Many of you have probably read or heard about the impact of stress on glucose.  Despite this, most people are only partially convinced about the connection.  Unlike the impact of something concrete and tangible like food and physical exercise, it’s often difficult to accept that something as abstract as your thoughts and feelings can actually influence your blood glucose levels.

Before the days of CGMs (continuous glucose monitors), I spent a fair amount of time pricking my fingers and measuring glucose to document the effect of various lifestyle behaviors.  My kids were younger, stress levels were higher, my diet was not optimal, my exercise was mostly high intensity, and my sleep was far worse than it is today.

I clearly saw the cumulative impact of these stressors on my blood glucose, but I chose to keep focusing on diet and exercise, while neglecting my thoughts and emotions.

Now that I’ve been using CGMs for years in my patients and in myself, the link between stress and glucose has become crystal clear.  Unlike my former self, my exercise is much more balanced and I’m far fitter, my diet is superior, and I’m sleeping better, so these are no longer the strong confounding factors they once used to be.  Fluctuations in my glucose are invariably linked to my emotional state and I see a similar pattern in my patients.  Let’s explore this further.

Stress Can be Sweeter than Chocolate Cake

A young female patient of mine with normal lab tests and a fairly unremarkable medical history requested a CGM to help monitor her diet and lifestyle.  I reviewed her glucose data and as expected, there were no alarming trends.  Despite eating a variety of different foods, her average glucose during the 2 week period was 95 mg/dL and most of her after meal glucose levels rarely topped the 120-130 mg/dL range.

However, there was one incident at dinner that resulted in a significant glucose spike that was far above her typical range, despite her eating a relatively low carbohydrate meal.  The difference was that dinner was at her in-laws and there was a heated discussion about the Covid vaccine which she said made “her blood boil.”

Apparently her blood was boiling with sugar based on the glucose report below that shows a significant glucose spike to 176, which was far above her range on any other day or time (refer to the values circled in red).

glucose curve

She then reported walking around after the stressful conversation to let off steam and then sat down for a dessert of chocolate cake at 7p, after which her glucose did not spike.

chocolate cake


In other words, eating a low carbohydrate dinner with high emotional stress caused a greater glucose surge than eating a high glycemic dessert after stress levels subsided.

I want you to reread the statement I just made and let it soak in.  How could it be possible that thoughts and emotions can physically cause an elevation in the number of glucose molecules in your blood?  Let’s explore further.

The Glycemic Impact of Stress

I’m going to compare how food and emotions can behave similarly using the glycemic index (GI) as an illustration.  Bear with me as I summarize GI briefly before tying in emotions. The glycemic index or GI is a measurement of the potential glycemic impact of a specific food on glucose.  The higher the GI, the greater the rise in blood glucose in most individuals.  This is a crude measure because there is so much variability in individuals based on their own metabolism.

glycemic index

A high GI food for a fit, metabolically healthy individual may cause minimal glucose elevations.  On the other hand, a moderate or even low GI food can cause a significant spike in glucose in someone who is sedentary and insulin resistant.

The GI for a specific food can also change in an individual as they become healthier.  For example, white rice used to cause significant glucose spikes in me over a decade ago when I was insulin resistant and had metabolic syndrome.  Today, rice causes minimal glucose spikes and is now an acceptable food in moderation.

Emotional stress I’ve found behaves similarly, which is why I’m referring to this phenomenon as the glycemic impact of stress.  Take a couple having an altercation and measure their blood glucose one hour later.  You may notice variable glucose responses in each individual as a result of the argument.  One partner may have a severe glucose spike, while the other’s glucose may hardly budge.  Let’s discuss why there’s so much individual variability.

Origins of Glycemic Variability with Stress

The variability in glucose from emotional stress is similar to what I observe with blood pressure.  Some individuals have marked increases in blood pressure from stress, anxiety, and anger, while others have blood pressures that remain unchanged in the midst of tumultuous emotions.  I refer to individuals with glucose spikes from stress as having “stress-sensitive livers.”

The question is, how and why are some of us wired to be more stress sensitive when it comes to metrics like blood pressure and blood glucose?  By the way, these don’t go hand in hand.  I have plenty of patients who have glucose levels that are highly sensitive to stress, while their blood pressures don’t budge, and vice versa.

One explanation is the role of in utero stress and its impact on fetal programming.  The developing fetus is heavily influenced by the mother’s environment, which includes lifestyle behaviors like nutrition, physical activity, and emotional stress.  In fact, fetal programming may also go back 2-3 generations, so even if mom reports a healthy, happy low-key pregnancy, the emotional state of grandma or great grandma may influence fetal programming, including metabolic sensitivity to stress.

What’s the purpose of maternal-fetal programming? During pregnancy, mom is literally streaming complex data about the environment (physical, metabolic, emotional, toxic, etc.) to the fetus so it can create a customized genetic blueprint to help it adapt and survive upon entering the world.  If the mother is under significant emotional stress, the fetal brain may be more sensitive to stress, and key organs like the liver may be programmed to produce more significant surges in glucose when encountering stress.

One of the reasons the liver is particularly stress-sensitive is due to the impact of the stress hormone cortisol.  Cortisol triggers increased glucose production by the liver (aka gluconeogenesis), and also causes other tissues like fat cells to provide further fuel to power gluconeogenesis.

Now before you go blaming your mother (or grandmother) for handing you a glucose-sensitive liver, keep in mind that fathers (and grandfathers) are not off the hook either.  This fascinating mouse study showed that using restraint stress (immobilizing mice so they can’t move freely) in mouse fathers to mimic emotional stress actually led to offspring with livers that produced excess glucose.  Yes these are mouse dads, not human dads, but often animal models show a strong link with physiology in humans.

Some of our livers may have been pre-programmed by our parental lineage to be excessive glucose producers when exposed to stress.

I’m fairly convinced I’m one of those people and have seen this pattern in numerous patients.  You might ask, how could having a stress-sensitive liver possibly be of benefit?

The evolutionary reason for being programmed to be a glucose hyperproducer is so the body can provide adequate glucose to the brain and muscles for energy during times of stress.  For our ancestors who experienced episodic stress, this type of programming was likely advantageous.  For most of us who experience chronic daily stress, frequent surges in glucose lead to health issues like insulin resistance and diabetes.

Also keep in mind that apart from the direct impact of stress in causing liver-induced glucose surges, stress also increases our hunger drive and cravings for carbohydrates/sugar.  In other words, both input (the carbs/glucose entering your body through food) and output (the glucose exported by your liver into the blood) are increased by stress, which together are a double whammy for increasing blood glucose.

Reducing the Glycemic Impact of Stress

The first step in mitigating the impact of stress on blood glucose is to acknowledge that a clear link exists.  I hope this blog post helped nudge you a little more closely in that direction if you were skeptical at the outset.  In an ideal situation, you might try measuring your own glycemic response to certain stressful situations using a glucose monitoring device.

I’ve had some of my patients categorize their stressors and document which ones cause greater glucose surges.  This might be broken down into family stress, work stress, financial stress, health stress, social stress, etc.

For myself and many others (including the case example), the family category of stress seems to have the greatest impact on glucose levels.

In the case example I shared, the patient I discussed is under very high levels of work stress, but it was a heated discussion with her in-laws that spiked her glucose.

family conflict

Whether it’s a family conflict, concerns over aging parents, kids and teens, tension with your significant other, etc., it appears that stressors in the home are like sugary junk food.  It’s like comfort food, but without the comfort!

I also had a number of patients with poor glucose control during the pandemic, despite improving many of their lifestyle measures (diet, exercise, etc.).  Facing the intense primitive survival stress of our ancestors in the midst of a pandemic appears to have been a strong trigger for glucose elevations.

Just like cutting out junk food, should we cut out the high glycemic individuals in our life?  Not necessarily, since often these are the people we care about the most.  Recall how earlier I mentioned that when I was insulin resistant years ago, carbs like rice and oatmeal would cause marked spikes in my blood glucose.  Now that I’m metabolically fitter, this is no longer the case.

With thoughts and emotions, improving your mindset is analogous to improving your metabolism.

Changing recurrent thought patterns, practicing cognitive reframing, and incorporating mindfulness practices can reduce the glucose spikes triggered by the high glycemic people and external situations in your life (health, finances, pandemics, etc.), even if you were born with a stress-sensitive liver.

In the case example, my patient could have escalated the argument, stormed out of the house, and ruminated on the conflict for several days or weeks.  Instead she removed herself from the situation momentarily, walked to physically help burn off sugar and allow her mind to reset, and she returned to the table to enjoy dessert with the family.

She rapidly reduced the glycemic impact of a stressful encounter through these actions and her normal blood glucose after chocolate cake reflected that.

Emotional resilience, like metabolic resilience, helps to stabilize the swings in glucose and other markers so we can better endure the inevitable stressors in life, with minimal adverse impact on health.

You too need to identify the emotional junk food in your life (situations, people, etc.) and decide how to metabolize the associated emotions so they don’t linger and cause harm to your mind and body.

Storing the emotional junk food away by neglecting it makes matters worse.  I know that firsthand. If you haven’t read my post on rumination, please be sure to do so.

Since I know I personally have a stress-sensitive liver, I am prioritizing increasing amounts of time to managing my own mind and thought patterns to avoid glucose swings and other related health issues.  The benefits go far beyond just stabilizing glucose levels.  If you need help with managing your stress, please reference my dedicated stress page below:

Stress Management Page

Closing Thoughts

I hope this post has provided some clarity on the real connection between emotions and blood glucose.  The human body is imperfect and takes long periods of time to change its evolutionary blueprint, which is why systems that provided survival advantages in the past can result in overcorrections in the present.

I used to resent having such a stress-sensitive liver, but have now reframed that to a metabolic adaptation that I inherited from ancestors who lived through tremendous stressors and made huge sacrifices so I can live the life I lead today.

Being aware of the mechanism by which you have inherited certain tendencies (emotional, metabolic, etc.), accepting them rather than succumbing to victim mentality, doing the best to bring your own systems back as close to balance as possible, and then setting up future generations for optimal health by passing on healthy lifestyle practices (mental and physical) to improve their genetic blueprint are goals we should all consider.