Tuesday, January 18, 2011

A psychological theory to explain rise of sugar, lipids and triglycerides causing metabolic syndrome in chronically stressed

A long time back, when I was in my late thirties, Single, and somewhat of a hypochondriac -a common affliction in people in mid-life and still without wife and children - one day, feeling out of sorts, slightly nauseous and light-headed, I asked a nurse to check my blood pressure.
And lo and behold, instead of the usual 140/90 it came as 155/98. I could not believe that my body was betraying my mandate to always serve me without a fault, and I was instantly filled with anger, apprehension, vague forebodings, and a desire to go on a rampage.
The nurse told me to calm down and handed me a candy bar. On my expressing surprise - for wouldn't sugar worsen my emerging metabolic syndrome, hastening diabetes alongside the hypertension - she said, "No. Eat the candy. The sugar in it will bring down your blood pressure."
And she was right. In a matter of minutes the blood pressure returned to its baseline - 140/90.
The nurse explained that sugar made me feel good, which brought down the blood pressure. Sugar, according to her, works like a reward and when you eat sugar, or any food, but especially food that is loaded with calories, it makes you feel like an instant winner. Winning and getting rewarded is what life is all about and for eons of evolutionary years the reward was basically one of two things - food or sex. When you eat or finish having sex, you feel like you have reached your goal and are getting rewarded. This sends a signal to your brain to turn off "the strife mode", which brings down your blood pressure. As long as you are in a state of strife your blood pressure remains high, for your body is geared up for "fight or flight". But when you have a feeling that you are getting rewarded, the body relaxes and the blood pressure comes down.
The nurse set me thinking. And I began to notice that when I am stressed, or feeling anxious, or agitated, I do reach - sometimes even without paying attention - for food, and the eating does help the mood. If I receive bad news, or am gearing up for confrontation, for example like having to argue with an insurance company rep. over discharging a patient from hospital prematurely, or doing even such a minor stressful activity like dictating medical charts, I do feel tension, or pressure, or presence of something like a foreign object, in my chest. And eating a cookie, or sipping coffee, or eating hot salty harsh food like jelapeno chips, helps. In fact all the while I am masticating the food, and feeling its passage through the esophagus, I feel virtually no stress and my mind gets distracted away from whatever is bothering me into concentrating upon the pleasure arising from eating and swallowing.
So eating lowers stress and takes away depression and anxiety, at least in me, and perhaps in all those who can use this mode of gratification to block out painful emotions arising from adversities. The pleasure from eating blocks out the perception of pain arising from the stress as if our conscious mind can handle only one affective tone at a time.
People who are couch potatoes, and eat all day long, must suffer from subtle dysphoria, or even overt depression and anxiety, and much of their eating is not for nutritional reasons but to counter their depression, I reasoned.
I wondered too whether people who live stressful life - especially that had its beginnings in childhood, when pleasure from eating is most profound - overeat to handle stress, and thus get overweight, and develop diabetes, and other metabolic problems.
And is it possible that not just the process of eating that lowers the stress but a rise in blood sugar also plays a role in bringing down the stress?
If the latter is true as well such people may be pathologically seeking to keep their blood sugar at high levels to create a continuous source of pleasure. And in an attempt to keep high supply of sugar to their system is it possible that their body turns on genes that lower their basal metabolic rate, and gear up metabolic processes that start storing lipids and fats more than what is good for them, and all in order to have a readily available internal source of energy, in case food becomes scarce in the stressful and dangerous outside world.
How does this constant high level of sugar consumption affects the glycobiology of these people? The purpose of high levels of sugar is of course for it to be readily available not just in the blood but inside the cells, especially in muscle and brain cells, which must function at a higher level of activity in order to deal with stress. For it is with brain that we scan our surroundings for danger and make strategic multi-step planning in our neurons to combat the enemy, and it is with muscles that we fight or flee away from the enemy and keep it taut to prevent any foreign object penetrating through its shield.
This assumption that blood sugar quickly moves into intracellular space when under stress also may explain as to why anxious people, at least in their youth, often show hypoglycemic attacks that go as low as 40 mg/dl. Panic pumps insulin out of the pancreas to move the sugar rapidly into the intracellular space for quick burning to face the danger.
Could this constant moving of blood sugar into intracellular region to prepare the body for flight and fight finally leads to the development of insulin resistance to prevent excessive conversion of intracellular glucose to lipids and triglycerides?
The insulin resistance in diabetics perhaps results from the following sequence of events.
  • High level of stress and anxiety, due to genetic predisposition and environmental stressors, especially childhood abuse and neglect.
  • High sugar consumption to deal with this anxiety by keeping the body's flight or fight mechanism on high alert.
  • Excessive insulin secretion to keep moving this sugar into intracellular region.
  • Development of insulin resistance to prevent movement of sugar into intracellular region where it is getting converted to way too much lipids and triglycerides.
  • Finally development of diabetes where there is high level of sugar in extracellular space while intracellular space is in sugar starvation.
The degeneration of various organs especially the nervous system, which exclusively uses sugar for its energy needs, occurs because of this intracellular sugar starvation.
Couple of additional points are worth taking up here.
Why does anxiety or stress cause lump in the throat, queasiness in the stomach, pressure on the chest?
Per my theory stress should activate the drive to search for food to raise blood sugar, but that does not explain the emergence of these physical symptoms in the upper GI tract.
Now it is not real hunger that primarily causes stress related eating. Eating is indulged in as a quick attempt to raise blood sugar but more so as a means to deny the magnitude of the stress. If one is eating then it gives a false signal to the mind that one is in a state of plenty and therefore there is no need to get too worked up and collapse altogether by overestimating the danger. Its mechanism is similar to addictive behavior. As long as one is indulging in addictive behavior all other realities of the world, including all sense of danger and worries, disappear. There is a psychologically adaptive mechanism in play here.
These physical sensations in throat, chest and stomach - almost like irritants - emerge not as much to invite eating - as an attempt to douse them with food - but because of an entirely different psychologically adaptive mechanism. They arise to give a sensation of there being a foreign body in the upper GI tract which must be got rid off; irritants that must be either doused with food or dug out from one's flesh with a counter-irritant.
From where does this sensation of the presence of a foreign body/irritant arise?
They owe their existence to anxiety -a somatic manifestation of anxiety. They are basically no different than other somatic processes of anxiety like irritation in lower GI tract causing different forms of colitis; irritation in bronchial tree causing allergic respiratory problems like asthma; irritation in the bladder with urinary frequency and in more extreme cases Interstitial cystitis; irritation in the sinus mucosa with secretion of tears and sinus fluids; irritation in the skin causing psychogenic pruritis; irritation in heart causing arrhythmias.
Why does anxiety causes these foci of somatic irritation?
If we turn to current psychiatry to get an answer as to why anxiety causes such somatic disturbances we find nothing. Yes, modern psychiatry does catalogue beautifully all manifestations of anxiety - plagiarized straight from Freud's earliest psychoanalytic writings, never crediting him - but gives no explanation as to why this happens. Actually current psychiatry despite its hoopla about being very biological and molecular based tells us nothing about soma and forget about psyche. All it does is to catalogue symptoms.
Now here I venture into a very far out hypothesis. Somatic anxiety, which is really not so much affect of anxiety but activation of mucosal tracts and surrounding tissues and muscles in various tracts of the body through which the interior of the body communicates with the outside world, is actually a psychological attempt by the mind to fight and do away with the agent that is causing the stress.
Before we evolved into humans anxiety/fear gave us two options: run away or fight. But by turning in to humans these two options have increasingly turned into non-options. In a civilized human society we have to stay our ground and deal with the agent of stress without running or attacking it. Animals also face this quandary, but not in such a regular fashion as humans. And when you have to deal with an enemy without the choice of making him disappear by running away or annihilating it, you are forced to use different strategies.
Creating somatic anxiety is one such strategy. The object [forces] that is causing the stress and from which one cannot run away or attack because of social restraints is as if "internalized" by the mind into one of the body tracts and the battle against it is waged there. It is "fight in displacement" which has psychological as well as biological/evolutionary roots.
The hated stressful object is as if swallowed inside one of the body tracts and the fight against is launched there. It the enemy is felt within the lower GI tract it is as if extruded into oblivion with the force of violent colitis. If it is in the urinary tract it is flushed out repeatedly. If it is in bronchial tree it is subjected to asthmatic choking by clamming up of the muscles. If it is in the skin it is treated as an irritating bug. In the upper GI tract it is treated as if it is a bad piece of food that was taken in by mistake and now either should be placated with sweet food and sent down the tract or burnt alive as with stomach acid using some harsh food or spirit such as particularly hot jalapeno or whiskey or thrown-up as vomit.
Here we are reminded of the phrases: eating someone alive, eating and spitting them out, burning in hell fire [of stomach acid].
The appearance of lump or heaviness in the chest is a recreation of the source of stress [the enemy] inside one's own body - in the GI tract - and then an attempt to destroy it there, because one cannot destroy it in the outside world. Granted it is not a real elimination of the enemy but a make-belief elimination done inside one's body and since it is make-belief, it keeps recurring as long as the external enemy exist, but it does give temporary relief. Preference for hot and spicy food over sugar is like using harsh tools against one's own flesh where the enemy is perceived to be launched.
This creation of enemy within one's system and then treating it as a foreign object and how it provokes secretion of steroids and activates body's immune responses and causes stress-induced autoimmune disorders are interesting fields of enquiry. Secretion of steroids in stress appears to be an attempt on part of the body to block body's immune response against one's own tissues that are being harnessed to play the role of foreign body.
A discussion about stress and rise of blood sugars and lipids cannot be ended without touching upon a puzzling clinical phenomena. Why do psychiatric medications raise blood sugar and worsen lipid profile?
This is an even more far fetched hypothesis but perhaps I am justified in putting it forward. Anti-psychotics and antidepressants at least partially work by raising the levels of carbohydrates and related compounds in the body. This is looked upon as an unwanted side effects of these medications. But perhaps it is more than side effect and may lie central to its therapeutic efficiency. After all the three most efficacious antipsychotics - Clozaril, Zyprexa and Seroquel - they all cause the greatest increase of blood sugar and lipids. In fact there seems to be a high correlation between greater disruption of carbohydrate metabolism and better antipsychotic efficacy. As if antipsychotic medication efficacy is dependent upon how much side effect they cause. A phenomena that was remarked upon by researchers when the first generation antipsychotics came into practice and it was noticed that therapeutic dose is often one that produces extrapyramidal symptoms. As if antipsychotics work by shifting the overactive dopamine activity from higher centers of the brain which do cognitive activities, and where madness lies, to lower centers which regulate autonomic activity including derivation of pleasure from eating and other body functions.
If there is indeed a psychotherapeutic angle to this rise in fat and sugar in body what could be the psychological factors that run parallel to the physical processes?
I speculate that a high storage of lipids and triglycerides and high blood sugar levels gives the patients a false sense of security and makes them stand up to their fears/stressors/enemies. For after all we were most secure on our mother's breast getting suckled by her sugar and fat laden milk. A rising levels of these "goodies" transports us back - even if in a very limited sense - to the days when we enjoyed the security of being one with our mothers through her breast, getting all our nutritional and love needs met without any effort.

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