Binge Eating and Type 2 Diabetes

There are a few of us who think “healthy eating is no big deal, it’s easy and it just comes naturally.” Many of us think that “eating healthy requires a lot of energy and discipline and it is basically impossible to achieve.” A study by The American Society for Nutrition surveyed 9,700 people and found that “99% overrated the healthfulness of their diet.”

Over 9% of the global population over-rate their diets as nutritious. According to The National Eating Disorders Association, “there are over 30 million Americans who will experience an eating disorder in their lifetime.” Binge Eating Disorder (BED) is more common in women with type 2 diabetes when compared to women without diabetes.

Also known as compulsive over- eating, binge eating remains underdiagnosed and under treated in women and men. “Up to 40% of patients with type 2 diabetes may meet BED criteria.” There are multiple eating disorders but binge eating, and type 2 diabetes are distinct, yet often related conditions.

What is binge eating?

A food binge is “when you eat past satisfaction to the point of discomfort. It is the uncontrollable consumption of large amounts of food in a brief time frame.” Binge eating can occur when you are not hungry or right after you have eaten an entire meal. It is a lack of control, both physical and mental, which results in severe overeating.

It occurs within a 2-hour window. It also includes how much is eaten in that exact time frame. Often, guilt, feeling physically sick and fully stuffed occurs after binge eating. There are instances where “binge eating is not a true eating disorder” but may involve problematic eating styles, attitudes and behaviors which can heavily affect your blood sugar control with diabetes.

It can also cause a significant decline in your overall health, contribute to the development of type 2 diabetes, and cause substantial weight gain. Depressive behaviors and symptoms are 2-3 times more common in diabetes which can often lead to binge eating.

Questions to ask yourself to evaluate if you are a potential binge eater:

Do you think about food constantly?
Do you eat in secret?
Do you hoard food?
Do you avoid questions about eating and your weight?
Do you lie about how much and how often you eat?
Do you eat even when you are not hungry?
Do you stash food in secret places inside and outside the kitchen?
Do you hide food in your car? In your desk? In your pockets? In your purse?
Do you feel guilty after eating?
Can you concentrate on other tasks besides food shopping, food preparation and eating?
Do you prefer high saturated fat and simple sugary foods?
Do you feel physically uncomfortable or stuffed after eating?
Do you eat your food super-fast?
Do you barely chew your food before swallowing?
Do you frequently begin new diets to start over and “eat clean” repeatedly?

Why is binge eating more common with type 2 diabetes?

Binge eating may have some components of genetics and environmental stress factors. It does vary from person to person. It affects women more than men. It recurs in certain families.

Studies have shown “that because diabetes focuses on taking diabetes medication, gaining weight, food portion size, food choices, dieting and food restrictions, diabetes treatment may increase the risk of developing a binge eating disorder.

Binge eating may even contribute to developing type 2 diabetes because it can decrease insulin sensitivity, increase insulin resistance and cause tremendous weight gain. The inflammatory stress on your body from binge eating and eating high fat/high sugar foods can cause further disease.

What other factors are common with binge eating?

Binge eaters, with or without diabetes, usually have other mental health issues which may not be diagnosed including OCD (Obsessive Compulsive Disorder), PTSD Post Traumatic Stress Disorder), ADHD (Attention Deficit Hyperactive Disorder), depression or anxiety.

They tend to experience extreme concerns about their body image, body size, and body type. Binge eaters often have higher overall A1C levels, without realizing why. Most of the time they are monitoring their food intake. When bingeing, there are no food limits. Sometimes they withdraw socially for no known reasons.

When taking insulin, they tend to manipulate insulin amounts so they can eat depending on the specific time. Binge eaters fear high blood sugars more than other type 2 diabetes patients since they can recognize the cause. They feel “loss of control” even when not consuming large amounts of food.

What can you do for diabetes control in the short term after binge eating?

Drink, drink, drink. Drinking plain water after a binge will help bring down blood sugars simply because of increased hydration. This helps dilute your blood sugar after consuming too much sugar and salty foods. Drinking water can also dilute the effects of drinking too much alcohol.
Walk, walk, walk. Walking after a binge may help you get your blood sugar down as well as burn calories. The energy used for walking is from the sugar in your system.
Eat high fiber/lean protein foods. After bingeing on too many empty calories, return to eating high fiber foods such as fruit, veggies, and quinoa as well as lean proteins like eggs, skinless chicken breasts, tuna, salmon, or lean red meats. High fiber and lean protein will keep you satiated and help limit episodes of binge eating.

What can you do in the long term to work on or help stop binge eating?

Pre-plan all meals and snacks. Do not be caught having to cook meals that require a lot of time.
Choose whole foods. Eat nutrient dense foods. This will not only help control your diabetes, but it will keep you more satiated and prevent binging. Remember to include vegetables, fruits, whole grains, nuts, seeds, legumes, and low-fat dairy. Think about eating a Mediterranean food plan.
Lean protein. Add a small serving of high quality, lean protein with every meal.
Fiber. Fiber reduces the risk of heart disease and type 2 diabetes. By eating plenty of fiber, your blood sugar will spike less. Remember, spiking blood sugars can lead to more “cravings and episodes of binge eating.”
Eat meals at home & eat out less. There is evidence that restaurants, both fancy, fast food and casual, tend to use more salt, sugar, fat, and artificial ingredients to enhance and intensify food flavors. This may lead to binge eating. Prepare your meals at home and you will “more likely eat fewer calories, add less sugar, fat and salt to your meals.” Eating out also leads to consuming larger portions. Currently food portions are bigger than they were 20-25 years ago.
Cook with healthier ingredients. Use fresh herbs. Think about growing your own in a simple kitchen shelf garden. Wash and cut up salad ingredients and have them ready to prevent binge eating on artificial snack foods or fatty cheese spreads and dips. Always go shopping with a grocery list and stick to the list and avoid impulse, last-minute purchases.
Never go to the grocery store when you are hungry.
Have healthy snacks. 3 cups of fresh air-popped popcorn without added salt or fat (serving size). It is considered a high-quality carbohydrate snack, with lots of fiber. Have fruit salad cut up in chunks or slices and ready to go. Sliced vegetables with 2 tablespoons of hummus, or avocado chunks, hard boiled eggs or low-fat cheese sticks are perfect options. Ready to serve snacks can ward off binge eating.
Hydrate with zero-calorie beverages. Drinking lots of calorie-free beverages can “increase your energy expenditure by boosting your metabolic rate.” It also takes the edge off hunger. Try drinking an 8-ounce glass of water prior to each meal to prevent binge eating. Tea, herbal tea, black coffee, seltzer, or mineral water are good choices too.
Never skip meals. Saving calories for the end of the day with one large meal “leads to binge eating and poor choices as well as elevated blood sugars.” Your best bet is to eat your meals throughout the day, every 4-5 hours, to avoid hunger or binge eating.
Eat and only eat. When you read, talk, scroll, or watch TV while eating, you are not mindful of each bite of food. You tend to eat more and faster, leading to binge eating. Pay attention, sit and eat at a dining or kitchen table or at least on a stool at a countertop, with no distractions. Do not eat standing or on the run. You will be able to “catch cues from your body” instead of simply shoveling food in.
Skip eating from “to-go containers” or eating directly from a large box or bag. It is easy to lose track of food quantities when you eat directly out of a container, bag, or box. By placing a portion or serving on an actual plate, you will be able to estimate portions more easily. If you find this approach difficult, then consider buying foods in “individual serving sizes” which are more expensive. You can purchase small glass containers and package individualized portions yourself. You can also vacuum pack individual food servings that you can freeze. This will ensure enhanced freshness later.
First divide your plate. Before you serve, fix and divide your plate. Discourage more than one portion except for plain vegetables. Certain foods lead to binge eating more than others. Certain times of the day lead to more binge eating than others. Use a plate and divide it into ½ vegetables, ¼ protein and ¼ carbohydrate. You will be less likely to binge if you eat more protein and fiber.
Do not go back for second, third or fourth servings. Do not leave the table hungry but don’t be stuffed either. Find a balance by following your own mental and physical feelings, signs, and cues.
Restful sleep. When you have restful sleep, your body “burns calories and uses energy” to help maintain proper metabolic functions. Sleep deprivation may negatively influence your food choices. Lack of quality sleep makes you feel hungrier before a meal and less satisfied after a meal. Your sleep cycle should be consistent and remain in the 7–9 hour range. “Quality or slow wave sleep helps regulate appetite hormones.” Often overlooked, quality of sleep can impact your motivation levels. When you do not have quality sleep you end up with a “hormonal imbalance” of leptin and ghrelin, which raise your cravings and desire for high calorie foods. Quality sleep does not equal quantity of sleep. Consider wearing a smart watch with a sleep tracker. This kind of device can supply information about your sleep quality. “An Apple watch can monitor changes in body position and changes in your breathing. An algorithm analyzes data to track your sleep metrics.” Deep sleep is needed for improved appetite regulation.
Move daily. Nothing fancy just simple walking is fine and helps to suppress your appetite and burn calories. If you prefer, try a sport or a formal activity. Consider a 30-minute walk after your main meal to help with blood sugar regulation and cravings. Walking can burn off calories and reduce excess blood sugar. “Exercise may function as an appetite suppressant unless you really overdo your routine. Too much exercise may make you crave more food, especially high calorie foods.
Figure out what are your triggers for binge eating. Is it a poor body image, driving in traffic, having a big report due at work? Is it family stress? Is it financial stress? It is often difficult to understand this alone. Collaborate with a therapist or mental health counselor. Consider learning cognitive behavioral therapy or CBT. There are other effective talk therapies available.
Monitor your own stress level. Everyone has daily stressors. Find ways to cope with them other than over-eating. Stress can prompt you to crave comfort foods including refined sweets and fatty foods. Raised cortisol levels (a stress hormone secreted from the stress response), can lead to intense cravings and eventually binge eating. Listen to music, read a book, play with your pet, or meditate instead of reaching for food.
Consider taking a probiotic. Always discuss taking additional products with your health care provider before starting any new vitamins or supplements. Taking probiotics is safe but may cause gas and bloating. You need 3 months of consistent use before noticing any benefits. The research on diabetes and probiotics is positive, but more research needs to be done. “Initial evidence shows that probiotics may help stimulate weight loss and keep appetite in check.” Probiotics add beneficial bacteria to your gut microbiome, decrease inflammation and support your metabolism. It may also have a positive impact on your heart and immune system. These factors may keep your appetite tamed and help prevent binge eating. Probiotics are “living organisms that have health benefits when eaten.” Some natural probiotic food choices include plain yogurt, kefir, sourdough bread, green bananas, tempeh, buttermilk, pickles, Kimchi, miso, brine-cured olives, and sauerkraut. The strains that have shown promise on supporting weight management are “Lactobacillus gasseri, Lactobacillus rhamnosus and Bifidobacterium lactis.” Probiotics are an addition to diabetes management. They should not be thought of as a replacement for your diabetes medication, proper eating habits, and exercise. “No probiotic can cancel out a steady diet of ultra-processed foods, lack of movement or binge eating, especially with diabetes.” Avoid probiotic powders and gummies which may have too much added sugar.
Do not rely on weight loss supplements. Supplements, including weight loss supplements, are not “FDA regulated or approved” and will not act like a magic pill. Weight loss supplements may also interact with your heart and diabetes medications. This includes super-caffeinated supplements and green tea extracts. Never start any new supplements without discussing them with your health care provider.
Weigh yourself consistently but not constantly. Do not obsess about gaining 1-3 pounds since water weight and sodium intake can influence your weight fluctuations. Do not weigh yourself daily, but don’t wait for your 3-month follow-up doctor visits either. Stay informed and think about weighing yourself weekly, on the same scale and at the same time of day, for more accurate results. Track trends and see if there is a particular number on the scale that you or your physician considers too high. Make changes immediately, using logic and common sense. The longer you avoid weighing yourself and comparing your weight, the higher the scale number can go. Each added pound makes it more difficult to achieve your ideal weight. With diabetes and an eating disorder, your weight should be frequently monitored just like your blood sugars.
Avoid strict diet rules. The more you learn about high quality nutrition and how to eat food properly, the healthier your relationship with food will become. Stop being so restrictive with food and diet limitations which often leads to binge eating.
Try to avoid emotional eating. This may sound easy, but it is not. Stress is not the only emotion that causes you to binge eat. Happiness, boredom, sadness, anger, depression, joy, anxiety, and trauma can lead to binge eating. Don’t use eating as a punishment or reward system. Find another way to help monitor and support your emotions. Besides trying CBT you can join a support group, take classes, read about real-life situations that center around emotional eating, listen to podcasts, or read applicable journal articles. Avoid distractions. Not being busy or stimulated enough or being too busy can lead to binge eating.
Dine with “like minded” friends or family. Find people who share your concerns about food choices, food styles, and portions. Discuss your options as a group before you order. You will find it easier to eat “within reason” when people around you have similar goals. Learn to share meals which may help cut down on food amounts.
Food journaling. Sometimes when you write down everything you are eating you have more ability to track your daily intake. Usually, you want your food intake to appear neat on paper. You may try using a smart phone app which can make it even easier to document. Some app choices are MyFitnessPal, LifeSum or Lose it.

Identify and know you binge eating triggers

Does it happen only at the end of the day?
Do you crave sugar? Do you crave salt? Do you crave fatty foods? Why?
Do you binge only on celebrations like holidays, ceremonies, birthdays, or anniversaries?
Do you weaken mentally during office meetings, seminars, or office parties?
Are there snack jars and treats around your home or office?
Do certain people that you have contact with trigger thoughts of binge eating?
Does a physically or mentally stressful day make you want to binge?
Is the weather a binge eating trigger?

What else can I do?

Do not obsess. Do not weigh and measure every morsel of food that you consume. Use small bowls and plates when they are available.
Put down your fork and knife between bites. Slow down your chewing and eating.
Do not drink your calories. As best as you can, try to limit any calorie intake through liquid forms. It is faster to add calories when you are drinking fruit juices, lemonade, energy drinks, mixed punch, sugar-sweetened teas, hard seltzers, sodas, or alcohol with mixers. These kinds of drinks tend to also be high in sugar and will elevate your blood sugars. Watch out for flavored creamers added to your coffee. Avoid adding flavored syrups to your lattes.
Alcohol can impair your judgement. It can make you lose self-control. You may then binge eat or make poor choices after drinking. Avoid alcohol when possible.
Do not eliminate or avoid all your favorite foods or snacks. Depriving yourself of all “feel good foods” or pleasurable foods can backfire on you. Some foods are ok to eat if they give you joy. Just watch portion sizes and how frequently you choose them. Be selective and try to find foods that make you happy as well as offer nutrients. Get rid of guilt and try to have a healthy relationship with food.
Professional advice. You may need to consult with a dietitian who is familiar with both diabetes and food disorders. Their services may be included in your health insurance plan, so take advantage.
Try medicine intervention. There are different medications which may help with binge eating. SSRI medication such as Prozac or Lexapro is often recommended for depression or anxiety and may help you break the cycle of binge eating. Vyvanse is a medication specifically recommended for binge eating. It helps with “impulse control.”

GLP-1

Medications such as Ozempic or Mounjaro are specifically prescribed to help regulate blood sugars in those with diabetes. They were first approved by the FDA in 2005. They may be covered by your health insurance. Talk to your health care provider about trying them.

What do they do?

They lower blood sugars
They slow gastric emptying
They make you feel more satiated
They promote weight loss
They improve fatty liver disease
They lower blood pressure
They improve lipid profiles
They decrease your risk of heart disease when you have diabetes
They decrease your risk of kidney disease when you have diabetes

Along with lifestyle changes and dietary changes, these medications may help prevent binge eating.

Binge eating can happen occasionally to anyone. Not all binge eating is considered a “true medical diagnosis but binge eating with type 2 diabetes can still do a tremendous amount of bodily harm. Binge eating becomes a true eating disorder when it occurs regularly, at least two times a week.

Binge eating makes it more difficult to control your weight and keep your blood sugars in control. Eventually more diabetes complications may occur. Avoid dangerous fad diets which can easily lead to binge eating. Most people can “recover from an eating disorder” including binge eating when it is addressed early.

Work on “regulation of cues” which teaches people to become more familiar to the signals the body sends when it is naturally full or naturally hungry. Often, binge eating happens when you lose your natural cues of hunger, especially when you choose to ignore the signals. Do not take a wait and see approach. It may lead to your diabetes to be more out of control.

Additional research is needed in the study of eating disorders and diabetes but monitoring calories, doing exercise, getting mental therapy, understanding, and taking body cues as well as being educated on binge eating is helpful for your overall diabetes control.

References:

https://www.verywellhealth.com/how-to-lose-weight-without-exercise-11684699
https://pmc.ncbi.nlm.nih.gov/articles/PMC10538145/
https://aspenendocrine.com/exploring-the-connection-between-diabetes-and-overeating/
https://www.verywellhealth.com/how-to-stop-overeating-8636815
https://my.clevelandclinic.org/health/treatments/13901-glp-1-agonists
https://health.osu.edu/wellness/exercise-and-nutrition/tips-to-recover-from-binge-eating
https://www.nationaleatingdisorders.org
https://www.eatingdisorderhope.com/blog/binge-eating-disorder-diabetes-link
https://www.newscientist.com/article/2344304-appetite-suppressing-probiotic-helps-overweight-people-lose-weight/
https://www.healthline.com/nutrition/probiotics-and-weight-loss
https://www.uclahealth.org/news/article/surprising-connection-between-sleep-and-weight-management
https://wwwseed.com/cultured/probiotics-for-diabetes-guide
https://www.nhs.uk/mental-health/conditions/binge-eating/treatment/
https://www.mayoclinic.org/diseases-conditions/binge-eating-disorder/symptoms-causes/syc-20353627