Podcast Transcript

Episode 70: Blood Sugar and Diabetes Care Without Blame, Shame or Stigma with Janice Dada, CEDRD, CDCES, & Certified Intuitive Eating Counselor

[Bouncy theme music plays.]

Sam: Hey, I’m Sam.

Ashley: Hi, I’m Ashley, and you’re listening to All Bodies. All Foods. presented by The Renfrew Center for Eating Disorders. We want to create a space for all bodies to come together authentically and purposefully to discuss various areas that impact us on a cultural and relational level.

Sam: We believe that all bodies and all foods are welcome. We would love for you to join us on this journey. Let’s learn together.

Ashley: If you have ever been the recipient of weight normative care  or care that suggests you need to lose weight  and then X will get better, then you can imagine how frustrating it feels when you cannot succeed.  You know the self-shamed flag that flies high.  You may even have decided to not go back to the doctor due to not wanting to be told that you didn’t do it, quote, good enough. This stigma exists in so many areas within our medical fields and especially within folks who are diagnosed with diabetes and or quote, pre-diabetes.  Our guest today is Janice Dada, a certified eating disorder registered dietitian, certified diabetes care and education specialist and a certified intuitive eating counselor.  Janice recently published her book, Intuitive Eating for Diabetes, The No Shame, No Blame, Non-Diet Approach to Managing Your Blood Sugar, and we were able to sit down with her to discuss how folks can manage their diabetes and blood sugar  with other approaches and tools rather than focusing on losing weight.  Also, I would just personally like to say that this material can literally be used for anyone who has ever been told that losing weight is the only way that their symptoms will improve.  So is this book helpful for those with diabetes? Definitely.  Is this book also incredibly helpful for literally anyone, especially someone that needs support advocating for themselves and their non-weight loss approach at the doctor? Absolutely.  To give you a little bit more about Janice, she is the owner of SoCal Nutrition and Wellness, a private practice in Newport Beach, California.  She specializes in helping individuals and families optimize their health, wellbeing and eating behaviors.  She offers personalized nutrition counseling using a non-diet, weight inclusive framework,  which means she helps clients work on health behaviors  rather than promoting eating rules.  She uses a client-centered model of care and guides and supports her clients on their personal nutrition and wellness journey, which could be to improve the health outcome, improve their relationship with food and body image, to learn how to properly fuel for a sport, or best practices for feeding a family of people with different food preferences.  Janice’s approach incorporates evidence-based nutrition principles, along with an understanding of human behavior and psychology. This process looks different for everyone, and there is certainly no one-size-fits-all. For clients who have diabetes, Janice is one of the few dietitians who offer a weight-inclusive, flexible approach to manage the condition. Instead of the traditional, rigid approach to diabetes care, she uses her expertise as a diabetes dietitian, combined with her extensive background in intuitive eating and eating disorders, to ensure that her clients have the tools needed to manage their diabetes while also eating the food they love. Today, Janice will discuss her unique four pillars approach,  which she covers in her book,  Intuitive Eating for Diabetes.

Hi everyone. Welcome back to another episode of All Bodies All Foods.  Ashley here with my co-host Sam and we are super excited to share our guest with you today and talk about all the lovely things we’re going to talk about in today’s episode.  Our guest is Janice Dada, MPH, RDN and author of Intuitive Eating for Diabetes, the No Shame No Blame, No Diet Approach to Managing your Blood Sugar. This approach sounds incredible to me. It feels very freeing, and Sam and I have been so eager really since we came across this book to get Janice on the program. And so Janice, you’re here with us today. Welcome.

Janice: Thank you. So happy to be here. Thanks for having me.

Ashley: We’re so happy that you’re here. Kind of before we dive into all things about your book. I was just curious if you could give us a little background about yourself, how you kind of came into this work, how you started working with diabetes, all of that jazz. 

Janice: Yeah, I got interested in nutrition specifically when I was playing high school sports. And then also kind of around the same time, you know, I became more aware that my grandfather had type two diabetes and he actually passed when I was 17 from complications related to it. And my mom also had gestational diabetes while pregnant with me. And at that age, I had no education in nutrition, and I didn’t know anything about diabetes other than kind of what I heard people around me saying. And so then as a nutrition student in college, obviously got a lot more. And even from there kind of going and I did my master’s in public health, as well, and sort of getting the sort of individual approach in college in terms of here’s what you say to somebody or here’s what you instruct them to do to somebody who has, for example, diabetes, and then going into a public health field where it was really looking more globally at like,  here are the socioeconomic implications  of environments and how they impact people’s health. And then really from there going into working one-on-one with people and hearing their stories about the messages they’d receive about the diagnosis, the instructions that they’d receive about how to manage it,  really just kind of over the years of working with clients helped me to kind of develop a framework based on, of course, the original intuitive eating principles that I felt fit it so well because it really made people, you know, in charge of their own bodies, where I feel like when they would get the diagnosis, they’d feel like they were no longer in charge. And now they just had to kind of have all this information dictated to them, which really was a big disconnect that I could see. 

Ashley: Yeah. Did you start to see that, you mentioned your grandfather was diagnosed when you were 17. Did you start seeing that kind of like him maybe feeling disconnected from his body or just kind of lik  having to do what the medical doctors did, you know, and just, I don’t know, did you start to see that in your own family system when you were that age?

Janice: He was diagnosed actually way before. He was diagnosed probably, I don’t know, 30 years prior.

Ashley: Oh, okay.

Janice: He passed when I was 17. And I think what I have been told, because I didn’t ask a lot of questions and didn’t really notice much, is he really didn’t have a lot actually told to him. And maybe it was because he was in a thin body, I don’t know, he had some other factors that may have given him some biases towards his treatment. I mean, I’m speculating, but he also was very interested in nutrition himself. And I actually found in his belongings, an old Ansel Keys nutrition book, was really fascinating. So, you know, my mom, I  think, had had shared with me that he wanted to try to manage it himself. And so I would love to, of course, ask him questions today or really kind of be in the room when he’d gotten information about his diagnosis. But in addition, of course, the way that it’s managed has changed as well. You know, in our field, we know much more about it at this point in time. So no, I don’t think that I saw that, although I think others around him would be like, “why are you eating that big bowl of cream of wheat” or “why are you eating, you know, all that jelly” or  things like that, think others probably  put their opinions on him. And my mom would say that she just didn’t think he ever really understood exactly how food and blood sugar worked, because he never had to check his blood sugar. He never really took medication for it.  But there were other consequences.

Ashley: Yeah. When you kind of came into the world of nutrition, did you plan on specializing in diabetes care and eating disorders? Or how did you kind of end up there?

Janice: I think I ended up there definitely. I actually did not plan on specializing in eating disorders.  Diabetes, I did always find interesting  probably because of that personal connection. And my first job was at the VA, and we had, I had also done my internship there, and we had a large population of veterans who had diabetes.  And I did diabetes classes and I worked one-on-one with them in an outpatient clinic. And I wasn’t really a fan of the way that it was sort of a one-size-fits-all approach to instructing people on how to eat with the condition.  And so I worked there for a couple of years and then went into private practice where I kind of got the opportunity to develop my own strategies for how I’d help individuals with diabetes. And that was also where eating disorders definitely showed up in my office without necessarily asking, you know, or, you know, kind of marketing myself as an eating disorder specialist. So I did get more training from there because it was clearly a need and it was clearly something that people were struggling with. 

Sam: Janice, you said something that really stood out to me when you were talking about your grandfather and you said, “I don’t know if he got different information because he was in a thin body.” And I feel like it’s hard to have this conversation today without acknowledging the quote unquote obesity epidemic that we hear about so much and its influence on medical care. And in your book, there’s a quote I want to just read here. You wrote, “despite the lack of evidence to connect weight with cause for disease, the American Medical Association decided to label obesity in quotes as a disease,  overriding  a committee recommendation against this classification.  As a result, doctors were able to receive medical insurance reimbursement for, quote unquote, obesity management, opening the door for a standard of weight normative care, medical care that focuses on weight and weight loss as indicators of health and wellbeing.”

This is a really important quote, I think. I’m wondering what your thoughts are. How has weight normative care impacted the world of diabetes care?

Janice: I think it’s impacted it tremendously. I remember when I first learned of that information that I shared, it was through, probably through the book Body of Truth by Harriet Brown, which is a great book for those who haven’t read it. Like a number of years ago, I read it and I was like mad, you know, like  learning about, you know, because in school we were sort of presented to it as this is, this is fact, this is what happens. And then to learn that there’s all of these behind-the-scenes things happening,  I felt like was, was really frustrating, of course, right? And then to learn from there how its domino effect has implicated, you know, conditions like diabetes  and also,  you know, people’s life insurance rates and things, right? You know, when really there isn’t a direct health correlation, you can’t say that because somebody’s body is this size, they now are not going to live as long. And in fact, the research shows that people in the BMI, you know, quote unquote overweight categories actually live longer. So it’s completely backwards. And there’s so much stigma around diabetes  and being  people in larger bodies,  the association there, and so I think people get a lot of bias if they’re in a larger body that they get weight stigmatizing treatment where practitioners may assume that they have blood sugar problems or they may assume things about the way that they eat if they do have diabetes, really kind of disregarding all of the other factors that can lead to diabetes, such as genetics being a huge factor and  socioeconomic factors, which are another huge factor.  So weight normative care focuses on weight as a focal point of treatment. But we do have another way that we can practice, which is weight inclusive care, which is really looking at other factors that have nothing to do with weight as our ways to approach health. And so those factors could be getting enough to eat, looking at environments, looking at movement patterns, looking at stress reduction, that there’s a whole host of things that we could use as potentially health promoting factors that have nothing to do with weight. And I say potentially health promoting because also health is never guaranteed regardless of what we do, right?

Ashley: Right.

Sam: Right. I’m so glad you’re bringing up social determinants of health. We talk about those things a lot on this podcast, and we’re pushing against an entire culture that wants us to believe that weight loss will always make you healthier and that the onus is on us as individuals to  achieve optimal health.  You know, there’s so many messages out there. 

Ashley: Janice, we were talking before we started recording and even just to piggyback on what you were saying, Sam, the diagnosis of pre-diabetes and how I think the statistic, and you can correct me if I’m remembering this incorrectly, was 59 % of folks diagnosed with pre-diabetes, nothing ever came of that, absolutely nothing.  So for them to then engage in the, quote, weight normative care, which would suggest weight loss and focus on their body shape and size, did absolutely nothing for them.

Janice: Yeah, and I can tell you, read a little bit more about this study specifically. It was a 2018 comprehensive review that looked at 103 studies and it showed that most people in the pre-diabetes range never actually progressed to diabetes over any period studied.  And in fact, your 59% was correct. 59% of the pre-diabetes patients studied returned to normal blood sugar values  in between one and 11 years without any treatment. So that meant they essentially left them alone, didn’t give them a medication or something like that and that they actually were able to return to  normal blood sugars without that intervention. And I think the argument about pre-diabetes that can be made is if we start giving people medications for pre-diabetes that are truly diabetes medications, are we really just fast tracking them and essentially saying that we have a new cutoff for diagnosing diabetes? Because those aren’t prediabetes medications, they’re diabetes medications.  Rather than us, you know, sort of to be curious and just kind of see what the numbers are doing or talk to an individual about their sleep and their stress and their water consumption and  their nutrition intake,  you know, we’re instead sort of saying like, :oh, there’s this big problem, let’s address the blood sugar immediately.” Whereas we could actually probably do much better with looking at some of the other factors that could potentially be putting blood sugar into a range that is maybe not what we expect, but also not in the diabetes range.

Ashley: Right. And I just want to note that when we’re looking at that, I guess, or the medical professionals are looking at that, I think something that gets negated is mental health, and the stressors that that puts on somebody.  I had a client that came in, like, I think it was literally six weeks after giving birth and got labeled as pre-diabetic, and just, and you all likely know, postpartum can be so intense in and of itself, so much postpartum anxiety, postpartum OCD, postpartum depression.  And then she was given the diagnosis of pre-diabetes and the mental weight, the mental heaviness that she had on her now, she was just in a constant downward spiral because of this diagnosis. So I think that we have to pay attention to that too, because it really, really can affect our mental health, as well.

Sam:  Well, and doesn’t stress impact blood sugar?

Janice: And hormones.

Sam: That’s the irony on it all, right? Let me stress you out and make your blood sugars worse. 

Janice: Well, I think you bring up another important point, is like, why is somebody that’s at six weeks postpartum getting labs to look at diabetes outcomes or blood sugar? Right, we also know that if they had their, and I used to teach or kind of lead a group that was new moms, and we’d talk about nutrition and, you know, they’d share all their kind of body concerns. And I’d also share that if you had labs taken right now, your cholesterol will likely be high because your body is still getting its rhythm back, right? Like there are so many things that are affected by the fact that you’ve just given birth, that it’s really not a time to be checking these labs anyway. We should be instead asking like, how are you doing?  Assessing for postpartum depression and physical discomforts and things like that. And I also had a teenager who had blood sugar labs taken as well, who it sent his family into a spiral when he was 0.1 into the pre-diabetes range for his A1C. You know, this was like, and I wrote about him briefly in the book. He was a varsity basketball athlete, also in a thin body and was now restricting his food and felt like he couldn’t eat carbohydrates as an athlete. You know, we could ask the first question, why were we having even taking these labs? He’s not presenting us with symptoms or reasons for us to be testing it. And also we have to look at the big picture here. Do we really suspect that there is an issue? Would we really want to restrict carbohydrates in an athlete who’s growing still?

Sam: Right. My mind goes immediately to now we’re introducing all these risk factors to an eating disorder. You know, they’re restricting, you know, if you’re an athlete, you might even be in an energy deficit.  And I’m thinking all the red flags are coming up for me that this is making someone vulnerable to actually developing a potentially fatal disorder.

Janice: Absolutely.

Ashley: Yeah, so one of those that you mentioned actually that is a risk factor to developing an eating disorder is the concept of weight cycling, which we might see with the current normative medical care and encouragement to lose weight when somebody gets diagnosed with diabetes.  So I’m curious if you can explain more about what weight cycling is, how it may occur within the normative medical care, and why it presents as a danger? In addition to that, what implications does it carry for somebody that might be developing an eating disorder or be kind of on that cusp to having a disordered relationship with food?

Janice: Yeah, weight cycling is the losing and gaining of weight, the same or more weight. And so often we can sort of tie it to diets or restrictions. And it’s been shown to be pro-inflammatory. It might cause fluctuations in things like cardiovascular risk factors, like blood pressure or heart rate. Also been shown to increase one’s risk of developing type 2 diabetes. And it’s really ironic because the prevailing notion is when somebody’s diagnosed with type 2 diabetes, they are often told, regardless of their body size, to lose weight in order to control their blood sugar. And so when this is repeatedly unsuccessful, it essentially puts them at risk of continuing the weight cycling over and over and over again.  And so several research studies have supported the value of using the principles of intuitive eating in managing blood sugar with diabetes. And, you know, because when we adopt intuitive eating principles, we are no longer striving for weight loss. That doesn’t mean the thoughts or the desire for weight loss are gone. I think sometimes people feel like they are quote unquote doing it wrong when they’re still sort of wishing that they would lose weight or thinking about losing weight. It simply means that we have put that off on the back burner. We understand that it’s a thought which comes from diet culture and our programming, but that we’re not pursuing it anymore, and that can help us to not weight cycle anymore, which essentially can reduce our risk. And so there was actually a study that looked at people with type two diabetes who weren’t on insulin and found that intuitive eating was associated with an 89% lower chance of having poor glycemic control. While another found that it increased body satisfaction, which makes sense because we are kind of coming to a level of acceptance. So weight cycling is correlated with negative metabolic health outcomes. So including diabetes, like I mentioned, and heart disease. And so if somebody’s feeling worried that they have weight cycled because they’ve dieted in the past or they’ve had a past eating disorder, they’ve restricted.  I certainly can understand that worry and our best option at the moment is really to just try to remove the continued pursuit of weight loss or body changes so that we stop doing the weight cycling. 

Sam: So weight cycling and we hear this term yo-yo dieting, are these terms interchangeable? Because I know the public might be more familiar with the concept of yo-yo dieting?

Janice: Yeah, I would say they’re interchangeable because they sort of lead to the same effect.  So we’re describing the starting of a diet, maybe there’s some initial weight loss. Oftentimes, people will say that they’ve lost the most weight on their first diet, which I think really allows them to think that it’s a possibility. They blame themselves when it doesn’t work. And by work, I mean that they’ve regained their weight and oftentimes more than they actually lost. And so then they start again or they try something new. And since diet culture is so sneaky and clever, everything gets renamed and repackaged. And so people think that it’s new when it’s really all the same stuff just packaged differently.

Sam: Right, right, exactly. So I’m glad you brought up intuitive eating and I was hoping we can talk a little bit about that. I was wondering your book is the “no shame, no blame, non-diet approach.”  And you, sounds like you were really inspired by the work of, there’s a book called Intuitive Eating. I was wondering, were there parts of this work that really inspired you? And, you know, how did you come up with this idea to write this book?

Janice: Yeah. So I’ve known both Evelyn and Elise, the co-authors of Intuitive Eating for many years. I actually share an office suite with Evelyn. We have our own spaces, but so we bump into each other from time to time. And Elise actually wrote the foreword of this book.  And so I did a lot of training with them over the years when I was a younger dietitian and I am a certified intuitive eating counselor. So I was familiar with the research. I was also familiar with using this approach with clients and knowing that it felt like, you know, it felt like a compassionate approach that really led people to better nourish their bodies, to heal their relationships with food.  And I also have been a certified diabetes educator or now called Certified Diabetes Care and Education Specialist,  lengthy.  And so I’ve been both and you know, had a client and I’ve had many clients who been like, can I do both together? And, you know, my answer was absolutely, you can do both together. And so I actually wrote of three of such clients in the last chapter of the book who were willing to kind of allow me to share more details about their journey with both having diabetes and eating intuitively and working on the intuitive eating principles.  And so that kind of made me interested in providing this information on a bigger spectrum, right? So that more people could understand how do you do this?  And so that’s kind of how I arrived at this method.

Ashley: Would you be willing, could we walk through kind of the four pillars of this care and could you share with us about those?

Janice: Yeah, sure. Okay.

Ashley: So number one, establishing a diet-free mindset as the first pillar of intuitive eating for diabetes. We’ve talked a little bit about that. Anything else you want to add to it?

Janice: Yeah, so I mean, basically in this pillar, we’re looking at the 10 pillars of intuitive eating or 10 principles of intuitive eating. Using the intuitive eating assessment scale, which is now in its third version, which was developed by a researcher named Tracy Tilka and her colleagues at the Ohio State University. And then also exploring eating styles that may undermine intuitive eating. This is where somebody is really assessing like how does a diet mindset or past dieting experiences or my thoughts around food or my body impact my ability to be intuitive?

Ashley: Yeah, that sounds like that might take some work.

Janice: It’s a principle that may make people may want to stay with for a bit or they also can come back to it.  I actually often have clients who, you know, sort of make their way through the different aspects of intuitive eating and then find themselves needing to come back to principle one, which is about rejecting the diet mentality because something may have happened in their life. They may have had another doctor’s appointment or they may have had a baby or they may have a friend who’s dieting, right? That there’s things that may make them question what they’re doing that they want to go back and remember, “oh, here’s why I was rooted in a diet free mindset.”

Ashley: Yeah.

Sam: From your perspective, what do you think are some really common ways that dieting gets in the way of intuitive eating? Would you be able to give an example?

Janice: Sure. And actually, I think we can even think back to like, if you’ve ever been around kids or seen kids eating, you are probably aware of this, but I also really love the research of Leanne Birch from the  90s, which really looked at the ability for children to self-regulate if given the opportunity to self-regulate, right? And so this study demonstrated that kids often eat inconsistently meal to meal, but that their intake over the course of a day was actually relatively consistent from one day to the next.  And so it really kind of establishes this like ability or this option to trust the body, right? That the body can guide you and that we’re born with that ability. And I also talk in the book about, you know, if you’ve ever seen a baby who’s breastfeeding, they’re put to the breast, they drink, when they’re done, they’re done and you cannot get them to drink more. And if we’re being attuned with bottle feeding, we’ll also see that too, right? And that is our natural inclination as humans when we’re born. And then somewhere along the way, it can often get lost.

Sam: Yeah, we unlearn it.

Janice: We unlearn it, whether it’s from, you know, being told to clean your plate or being told you’ve had enough of that or you can’t eat this kind of food or you have to eat more, right? These ways that we pressure, can lead to that. And also when we’re telling ourselves that we can’t, as adults, eat something because we’re on a diet or we’ve been told we have a medical reason to not do it, that that also moves us away from being able to be intuitive. And so I see this as a way of kind of getting back to our roots, that we have this ability to trust our body, but we have lost that trust along the way. So we need to have a reconnection so we can trust again. And that can take time.

Sam: So a history of dieting erodes our own trust in our body’s ability to self-regulate.

Janice: Right. It’s external forces that take away from our ability to hear and sense the internal information that we do have leading to, you know, that’s sort of the science of introspective awareness. And sometimes people really relate to introspective awareness when they think of it as like recognizing a full bladder or recognizing sleepiness, right? These are ways that our bodies communicate with us that we probably don’t deny. Like we won’t deny that we have a full bladder, but we might deny that we’re hungry, right? Like self-silencing hunger, people might do that. But if we kind of compare it to, are you going to tell your body that you actually don’t have to pee when you do have to.

Sam: Or feel like guilty and ashamed, like I can’t believe I have to pee again.

Janice: Although, yeah, although I have had some people tell me that sometimes they do, they do do that. So it’s sort of another layer of body trust that we can kind of work on reconnecting with.

Ashley: I love this topic. I love hearing about this. Sam knows this, Janice, I have a three-year-old, and so  I feel like I’m very much in this space that you’re talking about and it is fascinating. It really is fascinating to watch her cues and when she’s hungry and for her to feed herself and for her to stop when she’s ready to stop.  And one of, you know, I was, I was pretty nervous about this. I have, my three-year-old is a girl and I, you know, grew up as a female in diet culture and was pretty worried about,  you know, passing on messages that maybe were passed on to me. And so I spoke with a good friend, an eating disorder dietician in Nashville was pregnant, and her words were “you decide what she eats and she decides how much” and it’s just so helpful. And like my husband and I really are kind of wrapped around that, you know, and  so like having that has been really helpful.  But then also just kind of watching her navigate this has been really helpful and eye-opening for me, both personally and as a professional in this field.

Janice: Yep, yeah, I can totally relate to that because I also have children. I have a daughter who’s now 13  and a son who’s 10, but getting to watch firsthand, implementing  or really setting them  up in a food environment that is built on their own body trust, what that looks like and that any worries are my own worries and I need to keep them to myself. Which I think is, you know, every parent is going to have a worry about is my kid eating enough? Are they not eating enough of this thing? Are they eating too much of something else? Are their bodies growing the way they’re supposed to? All totally normal to worry about that. We just have to keep it to ourselves, right?  And I think being able to watch kids grow and develop  using their own ability to be intuitive, really just for me, like highlights how important this work is and how much I want others to really be able to access it too.

Ashley: Yeah. Yeah.  And I would say it also helps us see really how damaging I would say like diet culture and any of this has been for us.  Okay. So moving on, pillar number two, prioritizing self-care. Do tell us about that.

Janice: Yeah, so self-care is the process of attending to one’s needs, both physiological and emotional.  And it’s been found to be associated with better physical, emotional and mental health. So it’s engaging in health promoting habits. So that could include relaxation, taking time for rest, physical care, which includes giving ourselves enough fluid and food and whatever kind of movement we have access to and that feels good for us. It also includes things like self-compassion and having supportive relationships. So it’s beyond the bubble bath, which I think is what people think of when they think of self-care. It’s thinking of what are all the things that I can do that tend to my body?  If we think of a car, all these things that we have to do, rotate the tires, change the oil, and whatever else. I don’t know much about cars. But that we are also kind of taking care of our body in all of those different ways that they need to be taken care of.

Sam: Beyond the bubble bath. I feel like that could be a book, you know.

Ashley: Or the title of this episode.

Sam: Yeah, Yes, oh my goodness. Yeah, you know, just a good reminder of all the ways that we can take care of ourselves that have nothing to do with weight. Because I feel like a lot of people, their minds go to, if I want to get healthier and I want to take care of myself, I have to lose weight. That’s like always the message, and self-care, I mean, even learning how to express your emotions and express your needs is part of self-care. I think a lot of people forget the psychological aspects of self-care.

Janice: Right. Setting boundaries, saying no to things. Like that’s self-care, right? You have now protected your own wellbeing. 

Ashley: Well, and what I also think people forget is that how self-care impacts our hunger/fullness cues and our intuitive eating and our need to nourish ourselves. This is, I think this is awesome that this is one of the pillars is self-care.

Sam: Yeah. Self-care.

Ashley: Okay. So number three, focusing on gentle nutrition. Can you tell us more about that?

Janice: Yeah. So gentle nutrition is the 10th principle in the10 intuitive eating principles. And so here I’m highlighting it as a third pillar of intuitive eating for diabetes, which really just includes choosing food that honors your health and your taste preferences and also helps you to feel good. It’s not about weight loss and it’s not about food rules. And so in this chapter, I do also go through the nutrition facts label, because I think that’s a big area of confusion for people, especially when it comes to serving sizes and carbohydrate grams and sugars, right? So I go through that kind of line by line to really explain what does all this mean and how do you use it or not use it for your own well-being. And then I also go through, you know, kind of the different food groups and how do we build a balanced plate using your preferred foods, which includes cultural foods.  Unfortunately, many people have been told to just discontinue using foods that are staples in their cultural diet, and so that doesn’t have to be, we can fit everything onto a plate and still manage blood sugar.

Ashley: And then the last one, creating an individualized treatment plan.

Janice: Yeah, so this in this chapter, I go through medications.  What are they? How much do they reduce A1C based on the research, lab tests,  dietary supplements, not an inclusive,  not an all-inclusive list of dietary supplements, but I review a few that are kind of hot topics and that do have some evidence behind them.  And so really kind of reviewing some of the factors that somebody can take to their clinician and kind of play an active role in their diabetes treatment decision making so that they don’t feel like they are being dictated to, but instead it’s more of a partnership.

Ashley: Yeah, that’s awesome.

Sam: Collaborative, individualized. You talk a lot about, you know, finding a diet-free lifestyle that works for you.  And what did you mean by that exactly?

Janice: Yeah, so those four pillars were in part one of the book, and then part two is all about taking that and finding the diet-free lifestyle that works. And so that includes things like self-advocacy and partnering with your health care team. So that might mean setting boundaries, and I do include a resource to a letter that can be shared with a health care practitioner, which, you know, outlines some of the research behind intuitive eating and diabetes management together. And so that can be used if somebody would like to. Also, diabetes care your way, which can mean using foods that are going to be in cost, you know, that are going to be cost effective. I go through some budget-friendly food fines. Also talk about body image in this chapter. And so like I mentioned, it might mean setting boundaries with clinicians and vocalizing needs so that you don’t come into an appointment feeling like, “well, I didn’t get any of my questions answered and I was just sort of talked to.”  And also advocating for things that are necessary, like if you need cost-effective medications or you need to make sure that your clinician prescribes a generic so that it’s not going to break the budget each month. And then also I talk about values. So how does somebody kind of figure out what’s important to them so that they can do the things that are in line with their values?

Sam: Yeah. So it’s really about creating a plan that takes into account everyone’s unique circumstances. I mean, everyone has access to different resources or there’s food insecurity, there are financial issues, there are issues with accessing care. And it’s really about how can we kind of work with what we have to create the best outcome?

Janice: Right, yeah, I do talk a little bit too about insurance coverage and ways that you can find coverage with this.  And also some of the information about like insulin because there’s been a lot of fluctuations in terms of insulin pricing and coverage.  So there’s kind of a lot to know and so it can be a lot to navigate. So I give some resources for that. And in addition, if people are living in rural settings and they can’t very readily switch to a new provider just because they don’t really like what the provider they have right now is saying or they’re not having a good relationship, that’s where the boundary setting can hopefully come into play, where somebody can use that information so that they feel like they have, they are armed with the knowledge to get what they need at an appointment.

Sam: Yes, I love this letter that you talk about that you have in your book because I think sometimes with advocacy, sometimes all we need is just a script or like something to hand over because it can be really hard to advocate for yourself, especially when there’s a power dynamic. It’s like there’s this doctor and you feel like maybe they know more than me and I’m afraid to speak up. And I was just curious about this letter. What would be a situation where someone could hand this letter over?

Janice: I think in any situation, you know, where they’re going to either a new provider or a provider that they’ve already been seeing, because it’s really aiming to just say, “hey, I am using a weight-inclusive, I would prefer for you to use a weight-inclusive approach in my care. Here’s what weight-inclusive care means to me. I also strive to eat intuitively. Here’s what eating intuitively means.”  And it cites some of the references so that for a medical, clinician, whoever they’re seeing wants to actually look to the research on it, they can also see that  there is  support of the approach.  And this is really motivated by the work of Regan Chastain who has for years, in publishing her What to Say at the Doctor’s Office cards, which are so great.  They are available for download on her website. I do mention her in this chapter, too.  And it’s really just a very simple boundary setting exercise that she’s had. So she has always said, like, you could either hand these over, you could say them yourself, you know. And so I think whatever feels available to the individual. Sometimes you’re right, when you get in the room,  there’s a power dynamic and you no longer feel like you have kind of the ability to carry out the plan that you had in your mind.  So having it printed out can be helpful, because you could be like, here’s what I wanted to say to you.

Sam: Yeah, so it’s a tool that you can use at the outset with really any treatment provider just to make it super clear what your needs are, what your expectations are, and so that you can work together in the best way possible.

Janice: Yeah, and I find that most providers are receptive to that. I’ve had to call providers on behalf of my clients before. And even when it’s clear that they do work in a more weight normative way, they are willing to understand and appreciate what we’re asking.

Sam: Wow, that’s encouraging. They’re able to adapt. That’s really good.

Janice: It doesn’t mean it’s going to be perfect because they may not, of course, recognize some of the things that they say or do, but sometimes they just don’t even realize that, oh, the scale being out in the hall for everybody to see and you asking somebody to get on the scale, they may not recognize these practices until they’re really brought up to them. So in some ways, this can be a way for things to shift potentially in a provider who does want to treat their patients well and cares about their patients, which I think most providers do, right? That’s why they’ve got into the field.

Sam: Absolutely, yeah. It increases awareness of what’s going on and how they can change what they’re doing.

Ashley: Janice, I’m holding the book. Oh, you can’t see it. There it is. Right now, I’ve been just referencing it as we’ve been talking. And first of all, I just want to say, you know, I don’t have diabetes and I found this so incredibly helpful. And I don’t think that we have to have diabetes to read this book. So I just want to say that I think it’s pretty incredible. Also, it feels very freeing to me to kind of live by these pillars and the intuitive eating principles that we’ve referenced here.  And it’s so fascinating because it feels like in weight normative care with diabetes, the one and main goal we get pigeonholed into, again, it’s just the weight loss. The weight loss is going to fix everything. The weight loss is going to fix everything. And that to me feels very like boxed in and restrictive.  This feels like freedom, you know, like it just feels incredible to me. So anyway, I guess all that to say is would there be anything else as we kind of wrap up that you would want to share with our listeners anything else that you would want them to know about your book or about taking care of themselves in this weight inclusive care with diabetes, with pre-diabetes, all the above.

Janice: Yeah, well, I’m so glad that it landed that way for you, because I do think that it can certainly be helpful to somebody who also who does not have diabetes. You could kind of insert another medical condition there for sure. Or you could just kind of use it as a way to approach, you know, navigating the world of health care, as you know, we’re all probably going to encounter an interaction that maybe feels judgy or it feels very like we’re being dictated to. And so I would say if somebody’s ever had high cholesterol or another lab that’s out of range, I mean, even going to the dentist can feel like that sometimes, right?  So, you know, I do hope for it to be feel like a supportive way to feed yourself, to take care of yourself, regardless of what medical condition you have. And it’s certainly not saying like forget about your blood sugar numbers or forget about your lab results, but it’s addressing that we can address those conditions and those concerns in a number of ways that don’t have to focus on weight loss or on restricting foods. So, a great place to start is by thinking of how can I be more self-compassionate and really rejecting those tactics that are rooted in diet culture, right? And it’s challenging in the culture that we live in because our culture is obsessed with thinness and also wellness and health pursuits are often diets in disguise. So we have to be a little bit more detect, you have our detective hats on to figure out how to navigate that.  Hopefully this can help.

Ashley:  Yeah. Can I just add, so that self-compassion piece, I literally had a client this morning, we were talking about this high cholesterol and the self-compassion piece, think one of the best ways that that can be incorporated is to say,  why would my brain not have taken me down this need or desire to lose weight? Because that is literally like the messaging that’s like thrown at us.  So I just want to acknowledge that again and say like, y’all, please practice self-compassion because it…no wonder. mean, we live in a society that is so weight-centric and fat-phobic. And so, of course, these are the messages that we might even send ourselves initially.  And then as we grow in our tools and we can reject that messaging, you know, we begin to grow. But I just wanted to make that note on the self-compassion. I think it’s so critical.

Janice: Absolutely. Yeah. Saying things to ourselves like, other people struggle with this too. Like, it is not just me. It is not something I’ve done. It is something that others are also experiencing.

Sam: Right. That’s so validating.  Janice, thank you so much for being here.  I’ve learned so much. We’re so appreciative.  And we’re just so happy to alert our audience that your book is available. I think it can help so many people.

Janice:  Thank you so much. It was great being here.

Ashley: Thank you for listening with us today on All Bodies, All Foods, presented by the Renfrew Center for Eating Disorders. 

Sam: We’re looking forward to you joining us next time as we continue these conversations.

Ashley: Thank you for listening with us today on All Bodies. All Foods. presented by the Renfrew Center for Eating Disorders.

Sam: We’re looking forward to you joining us next time as we continue these conversations.

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