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Why Women Need to Be Paying Attention to Their Heart Health with Dr. Tara Narula
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- [00:02]
Gwyneth Paltrow
You know what I find myself doing more and more? Just sitting with things, not rushing to a conclusion. When I'm researching longevity protocols or trying to understand conflicting studies on hormone therapy, I need something that can go as deep as I want to go. That's why I've been using Clawd. Try Clawd for free at Clawd AI Goop and see why the world's best problem solvers choose Claude and as their thinking partner. Thank you for tuning into the Goop podcast. Today's episode is made possible by Polestar. Those who know me know my car is my mobile sanctuary. It's one of the few places in the day that can feel really calm and restorative. So the space matters. And that's why I love Polestar 3. It's an all electric SUV with a kind of thoughtful innovation that I'm always drawn to. Things like massage seats, immersive 3D surround sound, and Google Gemini, which can answer questions, set reminders, and just make life feel a little more streamlined when I'm on the go. The technology is seamlessly integrated and complements the minimalist design. Everything feels intentional, clean, and beautifully considered. Whether I'm heading to a meeting or just taking a moment for myself in the car, Polestar 3 makes the drive feel like a sanctuary. Learn more and book your Test drive@Polestar.com.
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Dr. Tara Narula
When you are pioneering anything or introducing
- [01:37]
Gwyneth Paltrow
new ideas to the culture, you get criticized. You do. Yeah. Did you hear about that?
- [01:43]
Dr. Tara Narula
I didn't find the one. I found someone I respected and we
- [01:46]
Gwyneth Paltrow
made it the one.
- [01:48]
Dr. Tara Narula
In the sort of longing kind of
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Gwyneth Paltrow
view of love, people understand each other as if by magic.
- [01:53]
Dr. Tara Narula
Nothing in itself is addictive on the one hand. On the other hand, everything could be addictive if there's an emptiness in that person that needs to be filled. I now know that nobody changes until
- [02:04]
Gwyneth Paltrow
they change their energy.
- [02:05]
Dr. Tara Narula
And when you change your energy, you change your life.
- [02:09]
Gwyneth Paltrow
I'm Gwyneth Paltrow. This is the Goop Podcast, bringing together thought leaders, culture changers, cult creatives, founders and CEOs, scientists, doctors, healers and seekers here to start conversations. Because simply asking questions and listening has the power to change the way we see the world. Here we go. Hello and welcome to the Goop Podcast. I'm Gwyneth Paltrow. Did you know that heart disease is one of the top killers of women in this country? That was a stat that surprised me. We hear a lot about the risks for diseases like breast cancer, and we hear about hormonal imbalances for women, but we don't spend a lot of time talking about the importance of heart health. Today my guest is Dr. Tara Narula. Tara is a cardiologist and a medical correspondent for CNN Health and the author of a new book, the Healing Power of Resistance. We talk about the many unknown factors that make women at risk for heart disease and why you may need to go to the cardiologist earlier than you think. We also talk about the tools you can use to maximize your heart health. Let's get to my conversation with Dr. Tara Nerula. So at what point in medical school do you kind of declare your specialty?
- [03:29]
Dr. Tara Narula
You don't declare it in medical school, so it's really more in residency. So once you get to residency, then you kind of have to. Well, I guess in medical school, you have to decide sort of generally obgyn, surgery, medicine. But then once you go into residency, that's when you then decide, like, for me, I want to do cardiology versus infectious disease or pulmonology.
- [03:49]
Gwyneth Paltrow
And why. Why did you choose cardiology?
- [03:52]
Dr. Tara Narula
Oh, God. You know, I love the heart, first of all. My father's a cardiologist, so I kind of grew up seeing it. But it's such an awesome organ because it has the electrical system and the valves and the pump and the arteries, and at the end of the day, people can get better, which I really loved. You know, cancer's hard and neurology's hard because you can't always help. But in cardiology, we have so many things we can do, whether it's treatments or prevention. And I get to see all ages. So I just finished seeing patients today, and in my practice, I see 20 and 30 year olds, and then I have 90. 90 year olds.
- [04:28]
Gwyneth Paltrow
So the full gamut, the full spectrum. Where are you based?
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Dr. Tara Narula
I am in Manhattan. So my office is in midtown, right by Bloomingdale's. Yeah.
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Gwyneth Paltrow
Dangerous.
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Dr. Tara Narula
Very dangerous.
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Gwyneth Paltrow
That means you're right near the Trace Anderson studio, too, on 59th Street.
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Dr. Tara Narula
Yeah, I'm on 59th between Lex and Park.
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Gwyneth Paltrow
Oh, that's great. I won't ask you about Tracy Anderson
- [04:54]
Dr. Tara Narula
right now, but I know who she is, but I didn't know her studio was right here.
- [04:58]
Gwyneth Paltrow
Yeah, it's right there. In fact, I'm told it's part of the reason my heart has been staying relatively healthy.
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Dr. Tara Narula
Aha.
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Gwyneth Paltrow
So I did want to ask you a little bit about that. I mean, so it turns out heart disease is a top killer of women in this country, which was a stat that I wasn't really familiar with until a couple of years ago. And it's interesting, like I never, when I sit around with my women friends, we talk about, you know, our hormonal health, we talk about like fears around cancer, we talk about, you know, joints and that kind of thing, but I don't. And breast cancer, of course, concerns about that, but we don't really talk about heart health. Which is kind of interesting because just when you correlate it with how often women have heart disease.
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Dr. Tara Narula
That's right.
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Gwyneth Paltrow
Why do you think that is? Why is it not kind of a de rigueur topic like at a girl's gathering?
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Dr. Tara Narula
I mean, you hit the nail on the head. And I just had a meeting today. I'm gonna be speaking at an event that Northw Katz Institute for Women is putting on and I'm going to be paired with an OB gyn. And part of our conversation was around why women think about their mammograms and their pap smears and everything else and not their cardiac health, when in fact it is, as you said, the leading cause of death for women. We always give the statistic that it kills more women than all forms of cancer combined. One out of every three women dies of cardiovascular disease. It's like one woman a minute. And it's just not on women's radar at all. And you know, my vision and hope would be that women start to think about screening for heart disease in the same way that we think about visiting our GYN and having our breast checked and our ovaries and our uterus. And we have really great tools in cardiology, whether that be blood tests that can help pick up on risk to risk calculators that we can use to calcium scores which are CAT scans that can look for heart underneath your, that you couldn't see and pick up on disease early. So we have these powerful screening tools. And also, you know, I work, I help run our women's heart program here at Lenox Hill Hospital. And there are female specific risk factors that a lot of women are not aware of. So in addition to the things like high blood pressure and high cholesterol and diabetes, if you had early periods, for example, you got periods before the age of 11. That's a risk factor for cardiovascular disease. Wow. Lupus, rheumatoid arthritis, psoriasis, a skin condition. Wow. Risk factor. Inflammatory bowel disease, and then all the things that happen during pregnancy. So if you had preeclampsia, gestational diabetes, an early delivery of a baby, a small sized baby, miscarriages, there's a whole, a whole host of things, those specific things that would increase your risk of cardiovascular disease that women just aren't told about and they get discharged from delivery, never told you had preeclampsia, for example, you're at increased risk of cardiovascular disease. And then we think about, you know, the arc of a woman's life and the later life periods and things like menopause, when we start to see risk go up for women, cancer treatments for women. So women who've had breast cancer and have had radiation or chemotherapy, for example, to the left side of the breast, radiation that can increase risk of cardiovascular disease. So it's this incredible list of risk factors that women are unaware of. And our hope as cardiologists who work in this field is to raise awareness, number one of the risk factors, number two of all those powerful screening tools, and number three, and this is really important, is symptoms. So a lot of women don't pay attention to symptoms and they get blown off. Either they blow them off or doctors unfortunately blow them off. So many times women will feel something here and they're told, you're just anxious, you're just stressed out, it's just acid reflux. So really increase the age old response
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Gwyneth Paltrow
to a woman complaining of anything.
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Dr. Tara Narula
It is, it is, it's. I had a family member actually go to the hospital in upstate New York with chest pain and she was told that she was having a panic attack and anxiety and sent out of the emergency room. And she called me and she said, the only reason that I'm calling you is because I've heard you talk about how in women, they, they can have things like just shortness of breath as a sign or fatigue or feeling like your bra's a little too tight, you know. So it's so important that women advocate and really recognize these symptoms. So important it is killing our sisters, our friends, our coworkers, women that we love.
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Gwyneth Paltrow
Has there been a material increase in heart disease in women over the last. I don't know how long?
- [09:53]
Dr. Tara Narula
Well, we've definitely seen, you know, risk factors go up, right? So we've seen a rise in obesity and high cholesterol and diet that are full of ultra processed foods and sugar, lack of exercise. So so many of the lifestyle things that we know influence cardiac risk. We've seen a rise in the last 20 or 30 years. And the important thing is that a lot of these things are things we can control and that they can be preventive. So we always say in cardiology that 80% of cardiovascular disease is preventable by risk factors. So that we have so much power in our hands by sleeping and exercising and eating healthy and managing stress and mental health. You know, all of these things that we can do on a daily basis, small little changes that will add up over time to a reduction in risk.
- [10:44]
Gwyneth Paltrow
You talked before about screening. What age are we supposed to start going to the cardiologist? I mean, nobody even suggested it to me until I was in my 50s.
- [10:54]
Dr. Tara Narula
Yeah. So interestingly, groups like the American Heart association, for example, talk about starting to know your numbers, for example, in your 20s and starting to have checked your blood pressure, your cholesterol, knowing your body mass index, your height, weight ratio, the blood sugar. So a lot of these numbers we can start looking at in our twenties. Another important thing is to know your family history. So a lot of people don't ask, they don't know. But if you have a strong family history of early cardiovascular disease in your parents or your siblings, in and of itself, that can be something that would want warrant you being screened at an earlier age. But then a lot of these risk factors that I mentioned, you know, the pregnancy risk factors and the migraines, for example, are risk factors for women. Those come up in your 30s and 40s. And so, you know, I always say it's never too early to see a cardiologist. It's never too late, but it's never too early to start. Really kind of getting a handle on what your particular risk factor profile is and what is in your hands to
- [11:54]
Gwyneth Paltrow
take control of should it become a routine thing like to start getting these baseline markers of cholesterol and blood pressure and everything you're saying in your 20s,
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Dr. Tara Narula
in your 20s, you should be knowing those important numbers. And you know, there is a risk calculator that we use in cardiology. You can look it up, anyone can look it up. Now. It's called prevent. If you go online and type it in, you can put in your age, your gender, some of your numbers and it will give you a 10 year risk score. What is your 10 year risk of having a heart attack or stroke? And it will give you a 30 year risk score. And this, you know, is for people who are anywhere, you know, starting in their 30s up to their 70s. So a lot of these things we can start doing earlier and earlier. And really the push in cardiology is to say that we are catching people too late. We need to be starting much, much earlier with our screening, with treating things like cholesterol. For example, they just released the new cholesterol guidelines on Friday that really lowered the age from really even thinking about cholesterol medicine to 30 from 40. So, you know, there's just this widening understanding that we need to start being more aggressive about risk factors and screening much, much earlier. When we look at even teenagers in autopsy who are 18, 19 years old, we see heart disease. We can see plaque in the arteries as early as the late teenage years. So that tells us actually we should even be targeting kids. Right. Much, much earlier in terms of how we're teaching them to live and eat and exercise and sleep and manage stress. So
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Gwyneth Paltrow
as far as heart disease goes, I mean, you were saying it's good to catch because it is treatable. How much of it is statins, repatha, those classes of drugs, and how much of it is lifestyle, diet, exercise?
- [13:47]
Dr. Tara Narula
Yeah, it's really both of them together. And I always tell my patients, you know, the medicine is really important, but equally important is all of those other things that you're doing that I'm not going to maybe write on a prescription pad. You need both. And they're both really powerful tools that we utilize. And I have a lot of patients who don't want to take drug therapy. You know, they hear a lot of bad news, bad about statins, for example.
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Gwyneth Paltrow
But there is quite a lot about statins negative, negative. I mean, there is.
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Dr. Tara Narula
It's. What is it? What.
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Gwyneth Paltrow
Oh, really? Are you. Are you pro statin?
- [14:22]
Dr. Tara Narula
I mean, every cardiologist will tell you that they are one of the biggest tools we have in our toolbox to lower cardiovascular events like heart attack and stroke on average by about 20 to 30%, which is huge. Millions and millions of Americans take them without any sort of problems. There are a handful of people, we usually say anywhere from 10 to 15% in studies that will develop some side effects, but those side effects are usually reversible. You know, their muscle or joint aches or pains. And typically will, you know, take someone off a statin and try them on a different one. We'll try a couple before we eliminate the class. And as you mentioned, we have new drugs like Repatha and Zetia and Dexlitol and lots of tools that we can use outside of statins. But statins really, in the guidelines, are the first line because they have the bulk of research over the last 20 years showing that they really reduce heart attack and stroke risk, not only by lowering the cholesterol, but also by stabilizing plaques. So if you have a plaque in your vessel, the statins will help it, prevent it from rupturing, which is essentially what happens when you have A heart attack, that plaque becomes unstable, they have anti inflammatory benefits. So you know, there's. It's definitely. Not everyone gets a statin, not everyone needs a statin. But for those people where it really is recommended, they really go a long way in terms of reducing risk.
- [15:42]
Gwyneth Paltrow
Right. And what about, you know, obviously I spend. This is such an interesting space, like the intersection of functional medicine and traditional allopathic medicine. And I actually have a good friend who's a functional cardiologist, which I think is so interesting. So some people say, you know, try first with, you know, red rice, yeast, that supplement and CoQ10. Is there a place for that? Does it depend on the severity of the heart disease?
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Dr. Tara Narula
So the new guidelines that just came out actually recommend against supplements.
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Gwyneth Paltrow
Interesting.
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Dr. Tara Narula
Or cholesterol, for example. And I will say in my practice I tend to avoid them mostly because they're not regulated by the fda. And so you really don't know what you're getting. And there is a growing body of data showing, for example, liver injury in particular from supplements. So a lot of these supplements can damage the liver and people end up going to the emergency room in the hospital with liver elevations and problems from taking things that, you know, we just have no idea what's in them.
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Gwyneth Paltrow
The idea might be good, but you don't know, like the supply chain necessarily of these. Right, Yeah.
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Dr. Tara Narula
I mean, there's no question that there, I mean, I believe that eastern medicine, there is so much we can learn from outside of western medicine. But I think you have to be cautious, right. And especially with something that isn't looked at or examined or regulated and that might interact with other things that you're taking, for example.
- [17:10]
Gwyneth Paltrow
Well, yeah, absolutely. There's for sure a real risk there. I heard you talk about something which I thought was really interesting. The kind of, you know, I think in our culture, right, we're in this incredible time where people's data is available to them, their health data. You know, you can be on a mattress that gives you data, OURA ring, you know, CGM on your arm, all the things. And I really, I mean I have an Oura ring, of course, and I love data personally, so I find it really interesting. But I heard you say that you think that on occasion that this popularization of the wearable technology can actually that you've seen it cause anxiety and it can sort of be contraindicated for lack of a better word. And I thought that was really interesting because, you know, and I suppose it depends on personality type, but for me, for example, data helps Me make better choices, Right. I'm like, oh, you know, or like I can say, is this glass of wine worth it? Like, I'm going to wreck my hrv and I'm, you know, I'm just, I'm not going to do it right. So I'm going to skip tonight or whatever, or my sleep score is lower because I went to bed, you know, I watched TV for too long in bed and so my latency's all fucked up, you know, like that kind of thing. Yeah. So for me, for me, it's like kind of a. Just a compass. But. But tell me about how you have seen or what worries you about people having so much access to their metrics.
- [19:03]
Dr. Tara Narula
Yeah, it's such an interesting space because like you, I think there's so much power in information in the hands of the person. Right. Gone are the days where you come into the doctor's office, I mean, or should be gone, where they kind of talk at you and tell you, well, this, this, this and this, right? We want to put patients, people in the driver's seat of their healthcare. And so much of what is helping us do that are these wearable devices where you can come in and say, here is what I found about my sleep. Here is what my Apple Watch told me about my heart rate. And there's so much useful information. I will say even the Apple Watch, for example, has picked up on irregular heart rhythms in some of my patients, like atrial fibrillation that they wouldn't have known they had, and that can cause a stroke. So I think tech and how we're using it is, is wonderful. But as you mentioned, I think there are a subset of people, not everyone is like you. I think I'm more like you. I would want the information. But for some people, it does cause anxiety. You know, they, first of all, everything in their world becomes around the numbers, right? And then they're sort of not paying attention to just enjoying their life because they're so focused on getting the numbers in line. And obviously life is so much more bigger than that, so it takes away from their enjoyment. But also they get worried when see the slightest blip or change in some of their data points. And then I think the third thing is, you know, as good as these devices are, they're not perfect. And so there are times where people will come in and say, my, my device told me this and actually it's not accurate information. And then, you know, they've been worked up and anxious and upset for no reason. So I think it really is like everything in medicine and life. It's a personalized approach and you have to kind of know you and what's going to work for you. But I think for the right person, it can be really, actually really motivating.
- [21:07]
Gwyneth Paltrow
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- [22:07]
Dr. Tara Narula
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- [23:15]
Gwyneth Paltrow
Do you feel that the sort of pressure to, you know, like in this longevity space and wellness and do you feel like that pressure can be counterintuitive for people? Like, do you think they have real stress responses to that?
- [23:33]
Dr. Tara Narula
I do. I have, like, I see several, like young guys in finance, for example, who are very much, you know, into wanting to live to, you know, New York City, wanting to live to 100, and they come in with literally spreadsheets, spreadsheets on their laptop that they show me of their data and they will tell me it is, you know, in their quest to sort of be the healthiest and the longest the monitoring of all this is making them stressed out. Right, right. So there is this balance between being healthy and living healthy and wanting to live long, but also enjoying your life and not driving yourself crazy.
- [24:13]
Gwyneth Paltrow
It's sort of like being focused on outcomes, like on grades, you know, like if you're taking a test, like, what is the grade? What is the grade? And living your life in that space rather than like, I'm gonna go sit outside and breathe some air and be in my body and live from that space. It's like when we get stuck in that achievement mode, which I guess can apply to any sector. It is. I mean, it is stressful. It doesn't feel. It doesn't feel good for longevity. Yeah.
- [24:42]
Dr. Tara Narula
And you're losing, as you said, like to use your example, I mean, you're not reading to read and, you know, enjoying what you're reading to just learn. You're so focused on the end goal. And it's that same thing I want people to enjoy every single day. And sometimes that means that your numbers, you might drink a glass of wine or you might skip your exercise that day. You know, I mean, you have to be human. We have to allow people to be human.
- [25:05]
Gwyneth Paltrow
Just reading about, you know, the link between stress not only on the heart, but on all the systems, on inflammation, et cetera, everything, every system in the body. Like, stress is obviously so bad for us, but we keep so hooked into it. It's like an addiction.
- [25:21]
Dr. Tara Narula
It is. And that, I mean, that was so much about why I wanted to write, you know, the book that I wrote was because stress is this like, pervas health issue, public health issue that affects all of us. And we talk about it being bad, but people don't really understand how bad it is that turning on of that pathway of those hormones, the epinephrine, the norepinephrine, the cortisol, every single day, nonstop, 30 times a day. I mean, that's damaging long term for every organ system, but in particular the cardiovascular system. So, yes, even if in your quest to live longer and be healthier, you're getting stressed out, stress response is damaging. You're working against your goals of longevity by creating more stress. And we have to kind of prioritize managing stress in this country. And we just don't do a good job teaching people how bad it is. And we don't do a good job teaching them how to kind of control it and turn off the stress response.
- [26:19]
Gwyneth Paltrow
I think it would be really helpful, if you don't mind, for me, and I'm sure Anybody listening to break down exactly what happens, right? Because we just like see a text or get a notification, and to us it feels like, oh my God. And then you're like, oh, okay, no, it's fine. It's not a big deal. But there's a cascade of things that happen, right. Once you have that kind of like hit from that we're anticipating as bad news or a problem or et cetera. So could you break down exactly what the body does in that instance in the cascade effect?
- [26:58]
Dr. Tara Narula
Yeah, I mean, I think the interesting thing is that our stress response evolved to protect us. So when you look in the animal kingdom, and we are animals, we have this stress response to help us survive. But we are meant to turn on the stress response briefly to evade a predator, for example, and then to turn it off. And as you said, you know, we get a text notification or something happens at work or with our child, anything, and we turn that on and we're doing it over and over again every single day. And that's where it becomes damaging. And so what happens happens is when you sense that threat or whatever it is, you know, it starts in the brain. So everything starts in the brain. You're processing it in the brain, and from there you're activating a pathway where you're releasing hormones that ultimately end up causing your adrenal glands to release things like epinephrine, the fight or flight hormone, norepinephrine, adrenaline, otherwise known, and cortisol, kind of the mother of all inflammatory hormones, the stress hormone. And all of that causes things like chronic inflammation. It can cause elevation in your blood pressure, elevation in your heart rate. Those things can damage the lining of the blood vessels. We talked about plaque in the blood vessels that can take a plaque that's stable and make it unstable. So it can trigger a heart attack, a stroke. It can cause arrhythmias or abnormal heart rhythms. There's actually a phenomenon called a stress induced heart attack. We see it predominantly in women, women who are older, 90% of the time in women. And it is essentially from this massive FL of these hormones that stuns the heart muscle and causes essentially damage to the muscle, weakening of the heart muscle. And it is absolutely in the setting of stress. And it doesn't have to be negative stress. We see it sometimes from positive things that just make people excited or overwhelmed.
- [28:50]
Gwyneth Paltrow
But that really sports you, like a world Series win or something like that,
- [28:55]
Dr. Tara Narula
or you win the lottery, you know, or something amazing happens. But we think about it, you know, with, with this stunning phenomenon of the heart. Most people will recover, but some people don't from this stress induced heart attack. But it is one of the most classic ways for us to talk about the damage of stress. The field of stress research is relatively new. It's essentially over the last hundred years. And part of the problem is that the stress research has really been separated, the psychology research from the practice of clinical medicine. But we are starting to use, which I think is great imaging studies to show literally what's happening in the body at the same time. So you can see with a PET and MRI scan how the brain is lighting up. As I mentioned, you can see inflammatory cells being released from your bone marrow and you can see inflammation in the lining of your blood vessels. And suddenly this phenomenon that sounds, oh yeah, stress is bad. We actually see a picture of how bad it is and what is happening in the body. And so I think over the next 10, 15 years, as we develop this more and as we talk about this more, hopefully people will start to take stress more seriously and importantly, learn how to dial it down. Right, that's the.
- [30:13]
Gwyneth Paltrow
Well, that's what I want to ask you about. Because now listening to you talk about it, now I'm stressed out, thinking about how stressed out I am all the time. So how do we mitigate that? What are your tools in your life, for example, for reducing stress?
- [30:29]
Dr. Tara Narula
Right. Well, the stress is, we can't, I tell my patients, you can't take away the stressors, you can't take away what's going to happen. But what you can do is change how you respond to the stress. That is really the key. And in writing my book, the Healing Power of Resilience, we really talk about changing a stress response to a resilient response. And so what does that mean? In my opinion, it is sort of the eight tools that I outlined in the book that start with acceptance of something that happens. So a lot of us rail against negative things that happen. We fight against them, we don't accept them, and that leaves us in that state of chronic stress. So acceptance is really one of the main keys to being able to move on to the next steps. But things like social support, so buffering stress by building your social connections, that's really important. Of course, how you treat your body physically is also going to affect your mind. So the same way that there's crosstalk from the brain to the body, by exercising and eating well and sleeping, we physically have the power to kind of dial down that stress response. Things like therapy. I'm a huge advocate for therapy. I think can go a long way in terms of helping people. Whether it's just have a place to unload your stress or to work through things like anxiety or fears, that can be really powerful. There are lots of different ways that tools that we can use. But it's very important that we start to think about that.
- [31:58]
Gwyneth Paltrow
In the book, you talk about how also traumatic events are stored in the physical body and how that manifests. And I thought that was really interesting to hear from a cardiologist. You don't hear that. I mean, that's like really the next frontier of medicine. And so I was really fascinated by that. Can you tell me how you arrived at that thought?
- [32:23]
Dr. Tara Narula
Yeah. You know, for me, it was this kind of work in stress and resilience was so important because I've seen it, obviously in my own life. I have witnessed stress and resilient responses in my family and in my friends. But I think because I straddle these two worlds as a journalist, covering stories and interviewing people who.
- [32:43]
Gwyneth Paltrow
Yes. On CBS News. And you've won an Emmy and everything, haven't you?
- [32:47]
Dr. Tara Narula
I was at cbsts for eight years now at abc. Okay. But in doing that, you know, interviewing and telling stories of people who have really survived unimaginable things and looking at how they were able to move forward in their life was important for me to talk about. What are those factors that help people do that? And then I would leave and come to my office and walk in the room and see patients who had just had a heart attack or a stroke or told they had heart failure. And it suddenly became apparent that we just. We need to do a better job really connecting what's happening in the mind and what's happening in the body. And I think the other main thing was I noticed when I would talk to patients about their new diagnosis, I realized that is a traumatic event. And we never say that out loud. We never say that being told you have breast cancer or you've had a heart attack is a form of trauma that causes a stress response. In the same way that having your home burned down in a fire is a form of trauma or your business failing. Getting a medical diagnosis upends your whole life. And, you know, my patients would look at me and say, when am I going to be myself again? Over and over I was hearing this, and it just became apparent that we need to tell people, you're not going to be yourself again. But we can help you find a way to still enjoy your life and move forward from this traumatic event and become resilient and my hope with the book is really that hospitals and medical centers everywhere build resilience training programs for patients to really buffer them and protect them and scaffold them in those moments where we hand them a diagnosis, we hand them a prescription to learn resilience. How awesome would that be? To really help shuttle patients forward and protect them mentally, because we can't really help them heal. We can't get them to go to their appointments and take their medicine and do all these things if they're frozen with fear or stuck.
- [34:50]
Gwyneth Paltrow
Right. And I suppose, you know, if you can leave feeling like you're a participant, like a true participant in your healing and that you have the power and capacity to do that. I imagine it. Yeah. I mean, that would be great to have that kind of. I don't feel yet that in Western culture we're good at that yet, you know, like arming a patient sort of with a bigger picture. But, I mean, I think your book goes a long way to that end. You know, I think it's very like the synthesis between a patient and their experience and the idea that they can bring on a set of tools to help them. And, yeah, maybe they're not gonna be the same as they were before. Maybe that's the wrong question. It's like, what is the blessing of this? And, you know, how can you kind of fold it in going forward and become who you want, like this next incarnation at this point.
- [35:56]
Dr. Tara Narula
Right. Yeah. I use the quote in the book of Michelangelo, carving the marble and setting the angel free. And it's this idea that we are constantly being shaped and evolving based on things that happen to us in our life that we can't control. But it doesn't mean our life has to stop and that we can't have joy in our life and meaning and thrive. We have to learn how to do that because the insults and the challenges are going to come at us forever from all different angles. But at the end of the day, people want to enjoy their life. They want to derive meaning from every single day. And so my hope is that we help people do that by teaching them that they can be. They have resilience inside them. That is an innate gift that most of us have, but we can actually strengthen it and build it just like we build a muscle.
- [36:43]
Gwyneth Paltrow
Yeah. You mentioned as well the importance of heart rate variability. What is heart rate variability, and why does mine suck and how can I get it better?
- [37:02]
Dr. Tara Narula
So what do you measure your heart rate variability with?
- [37:06]
Gwyneth Paltrow
A couple devices. I have an Oura ring And a mattress and an eight sleep.
- [37:15]
Dr. Tara Narula
So heart rate variability is sort of the range of your heart rate that we assess over time. And generally it's a marker of our underlying kind of nervous system. We call it the autonomic nervous system that controls the kind of excited tone and the quiet tone. And, you know, you want to see a more varied sort of higher heart rate that generally indicates kind of a better fitness level, at least cardiovascularly, better ability to have recovery or from stress. Whereas that low heart rate variability, we don't see much change in the heart rate over time during the day or night would imply that you're less cardiovascularly fit or able to kind of manage the challenges or stresses of your daily life. So it is a helpful tool for some people.
- [38:05]
Gwyneth Paltrow
So how do we improve it? Is it more cardiovascular activity? Is it.
- [38:12]
Dr. Tara Narula
In some cases it is. In some cases, yes. For some people it is. Improving their cardiovascular fitness can help with the heart rate variability. And in some cases, things like meditation and breathing and some of these other exercises that work our kind of parasympathetic nervous system can also help us as well.
- [38:30]
Gwyneth Paltrow
So what is this VO2 max thing? And do I need to go put that alien thing on my face and run on a treadmill?
- [38:40]
Dr. Tara Narula
Yeah, it's another measure, another exercise, another test that we do to kind of get a sense of your cardiac fitness. I don't tend to send patients for their VO2 maxes. That's not something I do in my practice. But some of the cardiac pulmonologists or heart failure Doctors will use VO2 max or exercise physiologists as well. So it's again, another tool in the toolbox. But these are not things. I think generally for most people, the advice is pretty straightforward. We talk about getting cardio exercise a moderate amount, about 150 minutes a week, or a vigorous amount, about 75 minutes a week. And that's kind of an easy number for most people to think about targeting and starting with.
- [39:22]
Gwyneth Paltrow
I mean, that seems pretty doable. Yeah, I feel like I used to do a lot of cardio and now I'm just so old.
- [39:36]
Dr. Tara Narula
You can't be older than me, so you're not.
- [39:41]
Gwyneth Paltrow
I'm like, do I really need to bounce all over? I'm just like, oh my God. But I guess it's important to do.
- [39:49]
Dr. Tara Narula
I mean, resistance and strength training is important too. And we are talking about that a lot more now. Generally in the cardiology world, we talk about two days of resistance training or strength training being built into your overall cardio and they're important for different reasons. Especially as women, we tend to lose muscle. It's important for our bones and and aging to kind of retain that as we get older.
- [40:17]
Gwyneth Paltrow
I've been thinking about this lately. What could your home actually be doing for you while you're not even in it for anyone with upcoming travel? Your place could just be sitting there empty when you could be listing it on Airbnb. And that's kind of the shift, right? Whether you're away for a long weekend, a work trip, or a proper vacation, your space doesn't have to just sit unused. It can work for you in a really low lift way. And that extra income can help offset the cost of your trip. If you live in a city that draws people in, concerts, tournaments, festivals you already know there's a steady flow of visitors looking for somewhere that feels a bit more personal than a hotel. Listing your space on Airbnb lets you meet that demand in a really natural way, giving people a place that actually feels like home and a more grounded way to experience your city. So it starts to feel like a smarter, more intentional way to travel. Knowing your home is working for you while you're away, your home might be worth more than you think. Find out how much@airbnb.com host. Movement becomes transformative when it stops feeling like an obligation and becomes a ritual. It feels like something grounding, something expansive, something that brings your body and mind back into alignment. That philosophy is what makes Peloton's Cross Training Tread plus so compelling. It's an ecosystem designed to help you find ease in the effort. With Peloton iq, every workout becomes responsive and intuitive. Personalized plans evolve over time. Real time insights guide each session and built in form feedback creates a sense of ease within effort. The experience moves fluidly, running to strength, cardio to recovery with a simple turn of the screen. And through it all, world class instructors offer both structure and inspiration, meeting each moment with clarity and intention. Because true progress isn't about perfection, it's about staying connected to your body and to what's possible. Discover the Cross Training Tread powered by Peloton iq@onepalaton.com. And is there some trick like, okay, you know, be out of breath for 20 minutes. Like is there some rule?
- [42:42]
Dr. Tara Narula
There's no trick. The trick is to do something you like. So I usually tell people, find something you enjoy doing. So if that's swimming or running or biking or dancing or the rowing machine, whatever you're going to be consistent with, and doing it to the degree that you're. You are a little bit out of breath. That's the kind of pace you want to think about.
- [42:59]
Gwyneth Paltrow
Okay, so it's not like gasping for air.
- [43:02]
Dr. Tara Narula
No, you do not do well.
- [43:05]
Gwyneth Paltrow
I think that's important because I think in the culture, we think, you know, for those of us it's like, okay, you have to be gasping for air in order for it to be like true heart, healthy cardio. But it's. It's good to hear that's not the case. What happens to the cardiovascular system during perimenopause? Are there changes?
- [43:26]
Dr. Tara Narula
Yes, sadly, you know, we do see, for example, risk of cardiovascular disease go up in women post menopause. So when we take a history of someone and we ask about the risk factors by virtue of being postmenopausal or, you know, being over the age of 55 as a woman, you know, is generally considered an increased risk factor. We see things like cholesterol levels go up postmenopause, blood pressure sometimes goes up. So a lot of these things change around that time. And that's why that's another great time point for women, if they haven't been plugged in with a cardiologist to get plugged in to make sure that their risk factors are really well managed.
- [44:09]
Gwyneth Paltrow
And does estrogen, you know, you hear about estrogen has a protective role in brain health, dementia, stuff like that. Does it have a protective role as it pertains to the heart?
- [44:20]
Dr. Tara Narula
It's such a complicated question. I think there's so much interest right now in hormone replacement therapy, and I think the best guidance we have now is that, first of all, it's individualized. And so you really have to look at a woman's risk. Does she have a history of breast cancer or blood clots or anything that would preclude hormones? But in general, part of the reason why women's risk starts to go up post menopause is because we do lose estrogen, and estrogen does, in some respect, have protective effects on the blood vessels. But what we think happens is that this is why we call it sort of the timing hypothesis, that once you're 10 years out of menopause or over the age of 60, the blood vessels change. And at that point, if you're add estrogen, there may be increased risk. So that's why we sort of say if you're doing it more around the time of menopause in someone who's low risk, then it's probably fine. Maybe there's some protective effects on things like cholesterol and Blood vessel health. But as you get older, it definitely can shift and change, and certainly if you're a higher risk woman. So we know that women, for example, who have cardiovascular disease, so let's say they have plaque in their arteries or they've had stents, they are not really candidates for hormone replacement therapy because that can actually be associated with increased risk. So I see a lot of women in my practice who come and say, can I take hormones? My GYN is sending me to you to make sure from a cardiovascular standpoint, it's safe.
- [45:49]
Gwyneth Paltrow
And you have to assess. There's no kind of panacea. You've got to assess.
- [45:53]
Dr. Tara Narula
We want to make sure there's no underlying cardiovascular disease. Do they have high blood pressure, cholesterol? What are their risk factors before we kind of make that decision?
- [46:02]
Gwyneth Paltrow
I get, like, heart palpitations at night. They say it's perimenopausal. Like, what are they? Why are they happening?
- [46:10]
Dr. Tara Narula
So palpitations are really common phenomenon.
- [46:13]
Gwyneth Paltrow
They're scary when they're strong.
- [46:15]
Dr. Tara Narula
They are. They hurt. They feel very weird. It feels like almost like you're on a roller coaster and suddenly your heart kind of just jumps. Most often when someone says they have palpitations, it's extra beats that the heart is giving off. So the heart gives off what we call a premature beat. Those are not generally considered dangerous at all. We worry when people have a lot of them. So, for example, when we give people a heart monitor to wear, we can count how many extra beats they're having. If they're having 1,000 in a day, or even 15,000. Not as worrisome as someone who's having 20,000. So first of all, identifying what the palpitations are is key. And that's really with a Holter monitor that we would give someone to wear, and that kind of records their heart rhythm, and it lets us see a tracing of what's happening. The reason it becomes the concerning part is if they end up having irregular heart rhythm. So there are some times where people will say, I have palpitations. And we do a heart monitor, and we find they have. Have irregular rhythms like atrial fibrillation or atrial flutter, and those carry with them a stroke risk. So usually if you're feeling palpitations, getting a heart monitor to kind of identify exactly what they are is really one of the first steps. Again, most often it's not anything concerning, but there are times where it could be. We hear a lot about palpitations around menopause, around periods with caffeine Lack of sleep, thyroid problems, alcohol, viruses, a lot of these things can trigger them. So people may not have them for a while and then suddenly they have them and then they kind of go away and they come back. Very, very common to have palpitations.
- [47:51]
Gwyneth Paltrow
Speaking of viruses, you just reminded me about a question that I wanted to ask you, which was this kind of post Covid, we heard a lot about people who had contracted Covid having more heart disease. Is that correct? Did that end up being right?
- [48:13]
Dr. Tara Narula
So we think the COVID virus did affect, does affect, can affect the blood vessels, no question. But the big finding was really with the vaccine and the concern for myocarditis, which is like inflammation of the heart muscle, which we saw in younger boys more often. Any virus can damage the heart muscle or cause myocarditis, and Covid itself can do that, can cause inflammation of the heart muscle. But that is one of the things that we did see with COVID and now we have long Covid. So I have. We see a lot of patients sometimes who have that autonomic dysfunction, we call it long Covid, where their blood pressure might be low, their heart rate might be up, they feel tired, they feel dizzy, and it's all sequelae or phenomenon resulting from COVID So Covid did a lot of things, it taught us a lot as well about virus and how,
- [49:03]
Gwyneth Paltrow
how are you able to pinpoint it, the cause to Covid as opposed to, you know, other.
- [49:09]
Dr. Tara Narula
You can't, you can't really. I mean, obviously the timing, if, you know, if they got Covid and then something happened right away. But if it's something where you're sort of putting the pieces together and saying, well, you had Covid and now you have this, maybe it's linked. But there's no way to definitively link sometimes these things together.
- [49:26]
Gwyneth Paltrow
You know, you talked about the sort of finance bro that you have in your office, this whole fascinating cadre of men, this new breed of what is the kind of female equivalent of that? Are you seeing sort of a hyper achieving woman come in? What do you think culturally the equivalent of that is on our side?
- [49:57]
Dr. Tara Narula
Well, if you're in New York City, I think it's different than if you're in some other parts of the country. But yes, I see a lot of women too, who, you know, what's interesting is they come in and they're thin and they're fit and they exercise and they eat healthy and they feel good. And then I'll send them for a calcium score, which is a screening test for heart Plaque, and it comes back showing they have heart disease. And they're shocked because they say, I was doing everything right, and I feel fine, and how can I have heart disease? And that's where, you know, a lot of these screening tools can be really powerful. But, yes, I see a lot of women, New York City women, who, you know, think they have their everything together, and they're really surprised when they find out that they might have heart disease.
- [50:44]
Gwyneth Paltrow
So is it. I mean, I know partially it can be genetic, but what's the common denominator? Is it stress? Why are they all having it?
- [50:52]
Dr. Tara Narula
I don't think we know. A lot of it can be family history or genetics. And that's why I said it's important to know your family history, because you can be doing everything right. But if you have a very strong family history of early heart disease, that can be enough to sort of tip you over. But certainly, things like sleep. I mean, I ask everybody about sleep, and I would say 90% of my patients tell me they're not getting 7, 8, 9 hours, they're getting much less. Sleep is a risk factor for cardiovascular disease. Stress, as we talked about, diet, I mean, a lot of what we eat that we think is healthy may not be healthy. So all of these factors may play into why we see coronary artery disease or plaque in people who we otherwise would have assumed would not have it.
- [51:32]
Gwyneth Paltrow
Right, Right. Probably a lot of it's environmental. Yeah. So if somebody comes in and they have early heart disease and it's a surprise. Right. Like they thought, wow, I thought I was healthy, and I run and I eat well, et cetera. Like the sort of the profile that you just mentioned, is it reversible when it's early and. And, no, it's not.
- [51:55]
Dr. Tara Narula
That's the hard part of cardiovascular disease, is that once the plaque is there in the vessels to your heart arteries, you can't take it away. It's there with you forever. And that's why it's so important to start this process early of prevention, because once the disease is there, you can't really get rid of it. You can maybe have a little regression or pulling back at some of the plaque with medications and lifestyle, but essentially, once the disease process is there, you can't change it.
- [52:27]
Gwyneth Paltrow
Darn.
- [52:28]
Dr. Tara Narula
And at that point, it's about managing the disease going forward.
- [52:32]
Gwyneth Paltrow
But you can keep it from getting worse.
- [52:34]
Dr. Tara Narula
Yes, you can keep it from getting worse, and you can keep it stable. So I have a lot of patients who have heart disease, and they're worried. You Know what if tomorrow I have a heart attack or am I going to live to 150? The answer is, it depends. I think there are a lot of people who have heart disease and live to 100 and continue to run marathons and live a wonderful life. A lot of those people are doing everything right at that point. It's really a turning point where you have to look at, am I taking the right medications, am I living the right way in terms of my lifestyle so that I can prevent my heart disease from progressing and getting worse.
- [53:08]
Gwyneth Paltrow
Tell me a bit about why you decided to write the book. What happened? What was the culmination that you thought, you know what? I need to really sit down and. And do this?
- [53:18]
Dr. Tara Narula
As I said, I think it was just an accumulation of interest in this concept of what allows us to move forward when bad things or difficult things happen to us in life. My father is an immigrant from India. I grew up really seeing his stories and hearing his stories of resilience. I had my own episode in medical school where I lost vision and part of my eye and nobody knew why. And that became a period of time for me where I had to really find my way through something that was the most challenging thing I've ever faced. And then, as I said, being a journalist and being a doctor and seeing it all around me, I just became fascinated with this. And so when I was at cbs, I said, I want to do stories, a couple stories on resilience. And I ended up interviewing psychologists who. Their whole world is about studying resilience. And they. They said to me, you know, number one, most of us are really innately resilient. And I thought, that's such an amazing fact that we don't tell people. Wouldn't it be great if we told people how strong they are? Because so many of us think we are not that strong, and we would really fall apart if something happened. And then in the same breath, they said, and we have all these ways we can build it. And we know this because we studied it in Navy Seals and we studied it in POWs. And I thought, if you have all these tools, why are we not getting this out there for everybody to use in their everyday life and for our patients to use? And so it was so important for me to then say, let's just put this information out there in a relatable way as a roadmap for people to easily use, step by step, to think through. What can I do to build my resilience and explain to them why stress is bad? So it was really a passion of mine initially. I got approached to write a book about COVID and that was the initial call. And I said, well, I can do that, but I really want to write about resilience. And thankfully that Simon and Schuster let me do that. So it was a labor of love getting this book out there.
- [55:20]
Gwyneth Paltrow
It's a beautiful topic and it's a very universal topic and I think it's great it makes sense. About your dad, I wondered if there was some thread that ran through.
- [55:33]
Dr. Tara Narula
He always told my brother and I, you know, no matter what happens, you'll be fine, you'll survive. It's like I hear him in my head and I thought that just those words are so powerful. Just being told you can get through it. Sometimes it's just those words, the shift in our perspective that helps us through challenges.
- [55:52]
Gwyneth Paltrow
Is there like a particular one or a few wellness practices that, that really bug you? Like when your patients come in and they're like, I'm doing this and I'm trying that. Whether it be, I don't know, IVs, hyperbaric chambers, whatever.
- [56:09]
Dr. Tara Narula
I don't know, probably all of those. Yeah. I mean, I think, listen, everybody's entitled to want to improve their health and to try things. And I think as long as it's not anything dangerous, I don't have a problem with people trying to do better for themselves. I think I get concerned if it's something that might cross the line, that might actually harm them. And that's, you know, what would that be? Well, like I said, some of the supplements, certainly that can cause liver injury or damage. That's, you know, might be concerning. But a lot of the other things that people do, the cold plunges and, you know, the saunas and the. Probably not harmful for most people. Right. So.
- [56:53]
Gwyneth Paltrow
And when you see like. Cause did you see that big Finnish study that came out on saunas that said like, reduces all cause mortality by like 30%? Is that true? Can that be true?
- [57:05]
Dr. Tara Narula
I mean, maybe. Probably has to be replicated. It's very hard to control for all the other variables that people who use saunas might actually be living healthier in other ways. And to make. To be sure it's the sauna that's doing that. But certainly, you know, there may be something to the heat and how your blood vessels respond and maybe they end up responding in a healthier way because they're exposed to heat. So, yeah, who knows?
- [57:29]
Gwyneth Paltrow
Tell me what your day looks like. You have two little girls.
- [57:32]
Dr. Tara Narula
I have two little girls and a Golden retriever. That's six months, so.
- [57:35]
Gwyneth Paltrow
And two careers.
- [57:36]
Dr. Tara Narula
And two careers. So I'm up at five and I walk the dog while everyone's sleeping because you know, they're sleeping and I want to let my husband with a coffee
- [57:46]
Gwyneth Paltrow
or a green tea or. That's very kind of you.
- [57:49]
Dr. Tara Narula
Yeah, I know.
- [57:51]
Gwyneth Paltrow
Wow.
- [57:53]
Dr. Tara Narula
I walk the dog and then I exercise. So my time for exercise for me is like my wellness practice and stress relief. So I'm up in the gym from like 5:30 usually to well, if I don't have TV till like 6:30, at which point I go back downstairs and get my kids up and start to get them ready for school. If I have TV then I'm usually out the door by 7:10 in the morning, so.
- [58:19]
Gwyneth Paltrow
Oh, you mean. Yeah, because you're going. I thought I was picturing you like watching TV on a treadmill. But you mean no going on tv.
- [58:25]
Dr. Tara Narula
Right, Right. So yeah. So for the last. So I was at CBS for eight years and then briefly NBC and cnn and then I've been the chief medical correspondent at ABC for the last year. And so I never know from day to day if they're going to want me on the next day. I usually find out the day before. And so yeah, so it's a lot of preparation the night before to kind of prepare for the segment the next day. But so I'll be up at 5 trying to get lunch boxes packed, breakfast for the girls, flat ironing my daughter's hair, which she requires me to do in the morning, eating my oatmeal and coffee and then heading to Hudson Square for Good Morning America. Usually do my segment around 8:05. And then I'm heading uptown to my midtown practice and I see patients here Monday, Tuesday, Wednesday from 9:30 to 5 usually. Oh wow, about 18 patients. And then.
- [59:20]
Gwyneth Paltrow
Big day.
- [59:21]
Dr. Tara Narula
Yeah, it's a long day. And then Thursdays I do telehealth for half a day in the morning. Do you do that from home? I do that from the office here.
- [59:29]
Gwyneth Paltrow
Oh wow. Okay.
- [59:31]
Dr. Tara Narula
And then I do some administrative roles. So I help run the do direct communications for the Katz Institute for Women's Health, which is Northwell's big women's health program.
- [59:39]
Gwyneth Paltrow
Right.
- [59:40]
Dr. Tara Narula
So that we have meetings for that. So the days are really busy. And then my husband works across the street from me, He's a plastic surgeon. And so we leave together. Six. Yes. And we take the subway home and we all try to have dinner as a family. That's really important to us. So we sit down, have Dinner. And then who makes dinner? So I have a nanny who.
- [60:02]
Gwyneth Paltrow
Fantastic.
- [60:03]
Dr. Tara Narula
Who does it. Yeah. But I order hellofresh. So she has all the ingredients she needs and all the recipes, and so she prepares the food for us while we're at work.
- [60:13]
Gwyneth Paltrow
And then we have Goop Kitchen opening in New York City very soon. This is our food delivery service that's healthy and delicious. So that will help you out.
- [60:23]
Dr. Tara Narula
I will love to try that. Yeah. I mean, I wish I have number one. I don't know how to cook, but I have no time. But the kits are really awesome.
- [60:32]
Gwyneth Paltrow
That's great.
- [60:34]
Dr. Tara Narula
Yeah. And then basically, we're hanging out, relaxing together for the next hour and a half, usually television, and then trying to usher my kids into bed, which is a process, so. And then my husband and I are usually in bed by, like, 10:30. Oh, wow.
- [60:49]
Gwyneth Paltrow
Okay.
- [60:50]
Dr. Tara Narula
So, yeah, it's a long day, but a full day.
- [60:53]
Gwyneth Paltrow
Well, thank you so much for joining me on the podcast today. It's been so interesting to talk to you, and the book is fantastic, and I'm so glad you wrote it. And I highly encourage everybody listening to read the book. And don't forget to go to the cardiologist.
- [61:11]
Dr. Tara Narula
That's right. Thank you. Thank you so much for having me.
- [61:13]
Gwyneth Paltrow
Oh, my gosh. Such a pleasure. Thanks for tuning in. This has been a presentation of Cadence 13 Studios. I hope you'll listen, follow, rate, and review all of our episodes, which are available for free on Apple Podcasts, Spotify, Odyssey, or wherever you get your podcasts.