There is a complex and bidirectional relationship between mental health and problems with blood sugar regulation. Blood sugar dysregulation refers to fluctuations in blood sugar levels, namely between high blood sugar (hyperglycaemia) and low blood sugar (hypoglycaemia) – both of which can have negative effects on mental health. Blood sugar dysregulation doesn’t just apply to those with the most severe forms (diabetes), but also those experiencing morning lethargy, night-time wakefulness, energy slumps throughout the day, irritability, mood disorders, brain fog and mental slowness- the list goes on!
High circulating blood sugar, characteristic of hyperglycaemia, can damage blood vessels and lead to body-wide “systemic” inflammation and oxidative stress, including inflammation involving glial cells in the brain, which can damage neurons (brains cells) and instigate cognitive dysfunction and mood disorders. Hyperglycaemia (and hyperinsulinemia, characteristic of Type-2 Diabetes) has been associated with an increased risk of depression, anxiety, and cognitive impairment, and can worsen symptoms of psychiatric disorders such as bipolar disorder and schizophrenia.
Hypoglycaemic crashes often occur after hyperglycaemic episodes; when taking insulin or other blood sugar-lowering drugs; and when skipping meals and fasting. Hypoglycaemia can be equally disruptive to mental health, with low blood sugar triggering the release of cortisol, the body’s stress hormone, priming the nervous system and fostering anxiety, irritability, mood swings and cognitive dysfunction. (8,9).
Studies also suggest that dietary factors involved in blood sugar dysregulation, including high intake of refined carbohydrates (white rice, bread, pasta, baked goods) are associated with increased risk of depression and other mental health conditions.
It goes without saying that managing blood sugar levels is crucial, not only for mental health and cognitive function, but also for stable energy, hormonal regulation and for preventing chronic diseases, such as diabetes. There are some good rules of thumb to follow to balance blood sugar levels:
1. Be mindful of the glycaemic load of your meal: Avoid high glycaemic-index (high-GI) foods, where the fibre has been removed and which are digested rapidly in the gut, with an equally rapid rise in blood sugar levels, triggering the “blood sugar rollercoaster” associated with mood swings and energy crashes. Examples of high GI foods include refined carbohydrates (white bread, rice, potatoes and pasta; cakes, biscuits and other baked goods); sugary drinks; sweets, ice cream and processed foods. Opt for fibre-rich, low-GI foods which digest slowly and foster the gradual release of glucose into the blood, such aswholegrains, root vegetables, whole fruits (especially apples, pears, berries) and legumes.
Eat a lean protein / healthy fat source with each meal: Both protein and fat are slow digesting, so can help slow the absorption of carbohydrates, attenuating blood sugar levels. Think lean white meat, oily fish (salmon, mackerel, anchovies, sardines, herring), eggs, legumes (beans, peas, etc.), avocados, nuts and seeds.
Increase your consumption of legumes (beans, peas, lentils, etc.): Compounds called ‘lignans’ found in legumes may bind and facilitate the excretion of excessive sugar. They are also rich in fibre!
Be mindful of meal sizes: Eating large, energy-dense meals can result in large rises in blood sugar. Eating smaller, regular meals throughout the day can be helpful in preventing both blood sugar spikes and dips.
5. Avoid sugary drinks and fruit juices, drink more water: Most carbonated beverages, canned drinks, cordials and even fruit juices are sugar-dense, and can cause rapid spikes in blood sugar. Opt for water (try fruit / mint-infused) and herbal teas.
6. Manage caffeine intake: Whilst your daily cup of Joe might seem harmless, caffeine stimulates the release of cortisol (stress hormone) and release of stored glucose into the blood (to mobilise the body for a potential attack), so consider reducing your intake to 2 cups daily ideally.
7. Avoid condiments: Sauces and condiments often contain sugar syrups, such as high fructose corn syrup and brown rice syrup (also found in many “healthy” cereal and protein bars) which have an excessively strong reaction on insulin, the hormone which ferries glucose into the blood, can negatively impact our ability to regulate blood sugar – and puts us into fat-storing mode. .
8) Smith, K; Deschenes, S; Schmitz, N. (2018). Investigating the longitudinal association between diabetes and anxiety: A systematic review and meta-analysis. Diabetic Medicine: A Journal of the British Diabetic Association, 35(6).
DOI: 10.1111/dme.13606
(9) Lindekilde, N; Scheuer, S; Rutters, F. et al. (2022). Prevalence of type 2 diabetes in psychiatric disorders: an umbrella review with meta-analysis of 245 observational studies from 32 systematic reviews. Diabetologia, 65(3). DOI: 10.1007/s00125-021-05609-x
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