#85 - What Does Weight-Inclusive Diabetes Care Look Like? with Dr. Gregory Dodell, MD

In this episode, weight-inclusive endocrinologist, Dr. Gregory Dodell joins me as we continue the conversation we’ve started on the podcast (with Val Schonberg and Danielle Bubblitz) about managing diabetes in midlife

Dr. Dodell emphasizes that diabetes doesn't discriminate based on body size. He advocates for a personalized, intuitive approach to eating, highlighting the importance of listening to your body. We highlight the fact that diabetes can bring emotional challenges, including stigma around medication and feeling like you've failed if diet and exercise alone don't cut it. 

So, if you or someone you know is dealing with diabetes, regardless of body size, this episode offers a reassuring and hopeful perspective. You're not alone in this journey!

To learn more about Dr. Dodell and his work, visit him at www.centralparkendocrinology.com and follow him on Instagram @everything_endocrine

Links Mentioned:
Episode 33: How to Ask Your Doctor for Healthcare Instead of Weight-Care with Dr. Maggie Landes
Episode 78: Filtering the Fear of Insulin Resistance with Val Schonberg
Episode 79: Finding Food Freedom with Danielle Bublitz

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Looking for more about midlife, menopause nutrition, and intuitive eating? Click here to grab one of my free guides and learn what I've got "on the menu" including my 1:1 and group programs. https://www.menopausenutritionist.ca/links

Transcript

Jenn Salib Huber  0:00  

Hi, and welcome to the Midlife Feast, the podcast for women who are hungry for more in this season of life. I'm your host, Dr. Jenn Salib Huber. I'm an intuitive eating dietitian and naturopathic doctor, and I help women manage menopause with old dieting and food rolls. Come to my table. Listen and learn from me. Trusted guest experts in women's health and interviews with women just like you. Each episode brings to the table juicy conversations designed to help you feast on midlife. And if you're looking for more information about menopause, nutrition and intuitive eating, check out the midlife beasts community my monthly membership that combines my no nonsense approach that you all love to nutrition with community so that you can learn from me and others who can relate to the cheers and challenges of midlife. 

Hi, everyone. Welcome to this week's episode of the midlife feast. My guest today is Dr. Gregory Dodell. Dr. Dodell is an endocrinologist who practices in the United States. And he is one of the few weight inclusive providers having conversations about diabetes in particular, and trying to broaden the conversation beyond cutting carbs and losing weight. So in my interview with Dr. Dodell I asked him some of the big questions that you all have you often asked me, which is how much do carbs actually matter? Do I need to cut out sugar? And what's wrong with someone telling me that I should try to lose weight to manage my diabetes? So this is kind of the third in a series that was that has happened this season on the podcast. 

So we first had Val Schonberg talking about insulin resistance and menopause. Then Danielle Bublitz was talking about some of the dietary myths and the things that we should be adding in to manage diabetes. And so this third conversation with Dr. Doe, Dell, I think is a nice way to round out the medical conversations around diabetes, especially through that weight inclusive or health and every size lens. So I hope you enjoyed as much as I did. And as always let me know if you have any questions. Welcome Dr. jodel. To the midlife feast. How are you?

Dr. Gregory Dodell  2:14  

I'm good. It's a rainy floody day in New York. But other than that, I'm good.

Jenn Salib Huber  2:19  

Well, it's a rainy day in the Netherlands. So we have that in common today.

Dr. Gregory Dodell  2:22  

Perfect, perfect. But otherwise, very good. Thank you.

Jenn Salib Huber  2:27  

Excellent. Thanks so much for taking the time. I we've been talking about all things related to diabetes and insulin resistance on the podcast this month. And I'm really excited to have your opinions kind of into this conversation to round out the medical conversation piece that sometimes really makes things a little bit messy, you know, for people who may be trying to navigate this in a weight inclusive way. So before we dive into the discussion, can you just take a minute to introduce yourself to our listeners? Sure.

Dr. Gregory Dodell  2:59  

I'm Greg Dodell. I'm a private endocrinologist in New York City, my own practice, Central Park, endocrinology. I am married to Alexis conocen, who's a psychologist at the anti diet plan, which I'm assuming, at some point, you could ask how I started practicing this way. So I figured I would jump to that and just say pretty much from her. And, and yeah, I'm looking forward to talking to you and, and hopefully your listeners will enjoy.

Jenn Salib Huber  3:28  

Yes, and Alex's book is a fantastic book and resource and definitely one that, that I recommend, and I should probably ask her to be on the podcast as well. But why don't you just tell us a little bit how did you get interested in Health at Every Size, because obviously your specialty would be one that would be considered, you know, fairly conventional, in terms of of the approach and regardless of the specialty haze or Health at Every Size is not typically conventional. So how did this all get started?

Dr. Dodell's Journey into a Weight-Inclusive Approach

Dr. Gregory Dodell  3:57  

Totally. Yeah, I mean, my first post, really like on Instagram that was like, geared towards this was basically like, endocrinologist are perfectly positioned to practice this way or have these discussions because it is so much of a metabolic specialty in so many of the patients that we see have faced, you know, the weight stigma, the weight discrimination, the stigma with regard to like, dealing and having diabetes, and you know, all the stuff that you talked about and menopause and all these life changes and body changes. So endocrinologist are really perfectly positioned to do that if we can do it in the right way to handle these tough, you know, phases of life and conditions and all this stuff. 

And how to get into it, as I said with really from Alexis, because we both had similar training backgrounds, the same hospital even she did her doctorate in bariatric surgery evaluations and the psychological ramification Emotions and the impact on that. And then we both went into private practice. And she was still doing these bariatric surgery evaluations and coming home and being like, this is just not working, you know, these patients are struggling and this and that she came across Health at Every Size, mindful eating, and it took like, 10 years for me to like, really get it probably, because it's so, you know, ingrained of like how we're supposed to practice. 

And I just started reading about it, I read her book, you know, rough draft, and did like a workshop, some workshops, and started following people on Instagram. And I was like, it just clicked, you know, and then started seeing patients, you know, from this lens, and just the more I did it, the more it made sense to me, and continues to make sense to me.

Jenn Salib Huber  5:49  

I think that that experience from a professional and a personal perspective is really relatable, because I know that when I, after practicing as a dietitian, and as a naturopathic doctor for 15 years, very much in the food as medicine very much in the traditional view, or kind of lens of nutrition, that when I saw, you know, kind of when the when the wool came off, you know that that veil was lifted of like, wait a minute, there actually isn't a lot of evidence that weight loss as a therapeutic intervention that is prescribed can actually work in the way that we're telling people it can. And so, when people come to you, and they are exposed to this kind of weight inclusive approach, what does that look like? If somebody has diabetes? As as an endocrinologist? What does it look like when you're practicing with that weight inclusive lens?

The Difference in Being a Weight-Inclusive Medical Provider

Dr. Gregory Dodell  6:42  

Good question. I mean, so I talked to them about behaviors the same way I talked to anyone about behaviors, how are they moving? How are they pairing up their foods, you know, with the carbohydrates, and the fats and the proteins, how's their sleep as a stress management, and then whatever medications we need to use to bring their blood sugar down. That's the approach. And of course, you know, weight may change as a result of those behaviors. And, you know, a lot of people don't realize that people actually lose weight, when their blood sugar is on controlled. You know, like, a lot of times when people are first diagnosed that diabetes, one of the initial signs could be like, unintentional weight loss. 

So of course, once you start treating the diabetes, their weight could go up, because they start holding on to muscle, and fat differently. So there's a lot of reasons that we can change. And it's a data point, it doesn't have to be, in my opinion, you know, the end all be all. And it's just something else to kind of put into the clinical perspective. And even if someone's weight doesn't change, you know, by increasing activity and focusing on all the things I mentioned, they will be healthier, and their numbers most likely, and hopefully will get better.

Jenn Salib Huber  7:56  

And that's at the core of a weight neutral approach is just saying that we're going to do and add in all the things that we know our health promoting, we're still going to talk about things like fiber, we're still going to talk about adding in more plants and moving your body in ways that you enjoy, which I think is is one of the things that people find difficult to understand, because weight is a proxy for health has been such a mainstay of that conventional paradigm around managing anything, but especially a metabolic condition.

So why do you why do you think that there's still so much stigma around diabetes, given everything that we know and all of the influences and the various factors that might, you know, lead someone to developing diabetes? Where's the stigma coming from?

Dr. Gregory Dodell  8:44  

I mean, you say everything that we know, which is like people that are like working in this space, but the average person on the street here has type two diabetes, they don't think about family history, you know, genetics, they don't think about, you know, stress and access to health care and all that stuff. They think this person's not eating, you know, quote, unquote, healthy and this person's not exercising, so that's why they have type two diabetes. 

So it's just breaking through that, you know, long held belief, which is just not true. I mean, a lot of people get diabetes who are living all the healthy behaviors, and you know, they have a medical condition, you know, they need to take steroids because they have arthritis, or they have, you know, some other thing going on, and that affects their pancreas and they get diabetes. So there's lots of reasons, you know, people have high blood sugar.

Jenn Salib Huber  9:35  

So what would be some of the thing that the major influences on type two diabetes in particular,

Factors Influencing Type 2 Diabetes

Dr. Gregory Dodell  9:42  

genetics is a huge one. Things like PCOS like polycystic ovarian syndrome, right as insulin resistance, which can predispose people to type two diabetes. Obviously, the lifestyle things do play a role so people aren't getting activity they're not getting enough sleep and you know, not eating a balanced diet, all those things can play a role, of course, stress, certain medications, you know, antipsychotic medication, antidepressant some of these can affect blood sugar. So there's lots and lots of variables.

Jenn Salib Huber  10:18  

Yeah, and I think that especially the genetic component sometimes surprises people, because diabetes has this, this label, especially type two as being a diet and lifestyle, disease. And people don't realize that genetic How strong is the genetic component with type two diabetes?

Dr. Gregory Dodell  10:36  

It's pretty strong. I mean, you you definitely have, you know, five to 10% increase, I would say, you know, for family history.

Jenn Salib Huber  10:44  

Yeah. And so when combined with all of the other things that, you know, we might experience through our lifetime, like you mentioned, you know, die other diagnoses or medications, it's easy to see that it's more than just what you're eating or not eating right afterward. Where do you find people are most confused when it comes to nutrition and managing their diagnosis?

Dr. Gregory Dodell  11:07  

I think most people have been taught or they hear you know, that they can't eat any carbohydrates at all, if you have diabetes. Which is, excuse me, it's just problematic because our body needs fuel. Right? So we talked about pairing up carbohydrates with proteins and fruits and vegetables, all the stuff that you know, you know, about we talked about, but not having any carbs not only is not sustainable, but people tend to feel pretty crummy, you know, in the long run by not having that major fuel source can lead to irritability and changes in digestion and energy loss and all these things.

Misconceptions About Diabetes and Nutrition

Jenn Salib Huber  11:48  

Yeah, so I want to say that again, because one of my my big missions on social media, and in this podcast is to debunk the myths around carbohydrates in particular, and so, you know, with midlife, and there's a lot of changes that happen around menopause. And if that comes with changes in blood sugar, or a diagnosis of diabetes, people get really scared. 

And they, they immediately and are often told by their healthcare providers, just cut your carbs, watch your carbs, you know, don't have carbs at certain times of day. And as we had, we had Danielle boo bullets on the on the podcast talking about that, and I've talked about it a lot. But I just want to say one more time, carbohydrates do not need to be eliminated, even if someone has diabetes, right? Correct. Excellent. You may the

Dr. Gregory Dodell  12:39  

thing is listening to your body, right. So if you just eat a carbohydrate by yourself and you feel or if you're someone who's monitor your blood sugar, if you see a big spike, and then a drop your sugar says Hi, you don't feel good, you're thirsty, your energy drops, take note, you know, and then maybe try and pair it up with something else or try a different kind of carbohydrate or whatever, you know, so the body knows it gives you feedback. And and that's really what you should be eating, not what someone else is telling you, you should be eating.

Jenn Salib Huber  13:11  

So can we talk about sugar as well? Because that's another big point of confusion and misinformation. That you know, obviously, sugar and what we eat can impact our blood sugar, blood sugar and overall health. But is there any evidence that eating sugar causes diabetes? No, no. And so when people have diabetes, they don't have to avoid it, completely eliminate it or worry that they've done something to cause it by by having dessert or a chocolate bar. Right?

Dr. Gregory Dodell  13:42  

Correct. I mean, obviously, that can take an effect have an effect on the blood sugar. And that's something to take note of. But the other stigmas around medication, right? So sometimes you just need medication to cover the nutrition that you want and need in your life. And that's just part of diabetes, and there's nothing to be ashamed of, or feel bad about by needing medication. But, you know, sometimes just eating you know, in line with how your body wants to eat means taking some medication to cover it.

Medication and Stigma in Diabetes Management

Jenn Salib Huber  14:17  

Yeah, and I think that the the narrative around sugar especially becomes really moralized that you're being a good diabetic. If you're not having any sugar versus being someone who is managing their blood sugar by including all the foods that they enjoy in ways that are supportive of blood sugar balance, those are two very different conversations.

Dr. Gregory Dodell  14:40  

I think, you know, you have to look at it as really a marathon too, not a sprint. And, you know, I think that living in such a restricted way of eating when food is supposed to be pleasurable and things that we can enjoy. That can create a lot of burnout for someone with diabetes, which In the long run affects your quality of life. So there's ways to live with diabetes and eat and enjoy cultural things and be at parties and all this stuff. But just figuring out what works for that person as an individual.

Jenn Salib Huber  15:14  

Yeah, and I want to come back to something that you said about, you know, medication and there's no stigma on medication. There's, there's such a, I guess, a halo around, or an expectation that something like diabetes, which is a quote unquote, lifestyle, disease, can be managed 100%, with diet and lifestyle. And so when I'm working with people to redefine the relationship with food, I'm always trying to manage those expectations that not everything can actually be treated with food and lifestyle. And that sometimes we need to have that, you know, holistic approach, which can include medication, is that kind of something that you see in your practice as well that people feel like they're doing something wrong? Because they haven't been able to control it with diet?

Adopting a Weight-Neutral Approach and Expectations

Dr. Gregory Dodell  15:56  

Yeah, and I try and obviously dispel that myth. And then there's people that really want to come off the medication, which I totally get. But you know, that's hard to do. I mean, some people obviously can take minimal medication and keep it controlled. But it's pretty hard to come off the medication.

Jenn Salib Huber  16:16  

Moving on a little bit, so when people hear diabetes, or they're given this diagnosis, and this often happens around midlife, so as estrogen declines, or maybe in association, we don't exactly know if it's a cause and effect. But there seems to be in association for some people, something we need to look out for, that insulin resistance may start to show up, they may start to, you know, even kind of head into that territory of diabetes. 

And when they hear that they immediately think weight loss, or sometimes prescribed weight loss as a treatment. So and the conversations that I have with people are often around well, I've tried dieting my whole life I have I have done every plan every diet, and it works for a little while, but it doesn't work in the long term. Is there anything else that I can do, which is where I think the weight neutral approach kind of really shines? So how, what kinds of things would you direct people to consider or talk to their healthcare providers, if they were trying to remain in that weight neutral space or weight inclusive space,

Dr. Gregory Dodell  17:22  

I think talked about behaviors, you know, without focusing on the weight, because it's normal for the body to change, obviously, as we go through life, and doing things like lifting weights or yoga or anything else, you know, beyond their usual exercise may be helpful to mix it up, you know, on midlife, sometimes sleep can be challenging, as people are going through menstrual changes, because of the the hot flashes and all the other stuff. So talking to the gynecologist or, you know, whoever can support them and making sure that they're getting sleep and managing those, you know, quote, unquote, vasomotor symptoms. Mood can fluctuate a lot. So if you know someone's feeling depressed or anxious, you know, getting help for that. So just really looking at the whole the whole picture of what's going on.

Jenn Salib Huber  18:15  

Yeah. So what are some of the other misconceptions? We've kind of covered a lot of them? We've talked about carbohydrates, and sugar and weight loss as like a goal. What are some of the other misconceptions that people have around body size and diabetes?

Dr. Gregory Dodell  18:30  

Right, that, you know, anyone, anyone, and everyone in a larger body is going to get diabetes or has diabetes, or is sitting around not moving or not eating, you know, quote, unquote, the right way, that's certainly not true. I see people across the size spectrum who have type two diabetes, and a lot of the conditions I treat, you know, whether it's thyroid or osteoporosis or whatever. So just trying to break through that.

Jenn Salib Huber  18:58  

I remember you sharing something on your Instagram earlier this year, that was I think it was a fairly large study of I think over, I think it was a couple million people where they were looking at people by BMI, which we all know is problematic for lots of different reasons. But that the it was the people in the quote unquote, normal BMI range of that 20 to 25. That had the greatest increase in new diagnosis, but that people in in the higher ranges, the rate of diagnosis was actually stable. Right. Am I right about that? Am I remembering that?

Dr. Gregory Dodell  19:31  

Yes, I vaguely remember that.

Jenn Salib Huber  19:35  

I guess just to kind of, you know, drive

Dr. Gregory Dodell  19:39  

and see what the punch line was. But yes, I do remember that. It sounds like something that I would find interesting because obviously it goes again, sorry, I

Jenn Salib Huber  19:48  

didn't mean to put you on the spot.

Dr. Gregory Dodell  19:50  

It was definitely definitely something like that.

Jenn Salib Huber  19:54  

Because people hear so much about, you know, waist circumference and you know, this The visceral, you know, abdominal adiposity. And, and this idea develops that you can tell that someone and I'm saying telling air quotes has diabetes or insulin resistance just by looking at them. Is that the case?

Dr. Gregory Dodell  20:14  

No, that's totally ridiculous. You know, I, you know, speaking of posts, I didn't know I posted something at one point about like, walk, walk through beautiful central park every day to get to work. And I see all types of bodies, you know, running and biking and all this stuff, including fat bodies, and I saw those people like somewhere else out of context, or even in that context, where I just assume, hey, that person's, you know, in a larger body, they must have diabetes. I mean, you know, it makes no sense.

Jenn Salib Huber  20:48  

Yeah. So, I mean, obviously, I think a lot of the questions that I've been asking you, hopefully, you know, this is information that is going to reassure people, especially around that, you know, this isn't, this isn't a moral failure, if you're diagnosed with this at any age, for any reason, and that the size of your body, you know, isn't involved in the in the diagnosis and meaning that, like, it's not the determining factor, and that there are so many other things that can be done in a weight inclusive weight neutral space, is there anything else that you would offer as kind of parting advice to anybody who might be feeling really scared, because that's pretty common with this diagnosis, and feeling like they've done something wrong or to cause this?

Advice and Encouragement for Those with a Diabetes Diagnosis

Dr. Gregory Dodell  21:33  

Yeah, I'd say number one, you know, a lot of our controls out of our out of our control. So you know, and even if it does happen, even if you could say, This is my fault, doesn't do any good. You know, you gotta you gotta move forward. And thankfully, we have so many so many good resources, you know, medications and exercise, fun exercise programs, and other things that we could suggest the nutrition changes, and so many other ways to approach this, irrespective of weight, that can help someone have a long, healthy, good quality of life, you know, diabetes or not,

Jenn Salib Huber  22:11  

and a healthy relationship with food needs to be part of that. One that's based on fear.

Dr. Gregory Dodell  22:16  

Totally, yeah. Because then you take away the quality of life if food is something that you know, we can and should find pleasurable, and going to parties and family events and not, you know, feeling like anything's off limits is a big a big goal.

Jenn Salib Huber  22:31  

Absolutely. Like, we need food joy in our life, not just nutrition. Right, right. So I always ask my guests, and I didn't prep you for this, but I always ask my guests what they think the missing ingredient in midlife is. So I would love to hear your answer,

The Missing Ingredient in Midlife According to Dr. Dodell

Dr. Gregory Dodell  22:46  

I think probably like hobbies.

Jenn Salib Huber  22:49  

Yeah, yeah, we definitely need more time to do fun things, don't we?

Dr. Gregory Dodell  22:53  

You know, I think about it a lot. And I asked patients who are like about to retire. And I'm like, you know, everyone works so hard. What are you going to do when you retire? Do you have hobbies? What do you want? A lot of people don't you know, in the end, the people that do well in retirement are the people that volunteer and they take classes and they, you know, have goals, other goals. So, you know, I think midlife is a time where like, you're like mid career potentially or towards the end of the career. And so much your focus has been on that and family and then, you know, that kind of is wrapping up in some sense. And then you know, what's next? So I would say, planning for the next next phase of life is important.

Jenn Salib Huber  23:36  

I love that the next season of life i Yeah, I'm going to try and find a new hobby. Awesome. Thank you so much for taking the time today. I really appreciate I know that your words of reassurance will go a long way and I appreciate you taking time out of your busy day.

Dr. Gregory Dodell  23:53  

I hope so. Thank you very much.

Jenn Salib Huber  23:56  

Thanks for tuning in to this week's episode of the midlife beast. For more non diet health hormone and general midlife support. Click the link in the show notes to learn how you can work and learn from me. And if you enjoyed this episode and found it helpful, please consider leaving a review or subscribing because it helps other women just like you find us and feel supported in midlife.