Diabetes and Me: The Dangers of Disordered Eating

Warning: This column is about eating disorders and eating disorders

diabetes and me – There’s an app on my phone that’s chasing me. It sits there on the screen, bright and shiny blue, teasing me to open it. It’s a calorie counting app.

Megan Whelan.
Photo: RNZ / Rebekah Parsons-King

When I started to review my diet to control my type two diabetes, it was very helpful. Knowing how much protein was in my dinner, how much carbs, how much fiber was important information. But to get this information, I had to weigh everything I ate and obsessively read nutritional information.

As I’ve written before, it took all the joy out of preparing a meal, but it also started to take over parts of my brain. And while macro information is useful, knowing how many calories I consume in a day is not information I particularly want. Because it seems to me the fastest way to restrict not only the types of food I eat, but an unhealthy obsession with how much, or indeed little, I consume.

The temptation to give myself a calorie goal that is too low to be healthy, to satisfy that voice in the back of my head, is strong.

I’m sure there are many people for whom this data is an essential and normal part of their lives. But for those of us who grew up trying fad diet after fad diet, or heard an endless repetition of “calories in, calories out,” it’s troubling.

Dr Roger Mysliwiec is an eating disorder specialist and director of the Eating Disorders Clinic of New Zealand.

He says that the anxiety I wrote about last week is not unusual for someone who has recently been diagnosed and that what might have been helpful was a diabetes specialist or GP who understood that such a new diagnosis could , for someone like me, create a lot of problems. anxiety that can lead to exaggerated and obsessive control of my eating habits.

“[Someone who was] psychologically informed enough to be able to talk to a newly diagnosed and concerned patient to help them find a good balance between the need to take care of their diabetes and the need to continue enjoying food and life. And also give them a reality check about the condition.”

Dr. Mysliwiec says that disordered eating can – and does – occur in many societies at different times.

“Basically, most diets could be described as disordered eating.” It does not refer to medically informed diets, such as a person with celiac disease not eating gluten. Or indeed, someone with diabetes who limits their carbs.

“A lot of diets respond to wanting to lose weight and start to get radical and a little weird.” He points to the keto diet, which has some evidence, in the context of treating epilepsy, but most people don’t follow it properly, or on the advice of a medical professional.

“[People do] this kind of restriction for four weeks, and then “I can finally eat all this again”, and it leads to this typical yo-yo effect. Losing weight is reasonably simple, easy. But maintaining a low weight is nearly impossible, at least with these common diets.”

This is not to say that most people who engage in disordered eating have an eating disorder, which has specific diagnostic criteria and a large genetic component. (Dr. Mysliwiec says there is a combination of many genes that make up a genetic predisposition to eating disorders, including metabolic genes.)

There is a very specific and dangerous disorder called diabulimia that people with type 1 diabetes suffer from: insulin-dependent diabetes. The onset of type 1 is usually at a young age, and usually means dieting – not eating certain things – and there is a risk of weight gain when you have to compensate for episodes of hypoglycemia such as apart from diabetes management.

People with diabulimia do not use the insulin they need, which causes their blood sugar to rise significantly. This means they can’t convert carbohydrates into energy and end up losing weight.

It also means they’re at serious risk of ketoacidosis coma: “It’s basically full-on untreated diabetes. And the significant secondary risk is that they end up with all these secondary complications, microvascular complications, which can lead to… [things like] blindness and kidney failure”.

He says it’s high risk and the risk of developing an eating disorder among type 1 diabetics is significantly higher than the general population.

So what to do about the anxiety about what I can and can’t eat now?

Dr. Mysliwiec says that for someone with a genetic predisposition, engaging with disordered eating is a common pathway to ending an eating disorder.

“The key thing is to have some awareness, to have some balance and to be aware of the risk of taking things too far… if you already have that vulnerability and start engaging in strange diets, you’re putting yourself at extreme risk. .”

He points me to a study done in the 1940s, immediately after World War II, where volunteers were put on a starvation diet and observed.

“Hunger affects our thinking and behavior around food…it becomes more and more important to our mind, to the point where it becomes obsessive…driving [to] compulsive behavior, often even strange.”

The APA writes of the experiment: “Hunger caused the men to become obsessed with food. They dreamed and fantasized about food, read and talked about food, and savored the two meals a day they were given. They reported fatigue , irritability, depression, and apathy. Interestingly, men also reported declines in mental ability, although the men’s mental tests did not support this belief.”

The men in the study did not have any eating disorders, but they were experiencing severe eating disorders, Dr. Mysliwiec says.

“Good healthy eating, comfort eating, a high-fiber diet, that’s not a diet. Someone diagnosed with diabetes should stay away from highly processed, high-sugar, high-fat foods… or just every now and then. It’s not like that. a diet.”

But balance is key, as is talking to people who can give good advice, he says. “Ultimately, you have to look at the big picture. You have to balance the potential cost of losing enjoyment and pleasure in life when you follow an overly restrictive diet against the expected physical benefit, especially if I become increasingly restricted and unhappy.” , he says

“If you focus too much on one thing, then the cost is too high. That’s a challenge we have in life all the time.”

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