This is a number one reason women in the US are dying. Heart disease is not only the number one killer of Americans, it's the number one killer of women. The first heart attack of a woman is more often fatal than the first heart attack of a man. No one taught them what to look for. Jaw pain is actually a very common symptom of heart disease.
Women will often mistake it for tooth pain and see a dentist. And guess what? You get to the dentist, they don't find anything wrong with your tooth, but the dentist isn't thinking jaw pain. I need to send this woman to the emergency room. Dr.
Jane Morgan is a leading cardiologist and one of the most respected medical voices in the country. She's led groundbreaking research on women's heart health. Hot flashes are not haha. This is not funny. They are markers of an increased risk of heart disease, an increased risk of stroke.
In this episode, she's breaking down exactly what women need to know to protect their heart. When we look at foods, we look at things that are more anti-inflammatory. I'm a big fan of the Mediterranean diet and what they need to avoid. Those are the kinds of drinks we want to be very, very careful about, especially those with artificial sugars because the data has shown. So, I have told the story before, but I found out I was in menopause on live television.
Well, during the commercial break, I was in the middle of reading a news story, and suddenly my heart started racing, beating out of my chest. I could feel sweat dripping down my back, my hands shaking, and I couldn't catch my breath. I thought at that moment I was having a heart attack, and it kept going. Later, I found out it was a really intense hot flash, and that I was in menopause. Looking back, though, not once did I think to see a cardiologist.
And the truth is, most women don't. We don't realize that menopause impacts our heart. We don't get taught how to read the signs. And too often we get dismissed. But today that all changes.
Dr. Jayne Morgan is one of the top cardiologists in the country. She has changed the way that I approach heart health. The truth is the number one killer of women is heart disease. And that's something we all have to come to terms with.
No matter what age you are, it is so so important for you to hear this episode. Whether it's for you or a woman you love. The next hour will be a road mapap to protecting your heart and advocating for your health. Before we start though, one tiny favor, please. If you can take just five seconds to subscribe, rate, and review this podcast.
Your support helps us record more life-changing interviews like this one. So, let's go ahead and get into it. Dr. Morgan, good to see you. Oh, Tamsen, so wonderful to be here.
I'm excited you came first of all to our studios. I really appreciate it. I think I'm hearing myself talk more and more and thinking more and more about heart disease lately because for me and I think for a lot of women for years I thought of it first of all as a as a guy's disease. My dad had heart disease his father had heart disease and not so much as a women's issue but that is the wrong way to think about this. It is the wrong way to think about it because heart disease is not only the number one killer of Americans it's the number one killer of women and we just don't get that message.
You know, women, we are taught socially to conform, be agreeable, suffer, don't make noise, make everyone else's life nice, you know, take care of yourself last. And somehow in the midst of that, we've also not gotten the message that we have a heart or brain or liver or any of the other organs, right? So, whenever you talk about women's health, people think it's all about reproduction, right? Is about breasts and pelvic mammograms and papsmears which are very very important but the fact of the matter is men have all these other organs as well surprise. What drew you to cardiology?
I grew up and my best friend lived across the street. Her father's an orthopedic surgeon and you know interestingly the person who lived on the left of us was a dermatologist and guy who lived on the right was a family practitioner and the guy in front of us was an orthopedic surgeon. So my best friend lived across the street. We would go over there and play and we would be down in the basement. These are days when you actually played.
And on rainy days, we'd go down to the basement and make these blanket houses. And I would always sneak into her dad's office cuz he had all these medical books with all these gross, weird pictures in them. And I would go and go through the pictures and, you know, and then close them and try to put the book back so he'd never know we were in there. And I think that really started to foster my interest in medicine, right? Just playing on a rainy day, making blanket houses, sneaking into her dad's office, who was an orthopedic surgeon, to see how many gross pictures I could find.
I later sort of developed an interest in medicine. So, went into medical school to become an orthopedic surgeon because that's what I knew about medicine, orthopedic surgeons, and the gross pictures and all the textbooks I've been secretly looking at. Wasn't reading them, just looking at the pictures. And sometimes I would read a little bit like, oh, didn't know what the words were. It was all Latin.
So then I go to medical school and you sort of your world starts to get bigger and you start to say, "Oh, there are more doctors in orthopedic surgeons. This is interesting." I remember in medical school I did a rotation in rheumatology. I had never even heard of rheumatology. The study of arthritis and I still don't know what it is, right? That's like rheumatology.
What is that? So as long as you were open to your world getting bigger, it just got bigger and bigger and bigger and eventually I couldn't decide what I wanted to do. So I did internal medicine which is just basic right this is internist breadand butter medicine and in doing so I did a cardiology rotation and just loved it. So this is way late in my career. I'm out of medical school.
I'm doing an internal medicine residency and I come into the world of cardiology and critical care. I liked cardiology better. I like the EKGs. I liked reading the squiggly lines. And then critical care involved a little pulmonary your lungs.
And I didn't like the sounds of the lungs, the gurgling, the sputum. I was like, "Oh, no. That's not for me. Don't really like that." The heart was good. It was just blood and and blockages and plaques.
I could do that. And the EKGs were good. So, it's interesting the kinds of things that turn you off. When you look at cardiology now, maybe from where you started, was it predominantly men that would come to be treated and women that didn't come until things were so bad? I I don't know.
When do you get a cardiologist? Not until you have a problem. Not only was it predominantly men that came to be treated, it was predominantly men who were doing the treating. It was all men and me. In fact, I often was ignored in the room and they would ask when the doctor was coming.
This is after I had done a complete physical exam and had completely talked to the family. Everyone was in agreement and then I would leave. They would say, "Well, when will the doctor be here?" And I would say, "Oh my goodness." And I would turn around, take a big breath, and go again because I had introduced myself as doctor. So my lab coat does say that. So people were expecting to see a man and probably expecting to see a white man.
And so even if I introduce myself as doctor, the lab coat says doctor, I go over the entire history, I do an complete physical exam, they still are waiting for the doctor. So that's how entrenched it is in our system. And so when you talk about did I see women, people not only didn't think of heart disease as a woman's disease, it was run by men for men by men. And it was very hard to get that entree. And even for me when I entered it, I did not see this as a woman's disease because of what I was surrounded with.
You have male patients, you have male attendants. And so I didn't even see it. I started as I became deeper and deeper involved in it, I started to see more women and I started to recognize that, oh, women always come in with these atypical symptoms. Atypical meaning atypical meaning this is not classic chest pain. This is not shortness of breath.
This is not what we think about as a heart attack. She probably is having a pan panic attack or some anxiety or something else is going on. But just to be sure, we're going to have a cardiologist look at her, but it's not really that serious. We call those atypical symptoms, meaning they've got something like back pain or fatigue or not feeling well. These generalized non-specific symptoms.
I started to see, wow, the women always have these symptoms. Men never get this diagnosis of atypical. I didn't put it all together, but I had started to notice that early in my career. What are the three main symptoms? Men would come in usually chest pain, shortness of breath or pain on exertion.
I feel fine until I walked two flights of stairs or when I got excited in a meeting, I started to have chest pain. We would call those classic, it's called anggina, angginal symptoms of chest pain. Women wouldn't generally come in with those kinds of symptoms. But what was interesting is that when men even came in with what we would call atypical symptoms, they generally were not given that diagnosis. They were given more of a benefit of the doubt.
They wouldn't write the word atypical in their chart. They wouldn't dictate it. They would say, "A man comes in with symptoms that are suspicious of chest pain." And you know, language drives our action or inaction. And so the word atypical was a dismissive term that was relegated more to women. And I noticed when men came in with those exact same symptoms, they were not given the term atypical.
They were say, you know, symptoms suggestive of, they would use other terms that also then would drive men towards more aggressive care. Do you think that's why we lose more women to cardiovascular disease? No, it's absolutely one of the reasons because there's a a delay in care. There's a delay in women recognizing it, not through any fault of our own, right? We don't recognize it because the system doesn't teach us to recognize it.
The simp system doesn't really even teach us that our health is of value beyond reproducing children and tending to the family. Can you say that to anybody who is watching or listening right now? What do women need to know? That our value is beyond reproduction and even the medical system only values women's health in the in the terms of the confines of reproduction and beyond that we sort of are dismissed. And that's why we have to take charge of our health.
We have to take charge of our health. It is very difficult. So not only do we delay in symptoms because we don't recognize them, then once you get to the health system, you've got another hurdle because the health system is also minimizing your symptoms as well. And for every five minutes of delay you get to getting to a cath lab, getting your artery open, your risk of death continues to increase. So 37 minutes of a delay and that's an average is a huge delay in getting life in getting life saving therapies.
Yes. So what does that mean? So 37 minutes could be the difference between life life and death. Absolutely. It's the difference between life and death.
That's why the first heart attack of a woman is more often fatal than the first heart attack of a man because there are these 37 minutes built in. And when you say 37 minutes, remember that's the average. Some people are out three and four days, right? Because you're at home and you're trying to do all these other things and you're not feeling well and people are not being supportive of you and they're still asking you to do things and you're still tending to other people and wondering why you're not feeling well and no one's encouraging you to go to the doctor. People are asking you when's the next thing that they need.
What are some of those key symptoms a woman listening should be aware of now to make sure that she doesn't wait 37 minutes? If you're feeling nausea, especially if the nausea is chronic or it comes and goes. Nausea is not normal. Ladies, don't tolerate nausea. Oh, I'm not feeling well.
What do we always say? I think it's something that I ate. I think, you know, my aspirin is bothering me. I think I whatever ran too much. We always make an excuse.
Stop making an excuse and actually listen to your body. Nausea is one. Jaw pain, a big telltale sign. Jaw pain is actually u a very common symptom of heart disease. Women will often mistake it for tooth pain and see a dentist.
But see the dentist late because it's not an emergency. You maybe don't run straight to the dentist, but at some point you make an appointment to evaluate jaw pain. And guess what? You get to the dentist, they don't find anything wrong with your tooth, but the dentist isn't thinking jaw pain. I need to send this woman to the emergency room.
They just do the oral dental assessment and send you out. So, nausea, jaw pain and then if you are tired, we should not normalize being tired. We normalize that. Why? Because we've got a million things going on.
We have 12 plates spinning in the air, another seven balls that are bouncing, and then we're trying to take care of a million people on top of that. And so, you have a million reasons for being fatigued. But ladies, do not normalize fatigue. If you are tired, see your doctor. If your energy is low, see your doctor.
So I would say those three things, nausea, jaw pain, and fatigue. Do not normalize them. Make sure you see someone sooner rather than later. What is jaw pain? Why is jaw pain a thing?
It's called a referred pain. So it's a pain referred from the heart. So you can think of a little bit like acupuncture. You might do the acupuncture in your hand for something that's bothering your back. It's a referred pain.
Wow. I I didn't I didn't realize that. I guess, you know, I It's funny. I have a friend that that I work with and we were walking in the park one day and she's like, I'm just so tired and my I said maybe is Dr. Morgan.
That was Saturday, Sunday. Yeah. I called her. How you doing? Yeah, I just I said I think you should go to the doctor or the the 24-hour just see what's going on.
She went to work the next day and did a a tellaalth appointment and the tele health person realized the doctor realized that she was in cardiac stress or distress and sent her there. She was having a heart attack. Of course, she was. Look at how we delay care. We say let me just wait.
But we don't do that for our children. We don't do that for our spouses. We only do that for ourselves because the system encourages us to do it. And we also don't recognize that the Yeah. Is a heart attack.
Yes. Because men don't get described as they get described as crushing chest pain, an elephant sitting on your chest, shortness of breath. And yet we are much more complex and individual and unique and beautiful creatures. And we need to own that and have more people in medicine on the forefront who look like me, who look like you, who can put the dots together and begin to put women at the center of healthcare instead of over at the edges. And it has to start with research.
And it has to start with research. It does starts with research, but it also starts with advocacy. It also starts with awareness, right? And in this big era of social media, we have an opportunity to get the information to people now and for the people to bring it to their doctors. We can work it back.
I'm pushing as many people there as I can. In midlife, we often chalk things up to stress or hormones. You have published work that has a real connection between menopause and heart risk. That's right. Can you talk about that?
Would love to. So part of what I do is I work in the digital health artificial intelligence space looking at cardiovascular solutions for people remotely how you can monitor these things yourself. That includes so my company is called Hello Heart. I'm the vice president of medical affairs there and we have a remote cardiovascular system for blood pressure. When we looked at digital health looking at the system and looking at women in midlife and comparing them to men and also comparing women at midlife to premenopausal women.
It turns out that if you are utilizing artificial intelligence or digital health solutions, women in midlife have an actual better response to lowering their blood pressure than if they were not using digital health solutions. So it's interesting to note that women in particular women in midlife are engaged in digital health in their phones in solutions and once they make that connection they will actually follow it and do the coaching and the advice and have much better results than either men or premenopausal women. Digital systems meaning an app that you're following or tracking Bluetooth enabled app. So in this case it's a blood pressure monitor that is connected to a Bluetooth enabled app on your phone that not only gives you your real-time readings. It gives you your trends over time.
Gives you information. You can ask questions. It can provide solutions. You can keep your medications in there. You can track your cholesterol.
It turns out when midlife women are simply tracking their blood pressure with the app and getting encouragement and feedback and their questions answered in real time, the responsiveness is much better, much greater decrease in blood pressure. And we know during midlife is when your blood pressure is going up and you're increasing your risk of heart disease, increasing your risk of heart attacks. It turns out that digital solutions are very aptly connected with midlife women. So it just goes to show you all those plate spinnings, all those balls bouncing, we're looking for something that can simplify and integrate into our lives and help us. And once we find it, we connect with it and we get those results.
So, I was really happy to publish that because I think, you know, this starts to open doors into how are we going to approach women's health. One of the things that I always say is it can't be the same old thing again. The way we've done it doesn't work. I don't like the people who've been leading it. I don't like the people who've created these guidelines.
They haven't included you. They haven't included me. I'm not interested in doing it that way. So from my perspective, digital health and artificial intelligence will actually be driven in the health system by this new paradigm of women's health that we are going to define. And it will be women's health that will put artificial intelligence and digital health on the map because we're the ones who really need it.
And we're not looking for the same old thing. We're going to go in a different direction to get the answers that we need and perhaps allow it to expedite the years and decades that we have lost out on quite frankly. Ding ding ding. Okay, that's right. Accelerating research, you know, these randomized clinical trials.
Maybe, maybe not. Maybe we'll go to artificial intelligence modeling and get the answer in six months instead of waiting 12 years, you know, and it may be women's health that will actually be driving this change. So it's super super exciting. We're the ones in in the greatest need and I think we are more interested in doing it a different way and showing the world that this is how it's going to be and then science is going to track alongside behind behind us. So this is the world that I work in.
This is what I'm hoping to I like you in the lead, my friend. I like you in the lead. Hot flashes and that hot flashes can be a very big indicator of something with your heart. Can you go into that and talk about it because I I think it's really important that since we come from a place where hot flashes have been the haha, right? That's been the thing everyone laughs about and yes, I understand that it can be humorous sometimes in the in the right context.
The truth of the matter is that that can be a very serious indicator of something else going on in your body. Not only can be is a serious indicator. So I was at the American College of Cardiology conference in Atlanta, American College of Cardiology, and they presented some very interesting research. Now it was not in the main theater. It was sort of on the last day in a back room all the way at the end.
Find it. That's right. Where we find women's health and menopause. But the fact of the matter is that that small room was actually had people in it. And I went in and they were presenting a very very interesting paper.
Now there weren't a lot of people in it but it there were people there. I I actually did not expect to see people to be quite frankly but the research presented was quite interesting. So they presented data on a trial where they enrolled women and they looked at the number of hot flashes they were having in a week from 1 to six. Now I know people who are listening like one to six hot flashes in a week. I have that in a minute.
I know, but I'm just telling you the research, right? So, the paper was set up one to six hot flashes in a in a week. Those women who had the most hot flashes in a week, six or more actually had narrowing of their corateed intimal lining. So, what is that? So, corroded arteries are the two big arteries on either side of your neck that feed the brain.
If those start to narrow, right, it decreases the amount of blood that can get to your brain, which means it decreases the amount of oxygen, which means it increases your risk of stroke. So those who had six or more, the women who had the most hot flashes had the most narrowing and the greatest increase of stroke. It successively decreased the fewer hot flashes that you have. And so hot flashes are not haha. As you said, this is not funny.
They are markers of an increased risk of heart disease, an increased risk of stroke. And what we're trying to figure out is is it the hot flashes that are are markers of of letting us know or is it that women who have more hot flashes already have more advanced disease and therefore this is what the hot flashes are telling me. Hey, my corateed artery intermaligning my corateed arteries are narrower than they should be. Either way, it's a telltale sign. When you go to your physician's office and you say you're having hot flashes and night sweats and sleeplessness and any number of symptoms of pmenopause, it should not be sort of a pat on the back and they're there and you'll get through it.
Even if you are prescribed, you know, medications to control the symptoms. What needs to happen in that physician's mind which is not happening which is why I make a point of publishing scientific data in journals that doctors read is that you should see that person in front of you as someone who is now at increased risk of heart disease and you should act accordingly. So if someone says I have hot flash or a frozen shoulder or that shouldn't be let me send you to the orthopedist let me give you an anti-depressant you can do all of those things but you should say aha this woman is telling me that her risk of heart disease is increasing and she's in the right age group let me ask some questions about parmenopause and menopause and begin to actively reduce her risk. Does she need to be on statin therapy to lower her cholesterol? Do I need to talk about weight control?
Do I need to really aggressively monitor her blood pressure? Do I need to get her on a home blood pressure monitoring system so we can see what her blood pressure is like in real life, in real time, what we call in the real world, and not just in this snapshot of time when you're in the doctor's office who we're we're starting to recognize we don't even know what that blood pressure really means. It's just a snapshot in time. It's just one moment. We're just taking a moment.
And so that's what these symptoms are telling us. And that's the connection the dot to dot that the health system is still not yet making because we don't have the scientific data being published which is why I am making it my life's work to publish data because that's where doctors are going to start to read it and start to think about it. And then we get it into guidelines. Now good luck kudos to the American Heart Association. They've actually put out some guidelines and the American Stroke Association actually put out some guidelines.
So, we're starting to think about it. People like you and others who are making a wave, lots of doctors. So, we've got these big organizations who now are starting to think about it, starting to at least publish some guidelines. They're not aggressive guidelines because they're looking for data. What are the type of guidelines that So the guidelines for American Heart Association, American Stroke Association are about recognition, midlife women, looking at blood pressure, looking at cholesterol, how aggressive should you be, is it something to be taken seriously?
Is there an increased risk of heart disease? And the American Heart Association, American Stroke Association are yes, yes, yes, yes. So that puts it on the doctor's radar. Now, it doesn't tell them what to do or how to treat it or what, but it's just saying, "Hey, this is out there. We're thinking about it.
You should think about it, too." If someone is listening right now, and I know we have listeners that are permenopausal, post-menopausal, menopause, what can you do to lower your risk of heart problems or heart issues, right? The first thing you need to do is have a talk with your physician or your healthcare provider, whoever this person is, and just have the conversation. Now, if you have a physician or other health care provider who's unwilling to have the conversation or can't have the conversation, then it may be time for you to transition to another doctor. And I and I and I say that often, and I say that with kindness. I've had to leave doctors.
It doesn't mean that they're not a great physician, that they haven't taken care of you all the way up to this point, but it may mean that now you need something else and you have to now look for that something else and move on to find what you need. It doesn't mean you have to take hormones. Doesn't mean you have to ingest them or use patches or do anything. You simply want to have a conversation with someone who understands it, who believes it, who can provide some valid validity to you, where you can feel seen. We talk about that.
Feel heard and have an intelligent conversation at least based on the data and information that's available today. As I said, American Heart Association and the American Stroke Association have published on it in the last year. So there is some reference via which to have these conversations for physicians. Could it be as easy as getting on hormone therapy to help reduce any risk of heart disease or do we have that correlation yet? Yeah.
And can it be that easy? And that's really a big question because we go back to the paper and the information that was presented at the American College of Cardiology. The question that isn't answered which may be when we have the next session coming up is if these woman women started hormone replacement therapy do we see a regression or an opening of their corateed arteries. So in other words do they have fewer symptoms and now we actually see these the plaque going away. Now very few there have been very few drugs that we have that actually cause a regression of plaque formation.
So plaque can actually decrease statins are one of them. So the medications that we often use to treat cholesterol can actually make your plaque smaller but we don't actually have a lot of them. So that's the question that we need to answer. I think what we think now is that it certainly can keep it from progressing and getting worse because ultimately what we want to do is decrease your risk of heart disease and stroke. I have a lot of women that are now listening and hearing this information and coming up and asking on the show, I I passed this window of I'm past 60 or oh gosh, I went into menopause 12 years ago.
Is it too late for me to do something now to protect my heart, my bones, my brain when it comes to hormone therapy? What is the answer to them? So, the old answer at the age of 60 or 10 years after menopause, we think, oh, you know, the window has closed. You've you've missed your window of opportunity. But new age thinking is maybe not.
And the reason we said that is that the data shows that in the first year of starting hormone therapy after you're 10 years or more beyond menopause, you do have an increased risk of heart disease, an increased risk of effects. Mostly that happens in the first four months. After that, however, your risk drops back down to normal. And so it it was thought it's not worth taking that risk. When we take a look at it, that risk is actually quite small.
And everyone's history and their physical activity level and physical being is different. How however many chronic medical conditions you have, what are you managing, that kind of thing. And so now we say it's an individual conversation that you will have with your physician. All 60 year olds are not equal. All people who are 10 years post menopause are not equal.
And so the answer is maybe have the conversation, but it's no longer no. That's a great answer. There you go. That's a great answer. I'm going to brag on you for a minute.
Oh, please do. Dr. Jayne Morgan is not only an incredible cardiologist, publishing research, but also has 17 certifications for Pilates. I do. Which is going to bring me into some lifestyle solutions because we talk a lot on this show about strength training and cardio and the best things to eat and the best ways to work out and I know there's a lot of noise out there but I want to come to you with this question.
There's a big focus on strength training and I know it's really important right now for protecting your bones and your brain and to make sure we don't fall and we don't slip and we're, you know, not frail as we get older. Do we do strength training and skip cardio or does that go against everything that you stand for? Right. We do both. And so I'm I'm going to combine and I know you're saying what a what a copout.
Tell me everything. Every anybody could have said everything, but here here's I'm going to just give you some context for it. And then and then as with everything, you can curate it and individualize it. So American Heart Association, remember I'm a cardiologist. We follow guidelines.
That's why I'm publishing research and data because doctors follow guidelines, right? We just we just, you know, aren't able to say whatever. We think we have to be able to have guidelines. So, the guidelines from the American Heart Association say that we should get 30 minutes of moderate activity, exercise for five days a week. We should combine that with some degree of resistance at least two of those days.
Is now modifying that somewhat because it can be hedged. If your activity is high intensity, then you can go to 3 days. If it's moderate intensity, it's kind of hard to remember. What I generally will say is that you need to get at least 30 minutes of movement in. I really prefer the word movement than exercise because people find exercise daunting.
They need an outfit. They need clothes. They need a membership. They need to be able to get somewhere. They've got to have a a a a girlfriend or a partner who's going to go with them.
They don't want to be the only one in the class. You hear every excuse in the book, right? So, I prefer the word movement. Now, movement has taken away all those things, right? We don't need a cute outfit.
We're It's just moving. So, I want you to pick an activity that you like. And when I say activities, it's not exercise. Activity, something that you like or something that you'll be doing that day anyway, and do it for 30 minutes. And then twice a week add some resistance.
So for instance and and at the risk of sounding I'm just going to say housework. You're going to do housework on a Thursday and you'll be vacuuming and mopping and doing laundry and blah blah blah blah blah. Try to do that intentionally for those 30 minutes. And then maybe if you want to add some resistance, carry the laundry basket up and down the stairs two or three times. Just have some movement.
If you're a gardener, then when you're getting out, crawl around on your knees to each of your different plants and just be in movement for 30 minutes. You can certainly walk and you can play pickle ball and you can do all these other things if you want and canoe and get with your friends, but if the word exercise just drains you, I want you to move away from exercise and say, "I'm just going to move for 30 minutes." Maybe you walk to your mailbox and then walk to your friend's mailbox and walk to your next friend's mailbox and come back and come just move for 30 minutes. That is it. You can wear whatever you want. So how many days you can look?
Yeah. How many days? I know. And so that makes it easy. We want you to move for 5 days a week.
Human beings, homo sapiens are made to move. Part of the reason that we are breaking down, we have chronic inflammation in our bodies and chronic medical conditions like the hypertension and cholesterol and obesity and kidney disease and diabetes and blah blah blah blah blah is because we don't move. Think of yourself, your body as a car and a beautiful a beautiful rare car that's so nice you keep it garage and you never take it anywhere and then when you get ready to drive it doesn't even start because you haven't used it. A lot of us haven't used parts. In order to keep that car running, you got to use the parts.
The parts got to move. So think of your body as a car. You've got to actually use it. We're made to be in motion and we've stopped moving. For somebody who feels out of breath after mild exercise, how do you know if that is an issue to be aware of or it's a deconditioning?
It is probably an issue to be aware of. And if you are feeling out of breath with mild exercise, you should definitely see your physician. Now, if you're out, you know, running two miles and you haven't run in 10 years, please don't come to the emergency room cuz you're out of breath. You're out of shape. And so, you probably shouldn't have started with the two-mile run, right?
Why don't you walk for half a mile for for a week and then so so be reasonable, people, and understand? But if you're just doing mild exercising, your shortness of breath or things that you used to be able to do, let's say you are a high level maybe marathon participant and and suddenly halfway through you you're running out of energy and you're feeling short of breath. That is abnormal for you and then you need to see someone. But these are people who are highly trained and they're doing marathons. That's when they need to see someone.
For people like me, I don't run marathons. If I decide to get out there and run a marathon and I feel like I'm about to die at the end, that's really my fault. I'm deconditioned. I should I should hydrate and probably go home and rethink my activities. I'll be there for you.
A lot of women talk about heart palpitations during this time. Is that something to be aware of or is that something that comes as a result? I know you're already I already see your look. If you if you're listening, you can't see the look she just gave me, but she gave me she gave me the look the Dr. Jayne look.
If somebody has heart palpitations and permenopause or menopause, what is that an indication of? Okay, so let me tell you my story and and and for all your listeners, I want you all to remember I am actually a cardiologist. I know tons of cardiologists. This is my world. So at 40 maybe four had gone through a divorce.
I had young children at home. I started having palpitations. Had never heard of anything about palpitations with permenopause. Think about this people. I'm an actual cardiologist.
Started having palpitations. They were coming and going. Couldn't get them to to go away. I saw a cardiologist. He had a full workup and was told that I have mital valve prolapse.
So mitro valve prolapse means that there's a valve on the left side of my heart that's a little floppy. That's an explanation. I'll tell you what. Wink wink. It means when you give a a woman the diagnosis of mital valve prolapse, it generally is something that we are saying to each other that she has anxiety.
So we generally mital valve prolapse it's real but for the rest of your life when doctors see that on your record anything that you come in with they'll say oh that's her mital valve prolapse because it's associated with depression and anxiety and panic attacks. So, you can have might valve prolapse and I did. It was it was mild one plus, but I'm sort of not a panicky person. I'm not really an anxious person. I wasn't really feeling depressed.
So, wasn't really buying it. But I recognize, okay, I've got mal valve prolapse. But the palpitations were still there. Couldn't figure it out. I just decided I'm a cardiologist, people.
I decided I was going to have to live with it, right? This is how women are. Suffer through it. I just suffered through I mean nobody could find I guess I'm not dying. I don't know.
Nobody knows. I wore a halter monitor the whole thing. But I had mital valve prolapse and it's like it's all in your head. That's really what they're saying without saying it. Wink wink.
Then I started to have vertigo. Saw a neurologist had a big workup for vertigo. They couldn't figure out why I had vertigo. It's actually one of the reasons I was doing Pilates. I started doing down dog.
All of these things because they said your Pilates will help with the vertigo because it will force you into positions where you will be sicker and over time your vestibular nerve will reset and you will feel better. I'm not kidding. This is from a neurologist. I'm a part of the system and this is what's happening to me in the system. Then I started having itchy ears and at first I thought I was coming into money.
There was something about there's like an old wives tale like if your ears are itching you're going to come into money or something. And I was like, "Oh, I think I'm going to come into money. I've got itchy ears. This is kind of weird." And then I talked to my mom, right? Turns out it's not itchy ears, it's itchy palms.
So it wasn't itchy ears. So it's like, "Oh, I must have allergies." I didn't see the doctor then. I just thought, "Oh my god, I've got these itchy ears. I was always making those weird sounds with my with my throat, trying to get my ears ringing my ears, that kind of thing. I never ever ever got a solution.
There was no doctor that put it all together. Oh, itchy ears, vertigo, palpitations, that must be parmenopause. I was still having regular menstrual cycles. Nobody knew. I certainly didn't know.
None of my colleagues knew. Why? Because we had never gotten any training in it. I didn't even know itchy ears were part of parmenopause at that time. I did not know at all.
All I knew were hot flashes and then that was just something that people went through. So that's my experience as a part of the system coming through the system that is creating doctors and we don't even know. So if you are listening or watching, you should not feel badly that you don't know what's going on because one doctor after another has told me a some other kind whether it was anxiety or not sleeping or can't remember tools in the the alarm. Heart palpitations is that a sign what is a heart palpitation? Is there a is there a quick definition for that?
Oh, the heart palpitation is like your your heart can be beating very fast and we've got estrogen receptors on our heart as we start to lose our estrogen and you know I hate to use the word lose because during parameopause sometimes it's just irreg it's fluctuating so it's not you know following a regular cycle our 28 day cycle it may be fluctuating and because you don't have binding of estrogen to those estrogen receptors regularly on your heart you can start to It's symptoms like palpitations, but nobody knew anything about it. I've never I never even heard the word menop. I was a cardiology fellow. I was a pacemaker fellow. I trained.
This is like my You make me feel better about myself. No one has ever used the word menopause in cardiology like ever. Ever. Never. You know that must be something maybe in OBGYn I assumed, but I don't know.
They were way over on the other side of the hospital. We never interacted. I had no idea what they were doing over there. And we cardiologists are over here. And then I find out years later, that's right.
When I talk to my OB/GYN friends, turns out, one of whom is my sister, by the way. She's an OB/GYN. Turns out they're over there not learning anything about menopause either. So, none of us knew anything. If someone has experienced heart palpitations or hot flashes, they should go talk to somebody.
They should talk to somebody. See your primary care physician. M your if your primary care physician is unaware or unwilling or unenlightened, talk to someone else. Find someone. It doesn't mean that someone has to treat you or someone has to fix you, but someone needs to have information such that you can make informed decisions about yourself.
These symptoms are not nothing. They are indicators of advancing risk of heart disease and stroke in women as we go through parmenopause. And that's how you must look at these symptoms. You cannot look at them as just an inconvenience or an annoyance or something you have to suffer through. I mean, for me, itchy ears, clearly that wasn't going to stop me in my tracks.
It was a mild annoyance. But the fact of the matter is, it should have stopped me in my tracks, especially vertigo. That's right. It should have said to me, "Oh my god, my risk of heart disease is increasing. Instead, I'm waiting for a trove of money to drop out of the sky because my ears are itching." You know, so it's just all itchy ears has to do with heart disease.
Yeah, apparently. But nobody told me because itchy ears are related to the parmenopausal changes in skin with collagen decreasing and your skin begins to thin. The first place that you will notice thinning skin is the inner lining of your ear where you already have thin skin. So the first symptom that you will have of thinning skin throughout your whole body is your inner ear. It will start to itch because this the skin is getting thin.
And how does that pertain to heart heart disease? So there's a indicator that your risk of heart disease is increasing. It's a permenopausal symptom of estrogen decreasing. And the first indicator you might get is your ears are itching. That those itching ears should have said to me, again, I want to remind you, I'm a cardiologist, itching ears should have said to me, "Oh my god, Jane, your risk of heart disease is increasing." Instead, nobody knows.
And don't forget, I'd already seen a cardiologist for the palpitations. I already been to a neurologist for vertigo, you know. Instead, you went to Pilates. That's right. Instead, I went to Pilates to do more downward dogs to force myself into positions that, you know, luckily I didn't end up on my head with a cervical fracture and lose dizziness because they thought I needed to reset my vestibular nerve.
I know sleep is a big issue during this time. Does sleep impact heart disease risk? It does. And again, back to data because I'd like to stick with data. What we have in data is that duration of sleep of less than 5 hours per night increases your risk of heart disease.
Those people who have 5 hours or less less than 5 hours of sleep per night in the study had a higher risk of heart disease than those who got 5 hours or more of sleep. So in the cardiology world of research and data where we live, five hours is the cut off. Now five hours doesn't even seem like that much but five hours is the cut off between whether your risk of heart disease has increased or decreased. What happens during pmenopause? You have sleeplessness, have chronic interruptions of sleep.
You may fall asleep and then wake up later, not be able to get back to sleep or you know you may lay in bed all night and finally not fall asleep till 4 or 5 in the morning when it's time to get up. You know those kinds of things that all equates to you are missing the duration that fivehour duration and if you're not getting that duration your risk of heart disease is increasing. So sleep is a risk factor for heart disease and then during parmenopause sleeplessness occurs along with blood pressure increasing along with cholesterol increasing. I mean it's amazing we haven't put all this together before along with increasing weight and fat deposition. All of these are risk factors for heart disease.
They're happening all at the same time. So pmenopause and menopause this is a time that you should be thinking about your heart more than anything. More than anything, heart heart risk, right? Should you get a cardiologist even if you don't necessarily have a quote problem? I would say yes, but I'm going to put a caveat to that.
Lots of smart doctors out there. If your primary care physician is engaged, your primary care physician can absolutely manage all of these symptoms because ultimately what you want to do is manage those symptoms that you're feeling that are intolerable that are making it hard for you to live, hard for you to focus, hard for you to get work done. You're uncomfortable. And I say that and also remember you don't have to suffer. So I'm sure some of you are saying, "Yeah, but I can deal with it." I'm going to throw those into those that you're having to deal with.
We don't want you to deal with them. So, you can certainly have medications and therapies that can control those symptoms, but we also on a deeper level need to have preventive and proactive therapies for those things that have not yet happened. So, we want to prevent heart attacks. We want to prevent strokes. So, that means more movement in your day.
That means if you're smoking, you got to quit. That means tighter control of your diabetes if you haven't been serious about it. That means weight loss, which is a hard time to lose weight loss and regaining weight. So, that's another another subject. That means really monitoring your blood pressure because your blood pressure can suddenly increase between your doctor's appointments.
It was it was normal one year and then the next year you go and it's high and you literally have done nothing else. That means controlling your cholesterol and getting treatment for your cholesterol, not allowing it to hang out there. So, yes, all of those things, you can have your symptoms treated for comfort, but you also need to proactively and preventively be working to drive your risk back down. Another way to drive your risk down, the correlation between foods that are protective for the heart. I know that we've talked about this before and I was kind of fascinated by some of the ones you said yes and no to.
Can you break down the foods that are protective for your heart? So, when we look at foods, we look at things that are more what we call anti-inflammatory. I'm a big fan of the Mediterranean diet and I know it does incorporate it incorporates sort of natural protein because it has a lot of beans and it has a lot of chicken. But for those who are vegans or vegetarians, you know, the kinds of things you need to think about are in a simple way those types of foods and vegetables that have a lot of animation to them, a lot of color, a lot of zest. They're not bland.
They're sort of interesting. They add some, you know, dynamic to your plate that wouldn't ordinarily be there. Those are the kinds of foods that you should be eating. Beautiful colors. If it has a beautiful color, it's probably something that you need to ingest.
It's going to have a lot of antioxidants and vitamins and all kinds of things in it that will be helpful to you. Often times people ask me, should I eat it raw or should I eat it cooked? You know, so there's a whole big, you know, field of study on this, but I would say eat them as you like. The only caveat to that is do not add salt or please minimize the amount of salt. Try to use other seasonings and eat them as much as you can in their natural format.
You want to have foods that reduce the inflammation in your body because inflammation is what drives heart disease as well. But also foods that are feeding you with vitamins and and nourishment and not empty calories. Alcohol. A study was released last year that scared everybody. Can you talk about that study?
It was it wasn't vague but it was scary. Well, American Heart Association has moved in the last year because of that study to recommend zero alcohol. No alcohol is what's recommended because there is no amount of alcohol that is beneficial to the body. It's all toxic to the body. So the American the stance of the American Heart Association is not don't drink it.
It's that we're not recommending it for your heart health because there used to be a recommendation of a couple of glasses of wine a week, couple glasses, especially of red wine. And that's because, you know, red wine contains flavonoids and flavonoids are really powerful antioxidants and anti-inflammatory agents that are very good for your body. And it was thought, oh my god, if you drink red wine, you know, you can really improve your heart risk. But it turns out that the toxicity of alcohol is greater than the amount of flavonoids in the red wine. So we say there's actually no amount to drink for heart health.
You can certainly drink it for enjoyment, but don't include red wine as a part of your heart health regimen. I'm going to have beets, squash, I'm going to eat some hummus, red wine, and I'm going to be there. So red wine can't be a part of it. If you want to have it, you can have it, but it cannot be a part of your heart health regimen. I love that.
It It does have the interesting look you described in the vegetables though. Yes, it does. Coffee or energy drinks. How do you feel about those for the heart? So, back to data.
There's actually interesting data that shows that coffee, especially black coffee, actually might have some beneficial effects on the heart. Well, thank goodness there's some good information, some good news and all that. We might be able to drink up in coffee. Green tea, specifically green tea, the same energy, coffee and green tea are okay for the heart. They seem to be okay for the heart.
We'll just continue to follow the research, but yes. Okay. Energy drinks probably a no. They all are not made equal. So, some are high in sugar, some are high in artificial sugars that are even worse than the natural sugars.
So those are the kinds of drinks we want to be very very careful about especially those with artificial sugars because the data has shown when we look at things like the saccharins like the artificial sugars there's an increased risk of heart disease increased risk of stroke and also an increased risk of cancer. So, we're trying to reel in especially the sodas and and all types of drinks where these artificial sugars are are just fulminant because it helps you advertise that it has low calories and it does have low calories but it also increases your risk. So, but it has the other stuff but Yeah. So, it's probably better to just have real sugar. If you're going to have some sugar, have raw sugar.
I know when we met, you were on stage and I was kind of blown away. I was standing on the side of the stage listening to your first the first speech, the first time I'd ever met you in Brooklyn. And you know, you talked about a lot of different things and I think it was the first time that I really tuned into how important cardiovascular, you know, health is and how to pay attention to it. For black women, the risks are even higher. They are.
Can you talk about that and how menopause may look different? I'm going to Africa in two weeks and I'll be in Liberia. I'm specifically going to be spending time with women and trying to understand their menopause experience. You may say, well, why are you going to Africa to do this? Part of the interesting part of Liberia is that Liberia is a country in Africa that was founded by blacks who were original Africans who came to the United States as slaves were slaves here and then repatriated back to Africa and created the country Liberia.
So really as a group of people they are I am thinking the most aligned outside of this country with African-Americans because they were African then they were African-American they went back to Africa. So, a very interesting I'm going to be speaking and meeting with a lot of these women because the experience of menopause is so much harsher. It's so much longer. It's even less discussed if you can believe it. We do not discuss it in our families and even more tolerated and you're expected to tolerate it.
But it is long and you know there are a number of things that could be driving it. Nutrition is one of them. I think good nutrition is really important and often times just from the history of slavery from the history of eating the refues of foods from the master's table. So things that they didn't want or things that were parts of the pig they didn't want or things but that we had to eat to survive and how we learn to take those and make foods. And make them flavorful so we could survive.
Those are the very things that are killing us now. The the techniques that we learned to survive and to make food that was not palatable to slave owners but had to but we had to eat it. And how you're going to make it such that it's edible. All of those techniques are now killing us. And so, you know, there's a whole culture to kind of unwind that when we talk about connecting the dots, people often don't even understand that it's the food because they'll say, "Well, collarded greens are very nutritious.
Spinach is very nutritious. The cornmeal is fine." Those things are fine in their raw form, but that's not what you're getting ready to do to them, right? So, a whole lot of stuff's getting ready to happen before. And those are the dots that we have to start connecting because when you sit down with the plate, the plate looks like, oh, look at all these colors. Look at all this stuff.
But they're things that are have had to be formulated to make them like rudabaggers, you know, are very bitter or very hard, but but but when you get ready to eat them, they're delicious. That means there's a lot that has happened. Something's been done to them. That's right. That's not healthy.
And so we are rampant with high blood pressure and cholesterol. And then often as well live in communities where maybe there's not access to green space. We're not moving. We're not walking. And then if you talk about women being, you know, relegated to secondass systems in the health system, if you talk about blacks, we often don't even want to go to the health system because we weren't even considered at all as part of the health system.
And so there's that distrust that then leads to even poorer health outcomes which all translates into more severe menopause symptoms. So more intense symptoms more intense more intense symptoms longer it's the foods it's the activity it's the epigenetics meaning how you live and how your ancestors lived and it is the weight the weight gain that's also coming that's a culmination of the entire diaspora and so there's a lot to unfold there but yes symptoms are longer they're greater duration they are even more poorly understood, there's even more suffering. I would say almost no one seeks relief from them because it's not expected that the health system is going to take it seriously anyway. And an underrepresentation in research and trials, complete under reppresentation except in areas where we've been abused and we were over represented. And so that's one of the reasons why it's very hard now to get blacks to participate in trials because there's just such a distrust and there's a large trove of medicine that has been developed just on our atrocities that were done to black people.
I mean the almost the entire world of gynecology was built based on atrocities done to slaves. And so people know that and and you know sometimes even when people don't know it, it's hard to explain. It's almost like your body remembers like the ancestors whisper to you. You know, why am I hesitant to that? No one's ever actually ever said something, but I had a visceral reaction.
It is something that is handed down through the generations through your ancestors that's kind of whispered in your ear without anybody telling you about it. That you automatically kind of withdraw and then sometimes you learn later. Sometimes you do have the information. But it's interesting and I always say listen to your body. I tell that to women as well.
Your body will tell you. Your body will tell you. And sometimes there's just that reaction and you can't even explain it. Like I just got maybe you don't even need to because you just trust it, right? You got to just trust it.
You have to just trust it, right? But we're moving now into an era and I say now, you know, I I I don't really know even now what's going on in research and science. But when we say we're moving, I mean, there is opportunity for principal investigators to be African-American, for people to have an opportunity for African-Americans and blacks in this country to really step up and participate in clinical trials because we've got to have data that's relevant to all populations. The way we do research in this country is we get data on white men. And globally, white men make up only 9% of the entire world's population.
If you can believe that, 9% of the entire world's population. But the United States, we make drugs and we make devices for everybody. But the only thing we really know about it is that it works on 9% of the people. Everybody else, we're just extra and the rest of us. We sure hope so.
We sure hope so. We sure hope so. And doctors know that. So, here's how we practice medicine, especially for women. When women are coming in and we're either, you know, sizing valves for devices or prescribing medication, we often will down adjust doses.
Nothing science to it. We can say, "Oh, she's kind of a smaller lady and you know, the trials are done on men." Like, you know what? I'm going to give you half a dose. Or what we'll do is we'll prescribe pills that we call scored pills. Meaning, if you ever gotten a pill, it's got a little line in the middle.
Those are called scored. Doctors love scored pills because we can tell our female patients, just break that in half. So if we give them the pill and they call back and say, "Oh, you know, I'm I'm dizzy or I had too much." Then we know, oh, that was probably too high. We can say, "Cut it in half." And they can easily cut it in half. Those are scored pills.
That is unscientific science that we practice every single day on women because drugs and trials are done on 9% of the demographic. And then when you talk about blacks and Indians and every other race in the world, Asians, we have no idea what we're doing. So what do what do we do so people don't lose hope? I mean, there is there a way to get involved in the research trials? Is there a way to find out more about it?
If somebody is listening right now and says, "Hey, okay, I want to get involved in this." Do you recommend that? And yeah, absolutely. I recommend everybody get involved in clinical trials because because we must have data that is relevant to everyone. So we can stop with this scored pill therapy, which is what I call it's common pra there a lot of things that are common practice in medicine that technically are voodoo. Oh gosh.
Technically, we don't really have any science on it, but we know that it's maybe not the best thing for this patient. Okay. But it's all that we have. So what can I do to try to, you know, fit a square peg into a round hole? For women to get better, feel better, handle something there, there's not another option in many cases.
And I'm not saying that we haven't made it feel better. I'm just saying that there are some areas where it's been a little hocus pocus because we need data because pill formulation was based on 9% of people and women are 51% of the population in the United States. So you know that oh them that oh them oh those women that you're going to have to figure out something for these other people and doctors will have conversations like oh you know I broke that in half do you do that and another doctor will say you know what I I I have my patients just go to every other day and not break it in half and another will say oh you know what I do but so we all have some way of finagling it with our female patients. What do you want women to walk away with today and especially understanding heart and cardiovascular disease in midlife? You must empower yourself and take charge of your health.
Get good information. Talk with your physician. If it's not the right physician, move on and do it right away. I had a good friend who told me something her grandmother told me and I always remembered it because this is how women think. There are seven days in the week.
I want you to do it. Do something for yourself today. There's seven days in the week and someday isn't one of them. I always say live your someday today, but that is really good. Dr.
Jane Morgan, where can people find you? Often, you know, will publish my data at Jane Morgan MD, but I'm also on threads and Tik Tok and YouTube and you can find me in a lot of places. So, I hope you follow along. I talk almost always science. I do a lot of media interviews that sometimes are not related to cardiology.
They are whatever's in the news at the time. But I do a lot of media interviews, but I speak a lot about science and medicine and menopause, digital health, artificial intelligence, clinical trials. I hope I make it entertaining and fun. I do a stairwell chronicles as well. 60 minutes, 60 seconds. I sit on my stairs and I talk to you about some aspect of medicine in 60 seconds or less.
Hopefully, you find it entertaining. You can take a little leaf, put it on your tree, and continue to kind of grow your whole bush at home and get smarter just because you're following me. You're wonderful. Thank you so much. Thanks, Tamsen.
I loved it. Oh, I loved it, too. I really hope this conversation with Dr. Morgan left you feeling informed and empowered because when it comes to your heart, knowing what to look for and what to ask for is the care that women deserve.
