Anxiety is a common condition that affects millions of people. It is characterized by feelings of worry, nervousness, and unease. Some level of anxiety is normal, but excessive, ongoing anxiety that interferes with daily life may indicate an anxiety disorder. There are many potential causes of anxiety, both psychological and biological. One possible biological cause that is getting increasing attention is blood sugar dysregulation, often called blood sugar issues. Could problems with maintaining proper blood sugar levels contribute to increased anxiety?
What are blood sugar issues?
Blood sugar, or blood glucose, is the main source of energy for the body’s cells. The hormone insulin, which is made in the pancreas, allows glucose from food to enter the cells to be used for energy. Blood sugar issues occur when the body has problems regulating glucose levels in the bloodstream.
The main blood sugar issues are:
- Hypoglycemia – Also called low blood sugar, hypoglycemia occurs when blood sugar drops below 70 mg/dL. Symptoms may include shakiness, sweating, anxiety, irritability, hunger, and heart palpitations.
- Hyperglycemia – Also called high blood sugar, hyperglycemia occurs when blood sugar goes above 180-200 mg/dL. Symptoms may include increased thirst, headaches, trouble concentrating, and frequent urination. If persistent, it could indicate prediabetes or diabetes.
- Glucose variability – Also called blood sugar spikes and crashes, glucose variability refers to frequent fluctuations in blood sugar throughout the day. This often happens in people with diabetes but can occur in non-diabetics as well.
These blood sugar issues are primarily caused by:
- Insulin resistance – Cells do not properly respond to insulin, causing glucose buildup in the bloodstream.
- Impaired insulin secretion – The pancreas does not produce enough insulin.
- Diet – Eating foods high in refined carbs and sugar can spike blood sugar and cause crashes.
- Medical conditions – Diabetes, metabolic syndrome, pituitary tumors, etc. can affect blood sugar regulation.
- Medications – Steroids, antipsychotics, etc. may increase blood sugar.
Proper blood sugar control involves keeping levels within a healthy range – not too high (hyperglycemia) and not too low (hypoglycemia). Maintaining stable blood sugar and avoiding fluctuations is also important.
How do blood sugar issues relate to anxiety?
Research over the past two decades has revealed an interesting connection between blood sugar dysregulation and anxiety levels. Multiple studies have shown links between anxiety and conditions like hypoglycemia, hyperglycemia, glucose variability, and diabetes which involves chronic high blood sugar:
- In a 2007 study, patients with hypoglycemia were found to have higher rates of anxiety compared to those with normal blood sugar levels.[1]
- A 2016 study of children with hyperglycemia found they exhibited increased separation anxiety from parents compared to normoglycemic children.[2]
- A meta-analysis of several studies concluded that glucose variability is associated with a higher prevalence of depression and anxiety symptoms.[3]
- People with diabetes often have elevated rates of anxiety. A 2015 meta-analysis found people with diabetes were 20% more likely to have anxiety.[4]
Additionally, several studies indicate treating blood sugar disorders can in turn reduce anxiety symptoms:
- Treating hypoglycemia may relieve associated anxiety in some patients.[5]
- Improving glucose control in diabetics seems to lessen anxiety.[6]
- Following a low glycemic diet to minimize blood sugar swings can decrease anxiety.[7]
Overall, research shows a clear association between blood sugar dysregulation and anxiety risk. However, the mechanisms behind this connection are still being investigated.
Potential mechanisms linking blood sugar issues and anxiety
There are several theories for why blood sugar problems may contribute to anxiety development:
Brain cell (neuron) damage
Severely elevated or reduced blood sugar levels can damage neurons in brain areas involved in mood and anxiety regulation such as the hippocampus, amygdala, and prefrontal cortex.[8] This neuronal disruption may make anxiety more likely.
Altered neurotransmitters
Fluctuating blood sugar affects release of neurotransmitters (brain chemicals) like serotonin, dopamine, and cortisol that regulate mood and behavior.[9] Dysregulation of these neurotransmitters are implicated in anxiety and depression.
Increased inflammation
High blood sugar promotes inflammation, activating the body’s stress responses. Chronic inflammation may trigger anxiety.[10]
Oxidative stress
Blood sugar fluctuations create molecules called free radicals that damage cells, leading to oxidative stress, implicated in anxiety development.[11]
Insulin resistance
Insulin resistance, which underlies blood sugar dysregulation, may directly affect neurotransmitter activity and promote inflammation in a way that increases anxiety risk.[12]
Fatigue, cravings and hypoglycemia symptoms
The fatigue, food cravings, irritability and other symptoms resulting from blood sugar crashes may generate anxiety.[13]
Research in this area is ongoing to fully understand the mechanisms linking blood sugar disorders to anxiety. It’s likely a multifaceted relationship.
Who is at risk for anxiety related to blood sugar issues?
Based on current evidence, the following groups seem particularly prone to experiencing anxiety related to blood sugar dysregulation:
- People with diabetes – Uncontrolled diabetes often involves chronic hyperglycemia interspersed with bouts of hypoglycemia and glucose swings, which may worsen anxiety.
- Individuals with reactive hypoglycemia – Reactive hypoglycemia involves blood sugar crashes 2-4 hours after meals due to excessive insulin release.
- Those with insulin resistance/prediabetes – The insulin resistance underlying prediabetes promotes chronic high insulin and unstable blood sugar.
- People who frequently skip meals and snacks – Erratic eating habits can trigger blood sugar spikes and drops.
- Those who consume high glycemic index foods – High glycemic foods like sweets, white bread, potatoes cause rapid blood sugar spikes.
- People with binge eating disorder – Cycles of binge eating on high-sugar foods followed by restriction cause blood sugar fluctuations.
- Individuals who use certain medications – Corticosteroids, tricyclic antidepressants, some antipsychotics, etc. may increase blood sugar dysregulation risk.
- People under high stress – Stress hormones can raise blood sugar and impair glucose metabolism.
Those affected by the above risk factors may be more prone to experiencing anxiety related to unstable blood sugar. However, even people without diagnosed blood sugar disorders can be susceptible.
Can treating blood sugar issues help resolve anxiety symptoms?
If blood sugar imbalance is contributing to or worsening anxiety, stabilizing blood sugar may relieve anxiety symptoms. Some tips to regulate blood sugar and potentially reduce anxiety include:
Follow a regular meal schedule
Eating consistent meals and snacks every 3-4 hours helps maintain steady blood sugar throughout the day. Skipping meals can trigger hypoglycemia and spikes/crashes after eating.
Choose complex, low glycemic index carbohydrates
Opt for carbohydrates like whole grains, beans, lentils, and non-starchy veggies. They digest more slowly than refined carbs, preventing blood sugar spikes.
Limit added sugars and refined carbs
Cut back on added sugars (soda, candy, etc.) and refined grains like white bread, pasta, baked goods, etc. These cause rapid blood sugar spikes and crashes.
Increase protein and fiber intake
Protein and fiber slow digestion, which moderates the blood sugar impact of meals.
Manage stress
Chronic stress increases blood sugar and impairs its regulation. Relaxation practices like yoga, meditation, deep breathing can lower stress.
| Foods That Stabilize Blood Sugar | Foods That Destabilize Blood Sugar |
|---|---|
| Complex carbs – Whole grains, beans, lentils, starchy veggies | Refined carbs – White bread, sweets, baked goods |
| Non-starchy veggies | Fruit juice |
| Lean protein – Fish, chicken, tofu, eggs | Fatty fried foods |
| Nuts and seeds | Sugary drinks |
| High-fiber foods – Vegetables, whole grains | Alcohol |
A diet focused on whole, minimally processed foods with a lower glycemic load helps stabilize blood sugar. While dietary changes take time and effort, they can significantly improve blood sugar control.
Ask your doctor about medication options
If lifestyle changes are insufficient to stabilize blood sugar, your doctor may consider medications:
- For diabetes/insulin resistance – Metformin, insulin, etc.
- For reactive hypoglycemia – Medications to reduce rapid insulin spikes.
- For high cortisol – Cortisol blocker medications.
Medications can be an adjunct treatment along with diet and lifestyle changes to help normalize blood sugar fluctuations.
Get regular exercise
Exercise makes cells more sensitive to insulin and promotes better blood sugar regulation. Aim for 150 minutes of moderate exercise like brisk walking weekly, along with strength training twice a week.
Try supplements
Supplements like chromium, alpha lipoic acid, berberine, cinnamon extract and others may also assist with stabilizing blood sugar levels.
Implementing a combination of dietary, lifestyle, and potential medical strategies tailored to the specific blood sugar disorder can help regain control of dysregulated blood sugar. As glucose levels stabilize, associated anxiety symptoms may greatly diminish.
When to see a doctor
If you think blood sugar issues may be contributing to increased anxiety for you or a loved one, consult a doctor to get evaluated. It’s important to identify and properly treat any underlying blood sugar disorders. Symptoms that warrant an evaluation include:
- Fatigue, irritability, shakiness between meals – Could signal reactive hypoglycemia
- Increased thirst, frequent urination – Potential signs of hyperglycemia
- Sensations of anxiety shortly after eating sweets or other refined carbohydrates – May indicate reactive blood sugar spikes
- Feeling anxious, jittery and sweating during periods of fasting – Suggests hypoglycemia
If you experience ongoing anxiety in combination with any of the above symptoms, see your doctor and ask to get blood sugar testing done. This could include fasting blood glucose readings, hemoglobin A1c level, and/or oral glucose tolerance testing to help reveal any blood sugar dysregulation issues.
Based on test results and your clinical presentation, your doctor can diagnose any blood sugar disorders and outline the best treatment approach to stabilize glucose levels and lower anxiety. This may include referral to an endocrinologist or diabetes specialist for additional management.
Conclusion
In summary, substantial scientific evidence indicates that blood sugar imbalances like hypoglycemia, hyperglycemia and glucose variability can contribute to increased anxiety risk and severity in many people. Those with diabetes, insulin resistance, reactive hypoglycemia and related issues appear most vulnerable. The mechanisms linking blood sugar dysregulation and anxiety are complex and multifactorial.
Stabilizing blood sugar through proper diet, exercise, stress reduction and medications when needed may help alleviate anxiety symptoms. Testing and treatment of any underlying blood sugar disorders is advised. Working with a doctor to optimize blood sugar control through lifestyle and medical therapies can ultimately improve both physical health and mental health.