Tom Hanks Has Diabetes

November 25, 2013Tom Hanks has Diabetes Reference:  Oct 7th, David Letterman Show  JAMA 2012 Tom Hanks is not overweight.  But he got diabetes.  What gives?  We thought that diabetes happens just to folks who are overweight and get insulin resistant.  That’s actually true for the most part, and the risk association is there.  Even with that, though, the majority of overweight people don’t become diabetic. They are just at higher risk than normal weight folks.  And certainly, the more overweight you are, the more insulin resistant you are and the more insulin you have to put out every day to control your blood glucose.  Eventually, your pancreas wears out as though it has a life time allotment of insulin it is able to make, and once that’s used up, your insulin levels fall, your fat cells are still resistant to your sugar then starts to inexorable climb.  You become “diabetic”. But what gives with Tom Hanks? He looks normal weight.  That raises a very interesting point.  What if you are normal weight and still have slightly elevated insulin and glucose? What’s your risk in that circumstance?   That’s what the JAMA article above is all about.  Folks who are essentially normal looking and normal weight, but are insulin resistant and eventually become diabetic have TWICE the risk of dying from the complications of their diabetes as folks who are overweight and diabetic.  That article is describing Tom Hanks. What is this conundrum about?  It’s all about waist size and belly fat.  You may be “normal weight” but be relatively inactive and sedentary.  You tummy may be bigger and you have a larger belt size or pant size.  Your weight is ostensibly normal, but your percent body fat is higher.  You keep that “normal” weight by having less muscle mass.  That belly fat is particularly dangerous stuff as it spews out boatloads of inflammatory cytokines.  In fact, if you biopsy it, it is not composed of just passive fat cells storing fat waiting for you to burn some energy. That fat tissue is actually filled with inflammatory cells, often attracted by fat cells that died and disintegrated.   The ratio of white cells to fat cells can become as high as 10:1 so the majority of cells in tummy fat can easily be inflammatory white cells.  The inflammatory cytokines that those fat cells put out turn on inflammation all over your body.  In your joints that causes pain.  In your brain it causes depression.  In your arteries it causes vascular disease.  (This is increasingly depressing.) Tom Hanks told David Letterman that his doctor told him he could get rid of it.  That’s true.  You can too.  Exercise, losing weight, eating less high glycemic food, building up muscle mass with weight lifting in addition to aerobic exercise will all help.
  1. WWW.What will work for me?  Time to have a talk with your waist size.  If your waist is bigger than 31.5 inches for women, 35.5 inches for men…you are at risk.  If you don’t do some sort of core muscle building and you make living sitting at a desk, you may think you are slim and trim…but….!   You want you know your insulin level in addition to your glucose.  If your insulin level is below 5, you are likely in good shape.  Most health systems say that the insulin level should be between 2-22 or thereabouts.  That's hoo-haw.  The average American is about 11.  That’s what this article is about. Tom Hanks is average, and in trouble.  The average American is in trouble.  We all need to know our insulin level.  Ask your doctor to get it next time you are in.  If you are at a level of greater than five, I would contend you are burning up your life time allotment of insulin, and on your way to trouble:  heart disease, Alzheimer’s, cancer and diabetes are all in your future.   My waist is 38 inches.  Bummer.  Height doesn’t seem to matter.  Double bummer.
Pop Quiz
1.  Adult onset diabetes occurs when your body is unable to control blood sugar because your insulin supply has run out, and then your blood sugar rises.  T or F
Bingo. True 2.   Adult onset diabetes is usually preceeded by many years of elevated insulin, often within the range of "normal" (2-22).  T or F Exactly on the mark 3.   Folks who have normal weight adult onset diabetes often have a larger waist size, indicating more inflammatory visceral fat.  T or F You got it exactly right. 4.  A normal weight diabetic person has three times the risk of dying from heart disease as an overweight person.   T or F False.  It's double, not triple. Double is bad enough. 5.   This all suggests that knowing your insulin level might be one of the most important pieces of data for you to know in your personal data dashboard.  T or  F True.  And less than 5 is normal, not 2-22.   Americans are all getting fatter and more resistant.  That's why we see that range. 6.  Every overweight person will become diabetic.  T or F False.  The majority will not.  At least not yet.  But the risk gets higher and higher with more weight. 7.  Height allows you to have a larger waist size.  T or F Sorry John.   No.

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