“I’ve noticed that when I eat sugar in the evenings, I wake up in the middle of the night feeling anxious, and I have more nightmares; is that a thing?”
This is a question I received from a friend recently when talking about the impact of the foods that we eat on our system. And by the way, the answer I gave is “YES!” But before I get into the “WHY”, allow me to explain the “HOW”.
BASICS OF METABOLISM: A REVIEW
As I’ve discussed in previous posts, when we eat a meal or a snack, our blood glucose levels rise, and as they do, insulin is secreted from the pancreas and ‘unlocks’ cell membranes to allow this glucose to be shuttled into the tissues where it can be utilized. If there is a greater amount available than what can be used immediately, the body, being efficient and survival-focused, finds a way to store the extra energy for future use (i.e. as glycogen in our liver and muscle tissue and as triglycerides in our adipose tissue). As the time passes since our last meal, our blood glucose levels begin to decline until they reach a threshold that signals to the body “we need fuel!” If glucose is not made readily available (by eating a meal or snack), the body will tap into its stores of glycogen first (in the liver and muscle tissue), and then the energy stored in adipose tissue. Additionally, different macronutrients (i.e. carbohydrates, dietary fats, proteins) break down into readily usable fuel at different rates, with carbohydrates breaking down the quickest; the more refined the source of carbohydrate, the more rapid spike AND subsequent decline in blood glucose levels (with refined white sugar being one of the quickest).
This is a very basic description of the mechanics of metabolism; my hope is that it will be helpful for building on the conversation of stabilizing blood glucose, especially when experiencing chronic stress and adrenal dysregulation.
ADRENAL FATIGUE AND CORTISOL
What we commonly call “Adrenal Fatigue” is actually a complex composition of symptoms that can include: fatigue, lowered immunity, lowered stress resilience, increased digestive distress and food/chemical sensitivities and allergies, feeling increasingly overwhelmed, brain fog, weight gain (especially around the midsection), feeling “tired but wired”, relying increasingly on sugar and caffeine for energy throughout the day, cravings for sugar and salt, experiencing energy “crashes” throughout the day (especially around 10am and 3pm), feeling more awake in the later evening hours, and the list goes on!
Sound like you? It’s not uncommon! In his book “Adrenal Fatigue: The 21st Century Stress Syndrome”, Dr. James Wilson offers rates as high as 80% in describing who will experience some degree of adrenal dysregulation due to stressors at some point in the their lifetime. So what do heavy stress loads and blood sugar instability have in common? The answer is CORTISOL!
You’ve likely heard of cortisol as it relates to stress and also “stubborn belly fat” (not my words; it’s often stated this way in the media), but it is SO MUCH MORE. Cortisol is a complex and essential hormone that is primarily excreted from the outer portion (cortex) of the adrenal glands (we have two; they sit atop the kidneys and are about the size of a walnut), and is responsible for many essential functions within the body, including (see Wilson, p. 3423 [kindle edition]):
Ok, now that we’ve seen that cortisol is not the bane of our existence, and actually serves as a life-enhancing regulator and modulator of homeostasis, let’s get into the effects of chronic stress on cortisol output and how this affects blood sugar stability.
CORTISOL AND BLOOD SUGAR STABILITY
When our brain (specifically the amygdala and then hypothalamus; Wikipedia) receives a signal that there is a perceived threat to our survival (ranging from walking down a dark alley alone to a hostile work environment to reliving or creating a stressful experience in our minds), it releases a chemical cascade to allow our bodies gear up to either FIGHT or FLEE. The adrenal glands are heavily involved in this: immediately, the adrenal medulla (inner portion of the gland) releases adrenaline, the jolt of energy we feel that gives us superhuman speed and strength to escape the threat. Shortly thereafter (and long-term if stress becomes chronic), cortisol is released, increasing blood pressure, as well as blood sugar, the latter of which works in concert with insulin from the pancreas to mobilize stored sources of energy for use.
While in the short-term, this response is brilliant in giving us the energy and functionality to survive, long-term, it becomes debilitating and toxic. The body’s primary goal is always to maintain homeostasis to the best of its ability. And a chronic state of limbic brain activation, heightened cortisol release, and increased inflammation is counter to this. So, the brain begins to downregulate cortisol production. Our system becomes LESS responsive. The hypothalamus (the area of the brain responsible for regulating cortisol output) may begin to signal less output of cortisol, the tissues may become less responsive to cortisol and the receptor sites less sensitive or cortisol resistant (in theory, similar to insulin resistance). Additionally, the kidneys have the ability to switch between cortisol (active form of the hormone) and cortisone (inactive form of the hormone); so one way to downregulate cortisol is to convert it into its inactive form, cortisone. I say this because in most cases, the body does NOT lose its ABILITY to produce cortisol, so the glands haven’t really become ‘fatigued’. The body has simply ADAPTED to its environment as best as possible, and made these modifications to do so. (Side note: often, cortisol is tested via saliva. Saliva tests “free cortisol” which accounts for only 3-5% of total cortisol in the body; Kresser, 2017)
But as we reviewed above, cortisol is involved in many regulatory functions in the body, so with this down-regulation of cortisol, we feel TIRED in the morning, we feel less resilient to stress, our immune system becomes overactive, our brains and thinking become foggy, our blood pressure plummets and we crave salt, our blood sugar drops and we crave sugar and quick sources of energy.
As it relates to blood sugar stability more specifically, this down-regulation of cortisol makes us less able to mobilize our stored reserves of fuel to provide all of our tissues and systems with the energy they need, as cortisol is required for this conversion. As cortisol also pumps the brakes on insulin so that a slow steady release of glucose moves into the cells, a deficiency allows insulin to rapidly unlock the doors to the cells so that the glucose is released much more quickly, and as a result, we are left with low blood glucose and may experience the effects of hypoglycemia (Cherney & Pietrangelo, n.d.):
I know this is a lot of information, and it can sound pretty serious and dire! While it is serious, luckily, there are MANY lifestyle changes we can make to help our bodies decrease stress, and reactivate cortisol in a balanced and functional way.
LIFESTYLE MODIFICATIONS TO STABILIZE BLOOD SUGAR
One of these is to make sure that we are FEEDING OUR BODIES ENOUGH FUEL, and feeding it the fuel that creates STABLE ENERGY across long periods of time. For many people, this includes INCREASING DIETARY FAT and PROTEIN, ESPECIALLY AT BREAKFAST! Why? Because, as I mentioned at the beginning of this article, dietary fat and protein take longer to breakdown, creating a slow steady rise in blood glucose, rather than a quick sharp rise and fall (crash). We want to create a steady ebb and flow, which MASSIVELY reduces the metabolic stress load on the body. This doesn’t mean ELIMINATE CARBOHYDRATES. Carbohydrates are often an essential component to healing adrenal fatigue as well; what matters is the QUALITY. Eating whole, nutrient-dense, minimally processed forms of carbohydrate such as sweet potato, squash, starchy vegetables, and soaked and properly prepared grains/legumes (if tolerated) WITH quality sources of dietary fat and protein is ideal. Eating highly refined sources of carbohydrate such as breads, pastries, energy bars, and cereals, especially on an empty stomach without the blood-sugar-stabilizing effects of high quality dietary fat and proteins, can send our body’s on a blood sugar roller coaster that creates further depletion.
So if you are experiencing the effects of cortisol insufficiency, including blood sugar disregulation and hypoglycemia, be sure to EAT BREAKFAST! Don’t skip it! Don’t skip lunch or dinner either! Eat a balanced meal of whole, nutrient-dense foods at each meal, including dietary fat and protein. Eat enough to keep your body satiated for 4-5 hours. You may find that your body requires smaller, regular meals throughout the day, or snacks between meals, especially at first. HONOR THAT. A handful of raw or roasted nuts or a tablespoon of nut butter (no sugar!) can be great as can be grass-fed jerky or some veggies with guacamole. You can even have a smaller portion of a meal as a snack. Keep in mind that cortisol demand goes up each time we eat and when chronically stressed, our digestive function may be compromised, so try to avoid “grazing” while PRIORITIZING EATING ENOUGH!
Alright! That's all for now! I hope that you found this deep dive into the roles of chronic stress and cortisol on blood sugar regulation helpful!
All the love,
Cherney, K., & Pietrangelo, A. (n.d.). The effect of low blood sugar on your body. Healthline. Retrieved from: https://www.healthline.com/health/low-blood-sugar-effects-on-body#1
Kresser, C. (2017). RHR: The myth of adrenal fatigue. Chris Kresser: Let's take back your health - starting now. Retrieved from: https://chriskresser.com/myth-of-adrenal-fatigue/
"Fight or flight response". (n.d.). Wikipedia. Retrieved from: https://en.wikipedia.org/wiki/Fight-or-flight_response
Wilson, J.L., N.D., D.C., Ph.D. (2001). Adrenal fatigue: The 21st century stress syndrome. Smart Publications: Petaluma, CA.
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