Losing Weight When You Have Diabetes

David Mendosa Health Guide October 28, 2007
  • When you try to lose a few pounds, do you ever get so hungry that you feel like you’re starving?

    If you are in that small group of people with diabetes who isn’t trying to lose weight, please go on to something relevant to you. And if you know how to lose weight without hunger, please add your tips as comments here.

    But practically everyone else who has diabetes constantly grapples with the question of being hungry. One of my correspondents, Linda, tells me that she constantly feels like she is starving.

    “I even have the headache to prove it,” Linda says. She recently upped her calorie intake from 800 to 1,000 calories per day.


    But even her current calorie level is on the low side. Most people agree that women need at least 1,000 calories per day and men need at least 1,200 calories per day. With a diet that restricted she might not be getting enough protein either.

    Linda is trying to find a way of eating for the rest of her life. She says that the thought of never eating out with friends or having a pizza again depresses her.

    Maybe she’s being too hard on herself. When we follow a short-term diet, we can avoid friends and pizza. But a lifelong eating plan has to make room for them.

    A few days ago at a party I ate two delicious slices of pizza and lived to tell this tale. I even kept my weight in check by eating less the following day.

    For me the biggest help in controlling my hunger and therefore my weight came when I started taking Byetta a couple of years ago. Some people who use insulin find that Symlin also promotes satiety. But I know that these drugs don’t make everyone feel full and that some people can’t afford them, particularly if their health insurance doesn’t cover it.

    For most people what and when we eat is more important than any drug. We need to focus on those foods that promote satiety.

    We can get help here from Dr. Susanna Holt’s satiety index, which ranks different foods on their ability to satisfy hunger. But she tested only 38 different foods.

    By far the most satisfying is boiled potatoes. She told me that the bulk and the blandness of potatoes could account for much of its high satiety.

    This is also key to the “Volumetrics” diet of Dr. Barbara Rolls of Penn State University, which Pam Cobo brought to my attention in her comment on one of my earlier articles here.

    “Basically, I create high volume (translation = big bowls) of food that is low in calories and glycemic friendly,” Pam wrote. “The large volume appeals to the brain, the mouth, and the tummy. You feel absolutely full.”

    Fish is another high satiety food, ranking second behind boiled potatoes in Dr. Holt’s satiety index. It’s also a myth that red meat – beef – is more filling than white meat. The level of satiety was significantly greater after a fish meal than after a beef or chicken meal in a 1991 study that my favorite Certified Diabetes Educator just brought to my attention.


  • This is all the more reason to incorporate fish in our diet. Adult men need 56 grams of good quality protein per day and that most adult women need 46 grams, according to the Food and Nutrition Board of the Institute of Medicine. Pregnant women and nursing mothers need 71 grams. This means we can get enough protein if we set our minds to it. For example, 4 ounces of chinook salmon gives us 23 grams of top quality protein. And that is with fewer than 100 calories. A can of low sodium, skinless, and boneless sardines in water gives us about 20 grams of protein and about 130 calories.


    Getting much of our protein from fish also helps us to minimize our input of the greater caloric density of fat. That’s simply because protein (as well as starches and sugars) has only 4 calories per gram, compared with the 9 calories per gram that fat has.

    Still, we shouldn’t even try to eliminate all fat. Our bodies need the two main types of essential fatty acids, omega 3 fats known as the fish oils eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA, and a very small amount of omega 6 fats, including gamma-Linolenic acid (GLA).


    Many people find that eating fish and other high protein foods is the best breakfast. Others, myself included, prefer to start our day with low glycemic carbs, like hulless barley.

    Each of us needs to check out whether protein or carbs promotes our own satiety better. But we now have proof that skipping breakfast is a mistake when you are trying to lose weight.

    It matters too whether we eat or drink our calories. Studies show that when we take our food in liquid form rather than in a solid one, we consume more calories. By all means have a drink to slake your thirst, but concentrate on water.

    Exercise is another arrow in our quiver that we can use to lose weight and keep it off. I know from my own experience that it’s a myth that exercise makes you eat more. We have to exercise regularly to keep our metabolism up to speed. Because physical activity increases our energy expenditure and counteracts the reduction in our total energy expenditure, it is a key component of any weight loss program.

    High stress also hinders our ability to lose weight.  It is easy to try coping by eating foods high in sugar or saturated fat.

     

    “These ‘comfort foods’ raise our levels of endorphins and serotonin, our bodies’ natural ‘feel-good’ chemicals,” writes David Spero, RN. “They make us feel more calm and more in control. But the good feelings don’t last long. Our blood sugars drop again when our insulin response catches up to them, and pretty soon you feel worse than before. You need another ‘fix.’”

    I saved the best news until last. Just like Dr. Strangelove learned to stop worrying and love the bomb in the 1964 movie, I have learned to like feeling hungry. When we feel hungry it means we are losing weight, and I know that’s one of the best things we can do for our health.