What exactly is prediabetes?

According to the CDC, 1 in 3 Americans over the age of 20 has prediabetes and for those over the age of 65, it’s 1 in 2. Up to 30% of those with prediabetes will develop type II diabetes within 5 years unless they make lifestyle changes including weight loss and increased physical activity.

30% of those with prediabetes will develop type II diabetes within 5 years Click To Tweet

What does prediabetes mean?

Though not recognized as an official medical diagnosis, prediabetes is a term used when a person’s fasting blood glucose (fasting plasma glucose) and hemoglobin A1c are higher than normal but aren’t high enough for a formal diabetes diagnosis. Fasting blood glucose and hemoglobin A1c are two tests doctors use to assess glucose control and diagnose diabetes. Normal fasting blood glucose is below 100, but diabetes isn’t typically diagnosed until fasting glucose reaches 126mg/dL or higher. Glucoses in between 100-125 are typically considered prediabetic results. For the hemoglobin A1c, normal results are 5.6% or below, while diabetes is typically diagnosed at 6.5% or higher, so someone with lab results in between 5.7-6.4% may be told he or she has prediabetes.

Fasting Blood Glucose levels

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A1C levelsScreen Shot 2015-01-27 at 1.21.35 PM

What are the symptoms of prediabetes?

Unfortunately, many people with diabetes or prediabetes don’t experience symptoms. Having your doctor run a fasting glucose, oral glucose tolerance test or a hemoglobin A1c is the best way to determine your current risk.

What are the risk factors?

Knowing the risk factors for developing diabetes is also helpful in preventing the progression of prediabetes to diabetes. Risk factors include age, gender, family history, physical activity level, body weight, pregnancy history and race.

Every decade over 40 increases your risk for diabetes and men are at higher risk than women. If your family history includes an immediate blood relative (parent or sibling), then your risk also goes up. If you’re getting less than 150 minutes of exercise per week and are overweight or obese, had gestational diabetes or birthed a baby weighing more than 9 pounds, those are additional risk factors. And while prediabetes rates don’t differ across racial groups, diabetes is most common in Native Americans and Alaskan Natives, then non-Hispanic blacks, Hispanics, Asian Americans and non-Hispanic whites respectively. Certain medications, like statins, and other health conditions like polycystic ovarian syndrome can also increase your risk for diabetes, so be sure to talk to your doctor about any concerns. Click here to take the American Diabetes Association’s risk assessment test.

How can I lower my risk for diabetes?

Fortunately there are many things you can do to take control of your health. Make sure your doctor is running a hemoglobin A1c so you know your results. Start exercising, aiming for at least 150 minutes a week, and get to a healthy body weight where your BMI is under 25. You can calculate your BMI by going here. Even losing just 10% of your current body weight can make a big difference! Make sure to eat lots of fruits and vegetables and limit refined carbohydrates like white rice, white pasta, sodas, sweet tea, crackers and desserts. Cut back on portions and find an activity you enjoy that gets you up and moving around. Feeling short on time? Research has shown three 10-minute walks a day can be just as effective as one 30-minute walk, so split up the time if needed. If you smoke, consider joining a tobacco cessation program. Put yourself in control of your health and be encouraged to know that you have the ability to change from having prediabetes to experiencing normal, healthy blood glucose levels.

prediabetes-inforgraphic

The meal frequency myth

“Eating five to six mini meals a day … keeps your metabolism humming 24/7,” proclaims a Redbook article. “Have a small meal or snack every 3 to 4 hours keeps your metabolism cranking,” notes a WebMD slideshow

You’ve probably heard similar statements—all based on the assumption that food grazing increases your basal metabolic rate (BMR) or the number of calories used in a day, leading to more fat loss.

Is there any truth to this? Are six meals a day better than three? And what about fasting? Does skipping meals negatively impact your health?

Deconstructing the metabolic fire analogy

Advocates of increased meal frequency usually compare BMR to a fire. If you think of a fire, the fuel is wood and when wood is thrown on an existing fire, more fire is produced, throwing off heat.

If you apply this analogy to people, the wood is calories from food and the reaction that produces heat is the thermic effect of food (TEF), which is the amount of energy your body has to expend to process food for storage and use.

Take a look at the chart below the bulleted list. It compares TEF for three people who eat the same amount of calories and macronutrients (fats, carbohydrates and protein):

  • One eats six meals a day (breakfast, a mid-morning snack, lunch, an afternoon snack, dinner and an evening snack)
  • One eats the traditional three meals a day (breakfast, lunch and dinner)
  • One eats only two meals a day (breakfast and dinner)
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This chart compares the thermic effect of food (TEF) during a day for three people who eat the same amount of calories and macronutrients, but eat in different patterns.

While the TEF spike duration and frequency is different, the total amount of TEF for all three individuals is identical. This means the amount of calories used in a day is the same, regardless of meal frequency.

The amount of calories used in a day is the same, regardless of meal frequency Click To Tweet

Research confirms this: Studies in both 1997 and 2010 noted as long the total amount of food eaten is the same, you can gorge or nibble—neither approach promotes more or less weight loss than the other.

Returning to the fire analogy, eating less but more frequently is like continually throwing kindling on the fire all day long whereas eating more in a sitting (but less frequently) is like throwing a big log on the fire.

What about fasting?

Many are fearful to skip meals because they hear that fasting lowers your BMR, putting your body into starvation mode.

This is oversimplified and inaccurate. It may be true that fasting decreases your BMR, but with one big caveat: It takes over three days of fasting to accomplish this.

In fact, researchers have found that short-term fasting actually increases the amount of calories you burn while at rest and doesn’t affect cognitive performance, activity, sleep or mood.

Could fewer meals be better for you?

A lot of recent research has come out in favor of eating less frequently. For example, a 2014 study found that frequent snacking might stress the liver, leading to a greater risk of fatty liver disease.  

Fasting for short periods of time has been found to have the following health benefits:

Numerous studies have shown that short-term fasting has health benefits and fewer meals may be better for you Click To Tweet

And lowers the risk of:

Eat the way that works for you

There’s no reason to stress out about meal frequency. If you find it easier to make healthy food choices by eating a couple of meals a day and a snack or two, then stick to that. If you like to spend more of the day fasting so you can enjoy larger meals and because it suits your schedule, then stay with that approach.

When it comes to weight loss, overall calories matter more than meal frequency, so always keep an eye on your portions. If you have issues with blood sugar control, work with your doctor to figure out a meal schedule that works for you. 

Reviewed by Kristen Kizer, R.D.