Anxiety and Blood Sugar
I see and treat many patients with anxiety and mood issues in my practice. One of the most common issues I encounter with my patients who have anxiety is that they tend to fall into a vicious pattern of letting their blood sugar fall too low, too often during the day. When I ask them to not change anything, but rather spend a week recording meals and snacks, we often find out that going too long between meals and snacks intensifies and triggers feelings of anxiety.
How are hunger and anxiety related? It all comes down to blood sugar control. And it’s something that you can easily manage.
Anxiety is defined as “a feeling of worry, nervousness, or unease.” This can be related to an actual event or anticipated situation, but often I define anxiety as extra thoughts about something that does not lead to any helpful action.
Blood sugar is literally glucose (sugar) circulating in your blood. Glucose is the main fuel used to create energy in the body. Every cell in your body has a factory inside it, in which glucose is turned into energy. The amount of sugar in your blood is tightly regulated by a range of different bodily organs and hormones, which work together to keep this blood sugar stable so that there is always available fuel.
Cortisol and Stress
Though we consider ourselves to be highly evolved, our physiology- how our physical body works- is still basically the same as it was thousands of years ago. We are still cavemen and cavewomen. This is significant for us because stressors for us are very different today than they were thousands of years ago, when basic survival was a constant demand on our bodies. Without modern storage options, food had to be obtained more often, and a large portion of our energy went towards this task. We needed a way to make energy even if our food supply (glucose) was low.
Cortisol is designed for just such a situation. It is a longer-acting stress hormone that is produced on a daily schedule, higher in the morning so you can get up and go, and lower at night so that you can relax and rest. (Figure A) It can also respond to daily stressors, by allowing your body to mobilize glucose to be made into energy for your brain and your muscles. These are the main organs that are necessary for hunting- tracking, planning and then moving your body. For the caveman this works beautifully. On an empty stomach, the caveman gears up for the hunt. Energy is mobilized and he seeks his prey, catches it, and is rewarded with a meal that will genuinely support his blood sugar and nutrient needs.
eating. Since your blood sugar is already slightly low after sleeping all night, a cup of coffee will trigger extra cortisol to be produced which will help mobilize a small amount of glucose from your stores. This and the coffee will keep you going for a short period of time, and then your glucose drops again, and your cortisol spikes again.
Cortisol serves its purpose and will help get your blood sugar up again (=energy). But the experience as a modern person of bursts of cortisol production- in the absence of physical activity or actual food- can be a harrowing one. Many people experience this as over-stimulation, or anxiety. Think about a physical reaction that should prep you to think hard, run hard, and manage dangerous situations (a hunt) all experienced while sitting still and staring at a computer screen.
For many this experience is anxiety. This can become a vicious cycle: blood sugar drops, big spike in cortisol, feel a little energized, still don’t eat, blood sugar drops again, etc. Many of my patients with anxiety find that when they actually write out what they eat and when, they see that the longer they go between meals, the more intense their anxiety symptoms can be.
Cortisol and Daily Life
I want to reiterate that cortisol is not only used for stressful situations. We all make this wonderful hormone every single day. It is one of the hormones that wakes us up every morning, ideally reaching its peak within two hours of rising. Our blood levels of cortisol gradually drop off during the day so that by the time you are ready for bed, your cortisol production is very low. We LOVE cortisol, yet we run into trouble when we are making too much or too little of it. If you can eat consistently to keep your blood sugar stable throughout the day, you can harness your own natural cortisol rhythm and plan your day accordingly.
Nausea and Blood Sugar- Why Many People Skip Breakfast
Another complication is that when people have anxiety, they often can experience heartburn or nausea symptoms which make them feel like they do not want to eat. Similar to when a woman is pregnant, this can be a very vicious cycle. Low blood sugar for many people can create symptoms of nausea (which by the way I find to be an evolutionary flaw in our otherwise spectacularly brilliant design as human beings). If you unaware that this could be because you are actually hungry, you won’t want to eat if you are nauseous for obvious reasons. Most of us don’t feel like eating if we think we are about to throw up. One of the best treatments for nausea during pregnancy is eating more often than you might even want to. Many pregnant women begin to feel nauseous as soon as their blood sugar begins to drop.
With stress and nausea, the solution is the same. Small amounts of food to raise blood sugar and fill the stomach can make a huge difference both in the nausea symptom and in stress hormone production. If your blood sugar levels out, your cortisol production should drop back down to a baseline and you should feel less overstimulated.
Coffee and Cortisol
Why do human beings have such a love affair with coffee? Primarily because it stimulates adrenal production of hormones that are excitatory- this means that it is stimulating to our brains and our bodies. I have no judgement regarding coffee drinking being an avid coffee consumer myself. However, we get ourselves into trouble when we drink coffee without eating or we drink it in excess. Just as we see in the above scenarios, drinking coffee and running on cortisol can trick us into thinking we are not hungry or our blood sugar is just fine. But when the caffeine wears off and the cortisol drops, we can experience horrible changes in mood and energy. This can lead to both craving for more coffee (hence the vicious cycle) or choosing foods that are quicker, easier and often less healthy for us.
Eating a healthy variety of foods can be a full time job and takes effort. I advise my patients to never drink coffee without some (even tiny!) amount of nourishment to accompany it. This helps prevent the cycle of stress and hunger that can be triggered, and can help avoid extra anxiety.
How to Correct the Anxiety-Stress Cycle
One of the best ways to support your mind if you experience anxiety is to eat consistently throughout the day. Your physician can help you understand just how much food is right for you. For my patients with anxiety I encourage them to eat every 2-3 hours. If this is shocking for you, that’s a sign that you probably aren’t eating often enough. If you have a very low activity level then these can be more like snacks. But if you are an active person you need to eat to fuel your body and mind.
If you hate eating in the morning and you skip breakfast, GET OVER IT. Some of your avoidance is habit, some is how you are designed (and I do try to honor each person’s individual makeup), and some of this might be that you feel a little nauseous in the morning. See above- you need to get your blood sugar up if you are feeling nauseous in the morning. Something as small as a tablespoon of peanut butter, chocolate milk, a smoothie, an apple- just get some food in there.
When I ask my patients to practice new patterns the idea is: commit to two weeks. Try eating something first thing in the morning (this means within 30 minutes of waking up) for two weeks. If you go two weeks and you are absolutely miserable and you come back to my office cursing me, then maybe you might be one of the very few people who really, truly are not meant to eat breakfast.
For the majority of us cavewomen, however, we are still slaves to our physiology. If you don’t eat, you make yourself more likely to experience stress, cortisol, and anxiety.