Health professionals always want to know what the best diet is for type 2 diabetes, but dietitian Lucy Carey says they are asking the wrong question.

No matter who I talk to — whether it’s a doctor, nurse or health coach — there seems to be one burning question they all ask… What’s the optimal diet for managing type 2 diabetes?

But here’s the thing: they’re asking the wrong question.

I get it. As health professionals, we like to fix things. We want to solve the mystery with numbers and formulas and hard facts. We think if we just keep searching, eventually we’ll uncover the magic formula that will solve everything.

And that dogged determination can serve us well in some respects. But when it comes to our nutrition advice for type 2 diabetes patients, it’s missing the mark.

Dietary changes can put type 2 diabetes into remission, it’s true. But it’s not because the diet itself is special. It doesn’t matter if it’s keto or vegan or meal replacement shakes – if your patient loses enough weight, it’s the fat loss that puts type 2 diabetes into remission. You could lock simply starve them and it would do the same trick (and many of these diets probably feel like that!). The diet itself isn’t special.

The DIRECT trial, the Look AHEAD study, the Virta Health Study – they all showed that weight loss can restore insulin production and reverse type 2 diabetes.

But what happens when our patients can no longer stick to that kind of highly restrictive diet? What happens when they’re stick of not being able to go out to eat with their friends, or share food at church, or eat the same food as their children? The diets work… Until they don’t.

For the DIRECT trial, participants had meal replacement shakes for 12-20 weeks, followed by a slow reintroduction of food. I can only imagine how hellish it would be to live off 850 calories for months on end. Never eating a meal with your family. Never partaking in the shared food at community events. Never going out to grab a bite and a coffee with your friends.

At the 1-year mark, 46% of participants had put their type 2 diabetes into remission. Pretty impressive stuff.

But at 2-years, participants were gaining the weight back. The number in remission dropped to 36%. Researchers then put together a further 3 years of extra support to try to keep the weight off.

But at 5-years, the numbers had dropped further, to 10%. That’s the latest data we have but I imagine it will continue to drop.

While it’s awesome to have been in remission for any period of time, I can’t help but wonder about the participants who gain the weight back again.

Because my clients who have lost weight on restrictive diets all tell me the same thing – not only could they not sustain the diet in the long-run, they also often ended up binge eating because the feeling of deprivation saw them become more obsessed with food than ever before. They put the weight back on plus extra. And their mental health suffered greatly with the guilt and shame that came with feeling like they had failed.

So it was on to the next diet, and the cycle repeated.

My worry is that we, as health professionals, may be unintentionally perpetuating this starve-binge cycle with our talk of the perfect diabetes diet.

How many of our patients who lose significant amounts of weight put the weight back on plus extra? How many do we make to feel like it’s all their fault when the diabetes comes back? How many do we drive into desperate attempts to lose weight again?

I saw an older man a while back. He had lost a lot of weight and his HbA1c (a measure of blood sugar levels over the last 3 months) had come down considerably. Every health professional he had seen was over the moon about his weight loss and he was praised left, right and centre.

Then I asked him how he had lost the weight.

Turns out, he was living off one shake a day, turning down all invitations to go out with friends and family, and he was getting more and more scared to eat real food by the day. In fact, his behaviours were becoming increasingly anorexic-like.

Through our talk of the perfect diabetes diet and our praise of weight loss through any means, are we making worse the very problems we are trying to fix? I fear so.

Perhaps, instead of searching for the optimal diet for diabetes, we should be asking what the most sustainable diet is for our individual patient.

Instead of focusing on everything they shouldn’t eat, we could focus on everything we’d like them to include in their diet.

Instead of understanding diabetes solely in terms of diet and exercise, we could think about health in more holistic terms, getting sleep routines and stress management in place.

And then, we might turn our attention to their relationship with food and their body.

So many of my patients with diabetes feel intense guilt and shame around their diagnosis. Some may be using food to cope emotionally. And many are engaging in very restrictive diets, only to ping back into binge eating and weight gain and spiralling thoughts of their worthlessness when they can’t sustain the diet.

It feels counterintuitive to many of the doctors, nurses and health coaches I speak with, but in my experience, there’s only one way my overweight patients lose weight and keep it off forever. And that’s ditching the focus on weight completely and healing their relationship with food instead.