Cut Stress - Cut Sugar

Cut Stress - Cut Sugar

Relaxation exercises may keep diabetes in check

By Mary Carmichael
Newsweek, September 27, 2004

Compared with other methods of managing diabetes—strict diets, insulin injections, vigilant blood-sugar monitoring—Richard Surwit's technique seems too easy to be true. It doesn't involve pills or shots. It doesn't technically require a doctor's supervision. And if you're a diabetic reading this, you can start treatment right now, just by taking a deep, relaxing breath. Feel better?

If Surwit is right, you should. By lowering stress, he argues, patients with diabetes, particularly type 2, can keep their illness in check. Stress raises the body's levels of cortisol and epinephrine and, via those hormones, the amount of glucose in the blood. Because diabetics cannot make enough insulin to metabolize the raised sugar levels, the sugar stays high long after the stress has ended.

Surwit, a psychologist, first stumbled on the principle 25 years ago. Mind-body medicine was in its infancy, and he was frankly more interested in its potential for preventing heart disease. But a colleague, a Duke University endocrinologist, came to him with a challenge: a woman with diabetes who couldn't keep her blood sugar low even with a rigorous diet and standard treatment. When her work or home life turned stressful, her glucose levels shot out of control, leaving her hospitalized. The endocrinologist was at a loss to help his patient; after one week of bio-feedback and muscle relaxation with Surwit, she was stable enough to leave the hospital.

Today relaxation is used to combat everything from asthma to labor pains, but there's a stumbling block for diabetic patients: most insurance companies won't pay for Surwit's therapy, classifying it as experimental. Nonetheless, other doctors are starting to pick up the idea, using it in conjunction with more conventional remedies. And this year Surwit has made the treatment widely available in a different manner; he published a book this spring. "The Mind-Body Diabetes Revolution" focuses on easy relaxation techniques, particularly cognitive behavioral therapy and progressive muscle relaxation. "Almost everybody can learn it," Surwit says of the latter, "and it only takes a week or so." Progressive muscle relaxation is just what it sounds like, a sequence of tightening, then slackening, exercises that allows people to monitor their stress levels based on muscle tension. Cognitive behavior therapy, says Surwit, consists of "getting the person to evaluate how they emotionally respond to situations, and to reality-test their response"—in other words, teaching people to think rationally in the face of adversity.

If these sound like techniques nondiabetics could stand to learn, too, that's no coincidence. Surwit says he wanted to design a program similar to others found in a wide variety of self-help manuals. "What's in my book is not magic," he says, although he does have one piece of advice for do-it-yourself types: keep it simple. "Some people try techniques that require almost a religious commitment," he says. "This isn't something you have to go to an ashram in India for."

Surwit's techniques may have a broader medical application, helping physicians diagnose patients at genetic risk for diabetes, allowing them to prepare for it and perhaps ward it off. Patients who don't have diabetes, but do carry some genes for it, respond to stress similarly to diabetics. Native Americans in the Pima tribe, for instance, are extremely susceptible to the disease. Even healthy Pimas have high blood-sugar levels when they're under stress. In the future, patients worried about their genetic risk could undergo a glucose test under lab-induced stress to find out whether they have something to worry about—and then can calm down.

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