A lot of women are cheering today, I

think.

So yes, as you mentioned, these are the first recommendations since 2014.

And we know that about 2 million women enter menopause annually every year.

And a lot of those women suffer for years, almost 10 years before the average age, which is 50.

A lot of those symptoms, about 50% to 90% are vasomotor, so hot flashes and night sweats.

Almost 20% to 60% have sleep-related dysfunction.

what else should women know if they're considering this type of therapy?

Dios, eso me parece una locura

... aprender a desactivar nuestra respuesta al estrés, porque nuestra respuesta al estrés fue diseñada para ayudarnos a sobrevivir.

Es un proceso biológico innato.

Lo vemos en el reino animal, así que si estás en la naturaleza y algo te persigue, lo activas.

Lo activas para que tu presión arterial suba, tu ritmo cardíaco aumente y tu respiración se acelere para que puedas correr y escapar.

Al mismo tiempo, apagas todas las funciones no esenciales, como la digestión, el crecimiento y la reproducción.

Así que este sistema bellamente diseñado está destinado a ayudarnos a sobrevivir en la naturaleza.

Pero puedes ir a un hospital y ver si tus problemas son tan grandes como crees que son.

just by itself.

Yes.

And that's why it's so important for us 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 non-essential functions like digestion and growth and reproduction.

So this beautifully designed system is meant to help us survive in the wild.

How much training did you have around navigating emotions when you were going to medical school? Zero.

And what makes the type of blood clot different, and how dangerous is it?

So we're talking about a clot in the superficial veins of the legs.

These are the veins that sit a couple centimeters under the skin.

The problem is that sometimes they can extend or propagate into the deep veins, or they can be associated with a deep vein clot.

And in that case, it can break off, go to the lungs, and as you heard in Will's piece, become what we call a pulmonary embolism, which can be life-threatening.

Mm-hmm.

We pick these up generally if someone has a red, swollen, tender, warm leg on an ultrasound.

We can see this in cases where there's some sort of lack of normal flow in the veins, and that can happen with a kick or an injury to the veins.

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

Yeah

... and suffering and heartache.

Um, and to me, uh, 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.

Um, I, I think a lot about my one patient, um, 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.

What advice would you give parents going through treatment while raising children? How can parents help their children feel less afraid?

Thank you so much, and congratulations to you.

And it's such a good question.

You know, there's about 3 million kids in the US who are living with a parent who has or has had cancer.

And of course this becomes a family issue, right? And so how do you best communicate with your children while always open lines of communication where you make it age appropriate, it's honest, it's in simple language.

You know, many times we wonder, should we tell our kids, but kids are so smart and they pick up on something.

And if we don't have honest conversations, they may make something much bigger in their head than it actually is.

What is the number one piece of advice for a young woman who feels something is wrong and her body faces a doctor who dismisses her concerns because of her age?

So which treatments carry cardiovascular risks and what should patients be asking their doctors about protecting their heart when they're trying to kill

a cancer? That's right.

It's such an important topic because it doesn't often get discussed with women while they're going through cancer treatment or even after.

But in fact, a lot of the therapies that we give women to help them survive actually could put their heart at risk down the road, even years down the road.

And so when we think about what types of cardiovascular disease we might see, it can range from valvular disease to heart failure, to disease of the vessels of the arteries to electrical abnormalities.

Some of the treatments that we talk about, so adriamycin-based chemotherapies, doxorubicin, adriamycin, HER2 therapies like trastuzumab, radiation therapy to the chest wall, and even some of the hormone therapies that women get put on long-term like letrozole and astrazole or tamoxifen.

So it is really important for women to know, keep a log of what treatment they had.

32.

Mm

... down the road.

Even years down the road.

And so when we think about what types of cardiovascular disease we might see, it can range from valvular disease to heart failure to disease of the vessels of the arteries to electrical abnormalities.

Some of the treatments that we talk about, so Adriamycin-based chemotherapies, Doxorubicin, Adriamycin, HER2 therapies like Trastuzumab, radiation therapy to the chest wall, and even some of the hormone therapies that women get put on long-term, like-

[applause]

... and thrivership.

And that's a great question.

Doc, what did they find?

Yes.

So the researchers here looked at around 95,000 adults, average age 59.

They gave them a wrist accelerometer or device to use for seven nights.

And they measured different parameters of their sleep.

Things like how often did they wake up? How irregular was their sleep from night to night? How often were they in light, deep or REM sleep? And how long did they sleep for? They then followed them for about nine years and looked at many, many different health outcomes.

And not surprisingly, your sleep was associated with your health.

OK, so what can you recommend for getting a better quality night of sleep?

Yes.

I think you said a couple other things which I think are really important to point out before I, I get to stress, which is that women, we say in cardiology, have been understudied, underdiagnosed, and undertreated.

So we know that women come to the emergency room with chest pain, they will wait longer than men.

They are less likely to receive guideline-directed medical therapy and treatments.

This is a problem, so we need to work on it from the medical establishment side.

Um, and then I think what you mentioned about stress is so critical.

And to be honest, that was really the impetus in so many ways for writing this book, was to recognize How much of a threat stress is to all of us in our daily lives.

Yeah.

Mm-hmm.

It do- doesn't tell us about the distribution of the fat.

So what might be a better marker wit- is central adiposity, or fat around the belly area.

We know that that seems to tell us much more about cardiovascular risk and be additive to body mass index.

In fact, that visceral fat, the fat around your organs as opposed to the subcu fat under your skin, we know is really a big problem in terms of causing metabolic dysregulation, inflammation-

... to figure out if you fall into this group.

You can measure your own waist circumference and waist-to-hip ratio.

So you basically want to do it without clothes on.

Okay.

However, if you are not BRCA1 or 2 positive, you're kind of generally considered low or average risk, you need to listen to this, right? And this is the time where you should be thinking about, am I done with childbearing? Do I wanna just be doing IVF? Do I wanna adopt kids? Do I not wanna have kids? That is the woman that should be considering this kind of surgery, which is just removal of the tubes to lower her risk.

Now, what should she know? There's still a very small residual risk of ovarian cancer that is starting from the ovaries, not the tubes.

Hmm

... of women have no risk factors.

We have no screening tools available.

When it's diagnosed, it's usually metastatic, and the survival's about five years.

That is huge.

getting resolution for a while.

And I wasn't getting resolution.

So, which is a difficult place, you know, and I was a doctor.

Like a lot of times as a patient, you just want a diagnosis.

You just want to know what it is so you can deal with it.

But when you don't know, and sometimes that happens in medicine, like we don't have an answer.

It's this horrible middle ground that you're living in.

How does that lend itself into the idea of resilience, like if you want to be a resilient person?

And you're not getting resolution for a while

... and I wasn't getting resolution.

So which is a difficult place, you know, now as a doctor.

Like a lot of times as a patient, you just want a diagnosis.

You just wanna know what it is so you can deal with it.

But when you don't know, and sometimes that happens in medicine, like we don't, we don't have an answer, it's this horrible middle ground that you're living in.

Um, so I ended up getting like a card [laughs] in the mail from my mom, which was the Serenity Prayer that she wrote down for me.

Um, h- how does that lend itself into the idea of resilience, like if you wanna be a resilient person?

[laughs]

I said, "I mean, I could write that." But they said, "What do you wanna write about?" And I said, "I really wanna write about resilience." And I had already started down this road of exploring this topic when I was at CBS News, um, and I had done two stories on resilience and understanding the science of it.

So this was really the natural evolution of my love and passion for this topic and really getting it out there.

And as I started to write it, and I really realized, you know, this isn't just important for everyone, but I really recognized the gap in really educating people about how to build resilience in the medical field, that we just don't do a great job connecting the dots between psychology and physical health.

And you know, too often patients are given a diagnosis and sent out the door, um, and that is a form of trauma.

When you're told you have heart failure, or you've had a stroke, or you have breast cancer, the reaction in the body and in people is the same as if they've suffered a collapse of their business, or they've lost their home in a fire.

It is completely paralyzing for people.

Mm-hmm

What do you tell your patients about that window? What does the research tell us?

It is a really important time, and it's a time where we start to see things like blood pressure, cholesterol go up, even weight.

And so a lot of women will say, "My blood pressure was normal and my cholesterol was normal before, and now I'm seeing this rise." So it is a time to reassess those numbers, those risk factors, but also to look at the risk factors that happen over the continuum of a woman's life.

And so it's not just limited to that period, but we think about even starting out at young ages.

If you had periods before the age of 11, that's a risk factor for cardiovascular disease.

If you had irregular periods, we think about what happens during pregnancy, really important time.

So if you had preeclampsia, eclampsia, gestational diabetes, a baby that was small for gestational age, um, or miscarriages, those are risk factors for cardiovascular disease.

Hmm.

Oh, my God.

So if you can imagine, you know, waiting and pushing and struggling so hard to have a baby, finding out during your pregnancy you have ovarian cancer, and it was one of those moments where, I mean, she had a choice, right? Where do you go at this unimaginable moment?And she was resilience personified.

She finished her pregnancy, she delivered her beautiful baby.

She lived those last two years that she was alive with her daughter, full.

And she wrote about her journey, she was present for her daughter, she made plans for what would happen for after she passed.

It was this incredible, beautiful story, my friend, Kaz, as we called her, of resilience despite the literally unimaginable happening.

And so that's what I want for people.

Dr. Narula, how can a person tell the difference, just, like, normal everyday stress of modern life and stress and pressure that is becoming a problem?

Yeah

... as you're going forward with these diet changes, but that's why it's so important to understand food is medicine.

You may not be able to see the changes on the inside, but it's affecting almost every organ system.

So eating healthy, we know it lowers the risk of chronic diseases-

Mm-hmm.

Your teeth, your eyes, and your digestive tract.

It affects your gut microbiome, your sleep, your energy, your mood, and certain diets can actually lower your risk of dementia or cognitive function decline over time.

What does normal really mean when it comes to a heart rate and is lower always better?

Great question.

And a lot of people worry about their heart rates now because, as you said, everybody has a wearable these days.

And so generally what is considered normal is a heart rate that ranges between 60 and 100 beats per minute.

That being said, we can see people who are extremely athletic, well-trained, who have heart rates that are really in the 40s or 50s.

and for them that's fine and that's totally normal.

So a little bit depends on who you are.

Is that important to check? What do those numbers

but not for them, how can you be reasonable in what you are approaching and how should you go about adopting a new lifestyle?

Right, so I think first of all, it's important to know that it's never too late to make changes.

I think a lot of people think I'm too old, I've been stuck doing the same thing.

Never too late in your life to start this journey of changing your habits and your routine.

The second is, I think for a lot of people, they have these expectations of a goal they want to meet, and it can be so overwhelming that they almost turn off to it, right? So I say start small and just focus on the day-to-day wins that you have.

Don't look too far ahead.

And all of a sudden, you look back and you realize, wow, I've made really significant changes.

They are painful.

They are really painful.

And one type of kidney stone, about, uh, a certain percentage, maybe five, six, 7%, is uric acid stones.

Now, uric acid is a derivative of purine.

Purine is a breakdown product of animal protein.

So if you eat a diet that is more of a carnivore diet, very high in beef, chicken, poultry, or seafood, you're going to potentially break that down into uric acid, which under the right conditions can crystallize and form stones.

And as you mentioned, they can be extremely painful.

200 a day?

Talk a little bit about some of the tenants on which you based the book and why they're

so important.

The first sort of half of the book and really the underwriting theory is that any sort of trauma or stress elicits a stress response.

So any challenge, and that could be I'm going through a divorce or I've had a death in the family, my business has failed, or I have a medical diagnosis.

The response in our body to any one of those challenges is the same.

It is a stress reaction where we release hormones like epinephrine, adrenaline, cortisol, all of this cascade starts from the brain, goes throughout the body.

And over time, that stress response becomes damaging.

What's your biggest hope for the book?

Mm-hmm.

And let's just say this is also one of those.

So we're talking about a trend that talks about Allegra and Pepcid.

Allegra is a drug that's typically used for allergies, Pepcid a drug that's typically used for ulcers or acid reflux.

Both of them have antihistamine effects.

They block histamine.

Histamine is a chemical in the body that we often think about with immune function.

Yeah

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Yeah.

So when you look in the animal kingdom, and we are animals, we have this stress response to help us survive.

But what was going on at that point in your life?

Yeah, it's interesting.

So I, as I said, I s- like my whole life, I had a bend towards science.

I went to science camp.

I loved...

I would go to the hospital and make rounds with my father.

I did research in the Department of Cardiac Surgery when I was in high school.

Maybe you can bring those two together.