By Marc Braman, MD, MPH

MB (Marc Braman, MD, MPH):
“The Dis-Stress of Diabetes.” I’m Dr. Braman and I’m joined by medical student, Marc Anderson. Welcome, Marc.

MA (Marc Anderson):
Thank you, Dr. Braman.

So, I wanted to ask you a few questions about stress and how it relates to diabetes. First, can the chronic high levels of stress many of us deal with every day cause diabetes or make it worse?

MB:
That’s actually a great question and something that many researchers are currently very interested in studying. Many people don’t realize that stress has major effects on our blood sugar and metabolism. There are a myriad of other ways that stress affects the body that we are still figuring out, especially chronic stress. But study after study shows that chronic emotional and mental stress contributes to diabetes, obesity, anxiety, depression, and a number of other chronic illnesses. We also know that these conditions contribute to each other, making understanding the details rather challenging.

MA:
When we talk about stress, what kind of stress are we talking about?

MB:
Well there are two main kinds of stress: acute and chronic. Acute stress is short-lived and happens during an event like a car crash, a fist fight, or even waking up late for work. This is normal and short-lived stress that is caused by your nervous system and adrenal glands secreting adrenalin into the bloodstream and directly into certain organs. This speeds up your heart and breathing rate, dampens pain, increases reaction time, and releases stored sugar for your body to use as fuel among other things; this helps you to deal with and survive the immediate event, and then you should return to a normal state after a relatively short period of time.

Chronic stress, the kind that many of us deal with as a result of things like money problems, social or psychological issues, the extraordinary busyness of modern life, is not normal at the high levels that far too many of us experience on a daily basis. This kind of abnormal stress has been implicated in a number of chronic health conditions.

MA:
So you mentioned that we don’t know exactly how chronic stress affects diabetes, but what do we know?

MB:
Over time our bodies try to adapt to constantly being in a high stress state by revving up the production of certain hormones like cortisol and immune system substances like interleukin-6. When stress chemicals are elevated, especially for long periods of time, we get increases in systemic inflammation, our immune systems weaken, our bodies want to put on weight, and a host of other negative effects. Along with weight gain our cells become resistant to insulin, which is the fundamental physiology of type 2 diabetes.

MA:
Can’t having a chronic condition like diabetes cause higher levels of stress?

MB:
Absolutely! Diabetes, along with many other chronic diseases, can greatly affect ones stress levels independent of any other factors. Additionally, research shows that diabetics report more problems like financial strain, less social support and cohesion, less sense of control in their lives, less optimism and higher levels of anxiety and depression. They are also more likely to be divorced or live alone. And having diabetes has been shown to impair the body’s ability to cope with these stressors. It is actually quite fascinating. It is a chicken and egg scenario. Does the stress produce the diabetes or does the diabetes produce the stress? It is likely some of both, and likely varies a lot from individual to individual.

MA:
That sounds really complex. So how can lifestyle medicine treat the stress component of diabetes?

MB:
Great question! First, we need to understand and give proper priority to stress for diabetes specifically. It is just as important as diet and exercise, if not more important in some ways. It directly changes our blood sugar, our body’s ability to use glucose or be resistant to it, and many other aspects of metabolism. It has strong indirect effects of making us tired and not feeling like exercising, or doing stress eating or drinking, or just not really caring. Part of lifestyle medicine treatment for diabetes means we need to be looking for and addressing the anxiety and depression that is often present in diabetes.

MA:
Are there specific techniques or treatments that are particularly useful in treating the stress factor of diabetes?

MB:
There are many tools to help lower stress, like exercise, meditation, positive regular social engagement like church or scouts, and improving coping skills. The ones that I have found most helpful for the least effort are: 1 – getting people connected in health promoting community whether that’s a good doctor, a fitness center, group exercise, a support program, whatever that is. And, 2 – teaching people basic therapeutic relaxation skills, which many people do not have. Most people don’t even know what it feels like to physiologically, genuinely relax. It is really fun, both for the doctor and the patient, as people get control of the things driving their diabetes (including stress) and they feel so much better and enjoy life so much more.

Treating the lifestyle medicine stress component of diabetes is good medicine!

MA:
Well, thank you so much Dr. Braman. It was a pleasure talking to you.

MB:
Thank you, Marc.

Disruption of Multisystem Responses to Stress in Type 2 Diabetes: Investigating the Dynamics of Allostatic Load. Steptoe, A., R. A. Hackett, A. I. Lazzarino, S. Bostock, R. La Marca, L. A. Carvalho, and M. Hamer. Proceedings of the National Academy of Sciences 111.44 (2014): 15693-5698. Web. 22 Nov. 2016.

Acute Psychological Stress Results in the Rapid Development of Insulin Resistance. Li, L., X. Li, W. Zhou, and J. L. Messina. Journal of Endocrinology 217.2 (2013): 175-84. Web. 22 Nov. 2016.

Psychosocial Care for People With Diabetes: A Position Statement of the American Diabetes Association. Young-Hyman, Deborah, Mary De Groot, Felicia Hill-Briggs, Jeffrey S. Gonzalez, Korey Hood, and Mark Peyrot. Diabetes Care 39.12 (2016): 2126-140. Web. 21 Nov. 2016.

Diabetes and Mental Health. Canadian Journal of Diabetes 37 (2013): 87-92. Web. 21 Nov. 2016.

Marc Braman, MD, MPH

Dr. Braman is board certified in preventive medicine/public health and occupational/environmental medicine. He is founding member, second President and first Executive Director of American College of Lifestyle Medicine and founder and current president of the Lifestyle Medicine Foundation which created LifestyleFACTS.org. He provides lifestyle medicine care in a wide variety of settings as well as initiating efforts to establish professional standards for the field of lifestyle medicine and planning and conducting national professional conferences in lifestyle medicine.

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