Stress Relievers Cited as Diabetes Risk Boosters: Meaningful Interventions Include Progressive Muscle Relaxation, Breathing Exercises, and Biofeedback

Article excerpt

LOS ANGELES -- Many behaviors that raise the risk of diabetes also act as stress relievers in patients demoralized by lifelong hardship, Dr. Ann K. Bullock said at the annual meeting of the American Association of Diabetes Educators.

Overeating, alcohol and drug use, cigarette smoking--even the numbing effect of watching TV rather than exercising--all can be seen as adaptive responses to profound stress.

"The problem isn't that we do dumb things to help calm stress. The problem is that we have so much stress," said Dr. Bullock, medical director of the Eastern Band of Cherokee Indians in Cherokee, N.C.

Evidence is mounting that even early childhood stressors affect adult coping behaviors that undermine health, she said. Nicotine, for example, "perks you up but calms you down."

Dr. Bullock noted that researchers from Kaiser Permanente and the Centers for Disease Control and Prevention showed in the late 1990s a strong dose-dependent relationship between "adverse childhood experiences," such as physical or emotional abuse, and smoking in adulthood (JAMA 1999;282:1652).

Carbohydrates modulate brain serotonin level, and high-fat, high-calorie "comfort foods" may help turn off the hypothalamic-pituitary-adrenal axis (Proc. Natl. Acad. Sci. USA 2003;100:11696-701).

"There's a little mini Prozac in that mac and cheese," she quipped.

Standing "in our nice white coats" lecturing people to give up cigarettes and comfort foods just won't work, Dr. Bullock asserted. "You want me to give up the stuff that helps me get through the day so I don't get a bad disease or a complication that might take me out of this painful life a little sooner? Hmmm," she said.

The key to reducing diabetes risk may lie in the amygdala, not the pancreas.

That primitive brain center is where stress takes root early in life, establishing autonomic nervous system hyperreactivity and potentially setting off a cortisol-and-epinephrine-driven cascade that increases hepatic glucose level, blood pressure, and heart rate while elevating insulin resistance in adipose tissue.

"We're running away from lions all the time," she said, which primes the body to ignite an exaggerated physiologic response to family conflict, job insecurity, and the "hugely traumatizing" lifelong effects of poverty and racism. …

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