140. Diabetes and Intuitive Eating with Lydia Leighton

This week, I’m bringing you a highly requested episode: Intuitive Eating and Diabetes. 

I’m joined by Lydia Leighton, a registered dietitian and nutritionist, to discuss how to navigate diabetes while maintaining a healthy relationship with food.

Lydia and I deep dive into Diabetes through an intuitive eating and anti-diet lens, including:

• Understanding what diabetes is and the differences between type 1 and type 2 diabetes
• How diabetes is not just governed by food
• Tests used to diagnose diabetes, and what those numbers and letters the doctor keeps talking about really mean
• How can we approach food and diet with diabetes in a way that aligns with intuitive eating principles
• Is there a "diabetic diet"? 
• Sugar - is it the devil?
• How to control blood sugar spikes
• Understanding carbohydrates
• How to listen to your body
• And we are debunking myths about diabetes

Meet The Expert: Lydia Leighton

Lydia has a wealth of experience in the field, having worked within the NHS in weight management services and with individuals facing various health conditions, including diabetes. Now, in her private practice, she focuses on supporting clients in a safe and sustainable way that prioritises health over weight loss. You can find Lydia here:

lydialeighton.com
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 ⚠️ Important Disclaimer (in addition to the usual disclaimer!!)

Before we dive in, it’s crucial to mention that this episode is not medical advice. If you are under professional care for diabetes management or suspect you may have diabetes, please consult your healthcare provider for personalised guidance.

Chapters

• 0:09 Introduction to Intuitive Eating and Diabetes
• 7:25 Understanding Diabetes
• 15:17 Diabetes Testing and Remission
• 27:19 Intuitive Eating with Diabetes
• 38:02 Balancing Meals
• 43:36 Personal Preferences and Food Choices
• 52:59 Tracking and Movement
• 1:04:08 Exercise, Nutrition, and Diabetes Myths
• 1:04:08 Lydia's Key Takeaway

Transcript

0:09

Welcome to the intuitive eating and body positivity podcast. I'm Terri and I'll be talking about all things intuitive eating, body positivity and health at every size and shaking off weight stigma, diet culture and food rules so that we can all have a better relationship with food and our bodies. Good morning. I have a very exciting episode this week. It is a much requested episode. It's one that people have been asking for a long time, it's not something I could talk about myself because I'm not an expert in this field. So we are going to talk about intuitive eating and diabetes this week. A lot of people have concerns when they hear the words diabetic or pre diabetic, then they have concerns about how they can be an intuitive eater and not get obsessed by the food they have to eat. So that is what we're going to talk about week. And I have very lovely Lydia Leighton with me. She is going to be our guest expert on the topic. Before I start talking to Lydia though, I just want to give a massive disclaimer for this episode. This is not medical advice. I know I say this about all my episodes, but this is really not medical advice. So if you are already under the care of a professional for your diabetes management, please listen to them, please take their advice, please work with them. If you are concerned that you might have diabetes or you are pre diabetic and you are looking for care around that, this is not the place. Go seek proper medical care. This is information sharing. We're just trying to give you some information, educate you a little bit around it, and give you some tools to use. Let's get into it now the boring stuff is done. Lydia, hi! Good morning, Terri. Lovely to be here with you. I'm excited for this. Yeah, me too. We've got loads to chat about. Yeah, we've had a few conversations leading up to this haven't we, and there's so much that we can get into. So I'm really looking forward to it. Yeah, Do you want to do a bit of an introduction and tell people who you are and what you do? Absolutely. Yes, my name is Lydia and I'm a registered dietitian and nutritionist and I run my own business Lydia Leighton Nutrition and Wellbeing. But before I did that, I worked in the NHS. Working within weight management services, within GP practices, working with people with diabetes, with raised cholesterol, as well as various other conditions like gut issues. Got plenty of experience in a wide variety of areas. It's really exciting to come and share some of that information with you. And now out here working on my own in, in sort of private practice. I absolutely love supporting my clients with their weight. And although we're not here to talk about that today, it's not about weight loss. It's about that Intuitive eating. It's knocking those diets on the head. How can we support our health for the future? And I have a real passion that making sure that what people do with their diets, they do it from a safe and sustainable way that protects their future health. I've seen so many people do funny things that cut out food groups and do all sorts of things and they end up in such a muddle and such a mess with sometimes quite serious knock on consequences. So this is really about your health and supporting you for the future and that's a real passion of mine. Yeah, it's good to hear. So yeah, the second you throw a medical condition in the mix. Yeah People start to lose the work that they've done around repairing their relationship with food and exercise and everything that's linked to it. And it all becomes about condition and what they have to do and how they can control it. And you lose all the nice relaxation around food and stuff that you did. Exactly. And when we'll talk about what diabetes is shortly, I expect, when we, when people do have that diagnosis, all of a sudden it flips into numbers. How much sugar should I have? Oh, I can't have grapes. I can't have bananas or I can't have carbs. It flits into that that diet mentality of can't have. And for somebody that's really struggled with that over the years and their relationship with food, it can be really damaging and can undo an awful lot of work that they may have done up to date. And of course, they're left feeling like they don't trust their body. Because, sometimes people can feel very let down that they then have a medical condition and of course then blame kicks in, guilt kicks in, all of these emotions and feelings and, that can be really unhelpful. It's something that we need to work on and we need to remove that blame and think about the future and think about, there's always something you can do to support your health for the future. Before you even said blame, I was thinking, yeah, I would blame my body because I'm trying to be intuitive. And I'm told that if I just listen to my body, it will do what it needs to do. And then here we are with a, Very serious condition. Yeah, and that's it. It all goes out the window then. So yeah, it's that age old thing, isn't it? Of health made up of Behaviors and not just the weight that you absolutely. It's nice to have the whole picture for this. And health is, obviously, yes, it's behaviours, it, and it's not just the way you are, but there's also all those other factors that go into play with diabetes and many health conditions like, your stress, it's not just what you eat, it's your lifestyle, your genetics, whether you're male, whether you're female, there are, your hormones, all of that. All of these things, whether you're taking medications for something else that has a knock on effect on creating diabetes, for example. So there are so many factors that work together in a way that can then end up with certainly like a diagnosis of diabetes or maybe something else. So it's what we call multifactorial and it's complex for the reasons that people get diabetes. Yeah. as is everything with the body. Exactly! Yeah, People just think it's simple isn't it? It's just eat less we're all move more or don't eat sugar or it's never one Never. And I think that's it. It's a gross oversimplification. And I think, when we hear these messages around diabetes, Oh, you've got diabetes or you need to lose weight. And you're like okay. Weight has a factor, but it doesn't mean that everybody who lose weight will get rid of their diabetes. It doesn't work like that. It may support it, but it isn't the only thing that you can do. And again we have to think about the individual and we have to think about where they've come from what's their background, what's their relationship with food, what's their family history like. There are lots and lots of factors that we need to pull together in order to support somebody moving forward. Yeah. Yeah, for sure. Do you want to start by explaining then? Yeah. like we've just got into it and haven't even explained what it is yet. Yeah. Yeah. do you want to go through? What it is. What diabetes is. I know that when I've had conversations with doctors and things about diabetes, there's all these numbers and letters and things thrown around, and I'm trained in nutrition and I understand a bit about this, but for somebody who doesn't know, can you explain what it is, a bit about how it works Yeah, definitely. and what these numbers and letters are that the doctors talk about. Yeah, absolutely. So we'll dive in with what it actually is. And then we'll get into the kind of numbers and see where it takes us, I think. But yeah, so diabetes is a condition that causes the level of blood, the level of sugar in the blood, to rise and become high and we don't want that because in the short term that level of sugar going up in the body can lead to short term symptoms such as excessive thirst, going to the toilet more often, feeling tired, maybe hungry, you may have weight changes without trying. You might have cuts that take longer to heal or you've got more longer term. So if we have the elevated level of sugar in our bloodstream, you can get longer term effects to the circulation, which can then affect other sort of parts of the body and cause damage. So there are two main types of diabetes. We've got type one and type two, and there are lots of subtypes, which we won't go into today. But certainly I'll just, give you a quick overview of the type one and two, and then that will help us to understand what we talk about later. But I think before we get into that, sometimes it's helpful to understand what happens food and sugar and insulin when we don't have diabetes? Because if we know what should happen, then we can understand better. What happens when we've got diabetes. So essentially when we eat food in particular, carbohydrate containing food, that gets broken down into glucose or sugar. And that is the body's main energy source. That's what our muscles use. And what a lot of people don't know is what our brain only uses. That's its preferred energy source. So when those foods are broken down into glucose, that sugar, moves into the bloodstream. Now, in response to this, and it's quite normal we each we eat carbohydrates and sugar, our level of sugar should go up in the bloodstream. But what happens is the pancreas, which is a little organ situated near the stomach, is triggered to release insulin, which is a hormone, which lots of people have heard about. And that insulin basically allows the glucose or the sugar to be taken up by the cells in the body and be used as energy or converted into the storage form of energy, which sits in the liver. And anything that isn't used. Sometimes the insulin will turn it into fat and will store it in various places. Now it's a little bit, think about a lock and key mechanism. So if you think about insulin being like a key and your cells being like a lock and essentially the insulin is the key that will unlock the cell doors and lets the sugar in to give us the energy that we can use. So if we think about the different types of diabetes with type one, it's Basically what's happened is the body's attacked itself, so it's what we call autoimmune disease, and the insulin is therefore not available, so there are no keys to unlock the doors. So essentially the sugar stays in the bloodstream because it can't go anywhere, and that sugar goes up and up and can cause problems. So those people need regular insulin injections for life. Type 2 is a bit different and that's where the body either doesn't produce enough insulin or the body's cells aren't reacting to it properly and we call that insulin resistance. So it's a little bit like having either not enough keys or faulty locks. So essentially the glucose will still build up in the body over time and cause that damage as it circulates around. Now type 2 has different treatment approaches. It could be diet and lifestyle, it could be medications and it could be insulin. Lots of people often view type 2 diabetes as being less bad, less serious, but both of them are as serious as each other if left untreated. So we do need to pay attention and do the best we can, work with our healthcare providers for the best results. So does that make sense? Yeah. Yeah. To me, it does. I like the lock and key analogy. It's a bit more visual isn't it? Yeah. And it's very easy to blame our weight, and we've touched on this already for type 2 diabetes. Or people say, oh you've eaten too much sugar, so that's why you've got diabetes. That's not the case. And, diabetes is complex. It's strongly influenced by genetics. We know both types are but it's also the environment we live in. It's the medications, it's stress, it's all sorts of things. So we can't simplify it and blame ourselves. Yeah. So it's important to think about that. And I think, for the purpose of our conversations today, we'll talk more about type 2 diabetes, because that's, 90 percent of the UK population that has type, has diabetes is type two, so it makes sense to focus more on that. Yeah. And I'm assuming that is the the type that is more controllable by the stuff that we're talking about. Exactly, yeah. But type one, if you need to inject insulin, that is just a, that's a functional treatment, isn't it? Whereas I don't know how, I actually genuinely don't know how much that's affected by things like the food and exercise that we have, but type two, that's the one we can have the most influence on with those things. Right. yes, it's a very different approach with type one, so it gets type one they may often measuring their blood glucose levels. For example, they'll have monitors. You have things like carbohydrate counting. So you actually have to start measuring and matching the amount of insulin you give to the certain number of carbohydrates. So it can get quite sort of complex, but equally people are still encouraged to eat normally as much as possible. And in a way, they're still encouraged to have a healthy balanced diet like the rest of the population. So it can, food can have a massive effect, but it's partly also because you've got to then match the insulin to what you're eating and your lifestyle. Yes, is, there's another layer of complexity, yeah. But yeah, certainly we've got to, For what we're talking about, it's more the sort of the diet and the lifestyle because a lot of people, when you've got type 2 diagnosis, depending on how early on it's picked up, may not go on medications for years. They may have that pre diabetes that we mentioned, and that's when your levels of sugar are a little bit higher than normal, but not high enough to be diabetes. So it's almost like a warning to say let's just keep an eye on things. And that's when diet, you would only then have the kind of the diet and the lifestyle element. And many people have that these days because diabetes is often picked up just through routine tests. Whereas years ago, You'd wait till somebody has serious symptoms and it'd be picked up when they were already quite advanced. Whereas it's not the case now. Yeah. It seems to be screened for in quite a lot of routine testing I've found. Yeah, definitely. You might just go in for a simple test and they'll stick down, they'll stick a glucose test on or an HbA1c, we'll come into that. But yeah, it's a lot easier to pick up these days. Yeah. Yeah. There's those numbers. Yes. Tell us a bit about that. Your doctor goes, here's the Lots of numbers. blurdy blur and you go, I don't know what that is. No, exactly, that's it. It's just do I have it or not? So there are various tests, which is why it gets a little bit confusing. One of the main ones is something called your HbA1c and that's all glycated haemoglobin, that's called, and that simply is a measure of is a three month average. So it's where a type of haemoglobin, which is what we find in the blood, protein in the blood, and that binds the glucose to it. So it gives us an average over that three month period. So it's measured in millimoles per mole. It's just a measurement. And generally speaking, it's more than 48 would be classed as diabetes. And if it's between 42 to 48, you'd be classed as pre diabetes. So that's what, but you A lot of people, unless they're interested in the numbers, probably wouldn't be given the numbers, but it's whether you've got that piece of paper and what that is. But ultimately you would probably, if you were just diagnosed, you'd be tested maybe in three months time. to get another average just to confirm it or to see if any changes you might've made to lifestyle may have improved that. Or likewise, if you'd started medications, they would want to check in usually about three months. If things are stable, then again, you might be pushed to six months. And if things are all good, pretty okay, you'd be pushed to kind of 12 month reviews and that's fine. You can also get random blood glucose tests where they use a finger prick test or they could take blood from the arm. So again, if you've gone in for a blood test, they could easily do that there and then. And if that's got a different measurement, so that's done in millimoles per litre, but if that's more than 11. 1, then that indicates that your body's struggling to process that sugar. Now we don't diagnose diabetes with that. You would then need another blood test, which would go to a laboratory to then confirm that. And then you've also got fasting blood glucose. So that's when you might, your doctor says come in before breakfast. You need to have not eaten since this particular time because I need a fasting blood glucose and that's taken from your vein. And if that's more than seven, then that would indicate diabetes. So it, that's probably why people get confused because there's lots of different ways of measuring it. And then you also get a glucose tolerance test but that's often used more in pregnancy. And that's where you drink a solution of sugar. And then they watch what your blood levels do a couple of hours later. Let me have a marker of what it should be. Yeah, so lots of numbers and then if somebody is having it's unlikely straight away with type 2 diabetes but people can test at home. where they're often given blood glucose monitoring kits. Again, there's different numbers for that as well. I'm not sure there's much point going into those. It's just probably going to be quite confusing. What I'd say there is everybody's very individual. So some people like numbers, some people don't. And I think it depends what kind of person you are as to how you respond to those numbers. Now, Numbers are only useful if you're going to use them objectively, not judge yourself. We're going to come on to things like that and obviously part of intuitive eating is not judging what you've done. It's being compassionate. It's learning. It's moving forward, isn't it? Whereas numbers, we can go, Oh, it's my sugar's one millimole higher than it should be. Oh my God. I'm, that must've been that piece of cake I had. It's ah, it might not be. So it's whether we've got the confidence and the support and the knowledge to deal with what those numbers are telling us. that is, whether it's beneficial or not. So for some people it would be, but again you might need a lot of support to help you with that. Yeah, you're right. It's very individual. And actually I think it depends on, like you say, what kind of person you are. Whether you want to know, need to know would get hung up on those yeah, or whether it would just be out of interest and for knowledge and for your own personal development of understanding the condition, but also I think there's also a responsibility on the doctor to make sure that person that being advised has the right level of knowledge. So would be sat there saying, or tell me about that. And what does that mean? And what is that number? Whereas for other people, it might just be absolutely mindblowing and yeah, they just want to hear, okay, I don't need numbers specifically. I just need to know how to stay well. Exactly, yeah, I think medical professionals have got a responsibility as we do ourselves. We a lso have a responsibility to take care of our own conditions. Absolutely. And I think that's something which, I always say to people, you know you best and it's sometimes we have to voice how we're feeling and, if we don't understand things or if you think something's not right, it's your health, it's your diabetes, and sometimes, We need to ask for help and sometimes you might have to keep badgering your GP or your practice nurse and say hang on a minute, wasn't I supposed to have a blood test or I'm not sure this is right or can I just get something checked and often we don't want to make a nuisance of ourselves they're busy practices. Sometimes Things get missed but you know whether things change for you. And again, that's part of being intuitive, not just in eating, but being intuitive in your body and your health and how you're feeling in general, because if you feel something's changed or something's wrong, it's always worth being aware of. Getting support, getting advice from a health professional because it's much, much easier to pick, to deal with things when it's early than waiting till any damage is done or trying to fix things. Yeah. You hear so often, don't you? That like, I just know that something's not right. Yeah. I just know that there's something wrong. And if they persist and ask questions and dig a little Yeah. sometimes it comes out that actually they were right. They were right to push. And think any medical professional worth their salt would not turn their nose up at somebody pushing Absolutely. Yeah. and advocating for themselves. absolutely. Yeah. And I know, often when we've worked and I used to do education days for diabetes and things, and we were always encouraging people to take ownership of their own diabetes, it was like, do get to know your numbers. If you can do keep a track on when your appointment should be, do question things. Because it's all that. that future health, even if there's a lot of talk about diabetes remission but, even then you've got to keep on top of things. It doesn't completely go away. So it's a life, it's a, it's progressive and it's long term. So we do need to get to live with it really and make it work for us. Can you go into remission from diabetes? So that's it. And I made some notes on this because I thought it's bound to come up. There's been quite a bit in the media as well about this. And partly because there was a study which was published or the five year results were published in the early part of this year in the Lancet. And there was the Direct Study which is diabetes remission clinical trial. And they, have demonstrated that under controlled conditions that with substantial weight loss, we won't go into numbers, but with substantial weight loss, then some people, yes, could technically go into remission. And now it was, those conditions were very controlled calories very low controlled calories over a number of weeks, 12 to 20 weeks. And then they would have reintroduction on how to build food back into their lifestyle over a period of time after that with lots and lots of structured support. Those calorie controls were also liquid, so formulas. Was a diet, so to speak and then of course they would lose a significant amount of weight and then they would be encouraged to maintain that weight loss over time. Those people that did maintain it, then technically, yes, they went into what they call remission, which is where they, with the, no diabetes medications are needed no kind of blood pressure drugs are needed and they would just. Essentially, their blood glucose levels would return to normal. But of course, we have to remember that those are controlled conditions, laboratory conditions, lots of support, very motivated people and not, real life gets in the way, so it can be very challenging to replicate those conditions. The real world when we have jobs, when we have families and trying to live our lives. It's not easy. It, for some, it can be the case, but again, it's not for everybody. And of course, if that weight is regained over time, then, that diabetes, the chances are it will come back because we know that the body is, struggles to then process those sugars. So a lot of it's to do with fat around the kind of the liver and the pancreas and stopping the body stopping those organs functioning properly. So that's the angle that it comes from, that, by reducing that around those organs, then they. they will function better. But yes, it's the headlines are very convincing. And and we have to remember for all the people listening to this podcast, that, we also have to bear in mind real life and staying in remission can be very hard work. You need lots of support around you, whether that's professional and personal in order to achieve that. So yes, like everything, it's not for everybody. Yeah. I'm familiar with that study. There are there are definitely some what should we say? Negatives to that study. There's some I understand what the dietary requirements are behind it. Like you said, it was a very short window of time and a very restrictive calorie controlled diet with very little actual food. And that, like you say, is, you can't maintain that as a lifestyle forever, and that's surely what we need when we're talking about medical conditions is behaviors and a lifestyle that supports you and has you as well as you can be without being an absolute chore to maintain. Yeah. And I think the study, while it's shown some results. I'm not completely dismissing the study, but I think it's unrealistic in what it expects people to do for a long time. and I think, again, it comes down to all of these things, doesn't it? It's the individual themselves, what they feel they can manage whether they can exercise that level of restriction over time. It's their, what's their family life like, what's their background with their kind of their weight and their dieting history. And we also need to remember that, you know as well as I do that yo dieting and going, losing lots of weight but regaining lots of weight and then losing it again and regaining it again and going backwards and forwards is not great for our health and you know when you have diabetes we want to avoid those highs and lows. We want to keep as consistent as we can for as long as we can. And particularly if you are on medications. So again, if you're crash dieting and regaining that weight and doing it frequently, that's going to play havoc with your medications. So we have to look at that big picture and work out what's best for that person individually. Yeah, absolutely. Okay. So all of that scientific stuff aside Yes. let's talk What you can do. what we can actually Yes. start with, let's start with the obvious one. Let's start with food. Yes. So from a nice intuitive eating perspective, how would you approach food and your diet with diabetes? Yes. Absolutely So first thing I think I need to say is there is no diabetic diet. So that's really maybe controversial. I'm a dietician and she's saying there's no diabetic diet. Now, what I'm saying is that, living with diabetes can be full of surprises, and eating the right food all the time doesn't guarantee that your blood sugars are being gonna be perfect. We just can't guarantee that doing the same thing every single day may not give you the same results that you're expecting. And that's because there are so many factors that are gonna impact your blood glucose levels. And we've mentioned some of them anyway in terms of the causes of diabetes. We've got stress. If you're stressed and you're chasing the perfect diet all of the time and fretting about whether you should have had that banana or not, that's going to raise your cortisol levels in your body. That in itself will raise the levels of sugar in your bloodstream. So being stressed is going to automatically spike. Illness. We know infection is going to spike your blood sugars. Movement can help reduce them. So that's a positive as well as making us feel better. We know that medications, sleep, hormones, alcohol are all things that are going to impact the blood sugar levels in our body. So what we need to do is from an intuitive eating perspective is, don't place blame on yourself. When you're looking at blood sugars and avoid jumping to conclusions. So lots of people, again, it depends whether you're measuring your sugars or not, but even if your numbers are a little bit higher at those three month blood tests, don't blame the bananas. Don't blame the grapes. Don't blame the bowl of pasta you had because it's different for everybody. And we can't just say that one food item, is going to blame the sugar, blame the results long term. So what we need to do is get curious, we need to think about our eating patterns, we need to look at them objectively, and as with all things Intuitive eating, we need to not have that judgment associated with it. So we need to find out what that best route is for us and find consistency as best as possible. So there's lots of things we can do. We can look at carbohydrates, which we can go into in more detail. And then we can also think about fiber. We can think about proteins and we can think about fat and how and when to eat them, which can be really helpful for people as well. Yeah. What should we do? Delve into carbs? Would that be a good starting point? Start with the carbs. That seems to be the enemy in diabetes, It does. Start there. And I think the thing just to say as well is diabetes, when you have a diabetes diagnosis, it can feel at odds with intuitive eating, as we've said, because it's almost like the two don't go hand in hand. But they absolutely can, and I think everybody can, should, have a level of intuitive eating in their life because it's health promoting. It's not about rigid food rules or quick fixes and it's about finding that sustainable way of eating and those lasting health behaviors for the long term. So the whole point of diabetes management is to get as stable blood sugars as we can over time. That's the whole point. We want to try and avoid. the highs and the lows. But that's the same throughout life as well. So that's the same if you don't have diabetes because we know that the highs and the lows can lead to cravings, they can lead to dips in energy they can mess around with gut health, the body likes consistency, which is really boring. People love to be spontaneous, but you know what? Sadly, the body does love a bit of consistency. And it doesn't mean we've got to do it all the time. There's that whole 80 20 rule, isn't there? And actually you know, that 20 percent shouldn't make much difference, but what we do most of the time really counts. So carbohydrates, they get such a bad press, don't they? They are blamed for all sorts of things. And when we have diabetes, we, as I said, those carbohydrate foods, so we're talking bread, pasta, rice, cereals, oats, cakes, sweets, biscuits, carbs are in fruit, carbs are in milk products, they're in most food groups, okay? People think, oh they cause my sugar to go up, so the obvious thing is to cut them out. But that's not the case. So people with diabetes do not need to cut out carbohydrates. We still need them in our diet. And remember that our brain is what uses glucose as fuel. So we need that. What's important to think about, I always encourage people to think about quality versus quantity of carbs. So both are important. So when we're thinking intuitive eating, we're thinking about that we try to get and build into our lifestyle. Regular snacks, if we need them. So we want to manage any highs and lows. And if it's long time between meals, then I'd always encourage somebody to have a snack. If you're talking more than four hours, roughly, tune in. How are you feeling? What's your hunger like? Are you feeling those sensations of hunger? And if you need to have something to eat, then think about what you're going to have to eat. What's going to help to satisfy you. What's going to make you feel fuller. Where are you going to place it on that kind of hunger fullness scale? And it's, Tapping into those hunger signals and responding to that hunger as well. So don't ignore it. When we're thinking quantities, again, people can get very hung up on what's a portion, how much should I have And it's always really difficult, I think, to give absolutes, because we can't, we're all different. You might need more some days than you do others. As a starting point, when we talk about plates, you could look at saying a third, quarter of your plate. with carbohydrates on or fist size. You don't need to weigh foods out. And that's just really a starting point. What we have to do then is when you've got that meal, you want to then think about how does that meal make you feel? We think about how hungry we are beforehand. We think about how, whether we have got that hunger satisfied after that meal. If a quarter of a plate's not quite right and you think, do you know what? I'm still quite hungry. then actually you might just need a little bit more carbs and that's okay for you. And we've got to work with that because if you're having a quarter of a plate of carbs, because the dietician's told you, and actually after the meal, you're sat there going, Oh my God, I really need something. I really want something and you reach them and have a few slices of toast because you're genuinely hungry. You may end up eating a more carbohydrate overall than had you just had an extra couple of spoons of pasta. So we've got to get curious, but not with judgment either. And it's a learning curve, isn't it? I ask a question? alongside the hunger and fullness, because I'm a massive advocate Yeah, in while you're eating absolutely. Seeing how full you are, seeing how satisfied you are, see how your body feels. Is there anything that people can gauge instantly with eating in respect of how it's affecting their blood sugar response, or is that a more delayed thing? It depends. So I think if you are fairly regular eating during the day and you're not getting those swings, those highs and those lows, the chances are you won't notice much difference. If you have been a bit spikes and lows, so you've gone I don't know if you've had something, I don't know, very sugary, for example, and your level of sugar's gone up. Some people can feel a bit buzzy, a little bit wired sometimes but what often happens is it comes crashing back down as the body deals with it, and then we can get that craving, that irritability, that kind of hangry feeling. So if you're at that low and you start eating, you might well feel that sort of starting to feel better. You can feel the food starting to work and that energy, but that would probably happen. It usually takes at least 20 minutes to 30 minutes for something to start happening. And for that food to actually get past and into the bloodstream. Yeah, it's probably more the brain and the stomach going on there. And then later would be the perhaps the feelings of that sugar. But again, some people may not notice that 'cause it can be so subtle. And it may just be more a case of that energy level and how they feel during that meal. And again, just that, that sort of fullness around, we all know how it feels when you're eating too much. And you get that kind of, you get that slump, don't you? And while your body processes and digests it and you can feel a bit like low in energy and brain foggy, can't you? So if maybe you've had a really high carbohydrate meal, like a bowl of a big plate of pasta, for example, you might feel you've got that. That might be an indication for some that they think, Ooh, I don't feel quite as good as I could do. So maybe I'll have a bit less pasta next time. And a bit more veg or a bit more protein. But all of that feeds into what is that kind of gentle nutrition approach anyway, and that balance of food groups, doesn't it? Making sure we feel we've got a range of different nutrients. But when we're thinking carbohydrates as well, there is, we know that there's different ways of eating and different types of food, which are more beneficial, but it doesn't mean that we can't have White bread. And it doesn't mean we can't have a piece of cake or a bit of chocolate. So it's thinking about maybe how often for some people, it might be thinking about how, when we have them and what we pair them with sometimes, which is important. We always promote whole grains. Your oats, your quinoa, brown rice, pastas, et cetera, because they are broken down more slowly in the body. and give a slower release of energy, and it avoids those spikes, compared to perhaps more highly processed carbohydrates. They're the ones you want more often, but again, it doesn't matter if you have that bacon sandwich with a, with your white bread once in a while. It's not going to undo all the good that you've done. Yeah. If you are having a particularly carby meal, as a diabetic, is there something you can do to counteract that a little? I'm assuming pairing some foods is going be a tool. Exactly. Yeah, so if when we think about, again, carbohydrates, so when we think about the quantity of carbohydrates, if we think that the bulk of it will eventually get broken down into sugar. So the more there is, the more sugar you will eventually get. But you can slow down the rate at which that gets into your bloodstream. So to avoid those spikes. So often when we talk about spikes, it's about how quick and how high that level of sugar goes. So something like white bread would spike it quickly. And if you eat lots of it, it will spike it quite a lot. And you can pair it directly with say whole grain bread. With the same quantity, it will be on a lower spike over a longer time. So it just might help people to visualize what's going on. But things like proteins and fats can help to slow down the absorption of the sugar into the bloodstream. For example, if you've got a big bowl of pasta with tomato sauce, for example, because maybe it's a busy night, the kids are out, and you're just Quick dinner, pasta and tomato sauce. You are much better off adding some tuna or some salmon or some chicken for protein because the protein takes longer to be broken down. So of course when you're eating it together in the stomach, it's all going to get mushed up and it's all going to be broken down together. So it's going to slow the absorption of that into the bloodstream and likewise fiber is going to do exactly that. Now fiber really should be your friend. So anything with fiber. in we want to make sure that we have. So if you can get like your frozen veg and some sweet corn for example, you're adding fibre. So all of a sudden you've got pasta, you've got tomato sauce, you've got some chicken in there, and you've got your peas and sweet corn. You've got a balanced meal as well because you've got your carbs group, you've got your proteins group, and veg in there. So all of a sudden you've gone from a carb heavy meal So it's not just going to benefit diabetes, it's going to benefit gut health, it's going to benefit probably your satisfaction of the meal. It's going to be more colourful for a start. You've got your peas and sweet corn and you've got something to chew on with your chicken. yeah, it's dead easy And it's quick and easy. Yes. This is part of the problem, isn't it? We think that everything's got to be micro managed, and actually some days you're just too tired, or you're just too busy Yep. or you've got a lot going on, or mentally you just cannot think about cooking another meal Yeah, exactly. that's just proven that the, you, it doesn't have to be difficult. You can just, quickly and easily add some extra bits that are gonna help with the absorption of the absolutely. Yeah. So definitely think protein, definitely think fiber and fat will also slow that down too. So we just need to be a little bit mindful of fat and make sure it's the right kind of fats. So again, we're getting those more nuts and seeds and olive oil and things like that. Those avocados, those kind of fats which are protective towards our heart more than anything. And again, things like nut butters and things like if you're going to have a snack so you might think, oh, I don't know, I'll have an apple, for example. Actually, if you pair that apple with peanut butter, then all of a sudden that protein and the fat from the peanut butter is gonna, and you've already got the fiber from the apple, you're gonna deaden the effect. of the sugars from the apple. Okay, so it's not that you avoid the apple because it's got sugar, it's actually there's a ton of other great nutrients from that apple. So put them together, again you've got something that's much more satisfying, tastes great, one of my favorites that and it takes a bit more time because you know you've got to slice the apple, you've got to get the peanut butter out, you've got to get a bowl and a knife and a chopping board, so actually it takes longer when you get that satisfaction that we're looking for. When we're talking all things intuitive eating, aren't we? And it takes longer to eat because It does. nobody can eat peanut butter quickly! No, it's so claggy! it's sticks to the roof of your mouth. And then if it's then you've got to pick the bits out your teeth if it's, if you've got the, if you've got the crunchy version. Always the crunchy version. Oh yeah, always. Although I have both in my household because certain people don't like that, so we've got both types. But yeah, crunchy all the way. But that's just the personal preference side of it. I do not choose apples as my fruit. I would much rather have something like strawberries and grapes and blueberries. And you've got to still be working with the personal preferences that you have for food. Absolutely. at the same time. You've still got to enjoy your food, right? And that's it. And that's actually leads me nicely on to say that always start with what you like. So yes, we've got all that advice out there of, have whole grains, have high fibre, have all these things, but if you hate brown rice, we're not going to make a lot of progress. So let's work with the foods that we do and actually, if you think you know what? I like granary bread. So yeah, I'll switch my white bread for granary. That's a win. Let's go with that one. Let's not worry too much about the brown rice. We can, there's other things we can do with rice. So it's about all of this, figure out what you like and let's roll with that. If it's not a chore, then you're more likely to do it. If you don't feel like you've got these restrictions placed on you it's all choice at the end of the day. And you have that free choice and yes, you can still have your cake and eat it. Oh, I love that. I quite like if you can take a positive approach to something, you're going to have a much better experience. Yeah. Nobody wants a diagnosis of diabetes. Nobody wants to hear that they are pre diabetic or diabetic and then have to do all this thought all this thinking around food that they didn't have to do before. What if it just became this bit of an adventure around food? Now I need to try and. some different foods. What do I like? What do I not like? Oh, I actually really don't like avocado. I do love avocado, So do I. For know, some people it is the worst thing in the world. But if it's your first time in trying something new, you either like it or you don't like it. You rule it in or you rule it out. becomes a bit of an exploration rather than a, I have to find things that I enjoy. And I think it's about having that open mind, isn't it? It's about, and going back to that, being curious again and see it very much. I always love to talk to my clients about what can we add in? I think people often come to me and then they think, Oh God, what's she going to say? I thought she was going to tell me to cut all this stuff out. And that's what they come to me expecting. But you know what? When I look at what somebody's eating, I'm always going, what can we add in? What difference can we make to their health? by adding in. Because so many diets whether it's for weight loss or for medical conditions, are about cutting out. So by the time you've gone through the entire list of what to cut out, people are left saying what do I eat? I've only got this left. It's no, we, there's lots of other things. And then once you start working together and you can piece together these different foods, you realize that there are infinite options out there. But sometimes we've got to go a little bit out of our comfort zone in order to explore that and actually trust ourselves a little bit and trust that, that we're going to also make mistakes. And we need to learn from those mistakes and we need to find our way. So that, that diabetic diet, there is no perfect, there's no perfect diet, so to speak. What I eat is a diet. What you eat is a diet. A diet is just the way that we eat. And it's the food that we choose. And people from one person to the next, mine would look completely different to somebody else's. Neither are wrong. They're just different. So there are so many different combinations. So we want to look at the kind of the overall picture and the patterns really. Yeah. And this is the ultimate intuitive eating, really, isn't it? The way that all this is coming out of the conversation is that going to think about your hunger and fullness, you're going to think about how the food satisfies both your mind and your body. But you're really tuning in on how it affects you physically, how it makes you feel and what impact it has on the inside. And it's just, it's up leveling your intuitive eating. Yeah, totally. Yeah, exactly. And I think you'll feel more powerful as a result and empowered. So there is so much scope to support yourself and to make change and to still enjoy the foods that you enjoy. Because again, restriction isn't good for anybody. It just leads to obsession. And that's what we're trying to avoid. Yeah. It's the whole binge restrict thing. Yeah, If you cut everything out altogether, it's the only thing you ever want. Absolutely. And then you get the restricted eating patterns. You get the highs and the lows that has a knock on effect on so many angles of your life. And we need that consistency. Yeah. It's really important. So Question then, sugar In terms of diabetes, is it the devil? Yeah. Is the one thing, isn't it? It is. people have a bit of an understanding around cutting out certain carbs Yeah, true. or adjusting the types of food that you eat. But when it comes to sugar Yeah. is bad what's your take on it? Oh yes. I'd say it's not the devil. I'd say you'll never completely avoid it, but work with it. Think about, we do need to be mindful of it, and again, everybody is different and everybody is going to respond to that piece of cake differently, but think about the type of sugar. So think about what it is you're eating. And then think about again, what could you do to make it better? So having something sweet isn't the end, it's not going to undo everything. And I think you'll just get stressed trying to avoid sugar because it is in everything more or less. So I think I would always say to people, what is it you really love and what is it you really want and let's build it in. So for example if you're going to have that. Piece of cake, say sponge cake, for example, for argument's sake. Is there something else sweet that you could have that kind of does the sweetness thing for you, but gives you more nutrition as well? So you could have, for example, fruitcake. So your fruitcake, still got sugar in it, but it's got a ton of dried fruit. Therefore you've got a load of fibre. Some of that fruit is locked within the raisins and grape grapes, you put that in, you know what I mean, raisins and sultanas. And if you've got, yeah, if you've got fruitcake that's got say nuts in it as well. Then again you, you've got nutrition, you've got extra fat, you've got extra pro protein, and you've got fiber. So that piece of fruitcake is still sweet and you can still have it with your afternoon cup of tea, but it might in have less effect than that piece of sponge cake. So it just goes to show that we can still get those sweet foods in there, but we can think about, we can be careful how we do that. And of course we can then look and say, when you get those blood results, you then look at the numbers, and then you say, okay am I doing all right, and am I not? And if you're not, we might need to rethink where that fruit cake goes, or how often we have that. But we can make those tweaks. And likewise, if you're going to have a bit of chocolate, or you're going to have some sweets, think about what could I have with it? Can I have a handful of nuts? It's going to deaden the effect slightly. Or if you're going to have a pudding, have it after your meal rather than in isolation, because again, the protein and the fats from the meal, again, will help to deaden the effect. It doesn't mitigate it completely, but there are ways of working with it so that we can make it work for the person. But likewise, and like you said at the beginning, if somebody's had dietitian advice already, they've worked with a health professional already and they've got more I like to use the word rules, but have been given more advice, do stick with what they've suggested for you rather than what we're doing is having a general conversation. But no, don't fear it. I think work with it. Yeah, that's the thing, isn't it? That's, it's the same with everything. You've gotta work with it. See how you can use everything to your benefit. And I think don't struggle alone. If you are really struggling and you're getting yourself in a real frenzy over what to eat because you've had a new diagnosis, then, go back to your health professional. See if you can get an appointment, with a dietitian either on the NHS or out there privately, whatever works for you, but get some specific help because, you might find a couple of appointments and you feel so much better. You've got a clearer idea of what's going on and it just helps you move forward. Yeah. Something else that's just come to mind while you're My brain is going ooh, all these thoughts. What are your thoughts on tracking? When it comes to diabetes and specifically, I'm thinking about the people who have done really hard work to get away from tracking everything that they eat, every last morsel, writing it down. I know you've already said, you don't have to weigh and measure everything, but when it comes to actually tracking food, possibly in the early days hmm. Mm I of diabetes when you're trying to figure out what works for you. Is there a way to monitor what you're eating in a fashion without the heavy tracking? That's a really good question. I would say my response always to tracking is only do it if you're going to learn from it and use it wisely. So like with all these apps, many people will come to tracking their food intake from a place of dieting behaviour and weight loss. And therefore, it's a very negative sort of place to be, isn't it? And for many, even the sheer thought of writing what they're eating down is going to be very triggering. So whether it's for diabetes or not, I think that using it for diabetes would probably just trigger past issues they've had with disordered eating patterns or maybe eating disorders. So I'd proceed with caution is what I'd say. For an individual, it depends what they're going to do with it. So again, it could be helpful if you've been given a home blood glucose monitor to measure it day by day or a few times a week, then it may be helpful. However, always make sure you've got somebody to rationalize it with you. And if you feel like you're going down a negative route, then I would stop. Sometimes what I say to people, because again, full blown food tracking can be, it's a lot of effort as well, it's time consuming and, with the best world in the world, I can't always remember what I had for dinner last night. Important. Sometimes people may like to measure a particular meal or a problem area. So for example, it might be snacking. A lot of people struggle with snacking. And so they might find they just write down the snacks they've had over the week and leave it at that. And then if the meals are fairly regular, you can just look at where the snacking is and how it's working for them. But unless you're relating it to your blood glucose numbers, there may not be a point. So unless you're going to change something, or be curious and objective about it and non judgmental. I wouldn't bother. I was genuinely interested because I don't know what the advice is when, with a new diagnosis, whether the advice is to suddenly start writing everything down, considering what you're eating and how it affects you and, or whether it is more relaxed than that. I genuinely have no idea. Yeah, again, I think it's just if you're going to use it, to be honest, and who's going to look at it. So if it's just you writing it down for yourself, and you're just writing it down and doing nothing with it, there is no point because you'll know what you've eaten during the day. If you're doing it, Like sometimes I would ask people to write down what they've eaten, but again it would only be if they're comfortable doing that, and if it's not a negative experience for them. And again ensuring that it's not coming from a place of judgment, because very often we can then focus in on what we consider to be bad. But, excuse me, it may not be bad, it may, it is what it is. So it's using that objective approach of having somebody else looking at it because it's very easy to hone in and say you shouldn't have had cake and you shouldn't have had chocolate and why did you have that? And that's something else with diabetes that we haven't spoken about, but, diabetes. When you get that diagnosis, people and everybody think I can, I have permission to comment on somebody else's food intake and say to them, should you be having that pudding? I thought you were diabetic. It's really unhelpful. It could really ruin a meal. So I think you are you and you have to look after yourself and try and block everybody else as much as possible. Yeah, everybody thinks they've got a right, don't they, to comment on other people, whether that's their food or their bodies or their health or I don't know where this comes from. I don't know why people think it's acceptable. It's just I know. norm, It is. Sometimes it can come from a place of love, can't it? From loved ones. But sometimes that can be a little bit misplaced. But yes, often. It's a challenging one, probably another episode that. And one thing we haven't spoken about is movement and the impact that movement can have on our blood sugars. So we know that movement can help to lower our levels of sugar. So again, if you've had a big meal, can you go for a walk after? But again, don't do it to burn calories. That's not the point of doing it. It's about using, do it because it makes you feel good. Movement supports good mood, good being, especially if you can be outside. So You know, again, just thinking about how you can build that into your lifestyle. How does that affect blood sugars and diabetes management? How, The movement? there is a benefit to going out for a walk after you've had a meal, what, how does that work? Yeah, so essentially what's happening is when we move our bodies we are, our body needs the sugar to use, so our muscles will be powered by the glucose. And if we haven't got it readily available, it'll use up the storage form from our livers. Essentially, When you remember we mentioned about insulin resistance where there might be our tissues are not using the insulin as well as they could do. So what happens is when we're moving our bodies it encourages those tissues to take up that sugar that's floating around so if they become more sensitive to that sugar and we'll use it up. So that's why it's a good thing to incorporate movement into our bodies. as often as we can. But then it has that add on effect of benefiting how we feel too. That's a nice thing to understand because for so many people coming out of disordered eating behaviors there is such a tie between exercise and food, exercise and calories. If we exercise, we must be burning the food off. And that's not the case, as you've as you just explained, it's about helping your body to use what you've put in to it. And I think that's it. People see exercise, you hear it. whether people are dieting or not, but they'll go, Oh, I've I've earned my dinner tonight because I've walked or I've been for a bike ride. I've earned my piece of cake. And you think no, it's a bit of a slippery slope. I don't, language like that is is, it's a bit of a red flag for me. Because our bodies use energy. We all have a basic need for energy and food every single day. Our bodies need that. The heavier we are, the more we need it. That's life. That's fact. So we have to supply that. We have to honor that hunger. It does matter what types of food it comes from because we want to make sure we're nourishing our body and it's getting the right nutrients to function properly. That's really important. When we just boil it down to calories, it's fairly meaningless. We've got to make sure that the food is coming from the right food groups to give our body what it needs to function well. I really dislike the calories in calories out kind of mentality around food and movement. Think just tying it in hand like that is so dangerous you'll never, actually you just need to see movement for the nice things that it is. It's mental health promoting. Absolutely, It's physical health promoting. Yep, When you've got a condition like diabetes, it's, it's helping your body to function better and that's what it should be. Yeah. And I think the thing with, apps and trackers and all of these things is you will never know just how much you burn each day. I don't know how much you burn. I don't exactly know how many calories you eat because, the calories that we eat, Not all of them are absorbed. That's very different. So it's, just having a number on an app isn't accurate. So that whole intuitive perspective about how you feel, what's your body doing? Are you healthy within yourself, mental health and physical health? That, that is so important. Yeah surely the goal for people around, I'm not saying that everybody has to have goals around their health. That's not my approach. However, if you have a goal with this sort of stuff, it should be to have a fit, strong, healthy body. Absolutely. Absolutely. You want good muscle quality. Absolutely. Good bone density. You don't want your bones breaking, you don't want to be falling over all the time, you want a good core strength, that sort of thing. That's what people should aim for as they get older, not, yeah. We don't want our hair falling out. We don't want nutrient deficiencies. You want to live, you want to live your older age well. I think that's really powerful sort of moving forward, isn't it? Yeah. have we missed? Have we missed anything? Oh, don't know. I I think I've covered most things in a roundabout kind of way. It's been wonderful. This might be a spring it on you question, Go for it. Do you know of any myths around diabetes that you would like to dispel today? Ooh we've done a few. We've done the whole Can't Eat Carbs. Yes. Sugar Causes Diabetes. That's a myth. Oh yes. ooh, what else? Because sugar does not cause diabetes right? No, exactly. No, it doesn't. Yeah, I don't know how much to go into that. No, it just doesn't. No, that's too simplified. If sugar caused diabetes, everybody would would have it, exactly. We all have sugar. I have sugar. Yeah, What was the other one? So type 2 diabetes is not a lesser form than type 1, so it's just as important. So that's a bit of a myth. Any others? Done carbs. I can't eat bananas and I can't eat grapes. Again, that's a myth. So you can eat bananas and you can eat grapes. Yes, they contain sugar, but all fruit contain sugar. And yes, All fruit has different quantities of sugar. Very often what happens, certainly with grapes, is it's rather tempting to eat a lot of grapes. So what happens is the quantity means you get that bigger spike. So again, sometimes we just got to think about how many people are having or what we're having them with or when we're having them, which can help deaden that effect. So yeah, that's probably a good one. yeah. Okay then, final thoughts then. If you were going to ask somebody to take one takeaway, one big takeaway from this episode, what would your key message be? Okay, so I preempted this. I've done this. Did you? I did! I've just sprung that on you out of nowhere. I want to say, remember that this is your diabetes and it's your health. You know you best and I said that earlier. Take it as an opportunity. If you're experienced in intuitive eating, you may have to do a bit of relearning. You may have to go back and look at that hunger and fullness scale. You may have to look a bit more objectively at a few things, but use it to your advantage. If you're new to intuitive eating, then I would say, you know, start as you need to go on really and build diabetes into it. So make it work for you. It can be so empowering. to move you forward. And you can absolutely manage your diabetes without micromanaging every gram of sugar or chasing the number on the scales. So intuitive eating and diabetes definitely has its place. And like I said, use it to your advantage to develop lasting lifestyle changes that manage your health long term. Perfect. I really hope that this has given people some comfort and taken away some of the fear and panic about around a diagnosis of diabetes or the potential for there to be a diagnosis soon. And I really, yeah, I really hope Yeah, that's eased that for people and they can feel a little bit more relaxed about it. definitely. Yeah, it's been great. you. Thank you so Oh, you're welcome. I've really enjoyed it. Oh, it's been excellent. It's been such a great conversation. I could never have covered that by myself. Never. This is why I need experts like you for certain conversations. Tell people where they can find you. If they want to give follow and look you up. Yeah, definitely. So you can track me through my website, which is LydiaLeighton.Com. And I'm on the kind of main social media channels as well at Lydia L Nutrition. Yeah, you can find me there and all my details are on the contact page on my website. But yeah, if you need any help, get in touch. And be more than happy to have a chat with you. It's been an amazing conversation. Thank you. Yeah, you're welcome. Thanks, Terri. I've loved it.