How Stress Can Cause a Heart Attack (And How to Heal) | Dr. Tara Narula

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Well, people obviously come to my office, 'cause I'm a cardiologist, they're concerned with their risk of cardiovascular disease, blood pressure, cholesterol, maybe they've had a heart attack or a stroke, or been diagnosed with heart failure, but usually, that's actually not what's top of mind for them, and that's what was really eye-opening for me, is that practicing year after year, day after day, when I would open the door and walk in and say, how are you? Which is always my first question to every patient, The answer I would get almost universally was, I am stressed, I am depressed, I am anxious, I'm just overwhelmed by everything that's happening in my life. So here you have a cardiologist, but my office space was being filled with people who weren't talking about what their blood pressure numbers were at home, or what their cholesterol numbers were, or if they even had chest pain. They were telling me about how they were feeling up here.

Mm-hmm.

And what was happening to them. Mentally and socially, and in terms of stress, the amount that people are carrying on a daily basis, and it's overwhelming. And for many people, just having that space to unload and just say, I'm not doing okay, many of them would cry or kind of—

Hmm.

To have a safe space where they can be vulnerable and talk about things that they don't talk about with anyone is probably one of the most meaningful things for me as a doctor, to know that I'm able to provide that. and just being able to listen, just being a listener for people, there was so much value there. And I saw it, I saw it when people would cry and say, thank you so much for letting me tell you this and for listening. A thank you for that, not for, thanks for getting my blood pressure less than 130 over 80.

Yes.

Or, you know, for sending me for that scan. And so, it just became so apparent to me in my cardiology practice that we were really missing the boat in terms of what people really need, Which is a medical community and a practice that focuses on people's mental and psychological well-being.

Gosh, that's so interesting.

These worlds are totally separated, and it's a big, big problem.

As a cardiologist, then, when you see people coming to your office, do you feel like it is the disease or the pain that is causing them stress and anxiety, or stress and anxiety that is causing them heart pain, chest pain, or physical disease?

I think it's definitely both. So certainly there are people who have had something really bad happen to them and they aren't feeling well and that causes them stress. On the other hand, there are stressful situations in their lives that may be giving them chest pain or difficulty in their physical aspect. And so it really is this bridge. And I think that's what's really important for people to recognize is so often we say there is a mind-body connection, We toss it out there, but we haven't done a great job explaining to people how intricately tied what happens up here is to here, and what your body— how intricately tied your body is to your mental wellbeing. It's like this circle, this cycle, and you have to fix both. You have to fix the mental wellbeing in order to address the physical. So, I can't have patients buy into taking their medications or even going for a test if they're suffering. And they don't even wanna leave the house because they're depressed, or they're dealing with financial issues, or their son has a drug addiction, or their husband is ill. They can't take care of their own needs because they're drowning under the weight of everything else that's happening in their life. And we are just not built right now as a medical institution to tailor our care to mental wellbeing.

Have you seen patients come into your office who have high blood pressure or high levels of anxiety and stress in the beginning, Then talk to you and kind of unload and maybe cry or just feel like they have a safe place to be seen, heard, and valued. Do you see their blood pressure come down just from like a 30 to 60 minute conversation?

You definitely can. I mean, we usually take the blood pressure more than once anyway for that reason. People come in and they're definitely very nervous initially, and so their blood pressure might be really high, and we always take it again. But I think the biggest thing for me is, number one, providing a space for people to open up and talk about Number 2 is validating and normalizing that it's okay to not be okay. It's amazing the response that people will give me in just saying, thank you for telling me it's okay that I don't feel great. And then the 3rd is, I really focus on telling people to seek therapy. So, here you have a cardiologist who's pushing therapy with so many of my patients. And again, many of them say, wow, I didn't think that you would be telling me to see a therapist. And that's really where that piece is that's so important, that in order for me to address their heart health and their cardiovascular wellbeing, I have to get them to buy into addressing their mental wellbeing.

That's interesting.

And so often, I will tell them, you don't need to see a therapist because you have a diagnosis of depression or anxiety. You can just see a therapist to have a place to go once a week or once a month to just talk, to just download. There's so much relaxation and dialing down of the stress response that comes From just communicating and verbalizing how you're feeling. So, that alone, having someone in your corner who's nonjudgmental, can do wonders for just helping you decompress and take the stress level down.

As a cardiologist, are you able to prescribe therapy? Like, can you write a script and say, go to a therapist?

I can refer people to therapists. The problem is, as you know, we have a crisis in this country. We don't have enough mental health practitioners. And so, many times, my patients will say, I can't find a therapist. The waiting list's like 2 months long.

Yeah, yeah.

They wanna charge thousands of dollars. I can't afford it. So, again, it's just frustrating because this is such an important area, not just for, as I talked about, the healing power of dealing with it, but it's prevention. So, in my world of cardiology, we wanna prevent, that's the key, preventing someone from having a heart attack or a stroke by controlling all these risk factors. So, if we deal with the stress and the mental wellbeing, we're actually helping prevent disease in addition to helping people heal from disease.

What are the main causes of a heart attack or a stroke?

So there are many risk factors, but typically for cardiovascular disease, we kind of dial it down to maybe 8 or 9 different things that range from your age to your family history, which is really important to know, to whether you have high blood pressure, cholesterol, diabetes, smoking, your weight, exercise, sleep, and then stress and mental health are a big one. So in all of my patient encounters, I ask, what is your stress level? Do you have any diagnosis of depression, anxiety, PTSD? Um, because it's important to recognize that.

Have you ever seen a patient come in who had, like, great-looking health? They were super healthy, they had a 6-pack, they were shredded, or they were— they looked very healthy physically, but they still had a heart attack or a stroke because of stress and their emotional state?

So, for example, there is something called a stress-induced heart attack, a real Entity in cardiology that not many people know about, and you can be super healthy physically. Yes, your arteries actually are relatively healthy, but you release this massive outflow of hormones like epinephrine and adrenaline and cortisol, and all of this hormonal surge stuns the heart. And so we call it takasubo cardiomyopathy. Takasubo is a Japanese octopus trap. So when you look at the heart in these situations of stress-induced heart attack, it actually has this balloon appearance to it, like this Japanese. octopus trap where only the bottom or the base of the heart is pumping. The rest of the whole kind of, we call the apex or the tip of the heart, is stunned and really just dilated and enlarged and not working very well.

A block is just not pushing blood through?

Only, yeah, sort of like a dilated muscular part, the outer part of the heart that's not really contracting. It's not contracting well. Only the base of the heart's contracting. So, a lot of people can develop heart failure and arrhythmias. Some people can die from this stress-induced heart attack. Most people will recover, and interestingly, we see it predominantly in older women. So again, this is a phenomenon where somehow women seem more vulnerable to this stress, and it doesn't have to be a negative stress. We see this sometimes even people who win the lottery or something that's really positive. It's that same massive surge of those hormones, and that's why it's so important for people to understand these aren't just Concepts, we say, oh, stress is bad. Like, literally, stress can cause a heart attack. Um, and so, this entity of stress-induced heart attack is one where the actual arteries to the heart look relatively healthy. But then, there are people who have stress-induced heart attacks who have plaque or blockage in their arteries, and the stress itself causes that plaque to rupture.

Hmm.

And that can lead to a heart attack, or stroke, or an arrhythmia, or sudden death. So stress is really, in my opinion, our biggest health threat in this country and one that we just have not addressed enough.

It kind of sounds like if you have, you know, 7 or 8 of these other conditions that kind of build up in your body or in your heart, that it sounds like if you add stress to it, it could be the thing that finally, like, I guess, breaks the camel's back. I guess that is the thing that It's hard to come back from if you pile that on top of anything else as well.

Yes, or even in and of itself.

Just by itself.

Yes, and that's why it's so important for us—

That's crazy.

To learn how to turn our stress response off, because our stress response was designed to help us survive. It is an innate biological process. We see it in the animal kingdom, so that if you're out in the wild and something's chasing you, you turn it on. And you turn it on in order for your blood pressure to go up and your heart rate to go up and your breathing to go up so you can run and escape. At the same time, you turn off all the nonessential functions like digestion and growth and reproduction. So, this beautifully designed system is help— meant to help us survive in the wild. The problem is that in our lives here at Los Angeles and in my daily life in New York, people are constantly turning on the stress response. chronically, day after day, hour after hour, for every single insult. They get a phone call that they don't like, their kid has a problem at school and it makes them upset, they have an argument with their coworker. And so you imagine, you literally imagine people walking around with this stress response turned on in the dial 10 position every day over and over again. And that is where we see it become really, really damaging.

Mm-hmm.

And so actually the father of modern stress research, that this field is relatively new, dates back to like the 1930s, said, His name was Hans Selye. It's not the stress that kills us, it's our response to the stress that kills us.

Hmm.

And so, really, the response is meant to get us back to this state of what we call homeostasis, right? We don't like to be out of whack. So, when you have a fever, you shiver to kind of get your temperature back to normal. So, when something happens, you do all these mechanisms, you know, biologically to help you survive, but then you wanna go back to that resting state, that homeostasis state. The problem is that when you're turning the stress response over and over again, You actually move away from that. And so, again, the original father of stress research said there are like 3 phases when someone is under stress. The first was an alarm phase. Oh my gosh, what's happening?

Mm-hmm.

The second is a state of sort of pushing against it or resisting the stress. And the last is exhaustion. You literally burn out because you just cannot fight anymore. And that's the part where we see people get chronically sick from chronic stress.

And it seems like burnout is happening more than ever now, right?

It, it's everywhere, in every, in medicine, in the field of medicine, and in everyone's everyday lives.

So first is the alarm phase with stress.

Yeah.

Then it's the, let's push through this.

Let's resist it. I can't believe this is happening.

Okay.

I'm gonna fight against it. And then when you're, you know, it's just on all the time, eventually you sort of become exhausted.

And you burn out. And you burn out. And then you're living in burnout, just trying to survive, I guess.

You are living in burnout, trying to survive.

Emotional survival.

Yeah, right.

Gosh, this is interesting. How much training did you have around navigating emotions when you were going to medical school? Zero.

I mean, people ask me, why did I write this book? What do I hope this accomplishes? I hope that this ignites a fire under every single medical institution and hospital and, you know, training program to say we need to do a better job integrating psychology into clinical medicine, because we keep them totally separate. So the fields of psychology do their research, medicine practices, and no one is connecting the dots. No one's teaching medical students, this is really important for you to ask about. No one's building it into how we treat patients, and no one's teaching about the stress response and how to change that. And so, that's why I feel like we're really missing the boat here in medicine. So, I hope that whoever's listening says, you know what, we should invest in teaching more of this. In our training programs, we should invest in building resilience training programs so that when I hand a patient a diagnosis, which is a whole other form of stress, I'm also handing them a prescription for how to walk through that moment.

Right. So when did you start to you know after decades of working with patients, when did you start to realize just prescribing a treatment isn't necessarily the solution that's going to give them the best results?

It definitely was, as you said, not something that they teach us. It was just sort of being in practice. And initially, my interest was much more in the stress reaction, and so, I gave a lot of talks on stress. And then, when I was approached to write a book by my publisher, and they said, well, we would be interested in having you write about COVID and diets, a COVID diet book. Is that something you wanna write about? And I said—

COVID diet?

Yeah, like, what diet can we give to people who have survived?

Oh, okay.

COVID and may have gained weight through the pandemic.

Gotcha. And you're like, I don't want to do that.

I said, I mean, I talk about diets all the time, but what I really want to write about is resilience, this concept of transforming a stress response into a resilient response, because that's the other half of this. So, we can sit here all day and talk about how bad stress is, and we should educate people about that. And in the first part of the book, we talk about that, but the whole second part, and the part that really is where we need to be investing, is How do we actually help people dial down the stress response and know that they can survive whatever life throws their way? And that's really what fascinated me from the time I was a little kid, was people who've been through sort of any kind of tragedy, and we see it everywhere. I see it in the stories I tell in the news, I see it in my patients, I see it in my family, I've had my own experiences, and you realize all of us are gonna face some sort of challenge at some point. And so, how do we thrive—

Hmm.

After we've been hit with some sort of, challenge, because that trauma or challenge elicits that stress response. So we need a way to combat that. And so creating a resilient response, as we talk about in the second half of the book, is the way to give you the power to say, I am not subject to what happens to me in my life. I can actually take control and figure out how to create a life that has meaning and purpose despite what has happened to me that has changed the trajectory of my life. Wow.

Did you struggle a lot growing up with learning how to navigate stress? Or was it always kind of easy for you?

You know, my, I had a really, I would say, easy upbringing in a lot of ways. I had 2 wonderful parents. My mom was one of the moms that sort of did everything for my brother and I. Oh, you need this? I'm gonna go get it for you. Let me make your sandwich. You know, she was very much the doer and the fixer. Um, but my father's an immigrant from India, came here with no money and built his whole cardiology career himself. And so I heard a lot of those stories and I think hearing those stories of coming here from someone else and really scratching out and carving out your life, and my father always telling my brother and I, no matter what happens to you, you can survive. He literally would say those words to us. So I was sort of infused from a very young age with this idea that whatever life throws our way, you can get through it.

You can handle it.

You can handle it. And then when I was in medical school, I had my own event where I lost vision in part of my eye.

Really?

And that was really a turning point for me when I became the patient of saying, oh my God, how did this happen? What does this mean? How do I walk through this diagnosis?

When you were young?

And I was 22.

Was it stress-related? Was it some other event? Was it—

No one knows.

Really? Just one night you were just like, I can't really see, it's kind of blurry here.

I didn't even know really what was going on. I knew I was in the lecture hall and I would see like colored lights out of the bottom part of my eye when they would turn the lights down to show us slides. And I thought, well, that doesn't seem normal, but I'm sure it's nothing. And I went home to South Florida, and I had some tests and they said, well, actually you failed your visual field exam and you have no vision in this bottom part of your right eye. And I said, how could that be? I'm healthy, I'm 22, I don't have any other medical conditions. And they said, well, you could have multiple sclerosis because that can cause that. You might've had a stroke.

Wow.

They didn't know. And they said, you have to have a brain MRI every year for the next 5 years. And I thought, I'm just Starting my medical career. I'm 22, and now I have this unknown diagnosis, and I have to have scans for the next 5 years that might show something or might not. And that was really the turning point for me. I think we all have that moment where I thought I was like spiraling, really. It was like the lowest, scariest point in my life. And I always tell the story I tell in the book that my mom sent me the Serenity Prayer on a little note card. Oh, that's beautiful. And with a little letter that said, you know, read these words and you can spend every day from here on out worrying about what might happen and waste all those days. Or you can just put one foot in front of the other and move forward. And maybe that never happens, right? 'Cause I was afraid, what if I lose my whole vision? What if I can't walk? Yeah.

It's almost like the fear of the diagnosis.

Yes.

Could cause you to have more challenges in the future than actually Correct. What would come your way? You know, it's like the anxiety around the unknown maybe causes more problems sometimes.

It causes so many problems. And that is like, for me, when I tell someone, you have heart disease. So someone like you comes to my office, you think you're totally healthy. I send you for a scan, like a calcium score that shows plaque in your arteries, and you're sitting in my exam room and I say, Lewis, you know, your scan showed you have coronary artery disease. And your whole world is—

You're like, am I gonna live? How much time do I have left? What can I do? Do I be on medication? What are my kids? And you start ruminating, right?

Exactly, ruminating. And this was the other reason when you asked me what was the turning point for sort of writing this, was telling people they had just had a heart attack, or a stroke, or they have a heart failure diagnosis. And every single patient would sit there and look at me with exactly that look of fear and paralysis, that their whole world has just been turned upside down. And it's a trauma. And I recognize that no one calls a medical diagnosis a form of trauma. Nobody talks about that. But we should, because when you tell someone you have breast cancer or colon cancer or heart failure, your whole world is turned upside down and you're afraid.

You're terrified unless you've been educated for years as a doctor and you know what the pros and cons are or what you can do or treatments. You ever grab the healthier snack, take one bite, and immediately wish you'd picked something else? If a habit feels like punishment, you're probably not going to stick with it. Look, committing to yourself starts with building habits that you can stick to. That's where Stars and Honey comes in. Their protein bars have 15 grams of protein and only 4 grams of sugar. Toss one in your gym bag, keep one in the car, or bring one to the office. And you don't have to choose between nutrition and taste. Try iced lemon cookie, mint chocolate chip, red velvet, or peanut butter mousse. Order Stars and Honey protein bars at starsandhoney.com or find them at Target stores nationwide. That's starsandhoney.com. Or pick up a box on your next Target shopping trip. Support for this episode comes from Ring. Whatever shows up around home this holiday season, with Ring, you're protected. The holidays get busy fast. You're running errands, gifts are showing up at the house, maybe you're traveling, and that's a lot happening at once. One thing I really like is being able to check in when packages are arriving at the front door with Battery Doorbell 2K. When you've gotten gifts being delivered and you're not always home when they show up. Indoor Cam is small and easy to set up. Just plug it in and place it pretty much anywhere inside. And Outdoor Cam Plus gives you retinal 2K clarity for your yard and outdoor spaces. Ring helps you stay connected to what's happening at home so you can spend more time enjoying the holiday moments that matter. With Ring, you're protected. Shop cameras, doorbells, and more at ring.com. As a loyal listener of this show, you're always challenging yourself to grow, to be better, to keep learning, and Southern New Hampshire University can help. Southern New Hampshire University offers over 200 career-focused degree programs online. Plus, Southern New Hampshire University has some of the lowest online tuition rates in the US, so balancing school, work, and life actually feels achievable and affordable too. Find your degree at snhu.edu/greatness. That's snhu.edu/greatness. How important is it for anyone to learn how to give bad news? You know what I mean? Not just a doctor, because doctors have to give bad news all the time, I guess.

We don't always do it the right way. We should.

Did they teach you how to deliver bad news?

That's a great question. I feel like we fail a lot in the department of emotional intelligence in medical training, but it is—

But I'm hearing you say it's a trauma just receiving bad news.

Yes, it is. And so, yes, To answer your question, we should be teaching people how to give the news, because the delivery and the communication matters in those moments, right? But I think the second thing that became apparent to me is that people would look at me and say, when am I gonna be myself again, Dr. Narula? When am I gonna feel like my old self? Because I don't feel like that right now. I feel petrified that tomorrow I could have another heart attack, or I could have another stroke and now not be able to walk, or I could die, 'cause I just had an arrhythmia and I have a defibrillator in now. What if it doesn't fire?

Hmm.

And so it was those conversations where people would say, when will I be myself again? And I would look at them and say, you will never ever be yourself again. But, and here's the thing.

Oh man.

But you can be something that is totally different and totally new and totally beautiful where you can have a life where you can thrive, a life of joy and meaning and purpose and value and happiness. We just have to help you on this new road, but you can get there. So I think it was this recognition that you're breaking away from this vision that you thought you had of your life. It was going down one road and now you're switching in a different direction and that's okay. And allowing people to recognize that there's that flexibility there, that life is not always the way you planned it for anyone. You know, Yeah. From your own life.

Of course.

Right.

Yeah, of course.

So—

It's relearning how to reinvent yourself when you get that type of news or diagnosis or whatever it might be, that trauma, you know, that you're experiencing.

Yes.

It's like, how do you reinvent who you're gonna be moving forward?

How do you not let it destroy you?

Yes, exactly.

How do you let it change you into something that, that allows you to actually do good in the world and to feel happy and to do all the things that we're meant to do when we're here on this planet? We have one life.

Yes.

And so we wanna make the most of it. And so the worst thing would be if a tragedy or a trauma happens to you and it makes you unable to be the most beautiful, best version of who you could be. Maybe something different than you might be, had had in your mind, but it can still be great.

So how did you learn to navigate that traumatic stress that came to you when you had, you know, blurry vision through an eye and you realized like, I have to do all these tests for the next 5 years and who knows? Am I going to see after that? How did you respond? Did you respond well or respond in a way that caused more anxiety and stress? What happened?

I think for that first month or 2, I was not responding well. Anytime I felt something, numbness in my hand, I thought, oh, here we go. It's multiple sclerosis and I'm losing feeling in my hand. Or I would be walking to my medical school class and I would trip and I would think, there it is. I'm losing my balance. You know, month or two were like crippling. And that's why I say I understand what that feels like.

So you were finding confirmation of all the bad stuff.

I was seeing it everywhere, even if it didn't exist.

You were making it up in your mind.

I was making it up in my mind because the fear was so— it was consuming. And so that's when I got the Serenity Prayer, and I really took my mom's words to heart and the words of the prayer, which is about accepting the things you can't change and changing the things that you can.

Do you know the whole prayer? Do you have it memorized or not?

It's just the 3 lines that she sent me. God grant me the serenity to accept accept the things you cannot change, the courage to change the things you can, and the wisdom to know the difference.

Mm-hmm.

So that was really part one. And then part 2 of what helped me at that time was, you know, we talk a lot about resilience, about role models. And for me, I found, um, a book by Richard Cohen, who was a journalist, uh, married to Meredith Vieira at ABC News. And he had multiple sclerosis and he had multiple bouts of colon cancer. And he wrote a book called Blindsided. And I read this book at this moment in time. It came to me. It was almost like serendipity. And, and I read how Richard walked through his diagnosis and his life, and he still had 3 children and he still continued to work and he still was married and had this loving relationship. And I thought, if Richard Cohen can do all of this and live this great life despite having multiple sclerosis and not being able to walk as well and losing vision, And then getting cancer, I can do this. And so it was that too. It was seeing someone else be able to just move down the path they wanted to and not become, as Richard calls it, the victim, not become defined by your disease. So often it's easy for us to say, I have heart disease, I'm heart disease, I have colon cancer, and that becomes your entire identity. And the disease takes over who you are. But to say that's a part of me, that's not all of me, and I'm going to continue. I'm going to deny that, as Richard says, he used denial in that way, that my trajectory or my path is going to be what you might think it is.

Right.

I'm just going to keep going down the road I want to go and dealing with my life and the things that come my way. So it was those 2 things, Lewis, that helped me navigate that very stressful time. And I think, again, founded my interest in this idea of why teaching people how to move forward from a traumatic event, whether it be a medical diagnosis or any other trauma, is so critically important.

I mean, if someone takes on the identity of a victim, yeah, when they receive traumatic diagnosis physically or emotionally, and they hold on to a victim identity, yeah, how much harder is it for them to overcome that challenge with the victim identity they're holding on to?

So hard. So hard. And it's not, it's not fair. You shouldn't have to carry that because that's not you. There's a beautiful book that I reference in my book that I read when I was doing a CBS News story on a woman named Sonia Wasdin, who wrote a book called An Impossible Life. And she suffered from bipolar and she had had multiple suicide attempts. Her daughter actually found one of her suicide notes.

Wow.

It was a very difficult life. And she realized that, as she says, she could still have a beautiful life. That she could still have this amazing life. It wasn't an impossible life, as she titled the book, despite having all of this mental health, you know, real mental health disease. She could navigate it. And she has, you know, a beautiful life now. Her marriage is intact. She's traveling around the country with her daughter donating her book to libraries. So it just shows you that no matter what happens to you, no matter how difficult it is, Mm-hmm. You can still be not only an agent of change for other people, but you can have, find meaning for yourself.

Are there any patients that come to mind without saying their names where they, they held onto the victim identity and that you really saw them go downhill afterwards? And then also others who maybe they're in really bad shape. You're like, I don't know about this person, if they're going to make it or not, but they took on an identity of inspiration, hope, possibilities, and not a victim identity, and you actually saw them turn it around and live a better life?

Totally. I mean, thankfully, I will say that for a lot of my patients, even if they started out with that victim mentality, we would talk about how they shouldn't feel that way and how they should put one foot in front of the other and just keep going forward, and that with time, the fear would dissipate. And so, a lot of them were able to move through that. But, there are other people who almost off the bat immediately Their outlook is one that is so full of hope and optimism and faith and a lot of the skills that I talk about that they really were able to walk through whatever their challenge was much easier and faster.

Mm-hmm.

And, you know, that's why in the second half of the book where I talk about the resilient response, it's really this idea that it becomes a kit for you to use. And the more you practice these techniques, whether that's staying fit or an acceptance mentality or flexible thinking or having hope or having social support, the next time you face a challenge, you're gonna be better prepared because you've practiced it. You've fired those pathways in your brain. You're more used to pulling on that from your toolbox to utilize it. And so I think the people, and this is why I may, if I ever write a book again, it'll be a children's book. I think we need to be targeting our youth.

Yes.

Because the earlier we can start training people, kids to think in that way, the better capable adults they will be in terms of navigating life's challenges. And my patients have informed a lot of my work. I think of this one patient I had who, I tell the story, he went in for a routine surgery, not a cardiac procedure, and something went wrong, and he came out almost legally blind. And he came into my office—

Did he see beforehand?

Yes.

Oh, wow.

And it was like a medical complication.

Oh, no. Oh, gosh.

And he came into my office, and you can imagine, I mean, this is horrendous. And I said to him, and he was like a shell of like who he had been.

Oh.

And he used to be, you know, totally vibrant and had a, he was physically exercising all the time and biking, and he had a career, and he couldn't do any of those things. And then I saw him 6 or 7 months later, and obviously had not gotten his sight back, but he was, there was like a lightness to him. And I said, I said to him, What helped you? How did you get to this point? And he said, to me, it was 2 things. Number one, I accepted what happened and I realized I couldn't take it back, I couldn't change it. And the sooner I accepted it, it opened me up to being able to heal. And the second were my friends. He said, my friends take me out on their fishing boat and, you know, they make me laugh.

Wow.

And they show me that there's still so much joy in life. So my friends and acceptance. I have other patients who've told me other strategies they've used, but a lot of what I talk about in the book is not just what I've read in psychology and what I've seen in my own life. It's what I hear from my patients telling me they've used to help survive and move forward.

I'm a big believer in, you know, developing our mindset to heal ourselves and having the correct mindset that can encourage healing, encourage peace, encourage alignment within ourselves. And when we have alignment within ourselves, I feel like our body gets into alignment as well. Have you seen any cases where people have really stepped into belief in God, spiritual belief, and that you've seen incredible healings because they believed so much in the power of God?

I'm so glad you asked that because I do feel like this is another area that we don't talk about a lot in medicine. Um, actually, one of my first projects as an intern when I was in training in Boston at the Brigham and Women's Hospital, we were allowed to do a project on any topic, and I picked spirituality in medicine, because I am a very spiritual person, and I believe that there is a real role for spirituality for our patients, and it's important that we ask about it. And so, you will find there is a growing movement in medicine to take a spiritual history, where you ask people about their spirituality.

Interesting.

Because it informs what kind of care they want. Do they want a defibrillator, or do they want to die if their heart goes into arrhythmia? Do they want a blood transfusion or not? What do they want to happen at the end of their life? So, we're, again, neglecting asking about this really important aspect of people's lives. But, as you said, it also helps them in times of challenge. And, I've had so many patients tell me that what pulled them through was their faith.

Really?

Was their faith. And, there is also a body of literature, albeit not the traditional, but that does show the power of prayer in terms of healing. And the power of that mindset belief that you will get better and that you have someone else in your corner, a spiritual being that helps you get better. So, there's no question that that is very powerful. And that's why I really, I wrote an entire chapter dedicated to faith and spirituality because I believe that that's so meaningful.

That's interesting. If stress is one of the main causes of, I guess, disease, not just heart disease or stroke, but if it's one of the main causes of a lot of different diseases, and if prayer brings people peace, then it sounds like it's a good prescription as well to use prayer to create more peace.

Anything that dials down your stress response, you know, so when people say like, how do I turn my stress response off? For everyone, that looks—

Yeah, yeah. Meditate, walk, right? Nature, whatever, prayer, whatever, my—

whatever it is. And therapy, music. For everyone, it's a little social connection. Go out and have coffee with someone.

Yes.

Be in nature, mindfulness, breathing, sleep. There's all kinds of things we can do, but it is very particular to the person, and that's why it's really a personal matter. The same prescription is not going to fit for everyone, but for some people, that time where they're in a church or a temple or they're in prayer, is the time where it's almost like you're in a state of meditation and you are dialing down the cortisol and the epinephrine and your breathing changes and all of that is a reset. It's a turning on of that parasympathetic calming part of your nervous system as opposed to the fight and flight sympathetic part.

What percentage of our days, our waking hours, do you feel like most people are in fight or flight mode?

In New York City where I see patients, it's probably like 90%.

Really?

It's a lot.

So if a human being is in, you know, let's say above 50% of their days in a, uh, fight or flight, you know, scarcity, their nervous system is on higher alert rather than a relaxed response, how much more likely are they to have some type of complication physically later in life?

There's no question. Again, you can look across different fields, but I'll speak to cardiology and in particular, which is the leading cause of death for men and women, that, that chronic stress, it causes plaque rupture, it causes the buildup of plaque, it causes inflammation, it can lead to arrhythmias, and heart failure, and heart attacks, and strokes. So, there are real physical consequences. And, one of the nice things that has happened in imaging world lately is we can see pictures now of what's happening in the body when people are under stress. And so, for a long time, stress research has been really hard to conduct because how do you tell what the effects are. But now, with PET scans and functional MRIs, we actually see the areas in the brain lighting up when people are under stress, at the same time that we see the inflammatory cells in the bone marrow, and the inflammation in the lining of the blood vessels. And you can very quickly, easily see this picture in front of you of how it's all tied together.

Wow.

So, it's very hard to ignore that stress is this damaging when you see it on the imaging scans. And so, this is really the future, I think, of stress research, and hopefully opening people's eyes to the negative effects of stress. But there have been other big studies. There was a big 52-country international study that showed people under chronic stress are twice as likely to have heart attacks. There are studies where we have people do mental stress exercises like subtract by 7, and you can see changes in blood flow to the heart just by being under that mental stress of doing arithmetic.

I used to be so stressed in school doing tests. I would just be anxious all day. The day before stressing, Trying to memorize all these different things, and I was just like, "I'm not a fan of tests." Yeah, I'm not either, nor of math. Yeah, right, exactly. My friend, I hope you're enjoying this episode, and the School of Greatness drops new conversations every Monday, Wednesday, and Friday around money, mindset, healing, manifestation, and relationships. And if you're not yet following the show, then you're missing all of them. Please tap the follow button. right now, and you'll get notified the moment every new episode drops because the next one might be exactly what you need. Now let's get back to the conversation. The School of Greatness is proudly sponsored by Amica Insurance. You know what they say, if you want to go fast, go alone. If you want to go far, go together. So go with Amica and get coverage from a mutual insurer that's built for their customers, one that looks after what's important to you together— auto, home, life, and more. Coverage that fits your unique needs. Amica helps you protect what matters most. Visit amica.com and get a quote today. When you're at work, you never know when you'll be interrupted. But with the Dell Pro powered by Intel Core Ultra with vPro, no matter what distracts you, your laptop won't. It's battery optimized for the way you work with built-in intelligence that quiets distractions when you need to focus. Your laptop will help keep you locked in even when it's bring your dog to work day. Built for those who stay in the flow, the This is interesting. So how much of stress is mental related?

I mean, again, the stressors happen to all of us all the time.

It's how we, it's how we observe it and how we—

It's how we choose to respond to it and react to it. And again, we're human, we're all going to have that response of Oh gosh, you know, I didn't want this to happen, or this person in front of me in the traffic, it just, you know, irritated me, or this didn't go right at work. It's gonna happen. But recognizing that you don't wanna stay in that state of being turned on, you wanna turn off is really what's key. And you wanna try to maybe let things go.

Mm-hmm.

And you wanna try to use some of these other outlets. Um, I like to talk a lot about like the micro moments in your day. Where you're turning the stress response down. And I was telling the story recently of, for me, many times that's just like holding my husband's hand when we watch TV on the couch or in the car. We'll be driving and he'll take my hand and hold it. And there's that physical sense of connection and touch that I can just feel peace.

Peace.

Yes, it just dials it down. Or we have a house in the country, walking outside and just being in the trees and the breeze and hearing the birds and That's helpful. So it's those small moments you can find in your day, just like the small moments where the stress response gets turned on. There are equally enough moments that you can find to do things where you can turn it off. You just have to pay attention. You have to pay attention that this is a problem and you have to prioritize not allowing yourself to be chronically turned on in that state.

Over the last 10 years, have you seen people become more stressed because of social media, their phones, AI?

The news and politics. That's what I hear all the time.

Really?

All the time. When I say, how are you? And they say, I'm stressed. And they say, I don't wanna watch the news anymore. And I say, I know, I work in the news, but I get it. But it's very difficult for people right now. They're telling me what's happening and what they're seeing in the country is giving them an intense amount of stress.

It's so interesting. My dad never let us watch commercials or the news. Yeah. Um, because of that, you know, I was growing up, whenever a commercial— and, you know, unfortunately, I think it's what, like 30 or 40% of all commercials are medical related, something like that.

Yeah.

And so if it's all about, here's the problem you're going to have, or if you have this problem and here's all the side effects, right? If you're just constantly being programmed to watch and listen to that, right? And see visually, like, oh, this is what, you know, skin condition you might have or whatever it might be. It's like you're programming this and it's causing anxiety and stress. Even if you don't have it.

You have this.

What if I have this? I need to remember this and I need to take this. And he was like, I never want you to watch the news. Um, he's like, I want you to be informed on what's happening, but not watch fear-based news, which is kind of all news. It's like you have to show the chaos in order to get people to watch. I like reading a newsletter and just being like, here's what's happening today in the world. Here's what's happening that you need to be informed on.

Yeah.

But not be tied into your stress around watching it.

But that is where we're at right now, unfortunately. Like, I literally have patients tell me they do not wanna watch the news, and I say to them, that's fine, don't watch the news then, because if that's giving you stress, I don't want you to be under stress.

Yeah.

But I agree. I mean, social media and screens and that whole world too. I have 2 young daughters, and that's a whole nother road of stress that parents are trying to navigate in particular. It's tough. It's a tough time we're living in right now.

What advice would you give me as a father of twin girls under 1? You know, yours are a little bit older now, I think 8 and 14, I think in that range. But as they get older and they're facing a whole new world, like, so I was 21 when Facebook came around for my college, uh, and then all the other social medias, you know, afterwards. But I grew up without it and then I kind of had it in my early 20s and I still have it now. I grew up without AI, but now I'm using it. But your kids, my kids, are growing up in that right away. What advice would you have for me knowing what you know now with your daughters?

Well, I think we like to teach our kids, first of all, we have not allowed them to have social media and my older daughter's 14.

Does she have a phone or no phone?

She does not have a phone.

I like that.

Let's go. Yeah. And I will give my husband a ton of credit too for this. He's been really good about, you have to really be But in some ways, social media aside, there is just the addiction of going to something for an answer. My kids will say, well, I'll look it up. And we say, we don't need to look everything up on the phone. You don't need to have that need to be satisfied every single second. It's just this constant craving for, well, let me look it up, or let me have the phone, or let me— I'm bored or I'm anxious, so I'm going to go to the phone to ease my anxiety. And so, we want them To be resilient. We want them to be able to be bored and deal with challenge without relying on a device to get them through. And then certainly we don't want them comparing themselves to other people, and that's a whole nother world. But we have had so many conversations with my kids about just being authentically you. And the problem with social media, I think, is it makes you feel like you're not good enough.

Yeah.

It's very hard as a young person to feel you're okay being authentically you. When you're being told that you should be this or you should be that. So a lot of the conversations with my 14-year-old are around being happy with who she is, that she's amazing exactly as she is. And that's what we want her to believe in.

When a young woman is comparing themselves to other women on how they look physically, or a young man is comparing themselves to another man who has more money or is more muscular or more attractive than them, per se, How much does comparison of what you don't have make you stressed and cause you to have more stress and disease?

How could it not? How could it not? When you're looking at something and then it's making you feel like, well, I should have that and I don't have that, or it's making you feel depressed or bad about your life or anxious about something. All of this data that we're seeing that we think is harmless is doing exactly that. I think your dad was right on. To take that off the table, take that away. And that's really what we're talking about with taking the social media away and turning it off is living in the present moment where it's really your interactions with people that are defining your daily life and how you feel about yourself or what you are doing every single day, your actions. It's not this fake, I think what's happening.

Yeah.

It's destructive on so many levels.

I'm sure I'm going to make a lot of mistakes and not be perfect, and I'm going to be on my phone more than I should and all these different things, but it's a reminder of myself not to do those things. But I was with my wife yesterday. We were having lunch at this restaurant, and I saw this father with a daughter who's probably like, I don't know, 10, maybe 12, maybe 13. I can never tell how old these young girls are. I'm like, I don't know, are you 8? Are you 16? I don't know. It's like— She was probably like 10 to 13 range. And I saw them talking for a few minutes, but then the whole rest of the meal, she was on her phone while they were eating and taking selfies and texting with people. Anytime I glanced over there, she was on her phone and the father was not. And I just felt so sad.

Yeah.

To see the father who maybe was going on a date with his daughter or taking her out, whatever it was.

Yeah.

But she was on her phone the whole time. Uh, from my observation, from my wife saw as well. And I was like, gosh, how do we make sure this doesn't happen to us? You know, how do we as parents make sure that we're modeling the right things, that we're not on our phone when we're around them so they don't do the same thing? All these different things. It's like we have to also have responsibility and check ourselves and ensure that we are being present. I'm assuming.

Totally. And I, I'm right there with you. My husband and I went out to dinner actually this summer, and we were at a restaurant and the Husband and wife and 2 kids, all 4 of them were on devices for the entire meal.

Oh my God.

The husband and wife didn't talk to each other.

No.

The kids weren't talking to the parents. My husband and I sat there and we felt, again, sad.

Yeah.

Sad for all of them because they're missing out on these moments of connection that are so important. The time that is so precious, especially with your kids as they're growing up. Yeah, I think it's, It's tough. It's a battle. There's no question. We face it every day when I hear, well, my other friends have a phone or my other friends have this. But, you have to fight the good fight, I think. And, we're learning more and more. We talk about it a lot in the news about the real damaging effects of screens on kids in particular because their brains are not developed yet until they're 21. So—

If a kid is, I don't know, 6 until 16 and they're on a phone for hours a day and they're using social media, how much does that impact their brain in a negative way?

It's totally changing the wiring and the firing and the way the brain is functioning. So, it looks harmless, but it is not. And, we just did a story on this recently, but it's that quick dopamine hit every time you see something. And so suddenly the real world where you don't have a dopamine hit every single second because it's boring sometimes or quiet becomes unappealing or you can't pay attention in the real world. So it's changing the way that children can even pay attention to life or to function in the real world. It's a real—

Wow.

It's a real problem. But I think in terms of the stress response, it's a big problem in generating untoward unseen stress inside the little bodies of our children.

As a parent then, I mean, when you're single and you're responsible for your own life, sometimes you could be extremely stressed of like, oh, I have to go make money and have these responsibilities and I go get a job or whatever it might be. And my boyfriend broke up with me, a girlfriend, whatever it might be. But it can also be very freeing. I have no responsibilities. It's just me. When you become a parent, There's a different level of stress because you're worried about—

It's the worst level of stress.

A child breathing 24/7 and you don't have full control over everything that happens, right?

Yep.

How have you learned as a parent to navigate your stress to make sure that you are a responsible human being and stewarding them in a proper way, but also not consumed by survival mode emotions?

That's such a great question because we don't talk about the stress. We talk about the stress of being a caregiver sometimes. We don't talk about the stress of being a parent, but it is really hard to parent. It is hard to manage the emotions of your children, the failures, the success, all of the things that come with raising a human, the injuries. My daughter broke both her thumbs in succession of 2 months.

Wow.

Comes running over to me with her thumb dislocated. There's a constant, almost on a day-to-day basis, there's something that's happening with your child that is eliciting that reaction in you. And I think as a parent, you start to learn again that you can't, I can't control if tomorrow she's going to be riding her bike like she was 4 weeks ago and fall and break something else. I can't control if something as bad is going to happen at school. My kid is going to get bullied or she might fail this test that was really important for her. And so, And to answer your question, part of what has given me a feeling of less stress is trying to arm my children with the tools of resilience.

Hmm.

Because I can't fix all of these things, I can't prepare them for all these things, but what I can do is give them a kit, a lesson, a roadmap to say, when these things happen to you in life, and they will happen, I want you to remember this. So in many ways, I talk about this book as being like it's meant for everyone, but in many ways it was a map or a letter to my girls so that when I'm not here, they can pick it up and say, I just got broken up with my boyfriend. What did mom want me to know about navigating this?

That's cool.

Or, I had this happen. And so I think as a parent, you relinquish some of that control over all of the inevitable things that are going to happen to your child that will cause you stress, And the best you can do is just try to do your best, be present, try to give them the best information and knowledge you can, be loving and caring, be in the moment with them, and give them the information.

Wow.

Give them the power to make the right decisions, to know how to navigate this. That makes me feel less stressed. If I feel like, I was recently telling someone my daughter who's 10, said to me, Mommy, I heard this song on by this artist and I think you'll really like it. And I said, okay, do you wanna play it for me? So she pulls up the song and it's called Tough People by Drew Baldridge. And I had never heard of Drew Baldridge. He's a very wonderful country singer. And I listened to the lyrics and it was all about how tough things in life create tough people. And she's 10. And I said, Layla, I said, I can't believe you love this song. And she's like, I knew you would love it, Mom.

Aw.

And I thought, okay, I'm doing something right. My 10-year-old recognizes the value of being resilient in life. And that's the kind of thing that brings me joy and happiness. And so it's that, and it's, Lewis, it's the small moments when I'm not stressed that I really focus on. So my kids give me a lot of stress, but there are—

And joy also.

So many moments of just pure joy and trying not to let all of the stress And the needs to do this or that take over being present in those moments of just laughter and cuddles and—

Play and fun.

Wins.

Yeah. So, Tara, as a cardiologist and as a parent of 2, what if you can only give 3 pieces of advice to parents on how to raise resilient kids so that they are empowered to handle life stresses and challenges that are going to come their way? While you're here and while you're not here, what 3 things would you tell them to do?

So in the book, we talk about 8. There are 8 tools that I talk about, but if I had to distill it down to the 3 that I would recommend, I think the first is the first tool, which is acceptance. And one of the researchers in psychology that I interviewed in the book and for a CBS News story, her name's Dr. Lucy Hone. She wrote a book called Resilient Grieving. She's fantastic. She gave one of the most watched TED Talks. Ever. And her first opening line is that adversity doesn't discriminate. And I think—

Rich, poor, young, old.

Everyone's gonna have. So I think imparting that lesson to your kids, really bad stuff's gonna happen. I don't know when, I don't know what it's gonna be for you, but something bad will happen and you have to accept it, right? So that's, I think, major lesson number one. The second tool is flexible thinking, which I think is also really critical for people. So it's this idea that Okay, maybe this was good, maybe this wasn't. I can kind of go down a different road. Lucy talks about, which I love, this idea of moving goalposts, which I thought was this beautiful visual image. So Lucy Hone, this resilience researcher psychologist who studies and publishes research, lost her daughter Abby in a car accident. Daughter was 12. So the resilience researcher now had to be resilient.

Ugh.

And she said she still had her 2 sons, her husband, and she realized, she couldn't fall apart because she still had life with them. So she gave the analogy of, well, we were heading towards this goal, but I'm just gonna pick up the goalpost and move it somewhere else. And I think it's that concept of being flexible and flowing and moving the goalpost and allowing yourself to create something different in terms of an image of your life. That's good. That's okay, right?

Yeah.

Painting a different picture, painting with a different color, painting a different image, still beautiful. I use the analogy in the book of Michelangelo, Carving and saying, I set the angel free from the marble. I saw the angel in the marble and I carved until I set the angel free, right? So we're all being carved and chiseled and chipped, but there's still an angel underneath. I want my kids to have, or any kid to have that message. And I think the third I would say is the power of, gosh, this is a hard one because I think love and social connection is really important and hope, which are probably the two other ones, but a purpose in life. Which is the very last chapter in my book, the very last tool. I think having something that drives you and gives meaning to your life, I call it the lighthouse, it is what pulls you forward from your darkest times and moments when you're wondering, how can I go forward? And suddenly you realize that there is a purpose inside you. Maybe you had it and you just didn't go after it, or maybe now you have a new purpose because of what happened to you in your life. I've interviewed a lot of people who've been through a lot of horrible things, and I've seen them create or chart a new chapter or journey in their life because of what happened to them.

Yeah. It's almost like the tragedy becomes their purpose.

Exactly.

To help others who've gone through something similar.

But that's a very powerful way to be resilient.

Yeah.

Is to find your purpose and go after it. And I hope my kids do that. Wow.

So if you don't learn to have acceptance, if you're not a flexible thinker and you have no purpose, you're probably gonna have a lot more stress and anxiety.

I think life will be a little bit tougher. Not to say you don't need that. And certainly there are other tools, as I said, you know, I think love and social support are so key and critical to our survival, and we don't prioritize our connections to other humans enough. I think having hope and an optimistic outlook is really important too in helping us get through really difficult times. And then I talk about facing fear as another tool. And that's where therapy and things like CBT or ACT therapy can come in really handy because we're all going to be afraid when something happens. You have a bad breakup. Am I— do I want to get into a relationship again? That could happen again. You don't want the fear in life to paralyze you from living your life.

What's your biggest fear right now?

Oh God, this is the survival and happiness of my children. It's talking about stress. Yeah. I mean, you realize as a parent, it's not even about you anymore. It's literally How do I get these little humans to a point where they can thrive and be happy and at peace, right? That's what I want for my girls— happiness, peace, and the ability to navigate life's challenge.

This is fascinating. What's a skill that someone can start practicing daily that can make them more resilient that will help them heal faster?

Well, social connection, which I just talked about, is a— is probably the easiest one. For all of us to really start with right away.

Not social media connection.

Not social media, real social life connection. So meaning joining a group, an art group, or a walking group, or a club, something that you like to do where you're around other people. Going to meet your friend who you haven't met with because you keep putting it off for coffee. Going for a walk with a friend. It doesn't have to be a big group, it can be one person. Even doing a Zoom or a telehealth with someone that you love just to kind of connect with them, even if it's over a screen. But really recognizing the power of connection in terms of healing is so critical. We often talk about, you've probably talked about the biggest study out of Harvard of what created a happy life for the people they followed, the Waldinger Study, and it wasn't money or success, it was their relationships. Our relationships in so many ways, make our lives and help us more than we could ever possibly imagine.

Yeah.

So I think really paying attention to our world and who we have in it and how we can build connections. And it could be even you go into Starbucks and you just talk to the person behind the counter. We are so used to not paying attention or being invested in people. I see it in New York a lot. Everyone's like this and nobody wants to talk to anybody, even in the apartment building elevators where we're crammed in, on the subway.

You're on top of people, but no one looks at anyone.

No one's connecting with people. And sometimes just the smile from a stranger or someone who does something nice for you or a conversation, it's helpful to that person. Maybe they needed that, and it's helpful to you. So it's just opening up your mind to the world of possibilities that exists right outside your door or sometimes inside your door, depending on who you live with. But yeah, really hardwiring in those social connections.

Have you ever seen as a doctor that money helps people have less stress, or do you feel like clients you've had in or patients who have lots of money have more stress?

Oh, that's a tough one. I think it, it can go both ways. I think, um, for some people, the financial stress of not having enough is, is huge. They can't pay their healthcare bills, they can't afford medication, they, Um, and that, that is a huge stressor for people. And then I, so I think having financial stability is an anchor in a lot of ways. On the other hand, I think a lot of people have financial stability, but they don't have love in their life. Mm-hmm. Or they don't have a job they love, or they have other things that are making them unhappy through—

Or they don't know how to navigate the money.

Yeah.

Or they're stressed about the money that they have. Or they're stressed, right. Or whatever, losing it.

Or losing it or keeping maintaining it. Yes.

Interesting. Do you see a difference between a mindset of individuals who live in New York City or in big cities that have a lot more money? But it also seems like some of them might have a lot more stress because they have more responsibilities or more money problems versus people that maybe live a more simple life. Maybe they don't have as much financially, but they're more in nature, more relaxed lifestyle. Maybe they don't have years of savings, but they're, they're comfortable enough. Have you seen a difference there?

Just personally, I, I've seen a lot of my patients who say to me, I've seen them for years and they've been working and under stress and they say, I'm retiring next month and I'm gonna move to Florida part-time. They say, don't worry, I'm gonna come back up here for my doctor's visits, but I'm gonna live down there. So I, I actually have a window into what happens because I see them twice a year when they come up to see me from, for example, Florida. And they're like a totally different person.

Really?

Yeah, because they're relaxed and they're not under the gun of whatever the career pressures they had were and the day-to-day routines. And they tell me, oh, I went out for a walk on the beach, or I'm gardening, or I'm just with my husband going for walks with our dog. And so that slowing down of the pace of life and just the retirement, I totally see it's like a weight is lifted off of people. Interesting.

I guess if they have money saved in retirement, you know, it's like, if you're like, ah, I'm retired, but I've got no money, Stressful too, probably.

And getting outside of New York City, as we were mentioning, the noise and the traffic and everything else that happens when you live in a big city that you don't even think is really affecting your level of stress. But it is because everything's difficult. It's challenging to get groceries. It's challenging to go anywhere 'cause everything is tough sometimes when you live in a big city. And sometimes when you slow down the pace and it does take the stress level down.

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Too long.

A decade or something?

I moved to New York City in 2007, and my husband and I just got our home out in the country in 2022.

How has that been, just taking a couple days a week and nature?

It's literally life-changing.

Really?

Life-changing. My husband and I talk about life BH, before the house, and life after the house.

Really?

Yeah. I mean, for us, we have 2 kids. We both have— my husband's a plastic surgeon, I'm a cardiologist. You know, we have intense lives in the city. And so being able to every single Friday get in the car and drive. We live in farm country where there are horses and cows, and we had black bears crossing the road and foxes. And it's quiet and it's peaceful and it's beautiful. It's life-saving for my husband and I on so many levels just to feel that peace and be outside. Also, my kids get to experience life that's not in a big city. So my husband has a tractor. Um, and so they ride on the tractor with him and we, you know, go shopping in big stores that we couldn't go with, like Walmart and Costco. And they, they get just a different glimpse of life.

Pace of life. Yeah.

Yes. Than they do growing up in New York City. Wow. Um, so it's, it's been good for all of us and our dog loves it cuz she can run around.

Wow. Between men and women, who faces More cardiac issues?

Both.

Really? There's no— it doesn't discriminate?

It is the leading cause of death for men and women.

Really?

Cardiovascular disease.

Is it more for— is a higher percentage in men or higher percentage of women, or is it the same?

Leading cause of death for both.

Wow.

More than— kills more women than all forms of cancer combined.

Wow.

Um, so one person every 34 seconds dies in this country from cardiovascular disease. I've been a longtime spokesperson for the American Heart Association and our Go Red for Women campaign. And unfortunately, we talk a lot, or fortunately, we talk a lot about cancer and other disease processes, which is fantastic. But what I don't think we talk enough about is cardiovascular disease.

Heart health.

Heart health. It's just not top of mind for people in a lot of ways because it's a silent process until it's not. So you can have problems building up and then you have a heart attack or you have a stroke, or, and suddenly, We realize you have underlying disease that you didn't know about. But it is so important. And one of the great things about cardiology is that we can do so much in terms of prevention. So, by identifying risk factors early and really teaching people how to manage those, we can hopefully prevent them from ever having one of those events where the heart cells die or the brain cells die. But it truly is your biggest health— your biggest health threat, my biggest health threat.

Okay, so, Tara, as a cardiologist, then, Is it possible for someone to die from a broken heart?

Yeah, well, that— the stress-induced heart attack I told you about is often called broken heart syndrome.

Really?

Yes, because we do see it a lot if a partner or spouse has just died and that person is grieving, and they will— they can have a heart attack themselves and die like shortly after. Yeah, I mean, usually you recover from the broken heart syndrome, but not everyone does.

You've seen it before?

Yeah, yes, yeah. That's crazy. So they could be physically healthy, totally fine, and just again, the massive release of that epinephrine, norepinephrine, we think from the brain. The brain is where you process your kind of feelings and fear and emotions in the hypothalamus and the pituitary release hormones that then go to your adrenal gland that causes your adrenal gland to release the epinephrine and the adrenaline and the norepinephrine and the cortisol. And, that flood stuns the heart and causes this stress-induced broken heart syndrome.

So learning resilience before you need it is really the key.

Learning resilience before you need it. Yes, getting these strategies in place, knowing that you are empowered.

When something happens.

Yes, and practicing them. Because it's not easy. It's not easy to think flexibly and to go to therapy and to stay fit. That's another one in there, exercising, sleeping, eating well. All this is hard work. mental and physical effort to do these tools and strategies, but the payoff is massive. The investment in building those resilience skills.

You might be able to help me with understanding what happened to me one time. I was going through, um, a challenging breakup, right? And I was doing therapy for months, very intense therapy, like weekends, 6 to 8 hour sessions. Like, I was like I want to find peace. I want to find clarity. I want to find freedom because I don't have it.

Yeah.

And I was dealing with a breakup I was going through. I was doing therapy in the relationship, but then the relationship ended and I was still doing it afterwards. And I was like, why am I still— and my heart was feeling like it was so tight for like years, right? In different relationships. And it was like, why is this so hard? And when I was single, I didn't have the pain. But when I was in a relationship, I was like, Constricted. And I remember one session I was doing in therapy, it was like I was feeling this chest pain, was kind of this heaviness, but I was super healthy and fit, but I was feeling this emotional weight and like a pain in my chest. And something finally clicked in therapy for me where in that moment I was sitting across from my, my coach and therapist and the things we were talking about, it's almost like I finally got it. And I integrated like what I was learning into my mind and my body. And it was the weirdest sensation. I've only felt this once in my life. It was almost like my heart popped and I felt a rush of what felt like plasma or some type of rushing goo throughout my whole body where I thought I hurt myself.

Hmm.

But it was like within minutes, it was like, I have no chest pain and I've never felt pain in my chest since. And this was years ago. And I don't know what happened, or medically if there's a terminology for this where it's like your heart literally explodes, but maybe in a good way. Is there something that this is—

There's no medical terminology for that, but I will tell you, people can absolutely experience chest pain, pressure, tightness, squeezing just from stress. So I have a lot of patients where we'll do a scan or imaging of their heart because we think it could be disease, and it's not. And so a lot of times, in fact, I had Chest pain at one point, and I thought it was my heart, and we did a scan, and it was under a time of stress. So, it is a real phenomenon where you can feel that kind of tightness or squeezing. A lot of times, we can see the very small blood vessels that go to the heart, we call them microvessels, or microvasculature, can be dysfunctional, and we can see that under times of stress. People can get vasospasm, which is spasm of the vessels. So, again, there can be real biological impacts.

Yeah.

To the small vessels or the bigger vessels when you're under stress. And it may not result in a heart attack, but you feel it here. And so I think what you just explained, what you spoke to, is the power of mental release.

It's like I finally got it and almost like the fear was gone.

Right.

It's like mentally I finally was like, oh, I'm going to be okay. I'm enough. I'm lovable. All these different things, these insecurities, fears that I was dealing with in relationships. It was like, oh, I'm going to be okay. It was almost like I understood resilience. Like, I'm going to be okay no matter what happens.

Exactly.

This works out, it doesn't work out, I'm alone forever, whatever it might be, I'm going to be okay.

And that's the power of therapy.

Yes.

Yes.

And the tools that I was learning are a lot of the tools that you have in your book, The Healing Power of Resilience.

I have a lot of patients just like that who will have chest pain for months and months. We don't find anything tangible, And then they go to therapy or the stressor goes away or they fix whatever was causing stress. And then they come and see me and they say, I don't have the pain anymore.

It's gone.

Isn't that interesting?

So a lot of this pain I feel like comes from how we interpret life's events, how we interpret what is happening or what might happen or won't happen.

Our response to the stress.

It's crazy, isn't it?

It's so important. I don't know why this isn't hardwired into how we teach our physicians to help patients because people are suffering. People are having chest pain for months and we're not helping them. But therapy, help talking through things, CBT therapy, changing how you respond to those feelings, your behaviors, all of that can have a massive impact. And really, at the end of the day, it's about your quality of life, right? That's what I wanted. That's what I want to give my patients. That's what my patients want. A lot of what I took for the book was from the field of palliative care. Palliative care is a field of medicine devoted to helping people at the end of life find meaning in life. And it was so important for me because that's really what everyone wants. We all want to be able to still be happy and have a great quality of life, even if something really difficult has happened or our whole life has been upended. We want to be able to enjoy it.

Yeah.

And when you're suffering under the weight of fear and anxiety and your own mind, you can't be a participant in life. You are literally not a player in the game. And then something like that, a therapist, one therapist, I had a wonderful therapist that I credit so much of my own healing to, helped me in so many ways that you're back in the game and you're able to get into a relationship that's healthy and experience life the way it's meant Yeah, it's almost like if you can master your mind, you can master anything. That is true.

I really like the idea of your next book being around faith-based healing. Like, you, you studied that in college.

I, I didn't really study it. I've just always been like—

You're interested in doing that.

I'm a very spiritual person, and I believe that there's real value to it. And so I've kind of always opened the door to really talking about that with my patients if they're interested in talking about it.

I just really believe that healing is a spiritual journey. You know, it's like sure, we're healing the material body, but there's a spiritual element to healing that I think allows for the body to heal is through spirituality in my mind. I'd love to see more research of that, and maybe that's something you can tackle in the future. But people can get the book; it's out right now. The Healing Power of Resilience: A New Prescription for Health and Wellbeing. And they can follow you, Dr. Tara Narula. On social media. Do you have a website also people can go and check out?

I don't, but I'm on Facebook, Instagram, X, LinkedIn. Yeah. And you can catch me on ABC News, um, usually on Good Morning America. Um, but sometimes elsewhere on their other platforms.

Very cool. Um, couple final questions for you. Uh, this is called the 3 Truths. So imagine hypothetically you get to live as long as you want, live the most incredible life from now until the moment you die.

Okay.

But it's your last day on Earth, and for whatever reason, all of your content is erased from this world. This conversation, your books, anything you've ever said, gone. Hypothetical. But you get to leave behind 3 lessons to the world, 3 truths. What would those be for you?

One would be love is the most important thing. I think that we are on this planet to love ourselves, learn to love ourselves, and learn how to love others. So I think love is the reason we are here. The second one would be about learning to find your passion and purpose in life and go after it, really nurturing that. Because I think when you don't, you don't feel fulfilled in life. And again, we have this beautiful chance to be on this earth, so make the most of it.

Yeah.

And then I think the third would be about being grateful. We don't— we talk a lot about gratitude, but not enough about gratitude. And I think gratitude is actually another tool to help us feel less stressed when we notice those things that are really awesome that happen to us in life. And they can be really tiny things or really big things, but really putting your focus intentionally on those great things that do happen to us, and for all of us, there are great things that happen, would be a really important lesson.

I mean, I guess if you feel like you're going through a stressful time in life, you could always go to a hospital and see what people are dealing with In a hospital, you know, and maybe as a doctor you get to see like—

I see it all.

Gosh, every day you see challenges with people and hopefully people healing as well after they come and see you a bunch of times. But it's like, go to a hospital and see if your problems are as big as you think they are.

I see so much, Lewis. You know, I think as a doctor, we all physicians see so much, and it's hard sometimes because people deal with incredible amounts of difficulty, whether that's in their social life or their physical world.

Yeah.

And suffering and heartache. And to me, I love working to be a healer, and I think we can all be healers for other people, for just listening to them and walking with them and being there for them. I think a lot about my one patient, I love this where he, I'm his cardiologist and his wife is my patient and he has Parkinson's and he's been slowly deteriorating in terms of his ability to function with his disease over the last year. And at one of his visits, he came to see me and he was sitting in the exam table and his wife was sitting in the chair. And he said, I said, do you have any more questions? 'Cause we had wrapped up the cardiology part. And he said, Dr. Narula, I just, I'm writing a book and I still have so much more that I wanna write. And I love my wife and I have so much time that I wanna spend with her. And I wanna see this part of the country. And there's so much more that I wanna do. How do I not lose hope? And I sat there in that moment, not as his neurologist who was treating his Parkinson's, but just as another human hoping I could say the right words. that would help him in that moment. And I said, you know, you find hope in the small daily wins. You find it in the evenings when you can hold her hand.

Mm-hmm.

You find it in the next chapter you're gonna write tonight. You find it in the idea that tomorrow there might be some other cure that comes around the bend for this aspect of your Parkinson's. You find it in the days that you still can get up and walk and play ping pong, which he loves to do. That's where you find your hope and you hold on to that. And I think that just speaks to not only the power of hope, but I know that that conversation was meaningful for me and I think it was meaningful for him. And we can all do that for other people. We don't realize how much our little small conversations might impact someone. You think what you say maybe doesn't affect someone, but you have the power— everyone does— to change even just one person's life sometimes by the words that you say. And I think that's so important for people to know the power they have to be healers for other people in their lives.

That's beautiful. Uh, Tara, I want to acknowledge you before I ask the final question for being an inspiration for people to learn how to heal themselves, because I think a lot of the times we don't feel like we have the skills or the knowledge or the tools And we, we need to go see a medical professional to look at these things for us, which is true once we get to that place. But if we can learn how to heal ourselves first, prevent these things, hopefully we don't have to go when it gets really bad. Hopefully we prevent things going bad and we can really create that inner peace that we need to eliminate a lot of this stuff. So I want to acknowledge you for writing this book and for being a voice online and on the news of giving people tools.

And I would just wanna say, I mean, I'm not a psychologist. This body of research really comes out of the world of psychology.

Yeah.

And they've been doing this for the last almost 70, 80 years, this growing research in resilience. But we have research there on Navy SEALs and POWs and 9/11 responders. We have psychology research that shows the power of our ability to build resilience. Like a skill and a muscle, because we've seen it, we've done it in all of these other places. We just haven't put it out there for everyone. And, that was really my goal was to say, gosh, we have all of this information. Everyone should know that they can do this themselves. They have that power in them that resilience is hardwired, it is innate for a lot of us, but it is so much a skill. Everyone should know that they can do this.

Yeah. Final question, Tara. What's your definition of greatness?

I think that greatness is being authentically who you are and loving yourself for your flaws, your perfections, your imperfections.

Mm-hmm.

And same with the people in your life. I think that is a great person who can just be themselves and accept unconditionally and love the other people in your life. I think greatness is being a light in the world for other people, a healer. Even if you are a healer for one person, that's great. And that's greatness. That's probably how I would define it.

Well, Tara, thank you for being here. Appreciate it.

Thank you for having me.

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