Calorie counting and carb counting are often touted as ways to manage type 2 diabetes, but in this week's Diabetes and Me Megan Whelan asks her dietitian how to manage her diet, while at the same time trying to have a better relationship with food.
Megan Whelan Photo: Rebekah Parsons-King / RNZ
I miss pasta. Of all the changes I have had to make following my type two diabetes diagnosis, pasta is the thing I miss the most. I've tried the substitutes, stirring red lentil pasta through tomato-based sauces, layering meat and cheese with wholewheat lasagne, and every time it has been disappointing.
Because I don't want low carb pasta. I want carbonara - a giant bowl of carbs and fat. I want to be able to come home and whip up proper fettuccine alfredo, a silky, luxurious mix of starch, butter and cheese. Pasta is my comfort food, my favourite thing to cook, and the best thing to order off a menu.
My dietitian tells me I can have pasta - in moderation, combining it with other foods. We'll talk next week about what those combinations could be, and why. But after last week's conversation with Pati Tyrell about emotional eating, I asked her about trying to restrict my pasta intake.
Laurette Cummins is a registered dietitian - and she's one of the only medical professionals who made me feel empowered. I saw her first in January, a month or so after my diagnosis*.
Laurette assures me I can have pasta. In fact, I can have almost anything I want, restricting what I eat is part of the problem. We talked about decisions around food coming from a place of abundance, not one restriction. So not "I can't have this" but "that food I am worried about having is one small part of a large and varied diet".
She says that can take a lot of relearning (and unlearning) particularly for people who have come from chronic dieting, or a restriction mindset.
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"I often find people who restrict or feel deprived, that shows up physically. And we find that that actually leads people into a restrict [and then] binge cycle, which is particularly problematic for diabetes, because then you get these fluctuating blood glucose levels.
"That's not great in the short term, but it's also not great in the long term, because then we get weight cycling, the toll of which could have a negative impact on your health, which we don't want to promote with diabetes."
This blew my mind. As a teen, I did the cabbage soup diet. You can still find this on the internet, promoting an unhealthy amount of weight loss in a short period, but I suggest you don't. In short, the diet encourages you to eat very little, except for an unlimited amount of soup that is mostly cabbage and water. Aside from how grumpy I was because I was starving, my family must have loved it, what with the, um, gastrointestinal effects.
Now I wonder how much that dieting in my teens and twenties put me here - how much my body's problematic relationship with insulin and glucose is due to starving and bingeing because that's what diet culture taught me to do.
So how to balance understanding that my body doesn't cope well with lots of carbs, while at the same not continuing that cycle?
"People can do well [on a carbohydrate restricted diet], but the majority of people that I see, really, that's not always sustainable," Laurette says.
"It's all about experimentation and getting curious and actually thinking 'I wonder how this amount of food or this combination of foods affects my body'.
"The key is, there's no one blanket recommendation. People do well and do better with different combinations, different variety of foods. And I understand that is a bit of a journey, and a bit of relearning, and a bit of tuning into our own body's cues to understand what works and what doesn't."
The first time I made carbonara after my diagnosis I gave myself permission to eat a huge bowl and have seconds - to eat like I used to. The result? I felt awful. Bloated and nauseous. I was so sad, like a beloved friend had been taken from me.
It hasn't though. As I write this, I am eating a doughnut in a lovely, sunny cafe, sipping an oat milk flat white. I had a salad with grains and avocado and salmon. These carbs will get me through the rest of my day, help my brain function and give me the energy for the 25-minute walk home. Plus, the doughnut is delicious and making me happy.
Laurette says an understanding of carbohydrates is helpful with diabetes because managing it can be really confusing - getting to know what works, particularly if people are monitoring their blood sugar levels - is beneficial.
"But I think there can be too much information and too much thinking about 'what am I eating?' Should what I'm eating be all consuming of my life - which takes me away from other things I value in my life and things where I should be investing my time and energy into?"
I expected Laurette to give me numbers - a calorie count to hit, a number of grams of carbs I was to stay under. And she wouldn't. And I found it frustrating, honestly. I like data - a way to track how "good" I am being seemed helpful. And for a while it was - weighing my food helped me to understand what 100 grams of yoghurt looked like so I know if I am getting enough protein in my day. But it also felt inherently dangerous. How much time have I lost - not just since I've had diabetes, but in my life - beating myself up about wanting French fries. How many times have I denied myself what I wanted, and ended up having it anyway, and then feeling bad about it?
"I'm always curious about people's lived experience with [diet] behaviour and the positives and negatives that have come from that in the past," she says.
We need to relearn how to tune into the signals our bodies give us about what it wants and needs, she says. As children we are born with the ability to do this, but then we're bombarded with all the ways we should change and treat our bodies.
"Imagine if I'm noticing the physical signs of hunger. But my [calorie counting] app tells me I'm at my limit, what happens in that situation? Does that then rise give rise to things like guilt and shame, which should never be coming into eating decisions? And when we're in shame, we can't take care of ourselves."
I want to underline that last bit. Or travel back in time and show it to my teenage self. I want to put stickers on the front page of magazines and write a bot that replies to tweets promoting diets. Imagine not feeling guilt about what you eat. Imagine a life in which no one had ever told you "you shouldn't eat that" or asked "do you really need that?"
I can have pasta. I know I am not great at pasta in moderation, so here's my plan for myself. I will have pasta on special occasions, when I want to cook for someone I love, or to celebrate at my favourite Italian restaurant. My lifelong dream to learn to make pasta at the elbow of someone's Italian grandmother can stick around.
In the meantime, I can follow Laurette's advice and listen to my body. Eat when I am hungry and stop when I am full. Make sure my blood sugar isn't swinging around all over the place by managing carbs, and combining them with proteins and fats and green vegetables. Exercise to help my body manage the glucose. And maybe stop overthinking all of it.
After all, I have this doughnut to finish.
* All dietitian appointments were fully paid for by me. Please seek your own advice from health care professionals.