Disclaimer: This column is about eating disorders and eating disorders
Diabetes and me – There is an app on my phone that haunts me. It’s sitting there on the screen, bright blue and glowing, nudging me to open it. It is a calorie counting app.
When I started reviewing my diet to manage my type 2 diabetes, it was very helpful. Knowing how much protein was in my dinner, how many carbs, how much fiber was important information. But to get this 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 cooking a meal, but it also started to invade parts of my brain. And while macro information is helpful, knowing how many calories I’m consuming per day isn’t something I particularly want. Because that seems like the quickest route for me, limiting not only the types of food I eat, but an unhealthy obsession with how much – or in fact little – I eat.
The temptation to give myself a calorie goal way 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 life. But for those of us who grew up trying fad diet after fad diet, or heard an endless refrain of “calories in, calories out,” it’s unsettling.
Dr Roger Mysliwiec is an eating disorder specialist and director of the New Zealand Eating Disorders Clinic.
He says the anxiety I wrote last week is not unusual for someone who has just been diagnosed and what might have been helpful was a diabetes specialist or general practitioner who understood that such a new diagnosis could, for someone like me, create a lot of anxiety that can lead to an exaggerated attitude 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 them find a good balance between the need to take care of their diabetes and the need to continue to enjoy life and food. And also give them a reality check on the condition.”
Dr. Mysliwiec says eating disorders can and do occur in many sectors of society at different times.
“Basically, most diets could be described as disordered eating.” He’s not talking about medically informed diets, like someone with celiac disease who doesn’t eat gluten. Or, a person with diabetes who is limiting their carbs.
“Many diets respond to the desire to lose weight and start to get radical and somewhat weird.” He points to the keto diet, which has some evidence for treating epilepsy, but most people don’t follow it properly or with the advice of a medical professional.
“[People do] those kind of restrictions for four weeks and then “finally I can eat all this again”, and that leads to that typical yo-yo effect. Losing weight is reasonably simple, easy. But maintaining a low weight is next to impossible, at least with these common diets.”
This does not mean that most people who engage in eating disorders have an eating disorder – which has specific diagnostic criteria and a strong 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. Type 1 usually appears at a young age and usually means dieting – not eating certain things – plus there is a risk of weight gain when compensating for hypoglycaemic episodes as part of diabetes management.
People with diabulimia don’t use the insulin they need, which causes their blood sugar levels to spike dramatically. This means that they cannot convert carbohydrates into energy and end up losing weight.
It also means they’re at serious risk of ketoacidosis coma: “It’s basically full, 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 that’s a high risk and that the risk of developing an eating disorder in type 1 diabetics is significantly higher than in the general population.
So what about the anxiety of what I can and can’t eat now?
According to Dr. Mysliwiec, for someone with a genetic predisposition, engaging in disordered eating is a common route to ending up with an eating disorder.
“The main thing is to have some awareness, to have some balance and to be aware of the risk of going too far…if you already have this vulnerability and you start following weird diets, then you put yourself at extreme risk.”
He points me to a study conducted in the 1940s – immediately after World War II, where volunteers were put on a starvation diet and observed.
“Starvation affects how we think and behave around food…it becomes increasingly important to our minds, as it becomes obsessive…leading [to] compulsive behavior, often even bizarre.”
The APA writes about experience“Hunger made the men obsessed with food. They dreamed and fantasized about food, read and talked about food, and relished the two meals a day they were given. They reported fatigue, irritability, depression and apathy.Interestingly, the men also reported decreased mental capacity, although the men’s mental tests did not support this belief.
The men in the study didn’t have an eating disorder, but they did suffer from severe eating disorders, says Dr. Mysliwiec.
“A good healthy diet, a non-comfort food, a high fiber diet – this is not a diet. A person diagnosed with diabetes should avoid highly processed, highly sugary and high fat foods…or n only have it once in a while. It’s not a diet.”
But balance is key, as is talking to people who can give good advice, he says. “At the end of the day, you have to look at the big picture. You have to balance the possible cost of losing pleasure and enjoyment in life by following an overly restrictive diet against the expected physical benefit, particularly if I become increasingly restrained and unhappy,” he says.
“If we focus too much on one thing, then the cost is too high. It’s a challenge we have all the time in life.”