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    Old Symptoms, New Risks

    Flashes, flushes, fatigue — they may have meant nothing in your younger years. But now they could signal a serious problem. What to watch for, what to do

    Symptom: Midday Crash

    What it may have meant in your youth: Too many late nights
    What it may signal now: Insulin resistance
    As you age or if you gain a lot of weight, cells in your body may develop trouble using the hormone insulin to take sugar from the blood and put it into your cells. So sugar builds up in your bloodstream, and the pancreas is required to make more and more insulin to try to bring the blood sugar level down. All that insulin eventually pulls a lot of sugar from your blood, fatiguing you — a crash that is especially severe hours after a starchy meal (like a gooey Danish or a huge muffin for breakfast), says Stuart Weiss, M.D., clinical assistant professor of medicine at NYU School of Medicine. Fatigue is only part of the problem: Insulin resistance also puts sufferers on the road to full-blown type 2 diabetes.

    If this happens to you: Excess weight is a major risk factor, but losing just a little (5 to 10 percent of your body weight) can make a difference. It's also important to get at least 30 minutes of exercise a day. To avoid blood sugar crashes, have whole grains, proteins, and healthy fats at every meal and snack. Even fruits can be too sugary if you eat a lot, so balance a modest portion with proteins — for example, dip apple slices in hummus, suggests Mary Gocke, R.D., a clinical nutritionist at New York City's Continuum Center for Health and Healing. Eating almonds may also help; last year, Loma Linda University researchers found that prediabetics who munched on two ounces of almonds (or about 46) a day improved their insulin response significantly more than a no-nut group. But note: Both sets of volunteers also followed individualized low-calorie diets. If you're overweight or have a family history of insulin problems, ask your doctor about being tested for prediabetes; at 45, everyone should be screened.

    Symptom: Bloating

    What it may have meant in your youth Your period was on its way
    What it may signal now: Food intolerance
    While intolerances are becoming more common at every age, in midlife your body can develop sensitivities to foods you've never had a problem with before, especially dairy, gluten (in wheat, rye, and barley), and, surprisingly, the sugar fructose (often found in packaged foods like energy bars). These sensitivities can show up without explanation, says Benjamin Lebwohl, M.D., instructor in clinical medicine at New York-Presbyterian Hospital/Columbia. They are not true food allergies, which involve specific components of the immune system and generally start in childhood; rather, intolerances produce gastrointestinal symptoms like gas, bloating, pain, and diarrhea anywhere from 30 minutes to six hours after eating the item.

    If this happens to you: See your doctor if you suspect that gluten is the offender. You'll need to be checked for celiac disease with a blood test and, if necessary, an intestinal biopsy. If that's the diagnosis, you'll have to follow a strict no-gluten diet. For other potentially problematic foods, note when your symptoms appear (After you drink a glass of milk? When you down a protein bar?) to try to zero in on the culprit. Then stop eating those foods for three weeks to clear them from your system; reintroduce them, and note your symptoms. Or, you can eliminate all suspects and resume eating each, one by one, to see if it causes problems. Even if the bloating returns, you still may be able to tolerate a problem food in small quantities, Dr. Lebwohl says. Or, try other forms--for example, getting your dairy from hard cheese and yogurt, rather than milk, often works. Because bloating can be a symptom of other conditions — most ominously, ovarian cancer — consult your doctor if the problem persists.

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