Why Type 2 Diabetes Might Be Linked to Chronic Stress
Researchers are exploring other connections between the body’s response to chronic stress and the development of insulin resistance, along with why some people’s environment, or co-occurring conditions like obesity, may raise their risk for this particular chronic condition. “We think that environmental stress, and the effect that it has on your biology and behavior, is a key factor or determinant in some of the differences in disease rates that we see,” Dr. Hasson says. Environmental stress includes socioeconomic status, and the health disparities for people with lower income, education, and occupations, such as less access to good quality healthcare, healthful and affordable foods, and neighborhoods or facilities where people can live safely and exercise affordably. Other environmental stressors include experiencing discrimination based on race, ethnicity, gender, or other minority status; and trauma during childhood, which is called adverse childhood experiences (ACE). (These, among other stressors, are addressed in Everyday Health’s United States of Stress story.) RELATED: How Ethnicity Affects Type 2 Diabetes
Obesity, Not PTSD Alone, Increases Type 2 Diabetes Risk
It’s been known that people who suffer from post-traumatic stress disorder (PTSD) have worse health outcomes, including a higher incidence of type 2 diabetes, than people without PTSD. Jeffrey Scherrer, PhD, a professor in the department of family and community medicine at Saint Louis University School of Medicine in Missouri, wants to better understand the underlying reasons why. He and his colleagues found that high rates of obesity — rather than PTSD alone — explains diabetes risk, in a study published in August 2018 in JAMA Psychiatry. Obesity is twice as common in people with PTSD as those without PTSD. “The bottom line is that there is no increased risk of diabetes that you can directly attribute to PTSD,” Dr. Scherrer says. Instead, obesity is the most significant contributor to diabetes in people who suffer from PTSD, much like people without PTSD. Other factors (besides obesity), like smoking, heavy alcohol use, sleep disorders, and high rates of depression in people with PTSD, may elevate the risk for diabetes. “Maybe relieving stress could help people make healthy lifestyle changes that can then reduce the risk of diabetes,” says Scherrer, while noting that research shows multiple factors are at play in the risk for diseases such as diabetes and heart disease. RELATED: How Your Genes Can Play a Role in Whether You Develop Diabetes
The Biology and Behavior of Chronic Stress and Type 2 Diabetes
So, what about the biology behind chronic stress and its relationship to the biology of type 2 diabetes? Our body releases the hormone cortisol throughout day to deal with different energy demands, including acute and chronic stress. Researchers have been investigating whether chronic stress, and therefore prolonged exposure to cortisol, might contribute to type 2 diabetes. Hasson and her colleagues found that cortisol may be associated with a decrease in insulin sensitivity and insulin output (two precursors to type 2 diabetes) in overweight Latino youth, in a study published in the Journal of Clinical Endocrinology and Metabolism. In other research, including a study published in June 2018 in the journal Clinical Epigenetics, Joseph and his colleagues have been studying markers of long-term stress on genes to decipher whether cortisol is associated with risk for diabetes and heart disease. Your coping behavior in reaction to stress could also play a role. Some people overeat or eat unhealthy, sugary foods that are high in fat to feel better when they’re stressed. We do this because these types of sugary foods stimulate our brain’s reward system. In a study published in March 2018 in the American Journal of Health Behavior, Hasson also found that male African-American adolescents decrease their physical activity when exposed to stress. Instead of stress working alone, Hasson says that stress can exacerbate other contributors to diabetes, like inactivity, high-fat and high-sugar diets, and obesity. “It’s an added risk factor that we really don’t pay that much attention to,” Hasson says. RELATED: A Guide for Reducing Stress in Your Life
How to Better Manage Stress in Healthy Ways
Hasson says that our bodies are ill-conditioned to deal with the constant psychological stress of today’s world, and overactivation of our system can lead to negative health effects over time. She’s hopeful that healthy behaviors, like exercise, mindfulness, and yoga, could reduce our bodies’ biological response to stress. Scherrer says: “We all know that stress is bad for our health, but I think patients should know that managing stress is important. It’s probably a necessary component toward lifestyle change.” Hasson agrees that managing stress is key for optimal health. “Be mindful of the factors in your life that are causing more stress,” Hasson suggests. Take an inventory of stressors and think about different coping strategies for each one. Consider steps toward a healthy lifestyle, such as incorporating small bouts of exercise or mental breaks where you can step away from stressful situations. “Those little things throughout the day can help improve your stress responses and your perceptions of stress … which can lead to better health outcomes,” Hasson adds. For more on how to help lower stress while living with diabetes, check out Diabetes Daily’s article “5 Ways to Manage Stress and Diabetes”!
