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Week 3
There are metabolic levers we can pull for increasing our metabolic fitness and weight loss. The metabolic levers we will look into for this section include diet, exercise, sleep, and stress. We use the term levers because these are adjustable behaviors that move on a continuum, not simply on/off switches. In fact, these metabolic levers overlap and collectively they have a significant influence on your blood glucose. For example, you could eat exactly the same thing on separate days and your blood glucose can differ based on your physiological state. Lifestyle factors such as how you slept the night before if you’re feeling stressed, or your current exercise/activity level all contribute to the larger picture of blood glucose.
By now, you’ve probably observed how the different metabolic levers interact with your blood glucose levels. Dietary choices will have the greatest impact on your metabolic health and can begin shifting your metabolic state almost immediately. But, to truly start optimizing metabolic health, we need to pull on other foundational metabolic levers.
“Should I eat this or that”, “It’s okay for me to have one more drink”, “I’ll finish one more episode and then I’ll go to bed”, “I don’t have the time now, I’ll get to me later”. Whether you’re aware of it or not, thousands of these micro-decisions are made daily and greatly impact your metabolic health. Specifically, the collective influence they have on your blood glucose levels.
Diet, exercise, sleep, and stress are the primary metabolic levers within our control. We strongly believe that positively managing these behaviors will significantly improve your metabolic health and promote weight loss. However, exercising control over these behaviors requires your attention and effort. Your CGM is a very effective tool, but this is not a magic pill or miracle drug. While the CGM is a powerful tool for behavior change, ultimately you have to discern and implement positive behaviors.
The goal is to notice the relationship between the metabolic levers and your blood glucose levels. When you begin observing the interplay, you can apply micro-strategies to promote and enhance your metabolic health. Observing and managing the metabolic levers is the catalyst for real behavior change. By managing these everyday behaviors, you enhance your biological systems. Thus, shifting your state into one of metabolic efficiency and high-performance.
Diet
Hands down, your dietary choices will have the biggest impact on your blood glucose, metabolic health, and weight loss. The more you discover about your bio-individuality, the more access, and control you have over your metabolic processes. Unlocking your bio-individual nutrition will be your best greatest advantage for metabolic health and weight loss. Because of your bio-individuality and physiological state, your specific food choices won’t be perfectly clear in the beginning. When designing your optimal metabolic diet, here are some basic rules to follow. Eliminate sugarToday, the average American consumes ~150lbs of refined sugar every year. Comparing this statistic with 200 years ago, refined sugar consumption has reached dramatically higher levels of what it was then (2lb). Currently, our metabolism is attempting to process more sugar in one year than it used to process over an entire human lifespan. The toxic load of this substance in the body is leading to a myriad of epidemics such as obesity, diabetes, heart disease, and cancers. By now, restricting sugar intake should be pretty obvious for your enhancing metabolic health. When it comes to managing your blood glucose, sugar in all forms must be managed. This substance delivers the quickest and most dramatic blood glucose responses causing metabolic inefficiencies. Obvious sugary foods are cakes, cookies, cereals, breads, soda, and fruit drinks. Some, not so obvious sugary food products are salad dressings, crackers, yogurts, spaghetti sauces, and other condiments. An effective way to reduce sugar consumption is by sticking with our ‘5 pillars. Specifically, focus on whole food sources and not purchasing processed foods. If you’re purchasing processed foods, make sure to read ingredient labels and look out for these names below.Avoid Fructose Fructose is singled out because of its potential to negatively damage your liver. While glucose is dispersed throughout all of the cells in your body, your liver is the only organ that can metabolize fructose. Therefore, fatty liver disease is more likely to occur from fructose rather than glucose. Recall that sucrose is composed of equal parts fructose and glucose. Liquids high in fructose that should be always avoided are sugary beverages such as sweetened iced tea, sodas, sports drinks, cocktails, juice, smoothies, some coffee drinks. These liquids are loaded with fructose and will instantaneously induce negative metabolic effects. Other obvious sources are the processed snacks listed above. What about the fruit? Technically, the chemical makeup of fruit and fructose is no different. When eating fruit, be aware and cautious of your amount. The dose makes the poison.
“Anchoring” your CarbsThis concept will be a helpful strategy for blood glucose regulation, metabolic health, and weight loss. Looking further into CGM data, we are witnessing a very interesting metabolic phenomenon when carbohydrates are consumed alone (naked) versus consumed with other foods (anchoring).
Using blueberries as an example - let’s say you decide to eat a pint of blueberries without any other foods. Consuming the pint of blueberries “naked”, could and will most likely cause your blood glucose levels to spike. However, combining the same pint of blueberries with plain yogurt and chia or flax seeds will give you a very different glycemic response. Anchoring your carbohydrates to other foods that are high in fat, protein, and fiber is going to help avoid dramatic blood glucose spikes.
This strategy works well because it slows and aids the digestion and metabolism process. There are variances here, but for most, when simple carbohydrates are consumed “naked”, they rapidly enter your bloodstream and cause immediate blood glucose spikes. Combining other macronutrients slows down the rapid metabolism of carbohydrates and aids with the digestion process. Here are a few ideas to get you started
- Instead of eating an apple or banana by itself, pair with either chia/flax/hemp seeds with your preferred nut butter. Chop and add your fruit to a chia seed pudding.
- Try pairing your sweet potato with a healthy fat like grass-fed butter, sprinkle with cinnamon, and add some nuts or seeds.
- Increase healthy fats like avocado or bone broth to your smoothies, while decreasing high sugary fruits.
- Experiment with adding tahini, olive oil, grass-fed butter and ghee to vegetables, legumes, and other foods
Eliminate all processed foodsThis is one of our ‘five pillars’ for metabolic health and weight loss. And, we can’t stress enough how fundamental this is for blood glucose. Eliminating all processed foods, refined grains, and sugars are going to have a profound impact on your metabolic health. If you can do one thing for your health, let it be this. The advent of processed foods has caused an alarming negative impact on our species.Hard, Fast Rules for Processed Food Elimination:
- The more processed the food, the higher the consequences.
- Eliminate seed oils
- Eliminate white bread, crackers, tortillas, bagels
- If it comes in a package, it’s processed. Be aware and thoroughly check the ingredients.
- The solution is simple - replace processed foods with real foods.
Meal timing
Experimenting with your meal timing is definitely something we recommend during this challenge. There is surmountable research and data linking the association between meal timing and metabolic markers, such as blood glucose. A fascinating metabolic phenomenon highlighting this effect is known as chrononutrition.
Chrononutrition examines the interrelationship between your hormones, meal timing, and circadian rhythm.
Rhythms exist everywhere in biology. And, our hormones are no exception to this universal law and behavior. Research into chrononutrition demonstrates the interconnectedness of your meal timing, hormone balance, and circadian rhythm.
In other words, when you eat and how much greatly influences your circadian rhythm and hormonal behaviors. For example, in the evening our cells become less insulin sensitive. Consequently, certain foods during night time will be less glycemic friendly than eaten earlier in the day. Therefore, it’s important to consider your biological clock as another component for metabolic health and weight loss.
Your blood glucose is going to be responsive to your meal timing. We recommend experimenting and measuring your blood glucose variances to find your timing window. Your CGM is going to provide you with a clear picture of this metabolic behavior.
Here are a few tips to help with hormonal balance and circadian rhythm alignment:
- Don’t eat after the sun goes down.
- Eating with the sun will improve glycemic response
- Try shifting your meals up by an hour. Progress in hour increments.
- Make your first or second meal the most calorically dense meal of the day
- Allow yourself at least 3 hours between the last meal and sleep.
- Take a walk after your last meal. This will help reduce blood glucose levels in the later hours of the day.
Food-sequencing
Properly sequencing your foods can have a profound impact on your blood glucose and weight loss. A recent study out of Cornell found that food order can lower your body’s blood glucose response to the exact same meal by up to 40%. The food order used in this study placed protein, vegetables, and fat first, followed by carbohydrates. This finding gives us another effective method for controlling blood glucose and insulin responses to our dietary choices.
Exercise
You’re going to notice blood glucose fluctuations when performing exercise. This is a common and natural biological response influenced by the time of day, the intensity of your workout, and a fed or fasted state. In addition, it’s worth keeping in mind that exercise can be a mild stressor to your body, which is another reason for the increased blood glucose response. As we will examine below, performing exercise is a massive net positive for metabolic health and weight loss.
Muscle tissue accounts for 80% of your glucose uptake. This is extremely important so let me repeat, your muscle is responsible for taking in almost all of your blood glucose.
Right behind your dietary choices, exercise and movement massively contribute to glucose regulation. For the average person, the skeletal muscle makes up between 40-50% of total body weight. This makes exercise extremely beneficial for managing your blood glucose. Research indicates that something as simple as walking for 20 minutes has the ability to reduce blood glucose.
Working muscle requires 10x the amount of glucose than sedentary muscle. This knowledge allows us to leverage exercise as a p[owerful tool when it comes to blood glucose regulation.
GLUT4 and Muscle Contraction
In week 2, we briefly touched on the glucose transporters and their importance for glucose entering and exiting your cells.
Of particular importance to this section, is GLUT4. GLUT4 is an insulin-dependent transporter found in the fat cells, brain and heart cells, and muscle cells.
GLUT4 and your muscle cells have a unique relationship. Whenever your muscles undergo physical activity, they need quick access to energy for their contraction and release mechanism. An interesting metabolic phenomenon that occurs from the excitation of muscles is the muscle's ability to bypass the need for insulin for glucose uptake. In other words, when the muscles are being used they will uptake glucose without the presence of insulin.
That being said, the muscle tissue can be thought of as a glucose sink. This is extremely useful for managing blood glucose, insulin and weight loss. Muscle excitation increases the uptake of blood glucose, does not require insulin, and promotes long-term insulin sensitivity.
As if exercise and movement need to be justified, think about using this metabolic-biohack to your advantage whenever possible.
- Go for a walk.
- Integrate physical activity into your daily routine.
- Occasionally (or frequently), lift heavy things.
- Do HIIT, sprinting, or low-level cardio training.
- Instead of doing your normal one-hour workout, try mini-workouts throughout your day.
- Incorporate yoga, pilates, and stretching.
- Whatever you do, just get moving.
- Do some push-ups, air squats, or bodyweight lunges right before/after a meal or incorporate throughout your day.
Fed vs Fasted State Exercise
Upon exercise, you will be in a fed or fasted state. This is worth a quick mention because your glycemic response is going to vary depending on the timing of your exercise.
For most, exercising in the fasted state will cause a short-term increase in blood glucose levels. This is completely normal and does not count against you during this challenge. The increase in blood glucose is your body’s way of responding to meet necessary energy demands quickly. The glucose is rapidly being pulled from your liver and muscle glycogen causing your blood glucose to rise. A recent study indicates that exercising in a fasted state promotes insulin sensitivity and metabolic health in obese men. Furthermore, the study showed a three-fold increase in AMPK activation for the fasted group. AMPK is a signaling molecule involved in fat metabolism, mitochondrial biogenesis, and glucose uptake.
The fed state exercise is also very beneficial for metabolic health and weight loss. Fed state exercise does promote insulin sensitivity and glucose uptake as well, however, not as quickly. While the type of exercise and intensity matter, typically, the fed state exercise will not tap into glycogen and is able to provide your muscles with energy from your past meal.
Aerobic vs Resistance Training
Ideally, you incorporate both aerobic and resistance training into your regimen. However, we tend to devote our limited hours to one form over the other.
Of the two training modes, aerobic exercise has been more studied and to a greater extent. The ADA indicates that aerobic training has very promising results on both blood glucose and insulin sensitivity. These very beneficial metabolic fitness measures are observed during the workout and for the following 24 hours.
Resistance training has shown to be a highly effective tool when it comes to blood glucose regulation and insulin sensitivity. This study shows that doing resistance training just two times per week is enough to move the needle for better metabolic fitness.
Placing the training modes side by side and comparing blood glucose responses and insulin sensitivity, minute for minute, resistance training seems to be superior. So, if short on time and metabolic fitness is your focus, resistance training will have the greatest return. This is likely due to the increase in muscle mass you get from resistance training over aerobic training. Recall, the above section about glucose uptake into muscle tissue without the need for insulin. Given that outcome, it makes sense why resistance training offers a higher return for these metabolic markers. If we have more muscle tissue, our body handles glucose uptake far better than the alternative.
Intensity
If high-intensity training causes an immediate blood glucose spike, don’t be alarmed. The physical efforts from this style of training demand a lot of quick, accessible energy. Not only that, this type of training is a mild stressor (good kind) to your body, therefore, causing an immediate blood glucose response.
The benefits of intensity training are far too great to ignore. Compared with aerobic and resistance training, this 2 week study showed high-intensity interval training had a greater reduction in both glucose regulation and insulin resistance. If you are able to exercise in a higher intensity state, the metabolic fitness and weight loss payoff can be very rewarding.
Keep in mind that your level of intensity might look different than others. And, that’s totally fine. With regards to intensity training, as long as you're pushing beyond your comfort zone during your exercise, this is what matters.
The Act of Doing
One study measured the effects of walking on insulin-resistant individuals over a three-month period. After the three-month period, the individuals significantly altered their body’s response to glucose and insulin, while losing 2% of body fat.
When it comes to doing exercise, the act of doing is what is going to move the needle for your metabolic fitness and weight loss. Any of the above training modes will help regulate your blood glucose levels and promote insulin sensitivity. In fact, building muscle and incorporating movement is such an effective method for glucose uptake it has the potential to continue up for every hour of your day.
Sleep
We all know that getting enough sleep is fundamental to good health. One-third of your life is spent sleeping. But, when it comes to your sleep needs, what is considered “enough”?.
Your sleep duration and quality will greatly influence your metabolic health and should be considered as another significant behavior for metabolic fitness and weight loss.
Similar to the other behaviors, we highly recommend using this challenge to find your optimal sleep range. This can be measured by tracking your CGM trends. While most of us fall into the 7-8 hour range without disrupting blood glucose and insulin levels, this is not the case for all. Your sleep requirements will be unique to you.
How Poor Sleep Contributes to Metabolic Syndrome
Something that is certain, however, is the negative implications caused by sleep deprivation and oversleeping.
Sleep deprivation
This review paper highlights the association between sleep deprivation and the negative impacts on your blood glucose, weight, hunger and satiety hormones, and insulin. Under normal sleep conditions, your glucose levels remain fairly constant throughout your night of sleep and this contributes to the larger 24-hour glucose cycle. When sleep deprivation was measured in, there was a 30% decline in glucose metabolism. More striking, this happened in as little as four days. Sleep debt is a metabolic nightmare that poses a serious risk to your metabolic health.
Bolstering this finding, other studies show that moderate reductions in sleep for just one week have the potential to disrupt blood glucose levels. The glucose disruption is so drastic that your baseline can push from normal to prediabetic levels. Furthermore, one week of sleep debt can make the body 40% more insulin resistant compared with normal sleep. And, another recent study found insulin resistance occurring in as little as two days in healthy men.
This translates to your body becoming highly inefficient for blood glucose regulation. The time it takes for your body to process your blood sugar is slowed by 40% compared to an adequate rested state.
For metabolic fitness and weight loss to occur, your blood glucose and insulin levels need to remain relatively stable throughout sleep. And, like other endocrine functions in the body, glucose and insulin have a cyclic rhythm.
Sleep abundance
Too much sleep (>8 hours) has also been shown to disrupt blood glucose and insulin levels. Studies have pointed out that long-duration sleepers are at an increased risk for type-2 diabetes, obesity, inflammation, and mortality. It is not exactly clear why, but my speculation is that long-duration sleepers are typically dealing with underlying health conditions.
Sleep for optimal Metabolic Fitness?
For sleep duration, the optimal metabolic fitness range seems to be 7 to 8 hours per night. According to this review, those that chronically sleep under 7 or more than 8 hours are at greater risk for metabolic syndromes such as Type-2 diabetes. Many studies have reported this U-shaped association between sleep duration and poor metabolic health. As the graph demonstrates, both the lack of and too much sleep brings about unfavorable metabolic conditions.
Sleep Quality
We know that sleep matters for metabolic health. And, if we are going to fully optimize this lever of metabolic fitness, we need to know the entire story.
Similar to sleep duration, sleep quality is just as important for metabolic health. I’m sure you’re familiar with those pesky nights of sleep. You finally shut down and get to sleep only to be stirred by a mild disturbance. Sleep interruptions are very common nowadays, and consequently, they negatively impact your blood glucose and insulin levels.
This can be frustrating to say the least. The metabolic consequences of poor sleep quality don’t help this scenario either. In this particular study, sleep interruptions were measured and showed unfavorable shifts in blood glucose and increased insulin secretion. Furthermore, an 8 year study demonstrated that interrupted sleep increases the likelihood of developing type-2 diabetes by two to three times.
Sleep interruptions are known triggers of cortisol production. We will discuss this more below (in stress), but cortisol is a hormone tightly connected to glucose regulation and insulin secretion. Under normal circumstances, cortisol has a 24 hour cycle or circadian rhythm. The cyclic behavior of cortisol peaks in the morning and decreases in the evening.
Your body interprets Interrupted sleep as a mild stressor and this stress response causes cortisol production. And, because cortisol is a gluconeogenic hormone it triggers the release of stored glucose to be pushed into the bloodstream. Furthering the sleep quality and cortisol issue, cortisol also inhibits insulin secretion. In other words, cortisol triggers glucose while blunting the insulin response. This is a dangerous one-two punch that causes your blood glucose to remain elevated for longer than normal.
Poor sleep Hijacks Hunger and Satiety Response
As if the above wasn't alarming enough, poor sleep can also disrupt your hunger and satiety hormones; leptin and ghrelin. Leptin is your satiety hormone and ghrelin is your hunger hormone. When these hormones become dysregulated from lack of sleep, your brain is unable to process the hormonal signals. So, the less you sleep, the more likely you are to overeat. Stacking this hormonal disruption with the issues above, inadequate sleep puts the body under a great deal of metabolic stress for the subsequent day and possibly longer.
Circadian Rhythm
Circadian rhythms exist in all living organisms. In humans, this is your 24-hour biological clock that affects physical, mental, and behavioral changes. Everyone generates a circadian rhythm and not only does this influence your sleep/wake cycle, but it also controls other rhythmic patterns important for metabolic health. These include your preferred meal timings, your core body temperature, your metabolic rate, and the signaling of other hormones.
If your biological clock becomes desynchronized, the metabolic consequences can be severe. Chronic conditions correlated with a disrupted circadian rhythm include obesity, type- 2 diabetes, neurodegenerative diseases, and mood disorders.
Circadian rhythms are controlled by your “master clock”, which is also known as the suprachiasmatic nucleus (SCN). Your SCN is found in the hypothalamic region of the brain and has direct signaling pathways to and from a group of photoreceptors in the eyes. Thus, the key to dialing in your master clock and circadian rhythm is all about light.
Using light as its indicator, your SCN responds by orchestrating a variety of other necessary metabolic processes. These processes include hormonal responses such as melatonin, serotonin, and cortisol production, body temperature, gut motility, pulse rate, blood pressure, and cognitive functioning.
When your master clock gets thrown off, a host of other metabolic processes become dysfunctional, and poor metabolic health quickly ensues. In fact, this study found that energy levels, cognitive functions, appetite, and weight management are negatively affected by a disrupted circadian rhythm. While light and dark are the primary cues for SCN operations, other factors like food, exercise, stress, work, habits also contribute as signatory behaviors.
To re-calibrate or balance a disrupted circadian rhythm:
- Try getting light exposure right when you wake up and as the sun is setting.
- Avoid or reduce your exposure to artificial blue light in the evenings.
- Time your meals to align with your sleep schedule.
Ways to improve sleep
As demonstrated above, the importance of sleep duration and quality are necessary for optimal metabolic fitness, weight loss, and metabolic health.
Here are some tips to help with sleep duration and quality:
- Dial-in and stick to a sleep schedule. We are creatures of habit and when it comes to going to sleep there should be no exceptions. Sleeping in on the weekends or staying up late to hit a deadline will not do you any favors for Monday morning or developing an optimal metabolic sleep rhythm.
- Try setting an alarm for bedtime. Why not? We do this naturally for our wake cycle so why not try the same tactic for sleep. This can help reinforce the importance of sleep for metabolic health.
- Avoid caffeine after 2pm. A single cup of coffee can take up to eight hours to fully exit your system so think twice before having an afternoon cup of coffee.
- Avoid large meals before bedtime. Try to eat your last meal at least three hours prior to your sleep. The three-hour limit should also be applied for beverages other than tea and water.
- Skip the alcohol before bedtime. This might help you immediately relax or wind down in the evening, but alcohol is a known disruptor of REM sleep. Thus, causing your body and brain to remain in the light stages of sleep. Alcohol consumption close to your bedtime can also lead to sleep interruptions throughout the night.
- Don’t nap after 2 pm.
- Try implementing a meditative activity before bed. Reading, stretching, drawing, breathwork, foam rolling, listening to something are parasympathetic activators and can help transition your mind.
- Take a walk as the sun sets. Seeing the last bit of sunlight can help align and balance your circadian rhythm.
- Create a dark environment in your bedroom. Light plays a huge part for sleep duration and quality. If for some reason you can’t fully darken your bedroom, try a sleep mask.
- Get your sound right. If you live in a noisy environment, try using a white noise machine. This will help blunt the incoming noise and keep a balanced soundscape flowing into your ears. If you have the luxury of a quiet sleep environment, consider yourself lucky.
- Put away electronic devices 2 hours prior to your bedtime. These emit blue light and can inhibit melatonin production.
- Get a pair of blue light blockers. These help boost melatonin production.
- Don’t lie in bed awake. If you find yourself tossing and turning, get up and read or do something to combat your inability to fall asleep. Typically, staying in bed and not falling asleep will exacerbate the problem.
Enhancing your sleep duration and quality will lead to better metabolic health and weight loss. Start with the small changes and low-hanging fruit like creating a dark environment, maximizing comfort, sound control, and limiting the afternoon cup of coffee. Once these areas are dialed in, begin layering other sleep techniques to optimize your sleep.
Stress
According to the American Institute of Stress:
- 33% of people report feeling extreme stress
- 80% of people feel stress at work
- 77% of people experience stress that affects their physical health
- 73% of people experience stress that impacts their mental health
- 48% of people have trouble sleeping because of stress
Stress is the remaining lever worth considerable attention for increasing your metabolic fitness and weight loss. Several studies report that stress has a huge impact on metabolic activity. In particular, the correlation between stress and blood glucose levels.
Stress can be defined as a real or imagined threat to our body or ego. The most common stressors today include physical, mental, acute, chronic, emotional, or episodic acute. Essentially, stress can be thought of as anything that changes the control you have over your body or emotions.
Stress takes many different forms and is not always an easy thing to pinpoint. There are acute stressors like public speaking, a job interview, or intense exercise. These are pretty common, and typically, will not cause harm to the body. However, if the acute stressors are frequent occurrences and prolonged they will lead to unfavorable metabolic conditions. Furthermore, chronic stress poses a very serious threat to metabolic health. If unmanaged, stress will lead to weight gain, metabolic syndrome, insulin resistance, and diabetes.
Both acute and chronic stress will undoubtedly raise your blood glucose. For increasing your metabolic fitness and weight loss, implementing stress management strategies are fundamental.
It is important to note that when we talk about “stress”, we are referring to anything that you perceive as a stressful event. Things like hitting a work deadline, being frustrated by the traffic on your commute, difficult personal relationships, along with many other occurrences can be considered as stressful situations. Under any perceived stressful circumstances, the body responds by releasing stress hormones, notably epinephrine and cortisol.
The reason stress is greatly disruptive to your metabolic health is due to the release of the primary stress hormones: epinephrine and cortisol. Both of these hormones are secreted by the adrenal glands and are gluconeogenic. In other words, when epinephrine and cortisol are secreted they will dump glucose into the bloodstream from your liver and muscle glycogen.
Epinephrine
More commonly known as adrenaline, epinephrine is a hormone secreted by your adrenal glands and responsible for your “fight or flight” response. As part of our evolutionary biology, this hormone was considered essential for survival during more perilous times. In today’s setting, we’re likely not encountering the same perpetual looming threats of our ancestor's time, but epinephrine is active nonetheless. In fact, epinephrine still remains a very active biological process, and if activated too much by modern stressors, it can lead to metabolic disadvantages.
In our current environments, epinephrine is typically secreted as a response to various acute stressors like those mentioned above. When secreted, epinephrine directly signals the liver to break apart glycogen and push glucose into the bloodstream. The additional glucose is available in order to meet the energy demands of this heightened physiological stress response. The stress we deal with today is very real, but far from matters of life or death. But, our internal endocrine mechanisms are unable to decipher this and process it as the stress being one and the same.
Bolstering this connection, another study found that epinephrine causes an immediate blood glucose response to individuals in the fasted state.
Exacerbating the epinephrine - blood glucose correlation, one study reveals that too much epinephrine over prolonged periods is likely to cause insulin resistance. The study measured insulin sensitivity in healthy men before and after an injection of epinephrine. In just two hours, the epinephrine injection caused a 40% reduction in insulin sensitivity. We examined the serious implications of insulin resistance, which is why stress management is necessary for metabolic health.
Epinephrine Case Study
Let’s look at the image below. Here, I’ve provided an experiential snapshot of the metabolic impact that acute stress can have on blood glucose levels. I’ve been working with this individual for ~6 weeks now; with a focus on metabolic health. After ~3 weeks, we really dialed in her blood glucose values. Abnormal spikes were eliminated and her baseline hovered around 80mg/dL.
A few weeks later we both witnessed a head-scratching blood glucose response to a meal that previously did not cause an issue. As you can see, the image on the left depicts a very different metabolic outcome than the image on the right.
Almost the exact same foods were eaten at nearly identical times. So, what gives?
The culprit - acute stress. During this 72-hour period, there was an unusual amount of emotional stress for this individual. The acute stress response altered her blood glucose levels causing abnormal spikes to occur throughout an otherwise normal day.
Cortisol
We briefly mentioned cortisol in the sleep section, but let’s further explore its relationship with stress, blood glucose and insulin. Cortisol is produced by the adrenal glands and like many other physiological processes, it has a circadian rhythm. Under normal circumstances, cortisol rises just before we wake, and then slowly drops throughout the day. Essentially, cortisol readies us for activity; hence the high levels as we wake.
It’s important to note that cortisol should not be thought of as the bad guy. A few necessary functions of cortisol in the body include controlling your blood glucose levels, regulating metabolism, memory consolidation, and reducing inflammation. For these reasons, cortisol is important to many biological functions. However, if cortisol becomes dysregulated and is secreted too often, this can lead to metabolic damage.
Cortisol - Blood Glucose
When it comes to stress, cortisol is considered the prototypical hormone. And, because cortisol is a “glucocorticoid hormone”, its direct impact on blood glucose is significant.
Similar to epinephrine, cortisol is released during times of stress. However, cortisol production is a multi-step process that takes minutes, not seconds. In fact, this study found that it takes approximately 15 minutes for cortisol levels to rise after the onset of stress, and that cortisol remains elevated for several hours after.
When perceived stress occurs or continues, your body needs to raise its energy levels. To meet these energy demands, cortisol signals the liver to make glucose. More specifically, cortisol signals the liver to make glucose from whatever it can use.
The violent effect of unregulated cortisol can be seen in people with Cushing’s syndrome. Cushing’s syndrome is a very extreme example of uncontrolled and overproduced cortisol in the body. If cortisol persits for too long, it will start pulling proteins (amino acids) from your muscle tissue or breaking down glycerol (fat) molecules to produce glucose. In addition, individuals with Cushing’s syndrome rapidly go from being insulin-sensitive to extremely insulin-resistant.
Cortisol - Insulin
The relationship between cortisol and insulin is worth noting. Previously, we examined the role of insulin in removing glucose from the blood and here we see the opposite, cortisol is working to increase glucose in the blood. This is another example of an evolutionary misfire. Elevated cortisol is telling your body to do whatever it takes to keep glucose in the blood to meet energy demands from the perceived stress. This sets up a counter-regulatory effect between cortisol and insulin. Simply meaning, they compete and act against one another. In this back and forth conflict, cortisol will be the dominant hormone, causing your blood glucose to remain high, while diminishing the effects of insulin. Inevitably, this leads to cells in the body becoming insulin resistant. Over time, your pancreas will begin to have a diminishing return of insulin production. As a result, this deepens the metabolic consequences of chronic stress.
As we clearly see, chronic stress sets up a downward-spiraling metabolic disaster. From the early stages of induced stress, your body now faces a frightening metabolic scenario. Even if you’re optimizing all the other metabolic levers, chronic stress can undo these efforts. We know the severe consequences of insulin resistance which is why managing stress is critical for metabolic health.
Cortisol and Visceral Adipose Tissue
Visceral fat is a type of fat stored deep inside the body. We typically store fat as subcutaneous fat - right beneath our skin, or as visceral fat - around our internal organs.
Visceral fat is a hormonally active component of total body fat and has the capability to influence and affect several biological functions. Visceral fat accumulation poses very serious risks to overall health such as metabolic syndrome, cardiovascular disease, and various cancers.
Elevated cortisol is a direct driver of visceral fat growth. The stress hormone will override normal fat storage and deposit fat directly into visceral fat tissue over the usual subcutaneous fat storage method. The combination of this fat storage process and insulin resistance makes elevated cortisol a very damaging hormone to your metabolic state.
Ways to Reduce Stress
Stress-relieving methods are abundant and finding what works best for you is what matters Below, we’ve suggested some common stress techniques that work for the majority of individuals.
- Breathing techniques
- Relaxation Therapies
- Meditation
- Getting in nature
- Stretching and Yoga
- Dancing
- Sunlight exposure
- Community events
- Talking to loved ones
- Listening to music
- Creative expressions such as drawing, painting, or playing an instrument.
- Engaging in a sport or physical activity
- Sauna
- Journaling
- Visualization practices
- Massage
- Giving to others
Final Thoughts
From an evolutionary perspective, the importance of epinephrine and cortisol as survival mechanisms is clear. The heightened state of awareness the body suddenly enters requires a quick, accessible source of energy from glucose. And, stress should not only be understood as a negative. The rise in blood glucose and insulin wouldn’t be an issue if stressful occurrences were infrequent and quickly recovered. However, stressful situations of today look very different and a constant stream of stress hormones causes more harm than good.