February 27, 2024

On Nutrition

We humans are amazing, complex creatures, and part of that complexity comes from the interplay of our minds and our bodies. On any given day, you might notice how mental stress leads to tension in your back or shoulders, how worry ties your stomach “into knots,” or how happiness seems to make you feel buoyant. But mind-body interactions go even deeper, with research uncovering connections between mental health and heart health, and how what we eat influences both.

“I can’t talk to my patients about their cardiovascular health without addressing their mental health,” said Dr. Erin Michos, director of women’s cardiovascular health research at Johns Hopkins School of Medicine. Speaking at the annual meeting of the Academy of Nutrition and Dietetics in Denver last month, she noted that there’s been an increase over the last 10 years of people with mental health disorders — especially anxiety disorder and major depression — being admitted to the hospital after having a heart attack.

Michos said both negative and positive psychological factors influence cardiovascular health. Take stress for example. “Not all stress is bad. Stress is what helps us meet deadlines, but chronic stress can change some processes in the body.” She said chronic stress — as well as anxiety, anger and depression — can directly trigger the release of stress hormones, elevate heart rate and blood pressure, increase inflammation, stiffen the arteries, increase the risk of blood clots, and constrict blood vessels on the heart’s surface.

A 2019 study found that people who slept less than six hours or more than nine hours per night were more likely to have a heart attack. Michos said this may be because short or long sleepers are more likely to be struggling with depression, other mental health concerns, or a chronic physical illness. In other words, is it the sleep pattern affecting the heart, or is it a physical or mental illness affecting both sleep and the heart? For example, a 2021 study found that women veterans with PTSD had a 44% increased risk of developing heart disease, possibly because trauma to the brain leads to both mental disorders and cardiovascular disease.

Chronic stress and poor mental health can also contribute to heart disease indirectly, by affecting how we take care of ourselves. For example, some people may try to cope with stress, anxiety or depressed mood by smoking, overusing alcohol, or stress eating. And when you’re in distress, you’re less likely to take medications as prescribed or seek preventive health care. On the flip side, positive psychological health — think happiness, emotional vitality, optimism, sense of purpose, gratitude, mindfulness — is linked to healthier blood pressure and blood sugar levels, but also to behaviors that support health, including increased physical activity, heart-healthful eating, and other essential forms of self-care.

Being optimistic — expecting that good things will happen for you in the future — and having a purpose in life are both linked to better survival from cardiovascular disease. So is having positive social connections. “Those who are more socially isolated have more cardiovascular risk,” Michos said, citing a 2023 U.K. study that followed 18,509 people with diabetes for more than 10 years and found that loneliness was associated with a 20% increased risk of cardiovascular disease. That makes it a bigger risk factor than depression and some “traditional” risk factors, such as high blood pressure and blood sugar, smoking, low physical activity and poor diet.

Michos pointed out that some stressors are very difficult to modify, because they may be related to socioeconomic status. For example, discrimination or living in an unsafe neighborhood. “I think too much blame is placed on the individual when they’re in a toxic environment, but having tools to buffer stress is still important,” she said. Sleep, physical activity and a nutritious diet help us build personal resilience against stress, but other factors include learning healthful ways to cope, bonding with family and friends, practicing mindfulness (perhaps through mindfulness meditation), engaging in genuine laughter and reframing setbacks as opportunities. Cultivating gratitude (perhaps with a gratitude journal), a sense of optimism and self-compassion are also key. “I think we’re harder on ourselves than others are,” she said.

The American Heart Association has tips for managing and finding relief from stress, as well as more information on how stress affects the body, and the links between stress, mental health and your heart at heart.org/stress.

Now let’s talk about food. An AHA-recommended heart-healthful diet is based on:

  • Plenty of fruits and vegetables
  • Whole grains (choosing them more often than refined grains)
  • Healthful sources of protein such as pulses (beans and lentils), nuts, avocados, fish and seafood, and unsweetened dairy products
  • Healthful fats from olive oil and other liquid oils (plus those in nuts and fish)

It also limits animal-based fats, foods high in sodium, and foods and beverages with added sugars. It also keeps alcohol to moderate levels — one drink per day for women or two for men — if you choose to drink at all.

“We know that diet quality at every life stage does affect health and well-being,” said Kristina Petersen, an associate professor of nutritional sciences at Penn State University, who co-presented with Michos. A poor diet — along with impaired sleep and reduced physical activity — are associated with major depressive disorder in what may be a chicken-or-the-egg scenario. However, at least 150 minutes of moderate-intensity physical activity per week can help buffer against stress, anxiety and depression, while directly benefiting heart health. Petersen said a healthful eating pattern is associated with lower odds of depression, possibly because the vitamins, minerals, phytochemicals, fiber and healthful fats have positive effects on the gut microbiota while helping to reduce levels of stress hormones, inflammation and oxidative stress in the body. All of this can, in turn, have positive effects on the brain, and, oh yeah, the heart.


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