The Secret Link Between Blood Sugar and Anxiety

By Gabriel Espinoza, MD

April 28, 2022

Anxiety And Blood Sugar

A healthy balanced diet is needed not only for a healthy body but also for a healthy mind. For example, recent studies suggest a link between blood sugar levels and the impact on a person’s mood and even the development of anxiety symptoms. This new information validates many who may feel “hangry” when going for prolonged periods without eating. The link between blood sugar levels and anxiety also shines a light on why a healthy diet can brighten up your mood.

Blood Glucose and Your Mood

An increase in the global consumption of sweetened beverages, refined carbohydrates, and pastries impacts a person’s glycemic index. The glycemic index is a measurement of the rate blood sugar rises after eating. Only carbohydrates have glycemic indexes. Therefore, foods with higher glycemic index scores can lead to blood sugar rising and falling like peaks and troughs.

A study in The American Journal of Nutrition found that, in 69,954 post-menopausal women, those who consumed a high glycemic diet had increased odds of developing depression. In Case Reports in Psychiatry, researchers noted improved symptoms of anxiety and blood glucose levels in response to changes to diet from a high glycemic index diet to one of lean protein, healthy fats, and low glycemic carbohydrates. Although a growing body of evidence suggests a relationship between mood and blood sugar levels, with poor glycemic levels leading to symptoms of irritability, worry, and anxiety, there is limited data to suggest poor glycemic control is the cause of anxiety. Therefore, we must look deeper into what defines anxiety.

Defining Anxiety

Anxiety is a condition that involves feelings of fear, dread, and uneasiness that may lead to symptoms of sweating, restlessness, tension, and a rapid heart rate. It can be normal to feel anxious due to stress or uncertainty about a test, work project, promotion, or visit to the doctor’s office. Therefore, anxiety is usually related to future concerns, with fear being one of the main components. Anxiety can serve as a coping tool since it can drive your sympathetic nervous system and focus on the task at hand. But for many, the feelings of anxiety can become unbalanced and lead to anxiety disorder.

Anxiety disorders are several anxiety conditions that may arise without a trigger and do not resolve or may even worsen over time. Although it is unclear what leads to the development of anxiety disorders, there is an association between genetic and environmental factors that can put people at risk for anxiety disorders. In addition, other risk factors can contribute to the development of anxiety disorders:

  • Inhibiting childhood behaviors and traits of shyness
  • Exposure to traumatic or stressful life events in childhood or adulthood
  • Family history of anxiety or other mental conditions
  • Medical conditions like an overactive thyroid
  • Substance abuse

Types of Anxiety Disorders

Anxiety disorders are different types of related conditions with persistent unexplained fear or concern about situations that have not occurred. Anxiety disorders can lead to people trying to avoid situations or triggers and, if the symptoms worsen, can affect a person’s job, schoolwork, and even personal relationships. Some of the feelings associated with anxiety disorders include:

  • Apprehension or dreading the worst
  • Feeling tense, restless, irritable, or easily startled

Physical symptoms include:

  • Pounding heart rate, shortness of breath, and excessive sweating
  • Tremors, headaches, insomnia, or fatigue
  • Gastrointestinal discomfort

The most common types of anxiety disorders include:

  • Generalized Anxiety Disorder (GAD): This produces an excessive and exaggerated worry about daily life, which interferes with daily activities. The worry can take up much of the day and can be accompanied by symptoms of restlessness, feeling on edge, tiredness, difficulty concentrating, and insomnia.
  • Social Anxiety Disorder: Unlike shyness, a person with a social anxiety disorder is constantly worried about being embarrassed, rejected, or humiliated in social situations. People may avoid social gatherings or conversations due to the fear of having panic attacks, which may lead to isolation.
  • Panic Disorder: Some of the main symptoms experienced with panic disorder include panic attacks that lead to an overwhelming sensation of physical and mental distress. This condition may lead many to the hospital since it can mimic heart attacks with chest pain, dizziness, or the feeling of impending doom.
  • Phobias: This disorder can cause someone to avoid places, events, situations, or objects that are usually not harmful but can lead to intense feelings of irrational fear. The fear will lead to tremendous distress, causing a person to avoid what they fear, such as heights or spiders.

Food to Feel Good

To combat the feelings of anxiety, fear, and impending doom, some may resort to doing things that make them feel good, and food is a huge comfort for many. Notably, high glycemic foods like desserts, pastries, pasta, refined bread, ice cream, sugary drinks, and candies are some of the foods much used to calm their nerves. This is because these foods impact the mesolimbic dopaminergic system of the brain, otherwise known as the reward/feel-good pathway in the brain.

As you eat these foods with high glycemic indexes, it takes about 4 hours for the blood sugar levels to drop after eating a high glycemic index meal, leading to feelings of excessive hunger, irritability, or feelings of anxiety. This results in a spiral of eating high glycemic index foods every 4 hours to keep your mood “calm” and become a learned behavior as this is activating your brain’s reward center. It’s important to note that this coping method has been predominately reported in people with depression. Although depression is commonly comorbid with anxiety, anxiety is not a risk factor for developing diabetes.

Managing Anxiety

Many tools can help people cope with symptoms of anxiety disorders and make treatment more effective. Stress management techniques like meditation, counting to 10, taking a time out, and phone apps can help you feel less anxious or stressed. Exercise like yoga, running, walking, and support groups can provide a healthy outlet for some. Learning more about what triggers your anxiety disorder, accepting that you may not be able to control everything, and helping family and friends understand the condition better can also be helpful. Finally, eating a healthy diet of lean protein, vegetables, and low glycemic foods can help manage your mood.

Treating Anxiety

If the tips above to manage anxiety are still not enough, treatment may be necessary. A mental health provider can help you find the best treatment option. One option is psychotherapy, otherwise known as “talk therapy,” which includes Cognitive Behavior Therapy (CBT). This is a type of talk therapy that helps change thinking patterns and help a person feel less anxious and can consist of:

  • Facing one’s fears and not avoiding them
  • Role-playing to prepare for situations
  • Learning to calm a person’s mind and body

If psychotherapy is not enough, then medications may be something to consider. Yet medications alone will not cure anxiety disorders, and for some, it may take trial and error with different types of medications to treat anxiety disorders.

Is Anxiety Medication Right for Me?

You and your mental health provider may decide if medication is the right treatment for you. One class of medications usually prescribed as the first line for anxiety disorders is Selective Serotonin Reuptake Inhibitors, SSRIs. These include fluoxetine (Prozac®), sertraline (Zoloft®), and escitalopram (Lexapro®), to name a few. These medications prevent the reuptake of serotonin in the brain, a neurotransmitter that helps regulates anxiety, happiness, and mood. Your provider may switch you from one type of SSRI to another if you are not responding to it, depending on your anxiety disorder.

Another medication that your provider may start you on is serotonin and norepinephrine reuptake inhibitors, or SNRIs. These medications prevent the reuptake of both serotonin and norepinephrine, both of which have been shown to help regulate mood. Venlafaxine (Effexor®) and duloxetine (Cymbalta®) are the two main SNRIs your provider may prescribe. Other types of medications that may be trialed include Tricyclic Antidepressants like clomipramine(Anafranil®). Although these medications were initially developed to treat depression, they have proven effective in treating anxiety disorders. Finally, buspirone is another type of medication that your mental health provider may prescribe.

If your provider prescribes these medications, check with your local pharmacist if your prescription savings card offers discounts. Some people save a little, and some people save a lot. Check the prices at your local pharmacy since prices may vary across zip codes. Even pharmacies across the street from each other can have substantial price differences. With over 25 years of experience in savings, let ScriptSave® help you save if you are prescribed any of the above medications.

Gabriel Espinoza, MD has experience in caring for patients in both primary care and emergency settings. Some of the topics he has focused on during his medical career include various areas in public health, pediatrics, and wellness. He has co-authored a chapter on the utility of point of care ultrasound in the diagnoses of various eye conditions. The content written by Dr. Espinoza is for information and educational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician with any questions you may have regarding a medical condition.

Resources:

  1. https://medlineplus.gov/ency/patientinstructions/000941.htm
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4515860/
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4963565/
  4. https://medlineplus.gov/anxiety.html
  5. https://www.nimh.nih.gov/health/topics/anxiety-disorders
  6. https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Anxiety-Disorders
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3743729/
  8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3499773/#:~:text=Anxiety%20disorders%20are%20not%20associated,diabetes%20in%20the%20present%20study.
  9. https://adaa.org/tips
  10. https://www.nhrmc.org/~/media/testupload/files/low-gylcemic-meal-planning.pdf?la=en
  11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573566/?report=classic
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