Persistence of the Old Starvation Diet

When I was first diagnosed with type 1 diabetes in 1966, there was considerable persistence of outmoded ideas more appropriate to the pre-insulin era, even though it had been over even then for more than 40 years. For example, I was put on a starvation diet more appropriate for treating patients before insulin became available, when the goal was just to strike a balance between death from ketoacidosis and death from starvation. As a result, I was skeletally thin with a body mass index of only 18 by the time I was 18, and photos taken of me look positively frightening. I was required to weigh all my food and to observe the prescribed balance of carbohydrates, proteins, and fats, so I could not eat any more than that unless I wanted to ‘cheat’ on my diet, which was unthinkable. I used to plead with my endocrinologist that I was not being allowed enough food, but he would just toss his pen down in disgust and say, “But then I would just be artificially increasing your insulin dose,” as though this was something poisonous.

During the whole period of living under that regimen, before I went off to university and found I simply could no longer live with that diet, I never dreamed about anything other than food, which was also a constant, nagging desire, all day every day. The degree of starvation I was required to observe was so obviously ridiculous to everyone who saw me that I suspect my endocrinologist may have been trying to do me a favor, since experiments in the 1950s had shown that if mice early in life were maintained on a starvation diet, they lived 20% longer than normal, so perhaps he was trying to counter the life-shortening effects of diabetes without telling me.

I can’t imagine sustaining the diet you describe. It impresses me as only accomplished with heroic amounts of will-power. To me, that is a recipe for failure. Maybe it could work for a child where all of their food is fastidiously controlled by a dedicated adult. It not only sounds unsustainable, but miserable, too. I suspect that this regimen may also produce pyschological and emotional damage leading to eating disorders.

As we grow older and experience new ways of doing things, we must make peace with our past and let go of things enforced by well-meaning adults in our childhood. Some of us need help to make that emotional separation and move on. I would not hesitate to consult with this type of support.

I use 24-hour fasts about once per week to help maintain my insulin sensitivity. I do not feel deprived when I do this. Maybe that’s due to the fact that I take on this regimen voluntarily and enjoy the fast’s benefits.

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You’ve spoken in the past of there being an element of cruelty in the treatment of people with T1. This certainly gives me greater understanding of why you’re so attuned to that.

Couple of things jump out for me. One is the way attitudes still lag behind standards, sometimes a generation or more behind. Things like assuming a T2 diagnosis because a patient is “too old” for T1, the undervaluing or negation of quality of life as a factor in designing a treatment regimen. It really sounds like your Dr was adhering incomprehensibly to a completely out of date treatment, on behalf of some principle known only to himself.

The other thing, maybe a subset of the first, is the profound misgivings around releasing control over this powerful substance we have to dose ourselves with to us. Ideally they’re supposed to be helping us manage it, not dictating to us, but there is an aspect of it that cuts against the medical grain. Letting you have any say over your treatment was apparently out of the question. And that “artificially” really sticks out. Artificial compared to what? I think there’s a lot less of that rigid, authoritarian concept of the role of physician now, thank goodness, but there are still bits of it around.

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