The Link Between Emotion & Heart Health

Columbus Batiste, MD, FACC, FSCAI

It is always a pleasure. It is good to see you again.

Joel Kahn, MD, FACC

Thank you. Cardiologists, and hospital administrators, making policies to make people healthier throughout the Orange County Kaiser system. A few minutes today to talk about Reversing Heart Disease Naturally, I know you have a passion for talking a bit about stress and heart disease. Just how does stress cause heart disease? A few thoughts there.

Columbus Batiste, MD, FACC, FSCAI

Yes. We understand this role in the relationship between stress and disease. It is estimated somewhere, as you well know, that probably nearly 80% of the hospital or doctor’s visits are due to stress to some degree. You start to dig and pass through the visits. That is where it is, whether or not we are looking at war, whether or not we are looking at raising kids or relationships—things of that nature. There is stress all around us. It has been seeing me through this pandemic. What is so interesting is that when you look at stress, it impacts the things that we always treat, which are the vessels; it impacts the endothelium, and we do not appreciate that. But our mental stress can be as impactful on what is called flow-mediated dilatation—how well the vessel dilates or relaxes and how well it constricts—as many other substances, foods, and things of that nature. A lot of times, I say that stress equals demands minus resources, and our health equals resilience divided by stress. The higher, we have to look at it in terms of the fact that the higher our stress, the poorer our health. We see this distinct relationship there. Many say they have shown that when you look at stress, apart from other factors, there is a level of increased risk for diabetes, for high blood pressure that we see, for all of it, for cancers, for malignancies when people succumb to this stress. 

Years ago, I believe it was around 2004, in a heart study told us that workplace stress and home stress were nearly two times the risk for heart attacks, and this has been replicated time and time again. Now, here is the thing that may ring true for many of the listeners out there: we see this in areas of bias, such as gender discrimination and racial discrimination. We see it in terms of the times of stress that are there—people have a heightened level of stress. That form of stress begets disease, specifically heart disease. I think the most interesting or not interesting thing is the choice of words. The one that was not taught to me in training is tackling civil disorders, broken heart syndrome, and stress-induced cardiomyopathy. I only ever thought about a broken heart. It was not the broken hearts I was given. I was receiving broken hearts from women and little girls back in the day. But when you succumb to this massive amount of stress, the heart and doctor, all of a sudden, cease to contract. Instead of squeezing in, it dilates out, expands out, and balloons out. This is an apical ballooning syndrome. It mimics acute heart failure, mimics an acute heart attack just from the weight of stress. Although this was described and based upon a Japanese octopus trapping container there, this is something that has been well-described in Asian countries for a while. Korosu and other things have high, intense levels of stress, begetting sudden death and sudden cardiac arrest. We understand that stress is so important in that pathway, that mechanism. It rides through the endothelium, the highway, throughout the entirety of the body.

Joel Kahn, MD, FACC

Wow. That is, you unpacked a whole lot of important topics. Just in case any of the listeners are familiar, there is a diagnosis called Broken Heart Syndrome. Dr. Batiste’s good-looking man is making a little joke about all the women in his life earlier on. I do not know how many. Let us not go there in honor of your dear wife; it was only a joke. But there is an illness called broken heart syndrome. It also has a Japanese name if you want, Takotsubo, and it is the ultimate example that you brought up so appropriately that stress is not just something that we people do not handle. Well, we all have it. God knows you have it. You are running a big administrative effort, and you are an interventional cardiologist taking care of sick people, and their lives depend on you. I have it. Everybody listening has it. If you do not manage it well, there is something called broken heart syndrome. You do not want it. It is just another version of a heart attack, but not due to a blood clot in a big artery you have removed from heart attacks. I have to, but thank you for that. Plea to focus on stress. We need techniques to manage stress. What is nutritional stress? I have heard you talk about that.

Columbus Batiste, MD, FACC, FSCAI

Yes, well, when you look at the idea of the health equation, that our health is tied to our resiliency, we develop our stress, and everything in life contributes either to our resiliency or to stress. We cannot avoid stress, first and foremost. Stress is just a natural state. You have stress, and you have distress. to a certain point, that amount of persistent stress it gets what we call an allosteric load, This weighs on you and begins to erode you over time. When we look at nutritional stress, it is very comparable. We look at nutritional stress. These are things that add to our stress instead of adding to our health and resilience. Those can be the form of oxidative stress. This rusting of pipes and so forth. We understand that you get oxidative stress from the environment, but you also get it from foods. You have this acidity from animal proteins and products that are there. We were uncovering that not only do we have the advanced glycation end products that are happening,

We have this Maillard reaction that occurs, which is browning. I grew up; with my family from New Orleans, and so I grew up making something called rue, where you brown a little flour and you make the gravy that is there. It is the beginning of mini stews, and mini gravies are there. The same thing happens in the vessels of your heart. We understand that it is the connection between your proteins and sugars that begins to happen. Emitting the high-temperature levels, some of the heart reactions begin to occur. Advanced glycation end products predominantly occur in animal products. Yes, they can occur in some plant sources, but in very low amounts. These are the things that age-advanced glycation. It impacts age on the inside and the outside. They are the things that begin the wrinkles and so forth. You understand why many movie stars moved towards the plant diet many years ago, not necessarily concerned about their health but concerned about their appearance, but, unbeknownst to them, the prevention of wrinkles. I am not talking about surgery and so forth, can also help their arteries and their health in general by eating in a healthful state.

These are all the things that begin to lead to stress in the body. Now, here is the way I describe it because saying terms like oxidative stress are very, it is not very practical. It is not something people can grab hold of. The easy way I think of it is to imagine if you are in a good mood and I walk in and I meet Dr. Kahn, and he says to me, Man, that is an ugly shirt. I am happy when I walk in and see him. I have all this happiness all around me. He says That is an ugly shirt. Why do you look the way that you do? All of a sudden? He steals my joy. He snatches an electron away from me. Now I am unstable. Now I am irritable at that moment. Now I turn and say something to his nurse, and I steal her joy. You begin to get this erosion that begets cancer, that begets diabetes, and that begets heart disease. This is what begins to happen when you have free radicals enter your body. They steal the joy from stable electrons, and you have this oxidative stress that begins to happen. The same thing occurs in a lot of the foods that we eat.

We have to have anti-oxidants. I always said, I know you asked me this question, but here is the thing. I always say that we, the celebrities of food now. We need Beyonce, the Jay-Z’s, the brawn, and the Kobe’s out there. They are known by one name: a singular ingredient: beans, broccoli, kale, potatoes, etc. Rice, all these things. These have singular names. Guess what they carry with them? Antioxidants, bodyguards, just the celebrities. What is the job of a bodyguard—to keep people from causing harm? In a very similar fashion, the more you can load your body up with bodyguards, the safer you are. It does not mean it is impossible. You cannot see harm, but it means that you increase the odds exponentially the more you load with these nutritious foods that build resilience in the armor inside your system. That is where the power lies.

Joel Kahn, MD, FACC

Wow. Good, good stuff. Again, everybody is listening. Plants have 60 times more antioxidants than animal foods. At a minimum, some have more. Pack your plate with plants, is what Dr. Batiste told us. What is it about getting selfish? How is being selfish a cure for stress?

Columbus Batiste, MD, FACC, FSCAI

Well, listen, I am going to tell you, there is so much stress now. When we look around the news, we look around social media and everything of that sort. Food is a central core component. It is the buttress of health and wellness, but it is not the only piece. It is supported by a complete package. Some in the Midwest might call this person the greatest basketball player to have ever played Michael Jordan. Michael Jordan once said that to be great, you have to be selfish. I do not mean selfish in terms of moving yourself, but it means that you have to seek purpose or be selfish. Stands for an acronym for spiritual. I do not mean this sincerely from a religious standpoint, but getting in tune with the focus of meditation, a prayer. It could include religion in that belief system that is there. Because of what begins to happen, we understand what the prefrontal cortex is. All of a sudden, your decision-making and your ability to plan and see those plans for fruition begin to take hold is what we call a keystone habit. It is a building block toward success. 

We understand that people who engage in meditation and prayer may suddenly notice that their blood vessels may dilate a little bit, their blood pressure may lower a little bit, and they become more focused and intentional. It is the beginning portion of this process that is there, because, in this fast-paced environment, we oftentimes do not take the time to focus and come to a peace, calm, and peace, which is what spirituality does for us like seeking a higher power. Whatever your belief system is going from there. We know that he stands for exercise. Now, it does not just mean getting on a date with Peloton or any of these other systems. It could be simply going for a walk in nature or forest bathing, you had to call it. I was wondering the first time I heard what that meant. But getting out in nature lowers the stress hormones, believe it or not. All of a sudden, the air in the sunlight, in measured doses, does miracles for your body. Studies have shown the benefits of simply walking for 10 minutes in your diabetic foot, lowering your blood sugar level, and improving your control. We know that for heart stabilization, all you have to do is walk. The letter L stands for love. But anyone who’s a doctor. Dr. Kahn, how long have you been married? How many years? 

Joel Kahn, MD, FACC

42.

Columbus Batiste, MD, FACC, FSCAI

42 years. I am buying your book. Okay. I need to buy your book. I am way behind you. I am buying the book on how. How do you get to 42 years for anyone who has loved anything or anybody for a while? You understand that love is not a noun. Love is a verb. It takes action, and it takes forgiveness. My wife has forgiven me many times over the past 25 years. That is love. It takes gratitude. It takes moving beyond yourself. Some call that volunteering. It takes acts of kindness that are there. It is an action where it is a verb. Studies have shown that when you engage in simple tools for forgiveness, they show improvement in blood flow to the heart muscle. When they compared individuals who went through forgiveness training to those who did not have anger recall, studies have shown that by doing these things, you can improve your health and well-being by being grateful. Blood pressure, longevity, weight loss—all of these aspects of engaging in love. Something missing in this world is love, empathy, and love in putting ourselves in other shoes. 

The F stands for food, of course. Come on. Whole food, plant food, rich food, and food that is nutritious. It is resilience for your body. It is adding to your future self. The I stands for intimacy in relationships. Not in a sexual way, but in intimacy, something we lost because we understood that simply because your immune system is more powerful when you come together as a community, studies have shown that loneliness is comparable to smoking 15 cigarettes a day. 

We understand that sleep is where the second is, which stands for rest. That could be a day of rest. That could be an issue in terms of going on vacation. It can be an issue trying to get 7 to 9 hours of sleep at night. Maybe you cannot tackle that all at once, but maybe you increase it by 15-minute increments. You get closer. We know the power that it is going to have. We have all lost our keys and four separate over a problem, and we wake up and all of a sudden the solutions are as clear as we can think. That is what the power is of sleep and rest; our phones need to be recharged. Our battery-operated cars need to be recharged the same way our bodies need to be recharged. 

Lastly, H stands for humor, laughter, for the joy of life. It is so important that laughter truly be medicine. Norman Cousins demonstrated this years ago. We have Patch Adams, who talked about this but believe it or not, there are studies. The one study I loved the most—I love to quote something Dr. Kahn is aware of—is that when we look at cardiac rehab patients, I am over the cardiac rehab for my organization. It is such a powerful tool that has been implemented for many years. But when we implement cardiac rehab, which focuses on nutrition, exercise, stress reduction, appropriate use of medications that are there psychosocial issues, and smoking cessation, people do better. This interesting study did one thing. They put everyone into this group or one group. They said I watched you watch 30 minutes of a comedy show. Anything that can make you laugh could be a dirty joke or a dirty comedian. It could be a regular comedy show. Surprise, surprise, surprise, guess what happened? The group that started laughing did better. They had less angina. They had fewer admissions to the hospital with recurrent events there. That is the power of laughter. 

I am here to tell you that small things matter and that every little bit matters toward your health, your wellness, and your overall well-being. Because the goal of being selfish is not just to achieve health. So what if you have achieved health? So what if you achieve the weight loss you are looking for? Now, what? The now what, so you can live a life of purpose. That is what being selfish is. Is to get selfish so you can live a life of purpose that entails more than just eating right. You have plenty of people eating right and are as angry as they can be. You need to live a life of purpose so we can make this world a better place for our kids. I can say that as I am getting older, my kids are getting older—my kids, my unborn grandkids. I better not have grandkids for many years now. But that is what it is about when you reach a certain point in life. You are recognizing that I am not going to be here forever, but I am trying to work on my healthspan. That is what it is about: my health span. We do not know today from tomorrow, but we understand that I want to live vibrantly. I want to thrive, as all of you want to do. This is something that studies have shown that you can achieve when you are committed because when you are committed, you do not let life circumstances derail you from your goal. You are committed. You stick to it, irrespective of how you feel. It is not about how you feel. It is about what you need to do.

Joel Kahn, MD, FACC

Wow. I think you have just provided one of the most passionate, deep, and purposeful summaries about starting with this stress-heart connection and ending up with a life of purpose. I want to thank you as we shut down this first part of a conversation with Dr. Columbus Batiste, from Orange County, California. We are going to leave some of our viewers here right now. Thank you for tuning in. I hope everybody furiously took notes on that acronym that we now have to work on. It is just phenomenal. Dr. Batiste, stick around for a minute. We are going to talk a little bit about Reversing Heart Disease for those who have participated in the full summit. Thank you for your time. We will be right back, everybody. 

Alright. Good. Let us go unscripted here. You gave the most beautiful description of stress in your view of just life and how the heart interacts. But we have The Reversing Heart Disease Summit. I think we still have so much work to do to convince people that you can diagnose heart disease. It is a condition that I do not tell people is completely reversible, but it is reversible to an extent that may make their life much been a plant-based guy for their whole life. Growing up in the Adventist Church, as we talked about a couple of days ago when we conversed. You are practicing, how many years have you been in cardiology practice?

Columbus Batiste, MD, FACC, FSCAI

16.

Joel Kahn, MD, FACC

You have been able to incorporate educating patients about nutrition, and while you are doing what I did for a long time, I do not do it anymore. But Cath Lab, crazy life. What have you seen in terms of people’s willingness to consider major dietary changes? What tools have you found most effective in helping them move forward, and maybe some of the results and outcomes are just a few minutes away from the perspective in your practice in reversing heart disease?

Columbus Batiste, MD, FACC, FSCAI

Yes. No, it is. I think the adage stated by many who preceded me is that it is not the timing at which you start to engage; it is the amount of effort you put in. For those who’ve gone in fully and have embraced it, they have had a full resolution. This is one of the best examples of this, and when I started, let me take a step back. When I started, everyone else was a bit guarded; whatever it was back in 2010 to go for, it was not as popular as it is now. I was hesitant to be an African-American interventional cardiologist, the only one I knew in the area who looked like myself was that guy who was saying something different than everyone else. But I felt obligated to go ahead and do it. I will tell you, for the first three patients that I may have recommended, I did not even have an elevator pitch. I did not have any scripts. I did not have anything. I think I gave them Dr. Furhman’s book, and as with the book, I gave Eat to Live, which is all I gave them. No spiel. I was like, You need to change your diet. I said, I tell you, you need to go; consider, you need to go plant-based, is all I said, I believe.

Three patients came back with incredible life stories about losing weight. One patient and they never forget, had so many symptoms walking in. He came back and saw me and talked about how he was doing better than I was. Would you do it? Because I listen to you and I read the book, all of a sudden I start walking and eating better. He changed his entire life. That is what took things off at that point. After that, it was more of an issue for every patient, and every time the evolution of things came where I started writing a list now. I called it my green sheet at that time, and I started writing. I realize that most people do not love to read. I wrote YouTube videos and I wrote down, typed rather, documentaries that I want them to watch, and then with some books and then for some cooking plants. That was the first iteration of things that we just handed to the people and gave them that. It was my green sheet. I did the same thing in the cap lab. I would talk with them. I did a challenge with the staff to get them going, to get buy-in from them, and nurse practitioners worked with this. She completely went whole-food plant-based. She started giving out my information, and slowly but surely, my interventional colleagues started to say that they had not moved towards eating tofu plant-based.

But when patients ask them what they should do, they tell them, Do Batiste’s diet; this is not my diet, but I will take it. That is fine. They will give them my information. Some of them will ask them. I hired a dietitian in my practice when I was a local chief. I started a cooking class to start a lecture in my free time. If I had their volunteer time, I would do a lecture for and with them. Interestingly enough, I started being a staff, having pharmacists, and having patients come to it. The cooking class we called the Cath Lab; Cooking Alternative To Health, was the place where you change and transform your disease and have a wonderful time doing that. Pandemic stopped it, as did many things at that point. Then I hired another cardiologist who has a similar passion, who began taking on the mantle, doing the lectures, and so forth as I got a bit busier and took that on. That is it. 

When I started seeing, in terms of patients, I would see patients who came to my office, and he sought me out. I believe that a combined integrative approach is the best therapy at the right time and understanding. He had what I felt were unstable symptoms at that point. I did not feel comfortable saying, I was just going to treat you with medications alone. I took him and did not answer him, and his vessels were just horrid. They were. I was surprised that he was not in the hospital with the way that they hit they looked, and they all began as I was scared. I have been doing this plant-based approach for quite some time, but I was scared for him, so I said, You do need to consider surgery at this moment. Through his grogginess, he said, Doc, I want to see you back in the clinic. He said, No. His wife said, Well, he said no. I said, okay. I said, Well, see, I am back. I am back in the clinic. I walked in and talked. He said I will do whatever you say, doc. I will do whatever I say, whatever I say.

I have not heard that in a long time. I say whatever you say. I did what we did: I put him on a complete fiber-rich diet and whole food plant base. At that point, there were no oils, no salt, and no sugar. We went in hard in the pain. His wife was fully committed, even though she did not eat everything that she cooked for him, and he transformed and got off his medications. All of a sudden, he came back to see me. I got scared. I had not seen him for a while, and his only complaint to me after suffering from intractable angina was foot pain from plantar fasciitis from walking a golf course. This is the person who set the table. He was not the first, but he showed me, and the interesting part is that data within the American College of Cardiology tells us we are for people who refute the fact that you can stall heart disease, but you can lead it to remission. They have shown and demonstrated throughout the years, of course, to pharmaceutical agents that subtle regression in coronary artery stenosis. When you look at the law of physics, that is enough to improve blood flow and decrease mortality events substantially. Why do we think we can accomplish that through food and nutrition? The power comes when we understand that, through aggressive fiber-rich plants, and rich foods, we can decrease our cholesterol, inflammation, and inflammatory burden.

That means that we can decrease not just our large buoyant LDL but our small dense LDL, that we can decrease apolipoprotein B, that all these things begin to happen, that we can decrease our blood pressure, and that all of a sudden we decrease the burden of stress on the heart. It is not surprising that we can cause subtle regressions of fresh, newer plaque and that through the adoption of aggressive, dark, green, leafy vegetables with vitamin K and some degree of K2, which has been shown to decrease the calcification of the vessels that you see the transformation that begins to happen. It is not surprising to anyone. Alexandra Chase said that a surprising event ceases to be a surprise and then occurs daily. When I see this regularly, as I have had good fortune, I am no longer surprised. It is just a matter of whether my patients are going to take the prescription to help me prescribe them. If they will not take one, then you have to take the other because people will say, Well, doctor, you still prescribe pills. I do, because, guess what? Sometimes people will not take my prescription for nutrition, but they will rather take a prescription pill. Sometimes they will take, sometimes they will not take either. It is, so it is a matter of seeing what it is that you want. What are you willing to do to get what you want, and what will you not do to get what you want? In the words of Kelly McGonigal in her book, The Willpower Instinct, those are three important, imperative questions to ask: What do you want, and what are you willing to do to get what you want? What will you not do?

Joel Kahn, MD, FACC

Well, that is a great summary. The green sheet. I guess I still use the green sheet. I have a little bit more time than most. Then I have a cardiologist on with a patient, and they love it when I pull out a legal pad, although I have it with my practice logo on it. I just write pretty clearly for a doctor. As you write documentaries, books, podcasts, recipes, and suggestions, I think there is more impact from that than maybe just handing them a pre-prepared list, which is better than handing them nothing. But, and then they come back, and I am blown away. You were blown away by that patient you are talking about; six, eight weeks later, there are substantial changes, and they bought in. 

Any time you can get a couple, whether they are a husband, wife, or significant other, and get them both on the team, it is certainly a challenge to many, particularly maybe to a guy who’s never stepped in the kitchen, never cooked, and is trying to make a lifestyle change. I have used some of these food delivery services if it is within the budget of a person of my favorites. I am sure you have heard of WholeHarvest.com. You want to go a few weeks and pay a little bit more to try some foods when you have never dabbled in cooking in the kitchen, and it makes it a bit of an easy win. You do believe that heart disease can be reversed and patients out of hearing about it. Now you have a pretty substantial position with Kaiser, and Kaiser Health has over the years had a little of a reputation for being more open about plant-based There have been some guides to nutrition for physicians that have come out. You see it stalled, you see it going down, or there is still a vibrant interest in plant-based nutrition within the Kaiser system.

Columbus Batiste, MD, FACC, FSCAI

Well, what I would say is that there are providers who are very passionate about plant-based nutrition, and there are growing ranks of dietitians, nurses, and physicians who are, organizationally, never making a strong statement advocating a particular dietary approach other than eating well and thriving. Very comparable to our guidelines. They will say the first line of every guideline for cholesterol and diabetes is to live a healthy lifestyle. But what exactly does that mean? You are not enacting any smart tool approach, being specific, measurable, achievable relevant, or at all. There is not necessarily that. But what I will tell you that is unique about our organization and compared to many others is that our sole goal is to keep people healthy. When you are healthy, when your numbers are controlled, and when you are doing well, then you are going to be better. Guess what? It has been beneficial for you. It is beneficial for us from a cost perspective. It is not an issue of withholding care; it is an issue of. let us do everything to a maximum, either early detect it or treat it before it happens as best as possible.

I think because of that, that is what opened the door for this plant-based revolution to seep into the Kaiser organization. But I will not say that it is full and widespread. But I think there is this awareness. The importance of lifestyle. Some of my colleagues do a wonderful job of educating physicians and going through the literature on why this is so important and how it impacts lives.

Joel Kahn, MD, FACC

Well, good. Well, listen, I have taken a lot of your time. You are a busy man. You have kids and a wife to get back to. I want to thank you so much for sharing. People want to learn more about you. Where do they go? What is a great website?

Columbus Batiste, MD, FACC, FSCAI

Yes. Now it is The Healthy Heart Doc, but I am going to be changing that name. There is a book coming out soon, Selfish: A Cardiologist Guide to Curing a Stressed and Broken Heart. It is coming out soon. That is now the site that you can find, and I appreciate it.

Joel Kahn, MD, FACC

The Healthy Heart Doc.com?

Columbus Batiste, MD, FACC, FSCAI

Dot org. 

Joel Kahn, MD, FACC

thehealthyheartdoc.org. Thank you. Then there will be a book coming out called Selfish.

Columbus Batiste, MD, FACC, FSCAI

Yes. Selfish. 

Joel Kahn, MD, FACC

Well, I am sure you just got a large number of people going to be looking for it; maybe preorder that book when it is available, and that will be awesome. Please do not send me a copy. I want to buy a copy. However, if you do want an endorsement, feel free to ring me up and it would be a great honor to do that too. 

Columbus Batiste, MD, FACC, FSCAI

I appreciate it. 

Joel Kahn, MD, FACC

Much gratitude, and appreciation for your time and your brilliance. Thanks, sir.

Columbus Batiste, MD, FACC, FSCAI

Well, listen, appreciate, and always appreciate being in your presence and in the work that you have done before me. I have always appreciated your work and looked at it admirably. It is always an honor. Thanks so much.

Joel Kahn, MD, FACC

Thank you.