Diabetes and Me: The dangers of disordered eating

Warning: This column is about eating disorders and eating disorders

diabetes and me There is an app on my phone that is haunting me. It sits there on the screen, bright and shiny blue, teasing me into opening it. It is an application to count calories.

When I started reviewing my diet to control my type 2 diabetes, it was really helpful. Knowing how much protein was in my dinner, how many carbohydrates, how much fiber was important information. But to get that information, I had to weigh everything I ate and obsessively read the nutritional information.

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

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

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

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

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

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

Dr. Mysliwiec says that eating disorders can and do 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 who does not eat gluten. Or, in fact, someone with diabetes who limits their carbohydrates.

“A lot of diets are in response to the desire to lose weight and they start to get radical and kind of weird.” He points to the keto diet, which has some evidence, in the context of epilepsy treatment, but is not followed correctly by most people or with the advice of a medical professional.

“[People do] these kinds of restrictions for four weeks, and then ‘I can finally eat all this again’, which leads to the typical yo-yo effect. Losing weight is reasonably simple, easy. But keeping your weight down is nearly impossible, at least on these common diets.”

That doesn’t mean that most people who get involved in eating disorders have an eating disorder, that has specific diagnostic criteria and a large genetic component. (Dr. Mysliwiec says that 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. Type 1 onset tends to be early in life and usually means dieting, not eating certain things, plus there is a risk of weight gain when hypoglycemic episodes have to be compensated for as part of blood glucose control. diabetes.

People who suffer from diabulimia do not use the insulin they need, which significantly increases their blood sugar level. That means they can’t convert carbohydrates into energy and end up losing weight.

It also means they’re at serious risk of coma from ketoacidosis: “It’s basically total untreated diabetes. And the big 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 anxiety about what I can and can’t eat right now?

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

“The essence 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 you start to engage in weird diets, then you’re putting yourself at extreme risk. “

He points me to a study done in the 1940s, right 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 minds, as it becomes obsessive… [to] compulsive behavior, often even bizarre.

The APA writes about the experiment.: “Hunger caused the men to obsess over 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 Men also reported decreases in mental ability, although the men’s mental tests did not support this belief.”

The men in the study did not have an eating disorder, but were experiencing a serious eating disorder, says Dr. Mysliwiec.

“Good healthy eating, non-comfort eating, a high-fiber diet, that’s not a diet. Someone diagnosed with diabetes needs to avoid highly processed, sugary, fatty foods…or only eat them once in a while. That’s not a diet.” diet.”

But balance is key, as is talking to people who can give good advice, he says. “Ultimately, one needs to look at the big picture. One needs to balance the potential cost of lost enjoyment and pleasure in life when following an overly restrictive diet against the expected physical benefit, particularly if I am becoming 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.”