Type 2 diabetes: is the impact of a stressful lifestyle being underestimated?

New research suggests the link between chronic stress and type 2 diabetes should be taken more seriously as diagnoses in the UK reach an all-time high

‘I was at a complete loss. I felt defeated really. I thought I’d tried everything possible to reverse it’ ... Tracey Igoe recalls thinking before she learnt that the stress hormone, cortisol, elevates the body’s blood sugar levels. Illustration: Kathryn Winter/Canva

After a lifetime of exercising moderately, eating her five-a-day, and never being over- weight, Tracey Igoe, 57, has recently been added to the growing number of Britons diagnosed with type 2 diabetes. Nine months ago, after visiting her local GP with complaints of chronic fatigue, she was told that her blood sugar levels were in a pre-diabetic state as her body had become insulin resistant. This means the body has stopped responding to the amount of insulin produced by the pancreas and,

therefore, cannot sufficiently regulate its blood sugar levels. “I was genuinely shocked as I’ve never had a poor diet or a particularly sweet tooth,” Igoe says. But, six months on, despite trying to follow the most publicised lifestyle advice on fine-tuning her diet and exercise regime to reverse the condition, her blood sugar levels had sky-rocketed. “I was at a complete loss. I felt defeated, really. I thought I’d tried everything possible to reverse it,” Igoe recalls. But she was determined to find answers.

“It was only by stumbling across a small section in Good Housekeeping [the magazine], while waiting at my local doctor’s surgery, that it all started falling into place,” she says. Learning that the stress hormone, cortisol, elevates the body’s blood sugar levels made her realise how much she may have underestimated the impact of her stressful lifestyle.

Caring for her vulnerable parents, juggling two jobs, one of which she lost during the pandemic, then walking a financial tightrope, “is only half of it”, Igoe tells me.

Similarly, former long-distance lorry driver, Gary Forey, 48, gave up his well-paid career eight years ago after being told his blood sugar levels were in a pre- diabetic state. “At the time, I only gave up the job because I couldn’t handle the stress after 14 years of doing it,” he says. But within eight months of quitting and taking up a new career in gardening, his glucose levels had started to decrease. Although he still struggles with slightly raised blood sugar levels, his doctor is far less concerned. Forey says: “I didn’t think for a moment that leaving the job would make such an impact. It’s only now I see how bad the stress of it was for my body.”

Hormone specialist and former NHS GP, Dr Helen Fawcett, explains that the excess cortisol, released when you’re stressed, also slows your metabolism and stops your body from breaking down sugar properly. It further makes you crave sugar and carbs because you feel drained and need a quick surge of energy. “And while you’re in this vicious cycle, your body will struggle to break down even small amounts of sugar in healthy foods,” says Fawcett.

“There is so much telling you that dieting is the primary solution, however, if you don’t get to the root cause of the problem - often stress - then it makes it a whole lot harder for your body to stabilise its sugar levels naturally, even with a good diet,” she says.

If you don’t get to the root cause of the problem - often stress - then it makes it a whole lot harder for your body to stabilise its sugar levels naturally, even with a good diet - Dr Helen Fawcett

According to Diabetes UK, more than 150,000 people have been newly diagnosed with type 2 diabetes since 2020. Yet, a recent survey by the British Nutrition Foundation reports that 62% of Britons have made healthier changes to their diets over the last two years.

On the other hand, the UK’s top independent mental health care provider, Priory Group, reports experiencing a 55% increase in people seeking help with stress or anxiety between 2019 and 2021. And, despite Covid-19 becoming less of a concern, Priory Group has seen a further 32% rise in stress-related enquiries this February compared to the same month last year.

While obesity and a high sugar diet are still the largest contributors to the onset of the condition, increasing cases like Igoe’s are making experts review the role of other lifestyle factors, which are often less regarded.

A study published earlier this month, by the Amsterdam University Medical Centre, presents a more conclusive evaluation of the contribution of chronic stress to the development of type 2 diabetes.

“The impact of a stressful lifestyle is not being taken seriously enough,” says Dr Mary Nicolaou, a type 2 diabetes specialist and co-researcher in the study.

The impact of a stressful lifestyle is not being taken seriously enough - Mary Nicolaou

“It’s much easy to determine whether someone is eating a poor diet or overweight, but it's very hard to measure chronic stress, which is why it hasn’t found its way into the popular sphere yet,” she says.

Nicolaou explains that there are different kinds of stress. A little bit can be beneficial to us, such as when we’re in danger and need to protect ourselves. “It's that fight or flight response. But, when it becomes chronic and repeated, it can

be a problem because your cortisol, and, therefore, blood sugar levels are then constantly raised,” she says. For the majority, making dietary changes and increasing their fitness will seem a far more viable approach to reversing or managing type 2 diabetes. Most will agree that stress, however, is much harder to tackle.

“The problem is that many people don’t even know they’re stressed; they just think it’s a normal way of living,” says personal wellbeing and yoga instructor, Helen Cruickshank. Her website, Zalva, has seen the number of customers interested in yoga and other stress-reducing activities triple over the last two years.

“Today, we are in a fight or flight state almost 24 hours a day,” she says. “I even think many of us sleep in that state too.”

Today, we are in a fight or flight state almost 24 hours a day. I even think many of us sleep in that state too - Helen Cruickshank

“A major issue in our society is that we're humans ‘doing’, not humans ‘being’,” she says. “We feel we have to be doing something all the time, and we’re not giving ourselves sufficient time to wind down to allow our bodies to rest and reset.”

‘Make one small change at a time. Once you’ve got comfortable with it, then you can make another one. Don’t try and do too much at once, otherwise you won’t be able to sustain it’ ... Helen Cruickshank. Graphic: Kathryn Winter/Canva, inspired by advice from Helen Cruickshank

Cruickshank’s biggest piece of advice is to take at least 10 minutes a day to do something for yourself. “Not what others are telling you is good for you, but something that speaks to you... like drawing or gardening,” she says.

Since Igoe’s wake-up call, she has been following a similar mantra. “It’s now my top priority to ensure I’m doing things that help my body find calm... I keep trying quirky hobbies, like willow weaving,” she says on a light-hearted note. Igoe tells me her blood sugar levels have significantly improved since focusing on her wellbeing, but that she’ll need to continue taking medication for the time being.

Although current research isn’t yet able to maintain whether stress alone can cause type 2 diabetes, it is suggesting that the contribution of a stressful lifestyle is more significant than acknowledged.