It’s widely known that type 2 diabetes tends to strike people who are overweight. In fact, about 85 percent of people with diabetes are carrying extra pounds, and one out of four Americans who are sixty-five or older have type 2 diabetes. But what about those who aren’t overweight?
A popular misconception: It’s commonly believed—even by many doctors— that lean and normal-weight people don’t have to worry about diabetes. The truth is, you can develop diabetes regardless of your weight.
An unexpected risk: For those who have this “hidden” form of diabetes, recent research is now showing that they are at even greater risk of dying than those who are overweight and have the disease.
THE EXTRA DANGER NO ONE EXPECTED
No one knows exactly why some people who are not overweight develop diabetes. There’s some speculation that certain people are genetically primed for their insulin to not function properly, leading to diabetes despite their weight. Still, because diabetes is so closely linked to being overweight, even researchers were surprised by the results of a recent analysis of twenty-six hundred people with type 2 diabetes who were tracked for up to fifteen years.
Startling new finding: Among these people with diabetes, those who were of normal weight at the time of diagnosis were twice as likely to die of non-heartrelated causes, primarily cancer, during the study period as those who were overweight or obese. * The normal-weight people were also more likely to die of cardiovascular disease, but there weren’t enough heart-related events to make that finding statistically significant. Possible reasons for the higher death rates among normal-weight people with diabetes include:
- The so-called obesity paradox. Even though overweight and obese people have a higher risk of developing diabetes, kidney disease, and heart disease, they tend to weather these illnesses somewhat better, for unknown reasons, than lean or normal-weight people.
- Visceral fat, a type of fat that accumulates around the internal organs, isn’t always apparent. Unlike the fat you can grab, which is largely inert, visceral fat causes metabolic disturbances that increase the risk for diabetes, heart disease, and other conditions. You can have high levels of visceral fat even if you’re otherwise lean. Visceral fat can truly be measured only by imaging techniques such as a CT scan (but the test is not commonly done for this reason). However, a simple waist measurement can help indicate whether you have visceral fat (see below).
- Lack of good medical advice. In normal-weight people who are screened and diagnosed with diabetes, their doctors might be less aggressive about pursuing treatments or giving lifestyle advice than they would be if treating someone who is visibly overweight.
Toxic Tea Bags
Perhaps you wouldn’t dream of microwaving plastic food containers, because you know that heating plastic can allow toxins to leach into your food. But you probably don’t think twice before dunking your fancy mesh tea bag into boilinghot water. Well, you may want to give that some thought right now. Yes, those pyramid-shaped mesh sachets filled with pretty multihued leaves lend sophistication to your daily tea-drinking ritual.
But: Even though they’re often called “silky,” those bags aren’t made from silk. Most are actually made from plastic, either polyethylene terephthalate (PET), polylactic acid (PLA, or corn plastic), or food-grade nylon (indeed, nylon is a plastic). PET, PLA, and nylon are widely used for food packaging, and their safety as packaging materials has been tested. “However, when you subject plastics to stressors such as heat, the molecules begin to break down and they can leach— no matter whether it’s a microwave oven or a cup of hot water that is warming the contents,” says Sonya Lunder, MPH, a senior analyst at the Environmental Working Group, an environmental health research and advocacy organization. “So, is stuff leaching out of the plastic in the tea bag and getting into your beverage? The answer is yes.
Problems with plastics:
No studies have looked specifically at leaching from plastic tea bags, so we don’t yet know how much of any particular toxin might be getting into our tea. But past experience should teach us to be wary. After all, people used to think it was perfectly OK to microwave food in plastic containers —until we learned that certain plastics contain bisphenol A (BPA), an endocrine disruptor that has estrogen-like effects on the body and that has been linked to breast cancer, prostate cancer, diabetes, obesity, heart fertility, early puberty, and cognitive and behavioral problems in children! The plastics used for tea bags don’t contain BPA. But PET plastics can contain phthalates (not because these chemicals are used as ingredients in the plastic, but rather because they may originate from recycled content), and phthalates are another type of endocrine disruptor that has been linked to birth defects. There is also some concern that PET may leach antimony trioxide, a heavy metal. “We just don’t know whether the amount of various substances in PET, PLA, and/or food-grade nylon might someday prove to have negative health effects,” Lunder says. “As yet, there is no scientific consensus about what is too much, who is at risk, or what other health effects we may be seeing from plastic food packaging. But given the worrisome potential effects on our hormones, I advise that people avoid heating plastics at every opportunity.
It boils down to this:
If you enjoy an occasional cup of tea made from a fancy “silky” tea bag, you probably don’t need to worry too much—that once-in-awhile treat isn’t likely to hurt your health. However, it’s possible that your body may reach potentially harmful levels of various chemicals if you are drinking tea made from plastic tea bags multiple times each day—particularly if you try to be frugal by making a second cup from a single tea bag, given that repeated stress in the form of heat can make plastics leach even more. What about good old paper tea bags? They might not be any better than plastic, because many are treated with epichlorohydrin, a compound that has been linked to cancer, infertility, and suppressed immune function.
Your best bet: Buy yourself a nice metal tea ball. They typically cost only a few dollars. When you want a cup of tea, fill the ball with your favorite organic loose-leaf tea, and let it steep in the mug. When the drink is as strong as you like, remove the strainer and enjoy your tea—worry-free.
HOW TO PROTECT YOURSELF
It’s estimated that about 25 percent of the roughly twenty-nine million Americans with diabetes haven’t been diagnosed. Whether you’re heavy or lean:
- Get tested at least once every three years—regardless of your weight. That’s the advice of the American Diabetes Association (ADA). Remember: If your weight is normal, your doctor may have a lower clinical suspicion of diabetes—a fancy way of saying he/she wouldn’t even wonder if you have the condition. As a result, the doctor might think it’s OK to skip the test or simply forget to recommend it. Ask for diabetes testing— even if your doctor doesn’t mention it. A fasting glucose test, which measures blood sugar after you have gone without food for at least eight hours, is typically offered.
Alternative: The HbA1C blood test. It’s recommended by the ADA because it shows your average blood glucose levels over the previous two to three months. Many people prefer the A1C test because it doesn’t require fasting. Both types of tests are usually covered by insurance.
- Pull out the tape measure. Even if you aren’t particularly heavy, a large waist circumference could indicate high levels of visceral fat. Abdominal obesity is defined as a waist circumference of more than thirty-five inches in women and more than forty inches in men. Even if you are under these limits, any increase in your waist size could be a warning sign. Take steps such as diet and exercise to keep it from increasing.
To get an accurate measurement: Wrap a tape measure around your waist at the level of your navel. Make sure that the tape is straight and you’re not pulling it too tight. And don’t hold in your stomach!
- Watch the sugar and calories. The Harvard Nurses’ Health Study found that women who drank just one daily soft drink (or fruit punch) had more than an 80 percent increased risk of developing diabetes. Research has consistently linked sweetened beverages with diabetes. But it’s not clear whether the culprits are the sweeteners (such as high-fructose corn syrup) or just the extra calories, which lead to weight gain. Either way, it’s smart no matter what you weigh to eliminate soda and other supersweet beverages from your diet—or if you don’t want to give them up, have no more than one soft drink a week, the amount that wasn’t associated with weight gain in the study.
Remember: A single soft drink often contains hundreds of calories.
- Get the right type of exercise. People who want to lose weight often take up aerobic workouts, such as swimming or biking, which burn a lot of calories. But if you don’t need to lose weight, strength training might be a better choice. When you add muscle, you significantly improve insulin sensitivity and enhance the body’s ability to remove glucose from the blood. Walking may not sound very sexy, but it’s one of the best exercises going because it has both aerobic and muscle-building effects. In fact, walking briskly (at a pace that causes sweating and mild shortness of breath) for half an hour daily reduces the risk for diabetes by nearly one-third. That’s pretty impressive!