Vicious Cycle

//by Morgan Jenkins
Poor diet. High blood pressure. Age. Genetic predisposition. These are some of the risk factors commonly associated with diabetes. When it comes to the disease, which currently impacts more than 30 million people in the United States, doctors tend to pinpoint physical and hereditary symptoms, but are far less likely to connect it to mental health.
Elizabeth Winings, lead nurse practitioner in the Division of Psychiatry at Nemours Children’s Specialty Care, specializes in the relationship between diet, lifestyle and mental health. She notes that the apparent relationship between diabetes and mental health cannot be understated. “Individuals with chronic medical illnesses such as diabetes are at a two- to three-times higher risk of having a co-morbid mental health disorder such as depression. Individuals living with depression are at a higher risk of developing type two diabetes due to low levels of physical activity, poor dietary habits and isolative behaviors or lack of social interaction.”
So why does this relationship between depression and diabetes exist? And moreover, what preventative measures can be taken to reduce the bidirectional risk of someone with one getting the other?
Diabetes occurs when a person’s blood sugar levels are considered higher than normal. Food that goes into the body is converted into glucose, which is stored in our cells for energy. The pancreas is responsible for creating a hormone called insulin to aid in transferring glucose into our cells. Diabetes results when the body either fails to make enough insulin (resulting in type 1 diabetes) or can’t use the insulin that it does make efficiently (in the case of type 2). In both cases, sugar accumulates in the blood, which can lead to a variety of subsequent health complications, some of which are fatal. Currently, diabetes is the seventh leading cause of death in the U.S. By 2030, the number of people with the disease is predicted to more than double.
One of the most obvious risk factors of diabetes is increased weight. People who struggle with obesity are 80 times more likely to be diagnosed with type 2 diabetes than those who maintain a healthy weight. A range of medications commonly prescribed to treat depression have been shown to impact weight in patients. “There are categories of medication for depression that have higher risks for increased appetite or weight gain,” Winings says.
Inversely, people who have been diagnosed with diabetes are more at risk for developing mental health issues. They can easily grow susceptible to the day-to-day stressors that coincide with self-management of the disease, known as “diabetes distress.” Someone with type 1 diabetes, for example, might be responsible at any given time for checking in on their glucose levels, ensuring that they provide their bodies with the appropriate amount of insulin and making good food intake and physical activity decisions. These constantly demanding responsibilities can become overwhelming and take an emotional toll, eventually contributing to feelings of depression.
Registered dietician Heather Borders recommends that people undergoing depression or diabetes-related weight gain incorporate a plant-based diet into their lifestyle as a means of prevention.
“Focusing on foods such as starchy vegetables like potatoes, butternut squash, beans, and whole/intact grains like quinoa or brown rice provide substantial fiber and bulk necessary to stretch our stomachs to satiety,” she says. “The fiber will slow blood sugar absorption and since these foods are low-fat and low-calorie, they will assist with weight management and insulin resistance. In addition to highly nutritious and anti-inflammatory diet, exercise and managing stress have proved to have a tremendous improvement on our mood and emotions.”
Winings agrees and attests that education, preventative regulation and maintaining proper nutrition are key. “Educating oneself on the risk factors, prevention, and treatment for a disease process is the most valuable thing an individual can do whether he has been diagnosed with depression or diabetes,” she says. “There is increasing data for diets high in whole plant-based foods for improving depression, diabetes, and in many cases reducing the use of medication—under the supervision of a prescribing practitioner. The Physicians Committee for Responsible Medicine and the Barnard Medical Center are wonderful resources for this research.”