What is it that makes our bodies stronger? Gives them greater longevity? Greater resilience to disease? Greater performance?

The strange answer to this is that often something that harms us, stresses us, is what ends up making us stronger. The process is known as “hormesis” and applies to pretty much everything we can think of. Low doses of all types of stressors can make us better by stimulating us to adapt – exercise, emotional stress, radiation, natural pesticides found in plants – also known as phytonutrients and so on.

When the dose is too high it proves to do the opposite – make us weaker. So it’s about balance – but how do we know when we get the “dose of stress” just right so that we get positive results?

Today’s guest, Todd Becker, runs the popular blog GettingStronger.org dedicated solely to the topic of experiments in using hormesis to improve HRV so we may improve our lives. Todd is a scientist from Silicon Valley working in biotech, and runs his own N=1 experiments with hormesis in a wide variety of areas from improving eyesight to improving estimated longevity and general health.

In particular he’s experimented with improving his baseline and temporary Heart Rate Variability, as a proxy for longevity, with a long list of activities, from the well researched to the more experimental. In this show he talks about the outcomes, what worked, what didn’t and the usefulness of tracking heart rate variability for general health and longevity.

The show notes, biomarkers, and links to the apps, devices and labs and everything else mentioned are below. Enjoy the show and let me know what you think in the comments!

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Show Notes

  • What got Todd started on his mission to experiment with hormesis – an experiment that reversed his myopia.
  • The hormesis framework, AKA the body as an adaptive system, with all the areas our health is modulated by hormesis.
  • Phytonutrients as natural pesticides, or toxins, and the work of Dr. Bruce Ames.
  • Can the gut microbiome also be improved via hormetic mechanisms involving probiotics?
  • The need for balance of the intensity of the stimulus given to your body to provide positive benefits.
  • Using lenses to stimulate growth in eye muscles, addressing myopia, sometimes in a matter of hours.
  • Why Todd sees the Heart Rate Variability biomarker as more useful than the majority of markers and chose it as the end result to aim for and measure.
  • A review of how heart variability works and illustrates our ability to adapt to stress.
  • The inverse relationship between the heart rate and heart rate variability markers.
  • The positive impact that cold showers can have on your HRV throughout the day.
  • How Todd increased his baseline HRV by 10 points over several months through eliminating a variety of lifestyle habits or modulating them.
  • Using fasting (also known as intermittent fasting) to increase your HRV.
  • The major factors Todd found that reduced HRV including alcohol, hot tubs and exercise.
  • Linking someone’s HRV to how they respond to emotional stressors and how additional stressors like alcohol can magnify emotional behaviors.
  • The amazing power of vacations to increase HRV, regardless of how you feel – food for thought before you skip that vacation this year.
  • Biomarkers Todd routinely tracks and finds useful to keep track of and his perspective on the value of tracking vs. anecdotal experience.
  • Todd’s and Damien’s benchmark values currently for HRV when well recovered or more stressed.

Connect with Todd on Twitter to thank him for the advice in this interview.
Click Here to let him know you enjoyed the show!

Todd Becker & Getting Stronger Blog

The Tracking

Biomarkers

  • Heart Rate Variability (HRV): Measures how your heart rate varies over time. Research studies link HRV to recovery status, stress and other aspects of human physiology. We have looked at HRV from a variety of perspectives in a number of episodes covering HRV.
  • Average Heart Rate (commonly referred to as heart rate): A high resting heart rate can be indicative of bad health, while a lower resting heart rate can be indicative of good health and fitness. Todd discusses how average heart rate often correlated negatively with heart rate variability.

The Tools

  • Cold Showers: Cold showers are a form of cold therapy that can be used at home to encourage the body to adapt. Todd’s experiments revealed that his HRV improved using these.
  • Intermittent Fasting / Fasting: Fasting involves fasting for several days typically, while intermittent fasting is based on a daily cycle. Standard approaches to intermittent fasting are 20 hour fasts, or 18 hour fasts.
  • Avoiding Alcohol: Alcohol effects HRV negatively so avoiding it or quitting it temporarily or permanently should enable you to improve your HRV.

Other People, Resources and Books

Full Interview Transcript

Transcript - Click Here to Read
[Damien Blenkinsopp]: Hi Todd, great to have you on The Quantified Body show. Thank you very much for having your time available today.

[Todd Becker]: It is great, I am happy to join you.

[Damien Blenkinsopp]: So you have got a very interesting site, which is pretty much very dedicated to the topic of hormesis, which is called getting stronger. Could you tell me particularly what prompted you to take an interest in hormesis and this topic when you first started out?

[Todd Becker]: Well, it wasn’t any one thing. I just noticed certain patterns in what made me healthier and it really came from a variety of different areas. I would say probably one of the most pivotal experiences was learning that I could improve my eyesight without glasses, and that was probably almost 15 years ago, and understanding that the eye can respond to stimuli and the vision can improve, very [inaudible 00:03:18] to the way that weightlifters gain muscular strength by going into the gym and training. And then I started to think about how that is try about so many aspects of physiology from the immune system, which benefits by being tested and exposed and I think autoimmune and immune problems come from an underactive immune system or an overactive immune system.

It is not trained properly, thinking about how calluses form on the feet when you walk barefoot and how when I started doing barefoot running rather than these cushy shoes providing benefit by cushioning me and protecting me or actually weakening me and by exposing my feet and my calves and knees and really the whole musculature to the shock that it was designed to withstand actually got stronger and less prone to injury and then thinking about how bones and the skeletal system responds and it really almost requires stress when astronauts go out into space and experience weightlessness. They rapidly lose bone density and it is hard for them to regain when they return, so really just starting to think about the body as an adaptive system and think about the factors that influence that.

Then I did some reading and I think for me it was just the concept that lies really at the nexus of all of those different adaptive phenomenon.

[Damien Blenkinsopp]: So how long have you been playing around with this idea?

[Todd Becker]: I think if you go back to the vision improvement idea that is 15 years and even before that I think another experience that led into this low carb dieting, which I first encountered in the mid 90s, I didn’t really realize at first that ketosis is a form of hormesis but what happened is I started to think about this framework and how much you can explain with it. And of course it doesn’t explain everything and it is certainly not the only factor in health but I think it is an important one and it has been overlooked so that is why i felt that there would be an intro in a blog that really focused on that concept.

[Damien Blenkinsopp]: Right, I like the way you put it. It is a nice framework to be able to look at things and I know you have done a bunch of your own experiments, so that is what I wanted to talk about. Before that, give people an idea of how broad this is. There are a whole number of topics you have looked at and referenced, like exercise you brought up, phytonutrients in plants, like some of the things that we thought had antioxidative and protective effects actually are working on a basis of hormesis as well. You talk about sunlight, radiation – have you looked at the topic of pesticides?

[Todd Becker]: A little bit. I would say that I guess when we talk about phytonutrients these are really natural pesticides if you think about it in this biological arms race where plants want to avoid being eaten and predators want to eat them. So they develop more and more effective toxins to scare you off but predators that are able to detoxify those natural pesticides get the spoils. So it is kind of this back and forth but as far as artificial pesticides there is probably some element that we know there has been a somewhat controversial analysis of dioxin which is highly toxic and actually has some hormetic benefits at low dose. So even artificial toxins can play that role.

[Damien Blenkinsopp]: Yeah, you are aware of the work of Dr. Bruce Ames?

[Todd Becker]: Yes, right, I think he was instrumental there and he certainly has been critical of modern toxicology and the sort of linear, no threshold concept that everything is toxic down to the tiniest measurable dose. Even though he developed some of the institutional tests, like the Ames tests that are used to look at mutogenicity or carcinogenicity, he is critical of over-extrapolating with those tests. But just for your listeners who don’t really understand the technical concept of hormesis it is really the idea that something that is damaging or toxic at higher doses can actually be beneficial at lower doses. At first that seems like a paradox but then you realize that evolution required us to survive in the face of all kinds of stresses including toxins and UV radiation and heat and cold and if we didn’t have some method of fending off those stresses either by adapting to them and defending ourselves against them or repairing ourselves or our DNA once we have been exposed, we would perish.

So I think most organisms have some hormetic mechanisms that allow them to adapt to harsh environments and survive. The key is what is that level? What is that sort of magic dose that gives you stimulating effect as opposed to the inhibitory or detrimental effect and it can vary quite a bit. I mean, some substances like alcohol, for example, show hormetic effects at much doses than some, say, metals that are considered much more highly toxic and only showed the [inaudible 00:08:18] effect at much lower doses. And there are a couple of researchers who really have done a lot of good work to kind of document the ranges in which different stresses are hormetic.

[Damien Blenkinsopp]: Yeah, it is very difficult to kind of assess where it is going to be overwhelming. I guess it is not what doesn’t kill you makes you stronger, it is more like what doesn’t overwhelm your system makes you stronger.

[Todd Becker]: Yeah, I think the other interesting thing is if you look at the work of people like Edward [inaudible 00:08:46] that these are the guys who are really documenting all of this [inaudible 00:08:51] sort of static type of hormesis where they will expose say a worm or a plant or a microbe or an animal to toxins and they will find that dose that is causing damage or disease and that dose that is causing a benefit. But what I am also interested in here is the idea that this can be a dynamic type of range that progressively you can become more and more tolerant by gradually exposing yourself to increasing stresses. of course there is always a limit and you can only tolerate so much radiation or UV or exercise or cold and there is a limit. But i think you would be surprised at what that range might be.

[Damien Blenkinsopp]: All right, so going back to your analogy of strength training because I think most people understand strength training and that you are not going to walk in and lift 100 kg the first time, but if you start at 50 kg or whatever as your level, after a couple of weeks you work up to 60 kg and after some recovery you kind of go through this process. You can eventually move up to that 100 and you can say it is very similar and you have an ability to kind of get stronger across all of these different stressors and deal with all of them. Is that the way you look at it?

[Todd Becker]: Exactly. I think that the principle is the same, the details are different in each case. And you hit on I think a key principle of doing this [inaudible 00:10:13], which is gradulous. A lot of people jump in too quickly, have a negative experience, and conclude that they can’t do it. I think a classic example is exposure to cold. After initial, awful exposure people say, ‘I could never do that.’ Or fasting is another good example. Some people try to just jump in and skip meals all day and they will get ravenously hungry or have hypoglycemia and they will conclude that they are incapable of it, not realizing that if you had built up to it gradually you can adapt. So I think that is a key aspect there.

The other thing which you touched on a little bit is rest and intermittency. Weight lifters go in and they will lift heavy weights but they are essentially causing microtrauma or tears to their muscle fibers and they have to allow for the damage to be repaired. And this is true in any kind of overtraining where you are running anything. If you don’t allow that period of recovery you are not going to get the benefit. So I think gradualism and then a progressive increasing and allowing adequate rest and repair, I think these are probably the factors that people overlook and leave them to conclude that this doesn’t really work.

[Damien Blenkinsopp]: Yeah, that reminds me of one of my buddies at University who used to come with us to the gym once every three months and he would hit it really, really hard and he would go home and he would feel horrible for three days and be in so much pain and he wouldn’t come for another three months. You would never get anywhere of course, doing that, and he would be through a lot of pain. So that was a nice analogy. That is not the way to go about getting stronger as the theme of your blog. It is really to take it gradually, as you say, with all of these things.

So what are the mechanics behind how this works? Do we have any ideas about it or is the science very vague at the moment still?

[Todd Becker]: I think you can cluster these things into a few different categories. One is physical changes to tissue, so the example of building muscle. You stimulate – you apply physical stress and cause some damage or change and then allow the tissue to remodel. The same thing is true with bone that you apply to stress. And part of it is directly within the tissue, part of it is the nervous system, part of it is stimulation of hormones, growth hormones, but there is response. Another really interesting example is vision improvement and particularly reversing myopia.

This is a very interesting stressor where by incremental defocus and by causing a slight blur, you actually induce differential growth in the scleral tissue of the eye by stimulating neuromodulators that actually grow differentially and cause the eye to change shape. It happens very gradually over many, many cycles, but there have been experiments in chicks and chimpanzees and then most recently in humans, that fitting people with concave or convex lenses, plus or minus lenses, induce these changes in growth literally within a matter of minutes and hours.

So there are these physical stressors – calluses are another example of a physical stressor that causes growth factors to build up the tissue. So that is one type of hormesis. Then I think there are metabolic processes – for example, real shifts in nutrient balance, for example ketosis, deprivation of carbohydrate and sugar, causes a shift in expression levels of different lipases that causes a reduction in insulin and causes hormonal shifts that actually up-regulate the ability to digest fats. And again, this is a process that might happen over weeks. So there are kind of different time scales.

[Damien Blenkinsopp]: Yeah, just to jump in there – it can be different according to the person where they are starting from, the condition of their body and potentially even their genetics, as to how quickly your – if their ability is to adapt to them.

[Todd Becker]: Certainly – let’s take another example as the tanning of skin. Some people can readily respond by producing the melanin that allows them to tolerate UV and get a suntan and is actually protected. Others, probably some of your buddies from the northern part of the UK may have very fair skin or reddish hair and don’t have quite that same ability. Metabolically some people can induce lactates that allows them to digest milk very rapidly. Others have very low or little ability to [inaudible 00:14:41] significant genetic variation there.

[Damien Blenkinsopp]: Yeah, and here increasingly we have got this biosis when people have problems with their gut, which is pretty common these days. I don’t know if you know a guy called [Chris Cressor 00:14:52]?

[Todd Becker]: Sure.

[Damien Blenkinsopp]: He talks now about using probiotics like kefir but in very small doses to start with, otherwise it kind of overwhelms the gut microbiome. So it seems like he is using some similar principle to hormesis there and with his patients or people who have problems. It has to start very, very small but eventually it gets to a large extent where the gut is able to digest and use it afterwards.

[Todd Becker]: And really that is a good example that sort of also follows the model of what is called oral immunotherapy. It used to be thought that people who had, for example, severe peanut allergies just that there was no hope. They had to take immunosuppressant drugs for the rest of their life and children who were vulnerable to this just had to stay away from even the slightest dust from peanuts in the air. But then there was some really good research that showed that very gradually reintroducing an allergen like peanut under the tongue in extremely minute amounts allowed the immune system to learn to tolerate it to the point where there was no problem anymore. I think that is another good example of that gradual exposure.

[Damien Blenkinsopp]: That is an interesting one because that is where the immune system is overactive in response to a stressor. And then you are teaching it to just be balanced. So it is kind of a slightly different twist to it.

[Todd Becker]: Yeah, well we are talking about allergies and autoimmune disease and I think it is very relevant to point out this recent book that I got very excited about called An Epidemic of Absence by Moises Velasquez-Manoff, and he really updated the hygiene hypothesis, which a lot of people are familiar with which basically holds that allergy and autoimmune disease that has become prevalent in the western world ever since we have instituted a lot of hygiene measures and cleanliness and since people have moved off of farms and paradoxically we have conquered infection, but allergy and autoimmune have gone up. And the idea is that somehow we are not getting exposed to allergens.

But what Manoff does in his book is how is this in terms of the what is called the old friends hypothesis and the idea is that we co-evolved with [inaudible 00:17:07] organisms in our gut, parasites that we lived with basically for evolutionary reasons to outsource some of the functions of our immune systems to those organisms. And that sort of took some of the work away that our own immune systems have to do. But now that we have pretty much banished them through better hygiene we don’t have parasites anymore, our diets have changed so that the microbiome in our guts – we wash ourselves and we don’t have the benefit of the service that they were providing.

So all we are left with is an undertrained immune system with the sort of reserve or the emergency system, the IGV system that just goes crazy whenever it has the slightest insult, and so the idea is let’s reintroduce some of the old friends. But what is particularly interesting in the book is he goes through one autoimmune or allergy disorder after another and shows that there is sort of a critical period in infancy or childhood where if you don’t get that exposure you are prone to these autoimmune disorders.

[Damien Blenkinsopp]: So that is the idea of balance again. It keeps going back to this balance and this is why I wanted you to come on and talk about this, because you have actually tried to identify balance for hormesis using heart rate variability. In my own experience, I have had back injuries and I have had various things where you want to get stronger, you want to recover, and you understand that this concept of hormesis can help you, as you pointed out with your eyesight, right?

But if you push it too far you potentially go backwards rather than forwards. It is the same as like my friend from the university who is going to the gym and pushing it too far and is actually going backwards instead of forwards. And in my training over the years, experimenting with different things, I have often done that as well and figured out that I needed more recovery and I didn’t have this balance.

I have eventually come back to trust numbers. So I thought it was interesting that you were using heart rate variability to look at a little bit and understand if the hormetic effect was having a positive impact or not.

[Todd Becker]: Sure. Now, I know you are a big biomarker guy and you like numbers and I am a little bit more cautious about that. I would certainly like there to be a magic number that I could follow. I have done a little bit of experimentation with a glucose meter, which kind of helped me understand how I responded to diet and exercise in terms of glucose. And I found it a little bit useful but also potentially misleading. I have friends who are sort of in the quantified self movement who measure just about everything and kind of I think go overboard with it But one thing I have seen is that it is very hard to take a single number in isolation because there are always exceptions or what you might be looking at is not a cause but a consequence, so it is difficult.

I stumbled on heart rate variability and what i like about it is it is not just some random measurement of some intermediate metabolite in your body which may reflect oxidation or inflammation but who is to say what the right level is. In the case of heart rate variability you are actually measuring something very close to real function and what I found before finding HRV is to try as much as possible to look at functional measures of strength or performance.

[Damien Blenkinsopp]: Sure, could you give an example?

[Todd Becker]: So the vision is pretty easy, right? You can read a Snellen chart and see when you lift weights and you know how much weight you are lifting. So when you run you can use speed, right? These are very objective things but what I like about HRV, so what do you do in terms of just overall metabolic health? Is there something that sums it up?

[Damien Blenkinsopp]: Why don’t you just take a step back there and clarify? When you were talking about the running and the speed and if it is improving then when you are doing is having a good, positive hormetic effect, right? But if it is going backwards, if you are taking longer times, then you know that you are going backwards – just to clarify for the audience.

[Todd Becker]: Exactly, and there is no question. If you are overtraining and you are running slower, then okay.

[Damien Blenkinsopp]: Right, if you are lifting less weight, which happened to me with many of my experiments back in the days, I would be basically lifting less and you are like, ‘Okay, something is not going right here.’

[Todd Becker]: Right, so if you would like to find something like that for just overall metabolic health, that is a harder one. Maybe you feel good but subjective feelings may not be the whole thing. So what I like about HRV, heart rate variability, is I think it is sometimes not fully understood, what it is. What it is essentially is the variation in the heart beat. You can have a low heart rate but if the heart rate is getting exactly once per second that has got no variability, right?

So why is variability a good thing? And apparently it is. Apparently people who are very fit have a higher heart rate variability, which means there is more variation. Sometimes their heart will be 1.05 seconds and then 0.9 and then 1.03 and then 0.85 and then you look at the standard deviation of that or some transformation of that and the more variation beat to beat there is the better it is. But you would think, why is that good? Because we know of arrhythmias as being signs of pathology and certainly at some level they are.

[Damien Blenkinsopp]: Could you just – what is an arrhythmia?

[Todd Becker]: An arrhythmia would be not having an exactly precise regular beat, having some irregularity to it. And there is different deviations from the regular. So the question is why is it good to have this variability and I was kind of searching for this but I read this book, an older book by James Gleek, called Chaos. It was written in the 80s that in chaos really describes what are called non-linear systems which underlie a lot of what is going on in biology or in the brain and in society.

There are a lot of effects that aren’t just additive but interact with each other in very complex ways. So he had this insight, which is basically non-linear processes are necessary for homeostasis, the ability to handle a stress or a deviation, and come back into control. If you have a linear system and you give it a slight nudge, you cause some [inaudible 00:23:27] to it and it tends to go off course and stay off course. In non-linear systems they have all these interactive components and if you give it a nudge it tends to return to a center, what they call an attractor in mathematical terms. In biological terms, if you have a fever your body acts to cool yourself. If your blood pH drifts there is something that pulls it back. If you eat a big meal and your blood glucose gets too high, the insulin turns on and brings it back within range. So there are these feedback systems that tend to bring you back to center.

So what is interesting is that you have got these two systems which work in cooperation – the parasympathetic and the sympathetic nervous system. And the parasympathetic system is generally the one that kind of calms you down and gives you this resilience where sympathetic is the fight or flight which you need to energize yourself but if it goes too strong it can cause stress, high cortisol and eventually the parasympathetic system has to bring you back down to normal after you have met the stressor, some type of event that you have to deal with. Now, if you are adaptive you can switch between these two systems readily and the key one is the parasympathetic one because the sympathetic one tends to drive, just very strongly and calming down and bring – changing your ability to go at full strength and then slower and adapt to the day is really an adaptive strength. If you look at people who are older and have Parkinson’s and walk very stiff or rigid and you measure their gait or their heart rate it is very regular, very stiff. It doesn’t deviate. If you surprise them, shock them, ask them to suddenly run or something, they have great difficulty shifting into that higher gear and people who are stressed out likewise have great difficulty turning down the stress and shifting. So it is a sign of health to be able to shift gears quickly and be adaptive. And essentially that is what HRV is measuring.

If your heart rate naturally can sort of move around to these different frequencies then it can quickly tune into the faster one or the slower one and it can move quickly. If it is locked into a steady beat it is just harder for it to change and I think this manifests itself in a lot of ways.

[Damien Blenkinsopp]: So you see it as a measure of your ability to adapt to stressors, which is actually similar to some of the other discussions we have had. I don’t know if you have tried this but if you looked at your HRV when you are lying down versus standing up. So in our first episode Andrew Flatt was talking about how standing up is a slight stressor. So you can see how it impacts the HRV and you have a slightly different score and you are basically applying a very, very slight stressor to yourself just by standing.

[Todd Becker]: Yeah, and people even look at how quickly can your HRV when you stand or sit come back to equilibrium. That is sort of a secondary measure and athletes who can run and then sit down and bring their heart rate down quickly are typically the ones who are fit. But if you look at disease states, cardiovascular problems, cancer, infections, these show up very quickly in reduced HRV and it is kind of almost a leading indicator of a problem so it is has even been introduced diagnostically and i think it is pretty powerful. And I find that is useful because we are all individuals as a tool for self-discovery. You can find out what tends to drive your HRV up or down and I learned a lot of things that I was very surprised about myself.

[Damien Blenkinsopp]: Yeah, and like you I have been fascinated by this measure and if you read around it is really applicable to so many useful things as well. I have seen people applying it to willpower and there are studies on willpower and of course we all want more willpower. There are a whole range of uses for this but what have you specifically applied it to and found that was most interesting?

[Todd Becker]: Well, I tried a lot of things relating to exercise and found some of the normal things that athletes find which is that when you work out very intensely it drives the HRV down and it takes a while to come back up. And when it is back up you are rested and ready to go, and that is what everybody knows. But then I just tried different foods and definitely noticed a big effect except the one thing I did notice is that I practice intermittent fasting which means that I eat one or two meals in a part of the day, typically dinner or lunch and dinner, and fast a lot of the rest of the day. And I found that well into the fast my HRV would tend to go up and then after a meal it would go down. So that was kind of interesting.

[Damien Blenkinsopp]: Did you notice an increase in your base line? If we talk about the daily – the specific time you are doing the experiment versus changes which tend to be longer-term?

[Todd Becker]: Oh yes, I definitely have noticed that. So let me get to that after and I will tell you a few specific ones and then I will get into the baseline. So that was a big one and the other really big one which really surprised me is cold showers. So i thought I am going to get in the cold shower and see what happens and I am sure what will happen is my heart rate will go up, which typically means my HRV will go down because it is not precise, but they tend to be inversely correlated, right?

, I am somewhat adapted to the cold showers and I have been doing that for several years. I get in the shower and actually measure it while I am in the shower and my heart rate goes down and my HRV goes up. And I get out of the shower and it has gone up by ten points. And that is kind of the average, it goes up by ten points literally within 3 to 5 minutes and it stays high the whole day, which also corresponds to my subjective feeling that cold showers are a real mood elevator for me, unlike caffeine or sugar or whatever, which is just kind of a quick thing and then it fades. I do that and then I am good for the whole day and it is consistent and it is a big effect. So that was a big positive effect. So fasting and cold showers are kind of the two things that really drive it up.

[Damien Blenkinsopp]: So the cold there is a cold exposure, basically, so it is a minor cold – ?

[Todd Becker]: Yes, cold exposure. So I get in a pretty cold shower and I am in there for several minutes. I used to, when I started that, I would shiver quite a bit. But that only lasts a little bit.

[Damien Blenkinsopp]: So, that’s a pretty cold shower?

[Todd Becker]: Yeah, and I do ocean swimming and things like that which is really fun. But then I found some negatives and of course I found that if I worked out really intensely, I could drive my HRV down really low, which worried me. But it would come back as hot tubs that are really hot that would also drive it down. The other thing that would really drive it down was alcohol. Usually it would be maybe two or three drinks and one drink didn’t have much effect but two or three drinks would really drive it down.

[Damien Blenkinsopp]: Is this like for a few hours, say for the rest of the day?

[Todd Becker]: A few hours or the evening. And then I thought about this and this was really interesting. I thought, wow. The cold showers surprised me because I thought that was definitely going to get my heart rate up and it didn’t. And alcohol, that will make me relax so my heart rate will slow and my HRV will go up, right? No. My heart rate goes up and basically the body is trying to deal with the alcohol. It is a depressant so it is trying to fight that and you are impairing yourself and I think this was a real insight because what is HRV? It is your resilience, your ability to take on the next stress and you may think that if you have had a few beers that you can handle things but actually you handle them a lot more poorly. Driving, of course, is an example but your judgement goes way down.

[Damien Blenkinsopp]: Yeah, that is very interesting. You see a lot of fights with alcohol, for example. And that is because people are not able to adapt to them and they are overreacting and not able to deal with emotional stressors around them.

[Todd Becker]: Yeah, the adjustment goes way off. So basically these things that are kind of relaxing can impair HRV and then things that are stimulating, the cold shower or fasting, which also tends to sharpen your focus and help the HRV. Then the other effect is – these are the immediate effects.

[Damien Blenkinsopp]: So just going back to the heat exposure, I do saunas, infrared saunas, and I have been doing that daily for the heat shock protein benefits, amongst others. I don’t know if you have done that and unfortunately I am going to have to track the HRV specifically around that and I am going to have to start doing that to see what happens. Do you think that would be similar to the hot bath?

[Todd Becker]: I think so, but here is the other half of the story because these are the immediate effects, right? The things that you notice within hours or minutes, but then you have got to look at the compensatory effect of what happens later. So for example exercise obviously impairs your fitness temporarily but you wouldn’t do it if – one of the reasons you do it is to become stronger and get fitter. So you do it and then the next day your HRV is actually a little bit higher. It may take two days or whatever the recovery period is so there is almost this ratcheting effect where you temporarily drive it down and then it kind of comes back up to an even higher level and I think that is pretty interesting. So the question is which things work that way and which things are just direct? So the cold showers brings the HRV up and then I don’t see a fading of that. Exercise I see it going down and then it comes up stronger and I think hot tubs and saunas are a little that way where it drives it down, but I think it actually can improve.

[Damien Blenkinsopp]: Do you think this could be in relation to the way your body perceives the intensity of the stressor? Maybe heat is a larger stressor than cold so your cold shower just happens that it is at the right balance?

[Todd Becker]: It may be and also heat on some level relaxing and another level is a stressor, so it may be the degree. And it is similar with alcohol. Moderate alcohol didn’t have the same effect as –

[Damien Blenkinsopp]: Yeah, so if you had like a tiny sip of alcohol potentially your HRV could have risen a little bit?

[Todd Becker]: A little bit more. So let’s go to the baseline question. So I have actually increased my baseline HRV over a couple of months significantly and there is a lot of noise and fluctuation if you look at my graft but what I did is I am careful not to overtrain and I noticed that can really set me back. Then with alcohol I have realized that one or two drinks, I feel the buzz. It is social, it is fine. And I really cut myself off there and I drink less. And that has really helped the HRV come up quite a bit. So I am just kind of paying attention to the things that really set me back and that is probably the main change and then it has come up about ten points.

[Damien Blenkinsopp]: Yeah, so I mean it is important to point out also that as you age it gets lower, so that is another reason you kind of want the baseline to be going up rather than going down. As you said earlier it is an indicator of general health but as age also so you could say biological aging. So I have noticed with intermittent fasting that is the one where I have been looking at it the most and I have done – I did one month on intermittent fasting and then two weeks off and then back to intermittent fasting again. and I am about ten points higher pretty much every day. It takes a little bit, a little while to climb back up to where it was if I stop intermittent fasting. But after about a week it tends to be about ten points higher than when I am not intermittent fasting, so that is about three months of data so far. But for me it seems – and I feel, of course – I mean, a lot of people talk about the benefits of intermittent fasting but I feel much better and much more energy throughout the day and so on.

[Todd Becker]: One thing I did that really drove it up and of course you can’t do this all the time, I took a vacation. And it went way up. Obviously, that was useful.

[Damien Blenkinsopp]: Yeah, that is a really important point you bring out here because especially you are from the US and very well known for having not taken any holiday or you have your standard two weeks, I believe, in the US?

[Todd Becker]: Right.

[Damien Blenkinsopp]: But of course, many people work in corporate and if they are not taking their holidays at all. You see a big increase in HRV like that and that is a really big sign that you are probably really overdoing it and you need to emphasize more some time out. I don’t know if you thought of it that way, when you saw those numbers, maybe I should do this more often?

[Todd Becker]: Sure, I tend to lead a life that even though it is busy I don’t feel stressed out and I really feel in balance. So I wasn’t feeling overworked but of course maybe I was fooling myself.

[Damien Blenkinsopp]: I mean, this is the beauty of trying to quantify stuff because I will give you an example. My dad, he is a workaholic and he always has been. And so he doesn’t – when he goes on holiday he falls asleep. And my impression is that he is highly strung. So he is working and I feel the same way when I am working and I have often had the case where I am working hard and then I will take a holiday and I will get sick when I am on holiday. And it is kind of like your body is just trying to manage the day to day and why you are stressed is just dealing with it. But as soon as it has an opportunity to let go. It would be like okay, you can recover now and I can be a bit sick.

[Todd Becker]: Isn’t that true? That is a common effect, you finish your exams and you come home and you get a flip, right? But my vacations tend to be somewhat active with cycling, body surfing, running, and so I wasn’t just sitting on the couch all day either but I was really enjoying myself and that was the key.

[Damien Blenkinsopp]: Great, some great insights there. Have you found any other areas with HRV as being useful besides these we have already spoken about?

[Todd Becker]: There is Dave Asprey who has written something and he has a little company and an app he has created to use HRV to detect food sensitivities.

[Damien Blenkinsopp]: Yes, they are actually using heart rate. We actually had Rhonda Collier on the last episode. She is the CEO of Sweetwater, who is behind that app.

[Todd Becker]: Exactly.

[Damien Blenkinsopp]: That one is based on pulse rate but she does some very interesting stuff on the stress side, splitting out the frequencies. And I haven’t played around with the app a lot on the stress side, but I think you have to get into it quite a bit to find some benefits. She certainly has over time, but she has been using it for a very long time.

So coming back to the whole hormesis side, I don’t know if there are any other biomarkers besides HRV? You have mentioned the difficulties of trying to assess, basically saying how much oxidative stress do you need versus not? It is very hard to say what is going to be beneficial versus what is going to be overwhelming for your body, which is why you are looking at the endpoint, the end result?

[Todd Becker]: Yeah, the functional endpoint and what really matters in terms of performance.

[Damien Blenkinsopp]: So obviously you brought up some others which are more specific to whatever you are doing, how fast you are running and so on. Is there anything else you have come across that you have found useful for looking at hormesis and how to balance it?

[Todd Becker]: Not in terms of quantitative measures. I think in this discussion we have really focused a lot on the physical side of hormesis but I think it applies quite well also to psychology and to sort of the spiritual side of health because really what is stress? There are physical stresses but what we are really talking about is your reaction to events, right? And so how you handle stress I think is very important to health and there is this concept out there that we are overstressed, that modern life causes not just physical but psychological ailments because of too much stress.

I think what they are talking about there is chronic, repetitive, daily stress that we are not handling well but I think the underappreciated side of stress is that we need it and particularly we need it at certain frequency and certain natural contexts and we need intense stress. Our body, we evolved to be able to handle it and if we protect yourself from psychological stress we actually become more vulnerable to it. I think that exposing yourself to intense physical exercise actually makes you more psychologically resilient but I think it is also important to confront fears, anxieties, and push yourself to higher levels and also to become comfortable with discomfort just in general. In fact, it is even sort of a psychological benefit to things like cold showers and that you are throwing yourself into what you perceive to be an intensely uncontrollable, disagreeable situation and you are pushing through it and you develop more resilience to it.

[Damien Blenkinsopp]: Right, because you talked about this on your blog and I started doing the cold showers, as I mentioned to you. And you say that you are tensing your muscles and you are psychologically preparing yourself for it and it is quite a horrible shock when you start but later on you start really noticing it. I mean, I found this after a few weeks or something and I guess that is what you found over time. Do you still find that you react a little bit to the shock of the cold?

[Todd Becker]: Yeah, and it is less and less. And there is this theory called the component process theory of emotion that Solomon and others sort of pioneered and Solomon was looking at – he was trying to explain addiction and also thrill seeking and he said these are really sort of the opposite sides of the point. A thrill seeker is somebody who does skydiving and the first time they do it they are confronted with this intense, paralyzing fear. It is uncomfortable. But when they land there is this euphoric afterglow that tends to last for a lot of the day. But the more they do it the event itself becomes less and less uncomfortable and the afterglow effect becomes stronger and stronger so it becomes pleasurable.

Cold showers, it is a little bit like that. Exercise can be like that. And you said it is the flip side of addiction. In addiction people pursue a direct pleasure, whether it is alcohol, drugs, sex, gambling – whatever it is, it gets their dopamine going right away. But then when they stop it there is this down or withdrawal. So this is the reverse to where the more they do it they become tolerant to the pleasure and it is less fun but the down becomes greater, so they get into this addictive cycle because they just need to do the addictive activity just to get back to normal.

So exposing yourself to hormetic stress is kind of the opposite of addiction and what I find is that it makes you more resilient to just daily stressors, arguments and things that come up at work and it increases what I call my background level of pleasure. I mean, I am just basically always happy and things don’t throw me off or blow me out and I think it is because by forcing yourself to expose to these intense stresses, you develop this resilience. It is something that has kind of gone away from the kind of lives that people, pioneers who lived away from civilization, had to face these natural stressors – the weather, hardship, lack of food, moving around. And the fact that we are more protective and that we live in an environment that is so regulated from stress I think we failed to develop this resilience. And so by engaging in some of these activities I think you get an enormous psychological benefit in addition to the purely physical.

[Damien Blenkinsopp]: Right, so that is a great overview. Basically the way you are using hormesis is if you can do this in lots of different aspects of your life then they are all kind of tied into your organism and HRV is like an endpoint measure which is global, so it is useful because it is like if my HRV is higher today I am going to be more resilient to emotional stress. No matter what it is if I have to be motivated to do something or take on a new challenging task like if I got higher HRV some days then it is probably going to be an easier day to start something new.

I have been looking at that a bit because I have heard about this, but I don’t know if you have – when you notice that your HRV is high if you find it easier to start more challenging tasks or take on conflicts or these kind of more mental challenges and I don’t know if you have noticed anything about that?

[Todd Becker]: Definitely, and I think that is the case.

[Damien Blenkinsopp]: Great, so what you are doing in terms of your routine and where you use biomarkers or you don’t, you have already talked a little bit about where you have seen them be useful or not, but on a week-to-week basis what kind of things are you tracking in your life?

[Todd Becker]: Quantitative things?

[Damien Blenkinsopp]: Right, whether it be HRV – what is kind of your routine for using any type of data about your health?

[Todd Becker]: I would love for there to be an app that really gave me information that I found useful and used all the time. And I understand companies like Apple are kind of moving into that space. And there are a lot of devices out there. So I am always interested in them but I just haven’t been convinced in their utility. And I am also a little bit hesitant to become too tied to tracking. I want to be much more tuned to my actual experience and try to find ways to use that as much as possible. I am a bit of an advocate also of simple finds, like relying as little as possible on external things, whether they be glasses or supplements or devices so that I can be fully present.

But if I can find a few things to track and if they are pretty robust I will go for them. So HRV is probably – I mean, I was experimenting with a glucose monitor and that was helping a little bit but I didn’t find it necessarily reliable. So the HRV is maybe the closest I have found so far, although I don’t know if I am at a level where I fully trust it yet. So I don’t know if there is any you find particularly useful?

[Damien Blenkinsopp]: Yeah, I track a lot of stuff and I kind of bring new ones in and then throw them out as they become inconvenient. Also one of the biggest challenges I think right now is the convenience. If we had a watch or some device which tracked everything accurately in the background it would be really easy to have interesting data. But on the HRV I use the averages, seven-day rolling averages, because it does go up a little bit and down. There is a little bit of variance in it and also just in the way you are measuring it you can introduce little differences based on emotional stress and other aspects so you have to watch out a little bit for that. So I find that I am really watching more closely the seven-day rolling average.

[Todd Becker]: I tend to agree. I think the weekly average is just about right and that seems to correspond to something that I see as a real shift.

[Damien Blenkinsopp]: Yeah, and I feel remarkably different when I am ten points higher on that average, so that is what I am trying to do, get it as high as possible. So just out of interest, I don’t know if you are lying down or you are standing up, what HRV score are you?

[Todd Becker]: Yeah, so I do it sitting and I am using the RMSSD, the natural log times 20, so on that scale I am typically in the range of in the morning 70 to 80. And on really good days I have actually hit 90, which doesn’t happen very often. And on sort of off days I might be in the 60s. But I would say kind of typically bouncing around between 70 and 80.

[Damien Blenkinsopp]: Right, you are a bit better than me. don’t get up to the 90s. My high is at the 80s. I am normally between 70 and 80 when I am intermittent fasting. Otherwise I can be between 60 and 75, maybe a little bit lower at 60 to 70 and it will go as low as the 50s on bad days. But I am actually dealing with some health issues so I think that is responsible for that mess.

[Todd Becker]: Certainly. I wouldn’t consider myself an athlete, I would just sort of consider myself generally fit for being 58 years old. So to me as long as it is sort of in that range I am happy and as an indicator that it is sort of a warning sign if it were to plunge, I start to look into it.

[Damien Blenkinsopp]: When mine plunges I take the day off. I have had some really crazy crashes and sometimes I don’t know what is going on and you have got a virus or something. I got a crazy flu virus from my nephew just recently and it took me out for a week. But I knew about it the day it was hitting because of the HRV. Even if I felt not so bad in the morning, the HRV showed it beforehand.

[Todd Becker]: Yeah, I think you’re right – fatigue, infection, and it picks those things up right away. And intoxication.

[Damien Blenkinsopp]: Alcoholic intoxication. Well Todd, thank you so much for your insights today about hormesis, which is really very a broad and interesting framework to look at all sorts of things we could be doing to improve our bodies in terms of performance and so on, and your experience with HRV has been very interesting to hear.

[Todd Becker]: Well, I have enjoyed talking to you. Thanks for the opportunity.


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In the first episode of The Quantified Body, we looked at the biometric of Heart Rate Variability or HRV and how to apply it to optimize training and workouts.

HRV has also been researched in other contexts such as stress management, general health, motivation, and willpower, where it can help you make decisions about how to improve these areas and identify what’s working for you – and what is not. So we’re going to continue to look at its use in these different contexts and the research behind it.

Today we’re looking at managing stress with heart rate variability and general health management, also our guest heads up the company which is currently leading the way in HRV apps targeting the stress management area.

Today’s guest is Ronda Collier, CEO of SweetWater Health, a company developing HRV applications for mobile platforms like the iPhone and Android. Ronda has over 25 years experience in technology product development and founded SweetWater Health in 2010 to focus on Heart Rate Variability.

She’s very hands on and working with a variety of companies in the area, so there’s a lot of practical details in our chat today and ideas from her on how HRV apps are going to progress over time.

The show notes, biomarkers, and links to the apps and devices and everything else mentioned are below. Enjoy the show and let me know what you think in the comments!

itunes quantified body

Show Notes

  • A review of the market of heart rate variability supporting devices and apps and the different standards and their accuracy.
  • What is required for accurate readings in terms of data input from the EKG compliance heart rate reading device (e.g. heart rate chest strap, ).
  • The best “use cases” Ronda has found for getting actionable data from heart rate variability.
  • The different measures of HRV: Time domain, frequency domain and non-linear.
  • Using HRV for stress management, to improve your stress baseline with activities like meditation and see the progress as well as identifying ‘high stress’ triggers for you.
  • Comparing the HeartMath coherence training to the use of the standard HRV stress measure (frequency domain).
  • How to use the SweetBeat and SweetBeat Life apps to monitor stress – some tips on Ronda on how to use effectively including health and less healthy (aka chronically stressed) benchmarks for HRV, LF and HF to compare your numbers to.
  • How the more advanced users are using the SweetBeat app and its more detailed metrics and functionality to improve their stress management over the day.
  • Other functionality on the SweetBeat and SweetBeat Life apps including food allergy/ sensitivity testing and correlating changes in a range of biometrics tracked by the app including HRV and other readings from devices it interfaces with.
  • Using HRV as an objective measure of effectiveness of alternative health treatments or techniques such as acupuncture or chiropractor.
  • The goal of raising your parasympathetic activity (HF) to lower chronic stress and the interventions and activities that have an impact on it such as yoga – Ronda provides benchmarks and examples of what they’ve seen work.

Give some love to Ronda on Twitter to thank her for the advice in this interview.
Click Here to let her know you enjoyed the show!

Biomarkers in this Episode

  • Heart Rate Variability (HRV): Measures how your heart rate varies over time. Research studies link HRV to recovery status, stress and other aspects of human physiology. See the specific measures below for which ones measure stress.
  • R-R intervals: Time interval in between heart beats (R = peak of heart beat).
  • RMSSD (Root Mean Square of the Successive Differences): The time-domain measure used to calculate HRV that has proven to be reliable and is used in a lot of the research studies – the industry standard for HRV.
  • lnRMSSDx20 (RMSSD with natural log and multiple of 20 applied): Applications have begun using this measure, which is basically RMSSD scaled to an index of 100, to make it more user friendly. SweetWater uses their own version of this.
  • LF (Low Frequency): Spectral measure that indicates combination of parasympathetic and sympathetic activation. The HeartMath algorithm uses a spike at a frequency within this band.
  • HF (High Frequency): Spectral measure that indicates parasympathetic activation.
  • LF/HF Ratio: The ratio of LF to HF gives a proxy measure of stress, or more specifically .
  • HeartMath Coherence Score: The HeartMath coherence score goes from 1 to 16 and measures your alignment with a spike at 0.1Hz on the frequency domain which is within the LF zone, and none or very low presentation in the other areas like the HF zone. LF represents both sympathetic and parasympathetic activity, so the 0.1Hz frequency is related to parasympathetic activity specifically. You find this within HeartMath
  • Resting Heart Rate (RHR): Measure of your heart rate at rest (typically measured upon waking). This is one of the measures Ronda tracks routinely to monitor her own health.
  • Blood Pressure: One of the biometrics that Ronda tracks for her own personal health.
  • The Coca Pulse Test: A measure of increase of heart rate that attempts to identify food sensitivities and allergies. You can read more about it in this book from the creator Dr. Arthur Coca, The Pulse Test: The Secret of Building Your Basic Health. SweetBeat and SweetBeat Life HRV apps use this test for their food sensitivity functionality.

Apps and Devices from this Episode

  • SweetBeat: The original HRV app that has been available for the last 2 years – it has HRV for training, HRV stress, food sensitivity functionality.
  • SweetBeat Life: Ronda’s new app that has extended functionality including the correlation function and additional data on HRV and real time HRV data.
  • Ithlete: One of the competing HRV apps with similar functionality to SweetBeat in the HRV for training area. Does not have HRV stress management functionality.
  • The Health Patch: One of the competing HRV apps with similar functionality to SweetBeat in the HRV for training area. Does not have HRV stress management functionality.
  • HeartMath: HeartMath use a proprietary algorithm measuring coherence with a variety of devices including the emwave2 and Inner Balance Sensor (iPhone, android).
  • Basis Watch: Watch that tracks heart rate and resting heart rate, but due its technology, has limitations in accuracy and sampling and is unable to record heart rate variability.
  • Mio Alpha: Another watch with heart rate monitor functionality which is working on a more advanced technology than the Basis watch, which may potentially track HRV eventually.
  • Bioforce HRV: Another application used for HRV for training similar to ithlete.
  • VitalConnect HealthPatch: A stick on patch that lasts for a number of days or longer depending on use that tracks heart rate and heart rate variability. The SweetBeat apps work with this patch and SweetBeat Life can use the data with its correlation functionality.
  • Withings WS-50 Smart Body Analyzer: This device weighs you and tracks other body data. SweetBeat Life interfaces with this and is able to use the data with its correlation functionality.

Other Resources Mentioned in this Episode

    Ronda Collier and Sweetwater Health

  • Connecting with Ronda Collier and SweetWater Health: You can connect with Ronda at her website SweetWaterHRV.com (company site) and also on twitter @BeatHealthy and facebook BeatHealthy.
  • Other People, Resources and Books Mentioned

  • Quantified Body Ep. #1 on “HRV for Training”: In this previous episode we looked at using HRV to optimize workouts and training sessions in great detail with Andrew Flatt, athlete and researcher.
  • The Quantified Self Conference: This conference takes place yearly in San Francisco and has many devices and apps companies attending as well as many presentations on quantified N=1 experiments and on the quantified self movement itself.

Who should I interview next? Please let me know by clicking here

Full Interview Transcript

Transcript - Click Here to Read

[Damien Blenkinsopp]: Hi Ronda, great to have you on the podcast.

[Ronda Collier]: Hi Damien, thanks for having me.

[Damien Blenkinsopp]: That’s great. I did see you briefly last year in the Quantified Self. Do you go to that conference every year?

[Ronda Collier]: Yeah, we have been the last – well, there have only been two and we have been at both of them. We presented at breakout sessions for heart rate variability. So they are pretty popular.

[Damien Blenkinsopp]: Yeah, and do you meet a lot of providers of HRV? You have been in this segment since 2011. How has it changed since then? How many players were there doing HRV stuff back then and how has it changed now? Are there different types of players? I noticed your proposition is changing a bit.

[Ronda Collier]: Yeah, back in the old days and really before smart phones, heart rate variability systems were big and clunky and expensive if you wanted to measure some of the standard HRV values like LFHV, which we can talk about. And nobody really heard of them quite frankly. I only know because that is our space. I think Heartmath really brought heart rate variability closer to the consumer with their M-wave products.

[Damien Blenkinsopp]: So they were the first ones, although theirs is actually a bit different to the standard.

[Ronda Collier]: Yeah, theirs is different and Heartmath is really more about coherence training, which is wonderful in itself, but they really had people talking about it in some of the more esoteric books, if you will. But I ran across Heartmath in reading some books for actually researching my thesis.

[Damien Blenkinsopp]: So how long has Heartmath been around? I know you worked there for a little while.

[Ronda Collier]: Yeah, they have been around about 20 years, yeah, for a long time. So they have an extensive amount of research on heart rate variability that is pretty interesting. And then three years ago you had iFleet starting to come out and that was really it. And then you have Zumio came out with their camera sensor, which is not very accurate but yet sort of furthering the cause of heart rate variability, which is important.

And moving all the way up until today where we are seeing a few more players like iFleet more in that space, Bioforce really not displaying all the HRV parameters like Sweetwater is, more the number used for training.

But I think the big news in heart rate variability is the Samsung, the new Galaxy is announced to measure heart rate variability.

[Damien Blenkinsopp]: Wow, yeah, that’s a big deal.

[Ronda Collier]: And even though it is just with the camera sensor, just for your listeners, a camera sensor is never going to be accurate.

[Damien Blenkinsopp]: Right, that is something I wanted to talk about today because I know you plug in with a variety of sensors. We did talk in our first episode with Andrew Flatt about some different sensors and some of the different measures and obviously we want to make sure people understand the practicalities and the accuracy, depending on which one they decide to go with. I think that is an important point.

[Ronda Collier]: It is – and so even though the Samsung is using the camera sensor, they are talking about it. And now that is great, and it means it is showing up in the mainstream. So we are really excited. It is such an important parameter that has just been kept in the closet for some reason.

[Damien Blenkinsopp]: Right, so let’s just kind of dive into the kind of accuracy since we are talking about it anyway and we won’t have to circle back. Obviously the thing about the Samsung Galaxy is they didn’t want to provide something external to the phone, and they want to try to have the device within the phone. And besides the camera sensor, is there anything else you could use that would actually come with the phone that would be able to help you track heart rate?

[Ronda Collier]: The closest idea I can come up with for you here is there is a company called AliveCore that has an iPhone and Android case, and it is actually EKG accurate, which is what you really need for accurate heart rate variability and that is all that Sweetwater will support, anything that is close to EKG accurate.

[Damien Blenkinsopp]: How do you establish that standard, EKG accurate? Is there a certain – I don’t know, is there sensitivity in terms of the speed of the heartbeat it has to be able to pick up? Or how do you rate that?

[Ronda Collier]: There is obviously the sampling rate. It has to be twice the heart beat. It is called Nyquist frequency for electrical engineers. But really what you need in simple terms are accurate, beat-to-beat intervals.

[Damien Blenkinsopp]: So you are saying that it has to sample twice as fast as whatever heart rate you are trying to –

[Ronda Collier]: At a minimum, yeah. There is something called the Nyquist frequency in electrical engineering, so if you want to get an accurate digital sample it has to be at least twice the frequency of what you are sampling.

[Damien Blenkinsopp]: Right, and for the normal population what is the maximum heart rate you are trying to track?

[Ronda Collier]: Oh we track, gosh, as low as 30. And if you are below that you are pretty sick and you probably aren’t using our product. Then up to about 200.

[Damien Blenkinsopp]: 200, wow. So you have to be running?

[Ronda Collier]: Some athletes actually get up close to that. My personal max heart rate is about 170, but people do get up in the 200s and we can measure that as well. So you have a wide range. But really it is getting accurate, beat-to-beat intervals that is the most important.

[Damien Blenkinsopp]: Yeah, does that mean with all of the different sensors you work with – because you have the application which interprets the data, and you work with a bunch of sensors from different providers, quite a few companies. Do you only work with providers which have the specification you just gave us? Do all of them fit that?

[Ronda Collier]: That’s right, that’s right. We support lots of shelf chest straps, like a Polar or a Zephyr, and there are a lot of Bluetooth heart rate monitors out there now, but now all of them work with Sweetwater. Some of them simply don’t transmit our intervals at all, and that is the beat-to-beat interval. So when I refer to R-R, that means the beat-to-beat intervals.

[Damien Blenkinsopp]: Right, so you are saying that some of them only track the heart rate and they don’t track the difference?

[Ronda Collier]: That’s right. And then some transmit the R-R intervals, but they are not accurate.

[Damien Blenkinsopp]: Could you give us examples of that? Is it because they are dedicated to a different application? Why is that?

[Ronda Collier]: I think that a lot of the vendors are starting to realize they want to transmit R-R intervals, but they just haven’t spent the time on it yet I would imagine, because we have worked with several vendors who did not have accurate R-R intervals and then worked with us to get there. Their focus was to get the Bluetooth heart rate monitor out first with an accurate heart rate and the R-R intervals were a secondary item. Then once they worked with us they got those to be accurate.

So that is usually the vendor is not interested in the R-R interval or they are interested in getting them accurate.

[Damien Blenkinsopp]: Right, and you think this is something that is changing, whereas people were just kind of focused on heart rate a few years ago, or three or four years ago, so these censors came out which didn’t look at the R-R now. Now would say most of them have this on their agenda in some way? Or is it still –

[Ronda Collier]: Yeah, I would say so. There are a lot of off brands that we haven’t even heard of, much less tested, that our customers are finding and then emailing us saying that their HRV doesn’t look correct. So we go and usually write the vendor and ask them before we go purchase the item.

But yeah, there are a lot and I am really surprised at the number of small companies doing the Bluetooth, low-energy heart rate monitors.

[Damien Blenkinsopp]: I guess that technology is relatively cheap, so there are a lot of chest straps and things like this that have come out. They haven’t necessarily done the full technical specification?

[Ronda Collier]: That’s right. So anyone that is going to use a heart rate variability app such as Sweetbeat or Sweetbeat Life, I recommend going to our website and selecting one of those, because we have tested those and we have actually measured that the R-R intervals are close to being correct.

[Damien Blenkinsopp]: So I guess the lesson here is there is no specific industry standard used by everyone. So if you were going to get something like Sweetbeat you should definitely go to your website, like you say, and check which ones are relevant – and it is probably going to be like that for a while, I guess?

[Ronda Collier]: Yeah, yes. Even the ones that look like they are working, we do a detailed test. We are all engineers at Sweetwater – the founders are all three electrical engineers so we are very careful about making sure that one plus one equals two. So what we will do is say a three-minute Sweetbeat session and then we will dump the R-R intervals, and they better add up to three minutes.

[Damien Blenkinsopp]: Okay, and yours is always three minutes?

[Ronda Collier]: For the HRV reading, yes, that is for the athletic reading. But you can do five minutes or eight minutes, but the R-R intervals need to add up. And some of the heart rate monitors don’t and so we work with the vendors to try to get that more accurate, because we want to support them.

[Damien Blenkinsopp]: Yeah, and it is better for everyone if you can support more sensors. So there are a bunch of different things coming out. There are the chest straps, which we have spoken about – so you are working with Polar, 60Beat, Zephyr, and Wahoo. And then there are biosensors, where you have these plastics that stick to you, basically?

[Ronda Collier]: Yeah, we just released our second product called Sweetbeat Life, and Sweetbeat Life works with what is called the health patch, which is a product by Vital Connect. So the health patch looks like a big band-aid, about three inches long, and that is an FDA-approved, single-lead EKG. It also measures respiration, body temperature, body surface temperature, calories burned – accurate, by the way, because it is measuring your body temperature and heart rate – as well as activity.

It is a real doozy, it has got everything in one. We are really excited about that because we are going to get a whole bunch of new metrics and be able to correlate that with heart rate variability and stress and provide more information.

[Damien Blenkinsopp]: That is great. How long does someone wear a patch like that for? How long does it work for?

[Ronda Collier]: That is a great question because we came up with a use model that Vital Connect never considered. Their original use model was it comes with a separate module, the patches are disposable and so you plug the module in and stick it on and their use model was you could wear it for three days until the battery dies.

[Damien Blenkinsopp]: It’s 24 hours?

[Ronda Collier]: You can, yeah, if that is what you want to do. What we do is we just keep the plastic that goes on the back and rather than have to put a chest strap on in the morning when you are doing your morning HRV reading you actually reach over and grab your patch, stick your module in, and stick it on. And so I get the patch to last for over a month.

[Damien Blenkinsopp]: You basically have this sticky part on you and then you just plug the electric part in every morning?

[Ronda Collier]: I peel the band-aid off, like take the band-aid off, and you pull the module out to save the battery, and I just have that sitting by my bedside. And in the morning I grab the band-aid and I stick the module back in and stick it back on.

[Damien Blenkinsopp]: Oh, so it sticks on and off without a problem, basically?

[Ronda Collier]: It does, and it is funny – different skin types can do it more than others. But if you are laying flat on the bed for your HRV morning reading it works pretty well for like a month.

[Damien Blenkinsopp]: You said two interesting things there. The first was you said FDA-approved for EKG. So does the FDA approve certain monitors and sensors and say they are EKG standard?

[Ronda Collier]: You go through a process, basically, to get a device clearance. But yeah, so this particular one is FDA approved. And for over-the-counter, obviously, because we are selling it to consumers.

[Damien Blenkinsopp]: Do all of them have to be FDA approved?

[Ronda Collier]: No, this is a consumer product. Although we – our product is we want to have values that are clinical grade and we do tests to make sure they are accurate. And I do want to note that HRV is very sensitive to the data going in. So if you have the wrong R-R intervals or the wrong interbeat intervals you are not going to get accurate data. So it is super sensitive. So anyone who is interested in HRV, make sure that you are aware that you have a quality heart rate monitor, whatever that is.

[Damien Blenkinsopp]: Definitely, and I want to talk more about the accuracy and use cases. The other interesting thing that you said though was you are using it and it sounds like you are using the HRV for training in the morning. Is that your main use for it? How else do you use it yourself?

[Ronda Collier]: Well, I use it for HRV for training in the morning. I also use it to track my circadian rhythm. I am really curious what is going on with me, quite frankly, at naptime in the afternoon. And it is very interesting – my parasympathetic nervous system actually increases in the afternoon?

[Damien Blenkinsopp]: Is that because you have a nap?

[Ronda Collier]: Yes, I will back up. Heart rate variability has a circadian rhythm, and I look to be curious, to see what is going on. And sure enough at 2:30 in the afternoon my parasympathetic or HF, HRV parameter increases.

I also use it especially early on with Sweetbeat. I used it when I was sitting at my desk to figure out what was going on and why I would get triggered. Because you are working all day and suddenly your neck hurts. And you are like, ‘What was I doing?’ You don’t even know because we do it all the time.

So I have actually learned that if a browser doesn’t load when I think it should, my face gets in the screen and I tense up.

[Damien Blenkinsopp]: You told me about this at Quantified Self. I think everybody hates that and we just don’t really realize how much.

[Ronda Collier]: Well, the important point here is that if you can learn one thing that you are doing all the time, then you can reduce your stress.

[Damien Blenkinsopp]: Yeah, and is that an HRV reading? You are using the stress monitor with your HRV app for that?

[Ronda Collier]: Right, right.

[Damien Blenkinsopp]: Okay, and previously we have talked a bit about HRV for training, so I think the audience has a reasonable grip of that and then how that works. And we didn’t look at all on the stress side, and that is a different calculation. Can you talk a little bit about what is behind that? How does it use HRV and how is it different with HRV for training calculation?

[Ronda Collier]: Yeah, absolutely, so the HRV for training calculation is based on – let me back up because I think it is better to give a high level of review. Heart rate variability, in itself, is just that – the variation of the heartbeats in the beat-to-beat intervals. It can be measured in several different ways. One is called time domain, or statistical analysis, like standard deviation. Root mean square of successive differences. The RMS, those are all typical statistical measures.

Then there is another way to measure the HRV and that is called frequency domain. And this is using [inaudible 00:16:43] fast forms and for you engineers out there, you kind of know what that is. And looking at the frequency components of the R-R intervals.

And then thirdly there is actually non-linear, which we are not using in Sweetbeat at this time. So the HRV for training uses a time domain parameter called RMSSD and that is a measure, it turns out, of your vagal tone. And the vagus nerve is the tenth of 12 cranial nerves in the nervous system, in the [inaudible 00:17:12] nervous system. And that particular piece of the nervous system is what gets fatigued during overtraining and endurance sports. So we measure that time domain measure for the HRV for training.

[Damien Blenkinsopp]: And you were saying that you specifically use that because the research has been based mostly on that measure?

[Ronda Collier]: Yes, that’s right.

[Damien Blenkinsopp]: So just one clarification on that – when you have actual score in Sweetbeat, the last time I spoke to you, you said it was based on 100. Is that the natural log of RMSSD times 20, or are you using something different? I think iFleet uses the natural log times 20.

[Ronda Collier]: Yeah, it is similar to iFleet but it is not the same.

[Damien Blenkinsopp]: So if you went out and got one and then a month later it broke or whatever and you went and got a different one, then you can’t have all of those values in Excel and compare it back for two months because they don’t necessarily fit?

[Ronda Collier]: No, no. And that’s actually a great point, Damien, because we have had people ask why is it different in iFleet? Because we use a different algorithm. We were 10,000 miles apart, having the same idea, but doing it differently.

[Damien Blenkinsopp]: So there is no industry standard, and it is basically because everyone decided it was going to be better to have it on a roughly 1 to 100 rating?

[Ronda Collier]: Yeah, it is a consumer thing. But there is an industry standard for HRV, but it is in numbers that a consumer would have a hard time with.

[Damien Blenkinsopp]: Could you give us a quick example?

[Ronda Collier]: Sure, so RMSSD, depending on who you are and HRV is very individual – while you sit there and in three minutes it can go between let’s say 60 and 68 – and it will sit there and vary because your nervous system is very dynamic. And then maybe the next day you get up and it is 54. So these numbers are just not easy for people to deal with.

So by scaling it from 0 to 100 it is easier for people to understand.

[Damien Blenkinsopp]: Yeah, that makes sense.

[Ronda Collier]: The stress level, so that is the HRV for training piece. And then the stress level, we actually use the frequency calculations of HRV and we measure the low-frequency components, which correspond, in simple terms, to the sympathetic nervous system. Actually, it is a combination of sympathetic and parasympathetic, but mostly sympathetic-dominant.

And then the high-frequency components, which are a measure of your parasympathetic branch of your autonomic nervous system. So for the stress level we look at those two and then we measure the balance between the two. So when you are sympathetic-dominant, you are stressed, sympathetic or fight-or-flight dominant, you are stressed. You want to actually be sympathetic-parasympathetic balanced.

But when you are really relaxing or just woke up in the morning and are sort of chilling, then you actually want to see yourself being a bit parasympathetic-dominant.

[Damien Blenkinsopp]: So if you are at work you would want to be a little bit sympathetic-dominant? So you are working on something and you are writing or doing a presentation?

[Ronda Collier]: Yeah, you normally would be. But you don’t want to be chronically that way.

[Damien Blenkinsopp]: Okay, so you are saying that balance would be 1-1, so LF and HF would be equal?

[Ronda Collier]: Yes.

[Damien Blenkinsopp]: What is bad? What kind of ratio is starting to look bad? Is it 2-1?

[Ronda Collier]: No, 2-1 is still pretty okay. You don’t want to be that way 27/7, but a lot of people are. When you start getting really bad is when you are over 4 or 5, which you would be surprised, is pretty darn common and people are even higher.

[Damien Blenkinsopp]: And you were saying it is throughout the day?

[Ronda Collier]: Every time you do a measure you are always – you are sitting at your desk and you can never, ever, get anywhere near 3, no matter what you do.

[Damien Blenkinsopp]: Even if you do some relaxation techniques, some people can’t get it down?

[Ronda Collier]: They can’t get it down.

[Damien Blenkinsopp]: That would actually probably be me, because mine won’t. I know there are some specific reasons, it is not because I am a really stressed out individual. But yeah, that would be me. And I was worried about it a bit more at first until I learned a bit more and I spoke to you at Quantified Self about it.

What is yours, for example? You were talking about when you get stressed at your computer. What does that tend to go up to? What would it normally be if you -?

[Ronda Collier]: I will qualify that with I have been meditating for a very long time. And I did a lot of coherence training with Heartmath for years, and so I will qualify that. But I am pretty balanced. Mine will go up to maybe 2 or 3, which is if I am really stressed. Otherwise I am usually anywhere between 0.8 to 1.5.

[Damien Blenkinsopp]: That sounds ideal, I guess? Is that?

[Ronda Collier]: Yeah, I am pretty balanced. I have worked hard to make my life that way, by the way. It was not always the case. I used to do chip design, which is very high pressure at Silicon Valley startup companies. I wish I had this app then because it would be interesting to see what I was running on, probably full time.

[Damien Blenkinsopp]: I was just going to ask you – that would be so interesting to know how that sort of evolved over time. And especially – this is when I started more meditation, this is when I did this, and you could see the steps down. Because I recently started – I didn’t really know how to track my meditation and if it was effective in any way. And I have been looking for a way to track it for a while.

So these days I go to the part and I switch on Heartmath. I have been using Heartmath to just track my meditation and it seems to be getting better, but honestly I don’t understand the difference between that and say the HRV for stress reading. Could you give me – like, could I use both of these for meditation and try and track how effective my meditation is? Or do you think that is not a reasonable use of it?

[Ronda Collier]: It is. This is a great question and we get this all the time in our support questions. Heartmath is a coherence training device or app, and what that does is get you into a state, basically getting your nervous system and all of your nervous system operating a – it’s called coherent, but in the frequency domain all you have is a little bit of energy at your breathing rate of 0.1 hertz.

[Damien Blenkinsopp]: You told me once before that this was in the LF zone?

[Ronda Collier]: And that falls into the LF. We don’t define what makes HF and what makes LF. So LF is 0.04 to 0.15 hertz, and HF is 0.15 hertz to 0.4 hertz, and that is an industry standard because we follow the HRV standards, and that is what it is.

So if you do coherence training you are going to have a huge spike if you are coherent at 0.1 hertz. And you won’t have anything anywhere else, because that is what coherent is. There is not going to be any energy in the HF range at all, or anywhere else, even in the VLF range, which are the very low frequencies.

So really it is a spike there at 0.1 hertz. And so that will show up as high stress in our app; however, if you are meditating and not doing regular breathing, your breathing normally and then you should be able to see your nervous system actually have a power increase. So that could be a measure of your meditative quality.

[Damien Blenkinsopp]: Do you mean the HF, the parasympathetic, would increase?

[Ronda Collier]: Actually, you could see the whole thing increase. It will stay balanced but the whole thing can increase.

[Damien Blenkinsopp]: I will go and try this for a few days. I go and meditate and I switch it on to the stress and then there is a chart in your app which looks at the LF and the HF and it shows it charting over time. Is that the screen you would look at?

[Ronda Collier]: That’s right, and Sweetbeat Life actually does it in real time now.

[Damien Blenkinsopp]: Okay, what is the difference?

[Ronda Collier]: It doesn’t show LF and HF graph in real time. Sweetbeat shows it in numbers in real time, but Sweetbeat Life, if you go to the landscape mode on the monitor screen, it shows it in real time. So it is a little more intuitive if you are meditating to look at a graph than read numbers.

Be aware though, if you have been doing Heartmath you just go coherent. When I meditate, I just automatically go coherent now so I don’t use it for that anymore. But I do use it in [inaudible 00:25:07].

[Damien Blenkinsopp]: Did you say you don’t go coherent in meditation anymore?

[Ronda Collier]: I do go coherent. All I have to do is think about meditating and I am coherent.

[Damien Blenkinsopp]: Oh, okay. And if you look at the research I am not actually sure that meditation correlates with coherence all the time. And actually if you look on the forums in various places, you will see some people who have been meditating for a while and they try to use Heartmath or something else and when they are in their usual meditation zone, they get a lack of coherence. THey go out of coherence and then when they focus on getting coherent, they go in under coherent. So I don’t know if there needs to be more research done around that. Do you know anything about that?

[Ronda Collier]: Once your nervous system is trained for coherence, and this is my experience, and our other founder Donna Lever, also as soon as she sits down to meditate, she is not trying to go coherent and she doesn’t have a device, but we go coherent. If you want to, you have to be mindful about not doing that regular breathing that brings you coherence. So there are a lot of meditative techniques where you breath in and hold at the top and focus and then that goes – so you just would do a different breathing technique.

[Damien Blenkinsopp]: Right, and breathing does seem to be essential. I think it makes quite a big difference in the Heartmath side. In your app – let’s move back to Sweetwater – does breathing make a big difference to stress numbers, the LF and the HF, in your app?

[Ronda Collier]: Absolutely. While we are not a coherence training device, if you go coherent you are going to see it. And so it will look like – you will see it once again as a spike at LF and so it will show up as stress.

[Damien Blenkinsopp]: Yeah, which in your app would be red, I am guessing?

[Ronda Collier]: That’s right, the stress levels are blue, green, yellow, orange, and red; however, you would be able to look at your power numbers and see what you are doing. You would want to see a super high power number in the LF.

[Damien Blenkinsopp]: Right, and so in your case when you were doing meditation, specifically, you would look at the LF and the HF screen, rather than the bar with the ratings? But just for general stress like you are talking about, you want to understand a situation like if you are stressed or not and if you are feeling a bit rough or looking at your screen and not feeling good or for presentation or whatever – would you use the LH-HF screen or would you use the bar with the red and the yellow and so on?

[Ronda Collier]: I think I would use the bar initially – for your listeners, definitely just use the bar and then once you start figuring out what you are looking at then you can actually look at the LF and HF and that can become second nature, once you are done with the bar then we tend to look at the geek screen at the LF and HF.

[Damien Blenkinsopp]: Right, and then as you said higher power is good as well as the ratio?

[Ronda Collier]: That’s right. When you are really feeling kind of dragging, if you look at the power numbers you could be – I am going to make numbers up. I have had listeners quote my numbers and there is so much variety in HRV numbers, so I am just going to use some average numbers. Some days your LF and your HF might be around 100 or less.

[Damien Blenkinsopp]: Both of them?

[Ronda Collier]: Yes, somewhere around there.

[Damien Blenkinsopp]: So is that a bad day?

[Ronda Collier]: For me that is a bad day. That is a low day where my energy is zapped or I have done something where I am emotionally or physically drained. Then there are other days where you are just on top of the world and you are at 2,000 to 3,000. So that is where you won’t see that from looking at the bar from blue to red, but you will see that looking at your numbers.

[Damien Blenkinsopp]: My numbers would be like – most of the time my LF is like 1,800 and my HF is like 200 or 300, if I am lucky. So if my HF isn’t high enough –

[Ronda Collier]: That’s right. And Heartmath should, over time, improve that.

[Damien Blenkinsopp]: It definitely helps and you can feel it. I guess you recommend to do this kind of thing, but once you identify something that is stressing you in your life and you do a Heartmath session or a meditative session and use the device, then you definitely come back afterwards and you have got more energy, you can get back to what you are doing, and it definitely makes a huge difference in my productivity. Once I discovered this it was pretty much a game changer for how I work.

[Ronda Collier]: Yeah, and you bring up a great point. One of the reasons that we created Sweetbeat was to not only provide you with feedback that you would go off and meditate or chill, but to provide you with real-time feedback so you can actually, right then and there, go, ‘Oh, I am doing this and I have been doing it all the time and I didn’t even know it.’ And then learn to actually correct your behavior right then and there. Put your shoulders back, uncross your legs, sit back, take a deep breath at your desk, and then reset.

[Damien Blenkinsopp]: Right, and so the idea is that you can be watching the screen and you can watch when your numbers readjust or go back to normal and then you can tell when you are in a better state.

[Ronda Collier]: That’s right, and then next time Sweetbeat gives you an alert if you change your stress state and you can program it to do that. So that is how I learned about the screen thing. Other customers have used it while they are driving and it starts beep, and they realize that they have just stressed out over something that they deal with every day. And so it brings to consciousness things that have been previously unconscious that are contributing to heart disease and hypertension in middle age.

[Damien Blenkinsopp]: Would you say this is the most common use case? I was going to ask what you find people are using the most. I guess you have this big database now with everyone’s data. I am not even sure if you have come to grips with that because you have all this data.

[Ronda Collier]: We have not come to grips with it yet. It is going to be a huge issue. What we do is when customers write in and want to know about their data we can help them with an analysis if we have time. We go ahead and look at some of their sessions and give them sort of a bird’s eye view of what is going on for them and so we are still doing that.

[Damien Blenkinsopp]: Yeah, but you can’t do things like understand what, on average, the users are using that for?

[Ronda Collier]: Oh we do, and we have done that. We have a large percentage – the micro market is lead athletes and even fitness enthusiasts using it to guide their training.

[Damien Blenkinsopp]: Right, so that is every morning as soon as they wake up?

[Ronda Collier]: That is that group. That group is also using it throughout the day, running 20, 30-minute sessions just to see how they are doing. Then there is the other market segment, which are quantified selfers and they are wanting to run it for like 8 hours.

[Damien Blenkinsopp]: Right, to see where they spike?

[Ronda Collier]: Absolutely. They want to run a session all day and then they want to sleep in it. They are just running it constantly.

[Damien Blenkinsopp]: When I first got mine I wanted to do it 24 hours and I think I even wrote to you about it.

[Ronda Collier]: Yeah, your phone won’t hold all that – there is a lot of data.

[Damien Blenkinsopp]: That’s what you told me.

[Ronda Collier]: But with the health patch we are working on making that a little easier for folks. So the health patch will make the full time monitoring much more accessible because it is actually comfortable and you don’t even know it is there. You can sleep in it without the strap on you, though some people don’t mind. I don’t sleep well with the strap, but the little health patch just sits there and it is not a big deal.

[Damien Blenkinsopp]: Anyway, the idea behind the 8-hour or the 24-hour is people are trying to figure out, and using the stress monitor, what kinds of things are triggering them throughout the day. This is what they are doing, right? They are just mapping the whole day and they are like, ‘Hmm, at 1 o’clock and 3 o’clock I got really stressed out, what was I doing?’ and that kind of thing?

[Ronda Collier]: Yeah, that’s right. And also they are tracking LF and HF. A lot of the folks have gotten big into looking at those numbers because once again, the stress meter only tells you the balance of LF and HF. The numbers themselves tell you the power levels.

[Damien Blenkinsopp]: So it is more interesting once you start looking at LF and HF?

[Ronda Collier]: People love the power levels, so yeah, it is really great and we were really pleased with that.

[Damien Blenkinsopp]: Yeah, is there a more detailed understanding though? As you have already described? A lot of people probably want to get their HF up higher and I guess there are two ways to look at it as the baseline, where you are from day-to-day. And I don’t know if you do kind of averages of how people evolve over time and they manage to address that kind of baseline versus –

[Ronda Collier]: You are bringing up a really important point for your listeners. Because HRV has a circadian rhythm, if you are going to do a day-to-day comparison you need to do it at approximately at the same time in the same position. If you are laying down and then stand up your heart rate increases to equalize the blood pressure. So really your position is important.

Also, your mental state will be important. So if you measure it at the same time each day but one day you are all stressed because something happened in your family, your HRV is going to be different. That is why we recommend that people do it first thing in the morning and really mindfully don’t start thinking about your day because that can affect the reading.

[Damien Blenkinsopp]: Yeah, what I do every morning now is I lie down and then I do a standing up reading as well. Which do you do? Do you both or do you just do lying down or standing up?

[Ronda Collier]: Well I just do lying down. I am lying in bed and I am not thinking, because once I get up then my mind starts thinking about my day and so that can affect the readings. We have done measurements where something was going on in my family and I was just sitting here and already had the strap on when I was testing in the early days and something happened and just from my thought and looking at what happened my stress soared right in front of my eyes and it was kind of crazy.

Our other founder, Joe Beth Dow, had the same thing happen. So really your mental and emotional state, if you are going to do the day-to-day comparison, you need to be mindful of that. And if you see it drop just really go inside and go, ‘What am I feeling sick? Or sad, or angry, or upset, or something like that.’

[Damien Blenkinsopp]: Right, to kind of detect if it is something you are causing yourself or if it is the underlying how you are feeling today, that is a good point.

[Ronda Collier]: That’s right. It can be physical, emotional, psychological, or environmental.

[Damien Blenkinsopp]: Yeah, I can definitely relate to what you are saying about it is easier when you are lying down when you first get up and then you tend not to think about it so much. But I do the lying down one and then I do the standing up one and I tend to start thinking about things. And I have to kind of catch myself, especially if I am thinking about work or something. So I think you are totally right about that, if you are going to do the standing one it is good to keep in mind that it is at the same time.

The other thing is movement. HRV for training is a very specific, three-minute reading. So you either do it lying down or standing up or sitting down.

[Ronda Collier]: Do your three-minute reading and you are done, yeah.

[Damien Blenkinsopp]: And you always do it the same just to keep it the same. How about movement? I guess some people doing these 8-hour cycles are also tracking all sorts of things throughout the day. Is it relevant to track HRV while you are moving? Is that an accurate reading? I had some experience with this before and I couldn’t really figure it out. What is your take on that?

[Ronda Collier]: That is another great question. You should see your heart rate variability changing through the day. When you go from sitting to standing or lying down to standing your heart rate should increase and your sympathetic should increase to increase that heart rate. So you should see nice cycles throughout the day. If you are not then that is a serious problem and that would be indicative of someone with some heart disease.

[Damien Blenkinsopp]: You are saying if the power levels aren’t changing, as you are doing different things?

[Ronda Collier]: That’s right, or even the stress level, which is the balance because I will repeat the example and when you are lying down and standing up – when you go supine to standing your sympathetic nervous system kicks in to increase your heart rate, to pump your blood, or to equalize the blood pressure. And that is normal.

For people who have low HRV to a point that maybe it is a heart disease, they have a hard time and their heart can’t respond and their nervous system is brittle, if you will. And so when they go from lying down to standing up their heart rate doesn’t increase the way it should.

And so if you were to go throughout your day in 8 hours and not see a lot of variety in your power levels and your stress levels, that would be a problem.

[Damien Blenkinsopp]: The HRV readings are accurate in terms of the LF and the HF – it is accurate data when you are moving around it is just that it is changing a lot. So your HRV should go down, I guess? In this case it is going to be the stress. So would you be more stressed when you are moving around, if I am walking or running it is going to be more sympathetic? Or can it vary per person?

[Ronda Collier]: It really depends. We were wearing it at CES the last year, or the last two years, and these kind of things usually stress me out. I guess I decided that I am not going to let trade shows stress me out anymore. I did, actually, mindfully because I will just go bonkers. And I needed to be present to go talk to all the people were were going to meet with.

And so I was walking around CES with a completely balanced green to yellow stress, which is pretty good. And really the numbers were high and I was just in a good space. Now, if you are running and exercising then your HRV is going to drop and that is just the nature of the beast.

But it is really more about that you are going to see the variation when you stand up and sit down and sit down and stand up or have an emotional stressor, or anger or environmental something coming at you.

[Damien Blenkinsopp]: Yeah, so it is not that there aren’t any people using this to track their exercise – are they tracking their HRV or their stress?

[Ronda Collier]: Oh, these guys use it for everything.

[Damien Blenkinsopp]: Is there any research behind that? What kind of understanding could you get?

[Ronda Collier]: Sweetbeat was not designed to be used while you exercise. There are some things you can glean from that. In fact, you can see where you hit aerobic to anaerobic if you know what you are looking at.

[Damien Blenkinsopp]: That is interesting.

[Ronda Collier]: It is, it is very interesting. We just having pursued that, but I can see it.

[Damien Blenkinsopp]: Can you give us a quick add to that or is it more complicated?

[Ronda Collier]: Yeah, it is okay – so your stress level goes up and your whole power levels just plummet. Your HRV plummets because everything is moving so quickly. And when you hit that threshold your stress level on the colored bar actually goes down when you hit that threshold, so that is the easiest way because your HF actually kicks in.

[Damien Blenkinsopp]: Your HF you are saying will go up when anerobic starts?

[Ronda Collier]: Yeah, and remember you are down in numbers in the teens now. So your listeners that want to try it, yeah.

[Damien Blenkinsopp]: Yeah, they should try that out.

[Ronda Collier]: Look at the geek screen and watch the numbers. Pay attention and then you will be in the red and then suddenly when you go a little harder it will back down and the bars will be like in the yellow and in the green.

[Damien Blenkinsopp]: Wow, that is really interesting. That would be interesting if you guys do something with that later.

[Ronda Collier]: And there is a bunch of research on that too. It is so dynamic and it is kind of hard to do in an app, but we think about it.

[Damien Blenkinsopp]: So I guess you will have some complicated algorithms you will have to develop and it might take some more research. It would be interesting if you could do that because currently the tests – I looked at different breath tests and so on you can do to establish anaerobic threshold. And it is not easy, you have to go to the labs and mess around. So eventually if we had an app like your iPhone app that would be really cool.

[Ronda Collier]: Yeah, I have done one and they pushed me too hard – I need to warm up. I do. And so they got completely wrong measures, said my max heart rate was like 150, which is just not true. I go to the gym and hit 165 all the time but I need to ramp up. So going on a full-force run in the first minute just doesn’t work for my body.

It would be cool to have an app that would let people – there needs to be a protocol because we have done enough looking into it with that, but not in the first minute, come on.

[Damien Blenkinsopp]: You have probably got your hands full with all the other stuff going on in your app already, so it is probably not for tomorrow. I just want to go back and we have touched on circadian rhythm a few times, saying how it distorts the figures. So I want to make sure the audience doesn’t get confused with that point. Is there a specific pattern? If I am looking at stress over the day, is there any way I can picture it in my mind so it will be a bit higher at this point or a bit lower at this point?

How do you look at the circadian rhythm? I guess the first thing to say is if you are doing HRV for training it should be at the same time every day? I woke up at one time at 4 o’clock in the morning, which I sometimes do, and then other times I will wake up at 8 o’clock and do my reading then. And one day I did it at 4 o’clock and it was completely different. It was actually a lot worse and I don’t know if that fits the typical theory. But I was like, ‘I think I better take this a bit later.’

[Ronda Collier]: It’s going to be individual, but typically – and I am just going to give you a typical case. Your HRV will be highest in the 6 am, 7 am, 8 am. And then it dips down in the early afternoon and then it comes back up in the evening.

[Damien Blenkinsopp]: And then it stays up during the night?

[Ronda Collier]: While you are sleeping your HF really should kick in and that is why people measure it when they are sleeping. If your HF isn’t kicking in then you are maybe not getting very good sleep.

[Damien Blenkinsopp]: That’s me, but we won’t get into that. That is why at 4 o’clock it was terrible. So you basically gave us the outline there. So in terms of stress that would be reflected in the stress levels as well, so you are saying in the afternoon you probably have the worst stress levels? It would be harder to be non-stressed in the afternoon, is that what you are saying?

[Ronda Collier]: Actually, I can give you mean. All I have is research numbers, so the only thing I can tell you from personally looking at the HF and LF numbers are that my HF kicks in the afternoon, which causes my heart rate to decrease, and I am sleepy.

[Damien Blenkinsopp]: Is that because you have trained yourself to have a nap?

[Ronda Collier]: But everything is low, so my HF will go from maybe 3,000 in the morning down to 900. But I am still HF-dominant, so once again, that goes back to the power numbers. They are just really – once people use Sweetbeat and get used to the stress levels then really dive into the power numbers because that is saying so much about what is going on for you.

[Damien Blenkinsopp]: And so your aim there is – 3,000 sounds incredible, like for my levels. You are saying that over time you would really like to get the HF up, that is the idea? To increase the power of the HF?

[Ronda Collier]: Yeah, most people want their HF up because they are sympathetic-dominant and kind of chronically stressed. So we have done a few case studies with yoga, so actually a young woman was one of the case studies in her early 20s who just felt stressed out, always. So her HRV was always on the low side and she was sympathetic-dominant. So she did yoga twice a week for six months and brought that into balance. She raised her power levels and brought herself much closer to balance.

[Damien Blenkinsopp]: How was she tracking that? Or how would you advise if someone is doing a long term intervention like that where they are doing classes twice a week or they are doing meditation once every day, how would you advise them to best use the app to track that?

[Ronda Collier]: I would do the HRV for training but if you are looking at LF and HF, I should mention this, it is better to have a five-minute reading or longer because with our algorithm, once again we use the industry standards for heart rate variability and there is what is called a short-term measure, which is five minutes, and a long-term measure, which is 24 hours.

So our algorithm is designed for a minimum 5-minute window. So you would not want to really use HRV for training because that is designed for the time domain accuracy and it is not the best. You are not going to get the most accurate LF and HF in the three minute, but you want a five minute.

[Damien Blenkinsopp]: Great, so your HRV for training switches on and off and it does the three minute and then it is finished. It is all built in so you don’t have to worry about that and it is going to do it for you?

[Ronda Collier]: Yeah, that’s right.

[Damien Blenkinsopp]: But what you are saying is that for the stress monitor it is labeled stress monitor in your app, as I remember, and that one you have to do for five minutes?

[Ronda Collier]: Yeah, at least. And usually you just want to put it on either right when you get up in the morning and do that, or still when you are kind of relaxed somewhere, maybe watching TV in the evening, or pick a time when you are kind of unwinding. So if you are doing the six-month intervention, pick a time a couple of times a week or every day that you go ahead and measure yourself and the history and the charting and you can see what your trends are.

[Damien Blenkinsopp]: So ideally that is the same time every day and should be the same activity, like you are saying – if it is always watching TV, although I think if you are watching an action film versus a romantic film or something it might have a little bit of an impact there too, so you have to watch out for that. Great.

[Ronda Collier]: That’s right, and if you have a favorite program that you always watch you should measure during that.

[Damien Blenkinsopp]: So you mentioned yoga – are there interventions that you know people have done in your user base? Are there examples of good things to try out in terms of experiments? What would be the top five things to try to raise the baseline?

[Ronda Collier]: Definitely yoga and meditation, those kind of go together. Nutrition, of all things, stop eating anything that is out of a box. Read the labels and if there an ingredient you can’t pronounce, don’t eat it.

[Damien Blenkinsopp]: So that would be easy if you start a diet on the first of the month. And then you can, over time, probably see some change over the next weeks if it is a positive change or a negative change?

[Ronda Collier]: That’s right, because our bodies are completely interdependent and interconnected. All the systems are connected to the other. Sweetbeat also has, which I haven’t mentioned, a food sensitivity test. And it allows you to test for foods that you may not be allergic to but you are sensitive to. And these foods can actually cause your heart rate to increase by quite a bit, even if you are just sitting.

So we have case study after case study of people sitting quietly at their desk, watching TV, or relaxing, and their heart rate goes up 20 beats after eating the offending food.

[Damien Blenkinsopp]: Did you base that on research? Where did that come from?

[Ronda Collier]: It’s called Dr. Coca’s Pulse Test – I think it is Coca’s Pulse Test. And Dr. Arthur Coca was a renowned immunologist in the 50s, founder of the journal of immunology, so he was quite well-known at the time. And he came up with this simple test to help his wife, who was having issues where they couldn’t find it in allergy tests, but they were suspecting that she was allergic. And so he came up with this pulse test for her and so she was able to fix a whole lot of ailments by using the pulse tests and eliminating offending foods.

And so all of the inflammation and all of that interacts with cortisol. There is stress cortisol and that is why I mentioned nutrition, because it is all interrelated and so if you are eating things that you could even be slightly sensitive to it can affect your heart rate variability.

[Damien Blenkinsopp]: Is it in peer-reviewed journals, this kind of research, as well? Or is it Dr. Coca’s? It sounds like it makes logical sense. Has anyone done any studies on it to validate it?

[Ronda Collier]: I could not find any peer-reviewed journals on this; however, they do teach it in medical school so a lot of allergists know about it. So yeah, it is very interesting that I have been unable to find any because we at Sweetwater go to the National Institute of Health database for our research. We want peer-reviewed research that will back up our algorithms. So yeah, the Coca pulse test, no, but a lot of functional medicine doctors, MD or not, use the pulse test and are familiar with it.

[Damien Blenkinsopp]: So it is worth finding out to see if there is something?

[Ronda Collier]: Absolutely.

[Damien Blenkinsopp]: Is there anything you would advice – and maybe you don’t know about this – but say if something is showing up and it looks like an analogy, what would be the next step for someone to try to get more validation around that? Have you got any suggestions, or is that something kind of out of your area?

[Ronda Collier]: Take it out of your diet. If you eat something, what the app does is if you are wearing a heart rate monitor it automatically will take your pulse at 30, 60, and 90 minutes. And assuming you are not out running or exercising, if your heart rate increases then that is not good.

So what you would do is note that and basically remove the offending food.

[Damien Blenkinsopp]: Yeah, so a lot of functional doctors these days advise – because a lot of the allergy tests aren’t that consistent either, so a lot of them advise you on elimination anyway. So I guess if you really wanted to validate it afterwards, don’t eat it for a month. And then eat it again and see what happens to you or if you feel worse, and again do the test with your app, for example. That is probably the next best thing to do?

[Ronda Collier]: That’s right. I wasn’t testing anything but I ate – and a reasonable, regular serving of cherries about a month ago. And I was just sitting at my desk and I was testing the Sweetbeat for something else and I wasn’t doing a food test, but I noticed my heart rate was 79. My resting heart rate is about 50 and I was like, ‘What is this all about?’

So I looked it up and a lot of people are sensitive to cherries. And I could feel my heart pounding. And so I am really aware, and I am going to retest cherries.

[Damien Blenkinsopp]: You are probably becoming a lot more aware about yourself and notice a lot more things because what I have found when you are using these kinds of apps it kind of validates tiny little – like if you feel a little bit off, it starts to validates you and you start to get more confidence in trusting yourself and starting to notice more because of that. So it is probably not something you are telling everyone, but using these HRV apps for this kind of apps for this kind of thing can help build your awareness of yourself over time as well.

[Ronda Collier]: That reminds me, sort of back to what people have done to improve their HRV. [inaudible 00:49:14] cofounder, walking in the park, in green – she learned a few things because her HRV was on the low side when we started Sweetwater and now even through a whole bunch of life events, a mother passing away and so her HRV has continued to increase through the years because she learned the things that increase it so she does them every day, versus doing them haphazardly.

[Damien Blenkinsopp]: Let’s get back onto the – what other kinds of things have we missed? We talked about yoga and meditation.

[Ronda Collier]: That is another one, we have done some research on – another one is acupuncture so we have done lots of case studies and actually there is peer-reviewed research on acupuncture. We have done some ourselves and your nervous system just balances and power levels increase during and after an acupuncture session, so that was another interesting one.

[Damien Blenkinsopp]: That is quite a controversial area. I know there is a lot of functional doctors who really support it and there is also a fair amount of research there. But when you bring up acupuncture a lot of people find it controversial still.

[Ronda Collier]: Well that is changing, and insurance reimburses acupuncture for people with arthritis. So Western medicine does acknowledge and that is why there are a lot of peer-reviewed papers surrounding acupuncture. They know and they can measure that the pain receptors have changed, specifically around the points for arthritis treatment.

[Damien Blenkinsopp]: Well here is the thing – I think acupuncture is a bit of an art, so some people might be better at it than others? Is that the way that it works? Could you evaluate the quality of the acupuncture you are getting based on the impact on HRV?

[Ronda Collier]: Yeah, absolutely. I have a good acupuncturist so I have seen my nervous system change about 20 to 30 minutes after the needles go in, which is about what you should expect. Another is chiropractic – we hold our stress in our bodies and there are, once again, peer-reviewed papers on chiropractic and HRV.

You can see whether the adjustment made a difference to you or not, so it is sort of an objective measure in general to some of these treatment venues that some people are not sure of, like acupuncture and chiropractic. You can actually measure whether it made a difference.

[Damien Blenkinsopp]: Yeah, so it is useful, especially if you are doing something new that you are not sure about, whether it is yoga or whatever you are trying that is new. I guess it also help your motivation, so if you can see the numbers changing it is this low thing, but if you can see that positive feedback you are like, ‘Oh, this is making a difference.’ Whereas sometimes – that can give you more motivation just to keep at it because you can see things changing.

So I know we have gone on quite a long time here and I wanted to make sure we cover a couple of other things, which is your new app and the correlation in particular, which has been added. Is there anything else new that has been added or is that the main thing?

[Ronda Collier]: Better graphing features and like I said, some of the real-time graphs. The Vital Connect patch so you can see real-time calories burned, once again accurate. I have a Fitbit so don’t get me wrong, but it is not accurate. Neither are the machines at the gym, by the way, but this gives a real accurate calorie burn.

It also gives – let’s see, respiration, body temperature, and calorie burn. It does measure number of steps and all that, as well as all of our HRV values.

What is new in Sweetbeat Life besides the Vital Connect patch, which has all that new information for you in real time – we have a correlation feature that allows you to basically correlate your HRV and stress levels to all the other parameters in the Vital Connect patch as well as correlate to your Fitbit, the number of steps you are taking, your calories burned, your calories eaten, and we also connect to Withings, so we have the withings scale and so your weight is in there as well as the Withings blood pressure.

One can learn what am I doing when my HRV is good? How many steps, how many calories? Or what am I doing when my weight is where I want or not want? I personally learned that it is not calories in versus calories out for me that helped me get to my desired weight – and we are talking three pounds here and it is important. It is the calorie out. I need to eat more and burn more and then I actually can lose weight easier. So that was important for me.

[Damien Blenkinsopp]: Right, so you are saying you saw a correlation with intake and activity levels?

[Ronda Collier]: That’s right, burning 1500 and eating 1200 I didn’t lose weight. But eating 1700 and eating 1400, I did. And so that was really important for me. And a lot of people will be concerned about what they are doing to maintain the proper blood pressure or stress levels and so on, so it is really a great tool to bring meaning to all this data.

[Damien Blenkinsopp]: And when did you launch this? I think it is the early stages in the understanding of the use cases.

[Ronda Collier]: Yeah, we launched in May. And if anyone does decide to try out Sweetbeat life, we have great videos embedded in all the screens now. For the correlation function we have put a lot of information on a very simple screen, so it is very important to watch the video and pay attention. Because once you know what you are looking at then you hit the buttons and there are all these buttons to see all this great information and you know what you are looking at.

But when you first go looking at it, you are not going to understand it, so please do take the time to look at the video. That is just the nature of trying to convey a lot of information on a small screen.

[Damien Blenkinsopp]: Yeah, and so what are your plans for that? Right now the correlations are between data of the Fitbit data and the Withings scale. What are the main areas people are correlating?

[Ronda Collier]: And the map my fitness, to measure how many mets your workouts are as well – just adding more, first we are going to stay where we are right now and get customer feedback on this. Once again, it is a lot of information crammed into one tiny screen, so we want to get that right first and find out what is useful to the customers and then do an iteration there and then just start adding more of the popular tracking devices.

[Damien Blenkinsopp]: Yeah and it sounds like you are going to learn as you go because you don’t know what is going to correlate either. And eventually patterns are going to pop out so it is going to be more interesting to integrate with some devices versus others.

[Ronda Collier]: That’s right, and one of our favorite scenarios is with the athletes that have been training using Sweetbeat and measuring all these things with let’s say blood pressure, weight, you name it, for a year and then they have Iron Man coming up. What we want to do is provide them with meaningful information of what they were doing that consistently got them into the most rested and ready state.

[Damien Blenkinsopp]: Yeah, like you were saying if they have six months of data or whatever that would be pretty amazing.

[Ronda Collier]: Yeah, and then they can go back and create this is what I was doing that consistently gets me to where I want to be the morning of the race, and so this is what I am going to do.

[Damien Blenkinsopp]: Whose idea is this? I don’t think anyone else is doing this yet. Obviously this is where people have been talking that things should go in terms of correlation.

[Ronda Collier]: This was our idea and oddly enough this came from an app challenge that we were going to do with Qualcomm Life. And Qualcomm Life collects data from so many different devices and so we were just going how can we show the value of the Qualcomm Life platform? And so that is what really led us to do this at the timing that we did it. So we are very grateful to Qualcomm LIfe for having that app challenge when they did because it really pushed us to get this together. So we really are the first people creating useful information besides just a dashboard with charts for all this data that everyone is collecting.

[Damien Blenkinsopp]: Yeah, and it will be interesting to see what kind of experiments they try to run and what correlations they can come up with. So how many users do you have using the Sweetbeat versus the new one? It has been out since May?

[Ronda Collier]: The new one has only been out since May so we have under 1,000 on Sweetbeat Life and tens of thousands on Sweetbeat.

[Damien Blenkinsopp]: I know you have got all this data – have you got any plans to try and sort through any of that? What are the most exciting things coming up next that you have ideas about? Or do you have ideas that you hope to do in the next two years?

[Ronda Collier]: I would have to kill you if I told you.

[Damien Blenkinsopp]: I thought it might be something like that.

[Ronda Collier]: We have a lot – that’s all of our secret road map. But we are doing some really cool stuff coming up and we are so excited, that is all I can say. And the health patch has really enabled this because it opens up a whole new market of people that frankly are not going to wear a chest app. They are just not going to put it on, so the patch really makes it more accessible. That allows us to create products for an audience beyond the Quantified Self hacker that will stick to the strap on or the athletes that already have straps.

[Damien Blenkinsopp]: How much does the patch cost?

[Ronda Collier]: So the starter kit is $199 and that comes with five patches and the electronic module.

[Damien Blenkinsopp]: So it is like $40 a patch, and they last – you said you used yours for -?

[Ronda Collier]: Well the replacement patches are $20, so a month or more depending on what you are doing with it .The price point is high because it is a brand new product, but that is going to be coming down as the volume ramps up, obviously.

[Damien Blenkinsopp]: It is brand new and I saw it.

[Ronda Collier]: It is brand spanking new. The only place you can get the health patch right now is through Sweetbeat, and we are the first app out with it. Consumers can expect that number to coming down in the years to come, like I said, as the volumes ramp.

[Damien Blenkinsopp]: Great, thank you very much. Just a couple of questions more about you and the way you use data in your life. What would be your number one recommendation to someone trying to use some form of data to make better decisions about their body’s health performance? What would be your number one recommendation?

[Ronda Collier]: Actually I think our correlation feature is our number one recommendation for me because it is giving you really useful information. HRV, for your listeners, should be measured along with your blood pressure, your weight, and your cholesterol because HRV perturbations are early indications to something that hasn’t shown up physically yet.

So if you are monitoring your HRV as you go through your life and you suddenly saw a drop, a consistent drop, then there is a problem. And then with the correlation feature you may be able to go back and see other aspects start to change with the lowering HRV. You can’t take one thing in isolation.

[Damien Blenkinsopp]: So you are using it as a discovery problem that you can’t see, because most health problems in our life take us by surprise.

[Ronda Collier]: Yeah, so I have the Withings scale and the blood pressure cuff and a Fitbit and I use iFitness.

[Damien Blenkinsopp]: So it is like risk management?

[Ronda Collier]: That is right, that is right, and learning what I can do. Sometimes, especially with weight loss, people are like, ‘I don’t know – I count calories and I do this and I do that. Why am I not losing weight?’ Then suddenly they will lose a couple of pounds and this will give some really useful feedback. I also want to mention on that vein that getting accurate calorie burn during the day – if you are really on a serious need and you need to lose 40 or 50 pounds, that is a long haul.

And 200 calories a day is a big deal when you are tracking, so getting an accurate calorie burn throughout the day is important. So really being more accurate, and Sweetwater health is really about more accurate feedback for the consumers and athletes.

[Damien Blenkinsopp]: Yeah, because there are a lot of apps out there and they are definitely not the same. I got the Mybasis watch and I think you know that compares unfavorably to some of the other trackers.

[Ronda Collier]: Yeah, we bought a Basis to check it out. And you have to wear it too tight on your wrist that it is not comfortable if you want heart rate. And it just doesn’t match my outfit.

[Damien Blenkinsopp]: Right, and just talking about the My Basis quickly, the reason you can’t do heart rate variability is that they are just not sampling quickly enough? Have you looked into it?

[Ronda Collier]: Any wrist face device, like [inaudible 01:00:52] use pulse oximetry, so what they are looking at are the capillaries in your skin as they expand and contract, so it is just very difficult to get very accurate beat times.

[Damien Blenkinsopp]: Right, so they are using averages to get the heart rate and they need way more accuracy to get to heart rate variability, which is more difficult than a heart rate. On My Basis if you start running around it starts losing track because your heart rate is moving, so it can’t even keep track of your heart rate.

[Ronda Collier]: Because it is motion and the pulse oximeters are very motion-sensitive because they are basically measuring capillaries and if you move your skin the capillaries are moving. And so Mio, just for those athletes, the Mio Alpha has done a terrific job of eliminating motion artifacts. You can actually use that one while you are running and still get an accurate heart rate.

[Damien Blenkinsopp]: A heart rate, but not heart rate variability.

[Ronda Collier]: No, and they want to do heart rate variability but they are also engineers and so they just know that they can’t.

[Damien Blenkinsopp]: They are struggling but potentially one day that technology might –

[Ronda Collier]: Potentially one day, yeah. If you can get the processing power without draining the battery in a watch it can be done.

[Damien Blenkinsopp]: You have probably told us some of this already. What data metrics do you track for your own body on a routine basis, like the things that you would keep in mind every month or every six months? What are the key five things that you think are most important for yourself?

[Ronda Collier]: I keep track of my HRV and I am aware of my blood pressure. I am also aware of my resting heart rate and I don’t know why, but I want to know. Mine actually drops low sometimes so I am worried on that end, it gets around 40 and I sort of want to keep an eye on that. I weigh myself, and weighing yourself every day is stupid, sorry. I weigh myself probably once every month or two and keep track of that.

You don’t want to – because pounds creep up and suddenly you are ten pounds overweight. And I track my steps because I work at home and you want to make sure you are moving your body. I exercise every day but man, if i don’t go out to the gym or go hike or do something like that –

[Damien Blenkinsopp]: Thank you very much for that. it is always interesting to hear what different people are focused on, especially when you are so involved in tracking yourself, so it is always interesting to hear what you focus on. Ronda, this has been an exceptional interview with tons of detailed information about how your app works and how you can use it. Thank you very much for your time today.

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Today’s episode takes a look at Methylation, it’s role and importance for many body functions, how it can enhance our quality of life and performance when running properly, or expose us to greater health risks like heart disease or cancer when it doesn’t.

Addressing methylation SNPs (genetic mutations that we all have some of to varying degrees) and related biochemical imbalances personally made a very big impact to the quality of my life, eliminating issues like migraine headaches, improving sleep, and enhancing my quality of life and productivity by smoothing out “mood dips and bumps”, and helping heal my body from chronic disease.

If you’ve listened to our other episodes you’ll have noticed that many of the guests have referred to methylation in some way. Because it affects so many people in so many ways, this is a topic that while not mainstream yet, is going to become increasingly so over over the next years. It has only just started.

Enter today’s guest, Dr. Ben Lynch. He is one of the people who has led the way in researching and helping both physicians and consumers understand methylation and how it is affecting them.

Dr Lynch is well known for his work and insights into treating methylation defects which has been his focus since 2011. He has done some incredibly detailed work in mapping out the various methylation pathways, how environmental and lifestyle factors affect them and how they can be supported. And as a result he is a highlight appearance at the conferences on topics related to methylation – which are growing in number and breadth.

His background is in environmental medicine and biochemistry and he has a doctorate in naturopathic medicine. He has worked with 100s of people with methylation defects, notably have started with the MTHFR gene (also “known as MotherFucker” gene because of the risk defects represent for cardiovascular health).

Besides insights into methylation, Ben makes some excellent points on how and when biomarker data is useful, what the most impactful actions are that we can take and optimizing methylation. I thoroughly enjoyed it and I hope you do too.

The show notes, biomarkers, lab test and links to everything else mentioned are below. Enjoy the show and let me know what you think in the comments)!

itunes quantified body

Show Notes

  • Methylation’s role in the body as a balancer of all the body’s functions.
  • How it drives detoxification via its production of SAMe (S-Adenosyl-Methionine) with links to Homocysteine and Glutathione.
  • The role of methylation as a deactivator of genes in the body and how under-methylation can cause a cascade of gene regulation problems turning genes on that typically aren’t.
  • Food, water and stress as the primary factors influencing the quality of our methylation.
  • Creatine – making up 70% of SAMe’s use, thus methylation, and its importance in athletic performance.
  • How epigenetics trump genetics with examples of the Agouti mice and the queen bee with completely different health, function and role outcomes.
  • The issues with therapies of supplements or foods targeting specific genetic SNPs and why they are unlikely to work.
  • Typical methylation related health issues like insomnia, anxiety, chemical sensitivity, digestive issues and fatigue.
  • Methylation’s role in mitochondria health and output via its production of Adenosine for the mitochondria’s use.
  • Measuring homocysteine, a recently popular metric for cardiovascular disease, and how it isn’t as straightforward as having high levels and supplementing to reduce them.
  • The range of labs and biomarkers related to methylation and what can be effecting methylation that Ben likes to look at.
  • Ben’s use of biomarkers and his strategy for making sure that values across tests are relevant and prevent a useful picture to identify issues or make clear assessments.
  • How eating sufficient protein can influence your dopamine and serotonin balance.
  • A look at the future of methylation and other areas: How Ben would like to see IT and applications get developed to predicts methylation biochemistry in connection with genetics and other biomarkers he’s looking forward to using and other important areas of development.
  • Ben’s current work looking into how supplements don’t work with certain cases to avoid creating the negative symptoms they sometimes drive with, in particular, people who are sicker.
  • The biomarkers and things Ben keeps track of for monitoring his own personal health and fitness.

Give some love to Ben on Twitter to thank him for the advice in this interview.
Click Here to let him know you enjoyed the show!

Dr. Ben Lynch

  • Connecting with Dr. Ben Lynch: You can connect with Dr. Ben in several places including his DrBenLynch.com (personal site), MTHFR.net (information on methylation and MTHFR specifically) and Seeking Health (his supplement company).

    You can also connect with Ben on both twitter @DrBenLynch and facebook Dr Benjamin Lynch.

  • MTHFR Basics: This book by Dr. Lynch provides an introduction into MTHFR.
  • Methylation Pathways Planner: You can download Dr. Ben Lynch’s map of the Folate and Methionine cycle and an 80 minute video training on folate metabolism.

Biomarkers in this Episode

  • MTHFR SNPs: Absolutely recommends getting tested for this via 23andme or other service, especially if you are planning pregnancy.
  • Red Blood Cell (RBC) Magnesium: The RBC Magnesium test is more often used for identifying magnesium deficiency as it provides a better evaluation than the serum magnesium, which can be high despite body magnesium deficiencies (very common in the population).
  • Serum Ferritin: The standard measure for iron in the body, most people’s levels, in particular men’s are too high. Ben discussed his wife’s inability to raise her serum ferritin because of pathogens in her gut sequestering it.
  • Iron Panel: Besides serum ferritin, other iron markers can offer insights into the functioning of iron metabolism. Iron panels often include serum iron, serum ferritin, TIBC (Total Iron Binding Capacity), Transferrin Saturation and UIBC. Chris Kresser has a good presentation covering the use of these iron biomarkers here.
  • Homocysteine: Ben discussed how it can be a useful value if it’s high, but if it’s low it’s not necessarily predictive of health risk factors. He also noted how it varies between children and younger adults versus older adults.
  • S-Adenyl-Homocysteine (SAH): The precursor to homocysteine. Ben sees it as a more useful test than homocysteine for diagnostic of methylation issues.
  • Biomarkers of mitochondrial function

    Ben mentioned several markers you can use as proxies for mitochondrial health and damage.

  • Lactate: Lactate elevation is an indicator of mitochondrial damage. Blood lactate is more accurate, but urinary lactate is more available via labs.
  • Lipid peroxidation: Ben referred to these markers generally. We looked at each of the specific lipid peroxidation markers in episode 4 on measuring oxidative stress.
  • Plasma Ammonia: Blood plasma levels of ammonia that are elevated can be an indicator of mitochondrial damage.

Lab Tests and Apps from this Episode

  • 23andMe Genetic Testing: The largest genetic testing service for consumers. You can download or connect your data from 23andme to better understand it with targeted applications looking at specific sets of genes. While health analysis data is no longer provided in 23andMe itself, you can simply download the data and use it with other gene analytics services.
  • MTHFR Support Variant Report generation system: This online application allows you to upload your 23andme data to it to get additional information about a wide variety of areas of your body including eye health, detox, tongue tie/cleft palate, methylation, allergy/mold, IgE, IgA, IgG, clotting disorders, thyroid, celiacs/gluten intolerance, mitochondrial function and sulfonotransferase genes.
  • Genetic Genie: Similar as above, an online application that allows you to upload, or connect, your 23andme data to it to get analysis of your detoxification and methylation SNPs (Single-Nucleotide Polymorphisms).
  • Doctor’s Data Adenosine Profile: Dr. Ben noted that he has been talking about getting Doctor’s Data to provide an Adenosine profile (not yet available).
  • Doctor’s Data’s Methylation Profile Plasma: A limited methylation profile that just covers the methionine cycle. Ben noted the usefulness of the SAM, SAH and SAM/SAH ratio in particular.
  • Health Diagnostics Research Institute – Methylation Pathways Panel: The most complete profile of methylation biochemistry currently available on the market – mostly used by Dr. Ben, notes that time lag of delivery of results is a bit slow.
  • ION (Individual Optimal Nutrition) Panel @ Genova Diagnostics: Ben uses this as a good place to start when looking for issues and things to optimize.
  • CDSA (Comprehensive Digestive Stool Analysis) or CSA (Comprehensive Stool Analysis): CDSAs / CSAs aim to cover a range of markers via a stool sample related to types of bacteria, to parasitology to digestive markers. Several labs run these tests with differing sets of analysis. Ben mentioned CDSA @ Genova Diagnostics, CSA @ Doctor’s Data and biohealth (this latter he found to be insensitive, not finding what he had found in other tests).
  • Mitochondrial Functional Profile: Acumen Labs’ mitochondria profile was mentioned by both Ben and Damien. The profile is used in research and clinically by Dr. Sarah Myhill.
  • Spectracell’s Micronutrient Test: Ben gave this test as an example of intracellular assessment of nutrients level, being better than traditional blood, serum or plasma levels. The spectracell looks at the nutrient levels in lymphocytes, a type of white blood cell.

Supplements

  • TMG (TriMethylGlycine): A supplement used in connection with methylation supports, and in particular can help lower high levels of homocysteine.
  • B-Complex: Another methylation support in the form of a B-complex combining B12, B6 and methylfolate. The Thorne version contains the active forms.
  • Creatine Monohydrate: As one of the most expensive molecules biochemically to exit from methylation, it can be helpful to support with creatine.

Other People, Resources and Books

Who should I interview next? Please let me know by clicking here

Full Interview Transcript

Transcript - Click Here to Read

[Damien Blenkinsopp]: Dr. Lynch, thank you very much for being on the show.

[Dr. Ben Lynch]: Yeah, thank you Damien.

[Damien Blenkinsopp]: First of all, I want to jump in to look at the area of methylation and how it relates to our health, performance, and longevity. What are the links with these objectives we have today?

[Dr. Ben Lynch]: With methylation?

[Damien Blenkinsopp]: Yeah, how does methylation impact our health, our performance, our longevity, our whole being, essentially.

[Dr. Ben Lynch]: Well it is central. It is absolutely central. So the mitochondria are the engines of the car and it seems that methylation seems to balance how everything works. So methylation is needed to create certain things in the body. So it creates SAMe, and a lot of us know what SAMe is.

SAMe is a primary methyl-donor which goes around the body and helps makes our neurotransmitters. It gets rid of them and it helps make a compound called phosphocholine for our cell membranes. Then we have quite a bit of methylation around. The body will say okay, we have got too much, and it will speed up one enzyme to help make glutathione and it will make creatine so our kidneys and our muscles will be happy.

So you can see a lot of issues with low creatine in people. It balances our immune system, it helps make immune cells, it supports creatine and CoQ10 formation, which are pretty important. It is very central. It helps regulate genes, turning them on and off. In fact, most of our genes are turned off and if we have low methylation then some of these genes will turn on and they will stay on and then we know what happens from that. The cancer can ensue. So those are some of them and there are probably some other major ones that I am not remember offhand.

[Damien Blenkinsopp]: Yeah, that is great. So does it play a role in detoxification?

[Dr. Ben Lynch]: Yes it does because methylation is a very small role if you look in the toxicology textbook. And when I read that I was kind of disheartened and sad. But at the same time when there is a lot of SAMe around, then SAMe will help promote the enzyme which takes homocysteine and moves it into glutathione. So homocysteine, which some people call ‘the evil marker’ on labs, if it is too low that is a problem and if it is too high that is a problem.

So we need to make sure there is adequate homocysteine because homocysteine will actually move into glutathione production. That in itself is a pretty direct connection between a major thing for a xenobiotic detoxification and glutathione is the mothership for that.

[Damien Blenkinsopp]: So to let the people at home visualize what methylation is, would you call it – is it like a biochemical process where the enzymes are many biochemical processes taking place through a whole line of enzymes which are required for the body? How would you explain it in a simple way or how would you tend to explain that?

[Dr. Ben Lynch]: I would say that methylation is a process by which there is a carbon with three hydrogens, which as a methyl group will bind and dock to certain thing. And it will bind to neurotransmitters. It will bind to chemicals, it will bind to DNA, but it seems the biggest methyl donor of the body is again [inaudible – 00:06:05]-methionine. And so what that SAMe does – methylation is a long, complicated process and there are multiple methyl donors.

Choline is one, SAMe is another one, methylfolate, glycine, and all of these are methyl donors because the body creates redundancy. Basically these methyl groups, as you said, will support various enzymes in the body and then these enzymes are proteins which do work. If these enzymes are malfunctioning due to various toxins in the environment or nutrient deficiencies, then these enzymes won’t be able to do work. And if you back up even one step further, where do enzymes come from?

Enzymes come from genes so if these genes are not functioning very well then they will not be able to make their end product. And so everybody knows about the MTHFR gene defect, making methylfolate needs that MTHFR enzyme, and that MTHFR gene to work so it can go in and do its job.

In summary, I would say that methylation is the process by which genes will produce an end-product which will then have a certain of functions and sometimes a singular function. And there are hundreds and hundreds and possibly even thousands of functions that are going on in our body that are due to methylation and I know that there are hundreds. There could be more than that. You need to also understand too that it is much bigger than that because think of a pyramidal shape – at the top of the pyramid you might have MTHFR and it is just one gene, but the downstream effect of that one gene will form a base of that pyramid. So the impact of that one gene not working is really broad.

[Damien Blenkinsopp]: Yeah, that can cascade down pretty quickly.

[Dr. Ben Lynch]: That’s right.

[Damien Blenkinsopp]: So what are the biggest methylation challenges that you see? Or the most common ones?

[Dr. Ben Lynch]: Stress, food, intake, and water I would say are the biggest ones. And I say that because if you work as a physician, you work with patients. And if you can modify their diet and their lifestyle alone then their methylation will balance very, very well. Of course, there are other things too like toxins in the environment, lead, and yeast overgrowth producing acetaldehyde and alcohol intake, those are other big ones. But I would say food, water and stress.

Stress is a big one because glucocorticoids, cortisol stimulate methylation. So you are saying well, that is good. It is good, but if you have ongoing stress you are pushing methylation all the time, which then means you need to be able to produce more methyl donors. And if you are eating McDonald’s or you are eating inappropriately and you are not eating your leafy greens or your grass-fed meats then your methylation is going to suffer.

So if you are under chronic stress and you are eating carbs to make you happy, you are not getting the proteins and the leafy greens and you are going to be in big trouble. Then it also goes back to our water levels here in the America that are pretty high in arsenic. And then so is our chicken because they use antibiotics laced with arsenic. And when they feed those chickens before they are butchered these chickens get bioaccumulation of arsenic throughout their life and then we eat that chicken. And then we eat another chicken and another chicken.

So our bioaccumulation of arsenic goes up. And then you have got arsenic in rice, which is a big issue. And then greens as well. So our bioaccumulation of arsenic is a really big deal in the United States and I think it is commonly missed. And arsenic is a real tough one to eliminate because it requires both glutathione and SAMe in order to get it out of the body. So our primary methyl donor and our primary antioxidant or detoxification compound need to be in their prime in order to get arsenic out of the body. And if you just have one or the other then arsenic transforms into a more brutal marker because our body will transform it into something more toxic.

So just the basic lifestyle being calm I think is really important. And another thing too I want to add to that really quickly about stress is not only does cortisol increase our methylation cycles but what neurotransmitters increase from being stressed? We have got norepi and epi. So these things also require methylation to get rid of. So if the norepinephrine increases then we need SAMe to convert norepinephrine to epinephrine, so again that is very catabolic.

And stress in itself is also very depleting of things like magnesium. And then also our adrenals might get shot and we might not be able to function very well and aldosterone levels might drop, so now we are peeing out sodium and other minerals that we actually need. So it is a big deal. So stress is a big one.

[Damien Blenkinsopp]: Right, so when you are talking about stress that is both emotion and physical. So it could be things you are doing like training?

[Dr. Ben Lynch]: Yes, excellent point – training and overtraining is a huge problem. I was a collegiate athlete at University of Washington. I did crew there and I wish I wish I knew about this. I would have been a way better athlete. But anyhow, creatine is a major user of SAMe and the more muscle mass that you have the more it takes for your body to make that creatine because your muscles will use up creatine.

So if you’re methylation is deficient and you are a bodybuilder then I know a lot of bodybuilders that supplement with creatine, which is great, but some of it is garbage. There are definitely inferior forms of creatine out there. But if you are eating grass fed meats and you are eating your veggies and not overtraining then creatine by itself is very important. They say that creatine and phosphocholine consume the majority of your SAMe in the body. I think creatine is about 70% of SAMe’s use.

[Damien Blenkinsopp]: Great. In terms of genetic defects we hear about the MTHFR and other snips – how big of a role are they and how important is this in the population compared to the other factors you have spoken about?

[Dr. Ben Lynch]: Well I would say that genetic factors are important but not nearly as important as the lifestyle and diet. So the epigenetics are what control the genetics. the epigenetics are the things that are around the outside of the actual gene itself – just our environment and our perception of the environment as Bruce Lipton so beautifully explains in his videos or in his book, the biology of belief. The epigenetics are so far more important than the genetics themselves. Do you ever watch that video, A Tale Of Two Mice, from NOVA?

[Damien Blenkinsopp]: I haven’t seen that.

[Dr. Ben Lynch]: Yeah, so you’re listeners need to see that. If you Google ‘NOVA A Tale Of Two Mice,’ you will see a perfect example of what I am talking about because these mice – I won’t get into too much detail. There are these mice and they are genetical. They are called agouti mice and they are genetically predisposed to cancer, cardiovascular disease, and diabetes. They are genetically predispositioned for this.

This means they will go through live and get it if their lifestyle and diet are going to be a mess. And so what they did is this mouse had little baby pups, mice pups. The pups were divided equally and they were genetically identical because they came from the same mom. They were absolutely genetically identical. They were divided in half and one group of these mice got methyl donors with their chow and the other group just got their standard chow.

Now they also had some BPA in there and that was another experiment because BPA messes up your methylation. But anyhow, the baby rats who were fed the methyl donors and the rat chow did not go on in life and get diabetes, cardiovascular risk, or cancer and their fur was a lot healthier. The other rats went on and they got basically everything under the sun. So that is a perfect example of epigenetics.

And another one that I like to talk about too is the queen bee. So the queen bee is genetically identical to the other worker bees but the epigenetics of them are totally different because the queen bee was nurtured and she was fed the royal jelly and all that. So that is another living example of how epigenetics is more important than genetics.

[Damien Blenkinsopp]: Great, thanks for making that point. I remember the rat and mouse from your Chicago presentation, actually. So is it worth us getting genetics tested for to identify snips in MTHFR and other area or do you think it is more worthwhile working on lifestyle first and then maybe later if we still have some problems looking at the testing?

The other question I have is doesn’t everyone have snips in some of the methylation process? We were just talking about how it has got hundreds of working parts to it. So isn’t everyone who has got some snips in part of the chain that is taking place in our body – we are pretty much all going around a bit and some of us are healthy and some of us are not so healthy. So like you said, is it more about the epigenetics side of it?

[Dr. Ben Lynch]: Well it definitely is but you have to take every situation in context for that specific individual. So while genetic testing is useful, and that is how evolution occurs – we evolve through mutations and these mutations can be hopefully selected and be an improvement for something in the future. So not all mutations are bad.

They have their various functions and even MTHFR has its benefits. But I would say if the person is going along and they are doing well, not going to doctors and not on various medications, they are just humming along and they are young and pretty confident in their health and how they are feeling and there is not much family risk, they look at their family and their family has a long life of good health and history, then I say it is not that big of an issue.

Now if you are born from a family that dies early, your parents are dying in their 50s or 60s, then you might want to be taking a moment, even if you are healthy because a lot of athletes, as you know, might look and appear healthy but the next thing they know they are in a wheelchair or they are dead. And they say this guy had super high risk for cardiovascular disease. Or he had the [inaudible – 00:00:16] genes and he had Alzheimer’s risk and his cholesterol was not normal but if you look at the cholesterol subfractions he was a mess. So sometimes you can just test for those things or you can look at the genetics, or you can do both.

Now, I am all about disease prevention and optimizing lifestyles, especially in unborn children. So if someone is looking to get pregnant then I absolutely recommend genetic testing through 23andMe and then running it through MTHFRsupport.com, with which I have no affiliation. Or these other things like genetic genie. The reason I say this is because there are specific genes which do mess up your methylation and it is good to know which ones they are. And then with proper education you can bypass these things. Also, if you look through history and see your family line was anxious, they had bipolar, they had breast cancer or various cancers, then again I think it is important to do genetic testing just so you can see which genes are the issue. And if you know which ones are the issue that you can focus more on that.

So it has its places in both sides where you can and you can’t. But it also depends on where you are mentally. If you think the genetic testing is going to scare you more than benefit you then I wouldn’t do it right away. I would maybe start with MTHFR and work on that or work on all the diet and lifestyle things so you can be less stressed out and then order the genetic testing under some false name if insurance kind of concerns you in the future.

[Damien Blenkinsopp]: I would like to talk about what is going to have an impact – so with some tests you can get a test but you can’t really take much action after that. So there is not that much benefit. It is nice to hear you talking about getting your lifestyle fixed first. That is probably going to have a big impact and if you want to refine things, maybe some testing will help you get a bit further. Is that the way you look at it?

[Dr. Ben Lynch]: Yeah, and I always tell doctors this because they come to conferences and they hear this term, methylation, and they see all these complicated pathways. And I say, ‘Look, you guys are already doing this.’ Diet and lifestyle are absolutely number one – food, water, sleep, loved ones around you, and getting some form of exercise. And breathing fresh air and all these things are so, so important and the basis of not having a toxic environment around you too.

So all those things sound very simple but in our current modern lifestyle we are not conducive to any of it. They are plugged into their phones all the time and so on. So the basic lifestyle is so, so important. And I cannot tell you how many patients I have worked with that have these genetic defects and that have gotten better with just the absolute basics. If you focus on the snips and you treat the snips, the genetic mutations or polymorphisms as a more appropriate term.

If you focus on these genetic variations and you give meds or supplements or even foods that target these specific genetic variations and you miss the big picture, you are going to be chasing your tail and you are not going to be going anywhere. So you have got to do all the basic groundwork first and I cannot stand when I see these genetic tests come back and there are long recommendations of a whole bunch of nutrients to take.

That just outright pisses me off to be honest and it is very self-centered and very incorrect because these patients will never get better because they are taking supplements or meds or certain lifestyle things that are targeted to their genes, and that isn’t right. You have got to do big picture.

[Damien Blenkinsopp]: That is great. Thank you for that clarification. I think one of the things is that we don’t hear about methylation that much and it is still kind of a new topic. So what kind of chronic health issues or symptoms do you think methylation can be related to that people don’t typically think of?

[Dr. Ben Lynch]: Anxiety, insomnia would be another one, fatigue, depression, addictive disorders, generalized fatigue, skin issues, digestive issues in terms of if you have ulcerative colitis or Crohn’s and obviously there is big picture there too, but methylation is a major component of that as well. Chemical sensitivity.

[Damien Blenkinsopp]: You have quite a long list. I guess the point is that it is kind of there and it is this big important part that you have been talking about but there is not a lot of information about it there and it links with that yet.

[Dr. Ben Lynch]: I think the best way to summarize that question and keep it as simple as possible is methylation has its fingers in every symptom out there. That is really it in a nutshell. It might not be a direct effect but it is definitely an indirect effect. So I would say whatever symptom is out there, methylation is playing a role somehow. So while it might not be the primary treatment thing to go after it is definitely something that needs to be looked at in every patient, no matter the symptoms or the condition.

It needs to be optimized all the time and it is constantly shifting. Methylation reactions are occurring in every single cell of your body every single millisecond. It changes based upon how you are feeling, if you are stressed out, if you are overtraining. If you are overtraining and running say, a marathon, and you are burning through all this ATP and your muscles are using a bunch of creatine and you are not re-supplementing yourself, then you might be depressed and fatigued after. And you are like, ‘Why the hell am I depressed? I just ran a marathon and I won the damn thing, but I’m so depressed.’ So it is connected to everything.

[Damien Blenkinsopp]: How do you think methylation relates to mitochondria and oxidative stress in the body? I am aware of problems with mitochondria and oxidative stress causing chronic disease as well now. So how does methylation relate to those two things?

[Dr. Ben Lynch]: From my understanding right now it is an indirect thing. And I am trying to put the pieces together more succinctly so I can explain it better. When you methylate there are leftover things and when your SAMe does its job of making creatine, then after it makes the creatine it makes adenosylhomocysteine and that homocysteine then will convert into adenosine. And we know what ATP is, adenosine triphosphate.

So methylation does form adenosine through its end reactions and it helps make this adenosine and while it is not the primary formation of ATP it is a big player because if your adenosine levels get built up for various reasons due to deficiencies in B6 or Kreb cycle intermediates – or end-products there like NADH, your adenosine if it gets too high will shift your metabolism. And we have shifts in metabolism in order to protect us. So if we are running we are primarily, in the first few minutes, we are probably mostly going through aerobic energy.

There are pyruvates going to acetyl-COA and it is making our NADH. But after a while our muscles are going to be running out of those primary – it is going to be running out of acetyl-COA and there is going to be adenosine building up. And then as that adenosine builds up it will be shifting pyruvate into lactate. And that is good, we need that anaerobic shift because our body can only fuel so much glycogen in the muscles and then that shift in metabolism occurs so we can run off of lactate.

The problem is that some of these people are running off lactate all the time. And if their adenosine levels are high because their methylation cycle is inhibited that is a serious problem. If your adenosine levels are high that is going to lead into metabolic disorders, diabetes, high cholesterol, fatty livers, and the end result of this is going to be cancer and death. So a long-term metabolic shift that is due to elevated adenosine, which comes from methylation, is a serious issue. And it is not looked at and getting tests and doctors to even know what adenosine is is a big problem.

There are very few labs that look at pyruvate levels or adenosine levels. They do look at lactate, and lactate is a very important marker to look at, but if you have fatty liver or your GGT or ALT or AST levels in your liver enzymes are elevated then your adenosine is up and you have got to fix that, now. And I think that adenosine is a huge marker. And I have been working with doctor data for the last few months. As you saw at Chicago I was beating them up during that conference. And they are coming out with adenosine on their methylation profile at some point here so I am very excited for that.

[Damien Blenkinsopp]: Great, and obviously I want to talk about some of the testing and the metrics and so on. Where would you start? If you have a patient would it be like a 23andMe genetics test or would it be something more like a methylation profile from the doctor data that you were just talking about?

[Dr. Ben Lynch]: Well when you say where would I start, do you mean where would I start initially?

[Damien Blenkinsopp]: Let’s say we have been working on lifestyle and these things are fixed but we still have some problems where some things are not optimum. Are there certain tests you tend to go to first because you find them the most useful? Biomarkers that you are looking for because they help elucidate the situation more quickly or tell you a lot more? They are a lot more actionable.

[Dr. Ben Lynch]: 23andMe I will get if I am struggling. So I will order 23andMe and it takes about a month or month-and-a-half to get. Once we get that done I will send them to Genetic Genie or MTHFR Support. And I like MTHFR Support report better because there are some genes that I told them to get that are on the report now, like GAMT for creatine for example, or phosphocholine production or vitamin A production.

[Damien Blenkinsopp]: So just for the guys at home, they have to download their data from 23andMe in a file and then upload it into these other sites, right?

[Dr. Ben Lynch]: That’s right, and if you go to those websites they will walk you through it. There are diagrams and maybe even a small video of how to do that. I know there is on MTHFR Support, the basic instructions, and it is very easy. But yes, you are right. Money is an issue and unfortunately it is for a lot of people.

I will do that 23andMe and I will just base everything off of signs and symptoms. And once you get good at it you can see these pathways in your head. But if you are not good at it you can see these pathways in your head. But if you are not good at it initially then I would be getting that methylation profile from doctor’s data and that is important to run but again you have to understand how to interpret it. And on [inaudible – 00:25:59] there is an article on there along with a podcast in the learning center about methylation profile analysis.

And I give a walkthrough of an actual test that I interpreted and discuss why these markers are the way they are. And I give various recommendations and that is a good thing to look at. So I would say with the methylation pathway I like organic acids a lot.

[Damien Blenkinsopp]: So you said that methylation – because the doctor’s data panel is called methylation profile, is it? Or is it the pathway? Because there is another company I know you have mentioned before and I have used before also, this Health Diagnostics. They used to be called [inaudible – 00:26:31] Diagnostics.

[Dr. Ben Lynch]: Yeah, I love their test. The problem is the turnaround time is pretty bad. But it might be hit or miss and I did hear from someone that if you call them for results and tell them to email the results it might speed up the return of the results by about three weeks. So that is worth mentioning, Health Diagnostics Research Institute. I think it is HDRI-USA.com or HDRI-Labs.com, something like that.

[Damien Blenkinsopp]: Yeah, we will put the links I am sure.

[Dr. Ben Lynch]: Okay, great. Their methylation test is the best out there right now. There is no question.

[Damien Blenkinsopp]: So what do you like about that versus the doctor’s data one then, for example? What helps you?

[Dr. Ben Lynch]: Well doctor’s data is basically – even Dr. [inaudible – 00:27:12] has stated that the methylation profile with doctor’s data is basically just a methionine cycle and it touches the transsulfuration cycle just a tiny bit. But we have no idea what is going on in the folate pathway. And the folate pathway is a significant pathway that leads into the methionine cycle and if we don’t know what is going on there, we don’t know why these markers are doing what they are doing in the methionine cycle. So you have to assume and assuming is not good. You want to know.

So the Health Diagnostics Research Institute will give all the folate derivatives, which is useful to the primary ones which is very useful. They don’t give the B12 in there, which I think would be nice, but you don’t really need it because if you see methylfolate as elevated and tetrahydrofolate is low, then you can know right there that there is a methionine synthase block of some sort, whether it is B12 or oxidative stress, lead, or yeast overgrowth or what have you. So I would say that Health Diagnostics is better in that regard.

They also look at adenosine. And adenosine isn’t in the methionine cycle but it is a beautiful marker once you understand how to use it. Again, I am still learning but I am getting better at it and I believe I know how to reduce it now. I know caffeine reduces adenosine, which is very interesting.

[Damien Blenkinsopp]: That is good news.

[Dr. Ben Lynch]: Yeah, for those coffee drinkers. I am not saying go and suck down coffee by the gallon, but –

[Damien Blenkinsopp]: Don’t quit your daily coffee.

[Dr. Ben Lynch]: Yeah, I mean a little bit of caffeine can be good, especially with D-ribose. I think some people, too, not to deviate too much but this is something I have recently learned, where if people aren’t doing very well in terms of they are getting post workout fatigue or soreness, that D-ribose is something beautiful. D-ribose is really important for producing ATP and it is very demanding to produce in the body.

So D-ribose and a little bit of caffeine, part of exercising, might keep that adenosine level low and then you might be able to use aerobic metabolism for a longer period of time before you shift into that lactic acid build up, the lactate. You might be increasing endurance that way. When it comes down to labs, if I am going to order labs what I would really like to do is just – they are expensive but you spend the money up front. Because if you order labs and one day you order the CBC and Chem and you get your serum ferritin and all that in there, your basic labs and you get those back and you find some things and you work on that.

Then you still have some symptoms and you order the CDSA and you look at the digestive function and you find some things there and you work on that and you say, you know, we still have some issues and you get the organic acids and you find that you are low in B12 or something else. And if you keep doing these labs this way then you are not connecting them. And the beautiful thing is if you order all those labs at once you can lay them out on your desk and you can stare at them with this built-in pathway planner which you have the privilege of staring at it in Chicago.

[Damien Blenkinsopp]: It’s huge, just for the readers. It’s huge.

[Dr. Ben Lynch]: Yeah, so I have got a whole new updated one so I will get you a new copy of that, Damien, for your listeners. So if you do all these tests at once and you look at it with the pathway planner then you can see how everything interacts and why maybe the CBC is bad because of this and this and this.

Or maybe why their methylation profile is bad, because of that and this and that. And you can see the underlying causes and you can say okay, look, now we know we have a pathogen in your gut and you are anemic and your iron levels are low, and your magnesium levels are low and your homocysteine is high. And your tetrahydrofolate is high and your yeast overgrowth is high and now we can say we have all this data and we can know why all these things are abnormal now, and the underlying causes are this, this, and this.

And so you work on those main underlying causes and you make such fast headway in the patient. It is an initial investment but the speed in which your patient can get better is tenfold because you are not chasing things. Now, mind you if the patient is under 30, or 30 and younger, and their main complaints are not that serious then would I do all this testing?

No, I would probably do most things empirical, meaning I just go for the lifestyle and dietary changes without looking at some labs but if it is the first, if they haven’t had labs done for years, then I would go ahead and do all this testing too. So it depends on if they have already had some baseline testing done. If they have never had baseline testing done then it needs to get done.

[Damien Blenkinsopp]: Right, so when you say baseline it sounds like you are doing – how many tests are you doing? Stool tests, urine tests, the methylation – ?

[Dr. Ben Lynch]: Yes, and I will get you that list too for your listeners. I have a list and I do what is called a roundtable for doctors. So I am going to Japan this fall and prior to going I am making them do all these different tests. And then what we are going to do is they are going to share their patients that are struggling to get better. And then I have a list of tests that I told them to get.

And so I will just get you that list if you like. Ion Panel by Genova is pretty good. The Ion panel looks at fatty acids. It looks at organic acids, it looks at amino acids. It looks at lipid peroxidation. So if you were to order just one test to keep it simple then the ion panel with the CBC chem panel would be something to look at. It is not perfect, no test is perfect. They all have holes, which is why I have a laundry list. But I think the Ion panel by Genova is definitely a good start.

[Damien Blenkinsopp]: So I guess one of the main points there is a lot of these tests are about biochemicals and they are not long-term markers that are changing over time and they are connected to each other. So unless you get the whole picture, like you are doing, then if you work on some problems with the CDSA then the methylation test you get could be different and it might not fit with the problems you have identified in the first place? You are looking in the wrong direction. Is it because the biochemicals are moving around too much?

[Dr. Ben Lynch]: That’s right and not only are they moving around too much, but why are they moving around? So if you order that methylation profile in 23andme because you are a doctor that specializes in methylation – and this is a big problem too, because methylation is not the tool. It is another tool.

If the patient comes in, they come to you because you are the methylation expert and you to MTHFR and the 23andme and the methylation profile and you just work on those things, and then you could be missing the underlying picture of why their methylation is wrong in the first place. And I cannot tell you as a physician – I would slap myself in the face multiple times for missing screening for pathogens.

And screening for pathogens is so hugely important because we are so susceptible to them now because of this stress and the lifestyle that we have and the likelihood of us having a pathogen is so high whether you have symptoms or not. And if you don’t have symptoms that is because you are supporting it through your lifestyle and diet or supplements or meds trying to mask the destruction that pathogen is doing on you.

So my point on this is that if you order the methylation test or your CBC and you get the things back and you work on that you might be missing the underlying picture of arsenic exposure or perhaps there is no pathogen there and maybe there is lead or mercury or maybe there are mercury amalgams in their teeth or root canals that were done that were festing anaerobic bacteria. That is why it is important to do all of these tests first so that you can see how all these things are.

And I have recently learned too is that some doctors already know this stuff but it just takes forever to link everything – but iron. I had my wife, for example, her serum ferritin just doesn’t go up. It just will not climb and her RBC magnesium too is just chronically low. And I have very good nutrients to work with this with all the cofactors and everything it is still low. Like, what the hell. And so RBC magnesium – I was reading this book and I don’t remember the title but it is by Dr. Myhill and it is her new one.

She talks about RBC magnesium being chronically low in people possibly because at rest I need to find a research citation to see if she is right or not but she says at rest 40% of ATP is utilized for moving minerals back and forth between the cell membrane. It’s like holy God, that’s big. So 40% of ATP at rest, not at exercise but at rest, is to move sodium and calcium and calcium and magnesium across the cell membrane. That’s big so magnesium has to be pumped in and so does potassium.

Potassium is a huge component that I think most people are deficient in. But my point here is RBC magnesium, I mentioned ribose earlier and this is also from Myhill, that she thinks that if people are chronically low on RBC and red blood cell magnesium it might be because their D-ribose levels are too low because their ATP levels are too low. And I give my wive ribose and I recommend it to her, but is she compliant? Sometimes. And the serum ferritin is low I believe because pathogenic bacteria in the gut, which we have recently found from the CDSA by doctor’s data is she has some pathogens in the gut and they suck up iron like crazy.

So why we are taking these nutrients, these high-quality nutrients – the pathogens in the gut are taking them all. And if you have yeast overgrowth in the gut then these things the yeast are using, your B1 and magnesium, to make acetaldehyde which is then converting to ethanol, which is disrupting your methylation cycle. So the gut is so central too – and I would do the ion panel with the CDSA probably first, and I like the RBC.

[Damien Blenkinsopp]: So the CDSA is the doctor’s data stool test?

[Dr. Ben Lynch]: I like that one.

[Damien Blenkinsopp]: Versus say metametrics or some of the other ones?

[Dr. Ben Lynch]: Yeah, there are a lot of them out there. I think Genova’s is getting better. I didn’t like Genova’s for a long time and I think GI stool effects was not very good. I like doctor’s data. I ran another one and I think I ran Biohealth and it came back with basically nothing so that everything looked fine. I did it for my whole family and I didn’t trust it, no way. And so I did the doctor’s data and it came back with all this useful data, so it is very important that you order the right test too.

[Damien Blenkinsopp]: So are there any methylation or other tests you have done which you didn’t find useful, whether it is for accuracy reasons that you didn’t trust or other reasons?

[Dr. Ben Lynch]: Well I would have to think about that one for a while.

[Damien Blenkinsopp]: I think you mentioned in a presentation homocysteine and it is in all of the main labs like LabCorp and Quest and so on, and it is obviously something that lots of people are getting tested now. How do you find that test, for example?

[Dr. Ben Lynch]: Well homocysteine is good if it is high, so if it is high it is useful and you know there is some type of blockage going on. And when I say it is high I am not talking about the standard range. I am talking higher than seven in an adult. Now, in kids homocysteine levels tend to be lower. And I think they are lower so normal in a kid say under 14 or so, shooting from the hip, I have it somehow in the forum of [inaudible – 00:38:20] and I need to remember the range is here and it is important. But anyhow younger kids have younger homocysteine levels.

So they might come back at five and he is like oh, that is too low, I need to work it up. No, they naturally run low and they naturally run low, probably because methylation cycles is humming along super quick because of their growth. So the younger you are the more methylation you burn through because you are growing. Look at autism, their methylation cycles are messed up and these kids are hurting big time.

But with homocysteine, my point here is that homocysteine is a good marker of a tie and the problem is that it is extremely rudimentary and we don’t know why it is high. So it is important to know why it is high but at least it is high. So doctor’s might take some action and get some B12, B6, TMG, methylfolate and so on, but the problem is if it comes back low, as you saw Dr. [inaudible – 00:39:06] lectured on about homocysteine and S-adenosylhomocysteine in the cardiovascular risk patients, because there is research out there that says look, homocysteine levels are not correlated with cardiovascular risk and you say well BS because all these other papers look at homocysteine and it is related to cardiovascular disease.

But some of these papers that are actually published are legit and they say homocysteine isn’t. But now if you look at S-adenosylhomocysteine, S-adenosylhomocysteine levels can be elevated while the homocysteine levels are normal and they are correlated. So those two things will be correlated to cardiovascular disease. So homocysteine, before you get to homocysteine is S-adenosylhomocysteine. I think while your listeners are listening to this show they should have this pathway popped up so they can follow me along a little bit but S-adenosylhomocysteine is above homocysteine and that pathway is bidirectional. SAW goes to homocysteine but homocysteine also goes back to SAW, so it goes two ways. So that is important to know, that homocysteine goes back to SAW preferentially.

So if you are to draw and write homocysteine on your piece of paper and homocysteine is your left hand and SAW is your right hand – there is going to be a bigger, heavier arrowhead moving from left to right from homocysteine to SAW than there is from SAW to homocysteine. So the pathway to moving back from homocysteine to SAW is fatter and now if your SAW is elevated your adenosine can get elevated. And if your adenosine gets elevated then it is metabolic syndrome, it is diabetes, and so on.

So you are absolutely right that homocysteine is very rudimentary and that is why methylation’s profile by doctor’s data is not as good as Health Diagnostics but at least it does look at SAM SAW and the ratio.

[Damien Blenkinsopp]: So that is right, the SAM SAW and the ratio, that is what you find useful in that one.

[Dr. Ben Lynch]: That’s right.

[Damien Blenkinsopp]: So another thing you just mentioned is some of the reference ranges are a bit different. Is that in a lot of the tests? Some of these tests are a bit young as well, like the methylation pathways from [inaudible 00:41:12] Diagnostics or [inaudible 00:41:14], as you said. Now, I am not sure how much data they actually have in a database to establish what a reference range is and what kind of populations – so how do you go about looking at reference ranges?

[Dr. Ben Lynch]: You have to remember that just like you said earlier a lab test is a snapshot in time. So I am going to answer your question here and I am a little bit delayed, so if I get too off track you can hit me on the head and I will get back to the answer. But in short a lab test is a snapshot in time.

So if you are stressed out and you are stuck in traffic to get to the lab test and somebody cuts you off or there is construction and now you’re late and the doctor is bitching you out for being late or the kids are screaming in the back of your car and then you draw your blood for the methylation test – it might make some impact. And then if the doctors don’t handle – or the lab tech doesn’t handle your sample properly, there can be some issues there.

Then it finally gets to the lab and maybe it gets lost in transit or maybe it is sitting in the back of the FedEx truck for a couple of extra days and that sample gets messed up. Maybe it doesn’t and say everything now is still on the way just fine and there are no hiccups, and then the sample gets processed in the lab and is done by humans – humans can sometimes make errors like adding too much reagent, being tired and not writing things down properly, or maybe the computer isn’t reset or reconfigured every morning and then didn’t do it properly that day.

They put the results on a beautiful PDF that looks fantastic and they have these little ranges on there and you get the results back and you are like, ‘What the hell? This doesn’t look right.’ You always need to look at the lab as a piece of paper and you need to match that to how your patient is at the moment. So if the lab comes back one way and your patient is completely the opposite, maybe the lab is right. But most likely I would say this is possibly a lab error.

Now, getting back to the ranges, I know for a fact that the Health Diagnostic Research Institute – their lab values for that methylation test was they tested 100 medical students. Now, when I was in medical school I was the sickest I had ever been in my life. I was tired, I was just run ragged and med school is the toughest thing I have ever done in my life besides rowing for UW. And I would say how healthy were these medical students? Were they drinking? Were they not?

Using the word ‘healthy’ medical students is such an oxymoron to me. So that is where those lab values came from, those ranges. So you have to keep that in mind. The ranges on all lab tests are coming from the population to some degree. So in our population as a whole it is pretty sick. I don’t know the historical thing but there is a really good book out there. Do you know it, Damien? It is about homocysteine. I think it is called – could it be your B12 levels? Or is it your B12?

[Damien Blenkinsopp]: Yeah, that was one of the first ones.

[Dr. Ben Lynch]: And that is a pretty good little read. It is pretty basic and it is pretty good to read and he talks about, or I believe – or she – the ranges of homocysteine and how they have historically elevated. And look at arsenic – George W. Bush, Jr. increased arsenic levels that are “safe.” So the safety level of arsenic now has been inflated over time. So the ranges – you are going to really have to take those with a grain of salt and again match it with your patient.

And I know some doctors can really dial in where they like the ranges and it would be so great if doctors could share their data, saying I find from my clinical experience that this range is the ideal one. But for some reason they latch on to these things and they keep that information private, and I don’t know why. But yeah, so homocysteine I believe a lot of them say it is greater than 11 for an adult and some even say if it is greater than 15, and that is way too high. I would say 7 is ideal, or 9 you have definitely have some work to do.

[Damien Blenkinsopp]: Yeah, and coming back to when we spoke a couple of times about supplements and we spoke a couple of times about supplements and we spoke about people using supplements to lower homocysteine. So some people have done some work on their methylation and some of them have been taking supplements, the B vitamins, the folates, and other supplements for their methylation and they will feel better.

But as you were talking about earlier the underlying condition – they basically have to take these supplements all the time now to keep themselves going. Is that a good idea? You were talking about continuing to look for the pathogen or whatever causes it. Are there dangers from supplementing? Or do you think it is a good idea to control symptoms for a while if you are still trying to figure things out and you should always be aiming to get off of them?

[Dr. Ben Lynch]: Palliation is removing the symptoms and the irritation of whatever is causing disturbance in your patient or yourself quick – that is what drugs do fast, super fast, unless they are causing other issues. I call it drive-thru medicine. You go to your doctor and say, ‘I’ve got a headache,’ and they prescribe headaches.

And maybe your ergonomics at work are not right or maybe you are not drinking enough water or maybe you are drinking aspartame or you are sucking down caffeine all the time – there are a million reasons for headaches. But if you are taking an aspirin and the body is saying, ‘Hey, listen to me and fix it,’ and you tell it to shut up, I am taking an aspirin – now, you are telling it to shut up too if you are taking methyl donors and you are not addressing the alcohol intake that you are drinking every night if you are drinking beers and wines and whiskeys and vodkas all the time.

You have a job as a real estate agent and you are celebrating house closings all the time with your patients. Then yeah, it is a social thing and it is fun to have your wine but if your methylation is not appropriate or you have yeast overgrowth in your gut that is inhibiting your methylation or you have got lead toxicity.

If you order the lab tests and you see your methylation is messed up due to the lead and you know you have elevated lead – or say you don’t know you have elevated lead but you are bypassing it with these methyl donors, these methyl donors only do so much. But the lead is still causing oxidative stress. It is still blocking other pathways that have no relation to methylation. And so while some pathways are being bypassed, others aren’t. So it is a big deal to address the underlying cause.

Let me give you a brief example here. I had a friend of mine who was drinking not a lot but he would have a few beers every night. He would wake up tired and his kidneys were sore and he was getting kind of sick of it and he asked what to do. I told him to quit drinking and he just kind of looked at me and laughed. So I said all right, take some B vitamins.

So he took the B vitamins for a while and that helped but after a while it didn’t and I said, ‘Well, now I know about methylated B vitamins, so take the methylated B vitamins. So he started taking those and he wrote to me and goes, ‘Thanks man, now I can drink even more and I wake up in the morning feeling fine.’ I was like that really defeated the purpose. But now he is making more but he feels fine.

Then I told him that drinking was a mitochondrial toxin that was affecting his mitochondria and that leads to a big issue. And that got him because he was a former athlete too and he likes to be fit. So as soon as I told him that alcohol is a mitochondrial toxin he went, ‘Oh crap,’ and he stopped drinking pretty darn fast.

But he kept going on these methylated B vitamins and he was just taking additional methylated folate and B12 as well. And he was starting to get really irritable and angry. Before he was just fine and then he just kept taking it. And he didn’t tell me this and we would talk about what I was doing these days and talking about niacin and if people took too much.

So one day he was driving down the highway and he had auditory hallucinations. The radio was off but he was hearing the radio. He kept cool because he knew it wasn’t him. He knew something was wrong and I remember Ben telling me that this could happen. So he stopped the methyl folate and he started taking niacin and everything was normalized. And then he stopped taking the methyl folate at all. He just stopped taking it. And he reduced the methylated B and he became fine.

So my point is that he had this environmental trigger that his body had to handle, which was alcohol and acetaldehyde. So his body was using all these methylated nutrients to clean up that garbage but as soon as that garbage was no longer coming in, too much of that nutrient now was causing other things. So he stopped it and lowered his dosages significantly. So I usually tell people before they reach for a supplement bottle to understand what it does and if they need it or not.

[Damien Blenkinsopp]: There are a lot of these polymorphisms. Are there any situations where you have a polymorphism in your methylation process where you may have to take a supplement for a long period or maybe forever?

[Dr. Ben Lynch]: Yeah. I don’t know what that is yet but I would say let’s look at a couple real quick. With MTHFR if you have the 677 homozygous variant then your ability to make methylfolate is reduced by about 70% to 80%. So you are making about 20% of methyl folate compared to the standard person who has no MTHFR.

Now, if you are eating a lot of leafy greens in general and you are also eating grass fed meat and you are not that stressed out and you are leading basically a perfect life then you might not need methylated folate. I think those with MTHFR 677 might need some methylated folate to some degree pretty much the rest of their life but if they are getting it through their uncooked leafy greens and they are definitely eating quite a bit then I think they are going to be good through that.

Now, there is a paper I talked about that is on the video at MTHFR.net – a lot of the information there is dated but it is still pretty accurate. That video there is free and I show the polymorphisms in various populations like the Chinese, Indians, Hispanics, and so on, that have a very, very high rate of – Italians, too – that have a super high rate of MTHFR.

Now at the end of that video I talk about neural tube defects in Mexico and the United States being related to folate. Then they did another study that looked at neural tube defects and MTHFR, Hispanics, and the Americans and those were all directly related. The researchers also looked at Italians in MTHFR and neural tube defects, and there was no correlation.

So the neural tube defects in Italy, these people with their lifestyle seems very protective, even despite the MTHFR polymorphism over there. So they eat a lot of salads and they drink a bit of wine that is a little bit as good, and not too much not. And their lifestyle is a lot less hectic than us Americans and we chase this American dream which is just a complete nightmare for people. So the American dream is the American nightmare – I think it should be renamed.

Then if you look at another gene – GAMT of creatine, I think people with the GAMT polymorphism may benefit from taking creatine and some form of creatine or at least eating meat. If you are a vegetarian and you have GAMT then you are probably going to be in trouble.

[Damien Blenkinsopp]: That is interesting that sometimes it can inform your lifestyle choices as well.

[Dr. Ben Lynch]: Yeah, and vegetarians and vegans – I was a vegetarian for a while and I felt terrible. Looking at my genes I think I could understand why, plus I didn’t know how to be a vegetarian properly. I was a carbitarian and I didn’t eat properly. I think if you are a vegetarian and you know how to eat very well and you are supplementing with choline, creatine, phosphocholine and B12 then I think you can be okay.

But some of the most ill people I have worked with are vegans and vegetarians and I would say the majority of women that have had recurrent miscarriage or can’t get pregnant were vegans and vegetarians. So in most pregnant women whether they are vegans or vegetarians or not, most pregnant women are deficient in choline. And most cancer patients are deficient in choline as well. So choline is a very, very important nutrient and that comes from meat, plain and simple.

[Damien Blenkinsopp]: And our friend, liver, in particular.

[Dr. Ben Lynch]: And our friend liver, yeah.

[Damien Blenkinsopp]: Great, thank you for all of those insights. I want to round off with a couple of questions a bit more about where you see things going over the longer term. So in the next five or ten years with this whole area of methylation, where would you hope it would go? What kind of things are you excited about in this area?

[Dr. Ben Lynch]: Well I am most excited about disease prevention with it and I think if it is utilized properly, meaning still focusing on lifestyle and diet and the basics, I think if there is a company like 23andMe that provides very clinically relevant polymorphisms and not a million polymorphisms that may mean nothing – but reducing it down to one 8.5 by 11 report of genetic polymorphisms that are very clinically relevant, that have been researched, that can bypass through lifestyle, diet, and nutrients, I think that would be very useful.

Right now there are a lot of polymorphisms that are published that may or may not have any clinical relevance. And I think that the 23andMe has – even with MTHFRsupport or Genetic Genie I think there are variants on that test report that are bogus, meaning no clinical relevance. I would like to see variations that are clinically relevant with actionable steps and understanding how to take action on them in simple, systematic ways and not so complex and convoluted – which I know some of my presentations can be.

I am trying to simplify things and would would be really cool too is to have some type of computer program that looks at all the polymorphisms that individual has along with their lab markers that are off, their diet, lifestyle, heavy metal exposures, and so on. You plug all that information into a database and the computer program will spit out some generalized recommendations for the physician to evaluate such pathogens or heavy metal screening or some certain things to look for, or nutrients that they absolutely must be taking and nutrients and meds that they absolutely should be avoiding.

So computerizing this I think would make it a lot more actionable. And also with prenatal screening, I think every person now should be taking some type of genetic screening that are actionable. There are things out there called Counsyl that looks at genetics that cause issues in the fetus during development. And why that test is useful – it also scares the hell out of the future parents, and having fear while you are pregnant is definitely no good because fear also messes up your methylation and a bunch of other pathways and blood flow to the baby.

So if you order a test which has actionable things that they can do through diet and lifestyle and the mother knows that and so does the father, because the father’s genetics are also significantly important for the baby’s development too, then I think that is the way to go. So I think that, in a nutshell, for disease prevention is important. And also mitochondrial disorders are really severe and you see a lot of early death in people who have mitochondrial dysfunction.

And as you may remember from the Chicago conference I talked about maternally-inherited mitochondrial disorders, because mitochondria is basically inherited from the mother. If you see a list of diseases that are all down from the mother’s side of the family or the women’s side of the family then it is probably a mitochondrial disorder and if you do any genetic testing on that you might be able to support the mitochondria immediately through NADH, COQ 10, glutathione, and so on. So again, I think disease prevention automation and specific targeted recommendations is where I would like to see it.

[Damien Blenkinsopp]: Yeah, in terms of tests is there anything that you see missing? I know mitochondrial tests, for example, you mentioned Sarah Myhill and I know she has a test she is doing, but I don’t know many other tests. Are there any other tests you feel would be useful to be available or are hard to access or they need further development?

[Dr. Ben Lynch]: Yeah, tons of them. And I would love to see this stuff on one panel and I have notes on these things trying to get other labs to look at it. So Acumen Labs, that is over in Wales or UK, Myhill promotes and works with a lot. Again, a test like this – not to spend too much time on it, but they were looking at a snapshot of ATP, ATP’s realization, and so on. And some of those tests look at causation too so I would say those are good tests. But would I necessarily order those? If they are not too expensive, yeah, and if they are expensive, no.

The reason why is because if I see lactate elevated on a patient, lactate is a very readily-available marker. So if lactate is elevated then I know immediately that the mitochondria in this patient are suffering, along with lipid peroxidation. If lipid peroxidation is elevated then we know their cell membranes are getting damaged. And if their cell membranes are damaged, then their mitochondria will be damaged.

I want to give you the markers now that are already available. So lactate, lipid peroxidation are great. Ammonia elevation is also a marker of mitochondrial dysfunction because mitochondria process ammonia, for the most part. So if that is elevated then we know the mitochondria are not working very well and creatinine is a great one for that as is general mitochondrial support. And so looking at –

[Damien Blenkinsopp]: You mentioned that it was difficult to access. Is that urine?

[Dr. Ben Lynch]: I don’t know, I don’t know what is better. I think blood lactate can be either, but I know urinary lactate is available. And I don’t know about pyruvate. And now looking at B12 – B12 is a nightmare. There are really no tests – well, I shouldn’t say that. Holotranscobalamin and methylmalonic acid are pretty good for B12.

You can look for macrocytic anemias too, elevated MCH, MCV, but those can be missed because you could have normalized MCV, MCH and still have a masked anemia because of folate, so a masked B12 anemia, I should say. So you want to be looking at methylmalonic acid and you want to be looking at holotranscobalamin, but the issue with B12 is if there is low glutathione reading about this now I have a bunch of papers on it actually, but glutathione is needed to carry B12 around and so if the patient has low glutathione their B12 levels may look elevated on the lab tests and serum cobalamin.

So serum levels of pretty much anything are not that useful. You want to look at intracellular and if it is an intracellular nutrient. And we know that B12 has to get into the cell. So if you see a serum folate and serum cobalamin elevated and your red blood cell, B12, and folate, I know Spectracell looks at T-lymphocyte testing for B12 and folates and that is intracellular, so that can be really useful for people.

Now to answer your question about tests that I want to see in the future, if you want to see oxidation, I want to see oxidized biopterin and reduced biopterin. These labs are looking at biopterin but they are not telling you if it oxidized or reduced. And if your biopterin levels are oxidized – say your biopterin levels are normal, but your patient still is having neurological symptoms or cardiovascular symptoms or they are having some type of mental or emotional imbalance.

Biopterin is really critical for this because biopterin recycles and helps revert your tryptophan and serotonin and tyrosine into dopamine and your arginine into nitric oxide for your cardiovascular systems. So with these things if you have oxidized biopterin and your biopterin levels are normal then this is going to be an issue so oxidative stress – if you measure oxidative stress this is why I also recommend looking at multiple tests at once, not just one at a time.

This is a beautiful reason why. So if their B12 levels are elevated and their folate levels are elevated in their serum – if their biopterin levels are normal but their oxidative stress is high and you know their oxidative stress is high through their lipid peroxidation, their lactate, and their glutathione levels are low and glutathione peroxidase enzyme is high or superoxide dismutase levels are high or their manganese levels are low and their zinc levels are low and so on.

If you put all these together you can immediately understand and say, ‘Hey, your oxidative stress is high and it is disturbing all of these enzymes downstream. It is messing up your glutathione, it is messing up your biopterin, your B12, your folates, your cells. We have got to get that oxidative stress down. But we need to understand your oxidative stress is elevated in the first place. So you can bypass the need for these new tests that I want to come up with if you order all these different things at once. But it is expensive, it is a pain in the ass, and it is time-consuming.

[Damien Blenkinsopp]: So it would be better if you could go straight to – it is kind of like you have to take these proxies and these indicators rather than getting directly at the issue.

[Dr. Ben Lynch]: Yeah, inflammatory cytokines can be really useful to look at, So [inaudible 01:02:00] 1, 6, 10, and then if you look at TNF alpha, these are coming back elevated and that can be a problem but again, why are they elevated? These mess up things too. I would like to see different forms of B12 and I would like to see adenosylcobalamin, I would like to see cobalamin itself, I would like to see oxidized cobalamin, and I think that would be very , very useful.

[Damien Blenkinsopp]: Especially with so many people supplementing these kinds of things.

[Dr. Ben Lynch]: Yeah, and if they are taking B12 and most of that B12 is going to oxidize cobalamin, which is causing more damage to their body, then they need to stop taking that B12, support the glutathione, but if they can’t support the glutathione because they are reacting to the sulphur or they are not hydrated enough, then that’s a problem. If they have urinary – they are not peeing well for various reasons because of dehydration or what have you, taking glutathione could be a big problem.

Or if they are sensitive to sulphites, glutathione if you take it then it can build up your cysteine levels and your cysteine levels go down and they make sulphites. That could be a problem too, so if people feel like crap taking glutathione, it could be they are not hydrated or their cell membranes are not appropriate, they are not healthy, or their sulphites are messes up and too elevated.

So it gets tricky fast, as you saw in Chicago, because I try to teach all this in an hour-and-a-half, just like we are talking now for an hour-and-a-half. But the point is just take this stuff and listen to it and relisten and if you glean one or two things from this, that is great. And if you listen to it again you might glean something something else or you might have an a-ha moment for this particular pathway in one patient and an a-ha moment for a different part of this combination in another patient. So it is bit by bit.

[Damien Blenkinsopp]: So you are obviously doing a lot of work on this research. What are the most important things coming out for you in that area? What are you working on right now, maybe for next year? What is the most interesting for you?

[Dr. Ben Lynch]: What is most interesting for me right now is why people react unfavorably to certain nutrients, like methyl folate, B12, glutathione, and so one and then understanding how to identify these patients before they even take these nutrients to say hey, you have this and this and this. You need to optimize this and this before you take this and this.

That is what I am working on right now. I am trying to prevent patients from flaring by identifying where they are currently and if they can respond to a particular nutrient or not and getting the reason why. That is what I am working on because I know that the majority of patients who are under 30 or even under 40 and they are not too bad, a lot of them can be taking these methyl donors and feel great.

But you start getting in the conundrum cases with the Lyme patients, the autistic patients and so on – the cancer patients. And if you start with them out of order you can flare them. If you flare them you lose patient compliance and you lose trust and it can take longer for them to get better. So what I am doing now is trying to do that work flow.

Part of that work flow seems simple when I say it like that, but the issue is I am tying it to the mitochondria and I am tying it to the hormones and inflammation. So I have always had a big hole in hormones and so I am looking at hormone-related connections. But if you look at hormones, how are hormones affected? Well, they are affected by methylation, inflammation, and mitochondrial function. And Sarah Myhill so eloquently stated in her recent book that every single pathway in the body is affected by mitochondria.

So my biggest focus right now is mitochondrial health, which is I am reading her book, because she is very well-versed in it. I agree with a lot of things in her book and she has provided me quite a bit of insight. I also disagree with a few things in her book but that is how medicine is. None of us are perfect and I say things that are wrong and we will collaborate and I will give Sarah a call or an email here at some point after I finish her book. But what I am working on now is that and when I was at that part two conference at [inaudible 01:05:57] and there were 300 docs there and I asked them what do you want me focusing on next? A few things were brought up and then I said, ‘What about mitochondria?’ And then the whole room was just in an uproar. Right now it is mitochondria in a nutshell.

[Damien Blenkinsopp]: Yeah, have you connected with Dr. [Terry Wyle 01:06:14]?

[Dr. Ben Lynch]: No, I haven’t. I know of her book and I know what she went through. I have read her book. I haven’t connected with her yet but she is another one I need to look into. And her book was pretty basic for me but she definitely recovered, which was beautiful.

[Damien Blenkinsopp]: I spoke to her a couple of weeks back so maybe I can connect you with her if that is interesting for you.

[Dr. Ben Lynch]: Yeah, that would be great, it definitely would be. And my thing too is this is all about collaboration. The stuff I am working on is the stuff that I want to give out and give people and not holding and hoarding. If I am able to help a doctor or two or 1,000, then that is my ultimate goal here. So the more doctors I can work with and collaborate with, the better.

[Damien Blenkinsopp]: And the more feedback you get as well so that is useful to you as well.

[Dr. Ben Lynch]: Yeah, exactly. Every doctor out there has got something that I don’t know. So Terry is going to have something I don’t know for sure and she might answer the puzzles faster than me sitting here in my office, digging through PubMed and she is like I wish I knew that ten years ago.

[Damien Blenkinsopp]: Yeah, collaboration is definitely the way to go. So what would be your number one recommendation to someone trying to use data to help them with the area of methylation? Is there once piece of advice you would give them?

[Dr. Ben Lynch]: Don’t be biased – look for bias. I don’t know if that is what you are going for, but bias is a big problem in research. So if you are reading papers and you are trying to gather data or you, yourself are working on a particular project make sure that you are eliminating bias. And I say that because when I got called in to present to the Cancer Treatment Centers of America and they wanted me to talk about MTHFR I quickly told them that cancer is about more than just MTHFR.

And I could have presented an hour-and-a-half on how MTHFR is related to cancer but I would have done them a major disservice because there are a lot of articles out there and papers that talk about MTHFR and how it is not related. So I could have presented an hour-and-a-half of totally biased research and when I say bias I mean personal bias. And some of these papers on MTHFR and cancer, a lot of them are totally legitimate saying that MTHFR isn’t related and some of them saying it is.

I think it is a bigger picture than this. And that is another thing, to keep the bigger picture. So if you dial down into MTHFR is not related to gastric cancer then you need to understand the bigger picture. You have got to zoom out, so keep the bigger picture when you are collecting data and you can’t forget the basics of diet and lifestyle. And I think that is so hugely important and compliance is super important and however you get your patients compliant, whether it is with 23andMe and MTHFR tests and you plop down in front of them and say, ‘You are a mutant,’ or you tell them, ‘Mitochondria are being destroyed because of your alcohol.’

You have got to find that pain point for that particular individual to get them compliant. So anyway, I would say keeping the bigger picture, don’t zoom in too close and make sure that you are not being biased and you are not reading papers that are biased.

[Damien Blenkinsopp]: Great, thanks for that. Okay, last question – looking at yourself, are there any data metrics or biometrics that you track for your own body on a routine basis yearly or whatever it is?

[Dr. Ben Lynch]: I look at fatigue for my own. I don’t look at data points and I look at my fatigue and my mental capacity and my moods. I look at a few data points with me personally. So if I am more tired than I should be then I ask myself why and then I review what I have been eating, if I have been more stressed, or if I am not exercising or exercising too hard. I am 40 years old now and you hit 40 and your mitochondria slow down more and more.

So I would say I look at my ability to think and my ability to maintain endurance, not only mentally but also physically. Muscle mass I think is super important because the more muscle you have the more mitochondria you have, so I am going to be starting lifting here soon so I can restore my glycogen and make more ATP. Muscle mass is a very important marker to look at. I am not going to be the Incredible Hulk by any means but if I am 213 pounds now I don’t know what my body fat is, probably 10 to 15.

But when I was rowing at UW I was 213 pounds and I was 4% body fat. I am not going to be 4% body fat again probably but I look at leanness and weight and the ratio of muscle to fat, so being fit is a marker that I am focusing on right now.

[Damien Blenkinsopp]: Great, thanks for that. Those are very interesting ones. Also the mood is something I think a lot of people don’t think too much about. They think they are in a bad mood today but do you always kind of relate that to something that might have gone on? Do you think there might be some kind of biological basis or could it just be stressful events?

[Dr. Ben Lynch]: Yeah, great question and I think you are absolutely right. If there is a stressful event you need to be able to understand that. But you should be able to adapt to a stressful event. And it is interesting – I was just at this conference last week and you know how loud noises can sometimes make people jump?

I was sitting there and the room was absolutely dark and people were holding up candles. It was the end of the conference and it was this little ceremony that we do every time which is really cool. So they turn off the lights and hold up candles and it was quiet for a long time. I was thinking this was going to be really interesting, how are they going to end this period of silence? Is somebody going to scream and whoop and go crazy or is there going to be a gong or a bell? What is it?

So I kept waiting for it and all of a sudden the band behind us just really laid into it. It was really loud and the woman next to me jumped and I was just as calm as can be – so your ability to adapt to stress is so important. So we started this whole conversation today about adapting to stress and adrenals and so I think adapting is really important. But your original question of moods, so if I am stressed I immediately know that I need to be focusing on my adaptogens, licorice and [inaudible 01:11:56] and what have you, and eating smaller amounts but more frequently with some type of protein, and healthy carbohydrates and veggies are super important.

And not only eating it but chewing it well and absorbing it is even more important but if I am moody when I wake up, something is wrong. And I have to say that I don’t wake up in moods. I don’t wake up on the wrong side of the bed anymore. I might wake up tired or foggy-headed because I am working too hard or I stayed up too late. But I don’t wake up pissed off or irritable or sad. I don’t have those moods. And if I do get mad – I have got three boys and they can definitely put you over the edge sometimes, but I always look inward in that situation and say, ‘Okay, why am I doing this? Do I need more support in something?’

I am MTHFR compound heterozygous and I have got histamine snips, I have got GAD snips. And when I say GAD, GAD is a big one. So I am more prone to have lot of glutamate in my head compared to GAVA, because the GAD enzyme works with converting glutamate to GAVA. I am very conscious of this and so I will take some more magnesium and B6 if I notice I am a little bit on edge and protein for me is very, very important.

But your mood is super important. If people are moody, depressed, sad, glad – sad and glad are great, but if they are overly glad then something might be off too.

[Damien Blenkinsopp]: Right, just what you were saying about yourself and how you understand your own biology thanks to some of the work that you have done with methylation and you understand that protein is important and so some certain vitamins might help you if you are in a mood and stuff. You can see how important this is to inform our lifestyles and they could just be like I need to eat a bit more liver or whatever it is at the moment because my mood is a bit off, or whatever. And so this is an incredible area, this methylation.

I would really like to thank you for all the information you have shared today. It has been really amazing.

[Dr. Ben Lynch]: Yeah, and one thing too Damien is when I presented at the [inaudible 01:13:56] I talked about how important food was from a research standpoint because there are a lot of MDs that come to my conferences and they don’t have any nutrition training to speak of. So I talk about nutrition and how important it is and I talked about how carbohydrates increase serotonin and proteins increase your dopamine.

So you think wait a minute, proteins also increase your serotonin. But tryptophan is very tough to absorb. So that is why carbs can increase the serotonin and so if people are down and out then they get addicted to carbs and you need to understand and sit back – why are they doing this? Maybe because they are trying to selectively increase their tryptophan levels because if they eat protein they are not really getting the tryptophan because the tyrosine competes with it.

So my point here is that the last paper I presented on this is that if the person eats a fair amount of protein consistently, 75 grams was what they used and I think they used 75 grams because the average weight of a person is about 150 pounds – so 75 grams and 75 kilos of weight as a really rudimentary measure of how much protein to get. But my point here is people who ate adequate protein in a day had consistent neurotransmitter balance.

So if you eat adequate amounts of protein your neurotransmitters get balanced. So it is not only eating it but you have to absorb it. You have to make sure your absorption is also good. So people who have difficulty absorbing it is an issue but again my point here is if you are eating a carb-based diet because you are sad and you need to increase your serotonin levels but you don’t know why you are eating carbs, that could be one reason. But just eat more protein and that might be the answer.

[Damien Blenkinsopp]: Well thanks. As I say again this has been really amazing and information-filled. I know the audience is really going to learn a lot from this.

[Dr. Ben Lynch]: Good. Thank you Damien for asking fantastic questions. You ask some fantastic questions that no other interviewer has asked me before. So thanks for that. I think people will get some good information from this.

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The paradox: We spend a lot of money and time on increasing our antioxidant intake through foods and supplements. Yet most of us never know if this effort is making any impact on our health. Should we be checking our oxidative stress levels as often as we check our cholesterol?

Not a day goes past that we don’t hear about oxidative stress in the news and interwebs, and how it is shortening our lifespan or causing diseases like heart disease, diabetes and cancer.

Unless you’ve been living under a HUGE rock, you also know that antioxidants protect us from oxidative stress. And you most probably spend some of your dollars on antioxidants through healthy food choices and supplements.

But how do you know if those dollars spent.. or the time you spend thinking or reading about antioxidants, rewards you with any real benefit?

Today we look at measuring oxidative stress and how you can use biomarkers to assess your health status and whether your efforts, such as making buying choices based on antioxidant content, are paying off.

“In my ideal world, I would love to see most people looking at their markers of oxidative stress once a year…. if once a year we could get an idea of antioxidant status in our system and know if our antioxidant level is keeping up with damage in our body, it just gives us a much better window into prevention.”
– Cheryl Burdette

Dr. Cheryl Burdette is president of Dunwoody Labs, a lab that specializes in cutting edge labs for integrative medicine, and a practicing physician at Progressive Medical Center, the largest center for integrative medicine in Atlanta, U.S.

She is currently lecturing on nutrition and cancer at the University of Bridgeport and has a number of published studies in the journals Alternative Medicine Review and Clinical Chemistry.

As education director at Dunwoody Labs she is involved in clinical trials of different nutritional products as well as development of functional testing profiles – and an area she has looked at in particular is oxidative stress.

The show notes, biomarkers, lab test and links to everything else mentioned are below. Enjoy the show and let me know what you think in the comments (click here – in the comments)!

itunes quantified body

What You’ll Learn

  • The usefulness of oxidative stress markers for managing and improving health.
  • The implications of high oxidative stress found in the body with connection with damage and cancer, heart disease and neurological conditions.
  • The two perspectives to understand your oxidative stress status: the direct measure of oxidative damage and reduced intracellular anti-oxidant status.
  • Glutathione’s role in protecting your body from oxidative stress and its relation with health and disease and what you can understand from its status.
  • The relationship to goals of longevity and physical performance of antioxidant enzymes like Glutathione.
  • Lipid Peroxides and the specific damage they relate to in the body, and the differences in biomarkers available: TBARS, MDA (MalonDialdehyde), F2-Isoprostane.
  • How oxidative stress levels negatively impact methylation processes and its negative feedback dynamic with mitochondria.
  • Some of the criteria Cheryl has used to select the oxidative stress markers for her assays and panels from amongst the over 30 currently used in research.
  • How taking supplements like bioavailable forms of curcumin, sulforaphane from Broccoli, and alpha-lipoic acid or resolving chronic infections can resolve raised oxidative stress levels.
  • Trends in use of the oxidative stress markers that Cheryl has noted such as use by integrative medicine practitioners and across the U.S. geography.
  • Appropriate testing strategies for healthy individuals for routine assessment of oxidative stress and how it can highlight future potential health risks vs. individuals that have some chronic or pathological condition.
  • Do we need oxidative stress? Can you overload on antioxidants so that they have a negative impact on your biology rather than positive?
  • Looking at oxidative stress markers in athletes or people who exercise heavily to understand issues they may have with their performance and their recovery.
  • Some of the trends, new research and tests Cheryl Burdette is looking forward to coming out in the next 5 years.

Dr. Cheryl Burdette & Dunwoody Labs

  • Dr. Cheryl Burdette: Her profile on Progressive Medical Center, where she works as a physician.
  • Dunwoody Labs: Cheryl’s lab, where she is president and education director.

The Tracking

Biomarkers

Used and Recommended by Dr. Cheryl Burdette

    Lipid Oxidization Levels
  • F2-isoprostane: A more direct marker of lipid peroxidation levels in your body than TBARS and MDA.
  • Oxidized LDL: A measure of the amount of your LDL (Low Density Lipoproteins) that are oxidized. This is considered to be a much more predictive marker of cardiovascular disease than straight LDL measures.
  • Intracellular Antioxidants and Enzymes
  • Glutathione Peroxidase (GPx): The body’s main enzyme for detoxification and for neutralization of free radicals (oxidative stress). This biomarker measures your current blood levels.
  • Superoxide Dismutase (SOD) I: Levels of an intracellular antioxidant that resides in the cytosol (inside your cells). More association with conditions like ALS.
  • Superoxide Dismutase (SOD) II: Levels of an intracellular antioxidant that resides inside the mitochondria. More association with fatigue and cancer, and general health status of mitochondria.
  • DNA Damage
  • 8-OHdG: 8-hydroxy-2′ -deoxyguanosine is tested via a first void urine test to show levels of oxidative stress in the body. This marker is supported by over 1000 research studies. See the Pubmed entry here.

Mentioned But Not Recommended by Dr. Cheryl Burdette

    Lipid Peroxidation
  • MDA (MalonDialDehyde): MDA is one of the most widely used markers for lipid peroxidation found in the research.
  • TBARS Assay (ThioBarbituric Acid Reactive Substances assay): As with MDA, this marker has been used extensively in the research.

Lab Tests

The Tools & Tactics

Supplements

  • Curcumin: Bioactive compound in the spice turmeric. Works as an antioxidant in part through the process of hormesis – a low-dose form of stress that stimulates the stress adaptation response in a healthy way. The most effective forms of curcumin are Curcumin BCM95 and Liposomal Curcumin. Learn more about hormesis in episode 8 with Todd Becker.

People and Other Resources Featured

Other Organizations Mentioned

  • JAMA: The Journal of the American Medical Association, also the most widely peer-reviewed journal circulated in the world. JAMA covers general medical topics with no specific focus.

Full Interview Transcript

Transcript - Click Here to Read
[Damien Blenkinsopp]: Cheryl Burdette, thank you very much for coming on today. It is a real pleasure to have you on. I was recently at a conference where I saw you highlight the importance of oxidative stress biomarkers for working on both disease conditions and aging. Could you give us a quick overview of why you think it is an important area of biomarkers and where it is most useful?

[Dr. Cheryl Burdette]: Absolutely. I think that the reason that these are important biomarkers are because they help us to answer some of the critical questions that we are looking at when we seek out preventative medicine and when we are trying to slow an aging process in the body or to turn down the inflammation of a pathology. And so oxidative stress markers, simply put, are ways that you can measure antioxidant status in the body.

And you are hard-pressed to find somebody out there who hasn’t heard that antioxidants are good for us or the fruits and vegetables that are the things that protect our DNA and lower our risk of cancer and heart disease and really the major players out there in terms of pathology; however, for some reason they are not routinely done. And so, for example, a marker called 8-OHdG, a hydroxy-2 deoxyguanosine – long name.

But basically it is a simply first morning urine that tells you you have too many free radicals in your body and it tells you if the DNA is being damaged. And when we go to the research and see how predictive is this marker, how strong is this marker, if we look at the peer-reviewed research in the past five years, you find about 1,000 clinical trials that show that it is predictive for things like cancer and heart disease.

Yet for some reason it is not routinely done yet. So that was another part of my drive for starting the lab, to be able to take these well-researched biomarkers and make them more available to people so that we could use them to help predict health, and to have better outcomes.

[Damien Blenkinsopp]: So you mentioned cancer in particular there, but where are the main areas where most of the research is being done? I also saw you talk about things like neurology, neurological conditions. Now what would you say the brunt of the research that is already existing has been done relating these two issues and things we can track?

[Dr. Cheryl Burdette]: So when we talk about oxidative stress it would depend on which marker we are speaking to and if we are talking about 8-OHdG, then that one probably is most often seen in terms of a risk factor for cancer. The higher it is the more damage there is to your DNA, and the more damage there is to the DNA, the increased chance there is for cancer occurring.

So, for example, we can think of cancer as a seed and not every seed will always sprout, not every seed will always produce a plant; however, if the environment is right around that seed this is what allows it to grow. So if 8-OHdG is high, that is an environment that is more favorable to a cancer growth. If we can see it is high then we can do something about it. We can increase antioxidants in our diet, we can use certain nutraceuticals to help with that.

But this is not the only oxidative stress marker out there, there are also markers for how damaged our fats are in addition to DNA or how damaged the mitochondria is or how damaged proteins are and so when we are looking at the body of neurological evidence now you look at a marker called F2-isoprostane. WHen this is high it tells us about our fats being damaged. Well, the brain is 85% fat, the outside of the nerve is all made up of fat, and the membrane of every cell is made up of fat. So if your fats are damaged then you are more likely to have conditions where there is fat in the body – i.e., your central nervous system, your peripheral nervous system, as well as cellularly.

So in general we see a lot of oxidative stress research around things like cancer, heart disease, and neurologic conditions. And from there you would pick and choose markers. Certain ones will have certain strengths base don the tissue type and based on the condition.

[Damien Blenkinsopp]: So as I understand, you have talked about lipid peroxidation and DNA damage markers there. As I understand it there are kind of two ways to look at this. There is the direct measure of oxidative stress and damage, which is already being done and the two markers you brought up, look at that. And then there is also reduced antioxidant status in the cells. Is that the correct way to look at it coming from those two perspectives?

[Dr. Cheryl Burdette]: Yes, absolutely. I would say that is spot on.

[Damien Blenkinsopp]: Okay, so some of the other areas that I saw that you are looking at, you have the antioxidant intracellular status and the enzyme assays – could you talk about those a little bit in the context of those?

[Dr. Cheryl Burdette]: Absolutely. So glutathione is our major intracellular antioxidant. What that means is the antioxidant that is most preferred in the tissue – so when we take in things, for example people may have heard of resveratrol from grapes, that is in wine and is associated with longevity and what is called the French paradox – even though they eat more fat they don’t get fat, and why is that?

Well, because of the resveratrol and so these plant-based antioxidants will often have the effect in the body of increasing our own production of glutathione and that is one of the more powerful ways that they work, to turn on our own antioxidant systems. So we can measure something like glutathione to see if people have the right level of this in their cells and then when we think about okay, what is that associated with?

Higher levels of glutathione are associated with a low risk of cancer, low risk of neurologic conditions, and glutathione is the major intracellular antioxidant for the liver. So it helps us to detoxify and keep up with toxic body burden from the environment and from chemicals on food, etc. It is also a highly-useful antioxidant in lung tissue. So if it is low you are more at risk for different respiratory conditions and we can use it as a treatment.

By increasing glutathione status in the lung tissue you will see improved respiratory outcomes and you will see decreased shortness of breath and a wide range of improvement. If you think about it, if every cell needs glutathione then increasing the levels can help many, many things.

[Damien Blenkinsopp]: Great, one of the things I was thinking about as you were talking about that, on this side we have the resources or the capacity to fight oxidative damage. So with glutathione, for instance, you are looking at that. Does that necessarily mean that our DNA damage markers and our lipid peroxidation markers – there is actually going to be damage?

Or can that also be if someone has had a very solid diet and they have lived a very healthy lifestyle with plenty of antioxidants, could those markers be higher than usual? And would the opposite be true – would they have used up, if they have some kind of chronic condition, would they have used up a lot of those resources, these antioxidant and glutathione peroxidase, so they would actually be lower and that is how you use it? You can use it as an indicator that there could be some chronic issue there because it is used up, even if perhaps it is not lipid peroxidation or DNA damage?

[Dr. Cheryl Burdette]: It’s an excellent question. So typically if you have high levels and you have strong levels of glutathione you should see less levels of damage in the system, less damage to the DNA, less damage to the lipids, and less damage to the protein; however, there will be times when let’s say, for example, maybe somebody has a chronic viral load and the infection is brewing but it hasn’t created symptoms yet and you can begin to see a depletion of glutathione before harm is done.

And so it allows us to capture things early and then also to intervene so that we don’t continue to slide into a state of disrepair. So on one hand you would think maybe if I am low on this antioxidant I would feel it but for example we measure things like cholesterol once a year for heart disease and we don’t necessarily feel it when that is increasing. The same could be true here. Your glutathione could be decreasing and you might not have outwardly signs yet but if we take time to look at it we can capture this trend and we can treat accordingly.

[Damien Blenkinsopp]: Right, right. And i think people are interested in longevity and human performance, whether it be in terms of brain performance or physical performance in terms of athletics or fitness and so on – would these markers, do you think it would be a useful thing to keep an eye on them in those contexts also?

[Dr. Cheryl Burdette]: Absolutely. That is a great point that you bring up. First of all, preventing pathology, but also optimizing. Because glutathione is the major intracellular antioxidant it is critical to the part of the cell called the mitochondria and the mitochondria is the part of the cell that makes energy, or ATP. So that ATP is what gives us energy, what gives us good performance, what gives us good muscle building, etc. So inherently necessary for optimizing performance as well.

[Damien Blenkinsopp]: So there you are talking about – correct me if I’m wrong – are those the enzyme assays, so superoxide dismutase I and II that look specifically at the mitochondria?

[Dr. Cheryl Burdette]: Yeah, so superoxide dismutase I is in the cytosol, and II is the one specific to the mitochondria. So the one specific to the mitochondria helps to improve function there, lets us know that the mitochondria is recovering like it should, and if we see that low then we can choose the right things to increase that, and know that we need to do more mitochondrial work.

[Damien Blenkinsopp]: Okay, great. So with these it looks like you can actually identify where different problems are; however, why is it that when we have oxidative stress in our bodies it doesn’t necessarily affect the whole body? You are talking as if it is different parts of the antioxidant and oxidative stress systems that will potentially give different patterns.

You take all of the biomarkers and it will give a different pattern depending on the chronic disease you have or the potential issues you have or potentially you are dire in antioxidants. Is that what you have seen in the labs? That people can have different patterns which can show you interesting facts and sort of paint different pictures? Or do you find it can be more or less across the board that there are problems?

[Dr. Cheryl Burdette]: It depends on the markers. So the glutathione might have more ubiquitous issues because again that is the antioxidant everywhere, but yes, you are absolutely right – certain markers are more associated with certain conditions. For example, that is why i choose to not do a total superoxide dismutase and tease them out because one is in the cytosol of the cell and it will have more association with particular conditions like ALS, whereas the one in the mitochondria has more association with fatigue and cancer. So if you are just lumping them all together you won’t get that picture.

[Damien Blenkinsopp]: Right, perfect. When I was looking at this I saw there were at least 30 biomarkers currently available in labs related to oxidative stress in some areas. Why is it that you chose these particular ones? I noticed that some of the areas you haven’t looked at include protein oxidation. You mention this a little bit – protein oxidation and nitration, the reactive oxygen species, assays, and RNA damage and repair. Could you talk a little bit about what you see the merits are and why you made the choices you did about the markers you chose?

[Dr. Cheryl Burdette]: Yes, I think the first thing is I wanted markers that were extremely well-researched. So like the 8-OHdG, if we just look at the past five years, over 1,000 clinical trials with that marker in terms of predicting oxidative stress and free radical loads. So that was my first consideration – do they have a strong body of research? Are they clinically relevant?

So I chose the ones that had the highest clinical relevance and then of course as a lab, the second part is how reproducible are they? How stable are they? How much changes once it goes into the test tube from coming out of the body? So, for example, F2-isoprostane, that is a lipid peroxide. That is a marker of how damaged fats are. And there are other lipid peroxides out there and people – some of the more common ones are things like T-BARS or MDA; however, those are not produced in the body so the T-BARS – the RS on the end of that stands for ‘reactive substance.’

And so it is an extrapolation that is done in a lab and it is a pinnacle reaction that is used to then say, okay, but we don’t make T-BARS inside of our system. They are not endogenously produced. It is extrapolation that is happening in the body; however, F2-isoprostane we make – it comes when you measure the blood. There is F2-isoprostane in it and so it is a better marker because it is more directly related to pathology and symptoms.

So two things for me, how evidence-based is the marker and then how reproducible is the marker as well. So those are the things that I look to. A third thing is then is it unique, does it bring us new information that we are not able to get? So as clinicians, one thing that you will often notice is you will go to the research, you will read about something, and you will think, ‘Wow, that is fascinating. I didn’t know that could be looked at. I didn’t know that could be measured.’

So an example is an enzyme called diamine oxidase, and that is something that we measure – it is the enzyme that degrades histamine. Well, you can see if you have a lower level of that you are going to be more at risk from anything that is histaminergic, meaning yes, of course hives, itchy eyes, runny nose, but also headaches and guy issues and a whole host of symptoms that can be made worse in a high histamine environment.

So you read about this and you say, well, how interesting that would be to know my body’s ability to break down histamine. But then you go to laboratories and you can’t find it. So a lot of these things are very heavily researched in academia but for some reason don’t make the crossover to be available to the general public. So that’s another focus for me as well, taking things that are highly researched and making them more available.

[Damien Blenkinsopp]: Right. I noticed one thing that you have done and correct me if I am wrong you have two different panels. So you have grouped a lot of the markers that you have been talking about today – you have grouped them into one panel so you take those all at the same time. Is that correct? I think you have a blood and a urine panel.

[Dr. Cheryl Burdette]: Yeah, we have probably 20 different panels that we offer – some are blood, some are urine, some are saliva, and some are even hair and some are stool – it just depends on what the best specimen is for what you are looking at. But yes.

[Damien Blenkinsopp]: Is this all on oxidative stress?

[Dr. Cheryl Burdette]: No, we have an oxidative stress profile, a leaky gut profile that looks at zonulin and diamine oxidase and lipopolysaccharide with a neurotransmitter profile that measures things like serotonin, epinephrine, and norepinephrine, adrenal stress testing, thyroid testing, heavy metals.

[Damien Blenkinsopp]: What I was trying to get at is have you tried to simplify – because you are saying each marker should kind of contribute something which is unique to decision-making and tracking and understanding status. So have you combined all into one oxidative stress profile the markers we have been talking about today? Or do you have two or more?

[Dr. Cheryl Burdette]: It’s a little bit of a tricky question because so many things can result in oxidative stress. But in general, the ones that are more intimately considered oxidative stress markers are on that profile but from a clinical standpoint you never have to order the entire profile. You can order single analyze – that is something that is more appropriate for that patient. Let’s say you do the entire profile first and only one thing is abnormal.

For followup purposes you can just run that one thing so that it is less expensive and more targeted to that patient; however, there are a couple of other markers that might get to the question of oxidative stress that are on different profiles – like on my cardiovascular profile, oxidized LDL. And so that is definitely a marker of oxidative stress and it is the truly bad cholesterol.

So people are taught that LDL is the bad cholesterol but it is once it is oxidized, the fat, that the whole story changes. LDL is taken up by the liver and it is utilized in cell membranes and in the brain. But once it is oxidized the liver can no longer recognize it and that is when it starts to be moved instead into these plaques in our arteries.

That does not occur until it is oxidized. That is definitely a marker of oxidative stress but it is not on that profile, it is on the cardiovascular profile.

[Damien Blenkinsopp]: And just to be clear, that is not typically available? Because we have all had cholesterol lab tests and it is pretty general to get your LDL and so on. But that is not a typical test to get?

[Dr. Cheryl Burdette]: No, and it is a great example of what I am talking about. Even journals like JAMA say that it is 17 times more predictive for heart disease than cholesterol itself but yet it is not being routinely offered. The research is much stronger than oxidized LDL and it would give you different treatment options too because if we’re trying to produce the LDL, which is the opposite of oxidizing – oxidizing is when it is charged by a free radical, reduced is when you have antioxidants to accept that free radical. And so if we are trying to reduce it so that it doesn’t become sticky and doesn’t become a plague former.

Then now you are going to use different treatments than just lowering the overall level. You are going to add more CoQ-10. You are going to add things like sulforaphane from broccoli sprouts. It improves our ability to treat these things too.

[Damien Blenkinsopp]: That’s great. So who today is actually using these? When it comes to Dunwoody Labs, what sort of people are using these markers and how are they using them? You mentioned some people use just one marker or some people use a whole panel. So what kind of trends do you see in the moment? Who is using what?

[Dr. Cheryl Burdette]: Because we’re a laboratory, you have to have a physician’s orders in order to get to the testing. So obviously, doctors are the people using them but more specifically the type of doctors that tends to be ordering these are what I would call an integrated physician practicing integrative medicine.

And these are people that are combining things like pharmaceuticals or standard of care, but adding to that – adding lifestyle interventions, adding vitamins, adding supplements, adding these other pieces and so these are typically people that have seen limitations in standard of care and so they are looking for more cutting-edge biomarkers to match their more cutting-edge therapies.

[Damien Blenkinsopp]: Great, thanks for that. Are there any particular trends that you have seen at all in the types of those? You said integrative medicine, but I don’t know, are there different areas of the US which seem to be working more on this? Do you work internationally? Are there specific cases, like you have seen a lot of people using cancer or for other chronic conditions?

[Dr. Cheryl Burdette]: In terms of areas of the country, interestingly I would have had a different answer ten years ago. There were more pockets where you were seeing it, and you likely might expect more West Coast, maybe a little stronger up in the New England area, but really now it has permeated much more than just kind of the periphery of the country.

People everywhere want good medicine. And good medicine demands that we think about lifestyle, that we think about diet, and that we look for better answers because nobody out there would say that we have the best answer to cancer, heart disease, or even the common cold yet.

So there is a lot of area where we still need to dig deeper. We need better answers, and we need better treatment. And so i am finding that really it is not just pockets of the country, but it is everywhere. And it is international as well. So we have associations with labs in South Africa and England, so really people are demanding better answers to help solve problems.

[Damien Blenkinsopp]: So you talked about a few areas where there is a lot of research. Which areas do you think these kind of markers would be very promising or potentially you are kind of experimentally, or others are experimentally, using them for treatment. But the research isn’t strong enough and we kind of need more research to strengthen up our opinions there and the clinical evidence?

[Dr. Cheryl Burdette]: These are applicable to many areas of research and the reason for that is because so often the way we have defined conditions is to say what is the condition? And that is important, absolutely, and they need to know a diagnosis. So for example, why do I not feel like myself? Well, I have a condition, I have a diagnosis of depression.

And then the way that is approached is to say well, in depression, we know that serotonin is low, so we will give a medication that increases serotonin; however, it misses a whole piece of the puzzle and that pieces of the puzzle is that even though there is depression and serotonin is low, why i shte serotonin low?

And so it turns out that an environment that is very high in oxidative that has too many free radicals would be an environment that makes it harder for serotonin in the brain to be made. And so in research they have often been focused on here is a medication, now does it make serotonin go up rather than saying what are these other pathways, what are the other things that are influencing this level of serotonin?

So we are seeing more and more studies wanting to look at underlying cause, measuring things like oxidative stress markers, measuring things like gut health, perceive patterns for the process that is causing the diagnosis. Is there a process of toxic body burden, nutritional deficiencies, inflammation, oxidative stress, and mental and emotional stress that is contributing to this.

[Damien Blenkinsopp]: Right, right. So it sounds like you really see that there is a lot of potential across the board with all sorts of applications which haven’t been explored fully in the research.

[Dr. Cheryl Burdette]: Correct, yes.

[Damien Blenkinsopp]: So in the conference where I saw you, you talked a lot about the link between mitochondria function and methylation function and oxidative stress. Could you talk a little bit about how they are related and how one can influence the other?

[Dr. Cheryl Burdette]: Absolutely. So methylation is a very complicated topic because it is not like there is one site in the body that is methylated. We have methylation of DNA, we have methylation of enzymes, and some things that will increase methylation in one place will decrease methylation in another. You might find something that up regulates methylation in the liver but can down regulation methylation in the brain.

So it is complicated and it gets very tricky to identify that singular pathway and then modulate that accordingly; however, we know that there are broad strokes and then we know that again there is this process that can influence changes in methylation. So for example, high oxidative stress will impact the body’s ability to methylate appropriately – whether or not that is hypo- or hyper-methylation. You will see improvements with that when we lower this burden of oxidative stress.

So for example, one of the things that is really starting to be understood mroe about oxism is they have a lot of problems with methylation and this will make it difficult to turn on neurotransmitters; however, that same problem with methylation makes it difficult to eliminate toxicity from the body. And so what you see is that there is often an insult of oxidative stress that skews the methylation and it is this one process that then causes worse outcomes. And so if we can look and see how much oxidation is going on then this gives us another way to improve methylation in the body too.

[Damien Blenkinsopp]: Great, because that sounds a little bit like a vicious cycle – once you have oxidative stress it is negatively affecting methylation which, as you said, affects your ability to resolve so many issues in the body.

[Dr. Cheryl Burdette]: Yes.

[Damien Blenkinsopp]: I haven’t heard of this before. Is that something that is quite new or unique to you? Or is it something that people are starting to talk more about? What kind of stage of development is methylation versus linked to oxidative stress, as being discussed in research?

[Dr. Cheryl Burdette]: I think that you would see hints of this back even a decade ago, but really this deeper level of understanding and how intimately intertwined they are. I would say that is probably a little newer. And again it gives us – when you speak methylation you are talking about genetically.

What people are measuring is probably polymorphism and you see these little snips, these little mistakes in the DNA pattern. And there is not a lot to do about it at that time; however, if we can improve the environment of oxidative stress we can improve the ability for those damaged genetics to function better so it gives us something very treatable to go after.

[Damien Blenkinsopp]: That’s great. So as i understand it, mitochondria has a similar kind of vicious circle dynamic going on with oxidative stress as well.

[Dr. Cheryl Burdette]: Yes.

[Damien Blenkinsopp]: It is similar, right? Correct me if I am wrong, but the oxidative stress will damage the mitochondria and the mitochondria will start to create more oxidative stress, which creates a negative dynamic.

[Dr. Cheryl Burdette]: Absolutely, and so while I characterized that marker 8-OHdG as a marker for DNA damage, what they are seeing in the research is that the damage in the DNA will also influence expression of the mitochondria too, so you can think about it as a marker for causing damage there as well.

[Damien Blenkinsopp]: Okay, so looking at some kind of typical scenarios where you have been using these biomarkers and found them of the most use, where would you say they are very useful for assessment of status, for help with diagnosis at the moment? Where would you mostly use them or mostly see the types of tests that people are most using it for at the moment? In which kind of cases?

[Dr. Cheryl Burdette]: Well on one hand, in my ideal world, I would love to see most people looking at their markers of oxidative stress once a year. And the reason for that is because I find them to be highly more preventative in their nature than cholesterol ever thought of being, for example. So if once a year we could get an idea of antioxidant status in our system and know if our antioxidant level is keeping up with damage in our body, it just gives us a much better window into prevention.

But otherwise if we are thinking about them in terms of where is oxidative stress, what pathology is oxidative stress most linked to, then I would say that the area where that shows up the most is probably cancer, heart issues, and neurologic.

[Damien Blenkinsopp]: Is that to assess status, like how bad it is? Is that kind of what you are trying to do with that?

[Dr. Cheryl Burdette]: You are trying to assess the environment and that pathology that it is in. Is this an environment that is going to cause the pathology to flare more? Or is this an environment that is a possibility of remission?

[Damien Blenkinsopp]: Right, great, so it gives an indicator. So you mentioned that it would be appropriate to get these taken once a year. Does that vary per biomarker? Basically, how quickly did these change in values over time? Are there some markers that it is relevant to take more often?

I mean, depending on the context as well. So for instance, someone who is just healthy and they and they just want to understand the level of oxidative stress for aging or performance preferences like optimum health, would it be most appropriate for a year because they don’t really change that often?

[Dr. Cheryl Burdette]: So if you were in a state of pathology, many pathologists deplete your antioxidants, so that is going to cause them to change more frequently. If we are generally well then once a year is probably enough because we are not seeing huge shifts in the system.

But any time there is a pathology or it gets advancing then I would say you want to look at it more often, maybe every three months, to make sure that you are changing the environment so that the pathology doesn’t continue to flare.

[Damien Blenkinsopp]: To go kind of out on this, if you do the intervention, say you did a month intervention would it be worthwhile redoing these biomarkers of oxidative stress tests again, or would you have to wait for three months because it isn’t really enough time to assess any change?

[Dr. Cheryl Burdette]: Some will change more quickly than that but in general to really get to see saturated and to really change terrain, you want to get the body – it is more of the body probably. You want to give the body – it is more the body, probably. You want to give it a good three months to really have that opportunity as it is more like building a muscle. That doesn’t happen overnight.

[Damien Blenkinsopp]: Right. So are there any inaccuracies or confounders to this data? For example, do they vary, a bit like cortisol can throughout the day? Does it vary throughout the day so that it would depend on what time of day? Are there any other confounders involved in how you collect the data that you have to be careful of?

[Dr. Cheryl Burdette]: Yes, some can change throughout the day; however, if the marker that is susceptible to that, then we do things to control for that. We say this one has to be withdrawn fasting in the AM before a certain time. So depending on the test it will do some things to adapt to that; however, if there aren’t specific instructions in terms of collection then know that those are the ones we have found to be stable when we look at multiple samples throughout the day and throughout the week, that they are consistent.

[Damien Blenkinsopp]: You mentioned also earlier that you try to choose the best, most accurate labs, which don’t have issues that say they move out of the body. I know you have seen labs in the past where you can get them taken and sometimes if they are not frozen immediately with the correct protocol that can skew the lab values and then you have got inaccurate data.

Are there any of these markers which require kind of a very careful protocol which has to be followed? Or are these kind of like standard blood tests where you can basically just give the blood sample and as long as you get the blood sample in reasonable standard condition it is fine?

[Dr. Cheryl Burdette]: So we have checks for that too, so when we receive a sample if it looks off for any reason, if it is hemolyzed or something of that nature, then we notify the clinic that we reject the sample. We we don’t run anything that we are suspicious of how it how it looks, but otherwise we have tried to choose things that are pretty stable because just for that reason, it will improve the validity.

Now, some things have a timeline so many of them will have them shipped overnight or shipped with ice to help preserve the quality of that specimen. And then we are very picky about, from our end, on receiving how quickly those things get processed and even moved to a -80 freezer in order to store these things in a way that they don’t degrade.

[Damien Blenkinsopp]: Right, that sounds like standard procedure, rather than any of these markers having specific instabilities, which would mean it would be more difficult – I think I am thinking of TGF-beta I and markers like that. I may be wrong here, but I have had had a history of the values being different based on the way the blood was taken.

[Dr. Cheryl Burdette]: Absolutely. So we try to do a lot around education. Every kit comes with very specific instructions that whoever is drawing it should follow and so we try to do a lot around quality control.

[Damien Blenkinsopp]: Right, so you have leaflets and brochures explaining how it should be taken. Because these are getting drawn now in different places, right, your samples?

[Dr. Cheryl Burdette]: Right every tube for every draw comes with a set of instructions that says exactly how it should be handled.

[Damien Blenkinsopp]: Okay, so at the conference you talked about some specific interventions which may have an impact on some of these markers. I would love for you to talk about those a bit. Now, you talked about things like [inaudible 00:34:32]. Which interventions have you found to be effective against these markers and to effectively lower them or increase them in terms of the antioxidant status?

[Dr. Cheryl Burdette]: In general some of the things I have found to most profoundly shift these markers of oxidative stress are nice, bioavailable preparations with things like percumins and cuminoids and those are compounds that come from turmeric and when those are put with certain black pepper extracts that really increases the plasma bioavailability and to see various shifts of the markers.

Also things like sulforaphane, which comes from broccoli, that I have seen be quite helpful in terms of improving glutathione and lowering F2-isoprostane; however, the interesting things about it is what is going to be the most effective for shifting the marker is going to be to treat the pathology – to treat the cause of what is going on.

And so sometimes it is not an antioxidant at all, but figuring out there is an underlying infection and getting that under control, or figuring out that there is some heavy metal toxicity and lowering the toxic body garbage. Or figuring out that there is a particular nutritional deficiency and increasing that or figuring out that somebody’s main reason for the oxidative stress is coming from a gut issue and treating that accordingly.

So that can be one thing that is really nice about these markers. There is no profile out there that is going to measure every chemical and every bug and every exposure that we have that you can see that it is doing damage to the body and now you can track that to make sure you are getting improvement.

[Damien Blenkinsopp]: RIght. So have you seen scenarios where you talk specifically about pathogens and infections and metals where you have targeted those or moving those and you have seen these markers improve without adding [inaudible 00:36:25] or any other thing to help with the markers?

[Dr. Cheryl Burdette]: Yeah, Lyme disease is a good example of that for two reasons. First of all, the infection itself is hard on the mitochondria and then second of all many treatments that are used for Lyme involve antibiotics and in fairly high doses and long term. So in terms of getting those up, treating the Lyme infection will help to improve some of the glutathione status and the mitochondrial status. So yeah, definitely, we see it all the time.

[Damien Blenkinsopp]: So does alpha lipoic acid have an impact on the oxidative stress or is it more working around moving heavy metals, so it is kind of working around the origin of the problem rather than the oxidative stress itself?

[Dr. Cheryl Burdette]: Things like alpha lipoic acid have so many different ways they work in the body that I think that is the nice thing about it. One the one hand it is a gentle chelator but it is a big chelator of metal, so it is a lower toxic body burden. on the other hand it is going to even just decrease the lipation of the foods you eat, which is going to decrease oxidative stress on the body that way.

It will facilitate and acetylcysteine part of the peptide that makes up glutathione and helps to pull that into the cell. So it helps to make glutathione that way. It recycles glutathione so that is the other way it is going to reduce oxidative stress. So think that is the beauty of the natural therapies, that they are not limited to just one mechanism by which they work and that is why we see such changes in things like that.

[Damien Blenkinsopp]: Great, thank you. We are coming towards the end of the interview now. There is one particular dynamic that I have seen discussed quite a bit lately, and that is there can be too much antioxidants. So I was wondering if these biomarkers, some of them have a U-curve or an N-curve, I guess you could call it also.

There is an optimum value and if it is too high often people will look at it in the media and the news and it will be like the more antioxidants you can get the better, no matter how much you take. So potentially you can take a ton of [inaudible 00:38:24], for example. But do you see scenarios where you could be overloading the body with antioxidants and it would push it the other way and cause problems to people who are potentially thinking about being aggressive with these kind of antioxidative stress strategies? Do you see that kind of dynamic in the labs?

[Dr. Cheryl Burdette]: You can, like for example there is a condition where if someone is missing the enzyme to recycle glutathione that can build up and that can even cause certain pathology; however, it is hard to do on planet earth. We are so assaulted by pollution and junk in the air and junk in our food that it is more difficult to overload in terms of the antioxidant piece of it now.

On the other hand, for example one of those markers we are talking about, 8-OHdG, there is more oxidative stress and to my knowledge there aren’t studies that talk about that if it is too low being a problem. But you could have an overload of an antioxidant causing issues elsewhere, it is just that 8-OHdG is not predictive on the low side for the condition.

[Damien Blenkinsopp]: Right, I see. So it is kind of missing the DNA breakdown because you are keeping it low. Because I understand that your 8-OHdG is a blood marker for damage that has taken place. Is there any way that you can have DNA damage taking place but somehow you have suppressed that marker? Is that what you are saying?

[Dr. Cheryl Burdette]: Well I don’t know that there are conditions that are associated – I don’t know that it is bad to have low DNA damage is I guess what I am saying. I don’t know that.

[Damien Blenkinsopp]: It sounds like in general in the labs you haven’t seen any – it is better to have high antioxidant status on one side of the markers and low damage and you haven’t really seen any cases where that isn’t the case?

[Dr. Cheryl Burdette]: Absolutely. I mean I am with you though. We have to have some oxidative stress. That is what causes us to have improved performance with athletics and some oxidative stress that comes up opens up our blood vessels. So yes, it is absolutely possible.

[Damien Blenkinsopp]: You just mentioned athletic performance oxidation. Do you have benchmarks? Would you be able to tell the difference to someone who has been training too heavily, for example, or when someone is not training? Can you tell the difference between someone who exercises a lot every week and someone who doesn’t based on oxidatives tress?

[Dr. Cheryl Burdette]: Yes, because in general even though exercise creates some oxidative stress when someone is performing well they will have better recovery. And so you won’t see DNA damage. You won’t see damage to the fats because those are more long term and they are more tissue markers and more of that long-term status.

So what you are seeing is that someone is not recovering from that oxidative stress that the exercise is creating and that is markers that start to go up. And I think of a particular patient who was a triathlete and she was not seeing improvement in her performance anymore and she was having troubles with recovery. When we got her oxidative stress markers down into more of a normal range then her performance picked up again.

[Damien Blenkinsopp]: Which markers specifically in that case were out of range?

[Dr. Cheryl Burdette]: Her 8-OHdG was elevated and her total glutathione was low.

[Damien Blenkinsopp]: So you basically helped her to rebuild the glutathione. Was she training too much? What did you link for the 8-OHdG to be too high?

[Dr. Cheryl Burdette]: Actually, interestingly it was part of the training but she ended up being one of those who had an underlying infection as well. So when we got her infectious load down her 8-OHdG came down and her marker of oxidative stress. Her performance went up and we also saw an increase in her white blood cell count.

[Damien Blenkinsopp]: I think you make a great, important point there. I think a lot of people are seeking – when you try to push yourself to performance, maybe it is working extremely hard or it is like doing fitness and athleticism. If you see problems in your performance it could well be there is a tiny infection or other issue that is holding you back.

So it is probably worth looking at these oxidative stress markers and that might help you. And seeing a physician to see if that can be resolved, then you can get back to performance. So it is interesting that people should really be thinking about this if they are suffering in their performance and what they are doing.

[Dr. Cheryl Burdette]: Absolutely, and you see a lot that just the wear and tear of training is a big deal. For example, athletes are uniquely susceptible to leaky gut all the time and [inaudible 00:42:41] less time than it takes to digest, so they will have markers of leaky gut that are off. And then when we treat those the oxidative stress improves as well.

[Damien Blenkinsopp]: So we talked a little bit about how these markers aren’t so widely available at the moment. What do you think are the main challenges to get them? What can be done to spread the use of these oxidative stress markers more?

[Dr. Cheryl Burdette]: Education – I think that people understand that having good antioxidant status is protective and preventative. Just the more we understand about them, I think the more motivated people will be to look at them. But the education needs to happen for physicians as well.

Now, in the States part of it is the way that our healthcare system is structured in that our health care says if things are for prevention they are given certain codes and these are less likely to be reimbursed by insurance companies. Now, as backwards as that seems you would think that insurance companies would be interested in prevention but it is not quite logistically the way it is set up at the moment. So education of patients, of physicians, and of our infrastructure too.

[Damien Blenkinsopp]: Okay, so what kind of things do you think will help or that you are carrying out in terms of projects at the moment, to improve the education? I know that you do a lot of conference talks.

[Dr. Cheryl Burdette]: Yes, absolutely out there they are talking about these things. But that is another reason that Dunwoody Labs is so intimately involved with research, because the way we are going to make our big breakthroughs is to publish more, to get the data out there, and then when that happens and we are able to validate these things more and more they will end up in clinical practice.

And so unless we support this research, we are never going to see that happen. So I am a big advocate of that and more training as well, increasing things like nutritional training in medical schools. All that will be important to really seeing a shift.

[Damien Blenkinsopp]: Great, thank you for that. Now, looking towards the future – I know in the next ten years, are there any areas you are looking forward to with excitement? In terms of the evolution of these markers. Are there new markers that are going to be available? New tests or anything interesting that is going to happen over the next ten years that you can foresee that is going to be pretty cool and going to help us to see a lot more?

[Dr. Cheryl Burdette]: Yeah, I think that what a lot of these markers are coming out and helping us to realize is that I think before there was a focus to find a biomarker that was shifted by a drug, and if you had those two things together – a drug and a biomarker – then that was really the package that healthcare was looking for to sell, so to speak. However, I think a lot of these markers that are coming out now, what the natural consequence of them is is that the real way you would treat them would be to change the diet, to increase exercise, to make some lifestyle changes.

So I think we are seeing more and more emphasis on markers that let us know about how lifestyle is affecting us and therefore more and more people will be motivated to change that. But beyond that the second thing I am really excited about is we are bringing on a suite of genetic testing and this is just fascinating because now I can look at somebody’s genes and I can say, ‘Based on your genetics, here are some of the functional markers that we need to look at once a year in you.’

So you could even individualize someone’s testing workup based on areas of weakness and you could say based on your genetics you should not take this medication because you are more likely to have these side effects or it just won’t work for you or here is a botanical that makes the most sense for you based on your genetics. Here are some food interventions that make the most sense.

[Damien Blenkinsopp]: That sounds great for preventative health, in particular. So what kind of time table are you looking at for that? Is it five years? A lot of people get 23 and Me today. Is that something you can use or does it need to be a lot more specific than that?

[Dr. Cheryl Burdette]: I think that is a great start and it gives you some information. But we are bringing on this genetic testing and it will be in the next month or two.

[Damien Blenkinsopp]: Well that’s great to hear. Cheryl, thank you very much for your time today. It has been a great chat and we have learned a lot about these markers. I look forward to seeing them in the [inaudible 00:46:40].

[Dr. Cheryl Burdette]: Yeah, thank you for having me on. I really appreciate it.

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Our performance and quality of life is largely dependent on a delicate balance of brain biochemistry. It defines our mental health, mood, our anxiety, our focus and attention, cognitive performance and ultimately even our personality.

Today’s guest estimates that 80 to 90% of the population have some kind of biochemistry abnormality that affects their brain. This is based on insights from a database of biochemistry he has collected over 35 years with over 3 million biochemistry test assays. So while many of us may not be included within the 26% of the population included in clinical diagnoses for mental disorders, most of us can improve our mental wellbeing or cognitive performance by addressing biochemistry imbalances.

Today’s guest is Dr. William J. Walsh, founder of the WalshInstitute.org. Over his 35 year career he has treated 30,000 patients with a wide range of brain related disorders, successfully treating them by addressing biochemical, methylation and epigenetic abnormalities. The treatments are nutrient based to realign biochemistry, and thus drug free.

William is also a frequent lecturer at conferences across the world including organizations such as the American Psychiatric Association, the U.S. Senate and the National Institutes of Mental Health. In short, he’s got a very in long and deep CV backed up by those 35 years of experience.

“In the areas of depression and behavior disorders and ADD and even schizophrenia… about 95%… have those conditions because of their abnormal biochemistry and by correcting and normalizing these brain chemicals, we were able to help most of them.”
– William J. Walsh PhD

This is a great interview that goes into a lot of depth in biochemistry, the labs, as well as looking at the emerging area of epigenetics and how work there will help us resolve more health issues and optimizing your brain via biochemistry.

The show notes, biomarkers, lab test and other links are below. Enjoy!

itunes quantified body

Show Notes

  • How 80 to 90% of the population are affected by biochemical brain imbalances
  • How abnormal methylation (over or under) affects the moods and personalities of 30% of the population
  • Mental disorders like schizophrenia and depression that can be correct through methylation therapy using specific nutrients
  • Correcting and normalizing brain biochemistry improves mood, personality and addresses clinical mental disorders
  • The inexpensive $300 to $400 blood tests you can do to get brain biochemistry imbalances assessed
  • The 6 or 8 dominant nutrient factors that have the greatest impact on your brain health and performance
  • Correcting imbalances via nutrients such as Zinc, Metallothionein activation and epigenetic and methylation mechanisms
  • Things that can bias the results of biochemical lab tests such as lab handling and supplements
  • The difficulties and problems caused in methyl folate treatment of methylation imbalances
  • William’s view on lab reference ranges used in a variety of labs
  • The link between oxidative stress and brain biochemistry abnormalities
  • Biochemical individuality and how we should get to know our own signature and optimize factors in our life such as nutrition and exercise accordingly
  • William’s view of where brain science and treatment is changing and will evolve to over the next decade
  • Biomarkers William tracks for his own health and how he corrects/ maintain his own methylation balances

Biomarkers in this Episode

  • Plasma Zinc: Zinc abnormalities, particularly low levels, are associated with brain imbalances. William assesses this as a reliable/ stable marker.
  • Serum Copper: Copper abnormalities, specifically high levels, are associated with brain imbalances and conditions. William assesses this as a reliable/ stable marker.
  • Urine Pyrroles: Used by William to detect abnormal stress levels and potential pyrrole disorder. More difficult to use for interpretation as levels tend to vary throughout day based on stress levels and should normally be between 5 and 12. William has seen people over 200 with severe disorders.
  • Whole blood histamine: The simplest and cheapest test used to assess your methylation status, whether you are under, normally or over methylated. Histamine is negatively correlated with your methylation levels.
  • Ratio of Plasma SAM / Plasma SAH: Looking at straight plasma ratio of SAM (S-Adenyl-Methionine) to SAH (S-Adenyl-Homocysteine) provides a relatively cheap but accurate assessment of your methylation status, with a bit more information as to the basis of under or over methylation (e.g. low SAM).
  • Ratio of RBC SAM / RBC SAH : Looking at the red blood cell (RBC) ratio of SAM (S-Adenyl-Methionine) and SAH (S-Adenyl-Homocysteine) gives an estimate of intracellular levels and methylation status. Slightly more expensive.
  • Methylation Gene SNPs (Single Nucleotide Polymorphisms): Gene mutations with enzymes related to methylation can impact our methylation status and cause methylation imbalances. Genetic tests identify these SNPs. The example given was the common MTHFR SNP.
  • RBC Folates: Using the Red Blood Cell (RBC) levels of the different folates (e.g. folinic acid, folic acid) as an intracellular measure for the status of your body’s folate resources. This can identify whether they are under resourced, over resourced or balanced.
  • Hair Metals Tests: William discussed the accuracy of reference ranges used in hair analysis by companies like Doctor’s Data.

Lab Tests from this Episode

  • William J. Walsh’s Brain Biochemistry Panel: William recommended this lab, Direct Healthcare Access II Laboratory, who he has worked with for a long time and runs his complete panel for $235. (See below for link to list of Walsh trained physicians for interpreting the labs, alternatively the lab has trained physicians who can provide a consultation with the test for $435 – see here)
  • Methylation Pathways Panel: Includes the RBC SAM, RBC SAH and RBC folates from Health Diagnostics & Research Institute, which William uses and was discussed in this episode.
  • Hair Toxic Exposure Elements Profile @ Doctor’s Data: This test looks at heavy metals levels in ppm (parts per million). [Note: William J. Walsh disagrees with the reference ranges, believing them to be too low, and indicating toxicity where there is none].

Other Resources Mentioned in this Episode

    William J. Walsh PhD. and the Walsh Institute

  • WalshInstitute.org: William J. Walsh’s non-profit research institution focused on publishing, educating and training physicians on his work.
  • Nutrient Power: Heal Your Biochemistry and Heal Your Brain: William’s book covering his discoveries, tests and protocols in the area of brain biochemistry and methylation. A great read with a lot of detail on treating conditions from ADHD to schizophrenia – highly recommended.
  • Walsh Institute Trained Physicians: A list of the physicians who have taken training programs with the Walsh Institute for labs interpretation and his nutrient protocols for resolving abnormalities.
  • William J. Walsh on PubMed: List of peer reviewed studies William has published over the last 20 years on biochemistry, epigenetics and mental disorders in a variety of medical journals.
  • Others Mentioned

  • Carl Curt Pfeiffer, PhD: William originally was mentored by Carl Pfeiffer, deceased in 1988, who is considered the founder of orthomolecular psychiatry, otherwise known as treating mental disorders via biochemistry. Carl Pfeiffer treated 1000s of patients through the Pfeiffer Treatment Center.

Interview Transcript

Transcript - Click Here to Read
[Damien Blenkinsopp]: William thank you very much for coming on the show today. I really appreciate it.

[William J. Walsh]: Well Damien, it has been my pleasure.

[Damien Blenkinsopp]: In order to get started I wanted to just quickly dive into the scope of your work. What is actually covered, I know it is all basically centered around mental disorders. Could you give a broad strokes overview of the areas you have look at and gone into over the last thirty years or twenty years.

[William J. Walsh]: It has been about 35 years actually. Basically I started as a scientist working on things like nuclear physics, chemical engineering. I worked for Argo National Laboratory, Los Alamos Scientific Laboratory, places like that, so I come background of heart of science.

About 35 or 40 years ago, I became a prison volunteer trying to help people living in prisons and in the course of that I got very interested in the clause of behavior disorders and that sort of launched me into studies on brain science and more than anything else.

Lately I have been studying with my colleagues and research associates, the microbiology of the brain and especially with respect to originally behavior disorders and then attention deficit disorder, depression, anxiety, bipolar disorders, schizophrenia and then most recently Alzheimer’s.

So I have been focusing on trying to understand what is going on in the brain that is different for these people. Along the way, I did start a clinic in Illinois that at one time I think was the largest complimentary medicine clinic in the world and we eventually saw 30,000 patients.

And we evaluated all of those with respect to metal metabolism and methylation and pyrrole disorders and malabsorption. I accumulated a lot of data and I have always collected the numbers so I have I think the world’s biggest chemistry database for a lot of these conditions.

[Damien Blenkinsopp]: Wow, that is pretty impressive. That is really why I want to get you on the show became I am pretty impressed by that number when you brought it up in another interview I had and of course your book is fantastic.

When I was researching before this interview I was looking for the mental disorders like some of the ones you have been talking about. Some of the estimates are that 26% of Americans age 18 or older actually have one of these disorders, so one in four Americans which is pretty huge. So in fact it is a huge slice of society.

Have you seen this as something that is very common place, so like the cases you have seen? Has it been very, very specific cases that have been clinical diagnosed or is it like something a bit more-broader like you had patients referred from all sorts of various work.

Perhaps they do not feel like they have a mental disorder as such. It is kind of a big word and maybe they are just having a few problems at work. They feel a bit depressed or is it something that they would not really feel is a clinical situation?

[William J. Walsh]: Well, we of course studied primarily people who had major problems severe clinical depression or schizophrenia. But in order to really evaluate something, you have to know what normal is. So along the way we study very healthy people who would not have these problems to get an idea what the chemistry should be and what the brain chemistry should be.

Now these disorders come in mild, moderate and severe, maybe it is 26% of the people of a population has a really significant problem. Probably at least 80% or 90% of us have some abnormalities in our brain chemistry and life would be better if we knew what those were and could normalize them.

[Damien Blenkinsopp]: That is pretty impressive. So it is really relevant to everyone and that is what I understood in your book and what I was really amazed about. And especially when you are describing some of the personality symptoms and I think we accept it as pretty much normal in society.

[William J. Walsh]: That is right because for example methylation is something that we have to evaluate everybody. About 70% of the human population has normal methylation but about 20% are undermethylated and that is basically genetic and you are born that way and another 10% are over methylated.

These conditions have a lot to do with mental functioning. With our personality and traits for example, undermethylated people tend to have a strong will. They tend toward high accomplishment in life. They are competitive, they are sort of driven individuals compared to the others.

Whereas the over methylated people are friendly, make wonderful neighbors. They might get involved in nursing or in charity work and the over methylated people, one of the tendencies is they tend to be very artistic and better at music.

Each of us is somewhat defined a bit genetically from the time we are born and we have tendencies that are there and it sort of makes us who we are and gives us the diversity that we all like. But in extreme cases with severe chemical abnormalities, biochemistry doesn’t function well when that happens, you could have a disorder that can really plague a person and cause a lot of misery and that is what we focused on.

When we evaluate a patient, we have to not only get the lab results. We also need to know everything we can about this human being because the symptoms and traits give a lot of evidence with respect to what the chemistry is and what neurotransmitters are not functioning properly.

[Damien Blenkinsopp]: Can you explain a little bit more about what methylation is and if it is a problem, you are saying some people are undermethylated and over methylated but the way you described the personality types and everyone knows these kind of people.

So is it okay in some situations when it gets more advanced, more away from a balance that it because a problem or is it a slight issues that are going to present some problems perhaps in concentration and performance at work or whatever it is?

[William J. Walsh]: People who are undermethylated and I am one of them and I suspect you probably are too. These are people who are self motivated. They tend toward obsessive compulsive tendencies and if they can channel that into a career or into a blind study, it can be a really good thing.

But of course it can also go in a wrong direction. These are the same people who are more prone to be hooked on things. If they sort of started to take illegal drugs for example, from females who got involved or anybody. It can involve shopping disorders or gambling disorders.

Basically it is a matter of extremes. The environment has quite a bit to do with it. Methyl is the simplest organic chemical that is one carbon atom with three or four hydrogens. It is a very dominant factor in human function that domination starts in the womb during the first three or four weeks of that little tiny baby developing in the womb.

Your DNA and every cell in your body, at that time methyl reacts with parts of your DNA and that acts like a switch that turns on some chemicals and turns off others. In other words it is a switch. They can turn on a gene or turn off a gene.

We have 23,000 genes and every genes had only one job and that is to make a protein. That is what every gene does. It makes one specific protein or enzyme, since we have the same DNA in every part of our body in order for a person to be healthy and normal, every part of your body.

Every tissue, your kidney, your lungs, your liver, you need different chemicals in every one of these areas and that is how this is all done. It is done with methylation. If people are over methylated or under methylated, then this changes things and that is why we get these different traits and symptoms.

Sometimes they are mild and just sort of define people, some people are talkative. Others are quiet. That is probably an intrinsic thing related to methylation. In many case, there are certain disorders that are associated with methylation.

For example, about 65% of all people with schizophrenia have a methylation disorder and then about 60% of all people who have clinical depression have a methylation disorder. And if we are going to identify what their methylation status is, we can provide them with nutrients therapy, drug free therapy that can usually create that and avoid the need for a drug medication.

[Damien Blenkinsopp]: You said a lot of things that are very interesting and I actually did see in your book. You’ve covered addictions for undermethylated. Have you seen any situations? So these are new applications of your work that I was not aware of.

Have you seen any application for drug abuse or areas like that for the kinds of treatments you are talking about?

[William J. Walsh]: Over our history, doing clinical work with 30,000 people, one thing that we never were very good at was trying to help people who might have cocaine addiction or heroin addiction or alcoholism and we actually would not invite those people to come to our clinic because we thought we are not likely to help them.

But in the last ten years, there has been some wonderful revealing research and addictions and it all has to do with the NMDA receptor in the brain. NMDA receptor and that seems to have everything to do with what they call memory extinction.

When something goes wrong with that receptor which is a glutamate receptor, that seems to have everything to do with addictions and there are now nutrient natural therapies that seemed to be working better than drugs in the research they are doing.

I think that is a very positive thing and we started using these therapies. It is still early. We are not quite sure yet. We have not done outcome studies but I think that for the first time in my life, natural treatments for alcoholism and drug addiction are not promising.

[Damien Blenkinsopp]: When you are talking about these changes in personality, in behaviors and so on. There is an epigenetic aspect to that when we talk about methylation that affects the epigenetics. Could you explain a little bit about that and is it permanent or are these treatments actually changing the epigenetic homeostasis of the body when you are fixing and treating people?

[William J. Walsh]: What happens as I started to say during early development in the womb, in the nine months of gestation, these methyl marks are put on and attached to certain areas of certain genes and basically switch the genes on or off.

They used to believe not until about ten years ago that these methyl mark. They call them book marks or marks and they thought these methyl marks were in there like concrete. You could not remove them or change them.

Now we know that is not completely true and in fact we now know that environmental insults can offer these marks and cause disorders. We now know that most cancers are epigenetic and result from things that happen after you are born, maybe when you are an adult even.

Cancer results from overwhelming environmental insults usually involving this thing called oxidative stress and free radical assaults on the body that can actually alter these methyl marks. And in cancer they have now worked it out that they understand which genes are being affected.

And we now know that most cancer research now is aimed at identifying the misbehaving genes. And in cancer, so far, almost every one of them has been marks that have turned off by a cancer protection gene. They know that is absolutely true for bladder cancer and prostate cancer and lung cancer.

Another example is skin cancer. If a person is in the sun too much or goes to a tanning bed too often and has too much of an environmental insult to their skin, eventually you could overwhelm your natural protectors and that can alter these methyl marks on parts of your DNA and that is what the onset of cancer usually is.

From that time on you have this cancer tendency that you have to deal with for the rest of your life. That is all pretty well established. We also know that most heart disease is epigenetic in nature. In other words, you might have a person with a predisposition for these problems but it is triggered by environmental insults which can be chemical, they can be emotional stresses. They can be physical injuries.

Things that can cause enough environmental stress and insult to change your gene expression and the way it changes is by changing these methylation marks.

Another thing that happen is for the first time because of epigenetics, nutritional practitioners and people who try to do natural therapies and it has really given us a whole new ability because in the past we have studied diet and the nutrients that go into the body and for the last 20 years, we have a lot of knowledge about how we can give nutrient therapies to alter these levels.

The one thing we have not been able to do is to address the enzymes, the important chemicals in our body that are genetically expressed. But now with this whole field of epigenetics, we are now able to do that.

For example, a lot of depressives, people with clinical depression have low serotonin activity. They do not have enough neurotransmission at serotonin receptors. We now know that reuptake is a major mechanism that controls that and because of the field of epigenetics we now understand that methionine or SAMe which are nutrients available at least in U.S. and every drugstore and health food store.

We know that they are serotonin reuptake inhibitors. In other words they do the same thing as antidepressants except that they do it in different mechanism. We know that the impact of folates and niacin and a number of nutrients have a really powerful effect on brain function.

Now with our nutrient therapies and biochemical therapies, we now have the ability to be far more effective than we could five years ago.

[Damien Blenkinsopp]: Certainly. So all of these things you are talking about are influencing methylation and as kind of downstream to that, that is impacting biochemical balances in the body and neurotransmitters is that correct?

[William J. Walsh]: That is correct. Our focus has been on the brain but this also has a lot to do with other disorders, some has to do with the rest of the body. We have just been discussing methylation but there are other imbalances that are also very important like metabolism disorders.

We know that specifically copper and zinc, two traced metals in the body are extremely important in brain function and we know which neurotransmitters they impact. If a person has a metal metabolism disorder, for example zinc deficiency or a copper overload, we have now developed treatments that can just normalize that and help a lot of people.

So it is not just methylation. It is just that methylation is sort of a new understanding. One of the complications is that if you are undermethylated, the best way to improve your methylation is to use folates either folic acid, folinic acid or methyl folate, different forms of folates.

The problem is that we now know epigenetically because of the epigenetic science that folates have extremely powerful effect on brain function. So if you got an undermethylated depressed person, you cannot give them folates or else it will get worse.

Even though the folates will improve methylation, but they patient will get worse. And they will get worse because the impact of the folates on neurotransmitter reuptake is in the opposite direction and it overwhelms the benefits of improving methylation.

It is very complicated. If you are studying it, it is really clear and it gives us a road map for helping people that is beyond anything we could do anything in the past.

[Damien Blenkinsopp]: I know it has been incredibly complicated. Just reading through your book you can understand that. One of the interesting things, it is all basically biochemical the way you look at this. It is about the biochemicals being used in our body and making sure they are in balance. Is that kind of the whole basis for it?

[William J. Walsh]: That is a lot of it. For things like depression and anxiety and behavior disorders, that is pretty much what is important. But there are other disorders like autism that actually are developmental disorders and in that case brain develops differently and you have what they call connectivity problems where different parts of the brain are slightly off spacially or you might even say geographically.

They do not connect like they should. It depends on the disorder but in most mental disorders, it is the chemistry that tends to dominate unless of course if the person has had a head injury or a stroke or something like that. I would say 95% of the cases, it is biochemistry.

[Damien Blenkinsopp]: Great. so by supporting biochemistry, that is addressable, the other 5% it is not really addressable because there is some permanent injury and it is basically a structural injury rather than some biochemicals that are out of balance.

[William J. Walsh]: We learned after doing thousands of patients, we learned there are some people we cannot help and we tried hard to identify who they are so we would not have them come and waste their time.

A big surprise for me was that in the areas of depression and behavior disorders and ADD and even schizophrenia that about 95% of them seemed to have those conditions because of their abnormal biochemistry and by correcting and normalizing these brain chemicals, we were able to help most of them based on outcome studies.

We would often study maybe a thousand patients from the last couple of years for the depression or for autism or whatever. And to find out what happened. Did they improve? To what degree do they improve? Are they still taking the treatment? Is life better?

And then we would find out how many people were really benefiting from this and how many of them failed to improve. And then of course we would study the non-responders and then eventually get our percentages better and better.

[Damien Blenkinsopp]: Your book talks about how you have broken down areas like depression into sub segments because you have got more detail and you can see different biochemical characteristics of different subsets with slightly different problems.

[William J. Walsh]: That is really important. My colleague Dr. Robert Devito is a known psychiatrist. We decided that one of the most important things we needed to make sure the world understood was about depression.

So we would give a paper at the annual meeting at the American Psychiatric Association as the big meeting once a year. We had 17,000 psychiatrists in all over the world and we wanted them to know two major things.

Number 1, Depression is not a single condition. Mainstream medicine throughout the world believes that if a person has clinical depression, basically their problem is low serotonin activity. Nearly every patient who comes to a psychiatrist or any doctor with depression is probably going to be given an SSRI antidepressant like Paxil or Proxaz or Serzone or Zoloft and the list goes on and on.

But what we found, I think the world’s biggest chemistry database for depression and what we found quite clearly is that depression is a world used for at least five completely different conditions. About nearly half of them have something else wrong and they are not going to get better. Antidepressants are not going to help the rest of them.

For example, one of these involves a condition that females have that involves elevated copper levels which has to do with hormone abnormalities and these people have severe anxiety and depression and antidepressants don’t help them. The drugs don’t help them.

Within about 60 to 90 days, we can usually completely correct that condition and most of them tell us that the depression is gone and they can throw away their medications. We wanted the psychiatrist in the world to know that so we gave this presentation and I think it went over really well, the psychiatrist that were extremely interested.

The second thing we wanted to them to know is that they can do inexpensive blood test that only cost about $300 or $400 dollars and that can guide their treatment. They can identify which biotype of depression a person has and they can find out who to give which medication to.

But even more importantly, we also talk about how they can help these people with nutrient therapies and not necessarily have to use a drug. I think that is really important. 14% of all Americans have been diagnosed with clinical depression that is a lot of people.

And so many of them are being treated improperly but just throwing antidepressants at them whereas there is another group where antidepressants are very helpful, it is very important to find out who is who? And there is one group of depressants that actually gets worst on SSRI antidepressants.

There is a lot of evidence now that that is responsible for the school shootings in America where children, teenagers usually get a gun and go into the school and kill people. We have studied the last 50 cases of school shootings and what we find is that these are different from other disorder in people.

I have studied 10,000 children and adults and usually they show their violence by the time they are 3 or 4 or 5 years old. The school shooters are different. They are usually well behaved, pretty good students, they develop anxiety and depression and they get put on in antidepressant, they all ready have elevated serotonin activity.

They get dramatically worse and then disaster happens and so I recommended during our talk at the APA to all the psychiatrists that before they give antidepressant to a teenage boy or really anyone, they really should do some blood test to find out if they are going to be able to tolerate it.

[Damien Blenkinsopp]: How many types of depression have you defined?

[William J. Walsh]: There are five major types that encompass 95% of all depressants. But there are other things that can cause depression. For example a person can be hypothyroid, low thyroid can cause depression and that is separate.

There is a number of what I call splinter types. Fortunately, 90% to 95% of people with depression have as their major problem one of these five types of depression. We are now able clinically with lab testing and with a careful medical history are able to accurately diagnose what type they have and they require completely different treatment approach, each one of them.

[Damien Blenkinsopp]: So as I understand it, you have this database which basically provides you fingerprints in terms of the biochemistry of each of these different segments now because of all the dates you have collected. What are the list of labs that you found most useful for creating these kind of fingerprints like the blueprints of what is what and what fits into where?

[William J. Walsh]: Well I think this is really the good news. There are really more than 300 nutrient factors that are important in the body. However, what we have learned is that with respect to brain function, the function of the brain that might go wrong, there is only about six or eight nutrient factors that have a really dominant effect.

And if we focus on those six or eight factors, we are able to help nearly everyone and the beauty of that is we do not have to do lab work for 300 different nutrients and we do not have to get a treatment to try to normalize 300 or dozens and dozens of things. If we can normalize these six or eight dominant nutrient factors, we can help most people.

For example we know we have to know a person’s serum copper level and we want to know there are several plasmin level that this has to do with how much free radical copper they have. We need to know their plasma zinc level.

And about maybe 20% of people that we work with, with mental problems have abnormalities that can be corrected that will help them. We have to find out methylation.

Now there has been a lot of people lately that have been trying to use genetic testing looking for SNPs like MTHFR enzymes that are weakened and now in genetic testing you can identify enzymes in the methylation for example that are weakened. We know that that is not a very good way to identify a person’s methylation status.

[Damien Blenkinsopp]: Could you explain why that is?

[William J. Walsh]: Well the reason is that people are all looking at the methylation cycle also known as the one carbon cycle. And that is the cycle in the body that basically produces this chemical called SAMe which is the methyl donor, S-Adenosyl methionine.

It is a relatively unstable molecule that goes throughout the body and it donates, provide the methyl for all these important reactions and people are focusing on things that can go wrong and can cause undermethylation.

One of which is the well known MTHFR enzyme which is really the limiting part of that cycle. And now genetically you can identify weaknesses in that that can cause undermethylation. Well what people are forgetting is that a lot of people are also over methylated.

So what can cause over methylation? Over methylation has to do with the utilization of the SAMe. There is about 80 or 90 really important reactions that have a lot to do with DNA, it have to do with cell division and they have to do with all kinds of important processes.

But more than half of all your methyl goes to one reaction and that is to make creatin maybe as high as 70% of all your methyl goes to make creatin. Well there are enzymes with snips involved with the utilization of methyl and if those are weakened, then you can be producing all of the SAMe with one carbon cycle and you have got SNPs that are tending toward over methylation.

So it is a tag of war genetically between those polymorphisms, they are called snips, Single Nucleotide Polymorphisms that tend to weaken and then you got a group of them that tend to cause over methylation. It is impossible with DNA testing to tell what the net effect is.

Clinically, what we really know if a person is over methylated or undermethylated, what is the sum total result of all these polymorphisms and you can actually have a person with the MTHFR 677-T which is the most damaging undermethilation source. Some of these people are actually over methylated because of the others that tend toward methylation.

[Damien Blenkinsopp]: So what you are saying is that the system is too complex. There are too many genes working together and plus, you can predict what the outcome is going to be by looking at the genes?

[William J. Walsh]: The SNPs are qualitative. They are not quantitative. They do not give you percentages. So even if you knew all of the SNPs, those that would tend to increase or reduce methylation, you still would not be able to know.

But fortunately there are some lab tests that can tell you or gives you strong evidence of whether a person is over or undermethylated.

[Damien Blenkinsopp]: Which labs are those?

[William J. Walsh]: The labs that we have been using primarily have been whole blood histamine. The reason is that histamine and methyl are inversed where everybody has a lot of histamine in every cylinder body. And it is metabolized and it is controlled or regulated or destroyed by methylation as the main process.

The second way of this seems even better than whole blood histamine. There are now labs that will measure both SAMe and SAH. SAH is S-Adenosylhomocysteine and that is what SAMe becomes when the methyl leaves and that ratio is the gold standard for measuring methylation in the body. Both of these are dramatically better than any information you can get from genetic testing.

[Damien Blenkinsopp]: So is that plasma SAM and SAH?

[William J. Walsh]: With respect to methylation.

[Damien Blenkinsopp]: Right because I have seen some people who are testing for Red Blood Cell or RBC, SAMe and SAH.

[William J. Walsh]: I think that is all worthwhile. You get the information from these things. I think that red blood cell foliate is a valuable measure. It tells you about the folate stores which are really important both in methylation but also really important in mental health in different directions.

They now know that folates actually in most of the body tend to increase methyl levels, SAMe levels. However, in your DNA and your Chromatin where you get genetic expression, it does the opposite in many areas and folates strip methyl away from your DNA areas. That is the reason why so many nutritionists get confused.

[Damien Blenkinsopp]: So you could basically over folate yourself is that what you are saying? Is it where you are consuming too many folates either by diet or when you are taking these supplements like the B-Complex or the folates themselves?

[William J. Walsh]: Yeah you need to have the right amount of folate. You do not have too much or too little and there is a lot of clear evidence now that there are new disorders and new problems throughout the world. People are enriching foods and cereals with folates.

But that is important for pregnant women for example. If you are low in folate, they are more likely to have a child who has spina bifida or also with autism.

[Damien Blenkinsopp]: I am just wondering if you have looked at the difference between folic acid and the other folates.

[William J. Walsh]: Absolutely.

[Damien Blenkinsopp]: Okay.

[William J. Walsh]: A lot of people are now saying I have got this MTHFR weakness and therefore I have to use methyl folate, also known as deplin. That is greatly overblown. For one thing, we have about 100,000 micrograms of folate in the body.

The amount of folate you can add with deplin, the idea is to bypass this MTHFR part of the methylation cycle. It is a clever and intelligent thing that seems possible. The problem is that this methylation cycle is like a race track with race cars zooming around the cycle over and over.

In fact there are more than a million methylation reactions every second in the body. The problem with methyl folate and deplin is that it is what I call a suicidal nutrient. It is used once and then it become garden variety normal folate and becomes part of the problem. It only acts once.

It probably is somewhat better than the other forms of folate which are folic acid or folinic acid. It is only slightly better and the impact of it is relatively small because again if you look at the biochemistry, if you look at the cycle, the deplin or the methyl folate, helps convert the homocysteine methionine.

It becomes THS, Tetrahydrofolate, just like all the other folate in your body. It becomes garden variety, normal folate after its first use. It is not nearly as effective as people hold back. And that is why a lot of people who are undermethylated, they might even be folate deficient but a lot of people are getting worse if they are undermethilated and they take methyl folate or any of the folates.

And the reason is epigenetics. If a person has a neurotransmitter problem, that is the exception to the rule. If you have got a problem with serotonin or norepinephrine or dopamine neurotransmission, folates have a tremendous powerful effect on those and they tend to drop and lower the neurotransmission of those.

The simplest example is an undermethylated person with low serotonin activity but that is a lot of people. That is nearly half of all people with depression. So they are undermethylated, they have depression. If you give them folic acid or folinic acid or methyl folate, they are probably going to get worse.

What will happen is that their methylation will improve because of the methyl folate or whatever, but their folates acts as a serotonin reuptake promoter and what the depressed people need are serotonin reuptake inhibitors. They go exactly in the wrong direction.

And that is why so many depressed people and then people with anxiety who are undermethylated, my probably have an MTHFR problem. Clinicians all over the world are now finding out a lot of these people are just getting worse and worse and I give them what ought to help them.

[Damien Blenkinsopp]: So in this cases the secret is basically doing multiple interventions like you are saying about the folate and the SAMe’s and inhibitors so in that case would you be putting two things at the same time basically to counter both sides or how do you deal with these kind of problems?

[William J. Walsh]: For the case of mental health, for the case of neurotransmitter problems with every patient or clinician to try to understand which neurotransmitter system is misbehaving and then in what direction?

For example if a person has low serotonin depression or anxiety or even schizophrenia or even bipolar then you have to do whatever you can to increase serotonin activity. Folates reduce serotonin activity and that is why that harm overrides the benefit of improving methylation.

[Damien Blenkinsopp]: Do you look at test with neurotransmitters in addition to the ones you have spoken about with your general blood tests?

[William J. Walsh]: We would like to but they do not reveal much. We have done a lot of that over the years and we do not think this is very significant, for a couple of reasons. One can do urine or blood studies or platelet kinetic studies or things like serotonin, dopamine and etcetera.

The question is, is that related to what is in the brain? What is happening in the rest of the body may not at all relate to what is going on in their brain.

For example serotonin, all of the serotonin in your brain is made in your brain. Yes there is a huge amount of serotonin made in the gut and in other parts of the body but none of that serotonin makes it into your brain.

And the mechanism and he synthesis of serotonin in the brain is quite a bit different from the way it is synthesized in the rest of the body.

For a while we were testing neurotransmitters in the periphery of the body outside the brain. We found that it really was not useful and did not really give us a better idea of what a person’s problems were in the brain and how to help them.

[Damien Blenkinsopp]: Which is why you are sort of using proxies, plasma, zinc, serum, copper, whole blood, histamine.

[William J. Walsh]: Yes, it has really gotten quite clear. It really stems from the original work by Abram Hoffer and by Carl Pfeiffer. I think they were the two people who really got this going.

Let me just give you one example. Abram Hoffer in the ‘50s. 60 years ago, he was the first person to demonstrate hat nutrients can have a dramatic impact on a person’s mental health. He found that giving niacin to schizophrenics had a dramatic improvement on so many of them.

He had a theory for that. He called it the Adrenochrome Theory. In the last five years, we now know why niacin works and it is a different mechanism and it is epigenetics. We now know that niacin in the form of niacinamide which is what happens to niacin in the body, it becomes niacinamide.

It is what is known as a deacetylase inhibitor. What it does is it increases reuptake all serotonin and dopamine. A lot of schizophrenics are high dopamine people. There is a dopamine theory of schizophrenia for many years I believe that schizophrenia basically is a problem where you got too much dopamine activity.

Now we know that because of epigenetics, that niacin dramatically reduces dopamine activity. So for the first time we understand why Hoffer’s niacin treatments work and that is wonderful to understand.

So now we know because of this new epigenetic field, we understand what methyl does, what SAMe or methionine do and because of epigenetics, they are reuptake inhibitors that increase serotonin activity which is exactly what you want.

The field of epigenetics is really guiding us to better therapies for people. The dominant effect in depression for example is reuptake. The same thing is through of anxiety and schizophrenia and bipolar, it is not the amount of neurotransmitter that is there. It is the activity. It is the reuptake. It is the speed which the neurotransmitter once it gets ejected into the synapse, how fast it goes back.

[Damien Blenkinsopp]: Right. And there is no way to directly account for that.

[William J. Walsh]: Well there is. There is now and it really has to do with understanding the processes of epigenetics and because they control this. The reuptake is controlled by the genetic expression of proteins that are called transport proteins.

And these are the passage ways for reuptake, for serotonin or other neurotransmitters. Once they are in the synapse to zip back into that original cell. The number of these transporters in the membrane of your brain cells turns everything. We now know how to change that.

What antidepressants do is they get in the brain quickly and they disable these transport proteins, these passage ways and they block the serotonin from going back into the original cells. They are inhibiting reuptake and that is why they work for some people.

We can do the same thing with nutrients by our knowledge of the epigenetics in that case, we have to avoid folate and we have to emphasize methyl and methionine.

[Damien Blenkinsopp]: The thing that people talk about when they are comparing the genetics we spoke about a bit before and looking at biochemical markers, there are some views that these markers can vary by chemistry. It can vary by the hour, it can vary by the day, by the time of the day, by the week.

So how stable are the markers that you are looking at in terms of in the bloodstream? Are very stable in changing over months and based on treatment they change very slowly.

[William J. Walsh]: Well this is has been one of the most exciting parts of epigenetics. The markers themselves, these bookmarks along the DNA strand, they rarely change. It takes a rather dramatic events or environmental insults that change them.

However, we now know that there is a process that is called histone modification. All of our DNA is wrapped around proteins that are called histones, we are able to change genetic expression by affecting what reacts to these hisotones and if you methylate the histones, you tend to shut down genetic expression.

And if you use folates or other chemicals, it essentially will increase genetic expression of a particular gene. So you cannot change the basic bookmarks along the DNA but there are two epigenetic processes and the other one is the one that we all ready are able to tinker or if are altered.

And so we are able to change gene expression by altering the chemical on the histones and it is called histone modification. What happens if you methylate a certain part of DNA or even have the histones methylated?

Your DNA gets all jammed together. The way that proteins are made, the way that genetic expression occurs, you have to have your DNA uncoil and be laid there so that large molecules like RNA polymerase and transcription factors, they have to be able to get out and make a protein.

In every cell in your body you have got RNA polymerase, a chemical that is sort of swimming around trying to find a gene to produce. It has to have access to the DNA. Your DNA wraps around these millions of these histone proteins. Methylation tends to jam it all together and prevent gene expression whereas other chemicals can cause it to uncoil and increase expressions.

So that is a complicated answer but the answer is that you cannot change the basic methylation of the DNA very easily. We do not know how to do that yet. Cancer researchers are finding ways in which you can maybe correct these things.

I think that is the way eventually how cancer will be cured and autism and schizophrenia and other epigenetic disorders will be cured actually eventually. But right now, we all ready can do a lot with histone modification.

[Damien Blenkinsopp]: Right. If I kind of resume quickly, what I understood from that. You are saying that a lot of the environmental insults you are talking about earlier which could be toxins, heavy metals, chemicals have altered DNA but undermethylating them by addressing methylation in the body that helps to counter some of these effects.

[William J. Walsh]: They could be. They are undermethylated or over methylated. If you have got abnormal methylation in the area surrounding a gene, you are going to have a problem with that particular chemical which might be in your liver or in your kidneys or in your brain And so you need to have the proper methylation and these bookmarks are all established in that first two or three months in the womb.

One example of an epigenetic disorder, do you recall thalidomide? Maybe you are not old enough to remember that. Thalidomide was an anti nausea pill given to pregnant women and it caused terrible deformities.

And what it was doing is it was altering these methyl marks and altering the chemicals produced in the different parts of the body and some of them are born without fingers and toes and arms and it was really quite awful.

What happened is it messed up and altered the epigenetic laying down of these methyl bookmarks. The question then with respect to people who are adults and they have depression or anxiety or whatever is what genes are misbehaving?

There now are methods being developed where we can now identify genes that are abnormally methylated, we now have the ability of doing that. It is really a piece of cake really. It is very easy to do.

[Damien Blenkinsopp]: Are those expensive tests?

[William J. Walsh]: Not really. I am just starting an experiment with some colleagues in Australia where we are going to do exactly that. We are about to do an experiment where we hope to demonstrate that schizophrenia is an epigenetic disorder.

If you take the DNA which is made up of literally billions of chemicals and hundreds of thousands of areas where you are looking for specific areas where methylation can either turn on or turn of a gene.

We now have a way of cheaply and very accurately determining every methyl mark is dipped to your DNA and to a bisulfate solution. The only cytosine molecules left are the ones that were methylated. We now have the ability to do that.

[Damien Blenkinsopp]: Are you able to do that down to the gene level? So we were talking about some SNPs earlier, would you be able to see which SNPs are methylated and which ones are not?

[William J. Walsh]: Well the SNPs themselves are the DNA mutations. The SNPs are DNA mutations but the gene expression is related to that of course but it is also related to this histone modification and it has to do with the abnormal bookmarks.

There are two different things that could go wrong and one has to do with the SNPs which is genetic, the other has to do with the methylation marks that regulate gene expression, it has the gene regulation that is going to silence or turn on genes and now we are able to do that too. We can identify both of them.

[Damien Blenkinsopp]: For example if you had a SNP but it was not methylated, so it is not active, you will be able to see that. When these people are looking at this complex system they can stop looking at that SNP and saying that is a course because it may not be turned on for example.

[William J. Walsh]: Well a SNP basically amounts to weakness in a protein enzyme. It is a weakness. It does not mean that you shut it off. Like MTHFR is a gigantic molecule. It has more than 500 amino acids. Its molecular weight is 77,000.

And what is a SNP? Of those 500 amino acids, one of them is the wrong amino acid. Just one out of the 500 and in most cases a SNP does not affect the function of that enzyme but there are a couple of places especially in that MTHFR, the 677-T and the 1298.

Those are two locations where you can get a really significant weakness, not in elimination of a function but a weakening of an enzyme. Those SNPs are there in the beginning. There are mutations that have occurred over centuries and over the millennium.

We all have mutations. I mean people are tall or short because of mutations, green or blue eyes because of mutations that is why people are basically different. We now know that there are more than ten million SNPs that have been identified in DNA.

I think every human being has at least a couple of thousand of these SNPs, we know that 52% of all people that live in Italy have MTHFR 677 and most of them don’t need treatment. I think it is important to get a perspective of what SNPs are. We all have SNPs.

[Damien Blenkinsopp]: And that is just to methylation.

[William J. Walsh]: It is.

[Damien Blenkinsopp]: I wanted to go back to the tests that you have been running which you are pretty keep and you said are very good at diagnosing a lot of the different mental disorders. So you have got the whole blood histamine, the plasma zinc, the serum copper, urine pyrroles and ceruloplasmin.

What I wanted to ask you, people talk about the stability that these kind of marker because they are biochemicals in your blood. Are those going to vary day by day and therefore be difficult to get an accurate reading?

For example if you take cortisol and it is rising. Is this a very specific marker of course but it is rising and going down so you have to take four readings per day to understand what is really happening.

With these markers that you have taken, are these longer term very stable markers which do not vary a lot over time so you are pretty sure of getting an accurate reading as to the state of them?

[William J. Walsh]: It depends on which test and we have to be very careful. For example with whole blood histamine, we have to make sure that a person has not had antihistamine recently or any allergy treatments like antigens can affect the histamine reading.

And that is why we are so excited about the SAMe, SAH, the new test for methylation. With respect to zinc, we have to make sure we insist that before taking a blood draw that they abstain from any zinc supplementation for 24 hours.

We have done enough, thousands and thousands of these that we know how to do it. They are not all totally stable. The same is through with copper. We do not want anybody to be taking copper supplements just before a copper test.

With the pyrroles, that is probably one of the more unstable ones. Your pyrrole level in your blood and in your urine tends to vary throughout the day and it varies with stress. When a person is under stress, their pyrrole levels tend to increase.

So you get a snapshot in time. We know that normal pyrrole levels are between maybe five and 12 using the units that we use in the USA. If a person is between say 12 and 20, we regard that as high normal and possibly mild pyrroles and people who are over 20 and we have had people as high as 200 or 300.

If a person tests really high in pyrroles, we know they have pyrrole disorder. We had a serial killer who was in prison in New York State and we did a study where we were testing his pyrrole level which was extremely high, he was 202 the first time we tested him.

Working with a psychiatrist, we tried him day after day and when we found when he was under high stress, his level might be 200 but on our calm day, it might be 40. In other words, those levels do jump all over.

In his case, he is always high but that high level, that severity can really alter and that is one reason why we need to know the symptoms and the traits because these symptoms and traits, pyrrole disorder are so sharp and clear.

We could diagnose pyrrole disorder just by meeting a person and spending and hour with them. We can pretty much predict what the level it is. So all of them are morning people, they are not hungry for breakfast. They stay up late at night. They have a tendency to sun burn. They are usually famous for their temper. If they gain weight, they have an abnormal fat distribution.

It is not completely simple and that is why at this time, I do not think people can really self diagnose themselves. In my book Nutrient Power that covers this, I deliberately did not give a road map for people to read this and just start treating themselves.

If you got a serious problem you really need to have a doctor who knows what they are doing to supervise this. You can make a person worse with nutrients.

[Damien Blenkinsopp]: It seems like it is very complex. In addition to the markers which are going up and down. So could someone have a urine pyrroles level which is normal when in fact most of the time it would be in the high reference and it would be something that you could look at.

[William J. Walsh]: The answer to your question is that there is a lot of false negatives with pyrroles. We have had people who tested normal with pyrroles and then three months later we found out that they actually did have really high pyrrole levels.

Another problem with the pyrrole sample is that if the urine sample gets overheated or if gets too much exposure to light it will just decompose the pyrroles. That is one of the issues.

[Damien Blenkinsopp]: That is an interesting point actually. I have come across this before. In terms of lab handling, some tests are more sensitive than others. So it sounds like urine pyrroles is very sensitive to lab handling and there could be errors for the lab.

[William J. Walsh]: Yeah, the challenge with a lot of sampling and the greatest errors we have in these markers and these studies are now what happens to the lab. But the ability to get a good sample to the lab, get the sample in good condition to the laboratory.

[Damien Blenkinsopp]: Because it is a centralized lab, specialist lab?

[William J. Walsh]: There are labs in Europe that do pyrrole levels and allow the samples to be sent at room temperature over days for the lab. That is a terrible idea.

You are going to get a lot of decomposition of the pyrrole molecule and it really need to be either hard, frozen and sent on dry ice and protected against light or else shipped on an ice packed in 24 hours and you have to be really careful about how that is done a lot of labs are doing it wrong.

[Damien Blenkinsopp]: I have seen that problem with other markers are well. If you look at for instance the plasma zinc and the serum copper, in that case I understand that you are addressing those imbalances through supplementing zinc and copper.

Is it very difficult to not overshoot? The zinc and copper markers are they stable like they are not moving up and down every day but they are moving if you supplement. So how do you judge how much you provided in terms of an input of zinc or copper versus the more natural methods like foods, so for example if you took some liver which naturally has zinc and copper?

[William J. Walsh]: Actually copper is one of the more reliable lab test. It almost never is wrong. The copper is not going to deteriorate. It can decompose. I mean coppers have metal. It is not going to go anywhere.

So the concentration of copper in a lab test, you can really rely on. Assuming you got a good lab and that is something that we are very confident of. Now what is a normal, healthy level? Well healthy, generally an ideal level would be between say 80 and 100 micrograms per deciliter.

But if you got a woman with anxiety and depression and she is testing at 180, that means she has low dopamine and elevated norepinephrine and the treatment for this has got to be done very slowly and gradually.

And he treatment really involves giving things like zinc and B6 because zinc in vegetables cause the excess copper to leave and the way it does that is it stimulates the genetic expression of a protein called metallothionein and I do not want to get into details of that.

But you have to do it slowly and careful because if you jump in and give a full dose of zinc to a high copper person, it will dump too much copper in the blood stream and they will have the worst day of their life. So you have to do it careful when you are trying to bring a nutrient level down, you usually have to do it gradually and gradually increase the doses in maybe for two to three weeks to avoid temporary side effects.

The typical healthy zinc level I think is between perhaps 100 and 120 micrograms per deciliter. You use different labs. We almost never see people who are high in zinc. Zinc problems are virtually always involving deficiencies.

We find in the cases we have had with mental problems that 90% of them are either low normal or totally deficient in zinc and that is probably the number one most common chemical imbalance in mental disorders.

It has a lot to do with oxidative protection. Your zinc is related to one of the major protectors in the body against oxidative stress and that is metallothionein protein that has stimulated the product of it, it depends on the zinc levels.

And that is how copper is regulated in the body. Copper is really important with mental functioning. Excess of levels for example cause, we think and we published a paper on this of post partum depression, the women who develop surprising depression or even psychosis after having a couple of babies.

And the reason is during the nine month of pregnancy, a woman’s copper level more than doubles. The fetus needs that, after the baby is born within 24 hours that copper level supposed to go back down to normal.

A lot of people do not have the ability to get rid of extra copper. People who have that disorder even whether male or female that is something that is so easily fixed within 60 days, we can do a nutrient therapy that will normalize their blood levels of copper and in many cases have dramatic improvement in functioning.

Copper and zinc are markers that are specially reliable, as long as you are careful not to have anybody taking zinc or copper supplements within 24 hours of the blood draw. The other markers, we have to be more careful with a lot of the others.

[Damien Blenkinsopp]: So have you had people that have entered you practice? I’m just asking if it has ever come up when they have been supplementing let us say zinc or say copper or maybe something else and they have managed to cause a mental disorder clinically and end up in your practice because of that out of interest?

[William J. Walsh]: Yes that has happened for sure. A lot of people we see are all ready on supplements. Before you do the blood work, you do not want them to stop all of the supplements because that would put them into a transition that might be transitioning over a month.

And so what we have to do is find out exactly what they are taking and just have them stop for about 24 hours before we do their blood work.

[Damien Blenkinsopp]: Once you put them on treatment, how often and frequently do you test to make sure that things are okay or what are you looking for?

[William J. Walsh]: A typical patient would come in and we would spend probably two hours with them. Most of them sometimes in getting their symptoms of trace for medical history, you learn a lot from many medications they have taken to which ones will help them, which ones would harm them, getting all of that information and then the blood work.

With all of that, we then can identify in most cases the chemical imbalances that are at the root of their problem hopefully and then we can start them immediately on a treatment program. A treatment program of nutrients aimed at normalizing these blood chemistry levels. Typically, I always like to see patients between four and six months after that visit.

[Damien Blenkinsopp]: It is quite a slow readjustment crisis.

[William J. Walsh]: Yes. People are different with respect to how well they absorb things. We might give a patient 50 milligrams of zinc but is that actually the right level for them? So if you can do a second test after they have done that for several months, find out what their zinc level is and then you can find tune the dosage and make it perfect.

And once you have done that in an adult, you really do not need to that maybe once every couple of years. Most of our patients we would want to see within six months after the first visit and after they have been taken the nutrient to look at their chemistry again and then we would typically see them once a year for a checkup. It is not a lot of doctoring.

[Damien Blenkinsopp]: That is good and you just get the test and make sure everything is up. When are talking about the test, are you using reference range that labs typically use or do you have your own because I think you mentioned I think zinc is 100 to 120. Are you using narrow ranges or ranges that you have developed yourself over time that you find are better optimum to avoid these kinds of mental disorders?

[William J. Walsh]: That is a very good question. The ranges that you see from laboratories whether it is Quest or LabCorp or Sonic or something like that, these are basically what they call two-sigma ranges. There are ranges in which roughly 95% of the population sits between these two levels.

And they are extraordinarily broad. But the functional ranges for mental health are much narrower. For example, whole blood histamine, the range is typically are between 25 and 150. However, Carl Pfeifer found years ago for mental health, the range should be between 40 and 70.

And people who are below 40 are basically over methylated and people who are over 70 are undermethylated. These broad ranges that you see on the lab reports, sometimes you have to ignore those ranges and focus on the narrow ranges that are related to mental functioning not just general physical health.

[Damien Blenkinsopp]: Thank you very much. This is very clear and I am sure it will be very helpful for people. In your opinion would it be helpful for someone who is suffering any kind of mental disorder or say they are going to psychotherapy because they are having problems. It would be helpful to get these blood tests in case anything comes up, just these five very basic tests.

[William J. Walsh]: Well there is probably a few more than five but I think it would be very helpful to do that and we have a few labs that are quite good at doing this. We have got one on the US Aid called Direct Healthcare Access that I asked to put together a protocol of these tests.

It is more than five tests but it gives all the information that we need to at least to first look at a person’s mental functioning. Another thing we are doing is we need to have doctors that can evaluate these tests, doctors who know their patient and can do the test and understand what it means and then develop the proper treatment.

Our main activity now has been to train doctors. We train I think 34 practitioners in Ireland last year. We did 66 doctors in Australia this year. I have a team that is doing international physician training and our goal is to have 1000 doctors scattered around the world who are really good at doing this and I think that is really important.

Unfortunately it is complicated enough that it is not something that the average person can do themselves.

[Damien Blenkinsopp]: Is someone able to do that panel you just spoke of to see if they have a problem?

[William J. Walsh]: Yes. A lot of people do that. Some of them do it to determine if they are good candidates to see a doctor and go to the travel of seeing a doctor.

A lot of people are doing that very panel. In fact I think they do that at a specialty lab near Chicago. I think they do this for people throughout the world.

[Damien Blenkinsopp]: That would be interesting if you could give me a reference for that because people might like to just run that.

[William J. Walsh]: Actually if you have my book and you look in the back of the book, there is a resources section and that lab is listed first with their contact information.

[Damien Blenkinsopp]: Oh great, you just ask for your panel.

[William J. Walsh]: Yeah they do my panel. I am not associated with them, they are separate from me but I have at times tested the proficiency of the lab and I think they are very good.

[Damien Blenkinsopp]: And as you said that is relatively cheap? I think you said under $500.

[William J. Walsh]: We are going to be training 40 doctors in the Chicago area in October and we are having about 40 patients that will be part of the training where we take real live patients who come in and we go through the whole process to help train the doctors.

We are going to you use that panel on them and I think the cost is between 350 and 400 U.S. Dollars.

[Damien Blenkinsopp]: That is great.

[William J. Walsh]: Not bad at all right?

[Damien Blenkinsopp]: Yes that is really good. Say something came up in one of these tests, you are talking about many doctors you have trained on your website or some are list of individuals, they could go to get these type of biochemical treatment or is a bit border, are there other organizations? Where could they get information about doctors that would help them with these particular problems?

[William J. Walsh]: Well as we train doctors, last we just sent out a questionnaire to doctors that we have trained that have been to our training programs to find out which of them are actually doing these therapies that are confident in them and would welcome new patients and we are going to put that on our website.

Right now there is a very small list of doctors that we have on our website but we hope to have maybe 100 or so throughout the world that will be on that website maybe a month or two from now when we get all the responses back.

And as we keep going, like I said our goals is to tray a thousand doctors in the next five years throughout the world and we are interested always in going to countries that are interested. If there is a group within a country that would like to have these kinds of therapies brought to their country we are very open to work with people.

My organization is a public charity. We are not interested in making money but we are interested in getting these effective therapies available to people throughout the world.

[Damien Blenkinsopp]: It is really amazing what you are doing. I want to look a little bit toward the future use of this over the next ten years. Could you see this kind of natural biochemical therapies replacing some of the drugs that are used with mental disorders today? How do you see this evolving over the next ten years for example where you would hope to see it evolve?

[William J. Walsh]: What I think is happening is I think we are just in the beginning stages of a new era in mental health. For about 100 years, we had the psychiatry model which lasted up until 1965 where the thought was if a person had depression or a mental problem, it was because of their life experiences.

Then in 1965 which was the biochemical revolution in psychiatry, they began to realize that the problem really was neurotransmitters and brain chemistry and mental functions, chemical imbalances in the brain.

The only way at that time, they knew how to correct and help these people was with drugs. So we have been on a pharmaceutical era that started in 1965 and I believe it is about to end.

And the reason is, as brain science advances, we are learning more and more how we can correct these problems without drugs. The basic fundamental problem with drugs is that they are foreign molecules. They are powerful foreign molecules.

And when a foreign molecule that is power enters the brain, you do not create normalcy. You usually have side effects or maybe a change in personality or it could be weight gain, it is not going to provide normalcy.

And as brain science advances and it is all ready beginning to happen. We are getting to the point where we are going to be able to normalize the brain without drugs because of scientific knowledge that is coming. The interesting thing is a lot of this knowledge and a lot of this great scientific work is being done by drug companies. Basically they are going to be hurting themselves.

They already are being frustrated at times by doing the research and finding that natural substances are working better than drugs for some of these conditions. The only problem is that the drug companies have the wrong goal and that is to make the next billion dollar drug.

And so when they find natural ways to correct the problem, or correct a brain chemistry problem, they don’t pursue it because it is not in the interest of their stockholders.

Anyway I think the answer is yes. We are just beginning a new era in mental health and it is going to be a tendency toward normalizing the brain ad being able to accomplish that without drug medications.

[Damien Blenkinsopp]: In terms of your own recommendation to someone who is trying to make better decisions about their body’s health and performance with data, what would be your top recommendation that they should do whatever it should be?

[William J. Walsh]: Well of course the things that we all ready know, everybody needs to have a good diet. We need to have nutrient-dense foods. However, the best diet for one person is not the best for the other. For example if you are undermethylated, you would thrive on a protein-based diet.

And if you are over methylated, the best diet would be a vegetarian diet, rich in green leafy vegetables. So there is biochemical individuality, each one of us is biochemically individual. It would be nice for people to get to know who they were biochemically.

Some people do this by trial and error by finding out how they feel on different kinds of diets but of course junk food diets are a problem. People need to have the right amount of the omega 3 or fatty acids which is a major problem in the U.S. and everywhere. We might say junk food type of diets which are throughout the USA.

And then the second thing of course is exercise. One of the major things that most people don’t realize is that importance of antioxidants to have diet and to have many supplements that provide antioxidant protection. Very high percentage of people with depression and anxiety and behavior problems and these imbalances have high elevated levels of oxidative stress.

That can be caused by outside influences like toxic metals or immune problems but often it has to do with a genetic weakness for some people in protecting against oxidant stress. They may not have glutathione or selenium or zinc. There is a long list of protective agents of the body that are supposed to protect us.

And a lot of people have insufficient levels of those. So I would think that it would be really important for people just fortify themselves with things like vitamin C and vitamin E and selenium and zinc. There is a long list of really effective antioxidants. I think almost everyone would benefit from that.

[Damien Blenkinsopp]: I noticed in your book by the way that when it came to heavy metals testing like urine and blood, you felt that the results from those tests were difficult to analyze. Is that still your view?

[William J. Walsh]: I first got interested in the very beginning when I found that criminals had very abnormal metal levels, I did a lot of testing of blood, urine and hair testing and actually with toxic metals, very often hair testing is done properly by a good lab can be really revealing.

It is probably a great way to find if a person has too much mercury or lead or cadmium or one of these nasty metals. One problem however is that these labs starting about 15 years go started doing something I really hated and they would list the correct parts per million level of the lead and the mercury and all.

But they changed the charts and they tend to exaggerate the toxic metals. In other words, I know what the average human being in American has about 1.5 parts per million lead in their hair. Almost all the labs make it look like 1.5 milligrams is an overload and that you are being poisoned.

[Damien Blenkinsopp]: It is shown in the red for example, something like doctors data they have the red.

[William J. Walsh]: Exactly and doctor’s data by the way use my reference normals, I think I have the world’s best reference normals for metals in hair and they were using it for many years. But then they changed the toxic level of the chart and I beg them not to do that. I asked them why and they said they have to do it for competition reasons and also because of dentistry.

At that time, a lot of their hair analysis was done by dentist who were looking for mercury and they said that the dentist like to see high levels of mercury. So they made the charts look like they had high levels so they could persuade their patients to have their feelings removed.

[Damien Blenkinsopp]: Yeah it is very unfortunate.

[William J. Walsh]: Very unfortunate. We still sometimes will use a hair analysis. I have done a lot of forensics. I have done 28 forensics studies of famous criminals and hair analysis is very revealing for evaluating this severe behavior disorders.

I can only use the actual levels, the parts per million levels. I just have to disregard the chart because the charts are crazy. They tend to make it look like everybody has toxic metal overload.

[Damien Blenkinsopp]: So in general the actual levels are okay but you would say like if it is in the red or in the yellow it may be okay.

[William J. Walsh]: It may be, we now done this enough times. I have done maybe 100,000 of this and I know what normal and health is. Everybody has some of these toxics in their body. We all have toxic metals in our body.

For example mercury, just from breathing in America, you get one microgram of mercury just from breathing and you get typically about 25 micrograms of mercury from a typical diet. And if you have tuna fish for lunch, you might have 50 micrograms of mercury.

Your body has to deal with toxic metals every day. Every brain cell in your body has toxics come in and leave every day. Your brain has toxics that enter the brain and depart the brain every day and you have got protectors in the brain, things like glutathione and metallothionein that are there to protect you.

And if any of these gets into the brain, it immediately reacts with it to keep it safe, but some people do not have that antioxidant protection. And we think that has a lot to do with Alzheimer’s disease, and other forms of dementia. Older people need to protect their brains with antioxidant supplements.

[Damien Blenkinsopp]: So it is pretty amazing all the areas you have worked in over the years. It is pretty much every aspects of the brain. Who besides yourself would you recommend to talk about these types of brain biomarkers and biometrics, someone who knows the brain perhaps in different areas, some people read their work and you find it good and you would recommend it or offer it like that.

[William J. Walsh]: Well there are a lot of people that do a very much job of nutrition biochemistry you might say and some people that I totally respect. Many of them are not in to the new knowledge. They do not track the brain science up to date especially the new impact of epigenetic switch.

So there is so much more about nutritional therapies especially related to brain disorders and mental disorders. We have put a list of them on our website, the next book I’ll write I hope they have a very long list of doctors who I think are very capable of doing this.

But there are not too many people out there who are doing our testing and our treatment methods that is why we are focusing our attention now on training doctors to do this and we have now trained about 200 doctors around the world that are doing this and I get such enthusiastic reactions when I talk to them about how they are so excited about how they can now help patients they could not help before and do it without drugs.

We are not enclosed to drugs. I want to make that plaint. Drugs, antidepressants, antipsychotics, so I have helped millions of people but I think that in most cases, improvements are partial in nature and the side effects very often are intolerable or very unpleasant and I think we need to move toward a better world, a better time when we can at least reduce the amount of the drugs.

In schizophrenics, most of them are on very heavy antipsychotic medication. Right now our knowledge level is not to the point where we can offer the likelihood to do nutrient therapy of eliminating their medications.

So what we do is we keep people on their medication, do our nutrient therapy together, do both at the same time. After about three or four months after we have completed our part of it, we then test lower and lower levels of the medication.

For depression, for anxiety, for behavior disorders, about 80% of the people tell us that they are at their best with zero medication. 20% say they would lose something if they get rid of the last piece of the medication and we say so be it.

We are not opposed to medication. We just want people to be functioning at their highest level. In schizophrenia, it is unusual. We can usually have schizophrenics become far more functional and many of them live a normal life, they can return to a normal life and be self dependent.

They usually need some medication support in the case of schizophrenia because our knowledge level is not high enough yet to eliminate the medication.

[Damien Blenkinsopp]: That is great. Thanks for those details. Last question, I just love to know what data metrics do you track for your own body on a routine basis, is there anything you keep an eye on for yourself?

[William J. Walsh]: Well about 35 years ago I brought a group of criminals fresh out of the prison to see Carl Pfeiffer and these are all sociopaths who had done terrible things. And when I was there he said I could not ask anybody to go through this test unless I was willing to do it myself.

So he ranged me through this complete array of biochemical test and he found out that I had two rather significant chemical imbalances. He found out that I was zinc deficient. Since I met Pfeiffer, I am now taking 100 milligrams of zinc a day and I do blood testing and it is just barely enough to keep my blood level normal.

[Damien Blenkinsopp]: So how often do you test for that?

[William J. Walsh]: Now that I am an adult, I did it last year and maybe five years before that. Every once and a while I will check on it to make sure that I am okay, that it is the right level. Some people do not need anything. A lot of people get those linked from their diet. In my case, I have a genetic weakness with respect to zinc.

Another thing he found was that I was very high histamine undermethylated person. For example I am sure I am MTHFR, probably 677. I am not going to bother to test it because I expect it and I doesn’t matter anyway whether I am or not.

I am undermethylated, the way I corrected that, I used to be with methionine but now I take 400 milligrams of SAMe a day and for me that works really well and what it does for me, it does two things. I used to have migraine headaches and they have disappeared ever since I’ve take some methylation.

And I also had really severe seasonal allergies, ragweed, grasses, I don’t want allergies. That has also disappeared as soon as I went on Pfeiffer’s program.

[Damien Blenkinsopp]: That is very interesting. I have exactly the same issue before I went on to methylation taking SAMe, headaches and my seasonal allergies, then went, and I’d never had those allergies until I got into my 30s.

[William J. Walsh]: I also had a tendency for low serotonin depression abut it has never happened perhaps because of methylation.

[Damien Blenkinsopp]: Yeah well just personally on that level, for your undermethylation, do you test every month or once every six months or once every year for yourself?

[William J. Walsh]: It is not necessary. Once you have determined your methylation tendency which you were born with, you have that the rest of your life. It is not going to change. I have never retested my histamine after the first couple of times.

And with patients, once you have done the histamine test a couple of times to verify that in fact you know what your methylation tendency is. You do not ever need to test it again because that is something that is part of them for the rest of their lives.

[Damien Blenkinsopp]: That is great. Well it sounds like you have everything under control for your own body without doing much testing apart from the zinc just every now and again.

[William J. Walsh]: Yes, so far so good. I do not take any drugs. I have it handy, since then I needed to go and see a doctor for the last 25 years but I think also it is great Carl Pfeiffer when he studied my biochemistry. He gave me a treatment program to normalize my chemistry.

I am not sure but I am not going to stop taking it. I think it has probably helped me.

[Damien Blenkinsopp]: Yes. That is great to hear. William, thank you so much for the interview today. It has been absolutely amazing. We have covered lots of topics I expected to and many topics I did not know about and I am really glad we had to cover too.

[William J. Walsh]: Okay Damien. It has been a pleasure talking to you.

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Whether you’re a professional athlete or a weekend warrior, taking a break from mental work to hit the gym at weekends, recovery is an important part of how you train.

When we don’t recover sufficiently we end up decreasing our performance and health rather than getting the results we desire – higher performance, beating our records and increasing our health and wellbeing overall. In today’s chronically stressed world, it’s all too easy to over train as we are so used to the constant stress burden.

Most people are aware of this now. But it’s still difficult to manage, even with this knowledge. How do we know when we need to take a break from training? When a workout is going to have an overall negative impact rather than the positive one we seek?

Enter “Heart Rate Variability” also known as HRV.

HRV is being increasingly used by professional athletes and the everyday gym goer to attempt to better manage recovery by providing an estimate of when we are over stressed vs. well recovered. Trying to answer the question – should I leave it a few more days before my next workout? Or should I go easy in today’s workout?

Over the last few years a large number of devices and applications have been hitting the market so HRV is a lot more accessible now. With just an iPhone or Android app and a relatively cheap sensor you’re ready to go. While many of these HRV apps look very straightforward, there is actually a lot to them with different metrics, and correct vs. incorrect approaches to using them.

To cover the HRV topic in depth, today’s guest is Andrew Flatt, owner of the blog HRVTraining.com – which is one of the best resources on using HRV for training I’ve found to date.

Andrew is a PhD student at the university of Alabama who has been working in the Human Performance Lab at Auburn University on research related to HRV and exercise. He has been making use of HRV since 2011 to monitor and optimize his own training and that of the athletes he coaches. He is also an accomplished athlete himself, and was the 2010 Canadian National raw powerlifting champion.

Andrew is very hands on and has done a lot of on the ground work with HRV, so he has a great practical as well as research-based perspective on how to use heart rate variability to optimize training.

itunes quantified body

Show Notes

  • What HRV (Heart Rate Variability) is and what it measures
  • How to use HRV to optimize your workout schedule, cycling of workouts and recovery from illness
  • The mechanisms behind HRV: vagal tone, autonomic nervous system activation, sympathetic and parasympathetic activity
  • A review of the different HRV metrics, and why RMSSD is recommended for convenience and non-professional use
  • The devices and apps you need to track your HRV at home and their accuracy (EKG/ ECG, finger light sensor, ear light sensor, phone and web apps)
  • Additional features that are useful in the apps to give more meaning to the HRV data
  • The impact of lifestyle activities on HRV (partying, sleep, sickness, alcohol and diet)
  • Benchmarks of HRV scores for strength and cardiovascular athletes vs. non-athletes – what’s a good HRV that indicates good recovery? What’s a bad HRV that indicates a need to recover?
  • Taking your readings methodology – arguments for Supine (lying down) vs. standing up
  • How and when to take your HRV readings to ensure that the data is accurate and meaningful for optimizing training
  • How HRV varies according to your age, gender, lifestyle, training schedule and type of training (cardiovascular vs. strength/ resistance training)
  • What Andrew sees coming up over the next years in the HRV domain and how it’s going to be useful
  • Andrew’s top recommendations on using data to improve decisions around training and health

Biomarkers in this Episode

  • Heart Rate Variability (HRV): Measures how your heart rate varies over time. Research studies link HRV to recovery status, stress and other aspects of human physiology.
  • R-R intervals: Time interval in between heart beats (R = peak of heart beat).
  • Resting Heart Rate (RHR): Measure of your heart rate at rest (typically measured upon waking).
  • RMSSD (Root Mean Square of the Successive Differences): A measure used to calculate HRV that has proven to be reliable and is used in a lot of the research studies – Andrew’s preferred measure.
  • lnRMSSDx20 (RMSSD with natural log and multiple of 20 applied): Applications have begun using this measure, which is basically RMSSD scaled to an index of 100, to make it more user friendly.
  • LF (Low Frequency): Spectral measure that indicates combination of parasympathetic and sympathetic activation.
  • HF (High Frequency): Spectral measure that indicates parasympathetic activation.
  • Coefficient of Variation (CV): Measure of variance across a set time period (Andrew has found to have good correlation vs. weekly mean value).
  • 7-Day Trailing Average HRV: Average of HRV values used to track your progress over time. Andrew uses this mostly to guide his training now.

Devices/ Apps from the Episode

Other Resources Mentioned in this Episode

Interview Transcript

Transcript - Click Here to Read
[Damien Blenkinsopp]: Andrew, thank you very much for coming on the show. It is a great pleasure to have you here.

[Andrew Flatt]: The pleasure is mine, Damien. Thanks for having me.

[Damien Blenkinsopp]: Thanks. What I thought we would do to start with is jump into what is HRV a little bit – Heart Rate Variability – so that people who haven’t come across this before can have a rough understanding of what it is and where it was.

[Andrew Flatt]: Sure. So heart rate variability often gets confused with basic heart rate, which is measured in beats per minute. Heart rate variability differs by measuring the actual time difference between heartbeats.

So on an electrocardiogram we R-to-R (R-R) intervals and from breathing patterns there is variance between successive R-R intervals. And what heart rate variability is doing is capturing those changes between those heartbeats.

So it is a little bit more specific of a measurement but it is not dissimilar from basic heart rates, so people shouldn’t get too confused with it.

[Damien Blenkinsopp]: So could you give me a quick overview – what is heart rate variability, HRV, and how do you use it? What is it all about?

[Andrew Flatt]: So your resting heart rate is generally not consistent. We learn in a textbook that a heart beats approximately every 0.8 seconds for an average of 75 beats per minute. What that doesn’t factor in is the actual changes in heart rate, the subtle changes that, in response to respiration, where when you breathe in your heart rate actually speeds in a little bit and when you breathe out your heart rate will slow down. And that is normal.

That is called respiratory sinus arrhythmia. And essentially what heart rate variability is capturing is those subtle changes in heart rate in response to respiration. So heart rate in beats per minute is kind of giving you that average of how many beats there were, whereas the variability is telling you how much variation there was between the beats.

Now, there are various statistical procedures and so forth that we can assess variability. There is a standard deviation, there is the Rubian square, there are spectral analyses. So there are various parameters for heart rate variability but in a nutshell it is just measuring the variance and changes between the time interval between heartbeats.

[Damien Blenkinsopp]: Right, and you brought up a little bit of terminology there – it is R-R intervals, which is basically R means the top of the beat, the kind of spike of the beat that you kind of see on the electrocardiogram, so R-R just means the time in between beats, correct?

[Andrew Flatt]: Right, because they are such high peaks it is really easy to measure the interval between them so that is generally why the R-R intervals have been used.

[Damien Blenkinsopp]: Right, and just out of interest, why is it called an R? Why isn’t it called a beat?

[Andrew Flatt]: The peaks are just alphabetically named. There is the P, QRS complex, the T-wave, so – we just –

[Damien Blenkinsopp]: And the peak just happens to be the R, good. So I know that you have been using HRV in a bunch of areas to basically make better decisions, mostly about training. Could you talk about the different scenarios you have been looking at it with and where you find it most useful?

[Andrew Flatt]: Well, I think it just comes down to why I started measuring heart rate variability. I first learned about it just reading on some strength and condition forums, a website called [lead ips .com 00:03:22]. And there were some strength coaches talking about how they are using it with their athletes, so I kind of gained interest in it then.

But it wasn’t until I was preparing for a powerlifting competition and training was going really well. I was pushing it real hard and I was set to set some personal record at a lighter body weight when all of a sudden, I took a dive and I actually got a little bit of a cold. I took a few days off from it and I went back and hit the weights and things were just feeling real heavy.

And it was too close to competition for me to really fix things and I actually ended up pulling out of the meet and I was really disappointed. And I thought to myself there has got to be some kind of way that I can better manage my training and maybe kind of prevent this or see it coming a little bit better.

So that was kind of the motivation to actually purchase a heart rate variability device and start using it. So my original motivation was to guide my own training. I am involved in powerlifting so it was kind of a selfish motivation more so than working with athletes, but eventually that is kind of where it came to, where I would actually start using it with athletes.

I was training friends and colleagues and I would get them using it and look at their data. And that is kind of how things went from there.

[Damien Blenkinsopp]: So you obviously found it very useful, to have gone into an insight using this with other people now. So what kind of decisions do you make based on this? Is this is the only indicator you use? Is it the main indicator you use with your training program and deciding when to change up the variables?

[Andrew Flatt]: You know, when I first started using the device I was very skeptical at first. I didn’t know much about it other than what I read on the forms and what I actually did was for six months I used it and collected data, but I did not use it for any kind of decision making.

In fact, I really didn’t look at the trends or analyze anything until after about six months when I would kind of look at the trend and I would look at my training log and I would try to see what it was telling me in the first place. I think one of the biggest mistakes is people get a device and they think they know how to use it and then they want to start making decisions with it.

I think you almost want to do some kind of cross validation with it on yourself first and see what it is telling you in response to training or in response to different kind of life events – you get sick, you travel – what is it showing you? Is it meaningful? Can that drive better decision making?

And essentially, what I found was after six months of using it I would look back on it and after heavy training sessions I would see a decrease in my HRV score. Most noticeably I would see, after any kind of a new training stimulus, so being involved in powerlifting I wasn’t doing a whole lot of conditioning work but at the time I was doing my Masters, I was working with a whole bunch of other people.

In the weight room I was a grad assistant strength coach and they love to do conditioning on Wednesdays. So on Wednesday morning, we would go and run these stairs, and man, it was tough for me – being a power lifter and not running since I played football years before. And my HRV scores would just absolutely plummet after these sessions.

But after a few weeks I would notice smaller and smaller fluctuations in my scores and I was kind of reflecting the progressive adaptation for that training stimulus, and I thought that was kind of cool.

[Damien Blenkinsopp]: Right, so what kind of impacts do you see? So, once your score has plummeted, what does that mean the next day? Say you start the day and you track your HRV and your score has plummeted, what does that mean in terms of how you are going to be feeling? What does that mean in terms of how it is going to change the decisions you make that day?

[Andrew Flatt]: A low score can definitely be the result of a heavy training session. Unfortunately it is not that simple. One of the great things about HRV is also one of its downfalls, that it is a global marker of stressors, whether that is physical, mental, or chemical. So not always will you see a low score because of training, it can be brought on by other things. So you really need to be tracking other variables to really make a meaningful interpretation of what the data is telling you.

[Damien Blenkinsopp]: Right, so in the context of your training program, if nothing else changes it is kind of like that it then should be down to your training?

[Andrew Flatt]: Right, so I think one of the main things is are you an aerobic athlete? Are you an anaerobic athlete? Are you a team sport athlete? It depends on your training because what heart rate variability is, is it is a reflection of the cardiovascular autonomous nervous system. So for the most part, and especially within the research, it has predominantly been used with aerobic athletes and that is kind of who would most benefit from it.

I mean, resistance-training athletes, at this point it is all experimental to see what it is we are actually showing but it doesn’t necessarily reflect muscle soreness. It doesn’t necessarily reflect muscle damage or your neuromuscular abilities for that day, your CNS potential. It is a reflection of the cardiovascular autonomic nervous system, which is still a very important piece physiologically for being prepared for training.

So it is only one marker to consider the cardiovascular system is extremely important with the recovery process, with removing waste products, and so forth. So when the cardiovascular autonomic nervous system has kind of rebounded back to baseline levels or super-compensated to above, that would indicate that system is ready to go and it is more likely to be in a more adaptive state to any kind of physical stress.

[Damien Blenkinsopp]: Right, so you have mentioned that it is the autonomic nervous system and another thing that we often hear is that it is an indicator of vagal tone. What does that mean?

[Andrew Flatt]: So the autonomic nervous system, simply put, is divided into two branches – you have your sympathetic branch and your parasympathetic branch. The term ‘vagal’ is referring to the vagus nerve, which is essentially the parasympathetic branch of the autonomic nervous system.

You have parasympathetic innervation in the heart that essentially – in any kind of physiology class your professor will give you the car analogy, where if your foot is on the brake the car is not moving, and that is your rest and response. And the autonomic nervous system is taking care of all the things that we don’t consciously control – so our blood pressure, digestion, endocrine gland secretion, and so forth. And then when you take that foot off the brake you have that withdrawal of parasympathetic or vagal activity.

Then when you hit the accelerator all of a sudden you get that sympathetic output and that is going to actually increase heart rate and prepare you for any kind of stressful events, whether it is exercise or simple postural change from lying down to standing up. You have to pump blood to the brain so you don’t pass out and that is a sympathetic response.

[Damien Blenkinsopp]: Right, and another way I have heard it described it is that basically your parasympathetic is trying to balance your system so that the vagal tone is the ability for you to balance and respond to stressors around you. Is that another way you look at it, or is that not correct?

[Andrew Flatt]: Yeah, so essentially the sympathetic nervous system will be quite active during physical stress like exercise and then to recover from that is when your parasympathetic nervous system will help rebuild structures and repair the damage essentially that occurs during those stressful events.

So that is why measuring your parasympathetic activity on a day-to-day basis is a reasonably good indicator of your recovery status. If your body is still stressed from training and you have a higher sympathetic output or even just parasympathetic withdrawal, you know that your system may not be fully recovered.

Now, what I want to be clear is that it doesn’t mean that you can’t train if your HRV is a little bit low. And a lot of these apps, what I think people need to understand, is only measuring parasympathetic activity through a timed domain measured called RMSSD. So that does not give you any indication of sympathetic activity. It is purely vagally-mediated, so parasympathetic.

[Damien Blenkinsopp]: So just a couple of other terms that you hear quite a lot is LF, low frequency, and HF, high frequency. As I understand it they often say LF is the sympathetic stressor and HF is the parasympathetic relaxation. Is that true or is it more complex? Some of the apps track the LF and the HF as well, but some of them don’t.

[Andrew Flatt]: So the way you are talking about it, they are called spectral measures from frequency domain analysis. HF generally does indicated parasympathetic activity. LF actually would be indicative of both parasympathetic and sympathetic activity. So it is not as clear as we would like it to be, where HF is parasympathetic and LF is sympathetic and it gives you an indication of sympathovagal balance, they call it.

It isn’t that clear and one of the issues with the spectral measures that you are referring to is that in terms of their practicality and field settings, they require longer measurement durations for a valid assessment. These are less reliable markers on a day-to-day basis so it has kind of been recommended that RMSSD is the preferred parameter, especially for convenience and non-expert users in the field that just need a simple number that they can read and interpret real easily. The RMSSD value is preferred for that.

[Damien Blenkinsopp]: So is RMSSD the one that has the most research behind it?

[Andrew Flatt]: Well with RMSSD, the reason why it is preferred is that it is a more reliable marker. It is very easy to calculate. If you have R-R intervals you can actually calculate RMSSD in Excel – it’s a statistical measure, root mean square of successive R-R interval differences, that is what it stands for. It is consistent in paced or non-paced reading situations, where as HF and LF are going to be a lot more influenced by your breathing rate.

So, for in the field with athletes who may not be sticking to a certain respiratory rate or whatever, it is not going to affect your numbers as much. And lastly, I kind of got to it before, is it can be calculated in a relatively short time frame. In fact, you can get an RMSSD measure in ten seconds; however, that generally isn’t enough R-R intervals to capture a real window of that autonomic activity.

So actually part of our research was seeing what is the shortest timeframe we can measure HRV in with RMSSD and what we did was we found 60 seconds to be no different than a criterion measure, which has been established as five minutes. So we essentially randomly selected 60-second segments within a five-minute ECG and we found no differences. But when we looked at 30 seconds and 10 seconds there was less agreement with the five-minute measure. So our conclusions were that 60 seconds was probably enough time to get a valid HRV reading with RMSSD.

[Damien Blenkinsopp]: That’s great, that’s very short. A lot of the apps, you said, do a lot of the standard – I think it just comes from the research, which is five minutes for a recording. But a lot of the apps now are looking at like three minutes or something like that. What kind of variance do you see across the apps? Have you seen any apps that go as low as 60 seconds, making it a lot more convenient?

[Andrew Flatt]: Yeah, there are some apps – ithlete, for example, is an app that uses a 55-second test. There is another app call HRV4Training that uses – it actually allows you to select your test duration so there is a 60-second option. I believe there is a two-minute option, a three-minute option. And then I think there is a device called Tink that I believe is a 40 or 45-second test. I used that briefly. And the other apps tend to use a little bit longer.

Now, the longer measurement is certainly not a bad thing to get a bigger sample of R-R intervals for analysis. The issue comes down to is the athlete or the client – are you willing to do that every day? If it is two or three minutes, that can be a little bit long. Fifty-five seconds or one minute, that is generally not too bad. I find it more tolerable with the athletes I have used it with. Generally they can handle it, so it call comes down to preference, right?

[Damien Blenkinsopp]: Yeah, totally. So we talked a little bit about the apps. So I would like to dive into that because I know there are quite a few out there and there are a lot of them coming into the market now and HRV is just starting to become pretty popular. So basically you are going to have a device for tracking your heart rate and you are going to have an app to go with it. Which ones have you looked at and what are the tradeoffs and benefits of each? Have you got preferences and so on?

[Andrew Flatt]: So I first started out with the ithlete app. That was the one I read on the forums that people were talking about. In fact, I think it was the only one available at the time.

[Damien Blenkinsopp]: So when was this, by the way?

[Andrew Flatt]: This was 2011, early. I think around summer 2011 is when I actually bought it. So that specific device at the time required a heart rate strap and a little ECG transmitter/receiver device that you would actually plug into the headphone jack of your mobile phone. And again, it was a 55-second test and I have stuck with that device.

There are a few reasons why I have stuck with it, one being that it uses such short measurement duration. And especially now that I have looked at the data, I am quite confident that short of a duration is still going to give acceptable measures or more valid data. So I have stuck with that but I have used others. I have done some beta testing for some people and looked at some other apps. And at the end of the day you just want one that you are going to be able to use and that provides your data that is easy to interpret, nice visual trends, health, or whatever is more affordable for you.

There have been some advancements in technology that allow you to measure HRV without an ECG receiver. Now you can just use a Bluetooth heart rate strap with some of these devices. There was recently validated, a pulse wave finger sensor that ithlete is using that you can literally without any kind of heart rate strap you just plug your finger into this little finger sensor device that is plugged into the headphone jack and you can actually get your heart rate reading from the pulse at your fingertip.

[Damien Blenkinsopp]: How accurate do you think that is? Because I used one of those for something called Heart Math, which is using HRV but in a different area and that uses your ear. So it is collecting your pulse from your ear. But I find that every time I move in any little way that it is messing with the signal and it is not very clear. So do you find the finger sensor? Because it is using light, right? So it is pulsing light in to see what your heart rate is. Do you find that reliable?

[Andrew Flatt]: I think we have about 15 athletes where we looked at the pulse wave finger sensor and compared it to EKG. They were soccer players, male and female. We did supine and standing positions. And it was accurate. It was more accurate in the supine position but acceptable agreement also in the standing position. So we haven’t published that yet. We want to collect more data on it. But I am pretty confident in it based on the data that I have collected with it.

Now the pulse wave finger sensor device, that is not putting your finger over the camera lens – where the flash goes. That is not what we measure, just to be clear.

[Damien Blenkinsopp]: So if someone is getting one of these apps, what would be your suggestion? So all of them are using RMSSD, I’m assuming. I know the one I am using, Sweetwater HRV plus a Polar H7 strap, so the heart rate with the Bluetooth that you mentioned earlier for an iPhone 5. So that works fine for me and that was relatively cheap to get off and running with. So I know that Sweetwater, for example, they take RMSSD and they modify it a little bit. They put it on this 1-100 index. Do the other apps modify this? Are there compatibility problems later if you want to switch apps and you can’t compare your score?

[Andrew Flatt]: So Sweetwater, or the SweetBeat app, I have actually experimented with and that, from when I used it, was providing various HRV parameters. It was giving you the HF, the LF, RMSSD, SDNN – numerous parameters of HRV, which is great if you know what those mean and how to interpret them. But I generally tell people to look at the RMSSD.

I know when ithlete started using a modified RMSSD value what they essentially did was they logged transformed RMSSD and multiplied it by 20, and that gives you a figure on a 100-point scale. BioForce uses that value. I wasn’t aware that Sweetwater or that the SweetBeat device did or not. I thought it was a raw RMSSD value, but I could be wrong.

[Damien Blenkinsopp]: I actually spoke to them one time, so it is definitely a modified scale version of it.

[Andrew Flatt]: Okay, so then they probably use that value or something very similar. Now, not all apps use that value. For example, Omegawave has a smartphone app and they are using their own algorithm to come up with a daily readiness score, so they are factoring in HF, LF, the HF-LF ratio, RMSSD, so it is not one parameter that they use. So there is difference among the apps and what they interpret. So it is something you would probably want to look into.

[Damien Blenkinsopp]: Right, and you probably don’t want to switch around too much once you have settled on one.

[Andrew Flatt]: Right, you find an app that you like. What is most important for the end user is I think the visualization of the data and how they can view it so they can see what their kind is like, how it is responding to their training. One of the things I really appreciate about the ithlete app is that it allows you to input your training load score, so depending on what kind of training you are doing or how you choose to quantify your training load you have your RPE values and you can calculate tonnage for weightlifting or powerlifting.

You can do a trim value for endurance athletes or what have you. So you can input a training load value and then it also gives you the ability to track your cyclometrics, you perceived level of stress, sleep quality, muscle soreness, mood, your nutrition. There is a sliding scale for that you can kind of rate. So all of a sudden you have a device that isn’t just tracking your HRV but it is kind of monitoring several variables which really makes interpretation of your HRV trend more meaningful. I know BioForce has an online system where you can go on, input your data similar to the ithlete one.

I am not sure if you can do that from the app or not at this point but it is a very similar system. So that is another great product to look into. So when you are evaluating what app you want to use, you want to look at what additional features it has to offer because an HRV score by itself is less meaningful without all this other information. So the more information you have and that you can maybe attribute your changes and your trend to, the better off you are going to be.

[Damien Blenkinsopp]: Right, I know for me there have been a few times where there has been a huge crash and I have been wondering what happened. I didn’t have a big training session or anything yesterday, so it is definitely like this little investigation sometimes – why did my HRV crash? I know you have got some interesting stories about times that you have seen athletes or your own scores crash. What kind of things have you seen the influence where it crashes? Have there been any times where you really didn’t find any reason for it?

[Andrew Flatt]: I mean, if we are talking a substantial decrease in your score, usually it is pretty easy to attribute it to something. Sometimes it is these smaller deflections where you are like, you know, I am kind of surprised it is that low today. That may be harder to attribute to something specifically. But if you wake up with fever, you are going to have some real low scores and your heart rate is going to be high and you are going to have some low scores.

One of my coolest little anecdotes that I have with using an HRV app is when I got real sick a couple years ago over March break and HRV I was able to use to guide my training to where I could kind of start pushing it hard again and kind of get back to my normal routine.

For a week I had terrible symptoms. I had fever, I wasn’t able to train. My scores were really low. Once my symptoms kind of subsided and I wanted to get back into training, what I was seeing was from very moderate workouts, very low-intensity, something I would consider like a D-load type of workout, these were causing pretty substantial decreases in my HRV so I could see that my body was reacting to the training. But it was quite stressful, according to those scores.

So I would actually continue to train relatively light until my scores wouldn’t fluctuate so much and that is when I would actually start pushing harder again and I could see in my trend that it wasn’t as stressful. I wasn’t seeing as big of swings in my scores and I was kind of able to guide myself out of that situation where typically a meathead like me, I will just start pushing the weight as hard as I can as soon as I feel ready, which may not have necessarily been the best thing to do at that time.

[Damien Blenkinsopp]: Right, totally. I have been in similar situations myself. I know I had a score of 80 just recently and it crashed to about 50. I don’t know if that something you see often?

[Andrew Flatt]: Yeah, that’s a big drop. Were you able to attribute that to anything?

[Damien Blenkinsopp]: Yeah, I have been suffering from a chronic illness and it has something to do with that, so it is pretty serious. It is a pretty serious thing, it is not a typical thing. So in terms of someone a bit more normal, who is not dealing with medical issues or anything, what would a typical rash look like? Is it 20 points?

[Andrew Flatt]: Everyone is individual and unique. Every individual’s data needs to be taken in the context of what kind of training they are doing, how advanced they are, how trained they are. A more advanced endurance athlete, for example, will see smaller swings more than likely. They will recover faster.

You take an untrained individual and you put them through an intense workout, whether it is weights or conditioning, and they are going to see a big drop. That can last for 48 to maybe 72 hours. So every situation is unique and every individual really needs to take some time to collect some data and observe how their trend is evolving in response to their training because unfortunately you can’t just say that this means that for everyone, because that is just not the case.

And you really do have to maybe do some calculations with your data in Excel, looking at the weekly mean value. You look at the variance within that week and all that kind of analysis will give you a better indication of how you are responding to your training.

[Damien Blenkinsopp]: So of course, a lot of the other things that athletes look into when they are training are all sorts of lifestyle factors that could be affecting their recovery and how they are performing. I know that you have had many experiences with this and in one post you talked about travel and in another you talked about going home for was it Christmas or Thanksgiving? And seeing some stuff there.

What kind of situations have you seen – like another guy who went on Spring Break and he was partying a bit? What situations have you seen that could be said to be obvious, but what kind of things would you say to look at? Just typical things that you have seen affect it.

[Andrew Flatt]: Yeah, so your lifestyle absolutely will affect your HRV responses. For example, working with a soccer team, we put them through a hard week of training and we see pretty typical HRV responses and then half of them go out on Saturday night partying, maybe having a couple of drinks, I don’t know. And the other half maybe stays at home, gets to bed at a reasonable hour, and you can definitely kind of predict who was out that night based on that.

Now, you definitely would need to do a little bit more investigation. You can’t just look at a score and say, ‘This person did this.’ But it does give you some kind of indication that maybe you have to look into what is going on. Was it the night before a game? How are your athletes behaving?

Not necessarily a tool to spy on anyone or anything, but it kind of will lead to some questions. Why isn’t this person recovering? Why are their scores low? Are they getting sick? Are they staying up too late? Are they not getting enough sleep? Sleep is definitely one factor that will affect your score. Alcohol – if you are out drinking you are definitely going to see some lower scores the next day.

Like I said before, with illness your scores will definitely drop from that. In my experience any time I have gotten a cold or especially a fever, the score has dropped. Now you were referring to some of my older posts where I talk about I actually went home to visit some family that I get to see maybe once or twice a year. And I actually had really high scores the next day. Is that the reason why they were high? I don’t know, that is just speculation.

But anything that you perceive to be very restful, whether that is sauna, you get a book and read outside, get some sun – something that you perceive to be restful and relaxation is generally going to promote some of that parasympathetic activity and that restoration that we want to get. So I think it depends on the individual and their own personality for what they perceive to be regenerating and relaxing.

[Damien Blenkinsopp]: Well certainly sometimes I will take a specific day off and say okay, I am going to recover this day because I need to because my HRV is down. And it definitely pushes the score up, I have seen that many times. So like you say, the relaxation could be different for different people. But it definitely seems to impact the score if you take a day off and forget the work and all the other stressors. I don’t know if you have seen examples of work stress figure into this?

[Andrew Flatt]: I have seen some studies. I am not as interested in that so I don’t pay too much attention, but there is definitely a stressful lifestyle, whether that is from work, you can have money problems. These are all things that can affect your autonomic nervous system. So it can be apparent in your HRV score. One thing I found is just within the literature but also through trial and error, that some light aerobic work has a stimulatory effect on parasympathetic activity. So some active recovery can really help get people’s scores up.

In fact, just a few weeks ago I was going through kind of a work capacity phase where I was just trying to get in better shape, bring up my aerobic fitness a little bit, so after my resistance training sessions I was doing 10 to 15 minutes on the bike, on off days I was doing 20 minutes on the treadmill or 10 minutes on the treadmill and 10 minutes on the roller, just trying to increase my fitness a little bit. And I have actually never seen anything like it in my trend before.

I wasn’t seeing any really big swings from day to day, even after a heavy resistance training session with five sets of five with 80% plus. Normally that would result in a lower score the next day but it appeared that these smaller aerobic sessions really attenuated those swings day to day so I was seeing very little variance between my scores for that two-week period, but then as soon as I stopped keeping up with that it went back to my old-fashioned hard workout and you see a lower score and it takes a day or two to come back up.

So it is interesting how much of an effect just light aerobic exercise has on stimulating that parasympathetic activity. There is definitely a threshold where too much or too intense and it will have the opposite effect, but a reasonably late session for not too long generally has a stimulatory effect and you will see a bump in your HRV 24 hours later or so.

[Damien Blenkinsopp]: So are you saying that is something that is going to help people? Or is this just modulating the HRV but it is not going to impact your actual recovery? So it is just modifying the number but it is kind of hiding the fact that your HRV would have gone down?

[Andrew Flatt]: Well, I think again it comes back down to what your training goals are. Now after a heavy squat session and I do some cardio, some light aerobic work after, and I don’t see a drop in my HRV, that doesn’t mean I am going to be able to go squat heavy again necessarily. It is just saying that my cardiovascular autonomic nervous system has rebounded back to baseline level, so that system may be ready to go again. So again it comes down to context.

If you are more of an endurance athlete it would probably be more of a marker of when you are ready to train again, but with resistance training there is muscular damage. That isn’t necessarily reflected in your HRV. There is just not enough data yet to show that an HRV score is related to any kind of nervous system potential for strength scores or power or anything like that.

[Damien Blenkinsopp]: That is interesting because one of the things you mentioned was that when you are doing something new, some kind of new activity, some type of new training, that you see your score crash down in particular in those situations. Is that – do you think it is because of neuromuscular or metabolic adaptation that has to take place there? What do you think that is down to?

[Andrew Flatt]: Probably a combination of everything. You have introduced a novel stimulus that your body hasn’t necessarily adapted to yet or in a long time so it is just harder to recover from. I don’t have the answer for that. It hasn’t really been, at least I haven’t seen anything to explain why – that is just how it is. A novel stimulus, whether it is conditioning, resistance training – if you do a drastic change in your volume or intensity, from what I have seen it is going to cause a lower score than typical. But with persistence and that new training modality or those methods you will see that progressive adaptation and you will see smaller swings after the body kind of adapts. It gets more familiar with it. There is probably a better scientific explanation, I just don’t have it for you right now.

[Damien Blenkinsopp]: Great, so I want to talk about recording – how you record it, what kind of numbers you want to make sure you get, frequency, and so on. But just before that, how about baseline? Can you increase your baseline over time? Or are we just looking kind of like at the dips and the highs and trying to keep it in the highs more and slacking off when we have more of the dips? Or are we able to actually influence this and in a way build more resilience over time?

[Andrew Flatt]: Your lifestyle is going to change, your training is going to change, your training frequency. If you are a competitive athlete that you have different seasons, different times, that is all going to affect your HRV because your training is going to change. You are not going to always be doing the same type of training. You might be doing less aerobic work in a different phase and that aerobic work is really what stimulates those higher HRV scores.

So if you are doing less aerobic work you are going to see lower scores. So you do have to take whatever your baseline is – you have to take it into context for that training phase and your new training goal, so you absolutely have to have an evolving baseline. A lot of the apps will use a rolling 7-day average but generally at the start of a phase you look at your first week, you look at the average, you look at the variance within that week.

A simple value to use is called the coefficient of variation. It is just the standard deviation divided by the mean times 100, and that gives you a percent value of the variance, and see how it evolves from there.

[Damien Blenkinsopp]: So what do you use the COV for?

[Andrew Flatt]: So the Coefficient of Variation is where you have a weekly mean value, which is just the average of a 7-day period. That average doesn’t necessarily indicate or reflect how much fluctuation existed between those scores on a day-to-day basis, right?

So we want some kind of value or figure similar to a standard deviation of how much variance there was because let’s just say your average between two weeks is no different, but you have much more fluctuation in one week than the other – well, that could be indicative of some positive adaptation or I have a case study that we did with a cross country endurance athlete that should be published in one of the next editions of Australian Strength and Conditioning.

We actually found that his CV value, the coefficient of variation, was much more related to his endurance performance than his weekly mean value. And we get into possible explanations of why in the paper but the variance is important.

[Damien Blenkinsopp]: So you want less variance, which means that your system is dealing with the different stressors and it changes more easily?

[Andrew Flatt]: I don’t think – I think it is a matter of maybe when you want that. If you are seeing big fluctuations in your scores that is not a bad thing. That is your body adapting and adjusting to the training. But that probably means that you are not in the best state to compete at your best or to perform at your best because your body is adapting and it is going through the stress and recovery phases.

But all of a sudden you have been doing that training for a while and you see less fluctuation in your scores and there is maybe less – it is not the same amount of stress as your body initially perceived it as and had you recover from. You may be in a situation where your performance – you may be at a higher level of performance.

[Damien Blenkinsopp]: Yeah, it sounds like COV low variance could mean that you have adapted to whatever stimulus you are giving yourself, and that could be lifestyle or it could be training. And in another situation if it is pretty high it could mean that something different is going on and your body is adapting to it.

If it has got high variance it could be a good thing if you are going through these training sessions. It is showing that your body is going through that adaptation, does that makes sense?

[Andrew Flatt]: Absolutely. And one thing I need to point out is I started using the COV value after reading a case study by Daniel Plews and Martin Buchheit and all those guys that are the experts in this area. And what they found with the CV was in an overtrained, high-level endurance athlete I believe the CV was related with the progression of overtraining.

So when you are looking at any kind of value, whether it is the mean or the CV, you really need to look at the training load. You need to look at their perceived levels of fatigue and stress to really give more meaning to that value. So again, a high HRV score or an increasing trend can also be indicative of overtraining and mostly in endurance athletes. So you kind of have to look at these other factors.

The HRV scores alone aren’t going to tell you much without all this other information. So the CV, whether it is good or bad or whether we want it or not depends entirely on the context of that training and what is going on with the athlete and how far we are from competition, so there is no such thing as we want this, maybe in certain phases we want this, but it is all relative to the individual and to the training, so everything needs to be factored in.

[Damien Blenkinsopp]: If you take two athletes or perhaps an athlete and a non-athlete and you compare their HRVs, their 7-day average right and getting their baseline, are they going to be different? Is the athlete’s going to be higher? Is that something like going back to your baseline, is that something you want to be higher or you should be trying to get higher over time. Is it possible?

[Andrew Flatt]: I mean, the average person, just for the cardio-protective benefits of having a higher parasympathetic activity at rest definitely generally higher HRV is a good thing. If you take a team of athletes and you have them monitor their HRV, you are going to get different scores and a group of female soccer players that I work with over this past season, their average scores range from the low-70s up to a couple of girls that were pushing 100.

There is a genetic factor here. There is lifestyle, there is fitness. All these things come into play and you can maybe generalize that an endurance athlete who has a very low resting heart rate is going to have higher HRV, which can be in the 90s plus anaerobic athletes can be between the 70s and high 80s, depending on their fitness level.

So you could maybe say that this would be where the average would be for this type of athlete, but in my experience everyone has kind of have their own trend and their own response to training – similar responses in terms of the fluctuations in following a heavy training day and whatnot. But you are not going to get a team of soccer players with everyone’s score at 90 with similar changes, everyone is different. And you should plan accordingly for that.

[Damien Blenkinsopp]: Right, so for someone in the 60s, is that okay? Or someone in their 50s?

[Andrew Flatt]: Well, I mean I would ask if that is being measured in a supine, lying down position or if that is a standing value, because that obviously will make a difference.

[Damien Blenkinsopp]: Let’s get into that then, because I know you take both readings, correct?

[Andrew Flatt]: Well, I have experimented with both. I have been sticking with standing – I had been doing it standing since day one but I did an experiment for a little bit and actually at different time points I experimented with supine readings as well. So you want to get into –

[Damien Blenkinsopp]: So I mean, supine just for the guys listening – that just means you are lying down? So you are taking readings when you are still in both situations, right?

[Andrew Flatt]: Correct.

[Damien Blenkinsopp]: So we are getting into sort of recording methodology here. How do we go about actually taking these readings and when would you do it to get reasonable results? I take it, for instance, every morning when I wake up and I will take the lying down one and then I will stand up and take that. I have to let it rest for a little while, so I will stand up for about a minute and then I will take the reading.

So you can tell me if that is like correct or not. I seem to get relatively stable readings. How would you go about it now? What kind of things have you discovered that are good and bad and help to get and what kind of things do you need to avoid?

[Andrew Flatt]: Well, it’s interesting. The general guidelines are a supine measurement where you record the last five minutes of a ten-minute segment, so you essentially have what I often call a stabilization period where you let your heart rate adjust to that position.

So that is generally a five-minute period followed by a five-minute recording. You know, with the research that I have been doing at Auburn University with Dr. Michael Esko is trying to investigate shorter, more convenient HRV recording procedures because one, we want to do research with these smartphone apps but we weren’t entirely sure if we were going to be able to publish anything without any kind of validated shorter measurement procedures that we could say, ‘You know what? We did a shorter measurement recording. We had a shorter stabilization period.

But that is not necessarily a problem because it is not really showing any differences to these accepted standard measurement procedures. So as I kind of mentioned before we found that 60 seconds was a suitable duration for an RMSSD measurement. We have a new paper that is currently in review where we looked at how long does this stabilization period need to be, at least in a supine position?

So we looked at a standard measurement – five minutes following a five-minute stabilization period. And we just looked at if each individual minute – you know, minute one, minute two, three, four, and five – were those values any different to the five to ten-minute segment? I am not able to reveal the results but I am pretty confident that we can get away with a shorter stabilization period, much shorter than what is traditionally recommended. And we are just looking at capturing a resting measure and we are not using this for clinical diagnosis or anything like that, right?

So in healthy populations in athletes where we just kind of want to get a general indication of their heart rate variability that day and we don’t need a whole ten-minute procedure.

[Damien Blenkinsopp]: So what is the statistical variance we are talking about between yours and the five-minute one? Is that 5% difference?

[Andrew Flatt]: Are we talking about the stabilization or the 60 seconds?

[Damien Blenkinsopp]: Yeah, if you do your shorter version. Which is one minute and one minute?

[Andrew Flatt]: Let’s just say that you use a one-minute stabilization period and then a one-minute test. I mean, you are trying to get me to get into the results, which I shouldn’t do until it gets published.

[Damien Blenkinsopp]: Just a rough idea. You said it is okay, right? Don’t give me a statistic yet.

[Andrew Flatt]: Let me putting it this way, it would be trivial. That’s the term we use with that statistic called the effect size, which is telling us how practically meaningful the difference is. The shorter stabilization period as opposed to the traditional one, you would probably see trivial differences.

I could tell you within the literature a five-minute HRV recording has been used following only a one-minute stabilization period and that has been used in elite endurance athletes and the data was still providing very meaningful information pertaining to training status so again, a shorter stabilization period of one minute has been used so I would say to go ahead and use the one-minute stabilization period.

[Damien Blenkinsopp]: So it sounds like it is reasonable to do a one-minute stabilization and a one-minute – depending on the app they do different times or automatically of course, but you think that would be okay for some guys at home who want to use this for training and so on?

[Andrew Flatt]: I mean absolutely. With the athletes I work with and with myself and then with the data that we collected and looked at, the one minute is not very different from the five-minute value. So yeah, I am quite confident in that shorter measurement with RMSSD, specifically.

[Damien Blenkinsopp]: Great, so what other things – are you still taking the lying down, the supine, and the standing – and the one we have just spoken about, the one minute, one minute, is that just fine for both of them?

[Andrew Flatt]: Yeah, after a postural change what happens is in the supine position your heart doesn’t need to work as hard to pump blood to the brain. Then you stand up all of a sudden you have receptors that are going to detect changes in blood pressure and this happens real quickly, but essentially your heart rate is going to shoot up real high immediately following a postural change.

And then it actually takes longer than a minute to actually stabilize, but in the research one minute following that postural change is when they will start recording HRV in the standing position. Going back to why I like the standing measurement, it is simply because what’s happening is you are introducing a small stressor to the body that it needs adapt to. It is called orthostatic stress, when you stand and put that little challenge on the heart where it has to react to the postural change and then you essentially are evaluating how your heart is responding to that.

If your heart rate variability is very low after you have given your heart rate time to stabilize, that may be a better indication of how your body is going to respond to physical stress that day. That is kind of a working theory. And that is nothing new. I am not sure if you are familiar with what is called the Rusko test, where you start by measuring the heart rate lying down and then you measure it following a postural change at different times, and you are trying to see what the changes are between those. So it is not a new concept and certainly nothing that I can take any kind of credit for.

But I did experiment with taking supine and standing measures and seeing how it related to my previous day training. This kind of unequalled one experiment – I have always found that the standing position provided a better reflection of my perceived level of recovery with yesterday’s training. That is not a very scientific method and I didn’t take any blood markers or anything like that but just from visualizing the trend I see that the standing position looks how it should, based on how it is feeling and what training was like the previous day. So I have pretty much stuck with that.

[Damien Blenkinsopp]: Okay, so now do you use just the standing or do you use both?

[Andrew Flatt]: Yeah, my preferred position is seated or standing. I do standing just because it is practical. You wake up, you go pee, you are already standing. I use the finger sensor now, so I plug in the finger sensor and I do my measurement right there in the bathroom. It is just easy.

The seated position would also be similar to provided that. You are obviously going to have to sit up and there is going to be that little orthostatic, that seated up, more vertical position challenge. So the seated position is probably – I wouldn’t think it would provide significantly different in terms of at least the trend. The number value might be different but the trend would probably be the same.

[Damien Blenkinsopp]: Do you see more variance and slightly lower numbers for standing versus supine, or lying down?

[Andrew Flatt]: Absolutely. The supine values are going to be much higher. I have data on the soccer team I have been working with. I had them do supine and standing measures because that is a question I have always been very interested in – what is the better position?

Some preliminary analysis on the data – I think what we’re seeing is that without getting too much into the results I think supine and standing may be potentially indicating some different information where supine may be related a little bit more to fitness and standing may be more related to the acute changes in response to previous day’s training.

Again, that is very preliminary and we have still got a lot of analysis to do but from that data that is kind of what I am seeing. From my personal experience –

[Damien Blenkinsopp]: So what you are saying is that lying down is kind of like your baseline and standing is what has been going on the last week in terms of what you have been up to and exposed to in terms of stressors?

[Andrew Flatt]: Possibly. It is hard to draw any kind of conclusion. But in the supine position in very fit athletes there have been issues of parasympathetic saturation, but all of a sudden you sit up or you stand up and you kind of eliminate that issue. So I know in a recent paper by Stanley Peak and Martin Buchheit where it was in sports medicine and they reviewed the literature on parasympathetic reactivation after exercise. And one of their recommendations was to measure in a seated position.

I would definitely recommend anyone, especially exceptionally fit athletes – any endurance athletes or some really fit athletes like soccer players, rugby, or what have you – with really low resting heart rates. I would definitely do either a seated or a standing position. For less fit individuals with higher resting heart rates, the supine position may be fine. That is a gut instinct and I don’t necessarily have the kind of data to support that. So take that how you want to.

[Damien Blenkinsopp]: Okay, a few of the other things – just to make sure there are no other confounding variables coming in here – do you have to make sure this is at the same time of day, or is that irrelevant?

[Andrew Flatt]: Actually yes, I meant to get into some of this stuff. You definitely want to be consistent with your measurement procedures. One of the best recommendations is you have to remain as motionless as possible. It is funny, you collect ECG data on a bunch of athletes and you are reviewing it and you see some funny things and you are like, ‘Man, what were they doing in there?’ And one athlete had a bit of a cold at the time and we could see her sneezes in R-R interval trend.

On the tachygram we could see when she sneezed. We could see when athletes moved positions or adjusted their position. This all is going to affect your heart rate. I looked at an ECG trend when the investigator walks into the ECG room, or the lab, and just that startles the subject or it might not startle them but it does provoke a heart rate response and all that can affect your heart rate variability information.

So you want to be as undisturbed as possible. You want to limit any kind of noises. You want to limit anything that can be distracting. You obviously don’t want to necessarily check your emails or messages first thing before you do it because that creates an anxiety based on work-related issues or anything really.

So you definitely just want to wake up, do your business in the bathroom, empty your bladder, and do your measurement, whether you do it seated or standing or if you choose to go lay down again. Or if you choose to just do your measurement right in bed after you wake up, you know. Consistency is the most important, definitely limiting the noises, like I was saying.

Time of day is a research question that we have and that is something we want to answer. There is definitely going to be circadian rhythm effect so if you do a measurement at 7 a.m. it is definitely going to be different by noon. But is there a difference between a 7 a.m., a 9 a.m., or if you are within a reasonable time?

We have been asked by some professional NFL teams if they can bring their athletes into the workout facility, have them lie down on a training table, and do their HRV then, as long as they control for all the other variables. My assumption is that it is not going to be the same information you are getting from a waking measure, but how different is it and can we still get some meaningful data from that? I don’t know – that is something we definitely want to look into.

[Damien Blenkinsopp]: So the whole thing about doing this first thing in the morning is it manages to eliminate a lot of potential confounding variables like what is going on in your environment, what you have been doing in the morning, anxiety, and all these other things.

[Andrew Flatt]: Yeah, and apart from sleep it is going to be your most rested state, right? So that is the ideal time to do it.

[Damien Blenkinsopp]: So some of these apps also correct for things like arrhythmias, errors, artifacts, ectopic beats, and a bunch of things which are kind of noise. Would some of them, like I know the Polar kind of automatically does that. I am guessing that some of the others do. Does this eliminate these kind of things we are talking about to any extent or not?

[Andrew Flatt]: Yeah, because we did a cross-validation with the ithlete device and we looked into how it goes about interpreting the data. And actually that device particularly has thresholds for R-R intervals where basically the average highest range for an R-R interval versus the lowest range, if you get a series of R-R intervals that kind of exceed that threshold, either above or below it, it is going to correct for it with the adjacent normal cycle.

So a lot of these apps will have built-in irregular beat detection systems. Again, whether it is the R-R interval that is way longer than average or way shorter than average, it will essentially pretty much red flag that as an irregular beat or an artifact or what have you, and correct for it. And that is a limitation of a shorter measurement.

If you are doing a 55-second test and if you experience a couple of ectopic beats, generally within a one-minute period you should be experiencing more than one. But the shorter measurement duration, that is a shorter series of R-R intervals, and there is more room for error in that situation. But like I said there is that irregular beat detection function. When we have compared and I think we had 25 athletes where we compared it to ECG and it was accurate, and that small sample of people didn’t have as many issues.

[Damien Blenkinsopp]: Right, great. So is there anything else in terms of recording that you have to be careful of to make sure the data is useful and current and so on?

[Andrew Flatt]: I think the key is that you want to be able to do this every day and you want to do it consistently for meaningful data analysis and the key is to just make sure you do it and you are consistent in your environment and where you are consistent in your position.

You don’t want to stand one day and do it seated the next day and then supine. If you want to experiment, when you do a measurement save it in your preferred position and just log your other position measurement. You don’t want to save it so that it affects your trend line by any means.

So the key is being consistent in your position, being persistent if you choose to do the paced breathing. Some of these apps provide paced breathing. A lot of them will give you 7.5 breaths per minute, which was kind of the mean breathing frequency of a group of endurance athletes.

That is kind of where that value came from. Just be consistent and don’t do paced breathing one day and then not the other. It shouldn’t have too much of an effect with RMSSD but you do want to be as reliable as possible with your procedures. So either do spontaneous or paced breathing, pick one or the other and stick to it. Stick to the same position.

I am not going to like, I don’t necessarily measure at the same time every day. I mean, my lifestyle changes and I will be able to sleep in on certain days. I might have to be up super early one day and I do it when I wake up. That’s just the way life is, right?

Some people take it pretty seriously and they wake up at the same time every day and that is great. That would probably be more reliable but you have got to be reasonable.

[Damien Blenkinsopp]: Great, so what I do, for example, is I track it every single morning and I am looking for either acute drops, like big changes to take notice of. Otherwise, I am kind of looking mostly at the seven-day average. How do you approach this. Ideally I want my seven-day average to go up over time so that I feel like I am getting somewhere with things. How do you look at it? What is most important? Are you looking mostly at the seven-day average? Are you looking at the day-by-day? What are you using most in your actual decisions?

[Andrew Flatt]: Well, I like to look at everything. I like to see the acute change of what happened between today and yesterday. I do not generally at this point in time use a daily change to be a huge determining factor in my training, specifically because I am more of a resistance-training athlete.

I am involved in powerlifting, so an HRV score isn’t necessarily indicating if I am going to be stronger or anything like that. But I do take a look at it and I see and I always like to compare it to what happened the previous day. What I like to do is look at the weekly average and the variation of the previous seek, just to see how that corresponds to my training plan. If I had a higher-volume week where I was trying to create some fatigue, I would expect to see a lower average and maybe some more variation and go from there.

[Damien Blenkinsopp]: But if you didn’t you might say, ‘Okay, well I have been undertraining and I want to push a little bit harder this week.’ Is that the case?

[Andrew Flatt]: Yeah, I mean you can use that to guide how you may structure your next training cycle. Again, it really does depend on what kind of athlete you are. But for resistance-training purposes, I just do a lot of personal experiments.

I went through a phase where I was using the acute changes to guide my daily training, so rather than taking a – I would work three weeks harder and deload every fourth week. I stopped doing that for a bit where I would just reduce training loads on a day with a low HRV score, should that happen on a training day.

Training like that was fine and I made reasonable progress. I didn’t find that not deloading was an issue. Every fourth week by just taking off a day here and there or reducing loads. That was fine.

The issue is if you really want to make any kind of marked improvements you are going to have to do some overload training. And if you are doing overload training you are going to accumulate some stress. And you are probably going to see a decreasing trend in your HRV and that is generally not a huge issue. You just want to be mindful that you are starting to accumulate some fatigue and how long you want to persist with that. You want to pay attention to soft tissue issues. Are you getting a lot of inflammation? I would get some tendonitis in my elbows and so forth. So you use it as a guide but you take it with other parameters as well, like I was saying before.

Again, an endurance athlete would be a little bit different. I would actually probably use HRV – the acute changes. I would probably use that a little bit more to influence my daily training just because it has been shown that HRV-guided training with endurance athletes, based on your parasympathetic activity, you may be in a more favorable position for training for endurance exercise. So again it all comes down to what kind of athlete you are, what kind of adaptations you are trying to create.

[Damien Blenkinsopp]: Yeah, great. So looking at potential alternative metrics, another thing that people use a lot is resting heart rate. Is that something you would use as well or do you find HRV better? Is it ever worth taking both and looking at them in conjunction or do you think – what have done? Or do you have any experience with that, at resting heart rate?

[Andrew Flatt]: Well I think that resting heart rate is a little bit more crude of a measure. That is – now, although it is a little bit more prudent it can still be very effective. In fact, if you look at your RMSSD trend against your heart rate trend it will generally be a nice inverse relationship between them where they will kind of mirror each other. I personally don’t monitor both. I mean, if you don’t have an HRV device I would definitely do heart rate. I mean, that is something you could do by just measuring your pulse every morning. In my experience I just use the HRV value. What I want to do with the data we collected in the soccer team is see if the heart rate variability provided more meaningful information than basic resting heart rate alone. Do we even need heart rate variability? Even though it can be more specific of a measure, is it necessary? I don’t think that people need to dismiss heart rate and think that it’s not useful because it absolutely is. There has been good data on it and again, your heart rate variability trend with RMSSD isn’t going to be too dissimilar from your resting heart rate trend, it is just kind of inversely mirrored, you know?

[Damien Blenkinsopp]: Actually a couple of things, confounders I forgot to look at but I think are important. Our age and our gender, do they influence?

[Andrew Flatt]: Absolutely. What you will find as individuals approach middle age or they start to get a little bit older there is going to be a natural decrease in parasympathetic activity; however, that can be changed with training. So if you are doing regular aerobic work you can mitigate those decreases and have reasonably high HRV on a regular basis; however, I would assume that would change if you should stop keeping up with that kind of training, but absolutely. Generally what you will see is older individuals will have lower resting heart rate variability. Females tend to have – if you have two sedentary individuals the female will generally tend to have higher – that is not always the case.

In our data we looked at 20 endurance athletes – 10 males, 10 females. Their resting heart rate variability was not statistically significantly different so we measured them and compared them as a group rather than by gender. So if you are endurance trained you are going to have higher heart rate variability generally, whether you are male or female. But when you remove the training factor females will generally have a higher resting heart rate variability versus males – but again, that is not always the case, just generally.

[Damien Blenkinsopp]: I would like to talk a little bit about where this is all potentially going. In the future are we going to be able to do different things with HRV? Because I do know that it is getting more popular and there are more apps and devices coming out. What do you see happening with HRV over the next five years? Do you see it getting more sophisticated? Are a lot more people using it in different areas? What do you see?

[Andrew Flatt]: Well definitely in the clinical setting with regards to cardiac rehab guiding training of individuals who have had cardiac events and so forth, I am not as interested in the clinical side but that is kind of where a lot of this came from and started. So there is going to be a lot more usage of HRV in those situations, especially when we have validated mobile technology where you can acquire a resting score in a reasonably short period of time. I see it growing there.

One way that I see it being included in athlete is with reduced requirement, a lower frequency of measuring. So for example there is a recent paper that showed that less frequent measures of only 3 times per week was suitably reflective of the weekly mean value. So it didn’t necessarily need the seven-day value. You can get away with three when you are looking at the average.

One thing we are looking at with our data in the soccer team is how few days can we measure HRV where the mean value and the coefficient of variation are no different. So if we get more data on that and we start to realize that we don’t need to measure HRV every day if you are looking at the means and the CV. It becomes more practical and they are affordable. It was previously cost-prohibitive to measure HRV. You needed either an ECG or an expensive device. You needed an experienced and qualified technician to operate the device or the machine and then interpret it. Now within two minutes or less you can get an HRV score. An athlete can take it home and figure it out. It is real easy to do interpretation. Again, with the visualization and these other factors it is becoming a lot easier to use. So it is becoming more feasible for people and it is more affordable. So I can see it being definitely more widespread in sports, especially for any endurance athletes or soccer teams that currently aren’t using it. There are definitely plenty. But I think the more evidence that comes the more likely they will be to use it. Even the fact that we can now acquire HRV with a finger sensor makes it a lot more practical for an athlete to wake up and do the measurement.

If you think about it, a one-minute test is not that hard. But you would be surprised how many athletes can’t seem to do it every day. So reducing the measurement requirements to fewer days per week and making it easier to acquire the data, that is just going to increase the usage of it, I believe. It will at least increase the research where we will have more data to see if it is even worthwhile using in a soccer team or in a football team, and whatnot.

There are other areas where HRV is being used in the biofeedback where you are adjusting your heart rate, trying to increase your HRV prior to – there have been studies looking at baseball batting, golfing to see if it affects how accurate they are with their putts and so forth. That is not an area I am involved in by any means but that is where it is used.

[Damien Blenkinsopp]: Right, and I would say that some people have been connecting that to the flow stake, which they say is the high-performance stake. So the idea was that a higher HRV would mean that you are accessing your flow and you are more in a flow state than having a lower HRV. So I think that is some of the thing around that. I don’t know if you have seen that?

[Andrew Flatt]: Yeah, I have looked at some papers. My interest has always been in a resting measure and how it relates to performance and fatigue and so forth. But that research is progressing so who knows where that is going to evolve. But again, it is just a matter of having more published data to show that this is how it can be used. We are pretty clear that it is pretty effective but how practical can it be in the applied setting with a team of athletes and so forth is the next question.

[Damien Blenkinsopp]: So where is a lot of the research on this and which journals do you find it in? Are they in some specific journals or is it sort of scattered around? Have you seen it increasing over time?

[Andrew Flatt]: There has definitely been an increase in the amount of research on heart rate variability for athlete monitoring purposes and so forth. Just to name a few journals you are looking at International Journal of Sports Physiology and Performance.

There have been some in the European Journal of Applied Physiology. Every month there are one or two of these papers in a lot of these sports and science journals every month that pertain to heart rate variability. Journal of Sports Sciences, European Journal of Sports Science, Journal of Strength and Conditioning Research, so yeah – I kind of go through these every month and see what has been recently published. You can get on Twitter and follow a lot of these researchers and interact with them and sometimes they will give a heads up on what is coming and you can discuss it with them. Attending conferences, you can kind of see what research is upcoming, what is being done.

In fact, that is how I got into all of this. I attended the National Strength and Conditioning Association – their national conference in 2012. And that is where I met my colleague, who I have been working with for the last year or two, Dr. Michael Esko. He was presenting a poster on HRV and he was the only on there doing any HRV research. He was living in Alabama, I was living in Toronto. We hooked up and the next thing I knew I was moving to Alabama and we started doing research together.

[Damien Blenkinsopp]: Great, so who else might this be – you may have already answered this. I know you mentioned a few names, but who besides yourself would you recommend to follow to learn more about HRV and these biometrics?

[Andrew Flatt]: Well definitely Martin Buchheit. You can find him on Twitter. Daniel Plews, who worked with Dr. Martin Buchheit. Jamie Stanley, another guy who has been producing some great HRV research. Fabio Nakamora, Joel Jamieson, who kind of runs the BioForce system and the 8 weeks out website.

The ithlete has a blog where they discuss HRV research and maybe they have an endurance athlete that posts a training log. I try and post some data and some new research here and there. So on any of those social media sources like Facebook or Twitter you could generally find some of these individuals.

[Damien Blenkinsopp]: Great, there are a lot of good references there. So of course there is your blog, which is HRVtraining.com.

[Andrew Flatt]: Yeah, I try and update it every once in a while. Things get busy so I am not as religious with it as I used to be. But the whole purpose of that was to just share data and there wasn’t much talked about it and I wanted there to be.

So that is kind of where it has started and now it has evolved to I will discuss some of our new research projects and post some new research. But it kind of was started with just posting data and then trying to analyze it and leaving it open for discussion.

So if you are interested in looking at some previous trends of my HRV or HRVs of athletes, where we discuss and analyze the data or try to come up with a meaningful explanation or some research review and you can check out the sites. I should warn you that a lot of the older posts, I kind of reread some of them recently, and they make me cringe.

[Damien Blenkinsopp]: Isn’t that always the way?

[Andrew Flatt]: Take it with a grain of salt when you read the older posts. I have learned a lot since I started and I have learned a tremendous amount. So just be aware that some of the other posts may not be a current reflection of my thought process these days.

[Damien Blenkinsopp]: Of course. Coming back to more of a general view in terms of you personally, what would be your top recommendation to someone trying to make better decisions about their body’s health or performance with data?

[Andrew Flatt]: You need to select what monitoring variables you are going to monitor and you need to be consistent with them. And you need to do a lot of trial and error. You need to almost separate yourself from the data, collect the data, analyze it later with your training lots, and see what it is telling you. If a training variable isn’t meaningful, if it is not – if you can’t figure out why you are measuring it or what it is telling you, then you probably don’t need to do it.

You want something – so, for example, with me and the resistance training I am continually experimenting with HRV. There is just not a lot of data in resistance training and how you may be able to use HRV as a tool to guide your training. So I am consistently just experimenting with it.

But it is pretty clear in the research that perceived levels of training load, RPE values, perceived levels of stress, fatigue, muscle soreness – those things are worth tracking because they do correlate with other markers of fatigue and stress. They are just noninvasive. They are easy to monitor and you go with it.

I can’t tell you not to monitor certain things because it is fun. It is fun to collect data, it is fun to experiment. But generally if you are just in it to try and improve performance, you want to pick the variables that are the most meaningful to you, that are the most supported, and you need to be consistent with it.

[Damien Blenkinsopp]: What other data metrics, biometrics, do you track for your body on a routine basis besides HRV?

[Andrew Flatt]: Well I do, again, the perceived levels of fatigue, muscle soreness, and all that through the app. I will do training load and every now and then I will calculate my tonnage, where I will multiply the weight I have used by the amount of sets and reps and so forth and see how that relates to my session rating of perceived exertion.

If RPE better relates to HRV or if the tonnage value does – I don’t do that all the time. It is time-consuming to do those calculations. But regularly I do my RPE for my workout. I will do my perceived levels of fatigue and muscle soreness and so forth. And generally there is a comment section so I will usually make a note or two of something that happened the previous day.

If I was out and had a few drinks with some friends I will make a note that I had a few drinks. If I am traveling, when my training structure changes, things like that – I will make note of it. And I do keep a training log where I write down all my workouts and so forth. So there are plenty others that you can do.

[Damien Blenkinsopp]: So it sounds like you have a little diary related to stressors and health in general.

[Andrew Flatt]: Yeah, and again that is all stored right on the smartphone app that I use. The training log in my gym bag is just a little notebook where I log my workouts. I was going through a phase where I was going through a reaction time test and a tap test, again, with two different smartphone applications. Honestly, I was doing it at a time where I was less familiar with certain statistical analyses and I probably really didn’t know how to analyze the data very well, but it is definitely something I have been interested in.

There is some data to support that psychomotor speed assessed through a reaction time test can be related to fatigue and overtraining. So there is a smartphone app. I believe it is free. And essentially the screen will prompt you to react to a light changing on the app. So as soon as the light turns green, you tap it, and then there is an unknown time interval where it will then prompt you to tap it again over a series of five taps. And then it will give you kind of the mean value of your reaction time.

And I think the data is pretty cool, that I have read, and that supports it. I haven’t really seen any kind of longitudinal data where it has been done every day with athletes, so that is actually something I would actually like to include in a future study along with HRV and some other measures, this reaction time.

[Damien Blenkinsopp]: Yeah, great. There are a few of those apps and I know that some of them are free because I downloaded and played around with them myself. But like you I haven’t really gotten into it. I played around with it once or twice. So thanks for all this stuff, Andrew. This is very detailed and we have really done the topic of HRV justice, really tackling it from every area. So thank you very much for your detailed explanations on everything.

[Andrew Flatt]: Oh, it is my pleasure.

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