Last month's issue included an article about diabetic ketoacidosis in children. In response, we received a letter from a reader who expressed concerned that it was perhaps not quite clear enough in the article that type 1 diabetes, which is by far the most common in children, is not associated with lifestyle factors such as diet or exercise, and felt that mention of any such factors may imply blame. We are working to clarify those points.
However, even where lifestyle factors do play a role, such as in type 2 diabetes and other long-term conditions, the important message of lifestyle changes for prevention and management may inadvertently carry a subtle undertone of blame; that had we eaten differently, moved our bodies more, smoked and drank less, perhaps we would not be sick. However, we know how complex, numerous and varied the reasons and factors behind illness are. We also know that people who regularly exercise, eat nutritious food and have never smoked a day in their life still receive such diagnoses.
This is not meant to take away from the role of lifestyle factors in long-term conditions. However, there is a fine line between personal accountability and blame, and intertwined with all of the ‘shoulds’ is the guilt of not always following them, the guilt of being human and wanting to feel free, and the negative impact this guilt itself can have on our mental and physical health. Further, the paternalistic nature of being told what and what not to do not only serves to condescend us as individuals; rather than empowering us, it can take away our ability to follow our intuition about what our bodies need.
In the case of nutrition, no person naturally craves deep fried, sugary, salty and processed foods 100% of the time. Our bodies will naturally crave a variety of foods and nutrients, and our hunger signals will let us know when we are hungry or full. However, now only have these signals for many been broken over time by rigid rules around eating, but some people may consume more of these foods out of habit, for stress relief or comfort, or out of a need to reclaim the freedom lost during times of successful prescribed ‘healthy eating’, which is bound to feel restrictive. This is particularly the case when some foods are labelled as ‘bad’ or ‘unhealthy’. People may expend energy resisting foods, only to eventually consume them anyway, but in much larger quantities than they would have if they just allowed themselves a small portion when they felt like it. Culture also plays a major role in diet, and a person should never feel that they need to stop consuming their traditional foods in order to eat healthily, unless they have an allergy or intolerance. In the case of diabetes, perhaps asking patients to brainstorm the types of foods they would enjoy that would help to regulate their blood glucose levels would be a more empowering approach. When it comes to exercise, yoga, gardening or running around with grandkids should be acknowledged just as much as running on a treadmill and strength training.
Rediscovering trust in our instincts so that we can eat and move our bodies intuitively as we once did as children is likely to be of great value for our health. Most of us know what to do—the question is, why so many are struggling to do it. Learning about nutrition, activity guidelines and being aware of our weight and body composition can be useful, but it would perhaps be of more overall value—at least day to day—to focus more simply on eating a variety of foods regularly, moving our bodies daily in ways we enjoy, and feeling good in our bodies and minds.