WEBVTT
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Mornings have a rhythm. You can hear it, feel it. And at Quaker, we fuel it. With 100% whole grain oats and a good source of fiber in every bowl, helping you turn that rhythm into your soundtrack for a great day. Fuel to start whatever's next. Quaker, official sponsor of FIFA World Cup 26.
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Hey, it's Christy from Lululemon, and I'm here at the office checking out the Shake It Out shorts. These have been my go-tos, and I kind of think of them as a middle ground between a true run short and a more playful, athletic, sporty short. They have all the performance you want for running, so a comfy liner, our lightweight, swift fabric, even a pocket for your keys. But what I really like is the flowy fit and layered hem. It gives it a little bit of volume, a little bit of fun, so they feel as good on a run as they do just at coffee afterwards. You can find the Shake It Out shorts in-store now or online at lululemon.com.
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00:01:02.671 --> 00:01:29.249
Chevy is called the heartbeat of America for a reason. With SUVs made to move with your rhythm. The versatile Equinox tackles your entire day. The spacious Traverse fits your crew and your whole weekend. And Trax brings style with value you can count on. All infused with tech that has your back. So your drive always hits the right chord. Chevrolet. Together let's drive it.
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A lot of the symptoms that occur that are atypical that occur more in women can be confused with a lot of other things. So fatigue, just feeling tired. But if you're feeling tired all the time, if you wake up tired, you haven't even started your day after you've been asleep and you're tired, that's not normal. And we should not normalize it. And women often normalize a lot of suffering because...
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We have a lot of reasons that it could be happening. We're taking care of aging parents. We're taking care of children. We've got a demanding job, especially during perimenopause and menopause. Many of us are at the peak of our career. Lots of responsibility. A lot of things happening. You have all kinds of things happening at home with your spouse. So if you start to be fatigued, you're thinking, no, no wonder. I've got a million things happening. It is true because you look at it and go, we have fatigued.
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usually two full-time jobs. Right. Because. Or more. Right. We, well, we have, so we have the kids. Right. So there's that one. I forgot that one. Right. My kids are out of the house. Right. But you have the kids' full-time jobs. Usually then you've got the parents somehow you're now taking care of too. Then you have the house that you're dealing with and you have your work. That's right. So you have all those things. So. And then somehow society expects you. So you're on, you know, committees and you're doing. Oh yeah. And then you've got PTAs. Women are supposed to be supporting the community. So,
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supporting the organizations. Men don't have those kinds of pressures. So you've got a million things. They should have to sit through a PTA meeting with the stay-at-home moms. That's what they should have to do. So someone's tired. How would someone be able to determine between like normal fatigue or like this is kicking my butt? How would you know? Such a great question. You should not wake up tired. So if you've been asleep all night, you should not wake up so tired you can't get out of bed. You're exhausted and you literally are just waking up.
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Also, if the fatigue goes on for long periods of time, even if you are overwhelmed with things in your life,
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should not be physically exhausted every single day. And I don't want to give you a long runway to say, well, I'll see how I feel in a month. No, I'm talking like three or four days. I'm just wondering. Start to get on top of what that is. So you start to feel this atypical fatigue. I'm going to use the atypical. Well, that atypical word. Okay, sorry, I snuck that in there. Right. To go with the atypical symptoms of the woman. So you start to feel fatigue that you didn't used to feel. It just kind of hit you. And it's not something that's going on for months.
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Wow, you're tired. You're just wiped out. You're tired. You're just wiped out. Or things like exertion is, you know, let's say exertion. Just, you know, you live in a two-story house. Your bedroom's upstairs. You're walking up the steps to your bedroom in the evening. You're just winded when you get to the top of the stairs. That's new. Okay, pay attention to that. So did you have a silent little heart attack that has now done some damage? That's right. And many times we will see women come in
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And you're getting an EKG on them for the first time, which is another little thorn in my hat that we don't get EKGs. But they're getting an EKG for the first time. And you go, oh, hi, Ms. Jones. When did you have a heart attack? You didn't mention that in your past medical history. And Ms. Jones goes, what? I had a heart attack? Yeah, the EKG shows you had one.
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And then you start to have a workup. It was, you know, three years ago when you were laying around after your kids went to summer camp and you were just so wiped out and tired and you thought you were exhausted and glad to finally have them at camp. But no, you were having a heart attack. Wow. And you survived it, luckily. But then when we go into deeper conversations, you have had some adjustments since then. Yeah, I don't really have as much stamina. Yeah, I have to go to bed a little earlier.
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I kind of, you know, whenever I can, I try to sit down when I'm cooking now, just feel tired standing up. These are all little adjustments you've made over three years that now the physician is sort of putting all together to go, oh, my God. Wow. Right. Well, and the bummer with fatigue is the less you do, the less you can do. So it becomes a thing. So beyond fatigue, what are some of the other ones? The other thing, jaw pain. And if you follow me on social media, I've done something recently on Stairwell Chronicles where I write a letter to dentists.
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to please put them on alert. When you're seeing women coming into you with jaw pain, especially between the ages of 37 and 60, and you can't find anything wrong with them, this is not your reassurance time, which is what we all do. We found nothing. Everything's fine. We've all heard it. Your labs are normal. Your tests are normal. You're fine. If you're at the dentist's office, this is for dentists out there as well,
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and you've got a woman who's there with jaw pain, and you don't see a reason for a root canal or a cavity to be filled or an abscess, there's nothing happening in her mouth, this is not reassurance and send her home. This is send her to the emergency room. Wow. Because jaw pain is often a referred pain from the heart, occurs more commonly in women, atypical. Wow.
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Off women go because we have no education. If your jaw hurts, it must be a toothache. Heart attacks evolve in different ways. You can sort of have, you know, a sudden one. But for women, because we have smaller vessels, oftentimes it's something that builds over. Wow. Because I look at something like the fatigue and you think, how many times has a woman got diagnosed with something like chronic fatigue syndrome and they missed it?
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Now, is the reason that these women, this is one of the questions, like the difference between men and women, is it because of the smaller blood vessels? Why does a heart attack in a man look so much different? Yeah, you know, so women tend to have smaller hearts. We tend to have smaller vessels. The heart beats a little faster because of the smaller size. We still have to pump the same amount of volume. So isn't this sort of...
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you know, the story of our lives, we have to, you know, work harder for the same results. So it's just kind of the heart is sort of an, you know, an encapsulation of that. So, yes, that is part of it. And then there's estrogen. And estrogen actually drives a lot of the function of the heart, a lot of the good hormonal milieu
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of the heart is because of estrogen and those estrogen receptors. And then during perimenopause, you start to have less and less and less estrogen binding to those receptors as well. So that impacts a woman's heart function as well. And it's one of the reasons why
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During perimenopause, a woman's risk of heart disease and a heart attack doubles. And that is not just by happenstance. That is because of the loss of protection. Doubles. Doubles. Because you've lost the protection of estrogen. So it is very, very, very important.
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So woman's heart is different. Women are different. And we should start to appreciate what those differences are and not accept male-generated data that's then applied to everybody. It's not just male-generated data. It's white male-generated data that we just ship out to the whole world. And it's kind of like, oh, it's good for us. It must be good for everybody. Yeah.
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So the estrogen going down, what are the things that are actually happening to the heart when that's... I know things like you get more inflamed, you get more insulin resistant, your LDL goes up, but what are the things that happen? Those are all the things, but also on those arteries, those small vessels, they get stiffer. They're not as compliant. So compliance means that they're more elastic. They're more expandable because the way we control our blood pressure is our arteries expand and...
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and expand. We've got to have that pliability, elasticity. So we lose that. We call that compliance. I'm trying to find a lot of other words, but it's compliance is what we say, but that's what it means. And so as those arteries stiffen, what happens? Your blood pressure increases. For every 10 millimeters of mercury that your systolic blood pressure increases, that top number, your risk of heart disease goes up by 20%.
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What's an ideal, because this is going to get into what labs and tests should women be asking for that they're not getting. And I have down here two things, EKG. And then the other question is, what age should women actually start worrying about heart health? I would think that labs, those two questions to me go together. You mentioned EKGs. Is this something that we should be having as part of a normal physical? When should we ask for an EKG? Yeah.
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We should have EKGs as part of our physical exam. Is it one, though? It's not. No, for men. Oh, really? We get mammograms and pap smears. That's wild. Right. Men get prostate exams and EKGs.
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Whatever. So do you need an EKG every year? No. But should you get one every few years? Yes. Should you have one on your electronic medical record as a baseline when you're healthy? Yes. And so what age would you want that? There is no age. Get one at 20. So it doesn't matter. Get one at 30. We want to know what you look like when you are normal and healthy. So if something happens later, especially if you're having difficulty advocating for yourself at
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there are some changes since the last one we got eight years ago. That's what men do, but we don't. And so not only is there not an EKG, a baseline EKG to compare, oftentimes we don't even get the one when we're having symptoms because the symptoms are atypical and so not driving us towards an EKG. So we just miss, miss, miss every step along the way. And so we end up dead. That's why
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The first heart attack of a woman is more often fatal than the first heart attack of a man. I remember asking you that last time because I'd always heard about that, but in terms of men. Right. And didn't realize it was in terms of women. Women. And so that brings me to this question then because we'd want to look at all the signs that could be pointing to having a problem. So labs, diagnostics, what should a woman be testing? Starting at what age? Like what should they be doing to protect themselves?
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You know, I would say definitely at perimenopausal age. And it doesn't mean that you are having perimenopausal symptoms. So I'm going to start at an age of around 35 to 37. That is still a perimenopausal age.
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It doesn't mean that you're not ovulating, that you can't have any more children, that you're not fertile, that you don't need birth control anymore. No, you need all of those things. But it just means that your hormones may have started to change.
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And they may be a little different than they were when you were 30 or 25. So you're starting, may not have symptoms, or you may have symptoms that you're not even recognizing, like itchy ears, like nobody knows about. That's my nemesis. Right. So you want to think about what's happening at that time, even if you're not having symptoms. That's early symptoms.
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You know, you can start early and really not have symptoms. Again, I want to be clear about this because I've had women ask me, oh, I don't need birth control anymore after 35. No, you do. Come on. So you can be in perimenopause starting early, but also fertile. So you do still need barrier protection or birth control.
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if you're trying not to expand your family or have children. So I want to make that clear. So baseline EKG, what else? What are the labs?
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So baseline EKG, definitely want you to get a blood pressure. And it's really ideal if you have a home blood pressure monitor. So you can stay on top of it. And is there a one that you should, like, are they all okay? Or is there? Well, some are validated and some are not. And, you know, I work at a company that provides one. It's called Hello Heart, but it's not consumer available. So if you want the Hello Heart one, which is the absolute, we are first in class in this one.
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It is available if you work for a company that has included it as a part of your benefits on your health plan.
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So all you ladies out there, if you work for companies and you've got insurance from your company, check your benefits. Hello Heart might be on there. And if it is, that's where you get your monitor. It's connected to an app. It's all digital coaching. So it's a whole big cardiovascular system. Amazing. That also has a menopause feature and pregnancy complication feature and a nutrition feature. And so a lot of things go into it. But the point is you want to catch your blood pressure.
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when it starts to rise, not when you go to your next doctor's appointment and suddenly it's high and nobody knows how long it's been high. Because remember what I said, for every 10 millimeters that it goes up, your risk of heart disease goes up by 20%. And the number we're looking for, is it 120 over 80? Is it 110 over 70? Like where's the, what's the range that is the good range versus you're getting outside of that? The number we are looking for is, this is a new number, less than...
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120 over 80. You're doing blood pressure. That's something you're monitoring at home. And then what about labs? So when you look at labs, what do we want to look at? We want to check your thyroid hormone. We want to check feridin. So we're back to anemia. We want to take a look at that. There will be no cardiology society who is saying that you are now in the world according to Dr. Jane. I focus though on women's health. My recommendation for women is that you need more than one. If you've gotten one before perimenopause, you need another one.
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during perimenopause. And you'd want to have that one before for a baseline. Yeah, a baseline is great. You can get a baseline. But when you are in perimenopause and headed towards menopause, do not think,
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because you've had one earlier that was normal, that you're good for the rest of your life because that's what we're telling you. And I know we're telling you that because those are the guidelines. Yeah, that's what I'd always heard. I just will say that is not true. That does not apply to women. So do not be lulled into a false sense of security because your level is normal. That also goes for the male relatives in your family because it's genetic. So if you have men, brothers, fathers, brothers,
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who've had their LP little a checked and theirs is fine. So they tell you, you don't have to worry about it's genetic and mine is fine. Yeah, but they don't have menstrual cycles and they don't have perimenopause and menopause. So even though there is a very strong genetic component, 90%, there's 10% that's variable and that is impacted and that could impact you.
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Mornings have a rhythm. You can hear it, feel it. And at Quaker, we fuel it. With 100% whole grain oats and a good source of fiber in every bowl, helping you turn that rhythm into your soundtrack for a great day. Fuel to start whatever's next. Quaker, official sponsor of FIFA World Cup 26.
2
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Hey, it's Christy from Lululemon, and I'm here at the office checking out the Shake It Out shorts. These have been my go-tos, and I kind of think of them as a middle ground between a true run short and a more playful, athletic, sporty short. They have all the performance you want for running, so a comfy liner, our lightweight, swift fabric, even a pocket for your keys. But what I really like is the flowy fit and layered hem. It gives it a little bit of volume, a little bit of fun, so they feel as good on a run as they do just at coffee afterwards. You can find the Shake It Out shorts in-store now or online at lululemon.com.
3
00:01:02.671 --> 00:01:29.249
Chevy is called the heartbeat of America for a reason. With SUVs made to move with your rhythm. The versatile Equinox tackles your entire day. The spacious Traverse fits your crew and your whole weekend. And Trax brings style with value you can count on. All infused with tech that has your back. So your drive always hits the right chord. Chevrolet. Together let's drive it.
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A lot of the symptoms that occur that are atypical that occur more in women can be confused with a lot of other things. So fatigue, just feeling tired. But if you're feeling tired all the time, if you wake up tired, you haven't even started your day after you've been asleep and you're tired, that's not normal. And we should not normalize it. And women often normalize a lot of suffering because...
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We have a lot of reasons that it could be happening. We're taking care of aging parents. We're taking care of children. We've got a demanding job, especially during perimenopause and menopause. Many of us are at the peak of our career. Lots of responsibility. A lot of things happening. You have all kinds of things happening at home with your spouse. So if you start to be fatigued, you're thinking, no, no wonder. I've got a million things happening. It is true because you look at it and go, we have fatigued.
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usually two full-time jobs. Right. Because. Or more. Right. We, well, we have, so we have the kids. Right. So there's that one. I forgot that one. Right. My kids are out of the house. Right. But you have the kids' full-time jobs. Usually then you've got the parents somehow you're now taking care of too. Then you have the house that you're dealing with and you have your work. That's right. So you have all those things. So. And then somehow society expects you. So you're on, you know, committees and you're doing. Oh yeah. And then you've got PTAs. Women are supposed to be supporting the community. So,
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supporting the organizations. Men don't have those kinds of pressures. So you've got a million things. They should have to sit through a PTA meeting with the stay-at-home moms. That's what they should have to do. So someone's tired. How would someone be able to determine between like normal fatigue or like this is kicking my butt? How would you know? Such a great question. You should not wake up tired. So if you've been asleep all night, you should not wake up so tired you can't get out of bed. You're exhausted and you literally are just waking up.
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Also, if the fatigue goes on for long periods of time, even if you are overwhelmed with things in your life,
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should not be physically exhausted every single day. And I don't want to give you a long runway to say, well, I'll see how I feel in a month. No, I'm talking like three or four days. I'm just wondering. Start to get on top of what that is. So you start to feel this atypical fatigue. I'm going to use the atypical. Well, that atypical word. Okay, sorry, I snuck that in there. Right. To go with the atypical symptoms of the woman. So you start to feel fatigue that you didn't used to feel. It just kind of hit you. And it's not something that's going on for months.
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Wow, you're tired. You're just wiped out. You're tired. You're just wiped out. Or things like exertion is, you know, let's say exertion. Just, you know, you live in a two-story house. Your bedroom's upstairs. You're walking up the steps to your bedroom in the evening. You're just winded when you get to the top of the stairs. That's new. Okay, pay attention to that. So did you have a silent little heart attack that has now done some damage? That's right. And many times we will see women come in
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And you're getting an EKG on them for the first time, which is another little thorn in my hat that we don't get EKGs. But they're getting an EKG for the first time. And you go, oh, hi, Ms. Jones. When did you have a heart attack? You didn't mention that in your past medical history. And Ms. Jones goes, what? I had a heart attack? Yeah, the EKG shows you had one.
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And then you start to have a workup. It was, you know, three years ago when you were laying around after your kids went to summer camp and you were just so wiped out and tired and you thought you were exhausted and glad to finally have them at camp. But no, you were having a heart attack. Wow. And you survived it, luckily. But then when we go into deeper conversations, you have had some adjustments since then. Yeah, I don't really have as much stamina. Yeah, I have to go to bed a little earlier.
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I kind of, you know, whenever I can, I try to sit down when I'm cooking now, just feel tired standing up. These are all little adjustments you've made over three years that now the physician is sort of putting all together to go, oh, my God. Wow. Right. Well, and the bummer with fatigue is the less you do, the less you can do. So it becomes a thing. So beyond fatigue, what are some of the other ones? The other thing, jaw pain. And if you follow me on social media, I've done something recently on Stairwell Chronicles where I write a letter to dentists.
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to please put them on alert. When you're seeing women coming into you with jaw pain, especially between the ages of 37 and 60, and you can't find anything wrong with them, this is not your reassurance time, which is what we all do. We found nothing. Everything's fine. We've all heard it. Your labs are normal. Your tests are normal. You're fine. If you're at the dentist's office, this is for dentists out there as well,
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and you've got a woman who's there with jaw pain, and you don't see a reason for a root canal or a cavity to be filled or an abscess, there's nothing happening in her mouth, this is not reassurance and send her home. This is send her to the emergency room. Wow. Because jaw pain is often a referred pain from the heart, occurs more commonly in women, atypical. Wow.
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Off women go because we have no education. If your jaw hurts, it must be a toothache. Heart attacks evolve in different ways. You can sort of have, you know, a sudden one. But for women, because we have smaller vessels, oftentimes it's something that builds over. Wow. Because I look at something like the fatigue and you think, how many times has a woman got diagnosed with something like chronic fatigue syndrome and they missed it?
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Now, is the reason that these women, this is one of the questions, like the difference between men and women, is it because of the smaller blood vessels? Why does a heart attack in a man look so much different? Yeah, you know, so women tend to have smaller hearts. We tend to have smaller vessels. The heart beats a little faster because of the smaller size. We still have to pump the same amount of volume. So isn't this sort of...
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you know, the story of our lives, we have to, you know, work harder for the same results. So it's just kind of the heart is sort of an, you know, an encapsulation of that. So, yes, that is part of it. And then there's estrogen. And estrogen actually drives a lot of the function of the heart, a lot of the good hormonal milieu
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of the heart is because of estrogen and those estrogen receptors. And then during perimenopause, you start to have less and less and less estrogen binding to those receptors as well. So that impacts a woman's heart function as well. And it's one of the reasons why
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During perimenopause, a woman's risk of heart disease and a heart attack doubles. And that is not just by happenstance. That is because of the loss of protection. Doubles. Doubles. Because you've lost the protection of estrogen. So it is very, very, very important.
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So woman's heart is different. Women are different. And we should start to appreciate what those differences are and not accept male-generated data that's then applied to everybody. It's not just male-generated data. It's white male-generated data that we just ship out to the whole world. And it's kind of like, oh, it's good for us. It must be good for everybody. Yeah.
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So the estrogen going down, what are the things that are actually happening to the heart when that's... I know things like you get more inflamed, you get more insulin resistant, your LDL goes up, but what are the things that happen? Those are all the things, but also on those arteries, those small vessels, they get stiffer. They're not as compliant. So compliance means that they're more elastic. They're more expandable because the way we control our blood pressure is our arteries expand and...
23
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and expand. We've got to have that pliability, elasticity. So we lose that. We call that compliance. I'm trying to find a lot of other words, but it's compliance is what we say, but that's what it means. And so as those arteries stiffen, what happens? Your blood pressure increases. For every 10 millimeters of mercury that your systolic blood pressure increases, that top number, your risk of heart disease goes up by 20%.
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What's an ideal, because this is going to get into what labs and tests should women be asking for that they're not getting. And I have down here two things, EKG. And then the other question is, what age should women actually start worrying about heart health? I would think that labs, those two questions to me go together. You mentioned EKGs. Is this something that we should be having as part of a normal physical? When should we ask for an EKG? Yeah.
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We should have EKGs as part of our physical exam. Is it one, though? It's not. No, for men. Oh, really? We get mammograms and pap smears. That's wild. Right. Men get prostate exams and EKGs.
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Whatever. So do you need an EKG every year? No. But should you get one every few years? Yes. Should you have one on your electronic medical record as a baseline when you're healthy? Yes. And so what age would you want that? There is no age. Get one at 20. So it doesn't matter. Get one at 30. We want to know what you look like when you are normal and healthy. So if something happens later, especially if you're having difficulty advocating for yourself at
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there are some changes since the last one we got eight years ago. That's what men do, but we don't. And so not only is there not an EKG, a baseline EKG to compare, oftentimes we don't even get the one when we're having symptoms because the symptoms are atypical and so not driving us towards an EKG. So we just miss, miss, miss every step along the way. And so we end up dead. That's why
28
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The first heart attack of a woman is more often fatal than the first heart attack of a man. I remember asking you that last time because I'd always heard about that, but in terms of men. Right. And didn't realize it was in terms of women. Women. And so that brings me to this question then because we'd want to look at all the signs that could be pointing to having a problem. So labs, diagnostics, what should a woman be testing? Starting at what age? Like what should they be doing to protect themselves?
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You know, I would say definitely at perimenopausal age. And it doesn't mean that you are having perimenopausal symptoms. So I'm going to start at an age of around 35 to 37. That is still a perimenopausal age.
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It doesn't mean that you're not ovulating, that you can't have any more children, that you're not fertile, that you don't need birth control anymore. No, you need all of those things. But it just means that your hormones may have started to change.
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And they may be a little different than they were when you were 30 or 25. So you're starting, may not have symptoms, or you may have symptoms that you're not even recognizing, like itchy ears, like nobody knows about. That's my nemesis. Right. So you want to think about what's happening at that time, even if you're not having symptoms. That's early symptoms.
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You know, you can start early and really not have symptoms. Again, I want to be clear about this because I've had women ask me, oh, I don't need birth control anymore after 35. No, you do. Come on. So you can be in perimenopause starting early, but also fertile. So you do still need barrier protection or birth control.
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if you're trying not to expand your family or have children. So I want to make that clear. So baseline EKG, what else? What are the labs?
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So baseline EKG, definitely want you to get a blood pressure. And it's really ideal if you have a home blood pressure monitor. So you can stay on top of it. And is there a one that you should, like, are they all okay? Or is there? Well, some are validated and some are not. And, you know, I work at a company that provides one. It's called Hello Heart, but it's not consumer available. So if you want the Hello Heart one, which is the absolute, we are first in class in this one.
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It is available if you work for a company that has included it as a part of your benefits on your health plan.
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So all you ladies out there, if you work for companies and you've got insurance from your company, check your benefits. Hello Heart might be on there. And if it is, that's where you get your monitor. It's connected to an app. It's all digital coaching. So it's a whole big cardiovascular system. Amazing. That also has a menopause feature and pregnancy complication feature and a nutrition feature. And so a lot of things go into it. But the point is you want to catch your blood pressure.
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when it starts to rise, not when you go to your next doctor's appointment and suddenly it's high and nobody knows how long it's been high. Because remember what I said, for every 10 millimeters that it goes up, your risk of heart disease goes up by 20%. And the number we're looking for, is it 120 over 80? Is it 110 over 70? Like where's the, what's the range that is the good range versus you're getting outside of that? The number we are looking for is, this is a new number, less than...
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120 over 80. You're doing blood pressure. That's something you're monitoring at home. And then what about labs? So when you look at labs, what do we want to look at? We want to check your thyroid hormone. We want to check feridin. So we're back to anemia. We want to take a look at that. There will be no cardiology society who is saying that you are now in the world according to Dr. Jane. I focus though on women's health. My recommendation for women is that you need more than one. If you've gotten one before perimenopause, you need another one.
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during perimenopause. And you'd want to have that one before for a baseline. Yeah, a baseline is great. You can get a baseline. But when you are in perimenopause and headed towards menopause, do not think,
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because you've had one earlier that was normal, that you're good for the rest of your life because that's what we're telling you. And I know we're telling you that because those are the guidelines. Yeah, that's what I'd always heard. I just will say that is not true. That does not apply to women. So do not be lulled into a false sense of security because your level is normal. That also goes for the male relatives in your family because it's genetic. So if you have men, brothers, fathers, brothers,
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who've had their LP little a checked and theirs is fine. So they tell you, you don't have to worry about it's genetic and mine is fine. Yeah, but they don't have menstrual cycles and they don't have perimenopause and menopause. So even though there is a very strong genetic component, 90%, there's 10% that's variable and that is impacted and that could impact you.
