The Diabetes Prescription is the conversation I wish I could have with all of my patients in endocrine clinic. I, like most doctors, love to teach. However, we just don’t have the time in clinic to teach in depth. So, this website is a growing body of information that I want my patients to know. Most of this information you can find other places on the internet, but it is broken up into little nuggets of knowledge here and there, interspersed with useless or conflicting information.

So what is the first thing I want you to know? I want you to know what diabetes actually is (link opens in new window). After reading the above link , it should be clear that diabetes is a problem of metabolism, and that the primary treatment for it is nutrition.

From there, it follows that you must take great interest in the food and substances you put in your body, and must place yourself in a position where you have great insight over what you eat and drink. I (like many of my colleagues) am convinced that cooking is the single most important skill someone with diabetes can have. Being able to prepare your own food puts you in control of your health. 
But I find that many people are overwhelmed by the information the hear from friends and family as well as what the see in the media, so they do not feel confident in how they can improve their nutrition. I wanted to make a resource for you so that you can meet your nutrition goals in a safe and sustainable way, so I made The Diabetes Prescription. 

Most people have had the experience of “going on a diet” for a few months, losing weight, then watch as the weight comes back. It’s because adipose tissue (fat tissue) is protected by the body- When you force the body to deplete it’s stored energy, it will produce a strong response to reduce your metabolic rate and increase your hunger. The brain does not play fair,  but it’s not hopeless. You can develop habits that allow you to overcome the body’s resistance to losing and keeping off fat. 

In my experience, people fail in changing their diets for one of 5 reasons:

1. The diet did not give them the results they were looking for. This is usually due to expectations that were too high or not actually following closely enough to the diet in the first place.
2. The diet is too boring to stick too long term, such as extreme calorie restriction or diets that eliminate entire food groups.
3. The person did not find their weight loss threshold. Diets that fail to restrict calories beyond the weight loss threshold will not result in weight loss. This is true for all diets, whether or not the diet is based on calorie restriction.
4. The person does not know how to cook or cannot find time to cook. Since  they rely on restaurant foods and other pre-packaged foods that tend to be higher calorie and induce overeating. While early on, they can narrowly choose these foods to keep caloric intake low, but over time, they get bored with those restrictive food options and slowly begin to eat meals that are outside their nutrition plan.
5. Failure of planning and organization. Being unable to keep up with amount of meal planning needed, which causes them to fall back into old habits.

Here is my suggested method for weight loss. I would recommend seeking the assistance of a physician trained I weight loss to help you, particularly in the prepapration phase and weight loss phase.

Preparation phase

1. Identify the motivation for weight loss and what your goal is

First, we have to consider what our motivation for weight loss is and what a reasonable goal is. 
Is your motivation to improve your appearance? Reduce the number of medications you take? Are you trying to achieve diabetes remission? Each of these goals may benefit from different amounts of weight loss. Perhaps you *think* you need to lose 20% body weight and you really only need to lose 5%. I would advise you to learn from your doctor what the specific health benefits you should expect upon achieving certain weight loss goals. Because the better you internalize the reason you are changing your life, the better prepared your mind will be to handle your body’s resistance to weight loss.  

2. Identify your unique challenges to weight loss

• Do you have issues in your life that may make it hard to lose weight?
  • Do other family members make it difficult to eat the way you want to? Does your work or travel schedule make it heard to eat well?
• Are you getting enough uninterrupted sleep?
  • Are you waking up becuase of stress? Are you snoring and have undiagnosed sleep apnea? Is your spouse snoring or your kids having nightmares? Are you not going to bed early enough? 
• Do you have dietary intolerances or digestive illnesses that may complicate a nutrition plan? 
• Do you have high stress, anxiety, or depression? We need to take these into account as they may need to be addressed before or during your weight loss journey. 
• Do you have injuries that have reduced your daily energy use (which your brain became used to and had already adjusted your appetite to take the energy use into account, leaving you now eating your normal amount and gaining weight).
• Do you have low muscle mass (sarcopenia), making your metabolic rate lower than expected. Risk factors for sarcopenia include multiple previous weight loss attempts and aging.
• Do you have a medication that is causing weight gain?  Common medications include some older diabetes medications, some antidepresants, medications for schizophrenia, steroid pills, seizure medications, birth control pills and hormonal implants, over the counter antihistamines, and medications for nerve pain. Don’t stop any medicines without consulting your doctor! Your doctor can help identify possible culprits for you and safely wean them off if needed.
• Do you have a hormonal condition?
  • In women, polycystic ovary syndrome is a common condition that is often associated with weight gain.
  • Insulin resistance is another common condition in men and women that is associated with weight gain. 
  • Endogenous cushing syndrome is a very rare condition where the adrenal glands make too much of a hormone called cortisol. While this is a frequently discussed hormone on the internet, the disease is far less common than many people realize. Doctors only test for Cushing syndrome if there are other suggestive signs or symptoms besides weight gain. 
  • Hypothyroidism is a common condition that is usually caused by damage to the thyroid gland, resulting in lower production of thyroid hormone. Mild versions of hypothyroidism and properly treated hypothyroidism does not cause weight gain. However, severe untreated forms of hypothyroidism can occasionally cause weight gain. 
  • Acromegaly is a rare condition caused by overproduction of growth hormone by the pituitary gland. This disease is typically only tested for if people have other suggestive signs and symptoms. 

3. Estimate your weight loss threshold.

4. Address identified challenges to weight loss.

If you have a suspeced sleep disorder, a sleep evaluation may be recommended. If you have complex dietary restrictions, dietician consultation may be recommended. Depending of your cardiac history, an EKG may be performed or heart testing may be recommended. Your doctor may suggest that you have basic labwork done. 

5. Create an activity plan

Weight loss is achieved in the kitchen moreso than the gym. So your primary focus is on your food intake. With that said, it still important to either maintain exercise habits (if you currently exercise), or begin increasing your activity (if you currently get little exercise). In general, doctors recommend 30 minutes of exercise at least 5 days a week. Talk with your doctor about specifics on how much exercise they recommend for you. 

6. Start creating a meal plan

• Are you going to eat 2 or 3 meals per day? Would you like to build in snacks (or dessert) into your mealplan? Based off how many meals and snacks you will eat, you can divvy up the calories for eat meal and snack. For example, if your weight loss threshold was 1500 calories per day, and you planned to eat 2 meals and 2 snacks: You could eat a 400 calorie lunch, a 600 calorie dinner, and have room for two 250 calorie snacks per day.
• If you are not currently able to cook, how are you going to obtain the food for your mealplan? My website has suggestions including frozen meals and meal replacement shakes, which you can use to help
• If you are able to cook, you can make use of the over 50 recipes on my website and begin to plan your first week. All of my recipes are categorized by calories, so working from the example of a 1500 calorie mealplan with 2 meals and 2 snacks, you just need to look up 400 calorie lunches and 600 calorie dinners. You can also check out my list of suggested snacks.  Select meals for the week, print off a shopping list, get the groceries, and you will be ready to get started!

6. Detemine if a weight loss medication is going to be used. 

Some patients elect to start a weight loss medication. If you do, be sure to talk with your doctor in order understand how this may affect you as you start your weight loss journey. 

Weight loss phase

• Under the guidance of your doctor, you begin your meal plan. Count calories and track them with your calorie tracking app. Your doctor may also ask you to track macronutrients such and protein or carbohydrates. 
• If you are comfortable doing so, you may weigh yourself either daily or weekly.
• Follow up closely with your doctor or their staff. During the early phase of weight loss, it is common to check in as much as weekly. 

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