeth Lagasse, RD
“Cutting carbs significantly or even completely is a bad move with diabetes management. The problem is that carbohydrates are essential nutrients and the body requires them to function at an optimal level. It is the brain’s preferred fuel! For this reason, cutting out carbohydrates typically creates an unsustainable behavior in the long run. If you deprive yourself of an essential nutrient it will ultimately lead to an out of control eating experience that we can also call a binge, or an “on the wagon off the wagon” sort of eating mentality, which then leads to a loss of control and weight cycling. Studies consistently show that weight cycling or “yo-yo dieting” is way more harmful on basically all aspects of health but definitely harmful for diabetes management.”
What are some of the other harms of focusing on weight loss primarily to manage diabetes?
“Since dieting and weight loss is not a sustainable or effective strategy in the long run, individuals end up wasting so much time and energy working towards something that is not even necessary. They then often feel like failures for not being able to follow “doctor’s orders” when in fact, focusing on weight loss is akin to focusing on the tree and not the forest. Our holistic approach at The Body Image Counseling Center is so much healthier for body and mind.
Then you may ask what is a better approach to diabetes management other than weight loss and dieting? There's a great number of A level research studies showing that diabetes is much more controlled and treatable without the focus on weight loss. If weight loss happens to occur because of change in the behaviors, fine, wonderful, but it's not the focus. You can still get the results of controlled blood sugar and therefore the lowered comorbidities that occur with diabetes with a focus solely on health behaviors.
What do I mean by not focusing on diet? For example, if a client absolutely loves bagels and the thought of giving up bagels makes them mentally distressed, then cutting them out won’t be sustainable. Our approach asks how can bagels fit in your diet to where it can still have a neutral to positive affect on your blood sugar. That can be done by spreading peanut butter on the bagel to add protein and allow your metabolism to have more time to release the sugar as opposed to going straight into the bloodstream. Or is it that we make the choice to have a smaller bagel, or to have a bagel that's chock-full of nuts and seeds? In other words, what we can do to still have the bagel but have it in a way that is going to have a more neutral to positive effect on the sugar levels.”
How do you use an intuitive eating approach with your clients with diabetes?
“We know that intuitive eating is not a diet but eating when you're hungry and stopping when you're full, right? And fullness is an indicator blood sugar levels. When your hunger signals go up, your blood sugar starts dropping - hunger signals go down as your blood sugar increases. So if you can tap into hunger signals through a mindful eating approach, you've literally come back into your own barometer for blood sugar. There is no need to control it externally through a diet.
I tend to fall back quite a bit on science, and science says number one that diets are not effective. There are honestly very few longitudinal studies on the effects of dieting on diabetes and the ones that are out there pretty much show that after two years the weight comes back. In fact there is more research that proves that weight cycling or yo-yo dieting is much more detrimental to your health and blood sugar levels than being a higher weight. This is health at every size. A quote I really love is that you can focus on health without focusing on weight!
Not focusing on weight doesn't mean you're giving up. You can still focus on health just without focusing on the weight. Something else that I think about quite a bit is that it's literally impossible to live a lifetime without ever experiencing weight change. It happens to everyone - there's no such thing as weight change never happening so why focus on the weight and make yourself miserable? It is not normal to stay exactly the same weight over a lifetime. Did you know that for women the average weight per month is 6 pounds weight gain or loss for a female in her menstruating years? Men do not remain the same weight either. This belief that it is even possible to stay the same weight over a lifetime (without having an eating disorder) needs to be a lot of debunking along with this belief that we could stay the same weight if we just work hard enough.
That's what I think that's why people don't go more regularly to doctors or traditional diabetes education classes. If you had a dangerous physical condition, and your medical providers or classes kept telling you you’re just not working hard enough or you need to lose tons of weight to have even a chance at health, would you continue to go? It is so detrimental! It is so much more effective to focus on health behavior then on shaming people about their weight and failure to diet.”
How does following a non-diet, intuitive eating program help to ease the symptoms of diabetes?
“When your blood sugar numbers improve through consistent intuitive eating, all the comorbidities that go along with diabetes, such as neuropathy, retinopathy, skin wounds, etc., all of those symptoms can decrease if blood sugar is controlled. Additionally, an intuitive eating, non-diet approach greatly improves quality-of-life factors such as energy levels, sex drive, restful sleep, and easing of anxiety and depression.
Think about it this way - humans are fundamentally designed for seeking pleasure. Our minds evolutionarily are geared towards seeking pleasure so that's part of this non-diet approach. We get to tap into your pleasure centers and work with them rather than fight them, in a losing battle I may add. And we're going to tap into that in a way that actually improves your health. An intuitive eating plan is going to improve the physical symptoms, that physical spoke of health, and we can actually have numbers to back that up. But you also have to consider the other spokes in that holistic wheel of health besides clinical factors. The other spokes are mental health, sleep quality, and longevity, for example.
It is always exciting to see what else improves in our prediabetic and diabetic clients besides their sugar numbers. I definitely notice an increase in their energy and overall mood. Think about it - if your blood sugar goes through constant highs and lows with prediabetes and diabetes, the bar of expectations gets lower and you can get used to feeling bad and accepting it as normal. So getting your blood sugar more controlled and more balanced without dieting will help you feel so much better every day.”
Liz, is it possible to be “cured” of diabetes once you receive the diagnosis?
“Unfortunately diabetes is not curable but it can be very effectively managed and you can still have a fantastic quality of life. What makes me mad is seeing all of these “experts” on Twitter and other social media who say things like “the keto diet cured my diabetes”. This is incorrect - diabetes can be effectively managed but not cured and every person is different. They may need medication as a tool to help, but intuitive eating and a non-diet approach are key to success over a lifetime. AND the best part is there is no need to make anyone feel ashamed or a failure about their weight!”
If you enjoyed this interview and would like to start a non-diet approach for diabetes management, you can work with Liz one-on-one, stop dieting forever, and stop the feelings of failure about losing weight. Here is the link to ask for a FREE 15 minute consult or set an appointment.