The first part of this episode is available to all listeners. To hear the whole thing, become a paid subscriber here.
Registered dietitians and diabetes educators Jessica Jones and Wendy Lopez join us to discuss why weight loss isn’t necessary for managing blood sugar, why the popular wellness-culture notion of diabetes “remission” or “reversal” can be harmful, how the popularity of Ozempic and other GLP-1 drugs as diet drugs is affecting people who use them for diabetes, the continuous-glucose-monitor trend for monitoring blood sugar in people without diabetes, Jess’s experience navigating prediabetes and other health conditions, and more.
Wendy Lopez and Jessica Jones are nationally recognized Registered Dietitian Nutritionists and Certified Diabetes Care and Education Specialists. With over a decade of clinical experience, they have helped thousands of individuals improve their relationship with food and achieve better health outcomes. Wendy and Jessica are the co-founders of Diabetes Digital, an innovative telehealth platform designed to empower individuals to manage and prevent diabetes through 1:1 virtual nutrition counseling. Through their previous work with Food Heaven, Wendy and Jess have made a lasting impact on nutrition and wellness, promoting healthier relationships with food and inclusive health education. The Food Heaven Podcast, boasting 5 million downloads, explores evidence-based nutrition, mental health, HAES, intuitive eating, and body respect.
Resources and References
Christy’s second book, The Wellness Trap: Break Free from Diet Culture, Disinformation, and Dubious Diagnoses and Find Your True Well-Being
Subscribe on Substack for extended interviews and more
My Food Psych episode on sugar, examining the (surprising) science on sugar consumption and diabetes
Christy’s online course, Intuitive Eating Fundamentals
Transcript
Disclaimer: The below transcription is primarily rendered by AI, so errors may have occurred. The original audio file is available above.
Christy Harrison: Welcome to Rethinking Wellness, a podcast that offers critical thinking and compassionate skepticism about wellness and diet culture, and reflections on how to find true well-being. I'm your host, Christy Harrison, and I'm a registered dietitian, certified intuitive eating counselor, journalist, and author of three books, including Anti-Diet, which was published in 2019, The Emotional Eating, Chronic Dieting, Binge Eating & Body Image Workbook, which came out on February 20th, and The Wellness Trap, which was published in 2023 and is the inspiration for this podcast. You can learn more and get them all at christyharrison.com/books.
Hey there. Welcome to this episode of Rethinking Wellness. I'm Christy and my guests today are dietitians and diabetes educators Jessica Jones and Wendy Lopez. They join me to discuss why people with diabetes don't need to focus on weight loss contrary to conventional wisdom. Why the notion of diabetes remission or reversal that's popular in wellness culture can be so detrimental. How the widespread use of Ozempic and other GLP-1 drugs as diet drugs is affecting people who use them for diabetes the trend of non-diabetics using continuous glucose monitors to obsess over their blood sugar, Jess's experience navigating pre-diabetes and other health conditions, and some of the surprising things she found out by using a continuous glucose monitor and more.
Paid subscribers get to hear the full episode, which includes a whole lot more of this great conversation with Wendy and Jess. To upgrade to paid, go to rethinkingwellness.substack.com. If you do, not only will you get to hear extended interviews like this one, but you'll also get subscriber only Q and A's and essays, full access to our archives, commenting privileges, and subscriber threads where you can connect with other listeners, and lots more. Plus, you'll get my undying gratitude for helping support the show and helping keep this an ad and sponsor free space. Just go to rethinkingwellness.substack.com to sign up or click the link in the show notes. And thanks so much to everyone who's already supporting the show. It really means the world.
I also want to make sure you know about my second book, which is called the Wellness Trap. You've heard me talk about it a lot here before. It was the inspiration for this podcast, and I launched it to continue the fascinating conversations I was having in my reporting for the book. So if you like the interviews here, I think you'll love the book. It explores the connections between wellness culture and diet culture, how wellness became so intertwined with misinformation and scams and conspiracy theories, why alternative, integrative, and functional medicine can lead to disordered eating and other harms, and most importantly, how we can both protect ourselves as individuals and reimagine well being as a society. If any of that sounds interesting, you can check out christyharrison.com/thewellnesstrap to learn more and buy the book or ask for it at your favorite local bookstore. With that, here is my conversation with Wendy Lopez and Jessica Jones. Welcome to the show. I'm so excited to talk with you.
Jessica Jones: Thank you for having us. We're so excited to be here.
Christy Harrison: So I'd love to start off by having you tell us a bit about yourselves and your own histories with diet and wellness culture.
Jessica Jones: This is Jess speaking now. I became a dietitian a while ago. I graduated from my program in 2012, and at that time, I was definitely more involved with diet culture. Wellness culture. I remember, I think me, Wendy, and one of our other dietitian friends, we all were like friends on MyFitnessPal and counting calories every day. And we had these fitness goals and calorie goals. It was, in hindsight, not the healthiest relationship with food. Now for most people would not recommend counting calories in that way.
And also, it was so problematic, too, because at the time, I don't know what it is now, but MyFitnessPal would congratulate you for being under your calorie recommendation for the day. And then everybody could see, or all your friends on MyFitnessPal could kind of see if you were under your calorie goal. So it was just like very toxic, very problematic. And I switched my outlook on nutrition, honestly, after taking Evelyn Tribole's course, her intuitive eating course for health professionals, and I think maybe I heard about it through this podcast. I think I remember hearing you, Christy, say that you felt you couldn't recommend weight loss for your clients anymore because you thought it was unethical. And then that prompted me to take Evelyn's course and from there, just a little bit more about, like, our professional background.
And I was like, oh, wow, that's a really strong statement. Why are you saying this? And that kind of prompted me to just do a little bit more of my own research, and it took time for me to get to a healthier place with food, I think, myself, and also being able to hold space for my clients and have those hard conversations. But, yeah, I definitely started here, and that prompted me to take Evelyn's course and from there, just a little bit about our professional background, Wendy and myself have worked together for the past 13 plus years as dietitians. We have a podcast. Our original brand was called Food Heaven, which includes the Food Heaven podcast.
And we do a lot of different multimedia work within nutrition, and we're focused on making nutrition inclusive and accessible. And some of our core pillars are things like intuitive eating, health at every size, weight inclusivity, cultural humility. And so we've kind of been doing that work for a while and recently pivoted to a new company called Diabetes Digital, which is all about one on one virtual nutrition counseling for people with diabetes. So that's my answer. A long answer. Wendy, you want to jump in with a little more about yourself?
Wendy Lopez: Yeah. So, also a dietician and diabetes educator. And like Jess was mentioning, you know, initially, I was also practicing from a weight normative approach, just cause, you know, that's how we were trained. And it just. I mean, I thought that that's how you were supposed to do things. And I did that for a little bit. It didn't go on for too long because I realized that the approach wasn't working, especially with the communities that I was working with. People were not feeling satisfied by the positive changes that they were making on the nutrition side because they didn't see the number move on the scale or it wasn't moving the way that they wanted it to.
And, you know, I think there was just, like, a lot of frustration on both ends because I'm like, okay, well, I'm kind of just regurgitating what I was told to say, and, you know, they're doing what I'm recommending, and there are no changes really happening with their weight for the most part. And so I just started kind of questioning things in conversations with Jess and, you know, just learning more about health at every size and intuitive eating.
I thought it was a really refreshing approach. You know, I think at that point, I was practicing for maybe a year or two years like you had touched on. It didn't feel ethical to keep pushing weight loss when especially for, like, the communities that I was working with, there was very heavy oppression, poverty, homelessness, food insecurity. And so it was just, like, so much going on with the communities that I was working with that it didn't feel right to, you know, just kind of keep pushing this weight loss approach because it was just so complex. And so I started incorporating some of this into my work, just like, being more weight inclusive, adjusting the recommendations along the way to make sure that it was appropriate for the people that I was working with.
And I saw positive results from that. I saw results that were more long lasting on the nutrition side. And it's just been a journey ever since, just always learning new things and kind of diving deeper into all of the nuance that comes with food and nutrition and, you know, developing like, a healthier relationship with yourself and your body.
Christy Harrison: It is such a journey, right. For all of us, I think, especially who are trained as dietitians in the weight normative model, it's such a big shift to move into a different approach and takes a lot of time to undo as well. So, yeah, so you recently launched, you mentioned this new platform, Diabetes Digital. And I want to get into all of that and talk about kind of the nuances of diabetes and its intersections with wellness and diet culture. But before we do, I want to hear about kind of the why behind it, because, as you mentioned, this was a pivot away from your first brand, Food Heaven. What made you decide to shift in that new direction?
Jessica Jones: Well, we had been doing Food Heaven, like I said, for 13 years, which is a really long time to do anything. And I think especially during the pandemic, we just got completely burnt out with so many things, with social media, with the Internet, with nutrition. And so I think part of the reason we wanted to create a new brand was because we wanted to get back to the roots of why we became dietitians in the first place. And it felt like while we love doing Food Heaven and there's so many people in our community who have said that it's been so helpful on their journey, and it helped them have a healthier relationship with food, we love doing that. And also after doing the same thing for 13 years, we were ready for a professional change, and we were ready to make a change and so serious about it that we were willing to just kind of completely walk away, you know, from doing Food Heaven or even working with each other, if we couldn't find something that made sense for us that we would be excited about.
And so that was kind of the, the reason why we wanted to change and then why we specifically decided to pivot to this new company called Diabetes Digital was because, as I mentioned, we felt like we wanted to do kind of more hands on nutrition again. And, you know, podcast is amazing, and we love that. But being able to, there's nothing that compares to kind of that one on one work with patients and creating, like, a platform where we felt it would be a safe space for patients who are dealing with diabetes or pre-diabetes, and they want to have a dietitian who is weight inclusive, who's culturally humble, we take insurance and so we felt like it was just a no brainer and something we were both really excited about.
Also, we are both diabetes educators, and we originally kind of got into the nutrition profession because we both have been touched by diabetes, whether it's like, personally, I shared that I had pre-diabetes during the pandemic, which is interesting, or even family members. Both of Wendy and myself have a family history of diabetes. And so that was something when we first became dietitians that we were really passionate about helping people with. So it kind of is like a full circle moment for us and opportunity, really, because there wasn't anything else out there like it.
Wendy Lopez: A lot of the resources that are out there for diabetes care are weight loss focused. And, you know, that was one of the biggest motivations for us because it's so hard, just in general, to find a provider who's weight inclusive. But then in the diabetes space, you know, weight loss is just front and center with the conversation. And so we were like, okay, well, this is, you know, just like a very unique angle that really reflects our values as professionals.
We also wanted to make it accessible in different ways. So Jess mentioned that we take insurance, but also, you know, about half of our dietitians are Spanish speaking, and that was really important to us because black and brown communities are disproportionately impacted by diabetes in the US. And there are not many. I mean, there's not many resources in general that are, you know, culturally competent, but especially when it comes to Spanish speakers. And so that was also really important for us as well.
Christy Harrison: Yeah, I was really excited to have you on because you're doing such great work. And also, there's so much misinformation out there about diabetes in wellness and diet culture, and I think you're both very well positioned to help dispel it. One of the things I see coming up a lot in the integrative and functional medicine spaces is this notion of, quote, unquote, getting to the root cause of diabetes, which can feel so blaming and shaming to people with it. And I'd love to hear your thoughts on that and how your approach is different, how you don't put the blame on people or on individuals necessarily.
Wendy Lopez: Yeah, that's a great point, because when I hear root cause and, you know, in the integrative space and when I'm constantly hearing that, to me, it translates, like, what is going on with me that has to be addressed to make this condition better. And especially within the context of diabetes, it's such a complex condition, it can easily lead to someone blaming themselves, someone feeling shame about their condition. And I think just like integrative medicine aside, most people that have been diagnosed with type two diabetes, I have seen that they just, they just always come with some level of shame. Like, there's something that I did. I ate too much sugar. I drink a lot of soda. This is why it happened to me. And not really taking into account the interplay of genetics, of socioeconomic factors, of all the systemic issues that can impact someone's risk for developing diabetes.
And so I'm not really a fan of that approach. Like, oh, let's address the root cause, because really, I mean, what is the root cause? Like, how does someone even know what that means? And I think it's much more effective to look at the bigger picture. And, you know, we've seen that when people feel guilt and shame around their health condition, oftentimes it leads to restrictive eating to try to correct in their mind. And just like, it has a negative impact overall with mental health, for people with diabetes, that can negatively impact blood sugars as well. And so, you know, when creating this platform, we want to be really intentional about having people feel supported where there is no shame around their condition, regardless of whatever eating habits they have.
You know, just acknowledging that diabetes is multifaceted, it's influenced by so many different factors beyond our control and what we're eating. And weight is not a good determinant of health or risk for developing diabetes. Again, there's just so many different factors. Food insecurity, mental health, medical history, medication. There's just so many things that influence risk. Also, what I've seen in the integrative space is you should eat this food, or apple cider vinegar is a big one. You should drink apple cider vinegar. It's going to help with your blood sugar management. And we stay away from that as well. Like recommending, oh, this is the type of food that you should eat that's going to help reverse your diabetes or cure your diabetes, because that's not true. We do like to, as dietitians refer to the science and the research, and we think a personalized approach is most effective.
There's so many different ways to take care of yourself with diabetes, and what works for someone might not work for you. So really just figuring out what's going on with a particular person's situation, what their preferences are, what they have access to, and then developing an intervention that reflects that versus, you know, this is what someone is doing online, or this is, you know, the one way that my provider told me that I should go about things.
Jessica Jones: The other thing that I want to add is this idea that it's not someone's fault, kind of like Wendy said, and I remember when we first launched, which was just a couple of months ago, but one of our first reviews that came through was a woman who said she was really appreciative, that the dietitian made sure she knew that it absolutely wasn't her fault. And I think when you get into, like, that root cause language, like Wendy said, it can kind of feel like you did something wrong. And also, you have the power to fix every last thing about your health. And a lot of our health is genetic. It's out of our control. And so I. Yeah, just want to agree that I feel like that type of language can be really problematic and not helpful for people.
Christy Harrison: I'm curious, your take on this. So there is this notion in diet and wellness culture, and just culture generally, that people, quote unquote, give themselves diabetes by eating too much sugar. But I've seen some evidence, or really discussion of evidence that actually could be sort of a reverse causation thing, where when people are getting diabetes, when their blood insulin resistance is coming on, then it can cause greater cravings for sugar and make them eat more sugar. But it's not that the sugar consumption is actually causing the diabetes, it's really that the emergence of diabetes is causing increased sugar consumption. Do you have any take on that?
Wendy Lopez: I mean, just like, in general, you know, the idea of, "Oh, I ate too much sugar, and this is why I would have gotten diabetes." I mean, I just also use logic in this, because there's people who have no risk of developing diabetes and are eating so much sugar and never develop diabetes, and then you can just kind of use that as a real life example. But, yeah, I mean, I could see how that could happen, especially if someone has very high blood sugars and it's uncontrolled and they're losing weight at a very rapid pace, they're urinating a lot because their body is trying to get rid of the excess sugar, but somehow they're always feeling hungry. I could see how maybe they have those stronger cravings and there might be a connection there. But, yeah, I think it's definitely worth exploring.
Christy Harrison: And, yeah, that's not to say that that's the only reason people could be eating sugar or that there's any sort of blame or absolution of blame or something there, but just like that, that's one potential explanation for if there is any sort of link between sugar consumption and diabetes. It's not necessarily that sugar consumption causes diabetes at all.
And also, from what I've seen in the research, there's really no good link between sugar consumption and diabetes anyway, right. Across multiple studies, it seems like sugar consumption in and of itself doesn't have any sort of prediction over whether someone develops diabetes. There may be some link with sugar sweetened beverages, but again, we don't know the direction of the causation or what confounding factors are there, and income and socioeconomic status and all of that is a definite confounder. I think, in that research saying that.
Jessica Jones: Sugar causes diabetes, it's just an oversimplification of a very complex disease. And I think that there's so many people trying to sell a hope and a dream. So saying that, you know, that it's as simple as, like, cutting out sugar, I think for a lot of people it's like, oh, yeah, logically that makes sense, right? Because diabetes involves glucose, and when you eat carbohydrates or sugars, like, they're converted to glucose, and therefore, like, if I don't eat those foods, then that's going to cure my diabetes. But, but it, as Wendy has said, it's just more, more complex than that. And there's so many different factors, including inflammation, genetic factors. And so I think that we really have to look at things from an individualized approach and, and, yeah, and kind of zoom out a little bit and look at the bigger picture and not zoom in on, like, one nutrient or one ingredient, because that's not going to be helpful for most people.
Christy Harrison: Wellness culture also pushes this notion of diabetes reversal or remission, which you touched on a little bit earlier, Wendy. Like, you know, there's this notion that you can reverse diabetes or cure diabetes, and it's usually because you're doing a low carb diet or taking supplements or whatever, but I'd love to hear your take on what the evidence really says. Can diabetes actually be reversed, or is this, you know, just a bunch of baloney? And what are some of the unintended consequences of taking that approach?
Jessica Jones: Well, it's just a bunch of baloney, I'll say that. And the research shows that diabetes can't be quote unquote reversed. And it's actually funny. When I was in school to become diabetes educator, and I went to this training that was like a four day training, this is one of the questions that I asked because it was, you know, just top of mind. And I was also curious because the woman who was leading the training her name is Beverly Tomasian, she was talking about how with diabetes, we all have beta cells on our pancreas, and these beta cells are responsible for making insulin. But what happens is, when you have diabetes, there's destroyed destruction of those beta cells, and so they're not functioning optimally.
And I asked her, well, can you get that function back? Because, you know, what if you make these changes? And she was like, as of today, the research shows that once you have that destruction of the beta cells, you're not able to get that function back, but you can prevent further destruction of more beta cells with different, you know, modifications, whether that's lifestyle, nutrition, medication, things like that.
So because of that, diabetes can't technically be cured. However, you. You can get it to a place where your glucose is in, quote unquote, normal range or at target. And some people might get to that non-diabetes range for their glucose or their A1C, which is their average blood glucose over three months. Or they may get to a pre diabetes level where their glucose might still be slightly elevated. But maybe, you know, they'll still have that history of diabetes, but maybe their glucose is not representing, like, being in that diabetes category anymore. And so that's kind of what I tell people. And we actually just had a podcast episode about this because this question comes up all the time, and there are so many programs claiming to reverse diabetes. And it's just, at least the research that we have today says that it's just not possible. And this is kind of what the medical establishments also agree when it comes to diabetes.
Now, in terms of why this is very problematic, because so many people think that they can reverse diabetes, and the only thing, quote, only that they have to do is, like, cut out all carbohydrates and sugars. And I actually joined a few different groups on Facebook, kind of diabetes support groups, just to kind of see what the conversation was to be able to offer any insight as a dietitian. And when I tell you the amount of people who are just getting a diabetes diagnosis and cutting everything out, and they're, like, sharing what they're eating, and it's no carbs and no sugars, and I'm just like, "Oh, my God, you don't have to do this." But I feel so bad for them, too, because I think that this is what, this is what the culture tells them that they have to do. This is what the 80,000 other people in the group are kind of encouraging them to do.
And you can kind of see the trends where people get newly diagnosed, they cut everything out. And then you see them post later saying that they're having a hard time and they're just like "F it. I don't even want to do anything because this is just too much." So I think that's kind of the harm there is people thinking that's what they have to do and then that kind of ruining their quality of life. And then they're not able to make any sustainable changes because they have this idea in their head that they have to do an overhaul that for most people is not necessary, for everyone is not necessary, and also not possible to maintain long term.
Christy Harrison: And that diet cycling, cycling on and off of a low carb diet, and probably having binges as a result in a lot of cases or like rebound eating can't be great for blood sugar management either. Right?
Jessica Jones: Right. Yeah. And that's the problem, too. With like a lot of diabetes programs or, or even, you know, no shade to doctors. I'm sure there's a lot of doctors who listen to this podcast, but when they give people just this handout or they tell them to cut out foods, which is typically what we hear from our patients, that doctors just said, hey, you know, don't eat any carbs or cut your carbs out. Again, it's like an oversimplification of nutrition. And they're also typically not trained in the disordered eating component of things and like, how that might manifest in somebody who gets diabetes, which is another reason why we wanted to create our platform, because we, we do have a experience with that experience with eating disorders.
And like, there's a huge intersection between, you know, somebody getting diagnosed with diabetes and then, you know, feeling like they have to engage in these disordered eating behaviors and not. And nobody really catching it for what it is. Because again, a lot of times people are like, yeah, cut out all the carbs, like even your providers will tell you to, and then you're not actually healing your relationship with food while also eventually being able to help manage your blood sugars.
Wendy Lopez: And I'll also add that the terms reversible in remission, they're very controversial in the academic space. And so currently, as of now, with diabetes, what is agreed upon is that it's not reversible, but that pre-diabetes is when it comes to diabetes, it's referred to as being in remission if the levels are outside of the diabetes range. But, you know, these terms change. So it's really, you know, just want to clarify that we're citing what the standards are currently, but that can change with time.
But I think it makes a lot of sense why the people doing the research and, you know, people at the American Diabetes association would say that it's not reversible, because also, as we age, our body changes, our organs aren't working as efficiently. And so it becomes even harder as you get older. If you already have been shown to have some challenge metabolizing glucose, it becomes even harder as you get older. So it's just always something to look out for. Whatever term you decide to use, if you say that you reversed it or that it's in remission, it's just something that you always want to be mindful of. If you have had challenges in the past with regulating your glucose levels.
Christy Harrison: Want to put a pin in the idea of pre-diabetes, because there's definitely a lot of discussion around that term and sort of what it means and what people do with that information. But first, I want to talk about the weight loss stuff and that everybody who gets diabetes, I think, probably has experienced some pressure to lose weight. There's so much weight loss advice in the diabetes world. Doctors will give out handouts or just blanket prescriptions for weight loss when people get diabetes, or even when they're labeled with prediabetes, but you don't subscribe to that. And I'm curious, your take on the approach to weight and weight regulation and why we don't need to focus on weight loss with diabetes.
Jessica Jones: Yeah. And I've actually issued a public apology in the past because I used to subscribe to this idea that with diabetes, losing weight was going to help you prevent diabetes. And I was citing the diabetes prevention program, which was one of the biggest studies about diabetes prevention that's ever been done, that I think a lot of people cite when they're talking about diabetes and preventing diabetes. And so what happened, though, with that study? As we know, with most people who engage in intentional weight loss behaviors, majority of the folks gained that weight back ten years later. But at the same time, when they continued the behaviors of eating more vegetables and engaging in more physical activity, they were able to reduce their likelihood of developing diabetes.
And so the point there is that while that study did show that people kind of, I think it was within five years, like, had reduced their risk of developing diabetes, the thing that they kind of left out was that what made the difference was the behaviors more so than the weight. And I think oftentimes we kind of talk mostly about the weight, and we don't isolate for the behaviors. And I think one of the biggest misconceptions is that you have to lose weight in order to improve your blood sugars, and that's just not true. We also know that significant and intentional weight loss is really hard to maintain long term.
I mean, we've seen this as we've talked about with so many of our patients, people, you know, they may lose some weight initially, and then they end up, you know, majority of folks end up gaining that weight back. It can be very stressful. Also, extreme diets and rapid weight loss methods can be especially harmful for people with diabetes that can, you know, make your blood sugars less balanced. Right. If you're kind of doing these methods for trying to lose weight or you're eating no carbohydrates or you're binging later in the day, like that can be counterproductive for the long term management of your blood glucose levels.
And so what we kind of focus on is this idea that it is possible to achieve glucose balance regardless of your weight and regardless of whether or not you lose weight. And that is something that we have seen with our patients. That is something that the research also supports, that the behaviors are the most important thing.
And I also want to point out, because, like, there's all this talk about that you have to lose weight when it comes to diabetes, but there's so many people who are in thinner, smaller bodies who are also predisposed to diabetes, and it's like, nobody talks about that. So it's kind of like, what advice would you give somebody who is in a thinner body for managing their diabetes? And that's the advice that you should give everybody for managing their diabetes. And that advice is not going to be centered around weight. It's going to be centered around behaviors, increasing fiber, increasing physical activity. It might need some medications to help as well, reducing stress, all those things.
Christy Harrison: Yeah, I think that's so helpful. And for anyone who's been recommended, weight loss for diabetes will probably be a breath of fresh air revelation or something shocking to hear if they've never heard the notion that you don't actually have to lose weight for diabetes. I think it's pretty striking for a lot of people in this culture.
Jessica Jones: Yeah. And that's another thing, too. The only reason why we will collect weight from somebody is because insurance will give them better benefits for a certain BMI, which sucks, because that's so oversimplified and ridiculous, honestly. But we want to get people the best insurance benefits. And typically, like, you know, depending upon weight, people won't have a copay or things like that. But other than that, like, that is not something in our practice that we focus on whatsoever. And I think a lot of people, they have not had that experience, especially with diabetes. It's so much focused on weight loss, and all the diabetes programs tend to be focused on weight loss, too. So, yeah, that's another reason why we wanted to start Diabetes Digital was just for people who wanted to take an alternative path and still, you know, care about their health, but, like, don't want to get caught up in all that BS.
Christy Harrison: And it's still evidence based information. It's just not pushing weight loss, which is such a tough thing long term, and can have those unintended consequences as well. Related to the weight loss conversation, wanted to talk about and get your take on Ozempic and other GLP-1 drugs which were originally developed to treat diabetes.
But they've obviously become a huge weight loss fad. And there's been such a huge marketing push from their manufacturers who've been throwing money at doctors and sponsoring continuing education, and now getting influencers on board to help make these into blockbuster diet drugs, which is something that's finally being reported on. I was hearing rumblings about that for a couple of years. And so I'm curious, in your experience, how that whole machinery of hype around Ozempic and related drugs for weight loss is affecting people with diabetes.
Wendy Lopez: There's so much to say about Ozempic and GLP-1s when it comes to this weight loss and diabetes conversation. The biggest issue that I've seen in terms of how people with diabetes are impacted is that they might be doing really well on a medication like Ozempic because it is intended for people with type two diabetes. However, they can't get it at their local pharmacy because there's been this huge increase in demand. Like, you literally can't find Ozempic and, like, a local, you know, one of like, your mom and pop or like a local chain.
And I've had clients who have gone months without the medication, and their blood sugars are spiraling because they might not know how to set up a mail order pharmacy, or they can't have frequent visits to their primary provider cause, you know, for people who live in marginalized communities, unfortunately, they're going to be impacted the worst. You know, you can't just call up your doctor to troubleshoot because these clinics are underfunded they don't pick up the phone. Appointments are like three to six months out. There's no availability, there's a shortage of providers.
And that is a huge concern for someone who has seen a benefit from taking Ozempic. They're seeing that their a one c is coming down. They're taking really well to it, but then they have to completely change their medication regimen because they just, they're unable to get it. So that's been like the biggest concern that I have seen in the communities that I've been working with.
But also there's been motivation from people who have type two diabetes to start Ozempic because of the weight loss claims versus the positive impact that it could have on their blood sugar. And so, you know, they might be overlooking really unpleasant side effects, which is super common with Ozempic because they want to lose weight so strong. And then ultimately this can increase the risk for disordered eating, for weight cycling, because how long are you really going to be able to stay on this medication that's causing you diarrhea and vomiting and severe abdominal pain? These are the common side effects with Ozempic. So I think that's something else that I see.
Christy Harrison: And that has negative consequences on people's overall blood sugar control. Right? If they're going on it in the short term and having all these side effects and having to go off, then they're kind of all over the place, maybe not being as well managed as if they were on one medication consistently that was working.
Wendy Lopez: Exactly. Yeah. Because then they have to completely change their medication regimen, which you need some time to adjust to the medication regimen that you're on and kind of plan your meals around that it just kind of destabilizes everything. So that's something to consider. And for people who do have that motivation to, to go on Ozempic, they have diabetes and they want to lose weight. There's also, what I've seen, a lot of unrealistic expectation.
You know, they think that they're going to lose so much weight on Ozempic. If they're not losing weight, they think that something is wrong with them, they aren't eating, you know, the quote unquote right way. If they do happen to lose weight and it's significant, it's usually because, because they're experiencing severe food restriction because of the unpleasant side effects and because it affects your appetite, you're just not as hungry. And then that can lead to deficiencies. It can lead to hypoglycemia if you're on medications like insulin or glipizide, you have those big fluctuations that we were talking about.
So, yeah, there's a lot of things that could go left if you're not taking all of these different possible scenarios into account. And just with those, I mean, the research is still emerging, right. And it's still coming out and we're seeing, but they don't state that this is a drug that's going to lead to a significant weight reduction. And I think people go into it thinking like, oh, you know, some clients I've seen, they think they're like, you know, getting what would be comparable to, like, a bariatric surgery. They think that they're really going to be losing a lot of weight, and it's really not very significant in my clinical experience. And also just, you know, if you go on Ozempic's page, you'll see the research that they've done. And it's not anything that I think for someone, you know, who has, like, body dysmorphia or they're really struggling with, like, body image issues, I don't think it's going to really make a huge difference, you know, based on what the research said.
Christy Harrison: Yeah. And from my understanding with the research too, it's like a significant portion of people don't really lose any weight. And that's not sort of called out in the marketing or that's not in people's expectations when they go in.
Wendy Lopez: Right. I've seen that all the time. It's like the weight doesn't budge. And then again, it's like that line of thinking like, oh, it's that I'm not doing something right. And then they come, you know, they come to the dietitian trying to troubleshoot or hack and figure out, okay, what else can I do? And it's like they're already under eating because of the medication side effects, and they wanna further restrict to try to get the medication to quote unquote work. And that's a huge issue.
Christy Harrison: And they're thinking that it's not quote unquote working unless they're losing weight. Meanwhile, maybe it is actually working for their blood sugar management, but that's sort of being overlooked.
Wendy Lopez: Right. Yeah. Cause that's the primary intention of the medication. The weight loss might be side effect, if you will, but it's not really the primary purpose of the medication for some people, like you said, they don't lose any weight at all.
Christy Harrison: Another trend, I think, that is making its way out from the diabetes world into sort of the larger wellness culture universe, is continuous glucose monitors for people without diabetes. It's become hugely popular thanks to some wellness influencers and, like, biohackers especially. And I'm curious, in your perspective, what some of the issues are with monitoring blood sugar when you don't have diabetes. And also if there are any situations where it could potentially be helpful.
Jessica Jones: Okay, so I want to give a nuanced answer to this,
