Dear Laura… How do we convince the grands they don’t need to cut out cake to manage ‘pre-diabetes’?

Welcome to ‘Dear Laura’ - a monthly column where I fashion myself as an agony aunt and answer the questions that readers submit. If you’d like to submit a question for me to answer next month - then you can leave it as a comment below or submit it here.

I’m happy to answer Qs about anti-diet nutrition, developing a more peaceful relationship to food and weight-inclusive health, annoying diet trends and news stories, body image challenges, and, of course, challenges with feeding your kiddos. Please give as much detail as you’re comfortable with and let me know if you’d like me to include your name or keep it anon.

Please remember that these answers are for educational purposes only and are not a substitute for medical or nutritional advice; please speak to your GP or a qualified nutrition professional if you need further support. (I have a limited number of family nutrition spots available for September - if you’d like to work with me then you can email hello@laurathomasphd.co.uk to book a preliminary call to see how I might be able to help you.)

I recently got two questions sent in via the Dear Laura Google form. They came in back-to-back and, at first, I thought they might have even been the same person. But no, there is just something in the water with the grandparents. In both cases, The Grands have been told they’re prediabetic. In both cases they think the answer lies in cutting out carbs and/or Michael Mosley (I can’t name one problem where the answer would ever be Michael Mosley). 

So let’s start with the questions:

Q1. My 75 year old parents have started doing 5:2 fasting because they’ve been told they are pre-diabetic and they watched the Michael Mosley BBC show on how to live longer. My sister and I are worried they are doing something really unhealthy for people their age, especially as our dad is recovering from prostate cancer, and also just making themselves miserable. They are already active and eat a healthy balanced diet but they’ve really bought into the blood sugar/glucose concept. Our mother used to work as a researcher and she wants us to ‘prove’ that our view is correct and not just ‘something we’ve read on the internet’.

Q2. My question is actually related to my Mum rather than my kid: at a recent health check she had a high blood sugar reading that suggested that she was 'pre-diabetic'. Three months later they checked it again and she was all fine, but in the meantime she had panicked and basically cut all sugar out of her diet. As she is basically an almond mum and didn't eat very much sugar anyway, this has involved her cutting out all dried fruit, fruit juice, honey, jam, any rare desserts/cakes/sweet breads, and reducing her fresh fruit intake to one or two pieces a day. She otherwise eats a very much 'wholefoods diet'. The result of this is that she has lost weight - and she was already thin. She has said that she doesn't want to lose weight and she wants to gain it again but she's so scared of being 'prediabetic' (I have pointed out that there are all sorts of problems with this category, and also that her results were probably an aberration) that she is now avoiding all sorts of foods, and I don't think her intake of 'healthy fats' will ever be sufficient to make up for the fast energy that she's now avoiding. It also worries me because my Dad - who has Alzheimer's - eats the same as her and he's also already pretty thin. How do I persuade her that eating tasty sweet foods is not going to make her diabetic, and in fact might be quite a 'healthy' option for her and my Dad at this point in time?

WOOF. OK.

So let’s talk about prediabetes, carbs, and diet culture.

To help me out, I asked Rebecca Lawton, a Diabetes Specialist Dietitian at Sussex Community NHS Foundation Trust. Not only does she practice through a weight-inclusive lens, she’s a long-time CIHAS subscriber. She gets it. Welcome Rebecca!

And so that we’re all on the same page, I thought it might be helpful to do a little glucose metabolism 101.

Glucose is a simple carbohydrate - a type of sugar - that virtually every cell in our body uses. It’s the primary fuel source most cells use to make energy, especially our brains and central nervous system. And if we’re sprinting or lifting something heavy, our muscles will burn glucose to help power them. 

We get glucose from the digestion of carbohydrates (bread, pasta, potatoes, rice, fruits, veg beans, cakes etc…) and protein (nuts, beans, meat, eggs etc…). Any glucose that our body doesn’t use straight away gets turned into a type of fat called triglycerides and stored in fat cells; triglycerides get turned back into glucose if our blood sugar levels start to fall too low (like overnight when we’re not eating, or hiking if that’s a thing you do). 

Glucose travels around our body in our blood, getting delivered to different cells and tissues that need it in different amounts. We can imagine the cells in our body being like houses in a town or city. Glucose is like people walking down the street. In the same way that we don’t want any old person walking into our house, we don’t want glucose getting into the cell if it's not meant to be there (for example if it already has enough). And as we have keys to let people we trust into our house, glucose needs a key to let it into the cells. The ‘key’ is actually a hormone called insulin which is made by the pancreas.

When we eat food with protein and carbohydrates our blood glucose – or blood sugar – level rises. This is normal and expected. Despite what the Glucose Goddess says, it’s important we have a rise in glucose levels after we eat to signal to the pancreas to make enough insulin to let glucose into the cells.