[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 a very special guest today, somebody whose name has been floating around my universe for so long. Recently with Dr. Sarah Jeffrey coming on about her AAPB article. I was like, oh, maybe I can get Dr. Linchenstein on the show. So Sarah gave a good reach out and I finally got Dr. Brad on the show. So big fan of your work already. Can't wait to explore your journey with heart rate variability. So Dr. Brad, give our audience just a quick introduction of you. And then I want to do a deep dive into your work and thinking around heart rate variability.
[00:01:16] Speaker B: Well, thank you for having me here. I always love getting a chance to talk about all these things with people. So thank you and thank you for the work you're doing.
Well, I'm a naturopathic physician. I've been a naturopathic physician for a few decades now.
Amazing how time goes, but tell me about it.
I know you wake up and it's been 30 years, and something happened during.
[00:01:43] Speaker A: COVID Brat, I was young before COVID.
[00:01:47] Speaker B: And now I was 20 before COVID Yeah, exactly.
But I've been practicing. So I'm a practicing naturopathic physician. I was teaching at Bastier University, which is the naturopathic medical school here in Seattle and in San Diego. I've been there for 27 years. I retired from teaching right in the middle of the pandemic.
And my focus has changed over the years. So that's interesting, like talking about my evolution of using heart rate variability. My background before going into naturopathic medical school was in, well, originally it was in theater.
And then I studied speech pathology and psychology. And I was really interested in psychology, but I became a naturopath. I've told the story many times, so it keeps changing as I say it. But I became a naturopath because I was going to go to conventional medical school in Chicago. And I drove there. I was packed up, I was ready to go, and I turned around and said, I can't do this.
My journey into naturopathic medicine actually began with nutrition and diet because growing up, I had been diagnosed with IBS, colitis, all kinds of GI stuff. I had severe eczema.
Finally, in college, I ended up in the hospital three times because I had GI stuff. I was in pain and everything. And so I was a vegetarian at that time. I was a vegetarian for about 23 years, but at that time, dairy was my biggest food, and it was for so many years. And I found out, I read an article, I found out about diet and nutrition, I found out about dairy could be causing problems. I got off of that and wow, everything changed. So that started my cascade in looking at an alternative medicine, because it was alternative. I'm from Pittsburgh, I grew up in Pittsburgh in the mean. So talking about food was really alternative.
It was. And my mom was quite alternative because she took me to. I've said this story too. She took me to my first yoga class in the basement of our synagogue when I was seven. So she was doing yoga in the late seventy S. And so I was always interested in meditation, in yoga, and all of those practices.
And so that's why conventional medical school, just a short version of a conventional medical school, wasn't aligned with me. I wasn't aligned with. Just like treating the symptom.
And I would say naturopaths do that too. To any naturopath listening, they can get mad at me. But a lot of naturopaths just use natural substances in place of treating the cause.
That's the phrase that we say, we want to really treat the cause, not the symptom. Like, you have a headache. Well, is it because you had too much caffeine? Is it because you didn't have any caffeine? Is it because you didn't sleep? Is it because your neck is out of alignment? Is it because you ate something? If we just take acetaminophen or Advil or whatever, or even willow bark or some natural thing, if we do that without knowing the cause, we're just going to perpetuate it. So treating the cause is very difficult because it's so multifactorial. We want to reduce it down to one thing, just like in HRV. Look, if you get a great HRV score, everything is going to get better and your son's going to come out and life's going to be better.
So we know that that's not true, but that's what was appealing to naturopathic medicine. Plus, we had a large toolkit. We could talk about diet, nutrition, we could talk about herbs, we could talk about adjustments. In certain states, we're allowed to adjust spine and extremities. We can do physical medicine in certain states. We can also talk about or prescribe medications. We can't in every state we're licensed in in Washington. We can.
We can do homeopathy. There's a wide toolkit in naturopathic medicine, and that was appealing at the time.
When I began my work as a naturopathic physician, though, I focused on HIV care, and I was doing HIV care back in the time before certain medications changed the outcome of the disease. And people who've heard me talk before hear me say this, because it's really foundational in shaping how I look at health.
Most of my patients back then did not survive.
And this will get to the HRV journey and biofeedback journey, because the goal really wasn't, let's do everything so I can live longer. Let's do everything to make, be superheroes. It was, how do you want to live your life right now? How do you really want to regulate? So I did that for years. I worked in mind body medicine, where I went and did meditation with hospice patients. I learned biofeedback and started to bring that into the bastier clinic.
And so I was also a yoga instructor. And I was teaching a yoga class At Bastier, a yoga therapy class. I was teaching several classes, and one of them was dedicated to breath. Here's the link now. So I was studying all types of breath work, from Reichean breath work to Bateko. Before, it was really big. All the different yoga breathworks, holotropic breath work. This was before Vimhof.
And so I was just fascinated. I was learning about them, and the research and science behind them were really small. It was really poor. There wasn't that much. I mean, and if you looked at some of the people that I may have mentioned, when they talked about their breath work, their claims were inaccurate. Oh, we're hyperoxygenating that. Well, no, you weren't.
So eventually, it was like in the 90, late ninety s, two thousand s, I got certified in biofeedback. And that was so cool because to me, I wanted to demonstrate to people what was happening in their physiology when they had different thoughts, when they had different breath techniques, when they did different things. And so that was what really started it. And right when I joined the Biofeedback Association, AAPB, association of Applied Psychophysiology and Biofeedback, heart rate variability was gaining more press. People were studying it more. And I thought it was fascinating because I was doing all these breath work techniques in the dark, basically.
And then I could see what actually happening in the body, and that was fascinating to see. And so I did a lot of personal research on myself and on patients and other people and my students, and, like, let's see what happens when you do this, and then let's look at that. So HRV, to me, was just another tool of looking at how we're orienting. That's what I talk to people like, how are you orienting? How are you showing up in life?
And then I started teaching biofeedback to the medical students, the psychology students, and would use it with patients. So that's kind of the broad strokes in a long winded way of how I was introduced to heart rate variability.
[00:09:40] Speaker A: Amazing.
I want to throw this out heRe. Just get your impression, because one, well, first of all, I got to thank you for your work in HIV, because I started my work in HIV working with providers probably around 2003, 2004, as we transitioned from terminal to chronic disease. And just as part of that work really dove into the history and realize how incredible. I knew this in a general way, being aware of what's going on in society, but just have such an appreciation for those that live through the epidemic and how powerful that work must have been and heartbreaking at times and rewarding, and just thank you for that.
My impression is you got this early exposure to yoga. You're working with all these different, I would say traditional breath work, probably on the being from Colorado, I use this word in a very positive way, but a little bit more on the hippie side of things. And then you start to bring in the biofeedback. And I wonder sort of as you were working with these different models, what did kind of the data that you were getting, how did that inform your work in your thinking? I guess kind of early on in that journey.
[00:11:17] Speaker B: That'S really a useful question for me to ask myself, and I think for all practitioners to ask themselves. I really do see, because to address that question, let me step out for a second. Having been in naturopathic medicine, we'll just say that when I was teaching about naturopathic medicine or nutrition, diet and HIV care, I traveled around the country doing this for different organizations. Many times, the medical doctors, the conventional MDs would say, well, where are you getting your research? And I was like, your journals, I'm getting it from you. It wasn't the naturopaths who were doing it, but I also had clinical experience with it. But what I wanted to say to this about the data, it's interesting having watched this evolution in my field and in functional medicine, the big word everybody's talking about now, functional medicine in nutrition, watching everything on. Well, I'm not on social media. I was about to say, Seeing things on social media, all the people saying, these are the biohacks, which personally, I have a hard time with that phrase, but talking about this like, this is the diet. Now you should do, everybody should be keto, everybody should do intermittent fasting. I know I'm going to get a lot of flak for this. Everybody should do this. And they're going to look at the data. Look at the data. Well, when I went to school, everybody was supposed to eat small, frequent meals. That's what we were supposed to do. What about all the data about everybody should be a vegan? I mean, the should is the problem for.
And going back to the data, we've got this data. What happened to all the studies that we used back then? Are we going to say that all the patients that I worked with, or Dr. Bastir, for whom the school's named, they didn't get better because they were based on the research at the time that didn't say, do cold plunges, although naturopaths, by the way, do a lot of hydrotherapy, hot and cold and all of those things.
[00:13:18] Speaker A: Love it.
[00:13:19] Speaker B: So to me, watching the evolution of saying, oh, now everybody should take Gaba and theonine. No, now you should take phosphatil ser.
I think it's disrespectful to the main principle of naturopathic medicine and ayurvedic medicine and all these traditional medicines of understanding the person in the context of their own life.
[00:13:41] Speaker A: Yeah.
[00:13:42] Speaker B: And I know we want, like, this is what we should do, and we want to apply it broadly to everybody.
So that's part of my soapbox. But then going back, the thing that biofeedback did was it wasn't necessarily based on studies. I could see biometric data on somebody when they did things.
[00:14:03] Speaker A: Yes.
[00:14:04] Speaker B: And that also helped me find that, like, wow, this is the meditation we should use, or this is the breath work we should do? Well, it's not having the impact we think it is.
There's the debate about Bateko method. Does it really change the whole thing about if you hold the breath, the CO2 levels change? Well, that only lasts for a point, because, by the way, the body is complIcated, our kidneys kick in, there's all these other mechanisms and compensatory things. So the rationale we say might be helping people might not actually be the true mechanism. So I'm saying that to keep a skeptical and open, curious mind so connected to what your question was coming back to, that it's like people would say to me, my heart's racing. And I was like, look at your heart. Oh, it's not racing. Oh, wow, that's interesting. I see what's happening in my data. Unless, of course, your sensor is not working, which that happens, too, or I love when people would say to me, I'm not stressed and their shoulders are up by their ears and the EMG tension is like, off the chart and like.
So I liked that biofeedback was a bridge to help look at some of these techniques that I was using, or approaches. I don't like even calling them approaches, but these modalities and seeing how they directly impacted the individual.
So I loved that.
Despite what I've said to people, like, I do try to get people off of their wearables, but despite that, I'm a tech geek. I love the technology and I love all of these things. It's fascinating. It's just how we use them. So biofeedback, heart rate variable, all of this was really helpful as a tool to create more awareness. That's the bottom line for me. It's just about creating awareness and see if we can link it up for ourselves about, like, what is happening for me. How am I showing up in this moment? Yeah, I answered that question.
[00:16:18] Speaker A: I would love to hear because it's been one of the frustrating things about getting older, as we joked about, is everything. And it seems like, and I pick on them a little bit like the dietitian, nutritionist world. I'm not going to say the dietitian and nutritionist, but where's the accountability? That we removed all the fat, which was horrible for us. We put in a bunch of sugar. Now fat is good. Sugar is cocaine to me.
I don't know even who to be pissed off at, but if I follow your advice, it could kill me. That doesn't seem to be what medicine.
[00:17:08] Speaker B: I love that. I really like how you said that. That resonates with me because you're saying, I don't know who to be pissed off at.
[00:17:15] Speaker A: Yeah.
[00:17:15] Speaker B: And that really rings true for me. And then where do I put my faith? But the thing, when we talk about the causes, I said, treat the cause. There is not one cause. It's socioeconomic inequality. It is, hey, try to eat organic food and drink pure water and breathe fresh air. Good luck in the world. Yeah, you could have all the filters in the world. I mean, I do still work with people with cancer and end stage disease, and many of them will say, hey, I did this. Just like you were saying, I did this diet, this, and I followed this, and how could I get this? It's like, because you're breathing.
And that's the other thing about breath work with people. It's like we're not, as a culture, addressing air pollution, but that's another topic we can go to.
But so the main thing, I think, is one of the causes, it's a paradigm shift.
We need to have space and time to really sit with ourselves and know what we're experiencing. And I will tell you, my hospice work, that's an easy and cheap card to play. Hospice work.
[00:18:32] Speaker A: Okay, you can play with me.
You can play that all day, my friend, because I appreciate that work as well.
[00:18:40] Speaker B: Well, yes, but I'm saying that because we're going to die. And for what reason do we have a problem with that? I'm not saying let's all go out and do something about it, but it's like, how do we become comfortable with whatever is uncomfortable? And I don't care if it's your own pain in your body, if it's your life ending, or if it's what's going on in the world. We don't know how to tolerate the distress, which I think dysregulates our, not just our vagus, our entire nervous system. We don't know how to tolerate it. So what do we do? We distract ourselves, or we take the other heroic, mobilized, very mobilized and sympathetic dominant approach and say, I'm going to control my food. I'm going to control my breath.
And that's the data about why I don't use biofeedback and heart rate variability. With so many people, they're so mobilized, using that word sympathetically dominant about controlling their breath. I was like, stop it. Look at your data.
[00:19:50] Speaker A: Yeah. And that's one of the things I'd love to get your perception on, is one of the things, for long time listeners, we haven't done one of these episodes in a while, but there was these in of one series where Matt's going to try something new. And what I love, for example, I did sober October. Now, I'm not a huge drinker, but I love my double IPAs, which a few of those. And the older I got, the less pleasant the next morning was.
[00:20:20] Speaker B: I'm not getting the sober november Matt, right? I'm not talking about sober.
[00:20:26] Speaker A: And yet I'm tracking my HRV, and I'm seeing, oh, wait a minute, like, cut this out.
No way do I advocate for everybody to just give up drinking. Hey, if it brings joy into your life, great. When I was younger, it probably wouldn't have impacted it nearly as much. But seeing that impact, doing resonance frequency breathing, and seeing for my morning readings, that baseline gradually go up. And I wonder kind of as you kind of shift with this, because it sounds like we share that passion or interest for the end of one, whether it's ourselves likely. I'm sure you've experimented a lot over the years as well, or what works for this person, because I would imagine in your work as well, especially in my work with trauma, what works for one person could actually do harm to another person. And it's that in of one, exactly that I really got a passion for heart rate variability because we got some immediate as well as longer term feedback on, is this working for Brad, is this working for Matt? And if it's not, how can I adjust? I'd just love to get to that.
[00:21:53] Speaker B: Yes, that is the one thing I love about some biometrics. And yes, I have. There was a six month period. I wore three wearables at night. I measured my heart rate variability in the morning on four different devices.
Okay, now people are going, okay, this guy, no wonder he's saying, don't do this. But I did it because I was wanting to see how I won't name the brands and the companies, but I wanted to see what the nighttime readings were. And I knew that they were different. Some were five minutes throughout the night. Some were the last. And again, none of these wearables can tell you about your sleep unless they're measuring your EEG. So it's an estimation, but everybody doesn't know. And that, I will tell you, the one bit of data that all of them screwed up was whether I was sleeping or not. Because I would be laying in bed and I'd be sitting there going, okay, I'm awake. I'm just going to rest here. Now, I've been practicing meditation for decades. I sit there and I go, I am going to appreciate that. I've got a safe bed and I can rest.
And so it would say, oh, you were sleeping? And I was like, no, I wasn't. I know that now.
The other thing is, I would also see some of the devices, again, not measuring everything exactly the same, weren't aligned.
And then I would see in the morning, my morning readings after I got up and fed the cats, because you have to feed the cats first.
[00:23:21] Speaker A: Got to feed the cats.
[00:23:23] Speaker B: And then I would sit down.
Most of them, the different apps, the different wearables, and then, of course, my more expensive biofeedback devices, they weren't always accurate.
I shouldn't say accurate. They weren't always in sync. Okay, big.
So I was starting to take that with a grain of salt.
But to your point, I would say, okay, I would track all of those things. Okay. I took magnesium this night. I took this this night, and I would see what impact. I don't drink. I do do green tea. I do caffeine. It's like, okay, I didn't have it this time. That close to bed. I had it that time, close to. Okay, what's the difference? Yeah, there are so many other variables that you. I. The logs on the devices can't keep, but it is useful. It is. And what has helped patients is when they do do this, and then they go, okay, yeah, I did drink last night, like that one, and my heart rate went up. My heart rate variability went down. Okay, that is interesting. It has an impact on me. I slept all through the night, but I don't feel as rested. See, the problem with those. You're doing it. I'm doing it. If you're not logging all of the other behaviors, it's useless to me. And so that's fascinating. I remember one patient, this is just a few weeks ago, she's in Colorado. Maybe if she's listening, she'll hear this, where her heart rate variability, know the morning readiness kind of thing. She's like, oh, I'm in massively parasympathetic today. It's like, really high.
But I'm going to go for a run anyway.
I don't advise that. And then she said, the next appointment, she didn't text me. She said, I was going to text you and go, you were right. I got sick right after that. I was down.
But if you don't know how to interpret the data, that's the thing. That's why I get nervous.
So long winded explanation. I think that this is a wonderful tool to help, knowing that it's flawed, but so is everything else. Blood tests, everything can have some issues, but I like that it can put it in your own hands. I mean, one of the ways I was using biofeedback or heart rate variability with people is I would have them on the monitor and we would just have a go. I would put it to the side so they weren't looking at. We weren't doing classic biofeedback trading, right? Yeah, but their heart rate. And then they'd be talking about something, and then we would show what happens when they would talk about something. And what happened to the breath, of course, because the breath is going to change the heart rate. But it's interesting just to see how when their mind wanders or they start to ruminate about something. If you see the change, you can ask them what just happened. That's actually one of the ways I got into biofeedback, is somebody put me on a bunch of biofeedback, biometric things, brainwaves, as well as heart rate variability and other things. And they asked me to meditate and do mindfulness because I was doing a meditation study.
And then they would see these changes. I don't know what they said saw. And then they said, what were you thinking? I was thinking about my breath. What are you talking about? I was focused and I'm like, no, you weren't.
So it helped me become more cognizant of what was happening for me. So I think these could be tools, as long as people don't approach it as I got to do it. Right.
[00:27:11] Speaker A: Yeah, I love that philosophy, for sure.
If you're obsessed about this, it does no good for you either. That's the thing. I think that a lot of the space, which has been interesting because my whole, and our listeners know this, they're probably sick of it. Like, how do we bring this into social work and homelessness and these industries that just get ignored until it's too late? And then we have to deal with health inequities because we never thought about it proactively, but at the same time, we've got the biohacker mentality, which is wholly different. So this space, still relatively small, has such a diversity.
I guess this is why I love the AAPB world, which we're not associated with, which would surprise most people who just tune into the podcast, because I love the work that the organization does, that it is that sort of still that I would say mission driven focus. But it's definitely an interesting space that in certain corners gets very annoying very quickly.
[00:28:26] Speaker B: Yeah. And I like that you're saying about talking about health inequities, because I think that may be when we talk about the cause, that could be a bigger cause of all health discrepancies.
[00:28:38] Speaker A: Absolutely.
[00:28:40] Speaker B: We could go down that route.
But again, feeling safe, if you want to use that language behind it, or just how you feel, you orient. See. So even when I'm talking to my patients, I tell them I don't work with anxiety, depression, PTSD. Although most of the patients who come to see me have anxiety, PTSD, a lot of trauma. And the approach, I says, we're not treating your PTSD. We're asking that fundamental question of how do you want to. I like to say, how do you want to breathe in this moment? AnD I like to use the breath because doesn't it reflect everything? If you're anxious, what are you gripping and holding? What's happening in the body? So then are you able to breathe?
So that's the essence of my work, is saying, how do you want to show up in this moment? Regardless of whether there's another pandemic tomorrow, regardless of whether, hey, well, you're in Colorado, but I'm in Seattle Fire season, which is all year round now, when you can't go outside and breathe, how do you want to show up? So that's the thing. It's not to put your head in the sand, not to avoid the news. I'm not suggesting, like, people say, oh, I got to take a news break. I was like, well, it's your relationship with how you're looking at the news, isn't that it? Like, at the beginning of the pandemic, I was looking at that John Hopkins website every day, multiple times a day. What was that going to do for me?
[00:30:11] Speaker A: We were in lockdown.
[00:30:12] Speaker B: I was in my house. I mean, I didn't need to look at numbers 18 times a day. So it's like developing that relationship, and I think that's where some of these tools can also come in handy of, like, can I learn to really. I don't like to even say regulate so much at times. Just, can I learn to be present? Wow, what a novel concept.
And not run away, not hide, not collapse, not defend. And that's what we see in the whole world of, like, I'm going to make a critique. I think in the biohacking realm, it's like I've had people come in and say to me, I want to live forever.
And part of me wants to say, why do you want to do that? Are you serious? Like, okay, I want to be superhuman. And I was like, I want to be human.
[00:31:04] Speaker A: Yeah.
How is your thinking as you drop off doing 16 different metrics and measurements, as you've kind of moved away from that, I wonder, the biofeedback, how does that still figure into, are you still doing biofeedback practice?
How's that evolved over time, maybe. When did you start doing biofeedback? And how's that evolved in your thinking, in your practice over time?
[00:31:43] Speaker B: When did I start that?
THat's a great question. It was before I moved to around then is when I started doing biofeedback. And it has evolved. Like when I was supervising at the Bastier center for Natural Health, the clinic here, we would see people certain, diagnosed, oh, have hypertension. Let's do heart rate variation. Let's do this protocol.
And I'm not besmirching and criticizing. Those protocols are very useful, and I think they're really useful.
It just changed for me. I'm all virtual now, so people seem to be virtually, and I will work with people multiple ways. Some of them buy heart rate monitors. Some people use apps, and they connect to their phone, and we see it, whereas before, we would be talking about the diagnosis. Hypertension, migraines. Do a protocol and see if it had an outcome. I mean, really, it's not treating the migraine right. It's having a cascade effect on the nervous system, which then, so the way I do it now, and I still use it, is to help people become clear when they're not clear about what is happening. I mean, the easiest one, I'm not doing remotely, the one I don't do remotely is EMG, biofeedback.
But guess what? I'm the biofeedback device. I'm asking people, what's your ergonomics? How are you sitting? When you talked? I interrupt people all the time. When you just said that, did you see your shoulders tense? Did you see that? It's that somatic awareness.
And then I talk about the breath. We talk about how posture. I mean, we could do all the breath pacing all day long, but this could be my naturopathic bent. But if you're crossing your legs, if you're sitting in this weird position, what's the point? You're still creating that stress. So I'm doing biofeedback, some with mirrors, with just looking at people. But then people do get devices, and I have them track certain things. We do some of that heart rate variability for some people.
But again, the intention is really to create awareness of how am I showing up in this moment.
[00:34:02] Speaker A: Yeah.
[00:34:02] Speaker B: And it's fascinating when somebody could do, like, breath pacing. We could look at it as well. It's the 4657 whatever ratio you pick.
We can look at it as getting it right, or we can say, that's just a guide. Are you able to follow it with ease and my experience, and I'd love to hear other people's responses to this is, they're practicing 5757. They're doing it. They're perfect. If you look at their respiration belt, you look at their heart rate variability, but then when they let go of doing it right, I see HRV, max Min increase.
[00:34:40] Speaker A: That's awesome.
[00:34:41] Speaker B: And that's just my, am I looking for? Am I getting the data that I'm looking for? Maybe.
But they also have a somatic experience of, wow, just like anybody who's an athlete, a musician, you're learning the notes, you're learning the notes, you're learning the routine. You're learning the routine. And at some point you go, let it go.
[00:35:00] Speaker A: Yeah.
[00:35:02] Speaker B: That'S how I'm using biofeedback. So I'm not working on the diagnosis so much, but really, how are you showing up? And then we even talk about practice with motivational, we talk about practice. It's like, you didn't practice. People go, oh, I didn't practice today. I was like, great, what happened?
[00:35:21] Speaker A: Yeah.
[00:35:26] Speaker B: I don't want the practice to be punitive because that's an example of how people are orienting the work.
[00:35:31] Speaker A: Yes.
[00:35:33] Speaker B: And so all of it is useful information to help work with people live more present in the present and at peace.
[00:35:44] Speaker A: I love it. So I always love to ask this question. I want to make sure we have some room to explore it, because I can't wait to hear your thinking is we've seen, and I'll be honest, as someone who's been hyper aware of this arena for five or six years. So I'm not saying that I have the long perspective that you have had in your career working with biofeedback.
It seems to be evolving. It seems to be at a point where the wearables again, and I totally agree, that varies. You put it on your ear, you put on your chest. I think we need to talk about this more. Like, what is it? Is it more just consistency? We're looking for all these questions getting brought up, but you've sort of seen the field evolve over time and been part of that evolution.
Where do you see, I guess, let me ask it twofold. Where do you see maybe your practice going as it's evolving and where do you see the field going? Where do you think we're going to be? Maybe 510 years from now, as technology is seeming, we're hitting this place of exponential with general, large language AI models. The world's a different place than it was, and I don't think we've even scratched the surface on where this could be. So I'd love to kind of hear where you're going and where do you see sort of the general field of HRV, HRV Biofeedback going?
[00:37:21] Speaker B: Well, that is interesting, because when you think about it, I started doing biofeedback before the smartphone or before the iPhone, we should say before the apps. And so if I just think about that, which, thank you for making me think about that, inviting me to think about that, it's like it's exploded. Look at the apps that we have and the things we can do. And I do not want a world. I'm not sure I want to live in a world. Let me say it that way. I'm not sure I want to live in a world where sensors are attached to my body 24/7 Although we know from some work at MIT and other places, you just have a camera on you, they can tell you what your heart rate is.
I'm not sure I want that. And I think it's evolving. The technology is evolving all the time. I mean, the camera app on your phone is almost comparable to, like, an EEG biofeedback on a high end biofeedback device. Not EEG, HRV. You know what I meant?
And it's like a photoplasmic graph or an ECG. So that's, like, fascinating to me. And the geek in me loves that. I love that technology is getting more precise.
I'm very tangential when I talk, but bringing in the thing of, like, when I was wearing those different apps, the one that was on the wrist and the one that was on the finger and the one that was on the ear, and then the pad that was attached to my abdomen.
The interesting thing is, if I laid on my arm a certain way, I knew that I blocked the blood flow. And so that's going to affect my HRV. The one on my wrist kept as tightly as I had it. It kept flipping over, and then the light would shine in my eyes and wake me up. So that wasn't a very good one. So I know, like, the data between some of those people like the room better, because I just believe that we're going to get such interesting things. They're going to be able to measure our brainwaves.
Again, there's questions about what are we measuring? Is it really what we think?
The other tangential thought. Again, one of the things I think about all of this, you come in to see a biofeedback practitioner or an EEG practitioner. I know I'm going to get flak on this one.
Just having the invitation to come into an office every day to regulate or not every day, but whenever, to have that time for you. We know that if you have major depressive episode and you don't go to psychotherapy, you're going to get better in so many weeks.
So is it the psychotherapist that helped? I do believe that just having that attention is helpful. If people use these tools to help direct more awareness of how they're living, I think that's going to be beneficial for everyone.
But I do think the field is going to just emerge that it's not just going to be apps that we're going to find. You can wear a sensor, and I can see it on my screen, and there's the part of me that's so excited about it and nervous about that, and excited about it and nervous about that.
But I think that's going to be fantastic for working with more people.
So I think that will be useful. I would love for us to find a way.
I wish there was a way to track blood pressure continuously without a cuff because so many people are worried about their blood pressure, and so many people, when they're not measuring it, don't have hypertension, but when they're measuring it, they do.
But I think all of this is going to be happening. I really do. And so that's exciting for me. As we talked about getting up there in years, more and more, my work is really just talking to People more about the stress tolerance.
And probably, I imagine in the next several years, I may not be using much of the devices that often, but I still think they're of merit. I'm not trying to say that at all.
And we'll also see where the technology goes, because maybe I'll change my mind. Maybe I'll say it's so effective that they can use it and I can see it and we can do it. It would be great.
[00:42:06] Speaker A: I love it.
[00:42:08] Speaker B: One of the things I like, just an aside, one of the things I like about doing all of this remotely. So some people buy more expensive equipment, some people buy just one heart sensor on their computer, or a lot of people buy it on their phone, and they sync their phone to their computer, and then I see the data in real time. One of the things I like about remote work, it's what I was saying about people come into your office. People would come into my office and they would just sink in the chair and go, okay, I'm away from everything. What was fascinating is to watch people in their own situation, in their real environment, and then talk about how they're orienting and regulating. And I found that to be, in my opinion, maybe more powerful than having them come to a separate place. Now I immediately have an argument with myself if their environment at home is not safe, if they don't feel like they have a place, that's important. But for many of the people, it's really great. We're doing a session, they're doing some breathing, and then they hear, daddy, daddy, daddy, daddy. Come here, daddy. And then I watch everything change. It's not just like, I'll be with you in a moment. It's like, okay, now we know what we want to practice.
[00:43:26] Speaker A: Yeah, exactly. I love it. I did a little in home therapy earlier on in my career, and it was just a totally different.
It was a whole different practice. I can't even compare it to someone coming into my environment, going into theirs, where I had a lot less control.
Like I said, I realized not everybody. I was sharing this story today. Not everybody has a floor. I realize I would walk into some houses, and it was just dirt. And, I mean, it was part of the populations that I've always worked with, my career, but it was like. So I would have never known that if they would come to my office. So it just gave me a total appreciation for that environmental piece of it. And it was just a totally different practice doing it that way.
[00:44:23] Speaker B: There was a time in my career where I did two things that were really powerful for me. One is I did go do home visits, and it was great when people would say, I'm eating. I'm following this diet. And then I said, well, let me just look. We're sitting at your kitchen table. Can I just open this? It's like Captain Crunch, by the way, is not.
That's process.
So going into homes was helpful because you could see that, like you said, I think that's fascinating, because then we could also see the inequities, too. We could see what people are really dealing with. But the other part that was interesting is when I would take people to the grocery store, and I only did that maybe a dozen times, because as a doc, I'm sitting here going, oh, there's all kinds of other things than gluten or all these things. And then they'd say, I remember one gentleman said to me, I didn't know there were this many vegetables.
What is that? I was like, it's colored. That's kale. This was, again, in the late 90s. But it's like. It's fascinating. I would love if medicine could include that more so that we could see people in their natural environment or take them to these places because we say things to patients all the time and clients, we don't know what they're really doing.
[00:45:39] Speaker A: My final question I got to ask because you're the second, as I mentioned with Sarah, there's so much frustration and I'll look at it more of my professional piece of it. And personally I feel this as well. But I'm also healthy enough to say I don't think I'd get any benefit out of a 15 minutes physical.
Really? What are you going to do in 15 minutes? I pay all this money and that's the only thing you're offering me as preventative or whatever. So I got my own frustrations with it, which you can hear. But one of the things that I'm so hopeful about, if I'm not frustrated with the current situation is talking to you, talking to Sarah, this ND, which I hope is a movement because talking to her and like well, I have an hour intake where I just have a conversation with somebody and I'm thinking about all the fairly qualified health centers I'm working with under these strict 1015 minutes visits because that's what they have to do really in many ways keep their doors open. It's not what they want to do. They know it's not best practice, but they're in this system and there's no flexibility. When you go into more of the Medicaid arena if you're in a state lucky enough to have expanded Medicaid, which isn't the case everywhere, weirdly. But basically I want to know when you all going to take over the world Dr. Brad, because you've got the answer to all not being a little overdramatic here, but let me be answered. All my problems my friend, like you look at it from a holistic I want my physician to spend an hour with me, get to know my name and where do you see your movement going? Because I want you to just take over medicine.
[00:47:37] Speaker B: Thank you. That's what I used to say.
Part of me also just has this bias, not sure if this is well founded, that the whole system just needs to burn down first and then let's see what evolves. But you pointed that out that many of the providers that are in that system don't want to be in that system.
I'm not doing the battle that MDs are bad and NDs are bad. I don't believe that at all because I will say and I'm not thrilled with a lot of the NDs in my field too.
And there are endies who do 15 minutes visits. My first office call is an hour and a half. My return calls are all an hour.
And when I was doing HIV care even, and I would go talk to a good colleague of mine, Medical and MD, who worked at the hospital, I spoke to his residents one time and they was like, oh, you don't run all these tests. And I was like, well, I don't have to run the test because you do. And we share the patient. But then I said, but my first office call back then was 2 hours.
And they said, oh. And the first thing they said, all of them said was, oh, well, if we had 2 hours we could get a lot more information too. And I was like, yes, the system doesn't support it. The system doesn't support. So I would love to see a movement where actually just the quality of care could change. But what does that mean? What do we have to overhaul? I mean, there's so many socioeconomic, political factors that we have to address and if we want to treat the cause, we have to really look at all of that imbalance.
So when's it going to happen? I don't know.
Love to see it happen.
But the issue is how do we step outside it? Not everybody can. That's one of the things can afford it, right? A lot of the providers, functional med docs or naturopaths or osteopath, they're not covered, or if they are, then there's confine for the provider that they have to work in a certain way in the system. So if we all want to regulate our heart rate variability, we need to overhaul the healthcare system.
[00:49:55] Speaker A: Yes.
I take pride and I hope the Ryan White services that came out around the HIV were, I think, a really good patient centered medical model. You got a case manager, you've got more time, maybe not hour and a half, 2 hours, but some of that was brought in, I think, to the Affordable Care act and the Medicaid expansion. And then like manage, I call it manage costs, not managed care. And I'm sure I'm not the one that admitted, know it just kind of eats way at it, but it also is not working and I think that's evident. And I'm seeing some states like California is using Medicaid dollars for housing and case management. So it's kind of coming back hopefully to that in a way that we can get enough data where showing that this works and it gives a good return on investment. I think that's what the Ryan White HIV services have shown, especially when we get these viral suppressions, and we're getting way on a tangent here, the rates of viral suppressions, and I was just in Iowa, they're getting like 98% viral suppression, which for those that don't know, is like the gold standard of outcomes in labs, again, data. But really, you can put that on T shirts and I'll support that. So it's just interesting, and I love talking to folks like you who are figuring out how to provide great services in what I just think is a broken system when we look at it from kind of that meta level.
[00:51:40] Speaker B: I love that idea. And we tried that at our clinic for a while, the case management model.
A lot of systems, a lot of HMOs. I know people are attempting it, and that's the problem. It's not necessarily great, but having a case manager who then is the conduit between everyone and knows all the players and everyone can come together and do case discussion again, this takes time.
But I love that model. I think that's fantastic. I mean, just even think about. I know I say I don't treat the disease, we treat the cause. Right, but it's like essential hypertension. Why isn't everybody taught how to breathe? Yeah, in other countries they are. It's like you have a heart attack. First line, let's teach you how to breathe. What an amazing concept. Low cost, but oh no, let's do some other things.
[00:52:37] Speaker A: Yeah, absolutely.
[00:52:38] Speaker B: I think we're on the same page.
[00:52:40] Speaker A: Yeah, I'm sure we could talk about a million different things, but I want to respect your time. I want to thank you for your work. You're just one of those. I feel so fortunate to bring the voices of the pioneers and to get your background of our shared work in HIV and other shared passions. I want to thank you for that. Like I said, waiting for you all to take over health care, I will be whatever advocacy you need to be. I'm trying to find an indie that I could get covered under insurance here and not having a ton of luck, but I'm not giving up. I got a few more weeks before it gets locked in.
But I just appreciate you, appreciate your work. We'll put some information, contact information, website information, in the show notes, if people want to reach out your website, we didn't even touch on philosophies, so we'll have to have you back at some point to continue this conversation. But I really appreciate your time, appreciate.
[00:53:44] Speaker B: Your work, and I appreciate you doing this as well. Thank you for getting all this information out there. Your disseminating information, I think that's important. So I appreciate it. I hope I didn't bore all the listeners.
[00:53:57] Speaker A: It was a huge honor. And knowing our listeners, I'm not worried about that at all. So everybody can get information. Like I said, get your show
[email protected].
Yeah, we'll put some information in there. Links and, Dr. Brad, thank you so much. And everybody, we'll see you next week.
[00:54:18] Speaker B: Thank you.
