Diabetes & Mental Health Coping strategies for anxiety and depression

An often forgotten, and even neglected, aspect of type 2 diabetes is the mental health burden that patients with this disease face. Thankfully, there are lifestyle strategies and natural supplements that may help patients cope with diabetes-related stress and depression.

Diabetes: mind and body

Diabetes mellitus is a metabolic disorder caused by an absolute or relative lack of insulin. Type 1 diabetes mellitus typically begins in childhood with the inability of the pancreas to secrete insulin and properly regulate blood sugar. The more common type 2 diabetes mellitus typically begins in adulthood due to poor lifestyle habits, and is characterized by insensitivity to insulin, which cannot be overcome by the pancreas.

There is much hope today for patients with both types of diabetes, since many natural health products and pharmaceuticals are available to improve blood sugar regulation while also reducing risk factors for kidney failure, nerve damage, blindness, and cardiovascular events such as strokes and heart attacks.

However, many clinicians approach type 2 diabetes by primarily focusing on the hormonal, visual, nerve, cardiovascular, and kidney issues, yet seldom discuss and manage the mental health implications of living with the disease. Type 2 diabetes affects both the mind and body, so it is imperative that clinicians take a holistic approach in their management of the disease.

Mental health concerns

The mental health burden that patients with diabetes face is worrisome. Compared to non-diabetic patients, there is a two-fold increase in the severity of depression and anxiety among diabetes patients. The combination of psychological disorders and diabetes is especially damaging because it can have a negative impact on psychosocial and medical outcomes.

Among type 2 diabetes patients, those with depressive symptoms will likely report more stress associated with having the disease, leading to an increase in negativity, which, in turn, is associated with more avoidance and passive behaviour. This is a vicious cycle, since the increase in avoidance and passive behaviour lead to more depressive symptoms or greater diabetes-related stress.

Depression and anxiety can also lead to other seemingly unrelated health concerns. For instance, a recent study showed that compared to healthy subjects, type 2 diabetes patients with severe depression and anxiety have a higher prevalence of gastrointestinal symptoms.

There is even a specific personality trait attributed to type 2 diabetes, known as the “Type D (distressed) personality.” Type 2 diabetes patients with Type D personality experience increased loneliness, stress, and emotional distress.

Manage stress

While it is evident that type 2 diabetes increases the likelihood of having mental health concerns and being less able to manage the daily stresses of life, the good news is that there are numerous strategies that can empower patients to better manage their psychological health and overcome these issues.

Yoga

One of the best strategies is to engage in yoga several times each week. Yoga helps to build body awareness and is great at calming the nervous system. It involves numerous postures that integrate or unite the body and mind. With experience the participant learns to breathe more fully and completely.

According to a study from 2011, yogic practices “enhance muscular strength and body flexibility; promote and improve respiratory and cardiovascular function; promote recovery from and treatment of addiction; reduce stress, anxiety, depression, and chronic pain; improve sleep patterns; and enhance overall well-being and quality of life.”

Another recent study showed that regular yoga among patients with type 2 diabetes significantly improved quality of life. Previous studies have shown yoga to help control the symptoms and complications associated with having type 2 diabetes.

By regularly practising yoga, type 2 diabetes patients may have less psychological distress and better management of their disease. The other benefit is the potential absence of side effects, since yoga is essentially side-effect free when practised correctly.

Mindfulness meditation

Mindfulness training is a form of meditation that helps people focus attention on the present and encourages a positive attitude toward that experience.

Some provincial health plans or extended health care plans will cover most of the costs associated with participating in such programs. However, some programs charge additional fees, such as for course materials, so it’s always best to double check. Programs are often offered at local hospitals or health care facilities.

The rationale for this type of meditation has been validated in the medical literature, especially for chronic conditions such as diabetes. Mindfulness-based programs are thought to improve medical outcomes and the ability to cope with clinical problems that often accompany chronic conditions. Similar research has shown that participating in this form of meditation may benefit patients’ ability to cope with diabetes-related symptoms, as well as more generally improve their quality of life and well-being.

Specific research on type 2 diabetes has shown that mindfulness-based training can improve pain, sleep, and worrying and decrease depression, anxiety, and general psychological distress.

Massage therapy

A lesser known therapy that may facilitate better mental health among type 2 diabetes patients is therapeutic massage. Results from scientific literature have been mixed. However, older studies have noted that it results in greater relaxation compared to resting alone and is thought to induce the relaxation response. The relaxation response brings more balance to stress hormones in the body and improves the utilization of insulin.

These studies have also noted that massage therapy has been shown to reduce anxiety in many groups, including individuals with type 2 diabetes. Other benefits of therapeutic massage include increased blood circulation, especially to the lower limbs.

Helpful supplements

It is best to complement yoga, mindfulness, and/ormassage therapy with natural medicines that may further de-stress the nervous system and help to reduce symptoms of anxiety and depression. Always check with your health care practitioner to make sure a supplement is right for you.

Chromium

One of my favourite natural medicines for type 2 diabetes is the trace mineral chromium, which is thought to increase the sensitivity of insulin in the body. It has been well studied and can safely enhance the effectiveness of blood sugar-stabilizing medications by improving blood sugar control (double check with your health care practitioner before combining with medications). A large meta-analysis showed that supplemental chromium reduces both glycosylated hemoglobin and fasting blood sugar levels.

The less well-known benefits of supplemental chromium involve its ability to reduce certain symptoms of depression, including carbohydrate craving, as demonstrated by a 2005 study.

Rhodiola

The other natural medicine that I often prescribe to type 2 diabetes patients with mental health issues is the herbal medicine Rhodiola rosea. I particularly like rhodiola since it has virtually no interactions with medication and therefore can be safely combined. Again, ask your health care practitioner to be safe.

Human studies support the use of rhodiola for the treatment of anxiety, mild to moderate depression, fatigue (burnout), and life stress. Very preliminary research on rats has shown it to reduce binge eating, which can be a problem among type 2 diabetes patients and may contribute to guilt and psychological distress.

Outcomes

Over the past 14 years I have treated hundreds of patients with mental health issues, including those with type 2 diabetes. In the majority of cases, the additions of lifestyle modifications and specific natural health products have successfully improved quality of life and medical outcomes.

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Eating Disorders

Eating Disorder Awareness Week is an international public education and outreach campaign that is recognized across Canada in early February each year. Awareness is the critical first step in helping families identify when someone they love is at risk.

Recognizing a problem

Most people are aware of some types of eating disorders such as bulimia nervosa and anorexia nervosa, yet they don’t always recognize those suffering in their own lives. If someone you care about is spending more time at the gym than with friends, rarely wants to join the family for dinner, or is always on a diet, they may be exhibiting early warning signs that a bigger problem is developing.

A mental health issue

Eating disorders are a mental health issue with devastating effects on one’s physical health and quality of life. Underlying the food and exercise behaviours are distorted and self-critical attitudes toward shape, size, and self-worth.

Equal opportunity disorders

Eating disorders do not affect just young females, as once thought. Research is showing that eating disorders are becoming more of a concern for men and women of all ages. While men experience all forms of disordered eating, they are more likely than women to engage in compulsive eating. Men are less likely than women to abuse laxatives or vomit but are more likely to use excessive exercise to control their weight.

Binge eating disorder

One of the most common forms of disordered eating, and perhaps the least understood, is binge eating disorder (BED). Those experiencing BED compulsively eat large quantities of food and tend to feel secretive and shameful about their eating.

Binge episodes are preceded by strong urges and a sense of being out of control. A person with BED has very similar drives and feelings as someone with bulimia, but they don’t attempt to compensate for their binges through overexercising, laxative abuse, or vomiting.

What causes eating disorders?

According to the National Eating Disorder Association, eating disorders arise from a complex combination of behavioural, biological, psychological, interpersonal, and social factors.

Personality traits

Some of the known personality traits associated with eating disorders are perfectionism and low self-worth.

People who have difficulty identifying and regulating emotions are also at risk. One study that focused on boys concluded that those who cope with problems through self-blame were more predisposed to develop an eating disorder.

Trauma

Traumatic life events such as a sexual assault or even transitional events such as relationship changes, moving away from home, or loss of a loved one can trigger eating disorder behaviours.

Research indicates that the lack of necessary supports during the transition rather than the transition itself is what may precipitate the onset of an eating disorder. Those who experience depression, anxiety, or obsessive compulsive tendencies are also at increased risk.

Understanding the illness

Sometimes families or friends have a hard time understanding how the desire to be thinner and to eat better or exercise more can lead to a serious illness. From the outside, the behaviours demonstrated by someone with an eating disorder don’t make sense and the temptation may be to encourage them to change their eating habits. However, recovery is about much more than food or weight.

At a recent orientation session for new clients at the Manitoba Eating Disorder Prevention and Recovery Program, counsellor Shannon Gander explained how eating disorders fulfill important functions for those who are suffering.

Familiar rituals provide comfort

“Despite the costs to health, relationships, and loss of opportunity, eating disorders fulfill needs that people haven’t yet learned to meet elsewhere,” said Gander. She explained that the familiar rituals can be soothing; they help people cope with intense emotions and provide comfort.

Behaviours offer sense of control

Clients are encouraged to view their illness with compassion as they come to understand how the behaviours developed as a way to deal with feelings of shame, anxiety, or powerlessness. Gander explained that eating disorders may also provide a sense of control: “Individuals may use food or exercise as a form of discipline or punishment or as a way to maintain a sense of order when their lives feel chaotic.”

Dealing with underlying issues

Recovery requires addressing the underlying issues that motivated the behaviours and helps people learn new ways to cope with emotions and life’s normal stressors.

Signs of eating disorder

Friends or family members may not always be sure when someone has a problem, but there are some warning signs to be aware of:

• preoccupation with food and weight
• distorted body image
• secrecy
• withdrawal
• skipping meals or making excuses for not eating
• eating only certain foods; refusing others
• cooking for others, but not eating themselves
• wearing baggy or layered clothing
• eating large amounts of sweet or high-fat foods
• using laxatives
• hoarding food
• exercising excessively

Chemical dependency

It is not uncommon for those with an eating disorder to experience chemical dependency. Research indicates that rates of substance abuse are higher among those with an eating disorder than in the general population. Approximately one-quarter of people with bulimia and over half of men with binge eating disorder struggle with alcohol dependence.

What to do

If you think that someone you care about is suffering from an eating disorder, it is important to speak up. People with eating disorders are often afraid or reluctant to seek help on their own. Others simply don’t see themselves as worthy or deserving of help.

Approach the conversation with compassion and without judgment. Keep the focus on your feelings and on the relationship you have, not on weight or food. Comments on appearance, both positive and negative, have been shown to perpetuate the problem.

Providing empathetic support and helping to facilitate access to professional services can set the stage for recovery. 

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What do the new buzzwords mean?

These terms are not used by treatment practitioners for clinical diagnoses, but they describe current trends and may help you identify when someone you care about has a problem.

Drunkorexia may apply to someone who restricts their food intake all day in order to offset the alcohol calories that will be consumed in the evening. Drunkorexia typically involves binge drinking and sometimes purging. Recent Canadian research shows a strong link between those who diet and drink and other high-risk activities.

Anorexia athletica is used to refer to people whose drive to exercise is fuelled by guilt and anxiety. Exercise may be the most important activity in that person’s life; while they are overtraining they are not eating enough to adequately fuel their activity level. The initial motivation may be sports performance rather than body image concerns, but the mental and physical health outcomes are as dangerous as other eating disorders.

Orthorexia may apply to someone who will only eat foods that they consider to be “natural” or “clean.” This is a concern when it involves caloric restriction and an obsessive preoccupation with healthy eating. Some people also secretly binge on and then purge the foods that they consider to be forbidden.

Pregorexia is used to refer to women who are engaging in disordered eating behaviours while pregnant. The fear of weight gain and external pressures to be thin may interfere with a woman’s desire or ability to properly care for herself and her baby. Undereating, abusing laxatives, taking diet pills, purging, and overexercising can increase health risks for both the woman and her developing fetus.

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Teeth Scaling May Reduce the Risk of Heart Problems

For some of us, going to the dentist for annual or semi-annual cleanings is synonymous with torture. (Think Dustin Hoffman’s character in Marathon Man.) Depending on the skill of the hygienist and our own regularity at flossing, teeth scaling can be anguished torment. And the worst part is, we pay good money to be tortured!

But if you’re tempted to skip your cleaning, you might want to think again. A recent study has established an association between teeth scaling and a reduced risk of future cardiovascular problems.

For some time now, poor oral hygiene has been associated with an increased risk for cardiovascular disease. But until recently, the role preventive dentistry could play in maintaining heart health, hadn’t been determined.

Long-term study Researchers studied 10,887 Taiwanese subjects who had regular tooth scaling at least once a year and compared them to 10,989 subjects who didn’t receive scaling. Subjects were matched for age, gender, and comorbidity (having a similar history of coronary artery disease, diabetes, hypertension, and hyperlipidemia).

Subjects were 50 years old or older and had received at least one tooth scaling in 2000. All subjects were then followed for an average of seven years.

Heart benefits of teeth scalingThose who had their teeth scaled at least once a year had a lower incidence of

• heart attack
• stroke
• total cardiovascular events

Those who had their teeth scaled more frequently had an even lower risk for all three categories.

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