Episode Transcript
[00:00:02] Speaker A: Welcome, friends, to the Heart Rate Variability Podcast. I'm. I'm very excited. Our guest today becomes highly recommended and I'm so excited. I don't think I've gotten better ideas for the podcast from, from any guests, including at some point, maybe a poem, which I'm really stoked about. I, I knew our guest would be a great fit when I saw that. So, Dr. Garbo, I want to welcome you to the Heart Rate Variability Podcast. I'm so excited to explore your expertise around this, but before we dive in, just give a little bit of an introduction of yourself for our audience.
[00:00:44] Speaker B: Thanks for having me. I've been looking forward to speaking with you.
I like your attitude. Two disclaimers. One, I gotta. I throw out opinions.
These are not Virginia Commonwealth University's opinions, the Veterans Administration or Department of Defense. These are my opinions only.
And the other is I'm not endorsing. I have no conflicts and I'm not endorsing any products.
Today I am a physical medicine and rehabilitation specialist. We are a jack of many trades.
I finished my residency at Ohio State in 1997 and the year before cotton was launched and changed my career forever. We were going to stomp out pain with medications and injections and we failed as a health care system miserably on that.
I was already burning out six years into practice and was admitted to my own hospital with atrial fibrillation, which is something I should. People you typically get 60s, 70s and 80s and the intern rips the ECG off the printer and we both kind of go afib.
So that was a wake up call that I was burning out, both physically and emotionally.
Persistent fight or flight response has physical health problems, but also behavioral consequences.
And both were happening to me. And mindfulness was a big route of my transformation. Physically, emotionally and healthy, wise and knew something was happening and knew I wouldn't get AFIB again until it was age appropriate. So I still haven't had AFIB since.
I feel different. And I can tell with people, you know, two people sitting next to each other, you have a conversation, you can feel something, you can see something. There must be a metric. And, and, and this is that metric. So around 2009, I, I found this metric and it's been my passion to understand it and apply it.
This is not hype.
There is a massive amount of data. There's the world of research, there's the world of psychology, there's the world of performance.
And extremely lagging behind is medical application.
One of my purposes is to bring those worlds together. With the work I'm doing at VCU that I joined three years ago and going to start having a conference with that goal of bringing those four worlds together and applying it clinically. And we have a grant, HRV Star grant to train, to train people pragmatically. You don't have to be a biofeedback expert, but in four to six hours I think we can train anyone with a healthcare or education degree to understand the basic metrics and how to modulate that metric. And so that's my purpose.
And so I love the topic. It's great to be here.
[00:04:25] Speaker A: Awesome. So I, I, there's so much to dive into here. But I, I'd love to kind of start out with the idea, I know you've published on this, of autonomic rehab. I, I love that, that just, that terminology, if you haven't copyrighted it yet, I, I highly encourage you should because it's, it's such a great term. But I'd love for you to explore kind of your thinking behind autonomic rehab.
[00:04:56] Speaker B: So I did coin that term in 2020.
I think if you do something long enough, it becomes an art and you start to be able to see things. And heart rate variability is a metric of the parasympathetic system.
All our studies in the autonomic center at VCU are around persistent sympathetic activation, which is threat mode, which is the thing you always have to remember. It's very powerful but very inefficient. And so it's around being stuck in threat mode. And so you must understand the yang if you're stuck in the yin.
And that's the parasympathetic system. And this is that biomarker. And so, so my mantra is autonomic rehabilitation for parasympathetic health. That, that and, and, and that's another way to, for people who get it, understand where we're going and it guides the thinking. So it's being adopted. It's, you know, there's some great research being done at Mount Sinai. They sort of co opted and so you'll get bigger hits on the Internet to them. But that's a compliment. I think I know where this is going and no one's seen more patients with a wider variety of horrible and distressing situation than I have in my 26 years.
And these are the themes. It's. Autonomic rehabilitation for parasympathetic health is I think the starting point. I think the two skills, heart rate variability, tracking and modulating. I don't argue that there Aren't a thousand ways to transform people are transforming their lives for thousands of years.
My argument is I believe I know the starting point where start with tracking and breathing and you get those down. You can go the thousand different ways of transformation but there's no evidence based.
Monetary data based, evidence based, safety based.
That's the starting point. And arising above the noise is difficult.
But in no way is heart rate variability a fad. It will transform the way we do healthcare.
[00:07:38] Speaker A: So I would love to start out with the tracking side of this because I know you've done a lot of thinking behind that. So I'd love to just explore your thinking and I'd love to throw another kind of sub question in there of something that I'm really an advocate for. Well, is to get this into mainstream healthcare. Sometimes I think it's an educational thing, less and less. But when I first started this I was amazed, like cardiologists really didn't know. I think I learned about heart rate variability in school. But here's all this research that I peer reviewed meta studies that I was seeing and like cardiologists don't know this, which was scary as much for like their practice. But I'd love to. How do you look at tracking and how the hell do we get this into mainstream medicine?
[00:08:32] Speaker B: The typical cardiology response is the Framingham study. This largest heart study, the landmark study basically of all healthcare in around the early 90s, shows that HIV is this incredibly important metric for cardiac health.
There was a ton of investigation towards that. But this is one of those situations where you can't make HRV what you want it to be. You take what it gives you.
[00:09:04] Speaker A: Yes.
[00:09:04] Speaker B: And so remember always, you know this, it is incredibly sensitive to whole health, cancer, emotion, cart disease, but it is horribly specific unless you design a study. So they wanted it to be a metric for cardiac health. Well, it's a metric for whole health.
[00:09:25] Speaker A: Yeah.
[00:09:26] Speaker B: And so you'll routinely get this. Yeah, we looked at that in the 90s and now we're looking at doing nerve burnings and ablations and we're looking at this and we've left that behind. But we looked at that.
[00:09:40] Speaker A: Yeah.
[00:09:41] Speaker B: And so they've stopped looking at it. And there are no incentives in the healthcare model to be truly value based. This is a value based metric and so the interest drops off. But fundamentally what I tell the residents is you need a North Star if you want whole health. Heart rate variability is that parasympathetic North Star. And then getting to what you're Asking. So in the performance world you'll see a lot of one to three to five minute recordings in the morning.
And life, you know, life is a day to day conflict between idealism and pragmatism. That is a very pragmatic way to approach a completely healthy, financially doing well, possibly a meticulous, possibly obsessed healthy person with a huge recovery bandwidth. Now if you're less resourced and you feel bludgeoned by the healthcare system and you don't have, you have reduced recovery capacity. So that's what makes these long Covid and other disorders invisible. They don't have the bandwidth to recover. And so almost all your brain rinsing, almost all your recovery of fixing tendons, cleaning up inflammation, fixing muscles, growing brain is done at night.
A morning metric is fine if all things are equal. And you're only trying to decide how much to run today.
[00:11:38] Speaker A: Yeah.
[00:11:39] Speaker B: So that's reasonable. But your thoughts and the way you breathe can affect those one to two minutes.
So. And prior to the last 10 years, right. The Olympics are in a wide variety of load tolerance. Tilt tables are load tolerance, stress tests are load tolerance.
These are all load tolerance. We now have a metric, equal, not more important, but equally important for recovery capacity.
So, so tracking recovery capacity is equally important to load tolerance. And the perfect example is long Covid. People are now doing two day exercise tests to show how badly you recover and how horrible you are the second day. And it, I find that it's in the right direction but needlessly gruesome. Yeah, you, we, we need to assess recovery capacity. So if recovery capacity is equal then we're going to have a ton of different metrics. How parasympathetic you get, how fast do you get in the first three hours, how deep do you get that night? What's your average for the whole night, which is the metric, how many hours of sleep. So now we are measuring your gas tank as it varies from day or your electric battery from day to day in five, six different parameters.
So morning tracking is pragmatic and okay in the healthy performance. But as we move forward and there's a great study by Haddad in 2021 and Bassini, I think 2023 just simply pick and I get everybody's reluctance. But just looking at 2am to 2:15am we don't know what stage sleep you're at, but we just check those 15 minutes and that's probably a more stable assessment than a morning in 45 to 55 year olds in the Copenhagen study halter study equally as Good. As the Framingham showed that people without any stroke factors tracking that for the next 10 years predicts stroke. Something parasympathetic is not going on between 2am and 2:15am in those people and it predicts stroke. That then should spark a ton more questions to refine that.
But, but so I, I believe the, the whole health biomarker is nocturnal heart rate variability. And no, you won't get an opinion on which, whether it's high frequency, blah, blah, blah today. That we'll figure all that out.
[00:14:30] Speaker A: Okay, well, when you do, you got to come back and share that with our audience too.
[00:14:36] Speaker B: Well, that, that's not probably going to be in my lifetime whether there's consensus.
[00:14:40] Speaker A: But yeah, yeah, absolutely. So I, I love you also mentioned too, and looking at this is like this idea of performance obsession. And I, I, I find it interesting, you know, coming in from, you know, the trauma healing world where we're really trying to help people recover to some level of healthy functionality, to this world of heart rate variability where there are folks like me looking at recovery and I know that's part of your work and there are folks that feel like if their RMSSD isn't in the hundreds every day, that, that something's wrong with them. And so I'd love for you to kind of speak with your experience of, you know, helping people just be like you mentioned, long haul Covid, feeling like they can get out of bed in the morning. To those who want to go, I hear this in Boulder, Colorado all the time. I want to go from a marathon to an ultra marathon. What shoes should I buy? So I love your perspective on that.
[00:15:45] Speaker B: So I'll make two examples. One is the person feeling the effects of PTSD and so forth or long Covid versus the ultra healthy athlete.
So if I start tracking nocturnal HIV and you have long Covid or PTSD and the number is really low, I've met my first bullet point and I tell them, look, there's, it's good news and bad news.
The, the bad news is you have a recovery capacity problem. Good news is I kind of knew that already. Now we have a number. Now we're focused in on something that we can sink our teeth in. And it's validating, it's not fully accepted, et cetera, et cetera. But there's a validation component to having a very low HRV compared to others. And then we never compare to others after that. It's only compared to yourself.
[00:16:46] Speaker A: Yeah.
[00:16:47] Speaker B: And so I want it to be validating and I want it to be helpful in their journey. That, and I tell them, other people may still judge you. You have to know, I'm telling you, this number is an assessment. How much brain rinsing or mitochondrial housekeeping is being done at night? That and repair work. And sleep is active. The car is not in the garage. The car is in the pit stop. And if you have good, healthy pit workers, they're lubricating chassis, replacing tires. But if they're sluggish, and they're sluggish multiple nights in a row, you'll be glitchier. So, but, so that's.
Did I answer the question?
[00:17:33] Speaker A: Well, I, I'd still like to get to the obsessed folks.
[00:17:37] Speaker B: Oh, right.
[00:17:38] Speaker A: I think you're hitting the one end of the spectrum. So let's shift our focus to, okay, those people.
[00:17:45] Speaker B: Right.
[00:17:45] Speaker A: So obsessed with this.
[00:17:48] Speaker B: So I, I. And so for the PTSD people, therapists and many people say, don't focus in on the data. It makes you worse. And, and yes. And no. I don't have control yet of what information a patient sees.
There is way too much data. There's way too much bad data.
If they're following my guidance and I make a big deal, I have data analysts that do fantastic with this model, and I have some that ruminate. And if they're ruminating and they can't follow my lead on what to look at, then we do stop. And so that's fair. But the problem isn't with the HRV data. That's the problem is with the obsession. And there are famous podcasts out there that cater. You have to remember, even though they're not selling expensive items, they may have a bent towards fueling the obsessed athlete. And no, I don't. Obsession is a. I call it the bellwether.
If you obsess on something that is telling you, you are now working to become passive to something. Now, yes, it's a good choice to obsess on running versus alcohol, that's for sure. But obsession, you're starting to become passive. And you're not. There's no free will. So my goal is always free will. And so those podcasts frequently have people obsessing on recovery. Obsessing on recovery is an oxymoron.
So that's. That's the problem isn't with the metric. The problem is with potentially the obsession.
[00:19:42] Speaker A: I love that.
[00:19:43] Speaker B: And you may need to go a different route temporarily.
[00:19:46] Speaker A: Yep, absolutely. And I, I see that, that, you know, for me, it's kind of pretty like my, My motto is HRV for everyone. Like one of the things that I got frustrated with is yeah, if you have $450 to buy a fancy watch or you know, $400 for an annual membership, you know, you could get this data, you know, and yet you, you know, what about working with folks with health inequities and other things? It is. And really trying to weigh that balance because we got both sides of it.
I'll talk to special forces one hour and then the next hour working on integrating this into a homeless shelter. And what I love is this metric can be informative to both populations but very, very different ways to frame the idea. Nobody should be obsessed with this. And I, I strategically, if I have a big like training to do, I will not look at my, my score in the morning. Like I, I know I can show up lower and do a great job but you know, it's just, I'm not.
[00:20:54] Speaker B: I'm not going there to try.
[00:20:55] Speaker A: I'll check it after the training.
[00:20:57] Speaker B: Yeah, at some point you have to trust yourself. But yes, here's the hope for, for the people out there who are policymakers or have purse strings.
I believe this will be a metric to reduce suicide.
[00:21:12] Speaker A: How?
[00:21:13] Speaker B: If, if, if people are, are and we, but we won't be able to prove it because we will, it's whole health. So, so there'll be this metric and somebody's number plummets for several nights in a row. It'll go to a database and it'll be how far, how rural or urban you are won't matter. Your race won't matter, your religion won't matter. And somebody will see that metric, they'll reach out and they'll have to be skilled at it to understand is this emotional, physical, both something else. And we will address the depression weeks before the suicide, before the suicidal thought enters the head and it's potentially could reduce suicide but never be able to prove it.
[00:22:02] Speaker A: Yeah. Well, one of the two studies that really got me very fascinated with this was both what significant drops in heart rate variability predicting relapse or self harm death by suicide. So you've got this. That was well, the clinicians need. Because I have no idea what happens between the week, the days that you're not in session with me. So being able to also I think track longer term, but also really a lot of these things get triggered by an event that happens and if they are lucky enough to have a professional supporting them, what a phone call might be able to disrupt could be life savings.
[00:22:46] Speaker B: Yeah, yeah. Two, two examples. I Pete, some people are very Good at it. One one figured out their number dropped for three nights after they had their bowl of gluten soup, and another one, during the Canadian wildfires, moved their air purifier from the hallway to the bedroom and their numbers went way up.
And so amazing.
If you're reasonable but disciplined, you can figure out stuff.
[00:23:15] Speaker A: Yes, absolutely. So I want to rewind a little bit and hear a little bit more of your story. So you shared that as too many people in the healthcare field, extreme burnout. I'm sort of curious, when you first started to get interested in heart rate variability, was it associated with your own kind of, you know, health awakening? I'm just curious about when did it hit your radar and what kind of the impact that it had on how you think about health and your health and others.
[00:23:55] Speaker B: 2002, I had a moment. I either after five years, I'm getting out, or I have to figure this out. And I remember one of the things for my chronic pain patients or other disorders, I remember having conversation with myself and thinking, if I figure this out for them, it'll help me. If I figure it out for me, it'll help them.
And I could proudly say that was the absolute right decision. I survived the opioid crisis that demolished obviously many people, but countless good quality practitioners I know out there.
And so far I'm surviving.
[00:24:54] Speaker A: That's great.
[00:24:55] Speaker B: And, and hopefully flourishing.
[00:24:57] Speaker A: Yeah, absolutely. So the, the other thing that you mentioned, probably a little rabbit hole for us, but you say you think about it quite a bit. It's something that I'm absolutely fascinated with, which is free will. You know, it's an interesting concept as our nervous system, as far as I understand it, is really, you know, works based on what kept us alive yesterday. I do a lot of work with behavioral change. So really we're designed many ways to do what we did the day before, the day before, the day before. We create habits for efficiency, all these fun things. And I always love, when I get into neurobiology literature is where's, where's the window for free will? And some people, I really respect that that window is closed. They, they would argue that there's no free will. I don't go there maybe just because philosophically I don't want to. I think scientifically they're wrong. But they're wrong. Yeah, I would love wrong. Get your.
I'd love to get your argument and how maybe improving HD can help bring happy window for the individual.
[00:26:08] Speaker B: And number one, don't mention dopamine once.
Okay, you're Down. If you start looking at dopamine, you're. You're already going down the wrong rabbit hole. All right, so. So.
And I do think, right, you've heard mental health change to become behavioral health. And we've changed many people's behaviors, but we haven't improved their health. So it's something bigger than me manipulating you to change your behavior, to quit smoking, even though you continue to get worse health.
[00:26:47] Speaker A: Yeah.
[00:26:48] Speaker B: So. So the answer, I'm sorry, to everyone out there, is not behavioral health.
It's free will. Cognitive behavioral therapy may the term, not how it's performed, may suggest it's about changing behavior. Well, there's something bigger. It's free will.
And yes, your central autonomic network is about keeping it simple. Fight, flight, or freeze.
I need to know, like, the difference between adult and childhood ptsd.
If you have adult PTSD and you remember what it was like to be safe.
[00:27:25] Speaker A: Yeah.
[00:27:26] Speaker B: And you didn't have too bad a branch. It's in your frontal lobe. So your frontal lobes are who you are, who you want to be, and where you want to go. And if I. You. You and I already know pretty much most everything. We need to know who we are, where we want to go. So we want to get to the frontal lobe, and we are stuck in the amygdala fear loop, and we got to get here. And I make a very big point that the latching mechanism is not fighting. If I fight or freeze, fighting to think right. You'll just remain stuck. And so you need to let go. So the big words for me are letting go, acceptance, and free will. So the basis of my 2020 publication is called stop. Basically track value recovery, shift. Shift your physiology, your thoughts, your emotions, and then decide in your frontal lobes in line with your purpose and values. My purpose is to help people adapt three words. If anything you ever hear from me at work or on this podcast isn't aligned with helping. And so I don't have to memorize any habits.
I know my purpose. And there's a famous book called the Power of Habit, which I think is beautiful. Making my point. There's 275 pages on how to manipulate your craving and your habits. The last four pages. If you have the book, read the last four pages. It basically says, that's all great, but you. At the end of the day, you got to believe in something. And. And there's more we got to look at. Blah, blah, blah. So. So this is it. And so. So how do you get to free will? Okay, if. If you're stuck trying hard and you're trying to avoid going, we'll use alcohol.
You feel like you're disappointing yourself and others constantly. If you fight to think right, constantly, then there's a day when you're depleted and your HRV has been low for days or week, nights or weeks, and you're now vulnerable.
And so we want to prevent you getting decision fatigue. Also when somebody says, hey, let's walk into this bar together, not knowing the ramifications of that, you want to breathe, you want to shift your physiology and you want to get to your frontal lobe. And so for a patient that wants to break the cycle for their child, you have to remember what's your purpose.
And so you have to clearly discuss and know your purpose. If you are harmed as a child so deeply and for so long, you may never know what safety feels like. So that is a much harder task. But I have plenty of people who are really stuck, horrible situations, but they are crystal clear on who they want to be, where they want to go and that sort of thing. And the decide portion, stop, shift inside is about free will. And so the parameter matters for me to keep it simple, to get to free will, you need to know your purpose that orients you.
For me, it's help people adapt. Then the next thing is what do I need to accept?
And whether you're an athlete, it's control, your controllables or spiritual, the serenity prayer. Nothing's better than that. So you accept. And in my case, right. So I have somebody complain, you know, a long time ago about the opioids I didn't prescribe, they complained to the state and I have to go through a horrible three month investigation. And what do I have to breathe for three months? Yeah, because I have, I accept. I finally had to accept. And I was so angry and I had to accept I don't have control of the investigators and the board, okay. But I have control of my physiology. And if I keep telling everyone how right I am, it's not helping my health or anybody who wants to hear it, right? So I, I give up the control. But then the decide. This was one of the decisions I had to make. A perfect example.
I was paranoid that those reviewers were not reasonable.
And so could I ever protect myself with perfect documentation from an unreasonable investigator? No, you cannot.
So I had to decide for those three months that they were reasonable and I can't control it even if they're not.
And, and so you have to accept. So I believe the route is know your purpose, accept and then let go of something beautiful. And letting go is the. And so what you just described was your HIV can be terrible for three nights for a big presentation, whatever. It's stress, it's who you are. But so in my poem, trust is parasympathetic and so you have to trust something and you trusted yourself.
[00:32:54] Speaker A: Love it. Love it. I think you're speaking to this, so let me ask this as a follow up. I didn't think that that rabbit hole would lead to this one so beautifully, but I think it is about HRV biofeedback. You mentioned mindfulness. I'm assuming this plays into to the model as well. But I'd love for you to think about that side of the HRV science as well.
[00:33:20] Speaker B: So that's great. That's skill two. Skill one is learning to track and prevent decision fatigue.
Skill two is how to modulate your HIV real time with breathing, HIV biofeedback and prevent threat, fight or flight decision making when you need something bigger and, and you are not programmed like so somebody with an anger management problem, if they take a test that they're not prepared for, they still don't scream at the teacher.
[00:34:00] Speaker A: Yeah.
[00:34:01] Speaker B: So they made a choice. Am I going to get angry? Am I going to run out of the room or am I going to just sit there and collapse?
And you need a fourth option in your frontal lobes where mathematics, who you are, poetry, where all those things reside and breathing improves, test taking, et cetera. And so it's all about learning how to shift. First with your diaphragm, then at the heart, your heart rate variability and then help you shift in your brain to different parts of your brain. So that's skill too. Learning at first with someone safe in a room with some toys, eventually on the elevator around five different people on your way to an interview without any devices.
That's the end point of that skill. And then we're. So we've talked about skill one and the decide part. And so skill two. So, and, and this is the theme. So stop, shift and decide.
[00:35:13] Speaker A: Excellent. Are there any more skills? I don't want to leave any out for, for our audience, there's thousands.
[00:35:20] Speaker B: But these are the not the best, they are the starting two skills.
[00:35:28] Speaker A: Excellent. So I, anything else that I, I want to make sure I know you've got the HRV hero, the star projects going on. Anything else about your work that you would like to share? I feel like there's so much great stuff to explore with you on this topic.
[00:35:46] Speaker B: Sure.
Yeah. One of the things I'M trying to tease out paradoxes, right? Paradox. I call it the exercise fatigue paradox. What's the largest modifier of heart rate variability? It's exercise. Yeah. What can tank your hrv?
[00:36:06] Speaker A: Exercise.
[00:36:07] Speaker B: Exercise. How do we thread that needle? Stop being angry at the devices and the metric, okay? Accept what it gives you, not what you want it to be. Accept paradoxes. I start some of my talks with nothing but a gray background, and it says, what color is this? Black or white?
It's both. Yeah, it's both. So learn to sit with paradoxes. Is dusk day or night? Okay. You don't get to make it day or night. So breathe.
Lower your vigilance level. And now let's solve the problem of these paradoxes. And the paradox in the rehab world that we have to solve is over training in people with low bandwidth.
So the exercise fatigue paradox. So is today a good day to have a load day? Well, what's your baseline nocturnal hrv? Okay. And have you been below it three or more nights in a row? Oh, okay. This is a high risk day. Maybe you want to make it a recovery day.
And so. So X you the parameters of that for somebody dealing with long covet is I actually. So there's something called the Levine program, and it's do something every day. I have a. And it has huge dropout rates. And if you. You. If I give you a standardized and I'm not tracking recovery, you're gonna have huge dropout rates. So two of the problems I have with the fantastic Levine protocol, one is you don't have to have two load days in a row.
[00:37:59] Speaker A: Mm.
[00:38:01] Speaker B: The other parameters. Yes, your heart and muscles do get smaller in two weeks.
So the decision is delaying a load day, one, two, maybe even three days, but not a week or two. And that's what a lot of people don't get when they're reluctant to do this with their patients.
I'm not saying don't exercise. I am saying value recovery. I'm not saying you're going to get better without exercise.
And here's a bit of way to think about long covet. I think of mitochondrial reserve. You have all these mitochondria that are there to clean up inflammation and address emotional trauma, address illnesses. You need a reserve. So these people may not have a true mitochondria. If you go to a mitochondrial specialist, they'll push you out the door. You don't actually have a mitochondrial problem.
[00:39:05] Speaker A: On.
[00:39:05] Speaker B: Based on current definitions, maybe. But maybe you don't have enough reserve.
And so you need mitochondrial reserve. For future emotional stress, trauma and illnesses. How do you get that? It's through exercise. You can get a substantial amount of mitochondrial reserve. Okay. Very low time commitment, but. And anyone listening with severe exhaust. I'm not telling you this is easy. I'm just saying it's very low amount of time. It's 30 minutes, moderately vigorous every other day. You get to that point and you have really a substantial health metric. Now the problem is getting there without crashing. So skill one, using internal HRV isn't trying to improve your hrv. This is very, very, very important. It is using it to try and increase your function without the crash.
How do we use it as a training metric? And so how long it takes you to get to that 30 minutes? It's not up to me, it's not up to you. It's up to your nighttime pitsop workers, mitochondria, whatever we want to call it. How well you're ready for your next load day. And if you're not ready for load day, you have to be patient, kind to yourself. Recognize that this is a recovery day. Talk yourself down from being an overtrier because many of my patients are mentally and emotionally over trying because they've been judged as an under trier.
[00:40:52] Speaker A: Yeah.
[00:40:53] Speaker B: And here's a data point and I tell them, use your, I want your smart side to talk down your tough side on a recovery day.
[00:41:03] Speaker A: I love that. I love that. So before I, I let you go here, before you read your poem, because I, I'm excited to share that with folks. You want to establish yourself as an expertise before you read it. And boy, my friend, you have done that many times over. 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 out at optimalhrv.com Please enjoy the show. So, one of the final questions, and I'm really excited to ask you this is where do you see us going in the next five to 10 years? You've been with heart rate variability, you know, for a couple decades now. When you look into the future as technology, as AI comes on board, as all these, we seem to be hitting another one of these moments where technology that we rely on seems to be taking leaps and bounds.
Where do you see when you look into a crystal Ball, what are we going to be talking about five, ten years from now that maybe we, we can't or aren't talking about today?
[00:42:27] Speaker B: Okay. Well, one of my hopes.
So unlike new treatments where you try and prove what it's going to show, the beauty of this is I get to say what's already proven.
[00:42:41] Speaker A: Yeah.
[00:42:42] Speaker B: And rising. When, when you're in a. When there's so much research going on, a million different things and there's so many monetary incentives, a value based incentive is hard to rise above the noise. My hope is that AI will continue to say, well, hey, the data is over here, the data is over here, the data's over here. And then as you put in your search, value based. Oh, hey, here's the data and the value. So, but, but what I want to do, short term, my goal is, let's say you have irritable bowel syndrome and that's autonomic dysfunction. And maybe you have emotional trauma in the past and maybe you have a concussion. All three of them cause persistent sympathetic activation. Before you get to me, your primary care doctor who may have a licensed clinical social worker in their home, patient centered medical home.
And they learn these stop, shift and decide skills and then they run into the new irritable bowel problem. They go ahead, the primary care sends them to the gi, they do the scope. The scope's fine. You have this irritable bowel. And remember these, the, the two HRV skills you were taught in primary care.
And, and then people are incorporated. So there, there, there is a model and a vocabulary. And in a mere four to six hours of HIV star training, you can get the basics of tracking, modulating, and free will.
[00:44:22] Speaker A: Love it. Love it. Well, I'm excited to be a part of that future with you and I'm so glad we connected. I want you to read us out on your poem. I will just do my blurb because I want the poem to be the last thing we do. We'll put information about Dr. Garbo and show notes. You can find that optimalhrv.com but I think I am so excited because the episode, I'm in the 190s right now and we have never had an autonomic nervous system poem on the podcast. So you are breaking new ground.
I would have required that of all my guests, though I think my guest list would dry up very quickly. So this has just been a beautiful conversation. I want to thank you for, for your tremendous work and I think reading this out on a poem is the perfect way to wrap up.
[00:45:12] Speaker B: All right, well, I'll do my best.
All right. Stuck on the hopeless fear superhighway. Fear is the fuel, our friend, for survival.
Cloaked as craving, consuming and pursuing illusionary control.
Anger, the petulant fear harnesser. Knowing autonomic is not automatic.
Hope is a process. Be open. Nurture kindness, not fear nor anger. Embrace. Embrace your amygdala exactly as it is. Let gratitude in. Permit gratitude to be the parent.
Feeling it, measuring it, let go. Trust is parasympathetic.
Forgiveness is wellness. Over time, adapt by growing insular off ramps.
Always remain empathetic, yet judicious with your heart's compassionate energy.
Know a life of purpose entails conflict and kindness will always remain the healer that conquers all.
[00:46:29] Speaker A: Thank you so much, my friend, and as always, thanks for joining us. And we'll see you next week.
