National Eating Disorders Association

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Pre-Diabetic
Orthorexia and pre-diabetes

Back in the 1990s, I fell for the candida quackery fad because I thought it would cure my problems with concentration and energy--which it turns out are due to a developmental disability. I did my best to avoid yeast, fruit, flour, etc. I read labels for hidden ingredients. I was rude to friends who offered forbidden foods and stopped eating with people in restaurants. I cried outside bakeries. I stuck to that diet like I would need an EpiPen if I cheated and cried if I made mistakes, even accidentally. I would skip meals if I planned badly and was caught without "safe" foods. I wasn't obsessing over weight, but by any reasonable measure, that is not healthy eating. Now, that would be called "orthorexia" and I'm super disappointed the screening tool here doesn't include it.

Fast forward to about a month ago--my carb-heavy diet, forgetting to drink water, stress, and lack of activity during the pandemic pushed me over the A1C limit for pre-diabetes. My primary care doctor scolded me on a phone visit and said I needed to be on a "low carb diet." I got a referral to a diabetes dietician from the same clinic, who said I need to count carbs, only have 3 meals a day and 1 snack, and fast at least 6 hours before bedtime. She said there is no difference between the recommendations for a pre-diabetic person and a diabetic person, including multiple blood glucose readings per day. I told her I was concerned about navigating carb counting without triggering a relapse of an eating disorder. Her response was that "There is no way that counting carbs can cause an eating disorder" and she wouldn't let me give her the backstory. I told her that I am doing the best I can with my diet, given that my developmental disability often prevents me from preparing regular meals. She wouldn't believe me. I said I needed support for meal planning/preparation, and she said I was "noncompliant" and it was a waste of time talking to me.

So y'all can guess what happened next. I tried to follow the diet in her My Plate handout, but when I was busy on deadlines or in the middle of a crisis, I would go for long parts of the day without eating anything but low-carb foods because I was afraid to eat the carb-laden foods I had stocked up on before the diagnosis. A lot of my food budget is tied up in that pantry.

I talked to the doctor again, who scolded me for using my glucometer as directed by the dietician. I have other sources saying the dietician's advice is terrible but now my brain can't process anything more complicated than "carbs bad--well, you can have a little bit but not much". If beans are so great for you, why am I pre-diabetic when they were a main part of my diet? (Not vegetarian but can't afford meat.)

But if I have insulin resistance, is it really enough to go back from "officially pre-diabetic" to "not quite pre-diabetic"? How do I learn to eat a healthy diet without triggering my carb-free diet habit, when I don't have a budget for premade diabetic meals? I asked the doctor again and the referred me to the food bank--which mainly sends people things that won't keep long enough for me to eat them all even if I am up to food preparation. Which I frequently am not, thanks to the underlying disability and possibly insulin resistance making me feel unwell.

My health plan won't let me have eating disorder treatment unless I'm in therapy for something else, so I have a referral to the group that does therapy for developmentally disabled people. I don't know what their eating disorder program is like, if I'll be doing it through the DD provider or my health plan. The diabetes dietician said she didn't believe that being Autistic was relevant to whether or not I could prepare meals for the MyPlate program so I'm worried I won't get support for having difficulty following whatever plan they prescribe.