PTSD and Metabolic Health

(This post was originally shared in our RCMP Newsletter - Protect Your Health)

Post-traumatic stress disorder is a severe psychological condition that develops in response to traumatic events that often leads to chronic, disabling symptoms lasting years or decades after the trauma. 

PTSD is characterized by intrusive flashbacks, interrupting thoughts, nightmares, sleep disturbances.  Avoidance of activities, relationships or thoughts that stimulate memories of the trauma can lead to irritability, isolation, guilt and depression.

A recent study estimates that 1 in 3 RCMP members currently have PTSD - almost four times the general population’s lifetime prevalence.

Effective treatments are available, including counselling, psychotherapy as well as medication.  Unfortunately, many people with PTSD have residual symptoms resistant to treatment and lead to long-term disability.
Current treatments all focus on psychiatric manifestations, with little to no emphasis on the metabolic and cardiovascular risk factors associated with PTSD. 

An emerging body of evidence shows that PTSD is a significant risk factor for metabolic dysfunction with higher rates of obesity, high cholesterol, high blood pressure, diabetes and heart disease.

The precise mechanism by which PTSD increases the cardio-metabolic risk has not yet been determined, but emerging evidence suggests that the link between stress and metabolism is central.

Stress, mediated through the sympathetic nervous system (“fight or flight”) and the hypothalamic-pituitary-adrenal (HPA) axis, leads to higher levels of the stress hormone cortisol.  Chronically elevated cortisol levels result in abdominal obesity, which leads to insulin resistance and inflammation, the underlying processes that drive the risk of diabetes and heart disease.

Cortisol also drives over-eating with increased consumption of comfort foods - high-calorie food choices.

Compounding these effects of stress, people with PTSD show changes in brain function associated with appetite and changes in reward-processing that make the over-consumption of high reward foods even more likely.  

Our brain recognizes foods with these characteristics as innately rewarding:

• High-calorie density
• High fat
• High carb 
• Sweet
• Salty
• Meaty

The overlap between these attributes and fast food is not accidental, as the food industry markets foods that are likely to lead to overconsumption.

Not surprisingly, research shows that individuals with PTSD have poor dietary habits and higher rates of emotional eating related to PTSD symptom severity.

For some people with PTSD, the positive stress of exercise, with adrenaline release, increased heart and respiratory rates, can trigger PTSD symptoms.  As a result, these people avoid exercise to minimize the risk of recurring effects of PTSD.  The result is a more sedentary lifestyle that only further aggravates weight gain and poor metabolic health.
Finally, the symptoms of PTSD often present with nightmares and disturbed sleep, further aggravating the stress response.  The weight gain and metabolic changes increase the risk of developing sleep apnea, setting up another vicious cycle.

How to address this?
PTSD requires a comprehensive treatment plan, often combining counselling and medication.  Often overlooked are the benefits of intensive lifestyle interventions to combat the effects of PTSD on diet, exercise, sleep and overall stress.
Recognizing metabolic dysfunction, insulin resistance, pre-diabetes or diabetes and applying proven lifestyle approaches (like the 4+2 Diabetes Reversal Strategy) not only improve overall health but are synergistic to the primary therapy for PTSD.

For RCMP:
Wellness Garage offers a fully funded, comprehensive, year-long, multi-disciplinary lifestyle medicine program to help members with weight loss, nutrition, fitness and lifestyle optimization.  The program is ideal for members with PTSD to pair with their psychological care plan.  

The program’s criteria are weight-based:  BMI >30 or BMI 27-30 with a weight-related diagnosis.  

Although PTSD has not traditionally been thought of as such a weight-related process, the emerging evidence presented in the literature and reviewed here suggests that it should be recognized as such.

Click here to learn more about this program.

Even if you don’t qualify for the funded program - please reach out to have a Lifestyle Medicine Assessment (funded through MSP), where we can assess risk and help you develop a lifestyle strategy.