S01_E05 - Healthy Matters of the Heart (...just in time for Valentine's Day)

Speaker 1: 0:03

Welcome to the healthy matters podcast with Dr. David Hilton, primary care physician and acute care hospitalist at Hennepin healthcare in downtown Minneapolis, where we cover the latest in health healthcare, and what matters to you. And now here's your host, Dr. David Hilton.

Speaker 2: 0:20

Hey everybody. And welcome to episode five of the healthy matters podcast. I'm your host, Dr. David Hilton. And today, just in time for Valentine's day, we'll be discussing matters of the heart. February is a good month to be talking about your heart because, you know, first of all, the American heart association has designated February to be a month where we're focusing on your cardiovascular health, but I, I'm also gonna talk in a more general sense about the connection between our mental health and our physical health. And we're gonna use the heart and the cardiovascular system sort of as a, a way to introduce that topic. But I don't know anything about that today. I'm joined by two of my distinguished colleagues from Hennepin healthcare here in downtown Minneapolis, Dr. Eduardo co is a psychiatrist and the chair of the department of psychiatry and Dr. Steven Goldsmith is a cardiologist and a national expert in heart failure. A very warm welcome to you both. All right, so let's get to it and talk to our guests first, Dr. Coone, I introduced you as the chair of psychiatry and how you were one of my very first teachers at Hennepin. Tell us little bit about yourself, if you could, you know, like how did you end up at HCMC and into psychiatry? So

Speaker 3: 1:27

I ended up, um, going into psychiatry after I had spent some time in medical school, uh, considering going into internal medicine. And I had the opportunity to work with a number of patients who were struggling with profound psychiatric issues. And I had mentors, people who were work at the interface of medicine and psychiatry. So late in my medical school career, I decided to go into psychiatry. And at that point, uh, looking at programs, I came to Minneapolis where, um, I had family relatives and it would be a lot easier to move with

Speaker 2: 1:57

My family. I, you were one of my very first teachers. You probably have taught how many people in psychiat and I'm talking about not only in psychiatry, but guys like me who are in internal medicine, you have been part of the teaching faculty for a lot of, a lot of young physicians, right? Yeah. That's

Speaker 3: 2:13

A tough question.

Speaker 2: 2:14

Not that I wanna make you feel old or anything.

Speaker 3: 2:17

So I was, I was at the university of Minnesota for six years. I doing consultation psychiatry in the department of psychiatry and a number of students and residents who rotate through that system. And when I came to Henapin, uh, early on the director for, uh, training in internal medicine approached me, Dr. Brian rank. And he asked if he could send over some medicine residents to rotate with me and that's become a tradition since way back when, uh, in subsequent only we opened up our own residency training program in

Speaker 2: 2:46

Psychiatry. I think, um, many people maybe don't realize that, uh, even at a hospital like ours, it is, I don't know, 400 beds or something. A quarter of them are on psychiatry. And we have a clinic system that has mental health, um, embedded in some clinics and in other, and we have a psychiatry clinic. I'm not sure everybody is aware of how large and impressive your department is. Yeah.

Speaker 3: 3:10

Thanks for saying that. Yes. We have a large department ranging from services in the emergency room, uh, inpatient units, as well as a number of outpatient programs. We see approximately 120 people a day, just in the psychiatry clinic. We have a partial hospital day treatment program, the mother baby program, uh, as well as, um, up to 103 beds at times for the inpatient unit, let's move to you. Steve,

Speaker 2: 3:33

Dr. Steve Goldsmith is a cardiologist also at, Henapin also a guy I've known for some deck gates. I was a, a brand new minted doctor, uh, or a, maybe I was even a medical student, walked in the halls of Hennepin county medical center. And I ran into Dr. Goldsmith, who is one of the preeminent cardiologists, uh, I believe, uh, nationally, um, particularly in the areas of heart failure. Steve, thanks for being on the show, but tell us, why'd you get into card or how'd you get to HeNe maybe?

Speaker 4: 4:02

Well, I was, I grew up in Pittsburgh and my family moved to Ohio when I was in high school and I went to medical school and did my residency at the Ohio state university, the Ohio state university. You'll notice that anyway. Um,

Speaker 2: 4:16

But then my kid went to Michigan. So, you know, you're our, you know, this, these

Speaker 4: 4:20

Are actually, we're never gonna get through this introduction. We're gonna have to find a different

Speaker 2: 4:24

Guest.

Speaker 4: 4:26

Well, at any rate, I got interested in heart failure as a resident, and I wanted to make that my life's work if I could. And there was a guy named Jay Cohen, uh, who was literally writing the book on revolutionizing heart failure treatment. And he was the chief of cardiology here at the university of Minnesota. So I was very lucky to get a fellowship here. And, um, I stayed on the faculty and I've, I've been on the faculty since 1981, and I've had a number of different administrative and clinical roles, but, uh, my clinical practice has been entirely at Hennepin county medical center. And the focus, the, the one constant throughout the entire time has been heart

Speaker 2: 5:02

Failures. Well, my, my thanks to both of you in advance for being here, let's get to the topic now, Dr. Cologne stress, mental health, anxiety, depression. Could you just talk about, uh, how, what have you seen, what has been the, the effect on people's mental, particularly in recent years?

Speaker 3: 5:23

I think the experience of the last couple of years basically has centered around access to care and watching people who have struggled in all areas of medicine, not getting the care that they need, that they deserve. And then showing up with a lot of complications along with that, obviously the direct effect of stress and stress gets defined differently. There's all kinds of varieties of it. There's a certain amount of difficulty. First of all, with the isolation that we've all experienced. And certainly with narrowing down the level of activity that you engage agents for some people it's very limiting. I like to say sometimes that I'm stuck in Groundhog day in terms of the routines, the fear of getting ill, the acknowledgement of the impact of the pandemic and people around you in your sense of vulnerability. So there's a lot of ways in which this has had a big impact. I think it's had a big impact on, uh, loss of sobriety for people with substance use disorders. And certainly we've seen people who have been struggling with, um, their preexisting illness and nuance of problems, such as depression, the need for mental health care has grown drastically at a time when we've also struggled to deliver it because of the restrictions at times of, uh, how many people can be seen in our hospital in particular, there has been an increase. Uh, there was a dramatic surge in the use of telehealth, and that's been a big, a big addition to our interventions over the recent years. There's certainly when you look around, people are exhausted. And I like to, to differentiate the sense of wellbeing from mental illness. And we've all struggled in the hospital with providers, with physicians, with, um, nurse practitioners, with nurses and, and the whole gamut of providers, uh, trying to figure out how we keep people well. And that means how you cope with stress, how you get along, how you feel. Uh, and obviously there's always the danger, the danger of the emergence of a more serious mental illness, which includes depression, uh, bipolar disorder. And for people who are struggling with these, uh, then it becomes a lot harder to have, uh, the stability that you're seeking. Uh, there's no doubt that the sense of social support has gone away or is it's been limited by a number of the, uh, difficulties that we struggle. So it's been a pretty difficult period of time, parents staying at home, uh, not having the interactions at work, having to care for their children, children with special needs, who have been pulled away from a lot of the resources that we're keeping them going.

Speaker 2: 7:52

What is the divide in line between those stressors that people are feeling and something that for maybe this is the wrong or a diagnosable mental health condition.

Speaker 3: 8:02

That's a great question. And I'll, I'll be somewhat vague about it. It's really hard to separate at times, but we know that when you cross the line, sometimes it becomes pretty evident. And I like to think in terms of how the severity, in terms of how, how profound the symptoms are, how uncomfortable you are, and then the area that you look at is the impact that has on your function. So to what extent does it interfere with your ability to do your work, to relate to people around you to take care of your children? So by the time you mix both of those, you have significant severity of discomfort. It affects your behavior to a point where your level of functioning is impaired. I think you begin to a essentially look at that point at the presence of a mental illness.

Speaker 2: 8:42

So how about the taking it to the next level and, uh, the specifics about this conversation about your physical health, what are your thoughts on whether it be a, a diagnosed mental health issue, or whether it be the stressors in your life, on your physical health, from the psychiatric world, where you come from, is there a connection between your mental health and your physical health?

Speaker 3: 9:05

Absolutely. You know, when I was a kid, I borrowed a book or I got a book that was called the body has a head, and I don't remember the content of the book, but I remember that the topic with me. And it's something that I think about pretty often, because you know, when we have this discussion, a lot of times about your emotions or your psychological psychiatric wellbeing, people think about the mind. And we tend to forget that we have this incredible organ in our body, our brain that's connected to every other organ and regulates a lot of function. So folklore has been very you're in the perception of human beings, that stress has an impact on how well you do and how much we've thought about it. Varies through the agency. Know a number of years ago, Walter Cannon, who, um, was interested in shock, wrote a paper where he got a number of anthropologists or people who did, uh, traveling to relate the story of what he called in this paper called voodoo death. The concept that there are areas where people are he, or I told they're gonna die. And they truly believe that, uh, this power exists in people around them. And they literally would go away into the woods and die. And that triggered a lot of interest. This was published in a major medical journal, subsequent to that George Engel. Who's kind of one of the fathers of consultation, psychiatry published a group of, I believe like a hundred cases, anecdotal reports from the newspaper of people who, who, uh, had some death in the context of psychological or events, including the loss of other ones and including good news. He related a story. For example, for mother who was Sur rise by her son, coming back from Vietnam, and then seeing the son, she collapsed and died of what we presume to have been sudden death. The area psychosomatics has been very rich, closely related to psychiatry and psychology. And, and, you know, there's a lot of areas in which we see the overlap for quite a long time. We went to the other extreme where we thought a number of disorders were caused just by psychological distress. And I think the research and the literature suggested that was perhaps overstated. And then we kind of tended to forget about it until I hope we continue to kind of merge in the middle and live where we look at the pathophysiology and how we explained some of those connections. A few years back, there was a paper published that looked at the outcomes of patients who have acute myocardial infarct. And we know that many of the patients who survive in my myocardial infarc have other events, including arrhythmias that, uh, lead to their deaths when you control for every other cardiovascular risk factor. The patients who were diagnosed with depression as measured by inventories, had a much lower survivorship at six months, certainly at one year. So if you had a profound depression at the time of your heart attack or develop one, the outcomes were significantly different. Now you could argue that that obviously has an impact on your physical wellbeing. You're less likely to follow a diet, to go to see your doctor, uh, to take the medications that you need to. But it's clear that there's also significant, uh, role in terms of the impact of stress. We know that people who have struggled with a number of stressors, including chronic stress, have a number of other complications that are physiological, and that play a role also for a while. People spoke of functional bowel syndromes, where that means a function, not necessarily of structure. And we know that emotions play a role in their GI function. They play a role in cardiovascular health. They play a role in just about everything. When I was growing up, the big connection that people made was that concept of type a personality. We used

Speaker 2: 12:32

To say that every single in med school was a type a personality. Well,

Speaker 3: 12:36

We got away from that because obviously it was kind of oversimplified, but it really kind of underscores the sense that there are things that we do that play a big role in how our body reacts with inflammation, with normal function, with the impact of your heart GI system, et cetera. I'm gonna turn now

Speaker 2: 12:52

To Dr. Steve Goldsmith, the cardiologist, and I'd like you Steve, to listen to this story for, for just a second. And then you comment, if you could, when I was a, I think I was a resident, or maybe I was a new faculty member at Hennepin, it was back in, I would've been a faculty, I guess it was in 2005. And for those of you, uh, who are from Minnesota, you might remember we had a U United States Senator, um, hall Wellstone, and whose plane crashed a small plane, crashed on a campaign trip up, uh, in the iron range of Northern Minnesota. Several days after that, I had a patient in our hospital in clinical heart failure. And, uh, previously, uh, as far as we knew, it was well to my, to my recollection. And she was over lot with grief about this public servant. It wasn't a family member of her, but, uh, and that's what we came up with as her triggering factor or her causative, uh, um, factor to her heart failure from a cardiologist perspective is that plausible and, and talk to us a little bit about cardiac manifestations of in this case, it was grief, but it could be any type of stressor.

Speaker 4: 14:01

Well, the topic of stress and cardiovascular disease is we could be here all day, obviously talking about that, uh,

Speaker 2: 14:08

And careful what you say I've got all day.

Speaker 4: 14:10

Yeah. Okay. But, but Dr. Coone has already mentioned about, uh, the voodoo deaths and if your patient had died, uh, and maybe I was a consultant, I don't remember, uh, it, it might have been an example of that because it's absolutely clear that acute stress, acute grief or acute stress of really any kind, but it's, uh, physical or mental can cause a form of heart disease called stress cardiomyopathy. And what that means is that the heart suddenly for no other reason, seems to not work very well. And it's usually not fatal. It's usually reversible, but you can die from it.

Speaker 2: 14:49

So you, so you could answer the question I posed at the top of the show, oh

Speaker 4: 14:52

Yes, you can die from a broken heart. You can die from a broken heart. Fortunately not come no most of the time, this is diagnosed in the context of other, um, significant physical illnesses, such as an acute episode of, uh, lung disease, exacerbation or pancreatitis, but it can definitely occur. It's been, it's been reported with, with many different kinds of, of mental stress. I had a very vivid case of a woman who had a panic attack. She was trapped in an elevator lobby, you know, in an El, between the elevators in a, in a hotel, had a panic attack and came in with severe heart failure,

Speaker 2: 15:30

Excuse me, for an interrupting. And from that panic attack, that was the

Speaker 4: 15:34

Thing that caused her heart. That was stressor. Yeah. I've had another patient who simply got it every time she had, she, it can recur actually, uh, a patient who got it every time she had to go to a particularly stressful family reunion. Um, so, okay. I bet a lot of people can relate to that. Yeah. Yeah. Well, as I said, I hope you're not implying that go into your family reunions, no lead you to heart failure, especially the last few years. Yeah. Oh yeah. I'm sure the incidence of this may be up in the, but you know, we have a long acquaintance with this because, um, the syndrome of stress cardiomyopathy was first described in the, by the Japanese decades ago, but only in the context of stroke. And they documented a very particular form of dysfunction of the heart. It's called taco Toba. And it's because the heart on an echocardiogram looks like an octopus trap and taco Toba is an octopus trap. It balloons out well actually Hennepin county medical center, my colleagues at Hennepin, we, you know, we, we were the first to describe this in the United States and in the Western literature and the first to describe score

Speaker 2: 16:33

One for the scrappy county hospital.

Speaker 4: 16:35

Yeah, absolutely. Scott Sharkie was my colleague at the time. And he's been over at Abbot Minneapolis heart Institute for the last 20 some years. I think he has the world's largest registry on this. So, uh, it's a, it's a condition we know very well. And I want to emphasize it's common. You, you can hardly go through a week at rounding at Hennepin without seeing a case, although it's usually the physical, it it's, it's a complication of the physical stress, but from the standpoint of demonstrating the power of stress, and I'll explain in a couple minutes why we think this occurs, uh, this is sort of the most dramatic example. And the answer to the question is you can die from it. And maybe those voodoo cases are, are cases of psychologically induced, uh, stress cardiomyopathy. There aren't that many things that kill you suddenly, right? If you're otherwise healthy, but it's a dramatic example, but stress in general, because the mechanisms I think are very common to the acute and the chronic stress in general is, is really bad news for cardiovascular disease. Uh, Dr. Coone beat me to it. You know, we've known for a long time that depression as a form of stress increases the death rates after myocardial infarction. It's also true in heart failure. I've submitted NIH grants to try to study this. And one of the big things you have to control for is depression, because it's an independent contributor to mortality in heart failure. That's chronic heart failure and heart failure, which is, as I said at the beginning, you know, has been my focus, my main focus within cardiology from an academic standpoint, for more than 40 years, heart failure, at least the common form of heart failure that we, we think of most of the time is a disease of disordered stress, hormones, whatever causes it to begin with. It's driven by maladaptive activation of a number of stress hormonal systems. And we know that because every single effective drug treatment for heart failure is based on inhibiting the effects of several of those hormonal systems. So the heart can be injured chronically from many things, virus, a heart attack, but it's the convergence of all of these stress pathways that makes it worse. And the proof is in the pudding, literally with, with, with, with the that's the essence of modern heart failure therapeutics by manipulating these systems, we've changed the outcomes in the disease without doing anything specific to the heart. But this is one reason it's been so exciting to me because I've been interested in this brain mind, whatever you wanna call it, heart connection for a long, long time. Are you

Speaker 2: 18:57

Suggesting Steve, that, that regardless of where these stress hormones came from, it might be from a psychological stressor. It might be from a S physical stressor you're in the ICU and you have sepsis or something. It can be a physical problem. It can be a psychological problem, but these stress hormones are elevated, right? And in, if we can blunt those,

Speaker 4: 19:16

We can treat heart failure. That's right. So acutely, we think, well, we know that acutely that these stress cardiomyopathies or broken heart cases, there's a huge surge of activity of the sympathetic nervous system. That's the fight and flight system, huge surge. And then what happens gets complicated. And there's probably more than one mechanism of how it can actually injure the heart. But there's no question that that's the, that's the initiating event, because we've actually seen it in people that accidentally got too much of these drugs, epinephrine or epinephrine accidentally it intravenously. It reproduces the syndrome. So that's what happens acutely. It's an overwhelming stress. And for some people why it doesn't affect everyone is a very interesting question. And there's, there's gotta be genetics involved, but this overwhelming surge of, of the sympathetic nervous system activity can injure the heart transiently by any number, different mechanisms. It could be some coronary spasms. It's the coronary arteries, probably not. The main mechanism could be what we call microvascular. Dysfunction could just be the effects of the hormones themselves contributing to, um, metabolic imbalance, too much calcium overload of the heart cells, for example, but whatever it is, it's dramatic. And it varies from mild to de dating, where people have to go on multiple medications to support their heart function, and you can die from it. Although if you're under medical care, it's pretty rare. Now you transition to the, the chronic state. As I said, these hormones are not nearly as overly active in the chronic state as they are in, in an acute situation like that. But over time, the effects of chronic elevations of the sympathetic nervous system, and several other systems are clearly very involved in, in the progression of heart failure.

Speaker 2: 21:01

So being on edge all the time, being stressed, being revved up yeah. Is perhaps not, not good

Speaker 4: 21:06

For no, it's definitely not. And it, and, and while it it's the hormones, it's not just those hormones too. I think ed touched on it a few minutes ago, but inflammation, we know that these, the stress releases from the brain, um, signals that increase the activity of inflammatory pathways within the body. Uh, some of the inflammatory pathways include pathways that trigger blood clots. And so, again, it's no accident that chronic stress particularly acute on chronic can cause heart attacks. It, it may, it may both contribute to the underlying disease and be a trigger when something happens. It's, it's, it's very complex, but these, these substances don't originate in the heart. They don't originate in the coronary arteries. They come from somewhere and it is the brain, uh, that, uh, that is the, uh, the initiating factor in response to the stimula.

Speaker 2: 21:57

When we come back, I wanna talk about a couple things with both of you. I wanna talk about that term inflammation and then get some advice on that. So we're gonna come back with our guests, um, right after this,

Speaker 1: 22:09

You're listening to the healthy matters podcast with Dr. David Hilton, have a question or a comment for the doctor become a part of our show by reaching out to us@healthymattersathcmed.org. Or give us a call at six one two eight seven three talk that's 6 1 2 8 7 3 8 2 5 5. And now let's get back to more healthy conversation.

Speaker 2: 22:33

So we're talking to Dr. Eduardo colo chair of a psychiatry at Hennepin healthcare in downtown Minneapolis and Dr. Steven Goldsmith, cardiologist at Hennepin healthcare as well. We've been talking about inflammation. We've been talking about some kind of scary things, and we've talked about GE you can get stressed out and, and have, have serious heart conditions. Comment about that, about how common that is

Speaker 3: 22:57

Eduardo. So I think we're talking about some, uh, pretty dramatic syndromes that are while Dr. Goldsmith said, they're common, meaning that they're not as rare as the literature used to say is not something that happened bin every day. And every moment, we're all subjected to a significant amount of stress on an ongoing basis. And we do need to think about how it affects us long term, but in terms of the immediate and acute danger people who have anxiety disorders, for example, who worry a lot and have autonomic instability, their nervous system is very reactive to the stress around them frequently can modulate that. And it does not end up causing these kind of syndromes except in rare conditions. So at some point, I think we will hopefully understand what leads to the extreme cases in terms of modulating it for the rest of us. So, for example, if you get stuck in the traffic jam in New York city, this has been done. You put an electrocardiogram in the person to measure what it's doing. You see a number of, uh, Aber and beats beats that don't belong there. So everybody's getting a regular heartbeats

Speaker 2: 24:03

And the blood pressure's

Speaker 3: 24:04

Going up. And yet the majority of those people might be cursing at each other, get into fights, but don't necessarily drop dead. Right? Right. So the concept is, there's something about your heart at some point that might make it more vulnerable, right? For that moment. And clearly exposing yourself to chronic unrelenting stress will have an impact on wellbeing, stress, reactions, anxiety, and stress reactions are supposed to be normal. When there's a threat, you're able to bring all this to the fore and defend yourself, fight or flight, but then it's supposed to go away. And what we do a lot of times in our lives is we subject ourselves to the constant effect, which leads to not break your, your systems very well. And has a profound impact on your wellbeing. Talk to

Speaker 2: 24:50

Me about inflammation. Is it bad? Is it good where we both used that word in our conversation about, uh, stressors leading to physical problems, Steve, your comments about inflammation? Well,

Speaker 4: 25:00

It, it, it's enormously complex. And, and I do think that there's a common theme between the other or hormonal systems that I've spent my career studying, uh, and inflammation. It's true that in both cases they're designed for acute responses and overexpression continuously, even at low levels, uh, seems to be associated with poor outcomes. And as I said, we know that in heart failure, we also know what it and coronary disease inflammation's been best studied in coronary disease and the, the disease

Speaker 2: 25:31

That leads to heart

Speaker 4: 25:32

Attacks. Yes, coronary disease that causes. And what we know is that people that have for any given level of cholesterol, elevation diabetes, et cetera, if they have high levels of inflammatory markers within their body, and there's a number of measurable substances, um, they do worse, you know, and, and the mechanism is felt to be the inflammation in the blood vessel wall. It triggers the formation of plaques in the blood vessel wall, which begin with cholesterol buildup. And they can trigger rupture of those plaques, which, which then leads to heart attacks in, in heart failure. There's also an abundance of studies that show that elevated stress markers, uh, inflammatory markers, I should say, are associated with worse outcome, but a very cautionary tale from about 20 years ago, a lot of effort went into developing a drug to block one of these because it worked in mice and guess what? Didn't work so well in humans, not only didn't work, it made things worse. So while the stress hormone systems like the fight and flight systems and some related ones that I won't go into the details, it's pretty clear that overexpression of those species is always bad. There's no good reason for them to be there chronically every reason acutely, but not chronically, but inflammation's tricky because if you inhibit the wrong system, as we did with that, even though it looked good in a mouse model, it was impairing the ability of the art to respond to damage. And so you have to be very, very careful, uh, in, in drawing conclusions, but from what we're talking about today, though in general, I think it's as a general rule, chronic activation of systems that can injure blood vessels and cause cardiac dysfunction, chronic activation of those systems is not so good for the blood vessels and for the heart. And, and that acute broken heart syndrome is one where the, the hormones it's too, it's too quick for inflammation, but it that's where the stress hormones seem to converge and, and cause a storm that, that, that, that literally causes the heart to stop functioning for several days to several weeks.

Speaker 2: 27:32

So if you'll let me talk to you a little bit about, um, meditation, it sounds like, uh, it sounds like, okay, what are you, what are you doing here? You're pivoting to meditation and you and I have chatted in the past. And in fact have had, had a talk about the role of mindfulness, the role of meditation. And I know that you, I think you might still practice that. And are you willing to tell us a little bit about sure about what your, your take is on the role of meditation and mindfulness?

Speaker 4: 27:57

Absolutely. In this topic? Well, I've been a daily, I've had daily meditation practice for more than 20 years. Um, and I got into it, not because I was seeking a new spiritual path, although I ended up as a practicing Zen, Buddhist

Speaker 2: 28:11

I'll bet. Not a lot of people know that about you.

Speaker 4: 28:14

Well, some people do some do now, a lot more dos. Yeah. But I, I got to that because I took a course called mindfulness-based stress reduction, which is actually curriculum course, of course, in the me university of Massachusetts medical school curriculum that was developed by a psychologist there named John Katzin. And what the course does is it's an eight week introduction to, uh, intense mindfulness and mindfulness and meditation are in many ways the same thing it's being aware are being present in a non-reactive and non-judgmental way with whatever is happening, because whatever it's happening, whether it's a good or ill perceived as good or ill, I, if we react to intensely to it, it, it, it can interfere with our ability to process what's actually happening. So I took that course because of my interest in heart failure. And as I mentioned, because we knew that heart failure is a disorder of too much stress hormones. And I thought, wow, I'd like to learn something about meditation, because there was already literature showing that meditation training can decrease your level of stress hormones. So I took that course. Well, it, it, it was, it opened a door that changed my life really, and in many, but, uh, and it also led me to try to get research dollars from the NIH to study this in heart failure. But I think, uh, they're not quite ready to fund those things yet, but it's enormously helpful for people to know that mindfulness practice is, is, is good for you or healthy for you, I should say. And, and, and it has been shown to decrease the level of some of these, uh, uh, stress hormones and inflammatory markers. There is literature on that. What we don't have is literature linking those reductions to changes in outcomes, not for hard target outcomes we have, does

Speaker 2: 29:59

It reduce heart attacks? We

Speaker 4: 30:00

Have no proof. It, it reduces it doesn't improve survival in cancer, but it certainly improves wellbeing in cancer and decreases resource utilization and time in the hospital. Uh, there's very little data in the cardiovascular real unfortunately, um, which I hope in the next generation of researches and will be remedied because if there is a disease that's ripe for potential, um, benefits from, from a, from a technique that you, that doesn't require any medicine, just some basic, simple training and time, it's just being aware. And there are many ways to do meditation. There's many ways to practice mindfulness. It can be anything from the way you approach your daily running the way you do.

Speaker 2: 30:41

What about the way you interact with others here? You know, here's an interesting thing. And, uh, just about three hours ago before I came over here to the studio to talk to you, I was with Suzanne, my colleague at work, and I was looking, we were in a conversation. And finally I heard in the back of my head, a voice saying, you're not listening to me. Are you? And it was her. It was my good friend, Suzanne. I was looking at my phone during a conversation. Can that be the least mindful thing you could probably, I mean, it's embarrassing to say it, but I, it happened,

Speaker 4: 31:10

Well, the goal of trying to be present

Speaker 2: 31:12

And sorry, Suzanne, if you've

Speaker 4: 31:14

Been around people that, that have been, have done meditation for a long time, as I've been fortunate to in the communities, I've been part of it. It's pretty impressive. You, it does make the difference, but you're always measuring for your own self, you know? Well, what would I have been like if I didn't do it, uh, I can, I can make some guesses because I'm most, most people that know me. Uh, you know, I, I could be calmer. I could be less reactive. That's, what's what we strive to do, but we also have to be who we are and you can't fight against who you are, but you have to understand who you, but then move on from that. If you can.

Speaker 2: 31:45

Yeah. 10 years ago, I would've been kinda laughing and scoffing at all this, but it's, I think you were spot on because I'm that way I'm Spacey, I'm flighty. I've got four conversations going simultaneously all the time. And then people look at me like, come on, focus a little bit. So, you know, I totally resonate with that. Eduardo, take us out here. Let's what do you think about that? Do you think about mindfulness and in ways that all of us can address the stressors in our life? Yeah. So

Speaker 3: 32:12

I'll use it as an excuse to talk about the concept of coping strategies. Yeah. I, I think when we see people dealing with stress with, um, all of the ups and downs of life, I, I like to say kind of like, uh, when it comes to investments, which I don't know a lot about, obviously it's good to diversify. So if you cope primarily by running, it's a wonderful way of people to burn off steam, to be mindful, to release some of the tensions. And all of a sudden you have an injury it's gone. You can't go jogging now, what do you do? And we used to see this in patients who were hospitalized, um, like when I was at the university in the bone marrow transplant unit, who of a sudden have lost all of their usual ways of physically burning out stuff. The nice thing about what Steve is talking about is that it's something you can do anywhere, any time that you want. And it's quite accessible to people contrary to popular belief, but it's hard for all of us to do. So when you talk about diversifying your, your way of coping, I think the notion of being, having people be able to, uh, focus on breathing, to focus on their attention. And, and by the way, I hear always a lot of controversy about the word, my, um, because you could argue that mindfulness training is not training to get your head full of stuff is to be able to have your head full of stuff, but not have it run what you're doing at that point. Exactly. And in some ways it's about being in the here and now in a very different way. And you know, it's a very difficult thing for the rest of us to try to do. Uh, you've been practicing it for quite a while. If

Speaker 4: 33:42

I may add, you know, there was a, there's a, a well known teacher who thinks that the term mindfulness has actually contributed to some misunderstanding. Yes. And because the mind, we don't know what the mind is. I mean, people have been arguing about what the mind is, as long as there's been people with minds, but we know what our body is. It's, we, we certainly know what our body is and, and whatever we experience we experience through our body. So when you're doing mindfulness training or mindfulness practice, really what you're doing is being aware of what your body's doing. And there's a famous teacher who says we should replace the term mindfulness with body. It just, it doesn't roll off the quite as easily. But when you practice this, you know, you're always taught to start with focusing on your breath and your breath is part of your body. It's, what's the ins and outs of, of your breathing. But for many people that know that do yoga, for example, it's the same thing. I mean, you're just being extremely conscious of, of your body as a, and, and being present in your body. That's a way of working back to the mind. You don't start with the mind you start with what's happening in your body. And as, as Dr. Clone just said, the idea is not to change it, not to fight it necessarily, but to let it not take over so that you're still experiencing, what's actually happening and not your reaction to it. And this has enormous consequences for how we treat other people, how we interact with every stress that's out there. We can make it worse, or we can just accept it and not necessarily accept that it's okay. But at least we have to accept with what's happening and not our reaction to what's happening if we're gonna get anywhere. A

Speaker 3: 35:20

Number of years ago when I was young. And that was a long time ago, Dr. Benson published a book called the relaxation response. And now Boston's this big mind body interaction program. And the argument was if people do relaxation training, which essentially was, um, meditating yeah. Twice a day, they can control their blood pressure. Well, I know some people who have hypertension who do meditate and that's not enough to control their blood pressure, but again, the, the, the topic and the idea is that, uh, you can do things that regulate, uh, a lot of these functions that your body has, that, that we have ignored in our modern life, uh, that we just bay basically drive it. You know, the, the stress literature that we're talking about, it's pretty clear that for example, people with posttraumatic stress, severe exposure to a severe stressor, that makes you be in danger of losing your life, uh, can have a blunting of your, your brain's reaction to stress. So the cycles that we normally go through through the course of the day, the reactivity of your central nervous system goes away. And in many ways, that is, you could think of that as a predisposing factor. You need to be able to not have certain hormones at certain times of the day and have surges when you need them. Exactly. And I think what you're doing when you're engaging in any strategy to try and increase your capacity, to, uh, get away from this, to relax, mindfulness, meditation, ballet, yoga, whatever it is that you're doing to focus, you're essentially kind of calming down your central nervous system and allowing for the balance that we normally have to establish people sometimes simplify it into this empathetic para empathetic balance. And I think that's a nice model, but we're really talking about being able to, uh, shut down some functions when you don't need'em and be able to stimulate'em when, when your body needs it. And your body's incredible in how it does this, but we've really abused it quite a bit. Well, top,

Speaker 4: 37:15

Top level athletes have known this for a long time, and, you know, there's a, there's a co somewhere that that talks about, uh, what are you thinking about? I'm thinking about non thinking, what is non thinking? Well, you know, if you talk to a, a pro tennis player, for example, he's not thinking when he's, when he's hitting that, uh, amazing shot. So the he's just letting it, he's just being completely his body with his skills with what's happening then, because if he starts to think about it, he is not gonna make the shot. And you know that. So

Speaker 2: 37:46

Such, such wisdom, gentlemen, and thank you so much. You continued to teach me yet to this day. Um, some decades into our, um, mutual relationship. I got a psychiatrist and a cardiologist to get together, to talk about mind, body, uh, issues. And that is a gift to all of us. So thank you, Eduardo. Thank you, Steve, for

Speaker 4: 38:04

Being that, thank you, David, for hosting this, this is a message I believe is really important for people to, to get and, and to act on if they can. Would you do

Speaker 2: 38:13

Have, um, time for a couple questions from our listeners?

Speaker 4: 38:15

Absolutely. Absolutely. Yes.

Speaker 1: 38:17

Okay. Time for an impromptu session of Hilton's house calls here, here, this question comes in from Steph in grand forks, and she says, I got dumped. I got a broken heart. What do you do

Speaker 2: 38:29

At Oro? You wanna take that one? What do you, what do you say to Steph?

Speaker 3: 38:31

So I, I think what I would say to Steph is this is, uh, an experience that most of us have had to a certain extent. We all speak for yourself. Yes, we all have moments of disappointment and we all have moments of grief and sadness. Fair enough. And sadness is normal to feel disappointed, to feel down. I think the important part is to be able to put in perspective and make sure that people are again, like continuing to function and that they do something or they get the help that they need. Uh, social support is a very important variable that's been looked at, um, in terms of impact on health. And I certainly these, these are times when we turn to friends, family, somebody you're close to for comfort, uh, and for somebody to essentially help you to move, move through. And this again is where I bring up the issue of what are your coping skills when you've gone through something difficult in the past, what has helped you the most, or what has been most destructive? And you wanna avoid the things that have been negative, and you want to focus on the parts that are positive, but I, I always say that it's important to kind of have the mindset of word doesn't become too much. And when do I need to seek help and seeking help? A lot of times is hard to do. It's a very difficult challenge right now, but one is pretty important. Good

Speaker 4: 39:47

Advice to a good question. Let's go to another listener.

Speaker 5: 39:51

Hi, this is Jack from St. Paul. My father suffered a heart attack at age 57 and he under and couple bypass surgery shortly after that, his father, dad have a heart attack in his early seventies. I'm in my early fifties. Now, what age do I need to start seeing a cardiologist? And how often should I get a cardiac stress test?

Speaker 4: 40:10

Dr. Goldsmith? Well, uh, I tell my patients all the time that, uh, well, we can't yet change our genes. We, we can potentially alter our genetic destiny. Uh, so you can't change your parents? Uh, no. That's, um, but for, with a family history like that, I think the most important thing, uh, is simply to make sure that all of your conventional risk factors are under meaning your cholesterol, your hypertension, if you have it, your diabetes, if you have it, uh, if you spoke, you shouldn't be, um, there's not much role for routine stress testing in asymptomatic people. Uh, even if you had a family history, no, because we, we know that what makes a difference is altering the risk factors. So an asymptomatic people, we don't generally do stress tests unless they're, unless they're really worried about taking on a brand new exercise program or something. Um, but it's the conventional risk factor that we know make a difference. And today we were talking about stress and it's not a conventional risk factor. And as I mentioned, there are studies that as best they can have isolated stress, whether it's depression or more generalized stress as an independent risk factor for cardiovascular disease manifesting. Now, many of those people also have risk factors. So while there's no proof, there's no proof that adopting some of these mindfulness strategies or trying to de-stress your life. To the extent you can is gonna make a difference. I just tell people, look, when the research is done, I think the benefits will be clear, but there's no harm. It's, it's not like a drug where there's where there could be a side effect, three years down the line. There's people have been doing these things for 2,500 years or more. And, and, and there's many, many benefits, but if I had that family history, I'd probably wanna look into that as well, just to do everything that I could, that's measurable and provable on the standard side versus things that are good ideas and make sense.

Speaker 2: 42:11

Thanks, Steve. So that that's all we have time for today. I wanna thank my guests, Dr. Steven Goldsmith and Dr. Eduardo cologne from Hennepin healthcare, my colleagues and friends, uh, here in downtown Minneapolis. I hope you'll join us for our next episode where we'll be talking with Dr. Ji vagi about everybody's favorite pastime sleep in the meantime, be healthy and be well.

Speaker 1: 42:34

Thanks for listening to the healthy matters podcast with Dr. David Hilton, to keep up to date with the latest in healthcare and your health. Subscribe to this podcast on Spotify, apple, Google, or wherever you get your podcasts for more information on healthy matters, or to browse the archive, visit our website@healthymatters.org. And if you have a question or comment for the doctor, email us at healthy matters, H C M E d.org, or give us a call at six one two eight seven three. Talk to catch all the latest from Dr. Hilton and the healthy matters podcast. Follow us on Twitter at Dr. David Hilton. Finally, if you enjoyed this podcast and would like to support us, please leave us a review and share the healthy matters with your friends and family. The healthy matters podcast is made possible by Hennepin healthcare in Minneapolis, Minnesota, and engineered by John Lucas at highball executive producers are Jonathan Comito and Christine Hill. Please remember we can only give general medical advice during this program. And every case is unique. We urge you to consult with your personal physician, if you have more serious or pressing health concerns until next time, be healthy and be well.