If you’re curious about what it looks like to stop pursuing weight loss, click here for some fabulous freebies that will help guide you in your journey!

Click here to leave me a review on iTunes and subscribe. This type of kindness helps the show continue!

Find FREE food voice resources here.

Thank you for supporting Find Your Food Voice!

Julie Duffy Dillon (00:00)

Great news, the Find Your Food Voice book is ready for pre-order. You can get to it at julieduffydillon.com slash book. Again, the Find Your Food Voice book, the book you need to help you reconnect to your own innate eating wisdom and help you break free from diet culture. I have written this book for you and I’m so excited to bring it to you. Get to it at julieduffydillon.com slash book.

Julie Duffy Dillon (00:26)

Welcome to episode 405 of the Find Your Food Voice podcast where we’re talking about intuitive eating and diabetes. Let’s get to it.

Julie Duffy Dillon (01:40)

Hey there, I’m Julie Duffy Dillon, registered dietician and your host. Welcome to the Find Your Food Voice podcast where today we are talking about intuitive eating and diabetes. So if you listen to episode 400, I got a chance to interview Elyse Resch, one of the co-creators and co-authors of intuitive eating. There was one topic in particular that you all requested more information on, more airtime on, and that was diabetes and the non-diet approach. Lucky enough, I have this episode and another one slated to coming out next month, all on diabetes and intuitive eating. And I’m so happy to bring it to you because just because you’ve been diagnosed with a chronic disease that’s connected to food to manage it, that doesn’t mean you have to diet forever, just like everybody else. We all can reclaim our relationship with food, even with chronic illnesses and chronic diseases. And I would say especially then. Today’s guest is Janice Dada who literally wrote the book on diabetes and intuitive eating. The book’s name is Intuitive Eating for Diabetes, the No Shame, No Blame, Non-Diet Approach to Managing Your Blood Sugar, and it’s available to order now. But in this episode, she gave us so many of the big parts of the book. There are these four pillars that she goes through the book. And when I read through these pillars, I was so excited to see them in print, for diabetes, because this is something I know that you have wanted so much was, what’s the book I can read to actually help me with diabetes? we get to hear so much of that information that she’s sharing in the book. And in particular, there’s this fourth pillar that I think is worth its weight all by itself. for you to buy this book because it goes through how to navigate for yourself as you’re navigating diabetes healthcare. But besides the four pillars, we talk about pre-diabetes and the history of it and some of the controversy play a part in the development of diabetes and what actually causes it? Of course, we also talk about medications, including GLP-1s. One of my favorite parts of the book included this exercise that Janice talks about, using kind eyes as it relates to exploring some topics and some concerns with body image. So we talk about that at the very end. So let me know what you think about that one. But I wanted to share a little bit information for you about Janice before we get to her interview. She is a weight inclusive registered dietitian with a private practice in Newport Beach, California. She’s a certified intuitive eating counselor, diabetes care and education specialist and an eating disorder specialist. She is passionate about simplifying and de-stigmatizing the nutrition and weight based discourse around diabetes. That’s why I wanted her on the show. I told you about her book, Intuitive Eating for Diabetes. You can order it now, the links below and her social media account is also there. Before we move on to our next segment, the Find Your Food Voice book is ready for pre-order. You can get to it at julieduffydillon.com slash book. And this book is gonna be in your hands the end of March. This is a book that I wrote for you if you have a complicated history with food for any reason, whether you have diabetes, PCOS, whether you’ve been trying to recover from an eating disorder for as long as you can remember there is a place for you to learn more skills and ways to help you navigate this diet culture BS and to feel at home in your body again. So you can get to the book at julieduffydillon.com slash book. And we’re gonna get to the interview with Janice all about intuitive eating and diabetes after a very quick sponsor break.

Julie Duffy Dillon (05:36)

Hey Janice, good to see you.

Janice Dada (05:38)

Hi, nice to see you too.

Julie Duffy Dillon (05:40)

I am looking forward to this conversation. One of the most common questions I get has to do with managing anything related to blood sugar and insulin levels and intuitive eating. Literally, it seems like this big block. And I had Elyse Rush on, and that was one of the questions people had for her. I had a number of people ask about, what about diabetes? And I feel like Elyse and I could not get into as much depth on that topic. I was already talking to her, I think, for like 40 minutes, and I tried to keep these to like 20. So I remember in the back of my head thinking, I’m going to be talking to Janice soon. And she has her Intuitive Eating with Diabetes book coming out, so we can really unpack all of this. So I appreciate you sending me your book to review. Listener, I loved it. I found it to be a really wonderful, easy to read, and practical resource. So thank you for writing it.

Janice Dada (06:14)

Yeah.

Julie Duffy Dillon (06:40)

And by page seven, you dropped some big gems already. And I was like, I’m so glad that someone is like putting it on the record that diabetes is not something that like is caused by weight gain. So can we start there? Yeah.

Janice Dada (06:40)

Sure. Yeah, so I think what you’re alluding to is in the first chapter of the book, I go into what diabetes is, how it occurs, the different types of diabetes. And one of the things that I mentioned is that oftentimes if somebody goes into their healthcare provider and they have elevated blood sugar, they’re told to lose weight as if that is going to you know, be the cure for their blood sugar. you know, sort of ironically, when you look at the science of it, something that we know about blood sugar regulation is that if somebody has insulin resistance, insulin resistance means that their body is not using insulin properly. And so when they’re not using insulin properly, their body can put out more and more insulin, you know, kind of the body’s way of saying like, what’s going on? Let’s use the insulin here to manage blood sugar. And insulin is a storage hormone. So insulin is actually a hormone that is related to weight gain. And so the question we could ask is, if somebody is gaining weight, is that a symptom of elevated blood sugar rather than the cause of the elevated blood sugar? Like a chicken and egg dilemma.

Julie Duffy Dillon (08:11)

Right, right, right. And the thing that I think is frustrating for me as a clinician is when I read through research or I specialize in helping people with PCOS in particular, which diabetes is something that occurs with that often. And when I look at their guidelines that they put out, they being the evidence-based guidelines that come out every five years, there’s even this explicit section that talks about this yet there’s still the push a sentence or two later to lose weight. And it doesn’t make sense because it’s not the cause of it. Do you have any guesses on why this kind of got all mixed up? Like, why is it being blamed for it?

Janice Dada (08:58)

I think it likely has to do with just being so entrenched in this kind of weight normative paradigm, right? Like this idea that weight is to blame for so many things, which has its history stemming back to BMI and kind of the misappropriation of the BMI to health. And so I think even with all the evidence laid out in front of very intelligent people, they can sort of see that and also still go back to, well, it’s got to help if you lose weight, right? It’s got to also do something, even though there is this lack of evidence to really support that.

Julie Duffy Dillon (09:36)

Mm-hmm. Yes, it’s so frustrating. I remember Chevese my gosh, I’m losing her name. Chevese Turner? Yes, I think that’s name. Her one time saying that the medical community and society in general is just so married to this weight loss as health connection. And something that I appreciate is we as human beings, many of us, have such a hard time admitting when we’re wrong. It’s okay to be like, know, we thought that was the cause, but now we know it’s not. It’s time to move on. something that I remember, and I think you and I have been dietitians around the same length of time. Do you remember when the pre-diabetes diagnosis came out and the controversy with all of that? And I was so glad that you brought that up in the book too, because self-disclosure alert, I have insulin resistance, probably kind of depends on when my A1C is checked that sometimes I have pre-diabetes.

Janice Dada (10:42)

Mm-hmm.

Julie Duffy Dillon (10:43)

So yeah, let’s talk about why this is controversial, the pre-diabetes diagnosis.

Janice Dada (10:50)

Yeah, I’m really thankful to Charles Piller, the investigative journalist who wrote about this because did such a fabulous job really outlining some of the conflicts and controversies. And so it really kind of starts with the renaming of what used to be known as impaired fasting glucose to pre-diabetes. And he outlined so wonderfully in this journal published in Science, I believe it was, in it really shares that this was a small number of kind of like diabetes thought leaders who got together and wanted to instill more fear. And let me tell you, they were very successful with that because I get clients in my office too, like really, really panicking because the term pre-diabetes sounds exactly like they want it to sound. It sounds like you are on the edge of going into this diagnosis.

Janice Dada (11:47)

where there’s a lot of other fears attached to it, where people are immediately thinking of the most extreme potential consequences. so impaired fasting glucose though, sounds different, right? It doesn’t sound quite as scary. And so they were very successful in their renaming of impaired fasting glucose to pre-diabetes. And they did this against sort of evidence and against the larger medical communities, I guess, agreement with it. So the World Health Organization still does not actually agree that we should have this labeling of prediabetes and that it should be treated in the way that it is commonly treated because there is no FDA approved treatment for prediabetes. And so what happens is medical providers will say, you have prediabetes, let’s prescribe you.

Julie Duffy Dillon (12:24)

Mm-hmm. Mm-hmm. Right.

Janice Dada (12:43)

this diabetes drug when the drug is really approved for diabetes. So we’re sort of like fast tracking this individual to being treated the way that somebody would if they actually had the condition, which now means they have increased healthcare expenses, they have more doctors visits, they have more trips to the lab, they may have side effects from the medications that they’re on. And the study that was discussed in the article was really a large study that demonstrated that most people do not actually progress to diabetes even over, I think it was like five to 10 years that they’ve looked at these individuals. And so the question is like, why? Why are we so panicked about it? And it doesn’t mean like, forget about it, don’t pay attention to your labs, but it could mean like, can we be curious about why I’m in this range? What is my family history? What was going on when I had this lab tested? Is there something that I could add to my lifestyle, my habits that might be helpful in some way? There’s a lot of things that we could look at before instilling this all or nothing panic.

Julie Duffy Dillon (13:55)

Yeah, yeah, I think the word fear that you brought up is so important here. Unfortunately, for a lot of our colleagues, like it’s the only like tool that they tend to reach for to motivate any kind of behavior change. And something I know is fear doesn’t seem to really stick very long. Certainly research supports that too. And it’s really just becoming this. What did you call it in the book, the diabetes police? I like how you worded that in the book too. This diabetes police it’s basically barking orders on what you should be doing. I also hear so much of the narrative, and I don’t know if this is just in PCOS circles or also diabetes circles, but basically outside of GLP-1s, of course, but this push to not use medicine, it’s almost like, let’s be more pure and natural against

Julie Duffy Dillon (14:52)

Metformin basically. And I know there’s pros and cons with any medication. And the thing with Metformin is like, it’s been around forever. It’s generic. It’s cheap. It’s accessible. Yeah, it’ll make you have GI issues, especially if you don’t have a meal with it. But still, it’s something that’s accessible. What have you noticed about the diabetes police? What do you hear them saying?

Janice Dada (15:08)

So I think, so the diabetes police can come from many directions, right? It could be an internal diabetes police, right? It could be family and friends who want the best for you, but they’re barking orders in a way that makes the individual feel sort of rebellious or resents that. And then also, of course, healthcare professionals are another big area of diabetes police. And so, I have certainly worked with individuals who have you know, kind of gone sort of an all or nothing pattern with this, right? Like I’ve had some individuals take it way too far. Like they are really like A plus students and they were told to do this and they took it to the extreme and you know, really like to the extreme that we could be describing what they’re doing as an eating disorder. And I also have had clients who have, you know, thrown in the towel, like this is impossible. Like, you can’t do this.

Julie Duffy Dillon (15:52)

Yes. Yeah.

Janice Dada (16:16)

Not really understanding that there’s a middle ground that we need to find the gray area. And so I think sometimes providers with the best of intentions, I’m sure, provide information in a short amount of time. So many healthcare providers don’t have enough time to truly go into the depth and the necessary amount of explanation that’s needed and really take the time to listen to.

Julie Duffy Dillon (16:31)

Yeah.

Janice Dada (16:42)

the individual and their lifestyle so they can give appropriate recommendations. And so, you know, sometimes it’s sort of like do da-da-da-da-da-da, and then it just sounds like a bunch of orders, which then is really like the diabetes police, right? And so I think that’s really unhelpful because we have to kind of match people with where they are and what they’re able to do at the moment.

Julie Duffy Dillon (16:54)

Mm-hmm. Right. Yeah, that’s what I was thinking about with your book. Thinking about providers who don’t have a lot of time. And as dietitians, especially in the type of work that we’re doing, we usually have like a whole hour to sift through with a fine-tooth comb what you’re eating, what your life is like, when you can go to the grocery store and where do you shop and making lists and all that. We can take our time with that. And I know most providers can’t do that.

Julie Duffy Dillon (17:35)

And what I pictured your book as, like, here is where you begin. And then if you need more, you can go see an individual dietician or someone similar. It’d be so great if that was just like the foundation for everyone with a diabetes diagnosis. This is the starter pack. And then if you need more, because it is, it’s like a really great foundation. We’ll get into some more.

Janice Dada (17:39)

Mm-hmm. Yeah. Right.

Julie Duffy Dillon (17:59)

before we get to that, I want to talk about two things. Okay, what do I want to start? I want to talk about the root causes of diabetes, but also your four pillars. So let’s do the root causes of diabetes first, because if weight is not the cause, let’s talk about what actually is the cause. And I have a feeling when you say this, this may be a shock. 

Janice Dada (18:09)

Mm-hmm. Yeah. Mm-hmm.

Julie Duffy Dillon (18:19)

I love the graphic that you have in the book to describe this. Do you know what I’m talking about? I’m sure. Yeah, that’s true. Yeah, so tell me about what causes diabetes.

Janice Dada (18:24)

Yeah. Yes, the tree. Yeah. Yeah, so the graphic that I share in the book is a tree with its roots, right? And so we’re sort of thinking like if diabetes is the tree, sort of expressing what it’s expressing, this is the condition at the moment, underneath that are a number of different factors that influence how that tree has developed, right? Or how diabetes has developed. And so I think a lot of these are really overlooked in that short time crunched session or in our weight normative, really weight focused healthcare system. And there’s so much personal responsibility. And I hear this with clients who feel shame and they’re blaming themselves. because the message that they’ve gotten is diabetes is preventable, diabetes was reversible. If you just do X, Y, and Z, you’ll never have this condition, which is so different than other conditions like…

Julie Duffy Dillon (19:06)

Yes. Yes.

Janice Dada (19:22)

If somebody breaks their arm, they’re not like, why were you doing that thing? You shouldn’t have been walking down the street and tripped, right? They just put a cast on it they’re like, it’ll be better soon. And so it’s very different with diabetes where we’re sort of like, you should be able to heal yourself without the cast. That doesn’t make any sense. And so if we look at what is contributing to diabetes, there’s so many factors that could all kind of come together to influence whether somebody is going to get this condition or not.

Julie Duffy Dillon (19:27)

Correct.

Janice Dada (19:51)

And a big one is social determinants of health, especially if we look at areas of the world and areas of the United States where we see higher rates of diabetes because we know that social determinants of health factors in things like our environment, what’s around us, what kind of grocery stores do we have, are our spaces walkable, what kind of pollution are we exposed to, like the environmental contaminants you know, because we know that certain chemicals are endocrine disrupting chemicals, which then directly impact our ability to manage our blood sugar. Also, we know that educational attainment income levels are also directly related to, you know, our risk factors, how far we are from living next to a highway, you know, so there’s a number of things that we can’t necessarily control, especially as a child, right? Like you’re just living where you’re living. You’re born into whatever family you’re born into. And then in addition to social determinants of health, sleep is a big one. And I read some really fascinating studies when I was writing my book about night shift workers, like nurses, right? Who have maybe worked decades as night shift nurses and their relationship to diabetes risk.

Julie Duffy Dillon (21:05)

yeah.

Janice Dada (21:14)

And so even if somebody comes home from a night shift and sleeps, you know, the seven or eight hours, that it’s not the same, that it still changes their risk, which is a big deal. So, you another factor that was related to sleep was sleeping too much or too little. So there was sort of like a sweet spot and sleep apnea. So especially if somebody has undiagnosed sleep apnea, that that’s a big factor. Certain medications are also root causes. So sometimes people have to take a medication for, you know, I had a client that I mentioned in my book who had been going through cancer treatment and needed to take steroids for a prolonged period of time and ended up with an A1C that was truly in the diabetes range. And because she was in a larger body, her doctors were like, lose weight. And, you know, it’s, I feel like that really just delays her treatment. And now her blood sugar is high for longer.

Janice Dada (22:09)

when really we know that she had all these extra risks that likely predisposed her to this diagnosis, right? Genetics, there’s an article that talks about at least eight different genetic mechanisms in which somebody could be predisposed to diabetes through different organ systems in the body. Nutrient deficiencies, so a study that looked at international populations finding that certain micronutrients and if we didn’t have them in enough quantity that those were potentially factors. And then a really big one is weight cycling because when we think about the common prescription for diabetes, lose weight, go on this diet. But what we also know about dieting is that it leads to weight cycling, the increase and decrease of body weight, The gain or the loss and then the regain of weight. So that’s a lot of factors.

Julie Duffy Dillon (22:44)

How interesting. Yeah. It’s a lot and especially that last one, I think it’s important to really take that in how folks are told to do the very thing to treat or prevent diabetes that is one of the causes. And that’s a big word to say something causes. So I think it’s important just to like let that sink in. And I think also people are surprised to hear like the genetic side of it.

Julie Duffy Dillon (23:37)

how much it is connected to just your genetics. And that personal responsibility piece, I’m glad that you mentioned that too, because I think it’s a part of healthcare that we, I would encourage everyone just to question and period. And if you have the ability to change your eating and around and I don’t know, eat more from the perimeter of the grocery store, I don’t know, like you’re already have more access than most people to modifying health behaviors. It’s probably not the changing of how much kale you’re eating. It’s probably more about where your position is and how much power you have. yeah, yeah. It’s so complicated, but I think it’s important because it’s not a personal blame game. I wish people could just remove that. Like, can we just pluck it out with some tweezers? It’s not part of this.

Janice Dada (24:16)

Alright. Yeah. Right.

Julie Duffy Dillon (24:37)

And something that I appreciated about your book was these four pillars that you talk about for someone who, again, I picture someone newly diagnosed with diabetes and they’re like, okay, well, if just focusing on weight is not gonna be the solution, because that’s a nice pretty package, right? It’s like concrete, feels like, I always say like starting a diet is like, it’s a seductive kind of experience because it’s hopeful.

Julie Duffy Dillon (25:05)

There’s like a warm fuzzy, we have a plan. And again, it’s very concrete. So seeing your four pillars, I was like, yay, concrete, we have something to like stand on, literally, we have four pillars to stand on. So what are the four pillars that you talk about in your book?

Janice Dada (25:10)

Mm-hmm. Yeah, so I talk about pillar one being establishing a diet-free mindset. And so within each of these pillars is the kind of incorporation of the 10 intuitive eating principles. And so in the established, and when we think about the 10 intuitive eating principles, we have some principles that are aimed at removing barriers to attunement. So removing barriers for our ability to kind of sense what our body needs and what it’s telling us, right?

Julie Duffy Dillon (25:34)

Mm-hmm.

Janice Dada (25:51)

And so some of those barriers include our diet mentality, which often comes from diet culture. It includes like food rules, includes the diabetes or the food police is how it’s referred to in the intuitive eating principles. And so this first pillar is all about trying to see those as they are and trying to disconnect from them as much as we can. Knowing that if we are in the back of our minds thinking, this food is not good for me, or thinking in black and white terms about things, it’s gonna be really hard for us to make actions going forward that are in attunement with our body, right? So if we’re thinking like, really want a cookie right now, but our diet mentality is like, no, cookies are bad, it’s gonna be very hard for us to honor that. But what happens if we don’t honor foods that we want to eat is that there’s often backlash with it, right? So if we’re sort of like, holding on really hard to not eating that food, we may eventually eat 10 of those things rather than the one that we really wanted. And so for that reason, it really helps for us to remove those barriers. The second pillar is all about diabetes self-care. And so this includes things like getting enough hydration, getting enough food to eat taking care of ourselves with movement that feels good, so joyful movement in whatever form that’s gonna be, and also in whatever increment that’s gonna be. So I think sometimes people have ideas about it needs to be this amount of time or it doesn’t count or it’s not worth it. And so, you in the chapter, I also described kind of the sum of the research, especially around blood sugar, that shows that even small little bursts called like exercise snacks can be very helpful to blood sugar. And so we don’t need to think in an all or nothing manner about it.

What else is in this chapter? Things like stress reduction, sleep patterns. So, you know, all of the things that are about taking care of ourselves, relationships. And then in pillar three, this is the chapter on gentle nutrition. And so in this chapter, we are looking at nutrition, but through a gentle lens. So we are talking about, yes, the food groups that, you know, are required for us to get the nutrients we need, but we are also looking at them without any rules around them, right? And so we’re thinking, looking at how do we build a plate that is likely going to help our blood sugar, but also choosing what foods we want on that plate, especially cultural foods, which unfortunately many clients have shared with me that their providers have told them you can’t eat this or that cultural food, which is highly inappropriate. All foods work here. And then also I break down the nutrition facts label because I think that is also a huge area of confusion for people.

Julie Duffy Dillon (28:31)

Yes. Yes. Yes, I love that you did that. That was so great. And can I always say one thing too, between the pillar two and three? I mean, I don’t know if the hierarchy has any intention or if it’s just random, but I was so glad to see the self-care before basically let’s talk about carbohydrates, was what I noticed. I mean, this was 20 years ago. I was a diabetes educator. I’m not anymore. But what I noticed doing that work was when people added in the sleep hygiene, making sure they get enough rest, taking more breaks throughout the day, movement when it fit and they were eating enough. Just doing that made such a big difference on their A1C. It was such a big deal. If people were starting more on the carb counting, crunching those numbers before, it wasn’t as impressive. I was so glad to see you do that because I know it doesn’t sound as big of a punch. but it does make a big difference to just like, make sure you’re getting your rest, know, make sure you have boundaries so you can not be, I don’t know, just overwhelmed all the time. So I was glad to see that.

Janice Dada (29:41)

Yeah, I think it’s kind of akin to when somebody would come into a dietitian like one of us and say, I just need a meal plan. And you’re like, wait, wait, hold on. Let me hear about you. I don’t know anything about you. I need to know what your life is like, what kind of things are going on. It’s not just we just jump straight to the food because it’s so much more complicated than that. Yeah.

Julie Duffy Dillon (29:58)

Yes, yes, yes. So much more complicated, yeah. So what’s the fourth pillar?

Janice Dada (30:16)

So the fourth pillar is your individualized treatment plan. so in this, yeah, and you know, this really stems from when I see clients, they often don’t know what they’re taking. They don’t know why they’re taking it. There’s a lot of missing information. And so I really aim to help people be in charge of their own health and their own advocates so that they can go into their appointments feeling well-informed having the right questions to ask or also creating boundaries around what is something that they want or don’t want out of their time with their provider, which I also get into when I talk about self-advocacy in the chapter that follows the fourth pillar. But in this pillar, I also talk about labs. How do you interpret them? Because most people also, I feel like, are very in the dark about them. They’ll maybe get a note from their doctor that says, do this, and they don’t really, they don’t know what that means, they don’t know why they’re being recommended to it. And then I also go into medications, like what are the medications? And if you need a medication, so be it, there’s many conditions in which a medication is required. What else do I talk about in that chapter?

Julie Duffy Dillon (31:26)

Mm-hmm. I think the information you give on lab work and medications alone is like worth the price of the book, like right there. I’m like, cause it’s so helpful because I think that’s a very common email I get or questions I would have with clients, like just so confused looking at their lab work, like what does it even mean? And I know for me, one of the first times a high blood sugar got flagged, I also had a high thyroid, but then that was just like an abnormal test. And the nurse said to me, the doctor just wants you to cut out carbs. I like, what? Okay. And then I was like, for what? They’re like, for the abnormal lab work. And I’m like, I mean, not that I agreed with it, but I’m like, I guess that’s for the blood sugar. Then I’m like, what about the thyroid? And she’s like, no, cut out carbs. I’m like, my goodness, this is really what you’re telling people. So I didn’t go back to that person, I found a new doctor. But I think that’s a really normal like,

Janice Dada (32:06)

Yep, uh-huh, that’s so common.

Julie Duffy Dillon (32:31)

like cascade of events is like people get lab work and then they get a call from a nurse or someone who’s just working triage or something and they’re told this instructions. So getting this information, if you’re like, wait, I don’t know what it means, you could actually get it from a trusted source. I also think about for folks who are in eating disorder recovery who they could Google it, but really it’s opening up a whole can of worms. Just open this book, you can look in there and it says what you need to know.

Janice Dada (32:39)

Mm-hmm. Yeah.

Julie Duffy Dillon (33:01)

And if you need more information, of course, you can get it, but it’s like a really great, like trusted kind of resource. So I was so glad to read that. And I know there’s a section on GLP-1s as well in there. Do you have an official opinion at this point? And I know it always changes, but like, yeah, what are you thinking at this point with GLP-1s?

Janice Dada (33:07)

Right. Yeah. Well, I think when we think about the GLP ones that are approved for diabetes specifically, it’s different than the kind of mass hysteria around the regular general public and the amount of prescriptions that are going out to people who don’t have diabetes. And it’s obviously very clear why people without diabetes are being prescribed like Ozempic, which is actually a diabetes medication and it’s because of the weight loss, right? And so I think what I really would like people to think about and discuss with their providers when and if they are recommended a GLP one is, what would you recommend to me if like for somebody in a larger body, would you like Reg and Chastain would often guide, right? Like, what would you recommend for me if I was in a smaller body? Would you still recommend this medication?

Julie Duffy Dillon (34:08)

Mm-hmm.

Janice Dada (34:14)

And so if it’s just for the weight loss aspect of it, then maybe we need to kind of be asking more questions because yes, there have been some pros seen in terms of health outcomes related to cardiovascular effects, but there’s also a lot of potential side effects. And the thing I think that worries me about them is that if somebody goes off of them, they have seen with the research that there’s immediate weight regain. And so then we’re back at weight cycling, right? And then we know that there’s harms of weight cycling. So, you know, something like Metformin, which you mentioned earlier, is a, it’s supposed to be a weight neutral medication. It’s been around a long time. It has a long track record. And even for somebody who has GI side effects from it, there are extended release options that may make the side effects much less. And so I’m not an advocate for one medication or another, but I would sort of be wondering if I’m just being diagnosed and you’re saying I should take a GLP-1.

Julie Duffy Dillon (34:50)

Right.

Janice Dada (35:11)

Why is that? When metformin has been the first line medication for many years.

Julie Duffy Dillon (35:12)

Mm-hmm. Mm-hmm. Right, right. And it’s so accessible. It’s been studied for a very long time. And yeah, there’s pros and cons to it, but it’s an option. And I think my opinion wouldn’t be so like, I don’t know, I could feel like my cortisol level shooting up what I think about it. Because what I’m hearing from folks that I’ve been working with is that, and again, most people I’m working with have PCOS that maybe is in the place where they’re also experiencing diabetes or their insulin levels are so high that for some people where the GLP-1, even without diabetes, has been helpful, at the lower starter doses. For a lot of folks that I work with, they’ve also been recovering from an eating disorder for 10, 20 plus years. What they’re experiencing is all the advocacy they’ve done over their lifespan to not get weighed. Finally, doctors respecting that once the GLP-1 is on the chart, it’s almost like game over. Everyone wants to talk to them about weight loss and talk to them about their weight and show them their weight and all these things. So I think that’s like a, I just want everyone to know, like, if you do want to experiment with it, just know that that could happen. And I do, I think at the lower level for, if someone can tolerate it, it seems to be doing some nice things, but there’s this big but. There’s definitely risks.

Julie Duffy Dillon (36:46)

And there’s a couple episodes that I’ve taken my time with more on this, because I know we can’t go into it too much, but I was curious to hear your opinion. So thank you on that. Yeah. So we’re running out of time, of course. So one last thing I want to mention is there was a phrase in the book that I love that I wrote it down. And I was reading it, of course, on my computer, so I couldn’t circle it and do all the things with it.

Janice Dada (36:56)

Yeah, yeah, absolutely.

Julie Duffy Dillon (37:16)

but you were talking about looking at pictures of yourself with kind eyes. And that was just such a warm, compassionate way to rephrase some of the body image experiences and just even how we talk to ourselves when it comes to food and body. So I just want to say thank you. I love having an arsenal of tools that help us reframe how we talk to ourselves. But could you tell us how to use that phrase in real life, how to use it?

Janice Dada (37:33)

Yeah, so I think this came from a client that I was working with who I do actually profile in the book with her permission. In the last chapter, there’s three personal examples of using intuitive eating with diabetes from clients I worked with. And she is somebody who we worked a lot on the body image piece as well. I think that may have actually been something she specifically said is that she got pictures back and we had worked on, like, how do we look at pictures and sort of a whole strategy for when you receive pictures, like, especially people who are getting married and now there’s like, you know, a thousand pictures to go through where it can be really challenging for somebody who’s struggled with body image to not really nitpick at all of the things that they see. So we’d kind of come up with a strategy of like, okay, I will look for, you know, like a count of three. I will focus on the emotion that I’m seeing from the picture rather than straight to my, you know, area that I’m always criticizing. And so, you we really talked about like looking at that picture through kind eyes, right? So you’re looking at it with a gentle, a gentle lens. And that was something that she had shared with me that when she did get pictures back that she was able to see her see her pictures through kind eyes, right? Like looking for the things that we want to see when we look back on a picture, like we want to see the memory or what it felt like or what we were experiencing in that moment. Like we don’t need to zoom in and you know really focus on that area that only we’re thinking about. we might look at a picture and say, I hate the way my arms look in that picture, right? And so instead we’re having the, we could be rephrase that to, I’m having the thought that I don’t like the way my arms look in that picture. And when we kind of add in, It’s a thought, it’s not a fact. Our brain wants us to think that everything that comes from it is fact. But when we recognize it’s a thought and then we can really try to remind ourselves, that’s an unhelpful thought. What’s that thought gonna do for me? It’s gonna… Yeah, blocking the memory, kind of making me feel like I’m in a funk the rest of the day. What is it that we’re getting from that?

Julie Duffy Dillon (39:35)

Yes, it’s blocking you from the memory. Yeah. Mm-hmm.

Janice Dada (39:57)

And so that’s kind of an aspect of self-care, right? We’re going, we want to take care of ourselves when we’re thinking about things that are going to be challenging. And it doesn’t mean we’re going to look at every picture and say like, I love that picture. And, but it’s, it’s trying to find some neutrality to it and find, you know, other aspects that are also important about a photo. and another thing that I discussed in that chapter is, you know, I think a lot of times I’ll discover with clients that they only have pictures from like 10, 15 years ago in their home.

Janice Dada (40:28)

And so then when they look in the mirror, they’re feeling a particular way about what they see in the mirror. And it’s like, well, you’re surrounded by pictures of what you don’t necessarily look like today. Can we also add in pictures around you that are from this time period?

Julie Duffy Dillon (40:28)

Yeah. Yes, I think that’s so important. I remember doing some really big deep dives into how our brain, like how our neurochemistry changes as our body changes and just how we see ourselves and how it can take five to 10 years for our brain to catch up with the now. And so if you have these old pictures that are getting even further back from that and that’s all you’re seeing, it doesn’t give your brain a chance to catch up to now.

Julie Duffy Dillon (41:13)

we are always, our bodies are always gonna look different. Like it’s just, that’s the only absolute, right? Like if we get to live longer, it’s gonna change. I know I said that was the last question, but I actually wanna sneak one more in if you have another minute. And I’m like, I’ve been at, this may take more than a minute, but carbs. if someone’s like, I wanna do intuitive eating, but I have to limit my carbs in order to have a normal A1C or to have a normal blood sugar.

Janice Dada (41:17)

Always, yep. Sure, yeah, of course.

Julie Duffy Dillon (41:41)

What’s your answer?

Janice Dada (41:43)

I guess I’d be wondering why do we have to limit the carbs in order to have a normal A1C? Because something else I discuss in the book is like if eating adequately, if you see that your blood sugar is still not in range while you’re eating adequately, nourishing yourself adequately, then that probably means that something else needs to be added to the regimen. Yeah, right? We shouldn’t expect

Julie Duffy Dillon (42:01)

Mm-hmm. Like a medicine. Yes. I’m so glad you said that. Yes.

Janice Dada (42:13)

Like we shouldn’t expect that we have to restrict and restrict and restrict in order to get our labs in range. That doesn’t make sense. is like diabetes doesn’t mean we all have to starve. That’s not the thing, right? So we need to be able to eat adequately and then figure out what do we need to help our blood sugar while we’re eating adequately. And, you know, of course within eating all the different food groups, right? So like I also talk about in the book ways that we can help our blood sugar to have a smaller rise is by adding in other things that we need like fat and protein and fiber. It’s not just single one food group, of course, but we also need the carbs. Like, you when providers say your blood sugar is high, cut out carbs, that actually makes no sense because that is a nutrient, a macronutrient that’s required by our body. So we can’t tell people cut out carbs. They need carbs.

Julie Duffy Dillon (42:46)

Mm-hmm. Yeah. Yeah, yeah. And of course, I think about like, how are you ever gonna like eat with other people? No matter what culture you identify with, no matter what’s around, like it’s just a normal part of eating. It’s a very nice shelf stable way to get food too. And especially if your insulin levels are high, it’s probably the thing you’re craving the most. And you I know so many of my clients with PCOS, would talk about how when their insulin levels were really high, how it felt like they were gonna die if they didn’t eat carbs or sugar and being told they had to remove those. And at the same time, literally not able to do that, how it just caused this huge shame spiral. And I always think about like, if you’re having those kind of cravings, it’s a message that something’s going on. It’s not like, let’s let it inform us and I really liked that part of the book. I’m so glad you said that when I brought up the carbs part because yeah, if you’re eating food and an amount of food that’s sustainable and enough and your blood sugar is still high, this is a chronic condition. You can’t fix it with food for everyone. Maybe that’s the push, but we can’t all do that. And it changes over time. It worsens. Yeah.

Janice Dada (44:19)

Right. And it changes over time, right? Like you might need more medicine as time goes on. And that is something we just know about diabetes, right? It doesn’t stay the same. Our bodies change, our diabetes changes. And so we have to be gentle with ourselves because certainly you’re right. Like when people get the message, do this, and they like really cannot do that, you know, because of biology really, they feel that shame and blame and wonder, why can’t I do this thing?

Julie Duffy Dillon (44:33)

Yes, it doesn’t. Mm-hmm. Yeah. Yeah, yeah, yeah, you just need another tool. That’s it. And this is where the food is medicine. It feels really irritating because it’s not, you know, we need enough. And I think that’s medicine, but like, it can’t, you may just need another tool. If you’re trying to do intuitive eating and you feel like it’s not working, it just may be that, yeah, you need another medicine or something like that.

Janice Dada (44:53)

and it’s not their fault. It’s just, yes. Yes, it’s a multi-pronged approach with nutrition as one aspect and then many other. Yes.

Julie Duffy Dillon (45:20)

So where can people find more information about you and your book?

Janice Dada (45:28)

So probably the best spot to find information about me and my book is on my website, socalnw.com forward slash book. And that will give a little synopsis and some places that you could purchase and pre-order. Book will be out April 1st, but it’s available for pre-order now.

Julie Duffy Dillon (45:45)

Yay. It would be a great bundle with the Find Your Food Voice book.

Janice Dada (45:48)

It would absolutely can’t wait for yours too.

Julie Duffy Dillon (45:51)

Yeah. Yes, we’ll have to continue to talk offline on like just living the life of the pre-order. So I’m really excited about your book. It’s been a request for a really long time. And I’m glad I have something to tell people now. I loved it. I loved everything about it. So thank you for writing it. Yeah, no problem. And have a great day.

Janice Dada (45:58)

Hehehehe Thank you. That means a lot. Thank you so much. You too.

Julie Duffy Dillon (46:16)

So there you have it. I hope you enjoyed this conversation all about diabetes and intuitive eating. Before we end, wanna let you know next week’s episode is going to have a very new topic for this podcast. It’s cannabis and intuitive eating. We’re gonna hear from Leah Kern who has expertise in this area. So be sure to check it out. And remember the Find Your Food Voicebook is ready for pre-order. You can get to it at julieduffydillon.com slash book. All right, I look forward to being in your ears next week, but until then, take care.