Diabetes Self-Management Blog

I like it when studies confirm what I’ve been saying for years, especially when most people didn’t believe me. For years, I’ve been reporting that stress is a major cause of overweight and Type 2 diabetes. And people have scoffed.

“It’s just how much you eat and how much you burn off with exercise,” they’ll say. “Stress might lead you to eat more, but that’s the only connection.” Even Richard Bernstein, the low-carb guru and author of Dr. Bernstein’s Diabetes Solution doesn’t get this, although he is right about so many diabetes-related things. He says stress doesn’t raise people’s blood sugar.

Well, maybe not immediately. But stress does increase insulin resistance and promote abdominal fat. So in the long run, stress will tend to make you fat, and raise your blood glucose, your cholesterol and your blood pressure significantly.

This has been shown for years — for example in this 1999 English study of 10,000 civil servants. Those with high work stress had twice the rates of obesity, heart disease, diabetes, and some neurological problems as those with low stress. But what is stress exactly, and what can we do about its effects?

Stress and Inflammation
Stress is anything that causes our bodies to feel threatened. Stresses can be emotional, economic, or physical. Physical stress can include things like cold and fatigue, and a recent study (reported on in Diabetes Flashpoints) showed that breathing polluted air caused insulin resistance in mice.

Now, how could breathing dirty air make a mouse (or a person) fat or diabetic? Experts like Janice Kiecolt-Glaser, PhD, say the link is that stress causes inflammation. When under stress, our bodies release chemicals called “pro-inflammatory cytokines,” which are good for fighting short-term infections and repairing injury. But if your stress levels are chronically high, these cytokines can cause insulin resistance and many other health problems, including cancer. This is true whether the stress is physical or mental.

Stress is also the way we respond to life’s dangers. If we react to pressure with shallow breathing, muscle tension, constant worrying, and excessive anger, the physical effects will be worse. Practices of breathing, relaxation, prayer, and exercise can help us minimize the effects of stress.

Scientists increasingly believe that inflammation is a major reason why people with diabetes get heart, kidney, or eye disease.

So what’s the good news?
If stress can make you sick, can reducing stress make you better? Studies suggest that it can. Dean Ornish, MD, showed that coronary artery (heart) disease can be reversed with a program including a low-fat, vegetarian diet; stress management; moderate exercise; and psychosocial support. But you need the whole program, not just the diet, especially since the meditation and yoga teach you how to cope with stress.

A more recent study in New Zealand found that “Women who meditated and did yoga lost an average of five and a half pounds (2.5kg)” over two years and kept it off, while those who focused purely on exercise and nutrition did not. “The ‘relaxed’ women were also generally happier and healthier at the end of the study.”

Study co-author Caroline Horwath, PhD, said, “The positive results are exciting, given the limited long-term success of traditional dieting approaches.”

Is there anything I can take for this?
If inflammation (caused by stress or any other reason) helps cause diabetes and complications, taking anti-inflammatory medicines might help. Green tea is a potent natural anti-inflammatory. A recent article in the LA Times reports on several studies showing that green tea reduces abdominal fat, giving a “boost to exercise-induced weight loss.” The researchers, based in the US and Japan, believe that green tea may “speed the rate at which fat is broken down in the body. It may also help the body’s sensitivity to insulin, lowering the risk of diabetes.”

If green tea reduces inflammation, might anti-inflammatory drugs do even better at preventing diabetes and its complications? Some researchers strongly hope so. They are studying an old drug, salsalate, a cousin of aspirin, to see. Pilot studies show that salsalate (discovered in the 1800’s) does lower blood glucose.

In a recent Wall Street Journal article, Myrlene Staten of the National Institutes of Health was quoted as saying that salsalate “is a cheap, generic drug that has the potential to add to our tools for improving glucose control in diabetics.”

Bottom Line
Of course, if you’ve read this far, you know that reducing inflammation will help you above and beyond its effects on blood sugar control. And reducing and learning to deal with stress is a major way of reducing inflammation. And having a sense of control reduces stress, so taking control by trying some of these things (green tea, yoga, relaxation, anti-inflammatories), hopefully along with exercise, is a win-win-win proposition.

What do you think? Does any of this make sense to you? What can you see doing about it? I’d appreciate hearing from you.

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Comments
  1. JOB STRESS and routine family stress opened the door for me to develop type 2,plus, breathing the dirty filthy air of NW Indiana. Steel mills and oil refineries poured out their filth and when the snow fell in the late afternoon, it turned a blue,rust,charcoal color overnight. I became a committed type 2.

    Posted by blackmaria |
  2. Yes, it makes sense. It makes so much sense that one wonders why the medical community is not doing a collective head slap while saying, “Doh!” While I would like to pursue that best remedy for stress (get rid of the stressors), I think you’ve offered a possible second best option: salsalate. I’ve been increasingly concerned about finding a tolerable anti-inflammatory for the recent increase in arthritis pain. Salsalate might be worth a look for that alone. If it helps reduce blood glucose, then it’s certainly worth a trial. Salsalate’s a low cost generic, which makes is all the more interesting. Of course, I will discuss this with my doctor first.

    Posted by Paka |
  3. Dear David.

    If stress did not raise BG then why, if I exercise less than 1/2 hour, does the BG goes up not down? Obviously the cortisol and adrenaline have something to do with that.

    It may well be that imflammation is a big deal since aspirin is one of the few medications that does make me feel better. Too bad it cannot be used on a daily basis, only in very small amounts that may do nothing.

    Posted by CalgaryDiabetic |
  4. I have thought these same things since being diagnosed with type 2 3 years ago. I do know that my sugars are not in control when I have alot of stress in my life. The outside is my stress releaver. Along with the children in my daycare. Yes I said the children in my daycare. They put such joy into my days. Along with my wonderful grandchildren. So find something that brings you joy.

    Posted by dbolduc |
  5. This makes tremendous sense for me. I have issues with all kinds of inflammatory conditions such as arthritis, fibro, etc. I will be anxious to discuss this with my doctor. I read that salsalate also is less damaging to the stomach than aspirin and causes less bleeding as a side affect. That would be great since I do not need anything to thin my blood.

    Posted by lagower |
  6. I have had arthritis since childhood (diagnosed at age 8), so I’ve dealt with inflammation a long time. I had had a very stressful job for 5 years prior to my diagnosis with diabetes, and believed at that time it was affecting my health.

    I have also heard about salsalate. I have a poor tolerance for most anti-inflammatories, but talked with my Dr about letting me try it anyway. She agreed, and so did my orthopedist. I’ve been taking it for a week now. The first 2 or 3 days, I had a very mild headache and very mild nausea starting about 30 mins after taking a dose and lasting about 2 hours. Both side-effects have disappeared. I do take the salsalate with food.

    As for effectiveness. I’ve not seen a lot of difference between the salsalate and Celebrex for my arthritis yet. And thus far have seen no difference in my blood sugars. But since so many meds take time to become effective, I’m not giving up on it yet.

    Posted by Ephrenia |
  7. Perhaps we can run our own trial on salsalate here :-) It would be good if readers who try it let the group know how it goes. Thanks, Ephrenia.
    David

    Posted by David Spero RN |
  8. Hi David, is a test for C Reactive Protein (CRP) a good measure of inflamation in the body and worth while having done?

    Posted by Florian |
  9. I have arthritis, fibromyalgia, condochonritis, ehlers-danlos, and type 2 diabetes (since Jan of this year). I was having a very difficult time controlling blood sugars on a daily basis, even going going low carb (I have lost 20 pounds on four months just with diet as I cannot exercise other than a strolling walk for about 10 min a day). My weight continues to drop about a pound a week.

    I talked to my endo doc two weeks ago about salsalate and she agreed it was worth a try. I stopped taking celebrex and started salsalate. I am also on metformin.

    My blood sugar levels have gradually lowered into the normal ranges and I have to watch carefully now (more frequent testing) because occasionally the numbers get really low (around 80) which for me is quite a huge difference.

    In another few days, if these low numbers continue to stabilize, I will back off the metformin by one a day (I am now taking four a day). If the numbers remain stabilized after a week, then I’ll back off to only two metformins a day.

    And so we will do this by trial and error. She says that as I continue to lose weight, I will be able to walk more as my joints won’t be so stressed and painful. Also the salsalate is beginning to help the joint and muscle pain. So it’s a GOOD cycle. Less weight and less inflammation, more walking — which means even better weight loss. Doc also says that hopefully within 3 more months or so, I can get off the metformin completely.

    My A1C was 11.7 in January and two weeks ago, it was 7.1 with the weight loss and careful eating.

    My goal is to lose 40 more pounds and walk more on a daily basis. Plus get completely off metformin and use on the salsalte.

    It seems to be working for me. It’s a slow process and does not happen overnight. But I’m hoping for the best.

    Posted by Sherlock |
  10. Thanks for the inspiring story, Sherlock. Keep it up and let us know how it goes.
    David

    Posted by David Spero RN |
  11. I have not tried salsalate, but I obeserved this recently and it could be tied to stress in some way: I have sleep disorders of apnea & restless legs, which are being treated (CPAP and Klonopin), but I began waking 2-3 times in the night again. When I had a resp infection & took Nyquil, I slept longer, as much as 6 hours without waking. My am sugar was abt 106-112, whereas it had been as high as 140, apparantly due to liver pumping gluc during the night. Mr Liver, has no controls as to when to stop, I’m told. But I have tried the sleep ingred in Nyquil which is apparantly safe for seniors, and had the same better results on AM bl sugars. Hopefully, I’ve hit on a winner, but can’t take sleep med regularly, so will check with dr.

    Posted by Janet Jensen |
  12. I AM A WHITE MALE AGE 67 AND HAVE BEEN A DIABETIC
    SINCE THE AGE OF 33. MY HIGHEST WEIGHT WAS 346 LBW
    IN FEB OF 2010.MY PRESENT WEIGHT IS 289. THIS
    REPRSENTS QUITE A LOSS. I HAVE BEEN ON THE VEGAN
    DIET. I HAVE ELIMINATED MEAT AS A STAPLE OF MU
    DIET. DO I CHEAT? YEAH I DO BECAUSE I WILL SOME
    TIMES PUT EGGS IN MY KIDNEY BEAN SALAT. ALSO,
    WHEN COOKING BUTTER OR LIMA BEENS (FROZEN NOT
    CANNED) I WILL ADD SOME REAL BACON BITS.

    THIS DIET HAS RESULTED IN LOWER BLOOD SUGAR LEVEL
    AND MY A1C AT LAST TESTING WAS 6.1. MY ENDO
    CRNOLOGIST IS ELATED WITH THE SUCCESS SO FAR.

    I AM ENCOURAGED BY STEADY LOSS IN WEIGHT. THE
    SECRET IS TO MAKE A LIFESTYLE CHANGE AND TO DO
    THAT YOU HAVE TO BE MOTIVATED. A BP OF 188/80,
    TAKEN WHILE WATCHING TV, WAS MY WAKE UP CALL. AT
    MY LAST DR VISIT MY BP HAD DROPPED TO 138/73.

    I STILL HAVE A LONG ROAD AHEAD OF ME BUT NOW
    I HAVE HOPE. I WOULD LIKE TO ADD THAT NONE
    OF THIS WOULD HAVE BEEN POSSIBLE WITHOUT THE
    HELP AND BLESSING OF MY LORD AND SAVIOR JESUS
    CHRIST.

    I TAKE THE FOLLOWING SUPPLEMENTS DHEA, BIOTIN,
    ACETYL L CARNITINE + ALPA LYPOLIC ACID, VITAMIN B,
    VITAMIN D3, VITAMIN D, ZINC, FISH OIL, COQ10
    3X100 AM AND 1X100 PM

    FINALLY ISULIN DOSES HAVE GONE FRIM 100 UNITS
    OF 70/30 BOTH AM AND PM TO APPROX 40 UNITS OF
    70/30 BOTH AM AND PM. BLOOD SUGARS ON WAKING
    AVERAGE 76-91. I WOULD APPRECIATE ANY SUGGESTIONS
    YOU MIGHT HAVE AS TO HOW I CAN FURTHER IMPROVE MY
    OVERALL HEALTH AND THE MANAGEMENT OF MY DIABETES
    I AN NOW WALKING MORE AND SOME LIGHT AEROBIC
    EXERCISING BECAUSE I FEEL BETTER PRAISE GOD

    Posted by RONALD RUSSELL |
  13. I know there are many types of inflammation however because of the side effects I think it is usefull to look at the natural anti-inflammatories in particular serrapeptase if you can

    Posted by serrapeptaseman |
  14. “Even Richard Bernstein, the low-carb guru and author of Dr. Bernstein’s Diabetes Solution doesn’t get this, although he is right about so many diabetes-related things. He says stress doesn’t raise people’s blood sugar.” This is an inaccurate statement. He devotes a whole chapter on the effect of stress on blood glucose levels. What he said was “that most prolonged emotional stress rarely has a direct effect upon blood sugar.”
    “Certainly there is no question that stress can have adverse effects upon your health. I have reviewed more than a million blood sugar entries from many patients, including myself. One common feature of all this data is that most prolonged emotional stress rarely has a direct effect upon blood sugar. This kind of stress can, however, have a secondary effect by precipitating overeating, binge eating, or indulgence in kinds of eating that will increase blood sugar. I know many diabetics who’ve been involved in stressful marriages, divorces, loss of a business, slow death of a close relative, and the countless other sustained stresses of life we all must endure. These stresses have one thing in common: they aren’t sudden but usually last days, or even years… An important thing to remember during sustained periods of life when everything seems out of control is that at least you can control one thing: your blood sugar.”
    The kinds of stress that he says can cause sudden blood sugar spurts are after brief episodes of severe stress, during stressful events like surgery, or the stress your body endures during an infection or moderate to strenuous exercise. “ Examples [that involve severe stress] have included an automobile accident without physical injury; speaking in front of a large audience; taking very important exams in school; and having arguments that nearly become violent…If an acute event is stressful enough to start your epinephrine (adrenaline) flowing, it is likely to raise your blood sugar … Epinephrine [also called adrenaline, is a] hormone produced by the adrenal glands in response to stresses such as extreme exercise, pain, fright, anger, and hypoglycemia. … Sooner or later a dietary indiscretion, an infection, morning exercise, acute emotional stress, or even errors in estimating meal portions may cause your blood sugar to rise substantially. …On the other hand, unexplained blood sugar increases extending for days or weeks can rarely be properly attributed to stress.”
    “Moderate to strenuous exercise causes an immediate release of “stress,” or counterregulatory, hormones (epinephrine, cortisol, et cetera)…In relatively short order, you will develop greater insulin sensitivity for lowering blood sugar. Similarly, your requirements for insulin (that which you create or inject) will diminish… Keep exercising in a progressive fashion. The payoff— longer life, lower stress, weight loss if you’re overweight, and better overall health— is usually worth the time and effort.”
    Bernstein, Richard K. (2011-11-01). Dr. Bernstein’s Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars. Little, Brown and Company. Kindle Edition.
    As for Dr. Dean Ornish’s program including a low-fat, vegetarian diet; stress management; moderate exercise; and psychosocial support, by any measure of inflammation you choose you will find that much of the diet consists of moderately to highly inflammatory foods that raises glucose levels so high that it is almost impossible to control without industrial doses of insulin in diabetics. If his program works, it is in spite of his diet, not because of it.

    Posted by Type2 lady |

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