Why Heart Disease Is the Number One Killer of Women with Dr. Jayne Morgan

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80% of heart disease here in the US for men and women is preventable. Diet, sleeplessness, stress. The biggest ones are high blood pressure and lack of mobility.

Heart disease isn't a man's disease. It's a missed women's disease.

There was a recent survey. Cardiologists, only 40% felt— they may not be competent— felt comfortable enough in treating a woman with heart disease. If you are diagnosed with high blood pressure as 50 64% of Americans are. We realize that for every 10 millimeters of mercury, that top number goes up, that 120th, it goes to 130, increases your risk of heart disease by 20%. If it goes up by 20 to 140, your heart disease risk goes up by 40%. So it's incredibly important. Wow.

Hey, I'm JJ Virgin, PhD dropout, scientist, Sari mom turned 4-time New York Times bestselling author. As a certified nutrition specialist, Fitness Hall of Famer, and globally recognized leader in health, I'm driven to keep asking the tough questions and use my podcast to simplify the science of health into actionable strategies that help you thrive. Want an ad-free experience? You can now subscribe to my exclusive VIP podcast at subscribetojj.com for just $4.99 a month or $49.99 a year. It's like your daily latte, but better for your health. I'd also love to hear your thoughts on the show. And here's the fun part. When you send me your review, I'll reply to you using my on-demand virtual me. That's right. My team and I created a virtual JJ packed with my books, speeches, and wisdom so I can personally connect with you. Here's how you do it. Subscribe and leave an honest review of the podcast. Take a screenshot of your review. Text it to 813-565-2627. That's 813-565-2627. My virtual JJ will reply directly, and trust me, this will make your day. So subscribe now at SubscribeToJJ.com and text me your review. Let's keep thriving together. If I were going to ask you what the number one killer of women is, what would you say? Now I'm guessing you'd say breast cancer, and that is not correct. It is heart disease by a landslide. And here's what's crazier about that, is that most women never even know it's coming because the warning signs look so different for us as compared to men. It could be fatigue, shortness of breath, jaw pain, anxiety, or just that sense that something's off. And quite often this gets brushed off both by doctors and by us. Well, that ends today, because today I'm sitting down with one of the most respected cardiologists in the world, Dr. Jane Morgan, to talk about what people really need to know about their hearts after 40. And by people, I say women. I met her at Tamsen Fadal's How to Menopause, the world's hottest menopause party, sat across from her at dinner. I'm like, oh my gosh, I've got to talk to you. She is a phenomenal physician, also a Pilates instructor, but she's more than that. She's a woman on a mission to really change the way that we address heart health in this country. And boy, do we need to do it. We're going to dive into some really cool things. We're talking about what one of the early things that you can notice when you're pregnant that could tell you if you are at risk for heart disease later on. What are the biggest things that you should be shifting in your lifestyle? Because heart disease is 80% lifestyle. What you do need to look at in terms of your genetics, what tests you need to ask for, and what are some of the big things, like in terms of medications, that you want to make sure that if you are prescribed, you take. So this is a very important episode. I've been waiting a long time to do this with her. She's in person with me in studio, so hang with me. I'll be right back with Dr. Jane Morgan. Dr. Jane Morgan, I'm so happy you're here.

Oh, I know. Thank you, JJ Virgin. It is a pleasure. I'm so excited.

Yes. All right, well, let's get into it. So for everybody listening, this is actually take 2, but it was so great, all the information you were distilling last time, but you were coming in from the Bahamas and right in the middle of all the greatness, like the internet drops. So it's like, we're just gonna start all over again.

Right.

So I'd love to just start with what I've heard you say. Mm-hmm. That heart disease isn't a man's disease. Mm-hmm. It's a missed women's disease. Mm-hmm. Like when, when did that become an aha moment for you?

You know, it started to sort of infiltrate during my cardiology fellowship when I started to see female patients come back with heart attacks after we had already assessed them, that they were always— not always, but oftentimes characterized with these symptoms that we called atypical. And it meant sort of that they waited and we drew enzymes and they were sort of relegated to a lower level of care and concern. And I started to be interested in it then. So that was way back during my cardiology fellowship at George Washington University. But no one was really talking about it. And this was just sort of my observation. And, you know, you're in a situation where you're a cardiology fellow, you're not super powerful. You're trying to learn from all the senior, important, smart people around you. Not make waves, just learn the information. This is how it's taught. This is how it is. So they must know. But, you know, over the decades, unfortunately, you know, to get where I am today, it was clear that No, they're really, you know, there is a separate set of symptoms that women tend to have more, and we are not being taught them. They are being deemed less important, and we are killing women because of it.

That's a big statement. That's a lot to unpack here. I just think of this, Jane. I think, well, what would have happened if back in those days when you were just trying to, you know, trying to figure it out, that you just ask those questions?

You know, it's not that you don't ask the questions, it's that the answer comes back so definitively knowledgeable.

Wow. Yes. Even though it's based on old information.

Until, "You must be wrong." "I'm the most junior person on the team. I'm the trainee. And you ask the question and you get this very definitive answer." And then that's that.

Like, "Okay." Right? It's so interesting though, because when you look at like how change happens, it usually is from someone outside of the current system looking in going, "Huh." And so it's such an opportunity that's being missed. And the other opportunity being missed, you talked about women's symptoms—

Right. —being different than men's. Right, right. And that, and that always sort of tugged at me during my cardiology fellowship. And even as a young cardiologist, I just was very much aware of atypical chest pain is what we called it. Atypical chest pain, atypical symptoms. And that it seemed to me that it was the women who more often had those. And why was that? And most of the time it came with what we call a rule-out, meaning it would be an R/o panic disorder. So it was a way of— it was kind of a wink and a nod of, eh, this— "Could be a heart attack, but probably not. It's probably just another woman having a panic attack." So it's sort of atypical chest pain, rule out panic disorder. That was an actual diagnosis. Wow. And I think when you say that, you're sort of giving the wink and the nod of, "Eh, don't take this seriously. This is another hysterical woman." And I saw that over and over again. Women were always anxious and panicky. Uh, men went to the cath lab and got, you know, stents and balloons and got their arteries open, but women weren't allowed to do that. Coming in with this crushing chest pain. And I remember I used to think sometimes, maybe I should tell women to just say they're having, you know, say you're having chest pain and shortness of breath, even if you're not, so that you can get the attention. But even I was confused. Like, oh, oh, maybe they are having a panic attack and maybe I should, you know, do a referral for a mental health and that sort of thing. So it was, it was very concerning, especially for the women where we wouldn't even draw enzymes. So this is sort of a blood tests that we would draw every so many hours over a 24-hour period where your heart would leak enzymes if it's being injured. And some of those women we would catch later because their enzymes would start to go up. But some women wouldn't even get, uh, the enzymes drawn. And even those where we would catch them later, it's later. We literally have now delayed their care 4 to 6 hours or 12 hours. But it was just me. Right? And you're just sort of, oh, sort of having these aha moments. But you're busy. You're crazy. You're managing all the other things in cardiology. Everybody around you knows more than you do. You're the trainee. How could you have something to say? So you kind of keep your mouth shut and you keep moving forward. And, you know, as I've learned now at this age, it doesn't go away. It stays with you. It doesn't— it's not as if one day you wake up and yes, you've joined the majority and you agree. It just nags at you. Yeah. It's always there. It doesn't go away.

So is it that women, are they downplaying their symptoms, or is it that they have different symptoms?

You know, that's interesting because we do tend to minimize our symptoms, not want to be a problem, not want to be a bother. The whole culture of, of societal norms of women taking care of others, not really needing much, being very selfless. And so I think there is some of that, but I think some of it is your symptoms just aren't chest pain, shortness of breath, and sweaty. And so you're like, "Oh, I'm kind of tired, and I'm always tired, and I seem to be more tired when I'm climbing the steps. I have to sit at the top of the steps and rest, and I used to be able to carry the laundry baskets. Now, you know, I'm not," or, "I just feel like I always have the flu and I can't shake it," or, "I've got jaw pain," or, you know, I just have nausea that comes and goes. And, you know, I keep changing my diet. And then I thought it was this, and I went to this restaurant. You know, so all of those kinds of things where, in our defense, they can be confused with other things— nausea, fatigue, back pain. It could be something else. But it also could be a heart attack. And we don't think about it because we're not taught it. And the health system isn't thinking about it either.

Well, and you're a cardiologist. I'm thinking about the— regular primary care, right? Would this be something in their 7 minutes that they think about?

Cardiologists don't even think about it.

So the answer is no.

The answer is no. The answer is no. And, you know, there was a recent survey done and it asked primary care physicians how many people, how many of them felt comfortable treating a woman with heart disease. And only 20% of them responded that they felt comfortable. Now, I want to say that's how they feel. They may not actually be competent at all, but they at least felt that they were comfortable and competent.

Only 20%. So maybe then half of the 20% were actually— were actually competent.

But then when they asked cardiologists, only 40%. And that's literally what we do. Our job is to treat heart disease 24/7. That's 100% of our job. Only 40% felt. They may not be competent. Felt. Comfortable enough in treating a woman with heart disease. So that is just how blurry it is. And when you allow people to answer anonymously, they will tell you, I don't really know what I'm doing.

So seeing that this is the number one killer of women, that's absolutely frightening. And I—

But most people don't know that, JJ.

Most people don't know that. I know. It's— well, because breast cancer has great marketing. They really have done a great job.

Listen, not only have they done a great job, they've decreased the rate of breast cancer. Yeah. And they've decreased the rate of cervical cancer. They've been very effective in driving those rates down. But breast cancer has never been the number one killer of women. It's always been heart disease. And part of why breast cancer also gained popularity, if I can use that word, or just shall we say, um, notoriety? I don't know what the word is. It became more entrenched in a greater awareness. It's because it fits into our societal and cultural norms that women's health is all about reproduction. So if you want to do women's health, everybody, let's get behind breast cancer and cervical cancer because now we're really supporting women. So that was something people could galvanize towards because it fits all of our biases about women. Women's health is just reproduction. So if you talk about heart disease, that's harder to think about. Women and hearts? That doesn't make sense. Women and breasts? Oh, got it. Yes, I'll support you. Women and hearts? Mm, I just can't connect those dots. Sorry.

Well, and then you have it more complicated because you have women, heart, and hormones. Right. And I would assume that most of this heart disease risk happens when women get into, you know, estrogen starting to drop.

Yeah, but, you know, we also have an increased risk with pregnancy complications with high blood pressure during pregnancy, hypertension in pregnancy. So that's another phase of our life where it gets missed. Yeah.

And I remember you telling me something that like, I was like falling off my chair the last time going, are you kidding me? You said something that happens during pregnancy that always gets missed. Right. That's just 100% predictive. What was it you were talking about?

Yeah, so we were talking about, you know, blood pressure. I think we were talking about blood pressure, but diabetes, preeclampsia, these are all— Oh, preeclampsia. Preeclampsia. Okay, yeah. You know, preeclampsia is just a more severe form of high blood pressure where you now have some end organ damage. But all of that is preventable with managing your blood pressure. But the problem is that any woman who develops these complications during pregnancy has really just declared that she has an increased risk for heart disease later in life. And that's where we have not been doing the handoff to cardiology. We have focused on the baby. Not the mom, getting the mom through the pregnancy so we can have a healthy baby, which is a very fine goal. That's fine. The problem is once the baby is delivered, usually those parameters go back to normal. So your blood pressure goes back to normal, your diabetes goes back to normal. And so we sort of congratulate ourselves, you know, do a big high five and everything's great. The baby's great, mom's great, but mom is not great because that blood pressure can start to go up. What she has declared during that pregnancy is that she has an increased risk of heart disease. The pregnancy did not cause the heart disease. The pregnancy unmasked it. It's telling you, you are at higher risk. So the pregnancy is letting you know. And we don't have that handoff to the cardiologist. So the woman just goes on with her life. And then she gets into perimenopause and menopause, where her risk is even further increasing. Yeah. And I like to say it's like Eminem's, you know, rap song. It's like when a tornado meets a volcano. So you've got a woman who told you she had a— she was at high risk of heart disease with a pregnancy complication, and we did nothing. And now she's in perimenopause heading towards menopause, and nobody recognizes that heart risk, and we're doing nothing. OK, so we have this— wow— collision.

So the woman who in pregnancy showed up with high blood pressure and then gave birth, what should have happened?

What should have happened is that a cardiologist should have been embedded in her What happens usually is that those women are managed by high-risk OB doctors, which is perfectly fine, right? This is a high-risk pregnancy. But it's not only high-risk for the baby, it's high-risk for the mom. And it's not just high-risk for the mom, it's long-term high-risk for the mom. That's what we have failed to recognize. And so a cardiologist is not on that team. So not only should a cardiologist be on the team managing that blood pressure, let's say a cardiologist is not there and the OB is managing it. It. Once that delivery is done, that mother should be referred to a cardiologist for long-term preventive care at a minimum. And that almost never happens. It's getting a little better because of shows like yours and talks that I give, and we're trying our best to get it out there. But most hospitals in the United States today still do not have a cardio OB unit. They do not have the combination of, of obstetrics and cardiology. There's not that recognition that a cardiologist must be a part of these high-risk pregnancy, um, women. And the other thing that we fail— there's so many things, but the other thing that we fail to follow is that long-term, this woman's pregnancy history is relevant whenever she sees a doctor. That's what I was just wondering.

Like, to me, hearing this now, if someone's listening, because this is well beyond 40, so— Right. We still have some people giving birth, but not usually, you know? But let's say that someone's listening and they're now in perimenopause and they had high blood pressure during pregnancy, this would be then their big sign to go see a cardiologist, correct?

Well, and it should— not only a cardiologist, it should be a question that is asked even after women have stopped having children, whether it's menopause or not. So if you just are not having any more children, generally we don't ask your pregnancy history. We only ask the pregnancy history when you are there with your OB-GYN. That's the only person that asks it. Nobody else asks it. But a cardiologist should be asking it.

But most of us are not meeting with— I've never met with a cardiologist. Yeah. What about that?

So now cardiologists should be asking it if you had a pregnancy complication, but also any woman that's seeing a cardiologist, that should be part of what is being asked when they're doing the workup. And then primary care physicians should be collecting that data. That's data that should be collected for the rest of the woman's life. Because that's an indicator of whether you have a higher-risk woman in front of you or not. And we don't ask that information. We just leave that to the OB-GYNs. And after she stops having kids, maybe she remembers it. Maybe it's in some chart somewhere, but nobody asks it anymore because no one understands the relevance of how it's connecting to her future health. Yeah.

And those charts, like those charts, what's really going on with those charts sitting in? So to unpack it so people can be proactive. Mm-hmm. Let's say someone did have some issues during pregnancy, whether they had diabetes, gestational diabetes, they had high blood pressure, and then everything normalized post-pregnancy. So now they're seeing maybe HRT doc, or they've got a functional medicine doc, and likely those questions weren't asked. That's right. And I mean, I'm not even hearing this in a lot of the trainings out there. So this, this is why, thank you. You're welcome. But what should that patient then come in? Like, what are the things that they would want to tell the doctor? What are the things the doctor should be looking for for, right? You know, because I also want to get into what can they be doing, but what, what should they tell the doctor and what types of testing would they want to look at to indicate if they're, you know, at high risk?

So how many pregnancies have you had? Were they normal pregnancies, meaning without complications? If they were complicated, what were those complications? Those complications were related to hypertension, meaning preeclampsia, eclampsia, or an older term, toxemia. Or gestational diabetes or even a low birth weight baby, then that woman sitting in front of you is at higher risk for heart disease. Here's a way to think about it. Here's why when we talk about diversity of thought, diversity of people, diversity of training, why this is important. When we are integrating these teams, medicine is often in silos. So the women go to their OB-GYN, right? And Nobody else really comes in there unless there's a real catastrophe. Then we get some emergency consult from somebody. But for the most part, you just stay in your silo. So you don't ever get any other perspective. So here's what happens. An OB-GYN sees their patient, says, "I've got a 37-year-old female who's in her 28th week of pregnancy and has developed hypertension." Cardiologist comes in and says, I have a 37-year-old female who's in a volume overload state and has failed her stress test. Same patient, different lens. The pregnancy for a cardiologist is a volume overload. If you develop any of these disease processes during your volume overload state, that is failing your stress test. And just like any stress test that you fail, you get referred to a cardiologist. But the OB-GYNs don't get that lens. Because the cardiologist never sees the OB patients. Cardiologists are unaware of the association of pregnancy history to cardiology, so they're not included on the team. So it's, you know, and women's health is only reproduction, so nobody even thinks, you know, so it just goes on and on and on and on. But if you can embed these people on the team and have a team of specialists who are thinking from their areas of specialty and bringing all of this different thought together, Now you've got a whole circumscribed patient and you can come up with a plan. But the OB-GYN never consults the cardiologist. Cardiologist never thinks to talk to the OB-GYN. Everybody's in their silo. You need something, call me. And we're not talking. And that's the part that kind of has always bothered me during my training. Like, oh my goodness, you know, why am I seeing this? Am I the only one seeing this? Why does this bother me?

I keep asking the questions.

You probably were the only one seeing it. I keep asking the questions and I keep getting these very authoritative, definitive answers. And you know, it's funny, you get answers from people who are so super smart, and then you feel better. You're like, "Oh, okay, that's true. Let me just— Why do— Let me just drop this. That's right. He gave me a great answer." And then you find yourself 3 months later with another female patient, and it's back in your head, turning again. It just turns. And he— You know, it can go away for a while, but that strong response, And then it just comes back and starts turning again.

Cannot be ignored. Well, would you say then for if someone has had a, some type of a high-risk pregnancy or any of those issues during pregnancy, should they go seek a cardiologist? Yes. Okay. So that's the first important action to take. 100%. Go, if you've had any of those issues, didn't, doesn't matter if you were 20, 30, it's like that's, you unmasked. Right. This preexisting chance of heart disease. That's right. And since this is the number one killer, you're going to go find a cardiologist.

Right. And I want to be clear, pregnancy did not cause the heart disease. Do not avoid pregnancy because you think being pregnant is going to give you heart disease. Pregnancy did not cause the heart disease. So your risk is the same. It helps to declare it. Because of the volume overload.

It causes the volume— It's like you have a stress test going on 24/7. That's right. That's right. Okay, that makes total sense.

So in some ways, a pregnancy is helpful. It's letting you know early. So I just, I just always want to make that point clear that people are not avoiding, oh my gosh, I better not get pregnant because I didn't— I heard that pregnancy causes heart disease. I don't want to get that. No, that's not what I'm saying.

Now, so we talked about— I started to bring up that menopause seems to be a time when a lot of this starts to show up. And then you mentioned that, like, the first show up is pregnancy. So that— and that's I think that's honestly great information for everybody hearing. 'Cause I would assume, what's the rate of people having some type of, women having hypertension or gestational diabetes and things?

Yeah, almost 13%. Huh? Yeah, it's high. It's anywhere between 7 and 13%. Wow. And higher in the US than in other countries. Higher in Black women than in other women. And interestingly, when we talk about Black women, only Black women who are born in the US have the risk. If you were a Black woman born in any other country outside the United States, Caribbean, Africa, France, wherever you were born and moved to this country, you don't have that risk of preeclampsia. You have to be born— only Black women who are born and grow up here have that risk. Isn't that very strange? Any clue why? Well, I think it's all part— lots of clues. That's another conversation. But all part of the weathering and epigenetics and the the chronic stress of navigating a society that is very gender conscious and very race conscious. And then the Black woman is both. And so that constant navigation and the stress and whatever, all the socioeconomic things. So it's interesting when we compare Black women from other parts of the country, they don't have it. But white women also have it here. But not to the extent. Not to the extent. But definitely white women have, uh, preeclampsia, and it's to a much higher degree than we see in other parts of the world. So here in the US, maybe high stress, high tension, high salt diets, high processed foods. I mean, we have no idea. All of the above. All of the above. All of the above. Multiple choice, I'll take it. Higher BMI, you know, we weigh more now. We, so all of those kinds of things.

Yeah, I would imagine all this is getting worse, not better. Mm-hmm. Wow, okay, well let's, now let's move into perimenopause and beyond. 'Cause I assume that's the second hit. And when really things start to go downhill for parts of me. I hate to say it's going downhill, It's all downhill. But I mean, what happens when estrogen drops?

Yeah. So, you know, so as you start perimenopause, which can start really as early as 35 years of age, and oftentimes I say that and people say, oh my gosh, that means, you know, that I can't have children. It doesn't mean that you can't have children. And it doesn't necessarily even mean that your estrogen is just dropping. It means that you're starting to have fluctuations in your hormone levels. So it could be going up and down and, you know, right and left and all and circling around. And that's why you get the symptoms. Most common ones you think about are hot flashes and night sweats. That's from your estradiol going up and then dropping and then going up and then dropping. That's the hot flashes because your hormones are just in chaos. But it doesn't necessarily mean— I just don't want you to think they just kind of like go to a cliff and just drop off. Thursday they were good, Friday you were done. You had no more hormones. That's not how it goes. So that period of chaos is what perimenopause is. So, you know, part of the reason that it's chaotic is that you also are still fertile. You still ovulate. You can still have children. You can still get pregnant. So you can actually be fertile and be in perimenopause at the same time. It doesn't mean that you don't have estrogen. It means it's bouncing around. And so you're heading towards menopause. Now, why is that important? That's important because Estrogen protects the heart. Estrogen is a hormone that protects us, that decreases— when I say us, I mean women— that decreases our risk of heart disease. So prior to menopause, our risk of heart disease is only half that of a man's. On the other side of menopause, it's twice that of a man's. And I say that very often. So what happens during that period of time? What happens? We lose that protection of estrogen. And estrogen not only is a direct cardioprotectant agent, estrogen is an anti-inflammatory agent for the body. And inflammation, we now know, is one of the drivers of atherosclerosis. That's developing those plaques in the arteries of your heart. Inflammation drives that. Estrogen is an anti-inflammatory agent. So as you get older, you get less and less and less of that estrogen. When it's bouncing around, you're getting all those symptoms. And we can talk about all the symptoms. Those are the ones that everyone knows about. But, you know, one thing that I will say about those symptoms is it's not ha ha ha. You know, oftentimes we laugh and go, oh my gosh, look at her. She's sweating. Everybody turn her fan on. It's so funny. Listen, this woman is literally screaming to you, hello, my risk of heart disease is increasing. Somebody do something. She's literally— her body is literally sweating to tell you. And we're just just like laughing and giving her fans. There's nothing wrong with being comfortable and giving a fan and cooling off. But the fact of the matter is those symptoms mean something else. It means that your hormone levels are changing. It also means now that it's time for doctors, in addition to yourself, but it's time for doctors in the health system to be proactive and do something about it.

Are there specialists who— first of all, are there female cardiologists, like, specializing in women? Mm-hmm.

Are you the unicorn or are there other people? I am the unicorn. So I am the unicorn in a number of ways. I mean, unicorn because I'm a female cardiologist. Hardly any. I'm a unicorn because I'm a Black female cardiologist. There are like none. And when we talk about women's health, I'm a unicorn because nobody's taught women's health, not even cardiologists. Wow. And so you're talking— So nobody really even knows.

Someone going in, someone going through menopause, and let's say they were one of this 7 to 13%, so 10% who had some complications in their pregnancy. Now they're in menopause.

And nobody's asking about their pregnancy complications. Right. And nobody knows anything about perimenopause. And it just, we're just going on through our lives, right?

What needs to happen for that woman now in terms of hormones? I would assume that hormone replacement therapy is gonna be more indicated for this. Like, I don't understand why everyone isn't on it. I know there's a couple indications for not being on it, but especially in terms of cardiovascular health. What are your thoughts with—

So my thoughts is part of the challenge is, ah, we're back to our system. We're back to our health system. Randomized clinical trials are the gold standard for therapy, for evidence-based medicine. These are trials that we do in phase 3. There are 3 phases of trials: 1, 2, and 3. 3 are these big trials that you hear about with 30,000 people in them. But to take a to take a drug, a compound, a device, a hormone, a substance, anything through all of the phases and get all the follow-up. Sometimes it can be 10 to 15 years. That's evidence-based medicine. That's randomized clinical trials. A lot of the data that we have on estrogen is not coming from randomized clinical trials. Actually, I'm going to correct that. Doesn't come from large randomized clinical trials. There are some smaller ones. Why is that? That is because women, by and large, are excluded from clinical trials. So here we are in this— we can't prescribe hormones because we don't have any data, and we don't have any data because we didn't put you in clinical trials. And so we didn't put you in clinical trials, we can't prescribe hormones. We're not going to prescribe the hormones because you're excluded from clinical trials. And it's just— it's insanity. It's just nuts. Now, do we have good data? We have good small trial data and randomized clinical trials. We have data, observational data. So in other words, large amounts of data that look at retrospectively what are the actions of estrogen on the body, what are the actions of progesterone on the body, what do we see in women who are on these retro— retro— we go back and look at data, go back through charts. And look at data and pull information. And that's what we have. That's not considered the gold standard. That is considered very good. And we do use a lot of observational data, but it's not considered the gold standard. So that's where we have the sort of, you know, diaspora of, of what are we going to do to manage it? Because women are being denied hormones because the system doesn't include them in clinical trials. So the system creates the problem, right? And then, and then the women are the ones with the— I will just say fewer choices. It doesn't mean that you have to go on hormones. I always say it is not about what you should do or what— it's not about what you should do. It's about what you could do. It's about having information and making the best decisions for yourself. Yourself. Everything is not the right choice for every person, but people should be able to have the information to make their own decisions. And we don't do that. The government, or the society, or the lead researchers, most of whom are these authoritative, knowledgeable men who always had the answers for me as well.

Give a man a hot flash and things would change quickly.

And so this is kind of where we are. So do we look at the observational data and say the observational data is super strong and we should move forward with hormones? Or do we say, well, the gold standard is randomized clinical trials and we don't really have these 30,000-patient randomized clinical trials because women's health isn't really considered that important. We don't really have funding for it and it's all about reproduction and nobody really knows heart disease is the number one killer of women anyway. So, ah, let's just keep going. We'll just ignore it. So that's the conundrum. And I'm not saying either side is right or wrong. I'm just saying that's the conundrum. That one side says, we can't prescribe this because we do not have these large randomized clinical trials. We only have smaller ones. And the other side says, but we have a plethora of observational data. And we've got this data. And we know how it works. And then in between, we've got the system that we're in. And so if we were to change the system and start to enroll women in trials, we still may not have answers for 10 or 15 years. So another generation—

So that's not gonna work for all of us. And I believe that most of the people that listen to this, listen to that information that they're not gonna get in their 7 minutes of a doctor stuck in the system. And I say that stuck in the system because pretty much all my friends are doctors and most of them are like, that's not why they came into this world. So it's frustrating for everybody. So someone listening to all this and—

And it's hard for us to understand to unlearn things. It's hard for anybody to unlearn. It's easier to learn it in the first place than to unlearn it and then have to relearn it. And so I spend a lot of time working on legislation and resolutions. Actually got a resolution passed in the state of Georgia with the Medical Association of Georgia House of Delegates on October 18th. Turned out to be World Menopause Day. That wasn't my plan. To request the requirement of medical students and internal medicine residents and cardiology fellows be trained on the information because it's important to learn it as opposed to now we're trying to unlearn and then relearn. It's just— it's just too hard. And doctors are busy and they, you know, we like to say we're saving lives, but you really are saving lives. But, you know, there is a flip side of it is if you're not keeping up with it, you actually might be taking lives as well.

Well, you should start a female cardiology specialization. Yes. I—

I think we should. All right.

We'll discuss that. We should discuss it. Anyway. Ready to soundtrack your summer?

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That's where my brain always goes to these things. Women's health? But for this person right now who will step outside the system. Right. And is looking at this going, what do I need to know first? To understand my cardiovascular risk? Let's say I am 50, I'm like, you know, either now in menopause or kind of still at that in-betweener stage, but I'd like to understand my cardiovascular risk. What shall I do? You hear about all the different tests, like CLEARLY, et cetera, out there. What would you recommend?

So we wanna start the basics, your family history, your personal history.

How big of a deal is your family history?

Your family history is that big deal.

Like, let's say my mom had toxemia, because that's back then, that's what they called it. That's all I know because I'm adopted. Okay.

But that's actually the most severe form of preeclampsia, the toxemia.

So I know that they induce labor. That's all I know.

Okay. Okay. That's it. All right.

So how big of a deal is genetics and family history?

Genetics is a big deal. So genetics, it's not as big a deal as choices, but I want to talk about both. 80% of heart disease here in the US for men and women is preventable. It's not caused by genetics. It's caused by lack of exercise.

What is it caused by?

Immobility, diets, sleeplessness, stress. So this is what— smoking, 80% smoking. What are the biggest ones?

Vaping, smoking, alcohol, vaping, the, the big—

sedentary. The biggest ones. Are high blood pressure and lack of mobility. Next would be cholesterol, smoking, sleep. The two biggest ones, though, are lack of movement and hypertension. And I have shifted in the last couple of years to saying lack of movement because as I've talked more and more with people, I realize exercise is so daunting. You say the word exercise and people are like, oh my God, I gotta get an outfit and I've gotta, you know, buy the— Well, the outfit's the fun part. Right. And then I've got to, you know, be in front of people and I don't know what I'm doing. And— or I've got to invest in a home gym. I need a partner. You know, they say you have your accountability partner. And that was just so overwhelming. It was like this whole thing.

As opposed to just go move.

So now I just say, I want you to move. Whatever you're doing, do it for 10 minutes instead of 5. Just pick something you like to do and I want you to do it and try to do it for 30 minutes. Or I talk about take exercise snacks. If you, you know, get up in the middle of the day, do something for 10 minutes and sit down for 2 hours. And then get up again, do something for 10 minutes and sit down for 2 hours. Well, what should I do? Do anything. I don't care what you do. Just do something. You decide what you want to do, something you can do on your own, something you can do spontaneously, or something you really enjoy and you're going to look forward to your next exercise snack. So try it. To move people away from exercise because the word exercise sounds too big for a lot of people. It sounds like a lot of preparation and a lot of work. And who's going to keep the kids? And if I have to go out for an hour and do I need to buy a special stroller? Do I need a double stroller? You know, it's just, just everybody puts all these roadblocks. It's just too much. Yeah. So now I just say mobility. I want you to move, get up and do something, whatever you want to do. High blood pressure and lack of movement are the two biggest ones.

Now, if you've medicated your high blood pressure into normal, does that bring you back down or not?

It brings you back down. And that is incredibly important. It's such a good point, JJ. Thank you for saying that. Listen, and I want to be clear for all of your listeners, if you are diagnosed with high blood pressure, as 54% of Americans are— 54%? That's right.

And high blood pressure being which numbers? What are the numbers you're— Greater than 120. 80. So even if it was 125. Too high.

Yeah, I have that. You really want it— and you know, there was a time we used to let you hang out at 135, 140. Ah, you're close enough. You'll be okay. We realize, we recognize now that for every 10 millimeters of mercury, that top number goes up, that 120, say it goes to 130, increases your risk of heart disease by 20%. If it goes up just by 10, your risk of heart disease goes up by 20. If it goes up by 20 to 140, your heart disease risk goes up by 40%. So it's incredibly important. Small movements in that top number really can change the trajectory of your heart disease risk. So it's not only 120 over 80, it's less, believe it or not.

Isn't it supposed to be 110 over 70 now?

The teens. 120 over 80 is great, but that's almost now the top number. It needs to be less than 120 over 80 because of your risk of heart disease. So 54% of Americans have high blood pressure. And here's the other thing. Back to your question. This is why it's such a good question. If you are prescribed medications for your blood pressure, this is for all of JJ Virgin's audience. If you're prescribed medications please take them, because if you can take your medications and get your blood pressure down to the normal range, you remove that risk of heart disease. And I have people say to me all the time, "Oh, Dr. Morgan, I just want you to know, you know, I'm whatever, 50 years old, 55, and I don't take any medications at all." And my response often is, "That doesn't mean that you shouldn't be." And people, especially as we get older, we like to brag and say, "We don't take anything. I'm great. I'm so healthy." But the fact of the matter is, it's better to take medications for your blood pressure and your cholesterol specifically and bring those numbers down to normal than for you to let your numbers hang out even just marginally high, but have bragging rights that you don't take any medications. So if you're on medications like I am, I take them every day. Every single day. I never miss because I understand the importance of having normal values, not in being medication-free. So if I can have one point there, I want people to take your medications. Now, if you've been told you need to lose weight, you need to exercise and control your diet, that's great. And if you are able to do that, we as physicians— when I say we, are happy to dial back your medications or even stop them. But just in case you can't meet that metric, or like menopausal women, your blood pressure may be going up despite everything you're doing because the estrogen is leaving your arteries and your arteries are becoming stiffer and your blood pressure is going up despite all of your best efforts. That silent, silent killer. Please take your medications.

This is a public service announcement.

Yes. Take your medicine.

Take your medicines. I have a son who has a traumatic brain injury that happened when he was 16. And that was the big blood pressure dysregulation. So that was like that, oh no, take your— like that has been ever since with blood pressure checks and everything else.

Yes. And home blood pressure monitors are great because it gives— we now recognize, and I say we, I mean physicians again, that that's sort of that single snapshot in time when you come into the office on Tuesday at 11:45 AM and get your blood pressure checked. That's really just a snapshot in time. We have really no idea what your blood pressure is for the rest of your life. Well, you also could be stressed out. You could be stressed out. Stressed out, or the opposite. Not only could you be stressed out or rushing, your blood pressure is high. There are people who sort of game the system, and they only take their medicines 4 days before they're coming to the doctor. They start drinking water, taking their medications, getting ready for the—

as they say, "Getting ready for my blood work." It's like cleaning up before the housekeeper.

And so— Wow. Yeah.

That's wild. Yeah. Yeah. Yeah. Interesting.

Because they don't want to hear what their doctor has to say. So they take everything. And then you can also look, you know, a different way artificially. So we now know it's better to have your blood pressure taken out in what we call your native environment, where you live, work, and play. What are you doing every day? What's happening every day? That's a better indicator. And it puts the— gives the power back to the person because now that person can inform their physician or their healthcare team, hey, my blood pressure seems to be up. Up. That blood pressure seems to be going up, as opposed to, let's say, you're normal, whatever, a healthy person, and you're waiting a year till your next physical exam. Oh, gosh. Especially for menopausal women, your blood pressure can change a lot in one year, even though it's been normal all your life.

Like, is that— is that time that you're waiting and you're not taking these medications—

it's damaging because the arteries, and also it's causing the heart to work harder against a greater force. Blood pressure is keeping the pressure up on the left side of the body. So we would call that systole, that systolic. So the heart is having to pump against higher pressure. Your heart's working harder. You want to reduce that pressure.

Give the heart a break. Okay, so we have the things that could indicate or the risk factors. What are the tests that you would want You want someone to look at it.

Yeah, so when we come in for tests, we wanna get your blood pressure, we wanna do your cholesterol. When we do cholesterol, we also want to measure Lp. Now I'm back to genetics. L is lowercase l, lowercase p, parenthesis, lowercase a, parenthesis. Lp, lipoprotein. This is a genetic type of bad cholesterol, if I wanna say that. LDL is the bad one, HDL is the good one. I don't know if this all sounds like Greek to you guys, but let's just say it's the bad cholesterol, the new bad cholesterol on the block. Now, it's not new to doctors. We've always known about it. And you may want to— you may ask, well, why haven't I ever heard about this? Because we don't test for it. You might ask yourself, why don't physicians test for that? Because there's no treatment for it. And here's a little secret. We don't like to test for things that we can't treat.

Now, wouldn't you want to look at Lp because it's an indicator of having more risk factors for heart disease?

You would want to look at it.— that is true. You would want to look at it because we now know, even though we don't have a treatment for it— and treatment's coming— we don't have a treatment for it. This is an indicator that this is a patient in front of you that you must be much more aggressive with lowering their parameters, much closer follow-up, and make certain that you can drive everything that you possibly can down to normal. Aggressive. Aggressive weight management, aggressive diabetes management, blood pressure flare. So low margin for error. Low margin for error. I mean, this is a patient that you would ride a little bit harder to at least control those things that you could control, right? So Lp, the other thing is if you are asymptomatic, especially if you're a woman, now we're talking about women in perimenopause and menopause, you can consider getting a coronary calcium score. Now I say asymptomatic, meaning you don't have symptoms of heart disease. Now we go back to what are the symptoms of heart disease?

And, yeah, who knows what the symptoms are?

And nobody's— and we're not really talking to women about what their symptoms are. But if you don't have symptoms of heart disease, you're not seeing the cardiologist because you're symptomatic in some way, and you are there maybe at your primary care physician's office just for your annual physical exam, then a calcium score is actually not a bad way to go. It does drive further workup for you. The calcium score is a 10-year risk indicator. It gives us an idea of what your risk is.

And so tell everyone what that calcium score is showing, like what, what is it?

Yeah, so we're looking for calcium deposits in your arteries, and it tells you, it tells us your risk of an event, meaning a heart attack, in the in the next 10 years. And the normal score is 0. So here's a test where you actually want to miss every question. You wanna just fail it and just get a 0. So the normal test, normal score is a 0. Anything really above a 0, even a 1, is considered abnormal. Now, there are different ranges of abnormal. Do we just rush to do something? Uh, we do not. Remember, this is a risk indicator. It's not a diagnostic tool. No. Now, if you have symptoms, then you would skip a calcium score. Calcium score is not for anyone who has symptoms. If you have symptoms, then you're moving on to diagnostic workup.

Because you don't need to see that because you know there's already an issue.

Or we need to work up something more actively. So this is a non-urgent, non-actively indicated part of a physical exam, if you'd like to have it. That's a calcium score. Okay. So something else to think about would also be, your thyroid hormones, check your thyroid hormones, and to—

And are you checking your thyroid hormones for what they— how they interplay with cholesterol or what's the reason?

No, no, you're checking your thyroid hormones to make certain that they're not changing and they're not driving any changes in your body.

Of course, you have to have someone who knows how to look at thyroid hormones correctly.

Yeah, you know, but generally, you know, everything's not 100% idiot-proof, but generally, the labs will come back and will have a normal range on the labs. So whoever's looking at them doesn't have to be a rocket scientist. They may not be able to interpret them, but they can see if it's high or low. Yeah. And then send it to somebody who knows what they're doing.

Yeah. The biggest challenge I've seen with thyroid is the range is too broad. Mm-hmm. And then they're not doing a free T3, T4. Mm-hmm. Right. So— I'm just gonna do a shout out. I don't know if you've looked at Mark's, Dr. Mark Hyman's Function Health, 'cause he'll do an Lp, they've got ApoB, they've got the whole thyroid panel, and it's like $500 a year for 2 comprehensive lab tests. So you get everything, it's cheaper than if you were trying, 'cause a lot of these things insurance won't cover. And so it just becomes crazy, and then you have to justify why you want it. So that's, I'm actually going to get mine tomorrow. So that's been a helpful thing. So thyroid. I will follow him. Yeah, this is, it's a great thing. So what other cholesterol ones or things like that do you do?

So the cholesterol, the LP, because I wanna talk about genetics back to that 20%.

And you just have to do that once, right?

All right, so here's another big topic. So should we do it once for women? So the current thought is LP is something that you draw once in your lifetime because it really doesn't change. So whatever it is, that's just what it is. And you need to manage your risk from there. The question is that people like myself now pose, because we are always the ones who have these questions, as a woman goes through perimenopause and menopause and has all of her hormonal fluctuations, and then eventually the estrogen and progesterone reach a nadir, meaning their lowest level, you have an increase in blood pressure and cholesterol and sleeplessness and all of these other risk factors, including abdominal obesity and visceral fat and all of these things that increase your risk of heart disease. Should women actually have two Lp? Should we have one prior to menopause and then have another one after menopause to see where it is?

Well, and then if you're doing HRT, I would think you'd need—

So here we go with the clinical trials. Do we need to be able to to see what is happening to a woman's LP, because the reason we have data on LP and we've been able to definitively say it only needs to be drawn once a lifetime is because that's what happened when we tested all the men.

See, it would seem even more like you'd seem to really need to see the difference. Yes. And that could also be something to look at should you go on hormones. Mm-hmm. So— I think I told you, I used to work in a doctor's office where they would have me prep people for their cosmetic surgery. So everyone would come in and I would look at all their labs. Well, this would be, I didn't know anything about them. I got that stuff ahead of time and I was gonna sit down and talk to them about their diet. I could tell if they were, 'cause I'd see their age. Mm-hmm. So I knew if they were on hormones or not because I could tell by their cholesterol. Like you could just see what was going on. It was so clear. And their, in their, and your inflammation and everything else, you're like, mm-hmm.

And here's the other thing that women should get. Just the final lab, I'll throw this out here. And that is an EKG. And that's the other thing that we should get as a part of our checkup.

I remember you screaming about EKGs from the Bahamas, like this is the thing to ask for.

And women should ask for that. And we don't get it and we're not offered it.

Well, where should, do we get that when we go into a regular office visit or do we go in when we're like, to the ER when we're having a panic attack. When do we get it? When do we ask for this? The panic attack.

The not really panic attack. I'm having a heart attack, but it looks— Right. All of the above. So if you are completely asymptomatic and you're just there for your annual physical exam, just doing great preventive care, then you should get an EKG because you should have a normal EKG on your record. Because men have normal EKGs on their records because they get it as part of their physical exam. They do. But here's the thing. Why it's important.

It's not part of a normal women's—

it's not, because women apparently don't have hearts or lungs or any of the other organs. We just have breast and vaginas. We just go for mammograms and pap smears. And the heart, huh, that's a head-scratcher. So yes, guess what? We should have an EKG on our record as well. And here's again why there's, uh, it's disparate in —treatment, successful treatment of men versus women, if you were to become symptomatic later in life and present to an emergency room, and I am the physician seeing you or any physician is seeing you, emergency room cardiologist, the man comes in, we have an EKG to go back to, to compare to any changes that may be seen that day. Mm-hmm. And then we also have an interval of time during which something may have happened. That is really important information. For women, we don't really know when— we have no EKGs on you. We have no idea. First time we see one is when you're showing up in the emergency room, we're getting an EKG. And that's why so often when we look at the first EKGs of women, we can see that they've already had a heart attack sometime in the past.

And you just have no idea when.

Just have no idea when, and they didn't know it either. Either. Probably one of those times when they were just so exhausted and so tired. And so the first EKG we have on the woman is the one that's abnormal that shows she had a heart attack. We don't know when. It's a system that just, you know, I look back over all the times all of my male attendings sort of in a nice way let me know that I was wrong and that here's how you think about it and that I I agreed with them because they were my attendings. And it's just— they were not right. They were not right. And they just hadn't thought about it. And again, when I talk about groupthink or everybody being the same, all of the smartest men sat in the room, and they all came up with the smartest clinical trials, and they all got ideas from each other, and they created this whole system, and they all reinforced each other's ideas and told each other they were right and that they had covered all the bases. And there's a blind spot. And you know, the blind spot, that's exactly what it is, a blind spot, because you don't know it's there. And you don't know it's there because you haven't invited anybody else to the table. Right. And so now here we are, women are punished by a system of, you know, well-meaning. I don't think people— men, meant to hurt women, but they just never got any other perspectives on anything. Even if you don't mean to cause harm, you have a blind spot of which you're unaware. That's what a blind spot is. You don't have any other voices coming in or any other perspective. So now we're in this system that's a patriarchal, male-dominated health system that women have penetrated successfully as physicians. But we are perpetrators of the same system because we've learned it the way it's been created.

You know, it's interesting when you look at the people who stepped out into more of the integrative functional side, 70% of those practitioners are female. Mm-hmm. Mm-hmm.

You know, where they just say, this just, this system doesn't work for me.

What has happened is quite often they had a family member get sick or they got sick and they went, oh, Oh, this is not working. Like I'm thinking of one of my friends I just was with last, last week who's an OB-GYN who was Suzanne Somers' doc way back when. And literally had a very traditional OB-GYN and then was like, oh, you know, and they went and created entirely different businesses because they wanted it for themselves. They needed it for their family. And I just wonder like the system's so slow to change. So slow to change. It's so like just even to get into medical school.

So, so derided now that it's even flawed.

You know, and then, and then you have to get into medical school, then you have to get on the test. That's right. Like, so you look at, so I'm just looking at all this going.

And all the decision makers are still the same. So you've actually got to convince the decision makers to say, you guys, you were kind of wrong. Or you just go outside the system. Or you go outside the system and you create another system.

I think, I'm like, let's just go outside the system. There's all of these amazing HRT doctors who need this information because they're really the first line to say, hey, these are These are the things that you need to go get tested on right now. These are the things that we're gonna look at. You need a baseline EKG. Like just all of these things that, you know, people listening here will go, I'm gonna go ask my doctor because, you know, I'm a big proponent of having the knowledge so that you can make the decision. Do I wanna do this? You know, I don't think— Exactly. Should everyone have HRT?

No, you should have it if you want it. It's not a one size fits all. It's not a one size fits all.

But if you want it, you should have the opportunity opportunity to learn about it and go make your decisions. Agreed. Can you do it with your doctor and your plan? Maybe not. Fortunately, there's a lot of great options out there now, and they're becoming way more affordable too.

So yeah, no, I agree with you. This whole system has been a challenge, and sometimes I don't really kick myself, but sometimes I say, what has taken me so long to come into my own when the voice has been there since the beginning of my cardiology fellowship? But, mm-hmm. And I questioned and I I still, you know, sort of got knocked down.

I was gonna say, you questioned it, got knocked down, question. And could you imagine being the only person seeing this stuff kind of going, I must be crazy, you know, I must be crazy. So I feel like it's a really good time and opportunity because such a spotlight's getting shown on women's health, whether the system takes advantage of it or not. It doesn't matter anymore because with the internet, there's just too much information. And, you know. For good or bad. Yeah, there's a lot of crazy information out there too. That is, that's a whole other side. Right. Oh my gosh, that. However, you know, this piece of it, and I don't like it when things go one way, too much one way or the other. You know, I live like very much in the middle. Like, you know, there's the people that hate Western medicine. I go, my son would be dead if there was no Western medicine. There's people that like can't stand the integrative, I'm like, you need all of these things. Why not take the best of everything? And that sounds like what you've been doing here is just let's take the best of everything. If, if we need blood pressure medications to get your blood pressure down, hopefully while you're getting it down, you're also working on the things and maybe you can taper down, but maybe you can't.

It doesn't matter. You know, you bring such a good point. I was recently out on the Navajo Reservation in Arizona. I really just love working with the Native Americans, but so much that I learned when we're talking about integrative medicine. So one of the things that they are looking at is how How do they combine Western medicine with their traditional healings? Yeah. Because a lot of people still want the traditional healings and expect them, and there's ceremony involved in it, and, you know, a sense of belonging, and that this is part of what takes place even before you go to the hospital. And how do we bring— How do we bring the old and the new together in a system? And I think that that's exactly sort of what you're talking about as well. When I look at also our Native American population, say, how do we kind of bring these two things together, the old and the new? Whereas within our culture, we sort of want both. And we don't want to say no to one or the other. We sort of want— like you said, we want to be middle of the road. Can we create something different? I say the answer is yes. Yeah, sure.

You can create your own system. You just probably can't do it within the current system. Right. So, and you look at it and go, if you could just take an outline and go, here is what I would love you to know, having been in this situation now for what, 3 decades, 2 decades? Yes. Okay. You look fabulous. Thank you. Is women represent, they present differently with symptoms. They do. Some of the earliest symptoms are when you're pregnant. Use that as a gift. As a gift. As a gift. That's right. Like, that's a gift. And know your family history of that, because if you know that, that's also a gift. Mm-hmm. And then know which test to monitor. Mm-hmm. And if your doctor won't run 'em, A, get another doctor, or B, you know, go to a place like— there's, there's lots of places now doing this direct-to-consumer labs, which at least give you the information that you can bring back to the doctor. And then know what you need to monitor and know the symptoms. Mm-hmm. And if your doctor passes you off, go get a different one.

Get a second opinion. You know, utilize telehealth services. You know, so many options. Think about home blood pressure monitoring. Think about how you can have information with you. Take your medications if they are prescribed because that's how you're going to stay healthy. And remember that 80% of heart disease is not genetic. It's not genetic, it's not family history. It's choices that we're making, the way that we're living, including how we're managing or not managing our perimenopause or menopause. All of those increase or decrease your risk of heart disease. So just remember, 80% of heart disease is all behavioral. It's all choices here in the US. That's incredible.

Mm-hmm. Yes. Okay, so if you were gonna give people one action step, step, one thing they're going to walk out with, do this one thing first, what would it be?

The one thing that I would say is I want people to move. That would probably be the one thing I want people to just move. If I were to have a second thing, I want people to get good information about hormone. Good, bad, or ugly, get the information. And then if I were to say a third thing, I would say, manage your blood pressure. It is probably the single greatest contributor to heart disease, especially for women in perimenopause and menopause. Get a blood pressure monitor, stay on top of it, take it the same time every week or every day, have good technique. You can follow me. I show you, I demonstrate actually on my social media page how to take a blood pressure correctly. Correctly. And we want to make certain that you do that because there is a right and a wrong way to do it. So, you know, sometimes just, just easy things, you know, take your medications. Just, you know, doctors aren't— you know, I know we're talking a lot about doctors being wrong, but doctors aren't wrong about everything. Okay, we're just— there's this one thing where we are changing.

It's not even that they're wrong, it's that they don't have that other information. Right. And, and again, I was asked to teach a nutrition course in a college and the amount of time it was gonna take to get it from their curriculum into the testing, into the— I was like, "Oh my gosh, it's just a nutrition course." Right, right.

By the time it gets into like the testing, all of the information has changed.

Yes, so that's the biggest challenging part of it is just, and then you're bogged down in work all day. So, you know, this is why, We've got to have you out as much as possible.

And this is why I'm working to get it into the medical school curricula. So the resolution will go before the American Medical Association. You know, they have tons of them that'll come in from all 50 states. So this one will come in from Georgia, from me. But, you know, it's sort of like the Supreme Court. They'll choose which ones, you know, they want to move forward. But it's there, right? We have to make— we have to at least keep knocking at the door. And then hopefully, you know, with the state of Georgia— I'm from Georgia, if you're wondering, why is she just focused on Georgia? Because I just live there. I live in Georgia, so I'm just looking at Georgia at the moment. But there is legislation that has been introduced in a few— a paucity of other states. So I would like to add Georgia to the list. Again, it may not be successful, but it is a knocking on the door. And sometimes people, legislators as well, need to be made aware of the information. They have to learn as well. Um, and I don't know how long it will take to socialize. I hope I'll be successful first time around, But we'll just keep knocking at the door because it has to be required in training, in medical school, during residencies, during fellowships, not when you're out practicing. And now, you know, the horse has left the barn and you're trying to put the horse back. Let's actually teach it the right way from the beginning.

Well, thank you for what you're doing. Amazing. So where are all the different places? Your Instagram, I would take it.

So Instagram @DrJaneMorganDR. Just D-R-J-A-Y-N-E. I have a Y in my first name. Thanks, Mom. Dr. Jane Morgan, M-O-R-G-A-N. So that's Instagram, but also on X and Threads and YouTube. And you can find me on LinkedIn at Jane Morgan, M-D, J-A-Y-N-E Morgan, M-D. I'm on TikTok as well. So I probably do the most on Instagram and LinkedIn, but I don't know, I kind of have a lot on YouTube as well, so it's hard to know.

Excellent. Well, thank you. I appreciate it. And we will be linking to all of that in the show notes. Okay. Thanks.

I loved it.

Just a recap from this episode that was just mind-blowing for me is the most powerful thing we can do is really get to know our bodies and pay attention when they tell us things. Don't brush them off. I'll never forget working out with a client and she started having pain down her arm and I wanted to call 911 and she was like, this was like a big fight over whether we're gonna do this or not. I'm like, don't brush these things off. Better to be safe than sorry, right? Remember the test that she talked about and what you need to ask for and getting that EKG, getting the baseline and monitoring your blood pressure. There were so many important takeaways in this episode, which is so important because again, this is the number one killer of women. So let's make sure that we're putting everything that we can in place so that we can have an amazing life and age powerfully. If you've got friends out there who need this information, please be sure to share it with them and I will see you you in the next show. Be sure to join me next time for more tools, tips, and techniques you can use to look and feel your best and be built to last. Would you prefer an ad-free experience? Join my VIP podcast at subscribe2jj.com for just $4.99 a month or $49.99 a year to unlock uninterrupted unlimited ad-free access to all the episodes and insights you love. Also, I'd love to connect with you and hear your thoughts on the podcast. Here's how. First, subscribe to the podcast and leave an honest review. Second, take a screenshot of your review. And third, text it to 813-565-2627. That's 813-565-2627. 855-565-2627. When you do, I'll reply using my brand new Virtual JJ. It's my on-demand virtual self built from my books, talks, and years of experience so I can interact with you directly. You'll make my day and I can't wait to hear from you. Thanks for tuning in and I'll catch you on the next episode. Hey, JJ here. And just a reminder that the Well Beyond 40 podcast offers health, wellness, fitness, and nutritional information that's designed for educational and entertainment purposes only. You should not rely on this information as a substitute for, nor does it replace professional medical advice, diagnosis, or treatment. If you have any concerns or questions about your health, you should always consult with a physician or other healthcare professional. Make sure that you do not disregard, avoid, or delay obtaining medical or health-related advice from your healthcare professional because of something you you may have heard on the show or read in our show notes. The use of any information provided on the show is solely at your own risk.

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