Diabetes and Eating Disorders: Yoga as an Adjunct

July 02, 2017

This article is contributed by Beverly Price RD, MA, E-RYT 200, CEDRD-S. Thank you, Beverly!

Individuals with Type 1 diabetes have a higher-than-normal prevalence of eating disorders. In 2013, the National Institutes of Health (NIH) reported, from a review of literature, that 12-58% of young women with type 1 diabetes overeat, while 37% omit or restrict their insulin in order to control their weight. Similarly, a study of adolescents ages 12-21 found that 10.3% of females in their sample reported skipping insulin and 7.4% reported taking less insulin to lose weight. In terms of males, a study showed males with type 1 diabetes to have a higher drive for thinness as compared to males without diabetes, which may be a risk factor for further development of disordered eating. Further, research suggests that males may be more likely to exercise than to diet for weight loss, and boys who participate in sports that emphasize weight or leanness, such as wrestling or diving, may be at higher risk for disordered eating behaviors.

Why the prevalence?

Because diabetes and eating disorders involve attention to one's body, weight management, and control of food, some individuals develop a pattern in which they use their diabetes to rationalize or mask their eating disorder.

Let's look at a snapshot in the life of an individual with diabetes:

  • Frequent testing of blood sugar
  • Continually staying on top of food that is consumed
  • Counting carbohydrates
  • Attending nutrition education programs
  • Multiple doctor visits
  • Learning the technology to use a blood glucose meter
  • Using a needle not only to test, but to inject insulin multiple times a day
  • Having people monitor records and state of health continually
  • Being considered "different" by peers
  • Monitoring during sports
  • Special snacks during the day
  • Loss of control of one's own body
  • Feeling scared at times
In addition, let's look at the dichotomy ("the Yin and the Yang") of diabetes with an eating disorder:

  • "Maintain your weight, blood sugar, and exercise! (numbers, numbers, numbers!)"
  • "Count your carbohydrates!"
  • "...but eat intuitively, do not count, measure or weigh… and let go of the control."
"Control" is a central issue in both diabetes and eating disorders. Individuals with diabetics may feel guilty, anxious, or out of control if their blood sugar swings more than a few points. Individuals with eating disorders may feel the same way if their weight fluctuates. The control needed for the individual with diabetes, followed by the mixed messages that individuals with diabetes and co-occurring eating disorders receive, have the propensity for the diabetes to spin out of control when coupled with the eating disorder.

Complications of Diabetes with an Eating Disorder include:

  • High blood glucose
  • Diabetic Keto Acidosis
  • Multiple organ failure
  • Low blood glucose when starting the refeeding process
  • Death
Treatment for individuals with Diabetes and Eating Disorders

The best treatment is a team approach with a knowledgeable, experienced and skilled treatment team including:

  • Physician - Endocrinologist and Potentially a Psychiatrist
  • Registered Dietitian
  • Licensed Mental Health Therapist
  • Certified Diabetes Educator
Addressing the underlying psychological issues, along with restoration of physical health are key interventions. This includes weight restoration and stabilization, through balanced, varied, and healthy meal plans that provide adequate calories and nutrients along with blood glucose control, and balanced exercise. Medication management, with the use of psychiatric medications to address depression, anxiety, is also the cornerstone of treatment.

What about Yoga?

For someone with diabetes and an eating disorder, the benefits of yoga can be a powerful adjunct to treatment. Yoga can help an individual by heightened awareness and improved perception, body acceptance and appreciation, the ability to begin to feel vs masking emotions and begin to let go of control through confronting their fears. Yoga teaches mindfulness. Individuals learn to experience the taste, texture, and other sensual qualities of food and begin to enjoy and appreciate food for its nourishing qualities.

Yoga targets the sympathetic nervous system, which in turn can help to lower heart right and blood pressure. The regulation of the nervous system can aid in the management of anxiety and depression. Yoga also works on the parasympathetic nervous system to regulate metabolism and emotions. In addition, yoga can raise gamma amino butyric acid (GABA) levels in the brain responsible for calming the nervous system. Yoga's work on the cerebral cortex, can improve decision making, aid in irrational thought process and reduce impulsive behaviors.

If an individual with diabetes and an eating disorder is planning on starting a regular practice of yoga, medical clearance needs to be obtained along with a baseline blood glucose, A1C, blood pressure, weight and behaviors. The individual needs to check blood glucose levels before and after yoga. The dietitian can help the patient manage a meal plan in relation to the intensity level of the yoga practice. In addition, since yoga involves all body parts, including the feet, the individual needs to understands the importance of checking their feet after each session to make sure that they are not irritated.

By the basic breathing techniques and simple movements, that yoga can offer an individual with diabetes and an eating disorder, individuals may find it easier follow a food and lifestyle plan, while becoming more aware and in tune with their condition and behaviors. The end result is improved disease management.

BEVERLY S PRICE is a certified eating disorder registered dietitian and IAEDP supervisor, experienced registered yoga teacher and IAYT certified yoga therapist. Beverly is recognized for bringing mindfulness-based yoga to the eating disorder treatment community along with yoga therapy training programs in eating disorders for professionals. 

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