Theories of Emotional Response
In the past, there was a belief that our emotions come from a physiological reaction to an event. For example, seeing a driver cut you off in traffic may lead to an increased heart rate. While the James-Lange Theory suggests our emotions arise from physiological reactions like an increased heart rate, the Schachter-Singer Two-Factor Theory adds that our interpretation of an event plays an important role in how we feel. In other words, how we view an event or process our thoughts may lead to an emotion that can trigger a physiological response (Ratey, 2007). Nonetheless, it is clear that emotions and the body are linked.
The Brain and Emotion
There are several regions of the brain that signal emotions. For the purpose of this article, we will focus on anxiety. The emotion of fear is linked to the feeling of anxiety. For example, feeling anxious because we are afraid that the car from the example above may cause us to get into a car accident. Anxiety can impact mental health in several ways – such as excessive worry, difficulty with memory, and feelings of depression. It is also important to acknowledge the role anxiety can have on physical health, although it may be more difficult to pinpoint. Not everyone has the same genetics, is on the same medications (or no medication at all), lives in a different environment – in other words, there are several confounding factors at play. What I mention in this post is a focus on anxiety could potentially impact a person’s physical health – not how it ultimately will.
Anxiety: The Mind-Body Connection
What is the connection between anxiety and physical health? Anxiety triggers the brain’s alert system, the amygdala, which then activates the hypothalamus. This activation prompts the release of stress hormones, including adrenaline and cortisol, preparing the body for a fight-or-flight response.
The hypothalamus helps keep our body in homeostasis, by regulating several unconscious systems such as body temperature. The hypothalamus is a part of the hypothalamic-pituitary-adrenal axis, along with the pituitary and adrenal glands. Cells in the pituitary gland secrete the Adrenocorticotropic hormone (ACTH), which stimulates the release of cortisol from the adrenal glands.
Examples of the Impact of Anxiety on Physical Health
Cortisol is a hormone secreted by the adrenal glands in response to a stressor, which can be physical or psychological. Although cortisol is sometimes referred to as the “stress hormone”, it is not “bad”. We need cortisol to help regulate the cardiovascular, metabolic, and immune systems. However, if blood cortisol levels are too high or too low for a sustained period of time, there can be harmful effects on the body.
The Cardiovascular System
There is evidence to support a link to higher cortisol levels and negative effects on the cardiovascular system. Elevated cortisol levels can lead to increased blood pressure and a higher risk of cardiovascular diseases by causing inflammation and changing how blood vessels function. In one review of primary research, an increase of 200 mg per day of cortisol (plasma cortisol) was correlated with an significant increase in systolic blood pressure (Whitworth et al., 2005). In a more recent review, in some studies, elevated cortisol levels were linked to poorer outcomes in participants who already had cardiovascular disease, compared to those who did not have higher levels of cortisol (Sackett-Lundeen & Cornelissen, 2019). These results may be due to the effect excess cortisol levels may have on blood vessels, such as an increase in inflammation, and vascular tone – impacting how blood vessels can constrict and expand (Walker, 2007). Abnormal vascular tone can impact blood flow, and therefore blood pressure, which may impact the cardiovascular system.
Metabolism
Elevated cortisol levels from prolonged anxiety can disrupt metabolism. This disruption leads to higher blood sugar and cholesterol levels, increasing the risk of conditions like type 2 diabetes and contributing to weight gain and obesity. In one study, elevated cortisol levels were correlated with higher total cholesterol and glucose levels in the blood. When blood glucose levels become too high and not be as sensitive to insulin levels, which can potentially lead to type two diabetes. In one study it was found that participants with type two diabetes have a higher level of salivary cortisol levels compared to pre-diabetics and non-diabetic participants (Salehi et al., 2019). Because cortisol helps metabolize lipids, An excess of cortisol can also lead to an increase in fat storage, potentially linked to a greater risk of obesity. Over a three year period participants in a longitudinal study with higher cortisol levels had a higher waist circumference and body mass index (van der Valk et al., 2021).
Immune & Digestive Systems
This study also found that immune defenses, such as leukocyte count (a type of white blood cell) were lower in the higher cortisol participants.Chronic high cortisol weakens the immune system by reducing the effectiveness of white blood cells thereby suppressing inflammatory responses to fight off disease, and repair wounds.
Anxiety and high cortisol levels can also affect the digestive system. The HPA axis can also secrete proinflammatory cytokines, which come from immune cells. They can alter the gut microbiota balance, leading to digestive issues such as irritable bowel syndrome. Disruptions in gut health can further exacerbate feelings of anxiety, creating a cycle between mental and physical health (Goel et al., 2022).
Parting Words
Keep in mind that this is a simplified, not comprehensive explanation of how anxiety may negatively impact the body due to higher levels of cortisol. The point of sharing this information is to illustrate that there is some evidence to suggest this connection. Understanding the link between anxiety and physical health emphasizes the importance of addressing mental well-being as part of holistic health care. Managing anxiety not only helps reduce its direct impacts on mental health but also prevents the injurious effects high cortisol levels can have on the body’s metabolic, immune, and digestive systems. Prioritizing mental health care can therefore play a crucial role in maintaining physical health and preventing long-term health issues.
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Citations/References
Goel, G., Requena, T., & Bansal, S. (Eds.). (2022). Human-gut microbiome : Establishment and interactions. Elsevier Science & Technology.
Hinds, J. A., & Sanchez, E. R. (2022). The Role of the Hypothalamus–Pituitary–Adrenal (HPA) Axis in Test-Induced Anxiety: Assessments, Physiological Responses, and Molecular Details. Stresses, 2(1), 146-155. https://doi.org/10.3390/stresses2010011
Ratey, J. J. (2007). A user’s guide to the brain: Perception, attention, and the four theaters of the brain. Abacus. Sackett-Lundeen, L., & Cornelissen, G. (2019). Amplification on “Cortisol and the
Heart”. World Heart Journal, 11(2), 123-128. https://proxy.lib.wayne.edu/login?url=https://www.proquest.com/scholarly-journals/amplification-on-cortisol-heart/docview/2306775235/se-2
Salehi, M., Mesgarani, A., Karimipour, S., Pasha, S. Z., Kashi, Z., Abedian, S., Mousazadeh, M., & Molania, T. (2019). Comparison of Salivary Cortisol Level in Type 2 Diabetic Patients and Pre-Diabetics with Healthy People. Open access Macedonian journal of medical sciences, 7(14), 2321–2327. https://doi.org/10.3889/oamjms.2019.340
van der Valk, Eline S., van der Voorn, B., Iyer, A. M., Mohseni, M., Leenen, P. J. M., Dik, W. A., van den Berg, Sjoerd A.A., de Rijke, Y. B., van den Akker, Erica L.T., Penninx, B. W. J. H., & van Rossum, E. F. C. (2021). Hair cortisol, obesity and the immune system: Results from a 3 year longitudinal study. Psychoneuroendocrinology, 134, 105422-105422. https://doi.org/10.1016/j.psyneuen.2021.105422
Walker, B. R. (2007). Glucocorticoids and cardiovascular disease. European Journal of Endocrinology, 157, 545-559. Whitworth, J. A., Williamson, P. M., Mangos, G., & Kelly, J. J. (2005). Cardiovascular consequences of cortisol excess. Vascular health and risk management, 1(4), 291–299. https://doi.org/10.2147/vhrm.2005.1.4.29