Monthly Archives: March 2015

We Can… Choose

When we hear the word ‘adolescence,’ people typically think of the human stage of development, and likely, their own bittersweet memories of youth. In the world of psychology, adolescence is characterized by identity formation, discovery of one’s place in the world, separation from authority figures and power structures, risk-taking and rapid maturity.

It’s interesting to see some of these features of the human developmental stage manifest themselves in the development of groups and organizations though. Some people, based on their experience with different organizations, businesses, or groups, especially younger, less established ones, might recognize similar dynamics. It’s not uncommon for nascent groups to come to a point when they struggle with such questions as: Who are we? What are we doing? Where are we going? As a mental health provider, I find it fascinating to see some of these developmental dynamics associated with individuals manifest themselves in group development. The universality of these processes is intriguing.

A couple of weeks ago, I was preparing to be a guest on the Diabetes Social Media Advocacy podcast to discuss veganism. For anyone who needs some context, I used to be very active in diabetes social media advocacy, but for various reasons, I’ve drifted away. Recently, I started thinking more deeply about the connections between veganism and diabetes, wondering how to re-engage with the diabetes online community on this topic. Being a guest on the DSMA Live podcast was an important opportunity to reconnect with my peers, and hopefully, begin a conversation that I’m excited to have.

As I was thinking about the intersection of diabetes and veganism, I thought about the culture of the diabetes online community, in which bacon and cupcake jokes have become staples. In fact, at one in-person gathering several years ago, before veganism was even on my radar, we feasted on bacon cupcakes. It has been my experience and observation that when people with diabetes gather, they purposefully structure activities to include food that is decidedly unhealthy: bacon, cupcakes, hamburgers, fries, cheese, ice cream, donuts. Which is not to say I don’t eat vegan versions of these foods now, but I think it’s worth reconsidering our consumption of the animal-based versions. Without these animal-based foods, a PWD gathering is not considered a fitting party, and there’s grumbling about having “healthy” food imposed on us. Because people in the community come from all over, on the infrequent occasions we gather, quite understandably, everyone is in the mood to celebrate togetherness, but over the years, the junkiest of mostly animal-based foods have become an inherent part of the party. This is the culture.

For the outside observer, likely influenced by diabetes standards of care of yore, this likely sounds peculiar. I think some history is warranted here. Until 1921, type 1 diabetes was a death sentence. Insulin was discovered, and it was the only treatment, supplemented by diet and exercise programs. From the 1920’s until about the early 1990’s, give or take, most people with diabetes were prescribed a diet that generally forbid sweets, or at least, reluctantly suggested they be consumed infrequently and in small quantities. Then new insulins and new dietary management philosophies emerged that have become the standard of today. A person who takes insulin can generally eat whatever they want, but they count the carbohydrates, and based on that number, calculate an insulin dose to counteract the food’s effect on one’s blood sugar.

Most people who do not live with, or care for someone with diabetes, do not understand this. A lot of people with diabetes get frustrated that misconceptions based on older management techniques persist, often manifesting themselves as presumptive, seemingly intrusive comments about what someone with diabetes can and cannot eat. After years of being aggravated by such interactions, I’ve adopted a laid back approach to responding, reminding myself that people either don’t know or might be curious, but each PWD has their own level of patience and style of response for dealing with usually well-intended comments or questions.

This brings me back to adolescence, and the culture of eating heavily animal-based food that persists within the diabetes community, which is a barrier to receptivity to plant-based eating. I feel like the best way to understand the junk food party that typically unfolds at gatherings of people from the diabetes online community is to frame it as an adolescent-like group response to: (1) the decades of restrictive diets that were once a staple of diabetes management, and (2) the ongoing public misconceptions that such restrictive diets are still standard. , Within a developmental framework, the natural response from people with type 1 diabetes to prevalent misconceptions that amount to, “You can’t eat that,” is to say, “Don’t tell me what to do. Yes, I can. Watch me.”

The benefits, if you will, of the junk food parties are that people have fun, and it enhances a sense of community. Having participated in such parties, we revel in the hilarity and irony of a bunch of PWD standing in line at the cupcake shop. There’s something immensely gratifying to do exactly what people think you shouldn’t do, or wouldn’t expect you to do, without regard for the health consequences. Sounds a little adolescent, right? Then there’s the hangover from socially pressured impulsivity and overindulgence. We fuss with our insulin dosage to correct the fat and sugar overdose, but anyone who’s been there, done that, knows that there’s as much guesswork as science to adjusting insulin, so recovering from the cupcake (or burger or milkshake or donuts or…) often has consequences in the form of erratic blood sugars for hours afterwards. But consequences be damned, colluding with each other to have a good time and maintain the culture is what’s most important. We couldn’t possibly reconsider our culture, and the implications of our choices, right?

People want to have a good time, so what? There are health implications of these kinds of indulgences, but we get together very infrequently for the most part. Unfortunately, almost none my diabetes friends are vegan, so these junk food parties are within the larger context of regular animal product consumption, which is associated with vascular disease which kills most people with diabetes. Call me a worry wart, call me selfish, but I’m afraid of losing my friends with diabetes to complications they potentially could have prevented or managed with plant-based eating.

Looking again at the developmental framework, I’d love to see a change in diabetes culture, transitioning away from the adolescent-like stage, characterized by thinking about food in terms of “can” and “can’t,” and instead, taking a more mature approach, thinking about foods we “choose,” giving mindful consideration to why we choose or don’t choose to eat something. I believe part of this is learning more about the detrimental health effects of eating animal-based products (check out Physicians Committee for Responsible Medicine for more information).

For decades, PWD were told they couldn’t eat like everyone else. Certainly, that’s how I grew up. Now, it seems we want to eat as poorly as everyone else, if not in our day-to-day lives, it certainly happens when PWD get together. Just because we have newer insulins, and we “can” eat a certain way, is that really what we want to choose for ourselves? Is the Standard American Diet (SAD) really our goal? Did we get away from the perpetual list of forbidden foods to embrace the diet that is contributing to epidemics of diseases? Is anyone willing to consider a third option?

Why aren’t we choosing foods in the interest of personal health that have been shown to be optimal for vascular health? We work so hard to manage our blood sugars, with the hope that we will live longer than the less-than-average lifespan predicted for PWD, but why are we aspiring to eat the SAD instead of choosing a way of eating that will protect the environment so we have a world in which to live? And lastly, as a group of people with a recognized disability (I intend to come back to this particular issue after I do some more reading), people who are marginalized, misunderstood, and maligned for having bodies that require insulin to survive, we should be collaborating to undermine systemic oppression in all its forms. Animals are also victims of oppression for not having certain abilities. What does it say about us that we are perpetrating oppression against them for being different, when we fight so hard to get our special needs met?

So, yes, we “can” eat what we want, but isn’t it time we aspire to something greater? Let’s choose with intention – for others, for the environment, for health.