Health professionals often focus on diet, exercise and weight loss when addressing blood sugar imbalances. However, many other lifestyle factors, especially chronic stress, affect blood sugar levels. This article discusses chronic stress, its symptoms, how it affects blood sugar and suggests simple tips to manage it.

Stress is the body’s natural response to external factors such as threats, illness, conflicts, financial strain, and work or family pressures. Short-term stress is helpful because it boosts alertness, performance, memory and motivation and helps us avoid danger. However, long-term or chronic stress is harmful because it can affect the body’s functions and encourage unhealthy lifestyle choices that increase the risk of chronic diseases like cancer, heart disease and type 2 diabetes (Yaribeygi et al., 2017; Rasheed, 2016).

Chronic stress is a feeling of persistent pressure or overwhelm. It occurs when the body is exposed to prolonged internal or external stressful events and fails to cope.  Chronic stress has harmful effects on the body; it affects memory, lowers immunity, promotes weight gain, reduces muscle mass, increases heart rate and blood pressure, and slows digestion, leading to digestive symptoms like constipation, diarrhoea and reflux (Yaribeygi et al., 2017).

Symptoms of Chronic Stress

The symptoms of chronic stress vary from individual to individual but can include (Mariotti, 2015):

• Brain fog
• Difficulty concentrating
• Irritability
• Mood changes
• Fatigue
• Insomnia
• Drinking excessively
• Binge eating
• Self-isolation

Prevalence of Chronic Stress

Data from Gallup suggests that 41% of adults worldwide experience stress, while the American Institute of Stress notes a slightly lower rate of 35%. Finances and work pressures (64%) are the most common causes of stress, followed by health-related concerns (63%), economic uncertainty (48%), and family responsibilities (47%) (American Psychological Association, 2018). Work is the most common cause of stress in the UK, with 79% of the population affected. Although no official statistics exist, the chairman of the Society of Family Physicians of Nigeria estimated in 2017 that a least seven million Nigerians experience work, financial, economic and health-related stress (The Guardian, 2017).

How Chronic Stress Influences Blood Sugar

Stress affects the body via two groups of hormones, glucocorticoids and catecholamines. The adrenal glands – the two small glands above the kidneys – produce and release these hormones.

Cortisol is the main glucocorticoid in the body. It plays key roles in the processing and using glucose, protein and fat. Catecholamines are the “flight-or-flight” hormones produced in response to stress. They include dopamine, adrenaline and noradrenaline (Sharma et al., 2022).

During short-term stress, these hormones stimulate the liver to produce glucose, causing hyperglycaemia or high blood glucose. The extra glucose is beneficial because it gives the immune system and brain energy to cope with the ‘threat’. However, this response can be harmful when stress is prolonged.

During long-term or chronic stress, cortisol prevents the beta cells in the pancreas from producing and releasing insulin. Cortisol and catecholamines also make the liver continue producing glucose and stop muscle and fat tissues from absorbing and using excess glucose; this raises blood glucose levels further and causes insulin resistance to develop over time. Left unchecked, insulin resistance can lead to prediabetes and eventually type 2 diabetes (Sharma et al., 2022).

How to Reduce Chronic Stress

Everyone experiences stress, and while we can’t eliminate it, we can prevent it from becoming persistent and overwhelming with simple lifestyle changes.

1 | Be active: Physical activity can reduce negative emotions and enhance positive ones. It can also encourage healthy eating behaviours that provide essential nutrients to enhance well-being (Schultchen et al., 2019). The Chief Medical Officers in the UK recommend at least 150 minutes of moderate physical activity, 75 minutes of vigorous physical activity per week or a combination of both. The guidelines also recommend adults do resistance or muscle-strengthening activities at least twice a week (Department of Health and Social Care, 2019).

2 | Eat a healthy diet: The body needs more nutrients during stressful periods to cope with energy demands. Ironically, most people experiencing stress choose high-fat, high-sugar foods lacking essential nutrients their bodies need to function optimally (Gonzalez and Miranda-Massari, 2014). Studies link healthy diet patterns, such as the Mediterranean diet to lower stress and greater stress tolerance (Khaled et al., 2021). People eating Mediterranean diets also recover faster from stress, displaying lower heart rates and cortisol levels than those eating Western diets that typically contain unhealthy, nutrient-poor foods (Shively et al., 2020).

3 | Use relaxation techniques: Relaxation techniques are therapeutic exercises designed to help individuals increase feelings of calm and reduce feelings of stress, tension and anxiety (Norelli et al., 2022).

Many relaxation techniques exist, including deep breathing, guided imagery and muscle relaxation. Box breathing is a type of deep breathing exercise that can be done in four steps:

• Step one: breathe in through the nose for a count of four.
• Step two: hold your breath for a count of four.
• Step three: breathe out for a count of four.
• Step four: hold your breath for a count of four.
• Repeat

Guided imagery involves visualising a calm environment to distract individuals from unsettling thoughts, while muscle relaxation involves performing specific movements to release tension in the legs, hips, buttocks, stomach, chest, shoulders, face and hands (Norelli et al., 2022).

4 | Sleep: According to the American Psychological Association, adults who sleep fewer than eight hours a night report higher stress levels than those who sleep at least eight hours a night. These adults are more likely to report symptoms of stress, such as feeling irritable or angry, lacking interest, motivation or energy and skipping exercise (APA, 2013).

Implementing habits such as removing electronic devices from the bedroom, avoiding large meals, caffeine and alcohol before bedtime, and maintaining a quiet, dark and relaxing bedroom can encourage good sleep (CDC, 2022). Get at least seven hours of sleep per night.

5 | Connect with others: Maintaining social connections with others can improve resilience to stress (Ozbay et al., 2007).  Social connections can trigger the release of ‘feel good’ hormones, including oxytocin, dopamine, serotonin and endorphins, that increase pleasure, calm, and tolerance to emotional and physical discomfort.

6 | Limit alcohol and stop smoking: Avoid drinking or limit alcohol to no more than two drinks if you’re a man or one drink if you’re a woman. You can get help from the NHS to quit smoking.

7 | Seek support from a professional: Get support from your GP or physician if you still struggle despite implementing these techniques. You can get cognitive behavioural therapy (CBT) on the NHS

Try these Tips

1. Identify the major source of stress in your life.
2. Choose a stress-reducing technique and decide how often you’ll use it.
3. Monitor your stress levels using an app or a notebook to ensure your chosen technique is effective.

REFERENCES

1. Yaribeygi, H., Panahi, Y., Sahraei, H., Johnston, T.P., and Sahebkar, A. (2017) The impact of stress on body function: A review. EXCLI Journal, 16: 1057-1072.
2. Rasheed, N. (2016) Prolonged stress leads to serious health problems: Preventive approaches. International Journal of Health Sciences, 10(1): V-VI.
3. Mariotti, A. (2015) The effects of chronic stress on health: new insights into the molecular mechanisms of brain-body communication. Future Science OA, 1(3): FSO23
4. Stress in America Generation Z. (2018) American Psychological Association. Available: https://www.apa.org/news/press/releases/stress/2018/stress-gen-z.pdf Accessed: 22 July 2023.
5. The Guardian. (2017) 7m Nigerians suffer stress, depression. Available: https://guardian.ng/features/7m-nigerians-suffer-stress-depression/# Accessed: 22 July 2023.
6. Schultchen, D., Reichenberger, J., Mittl, T., Weh, T.R.M., Smyth, J.M., Blechert, J., and Pollatos, O. (2019) Bidirectional relationship of stress and affect with physical activity and healthy eating. British Journal of Health Psychology, 24(2): 315-333.
7. Department of Health and Social Care. (2019) Physical activity guidelines: UK Chief Medical Officers’ report. Available: https://www.gov.uk/government/publications/physical-activity-guidelines-uk-chief-medical-officers-report. Accessed: 22 July 2023.
8. Gonzalez, M.J. and Miranda-Massari, J.R. (2014) Diet and stress. Psychiatric Clinics of North America, 37(4): 579-589.
9. Khaled, K., Hundley, V., and Tsofliou, F. (2021) Poor dietary quality and patterns are associated with higher perceived stress among women of reproductive age in the UK. Nutrients, 13(8): 2588.
10. Shively, C.A., Appt, S.E., Chen, H., Day, S.M., Frye, B.M., Sahaltout, H.A., Silverstein-Metzler, M.G., Snyder-Mackler, N., Uberseder, B., Vitolins, M.Z., & Register, T.C. (2020) Mediterranean diet, stress resilience, and aging in nonhuman primates. Neurobiology of Stress, 13: 100254.
11. Norelli, S.K., Long, A., * Krepps, J.M. (2022) Relaxation techniques. In: StatPearls. Available: https://www.ncbi.nlm.nih.gov/books/NBK513238/. Accessed: July 22, 2023.
12. American Psychological Association. (2013) Stressed out without enough sleep. Available: https://www.apa.org/news/press/releases/stress/2013/sleep. Accessed: July 23, 2023.
13. Centres for Disease Control and Prevention. (2022) Tips for Better Sleep. Available: https://www.cdc.gov/sleep/about_sleep/sleep_hygiene.html. Accessed: July 23, 2023.
14. Ozbay, F., Johnson, D.C., Dimoulas, E., Morgan, C.A., Charney, D., and Southwick, S. (2007) Social support and resilience to stress. Psychiatry MMC, 4(5): 35-40.

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