Dr. Sara Szal Gottfried Explains the Health Impacts of All the Anger You’re Feeling (Plus What to Do About It)

It was a long road leading up to last week’s election, and many of us are feeling all the feels—fear, anger, anxiety, sadness, or maybe even just numbness. What we’re collectively going through is a stress response, says Sara Szal Gottfried, MD, a physician, researcher, and New York Times bestselling author.

This response isn’t inherently a bad thing. “The human body is incredibly well-designed to regulate itself externally and internally in response to stressful inputs to maintain balance in the body, or what we call homeostasis,” says Dr. Szal Gottfried. Where the problems can set in is when the stress response system gets stuck in the “on” position. That’s when it can have some serious consequences on our physical and emotional wellbeing.

The Sunday Paper asked Dr. Szal Gottfried to fill us in on what all of the anger, anxiety, and other uncomfortable emotions we’ve been experiencing are doing to our bodies—and what we can do to counter the negative effects.

A CONVERSATION WITH SARA SZAL GOTTFRIED, MD

So many Americans are feeling anxious and angry right now. What do we know about the very real health impacts of these emotions?

Anxiety and anger are normal emotional responses to the events we experienced this week. These emotions could be a very sane reaction to insane events. What’s helpful to know is how to distinguish healthy fear and anger from potentially harmful reactions.

If you’re feeling fear this week and perhaps frozen or numb, that’s the stress response. If you are trying to figure out how to maintain harmony in your circle of friends and family, that’s a healthy stress response—if you don’t shift to people pleasing and lose your authenticity and voice. 

Ideally, we experience emotions such as anxiety and anger and then find ways to resolve them. They are part of the stress response of fight-or-flight, which helps you mobilize large muscle groups and move the stress through the system of your body. However, emotions and stress start to impact our health when the body doesn’t respond well to external factors, and we have difficulty modulating our emotional responses. Women are more likely than men to internalize and insufficiently mobilize the stress response—instead of fight or flight, women are more likely to experience “freeze or fawn.”

Some of the symptoms of heightened levels of emotion and chronic stress show up as:

Brain: disrupted circadian rhythms, increased risk of depression and dementia
Sleep: decreased sleep, insomnia
Ears: ringing, hearing loss
Eyes: blurred vision, fatigue, pain in and around the eyes, headaches, twitching
Thyroid: lower production of active thyroid hormones, like T3; higher hormone receptor blockers like reverse T3, which puts a brake on your metabolism
Skin: increased oil production, acne, eczema, psoriasis, cold sores, wrinkles
Heart: increased heart rate and blood pressure, higher risk of heart attack and stroke
Muscles: spasm, chronic muscle aches and pains
Immune system: inflammation, more susceptibilty to infections and autoimmune conditions
Belly: increased fat deposits
Gut: acid reflux, decreased blood flow, leaky gut and food sensitivities, altered transit time, irritable bowel syndrome
Adrenal glands: cortisol and adrenal surges, lower sex hormones, 
Ovaries: diminished sex drive, lower sex hormones
Bones: reduced bone density 

Can you walk us through the basic reactions that happen in our bodies when we feel anxious or mad?

The classic process is that when you’re exposed to a stressful situation, your body releases adrenaline. Then your cortisol goes up temporarily so you can fight or flee.

What can happen to many of us, especially those who have experienced trauma—perhaps in a previous election cycle— is that you get stuck, and you may feel stressed even when the stressful situation has passed and you’re now safe.

As a result, your blood sugar may be chronically high, your cortisol remains elevated, and the effects of stress in your body do not resolve. This persists as physiological dysregulation.

What are some of the signs that we’re having a physical reaction to anxiety or anger? 

There are a number of symptoms, including: 

• Increase in heart rate and blood pressure
• Unable to take a deep breath or breathlessness
• Flushed skin
• Tension in the jaw
• Tightening of muscles in the shoulder
• Cortisol problems from high perceived stress
• Sweating
• Autoimmunity
• Hypervigilance 

What are some of the best ways to stop this reaction in the moment?

The first step is awareness that you are having a reaction. I give myself 90 seconds to the feel all the feelings. After that, anxiety, fear, and anger aren’t productive.

The second step is to create calm and safety in your body. Slow down your breath. Try a 4-count inhale, hold for 7 counts, exhale for 8-count. Breath is a force for good in the body when leveraged for calm. It counteracts the sympathetic nervous system threat response.

The third step is the 3-3-3 rule: Notice three things you can see around you, identify three sounds you can hear, and move three parts of your body. 

What do you personally do when you feel one of these emotions creeping in? What does your practice look like?

I reclaim the breath. I tend to pant like a rabbit when under threat, so instead of relying on my default, I slowly breathe into my belly. It’s calming medicine.

I also avoid caffeine and alcohol. They dim my light and cause more anxiety.

I started lifting heavy weights again in the past year. This is so important for women in perimenopause and menopause, and it’s a way to keep your brain healthy and slow down aging.

And I practice meditation every morning. Ten to 30 minutes of what I want to create in the future, how I want to be of service, and how I can share my gifts with the world. Then I go out into the world and shine my light.

What are some actions all of us can take to better manage anxiety, anger, and other emotions that put us in that fight-or-flight state?

We all have an innate capacity to counteract toxic stress. When you add a new approach to your default response, that’s the start of retraining your mind and responding to stress differently.

Here are some actions you can take to manage your emotions and self-regulate:

→ Reduce caffeine. It directly induces the adrenocortical cells to produce more cortisol, as well as more epinephrine, norepinephrine, and insulin. I don’t tolerate caffeine well but for those that do, I recommend finding the smallest dose of caffeine that supports your productivity yet doesn’t undermine your health. 

→ Limit or quit alcohol. It raises cortisol, which then disrupts your sleep. This has a knock-on effect on insulin. We know that one night of bad sleep makes you more insulin resistant the next day. Higher cortisol may disrupt the regular insulin signal. Chronically disrupting it with a moderate to heavy amount of alcohol leads to more insulin resistance.

→ Add in some vitamins. When cortisol-raising stress stays high for too long, it can deplete certain micronutrients, including vitamins B1, B5, B6, B12, C, and tyrosine. Excess stress also can cause you to excrete magnesium, a mineral key to calcium absorption. You might also consider supplementing with vitamin C (which has been shown to lower cortisol levels), L-theanine (found in green tea and thought to reduce stress and calm down the sympathetic nervous system), and omega 3 (which lowers your cortisol levels, increases lean body mass, and improves vagal tone as measured via heart rate variability).

→ Try meditation. Choose whatever type works for you. It can include focused attention, where your focus is placed on a single object, such as the breath or a visualization. Examples are loving- kindness and centering prayer. It might be open monitoring, where rather than focusing attention on a single object, you openly monitor all aspects of your experience without judgment. Or it could be transcendental meditation, a type of meditation where you repeat a word or seed mantra, or a moving meditation like yoga, labyrinth walking, or walking meditation.

As you search for the right fit, set a goal of short duration—about 10 minutes— so it’s an easy win. If you can’t do 10 minutes, start with five. If 10 minutes is easy, try 20 minutes. There’s a benefit to simply sitting with erect posture and breathing more deeply, even if your mind is monkeying around. You are still altering your stress response and getting on the path to retraining your mind. Meditation stimulates the vagus nerve, which is the most important nerve in your parasympathetic (rest-and-digest) nervous system. An amped-up perception of stress causes lower vagal tone (or responsiveness), which means the vagus nerve is not fully performing its functions.

Sara Gottfried, MD, is a Harvard-educated physician-scientist and a clinical assistant professor in the Department of Integrative Medicine and Nutritional Sciences at Sidney Kimmel Medical College, Thomas Jefferson University, where she serves as the Director of Precision Medicine at the Marcus Institute of Integrative Health. Her clinical focus is performance-based and personalized care of executives and professional athletes. She is the New York Times best-selling author of four previous books about the interface of mental, physical, and spiritual health, including Women, Food, and Hormones and The Hormone Cure. She lives in Mill Valley, California.