The BBC posted an article earlier this week called “I’m slim so why am I at risk of diabetes?”, which prompted me to think about the type 2 diabetes diagnosis in thin individuals such as myself. So today I am just doing a “thinking out loud” post about the whole situation. I know thinking about our diseases and what causes them can be an unproductive exercise a lot of times as feelings of guilt and blame can start to set in. However, I personally really like to know the “why?” of things and although I can’t reverse my diabetes and will never know for sure what caused it as there are many variables involved, I can still learn something from it that may help me manage my condition better and avoid making it worse (I still expect the condition to progress though, as that’s what diseases naturally do, unfortunately, even when managed well). I try to make it a positive exercise and learning experience. Please note, I am not a health professional or researcher in the medical field, just a patient that lives with diabetes so the synthesis of information in this blog post is what I have learned about the disease by doing a lot of reading from many different sources.
Who can get type 2 diabetes? Anyone (regardless of weight) can get type 2 diabetes. Although type 2 diabetes is often linked to obesity, a lot of times the obesity is a symptom of the diabetes itself, so it’s not that simple and can be a chicken and egg problem (type 2 diabetes can go undiagnosed for years before the individual starts showing symptoms so it’s difficult to determine if the diabetes or obesity came first). Type 2 diabetes is characterized by insulin resistance, where the cells in the body stop responding to insulin and as a consequence, the body starts producing more and more insulin. Since insulin is a fat storage hormone, the reaction of some people’s bodies to this excess amount of insulin is weight gain. Not for everyone though, for others there is weight loss. Many of us are slim and have type 2 diabetes as well. Although we physically haven’t gained any weight (yet), that doesn’t mean our body hasn’t been storing fat in areas of our body where it is quite dangerous and impairs the ability of our organs to do their job effectively, eventually leading to issues with blood glucose control, heart issues, obesity, etc.
This is one of the main discussion points in the article. It indicates that some people have a genetic predisposition to deposit fat in the abdominal area (true for many people with a slim physique and very little muscle), and the accumulation of fat in this region (and in the liver) over time can eventually cause your tissues to become insulin resistant. In summary, all of us have different genetic makeup that determines where the fat in our body will get laid. Some people gain weight all around their body, while other people seem to gain weight in very specific areas of the body, such as the waist area (it gets deposited as visceral/belly fat around the organs). The waist area is one of the worst regions of the body to deposit fat as it wraps around all the vital organs and makes it difficult for them to work properly. This is where some people that are slim tend to deposit fat. Further, if the individual doesn’t have much muscle mass either (which helps burn excess fat in the body and use up glucose) and if their lifestyle is sedentary, the situation is even worse as more fat is being deposited there rather than being used up by the muscles as energy. So even though an individual may look slim, it doesn’t mean there isn’t a lot of fat being deposited around their organs and filling the liver, which over time starts causing insulin resistance and leads to the diagnosis of type 2 diabetes.
So how does this happen? How does the body get clogged up with all this visceral and liver fat? Well, for most of us it’s due to a processed food and carbohydrate rich diet and all of us (unless we’re on very specific diets) over-consume carbohydrates as everything is chock full of them. Further, if you consume foods that are both carby and fatty, the issue is even worse as now you’re storing both the fats and carbs (fats alone are not a problem, it’s when the fats are consumed with excess carbohydrates that it becomes a problem). Carbohydrate intake triggers the release of insulin, our fat storage hormone, so the more rich in carbs the diet is, the more insulin we have in our body, which means more fat will get stored in our body (and for some people, more of this fat gets deposited around the organs and in the liver). Fat makes tissue resistant to insulin, which causes glucose in the body to keep building up and over time can eventually lead to type 2 diabetes. Furthermore, if you already have type 2 diabetes, your body may start depositing even more fat in the visceral region, as the cells in the rest of your body and your liver have now become insulin resistant. So now that your body can’t store fat well in your muscles and your liver can’t help store some the excess fat anymore either, your body has to scramble to find somewhere to deposit the fat, and dumps it in the visceral area, which over time can lead to weight gain and other health issues. This makes exercising very important for type 2 diabetics.
Another issue discussed in this article, in addition to having a body type and genetics that promote fat storage in the visceral area, is the impact of certain foods that are dietary food staples in certain countries on blood glucose. There are certain foods, such as white rice, that are known to cause big insulin spikes. The fiber is removed from it, which fills you up less because it’s easier to digest, so you eat more of it, which causes your blood glucose to go through the roof. Over time, this can cause havoc on your body. Certain cultures are at higher risk for type 2 diabetes due to both genetics and the consumption of these types of foods on a daily basis. In my culture, hispanic, white rice is one of the main food staples. White rice and beans are front and center every day (and in large quantities). Why? Because it’s cheap, easy, and carb-alicious. Plus if we add all the carbs we consume the rest of the day in addition to the rice, such as sodas, snacks, sandwiches, cereals, etc, you have your blood sugar on a roller coaster ride from hell for years and years until your body says “I can’t take it no more, captain!” and wears out.
Is all of this what happened in my case and led me to develop type 2 diabetes? I’ll never know for sure as there are many other variables involved that contribute to develop type 2 diabetes (can’t put everyone under the same umbrella as everyone’s diabetes is different). However, I feel both of these are quite plausible for me. Although I have never been overweight, it’s entirely possible that there is still a lot of fat that has been stored around my vital organs or in my liver that started causing my issues with the metabolism of glucose. This buildup doesn’t happen overnight, it takes years and years. It’s surprising to see, though, that a lot of doctors still seem confused when they find type 2 diabetes in thin patients. Even my doctors seemed to be surprised about my diagnosis of type 2 diabetes as I am borderline underweight, my BMI is good and has always been good, and my waist circumference (27 inches) is good as well (>35 inches for women would indicate risk for type 2 diabetes). Just goes to show that not all cases of type 2 diabetes are very straight forward, there’s probably many other variables like stress, lifestyle, body chemistry, genetics, sleep, hormones, that play a role in the development of the condition. Some people eat the same carb dense diet I used to eat on a daily basis (pastas, rice, sandwiches, etc) and they never get type 2 diabetes, so everyone is different and there’s probably a lot more to it than diet alone.
I personally think I really have type 2 diabetes and am not a type 1.5 (given that my body has responded well to carb restriction and exercise) and although I have been managing it well so far with a low carb diet and exercise, I know I have to keep taking care of myself. Although a restricted carbohydrate diet helps reduce the amount of glucose in the blood stream (and consequently helps reduce the amount of fat that gets stored in our body as the insulin levels in your body are lower and less insulin=less fat stored in your body), I still have to eat food to live and the excess glucose and fats that are processed by my body need to be stored somewhere (most likely around my organs due to the insulin resistance in the rest of my body). I will continue doing the best I can to stay healthy: carbohydrate restriction and exercise to develop some muscle that would help burn any excess fat that could potentially be stored in dangerous regions of my body.
So my advice to people, really watch what you eat and become an expert in reading food labels. Even things that some would think are “healthy” are still loaded with carbohydrates. And remember, just because you’re thin and exercise, it doesn’t mean you aren’t at risk for developing type 2 diabetes (if you don’t have it already and don’t know it yet). Although there are many risk factors involved in addition to diet alone for developing type 2 diabetes, you can try to minimize your risk by watching the food you consume, exercising, finding ways to reduce your stress, and getting plenty of sleep! Happy eating!
Below is the link to the BBC article: http://www.bbc.com/news/magazine-35280028