How Mental Clutter is Hurting Your Heart with Dr. Alan Rozanski

0:03Thank you for joining us for episode 532 of Live Happy Now. Many people today feel unfocused or overwhelmed, and today's guest is here to explain why it's not just a challenge for our heads, but it could be harming our hearts. I'm your host, Paula Phelps, and this week I'm talking with Dr. Alan Rozanski, a distinguished professor of medicine at the Icahn School of Medicine at Mount Sinai and director of nuclear cardiology at Mount Sinai St. Luke. Dr. Rosenthal has dedicated his career to exploring the connection between our mindset and our physical health, and his comprehensive health model, the six domains of health, reveals how the quality of our thoughts directly affects the quality of our physical health, especially heart health.

0:47He's here to break it all down for us, so let's have a listen. Dr. Rosansky, thank you so much for joining us on the show this week. It's a real pleasure to be here. Thank you for having me. You are doing some amazing work, and I'm very excited to talk to you because we talk on the show a lot about how our thoughts and our emotions affect our health, but we rarely get this specific. And so as a cardiologist, you have incredible insight into how things are specifically affecting our heart health, but you are also an expert in health psychology. So let's start with the big picture. What do you see is the biggest misconception we have as a society right now about our health?

1:26How we define health. I've been fascinated by the question for a long time, and I'll ask my colleagues and other people, and either they'll grin or they'll give me an answer in terms of, well, health is, and they'll give me a few things. And it's always about, it's more than just the absence of disease. The healthcare system is geared toward helping people in a curative fashion. That's our emergency setting. Now, we talk about preventive things, but prevention is about preventing disease. It's not about necessarily promoting health, right? I mean, if someone is not depressed, it doesn't mean they're happy.

2:03If someone doesn't have illness, it doesn't mean they're thriving. So I think we have to think of health as toward the opposite spectrum. How do you thrive in life? And it turns out when you look at the things that make you thrive, they make you healthier. We tend to treat our health as we would treat our car. Like I'm not going to do something until there is something wrong with this part and then I can get that part replaced or I can get it tuned up. Is that how you see it within your practice? Are we kind of taking our bodies for granted and not really caring for them on the whole level? I think it's a bit more subtle.

2:39So I think many people either do take care of their health or want to, but it's like one of those what Stephen Covey called quadrant two things in his time management thing, which was like important but not urgent. And so what happens is I'll start to exercise tomorrow. I'll start my diet tomorrow. And you really want to do it, but the next day you have more things on your plate and you just keep not getting to it. This is one of the big, I think, psychological barriers we have. How common do you see people having issues with their hearts, with their whole being, and they're just not able to make those changes until there's a problem?

3:19Exceedingly. That's part of the human condition. We're always, you know, overvaluing what's in the present and undervaluing what's in the future. Actually, that's a whole psychological field called behavioral economics, and it applies to health. It's a big issue. So we wanted to talk specifically today about mental clutter. And this was really, really interesting to me because we don't think about how the things going on in our head are affecting our health. And so let's start by defining what you call mental clutter. Well, I would talk about it in terms of mental vitality. In other words, we have a brain here, and it's a wondrous organ that we have.

3:58And we use it to think, to feel, to figure out all the things and so forth. and we should take care of it. The brain is not a muscle. It is a collection of neurons, synapses and so forth. But we could think of it like a muscle. In other words, your brain functions better when you have restful periods. It functions better when you protect your focus. It functions better when you actually do helpful things like exercise and get enough sleep and so forth. But it's also a function of your thought processes. You know, we have a thing I would call a quality of thinking. And it's interesting that we're always in the doing mode all day long.

4:37And we're not in the stop mode. And, well, what am I thinking? Why am I thinking this? And how could I think better? You know, and we don't, we just don't get to that. And I think we could do better. How does it affect our heart health when we aren't taking the time to check in with ourselves, to clear our minds, to give ourselves that reset? Can you talk about our heart health first and then overall in our body, what's happening? Sure. Sure. Well, I looked at this objectively. It was a process over decades. I'll tell you, it actually started with a study we did years ago when I wasn't interested in psychology.

5:11I was interested in what makes the heart work and what makes it vulnerable. And we were taking patients who were undergoing stress testing. We put them on a treadmill and we look at the wall motion of the heart. And then when people exercise, the walls go more vigorous in. But if you have a blockage of one of your coronary arteries, then one of those walls starts to slow down. It might even stop moving. Well, for reasons that I had based on certain data, we put people under mental stress. And one of the things we had them do was talk about the stress in their life. We had to play video games and other things they did.

5:48The second patient we did was a man, 59 years old, about to lose his job. And he's talking about the stress he's feeling. We're imaging his heart. And about half his heart stopped moving while he was talking about his stress, which was remarkable. And that was my aha moment. By the way, that's been reproduced in about 30 studies. Chad, for your audience, that was people with very substantial heart disease. This does not happen to normal people. But it did happen in a number of our patients. We published that work. and then I started to get invited to speak at you know medical meetings seminars and got exposed to what other people were doing and this whole field of medical psychology was evolving this was back in the 1980s new data was coming out at that time it showed when people were depressed the body started to go hey why your catecholidin level went up your stress hormones went up you developed insulin resistance, visceral fat, and actually more heart disease.

6:50And the same was true with chronic stress, where we were seeing all of those things going on with chronic stress, with severe depression, anxiety, and social isolation as well. So that was my introduction to all of this back in the 1980s. And I came to realize, wait a second, you can look at this all objectively. The body testifies as to what's healthy and what's not healthy. We've learned since then that optimists live longer. Pessimists don't. Optimists have less heart disease. Pessimists have more. So you can develop this whole, you don't have to debate what is healthy and healthy. You could actually have the body testify.

7:28And once you understand that, there can be a certain pressure where you're like, well, I'm very pessimistic. And now you're kind of forcing yourself, how am I going to become an optimist? So how do you start thinking that without adding more stress into your life of, I'm going to die if I don't change my attitude. Well, I'm laughing a little bit because the way you phrased the question is a little pessimistic. I know it is. But I would look at it the other way. In other words, wait a second. The more factors that affect our health than we knew of, this gives me more entree points to make myself feel better and to be healthy.

8:06I wouldn't look at it from the negative. But, you know, gee, wait, even my very thinking can affect my health. You know, so maybe if I work on my mindsets, I might feel healthier. And we do have that natural negativity bias that we're all born with. And that comes at different levels. You know, different people have a different set point of a negativity bias. So if someone does have a strong negativity bias, what are some of the things that they can do to change that to start altering their physical health? Well, I would rephrase the term. I mean, there is a term called negativity bias, but the problem with that is it's a kind of diffuse term.

8:49I would say, as an example, we have a tendency to take things for granted. You know, we are born that way. You know, when do you start to work on? wait a second, I should stop to smell the roses. You had a guest a number of weeks ago, and he talked about as we get older, we more naturally gravitate toward being grateful for things in life. It comes with age, and it's one of the reasons people might be more happy as they get older, provided they have good health. But why wait till you're old? Start younger. But then you have to work on that particular negativity bias, if you will, to take things for granted.

9:26As we talk about our distractions and our mental clutter, can you explain the connection between those things and inflammation in our body? And then can you explain why inflammation is so dangerous and harmful for us physically? So what happens is that when you're under stress of any sort, and it might be emotional stress, it might be mental stress, it could be situational, it could be loneliness too, right? These are stress responses. And one of the things that happens when you're under chronic stress, stress that would be enduring or you can't control or has a lot of emotional negativity, is you have increase in cortisol and neoprenephrine, and then you have all these peripheral effects from it.

10:14There's newer data that shows actually one of the things that happens under chronic stress is the bone marrow gets stimulated to produce white cells, which actually end up going into the arteries and promoting atherosclerosis as well. So we're learning new mechanisms by which chronic stress can cause heart disease. But I would hasten to say, you know, it's like, talk about negativity bias. We have so much data out there. Every time there's a new study about stress does that, we're sending a message out to the public that stress is bad. But wait a second. Stress is our growth medium. People, when we handle stress well, we grow in optimism, in self-esteem, in, you know, a sense of challenge and growth and happiness.

11:05So, you know, without stress, this data that shows that actually the relationship between stress and well-being is U-shaped. And there's a sweet spot where you're under some moderate stress. But people who are bored actually don't have as good health. the body's testifying there hey wait a second we do need stress it's so stress is not bad you can see the upside of stress and by the way that's one of the mechanisms of dealing with stress to see the upsides the things that make a toxic stress is when it's chronic when it's you don't feel you can manage it or when it's meaningless like one of the worst forms of stress is people who've been subjected to trauma and abuse you know which has no good meaning for it and and and it's It's a very enduring stress for many people.

11:51It takes a lot of work, emotional work, to deal with that. So it's interesting you bring that up because the guest next week, after yours, talks about how we use stress as a superpower. So we'll just piggyback you two together. Yeah, yeah, yeah, yeah. I like looking at it from a positive sense. We'll be right back with more of Live Happy Now. If you're looking for a little more joy in your week, we've got two ways to help you boost your mood, right when you need it the most. Our Sunday Sillies newsletter has become a huge hit with listeners, bringing you a weekly pep talk, a couple of lighthearted happiness hacks, and a few ideas to help you wrap up the weekend with a smile.

12:32And starting in September, we're giving your Monday mornings a lift, too. Our new Wake Up Happy text campaign will send you a tiny dose of encouragement to start your week feeling grounded, supported, and ready for whatever comes next. So you can end your Sunday with a smile and begin your Monday with a little spark of joy. Watch for more details when you sign up for Sunday Sillies under the Connect tab at LiveHappy.com. And let a happier week find you.

13:03and now let's hear more from dr alan rozansky we are in a time of great stress as a nation as as a planet there are a lot of things going on and people are talking about just how stressed out and how anxious they are right now and so how is that adding to our mental distractions and what is that doing to us? So before we had this podcast, you'd sent a note that this was one thing that you'd like to discuss. So I had a little time to think about it. And, you know, it's true that today we have, you know, some stresses that have been accentuated. Time stress, more in our plate, more overstimulation.

13:50There's a lot of economic uncertainty, political uncertainty, if you will, and so forth. So I was thinking about that. And, you know, I we can go back to a period of time where we can compare and say that wasn't there. But on the other hand, if you go back to, let's say, the 1950s, when people had an idyllic view of what life was like then, you know, Leave it to Beaver, My Three Sons, all those shows from those days were happy families and so forth. But what about summertime when, you know, polio broke out and you had to escape from, you know, to the country and hide your kids away and they couldn't go to camp and so forth when we didn't have the treatments for heart disease?

14:31I remember when I was 10 years old, hearing the sirens in the middle of the night, looking out the window and across the street, they were taking out Mr. Rosenberg, who was 45 years old and didn't return the next day. And heart disease was threefold more common in the 1960s as it is today. I mean, in terms of mortality, adjusted heart rate deaths. So there's a lot to be beneficial, to be thankful about. What's different today is the stresses of today are different, unique. So we need new ways to deal with the time stress and the overstimulation. And how do I deal with social media? And what should I do in terms of using the benefits of it without suffering the downsides?

15:12So that's how I would look at it. And do you have an answer for that? How do we? Yes, I think every single one of these issues, you know, what doesn't change over time is the principles. The situations change and we need new strategies, but the principles don't change. So we know, for example, that when you maintain your focus, you are actually more energetic. You know, think of like a laser light as opposed to the candescent light. Why is laser light so powerful? Because it's more focused. When we're more focused, we're actually more energetic, you know, provided that we're enjoying what we're focused on.

15:52But when we scatter that focus, we lose that energy and we don't, it's not a restful kind of rest. You know, so scrolling, for example, if you need a break, is not as nourishing as taking a five-minute walk in the pool. So you can do that. And then you need to put boundaries. You do have to put boundaries on your use of social media. These are things that you have to do. But the solutions, whatever problem you raise, I think we could come up with principles to deal with it. And when we talk about focus, you talk about the need to focus with intention. Can you explain kind of what that means and then how we set that attention, how we go about doing that?

16:31Because I know the distractions today are a big factor in many people's lives. And we feel like we're being pulled all these different ways and we have these pings and alerts and all these things going on for us. So can you address that for us? Sure. There was work done in the 1970s regarding this phenomenon called flow. and flow is when you're enjoying something you're focused on it without distraction and you are losing your sense of time you feel you could be doing this all day and it's a very happy feeling it's been described by people playing basketball by and you don't have to be a professional basketball player i think anyone who's played a pickup game knows the concept of getting flow and into a basketball game, ballet dancers, anything you do in life, you could have flow.

17:21But the minute that we're distracted, we break the flow. It's not there. Okay. So that's why you say, wait a second, I'm going to do this work, but I'm going to avoid distractions during that time. If it's work you do. Now, a lot of work we do is not going to get us into flow. I mean, You know, I'll be honest, when I'm reading electrocardiograms as a cardiologist, I'm not in flow as I read them. It's just part of my job. But the other thing about that is coming back to the mind as a muscle is that the mind tires. And what happens is we are too, we're too involved in ourself that we don't, it's not like when we feel hungry.

18:01We often don't feel ourselves, the mind getting tired. We're slowing down, but we don't sense it. So there's all these techniques now in terms of different cycles, like Pomodoro, work for 25 minutes, take a five-minute break. After three of those cycles, take a 15-minute break. There's 60-10. There's all different types of things, but the concept is the same with all of them. You do need to instill rest periods. And then what does that rest look like? If it's scrolling on the phone, it doesn't work the same way as intentional rest that nourishes you. And what does that flow do? We know kind of what it does for us mentally, and we've addressed that on the show and in the magazine before, but what does it do for us physically when we get into that state of flow?

18:45How does it change the way things are functioning for us? Well, that's a great question. I don't know that we have the specific answer to that, but in a more general sense, when we're pursuing things that produce flow or things that are meaningful for us, we find that nourishing that sense of purpose is itself associated with better health. And part of that is probably physiological. Again, probably, you know, you're in more parasympathetic tone, if you will, less inflammation. There's not profound data showing that our sense of purpose, how we live purposefully is also related to our health and even in the stepwise fashion.

19:25So I think it works. And the other thing about all these things, and I have to bring this in as a physician and as a cardiologist is that what we're ignoring in all of this is when you look at all of these areas, whether it be in terms of our feeling state happiness or mindsets in terms of optimism, or whether we feel socially connected versus lonely, or whether we feel a sense of purpose, tremendous empiric data showing that people have better health habits. So people who are optimistic, are generally eating better, they're exercising more, they're taking better care of their health. And that is such an important mediator of health.

20:05Yeah, and it's something that we often overlook. I think it gets easy to get overlooked. But one thing that you've developed, and I was really excited to discover this framework, and that's the six domains of health. Can you walk us through that? Because this is a beautifully easy to understand way to really take control of your health and understand all these different areas. Okay. I'll give you the, what do you call it? The clip version, the super clip version, because normally any one of these topics would be a podcaster. It is. Yeah. But in short, as I said, the body tested by, so these are the six areas in which when you're doing the positive of it, it is actually promoting your health, longevity, less risk of disease, and the opposite promotes more, you know, risk for disease.

20:54So the first area is your physical health habits. And here you have four pillars, taking care of yourself in terms of exercise and resistance training, a big part of health. I know you've had podcast guests about that too. Sleep and your diet. Then we go to the second domain, which is the quality of your thinking. So for example, optimists, as I said, live longer. Gratitude's a big one. People who live with it, you know, work on it, develop a grateful personality, actually have better health. The third domain is your emotions. What's your relationship to your emotions? Are you generally happy or are you more on the sad side?

21:33Are you a resentful person or someone where things just bounce off of you more? Well, these things affect your health, too. So that's the third domain of health. The fourth domain of health is your social life. There's a basic psychological need that every human being has to be connected to other people. That doesn't mean you have to be an extrovert. There's a different manifestation in different people, but we need to feel that sense of connection. And very often in our society today, that's one need, although it's basic, it can be sublimated because we're so busy doing other things. and actually then when we need to have that social connectivity in life in a time of need or as we age, often we haven't put the right things on the bookshelf and we feel more lonely.

22:20So that's a fourth area. Fifth area is your sense of purposeful living. So again, people who have a stronger sense of purpose have better health. And the sixth area is stress management area, which I describe as a you-shaped relationship where actually we need stress because, and I'll tell you why we do, because we need to pursue a sense of purpose. We need to grow. And you can't grow if you're committed to being comfortable. You know, so you have to pursue that. So that's your six domains right there. I've never had to explain it in one minute. I know. That was so good. I didn't know why you were going to do that, but you did.

22:58So if you're speaking with someone, if you're talking to a patient, Is there one area that you say is most important to start in? Is one area, domain of health, more important than the others? Very good question. In reality, I think there's a couple of foundational areas. Coming as a physician, I think everybody needs to be, you know, moving. We're built to be moving to exercise. It's just a foundational habit and our sense of purpose. Those are the two that are most foundational. But the way I approach it with a patient, I have a specific question I like to ask, which is, you know, how energetic are you feeling?

23:41How energetic are you feeling? It's a vital sign. You know, when our energy is up, you know, things are working well, that's good. But when it's not, why isn't it? What's missing? It's something, one of the things in the six domains. Maybe I'm having social issues. Maybe I'm overstimulated or I'm not taking care of – I'm not getting enough sleep or not enough exercise. It's in one of those areas where you are having an issue if your vitality is down. That's important to point out because I know people who are much younger than myself who say they don't have the energy they used to. And they say that's just part of getting older.

24:23And I'm like, okay, first of all, that's not. And so how do you kind of make sure, how do you check yourself? How do you say this isn't just aging? This isn't something that is normal, but this is something I need to look into. Another great point. This is one of the greatest misconceptions we have about life and about aging. It is true as we age physically, we are, quote unquote, in a decline of some sort. I mean, we definitely have primary aging. We're losing muscle mass, bone density, et cetera, as we age. And we could be losing energy as well. But the other parts of what compose feeling energetic, they don't age.

25:09They can get better. You know, we generally, as I said, we tend to be more grateful as we get older. We tend to pick up wisdom called the school of hard knocks. You know, of course, we should listen to podcasts. so that we get wiser quicker. But the fact of the matter is that you can be every bit as energetic when you're 90 as when you were 19. You can't have the same physical energy. I mean, I watch these tennis players who are 38 and I say, well, how are they competing with 20-year-olds? Because they've already lost some fast twitch muscles and so forth and they can't compete quite the same way.

25:45So we're aging that way. But the other areas don't age. and if you're vibrant, I know many, many people living with many medical illnesses who are so admirable, are doing so many amazing things and feel very energetic. So that's a very optimistic take on that. So then where does somebody start? We are going to tell them how to find your website, how to find that six domains of health, because that is just gold. And how does someone start changing their mindset, changing that mental clutter, and getting on this track of health that's really whole being health. It's different for different people.

26:28And you could ask somebody, we have a sense, there's a kind of inner tuning fork that people have of things that maybe they'd like to do. Or they'd go back into life and think about it. When was there times when I felt I was doing something that was I resonated with time stopped I felt this was me and maybe you never did it but it's never too late you could say well you know can you give it five minutes a day so I'll tap into that with people um and I'll always tap into you know are you moving I you know I we we always want to get because it's it's just as you move physically it's a spiritual and psychological intervention as well.

27:10So if I have people who are not moving of the sedentary, I try to get that as the first step. That's beautiful. And you've given us so much insight. There's a lot more we can learn, and which is why we're going to tell them how to find you. And as we let you go, what is your suggestion for everyone who's hearing your voice today? What would you like them to take away from this and do. I often say that the biggest mistake in life we make is we don't count our blessings. We take it as lip service. So if you give five minutes a day to doing that on a consistent basis, watch how it makes you feel.