A Daughter on Father’s Day: Coping with His Absence

Some mornings, I wake up wishing someone would stop the Earth so I can get off. This Father’s Day morning is one of them. This year, I’m the same age my dad was when he died. He passed three months and 12 days before he turned fifty-six on Christmas Day. He always joked about how he was “ripped off” by having to share his birthday with Christmas. As a child growing up in a poor household, he got one gift for his birthday and Christmas. As a father of three, he showered us kids with way more than enough presents on Christmas morning.

If he were still around, I think he’d be proud of his daughter. A college graduate, married for 24 years, who is now heading towards retirement. It’s sad to think that if he were still around, my path in life might have been different. So, I chose to believe my accomplishments would have given him something to brag about.

My dad cared a lot about his family, but was controlling to a fault. The stories he told about his childhood illustrate why he did things his way and believed his way was the only way. He grew up with two brothers and a single mother. My grandmother suffered from alcohol abuse disorder. All I knew were bits and pieces of stories that were brought up in conversation. My mom told me my dad said he and his brothers would come home from school to find my grandma passed out. He also said how awful he felt one day when he saw his dad walking alone on the street. He hadn’t seen him for a long time and described him as a broken man. I don’t remember exactly how the conversation went, only that my dad was heartbroken.

As I saw it, during the last few years of his life, my father gave up living. He isolated himself from friends and family. His health took a turn for the worse. One of my darkest memories as a teen was visiting my dad in the ICU when a nurse asked my mother how long my father had been diabetic. My mom looked surprised and said, “I don’t know,” words she always used to deflect the harshness of my father.

Before ending up in the hospital, my dad drank 2 liters of soda every day. My mother recalled my dad saying his doctor told him he had diabetes, but he didn’t believe it. No one could tell my father anything, even trained professionals.

I always thought that my father was tough. Until one day, he caught me off guard by showing a vulnerable side. One morning, I came out of my room and found him sitting on the couch, crying in the living room. He told me he was feeling sick and hated that he couldn’t take care of our home the way he used to. He said he didn’t want to be a burden to anyone. I didn’t know what to do as my mind raced and I felt my body go numb. It was the first time I ever saw tears streaming down his face. All I could do at the time was hug him. Through the awkwardness, not many words came out of my mouth. The right words never came.

I’m sure there was cognitive impairment as the symptoms of diabetes got worse. Excessive thirst, accompanied by a craving for carbohydrates, is a classic sign that shouldn’t be ignored. It could’ve played a part in his decision to isolate himself and allow his health to decline. The day he cried in front of me also might have been the only time he tried to tell someone how he was feeling. But what’s a kid going to do?

My mom begged him to see his doctor, but he refused. I came home from high school one afternoon to my mom in a panic. She told me to help her get my dad into the car. He was noticeably incoherent and couldn’t walk without us holding him up. My mom drove him to the doctor’s office, and he advised her to take him to the emergency room right away. He was in what I believed to be a Hyperosmolar Hyperglycemic State, which needs immediate medical attention.

The doctors said a stroke and severe hyperglycemia ended his life. He also suffered gangrene in his large intestine, which was operated on, but his condition never improved. Both of us were by his side in the hospital when he passed around three in the morning. I don’t know which was worse, watching my father pass away or watching him mouthing the words “home” in the ICU while I felt helpless. There wasn’t much either of us could do.

At fifty-six, I think I know how my dad was feeling.

Rare as it was, there was a time when my dad and I found common ground. In the early eighties, HBO’s Red Skelton’s Funny Faces came on. Together, we watched the beginning monologue and shared a laugh. He appreciated that a person my age thought he was funny. Red was well past his prime but was still up on his game. I used to tease my dad about the famous heroes of his day. He would joke in response, but now I wonder if he felt hurt by it.  

I remember how my dad watched his favorite entertainers fall out of favor while 80s B-rated flicks and heavy metal music of my generation became popular. Today, social media is full of memes poking fun at the big hairstyles of the eighties which illustrates that I’m no longer in the prime of my life.

It took me years to forgive my father for his controlling nature, which didn’t prepare me for a future without him. He didn’t finish high school, yet he set an example by working the better part of his life to provide for his family. He tried to do right for his health by giving up cigarettes, alcohol, and taking his blood pressure medicine.

Whenever I complained about my life as a teenager, he used to say I had it much better than he did. If he saw me unhappy, he’d say, “Act happy, and you’ll be happy.” None of that advice was helpful back then, but I understand why he said it. I’m sure there were plenty of times he had to act happy. Especially as a child on Christmas morning while opening his one gift.

It’s time to make the best of every moment.

Now that my mom is in her seventies, I cherish our time together as she reminisces about her past. My mom talks more about her side of the family. She’s answered questions about things I’ve always wanted to know. She speaks highly of the wisdom my grandpa shared with her when she was little. She has memories of sitting on her great-grandfather’s lap at the age of four. Within these stories, I learn more about myself.

Neither of my parents had much when they grew up, but they always gave me what I needed. My mom always says, “I’ve got your back.” Every day, I work hard to give her good reasons to do so.  

Telling people to be healthy misses the mark.

Whenever someone blurts out, “Just eat healthier and exercise more,” and all your problems will go away, I know they don’t get it. In the field of psychology, it’s well understood that how we act is driven by how we feel and think. This off-the-cuff advice misses this complexity. It disregards a life story that correlates with the way people take care of themselves. Since we are our own worst critics, we aren’t always going to do what’s best for our bodies.

What we believe about ourselves plays a huge part in health outcomes and the aging process. Healthy habits are always within our reach if we want to work on them. Yet most of them are unsustainable. The story is always the same. I used to exercise, but now I work 60 hours a week. I lost twenty pounds but gained back thirty after my mom died.

Personal health remains at the bottom of the list in our busy society despite the attention it receives. No one wants to admit to not making it a priority. It’s easy to criticize others for neglecting their health when you don’t know the path their life is on.

We need to stop talking and listen to what others are saying. Put aside the righteousness of whatever it is you think you know. In this world, too many of us feel like we’re not being heard and feel the pressure to justify our positions. Sometimes it just is. Accepting someone’s current situation can go much further when we don’t say anything at all.

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

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.

GLP-1 agonists promise weight loss, but what about the consequences of perpetuating the thin ideal?

Over the last few years, the medical landscape has turned completely upside-down. With all the recent hype around GLP-1 agonists, we don’t need any more proof the world’s gone mad.

Semaglutides are effective for significant weight loss and may have other health benefits. Many great resources explain their effectiveness, so I won’t discuss them here. The main thing to know is they slow down the stomach’s digestion and curb appetite, which can result in weight loss. However, some people lose their appetite completely and stop eating. This is where I have a problem.

Losing your appetite is a serious side effect that can lead to severe consequences

  • Significant weight loss in a short amount of time puts patients on the fast track to malnutrition. Fat cells don’t go away, they shrink. Unintended loss of lean muscle mass diminishes strength, stamina, and resting metabolic rate.
  • Dehydration and constipation are major side effects of weight loss that need immediate attention.
  • Gastroparesis which is claimed to be a rare side-effect of GLP-1 should be assessed by a health practitioner.
  • Significant weight loss and meal restriction are associated with depression, anxiety, and disordered eating.

No one is immune to the pressures of the ideal body weight

I’m not pretending that I understand another person’s struggle with weight or health issues. As a female living in the US, I’d be lying if I said I never experienced negative thoughts like feeling bad about my body size, being unhappy about what I see in the mirror, or feeling guilty after eating certain foods. Conducting medical nutrition therapy sessions over the years has fine-tuned my ability to pick up on the hatred of fat in our society, and how people sell themselves short because of their body size. Let me tell you it’s no picnic to inform patients I don’t specialize in weight loss. The conversation often comes to an incredibly uncomfortable abrupt end. It’s an emotional hot button that’s impossible not to push.

The psychological perspective is always ignored

We all know there are consequences for our actions. The likelihood of maintaining a healthy weight decreases If you are clinically depressed and anxious. There’s no doubt in my mind that mental health issues affect normal eating patterns. So, chances are your weight will go up or it will go down. No matter the direction it won’t be healthy or sustainable if you don’t find a way to deal with reoccurring issues in your life that are holding you back. A healthy mind usually follows a healthy body. Usually. If someone spends most of their time dieting, there’s no way they feel good about themselves. That’s where the focus should be, not on body weight.

What adds to this is when well-intentioned friends, loved ones, and health practitioners validate a person’s bad feelings about themselves and comment on their weight. If you’re somebody who comments on other people’s weight stop it. It’s not helpful and you’re not earning points by doing it. It was once said that if shaming worked everyone would lose weight. Well, it doesn’t. So, knock it off. If people in larger bodies bother you, maybe you should find out why that is.

Are GLP-1 agonists the cure for obesity?

I don’t believe obesity is a disease the way social media preaches it. It’s way too complicated for medication to “make it go away.” As I see it the medical profession continues to ask people in larger bodies to sacrifice way more than thin people to be healthy. As much as it’s proclaimed that side effects are not the norm for most people, it isn’t comforting to those who’ve taken the drug and experienced gastroparesis gotten so bad they couldn’t get through the day without vomiting to the point of severe dehydration. For them, the “rare side-effects” have made a huge impact on their lives. Either way, it’s a lot to expect from folks when there are so many other factors that cause ill health other than obesity.

It’s too early to know what the long-term efficacy will be

If you don’t have an eating disorder, there’s reason to believe you could develop one while taking semaglutides. Medically induced appetite suppression still leaves us with many questions. But what we do know is that severely restricting dietary intake and losing a significant amount of weight messes with the brain and creates an unhealthy obsession with food.

If you’re considering semaglutides for weight loss, you still need to make major lifestyle changes. It’s not a magic pill. You are still responsible for the outcome. An adequate diet and exercise will be necessary to get results. Don’t do it alone. There are plenty of great dietitians out there. Remember no one can predict how your weight will trend within your lifetime. You might need to take the drug for the rest of your life. With the recent shortages, you might not be able to take it the way it’s prescribed. Most importantly, think about how you might feel if your weight doesn’t trend the way you want it to. Semaglutides won’t do much for your mental health.

Increase your awareness by being a devil’s advocate

For every practitioner prescribing this drug, there’s a pharmaceutical company with an inexhaustible marketing budget earning record profits. Semaglutides are already in a nice comfortable space within the diet culture which has welcomed them with open arms. You can be sure there are plenty of weight loss companies vying for the extra dollars by adding them as a weight loss option.

As a consumer, you have the choice to take the wait-and-see approach. Dig your heels in. Don’t let the catchy jingle on the commercials or the celebrity weight loss stories give you false hope. Learn about every side-effect and don’t be afraid to ask the tough questions. In the grand scheme of things, you are the strongest advocate for your health and well-being. No one knows more about what you need than you do.

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.