← The mindbodygreen Podcast
The mindbodygreen Podcast
634: A cardiologist’s guide to mind-body medicine | Tara Narula, M.D.
00:48:58
Tara Narula, M.D., a board-certified cardiologist, Assistant Professor of Cardiovascular Medicine, and author of The Healing Power of Resilience, joins us today to explore how resilience, stress, and mindset profoundly shape heart health—and how we can build these skills to improve both recovery and long-term wellbeing.
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Welcome to the MyBodyGreen podcast. I'm Jason Wakab, founder and co CEO of MyBodyGreen and your host.
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What if two people could receive the same exact diagnosis and one recovers, adapts and even thrives while the other struggles? What if the difference isn't just medication or procedures, but something far more human? Today's guest believes the missing link in modern medicine is resilience and that learning how to build it can change the course of our health and our lives. Today's guest is Dr. Tara Nerula, a board certified cardiologist, Assistant professor of Cardiovascular medicine and author of the Healing Power of Resilience. In today's show we dive into why stress may be one of the most under recognized drivers of heart disease, how receiving a diagnosis can itself be a form of trauma, and why doctors need to do more than treat numbers like cholesterol and blood pressure. We'll explore the science behind resilience, the powerful connection between mental health and physical recovery, and eight practical tools Dr. Narula believes anyone can use to build resilience before and after life changing health events. Let's dig in. So you write the two patients with the same diagnosis can have wildly different outcomes and the differentiator is resilience?
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B
It can be, yes. You know I see a lot of patients in my practice, as you mentioned, a lot of them with the same diagnoses and I witness their journey, and I've seen exactly that. You know, some do very well and some not so well. And when you try to tease apart what one or some of those factors might be, we continue to learn in cardiology and I think in medicine how much psychological well being plays into our outcomes and our physical recovery. And so for me, it was really important to talk about this because I don't think we do a great job in medicine, number one, explaining that to patients, asking about their psychological well being, and then scaffolding them with resources to support them in their journey to recovery. But it is extremely important. And I think that's like one of the big core messages that we can't treat the physical without treating the mental.
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A
Well, I think it's so interesting that you're a cardiologist and you're writing this book and you're talking about stress because, you know, traditionally you walk into a cardiologist's office and, you know, a good cardiologist will say, you know, immediately, okay, blood pressure, you know, let's look at your lp, your apob. Maybe we'll dial into the cholesterol a little bit. Maybe we'll do a clearly or calcium to, like, get a 3D MRI of the heart. And then, like. And that'll be. And like, that's kind of would be considered the gold standard if you go to a good cardiologist, but there's no mention of, like, what's going on in the rest of your life.
- [03:55]
B
Exactly. And I think, I mean, that's exactly right. I do think that cardiology as a field is a little bit ahead of the game that, you know, despite what you said in terms of recognizing the impact of mental health, whether that's anxiety, depression, ptsd, stress on heart health, there was actually guidelines published around this several years ago about psychology and the interface with cardiology. So we are taking steps in that direction, but we're clearly not where we need to be. And so every single patient that I meet on their first encounter and every subsequent visit, as part of my history and talking to them, I ask them, you know, what is your stress level? Like, what is your mental health situation like? Are you seeing a therapist? Do you suffer from anxiety or depression? How well controlled is that? So we have those conversations, and a lot of them will look at me and ask, why are you asking me this? Because again, I think we haven't explained the connection between the brain and the mind and all the chemicals that get released and how damaging chronic stress can be. And I Think that is why the whole first, you know, part of the book, I really wanted to devote to just educating about the impact of stress on our bodies, acute stress and chronic stress. And then the second half is really much more about how we reverse that response, because we can do that, right? So the same way that stress can be damaging, we have the power to kind of flip that. And that's where the change in outcomes comes in. But I do wish that more cardiologists, more doctors asked about this, not just because it's part of prevention, but also because how can we get our patients to take the medicines that they need to take or exercise when they're mired with fear or anxiety or depression? So we have to address those things in order to then get them to want to do the procedures that we want to send them for or to be able to. So they're so interconnected. But we don't often talk about it. And I think one big area where we don't talk about it, and this was really, again, another reason why I wanted to write the book, is when we give patients a diagnosis. So when someone comes to me and I send them for a cardiac CTA and we discover that they have heart disease, and I tell them that that's a real moment of stress, of, you know, trauma for a lot of people when they learn they have heart disease and they thought they didn't. Or when I tell them you have to have a procedure done to fix a valve that's defective. All of these diagnoses, these procedures that people undergo, that is a traumatic experience. And we just don't talk about that in medicine in the same way that we talk about other forms of trauma. And so many of my patients really would look at me and just say, like, when can I. When am I gonna be myself again? This has really upended my whole world. And I think that's where, you know, we need to do a better job in medicine at recognizing that this is an opportunity, this moment in time where we give someone a diagnosis when they've learned that something has happened that is going to change their life, to teach them the skills of resilience, building to arm them with the ability to say, despite the fact that this has happened, I am in control of where I'm going in the future, and I have the power to potentially create the quality of life and the meaning in my life that I want. Even though I have a new heart valve or I have a defibrillator or I have heart failure, and you can apply that to Anything in medicine. Breast cancer, colon cancer, diabetes, whatever the situation is. And so it just became apparent to me that teaching resilience is not just important for us in life. Right. I have kids. I want them to learn how to be resilient. It is really important when you're in a healthcare setting. And no one in healthcare to date is really connecting these worlds of psychology and how we practice clinical medicine. It's missing. It is a missing link. And that's really what I wanted to do with the book, was bridge that and say we in medicine and healthcare need to do a better job working with our colleagues in psychology and psychiatry so we can help people heal and recover and thrive. And that's what it's about at the end of the day.
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A
So are you able to share some examples of a patient and what was the subsequent outcome?
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B
I mean, I have a great. I have a lot of patient examples, and they're all very different. You know, one in particular that comes to mind is actually. He was a producer at CBS News that I worked with in my other role as a journalist, and he actually ended up coming to see me as a patient. And he had had stents placed in his heart years earlier. Before I met him. He, over the years, had gained a lot of weight, his cholesterol was high, his diabetes was out of control. And upon meeting me, we really worked on how he could kind of change the trajectory of his life. And it's been really miraculous to see him do that. He took control of his diabetes, got his sugars under control, started training for marathons, lost a ton of weight, and over the next several years, had to undergo more heart procedures because he has very aggressive coronary artery disease. But he turned his life around, and his life was difficult socially, too. And that was another aspect we talked about. The stress of being a producer at a major news network, the stress he had at home. He has a child with autism, and his own home life stressors sort of factoring into his health. And yet, despite all this, he is a real survivor to the point where he ended up having the word resilience tattooed on his arm. He sent me a picture of that, which I just thought was so true. So. So on point for him, because he is the true definition of resilience, that he's been hit over and over again with little mini traumatic events. And yet he's really taken control of his ability to live his life and find happiness and success, despite the fact that he's had multiple. Multiple stents, has high cholesterol and diabetes And a social situation that's very difficult.
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A
So you mentioned taking control. Walk us through mindset. And in your view, what's critical once a diagnosis occurs, you know, one tends to think of, okay, there's denial, there's optimism, there's acceptance, there's a lot. What is the recipe for a positive outcome when one is given any sort of diagnosis they're not exactly thrilled about?
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B
For me, as a cardiologist, I kind of, like I said, straddle these worlds of seeing patients, but also as a journalist, learning about psychology through the psychologists that I interviewed who study resilience. And it was important for me to figure out really what is the first step. And that's why in the second half of the book, when we lay out sort of the eight pieces, the eight tools that people can use, number one was acceptance. That was very important for me to have the very first tool be this concept of acceptance. That again, in order for us to do any of the following things, whether that's get fit, be able to seek therapy for to face our fears, find social connection, find we first have to accept what's happened to us. And that's a really hard thing to do in a lot of cases because we rail against what we thought our life was going to be. How could this happen to me? And so really that change in mindset of saying, I, I, I accept that this is not what I wanted, but I'm going to make peace with it. That is really the beginning of opening the door to resilience. And I saw that in my own life. When I was in medical school, I lost vision in part of my eye. And that was just an eye opening experience for me because I became a patient and I had to say, I have lost vision in my eye at the beginning of my journey in medical school. I don't know what's going to happen. Am I going to go blind? Am I going to be able to finish becoming a doctor? I fought so hard to get to this point. Am I going to be able to finish medical school? And I had to really learn to say, I did not want this to happen. I did not anticipate this was gonna happen. I don't even know why this has happened because I saw multiple doctors and no one could figure out why, but I'm just gonna accept it. And that for me, that message came from my own mother, who sent me the serenity prayer on a little card in the mail when I was in California and she was in Florida and I was in medical school and going through all of this trauma, myself with the vision loss. And as you know, or you know, many people may have heard of the Serenity Prayer. God grant me the serenity to accept the things I cann. And that's the very first line. And I just remember reading that and sort of really internalizing it. So for me, in my own journey, that was important. I have seen that in my patients, and I've, you know, learned that through the psychologists who study this. And that's why that was really the first piece.
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A
Let's spend a moment on that. The Serenity Prayer and how one spiritual practice plays a role here. You know, what you're describing in many ways, I think, is, you know, letting go and letting God, if you will, for those who practice Christianity or believe in God. And in my view, that's a critical. A critical step. What's your take?
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B
Yeah, I think, you know, I'm a very spiritual person as well, and that infuses how I practice medicine. And I think, you know, that goes back again to when I was in my early training at Harvard at the Brigham and Women's Hospital. I remember in my intern year, they asked us to do a project, and I chose spirituality and medicine as my project because not many doctors talk about that. And there is, again, an evolving field in medicine that says we should be. We should be taking a spiritual history of patients and asking them, what is your faith? What is your belief system? How does that guide you in your choices? Again, all of that stuff that, you know, a lot of people think is fluffy plays into how someone can recover or what they want to do in their recovery or how. Where they find strength. And so whatever that spirituality may look like, whether it's an actual practice and a religious community, whether it's prayer at home or nothing, that's actually important for us as clinicians to know about because that matters. And again, I hear it from my patients when they've gone through something and they say, I've called upon my faith. That's how I've survived, you know, Or I'll see a cross around their neck when I'm examining them. And I'll. And I'll say, oh, you know, I see what a beautiful cross. And then they'll. It opens the door to them talking about, you know, their religious practice or their beliefs. But I think we can't be afraid to explore that in medicine. It is, again, it is an integral part of who people are, how they live and how they're going to survive life. So, yes, I think acceptance takes many forms, and for some people, it is, you know, part of their spiritual practice. For others, it's just a concept. But I think, to answer your question, I think spirituality is extremely important in medicine.
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A
Well, I think the data will show or probably does show that there are better outcomes for people. Well, I know there are. I know the data does show there are better outcomes with regards to mental health. We've had Dr. Lisa Miller on this podcast. It's a big part of her work. And if you just for, for those who are just take a step back. Let's say I'm a non believer, I'm agnostic. Just this idea of, from a mindset standpoint, questioning, you know, why did this happen to me versus what can I learn from this? There's a shift there from acceptance to action versus acceptance to. For lack of depression. Or maybe I'm overstating that, but what's your view?
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B
Yeah, and I think that sort of gets into the next tool, which was that concept of flexible thinking. So, yes, once you've accepted what's happened to you, then you're able to say, okay, where am I going to go from here? And I remembered interviewing for a story I did for cbs, Lucy Hone, who is a psychologist who studies resilience, who lost her own daughter in a car accident, tragically. And so here the resilience teacher had to kind of practice what she is teaching in the most horrific of situations. And, you know, she said it's like this idea of moving a goalpost. And I thought that was such a beautiful image of taking what you thought was your goal and picking it up and moving it somewhere else. So you still have your goals for where you want your life to go, your dreams, your visions, but they're just moved a little bit and you're in control of that. And so I love that concept of just having that flexibility in our mind to say, I can pivot, I can shift, I can move the path that I was on. And that's really powerful. Just that little bit of knowing I can pick up my goals and move them somewhere else.
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A
I think it's a segue to two of your other resilience skills, hope, which I think when you find, when you lose hope, it's game over. And the same thing with purpose. I think in my view, hope and purpose are cousins, if you will. They're very related. But you tell us.
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B
Yeah, I think, you know, again, in sort of laying out the book and figuring out which pieces were important in my view, and where I wanted them to be, you'll Find in the book there towards the end of kind of the, the journey and purpose is the last one. But I'll talk about hope first. You know, again, I have seen this in my own patients. You know, I've seen patients give up hope and succumb to their disease. I've seen patients hold on to hope and last longer than we ever thought they would live. And, you know, I go back to a story again that I tell in the book about one of my teachers when I was in medical school who was an oncologist and she taught us as medical students through a story of her own about a patient with an end stage cancer but could have lived several years, who doctors were rounding at the bedside and the attending doctor in charge in front of the patient told the other junior residents in training, well, you know, this person probably has, you know, a month or two to live and walked out of the room. And she said the patient died within, you know, a month. And her lesson to us was never, ever take away hope from a patient. And I never forgot her words and I never do. And so when I give patients a diagnosis, you have heart failure, you have an arrhythmia, you had a heart attack. And they asked me, what does this mean? The answer is never. Your life is over. It is. We're going to work to get you through every single day and we're going to give you all the tools we can with the medicines and the procedures and the mindset change. But no one knows, no one knows whether it's today, tomorrow, a year from now, any more than I know walking out the door, whether I could, you know, get hit by a bus. And I think having that open road laid out in front of you as a patient, despite the fact that you've been given some really difficult news or a diagnosis is really important. And hope is critical. It is a critical piece.
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A
And a doctor providing a diagnosis plays a critical role here if you take away hope with it. And so if you were to, like, if we were to structure, if we were to create a guidebook for practitioners around the world with some loose guidelines, what would that look, what would the instructions be for giving a diagnosis? Is it like, is it, here's what we know, here's what we don't know, here's.
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B
I think that's a good way to put it. I think, you know, let's deal with what we know, right? Here's what your diagnosis is, here's what it means, here's what's happening inside your body. Here's what you can do right? Here's what's in your control. This medicine, maybe this device, maybe this procedure, maybe this lifestyle change of exercising more, eating differently. And here's what we don't know, right? We don't know whether you might have a heart attack next year or in 10 years. We don't know if your stent's going to close down tomorrow or never. We don't know. No one knows. And anyone who tells you they know for certain, I think is telling you information that's incorrect. Because again, all of us who practice in medicine have seen people outlive whatever we thought their diagnosis would do to them. So I think, yeah, it's being very clear about the information we have, what's in someone's power and the fact that the beyond that we have an idea of what the course might be, but the course could be totally different and you know, and leave it at that. I think that would be the way to talk through, you know, a disease process or a diagnosis with someone.
- [20:36]
A
Well, I think too, it doesn't help. I saw a statistic recently where trust in physicians and hospitals in the US was, I think it's 71% in 2020 and it dropped to 40% in 2024. It is sad.
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B
Yeah.
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A
And I am optimistic that on the diagnosis side, just from a pure data standpoint and like getting the right diagnosis AI will be tremendously helpful in the future. But still, bedside manner, you can't just offload to a machine. That's something we could probably do a better job. You know, in terms of what, what I also really like about the book is like, you just don't ignore like the core theme is resilience and our emotional, spiritual and mental well being in the role. But you also don't ignore physical well being. So let's talk about that. What, what have you seen in terms of one, just from a pure physical standpoint, what should people be working on and then how that plays a role in building those resilience muscles.
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B
Yeah, exactly. I mean, I think in any area of medicine, you know, it's gonna be the same factors of, you know, exercise, diet, sleep, avoiding toxic substances. In cardiology, that's like at the top of the list of the lifestyle stuff that we talk about with people and all of that matters. And so, you know, the recommendations that we give are, you know, cardio exercise, 150 minutes a week of moderate cardio or 75 minutes a week of vigorous cardio working in strength training, at least two days a week, heart, healthy diets, you know, we talk about the Mediterranean diet and the dash diet and more plant based diets or vegetarian diets. We talk about sleep, which is, you know, everyone does it, everyone in my practice, no one gets enough of it. But seven to nine hours of sleep is sort of being the ideal. And then, you know, avoiding obviously smoking and excess, if any alcohol, managing stress and mental health, you know, but these sort of lifestyle things are really critical and you know, maintaining a healthy weight. You know, we, we continue to learn about obesity and the, the many cancers that are linked with obesity, not to mention high blood pressure and high cholesterol and cardiovascular disease. So yeah, I think it's really critical that people empower themselves by taking control of all of these things that they can take control of. And it's not easy, I tell my patients, it's not easy to prioritize exercise and sleep and to eat healthy. You literally have to. It requires a lot of mental energy to not pick up the fast food when you want to, but to choose a salad, right? It's hard, it's hard to get up at six in the morning and go exercise when you're tired and you want to sleep. But all of these little baby steps, all of these little things that you think are not important ultimately build up your strength, right? You release those myokines or hope molecules, you release endorphins, you turn off cortisol and the stress response. So that movement is really powerful with healthy diets. There's so much that comes from that, not just about weight, but you change your microbiome and how that plays into things with your gut bacteria, antioxidants. So all of this is, is medicine, the food is medicine, the exercise is medicine and sleep, which unfortunately, you know, so many people take for granted because we think it's this kind of useless time where nothing's happening. But there's so much that's happening in the body and the brain when we sleep, that's really important for us. And unfortunately, as I said, that seems to be the thing that goes first. When people are pulling for time in their life, they cut out the sleep. Majority of my patients will say they don't get enough at all. But all of these things are really important for our mental well being and our physical well being. And I wish that we did a better job ingraining these habits at a younger age so that people weren't working to so hard when they get older to figure out how to start building an exercise and diet changes and all of that. Which is why I'M a huge advocate for starting in childhood, having two children myself, really teaching these lessons early on. So it just becomes habit and routine and you don't have to then change. When you get into your 40s, 50s, and 60s, Rei Co Op knows when you're up at 4:30am on a Saturday for a long run, and you're actually excited. Not everyone gets it, but we do. At rei, we're here for people who get outside gear up for your next.
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A
Run in store or@rei.com well, the beauty of doing, say, a VO2 max workout is not only increasing your VO2 max for maximum physical fitness, but it's also this idea that, yeah, I can do really hard things and I can push myself to exhaustion. So it's that double benefit.
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B
That's right. Yeah. I mean, you realize how strong you are.
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A
And I think mentally, the way I view physical fitness and sports and all of that, like, it's this idea of I can push myself, I can go further. And so when resilience is needed, you can look back at, hey, remember this time? Like, I didn't think I could do anymore on the treadmill or do anymore playing whatever sport, and I did it. I can do this.
- [26:01]
B
That's exactly right. That's exactly right. And that's, you know, that is the psychologist Dennis Charney, who I interviewed, who studies resilience. You know, he talks about this idea of like a toolbox and literally pulling these things out as you need them throughout your life. So you have all these tools there and you remember, you know, yes, I did this back then, and I can go back to that and pull it out when I need it. And you're right. I think exercise and sports is a great training ground for realizing you can do so much more than you think you're capable of. You can push yourself beyond the point you thought you could. And that's a great lesson for all the other difficult things that happen in life that you have to push yourself to get through.
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A
And so what do you think kills more people? Loss of hope or purpose or, you know, having really high cholesterol? I'm trying to think of two opposites here, because I have a. I have a view on this.
- [26:51]
B
But I mean, again, I will say that when I walk in the room and I see a lot of patients in my practice, I mean, I see like 18 patients a day, and I always walk and say, hi, how are you? And, you know, 60% of the time, the response I get is, oh, you know, I'm like, so, like, depressed. Because this happened, or I'm feeling really stressed out, or I'm very anxious. They're not talking to me about, you know, oh, well, my blood pressure numbers have been this or, you know, even a symptom. I had chest pain. The first thing is how they're feeling. And that again is why the mental part really plays in so strongly to what we do. I can't begin to address any of the other stuff until I've spent five or ten minutes talking about what's happening in their life. You know, and then they tell me I'm caring for my aging mother, my son is in drug rehab, my, you know, husband is drinking too much. Right. All of this stuff that matters in terms of how they feel and how they're able to exercise or not exercise or get to sleep on time or they're waking up in the middle of the night because they're worried about something that's going on. I mean, so when you ask me what I think is killing people the most, I will say in my opinion it is all of the mental stuff that is happening to people, which of course, you know, worsens the physiologic, the blood pressure and the cholesterol and all that. And that is extremely important. I mean, no doubt. But you know, I think we have an epidemic in this country that we're not dealing with of people suffering the suffering and we're not taking care of it. And that is why again, for me, it was so critical to just bring this out into the open and talk about psychological well being as part of how we treat people. I went to the American College of Cardiology meeting. It's our big meeting that happens every year. Tons of cardiologists show up, descend on one place, they've got sessions all day long for three days. And I looked at the brochure and there was one session, one 30, 40 minute session in that time that was devoted to psychological well being. And I remember thinking, we are missing the boat here in my own field, we are missing the boat that we have all these sessions dedicated to everything else except for what I'm seeing in my practice, which is what is holding people back from moving forward through their life, through their diagnosis. There's they're suffering under the weight of how they're feeling. So, you know, I talk a lot about therapy with my patients. You know, have you seen a therapist? I think everyone should see a therapist. I think that's a great tool for you. And again, I think people are surprised to hear their cardiologist talking about therapy. But you know, I think it can be a really powerful thing to help people in their life, in their medical journey, socially and in every aspect.
- [29:48]
A
And I think for those people who choose to wear a wearable, I'm one of them. I've got my aura and my whoop. I would say the greatest impact beyond alcohol at night. I don't really drink alcohol anymore occasionally, like rarely actually. And is stress like my, my resting heart rate and heart rate variability will move the most in a negative way when I am very stressed. And so that, that is the. And it changes daily.
- [30:19]
B
Yeah, I mean, stress is. Stress is a killer. And that again, that is why in the first half of the book, I wanted to be very clear in laying out, you know, the history of stress research and what stress does to our body. I mean, this is a, this is a relatively new field in medicine as well. I mean, we started to study stress in the last, you know, hundred years. This is not something we have been looking into for a long time and we are learning more and more. But you know, it is damaging and I tell my patients, to every part of your body, right? And there is, you know, we see it in cardiology, there's a stress induced heart attack, which is an acute stressor that can literally cause a heart attack and the heart function to decline. So I mean, I don't know, you know, that that is the best evidence of a sort of an acute trauma and the real impact that can have on the body. And we see signs of chronic stress. And now that we're using imaging, PET scans and everything else, we're able to finally show people pictures which I think will hopefully change people's understanding of how areas in the brain light up and the bone marrow lights up and inflammatory cells are released from the bone marrow. And then the heart cells, the lining of the walls of the vessels, become inflamed. Right. So we're linking these visually so people can see, aha. Stress is not just this amorphous thing that's bad. We actually physiologically see the connection between the mind and everything else and all those hormones that are released. And so I tell my patients, look, you can't change the stressors in your life. You can't change your job all the time. Maybe you can, but you can't change a lot of things. But you can change your response. You can try to turn off your stress response periodically throughout the day, whether that's with exercise or meditations or breathing or taking a walk in nature or putting on your headphones and Listening to music that dialing down is very, very, very important. And so I agree, I think, you know, stress is the ultimate destroyer of our bodies, heart and everywhere else in the body.
- [32:22]
A
But you need just enough. You need like just a little bit. You can't have a stress free life where you, you know, eventually devolve into a vegetative state because you're not stimulating yourself and you're, you know, you can't do that. All you do. Just enough.
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B
Just enough, yes.
- [32:36]
A
So of the science when researching the book, what, what really stood out in your view?
- [32:42]
B
Yeah, I mean, I think, you know, again, one of the real reasons why that excited me and I wanted to kind of write this book was for people to understand that we are innately resilient, that we are kind of hardwired to survive. And I think a lot of people think if something really bad happens to me, I am going to fall apart, I am going to develop ptsd, I can't handle it. And I wanted people to know that we're so much stronger innately than we think, that we are wired. Just like we're wired to have a stress response, we are wired to survive. And I think that's a really important fundamental concept, is that we are very, very resilient. And then the second is that we can build resilience. And there are skills, there are tools again in the psychology world that psychologists have used that, you know, they have training programs that have been developed, for example, not many in this country, but first aid trauma for areas of the world that have had traumatic situations. Or here in New York City, Mount Sinai had developed a resilience training program for healthcare workers during COVID or for survivors of 9, 11. There is the science there of how to teach people to be resilient. It's just no one's really broadened that out and said, let's not just teach this to nine, 11 survivors and Covid healthcare workers. Let's take these skills and teach everyone how to be resilient. Because the psychology research supports that. Let's take these skills and put them in healthcare settings. I mean, my vision for this book and the future would be that every single hospital, every medical center, builds a resilience training program for patients so that when you get given a diagnosis, you're handed also a piece of paper that says, would you like to enroll in our resilience training program? Right. Just like we have cardiac rehab and we have smoking cessation programs and we have nutritionists, give people the tools to, to have the quality of Life and the meaning that they want, even though they've been given this diagnosis and there's no reason that cannot happen in this country, it is not a difficult thing to create a program with the science that exists in psychology, and every hospital should have it. I mean, I would love to give that to my patients. And again, that for me was. Was so much about why I wanted this book to be out there, was for people to really recognize that they are resilient and that they can build it just like you build a muscle, just like you, you know, build anything that you're working on. It takes time and practice, but we have the ability to teach you how to do that.
- [35:12]
A
So you mentioned building a muscle. If someone wants to start working on their resilience muscles, today is their one daily practice. Mindset shift, lifestyle modification. What do you recommend for someone saying, you know, I'm good, nothing's, you know, I got not. I really have nothing to be resilient about at the moment, but I want to build this muscle, so I'm ready?
- [35:30]
B
Yeah, well, you might not have anything to be resilient at this moment, but you will because something's always coming. I think that's the thing, right? Something. Something's always around the corner for us. It's like, you know, one minute you're fine, and the next minute, you know, you've lost your job or, you know, your spouse died or you have a financial issue of some other. I mean, literally from day to day, whether it's a medical or something else, there's always something that we're being hit with. So, yes, it is in someone's best interest to learn how to build that resilience muscle before something happens. And I think, you know, obviously in the book, we lay out the eight steps that I think are important, with the acceptance and flexible thinking being first on that list. You know, I think the second part about building connections and is important, right? We've learned about the importance of social support and strong relationships against scaffolding us. And that's something that people can do before something happens, is make sure that they're not alone, that they're not lonely, that they have a community, that they have someone. Because when that day comes, that something happens. In addition to you turning internally and figuring out how to get fit and be flexible in your thinking and stay hopeful, you're going to need help from outside of you. And, you know, we are not meant to be like insular, isolated human beings. We are meant to have other people in our lives that can help Us. And so it doesn't have to be an intimate partner or spouse. It can be, you know, your church group or your chess group or, you know, a few friends. But we all need other people. And that's something that building connection that everyone can look to start doing so that when that day comes, they have that support built in.
- [37:10]
A
I think this is where men are traditionally much worse than women and they are in maintaining relationships about being open. And I also think men who unfortunately maybe get divorced or single and if something happens, the outcomes are very bad because there's no one to turn to and they often will not share if they're really hurting.
- [37:31]
B
Correct. We all need someone. We all need that. In fact, we just talked about this yesterday in a story I covered on ABC News about how couples who got health interventions did better in terms of their mental health outcomes and their health behaviors when the couple received health teaching as opposed to the individual. And it was, you know, a paper about heart health and, and how we should be treating heart patients. And it was again, an eye opening thing to say, look, we shouldn't just be targeting the patient, we should be targeting the unit. Right. Because heart disease doesn't just happen to one person. It is, it's happening to the couples, the partners. And they have the ability together to work on not just improving the outcome of the person who has heart disease, but preparing the person, maybe who doesn't, the partner, with learning these tools to improve their own health. So again, we're all interconnected and I think we have to start recognizing the importance of again, dealing with that from a medical perspective in terms of how we educate and teach patients. It's again, one of these concepts that we talk about loneliness is bad. But my friend Vivek Murthy, who I trained with at the Brigham, has done a wonderful job in really, I think, again, opening up people's understanding about how detrimental loneliness can be.
- [38:47]
A
We just spent a moment on men. Can we talk about how resilience is different from for women and how women should be thinking about protecting their heart health?
- [38:54]
B
Yeah, well, I mean, women, I mean, I, I help run our women's heart program here at Lenox Hill Hospital. And you know, one of, and I am a spokesperson for the American Heart association and Go Red for Women campaign. And one of the big messages we try to give women is that they don't think about their heart health. They think about, you know, their breast health and their ovaries and their uterus and a lot of kind of the traditional things that women think they're going to be vulnerable to. But we always try to tell women that, you know, heart disease is her greatest health threat, killing more women than all forms of cancer combined. So, yes, I think women, you know, need to understand that they are vulnerable to heart disease, as vulnerable as men are, and take the steps that we try to teach them about, you know, lifestyle and healthy living and paying attention to symptoms and risk factors and all of that to make sure that they can be resilient if something happens to them with their heart.
- [39:43]
A
And women are also so misdiagnosed. With men, it's the classic, like, chest pain. With women, it's not correct.
- [39:49]
B
And that's another, you know, again, we. We have to continue to educate women that for many women, it's just fatigue. You know, I see a lot of women where they're. They just say, I'm just exhausted. I can't do as much as I used to do. I used to be able to do this much. I can only do this much. And that might be the only sign of heart disease. Or they say I might get a little bit, you know, short of breath or winded that when I walk up the stairs or when I fast walk or, yeah, I just have some acid reflux. I mean, women are very good at sort of either downplaying their symptoms or maybe not recognizing. Fortunately, sometimes doctors don't recognize some of these symptoms. And they tell women they're just anxious. You know, you're just stressed out, you're anxious, when, in fact, they have a real issue going on. So it's a big problem that we.
- [40:29]
A
Need to continue, which is so frustrating, by the way.
- [40:32]
B
It is extremely frustrating for a woman.
- [40:34]
A
To be like, oh, you know, just anxious. It's like, really, it is.
- [40:39]
B
I mean, the stories I could tell you about what women have told me they've heard, unfortunately, from other providers. Sometimes it's heartbreaking, you know, So I always tell women, you know, trust, you know, your body, you have to trust it. If something feels off, you know, you need to speak up about it. And in particular, if it's in this area or any of those things we talk about, you know, don't put it on something else like stress or, you know, just being out of shape. Like, talk to a doctor or cardiologist and let them figure that out first.
- [41:05]
A
And not related. I guess it's related to the book. But, you know, we had Peter Attia on recently, and he has a very strong view on cardiovascular disease and goes as far as saying, you know, 19 million people die. The number should be like 19. And that where we sit in at this time, there are so many pharmaceutical interventions where even if you say like, I don't like statins, I got like 10 other options for you and I could take your APOB from north of 100 and high risk to, you know, less than 60 or 50. And it's just insane. And he also goes on to say, like, look like, you know, pharmaceutical industry is not perfect, but this is one area where we're pretty good right now. And, and this goes. And he'll say that nutrition is not the best lever for heart disease. It's fantastic for metabolic health because you could be very fit and do all the right things and still be at risk for heart disease because of genetic factors. What's your take on that view?
- [42:08]
B
I don't think you can pin it on one thing, right? I think that it is the combination effect of lack of exercise and a poor diet and our weight and our genetics and for everyone, it might be a little different. I mean, I do see a lot of people who look like the picture of health. They eat very healthy and they exercise and they're in normal, healthy body weight, body mass index and they have heart disease and they're like shocked. And lots of times it just comes down to the fact that they have their genes. It's, it's, it is genetics, genetics, genetics. So there are some cases where that really is the driver. And then there are other cases where, you know, it is that they're not moving or they're just eating really poorly and, and all of it matters. I mean, I just think it's never as simple as saying it's one thing. It's just like when people say, well, I'm just not going to eat carbs or I'm not going to eat protein or not going. You know, we need all of these things. We need to pay attention to all of these factors to put us in optimal shape to reduce risk over time. You can't just say, well, I can eat whatever I want, but if I'm exercising or I can, you know, not exercise, but eat really healthy, like it all matters.
- [43:16]
A
I agree. I think in the context of for people doing all of the right things, assuming they're not sedentary, you know, eating M&M's all day and all the bad stuff, like relatively healthy but still at risk, taking risk completely off the table. But I hear you. It's a fair point. I'm curious what's been game changing for you? What have you changed? You know, you're on this journey. You're a cardiologist. You wrote this amazing book. What did you say? Like, huh, I could do a better job here. Or this has been. Had a meaningful impact on me personally.
- [43:48]
B
You know, my mental health. I started seeing a therapist over the last probably six or seven years, which I think has been amazing. And, you know, I. That's why. Part of why I feel like everyone should have someone in their corner that they can talk to about their life and what's happening in their life. And so I think for me, you know, exploring what I felt were my issues and what I wanted to deal with and get better at were so helpful for me and helpful for my family. Helpful for me as a wife, as a mother. And, you know, as I was writing this book, of course, things happen in my life too. And I remember thinking, okay, I'm gonna go through the eight steps, the eight tools. And really, you know, I wanted this book to be simple enough that people could literally, in their mind, do that. You know, I didn't want to write something that was like, mired in details and, you know, stats. And I just. I wanted them to be able to say, okay, have I accepted what's happened? And I think about this flexibly. I'm gonna go out and exercise tomorrow. I'm gonna, you know, meet with my therapist, like, literally the checklist. And that's. And I've. And I used. I have used it, of course, in my own life in the past several years as things have happened. But I think for me, therapy has really been life changing in terms of my ability to handle things that have happened to me in my personal life, in my, you know, professional life. So that, that's been a real key and managing stress, you know, actually to be able to have a place to just download. And I will tell my patients a lot of times, they'll say, well, I don't have depression. Why do I need to see a therapist? And I will say, look, it's someone you can talk to. And sometimes just talking about what's happening in your life, just letting it out is enough. Right? You don't need someone to solve your problems or maybe teach you a different way to look through. You don't need CBT therapy. Maybe you just need a place to unload because you're not carrying it all inside on your own.
- [45:41]
A
So we covered a lot today. Is there anything in closing you want to touch on or perhaps leave our audience with some wor of wisdom before we close?
- [45:50]
B
Yeah, I mean, I think the last chapter on purpose, which we kind of touched on briefly. I think we all have that in, in us, right? What, what we feel we were meant to do or want to do and accomplish in our time here. And that can be a really powerful force when things are hard and tough and you can't see your way out of the dark is to figure out what do I want to. To do with my time here? What, what do I want my legacy to be? What is really that drives me, my passion in life, what's meaningful for me. And I think that can be such a strong motivator to carry you through really tremendously difficult situations. So I would hope that everyone really, you know, look inside, find what that purpose is for you and cultivate it and go after it and never, you know, never give that up. Right. Never give up hope. Never give up your vision. Never give up your purpose.
- [46:42]
A
Amen. We'll close there. Thank you so much.
- [46:46]
B
Thank you.