87 - The Food Police Exposed: A Diabetic's Guide to Intuitive Eating

Ever wondered why diet culture sets such unreasonable rules? Join me and my esteemed guest, Robbyn, as we challenge the food police and their arbitrary restrictions, especially as they pertain to those managing diabetes. In this engaging conversation, we unravel the myths surrounding food, body size, and diabetes while advocating for intuitive eating. 

Robbyn, herself a diabetic, offers an enlightening perspective on the disease. We walk through the signs, symptoms, and diagnosis process, shedding light on the potential for misdiagnosis and the importance of self-advocacy. Delving into the complexities of diabetes management, we underline the essential role of understanding carbohydrates. However, we strongly believe that managing diabetes doesn't mean bidding farewell to the joys of food. 

Our conversation culminates in the affirmation that diabetes is not a death sentence. You can, indeed, lead a happy, healthy life alongside managing this condition. We discuss evidence backing the practice of intuitive eating for those with diabetes and stress on the importance of body autonomy. So lend us your ears, shift your perspective, and join us in dismantling diet culture's food police, advocating for body positivity, and embracing the freedom to enjoy food.

Transcript

Speaker 1: 0:48

Robin, welcome back to the podcast. So glad you decided to come back again. Ha ha, we just got done recording your first episode. You didn't really come back, you didn't go anywhere. For those of you listening, it seems like we did so.

Speaker 1: 1:04

Today, robin and I are going to talk about the food police and how that shows up for diabetics Because, if you don't know, november is Diabetes Awareness Month, so we thought what better way to help bring awareness and education but talk about it on the podcast In light of intuitive eating terms. How do the food police show up in that? So I thought we would start with just talking a little bit about what the food police are. And we have these fun little card decks of intuitive eating that we use in our counseling practice, and one of them is specific for the food police. So it says scream aloud no to thoughts in your head that declare you are good for eating minimal calories or bad because you ate a piece of chocolate cake.

Speaker 1: 2:03

The food police monitor the unreasonable rules that diet culture has created. The police station is housed deep in your psyche and its loud speaker shouts negative barbs, hopeless phrases and guilt provoking indictments. Chasing the food police away is a critical step in returning to intuitive eating. If that makes no sense to you as you are listening, that's OK. We're going to dissect this and help you understand it from, hopefully, a very personable level. So, robin, you're a little bit newer to intuitive eating than I am. When you hear, or heard the words food police, what do you think of?

Speaker 2: 2:52

I think it means something different for the diabetes community. So the first time I heard the words food police, you know I tend to think of the relatives at Thanksgiving or people around me Meanwhile when they say things like did you be eating that? Like if I go to tear into a full sugar right, full sugar slices, pumpkin pie, or if I'm drinking a regular soap, things that people typically associate with diabetes. That's kind of where I think of food police, like the external food police, but that's from a diabetes perspective.

Speaker 1: 3:27

So that's really interesting, because in intuitive eating, the idea to challenge the food police is something different. Right, it's the notion that we have these food rules in our head telling us what we should or shouldn't eat. But what you're saying is individuals with diabetes have these external food police as well. So you have the internal and the external Yep exactly.

Speaker 2: 3:51

So, like sometimes, it seems like there's this misconception about diabetes one where if you have diabetes, you can't have sugar, and that's not true. I can have sugar. I can have any of the foods that anyone else can have. So, in fact, I absolutely hate diet soda. I hate sugar substitutes like I will not do swenda things like that. I'm not choosing those myself, right? Those are not foods that I choose. Intuitive eating being. You're going to choose foods for pleasure and enjoyment. I will not choose diet soda personally.

Speaker 2: 4:22

But as someone who has type one diabetes, I think the main thing that's different for me is that, you know, I don't influence. My pancreas doesn't make insulin on its own. So anytime I'm eating a food, I do need to know how many carbohydrates are in that food so that I can go insulin for them, because I need sugar to survive, right? I'm often carrying a bottle of soga with me in case I end up going too low, like where my body doesn't have enough sugar. So it is this constant balance of sugar and insulin throughout the day, and I use words like sugar and carbs interchangeably. But I think the main idea is that I can have chicken.

Speaker 2: 4:59

Individuals with diabetes can have sugar. It's just knowing how much you're ingesting, since you need to dose insulin or take metformin medication to manage how effectively your body is breaking down that sugar or carbs. So type one diabetes, you know this is an autoimmune disorder where my body's attacking itself so over time, if I'm not careful about my daily management, you know that's when complications are real. However, it is possible to manage diabetes. It's possible to practice intuitive eating when you have diabetes. You know we're still human, we still have cravings, hunger, queues. So yes, people with diabetes can practice intuitive eating. There's just that additional element of diabetes management.

Speaker 1: 5:51

Really interesting and thanks for bringing awareness to this. Look like diabetes is an autoimmune condition and so your body is working against itself. Because I think a lot of what we try to work on with intuitive eating is that befriending your body and working with your body when your body is working against itself and just cannot produce sugar. So, yeah, I'm guessing intuitive eating has to look a lot different for somebody with diabetes.

Speaker 2: 6:24

And it does depend on the type. Like type one of the autoimmune piece type two you can have some insulin resistance where your body, like both conditions both type one and type two your body either doesn't produce insulin at all, which is mostly the case for type one and in type two, sometimes your body either isn't producing enough insulin or there's some insulin resistance where your body is not able to use the insulin that you produce. Intuitive eating when you have diabetes. I personally see benefits to my A1c from this practice. So, like every six months I go to my endocrinologist to have my blood sugar method. Like how well are you controlling diabetes? Basically, is what an A1c lab draw measures. But by practicing intuitive eating I don't feel trapped by the diabetes, like I'm not trapped in my body. That will never change. I'm really at peace with food. I can live a full life with diabetes just by changing my relationship with food and my body in a lot of positive ways. There's also evidence for this. So if you've read the intuitive eating book, there is a ton of research research that supports the practice of intuitive eating, but also supporting this practice for individuals with diabetes. So in the book there's a study about eating in response to initial hunger. So when people did this, it was actually found that they had improved insulin sensitivity compared to the control. And when insulin is less effective in your body, that's called insulin resistance and that's what contributes to some of those more long term complications or chronic health concerns that come with diabetes. Interestingly, the research team for this study also found that restoring and validating hunger and training people to recognize initial hunger so like we do with intuitive eating that actually helped in treatment of diabetes. So it's not that just insulin resistance is improved, like you would do that in type two or type one, but emerging research is suggesting that intuitive eating programs, like the ones that we use in our practice those could be a valuable tool to improve blood sugar control. It was also found in studies of children and adolescents who have type one diabetes that there's this inverse relationship with A1C and intuitive eating scores. So inverse relationship, meaning, as intuitive eating practices go up, the level of your A1C is down, which is good, right. The A1C that we tend to aim for is being like that standard, or the typical A1C of a non-diabetic person is a 6.0.

Speaker 2: 9:05

And intuitive eating practices. They might actually be very important to managing diabetes. You know, eating mindfully, paying attention to what we are putting into our mouths, not just how many carbs that something has, but like are we satisfied by the food that we're consuming, things of that nature. So not just carb counting and getting lost in the numbers. People with diabetes. We're at a higher risk of developing eating disorders, and intuitive eating has been associated with decreased risk of problematic eating. So I specialize in treating eating disorders right, we both do. But I'm here learning, working towards my full licensure as a counselor here in Iowa, and I'm very interested in working with this population and others who might be like me. Right, we just want to find that freedom, but we'll also managing the diabetes diagnosis.

Speaker 1: 9:58

From one nerd to another. To all of the nerds listening to this episode, I just want to say a big thank you for bringing in some of these research pieces of. Sometimes I think in the fitness world and the nutrition world, like intuitive eating is still seen as those like woo-woo type of thing. I love when we have research to support the stuff that we're saying, especially when it's dealing with some of these chronic health conditions. And it's not just another quote fad diet that's going to help you lose weight and manage your numbers. It's no, we're teaching you how to manage this long term. Oh, 100%.

Speaker 2: 10:46

I'm also a resident nerd. I'm going for my PhD. I love writing, I love research. So anytime you can bring research into what you're doing, evidence-based best practices, those kind of things, I'm definitely all for it.

Speaker 1: 11:01

We mentioned at the start of this episode that it is Diabetes Awareness Month, so can we talk? Can you share some of the signs of type 1 diabetes? Sure?

Speaker 2: 11:12

yeah, for me. I think I've always had signs of type 1 diabetes growing up, but I'm one of those special cases, so my diabetes actually went unrecognized in my adolescence and my early adult years. So I remember being a teenager in high school. I remember going to our family doctor. He would ask me questions like are you going to the bathroom more than usual? Are you urinating more frequently? And for me, like a teenager or kid, I had no idea how much was more often Like do I go to the bathroom a lot? I don't know like sure, being like what is a lot, what is typical? So having to go to the bathroom more than usual is a sign Like having to urinate more than usual.

Speaker 2: 12:02

I also was extremely skinny as a teenager and a young adult. So no matter what I put into my body, it was nearly impossible to gain weight, and one of the signs of type 1 diabetes can actually be unexplained weight loss. So I had a lot of friends' parents acting my mom if I had anorexia, which I did not, but I was extremely thin to where it could have looked as if I had that condition. So that's also another important reason why you would have a medical care team and some of those decisions in treating eating disorders, like make sure we're ruling out other conditions. But over the years, like, I've gained weight to the point where I was misdiagnosed as having type 2. And there's a lot of medical stigma that comes with that right. So, because I was overweight, when I went to see my primary care provider I was told oh, it must be type 2. And in reality, a few years later, when the signs for type 1 diabetes came into play like those are things such as frequent urination, having to go into the bathroom more often, like due to high blood sugar levels, excessive thirst, fatigue, exhaustion, unexplained weight loss. Some of those signs, though, like those, are seen in type 2 as well, with weight loss being less common in that population. So, type 2 diabetes, you do still tend to have the excessive thirst, going to the bathroom, where it's unusual, and having that exhaustion and fatigue.

Speaker 2: 13:35

I was actually diagnosed with type 1 diabetes at age 30. So it's a little rare to get a late in life diagnosis like that, but I do have type 1. You know we did a steep half tide. I'm also a person in a bigger body, so that's not typically what people think of when they think of type 1 diabetes. There's a lot of myths out there about smaller bodies having type 1 and bigger bodies having type 2. But your body size really doesn't determine your health, right? We know that we can have health at every size. We can have diabetes at every size. I had my first child at 30. And that's when they did a steep half tide that confirmed that, yep, you are a type 1 diabetic after I had my first child. But I've lived as both. I've lived as both types.

Speaker 2: 14:23

I was treated with metformin as someone who had a bigger body, and it did nothing for me, right? You have type 1 and you were taking metformin. That's not going to help you. My body didn't make insulin, so you know my body needed insulin, and then I was put on insulin by my doctor. When I found out I was pregnant with my son.

Speaker 2: 14:42

But To get to the point, some of the signs for type 1 diabetes, they're things such as frequent urination, having to go to the bathroom often because your blood sugar levels are higher, having that excessive thirst because your blood sugars are higher, right, and then having that exhaustion, fatigue, unexplained weight loss. Some of these signs, though, they are seen in type 2 diabetes as well, with weight loss being less common in that population. With type 2, you tend to still have the excessive thirst going to the bathroom or after the usual and that exhaustion and fatigue. So it's rare to get a diagnosis like this late in life, but it is something that I've learned to manage, that I've come to term with and I've been able to incorporate into a diabetes with as well.

Speaker 1: 15:32

As it's Diabetes Awareness Month and you have diabetes and you've walked through that journey of being misdiagnosed as type 2 and then appropriately diagnosed as type 1, if somebody's listening to this and resonating with those signs and symptoms that you just explained, both from your own perspective and then more of just like a diagnostic criteria, what are some steps that they should or could take?

Speaker 2: 16:01

I would definitely say, if you think you're experiencing some of the signs, I would reach out to your primary care provider Addressing that with them. If they do not specifically treat diabetes, they may refer you to endocrinology. They might do that work. Like for me it was doing lab work right. Like For that cut to come back and say, oh, you have type 2. All it came back to the lab workshop I have diabetes. I needed to see peptide to figure out what my type of diabetes was.

Speaker 2: 16:32

So, like, if you are someone who either getting diagnosed with diabetes for the first time, get to meet with your doctor, maybe show some of these signs, say this is why I think I have this, or if you are type 2 and you're like, hey, same experience we're. Like this is literally doing nothing for me. Can you ask them to do a CPAP type Determine? You know, do I really have type 2 or is this a diagnosed type 1? Because the only thing that's really going to do that for you is that CPAP test is that's going to determine your type. So someone in a bigger body just to look at me and say I have type 2. I have some opinions on that, obviously, but like just for someone to look at me and say, well, based on your size, you're type 2. When the science shows actually my CPAP type shows that I'm type 1. Like they're the lab test that can determine what that condition is and what type I have.

Speaker 1: 17:30

Is the CPAP type as simple as like taking a blood test?

Speaker 2: 17:33

Yeah, that's all it is. All this is like blood work I hate needles, by the way, so like, if anyone else is out there and like you, like medical for me, like me too, but yeah, like the way they determine it is through a blood test, so like at Endocrinology they can just do like a fingerprint and that will enable them to do like my A1C when I'm in the more rural areas of our state, like it's still taking lab work from my arm which sucks, but like, yes, it is a lab draw.

Speaker 1: 18:01

You get it from lab work. How would you suggest people advocate If they're questioning? Well, I do have a larger body, but the treatment that we've tried for type 2 just doesn't seem to be really doing anything. How do they advocate for testing for type 1?

Speaker 2: 18:18

I really think it depends on where you're at. I think, like in Iowa specifically, I've been born and raised here, right. So like I think it also depends on where you're at, because I've noticed like I see my endocrinologist in Iowa City. I don't live in Iowa City, I live in a rural area and, like having to advocate, it seems like I get more, I have more ability to kind of say like hey, I would really like this lab work there, versus when I've gone to some of my rural sites and they're like, oh, like we don't know where to send you sometimes, like sometimes it's just like we don't have access to like to do that kind of test. We're gonna have to make a referral. So like some of it can be medical access.

Speaker 2: 18:59

But as far as advocating, I am a big proponent on finding a medical provider that works for you. I can't tell you how many times I've changed who my endocrinologist is, but I'm like this is not working for me. So even just finding a provider that fits you interview providers like I've been all over. I've been to Ames, I've been to Des Moines, I've been to Iowa City. That's where a lot of the endocrinologists are. It's finding a provider that works for you, because I mean, it's like that was therapy too right? Like, finding the right fit for you.

Speaker 2: 19:33

If you are someone who you seriously think I might have type one, I really want this C-Peptide test. Find a provider who's gonna work with you and rule that out. Like, if you're running up against a brick wall, look at other options. Find a second opinion. I mean, that's what I would do, that's how I would advocate. Like, find a provider that works for you instead of trying to like fit into the parameters of that provider's definition of your diabetes. You're the one in charge. Like, find someone who's gonna advocate with you and work with you instead of working against you.

Speaker 1: 20:12

Speaking of finding providers that work with you and that's a good fit, I'm assuming that there's some education and dietary nutrition pieces that come in to helping manage both type one and type two diabetes. And now that you are in the health at every size space and the intuitive eating space, are there things that we should be looking for within dietitians, nutritionists, that aren't just gonna give us that, like diet culture BS, eat less carbs.

Speaker 2: 20:46

Very good question. Yes, I think yes, especially with diabetes. Like you, often, when you were first diagnosed, you were sent to diabetes education. You were sent to a diabetic educator, someone who sits down with you and explains like I remember my first session was okay, you need to have 15 grams at a snack and 30 to 45 at a meal. Like no more carbs than that. I'm like, oh what. Like you get introduced to carb counting, like which, if you are coming from diet culture, like that completely speaks against what you would do, like trying to reject this diet mentality. It completely speaks against that.

Speaker 2: 21:30

But when you have diabetes, those things are important to how you manage. Like you do need to have some awareness of what you're eating, or like how many carbs are in your food. But I also think, once you have a good management of that side, like I know what I should be doing right the quotes around, should I know what I should be doing to manage my diabetes? For the most part, I follow this guidance from diabetes education, but I myself have really started to branch out in more of the intuitive eating pieces where I'm like what sounds good to me, what do I want? And so, instead of looking at food as 15 grams of carb, 30 grams of carb, 45 grams of carb. I'm following more of my instincts, you know like. What am I craving? What am I hungry for? Okay, that's what I want. How many carbs is that? How does that fit into the diabetes piece? So you're still following the guidance the diabetes education is providing to you, but you are finding ways that work with intuitive eating and you're listening to those hunger fuse. You're listening more to yourself.

Speaker 2: 22:44

For me, as far as what to look for, I think I've had good diabetes educators that will give me the basic. Here's how to manage your condition. It's not all about food either. I had to learn how to use insulin for my diabetes education when I had to start that for the first time, or how to make pump adjustments. There are some other things you would go to a diabetes educator for, but I think the big thing for me for advocating those settings, is to remember you may not be someone who lives with diabetes every day and a lot of this may be textbook.

Speaker 2: 23:23

As someone who has diabetes, I tend to take in the information but adjust it to my own way of life, and that does include intuitive eating. My A1c is fine, look, it's not skyrocketing. It's not that perfect six, but it's fine and I'm able to live and have this healthy relationship with food. Instead of being imprisoned by the carb count and really getting down on myself about I can't have this because blood sugar can't have that, or avoiding carb altogether. I'm finally at a healthy balance six years into this, at a healthy balance of yes, I can have this and it's this many carbs.

Speaker 1: 24:11

From my perspective, I've seen you in several different settings of being in the office, going out to lunch together, being at an all-day conference and you're tracking. You're keeping an eye on some of your carb intakes, but from my perspective it looks more of like I'm doing this because I feel better when I do this. I'm better able to focus, I'm not as squirrely. My ADHD doesn't get us out of control. Rather than from a, I need to manage my diabetes and I need to eat only a certain number of carbs.

Speaker 2: 24:49

I relate to that, yeah, because what you say, that would have been me at three. So getting diagnosed, especially during pregnancy, it was really difficult during pregnancy because that's a whole other podcast episode of how to manage that. And eating, because that is a whole other thing. But that was very, very strict, and for a good reason. I'm a very human being. But aside from that, I think, yes, eating choices.

Speaker 2: 25:16

When I first got diagnosed, it was very much like, oh no, I can have mustard and pickles. Those have no carbs. The fear factor of carbs or sugar is bad, sugar is bad. And then, and that's your food police, right, that's your intuitive eating food police. That's like I can have this and I can't have that. But as you grow and you've managed the diabetes well, you start to get that healthy relationship with food back. And I think, getting to that point where I'm at now and even before I even heard about intuitive eating right Like I've been doing this a while where it's like I'm done, being burnt out and following all these rules, I can still be a healthy person, I can still manage my diabetes well. But there's gotta be some life in this, there's gotta be some pleasure from eating, because I'm not gonna exist on mustard and pickles and saltines. That's really nasty Like you know what I mean.

Speaker 1: 26:13

But if it fits the carb count, so we do it.

Speaker 2: 26:17

So it's finding the fit that works for you. It's breaking free from, like these very rigid restrictions that you can get in diabetes education where, like you, feel like these are the only foods I can have. I can eat anything. I can eat anything the same way anybody else. The only difference is that, as a type one, I have pancreas that doesn't function and give me an implant so I have to get it myself. When you're treated as type two, yes, you have a little bit more parameters to work with, but, like you are still a functioning person. You are taking medication, you are getting water when you need to like bring a blood sugar down, but, like you're making choices for you, not because you're trapped by diabetes, but because you enjoy the food.

Speaker 2: 27:14

Robin, is there anything else that you think the listeners should know, need to know about diabetes, whether it's type one, type two, I would say, like, as someone who very much appreciates education, I educated myself all there was to know about this condition, and so I'm not downplaying complications. Diabetes is a very serious chronic condition. Management is very important. I just think, like, at this point in my life, I've come to a place where you can still manage diabetes and you can have a healthy relationship with food. It doesn't have to. Your diabetes doesn't have to control your entire life. Carbs do not have to control your entire existence. You can find a way to control all of that on your own and not have it control you.

Speaker 2: 28:05

And I think that's also something that comes from therapy, right, like that's a lot of what we would do in therapy together is, you know, looking at how that shows up for you? And how can you think about this difference? What are some choices you can make that you are still honoring yourself. You are still honoring your hunger. At the same time, you're also managing your health condition.

Speaker 2: 28:28

But what are some different ways to kind of get a handle on this to where the diabetes doesn't control you? You control the diabetes, you manage the diabetes, because I feel like, as someone who has diabetes that's a big thing is feeling like defeated by, like the diabetes management piece and like I don't feel defeated anymore. I'm on the other side of that, like I don't feel defeated and if I told you my health team and stuff, right, like I'm not going to do that, but if I told you those things right, like you would be getting the same information. Like yeah, like my A1C is fine and I'm doing good, I'm not as well managed, but I'm also not trapped in the mindset of having count carbs and everything.

Speaker 1: 29:10

So big takeaway is that you can live a happy and an enjoyable life with type one or type two, and you don't have to be so defeated. You don't have to feel so controlled by food. It's not a death sentence.

Speaker 2: 29:30

And you can still be that quote unquote healthy right. You can still have that diabetes management and not have without having all of the food police, not having the food police in your head, external and internal.

Speaker 1: 29:46

Yeah, and you still may choose to abide by some of those quote food police rules, but not because of some sort of diet culture, not because somebody else tells you to, but because your body feels better. You feel better when you do those things.

Speaker 2: 30:06

Yep 100%.

Speaker 1: 30:09

Wonderful Well, thank you for coming on and bringing some awareness to diabetes during Diabetes Awareness Month and look forward to hosting more episodes with you in the future. Awesome, thank you for having me.