Researchers conducted a study to see if young people with type 1 diabetes who followed a dietary intervention would experience increased disordered eating behaviors.
They also looked into the relationship between disordered eating behaviors and blood sugar management and variability.
Psychology Today reports that disordered eating symptoms may include the behaviors we “commonly associated with eating disorders, such as food restriction, binge eating, purging (via self induced vomiting or excessive exercise, and use of diet pills and/ or laxatives).” But they add that it may also include symptoms such as:
- self-worth being dependent entirely on weight or appearance
- excessive or rigid exercise regimen
- obsessive calorie counting
- feeling anxious about certain foods
- a rigid way of eating like “only eating certain foods, inflexible meal times, refusal to eat in restaurants or outside of one’s own home,”
Whole Food Plant Based Dietary Intervention
Teenage participants in a dietary intervention lasting 18 months long reported any disordered eating behaviors and overall diabetes management at the start of the study and at 6, 12, and 18 months. Participants wore a CGM, but it was masked, meaning they wore the sensor but had no access to data. Researchers also tested their A1c and 1,5-anhydroglucitol levels.
The corresponding author of this study, Miriam Eisenberg Colman, Ph.D. and senior scientist at Fors Marsh Group explains via email that this dietary intervention focused on improving the quality of carbohydrates consumed. She writes that “Specifically, sessions focused on increasing intake of whole plant foods. This included nuts, legumes, fruits, vegetables, and whole grains”.
This was done because of the way teens with type 1 diabetes typically don’t consume enough of fruits, vegetables, and whole grains according to standard recommendations and because they tend to eat too many refined grains and snack foods. Dr. Eisenberg Colman states that “this framing encouraged a positive approach to healthful eating rather than focusing on dietary restriction. ”
Linear mixed models were used to estimate the effect from the intervention on disordered eating behavior as well as the relationship between disordered eating behaviors and measures of blood sugar management and variability and if these disordered eating behaviors changed “glycemic trajectories” of the youths.
Does Dietary Intervention Lead to Disordered Eating Behaviors?
Researchers found no effect from the intervention on disordered eating behaviors on the teens, whose ages ranged between 13 and 16.
They did find disordered eating behaviors were associated with higher A1c levels, mean sensor glucose level, and percent sensor glucose values over 180 mg/dL as well as with lower 1,5-anhydroglucitol and with worse diabetes adherence.
Disordered eating behavior was not tied to percent sensor glucose values under 70 mg/dL or any measures of glycemic variability.
In their study abstract, the researchers also wrote that “There was a significant [disordered eating behavior] × time interaction effect for mean sensor glucose (P = 0.05) and percent sensor glucose values >180 mg/dL (P = 0.04).”
“Participants reporting more [disordered eating behavior] had poor glycemic control at baseline that remained poor throughout the study,” they added.
Dr. Eisenberg Colman explains that one of the notable findings in this study include how the teens with more disordered eating behaviors had poor blood sugar management throughout the study and that on average, the teens in the study with more disordered eating behaviors “reported only a modest amount of disordered eating.” She adds that “this suggests that even modest amounts of disordered eating among adolescents with type 1 diabetes can have an adverse effect on glycemic control.”
The study authors conclude that these findings indicate that trying to improve diet quality may not increase disordered eating behavior but did find that it is tied to “persistent hyperglycemia but not hypoglycemia or glycemic variability.”
Focusing on Positive Choices Versus Restriction
Dr. Eisenberg Colman states that “In our research and interactions with healthcare providers treating type 1 diabetes, we have heard the concern that interventions to improve diet quality could increase the risk of disordered eating behaviors.”
She said that this study shows that diet quality can be improved without increasing the risk of disordered eating behaviors. She notes that this intervention used a positive, empowering approach to healthy eating which focused on choosing healthy foods versus avoiding or restricting unhealthy foods.
This study approach “focused on general benefits of healthful eating rather than weight-related issues, and it incorporated a family-based approach which may have provided a stronger support system for the adolescents,” says Dr. Eisenberg Coleman.
Positively framing our perspective might be a powerful tool to help us focus on wise choices versus what we might feel we’re missing out on.
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