305 ‒ Heart rate variability: measure, interpret, & utilize HRV for training and health optimization
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- เผยแพร่เมื่อ 18 มิ.ย. 2024
- View show notes here: bit.ly/3RfDCTG
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Joel Jamieson is a conditioning expert who developed Morpheus to give people a smarter way to build their conditioning regimen and improve their recovery. In this episode, Joel dives deep into the world of heart rate variability (HRV), explaining its scientific foundation, how it measures the balance between the sympathetic and parasympathetic nervous systems, the various methods of measurement, and how it can guide healthier lifestyle choices and improved training performance. He explores the nuances of HRV calculation, the impact of aging on HRV, and the roles of genetics, exercise, and other lifestyle factors in this process. He also covers Morpheus, the innovative training tool that won Peter over after his initial skepticism, highlighting its practicality and effectiveness in guiding training and optimizing fitness outcomes.
We discuss:
0:00:00 - Intro
0:01:53 - Heart rate variability (HRV): evolution, science, and practical applications of HRV in athletic training
0:10:11 - Methods of measuring HRV: EKG, wrist-based sensors, and more
0:21:45 - How HRV is calculated from the data
0:25:10 - The role of the autonomic nervous system (ANS) in regulating HRV
0:33:14 - The decline in HRV with age, and the mitigating effects of fitness and other lifestyle factors
0:37:00 - The role of genetics in HRV, the modifiability of HRV, and a comparison of VO2 max and HRV as predictors of mortality
0:43:58 - How aging affects HRV and sympathetic drive, and the importance of spontaneous movement and exercise in maintaining the body's adaptability
0:50:43 - How Morpheus measures HRV using RMSSD and normalizes it to a 100-point scale for easier interpretation The Morpheus system: development, integration with various metrics, and personalized daily training recommendations to optimize fitness and recovery
1:04:45 - The benefits of morning HRV readings for assessing daily readiness compared to overnight HRV measurements
1:1:59 - Why Morpheus recommends using a chest strap rather than an arm band
1:13:26 - The impact of consistent exercise, stress, alcohol, and other lifestyle factors on HRV
1:21:26 - Optimizing zone 2 training with Morpheus
1:26:04 - Using heart rate recovery (HRR) as an indicator of athletic conditioning and the balance between aerobic and anaerobic systems
1:32:35 - The importance of tracking HRV trends over time rather than focusing on data from a given day
1:38:37 - Effect of GLP-1 agonists on heart rate and HRV
1:46:38 - Where HRV belongs in the hierarchy of health metrics
1:51:31 - Parting thoughts
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About:
The Peter Attia Drive is a deep-dive podcast focusing on maximizing longevity, and all that goes into that from physical to cognitive to emotional health. With over 90 million episodes downloaded, it features topics including exercise, nutritional biochemistry, cardiovascular disease, Alzheimer’s disease, cancer, mental health, and much more.
Peter Attia is the founder of Early Medical, a medical practice that applies the principles of Medicine 3.0 to patients with the goal of lengthening their lifespan and simultaneously improving their healthspan.
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In this episode, we discuss:
0:01:53 - Heart rate variability (HRV): evolution, science, and practical applications of HRV in athletic training
0:10:11 - Methods of measuring HRV: EKG, wrist-based sensors, and more
0:21:45 - How HRV is calculated from the data
0:25:10 - The role of the autonomic nervous system (ANS) in regulating HRV
0:33:14 - The decline in HRV with age, and the mitigating effects of fitness and other lifestyle factors
0:37:00 - The role of genetics in HRV, the modifiability of HRV, and a comparison of VO2 max and HRV as predictors of mortality
0:43:58 - How aging affects HRV and sympathetic drive, and the importance of spontaneous movement and exercise in maintaining the body's adaptability
0:50:43 - How Morpheus measures HRV using RMSSD and normalizes it to a 100-point scale for easier interpretation The Morpheus system: development, integration with various metrics, and personalized daily training recommendations to optimize fitness and recovery
1:04:45 - The benefits of morning HRV readings for assessing daily readiness compared to overnight HRV measurements
1:1:59 - Why Morpheus recommends using a chest strap rather than an arm band
1:13:26 - The impact of consistent exercise, stress, alcohol, and other lifestyle factors on HRV
1:21:26 - Optimizing zone 2 training with Morpheus
1:26:04 - Using heart rate recovery (HRR) as an indicator of athletic conditioning and the balance between aerobic and anaerobic systems
1:32:35 - The importance of tracking HRV trends over time rather than focusing on data from a given day
1:38:37 - Effect of GLP-1 agonists on heart rate and HRV
1:46:38 - Where HRV belongs in the hierarchy of health metrics
1:51:31 - Parting thoughts
My samsung watch 5 pulse rate closely matches my polar chest strap.
I wish you had gotten into a discussion on volume of exercise recommended by Morpheous. At 68, and very active, one hike in the mountains will put me over the top for the week...throw in the dirt bike riding and indoor cycling and I'm probably double, or triple, as active as the recommendation. (There's only been 1 time that I can recall Morpheous telling me I was RED on Recovery...some Orange mixed in...but still mainly Green.)
As you mentioned (not using it for rucking), I've stopped wearing it for activities other than the specific Indoor Cycling Workouts. If I'm hearing correctly, Recovery and HRV scores don't care that this other activity is not included?
BTW: the main reason I do all this is because Docs like you tell me I may live longer...
Thanks for this chat...
Joel is one of the best and single-handledly changed the way I looked at conditioning when I was a young coach! Pumped to listen to this!
I’m a 64yo woman with VO2 max measured 39-44 on Fitbit and HRV 25-35, mostly in the 30s. A year ago I had an afib scare and stopped drinking alcohol altogether. At that time, my HRV was regularly in the teens. When I stopped drinking, my HRV slowly climbed up to the 30s and has stayed there. Over the holidays, I had a few glasses of wine and my HRV again plummeted to the teens. I gave up that evening glass of wine!
Great job listening to your body! I can get away with one drink, but anything more will tank my HRV as well!
Interesting I am a 63 year old man my measured Vo2 is 44 but my HRV is rarely over 25 . I train 4/5 times a week 2 hours zone 2 30 mins Vo2max level 4/5 on an erg . I also do two light weight sessions . My diet is 60% plant based with some fish rarely or never any meat . I sleep well and have no real problems. I still work in a job I love . I drink wine once a week . 2/3 glasses. Anyone got any ideas how I raise my HRV ?
@@neilcollins5930 I think there's a lot to be said for focusing on VO2 max, like they said, but beyond what you're already doing for HRV, consider breathing exercises that impact vagal nerve function
I used Fitbit for a number of years, and am familiar with what you talked about. My take is, if I drink before going to bed, my rest heart rate will go up, and HRV will go down.
Same principle, for periods that I’m ‘overtrained’ with too much activity (like hiking for 4+ hours a day, several days in a row), my resting heart rates goes up, HRV goes down.
So, to trick HRV up per Fitbit, try lowering resting HR. Drink well ahead of bed time, if you want to enjoy a glass or two.
@@MT-sq3jo that’s cheating you rascal
Been waiting for Joel forever! So happy you finally booker him!
*booked
The Morpheus chest strap itself is worth every cent. It’s far better than Garmin or polar or anything I’ve ever had. I’m using Morph, Whoop, Elite HRV and Garmin HRV stress test combined to make my decision about next days workout in light of my morning recovery. I haven’t lost a single race since. Awesome podcast with awesome guys talking awesome technology🙏🏼🙏🏼
Awesome
How many people ordered the M7 after seeing this? I certainly did, and saw that there is a notice stating they are currently inundated with orders after this podcast dropped! Amazing!
Glad I got mine before this interview!!
Peter, you turned me onto Morpheus before this interview. FYI, I do use the Polar H10 with the Morpheus at the same time the Polar is connected to my Concept Rower. To make it work, connect the non Morpheus devices with the ANT designation, and then fire up Morpheus. Both devices will now register your heart rate.
Joel Jamieson the Best in the business 🙏🏻
You booze you lose; one beer close to bed time drops my HRV 20-30 points. I’m good on that
what do you mean that it drops your HRV? you mean that your rate of beats changes? I'm a regular drinker and thinking of getting a measurement device so that i can start figuring out a plan to get healthier
@@sreckohorvat2298 HRV is a measure of the time between heart beats. If it’s lower, it generally means your body is dealing with more stress.
Currently I am consistently at about an 80. If I go out and have 2-3 drinks close to bed time it will drop me to 20-30. Not good! As a result I have pretty much stopped drinking entirely (I was a casual drinker anyways, not a huge deal for me)
Yes! Joel is an outstanding guest to have one.
Fantastic podcast. Super guest in Joel. Killed it. 👏
I'm probably too easy to convince, but if this system delivers what you suggest, it's invaluable for me. Just ordered my M7.
Incredible how he realised that it’s a hunger-suppressing drug that Peter was explaining the effects of. That won me over. Big kudos.
joel is the goat, using morpheus hrv to determine my training intensity is actually on a different level. when your hrv is high you feel cracked out during your workouts and when its low you can really feel a drop in performance.
The GOAT 100%..he's been at this for almost 2 decades
@@StatzGee too many people don’t know about him
Two decades sounds like a long time. I'm getting old.
@@coachjoeljamieson was the cardiologist you met in Russia Fedor Fomin? I took your course last year and my family is in the cardiopulmonary space in china and one of our partners brought a russian cardiologist that works with the olympic team and there's only a handful of them in the world that understand this topic so maybe its a coincidence?
Brilliant guest. HRV has been a, wait for it…
Game changer. A cliche, yes, but true nonetheless.
It’s helped with knowing when I will benefit from pushing harder, and when I’d be better off not.
Recovery and performance are both improving.
Yes! I'm the furthest thing from an athlete, but I've enjoyed recovery and performance improvement leveraging the info from my wearables
I love this!!! Thank you so much!
Excellent episode!
You should also talk to Marco Altini, he's very knowledgeable about HRV
Marco is great
Pure gold, thank you!
when dr attia said his garmin was garbage I laughed so hard. When i first started running I used my apple watch to monitor HR and then I got the morpheus chest strap and I compared the HR and the apple watch was off by 50 beats lmaooooo
I found the discussion on wrist based HR interesting, I do find that my Apple Watch reads close to what a chest strap does other than a bit of lag when effort changes. I hadn’t realised that Garmin show junk data and Apple screen it out
It's strange, I had an apple Watch for years and seemed to get haywire all the time, by Garmin forerunner nearing two years old now has been fantasti, even checked it against Suunto chest strap
loooooooooooong zone 2 a few times a week over many many months is what gets hrv highest ime. transiently, for a day or two, a single zone two session will elevate hrv. but that will only last for a few days before it returns to baseline.
interesting subject. My first reaction to the concept was to think it might be pseudoscience or at least exaggerated!
But after listening to this discussion I'm certainly going to read and watch more on the subject....
Very interested in the power of the nervous system.
"I'm not a competitive athlete I'm a competitive father" made me cry ❤
OUTSTANDING THAT IS ALL I CAN SAY THANK YOU PETER ATTIA FOR THIS INFORMATION 💯❤
I have been obsessed with my heart readings for a long time especially my HRV
Can you provide any information on getting in touch with Joel Jamieson and his team ?I have a specific question for them as a female elite athlete
There seems to be disagreements about HRV among experts. Menno Henselmans said it did not correlate with training performance. The expert on Rhonda Patrick's latest video said the same. (With Dr. Benjamin Len Levine, and the title including "...and why HRV is a sham")
Hunh...interesting!
I'll ck it out. TY for posting😊
That video with Dr. Levine seemed very clickbaitey: his insistence on the uselessness of HRV hinged on the premise that the protocols and devices measuring it in an automatic way are not consistent, therefore it is not a reliable metric -- which is flawed logic.
If by HRV we mean the (overnight) number that Garmin/Fitbit/Apple spits out every morning in its report - yes, that might as well be voodoo. But if a person consistently employs a rigid protocol to measure HRV (such as a seated manual 2-minute sampling every morning) with the same reliable device able to provide ECG-quality signal (such as a Polar H10 chest strap) and then uses it to judge long-term patterns and trends (and not compare it to other people's HRV) -- it is a useful metric.
@@veydajarwhy is overnight HRV voodoo?
@@humanage1547 'Voodoo' may have been too strong of a word! :) To elaborate -- it is way too close to the acute stressors of the day before (including training, alcohol, stimulants, and literal stress) and is also affected by how much sleep (and what quality sleep) has one had that night, so the Overnight HRV Average is more of a metric of _how busy our body was recoverING_ that night rather than _how recoverED and ready we are_ for training in the morning. Hope that helps!
Why do we project HRV recovery estimation to the whole body? My legs get toasted if I run long distances daily, but I still have decent recovery value. Can we specify what is recovered? Heart muscles, nervous system, circulation?
I have been measuring hrv and trying different devices for years. A few years ago I was using a dedicated hrv device that was supposed to be the best. Upon awakening, I would stay in bed, measure my hrv on 1 finger of my rt hand, then re measure on another finger of the left hand. The results were frequently very different. Same position, same time. This metric is not reproducible even in the same person, IMO. Now I use oura, look at the hrv, but dont take it too seriously. Trends, maybe. I have noticed my red light panel raises it but not always. If something is not reproducible you cannot make clinical decisions.
It's good to know that there is competition in this field of study and merchandise development.
The highest average HRV I've seen is 135 with a peak of over 170. This is overnight from my Oura ring. Usual average hovers around 120. My lowest resting HR hovers around 40 but is occasionally as low as 35. This is from around 12 years of cycling of around 10-12hrs a week, mostly zone 2 in the past 6-7 years but I also race cyclocross and XC mtb.
That's incredibly high
what is your estimated VO2 max out of curiosity and is that reading from Oura, Fitbit, or lab?
I also race bikes, I’ve seen mid 100s. Highest ever recorded by me was 300.
My Garmin Epix Pro optical sensor matches pretty perfectly with my Garmin HRM Pro Plus chest strap for running, intervals etc. when I look at the FIT file it records. Maybe there’s a problem with your watch Peter? I wonder if your other wrist would be different.
Peter - please get Stephen Seiler on, it would be a great endurance discussion.
I had covid twice. Both times, the HRV an all of my devices Oura, Garmin and Whoop predicted it coming 2-3 days ahead.
I think on the discussion between HRV and ACM its hard to ask him that and he has to give a PC answer to that. The research doesn't really show. But we know that HRV is correlated to ACM just like you stated yourself Dr Attia, therefor just because we dont know the mechanisms and we dont know which came first the chicken or the egg with lots of these other metrics that also decline with age, I think it would be safe to say that a person with higher HRV is still going to live longer than someone without high HRV on average. It doesn't really make sense that every other thing we look at that declines with age, if it declines, will increase ACM but then this which also declines with age and then we even see higher HRV is correlated and we have studies showing HRV as a predictor of ACM (obviously not as robust as some other markers) hes sort of having to answer in a round about way because we dont know yet.
Also genetically it would be make sense. THe woo-woo world you dont agree with talks about generational trauma, the health of the mother and father especialyl mother during conception and birth, while being breastfed etc. So it makes sense if your mother was in not optimal health when she had you, you would already begin with a lower HRV or have poor genetics to lower faster. This isnt proven im just saying its in line with all the other stuff we see in non-allopathic medicine model
I did a stress test 3 weeks ago with 12 lead EKG machine at 90% max heart rate and tested my Samsung Galaxy 4 watch. to see the difference with Heart rate. And the watch was pretty accurate. it was sometimes delayed by a few seconds with a variance of 2 to 3 points. but it was mostly at par with the EKG as far as Heart rate is concern.
Curious how old Attias Garmin watch is, there have been two fairly large improvements in the last 18-24 months with their optical sensors. I use chest (Garmin HRM-Pro Plus) and wrist (Garmin Fenix 7X) simultaneously to monitor a lot of activities and mine are usually very close with wrist just lagging slightly sometimes. I'm sure there's other variables as they mentioned like skin tone, bone structure, type of movement, etc. but just found it curious his is so innaccurate.
FYI the Polar H10 chest strap will pair to 2 bluetooth devices AND 1 ANT+ device (3 devices total) at any given time. You just need to turn on the 2-bluetooth pairing option in the setting for the H10.
On the point about heart surgery, does HRV go away temporarily or permanently? Either way, how does one manage/accommodate that??
Perfect timing I need a a fitness watch, Should I go Garmin or wahoo? with chest strap
I watched the episode and downloaded the Morpheus app to my iPhone. Unfortunately, the app registers Polar H10 HRM but refuses to work with it. It says incompatible
46:00 this is actually the way our algorithm is programmed. The "Read rate" for the kids or any young animal (like my kitten) is very high (sensory data). They bounce around and get "data" from the world around them. This helps to build their reaction time, their muscles, coordination, etc. When we are young we need to do a lot more of this because we are growing so fast (if you think of this like a self driving car being trained imagine the wheelbase has expanded, or the acceleration is more powerful now) Once you are done growing this slows down and kids/young animals become more calm. It's just a theory of mine but I think it's correct. Would like others to weigh in.
I’m 50yr old male with 49 resting heart rate; 48 VO2 max but only HRV (RMSSD) of 40. Genetic low HRV or sign of high systemic stress?
Hi Thomas, I have very similar stats, rest heart rate of 49, VO2 Max of 53 and HRV of average 40, 50 seems highest score i see and 25-30 lowest when recovering. Would love to know why its so low when i'm otherwise fit. Just an age thing? Or are people in their 50s seeing HRV of 70+?
@@timdawson8127 I've been using Morpheous for a while now...30 day average HRV is 77...I'm 68. Apple Watch tells me it was 65 over the last month...(for comparison).
Im 57 and was diagnosed w Ventricular Tachycardia 12ys ago. They couldn't find a "physical cause" so they gave me sotalol and an ICD to manage the symptoms. It would be nice to find tests to give me more info, especially since now I have leg swelling, low blood pressure and I occasionally feel Im about to pass out😳 They're gonna try just lowering my sotalol from 120 to 80. Does anyone have some unique ideas/tests getting to the actual reasons behind this? Thanks!
go to an exercise clinic and do an exercise stress test, CPET or cardiac output
@@kevinye9714 thanks!
Why is my hrv so high. My whoop consistently measures 140-185. My RHR is 40 and I have high blood pressure. 24M and stregnth train 5x a week. Just getting into running.
My Coros Pace 2 watch HR is very accurate unless I'm sprinting but then you'd never track HR when sprinting!
40 years old, VO2Max around 55, HRV on average around 60.
My HRV when fully rested is around 250-280 however when I do a ridiculous cross fit workout that literally destroys me (makes me feel sick) it will drop to 20 - 40 and takes a few days to get back up, when im at 20 hrv I for sure am completely broken so I do use HRV as a recovery metric.
what is you HR in that rest mode? if more than 100 for example you have the afib hrv so high.
@@nrgyu4508 my resting HR is around 46-51 (lower side) I personally do think I have afib though
Actually it's probably a lot higher due to the stress, I'm actually not sure, I think it was around 80/90
@@Vqrdict sorry, but you're not serious, confusing some other people here, how you can measure the HRV not knowing your rest HR? you measure it with your finger ;-) ???
@@nrgyu4508 for instance, today I had a 240 HRV reading and my HR was 46
The Russian guy anecdote is hilarious! 🤣
I was gettin' nervous for a minute 😄
@@pirateslife4me Me, too! 🤣
@@pirateslife4me oh he def lubed him up and took him "extra diagnostic"
Im a 26 year old male.
Not sure what my max heart rate is, last week i was at 216 doing a cooper test, and im sure i could get it to 225.
Resting is about 40, higher if im using nicotine at the time,
Is that normal?
I can confirm that 216 is far too high for heart rate, 225 is even worse. The general rule of thumb for max heart rate is 220 - your age. For you being 26, it would 220 - 26, so roughly 194 would be your max. I would try to not go over that in most scenarios. Resting of 40 seems pretty low unless you’re an elite athlete.
@@elijahmandeville8475 yeah thats what im thinking, trying to avoid going over 200 when training.
Im not near elite athlete level.
My high heart rate suggests im in bad shape.
My resting heart rate suggests in in excellent shape
@@klasse3406 I’m not a doctor, so I can’t give you that kind of advice. I do know that a resting heart rate below 60 (especially that far below 60) is known as bradycardia, and is only normal in very young, very fit people who train all the time. If I were you, I would recommend going to see a doctor to just get it looked at. Could be a thyroid issue, electrical problem, or nothing, you just never know.
I’m currently working on getting my heart rate down while training as well. I wanted to start running but I have to watch my heart rate and take breaks when it gets too high. I can say that after a couple months, it’s much easier to train without my heart rate shooting up into the 190s!
@@elijahmandeville8475 Yes i know, thanks anyway.
Doctors here arent the best.
Gonna quit nicotine, and coffee completly. And do zone 2 for a few months and see what happens. Those seem to have affect my heart rate pretty wildly.
@@klasse3406 that sounds great! I’m also working on zone 2 to get my heart in healthiest place it can be. Best of luck to you!
Peter's analysis of the Garmin watch is spot on. Yesterday I was walking on the treadmill, slow. If i had to estimate, i was probably at 87bpm. Checked my watch and it says 192bpm. The other day I was doing a HIIT workout, and deep into Zone 5. If I had to guess, i was between 170-175bpm. Watch tells me I'm at 81bpm. So frustrating. I find wearing the chest strap makes it work infinitely better, but there's some days I'm out and about and I don't bring it along with me. Is there any watch that does well on it's own without a strap?
@SF_Native Well...apparently (based on Joel's input in this discussion) - the one you'd want is the Apple watch. 😊
It's often a side effect of poor placement of the optical sensor.
1-2" _above_ the wrist bone, with the strap tight enough to where you can _barely_ insert a pinkie between it and the forearm (and one notch tighter than that during _vigorous_ exercise) but not tight enough to cut off circulation. Anecdotally, shaving arm hair (for those of us of the male persuasion) under the sensor helps a little too. All of those, combined, make Garmin _quite_ accurate for me.
However, that still won't be as accurate as a chest strap -- especially in exercise that causes rapid acceleration and deceleration of HR, such as HIITs. But in steady-state aerobic conditions? Good enough.
one word....GROUNDING.
I mean we've known this for a long time but never applied it to adults. Its 100% what fetal monitoring is about during labor.
@csgofordummies1239
You lost me with your ACM reference.
I c/n think of what ACM might mean (as a biomarker, I'm guessing?)
So I googled....
(I'm only halfway thru, rn, and maybe ACM w/b clarified later in the discussion?)
But, per Google, it appears to be a cardio disease state??
E.g., 'Arrrhythmogenic Cardiomyopathy'
Can you please clarify ACM in the context of your comment?
ACM means All Cause Mortality. HRV declines with age, so it correlates with longevity, but there’s so much variation within the population that it isn’t as good a predictor as VO2Max for example.
somebody forgot to switch off auto-focus on cameras
Sadly this podcast did not go into more advanced concepts like Type 1/Type 2 errors with HRV, HRV saturation and any research validation of the approach behind the Morpheus tool.
Sounds like you need a new watch. If your Garmin is off, by that much, it’s obviously not operating correctly.
Is he talking about the last Garmin sensor monitor on the pro watch? Because they change the sensor and add more led for spo2 and better heart rate?
th-cam.com/video/3TClfAvj2-Q/w-d-xo.html This is right on and really we should ship the raw data and the refined data. That way if you are using a technique, e.g. Kalman Filter, to smooth data points you can still get the raw data out of the series.
Stephen Porges's PolyVagal theory has A LOT of criticism.
I wish Peter wouldn’t interrupt the guest to talk about himself. I really wanted to hear Joel finish his answer several times.
I hate to criticize but he does that all the time. I think he believes there is something that needs to be known before the answer, for context, but I think he could always ask a follow up question and arrive at the same result.
@AaronTrainerFit as a newer listener, I can appreciate the added context. It can feel like mansplaining but personally it helps me to check in and be sure I'm understanding the answer in the same way they're talking about it.
@@wertacus yes but the added context could come after his guest has finished their sentence. “So by X, are you referring to Y?” Gives just as much context as “okay real quick do you mean Y?”
No one interrupts to add context. It’s not remotely a social norm.
Peter invites guests to a podcast so that he can speak. 😂
@@NYGuy2000 🤣
According to Fitbit my HRV is routinely in the high 40’s to high 50’s. Im 67 yo female.
why is nobody includes sex when talking about exercise? I'm sure if you had an hour of active sex, then you're done for the day. it's about 1000cal expenditure at moderate to high intensity. no?
Peter, you seem to be uninformed about the quality of various devices. Check out the Quantified Scientist, who tests and measures heart rate and sleep tracking against lab values.
Great, but please don't interrupt your guest 🙏
garmin sucks
South Asians are dying of cardiac arrest as young as 40 30 etc. please have a podcast for South Asian and their risk of heart disease, metabolic syndrome, diabetes NAFLD please. Their BMI can be way lower than white people and they are still at a huge risk of developing these.
they love their sugar!
@@esgee3829 it’s not as simple as only sugar. Look it up South Asians are born with narrower arteries and that makes all the difference!
@@L20241 you're wrong. dead wrong. there are good review papers on this. or if you just watch youtube videos "Coronary Artery Disease in South Asians" by jamnadas should do.
How many times does peter use the word I in a webinar. Quit talking about yourself, it nauseating!