Diabetes and weight gain: has conventional wisdom got it all wrong?

It has been many years now since I was a new grad, yet I still remember with such clarity the first ever diabetic patient I saw.

This gentleman had poorly controlled diabetes and was also overweight, clearly holding most of it in his mid-section. He had seen a dietitian before, and according to him, he had “done everything he was told” and was therefore not entirely sure why he was sitting in my rooms that day. “The GP wants to make sure I am doing what I need to do I guess” was the best he could come up with.

I was so excited to see what I could do to help this gentleman. “I am going to be changing someone’s life!”

Channelling everything I had been taught up until that point, I went on to discuss his goals and look at his current intake so I could make some recommendations. I was adamant that losing weight will help improve his glycaemic control. So, in my head, I already had a few key things I wanted to address with him: I wanted to ensure that all his carb choices were low GI; I wanted to ensure all his food choices were lean and low fat; I wanted to make sure he ate regularly, without skipping any meals; and I wanted to make sure his meat were palm sized and that he controlled his total portions.

What caught me off guard was that his intake at the time was not far off that. He indeed was doing everything his previous dietitian had recommended. He chose Weetbix or oats for breakfast and had this with skinny milk and fruit. He snacked on fruit and low GI muesli bars (which also had a “Heart Tick”). His lunch was a salad sandwich with low GI brown bread, and he would seal the meal off with a piece of fruit. His dinner was lean meat with vegetables and some basmati rice, pasta or sweet potato. After dinner, he would have a low fat yoghurt, or some plain low fat crackers with some low fat cheese. He only ate when he was hungry and he rarely had chocolates, cakes or other indulgences.

So why was he not losing weight? Why did his sugar control get worse? I had no answers, except to tell him to continue with what he was doing, and to go back to his GP as he probably needed to increase his medication. “The diabetes is just getting worse and it isn’t anyone’s fault” I remember saying as I walked him out of my consult room, feeling sad that I couldn’t do anything, but knowing with confidence that he was doing everything right.

Well, fast-forward 7 years, and I am no longer so adamant I did the right thing. I am no longer so confident that he was doing everything right. Today’s me would have asked a lot more questions around his sleep, his work, his stressors. Today’s me would have requested to see a lot more blood tests to determine his hormone levels. Today’s me would have made dietary modifications to minimise insulin secretion so as to help him alleviate what was making him sick, what was making him fat.

Today’s me have successfully helped hundreds of clients go into “remission” from their diabetes just because I no longer believe what I used to believe.

You see, I no longer believe that diabetes is a disease that “only gets worse”. I no longer believe that weight gain causes diabetes. Instead, I know that weight gain does not cause diabetes, but is rather a symptom of the insulin resistance present in diabetics. Then when you add to that the fact that insulin resistance is not only found in those with diabetes, but also those with “normal” glucose readings, pre-diabetics and women with PCOS, it can become a lot harder to identify. But, once identified, it could be what prevents our current diabetes epidemic from continuing to spiral out of control, as well as end the frustration people have with their struggle to lose weight, despite their best efforts.

As the saying goes, “you live and you learn”.

Now at Metro Dietetics, we specialise in metabolic health and we thrive on seeing our clients achieve phenomenal results.

If only I could dial back 7 years so I could help that gentleman who sat in my rooms that day…

But hey, at least I can say that I did do the best I knew then, and now, I do the best I know now. At least I can say that I did live and I did learn and as a result, I am now actually helping change people’s lives for the better.