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En español | Turn on the television, scan the headlines or scroll through social media and you'll see some alarming stats: More than 1 in 3 people have prediabetes! Fifty-eight million people have precancerous skin lesions! It's enough to make you prematurely gray. And you may wonder, Where did all these new prediseases come from?
"There's ‘pre-’ almost everything,” says Mara Schonberg, associate professor of medicine at Harvard Medical School. Many of these diagnoses have existed for only the past few years. And while they can motivate us to take control of our health, “diagnosing prediseases, especially in older adults, can occasionally be more harmful than helpful,” Schonberg adds. Preconditions often don't turn into the full-blown disease, and a diagnosis can cause added stress and lead to unnecessary medical treatment.
That said, knowledge is power, says Bernadette Anderson, a family physician based in Columbus, Ohio. “You have an opportunity to prevent the full-fledged disease from actually occurring.” Here's what it means, and what to do, when the doctor says …
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One-third of Americans — and just about half of people over 65 — have fasting blood sugar levels that float between normal (below 100) and type 2 diabetes (above 125), a condition called prediabetes. That sounds pretty dire until you consider that almost nobody was diagnosed with prediabetes before 2010. And the medical community doesn't completely agree on whether the epidemic is real. “Prediabetes is questionable because it's very fuzzy — such a small percentage of people who get that label ever actually progress to diabetes,” says Eric Topol, a cardiologist and director of the Scripps Research Translational Institute in San Diego.
On one hand, blood sugars in this intermediate range do increase the risk of diabetes (and with that, the risk of heart disease, stroke and Alzheimer's disease). But some research finds that every year, just 2 percent of prediabetics go on to a full-blown diabetes diagnosis, and less than half of those diagnosed with prediabetes will become diabetic within a decade. “I have seen some patients who have diabetes the next time we check, and some who stay in the prediabetes range or go into the normal range for years and years after,” says Grenye O'Malley, an endocrinologist and assistant professor at the Icahn School of Medicine at Mount Sinai in New York City.
Doctor's orders: Your physician should have you come back in six months to a year for one of three tests, O'Malley says: a fasting blood sugar test, a hemoglobin A1c test (which measures average blood sugar levels for the past two to three months) or an oral glucose tolerance test (where you fast, then drink a sweet liquid and measure blood sugar levels two hours later). In the meantime, he or she will tell you that weight management needs to become your top health priority: Gaining more weight could push you into the diabetic realm, while just a 5 to 7 percent drop on the scale (as little as 10 to 14 pounds for a 200-pound person) cuts the risk of developing diabetes in half. And while there are at least 10 classes of drugs on the market that target prediabetes, medications seem primarily to delay, rather than prevent, the onset of full diabetes. “In the largest trials, lifestyle changes with weight loss were the most effective prevention for diabetes—even more so than drugs,” O'Malley says.
Your action plan: Ask your doctor to test your vitamin D levels, and consider a supplement. In a 2018 study (average age of participants: 74), one-third of those with vitamin D levels above 30 nanograms/milli-liter had a risk of developing diabetes, but only one-fifth of those with levels above 50 ng/ml had this risk. (Most people are in the 20-40 ng/ml range.) And eat more fruit: People with prediabetes who ate two cups of raspberries with breakfast dramatically lowered their blood sugar levels, according to a recent study in the journal Obesity. Flavonoids and polyphenols in the fruit have antidiabetic properties, the researchers say.
Symptom alert: Increased urination, extreme thirst, blurred vision or unintentional weight loss are all signs that you may be tilting toward full-blown diabetes.
Precondition: Stage 1 hypertension
In 2017, new guidelines did away with the term “prehypertension,” which is why you may have heard the terms “elevated blood pressure” or “stage 1 hypertension.” In the U.S., stage 1 hypertension means your systolic blood pressure — the top number — is rising into the 130s, and your doctor should advise you about treatment, notes the American College of Cardiology. But in a study of 12,000 patients in Germany, where that BP level isn't considered worthy of treatment, researchers found that, over 10 years, there was no increased risk of mortality from cardiovascular disease for people in this category, once other factors were considered.
Doctor's orders: The real risk here is blood pressure (BP) creep: Once your systolic blood pressure settles above 130, it's critical to begin making lifestyle changes, says Icilma Fergus, a cardiologist and director of cardiovascular disparities at Mount Sinai Medical Center in New York City. And if you have heart disease and diabetes, medication could be an option. If you're on a new BP medication, the doctor may choose to see you once or twice a month at first. Otherwise, start taking your BP on your own — weekly if it's generally stable and daily if it's not (or if you have a goal in mind). Use an at-home, cuff-style biceps monitor, or visit a pharmacy with a BP measuring station. Try a low-sodium diet such as the DASH (Dietary Approaches to Stop Hypertension) eating plan for at least two weeks, consuming no more than 1,500 milligrams of sodium a day. “We have a very rapid response to reducing salt intake,” says Fergus. In fact, the DASH diet has been found to be as effective as drugs for many adults.
Your action plan: Take a nap. Middle-of-the-day sleep appears to lower blood pressure just as much as taking low-dose antihypertensive medications, according to a recent Greek study. “There is a natural drop in blood pressure when we sleep and likely a downregulation of our sympathetic nervous system,” explains Chris Winter, a physician based in Charlottesville, Virginia, who wrote The Sleep Solution. “Doing it consistently can put your body into a rhythm of turning down the pressure within your circulatory system every day."
And fill up on foods high in potassium (potatoes, bananas, kidney beans, wild salmon) as well as calcium and magnesium (yogurt, dark leafy vegetables and almonds). They help stabilize blood pressure, says Anderson.
Symptom alert: Hypertension is called the silent killer because it's often symptomless, Fergus points out. Instead of relying on signs, keep a diary or a log so your doctor can review it at appointments; call your physician if you get persistently elevated readings or three readings of 150/90.
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Precondition: Mild cognitive impairment
First, take a deep breath: About 60 to 70 percent of people with MCI don't progress to dementia. MCI describes common, mostly short-term memory problems — the kinds that can cause momentary embarrassment but don't interfere with day-to-day life.
Doctor's orders: Have appointments every six to 12 months to make sure MCI isn't progressing toward dementia. There's no one test for dementia, so visits might involve full physical exams, memory tests or lab work. There's also no standard treatment or medication. As a result, adopting a Mediterranean diet (including fruits, vegetables and olive oil) is one of the World Health Organization's primary recommendations for reducing risk.
Your action plan: Commit to taking a brisk, 30-minute hilly walk four times a week. This improved brain functioning in people with MCI, notes a study published in the Journal of Alzheimer's Disease. The reasoning is kind of sci-fi: People who are experiencing subtle memory loss can experience a compensatory increase in blood flow to the brain, says J. Carson Smith, a professor at the University of Maryland School of Public Health and the study's lead author. “Exercise seemed to normalize this compensatory blood flow, and that decrease was related to an improvement in cognitive test scores.” The trick: Your cardio should be at least moderately hard (you're a bit out of breath; maybe you're sweating).
Symptom alert: You experience increasing difficulty in functioning (you need help managing medications, finances or appointments), or your family or friends notice more memory changes. These are signs that MCI could be progressing toward dementia, says geriatrician Audrey Chun, director of the Martha Stewart Center for Living at Mount Sinai in New York City.
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We all lose bone mass as we age. When levels get lower but not quite low enough to be deemed osteoporosis, that's called osteopenia. In this case, it ought to serve as a wake-up call. For women over 45, osteoporosis accounts for more days spent as a patient than for diabetes, heart attack or breast cancer. The National Osteoporosis Foundation recommends that women over age 65 and men over 70 have a bone density test. But anyone over age 50 with risk factors (you have broken bones, have lost height or have a family history of osteoporosis) should consider asking about a bone scan.
Doctor's orders: Calcium and vitamin D are generally the first things your physician will talk to you about: Women 51 and older and men 71 and older should have 1,200 mg calcium and 800 to 1,000 mg vitamin D a day; men under 71, 1,000 mg calcium and 800 to 1,000 mg vitamin D a day. Your doctor should also talk to you about taking up weight-bearing sports or exercises such as hiking, tennis or resistance training.
How soon you should return for a checkup depends on how close you are to osteoporosis; it could range from a year to five years, Chun says. Unless you're at risk of a fracture, you likely won't need medication.
Your action plan: In addition to supplements, consider a food source that's been shown to reduce osteoporosis risk: yogurt. According to a study in Ireland of more than 5,700 people, increased yogurt consumption was associated with a significantly reduced risk of osteopenia and osteoporosis in men and women. Yogurt is high in calcium and also contains probiotics, which may play a role, too. In a 2018 study of 90 women (average age: 76), probiotics found in yogurt cut bone loss by half. Meanwhile, scientists have developed Bone, Estrogen, Strength Training (BEST), a workout that some believe is optimal for preventing osteoporosis. “The specific exercises focus on strengthening target muscle groups that have connections to bone areas that have a high risk of fractures,” says Linda Houtkooper, an emeritus professor of nutritional sciences at the University of Arizona and one of the program's lead researchers. For the best results, do the following workout three times a week, on alternate days — or one day a week at a minimum:
- A 3- to 5-minute cardio warm-up
- 20 minutes of strength-training exercises, with 2 sets of 6 to 8 repetitions of each exercise: back extensions, lat pull-downs, leg presses, one-arm military presses, seated rowing and wall or Smith-machine squats
- 15 minutes of cardio weight-bearing activity (weighted walking, stair climbing or jogging)
- 5 minutes of abdominal exercises
- 5 minutes of balance and stretching
Symptom alert: Watch for loss of height, or fractures.
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Precondition: Precancerous lesions
Also known as actinic keratoses, these are scaly, sandpapery dry spots that are unaffected by moisturizer and show up on sun-exposed places such as your scalp, face, ears, neck, hands or forearms. Leave them alone and they might go away. But they also have a 1 in 10 chance of morphing into a nonmelanoma skin cancer called squamous cell carcinoma, says dermatologist Meera Sivendran, an assistant professor at the Icahn School of Medicine at Mount Sinai. Plus, one study showed that people with squamous cell carcinoma were more than three times as likely to develop melanoma.
Doctor's orders: Squamous cell cancer is less prone to spread than melanoma, but your doc will probably play it safe and freeze off the lesions with liquid nitrogen. Wear sunscreen and a broad-brimmed hat that covers your ears — a high-risk, overlooked spot. You might look goofy, but it could save you from both future cases and potentially disfiguring removal procedures. Depending on other risk factors, you'll likely be expected back within six months or a year for a skin check.
Your action plan: Drink less wine in the sunshine. Risk of squamous cell carcinoma shot up 11 percent for every beer or glass of wine consumed each day, according to a study published in the British Journal of Dermatology. Combining booze and beach vacations may be particularly hazardous: There's some data to suggest that alcohol lowers antioxidant defenses, making you more vulnerable to the sun's rays, says Joshua Zeichner, a dermatologist at New York City's Mount Sinai Hospital.
Symptom alert: Squamous cell cancer can appear as scaly red patches, open sores or warts that crust or bleed.
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Precondition: Borderline high cholesterol
If your cholesterol levels are above normal but not quite in that “high” range yet, it's still worth making changes. Even borderline high cholesterol levels can put you at an increased risk for heart attack or stroke.
Doctor's orders: You could potentially receive a prescription for a statin; hopefully you'll get an order to clean up your diet, too. “The use of statins to control cholesterol shouldn't necessarily be your first go-to,” Anderson says. A recent study in JAMA Internal Medicine found that statins are no more effective at preventing cardiovascular events than dietary changes: Cutting saturated fat intake (red meat, full-fat dairy products) to about 5 percent of your diet and filling up on fiber and omega-3 fatty acids (salmon, walnuts) can work as well as medications, she adds.
Your action plan: Aim for 25 grams of soy protein (edamame, tempeh) daily. Doing so can reduce LDL cholesterol by 3 to 4 percent, perhaps by inhibiting the synthesis of a protein that carries this “bad” cholesterol, a University of Toronto study showed. Swap your beef burger for a soy one; you could cut cholesterol levels 3 to 6 percent more, says David Jenkins, a physician on the faculty of the University of Toronto and one of the study's authors. Consider taking a genetic test that offers a polygenic risk score measuring your likelihood of developing a slew of conditions, including high cholesterol. It could help you learn whether you'd benefit from medication.
Symptom alert: There are usually no symptoms. To check cholesterol levels, you need a periodic blood test.
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Precondition: Colon polyps
If your doctor removed polyps — small growths on the lining of your colon — during a colonoscopy, that's normal. Up to 50 percent of the American population gets them, says Folasade P. May, a gastroenterologist at UCLA Health in Los Angeles. Docs worry only about the precancerous ones but remove all of them, she says, because there's no way to discern between benign and precancerous polyps just by looking.
Doctor's orders: Keep up on your colon cancer screenings. If your doc found more than three high-risk polyps called tubular adenomas (or one that was bigger than a centimeter), you'll likely need a colonoscopy every three years; otherwise, once every 10 years is the standard. Also, do a diet check. Processed foods, red meat and booze all increase your risk for colon cancer. Fruits and vegetables reduce it.
Your action plan: Don't drink your calories. High-fructose corn syrup (the sugar found in soda) can feed polyps, a recent study published in the journal Science found. But fruit juice and smoothies can pose problems, too, says Lewis C. Cantley of Weill Cornell Medical College in New York City and one of the study's authors. The reason? Speed. “When delivered in a liquid form, sugar rapidly passes through the small intestine and makes its way to the colon, where the polyps can eat it.” The sugar in a single 12-ounce soda or a glass of OJ is enough to drive polyp growth — but the same amount of sugar consumed as part of natural whole fruit doesn't do this, he notes.
Symptom alert: Most of the time, colon cancer comes with no symptoms until late in the game. That's why it's best to keep up with screenings.
Journalist Cassie Shortsleeve has written for Prevention, Women's Health, Men's Journal, Outside and other publications.