Frederic Vagnini, M.D.--

Too many type-2 diabetics trying to lose weight are often frustrated by their slow progress, if any at all.  Despite the numerous "branded" diet plans they've followed carefully, most gain back all of the lost weight between 1-5 years.  Worse, these plans cost over $60 billion a year and more than 400,000 people--not ony diabetcs--die from obesity each year. 

There are many reasons pounds don't easily drop off type-2 diabetics. One is that they are likely pursing symptom based plans, (running, calorie restriction etc.) attacking only the overt or visible signs of weight gain like adipose fat or bulging bellies. You can, however, be facing a common and silent roadblock that many type-2 diabetics encounter when trying to lose weight -- a critical aspect of the metabolic balance you require.

Few physicians or weight loss programs recognize that stress may actually be holding you back, adding pounds and you may not have a clue why. It happened to me. As a type-2 diabetic for more than a decade (during much of the time with undiagnosed heart disease) I was overwhelmed by the both the medically required changes I had to make in my life and the potential metabolic complications I'd suffer if I didn't comply with all the new "rules."

To make matters worse, for most of my life I had been a stress junkie. Many people, like me, thrive on stress, setting absurd goals and deadlines then driving themselves to achieve them.

Weight-wise I'd always been "normal" until I was diagnosed with type-2 diabetes. Unfortunately a decade later, I added a number of stressors to my life that included family, personal and professional disruptions and disasters. While my diabetes stayed in relatively good control, I suddenly discovered that my jeans didn't fit, my suits were too tight and I couldn't button my collar. The scale didn't lie -- 20 new pounds had joined the pressures and strain in my life.

Still, stress didn't come up as a possible reason. Other diabetics and web sites suggested that my medication -- insulin might be one -- caused the weight gain. But others in my regimen did not. Byetta helps with weight control and the rest have little or no effect. My physicians all had the same prescription; eat low sodium, low glycemic carb meals and begin an exercise program.

The first part was easy. Calorie restriction became my mantra -- but within 6 months the will power wasn't there. A year in Weight Watchers helped -- but then I moved and was back on the "Yo-Yo program." My problem was clearly me and my stress. I found many specious excuses to avoid exercise. Eating properly and regularly was "too hard for a single person."

One important thing I finally learned was that to beat stress you had to understand it and why it affected my diabetes, causing weight gain. There are other negative health consequences attributed to stress that include heart disease, and cancer from smoking, obesity from compulsive eating, liver disease from alcoholism, immunodeficiency, chronic headaches, ulcers, colitis, phobias, panic disorders, and suicide. Stress is everywhere, and costs the U.S. health care system billions of dollars per year.

Stress exists in everyone's lives but especially diabetics whose systems may not balanced so the reaction can be more extreme. This is what happened to me. Despite my efforts, my stress levels knocked me back two steps for every one I took forward.

The biology of stress is a response that dates back to our days as cave dwellers. When we encounter a potential physical or emotional threat, the body sends a question to the brain via the sympathetic nerves: Do we stand and confront this or turn and head for safety?

The feeling of fright sends a signal over the sympathetic nerve system to the adrenal glands, two organs above our kidneys. The brain's signal to the adrenal glands, calls for a jolt of adrenalin for energy, endorphins, and cortisol. Once adrenalin is circulating in your body, respiration accelerates, pupils dilate, and you perspire.

According to the American Diabetes Association (ADA), "Stress can alter blood glucose levels in several ways. First, people under stress may not take good care of themselves. They may drink more alcohol or exercise less. They may forget, or not have time, to check their glucose levels or to plan good meals. Second, stress hormones may also alter blood glucose levels directly.

"Scientists have studied the effects of stress on glucose levels in animals and people. While most people's glucose levels go up with mental stress, others' glucose levels can go down. In people with type 2 diabetes, mental stress often raises blood glucose levels. Physical stress, such as illness or injury, exacerbates higher blood glucose levels in people with type-2 diabetes."

• Stress is often diverting and overwhelming -- you lose focus on other important goals in your life.
• Stress can directly cause disease like high blood pressure and heart disease, which in turn affect your diabetes.
• Food behavior is one of the most common responses to stress, frequently leading to extremely bad eating habits leading to high-calorie "comfort food" diets, full of sweets and carbohydrates, that can compromise other biological functions if you are not getting enough needed vitamins and other nutrients.
• Stress leads many diabetics to fad diets in an effort to feel better about themselves. These usually fail, they gain back anything they've lost and their stress (and weight) reaches even higher levels.
• Stress can increase smoking and drinking, both of which are diabetes roadblocks that also can affect weight loss among diabetics who substitute cigarettes for healthy exercise and high-carb booze for good food.

©2009 Frederic Vagnini, M.D., FACS, and Lawrence D. Chilnick, authors of The Weight Loss Plan for Beating Diabetes: The 5-Step Program That Removes Metabolic Roadblocks, Sheds Pounds Safely, and Reverses Prediabetes and Diabetes