Got diabetes? Need advice? Of course you do! And you came to the right place: Ask D’Mine, our weekly Q&A hosted by veteran type 1, diabetes author and community educator Wil Dubois.
Today, Wil takes a crack at two questions involving weight… losing it and gaining it. Always a touchy topic, diabetes or not, but even more complicated when the D and other health concerns like thyroid issues may be at play.
{Have diabetes questions of your own? Email us at AskDMine@diabetesmine.com}
Shauna, type 2 from California, writes: I have looked everywhere for an answer and have had no luck. Here is my problem: I am 5’1” and at 147 pounds, too heavy. My whole life I have been a comfortable 108-115 pounds until recently. I was diagnosed with hypothyroidism one year ago and was also diagnosed with type 2 diabetes. I was born with celiac disease and I’ve done research on what I should eat to lose weight, control the blood sugar, thyroid and celiac, but the suggestions for what to eat all contradict each other.
I need a list of exactly what I can eat that will be compatible with all three: celiac, hypothyroidism and kicking the diabetes and obesity before it’s too late and my A1C goes over the top. I have no problem eating whenever I need to and am willing to eat mostly anything. I just need to know what foods go with all of these conditions and do I need to cook things or can I eat, raw veggies, for example. I really hope you can give me a list of a diet that will help me conquer these problems and lose the weight. Oh and I do walk at a steady pace on a treadmill but do not lift weights because I have a back injury. I’m a stay-at-home mom and wife so I stay pretty active. Thank you so much for your time!
Wil@Ask D’Mine answers: First things first. There’s no secret to losing weight. You just need to bring fewer calories into your system than you burn. It’s that simple. All the various crazy-assed diets are just different ways of doing that. Counting carbs is a workaround for counting calories. Eating Mediterranean is another way of putting fewer calories into your mouth than eating American-style. Eating multiple small meals to keep portions down and hunger at bay is just another form of calorie reduction.
And so it goes.
Of course, really, your celiac is the true limiting factor for you. It trumps all other diet advice. Celiac quite literally commands what you can and can’t eat. And on this front I think you are lucky, although I’m not sure you’d agree with me. But the way I see it, as you’ve had celiac from day one, you’ve got that down pat. Really, all you need to learn is diabetes and thyroid.
So let’s talk about thyroid diets first.
To be honest, I’d never heard of a thyroid diet, and I’m hypothyroid myself. But no wonder you are confused: When I investigated I found that an entire industry has been built on the concept of thyroid-healthy diets with books, videos, and various know-it-alls spouting off about what you should and shouldn’t eat for a happy and healthy thyroid.
Sadly, there’s no science to back it up. Any of it. If you don’t believe me, believe the experts at the Mayo Clinic. Of course, while there’s no scientifically validated diet for treating diagnosed hypothyroidism, it’s worth touching on the impact of diet on the medications used to treat it.
Thyroid meds come in two flavors: synthetics and “naturals.” The synthetics can be affected by dietary fiber, some flours, and other meds—so the official directions say to take them on an empty stomach at least an hour before eating, drinking, or taking any other kinds of meds. But that’s not the reality in the trenches. The endos I used to work with were more pragmatic: They told our patients just do what you normally do, consistently, and we’ll adjust the dose to match your lifestyle. The natural pill, called Armour Thyroid, apparently doesn’t play well with soybean products. But that’s about it for thyroid diet.
And the thyroid shouldn’t be an issue with your weight, as long as it is properly controlled with medications. When your thyroid first went out of whack, it was easy for you to gain weight and hard to lose it. In fact, weight gain might have been what tipped your doctor off to the fact that your thyroid was misbehaving. But I have to assume that your doctor now has your thyroid meds set right for you, and a medicated thyroid is doing the same job as a fully healthy one — so you should be back to square one on the ability to maintain a healthy weight. Having controlled hypothyroidism is the leading cause of nothing, much less weight gain.
So much for thyroid.
Now, you’ll be happy to know that diabetes diets are simple. But I cannot give you an exact list of what you should eat like you asked for, because no two cases of diabetes are created equal. We are all different. That said, I can tell you how to make your own list. And all you need is a pen, a notebook, and a glucometer.
Unless your doc says otherwise, a meal that treats your diabetes well won’t make your blood sugar rise more than 60 or so points. Higher-carb foods like starches will of course cause the most rise. To make your own personal list of foods that work for you takes trail and error. First, test your blood sugar. Write the result down, along with what you are about to eat. Next set a two-hour timer and sit down and eat. In two hours, test your blood sugar again. Look at the difference in the numbers. If the second number is more than 60 points higher than the first number there’s a problem with the meal. It might be what you were eating, how much of it you were eating, or what combinations of things you were eating. This kind of exploratory testing is called Testing in Pairs, as you are doing two tests, a pair, to study cause and effect around meals.
Important: Don’t get stressed out by people who say things like, “After a meal your blood sugar should never go above a target of 180 mg/dL.” People who say things like that are being stupid. Sorry, but it’s true. There are two separate components to blood sugar: Rise and Target. And they are separate problems. True, in the long run you want your after-meal numbers in target, but if your before-meal numbers haven’t been properly adjusted yet and are high, your after-meal numbers will be that much higher again, regardless of how good the meal was for you.
When it comes to learning how to eat for your personal diabetes, rise trumps all. If the rise—the difference between the numbers before and after the meal—is good but you are still above your doc’s target, that’s a problem for your doctor to fix. You don’t need to change the meal.
OK. So you already know how to eat for celiac. You now know there’s no special way you need to eat for hypothyroid. And you know now how do develop a list of foods friendly to your personal diabetes. Now. How do you lose weight?
Simple. Keep to the low-calorie food choices, and/or reduce the portion sizes on the higher calorie choices. Before long you’ll be back to your comfortable 108-115 pounds.
Meanwhile, our next reader is keen to gain what you are keen to lose…
Bankim, type 1 from India, writes: I want to increase my weight. I’m a 29-year-old vegetarian. My weight is 52 kg and I’m 163 cm tall.
Wil@Ask D’Mine answers: So for U.S. readers, Bankim’s weight translates into about 115 pounds. And at five-foot four-inches, Bankim has a body mass index of 19.7, slim, but not medically underweight. Still, if you’d be happier heavier, we are here to serve.
And just like losing weight, there’s no secret to gaining weight. You just need to bring more calories into your system than you burn. It’s that simple.
Well, except for the fact that most of the high-fat, weight-gaining foods that are low-carb (and thus diabetes-friendly) aren’t exactly on the vegetarian menu. My only advice is to look for higher-calorie vegetarian food choices like rice, pastas, and potatoes, increase your meal size if you can without spiking your blood sugar, and consider adding snacks or an extra meal to your day.
Oh, and check your thyroid to make sure you aren’t hyperthyroid (overactive thyroid), the other side of Shauna’s coin. Just as uncontrolled hypothyroid can make it hard to lose weight, uncontrolled hyperthyroid can make it hard to gain it.
This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.