Nov. 11, 2011 at 8:30 AM ET
Stephanie Yi, 29, had a body most women would kill for. She never had to work hard to maintain her long-limbed, flat-bellied frame -- weekend hikes near her northern California home and lots of spinach salads did the trick. She could easily afford to indulge her sweet tooth with the occasional buttery, sugary snack. At 5'7" and 120 pounds, she had, she figured, hit the good-genes jackpot.
But everything changed two years ago, when a crippling fatigue left her sidelined from college classes. Listless, she dragged herself to a doctor, who suspected a thyroid imbalance. A blood test and a few days later, she received the alarming results: Her thyroid was fine; her blood sugar levels were not. She was prediabetic and on the cusp of developing type 2.
Stephanie was stunned. Of course, she'd heard diabetes was a health crisis. (At last count, 26 million Americans had the disease, according to the Centers for Disease Control and Prevention.) But weren't type 2 diabetics fat, sedentary, and on junk-food-and-soda diets? Stephanie hadn't been to a drive-through in ages; she didn't touch meat. Yet, somehow, she'd gotten an illness most slim women dodge.
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A Growing Threat
The CDC estimates that one in nine adults has diabetes and, if current trends continue, one in three will be diabetic by the year 2050. For decades, typical type 2 patients were close to what Stephanie pictured: heavy and inactive. They were also older, often receiving a diagnosis in middle age or beyond. But while such type 2 cases continue to skyrocket, there has been a disturbing increase in a much younger set.
The number of diabetes-related hospitalizations among people in their thirties has doubled in the past decade, with women 1.3 times more likely to be admitted than men. Perhaps even more troubling is the enormous number of people age 20 or older with prediabetes: 65 million, up from 57 million in 2007.
Suddenly, a condition that can take half a lifetime to develop has become a young person's problem. Even more surprising, about 15 percent of people with type 2 diabetes aren't overweight, according to the National Institutes of Health. They're not feasting on ice cream and cheeseburgers. But their average-weight bodies are hiding a dark secret.
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Skinny-Fat and Stressed Out
Molecular imaging expert Jimmy Bell, M.D., studies a condition he calls TOFI--thin outside, fat inside. Nearly undetectable from a person's appearance, TOFI happens when fat that would normally build up under your skin (hello, thunder thighs!) gloms onto your abdominal organs instead. This visceral fat is way worse than any muffin-top chub--it can cause inflammatory substances to affect your liver and pancreas, and lower your insulin sensitivity, putting you at risk for type 2. "With TOFI, you might look slim," says Bell, "but your insides are behaving as if you are obese."
A big skinny-fat risk factor? Neglecting exercise and regulating weight through food choices alone, a behavior plenty of young women in our diet-obsessed, desk-strapped culture are prone to. Turns out, breaking a sweat is key in lowering blood sugar, because even moderate exercise causes muscles to suck up glucose at 20 times the normal rate (regular workouts are also the only way to shed visceral fat).
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That's a fact Corinne Waigand, 30, wishes she had known. In college, she regularly skipped breakfast and pounded Mountain Dew in lieu of lunch to keep her wired for class. After school, she'd indulge all of her cravings--cookies, cake, pasta, chips--before sometimes heading out to parties with friends. She rarely exercised, though she did go on the occasional low-sugar kick; one year, she gave up soda for Lent and dropped 10 pounds (she gained it all back). At 5'10" and 165 pounds, she was never overweight, let alone obese, but her behavior caused huge troughs and peaks in her insulin production.
Corinne was diagnosed with type 2 diabetes two years ago. Like Stephanie, she was shocked. "I didn't fit the physical description of someone with type 2," she says. "Sure, I had some bad eating habits, but it never showed on my body."
Many young women also unwittingly engage in a second big TOFI and diabetes risk: yo-yo dieting. "Each time you lose weight through dieting, you also lose muscle," explains Betul Hatipoglu, M.D., an endocrinologist at the Cleveland Clinic. "And each time you regain that weight, you gain only fat." In other words, yo-yo dieters lose the muscle mass that would help them burn visceral fat and control blood sugar--a type 2 double whammy.
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Layered on top of these risks is another familiar culprit: daily stress. When your mind is taxed, your body produces the stress hormone cortisol to give you a jolt of energy. Problem is, cortisol also temporarily elevates blood sugar--a diabetes danger if you're tense all the time. Plus, scientists have found that too much cortisol can also mess with fat storage and lead to a spike in visceral blubber among stressed-out, normal-weight women. That's right--chronic stress contributes to making you skinny-fat.
The Genetic Connection
Stephanie Yi didn't yo-yo diet and wasn't super stressed. Sure, she had that sweet tooth, but don't lots of fit women? After her prediabetes diagnosis, she called her father. He reminded her that his father had died from a heart attack related to diabetes when Stephanie was very young. She was likely the victim of yet another type 2 risk: genetic predisposition.
Scientists are still working out the specifics, but lean young people might be at a bigger risk of developing type 2 if one of their also-lean relatives was diagnosed, according to the Joslin Diabetes Center at Harvard Medical School. (If both her parents have type 2, a woman has a 50 percent chance of getting it herself; if both of her parents and a sibling have it, her risk increases fourfold.) Why? It's possible that normal-weight type 2 patients inherited a specific set of genes that affects the way their body handles even a bit of excess fat.
Losing Weight to Prevent Diabetes
For example, some women can house ample junk in their trunk without serious health consequences--their pancreas functions as a genius locksmith that distributes insulin keys to open the doors that let cells store sugar. But other women, like Stephanie, might have a much lower threshold for excess food or fat. Certain DNA might hinder their pancreatic function; no matter how many keys are passed out, none work.
Sugar gets locked out of cells and floods the bloodstream, damaging organs like the liver and heart, says endocrinologist Nicola Abate, M.D., of the University of Texas.
While the only test for "type 2 DNA" involves a long, hard look at a family tree, researchers know that certain people might be at a higher risk. Asian Americans, for instance, are more likely than white Americans to develop type 2, even though just 9 percent of the former group are obese, compared with 32 percent of the latter, according to the National Diabetes Fact Sheet. It appears, says Abate, that Asian Americans are genetically predisposed to be extra sensitive to extra calories.
Stamping Out Prediabetes
Some doctors, such as leading diabetes expert Richard Bernstein, M.D., believe that many of the slim women diagnosed with type 2 don't actually have that disease. Rather, they could have an undiagnosed case of type 1.
"The definitions of type 1 and type 2 are too vague," he says.
"Many adults show symptoms of both." After all, the signs--extreme thirst, blurred vision, high blood sugar--can be similar, according to the National Institutes of Health. So it's important to get tested for both types (the typical type 2 screen does not look for the autoantibodies that come with type 1). "Most doctors don't test for diabetes unless their patient is obese," says Abate. But they should; symptoms might not show up until the disease is well under way. Ask your doctor to check you every five years.
Your best bet, of course, is preventing type 2 symptoms altogether. Even if you have type 2–prone DNA, the disease is almost entirely preventable if you make smart lifestyle choices or catch prediabetes early. "While type 2 can never be reversed, prediabetes can," says Abate. The problem is that about 93 percent of prediabetics don't even know they're sick.
Besides being tested, a crucial antidiabetes move is to eat healthy foods--not just foods that seem healthy, says Bell. Women can up their TOFI risk by downing too much junk food in disguise--all too easy with sugar lurking in "health foods" such as low-fat salad dressings, breakfast cereals, and vitamin drinks. Such fare is often packed with high-fructose corn syrup, which the body converts into visceral fat. Eat as little added sugar as possible each day and stick with low-glycemic-index carbs and unprocessed foods like fruits, veggies, and whole grains.
Since cutting out her guilty pleasures, Stephanie has watched her blood sugar levels drop. She has also said good-bye to carb-heavy white bread and embraced exercise nearly every day of the week. (Studies show that just 30 minutes of brisk walking a day can cut people's odds of developing type 2 by 58 percent--even people who are already prediabetic--according to the NIH.) "I know my body better now," says Stephanie. "Making these small changes has made me healthier." The last time she checked, her blood sugar was close to normal.
How Type 2 Works
Say you bite into a cupcake (yum!). The minute the sweet treat hits your stomach, your body's digestive system begins to transform the cupcake's carbs into a simple sugar called glucose. Once that sugar enters your bloodstream, your pancreas squirts out insulin, a chemical that unlocks muscle cells and allows them to suck in glucose to use as short-term energy. Simple enough.
But let's say you eat another cupcake, and then another; or maybe you have a particular fondness for sugary high-carb treats like French toast with whipped cream or waffles with syrup. Overloaded, your pancreas is pumping like crazy, and over time your muscle cells begin to ignore the insulin. This problem is known as insulin resistance, and it can lead to a bloodstream chock-full of glucose. Eventually, your pancreas can peter out entirely, leading to toxic, too-high blood sugar levels--a.k.a. type 2 diabetes. (Type 1 diabetes, which typically develops in childhood, is a much rarer autoimmune genetic disorder in which the immune system attacks the pancreas and hinders insulin production.)
Though excessive sugar intake and obesity are the leading causes of type 2 diabetes, they're not the only ones. Several stealth factors can contribute to insulin resistance. And so dangerous are consistently high blood sugar levels that both types of diabetes can eventually lead to heart disease, blindness, or stroke. In fact, diabetics have a 25 percent higher risk of dying of cancer and a whopping 132 percent increased chance of dying from vascular complications than nondiabetics do, according to research published in The New England Journal of Medicine.
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