Why Dr. Jayne Morgan Says Women Miss Heart Risks

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Can someone be fit and skinny and still have heart disease?

Oh yeah. Skinny should not be our goal. And I know society says that skinny is beautiful. I'm not saying it's beautiful or not beautiful, but I just want women to understand, especially in perimenopause and menopause, that skinny should not be your goal. Healthy should be your goal.

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I am back. Hi, JJ.

You know, whenever you're in town, you are always welcome to come on over.

Thank you. I appreciate it.

Well, last time I got a bunch of questions.

Oh, okay.

Yes. So what we did is we sent it out to social and we said, okay, give us all your top questions for the cardiology queen. Okay. Queen Bee.

All right.

So that's what we're gonna do. Ready? All right. So you'll love this one.

Here we go.

Why do so many women think heart disease is a man's problem and what are they missing?

And I want to first say that it is not your fault that you think that. Women, we always take on so much blame and responsibility. Like, why are we thinking this? The way, the reason you're thinking that is because that's what you've been taught by the patriarchy. That's what you've been taught by a male-driven health system. So you're thinking what the health system unfortunately also thinks and what you've also been led to think and what data is going to drive you towards, because all of the data is also done on men. So first thing I want to say to your listener, to whoever wrote that question, is it is not your fault. Remove the blame from yourself. You are part of a society and a system, and this is how it is taught. But heart disease is the number one killer of women, as sounds like your listener now has educated herself. And it's not breast cancer. It's not cervical cancer. It's not, you know, all those mammograms and Pap smears that we've had, which is great. We have done a great job in lowering the rates of those cancers and death, even with therapy. The human papilloma vaccine, the HPV vaccine, decreasing cervical cancer. Outstanding. But the fact of the matter is, it's what's behind your breast that's killing you, not the breast. The breasts are obvious. They're standing out front. And again, remember, this is a patriarchal society. That's what they see. But I want you to look behind the breast and let's talk about what's back there, because that's what's killing you.

It's so amazing that this is the number one killer, and yet it just gets So little press.

No press.

Not interested. It needs a PR company behind it.

Well, listen, the health of women is surrounded by the focus of men.

Boobs.

Breasts and vaginas. Yeah. Okay. And we bought into it as well. It's all about reproduction. And, you know, reproduction is what is of value to the system. So that's women's health. Nothing else is. Is important. So this is your value to ours, to our society.

So what are the early warning signs then of heart issues in women that doctors often overlook?

You know, doctors often overlook symptoms because we are taught in a very subtle and messaging way to overlook them. So the symptoms that are more common in women in medicine, we call these atypical symptoms. We might call them atypical symptoms, atypical chest pain. This is actual official language. Wow. This is how doctors talk to one another. This is how it's written in the textbooks. This is how it's coded. Atypical.

For reimbursement. Even though it's typical for women, it's considered atypical.

Isn't that amazing?

It should just be atypical for men.

Isn't that amazing?

Wow.

Isn't that amazing? So women's symptoms are denoted atypical. Atypical drives behavior, right? It drives interest. So the person who comes in with classic symptoms, chest pain, shortness of breath, the man, off he goes to the cath lab to get that artery open, get that blood and oxygen. Reperfusing back to his heart, and he's healthy and safe. The woman, on the other hand, also having a heart attack with— but she's been labeled as atypical, sits on the sidelines while we wait to see what we're going to do with her while she's also having a heart attack.

And what are the symptoms that she's having that we would never associate?

So in defense of the system, a lot of the symptoms that occur that are atypical that occur more in women can't be confused with a lot of other things. So fatigue, just feeling tired. But if you're feeling tired all the time, if you wake up tired, you haven't even started your day after you've been asleep and you're tired, that's not normal. And we should not normalize it. And women often normalize a lot of suffering because we have a lot of reasons that it could be happening. We're taking care of aging parents, we're taking care of children, we've got a demanding job, especially during perimenopause and menopause. Many of us are at the peak of our career. Lots of responsibility. A lot of things happening. You have all kinds of things happening at home with your spouse. So if you start to be fatigued, you're thinking, "No, no wonder. I have a million things happening." It is true.

'Cause you look at it and go, we have usually two full-time jobs.

Right.

Because—

Or more.

Right. We, well, we have, so we have the kids.

That's right.

So there's that one. I forgot that one.

Right.

My kids are outta the house.

Right.

But you have the kids' full-time jobs usually. Then you've got the parents somehow you're now taking care of too. Then you have the house that you're dealing with, and you have your work. That's right. So you have all those things.

So, and then somehow society expects you— so you're on, you know, committees, and you're doing—

oh yeah, and then you got PTAs.

Women are supposed to be supporting the community, supporting the organizations. Men don't have those kinds of pressures. Yeah, you've got a million things.

They should have to sit through a PTA meeting with those— with the stay-at-home moms. That's what they should have to do. So someone's tired, how would someone be able to determine between like normal fatigue or like, this is kicking my butt?

Like, how would you know? That's a great question. You should not wake up tired. So if you've been asleep all night, you should not wake up so tired you can't get out of bed. You're exhausted and you literally are just waking up. Also, if the fatigue goes on for long periods of time, even if you are overwhelmed with things in your life, You should not be physically exhausted every single day. And I don't wanna give you a long runway to say, well, I'll see how I feel in a month. No, I'm talking like 3 or 4 days. I'm just wondering. Start to get on top of what that is.

So you start to feel this atypical fatigue. I'm gonna use the atypical.

Ugh, that atypical word.

Okay, sorry, I snuck that in there. Right. To go with the atypical symptoms of the woman.

That's right.

So you start to feel fatigue that you didn't use to feel. Mm-hmm. It just kind of hit you.

Mm-hmm.

And it's not something that's going on for months. It's just all of a sudden you, you're like, Wow, you're tired.

You're just wiped out. You're tired.

Wow, you're just wiped out.

Or things like exertion is, you know, let's say exertion, just, you know, you live in a 2-story house, your bedroom's upstairs, you're walking up the steps to your bedroom in the evening, you're just winded when you get to the top of the stairs. That's new. Okay, pay attention to that.

So did you have a silent little heart attack that has now done some damage in there?

That's right. And many times we will see women come in and you're getting an EKG on them for the first time, which is another little thorn in my hat that we don't get EKGs. But they're getting an EKG for the first time, and you go, "Oh, hi, Mrs. Jones. When did you have a heart attack? You didn't mention that in your past medical history." And Mrs. Jones goes, "What? I had a heart attack?" "Yeah, the EKG shows you had one." And then you start to have a workup. It was, you know, 3 years ago when you were laying around after your kids went to summer camp and you were just so wiped out and tired and you thought you were exhausted and glad to finally have them at camp. And you were having a heart attack. Wow. And you survived it, luckily. But then when we go into deeper conversations, you have had some adjustments since then. Yeah, I don't really have as much stamina. Yeah, I have to go to bed a little earlier. I kind of, you know, whenever I can, I try to sit down when I'm cooking now. Just feel tired standing up. These are all little adjustments you've made over 3 years that now the physician is sort of putting all together to go, oh my God.

Wow. Right. Well, and the bummer with fatigue is the less you do, the less you can do. So it becomes a thing. It becomes a thing. So, but beyond fatigue, what are some of the other ones?

The other thing, jaw pain. And if you follow me on social media, I've done something recently on Stairwell Chronicles where I write a letter to dentists to please put them on alert. When you're seeing women coming into you with jaw pain, especially between the ages of 30 37 and 60, and you can't find anything wrong with them, this is not your reassurance time, which is what we all do. We found nothing. Everything's fine. We've all heard it. "Your labs are normal. Your tests are normal. You're fine." If you're at the dentist's office— this is for dentists out there as well— and you've got a woman who's there with jaw pain and you don't see a reason for a root canal or a cavity to be filled or an abscess, there's nothing happening in her mouth, This is not reassurance and send her home. This is send her to the emergency room. Wow. Because jaw pain is often a referred pain from the heart, occurs more commonly in women, atypical. And off women go because we have no education. If your jaw hurts, it must be a toothache. Heart attacks evolve in different ways. You can sort of have, you know, a sudden one. But for women, because we have smaller vessels oftentimes is something that builds over time.

Wow. That's— because I look at something like the fatigue and you think, how many times has a woman got diagnosed with something like chronic fatigue syndrome and they missed it? Now, is the reason that these women— this is one of the questions, like the difference between men and women— is it because of the smaller blood vessels? Why, why does a heart attack in a man look so much different?

Yeah. You know, so women tend to have smaller hearts. We tend to have smaller vessels. The heart beats a little faster because of the smaller size. We still have to pump the same amount of volume. So isn't this sort of, you know, the story of our lives? We have to, you know, work harder for the same results. So it's just kind of the heart is sort of an, you know, an encapsulation of that. So, yes, that is part of it. And then there's estrogen. And—

Oh, yes.

And estrogen actually drives a lot of the function of the heart. A lot of the good hormonal milieu of the heart is because of estrogen and those estrogen receptors. And then during perimenopause, you start to have less and less and less estrogen binding to those receptors as well. So that impacts a woman's heart function as well. And it's one of the reasons why during perimenopause, a woman's risk of heart disease and a heart attack doubles. And that is not just by happenstance. That is because of a lot of protection. Doubles, doubles, because you lost the protection of estrogen. So it is very, very, very important. So a woman's heart is different. Women are different. And we should start to appreciate what those differences are and not accept male-generated data that's then applied to everybody. It's not just male-generated data, it's white male-generated data that we just ship out to the whole world. And it's kind of like, oh, it's good for us. It must be good for Everybody.

So the estrogen going down, what are the things that are actually happening to the heart when that's— I know things like you get more inflamed, you get more insulin resistant, your LDL goes up, but what are the things that happen?

Those are all the things, but also on those arteries, those small vessels, they get stiffer. They're not as compliant. So compliance means that they're more elastic, they're more expandable because the way we control our blood pressure is our arteries expand. Expand and contract and expand. We've gotta have that pliability, elasticity. So we lose that. We call that compliance. I'm trying to find a lot of other words, but it's compliance is what we say, but that's what it means. And so as those arteries stiffen, what happens? Your blood pressure increases. For every 10 millimeters of mercury that your systolic blood pressure increases, that top number, your risk of heart disease goes up by 20%.

What's an ideal? 'Cause this is gonna get into what labs and tests should women be asking for that they're not getting.

And I have down here two things EKG, what—

and then the other question is, what age should women actually start worrying about heart health? I would think that labs go— those two questions to me go together. Yeah. You mentioned EKGs. Is this something that we should be having as part of a normal physical? When should we ask for an EKG? Yeah.

Yes, yes. We should have EKGs as part of our physical exam. Do you get them?

Is it one? No, it's not.

No, for men. It's not for women. Oh, really? We get mammograms and Pap smears. That's wild, right? Men get prostate exams and EKGs, whatever. So do you need an EKG every year? No. But should you get one every few years? Yes. Should you have one on your electronic medical record as a baseline when you're healthy?

Yes. And so what age would you want that?

There is no age. Get one at 20. So it doesn't matter. Get one at 30. We want to know what you look like when you are normal and healthy. So if something happens later, especially if you're having difficulty advocating for yourself at the hospital with your doctor in the emergency room, you can always ask for an EKG. And then they have something to compare it to and go, oh, there are some changes since the last one we got 8 years ago. That's what men do, but we don't. And so not only is there not an EKG, a baseline EKG to compare, oftentimes we don't even get the one when we're having symptoms because the symptoms are atypical and so not driving us towards an EKG. So we just miss, miss, miss every step along the way. And so we end up dead. That's why the first heart attack of a woman is more often fatal than the first heart attack of a man.

I remember asking you that last time because I'd always heard about that, but in terms of men. Right. And didn't realize it was in terms of women. Women. And so that brings me to this question then, because we'd want to look at all the signs that could be pointing to having a problem. So labs, diagnostics. What should a woman be testing? Starting at what age? Like, what should they be doing to protect themselves?

You know, I would say definitely at perimenopausal age. And it doesn't mean that you are having perimenopausal symptoms. So I'm going to start at an age of around 35 to 37. That is still a perimenopausal age. It doesn't mean that you're not ovulating. That you can't have any more children, that you're not fertile, that you don't need birth control anymore. No, you need all of those things. But it just means that your hormones may have started to change. And they may be a little different than they were when you were 30 or 25. So you're starting— you may not have symptoms, or you may have symptoms that you're not even recognizing, like itchy ears, which nobody knows about. Itchy ears. Those kinds of things.

That's my nemesis.

Right. So you want to think about— what's happening at that time, even if you're not having symptoms. That's early. You know, you can start early and really not have symptoms. Again, I want to be clear about this because I've had women ask me, "Oh, I don't need birth control anymore after 35." No, you don't. So you can be in perimenopause starting early, but also fertile. So you do still need barrier protection or birth control. If you're trying not to expand your family or have children. So I want to make that clear.

So baseline EKG. What else? What are the labs?

So baseline EKG, definitely want you to get a blood pressure. And it's really ideal if you have a home blood pressure monitor so you can stay on top of it.

And is there one that you should— like, are they all okay or is there—

Well, some are validated and some are not. And, you know, I work at a company that provides one. It's called Hello Heart. But it's not consumer available. Mm. So if you want the Hello Heart one, which is the absolute— we are first in class in this one, it is available if you work for a company that has included it as a part of your benefits on your health plan. So all you ladies out there, if you work for companies and you've got insurance from your company, check your benefits. Hello Heart might be on there. Oh. And if it is, that's where you get your monitor. It's connected to an app. It's all digital coaching. So it's a whole big cardiovascular system.

Amazing.

That also has a menopause feature and pregnancy complication feature and a nutrition feature. And so a lot of things go into it. But the point is you want to catch your blood pressure when it starts to rise, not when you go to your next doctor's appointment and suddenly it's high and nobody knows how long it's been high. Because remember what I said, for every 10 millimeters that it goes up, your risk of heart disease goes up by 20%.

And the number we're looking for, is it 120 over 80? Is it 110 over 70? Like, where's the— what's the range that is the good range versus you're getting outside?

The number we are looking for is— this is a new number— less than 120 over 80.

You're doing blood pressure. That's something you're monitoring at home.

Mm-hmm.

And then what about labs?

So when you look at labs, what do we want to look at? We want to check your thyroid hormone. We want to check ferritin. So we're back to anemia. We want to take a look at that. There will be no cardiology society who is saying this. You are now in the world according to Dr. Jane. I focus, though, on women's health. My recommendation for women is that you need more than one. If you've gotten one before perimenopause, you need another one during perimenopause.

And you'd want to have that one before for a baseline.

Yeah, you can— a baseline is great. You can get a baseline, but when you are in perimenopause, and headed towards menopause, do not think because you've had one earlier that was normal that you're good for the rest of your life, because that's what we're telling you. And I know we're telling you that because those are the guidelines.

Yeah, that's what I'd always heard.

I just will say that is not true and that does not apply to women. So do not be lulled into a false sense of security because your level is normal. That also goes for the male relatives in your family. Because it's genetic. So if you have men, brothers, fathers who've had their Lp checked and theirs is fine, so they tell you, you don't have to worry about it, it's genetic, and, and mine is fine. Yeah, but they don't have menstrual cycles and they don't have perimenopause and menopause. So even though there is a very strong genetic component, 90%, there's 10% that's variable and that is impacted and that could impact you.

Wow. Okay, so Lp.

Mm-hmm.

HSCRP, ferritin.

So here's the thing. The reason I'm kind of plus minus on inflammatory markers, because I think every woman needs to be treated as if she has inflammatory markers.

Well, for estrogen dumping, she will.

Right. If you want to measure the impact of your intervention. But regardless, I think every woman needs to be treated as if she's got inflammatory markers.

Any other labs that are important here?

Those are probably the, the main ones. Yeah. That I would look at.

Is it the estrogen loss that drives heart issues or is it more about lifestyle habits? And what I would add to this question is how much could you offset with doing some lifestyle?

Yeah. And I think that's a great question. I think you can offset it. And I say a lot about non-hormonal interventions cuz hormones are not for everyone. And we want to adopt a healthy lifestyle. And I often say this. I know I sound like a broken record, but you need to think about the life you want to have 20 years from now today. And then whatever that life is that you envision for yourself 20 years from now, you need to live it now so you can actually get there. And there are a lot of things you can get from nutrition. And you need to focus on nutrition and focus on foods and what it is that's going to make you healthy and strong. Now, is there a substitution for estrogen? So far, I don't see a substitution for estrogen. Do you absolutely need it? Does every woman absolutely need it? I'm not going to say that. I think it's different for different people. And lifestyle is going to play a huge, huge, huge role in the quality quality of life, which is actually what this whole conversation is about, your quality of life as you age.

So is there a time when HRT— this is another question here. What's the truth about HRT and heart health? Is it protective or is it risky?

Yeah. So when we talk about, when we talk about HRT, I'm assuming they're talking about maybe for heart disease or for, I don't know if you're talking about for breast cancer. I have no idea.

Yeah. I think that it's more in terms of, because the only reason I'd imagine someone reason someone's not taking HRT is they're concerned about a cancer risk, even though a lot of that information now has been disproven. But I think this one looked more of it as the risk for heart disease, which I wouldn't imagine.

Yeah, so when you look at heart disease, so there are some areas that are controversial. So we used to talk about the timing window that you needed to start HRT within, you know, 10 years of perimenopause, or at least by the age of 60. And beyond that, we would sort of, deny you HRT because it's a cardiovascular risk. Now, why do we say it was a cardiovascular risk? Because beyond that, you know, aging is not our friend. You develop more comorbidities, meaning you have more chronic medical conditions. You've got diabetes. You probably, even if you're not symptomatic, have some plaques that have built up in your arteries over time. So the thought is, if we give estrogen beyond the age of 60, we might actually propagate an event, an event meaning a heart attack or a stroke. Turns out, eh, it's not really that true. What some of the data shows is that the first year of starting hormone replacement therapy, roughly after the age of 60, your risk of a heart attack increases slightly for only that one year, and then it goes right back down to normal. So there's sort of this little bit of a risk that first year, that bump, And even that is vague and being challenged because why? We don't have that many studies on women. So we're going on very small number of studies with a very small population and trying to make big assumptions. And we don't even know if it's true. Maybe it's true that these are the women who actually need more hormone therapy than, than the others.

Yeah, true.

But we don't have the data on it. So we have to go on what the data shows now. But this is now individual conversations. It is not an absolute no.

So good, so good, so good.

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Trying to save ourselves from ourselves. And, you know, now we're trying to right this ship. But the fact of the matter is we still don't have a lot of the hard data that we have on men because we weren't included in studies of men. And we also have not had studies just of women that are beyond breast cancer and cervical cancer, you know, unfortunately. And now currently, we even have had research funding slashed. So any research that would have gone forward, especially the government funding, it's all been slashed. We are trying to move women out of the dark ages. We're trying to base it on data and literature. And yet we recognize that we've been left out of the literature. Yeah. So it prevents us from going forward. And so we can't go forward because we don't have the literature, but we were excluded from trials, so we don't have the data. So now we can't move. So we're like in this whole thing that's going round and round.

Can someone be fit and skinny and still have heart disease?

Oh yeah. All that skinny fat. We sure do. You can be. And, you know, skinny doesn't mean healthy, especially in this era of GMOs.

Oh my gosh. Right now, what— one of my girlfriends is like, what has happened out there in Hollywood? Like, now it's back to like heroin chic's back in.

It's frightening.

I mean, did you see like the recent, like Nicole Kidman in some dress at the Oscars?

I'm like, oh, after 45, after 50, 55, losing weight also means that you lose subcutaneous fat and you lose muscle. A 20-year-old who loses 40 pounds will still maintain the fullness of her face and a figure. But a 60-year-old is not going to. And you have lost very important lean muscle as well as fat. We do need fat on our body. We need fat. I wanna say that again. We must have fat. Fat is— it helps protect us. And there are some very positive things for fat. We shouldn't be fighting it all the time. There are good things about fat.

Well, and we have more fat than— I mean, just to start out, for essential fat on the body, men have 3 to 5% are essential fats. 10 to 13. So we have way more fat to begin with before we're even getting started.

You know, I find it alarming because the images are clearly underweight, just clearly underweight. And it's, you know, underweight is also a strain on the heart as well. So these are— I'm concerned about heart issues and how much reserve you have. And whether you've gone too far and whether society reflects that as normal and beautiful. And so you are— it reinforces that behavior.

I just wonder who sees that, like, because I always have heard most men, you know, women tend to lose weight for themselves and each other. Most men would not look at someone who's like this skinny, emaciated look and go, wow, that's hot. Like, that's not attractive to most people. And I'm looking at a lot of these people right now and go, what the heck is going on here?

I don't know if— I don't know these people. I don't know if they do it for men or you just do it for yourself. You just think, I am concerned about it. I'm concerned about the extreme weight loss in women over the age of 45.

Well, yeah, 'cause try getting that muscle back, you know?

It's— Very hard. Just a battle. Very hard. And GLP-1s especially can drive the loss of lean muscle mass, which we're already losing with the loss of hormones. Now that drives that even further. So you have a greater risk of fractures later. I know I'm like all outside of my subject now. I'm a cardiologist. I'm talking about fractures and lean muscle mass. But here's the thing. Here's why I'm talking about it. The heart is also a muscle. It is the only organ in your body that is also a muscle. It is striated muscle, the same as your arms, the same as your legs. And so I wonder, if we lose that much lean muscle mass that is visible to us on our bodies, what does that also mean for the muscle mass of your heart? And these are things— these are questions I don't know the answer to.

Yeah, I know that, you know, one of the big challenges when you're looking at muscle loss is most of the time you're using an InBody or even a DEXA, you're getting a prediction. So you get fat-free mass, and that's gonna give you a prediction of how much is skeletal muscle mass, which, and they do that based on age and sex. And so you're never gonna know unless you're doing something like a D3 creatine test, and then they'll show fat-free mass going down. And so you don't know, is it heart tissue? Did you, you know, something going on with your other organs? Hard to know. Like, one of the things that I've done is I take an InBody or a DEXA and I put it together with grip strength in a 30-second squat test so I can test muscle quality. 'Cause I think that's really the only way we can tell right now. 'Cause if you're losing muscle quality, guess what?

You know?

And I mean, the thing that I think is most important is to make sure that we are holding onto our— better yet, I love, I think it was Jennifer Aniston or Halle Berry was like, "I'm gonna pack on as much muscle as possible." I'm like, amen. You know? And women need to hear that 'cause they're still like, "I'm gonna get big." I'm like, "You're not getting big." Like, not in your wildest dreams. Unless you're taking some steroids. Like, if you could put on 5 or 8 pounds in a year, it'd be a miracle. So it's not easy.

Skinny should not be our goal. And I know society says that skinny is beautiful. I'm not saying it's beautiful or not beautiful, but I just want women to understand, especially in perimenopause and menopause, that skinny should not be your goal. Healthy should be your goal. You can be skinny and still have that visceral fat in your belly.

Yeah.

That's driving all those inflammatory markers and still increasing your risk of heart disease.

Like such an interesting one because you look at it and go, you know, it's not about your body fat, it's where that body fat is located. If your body fat's all in your thighs and butt, great. Right. You know, but if it's in that visceral adipose tissue, right, big problem. Right. So. Correct. All right. What are the biggest diet mistakes you see women making that impact their heart health?

A couple of things. You know, so I don't, I don't necessarily think that they are mistakes, but I will say that I think women on Back to Skinny Fat avoid fat, and not all fat is bad fat, and there are healthy fats, and we should probably have more nuts in our diets. But many people don't because they're high in calories, they're high in fat. But so we've got to begin to kind of reposition what fats are and what healthy eating looks like. And healthy eating is kind of more whole foods and not really so much focused on the calories, but focus on foods that are nutrient dense, that can give you a big—

Okay, so what does, what does Dr. Jane eat?

I do like Do you like fish? And do you like chicken? So I'm not a vegetarian. I'm not a vegan. My diet is probably closest to a Mediterranean diet. It's probably the closest to that. I like— I do— I happen to like— I like a lot of fresh fruits. I like a lot of vegetables. I happen to like those things. I like lean cuts of meat. I like turkey. I like fish. I don't have so much shellfish, not because there's anything wrong with it, but I don't tend to like it as much. As far as desserts, do I eat dessert? I do eat dessert. I tend to like things that are vanilla and lemony. I'm not a big chocolate fan. And actually, chocolate, especially dark chocolate, is probably better for your heart than the stuff that I eat. So what am I saying to you? I'm saying that I'm not perfect. I don't think you should strive for perfection. I think you should try to get most of it right and give yourself some latitude on either side. So I'm not a chocolate lover. I'm not going to force myself to eat chocolate because it might be better for my heart, dark chocolate. I prefer the pound cake and the lemon cookies. That's me. And if I'm going to have it, I'm going to have something that I enjoy. Do I eat them all the time? No. So I would say those are probably— and it's probably my biggest deviation from the American Heart Association that recommends the DASH diet. The DASH diet is like a low-salt diet. I think low salt is important, but the Mediterranean diet incorporates low salt. Low salt incorporates It's high protein, which I think is good for midlife women.

What about the salt, though? I thought the salt, like, the salt was— some people were salt sensitive, but it wasn't an overall issue.

Yeah, so it's not even about salt sensitivity. It's about adding salt to foods that are already cooked. It's the salt shaker on the table. I don't think salt is such a big enemy as people make it out to be. I mean, I'm not saying pour it in your hand and just lick it. But, you know, I mean, there are some, you know, benefits to salt. You know, same, there's some benefits to sugar. The fact of the matter is we just kind of overdo it.

It's probably more the ultra-processed food and all the—

It's the ultra-processed food and all the canned food and all the things that have high in salt. But when you're talking about fresh food, I don't think seasoning is a bad thing. I don't think we should overdo anything.

How does blood sugar instability affect cardiovascular risk over time?

That insulin sensitivity drives atherosclerosis. That means plaques in the arteries. It also drives chronic inflammation, which is also a driver of heart disease. So all these things kind of are bedfellows. They go together. Where you see one, you start to see the other one. They all kind of hang out together.

So if you have elevated insulin, it's gonna drive inflammation and plaque? Mm-hmm. And so, 'cause you didn't mention the fasting insulin test, would that be one that we wanna add in or not?

So if, if you have You know, sometimes maybe. I don't necessarily think, you know, so as a part of your baseline test, you'll have a glucose done. So if there's any indicator, you move on maybe to the glycosylated hemoglobin. But if for some other reason, again, very specific, that you have a history, that you've got a personal history, you've got symptoms that are making us concerned, then it's something that we should probably do.

Are low-fat diets still being pushed? And are they actually hurting women? Are they still being pushed? They're not being pushed, are they?

So it's not low-fat diets, it's, you know, sensible lifestyle. I don't think that's necessarily low-fat.

So it's not just dumping, dumping fat on everything, but it's also not going low-fat.

But it's also recognizing that all fat isn't bad fat. There are some fats that are good fat.

Well, I mean, we have essential fats. —that we need in our diet. So, yeah, choose wisely.

And the American Heart Association went so far as to acknowledge that whole dairy yogurt and products versus low-fat dairy, that most of the data supports the low-fat dairy for heart health, but there is some data that also supports whole fat. And so they went so far as to say, you know, there is this other part We, the preponderance of data still supporting low fat, but there is something to be said for whole fat. So—

The reality is there's enough fat in low fat dairy when you look at how much fat's in it, that there's still a lot of fat in low fat dairy. Right. It's not like when they say 2%, that's not what you think it is. Mm-hmm. So I personally don't like full fat dairy. I like low fat dairy. All right, which type of exercise gives the biggest return for heart health in midlife?

People who mixed up their exercise had better results and less aging than people who did the same thing all of the time. Like myself, I do Pilates all the time and I'm a walker. According to this article, I should maybe swim once a week, play a game of tennis the next week, still do my Pilates, but mix it in. So people who had variation that means variation in effort, variation in skill, variation in the amount of sweating, heart rate, all had better outcomes than people who tended to do the same thing. So if you're a gym rat and you go into the gym, you're doing the same thing, you hit your same circuit, you know what your 30 minutes are, and then you leave with whatever, you know, 30 minutes on the treadmill or stairmill, and you do that same thing and you're in great shape, and that is great, and I'm not discouraging you, I'm only saying if we are comparing it, if there's something you could do better, then you would mix in something else.

How much does chronic stress actually impact heart disease risk in women? Yes. That was a setup question. Yeah. Chronic stress impacts everything.

And think about chronic stress as a driver of inflammation. And remember what I said, that inflammation is a driver of atherosclerosis, which are plaques in the arteries, which is the driver of heart disease. This is— it's a step process.

But how do you know? Like, this is, I think, one of the biggest challenges is I don't— whenever they do the study and they compare the people under stress and the people not, I'm like, where are those unicorns that are not under stress? You know, who are they?

I think they're living in, um, like the mountains of Italy and Peru. They're always like surrounded by goats, drinking whole milk, and they always have community around them, right? Friends that they've known for a very long time. 70 years. They live to be 100. They're riding horses. They usually have no furniture. They sit on the floor. They get up and down from the floor. Their hip muscles are— their hip and glutes are strong because they get up and down from the floor. They don't have the support of chairs and sofas.

And that was the thing on the Amazon, by the way. They did not have comfortable chairs. Right. Everything was so uncomfortable because you had to watch for predators. You couldn't ever get comfortable. I'm like, oh, this is bad. Right. Jaguars. Great. Okay, so we know chronic stress does— I always come down with chronic stress of like, how do we quantify this? Like, how do we know? Are there some ways that you kind of evaluate this since it's such a big player?

Right, and I think we're back to those inflammatory markers, especially in women, you know, an opportunity to measure the inflammatory markers, which are markers of stress, and also markers of nutrition. They're sort of markers of health. Yeah. Um, and when we— when we look at Black women and we talk about chronic stress and we talk about advanced aging of the body and we talk about DNA and the end caps of DNA called telomeres, and that they are shorter in Black women in comparison to white women. Really? And it's related to chronic stress. Is it generational? It's related to epigenetics and chronic stress and the— impact of high-effort coping at every stage of life to navigate a society that's very race-conscious and gender-conscious. How much shorter are they? Enough such that the average biologic age of a Black woman, meaning the body— the age of her body, not the age on her birth certificate, is about 10 years more advanced. So it's something to really think about when we think about the impact of chronic stress— it's called weathering. Because when you look at Black women, we are a— a case study of what weathering is and what chronic stress does to you over time. And we talk about epigenetics, meaning the environment that the baby is in when you are pregnant. And you are a weathered parent, a daughter of a weathered parent. And now you are pregnant. And what does that mean? Drives these inflammatory markers, you know, is that a reason for higher risk for heart disease in children later, higher risk of obesity, you know, the stress of not having enough. And the genes don't change, but how they respond to the environment then begins to change.

So let's say someone's got this weathering and they've been stressed, chronic stress for years and years and years. Can you— turn that around?

So when once the end caps shrink, I, I don't, I know of nothing that regrows them.

It was interesting. I had my telomeres tested and that was what they said. There's nothing we can do. I go, why are we testing this then? This is like just stressing me out more that they—

It's a marker for whether, you know, you're younger or older. I would never get mine tested because I'm pretty sure mine are older. Great. I've done my best, but there's some things that you just can't escape. I can't escape the environment that I was in when my mother was pregnant and what she was doing. You know, there are things I just— there's nothing I can do about them.

All right. What's one daily habit you'd prioritize if someone wanted to protect their heart for the next 20 years?

The main daily habit would be movement. I would say make sure you are out there moving. It doesn't have to be to the degree of exercise, but it needs to be more than what you would normally do and you're focused on. So I would say the best thing is to keep your body in motion. Human beings, Homo sapiens, were made to be in motion. And technology— and I work for a digital AI company, so I'm guilty— technology has not been our friend in that way. It has allowed us to be less mobile and let all the things around us do the work. And it has not been good for our health. So that is probably the number one thing I would say, movement. The other thing I think that is overlooked is just sleep. And I think with all of our cell phones and devices, including TVs, all these things in the bedroom and all the lights and the blue lights and, you know, and then for women, hormone interruption. But, you know, nobody gets any sleep anymore. But sleep actually has a direct correlation to heart disease. One of the things that is is overlooked in our high-pressure, high-impact society. As, you know, I'm traveling to Tampa to do this and leaving and bringing my exercise, so I'm guilty. But I do try my best to sleep and have a sleep environment. I turn the phone upside down so that the light doesn't illuminate in the room. I have the TV off. I have— it is dark and it is quiet. And I try to create an environment where I sleep. But sleep is a big one.

What's something women are doing every day that's silently damaging their heart?

The one thing that we're doing every day that's silently damaging our heart is we're losing one hour. And when I talk about that, we lose an hour every day. Studies have shown that men get one hour of exercise more a day than women do. Because of the way we started this podcast, the parents, the kids, the job, the everything is going on. And women, the cumulation of that is that we get 1 hour less of exercise. What's interesting is that an hour of exercise actually has a greater benefit to women than men. Women can actually exercise for a shorter amount of time and derive greater benefit than men. But we are getting— less exercise. Now, a couple of things. Men tend to exercise because it makes them feel good. Women tend to exercise because it makes them look good. So two different drivers. Mm-hmm. It's probably better to feel good. People— it's not a chore if you're enjoying it when you're doing it. Also, maybe not our fault because women grow up in our society where we are less likely to be in sports, less likely to be in organized things. We don't really grow up in gym, whereas men grow up in sports and gyms. And so it becomes, you know, by the time you're older, you are socialized into a woman's role. And sometimes that doesn't include being sweaty and exercising. But then you also have all of these other responsibilities. So that power over time is what leads to that heart attack later. And the other thing that is interesting is that when we look at data, even though of households where both the man and the woman work, and they both say that they split the household chores equitably, especially when children are there. Turns out that the men sort of end up doing the chores that are more independently driven, that they can schedule on their own time, like mowing the lawn, and fixing the cars, and painting the house, and making a repair. Women have all the chores that other people depend— they're on somebody else's time. When they're going to get the baths, when they're going to get the meals, when they're going to have lunch ready, when are they going to get the homework, when— so they're on somebody else's schedule. They can't schedule it because their, their day is already scheduled for them, whereas men can schedule their equal share of household duties and off they go to get their 1 hour. Right? So there's that.

Yeah. Well, so the takeaway there is block that time out for yourself and protect it ferociously.

Even if it means you've got the kid on your hip and you go up and down the steps 5 times. That kid is helping you add some weight and helping you with your 5 minutes of exercise.

I used to— I had 2 babies, like, within a year of each other. And I used to strap one on the back, one on the front, hike with them. Do squats with them.

It's like they were my gym. Use those kids, ladies. Use them. Oh my gosh. Thank you so much. You're welcome, JJ Virgin. I'm so glad I came.

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