Stress, Mental Health and Your Heart

Feeling “stressed out” happens more often than we would like to admit. Managing stress is an essential component of a healthy lifestyle – since chronic stress can adversely affect physical and mental health.  

April is recognized as National Stress Awareness Month to bring attention to the negative impact of stress.  

What is stressful to one person may not feel the same for another. But how much stress you personally experience and how you react to it can lead to a variety of health problems, most notably mental health, and heart health conditions. Common causes of stress include worries related to money, work, health issues, family or caregiving responsibilities, politics, discrimination, violence, or climate change. Many times, stress arises because of factors outside of our control.  

Chronic, unmanaged stress can lead to depression and anxiety, plus it does affect the heart. According to the American Heart Association (AHA), stress may also contribute to poor health behaviors linked to increased risk for heart disease and stroke, such as: 

• Smoking 
• Overeating 
• Higher cholesterol levels 
• Lack of physical activity 
• Eating an unhealthy diet 
• Being overweight 
• Not taking medications as prescribed 

Your body’s response to stress can include physical symptoms, such as: 

• Headaches 
• Body pains 
• Stomach pains 
• Rashes 
• Fast heartbeat 

Stress can also: 

• Reduce your energy and motivation 
• Zap your creativity and productivity  
• Wreak havoc on your sleep 
• Make you feel cranky, forgetful, or out of control 
• Weaken your immune system  
   

The toll of micro stressors 

A stressful situation sets off a chain of events. Your body releases adrenaline, a hormone that briefly causes your breathing and heart rate to speed up and your blood pressure to rise. These reactions prepare you to deal with the situation, giving you what is known as “fight or flight” response. According to Boulder Heart cardiologist Nelson Trujillo, MD, these events include mass shootings or car accidents – which have a definitive conclusion. 

“What doesn’t end – especially in today’s world – are micro stressors, and we experience millions and millions of them all day long,” says Dr. Trujillo. “They are so subtle that we do not even appreciate them. These are small moments of stress which are manageable on their own, but over time, add up. These are the little hassles of everyday life – the passive aggressiveness of our teammates, the television playing the news, the cellphone ding when a new email arrives, or the flash notification from Facebook.  

“All these little elements can build up and through the heart/brain access, through the adrenal glands, they can cause repetitive injury and predispose us to cardiovascular events. They deplete our emotional reserves. They’re responsible for burnout.” 

Further research is needed to determine more about how stress contributes to heart disease and stroke. For certain, negative psychological and mental health is associated with an increased risk of heart disease and stroke and can impact your quality of life.  

One in five U.S. adults experience mental health needs each year. In Colorado alone, 924,000 adults have a mental health condition. That’s more than 8X the population of Boulder. 

The big question. What can you do to help manage your stress? 

Steps towards stress relief  

• Spend time in nature for lower stress and better memory (American Heart Association – AHA). Fresh air and nature can calm nerves, instead of frazzling them. “One of the foundational elements of our Pathways Program is that we take people out on hiking trails around Boulder to do our therapy,” says Mike Lewis, LCSW, Outpatient Behavioral Health Services manager. We have research that shows that it’s good for mental health to be out in pretty places and there are actual chemicals that get released from plants and trees that can calm us and lift our mood. Enjoy the lovely spaces.” 
   

• Deep breathing. Great for relaxation of mind and body. “If you find yourself feeling anxious or nervous or stressed out, check in with your body,” Lewis says. “You’ll notice you might be breathing very shallow. Basically, you want to fill up your whole lungs and do belly breathing. You can put one hand on your belly, and when you breathe in, you want to feel your belly expand first, then come up into your chest. If you do a deep breathing exercise for about five to 10 minutes, you’ll notice a difference.” 
  
  Dr. Trujillo also recommends breathing exercises. This one below has been shown to lower blood pressure and reduce cardiovascular mortality: 

1. Start with your right index closing your right nostril. 
2. Slowly inhale through your left nostril. 
3. Slowly exhale through your left nostril. 
4. Pause briefly at the bottom of your exhale as you empty your lungs completely. 
5. Repeat this three times. 
6. Then close your left nostril with your left index finger and repeat the steps above. 
7. Perform this exercise at least once per day.
    

• Meditation. It may help lower stress, but it also may help improve anxiety and lower blood pressure. BCH is now offering meditation and mindfulness classes, and you can learn more here.
   
• Be mindful of micro stressors and reduce screen time. “I know when my micro stress is really building up,” says Dr. Trujillo. “I become paralyzed; I would rather sit on my couch looking at my phone.” Use the “Do Not Disturb” setting on your phone. Only check news headlines once a day and office emails during work hours.  

• Discover healthy food and drink go-tos. “I love eating almonds, pistachios, blueberries, and smoked salmon,” says interventional cardiologist John Schutz, MD. “I like these foods because they are easy to eat on the fly. I try and drink as much water as possible. I avoid highly processed foods and try to cook at home. 

• Connect often with others. Meet a friend for coffee. Call a family member. Say hi to a stranger at the grocery store. Join social groups. 
  “The biology is pretty straightforward in people who are isolated and lonely,” says Dr. Trujillo. “There are increased stress hormones which causes inflammation, which we know causes cardiac events.” 

• Know your risk and follow the science. “My grandfather suffered a heart attack and died from cardiac arrest at age 32. Then my father suffered his first heart attack at age 40. I’ve always followed the science on the very best ways of avoiding coronary artery disease. Based on what I learned, my family and I follow a whole-food, plant-based diet that’s low in salt, sugar, and fat. This helped me lower my high cholesterol, triglycerides, blood pressure, and blood sugar to very healthy range. It’s a big change, but was easier to do than I expected. Now it’s second nature and I can’t imagine going back to eating an unhealthy diet! 

• Find a furry friend. Interacting with your pet can relieve stress and suppress stress hormones. Did you know that studies show that merely the act of petting a dog decreases blood pressure? 

• Move more. Exercise is a great antidote for stress. “I try to practice what I preach; I walk often and have a stand-up desk at work,” says Dr. Schutz.  

• Get professional advice. Discuss your stress levels with your health care provider. This is especially important if you have other risk factors for heart disease, such as obesity or high blood pressure. Experienced behavioral health specialists are available in each of our eight primary care clinics (family medicine and internal medicine) to provide therapeutic interventions, new coping skills, treatment recommendations and referrals. 
  
  “Find a primary care provider and stick with them,” says Dr. Trujillo. “Create a relationship.”