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The Stress and Diabetes Link
by author Gabor Maté, MD

Diabetes is a disease of civilization. It is a disease of unhealthy eating patterns, low levels of physical activity, and chronic emotional stress. Canada’s aboriginal people provide a dramatic example.

A few decades ago, diabetes was virtually unknown among the Cree nation of northwestern Ontario. Now they suffer from it at a rate five times the Canadian national average. What has happened? The genetic makeup of the Cree people cannot have changed in a few generations.

The destruction of the Crees’ traditional physically active ways of life, the substitution of high-calorie diets for their previous low-fat, low-carbohydrate eating patterns, and greatly increased stress levels are responsible for the alarming rise in the incidence of diabetes among the Cree. The same pattern, if not quite at the same rate, is discernible in the general population.

In diabetics, blood sugar levels from food sources remain abnormally high. Insulin has the role of facilitating the passage of sugar from the blood stream into the cells of the body, which utilize glucose for energy. In diabetes there is either not enough insulin or the cells develop a resistance to insulin. It is easy to see the role of poor diet and lack of exercise in promoting diabetes, since high calorie meals increase blood sugar while exercise helps to lower it. But how does stress contribute?

There is an intimate relationship between our emotions and our hormonal system. The unity of mind and body is only controversial to people who haven’t looked at the research evidence linking the emotional centres of our brain with the nervous system, the immune system, and the hormonal apparatus. Emotional stress induces a gland in the brain called the hypothalamus to release substances to the pituitary gland that signals our adrenal glands to produce cortisol. These three glands–hypothalamus, pituitary, adrenal–make up the so-named HPA axis.

Among the many effects of cortisol, when chronically activated by our emotions as they act through the HPA axis, are the elevation of blood sugar levels and the redistribution of body fat over the hips and lower abdomen. That is one mode where stress is responsible for diabetes.

Stress, via the HPA axis, also acts on our immune system. Stress can reduce the effectiveness of the body’s immune defences, making us more susceptible to infections or malignancy. It can also turn the immune system against the body. Antibodies from an immune system deranged by chronic stress may cause damage to the pancreas.

In the treatment of diabetes it is not enough to consider physical factors alone. Healthy nutrition and regular exercise are important but we must also pay attention to the emotional stresses that plague so many people’s lives. These stresses may be externally imposed, such as job pressures and financial worry; or they may be self-generated, such as the need to succeed at all costs and the drive to keep working as a way of justifying one’s existence or to feel important; or they could arise because of relationship issues stemming from childhood patterns.

No matter what their source, these stressors will have powerful physiological effects, diabetes being one of them. Where they can be eliminated, they must be. Where they have to be endured for reasons beyond our control, we need to balance our lives with enough love, rest, and recreation so that stress does not dominate our existence.

Gabor Mate, MD, is a Vancouver physician and the author of When The Body Says No: The Cost of Hidden Stress (Vintage Canada, 2004).

Source: alive #265, November 2004