You are not alone.

Autumn is a season of change—and not just because of cooler temperatures, shorter days, foliage, and a faster pace. For many people, fall is also a time of adjusting to changes in life circumstances, both great and small.

Transitions can include the start of a new school year, busier work schedules, demanding project deadlines and/or more travel. Life transitions can include the purchase of a new home, becoming new parents, death of a loved one, job loss, moving to a new city, or retirement, all of which can feel more intense in a season with less daylight and chillier nights.

Humans are creatures of habit. Situations that involve transitions or which introduce change, uncertainty, or disruption of a regular routine, can trigger anxiety.

What is anxiety?

Anxiety is the body’s response to a stressful situation—real or perceived.

For example, going on a first date, anticipating an important job interview, or public speaking can trigger anxiety. Anxiety is associated with feelings of tension, distress, nervousness, fear and/or apprehension and is characterized by worried or intrusive thoughts.

That said, anxiety is not the same as fear.

Anxiety is considered a future-oriented, long-acting response broadly focused on a diffuse (non-specific) threat, whereas fear is an appropriate, present-oriented, and short-lived response to a clearly identifiable and specific threat (1).

Physical symptoms of anxiety can include:

–Restlessness
–Racing heart or increased heart rate
–Sweating
–Shaking or trembling
–Nausea
–Feeling faint or light-headed
–Changes in body temperature (too hot, too cold)
–Digestive issues (e.g., diarrhea, constipation, indigestion)
–Changes in appetite
–Shortness of breath
–Headache
–Dry mouth
–Sleep problems or insomnia

Anxiety disorders affect 19.1% of the population, or 40 million American adults, aged 18 or older (2).

I find it fascinating the extent to which Western medicine has “medicalized” anxiety. Now, your family doctor or PCP (primary care physician) can prescribe anti-anxiety medication for “moderate” anxiety. Really?!

In our convenience-oriented, one-click culture, taking a pill for every perceived ill seems like an easy, quick fix. However, many people are seemingly unaware of the wide range of potential (and common) side effects of taking anti-anxiety medications.

Depending on the type of anti-anxiety medication you take, side effects can include—and are not limited to—weight gain, sleep problems/insomnia, dizziness, changes in blood pressure (higher or lower), memory issues, confusion, increased agitation, headache, gastrointestinal issues (e.g., constipation, diarrhea, stomach upset), tremors, dry mouth, increased feelings of anger, hostility and irritability, addiction, depressed mood….and, oh…increased anxiety (3, 4, 5)!

Anxiety is not caused by a Xanax deficiency. Anxiety can have many root causes, including poor gut health, nutritional deficiencies, blood sugar imbalances, sleep deficiency, hormonal imbalances that occur during post-partum, perimenopause, menopause or andropause (male menopause), overexposure to blue light and unaddressed trauma.

What is often overlooked is that our food choices and lifestyle habits—areas of our life where we can make different choices—can cause or worsen anxiety.

Here are six common culprits:

1.  Sugar

With my clients, I always emphasize that optimizing blood sugar is the cornerstone of good health. And this includes mental health! Food or drink with a high glycemic index (e.g., high fructose corn syrup, sugar in any of its 57 forms, wheat) and/or high sugar foods—including sweetened beverages, sodas, refined carbohydrates, refined grains (e.g., breakfast cereals, crackers, etc.), flour-based foods (e.g., bread, pastas, pizza, sandwiches, etc.) and processed foods—cause a rapid rise in blood sugar.

Your body then compensates by releasing excess insulin to help lower too-high levels of blood sugar. This, in turn, causes your blood sugar to plummet (too low, too fast), triggering hypoglycemia, or a “sugar crash”, which is often experienced as a sudden drop in energy levels or fatigue.

This sudden lowered blood sugar state causes your adrenal glands to release stress hormones—like cortisol, norepinephrine, and epinephrine. These same hormones, which are released when you are in an “emergency” fight-or-flight mode (e.g., metaphorically being chased by a tiger), can cause or contribute to feelings of anxiety, irritability and/or hunger (6, 7).

Before you start an anti-anxiety medication, consider your food choices. Keep in mind: The symptoms of reactive hypoglycemia, which can be triggered by consumption of high sugar foods, including simple sugars (e.g., candy, sodas, sweetened beverages) and refined or simple carbohydrates (e.g., fruit juice, milk and milk products, white flour, white rice, bagels, pizza, pasta, etc.), are similar to symptoms of anxiety (8).

What you can do: Be mindful of eating whole food-based meals. Eat protein, especially at your first meal of the day; animal protein is ideal because it can help stabilize blood sugar. Include fiber (a.k.a. vegetables) and a source of healthy fat at every meal. Consider getting support from a functional health coach and schedule a free 15-minute consultation. Start your journey with a Food & Lifestyle Review.  Or, order your own labwork to stay on top of blood sugar management, nutrient status and metabolic health.

2.  Caffeine

Caffeine is the most widely used—and socially acceptable—psychoactive drug in the world. Approximately 90% of adults in North America consume coffee every day (9).

A study, specifically focused on U.S. caffeine consumption, and published in Food and Chemical Toxicology, surveyed 37,602 consumers who completed a comprehensive beverage survey regarding their consumption of caffeinated beverages. Results showed that 85% of the U.S. population consumes at least one caffeinated beverage every day. Approximately 96% of caffeinated beverage intake is from coffee, soda and tea. Among children, carbonated soft drinks were a main source of caffeine compared to coffee in adults. For US consumers, coffee remains the top choice of caffeinated beverage. (10).

While the benefits of caffeine have long been touted, caffeine intake has also been associated with anxiety, headache, nausea and restlessness (11). Caffeine can trigger anxiety symptoms, especially in those who have pre-existing anxiety disorders (12).

Caffeine affects how we think and how we feel. It is speeds up our breathing, heart rate and blood pressure, and is associated with increased alertness, motivation, focus and productivity.

However, as a central nervous system stimulant, caffeine use has also been linked with anxiety disorders, sleep disorders and eating disorders and a possible association with schizophrenia (13).

Why can caffeine significantly contribute to anxiety? Because:

–Caffeine increases heart rate, blood pressure and stress hormones, like cortisol and adrenaline, which can worsen feelings of stress and overwhelm (14, 15).

–Caffeine disrupts sleep, and a common side effect of caffeine consumption, especially among those who are prone to anxiety, is insomnia. Many people struggling with anxiety experience sleep problems. Getting restorative sleep is essential for balanced mood and overall mental health.

–You may be sensitive to caffeine—and not realize it. It is important to understand: caffeine can be experienced differently at different stages of life and depending on your hormonal balance, overall health status and whether you have the genes to efficiently metabolize caffeine—or not (16). I have personally experienced a shift in caffeine tolerance over time. For me, drinking espresso was a once much-anticipated daily ritual. I could even drink an espresso at 11PM and fall asleep immediately! Now? I still enjoy espresso, but only as an occasional “treat”.

Overall, studies suggest that caffeine sensitivity tends to increase with age. Research indicates that caffeine has a greater impact on calcium metabolism and bone in older people (17).

Taking synthetic hormones (e.g., oral birth control pills or conventional HRT) can slow down how you metabolize and eliminate caffeine from your system (18).

If you are perimenopausal, menopausal or post-menopausal, caffeine can worsen vasomotor symptoms, such as hot flashes and night sweats, as well as worsen sleep problems and increase frequency of urination (19).

Taking certain medications can slow the breakdown of caffeine in your body and increase the negative side effects of caffeine. These medications include—but are not limited to—some antidepressants, antipsychotics, cardiovascular drugs, anticoagulants and NSAIDS (20).

Even if you don’t drink coffee per se, keep in mind that the caffeine in energy / sports drinks, energy shots, sodas, caffeinated teas and iced teas can also cause or worsen anxiety.

What you can do: Be mindful of when and how much caffeine you consume throughout the day; what food(s) you may have with your caffeine (e.g., cookies, chips, candy, breakfast sandwich, etc.) and its effect on your blood sugar and energy levels. Depending on the extent of your caffeine dependency (none, mild or severe), taper off gradually or just take a break altogether. Swap out coffee and colas for green tea (stimulating without the jitters), decaffeinated green tea or calming herbal teas. Schedule a free 15-minute functional health coaching consultation. Consider doing a 7-Day whole foods-based Fall cleanse to reset your system.

3.  Alcohol

Unlike sugar and caffeine, which are stimulants, alcohol is a depressant. For those who are socially anxious or feel anxious in general, alcohol is an attractive antidote to anxiety; its ability to slow down processes in your brain and central nervous system, can make you feel—at least initially—less inhibited and more relaxed (21).

However, if you are prone to—or regularly experience—anxiety, alcohol can actually increase anxiety levels. How?

A 2019 study, published in Alcohol and Alcoholism, explains that the initial stimulatory feel-good effects we can experience after drinking alcohol is caused by temporary changes to chemical messengers in the brain called neurotransmitters. GABA is the brain’s natural calming neurotransmitter.

Drinking alcohol temporarily increases GABA while blocking glutamate, a neurotransmitter associated with excitability. The brain then tries to compensate for these effects by decreasing GABA production and increasing glutamate. However, once alcohol leaves the body, the brain is an overactive state, causing anxiety and/or other symptoms of a hangover (22). 

It can become a vicious circle to break (23):

–You drink alcohol to cope with anxiety.

–You feel calm from alcohol’s initial relaxation-promoting effect on the brain.

–You feel anxious as a symptom of alcohol withdrawal.

–You then feel compelled to drink again to relieve your anxiety.

Sure, there are general guidelines for how much alcohol consumption is considered “normal” or “safe”. In reality, however, alcohol tolerance is unique to an individual, depending on their gender, race, overall health status, hormonal balance and age, as well as genetic factors or predispositions.

What you can do: Pay attention to how much you drink on a daily / weekly basis. When and how frequently do you drink? Do you absolutely “need” alcohol to unwind or cope with stress? Are you able to take a break from alcohol? Are you able to soothe your anxiety in ways other than alcohol? Consider seeking support from a CBT therapist or CBT-trained coach, like myself, to identify triggers for anxiety, to develop adaptive coping strategies and to cultivate / prioritize self-care. Schedule a free 15-minute phone consultation here. Consider doing a Comprehensive Wellness Assessment to better understand where to make lifestyle changes first.

4.  News Consumption

Many of us seek certainty in uncertain times. One of the ways that many people try to feel more “in control” of their lives is by overconsuming “news”, whether through mainstream media (e.g., CNN) or social media feeds (e.g., Twitter).

Focusing all of your energy and attention on “the news”, whether on television, online, or via our phones, actually increases anxiety levels in the long run because it feeds the false belief that if you have enough information, you can remain in control (24).

I have worked with many clients who grapple with anxiety. *Beth (not her real name), who was in her mid-60s, intelligent, articulate and highly anxious, expended all of her mental and emotional energy obsessing about the war in Ukraine, the current US political environment, people who did not wear masks, and she expressed great fear about getting C*V*D. (Ironically, she came down with a severe case of C*V*D, rife with adverse health complications, despite being “up to date” on her shots). Energetically, we attract what we most fear, especially if we live in—and act from—a place of fear.

Beth was so consumed by external events beyond her control that she was absent from her own life. Staying glued to the news kept her distracted from dealing with a deteriorating marriage, myriad health problems, out-of-control clutter, dysfunctional “friendships” and unresolved trauma. One of the first things we worked on was limiting her news and social media consumption.

Keep in mind: today’s 24/7 news cycle literally assaults viewers with a barrage of negativity, fueling anxiety, fear, overwhelm and feelings of powerlessness. Even if you don’t turn on the television, you are served up “the news” on your phone, elevators, medical offices, and taxis. Like processed foods, news headlines are click bait, designed to keep you hooked and wanting more.

Humans naturally have a negativity bias; meaning, the human brain is wired to detect threats, so it will pay more attention to negative or scary information that could potentially help avoid a harmful situation (25).  However, overconsuming gloom-and-doom news stories can take a toll on your mental and physical health.

In a study published in the British Journal of Psychology, researchers found that participants who were only exposed to negative television news bulletins experienced greater levels of anxiety and sadness; this translated to these same participants experiencing a significant increase in worrisome thoughts about their own lives (26).

What you can do. Managing anxiety is like a meditation practice. Many meditation practices advise bringing your attention back to your breath when your thoughts wander. Likewise, when you feel anxious, gently bring your attention back to the present moment; this can include engaging in relaxation or deep breathing practices. Ground yourself, literally, by walking barefoot on dirt or grass, to release oxidative stress and tension. Notice sensory details of your environment; for example, the sun is shining; birds are singing; it feels cold; or a dog is barking in the background.

The best way to deal with uncertainty is to practice acceptance of what is beyond our control and to refocus our attention on things that we can control, like our own self-care—getting enough sleep, eating unprocessed whole foods, hydrating well, moving our bodies, and spending time in nature. For guidance and support, schedule a free 15-minute functional health coaching consultation. Consider doing a Comprehensive Wellness Assessment for an objective perspective about areas where you may have blind spots.

5.  Sleep

Which comes first…sleep problems or anxiety? Actually, both are intertwined.

Sleep problems, including insomnia, are a common symptom of anxiety disorders. People who ruminate tend to have obsessive thoughts about their problems or fears. Rumination often leaves the ruminator in a negative emotional state and, consequently, less able to come up with good solutions to problems or concerns. As a result, rumination is associated with anxiety (27).

Rumination, described as “racing thoughts”, “overthinking” and “unable to shut my mind off”, can instill a feeling of dread about going to sleep or prevent a ruminator from falling asleep (28).

Mental hyperarousal, triggered by worry, has been identified as a key factor behind insomnia. This means that if you frequently feel anxious, you are more likely to have sleep problems under duress (29).

On the other hand, not honoring your sleep needs can cause anxiety—even if you do not experience anxiety regularly.

Sleep is vital for optimal physical, mental and emotional health. As a functional health coach and CBT coach, I can attest that sleep deficiency in my clients is highly prevalent—and a major factor that contributes to the intensity of anxiety they experience.

Sleep deficiency occurs when (30):

–You don’t get enough sleep (a.k.a., sleep deprivation or sleep debt).

–You sleep at the wrong time of day (e.g., you work the night shift and sleep during the day.)

–You get poor quality sleep or have disruptions in your sleep cycles (e.g., no REM sleep)

–You have a sleep disorder (e.g., sleep apnea) that prevents you from getting enough sleep or causes poor sleep.

Depriving your body of sleep is a physiological, mental and emotional stressor.

Sleeping—at the right time—enables the body to heal and repair itself. When you sleep too little, poorly, or against circadian rhythm, stress builds up in the body.

Sleep affects brain health. Getting enough sleep enables your brain to properly detoxify by removing cellular “trash”—metabolic waste proteins, like beta amyloid (its accumulation in the brain is associated with Alzheimer’s) that build up in the brain throughout the day). This brain-cleaning process may reduce the risk of Alzheimer’s (31)^.

Sleep deficiency makes us less stress-resilient and more emotionally reactive to perceived stressors. A 2013 study found that sleep deprivation intensified reactions in the amygdala, the area of your brain responsible for emotional processing, especially anxiety and fear.

Sleep deficiency also impacts the anterior insula, the part of the brain that seeks cues for certainty and is also associated with anticipatory anxiety (32). A 2020 study found that poor sleepers and those who experience insomnia are more vulnerable to generalized anxiety disorder (GAD) during periods of chronic stress (33).

Bottom line: whether or not you are prone to anxiety, it is highly likely that not getting enough sleep or poor quality sleep will trigger or intensify feelings of anxiety.

What you can do:

–Create a bedtime routine. Plan in advance when you go to bed and give yourself an hour to wind down; e.g., brushing teeth, washing face, reading a book.

–Take a 10 to 30 minute walk outside—if you feel safe enough to do so—after dinner. This helps lower blood sugar, blood pressure and exposure to natural darkness increases melatonin production which can help with sleep.

–Maintain good sleep hygiene. Make sure your room is dark, cool and quiet. Keep all electronics, including the television, out of the bedroom.

–Keep a worry journal to counter rumination. Spend 5 to 20 minutes writing out all of your worries and concerns as a way to release repetitive thoughts.

–Consider working with a therapist or coach, such as myself, trained in CBT (Cognitive Behavioral Therapy) approaches to identify negative thought patterns, develop adaptive mindset strategies and create healthy sleep habits. Schedule a free 15-minute coaching consultation here.

6.  Movement

Did you know: people with anxiety disorders are at greater risk for heart disease and premature death (34)?

Previous studies have linked sedentary behaviors, such as sitting for work or travel and screen-based activities (e.g., online engagement via computer or phone, television viewing and electronic gaming), with increased risk of chronic diseases in adults and children.

Researchers have also found a positive association between sedentary behavior and anxiety risk. That is: the more you sit, the greater likelihood you will experience anxiety (35).

One 2015 study found that people with mild to moderate symptoms of anxiety disorders were sedentary most of their waking time (about 9.1 hours) and engaged in low-intensity physical activity—if at all (36).

Physical activity appears to have a protective effect against anxiety; aerobic exercise, in particular, has been shown to significantly reduce symptoms of anxiety (37).

To be clear, exercise is a subset of physical activity. Though the terms are often used interchangeably, they are not the same. Physical activity is any activity that requires an expenditure of energy, like walking up the stairs, walking the dog, gardening, or raking leaves. On the other hand, exercise is physical activity that is planned, structured, repetitive, and purposeful in its intent to improve one’s physical fitness. Examples of “exercise” include biking, swimming, brisk walking and running (38).

Why is exercise so effective in reducing and preventing anxiety?

–Exercise is present moment-oriented and can provide a healthy distraction from what you are feeling anxious about (39).

–Moving your body releases muscle tension. As a result, you feel less tense and less anxious (40).

Exercise, especially vigorous exercise, produces endorphins, which act as “feel good” neurotransmitters. Endorphins have natural pain-killing, anti-inflammatory and anti-stress effects on the body. Endorphins also trigger the release of dopamine, another neurotransmitter associated with feeling pleasure and reward (41).

–Regular exercise improves sleep, which is key to good mental health, including the prevention and reduction of anxiety (42).

–Exercise can help the body better cope with stress. When we have greater stress resilience, we feel less anxious overall. One study revealed that those who engaged in regular, vigorous exercise were 25 percent less likely to develop depression or an anxiety disorder over the next five years (43).

What you can do: I have coached many people who felt overwhelmed trying to find time to “go to the gym”. You don’t have to “go to the gym” to move your body! If you spend a lot of time sitting, the first step is to simply find ways to incorporate physical activity into your day. For example, walk wherever you can instead of driving; take the stairs instead of the elevator; or make a date to go walking with a friend. When it comes to exercise, engage in exercise that feels good to you: spinning, kickboxing, swimming, biking, doing the elliptical or brisk walking. Keep in mind: exercising longer and harder is not necessarily better. It depends on an individual’s state of overall health, mobility, and fitness. Studies suggest a 10-minute walk can be just as effective for some people in relieving anxiety as a more intense 45-minute workout (44). Looking for support, guidance and a “partner” to help you achieve your health goals? Schedule a 15-minute free functional health coaching consultation here. Consider getting your health back on track with a Food and Lifestyle Review.

Sources

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2  Anxiety & Depression Association of America. Facts & Statistics. 10/28/22.
3  Anti-Anxiety Drugs (Anxiolytics). Charles Patrick Davis, MD, PhD. RxList.com. 8/11/22.
4  Alramadhan E, Hanna MS, Hanna MS, Goldstein TA, Avila SM, Weeks BS. Dietary and botanical anxiolytics. Med Sci Monit. 2012 Apr;18(4):RA40-8.
5  Drugs.com. 9/26/22.
6  Aucoin M, Bhardwaj S. Generalized Anxiety Disorder and Hypoglycemia Symptoms Improved with Diet Modification. Case Rep Psychiatry. 2016;2016:7165425.
7  Gangwisch JE, Hale L, Garcia L, Malaspina D, Opler MG, Payne ME, Rossom RC, Lane D. High glycemic index diet as a risk factor for depression: analyses from the Women’s Health Initiative. Am J Clin Nutr. 2015 Aug;102(2):454-63.
8  Cleveland Clinic. Health Essentials. How to Treat Reactive Hypoglycemia. 9/7/21.
9, 20  Belayneh A, Molla F. The Effect of Coffee on Pharmacokinetic Properties of Drugs : A Review. Biomed Res Int. 2020 Jul 24; 2020:7909703.
10, 11 Mitchell DC, Knight CA, Hockenberry J, Teplansky R, Hartman TJ. Beverage caffeine intakes in the U.S. Food Chem Toxicol. 2014 Jan;63:136-42.
12  Broderick P, Benjamin AB. Caffeine and psychiatric symptoms: a review. J Okla State Med Assoc. 2004 Dec;97 12):538-42.
13  Winston, A., Hardwick, E., & Jaberi, N. (2005). Neuropsychiatric effects of caffeine. Advances in Psychiatric Treatment, 11(6), 432-439.
14   Brown University. What are the effects of caffeine?
15  Lovallo WR, Whitsett TL, al’Absi M, Sung BH, Vincent AS, Wilson MF. Caffeine stimulation of cortisol secretion across the waking hours in relation to caffeine intake levels. Psychosom Med. 2005 Sep-Oct; 67(5):734-9.
16  Harvard T.H. Chan School of Public Health. New genetic variants associated with coffee drinking. Oct. 7, 2014.
17  Massey, L.K. Caffeine and the Elderly. Drugs & Aging. 13, 43–50 (1998).
18  Institute of Medicine (US) Committee on Military Nutrition Research. Caffeine for the Sustainment of Mental Task Performance: Formulations for Military Operations. Washington (DC): National Academies Press (US); 2001. 2, Pharmacology of Caffeine.
19  Faubion SS, Sood R, Thielen JM, Shuster LT. Caffeine and menopausal symptoms: what is the association? Menopause. 2015 Feb;22(2):155-8.
21   Gan, G., Geuvara, A., Marxen, M, Schwartz, D., Zimmermann, U.S., Smolk, M.N. Alcohol-induced impairment of inhibitory control is linked to attenuated brain responses in right-front temporal cortex. Biological Psychiatry. Vol. 6, Issue 9, pp 698-707, Nov. 1, 2014.
22  Live Science. What is hangxiety and why do some people experience it? Anna Gora. 12/23/22.
23  Drinkaware. How alcohol affects anxiety. 7/1/22.
24  Anxiety & Depression Association of America. Is watching the news making your anxiety worse? 4/27/20.
25  Vaish A, Grossmann T, Woodward A. Not all emotions are created equal: the negativity bias in social-emotional development. Psychol Bull. 2008 May;134(3):383-403.
26  Johnston, W.M. and Davey, G.C. The psychological impact of negative TV news bulletins: the catastrophizing of personal worries. British Journal of Psychiatry. pp. 85-91. April 13, 2011.
27  Michl LC, McLaughlin KA, Shepherd K, Nolen-Hoeksema S. Rumination as a mechanism linking stressful life events to symptoms of depression and anxiety: longitudinal evidence in early adolescents and adults. J Abnorm Psychol. 2013 May;122(2):339-52.
28, 29  Sleepfoundation.org. Anxiety and sleep. Eric Suni and Alex Dimitriu. 9/22/23.
30  NIH. Sleep deprivation and deficiency. 3/24/22.
31  Lulu Xie et al, Sleep Drives Metabolite Clearance from the Adult Brain.  Science 342, 373-377(2013).
32  Goldstein AN, Greer SM, Saletin JM, Harvey AG, Nitschke JB, Walker MP. Tired and apprehensive: anxiety amplifies the impact of sleep loss on aversive brain anticipation. J Neurosci. 2013 Jun 26;33(26):10607-15.
33  Kalmbach DA, Abelson JL, Arnedt JT, Zhao Z, Schubert JR, Sen S. Insomnia symptoms and short sleep predict anxiety and worry in response to stress exposure: a prospective cohort study of medical interns. Sleep Med. 2019 Mar; 55:40-47.
34, 37  Kandola, A., Stubbs, B. (2020). Exercise and Anxiety. In: Xiao, J. (eds) Physical Exercise for Human Health. Advances in Experimental Medicine and Biology, vol 1228. Springer, Singapore.
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41  Mental Health America.
42, 43, 44  Anxiety & Depression Association of America. Exercise for stress and anxiety.

Follow your heart.

A loving heart is the truest wisdom.

Kind-hearted. Pounding heart. Heartbroken.

The heart been long been regarded as an organ of emotion.

The heart is not only central to our emotional system; it affects—and is affected—by what we feed our body (food, drink, movement) and our mind (thoughts, perceptions of reality).

Managing your emotions is key to building resilience and effectively coping with stress, which can go a long way toward improving heart health.

Valentine’s Day celebrates the emotion of love, traditionally associated with the heart. Since 1963, February (the entire month) has also been dedicated to raising awareness about heart health.  In the U.S., heart disease is the #1 killer of both men and women. Approximately 610,000 Americans die of heart disease every year; that’s 1 in every 4 deaths.¹

But we should be mindful of our heart health beyond February.

Managing our emotions is essential for a healthy heart. However, since unexpressed, repressed or negative emotions can manifest as physical symptoms, it is also important to understand the physical risk factors for heart disease.

Physical Risk Factors for Heart Disease

Stereotype: The “typical” heart attack victim is a Type A (workaholic) male executive in his 50s.

Fact: Heart attacks are affecting younger people today. A study published recently in the medical journal, Circulation, found that the overall proportion of heart attack-related hospital admissions in the U.S, attributable to “young” patients (men and women aged 35 to 54) rose from 27% in 1995-99, to 32% in 2010-14, with the largest increase (from 21% to 31%) among young women.²

The reality is that the risk factors leading to heart disease can happen at ANY age.

These include:

Overweight and Obesity. Over 70% of American adults are overweight; of this 70%, 40% of American adults (more than 1 in 3) are obese, and 18.5% of children (apx. 1 in 6), ages 2 to 19, are obese. Extra weight puts stress on the heart.³

High blood pressure. Uncontrolled blood pressure increases risk of heart disease and stroke.

High cholesterol. Obesity, smoking, diabetes, physical inactivity and unhealthy food choices contribute to an increase in bad cholesterol.

Smoking. Smoking damages the blood vessels and can cause heart disease.

Diabetes. 1 in 10 Americans has diabetes, a condition where sugar builds up in the blood.

Lack of physical activity. Only 23.5% of Americans, 18 and older, meet the recommended guidelines for aerobic and strength-training activity.⁴

Excessive alcohol consumption. Heavy drinking or alcohol abuse can lead to heart failure, known as alcoholic cardiomyopathy, or alcohol toxicity to the heart muscle.^5,6

Alcoholic cardiomyopathy is most common in men, ages 35 to 50, with a history of heavy, long-term (apx. 5 to 15 years) drinking. For men, “heavy drinking” is more than 4 drinks daily or more than 14 drinks per week. For women, heavy drinking is more than 3 drinks daily or more than 7 drinks per week.

Poor diet. Only 1 in 10 Americans eats the recommended 5-9 servings of fruits and vegetables every day. Diets high in unhealthy fats, sugar (added and/or artificial sweeteners), refined carbohydrates and processed foods increase risk of heart disease.⁷
 

Emotional Risk Factors for Heart Disease

In my practice, I see clients who often feel overwhelmed by stress.

No question about it: modern life is stressful. And negative emotions often drive our unhealthy food choices and lifestyle habits.

Feeling frustrated because you’re not getting the recognition you deserve at work? Maybe this is why you have an intimate relationship with comfort foods, like pizza, takeout Chinese and ice cream. Feeling trapped in an unhappy marriage or job? Maybe it feels more bearable when you pound wine or cocktails every night. Feeling angry because you feel like you do 85% of the work at work—and at home? Maybe that’s why you look forward to zoning out in front of the television (until 1 or 2 AM) after the kids are in bed. Feeling anxious because your latest entrepreneurial venture tanked? Maybe it feels like smoking or vaping helps calm your anxiety.

Chronic, negative emotions can feed inflammation and adversely affect heart health. These include:

Anxiety or anxiety disorder (e.g., panic disorder, post-traumatic stress disorder, obsessive-compulsive disorder). Anxiety may be associated with rapid heart rate, increased blood pressure and decreased heart rate variability.⁸

Anger. Studies have suggested that outbursts of anger or episodes of intense anger can increase the risk of heart attack, stroke or other cardiovascular events.⁹

Stress. Emotional stress can lead to behaviors and factors that increase your risk of heart disease: overeating, lack of exercise, drinking alcohol and smoking can lead to high blood pressure and high cholesterol.

Depression. Depression is common in people with heart disease or who have undergone a coronary artery bypass.¹⁰ However, depression, itself, is an independent risk for heart disease—even without known heart disease.¹¹

Grief. Heart attack risk can increase significantly during the days and weeks after the death of a loved one.¹²  Stress, caused by intense grief, can increase heart rate, blood pressure and blood clotting, raising chances of a heart attack.  At the beginning of the grieving process, people are more likely to experience less sleep, low appetite and higher cortisol (a stress hormone) levels, which can also increase heart attack risk.¹³

Even if you don’t have heart disease or you’ve never had a heart attack, emotional stress still affects your heart. For example, in a 1997 study, researchers monitored EKG (electrocardiograph) changes in healthy physicians during emergency calls while they were on hospital duty. The EKG changes that occurred before and during the first 30 seconds of an emergency call indicated oxygen deprivation and abnormal heart rhythms.¹⁴

A 2016 study, published in Trends in Cardiovascular Medicine, explored the brain-heart connection. Researchers found that negative emotions (considered “brain-based”), such as stress, anger and depression, can increase the frequency of heart arrhythmias (irregular heart beat).¹⁵

An earlier study found that depression—whether major or minor—is a risk factor for a fatal cardiac event. Even in people without prior heart disease, major depression (versus minor) doubles the risk of dying from heart-related causes.¹⁶
 

The Heart, Emotions and Stress

The heart and brain have a two-way communication system.

Our thoughts or emotional state can greatly affect our physical well-being.

The heart has its own “brain” and nervous system, which send signals to the brain (in the head), influencing how the brain processes emotions and cognitive function, including attention, perception, memory and problem-solving.¹⁷

When we experience a specific feeling or thought, it affects our autonomic nervous system (ANS) by releasing neuropeptides, nerve proteins that link perception in the brain to the body and emotions. The quality of the emotional signal our heart sends to our brain determines the type of chemicals our brain releases into our body.  “Stress” is usually rooted in unmanaged negative emotions.¹⁸

For example, let’s say that you are going through a nasty divorce, including a custody battle. You feel fear and anxiety (the emotions at the root of your stress) about the outcome. This stress triggers the release of cortisol and adrenaline, two “fight-or-flight” stress hormones, in anticipation of a perceived danger. Cortisol and adrenaline “rally the troops” by sending energy to your muscles, increasing your heart rate, blood pressure and breathing rate, while, at the same time, shutting down digestion, reproduction, growth and immunity (unimportant metabolic processes if your body is preparing to flee a tiger!).

When your body is in continual high-alert “EMERGENCY!” mode, these stress hormones and neuropeptides can cause health problems, from high blood pressure and digestive issues, to problems with your memory, immune system—and your heart.

Studies conducted by HeartMath Institute, a non-profit organization specializing in emotional physiology, resilience and stress management, show that emotions affect your heart rate variability (HRV), a measure of beat-to-beat changes in heart rate. Different patterns of heart activity influence cognitive and emotional function.¹⁹

For example, if you are under duress and experiencing negative emotions, such as anger, frustration and anxiety, your heart rhythm pattern will be irregular and chaotic (mirroring your feelings). This creates “distressed” neural signals, traveling from your heart to your brain, that limit cognitive function. This is why, under stress, you may act impulsively (e.g., go on an online shopping spree) or make rash (bad) decisions (e.g., drink and drive).

On the other hand, positive emotions, like gratitude, appreciation and caring, produce a regular, stable heart rhythm pattern. When the brain receives these harmonized neural signals, your stress hormones decrease, and your immune system is stronger. When you are in a positive emotional state, you will likely be thinking clearly and making effective (good) decisions.

The pattern of our HRV reflects how well we can adapt to stress; it serves as a marker of our physical resilience and our ability to change behavior (when necessary).²⁰
 

How to Get (and Stay) on a Positive Emotional Track

Emotions are at the core of our “stress” experience. Our thoughts, too, tend to carry an emotional charge.

Neuroscience researchers have found that emotional processes operate at a higher speed than thought processes, and can bypass the mind’s linear reasoning process.²¹ As a result, what you think does not always result in how you feel.

This is why feeling positive involves more than just thinking positive.

So, how can we cultivate confidence, emotional positivity and emotional resilience?

By actually facing, acknowledging and moving through uncomfortable feelings.

Let’s face it: nobody wants to deal with painful, uncomfortable feelings. Most of us prefer to disconnect or distract ourselves from feeling bad. We do this by ignoring our feelings, doubting or questioning whether our feelings are even valid, and/or by engaging in addictive escapism behaviors (alcohol, drugs, overeating, binge-eating, compulsive shopping, electronic distractions, zoning out in front of the television)—anything that enables us to “check out”.

Even socially accepted behaviors, like exercising, being in constant multi-tasking “busy” mode, or being work-obsessed, can serve as distractions from uncomfortable feelings. In my past life as a freelance writer, I often dealt with my work-related feelings of frustration and anger by pounding my body with aggressive over-exercise (spending 2-3 hours at the gym). This “healthy” behavior—and my results—were praised; nonetheless, it was a distraction from what I was feeling inside. In the end, over-exercise drove my hormones into the ground and crashed my immune system.

In her illuminating new book, 90 Seconds to a Life You Love, psychologist Dr. Joan Rosenberg, gives practical guidance and strategies for creating emotional confidence and resilience. She writes:

“As paradoxical as it seems, the answer is tied to your capacity to tolerate pain—or your ability to handle unpleasant feelings. The more you are able to face the pain you experience, the more capable you become. The essential keys to developing confidence, feeling emotionally strong, and being resilient involve an openness to change, a positive attitude toward pain, a willingness to learn from any experience, and a capacity to experience and express unpleasant feelings.”

Her “Rosenberg Reset”, which helps you move through unpleasant feelings, is a simple 3-step formula: One choice. Eight feelings. 90 seconds.

1. The “one choice” is to be present and to be aware of how you feel from moment-to-moment; this may include experiencing unpleasant feelings in the process.

2. The eight common unpleasant feelings include: 1) sadness; 2) shame; 3) helplessness; 4) anger; 5) embarrassment; 6) disappointment; 7) frustration; and 8) vulnerability.

3. You endure these unpleasant feelings by riding one or more 90-second waves of bodily sensations—like warm cheeks (e.g., feeling embarrassed), a pounding heart (e.g., feeling angry), or a heavy pit in the stomach (e.g., feeling deep disappointment)—that may accompany uncomfortable feelings. Pay attention: these physical sensations are how the body communicates our feelings to us.²²

Rosenberg contends that major life choices—a spouse/partner; the “perfect” job, the college of your choice—can influence the opportunities we have in life, but not our overall happiness, sense of peace and well-being.  Instead, she maintains, it is our moment-to-moment decisions that have a cumulative effect on our health and well-being.

For example, did you voice your true opinion at a work meeting? Did you trust your gut reaction on an awkward first date? Did you express how you really felt when a friend cancelled lunch last minute and rescheduled for the umpteenth time? All of these moment-to-moment decisions to address or ignore your feelings add up to how confident—and competent—you feel in navigating unpleasant emotions.²³

It is like building an emotional “muscle” that, over time, enables you to speak your truth. By consistently experiencing and dealing with difficult feelings, Rosenberg maintains, you increase your capacity to engage in courageous conversations, which can enhance relationships and deepen the purpose and meaning of your life.
Perhaps, it only makes sense that the root of the word “courage” is “cor”, the Latin word for “heart”. And the original meaning of the word “courage” was “To speak one’s mind by telling all one’s heart”.
 
 
 

Sources:

¹  Centers for Disease Control and Prevention, Heart Disease Facts.
²  Circulation. Nov. 2018; 139:1047–1056
³  AAFP.org
⁴  CDC. National Center for Health Statistis.
⁵  Herz. 2016; 41(6): 484–493.
⁶  Curr Atheroscler Rep.2008 Apr; 10(2): 117–120.
⁷  CDC: Division of Heart Disease & Stroke Prevention.
⁸  John Hopkins Medicine: Heart & Vascular Institute.
⁹  European Heart Journal.  2014 Jun 1; 35(21):1404-10.
¹⁰  Cleveland Clinic: Depression & Heart Disease.
¹¹  University of Iowa Hospital & Clinics.
¹²  Science Daily. Jan. 10, 2012
¹³  Circulation. Jan. 9, 2012.
¹⁵  Journal of the American College of Cardiology. Vol. 30, Issue 3, July 1997, pp. 774-779
¹⁶ Trends in Cardiovascular Medicine. Vol. 26. Issue 1. Jan. 2016, pp. 78-80.
¹⁷  Archives of General Psychiatry. Vol. 58, Issue 3, Mar 2001, pp. 221-227. University of Groningen.
^{19, 20}  HeartMath Institute
^{18, 21}  Stress in Health and Disease. Wiley-VCH. 2006.
^{22, 23}  90 Seconds to a Life You Love.  Joan I. Rosenberg. Little Brown. 2019.