Is There a Relationship Between PTSD and Metabolic Syndrome?
- mclapham9
- Jul 21
- 7 min read
Image from Wix Media
Written by Michelle Clapham, RN, MSN, APRN (retired)
Post Traumatic Stress Disorder (PTSD) is more than a mental health disorder. There are biochemical changes associated with PTSD which place persons with PTSD at risk for serious chronic diseases.
What is PTSD?
PTSD, as defined by the Diagnostic and Statistical Manual, VI (DSM V) (1), is mental health disorder which develops after experiencing a traumatic event. These events may include:
Sexual assault
Child Abuse
Warfare
Interpersonal violence
Natural Disasters
Accidents
Not everyone who experiences trauma will develop PTSD. It is not known why some persons exposed to traumatic events develop PTSD and others do not (5). Many people who are diagnosed with PTSD will recover.
It is estimated that in any given year, approximately 5% of the U.S. adult population will have PTSD. In 2020, it was projected that 13 million persons had been diagnosed with PTSD. Women are more likely to develop PTSD than men as women are more likely to experience intimate partner and sexual violence. Also, veterans are more likely to develop PTSD than non-veterans (2). It is estimated that approximately 6% of the U.S. population has been diagnosed with PTSD at some time in their lives (2).
There is evidence that vulnerability to PTSD may be genetically inherited (3). Researchers have found PTSD shares many genetic similarities common to other mental health disorders such as panic disorders, generalized anxiety disorders, alcohol dependence, drug dependence, and nicotine dependence (3).
Symptoms of PTSD may include (1, 2):
Recurrent, intrusive thoughts or feelings related to the trauma
Avoiding discussion of the traumatic even
Dreams/nightmares related to the traumatic event
Experiencing trauma-related cues (known as triggers) which reactivate the mental experience and/or cause physical distress
Avoidance of trauma-related cues
Increased or hyperactive fight-or-flight response
Hypervigilance
Flashbacks – episodes of detachment where the person is reliving the trauma
In order to be diagnosed with PTSD, these symptoms must be present for longer than one month after the trauma and be present to such an extent the person begins experiencing dysfunction in their life, relationships and work (1).
Brain-Body Connection
Researchers have determined that an overactive fight-or-flight response is the source for the symptoms of recurrent PTSD. The fight-or-flight response is the body’s response to acute stress, a perceived harmful event or attack or threat to survival. The body releases catecholamines (norepinephrine and epinephrine) and hormones (estrogen, testosterone and cortisol) and the brain releases neurotransmitters (dopamine and serotonin) in response to the perceived threat (6) . These chemical changes prepare a person to fight the threat or flee from it. Once the perceived threatening situation goes away, the fight-or-flight response innately ceases, and the body and brain return to homeostasis (balance).
In persons with PTSD, the hyperactive fight-or-flight response creates pathways in the brain which remain active long after the initial trauma or threat has passed. These pathways cause a person to be hyper-reactive to any perceived fear-provoking condition (4). The hyperactive fight-or-flight system also causes persistent elevations of the catecholamines, hormones and neurotransmitters associated with the fight-or-flight response.
These elevated stress hormone levels interfere with the normal function of the brain’s hypothalamus, which is the body’s “control center”. The hypothalamus’ role is to keep body functions stable (homeostasis). The persistent elevation of stress hormones and their interference in the function of the hypothalamus are felt to be a major contributor to the development of PTSD (6, 7).
One main consequence of PTSD is the presence of high levels of cortisol in the blood. Cortisol is a hormone produced by the adrenal glands. Cortisol helps regulate blood sugar, helps the body to fight infections and helps the body respond to stress (7).
In PTSD the presence of a hyperactive fight-or-flight response causes the brain to perceive the body to be in a state of ongoing peril. As a result, persons with PTSD have chronically higher levels of cortisol circulating in their blood stream.
Persistently elevated blood cortisol levels are known to contribute to a number of chronic conditions including difficulty regulating blood sugar levels and may also lead to the development of insulin resistance and chronic inflammation (15).
What is Metabolic Syndrome?
Per the Cleveland Clinic, metabolic syndrome is “a group of conditions that together increase your risk of cardiovascular disease, Type 2 diabetes and stroke” (9). It is estimated that 30% of persons in the U.S. have metabolic syndrome and the prevalence increases with age to where approximately 60% of persons over the age of 60 have metabolic syndrome (10).
Some persons may develop metabolic syndrome because of their race or ethnicity. Other persons may develop metabolic syndrome because of lifestyle choices including inactivity/lack of exercise, a diet high in saturated fat and sugar, excessive alcohol consumption, and vaping/smoking (11,12).
To be diagnosed with metabolic syndrome, a person must have 3 out of 5 of the following conditions (11).
High blood pressure
High fasting blood sugar
Abdominal obesity
High triglyceride level
Low HDL cholesterol level
A component of metabolic syndrome is the presence of insulin resistance. Insulin is a hormone produced by the pancreas. Insulin helps to regulate blood sugar (glucose) by bringing blood sugar to the cells to use for energy.
When a person has insulin resistance, the cells of the body don’t recognize the insulin and won’t allow the insulin to deliver glucose. Over time, the blood sugar levels rise, and this cycle of excessive blood sugar levels and insulin resistance may lead to pre-diabetes or Type 2 diabetes (14). In metabolic syndrome, the presence of obesity and chronically elevated levels of blood glucose along with insulin resistance has been related to the development of chronic inflammation in the body (16).
What is the relationship between PTSD and Metabolic Syndrome?
Can having PTSD lead to the development of metabolic syndrome? Yes, according to the American College of Cardiology (11). In their 2013 retrospective study, 207,954 veterans, some with PTSD and some without, were followed over two years. Thirty-five percent of participants with PTSD developed insulin resistance as compared to 19% of the participants without PTSD. Also, metabolic syndrome was diagnosed in 53% of the patients with PTSD versus 38% of the patients without PTSD (11). The study indicated PTSD was independently associated with the development of higher rates of metabolic syndrome and insulin resistance.
Of note, a diagnosis of metabolic syndrome does not always indicate a concurrent diagnosis of PTSD. Both are separate chronic conditions and both conditions must be evaluated by your health care provider.
Addressing lifestyle factors in PTSD modifies risk factors for metabolic syndrome
Risk factors for the development of metabolic syndrome are similar to unhealthy lifestyle choices sometimes seen in persons with PTSD. Individuals with PTSD often struggle to maintain a healthy lifestyle secondary to the severity of their PTSD symptoms (15). Poor sleep quality, consumption of foods higher in saturated fat and sugar, increased volume of food intake, overuse of alcohol, smoking/vaping and lack of physical activity may all contribute to the development of obesity, insulin resistance and subsequent chronic inflammation (15).
Treatments for the psychological/mental health aspects of PTSD are well established and well researched. Holistic treatment of PTSD needs to also include ways to address the non-psychological issues related to PTSD. These interventions should include:
Healthier dietary choices including protein, fruits and vegetables; foods low in saturated fats and simple sugars
Regular physical exercise and daily movement/activity
Improving the quality and duration of sleep
Eliminating tobacco/nicotine use
Weight loss
Stress reduction with interventions such as meditation, yoga and breathing exercises
Avoidance of excessive alcohol intake
Addressing the non-psychological issues related to PTSD may reduce risk factors for the development of metabolic syndrome. Reducing the incidence of metabolic syndrome lessens a person’s risk for cardiovascular disease, Type 2 diabetes and stroke. A reduction in the burden of chronic disease may lower the cost of health care and improve quality of life. Further research into the mechanisms behind the relationship between PTSD and metabolic syndrome are needed. This research would provide opportunities to develop treatments targeted to reduce the incidence of metabolic syndrome in persons with PTSD (17).
Bibliography
Diagnostic and Statistical Manual of the American Psychological Association, Volume 5; 2016
How common is PTSD in adults? from National Center for PTSD. (2025) Retrieved June 18, 2025, https://www.ptsd.va.gov/understand/common/common_adults.asp
Skelton K, Ressler KJ, Norrholm SD, Jovanovic T, Bradley-Davino B. PTSD and gene variants: new pathways and new thinking. Neuropharmacology. 2012; 62 (2): 628-637.
Feriante, J., Sharma, N. (August 2023) “Acute and chronic mental health trauma” In: StatPearls [Internet]. StatPearls Publishing; Retrieved on June 17, 2025, from https://pubmed.ncbi.nlm.nih.gov/37603622/
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What is Metabolic Syndrome? American Heart Association (2024); Retrieved on June 18, 2025, from https://www.heart.org/-/media/files/health-topics/answers-by-heart/what-is-metabolic-syndrome.pdf?la=en
Prevalence and risk factors of metabolic syndrome: a prospective study on cardiovascular health; Rus M, Crisan S, Andronie-Cioara F, Indries M, Marian, P, Pobirci OL, Ardelean, AI. Medicina (Kaunas). 2023; 59(10):1711.
PTSD linked to insulin resistance and metabolic syndrome, early markers of heart disease (2013) American College of Cardiology; Retrieved on June 18, 2025, from https://www.acc.org/about-acc/press-releases/2013/03/11/19/36/ptsd
Insulin Resistance: What It Is, Causes, Symptoms & Treatment; Cleveland Clinic Health Library (2024) Retrieved on June 27, 2025, from https://my.clevelandclinic.org/health/diseases/22206-insulin-resistance
PTSD and diabetes: the complex link and connection explained (2024); Retrieved June 26, 2025, from https://neurolaunch.com/diabetes-secondary-to-ptsd/
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Cortisol (Blood); The University of Rochester Medical Center; 2000-2025 The StayWell Company, LLC (2025) Retrieved June 27, 2025, from www.urmc.rochester.edu/encyclopedia/content?contenttypeid=167&contentid=cortisol_serum
Farr, OM; Sloan, D; Keane, TM; Mantzoros, CS. Stress and PTSD-associated obesity and metabolic dysfunction: a growing problem requiring further research and novel treatments. Metabolism. 2014; 63(12); 1463-1
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