Dear High-Achieving Women: Your Heart is Talking. Are You Listening?
Chronic Stress is Rewriting Your Heart’s Health Story
Full Audio Recording
Pounding heart. Butterflies in the stomach. Difficulty concentrating. Sweaty palms. What comes to mind when you think of experiencing these types of symptoms? Is it something incredibly stressful? Or something incredibly exciting? Fun fact: The body doesn’t know the difference. It doesn’t know whether you experienced a near-miss car accident, are riding a rollercoaster, achieved something BIG, or fell in love. Your body interprets all of these as stress; your mind provides the context and perceptions of positive or negative associations.
We all experience life stressors. Pretty much everyday. For some of us (most of us), multiple times a day, all day. And, this will come as no surprise to women—especially, high-performing, high-achieving women: We experience more stress at higher intensities than men1. We experience more stress-related depression, anxiety, sadness, and fear than men, but, we also experience more joy1. Our highs are higher and our lows are lower.
Unsurprisingly, we also carry more distress about our rights and civil liberties—feeling like our rights are more under attack compared to men2. Given we’re the ones who are constantly fighting for bodily autonomy and equal pay, to say the least, that tracks. Individuals who identify as LGBTQIA+, also—again, unsurprisingly—feel the most distress about their rights and civil liberties being under attack2. Black individuals feel civil liberty distress at about the same rate as women2. Consider, now, the intersectionality here. What level of distress must a Black trans woman feel? This is not a political blog, so all I will say is that I don’t give a shit what side of the aisle you’re on, but I don’t know how you read those stats and not find a space of deep compassion for your fellow human. I’m here to help women who experience high levels of stress—all womxn.
Simultaneous to this, about 44% of women in the U.S. have some form of heart disease3. For the past 30 years, heart disease has been the number 1 killer of both women and men. However, only 56% of women are aware of that fact3. So, we essentially have about half of women that have a heart condition AND don’t know that it’s their most likely cause of mortality … granted, it’s a bit of a stretch to say that the same exact group of women fall into both categories.
So, what does one (stress) have to do with the other (heart disease). Well, aside from stress and heart disease affecting women more, stress just happens to be one of the key risk factors for heart disease. It’s why getting physiological and psychological stress and stress-related symptoms under control is so important.
When most people think of stress reduction, most of the time, they think of meditation, yoga, breathing exercises … sometimes associating only “woo woo” activities with stress management. However, there’s three BIG modifiable factors that can work to reduce stress MORE than general mind-body go-to practices: Nutrition, sleep, and exercise.
This article will focus primarily on the connections between stress and heart disease and nutrition for heart health; I’ll cover sleep (the undercover hero for SO many conditions and concerns) and exercise another time. First, it’s important to lay a deeper foundation for stress and heart disease.
Physiology, Types and Symptoms of Stress
Physiology
A stress response occurs in the body when its internal balance is disrupted by physical or psychological stimuli that are considered stressors4. Stress is how the body reacts to these stressors, situations or life events; this can be a momentary concern or long-term, repeated exposure. When the body reacts to stress, the nervous, endocrine and immune systems are activated to allow the body to quickly fight, GTFO, or freeze. It starts with activation of the adrenals via the release of epinephrine (adrenaline) and norepinephrine (noradrenaline). From there, a whole cascade of hormones and neurotransmitters occurs that affects all of the bodily systems.
Check out this image to see how various parts of the body are affected by the stress response.
Image Credit: https://www.healthline.com/health/stress/effects-on-body#Central-nervous-and-endocrine-systems
Types of Stress
Did you know there are different types of stress? I’m only going to focus on eustress, physiological, psychological, and chronic stress. Other categories include: acute, episodic acute, traumatic, and environmental. I’ll cover all types in-depth in another article.
Eustress
Remember the examples above of thrilling and exciting situations that produce a stress response? Riding a rollercoaster, achieving something BIG, and falling in love. Stressful situations that are exciting, inspiring and/or productive produce good stress called Eustress. YES, good stress! This type of stress helps keep us motivated and makes us mentally sharper4. Exercise falls into this camp, as well. Exercise also utilizes hormesis, where some potentially negative stress creates positive effects, but incredibly large amounts may be detrimental to the body.
Tapping into this Eustress is what I help my clients do. I help them minimize the negative stress and amplify the eustress to create their personal combination of balance (which, I assure you, looks different from your bestie, sibling, or significant other’s personal combination of balance!)
Physiological
This is stress that occurs when internal or external stressors disrupt how the physical body functions. This can include things like injury, illness, disrupted sleep, and nutritional deficiencies4. This also can include some of the other types of stress like environmental stress that comes from exposures to problematic environmental stimuli; traumatic stress from trauma or injury from accidents and natural disasters; and acute stress like minor or major injuries.
Psychological
This is stress that occurs from mental or emotional factors, which may include things like fear, perceived threats, worries, and others4. Psychological stressors can come from any source that produces negative or concerning thoughts and feelings; common sources include work, school, parenting, family, financial instability, socioeconomic factors, social media, and social/peer pressure. This also can include some of the other types of stress as well, including traumatic stress, episodic acute stress, environmental stress, and chronic stress.
Chronic
As with any chronic condition, chronic stress occurs from repeated exposures to stressors over an extended period of time. Both psychological and physiological stress can be chronic stress. This prolonged exposure to stress can contribute to heart disease, anxiety, depression, sleep conditions, reduced fertility, hormonal imbalance, lifestyle diseases, chronic diseases, and more. More on this below. Chronic stress is one of the most common and problematic health concerns today.
Stress Symptoms
The symptoms of stress are wide-ranging and as the image above demonstrates, stress impacts all systems and all areas of the body. Common symptoms of chronic stress include5:
Pain, including back pain
Acne and other skin problems, like rashes or hives
Headaches
Upset stomach
Feeling like you have no control
Forgetfulness
Lack of energy
Lack of focus
Overeating or not eating enough
Being easily angered
Trouble sleeping
Drug and alcohol misuse
Loss of interest in things you once enjoyed
Less interest in sex than usual
Stress can also be a trigger and contributor of irritable bowel syndrome (IBS) amongst other conditions and diseases. I call out IBS, specifically, though, because it’s one of the most common, painful, and disruptive stress-induced experiences.
Stress and Women
As noted above, women experience stress more often and more intensely than men, and tend to have more feelings of fear, sadness, anxiety and depression. In fact, for women, chronic stress can be a predictor for depression and the onset of a major depressive episode after an acute stress event6. More simply stated: If you’re experiencing chronic stress, like working in a high-stress environment, and then you experience an acute stress event, like an injury, there’s a bigger chance that acute event may be the tipping point into a major depressive episode. And, if you’re an African American woman, gender or racial discrimination contributes to increased risk of poor health and low wellbeing due to individual stressors directly and indirectly having greater impact on your health—it’s a chronic stress ripple effect that creates added stressors with each ripple7.
Chronic stress affects women, uniquely, in a number of ways: Stress-induced over-eating may change the body’s sensitivity of estradiol (a primary form of estrogen) which may contribute to obesity8; reduces fertility and the probability of conception9; contributes to increased PMS10,11 and perimenopausal symptoms12; and an increased risk of heart attack from both long-term stressors (like a sedentary lifestyle and smoking) and acute stressors (like natural disasters)13.
Physiology of Heart Disease
Heart disease can refer to many conditions or disease states. It can refer to arrhythmia (palpitations or feelings of fluttering in the chest), heart failure or others, but it’s most often referring to coronary heart disease or coronary artery disease. An artery’s job is to carry blood to the heart; when the heart/coronary arteries become blocked, the heart can’t get enough oxygen-rich blood to it—it’s like it’s being suffocated. Depending on the blockage, you could experience chest pain, shortness of breath, or even a heart attack.
What causes an artery to become blocked? Structural issues with the artery can occur, but the most common cause of a block is the formation of plaque (a dangerous combination of cholesterol and fatty substance) on the inside of the artery wall. Plaque build-up can come from excessive blood cholesterol, excessive blood sugar due to diabetes, high blood pressure (aka hypertension), and smoking14.
Stress, Heart Health, and Women
Chronic stress is one of the key risk factors for poor heart health; it can increase the risk of heart disease and a cardiovascular event, like a heart attack. It’s not a lone actor, though; there are other risk factors as well. You may be at higher risk if you14,15,16 …
Have gone through menopause, regardless of age (you no longer have the cardio-protective benefits of estrogen)
Are a woman over the age of 55 (the assumption is you’ve gone through menopause, therefore lack the cardio-protective benefits of estrogen)
Have a family history of heart disease (immediate family members)
Smoke (smokers are four times more likely to have heart disease)
Consume excessive amounts of alcohol (there’s a lot of debate around if even 1 drink per day for women is considered heart healthy; more than 3 drinks per day can lead to increased triglyceride levels and increased blood pressure, both of which can be damaging for the heart)
Have high LDL cholesterol or low HDL cholesterol
Have mild, moderate, or high blood pressure
Have diabetes
Have overweight or obesity
Have metabolic syndrome
Lead a sedentary lifestyle or get inadequate physical activity
Experienced preeclampsia, gestational diabetes, or anemia while pregnant
Use hormonal birth control
Have endometriosis
Have polycystic ovary syndrome
Have an inflammatory or autoimmune disease
Experience mental health concerns like depression or anxiety
Don’t eat a nutritious diet and/or consume what’s considered a Standard American Diet, which is characterized as an eating pattern high in saturated fats, refined carbohydrates, red and processed meat, and sodium; low in vegetables, low-glycemic fruit, fiber, lean and plant-based proteins, quality fats, nuts and seeds, and whole grains.
Have a combination of the above
What’s interesting to note about this list of risk factors is that nearly all of these conditions and disease states are examples of physiological and/or psychological stress on the body and mind or are outcomes of physiological or psychological stress—nearly all are associated with chronic stress.
Not Just for Older Women
Lest you’re eager to believe that age shields you, younger women (under the age of 50) are twice as likely to experience mental stress-induced myocardial ischemia (lack of oxygen-rich blood to the heart) than women over the age of 5017.
I’ll also bring attention here to menopause and the ovaries. Menopause is affecting women younger and younger these days. With natural menopause, not menopause due to partial or full hysterectomy, the ovaries stop producing adequate amounts of estrogen and progesterone to maintain a menstrual cycle. A lack of estrogen production also occurs when the ovaries are surgically removed or when a dysfunction occurs that severely limits appropriate ovarian function. As noted above, estrogen is cardio-protective. Thus, the increased risk for heart disease.
Signs of Heart Disease and Heart Attack in Women
The signs and symptoms of heart disease and a heart attack can present differently than in men. It’s important to understand these differences, because most marketing materials that teach the signs of heart attacks are referencing the typical male presentation, though there has been a public health push in recent years to raise awareness for the subtle symptoms women may experience.
Symptoms of Heart Disease in Women may include16:
Dull, heavy, or sharp pains or discomfort in the chest
Neck, jaw, throat, upper belly or back pain
Nausea or vomiting
Unusual fatigue
Shortness of breath during exercise or physical activity
“Women who have coronary artery disease are more likely than men to have chest pain when resting or doing daily activities, rather than during exercise. They're also more likely than men to feel chest pain from mental stress.”16
Symptoms of a Heart Attack in Women may include16:
Crushing or squeezing chest pain, though women experience chest pain less than men
Pressure or tightness in the chest
Dizziness
Unusual fatigue
Gastrointestinal symptoms like indigestion, heartburn, nausea, vomiting, or stomach pain
Shortness of breath
Heart attacks are not always dramatic and BIG events; they may be mild, start slowly, stop and restart.
Nutrition and Heart Health in Women
Nutrition is one of the best ways to decrease the impact of stress on the body, improve your heart health, AND decrease your risk of heart disease. We don’t often think of nutrition as a way of influencing the stress response, but it can be a powerful ally in modulating the sympathetic nervous system, reducing chronic inflammation (which occurs with chronic stress and immune activation), and reducing oxidative stress (aka “internal rusting”) that comes from the over-production of reactive species, sometimes referred to as “free radicals” (which also occurs with chronic stress, inadequate nutrition, and immune activation).
Dietary patterns aimed at reducing inflammation, like the Mediterranean Diet, are excellent for heart health as is the Dietary Approaches to Stop Hypertension (DASH) Diet. The Mediterranean Diet has shown particular effectiveness in the primary prevention of heart disease and death in women18.
However, you don’t have to follow a specific diet or eating pattern to improve your heart health. Here are a few heart-healthy suggestions:
Ensure packaged foods have vitamins and minerals in them; most do not … most contain very little, if any, vitamins and minerals. If you pick up a product and the vitamin and mineral section of the nutrition label is all zeros or close to it: Put the product back and find a better one.
Choose fiber-filled, colorful vegetables and low-glycemic fruit that are in their whole form versus a processed version
When picking canned vegetables, make sure to choose low salt, low sodium, or unsalted versions. Flash frozen vegetables are a better option.
When selecting canned fruit, look for no sugar added versions. Canned fruits are often packed in sugar syrup. Flash frozen fruits are a better option, as well.
Rinse and drain canned vegetables and fruit thoroughly to remove excess salt and sugar
Skip the red meat and the processed meat; opt for lean protein and plant sources of protein, instead
Opt for whole grain instead of refined grain
Minimize intake of saturated fats
Minimize intake of added sugars; try to keep added sugar to less than 10% total of your daily sugar intake. Look for the Added Sugar line on a food label, listed under the Total Carbohydrates section.
Be on the lookout for sugar in disguise, it may be called:
Agave nectar
Barley malt syrup
Beet Sugar
Cane juice
Cane sugar
Cane syrup
Caramel
Corn sweetener
Corn syrup
Carob syrup
Dextrose
Fructose
Glucose
High fructose corn syrup
Honey
Invert sugar
Maple syrup
Molasses
Raw sugar
Rice syrup
Sucrose
Turbinado sugar
I’m a believer that most foods, including fun foods, like junk food, can be part of a well-balanced diet pattern. The key there is: PART OF. The impacts to our health occur when fun, convenience foods make up the majority or entirety of our diets. And, for the average American, ultra-processed foods—generally the nutrient-lacking kinds—make up about 60% of our diet. Leaving 40% of our diets to fuel 100% of our body’s function.
I acknowledge that folks who live in a food desert or food swamp or both may not have access or the socioeconomic resources for whole, fresh vegetables and fruit. If you find yourself in this situation, choosing the best option available is the way to go, and that may honestly be choosing the least unhealthful option. We do what we can with what we have. It’s my personal belief that nutrient-dense, whole, fresh foods should be a RIGHT not a privilege.
Understand what options you have around you; look up menus when you can. Smaller portion sizes or even kids meals (they often have apple slices and the like) may offer alternatives that will help minimize impact to your heart health compared with choosing large/XL sizes or making it a meal. Same can be said for opting to skip a bun and go with a lettuce-wrap/”protein-style” for a burger or sandwich; skipping the cheese; going easy on or skipping the mayo; skipping the fries; going easy on the rice for burritos/burrito bowls; going with chicken over beef; and adding extra tomatoes.
Fun Fact: Most fast food chains use fries that are made with over 10 ingredients, some use over 20 ingredients … definitely not just potatoes, oil and salt; though, In-N-Out and Five Guys do only use potatoes, oil, and salt. So, kudos to them, I guess.
February is American Heart Month
Join me in the month of February (through March) for Heart Wise: Nutrition and Cooking for Heart Health, a self-guided heart health program.
The program goes from February 1 through March 31.
It’s designed as a 4-week program, but it’s completely self-guided, so you set the pace
Modules are designed to be completed in 30 minutes, give or take
There’s nutrition lessons and cooking demonstrations along with food lists that you can use to make the recipes from the videos each week
There’s also a ton of super-helpful handouts: Everything from easy ways to judge portion size to how to choose cooking oils and how to read nutrition labels, and so much more.
Register today and get a FREE heart health e-book as a bonus.
References
3 About Women and Heart Disease
6 Chronic and acute stress as predictors of major depression in women
8 Stress-induced alterations in estradiol sensitivity increase risk for obesity in women
9 Stress Reduces Conception Probabilities across the Fertile Window: Evidence in Support of Relaxation
11 Prior stress could worsen premenstrual symptoms, NIH study finds
13 Physical, Psychological and Chemical Triggers of Acute Cardiovascular Events: Preventive Strategies
14 Health Conditions: Keep Your Heart Healthy