Imagine you have a medical condition that causes you to lose weight.
And miraculously, the more you eat, the more you lose. Pastry for
breakfast, pasta with clam sauce for lunch, a five-course dinner with
crusty bread and any dessert you like, plus snacks in between — the
sweeter the better. Follow this diet
and you can drop five pounds by tomorrow morning, shrink a dress size
for the weekend, show up at your high school reunion enviably trim.
There are a few downsides: Your hair will fall out, you’ll be tired
all the time, your mind will be muddled, and your extremities might
tingle strangely. Over time, you’ll likely go blind, lose a limb, end
up on dialysis, or suffer a sudden heart attack. But in the meantime,
you’d be able to eat anything you want and wear a size two.
Thousands of the approximately one million people with Type 1 (or juvenile-onset) diabetes are willing to take the risk. Mostly teenagers and young women, they suffer from a unique eating disorder called diabulimia.
These are girls growing up in the same diet-obsessed America as
everyone else. They might begin childhood average size, or even a
little fleshy. Then, inexplicably, they begin to lose weight no matter
how much they eat. The other symptoms of illness — excessive thirst
and fatigue — are far less compelling than the ability to eat an
entire bag of chips without getting fat. But eventually, someone else
catches on, a parent or a doctor, and they’re diagnosed with diabetes:
taught to read food labels as carefully as a scientist; warned to
restrict their caloric intake religiously; and put on a medication
called insulin that perversely, literally overnight, causes them to
plump up like a water-soaked sponge.
Further, they must go through life focused, constantly, on food —
but only its chemical elements, never its comfort or taste. And the
cure is hardly attractive: They will gain weight, even eating as
ascetically as monks. The untreated disease, however, with its wasting
syndrome? Now that has its appeal.
Katie, a young woman from suburban Minnesota, was a competitive
gymnast on a team that was Olympics-bound several years ago. At
4-foot-10, she weighed about 60 pounds; she collapsed often, but at the
end of every practice, her coach would stand her in front of the other
girls. This, he told them, was how a gymnast ought to look.
One day, Katie’s mother took her to the team doctor, not because of
her low weight or bouts of fainting, but because the team was going to
California for a meet and Katie was afraid to fly. They needed
sedatives. Katie’s regular physician, a man who’d been ignoring her
appearance and (it would later emerge) blood tests, in order to help
keep her ultra-slim, happened to be away on an emergency. The doctor
who was filling in took one look at the emaciated girl and ordered a
series of tests, then ordered an ambulance. Katie’s blood sugar levels
were the highest he had ever seen and she was on the brink of
ketoacidosis, a combination of high blood sugar and dehydration so
severe it causes a toxic buildup, deteriorates fat and muscle tissue,
and can cause coma or, if untreated, death.
In the hospital, endocrinologists diagnosed severe diabetes, got
Katie’s glucose (blood sugar) levels under control, and taught her how
to test her blood and give herself insulin injections. She left
mid-summer weighing 40 pounds more than when she’d gone in — a sturdy,
round-cheeked girl.
The response was horror: from her coach, who banished her from the
team, and from her parents, who had dreamed for years of sending their
daughter to the Olympics. Her peers weren’t horrified; they were
amused. People whispered when Katie walked down the halls at school and
taunted her constantly about how fat she’d become.
At first, Katie didn’t make the connection between insulin and her
weight. She tried dieting and wound up going into insulin shock
(potentially fatal hypoglycemia, or low blood sugar) twice. But it
wasn’t until college — after she’d begun eating pizza and drinking
beer and bulked up even more — that Katie realized she was doing
things backward. Rather than take her insulin and cut down on her food
intake, she had to do just the opposite if she wanted to lose weight.
"I remembered back to the time that I was admitted to the hospital
and how skinny I was," she says. "So I started skipping my shots."
Also, she ate only refined carbs and sugars: bread, brownies,
cookies, candy. The opposite of Atkins, this was a diet devoid of
protein and most nutrients, but it ensured she would absorb no
calories. No matter how many Dove Bars, croissants and bags of
M&M’s she consumed, the weight fell off.
The "magic" Katie had discovered actually was the most dangerous
component of her disease. Insulin, a hormone produced by the healthy
pancreas, breaks down sugars and carbohydrates and helps store their
component molecules — and calories — in the body’s cells. With Type 1
diabetes, the pancreas produces little or no insulin, so all the sugars
and simple carbs a juvenile diabetic consumes are "wasted," flushed
through the body without being stored. It all gets urinated out.
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