By Lauren Plunkett RDN, LD, CDCES.
This year, we celebrate the 50th anniversary of ADCES and it already feels like a year of spectacular opportunities! The cover of the January 2023 edition of In Practice presents article headlines about medications for weight loss in type 1 diabetes and the safety of a very low carb ketogenic diet.
Seeing these titles in tandem, I could not have asked for better evidence as to how we can advance as a profession over the next 50 years.
In the forefront, we have two emotionally triggering topics for a population who is taught to make difficult decisions with food from the day of diagnosis. The author provides a striking argument that weighs short-term results against long-term risks. Please read the call out box on page 38 of a PWD’s experience “on keto” for the detailed experience.
As DCESs, we are in a position to examine and translate often conflicting research into options that individuals can choose for themselves. The toolkit we carry is heavy, detailed, and updates faster than the firing of one brilliant thought.
As a person living with type 1 diabetes, the dose of mental energy it takes to maintain a positive mindset as a RDN, DCES, is a phenomenon. This era of pills before skills and restrictive dieting programs is the reason I work with the people that I do. They are often frustrated and fed up with diet culture.
People with T1D have been encouraged to cut carbohydrates since insulin injections began 100 years ago. They were advised to eat more protein, which really meant ‘eat more meat, cheese, and eggs’. This advice failed to teach patients that plants have protein, little to no saturated fat, and something that animal products will never have: FIBER.
The burning question is: how is teaching people with diabetes to restrict the nutrient that is consistently at the core of the most effective research in weight loss, preventive health, and reversing insulin resistance, collectively working?
CDC statistics tell us that 60% of Americans are on multiple medications to treat one or more chronic conditions. Meanwhile, recent headlines advise HCPs to add more medication to support their perspective on the primary problem: obesity.
From the patient’s perspective, a pill will never heal our relationship with food if we don’t learn how to eat, instead of how to diet. And determining if a person has a history of disordered eating practices is vital prior to recommending an appetite suppressant. The role of the DCES is front and center in shedding light on the impact that a food-focused disease has on mental health, body weight, and self-management.
In the next 50 years, I envision that ADCES makes an example of the past to catapult our evolution towards a modern and leveled-up practice. Supporting a healthy mindset around life with disease not only changes lives, but humanity in general.
The best research we have is the collective account of the lived experience that people with diabetes share.
After working with primary care providers nationwide for the last three years, I found that 90% of them had no experience with plant-based nutrition. It was also evident that most primary care patients with type 2 diabetes had never spoken with a DCES and all of them were lacking in lifestyle education. They were also frustrated with how many medications they were on without understanding they had options for decreasing their dependence.
Upon intake, almost all PWDs responded that they were encouraged to eat low-carb and the majority were eating a diet high in saturated fat and animal protein. Lipids were often elevated with a high body weight and A1C above goal, yet many of them still believed that carbohydrates were the problem.
Every patient thought they were eating the way their primary care doctor advised them to. They were frustrated by their A1C that hovered above goal for many years. Some had tried multiple restrictive diets to lose weight quickly. Calorie restriction had worked for some but most of that weight, if not more, was regained.
The most consistent denominator in people who restricted carbohydrates for weight loss, was having a difficult relationship with food as chronic dieters. They did not know what causes insulin resistance, or that the whole body benefits from eating fiber-rich foods, or that animal products are the major source of saturated fat that raises blood lipids and increases insulin resistance.
Every meal of bacon and eggs, cheese wedges and jerky snacks, and buttered steak was making diabetes worse. Not better. And patients often responded in shock, “but there aren’t any carbs in these meals!”
Once a person with diabetes realizes that insulin resistance is reversed and overall health improves by eating the exact opposite method of high animal protein or high fat, they often feel betrayed. But now, they’re hungry to learn.
That’s when a progressive conversation about building a healthy relationship with carbohydrates begins. Followed by an increase in insulin sensitivity, improved mental health, and a happier person who feels more confident in their lifestyle choices.
Perhaps our patients could start to envision an entirely new future of capabilities they never thought they had, simply because they learned how to eat instead of how to diet.
Imagine how it would feel being a part of something like that for the next 50 years?
You can learn more about practical strategies for healthy eating on the ADCES website.