Getting to the bottom of common weight loss and diabetes questions

Last Modified: 12/05/2022

diabetes and weight managment

Weight loss and diabetes often go hand-in-hand, with many patients posing similar questions to their providers. To help combat the confusion, we enlisted the help of Ryan Singerman, DO, PPG - Weight Management & Bariatric Surgery, and Emily Schroeder, MD, PPG – Endocrinology. Follow along as they share their insights and weigh in on some of the most common questions surrounding diabetes and weight management.

What role do food tracking and calorie counting have in weight and diabetes management?
Dr. Singerman: By eating within an appropriate calorie goal for yourself, you can reduce your overall body weight, medicines and insulin dosage, potentially reducing or eliminating your diabetes. Tracking your intake and calorie counting is the only way to ensure you achieve your goal.

Dr. Schroeder: Food tracking is essential in diabetes self-management, especially if it is accompanied by measuring and analyzing the glucose impact of different types of food and their portion sizes. For many people living with Type 2 diabetes and everyone living with Type 1, tracking the amount of carbohydrates can be extremely helpful, allowing those individuals to meet their glucose goals. Calorie tracking can also help those with diabetes meet their weight loss goals.

Is intermittent fasting a healthy and effective alternative for those who want to lose weight and/or manage their diabetes?

Dr. Singerman: Generally speaking, intermittent fasting is no better than any other diet when it comes to losing body weight, but it does depend on the person eating an appropriate amount of calories for their age, height and activity level. However, for some individuals, intermittent fasting has been shown to improve their insulin sensitivity and may (on that level) help those with diabetes reduce their disease burden.

Dr. Schroeder: Intermittent fasting can be a healthy and effective diet plan for some people with diabetes. But, before starting intermittent fasting, they should speak with their provider or the health care professional helping them manage their diabetes. They may need to adjust their medications to avoid developing hypoglycemia and hyperglycemia.

Sugar substitutes are often seen as a "diet" staple, but can they cause more harm than good when managing weight or diabetes?

Dr. Singerman: Sugar substitutes, on their own, don't contain calories and are generally considered safe for consumption. If you were to choose between a regular soda and a "diet" soda with a sugar substitute, the "diet" would be better. However, some research suggests that a steady consumption of sugar substitutes can ramp up your appetite, increasing your chances of overeating. The bottom line is that sugar substitutes are not generally associated with a significant amount of weight loss, but they are also not proven to be harmful.

Dr. Schroeder: Sugar substitutes or non-nutritive sweeteners can be a way to eat sweets without consuming a lot of carbohydrates. However, they are also associated with weight gain and higher blood sugars. The mechanism underlying this effect has yet to be entirely understood but may involve changes in the gut microbiome, alter your taste preferences for sweets, and impact the signaling between the gut and the brain. So, it's best to stick with water when looking to quench your thirst.

Between low-fat and naturally full-fat dairy products, is one more effective than the other in combating weight gain?

Dr. Singerman: No, neither one is particularly better or worse. The "fat" fad has a robust history behind it, but it's not specifically dietary fat that is an issue; it's total calories, and for those with diabetes, total carbohydrates. The fat content of food is important when looking to reduce hunger. Generally, the more fat something contains, the slower it spikes one's blood sugar, but the longer it maintains, the higher the sugar level. This can help people feel full for longer periods, helping them not to seek out snacks.

Is juicing or juice cleansing a safe and healthy way to lose or maintain weight?

Dr. Singerman: Juicing and cleansing have not been proven safe or effective for anyone, let alone someone with diabetes. Due to additives, rapid electrolyte shifts, and steep decreases in calories and blood sugar, juicing and juice cleansing could actually be harmful. It should only happen with specific physician direction or supervision, despite what celebrities on social media say.

How can individuals with diabetes or trying to manage their weight prepare for the holidays and the indulgence it has to offer?

Dr. Singerman: I like to tell people to have a taste, not a serving. Instead of taking a large scoop (or two) of your grandmother's famous dessert salad, have a small spoonful. This also goes for stuffing, yams or anything else on the table. Remember, you can have a little of everything. Focus on veggies and proteins, and don't deprive yourself.

Dr. Schroeder: The easiest way to prepare for holidays is to plan ahead and consider what holiday foods fit best within your diabetes meal plan. Here are a few smart strategies to help you prepare and stay consistent while managing your diabetes during the holiday season:

  • Take a pass – Many holiday foods are high in carbohydrates, so don't feel obligated to eat every food offered.
  • Mind your medicines – If you are eating meals at different times than usual, you may need to adjust the timing or dosing of your diabetes medications.
  • Sensible snacking – Be mindful about snacking during your holiday adventures. Try to pick healthy snacks and avoid constant grazing.
  • Size matters – Be aware of your portion sizes when filling your plate, and stick with smaller servings of your favorite foods.
  • Stay active – Family traditions that include getting up and out, like an after-dinner walk or active holiday games, can be lots of fun while also helping to keep your blood sugars down.
  • Balance is key – Try to balance your total daily intake by eating less at other meals on the day of the big feast.
  • Smart drink choices – It’s fun to indulge during the holidays, but beware of drinking too many calories, sugars and alcohol.

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