We're still accepting applications for fall ! Apply Today. Home The Pursuit Is Your Mood Disorder a Symptom of Unstable Blood Sugar? Is Your Mood Disorder a Symptom of Unstable Blood Sugar?

Isa Kay, MPH '18 October 21, Many people may be suffering from symptoms of common mood disorders, such as depression and anxiety, without realizing that variable blood sugar could be the culprit. Tags Alumni Nutritional Sciences Mental Health Nutrition.

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Student Resources Career Development Certificates Internships Graduation. Connect Contact Us The Heights Intranet Update Contact Info Report Website Feedback Directory. Heterogeneity of regression was tested to ensure the validity of the covariance adjustment.

Statistical analysis was accomplished using SAS Proc Mixed version 8. The initial mixed-model regression analysis included the four replicate measures as levels of a class variable to provide an omnibus test of differences among time points.

The regression analysis provided estimated values for HbA 1c for the two groups and the four follow-up points, and these values are shown in Fig. A second mixed-design regression analysis was performed to test the linear effects of time after treatment and the interaction of time with treatment.

Using coefficients provided in the solution of this regression equation, the linear effects of time were plotted in Fig. The plot of the linear effects shows the contrasting downward and upward trends of the treatment and control groups more clearly.

These analyses support the hypothesis that stress management training would improve glycemic control over time, although data suggest that the benefits may take several months to appear and may be modest in size.

To test the hypothesis that stress management training would benefit subjects who had higher anxiety, we tested mixed regression models that included baseline levels of trait anxiety STAI-trait as a factor, along with factors for treatment group and time and baseline levels of HbA 1c as a covariate.

However, neither the effect of baseline trait anxiety score nor any of the interactions with treatment and time was significant. These results provide no evidence to support the hypothesis that stress management training is of greater benefit to subjects who began the training with higher levels of anxiety.

This analysis was repeated with data from the treatment group alone and, again, the effects of baseline trait anxiety and the interaction with time were not significant. Additional analyses examined the effect of treatment on measures of perceived stress, anxiety, and general psychological health.

Although treatment and control groups did not differ at baseline on any of these measures, the covariance approach was again used to assess changes over time in these variables.

Scores on the PSS, STAI-state scale, and the GHQ collected at 2, 4, 6, and 12 months were analyzed individually by mixed-design regression, with treatment group and time as experimental factors and baseline levels of each measure as a covariate.

These collected analyses provided no evidence of effects attributable to stress management training. All of the main effects and interactions of treatment group were nonsignificant.

The main effect of time was also nonsignificant. Changes in diet and physical activity were evaluated by analyses of calorie consumption based on diet analysis and scores on the DASI. Mixed-design regressions testing the 2-, 4-, 6-, and month follow-up data as repeated measures with the baseline value as a covariate revealed no effects of treatment group or group-by-time interactions.

Therefore, neither diet nor physical activity changed in a way that could have produced the observed effect on glycemic control. Consistent with standard stress management training, after subjects had successfully learned to relax, they were instructed to reduce formal practice with the relaxation tape.

However, they were free to use the tape as often as they wished. Self-reports collected at follow-up visits revealed that subjects did transition from formal practice.

Shortly after completion of training, subjects in the stress management group reported using the cassette tape an average of 3. At 12 months of follow-up, the group average was 0. Therefore, evidence suggests that subjects did decrease formal practice over time, as they learned to use the techniques during daily life.

The dropout group differed only in age Proportions by sex, race, and treatment group did not differ. Therefore, failure to complete the study was not related to any of the study variables. The findings from this investigation support the efficacy of outpatient stress management training for the improvement of glycemic control in patients with type 2 diabetes.

At the end of a 1-year follow-up period, patients who received training in stress management skills demonstrated approximately a 0. Although previous studies using more intensive one-to-one interventions have shown that stress management can improve glycemic control, this is the first demonstration that a simple, cost-effective group approach can have a meaningful therapeutic impact.

It is interesting that the impact of stress management did not become evident before the month data collection point. Control and experimental patients both showed decreased HbA 1c up to 6 months. However, after that point, the average blood glucose of control subjects deteriorated, while that of stress management subjects continued to improve.

This effect was not due to changes in BMI, diet, or exercise in the stress management group, because the two groups did not differ on these variables over the month course of the study. Practice data from this study suggest that subjects complied with treatment instructions as patients in our other stress management programs.

Subjects had been instructed to decrease formal practice with the tape as they gained proficiency in relaxation. Although we have no data to prove that patients began to internalize cues for relaxation as formal practice waned, a similar decrease in formal practice is seen in our clinic population undergoing stress management for other conditions.

It does seem that clinical improvements may not require continued daily practice to be effective. The second aim of this study was to examine whether patients with higher levels of anxiety would respond more to treatment.

Remarkably, baseline trait anxiety did not predict treatment effects. This finding adds to controversial literature demonstrating that highly anxious 5 , stress-responsive 9 , and low-anxious individuals 13 benefit differentially from stress management training.

Although these previous studies reported effects of individual differences in anxiety proneness, we could not replicate these findings in the current investigation.

Even though a modest group-based stress management program was successful in improving glycemic control in this study, stress management training may not be an option for every patient. Previous investigations have shown that anxiolytic therapy with benzodiazepines can also improve glucose metabolism in diabetes 5 , 6.

Although chronic benzodiazepine therapy is not a desirable option for glucose control, diabetic patients who respond to benzodiazepines have been shown to be more likely to respond to relaxation training 5. Therefore, patients who have adverse metabolic control due to acute stress might be treated initially with benzodiazepines and then started on a behavioral stress management program.

Nevertheless, this study, combined with previously published literature, suggests that stress management can be a meaningful addition to a comprehensive treatment program for patients with type 2 diabetes. Treatment-related changes in HbA 1c with statistical adjustment for baseline levels.

The linear component of change is shown by the straight line. This study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases grant 1RDK and the National Center for Research Resources, Clinical Research Centers Program, National Institutes of Health grant MRR Address correspondence and reprint requests to Dr.

Surwit, Box , Duke University Medical Center, Durham, NC E-mail: richard. surwit duke. A table elsewhere in this issue shows conventional and Système International SI units and conversion factors for many substances.

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Figure 1—. View large Download slide. Table 1— Sample characteristics at baseline. View Large. In Contemporary Endocrinology. Ingbar SH, Ed. New York, Plenum, , p. Psychosom Med. Arch Intern Med. Arch Dis Child.

Diabetes Care. A review of the comparative empirical literature. In Principles and Practices of Stress Management Techniques. Woolfolk RL, Lehrer PM, Eds. New York, Guilford, , p. New York, Wiley, J Behav Ther Exp Psychiatry.

She is also a Navy veteran, yogi, and integrative health coach. Treating the body as an interconnected whole, Isa links nutrition with brain health, mood, and mental wellbeing.

Her continued interests include the emerging field of nutritional psychiatry, functional medicine, and the gut-brain axis.

You can follow Isa on social media at meanutrition. We're still accepting applications for fall ! Apply Today.

Home The Pursuit Is Your Mood Disorder a Symptom of Unstable Blood Sugar? Is Your Mood Disorder a Symptom of Unstable Blood Sugar? Isa Kay, MPH '18 October 21, Many people may be suffering from symptoms of common mood disorders, such as depression and anxiety, without realizing that variable blood sugar could be the culprit.

Tags Alumni Nutritional Sciences Mental Health Nutrition. The carbohydrates listed below are optimal for managing this hypoglycemia-initiated stress response and have plenty of other health benefits :.

Are refined carbs like white bread and foods with added sugar like dark chocolate, candies, and cookies completely off-limits? Nope, you can still enjoy them as part of a balanced diet, but they should make up a smaller portion of the total carbohydrates you consume.

This depends on the person, and factors like age, health, and physical activity level can greatly impact how many carbohydrates an individual should eat.

You can simply hit these goals by increasing your intake of nutrient-dense carbs. Adding complex carbohydrates like fruit, vegetables, whole grains, and legumes to meals and snacks is a great way to stabilize your blood sugar and cortisol levels, and raise your serotonin levels, which reduce depression and anxiety symptoms.

Eating every 2 — 4 hours will also help prevent low blood sugar. For best blood sugar control, add a source of protein and fat to your carb intake. If you have a medical condition like diabetes, we recommend working with a Registered Dietitian Nutritionist to determine the best carbohydrate timing and portion size for you.

Growing evidence shows a link between nutrition and anxiety. If you have anxiety or experience chronic stress, you may find that balancing your blood sugar with complex carbs can bring some relief.

Reaching out to a mental health professional is also a great idea and something we always support here at Culina Health.

Have more questions about carbohydrates and stress? Get started. Any general advice posted on our blog, website, or application is intended for reference and educational purposes only and is not intended to replace or substitute for any professional medical advice, diagnosis, treatment, or other professional advice.

If you have specific concerns or a situation arises in which you require medical advice, you should consult with an appropriately qualified and licensed medical services provider. Join our email list to gain access to a treasure trove of nutrition tips, the latest on nutrition research, and delicious recipes, all curated by our expert registered dietitians.

Book a Virtual Session With a Registered Dietitian. A Crowd Favorite: Healthier Buffalo Chicken Dip Recipe. Why You Should Eat More Fiber Sheet Pan Recipe Included! How To Choose Healthy Milk Alternatives.

How a Registered Dietitian Can Help People With Diabetes. What I Learned About Food After My Cancer Diagnosis. Our Specialties. Major Locations. Who We Are. Current Patients. We have frequently been told that eating more complex carbohydrates than protein is healthy.

However, it has been proven that an excess of carbohydrates to protein results in excess levels of insulin. Excess levels of insulin cause adrenal stress, including hypoglycemia.

In order to normalize blood sugar, the adrenals have to produce increased levels of cortisol and epinephrine. This often leads to long-term cortisol depletion and ultimately adrenal exhaustion. One of the most effective ways to prevent or reverse the excess production of insulin and cortisol is to balance the amount of carbohydrates and proteins that are eaten with each meal.

The proper ratios are approximately 2 parts carbohydrates to 1 part protein by weight in grams ratio. An example of this is 20 grams of protein with 40 grams of carbohydrates.

Proper ratios of carbohydrates to protein will vary depending upon the glycemic index of the carbohydrates consumed. The higher the glycemic index of a carbohydrate, the greater the need for protein in order to maintain glycemic control. High glycemic food releases sugar into your blood stream very quickly, thereby driving up insulin levels.

Examples of very high glycemic carbohydrate sources use in small quantities include: rice, potatoes, bread, oatmeal, corn, carrots, sugar, honey, bananas, and raisins.

The glycemic control diet requires that adequately balanced portions of protein and carbohydrates be eaten with each meal and snack. Low glycemic carbohydrates such as green vegetables should be emphasized over high-density carbohydrates such as bread.

Fats, especially those with essential fatty acids, play many important roles in normal body functions, including helping to maintain blood sugar by slowing the release of glucose sugar into the blood stream.

Fish is a good dietary source for healthy fats.

When you have type 2 diabetes, low blood sugars from too much medication or insulin are a common cause of stress. The hormonal response to a low blood sugar includes a rapid release of epinephrine and glucagon, followed by a slower release of cortisol and growth hormone.

These hormonal responses to the low blood sugar may last for hours — during that time the blood sugar may be difficult to control. When you have type 2 diabetes, stress may make your blood sugar go up and become more difficult to control — and you may need to take higher doses of your diabetes medications or insulin.

During times of stress, individuals with diabetes, may have more difficulty controlling their blood sugars. Self assessment quizzes are available for topics covered in this website.

To find out how much you have learned about Facts about Diabetes , take our self assessment quiz when you have completed this section. The quiz is multiple choice.

Individuals with recurrent mental health symptoms may choose to rule out alternative causes before jumping into mental health treatment or interventions. Several lifestyle principles can help stabilize blood sugar:.

She is also a Navy veteran, yogi, and integrative health coach. Treating the body as an interconnected whole, Isa links nutrition with brain health, mood, and mental wellbeing. Her continued interests include the emerging field of nutritional psychiatry, functional medicine, and the gut-brain axis.

You can follow Isa on social media at meanutrition. We're still accepting applications for fall ! Apply Today. Home The Pursuit Is Your Mood Disorder a Symptom of Unstable Blood Sugar?

Is Your Mood Disorder a Symptom of Unstable Blood Sugar? For most of us who experience chronic daily stress, frequent surges in glucose lead to health issues like insulin resistance and diabetes. The first step in mitigating the impact of stress on blood glucose is to acknowledge that a clear link exists.

I hope this blog post helped nudge you a little more closely in that direction if you were skeptical at the outset. In an ideal situation, you might try measuring your own glycemic response to certain stressful situations using a glucose monitoring device.

This might be broken down into family stress, work stress, financial stress, health stress, social stress, etc. For myself and many others including the case example , the family category of stress seems to have the greatest impact on glucose levels.

In the case example I shared, the patient I discussed is under very high levels of work stress, but it was a heated discussion with her in-laws that spiked her glucose. I also had a number of patients with poor glucose control during the pandemic, despite improving many of their lifestyle measures diet, exercise, etc.

Facing the intense primitive survival stress of our ancestors in the midst of a pandemic appears to have been a strong trigger for glucose elevations. Just like cutting out junk food, should we cut out the high glycemic individuals in our life?

Not necessarily, since often these are the people we care about the most. Recall how earlier I mentioned that when I was insulin resistant years ago, carbs like rice and oatmeal would cause marked spikes in my blood glucose.

Changing recurrent thought patterns, practicing cognitive reframing, and incorporating mindfulness practices can reduce the glucose spikes triggered by the high glycemic people and external situations in your life health, finances, pandemics, etc.

In the case example, my patient could have escalated the argument, stormed out of the house, and ruminated on the conflict for several days or weeks. Instead she removed herself from the situation momentarily, walked to physically help burn off sugar and allow her mind to reset, and she returned to the table to enjoy dessert with the family.

She rapidly reduced the glycemic impact of a stressful encounter through these actions and her normal blood glucose after chocolate cake reflected that. Emotional resilience, like metabolic resilience, helps to stabilize the swings in glucose and other markers so we can better endure the inevitable stressors in life, with minimal adverse impact on health.

You too need to identify the emotional junk food in your life situations, people, etc. Storing the emotional junk food away by neglecting it makes matters worse. I know that firsthand. Since I know I personally have a stress-sensitive liver, I am prioritizing increasing amounts of time to managing my own mind and thought patterns to avoid glucose swings and other related health issues.

The benefits go far beyond just stabilizing glucose levels. If you need help with managing your stress, please reference my dedicated stress page below:.

Stress Management Page. I hope this post has provided some clarity on the real connection between emotions and blood glucose. The human body is imperfect and takes long periods of time to change its evolutionary blueprint, which is why systems that provided survival advantages in the past can result in overcorrections in the present.

I used to resent having such a stress-sensitive liver, but have now reframed that to a metabolic adaptation that I inherited from ancestors who lived through tremendous stressors and made huge sacrifices so I can live the life I lead today.

Being aware of the mechanism by which you have inherited certain tendencies emotional, metabolic, etc.