How Nature Can Help Heal Our Mind, Body, And Soul

We all know that being active and spending time outdoors is good for our health. But did you know there are specific benefits to getting proper sun exposure and spending time in nature? In this podcast interview, Dr. Aruni Bhatnagar, a leading expert on how environmental exposures affect cardiovascular disease risk, discusses the importance of sunlight exposure and time spent in nature for our overall health.
Hosted by
Laurie Marbas
Last updated
September 30, 2022


00:00:00 Introduction
00:02:04 Dr. Bhatnagar's background
00:04:00 How your environment affects your health
00:08:04 The different categories of environmental factors that can affect your health
00:12:09 How decreasing trees increases heart disease
00:15:15 Benefits of horticulture therapy
00:19:48 Why it is healthy to walk in nature
00:24:22 The negative health affects of cooking
00:29:26 How you can improve your community's health

Podcast Transcript

Dr. Laurie Marbas: Welcome to the podcast. I'm Dr. Laurie Marbas. And today I'm excited to welcome Dr. Aruni Bhatnagar. How are you?

Dr. Aruni Bhatnagar:I'm doing well, Laurie, how are you?

Dr. Laurie Marbas: I'm very good. Thank you. And I'm really excited to speak to you about your unique work and the, how the environment impacts our health. And it sounds like there's many exciting projects and many rabbit holes. I feel like we could go down, but could you give us a little bit of your background and how you came to find this type of work and become interested in it?

Dr. Aruni Bhatnagar: Yes, I, I did my PhD in, in India, but then I did my training in the university of Texas, the, at the university of Texas medical branch at Galveston. And my area of interest has always been to study heart disease and particularly cardiac physiology. I was trained to do cardiac electrophysiology and, and recording electrical currents from the heart. My area of interest was the pacemaker cells, and I always found them fascinating because they would oscillate on their own and they have their own rhythmicity. So I was studying underlying mechanisms, electrical currents, and so on. And as I worked more and more in the circles of people working with heart physiology into heart disease, that I it sort of occurred to me that since this is such an important problem, that really need to understand the real origins of the disease, why I do so many people have heart disease.

Dr. Aruni Bhatnagar: And why is it that remains despite all the advances, the leading killer in this country and in many, many places in the world. So maybe there is something fundamental that we have failed to understand about the nature of the disease. And so in, in that reign, as I probe deeper I came to the realization that maybe most of this disease originates from environmental factors. And I use that word broadly in the sense that there are environmental exposures, there are environmental conditions. And then there are ways in which we interact with the environment that is, seemed to me to be one of the main drivers of the disease. So then I've been working in this area we call environmental cardiology for a long time.

Dr. Laurie Marbas: Hmm. So can you give us a little bit of background in the sense of what are those environmental factors and what you mean by how we interact with the environment and how it can affect us

Dr. Aruni Bhatnagar: As well? Yeah, so I I've been thinking of this in terms of sort of different concentric circle. So there's this real broad set of conditions, which you call the natural environment. And, and then nested within the natural environment are the social environments that we have social structures, social networks, and further embedding embedded in those social networks, our own personal environments. And so you hear a lot of people talking about social determinants of disease and so on, but even though you and I may live in the same city, we may have completely different environments depend upon how our personal environments are created houses, our families, and so no into individuals living in the same community or the same city, even the same neighborhood have similar environments. So we have to understand all these complexities of different environments that we live in particularly interesting is the role of the natural environment was usually ignored.

Dr. Aruni Bhatnagar: And in the natural environment, of course the most of the important features are something like the cycles of night and day, right? So you, you have the circadian rhythms and we are all tied or tethered to these cycles and there is no deviation permitted. And so if you deviate from these cycles, you have health costs. And part of that could be heart disease, obesity, diabetes. The same's true for our relationship to the sun. We are, most people don't realize this like plants, we need specific amounts of sunlight to flourish, and it's a very specific requirement it's irreplaceable with anything else. And so if we derive, deprive ourselves from these natural exposures, then that is a cost to a health. And then of course we have our environments of social environments and social support structures, you know, access to medical care and all of that, which there is a lot of work on that.

Dr. Aruni Bhatnagar: And then finally there are these personal environments where we create the worlds that we live in, either by choice or by chance could be either that. And then even within that, we have personal choices of either we choose to smoke or drink or exercise or sleep well or, you know, or those sort of health behavior sort of things that people used to call, you know, your lifestyle issues. But those lifestyle issues are not entirely because of individual choice. Most of the time, it's the larger environments of social structures and networks that dictate our set of choices. And so we, when we consider this whole continuum of environmental or in some sense, external exposure that that explains maybe 80 to 90% of heart disease and diabetes and obesity. So the idea is then should we should be looking at these rather than being stuck with just the biology, like which valve was wrong, or which arteries blocked and that sort of thing.

Dr. Laurie Marbas: Mm I agree. Oh, there's just absolutely true because my work really focuses on that personal environment, but we constantly speak to the other constructs around the world, like around the, like driving down, for example, just the road to go to work, you may be inundated with signs for McDonald's and burger king. So they're being influenced in so many ways that are outside of their control or the lifestyle that you grew up thinking was normal and healthy, maybe isn't so, yeah. So I'm totally understand that. And I love that. So where does your realm of work fall in, in those circles of influence? Where, where do you to particularly like to focus your work?

Dr. Aruni Bhatnagar: Right? So we, we are trying to understand what are these larger nonpersonal domains that influence personal activity and choices. Just like you said, we have people here that come to the clinics and we say, you know, you need to exercise and you need to be physically active. Then we make cities in which we make it impossible for anybody to walk anywhere. Right? And then we just keep on blaming and shaming people and say, you are obese and you don't exercise. So these are the largest structural issues that we need to address. And that's where we've been focusing our work on rather than trying to persuade each individual, which is not usually, it's not an individual's fault. So whether it's advertisements of food or whether it's tobacco or alcohol, or whether it's you know, work environment, all of these structural issues are key determinants of health that have been overlooked.

Dr. Aruni Bhatnagar: Hmm. And, and so that's very focusing on one of the main areas of interest we have is the natural environment. And we think that one of the drivers of health and disease outcomes could be the natural surroundings that we have particularly green spaces and nature. And our interactions with nature is also a very primordial need. And there isn't a way in which we can divorce ourselves from nature and then pretend to be healthy. Right. Yeah. And so we are trying to look at communities, particularly communities, a disadvantaged communities, what are the these natural resources, they have access to nature, access to green spaces and how that might impact health.

Dr. Laurie Marbas: So what have you found in your research? Like, is there particular cities that you found as good examples or what, what would you recommend or like, yeah, please tell us more, like, what are your, what are you finding in your research?

Dr. Aruni Bhatnagar: Yes. Specific. So, so that's, it is, it's still an ongoing activity. There's little work that's been done in this area, but there is still some really interesting findings. And these relate to the urban green spaces, which is what we apply, because that's where we spend most of our time living and sleep. I mean, we can go on a, have a break and have a little surge in nature and say, oh, we spend a weekend in the mountains, but that's not most of how most of us live and that's may not, may or may not have lasting impact. So what are the natural conditions in which we live our everyday lives? So we've found that, and others have, have reported that people who live in more green areas tend to live longer, tend to live healthier lives report, lower levels of depression and anxiety tend to be out and more often.

Dr. Aruni Bhatnagar: And so this sort of natural environment encourages healthy lifestyle and living, and also has effect that decreases the risk of disease. And the problem is that people who are living in green spaces are generally better off socioeconomically. And so they are, they have much better health behaviors. So we are trying to disentangle the effect of socioeconomic factors from natural factors. One of the papers we just published a few months ago was looking at these 5 million cancer survivors. So when you have a diagnosis of cancer and they're, they're registered, and then we followed them for 12 years, and we found that people who live in greener cities tend to do better after cancer diagnosis than people live in less green cities or less green areas around their houses. So exposure to green spaces can prolong a survival after cancer. At least that's the associated relationship we found.

Dr. Aruni Bhatnagar: There is a 10 to 12% decrease in total mortality, you know, eight to 10% decrease in cardiovascular disease, risk and cardiovascular deaths. Wow. So there was a very interesting study in here in north America, where we have Northeastern part of the country. We had an infestation of the ASBO beetle, which is killing all the Ash trees and we've lost millions and millions of Ash trees. So a colleague of mine, he traced the, the spread of this epidemic as the trees were dying, the risk of heart disease kept increasing in the communities. So it would mean that in communities where trees die, people die as well. Oh, wow. And, and so we think that there is a strong association within the health and wellbeing of a community and the surrounding greenness in which they live.

Dr. Laurie Marbas: Mm. Is, do you know what cities you'd, you'd prescribe for best health as far as being green cities? Is there any particular areas?

Dr. Aruni Bhatnagar: Well, well, there are many cities that are quite green in the United States. The, the, the tragic part is that almost most cities are green only in one part. Oh. And not the other. And so if you go in, for example, I'm from Louisville, Kentucky. And so if you go to the east and the city, it's one of the greenest cities you'll ever come to. But if you go to the west end the city, you know, you might as well be in Phoenix, right. So there's no trees, there are no SHS, there's no bushes. So there's the inter city grads are so much greater than interested in gradients.

Dr. Laurie Marbas: Wow. Oh goodness. And so is there something that anyone can do also in their home that, you know, because we have this micro environment here out, even outside, you know, within our walls and then there's the outside. Yes. Anything in particular like a number of plants or things that we should be thinking about that we can make our homes even conducive to better health in that sense.

Dr. Aruni Bhatnagar: Right. So one way of improving health is, is income. So if you increase a, a person's income, the health increases, that's, we've seen very, very graded response. So putting one tree in your house, so your back or front yard is equal to improving your income by 12 to $15,000.

Dr. Laurie Marbas: Really.

Dr. Aruni Bhatnagar: Yes. And, and so that means that if you have a large tree in the front of your back of your house, that has important bearing on your, your, your health. And, and we still do not know quite why we think that part of what trees do is shield houses from air pollution. And we've done several studies showing that exposure to things like volatile chemicals, like benne, Tomine zine, all these things that people are, are exposed to the exposures are much lower in green spaces. You know, there are lower levels of anxiety, lower levels of depression. And, you know, even you have lower energy consumption in houses, which have trees. So there are this variety of different possible hypotheses, but we had to figure out to what extent each of these relationships contribute to the overall beneficial effects of greenness.

Dr. Laurie Marbas: That is really fascinating. Cause I went down a rabbit hole. <Laugh> one it's, it's one of my many things I get to do on this podcast. And discovered horticultural therapy. And the reason I even found this was there was a young woman in New York who excuse me, she was actually a professional model, beautiful young woman mm-hmm <affirmative>, but she had like 1400 plants in this apartment in New York. And she wrote a book, but what was interesting is on her social media accounts, she started encouraging others to bring plants in. And they were talking about how their moods changed, literally from depressed state to this. And I was like, this is so fascinating. Right. And it was such a fun thing to interview her and discuss. And, and then I found the horticultural therapist that she wrote about <laugh> like, I literally went down this really interesting path cuz I didn't ever had never even heard of horticulture therapy and I'm a physician. I was like, amazing.

Dr. Aruni Bhatnagar: Right. So we, we don't, we, we don't know the details. So we need to elevate this relationship to more rigorous science. So that physicians like you and other understand the value, the only way we can do it is to quantify the benefits. So in order to do that, we launched a program or a project it's called the Greenheart project and what we are doing in this project which is almost happy through now is that we will, we go and we evaluate the level of air pollution in neighborhood. We look at the risk of heart disease in that neighborhood. And then we plant large established trees because if you plant small trees, it's gonna take, you know, 30 years for the study to complete. So we plant large established trees and date. We plant, we sort of planted over 8,000 mature trees in area of like two square miles.

Dr. Laurie Marbas: Wow.

Dr. Aruni Bhatnagar: And, and these yeah. And these trees are some 20, 30, 40 foot trees. They're not like little SAP place.

Dr. Laurie Marbas: Goodness. Oh,

Dr. Aruni Bhatnagar: Wow. And, and then we have an area which, where we didn't plant the trees. So it's like a controlled clinical trial. It's funded by the national institutes of health who say, okay, we'll fund other clinical studies, but you're not buying your trees. So you went to the nature <laugh> yeah. So, and I just not in the business of buying trees. Okay. <Laugh> so we went to the nature Conservancy and so they're supporting all the greening.

Dr. Laurie Marbas: That's fantastic.

Dr. Aruni Bhatnagar: And it is that's why, because it's a very expensive project it's like about, you know, 15 million project can

Dr. Aruni Bhatnagar: Imagine. Yeah. Yeah. You can put all those trees and around the, and they have to, we are trying to look at the placement where the tree should replace next to the freeway next to your house. So I think the idea that we could do an experiment as sort of an intervention, and it would be a, a clinical trial that, you know, physicians like you would understand the value of clinical trial, right? Where the intervention is not a pill, but a tree. Right. And see what the, and then measure, use the same rigorous methodology to measure the outcomes like we do in any clinical trial.

Dr. Laurie Marbas: I am very, when will this conclude? And when, when and where can we expect the results to be published?

Dr. Aruni Bhatnagar: So we have some results from the cross sectional data already, which we have published. We know that people live in green spaces, the neighborhood have much better health outcomes or poor exposure to, or less exposure to volatile chemicals. We just finished up planting this summer. So we are going to follow next year and the year form. And I hope the project never ends because one thing with the trees is they just keep growing. You don't they? So, so there are a 20% increase in the greenness of the area every year. And so we can chart the health of the community as the greenness increases in the area. That

Dr. Laurie Marbas: Is fun. I mean, those lucky people is this in Louisville, this happened. Oh, fantastic. They're lucky those in the, that square two miles, eight

Dr. Aruni Bhatnagar: Trees, our, our community has been very, very involved and engaged. Wow. In that. So we went to house to house and door to door asking people if they would take trees from us. And, and some people, of course, we don't wanna bother the tree. They get out, you know, but some people were very surprised like nobody, I mean, what's, what's the catch, you know? So there is no catch <laugh>,

Dr. Laurie Marbas: It's not very often that someone comes like, Hey, can I come plant this 30, 40 foot tree you're in? Yeah. Well, that's fantastic. Yeah. I mean the value, well, we all understand just even walking in nature, you feel calmer and more relieved going to the ocean. I mean, that's one of the reasons I loved Colorado Uhhuh, but year round, you know, there's only so much snow in colds you can take, but here in California, like the ocean's there, I'm in Southern orange county. It's like trees, you're, it's gonna be warming warmer. Your, I am so tickled to be here.

Dr. Aruni Bhatnagar: <Laugh> and, and the reason some people believe that there's a, there's a hypothe called the biophilia hypothesis. It is, it says that we evolved in green and natural environments. And that if, and that we had this sort of an inable bond with the, with nature that we cannot live without nature. And, and the, and it has mental effects. Like if you go out, like you said, you know, it relaxes you. If you pay, if you talk to people and you're in the house, you to pay attention to everything that's artificial around you. But if you interact with nature, it's an effortless attention. You don't have to pay attention to any part of nature. You're just there. Right. And, and that sort of rejuvenates and recharges your attention. And, and so that's why I interact with nature so critical. There are lots of, there's a big literature in, in mental stress and attention. And, and also anxiety, depression, even suicide rates are lower in greener areas. Right. So there's a lot of work there, but we were looking for whether we can find some measurable physical effects that we can quantify.

Dr. Laurie Marbas: Hmm. So I'm, I'm curious as to, what do you feel the mechanism is for heart disease in particular and this environmental, you know, exposure is there, is, are there certain endocrine effects or hormonal effects or like mm-hmm <affirmative> where is that breakdown occurring? And then how quickly does it take to get better if we move to greener spaces? I mean, is there, do you have any way to quantify that or give a quote unquote prescription for someone to understand?

Dr. Aruni Bhatnagar: Well, so the, the, the reason I got into this greenness research was my interest in heart disease. And one of the leading causes of heart attacks now, which is, is a small risk, but is with, so among so many people is exposure to air pollution. And, and there are, you know, 7 million premature deaths per year, worldwide because of air pollution. And of those 80% are caused by cardiovascular disease, heart attacks and so on. So that when we first got the day that it was very surprising because we thought that most of the deaths, U air pollution, we lung related deaths, but that's not true. It's all, it's all heart disease. So when, when we, and we can see that. So if you have cities like whether it's Boston or whether there's New York, you see an increase in the rates of air pollution, then within six hours, you see increased death from heart disease and hospital admissions.

Dr. Aruni Bhatnagar: Oh, wow. So, so there is a very immediate effect. And then there's a long term effect that if you live in more polluted areas, you have greater progression of what we call atherosclerosis and atherosclerotic lesion formation. And so that's what I've been studying. And, and, and so what we thought that, you know, since there is very little we can do with air pollution, we lowered a lot of air pollution in our country, but we still have cars. And there're still neighborhoods, you know, that, especially in the Midwest and here, and, you know, freeways going through people's neighborhoods and when they were first made. So what can we as a community do? So that's where you got into green spaces. So one of the mechanisms by which green spaces maybe promoting health is by decreasing exposure to air pollution. Hmm. So that green one mechanism, the other we are seeing is that maybe there is some association with improving sleep quality. You live in more greener spaces, you have better sleep. For some reason, one of a very, very early hypothesis we are pursuing is the trees emit all sorts of volatile chemicals. And when we inhale them, for example, in pining and limine, that lowers your blood pressure and your heart rate and has direct physiological effects on, on your vascular function. And so that may be one of the mechanisms, but in order to sort out, we have to do something which we were talking about, like an interventional trial to figure out each of these mechanisms.

Dr. Laurie Marbas: Mm. That is really fascinating. So, I mean, when I think about, you know, what exposure, so we just moved into a home. I've always had electric stoves, but now I have a gas stove here. I've been here literally like six days. <Laugh> our new our house. And, you know, I'm just curious about what's when I'm using natural gas stove, is there any concerning toxic elements that I need to be worried about? Like, should I try to get this turned back to an electric stove? So cuz I haven't dealt with that and I know there can be some, some yes.

Dr. Aruni Bhatnagar: I think there was a, there was a recent study within a few month or weeks, a few weeks ago. And they were saying that there are, there is some residue, risk exposure associated with gas cooking and then the electric heating is, is safer. But, but, but cooking in general, I don't know. Most people don't realize if the, the cooking is a very rich source of, of these fine and ultra fined particles. So when you cook over open walk, they have you, you breathe in those particles that causes cardiovascular issues and the cardiovascular diseases much higher in cooks than most other people because of cost and exposure. Yeah. So if you're cooking in an open walk and you see all these fine particles, you can see the MIS coming out, all those are, are actually small particles that lodge into your lung and cause issues, but inflammation in the lung and that spreads to the heart and the blood vessels. Wow. So that's an important source of of, of cardiovascular disease risk. So you're right. I mean, in, in we have electric stoves, we never had gas here and

Dr. Laurie Marbas: Yeah, it's, it's an interesting thing. And then, you know, electric <laugh> there's electric dryer downstairs too. So like I've never had that either. It's like, so I'm not sure. Well, that's gives me some food for thought. I'm gonna go do some research show. <Laugh> maybe doing some renovation in the kitchen.

Dr. Aruni Bhatnagar: Yeah. Probably, but, but it's always a good idea to keep your exhaust open. Don't don't just look directly into the, the cooking walk and, and try, try and have minimize exposure that way. I mean, the other source of exposure too, for example, burning candles and incense indoors is, is, is a very high Soter. Those are very highest I images of these particles and fine particles. Right. And then on the other hand, there are these cleaners that we use in other sort of chemicals. So in most homes that we have seen the indoor air is actually far worse than the outdoor air mm-hmm <affirmative>. Right. Yeah. And so that's a much greater threat than the general pollution that we hear about.

Dr. Laurie Marbas: Mm. Yeah. I, I, I can definitely see that, especially with cleaners or if you like an ant infestation and then you're using other type of insecticides and other things. I mean, there's all sorts of things when moving into a home or leaving a home, I certainly become acutely aware of that because you're using things to get it clean and prepped for moving in or out. It just, yeah, it definitely makes you start thinking and then, or how your animal reacts, like cuz we have a, a dog and if you spray something she's sniffing and sneezing and you know, you're thinking, what am I doing to this animal who lives by aroma <laugh>

Dr. Aruni Bhatnagar: <Laugh> yeah. And, and then, and then we would have the same effect on people as well as live dogs. Yeah, yeah, yeah. But, and then people have tried to study where the indoor plants are going to clean up indoor air. But I think the ju is still out on that. We don't know, maybe it takes a lot of plans, like your friend, maybe a few hundred plans <laugh> but, but in, but in, in their are, but you know, NASA did put out a list of 10 plans, the most active in cleaning away the indoor air, but there's very little evidence supporting that. They make a significant difference.

Dr. Laurie Marbas: Mm. But they are, they do have that green effect though. Right. They are the, the living. So I'm curious about like in the home then what about like air purifiers and those type of things, are those a waste of money or is that something worth looking and investing in?

Dr. Aruni Bhatnagar: So if you have filters, if you have a HVAC in your central air and heating, then putting filters, and those makes sense with the problem with this air purifiers, when they're local, then it's, they only cleans up a little bit of air and you know, you're not there all the time. So I don't know how effective those are, but air it's certainly it could be good when you're sleeping because that's one time that we think the exposure makes a big difference. And one of the, the results we had was that people who live in more polluted environments have poorer sleep quality. Hmm. And, and so cleaner air promotes better sleep. Mm-Hmm <affirmative>. And so if you can have these air purifiers that the bedroom environment is so critical, and if air purifiers in your bedroom that might help you, you know, sleep better and have lower levels of pollution, but in general, having he filters and installing those UV lamps to kill off any microorganisms in the lines of your air conditioning units, that helps.

Dr. Laurie Marbas: Gotcha. Yeah. The other thing is getting these ducts cleaned out as well, mold mildew, those type of things. Wow. So that is fascinating. So when, if we go back and step outside literally into are there any things that people can do in their own communities to make things better? Is there, is there someone in like they should be looking to, to speak to about the walkability or like who should someone contact or like, you know, we wanna make our space here while they're still living in this wherever they are in the environment, like who should they be looking to contact in this type of arena?

Dr. Aruni Bhatnagar: So, I mean, the, the advice is, is very old and ancient. So we really wanna make a world better. Just plant a tree. That's very, we will begin. I think that's, it makes it having a tree in your back front yard makes a big difference. Sometimes here, your trees are new there, shed leaves and you're to maintain them, whatever. It's a little bit of care, but like that's what we do with the pets and that's we do other things, living things, trees. Yeah.

Dr. Laurie Marbas: So, yeah,

Dr. Aruni Bhatnagar: And that, that's a whole different story. <Laugh> trees don't take that much attention and they're not, so they're not so annoying at all. <Laugh> so, so, so we need to do that. We need to, to figure out what are our fundamental rights as a neighborhood. So what makes a healthy neighborhood and so that we need to work together as a community. I'm sure you have, you know, the community organizations within, with places where people live and you can talk to people say the greening should be a priority. Having clean air, not having no sources of traffic, go through the neighborhood and walkable space. There are actually analyses that you can do. And other people can do about the walkability of the area that you live in. And so ha if more people are outside, especially, you know, during COVID, lots of people are outside and spending time in the nature mm-hmm <affirmative> and being outside is critical so that you can spend time there.

Dr. Aruni Bhatnagar: We have also found, interestingly that, you know, one of the mechanisms by which greenness can improve health is by promoting social cohesion and social interactions. So you go out, you, you, you talk to people you're running or doing whatever outside you feel better. And, and you know, your, your blood pressure comes down. And so your risk overall in many years will come down. If you're better social contacts, mm-hmm <affirmative>. So, so being part of the community, do that be, be careful about what sort of sources of pollution are there in your neighborhood. Right? And so that's very important, but things like that we have had, we partly overcome the problem, for example, led, and we have lots of people in the east where they have led in their pipes. Mm-Hmm <affirmative>, and it it's the water from the city's cleaned, but you get contamination. So it's very easy. I think here it's a free program. You can call up the city government, ask for lead testing in your drinking water, right. Or you can ask for less testing of lead and other things in the paints. And so on, there are companies that would, you can do for a small fee, get the fungal evaluation of how much, whether there's fungus infestation in your house. So if you maintain, I think, I think that's having a clean house is so critical to having a healthy life.

Dr. Laurie Marbas: Mm. That is really interesting. Do some thinking and research on thing in a new space, it's an older home. Right. So that you think about all the things that you don't think about in a newer place mm-hmm <affirmative> fasting. So excuse me again, sorry. ING. Before we started with the, the, the COVID is getting over that and clearing my throat on a continual basis. Excellent. So then where do you see like future research going? Is there any other projects online other than what you're already currently working on? I mean, I feel like there's just so many,

Dr. Aruni Bhatnagar: <Laugh> so many avenues, so many avenues to so many avenues to pursue. So no. So the thing is we are doing this as a test case. And the overall idea is that if we can understand which trees to what density at, at what placement and in what shapes are ideal for urban greenness, then we can create, you know, blueprint or, or if you were a green print for how to build healthier cities in the future. We also need to understand that these impacts are not just in isolation, right? Everything in a social structures are connected. So there is a strong environmental justice and health equity issue that we cannot deprive. Some communities of, you know, know clean living conditions and green urban environments, right? So we need to work on that, but more critically that for us as investigators and as physicians and scientists, it's important to understand that there is a direct contribution of the natural elements to our health, whether there are circadian rhythms or green spaces, whether it's sunlight, but we really don't understand specifically, you know, for example, how much exposure sunlight we should have and not many people understand that.

Dr. Aruni Bhatnagar: And it varies with your attitude and your season and your skin color and lots of other things. And, and so we need to work all of that out and related to why it affects the risk of heart disease. So ultimately we want to be able to explain these interactions with nature on a molecular and cellular basis.

Dr. Laurie Marbas: Hmm. Yeah. I would love to be able to write a prescription and say, I need you to get this much sunlight in the morning, this in the evening <laugh>

Dr. Aruni Bhatnagar: Yes. And you know, but

Dr. Laurie Marbas: This is Lipitor <laugh>. Yeah, no, I don't vitamin in

Dr. Aruni Bhatnagar: <Laugh> they, they do. They do sometimes. And now they're trying to have physician write a prescription, you to spend 30 minutes in the park every day mm-hmm <affirmative>. And, and I'll tell you a interesting story. This is from London where they did a randomized experiment and people with heart failure, right. And they had a group of people walk in Hyde park, and another group of people walk in Oxford street, which is a very busy street in, in London. And they compared, and people who walked in the Hyde park had better parameters and controls of the heart failure diagnosis than and the cardiac function. And this effect lasted for about two weeks after spending an hour in the par. Wow. And, and the people who walked on Oxford street saw their heart failure conditions worsen within a couple of days. Oh my right. So, so it's, it's such an interesting concept that as physicians, and if you're dealing with people with chronic illnesses where there's cancer diagnosis, where there's heart failure, that maybe it may not be a large effect, but it may be even if it's a small effect that we should encourage interaction with nature, and that could be beneficial to our health.

Dr. Laurie Marbas: Well, and I guess it depends too on the time too, right? Because these small incremental exposures over time can have a substantial impact. I would imagine just like somebody eating one vegetable one time versus eating one vegetable every day is gonna have the quantitative

Dr. Aruni Bhatnagar: Effect. Right? So there is a company that's making an app. And I think it's out is that when you write a prescription for your patients, you could look up, which is the closest park to their place. And then you can tell them, please spend 30 minutes in the park next to you. Oh,

Dr. Laurie Marbas: That's, that's fantastic. Yes. Minority says more vegetables, get more sleep, decrease stress. So I'm just gonna add the vitamin in for nature. That's right. As well. That's right. That's right. Absolutely. You take your daily supplement. Well, this is fantastic. So I'm excited to read about the green heart program and I can't wait to see what those results are. Oh my goodness. It just says. Sure. Thank you. Fabulous. geez.

Dr. Aruni Bhatnagar: Yeah. Fantastic. We had, if you wanna see a little bit what it looks like there was a PBS news hour 10 minutes special on the Greenheart project. You should see that. Okay. If you just put PBS in Greenheart Louisville, you would, the video would come up. So they, they came here, they did a whole survey, how we're planting the trees, what we are studying and met with our neighbors here and what it means to them. It was a really nice 10 minute piece.

Dr. Laurie Marbas: That's fantastic. No, I will be watching that as soon as we're

Dr. Aruni Bhatnagar: That's

Dr. Laurie Marbas: Concluded. Yeah, absolutely. This is fantastic. So, well, this has been absolutely fun. I knew it would be fascinating talking to you. And I feel like there could be so much more. I can't, like I said, I just, there's so many things about nature that are just, I just, you know, just talking about it honestly makes me excited. <Laugh> and but I I'm excited for people like yourself who are doing the, this really important research, cuz it is a very neglected field. Mm-Hmm <affirmative> yet one that's so powerful and, and important. And so any final words you'd like to share with our audience?

Dr. Aruni Bhatnagar: No, I'm only that, you know, we cannot sever a bonds with nature. We just have to learn to live and, and it is, I know sometimes nature could be problematic, right? So there are snakes and scorpions and you know what it leeches, but we have, but we don't have a choice that's but we, we are part of it. We are not like a separate entity. We are nature. We just, someone plopped into the, into nature like this, but we have organically grown out of it. So we should sort of value that bond.

Dr. Laurie Marbas: Yes, absolutely. And it's only meant that to be there, to make us healthier. So it's, it's not something to be fought and yes. Turned against. That's fantastic. Well, thank you again. This was absolutely lovely. And everyone, I hope you enjoyed this, but go check it out. We'll put the links to the PBS 10 minutes special as well. And I'm excited to for everyone to hear this message is it's just another reason to go outside and take a walk.

Laurie Marbas
Laurie is our Chief Medical Officer, double board certified family and lifestyle medicine physician, licensed in all 50 states and DC.

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