Calling all ‘skinny diabetics’: Prioritize weight loss to unveil metabolic wellness—discard secret fat for a healthier you.
Click to listen to the audio…
The science behind the fat threshold hypothesis
Type 2 diabetes is often painted as a disease of the obese, with an innuendo that well…
IT’S SOMEHOW DESERVED.
THE PERSON LET THEMSELVES GO.
The default response to the problem is a command to LOSE SOME WEIGHT. But not all type 2 diabetics are fat so this advice can land like a wet blanket on someone who isn’t visibly “fat”. To be honest it’s often not that helpful for someone who is visibly fat, but I digress.
The plight of “skinny diabetic” is often “ignored”…..
And for the record, “skinny” diabetics are pretty common – it’s estimated that 1 in 6 people diagnosed with type 2 diabetes have a BMI < 27. These people are seldom given the “lose weight advice”, the dietary advise they’re often given is to concentrates on eliminating “offending” foods from their diet, specifically saturated fat and cholesterol. Unfortunately, when this is practiced, it can actually be counterproductive.
Time for a new perspective
This needs to change, research from Newcastle University in the UK suggests, if you’re “lean” and diabetic, losing weight should still be on your agenda.
Because “fatness” is relative.
The fat threshold hypothesis
It’s been postulated that thanks to genetics, we all have a fat threshold i.e. a maximum amount of fat we can comfortably carry. When we exceed this threshold, metabolic troubles manifest.
For some the fat threshold is enormous, for others it’s tiny.
For the record, the fat cells with the problem are not actually the cells implicated in the pathology. Belly fat is blamed, but the reason fat is accumulating in the belly, is because fat cells meant to be squirrelling away supplies for a rainy day, aren’t accepting fat deliveries.
The body resorts to plan B.
Storing the fat, in other places e.g. the liver (NAFLD).
When it’s stored in the liver/pancreas, metabolic challenges follow.
Not fat enough
Now an off shoot of this idea, is that if you’re currently metabolically healthy and obese – you’re just not fat enough. And if you continue to pack on the pounds, it’s just a matter of time before you “break”.
This can be true, but it’s not A FACT.
It’s good news for some…
Obesity does not equal insulin resistance.
Having said that, excess fat can be tough on other body parts, so carrying excess weight is not ideal, your health is still impacted.
On the flip side, it is bad news for some……..
BMI tells you nothing
You can be “normal” weight and be metabolically challenged i.e. a skinny diabetic. That would be me. I had a metabolic meltdown with a BMI of just over 25. (Normal is 18 – 25).
“Skinny fat” is the term that is euphemistically applied to this situation.
“Skinny” fat people, look normal weight on the outside, but inside they’re carrying extra pounds, especially pounds around the belly i.e. visceral fat. This is captured well in this CT scan of pediatric oncology patients.
The red represents skeletal muscle, the blue subcutaneous adipose tissue and the yellow visceral adipose tissue. The person in the middle is skinny fat. You can see the blue layer is relatively thin i.e. close to normal, but there is lots of yellow inside the body. It’s the yellow bits that are the problem in someone who is “skinny” fat.
Unfortunately falling into the category of “skinny” fat often puts you on a worse health trajectory, than someone who is genuinely fat.
The curse of the “skinny” fat
One of the reasons…………
You’re often flying under the radar.
Unlike in the obviously “FAT”, the medical fraternity is NOT expecting trouble, so they don’t always pick up problems and the seldom advise weight loss.
NOTE : Should trouble be found, prescription meds are the GO TO SOLUTION. the thinking is there is NOTHING you can do to FIX the situation.
The counterintuitive solution
Actually there is something you can do.
LOSE SOME of your “secret” fat.
It has the potential to make a difference to your metabolic health.
Fat thresholds are REAL.
The reTUNE study
This is what happened to a group of skinny diabetics, when they participated in the reTUNE (Reversal T2DM upon normalization of energy intake) study, between May 2018 and Nov 2021.
Here is a little background about these peeps. There were 20 in total, they all had a diagnosis of type 2 diabetes, their diabetes was being managed with diet/drugs, not insulin. None of them had been diabetic for an extensive period of time (all were less than 6 years into their diabetic experience). Genetic tests confirmed that none of them were suffering from monogenic or autoimmune diabetes.
NOTE : This is important to know, dieting will NOT fix all people with a diagnosis of type 2 diabetes.
The “skinny” diabetics
They were normal weight – you are only considered to be overweight if you have a BMI > 25. But they did have expanded bellies (you can see this in their waist circumference) and their blood work showed dyslipidemia. The values in read are considered normal. The one’s to watch are triglycerides and HDL. LDL cholesterol although often higher in someone with metabolic syndrome it is not a marker of insulin resistance.
Two cycles of “dieting” helped them lose their “bellies” and corrected the lipid profile, an effect which was still seen a year later.
“Curing” type 2 diabetes
But this study is about REVERSING diabetes…..so the most interesting numbers are these ones. Both HbA1c and fasting blood glucose had dropped back down to normal. OMG ! The skinny diabetics were “cured”.
I know what you want to know NOW.
What diet did they follow ?
They pretty much “starved”. For a period of 2-4 weeks, they followed a low calorie diet, consuming a meal replacement formula which provided them with 600 kCal a day. To put this in perspective, we typically eat 2000 – 2500 kCal a day, so 600 kCal a day is running on fumes. Lol !
This was followed by 4-6 weeks of “normal” eating, the diet that was recommended was a Mediterranean style eating pattern.
Just two torture sessions
For one person, one round of this “torture” was enough to move the needle and get them back to “normal”.
Most needed two sessions.
A few opted/needed three to reverse their skinny diabetes.
This study suggests fat thresholds DO EXIST.
And if you lucked out on the genetic lottery, lightening the load, by losing some of your SECRET fat, can make a difference to your metabolic health. Yah !
Carpe Diem (SEIZE THE DAY)
A week or two of severely cutting your calorie intake is probably something we all can do. If you need a little help “starving”, try this technique Chinese monks use to help them fast for religious occasions.
The important thing, SHORT AND SHARP.
Don’t drag it out.
Dragging your calorie restriction out over an extended period of time, can back fire, because your body is likely to make adjustments to your basal metabolic rate, which will see you fighting to keep the weight off. Click here to learn more.
The take home message from this research….
“Dieting” is for everyone
Thin or fat, if you’re dancing on the edge of being diabetic, GO ON DIET for a week or two even if you think you have nothing to lose. You might just gain back your metabolic health.
And this is priceless.
NOTE : Being insulin resistant puts you at an increased risk of EVERYTHING.
Slow and steady wins the day
If the idea of “starving” for 2 weeks puts you into a panic, you can achieve the same result with the slow and steady approach of CANDY FLOSSing. The extra fat might not fly off quite as fast, but little by little it will move out and you’ll develop a sustainable lifestyle that will keep the weight off, FOREVER.
Download the Willpower Report, it’s free and begin the journey today to creating BETTER BODY CHEMISTRY and BETTER HEALTH. BETTER BODY CHEMISTRY.
Prediction of whole body composition utilizing cross-sectional abdominal imaging in paediatrics. Eur J Clin Nutr (2023) 77(6):684-691. Rebecca Deyell, Sunil Desai, Andrea Gallivan, Alecia Lim, Michael Sawyer, Steven Heymsfield, Wei Shen, Vicky Baracos.
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