Connection established between anxiety control, inflammation, Type 2 diabetes
A Rice University study has found a link between emotional stress and diabetes, with roots in the brain’s ability to control anxiety.
That control lies with the brain’s executive functions, processes that handle attention, inhibition, working memory and cognitive flexibility and are also involved in reasoning, problem-solving and planning.
The study published in Psychoneuroendocrinology establishes a metabolic chain reaction that starts with low inhibition, aka attention control, which leaves a person vulnerable to tempting or distracting information, objects, thoughts or activities. Previous studies have shown that such vulnerability can lead to more frequent anxiety, and anxiety is known to activate a metabolic pathway responsible for the production of pro-inflammatory cytokines, signaling proteins that include interleukin-6 (IL-6).
Along with cognitive tests that measured attention control, the Rice study measured levels of both blood glucose and IL-6 in more than 800 adults. IL-6 is a protein the body produces to stimulate immune response and healing. It is a biomarker of acute and chronic stress that also has been associated with a greater likelihood of diabetes and high blood glucose.
The research showed individuals with low inhibition were more likely to have diabetes than those with high inhibition due to the pathway from high anxiety to IL-6. The results were the same no matter how subjects performed on other cognitive tests, like those for memory and problem-solving.
Researchers have suspected a link between anxiety and poor health, including diabetes, for many years but none have detailed the biological pathway responsible, said lead author Kyle Murdock, a postdoctoral research fellow in psychology. He said the Rice study takes a deeper look at how inflammation bridges the two.
“The literature shows individuals with poor inhibition are more likely to experience stressful thoughts and have a harder time breaking their attention away from them,” Murdock said. “That made me wonder if there’s a stress-induced pathway that could link inhibition with inflammation and the diseases we’re interested in, such as diabetes.
“Plenty of research shows that when individuals are stressed or anxious or depressed, inflammation goes up,” he said. “The novel part of our study was establishing the pathway from inhibition to anxiety to inflammation to diabetes.”
Murdock works in the Rice lab of Christopher Fagundes, assistant professor of psychology. The Fagundes lab investigates processes that happen along the border of psychology and physiology, and how those processes affect overall health and potential treatments.
The data came from a Midlife Development in the United States study of 1,255 middle-aged adults whose cognitive abilities were tested two years apart. More than 800 of those also underwent blood tests to check IL-6 and glucose levels. The Rice researchers found not only the positive link between inhibition and diabetes, but the absence of a link between other cognitive functions and the disease. They also determined that the pathway only went in one direction: Inflammation never appeared to affect inhibition.
Murdock said a year as a clinical psychology intern at the Oregon Health and Science University, where he studied with co-author and psychologist Danny Duke, led the researchers to think there could also be a feedback loop at play in those with diabetes. “Individuals who are anxious are more likely to avoid treatment and use maladaptive strategies (like smoking or unhealthy diets) that enhance their blood glucose, which is problematic. It’s a snowball effect: The further they go, the worse it gets,” he said.
“We also know that extremely high blood glucose can impact cognition as well. We talked about how, if we’re going to treat these individuals appropriately, it won’t be by sitting them down in a room and saying, ‘Hey, you need to eat better,’ or ‘You need to use your insulin on time.'”
The researchers listed several possible interventions, including mindfulness therapy, stimulant or anti-inflammatory medications and cognitive behavioral therapy. “Research shows that people who practice mindfulness do better on the inhibition tests over time,” Murdock said, suggesting that shifting one’s attention away from stressful thoughts may affect physiological responses.
“I’m a firm believer that mindfulness-based approaches to treatment are a great idea, for a lot of reasons,” Fagundes said. “That doesn’t mean medicines that promote inhibition, such as stimulants, shouldn’t be considered, but a combination of the two could be really helpful.”
Co-authors of the paper are Angie LeRoy, a Rice staff member and a graduate student at the University of Houston; and Tamara Lacourt, a postdoctoral researcher, and Cobi Heijnen, a professor of symptom research at the University of Texas MD Anderson Cancer Center.
The National Institute on Aging and the National Heart, Lung and Blood Institute supported the research.
“The findings gave me food for thought”
I see what you did there.
Regards,
-MB
I am not familiar with the term “inhibition aka attentional control”, in psychology. I looked it up in Wikipedia, and could conclude that it is what in other terms would be normal GABA synthesis in the CNS?
Unfortunately I wasn’t able to read the paper, so it remains unclear to me whether the patients in this study had or were developping type 2 or type 1 (LADA) late onset autoimmune diabetes of adulthood. Where in the latter there is another relationship between anxiety and diabetes – through the Anti-GAD antibodies generally better known for their diagnostic role in diabetes but also known in a range neurological and (neuro)psychiatric diseases/syndromes, where GABA synthesis in the CNS is impaired by these antibodies. I think your article then shows that there are at least two pathways, in the development of diabetes.
Your article raises the question whether it isn’t the best approach for many if not all diseaes and syndromes to use a two track approach, as again it proves that physical an psychological processes influence each other two directional.
Most would consider it absurd to treat a type 1 diabetic purely and only with psychological means, such as cognitive behavioural therapy or meditation and
otherwise. However, in diseases labeled “a physical problem” in fact just as absurd, but considered completely normal, the psyche of the patient still usually remains non relevant in terms of treatment, effects of recovery and/of amelioration of well being.
I think the two track treatment approach is appropriate in many if not all disease as opposed to the (at least where I live, and problably many other parts of the world) dividing patients up (sometimes ad absurdum) in different body parts, in body – mind of by fields medical specialisms ignoring the all the rest and the body – mind interactions too. By this usus missing opportunities to effectively treat patients, or at least helping improve their quality of life… and isn’t that what in medicine it all is about, or should have been about..
Considering there are vast numbers of patients labeled with psychogenic problems, of psychiatric diagnoses, for whom this division in mind – body often results in neglect of physical causes for their problems, and then society’s attitude towards psychological or psychiatric problems and socio-economic impact of being labelled as such, does make this group of patients worst of in the common “one-track” (or either-or) approach of medicine practice these days.
In my opinion it has evolved to a monstrous system of specialist islands leaving the patient as is and as a whole organism (too) often out of the picture.
Thank you for the interesting article and discovery, creating a refreshing view on the beautiful complexity of living organisms.
The findings gave me food for thought, I hope it will for the entire medical profession.
Best regards,
K.