Author: Green Apple Dietitian

Cindy Dexter, RD, CD

Type 2 Diabetes. When family history makes a healthy lifestyle ALMOST irrelevant.

~ Green Apple Dietitian ~ Leave a comment

I’ve known for a while that diabetes was always a few steps behind lurking in the background. Eventually, it will catch up. Why? Family history. With five family members who have the disease, I understood a long time ago that membership in this club wouldn’t be optional. During my last physical, the doctor focused on abnormal lab values indicating diabetes could still be a reality. But of all the diseases I could end up with, diabetes is a disease that can be more or less of a burden based on the choices I make.

For most of my life, I did a decent job taking care of myself, but I also did two of the best things anyone can do for their health, quit smoking cigarettes and drinking alcohol. These habits in tandem make any effort toward a healthful lifestyle useless.

As a teen, taking up smoking was a window to the in-crowd and a way to rebel. What I felt was a symbol of freedom would’ve been a severe detriment to my health if I continued. Luckily, there were enough people around who reinforced the harmful effects of smoking. After a while, I stopped smoking altogether.

The best way to describe my alcohol intake was problematic binge drinking. Like many of us, having a few made socializing easier. I abstained from alcohol use during the week, but I wasn’t a person who could stop after having just one. Luckily again, someone close to me nudged me toward better health. I stopped drinking altogether.

Alcohol abuse puts patients at risk for diabetes. I’ve met patients in my practice with a history of alcohol use disorders and a prediabetes/diabetes diagnosis. Most of them were admitted with a metformin prescription and were confused as to why their bodies became insulin-resistant after they stopped drinking. One patient believed it was a punishment for their detrimental habits.

The World Health Organization published its views this year on the unhealthy effects of alcohol and the National Cancer Institute maintains ethanol and ethyl alcohol as carcinogens that contribute to many types of cancer. Click on the links above to read more.

Did alcohol use increase my risk? I don’t know for sure, but heredity on the other hand isn’t something I can change. My mother was diagnosed with diabetes over 10 years ago and her brother and sister also around the same period. My father died of complications related to the disease. In 2018, my brother lost his toes to gangrene from uncontrolled hyperglycemia.

Becoming a dietitian helped me support my mom in many ways and I learned more by observing her experiences. I remember going with her to her first appointment with the diabetes educator when she said, “I want to control my diabetes.” A phrase she kept true to this day by keeping her appointments and doing what her practitioners recommended. She’s been a positive role model for me as she rose to the challenge of necessary lifestyle changes. I’m proud of her for it.

There isn’t a clear path to heredity when it comes to diabetes, but does this mean I shouldn’t care for my health since I probably won’t prevent it? I can’t say what the future will bring if I become insulin-resistant enough to start treatment, but the life I’ve lived so far has put me ahead of the game. Diabetes complications can range from neuropathy, heart disease, renal disease, and gangrene, but this doesn’t have to be my story or anyone else’s.

Knowledge and insight are my best defense against this disease. As my journey unfolds my experience with diabetes will give me an edge to help patients who are motivated to maintain their health.

When to see your physician

Insulin resistance is when the body doesn’t digest glucose properly, it overstays its welcome in the blood. When the insulin in your body isn’t stimulating liver, muscle, and brain glucose metabolism to remove it from the blood, elevated blood glucose levels eventually affect the heart, blood vessels, and kidneys.

If you’re at risk of developing diabetes, there are a cluster of three symptoms to discuss with your doctor, like increased:

  • HUNGER: when meals aren’t satisfying or there are perpetual cravings for sugary foods
  • THIRST: unable to quench thirst even after drinking adequate amounts of fluid  
  • URINATION: are you always in the bathroom?

Other symptoms include fatigue, blurred vision, slow-healing wounds, and weight loss. Have you lost significant weight recently but are unsure why? Unexplained weight loss related to hyperglycemia isn’t healthy. Along with the other symptoms, it signals that your body isn’t producing enough insulin or metabolizing insulin appropriately.

If you have any combination of these symptoms, make an appointment with your doctor, don’t wait.

Counting Carbs

Since the 1920s, tracking carbohydrate intake with insulin or other diabetes medications has been the gold standard for managing hyperglycemia for patients with type 1 diabetes. However, researchers continue to explore the efficacy of tracking for T2DM. Recently the medical community has been moving away from it. The American Diabetes Association offers a diabetes plate approach similar to MyPlate. More recently patients informed me that their endocrinologists don’t emphasize medical nutrition therapy while using glucose meters and insulin pumps. My RD brain thinks they should’ve been referred to a registered dietitian diabetes educator. In my experience, MNT should be tailored to the individual. Some patients are more willing than others to utilize education, while others want to be told what to eat.

Avoiding carbs altogether is never the right way to go. Even with hyperglycemia the body still needs adequate carbohydrates. Your muscles and brain need them to function. Avoid listening to negative messages about carbs and learn why the body needs them. Arm yourself with education from trusted sources. Avoid Clickbait websites offering cures using vitamin supplements or other unproven remedies. There’s no cure for diabetes and spending too much time looking for one is a sure-fire way to miss out on healthy successful management.   

Get enough fat in your diet

I’m old enough to remember the fat-free frenzy in the 80s and 90s and guilty as charged following it without questioning it. Society learned its lesson with a hungrier population that overconsumed carbs.

A balanced diet includes heart-healthy fats in avocados, nuts, seeds, and fatty fish. Fat adds flavor to food and helps us feel fuller longer. The jury is still out on whether saturated fat should be limited for heart health, but it’s important to remember your overall dietary intake and eating behaviors. Even so, to manage diabetes, I don’t recommend the Adkins or Carnivore diets.

Avoid high-protein fad diets

Fat-free mania gave way to the protein obsession that’s evident at every grocery store. Everywhere we’re told we don’t get enough of it, and of course, there’s a product to help with that. Healthy people on a regular diet, while not restricting their dietary intake, usually consume enough. Overconsumption leads to weight gain and is harmful to the kidneys, especially with the overuse of protein powders and supplements.

Get moving

Physical activity improves muscular, skeletal, and cardiovascular fitness while it improves glucose metabolism. If you are sedentary, look for opportunities to move more. I know it’s easier said than done, there are barriers to exercising and it’s never easy to start. How can you increase activity by making it part of something you enjoy? I like to hike in state parks to get fresh air while watching the butterflies and bees interact with the native plants. You don’t have to join a gym or jog on the side of the highway. Check with your doctor before starting any exercise program if you’re experiencing any health issues.  

Take care of your mind

Receiving a diabetes diagnosis can be a slap in the face for some patients. It’s usually followed up by the overwhelming education from health practitioners which results in information overload. It’s understandable to feel a range of emotions after going through that. There’s nothing wrong with letting things settle and giving yourself time to process it all.

Even though I mostly accepted my situation, I can’t help but wonder if there’s something else, I can do to prevent a diagnosis. Deep down inside I hope for a cure. But then I think of the privileges I was fortunate to possess for maintaining my health and how my choices benefited me later in life. I also believe that if there is breath in your lungs and a beat in your heart, it’s never too late to keep learning and doing.

Plenty of research points to weight loss for diabetes management. Science continues to evolve and rarely considers a patient’s individuality and how they think and feel. I recommend staying focused on improving your body’s physical fitness and making necessary dietary changes. Your weight will trend accordingly because your body will respond to how you treat it. Steer away from black-and-white thinking: good foods vs bad foods or thinner bodies are healthier than larger ones to avoid increasing anxiety and allow for an open mind. Self-blame and unacceptance won’t move you forward. To reach your fullest potential, accept what nature gave you then maximize it.

DISCLAIMER: The Green Apple Dietitian blog/Substack provides nutrition information for education only and is not intended to offer medical advice or cure any health conditions. The content should NEVER be used as a substitute for medical advice, diagnosis, or treatment of any health condition or problem. Any questions regarding your diet and health should be addressed to your specific healthcare providers. NEVER disregard professional medical advice or delay seeking treatment because of something you have read on this blog/Substack website or social media.Green Apple Dietitian makes no warranties expressed or implied regarding the accuracy, completeness, timeliness, comparative or controversial nature, or usefulness of any information posted or shared on this blog/Substack. Green Apple Dietitian does not assume any risk whatsoever for your use of any information contained herein that was posted or shared on this blog/Substack in the past, present, or future. By accessing this blog/Substack, you agree that neither Green Apple Dietitian nor any other affiliated party is to be held liable or otherwise responsible for any decision made, or any action taken or not taken, due to your use of any information presented on this blog/Substack website or social media.

Wild and free as green as can be

~ Green Apple Dietitian ~ 1 Comment
Daily writing prompt
Tell us about your favorite pair of shoes, and where they’ve taken you.
View all responses

When I saw these green Crocs, they had to be mine. I bought them when I wanted to look different from everyone else. It was a time when I was feeling tired, resentful, and disillusioned. The downside of getting older. Those who get it know sometimes buying a new pair of shoes can be therapeutic.

At my age, it’s not the typical slide you’d see a woman wear. Yet I see women wearing the unexpected in my age group, more than ever. More women are putting on shoes that speak to their inner souls. When I got to be my age, dressing to impress mattered so much less than dressing for how I felt in the moment. Load and obnoxious was the remedy I was seeking.

Despite their brightness, they’re meant for comfort with the right pair of socks. But, “You’re not supposed to wear socks with sandals,” I often heard from members of the older crowd. Don’t let the Birkenstock people hear that. The socks in the photo come close to the ones I want to wear with these slides. But I haven’t found them just yet. I predict I’ll find them during a winter clothing sale. They’ll be the right color, the last pair on the rack, and deeply discounted. A satisfying purchase it will be when it happens. Until then, I’ll delight in the silliness of my well-worn socks sticking out of all the green that’s surrounding them.

January is over. How’s the weight loss diet going?

~ Green Apple Dietitian ~ 1 Comment

Around this time of year, diets lose steam as old habits die hard. Once that person brings donuts into the office again all bets are off. But I get it. I’m not on a diet to lose weight, but I’ve had my share of treats at the office. Treats are one thing but underconsumption has consequences, usually increased hunger, which affects our mood and energy levels, so, understandably, dieting fails.  

For those trying to lose weight, on some level, I think there are parts of dieting we can all agree on. For one, it’s hard to change eating habits for the promise of a better lifestyle in a thin body. What I’ll never agree with is that body weight is completely controllable, especially since many other variables exist. Our body reacts to everything we do to it.

If you’re losing weight and are feeling good about yourself for getting smaller, I hope that you’re not feeling deprived and forcing a big smile while your body suffers through the restrictions you’ve chosen to put on it. I hope you’re getting enough food, water, and sleep, and are managing the stressors in your life. One word of advice, try to accept yourself a little bit more in the moment.

If you’re wondering why I’m skeptical of your weight loss journey, it’s usually because the story ends with someone losing weight but goes no further. The aftermath of dieting is weight gain. The weight loss movement wants you to believe that the body’s normal reactions to deprivation are a failure.

Having an appetite isn’t your fault.

Forcing your will against nature is futile. While dieting the body will fight undereating by increasing hunger cues and turning on carbohydrate cravings. This makes sense since the body digests them first for energy and cognitive function. The body wants to maintain a stable internal environment despite changes in the external environment. So, it has nothing to do with willpower when all the body is trying to do is survive. If you understand this, it should make the promotion of weight loss, on an otherwise healthy individual, look very cruel and unempathetic.

I’ve observed significant weight increases in patients after severely restricting their eating and losing weight. They don’t understand why they lose out to binge eating. Reasons for restricting their food intake were usually anxiety-related. However, since they believed they were better at a lower weight, the weight gain was accompanied by feelings of failure, inadequacy, and depression.

Patients entering adulthood often fail to understand the changes in weight trends from high school to college. Somehow, along the way, they learned that higher body weight is unacceptable, so they had difficulty accepting their adult weight. We are all told at a young age to control our appetites and are bombarded with misinformed ways to do so. And now we have a pharmaceutically successful way to do so artificially.

Weight loss medications focus our attention on the high failure rates of dieting.

With the rising popularity of weight loss drugs, the cruelty of diet culture has accelerated. As of this blog post, the drugs are mostly available to those who can afford them.

Even the weight loss companies understand this and they’re scrambling to stay in business by offering versions of these drugs not approved by the FDA. Whatever your opinion is on this, remember there’s a company out there making money off your desire to lose body fat— a lot of money.

While looking at social media, I saw an advertisement for a high-profile weight loss company. I won’t disclose which one it is. A good or bad promotion equates to a promotion, nonetheless. Anyway, the ad promoted offerings of a compounded GLP-1 drug as part of their new and improved weight loss program. People can lose even more weight faster than ever before, blah, blah, blah. So, they thought putting sharps into the hands of untrained individuals (without diabetes) to give themselves injections using needles was a good idea, but I digress.

Then I browsed the comment section. What I found was surprising, yet it wasn’t. Most already know that weight loss is temporary. The range of responses included life-timers who started dieting again using old notes when their weight went up, those who wanted the old program said they needed the one-on-one counseling, and others who declared they were not falling for the dieting hype anymore.

Overall, the commenters were blunt about the company adding medication. One said they thought the weight loss program was great but hated the constant changes and gave up. They said it seemed like a way to make more money, “I’m over it!” Another stated they lost respect for the company when they started prescribing drugs, “Everything you preached is not true now.”

The commonality was disillusionment with a company that always promoted food modifications and exercise. With the addition of medication, it became obvious to some commenters that the old advice wasn’t working. This didn’t jive with what they thought they bought into.

Go deep on why you want to change the body you have.

If you have strong feelings of guilt and shame around your body image and food, you deserve to pause and discover what’s going on inside. Do you find yourself:

  • Unable to be flexible with food availability during family gatherings or unfamiliar environments
  • Following specific rigid food rules that cause you to skip a meal if it doesn’t follow the parameters
  • Avoiding hunger cues after missing meals to control weight or eating large amounts of food after a period of restriction
  • Spending most of the day thinking about food or your body
  • Feeling so much anxiety that it is difficult to meet your nutritional needs

If your thoughts and feelings are getting in the way of the positive intentions in your life, it’s time to take heed. Some things you can do:

  • Stop watching social media influencers and TV commercials about health and weight loss
  • Distract yourself by doing something you’ve been putting off for a while
  • Talk to someone. Find a dietitian and a therapist specializing in disordered eating. If your behavior concerns you and those around you, it’s already past the time to do something about it.

Don’t ignore the signs. Some folks can shake things off like a little weight gain while others can’t. It’s okay to ask for help if you feel you need it.

Treat yourself with kindness. Eating what you prefer, rather than following someone else’s advice can still lead to positive outcomes.

DISCLAIMER: The Green Apple Dietitian blog provides nutrition information for education only and is not intended to offer medical advice or cure any health conditions. The content should NEVER be used as a substitute for medical advice, diagnosis, or treatment of any health condition or problem. Any questions regarding your diet and health should be addressed to your specific healthcare providers. Never disregard professional medical advice or delay seeking it because of something you have read on this blog. Green Apple Dietitian makes no warranties expressed or implied regarding the accuracy, completeness, timeliness, comparative or controversial nature, or usefulness of any information posted or shared on this blog. Green Apple Dietitian does not assume any risk whatsoever for your use of any information contained herein that was posted or shared on this blog in the past, present, or future. By accessing this blog, you agree that neither Green Apple Dietitian nor any other party is to be held liable or otherwise responsible for any decision made, or any action taken or not taken, due to your use of any information presented on this blog website.