Less than 7% of US adults are metabolically healthy, according to a study published in 2022. This means 60% of the US adult population is either prediabetic or diabetic, and surprisingly, most aren’t even diagnosed. The picture in Australia is likely similar. That is, many people are likely to have diseases without knowing it.
I’m not surprised by the figures as I regularly see patients complaining about feeling less healthy and capable. Blaming these symptoms on ageing alone is incorrect, and age shouldn’t be used as an excuse for loss of vitality in anyone under 80.
So, who’s at risk for metabolic illnesses like type 2 diabetes? Keep reading for 9 surprising signs and symptoms that might indicate you are at a higher risk (and if you really want to understand your likelihood of developing type 2 diabetes, take our risk assessment today).
1. Waist circumference
The most obvious sign is body shape, not weight! Where fat is found in the body makes a huge difference to your risk of developing a metabolic disease. Fat around the middle, known as visceral fat, is more of a problem than fat around the hips and thighs. This is why measuring around your stomach better predicts metabolic risk than body mass index (BMI). Lie on your back and loop the tape measure at the level of your belly button. This is more accurate than measuring while standing. Anything over 80 cm for females and 94 cm for males may increase metabolic illness risk.
Interestingly, the greater your waist circumference, the bigger the risk factor for dementia. This is because the brain is especially vulnerable to metabolic disease. While it’s only 2% of body weight, the brain uses about 20% of available energy. Anything impacting metabolic health, or how the body uses energy, is likely also to impact brain health. So much so that dementia is now often referred to as type 3 diabetes. If you find your memory isn’t quite what it used to be, consider the possibility that you might be in the early stages of metabolic illness.
Too much sugar in the blood can overwhelm the kidneys, leading to an overflow of glucose into the urine. This has been known for thousands of years. The presence of excessive sugar in the urine can attract water, increasing the amount of urine and the need to urinate. This is one reason many diabetic patients get up several times every night! You may also become quite thirsty to make up for the loss of this extra fluid. If you’re feeling extra thirsty and visiting the loo more often, you should make an appointment to see your doctor.
Another consequence of excessive sugar in your urine is infection. Many bacteria will happily feed on glucose and multiply. This is one reason diabetes, with its increased levels of urinary glucose, is linked with higher rates of urinary tract and genital infections. Metabolic illnesses like diabetes also impair the general functioning of the immune system, raising the risk of numerous other infections like coughs and colds, pneumonia, skin and wound infections and fungal infections, amongst others. If your immune system is not as robust as it once was, you should consider getting checked out.
5. Prostate enlargement
High levels of insulin in the blood is a hallmark of metabolic disease. It also happens that insulin is a growth factor for the prostate, a small gland that wraps around the urethra, the tube which carries urine from the bladder in males. When the prostate enlarges, as it can when insulin levels rise, it can restrict urine flow. This then results in the typical symptoms of prostate enlargement, including restricted flow and impaired emptying of the bladder. As well as a weak stream, males often need to urinate several times overnight due to their inability to completely empty their bladder. If you notice any of these symptoms, consult your doctor.
6. Erectile dysfunction
I consider erectile dysfunction a canary in the coal mine when it comes to metabolic disease, especially diabetes. One of the major reasons for this is that high blood glucose levels can damage the nerves that regulate blood flow to the penis. Combined with damage to the blood vessels themselves, this leads to impaired engorgement of the penis, and thus erectile dysfunction. The ready availability of drugs such as Viagra means that the significance of erectile dysfunction is often overlooked in favour of the band-aid approach of taking a little blue pill. The fact is healthy males should not consider a significant decline in their sexual function in their 50s or 60s to be normal without first being investigated.
7. Female sexual dysfunction
Similarly, females with diabetes often experience nerve damage which compromises their sensation about their vagina and clitoris. Some studies indicate that the rate of sexual dysfunction in females with diabetes is more than 75%, including impairments of lubrication, ability to achieve orgasm and overall sexual satisfaction. Importantly, these findings are not attributable to menopause, as it’s seen in females under 45. Any female noticing a decline in sexual function, including desire, should consider being evaluated for metabolic issues.
8. Skin tags
Skin tags are little outgrowths of skin commonly seen around the neck, in the armpits or in the groin. Because they are usually painless, they are often considered nothing more than a cosmetic nuisance, with many doctors being only too happy to freeze them off. In reality, however, skin tags indicate metabolic disease. They usually occur in the setting of high insulin levels, suggesting a likely diagnosis of pre- or full-blown diabetes. If you notice little painless skin growths around your neck, armpits or groin, or for females under your breasts, it may be time to see your doctor for a metabolic health check.
9. Skin pigmentation
High insulin levels, associated with metabolic illness, may also result in patterns of skin pigmentation. This usually happens around the neck or in the armpits. My patients often tell me that they initially thought this increased pigmentation was ‘dirt’, and that they had unsuccessfully tried to wash it off. As with skin tags, if you notice a darkening of your skin around your neck or in your armpits, it is time to visit your doctor.
Why blood tests might not be as accurate as you think
Undiagnosed metabolic disease is a problem made worse by doctors interpreting blood tests as normal, even when there are clear signs of deteriorating health, such as lethargy, weight gain and impaired physical ability. Normal blood test results do not always indicate good health.
The ranges doctors use to interpret blood tests are based on the results seen in an apparently healthy population. But given that 7 out of 8 adults with metabolic illness are undiagnosed, the majority of those in this apparently ‘healthy’ population almost certainly falls in the spectrum of metabolic illness. So consequently, while blood test results may seem ‘normal’, they almost certainly aren’t ‘optimal’ results. The fact is it is quite possible to have blood results clearly indicating metabolic illness, which are considered to be ‘normal’.
Blood test parameters, formerly known as reference intervals, don’t reflect good health so much as they reflect average health. That is, these reference intervals are based on population averages. Specifically, these reference intervals are often determined based on the upper and lower results seen in 95% of an apparently healthy population. Given that less than 7% of adults can be considered healthy, with the vast majority of those with undiagnosed metabolic disease, these reference intervals encompass a broad spectrum of ill health. At the end of the day, having blood results that fall within the reference interval suggested by a particular laboratory does not necessarily indicate a good result.
This does not mean, however, that blood tests cannot be useful. In fact, I believe the information from blood tests is invaluable when interpreted based on values that reflect health rather than mindless use of reference intervals. For example, it’s appropriate to interpret a blood glucose level of 5.6 mmol/L or higher as being consistent with sub-optimal metabolic health, despite many laboratories reporting it as normal. Even more striking, many laboratories around Australia today still report a fasting insulin level of up to 20 mmol/L as normal when it would ideally be less than 6 mmol/L. Many doctors who specialise in low carb medicine are experienced in assessing metabolic health using blood tests, so making sure your health team are looking at both your blood test results and your physical signs of health is critical to making sure you’re overall health is being accurately assessed.