How to Boost Your HRV | With Dr Boon Lim (Film 3)

in this final part of my trilogy with consultant cardiologist and electrophysiologist dr boon lim we talk about the importance of hiv or heart rate variability in managing long covid what is it why is it so important and how can we manipulate it to most effectively improve our symptoms let's dive in so obviously you know drugs can help manage you know a bunch of the physiological stuff that governs blood pressure and heart rate one of the sort of topics around which we haven't really discussed at too much length yet is uh is hiv and a lot of um long haulers have become aware of hiv in a way that they weren't previously and the general observation is that hiv is surprisingly low amongst long haulers and we feel better when we can do things that raise that hiv i know i certainly do and i know that you know when i go and try and do my parasympathetic stimulation the goal is to essentially increase the hiv um different ways of measuring it of course depending on what device you have whether it's an orange or a garmin watch or or anything else but i was wondering if you could just talk a little bit about how you use hrv in your practice and what you see the role of measuring it to be and how being aware of it can help long haulers it's a very good series of questions i'm just going to show your audience what's called a in a balance tool this is made by heart math there's a link on the website stop painting called breathe yourself better where i demonstrate this over a 45 minute video about how breathing patterns can shift your hrv i've just put it on my ear clipped it on my collar as you can see like this and i'm going to start recording a hrv pattern and whilst i'm recording i'm going to share my screen jazz and actually um continue talking so that people can see what a lousy hrv looks like okay because when you're speaking or when you engage in any kind of activity that takes away your breath uh it's quite quite difficult to have a good cadence so just let me get to my screen and i'm going to share my screen and when i start the broadcast you'll be able to see the inputs into the into the hrv the actual platform which is the inner balance platform in hrb so i'm starting to share and what i'm really uh going to illustrate to answer your question is there is a mandela that you can see and the mandela goes big and small and as you go big and small i've just set this counter to five seconds and five seconds out so another way of looking at this more with very clear example of what's happening to your heart rate is actually looking at this top line that is going to the left and the right and i'm following the breath in going up and following the breath out going down so anyone watching this now whilst watching can already start to breathe in this pattern i'm not breathing in this pattern because i'm talking but what you can see at the bottom which is the blue line which is going up and down is actually my heart rate so as i'm speaking now it's picking up my heart rate and right now it's 85 going up to 90 coming back down and then at the bottom where you see three colors red blue green is actually my coherent score and anything above one is pretty good anything above four is very good so to be in a coherent state means you're expressing respiratory sinus arrhythmia and you're actually becoming very very autonomically centered where you're balancing the sympathetic and parasympathetic state and breathing in this pattern can be quite calming so jess you already said that sometimes you just take a two-minute reset put on alpha stim and breathe and you feel a switch in your system now instead of feeling it jazz what i'm going to try and do is show you a switch now if this guy can perform i'm going to try okay so i'm going to go i'm going to stop talking very shortly and i'm going to breathe in okay so just so that we're not holding silence here i'll let boone do his breathing and what we're essentially looking for here is um we're expecting to see the white line that's in the bottom left pair of boxes we're hoping that that white line should start to increase uh maybe boone can just nod at me if i'm if i'm if i'm correct here and it should go from the red zone towards the blue zone and maybe up towards the top towards the green uh meanwhile what would what i'm also noticing straight away is that the uh the heart rate line has become much smoother since you stopped talking it's now a very sort of smooth sine wave if you like and whilst the actual bpm hasn't necessarily dropped hugely the shape of what's going on in terms of that heart rate has changed a lot and maybe i don't know if that's just the nature of the way it's recorded but maybe boone when he's finished can can talk about that too now look what's happened straight away to that hrv line he's gone flying straight up into the green zone that's remarkably fast i wasn't expecting it to work that fast and this is simply through concentrating on the coherence breathing and coherence breathing is generally understood to be five seconds breathing in through the nose five seconds breathing out through the mouth and again trying to focus on filling the belly with air as opposed to your upper chest and you can see how that green zone at the top of the chart now has actually expanded because he's expanding it at the top level up towards 6.2 now um i don't know how far and how high he can go here it's like some sort of like olympic diver but um but yes i mean this is actually really remarkable to see just how dramatic the results can be from breathing alone and if ever there was a doubt that breath work seems like well i breathe all the time what's breath work i don't understand what that means how can i have a physiological impact here you go right there is there okay so it's a great demonstration yeah so amazing uh over running commentary because you you got it exactly right jazz and shifting to this state took me three minutes i think or maybe a minute and a half yeah and this is something you're doing as well now when i did that as you were talking even with the the barrage of your narration and looking at this thing and trying to be a performing monkey yeah i was feeling calm and that is the predominant feeling i have when i breathe in this way and actually navy seals before they um engage in a fight or a battle are taught to do box breathing and it's a very similar concept with four in four hole four out four hole and it's a very similar pattern to just steady your sympathetic and really have some parasympathetic control and you can see how quickly i also fall back into this lousy pattern with a low coherence once i stop the breath work right but i'm still feeling calm so this is a very sensitive way to really recognize when you're coherent and actually within two minutes if you have this on and when i first got this gadget i was using it all the time because it was something that you could use as a bio feedback tool to recognize when you were in the zone when you were in a coherent place with good level of hrv but after a while and i'm not i'm going to say that you don't you are likely not to need this dress i mean unless you want to play with it academically but somebody like you who is a breather who has practice breathing probably does not need to use this biofeedback tool you can already feel it you feel it in how your body speaks to you when you're breathing in this way and i i know it's a it's a sixth sense you know your autonomic balance or coherency is a sick sense but when you practice you can switch into this mode and know you're there and this is my kind of very strong feeling about hrv which is it is a very useful um thing to just know about and i hope that the illustration here is simple enough that most people can understand what hrv is and the ability to get in there quite quickly with it with just 60 to 90 seconds of pacing your breath is uh as you say quite remarkable and the ability to shift into this very positive state of coherence is also very um very impressive and and actually is exactly what you said exactly what you said at the start that you were doing because in between these recordings we have been um we've had to stop and start again and for the audience who don't know jess then did a two-minute breath breath work exercise and got himself into a much better state of coherence and autonomic stability um so uh the the role of hrv tracking i think um is is challenging as you can see here on the trace if you're tracking hrv continuously and you are in day-to-day the day-to-day thrall of life and just engaging with normal life activities it might not mean that much but when hrv tracking comes into its owners during sleep and actually during sleep your your natural winding down of thoughts and expectations switch you into a very baseline hiv mode and that's what things like your apple watch or aura tracker will be able to give you now in time your hrv at night will be influenced by many practices of conscious coherent breathing in the daytime and i would start with something like 10 minutes three times a day morning afternoon before you sleep and as i said couple this with a very positive emotion and a combination of an emotional feeling that switches you into vegas plus the breath work is what can get my score sometimes up to ten so but if i'm just doing breath i somehow don't don't get there so there's an additional kind of subtle component just which no one really talks about but beyond breath there's something else that gets you even more coherent which is a feeling yeah and this is where we start to get into the very controversial subjects of things like you know the gupta gupta program and lightning process and things like this and a lot of those they use nlp and there's a lot of visualization that goes along with breathing exercises and actually there's been a lot of criticism that's aimed at that because it falls under some people's banner of inverted commas thinking yourself better um but the reality is in the these shades of grey between thinking yourself better at one end and taking like some hard drugs at the other in the middle there there is this space where we can do things with our mind and body affect us physiologically especially when it comes to the autonomic system which we know is a huge part of the puzzle for most people's long-covered symptoms um and i think this is you know this is why i've been banging on the drum about breath work for two years now and i and i think it's i think something like what you've just demonstrated here is really powerful because it's not just this idea of oh just do some breathing i breathe anyway we can see the physiological changes measured here as you're doing it and given that we know that sympathetic overdrive is a thing here is probably one of the most effective tools that we have that's completely free and you can do it whenever you like which will manage your condition surprisingly effectively i mean i don't i don't know if you've had feedback or how aware of this your patients your long-covered patients have been when they've come to you boone is this something that they're all sort of already aware of or or are people not aware of it and then they you you help them do it and then they notice a big change what's what's been your experience there i think 30 of patients have already um self-selected an educational program or looked at your videos or you know google stuff and found the gupta program and so there is an awareness of these processes but actually seeing it live in action is really powerful seeing the hrv occur and the changes in the coherence breathing occur immediately can be extremely powerful for patients to kind of acknowledge that there is something that they can do within three to five minutes to immediately switch their autonomic nervous system to uh to a different state a more healing bagel state so i think their awareness is there the trouble i find is that maybe 60 or 70 of patients that come into my clinic i literally stand up and i show them what a breath is like and a belly breath should be so the simplest way to demonstrate is one hand on your chest one hand and your navel and on the breath in balloon in the abdomen coming out and on the breath out navel touching spine okay so i'll show you i'll show you what most of my patients do when they come into my clinic they're breathing like this this is a paradoxical breathing pattern where we get a chest expansion through the thoracic muscles the the ribcage are all needing to expand to expand your lungs the other way of breathing which is a belly breath is here i am taking a fairly deep breath out belly touching the spine okay so there are many ways you can you can feel this you can also feel this by putting your hands on your chest and feeling the abdomen rise when you breathe uh when you breathe in the abdomen rises when you breathe out the abdomen comes down and if you're not feeling this through that simple exercise then actually you need to just not beat yourself up over it just very gently bring yourself and focus your attention back on the breath so just focus on on expanding the diaphragm so your diaphragm is this muscle that sits underneath your your thorax in between the thorax and the abdomen that when you breathe in it pulls down so it expands those lungs because it's pulling the thoracic cavity down and it's creating more volume and that is the proper way that you should be breathing for maximal kind of lung expansion but also vagal activation and that's the way we lose our breath when we become very sympathetically driven so as you said people always say i've been breathing throughout my life why are you telling me about breath there are so many specific breath techniques uh that can be extremely helpful and that's why things like yoga and actually the english national opera brief program are singers in particular or choir members are very good at their die from breath so when they come into my clinic they immediately have that die from breath and um you know it's it's very nice to see because that's the way they've been trained to uh to to to breathe and express their kind of sound um so so i think breath is fun fundamental i i think there is another question which is when you are swatted by this resonating uh frequencies in your heart rate blood pressure particularly your blood pressure is low it's very difficult to then in my mind as a soul treatment breathe yourself to wellness it doesn't work like that and as you said you need to take the best of every single facet that's available to you to come together and develop the treatment program that you need so i i would urge i mean seeing as this is focus on autonomic dysfunction which is my bag i would urge you to really have an upper arm cuff blood pressure uh and so you can check it check it whilst you're standing stand for seven minutes and if you're getting symptomatic while standing and better whilst lying down and your pressure is low have more fluid more salt more compression do the isometric exercise and try and get your blood pressure at least your blood volume status better all the while coupling that in almost a parallel stream with what is considered autonomic retraining by breathing and by feeling positive emotions the easiest of which i would say is gratitude and i think the combination of that will be quite helpful for patients with this um syndrome of autonomic dysfunction in long coverage and as i say the caveat is not everyone has this and if your symptoms are not changed whatsoever by sitting standing or lying then it may be you don't have such fluctuations but if they if you do have the symptoms i strongly suspect you might have an element of autonomic dysfunction so i mean obviously you've seen this sort of autonomic dysfunction after ebv in the past ebv tends to resolve um by itself and post-viral fatigue glandular fever tends to resolve after 12 months or so what what do you see as the prognosis for for long covered and dysautonomia in long covid and i was wondering if you could just speak to anything specifically around the fact that dysautonomia isn't necessarily something that's going to be with you forever now it can be improved you know how how are your patients doing generally and what do you see as the prognosis for this so i would say 95 percent of my patients are improved within six months uh and maybe 70 percent or 60 to 70 percent are improved to the extent they can get back to part-time work substantial maybe 70 to 80 of their part-time work and at a year maybe that 60 or 70 are back to full-time work um so it's it's i'm often very humble by the fact that you know patients who recover have taken a lot of the stepwise management into their own hands particularly the conservative strategies that we talked about um and that leaves us to talk about the 30 or 40 percent who actually are all find it quite difficult to make further progress right despite everything that's thrown at them and i think i think that the the features there with respect specifically to autonomic dysfunction is as you said there is a lot of waxing and waning of symptoms when you get to this cohort of patients because those who continue to do unwell they actually don't they don't come back to see me until they're flawed by the next wave of symptoms having had a relatively good time for or a reasonably good time with their health for two or three months and then something happens so there is this constant threat of a re-triggering of the symptoms but by and large nearly everyone makes an improvement and then have have this down downward triggers that really the second time around sends their the kind of psychological state into a much darker place jazz because you feel you're recovering and then when you step back again after trying to achieve more and more in life getting back to work and getting a sense of normality to then have that setback again is a very very negative experience much more so than the first time um and and i think this calls for some of the more if you like holistic approaches such as work support social support family support prolonged self-support or understanding and kind kindness to self and staying the cause right in your mind knowing that actually things have improved before they will improve again and finding that narration of expectation of recovery and hope being very positive rather than the opposite narrative which is damn it i've gone down again and i won't come up again and i'll keep coming down in life so this is quite a fine fine balance and i have to be careful with with with what i say exactly because if everyone is throwing everything at the problem including drugs and fluid and salt and they're still falling off a cliff sometimes sometimes the falling off a cliff is what happens when you pick up kobe again or when you pick up an intercurrent infection or when you go on a holiday and it's too hot in the sun and you've had a few more alcohol drinks than you should have but you know life's there also for the taking from enjoying so don't be so hard on yourself is is my point and actually things will regulate again we live in this sinusoidal pattern and just as you were down there will be enough if you won the lottery tomorrow and uh the condition was that you had to put put the winnings into your dream research project what would that do you have an idea about what that dream research project would be i'd like to solve the problem of the blind man and the elephants and for those who don't know the the six blind man of industran i don't know this i i don't know this reference so you might have to enlighten me yeah yeah so john godfrey's sex i mean you can google it and put a reference i'll give you a link you should put a reference it's a beautifully written poem the six blind man of industran to learning they were much inclined chants upon an elephant and um the the the elephant was uh touched and felt in very different uh uh places so the one who put the hand on the side of the elephant described the elephant like a wall and the one who grabbed the tail of the elephant described tele the elephant like a rope and the one who felt the tusk describe the elephant as a spear now are they all right or are they all wrong are they all both right and wrong with this so the answer to the million dollar research question is that we need to come away from our silos because both as consultants as physicians we need to understand that the body is a whole and not only for long covey to be honest for every condition that there is out there we are sometimes so driven down the nth degree of iteration and kind of molecular characterization which are important definitely for some diseases but we sometimes lose the bigger picture and the six flying men of interstate really tell us that there is a bigger picture both for the physicians which is an educational component which will be subject i think to a lot of resistance because we all sub-specialize me included and i don't even do cardiology i do electrophysiology and syncope so i wouldn't know how to blow up a stent in somebody's arteries right and that's how subspecialists i am so in hematology for example there's somebody who will only do white cells and don't want to touch red cells that's how subspecialist we are we need to now see the pathology of the patient as a more holistic approach so we can understand that sometimes the factors are linked together and how a more holistic approach of healing can really put the patient in control of their condition so that's number one number two i'd like patients to also understand that that's that there is this parable and actually for a patient to really grab a whole of this concept and forgive the adopters who don't know that much about their condition is one of the things that i think will transition the healing that we see in long cover in a much more aggressive way because i'm often seeing patients who have just gone round and round and round and seeing that ologist i.e one of the blind man to another ologist to another all we can see as ologists including me i can only see the heart right if i'm asked a specific question about palpitations but if i open my mouth or the patient said to me actually my gut is slightly disturbed actually i have temperature dysregulation actually i've got brain fog i've got some other stuff going on with me we can link it up into a more upstream uh important factor that is driving the whole constellation of symptoms and sometimes the treatment needs to be driven upstream and that upstream treatment need not be delivered by a physician which is my point which is why some of these phenomenally successful uh programs are like yoga in long corbid uh so susie bolt's program is you know um one that a lot of my patients have been to and said they've recovered very well from it and it provides a very nice safe nurturing platform but also the the kind of singing programs and the community programs all across the world they provide that more regular input to help patients to navigate so you're not on your own it's like any practice jazz if you were meditating and you came and watched this webinar and you were doing the the kind of cycles with with us and they said wow i've had the treatment i you know i felt coherent during this meditation but then you only did it once or only did it once every month it's not enough so this needs to be a daily practice and just like diets when you lose that impetus of the first whatever six weeks of the first consultation and time steps away from you you forget that the way to enhance your vegas is daily dedicated routine regular practice and this is the other thing the other the other piece of research to unlock would be how to allow patients to feel empowered to take this practice into their own hands maybe it's with a bigger group of non-physicians who have the kindness and the time to share this this aspect of healing with with patients anchored of course by kind of protocols to diagnose something that needs diagnosis and treat and and treat it so that i guess is where i would put my my money into rather than looking at the molecular biology of antithrombin iii or you know some some some other immune mediated molecule with one specific treatment yeah i very much agree um boon thank you so much for your time this has been absolutely outstanding insightful on so many different levels another absolutely fascinating discussion in my opinion and i hope you found it useful if you're in any doubt about the efficacy and importance of breath work i hope those doubts have been suitably dispelled look after yourselves until next time

Channel: Gez Medinger

Views: 20,325

Keywords: psac, pasc, long haul

Id: XH34JI0FOxk

Length: 28min 28sec (1708 seconds)

Published: Fri Jun 24 2022