Do you take any medications? If not, do you ever worry you’ll have to go on them some day because of your health habits? Many people worry no longer dieting will lead to health concerns that require medications. This idea is a MAJOR roadblock to progressing in your Intuitive Eating work. How do you stop letting this common fear hold you back from becoming an Intuitive Eater? In this episode Melissa talks to fellow Dietitian Kristie Messerli about why even the IDEA of going on medication comes with so much guilt, fear, and shame and how to get past it.
As a Certified Diabetes Educator, Kristie shares how to use informed decision making when it comes to deciding (with your doctor!) how medication might fit into your health care plan
Though these examples center on Kristie’s experience with diabetes medication, this episode is a must-listen for anyone trying to understand more about Health at Every Size and how the philosophy considers medication as a tool for health. We discuss:
- Common fears people experience before going on medications
- What different diabetes medications do in the body – including pros and cons
- Can you go from pre-diabetes to normal range without medication?
- What kinds of things should you be considering before you go on medication?
- What is informed decision making? How can you practice it in your everyday life?
Of course – Kristie and I are Dietitians, but we’re not YOUR Dietitian so please consult with your doctor before making any changes to your lifestyle behaviors or medication usage. Our opinions are our own and do not serve as a substitute for medical advice.
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Follow Kristie on Instagram: @type2diabetes.nutritionist
Check out Kristie’s post on informed decision making and Metformin here: https://www.instagram.com/p/ChAIrcirF-F/
Join the Break the Diet Cycle Podcast Community in Instagram: @break.the.diet.pod
Connect with Melissa on Instagram: @no.more.guilt
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This episode was sponsored by No More Guilt with Melissa Landry. Reminder that though we are dietitians, we’re not *YOUR* dietitian. Podcasts don’t constitute treatment. If you have concerns about your dieting behaviors, seek out guidance from a medical or mental health professional. And if you’re looking for the process, support, and focus you need to live life without food guilt apply for a coaching program from today’s sponsor. No More Guilt with Melissa Landry is currently enrolling clients into 1:1 programs, group programs, and, recently added a do-it-yourself learning format: the Ex-Dieter’s Guide to No More Guilt.
how to get past fear of needing medication with Kristie Messerli, RD, CDCES transcript
Melissa Landry 0:02 Hi there, I'm Melissa, a registered dietitian specialize in intuitive eating for on again off again, chronic dieters, and I'm here to help you take the guilt and stress out of eating so you can be the first in your family to break the diet cycle. I'm interested in helping you unlearn generational diet trauma, so you can be who you are without food guilt. Be sure to follow on Instagram at no more guilt for more support between these episodes. Are you ready? Let's jump in. Hey, Kristie, how you doing? Kristie 0:36 Good. How are you? I'm excited to be here with you. It's so funny. I keep having guests on. And I'm like, This is my internet dietitian friend. You are one of them, too. I feel like we entered into the Instagram space as well around the same time. And you've always been so supportive of me and my work. And I'm just delighted to meet you in person today. Same. Yeah, I was thinking that when we were hopping on the podcast, I was like, Oh my gosh, I always have followed you in like your story about your mom dieting and stuff really resonates with me and I sent her your struggle. Are you she's a lot better about it now that we're older. But like when we were younger, I'm just like, oh my gosh, this is my life. Like it just resonates with me so much and my sister. So pretty much all the women in my family follow you. Well, hello, tell them as early women, you're paying for your married name, but to the Kristie's peeps. It's really funny because as you know, when you put yourself on social media, it's not just for your future clients or your community. It's not just for your community, often people in your life follow and I get messages all the time from friends or from family that open up about this. And it's so interesting people I've known my whole life, you just never know what people are going through and how many people go through generational diet stuff. So I'm with you. Totally, totally. You are specialized in diabetes, you have a very unique lens on diabetes because of your training and credentials. So before we jump in, on this discussion about medication and you know, should we be avoiding it at all costs? Would you mind introducing yourself and your practice to us? Yes, so, my name is Kristie. I am a dietitian and certified diabetes educator. I worked in clinical for a very long time where I became a diabetes educator when I was working in clinical and hated the, just the clinical system. It was just so challenging for people to get what they needed. And so much like, just lose weight, cut carbs. And so I would have patients come to my office and they just like didn't want to be there or they felt like they were being reprimanded instead of like helped. And I hated that narrative. It just drove me nuts. It drove me nuts when I was an intern. But then when I was a dietitian, and that I was only seeing pretty much people living with diabetes or prediabetes, it was even worse. And so when I started my online business, I was working clinical full time still. And I was like, wow, this is really needed. Because people would message me daily, they still do. Like, oh, I just got diagnosed, I was told to lose weight, cut carbs. And then I also have people who are in smaller bodies who are like I was just diagnosed and my doctor had no information for me, like people on all ends of the spectrum. All body sizes are experiencing like this lack of education around diabetes management. And I mean, I even in clinical, I would have people like their bloodwork would look great. And they would come to my office, and I would have a referral for like weight loss. And I'm like, do you want to lose weight? And they'd be like, no, like, Okay, well, you don't have to be here because your blood work looks great. Like there's really nothing to discuss. But the fact that they were still pulled like, oh, you need to see the dietician to lose weight, even though their lab work looked amazing. And they had no intention to want to lose weight. It just didn't resonate with me, it didn't align with me, started running like group coaching programs, and it's just been so successful ever since. So so needed, there is a big lack of information or there's maybe maybe it's not lack of information isn't the right phrase, there's plenty of information. It's just not organized for people so they understand how to use it. Anyone you've ever spoken to who has a pre diabetes or diabetes diagnosis, it feels completely overwhelmed. The fear and the urgency is like level 10 We'll talk a little bit about that and why that might be. You are super needed. So at the end of the show are definitely going to give your handle and information and shownotes anyone who is wanting that specialized diabetes care definitely recommend Kristie's education. It's awesome. Awesome. Thank you. Yeah, that it always feels really good to hear because, I mean, you probably experienced this but when you're working in Senegal, like you kind of think like you just have to go with like what the doctors say and I mean I would message the doctors and be like the patient doesn't even like want to lose weight like I'm declining the referral on their part because they don't like want to be here. And well that some doctors like still really wanted me to like sit in my office and like, reprimand people for their weight, and it never sat well with me, so I just never really did it. But I knew that that's kind of what they want to see in clinical sometimes. There's the undercurrent, though, and I think why so much fear exists. I won't say all doctor's visits, but when folks go to the doctors, there's a lot of urgency and fear and red alarm language and behavior around diabetes screening and risks, particularly for folks in larger bodies. So I wonder if I can just kind of start there. What do you think about the way that primary care talks about diabetes or prevents diabetes? Do you feel like there's a little bit of I don't know, too much urgency? Is it the right amount of urgency? I feel like everyone's terrified of diabetes should they be? I want to, there is a sense of urgency. Yes, of course, when we have elevated blood sugars for a period of time, we know that damage is happening inside of our bodies. So I won't ever discredit that there is a sense of urgency if someone's blood sugars are elevated. Even in pre diabetes, pre diabetes is saying, hey, we need to take some action, your sugars are elevated, there's work that needs to be done. And of course, if you have diabetes, and your blood sugars are elevated, I do agree with the sense of urgency to start managing it. What I don't agree with is the absolute the all our nothings when it comes to the blood sugar management, because those are never going to serve anybody like it doesn't serve any of us when we're talking about that in everyday life. Like he's like, I'm going to exercise every single day, I'm not going to exercise at all, I'm going to work on my stress management or not working at all, like those are absolutes. And that happens in diabetes care more than I see in any other chronic illness. And it's you can't eat this, you can't eat this, you must do this, you must do this. And so people just feel scared. I mean, and people feel like their current way of living is completely threatened, whether it's like their culture. I recently worked with an amazing woman who lives in San Francisco, and she is Asian. And she's like, I eat rice all day, every day. That's something I eat breakfast, lunch, and dinner. And I was told I can't do that anymore. And she's like it threatened like my, who I thought I was, and she goes, I my parents were mad at me, like I would go to family dinners. And I would say no to Rice, and they literally were mad at me, it's like that. And that's inaccurate information that tell her she can't eat right. So like, that's like the biggest issue. I do agree with the sense of urgency, but I don't agree with the absolutes when it's coming to like the education around it. Primary Care is doing their job as screeners that is not all that primary care does. But one of the functions of primary care is to take a population of folks and bubble up people who might need more specialized or intensive care at any given time. So that's why you get your a one C checked periodically at the doctor's office, depending on your family history or other risk factors, they might do it more or less often. So absolutely nothing wrong with checking this number, or raising the flag to say, hey, it's changing. But where it starts to fall apart is the moment it changed this reaction of like, especially with that phrase weight loss, oh my lord, it's like a trip wire. If someone says weight loss, all that traumatic stuff, you might have done your whole life, for plucking out that old wound and that black and white thinking often comes with it, that helps color it in a little bit better, right? That it's important. But we don't need to go to any extreme. Once we hear this information. No. And there's a whole algorithm to follow when it comes to medication, something that I see is people will have an A1C 11, which for those of you who don't know is pretty high, that's a pretty that's that's telling us that your body is not using sugar, the way it needs to your pancreas is not responding to insulin the way it needs to etc. Or I'm sorry that your cells are not responding to insulin the way they need to. And so you might get put on a lot more medication than someone who presents with an A1C of seven. And the urgency in that is to get your blood sugar's down If your agency is at 11. Because we don't want damage to be further happening, it doesn't mean that you'll be on that medication forever. I've had people like decline medication at an agency of 11. And they're like, Well, I declined it. And I'm like, I don't agree with that. Because in the time that it takes to make some of these lifestyle changes, which is amazing. In the interim, you could be doing damage to your body. So it's better to be on that insulin or on that medication. Right from the get go if your doctor you know asks you to be on it. And then you might be able to be weaned off of it after you start making some other changes. Again, that all or nothing, right? It's not necessarily permanent. And with these numbers, I like to get clients to think about apt get think about these numbers like feedback. These numbers are telling you trends and patterns within your body and we're doing our best to make associations how those linked to your behavior. or sometimes don't sometimes there's other factors that are impacting the progression of diabetes. So taking a breath, and being strategic and thoughtful is really, really important. Like, I'm just gonna name the elephant in the room here, I think that a lot of people do feel like this diagnosis is their fault. I think that a lot of people feel like their size is their fault. Curious, from your perspective, you know, we're going to talk about diabetes, but this could extend to many medications and diagnoses out there. But for the sake of this diabetes conversation, what do you say to someone who is like, I don't want to go on medications, because it's my fault. And I shouldn't have been in this position, and I should try to avoid that. How do you talk to people who really feel like, that's shame or that self blame around these numbers? Oh, my gosh, I mean, I have a whole section in my group coaching program about self compassion, and how to talk to yourself about the numbers, because that's never gonna get you anywhere, like to blame yourself and just be so hard on yourself is never going to do you any injustice at all, when you're looking at something on the internet. I mean, you get a diagnosis, the first thing you will do is go start Googling things. Google it, it's going to tell you that it's preventable, that you can manage it, you know, you could have prevented it, things like that. It's not always preventable. And I think it's really important to get that narrative into anyone's head. And I started that at the beginning of my group coaching, like it is not always preventable, or sometimes it's preventable for a little while. Age has a huge role in the development of diabetes sometimes can prevent it. And then as you age, you become more insulin resistant, and it's harder to prevent it, placing the blame on yourself is never going to make your blood sugar's better. I mean, it's probably going to make them worse, because you're having more anxiety and shame around it. I always want people to own up to things in their life that might not be helping their blood sugar's though like if someone's like, Oh, this is my fault. What I'd rather them say is, well, this can happen to anybody, here are the things that I need to work on. Because I know that this will help my sugars, that's a way more powerful reframe than just yourself and just feeling like, excuse my language, like a piece of shit, because you were dying all the time, like I just, you know, and it's so heartbreaking. And it's like, you know, I want them to have accountability for some of the things in their life that are contributing to their numbers being higher. But at the same time, not having self compassion for yourself, isn't going to make your numbers any better, Melissa Landry 12:28 not helpful, it adds stress. And it leads sometimes to avoidance around the things that could make a difference. Kristie 12:34 Yes, I would agree that I see a lot of people in that avoidance phase where they're too scared to kind of do anything, and so they don't do anything. And not doing anything, when your blood sugars are high is not the way to go. Doing anything versus not doing anything is going to get you in a better place. Melissa Landry 12:51 People I talk to and I work with, they maybe had a family member growing up who had diabetes who had some really scary outcomes. Maybe this was in like the 70s or 80s, that they observed this 90s Sometimes clients tell me that they were told at a young age, like if you don't lose weight, you will get diabetes, and then that coming true pucks at that old wound. And so there's so much, you know, for anyone who has that initial, I would call it like a flight or freeze response around around this where we either get super, super perfectionist or like shut down. That makes total sense. This can be hurtful and painful to some of the things that maybe happened in your past or narratives that you've heard. And so the best thing you can do is to recognize when that's happening, and find someone like Kristie who can like teach you in a way that is going to help you to take those steps proactively or effectively versus using shame and guilt which you know, for my handle, we don't want it no more guilt no more. Thank you Kristie 13:51 really your handle. I would also say that you know, a lot of people are scared because you're right. They've seen diabetes and maybe they have an aunt and uncle a mom or dad or grandma grandpa who didn't manage their blood sugar's and ended up with an amputation or on dialysis. That's very scary. And I can only imagine how scary that must feel. If you watched a family member go through that. And then you're being told that you now have it. And you watch this like really traumatic thing happened to someone you love a lot. I think like it's also just I tell I like Creech this, that those things are preventable. I think that when people get a diagnosis, they look at it as a death sentence. I get told that daily like I got diagnosed, it feels like a death sentence. It feels like I'm going to have an amputation. It feels like I'm going to die from this. And I really just like want to normalize that our blood sugars are something we can manage. We can control them. And we can prevent things like amputations, heart disease, like some of these effects that can happen from having high blood sugars. The best thing you could do is keep your blood sugars in target. And that doesn't mean that you can't have your favorite foods or cultural foods that you're just doomed because You have this diagnosis, you might have to be a little bit more proactive and aware on the daily than a person who doesn't have diabetes. So all of us should be being proactive and getting outside moving our bodies like balancing our foods, we all should be doing that. And when you have diabetes, it might seem a little bit more like a little bit more pertinent, I guess, because you see those numbers, and you know that your daily habits affect those numbers. I'm giggling because I'm thinking about a conversation I had with a friend of mine. And she's like, Isn't it scary to own your own business? Like, you just don't know, at any moment? What could happen with your job? And I was like, nope, same goes for you. It's just I have to live with it every day. Like we live in this this world, sometimes where depending on your context, you don't think about certain things. But that doesn't mean that they're not happening, or they're not important or that things can't happen. And so that's an important I love that that like the things that you work on when you seek to manage blood sugars are the menu of changes that anyone might choose to enhance their health, it's really not a specialized care. It's just a more targeted care in that way. Yes. And another thing is that people will tell me, you know, if they've been dieting their whole life, and they're trying not to, and I don't teach or talk about dieting, or eliminating food groups, or weight loss in general. I mean, I believe in body autonomy. If someone wants to lose weight, that's fine. But I don't talk about it any my programs, but people will, you know, tell me like if I lose weight, if I just focus on this weight loss, will my blood sugar's come down? And I'm like, no, because weight loss does not equal better blood sugars. If it did, we would have the answer. We wouldn't have dietitians or diabetes educators we wouldn't we wouldn't eat we would just be like, okay, weight loss is it go into a calorie deficit and your blood sugar's would be great. And I've seen people lose weight and their blood sugar stay exactly the same. I see people gain weight and their blood sugar stays exactly the same. I've had people maintain their weight and their blood sugar's get better. I mean, I've literally seen that across the board across body sizes. So making it strictly about like weight isn't serving anyone either, particularly given that weight loss programs are not sustainable. We've seen that over and over again. And one of the biggest trials we ever had was the Look Ahead trial, which in type two diabetes population did not really show it made a difference in the long term outcomes. So it's very interesting when you look at the research how time and time again, focusing on weight loss, as the main intervention doesn't pan out for people the way my clients will tell me like I've been focusing on weight loss the whole time. And once they shift their focus, their blood sugar's come down, and maybe their weight changes also. But I'm like, isn't it interesting that when you stop focusing on your weight, and you're focusing on all these other things, you're seeing your numbers come down. And if they wanted to lose weight, now they're losing weight, you know, and they're like, Wow, these things just kind of started to fall into place without just getting on the scale every single day, and berating myself about the scale. The cool thing about diabetes, I don't know if it's cool, but I like to track people's blood sugars is because I think it's really cool for them to see that, you know, making certain choices. And being consistent with those choices, they'll see their numbers come down pretty quickly, like not the same day. But like say someone's not moving their body at all, and they start going on 10 minute walks five times a week, after like two weeks, they are going to see lower blood sugars. But when they're focusing on weight loss, we know that that scale doesn't move often. And they feel so frustrated by it. So they're I love when they focus on another data point instead of weight, because they see their numbers come down pretty quickly, just by implementing small, but really sustainable changes, not just another data point, a relevant data point. There is a biological mechanism. There's a reason why movement helps blood sugars enter your cells. There is no biological mechanism that is beyond the theoretical. That weight impacts these blood sugars in real time, the selection of metrics and how you experiment and assess yourself. This is all stuff you might want to consider in design as you approach it. Super, super important to remember that it can be small, it doesn't do this dramatic thing. Absolutely, yeah. Melissa Landry 19:08 We've talked a little bit about fears that exist, maybe past traumas that can shift your reaction or response when you're told your blood sugars are elevated. When you think about informed decision making, which is a term you use in one of your posts. I really loved that phrase. How Should folks be thinking when they're told, you know, I think some medication would be helpful. What is it that their provider should be talking to you about and considering as they decide whether or not medication is a nice next step for them in their goals? Kristie 19:42 When you emailed me that you loved the informed decision making, I'm like, Ooh, I need to talk about this more because we can apply informed decision making to every aspect of our life. As far as medications and diabetes management goes I have a lot of clients who are put on a medication. They're super scared they don't know The side effects they don't even know what that medication is doing in their body. So those of you don't know there are classes and classes of medications for diabetes, some medications help our pancreas release more insulin, some medications, help ourselves be more insulin sensitive, some medication helps us pee out or have sugar come out in our urine. So it's not being reabsorbed into our bloodstream. There are so many different medications and informed decision making when it comes to your medications is this is the medication I want you on. This is why these are the side effects that you can expect. And this is the outcome that you can expect from this medication, for example, is talking about Metformin because Metformin is the most known medication for PCOS, insulin resistance, type two diabetes, etc. Metformin is an awesome medication. I stand by Metformin, 100%, if someone wants to be on it, and I think that's the post that I did was on Metformin, Metformin. If I had a patient, if a patient goes into the doctor's office, and they get put on Metformin, that doctor should tell them Metformin, the way it works, and the way it works is it helps our liver not released so much sugar, and so less sugar is entering your bloodstream. And it also helps our cells be more insulin sensitive versus insulin resistance. So those are the two main mechanisms of metformin, a patient should be told that they should also be told the side effects which GI upset like nausea, vomiting, diarrhea, stomach cramping are major side effects of metformin. Some people don't want to be on Metformin for those reasons. But again, they should be told that so that they either expect that to happen, or if they're having those side effects that are like, okay, my doctor said, you know, this might happen for a little while. Another positive of metformin, is it shown to reduce your agency by 1%, in most people, which is pretty good, if your agency is eight, and you're only put on Metformin, and it comes down in three months to seven, that's amazing. So if the patient were told all of those things, then they get to decide if that's the medication for them, or if they want to hear other options, because there are other options out there. Unfortunately, I feel that people don't have that informed decision making. When it comes to medications, they have no idea. They're just put on a medication, they go pick it up from the pharmacy, and they hope for the best. I've heard people start taking metformin and stop after like three days, because they're having stomach cramps, and they're scared because they don't know, they didn't know that that was a side effect. So informed decision making is basically you know, all of your options, and you know, the side effects and you know how they're going to help you and then you get to decide what's going to work the best for you. Even if you do not currently have diabetes, or you don't anticipate having diabetes, this is such an important skill set to have. Very likely at one point in all of our lives, we are going to be recommended a medication, it might be temporary, it might be long term. It might be pill, it might be injection, it might be cough syrup, like when we were kids, I don't know I'm not a pharmacist, but we are going to be offered a medication as a choice to receive medical care. And what if we could expect accept and neutralize that in a way where we're prepared to say, Okay, tell me the pros and cons, and work with our doctor to decide our choice. If we want to accept the risks for the benefits or not. That's a really empowering thing that I see changing in healthcare. But I don't think historically patients were invited to the table to think collaboratively with their doctors and caregivers. Yes, yes. And informed decision making, we can apply it to anything, think if you go to a job interview, you're not just gonna like it will take the job, like you're gonna want to know how much you're getting paid, like what your PTO looks like, like, you might have a lot of other questions, that's informed decision making, you're gonna take the job, if it's fitting what you're wanting, maybe there's some cons but the pros outweigh the cons. So you're gonna go ahead and take it. So same thing with medication, it's the same thing, working with a certain doctor or a certain dietician, like if someone wants to work with me, in my group coaching or my one to one coaching, I'm not going to not give them information, because that wouldn't be informed decision making, like what if they join my program thinking I'm going to help them lose weight? If I don't relay that information, they might join my program thinking they're gonna lose weight. And I'm like, I'm not going to talk about that. And then it right like, it's important to have informed decision making in all areas of our life because there is no one right way there's right for you. There's my view based on what's happening, your values, your goals and right for you can change. You don't have to just because you agreed to the first plan, stick with it, if it's not working for you. This is definitely a little bit of a privileged conversation because I know many of my clients are in regions where there is a Doctor Who, whatever their practice style is the one that they they have to kind of go with but if you can access provider, you feel comfortable having these conversations with if you can maybe it's not the doctor, maybe there's a PA or a nurse practitioner or a certified diabetes educator on staff where you can just get that extra five minutes to talk through your concerns. That's their job, or it should be it should be your job to listen and answer those questions. Yes, and there's certain medications that are more often to build another for example, Metformin, even without insurance is so affordable. But if someone doesn't understand how it works, or they're concerned about the side effects, they might not go for it, and then they're not on anything, when really the Metformin could be very cost effective, it could be helping their symptoms, etc. Again, like cost is going to play a huge factor in some diabetes medications are outrageously expensive. And if your doctor puts you on it, maybe your insurance doesn't cover a lot of it. And informed decision making would be, oh, my copay is $80. I mean, that would might be a lot like $80. For one medication could be a lot, even if your insurance covering some of it, or maybe your insurance doesn't cover any of it. And you don't know that you don't have to take a medication that your insurance doesn't cover that there are other options. That's a different part of informed decision making. But it's really important. Melissa Landry 25:46 Yeah, so we're thinking, benefits, side effects cost anyone out there diabetes or otherwise covered here that medication is a part of life, it's part of medical care. And blaming yourself is probably not true. There's this is a whole philosophical thing is like, is it ever our fault, when we get sick, some people will have that attitude that it is your fault when you get sick, and you should be able to prevent things? I disagree. I don't know how we are asking ourselves to live life in a way like are we going to live in a bubble and not offend our genetics at all? And even if we did, that, we still would get sick. That's part of life that helps you to borrow that that mindset. I don't believe diseases are false. I believe it's something that happens. And if you have that attitude, you're more likely to have the beliefs that allow you to do informed decision making because you're coming from that place of proactivity and problem solving versus shame and blame. Yep, I would agree. 100%. What do we what do you think we need to do to get the message out that diabetes is not a moral failure? What would be different in the world Kristie, it's like you and me and our individual sessions like and other dieticians and folks like us having these one to one conversations, but I wish I could just give you ever like want to be on the radio or something to people listen to the radio and be like it's not anyone's fault. Kristie 27:05 People think it's their fault, because what we do can affect our sugars. For example, like I'll never say that drinking a soda is not going to increase your blood sugar's we know it's going to, for example, I have this client. Well, she's not a client. She's a follower on Instagram, but I just love her. But she always shares her story on my posts, and I love it because she lives in the smaller body was having symptoms of diabetes, including weight loss, because that is a symptom of high blood sugars. Is it an unintentional extreme weight loss, weight loss, she went into the doctor, she was super concerned and they were like, well, you lost weight, great job. She was having like severe thirst, frequent urination, literally every sign of diabetes, they did not diagnose her. They sent her on her way. And she ended up in a coma in the hospital. She shares a story all the time on my Instagram, and I don't obviously don't love that that happened to her. But I love that she's here to talk about it and about how poor her care was simply because she lived in a smaller body just like people in larger bodies get or care as well. Like she's never gotten any education in managing her blood sugar's ever. They've told her well, you can cut carbs that could help. Like that's all you're gonna say to her because she's in a smaller body, your employer to cut carbs, but if she were in a larger body, you would tell her to lose weight. And then what like what if someone on a larger body loses weight and their sugars stay the same? Then what education are you giving them? The answers usually a blank they don't have it? Or is this pamphlet? Maybe you remember this in clinical like a pamphlet from the American Diabetes or Dietetic Association on food you can and cannot have? And Brad I would burn it. I would never see it again. How unhealthy is that? First of all, it doesn't address cultural foods at all. It pretty much is just like the most basic of foods and it's a do and do not list and people don't like that. You know, I wouldn't like that if someone told me you can't eat ice cream that's exactly what I would want and probably go eat Melissa Landry 28:49 tried and true method to want more ice cream is also when they can't have ice. Kristie 28:54 Exactly. It's the all or nothing thinking I don't know how to get them out. I mean, I put it all across my Instagram literally every single day. But I just think it's a lot more education around the topic. People are just not as educated that are in the healthcare system as they should be. And I think education and is the only way to get the word out Melissa Landry 29:12 public health like you said, it is something that we can intervene on and it is it is important and sometimes urgent depending on high those sugars our public health education i because they were trying to communicate to a broad audience and mass produce these messages. It's like we got all the urgency and shame and none of the nuance, I guess, is a function of this communication. But ultimately, the takeaway was this is a fat person's disease and it's you know, bigger folks and bigger bodies fault. There's a whole history behind this and the social determinants of health and how we there's all of this stuff that goes behind why that is but it's important to recognize if you heard those messages, they're amplified and being able to navigate your doctor's visits with a little bit more grace is is going to be important for your overall outcomes. Kristie 29:56 And focusing less on the on the weight loss and more on things that we know affect our sugars. I don't really recommend a drink soda because it will spike your sugars pretty quickly. But if someone's like, Well, I mean, I, my grandpa he passed away a few years ago, he was in the pre diabetes range for like 20 years, and he would always drink a coke with dinner always. And I remember I'm a dietitian, then I became a diabetes educator. And I remember my mom was like, Should we be telling him to like, not be drinking that? I'm like, no, he's like, 90 years old. I'm not ever going to tell him that he can't drink the soda, right? And even now, if I have a client who's younger and really trying to manage their blood sugar's if they enjoy like a soda at Disneyland or on vacation, do I recommend that often? No, because your blood sugars could be kind of on a roller coaster because it is really quickly absorbed into our bloodstream. But there is a way to balance it, those nuances are ever met with people. And so they just think, Oh, I can't ever have it. And then what does that create, like, oh, I want it even more, because now I can have it. Melissa Landry 30:51 I'm thinking about folks who are diagnosed with type one diabetes, which might happen earlier in life, though not always, we're learning more and more about diabetes, there's all these different variants that exist, you know, for them, they don't make insulin at all, when you have type one, you can't get blood sugars perfect all the time, when you have type one diabetes, we kind of accept that with persons with type one diabetes, that we're going to do the best I can to stay in range. And we have to think about this over a lifetime. We always apply that same grace or flexibility of thinking of like, how can we be flexible to capture some quality of life and preference and culture, while reducing risks as best we can. That's what this is. Chronic Disease is about managing risks, because we cannot erase the diagnoses that that is coming from genetics and epigenetics and the wear and tear of the body over time. Aging, like you mentioned, will activate this over times. All right, you guys get it, we just really, really want to hammer home. And if anybody gets on whatever the equivalent of the PSA system for the United States of America is please pass the mic to me and Kristie will be like diabetes is no as well, just good care. Kristie 32:04 Its okay, if you need it, you need it. The ultimate goal should always be to get your sugar's within target with regardless if that is medication based or not. That should always always be the goal. I know people sometimes don't want me on medication. But if you're presenting with an agency above 10, you need to be on medication, maybe just for a little while, because now you're aware of it. Sometimes when people come in in their agencies that high, they don't frickin know that it's that high. So they haven't been doing anything. So maybe if you're on medication for a little while and you're working on diet and lifestyle and all these other changes, then your doctor likely could decrease or take you off of that medication. I would say that if your agency is 7.5 or lower, asking your doctor to work on diet and lifestyle for three months is great. If your agency is much higher than that the goal should be to get your blood sugar's down alongside medication and working on it on your Melissa Landry 32:53 own loose cut offs for you to consider obviously your doctor is going to be your best console here that can help you to understand from this lens of feedback and using that feedback to decide what methods are going to work for you to hit the goal which is to get the sugars in range, however that looks for you is the right way to go. That's the practice of it all and something that hopefully gets easier and more effortless over time as you understand self and your numbers. Kristie 33:22 I've had a client she was she had an agency of like 10 point something and she declined medication and then a side effect of high blood sugars or a symptom is fatigue, fogginess and forgetfulness and she didn't want to be on medication then when we were talking she was having a really hard time staying awake for our appointments and retaining the information we were going over and if she had been put on medication prior to that appointment and started to get her blood sugar's down in our appointments she probably could have been more present and awake literally because she her sugar's were too high to focus. like training wheels, you know, you can, you can have a more enjoyable ride when you're learning to ride your bike if you take the training wheels off. Sure, I guess you can do a better phone and a lot. If you're training wheels on maybe you get the groove a little bit faster. You get to see more of the VISTA wherever you're riding your bike, it's okay to lean on medication as a tool. It is a great example of how it can hold you back in a way you didn't expect. Yeah. And she acknowledged that because in our second call, I really recommended that she be put on medication and talk to her doctor and like a month later, I was like you were right. I was so tired. I could hardly keep awake for our appointments like I wasn't absorbing any of the information and I worked with her for like six months and she ended up getting taken off of the medication she was put on but for a short time was on it because without her blood sugar's being within target. She was like unable to really really focus and be present to understand and learn the information she needed to. Melissa Landry 34:46 I keep making this extension to other medications, which we won't talk about here. But I want to invite everyone to think about that any medication that you're on it is a tool and sometimes that tool can help you get to your end game faster or with more ease and we hope that we've given you a little bit of openness around medication and a little less shame Christy, thank you so much for sharing your perspective. I'm going to put the post that inspired me to call you for this episode in shownotes. What else would you like to let people know about following you and continuing to learn from you? Where can people find you? Kristie 35:21 Um, so I am on Instagram at Instagram while I'm at type two diabetes dot nutritionist. And one thing I will say is that there are a lot of quote unquote blood sugar coaches on Instagram and that is not a thing if you see blood sugar codes, that's not real. If you're looking for like education and you're really looking to understand look for dieticians, who have their Registered Dietitians or certified diabetes educators they're going to be and obviously like your doctor and they're going to be the ones with the most up to date real certification and knowledge. Melissa Landry 35:53 Definitely when there's a lot of fear. We see a lot of industry on that fear and it's hard to know who to trust RDS CDE is are usually your best bet or shortly I will put your Instagram in the show notes. Everybody go follow Kristie, you can also check her Lincoln bio. I know she always has links to her offers and things like that. Kristie, thanks for spending time with me. I'll see you around us. Kristie 36:15 Awesome. Thank you. Bye. Melissa Landry 36:18 I am recording this after we had breakfast for dinner bound up with this delicious spinach and feta cheese omelet and it is 1,000%. Okay, if your dinners aren't elaborate, all planned out and picture perfect Pinterest beauties, especially if you work wackadoodle hours, or you're feeding small humans, or maybe you just don't like to cook. That's okay. All of those things are okay. We need to normalize just feeding ourselves. I hope you're thinking about what sounds good. It's an intuitive eating question you get to ask now that you are no longer a dieter, it's such an easier way to think about food versus trying to be perfect all of the time. So if you needed to hear that today, it was on my mind and I had to share it with you. This episode this episode, we are talking about the interview with Kristie, such an interesting conversation. So many of us are taught that it's our fault if we experienced some sort of health concern. And so if you're going through a health concern right now, that requires medication or you were you might someday face that. I hope this helped you to see it's not your fault. And it wouldn't be your fault, you are learning how to see your individual body cues as well as feedback from your doctor's office lab values as bits of information or data that you can use to make choices for yourself. That's why Kristie's points about informed decision making are so so valuable, it can help to take the fear and guilt and shame out of the whole experience, which is exactly what we're trying to do. As we break this here diet cycle as much as I can. I want to give you these skills to help you out because it's important to me that you feel confident in applying intuitive eating into your life. I have been welcoming new one to one clients these past weeks who are just so ready and so relieved to finally have a space where they can talk about what they go through non judgmentally and make changes in their lives in ways that feel effortless and free. Versus pressure they know they can only do for a week or two view wanting a little bit more process and support. Let me know what you're working on. And we can strike up a casual no pressure conversation to see if the program would be right for you. The other thing you can do is put your name on my groups waitlist, I put the link in show notes. This group is to start in the new years to perfect time if you are somebody who always starts a diet in the new year and you just don't want to do that anymore. Go ahead and put your name on the waitlist I'll keep you posted as things evolve. One last thing before I go if you've been loving the pod new video for a while doesn't matter. Your five star review and feedback means the world to me, helps this podcast get found and for people to trust that they won't be wasting their time if they spend about a half an hour or more with yours truly getting to know concepts about intuitive eating and Health at Every Size. So after you're finished listening, go ahead drop me a five star review. Write out some feedback and I appreciate you supporting the pod so we can help others become the first in their family to break the diet cycle just like we are. Until next time. Good to your good body. Transcribed by https://otter.ai