#67: Dr. Monica Aggarwal - A Doctor’s Prescription for Happiness is Plants
What happens when a confident doctor becomes the desperate patient who, like the rest of us, feels powerless when we get sick?
This is the moment that board-certified cardiologist, Dr. Monica Aggarwal, describes as her moment of truth when she was diagnosed with a devastating form of rheumatoid arthritis shortly after the birth of her third child.
In an instant, she went from being an avid runner, busy doctor, and engaging parent to someone who could barely move.
Anger, blame, denial...you name it...she had it.
She also had the answer -- a radical change to her diet and lifestyle.
Our bodies have miraculous ways to heal and Dr. Aggarwal shares her prescriptions for joy, vitality, and health from her book, “Body on Fire: How Inflammation Triggers Chronic Illness and the Tools We Have to Fight It.”
Finally, we have a prescription you’ll look forward to taking.
Episode Resources:
Dr. Monica Aggarwal Website and Book Information
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Dr. Monica Aggarwal:
The goal is to eat more plants. And if you cut out the animals and eat more plants and you be active and you cut out simple sugars and you don't smoke, you're going to do okay. I always tell patients, your genes are what your genes are. I have rheumatoid arthritis because my genes had that. But what triggers those genes and what makes those genes activate, you can control. And also remember we have what we have, but it's how we respond to it, right? And so changing your lifestyle now at this moment, at 50 or at 20 or at 70, it's never too late. Just go do it. Let's go.
Rip Esselstyn:
Season three of the Plant-Strong Podcast explores those Galileo moments where you seek to understand the real truth around your health and dare to see the world through a different lens. This season, we honor those courageous seekers who are paving the way for you and me. So grab your telescope, point it towards your future, and let's get plans drawn together. Doctors can be a little cocky. So imagine the humility you must learn when you go from being doctor to patient literally overnight. This is the moment that cardiologist Dr. Monica Aggarwal describes as her moment of truth when she was diagnosed with a devastating form of rheumatoid arthritis shortly after the birth of her third child.
Rip Esselstyn:
In an instant, she went from being an avid runner, busy doctor, an engaging parent to someone who could barely move. Anger, blame, denial, you name it, she had it. She also had the answer, a change in her diet and lifestyle. Today, Monica and I discuss her journey and her book, Body On Fire: How Inflammation Triggers Chronic Illness and the Tools We Have to Fight It. This roadmap helped her and I know it will give you hope as well.
Rip Esselstyn:
I am here with Dr. Monica Aggarwal. Welcome to the Plant-Strong Podcast. It's an absolute pleasure to have you. We've actually never officially met before, which is actually surprising given how much I've heard about you, great things about you from my father and my mother and my sister Jane but thank you.
Dr. Monica Aggarwal:
It's my pleasure. Thank you for having me here.
Rip Esselstyn:
Oh, yeah. So what I'd love to do, I want to dive in, I want to talk about your journey to plant-based nutrition. I want to about your new book, Body on Fire: How Inflammation Triggers Chronic Illness and the Tools We Have to Fight It. I read it. It's magnificent. It is very all encompassing. You guys did a fantastic job with this, congrats on that.
Dr. Monica Aggarwal:
Thank you.
Rip Esselstyn:
But I want to start out by asking you this question and season three is really about what was the defining moment in your life? That turning point when the light went on for you like wow, something as simple as plants can really be a huge evolution and maybe the direction I want to go. So was there a turning point, defining point for you?
Dr. Monica Aggarwal:
Yes. There was absolutely a defining moment. So as a clinical cardiologist, we're always talking about the science and we're always, "Well, where's the data? Where's the data?" And then when were in medical school and training, I remember when we were talking about lifestyle, that talk in nutrition, it would take about five seconds of medical school. And we would say, okay and with heart disease, make sure you get people to eat well and stay healthy and exercise. And that was pretty much. In fact, the interesting thing is on the medical boards and on the cardiology boards and most common answer for management of cardiac patients is alter lifestyle, but we aren't actually taught so well how to do that, right? And that's become sort of the big conversation point is why aren't we teaching our doctors better?
Dr. Monica Aggarwal:
So for me, I think I was always interested in lifestyle. I did an integrative fellowship at the University of Arizona when I was a fellow. So I was always interested in it, but there was always this "Yeah. Yeah, I'll get to that." Or, "Yeah. Yeah, that's good in concept," until I personally became a patient. And I think that was really that life altering moment. So I went from being... I have three children and after I had my third kid, I became very, very sick. And within four weeks, I went from being an avid runner to being unable to climb the stairs. I always tell people that I couldn't... I remember the baby snaps on their clothes and I remember thinking I was going to write letters to baby clothes companies, because I couldn't snap their clothes.
Dr. Monica Aggarwal:
And I thought snaps were ridiculous. Why do we even have snaps? It's the snaps that are the problem, because it's not me. And I changed my shoes three times because my feet used to hurt so, so much. And I thought, oh, for sure, it's the shoes. I changed my shoes three times. So I went through this time, a four week period, where I went from being super active to not being, and I was diagnosed with a highly poor prognostic form or a devastating form, they called it, rheumatoid arthritis. And rheumatoid arthritis may conjure up some images for some people, maybe not for others of your listeners. But typically, it's associated with significant breakdown of the joints. It's when your body attacks itself and it attacks the joints.
Dr. Monica Aggarwal:
And so it classically affects women in their 20s to 50s. And what you most notable is something triggers it. There's some sort of inflammatory state that triggers it and then you just so rapidly get sick. And I remember pain in all my joints, in my finger, they were hot and swollen and my shoulders and I had all these things happening so quickly to me. And when I went to the doctor, which took months, by the way, I mean, it took weeks rather, by the way, because I was so stubborn, I checked my own labs. I diagnosed myself with Lyme disease because that's what we do. We're crazy physicians. I thought I had Lyme because I'm a big hiker.
Dr. Monica Aggarwal:
So I treated myself for Lyme. I had to go through all of that before I finally went to see a doctor who told me I had this condition and that I needed to get on meds within a week. And I was going to be on meds for the rest of my life. There was no way out of it. I just need to accept that this is my future. And they said that that's the hardest part is that a patient who's young has to understand that they'll be on meds for the rest of their life.
Rip Esselstyn:
How old were you when this happened?
Dr. Monica Aggarwal:
So this was now I was 37.
Rip Esselstyn:
Okay.
Dr. Monica Aggarwal:
So I had just had my third kid. I was 37. And so the worst thing they told me was that I had to get on medications within a week because my numbers were so high that I had to get on medicines within a week. So you can imagine, and maybe this is too much information for your listeners, but I was massive. I was gorged with milk. I was nursing all the time and they said, "Basically, you have to stop nursing this week." And so in a seven day period, I had to stop nursing my four month old baby. So probably the darkest time for me is that or those moments when I look back and think back to those times, and the worst part is I was just given medicines and that's it. No other options.
Dr. Monica Aggarwal:
And so my hair fell out and I was nauseous all the time and everybody would admire how I'd lost my baby weight so fast because I was nauseous all the time. And I felt very hopeless. I mean, those feelings of hopelessness and sadness and feeling like I had pushed myself beyond and I shouldn't have had a third baby and all that anger. And so I think that was the moment. And even then maybe I still didn't make a connection until this woman came to one of my events. I used to do these community outreach events in Baltimore and she said, "Let me do your nutrition profile. Let me do one for your patients." And I was like, "No, no, no, I'm vegetarian. I got this."
Dr. Monica Aggarwal:
And the irony is I really didn't, right? So you think you know so much and as physicians, we're kind of cocky and we're kind of obnoxious, we are. And so boy, have I learned humility. And so spending time with her, she says, "Let me just see your nutrition, how you're doing and what you do with your lifestyle and how you live." And it was the first time I really started thinking that beyond that there could be more to it that if something triggered me to develop rheumatoid arthritis at that moment, then I had a gene. And so if you trigger that gene to express itself at that time, then is there a way to suppress it? And so it really started me down this path of trying to understand the gene process and epigenomics and understanding that there are ways that you can change your lifestyle to then alter the impact or the expression of the gene.
Dr. Monica Aggarwal:
And it started me thinking about how there's things that you can do with what you eat and the connection to the gut biome, and then your sympathetic tone. Like I was crazy when I got diagnosed. I was sleeping four hours. I was always stressed. I was managing heart attacks, but nursing a baby. I had three kids under four. I mean, there's so much we don't appreciate about the role of stress and all of those things.
Rip Esselstyn:
And you talk about that in great length in the book about basically finding that balance. And typically when your body's not in balance, when your life's not in balance, it can lead to what you just talked about, right? The expression of maybe something coming to light, like your rheumatoid arthritis and all other kinds of chronic illness.
Dr. Monica Aggarwal:
Right. So it could be for so many things like it could be a heart attack. Why does the plaque rupture in times of stress or it could be Crohn's disease or Type 1 diabetes, and all these diseases have a genetic predisposition, but then something causes the expression. And I think that's the connection that I think is the most important. And the reason we named the book frankly Body on Fire is because it's that inflammation that we don't talk enough about. And I always tell people when people say, "Well, what is inflammation?" It's your body's mad at you. Your body is mad and you have to kind of think about how to make it not mad and it's what you eat.
Rip Esselstyn:
Yeah. And it seems like as Americans, we almost do everything we can to make sure that our body is always on fire.
Dr. Monica Aggarwal:
We do. It's so sad. It's funny. Like think about your phone, when it's 7%, you're like panicked. You're like, "Oh my God, I need a charger." Right? And you're like, "Where's my charger? I need a charger. I need to charge my phone." But yet we don't charge our bodies, right? And we keep going and going, it's funny I just had a meeting with somebody and she said to me... I'm a chatty person. Sorry. She just said to me this very funny thing, she said, she goes, "Yeah. I know how to tell other people to do well and eat healthily and do well, but I can do more. I can handle more than everyone else."
Dr. Monica Aggarwal:
And I just listened to her and I smiled. And I was like, "Yeah, maybe you can." Because I think that's the problem is that when we're young, we keep thinking that, oh, we can handle it. We can do it. I certainly felt that way. And even as I've gotten older, it's taken time to say, no, you actually can't handle it. And it's not a badge of bravery or honor to say you slept five hours and still had a full day. I mean, it's so backwards.
Rip Esselstyn:
Yeah. So you talk about how your daughter saved your life, how did your daughter save your life?
Dr. Monica Aggarwal:
So if I'm being totally honest, I wasn't at my best.
Rip Esselstyn:
Let's go with that. Let's go with the total honesty.
Dr. Monica Aggarwal:
So if I'm being totally honest, I would say that I was not at my best when I got diagnosed with RA. I was probably mean, I was probably angry. I mean, I was definitely angry and I blamed her. I blamed my third kid. I had a lot of if I hadn't tempted fate, if I hadn't had her, then I wouldn't have gotten sick. And I was dark. And it took me months and years arguably to understand that she was giving me a sign, that she was teaching me how and it was only because of her I got sick that I learned how to get better.
Dr. Monica Aggarwal:
Otherwise, I would have been on the same track, I would have continued to be doing the same thing, just giving out prescriptions, giving out more and more Lipitor instead of teaching people about nutrition. If it wasn't for her, I would never have learned how to do better. So I feel great sadness about how much anger I had and how much I blamed my kid. And it was really her who saved me because if I hadn't gotten sick, if it wasn't, I would never have been better.
Rip Esselstyn:
How is your relationship with that third kid now?
Dr. Monica Aggarwal:
That little sprightly kid is nine years old and is incredible. She is me on steroids. Like she is me, but at nine years old and she's fabulous. And she has read that story recently actually for the first time. And it was interesting. I didn't give it to her to read. And she just picked up my book and she started reading it and I saw her tearing up and it was really sad actually. And I said, "Why are you crying?" And she said, "It's mama, because I made you sick." And I said, "No, no, no, baby, you didn't make me sick. That's the beauty of it all is because you actually fixed me. You healed me. And I will always be thankful to you for that."
Rip Esselstyn:
Yeah. No, our kids, they can heal us in ways we never imagined they really can.
Dr. Monica Aggarwal:
It's amazing.
Rip Esselstyn:
I want to ask you about all kinds of things. Before I do though, so you decided to go into cardiology, why cardiology A, and B, how hard is it going into cardiology being a woman, being a female? I mean, in my opinion, it seems to be kind of dominated by men. And I'm wondering if they felt threatened by you at all and was that a tough row for you? Go for it.
Dr. Monica Aggarwal:
Sure. So I've always been somebody who's liked where things make sense. And so cardiology to me was the field that made the most sense. If you do this, this happens. I'm not super smart and I can't maybe think out of the box, I like that you do this, this happens, if you change this valve, this happens so the valve leaks. If you fix this valve, this happens. And so everything is very... The physics of the heart is fascinating. And I love being part of acute medicine. I like rounding the ICU, and then I love also the teaching. And there's so much you can do in cardiology.
Dr. Monica Aggarwal:
I also like that it's not just one thing, you can do so many different things in cardiology. You can do prevention, you can read stress tests, you can read echos, you can take care of highly sick patients. And one of the most gratifying things to do in cardiology is that the patient who is totally normal then comes in with an acute heart attack and then you fix it, you fix it with a stent, or you do a procedure and they get better so quickly. And that's a miraculous thing as well, and shouldn't be undervalued. And so I think cardiology has all that in one. So I was-
Rip Esselstyn:
Do you do any of that? Do any of that-
Dr. Monica Aggarwal:
I don't do stents.
Rip Esselstyn:
No. Okay. Yeah.
Dr. Monica Aggarwal:
I'm a preventive cardiologist. So I reduced the business of those procedures. I spend an hour with my patients. Every single prevention patient gets at least an hour or sometimes an hour and a half of my time.
Rip Esselstyn:
Bless you.
Dr. Monica Aggarwal:
And I love it though, because I just had the best day. I'll tell you one little offsite because I know it'll answer your other question. My greatest patient came in the other day. And he came in and the first time I saw him, he's 350 pounds and he was so sad and he was sad about his weight. And he had some personal issues going on in his life that were in him. He had high blood pressure, high cholesterol, and he came in with his wife and he couldn't look at me in the eyes and he didn't have eye contact. And there's so many sad things and we spent an hour and a half together talking about life and about self-love and about positivity and nutrition.
Dr. Monica Aggarwal:
I know I do a lot of self-love because I think that so much of the time we eat when we don't like who we are. And so we talked a lot about that. And he came in now yesterday, two and a half months later, he was smiling. He goes, "Hi Dr. A." And I was like, "Okay. Hi." And he had lost his 350 pounds, which is really a lot of weight and very difficult when you're at that level of weight to lose weight because there's so much motivation, needing comfort, et cetera, from food. And he'd lost 13 pounds. He was playing basketball with his kids. I cut back on one of his blood pressure medications. I was like, "Yes." But who is supporting that, right? I mean, I spent all that time with this patient and I get great joy and the patient does better, but that's not what pays the bills, so to speak. And so that's not what the hospitals are inclined to support, so they will support it because it's the right thing to do but it's not what makes the money.
Rip Esselstyn:
Yeah. Well, it has great dividends to your soul and the good work you're doing there.
Dr. Monica Aggarwal:
I have to tell you, it's like I told you about my B's, I feel like these patients they're my people when I got to take care of them and I love to hug and I can't hug them because of COVID. So we have these virtual hugs going on. It's awesome. But we must-
Rip Esselstyn:
The second part of the question was being a female.
Dr. Monica Aggarwal:
Yeah. It's rough. I don't know. There were times that I debated if I should have gone into cardiology, I debate sometimes when I mentor a lot of young women. For a while there, I didn't want to mentor them because I wasn't sure I would tell them to go into cardiology because it's not a fantastic field, it is. It's just not female friendly. But so I had to decide and I had to think over the last two years, do I want to be part of that or do I want to help change it? So currently, 50% of doctors are female right now, but only 10 to 12-
Rip Esselstyn:
Wow.
Dr. Monica Aggarwal:
Yeah. But 10 to 12% are only cardiologists. 10 to 12%, that's terrible numbers. It's because there's so much pressure. It's so long, the training is so long, you are expected to do as much. It's the time of your life when you want to have kids. So for me, I wanted to have three, four kids. I didn't know what I wanted but I wanted a lot. And I wanted to have all these kids. And you can't... Like if you have kids while you're in your training, people are like, of course you can have a kid when you're in your training, but they look at you like, oh, I have to cover your call. She was out for three months. That's what I would have heard or at least that's what I felt I would have heard. I remember hearing something from one of my partners when I was already a faculty member, he goes, "Hey Aggarwal, why don't you come out and why don't you have lunch with us every day?"
Dr. Monica Aggarwal:
And I was like, "Well, I don't have lunch with you every day because I got to work during lunch so I can go pick up my kids from school. So that's why I don't have lunch with you." And he's like, "Well, come on man." And I said, "I bring my lunch." And he said, "Why do you that?" And I said, "Well, I don't have a wife home. And so I got to have to take care of my own lunch and I got to take care of my kids." And he's like, "Well man, I didn't ask you to do that. You should just go home and do that." I was like, "Wow." That was probably four years ago, 2016, people were sitting next to me.
Rip Esselstyn:
Incredible.
Dr. Monica Aggarwal:
Amazing. So it's a difficult field, but it is super rewarding. And what I've learned and come to is that I want to support the future generations of women. And so I now mentor actively young women cardiologists and residents because I want people to see I'm done with the years of not talking about my kids. I used to not talk about them. I mean like massive breastfeeding, pumping, hiding everything, because I didn't want anybody to know my weaknesses. I'm done with all that. No more hiding weaknesses. This is your life.
Rip Esselstyn:
Yeah. Show the weaknesses, that's a strength.
Dr. Monica Aggarwal:
That's who I am, right?
Rip Esselstyn:
Yep. Yep. Well, let me ask you this. So as a cardiologist, I think I'd love for you to let our listeners know what are the two major types of ways that people have heart attacks.
Dr. Monica Aggarwal:
Sure.
Rip Esselstyn:
Yeah.
Dr. Monica Aggarwal:
Okay. So imagine a blood vessel's like a pipe. So if this is the pipe and this is a blood vessel, so when you first are born, this is super clear, it's pink and soft. By the way, at that time, your LDL cholesterol, I like people to know this, is about 40 to 50. Yeah.
Rip Esselstyn:
Nice.
Dr. Monica Aggarwal:
Yes. So that's really important to know because people are like, "Oh, my LDL is 120. I heard it was okay." Let's just regroup when you're 40 to 50. I also say that as a pitch because people are like "Well, I need cholesterol for my neurons." Right? But when you're a baby, that's when you're having the most neuron development, right? Myelin sheaths and all that. And that's when your LDL is 40 to 50. So to give people perspective, I just like people to know that. Okay. So this-
Rip Esselstyn:
Let me stop you for a sec.
Dr. Monica Aggarwal:
Yeah.
Rip Esselstyn:
That's what your LDL is, but typically, do you have any idea what the HDL and the total cholesterol is in relation to that?
Dr. Monica Aggarwal:
The HDL when you're born, don't quote me on it, but I seem to remember it's in the 30s or so. So your total cholesterol always is typically less than 100 as a child.
Rip Esselstyn:
Yeah.
Dr. Monica Aggarwal:
And so the total is under a 100.
Rip Esselstyn:
Yup.
Dr. Monica Aggarwal:
Okay. So the blood vessel's pink and soft, and as you exercise or move it dilates, that's the job. That's called vasodilation. And you have these little cells on the edge of the wall called endothelial cells and SE loves to talk about endothelial cells.
Rip Esselstyn:
He's the master of it.
Dr. Monica Aggarwal:
He loves the endothelial cells, which I love that he loves that because I'm like you would meet with people. So you've got these endothelial cells. Okay. So as you're going through your life eating fatty food, McDonald's, smoking cigarettes, maybe eating too many sweets or not exercising, not to say that would be what we would all do, but might happen. And so if you had some of those kinds of habits, what happens is that blood vessel starts getting cracks in it, these little fissures in them. And so your body is like, "Oh my God, I got a crack in my blood vessel." And so the body's like, "No problem. I've got platelets here." And so it triggers inflammation. And so all those little platelets come over and they make a little bandaid on your little crack.
Dr. Monica Aggarwal:
And so well, on that little band-aid, then you put on top of it, then cholesterol floats by and then it builds up a little bit more of that little scab that's now forming here. And then you have all these others so more and more cholesterol. And so over time, you build this little plaque and it has this little cap on it. Does that make sense?
Rip Esselstyn:
Yeah.
Dr. Monica Aggarwal:
So that was your blood-
Rip Esselstyn:
Is it almost like a pimple of sorts or not?
Dr. Monica Aggarwal:
Sure. I like that, a pimple. So if you have a scab on the outside of your body, then it doesn't matter if it's this big or this big, but when you're in a blood vessel, the more that scab fills up, the less blood goes through. So then when you're exercising, your body's like, "I need some blood. So I need blood, let's get the blood through." And the hearts is like, "Well, what do you want me to do? I got like this much space to space my clog." Right? And so that's how you develop angina in times of exercise typically, right? You're exercising, your body's blood. And it's like, I don't have the blood so you get angina. And so that angina is kind of that precursor of a problem.
Rip Esselstyn:
And for people that don't know what angina or an angina, what is that?
Dr. Monica Aggarwal:
So angina is the actual chest pain that happens when the blood flow to the heart is compromised. So these blood vessels are now... And just to clarify one step before, your heart is this pump, right? And there are three main blood vessels on top of it called coronary arteries. And then there's the aorta that pops out of the heart which gives blood to the body. But if the coronary arteries, which are here, don't give blood to the heart, the heart can't pump and blood can't go to the body. So when we're talking about heart disease, we're talking about those arteries on the heart that feed the heart. And when we're talking about this pipe in the smooth pipe and the heart attack, we're talking about coronary arteries. It's not that you can't build plaque in your neck, which are your carotids or in your brain, which are cerebrovascular arteries, which can cause strokes or in your legs, which you can cause plaque, which can cause claudication and plaque buildup in your legs.
Dr. Monica Aggarwal:
Those are all the same process, but they're not heart disease that we're talking about when we're talking about heart attack, which is those arteries. Okay. So when we're looking at that pipe, so there are two ways for this scab to cause you trouble. If this scab builds up over time and then just fills up this clog, this blood vessel, sorry, then you have a heart attack because there's nothing... A heart attack is absence of blood flow to part of your heart. And so if this doesn't get blood, if it's all full of clog, then there's no flow. That's called what we call a non-ST elevation MI that's for those of you who care about that stuff. But what that means is this is actually the more benign heart attack. And I say benign in quotes because it has a very high mortality as well. But the reason it's more benign is your body's had time to get used to it. So as you're building up over time, the body's made other blood vessels called collaterals to work it out around this clog.
Dr. Monica Aggarwal:
So your body, you build it up over time. It happens over time. Typically, people have angina or they'll have shortness of breath or some sort of manifestation that maybe they ignored or didn't ignore. But usually there's some symptoms. This is when you have an abnormal stress test, you go for your stress test, it's abnormal. And then you're like, my doctor said I need to be more aggressive more with my medicines, or I need to have a stent or whatever. They may say that but that's based on the buildup to the plaque slowly over time, the rub is-
Rip Esselstyn:
No. And I was going to say, is it safe to say that then but is more of a stable plaque?
Dr. Monica Aggarwal:
Correct. That's a more stable plaque. Absolutely. And think about the reason that is, is because over time it's just getting hardened and fibrous and all the crack's going to sit sitting on top of it and sitting. It's just getting layered and layered on. And so they can rupture, but they're much more stable. So they kind of just slowly build up along. The problem is the small plaque. So I will tell you, if you look at studies from 20 year olds who died in Korea and in Vietnam, they already have plaque in their hearts. And so I say that importantly because the small plaques are the problem. So the little plaques are the plaques that just kind of remember, go back to you in your mind to the crack in the blood vessel, the platelets came over, inflammation, and you get this little plaque, but maybe those plaques didn't build up all the way for whatever reasons.
Dr. Monica Aggarwal:
There can be lots of reasons. Maybe you got a little healthier or maybe that plaque didn't have little swingers on it to get more things attached. So you get these smaller plaques, but then something about that plaque, because it's not as calcified over, it's definitely more unstable and it's more prone to rupture. And so what can happen is you could be chilling out having a great day and then that plaque, it explodes. And it goes from being this little guy to totally occlusion. That is a massive heart attack. The outcomes are very poor and you have to go to the hospital and you have to go for a cath and you have to get a stent. So let's just be very clear, unlike the stable plaque, the unstable plaque in the acute heart attack, you have to get a stent because that vessel is occluded and occluded so fast that the only way to open this one is quickly opening it or it's very difficult to make it.
Rip Esselstyn:
Yeah. But I think that I've read that 50% of the time when you have a heart attack like that, it's usually instantaneous death.
Dr. Monica Aggarwal:
That's correct.
Rip Esselstyn:
I mean, so you're saying the other 50% that within hours, you have to get through a hospital and have that stent put in.
Dr. Monica Aggarwal:
Yeah. It's like, I think about a third of the patients will die suddenly. And yeah, it's catastrophic. And I think the thing to... That's why I really liked doing prevention, because if you can prevent those soft, small, soft plaques from filling that building, then you're not going to be prone to heart attack. But I also tell people just because they tell me that they had a negative stress test, so what? That just means you don't have a 70% plaque in your blood vessel. Well, if you have 30% plaques, you're going to run on the treadmill just fine until you smoke another cigarette or do something inflammatory that makes that plaque rupture, that acute heart.
Rip Esselstyn:
So it'll basically be invisible for the most part.
Dr. Monica Aggarwal:
That's correct.
Rip Esselstyn:
So let me ask you this. Do you have any idea like your typical American, let's say American male in their middle 50s, if we were able to go in, stick our head in one of their coronary arteries and look to see how many of these juvenile plaques there are, would there be like two, would there be 50? I mean, is it a pimple party in there typically?
Dr. Monica Aggarwal:
I love the pimple party. I'm happy to use that because my visual image of my son's going through puberty right now, so I imagine all those. Too much information. Okay. So the answer is I don't know for sure. And the reason is because every person is so different but if I use, we have this thing called CT angiogram now where we actually can look at the heart arteries with dye and do like a CT. So like an X-ray of those arteries. And yet we're finding loads of little 25 to 50% plaques, loads of them. And remember... And the reason I say that this is important is because when you do a heart catheterization, you may not detect a 25 to 50%. At 50 you would notice but a less than 25% lesion, you may not see, because imagine a coronary artery is when we do a cardiac catheterization, we inject dye into the hole. So all you see is the glow in the dark outside vessel, right? Like the outline, does that make sense?
Rip Esselstyn:
Yeah.
Dr. Monica Aggarwal:
So if you have an acute heart attack where you see this like it's gone, right? But if you have a small deep down and then goes back up, you may not appreciate as a cardiologist that there's a little plaque there. Now we have much more advanced technology now with CT and the cath lab, et cetera, where we can actually look at those blood vessels from the inside. But in the general, most people, if you just have 25 to 50% plaques or 25% plaques, you're just going to be told essentially normal or less than mild disease, mild. And then people go home often with this concept that they don't have heart disease. And I hate that because I'm like, "Wait, wait, wait, let's go back and look at this."
Rip Esselstyn:
Well, and I've read and I've heard from my father that almost 90% of heart attacks are caused by these juvenile plaques which leads me to believe that most of us are unwittingly walking around with pimple parties that are susceptible to whether it's just our body's out of balance or the stresses we're putting on it that you're doing whatever and then all of a sudden that little pimple explodes and you're in trouble.
Dr. Monica Aggarwal:
It is true but I also want to not have everybody panic like every second that all these pimples are exploding inside of them, are going to explode any minute. I think the thing to reassure us is that if we eat healthy and again, that discussion, I think between you and me is very clear, but not to everyone, which is that you eat almost, you could say, mostly plants, all plants. I am an all plants kind of girl but the goal is to eat more plants. And if you cut out the animals and eat more plants and you be active and you cut out simple sugars and you don't smoke, you're going to do okay. I always tell patients your genes are what your genes are. I have rheumatoid arthritis because my genes had that, but what triggers those genes and what makes those genes activate, you can control. And also remember we have what we have, but it's how we respond to it, right? And so changing your lifestyle now at this moment at 50 or at 20 or at 70, it's never too late. Just go do it. Let's go.
Rip Esselstyn:
So that was going to be my next question. And I'd love for us to expand on it. And that is on the typical American that's got all the typical stressors and I'm eating the standard American diet and I'm not sleeping enough and I'm a couch potato, and I've got a pimple party in my coronary arteries, I'm susceptible to having one of these things, rupture and burst. And you talked about this at great length in your book but so what's the protocol? I mean, let's go through... Maybe let's start with what are some foods that we should eliminate and then what should we bring on board for starters?
Dr. Monica Aggarwal:
Sure. So there's the where I want people to be and where they are, it's not always sort of black to white. We can't get from here to here in one time. And so at least in my patient population often if I get people anywhere closer to this side, I'm really happy and keep pushing every time to get them closer. So if I were to give a message to the audience, I would say, you know what? Don't feel bad about what you're not doing, but just focus on what you're doing right and try to get better every day. So what to eliminate. So in terms of elimination, my hard fast eliminations are red meat, fried foods, dairy and that's one that is contentious.
Rip Esselstyn:
And when you say dairy, do you mean all forms of dairy?
Dr. Monica Aggarwal:
I say all dairy but if they say, "I really need my yogurt." I'll say, "Yogurt, you can keep at the beginning." Again, it's always a transition for me. And so I look at the person and sort of see what they're willing to do. And then-
Rip Esselstyn:
But you wouldn't look at them and say, "Yeah, I understand you like your yogurt, but there's so many amazing plant-based yogurts that are out there right now. And you're not going to miss the cow's milk."
Dr. Monica Aggarwal:
Sure. I typically will stay that conversation and they'll look at me like, look, you're taking my steak. And so if I have to choose that battle, I'll say, "Okay, let's just eliminate the steak." And I'll know I'll tackle that next time. And that's okay with me. I don't let the enemy of perfect is... Enemy of good is perfect, right? So I do my best and I will tell you that's really worked for me because when I first started in practice, I was like, "Look, you need to eat these foods. You need to do this. And this is the end of the line." And people would come back or wouldn't even come back because they'd be like, it was too hard. It was too much. I couldn't do it. And so I find that this sort of transition, if I just get people to eat more plants, I'm doing great. So no red meat, no fried food, no dairy and no processed foods. So that's my-
Rip Esselstyn:
What does that mean processed foods in your book?
Dr. Monica Aggarwal:
So for me, processed foods are most foods are processed as your point is well taken that most foods we process them in order to eat them even oats, right? If you take it away from a steel cut oat to make it into a whole roll dough, we've processed it. So what I mean by processed, I usually mean things that have, if you look at the ingredients, there are ingredients you've never heard of. If there's preservatives in them, if we've taken the original form and we've shrunk it down from a normal oat, and we've shrunk it down to an instant oat, that's very processed. So those are things I think about when I think of processed, if they have added sugars, that's usually a processed food. So those are things that I would tell people to avoid. Now that freaks people out. But usually, if I do some of that and they'll do half of it maybe usually after the first visit, fine.
Rip Esselstyn:
What about white flour and white pasta and stuff?
Dr. Monica Aggarwal:
Yeah. So for tier one, I usually start with that in terms of eliminations. And then I move into as they come back and they get more comfortable with how they've done like, "Oh, it wasn't that hard to give up red meat." And you're like, "Yes." Then I'll add in the next tier which is like, "Well, now let's talk about less chicken." And like, "Wait, where are you taking my chicken?" I was like, "Look, you got rid of your red meat, let's go with chicken." Right? I mean, I'm one of those like typical moms. I'm like, "I'm glad you said that because now we're going to do this now." So I typically-
Rip Esselstyn:
Tell me this, when you're trying to take away the chicken which I did with these firefighters, are you saying, well... Do they say, "Why? I thought chicken was healthy." And then what do you say?
Dr. Monica Aggarwal:
Yeah. So I usually tell people, well, chicken is healthier than red meat, but not as healthy as no chicken is usually how I tell people. And so I'll always remind people that all animal products have cholesterol. So that's important to understand that plant products don't have cholesterol. And then somebody will say, well, I need cholesterol because your body needs cholesterol to make, again, we go back to the neurons and cell walls. But remember your LDL is 50 when you're born. So you don't need a whole lot of LDL.
Rip Esselstyn:
Then you go back to the baby story.
Dr. Monica Aggarwal:
Yeah. I get to back to baby and all that. Yeah. So there's that. Then I also tell them that chicken has lots of saturated fat and that was another negative, which it also predisposes them to heart disease. And then if they're really interested, I'll go into the TMAO story. And that really then blows their mind. I'll even pull up the picture.
Rip Esselstyn:
Yeah. So our listeners don't feel left out. Let's talk for a sec. So you mentioned because we all know that red meat is loaded with cholesterol, saturated fat, typically 40% of it's coming from saturated fat. A lot of people don't know, but chicken is about 30% saturated fat eating your wing piece. And in your book, I love it. You guys talk about how a lot of people reference this pure trial that says that saturated fat is not the enemy and the enemy are carbohydrates. And the response that you have is that... And I'm quoting right now. It is not that saturated fat is good and carbohydrates are bad but rather that saturated fat is bad and simple refined carbohydrates are worse.
Dr. Monica Aggarwal:
That's exactly right.
Rip Esselstyn:
Yeah. But so you tell your patients yeah, saturated fat. Because most people, especially the paleo and the keto and now the carnivore tribe, they're thinking saturated fat is good, but the preponderance of the scientific evidence doesn't tell us that, right?
Dr. Monica Aggarwal:
That's exactly right. So in general, and so what you're bringing up has become a source of contention in cardiology in the community in general, because there's a small group of current... So our guidelines are based in... Our 2018, 2019 prevention guidelines say that a diet that is low in fat, high in fruits and vegetables, whole grains, beans, fish and I think we add in low fat dairy is the optimal preventative guidelines. That's what the guidelines say. However, in the last year, and really for years now, this question of either saturated fat or cholesterol is good or bad. That study was bad. That's why it said that saturated fat is the enemy or not the enemy. But 75 to 90% of us still believe that saturated fat is the problem. But there are certain studies that you can find often or that are retrospective that look at in some of the prospective ones too that show that saturated fat is okay.
Dr. Monica Aggarwal:
But as you see here in the quote, they're not comparing like things. They're comparing it to all carbohydrates. Well, a whole bean and a cracker or a chip that's like comparing oranges and, I don't know, footballs. They're totally different things and so if you look at the studies carefully, it's not exactly that. It's not that saturated fat is good, but that the simple carb is bad. And so to all the people who come into my clinic and say, "I want to eat low carb." I'll ask them, "Well, why is that? Why do you want to do that?" "Oh, I'll lose weight better." Well, actually that's not true either. When we studied low fat versus low carb, there is no difference in the weight. And so it's not that low carb does so much better. Okay, well, my lipids will get better. Well, actually that's not true. So there's a huge range in lipids or cholesterol in patients. Some people do get better, but some people don't.
Rip Esselstyn:
Let's dive in, you brought up TMAO trimethylamine N-oxide, can you let our listeners know kind of what that is, where it comes from and why it's a bit of a hellish molecule?
Dr. Monica Aggarwal:
Yeah. So TMAO, trimethylamine N-oxide is interesting because Stan Hazen from the Cleveland Clinic sort of discovered to kind of put this on the map. And basically what he did was he gave everybody radio iodinated meat, like steak or cheese or eggs and those are the things that were given in particular, because when you eat those foods and they go into your gut, then your gut via the liver makes this thing called trimethylamine N-oxide. And so what he found was the people who had the highest amount of trimethylamine N-oxide in their body also had the highest cardiovascular events or risks. And so the most interesting thing about this, and so he gave all comers, so he gave omnivores this and he gave vegans this. So I don't know how he got vegans to eat a steak, but that blows my mind, but he was able to get vegans to do it.
Dr. Monica Aggarwal:
But what was most interesting was that when he gave the omnivore the radio iodinated meat product, the TMAO levels went up within 12 hours. So up within 12 hours. But when he gave it to the vegan, the TMAO levels were flat, which makes you realize that the gut is everything. So it just shows because the vegan has a healthier gut flora and a different gut flora, then even if they have that one challenge in that meat product, their TMAO level didn't go.
Rip Esselstyn:
But are you then saying that the TMAO, it's a by-product of the bacteria with the meat and so the vegans didn't have that and so that's why they didn't produce the TMAO?
Dr. Monica Aggarwal:
That's what we have to think. But it's the bacteria in their gut, not the bacteria in the meat. I just want to make sure I understood that correctly.
Rip Esselstyn:
Yeah. Right.
Dr. Monica Aggarwal:
In the gut, that's correct. I mean, that's what you have to think. I mean, that's fascinating and mind blowing. Now we don't know for sure because the skeptics of TMAO will say, I don't know for sure that it's causative and that is true. We don't know that if you have tide TMAO, you're going to have more heart disease, but we know that there's a whole circularae these certain types of who have these multiple risk factors and eat these kinds of foods, they have higher TMAO and they have more events.
Rip Esselstyn:
Yup, yup.
Dr. Monica Aggarwal:
Back to the beginning. So back to the chicken. Hi TMAO. Don't eat it.
Rip Esselstyn:
Yeah. So the foods that we should be eliminating, right? You talked about red meat, the processed, refined foods, the added sugars, and then all dairy.
Dr. Monica Aggarwal:
Refined food, all dairy and then we go to chicken.
Rip Esselstyn:
Yep. And so I'm sitting in your office and I'm like, "Okay, well Monica, what do you want me to eat? If you don't want me eating that stuff, what can I eat that's going to make that pimple party be non-existent, my gut flora, become a fortress. What do I do?"
Dr. Monica Aggarwal:
So for the people that are really advanced heart disease are mostly more motivated. I really start with stage all the tiers at once. Removing all those foods, even the chicken and fish, if I can get them to. And then what do I add back? So I add back more... I tell people I want them to pee green and I don't literally mean that, but I sort of do. I always tell people about the story of my son. You probably don't want to know... Too much information. I was going to tell you about my son's poo when it turned blue.
Rip Esselstyn:
No. The reality is I'm actually glad you brought that up because at our medical immersion programs that we've been throwing since 2010, the people start talking about because we have them eating five to six servings of green leaves a day, it becomes a conversation. Oh my God, my poo is green.
Dr. Monica Aggarwal:
Yes.
Rip Esselstyn:
Yeah. That's how when you're eating enough green.
Dr. Monica Aggarwal:
And you're like, "Yes, we have achieved. Yes." So that's it. It's at least five servings of fruits and vegetables per day. Most of the vegetables, less fruit and some studies show up to 10 servings per day. So what I tell people is go buy baby kale and just buy stock in it and just get bags and bags of it and make a salad every day that's bigger than your head. And when I say bigger than your head, I mean that to be the green part. You can add a lot of other things, but the greens should be bigger than your head. And so people kind of add tomatoes, onions, anything you want that's rotting in your fridge have added. The greens should be bigger than your head. And so yes, five to seven to 10 servings of fruits and vegetables every day. And remember a serving is not three strawberries, it's a baseball size fruit, or a cup of uncooked vegetables, or a half a cup of cooked vegetables. That's a serving. So as you're thinking about five to seven to 10 servings, that's the goal.
Rip Esselstyn:
I'm so glad you said that because I know in the book you talked about how in 1990, the World Health Organization talked about how we want to be getting 450 grams of fruit and vegetables a day. I'm like, that's the most ambiguous thing I've ever heard. What does that mean? That has no real life bearing for anybody. And I don't even think five to seven servings does. So I'm glad you said the size of your fist, the size of your head, right? The green leafies. And I mean, frankly I would say that if I had to count up how many servings of fruits and vegetables and whole grains and beans I eat a day, it's probably 25.
Dr. Monica Aggarwal:
Yeah. Good. I mean, that's great. And so that doesn't even include... Right. So when we're talking about the greens, this is like the salad for lunch, that doesn't include the other servings that I want you to get. So I agree with you. By the end, when you're really engrossed and we have you, then people are able to be accountable, "I had greens with breakfast." I'm like, "Yes." That's when I know I have you.
Rip Esselstyn:
Okay. So you want me eating fruits and vegetables, what else?
Dr. Monica Aggarwal:
So beans and lentils. So lots of beans and lentils, but one of the things... So yes, lots of beans and lentils but that shouldn't discount the need for all the greens. So sometimes people when they switch over from red meats and they eat vegetarian, they end up eating a lot of beans and then they haven't really done the greens. So I just want to emphasize that it's greens and then the beans go on top. And so those are absolutely important and a great source of protein and calorie density that we need when we eat a lot of greens, but it's greens and then beans. So lots of beans. What kind of beans? Any kind of being you want, should you use it canned, should you use it dry? Well yeah, it's nice to use dried beans because they're the most optimal.
Dr. Monica Aggarwal:
But you know what? I've got three kids, a full-time job, cans work sometimes too. Is there more sodium in a can? Yes. If you have high blood pressure, should you wash them really, really well? Yes. Would dried be better? Yes. Is frozen vegetables good? Fine. Is fresh better? Sure. But that doesn't mean... The reason I say it that way is because I think so much of the time, we get caught up in frozen or fresh, however you can get it. I have patients that sometimes don't have the means or on snap programs. Like get frozen, that's okay. You can still get your vegetables that way. No problem.
Rip Esselstyn:
Yep.
Dr. Monica Aggarwal:
So what do we say? Beans, lentils, any type you like, enjoy them, beans, greens, whole grains.
Rip Esselstyn:
What about what's your opinion on nuts and seeds and fats and oils?
Dr. Monica Aggarwal:
Yeah. So I am usually supportive of nuts and seeds depending on the patient. Depending on their cholesterol and the advancement of their heart disease, I do sometimes have to cut out nuts and seeds. There is a lot of data on walnuts and omega-3 fatty acids and walnuts and almonds. And so if we're going to eat nuts, that's typically the ones I recommend, but cashews have magnesium in them and the handful should not be... Maybe your hand may be bigger than mine. So people are like, "Oh yeah, I just had a handful of nuts." Oh yeah, you have a lean hand. So that's the right amount whereas I have some people that are like, "Oh yeah, this many nuts." So of course, that's going to be a problem a little bit too much.
Dr. Monica Aggarwal:
So this is sort of the goal for the nuts for the day. But then again, if you have more advanced disease, I sometimes have to cut the nuts out. It sort of depends. I kind of keep them at the beginning unless they are really advanced. And sometimes I'll have to say, "Look, this has to go, or it can stay." If you're going to do seeds, I recommend chia seeds and flax seeds, again, loaded with omega-3 fatty acids. Well, decrease omega-3 fatty acids. Remember our anti-inflammatory, they decrease, remember Body on Fire anti-inflammatory, they decrease your triglycerides which is really important, which is the kind of the sugars and fats of your cholesterol. So it has that benefit as well. So in terms of oils, I'm not a fan of oil.
Rip Esselstyn:
No, you're preaching to the choir here.
Dr. Monica Aggarwal:
Exactly. So in general people say, "Can I have a little bit of oil?" Okay. If that's where I can get you, okay. But if I can get you to completely eliminate, I mean, I think the difference is that most people are here and we're trying to get them here, but I'm okay with here. I'm okay with really close. And so if you need a tablespoon or two to use to cook an onion, okay. But what I usually tell people most of the time it's learning how to cook with no oil which is the art. And so some people think their food burns if they don't use oil. And so often it's just that you have to use the right pan, the right amount of heat, and you got to not walk away and have a little party, you'll lose your food. You got to sit right next to it and really kind of own that food. But then you can cook without oil.
Rip Esselstyn:
Yep. What about spices? We talked earlier about turmeric and how that's your gold.
Dr. Monica Aggarwal:
So I want you to see my cup because... Do you see the color of that inside maybe?
Rip Esselstyn:
Oh yeah, absolutely.
Dr. Monica Aggarwal:
That is stained. That is stained that color now. So there are certain things that people don't realize about spices is that there are certain phytonutrients, so I mean plant nutrients that you can only get from spices. So for instance curcumin, which is turmeric, which is what we were going to talk about can only be obtained from turmeric. So I must have 50 turmeric plants in my backyard. I'm embarrassed to say, but not really, it's a little bit of a problem.
Dr. Monica Aggarwal:
So I harvest this much turmeric from each plant and we love it. We hug it, we put a blanket on it. No, I'm kidding. But we dehydrate it and we grind it and we use it all the time, because it's really potent anti-inflammatory if you compare it to NSAIDs or anti-inflammatory meds like ibuprofen when they were compared head to head, small trials, admittedly they were considered equal. I use it every day. I find that my joints do better. If it's a placebo effect, I don't care. And so people say that a lot, "When do you know if it could be a placebo effect?" So what? If the placebo works on me, it's good enough.
Rip Esselstyn:
Yep. Right. I'd love for you to talk a little bit about water because it seems like most Americans probably are a little dehydrated, our body is over 60% water, you actually talk about how coffee, sodas, juices, and energy drinks actually have a dehydrating effect. What's your opinion on water?
Dr. Monica Aggarwal:
So the more you drink the better is I guess the general thought. And what's the right number, we don't know. We don't know the right number, the standard eight cups of water. I looked that up to figure out actually where that came from. We don't actually know. It's like this random thing that somebody came up with and said, "Yeah, eight cups seems about right." It probably is about right. The truth is well, we don't know for sure. Some people need more, some people need less, I can't use urinary. So if you drink a lot of coffee, I have to remind people that coffees and teas are diuretics. So they make you pee. And so you can't say, "Oh, I pee every hour," but you drink coffee every hour.
Dr. Monica Aggarwal:
And so that's not a good indicator. And so I always tell people, if you drink a cup of coffee, you should drink at least a cup or two of water with it at the same time. And you can look at your skin. Sometimes I look at people and their lips are all dry and you can see their tongue and how much water do you drink? I also have the benefit of looking at people's labs and I see they're dehydrated. So yes, people are dehydrated. Your skin will do better. You should urinate a lot frequently clear urine. You should not have dark colored urine. That is not what we are looking for. Unless it's green, then we'll approve. That's a joke that was about the greens. So yeah, lots of fluids as much as you can drink, less caffeinated drinks. Caffeine is okay, it's just make sure you're drinking enough water.
Rip Esselstyn:
Good water. I mean, yes, love the water. So you also talk about... So I want to talk about two more things before we wrap things up and that's sleep and exercise and how critically important those are. With the Body On Fire, you actually say something in your book about sleep that think of sleep as an antioxidant and I never have before, but I love that. And also the fact if you're not getting enough sleep, it actually can act like an immune suppressant, which is not good.
Dr. Monica Aggarwal:
Absolutely. So the American society and really the world now, we're just not sleeping enough. The average human adults should sleep between seven and nine hours per night. That's really not six, that's seven to nine. We know that when you sleep less, your immune system's on overdrive. We know that your cortisol levels are higher, which are your stress numbers. People can't lose weight as well when they don't sleep, because you have too much cortisol if you don't have that restoration that comes from... Just think about how your mom used to tell you, or my mom used to tell me when I had a cold, "Go sleep." And you wake up and you feel great. That's absolutely true. When you sleep, your body has a chance to not focus on eating, thinking, doing all these other things that our body has to focus on.
Dr. Monica Aggarwal:
It can really just focus on the one thing that's ailing and which is the illness. That's why sleep works. And so we shut the rest of us off and really focus on that one thing. So absolutely seven to nine hours. And I think our children aren't sleeping enough. I mean, anybody who knows me knows that I'm like, "Kids in bed right now, that's it." And so the kids have to sleep nine to 11 hours depending on age. I hope you can look it up at the American Sleep Association, but my kids, for instance, their age group need to sleep at least nine to 11 hours. I don't care what is happening in the world. We're sleeping nine to 11 hours when we're kids and our kids just don't sleep enough.
Rip Esselstyn:
Yep. And I've read that almost 50 to 75 million Americans have some sort of a sleep disorder, which is really unfortunate. Do you have some-
Dr. Monica Aggarwal:
Probably like sleep apnea. And I mean, there's so many issues, they're obese then the sleep apnea, right?
Rip Esselstyn:
Do you have some suggestions for sleep hygiene?
Dr. Monica Aggarwal:
Absolutely. So one of the things in particular is put away your darn phone.
Rip Esselstyn:
Don't take away my phone, don't do that.
Dr. Monica Aggarwal:
I want food. So we have a rule in our house. Actually I've just bought today, even something to take it up a notch, but I don't use my phone often at night, but admittedly it creeps back into all of our lives. Again, the key is not to judge ourselves for what we did wrong, but how we're going to improve for the next day. So now I'm actually moving my phone to another room, just put it down. You don't need it. There's nothing on that phone that's that emergent. And so I always tell people, don't use your phone for at least one hour before bed. Like, what do you mean? Nothing? Reading? No, you cannot use an electronic device from one hour before bed. I don't want to mention the blue light which actually prevents you from feeling tired. And so that's another issue that happens with phones. So no devices one hour before. You can talk to your spouse, you can listen to music, you can meditate, you can breathe, whatever you want, but not devices.
Rip Esselstyn:
Yup. What about dark room?
Dr. Monica Aggarwal:
Oh yeah. Sorry. Other things for sleep hygiene. So some people say don't work in the same place that you sleep. That's never worked for me. I typically lay on my bed and work on my computer. But there just has to be boundaries. I think that's the key is that the time, there has to be the ritual in... You have to worship the sleep. And that's how I always think about it. And that you have to honor it. And so you have to put away your stuff, you have to have a bedtime ritual. Maybe don't take a shower right before bed, don't exercise before bed.
Dr. Monica Aggarwal:
All of those things really make endorphins go up and not down and then just maybe have a bath or massage or use a massager or some dark room, relax. Make sure there are no lights from all those electronics. They're all in everybody's rooms. Get your dogs out of your... I had a woman who told me she just can't sleep. I was like, "How many pets sleep in your room with you?" And she's like, "Well, I have a cat and two dogs." I was like, "Okay. They aren't going to start." So the pets have to leave the room. And it's not that you don't love your pets, but they don't have to be there. Sleep should be honored and worshiped. I worship my sleep.
Rip Esselstyn:
Yeah. I love it. And then the last thing, let's talk about exercise. I know that you're now... Are you still doing triathlons?
Dr. Monica Aggarwal:
I haven't done one in a while. So I've been swimming a lot and COVID is... I still run a lot more than I should probably. I'm an obsessive runner. I just love it. And now I've got these books on tape, so I'm like, I don't want to stop running. I'm like, "No." So I do a lot and I still do a lot of yoga. But what I think that's the thing to remember about exercise, in my clinic, people tell me that one of my best pieces of advice, and this is why I'll give this right now, is that I often tell patients who don't exercise at all, I ask them to exercise for five to 10 minutes a day. And sometimes... I'll tell you this because people over and over again tell me the one thing that made them exercise because I made it very doable.
Dr. Monica Aggarwal:
And so I think that that's the key. Like when we tell patients go out and exercise for an hour, they're like, what? I don't do anything. Like how can I do that? So just start with five minutes or listen to some music and dance around the room, or do stuff like where you're walking with your kids or just put the alarm on, start it and then stop it. It can only be five minutes. And I always tell them, start your alarm, switch off your alarm, do exercise for that five minutes and then you're done. And I'm like, well, what if I want to do more? Well, you can do more, but that doesn't mean that you can tell yourself the next day, "Well, I did 10 yesterday, so I don't need to do five today." So then you got your five every single day. And then after two weeks we build up.
Dr. Monica Aggarwal:
So exercise super important, increases endorphins, dilates blood vessels, clears out your head. God, I mean, it's so good for you. I'm a huge proponent. It's great for your heart, great for my joints, great for osteoporosis and sarcopenia, which is breakdown on the joints and thinking is clear. Absolutely, it's awesome.
Rip Esselstyn:
Yeah. Well, I'm a big fan of exercise.
Dr. Monica Aggarwal:
I know you are. I know that's your thing.
Rip Esselstyn:
Yeah. It's one of my things.
Dr. Monica Aggarwal:
One of your things. Right.
Rip Esselstyn:
So I want to finish with optimism. So I mean, I love optimistic people. I find it so easy, especially in this day and age to be pessimistic and to be kind of a bit of a downer. So why do you have a whole chapter on optimism?
Dr. Monica Aggarwal:
So I give out a survey to everyone when they come into my clinic, it's two or three pages, admittedly kind of long. But the last question on the survey is, are you happy? And nine out of 10 people say no. And that's really sad. So that chapter comes from that feeling. And so I guess... So optimism is important for everything. If you don't feel hopefulness, then nothing else will happen. You can't eat healthy or go out and walk your dog or exercise if you don't have that hopefulness. And so people will say, well, it's easier said than done. In fact, somebody on Instagram emailed me and said, "I had something happen to me six years ago that I regret and I still carry that with me." But I think the key on optimism is you have to remember that we all have bad things happen to us or things, and you wonder, gosh, should it have happened this way?
Dr. Monica Aggarwal:
Or should I have answered this thing differently? But there's that old Chinese farmer adage, which I really love it. I know we got to finish, but it's the guy's in the village and he's working on the farm and the horse runs away and the villagers come over and they say, "Man, you lost your horse, bad luck." And he goes, "Maybe yes, maybe no." And then the horse comes back again and he brings seven horses with them and the villagers come over and say, "Hey, great luck. You're so lucky." He goes, "Maybe yes, maybe no." And then his son tries to tame one of the new horses and he is on the horse and he falls off and breaks his leg. Villagers, come back and say, "Broke your leg, bad luck." "Maybe yes, maybe no."
Dr. Monica Aggarwal:
And the next day is the draft and the kid doesn't actually end up going to war because he broke his leg. So I don't know. I guess what I would say is that life is hard. It's hard right now. It's hard for everyone. But remember that if you were sick with COVID, you're better now, or if you're healthy and you're stuck in your house, you're okay. You're not sick, that's okay. And just try to get outside more, try to feel, remember how much beauty there is in the world and how the sun shines and how you get to eat healthy foods. I was listening to Malala the other day, she gave a talk at University of Florida and she reminded me how many kids like my kids, there's so many kids on Digital Academy here and they're complaining about Digital.
Dr. Monica Aggarwal:
And she reminded me that there's so many kids around the world that don't even have access to Digital Academy. So they're sitting at home, hanging out, doing nothing. And so is optimism important? Absolutely. Because you can't do anything else in your life well if you don't do it with joy and hopefulness, and I think that so much of the time, frankly, in my clinic, I focus on that to start. Because we write positivity journals and we start thinking, and sometimes I'll tell people, I want you to look in the mirror and see one thing about yourself that you love. People often will say there's nothing that they love. And I'm like, what I see is your eyes are beautiful or I love the way your hair fluffs up, or I love your shirt today. Or just the sort of when you start changing the way you look at something, everything changes.
Rip Esselstyn:
Yeah. Well listen, this has been a really great conversation, Monica, thank you so much. Thank you for all the wisdom that you're imparting to all your patients, for your passion, for your love of empowering people with this knowledge. Thank you for getting this out into the universe, Body On Fire. It's great. And it's been fantastic getting to visit with you.
Dr. Monica Aggarwal:
All right. It's been fun. So thank you so much for having me.
Rip Esselstyn:
Is your body mad at you as Dr. Aggarwal describes? Are you in a state of constant debilitating inflammation? Perhaps now is the perfect time for your own diet and lifestyle intervention to set you on the path to recovery and vitality. To learn more, visit our show notes at plantstrongpodcast.com. Thank you for listening to the Plant-Strong Podcast. You can support the show by taking a quick minute to subscribe, rate, and review at Apple podcasts, Spotify, Amazon Music, or wherever you listen to your favorite shows. Sharing the show with your network is another great way to help us reach as many people as possible with the great news about plants. Thank you in advance for your support. It means everything to me.
Rip Esselstyn:
Have you had your own Galileo moment that you'd like to share? What happened when you stepped into the arena and shed the beliefs that you thought to be true? I'd love to hear about it. Visit plantstrongpodcast.com to submit your story and to learn more about today's guests and sponsors. The Plant-Strong Podcast team includes Carrie Barrett, Laurie Kortowich, Ami Mackey, Patrick Gavin and Wade Clark. This season is dedicated to all of those courageous true seekers who weren't afraid to look through the lens with clear vision and hold firm to a higher truth, most notably, my parents, Dr. Caldwell B. Esselstyn Jr. and Ann Crile Esselstyn. Thanks for listening.
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