Gaining Weight with Diabetes: A Nutritionist's Guide to Healthy Weight Gain Strategies

While most people associate weight gain with diabetes, weight loss can also be a struggle for people with diabetes for a variety of reasons. When you have diabetes you may struggle with poor appetite due to medications, delayed gastric emptying, metabolic and hormonal changes, or high stress due to managing your condition. Additionally, people with diabetes are encouraged to exercise more regularly to help manage blood sugars, which can make weight gain attempts even more challenging. Unintentional weight loss can also be a sign of unmanaged diabetes, so it is always recommended to check with a medical professional with any sudden changes in appetite or weight.

For people with diabetes, it is important to take a balanced approach to weight gain while keeping in mind blood sugar levels. There are a variety of ways to do this including eating small frequent meals, adding high calorie, low volume food to meals and snacks, adding in drinks with calories that have a balanced nutrient profile, and adding in nutritional supplements that are low in sugar, if unable to meet calorie goals through food alone. It is also important to assess your exercise routine when trying to gain weight with diabetes. Adding in regular strength training, can help to promote gradual weight gain through increased muscle mass.

Understanding Weight Loss in Diabetics

There are a variety of reasons why a person with diabetes may lose weight. The most common factors contributing to weight loss amongst people with diabetes are insulin resistance, elevated blood sugars, increased glucose excretion through urine, and medications that impact appetite. 

When cells become insulin resistant, as in pre diabetes and the early stages of diabetes, weight loss can be the result. The main function of insulin in the body is to help transport glucose (sugar) from carbohydrates into cells of the body for use. When cells become resistant to insulin, blood sugars levels remain elevated. As a result, cells must rely on alternative sources of energy such as breaking down body fat or muscle for use. If blood sugar levels remain high for a long period of time, this increases inflammation, which has the potential to speed up metabolic rate and result in weight loss if calories are not increased.

Additionally, the elevated blood sugar levels that result from insulin resistance can lead to excess sugar being excreted in the urine. This can mean more frequent trips to the restroom, and that the body is not absorbing calories from carbohydrates consumed.

There are also a variety of medications for managing diabetes that can lead to weight loss through various mechanisms. Many of the medications can alter appetite hormones, leading to increased satiety and decreased hunger. As a result, it may be difficult for people with diabetes to get adequate calories to maintain weight. Some medications are also known to slow down the transit of food through the digestive tract, known as gastric emptying. This slow down of food means feeling fuller for a longer period of time, making regularly eating a challenge. 

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Why Is It Hard to Gain Weight with Diabetes?

Weight gain for diabetes can be challenging due to a combination of metabolic changes and dietary restrictions that people with diabetes have. Metabolic and hormonal changes that can impact weight gain attempts for people with diabetes include insulin resistance, delayed gastric emptying (this refers to the slow down of food throughout the digestive tract), increased inflammation, and alterations in metabolism that lead to the loss of muscle tissue. 

People with diabetes are often told to restrict certain types of food to better manage their blood sugars.

The restriction to specific carbohydrate types and amounts can make it difficult for people with diabetes to gain weight. People with diabetes are at a higher risk for developing heart disease, and are often educated to limit dietary fats consumed. The restriction in these certain food groups can lead to weight loss. Additionally, the stress and feeling of overwhelm from food restrictions can worsen appetite and make it even more difficult to gain weight.

How to Prevent Weight Loss from Diabetes

It is important to consult a medical professional, such as a primary care physician or endocrinologist, if experiencing sudden changes in appetite and/or weight. You want to ensure you have the right medication to manage your blood sugars and address any factors that may be attributing to weight loss. Dietitians specializing in diabetes can also be a great asset to help with implementing nutrition strategies to prevent further weight loss. 

Strategies for Healthy Weight Gain weight with diabetes

Balanced Nutrition for Weight Gain

In order to promote gradual weight gain in diabetics and manage blood sugars, it’s important to consume enough calories as well as getting the right balance of protein, carbohydrates and fat in your diet.

The following are tips to ensure balanced nutrition to support weight gain with diabetes:

• Eat at consistent meal times: Aiming to eat your meals around the same time daily can help to regulate hunger hormones. It is recommended to eat at least 3 meals per day and ideally 1-3 snacks when trying to gain weight.
• Choose high protein foods with meals and snacks: Adding in high protein foods with meals can help to better regulate blood sugar when consumed with carbohydrate dense food. Adding in protein can also help minimize muscle mass loss that often accompanies weight loss.
• Add in high calorie/low volume foods where possible: Adding in healthy fats to meals and snacks are a great way to add calories without the added volume. Fats have less of an effect on blood sugars compared to carbohydrate rich foods.
• Add in calorically dense drinks that are high protein/low sugar: Sipping on a low sugar, high protein beverage such as low fat milk or unsweetened soy milk can be a great way to add in calories and protein if you are struggling with poor appetite. Milk can be used to replace water in certain recipes such as oatmeal. 
• Consider nutritional supplements: If you are unable to meet caloric needs through food alone, adding in a diabetic friendly nutritional supplements can be helpful in meeting goals and gaining weight. 

What Foods Can Help a Diabetic Gain Weight?

Focusing on nutrient dense foods and healthy fat foods that optimize blood sugars are important to help a person with diabetes gain weight. This can include a mix of the following: 

Healthy fats:

• Olive oil
• Raw nuts
• Nut/seed butters such as peanut, almond, sun butter
• Hemp seeds/chia seeds/ground flax seeds
• Hummus 
• Avocados 

Complex carbohydrates:

• Whole grains such as oats, brown rice, barley
• Whole grain bread
• Pasta
• Starchy vegetables such as sweet potatoes, corn, peas, pumpkin
• Whole fruit

Lean Proteins: 

• Chicken breast
• Ground turkey
• Fish
• Bean/Legumes
• Lentils
• Tofu
• Low fat dairy including: plain yogurt, cheese, milk
• Soy milk
• Protein powder if unable to meet needs with foods 

Meal Timing and Frequency

Meal timing and snacks are important considerations when trying to gain weight and manage blood sugars. Eating on a consistent schedule daily will help to regulate appetite hormones and add predictability to daily routines and blood sugar monitoring.

It is recommended to eat at least 4-6 times per day when trying to gain weight, and ideally 3 meals and 1- 2 snacks for optimal blood sugar control. Eating every 3-5 hours during the day can help increase overall calories. 

If low appetite is a concern, pay close attention to natural hunger patterns. Have the largest meal where hunger is at its peak and plan a liquid or nutrient dense snack when appetite is at its lowest. Planning a meal or snack after planned exercise or walking can help to get in additional calories and keep blood sugars within range. 

Lifestyle Modifications

Exercise and Muscle Gain

Strength training is an essential component of an exercise plan, but even more important for a person with diabetes trying to gain weight. One common reason people with diabetes lose weight is due to muscle loss, or the breakdown of muscle for energy. Thus, incorporating resistance training at least twice per week, will help to minimize muscle loss and promote muscle growth. When starting any exercise program, it is important to have medical clearance from a physician and reach out for support from a skilled fitness professional if new to strength training.

Stress Management

In addition to physiological challenges, psychological factors can also play a significant role in weight gain efforts for individuals with diabetes. Managing a chronic condition like diabetes can be emotionally taxing, leading to stress, anxiety, and even depression, all of which can impact appetite and motivation for weight gain.

Stress can also be a factor that impacts weight and blood sugars. When your body is in a chronic state of “fight or flight” a cascade of hormones are released, which can impact blood sugars, digestion, mood, appetite, and ultimately cause unintentional weight loss. 

Adding in daily stress reduction is key to helping minimize these negative consequences of chronic stress. First start by observing how stress feels in the body. Then find tools to help manage stress such as regular physical activity, deep breathing, social connections, creative expression and self care. 

Diabetes Weight Gain Supplements

Overview of Supplements

Supplementation can be appropriate in certain cases of diabetics trying to gain weight or where nutritional needs cannot be met through diet alone. Supplements for weight gain in diabetics can include protein powders, bars, or meal replacement shakes. When selecting a protein powder or meal replacement, aim to find one that has at least 20 grams of protein per 8 oz and low in total carbohydrates to ensure blood sugars are regulated. It is also important to get your vitamin levels checked annually, but especially if appetite or weight loss is a chronic issue. 

Considerations for Supplement Use

Before adding a nutritional supplement into one’s daily diet, it is important to check with your healthcare provider to ensure there are no medication interactions. Supplementation is based on the needs of the individual, and is generally not used to treat or manage diabetes. 

Can a Diabetes Nutritionist Help?

There are many different ways to meet your weight goals while managing diabetes. Whether it is creating personalized strategies to increase calories, better controlling your blood sugars, or support with meal planning, working with a diabetes nutritionist or registered dietitian who specializes in diabetes care can help make that possible.

An RDE specialized in diabetes can help you identify and understand why you're losing weight and help outline a path for you to achieve your ideal body weight in a healthy way.

Gaining weight with diabetes can feel like an overwhelming task, and have its share of challenges, but finding the right support can help ease your way and support you in reaching your goals.

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