What is the first thing that you would drop for
women in their 40s to know about heart health?
Your risk is not really lower than men. Hypertension
is actually more common in older women than it
is in older men. Diet, like a bit of a pescatarian
diet, so to speak. It's very hard for Singaporeans
and Asians to do. You need about 150 minutes
a week of moderate intensity exercise to pass
if your heart's healthy, but you fall down when
you're going down a flight of stairs. It's still
not great. Everybody was just no carbs. Every
girl wanted to be tiny and little. You can be
strong and being strong is great. and welcome
to The 40s Formula, your go -to place for insightful
discussions on navigating the 40s and thriving
in this transformative decade. We're your hosts,
Jasmine and Amanda, two women that are passionate
about exploring the challenges and adventures
that come with turning 40 and what lies ahead.
Dr. Jean Ong is a cardiologist at the National
University Heart Center Singapore and Ung Teng
Fung General Hospital. She has clinical interests
in women's heart health, heart failure, cardiac
imaging, and cardiac rehabilitation. She is passionate
about spreading awareness on heart disease in
women. When she's not working, Jean can be found
throwing around a barbell in the gym or chasing
after her border collie. All opinions expressed
in the following episode are her own. and do
not represent any hospital, institution, or constitute
any medical advice. All right, well guys, you
know that I'm about to go full fangirl today
with the guests that I have been waiting to talk
to you for the past few weeks, who I've been
calling the CrossFit cardiologist. She didn't,
she didn't coin it, but I'll take it. She's both
a consultant for the National University Heart
Center here in Singapore and a competitive CrossFit
athlete. So in other words, she's a total baddie
in all walks of life. Welcome, Dr. Jean. Thank
you so much for having me. Yeah, we are super
happy to have you here, as you know. Oh yeah,
Amanda has been going on and on and on about
this episode. I'm so glad. So what is the first
thing that you would drop for women in their
40s to know about heart health? That's such a
difficult question. I want them to know everything.
Yes, I want them to too. I think the most important
thing that I would advocate for people to know
is that your risk is not really lower than men.
Your lifetime risk is not lower than men. A lot
of women think heart disease is a... men's disease
and they don't consider it to be something that
they will have to worry about in their lifetime.
But because we kind of live longer than they
do, we tend to experience heart diseases much.
you know older age it's more complicated so that's
kind of like the first thing i do want people
to know first thing is beware it's going to get
you in the end yeah but no you're right i operated
under that misunderstanding before that it's
like oh you know men die of heart attacks women
die of xyz right but it's like no we just die
of older heart attacks in a way yeah very much
so so to that end right i found a youtube video
where you're talking about the shocking fact
that women die of heart failure at higher rates
than men can you can you explain that so heart
disease heart failure like what are what are
the distinctions so usually when people say heart
disease they're talking about blockages in your
heart arteries so that's very long word for it
is atherosclerotic coronary artery disease which
in in and of itself is a it is more uh a male
disease but when we talk about heart failure
that's kind of the end point of all heart disease
if you don't treat heart disease well your heart
gets weak or you're unable to pump uh effectively
and that's heart failure the sad thing about
heart failure is there's there's a few different
types this one where your heart is stiff and
this one that where your heart's weak women get
the stiff heart one more common so the function
of the heart by right It's normal. Okay. But
you're not filling your heart as much with as
much blood. So you're still not getting enough
blood to the rest of your body. That's one. So
we get that. And honestly, the treatment for
that type of heart failure is very complicated.
It's very complex. And only in the past, maybe
five, 10 years, do we actually have. you know
guideline directed medication for that uh first
for the weak heart um surprisingly as well that
is kind of more common in men but we women are
still less likely to get all the medication required.
So the chances of women dying after a heart attack
from heart failure are actually higher than men.
Oh, so okay. So that's where that kind of number
comes up. There's a lot of little nuances to
it, but there are numbers in various aspects
to show that women overall, after they get diagnosed
with heart disease, they do way worse than men
do. What would you say are the biggest driving
factors that cause... heart disease or heart
failure in women? You know, is it something that
we're eating? Is it something we're doing or
not doing? What would you say? So it's very different
in different parts of the world as well. I think
here, but one of the most common things that
has come up is actually hypertension. So hypertension
is actually more common in older women than it
is in older men. It's also less likely to be
treated well. When you say less likely to be
treated well, what do you mean? So women get
less medicine, get less medicated for it. They
are on lower doses of medications. Is there a
reason? Yeah, why is that? I mean, there's been
many people who've looked into this, you know,
many studies out there, but it's just multifactorial.
Women don't like medicine. We also don't feel
that we should be taking it. We all prefer to
take supplements over medicine. You're talking
to two nutritionists. Believe me, we know people
do not want to take medicine. They'll take whatever
unregulated supplement. They will take some oil
and powders and whatever, but they're not going
to take their medication. Also, you know, if
you see a little old lady or a small little lady
come in and her blood pressure is a bit high
and she goes, I'm a bit nervous. You're like,
it's OK. Yeah, it's white coat. Yeah, it's white
coat. You're anxious. Go home and relax and you're
fine. So I think there's a lot of little nuances
to it, but it's still something we're trying
to figure out how to get over as well. OK, let
me tell you this. This is an honest example of
myself. So I'm just going to cut the shit. I
am a woman in my 40s, early 40s, always been
active, always been. athletic never been overweight
no risk factors except yeah that i do have a
father with high blood pressure who is medicated
right so medicated normal blood pressure but
unmedicated high i've never been medicated my
blood pressure is always high normal so if 120
over 80 is like you know normal normal i'm always
like 130 over 85 for someone like me what would
you recommend so by and large right now it's
still a lot of you know, lifestyle modification
at this point in time. Because we also don't
want to medicate people for long periods of time
if they don't need to. So by and large, I think,
if I'm not wrong, the American guidelines do
just state to modify your risk factors. But there
is a whole train of thought of people who are
aiming for blood pressures of under 120 for everyone.
And I think that becomes a very personal choice
as to whether or not, you know, does your dad
just have high blood pressure or does he have...
complications of high blood pressure and if he
has all these complications do you then want
to take measures earlier to prevent yourself
from getting those complications yeah but if
he just has fairly well controlled high blood
pressure you know you're fairly healthy doing
what you you know you're doing everything you
should be doing then then um what more is there
to do really at this point i guess that's true
yeah yeah and hey i'm gonna give my dad a shout
out here my dad is 76 years old about to be 76
years old and he runs a 5k every other day wow
so either three or four times per week depending
yeah my husband is always like your dad's the
healthiest old dude ever like he has one little
blood pressure med is no big deal but but again
because i have it i'm like ah like why so does
the hypertension or risk of hypertension change
or vary depending on like your ethnicity or your
background so for example would somebody who
is of american descent have generally a better
blood pressure than someone who's let's say of
indian descent or someone who's indian living
in england another hypothetical so i'm just wondering
because you know if 120 over 80 is the ideal
Is it really the ideal or would that change based
on who you are, where you're from, what you do?
There's a little bit of variance in who you are,
where you're from. But I think in all populations,
there are people who are at higher risk and there
are people who are at average risk and things
like that. I mean, obviously I know the Asian
statistics or the Singapore statistics better
because most of my practice has been here. But
I do think that in America, the blacks and Hispanics,
they do have higher risk. south asians wherever
you live unfortunately you have high risk i'm
so sorry to tell you i know i know this like
the indian gene first we found out it was bad
to be married remember and now we find out it's
bad to be south asian sorry but that ethnicity
doesn't necessarily contribute to your blood
pressure being higher it just means that if you
do have high blood pressure maybe you want to
be more aggressive with treating i've actually
got hypotension oh interesting do you pass out
i've never passed out so actually whenever i've
gone to get checked i've always they're all i'm
like Like low average, but I've never passed
out. And when I had my DNA thing done, it says
I am at risk of hypo. But I think because I work
out and I do, you know, I eat plenty of salt,
you know, I'm fine. She's salty. That's okay
for now, I think. Like how hypo is problematic.
Yeah. I mean, nowadays we know a lot of women
who have POTS. um it's postural autostatic tachycardia
so very long i have i've had the full term yes
and they've got uh inappropriate sinus tachycardia
we talked about it a lot uh after and during
during covid because so many people had it during
covid i kind of feel that so many people had
it during covid because everybody had at the
same time so therefore they when i have this
oh you have this oh this actually is a thing
whereas if we all had it at different times you'd
be like It's fine. But what happens is, you know,
actually when you sit to stand, your heart rate
should increase and some people's increases abnormally,
things like that. So they can pass out. Having
changes in blood pressure from sitting to standing
is perfectly normal. And usually if that happens
and you do faint, our general treatment guidelines
are usually, again, mostly lifestyle, salt, isotonic
drinks. If you feel like you're going to pass
out, lie down on the ground. There are medications
for it, but we don't like to give it because
these medications cause hypertension and things
like that. But I think low blood pressure in
itself is not really a danger if that's what...
you've always had. Obviously, if your blood pressure
suddenly became low from being high, then that
might be something else. But if you're always
on the low side, that probably protects you,
you know, hopefully. For something. Yeah. It's
like that came full circle. What about food?
Now, we always, I mean, the sort of the past
thoughts have always been, you know, cholesterol
is going to lead to heart disease. High fatty
food is going to lead to heart disease. What's
your thoughts on that? Disclaimer, not a dietician.
Not a nutritionist even. But I think from my
kind of understanding is that, you know, diet
trends always change. At the end of the day,
we do know the basics. Too much of anything really
is a problem. The heart healthy diet is always
kind of the Mediterranean diet, which is fish,
lots of leafy vegetables, some legumes, some
carbohydrates, but not a lot. So that's kind
of the tried and tested. diet like a bit of a
pescatarian diet so to speak it's very hard for
singaporeans and asians to do because you go
to the hawker center and everything is cheap
and good and and fried and fried yes and not
fishy yeah yeah i'm not so strict with my patients
i tell them if 75 of the time you're well behaved
and 25 of the time you're not that's better than
i feel like you're kind of most people say 80.
yeah yeah 75 is gentle you can tell you you can
tell you're working 80 but i kind of go by like
if you have four four meals a day you know like
one of them can be yeah one of them can be a
little cheeky yeah but if the rest of them are
good then you're still kind of winning because
if not a lot of people end up restricting too
much And then they go the complete other direction.
So, yeah, but I mean, I don't think there's any
magic diet. There was some data on intermittent
fasting. There was some data on ketogenic diet.
There is a very interesting dietitian here who
does healthy keto. Yes. Which, yeah, which honestly
basically is kind of. like the Atkins pescatarian
diet. It's kind of just low carb, but she's actually
used that very effectively in patients who are
obese and actually decrease their risk. But if
you look at what's actually happening, realistically,
they're just restricting their calories, losing
weight. And yeah, so. Yeah, my mother -in -law
was in that study, in the pilot study for the
healthy keto. So she was one of those individuals,
the elderly, you know, 65 plus Singaporeans that
was given the meals and all this stuff. And it
was wonderful, you know, and I think, you know,
healthy. keto it needs to be rebranded to something
that isn't because as soon as people hear keto
they think oh no no I have a heart problem I
can't do keto and it's like okay what can we
call it I feel like pumped up pescetarian but
it's really great because they got a thumbs up
or a thumbs down depending on if the food fit
the framework you know so for for elderly people
it was fantastic right because it's very clear
thumbs up thumbs down no need to track macros
you just see the little thumb yeah and then obviously
the meal delivery service was the additional
level it was such a great program so props to
that doc yeah it was great it's amazing and i
think that these are like at the end of the day
that's what you need you need people who are
really doing things completely differently to
actually change you know how people see things
and how they do things because if not every singaporean
is going to be like where do i get healthy You
know, for example. Exactly. Yeah. And until until
unfortunately the Hawker Center has like cognac
noodles or something, you know, something that's
like a true alternative. Yeah. It's never going
to change. But even then it's going to be pricier.
You know, so then it doesn't have to be, though.
The government has plenty of money to subsidize
whatever they want. Oh, yeah. OK, please don't
take my podcast off the air. Maybe one day. Yeah.
And I mean, so diet is obviously one huge part
of lifestyle. Right. But girl, you are standing
before me with these guns like we have to talk
about. exercise like exercise is another massive
piece of the puzzle yes so if we're talking about
what exercise moves the needle toward better
heart health talk to us about it it is unfortunately
um cardio exercises are good for cardiology i
guess it's actually quite a fair bit of exercise
you need about 150 minutes a week of moderate
intensity exercise Yes. Two. to say that you
are gaining a benefit. What's moderate? Oh, so
there's so many ways to look at it. But the way
that I feel is the most accessible to most patients,
it's just you can talk, but you can't sing, which
is what I use for my elderly patients. We want
you to be able to talk, be a bit out of breath.
But if I ask you to sing, you wouldn't be able
to. You know, if you've got heart rate zones,
go ahead and use that. So if you're using your
watch, kind of a zone two to zone three would
be where you would go, bearing in mind that the
watch is not super accurate for you. heart rate
um but yeah it's usually half an hour five times
a week or you can be like me and choose hit or
high intensity interval training because then
you get to do half the amount which is 15 minutes
it just feels much worse 10 times harder i feel
like i i mean i do do hit as well i actually
prefer it i prefer to just get it over and done
with Amanda, I feel the older we get, the more
important protein is. But the thing is, not many
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.sg, get cooking, and who knows? You could even
get $250 off your next shop. I have to say, I've
been running and doing a little bit more Zone
2 now, and it is still very enjoyable. Dr. Jean,
so off -brand. I tried High Rocks. I did High
Rocks. Did you really? I did. Here in Singapore?
Yeah, we actually managed to qualify for Chicago.
Wow! It's just because no one else did the pro,
you know, and we were CrossFit girlies. So we
were like, we have to do the heavier weights.
So we did them and nobody else did it in our
age group really. And we were like second and
we were like, oh. Oops. So now I've got to go
there and be not embarrassing. So we've been
running. But you will have to run. That's true
fact. That's what puts me off my rocks is the
running. I'm going to be honest with you. It's
a running event with some other things. Yeah,
but it's only 1K at a time. So it makes it a
little bit more. I do like the other things.
I love the idea of the other things. Just the
running. I'm like, ah, it's still 8K. Can I do
it? Just think about 1K at a time. That usually
helps. Because that is what you literally have
to think about. Even those laps, right? It's
like one lap at a time. And then it's like, okay,
I can get three in the night. So because of that,
I've been doing a little bit more running. So
that's nice. It's nice to get a variety once
in a while. But the hit's great, especially if
you're busy. Women are always busy, I feel. You're
stuck with all sorts of responsibilities sometimes
you did or did not ask for. Can I ask you about
the HIIT though? So I think this is something
that I think women in their 40s get a ton of
conflicting evidence about, right? So let's talk
about what is HIIT. Okay, so what type of exercise
qualifies in that category? And then what the
dosage of that exercise would be optimally? And
then, you know, I'll bring up my counterpoint.
So again, very, very debatable, even amongst
the cardiac. rehabilitation community. People
don't quite know, even in the cardiac rehabilitation
community, how to administer HIT in a consistent
way. Because, you know, continuous 30 minutes,
everyone knows how to do that. Plunk a patient
on the treadmill, set it, look at your heart
rate and go, yeah, you've done 30 minutes. But
there, you know, anything that kind of increases
your RPEs to, I mean, we're going out of 10 here.
So seven, seven and above, six to seven and above,
or your heart rate zones are four to five and
you come back down, that is HIT. So you're doing
high intensity at various intervals. People have
gone anything from eight minutes on, one minute
off, which is literally like, what, two cycles?
To going four minutes on, one minute off, anything.
People have found that regardless of which one
you do, they do provide some benefit. There are
studies that have suggested that they increase
your VO2 max a little bit quicker, faster, and
there's more time saving. But these, if I remember
correctly, they're still a little bit because
we're not really testing a person's true VO2
max most of the time. We're taking a watch parameter
or something along those lines. VO2 max seems
to be the buzzword right now. Lots of people
are talking about it. So for people who don't
know, could you just explain what that means?
So this is perfect time because I just went.
for a VO2 max, like a CPAT study. So the cardiopulmonary
exercise test study thing yesterday or the day
before. So basically we're testing when your
body changes from using aerobic to anaerobic
exercise. And that is kind of the maximum kind
of oxygen your body can process beyond that it's
processing carbon dioxide in my very layman terms
of describing it. So it's like you're a lactate.
threshold. People use it to determine fitness,
health and things like that. There are some people
who believe that your maximum VO2 max you could
ever achieve is genetic and it's not something
you can change. I don't want to believe that.
If not, why am I running so much? What is training?
Why? Are you willing to share your result? No,
I didn't do it. I've got mine on my watch, but
I don't believe that one. If you ever want to
test, my husband and I run an exercise lab. We
administer VO2 to test every single day. It is
one of the joys of my life. As you know, nothing
I hate more than testing myself, but nothing
I love more than testing others. Because it's
so, first of all, it's a beautiful study in physiology.
Second of all, it's a beautiful -er study in
psychology. Because when you, this is what I
wanted to bring up with women pushing to zones
four and five, or pushing toward your functional
maximum. It is uncomfortable. okay it's uncomfortable
is uh putting it lightly you you get to the point
well let's put it this way it teaches you a lot
about yourself in terms of what you can handle
and and what you're willing to trade off yeah
you know so you mentioned which i agree with
hit is excellent for time poor women right you
don't have a lot of time do you have 15 to 20
minutes yeah let's hit it that sounds very appealing
when you're actually in the zone five workout
And you are operating at a heart rate of, you
know, like for me, like 176. It's unbelievably
uncomfortable. It's so awful. It almost pushes
you to the point of panic because you're like,
can I finish? Can I keep on going? Right. So
the cortisol and the stress after that, you know,
of that intensity of effort can be really difficult.
I think for particular for some women, particularly
those who have a lot of. chronic stressors in
their life yeah so this was kind of my point
is like is HIT for everyone um are there patients
that you would advise choosing different modalities
it's very personal what you decide to to me I
you know I it's very crudely I say I don't care
what you're doing as long as you're doing something
and you enjoy it I think that's what we also
say and it's something you can maintain yeah
and for me that might be hit because it's faster
it's quicker I enjoy it chronic stress wise I
feel that it's a great place to to expend all
of the stress. Especially in CrossFit when you've
got some weights to smash around. It's great
just being able to drop something and it not
break, you know? And it's funny you say that
about like expressing stress, right? Because
yeah, so you can probably tell from the way I
describe it. Zone five makes you want to die.
The CrossFit Open is literally my worst nightmare.
It's my worst nightmare. It's like having to
perform at my best over and over and over. Usually
I give my best like once a year. I have to give
my best three times. Anyway, you know, I hear
a lot of women say like, oh, you know, I love
exercising because it like, you know, I think
about my kids and the example I want to set for
them or whatever. I actually, when I'm exercising
at that level, it's when I do not think about
my kids. I don't think about anything. I think
about raw survival, getting through without disease.
And like, you know, it's one of those things
where I think that can be appealing. Like if
for women who've never tried it, and I'm not
saying CrossFit, I'm just saying that intensity
of exercise. Yeah. Being able to have an outlet
like that can be really powerful. And so dissuading
women away from it, I think is a bit of a disservice,
right? Because it's like, hey, it could actually
be a solution for you, you know, for women who
struggle with. lots of stress i really resonate
with that i feel like the only time my brain
is not thinking of something else is when it's
thinking about trying not to die yeah breathing
yes yeah which is really because you're just
like i'm taking a breath i'm okay yeah okay i'm
not gonna die it's so true i feel like when you're
in the gym you have like two types of people
especially when the countdown's on for that exercise
you've got the last i don't know 10 seconds left
and you've got the people who are like right
i'm going to smash it and i'm going to go hard
then you've got that oh there's 10 seconds left
i can stop now they put it down yep they put
the kettlebell down they're like that was enough
they're still trying though yeah i mean yeah
everybody's in the same room and i appreciate
that and that that's what i love about crossroads
like everyone's there together yeah Regardless,
I mean, everyone is dying in their own way. So
I think, you know, whether you look like you're
dying less than someone next to you doesn't mean
that you are. I do think that, you know, exercise
is a very personal choice because I've, and I
think. if you've been exercising like all your
life if you played sports growing up if you've
been running if you were like in a situation
where you were dying as a 13 year old yes doing
a sport and your coach was like you're not dying
get up and go you know you know that you can
push yourself but i've met women who have never
exercised all their life come to me and gone
like i went for a run with my partner and i was
breathing a bit hard and something is wrong with
me and Usually I'm like, you know, that's exercise.
That's exercise. And yeah, that's exercise. And
also like wink, like you might be out of shape.
It may be an indicator. But you have to tell
them really nicely. But so there's been situations
where I've had to talk to people to explain to
them like that is what happens when you breathe.
And they're like, no, there has to be something
wrong with me because everybody else doesn't
look as out of breath as I do. I'm like, oh,
sweetie. Yeah, just try again. Like it's honestly
true. Well, so this actually is a good segue
into what I wanted to ask you. getting deeper
into women and exercise right i have found in
my profession that i've seen two major drop -offs
right in terms of when women lose their fitness
level yeah one is pregnancy yep One is perimenopause
and menopause, the transition. Those two transitional
periods I feel are like when women really start
to kind of lose the script on their consistency,
on their self -doubt starts to creep in because
their bodies are changing. Do you see that as
a cardiologist? And then if so, how do you encourage
women to keep going through these times? Even
at this point, you know, my friends, everything
like that. But I think my job is to tell them
it's okay. It's okay if for a phase in their
life they can't. really exercise we've got you
know a lot of great health coaches who work with
us nowadays who try and find little pockets of
time that patients can go and exercise so they
would be they would say you could take the stairs
instead of take the elevator and our general
mantra is that something's better than nothing
Five minutes is better than zero minutes. So
even if that's all you can find, try and do it.
Try and do something with your kids if that's
possible. But if it's really not, if it's really
not possible at this point in your life, then
maybe that's OK. Put a pin in it. Come back to
it later. You know, I mean, I don't want to add
additional stress onto a woman who is probably
struggling, you know, being a first time mom
or with. suddenly two kids from one you know
so they're chasing everyone around all the time
so i usually tell them that phases in life happen
and it happens for everyone and it's okay if
for a period of time you can't you can't do it
yeah but when you're ready get back to it get
back to it it's funny that you say that right
because like so i'm obviously a huge advocate
of exercise in pregnancy but having to choose
something different you know i mean like you
may be able to do crossfit and then and then
that's great you know but you may not So then
being able to choose something better than nothing
is still an option. You know, it's like, I totally
agree with you there. It's like, fine, you know,
either, yeah, know that it's all temporary, you
know, whatever adjustment that you have to make.
Okay, so now we've talked a lot about cardio,
right? Let's talk about strength. Is there any
correlation between strength training, muscle
development, accumulation of lean mass, and the
prevention of heart disease? Are those two things
linked? I think for heart disease prevention,
you can always say that if you've got more lean
muscle, you're able to keep fat off, especially
visceral fat. That's going to improve your cardiovascular
outcomes. But I think if you're talking about
directly kind of making your heart stronger,
better, less the lower likelihood of heart disease,
that's probably not something that has come up.
That being said, when we run a cardiac rehab
program, we still involve strength and resistance
training. say weight training, because not everybody
likes weights, but we want to maintain bone density,
especially muscle mass, balance and stability.
I mean, these are going to all help us as we
age. If your heart's healthy, but you fall down
when you're going down a flight of stairs, it's
still not great. No, still not great. Still not
great. Still don't land you in the hospital.
Have you ever seen someone who is relatively
fit, you know, lots, plenty of muscle mass, great
bone density, but has heart disease heart disease
yeah oh wow because there's a lot of things that
are just genetic that we can't control yeah so
like apb yeah and even then you know like just
just even if you've got high cholesterol in your
family which a lot of asians and singaporeans
do we look really healthy but all of us have
terrible cholesterols um and a lot some of my
patients come up to me and be like i exercise
all my life why do i have heart disease and they
feel really upset they cheated right like i did
this yes they get invested and and this happens
and i tell them well if you didn't do all of
this you would have gotten heart disease 10 10
years earlier five years earlier it's not it's
not like you could have prevented it completely
but you've delayed it significantly there is
also a very unfortunate side of all these things
where over training and marathon training and
and um and uh kind of long distance endurance
athletes do get calcium in their heart arteries
um over time and that's because of just what
they think is the higher shear pressures in your
in your arteries but um you know that's a whole
nother aspect of things yeah that's interesting
i you know everyone obviously thinks cardio more
if cardio is good more cardio is better but not
necessarily not necessarily there's there i can't
remember off the top of my head but there is
like a a peak amount that beyond that that people
do think that it's not good for you but it's
very hard to define because again your genetics
you know how your body is really contributes
into whether you develop those things you mentioned
visceral fat so can you talk about if you don't
mind what is visceral fat like why is why is
this word such a dirty word right and how does
it correlate with heart disease so visceral fat
is just the fat around your organs In terms of
heart disease correlation, I believe that it's
kind of correlated to your general, you know,
your cholesterol levels and everything as well
and your general health. So I think that kind
of correlates to heart disease. Do you guys assess
that with patients? Are you able to? Not often.
We still use very crude metrics here. BMI, things
like that. Yeah. So there's weight circumference
as well. There's a certain, I can't remember
now, if your weight circumference is above a
certain number. at high risk of a whole bunch
of things. Yeah, I do have that number just because
I just gave a talk on it. So it's for Asians
80, 8 -0, Asian females, 88. for caucasian which
is actually quite a big difference yes i know
it's a massive difference yeah but it's also
not a lot really you know i mean i mean i guess
if you look at our relative sizes if you look
at me versus jasmine i think you see the difference
no but i mean you see lots of people with who
have to be above 80 or 80 oh yeah right yeah
you think oh actually maybe i should be a little
bit oh you're saying like those numbers aren't
that big yeah yeah no they're not But no, but
yeah, it's actually not that big. Like I would
say in our practice, and obviously we see self
-selected people for weight management. So of
course, you know, but like, yeah, it's actually
very rare that we see an ADCM or below coming
in with a weight problem, right? Like usually
if there is an existing weight problem, if BMI
is out of normative category, then it's, yeah,
it's. Except when I say rare, I think I can't
think of a single patient that was under 80 but
had like physical fat problems and all this stuff.
But I think we use quite crude. We still use
BMI. I mean, we don't necessarily want to subject
all our patients to all those, you know, fat
testing, things like that. Not in a hospital
setting, I think. And also because you've got
too many different machines. They're not sure
if they're validated, all of those things, you
know. They're useful for if you work out, if
you're at the gym, you want to see your fat percentage
change. But I think in a setting where the patient's,
someone's clearly unhealthy or clearly needs
to modify risk. factors and so i guess you would
know like if someone came in and they had a bmi
of 25 but they look like it's muscle probably
not too much of an issue but if it's obviously
not and they yeah you can tell yeah you can tell
generally so talk us through a day as a cardiologist
so like what what type of patients are you seeing
are you seeing patients like you know like like
what urgency do you know i mean like are you
like you know on the ground saving people's lives
that sounds i mean that's that's what the tv
would suggest yeah that is what i'm basing it
on that yes i think i i think um at least where
i work um i'm quite lucky that we don't rotate
on the wards that much but when we do it's it's
awful um so meaning that we're really busy so
i actually work out in the west of singapore
um in the hospital there so uh when We are on
the wards. We go in for the morning. We see up
to 40 patients in the morning. In the morning,
just in the morning? In the morning, like in
the rounds in the hospital. And then we run a
chest plane clinic in the afternoon and our teams
do an exit round in the afternoon, which if they've
got any issues, they highlight to us. And then
we're on call the whole week as well. So if there's
any issues with patients overnight. um someone
can't read an ecg they give us a call so that's
kind of the more exciting part of it exciting
is a word if people have heart attacks they come
in and we have to whisk them off to the lab the
cath lab and get their arteries stented that's
generally done by my junior doctors now or the
residents so that was me some time ago But then,
you know, I just have to make the decisions about
what's happening with people. We get called for
people who, you know, have heart attacks outside
of hospital and collapse, whether we need to
make some decisions about whether we're going
to do an angiogram tonight, you know, things
like that. That'll be my busy weeks. Yeah, that
sounds busy. But the other times I run clinics.
So we run clinics three to four times a week.
I do run a women's heart clinic. So we see women
-specific heart diseases and things like that.
The rest of the time, we just see everyone. So
people with any kind of heart disease or people
with just chest pain. And then... I either do
some imaging in the afternoon. So I look at heart
scans and things like that. And then I try and
go to the gym. Yeah, well, that's what I was
going to say. So if you guys are hearing what
a day in Dr. Jean's life is like, talk to me
about how you do fit exercise in. Like, where
does that even slide for you? So I'm going to
be very honest and admit some days I do get lucky
because I do this imaging thing. And my boss
has been very supportive that if we don't need
to be physically. in the hospital we can work
from home so he's made it so that we can all
report scans from home which has been great for
the moms and in the team and things like that
um so while they're looking after their kids
i'm at the gym yeah um so flexible work arrangements
guys works for everybody it's the best you still
get your work done you know you can choose to
get it Done whenever. And then that's when I
try to hit the gym. On the days when I'm on the
wards, it's kind of like a 6 p .m. thing. You're
always getting called on the phone. So it's not
the best. But, you know, I try and remember that
as long as I'm doing something, it's better than
nothing. I would say this really wise doctor
we had on the show said something is better than
nothing. Yeah. But that's again, if you can fit
it in with what you just described, I mean, everyone
can do it. Right. What would you say came first,
the cardiologist or the CrossFitter? Definitely
the cardiologist, I would say. I mean, I picked
up CrossFit when I was in residency at some point.
And it was because I could go for an hour class,
get all of these random fun things, learn random
new fun things. And I could do it at like 7 p
.m. because sometimes the classes would run late.
And I could go to work the whole day and then
show up there. Someone would tell me what to
do. um i just got to learn something new i get
to like switch off my brain for a while and obviously
like at that point in time you know i wasn't
really thinking about where it was going in terms
of whether i was ever gonna do things more competitive
to be honest sometimes even now i don't really
see myself as it's a bit of imposter syndrome
when it comes to competing for sure for sure
you're allowed to have it but you don't need
to you're the real deal you know i feel like
you know you know most of the time when you see
me at the gym and it looks like you know everyone's
like oh you're lifting so much you're lifting
so heavy i'm just like it's just it felt awful
yeah yeah i was just snatching 80s it's fine
it's fine like it just feels awful so you just
feel like you're doing your best you know and
and i've been lucky that that's been good enough
to to get me to experience things like competing
and things like that it's amazing that you picked
up crossfit you know and it wasn't like oh drinking
or going to a bar and so do you feel like obviously
going through medical school and doing your residency
kind of influenced that journey as well a bit
or was it purely just a way for you to switch
off it's a little bit of both i think you know
there was definitely a period of time when i
was in when i was in med school and we were out
drinking all the time yeah definitely you needed
one of those things to be a balanced human being
um but i think sometime after that i was one
day i was like i'm not very fit and i was doing
pole dancing for a while wow um and i realized
that i couldn't go more than four minutes without
feeling really out of breath and i went this
is not okay like you know this i know this is
not okay so that's when i started to look around
for other things to do i didn't feel like um
i could run because you'd spend so long on your
feet in the hospital that running just felt like
another extension of that yeah like my feet already
hurt i'm just not gonna make them hurt more.
So I think that was the choice I also made because
I felt that if I'm going to have to sit there
and tell my patients to go and exercise, I should.
look it and now they can't argue because it's
like you know some of them come in and go like
do you work out and sometimes i'm like no i don't
do they do they see you like like nowadays they
would never ask that sometimes they do and i
go like no no i mean like you're lying you're
lying look at the guns obviously what do you
love about crossfit like so you picked it up
through your residency so you came to it as an
adult let's say right it was somewhat of the
gymnastics bits of it you know like just flinging
yourself around i mean i was doing pole dancing
so yeah similar yeah that's transferable yeah
flinging yourself around something i thought
that it had a good kind of balance of of cardio
and like all these other random skills that you
were doing um and then weightlifting just felt
like something to master something that seemed
difficult seemed hard but i kind of like challenging
myself with something and just seeing whether
you can do it or not yeah yeah so i think that
was kind of the thing for me but you know it's
i know it's not for everyone yeah um but there's
so many people nowadays i see doing hit because
you've got places so many functional uh fitness
places like revel bft f45 which are way more
friendly for women i think to go through yeah
well that was gonna be my question right like
how do you you know again we're not crossfit
is not sponsoring this podcast right but let's
just say the sport of functional training right
so something that's different from maybe what
women have been fed in the past right like you
know your body pump or your yeah your zumbas
and stuff like that right like how would you
give advice to a woman that was looking to try
something like crossfit or olympic weightlifting
or using a barbell for the first time but it
just seemed too intimidating like how did you
walk in the door that first time i actually think
i did a um a trial class somewhere and then thought
i didn't like it I think this was way before
and then didn't come back to it for a few years
and then decided, oh. For a few years, wow. Took
a few years off and then thought, you know what,
that was a good time. I was like, maybe I'll
try again at some place different. I think sometimes
it's the place and not necessarily the exercise
that you're doing. It's wherever you go nowadays,
fitness is about community, right? I'm not going
to say it's just CrossFit community, obviously
not, because people at all of these gyms, they
meet. you know like -minded people people who
encourage them even if people are just going
for a run club like they're meeting people that
that that they like and i think that's that's
part of it go with a friend then you won't be
so scared and even if you're you know even if
they decide not to pursue it later on at least
you've changed a habit but yeah i love the the
aspect of crossfit that also kind of encourages
women to be strong and not just you know, the
runner's body or this and that, which is fine,
no judgment to anyone's body, but you know, everyone's
body is different really. So you always hear
sort of CrossFit and paleo together. Did you
ever follow the paleo diet? Do you follow the
paleo diet? What are your thoughts on it? No,
I like my carbs a little bit too much. uh nah
not for you not for me i think i think you know
you've got all these other things that you shouldn't
be doing with red meat you know people have all
of those things down down that line as well but
i think um if you were really subscribed to the
full crossfit thing back then it probably that's
what i think they're they teach in their level
one course they tell you to go on paleo and stuff
like that but um that for me felt a little bit
too much of a one track Thing one -track solution
when there's many many ways to lose weight this
many ways to have a healthy diet I was strict
paleo when I got when I joined CrossFit in 2009
I was also strict CrossFit when I was like in
2009 when I was young and free I did four days
a week every single week four to five depending
right and then I was in run clubs at night so
I get my cardio up and I was strict strict paleo
and I think I've told you this story I had a
memory my birthday that year. So it would have
been my 26th birthday. I remember I would not
let up paleo So. For my birthday, I had my little
ground beef that I've been eating. But you probably
could have had like a paleo cake, you know? I
mean, nowadays there's more stuff. Oh, yeah,
yeah. Back then, you're right. Yeah, you didn't
have Pinterest. I was so gutted there was no
Pinterest back then. That was like my prime Pinterest
date. Now I'm a busy mom. Ain't nobody got time.
I wouldn't do that if I was paid. But, you know,
it's like I was so strict paleo because CrossFit
told me to. And I was really trying to be into
it and be my best. Looking back now, obviously,
in the profession that I do. the maturity in
the sport it's one of those things where it's
like i don't necessarily think that that matches
the sport as well as as well as it no was purported
to so i've been so since i've you know been a
bit more competitive in crossfit we have i do
have a nutritionist She doesn't like me very
much because half the time I don't log my food.
But I'm like, I've got so many things to do.
The last thing I'm thinking about doing is logging
my food. You know, it's been such a evolution
for everyone in CrossFit from going to something
very paleo and low carb to going like, you need
the carbs to perform at the level that you want
to. And then her going, okay, you need to eat
this and that. And you actually feeling the difference
when you train. And it's been, it's been crazy
because, you know, growing up, like when I grew
up here in Singapore, everybody was just no carbs
every girl wanted to be tiny and little i'm surprised
actually that that's a big thing in singapore
like i just assumed well i think being tiny and
little oh yes of course whatever is the popular
path to tiny and little yes yeah it makes sense
it used to be like you know i would not have
lunch and go play tennis the whole afternoon
come home have dinner with no rice and people
were just doing all of these things and that
was the norm because you know people just want
it to be little yeah yeah and you can imagine
if we had some to actually sit us down when we
were kind of school athletes or whatever we were
trying to do at that point in time and just been
like maybe you should eat some rice you know
yeah yeah yeah oh it's so true no I mean Jasmine
knows this I've been on this like well right
now four month gains journey so I'm trying to
put on 10 pounds of mass so I can be more competitive
at CrossFit right because I always joke like
the girls that are my weight in CrossFit are
10 centimeters shorter than me, right? It's like,
I need to get bigger. And one of the big revelations
is how many carbs it takes. I don't know how
you do it though. You saw me do it last night.
We went out for pasta last night and I was like,
I have to eat this. You went out for pasta. Sorry,
we were at a pasta restaurant and I was like,
I have to finish this bowl or I'll die. I had
a pasta this pasta. But yeah, I mean, I think,
yeah, the changing waves of nutrition when it
comes to performance, I think it has made a huge,
it's so much different than it was in 2009. Yeah.
And I, you know, I see all these little, I'll
say little kids. I see all of the younger CrossFitters
coming up now. And I'm like, it's great for you
that you're in a space that this can happen.
And then in the US you have the rugby player,
Ilona Mara, just being amazing. And people have,
you know, people to look up to who don't look
a specific certain way and who are healthy and
strong and are confident. you know, that just
builds everybody up into, into the fact that
you can be strong and being strong is, is great.
Yeah. That's the thing. I think everyone needs
to hear this. Like. aim for strong not skinny
yeah exactly aim for strong and you know my husband's
always quick to say you know like like strength
and size are correlated but not it doesn't have
to it doesn't always mean that you need to be
huger to be stronger right you can work on muscular
strength aside from hypertrophy yeah or you can
have both and then also you have performance
no because i think hypertrophy i mean at least
from what i understand is also very genetic like
how much yeah how much muscle yeah what your
potential yeah yeah so that's what i blame so
obviously you're not skinny skinny you're not
petite in that sense do you find people judge
you or say things to you or are they like a bit
intimidated like a bit scared all the time all
the time but i think it's you know it's not always
out of it's not always ill -intentioned i used
to always get really sensitive about it yeah
but i think that's normal i mean even now sometimes
if like clothes i have don't fit i'm still like
Maybe I should maybe I should cut a little bit
because I want to put my clothes on, you know,
but I think. I think that generally now I feel
that, you know, people have come in and said
like, oh, your biceps are so big, like guys can
be intimidated. And people would just be like,
well, you can get them if you tried. Amazing,
I love that. Yeah, if you worked as hard as I
did, right? I met someone at the gym. She was
an ex -fighter and she looked amazing. Like you
could see her muscle definition. She just looked
amazing. So I asked her, you know, like a few
questions and her response was, I need to lose
weight. I was like, are you kidding me? like
if you i don't know if she lost weight it would
be muscle like she's so lean already yeah it's
about you know continuing to share that and say
that even if you don't fully feel it all the
time just so that it's out there and everyone
knows so but i think you know now generally it's
it's positive things because i think being strong
and exercising and having a good kind of exercise
regime is what people kind of look look to or
look at nowadays so generally They're good things.
And I try not to see the bad things too much,
as much as I can. Unless they're really mean,
then I'll just be like, cool. Then you just take
them in a headlock and bring them into submission.
Well, so Dr. Jean, we have loved having you here
today. And you've given us, first of all, a lot
of laughs. And second of all, a lot of great
information. But the last thing that we ask every
single guest sitting in this chair, and I'm going
to disclaimer, I know you're not 40 yet. So I
know that this is advice coming from a youth.
OK, perspective. But what's your 40s formula?
What advice would you give women who are in our
40s for kind of how to thrive in this decade?
I always try and put on my doctor hat here because
I'm looking at like a patient. And what do I
say? If you're looking at some old ladies, what
do you say to us? Firstly, I would say like,
you're not old. That's the first thing. You were
young and really healthy and you've got so much
life to live. Be who you want to be at 50 and
60 and 70 and continue to do the things that
you love. Then you really need to kind of embrace
all of these healthy lifestyle changes as much
as you can. But at the same time, you're also
40. You've got all sorts of other responsibilities.
And if you know you have to do them, you have
to do them. of try and understand especially
for my patients in that age group that you're
really dealing with everything at the same time
and um but the first thing is that you're you
know life is just kind of beginning for you as
well in a way. Yeah. I love that. Yeah. We're
not young. Yeah, we're not young. We're not old.
We're not young, let's be fair. We are young.
We're not old. But we still have a lot to do.
Yeah. Yeah. There's still lots of time. There's
still lots of time to do lots of things. Plenty.
Well, thank you so much, Dr. Jean. Yeah, thank
you so much for having me. Yeah, I see you again
and thank you very much for being on the show.
It was great. Thank you. Thank you. Let's be
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guests. Bye. What's a sticky grip? Basically,
it sticks your hand to the bar. The problem with
this though, have you ever had grip lock? Did
you ever use sticky grips? I don't. I death grip.
I don't put my thumbs around so I don't get stuck.
They have like these grips that are now developed
so that you barely even need to grip the bar.
You just basically hang on by your wrist. But
it actually makes people perform a lot better
because you don't worry about grip strength and
stuff. I do kind of get bruises from the frog
grips. I do too. Because I keep. Like it's so
tight. But at the same time, it's better than
people flying off. Yes. So we finally had things
that said semifinals on it. And it was like a
good gathering of like the Asian CrossFit community.
And then now they've gone like, oh, we're not
going to have that anymore in this capacity.
So you're actually taking away a lot of people's
like first level goals. So I think that's problematic.
It makes people not want to join. Like either
your elite level and you go straight to the games
or yeah, there's no like in between. Strong amateur
me