[00:00:00] Speaker A: Welcome to the Heart Rate Variability podcast. Each week we talk about heart rate variability and how it can be used to improve your overall health and wellness. Please consider the information in this podcast for your informational use and not medical advice. Please see your medical provider to apply any of the strategies outlined in this episode. Heart Rate Variability Podcast is a production of Optimal LLC and optimal HRV. Check us
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Welcome, friends, to the Heart Rate Variability podcast. I am Matt Bennett. I am here with my good friend, doctor Janelle Mensinger. My friend, Janelle. I am so excited to finally have this episode with you. We did a presentation on this, and I've been bugging you about this probably for about a year or 18 months to do this episode. So in this episode, we're going to, if we can, have a little fun with it, BMI versus HRV as a metric for health and wellness.
So we're going to go cage match style with these two.
But I would love, first of all, welcome back to the podcast.
I'm so excited to have this conversation with you, um, because we've, we've talked a lot about this over the years. Obviously, getting our presentation, delivering a presentation on this was a huge honor to, to do that with you. Um, so I would love to start out, uh, let's talk about the body mass index, because this thing is everywhere, and I've been, I've been sharing a lot with you. I see people say this is bad, and then they use it to make their point. So I've got some thoughts on it. But I want to start with you. If we're going to make an argument against the BMI, what would be some of the points we make to say? Maybe we should not be using this for a diagnostic, diagnosing people to, you know, as a wellness metric, what would some of your things to say? Maybe we could do better than the BMI.
[00:02:21] Speaker B: Wow. So, first, I just want to put out that this is a really loaded issue. And Matt, I have to say thank you for pointing out the very obvious technique that I think we all do. We all engage in this almost double speak about the BMI. We say the BMI, the body mass index is a bad metric, as it doesn't represent health and well being very well, or if at all. And yet, to prove our point, we turn to the BMI.
[00:02:59] Speaker A: Yeah.
[00:02:59] Speaker B: So thank you again for turning my attention to the hypocrisy that we all engage in, myself included.
[00:03:10] Speaker A: Well, I would give you a little bit of grace on that, my friend, and everybody else, is there not necessarily been a replacement placement metric? So it's like, if you take that away, what research can you really start to talk about? Which is why I like this discussion as maybe a path forward away from a metric that no one seems to think is worth any worth measuring, and yet everybody uses it to, if they have a point to make, this is true.
[00:03:43] Speaker B: Right? So, I mean, I think the most important place to start in terms of deconstructing the BMI is just the data, right? The data show us that the BMI misses so many health problems, right? If we were just to use the BMI as a marker of good health and bad health, we are missing the boat entirely. And there's been a number of articles that have shown this.
Jeff Hunger, Janet Tomiyama, and colleagues produced a paper. It's probably not new anymore in most people's eyes, but I think it was 2016, maybe by now, that showed, and it was a replication study that showed the percentage of people who we can identify as in some cardiovascular risk profile is just very poorly represented by the BMI.
If we say, okay, people who have a BMI between 18 and a half and 24.9, which is in the CDC's categorization, the quote unquote healthy body mass index, then we are missing a very large portion of people in that category who have cardiovascular risk factors. Then, similarly, when we look at those individuals who are in the higher risk categories by the BMI, so what they call the overweight group, which, as we've discussed in our workshop, is not a good even name or label, right? For this category, because the thing that we always think about in my field, and I come from the field of eating disorders, is over what weight, right? Like, what's the weight that you're supposed to be at? There is no good singular weight. So when we say overweight, it's just a bad label. And then, of course, the terminology that we use for a BMI over 30, being obese, is just a terrible use of a label because of the dictionary definition of obese, meaning literally, to eat oneself to death. So this is a problem in and of itself, the labeling, right? So even taking aside the labels, which is a whole topic in and of itself, to be honest, and some of my PhD students might. Molly Robbins and Katerina Rinaldi are doing an analysis as we speak under Maya, my colleague, doctor Paula Broshu, under our advisement, doing some studies to look at the labeling, the words that we use to label these categories, words aside, the categories themselves, even if we did have good labels, don't represent the health status of the people who fall into those categories based on height and weight ratio, because that's all that the BMI is. Right? It's a ratio of somebody's height to their weight. And if we say that a person with a BMI 25 and over is at higher risk, we should indeed be capturing most of the people who have a lot of cardiovascular risk, and we are actually miscategorizing them. There's something like a third of the people in that category who do not have any cardiovascular risk. And I think the thing that taught me this lesson the most was that a while ago, I did a randomized controlled trial to test how well we could promote health for. It was actually, I was looking at women in particular for women with a BMI over 30. So I kind of got myself into the trouble spot that you're describing. Like I'm saying, let's get rid of the BMI, yet let's use the BMI to qualify people to be in this study. Right. So I was in a stuck position, right. Like, I'm working in the paradigm that everyone else is. I have no other way to determine, at least in my head, in my naive head, right. No other way to determine how to get people into this study. So I use the BMI. I tell myself and everybody in the grant that I wrote, the grant application that I was writing for, like, the BMI doesn't work, but let's use the BMI to get people into my study. Well, I made the very false assumption in that recruitment process that.
And this shows my naivete. This shows how little I got at that point.
I made the assumption that I was going to get people who had cardiovascular risk into my study just by cutting off the BMI and saying, if you have a BMI over 30, you're in my study, and I'm going to show that we don't need to reduce your BMI to reduce your cardiovascular risk. Do you see the problem that I've created for myself if I'm already saying that a lot of people with high BMI don't have cardiovascular risk factors yet I'm trying to use the BMI to recruit women into my randomized control trial to help them improve their cardiovascular risk factors, I've created a big conundrum for myself. Right. And that's exactly what happened. So a lot of the 80 women that I recruited into that trial did not have cardiovascular risk. So when I tried to reduce their cardiovascular risk by either half of them were randomized to be in a behavioral weight loss program, and the other half of them were randomized to be in a size acceptance health at every size program.
My hope was that, or my hypothesis was that people would actually be able to reduce their risk in either situation, that you didn't have to necessarily lose weight to improve your health cardiovascularly. You could actually accept your size and engage in health promoting behaviors and do nothing about your weight, and you would still get benefit. Cardiovascular biometric benefit. Well, there was a fatal flaw to that logic that there were so few people, because these were relatively young people, they were between the ages of 30 and 45. So few people actually had the cardiovascular risk in the first place.
We couldn't statistically reduce something that wasn't there.
So I backed myself into that corner, and I think we continue to do that. We continue to make these errors, these logical errors, by using the BMI as a health metric. It's just bad science. We have so much data, population data, to show mortality is similarly flawed based on the BMI. We don't have much evidence to suggest that if you have a higher bmI, you're going to die more quickly or earlier, your longevity will be negatively impacted. In fact, we have a very clear U shaped distribution on that. So the long and short of the problem is that we just have to stop using it. We can't be saying this is a bad metric and then still do our science based on this metric.
[00:12:05] Speaker A: Yeah. And that's diving into this world with you. And you've been a great mentor for me.
It's just interesting to see a field struggling so much, because, like you said, a lot of these books, a lot of these arguments, you. What. What do you use if you don't use BMI? And I, you know, so as I dive into the history of BMI, it's a pretty dark, scary capitalism. Racism, the foul. The person who discovered it, I believe, said, you're all using this. This was never designed.
[00:12:46] Speaker B: It was called the Cadillac index. Catalette was a statistician, I believe, astronomer. A European. I forget what country, to be frank.
But Catalay, maybe I'm not even saying his last name correctly, because I think there's a french component in there.
It looks like catalette, but I don't think we could pronounce the t. But, yeah, absolutely. He never meant for this to be a metric that represented health. Never. And this is where we are in 2024. It is mind boggling to think about scientists still using and medicine. I think the biggest problem here is how integrated the metric is to the medical industrial complex, the healthcare system, the healthcare industry, the health insurance industry, the BMI has found its way all the way into these systems, these portals. It pops out of your record because it's been built that way.
And to unbuild it is really what we're struggling with.
[00:14:08] Speaker A: Talking to medical providers at the conference is part of their electronic medical records. So establishing getting BMI is part of medical care, even though there's really no research to support that, that is any sort of vital sign that should determine the course of care if I'm putting the pieces together correctly.
[00:14:33] Speaker B: Correct. Right. So this is not a useful metric, and it shows up on every person's healthcare record. So we have a lot of work to do in medicine and healthcare to undo that. And I have to give you the credit, Matt, for introducing me, I mean, at least to the idea of the HRV, because it was your book that I read a number of years ago now. I think it was your original.
Your original edition of the book, HRV, what is it called? It's somewhere on heart rate variability. Heart rate variability. That's it. Right? Yeah, here it is. It's the skinnier one right here.
[00:15:22] Speaker A: Yep. The skinny one with the bad subtitle.
[00:15:27] Speaker B: So now you've got an expanded version, which. Which I also have, that includes heart rate variability. Biofeedback, I think, is kind of the name.
But it was your book that really. I mean, I had heard of HRV in some of my work as a health psychologist and doing work in the field of eating disorders and weight stigma. I was looking at HRV as a potential stress marker. Right. HRV reactivity, in fact, was something I came across maybe about eight years ago. I was putting together a research application to look at the stress that people who are in larger bodies. So people with a higher bmi. Right.
[00:16:10] Speaker A: Yeah.
[00:16:11] Speaker B: The stress that they were experiencing in a healthcare encounter. A lot of my research has considered health care stress and the idea that people in larger bodies will often avoid healthcare because of the fact that their bmi is being measured in these appointments. And it's often, a lot of assumptions go into that discussion around that metric popping up on the chart. And so when I was really kind of embedded in that work on weight stigma, I started looking at the stress markers of experiencing a healthcare encounter as a person in a larger body. And one of them that came across my eyes in the research was this HRV reactivity. So HRV I understood as something that responded quite quickly to stress. Right? And so that's when I started to learn a little bit about HRV. But, no, I didn't really think about this as a biomarker or a biometric in the same kind of way that we could think about BMI as being used as a biometric until I read your book.
And I have to say, that is when the wheels started turning for me, that. Wait a second. Why are we saying, well, we're using the BMI because it's easy, right? Like, we can step on a scale. Anybody gets. You know, anybody has a scale in their house, right. It's a. It's a very low barrier type of a device, if you will. Right. Anybody can tap up on the scale and get a number, right? Well, today, why not say, well, if we need something, if we need something, let's put that caveat out there, right? If you really need a number that represents how you're doing in that day, in that moment, we now have technology that can provide you a number, just as simple as it is to step on a scale. Okay. Maybe a little bit. Little bit more complicated it. Because a scale you can step on in 1 second. Right. The HRV, though, with a simple app on the phone and a very inexpensive, I'll call it the price of a scale, a very inexpensive heart rate monitor. You can capture that number in three minutes.
[00:18:50] Speaker A: Yeah.
[00:18:50] Speaker B: So we are talking about two minutes and 59 seconds longer. So it is a little bit more complicated, but I'm willing to give up two minutes and 59 seconds a day.
[00:19:02] Speaker A: Yeah.
[00:19:03] Speaker B: Know something about my body?
[00:19:05] Speaker A: Yes.
[00:19:06] Speaker B: If I'm interested in that. Right. If I want to know something about how I'm doing today, I am willing to give up two minutes and 59 seconds beyond what it would take me to grab out. You grab a scale and step on. Step on that, too.
[00:19:23] Speaker A: And so let me ask you, because I think the one counter punch BMI has in our cage match year, or at least I thought it had, I've since educated. You've helped me educate myself, is the tricky thing that I was trying to figure out, the relationship between kind of fat and heart rate variability, was I was looking at fat as a potential stressor. We all have fat fats, not good or bad. I think in the literature, it's. Fat is a little bit more complex than that, too. If it's around the organs that can be more detrimental. Learned a lot about people who we would look at and call Finn are diabetic because of the kind of the. Some of the fat makeup that they have or how lifestyle stuff that we can't use that. But that was the thing is like, well, this is a stress on the autonomic nervous system. And since that has gone away, that's been my professional development is really like, okay, my brain works that you can't tell me it doesn't work. I need to read the research and it doesn't work. It just doesn't work in that way.
So I love where you talk about that because I think that's the last thing we hold on to. Well, we know that, you know, or we think is fat equals diabetes or fat equals heart disease or fat equals this, that or the other. And we, we get in this mentality as fat is bad, and we, we need to get out of that, that mentality.
[00:21:07] Speaker B: Yeah. I mean, I think it, it's nuanced and it's complicated. And we also have to remember that we all need fat, right? We need fat on our bodies to function, in our bodies to function.
[00:21:22] Speaker A: And it can be a resiliency factor.
[00:21:25] Speaker B: If you.
[00:21:27] Speaker A: I think that's one of the reasons these colds I get destroy me. I don't have those reserves to get. Get it out. You know, the interesting science around the resiliency factor of having fat and having.
[00:21:42] Speaker B: Abundance of fat, right? Think about. Think about when, like in generations and generations ago, the people who were wealthiest were the fattest, right?
[00:21:56] Speaker A: Yeah.
[00:21:57] Speaker B: Fatness was, was a factor that was associated with having a lot, right? Being wealthy, being like, it was all backwards in terms of where we are today and where we were many, many generations ago. And what I think has maybe complicated things is that we have almost forgotten about the usefulness of fatness, right? Usefulness. We've instead associated only the socio cultural idealization of how people look and having this idealization of leanness in terms of what's good and what's bad on the bot, right? And it's just a lot more complicated than that. Fatness can be good, but I don't even want to talk about it as good or bad. I think that's part of our problem, is that good, bad, these are moral statements, and there's nothing moral. Or in my view, you know, we should, and I even use the word should. But attaching moral terms to the body is not useful, right? We need to sort of disconnect morality from all of this because a person's body is who they are, it's part of their identity. And attaching moral words to it is just not a useful place to go psychologically or health wise and medical wise. Why are we attaching good bad to any of this?
I think in terms of deconstructing fat, I almost just want to set that aside, right. Because let's not talk about it in any way as good or bad. It just is that is there. Some people have a lot of fat and some people have less fat, and that's all just there, right. You are given a body when you're born because of so many different factors, right. Genetic and environmental and so many different things relate to the body that you are born into. And some bodies are going to be larger, and some bodies are going to be smaller, and some bodies are going to be large with little fat, and some bodies are going to be small with lots of fat.
[00:24:47] Speaker A: Yep.
[00:24:48] Speaker B: So I think this whole sort of linearity or assumption that small means little fat and large means lots of fat a is flawed. Right. And then the linearity of more fat is bad and less fat is good is flawed. The linearity of everything here is just flawed. When we see this in these analyses, these epidemiological analyses of mortality and the BMI. Right. These are not linear relationships. They are cute. I mean, they are u shaped distributions, like we were saying.
[00:25:25] Speaker A: Yeah.
[00:25:25] Speaker B: So I think discussing fat and whether or not we need it is, is almost like a moot point because. Yeah, we need fat. Like, we need fat for our bodies to function. That's not in question.
How much do we need? Why do we need to talk about that? Because we can't control very directly how much fat our body has. In fact, as we age. Right, as women particularly age, as we reach menopause, our body will start to accumulate a lot more fat because of the hormonal shifts the body is going through. And that is natural. That is normal. And what I think we are doing as a society that is a disservice to everyone is to stigmatize that and to take the sort of normative sort of process or natural process that is happening for women and for people in general as they age, in fact. So I'm not sure how to scientifically talk about fatness because I don't think that's where the conversation is most, most readily helpful.
[00:26:46] Speaker A: Maybe we do it, like, if you think about, like, just a thought that as you were talking, I'm six seven.
Okay. Right. Like, okay.
That. Do. Are there certain things. Do I hit my head more than you do? Probably. Right. You know, so there are some health risks of being six seven. I can also.
[00:27:06] Speaker B: You may have more likelihood of head injury.
Right.
[00:27:10] Speaker A: Right. So I hit my head more. It's all scarred up over there. Right. But I can see at concerts, which could be a safety thing. So it's like, it's like, to me, what I'm hearing, it's like, okay, Matt, six, seven, does six, seven, does that have to do, does that impact Matt in any way? Yeah, it may hit his head a little bit more, but we're not going to judge Matt for being six, seven. It's not necessarily a good or bad thing. It's Matt and approaching it from that neutral thing. And I really appreciate your, the last things you just said because I think I've been so, in the mainstream culture is certain amounts of fat are bad, and so I think I'm in the place of, no, we need to say it's neutral. I think that's in some ways, it's like, okay, there, let's move on. Like, let's move on. If somebody wants to personally have less of it or more of it.
Okay. I mean, we don't take away that from somebody.
[00:28:16] Speaker B: But I wouldn't, I wouldn't like, and this is just my view that wanting more fat or wanting less fat is not, it is not really a, a thing in someone's direct control.
And I don't think in our culture, I don't think you will. I think you'd be very hard pressed to find somebody who would say, yes, I'm signing up for more fact. Right. I think that it's a pretty safe assumption that nobody, I don't care from what kind of perspective they live in in this particular topic. Nobody is signing up for more because of the way our culture has demonized that as a moral failing. We are so embedded in that socio cultural morality kind of domain that I think we're pretty safe to say that nobody's signing up for that.
And it's not about like, oh, people need to have the ability to want one way or the other way. I think what's important is that our bodies are just our bodies, and we, you know, we can engage in health promoting behaviors regardless of the fat on our bodies, and do it in a way that's going to enhance our well being.
That's sort of where I'm coming from here. Not like, let people be fat if they want to be fat, or let people be thin if they want to be thin. It's not really there, like the choice, the control is, I think we have lots of research. I mean, we're going back into, I mean, maybe this isn't that long, but into the sixties, where we've been trying to help people control their size. We've been looking at diets as far back. I mean, I think Mickey Stunkard's work dated into the fifties. Albert Stunkard, a professor at University of Pennsylvania, he was a real pioneer in weight related research and started studying diets as far back as the fifties. And we just haven't found diets as an effective method for controlling the size of our bodies.
The number of failures far outweighs the number of successes. So I feel like just taking off the table, the choice in how our bodies are and the amount of fat we have is probably the way we want to move forward scientifically and just say, okay, given what we have, what things can we do to promote our well being? What things are you interested in doing? Right. Like, from my perspective. So this is about what you want to do to promote your health and well being, instead of saying, well, you have to do x, y and z because you have a body that looks like this. And therefore, I mean, because sometimes I feel like there's a lot of, like, well, if you, if you're in a larger body by nature, right, that's, that's how the genetics cards fell, then you have to, you have to eat this and only that and not eat this. But if you're in a small body and you were given the genetic, whatever you call it, lucky gene, you're in a small body. Well, then you can eat whatever you want. You can have ice cream, you can have cake. No, none of that, in my view, is the way this really is. I don't think that's a useful way to think about it either. And again, all of this is based on just years and years of being in the research, doing my own research, running my own studies in both the quote unquote obesity field. Right. And the eating disorders field, which is kind of the, you know, the, in my view, the mirror image of what happens when we focus on weight. We focus on weight, we get more eating disorders.
[00:33:04] Speaker A: Yeah, I think the only pushback I would have is being at 1.67 and 130 pounds. I would have taken any additional pounds I could pack on. So I think in some ways, sports would be. My only argument is I tried to put on fat because fat can turn to muscle and I was trying to get any of it. I think about some of my friends that were football players, lineman, exception to the rule.
[00:33:34] Speaker B: I don't even know if I would see that as an exception as more of just a functionality issue.
[00:33:41] Speaker A: Yeah, I would. I wouldn't argue that. Yeah, I think your point is incredibly well made. But I think, like, I think some people here is like, then they feel stigma. What I don't want to have happen, and I don't hear you doing this is, hey, maybe I want to be in a different body and getting help to want to do it. And this is where we get into tricky territory. Right. I mean, because we've had hours of discussions around the new ozimpic pill set, I don't want to feel invite shame for making that decision as well. I mean, it gets in a really tricky ground as we try to talk about it in the best way it's possible, which I feel like I'm just tripping all over myself at this point.
[00:34:26] Speaker B: So we all do. It's a very tricky space, and it's not anyone's place or my place. I should just speak for myself. It's not my place to judge how people want to deal with their health. Right. And if somebody chooses to take a medication or if somebody chooses to get surgery, that's not my place to judge.
[00:34:51] Speaker A: Yeah.
[00:34:51] Speaker B: Right.
[00:34:51] Speaker A: Absolutely.
[00:34:52] Speaker B: People need to make these decisions in ways that are informed. I think what I care about is that people aren't being misled by, quote, science that says if you are in a larger body, you will die. And if you don't do something incredibly.
What's the word I'm looking for? Just invasive to fix that, then you will die. That's where I start to say, no, no, wait a second.
I think some of the science might be a little skewed. And let's think about some of the reasons behind, or the incentives behind why people are being told they should take medications that have a lot of side effects or why they should be getting surgeries that are very dangerous. Right. Is there some kind of financial incentive behind that? I think that's also very tricky. Right.
[00:35:53] Speaker A: Yes.
[00:35:54] Speaker B: To do those things, it's not my place to judge. Right. People need to make choices in the best.
In the best amount of information that or the most valid information they can gather. And whatever their choice is, is their choice. I think that's what it's really about.
[00:36:17] Speaker A: Yeah. So, so far, BMI, even from the founder of BMI. And if you're. If you just want to hate BMI, go back and look at its history, because it's not pretty. But even the founder said you're. You're using it wrong. Um, basically no scientific validity around this metric. So we've been it down pretty hard here. Let's. I know you've integrated heart rate variability into your research as well. So how can we. How can we start to think about. You've already kind of let us into this, like, HRV. Now, now let's. Let's shift the spotlight over. And especially, and I know we're dancing on maybe some speculation here, some fun with the podcast, but as a replacement for this invalidated metric that is unfortunately in electronic medical records and everywhere else, how can we then start to integrate heart rate variability as a replacement metric?
[00:37:18] Speaker B: So, I mean, I think it's complicated, as we've been saying, like, the whole thing's complicated, but I think the first place to start is taking the BMI off the table. Right? Like, that's where we start. So if we want to have fun and live in the world of, like, idealism, yeah. The BMI just gets taken out of the EMR, the electronic medical record, right? We don't have to stand on a scale when we go to the doctor. However, I will tell you, there's a lot of medical professionals that say, hey, monitoring weight does have some value. And this is a caveat that I want to put in, because when you have heart failure, right, like, you, you really want to make sure that you're not dealing with edema and things that could make, you know, that could be evidence that your health is going south. So there are places in medicine, and please, for anyone listening, don't think that I'm saying, like, oh, we should never put our body on a scale ever again, because I think there are places in medicine where we need to. Right.
It's the attachment of the body mass index to a specific health status that I contest that that particular metric, the BMI, is not attached to a health status. I'm not saying we need to toss out entirely the use of the scale for monitoring health markers that are, you know, that are particularly existent in certain health conditions.
So I just do want to, like, make that statement, because people could come up with a firestorm of reasons why what we're saying is just, like, way off. Right?
So, however. So in our ideal world, if we could take the BMI itself off of the medical record, I think that it would be very cool to have the. The person's sort of baseline HRV available in a way that now, HRV, from my understanding, and I've only been studying it for a short time now, and comparison to the 25 years I've been studying the BMI, I understand that HRV is very individual.
I understand that there aren't great norms. The standard deviations are enormous. So if we do talk about norms. The, you know, the person who's either above or below the norm for their gender and age is.
It doesn't really do us a lot of good to say, oh, my gosh, I'm healthier than the norm or I'm not healthier than the norm. So I think HRV has its own set of complexities. Right. However, from what I understand is that we can establish a baseline HRV at the individual level. If we were to do every day regular monitoring, or even, like most days regular monitoring, say we got people to take that three minute reading, you know, three to four times a week. Right. I mean, I would say, why not do it every day? It's. It's plan your day. Right. Like, let's. In an ideal world, why not do it every day? But we, if we could get people to do it those days, we can still establish good 30 day averages. Right. And those averages, if we start to see a sort of, like, pretty significant decrease, may be a marker for something being wrong.
[00:41:19] Speaker A: Yeah.
[00:41:20] Speaker B: And to me, that's powerful.
[00:41:23] Speaker A: Yeah.
[00:41:23] Speaker B: Because this is a non specific indicator of nervous system functioning. Right. It's not just, are you stressed out in this moment or did you not get good sleep or have you, you know, like, over trained, over exercised or haven't you eaten in a way that's nourishing for a week and a half? Who knows? Like you've been traveling or whatever.
[00:41:51] Speaker A: Yeah.
[00:41:51] Speaker B: There are a lot of things that can throw this off, but it's also a good indicator of mortality. And if we're seeing a very significant sort of prolonged dip in HIV, maybe that's something that can help people understand. Well, wait a second. Maybe I need to see a doctor.
[00:42:17] Speaker A: Yeah.
[00:42:17] Speaker B: Cause I'm sleeping, I'm doing all my other typical health engaging behaviors or health promoting. Sorry. Health promoting behaviors. And yet my HRV seems to be, you know, consistently for this last month, seems to be a lot lower than it's been.
[00:42:37] Speaker A: Right? Yeah.
[00:42:38] Speaker B: So maybe in my ideal world, maybe this could be a way to screen for major health problems.
[00:42:50] Speaker A: Yeah. Yeah, absolutely. I mean, it's that early indicator of something's going on here. Like you said, talk to a medical provider to identify that because it's not going to tell you exactly here's what's going on with you, but it can give you that alert. And what I love about it, too, as we beat down the BMI, is, and I know that the terminology is changing, but, you know, the healthy at every size, you know, really being healthy. Right. That that's what we're measuring here. So it's a, you know, you. You could probably back yourself way into how HRV can be stigmatizing.
[00:43:36] Speaker B: I.
[00:43:37] Speaker A: We got ways to go before that happens.
[00:43:39] Speaker B: Yet, like, you can stigmatize anything, right?
[00:43:43] Speaker A: Anything. Yeah. As we say, you can look at population norms. The next thing you need to do is forget about the population norms and just look at your own, you know, and then how do you feel? Because you're establishing, like you said, that own baseline, a 30 for you might feel great, whereas a 45 for me might be sick. You know, that's. That's the. But it's that individualized piece of things. And then lifestyle changes or, you know, you can measure these of. Is this or is this not improving heart rate variability, hopefully without stigma and shame that we're so engrossed in. And with the previous conversation around the BMI.
[00:44:28] Speaker B: Exactly. I think. I think really keeping it neutral. I mean, you're never going to neutralize fat. You're never going to neutralize weight. It just. It's too late. Right.
We have media that has for decades upon decades, said, this is a body that you should attain or, like, strive for. Can we get a similar. Not a similar, can we get a neutral sort of metric, like the HRV, to not take on similar kinds of good bad attributes? I don't know. I don't know. But if we need something, right, I think the HRV is about as neutral as it's going to get right now.
It's about as neutral as it's going to get. And because precision medicine has become such a sort of a buzzword, I feel like this could get sort of channeled that way because it's so individualized, it's so unique to a person's history, their life, their lived experience, that their HRV is a value that only. That is only unique to them.
[00:45:56] Speaker A: Right.
[00:45:57] Speaker B: And the doctor could, the healthcare practitioner, whoever it is, could monitor that. It could even be a psychologist or a therapist to say, hey, let's talk about this. I've noticed it's really low this month. What could be going on? Maybe you need to see a physician, or maybe you need to see a therapist, or maybe you need to see someone about your nutrition or somebody about, like a physical therapist, about the way your body's, you know, moving. Like, I. There's so many. This is about as interdisciplinary as a metric can get.
[00:46:39] Speaker A: It really is, because you're coming from all that. And some of the dietitians, nutritionists I talked to about this, I, you know, are fascinated with this conversation as well, because there are still foods that can create, for me, it's just down to inflammation versus anti inflammatory. But really, like, how do we, how do we moderate, you know, just like alcohol, as we've talked a lot about in this thing, another thing that can carry a lot of shame in it, addiction in it, those sort of things. We know what alcohol does to heart rate variability. It's not spectacular, you know, and finding what works for Janelle and what works for Matt and then just having the data to say, right, yeah.
[00:47:30] Speaker B: Like, if you are a person that doesn't want to give up some kind of food group or alcohol or whatever it is in your life, and that should be okay, right? Like that, no one is saying, oh, because this lowers your HRV to alcohol. I'm talking, you know, because this lowers your hrV. Nobody should. Should ever have a drink again. Right. If that's not something that you want to do, that, like, no one should be judged for those decisions. And at the same time, so if you are noticing a decline, a significant decline in the HRV and. And you weren't out drinking the night before and you did get good sleep, and you aren't especially stressed because you've got something crazy going on at work or you lost a loved one or something is going on in your life, then again, maybe that's where we can drill down and say, let's figure out. Maybe that's when the blood work gets done and this gets done and other kinds of tests. Right, exactly. Easy, low hanging fruit that help us monitor our holistic well being. I mean, for me, I think what is really cool about measuring HRV is because I do this. I mean, I don't know if I've said this previously on your podcast, but I've measured now since doing the research in using the optimal HRV app. I started measuring my HRV daily to see, is this a reasonable ask of the participants in my study. I started doing HRV biofeedback on the app. I started measuring my HRV. And what I've noticed is now I'm aware of the things that, beyond lifestyle, the things that improve my HRV and the things that lower my HRV. And for me, as an. An extrovert, and this is totally individual, being with friends increases my hrV. So it's an encouragement, in my view, of a holistic health to be with people. Like, don't stay behind your computer working 24/7 because your HRV will take a hit.
[00:49:58] Speaker A: You need people.
[00:49:59] Speaker B: You need to socialize and I saw that as a very consistent sort of single subject design, that when I was with people, even after traveling, I mean, I saw it at our conference the other week. I mean, we know that that trip, I mean, especially the way back, but we know that trip was stressful. Like, I had multiple flight connections, and there were some maintenance issues on flights and delays and connections, and it was stressful. And, yeah, my HRV took a hit the first day, but then the second day, I was with everybody. I didn't get much sleep. So normally sleep would lower the HRV. But my HRV was, like, was high for me. And that to me, is data.
That's an indicator to me, like, how do you want to stay? Well, how do you want to stay functioning? The other thing I love about the HRV, unlike the BMI, is that I can train it using another very low hanging fruit technique. I don't have to, you know. Okay. It is. I would say there is a barrier because you do need the app, and you do need a. Or an app, right? You do need an app and a heart rate monitor.
[00:51:16] Speaker A: Yeah.
[00:51:17] Speaker B: These are very low cost, though. I mean, like, if you think about the world of our expenses today, $5 a month for an app and $45 for a monitor, or maybe $50 for a monitor that lasts several years. That's as cheap as a decent bathroom scale. Right? I can train with those two tools. I can train through HRV, biofeedback, my HRV, to be more resilient, to go up. And we've got lots and lots and lots of years of studies that show that anybody can do that.
And maybe I'm being a little exaggerating in terms of anybody. Most people, right? Most people. I mean, yes, there's people with certain limitations, medications. And maybe people on pacemakers won't be able to change their HRV. So I'm, you know, like, excluding some people, for sure, but most people, way more people that can change that then, then can change their weight. Right? Most people can train their HRV to go up and not. Not reach an ideal. There's no ideal here, but to go up to be higher than it was two months ago before you started training your HRV, or even six months ago, you know, like, it's not something that's inconceivable, in my view, to control with something as low hanging as biofeedback. So taking lifestyle out of the equation. Lifestyle requires privilege, right? We need money to buy nutritious food. We need time to exercise.
We need time to sleep, right? Not everybody has those privileges.
But if we can get biofeedback into the hands of people, that's powerful. And it's a powerful way to use a weight inclusive framework, to use the language of academic health at every size. The weight inclusive approach can be to train people on HIV biofeedback as a way to holistically improve their, their well being.
[00:53:38] Speaker A: Love it. I don't know. I think we could talk about this for two more hours, but I think you wrapped it up on a great note there. Any final words? I know we'll put some links to the articles we've kind of talked about in the show notes, but any. Fine. Any final thoughts? So we can just shovel the dirt on the BMI and say bye bye now?
[00:54:03] Speaker B: I think what's important, if any listeners are interested in the replacement paradigm for the weight centered paradigm, we'll provide some resources to talk about the ways that we can approach health, even aside from the BMI. Matt and I are having fun with this idea of take the BMI out. You need a new metric. Why not HRV? Even aside from that, how can we shift our paradigm in healthcare away from the weight center paradigm? I've got several papers that talk about the, you know, the disordered eating components that are, you know, sort of embedded into the weight centered paradigm, or not embedded into, but like consequences of. Right, right. And so, yeah, I would just check out some of those articles that we'll provide links to and really just start questioning our assumptions. Right. I think that's what this about. We need to really question our assumptions about our bodies and about the kind of control that people really have because the data just aren't there. People are given bodies by a lot of different factors. And this is not something that I think in healthcare we should be expecting people to automatically have the ability to change.
[00:55:35] Speaker A: Love it. I love it. And I would just add for my two cent, be gentle with yourself around this.
I continue to read, I continue to adapt my language.
I feel like I've tripped over myself several times in this episode. So I apologize. Hope I have not offended anybody with this.
[00:55:56] Speaker B: Everybody does.
[00:55:59] Speaker A: It's a tough area internally because we've been so since a young age, been given misinformation. Even we knew it was misinformation when we were given it. And then it just is an incredibly frustrating to look back, being almost 50 now and what I was told even ten years ago when we were talking about a book is, oh, wine's good for you. No, that, that was, that was kind of B's. At the time as well. Like, no, it's not. I mean, it's safe for you. Enjoy it. But it's not a health food. But we were sold wine as a health food. It's not. Have a grape. Have one grape. It has all the benefits and none of the drawbacks is a glass of wine. So, you know, be gentle with yourself.
I just appreciate you, Janelle, of being patient with me as I've asked the questions, because I think some of us don't feel like we have a Janelle in our life to say, okay, I need to be vulnerable. I have these questions. I don't even know if I'm using the right words to do so. I would just be gentle with yourself no matter where you're at in this conversation. And hopefully, together we can chart a new path forward, because shaming people on, hey, they may use the o word, you know, is not kind of helpful to bringing them over to our. To this movement of just overall health. And that's where I'm really excited to work with you and our team to hopefully reset this conversation. I mean, it's going to take probably the rest of both of our lives and then some to do it, but we've got to at some point. Let's stop this. Just the craziness right now of the BMI. Let's just stop.
[00:57:50] Speaker B: Sounds like a good place to start. Let's just stop.
[00:57:53] Speaker A: All right. Well, my friend, I appreciate you as always, and I want to thank our listeners again. Show notes. You can find those usually in the. Wherever you're listening to the podcast, but we'll also have all that at optimal hrv.com as well. Thanks for everybody listening, and we'll see you next week.
[00:58:09] Speaker B: Thank you.
