Illustration by Clifford Alejandro

Even if your mother's and grandmother's bones fractured from osteoporosis, or all the men in your family seem to die from heart disease, your future is far from preordained. You have ample opportunity to change your health outlook for the better, thanks partly to a new health care trend that has doctors diagnosing people with such conditions as prediabetes, preosteoporosis, and prehypertension (high blood pressure). An array of early screening tests can now pinpoint your potential problem areas. Then it's up to you to create a diet and lifestyle that provide maximum protection.

"Finding out that you have a predisposition to a disease is actually an opportunity," says Elena Michaels, PhD, a naturopath based in Santa Clarita, California. "It is a chance for you to take charge of your health. By making simple adjustments—such as working out with weights if your concern is osteoporosis—you will be much more in control of your future health."

Prediabetes ::
What is it?
Prediabetes (also known as metabolic syndrome) is a fairly new term that describes when a person's blood sugar level rises higher than normal but not quite high enough for a diabetes diagnosis. The estimated number of Americans with this condition is near epidemic: 41 million, or about 40 percent of adults 40 to 74. By contrast, only 6 percent of Americans have diabetes itself. But as Robert Rizza, MD, American Diabetes Association president and professor of medicine at the Mayo Clinic in Rochester, Minnesota, cautions, "If prediabetes is not properly treated, people are at a high risk of developing diabetes."

Type 2, or adult-onset, diabetes (to which prediabetes can lead) occurs when the pancreas produces the hormone insulin, which allows blood sugar to enter cells, but the cells of the body are insensitive to the insulin and thus become starved for sugar.

How do I find out if I have it?
Two tests help detect prediabetes: the fasting plasma glucose test (FPG) and the oral glucose tolerance test (OGTT). Administered in the morning, the FPG test measures blood sugar levels after an overnight fast.

The OGTT measures blood sugar after an overnight fast and again two hours following a sugary drink.

Should I get tested?
Everyone should have their blood sugar checked when they reach 45. "However, if you have certain risk factors," says Rizza, "you should certainly get checked earlier." So talk with your doctor about blood sugar testing if you are younger than 45 but are overweight, or have high blood pressure, low HDL cholesterol, high triglycerides, a family history of diabetes, or a history of gestational diabetes or giving birth to a baby weighing more than 9 pounds.

How can I ward it off?
The best advice for someone with prediabetes (or anyone else who wants to avoid diabetes), says Rizza, is to stay lean, stay fit, and eat a healthy and nutritious diet. "But even for those of us who will never be lean and fit," he recommends, "modest changes—such as losing 5 to 10 pounds and engaging in 30 minutes of daily moderate exercise—can slash the risk of diabetes by 60 percent."

In addition, a high-fiber diet helps control blood sugar. So as much as possible, cut out refined carbohydrates, such as sugary foods, white bread, and white rice. Instead, focus on whole foods, such as whole-grain breads and cereals, beans, legumes, and vegetables.

Preosteoporosis ::
What is it?
Coined just 15 years ago, the term osteopenia (or preosteoporosis) describes bone densities that are lower than normal. "It is not a disease per se," says Felicia Cosman, MD, clinical director of the National Osteoporosis Foundation, "but rather a descriptive term to identify people who are starting to lose bone mass."

Osteoporosis, which can be an outcome of osteopenia, is known as the silent disease because it has no outward symptoms until a bone breaks. "Ten million Americans, 80 percent of them women, have osteoporosis. But the number of people on their way to osteoporosis is much higher: 44 million Americans—33 million women and 11 million men—have osteopenia," says Cosman.

How do I find out if I have it?
A noninvasive bone density scan measures bone strength. Bone density scans are rated by something called a T score. Normal bone density is anything above a T score of 1. "Osteopenia starts at a score of –1, but it is not really a concern until the score drops to between –1.5 and –2. Osteoporosis is diagnosed at –2.5," Cosman explains.

Should I get tested?
Because osteoporosis overwhelmingly affects women, all women should have a bone density test by age 65. Younger women should get tested if they have entered menopause and have any additional risk factors. These include a personal or family history of fractures; smoking; drinking in excess; taking corticosteroid or thyroid medications; or having type 1 diabetes or chronic liver or kidney disease. Men who pursue exclusively non-weight-bearing exercise programs, such as serious cyclists, may also want to get tested.

A recent study at San Diego State University found that even very fit male cyclists could be at high risk for developing osteoporosis later in life if they pursued no other forms of physical activity (Osteoporosis International, 2003, vol. 14, no. 8).

How can I ward it off?
For starters, stop smoking and don't drink alcohol excessively (no more than two drinks on any given day). If you're taking bone-sapping corticosteroid drugs (to treat rheumatoid arthritis, asthma, or eczema) or thyroid hormone medications (to treat hypothyroidism, goiter, or Hashimoto's disease), be certain you are taking the appropriate dose.

Regular exercise helps tremendously; in particular, high-impact activities such as jumping, running, or aerobics. If you have joint problems, try lifting weights, which benefits your bones because it's load-bearing.

Finally, give your bones the nutrients they need to stay strong—especially calcium and vitamin D. Calcium-rich foods include milk, cheese, yogurt, tofu (if processed with calcium sulfate), calcium-fortified orange juice, kale, and bok choy. Aim for 1,200 mg per day of calcium. Recent research shows that taking 1,000–2,000 IU of vitamin D daily not only helps prevent bone diseases but many other conditions as well (American Journal of Clinical Nutrition, 2003, vol. 77, no. 1).

Prehypertension ::
What is it?
Blood pressure is the force of blood against artery walls. When this force increases beyond optimal levels, it is known as high blood pressure or hypertension. High blood pressure causes the heart to work too hard and increases the risk of heart disease and stroke. When blood pressure rises above the normal range but hasn't quite reached hypertension status, it qualifies as prehypertension. Having prehypertension makes it more likely that high blood pressure will develop, unless you make diet and lifestyle changes.

How do I find out if I have it?
A sphygmomanometer—the technical name for a blood pressure cuff—gauges blood pressure. Normal blood pressure is 120/80 and below. High blood pressure begins at 140/90. Prehypertension falls in the middle of these readings.

Should I get tested?
"All adults should have their blood pressure checked every two years, even if it has been normal," says Nieca Goldberg, MD, national spokeswoman for the American Heart Association and author of Women's Healthy Heart Program (Ballantine, 2006).

How can I ward it off?
"A good first step to lowering blood pressure is to reduce your intake of salt to no more than 2 grams of sodium per day," Goldberg recommends. Part of the ongoing DASH diet study, sponsored by the National Institutes of Health, recently showed that a diet rich in fruits, vegetables, whole grains, and low-fat dairy products reduced blood pressure (Current Atherosclerosis Reports, 2005, vol. 7, no. 6). In addition, regular aerobic exercise (several times a week) lowers blood pressure—even if you don't exercise enough to lose weight. Of course, shedding a few extra pounds can slash blood pressure even more.

Victoria Dolby Toews, MPH, has been writing articles and books about health issues since 1993. She and her family live in the Pacific Northwest, where they enjoy hiking, cross-country skiing, and cycling.