Joey Wahler: Did you know your heart can affect your mind and vice versa, so we're discussing that connection between the two. This is Be Well with Skagit Regional Health. Thanks for joining us. I'm Joey Wahler, our guest, Dr. Bhrigu Parmar. He's medical Director for Cardiac Rehab and the Echo Lab at Skagit Regional Health. Dr. Parmar, thanks for joining us.

Dr. Bhrigu Parmar: Thank you Joey, and thanks for having me here.

Joey Wahler: Great to have you. So first is this connection, and of course we'll get into the details in a moment, but is it something, the connection between mind and heart that you think most people are aware of or No?

Dr. Bhrigu Parmar: Well, I think it's literally on the back of all of our minds, but it's not a topic that was discussed commonly and so I'm glad we are discussing this today.

Joey Wahler: So why is it so important for people to be aware of this connection? Obviously it's to have better cardio health, but specifically what is it about learning about this connection and taking advantage of it that you think can be helpful to people?

Dr. Bhrigu Parmar: Oh, very good question. So, I'll kind of break this question into two parts here. So, how does mind affect our heart and really our health negatively and positively? So let's start with the negative part first. And so research has clearly shown that negative psychological health adversely affects the heart. So, chronic negative psychological health such as pessimism, loneliness, anger, hostility, anxiety, stress, depression, etcetera, are associated with up to a hundred percent increase risk of cardiovascular events. So not only the heart, but poor mental health is also correlative with other negative health issues, including dementia.

So it clearly is very important to avoid negative mental. The mechanism by which the negative psychological health affects the heart and overall health are manyfold and include poor habits such as eating smoking, alcohol, etcetera. And also negative psychological health increases stress hormones such as cortisol and or adrenal. So in addition to the increased, cardiovascular risk, negative mental health also impairs our ability to take care of cardiac patients because patients who have mental health issues tend to be less willing or likely to take medications because of mental health issues.

So that's kind of the effect of negative psychological health on the heart. Now on the flip side, you have positive psychological health. That includes happiness, optimism, gratitude, sense of purpose, life satisfaction. All these are, at least some of these are associated with up to 50% reduction in cardiovascular events. And so we should really all try for postive mental health in our daily lives.

Joey Wahler: Very interesting indeed. So let me ask you a couple of follow ups there based on what you just said, first, what you mentioned makes me think of a couple of sayings or phrases that we hear from time to time. One being, you're gonna give yourself a heart attack. Can people actually directly or indirectly, even if it's more of a buildup that leads to it, make that happen? Can you give yourself a heart attach?

Dr. Bhrigu Parmar: Yes. So people who are very anxious or an anxious, attack. For example, anxiety attack. They can have the heart artery become spastic, meaning it can literally narrow because of the anxiety and that can lead to a heart attack. So this is not uncommon, that's why we are discussing this topic today so that people recognize the adverse effects of anxiety and stress in our lives.

Joey Wahler: Gotcha. Also, another thing that we hear every so often is when people will sometimes refer to someone as having died of a broken heart. It might be an elderly couple where either the husband or wife passed first and the other one dies soon after, and they'll say it was because they couldn't bear to be alone and they died of a broken heart. You buy into that?

Dr. Bhrigu Parmar: Oh yes, yes. That's something we see not uncommonly actually in our practice here. it was discovered in the 1980s in Japan, and it's called broken heart syndrome. And the medical word, believe it or not, is called taka zubu. So Japanese word. And so that's what happens if some is a acute stressor in people's life. You can literally have broken heart syndrome and people in rare situations can die from that as well.

Joey Wahler: So now let's switch gears for a moment and talk about how the heart can affect the mind.

Dr. Bhrigu Parmar: Yeah. So, research has shown that cardiovascular diseases are associated with increased psychological illnesses such as anxiety and depression. And the reason, reasons are many fold and include just the fear, anger, just adjustment. And so, it is really crucial that we manage these mental health issues in patients, who are having heart diseases. And unfortunately, these are often underdiagnosed in patients in general, but particularly cardiac patients. We care because we are so focused on the heart. So I think it is crucial that patients bring this up if they are seeing their cardiologist and doctors do also ask questions. So that there is more discussion on this topic.

Joey Wahler: So if you're someone that, as it turns out, is having issues both psychologically as well as in terms of heart problems and you do want them addressed, how do you know where to start?

Dr. Bhrigu Parmar: Yeah. Most patients who are in this situation will have a primary care doctor and a cardiologist, so I think they should openly discuss with the primary care doctor and the cardiologist, and depending on the nature of the issue, they may need further evaluation and work up, maybe even referral to a counselor or psychiatrist, for example. But I think a good place to start is a primary care doctor and even your cardiologist.

Joey Wahler: Now nutrition and exercise can also affect this mind heart connection. So why don't we please take those one at a time. How about diet, nutrition, what to eat and what not to, what kinds of things should people be aware of there?

Dr. Bhrigu Parmar: Yeah. That's a very good question actually. And diet plays a very important role in both mental health and, physical health. And I've actually refer our listeners to our great podcast by my colleague Dr. Manatre on a heart healthy diet. But the good thing is that, good heart healthy diet is also good mental health diet, so you want to eat a more plant based green leafy Mediterranean, vegetarian friendly diet that is rich and tree nuts, avocados, extra virgin olive oil, etcetera. You want to avoid meats, particularly red meat and avoid or minimize processed foods. So I think such a diet is helpful from a mental health standpoint and make us happier and less anxious also good for our.

Joey Wahler: And then I mentioned exercise. How important is that and how does that manifest itself when it comes to this connection between mind and heart?

Yeah, so I usually use the word physical activity cuz some people are active but may not exercise. So we, want to include all of that. So physical activity is really, really important for our hearts and for our minds. And I think any activity is good. So whether it's gardening or cleaning, your house and as long as you're doing vigorous activity that is getting your heart rate up for as view as five minutes, I think it's adequate to help, but obviously more is merrier.

You Make a great point there that it doesn't have to be exercise per se, quote unquote. For instance, a lot of people do walking on a regular basis, and even that doesn't have to be taxing. It doesn't have to be for long distances. I guess consistency there is often the key, right?

Dr. Bhrigu Parmar: Exactly. Yeah. So walk your dog. Just walk your dog uphill if you can. And that is actually very good exercise and very good physical activity.

Joey Wahler: How about anything, doctor, that our listeners might not think of off the top of their head, that you can also suggest that plays a key role in having a healthy mind and heart?

Dr. Bhrigu Parmar: Yeah, so there are two other key lifestyle strategies that are ancient and now have increasing evidence to show positive effects on heart and mental health, and they are mindfulness and meditation. Mindfulness as the name literally suggests, it basically means you are deliberately and actively present in the moment while watching our thoughts and emotions in a non-judgmental manner. So, for example, when, most of us when we are driving, we are spending most of our time driving and our mind is kind of wandering all over the place and we may have some anxiety or agitation. And so that would be like the regular driving.

And if you wanna be mindful for example, while driving, you can be more purposeful, enjoy the surroundings and acknowledge your emotions without acting on them. So that's mindfulness and meditation is kind of the art of reaching a higher level of self-awareness and transcending the thought. So, I often will share with my patients to just sit down in the morning or afternoon or evening, whatever works for them. Close your eyes and just slowly take deep breaths, for five minutes and focus on your breath. And that will help in relaxing and calming the mind, and overall bringing a more positive psychological state and positive heart health.

Joey Wahler: And indeed mindfulness, am I right, has become, for lack of a better word, more popular in recent years. People are becoming more aware of it, it seems, and again, I'd make the point that it's normally associated with better mental health. But you're here to say that it also makes for a more healthy heart too, right?

Dr. Bhrigu Parmar: That's right. Yeah. Well, mindfulness has been actually shown to improve cardiovascular health pretty significantly. We are talking about up to 50% reduction in cardiovascular events with mindfulness. So I think the key is, yes, it is becoming popular, but use of that is still limited even for people who want to practice. It is hard, and so you have to really practice it regularly and daily, and then you get the benefit from it.

Joey Wahler: And then finally, If a patient is found to have psychological or mental issues that are adversely affecting their heart, where they're also being treated by a heart doctor, will a cardiologist and say a psychologist or a psychiatrist, sometimes confer and kind of team up to treat a patient as a tandum?

Dr. Bhrigu Parmar: Yeah, so we often do that if a patient has significant mental health issues, and obviously, I'm seeing a patient in my cardiology clinic. We will work with a psych psychiatrist or the psychologist and make sure that we're treating them appropriately and make sure the medications are all synced, to treat their heart and their.

Joey Wahler: Well, certainly a connection that obviously is very important to our overall health and one that people need to be more aware of, to say the least. Dr. Bhrigu Parmar, thanks so much again.

Dr. Bhrigu Parmar: Thank you.

Joey Wahler: And folks we trust you are now more familiar with this important connection between mind and heart. For more information, you can visit skagitregionalhealth.org to learn more. Again, that's Skagit, S K A G I T regionalhealth.org. Now, if you found this podcast helpful, please do share it on your social media, and thanks again for listening to Be Well with Skagit Regional. Hoping your health is good health. I'm Joey Wahler.