Summary:
Dr. Alan Rozanski, a cardiologist, shares his journey into cardiac rehabilitation. He discovered his passion for helping heart attack patients recover through exercise and lifestyle changes. He faced challenges in establishing his rehabilitation program but persisted, ultimately creating a successful program that benefited many patients. Dr. Rozanski provides valuable insights into the importance of cardiac rehabilitation and the dedication of healthcare professionals in this field.
Full Episode:
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Transcription:
Megan Lyons: Thank you so much, Dr. Alan Rozanski, for coming on wellness your way. I am very excited to have you here today.
Dr. Alan Rozanski: Thank you so much. It’s a pleasure to be here.
Megan Lyons: Of course. Well, I’ve read your very impressive bio to our audience, but please just tell them a little bit about you and how you got into this line of work.
Dr. Alan Rozanski: It was kind of a transition. Finished medical school and then did my internship, residency, cardiology fellowship, and I was going straight into private practice at that time. A new field had opened up, cardiac imaging, and I was looking to get a little extra training in it. And one thing led to the next and lo and behold, I’m getting this training. I lived in New York, but I went to Los Angeles to see, to sign a medical center to get this training. And they offered me a job to stay on. So I’m doing this and I’m writing papers for the first time in my life and I’m working as an imaging cardiologist. And about two to three years into this, I’m starting to get a little bit depressed. Something didn’t feel right. I was not having the contact with patients I wanted and so forth. Then this was like providence. And when you end up with something offbeat, there’s usually a story behind it. So what happened was that the position of directive cardiac rehabilitation had opened up at the hospital. And for your audience, what that is, is where we take people after they’ve had a heart attack or after bypass surgery, no matter how frail they may be. And we put them through a progressive exercise program over twelve weeks, three times a week. And that’s the program basically. And it’s been shown to be amazingly helpful to people. So I was able to get the job. And at the time it was a very small program. We had maybe, maybe 800, 900 patients. We could accommodate only for 45 minutes sessions, which was not adequate. And CDers is full of practicing cardiologists. So it should have been a large program. So over the course of a year or two, I was able to get maybe additional few hundred square feet. And we had like maybe eight patients per hour. And then Cedars bought a building with five floors on it. Each one was 13,000 sqft. So I wanted the whole floor. And they saw the program was successful and they said, we’ll give you 2500 sqft. So this went out for a few months and no, they wouldn’t give me any more space. I had a friend, a colleague who’s actually a senior person on the board of directors for the hospital and he was close to the CEO of the hospital, Stu Marylander. And so this colleague, Chuck Clement was his name. He talked to him. He said, I can get you five minutes with the board of directors and no more than five minutes.
Megan Lyons: Wow.
Dr. Alan Rozanski: Come in and you have to make your pitch, and it better be good.
Megan Lyons: That’s pressure.
Dr. Alan Rozanski: Little did I know I was like 30 years old.
Megan Lyons: Wow.
Dr. Alan Rozanski: Anyway, I was over that week, and this all happened over three or four days. I was over that week and able to get into the building. So I saw the space first time. It was all unbuilt space. I had a friend who was an architect, and I had another friend who was a program administrator. He just knew a lot of things. And they said, well, for $3,000, we can get these architect plans done for you, which I didn’t have. So I went to the chief of cardiology and I told him I wanted architect plans done. And over the weekend, he approved it. They drew up plans over the weekend. I went into the board of directors meeting, and I just laid out the architectural plans, and I showed him. This is the gym. This is the bigger gym for the community. This is a cooking school and so forth. And they approved the whole program.
Megan Lyons: Amazing.
Dr. Alan Rozanski: Yeah. Yeah. Now, why do I tell you this story? Because, first of all, what was key here was that when you did cardiac rehab in those days, it was three months or twelve weeks, and then that was it. So some patients would continue, others did not. And I wanted a continual program, and I wanted a program where people could be part of a community.
Megan Lyons: Yes.
Dr. Alan Rozanski: So then what happened was that I’m seeing over the course of six years, I ran a program for six years before I left Los Angeles. And what I’m seeing is constant transformation. People who would come in in their sixties, seventies, late seventies, in those days, who were friends, who maybe hadn’t exercised in their life and maybe had a large heart attack, and we would see these people transform from people who had no confidence to even get on a treadmill, to people who felt like they’d been reborn and they felt now a sense of self esteem and empowerment. And some of these people were breaking the bank who were frail to begin with. And more than one patient expressed the idea that, you know, I wouldn’t have voiced a heart attack on me, but in a way, it was the best thing that ever happened to me.
Megan Lyons: Wow.
Dr. Alan Rozanski: That created the holistic path that I’ve been on for the last 40 years.
Megan Lyons: Oh, that is incredible. I will tell you something personal about me. I don’t know, you know, social media, their algorithm just gives you exactly what you want to see. And what I want to see is the centenarian Olympics. I love seeing a 90 year old participating in the decathlon. I love seeing all of these people in their later years really reclaiming their health, because there’s so much that we can do about it. And you are a testimonial for that. You have been helping people through this for decades. So thank you for the work that you’re doing. And, wow, good job for you for pushing those architecture plans through, because it certainly made a lot of difference.
Dr. Alan Rozanski: Thank you.
Megan Lyons: Yes. Well, you fast forwarded through many decades of continuing to serve patients at a deep level from all of that time in the trenches, you’ve created a health model that you call the six domains of health. So I’d love for you to give our audience a preview of what this is.
Dr. Alan Rozanski: Sure. Well, that was something that developed also a little bit by accident, but it was where the data just spoke to me. What happened was that there was, I guess it was the early 1980s. We were starting to see with these new ambulatory EKG monitors, which we didn’t have before, looking at the people performing their daily life activities. And we were seeing that there were people who had what we call myocardial ischemia, which means lack of blood supply to the heart while they were driving, while they were doing daily activities, maybe washing dishes. And it wasn’t with the, what we call anginal chest pain. It was, like, without symptoms and waves. So we called this silent ischemia. But we did not understand what was occurring. One thing led to another, and I said, wait a second. We can study this in a laboratory. Let’s take people who are undergoing exercise imaging stress tests and image them during mental stress. Now, just to explain what these tests are, in one word, how do we diagnose heart disease? One of the ways is we take people and we put them on a bike or a treadmill, and we have a camera over the heart, which can look at the wall motion of the heart. If someone doesn’t have a significant blockage in their arteries to the heart, what happens is when you exercise, the walls go in much more vigorously. But if you have a blockage in one of your arteries, a wall can slow down or even stop moving. And according to the amount of it, that’s how much heart disease you have, a great non invasive way to image the heart and to find out if people have heart disease. So I said, well, what happens if we have people doing mental stress? So I hooked up with a couple psychologists, and they said, look, you got to give them a battery of tests, because what’s stressful to one is not stressful to another. We had them do, like, serial subtractions of sevens and some sort of video task game, and we had them just talk about the personal stress in their lives. The second patient that I’m imaging was a 59 year old man who was about to lose his job. And as he’s talking about this, nearly half of his heart stopped moving.
Megan Lyons: Wow.
Dr. Alan Rozanski: First of all, just to put out, this is just happens with people with significant heart disease, and it’s in a controlled situation. So when he stopped, the wall motion went back to normal. But when he got on a bike, the same thing happened. So from that, and we did 40 patients. We reproduced this in, you know, about 20 patients out of the 40, and it’s been reproduced in about 20 medical articles since. So that was my aha moment. I said, wait a second. Whoa. There is this mind body relationship. I got to think beyond being just a cardiologist. Yeah, I began to study that. And to make a long story short, the thing that really gathered my attention as I started to look at this was the world in the 1980s of depression. We were seeing that people who were depressed were having a significant amount of heart disease. We didn’t know much in those days why, but as we began to look at it and the pathophysiological studies came in, we saw that people, when they became depressed, they developed autonomic dysfunction, insulin resistance, more diabetes, more visceral fat. In other words, the amygdala increased in size. Literally all major physiological systems went haywire. So I said, oh, gee, wow, this is really interesting. What else causes this? So then we looked at chronic stress and we looked at social isolation, and all these things were. It was like the body testifying what’s abnormal. Okay.
Megan Lyons: Yes.
Dr. Alan Rozanski: What we weren’t doing in those days was looking at the opposite side. But as that literature began to emerge, the positive psychology literature, I thought, wait a second. All the opposites promote health.
Megan Lyons: Yes.
Dr. Alan Rozanski: So what I came up with, ultimately, is these six domains of factors which promote your health if you’re functioning well in them and do the opposite if you don’t. And they include the physical factors of exercise, resistance training, sleep and diet, but also the quality of your thinking. Your mindsets, like optimists, live longer. Pessimists don’t, of course. Emotions, depression, positive emotions. Your quality of your social life, your sense of meaning, like your sense of purpose. And then finally, a 6th one. Is how you handle stress. So those are the six domains of health. I did not make this up. I just followed what the body said.
Megan Lyons: Yes, the body is so wise. I think almost all of science is us, or at least medical science is us trying to learn to interpret the body because it’s telling us stuff. We just can’t always speak that language. That’s really, really fascinating that you’ve identified or interpreted these six domains. And I want people to hear this is from one of the world’s leading cardiologists. These things really matter. So when people say, diet doesn’t matter for my heart, stress doesn’t matter for my heart, exercise. Very few people say, exercise doesn’t matter for my heart. But if they did hear it here, that is not the case. There are always things that we can do to improve the health of our heart through primarily these six domains. So I’d love to dive into a couple of these. My favorite is always nutrition. So let’s start here. What are a couple maybe drivers of disease, things that we could be staying away from and also promoters of health in terms of diet.
Dr. Alan Rozanski: So diet is one of those mains with the positive and the negative. Yes, positive factors. The almighty gave us so many choices of healthy foods. All the different vegetables, the fruits, you know, whole brains, you know, fish, chicken, turkey, you know, a good card of, you know, lean meat. All these are healthy foods and their absence is bad because let’s say you’re not eating fruits and vegetables. Well, you’re losing out on important minerals, vitamins, flavonoids, antioxidants, important things that you’re not adding that are protection to your physiology and your health. Yes, but where we get most stuck, obviously, is the large amount of highly processed foods that we’re consuming. The data is stunning. It’s close to 60% of our calories. And this is both adults and children come from highly processed foods. So that’s where the battle is to kind of focus more on positive foods and less on these ultra processed foods. And of course, this is your, your daily work, your life, you know, saying it’s not easy, right? It’s not easy.
Megan Lyons: Well, it’s not easy, but I think you framed it the right way. That the lack of these healthy foods that we’ve been provided, things that grow on trees and, and things that occur naturally, that’s the problem. So I just usually start with people encouraging more and more of these servings. Because if you go from eating zero servings of vegetables to six servings of vegetables per day, automatically some of the processed food kind of filters out, and then they start feeling much better. Then we can try to refine even further the processed food. But I think, like you said, both are very important.
Dr. Alan Rozanski: That is exactly my approach. That is exactly my approach. Just start eating more, you know, healthy foods and work from there.
Megan Lyons: Absolutely. What is your personal favorite healthy meal that both makes you feel great and you really enjoyed eating?
Dr. Alan Rozanski: Well? That’s a great question. You know, I’m very simple. You know, I have people in my family who love to cook, and I go along for the ride, but, you know, I’d be okay with, you know, salmon with, you know, a helpful, you know, amount of vegetables. Something kind of fun as a dessert is, I will take a banana, cut it in half, put, you know, peanut butter in the middle, put it in the freezer, let it freeze overnight, and eat it the next day as an ice cream.
Megan Lyons: That sounds delicious. Now you’re selling me. If we ever get to meet in person, I would love to share salmon, vegetables, and a peanut butter banana, frozen peanut butter banana with you. It sounds amazing. Okay, wonderful. Well, maybe we’ll get into a couple of other nutrition questions, but I’d love to have you touch on one of the other domains. So you choose your favorite or one that you just want to talk about today outside of diet?
Dr. Alan Rozanski: Well, golf favorites. But I start as the foundation with everybody with exercise, you know, to be moving because that’s the foundation, and that’s because exercise isn’t just for the help your health, it’s for how you feel. It feels more vital, you feel happier. There’s a lot with exercise. A colleague of mine, Jim Blumenthal, took patients. This was incredible work because this was randomized controlled studies, which is like the highest level of epidemiological study. So three NIH sponsored studies where you took people who were depressed and they were randomized to either an SSRI and antidepressant medication, or they were randomized to an exercise program, and they followed them over time for their remission of depression, and they got the same results with exercise as with an antidepressant. The day to day is enormous in terms of the benefits of exercise, in terms of mood. So, you know, we’re not psychologists, but we have the best handle to start with. So I start. Even if you’re starting on a diet, I often will try to get people to start with exercise first. Other than that, interested in a diet, start with exercise first, and I. Things begin to follow. So I start with exercises, maybe my favorite domain.
Megan Lyons: I love that I have cited that study many, many times. So congrats and thank you to your colleague. Now, what about people who are saying to you, yes, I know I should exercise. I put should in air quotes because I hate that word. It usually means I’m just not motivated yet. But they might say I should exercise, but I don’t have time or I don’t want to. Orlando. I hate running. They’ll come up with one thing they think they have to do. What do you say to some of those common barriers?
Dr. Alan Rozanski: So I guess from my perspective, I have always dealt with the people at the front end, not the people who are getting proactive at an earlier age. I’m dealing with people who already have heart disease, a lot of risk factors, who are sedentary. I’ve had to think about these tools over a long time. So we have a principle in psychology, it’s called self efficacy, which says that people, if they don’t think they can do something, they won’t do it. So the goal is not aerobic success, but psychological success. You have to get people on the playing field. Now, what’s really interesting, and most doctors I’ve been in medical meetings, still don’t know that in 2018, the physical activity guidelines for Americans were changed because we always promulgate you have to have 150 minutes of exercise per week, 30 minutes, five times a week, all these sort of things. Well, we’ve lost a lot of patients right off the bat.
Megan Lyons: Yeah.
Dr. Alan Rozanski: 2018, they changed the guidelines to say that we now have new data, using accelerometer data, that any amount of physical activity counts.
Megan Lyons: Yeah.
Dr. Alan Rozanski: If it’s five minutes, it doesn’t have to be a ten minute bout anymore. We used to think it had to be ten minute bounce, which means I. That anything you do, you’re just walking your stairs an extra five times per day or two times per day, or you’re just doing one walking yarn per day. This begins to count for your health. Now, I’ll tell you that when I say these patients, there’s often skepticism about this, but we have a discussion about it and we want to enroll people, and it’s very helpful.
Megan Lyons: Yes.
Dr. Alan Rozanski: And by the way, it’s not so simple. Many, many times with patients, they can’t do it be five minutes because they’re really not committed. It’s like, I’ll do it, but I’ll start tomorrow.
Megan Lyons: Yeah.
Dr. Alan Rozanski: So, but this is what has changed over time. You know, there’s really not an excuse of even lack of time because. Can you give me five minutes a day?
Megan Lyons: Yes.
Dr. Alan Rozanski: By the way, one key thing about all this, when you look at the epidemiological data, the greatest benefit for exercise is people who go from being completely sedentary, you’re doing nothing, to some physical activity per day.
Megan Lyons: Yes.
Dr. Alan Rozanski: That is the equivalent of giving someone with a high cholesterol statin in terms of its effect, in terms of reducing mortality risk. That’s how powerful it is.
Megan Lyons: Wow.
Dr. Alan Rozanski: People walking.
Megan Lyons: That is amazing. I’m so happy to hear you say that. And I’m curious, have you ever seen the study on the cleaning staff at hotels where they told half the people that they were getting exercise by doing their daily labor of cleaning the toilets and changing the beds, and then they told the other group nothing? Have you seen that study?
Dr. Alan Rozanski: Yes, I think that’s by Lisa Crumb at Stanford, where she’s done all this work with mindsets. And it’s a very fascinating study.
Megan Lyons: Yes, it really is. Well, you can probably correct me, but for the audience, the way that I interpret it to people is those who believed they had self efficacy, that they were exercising and they could exercise and they had their mindset in it, they actually experience better cardiovascular, metabolic health, et cetera. Parameters encourage the audience to think about your daily activities. Maybe you’re gardening, maybe you’re vacuuming the house. Can you think of that as activity, as exercise? Maybe even pick up the pace, maybe even double down on it and then feel so good about it that maybe you want to go for a ten minute walk after that or something like that? It really does build on itself.
Dr. Alan Rozanski: It’s interesting. I think maybe it’s also a bit exemplifying the power of the mind. Yes, you’re doing something good. You’re feeling better.
Megan Lyons: Yes, I know. For me, I do not feel the same way. If I get injured or an extended period of time goes by, for whatever reason where I’m not exercising, I just don’t have the same zest for life, I would say so. It really is such a gift to be able to do this and to be able to move our bodies. Especially those of us who are on the preventative side, thankfully, have not yet had these huge cardiovascular events. We can get so excited about exercising for good. Yes. So on that note, I think many people still think cardiovascular disease, heart health, all of this stuff, this just kind of knocks us down one day. It just happens overnight. And I think you and I would share the thought, the scientific belief that almost always that’s not the case, that it’s been building and building and building. So I’d love to hear your thoughts on that, I’ll let you take it wherever you want to go.
Dr. Alan Rozanski: Sure. Well, one of the challenges with heart disease is that it does build up over the course of years and decades, and then can just appear as a sudden heart attack. God forbid, even sudden death. I remember when I was ten years old, there was a man across the street, Mister Rosenberg, mid forties. One night we hear an ambulance, about three or four in the morning, woke us all up. I remember looking out the window and just seeing things going on. And then the next morning, I heard that he had died. Now, back in, when this occurred in the 1970s, heart disease was three times. Death from heart attacks was. Heart disease was three times more prominent from cancer.
Megan Lyons: Wow.
Dr. Alan Rozanski: It’s about, in other words, the death rate. Age adjusted for heart rate, for heart disease, and for stroke, two, by about 70%. So that’s terrific. But on the other hand, there is still the risk that this can just appear suddenly. In other words, it’s been building up for years. What’s happened over time, however, is we have great tools we didn’t have before, such as ones called a cornea calcium scan, of where you can do a scan takes about 30 seconds, and you look to see is there any deposit of calcium in the coronary arteries? And if the calcium there, it means that there’s underlying plaque or buildup of cholesterol, because that calcium forms within it. If we see that we’re having something that’s predicting a heart attack that could occur 15 years from now, but now you know, and you can get the cholesterol lower, and you can have a better diethouse. We have these tools we didn’t have before. So this has become, thankfully, less common, but it’s still common enough, and that’s why we need tests like calcium scanning.
Megan Lyons: Yes. So what if someone’s listening and they say, wow, a calcium artery scan that takes 30 seconds, it’s non invasive, that can help protect me multiple years in the future. How do I ask my doctor for this? Because I know a lot of people might ask their doctor, what can I do? Preventative. And depending on their age or situation, they might say, oh, you don’t need that. How would you advise people to talk to their doctor about it?
Dr. Alan Rozanski: I think most doctors today are familiar with this, so that if you go to them, one of the problems is that the test is not covered by insurance. That can be a different segment. That’s wrong. But the prices become quite low with the ubiquity of scanners we now have. So you’re talking about in most places, $100 per scan or maybe the cost of a copay. They’re offered in many places. And in most places, you still need a doctor’s prescription. Some places you don’t. But most doctors, I think, are familiar with calcium scanning. Now it’s just a number need to be asked if I can have the calcium scan. I think that the scan is a good idea when people reach middle age and have one or more risk factors of family history or something, or if they’re the worry. Well, I mean, I think there’s a. It’s perfectly fine to do this test.
Megan Lyons: Yeah. What’s middle age in your mind?
Dr. Alan Rozanski: 75.
Megan Lyons: Okay. I like that answer. And maybe if someone’s 60, maybe they should consider the calcium.
Dr. Alan Rozanski: Yeah. Well, I think even the 50, even 45, you could consider it. Sure.
Megan Lyons: Okay, great.
Dr. Alan Rozanski: I like the 70 family history even earlier.
Megan Lyons: Yes. I like that answer, though. 75. That’s great. Okay, so we have this technology that’s emerging. It’s getting more accessible. It’s very good at telling us real risk. Would you say the calcium artery scan is a better indicator of future health than just a normal lipid panel?
Dr. Alan Rozanski: Well, it’s a more powerful predictor than any single clinical factor, yeah. And once you have that, you can combine that with understanding better what to do with a high cholesterol. So we will be more aggressive, even with a normal, so called normal cholesterol calcium there. We’ll perhaps try to target a very, very low cholesterol level at this calcium abnormality. So I wouldn’t think it of either. Or if you’re going to have a calcium scan, you will definitely had a cholesterol panel as well. So you’ll use the combined information.
Megan Lyons: I was. I think you answered, and I understand if you’re hesitant to answer this. I would say, um, where I was going is if someone has maybe borderline high cholesterol, but their calcium artery scan was squeaky clean, zero, absolutely no buildup. Might you be a little more lenient in their treatment decisions as opposed to someone who did have that buildup?
Dr. Alan Rozanski: That is a lot of current thinking, and a lot of doctors will answer yes to that. And you’ll call this the power of zero. The only thing I would say about that is that it’s not a golden rule here, because even if you look at people who have zero calcium, within five years, about 20% of those will convert to a positive scan. So if I’m walking around with a high cholesterol and even though I have a zero calcium score first of all, I never stopped trying to have the best diet I can, for all reasons.
Megan Lyons: Yes.
Dr. Alan Rozanski: You know, it’s, it’s, there’s some doctors a little more cautious about giving a, you know, blanket rule. Don’t worry about, you know, certainly it’s a very high cholesterol. I think you have to be very cautious.
Megan Lyons: Yeah.
Dr. Alan Rozanski: Even with the zero calcium score.
Megan Lyons: I agree. I agree. There’s for sure of such a thing as too high cholesterol. I also think the drastic difference that some people consider between a total cholesterol of 199 versus 201, it’s not really like a switch flips once you get to 200. It’s really a spectrum. We need to take into consideration a lot of different things. The calcium artery score, lifestyle history, all of your six determinants of health or your six domains of health. All of these things.
Dr. Alan Rozanski: Absolutely.
Megan Lyons: Yeah. I’m curious to hear if you think there’s such a thing as too low cholesterol.
Dr. Alan Rozanski: We don’t know. Yeah, we’re seeing people now get to extremely low cholesterol levels. And when it comes to some of these data, I’ve been around a long time and we turn the corner five years later and we find out that maybe there is a problem. So don’t know for sure.
Megan Lyons: Yeah. I think it will be such an interesting, it is such an interesting area of emerging research. I am looking to see more research in terms of brain health and to low cholesterol, but I think we’ll all wait with bated breath until conclusive evidence comes out.
Dr. Alan Rozanski: In terms of exercise and good brain health. Right. That data.
Megan Lyons: Yes, absolutely. Extremely great data on exercise and brain health. So maybe that transitions us into the next question. If someone is thinking, okay, great. I don’t have high cholesterol. I don’t have family history, but I want to make sure I never get there. What else would you advise this person right now to consider?
Dr. Alan Rozanski: Well, I think it’s all the things that we normally advise, you know, be physically active, do resistance training. That’s something that’s not emphasized enough because one of the things that happens with age, we changed the goalposts.
Megan Lyons: Yeah.
Dr. Alan Rozanski: To be concerned how we were going to be in our seventies. Now many people are living to the nineties. We’re hearing people make it 100. I think Jimmy Carter made it to 100.
Megan Lyons: Yes. Just yesterday or sometime. Yes.
Dr. Alan Rozanski: The blessing is we’re living longer. The obligation is how am I going to be in my eighties or nineties? And one of the most important determinants of that is do you still have good muscles hopefully have not outlived your muscles. So resistance training key, very important. Sleep we haven’t talked about. That’s important, you know, and then we get into these six domains, you know, a sense of life purpose, learning how to have better positive mindsets.
Megan Lyons: Yeah.
Dr. Alan Rozanski: Factors are these are all entrees to better health and their entrees to the same highway. So what happens is, if you, the data is, to me, very interesting. I think. I wonder what you think of this as nutritionist, when you just look at the empiric data and you say, look at each of these domains, let’s say optimism versus pessimism, having a vibrant social life versus a poor social life, lonely. All of the negative factors are associated with poor diets. Something about the way we feel and the way we eat.
Megan Lyons: Yes.
Dr. Alan Rozanski: And without having to connect the dots, you just look at the data and say, this is what the data shows. It’s strong data.
Megan Lyons: Yes, I think that is so true. And I will say I have read the books, but I actually have not seen the blue zones documentary, the movies. But I know all of my clients tell me all these people are sitting around in community, and they’re eating these meals and they’re relaxed and they’re outside and they’re walking the hills and all of this stuff, and they have the longest percentage of living to be centenarians and beyond. There’s something there. Exactly what you said. When we’re in community, when all these other domains are in place, well, we naturally happen to eat healthier foods. So, yeah, it’s the chicken or the egg. Where does it start? But all these are important. I’d love to pick up on a few things that you said there. One is a sense of purpose. So I notice in my clients a lot of people who maybe they just retired in the past few years, their kids are long out of the nest and they’re feeling a lack of purpose. They don’t know what their day to day is supposed to be and what is really supposed to drive them. And I notice often that goes along with a decline in health. Have you seen any research on that or do you have any experience with that?
Dr. Alan Rozanski: Absolutely both. So the MacArthur foundation had sponsored some studies in terms of successful aging, and in one study they asked people their sense of feeling useful in life, and when they did not, it was a profound predictor of increased mortality risk. Study is, you can retire, but you can never retire. You need for purpose. Yes, you can’t. So this is an important area that we need to address much more now. That people are living longer because a lot of people haven’t, you know, it’s understandable. Life is challenging, you know, how do I pay the bills? I got to raise the kids, I have taken my grandparents. You hit the late sixties, early seventies, you can retire. But what, it’s a problem if you don’t have something to live into. So it’s important I tell all my residents and fellows that I want them, besides reading medicine, at least 15 to 20 minutes a week, be reading something that’s not in medicine. I tell them, you gotta stay in life.
Megan Lyons: Yes.
Dr. Alan Rozanski: It’s all about side interests. And when we’re interviewing candidates for a fellowship training program, something I do, every interview asks, what are your hobbies, what are your interests? I’m happy to say there’s a lot of interest that people have. I’m happy to hear it and see it.
Megan Lyons: That’s incredible. And what a fantastic thing to ask them so that they know that you accept that and you support that as well. They really do have to be humans, even as residents.
Dr. Alan Rozanski: Absolutely.
Megan Lyons: Great. And one other thing you said in there was sleep. We haven’t touched on it much. We have talked about it on wellness your way before, but I’d love to hear your take on what’s really important with sleep and what we can do about it.
Dr. Alan Rozanski: Well, we’ve learned a lot over the last number of years and there seems to be a sweet spot there in terms of 7 hours around there, give or take some window where people seem to thrive best, and that when they’re outside that window, we start to see metabolic abnormalities, increased insulin resistance, increased risk for inflammation, many factors here. And what we now know is that the brain, in terms of its excretion, of its waste products, it’s really occurring at nighttime when you sleep, where those cells between the brain start to open up and shrink a bit and the cerebrospinal fluid can escape and get its waste products out, which is pretty, a stunning phenomenon. We’ve only known this about the last ten or 15 years. Well, so that’s one of the things, one of the things I’ve always thought about is because I know a number of very high achievers who go on relatively little sleep. What I’ve seen, they’re all high achievers, they all have this tremendous sense of purpose. So I just wonder if there’s some bit of a counterbalancing factor. What I say is, how do you feel when you wake up in the morning? If you’re feeling tired, then something’s off. Another thing we’ve learned over time is the importance of what’s called the sleep hygiene tips. Cool room. It should be dark. Don’t be on your cell phone right before you go to sleep. And the regularity of sleep hours. That’s awesome. To be a very helpful factor.
Megan Lyons: Yes, all super important. Thank you for that. So I think your answer will be, well, the six domains of health are the answer, but let’s try. What can we do to combat all of the things that we’re facing these days? We’re facing constantly connected, lots of hours being connected, facing not enough nature, not enough sleep, not enough activity, not enough processed food. What do you think you would advise is something that can counter all of those modern inconveniences?
Dr. Alan Rozanski: It’s a great question. I don’t think there’s any one thing and I don’t think that the battle or living with the best way I can ever go away. We’re always challenged to be better than we are.
Megan Lyons: Yeah.
Dr. Alan Rozanski: Last moment of life. We’re always challenged to be better. It doesn’t go. That’s not in this world. In this world, we always constantly improving. Number one, we can enjoy the battle, right?
Megan Lyons: Yes.
Dr. Alan Rozanski: As taking pleasure in what we have. And these are all ramps, as I said, to being better. But, you know, as you get older, you know, we do age and we’re going to lose muscle mass, we lose bone density, etcetera, and we’re not going to be as strong. And sometimes we’re not. You know, illnesses do come on with age. And that’s sometimes when these other domains that you’ve worked on become very important because you have that sense of purpose and you have that sense of community and you have positive mindsets that build resilience. All these are factors that become resilience resources as you get older. So all of these areas could be worked on. I don’t know what I can put it all into. One thing, we’d have to take each one of them, say, well, this is how you improve in this area. This is how you improve in that area. But that’s the roadmap.
Megan Lyons: Yeah, that’s great. And I’d love to use you as a role model because you certainly are. I bet your resilience is quite high because you have spent decades in a, quote, high stress job and you’re still doing really incredible work. You seem like a very happy, well rounded person. So talk to us about your personal health habits. Are there any things that really stand out that move the needle for you?
Dr. Alan Rozanski: Sure. Well, you know, I exercise, I try to have a good diet. I’m not necessarily winning the sleep battle, I’ll be honest about that one. You know, I tend to burn it at both ends of the candle. I have as a new year resolution. Go to sleep earlier. But I think one of the areas that I do work on a lot and take quite seriously is working on gratitude. That is something I think that I’ve worked on for many years. And I think that most people, I always call it a tragedy of life that people just hear about grad. Everyone agrees it’s important. We have Thanksgiving day, but we hear it in terms of lip service. But I say gratitude is like exercise. You got to go and work out, go to the gym, do push ups, etcetera. You have to work because it’s human nature to take things for granted. It is just a human nature. So we have to work on those things. And there’s many tools, and people have different tools that they use. That one that I’ve kind of taken on for myself is, I guess what you’d call an implementation intention. Or when it’s this, I will do that. So for me, it’s when I get stuck in a line somewhere in traffic, when I’m waiting at the bank or whatever, that’s when I said, okay, that’s a cute think about, you know, gratitude. Okay, so that’s one. One I do and another one I do is with. That is just talk to people about the importance of it, because when you talk to others, you take it in yourself. My son, last week, he was invited to a dinner that he really wanted to go to. You can’t make up this story. What happened was he rented a cardinal, and as he’s leaving, something mechanically went wrong with the car, and he’s stuck in the middle of the road with it, and he has to find a friend, and they’re trying to push it to the side. He never made it to the dinner, so he was a bit upset. So I talked to him about it afterwards, and I said, well, did you ever think about all the times that the car did work and we just took it for granted, and he was struck by that? And then we got into this whole discussion about gratitude. Well, that helped me take it in more.
Megan Lyons: Yes, absolutely. I think I get the benefit so often of talking to people about gratitude, because it’s been one of the practices that’s changed my personal health and life really much more than a lot of other things. And like you say, when you talk about it all the time, it’s like a ripple effect. It comes back at you. It really, really feels good. So that’s another challenge to the audience. Try to work it into a conversation today. Just talk to someone about something you’re grateful for or help them reframe a situation and try to work some gratitude in there. I know it will ripple between the two of you and hopefully more as well. So thank you for sharing that. I think what you said about sleep is really interesting. You’re pushing so many of these domains on the purpose in life, on the gratitude, on the diet, on the resistance training, all of this that we don’t have to be perfect, perfect, perfect in all six of them. If we have one little gap, but we’re really strong in some of the other areas, I think we’re going to be okay. And there’s room for continuous improvement on that sleep, right?
Dr. Alan Rozanski: Sure. Just take one at a time.
Megan Lyons: One at a time. Amazing. Well, I know people are feeling incredibly inspired by everything that you’ve shared today. I wonder where you direct them. I’m not even sure if you’re taking patients, if they want to learn more about you or cardiovascular health. Is there a book or a website or anywhere you direct them?
Dr. Alan Rozanski: Sure. Well, for all these years, I’ve been in the medical world, in the academic world, written hundreds of papers, and that was my audience. But about two years ago, I started giving my fellows these wellness lectures and it developed a life of its own. And then I said, well, you know, I have to get out to the public more. So it was a late awakening. But you can find me now on LinkedIn. I have a website which should be up in another month or two. It would be my name, alanusanski.com. so that’ll be available. And of course, if you want to look at some of my articles, last year I read a whole series of articles that are on Pubmed. So if you go to PubMed and put in my name and look at 2023, then you’ll see a series of articles that they’re more for a medical audience, but they’re really, in a way that I think, you know, many people could understand them. Still a lot of references and data and figures.
Megan Lyons: That’s amazing. I think for many of my clients in our audience who are just health interested, even just reading the abstract is a really good start for a lot of these papers. So I’ll link to that. I’ll link to the PubMed search results, the LinkedIn and your website, which will be up soon in the future. I really genuinely appreciate you putting out so much good into the world. This is helping a lot of people. And I know you have saved so many lives and changed so many lives. So thank you for the work that you’re doing, and thank you for your time today.
Dr. Alan Rozanski: Thank you for having me. It’s been a real pleasure.
Megan Lyons: Of course.
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