Diabetes despite bmi 18 and healthy eating

[Charcharm]

Many of the women in my family - my late mum and grandmother included- develop type 2 diabetes in their 60s and 70s. What’s perhaps unusual is that they have all had bmi 17-18 with healthy eating habits. No sweet tooth whatsoever, not because of any particular efforts, but just naturally so. My mum didn’t enjoy sweets or baked goods and preferred fruit. Alcohol only a few times per year.

Yet they all develop out of control diabetes. I can only assume there is some powerful genetics at play?

I am now 50 and am wondering what I can do to prevent diabetes as all the advice I hear centers around making lifestyle choices, which didn’t help anyone in my family. It’s not just the diabetes, vascular dementia followed the diabetes diagnosis within ten to fifteen years in all cases. It was horrific and I don’t want to put my children through anything like that if I can help it.

My gp has no time to discuss any of this, I get the same old advice about watching what I eat etc, so I thought I’d ask here. If anyone has any knowledge to share I’d be so grateful.

That’s interesting, so being (slightly) underweight might be negative in this context? I just checked and I’m 18.7 and I have a muffin top and am soft around the middle (bmi is lower end of healthy weight but as you point it’s a blunt tool), which signals to me that I probably have too high body fat at the moment so was planning on addressing this for health reasons. In an ideal world I should build muscle instead but it’s not realistic at the moment (dead tired due to anaemia and newly diagnosed heart condition etc etc)

I was just reading about the ozempic-dementia connection! I’ll do anything to stave off this disease as it’s devastating for families

To sum up

• Get continuous glucose monitor
• increase muscle mass
• daily (?) cardio
• watch diet/consider paleo or carnivore depending on what glucose monitoring shows
• watch stress and sleep

Thanks everyone, will get started on actioning the above.

I’d suggest weight lifting and eating a lot of protein. Try to significantly increase your muscle mass. HRT might help but only with weight training and adequate protein. I think the issue is that there is a genetic disposition and the low muscle mass (anyone with BMI that low has low muscle mass) is what’s contributing).

I might be tempted to have a dexa to look at muscle mass to have a baseline and to determine if it is low.

It depends how energetically you walk. A gentle stroll won’t help much, an hour’s brisk walking will raise your heart rate a bit.

Walking is ok as cardio as long as you walk fast enough to get out of breath but to me the issue looks like it could be low muscle mass and cardio won’t help with that.

I was actually an elite athlete but that was obviously a while back. BMI was a smidge lower back then. Very lazy these days when it comes to exercise. Hate the gym, always have. But I think I know what to do now. This was a bit of a wake up call so thanks everyone

Read about Prof. Tim Noakes. He was an elite athlete who developed type 2 diabetes.

It’s all about the carbs. I eat keto/carnivore because I was prediabetic. I’ve eaten this way for 10 years and I’m very healthy.

Obesity is a protective mechanism that allows the conversion of excess glucose to fat. If you can’t get fat then the body has not much backup storage so you get diabetes.

What sport? Some require good levels of muscle mass and some less so. But that may put you at an advantage compared to other family members.

I recently took part in a research study as a weight lifter, and they used cyclists as the control group due to lower muscle mass (but still really fit.)

As a PP says, genetics. Lifestyle is only one factor.

it’s also possible though I think less likely at that age, that it wasn’t T2D but LADA. this is a slower moving kind of autoimmune diabetes (T1) that was historically misdiagnosed as T2 because of age at onset. Now that we can tell the difference via blood testing (antibodies and C-peptide tests) we know more. Rapid progression to insulin is a tip-off. If it’s LADA there’s no way to prevent it.

Definitely less muscle than weightlifting in my sport:) was just thinking I had more muscle than the average person due to having done elite level sport, for a part of my life at least, but perhaps not enough to offset diabetes risk

Thanks for the tip, will read up on him. Can I ask how strict carnivore you are? Jordan Peterson style with nothing but steak, salt and water? Or do you include the occasional low carb vegetable/dairy/lower carb fruit? How about occasional glass of wine or even deviating completely for meals out, celebrations and such?

Are you maybe a TOFI? Thin outside, fat inside.

TOFI and FOTI: Why Thinness Isn’t Always an Indicator for Health – Diets Debunked

@Charcharm I rotate between keto and carnivore as needed. If I eat too much fibre I get bloating and discomfort so I go carnivore for a week or two. I always feel so much better on carnivore but strict is hard to do because there is little variety.

Eventually I start to add in low carb vegetables and some berries in season. I try to stick to low fibre vegetables but having the break from eating them always does me good.

Edited to add: I don’t deviate. I can’t because I cannot moderate high carb food. It spirals into carbs at every meal and in between. So as a carb addict I have to abstain. I do make myself keto cakes and biscuits as an occasional treat. DH made me a keto tiramisu for dessert at Christmas for example.

very limited and also mixed evidence for hrt and dementia.

a great deal of evidence for resistance training though. Also other exercises but the resistance training in particular.

I believe that building lean muscle mass also helps lower risk of type two diabetes. Some researchers are starting to see muscle as an endocrine organ as it needs carbs

That’s the south Asian phenotype isn’t it? Too much visceral fat? Might be the case for me today, who knows. I can’t think why else people in my family would develop diabetes. As I have mentioned before, the women with diabetes were all averse to sweets and treats to the point of never having any, and drank alcohol maybe once or twice per year. No white bread either. It’s still difficult for me to accept that an orange per day and some vegetables with dinner can lead to the accumulation of dangerous levels of visceral fat, which so far has led me to conclude that it doesn’t make any difference and that the diabetes and dementia will come no matter what I do. But who knows? Lots of good advice here which I’m looking into.

Very interesting. I’m going to look into that

The carnivore diet is socially difficult as well. Not exactly the dream dinner guest…

And it can be expensive (I don’t like eggs so that’s one affordable source of protein off the list).

I’m going to give it a try

https://zoe.com/learn/podcast-resistance-training-as-you-age?utm_source=chatgpt.com

i think these were some of the podcasts I heard about it.
Chat gtp had a few more too

I think Michael Mosely also did a “just one thing” episode on it

You could get a blood sugar testing kit. I did when I was diagnosed as pre diabetic.

I learnt that rice sends my sugar levels rocketing and stays there for days (unlike chocolate which was a quick spike for a few hours).

Also worth reading books like the Glucose Goddess and the Michael Moseley books.

Read into epi genetics. I am in your position, also very slim. I work to control my blood sugar everyday and stopped eating fruit when it spiked me. I eat a lot of specific fibrous foods and fats to control my blood sugar. I test every year and check my levels. Good luck!

There are a lot of helpful foods and supplements that can help regulate blood sugar (and are just good for us in general). Eating more foods like Jerusalem artichoke (preferably raw) and other foods high in inulin helps regulate blood sugar. If you're pre-diabetic, there are many foods that will support you in preventing diabetes. I suppose in reality, you are not pre-diabetic but sort of living as one in case you too develop older age diabetes. Given your family history, I would be doing the same as you... living preventatively.

And higher protein in your diet doesn't have to be too complex. Two poached eggs for lunch with whatever sides (salad, wholegrain toast, etc), is such an excellent source of quick, easy, high protein. I bought myself a nice egg poacher and this in itself got me eating much more protein than before. If you're a tea drinker, keep enjoying it (without the sugar perhaps). Different teas are very helpful for managing insulin spikes/blood sugar, etc.

Not necessarily, I’ve known patients with type 2 but slim phenotype be tested in the NHS because they don’t “fit” the standard T2DM type - I have one patient with an insulin receptor mutation (meaning she is resistant to insulin despite being very young and slim). Her whole family have it. Genetic testing isn’t that expensive these days.

Also, some scientists have identified that a major contributor of type 2 diabetes is a fatty pancreas (thin people can still have a fatty pancreas).

https://www.ncl.ac.uk/press/articles/archive/2015/12/pancreasstudy/

'Lifestyle choices' doesn't necessarily mean dietary ones or other poor lifestyle choices. Other factors at play with T2 include stress and getting enough sleep, and having family members who have developed it.

It is increasingly looking like there is a hereditary predisposition. Have a look on the Diabetes UK website.