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Heart Rate Variability (And The Coffee that Almost Killed Me) — Transcript

by Nick Norwitz MD PhD · 4,001 words · 642 segments · language en · Watch on YouTube

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0:00This coffee
0:01almost killed me.
0:05But in so doing, it provoked my profound
0:08curiosity for the interconnectedness of
0:10our nervous systems and our hearts. And
0:12one biomarker in particular that can
0:14predict a fivefold increased risk of
0:16death. If you aren't measuring it, you
0:18should be. It's called heart rate
0:22variability. Heart rate variability or
0:24HRV for short can predict death in some,
0:26increased risk of first heart attack in
0:28others, but it's so much more than just
0:30a heart health marker. It's a marker
0:32[music] of effective brain-body
0:34integration. You could say neurocardiac
0:36agility. And it's easy to leverage and
0:39easy to modify to [music] improve your
0:41overall health. I'm going to show you.
0:43And I promise we will return to that
0:45horrible day where I nearly killed
0:46myself with a cup of coffee, where I
0:47missed a flight to meet a famous
0:48neuroscientist who you should check out
0:50and ignore it. Ended up in an ambulance
0:51with a heart rate in the toilet. Was
0:53even subjected to the embarrassment of
0:55my girlfriend's colleague seeing my
0:56naked white butt. But, like the buzz
0:59from a good cup of coffee, that's going
1:01to be a story that's delayed
1:02gratification. So, wake up your brain.
1:05Take a sip of caffeine because I'm going
1:07to teach you some wild and deeply
1:08[music] practical science,
1:10and you're never going to see a cup of
1:12coffee the same way again. Low HRV was a
1:15gong summoning the Grim Reaper. It's
1:17something you can actually measure
1:18today, understand, and improve. Heart
1:20rate variability isn't just some
1:22biomarker. It's a real-time window into
1:25how well your brain and body and heart
1:27are working [music] together. Heart rate
1:28variability reflects something even
1:30broader.
1:33Okay, real quick before we begin. If you
1:35want extra nuances, early access to this
1:37sort of deep dive content, you should
1:39check out our best-selling science
1:41newsletter, Stay Curious Metabolism.
1:43Find out why it's the fastest growing
1:45premium newsletter on the platform and
1:47why users exclaim it's the best
1:49investment they've ever made in their
1:50health. But, plug over, let's dive in.
1:53This video is organized into what, why,
1:56hows, and WTF. What is heart rate
1:59variability? Why does it matter? How do
2:01you measure it? And how do you improve
2:03it? And then my WTF story. So, let's
2:06start with what is heart rate
2:08variability, HRV?
2:10HRV is not your heart rate, the number
2:12of beats per minute, but the variability
2:15within those beats. Because your heart
2:18doesn't beat like a metronome, tick tick
2:21tick. For example, if your heart beats
2:23at 60 beats per minute, one beat might
2:25take 1 second, the next 1.05 seconds,
2:28the next 0.92 seconds, and so on. Heart
2:31rate variability captures those micro
2:33fluctuations in your heart's rhythm. And
2:36those micro fluctuations are direct
2:38signature of what your nervous system is
2:40doing with your heart. Kind of written
2:42in doctor scratch like that on a heart
2:44tracing. And yeah, I'm going to show you
2:46how to read at least part of a heart
2:47tracing in a moment. Stay tuned for
2:49that. But, back to HRV.
2:51Here's the physiology in plain English
2:53or as plain English as I can make it for
2:55you.
2:56Your autonomic nervous system has two
2:58main branches, the sympathetic, fight or
3:00flight response, and the
3:01parasympathetic, the rest and digest
3:03response.
3:05The rest and digest response, the
3:06parasympathetic, is mediated by the
3:07vagus nerve, the 10th cranial nerve.
3:10But, both the sympathetic and
3:11parasympathetic act on the heart's
3:13pacemaker system.
3:15The sympathetic system pushes your heart
3:17to beat faster and more steadily. The
3:20parasympathetic does the opposite. It
3:22slows things down.
3:23But, more importantly, it does so
3:26rapidly and dynamically, like a good car
3:28brake, creating variability in each
3:31beat. So, let's make it intuitive with
3:33an analogy.
3:35Think of your body as a car and your
3:37heart as the engine of that car, which
3:39it kind of is.
3:40The sympathetic nervous system is like
3:42pressing on the gas. You speed up and
3:44the ride becomes smooth and steady, low
3:46variability, although you're moving
3:47fast. So, this is me in sympathetic
3:49drive. I'm moving quickly, but very
3:52consistently. So, heart rate variability
3:55is low. There's very little variability
3:57in my speed, no brake action.
4:00The parasympathetic system is like
4:01[clears throat] tapping the brake.
4:03Small, rapid adjustments that are kind
4:05of jerky and create subtle fluctuations
4:07in speed. Now I'm slowing down. My
4:10parasympathetic tone is up and I'm
4:11jerking all around. There's a lot more
4:14variability in my speed.
4:16That's parasympathetic drive. That's
4:17high heart rate variability.
4:20Now, the analogy breaks down a bit here
4:22because while you're driving, you don't
4:23want somebody tapping the brake and
4:25jerking you around. But, in physiology,
4:27that's exactly what we want. Those tiny
4:30adjustments reflect a brake system
4:33that's responsive, precise, and working.
4:36And obviously, you don't want broken
4:37brakes.
4:38So, seen this way,
4:40heart rate variability is a marker of
4:43vagal tone, parasympathetic strength,
4:45your ability to rest and digest or
4:48recover. But, zooming out, heart rate
4:50variability reflects something even
4:52broader, your body's capacity for
4:54adaptive regulation, the ability to
4:56continually adjust our internal
4:58environment to meet external demands.
5:02This is fine.
5:03Or, if you want to coin a phrase,
5:05neurocardiac agility. So, to review, a
5:09high heart rate variability means a
5:11flexible, responsive system. A low heart
5:15rate variability means reduced
5:16parasympathetic vagal tone and a system
5:18that is less adaptable, more like flying
5:21down the highway of life with broken
5:23brakes. You don't want that.
5:27So, that's the what of heart rate
5:29variability. Now, why? Why does heart
5:31rate variability matter? Okay, let's
5:33walk through a few landmark studies,
5:35starting with one published in the
5:36American Journal of Cardiology in 1987.
5:40In this study, researchers followed 808
5:42patients who had already survived a
5:44heart attack. They put Holter monitors
5:46on them to track heart rate variability
5:49over the course of 11 days, looking
5:51specifically at variability in what's
5:52known as the RR intervals. Okay. Pause.
5:56I'm throwing jargon at you. What the
5:58heck is an RR interval? Now is when we
6:00get to have a little fun, cuz I could
6:02just say this is a measure of heart rate
6:03variability, but I want to explain to
6:05you what it is. And this is a great
6:06excuse to teach you, doctor, how to read
6:09an EKG. So, the R wave on an EKG is that
6:12big spike. You've probably seen it, but
6:15you probably never asked what it was.
6:17It's actually really simple.
6:19When you're measuring heart activity,
6:21you put little leads all over, and you
6:23can measure electrical signals coming
6:25out of the chest from the beating of
6:26your heart. The R wave, that big spike,
6:29represents the electrical impulse as it
6:31travels through the ventricles, the main
6:33pumping chambers of your heart.
6:35They depolarize, contract, and whoosh,
6:39blood flows out your heart and into your
6:41arteries. That is the R wave. So, if you
6:44measure the time between those spikes,
6:47and how much that time changes from beat
6:50to beat, you get heart rate variability,
6:52the micro fluctuations in the beat.
6:54Simple enough, right? Good job, doctor.
6:56You can now read an EKG. Pat yourself on
6:58the back. Anyway, that's what the
7:00researchers measured. And then they
7:01grouped people based on their HRV.
7:03Remember, higher HRV is better, lower
7:05HRV tends to not be as healthy. So, what
7:08did the researchers find?
7:10In the group with low HRV, survival
7:12plummeted. It was like low HRV was a
7:15gong summoning the Grim Reaper.
7:23I have come.
7:24These low HRV individuals had a 5.3-fold
7:29higher risk of death in the years that
7:32followed. And to be clear, it wasn't a
7:34short-term effect. These patients didn't
7:36just drop dead in the next few weeks.
7:37This was a longer-term predictor of
7:40mortality over years.
7:42That's really remarkable. Don't you
7:44think?
7:45But, hopefully, you haven't had a heart
7:47attack. I haven't and I'm hoping I never
7:49do. So, you might be wondering, is this
7:52actually relevant to you and to me? So,
7:55let's look at another study where the
7:56goal was to examine whether low HRV
7:58predicts a first heart attack. To do
8:00this, researchers followed 2,501
8:03individuals for an average of 3.5 years.
8:06And even after adjustments for the usual
8:09suspects, like age, sex, smoking,
8:11diabetes, and other risk factors, the
8:13signal held strong. Lower HRV was
8:17significantly associated with a higher
8:18risk of a cardiac event.
8:20Even a one standard deviation drop in
8:23HRV was associated with a 47% increased
8:26risk of a new cardiac event, like a
8:28first heart attack.
8:30So, what we're seeing is profound. What
8:32we're seeing is low HRV predicts
8:35mortality after a heart attack, and low
8:37HRV also predicts who is more likely to
8:40have a first heart attack in the first
8:41place.
8:42That's a big deal.
8:44And yeah, it's a little unsettling. But,
8:47as we'll see, it's also super empowering
8:50because now we get to the house. What,
8:53why, and hows. How to measure and how to
8:55improve your heart rate variability. So,
8:57let's start with how to measure your
8:59HRV. The good news is it's gotten a lot
9:01easier than since 1987. There are many
9:04wearables, like Oura Ring or Whoop. I
9:06don't have any affiliations with either,
9:07but you can use wearables to track your
9:09HRV. You can also get a dedicated
9:11tracker, like Elite HRV. But, when it
9:14comes to measuring HRV, you really have
9:16two main options for protocols.
9:18One, this is what I do, is right after
9:21waking. This is while still laying in
9:23bed, before checking your phone, before
9:25caffeine, before food, before any real
9:28movement other than just grabbing your
9:29HRV device.
9:31This gives you a very controlled
9:33baseline with minimal external noise.
9:35It's a great baseline you measure
9:37day-to-day to day.
9:39The alternative is overnight
9:41measurements, which many wearables
9:43provide. The upside here is you get a
9:45much larger data sample, hours instead
9:47of minutes. The trade-off is it's a
9:50little bit less of an authentic baseline
9:52than a waking measurement since it can
9:54be influenced by sleep disturbances. So,
9:56zooming out, the key is not to obsess
9:59over which one is better, resting in the
10:01morning or overnight. The key is
10:03consistency. Pick one that works for
10:05you, stick with it, and track your HRV
10:08over time, across training cycles,
10:11stressful periods, travel, new
10:13medication, illnesses, seasons, all of
10:15it.
10:16Now,
10:17to the practical. The big question I
10:19know you've been waiting for, how do you
10:21improve your HRV? I'm going to go over
10:23three main ways. The first and
10:25best-funded way to improve your HRV is
10:27regular aerobic exercise. I know it
10:30sounds boring, but it's the truth. This
10:31has been demonstrated across many
10:33systematic reviews and meta-analyses,
10:35including of randomized controlled
10:37trials. And honestly, the connection
10:39makes intuitive sense. It doesn't
10:41require a ton of exposition.
10:43The more important question, maybe the
10:45one more important to you, is what is
10:47the best type of exercise for improving
10:49heart rate variability? Let's compare
10:51two types of aerobic training, zone two
10:54cardio and high-intensity interval
10:56training or HIIT.
10:58Zone two cardio is performed usually at
11:00about 60 to 70% of your maximal heart
11:02rate. A quick heuristic for that is 220
11:05minus your age, and that's your maximal
11:06heart rate in beats per minute, more or
11:08less.
11:09During zone two cardio, you can usually
11:11hold a conversation. Think of it as
11:12moderate cycling or light jogging for
11:14some people. This type of training
11:16consistently increases heart rate
11:18variability. So, if you're starting from
11:20scratch, zone two is probably your most
11:21reliable way to increase your baseline
11:24HRV.
11:25HIIT is more complicated. HIIT is
11:26powerful, but it's a double-edged sword.
11:29It involves short bursts of very
11:31high-intensity efforts, sprints,
11:33intervals, all-out pushes. And in the
11:36short-term, because of its intensity,
11:38you get a stress response and your HRV
11:40will drop. That's expected. But if dosed
11:43correctly, HIIT is an incredibly
11:44efficient way to improve your overall
11:46cardiovascular fitness, which can
11:48increase your HRV over time.
11:51The catch to HIIT is dosing. Too much
11:54and you can end up with a lower HRV
11:56because of poor recovery. But used
11:58strategically, it can be what really
12:00drives meaningful improvements in HRV
12:02once you're doing zone two cardio at a
12:04sufficient base.
12:06There's no correct ratio for how to
12:08balance these things. But to give you a
12:09practical starting point, maybe make
12:11zone two cardio like 70% of your aerobic
12:14work and then have HIIT be the remaining
12:1630%. As for what I do, I do HIIT one to
12:19two times per week. That's sufficient
12:21for me, keeping sessions short but
12:23really intense.
12:24Usually 20 minutes twice per week. Then,
12:27use your HRV to personalize the
12:30protocol. That's the whole point of
12:31tracking it. If you're measuring HRV
12:33daily and do a hard HIIT session and
12:36your HRV drops, that's not a problem per
12:37se. That's a signal. It's the signal
12:40your body needs recovery. So, you let
12:42your HRV come back up before your next
12:44hard session. Now, before we get to the
12:47next two ways to improve your HRV, let's
12:50discuss a common drug that lowers HRV.
12:53You know it. You love it.
12:56Caffeine.
12:57But caffeine isn't dangerous. And here's
13:00why.
13:01Over the short-term, caffeine suppresses
13:03HRV by shifting your nervous system
13:04towards that sympathetic fight-or-flight
13:07state, pushing the gas on your nervous
13:09system. Lower HRV, smooth but fast ride.
13:12That said, it's a temporary, controlled
13:15stressor, similar to exercise. And both
13:17exercise and caffeine can paradoxically
13:19improve HRV when used and dosed
13:22appropriately. In general, and here's
13:24some good news, up to four cups of
13:26coffee per day is generally either
13:28neutral or beneficial for cardiovascular
13:30and overall health, especially when
13:32consumed in the morning. Just not before
13:34you take your morning HRV test. Now,
13:36back to the other two ways to improve
13:37HRV.
13:39One nutrient shown in multiple
13:40randomized controlled trials to boost
13:42HRV is omega-3s. Specifically, the
13:45long-chain omega-3s EPA and DHA.
13:48They do so via many mechanisms,
13:51improving membrane fluidity by being
13:53incorporated directly into cell
13:54membranes of neurons and heart cells.
13:57They also reduce chronic inflammation,
13:59which can otherwise suppress HRV. And
14:01finally, EPA and DHA act through the
14:03central nervous system, through the
14:05brain, by accumulating in key brain
14:07regions like the brain stem, which can
14:08help to improve vagal tone. As for
14:11dosing omega-3s, extrapolated from the
14:13randomized controlled trials, between
14:153,000 and 4,000 mg per day of combined
14:17EPA and DHA represents the clinical
14:20grade range. You can reach this with
14:22supplements, but also with food. In
14:24fact, just three cans of sardines per
14:26day will land you in that 3,000 to 4,000
14:28mg range. And perhaps not
14:31coincidentally, my HRV was never higher
14:34than when I did my sardine diet
14:35experiment, where I was consuming a
14:37minimum of 6,000 mg of EPA and DHA
14:39daily. And if you're into
14:41supplementation, my go-to brand is
14:43Xcentrate Omega Max for omega-3s. It
14:46includes a special form of omega-3
14:48called lyso-phosphatidylcholine DHA,
14:50which gets into the brain and brain stem
14:52relevant to HRV more efficiently than a
14:55standard fish oil. The total dose of
14:57omega-3 is lower than some other
15:00products, but this is because this form
15:01is harder to concentrate, and in many
15:03cases, including beyond HRV, brain
15:06delivery matters more than raw dose,
15:08which is why I like this supplement. I
15:10still consume this on the back of a
15:12fish-rich diet, but this is what I
15:14personally use and stand by. Now, as a
15:17quick caveat, you never need to buy
15:19anything from me, but I know a lot of
15:20you ask, so that's why I share this. My
15:22answer for what I use. And if you want
15:24to try it, you can use my discount code
15:26stay curious for 20% off. And before we
15:28get back to our main video, I do want to
15:30be transparent. I earn commissions on
15:32this product. It is sponsoring this
15:34video, but that money goes right back
15:36into this channel. Things like editing
15:39fees, editing fees are not cheap, and
15:41even paying open access fees for
15:43research papers and funding experiments
15:45that I will share here, including one I
15:47have coming that cost me a few thousand
15:50dollars, actually upward of 10 grand,
15:52and 7 years of my life.
15:54So, stay tuned for that. But now, back
15:57to the video. I just want you to know
15:58that I invest what I make from you back
16:01into educating you. Okay, I got that off
16:03my chest. But the third thing that
16:05improves heart rate variability is heart
16:07rate variability biofeedback.
16:10It's a protocol to improve your heart
16:11rate variability. That is exactly what
16:13it sounds like.
16:15Structured breathing while monitoring
16:17your heart rate variability in real time
16:20to train your nervous system. The core
16:22principle here is something called a
16:24resonance frequency.
16:26This is the breathing rate at which your
16:28heart, lungs, and blood pressure all
16:31synchronize to produce the strongest and
16:33most efficient HRV signal.
16:37You can think of it like pushing someone
16:38on a swing. Each time you push
16:41perfectly, each swing builds on the
16:44last, and the amplitude builds. In this
16:46case, the heart rate variability builds.
16:48Here, the oscillations are your heart
16:50rate variability. In other words, it's
16:52the sweet spot where your nervous system
16:54responds most powerfully to your breath.
16:58For most people, this sits in the 5 to 6
17:00breath per minutes range, or 10 seconds
17:03per full breath. So, a 5-second inhale
17:06and a 5-second exhale. And I won't
17:08actually do that exercise for you
17:09because 10 seconds is actually a long
17:10time in YouTube video time. That is a
17:12great place to start. And research shows
17:15that heart rate variability biofeedback
17:17can increase HRV, improve stress
17:19resilience, and even have a positive
17:21effect on anxiety, depression, anger,
17:24and athletic performance. So, here's how
17:26you do it in a nutshell.
17:27Find your breathing rhythm. Start at 5
17:30to 6 breaths per minute or one breath
17:32for every 10 seconds, and then adjust
17:34slightly based on what feels most
17:36natural and sustainable for you.
17:38Then practice this for 10 to 20 minutes
17:41one to two times per day.
17:43If you're using a device, you can
17:45actually watch your heart rate
17:46variability waveform in real time, and
17:48you're looking for smooth, large
17:50oscillations. During the actual session,
17:53you might see your HRV typically
17:55increase as you drift into the
17:56parasympathetic state. And over time,
17:59usually 4 to 8 weeks of this training
18:00with biofeedback, you may even see
18:02modest increases in your baseline HRV
18:05with morning or overnight testing. But
18:07now, zooming out, let's look at the big
18:09picture.
18:10Heart rate variability isn't just some
18:12biomarker for physiologists or elite
18:14athletes. It's a real-time window into
18:17how well your brain and body and heart
18:19are working together. How efficiently
18:22you can adapt and recover in response to
18:24stress. It predicts death in some
18:26people. It predicts first heart attacks
18:27in other. But more importantly, it's
18:30something you can actually measure
18:31today, understand, and improve.
18:34Now, the video could end there, but I
18:36really want to pay off the opening hook
18:38and tell you about the craziest coffee
18:41and Starbucks story you have ever heard,
18:43guaranteed.
18:44This is a few years ago, and I was
18:46headed to Los Angeles for a business
18:48trip. A few meetings, including a very
18:50generous offer to meet with Andrew
18:51Huberman. The date was precisely July
18:5520th, 2024. That was the day, if you
18:58remember, of a massive airline tech
19:00meltdown. Thousands of flights were
19:02canceled. On Delta alone, something like
19:041.3 million passengers were affected.
19:08But I still wanted to make my trip to
19:09LA. So, I scrambled, rebooked, and ended
19:12up stuck in Boston Logan Airport for
19:14several hours. I figured I'd be
19:16productive. I was a med student, I had a
19:17lot of work. So, I went to a Starbucks
19:20to get a drink and do that work.
19:22I ordered a mint tea.
19:25I also lied at the beginning cuz it was
19:27a tea, not a coffee. Sorry about that.
19:28Anyway, that was my first mistake.
19:31Now, I don't know if you've ever been to
19:33Starbucks recently, but they serve their
19:35tea hot, and this one was not hot. It
19:38was volcanic. And it was filled to the
19:40absolute brim, and even double cupped,
19:42it was burning my hand. So, I set it
19:44down and tried to pop the lid off to
19:46pour a little out and put in some cool
19:48water. That was mistake number two,
19:50because as I lifted the lid, boiling
19:52water spilled onto my hand, and I
19:53reflexively dropped the entire cup over
19:56myself.
19:58>> [screaming]
20:00>> And instantly, I knew it was bad. And
20:02then it got worse as the burns started
20:04to set in. So, I ripped my shirt off in
20:06the middle of Boston Logan Airport.
20:09But, it gets worse, because the liquid
20:11had soaked through all my clothes,
20:13including down my leg into sensitive
20:15territory.
20:17So, now I was already shirtless in the
20:19middle of Boston Logan Airport with kids
20:20with little balloons staring me like,
20:22"What the heck's going on?" I had a hard
20:23decision to make.
20:25Pants on or pants off?
20:27Because like I said, there were children
20:28around, I made the noble sacrifice of
20:31sprinting to the bathroom before taking
20:33my pants off and jumping in the sink.
20:35Unfortunately, the delay was enough. The
20:37burns had set, especially around my hip
20:40and butt. The blisters started to form
20:42pretty quickly. And long story short, I
20:44ended up with 20% body surface area
20:47burns, mostly second degree, from a
20:49Starbucks mint tea. Now, thankfully,
20:52except for a little scar on my right
20:54buttock, I've made a full recovery. No,
20:55I'm not going to show you that scar.
20:57But, what ended up happening was EMTs
20:59had to come pick me up and bring me in
21:01an ambulance to the MGH emergency
21:02department, where who cared for me other
21:05than my girlfriend's colleague at
21:08Massachusetts General Hospital who is a
21:09surgical resident. So, yeah, my
21:11girlfriend's colleague got to look at my
21:13naked white blistering butt.
21:17That was awkward.
21:18But,
21:19here's where things get physiologically
21:21interesting.
21:22That level of burn triggered a systemic
21:25response in my body. My body essentially
21:27started going into shock. My blood
21:29pressure, which usually sits around 100
21:33mm of mercury systolic, dropped, then
21:36shot up to 200, and bounced around a
21:38bunch. Now, if you know about basic
21:40physiology, you'd expect my heart rate
21:42to go up with this stress response. But,
21:44instead, I had a weird bizarre reflexive
21:47bradycardia. My nervous system was all
21:50over the place. Blood pressure shot up
21:52and down, heart rate fluctuating wildly,
21:54at times dropping into the 20s and 30s.
21:57And if anybody does have an explanation
21:59for the exact series of biological
22:00events that went on in my body, please
22:02feel free to leave it in the comments.
22:04But, one interpretation, especially
22:05through the lens of HRV and related
22:07topics, is that my paradoxical drop in
22:10heart rate may reflect a very strong
22:12vagal parasympathetic tone. Maybe I'm
22:15stretching here, but it would be
22:16consistent with a high heart rate
22:17variability. So, yeah, I had to cancel
22:19my trip, which was a bummer. And to his
22:21credit, Andrew Huberman was incredibly
22:22kind and concerned when I explained why
22:24I had to cancel. But, on the bright
22:26side, this might be the most painful
22:28confirmation ever that I've got pretty
22:30solid vagal tone. So, I guess there's a
22:32silver lining in there. Maybe I'm
22:34stretching a bit, but hopefully this
22:35story was entertaining and one you'll
22:36remember. And hopefully, my heart will
22:39keep me going for many years to come,
22:40provided I don't take myself out first
22:42with a tea or coffee.
22:44Stay curious. I hope you learned
22:46something. I hope you had fun.
22:58>> [music]

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