[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 out at optimalhrv.com Please enjoy the show.
Welcome friends. The Heart Rate Variability Podcast. I am back here with great friend of the show Stephanie White to talk about a training Stephanie put on my radar and we talked about this in the last episode a little bit.
Something I believe everybody should watch at least the first course. And if you like the first course, you're going to probably like the next two courses. But I am really excited, my friend to nerd out about some of the things that we both learned.
Which as much as we nerd out about hrv, that says a lot for a training to both Stephanie and Matt took away some really great stuff from these workshops. So Stephanie, welcome back to the show. Just really quick for maybe some new listeners. Just a quick introduction before we nerd out together.
[00:01:28] Speaker B: Yeah. So sharing with Matt just a minute ago, most people would never guess my undergraduate degree was in agricultural economics, which seems totally unrelated, but I spent many years running the agriculture technology program for Virginia Tech and working in the ag credit industry.
I was very active in all of that until I got sick.
And so in 2016 I had breast cancer, double mastectomy, immediately followed by pneumonia, immediately followed by chronic fatigue, lymphedema, POTS diagnosis, and my world changed.
So as part of all that, I was stuck on a La Z boy four hours a day, pneumatic pump, get my limp to go back where it needed to go. And while I was stuck, I learned everything I could from Paul Laird, dick converts, Roland McCready about resonant breathing and stress and how to manage it through heart rate variability biofeedback, pursued PhD and applied psychophysiology that I had to pause due to medical conditions. But yes, I became a heart rate variability expert. I am the first beat device rep for researchers that want to do overnight or 24 hour HRV. So yeah, I learned a lot and this is kind of the area I'm working in these days as opposed to agriculture. That's kind of my story.
[00:02:54] Speaker A: Awesome. Well, let's dive into the good stuff.
[00:02:59] Speaker C: Yes.
[00:03:00] Speaker B: So as usual I brought slides. So if you're listening to this in your car, keep listening. We're going to describe exactly what we're talking about and you'll get a lot out of it. But when you get home, if you want to see any of the graphics, Matt operates a wonderful YouTube channel and you'll be able to see the graphics as well.
So I am going to go ahead, make sure the slide shows what I've got up.
Share my screen.
Yeah. So this is the free HRV masterclass that Matt and I ended up with on our last episode to kind of encourage everybody to go watch it before we geek out about it.
It's not necessarily that you watch it before you listen to this, but if you either way you can watch it first or you can listen to us first, it's all going to work out fine. But yeah, it was exciting for Matt and I to learn new stuff or find better ways to explain stuff that we frequently come up against.
Dr. Ahn, who's a cardiologist, did an excellent job at preparing this information and delivering it.
And so the course is free.
[00:04:14] Speaker C: I don't know.
[00:04:15] Speaker B: Let me get to the next page. Come on.
Yep, it's free.
You can get to it by going to www.labfront.com collection heart rate variability with dashes in between it.
But it's a three part course.
And so the first part is kind of an overview and it also gets into the time domain measures and then the second part goes into some pathophysiologies.
[00:04:50] Speaker C: That can occur where heart rate variability is related.
[00:04:54] Speaker B: Talks about autonomic nemor system assessments, diabetic.
[00:04:59] Speaker C: Autonomic neuropathy, cardiovascular issues and other clinical things that can affect heart rate variability.
[00:05:07] Speaker B: And then the third, if I could.
[00:05:09] Speaker A: Just put in Stephanie real quick, I think if you're in the mental health or other non cardiologist fields, what I found interesting about this was to get their perspective, you know, the people that are working on your heart and think about the heart, obsess about the heart.
It was really interesting to get this history. Whereas like in the APB world you don't get it nearly as much. And one of my questions was when I talked to a cardiologist and I tell them about HRV and they're like, I think I learned about that in school. I could never understand that because of all the research. And this really gave me some empathy for why that was some understanding that okay, cardiologists aren't, you know, just way behind the times. There's some reasons behind this and some reasons they should also be googling it to come back to it as well.
[00:06:15] Speaker B: Yep. I apologize for the coughing, but yeah, that's. That's kind of where I want to pick up from, from our last discussion.
It's important that an is a cardiologist and that we get his perspective. Because of all the doctors, cardiologists have a unique experience with heart rate variability.
Back in the day.
What cardiologists found and why it was so important to them at one part in their history was that after myocardial infarction, where the person's heart rate variability was specifically their 24 hour SDNN, if it was below 50, their chances of dying in the next 3 years were 5 times higher.
So their 24 hour SDNN stratified the risk for death after myocardial infarction back in the day, until it didn't.
And so the reason it fell out of favor with the cardiologists is as soon as stents came around, an immediate perfusion became possible when blood had been cut off to a certain segment of the heart, as soon as perfusion was immediately available through surgery, all of a sudden our variability wasn't needed because they were all pretty much successful. If you survived the surgery, you were pretty much good to go.
And so it wasn't necessary to measure heart rate variability right after surgery because everybody did so well from a cardiologist perspective, where for them it was essential before stents were available.
Once they became available, it became obsolete because it didn't add any value to the process and they stopped doing it. So a lot of cardiologists are stuck in that mode where, yeah, it was important for a while until it wasn't because reperfusion incidents became available and just wasn't a deal anymore. So a lot of cardiologists just kind of blow it off now as no longer being needed.
But interestingly enough, the people who are in the know now know that six months after surgery has taken place.
If you measure the heart rate variability at that point, if it has dropped since surgery, you're back up against the old risk stratification factors. And, and so what's the more accurate thing for cardiologists to think is the reading right after surgery is no longer relevant, but six months later, if it's dropped back down again, it is still very relevant to their outcome and to their survivability.
But most cardiologists haven't gotten that message that it still has value six months later.
[00:09:33] Speaker A: Yeah.
[00:09:34] Speaker B: So that's unfortunate.
But if you're.
It befuddles me. And that's kind of the next. Well, let me show you the screen. It Befuddles me that cardiologists routinely send people home with Holter monitors or something like a Holter monitor.
And they're only programmed to determine when a piece of the heart isn't working correctly and a piece of the heart is throwing off a weird rhythm.
Holter monitors can figure that all day long.
But if the rhythm itself is off and all the pieces of the heart are working, Holter monitor won't show that at all. I'm referring to heart rate fragmentation, which if anybody's listened to the other episodes.
[00:10:19] Speaker C: They know that's something I'm really interested in. Holter monitors will tell you nothing about heart repregmentation because it's coming from the SA node.
[00:10:27] Speaker B: And we're going to talk about that.
[00:10:28] Speaker C: In just a second.
But all the components of the heart are working perfectly.
It's not about ectopic beats or afib or any of that stuff.
While Holter monitors have the data, they're just not using it to show heart.
[00:10:44] Speaker B: Rate fragmentation and heart rate variability, which.
[00:10:47] Speaker C: Is unfortunate because they have the data.
[00:10:50] Speaker B: Anything you want to add to that, Matt?
[00:10:52] Speaker A: No. Are you going to talk about the beta blockers as well? Because that was another thing that I found.
[00:10:57] Speaker B: The beta blockers is not in my list of things to talk about. So why don't you go ahead and insert that now?
[00:11:02] Speaker A: Yeah. So. So. And you can maybe correct. Make sure that I kind of heard it, is that beta blockers really make measuring HRV not unreliable. But, you know, it. It throws off the HRV to a point where the data isn't that useful medically any longer. And I. I thought that was.
Was an interesting piece of this as well, of why it may have fallen out of use with cardiologists. Because if they. I mean, I believe. And again, I'm way outside my area of expertise when you talk about cardiology is beta blockers are very prevalent as a treatment. And if those are disrupting the usefulness of HRV data, you know, feel free to put that in more scientific language. That. That is another reason why cardiologists have kind of veered away from seeing HRV as important, because so many people are on beta blockers.
[00:12:07] Speaker B: Okay.
[00:12:09] Speaker A: Yes.
[00:12:11] Speaker B: And so beta blockers is one of my hot buttons that when you press it, steam comes out of my ears.
[00:12:26] Speaker A: Wow, I didn't know I gotta do that today. That's.
[00:12:29] Speaker B: Yeah. Beta blockers make. Steam comes out of my ears. And so let me just give my personal story with beta blockers and my professional story with beta blockers.
I was put on a beta blocker. I never had high blood pressure until after the cancer diagnosis and my blood pressure went through the roof. And they described, they prescribed beta blockers.
So within nine months after prescribing beta blockers, I developed non alcoholic fatty liver disease.
And so in some functional health spaces, functional doctors believe when your body is trying to protect you and has determined that higher blood pressure is needed to do everything the body needs to do at the time, if you arbitrarily come in and just change and lower the blood pressure, then two things are going to happen.
You didn't change the reason why the body had determined higher blood pressure was the right answer to begin with.
And so the body's still going to try to correct the problem by increasing the blood pressure. Which number one is why most people, it's only a matter of time before they go on the second medicine and the third medicine, because the body continues.
[00:13:57] Speaker C: To try to correct for whatever it was that it determined the higher blood pressure was needed to resolve in the first place.
[00:14:04] Speaker B: And so you don't stay on one medicine long. And you can find journal articles asking.
[00:14:09] Speaker C: The question, is three enough? Should you go to four medicines?
[00:14:12] Speaker B: So the body smart, it was trying to achieve something. And if you take away its ability to achieve it, the body's going to.
[00:14:20] Speaker C: Compensate in ways that result in the need for more medications.
[00:14:24] Speaker B: That's thing number one. But thing number two is one of the reasons why it often needs higher blood pressure is because the liver gets.
[00:14:31] Speaker C: Sluggish, because everything you're throwing at it.
[00:14:34] Speaker B: And so if that was the reason.
[00:14:36] Speaker C: It needed the higher blood pressure and.
[00:14:38] Speaker B: You lower and you remove the body's.
[00:14:40] Speaker C: Ability to get stuff through the liver, Non alcoholic fatty liver disease as a result.
Wow.
[00:14:48] Speaker B: And so when I saw that video.
[00:14:51] Speaker C: That talked about the more than one medication and if the liver was the reason why it needed it, you know, that's gonna, that's.
I was dumbfounded because I had never heard that before.
[00:15:02] Speaker A: Interesting.
[00:15:03] Speaker C: And so I believe in our lifetime we're going to learn that beta blockers might not be the best idea for the body.
[00:15:15] Speaker B: And I believe my work in heart.
[00:15:17] Speaker C: Rate fragmentation and the overnight cvnn, if I can catch people before they start the bladder blockers and after, I believe it's going to show a overnight loss in resilience.
[00:15:29] Speaker A: Yeah, Interesting.
[00:15:31] Speaker C: Due to the beta blockers, I believe beta blockers take your resilience away and they definitely lower your heart rate.
[00:15:37] Speaker B: And so the reason I know that.
[00:15:40] Speaker C: For sure is because in first beat training for the Bodyguard 3 devices.
You have to override the maximum heart rate and lower it 2120 points for beta blockers because they lower heart rate.
[00:15:56] Speaker A: Wow.
[00:15:57] Speaker B: In order to give start to come.
[00:16:00] Speaker C: Even close to giving them exercise points.
Otherwise they don't, they're not qualifying as doing exercise because their, their heart's lowered so much.
[00:16:10] Speaker B: And so, you know, having the ability.
[00:16:13] Speaker C: To push blood through the body. I've got pots I want to maintain cerebral perfusion.
[00:16:19] Speaker A: Yeah.
[00:16:20] Speaker C: If my heart can't raise the response to keep blood to the brain, that causes problems.
[00:16:25] Speaker A: Yeah.
[00:16:26] Speaker C: And so as we learn more, I really think beta blockers in general are going to be called into question because I. And the other thing that's not known is it is a mitochondrial disruptor.
And so when it comes to cardio metabolemic and things, it completely screws up.
[00:16:49] Speaker B: Your energy creation systems.
[00:16:51] Speaker C: Fascinating. So there. Yeah.
[00:16:54] Speaker B: That you'll get me going when you.
[00:16:55] Speaker C: Talk about beta blockers.
[00:16:57] Speaker A: Well, and I think that it was very. I'm glad I did not, not to trigger you but to, you know, look at how you handle, try to handle the data to make it useful takes another step. I don't know the other question I had because you, you kind never hear cardiologists unless they're really into this stuff talk about HRV biofeedback. Because you know, I talked to dozens of people with heart conditions after, you know, what's this due to my hrv? I'm like, you kind of got to talk to your cardiologist about this because they know exactly what medicines you're on and what procedure you had because rarely could somebody rattle all that off for me. But you know, would let me ask you with the total approval to say hey, I, I don't know either is like can you get a good residence frequency breathing assessment on somebody on beta blockers? Can you get benefits from HRV biofeedback with beta blockers? Because we always kind of talk about tracking or H biofeedback. But this seems to be something that would interplay across both. And I'm assuming HRV biofeedback would be a really, really good tool because of some of what you said for individuals coming off heart conditions.
[00:18:21] Speaker B: So there's two pieces to that puzzle.
There is an FDA approved device that teaches biofeedback that is absolutely known to be completely effective at lowering your blood pressure.
So whether you're, you've yet to go on your first medication or you've just started your first medication, I would absolutely simultaneously or before try to get the prescription for the device or start using, you know, your optimal HRV app.
In doing biofeedback at a coherent pace or a resident price for 20 minutes twice a day can potentially replace medications and lower your blood pressure because you're exercising the systems and you're increasing the responsiveness and blood pressure naturally goes down.
And so it is extremely effective. But a lot of people don't know that it's FDA approved, it's been tested, it's gone through the systems.
And so there's a device that insurance will cover that teaches it. But, you know, you can do the exact same things with the optimal HIV app, practicing at a coherent pace or a resident pace 20 minutes twice a day.
Some people say it can get down to 10 minutes twice a day. But it is extremely effective and it's, it is well worth it not to have the mitochondrial disruption, the liver disruption, all the other things that come along with the medications.
[00:20:08] Speaker A: And if you're fortunate, even if you want to use, if you want to use optimal, I would say if you're trying to manage a heart condition, probably worth going to a biofeedback professional who hopefully would then talk to your cardiologist and back and forth though. I know, yeah, you and me, my friend, living in the United States, not all health care systems do that, but boy, would it be nice to have a team that would work on right stuff while the cardiologist is, you know. But yeah, you know, that, that would be, you know, don't treat yourself on this if you're interested in this. Like a biofeedback professional can really help you structure that. Again, if your providers are actually talking or communicating with each other.
Oh, what a great world that would be.
[00:20:57] Speaker B: That would be an amazing world.
[00:20:59] Speaker A: Thank you for that little tangent, my friend. I had to, I had to bring it up because it's one of the things of this training that just.
[00:21:06] Speaker C: Yeah.
[00:21:06] Speaker B: And so some doctors say HRV is absolutely unusable when you're on beta blocker. I know a doctor that says that.
I do not agree with that. You can still use it and your trends are important.
It's not unusable, but it's not. The numbers are not going to be compared to a healthy individual. Because your heart rate's lowered, your ability to.
The flexibility of your heart rate to change is lowered. So it's different, it's not usable.
[00:21:38] Speaker A: Then. This is what I, I made me question from the training is you could still track heart rate variable.
[00:21:47] Speaker B: Absolutely.
[00:21:48] Speaker A: Against yourself.
[00:21:50] Speaker C: Absolutely.
[00:21:50] Speaker A: You'd want to throw away the Almost useless anyway. Population norms that.
[00:21:57] Speaker B: Right. You can't compare yourself to the norms for sure.
[00:21:59] Speaker A: But, but, but in your opinion, you could compare that.
You could establish a baseline and look for improvement. With the caveat is, hey, you may be 10, 15 points lower.
[00:22:12] Speaker B: Exactly, exactly.
[00:22:14] Speaker A: That is great, great stuff.
[00:22:16] Speaker B: Oh, absolutely. And so the other thing to recognize that when people read the research and look at the baseline numbers, what they might not see glaring at them in the small print is people and beta blockers are automatically excluded.
Almost every research project on HRV people and beta blockers are automatically excluded. So you can't compare yourself to those numbers, but your numbers are meaningful for you across time.
[00:22:47] Speaker C: Absolutely. Awesome.
[00:22:48] Speaker A: Thank you for that tangent. That was very, that was helpful for me and hopefully for the audience as well.
[00:22:54] Speaker C: Yeah, that was a good point to make. Thanks.
[00:22:57] Speaker B: So, going back outside of the part about when stents became available, he lists a couple of other reasons why heart.
[00:23:09] Speaker C: Rate variability is not readily adopted by the medical profession.
[00:23:16] Speaker B: And so one reason is it's really.
[00:23:20] Speaker C: Cumbersome to collect the data, store the data and analyze the data.
[00:23:25] Speaker B: And so for that reason alone, the.
[00:23:29] Speaker C: Medical industry is stretched so thin right now, they just don't have the resources to do it.
[00:23:35] Speaker B: Yeah.
[00:23:37] Speaker C: So it's not going to happen anytime.
[00:23:39] Speaker B: Soon because I don't see anybody mysteriously getting bigger budgets.
[00:23:45] Speaker C: And so because of that, it's not going to happen in the medical space anytime soon.
And because it's difficult to integrate it into a disease centric organization where they're trying to manage specific conditions, it's taking over a lot more in the health optimization space for people whose goal is to have better health.
But when you're trying to prevent or treat sickness, it gets a little dicey.
[00:24:17] Speaker A: Yeah, I do, I do have to just note though, one of the areas, the arms of HRV research, that I don't know if it'll lead to change or not, but it is making the argument that if you're in the hospital and you're hooked up to all the machinery and you're getting HRV in that machinery, look at the freaking hrv. Because it's telling you something with most disease states that is very valuable and maybe an early indicator of something else. So there is this argument that kind of admits it's going against the tide and we need AI to present this to say, not to say, hey, their RMSSD is dropped or their high frequency is dropping. It's like, hey, this is an indication of X, Y and Z, maybe the heart. You're probably putting a couple of metrics together to get that. But that HRV does give you a.
I mean, sympathetic activation could be really, really scary and even life threatening if you see huge crashes in hrv. So there's the argument, and I'm not going to hold my breath, right, that it's going to be implemented or not, but maybe with AI and instead of looking at a bunch of numbers on the screen.
Yeah. You have somebody in the background who's sending out alerts in real time. So I think that's. Even these researchers who are making the argument are like, maybe, maybe, but don't hold your breath.
[00:25:55] Speaker C: Yeah, yeah.
[00:25:58] Speaker B: But going back to the last episode.
[00:26:00] Speaker C: Matt and I did where I talk about making this, this information available at the consumer level. I'm not a medical provider. I'm an educator. And so I can store and collect this data. And I'm not relying on the medical world to fund it. The consumer is paying for it as a functional assessment. I can easily make this available so that they can see their trends and their metrics and learn from it, make decisions based off of it. I'm in a better position to provide it than current medical providers. Providers are because It's.
They're probably 20 years away from really making this a reality.
And it'll be wonderful when they do. Things will definitely improve when they do. But there's still quite a ways from being able to, to use it in a medical setting.
So he does a really good job of explaining that.
And so this one is the one I knew you'd get excited about. You and I are always talking about people's interpretation of LF frequency and HF frequency on power spectrum. And people have a tendency to want to label one or the other parasympathetic and sympathetic. And I keep saying that. Have you seen that wedge graphic?
[00:27:16] Speaker A: You want to talk about triggers, my friend?
That's when, you know, comes out. You got me back right here. You got me back.
[00:27:24] Speaker C: And so I tell you often, you know, Roland McCrady and I had a conversation back in, like 2018 when I got the chronic fatigue diagnosis.
I made the statement to him that I had poor parasympathetic functioning.
And Roland said, stephanie, what makes you think that? Who told you that?
He said, what is your resting heart rate? And I said, 53.
He said, if your resting heart rate is 53, you have very good parasympathetic functioning.
And the example he gave me next changed my world.
He said, stephanie, if I were to cut your chest open and remove your heart and turn right around and put your heart back. It would be a denervated heart. You would have no parasympathetic nerves. You would have no sympathetic nerves controlling your heart function at that point. Over time, it would renervate, but until it did, you would have an intrinsic heart rate of about 100 beats per minute.
[00:28:32] Speaker A: Yeah.
[00:28:33] Speaker C: So anytime your heart rate goes below 100, there are parasympathetic factors at work, period.
Anytime it goes, you know, up above 110, 120, you know, there's sympathetic factors at work.
And really, that's the only times you can say for sure what's parasympathetic and what's sympathetic is based on the rate at which your heart's beating. And what's based on what's got the. The most control will pull it above a hundred or below 100.
[00:29:09] Speaker A: Yeah.
[00:29:09] Speaker C: You know, but between like 70 and 150, there can be some of both.
[00:29:17] Speaker A: Right.
[00:29:20] Speaker C: So using the power spectrum as a way to determine that for parasympathetic, sympathetic doesn't really make a lot of sense.
[00:29:31] Speaker A: Right.
[00:29:31] Speaker C: But I'll explain why people got into that and. And on in the course explains how people fell into that logic. So let's do that next.
[00:29:45] Speaker B: The reason people fell into that line.
[00:29:47] Speaker A: Great. I love this. If you're a little sleepy right now, wake up.
[00:29:52] Speaker B: Why did people fall into the doom of labeling power spectrum parasympathetic or sympathetic?
[00:29:59] Speaker A: Well, Stephanie, before you do, you've had essay node on the last two slides.
Are you going to explain?
[00:30:08] Speaker B: Yeah, yeah, we're getting to it. I've got the really good essay.
[00:30:11] Speaker A: I know I'm not the only one that's seeing that pop up. And.
[00:30:14] Speaker B: Yeah.
[00:30:15] Speaker A: Excited about. So go ahead. My apologies.
[00:30:17] Speaker B: Yeah, yeah, yeah. The. The essay node slides coming up so we can really hit that hard.
The reason people fell into that line of thinking was people could do research where they stimulated the parasympathetic nervous system.
And what they found is when you stimulated the parasympathetic nervous system, the impact on heart rate was virtually immediate.
[00:30:43] Speaker A: Mm.
[00:30:44] Speaker B: It very quickly lowered.
And if you took away the stimulation, it very quickly went right back to normal almost instantaneously.
So they're like, oh, wow. Parasympathetic changes occur really fast.
And so HF corresponds with really fast changes. So we're gonna say anything in the HF zone comes from parasympathetic sources because, you know, when we turn on and turn off the stimulation, they happen super fast.
On the other hand, if the sympathetic nervous system was stimulated, it Took several seconds for the heart rate to increase, and it took, like 20 or 30 seconds once it stopped for those effects to no longer be relevant. So it's slow to come on, and it's even slower to go away after it's been stimulated.
[00:31:49] Speaker A: Let me ask you this question for our audience, because one of the things where I had to really rewind and watch and rewind and watch the training is how we talk about the sympathetic. And the parasympathetic break is fight or flight is always immediately available.
And so this delayed onset is a little counterintuitive to anybody who's gotten cut off in traffic. And boom, heart rate goes up immediately. Flight, hopefully flight and not fight response.
Flight response safety reestablished. Obviously, the heart is still pounding. I get the slow kind of longer recovery.
But it was very interesting to me that the delayed onset. So I'm imagining the audience is also kind of where I was. So I'd love to talk just a little bit about that. About what. What we're seeing there versus what we've kind of learned over. Over the years and on this podcast as well.
[00:32:59] Speaker B: Yeah.
[00:33:00] Speaker C: So there's two pieces to this conversation.
[00:33:02] Speaker B: Yeah.
[00:33:04] Speaker C: First, if you're trying to internally.
[00:33:14] Speaker B: Make sense out of this information, knowing.
[00:33:16] Speaker C: That when someone cuts you off in traffic, you get an instant change.
[00:33:22] Speaker B: What.
[00:33:22] Speaker C: We'Ve learned is what happens the fastest is parasympathetic withdrawal.
So the fact that the parasympathetic gets cut in a startle response can automatically bring your heart rate up to the 100 range.
[00:33:38] Speaker A: Yeah.
[00:33:39] Speaker C: Because it's been withdrawn. That happens first.
And then sympathetic comes on board and takes it higher. Longer.
[00:33:48] Speaker B: Yeah.
[00:33:50] Speaker C: And so we do know now from the startle response and from other things.
[00:33:54] Speaker B: The first thing to occur is the parasympathetic withdrawal.
[00:33:57] Speaker C: And then the sympathetic comes on board, takes it higher, and keeps it going longer.
So you're right. Those changes do feel like they happen.
[00:34:07] Speaker B: Immediately, because they do.
[00:34:09] Speaker A: Yeah.
[00:34:10] Speaker C: But the parasympathetic withdrawal comes first, so sympathetic comes second, and then it sustains it for longer. So.
[00:34:16] Speaker A: So to be rough with the analogy, the. The parasympathetic withdraw is if you're in the fight response, it'll give you the good first three or four punches, and sympathetic is going to get you through the rest of the. The fight, so to speak, and keep. Keep giving you that energy to. To stay in those survival types of modes.
[00:34:37] Speaker C: Yep.
[00:34:38] Speaker B: Yeah.
[00:34:38] Speaker C: But I just want to remind people that the second part of the conversation is, as you learn more about this, you have to start appreciating the sympathetic nervous system and stop vilifying it.
[00:34:53] Speaker A: Yes.
[00:34:55] Speaker C: Because it's got an important job to do.
When you need to do something, you need the sympathetic nervous system to get it done.
There's certain. And if you want to digest something and if you want to move it through your body and all the way out and eliminate it in a reasonable time frame, so it's not painful to do so you need the sympathetic nervous system to do that. So.
[00:35:20] Speaker A: Or just stay alive, I think would also.
[00:35:23] Speaker C: Yeah.
Learning to appreciate that it takes both to be resilient and resilience is what you really want.
[00:35:34] Speaker A: Yeah.
[00:35:37] Speaker C: Until people come to peace with that internally, that their sympathetic nervous system is their friend and being able to engage it and disengagement as appropriate in order to be resilient, that's what you want.
And so when people say they want to be more parasympathetic, it's like, really? Do you know what that means?
I mean, do you like shutdown and freeze? Because that's the most parasympathetic you can be.
[00:36:02] Speaker A: Right.
[00:36:03] Speaker C: You don't want to be over either one of them.
[00:36:05] Speaker B: You.
[00:36:05] Speaker C: You want appropriate functioning to be resilient.
[00:36:09] Speaker A: Yeah.
[00:36:11] Speaker C: And so sooner or later you come to that realization that they're both your friend, you need to work with them and use them when it's appropriate to do so and be able to turn them off when it's appropriate to do so. Have. Yeah, so there's that piece of the conversation as well.
[00:36:29] Speaker B: So, yeah, that's how people got into thinking. LF and HF were readouts on parasympathetic and sympathetic functioning.
I keep in other places, other conversations with you, I've told them you only use the power spectrum to tell me about timing because it tells you what's driving the bus, so to speak, and what time frame it's occurring in.
So most people can relate to breath rate. So if you're breathing two times a minute, that's every 30 seconds.
So a hertz in the VLF range, like.03 is every 30 second occurrence. Only monks are breathing two breaths per minute. So typical breath rate's not going to take you there.
But to be in the LF range, which people who are coherent in resonant breathing are typically in the LF range. That'd be four breaths per minute, which is every 15 seconds to eight breaths a minute, which is every four seconds.
[00:37:36] Speaker C: So.
[00:37:40] Speaker B: While LF happens slower, it can't all be sympathetic because when you're coherent, resonant breathing, you're Engaging and disengaging the parasympathetic nervous system to get those nice oscillations. So we know that example alone disproves that LF is solely sympathetic.
[00:38:02] Speaker A: Yeah.
[00:38:02] Speaker B: You only need one example. That example alone proves that's not the case. Yeah.
And so in the HF rain, you're talking 10 breaths a minute per. To 20 breaths per minute. That's every six seconds to every three seconds.
I can prove that's not always parasympathetic just simply because of heart rate fragmentation.
Heart rate fragmentation typically shows up in the 0.25 Hz and above and frequently goes above 0.4, which is why a lot of the research points to the VHF range above 05 point.
Yeah, you can't, you cannot, with just the power spectrum number alone tell what's driving the bus.
[00:38:49] Speaker C: Period.
[00:38:50] Speaker B: Period.
You need more information?
I, you know, I deal with a lot of pots. People, upon standing, their power spectrum typically concentrates around the point where one.
Upon standing. Now, let's think. What if it's not breath rate? What happens around 0.1? Well, that would be the Myers waves associated with blood pressure.
So blood pressure is a logical response to be able to maintain brain perfusion when standing.
So it's all about what's driving the bus and what time frame it's operating in.
And depending on the scenario, the posture, the breathing rate, the health of the individual, I mean, all those things have to be taken into consideration. Yeah.
Yep. So that's, that's how we got into the mess of people interpreting power spectrum that way. But it's also how to appreciate. That's not all that's going on.
[00:39:54] Speaker A: Yeah.
[00:39:57] Speaker B: Yep. So the course did a really good job of explaining it and providing the graphics that make it perfectly clear. I really appreciated that part of it.
[00:40:05] Speaker A: Absolutely.
[00:40:08] Speaker B: Okay, so I mentioned before, and just.
[00:40:14] Speaker A: For our listeners out there, you will want to look at this. I, I'm assuming that, Stephanie, you're really good at describing things, but this is a very.
[00:40:25] Speaker B: This is intricate.
[00:40:26] Speaker A: Yeah, we're getting into it here. So. So you'll definitely want to get the PowerPoint, get, get on YouTube at some point for this.
[00:40:35] Speaker B: Yeah. And so this is covered in the first module of the course. Towards the end, when I go over the frequency domain.
Essay node. What is that?
It is the pacemaker portion of the heart.
And so it's not, you know, you've got the ventricles, you've got the different segments, four quadrants of the heart. It's not any of that.
All of those Things can be working at normally or abnormally.
The SA node is what determines how many milliseconds are between heartbeats.
And so SA node functioning requires cofactors to be present in order for it to be able to do its job.
So in addition to parasympathetic and sympathetic nervation that feeds information that determines how fast or slow it decides to be, you got to have cofactors like acetylcholine.
A lot of the people with chronic fatigue and pots that I work with are taking a drug called pyridostigmine to help them better utilize acetylcholine.
Because in some bodies, there's an issue with how that's handled. And so that's one of the drugs that commonly helps them because it helps process acetylcholine better. And that directly impacts how the SA node functions, whether you can use it or not. So acetylcholine is one of them.
You've got the epinephrine and the other things, but the part that really stands out in my work, you've heard me talk about it before.
Electrolytes.
[00:42:37] Speaker A: Mm.
[00:42:38] Speaker B: It's the. The gated channels that change the ions are sodium, potassium and calcium.
And those three can't work properly without magnesium.
And so while magnesium's not on this chart as being important for SA node functioning throughout the body, you can't maintain proper balance of those three without having the correct, correct amount of magnesium.
So the four big minerals, bulky minerals that are needed is sodium, potassium, calcium and magnesium.
And so in a highly stressed body, we've talked about this before, but I'm going to say it again. In a highly stressed body, you can chew through those minerals faster, much faster. In my body, it's three times faster than the recommended daily allowance.
I use a functional test called a hair tissue mineral analysis to dial it in to see what's the right amount I need at any given time so I can customize it for my body. Everybody's body's different, but the reason I point that out is these are bulky.
And so I have friends that brag about they take one multivitamin a day.
If you take one pill a day and it's a little multivitamin, minerals are way more bulky than that. One little pill isn't going to do it.
So typically, when you, you supplement minerals in a highly stressed body, you may be talking six to 12 capsules, they're that bulky.
So dialing it in and knowing for your performance level, for your stress level, for your life level, what's right for you can absolutely determine whether your heart can do what it needs to do, when it needs to do it or not, because it's completely contingent upon it. I'm going to hush and see what you have to say about the essay. Note.
[00:44:38] Speaker A: Oh, you know, I. There's so much good stuff here that I, I know you're going to walk us through with endorphins and ATP and all this good stuff.
[00:44:46] Speaker B: I'm gonna let you do that.
[00:44:50] Speaker A: It's your slide deck.
I. There, there is an interesting thing. Let's just throw this into pop culture right now is the electrolyte industry is exploding and I've, I've now heard a few people that I trust saying, be careful.
Be, be very, very careful.
If there is like, you know, and I'm not saying Stephanie White be careful because I know Stephanie White has done her homework and her assessments and has it dialed in.
But, but I think some people will hear Stephanie White say electrolytes and they see the super bowl ad for electrolytes and they go their grocery store now and I'm like, wow, there's a lot of salt on the aisle that, you know, we're in the U.S. we already eat a very high salt diet already.
I just, I'm curious about, you know, what, what you think about electrolyte supplementation because it seems, I'm not saying it's people don't need it. I'm also saying probably a lot of people are taking it that don't need it because they watch the super bowl ad and they think if their P is too dark, they need to buy something, which I don't think makes any scientific sense. Just drink more water. But I'm curious kind of your thoughts on this because.
Yeah. As you, as we kind of wade into this area.
Yeah.
[00:46:31] Speaker C: So the first big thing is.
[00:46:35] Speaker A: If.
[00:46:36] Speaker C: There'S any kidney health issues, you should not do any form of supplementation without your doctor's consent because if your body cannot eliminate these things effectively and they build up, bad things happen.
So I'm, I'm first of all assuming you've got good kidney function and if there is any excess, your kidneys are capable of eliminating it so that it doesn't cause a problem. If that statement is not True, you need Dr.
Approved supplementation choices because bad.
[00:47:11] Speaker B: Things will happen if you don't.
[00:47:14] Speaker C: But second, you're asking a person with pots.
And so in pots, I often have to teach people you don't need a sports electrolyte replacement that was designed to replace sweat. Yeah, that's not what we're doing in pots, we're trying to enhance blood volume.
And so what we need is a more medical strength solution, not a sweat replacement solution. So in the POTS population, salt intake, because we're not holding onto our blood volume correctly, we're using salt as a lever to help us resolve something that's not happening in our body right now.
So for POTS people, the recommendation is different from an athlete. Yeah, athletes trying to replace sweat. And so sweat is not as big a requirement. So the elementees and, you know, all the little sports supplements out there, I mean, you might talk 1 gram of salt maybe, or 500 milligrams of salt.
So you do have to be careful because depending on how your body's wired, some people are more sensitive than others, and just a little bit of salt leads to hypertension that they wouldn't otherwise have.
[00:48:45] Speaker A: You're right.
[00:48:47] Speaker C: And so knowing your body and taking other measurements like blood pressure to dial it in are going to be really important.
So there is not a one size fits all.
[00:48:59] Speaker B: Yes.
[00:49:01] Speaker C: And, you know, it's worth it to, to work with a medical provider or a really good functional health coach that has some tools at their disposal to dial it in for you specifically, because no one size fits all, period.
[00:49:16] Speaker A: Thank you for that. Thank you for that.
I guess my, my next nerdy thing here is.
So we're looking at this, you know, and, and again, you really need to go to YouTube at this point to, to see this beautiful slide, you know, or go reinforce what you're listening to now by taking the training, which we will also link to in the show notes, you know, so this is.
[00:49:42] Speaker B: I'd rather them hear an's explanation for the intricacies of this slide.
[00:49:46] Speaker A: Yes, but, but I'm interested. Like, this is how a cell responds to sympathetic and parasympathetic stimulation.
And boy, is it just a lot easier to say sympathetic and parasympathetic. But I think a lot of times we throw around those terms because we think the sympathetic is fight or flight and the parasympathetic is rest and digest. And I almost think we should just stop it.
[00:50:16] Speaker B: Oh, yes, I agree.
[00:50:17] Speaker A: Just doing so much misunderstanding by trying to simplify it, and here it is. And you know, so I'm, you know, this is going on. I'm assuming the SA node has many of these cells that this is working through.
[00:50:34] Speaker B: Oh, yeah.
[00:50:35] Speaker A: Where again, you got that sympathetic stimulation. And those action potentials down below too, are fascinating and above themselves, you know, so, you know, I just find, you know, you Bring in ATP, bring in the cmt. You know, all these juicy stuff that you and I nerd out about is all coming together in something that creates heart rate variability.
And wow, it's not just a one or zero, sympathetic or parasympathetic.
It's a, it is a lot. Do you have enough ATP?
You know, how's your, you know, f or nephrine? You know, do you have too much of that? And here's where the science comes into a beautiful slide. Like when he, as somebody who appreciates a good PowerPoint slide, this, this is one of the best I've ever seen of really understanding this at a whole different level.
[00:51:35] Speaker B: Level.
Absolutely, absolutely. It, it is an elegant dance.
And with aging, SA node functioning does become impaired.
Active measures can be taken to slow the decline, but the tissue can become fibrotic.
So anything that results in inflammation can speed up the degradation of SA node functioning.
Anything that impacts metabolism and ATP production can impact SA node functioning. And so health from a multidimensional perspective very much influences this. Absolutely.
And so it's really cool to see it all in one place. How many things have to come together for this to work effectively.
Right.
It's more than parasympathetic and sympathetic.
[00:52:39] Speaker A: Absolutely right. Yeah. But it's all supporting that at a, a larger level too. There's just so much complexity and things feeding into it, which is probably in some reason why we see nutrition, movement, sleep, you know, all the things that we know can improve heart rate variability for, for a lot of people coming into play all of a sudden that now we, you know, you see the, you know, I can't say that. Epinephrine coming in here, which, you know, there, there's the stress response too. And for you, you know, neuro nerds like me, I spent a year just geeking out about action potentials. Here we go here as well, is that again. And I'm going to let you take us here, my friend. But like that, the sympathetic chemicals and activations, you know, start the action potential and the vagal nerve then decreases that, and then there's a pattern that goes on here.
Like all action potential. It's a very, very, very quick process. And that's just going on again. We talk in hrv, we talk milliseconds, and here it is. And we bring in our friends calcium and potassium and all the good stuff as well.
[00:54:09] Speaker B: Yep, absolutely.
Absolutely. We've got our friends, the muscarinic receptors in there as well. All kinds of good stuff.
So, yeah, it's a delicate Dance. There's lots of co factors and it's more than just parasympathetic and sympathetic.
He also goes into the bare reflexes.
And so I mentioned before, you've got the Myers waves that happen at point one. And for anybody that's ever learned about resonance frequency, I did a episode with Matt earlier on resonance versus coherence. Yeah. You know, resonance is when you synchronize with the bare reflexes at about 0.1 Hz. Everybody's got a little bit of a difference, but it's generally around 0.1 hertz.
And what I think is super cool, you know, from the POTS research and the things that we're doing, the carotid body is sitting right there at that aortic branch with the baroreceptor right beside each other. I don't think that location is an accident.
The carotid body gets a readout of blood pH, CO2 and O2 levels. And it, along with the baroreflexes, is part of a closed loop system that influences what heart rate variability is doing at any given time.
So the fact that all of these are working together beautifully, it's not an accident.
It's really cool how it all comes together.
[00:55:48] Speaker A: Absolutely.
[00:55:50] Speaker B: And so he does do a good job of explaining the bar reflexes. And going into that, I'm not going to steal his thunder. He does it magnificently. But he does do a really good job of explaining bar reflex. Lexus. Yeah, it fits into all of this.
A lot of.
And so optimal HRV provides a morning readiness reading.
I.
One of the things Roland McCrady told me back in 2018 was among athletes, heart rate variability day to day is very stable.
But as soon as you get into chronic health issues, all bets are off.
[00:56:45] Speaker A: Yeah.
[00:56:48] Speaker B: The coefficient of variance of heart rate variability, one morning to the next, an athlete can be as little as 6%. That's what they shoot for. Six to eight.
In a person with chronic health issues, it can be 30 to 40%. There's a lot of variability.
And so athletes learn. I mean, they're used to being so religiously trained in specific ways.
[00:57:12] Speaker A: Yeah.
[00:57:13] Speaker B: They get down pat what their morning routine is so that they can take out all the variability.
When you're dealing with a layperson who's not used to that regime that they're used to, the lay person asks me when I'm doing a morning readiness reading or I'm doing a breathing reading, what kinds of things will influence the results or potentially throw them off.
And on goes into some of the Biggies, which is really helpful. So caffeine intake, some medications, or forgetting a dose of your medication.
Alcohol consumption, the time of the day.
Some people have heart rates in the morning versus the afternoon that are 15 to 20 beats different religiously. And depending on the person, mornings could be lower or higher than the afternoons.
Different people have different patterns for different reasons.
Exercise, you know, a reading taken right after strenuous exercise is going to be different than 12 hours after strenuous exercise. With adequate recovery food intake and the size of the meal and the composition of the meal. Yeah.
Can make a big difference. Water intake or lack of intake.
You know, adequate hydration makes a huge difference. Some people will say that's the number one thing that can increase heart rate variability the most is to be, you know, adequately sufficiently hydrated and your bladder stat. Bladder status.
Do you need to go to the bathroom?
I share that my morning is completely different whether or not I've had my first bowel movement or not, because I religiously have a bowel movement in the morning.
But if I take my reading before it and my stomach starts to grumble, you can totally see it. Hijack the signal.
[00:59:13] Speaker A: Yeah.
[00:59:14] Speaker B: When my belly grumbles.
And if you really want to have fun, start an HRV measurement before you sit on the toilet and have a bowel movement while you're measuring, you'll see an interesting pattern.
You will see a very interesting pattern.
[00:59:29] Speaker A: I'm sure you will.
[00:59:32] Speaker B: So, yeah, that impacts it. And by the way, everybody's brainwashed that the autonomic nervous system has two branches.
Nothing could be further from the truth. You got that whole enteric thing going on. And the enteric nervous system is the third branch, and they do interrelate. So what it's doing impacts what parasympathetic and sympathetic are doing, which is one of the reasons why you get that very unique path pattern if you were to measure it during that time frame.
So he does a good job of going over all the things that can throw a reading off.
Some people who teach heart rate, variable viability, biofeedback want to know what to recommend that their client do or not do before they come for a session.
And so he teaches it according to a research protocol run by a doctor. And so some of these recommendations are not appropriate for a education person without a medical background who's just got BCIA certification to make. We're not going to tell people withhold medications.
That's not going to happen. Right. But a lot of these things we might include and what we send to the client in advance and say, please before your session, take these things into consideration.
So he goes in terms of autonomic testing, which is like a head up tilt table tested, an autonomic clinic run by a doctor in those environments. It includes these kinds of things. 48 hours before, you're going to withhold a lot of the medications you usually take, like the anticholinergics, the sympathomic mimetics, the parasympathetic mimetics, the mineral corticoids, the diuretics.
Stop taking all Those if it's doctor supervised and recommended. 24 hours before.
Stop the alpha and beta antagonists 12 hours before. And so here's where a typical person teaching heart rate variability biofeedback might recommend these things. Avoid alcohol and analgesics the morning of. Don't wear confining clothing. No corset, no support stockings. Three hours before, withhold nicotine, coffee and food.
This doesn't say anything about exercise, but you're probably going to want to make an exercise recommendation and you're probably going to want to make a hydration recommendation to make sure they're adequately hydrated.
[01:02:07] Speaker C: So it goes back to the previous list.
[01:02:08] Speaker B: You're going to want to cover these, both these lists when you're making recommendations.
[01:02:12] Speaker C: Of what people do and don't do.
[01:02:14] Speaker B: Before they come for biofeedback training or other things. But he does a good job of.
[01:02:19] Speaker C: Reviewing all that and so it was nice to have it all in one place.
[01:02:23] Speaker B: Anything you want to add or, you.
[01:02:25] Speaker A: Know, I, I think it's interesting to think about this from a biofeedback perspective because, yeah, I, I hadn't kind of applied it to that because I, you know, I, what's in my head with a biofeedback is you go in, you work with a professional, you're hooked up, you're working your breath or your temperature, you know, all those factors together, you know, kind of, of whatever state you're into.
I do biofeedback, you know, and you and I do biofeedback several times throughout the day. And so I don't at least pay attention to any of this, you know, let's do it. So I still think that there's probably a good argument is no matter what you've done, it's good to regulate your state through biofeedback regardless.
However, I, I think, you know, so that, that's one part. The other part is this, I think with research plays a whole different role, especially if you're going to do a pre Post test sort of reading be really good to know. It also just says, you know, getting, whether it's during sleep, whether it's first thing in the morning, last thing at night, getting baseline data is going to be way more useful, you know, getting multiple data points than just one, you know, piece of this because this is a lot to go through for our people, you know, some folks to, to get a good reading. So I think biofeedback, I'd love to get your opinion could still be a useful intervention.
Whether or not, you know, right now I'm wearing, I love my compression socks. I wear them all the time. Where or not I'm wearing compression socks during biofeedback. Biofeedback still going to be a good thing for me to do. However for researchers or hey, I need to get an accurate RMSSD or high frequency assessment at resting normal breathing rate.
This is really 10 commandment level things to follow for that importance. And we do none of these during vital signs usually as well when we go into our physicians which all these could also impact that I would assume as well.
[01:04:43] Speaker C: Yeah.
[01:04:43] Speaker B: And I think another way this comes up is when you complete a session and you look at the data and they compare it to last week's data and they're like wow, yeah, why is today so different?
And then you kind of run through the mental checklist.
You know, did you just have a big meal? You know, you coming from the restaurant, have you drank? You know, you can ask those kinds of questions to help explain what can cause those big differences. Because people get frustrated.
[01:05:13] Speaker A: Yeah.
[01:05:13] Speaker B: When it doesn't feel like a predictable change and there's, you know, some of these things can be the reasons why unpredictable changes occur.
[01:05:23] Speaker A: I love that. Yes.
[01:05:24] Speaker B: And so it's, it's nice to know that these are the things that move the needle the most.
So.
[01:05:34] Speaker A: Yeah.
[01:05:36] Speaker B: Excellent class. Takes about five hours to complete. It's in three sections.
Section one's must CTV sections two and three are very optional.
By the time it gets to section three it's high level.
So don't feel bad if section three feels overwhelming or too technical because this pretty darn technical for me.
[01:05:59] Speaker A: Yeah. And I don't think as applicable to some people then, then the, the like you said the first ones you need to see it like if you're interested R and R conversation you got to see it. It does get pretty granular as you go forward. But for you HRV nerds out there, you know, I was in my sauna bag doing my sauna. It was perfect thing to watch because it was still really engaging at the same time. So. But like you said, if you're like, yeah, I'm interested enough in HRV to turn into this episode.
Yeah, just watch one and then if you want to go through the second two, do it.
[01:06:44] Speaker C: Yeah.
[01:06:46] Speaker B: He does go into point care plots. I am a huge fan of point care plots in my routine work. It helps me see where the anomalies are in my heart rate fragmentation work. You definitely see multiple clouds in the point care plot as a result of the fragmentation.
You know, he. He goes through different things that can happen from this work.
I looked at multi clouds and what.
[01:07:16] Speaker C: Other research has shown, interestingly enough, the.
[01:07:24] Speaker B: Sudden cardiac death and sudden infant death, the ones that have had the halter or the.
The EKG data leading up to it, the patterns are identical.
[01:07:39] Speaker A: Yeah.
[01:07:39] Speaker B: So there are signature patterns in the point care plot that have a high probability of an infant. Sudden infant death, and in cardiovascular disease, sudden cardiac death.
I find that work way super interesting.
[01:07:55] Speaker A: Yeah.
[01:07:57] Speaker B: And so he does go over some of those plots and how, you know, it goes from that beautiful ellipsis to something multi clouded. Yeah, he does talk about that. I do think that's interesting in that. That in a lot of neonatal units.
[01:08:15] Speaker C: They'Re putting the heart rate monitors built.
[01:08:17] Speaker B: Into the bed so that they do get alarms when things like that are happening.
[01:08:22] Speaker A: There's really no excuse not to do that.
I. I would assume that that's standard practice.
[01:08:30] Speaker B: Yeah.
[01:08:30] Speaker C: I mean, they've just had a lot.
[01:08:31] Speaker B: Of success with that.
[01:08:32] Speaker A: You want to see where heart rate variability is accepted best practice. It is. It is in that. That arena for sure. Tons of research there.
[01:08:42] Speaker B: Yep, yep, yep, yep. So that's. That's really amazing. And it's. It's interesting to listen to him elaborate on that.
Yeah. So that was my.
Those are the things that were the.
[01:08:55] Speaker C: Big things that I got out of it.
And it was fun comparing notes with Matt because he had indicated he'd gotten some things out of it too. So I thought it was worth sharing with this community because they're definitely interested in hrv.
And regardless where you learned about hrv.
[01:09:14] Speaker B: It'S fun hearing a cardiologist perspective.
[01:09:16] Speaker A: Yep. And I would say that was why I was so excited to do this episode, is there was a lot there that I think everything in many ways, especially course one, but really all the courses that I apply to how I think of this and some of it, like the essay node getting to the cellular level, was incredibly helpful and interesting with this. And I hope with our audience, you know, having two HRV nerds kind of process this will also help you process it as well because it is from a cardiologist perspective, which I think is great and needed for, you know, our audience to get that perspective. And hopefully this gives you a Lynn to kind of, kind of process it with us or know when you're going into it, sort of how we process it ahead of time as well. So I hope this has been as beneficial. Like I said, whether you stopped it, watched it, you know, you knew we were going to talk about it or you watch it afterwards, it's gonna, I think, give a great learning opportunity to dive deeper for folks.
[01:10:36] Speaker C: Absolutely.
[01:10:38] Speaker A: Well, Stephanie, it is always a pleasure, my friend.
Hey, you know, you've got a good friend when you can trigger each other and still have a great conversation with it. I my own excuse. I didn't know I was going to trigger you. You knew you were going to trigger me. So. So this. But this was just a joy and I helped me really integrate some of this of what I learned as well. I think I'm going to go just watch the vid the training over again just to deepen.
[01:11:08] Speaker C: I think I've watched it three times so far.
[01:11:11] Speaker A: Yeah, I mean it's really that especially again that first course, you know, I want to be able to present at the level he presents at and that that takes more than one watch for sure. So thank you so much, my friend. We will put show notes, links, links links both to Stephanie, her work as well as what we talked about
[email protected] thank you, Stephanie. Thanks for everybody and as always, we will see you soon.
[01:11:40] Speaker C: Thanks, Matt.
