Overcoming Rheumatoid Arthritis With Diet | Dr. Monica Aggarwal

0:04 my next guest is a highly respected cardiologist and a phenomenal author and today she is also an inspiration like no other overcoming unbearable pain a pain that has transformed her life and the way she views medicine with that we welcome dr monica agarwal to the exam room live thank you so much for being here thanks so much chuck for having me it's great to see you again when you and i were talking about your book uh body

0:33 on fire i was blown away i honestly at that point did not yet realize that you had been through the thick of it yourself um as an r.a sufferer so i'm really glad that you're able to almost check that that doctor portion of yourself today and i just i want to focus more on your story as the patient if that's okay with you sure um do your road to becoming a doctor let's start with this has not always been easy

1:02 you know some people do it a little bit more quickly it took you i believe 10 years to get through all of your training and then you have also written eloquently about the challenges that came from just being a woman in medicine as well can you talk to us a little bit about that decade-long journey just to get uh into where it is that you are yeah so um becoming a cardiologist is not a easy process so

1:31 it started when you're 18 years old and you have this con actually interestingly i was a religion major in college my parents wanted me to be a doctor or indian parents always you have to be a doctor or engineer it's sort of the thing and so my parents wanted me to be a doctor so i of course naturally being american born fought that and had my own independent ideas and i did economics for a while i did a little

1:56 list for a little while and all that for a while i thought i was going to be a philosophy major ultimately i majored in religious studies interestingly with a focus in buddhism but my dad said that he would not pay for my college if i didn't um finish he wouldn't pay for my college unless i did some sort of science um component so i got a minor in biology so that's how i got around it um and then when i finished um when i

2:22 got through uh when i was in the middle of college at the end of college i started meeting some influential mentors of my sisters my sister was already in medical school and really made me see sort of that yeah i actually think that being a doctor would be pretty awesome and i had a specific mentor in college named richard edlick who was a plastic surgeon who developed debilitating multiple sclerosis and was in a wheelchair and he took me under his wing and i

2:49 became i worked with him a lot and he really showed me that there's such a connection between sort of actually between religion and medicine interestingly so when i went into medical school um you go through four years of medical school then after you graduate medical school you do three years of internal medicine and then after that you have to do three more years of cardiology so by the time you finish your training you're older you really it takes um from the time

3:19 you're 18 effectively medical school uh residency that's already you know 11 years or so of training and many of us go on further to get further sub-specialty in prevention or interventional cardiology so it can end up being 10 to 12 years so by the time you finish all your training you um you are realizing that you are at the time where you want to have kids and your clock is ticking so to speak and that's a tricky thing and so some

3:50 people say why don't you have kids while you're in training but cardiology in general and subspecialty medicine is not a women's game it is a man's game and it's not um well looked upon if you get pregnant in your program now people will say outwardly yes it's okay and nobody would say anything well nobody does still say anything but it's it's always there it's always in the room that this person took

4:21 off three months for pregnancy and so for whatever reasons i felt i couldn't have a child while i was in residency or in my fellowship training because somebody has to cover you all the time somebody has to cover you when you're not um when you're not working and so it's already such an intense time where you're taking so much call and then if some one person is not there then your call is just doubled and and it's it's

4:45 really difficult for those other people um and it creates a lot of mal intent unfortunately so uh being a woman in medicine is very challenging i think it's interesting about fifty percent of people women uh metal sorry fifty percent of medical school actually is women right now uh and in pediatrics you're gonna see actually more women than you're gonna see men in internal medicine i think it's about 50 50. but once you go into sub-specialty like cardiology only about

5:13 10 to 12 of your of the group of cardiologists is going to be a female and there's so few female faculty um that it's a it's a it's a real problem and ironically uh you know physicians and and female physicians are considered to be better doctors because we tend to be more emotional um more in tune to sort of the other factors uh take in terms of taking care of patients yet somehow only 10 to 12 percent of cardiologists are

5:40 women so that's really a tenth so you know there's a lot of pressure um to go through um and i think that once i finished training i definitely was like oh my god i gotta have kids so that's what i did yeah and you you you had them in quick succession one two and three just back to back to back were you able at all to i mean continue in medicine like how did you balance the schedule i mean three kids

6:08 for anybody is is a lot and then to be in medicine as well i mean i just can't even imagine that you were getting more than two or three hours of sleep at night at best yeah so it was a crazy life so what i maybe didn't haven't told you or didn't write in the book is that so when i first decided that i wanted to have kids i decided to get pregnant in the end of

6:29 my third year of training so this is now six now my tenth year of training after you you decide okay like if i plan it just right because in your mind women we all do this and this is something that i try when i mentor younger women i'd say you know it's completely unpredictable so when i you think you can plan out pregnancies and deliveries and everything's going to go exactly the way you want it which is

6:51 just it's so hard to it's so far from the truth so when i was in my last year of training i decided to get pregnant um so because i finished if i the way i worked it out in my head is that i would deliver the kid right when i finished my training and i wouldn't affect anybody um but i actually had three miscarriages in a row um so i one of my first miscarriage actually was pretty far along

7:16 and it was devastating and then um continued to have another and another miscarriage i had a ob gyn and this is when i started realizing god how much compassion is needed in medicine i remember telling the ob you know crying with with the ob gyn saying i said when can i start trying to have another baby and he said well you can go you can try again as long as you whenever you're ready to lose the baby again

7:44 and i thought that that was the most horrifying thing i've ever heard for somebody to say is that you are ready to have another baby when you're ready to lose the baby um and so that because the miscarriage rate is so high at 20 he was correct but the way he said it was just horrifying so i had three miscarriages um and um which was very complicating they could never figure out why i had so many

8:09 miscarriages and then when i got pregnant another fourth time the baby took and it stayed and that's my boy um and so now you can imagine so i did all that training then i had multiple miscarriages and so by the time i really started having kids i was really feeling the the the bru the time so you know i'll tell you when i had my first kid i was on them i was on the moon you know it was amazing to have a

8:34 kid to be able to appreciate the fact that i after so much trying to have this child he would there was nothing that was gonna make it un not uh not a pleasant experience for me no matter the the amount i tore in my pregnancy the the two and a half hour pushing the um the post uh when he was del he delivered when he turned yellow the nursing the pain i mean there were so many things

8:59 but i was still just so so happy to have um this little guy um and it was wonderful so um i because of that time clock that we keep talking about i decided to have multiple children uh quickly uh you just know because i knew that having had all those miscarriages i knew that i may not have that much time what if i miscarry again there could be a huge gap in between the kids but interestingly as soon as we

9:25 started trying we became pregnant again and so i always joke with my friends that my patients even will say oh i knew i remember you when you were pregnant i'll say oh you know there was a six year period i was either pregnant or or nursing so i was big in the tummy or big in the breast whatever you uh one of those times that was always always one or the other um but that's how it was

9:45 like i literally was pregnant in nurse or nursing for six years because as soon as i delivered and we were sort of emotionally ready like okay we want to have start trying again i would get pregnant immediately it was like my body finally figured it out and we just started having kids so yes i have three kids under four um i had a three and a half year old a two-year-old and a newborn uh yes life was crazy i was

10:10 working full-time i only took six weeks off in between maybe eight weeks off in between each pregnancy because that's what i felt i had to do as a physician so people weren't covering me um and i think that's probably a little bit on me or a lot of us as physicians as women female physicians we don't want to have other people taking care of our responsibilities we're we're taught to sort of chin up um and so i took six or eight weeks off and

10:38 then went back to work so i was covering call and working full-time and so i always described that you know somebody i'd be on the phone with somebody having a heart attack in the emergency room and having to guide the er team on what i wanted to be done and there would be a baby on my breast you know that would be cooing in the background so that that was my life and so there were it was a

10:58 crazy time where i was pureeing baby food i was pumping nursing sleeping yeah maybe three four hours a night if i was lucky five i was trying to run because i had to get fit again and recover from my baby weight each time it was a crazy crazy life and then i mean such a stressful schedule not a whole heck of a lot of time were you then falling prey to the standard american diet which is largely grab and

11:27 go a lot of fast food a lot of heavily processed food what what was it that you were eating really at that time so at the time i would say that i was i was vegetarian at the time but i was sort of a bad vegetarian agree that i was eating a lot of like cheese sticks i remember cheese sticks were a big go-to for me um i would eat a lot of dairy dairy was a big thing for me so i would

11:51 have a lot of cheese cheese sticks were regular i would try to have fruits and stuff and i wasn't a big processed food eater but uh enough different um and just sort of more consumption than actually using for sure and you know i wasn't somebody who picked up chips necessarily but i would uh i would be known to microwave food that i'd prepared before or i'd get an instant meal for the family uh if needed or uh and maybe not as many fruits and

12:23 vegetables she can't get to the grocery store um and so that was sort of the way i ate and often sadly i didn't eat i there were hours you know i would spend eight hours or ten hours a day not eating i remember my urine would be crystallized because i just hadn't eaten and i was nursing which dehydrates you too and then i'd be constipated because i was totally dehydrated i wasn't eating super well uh and nursing makes you

12:47 wicked constipated nobody talks about that but so all of those things plus i was working 8 to 10 to 12 hours a day as i was managing these three kids so life was absolutely crazy and i don't look at that time period of my life uh the way i handled it with great pr pride because i was so um it was crazy let's talk about the toll then it began to take on you physically um you've written that

13:16 you started to experience uh pain and it increased exponentially uh rather quickly what was the first thing that you noticed and how did it progress so um when the when the the third was uh four four and a half months old around there i was i started developing joint pain uh and all it was out of the blue i mean i'm a runner i was a marathoner um and um i started with a with my finger i always

13:48 start rubbing my finger because i always remember that finger being the source of pain first and it was got red hot and swollen and i remember thinking how odd it was that the finger was all uh uncomfortable um and i thought oh i must have hit it somewhere um and then i ignored it and let it go away and then it was my shoulder um and my shoulder started getting hot i couldn't lift it up and that caused a lot of pain and then

14:16 that went away and then it was another finger um and then it was my knees uh and then it was my feet and you know the feet i remember my feet in particular because every time i would step i would feel like there was glass or cutting through my feet in fact my husband remembers how i used to change my shoes i kept buying new shoes because i thought there was something wrong with the shoes that's

14:38 why i couldn't step down so easily i would go to the hospital but somebody who usually runs up the stairs i would try to find elevators on the other sides of the hospital where people couldn't see me taking the elevator um because i couldn't climb the steps with any grace um i remember um that i was extremely tired and i used to blame that on um just having three kids and being having a full-time job um but

15:07 the joints just continued to get worse and worse i remember that i couldn't do the fine motor skills of of just putting my fingers together in fact the snaps on baby's clothes they used to drive me crazy and i remember i remember sitting on at two in the morning clipping my the baby's clothes thinking i'm gonna write a letter to i don't know carter's or baby gap or wherever the clothes were from and say that they

15:29 shouldn't make clothes with snaps because that's too hard for people to do to make that snapping motion because i couldn't do it um because clearly the clothes were the problem and not me um and so that's how things went for months and then i for weeks sorry it just went so quickly and i remember there was one day that everything sort of came to a head uh in that day um still to me is a painful one

15:55 to talk about it was the day that i remember it's like four in the morning the alarm had gone off for me to get up and so for me the ritual of the morning is complex or was complex i have to first wake up take the dogs out um so i would hobble down the stairs and take the dogs out then i would have to start making meals so i have two kids that had to go to daycare and then i had the baby

16:16 that needed to go needed to be nursed and then i had to make my lunch uh the dogs had to be fed so all of this stuff and then i had to be ready to go to work because i started clinic at eight o'clock so all of this stuff between four and um you know leaving by seven or seven o'clock or um in order to get everybody where they needed to get so i remember that day um because i went

16:39 down the stairs hobbling let the dogs out and was getting started on my morning and the baby started crying and if the baby starts crying and the baby's room was right near the two-year-old in a four-year-old's room so i was worried that the other kids would wake up and so i was like oh my god you know and so i started running towards the stairs to to go pick up the baby but i couldn't get up the stairs that

17:04 day um i had to crawl up the stairs that day um because i i just couldn't make it up and um my husband he found me at the bottom of the crib crying um and the baby screaming because i actually couldn't get the baby out of the crib uh i couldn't get up to her crib and do the reaching motion so that i could pick her up um so that's where he found me um and it was at that point when he

17:33 lifted up the baby and put him in my put her in my arms so i could nurse her that i realized that i i was really in trouble something was something very bad was happening to me and how old were you at this point if you don't mind my asking so i was probably 37 36 36 still you know relatively young and for somebody that age even though you had been pushing yourself to the max between

18:00 your career and your family to be having something this severe occurring to your body must have i mean frankly just scared the bejesus out of you it did you know i um but you know i you know what i think that shocked me most is how quickly everything ds you know just escalated i i went from being such an active runner to like literally not being able to climb the stairs i mean can you imagine the

18:28 humility of just sitting there on the ground my breasts were leaking because the baby's crying and i could not get her out of the crib it was it was uh it was an incredible moment and one that i don't remember and think of fondly and so i did what any good physician does i started treating myself for lyme disease because i decided that i had migratory joint pain i lived in a wooded area i must have have lyme

19:00 disease so i started myself on antibiotics uh thinking i'm gonna get better within a week or two and i just continue to get worse and worse i had a friend of mine draw some blood for me and my blood work was completely abnormal all my inflammatory markers were elevated and my autoimmune factors were abnormal my rheumatoid factor was if the normal is i don't remember offhand 0 to 10 or something mine was greater than 50. so

19:31 she checked in something called an anti-ccp antibody which is um it shows prognosis in rheumatoid arthritis so it shows how sort of debilitating your illness will be and mine um i think you suppose i can't remember the numbers offhand it's supposed to be less than you know zero to ten or something like that let's just say and mine was greater than um 250. so uh it was at that point that i said that okay i'm gonna go see a rheumatologist

20:02 um so i went to the best rheumatologist in town i was in maryland at the time and i went to hopkins and i saw a rheumatologist there and he told me that i had a poor prognostic form or a devastating form of rheumatoid arthritis he said that uh the disease was incurable and that i needed to get used to the idea that i have an illness and that this is my future that i will be on

20:33 medications for the rest of my life and if i got on medications now within a week then i had the best shot of doing okay he painted a very grim picture the waiting room was grim it was hard to walk through the waiting room where everybody's in wheelchairs and canes and um such a such a difficult moment and hearing all those things i remember when i asked well what if i try other things

21:03 he said well you can try anything but nothing's going to work um and this is the future this is what you have to get used to boy i can't even imagine what would be running through your head at that point um still relatively uh early on in your medical career a cardiologist obviously this is going to greatly impact that but then i think the greater toll would be how are you going to raise your kids you

21:31 know if if things are as dire as the doctor is saying how in the world are you going to be effective as a mother talk about the emotions that came with all of that and and how you were you know just wrestling with it i think that this is a topic certainly that we um we don't talk enough about and admittedly i have trouble myself talking about you know i think um i think women are superheroes and i

22:02 really think that we do so much that is ridiculous and crazy and we're not good about asking for help and uh i you know i wanted to be perfect at everything and i wanted to be a great doctor but more importantly i wanted to be a great mom like i wanted to do i remember there were times at midnight i'd be making cupcakes for the kids to go to school so they could take them for school i mean they were two years old

22:31 and four years old but i felt i had to make the cupcakes for the birthday so i would be doing the icing at night and then i would um not even be there in the morning for them to see the joy of seeing the cupcakes in the morning and i was puring baby food and pumping all the time and just so they had enough milk and so you feel like you have to do all these things but you want to do it you

22:53 know all those miscarriages and i i really wanted to be this great mom like i wanted to just enjoy that time and so when you get an illness diagnosis and you're told that you um you're not sure how things are going to go you're not sure how your practice cardiology is and the fact that i couldn't even snap or climb the stairs you you see all those wheelchairs in the in the in the waiting room it it puts you in a

23:23 really dark place i remember they i was getting some sort of scan done and i remember i was in a wheelchair they put you in a wheelchair and i was in it when it was a huge wheelchair and i was this tiny person i remember how how you feel so small and you know that you know it's that classic doctor become the patient you really start understanding what it's like like when you're the doctor you tell patients i used to tell

23:46 patients oh the risk is one in a thousand it's never gonna happen but when you're the patient you start realizing that you are thinking you could be that one in a thousand and so you start thinking about things totally differently when all of a sudden the side effect profiles are being said because that because i was told the medicines i was going to start won't cause any problems most people tolerate them just fine you it's one in a thousand that you

24:10 could have liver failure but i would dream at night that i was going to be the one to have liver failure and not wake up in the morning and what would my kids do who was going to take care of them and don't get me wrong i have an amazing husband who does so much and is so helpful but to have not have a four month old who i'm nursing than not have their mom you know and so this is where

24:30 you think and maybe it's not totally logical and i'm an extremely logical person but when you get an illness or when something happens to you logic so much of the time goes out the window and emotion takes over for even for for everyone i think and i think it's that emotional um that's fear i was so scared i was so nervous my husband and i would just hold hands and he would just squeeze my hand and say it's gonna be okay we're gonna

24:57 get through this and you know and some people would say well gosh it was just rheumatoid arthritis like it wasn't that bad but to me because of how much i'd fallen from where i was and how much they i felt like i was gonna be in a wheelchair i'd wake up dreaming that i would be in a wheelchair in a week and that that is hard to overcome and you were put on medication there but i understand that

25:24 there were some side effects so you did see some improvement but there was a lot that came with that as well what was the treatment plan you were given and what were those side effects you were experiencing so i um the standard of care for um for rheumatoid arthritis is to be started on steroids usually initially to deal with the acute inflammation so steroids cause you to be puffy they make you gain weight and people will say like

25:52 how do what can't just control your appetite well you just feel this munchy feeling all the time you get nauseous from the steroids as well which makes you want to eat breads and refined carbohydrates and then you're started on disease modifying anti-rheumatic drugs they're called demards um for short and those are medications like methotrexate which is standard of care for rheumatoid arthritis with that that's the one that can cause liver dysfunction again it's the amount that you get more than one dose although

26:23 you can have an acute response but most people you build up over time and you have to monitor liver function tests regularly usually every three months to make sure your liver is handling the methotrexate then you're given um folic acid because you have to be on folic acid while you take methotrexate and then you're given um if you have a side effect problem with one of those medications you could be put on another medicine which i was offered at one

26:50 point and if those fail you are given biologic medications so use immune blockers and those medications are injectables and that's sort of the next stage so i was started on pregnazone and methotrexate to start as well as folic acid i was told that i needed to stop nursing my kid within a week and so if anybody's ever nursed a baby um that maybe the most tragic thing that

27:21 i felt was having to give that up so if you can imagine and maybe this is too much detail but i remember having these engorged breasts full of milk and the baby would cry and then i had to walk away and so i had to walk to the other room and my husband would have to give her a formula bottle when i would had to and i had to make my milk go away um and so over a week maybe the hardest

27:47 week i made the milk go away the milk and then i started medication so within um a couple you know you have symptoms like you take it once a week and i can't remember exactly but i remember i felt better in terms of the joints pretty quickly but i think that was mostly because of the steroids remember the story steroids are fairly short acting steroids made me not sleep well at night they make you a little

28:12 hyper again there was the eating issue but then when i started on methotrexate i had a lot of side effects like um i had a lot of nausea um i lost started losing my hair would just fall out um in the shower and then um sensitivity to the sun uh anemia uh these are sort of standard side effects and i had i remember people telling me how amazing it was that i lost all my baby weight um it was really

28:39 that i just didn't want to eat because i was nauseous all the time so um yeah it's a funny funny time you know nobody you know talks about sort of the evil underbelly of medications and that sort of humbleness and though how how fragile you feel um where you carry it we all carry these exterior coats of armor uh and that inside is sort of falling apart and had you given any thought as to what caused all of this in the first place

29:09 were you looking at your diet did you think maybe your pregnancies had triggered this was it genetic yeah so i don't have any rheumatoid or autoimmune illness in my family um but for some reason i do have some sort of genetic code that tells me that i should have rheumatoid arthritis but why is it that a person or why did i get the ra at that time well the medical thought is that the pregnancy is a hyper immune hyper

29:37 hormonal time and during pregnancy actually very commonly people post pregnancy will develop autoimmune illness i didn't start thinking about lifestyle for several months after i started getting better until i met some people and met a woman in particular named karen and karen was a nutrition consultant and she wanted to come to one of my events like i used to run these prevention programs even back then just to measure blood pressure and cholesterol to get people motivated change and she was like

30:06 what about a nutrition component i said well you know i got that nutrition thing you know eat better you know eat less fat and she said well i think there's more to it than that and i probably was cocky and obnoxious like i got this um and she said why don't i do your dietary profile you know let me just do it for you and so i remember being like i don't really need any help i'm already

30:27 vegetarian i got this so but i did it i did this dietary profile and she came over to my house and we sat and chatted about it and she said you know i think there's some problems in your diet and we started talking about them it was the first time i started thinking about how diet can impact your lifestyle so and how that lifestyle could then affect your ability to get illness so i think one thing that people

30:52 maybe don't understand and maybe i did i certainly didn't understand is that i think people have genetic predisposition to illnesses we all we can't change our parents you know we're going to get the heart disease the cholesterol the blood pressure autoimmune celiac disease you know some of that stuff is predisposed because we have genetic code for it but what turns that gene on like what is the epigenetics what surrounds that gene that makes that gene trigger

31:21 well what if you consider and so most of us in science we would say well the gene gets activated it was the pregnancy that triggered it and then our job is to treat the inflammation acutely that was the pregnazone and then we are going to treat the illness with those disease modifying anti-rheumatic drugs so that's the standard treatment but what if you think about it differently and you say okay well yes i had a i had a genetic illness that i was

31:47 destined to get or maybe not destined to get maybe the pregnancy triggered it but maybe it was also that i had a really bad lifestyle where i slept three or four hours a night i was woken up all night because of the baby i was working full-time i had three kids i was trying to exercise i was trying to be a super super person and i was stressed all the time and i was falling apart and it's that sort of milieu where your

32:16 your resources are not keeping up with the demands on your body that then also triggers inflammation so maybe pregnancy was always going to trigger rheumatoid arthritis for me but maybe i made it so much easier because my milieu my all the other things i had doing to myself was making me worse so then if you think of it that way then there should be a way to treat that milieu so maybe you don't activate that gene

32:44 or if you do activate it you should be able to suppress it so that's when i started thinking a lot about those other factors that's when i started thinking about the diet and maybe not just diet but sleep and stress and exercise and the impact of all these things on your body and how those things can change how you do or how you respond to your genetic information so you have the genetic code you have you can't change that but you

33:12 can change how your body responds to it and i think that's the fundamental key that people don't get and i certainly did not and that even if you do get illness there's ways to suppress it and that is the money so what were some of the things that you and this dietitian came up with as far as changing your diet what were some of the bigger changes that were made so her big thing for me was that i was

33:37 eating too much dairy and um i was eating a lot of um simple sugars um so i changed everything i i didn't just change one thing i i started i went gangbusters i she started me off on this process of reading and understanding about dairy she taught i started looking at things which led me into the area of the gut and then i started becoming obsessed with the gut so i started going to conferences i remember going to

34:04 conference at harvard meeting a fabulous guy named alicio fasano who actually helped me write the microbiome chapter of our book on body on fire and he's over at harvard right now and i went and spent he's just an incredible person and i remember trying to understand the mechanism for why all these things then affect your cause inflammation and so much of that is there's multiple issues there's sympathetic tone or an imbalance between high levels of sympathetic overdrive

34:35 versus parasympathetic which is your rest in recovery so there's that stress response but then there's also at the level of the gut there's the microbiome so the gut bugs that you have change depending on what you eat and how you sleep and how you how your day to day is and then you have not only do you have those gut bugs that change and there there's also the way the gut bug or the how the intestinal cells they stick

35:02 together and if they break apart you can get something called a leaky gut so there's so many different levels where your things that are happening and that you're doing in your lifestyle are affecting sympathetic and parasympathetic tone like stress then there's also the gut biome the actual bugs that are changing based on what you're doing and then the actual concept of the leaky gut so that's three levels of where you could be damaging or impacting your

35:29 response to illness and you so you're i mean you essentially it sounds to me based off of what you're describing is you're kind of going through medical school again i mean you are acquiring a ton of knowledge at this point and it had to have been exciting for you to not only be acquiring this knowledge but i'm assuming throughout this process your own health is improving yeah i mean that was sort of the coolest part and that's you know why i always so

35:59 yes so it was the first time i felt like i was totally in control of my learning like it's not that medical school wasn't my choice it was but you have to like do what everything you do is sort of required and you just got to go through it but this time it was really personal right i needed to figure out how to heal myself so i was going to these conferences and trying to read everything i could it's not taught in

36:22 medical school nutrition isn't taught in medical school lifestyle is not taught in medical school and so that's the funny thing right and so you know we actually studied this and like night over 90 of cardiologists will tell you that they had no nutrition education in all of their training um and you know cardiologists like we should be good at nutrition but we aren't because we're not taught it so yeah i went through everything again but in a way i was it

36:44 was a joy because i was able to read about it think about it meet people that were doing sort of cutting edge stuff and then try to implement it in my own life and then i would test my labs and see what would happen so i did i started changing everything i started cutting out i cut out dairy first that was the hardest thing for me because i loved as you could tell i was eating cheese like crazy um but i always tell

37:09 people because people say oh that was that'll be really hard for me too i always tell people you know what yeah change is hard change is really hard but you know what feeling better is worth every single moment of change of that change because it was it was absolutely worth it and so i started cutting out dairy i started eating whole grains um i started cutting out sugar sweetened foods i started eating everything fresh and i

37:34 needed loads and loads of fiber i remember being like what is happening to my gut dear god so much fiber and anybody who starts this process i tell them now like be prepared the first couple weeks is gonna be you're not gonna like me because you're gonna you're gonna be so gassy and so bloated that you're gonna wonder like what is going on but it's absolutely worth it just stay with me because after a couple weeks it's gonna

38:00 be amazing and so you know i would i would try those things and you know and i started sleeping i just started sleeping more i started allowing and that's a key thing for a woman especially a controlling woman like myself i started allowing my husband to take over more responsibility for the baby which was something i had a lot of trouble doing actually in saying that it was okay i forgave myself for not being able to do everything and so that allowed me

38:27 amazingly just that forgiveness allowed me to sort of let go of so many things where i said okay it's okay if i don't exercise every day ironically i'm a huge proponent of exercise but i was exercising in a negative way when i was over-retired didn't have enough resources and that exercise was hurting me so i needed to allow myself to recover i started sleeping i started doing yoga i started you know i just cut down my stress and most importantly i

38:54 forgave myself for what i could not do and then i got better i got i got so much better and that just really fed the process of learning and healing uh and wanting to make changes let's talk about that healing process because i know um that eventually you were able to come off of those medications that you were talking about um that that you were not necessarily thrilled with those side effects so how long was it after changing your diet and

39:23 really becoming focused on that that you were able to come off of those meds and what was that process like you know i always worry that people hear this and they're like i'm going to stop taking these right away you know just cold tofu as the vegans like to say so what was that process like for you how quickly did you start to feel better so i started feeling better within weeks of changing my diet but

39:47 uh i was also taking medication so the scientist in me was not sure that it was the diet or the medic the medication just working so i wasn't sure for some time uh months would go by and i was really starting to have fewer and fewer side effects uh and just feeling like myself again and just uh you know just trim and strong and healthy and that hadn't happened during all the time that i was taking the uh

40:13 that i was taking the drugs i just i hadn't really felt clean and healthy until sort of getting my lifestyle improved and then i went back to the rheumatologist and i said look you know i'm doing all these things i really feel i'm better my inflammatory markers are incredibly better let's start weaning the drugs and he said no he said it's you can't do that it doesn't work that way you will be on medications for life you cannot come off these meds

40:40 um and i went home disheartened um and i continued to take the meds continued to work on my lifestyle continued to learn and read and then i switched rheumatologists and and this was the same rheumatologist who who told you like get used to this this is the way life is going to be when you first uh went there and and were diagnosed correct absolutely okay okay um was that nerve wracking for you though i mean i know that you had made

41:09 all of these lifestyle improvements you said you were feeling better at that point but still i mean coming off of those medications even though you really wanted to give it a try it must have been a little bit nerve-wracking for you a little bit it was a huge amount of nerve-wracking yes absolutely i was totally freaked out um and scared because you know you don't wanna i was finally in a place where i felt like maybe i'm good maybe i need to listen to

41:33 the smarter people in the room who are not not me i'm not a rheumatologist um i should listen to these people and so i absolutely because i get this i get an email or two a day sometimes asking me how i came off my medications and i would say that i did not do it lightly i did not just come off coulter told tofu i did not do that i i did it slowly judiciously i looked at

41:59 my labs i checked everything and i did it under the care of a rheumatologist and so i don't recommend cold turkey tofu i don't recommend that i recommend you do it sort of judiciously and it takes time and some people's gut and they've been sick for so long it takes longer to recover and that should not be considered a failure just because i was able to come off medications and somebody else isn't it's not a failure

42:26 of lifestyle it just means that sometimes somebody some people need a little bit more their bodies have been sicker for longer and it takes longer to turn and not everybody can suppress all the inflammation because sometimes we don't know what all the inflammatory triggers are and not everybody's going to have the same results but so many people will get better and that's what you hang on to and so i i i'm glad you brought that up

42:50 because i do think i do get so many emails asking me that question like you've given me hope and i love that i want to give everyone hope that you can get better because you can but will you come off in five days well it took me a year it took me over a year to wean my medications so once i met the new rheumatologist we talked about it and he was just sort of more in line

43:12 with my mentality and we talked a lot about life so he said you know the truth is i don't know the answer to a lot of these things that you're bringing up which is okay not every physician most physicians will know nothing about nutrition and lifestyle but somebody but he said i'm willing to try and work with you because i do think that there's something to what's happening to you and we always have the ability to go back

43:32 you just have to be aware that if we wean sometimes if it flares that you have to be on more medication than when you started and so you're hearing all these things and you're scared and you're thinking like what the hell am i doing what the heck am i doing here and um am i really going to be this crazy am i really going to take this leap of faith so it took me a long time emotionally to

43:53 prepare to do this and i remember the when i did it i did it two weeks before my first triathlon uh i stopped taking my meds hold on talk to me about the timing of that because oh my god that just seems like ultra nerve-wracking you've got this huge thing coming up and now you're going to make this huge decision as far as as your treatment oh my goodness i know so crazy right so well so what

44:19 happened was is that i started working with a rheumatologist and so he suggested the new rheumatologist suggested that i cut my medication one tablet per week no i'm sorry one tablet per three months so you're taking like 30 milligrams which is like five or six tablets i can't remember and then per week and you take them once a week and i remember that every three months he said i could decrease by one tablet and then i would check my labs

44:48 concurrently like so it was very slow very judicious and very analytical and so as we made the changes we would wait we would watch we would think kind of reassess um i maybe have gone a little faster than he wanted me to but it definitely still took about a year and then i was due to come off my last medication my last pill around the time of my triathlon so i said you know what i'm just going to do

45:14 it a couple weeks before and then just be light and free and i remember i did that triathlon and i don't know if you've ever seen i should send a picture to you of me coming out of the water that triathlon because first of all it was my first triathlon secondly i suck as a swimmer and i get training as in my swimming because i just was a terrible swimmer and i came out of the water and i

45:37 remember there was no greater pride than i felt at that moment because i had three children that were so still so little i was i had recovered i had made these babies that i didn't you know i was so i wasn't sure i was gonna be able to even have a kid and i had these three amazing kids cheering for me with my fabulous husband and then i uh had just come off my medications and i was able to overcome a swim and i suck

46:02 at swimming and i remember coming out of that with that water being like okay i did it i did i remember that there was no greater pride i think than that moment when i came out of that water even my son to this day remembers that moment he goes mommy i remember you coming out of the water and i remember that smile there i am uh yeah what a i mean geez louise what an emotional day i mean that sense

46:28 of accomplishment not only being your first triathlon but at that point i mean you might as well have just climbed mount everest i mean just an incredible incredible turnaround um and i i personally am really proud of you i mean for making those changes and investigating everything and coming to this solution and research and now paying it forward um i i want to touch on a couple of other things as as we wrap up here um

46:55 you mentioned your kids and initially you thought maybe the pregnancy did play a role in this and i know one of the emotions that you struggled with initially with your diagnosis was maybe a little bit of resentment to your your youngest because it was after her birth that you started to develop all of these symptoms that is is really difficult do you feel like you maybe harbored a little bit of resentment toward her because

47:27 maybe you weren't ready yet to think that it was something that you were doing to yourself at that point or i mean just just talk to me about that a little bit yeah i mean i would say that these were not my finest moments um and um after baby number three i looked at my husband and when i started getting sick i remember asking him i was like what did we do here like what were we

47:51 thinking having a third kid as it is you you know you knew people had already said why are you having three kids when you're having your when you're pregnant this is you know you already have a boy and a girl you hear so much of that and when you when i remember thinking and saying to my husband what are we thinking like why did we do this it's you know and because i was in such a

48:10 dark place remember i was blaming clothes companies for my ability not to snap and changing my shoes i blamed her i blamed my poor little baby girl for being the reason for why i got sick and it's one of my darkest and most embarrassing moments um where i i i did i harbored resentment that she was to blame not me clearly not me but it was because i had had her that i had gotten sick and so you know when i got

48:41 better and started healing that that's why i wrote the book isn't it you know i i write that chapter chapter two of the book because to because i and i tell her because she's read that chapter and she cries she goes mama i made you sick and i said baby you know you didn't make me sick you were actually the reason i got better because it was only because of her that i learned how to heal and um so

49:04 i always tell her she's the one who saved me yeah wow i that is a heck of a heck of a way to to definitely look at that and uh i personally would not beat yourself up i don't want to editorialize here but i think that the emotions you are feeling you're just human at that point and so every emotion possible is going to be on the table you know so i i think that when somebody's going through such

49:35 trauma and they're so hurt and they're so confused and they're so much just trying to figure everything out like emotions are going to be what emotions are going to be but at no point did you love your child any less you know yes no i appreciate you saying that i i definitely you know have had to go through that process and and also with my kid because now she's old enough to understand and see the story and how it's played out and so

50:03 it's a process that we've had to go through together to kind of talk about because yeah no i know that emotions and i appreciate you saying that because i definitely will always carry a little bit of sadness that i had so much anger there will always be a little that i do forgive myself for it and she forgives me for it and i do truly believe that it's because of her that i'm better because i know

50:28 that i would never be on this path i mean it's changed my whole life i mean i practice preventive cardiology and plant-based nutrition and i teach people about meditation in my clinic and i do breathing exercises with them and i'm probably the only cardiologist in the country that teaches people how to breathe and meditate you know it's so crazy and so but it's so fabulous and it's because of her that i can uh it's and i truly thank her for that

50:54 every day she's truly yeah absolutely look everything happens for a reason you know that's that's cliche to say but it is true um let's end on a super positive note well an inquisitive one anyway and i think that i can't let you escape this interview without asking what is it that dr monica agarwal eats in a day now if somebody has been listening to this interview has become inspired by your story and wants to begin making dietary

51:23 changes themselves what is it that you're eating what are some of the top foods you would recommend okay so a positive note so i love to eat and i love to eat um um i love to get fresh foods and i love to grow a lot of food so we grow a lot of our vegetables i have the benefit of living in florida and so i grow a load of our greens in our yard and my husband

51:45 is is not to be ignored because he does a lot of the growing um so for breakfast i often some people you know i outline in my clinic when people come in they'll say i eat really well am i going what's for breakfast what's for lunch i go through every single food item that they eat i google the items that they tell me they eat that i've never heard of so i can lick it look at

52:06 the instru the nutritional content so i like everything on the table so those are the things that i go through because i think there's so much to be found in what people are eating so what do i need so i eat for breakfast i often will eat um a whole 100 whole wheat bread uh two pieces um usually the the only place i order bread from because i think most bread is junk um they make their bread with no oil no

52:32 sugar and no preservatives so it's on it's 100 whole wheat um so i eat whole wheat bread and i usually put um hummus and um alfalfa sprouts that's my um breakfast these days sometimes i'll put avocado sometimes i will do hummus and tomato and black pepper those are that's usually my breakfast with blueberries a cup of tea with turmeric usually green tea and turmeric and sometimes yeah usually that's what i eat and then a couple hours later i usually

53:02 have a handful of cashews because i'm addicted to raw cashews they're loaded in magnesium often i'll use walnuts because they have a lot of omega-3 fatty acids which are anti-inflammatory i told you in my tea i have turmeric because that's a very anti-inflammatory spice for lunch i um usually have two or three glasses of water maybe a carbonated water if i'm feeling like i need some fizz and i have a massive salad usually the salad is bigger than

53:31 my head it is so massive um and i eat usually i'm growing a load of kale so i always eat kale i chop it up really finely i often put a tablespoon or two of hummus i use balsamic vinegar not vinaigrette vinegar um i eat every vegetable that's rotting in my fridge my husband tells me it's the trash can salad because whatever's rotting i throw into there i'm like oh that's good enough i often put kimchi in it

53:56 or sauerkraut but i prefer kimchi because it has a little bit of a bite what else do i put in i put nutritional yeast in it for my b12 i often put tofu in it i often put chickpeas in it not all of it all at once necessarily but different varieties of those concoctions all the time and then that salad i usually eat at one o'clock and then i usually can't finish it so i eat the

54:18 rest of it at three o'clock um and i usually have an orange somewhere along the way because i have the benefit of living in florida and i love citrus and um usually that's it i don't often have dinner i don't find that i need dinner um i'm at a point where i find that i have such nourishing breakfast snacks and lunch that usually around three or four o'clock i'm done for the day i know that that seems strange to a

54:42 lot of people and i'm not sort of necessarily advocating that for everyone but for me i find that i often don't eat dinner and then i'm usually good until the morning the next day and so i find that that those are the foods i eat i have a vitamin d supplement and other than that i don't take any other supplements can i just tell you that that salad sounds amazing i mean i i i throw a lot

55:07 of stuff in mine too i call it the kitchen sink i mean what you have are two kitchen sinks in your salad that is just incredible it is an incredible salad my husband looks at it like are you gonna really eat that and i'm like yes i'm going to really eat that and i'm going to eat because he just thinks it's so much food how am i going to eat it but i eat it at 12 i eat again at two or

55:27 three like i just eat it a couple ever you know i eat the whole thing it takes time and there's a lot of roughage yeah but you man but you get down that that is phenomenal see i wanted to end on a high note and dag on it that salad is definitely a high note i love that so much yes i'm glad well i'm i'm so glad that you were able to join us for gosh i mean close to an

55:50 hour at this point um just truly a remarkable story and i can't again begin to express how happy i am for you and proud i am of you um and and just for your patience i mean everything that you have been through now is making you a better doctor today and so i think that your patients are also reaping the benefit of everything that you went through so it did serve a purpose and i'm so glad that you were

56:19 able to share that story with us today thank you thank you for saying that i appreciate hearing that it means a lot [Music] if you feel like you've raised your health iq by a couple of points go ahead and subscribe to this channel and leave a nice comment below and to hear the entire interview head over to apple podcast or wherever you get your shows from and subscribe to the exam room by the physicians committee and please

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