Transcript:

00:00:01: Shireen

In today's episode, we are in conversation with dietitian Janice Dada, who specializes in eating disorders, diabetes care, and intuitive eating.

She shares her journey, explains how intuitive eating offers a fresh, non-diet approach to managing health.

We explore how this framework works alongside chronic illness, dietary restrictions, and cravings and discuss the importance of listening to the body's hunger and fullness signals.

Janice also offers insights into the future of intuitive eating and chronic illness management.

Stay tuned.

Janice Dada specializes in helping families and individuals of all ages optimize their health, well-being, and eating behaviors through a weight-inclusive, non-diet framework.

Her book Intuitive Eating for Diabetes is available for pre-order now and will be published in April of 2025.

00:00:58: Shireen

Welcome, Janice.

00:00:59: Janice Dada

Thanks so much for having me.

00:01:01: Shireen

Such a pleasure having you on.

So, Janice, I want to start out with your “why.” Can you tell us a little bit about your journey to becoming a dietitian specializing in eating disorders, diabetes care, and intuitive eating? How did all that happen?

What was your journey like into this?

00:01:15: Janice Dada

Sure, absolutely.

I became a dietitian in 2007.

I did my internship with the VA and then went to work for the VA initially, and it was a great experience in many ways. I worked with many patients with diabetes, and after a couple of years, I just found myself craving a bit more independence with my schedule.

I wanted to do things in the community, like teaching college nutrition classes, and I also wanted to counsel patients differently.

I found that there was a very prescriptive way that patients were being counseled with diabetes, and it was also a very weight-centric, top-down approach.

We also had very little time with patients, and I just craved a little bit more independence with how I was going to work with them.

So after about two years at the VA, I left, went into private practice, and started teaching college nutrition classes. I also did additional training.

I worked with Evelyn Tribole, co-author of Intuitive Eating, and did mentorship and training programs with her. I also pursued more client-centered counseling training, such as motivational interviewing.

And without really seeking out eating disorders, they came to me.

I embarked on additional training within that realm because I found there was a big need, especially as it related to people with medical conditions such as diabetes.

So I started integrating intuitive eating with diabetes care.

Intuitive eating with diabetes allows clients to listen to their inner signals while making choices that work for their personal blood sugar management, rather than following something very prescriptive and rigid that may not be necessary for each individual.

00:03:07: Shireen

And that's really the topic for our discussion today—understanding the intersection of intuitive eating and diabetes.

Which takes me to my first question.

Now, we've talked about intuitive eating with a few guests before. My question to you is: First, just help us understand or reestablish the basics of intuitive eating.

It sounds simple, but I know it's not.

Please walk us through that first.

And then, how does it differ from traditional diabetes management approaches?

Because we often hear about diabetes management in terms of controlling the types of foods consumed.

Walk us through that.

00:03:41: Janice Dada

Yeah, absolutely.

Intuitive eating is a way of eating that integrates instinct, emotion, and rational thought.

There are 10 principles.

I think sometimes people boil it down to something very simplistic, but as you mentioned, it involves much more than just hunger and fullness, which are only two of the 10 principles.

Intuitive eating helps people focus on their internal cues and shift away from dieting and external rules that often backfire. Instead, it moves them toward more positive self-care.

There are over 200 published research studies on intuitive eating.

A number of those studies have examined intuitive eating in relation to diabetes.

One of the researchers, Tracy Tilka, developed the Intuitive Eating Assessment Questionnaire, which helps people assess their own intuitive eating skills.

Her research found that intuitive eating was associated with greater weight stability.

And that’s really critical because weight cycling—where weight fluctuates up and down—is a known risk factor for diabetes and other metabolic and psychological health issues.

So that's really crucial.

Typically, diabetes care follows a weight-normative approach, meaning that weight is the cornerstone of treatment.

Intuitive eating, on the other hand, follows a weight-inclusive approach.

That means we don’t use weight as the primary treatment focus. Instead, we look at health behaviors to improve overall health outcomes, particularly blood sugar management.

00:05:33: Shireen

And can you walk us through what traditional diabetes management tends to look like and how intuitive eating just really plays a different role within that?

00:05:41: Janice Dada

 Yeah, so traditional diabetes management often focuses on weight.

So whether somebody—regardless of where somebody is on the weight spectrum—I find that often weight is a focus.

Often, physicians will use the BMI, which has a number of problems, but they may be given instructions to lose weight without any real recommendation as to how to do that.

Just sort of, “Do it,” as if it's this easy thing to do.

In addition, often diabetes care—or the kind of the traditional diabetes care—comes along with carbohydrate restriction.

So I've had clients come in and say, “My doctor told me to lose weight and not eat anything that's white.”

You know, really not very clear guidelines.

And it also makes patients feel very shamed and blamed—sort of like they've done something wrong.

That they must be eating the wrong way and that's why they have this blood sugar issue.

Or they must be at the wrong weight and that's why they have a blood sugar issue, which is really not the case.

Because we know that diabetes occurs for a whole host of reasons.

That could include things like genetics, their environment, exposure to things like pesticides, their trauma history, their sleep patterns.

The list goes on and on in terms of the root causes of why diabetes occurs.

And so those just blanket statements of, “Do this and your blood sugar will get better. And if it doesn't get better, you must have done it wrong,” really doesn't help patients move in the right direction.

So I have worked with patients that have both taken it way too far, and their restriction has ended up in a clinical eating disorder.

And I've also worked with patients who have said, “This is impossible,” and thrown in the towel, saying, “Whatever happens, happens.”

“I can't do what this practitioner has told me to do.”

00:07:32: Shireen

You know, you mentioned weight there for a second, and I know you take a very weight-inclusive framework.

Can you explain what this non-diet, weight-inclusive framework really entails and why it's so effective for long-term health and well-being, including diabetes?

00:07:49: Janice Dada

Yeah.

So a weight-inclusive framework focuses on health behaviors rather than weight.

That might mean that we're working on sleep patterns, for example.

Because we know that sleep actually really affects blood sugar management.

So whether it's undiagnosed sleep apnea—I might ask questions of my patients about how they feel in the morning when they wake up, how they feel throughout the day, how well they're sleeping at night.

If they're having trouble falling asleep or staying asleep.

If they have a partner who says that they are snoring or that they sound like they are struggling to breathe while they're sleeping.

Then we might do a test for sleep apnea, which—with the treatment for sleep apnea—can really actually have a big impact on blood sugar management.

Or we might look at joyful ways to move the body.

There have actually been some studies that have looked at the idea of “exercise snacks,” which are little breaks in movement throughout the day.

I think sometimes people get in their minds, “If I don't do X amount of minutes all at once, it's not worth it.”

But actually, the research finds that exercise snacks—little 10-minute increments throughout the day—are just as effective as doing something all at once.

And actually, maybe even better because it interrupts periods of prolonged sitting.

So that might mean a 10-minute walk a couple of times during the workday, which can have multiple benefits.

Because we also then get to take a break from our work, which can make us more productive.

And we may be helping our blood sugar and getting some stiffness out.

So that's something that we might look at with people to really understand.

First of all, what kind of ways do you like to move your body?

Sometimes their idea of movement has been tarnished by diet culture in general.

Thinking that there are specific ways that are right or wrong to move.

I had a client who rediscovered her passion for soccer when she'd been trying to make herself use a treadmill and just didn't find that enjoyable.

So she was avoiding it.

But then when she realized, “I could actually join an adult soccer league,” she did that and found that was so much more fulfilling than making herself do something that she thought she was supposed to do.

00:09:58: Shireen

And I love the concept of also making it fun along the way.

It shouldn't feel burdensome.

Like, “Oh, I have to do this one other thing that I have to intentionally carve out time for.”

It can be fun at the same time as well, is what you're saying.

I love that approach.

00:10:10: Janice Dada

Yeah, absolutely.

00:10:12: Shireen

What can this look like for someone with diabetes who is new to intuitive eating?

Where do you tell them to start?

Where do you begin?

You mentioned 10 principles.

Do I do all 10?

Walk us through what the initial steps look like.

00:10:25: Janice Dada

Yeah, I actually love to take clients who are new to intuitive eating through the assessment questionnaire that I mentioned was created by researcher Tracy Tilka.

I actually have it posted on my website too.

So people can take it and then see where their results fall.

And that can highlight some areas.

That can tell me if they have a lot of food rules, or if they are eating things that are not satisfying to them, or if they find themselves to be eating with sort of an emotional base behind the reasons for their eating.

So that may also point us to where we start first.

Because, yeah, the 10 principles don’t have to be done sequentially.

Although the last principle, gentle nutrition, is ideally not done in the beginning.

Because the idea is that we've really worked through some barriers to attunement along the way.

And the barriers to attunement are essentially these things that get in the way of us really hearing and listening to our own body signals.

For example, if we are not eating enough throughout the day, then we may end up overdoing it at some meals.

And then some people will think, “I'm an emotional eater,” when really they’re not an emotional eater.

They're just hungry.

And we eat differently when we are overly hungry.

So that could be something that we start with.

I know Elise Resch, the other co-author of Intuitive Eating, likes to start with satisfaction because that is the hub of intuitive eating.

So sometimes we could start there.

For example, let’s say somebody's eating their lunch at their desk and their desk is cluttered and people are calling them on the phone in the middle and interrupting them, and then they're getting emails that are popping up.

And they’re really not having an enjoyable lunch experience.

We might just say, “Hey, is there somewhere you can go sit outside away from your desk and have 10 minutes quietly and peacefully to eat your lunch?”

And that could make a difference in just the way that they’re able to be satisfied from that meal.

So we could really start anywhere.

We just don’t start with gentle nutrition in most cases—although I will certainly give clients some framework around what would go into a meal so that they can feel satisfied with regards to all the food groups and whatnot.

Does that make sense?

00:12:42: Shireen

It does.

And I'm almost also tempted to talk about maybe if there's a flip side to this.

So we've been talking about the pros of intuitive eating and diabetes management.

Are there any cons?

Are there things that we need to be mindful of or aware of as we explore intuitive eating in diabetes?

00:13:00: Janice Dada

So something that we should be aware of is potentially medications that somebody might be taking that impact their ability to feel hunger.

That could be somebody who’s taking medication for ADHD, for example. Some of those medications do cause periods of time throughout the day where hunger is blunted.

Also, some of the diabetes medications impact somebody’s sensation of hunger.

So I might work with somebody to understand their hunger first.

But if hunger doesn’t come in the time frame—say, if three to five hours have passed between a meal—then we’ve got to use the clock.

So really helping them to understand that they need to fuel their body, not just rely on their hunger signals.

Another situation could be somebody recovering from an eating disorder who may also have blunted hunger signals.

So if hunger signals are essentially “offline,” then we need some framework or structure around creating that pattern of eating.

00:14:03: Shireen

Can intuitive eating also exist within dietary restrictions like vegetarianism, veganism, or any other kind of restrictions?

00:14:17: Janice Dada

Yeah, absolutely.

That is actually why I wrote Intuitive Eating for Diabetes—because I would get people asking all the time, “Can I eat intuitively if I have this going on?”

And I actually had a patient—who I discuss in the book—who I worked with on intuitive eating first. Then he was diagnosed with diabetes, and he came back to me and said, “What do I do now? I’m being given all this information that’s different from what we had worked so hard on.”

So absolutely, we can use intuitive eating with dietary restrictions.

With a food allergy or a particular cultural way of eating, we essentially just change the foods we consume to match what that particular need is.

For vegetarianism, of course, we would swap out protein sources to match a vegetarian diet.

But also, this is where gentle nutrition comes in—being cognizant of what might be missing in terms of vitamins or micronutrients when avoiding a particular food.

For example, my son has a dairy allergy.

So I know that I’ve got to pay extra attention to calcium, magnesium, and vitamin D for him.

So we just add that in where we need it.

But then, of course, he needs to avoid dairy because he is allergic to it.

So we certainly can adapt intuitive eating to accommodate any medical condition.

00:15:37: Shireen

As you're mentioning intuitive eating, I feel like it's such a mind-body connection.

You really have to be attuned to those cues.

Do you find that patients come back to you and still talk about struggling with cravings and temptations for salty snacks or processed, sugary foods?

Is it possible to have those types of temptations?

And then again, where do you go with intuitive eating if you are craving those types of foods?

00:16:02: Janice Dada

So there are no off-limit foods.

I think sometimes intuitive eating gets interpreted incorrectly.

Some people think it’s the “eat whatever you want without regard” philosophy around eating, which is not true.

Because then that wouldn’t be intuitive, right?

A lot of times, we have to really work on making peace with food.

That’s actually one of the intuitive eating principles—to help people feel that they are in control and not being controlled by food.

We aim to habituate to food.

Habituating meaning it becomes no big deal.

For example, I give an example in my book about a client who felt like every time he ordered Chinese food, he would just go nuts with it.

And this was the way he described it to me.

He felt like he couldn’t trust himself around it.

So he’d try to avoid, avoid, avoid—until he ordered it again.

And then it was sort of this cycle.

So what we did was aim to make peace with Chinese food by building in some structure and strategies around it.

We made a plan to order Chinese food regularly but with a different mindset.

We decided:

He would put it on a plate.

He would give himself full permission to go back for more.

But before he did, he would check in with his body to see how he was feeling.

He would remind himself that he could eat this tomorrow, the next day, and anytime he wanted.

This way, the food wasn’t going away, and he didn’t feel that urgency to eat it all in one sitting.

A lot of times, that scarcity mentality makes people feel like, “I have to have it now!”

And feeling like a food is “healthy” or “unhealthy” can also create that urge.

So really allowing somebody to recognize that all foods fit—and that they can eat them when they feel like eating them—helps.

But we also ask:

Are you really eating that food because you want it?

Or do you feel like you have to eat it now because you won’t get it later?

That “last supper” mentality is something we work through.

Does that make sense?

00:18:26: Shireen

It does.

What you're saying resonates so strongly because there is that little voice that says, “If I don’t eat it now, I won’t have it later.”

It’s like this denial that’s coming up, so I might as well try to make up for it.

But even as much as I eat it in one sitting, it’s still not going to stop the craving later.

So, what am I really accomplishing by overindulging in it now?

I really like that approach around the scarcity mentality and trying to get ahead of it.

By opening up the possibility that, “I can have it whenever I want,” suddenly, I don’t want it as much.

I love that approach.

00:19:04: Shireen

Where do you see the field of intuitive eating and non-diet approaches really heading?

We hear a lot about this today, but help us see down the road a few years out.

Where does this go next, particularly in the context of chronic condition management?

00:19:21: Janice Dada

Well, as I mentioned earlier, there are over 200 research studies highlighting the benefits of using an intuitive eating approach.

And a handful of those studies have specifically looked at intuitive eating for diabetes care.

So I’m optimistic that the body of research will continue to grow—as it has been.

It’s been steadily increasing since the first Intuitive Eating book was written.

I’m also hopeful that more practitioners will get on board.

It’s encouraging to see more medical doctors—including endocrinologists and primary care physicians—taking a weight-inclusive approach.

Because they are usually the first line of care for someone with diabetes concerns.

As I mentioned, I was motivated to write Intuitive Eating for Diabetes because there was no other book addressing this topic.

If you look up books on diabetes, you’ll find a ton of books that tell you different ways to restrict your diet.

And we know—from both research and personal experience—that restriction doesn’t work.

00:20:36: Janice Dada

A friend, a dietitian colleague, actually just forwarded me a study today.

In the study, they limited carbohydrates to 9% of the total intake.

For those of you listening, we typically need at least 45 to 60% of our intake to come from carbohydrates.

So even if a study shows that blood sugar might be “better” with this highly restrictive approach, the bigger question is:

How long can somebody actually sustain that?

And when they can’t sustain it, what happens next?

I’ve seen in my own practice that when people try an extreme approach and then can’t maintain it, they feel shamed and blamed.

They think:

“I wasn’t able to do this incredibly difficult plan, so I must be the problem.”

And then they might throw in the towel completely.

That’s why I hope future research focuses on long-term results.

We need to ask:

Who dropped out of this study?

What happened to them five or ten years later?

Were they able to maintain that restrictive diet?

If they didn’t, what were the effects?

The issue with a lot of current research is that studies are often short-term.

So when some healthcare practitioners say, “But the research shows…”—what they’re actually referring to is data from short-term studies.

We don’t always know what happened to those patients in the long run.

00:22:02: Shireen

That’s super helpful, Janice.

We are wrapping up and toward the end of the episode.

At this point, I’d love for our listeners to know how they can connect with you and learn more about your work.

You mentioned your website earlier.

Tell us how we can connect.

00:22:15: Janice Dada

Yeah, absolutely.

My website is SoCalNW.com—that’s my private practice website.

I have a tab that links to the pre-order for my book, as well as a place where interested people can subscribe.

You can also follow me on Instagram, where my handle is @socalrd.

00:22:38: Shireen

Love it.

Thank you so much, Janice, for your time.

It was such a pleasure talking to you and learning more about this intersection of intuitive eating, diabetes, and chronic care management in general.

To our listeners, thank you for tuning in to another episode of the Yumlish Podcast.

Thank you so much for spending time with us.

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With that—Janice, thank you again for your time.

Connect with Janice!

Website URL: https://www.socalnw.com/

Instagram URL: https://www.instagram.com/socalrd/

Facebook URL: https://www.facebook.com/socalnw/

Twitter URL: @SoCalRD

LinkedIn URL: http://linkedin.com/in/janicedada

Other promos: Intuitive Eating for Diabetes: The No Shame, No Blame, Non-Diet Approach to Managing Your Blood Sugar is available for now!