If you live with diabetes or support someone who does, chances are you’ve come across advice that feels more punishing than helpful. Things like “cut carbs,” “lose weight,” “no sugar ever,” or “just eat less.” These messages get repeated so often that they start to sound like truth. But in my experience as a dietitian, this type of guidance rooted in diet culture doesn’t help. In fact, it often makes things worse. That’s exactly why we were so excited to sit down with Janice Dada, a weight-inclusive dietitian, intuitive eating counselor, and diabetes care specialist, for a recent episode of the Diabetes Digital Podcast. You can listen to the full episode here.
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The Impact of Diet Culture on Diabetes Management
Understand the harm of “just cut carbs” advice
One of the biggest diet culture myths people hear after a diabetes diagnosis is that carbs are the problem. But as Janice explained, it’s not that simple. “Carbohydrates are a big contributor to our energy,” she shared. “And there are a lot of micronutrients that come along with a lot of our carbohydrate foods, namely B vitamins and iron.”
Instead of cutting carbs, Janice encourages an additive approach: building meals that include protein, fat, and fiber to help with blood sugar stability. She also encourages clients to learn how their individual body responds to different foods. That self-awareness is part of intuitive eating too.
Research supports this individualized approach. A landmark 2015 study published in Cell found that people can have vastly different blood sugar responses to the same carbohydrate-rich foods. This shows why blanket carb-cutting advice can be misguided, and why tuning into your body’s unique patterns is a more supportive way to manage diabetes.
Recognize the harm that comes with restriction
Disordered eating is often hiding in plain sight in diabetes care. Janice explained how restriction is sometimes praised in clinical settings even when it leads to harm. “I’ve had several clients who’ve restricted their intake so intensely that they now have a clinical eating disorder. And yet when they see their providers, they’re often praised for things like weight loss or their blood sugar numbers, but they’re not being asked what they’re doing to accomplish this.”
This disconnect, also rooted in diet culture, is dangerous and reinforces the idea that health only looks like certain numbers, even if the behaviors getting someone there are harmful.
Make space for cultural foods
So many of our clients tell us they’ve been told to cut out rice, tortillas, plantains, or fruits like mangoes. This kind of guidance erases culture and often backfires.
“Rice is a targeted food. And it’s a food that so many cultures around the world use in various forms,” Janice said. “When somebody then goes to a family gathering or they go to a restaurant, they want to order rice… and then it’s what the research calls the ‘what the hell effect,’ where they eat all of it now because they feel like they won’t be able to have it again.”
Instead of banning foods, Janice recommends finding ways to enjoy them with supportive pairings or timing strategies. Cultural foods can and should be part of diabetes care.
Research backs this up. A 2023 study focused on Black Americans with type 2 diabetes found that both diabetes-related and weight stigma were linked to disruptions in intuitive eating, especially eating based on physical hunger. But here’s what’s powerful: family relationship satisfaction helped buffer those negative effects. This suggests that culturally rooted support networks—and non-restrictive approaches like intuitive eating—can play a critical role in protecting self-care and emotional well-being in diabetes management.
Know that intuitive eating can be helpful for those with Type 1 Diabetes or on insulin too
We hear this question a lot: Is intuitive eating possible for someone who uses insulin? According to Janice, it absolutely is. “The intuitive question here is, well, I may not know initially how much I’m going to consume. So how do I give insulin for it?” she explained. “Depending on how someone uses insulin, it can be given in phases, or halfway through a meal, or adjusted depending on the combination of food.” With support from a provider, people can learn to use insulin in ways that honor flexibility rather than rigid control. This might involve dosing based on past experiences, checking in mid-meal to adjust for hunger cues, or using general carb estimates instead of exact numbers—allowing more space for satisfaction and ease. It may take time to build confidence, but it’s absolutely possible.
Recent research supports this. A 2023 study examining adolescents with type 1 diabetes found that those with higher intuitive eating scores—especially those who ate based on physical rather than emotional hunger—had significantly better glycemic control, with lower HbA1c levels. The study also found that teens with diabetes had lower intuitive eating scores compared to their peers, suggesting a need for more emotion-aware, flexible nutrition support. These findings highlight intuitive eating not only as a viable approach for those using insulin, but as a promising part of broader diabetes care that supports both physical and emotional well-being.
Stop blaming individuals for diabetes
Too often, people with diabetes are made to feel like they’ve brought the condition on themselves. This narrow, diet culture-influenced view ignores the real, complex web of contributing factors, many of which are shaped by larger social systems. As Janice put it, “There are several factors that are more a result of society-wide issues than some sort of personal failing.” Things like chronic stress, systemic inequities, medications, genetics, sleep disruptions, and cycles of weight loss and regain all matter.
A synthesis of 57 international studies with Black and ethnic minority adults living with type 2 diabetes reinforces this perspective. Participants emphasized how identity, cultural understanding, and meaning-making shaped their ability to manage diabetes. Their stories challenge the idea that behavior alone determines health and make it clear that respectful, person-centered care must reflect people’s lived realities.
Shift from fear to curiosity
Janice encourages curiosity over fear when trying new things or reevaluating old habits. “I always just encourage curiosity around these new practices,” she said. “If someone says, ‘I feel better without carbs,’ I ask, what else might be changing? How’s your energy? Are you getting enough micronutrients? What happens at your next family meal or social event?”
Intuitive eating is not about doing it perfectly. It is about building awareness and flexibility that allows people to live a full life while also supporting their health. This might look like experimenting with different meal times to see when you feel most energized, noticing how your body responds to certain foods without judgment, or pausing to ask yourself what you’re truly hungry for, both physically and emotionally. Curiosity creates room for learning rather than punishment.
Science supports this mind-body connection. A recent study that mapped 100 core human feelings found that all feelings, whether emotional, cognitive, or physical, are deeply interconnected and embodied. The researchers identified five major feeling clusters: positive emotions, negative emotions, cognitive processes, somatic states, and homeostatic states. What we feel in our minds is reflected in our bodies, and the reverse is also true. This reinforces the value of tuning in with compassion. When we approach our choices with curiosity instead of criticism, we can better understand what our bodies are telling us and respond in ways that support both emotional and physical well-being.
Consider gentle nutrition, not food rules
Diet culture is about restriction. Gentle nutrition is about making food choices that honor both your health and your taste preferences without judgment. This principle gets lost in a lot of diabetes education that pushes strict food rules.
“We can think about, what do I add if I’m going to have a cookie? Do I add a glass of whole milk or something to it? Because now I have fat and protein coming along with the cookie. That could help the blood sugar response.”
This way of thinking allows room for flexibility, satisfaction, and blood sugar support all at once. Gentle nutrition could also look like choosing fiber-rich versions of your favorite foods when it feels good not because you have to, but because you’ve noticed they keep you fuller longer. It might mean making sure you’re getting enough iron or vitamin D because you’ve seen a dip in labs, or adding veggies to a dish not to dilute it, but to complement it. The goal isn’t perfect eating, it’s caring for your body without turning food into a set of rigid rules. When you approach nutrition through the lens of support instead of control, you’re much more likely to build habits that actually last.
Don’t underestimate small changes
Janice talked about “exercise snacks,” short bursts of movement like 10-minute walks that can improve blood sugar regulation without requiring intense or time-consuming exercise plans. “It could be before or after a meal, or just interrupting periods of sitting,” she said. “That can actually make a big difference on blood sugar responses.” These small, approachable tools often feel more doable and sustainable than the all-or-nothing approaches promoted by diet culture. A short walk around the block after dinner, stretching between work calls, dancing to a favorite song, or using a walking pad while catching up on a show can all support blood sugar without the pressure of “earning” your food or chasing weight loss goals.
Research supports this approach. One study compared traditional 30-minute moderate-intensity exercise with brief, high-intensity “exercise snacks” performed before meals. The results showed that these short bouts of movement, such as six one-minute intervals before each meal, were more effective at lowering post-meal blood glucose levels and reducing overall 24-hour glucose levels in people with insulin resistance. A variation that alternated between walking and resistance-based exercises offered similar benefits, showing that short, flexible options can make a meaningful difference in blood sugar management.
Transcript
Diabetes Digital Podcast by Food Heaven
0:00
Welcome back to another episode of the Diabetes Digital Podcast.
We are so excited to have one of our colleagues on Janice Data, who is a weight inclusive Rd. registered dietitian with the private practice in Newport Beach, CA.
She’s an intuitive eating counselor, certified diabetes care and education specialist and certified eating disorder specialist.
0:22
She’s passionate about simplifying and destigmatizing the nutrition and weight based discourse around diabetes.
And she actually has a new book that came out, intuitive eating for diabetes, the no shame, no blame non diet approach to managing your blood sugar.
And The funny thing is that in our Slack channel for our team of dietitians, there was one of the dietitians who was like, does anyone know of a book that covers intuitive eating for diabetes?
0:48
And it was funny because I was like, oh, actually we just found out about this book that came out that we actually endorsed, and we’re going to be interviewing the authors.
So our team is super excited about this interview.
This is a conversation that we have all of the time about like how to incorporate intuitive eating for a chronic condition like diabetes and especially for type one.
1:10
That’s a conversation that comes up a lot on our team.
A lot of people find that it’s more challenging to incorporate these principles if you have a condition that includes like insulin, for example.
And so really excited to talk about all of the nuance when it comes to intuitive eating.
1:28
In this episode, we’re going to talk about how diet culture shows up in diabetes care and how it can make things worse.
And Janice has a ton of expertise in this area.
She’s going to talk about how food fear, rigid nutrition advice, and weight focused care can lead to disordered eating and make blood sugar management actually harder and not easier.
1:50
We’re also going to talk about ways to recognize how diet culture can show up in care and why shifting away from a shame based approach is really important, and how it’s possible to support your blood sugar while still honoring your relationship with food and your body.
So whether you live with diabetes or support folks who do, we hope that this conversation offers validation, clarity, and a more compassionate approach to diabetes.
2:15
Welcome to the Diabetes Digital Podcast.
I’m Wendy.
And I’m Jess, and we’re best friends, registered dietitians and diabetes educators.
Through our telehealth platform, Diabetes digital.co, we offer accessible and personalized virtual nutrition counseling for people with diabetes and pre.
2:31
Diabetes.
Visit diabetesdigital.co.co to book your first appointment.
We accept insurance and offer affordable self pay options.
Now let’s get into today’s episode.
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2:48
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4:37
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Now on to the episode.
Welcome to the podcast, Janice.
Thank you so much for having me excited to be here.
Yay.
So I just want to start off by learning a little bit more about your background, right?
4:54
So you’ve you focus on this intersection of diabetes and intuitive eating, your certified intuitive eating counselor.
How did you get into this specific like focus of your work?
Did you always have a focus on intuitive eating?
5:11
I mean, certainly the focus on this work came from just my experience with clients and things that they were sharing with me, my observations from, you know, what I would see clinicians that they’d see medical providers and so on sharing with them.
It got a lot of experience working with people with diabetes at the very beginning of my career because I did my Dietetic internship through the VA and then worked there for a couple years.
5:35
And there there was a large population of people who had diabetes.
And so I got a great, you know, great overview of different types of individuals, different kinds of medications that they would use.
And it was certainly a very weight centric, very diet focused approach.
5:52
You know, there was small amount of time for for people to be seen.
We’d have classes that were three hours long and we’d sort of like jam pack all of this complex information in.
And I could see that, you know, in many ways a lot of these approaches weren’t really working very well.
6:09
I, I could see people sort of shutting down during this long 3 hour class.
I could see, you know, my colleagues handing out Flyers that said just eat like this.
And it just, it didn’t really didn’t really match what I could see people probably needed with this condition.
I was already interested in diabetes because I, my grandfather had diabetes and my mom had gestational diabetes with me when she was pregnant.
6:32
And so, you know, I didn’t know much about it, of course, when I was younger and my grandfather had the condition.
But sort of in looking back and sort of seeing the messages that were communicated about it, it was it was always of interesting topic to me.
6:51
And then when I went into private practice, it became a certified diabetes educator, which is what it was called at the time.
And also started doing more training and intuitive eating and would definitely see individuals feel this kind of pull as to can I still practice intuitive eating principles if I have this condition, whether it was diabetes or another condition?
7:13
And so, you know, that’s really got me interested in the topic.
And I could see that there were no other resources really putting the two together.
And so that was really the motivation for writing the book because I wanted to extend beyond, you know, my client work to the greater community to be able to share, you know, how do you use intuitive eating principles with a condition like diabetes, which is so prevalent and the numbers are expected to grow, and yet we still sort of, you know, kind of give the same message or in general, the population is giving the same message about how to manage it.
7:48
Yeah.
What are some of the ways that you see disordered eating or diet culture show up for people that have diabetes?
Yeah, unfortunately, I think diet culture is so entrenched in diabetes, traditional diabetes care and the messages that people often receive are boiled down to things like eat less, lose weight, move more, cut carbs, really generic statements that don’t have a lot of instruction as to how do you actually do those things and still, you know, maintain your quality of life and also meet your nutrition needs.
8:22
Right.
So I, I also often see a very personal responsibility narrative that comes along with a diabetes diagnosis, which really ignores all of the root causes of diabetes, you know, which includes several factors that are really more of a result of society wide issues rather than some sort of personal failing.
8:42
And I, I talk about these in the book as the, you know, root causes of diabetes.
So, you know, I describe social determinants of health, sleep patterns, certain medications that people may have taken in the past or be currently taking, exposure to things like endocrine disrupting chemicals, genetic factors, nutrient deficiencies, and then also weight cycling.
9:07
Weight cycling is this loss and regain of weight that people often have if they’ve restricted their food or they’ve dieted for some time.
So I think those are really important for people to understand because otherwise they feel like, wow, what have I done wrong?
Why do I have this condition?
9:23
And that’s often the message that they’re receiving.
So they they take that with them.
Yeah, totally.
And I’m also wondering about some of the patterns that you see because I’m sure there are people listening or even people who have family members with diabetes where they may think that they’re doing the quote right thing.
9:41
But us as clinicians, you know, we might have a little bit more insight into what might actually be a little bit more of a disordered eating pattern.
So what are some of these patterns you see in clients with diabetes?
And also, how might some of these patterns go unrecognized, especially by other more traditional healthcare providers?
10:01
Yeah.
I mean, I’ve had several clients who’ve restricted their intake so intensely that really they have now a clinical eating disorder.
And yet when they see their providers, they’re often praised for things like weight loss or their blood sugar numbers, but they’re not being asked what they’re doing to accomplish this.
10:20
And so, you know, somebody may be restricting their food intensely in order to accomplish what the providers I’m praising them for, which is really just praising eating disorder behaviors.
And so this praise that they receive and the accolades they receive, it allows them to continue practicing their disordered habits.
10:39
And then they get stuck feeling like this is the only way.
And so, you know, I think it’s important to be able to share with people like there is another way.
You don’t have to, you know, have an eating disorder in order to manage diabetes.
That that’s not a practical approach, of course, right.
And then on the flip side, I’ve also had clients who’ve approached diabetes management with a very all or nothing mindset.
11:00
And so while they where they’ve seen the recommendations as impossible, so they have kind of given up on their diabetes care.
They may not take their meds or they may not check their blood sugar because it’s sort of seen as like, what’s the point?
I can’t do it?
So I think it’s a really dangerous message.
11:18
And so helping people to find this Gray area in the middle where we can sort of do both, right?
Yeah, we see this a lot too with cultural food.
And I’m trying to remember, Jess, do you remember who it was that like we literally had someone call our customer support line a few weeks ago and they were like, you guys are not giving good advice to people with diabetes.
11:44
Like it was like a angry caller.
That was a first.
I’m trying to remember what it was like.
I think it was maybe something about like us recommending rice or something like that.
I don’t remember.
It was definitely, I think, something to do with rice.
Yeah, I feel like rice is just such a hot topic.
12:02
People feel so passionate about cutting out rice and yeah, in like the diabetes space, but we see that a lot, whether it’s rice or potatoes or tortillas or root vegetables, plantains, that’s something I see a lot in my culture where people are like, Oh yeah, I definitely can’t eat plantains.
12:24
I have to cut that out.
Or literally my mom just got diagnosed with pre diabetes and she was like, since diagnosis I haven’t had any mangoes like she’s and like we have a mango tree in the backyard.
So it’s kind of hard.
So how do you see that play out with people’s cultural foods and like the messaging that they’re getting around that?
12:42
Because that’s really hard.
Yeah, definitely.
Yeah, I I hear all of that as well.
And definitely, rice is a targeted food.
And, you know, it’s a food that so many cultures around the world use in various forms.
12:57
And it’s not usually brown rice, although I think that’s the message people get when they go to their providers, right?
Well, now you can no longer eat white rice or, you know, whatever version of rice your culture consumes.
And now I want you to eat brown rice when, you know, really we’re looking at like an extra what, 3 grams of fiber that may be contributing some small effect to the blood sugar, but we can actually add in other things to the rice which will help blood sugar stabilize.
13:26
And so, you know, it’s a very narrow minded approach when we’re thinking like, oh, you have to pull that out.
And the, the thing that I think backfires is when somebody then goes to say a family gathering or they go to a restaurant and they want to order rice or whatever other carbohydrate based food they want to consume.
13:45
And then it’s what’s actually called in the research, the what the hell effect, right?
Where they’re just sort of like, well, I’ll just eat all of it now because I’m not going to be able to eat it later.
It’s going to be taken away again.
And that is actually worse for blood sugar than just having it regularly and being able to listen to our body cues about how much and when to consume that food.
14:06
It’s definitely can be included.
I don’t see any reason to exclude any cultural food, whether it’s rice or beans or tortillas or hala, right?
That they all can be part of it.
Yeah.
I’m curious how do you think about carbs because so many people come in and you know the messaging is very much diabetes equals no carbs, pre diabetes cut out all the carbs.
14:30
How do you teach your clients about carbs and how to incorporate them if they do have struggles with blood glucose regulation?
Yeah.
So I, I use an additive approach like I was mentioning where, you know, we’ll include carbs as part of the whole plate, right?
14:48
And so we’ll, you know, want to include, of course, a protein source and a fat source and something that has fiber.
And so those 3 additions help manage the blood sugar a lot better.
And so I think that it’s helpful for people to understand how to build a balanced plate that will help them with their blood sugar management.
15:10
And in addition, you know, people have their own personal responses to different kinds of carbohydrates.
I have some people tell me like, well, this particular food, I see a bigger blood sugar rise than this other type of carbohydrate food.
And so I think that’s also very useful for people to just kind of get to know their own body’s responses, which also is kind of part of the intuitive process so that they can maybe know how much do I need to add to this or how much do I handle of this food.
15:38
And then in addition, there’s other ways that we can help blood sugar after a meal.
In the book, I talk about the concept of exercise snacks, which are sort of these ways of just incorporating small bits of physical movement that use the large muscle groups throughout the day.
15:54
So that could be before or after a meal, or it could be just interrupting periods of and, and it’s really something casual, like it could be going for a 10 minute gentle walk, which also could be kind of a nice break during the midst of a work day, right?
That can actually make a big difference on blood sugar responses.
16:13
So I think we have to kind of look at how does this particular individual respond to different kinds of foods?
And then what could we add in that might feel supportive?
And then something else that doesn’t get talked about that much is the idea of how carbohydrates change when they’re refrigerated.
16:29
And so this Lana starch retrogradation and that also probably somebody would have to figure out for themselves, how much does this make a difference for me.
But for example, refrigerated rice that then is reheated or potatoes that have been cooked and then cooled and then reheated, that changes how much we actually absorb of the carbohydrate.
16:49
So that could potentially affect the blood sugar response too.
Yeah, we just, I just did a Instagram post about that.
So for people, something to try, there’s so many tools, right?
OK, so I have some scenarios and I’m just coming up with these as you’re talking that I can just hear patients saying, so one of them is what if somebody is they have diabetes and they just decide that like, oh, I feel better with no carbs.
17:17
Like I tend to just focus on like my protein and my vegetables and that makes it easier for me to kind of track if someone’s on insulin, it’s kind of helps with maybe in their mind with their insulin.
Like what do you say to that?
I always just encourage curiosity around these new practices, you know, So I would be curious as to what else might be changing.
17:40
How is your energy level?
Since carbohydrates are a big contributor to our energy, There’s also, of course, a lot of micronutrients that come along with a lot of our carbohydrate foods, like namely a lot of the B vitamins and iron.
So I’d be curious like, where are we going to get those if we’re cutting things out?
17:58
And does it feel like a very all or nothing approach?
Is this an individual who has kind of all or nothing tendencies in general?
And you know, I’d also be curious about, well, what are, what do you think about when you go to the next family gathering or party or restaurant is are you still going to feel good eating that way?
18:18
And so hopefully, if this is somebody who’s continuing to follow with their dietitian that they can kind of continue to have those curiosities.
Because a lot of times that feels a lot of a lot like how we might feel at the beginning of a diet or how people describe feeling at the beginning of the diet, right?
18:34
They’re excited, they’re all in, there’s something kind of that feels good about it.
And then at some point it doesn’t feel good anymore.
And that’s when it can lead to that opposite action where now we’re eating a lot more of that food that was restricted.
18:50
Yeah.
OK, So what about sugar?
Like foods with sugar?
Because people with diabetes will report that everyone is almost like hyper vigilant for them in a way that sometimes doesn’t feel helpful.
And I think that can become internalized as well, right?
19:06
So there are foods that contain natural sugars but still have sugars.
I’m thinking like dried fruit.
I have like a bowl of dried fruit on the counter right now.
Or even things like dessert, cookies, pastries, people will come in and say, hey, I can’t have these foods.
What are your tips for people to be able to incorporate those foods while still being mindful of blood glucose?
19:26
Yeah.
I mean, I think eating all of those foods is part of our normal like everyday eating, right.
We’re unless we actually don’t like Swedes or don’t like desserts, and I don’t know very many people that don’t like to have some sort of dessert, it’s probably not very practical for us to think we’re never going to have those again.
19:46
And so, and I’ve referred to that a little bit as in the book as like the diabetes police, especially when it’s coming as sort of this like from other people like, Oh no, you know, you can’t have cookies because of your diabetes or even our own internalized diabetes police.
20:02
And so I think certainly as part of a meal can be helpful.
So, you know, having dessert like along with the food that has the protein and the fiber and the fat can help to slow down the blood sugar.
Some people will use that as part of their carbohydrate portion of their meal.
20:18
Could also, you know, think about what do I add if I’m going to have like a cookie or something, do I add a glass of whole milk or something to it?
Because now I have fat and protein coming along with the cookie that could help the the blood sugar response.
So definitely the additive approach is kind of how I would approach the sweets and sugars as well.
20:38
And when it comes to like non nutritive sweeteners, I think that can also be a personal preference.
Think I like people to just understand that it doesn’t have to be something that’s used.
And if they don’t like the taste of, you know, say something like Splenda or monk fruit or or whatever the sweetener of choices that they can use regular sugar.
20:59
It’s just sort of like, how does that impact the rest of my management?
It’s not.
A rule.
And by the way, for people who are wondering about non nutritive sweeteners or artificial sweeteners, we do have a whole episode about those with a wonderful dietitian, my feller.
21:16
So we’ll include that in the show notes if you want to check it out.
Yeah.
Along the lines of scenario questions, something that I see all the time too is for people using injectable.
Well, not not even injectables, but insulin specifically.
More so for type one, but also for type 2.
21:33
They say that it’s really hard to wrap their head around intuitive eating because they have to time everything with their insulin regimen.
You know, sometimes they question us as dietitians, like is this even possible?
It’s really hard.
I feel like I have to have such a strict regimen or I might go too low or I might go too high.
21:54
So what are some ways?
Like first of all, is it possible to incorporate intuitive eating with type 1 and what are some ways to do that if so?
Yeah, it definitely is possible to incorporate with Type 1.
I do discuss a couple different case examples in the book. 1 is actually somebody with Type 2 who’s on insulin and sort of when he was first diagnosed being given a prescriptive limited amount of carbohydrates to consume and then told, you know, sort of like give yourself this much insulin and eat this many carbs, which is not a very intuitive way to eat, right?
22:29
That we’re sort of thinking this is the amount that I only can have.
And so I actually was able to work with his practitioner to give him a carb to insulin ratio that then he could use so that he could eat the amount that he wanted to consume and then give the appropriate amount of insulin for that, the amount of food.
22:48
And so the, I think the intuitive question here is, well, I may not know initially how much I’m going to consume.
And so then how do I, you know, give the insulin for it?
And so I think there’s a few different ways to to go about this.
And it really probably depends on the way that somebody’s using insulin, whether it’s through a pump or it’s through their own, you know, syringe and needle injection or if they are using, you know, a loop system, right?
23:16
That there’s different so many different ways that people will give themselves insulin now, you know, you can sort of give it in phased, phased doses.
So we could give an amount and then give a correction or we could sort of estimate how much we think we’re going to have or give it halfway through.
23:34
So sort of depending on the combination of food ingredients that are in that.
So let’s say it’s actually has a lot of fat and protein and fiber.
Would it be OK to give it a little bit later?
Because we know that the rise of the blood sugar is actually going to come a little bit later, right?
23:50
So that we could kind of match that right with the insulin.
And then also depending on what type of insulin, if it’s a rapid acting, short acting.
And so I think that’s something really helpful to work with an individual diabetes educator on so that it can be personalized.
Because I I definitely think that insulin management and combination with carbohydrates is something that is complicated and does does need to be personalized.
24:14
Agreed.
So let’s talk about just some of the long term consequences, both mentally and physically, for people who have diabetes but are really stuck in diet culture or disordered eating and thinking that they’re doing the best thing for their diagnosis.
24:32
Well, so the restriction, right, is definitely a long term, can lead to many long term consequences.
So whether it’s like a nutrient deficiency because of what’s being restricted or overall fatigue, the weight cycling I think is a really big one because we know that restriction or dieting can lead to this kind of yo yoing with body weight, the poor mental health outcomes.
24:56
And then, you know, I think I’ve often seen people socially isolate, maybe saying no to lunch invitations or saying no to outings that involve food.
And, you know, that certainly leads to, like, decrease quality of life.
25:11
Being stuck in diet culture really limits what we’re going to do, what we’re going to, who we’re going to engage with, not only with our food, but sort of extending far beyond that.
So as dietitians, a lot of the research that we see with diabetes and even pre diabetes, it’s always tied to weight loss.
25:31
That’s hard because I think that we also get questioned when it comes to like intuitive eating and diabetes like, well, a lot of the research that I have seen is promoting weight loss as being helpful for diabetes.
And so I would love to hear about any research that you’ve come across that looks at intuitive eating within the context of diabetes and how it might be helpful.
25:56
Because I, I know that compared to the research that is tied with weight loss, it’s not as abundant.
So what have you come across?
Yeah, luckily there are several studies that have used an intuitive eating framework to look at blood sugar management for both people with diabetes, people with gestational diabetes, and then, you know, just intuitive eating.
26:17
Research on its own has over 200 studies.
Of course, there’s fewer that look at specifically intuitive eating and diabetes, but hopefully in the future we’ll get more.
But several studies have found that the use of an intuitive eating framework can be a valuable tool for blood sugar improvement because it’s been associated with weight stability, which is critical given kind of what I’ve shared briefly about the harms of weight cycling.
26:41
And then in addition, there was a study published in 2021 that found that regardless of BMI, intuitive eating was associated with an 89% lower chance of having poor glycemic control in people with diabetes who weren’t using insulin.
In addition, another study found that there was an association with intuitive eating and increased body satisfaction in people with type 2 diabetes.
27:05
And other studies have found that intuitive eating leads to or is associated with lower triglycerides, lower blood pressure, less body dissatisfaction and less disordered eating.
Plus they found better HDL, that good cholesterol, greater food variety, and then more pleasure from eating.
27:25
And then the studies that have looked at the effects of intuitive eating on gestational diabetes have all been positive.
They have found that intuitive eaters had better fasting blood sugar and A1C one year postpartum.
So I think all of it is really positive and just need more research to kind of connect the two.
27:46
But everything we’ve seen of that I’ve read so far has has been really supportive of the approach as a management tool.
And love all that.
Thank you for sharing.
One thing that you also kind of touch on in your book is just this idea of dismissal or judgement in the medical settings, especially for people in larger bodies, bipod communities, or those navigating multiple identities.
28:10
What advice do you have for people who are trying to advocate for themselves in a weight centric healthcare system?
Yeah, such a challenge.
And I do include a resource as part of the book resources that is a letter that can be used with a healthcare provider.
28:27
I think really self advocacy is something that I often hear clients really struggling with as they’re approaching their medical appointments, figuring out how do I really get my needs met from this, from this visit.
And so it’s certainly challenging to advocate for our needs and especially in marginalized communities and identities.
28:48
What I think is helpful is maybe to practice, to outline what is it that I want to be accomplished in this appointment.
I love Reagan Chastain’s work around this topic because she really encourages people to ask very frank questions such as what advice would you give someone in a thin body with this problem?
29:07
And in addition, you know, she also outlines like from the get go that you could sort of just start out the visit with.
Here’s what I’d like to focus on in our limited amount of time together, knowing that most visits are like 15 minutes or less with a medical doctor.
So you know, if if you’re going in and getting a big lecture on something that you really don’t is not the focus, that’s such a waste of time and co-pays and everything, right?
29:33
And in addition, there are a couple lists that have been put together that include names of inclusive providers or at least names of of that people have shared where they have not had a negative experience, which can be helpful for people.
I think it’s harder in areas where there aren’t as many clinicians to choose from, right?
29:52
And so in that case, that’s where we really wanted to sort of think about how will I advocate for my needs here?
Yeah.
And if for listeners who want resources on that, we do have a list of weight inclusive providers in different states, so you can always e-mail us and we can try to guide you in the right direction.
30:12
For someone who’s listening.
And they’ve been recently diagnosed with diabetes or they’ve had diabetes for a while and they really struggle with practicing intuitive eating.
They have a history of disorder eating or dieting.
What are some good starting points for them?
30:30
Maybe things that they can take into consideration?
Questions to ask themselves are things that they can actually do to move away from restrictive dieting and move towards intuitive eating.
Well, so I think that a starting point is to really identify like what types of practices or rules am I holding on to and how is that aligning with where I’d like to go?
30:56
So sort of like a, a values assessment.
So if I would like to have a better relationship with food in my body and I’m, you know, restricting my these foods or I’m talking to myself in this way, how is that helping me to kind of align with this goal that I have?
You know, the intuitive eating principles outline 10 different, you know, 10 different principles that we can use to become more intuitive with our eating.
31:20
And at the beginning of it is really rejecting diet culture or rejecting the diet mentality.
And so that is a place that we could start.
We don’t have to start there.
We could also start with thinking about like, how do I bring in some elements that make me feel good?
31:36
That could be thinking about like what ways can I care for myself in a better way, which could be sort of setting up guideposts such as, you know, things that we could do to encourage regular eating, regular hydration and other ways that we can kind of add in some self-care and some self compassion.
31:52
Which a self compassionate statement that we could use with ourselves could be as simple as, you know, just reminding ourselves that other people struggle with this too.
Sometimes I think it feels many people feel like I must be the only one or how come I can’t figure this out.
32:08
And so really kind of starting with with that in mind or just the way that we’re speaking to each other can be a good approach.
I also like to use the intuitive eating assessment that a researcher named Tracy Tilka House created.
It’s in its third version now.
And that can also give people an idea of where am I kind of struggling with intuitive eating principles and that can kind of highlight where would I start?
32:31
So it may be attunement disruptors, like what am I doing that’s getting in the way of me being able to hear the messages from my body, or it may be ways that we can think about enhancing our attunement.
So that kind of leads us to which of those principles may be a helpful starting place when it feels like a little bit overwhelming to think about all of them at once.
32:51
Your book, we were so excited about it because as we’ve mentioned, there is a lack of resources and diabetes tends to be very diet centric.
So there’s a lack of like intuitive eating resources.
So can you give listeners a bit of a sneak peek of what they can expect from your book, Intuitive eating for Diabetes, where they can get it, all the things?
33:13
So the book includes 9 chapters, so those we start out with an explanation of diabetes, but it may be an explanation that people haven’t received before.
So in addition to talking about the different types of diabetes, I also go into the root causes that we briefly discussed today.
33:31
Then from there we go into the four pillars of intuitive eating for diabetes, which includes establishing a diet, free mindset, self-care, gentle nutrition, and an individualized treatment plan.
And so there are intuitive eating principles kind of weaved into each of those 4 pillars.
33:48
And then from there, I have a chapter that covers self advocacy, which we also briefly touched upon how somebody can do diabetes care their own way, and a chapter on body image.
And then lastly, there is a chapter all about intuitive eating for diabetes in the real world, where I have three of my former clients who have been willing to allow their stories to be shared.
34:10
And so they talk about how they used intuitive eating to manage their diabetes.
And so it’s somebody with type 2 who uses insulin, there’s somebody with type 1, and then there’s somebody with type 2.
So it’s kind of a little array of different experiences and how it was helpful for them.
34:28
Amazing for listeners who want to learn more about your work.
Do you have a website if they want to work with you?
I don’t know if you’re taking on clients, but where can they learn more about you?
Yeah, so there is a book website and I have my private practice website.
So the website for the book where you can learn more about the book and have links to where you can order it is Intuitive Eating for diabetes.com.
34:51
My website is also linked through that which is socalnw.com and that’s my private practice, Socal Nutrition and Wellness.
Oh, cool.
OK, amazing.
Well, thank you so much, Janice.
This was a excellent conversation.
I know our listeners are going to love it.
Thank you so much.
35:09
Thanks for joining us for today’s episode.
If you’re interested in nutrition counseling with one of our expert dietitians to help improve your pre diabetes or diabetes, visit us at diabetesdigital.co.
Also, if you found our conversation helpful, do us a favor and rate and review this podcast on iTunes, plus share with someone who might find this helpful.
35:29
You can also connect with us on Instagram at Diabetes Digital dot.
Co and TuneIn every Wednesday for practical, inclusive and culturally humble diabetes BD’s insights.
We’ll catch you later.
Bye.
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Janice’s book Intuitive Eating for Diabetes is filled with practical advice and powerful real-life stories. You can find more about her work at intuitiveeatingfordiabetes.com. And if you’re looking for compassionate, culturally affirming support for your diabetes journey, we’d love to support you at Diabetes Digital.
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