← The Dr. Gabrielle Lyon Show
The Dr. Gabrielle Lyon Show
Understanding Heart Rate Variability: Improving Your Health & Performance | Joel Jamieson
01:59:13
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- [00:00]
A
I'm Dr. Gabrielle Lyon and I work with elite performers, military operators and high achievers who want more than just inspiration. They want measurable results. And yet, I've never seen a tool more misunderstood than hrv, which is heart rate variability. That's why today's guest is Joel Jamison, a world class performance coach to combat athletes, special operations and pro sports teams. He's the creator of Morpheus, the first HRV guided training system built on over 20 years of data. We dive into what HRV really measures, how it changes with age, how stress impacts it, and even if you're sleeping fine, and why most people are training in the dark.
- [00:49]
B
You know, if you're waking up tired, it's not because you're lazy. It's because your body is already out of gas before the day even starts. People think it's just the training that makes them stronger. But the reality is if you don't understand your nervous system, you're basically just guessing through health and fitness.
- [01:06]
A
Think you're recovering, think again. Think your fitness tracker is helping? Maybe, maybe not. And if you're training hard every day without understanding this one signal, you might actually be getting worse. Maybe everything you thought you knew about recovery, performance and stress is wrong. Joel Jamison, welcome to the show. This is actually a long time coming and I'm really grateful to have you here. You have been a coach for two decades. Yeah, a little over that, A little over that. And you have coached world class athletes, Olympians, fighters, you name it. I know that you know our mutual friend Rob Wolfe, right? In the beginning of the CrossFit days.
- [01:47]
B
Yeah, long time ago.
- [01:49]
A
And you have some very innovative ways of thinking about training and recovery, which is quite frankly why I would love to have this conversation. And I'm grateful that you're here. So welcome.
- [02:00]
B
Thanks for having me. I'm happy to talk to you and your audience. And like I said, it's been two decades of coaching and learning and trying things out. And any opportunity to share what I've learned over the years is a really important one to me.
- [02:11]
A
That's very valuable. There's a lot of discussion around evidence based medicine and evidence based practices. And part of evidence based practice is, yes, the science, but also it is the clinicians or the providers or the coaches experience.
- [02:28]
B
Yeah. It's funny because we live in an age of social media, obviously, and you know, I post stuff that I've done with athletes that I'm working on, and you'll get people respond, that doesn't work. There's no Evidence to support that. Well, the world champion I trained last year did that and it worked just fine for him or her or whatever the case may be. So, yeah, we always have to keep in mind of what the science tells us, but I think we have to be aware of there are real limitations to the science in a lot of areas. And there's a lot of things that science tells us now. Work that we've been using for a long time that we've known works in the Komotion community. So there's always this combination of looking at the science and the data, but then also what works in the real world. So I've always tried to bridge that gap and understand both sides of it.
- [03:07]
A
And that's really valuable. One of the things that the athletic community seems to have a leg up on is you guys do a lot of things and like you said, the science comes out a bit later. You'll see. You know, you look at the bodybuilding type diets or just the ways in which they have utilized certain behaviors and over time you'll say, okay, well, that's why that worked. And I think that, you know, I think that the same is probably true for things like HRV and some of the recovery modalities that you have been using. And I'm curious, tell me a little bit about your coaching career. Just a brief background.
- [03:44]
B
Yeah, so like a lot of coaches, I was a failed athlete at some level. Tried to play college football, didn't last too long at that, but I'd always really loved the training side of things. So my senior year in college, I went down the weight room. There was a fantastic strength coach down there named Bill Gillespie, who people in the powerlifting world will probably know, but others may not. I, since he said, hey, Bill, I would love to, to learn from you and to work with you and be part of the program here if I can. And he said, sure, come on down. And at the time I had been just reading the Russian, old Russian manuals, the Soviet cell training, Yuri Vershansky, kind of all these older powerlifting weightlifting textbooks. And Bill was a, I don't know how to put it, the most focused powerlifter I've ever seen. So he wanted to bench press more than anything in the world and he focused purely on that. And so Bill now is. I don't want to overage Bill, but I think Bill's 70 or late 60s. He's bench pressed, I think, a thousand pounds. I mean, just some insane number broken, who knows how many world records. So anyway, I Went down there. We just started chatting all the time. And the biggest thing I learned from Bill is he was open to me at 21, whatever. I was giving him ideas and he'd been doing this for decades. But I would say, hey, I read this in this manual. What do you think about this technique? He's like, let's try it. And so we formed this partnership where I would dig in the science and look these old Russian manuals. And Bill would be like, yeah, let's try it and see what would happen. And so that was really the start of trying to bridge that gap between the scientific side of things and these old Russian manuals. And Bill's powerlifting and collegiate strength conditioning. After about a year, he went to University of Or so he went to the Seattle Seahawks. I followed him there as an intern, worked in Kent Johnston, same thing. Kent had been in the field for four decades at the time, three decades, whatever it was. Worked at Green Bay, Tampa Bay, the Seahawks, and same thing. You know, these guys are just so open to ideas and trying things and discussion. And it really just sparked a love of this idea of performance and training to help athletes get better and help people reach their goals. But I decided I didn't want to be a collegiate or a professional strength coach because you have no job security, you know?
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A
Right.
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B
You're moving around the country all the time. It's like musical chairs every time the coach you're working for gets fired. Now you're looking for a job. I just didn't want to play that game. So, 23 years old, I decided to open a gym. And looking back on, I was very naive about what that would take, but I did. I opened it in a place called Kirkland, Washington, which was just outside of Seattle. And fortunately for me, I opened it next to a gym called AMC Pancreation. I wish I could say this was planned, but I had no idea that AMC Pancreation was really the best mixed martial arts gym in the world. And the coach there, Matt Hume, without question the best mixed martial arts coach of all time. And so very quickly I had these high level combat athletes coming over and saying, hey, can you train me for a fight? And I was like, yeah, yeah, sure. And I was like, what fight? Like K1. I was like, what's K1? Google that. Right? I really had only worked primarily with football and strength and power and that side of things. And so my first approach was, let's treat them like I treat everybody else. I do an assessment. I'm like, these guys are weak, right? They could do like two pull ups. Some of them couldn't even do a pull up, which boggled my mind. You know, they couldn't squat their body weight compared to the athletes and the pro level. I was like, man, these guys are just really underpowered and under muscle. I'm just going to make them really strong and they're going to go kill everybody. I'm looking genius. But it took about 30 seconds of training with myself and gassing out and getting destroyed despite being significantly stronger than them to realize, hmm, maybe I don't know what I thought I knew about conditioning. Maybe there's a whole other side to this that I've not dug into. And so that's where this fascination with conditioning and getting people in shape from a, you know, not just lift weights and call it good standpoint. And really kind of around the same time I started working with Seahawks, I was also introduced to heart rate variability by an old Russian coach and sports science team. So as I was trying to understand how do I help these fighters become better fighters, I was also looking at heart rate variability way before most people knew what it was. And I was using this expensive Russian system where you had to put electrodes on people and it was super invasive. But I was looking at real numbers. I was looking at the athletes performing. And in team sports, it's really hard to say, like, oh, I helped the team win. There's lots of variables, right? There's multiple players in the field and there's all kinds of stuff going on. But combat sports, like that athlete gets in the cage of the ring, it's one on one, they gas out. And your job was to help them prevent that from happening by getting them in shape. You know, you got to look yourself in the mirror. And so I took my job very seriously, of course, making sure I learned everything I could about conditioning, making sure these guys are going into the fight recovered and able to perform. And, you know, over time I just kept learning and kept trying things and worked with Matt, who again, had been in their field for a long, long time. And that really was where the, the whole conditioning HRV intersected and really set my course on that career and then keep a long story a little bit shorter. You know, as I've aged, as the people around me have aged, I've. How does shift focus a bit towards how do we now look at conditioning and fitness from a longevity standpoint? Not just I want to knock somebody out or not get knocked out myself, or how do I look at using the same types of tools Like HRV and recovery and conditioning, but rather, then again, performance to live a longer, healthier life and have taken that path as well. So that's the shortest version. I think I can make your career.
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A
I think it's really fascinating. It sounds like Russia had a leg up on us in terms of being very innovative.
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B
Yeah, the Russians. You know, I would never want to live in a communist regime personally. But I will say what they had is massive structure and massive organization that the United States never had that came from the top down. So, you know, they would have sports groups by type of sport, where they have a very clear hierarchy of coaches at top versus coaches at bottom. They would get together and have conferences. They were doing blood testing back in the 80s and they were. So the, the athletes I've talked to and the coaches said they would get blood tested every week based, looking for different blood markers, vibrant mineral panels, they would have customized supplementation, pharmaceuticals. All that stuff was literally customized as far back as the 80s. And they were using HRB back in the 80s to try to figure out how to use it because they had actually created it. They didn't create it per se, but they took heart rate variability and used it with the space program and the cosmonauts to see what happens when you send someone to space. So they'd been using technology in a meaningful way for a long, long time. And so when you got to a communist regime where they could focus everything in a very organized, structured, and quite frankly, maybe unfair way, using a lot of performance enhancing drugs, you know, you saw a lot of it come out of it.
- [10:33]
A
And were they better, stronger athletes?
- [10:35]
B
They were better, stronger athletes than us. But I will say what's funny is after one of them that started the HRV system came to the U.S. who was it? My name is Val Nsedkin. So he was a decathlete himself and he was a track coach and then did some other stuff and started a megaway, the first HIV company. He went to Oregon of all places. And he was telling me like in Russia for a while, he'd been a selector, meaning he would go to the schools and he would select which athletes were brought into the program to be trained. And that's the other thing they had is like they would select athletes at youth and youth in like sixth grade or beyond, below, and they would train them systematically all the way until they try to break world record. So that's the other thing they had is this huge organized junior program that would train athletes all the way through. China has it now. I Can tell you crazy stories about China.
- [11:21]
A
Do you think the US will ever have that?
- [11:23]
B
I don't think so. We have a different system that I think is broken in a lot of ways. I think we abuse kids because they just get thrown into. I mean I started training a lot of you athletes, youth athletes, they go from club sports to team sports and their school almost year round, they're just trained massive amounts with no real coordination. The one thing that the Russians did have is they had that coordinated system, right. They had a long term plan and you have well meaning parents putting their kids in 12 months straight of training. So we had, you know, youth athletes 13, 14, 15 with major ACL reconstructive surgeries. And when I was coaching those athletes and just low back problems and shoulder problems because just massive overuse. You take these 13, 14 year old girls and you train them 12 months year round. You know, it was crazy. The Russians Soviets were much more cognizant of we need to keep these athletes healthy. Because going back to the story when Val was selecting, he'd said he would go into an elementary school or middle school and he would select between like three and 10 athletes based on their athletic ability. Which is crazy. They're trying out, right?
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A
Very. Also very young.
- [12:22]
B
Very young. Yeah. And he would watch a move, he would look at mechanics or coordination skill set and he would select the athletes to come into the program for given sports and they would actually say, oh, you're going to be this, you're going to be that. They would select you and then put you in a sport. He said when he started coaching in Oregon, he went into elementary school and he said, I would have selected 20%. And the difference is we have massive genetic diversity here. They only had Russians, right. So if you, you know, not to play the, you know, big game, if you took out all of the races in the U.S. except for Europeans, you'd have a whole lot less athletic performance in the real world. And they didn't have that genetic performance diversity in gene pool. So we have significantly better genetics and significantly bigger gene pool to draw from than I think the Soviets ever did.
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A
Wow.
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B
Which is why he was like, look, we had to take our athletes and be mindful of recovery and we couldn't burn them out. I think we have so many talented athletes that are just more room for error for us. Way more room for error.
- [13:16]
A
And you train young children, you train kids now?
- [13:20]
B
Not anymore, no. It's a long story. When Covid hit my gym, got taken over by Google at the same time so Google shut my, bought the building, I trained. Oh yeah, not 15 years so long ago. No, 2003 until 2020. Basically.
- [13:35]
A
I, you know, I am obviously a parent. I don't know if you knew this, but I have a four and five year old and I have one child who is extraordinary, extraordinary, Lee athletic, tons of coordination and just seems like a lot of capacity. And, and I think about genetically, if we train her up well and she loves it. And then I think about exactly what you were saying. I have friends that their kids are in basketball, track all year round.
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B
Yeah, all year.
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A
And I wonder for parents listening, thinking about how they want to develop their children, do you have a suggestion for how we can develop our children into lifelong athletes? Because now in your, dare I say 40s.
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B
Yeah, mid-40s.
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A
Mid-40s. Sadly, you're beginning to think about what that looks like from a longevity perspective.
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B
I mean, look, I think first of all, it's taking a long term view, as you mentioned. The problem with I think our system is we have so much, the kids have so much pressure to make the varsity team in middle school, then they have to make a very good club team in high school and then they have to get selected for college and try to get a scholarship. So there's a tremendous pressure from early on to make these teams. And in the short run, yeah, you spend more time playing your sport, you're more likely to develop the skill to make those teams. But you're also risking burnout and overuse injuries to which you know, if you're in high school in your senior year and you blow out your shoulder, your back or something as an athlete, you're not going to get a college scholarship or it's a lot, lot harder. So much harder. So I think the biggest thing is just maintaining that idea of like we're not developing the athlete for your son or daughter. The short term, the short term, it's the long term. And going back to that, the most fascinating thing that the Russians told me, several of them is they said when we would select an athlete at some point in their career, we'd make a decision is this an athlete that we think can make it to the national level or is this an athlete we think can make it to the international or Olympic level? And they would put them on different tracks because they believe that peak performance for the Olympic athletes needed to be delayed. Actually because for most sports and in other sports where it's not the case, they thought that most sports they would peak somewhere in the mid 20s, mid to late 20s is where their optimal window of performance was. And so they would actually slowed down the training. Olympic athletes versus what they thought were the international or the national level athletes, they would peak them earlier and they would intensify their training earlier because they thought they had a shorter window to perform. So if they said, look, this is a special athlete, rather than accelerating their training, they would actually try to delay it and draw it out so that they had a longer career and they could get to that point.
- [16:05]
A
It's kind of the opposite of what we do.
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B
It's the opposite what you think now. I also had the chance to go to China several times and China takes almost a Russian approach, but without this mindfulness of we need to maintain these athletes. Right. They have a single population of Chinese. They want to get to the highest level possible. They do a lot of recruiting. I went to work for the judo school for the Chinese National Games and they train like I've never seen. So I get to this school outside of Beijing one time and they wanted me to help train their athletes for the upcoming competition.
- [16:39]
A
How did they find you? Word of mouth.
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B
Yeah, word of mouth. There's a company that brings over us coaches over there.
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A
Okay.
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B
And so I show up in day one and you know, they're like, we want you to train our athletes. I'm like, okay, I need to see what your athletes do right first. And so they, I watch about a two and a half hour, three hour judo practice. It's, it's intense. I mean, these kids are going, going hard from the start.
- [17:01]
A
How old were they?
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B
Anywhere from like, I think 12, 11. 11. 12 was the youngest up to 18. These are youth athletes. And so I'm like, okay. I watch them and then they're like, okay, they're gonna have lunch and then we want you to do a program with a training program. I'm like, I'd like to do an evaluation first, maybe like, understand. Yeah, like see what's going on.
- [17:21]
A
Heads up.
- [17:22]
B
Yeah. So they're like, no, we want you to train them. And so I'm like, okay, like, you know, let me see what we can do here. And so I just kind of put them through a standard strength training athlete type program for combat sports just to kind of see where they're at, see what they were doing. Takes about 90 minutes. They're like, we want to give you our best athletes first. These are the most important takes, 90 minutes. And they come back and they say, well, what's going on? I was like, well, we're done. We're Gonna do a cool down. They're like, well, no, can you do that again? And I was like, do that again? What do you mean, do that again? And they're like, well, you have three hours. We have to train them for three hours. Can you just go through the workout again?
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A
Unbelievable.
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B
I was like, no, I can't go through the workout again. The funny thing was they had a second judo practice session later in the evening the same day.
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A
I mean, so they. Do these athletes burn out faster?
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B
Oh, of course, of course. Like, we find, yeah, they. It's just a meat grinder, unfortunately, that, you know, we finally got. I finally got some access to, like, how many injuries they dealt with. We found that 70 of the youth athletes had at least one major reconstructive surgery. 70, 70. At least one major reconstructive surgery. While we were there. One of the girls blows your ACL out, like four or five days before the competition. And we're like, you need to get an MRI and see what they're like, why would we do that? She's got to compete in five days. Like, why would we look at imaging? She's got to compete.
- [18:32]
A
You know, it makes me think about as you're building, you know, as we talk about heart rate variability and recovery, one of the things that I was thinking about is that, is it the athletes, let's say you select them young, Is it their innate capacity that you build upon, or are they better at recovering?
- [18:52]
B
I think it's both. Right. So after working with a lot of pro athletes over the years, one of the big things obviously is their skill. Like, they just. They have a better kinesthetic awareness, they have better coordination. Like, they just have a gift that they turn to skill in their sport through lots of practice. The other is they are just recovery machines. And that was the first thing that struck me when I first started.
- [19:12]
A
They are or they're not.
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B
They are. They're just. They're just work capacity recovery monsters, at least most of them. So when I first started measuring hrv, you know, I was mostly using it myself. And then I started working with the Seahawks and looking at their data, and I was like, that's why these guys are in the NFL and I'm not. Because you would watch them, they'd go out to a practice and they would come back from practice and we'd measure them. Because they're doing two days in training camp, and you're like, these guys look like they just got out of bed. Like, they're perfectly fine. Like that two hour training session that would have just obliterated most people and myself included. It did nothing to them. They were prepared for it. They had the work capacity. And so you see this tremendous difference between the elite athletes of the world and everybody else.
- [19:51]
A
The regular, right.
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B
They can just recover. Their HRV is always higher. They just have a capacity to recover faster than anybody else, you know, because part of it, because they've done their whole lives and they just, you know, are used to that. But part of it's just they genetically are superior human beings.
- [20:06]
A
And they would argue, you know, it's kind of like the military operators. They would argue and say, no, we just are focused on training. But there has to be some baseline genetic.
- [20:18]
B
Very interesting. There is, absolutely. And I'll give you a little secret here. When I was with the Seahawks, one of the running backs, Sean Alexander, won the NFL MVP for rushing touchdowns or Southern Rescue rushing touchdowns and won, I think the NFL MVP that year.
- [20:32]
A
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- [22:22]
B
I could be wrong. Anyway, Sean hated to lift weights, hated train, just didn't do it. Like, I never saw that guy lift weights. Didn't do it. But he was, didn't matter. He was still able to set the NFL record.
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A
Isn't that unbelievable?
- [22:34]
B
For rushing touchdowns. Just did not lift weight. Hated lefty and would go run and had a running coach and did some running stuff. But like, dad didn't want to touch a weight, you know, Ken Grippy Jr. Legendary baseball player. Like his, his joke was the recliner in the, in the clubhouse was his gym. Because you just lay back in the recliner. Everyone worked out. You know, I hate to break it to people, but there's a lot, a lot more than people think of pro athletes who can succeed despite their training, not because of it.
- [23:00]
A
You know, I. Yeah.
- [23:01]
B
They just are genetically gifted human beings that can do things that nobody else can do.
- [23:06]
A
Yes. And even despite genetics, we're going to cover this heart rate variability. And I have a definition here I would love to hear because you again have been looking at this for 20 years. And then I want to tell you a story about my sister.
- [23:19]
B
Sure.
- [23:20]
A
Which she's going to be embarrassed, but I don't think she listens to the podcast. It's okay. Heart rate variability is. So it's a non invasive marker of the autonomic nervous system. Right. And it is measuring the balance between sympathetic and parasympathetic input into the heart. Is that right? And it's the. If there is 60 seconds in a minute, it's the space between beats.
- [23:45]
B
Yeah. It's mostly right.
- [23:47]
A
Please correct. Correct me.
- [23:49]
B
Yeah. It goes back to what you talked about is this balance between the sympathetic and the parasympathetic. So for people who aren't familiar, you have these two branches of the autonomic nervous system. Right. You have what we call a sympathetic, the fight or flight. And then we have the parasympathetic we think of as rest and digest and recovery. I don't necessarily love those definitions because then people think it's like a switch that you turn on or off. Like you think like, oh my, I'm fight or flight. My synthetic turns on and turns off. No, it's not quite that simple. Or we think that like the rest and digest turns on. It's these two systems are more like dials, I think is the best way to think about them. Because they can turn up and turn down and they can both be modified independently of one another. So when we're looking at heart rate variability, we're looking really at how the vagus, the parasympathetic, is impacting the heart itself. And the more that system is impacting the heart in a given time, the more variability there is in the heart. Meaning if I was to measure your heart rate at 60 beats per minute, you might think, oh, well, it's very evenly distributed, that every one second you're getting heartbeat, but you're not. That's because the parasympathetic system is active and it's pulsing in a way that's in rhythm with our respiration. That input causes this variability. The greater the input of that parasympathetic system, the greater that level of variability into the heart. We see a different pattern of the heart rate when we see higher parasympathetic system input than when we see lower parasympathetic input. We're not really measuring the sympathetic system itself directly through heart variability. We're measuring that resting level of the parasympathetic system. And so, like you mentioned, it does meant that does give us a picture of that balance of what is the body doing right now? How is the body regulating itself in response to the world around it? And to me, that's what it comes back to. It's understanding that we have a lot of stress in the world, mental stress, physical stress, environmental stress. And our body has to always cope with that and react to that. And the way that it does that is reflected in hrv.
- [25:40]
A
And when someone is measuring their hrv, how. And there's a lot of. You know, it's interesting, it seems, based on our research, it seems as if, is that it is pretty well established as a marker.
- [25:56]
B
It's been around for 70 years. Right.
- [25:58]
A
But it, but certainly not established as the only marker. Right. There's hrv, there's respiratory rate, there's all of these other inputs that would maybe determine readiness. But from an HRV standard standpoint, what are the things that. Or I suppose first of all, what does a healthy HRV look like and what, what should our HRV do? We have a sense of, for example, what my HRV should be versus yours or max.
- [26:27]
B
Yeah, sure. So the, the tricky part with all of this is if you think of blood pressure, for example, like we know how to measure that, we're going to get very standardized measurements. We're not going to use two different devices and get totally different numbers for blood pressure. We know, hey, here's a Good blood pressure. Here's a not so good blood pressure. We measure resting heart rate. We know, okay, we're measuring beats per minute. It's better and more accurate to think about HRV as this framework to measure this variability. But there are many different ways to calculate the final number and there are many different devices that can measure it differently. A chest strap, for example, measure it by using electrical activity.
- [26:59]
A
That's the number one.
- [27:00]
B
Yeah. Chest strap's always most accurate. Right. But the ppg, the wrist based devices can do it as well. They use a different technique, gives you slightly different numbers to some extent and then you can end up, like I said, with different calculations that are used. There's what's called time domain, is what's called frequency domain. There's what's, you know, there's nonlinear dynamics, there's different calculations to give you heart rate variability. So it's really difficult to say you should be this and I should be this and he should be that. Because the number you're getting depends on what measurement you're using, what device you're using when you're measuring. Right. There's, there's measuring overnight, which a lot of devices are doing in the background. There's the more standardized way to do it, which I believe in, which is measuring it first thing in the morning. And those are all going to give you different numbers. So it's really hard to say you should be this and he should be that because there's just different ways of looking at this and there's.
- [27:47]
A
Do you have a ballpark?
- [27:48]
B
So, yeah, I would say that the most common thing you're going to see is what's called rmssd. That's the most common measurement technique that devices are using for the most part nowadays that does not apply to Apple Watch. The Apple Watch using what's called sdnn. You cannot compare the Apple Watch to a OURA or any other device.
- [28:07]
A
That's good to know. So friends, if you use the Apple Watch versus Oura Ring or Whoop or something else or Morpheus, you should know that they're different.
- [28:15]
B
And Morpheus actually is a bit different too. We use rmssd. The problem with rmssd.
- [28:19]
A
And what is rmssd?
- [28:21]
B
Yeah, so it's just a calculation method where we take the time between each beat, we do some math called the root mean successive square differences, which is just a mathematical model and that gives us a number in terms of milliseconds since the average variability in that heartbeat over time. So higher number means there's greater variability.
- [28:40]
A
And do you Want greater variability in general.
- [28:44]
B
In general, over the long term, you want higher numbers. Higher numbers correlate with higher aerobic fitness and VO2 longevity. Because this is a important thing to understand. Mostly what we're trying to achieve in my mind is resilience.
- [29:00]
A
How do you define resilience?
- [29:01]
B
The ability to cope with the stress the world around us in a positive way, I would say, because again, it comes back to, we're exposed to stress our whole lives. Physical stress, mental stress, environmental stress, nutrition, you name it. Stress is acting upon us. And it's our autonomic nervous system's job to respond to that stress. So let's give an example. Let's say I'm going to go do a workout. Okay, well, in a workout scenario, I need more energy than I do at rest, right? So what happens? Our fight or flight system dial turns up so we can create more energy. And at the same time, our parasympathetic system turns down a bit because we don't need rest and digest when we're out training. We need energy. Now, a simple way to think about this is anabolic, catabolic. To some extent, the sympathetic fight or flight is mobilized energy. It's more catabolic. The rest in the jest. Parasympathetic is more on the anabolic side. So as I go work out, my stympathetic system turns on more. My parasympathetic system turns down more. And now I create a whole lot of energy so I can go out and train. Well, what happens afterwards? This is where we get into resilience and recovery. The first thing we have to do is say, ooh, we don't need that energy anymore, right? We don't need this big influx, our big, big production of energy. Now the sympathetic system has to turn back down. That dial has to come back down to where it was. And then simultaneously or in conjunction, that parasympathetic system has to start to come back up so it can facilitate energy storage and recovery. And the anabolic things that follow that, right? The faster and the more efficiently we can do that, the better results and the more adaptable we are because we have to be able to take that workout stress and turn it into something positive, be it better mitochondrial function, aerobically, stronger muscles from a strength standpoint, more efficient movement. All these things have to happen through those processes of recovering after the workout. So we don't get stronger in the middle of a workout, right? We get stronger by adapting to that workout afterwards. And that happens through that parasympathetic system driving energy into recovery and growth and repair, rather than that sympathetic system driving energy into dealing with that workout right now. And how that happens over time is what dictates a lot of how our body functions. Because the more stress we impose on ourselves, the more we have to be able to deal with that stress. If we can't deal with it in a positive way, that's where we get negative adaptations and over training and overuse injuries. But from a longevity standpoint, it's also where we get chronic inflammation. That's where we get all sorts of hormonal dysfunctions, where you get mitochondrial dysfunction. All these sorts of things happen. If our body cannot cope with the stress the world is imposing on us. And part of this is just that inflammatory cascade, sympathetic system, more pro inflammatory, parasympathetic system, anti inflammatory, it turns off the inflammation that was created during that sympathetic process. When those two systems get out of balance and we start to lose that ability to turn off inflammation, we start to lose the ability to cope with the world around us. This is where aging accelerates. And we know if you look at mitochondrial dysfunction and all these sorts of things, you see how much it is related to all kinds of aging. That is a very big part of where we see this connection between HRV and longevity. Because we know that HRV is closely related to mitochondrial function, aerobic function, this anti inflammatory reflex, all these sorts of things. So there's a really big connection between all of it.
- [32:16]
A
And HRV from your perspective, is not a single unit measurement. For example, let's say I wake up, I again, I have two little kids, they keep me up. I'm sure that my HRV is pretty terrible, totally in the tank. And that might just be a season of life, right? Because I don't get good sleep. It's not that moment to moment or day to day. It's probably, and I suppose I should ask you, it's over a, over seasons, over years, right?
- [32:46]
B
It's both. Right. So. So we look at, from two standpoints, we look at where you are on a day to day basis to understand how the world around us is having an impact. And what I mean by that is if we see these big fluctuations in your HIV from day to day, that's the body reacting to a lot of.
- [33:03]
A
Stress, even though it might be out of our conscious awareness.
- [33:06]
B
Sure, 100%. A lot of times you feel the effects of stress after it's already had an impact on you. And sometimes you see much different results in HRV than you expect. But on A daily basis we're looking at how much am I changing? And if it's again, if we're seeing big fluctuations from one day to the next, it means your body's coping with a lot of stress. If we see over time that number going up or going down, that indicates how your overall resilience and how your overall aerobic fitness is changing. So over time, we want to would like to see increases up to healthy levels, right through aerobic fitness training and all these things that can boost HRV from a lifestyle standpoint.
- [33:42]
A
What's the biggest one?
- [33:43]
B
Aerobic fitness. By far, aerobic fitness, 100%. So you have to understand the recovery system. It's driven by aerobic metabolism. Right.
- [33:53]
A
And when you say recovery system, well.
- [33:55]
B
I mean when the parasympathetic system driving energy into our cells for growth and repair, we're functioning aerobically. In that case, it's driven by mitochondrial function and it's driven by the mitochondria giving the right amount of energy to the cells that need it. So we have 30 plus trillion cells in our body, which is a lot of cells, and they all need energy. The question is which cells get energy or which cells get how much energy and when? That's what the autonomic nervous system is figuring out. It's saying, hey, your muscles have to produce more energy. Your brain needs to function higher level, your heart has to function, boom. Put energy into those cells so they can go do their job. Then it's saying, oh, that workout was stressful. We need to rebuild those muscle tissues that got damaged. We need to restock our glycogen storage. We need to do all these things to promote growth, put energy into those cells. And so the autonomic nervous system is communicating and using our mitochondria to drive energy into these different tissues. Need it when they need it. The more effectively we can do that, the more effectively you're going to live a healthier, longer life. And that comes down to the aerobic side of the equation. Because the aerobic system is what's driving the energy in 99% of our life. Right. We're really only using anaerobic energy as necessary to do things are higher force and higher power, but the aerobic system turns on is there from when we're live. And as soon as we don't have oxygen to create energy, we're dead within a few minutes. So it's so fundamental and we see this connection between heart rate variability and aerobic fitness across the board. It's just the way it is.
- [35:20]
A
And the way to improve. And I don't want to say increase or decrease because you pointed out that it's somewhat relative to the person. If we recognize HRV as a marker of readiness, is that fair to say? Or longevity or.
- [35:35]
B
Yeah, I mean, I was fair. Again, I would say it's a marker of resilience in terms of your. So I would say this. We see your average baseline hrv. That is a marker of how influential and how effective your parasympathetic system is, your recovery system. The more effective that system is, the higher that baseline level. That's what we're measuring, the baseline level of hrv. The more you're able to turn off the stress as it comes at you and adapt to it. So basically, if I have higher HRV on average, it just means in general I'm better at dealing with stress. And that has a lot of benefits. If it's lower on average, it has a lot of detriment because I can't deal with stress as effectively. And that's also why you've seen athletes at the highest level, they have very high HRV because they are just machines.
- [36:16]
A
And it makes me think of the individuals then, I suppose that were running a marathon. If we were to put the two together, those with greater aerobic fitness might be more resilient, of course, which again, I think is fascinating. Is there a minimum dose Response to improve HRV? For example, we have the recommendation for 150 minutes of moderate to vigorous activity. Do we know if that input is enough to improve HRV in any meaningful way?
- [36:45]
B
I mean, yeah, it depends on where you're starting. It's like anything else. So if you, if you just substitute the word like aerobic fitness for hrv, you're probably going to get the answer, which is. Yeah, of course, if someone is fairly unfit, they start training.
- [36:56]
A
But what I'm. But I also.
- [36:57]
B
What.
- [36:57]
A
I mean. Sorry to interrupt, but. But you've seen thousands of people over time. And so, I mean. And also, to be fair, you're taking care of very highly trained individuals, but I'm sure not all of them were aerobically fit because it just depends on what their sport of choice is.
- [37:13]
B
Yeah.
- [37:14]
A
So I'm curious as to what you see as a. And it's difficult, right, because a global. The idea of a global foundational program is probably impossible because a specialization in someone doing jujitsu versus someone playing football versus someone who's like Justin Gatlin or a track star. But is there, say, a minimum input that you See, just somewhat across the board for similarly to. I know that I would never Recommend Less than 100 grams of dietary protein.
- [37:45]
B
Sure. I would say at a bare minimum, three days a week of some sort of physical aerobically driven activity, probably 80% of that in the lower end of the spectrum, the zone 2 type cardio, and, you know, 20ish percent on the higher intensity. If you get three days in, you're going to improve your HRV at a baseline level. Now that's going to diminish as you get higher and higher aerobic fitness. But I would just say starting out, you need three days a week of doing something physical. And again, someone who's just getting off the couch can still make progress with like my producer.
- [38:14]
A
Yeah, yeah. Well, some people can't be good at everything.
- [38:17]
B
The lower you're at, the bigger your room for improvement, the faster it's going to happen with less work. And that changes over time, obviously.
- [38:23]
A
I like that you're saying that it changes over time. And one of the things I think you're now very interested is in this idea of longevity, of how do we maintain a healthy HRV over time. Does that mean we need to continuously increase the stimulus to improve HRV over time?
- [38:41]
B
Yeah, I mean, two things here. One is there's a genetic component to HRV which I want to point out.
- [38:45]
A
Just like, is it 50% or.
- [38:47]
B
I mean, the papers you read are all over the map.
- [38:50]
A
They are.
- [38:50]
B
It's hard to put that as a true number. I don't think we have a great answer in that. I would say it's, I don't know, 40% somewhere in that range. And I've seen this all the time. I'll have people walking down the street, they're clearly not in good aerobic physical condition. They haven't worked out maybe in years. Maybe their metabolic health looks poor. And you'll test for HRV and you're like, what?
- [39:10]
A
And it's good.
- [39:11]
B
And it's very good. The same thing. You know, you see people, you see people are. Yeah, but you see it. I'm sure you see people that come in, maybe they don't look metabolically healthy, they're carrying more fat. They should be, their diet's terrible. And then you test them, you're like, oh, like what? They're. They look great. Like there's just that end of the genetic spectrum. And then you see the opposite. And I even put myself in this.
- [39:30]
A
Category, which you, I would love to hear you mention a little bit about the stuff that we were Talking about. Because it's just so important.
- [39:37]
B
Yeah. So genetically, I've always had lower HRV than I should. So what I mean by that is, if I look at some of the aerobic fitness, their VO2 max resting heart rate, you know, other markers of actual aerobic performance, you can kind of assume roughly where you think they should be, you know, from an HRV standpoint, because there's a very broad correlation, like I said, between VO2 and HRV. I've always been the much lower end of that. Maybe it's because early in my life, I did a lot more lifting weights for a long time than I. Than I focused on the conditioning side. Maybe it's because it's genetically, you know, my family has lower hrv, which I've seen now, but there are multiple reasons for it. And so when I looked at my own HRV relative to where it should have been, it was always on the lower end, and I took that.
- [40:15]
A
You know, it's kind of ironic, right?
- [40:16]
B
Yeah, it's kind of ironic. It is. You know, and. But. But it was just a reinforcement of, like, this is a genetic thing. I've always been a strength and power athlete. I was, you know, I've. I've squatted five, five hundreds, bench in the 400 draw, same, you know, perfect. You know, when I was younger, that's what I love to do, is lift weights. And, you know, that's what I did. And it really wasn't until my twenties I started to take the conditioning side more seriously as I trained these athletes. But regardless, you know, I've always seen that in my family, who has a very bad history of cardiac problems. I think we were talking about this. So my mom had a stroke when she was 61. She had severe cardiovascular disease, and he had three stents. She then had sarcoidosis in the lungs and that she had breast cancer. And so it was a series of things, obviously, and I got to see very clearly what happens when you lose your mobility, what happens when you lose your ability to get up and do things you want to do because it's so energetically demanding for you and so hard. She was. She started 110 pounds. She ended up in like 90 pounds. So severe sarcopenia, bone density was terrible, obviously, and it was just a very heartbreaking thing to watch and her, you know, go through life for the last 10, 12 years of your life in such a miserable state.
- [41:23]
A
It's very difficult to see.
- [41:24]
B
It's very difficult to see. And you realize, I think at that point, your Ability to do the things you love doing as you age is so important.
- [41:32]
A
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- [42:55]
B
Drlion and I'd go to the retirement community with her and I'd watch these people and you'd see a mix. You'd see people who were just kind of resigned to their fate. They weren't trying that hard. They were just kind of waiting to die as to say. And then you see people who are the opposite. She had this friend named Peggy. Peggy was 94 and she had a little walker and she would go to my mom's room and she would drag my mom to every field trip that they ever had. And she would just sit there and say, you have to do everything that you can dear. You have to do everything that you can. And she had the most positive spirit I've seen. And Peggy made it to 95 like that. Like she went on a field trip and then the next day she was gone. But till the very end, I love that she was active in doing the thing that she loved. And I think that's how we all want to live our lives. But I saw the opposite of that and my mom's spirit just slowly sucked away from her in, in that scene, certain things, but kind of back to the story, you know, so I, I was aware that genetically I had, you know, not cardiovascular disease. My dad had a heart attack at 62. No, sorry, no. He had a heart attack in his late 50s and then had quadruple double bypass, early 60s and died a year later. My brother, at my age, now 45, had three stents or two stents put in and both grandpas died in early heart attacks. I knew I had the bad end of the stick as far as genetics, cardiovascular.
- [44:13]
A
It was coming for you.
- [44:14]
B
Yeah, it was coming for me. And so, you know, and knowing that my HIV was lower was also a symptom. Right. It was a clear indicator that there was probably something there.
- [44:23]
A
What about your. Just out of curiosity, your resting heart rate?
- [44:25]
B
Low 50s.
- [44:26]
A
You're. Oh, God. Okay. Because some people, I think genetically, no matter how much, but it's taken me.
- [44:31]
B
A lot, so I would say it takes me a lot to get my resting heart rate. Low 50s. It takes me a lot more cardiovascular work and I have to cut back my strength train. I hate to say it, but if it was up to me, I would lift weights five days a week and do as middle of cardio as necessary. It doesn't work.
- [44:44]
A
So that's informing your decisions 100%. That's bad news for me, unfortunately.
- [44:49]
B
So I'll keep telling the story and we can get there. But. So again, I was aware of all this sort of thing, and my predisposition was towards lifting weights, being strong, lifting heavy, you know, building muscle. I used to be 230, 235.
- [45:02]
A
Really? How much are you now?
- [45:03]
B
205, 210. So as I got more and more aware of this, when I was taking my mom to the cardiologist, I would say, hey, what do I need to do to prevent being in this situation? Right. I'm in the health space. Like, I want to do everything I can to prevent this. So in my 20s, late 20s, I started getting blood work every six months, life extension. I would do NMR, lipoprofile, which looks on my cholesterol. I would do CRP. I would do, you know, a mix of things depending on, like my hormones, testosterone, like, look at everything. CRP was sure low, but something super fast and is when I would lift weights and measure crp. The next day it'd be like six, which is very high.
- [45:40]
A
What about your liver enzymes?
- [45:41]
B
All normal. All perfect.
- [45:42]
A
They always stayed normal.
- [45:43]
B
Yeah. What's fascinating is I took two different biological age tests, markers. They all said I was between 10 and 12 years younger, or both of them said I was between 10 and 12 years younger biologically than I am now.
- [45:54]
A
Great.
- [45:55]
B
Great, right? So I'm thinking, oh, I'm good. And my cholesterol was never bad. So my cholesterol was, like, 100, 110. The worst I ever saw was 120 during holidays. You know, all my metabolic panel numbers look good. Passing glucose.
- [46:08]
A
And for those who are listening, you are a very trim, lean. You know, sometimes there's a creasing in the ear for cardiovascular disease. Have you seen that sign? You don't have that.
- [46:16]
B
I mean, my skin does not show.
- [46:18]
A
Your Botox is looking great.
- [46:19]
B
Perfect. So, yeah, all my metabolic numbers looked healthy, basically, like, they did not signal, like, oh, this person's at risk for things. My triglycerides are always in the 50s and 60s.
- [46:32]
A
Wow. Like, and for people listening, we like to see it less than 100.
- [46:35]
B
Yeah. I mean, all those numbers, basically incidents, it was always the top of the chart. So as I was seeing this cardiologist bringing my mom to him, he was like, look, all your numbers are great. You clearly exercise. Like, all signs are good. Like, I'm not worried about you. You know, come back when you're 40 and we can do some more testing. So that was very heartening. Right? Like, I'm like, okay, I'm doing the right things. All my numbers look good, and I continue to test every six months. I have years of years of my blood work, and I wasn't testing back then, but I have since then. So regardless, 40 comes around and Covid hits, and I'm 40. So, you know, the odds of me going back in there to get preventive screening were not high. I tried to actually call, and they wouldn't even like, no, you can't get.
- [47:16]
A
Because you had no abnormal markers.
- [47:17]
B
Yeah, no markers. And it was not an emergency. Right. So long story short, you know, I'm just kind of resting. The fact, like, hey, my. My. My VO2 max is in low 50s. Not like marathon runner by any stretch, but for 45, that's not too bad.
- [47:28]
A
Where does someone want their VO2 max?
- [47:30]
B
I mean, higher for longevity? Seems to be better at 50s. At my age, is. Is it in the top? Probably 10, 20%. So all numbers, again, look like I'm. I'm on the right track. And so last year, I'm like, finally make the point, get back to see the same cardiologist, and he does the ekg. Listen to my heart. Like, looked at my numbers again. He's like, oh, you're doing great.
- [47:51]
A
The EKG was normal, Totally normal. But could you have looked at a heart rate variability with the EKG you.
- [47:58]
B
Could, but their system's not really designed to do it.
- [48:00]
A
It's interesting because I, as I was prepping for your podcast, nearly everyone gets an EKG prior to that, but you could tack it on as a biomarker, and then we would have a tremendous amount.
- [48:10]
B
Yeah, of course.
- [48:11]
A
So, like, additional data.
- [48:12]
B
The first HRV system I use, like I mentioned, we actually had to do a full 60 ECG EKG. So we were doing that. So, yeah, of course, in the hospital setting, they could get that. They just aren't trained, but it would be interesting.
- [48:23]
A
So we cardiologists that are listening to this, very fascinating. It would. It probably just be another algorithm in which they would put.
- [48:30]
B
It'd be another biomarker to pay attention to. Okay, so long story short, he's like, no, you're not. He does another blood panel. Like, your numbers are great. Does ekg. Everything sounds great. Like, you're on. You're on good track. Like, keep it up. And in the back of my mind, I'm thinking, like, let's do something more than this because, you know, I want to make 100% sure that I'm doing the right things and things are heading the right direction. So I'm like, what about getting a CT angiogram? It's something Peter Tia had talked about it, like, just been through his book and he mentioned CT angiogram. And I'd heard about it before, you know, five years ago, but wasn't super common. And he's like, he's like, yeah, you could do that. You could do calcium score, cta. Like, it wouldn't hurt. You know, like, everything looks great, but if you want to do it, you know, it's 1500 bucks out of pocket, by all means.
- [49:09]
A
Did you do a CT angiogram or do you do a clearly hard and plaque?
- [49:13]
B
I did CT angiogram. Well, CT angiogram gets soft and heart plaque clearly is just the AI algorithm that tries to quantify that. Right. So I found a radiologist who's great in my area. She does out of pocket CT angiograms.
- [49:25]
A
And she reads soft plaque as well.
- [49:26]
B
Oh, yeah. So just for your listeners, the. You get a calcium score, that's just the hard plaque. And that's like 200. That's right.
- [49:33]
A
Doesn't tell you anything. You expect it to be zero.
- [49:35]
B
You expect it to be zero. Or you can get the full CT angiogram, which is just the same process, but they put contrast dye to see the soft plaque. Then the clearly is an algorithm that looks at the results of the CT angiogram and then tries to quantify the percentage of the soft plaque. Or the radiologist I worked with used to sign off on the clearly report. So what they do is they have the CT angiogram, spits out the imaging, and then clearly does an algorithm, and then a radiologist reviews it and signs off on it. And she said that she was finding discrepancies 15, 20% of the time from what clarity would say versus what she saw radiographically. And so she stopped signing off on them, but she still thinks there's some value to it.
- [50:12]
A
So just out of curiosity before we move on, because I do think hard and soft plaque, and you are an example of why measuring hard and soft plaque is important. How does she. Or how do you. How does one recommend making sure that you're getting.
- [50:25]
B
Well, that's the full TC angiogram. Right. So the full CT angiogram is, like I said, it's usually like $1,200 to $1,600. They pull you. They do. They put you in the ct, they pull you back out, they put in contrast dye, and they put you back in. If you're doing that process, you know, because you're paying for it. Right. It's a lot more expensive and you.
- [50:42]
A
Feel like you're peeing down your leg.
- [50:43]
B
Yeah, exactly. It is a little weird.
- [50:45]
A
Yeah.
- [50:46]
B
But if you're getting that done, you're getting hard and soft plaque, Right.
- [50:49]
A
If you're just a CT. Yeah.
- [50:51]
B
If you're getting. If you're paying 200 bucks, you're probably just getting a single calcium score or maybe calcium scores of different coronary arteries, but you're not going to contrast dye. That's the biggest difference. The biggest thing is the end state is that hard plaque. Right. But the soft plaque is what calcifies into the hard plaque. And if you don't see the soft plaque, you could potentially have a zero calcium score, but still have a fair amount of soft plaque hidden. And that's a problem.
- [51:13]
A
Is that what happened to you?
- [51:14]
B
No, I have both, unfortunately. So I get the CT angiogram, and again, it was 1500 bucks out of pocket. And I say this because for most people, it's not small amount of money, but it's. Your life is on the line here. How many times you spend 15 bucks on cars and far less important things? So I get the CT angiogram, and completely unbeknownst to me, my good friend from high school's, his wife is the lab tech, and I Had no idea that she was working there. It was complete random coincidence. And so I get down the ct, she's running it, and I get done with him. Oh, I'm great, right? And she kind of, like, looks at me and, like, doesn't say much. I'm like, this can't be good, can't be good. And so she's kind of like, you know, giving me the look, but she can't say anything because she's the lab tech, she's not the radiologist. And so, sure enough, I meet the radiologist, and she's like, yeah, you've got some significant blockages here. You know, my calcium score is at 1300 and you want zero. At my age, 1300 is very high, very high. Now, part of that could be because one of the things the cardiologist did tell me to do is take red rice yeast, which has a naturally current levostatin in it, and statins calcify soft plaque. So that could be why my score was much higher than it would have been if I hadn't taken one. That was one take on it. But regardless, I had a 50% blockage in the LED, which is a widowmaker, which is considerable.
- [52:34]
A
And for the, for listeners, the widowmakers, typically, when people, when you hear of someone having a massive heart attack and dying, that's why they call it the widow.
- [52:44]
B
Don't want to have them with black.
- [52:45]
A
Yeah, well, you're a winner. What can I say?
- [52:48]
B
So, you know, obviously, I'm shocked. I went into this thinking I was going to get this thing done to validate. I was doing all the right things, and I come out with a pretty shocking diagnosis of a blockage. So I go back to cardiologist, and I'm kind of like, what? You know, why did you not, like, kind of frustrated, because I really wish I had been told to do this earlier. It would have picked something up, and I was not. And it's just a reminder. You have to look at your health and your own needs.
- [53:13]
A
You have to be your own advocate.
- [53:14]
B
Yeah, I mean, I did, in the sense that he didn't even tell me to go get the CT angiogram. Well, I had to ask, I had to say, hey, should I go do this?
- [53:20]
A
Well, to be fair, all of your markers were normal, but the difference is, and I'm sure your radiologist friend would agree, is that you had a significant family history of cardiovascular disease.
- [53:29]
B
I was there with my mom.
- [53:30]
A
Yeah. So that's unusual. And we, you know, we have a full medical practice still to this day. A shout out to you guys. You're the best. Dr. Lisa and team, we typically always recommend individuals get and listen. At your age or a little bit younger, late 30s, early 40s, people are very resistant. They will say, listen, all of my markers look good, just like you did. LP, less than 25 APOB, all of total cholesterol, triglycerides. And people will not want to do it.
- [54:01]
B
Yeah, I mean, I have friends now. I've been so ever since I had done it, I've been trying to convince my friends that have high risk to go get it done, because why not, right?
- [54:08]
A
And when you define high risk, you mean.
- [54:10]
B
I'm looking at cardiovascular. I'm looking at cardiovascular disease history above all else at this point. And talking to the radiologist. Genetics. Right. So anyone that I know is most likely in the fitness space, and they're in my mind frame mindset of, oh, I'm fit, like, I'm probably fine. But if I, you know, talking to them, hey, do you have cardiovascular family history? All the ones that have it. I'm like, you need to go get this check.
- [54:28]
A
And friends, all the ones that don't. If you do not know your family history, you. I would strongly encourage you to either get with our practice or get with a practice that is willing to order it.
- [54:40]
B
Yep. Because that's really important, because you can get the calcium score. If you don't want to spend the 1500 bucks. I understand that the $200 calcium test and sometimes insurance covers that for 200 bucks, you're getting at least something. You're getting a good marker.
- [54:51]
A
It's not as or advanced cardiovascular lab markers, which is unusual. So the big question is, then you start on medication, right?
- [54:59]
B
Yeah. So, yeah. Well, actually, the first thing I do is stress echo, and so I think this is least somewhat reaffirming or reassuring. He does the stress echo miserable tests. I do the Bruce protocol test, which is incline and Speed up by 8.
- [55:10]
A
I'm surprised you say it's a miserable test.
- [55:13]
B
It's not easy considering how faint I max it out. I mean, I finished the test for the BR Protocol.
- [55:17]
A
What are you talking about? Busting drops is you're on a incline. They're pushing you up to your max. Max effort to see how I went.
- [55:25]
B
I did. I finished the test 21 minutes, which they really see. It's terrible. Yeah, it's easy. Until you get to, like. I think it's like 15% incline at like six miles an hour.
- [55:33]
A
Whatever it is, never break rule number one. Yes.
- [55:34]
B
And you had to have your hand on the treadmill, which is another problem. But again, it wasn't in the world. I finished it. He looks at everything. He's like, look, you have no ischemia. Your heart looks great. Everything's functioning really well. So that was reaffirming. And again, the fact that my brother at my age, who didn't work out, who had much higher stress lifestyle than I did, he died of a motorcycle accident, unfortunately. So we know where he would have been.
- [55:57]
A
Oh, it's terrible.
- [55:58]
B
But in his. In his 40s, my age, he had to have stents put in.
- [56:01]
A
He had stents.
- [56:02]
B
He had stents. And I do not, clearly.
- [56:03]
A
So if you had not. This is. There's three things here. Number one, I'm sorry you lost your brother. Number two, had you not been doing the behaviors that you have been much worse, probably much worse. And number three, if you have a family history, someone you know, whether your blood markers are good, you should be evaluated 100%. When you went through treatment, and for everyone listening, you were doing all the cardiovascular, all the weightlifting. Although you're telling me that less weightlifting, more cardio. Now, did it change your heart rate variability?
- [56:39]
B
So here's a long story.
- [56:41]
A
That means.
- [56:41]
B
No, no, it does, actually. So, but what's fascinating to me is that statins have been packing my HRV.
- [56:47]
A
In a positive way.
- [56:48]
B
Yeah, positive way, but interesting way, but going back to that. So when I did so once I got diagnosed, I'm like, I need to understand this more. And so I did a bunch of genetic testing on everything. I did sterols testing, and I'm basically.
- [57:00]
A
You did a what?
- [57:00]
B
Sterols testing.
- [57:01]
A
Oh, yeah.
- [57:02]
B
I'm a hyper producer.
- [57:03]
A
Well done.
- [57:04]
B
Yeah, I'm a hypercholesterol producer, which also tells me that because my cholesterol was not super high, it tells me that my diet was poor, it probably would have been super high, which would have spiked things even more. Right. So I think there's clear indications that things I was doing and still do was massively helpful. Then I looked at a bunch of genetic markers as well, and I have a. They call it heart attack gene. It's endothelial dysfunction. And basically, the vascular smooth muscle cells tend to be hyperproliferative, and those smooth muscle cells can proliferate and become part of the plaque themselves. And it causes basically, you know, endothelial dysfunction, as I said, which makes you more prone to inflammation. So it's possible, you know, maybe years of heavy lifting exacerbated some of that.
- [57:48]
A
I don't know. About that. It's possible endothelial dysfunction. So if you, how are you measuring that myeloperoxidase endometriolis?
- [57:55]
B
I didn't measure direct test. I'm just looking at the genetic, genetic likelihood.
- [57:59]
A
I'd be hard pressed to believe you're training. Resistance training if you're recovering well would.
- [58:04]
B
Yeah, you wouldn't think so, but, but I would say the interesting thing to me is like I said, I've now sent seven different people into the sphere to go get CT angiograms and six of them have had blockages that were in high calcium scores their ages and they're all lifelong athletes and lifters. Also if you look at there was two papers, the Mark 1 and Mark 2 Marc, which is measuring athletes risk of cardiovascular disease. They found that lifelong athletes often had higher calcium scores in general public. And more blockages. Which is interesting.
- [58:32]
A
That is interesting. We'll have to look at those. So that could be, that would be interesting if you're producing more reactive oxygen species.
- [58:41]
B
Yeah. And there's, there's. I mean I, I personally think most things have U shaped curves. Right. Like more is some is good, more is better until it's not and that's worse. If you look at some of the papers on longevity we discussed or I sent over and they looked at dose response to strength training and you do see that about three sessions a week of strength training is where we tend to be the most benefit associated with that. Can't prove causation. But you do see that the five, six days a week people seem to have risk of the wrong direction in these multiple studies and trials. Again, I'm not saying that strength training itself is inherently bad. But I will tell you in my experience what happens is if we do lots of high pressure, high blood pressure work, those arterial walls become thicker. There's no question about that. And your HRV is lower. I can tell you that for decades of looking at HRV, that chronic weightlifting, heavy weightlifting powerlifters, strength athletes, they have lower HRV because they have less cardiac output and they have much more thickened cardiovascular system in general. Right. The vascular smooth muscle cells become thicker, the walls become more dense and more fibrous over time. Your left ventricle thickens in a way that can handle high blood pressures. It's just a response to high blood pressure. Right. The body gets better at dealing with high blood pressures. The way it does that is by the vascular system adapting by becoming thicker and more rigid. That's not a great thing in the long run. And it's the opposite. We see in the aerobic side where we're training elasticity in the vascular system, more or less. So I'm not blaming my condition by any stretch on lifting weights. I'm not saying that by anything. But I do think genetically you have to be aware of where your strength and weaknesses are. And probably for me, focusing on the aerobic system my entire life would probably have been, you know, a benefit versus focusing on not telling. I think that's.
- [60:20]
A
I think that's valuable in the way that HRV could direct and inform links or missing links to what is potentially personalized training. Right. There's this desire to be big and strong, but perhaps there's something else that can inform the direction from a longevity standpoint.
- [60:41]
B
I think the problem is we like to do what we're good at. I was always strong in the aerobic side, was never my strong point. And so I like to revert back to what I'm good at. Most people do. I love lifting weights. I saw better progress. Building aerobic system was always harder for me. It was not the easiest thing in the world. So I did less of it. Just inherently. Right. So it's a good reminder. It's often more effective to be attacking your weak points and just reinforcing what you're already good at. And especially if it's on longevity side. We know how important the aerobic system is. We know how important VO2 max is.
- [61:13]
A
And do you care how one gets to improve the VO2 max as a coach? For example, do you know Martin Gabala?
- [61:19]
B
Yeah, I know.
- [61:20]
A
Yes. Yeah. Out of McMaster University. He's been on the show. We'll be seeing him here shortly. Do you think that it matters how someone improves their VO2 max from a heart rate variability? For example, could you do high intensity intervals and improve your VO2 max and then thus have a positive influence on your heart rate variability? Or does one need to do slow, steady state and then that also improves VO2 max? But the means to the end of the improvement in VO2 max is still the same metric, but the input to get there was different. Does either. Hopefully I'm making that clear. And does either input change the heart rate variability more or less?
- [62:04]
B
Well, I think if we look at a long picture, long term picture, and just my own anecdotal experience, we build a foundation for a higher VO2 ceiling through the lower intensity work.
- [62:15]
A
Joel and I have been talking all about heart rate variability and recovery. And if you've been following me for a while, you know I take light exposure seriously. Why? Because it impacts your sleep, hormones, mood and even your ability to recover and focus. That's why I use one of the sponsors, which is Boncharge. Boncharge creates science backed tools to help you live in better alignment with your biology, especially in a world that is overloaded with artificial light. Their blue light blocking glasses are a staple in our house. They help me wind down my nervous system and protect circadian rhythms, especially after a heavy screen day. I also use their infrared mats with my kids just laying out, chilling. It is amazing. It also helps me feel relaxed towards the end of the day. And if you've never tried red light therapy, let's face it, you know you're missing something. Their devices are some of the best quality that I have ever seen. Great for skin, mitochondrial health, supporting overall resilience. And if you care about optimizing your sleep and recovery or just reducing your relationship with stress in your environment, Bon Charge is the place to start. Head to boncharge.com drlion and use the code DRLION to get 15% off your entire order. That's B O N C H a r g e.com it's simple, proven, designed beautifully and effective to help you leverage your biology, not fight against it.
- [63:55]
B
And there's two reasons for that. One, we want to increase two things to build VO2. Well, the biggest thing that drives VO2 in the long run is heart size. And we see this in a bunch of research. A bigger heart can pump out more blood and more oxygen. And at the end of the day, that's what's going to limit VO2 is how big your heart is. And that's where a lot of genetics comes into it. If you have a bigger heart, you have higher capacity for cardiac output, you have more stroke volume, you can have a higher VO2. We know that lower intensity training causes the heart to dilate more. You get a bigger left ventricle and you get more angiogenesis, you get more vascular development. And those things happen through lower intensity training. We also know we get more fat oxidation. We're doing slow type cardio because we're focusing on burning fat versus high intensity training. So I think it's pretty well understood, at least in the endurance world. And I think mostly now starting to populate down to the rest of the world. The lower intensity you do, the more of that you do, the more you set the ceiling for higher VO2. So somebody could say, in the six week period, I did a bunch of high intensity and I got better results for my VO2 than if I just did lower intensity. Sure, you probably did, because you just put your body in a more load. But I think your ceiling will be less high. Will be. Will be lower than if you had spent the time doing the lower intensity work. So I think the answer depends on what's the ultimate goal. Is the ultimate goal to raise your VO2 for next six weeks, or is ultimate goal to raise your VO2 to the highest levels over the next 6, 10, 20 years? And if all you do is high intensity training, you will ultimately limit your ceiling and where that VO2 can get to. And that's just what we see in research. If you look at even, even the infamous Tabata study, right. They had seven people in each of those groups. The high intensity group that did the Tabata intervals increased their VO2 slightly more over the course of the study. But in the second half, the second three weeks, it basically stayed flat versus the endurance group that did the lower intensity. It increased fairly uniformly across the full six weeks.
- [65:43]
A
So that's fascinating.
- [65:45]
B
Yeah. I think that. Are we the problem with research in.
- [65:47]
A
This context, specifically in training?
- [65:50]
B
Look at, we'll just look at training research of like, okay, very challenging. It's very challenging. If we say, hey, is high intensity or lower intensity better? If we have six weeks, which is what a lot of studies are, 10 weeks, eight weeks, whatever, high intensity will win. It's just a, it's a greater stimulus in the body. It's like saying if we had two people lifting weights, one did a bunch of three rep, five rep maxes, and the other group did like 10 to 12 reps. Yeah, the three to five rep maxes and get better at three to five rep maxes and be stronger. But does that mean every athlete should just do nothing but lift three to five reps every time? No, you need to build muscle. You need to build a pound. It's same. I would say it's the same exact concept, actually. If you said, hey, I want to get as strong as possible and I just did a bunch of heavy lifting, I would maximize my neurological component and I would eventually hit a peak where I couldn't get any stronger unless I built more muscle. Right. It's the same thing. If I just do high intensity, I will maximize the cardiovascular adaptations. I have to get to the highest VO2 that I'm capable of with that physiology. But if I want to develop a higher VO2 that increases over time, I have to build a physiological foundation. That's where the lower intensity work comes in. It builds that Process of change within the body, within the vascular system, within the cardiac capacity itself to raise the potential for how much VO2 I can deliver down the road. It's a very similar process.
- [67:05]
A
That's a really good point. I will say that I typically dismiss slow, steady state, and I might have to reconsider that.
- [67:14]
B
Yeah, I just think. But here's a caveat to all of this. Yeah, There's a lot of genetics in that. So if a person has a high genetic VO2, they can probably get away with doing less of it because they already have that higher genetic potential anyway. They already have a bigger heart to start with. They already have better cardiopulmonary potential because their lungs are bigger. They just have that innate capacity. Those people will build it faster. I would also say people that spent a youth doing team sports or doing endurance sports, they've built a foundation from a youth perspective that probably will make it much easier for them to do it later in life. In my case, I can tell you that looking at athletes who are lifelong strength athletes, they have a much harder time building high VO2 without that foundation. The worst part is I hate it. Like they don't like doing. I don't love doing low intensity cardio.
- [68:00]
A
But you do it. Do you think there's a minimum time. So you had said three days a week of doing. Three days a week of doing some kind of zone two training. Do you think that there. It needs to be 45 minutes, I mean, 30 minutes?
- [68:12]
B
It's probably, it's probably a starting point for most people. I mean, I hate to use this generic answer, but you need to do however much it takes you to get better. Right.
- [68:18]
A
I mean, it's tough because training stimulus and the conversation around training and longevity is much more complicated from a biometric standpoint of heart rate variability, blood pressure, the inputs and the training inputs are so much more challenging than say, as a physician who studies nutritional sciences. That's so much easier.
- [68:39]
B
Yeah. I mean, and everything's modified by what you did before. And I think, yeah, that's the other thing you realize with hiv, we can talk a lot about is what you ate for breakfast, how your sleep was, what your workout was yesterday, where you're at in different cycles. All of those things will modify the response that workout to HRV or hiv that workout. It'll change response that workout. And the biggest thing people fail to understand is HRV is this aggregate. It's the total picture of stress response and it's the total picture of how your body is coping. With the world around you, it's not just, hey, you work out. HRV does this, hey you, do you eat this food? HRV does that. Like it's just nowhere near that simple because the body's not responding to just one thing. It's responding to literally everything. It's making choices based on the whole picture of your life.
- [69:24]
A
But how can that inform. That would be challenging then to have it informed decisions. Because if we know that the biggest driver would be say aerobic fitness, then if someone has a poor hrv, you add in aerobic activity, now their HRV is improved, but not necessarily because maybe they're not sleeping or they are having a high cognitive load or it's cold outside. Yeah, I mean that's, they sneezed. I don't know.
- [69:50]
B
So that's, that's the difference between what I would say, daily changes in HRV which reflect those things and long term changes in your baseline hrv. So yeah, on a daily basis, if I get a poor night's sleep or I have a bunch of alcohol or whatever, like, yeah, that's going to probably tank my HRB for that day. But over the long term, if I'm building aerobic fitness and doing the things it takes to build the aerobic side, that average will go up over time and that's what we're looking for. I would say the single thing that you can do to stop overanalyzing HRV is just look at a weekly and a monthly basis.
- [70:19]
A
A weekly basis?
- [70:19]
B
Oh, absolutely. Weekly basis. I'm looking at weekly basis more than looking at daily these days because it's very informative of two things. Am I trending a certain direction over that week and how much variability is there in that?
- [70:32]
A
I love that most people say look at it daily. Right. A lot of my friends are wearing all these different devices and they're like, oh, my HRV is, or I'll get calls from patients. My HRV is terrible and I'm afraid I'm getting sick.
- [70:44]
B
And yeah, I mean, look, daily basis can be informative, but it's just one data point within a greater picture. And it is dependent on you measuring accurately at the same time of day or using the device very consistently and making sure that you're getting good accurate data. But that single day is just one single day. It's just telling you what your body's doing right now. It's like a big example would be if I woke up in the morning, I was a pound heavier than I was yesterday. Am I going to throw out My entire diet because I was maybe a pound heavier than I thought I was going to be. Or am I going to be, oh, maybe I ate a little bit too much yesterday or my hydration's off or whatever.
- [71:16]
A
What else really impacts hrv? And you said something really interesting. You defined resilience as the ability to withstand stress around you. How much of HRV is. And then you spoke about the woman. What's her name? Peggy. Peggy. Peggy Sound like she had a really positive outlook. How do we know the influence of mood on hrv?
- [71:40]
B
It's huge. I mean, look, when we are stressed out about something, it is a physiological response. Our heart rate is higher. Our resting HRV at that point is lower because we are by definition turning. I would say we have to kind of define stress. To me, stress is anything that turns that sympathetic dial up. And so stress is not like a on, off switch or yes or no. It's a degree. How much stress are we under? It's how much is that sympathetic system activating? So if we sit here and we look at social media and we look at politics and we watch the news, it's very easy for us to be sympathetically dominant or driven because we're stressed out. Right. There's stock markets going all over like this life around us is very stressful. And to me, that is. And after years looking at this as as much or probably more of a player in your HRV on a daily basis than your workout is, the funny thing, because that's fascinating, what it comes down to is the workout's an hour a day, right. Maybe nine minutes, maybe two hours. Very most. The rest of your life is.
- [72:37]
A
Or if you're in China and you're in pseudo training, you're about seven hours in.
- [72:42]
B
Yeah, no, it was more. It was at least that they would do five workouts. And they told me the recovery workout in the morning for injured athletes was another recovery session. I watched it. It was a workout. They apply metrics. Yeah. But the big picture of your life is it's 24 hours a day. It doesn't stop when you end your workout. It's where the recovery process starts. Right. So mental stress is a huge, huge component of this. And, you know, I can give you endless examples. I had this pretty early on, actually, my using hrv. I had this. This guy from Microsoft. He was an executive. He's in his 40s, and he was a. Racquetball or not. Sorry. He was a volleyball player. Recreational. He's like, I want to increase my vertical jump. Well, Biggest problem, he's missing one of his big toes, which is not the best recipe for vertical jump.
- [73:24]
A
Totally fine.
- [73:24]
B
But he was like, I really want to increase my vertical jump. And I also keep rolling my ankle. And so I said, okay, let's get to work. And he'd never done much training other than play volleyball, So I measure his hrv. He comes in twice a week. And back then we didn't have mobile apps. Like, I had to put my whole system on him, and I could only measure. He came in in the evening. So I only saw him twice a week. First four to six weeks, his vertical jump goes up and everything's going great, and then it plateaus as I start to increase load, and then it starts going back down and it's. I'm like, why is this happening? Because when he's coming in this twice a week, like, he looks pretty good. Like, his recovery looks. Looks okay. And so I'm like, okay, I'm clearly not seeing a big picture here. And so I said, look, if you really want to get your vert up, which you clearly do, we're going to have to look at more broadly, you know, bigger picture and look at your lifestyle outside just two days a week. So first thing I do is have him do a diet log. He's drinking 20 to 25 cans of diet Coke a day because he worked at Microsoft, and it's right next to the refrigerator. So that was problem number one. But problem.
- [74:23]
A
Was it the caffeine or just the. I think it's just stimulus.
- [74:26]
B
Yeah, it was just. It was caffeination all day long.
- [74:28]
A
Is there something wrong with that? Matt, we are in trouble. Does caffeine lower your hrv?
- [74:33]
B
A lot of it. But it also is genetically dependent on whether. How you synthesize comt.
- [74:37]
A
Right. If you have a. Yeah, if you're.
- [74:39]
B
A fast metabolizer, it's much less of an impact.
- [74:40]
A
I'm a fast metabolizer.
- [74:41]
B
What's interesting for me personally is I've always. I'm a fast metabolizer, and I've always been able to have caffeine pretty late in the day and not affect my sleep. Until now it does. In my 40s, something changed, and now it affects me more. Same thing with working out. It didn't used to affect me at night. I could work out at night, no problem. Now it impacts my sleep greatly. So we change over time. Anyway, the second problem is when I had him start coming in and measuring HRV every day and early in the day so I could see his Bigger picture, what I found out was he was playing video games until like 4 o' clock in the morning on three nights a week.
- [75:10]
A
Well, he does. Did work at Microsoft.
- [75:12]
B
Yeah. And he was up late and so that was absolutely killing his recovery. I just couldn't see it. And looking at twice a week, do.
- [75:19]
A
You think it was the sleep or the stimulus?
- [75:20]
B
Both. It was both. They're linked. And so very quickly I'm like, oh, this is why you're not improving. Right. Because three nights a week your sleep is trash and you're mentally stressed out of your mind playing this video game all night long. As soon as we fix that, his vertical jump went up 2 inches just. Just by making a change in his lifestyle. Same thing. Another example, we had a college, my old HRV system called Bioforce. We had a college team that was a collegiate soccer team. And we had a year of data and we started looking at all these different patterns and I was like, what is that? Like, what is going on here? Because it was this period where the team was under just insane stress and it was the highest point of stress I could find. It was when they were finals. Yes, it was finals week. Finals week is way more stressful than their tournament, than their. Any of their tournaments where they're traveling, playing multiple games a weekend and coming back. That was less stressful than finals week to them. And you see this time and time again, it's. The lifestyle is the single biggest driver of stress, not the workout. Because of the time component. Workout's an hour, 90 minutes, whatever it is. Unless you're in China, the lifestyle is the whole rest of your day. Right. It's how you eat, how you function within your social group, the stress of just being in the world.
- [76:31]
A
Speaking of social group, I want to ask you about heart rate coherence. Heart rate coherence is something that I found when I was in my first, second. In my second residency because I could not regulate my nervous system when I was on call. We would be, you know, as an intern, you're on call, you're supposed to be running the codes, your nervous system, at least for me, maybe not other people, but my nervous system was totally out of whack. I. You have support, but you have to be able to run. If someone is. You have to run a cardiac arrest code. I could not get my nervous system to calm down. I wasn't measuring heart rate variability, but I was just almost.
- [77:14]
B
I bet you would have seen terrible. It would have been sympathetic if you'd shifted terrible.
- [77:17]
A
So I found something called heart rate coherence. It was this heart math institute. What? Yes, forever. And basically it was. And I started doing their meditations. They had like an ear clip and it was this idea of this harmonious interaction between the heart, brain and the nervous system. And it was supposed to balance this efficient state of physical and mental well being and that it would smooth out again this heart rate variability signal. So I was curious as to if something like that, if you've seen that have impact. And they also talked a lot about breathing. One of the things to improve the heart coherence, heart rate coherence was now, when I think about it, somewhat of a tactical breath.
- [78:08]
B
Yep. Yeah, it's. So there's what's called respiratory sinus arrhythmia and that just means there's this influence on our breathing, both our rate and our inhale, exhale pattern, on our heart rate variability. Because as we're exhaling that's when the parasympathetic system is essentially turned on, inputs amplified. And when we're inhaling the ops is happening. And that's happening for a whole lot of physiological reasons. But heart rate coherence is essentially this technique of trying to maximize the way that we're breathing in a way that can influence heart rate variability to be at its highest point. And that's usually around six, eight breaths per minute, depends slightly on the individual. And it's also supposed to optimize what's called baroreflex and train the Barore reflex to manage blood pressure effectively. I think there's something, there's a good amount of research showing that when you do breathe in this pattern that you do maximize HRV in that moment. And I think there's a huge benefit to people learning how to turn that parasympathetic system off or sorry, that sympathetic system down, I mean, and taking time out of your day to breathe. I think honestly this is the foundation to me in yoga and meditation, any of these sort of breath work things, they're doing this in one form or another. They're developing a pattern breath that's focused more on the exhale and slowing your respiratory rate down, which just does increase the parasympathetic function. It's turning down the sympathetic system and it's turning up the parasympathetic system. Whether or not you need to have a clip on your ear and have the specific exact ratio of inhale, exhale. I think it's less important than the fact that people are just doing it. So I've seen a ton of benefit. I think there's a lot of reasons why people do like meditation and you know, these sorts of things because they're calming their sympathetic system down. Whether it's following this exact pattern in the app or it's just taking time out of day to relax and meditate. Those things are hugely beneficial because they break that cycle. They break that sympathetic stress driven cycle. And doing that, I think has a huge amount of benefit.
- [79:56]
A
And you've seen individuals taking on breathing or meditation improve heart rate.
- [80:00]
B
Absolutely, yeah. There's real research on it. There's research showing mindfulness and yoga and meditation, all these things that get you to stop that sympathetically driven cycle you're in and take even five minutes out of your day can break that process and shift you back into a more balanced state where that parasympathetic system is doing what it needs to do. So yeah, absolutely.
- [80:18]
A
What about the influence of things that seem to increase your sympathetic nervous system that we think about for recovery? Like cold plunge?
- [80:25]
B
Yeah. So I would put recovery strategies in two buckets. One, I would call them relaxation strategies. And that's where breath work, massage, deep water, floating like things like this, where we're just trying to actively turn that sympathetic system down. That's a relaxation, a regenerative type recovery strategy. The other one is what I'd call stimulative. And it's under the same guise of training. It's a hermetic effect. So if we do a cold plunge or we do contrast therapy or we do some sort of load in training, we're turning the sympathetic system on briefly with a parasympathetic rebound afterwards. So a cold plunge is going to be sympathetic as you hit the water. But after you get out, your body's going to have to regulate temperature back in and everything's going to have to be put back and there's a recovery response. So we're trying to trigger that recovery response by a small stimulus. Now the biggest thing I would say about all those things is those sort of stimulative type methods, the body adapts to them. That's what people don't understand. If you do the same stimulatory thing every day, cold plunge or contrast or a million other things, your body adapts to it. It doesn't have the same effect like anything else. The body gets better at dealing with it and it's going to have less of an impact and recovery. You can't expect the exact same workout to have the exact same effect and you can't expect the exact same Recovery modality to have the same effect over time. The other thing is cold plunges immediately after workouts can dampen the response of the workout. Cause they're turning off inflammation as part of the signaling process. But I would say in general, it's a very individualized thing and it needs to be varied. You know, you need to find something that you can do in cycles. You shouldn't do the same recovery modality every single time. And you really probably shouldn't have to rely on an overuse of recovery method. Your programming, your lifestyle should be. That's a really conducive to that to begin with. If you're having to constantly rely. It's one thing if you're a team sport athlete and you're in season or you're doing particular stress or period. But if you have to try to recover every single workout, maybe your workout should be adjusted down.
- [82:22]
A
Do you know Jordan Chalo?
- [82:23]
B
I don't think so.
- [82:25]
A
I think he's also good friends with our mutual friend Luca. But he always talks about the best form of recovery is better planning.
- [82:33]
B
Yeah, it's true.
- [82:34]
A
It's better programming.
- [82:35]
B
Yeah. And I would say too, the other thing here is if you don't like the thing, so you're like, oh, I want to do cold plunges. But if you hate doing cold plunges, just that mental, I hate to say the mental stress and the mental load up doing that is actually more likely to have a negative impact. Like when it's funny, going back to China, I had all these kids and I could tell these kids were just beat down. And so something we did in combat sports was swimming a lot because it's very low impact. We could work on breath hold, which has some capacity to different things. And so I was like, oh, let's take, can we take the kids to a pool and do a recovery session? And she's the head coach, like, I don't know. And so they looked into it like, yeah, we can do it. So the next day they bring a bus and we drive like 30 Chinese kids, judo kids to this public pool. And I could see their eyes as wide. Cause they, they just like, we're out, we're out of here. Like they lived in the camp. These kids live in the school where they train. That's all they do. And so I was like, okay, we're doing a nice easy recovery session. We're going to do some water treading, some deep water floating, some lap swimming. And so I'm like, okay, get in the pool. This kid's all jump in the pool. And it dawns me in the first 10 seconds, they can't swim.
- [83:44]
A
Oh, my God.
- [83:45]
B
None of them could swim. So I'm looking like they're half drowning. The kids had jumped in. The shallow end were fine. The kids jumping the deep end were literally drowning.
- [83:53]
A
And you got fired.
- [83:54]
B
No, I didn't get by it. So the funniest part is I'm like, oh, this is not gonna be so recovery driven. And I try to give him the shallow end. We go through a bunch of exercise, but they're just dying because they don't know how to swim. The funniest thing, if you get back and the coach is like, oh, I heard it was very difficult. I was like, you didn't tell me the kids can't swim.
- [84:11]
A
But how crazy that they were willing to jump in.
- [84:12]
B
Oh, they were 100% no, no questions asked. That's the mentality. But the funniest part was head coach was like, I heard it was very hard. I was, yeah, because they can't swim. She's like, we're doing again tomorrow. I'm like, how incredible, though, because that was the mindset, right? Like, oh, it's hard. It must be effective. I'm like, no, it was supposed to be recovery.
- [84:29]
A
I don't know. I think that we're probably missing a lot of that here. Not that kids should jump in pools that they can't swim in, but that is really.
- [84:36]
B
Oh, yeah, they did. They did whatever they were told. No, no. No questions asked.
- [84:41]
A
Unbelievable.
- [84:41]
B
No questions asked. There was no. Like, maybe they just didn't think they could. They could drown. I don't know. But I'm literally running around, like, throwing noodles and stuff in the pool to keep these kids from drowning, because then I might have gotten fired.
- [84:53]
A
What. What populations are or is heart rate variability not good for would you expect? You know, I've looked at some of the data, and it seems the older people get, the less robust or, you know, the heart rate variability is not as good. But then I've seen other data that really. It's more about lifestyle.
- [85:12]
B
Yeah. So we do naturally decline with HRV as we age. Women tend to be higher until they hit menopause, and after that, it tends to decline during menopause and then stabilize. But yeah, it declines as we age, but there's no reason not to try to improve it. And when I looked at the Morpheus data, which is. Which is my HRV app, we found that Basically the top 10% in each age group had the HRV of a 30 year younger group on average. So if you took someone in their 60s and took the top 10%, that was like the average of someone in the 30s. So you can have, you know, some of that's genetics like we talked about. There's no doubt to get to 10%, you probably have some genetic component to that.
- [85:46]
A
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- [86:55]
B
But you can increase your aerobic fitness throughout your age. There's no point where you can't increase aerobic fitness and where that's not going to have a beneficial effect. So I wouldn't say for older population, you shouldn't do. You absolutely should. I would say that challenging ones are people that have beta blockers or people have arrhythmias that make it impossible if you get an accurate meeting. If you've got different types of arrhythmia, sometimes you just can't get like afib.
- [87:17]
A
Or just some kind of abnormal, not normal signs.
- [87:20]
B
There's a bunch of them. There's so many different ones. Some of them impact HIV and some.
- [87:23]
A
What about pregnancy?
- [87:24]
B
So in general, pregnancy is an interesting one. You do see that, number one, you're producing way more energy, right? Like your metabolism revs up and you have more blood volume because you're delivering nutrients to produce a baby. So you tend to see HIV decline across a pregnancy and it seems to be the lowest in the third trimester as you were just getting ready to give birth. But how that declines and how much it declines is so Variable and I think that's another really big takeaway here is you can't always say a blanket statement. HRV is going to do X, Y or Z at this time because there's so much individual variation. Like let's say somebody never works out and they have a bad lifestyle and then this person gets pregnant and she thinks to herself, oh, I really want to start improving my self care because I want to make sure I'm doing the best for my baby. You know, she starts working out more, she gets focused on her sleep. She does always. It could go up, like it could go up just from making really important lifestyle changes and building fitness. Even though you know you would say that it's going to decline over the course of pregnancy for that individual person, it could go up during that period and because they improve their fitness. So it's, it's really just never one thing. No matter how powerful that thing may be. Even pregnancy, it's a very powerful thing. It still has multiple influences that can dictate what happens.
- [88:34]
A
You know, looking back at your career, do you ever think man, heart rate variability was only one part of it? Or I wish that I had thought about X, Y or Z again. Because you've had a 20 year career and do you have any thoughts like that or any insights?
- [88:54]
B
Yeah, I mean I think we always. The more I've looked at this, the more it comes down. I think the biggest thing is performance at the end of the day in terms of what are the endpoint changes we're trying to move. Is it VO2 max? Is it strength? Is it muscle mass? To me those are the most important factors. And what we're trying to do is use HRV to get those things to where we want them to be. And so I think early on when I started using hrv, it's really easy to overcoach right by it and become obsessed to some extent with that one number moving the way you want to move and trying to over like why do this? Why is it doing that? Like this is frustrating.
- [89:26]
A
How many years did you spend like that?
- [89:28]
B
5. 5.
- [89:30]
A
With protein metabolism, for us, the same thing. And then all of a sudden you're like, I gotta get every single blood work and every single this and this is the input that it has to be. And then everything gets, everyone needs this hormone. And then five years later you're like.
- [89:43]
B
Nah, yeah, it's a big. I think we have to use as much information to make the best decisions we can. That's what HRV is hopefully doing is informing Us to make decisions about how to adjust training and lifestyle variables to get the outcome.
- [89:57]
A
So what happened after five years, you.
- [89:59]
B
Just kind of realize, like, chasing that needle is not moving the needle. Right. Like, at the end of the day, you realize the big. What I really want to stress to people is the big picture is what matters the most. And you look at people's lifestyles and you're like, wait a minute, I can make a much bigger change by improving their sleep a little bit or getting their diet a little bit more dialed in. That's gonna have a much bigger impact. And try and micromanage 3 sets vs 4 sets or 12 reps vs 15 reps. Right? You can micromanage the workout all you want, but those things usually have very small changes relative to these bigger lifestyle variables and the bigger picture of their workout. So the more you can look at the big picture and stop worrying about these little minute changes in details, like the body's just dynamic and you can't outguess it. You just have to look at the data and make your decisions.
- [90:44]
A
Was there any point in your career where HRV just failed you? Where you thought to yourself, man, I totally did not see this coming? Or this athlete completely tanked on X, Y, or Z?
- [90:56]
B
Not necessarily. I think the biggest thing is when you have athletes that are really competitive, it's really hard to get them to measure HRV accurately.
- [91:04]
A
Why is that?
- [91:05]
B
Some. Because they just don't want to do it, to be honest with you. Like, there was a big push for a while in the pro sport realm to get athletes to measure all these data points. Like there was. We just worked project with the 49ers for a while. I did some stuff with the Philadelphia Eagles, and we looked at a bunch of data. Athletes in general resist data at that level because they don't want the coaches to use against them. And so trying to get them to wake up in the morning, measure a data point, share that data, point their coaches, it's really, really difficult. And there was actually a lot of pushback in the NFL Players association across different sports leagues now about what athletes can or can't be required to use. And so a lot of athletes just psychologically also believe, like, oh, if I see a number trending down or go down, it's going to. It's going to impact me physiologically. And so, yeah, I think in those scenarios, HIV is a really tough marker to use. And you work with the athletes that want to do it and then use it and athletes that don't. You can't force it upon them because they're not going to measure it accurately anyway. Like we had a, we built this program with a friend of mine, the going to 49ers when they were supposed to measure HRV every morning and then it was supposed to be part of this big thing or Chip Kelly, where you're going to look at like readiness, self evaluation and hydration and body. Like you're looking all of these markers. And I went in there and they were like on their phones measuring HRV and they were like talking to each other and sit there and drinking whatever they're drinking. Like they, they just didn't want to do it and they didn't care about doing accurately. And so the data was ultimately totally worthless. And so you have to always be aware of data integrity matters. If the data is worthless, then chunk, you know, garbage in, garbage out.
- [92:36]
A
You don't want to use that and HRV algorithms. And those things are really challenging anyway.
- [92:41]
B
They are, yeah. So the one thing I'll say is the biggest challenge HRV is it's sensitive, which is also its attribute because its sensitivity picks up a lot of things. But sensitivity means if I'm sitting there in the morning taking a measurement or if I'm measuring overnight, which we can talk about the differences and I'm stressed out in the morning for some reason, that measurement is going to be very reflective of that stress in the moment. It's not really reflective of where is my true resting HRV at. Because again, we can turn that sympathetic stress response on cognitively, functionally, by thinking about something stressful. And to see this, look at your heart rate and think about something stressful, your heart rate goes. It's because you've activated that sympathetic system, you've turned your HRV down.
- [93:19]
A
And if you want to measure HRV accurately, what does that look like? Is that over a 24 hour period? Always. Is it in the morning, is it in the evening? And also, for example, some people have an increase in cortisol. If you are healthy and normal cortisol increases in the morning also blood sugar might increase.
- [93:40]
B
Absolutely. So historically there's been a few different use cases, but what has the most research is these shorter term measurements of like two to five minutes generally in the morning. Because that gives us a window into where you are as each 24 hour period. There's also research where they looked at 24 hours that usually uses SCNN or different types of markers. Because when on 24 hour basis your average HRV is just gonna reflect your activity. Right Cause as I get up and move around, I work out, I do stuff like my sympathetic system's higher, my HRV is lower. So if I'm really active, my HRV is going to be lower than if I'm less active. It's not super informative other than just like, oh, how mobile was this person throughout the day? The biggest thing now is we've kind of seen two different divergent camps. And I would say my Atmorpheus is one of the only ones down this one. But the two biggest camps are overnight measurements, where you wear a wearable overnight and then it just gives you an average across that sleeping period. And then two is what I do now with mine, which is we wake up each morning and we take a morning measurement. The advantage to that in my mind.
- [94:37]
A
Is it on the. It's a chest strap.
- [94:38]
B
I have a chest strap. We just have a wristband.
- [94:40]
A
Me one?
- [94:41]
B
No, but I can get you one. The biggest advantage to that is we can see where you are at the end of that sleep recovery cycle. Because the way I approach this is each day is its own stress recovery cycle, right? And we just repeat this process. I get up, I go about my day, I live my life, I do some workout or I don't to deal with stress. I go to sleep, my body tries to repair itself, regenerate, and then I start that again over and over again. I want to see where I'm at in the morning and what that process looks like at the end of it, so I can make informed decisions and see where I'm at in a comparatively same context every day. And that's where historically most research has been done from an HRV standpoint. The overnight measurements before these current formal wearables were done with EKG and in hospitals and in sleep studies and things where they were using accurate EKG leads and they were doing this in that sort of context. These overnight wearables, looking at average overnight is a very new thing. And most research been done on them has been done by the companies that are selling them, to be honest. Not that there's not utility in that, but in my mind and now looking a lot of data, myself and other people, you're looking at something different, right? You're looking at an average across a period is different than an instantaneous of where are you right now? And the biggest thing is if I'm looking average over eight hours of sleep, the things I did closest to that sleep period have a huge influence. If you work out in the evening, that's going to influence Your average tremendously because you're going to spend the first part of your hours of sleep in a different state than if you didn't work out. If you had a couple glasses of wine before you went to bed, that's gonna have a massive impact on your average across the sleep period. It's the same thing in some respects. Not exactly, but like let's say I wanted to lose weight if I measured, if I measured myself an average across multiple times a day, that's different than measuring myself each time in the morning on a fasted state. The fastest state is giving me more data and more accurate data. I'd say to figure out am I losing or am I gaining measure. My average throughout the day is reflective of what I ate and when I ate it and how much I drank and all those sorts of things. So I think when we look at overnight, we're looking at the influence of sleep. Very specifically, we're looking at what you did in the hours leading up to your sleep. All those sorts of things will change your numbers pretty significantly. And I think just anecdotally if you measure overnight, I would take those daily changes with much less of, I wouldn't say with a grain of salt, but I'd be putting much less weight in the daily changes. I would still look at long term trends. I think those are valuable. But if you measure it first thing in the morning like I do with Morpheus, I think that gives you just a better picture of where am I at right now after that full 24 hour period. And I can use that information to make more informed decisions moving forward.
- [97:11]
A
And it's really fascinating. I was thinking about what are some things that would be surprising that affect hrv. And it looks like, and you might not find this surprising, maybe the listener is doesn't or the viewer doesn't find this surprising, but experience exposure to natural sunlight is a way, it says to promote this natural circadian rhythm and improve hrv. There's also an interesting paper here. It looks at the effects of post awakening light exposure on heart rate variability. This was just in healthy men and it was talking about the LED light of different spectrum compositions and that red light decreased. So it's the LF HF ratio. What is that?
- [97:57]
B
So going back to, there's lots of ways to measure hrv. One of them is called spectral analysis where they essentially take the heart rate and they break into frequencies and they break it into high frequency, low frequency and some other frequencies. And that ratio you just mentioned tends to be the balance and the Parasympathetic. So it's just a different way of quantifying hrv. Basically.
- [98:16]
A
Do you want it lower or higher?
- [98:18]
B
You want it higher? Frequency is more parasympathetic.
- [98:21]
A
Okay. And it said the blue light LF HF ratio consistently increased across 40 minutes of light exposure.
- [98:30]
B
Yeah, I mean, I think in general anything that's going to improve either A, your mood, B, your circadian rhythm is going to have a beneficial impact on hiv. It's pretty much there are certain things are always going to have beneficial effects and that's one of them.
- [98:42]
A
But I think it also informs us to make better decisions in our life. The idea that light exposure, although we would think about light exposure as yes, it would improve your mood, but we still live in highly industrialized worlds. And again, it's just fascinating to think that we could improve longevity, not even take out exercise and diet, just by our environment.
- [99:08]
B
Well, of course, I think if you step out of the fitness realm for a second and we look at the, you know, the octogenarians, the people with centenarians, like most of them are living in places where like, they're not training their ass off every day. Like they just live in a very positive community. They have good genetics, they eat healthy whole foods, their stress is way lower. Their industrialized world and they live longer. There was just a paper came out not too long ago looking at a tribe in Amazon called the Tsunami Tribe. I'm probably butchering the name, they say it, but they went in there and they measured calcium scores and they had the lowest calcium scores. They had, I can't remember numbers off my head, but they had the lowest calcium scores indicating the best cardiovascular health of any tribe or group that ever measured across the board, period. And they're just living in the Amazon. They're exposed to all kinds of pathogens. Like they're not exactly living in clean sanitary conditions. And despite having higher than CRP than normal, they still had almost no atherosclerosis whatsoever across the board, across all ages. And they eat like 70% carb and like 15% protein, 10% fat, whatever it was. But they're just living such a different lifestyle than we could ever possibly live. I'll also say it's fascinating. So I lived in Hawaii for four winters.
- [100:19]
A
What island?
- [100:20]
B
Oahu. North Shore. So I live in the North Shore, which is where the surfing is beautiful and I live there a lot of the way. Reason because Washington is a very depressing state in the winter months and Hawaii is the polar opposite. Right. What was fascinating to Me is just the pace of life is so much slower. But you see a lot of Hawaiians who are unhealthy looking, to be frank, but they have the highest life expectancy in the U.S. they do, yes. Which is super fascinating.
- [100:45]
A
I didn't know that. I thought that.
- [100:47]
B
No.
- [100:47]
A
Really?
- [100:48]
B
Yeah. Which is. So look, if you want to, like, look at the picture of health, you don't look up Hawaiian food.
- [100:53]
A
No, you don't.
- [100:54]
B
Because it's not exactly.
- [100:55]
A
No, it's not a lot of Spam.
- [100:57]
B
Spam and wasabi and, and cutlets and.
- [100:59]
A
I used to live on Kauai.
- [101:00]
B
Oh, yeah. So you get it. So, yeah. I lived in North Shore for, like I said, four years. And you, you just realize it's a different style of life. It's, it's a more relaxed pace, which sometimes it's frustrating when you want to get something done, but you just kind of realize, like, they have a very strong.
- [101:13]
A
Or if you want to drive anywhere. Anywhere as well.
- [101:16]
B
Yeah, exactly. And that was the problem with North Shores. There's massive traffic and all sorts of other problems. But you realize, like, outwardly, like, their diet doesn't look awesome. Like they, they don't look like they're metabolically healthy. But looking at them, there's certainly some that work out, but a lot of them are surfing and doing things outside. But they're outside and they have a very strong sense of community. And, you know, that translates into something. I'm sure there's genetic component to it, but you would not look at the Hawaiian population like, oh, that's the healthiest part of the US but if you.
- [101:42]
A
Look at life expectancy.
- [101:43]
B
No, if you look at life expectancy, there it is. Right. So I think if we look at, again, I think lifestyle matters tremendously. Our fitness matters tremendously. The fitness. If we look at markers of these different papers, you can talk about, you see people's fitness levels reduce risk anywhere from, I don't know, 10% in the low end to 40% on the high end. Mid 40%. In terms of all cause mortality, that's a huge percentage. But lifestyle matters more. It's the big picture of our genetic interaction with our environment and our lifestyle. All these things are tremendously important. So we can't forget you can be fit, but if you're in an unhealthy lifestyle, you know you're still gonna pay the price over time.
- [102:26]
A
Speaking of that, was there anything surprising in over two decades of looking at this that didn't have an impact on HRV that you were sure was going to.
- [102:36]
B
Yeah. I think just in general, looking at like different supplements, I think it's really hard to find supplements that move the needle. Like I was a big supplement guy, I worked at a supplement store when I was in college and I had you have this idea, like all these supplements are like gonna do all these things and then you start testing different supplements and different dosages and like it's really, really hard to use supplementation to move the needle. I'm not saying that they can't, they never do. But I think the dietary picture is so much bigger from nutritional standpoint, what they're eating than you take some set of supplements. It's really rare to find a supplement that really moves much of the needle in terms of hiv. So that was something I probably early on spent a lot of time trying to figure out, like these different supplement combinations and you just don't see it that often, to be honest with you. Or like you mentioned earlier, like you have this idea that cold plunge. Yeah, cold plunge will do it, right. And then you see for some people, like, yeah, it proves a little while and then doesn't do anything after that. Or some people, like it exacerbates their recovery or slows it down, makes it worse. So you just kind of realize over time there's no one size fits all approach. There's no magic bullet. There's no universal truth for most of these things that are always going to work for everybody.
- [103:38]
A
It's fascinating. It really is fascinating. What about alcohol or drugs?
- [103:43]
B
Generally speaking, alcohol is a sympathetic stimulant. You're going to see HIV go down. It's pretty rare. You see benefit of that as well. It's the other thing I would say is there's always research like, oh, maybe two glasses of wine are really good for you and maybe there's these things in the wine that are beneficial. But now they're, I think they're looking more and more research saying, like, probably not, right? Like maybe it's not the best thing for you. So I would say it tends to lower sleep quality from what I've seen in most people. And that improves in itself has a negative impact. I'm not saying it's the end of the world. I'm not saying everyone who drinks is daily.
- [104:13]
A
And sedatives or sedatives don't move the needle.
- [104:17]
B
No, not usually. I mean, look, the biggest thing moves the needle is just getting good sleep quality because your overall day is less stressful and your workout is managed more effectively.
- [104:26]
A
Do you think that that would be an early indication of, for example, sleep apnea.
- [104:30]
B
Sure.
- [104:30]
A
If someone is. They have a poor hrv, but they don't snore, they're not overweight. Their hemoglobin, hematocrit is not.
- [104:37]
B
Yeah, I think it's one more indicator that would suggest they're more likely. And even see with like arthritis and rheumatoid arthritis, there are some research like you would see, or fibromyalgia, you would see that the sympathetic system would be more dominant and those symptoms start to flare up more because they're connected. So you see any sort of inflammatory type thing, which I'm not saying sleep apnea is basically more inflammatory type conditions exacerbated by lower hrv, because it means that sympathetic system is sort of heightened state and the HRV is not turning it. Other parasympathetic systems not turning it down the way that it should be.
- [105:07]
A
Is there a way to measure it naturally? Do people always have to have a wearable?
- [105:10]
B
No, unfortunately not. So you have to measure. In order to measure hrv, you have to get basically the time between one heartbeat to the next. The way they're doing with chest wrap is measuring the peak of the R wave, the RR interval. And you have to do that within plus or minus a couple milliseconds, which is very, very accurately. And it looks at the electrical signal and it says, this is the point. And it measures the distance between heartbeats and that filters out what are called ectopic beats that don't arise and then in the same area and there's signal processing. So, no, I mean, I would say if you aren't going to measure hiv, resting heart rate is not really a proxy in terms of like daily stress per se, but it's also a good indicator of general aerobic fitness. So you could look at trends in resting heart rate and say, oh, my. Resting heart rate is declining. Chances are, if your resting heart rate's declined significantly, chances are your HIV is probably going up at the same time. Not always, but probably. And that's something you can measure a lot easier without having to get, you know, without having to measure hiv. But no, you can't just like put your finger on your pulse and measure it, unfortunately, unless you're superhuman.
- [106:10]
A
Unless you do jujitsu.
- [106:11]
B
Yeah.
- [106:12]
A
Do you think that there is a way to. Or do you see, in the future, for example, an individual will be able to predict a thyroid imbalance or something that drives. So, for example, thyroid hormone in, from my perspective, probably drives sympathetic tone. Right. Somewhat Of a stimulus.
- [106:32]
B
It is 100%. If you take thyroid, you're going to see a decrease in hiv.
- [106:37]
A
You will feel it. Do you think that if we collect more data or is there a world where we say, okay, your space between beats is X? We see this group from, I don't know, just make up the number from 30 to 40 with a thyroid dysfunction or again, that's really specific.
- [106:58]
B
Yeah, sure.
- [106:58]
A
But I mean, there's probably imprints or just like a, I don't know, some kind of tracking.
- [107:09]
B
Sure.
- [107:09]
A
That would indicate a pattern.
- [107:12]
B
Yeah, I would say that again because the stress response is generalized in nature. It's the sympathetic system reacts to so many things. It'd be really hard to say, oh, you're HIV is low, therefore you probably have X, Y or Z. But you can say, oh, your HIV is low. This means you're probably more likely to have this set of things that you mentioned. I don't think we could ever necessarily say, oh, your HIV is low. So this is probably the problem. It'd have to be in conjunction with other metrics and other monitor, other blood work.
- [107:37]
A
But I bet you we could get there.
- [107:38]
B
You could definitely. Correlations for sure. I'm sure you could come up with a set of things and say, oh, if HPV is low or it has this pattern, you also might be at serious risk for these other variables. Anything that inflammatory, like I mentioned is probably going to be at higher risk for it hormonally can be at higher risk for it because that can influence things, you know, and that's also where there's all sorts of variants. Right. People have very different hormone profiles. Women have different birth controls. Like all these things influence your hrv.
- [108:03]
A
It does, Right. What is, what does oral contraceptives do? We know what that.
- [108:07]
B
I mean, it depends on what you're taking. It depends if you're taking the same dose of what type of progesterone. Progesterone generally is more sympathetic. It depends on which one you're taking. It depends on whether you want it. One that changes dose throughout the cycle versus when it's steady. It depends on your own response to it. I mean, we have. That's the other thing I'll say is that we have very different responses to drugs. Right. So it shouldn't surprise us. We have very different responses to everything. We have different responses across the board because we're different individuals. So I can't say you're on this birth control. It's going to affect you the same as this person on the same Birth control, It can't. It's the same thing with most drugs. Like statins are not on a statin, like I mentioned earlier. What's interesting is it seemed to have raised my baseline hrv, but also makes it more volatile.
- [108:48]
A
That would make sense. So when the drug wears off.
- [108:50]
B
No, it makes more. I don't think so. I think it's got a fairly long half life. I'm on rosuvastatin. I think it's because we see greater muscle damage in people with high levels of or high statin dose because it exacerbates that somehow. I don't know.
- [109:01]
A
The mechanism probably depends. Hmg coas?
- [109:05]
B
Yeah, I'm sure it's something to do with it.
- [109:06]
A
It depends on if it's a fat soluble or water soluble.
- [109:08]
B
Yeah, exactly. So when I went and got diagnosed, the first thing the doctor did was give me 40 milligrams of Crestor, which I didn't want because I did not really want to maximize the dose of that because you get a lot of the response from much lower doses. But the only way to get approved from insurance for Repatha, which is the injectable, that works differently. Those who are listening, I had to do that and then see if it worked. And it did drive my HIV lower. That one actually did. But I started getting soft tissue injuries, like legitimately started getting weird injuries walking down the street. I pull a quad and I rolled an ankle. I rolled an ankle like in 20 years. Like I just had all these weird soft tissue things. So it really. So I really. And I know what normal is for me. And so that 40 milligram dose did not sit well with me, did not work well and I cut it down to 10 milligrams and now I got the Repatha prescription and I haven't had any injuries. My HRV is actually up as an average back into more of a normal range where it should be relative to my age and VO2 and we'll find out when I do the CTA again what it's doing to my actual plaque. My cholesterol numbers are super low now, so hopefully that will have the impact I want. But other people could have a different response on that statin versus another statin. Everyone responds differently, I think. So that's an interesting way to see that is, oh, a high dose of the statin had a lot of negative effects for me. Low dose seems to be pretty beneficial and raised hrv, so.
- [110:33]
A
So it's kind of like people may have kind of swung to over quantifying their life a bit. And it's really. There is an art to training, there is just an art to medicine. Where do you think the future is going with HRV or just in general performance and recovery metrics?
- [110:49]
B
Look, I think at the highest levels of sport and performance, like, they're getting really good at building these really complex models to take into account huge amount of variables. So they're looking at saliva for different things, are looking at hormonal profiles in some sports, but again, some sports are also resisting that and they're trying to build models. I think the question is, how do we build models of taking as many data points as possible to give us the best possible guidance, more or less. And I think those will continue to evolve and improve as we get more data from more different types of devices and more types of measurements. And we can use saliva to measure more stuff. And there's less invasiveness involved in all this. So we'll get more and more data and hopefully we'll be able to. To use. You know, AI is the talk of the town these days. I'm sure AI will do a good job at some point of sorting all this stuff out and giving us guidance. But I think the bigger challenge, honestly is, is influencing people do the right things. Because I don't care how good the data is. If the person doesn't change their behavior because of it, like does. It doesn't matter. You know, like, I had a guy named David Tenney, and he was the performance coach of the Seattle Sounders when I was first starting to use hrv. Very progressive guy. And he said, oh, I want to come in and have a certain number of players measure HRV to see if it's useful for our team. And this is back in like 2005 or 2006, really early on, somewhere around there. So he brings in a bunch of players. We spend like six months measuring data he's looking at on field metrics. He thinks it's really valuable. Long story short, they get their own HRV system, they get catapult gps, they start getting a whole bunch of data metrics. And they bring a guy from Microsoft to build a big machine learning platform. And it's at this time, this again, this is like 15 years ago. It's very advanced, probably the most advanced sport metric system at the time outside of Europe. And so he builds this big model. He predicts risk of injury. And it's like takes all this data and says, hey, this player, he does two things. He models game load by training. So he says, hey, this practice was, you know, 102% of game load, or this practice was 80% of game load, which is super valuable for a coach to know, like, how hard is that practice relative to a game? Anyway, he comes up with this really advanced model and he's able to predict injury risk within a certain percentage. So he would say like, oh, this person has increased injury risk by 10% or this athlete is 20 increased risk of injury. And so he's working with all these people to develop this model. And the coach listens to him and is making decisions. And then Dave says, oh, this athlete is at a 25% increased risk. Like, this guy is really at high risk, which means he's 75% not right, but still. So what happens is the guy goes out and has a game of his life, scores like three goals. So what's the coach say? Oh, your data model sucks.
- [113:18]
A
Oh my God.
- [113:19]
B
And just kind of disregards it. Because that's the problem is like if, if the person making the decisions decides that data is not what they want to make the decision on, then the whole thing's kind of shot. And so Dave's model, again, it said like 20% risk or whatever. If someone 80% chance he wasn't going to get injured. But in the coach's mind, because David said, oh, this player like to get injured. And he went out and performed really well. The coach was like, oh, your data doesn't work. And it was. I mean, that's not the case, right? It's just, it comes back to, I think we can come up with all the data analysis in the world. We want all the tools you want. You can use Morpheus, all these things, but ultimately you have to figure out how do you use that information to make better decision, better choices? And that's the hard part, right? Like, I think the one good thing I would say not that one, but one of the things wearables have done is make people more aware of all these things. They make people more aware that sleep matters, that, you know, food choices matter, that training intensity and frequency matter. And that more is not always better. I think it's brought awareness to that. And I see that in the Morpheus data. And we see people email me all the time and saying, hey, I didn't realize how much sleep was killing my progress, or I didn't realize how much I was doing way too much, you know, than I should have been doing. So awareness, I think is the first step. And then, you know, talking about it is a really important thing because it wasn't that long ago where recovery was like, what do you mean you need recovery? Like, shut up and get back to work. That was, that was the mindset right there was this all intensity all the time. Kill yourself or you're not making progress. Like it was, that was the mindset of the fitness community. I think we've seen a pushback because people got beat to hell doing that.
- [114:48]
A
Yeah, totally.
- [114:49]
B
Injuries and, you know, CrossFit took a, took a while to figure that out. But, you know, in general, the community has to say recovery is important, it matters, we need to focus on it. And I think that's ultimately what the data helped, can help drive. So I don't know that more tech is the solution.
- [115:04]
A
I think more, I think that's right.
- [115:05]
B
More discussion and more, More discussion, more coaching, more recognizing this paradigm shift into train and recover and lifestyle and training are intertwined. They're not separate entities. You know, all these things will hopefully help people make better decisions. But the data is there. You know, like, we have good data, HRE works, We have other markers.
- [115:25]
A
Would you still have people measure hrv?
- [115:28]
B
Oh, yeah, absolutely. Of course, when we've got thousands of users on Morpheus, we look at all the data. So, I mean, one thing we were able to do that's really cool is we, we said, okay, can we figure out how much volume intensity people use? On average, they're using Morpheus that see their HRV increase over time versus people that don't see their HRV increase over time. So we have thousands of thousands of data points, you know, millions of people doing workout or millions of workouts. And so we segmented people by their average resting heart rate and their average HRV into low, medium, and high. So basically, people that were low fitness, people that are moderate fitness, and people that were high fitness. And then we ran some computer machine learning stuff to look at over 12 week periods, how much time they spent at high intensity, moderate intensity, and low intensity. So we're looking at volume intensity in these three groups. And we found particularly in the low and moderate groups, the people that did the higher amounts of volume intensity got worse or it got no better. The people that did lower, certain lower amounts of it got better. So it just, it just meant that like the people in the low to moderate fitness categories were overestimating how much they could do.
- [116:28]
A
Wow.
- [116:29]
B
They weren't recovering. And we found that people that were somewhere between 80 and 85% recovery in our system, at least across a week, were much more likely to see improvements in their HRV. And resting heart rate than people who were below 80%. So it just showed a real world data analysis peak picture that showed us that, hey, people in lower to modest fitness categories that do more and more and more, they're not seeing the result for a reason. And I think that's the biggest thing I would tell people that say, oh, I need to train hard every day. I'm like, but are you improving?
- [116:58]
A
I love that.
- [116:59]
B
It's pretty, pretty straightforward, like, are you getting better or not? And if you're not getting better, maybe trying less would be an approach to start with.
- [117:07]
A
Well, Joel Jameson, this has been a fascinating conversation. I learned a tremendous amount of. And you know, the big takeaway for me is, and I'm curious as to what the listener or viewer sees is that understanding where you are and you might not be able to feel your heart rate variability, you would think that you would, oh, I feel crappy. Maybe it's this, but there's a lot of influence that goes into it, whether it's sleep or external dynamics. But also over time, if you are not improving, then it can absolutely help direct your training, whether it's aerobic capacity versus strength. And that is a very meaningful data point or data points, especially if we want longevity.
- [117:53]
B
Yeah. I think the biggest lesson I've learned over my whole career is that we're all unique, we're all individuals. And rather than spending your time looking on TikTok or Twitter or Instagram or whatever X whatever it is to find what other people are doing, focus on what you were doing and what you can do better. And I think you can use other people's experiences to help give you ideas. But we're too fascinated with copying what other people are doing. And unless you are them, you're not going to achieve the results they are. Right. I don't really care what a pro athlete's doing because I'm not a pro athlete. I don't care what someone's doing on Instagram because I'm not them and I've got my own things to deal with. So I think that's where HRV can separate itself, is it can help you as an individual make informed decisions about you as an individual. And over the long run, I think that's what creates sustainable fitness and sustainable change. Finding what works for you and understand how your body changed over time, that is the path to success. The path to failure is constantly trying things that you see online and just jumping from one thing to the next and never really knowing what's working, what's not and never really finding that path. So I think if your goal's longevity and sustainability, HRV and that sort of data, and learning about your own, your own path, your own body, your own genetics, your own life, think that's the most important thing.
- [119:04]
A
Very well said. Thank you so much for coming on the show.
- [119:06]
B
No problem. Got to be here.